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_h0067	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_k0068	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_n0068	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	2012	9	h.6.	h.7.	i.7.								OP Facility - Other	OP Facility - Other	Professional								PT/OT/ST/Cardiac & Pulmonary Rehab/Pain Clinic	Hospital-based Clinic Visits	Outpatient Substance Abuse								A		D	Coin	T	Coin	Coin	V	V	Coin	V	Coin	Coin	V	V	V	V	V	V	V	Coin	P			V		V		V		V	V	Coin																																																0	NO	224.8241685		1368.80912		118.4101125	24.65462927	8.572633897	247.1372902	466.1178795		825.9890261	0.092461521		0.726410884	4174.173046	4239.061514	184.6899672	1055.475014	2473.169368	853.3511858	63.41768274	55.70284144			169.9529388		51.24811246				635.0459684	490.1923487	0.004804143									$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/14B)"	0% coinsurance (#8A)	"$0 coins for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, SPECT, & CT scans; all other diagnostic radiology 15% coins; Therapeutic Radiology $25 copay (#8B/9A)"	Partial Hospitalization: 20% coinsurance (#5)	0% coinsurance (#12)	Urgent Care: $30 copay (#4B/7A/7D/7F/7G/16B)	"$10/visit, except $0 copay for Physical Exams (#7A/7G/14B)"	"$25/visit, except $0 copay for Physical Exams & Glaucoma Tests (#7D/7F/7G/14B/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 CT, MRI, MRA, PET, & SPECT; all other diagnostic radiology 15%; Therapeutic Radiology $25 copay (#8B)"	Chiropractic Services: $20/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 (#14C/14D/14E)		$25 copay (#3/7C/7I)	$10/visit for PCPs; $25/visit for Specialists (#9A)	20% coinsurance (#9C)								0	NO	550		37.27	0	75	0.15	0.028	50	92.25143309	0	21.11	0.2	0	30	9.79	23.00194859	24.48504169	25	21.31	20	0.1	25			25		24.42374854		0		25	17.02140192	0.2								NO	482.5950535		32.70239572	0	65.80841639	0.131616833	0.024568475	43.87227759	80.94560962	0	18.5228756	0.17548911	0	26.32336656	8.590191953	20.18295748	21.48429092	21.9361388	18.69836471	17.54891104	0.087744555	21.9361388			21.9361388		21.43050952		0		21.9361388	14.9353534	0.17548911									9.0416	0	3.730278127	0	0.649365166	3.244964218	0.210616545	0.90353965	3.144182992	0	1.274974331	0.01622599	0	0.001593465	2.988078976	7.129733189	0.330661082	1.929420534	3.853685235	1.24794867	5.564556363	0.101825438	0	0	0.310675938	0	0.091522763	0	0	0	1.160871375	0.610099664	0.000843075	0	0	0	0	0	0	0	47.5372	0	NO	6.64	9.0416	0	3.730278127	0	0.649365166	3.244964218	0.210616545	0.90353965	3.144182992	0	1.274974331	0.01622599	0	0.001593465	2.988078976	7.129733189	0.330661082	1.929420534	3.853685235	1.24794867	5.564556363	0.101825438	0	0	0.310675938	0	0.091522763	0	0	0	1.160871375	0.610099664	0.000843075	0	0	0	0	0	0	0	47.5372	YES	$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/14B)"	0% coinsurance (#8A)	"$0 coins for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, SPECT, & CT scans; all other diagnostic radiology 15% coins; Therapeutic Radiology $25 copay (#8B/9A)"	Partial Hospitalization: 20% coinsurance (#5)	0% coinsurance (#12)	Urgent Care: $30 copay (#4B/7A/7D/7F/7G/16B)	"$10/visit, except $0 copay for Physical Exams (#7A/7G/14B)"	"$25/visit, except $0 copay for Physical Exams (#7D/7F/7G/14B/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 CT, MRI, MRA, PET, & SPECT; all other diagnostic radiology 15%; Therapeutic Radiology $25 copay (#8B)"	Chiropractic Services: $20/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 (#14C/14D/14E)		$25 copay (#3/7C/7I)	$10/visit for PCPs; $25/visit for Specialists (#9A)	20% coinsurance (#9C)								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	NO	0	9.0416	0	3.730278127	0	0.649365166	3.244964218	0.210616545	0.90353965	3.144182992	0	1.274974331	0.01622599	0	0.001593465	2.988078976	7.129733189	0.330661082	1.929420534	3.853685235	1.24794867	5.564556363	0.101825438	0	0	0.310675938	0	0.091522763	0	0	0	1.160871375	0.610099664	0.000843075	0	0	0	0	0	0	0	47.5372
E6036_801_0	2012	6																															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						13.60554926	12.88653612	477.7685251																8.175360332																	6700						11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $25; 4b (Urgent Care) - $25																"16a (Dental) - $0 Deductible, 20% Preventive/30% Basic/50% Major"																		NO						0.2	0.2	25																0.304001343																	NO						0.199899453	0.199899453	24.98743161																0.303848511																		0	0	0	0	0	2.719741853	2.576011519	0.994850695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.484071063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7747	0	NO	0.004413562	0	0	0	0	0	2.719741853	2.576011519	0.994850695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.484071063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7747	NO																																																																																		0	0	NO	0	0	0	0	0	0	2.719741853	2.576011519	0.994850695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.484071063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7747
H0084_001_0	2012	9																															D	A	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1223.059316	13.9143117	54.4154595	0	138.8361723	7.447776026	4.715305135	361.3017894	185.3797386	6.439689739	19.26366951	0	0	1296.259992	3380.812399	4306.726214	211.06414	195.7971239	14.1831288	49.7007851	29.99340759	340.2080862	0	154.6341322	259.6909091	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	62.93467444	150	0.2	0.2	0	0	37.48412208	35	47.79233539	39.75352494	50	0.2	0.164949875	0.2	49.80975129	0	10	10	0	0	0	0	0											YES	171.6070238	980.6115647	127.4795034	0	156.8978503	0.196122313	0.196122313	61.71446958	147.0917347	0.196122313	0.196122313	0	0	36.75736361	34.32140476	46.86571679	38.98276629	49.03057823	0.196122313	0.161751755	0.196122313	48.84401815	0	10	10	0	0	0	0	0											6700	17.4905	1.137044581	0.578071313	0	1.815258082	1.46067506	0.924776549	1.858129024	2.272318944	1.262966846	3.778035421	0	0	3.970591656	9.669519232	16.81981759	0.685655337	0.80000385	2.781628025	8.039189196	5.882376468	1.384760828	0	0.128861777	0.216409091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9566	0	NO	1.633372028	17.4905	1.137044581	0.578071313	0	1.815258082	1.46067506	0.924776549	1.858129024	2.272318944	1.262966846	3.778035421	0	0	3.970591656	9.669519232	16.81981759	0.685655337	0.80000385	2.781628025	8.039189196	5.882376468	1.384760828	0	0.128861777	0.216409091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9566	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.2069	0	1.1798	0.6359	0.0189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											9.0415	0	NO	0.178766248	17.4905	1.137044581	0.578071313	7.206946525	1.815258082	2.640451071	1.560638316	1.877029857	2.272318944	1.262966846	3.778035421	0	0	3.970591656	9.669519232	16.81981759	0.685655337	0.80000385	2.781628025	8.039189196	5.882376468	1.384760828	0	0.128861777	0.216409091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.998
H0084_003_0	2012	7																															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	YES	652.2573711	14.36333086	43.19362189	0	37.53822734	87.64693391	62.13704981	55.62053964	83.63256387	12.95289345	32.37705179	0	1.262275752	39.44708256	134.8176552	118.4978456	5.131395889	9.186091593	49.17207816	151.6711597	60.24206062	8.985837669	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.075856641	0.075856641	0.192759158	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223927914	0	15	0	0	0	0	0	0											YES	0.075856641	0.075856641	0.192759158	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223927914	0	15	0	0	0	0	0	0											6700	49.4781	1.089554031	8.325966188	0	8.408562925	19.6329132	13.91869916	12.45900088	18.73369431	2.901448133	7.252459601	0	0.282749768	8.836146493	30.19915476	26.54351741	1.149432679	2.057684517	11.01454551	33.97433977	13.49422158	2.012179882	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	272.0812	0	NO	0	49.4781	1.089554031	8.325966188	0	8.408562925	19.6329132	13.91869916	12.45900088	18.73369431	2.901448133	7.252459601	0	0.282749768	8.836146493	30.19915476	26.54351741	1.149432679	2.057684517	11.01454551	33.97433977	13.49422158	2.012179882	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	272.0812	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1241	0	NO	5.55E-17	49.4781	1.089554031	8.325966188	0	8.408562925	19.6329132	13.91869916	12.58312783	18.73369431	2.901448133	7.252459601	0	0.282749768	8.836146493	30.19915476	26.54351741	1.149432679	2.057684517	11.01454551	33.97433977	13.49422158	2.012179882	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	272.2053
H0084_004_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	2242.215123	11.17477278	77.48674564	0	246.6400603	30.50163214	8.548260715	625.7307014	320.3121846	6.521342424	16.31400764	0	0.708580858	1839.213183	5046.796472	6142.262826	152.9537161	313.0947135	17.70916604	64.43341568	35.51319058	542.7761511	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	30.00106625	25	49.0674627	39.26548803	50	0.2	0.172178189	0.2	50	0	10	10	0	0	0	0	0											YES	168.1677186	960.958392	124.924591	0	153.7533427	0.192191678	0.192191678	61.97033903	144.1437588	0.192191678	0.192191678	0	0.192191678	28.82977638	24.0239598	47.15179006	37.73250024	48.0479196	0.192191678	0.165456075	0.192191678	48.0479196	0	10	10	0	0	0	0	0											6700	31.4224	0.894874307	0.806666667	0	3.160144476	5.862159875	1.642904574	3.231395309	3.847583523	1.253347746	3.13541651	0	0.136183344	4.418675398	10.10366963	24.1348906	0.480943844	1.253629135	3.403554344	10.66090007	6.825339703	2.173272072	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0686	0	NO	4.828526618	31.4224	0.894874307	0.806666667	0	3.160144476	5.862159875	1.642904574	3.231395309	3.847583523	1.253347746	3.13541651	0	0.136183344	4.418675398	10.10366963	24.1348906	0.480943844	1.253629135	3.403554344	10.66090007	6.825339703	2.173272072	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0686	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	19.2729	0	6.3131	0.2188	0.034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											25.8388	0	NO	1.049774984	31.4224	0.894874307	0.806666667	19.27290558	3.160144476	12.17525513	1.861740696	3.265403949	3.847583523	1.253347746	3.13541651	0	0.136183344	4.418675398	10.10366963	24.1348906	0.480943844	1.253629135	3.403554344	10.66090007	6.825339703	2.173272072	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.9074
H0084_005_0	2012	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	319.2593046	21.31311959	38.0038279	0	17.58763998	30.17700639	22.83462496	34.21764828	45.54162082	6.713318918	21.93499763	0	0	28.98617867	76.30091111	67.51004915	7.213788122	5.720226285	32.64744675	94.15906929	40.93245333	4.614137828	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.075856641	0.075856641	0.192759158	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.075856641	0.075856641	0.192759158	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	24.2179	1.61674166	7.325585869	0	3.939631356	6.759649432	5.114955992	7.664753215	10.20132306	1.503783438	4.91343947	0	0	6.492904022	17.09140409	15.12225101	1.615888539	1.281330688	7.313028072	21.09163152	9.168869545	1.033566873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.4687	0	NO	0	24.2179	1.61674166	7.325585869	0	3.939631356	6.759649432	5.114955992	7.664753215	10.20132306	1.503783438	4.91343947	0	0	6.492904022	17.09140409	15.12225101	1.615888539	1.281330688	7.313028072	21.09163152	9.168869545	1.033566873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.4687	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0764	0	NO	1.39E-17	24.2179	1.61674166	7.325585869	0	3.939631356	6.759649432	5.114955992	7.741181903	10.20132306	1.503783438	4.91343947	0	0	6.492904022	17.09140409	15.12225101	1.615888539	1.281330688	7.313028072	21.09163152	9.168869545	1.033566873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.5451
H0084_006_0	2012	7																															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	YES	568.110036	12.5103261	29.71405237	0	36.04313385	129.7493094	91.98541173	105.2635784	84.33372433	16.81925634	42.04141227	0	1.639057677	51.19743643	84.55302588	74.31779903	3.218236134	5.761202708	30.83904694	95.12296793	53.25443929	8.625807841	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.08246492	0.08246492	0.194303827	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223924482	0	15	0	0	0	0	0	0											YES	0.08246492	0.08246492	0.194303827	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223924482	0	15	0	0	0	0	0	0											6700	46.8491	1.031663039	5.773554079	0	8.073661982	29.06384531	20.60473223	23.57904155	18.89075425	3.767513421	9.417276348	0	0.36714892	11.46822576	18.9398778	16.64718698	0.720884894	1.290509407	6.907946515	21.30754482	11.9289944	1.931529556	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	258.8779	0	NO	0	46.8491	1.031663039	5.773554079	0	8.073661982	29.06384531	20.60473223	23.57904155	18.89075425	3.767513421	9.417276348	0	0.36714892	11.46822576	18.9398778	16.64718698	0.720884894	1.290509407	6.907946515	21.30754482	11.9289944	1.931529556	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	258.8779	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.2349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.2349	0	NO	8.33E-17	46.8491	1.031663039	5.773554079	0	8.073661982	29.06384531	20.60473223	23.81395563	18.89075425	3.767513421	9.417276348	0	0.36714892	11.46822576	18.9398778	16.64718698	0.720884894	1.290509407	6.907946515	21.30754482	11.9289944	1.931529556	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	259.1128
H0084_007_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1810.998564	9.025671647	126.1648263	0	205.1820876	20.98434821	6.310451937	677.5274231	321.9871632	9.343801525	23.37476544	0	1.015257054	3049.811647	3798.154702	4622.588718	115.1110173	235.6310909	12.10466973	44.04189414	17.43210533	534.3881544	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.98053976	25	49.0674627	39.26548803	50	0.2	0.177170822	0.2	49.82500479	0	10	10	0	0	0	0	0											YES	170.3156905	973.2325174	126.5202273	0	155.7172028	0.194646503	0.194646503	62.76187352	145.9848776	0.194646503	0.194646503	0	0.194646503	29.17803618	24.33081293	47.75405024	38.21444977	48.66162587	0.194646503	0.172428405	0.194646503	48.49131484	0	10	10	0	0	0	0	0											6700	25.7035	0.732006428	1.330200208	0	2.662531729	4.084530006	1.228307405	3.543574203	3.917104717	1.818738296	4.549816362	0	0.197616236	7.415626215	7.701015962	18.39561116	0.366575349	0.955515999	2.356131638	7.594073569	3.393098351	2.15943202	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3256	0	NO	2.753255545	25.7035	0.732006428	1.330200208	0	2.662531729	4.084530006	1.228307405	3.543574203	3.917104717	1.818738296	4.549816362	0	0.197616236	7.415626215	7.701015962	18.39561116	0.366575349	0.955515999	2.356131638	7.594073569	3.393098351	2.15943202	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3256	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	5.207	0	5.446	0.1888	0.0373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.8791	0	NO	0.299216	25.7035	0.732006428	1.330200208	5.207008382	2.662531729	9.530570015	1.417088063	3.580868353	3.917104717	1.818738296	4.549816362	0	0.197616236	7.415626215	7.701015962	18.39561116	0.366575349	0.955515999	2.356131638	7.594073569	3.393098351	2.15943202	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2047
H0084_009_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1148.853517	8.354166383	92.34613136	0	108.3987956	6.419797463	4.441813093	364.1001134	225.6160024	6.318083675	21.10161526	0	0	2012.481212	2996.790026	3618.565715	183.1851404	219.6141359	11.84978662	33.79801213	31.13945483	349.6198322	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.50742491	35	48.05447343	39.7534037	50	0.2	0.180586502	0.2	49.50590585	0	10	10	0	0	0	0	0											YES	172.1978725	983.9878428	127.9184196	0	157.4380548	0.196797569	0.196797569	63.57142888	147.5981764	0.196797569	0.196797569	0	0	36.90685013	34.4395745	47.28501765	39.11686595	49.19939214	0.196797569	0.177694923	0.196797569	48.7132095	0	10	10	0	0	0	0	0											6700	16.4858	0.68503318	0.984397598	0	1.422174628	1.263400531	0.874138017	1.928863705	2.775042544	1.243383505	4.152746577	0	0	6.189528539	8.600681114	14.25866197	0.597135715	0.900406832	2.332009195	6.005735151	6.128168996	1.419258678	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4673	0	NO	1.273285074	16.4858	0.68503318	0.984397598	0	1.422174628	1.263400531	0.874138017	1.928863705	2.775042544	1.243383505	4.152746577	0	0	6.189528539	8.600681114	14.25866197	0.597135715	0.900406832	2.332009195	6.005735151	6.128168996	1.419258678	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4673	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	2.7849	0	1.2634	0.6809	0.0192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.7484	0	NO	0.077269845	16.4858	0.68503318	0.984397598	2.784944169	1.422174628	2.526801063	1.555070742	1.948015073	2.775042544	1.243383505	4.152746577	0	0	6.189528539	8.600681114	14.25866197	0.597135715	0.900406832	2.332009195	6.005735151	6.128168996	1.419258678	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2157
H0084_010_0	2012	7																															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	YES	714.8716708	15.7421576	52.60614147	0	27.48263506	86.64782422	61.42873378	73.30270985	72.02462983	12.40744495	31.01364873	0	1.209121109	37.78009118	108.4198931	95.29555851	4.126650867	7.387423161	39.54401558	121.9734233	31.84851714	8.635294861	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.088124934	0.088124934	0.143916931	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223923843	0	15	0	0	0	0	0	0											YES	0.088124934	0.088124934	0.143916931	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223923843	0	15	0	0	0	0	0	0											6700	62.998	1.387276602	7.570914422	0	6.156110253	19.40911263	13.76003637	16.41980701	16.13351708	2.779267668	6.947057317	0	0.270843128	8.462740424	24.28605605	21.34620511	0.924369794	1.654782788	8.857859489	27.32204681	7.134067839	1.933648408	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.0706	0	NO	1.14E-13	62.998	1.387276602	7.570914422	0	6.156110253	19.40911263	13.76003637	16.41980701	16.13351708	2.779267668	6.947057317	0	0.270843128	8.462740424	24.28605605	21.34620511	0.924369794	1.654782788	8.857859489	27.32204681	7.134067839	1.933648408	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.0706	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1636	0	NO	0	62.998	1.387276602	7.570914422	0	6.156110253	19.40911263	13.76003637	16.58339481	16.13351708	2.779267668	6.947057317	0	0.270843128	8.462740424	24.28605605	21.34620511	0.924369794	1.654782788	8.857859489	27.32204681	7.134067839	1.933648408	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.2342
H0084_011_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1515.694132	7.553930649	102.1867236	0	130.7240223	27.93899896	8.401867353	453.7906288	278.4860318	5.427664112	13.57802551	0	0.589746503	2261.848986	3784.241666	4605.655694	114.6893537	234.7679497	13.01166796	47.34193628	24.48125886	515.5370826	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.98639793	25	49.0674627	39.26548803	50	0.2	0.173192936	0.2	49.92439639	0	10	10	0	0	0	0	0											YES	170.8109769	976.0627252	126.8881543	0	156.170036	0.195212545	0.195212545	62.94438812	146.4094088	0.195212545	0.195212545	0	0.195212545	29.26860528	24.40156813	47.89292136	38.32557926	48.80313626	0.195212545	0.169047169	0.195212545	48.72934239	0	10	10	0	0	0	0	0											6700	21.5748	0.614425845	1.080523729	0	1.701264605	5.454043093	1.640149909	2.380297789	3.397747939	1.059548125	2.650600917	0	0.115125916	5.516763764	7.695119236	18.3815255	0.366294659	0.954784353	2.540040817	8.00302031	4.779048847	2.093481918	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2192	0	NO	2.256202479	21.5748	0.614425845	1.080523729	0	1.701264605	5.454043093	1.640149909	2.380297789	3.397747939	1.059548125	2.650600917	0	0.115125916	5.516763764	7.695119236	18.3815255	0.366294659	0.954784353	2.540040817	8.00302031	4.779048847	2.093481918	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2192	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	4.6864	0	7.2721	0.2521	0.0251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											12.2356	0	NO	0.300069004	21.5748	0.614425845	1.080523729	4.68638247	1.701264605	12.72610055	1.892227343	2.405349101	3.397747939	1.059548125	2.650600917	0	0.115125916	5.516763764	7.695119236	18.3815255	0.366294659	0.954784353	2.540040817	8.00302031	4.779048847	2.093481918	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4548
H0084_012_0	2012	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	390.3638804	26.05992041	33.73428009	0	24.88209548	46.04050431	34.83836783	56.45470947	68.23239939	6.326621554	20.67150846	0	0	27.3131144	68.43142652	60.70570276	6.469776109	5.130256494	29.28027098	84.44773905	38.450785	4.688535724	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.088124934	0.088124934	0.143916931	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.088124934	0.088124934	0.143916931	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	34.4008	2.296528771	4.854934054	0	5.573589387	10.31307296	7.803794395	12.64585492	15.28405746	1.417163228	4.630417895	0	0	6.118137625	15.32863954	13.59807742	1.449229848	1.149177455	6.558780699	18.91629355	8.612975839	1.050232002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.0017	0	NO	0	34.4008	2.296528771	4.854934054	0	5.573589387	10.31307296	7.803794395	12.64585492	15.28405746	1.417163228	4.630417895	0	0	6.118137625	15.32863954	13.59807742	1.449229848	1.149177455	6.558780699	18.91629355	8.612975839	1.050232002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.0017	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1261	0	NO	0	34.4008	2.296528771	4.854934054	0	5.573589387	10.31307296	7.803794395	12.77195241	15.28405746	1.417163228	4.630417895	0	0	6.118137625	15.32863954	13.59807742	1.449229848	1.149177455	6.558780699	18.91629355	8.612975839	1.050232002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.1278
H0084_013_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1157.361329	8.416032998	91.22590068	0	97.13984934	7.372969108	5.101305907	350.7400319	216.0561228	4.295282682	14.34571102	0	0	1565.769771	2994.298628	3615.5574	183.0328484	219.4315584	13.29613249	37.923286	31.92425818	347.642041	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.32544619	35	48.05447343	39.7534037	50	0.2	0.173765148	0.2	49.68272598	0	10	10	0	0	0	0	0											YES	172.3192579	984.6814739	128.0085916	0	157.5490358	0.196936295	0.196936295	63.61624155	147.7022211	0.196936295	0.196936295	0	0	36.75367537	34.46385159	47.31834972	39.14444015	49.23407369	0.196936295	0.171103322	0.196936295	48.92165985	0	10	10	0	0	0	0	0											6700	16.6196	0.690592648	0.973141589	0	1.275357467	1.452005218	1.004632284	1.859396883	2.659330768	0.845897056	2.825191174	0	0	4.795649487	8.599588626	14.25685079	0.597059865	0.90029246	2.618491067	6.488800225	6.287045119	1.417268806	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3869	0	NO	1.184905366	16.6196	0.690592648	0.973141589	0	1.275357467	1.452005218	1.004632284	1.859396883	2.659330768	0.845897056	2.825191174	0	0	4.795649487	8.599588626	14.25685079	0.597059865	0.90029246	2.618491067	6.488800225	6.287045119	1.417268806	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3869	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	2.3612	0	1.452	0.7826	0.0185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.6143	0	NO	0.071783614	16.6196	0.690592648	0.973141589	2.361230218	1.275357467	2.904010435	1.787216939	1.877858526	2.659330768	0.845897056	2.825191174	0	0	4.795649487	8.599588626	14.25685079	0.597059865	0.90029246	2.618491067	6.488800225	6.287045119	1.417268806	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0012
H0084_014_0	2012	7																															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	YES	558.8740437	12.30694071	63.35563223	0	29.59722144	95.02350227	67.36664742	102.7227587	124.3326226	18.45756461	46.13652753	0	1.798712877	56.18821543	106.9334621	93.98906143	4.070074701	7.286141979	39.00186921	120.3011741	76.43822117	8.80788901	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.083592281	0.083592281	0.193514535	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926402	0	15	0	0	0	0	0	0											YES	0.083592281	0.083592281	0.193514535	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926402	0	15	0	0	0	0	0	0											6700	46.7176	1.028765252	12.26023568	0	6.629777603	21.28526451	15.09012902	23.00989795	27.85050746	4.134494473	10.33458217	0	0.402911685	12.58616026	23.9530955	21.05354976	0.911696733	1.632095803	8.736418702	26.94746299	17.12216154	1.972318894	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	283.9759	0	NO	0	46.7176	1.028765252	12.26023568	0	6.629777603	21.28526451	15.09012902	23.00989795	27.85050746	4.134494473	10.33458217	0	0.402911685	12.58616026	23.9530955	21.05354976	0.911696733	1.632095803	8.736418702	26.94746299	17.12216154	1.972318894	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	283.9759	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.2292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.2292	0	NO	8.33E-17	46.7176	1.028765252	12.26023568	0	6.629777603	21.28526451	15.09012902	23.23914174	27.85050746	4.134494473	10.33458217	0	0.402911685	12.58616026	23.9530955	21.05354976	0.911696733	1.632095803	8.736418702	26.94746299	17.12216154	1.972318894	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	284.2052
H0084_015_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1558.797076	7.768747504	131.145618	0	227.1293416	26.7288422	8.037946778	718.5466942	307.2661995	7.601823056	19.01697402	0	0.825981209	2972.115708	3573.99532	4349.772913	108.3173987	221.7246222	12.26113131	44.61116736	24.02702501	555.2153611	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.97995264	25	49.0674627	39.26548803	50	0.2	0.173306572	0.2	49.96838632	0	10	10	0	0	0	0	0											YES	170.613184	974.9324798	126.7412224	0	155.9891968	0.194986496	0.194986496	62.87150079	146.239872	0.194986496	0.194986496	0	0.194986496	29.22842957	24.37331199	47.83746309	38.28119962	48.74662399	0.194986496	0.168962206	0.194986496	48.71580278	0	10	10	0	0	0	0	0											6700	22.1626	0.631167022	1.385129661	0	2.952476964	5.211763282	1.567291077	3.764675754	3.744547473	1.482252841	3.708053128	0	0.161055182	7.239189554	7.25917525	17.3401751	0.34554333	0.900693899	2.39075503	7.537601271	4.684945415	2.253980169	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9437	0	NO	2.48694948	22.1626	0.631167022	1.385129661	0	2.952476964	5.211763282	1.567291077	3.764675754	3.744547473	1.482252841	3.708053128	0	0.161055182	7.239189554	7.25917525	17.3401751	0.34554333	0.900693899	2.39075503	7.537601271	4.684945415	2.253980169	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9437	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	2.9014	0	6.949	0.2409	0.0396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.1309	0	NO	0.260486368	22.1626	0.631167022	1.385129661	2.901384717	2.952476964	12.16078099	1.808170713	3.804296875	3.744547473	1.482252841	3.708053128	0	0.161055182	7.239189554	7.25917525	17.3401751	0.34554333	0.900693899	2.39075503	7.537601271	4.684945415	2.253980169	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0746
H0084_016_0	2012	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	356.4206269	23.79393595	37.37265971	0	14.28947521	24.40922135	18.47020237	44.29816508	46.02810022	7.268036341	23.74747303	0	0	31.36416843	65.19419396	57.86399294	6.163715416	4.887563419	27.89513185	80.45283519	25.25766211	4.338647138	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.083592281	0.083592281	0.193514535	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.083592281	0.083592281	0.193514535	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	29.794	1.98898939	7.23215285	0	3.200842448	5.467665582	4.137325331	9.922788978	10.31029445	1.62804014	5.319433959	0	0	7.025573728	14.60349945	12.96153442	1.380672253	1.094814206	6.248509535	18.02143508	5.657716313	0.971856959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.9672	0	NO	0	29.794	1.98898939	7.23215285	0	3.200842448	5.467665582	4.137325331	9.922788978	10.31029445	1.62804014	5.319433959	0	0	7.025573728	14.60349945	12.96153442	1.380672253	1.094814206	6.248509535	18.02143508	5.657716313	0.971856959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.9672	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0989	0	NO	0	29.794	1.98898939	7.23215285	0	3.200842448	5.467665582	4.137325331	10.02173355	10.31029445	1.62804014	5.319433959	0	0	7.025573728	14.60349945	12.96153442	1.380672253	1.094814206	6.248509535	18.02143508	5.657716313	0.971856959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.0661
H0084_017_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1139.540069	8.286441396	125.4743129	0	117.8440969	6.067924684	4.198354771	436.445815	197.5298015	4.891518576	16.3370649	0	0	1911.278595	2543.109567	3070.755378	155.452961	186.3670144	11.75241746	33.52029539	29.85259382	346.5877044	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.66428205	35	48.05447343	39.7534037	50	0.2	0.171595323	0.2	49.80535245	0	10	10	0	0	0	0	0											YES	172.563875	986.0792857	128.1903071	0	157.7726857	0.197215857	0.197215857	63.70654845	147.9118929	0.197215857	0.197215857	0	0	37.13996834	34.512775	47.38552083	39.20000792	49.30396428	0.197215857	0.169206593	0.197215857	49.11202637	0	10	10	0	0	0	0	0											6700	16.387	0.680924018	1.340382559	0	1.549381638	1.196690968	0.827982135	2.317038038	2.434750569	0.964685029	3.221928258	0	0	5.91540221	7.314147358	12.12577858	0.507813109	0.765719385	2.317763083	5.671854986	5.887404878	1.418468707	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0657	0	NO	1.028371063	16.387	0.680924018	1.340382559	0	1.549381638	1.196690968	0.827982135	2.317038038	2.434750569	0.964685029	3.221928258	0	0	5.91540221	7.314147358	12.12577858	0.507813109	0.765719385	2.317763083	5.671854986	5.887404878	1.418468707	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0657	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	1.957	0	1.1967	0.645	0.023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.8217	0	NO	0.053952152	16.387	0.680924018	1.340382559	1.957047122	1.549381638	2.393381935	1.472960525	2.340043525	2.434750569	0.964685029	3.221928258	0	0	5.91540221	7.314147358	12.12577858	0.507813109	0.765719385	2.317763083	5.671854986	5.887404878	1.418468707	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8874
H0084_018_0	2012	7																															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	YES	341.6733057	7.523972825	30.33604421	0	22.52211005	77.26829078	54.77913966	81.97279744	72.72671362	16.6183649	41.53926403	0	1.619480553	50.58393847	76.16368197	66.94399344	2.898923023	5.189576674	27.77919937	85.68487529	104.8362923	7.911250396	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.080613365	0.080613365	0.164621184	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223924909	0	15	0	0	0	0	0	0											YES	0.080613365	0.080613365	0.164621184	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223924909	0	15	0	0	0	0	0	0											6700	27.5434	0.606532766	4.993955524	0	5.044952652	17.30809714	12.27052728	18.36190663	16.29078385	3.722513738	9.304795143	0	0.362763644	11.33080222	17.06066476	14.99545453	0.649358757	1.162465175	6.222540659	19.19341206	23.48332947	1.771526025	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	211.9967	0	NO	0	27.5434	0.606532766	4.993955524	0	5.044952652	17.30809714	12.27052728	18.36190663	16.29078385	3.722513738	9.304795143	0	0.362763644	11.33080222	17.06066476	14.99545453	0.649358757	1.162465175	6.222540659	19.19341206	23.48332947	1.771526025	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	211.9967	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1829	0	NO	2.78E-17	27.5434	0.606532766	4.993955524	0	5.044952652	17.30809714	12.27052728	18.54484325	16.29078385	3.722513738	9.304795143	0	0.362763644	11.33080222	17.06066476	14.99545453	0.649358757	1.162465175	6.222540659	19.19341206	23.48332947	1.771526025	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.1796
H0084_019_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1720.181941	8.573058907	75.76824248	0	191.4540234	29.06524726	8.740554819	859.4662614	295.1786953	7.18206755	17.96689965	0	0.780372392	2246.444329	3400.493223	4138.610152	103.059055	210.9608457	13.07280006	47.56436065	22.27163043	517.7512555	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.9842153	25	49.0674627	39.26548803	50	0.2	0.167867229	0.2	50	0	10	10	0	0	0	0	0											YES	170.3141259	973.2235767	126.519065	0	155.7157723	0.194644715	0.194644715	62.76129695	145.9835365	0.194644715	0.194644715	0	0.194644715	29.18134526	24.33058942	47.75361155	38.21409871	48.66117884	0.194644715	0.163372345	0.194644715	48.66117884	0	10	10	0	0	0	0	0											6700	24.4143	0.695291921	0.798843933	0	2.484367593	5.657396779	1.701302805	4.495101438	3.59093582	1.397951494	3.497162068	0	0.151895362	5.462855632	6.894667036	16.46946513	0.328192408	0.855466953	2.544551446	7.770701116	4.335055165	2.099532203	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8657	0	NO	2.631493248	24.4143	0.695291921	0.798843933	0	2.484367593	5.657396779	1.701302805	4.495101438	3.59093582	1.397951494	3.497162068	0	0.151895362	5.462855632	6.894667036	16.46946513	0.328192408	0.855466953	2.544551446	7.770701116	4.335055165	2.099532203	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8657	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.5097	0	7.5432	0.2615	0.0473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.3617	0	NO	0.422647853	24.4143	0.695291921	0.798843933	7.509700077	2.484367593	13.20059248	1.962778932	4.542409883	3.59093582	1.397951494	3.497162068	0	0.151895362	5.462855632	6.894667036	16.46946513	0.328192408	0.855466953	2.544551446	7.770701116	4.335055165	2.099532203	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2273
H0084_021_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	845.7313704	6.149940337	57.71750009	0	100.2763004	7.054606893	4.88103331	447.1541109	219.5477085	5.013278817	16.74372899	0	0	1348.773424	2607.472668	3148.472572	159.3872919	191.0837435	12.09154785	34.48756454	27.35362776	322.9091392	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.3412122	35	48.05447343	39.7534037	50	0.2	0.171411574	0.2	49.78018832	0	10	10	0	0	0	0	0											YES	172.8742932	987.853104	128.4209035	0	158.0564966	0.197570621	0.197570621	63.8211476	148.1779656	0.197570621	0.197570621	0	0	36.88763238	34.57485864	47.47076074	39.27052324	49.3926552	0.197570621	0.169329456	0.197570621	49.17551355	0	10	10	0	0	0	0	0											6700	12.1838	0.506269804	0.617677793	0	1.320776729	1.393783063	0.964348781	2.378157376	2.711011066	0.990476608	3.308068932	0	0	4.146088187	7.512749909	12.45503235	0.521601863	0.786511122	2.388934615	5.839760529	5.404273218	1.323268563	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9732	0	NO	0.820806633	12.1838	0.506269804	0.617677793	0	1.320776729	1.393783063	0.964348781	2.378157376	2.711011066	0.990476608	3.308068932	0	0	4.146088187	7.512749909	12.45503235	0.521601863	0.786511122	2.388934615	5.839760529	5.404273218	1.323268563	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9732	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.106	0	1.3938	0.7512	0.0236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.2746	0	NO	0.064857289	12.1838	0.506269804	0.617677793	3.105955134	1.320776729	2.787566127	1.715553546	2.401769706	2.711011066	0.990476608	3.308068932	0	0	4.146088187	7.512749909	12.45503235	0.521601863	0.786511122	2.388934615	5.839760529	5.404273218	1.323268563	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2478
H0084_022_0	2012	7																															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	YES	566.9042394	12.4837733	42.43393113	0	37.93505536	58.94223992	41.78693691	51.47127382	60.40533527	13.753648	34.37861781	0	1.340310289	41.87188556	93.61049642	82.27885386	3.562979313	6.378352991	34.14258051	105.3127095	32.69929394	8.572063959	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.090752243	0.090752243	0.183057007	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926615	0	15	0	0	0	0	0	0											YES	0.090752243	0.090752243	0.183057007	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926615	0	15	0	0	0	0	0	0											6700	51.4478	1.132930422	7.767828446	0	8.497452402	13.20306174	9.360273868	11.52956534	13.5307951	3.080817151	7.700810389	0	0.300229505	9.379302365	20.9687512	18.43046326	0.798107366	1.42875107	7.647938034	23.59004692	7.324641844	1.919513267	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.356	0	NO	8.53E-14	51.4478	1.132930422	7.767828446	0	8.497452402	13.20306174	9.360273868	11.52956534	13.5307951	3.080817151	7.700810389	0	0.300229505	9.379302365	20.9687512	18.43046326	0.798107366	1.42875107	7.647938034	23.59004692	7.324641844	1.919513267	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.356	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1149	0	NO	0	51.4478	1.132930422	7.767828446	0	8.497452402	13.20306174	9.360273868	11.64443248	13.5307951	3.080817151	7.700810389	0	0.300229505	9.379302365	20.9687512	18.43046326	0.798107366	1.42875107	7.647938034	23.59004692	7.324641844	1.919513267	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.4708
H0084_023_0	2012	8																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	2175.654017	10.84304492	114.3676439	0	164.5655957	22.43236775	6.745903046	430.9258542	285.1040061	5.466751098	13.67580682	0	0.593993526	2353.473756	4264.437193	5190.083292	129.2426828	264.5584677	14.90398353	54.22697849	25.62316584	560.315868	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.98830045	25	49.0674627	39.26548803	50	0.2	0.172376754	0.2	50	0	10	10	0	0	0	0	0											YES	169.8073795	970.3278829	126.1426248	0	155.2524613	0.194065577	0.194065577	62.57455929	145.5491824	0.194065577	0.194065577	0	0.194065577	29.09848408	24.25819707	47.6115272	38.10039788	48.51639415	0.194065577	0.167261971	0.194065577	48.51639415	0	10	10	0	0	0	0	0											6700	30.7868	0.876775735	1.202219565	0	2.129101148	4.353350381	1.309147564	2.247082951	3.458054584	1.060908204	2.654003336	0	0.115273696	5.706876552	8.62062982	20.59231599	0.410349803	1.069618575	2.892350157	9.070111282	4.972574453	2.265375458	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0136	0	NO	3.235093203	30.7868	0.876775735	1.202219565	0	2.129101148	4.353350381	1.309147564	2.247082951	3.458054584	1.060908204	2.654003336	0	0.115273696	5.706876552	8.62062982	20.59231599	0.410349803	1.069618575	2.892350157	9.070111282	4.972574453	2.265375458	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0136	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.0496	0	5.8045	0.2012	0.0236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											13.0789	0	NO	0.399947337	30.7868	0.876775735	1.202219565	7.049625628	2.129101148	10.15781756	1.510352684	2.270732251	3.458054584	1.060908204	2.654003336	0	0.115273696	5.706876552	8.62062982	20.59231599	0.410349803	1.069618575	2.892350157	9.070111282	4.972574453	2.265375458	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0926
H0084_025_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1308.663345	9.516262227	93.4172907	0	123.8380878	5.436337101	3.761363727	277.0673204	170.2864825	3.543649299	11.83534882	0	0	1434.623008	3042.106774	3673.284807	185.9552226	222.9350887	14.33786886	40.89453095	29.18599021	352.9830987	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.25188686	35	48.05447343	39.7534037	50	0.2	0.170556643	0.2	49.80825111	0	10	10	0	0	0	0	0											YES	172.270818	984.4046741	127.9726076	0	157.5047479	0.196880935	0.196880935	63.59835865	147.6607011	0.196880935	0.196880935	0	0	36.67093154	34.45416359	47.30504825	39.13343641	49.2202337	0.196880935	0.167896757	0.196880935	49.0314752	0	10	10	0	0	0	0	0											6700	18.787	0.780654418	0.996237857	0	1.625423899	1.070311131	0.740540807	1.468418901	2.095385116	0.697676987	2.330154539	0	0	4.384080176	8.734437038	14.48040959	0.60642224	0.914409764	2.822853025	6.866059106	5.746165036	1.442273504	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8096	0	NO	1.213352343	18.787	0.780654418	0.996237857	0	1.625423899	1.070311131	0.740540807	1.468418901	2.095385116	0.697676987	2.330154539	0	0	4.384080176	8.734437038	14.48040959	0.60642224	0.914409764	2.822853025	6.866059106	5.746165036	1.442273504	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8096	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.3988	0	1.0703	0.5769	0.0146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.0606	0	NO	0.080171829	18.787	0.780654418	0.996237857	3.398833744	1.625423899	2.140622261	1.317404483	1.482998589	2.095385116	0.697676987	2.330154539	0	0	4.384080176	8.734437038	14.48040959	0.60642224	0.914409764	2.822853025	6.866059106	5.746165036	1.442273504	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8702
H0104_010_1	2012	8																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1000.268514	13.5975389	350.1477555	48.25008582	206.3255499	21.97990772	6.545819723	284.9679357	568.4870324	5.065073809	553.5265625	0	0.018038734	282.7831657	5242.682994	5268.240549	272.0550233	761.0191874	35.24881938	28.45144999	68.78381335	0	0	1134.600185	0	0	0	0	59.93095412	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/$90/$0/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $30/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	175	175	90	0	150	0.2	0.064928285	29.89696782	175	0	24.92063047	0	0.2	85.62737795	10.0013971	28.70232133	30	30	0	10.71093527	0	0	0	0	0	0	0	0	0	0											NO	158.6341177	158.6341177	81.58326054	0	135.9721009	0.181296135	0.058856235	27.1010235	158.6341177	0	22.59006987	0	0.181296135	77.61956317	9.066073167	26.01809955	27.19442018	27.19442018	0	9.709255809	0	0	0	0	0	0	0	0	0	0												13.2231	0.179752799	2.380516297	0	2.337876541	3.984872307	0.385262307	0.643576894	7.515119901	0	1.042016977	0	0.003270353	1.829125483	3.960878968	11.42246725	0.616531551	1.724622962	0	0.023020201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.272	0	NO	5.2896	13.2231	0.179752799	2.380516297	0	2.337876541	3.984872307	0.385262307	0.643576894	7.515119901	0	1.042016977	0	0.003270353	1.829125483	3.960878968	11.42246725	0.616531551	1.724622962	0	0.023020201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.272	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	2.322	0.0133	0.3238	0.3416	0.0645	0.1919	0.0533	0.1199	0.8305	0.0635	0.1169	0	0.0002	0.1839	0.5902	1.0932	0.0182	0.0727	0.3443	0.3004	0.6497	0.0042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.6984	2000	NO	3.55	15.5451	0.193067492	2.704360774	0.341624279	2.402404913	4.17673796	0.438542716	0.763473813	8.345632947	0.063541722	1.158917818	0	0.003476566	2.013050439	4.551105292	12.51564274	0.634705541	1.797357983	0.344308112	0.323448455	0.649677649	0.00418684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9703
H0104_010_2	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	729.2681938	9.913789922	194.6686381	23.59718598	144.9722377	16.55461668	4.930079088	215.6353102	443.8431869	4.896796698	421.3228953	0	0.011596257	194.3638141	4218.517428	4101.132774	191.336283	535.2244774	26.11691414	22.79127282	41.69071535	0	0	1134.600185	0	0	0	0	59.93095412	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/$90/$0/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $30/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	175	175	90	0	150	0.2	0.064928679	29.89696782	175	0	24.92057083	0	0.2	53.94174497	10.00139707	28.82763915	30	30	0	10.62417514	0	0	0	0	0	0	0	0	0	0											NO	165.1576356	165.1576356	84.93821259	0	141.5636876	0.188751584	0.061276955	28.2155001	165.1576356	0	23.51898603	0	0.188751584	50.90794891	9.438897674	27.2063127	28.31273753	28.31273753	0	10.02664941	0	0	0	0	0	0	0	0	0	0												10.037	0.136444842	1.377900514	0	1.710233715	3.124710114	0.302100234	0.50702151	6.108674277	0	0.825757274	0	0.002188812	0.82455526	3.318179528	9.29805839	0.45143783	1.262805846	0	0.019043342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3061	0	NO	2.3424	10.037	0.136444842	1.377900514	0	1.710233715	3.124710114	0.302100234	0.50702151	6.108674277	0	0.825757274	0	0.002188812	0.82455526	3.318179528	9.29805839	0.45143783	1.262805846	0	0.019043342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3061	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	2.1638	0.0124	0.3075	0.3244	0.0612	0.1822	0.0506	0.1153	0.7839	0.06	0.1103	0	0.0002	0.1736	0.562	1.0418	0.0172	0.069	0.3271	0.2852	0.616	0.004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.2677	2000	NO	2.8072	12.2008	0.148845417	1.685415736	0.32439851	1.77145475	3.306901626	0.352693782	0.622345286	6.892545916	0.059977185	0.936094276	0	0.002384627	0.99810528	3.88021822	10.33986469	0.468682898	1.331824276	0.327081201	0.304251615	0.615962084	0.0039517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5738
H0104_010_3	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	682.3976035	60.6009998	153.292624	24.6523777	155.7982244	15.80905908	3.914910334	283.8181631	486.8706138	2.572549917	592.1871118	0	0.019705285	138.6957739	4035.023991	5085.321349	151.5318361	740.8599858	29.55499642	32.0812041	76.4425921	0	0	1134.600185	0	0	0	0	59.93095412	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/$90/$0/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $30/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	175	175	90	0	150	0.2	0.037549196	29.89696782	175	0	23.11921183	0	0.2	80.99522933	10.00226798	27.67721776	30	30	0	10.94153828	0	0	0	0	0	0	0	0	0	0											NO	163.7829173	163.7829173	84.23121459	0	140.3853576	0.187180477	0.035142382	27.98064347	163.7829173	0	21.63732548	0	0.187180477	75.80362825	9.361146454	25.90317409	28.07707153	28.07707153	0	10.24021176	0	0	0	0	0	0	0	0	0	0												9.3138	0.827117378	1.076001992	0	1.822649122	2.959147218	0.137579275	0.661784569	6.645090788	0	1.067778774	0	0.003688445	0.876136907	3.14770421	10.97716368	0.354547517	1.733431568	0	0.027376527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.631	0	NO	2.8512	9.3138	0.827117378	1.076001992	0	1.822649122	2.959147218	0.137579275	0.661784569	6.645090788	0	1.067778774	0	0.003688445	0.876136907	3.14770421	10.97716368	0.354547517	1.733431568	0	0.027376527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.631	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	2.3719	0.0638	0.2119	0.2224	0.0672	0.1785	0.0406	0.1437	0.8784	0.0722	0.1319	0	0.0001	0.2027	0.4773	0.9984	0.0071	0.0436	0.2997	0.2496	0.5473	0.0158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.2242	2000	NO	2.7296	11.6857	0.890935368	1.287931732	0.222360214	1.889864072	3.13769079	0.178201995	0.805469779	7.523489289	0.072237246	1.199674449	0	0.003826872	1.078804999	3.625002845	11.97554484	0.361654296	1.77704003	0.29967752	0.276978581	0.547291052	0.015807458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8552
H0104_010_4	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	891.2529892	85.24185312	209.0750929	46.69377012	184.5017846	16.4176363	5.223133326	276.0240357	549.6753016	4.146256129	446.7228361	0	0.154661341	261.6586143	4411.758604	4637.462259	344.6039443	598.0548415	35.97449693	33.36371313	69.72542643	0	0	1134.600185	0	0	0	0	59.93095412	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/$90/$0/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $30/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	175	175	90	0	150	0.2	0.073559036	29.89696782	175	0	24.14926341	0	0.2	72.60791039	10.00175827	28.65356165	30	30	0	10.55431332	0	0	0	0	0	0	0	0	0	0											NO	161.4959235	161.4959235	83.05504636	0	138.4250773	0.18456677	0.067882768	27.58993388	161.4959235	0	22.28575769	0	0.18456677	67.00503738	9.229961079	26.44247657	27.68501545	27.68501545	0	9.739877577	0	0	0	0	0	0	0	0	0	0												11.9945	1.147184316	1.447061794	0	2.128306149	3.030150099	0.354560748	0.634623741	7.397526704	0	0.82962974	0	0.028545344	1.461037102	3.393363351	10.21883226	0.79503046	1.379763128	0	0.027079873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2672	0	NO	3.8688	11.9945	1.147184316	1.447061794	0	2.128306149	3.030150099	0.354560748	0.634623741	7.397526704	0	0.82962974	0	0.028545344	1.461037102	3.393363351	10.21883226	0.79503046	1.379763128	0	0.027079873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2672	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	2.1161	0.0856	0.2167	0.3528	0.0687	0.1605	0.0478	0.1009	0.7732	0.045	0.1504	0	0.0016	0.1794	0.5217	1.0162	0.024	0.0613	0.3293	0.3143	0.7465	0.0056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3178	2000	NO	2.9168	14.1106	1.232764129	1.663778308	0.352772737	2.196964655	3.190693653	0.40240731	0.735549773	8.170691634	0.044983914	0.980063509	0	0.03017094	1.64045111	3.915073398	11.23505855	0.819021542	1.441042068	0.329347273	0.341378481	0.746481597	0.00562866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5849
H0104_010_5	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	889.2054713	39.53954441	302.403175	40.73211307	224.931093	18.44268878	4.375020293	352.0723584	612.4456263	7.468294466	651.813888	0	0.229726137	344.4201409	4718.828277	5349.841438	328.259887	586.4470107	34.39325246	29.06794569	98.77690489	0	0	1134.600185	0	0	0	0	59.93095412	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/$90/$0/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $30/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	175	175	90	0	150	0.2	0.030437858	29.89696782	175	0	24.45044342	0	0.2	62.85592051	10.00119422	27.53614832	30	30	0	11.60371803	0	0	0	0	0	0	0	0	0	0											NO	159.7120449	159.7120449	82.13762311	0	136.8960385	0.182528051	0.027778815	27.28517639	159.7120449	0	22.31445896	0	0.182528051	57.36484344	9.127492459	25.13059747	27.3792077	27.3792077	0	10.59002021	0	0	0	0	0	0	0	0	0	0												11.8347	0.526245124	2.069889835	0	2.566014631	3.366308044	0.121532879	0.8005297	8.151245283	0	1.212072854	0	0.041931464	1.646467288	3.589255793	11.20372598	0.748957969	1.338037876	0	0.025652511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2426	0	NO	4.7136	11.8347	0.526245124	2.069889835	0	2.566014631	3.366308044	0.121532879	0.8005297	8.151245283	0	1.212072854	0	0.041931464	1.646467288	3.589255793	11.20372598	0.748957969	1.338037876	0	0.025652511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2426	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%		16a:  Preventive Dental - $0/service ($125 per year allowance)					14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	2.5216	0.0376	0.2499	0.3305	0.0717	0.1509	0.0328	0.1352	0.7989	0.0746	0.178	0	0.0022	0.19	0.5359	0.9901	0.0202	0.0466	0.3288	0.2808	0.8788	0.0073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.8623	2000	NO	3.8712	14.3564	0.56383107	2.31982772	0.330465055	2.637665062	3.517165102	0.15428553	0.935764024	8.950183525	0.074553473	1.390029259	0	0.044098231	1.836515213	4.125177514	12.19380931	0.769191952	1.384660321	0.328824585	0.306462927	0.87877419	0.007282044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1049
H0104_011_1	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1237.195336	26.49905701	139.3158498	51.96099759	223.1331097	18.55591152	4.140630508	341.8766462	585.7259569	8.312178662	756.2290693	0	0.004634793	348.3923998	4289.37617	5017.253871	279.48841	732.3653149	28.10907497	40.7574234	70.10880196	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.019732027	33.69646653	300	0	24.84828418	0	0.2	88.49357442	20.0009981	34.31916833	40	40	0	10.42833612	0	0	0	0	0	0	0	0	0	0											NO	169.774823	169.774823	78.35761061	0	130.5960177	0.174128024	0.017179495	29.3374956	261.1920354	0	21.63391307	0	0.174128024	77.04605607	17.41367134	29.87964476	34.82560472	34.82560472	0	9.07932779	0	0	0	0	0	0	0	0	0	0												17.5037	0.374906059	0.909704759	0	2.428357961	3.231104199	0.07113394	0.83581705	12.7489129	0	1.363349496	0	0.000807047	2.236855031	6.224482239	12.49281361	0.811112741	2.12542208	0	0.030837501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3893	0	NO	9.4184	17.5037	0.374906059	0.909704759	0	2.428357961	3.231104199	0.07113394	0.83581705	12.7489129	0	1.363349496	0	0.000807047	2.236855031	6.224482239	12.49281361	0.811112741	2.12542208	0	0.030837501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3893	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.8759	0.0181	0.1216	0.2182	0.0708	0.1622	0.0329	0.1338	0.4871	0.0519	0.2798	0	0.0001	0.2236	0.5759	1.0546	0.0248	0.0783	0.23	0.3043	0.772	0.0085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7246	2000	NO	3.0695	19.3796	0.392975201	1.031306838	0.218227351	2.499171324	3.393307019	0.104066085	0.96961242	13.23602914	0.051894803	1.643162988	0	0.000868051	2.460501364	6.80041479	13.54743141	0.835929416	2.203746152	0.230044629	0.335150849	0.771986025	0.008514506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.114
H0104_011_2	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1387.505926	56.94473397	351.7132864	48.96381992	294.618798	21.66633437	6.43301048	359.5348263	592.2758713	5.406167732	556.4426149	0	0.198786218	267.5396011	4460.453906	5082.964454	232.2906229	576.7498428	27.69891793	35.74001224	65.41005505	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.064532644	33.69646653	300	0	26.2175588	0	0.2	103.0368064	20.00088181	35.21237119	40	40	0	10	0	0	0	0	0	0	0	0	0	0											NO	167.1978379	167.1978379	77.16823287	0	128.6137214	0.171484962	0.05533189	28.8921864	257.2274429	0	22.47958536	0	0.171484962	88.34631412	17.14925228	30.19196067	34.29699238	34.29699238	0	8.574248096	0	0	0	0	0	0	0	0	0	0												19.3323	0.7934197	2.261757732	0	3.157668335	3.715450525	0.355950628	0.865645602	12.69580065	0	1.042383272	0	0.034088847	1.969678136	6.374454109	12.78872191	0.663905811	1.648398747	0	0.025536978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7252	0	NO	11.26155	19.3323	0.7934197	2.261757732	0	3.157668335	3.715450525	0.355950628	0.865645602	12.69580065	0	1.042383272	0	0.034088847	1.969678136	6.374454109	12.78872191	0.663905811	1.648398747	0	0.025536978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7252	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.9992	0.0269	0.2951	0.3281	0.0727	0.1554	0.043	0.131	0.634	0.0507	0.2049	0	0.0018	0.2148	0.4442	0.8569	0.0125	0.0502	0.2541	0.2769	0.5903	0.0148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6574	2000	NO	2.9701	21.3315	0.820272896	2.556847686	0.328057763	3.230401234	3.870871131	0.398971322	0.996649193	13.32982342	0.050729397	1.247237917	0	0.035857435	2.184516682	6.818701044	13.64558827	0.67636004	1.698584781	0.254053021	0.302455599	0.590349655	0.014785952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3826
H0104_011_3	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	715.4624942	45.0949022	109.6338848	23.92987862	118.3858298	15.02778308	4.081495111	377.2649214	493.0996389	5.494966491	658.0367003	0	0.108025071	430.3599394	3858.067881	4470.715616	115.741379	360.8909107	29.58284263	25.33399663	53.00739037	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.051903272	33.69646653	300	0	26.3703562	0	0.2	85.29051726	20.0008513	35.02099164	40	40	0	10.43579832	0	0	0	0	0	0	0	0	0	0											NO	176.7384396	176.7384396	81.57158752	-2.90E-19	135.9526459	0.181270194	0.047042581	30.54082521	271.9052917	0	23.90079799	0	0.181270194	77.30314326	18.12779103	31.74130983	36.2540389	36.2540389	0	9.458495953	0	0	0	0	0	0	0	0	0	0												10.5375	0.664166888	0.745250836	-6.94E-18	1.3412389	2.724089161	0.192004065	0.960165169	11.17303343	0	1.31063352	0	0.019581726	2.772348004	5.82818736	11.82553079	0.349674371	1.09031276	0	0.019968459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5537	0	NO	5.3268	10.5375	0.664166888	0.745250836	-6.94E-18	1.3412389	2.724089161	0.192004065	0.960165169	11.17303343	0	1.31063352	0	0.019581726	2.772348004	5.82818736	11.82553079	0.349674371	1.09031276	0	0.019968459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5537	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.7887	0.0354	0.1041	0.1666	0.0517	0.1303	0.0328	0.113	0.7561	0.0583	0.1651	0	0.0012	0.1797	0.4942	0.9128	0.0081	0.0335	0.3035	0.2878	0.5316	0.0034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1577	2000	NO	2.1644	12.3262	0.699581343	0.849330314	0.166589092	1.39288974	2.854350728	0.224762939	1.073171994	11.92911478	0.05825087	1.475780538	0	0.020760901	2.952054174	6.322403132	12.73832032	0.357732599	1.123768972	0.303501026	0.307810749	0.531645541	0.003350117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7114
H0104_011_4	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	586.0308775	53.77322517	103.3337237	24.69731345	129.1385934	13.15262509	3.540507821	332.591295	505.5550147	6.376888015	545.7468546	0	0.114536601	315.0226948	3985.940121	4625.526529	245.79049	451.2182568	24.25847832	22.18137735	62.46880284	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.050580079	33.69646653	300	0	26.54783921	0	0.2	75.28067945	20.0007233	34.95584164	40	40	0	11.33104373	0	0	0	0	0	0	0	0	0	0											NO	177.7050316	177.7050316	82.0177069	0	136.6961782	0.182261571	0.046094023	30.70785462	273.3923563	0	24.19325439	0	0.182261571	68.60387447	18.22681624	31.85553305	36.45231418	36.45231418	0	10.32606915	0	0	0	0	0	0	0	0	0	0												8.6784	0.79631439	0.706266255	0	1.471062681	2.39721811	0.16319625	0.851097095	11.51790639	0	1.100282707	0	0.020875621	1.800981451	6.054249844	12.2790511	0.746636014	1.370662472	0	0.019087203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9733	0	NO	4.8636	8.6784	0.79631439	0.706266255	0	1.471062681	2.39721811	0.16319625	0.851097095	11.51790639	0	1.100282707	0	0.020875621	1.800981451	6.054249844	12.2790511	0.746636014	1.370662472	0	0.019087203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9733	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.6116	0.0513	0.0902	0.2093	0.0439	0.1138	0.0283	0.1441	0.7545	0.0699	0.1485	0	0.0012	0.1839	0.4957	0.8781	0.0153	0.0395	0.2523	0.2637	0.6269	0.0096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0316	2000	NO	1.99815	10.29	0.847651813	0.796501993	0.209271139	1.514964051	2.51097901	0.191531303	0.995212359	12.27238317	0.069895566	1.248757161	0	0.022029926	1.984879949	6.549919447	13.15720071	0.761942944	1.410124461	0.252296298	0.282831273	0.626932434	0.009568023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0048
H0104_011_5	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	691.9988238	79.89332148	123.3629849	19.88602359	132.5948475	13.67390009	3.33086391	275.6931242	475.8125208	2.569115593	560.8690604	0	0.017973136	129.1506017	3687.517862	4961.886086	169.2799068	662.1333511	29.42219991	31.85941297	65.34804671	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.034863395	33.69646653	300	0	26.31921128	0	0.2	91.3429712	20.00124389	33.76073161	40	40	0	12.17248823	0	0	0	0	0	0	0	0	0	0											NO	177.2529815	177.2529815	81.80906839	0	136.3484473	0.18179793	0.031690465	30.62973928	272.6968946	0	23.92389062	0	0.18179793	83.02981531	18.18092365	30.68815557	36.35958595	36.35958595	0	11.0646658	0	0	0	0	0	0	0	0	0	0												10.2216	1.180110786	0.841017572	0	1.506591798	2.485886728	0.105556627	0.70370071	10.8127164	0	1.118180838	0	0.003267479	0.89361255	5.586873394	12.68926101	0.512912277	2.006241208	0	0.029376146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6969	0	NO	5.0759	10.2216	1.180110786	0.841017572	0	1.506591798	2.485886728	0.105556627	0.70370071	10.8127164	0	1.118180838	0	0.003267479	0.89361255	5.586873394	12.68926101	0.512912277	2.006241208	0	0.029376146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6969	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.9124	0.063	0.1579	0.1651	0.0535	0.1422	0.0318	0.1345	0.7638	0.0664	0.1122	0	0.0001	0.1706	0.4205	0.8737	0.0071	0.0367	0.2774	0.226	0.4442	0.0089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0681	2000	NO	2.023	12.1339	1.243073248	0.998920463	0.165106642	1.560140353	2.628037402	0.137324428	0.838241025	11.5765445	0.06640478	1.230424435	0	0.003383699	1.06425973	6.007414355	13.56295304	0.520034069	2.042923951	0.277388681	0.255380641	0.444177554	0.008886853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7649
H0104_011_6	2012	5																															D	D	D	coin	T	coin	coin	V	V	coin	V	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	611.6311097	39.98692193	88.37720198	21.22402655	93.35402875	13.31921583	3.743643076	205.2380156	489.7138281	3.403668737	430.0955775	0	0.027331803	222.3043699	3981.303361	4501.799751	206.5158297	606.7342265	27.19473503	37.5431642	44.81097813	0	0	0	0	0	0	0	59.93095412	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 1-7/8-90	2:  Skilled Nursing Services - $0/$90/$0/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 - $65/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												0	NO	195	195	90	0	150	0.2	0.056892053	33.69646653	300	0	27.09061621	0	0.2	83.79185351	20.00103981	35.44366191	40	40	0	12.56060337	0	0	0	0	0	0	0	0	0	0											NO	178.4147697	178.4147697	82.34527833	0	137.2421305	0.182989507	0.052053244	30.83049906	274.4842611	0	24.78649258	0	0.182989507	76.66514999	18.29990211	32.42909117	36.59790148	36.59790148	0	11.49229312	0	0	0	0	0	0	0	0	0	0												9.0937	0.594521456	0.606453775	0	1.067675483	2.437276744	0.194868767	0.527299204	11.20156152	0	0.88838007	0	0.005001433	1.420249822	6.071455148	12.16577288	0.629837166	1.850433287	0	0.035954754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7904	0	NO	4.5355	9.0937	0.594521456	0.606453775	0	1.067675483	2.437276744	0.194868767	0.527299204	11.20156152	0	0.88838007	0	0.005001433	1.420249822	6.071455148	12.16577288	0.629837166	1.850433287	0	0.035954754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7904	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 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%	9d:  Blood - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/												5100	1.4803	0.0379	0.0967	0.1678	0.0364	0.1323	0.0345	0.0945	0.664	0.0406	0.1328	0	0.0003	0.1442	0.5126	0.9578	0.0164	0.0633	0.2758	0.2946	0.4732	0.0021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6581	2000	NO	1.54175	10.5739	0.632413663	0.703184538	0.167762173	1.104103181	2.569623214	0.229405782	0.621756201	11.86556347	0.040626531	1.021229405	0	0.005317475	1.564473846	6.584023924	13.12358358	0.646188369	1.913728847	0.275776176	0.330593042	0.473155685	0.002103923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4485
H0104_801_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	242.5807153	4.374091785	34.81216402	49.95252185	10.27591781	20.451806	5.097008546	20.93855602	78.21831417	5.150595533	13.35964322	0	0.697966676	10.73710567	55.67363251	110.6656183	1.206121738	5.870539313	30.42845341	29.16392474	68.72937472	0.355295949	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	NO	0.090888799	0.090888799	0.172621798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.081106603	0.081078082	0.154419868	0	0.200010704	0.19987102	0.199725859	0.2000344	0.199855655	0.199763006	0.199612074	0	0.200750716	0.199687523	0.199786871	0.199818639	0.199275611	0.199881626	0.19967046	0.199726552	0.199746037	0.199118754	0	0	0	0	0	0	0	0											3300	19.6749	0.35464297	5.375689764	0	2.055293553	4.087723327	1.018004412	4.18843149	15.6323724	1.028898447	2.666746088	0	0.14011731	2.144066031	11.12286085	22.11305329	0.240350646	1.173412945	6.075663304	5.824810145	13.72842022	0.070746087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7162	0	NO	14.35101511	19.6749	0.35464297	5.375689764	0	2.055293553	4.087723327	1.018004412	4.18843149	15.6323724	1.028898447	2.666746088	0	0.14011731	2.144066031	11.12286085	22.11305329	0.240350646	1.173412945	6.075663304	5.824810145	13.72842022	0.070746087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7162	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	0.8178	0.0153	0.2592	0	0.073	0.1467	0.034	0.1683	0.597	0.0373	0.1192	0	0.0085	0.1272	0.484	0.9535	0.0106	0.0601	0.2496	0.25	0.6097	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.0246	0	NO	0.27117055	20.4927	0.369900397	5.634922771	0	2.128338651	4.234459732	1.051974335	4.356742925	16.22933162	1.066185896	2.785938501	0	0.148659448	2.271259196	11.60681418	23.06656472	0.25093891	1.233481221	6.325295558	6.074826014	14.33815185	0.0742742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7408
H0104_802_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	238.3439443	4.557842937	19.84695265	43.40659526	9.056397714	20.43503703	5.717357016	17.97969953	79.19448273	5.616033649	16.27087808	0	0.179136629	12.429467	59.61390754	115.481662	1.812152739	5.816016111	35.56431306	32.70177578	75.94703981	0.581319874	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	NO	0.090888799	0.090888799	0.172621798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.080783279	0.080783279	0.153428749	0	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0	0	0	0	0	0	0	0											3300	19.2542	0.368197495	3.045093108	0	1.803078408	4.0685022	1.138293978	3.579658163	15.76718098	1.11812106	3.239441317	0	0.035665106	2.47463774	11.86879738	22.99175652	0.36078953	1.157936456	7.080656899	6.510741651	15.12063316	0.115737553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0991	0	NO	15.1488	19.2542	0.368197495	3.045093108	0	1.803078408	4.0685022	1.138293978	3.579658163	15.76718098	1.11812106	3.239441317	0	0.035665106	2.47463774	11.86879738	22.99175652	0.36078953	1.157936456	7.080656899	6.510741651	15.12063316	0.115737553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0991	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	0.7465	0.0148	0.1558	0	0.0625	0.1411	0.0366	0.1594	0.5933	0.0459	0.1346	0	0.0014	0.1566	0.4585	0.9013	0.014	0.0449	0.2651	0.2351	0.5496	0.0053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7221	0	NO	0.2216	20.0007	0.382949004	3.200916097	0	1.865607015	4.209593001	1.174930923	3.739030199	16.36049244	1.164004455	3.373996702	0	0.037061436	2.631234591	12.32726572	23.89301868	0.374751966	1.202796989	7.345746993	6.745864931	15.67023471	0.121028972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8212
H0104_804_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	238.3439443	4.557842937	19.84695265	43.40659526	9.056397714	20.43503703	5.717357016	17.97969953	79.19448273	5.616033649	16.27087808	0	0.179136629	12.429467	59.61390754	115.481662	1.812152739	5.816016111	35.56431306	32.70177578	75.94703981	0.581319874	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	NO	0.090888799	0.090888799	0.172621798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.080783279	0.080783279	0.153428749	0	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0.199094437	0	0	0	0	0	0	0	0											3300	19.2542	0.368197495	3.045093108	0	1.803078408	4.0685022	1.138293978	3.579658163	15.76718098	1.11812106	3.239441317	0	0.035665106	2.47463774	11.86879738	22.99175652	0.36078953	1.157936456	7.080656899	6.510741651	15.12063316	0.115737553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0991	0	NO	15.1488	19.2542	0.368197495	3.045093108	0	1.803078408	4.0685022	1.138293978	3.579658163	15.76718098	1.11812106	3.239441317	0	0.035665106	2.47463774	11.86879738	22.99175652	0.36078953	1.157936456	7.080656899	6.510741651	15.12063316	0.115737553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0991	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	0.7465	0.0148	0.1558	0	0.0625	0.1411	0.0366	0.1594	0.5933	0.0459	0.1346	0	0.0014	0.1566	0.4585	0.9013	0.014	0.0449	0.2651	0.2351	0.5496	0.0053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7221	0	NO	0.2216	20.0007	0.382949004	3.200916097	0	1.865607015	4.209593001	1.174930923	3.739030199	16.36049244	1.164004455	3.373996702	0	0.037061436	2.631234591	12.32726572	23.89301868	0.374751966	1.202796989	7.345746993	6.745864931	15.67023471	0.121028972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8212
H0108_004_0	2012	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			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	1421.61	44.68	451.36	1946.82	275.02	11.84	4.09	342.34	292.23	509.53	981.74	85.77	1.03	3.46	3617.93	3327.41	70.86	515.86		1478.71	22.63	0			0.6				3.34	0.95	861.25	0.06	279.41								3400	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$200/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$200/Visit: 8b, 9a. $200 DMAM -- OP,8b. $200 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $200 Radiology OP -- Facility"	"$200/Visit: 5. $200 Partial Hospitalization,7h. $200 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$30/Visit: 7b. $5 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $200 Nuclear Medicine,9a, 9c, 9d, 14d. $200 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"										141.569359	116.360647	37.847069	0	100	0.2	0.2	65	151.439823	0	139.131334	200	0.2	0.2	5	29.269787	30	30		0	0.2	0			0				0	0	0	0	169.999423								NO	112.530086	92.492285	31.692719	0	87.6721	0.175344	0.175344	56.986865	132.770473	0	121.979362	175.3442	0.175344	0.175344	4.383605	25.661437	26.30163	26.30163		0	0.175344	0			0				0	0	0	0	149.042064									13.3312	0.344379608	1.192068804	0	2.009298412	2.07607296	0.71715696	1.62574028	3.233292944	0	9.979334904	1.25327267	0.18060432	0.60669024	1.321631336	7.115510174	0.155311125	1.130663238	0	0	3.96803472	0	0	0	0	0	0	0	0	0	0	0	3.470320259	0	0	0	0	0	0	0	53.7105	0	NO	9.222317	13.3312	0.344379608	1.192068804	0	2.009298412	2.07607296	0.71715696	1.62574028	3.233292944	0	9.979334904	1.25327267	0.18060432	0.60669024	1.321631336	7.115510174	0.155311125	1.130663238	0	0	3.96803472	0	0	0	0	0	0	0	0	0	0	0	3.470320259	0	0	0	0	0	0	0	53.7105	NO																																																																																		0	0	NO	0	13.3312	0.344379608	1.192068804	0	2.009298412	2.07607296	0.71715696	1.62574028	3.233292944	0	9.979334904	1.25327267	0.18060432	0.60669024	1.321631336	7.115510174	0.155311125	1.130663238	0	0	3.96803472	0	0	0	0	0	0	0	0	0	0	0	3.470320259	0	0	0	0	0	0	0	53.7105
H0108_005_0	2012	6	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		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	1305.45	55.92	462.02	2179.72	233.57	13.82	5.89	328.5	273.54	647.94	1045.97	123.61	2.43	4.83	4404.62	3824.87	86.83	627.52		1605.99	26.83	0		2.61	2.86				3.34	0.95	339.74										3400	"$0-$100/Day(Days 1-5): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-5): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $100 Radiology OP -- Facility"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$5/Visit: 7b. $0 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												62.919715	51.715843	23.252638	0	100	0.2	0.142405	65	78.078482	0	55.710355	100	0.199929	0.2	0	4.804324	5	7.470337		0	0.2	0		0	0				0	0	84.3587										NO	58.424164	48.020798	22.303047	0	95.0478	0.190096	0.135353	61.78107	74.211879	0	52.951467	95.0478	0.190028	0.190096	0	4.566405	4.75239	7.100391		0	0.190096	0		0	0				0	0	80.181088											6.3558	0.223776919	0.858704481	0	1.850026221	2.62712672	0.79722917	1.691256791	1.691659782	0	4.615470495	0.979071547	0.46176804	0.91816368	0	1.455492124	0.034387502	0.371303113	0	0	5.10027568	0	0	0	0	0	0	0	0	0	2.270060236	0	0	0	0	0	0	0	0	0	32.3016	0	NO	1.838411	6.3558	0.223776919	0.858704481	0	1.850026221	2.62712672	0.79722917	1.691256791	1.691659782	0	4.615470495	0.979071547	0.46176804	0.91816368	0	1.455492124	0.034387502	0.371303113	0	0	5.10027568	0	0	0	0	0	0	0	0	0	2.270060236	0	0	0	0	0	0	0	0	0	32.3016	NO																																																																																		0	0	NO	0	6.3558	0.223776919	0.858704481	0	1.850026221	2.62712672	0.79722917	1.691256791	1.691659782	0	4.615470495	0.979071547	0.46176804	0.91816368	0	1.455492124	0.034387502	0.371303113	0	0	5.10027568	0	0	0	0	0	0	0	0	0	2.270060236	0	0	0	0	0	0	0	0	0	32.3016
H0108_006_0	2012	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	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	1348.05	54.08	469.94	2008.95	147.8	11.33	3.22	344.09	269.46	564.19	1175.09	87.78	0.5	3.95	4016.15	4195.29	82.99	654.29		1800.17	27.26	0		2.61	2.86				3.34	0.95	620.74	0.09	321.14								3400	"$0-$100/Day(Days 1-5): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-5): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$5/Visit: 7b. $0 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										62.919715	51.715843	23.252638	0	100	0.2	0.2	65	77.300734	0	14.990665	100	0.2	0.2	0	4.881621	5	7.045334		0	0.2	0		0	0				0	0	0	0	77.092432								NO	58.138257	47.785801	22.276376	0	95.8017	0.191603	0.191603	62.271105	74.055417	0	14.361312	95.8017	0.191603	0.191603	0	4.676676	4.790085	6.74955		0	0.191603	0		0	0				0	0	0	0	73.85586									6.5311	0.215354677	0.872380011	0	1.179957605	2.17086199	0.61696166	1.785572043	1.662914389	0	1.40631951	0.700789436	0.0958015	0.75683185	0	1.635001005	0.03312743	0.368013589	0	0	5.22309778	0	0	0	0	0	0	0	0	0	0	0	1.976505907	0	0	0	0	0	0	0	27.2306	0	NO	1.452507	6.5311	0.215354677	0.872380011	0	1.179957605	2.17086199	0.61696166	1.785572043	1.662914389	0	1.40631951	0.700789436	0.0958015	0.75683185	0	1.635001005	0.03312743	0.368013589	0	0	5.22309778	0	0	0	0	0	0	0	0	0	0	0	1.976505907	0	0	0	0	0	0	0	27.2306	YES	$0-$225/Day(Days 1-5)	$0-$225/Day(Days 1-5)	"$0/Day(Days 1-20), $120 (Days 21-100)"	$0/Visit	$100/Trip	20% Coins	20% Coins	$65/Visit	25% Coins	25% Coins	20%-25% Coins; $20-$35/Visit	25% Coins; $100/Visit	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	$35/Visit		$20/Visit	20%-25% Coins	$0/Service		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"							$0/Proc	25% Coins; $35/Visit								3400	0.6785	0.0224	0.065	0	0.6125	0.4244	0.1207	0.0679	0.4235	0.0628	0.1668	0.0332	0.0037	0.029	0.2878	0.3006	0.0059	0.0515		0.0737	0.1476	0		0	0				0			0	0.1077								3.6851	0	NO	0.927218	7.2096	0.237728677	0.937333011	0	1.792472605	2.59522899	0.73767366	1.853439043	2.086409389	0.062849	1.57309151	0.733954436	0.0994735	0.78587285	0.287754	1.935591005	0.03907343	0.419516589	0	0.073704	5.37068378	0	0	0	0	0	0	0	0	0	0	0	2.084240907	0	0	0	0	0	0	0	30.9157
H0108_008_0	2012	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	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	1433.77	57.52	499.82	2379.08	238.23	13.58	3.86	360.82	282.56	591.61	1229.76	93.21	0.51	4.03	4153.23	4338.49	85.82	678.56		1861.62	27.44	0		2.61	2.86				3.34	0.95	734.14	0.1	336.75								3400	"$0-$150/Day(Days 1-8): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-8): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0% Coins: 11b. 0% Supplies,11b. 0% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										114.607281	102.868367	23.252638	0	100	0	0	65	77.300734	0	69.930048	100	0.2	0.2	10	24.644863	25	25		0	0.2	0		0	0				0	0	0	0	83.084732								NO	96.484088	86.601483	20.843757	0	90.5013	0	0	58.825845	69.958169	0	63.287602	90.5013	0.181003	0.181003	9.05013	22.303921	22.625325	22.625325		0	0.181003	0		0	0				0	0	0	0	75.192763									11.528	0.415109775	0.868177219	0	1.796677058	0	0	1.768795116	1.647281686	0	6.485713453	0.702968848	0.09231153	0.72944209	3.132272618	8.063778185	0.161808783	1.279386711	0	0	4.96672232	0	0	0	0	0	0	0	0	0	0	0	2.110096912	0	0	0	0	0	0	0	45.7485	0	NO	5.80071	11.528	0.415109775	0.868177219	0	1.796677058	0	0	1.768795116	1.647281686	0	6.485713453	0.702968848	0.09231153	0.72944209	3.132272618	8.063778185	0.161808783	1.279386711	0	0	4.96672232	0	0	0	0	0	0	0	0	0	0	0	2.110096912	0	0	0	0	0	0	0	45.7485	NO																																																																																		0	0	NO	0	11.528	0.415109775	0.868177219	0	1.796677058	0	0	1.768795116	1.647281686	0	6.485713453	0.702968848	0.09231153	0.72944209	3.132272618	8.063778185	0.161808783	1.279386711	0	0	4.96672232	0	0	0	0	0	0	0	0	0	0	0	2.110096912	0	0	0	0	0	0	0	45.7485
H0108_009_0	2012	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	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	1431.46	57.43	499.01	2133.25	156.94	11.7	3.33	365.38	286.13	599.09	1247.79	93.21	0.52	4.08	4264.63	4454.86	88.13	694.77		1911.55	28.14	0		2.61	2.86				3.34	0.95	659.15	0.1	341.01								5000	"$0-$150/Day(Days 1-8): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-8): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0% Coins: 11b. 0% Supplies,11b. 0% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										114.607281	102.868367	23.252638	0	100	0	0	65	100	0	69.840619	100	0.2	0.2	10	24.644863	25	25		0	0.2	0		0	0				0	0	0	0	83.084732								NO	101.954752	91.511802	21.854805	0	93.7097	0	0	60.911305	93.7097	0	65.447435	93.7097	0.187419	0.187419	9.37097	23.094627	23.427425	23.427425		0	0.187419	0		0	0				0	0	0	0	77.858453									12.162	0.437960232	0.908813854	0	1.225566693	0	0	1.854647718	2.234429705	0	6.80538791	0.727890095	0.09745788	0.76466952	3.330309983	8.573610836	0.172054914	1.356389339	0	0	5.27397066	0	0	0	0	0	0	0	0	0	0	0	2.212542588	0	0	0	0	0	0	0	48.1377	0	NO	3.946177	12.162	0.437960232	0.908813854	0	1.225566693	0	0	1.854647718	2.234429705	0	6.80538791	0.727890095	0.09745788	0.76466952	3.330309983	8.573610836	0.172054914	1.356389339	0	0	5.27397066	0	0	0	0	0	0	0	0	0	0	0	2.212542588	0	0	0	0	0	0	0	48.1377	YES	$0-$225/Day(Days 1-8)	$0-$225/Day(Days 1-8)	"$0/Day(Days 1-20), $128 (Days 21-100)"	$0/Visit	$100/Trip	40% Coins	40% Coins	$65/Visit	25% Coins	20%-25% Coins	20%-25% Coins; $35/Visit	20%-25% Coins	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins; $35/Visit		$35/Visit	20% Coins	0% Coins		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"							20% Coins	20%-25% Coins								5000	0.94	0.0338	0.0806	0	0.6789	0.9146	0.2602	0.0752	0.4564	0.0666	0.181	0.0076	0.004	0.0313	0.1367	0.3287	0.0066	0.0533		0.143	0.1515	0		0	0				0			0	0.1104								4.6603	0	NO	0.900192	13.102	0.471809232	0.989452854	0	1.904474693	0.914632	0.260168	1.929871718	2.690806705	0.066633	6.98643291	0.735475095	0.10141388	0.79596552	3.467000983	8.902275836	0.178645914	1.409692339	0	0.142962	5.42542066	0	0	0	0	0	0	0	0	0	0	0.000011	2.322906588	0	0	0	0	0	0	0	52.7981
H0108_010_0	2012	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	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	1532.71	61.49	534.31	2284.13	168.04	11.37	3.23	391.23	306.37	641.47	1336.04	99.8	0.5	3.96	4566.26	4769.95	94.36	743.91		2046.76	27.35	0			0.61				3.34	0.95	705.77	0.11	365.13								3400	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$200/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$200/Visit: 8b, 9a. $200 DMAM -- OP,8b. $200 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $200 Radiology OP -- Facility"	"$200/Visit: 5. $200 Partial Hospitalization,7h. $200 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$30/Visit: 7b. $5 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $200 Nuclear Medicine,9a, 9c, 9d, 14d. $200 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"										141.569359	116.360647	37.847069	0	100	0.2	0.2	65	154.601468	0	136.79806	200	0.2	0.2	5	29.408104	30	30		0	0.2	0			0				0	0	0	0	161.658727								NO	101.257767	83.227185	28.12287	0	82.2788	0.164558	0.164558	53.48122	127.204232	0	112.555802	164.5576	0.164558	0.164558	4.11394	24.196635	24.68364	24.68364		0	0.164558	0			0				0	0	0	0	133.010861									12.9332	0.426469967	1.252194222	0	1.152177463	1.87102446	0.53152234	1.743621475	3.247630046	0	12.53158781	1.368570707	0.082279	0.65164968	1.565443305	9.618061593	0.194095689	1.530200553	0	0	4.5006613	0	0	0	0	0	0	0	0	0	0	0	4.047187973	0	0	0	0	0	0	0	59.2476	0	NO	15.36539	12.9332	0.426469967	1.252194222	0	1.152177463	1.87102446	0.53152234	1.743621475	3.247630046	0	12.53158781	1.368570707	0.082279	0.65164968	1.565443305	9.618061593	0.194095689	1.530200553	0	0	4.5006613	0	0	0	0	0	0	0	0	0	0	0	4.047187973	0	0	0	0	0	0	0	59.2476	YES	$0-$225/Day(Days 1-5)	$0-$225/Day(Days 1-5)	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100)"	$0/Visit	$100/Trip	35% Coins	35% Coins	$65/Visit	30% Coins; $0-$300/Visit	20%-25% Coins	20%-30% Coins; $0-$40/Visit	25% Coins	20% Coins	20% Coins	$35/Visit	$40/Visit	$40/Visit	$40/Visit		$0/Visit	20%-25% Coins	$0/Service			"VIS775: Vision 17a,17b"						35% Coins	20% Coins	25% Coins; $40/Visit								3400	0.7178	0.0237	0.0688	0	0.6698	0.7167	0.2039	0.0742	0.328	0.0597	0.1551	0.0081	0.0035	0.028	0.3147	0.3757	0.0074	0.0644		0	0.1424	0			0				0		0.0571	0	0.1062								4.1252	0	NO	1.275668	13.651	0.450137967	1.320976222	0	1.822008463	2.58774246	0.73539334	1.817839475	3.575626046	0.059673	12.68668681	1.376701707	0.085823	0.67967668	1.880124305	9.993738593	0.201527689	1.594569553	0	0	4.6430953	0	0	0	0	0	0	0	0	0	0.057095	0.00001	4.153351973	0	0	0	0	0	0	0	63.3728
H0108_011_0	2012	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	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	1500.34	60.19	523.03	2489.55	249.29	16.49	4.69	377.57	295.68	619.08	1286.86	97.54	0.62	4.89	4346.08	4539.94	89.81	710.06		1948.06	33.32	0		2.54	2.86				3.34	0.95	768.23	0.1	352.38								3400	"$0-$50/Day(Days 1-10): 1a. $50 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$50/Day(Days 1-10): 1b. $50 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$10/Visit: 7e, 7h. $10 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										40.848439	37.853597	23.252638	0	125	0.2	0.2	65	13.650367	0	67.793267	100	0.2	0.2	0	9.763242	10	13.102071		0	0.2	0		0	0				0	0	0	0	83.084732								NO	38.157834	35.360257	22.270981	0	116.9985	0.187198	0.187198	60.83922	12.77658	0	63.453684	93.5988	0.187198	0.187198	0	9.138277	9.35988	12.263382		0	0.187198	0		0	0				0	0	0	0	77.766313									4.7708	0.177361156	0.970699266	0	2.430546339	3.08689502	0.87795862	1.914255358	0.314814931	0	6.804667316	0.760802246	0.11606276	0.91539822	0	3.457269107	0.070050902	0.725644752	0	0	6.23743736	0	0	0	0	0	0	0	0	0	0	0	2.283607781	0	0	0	0	0	0	0	35.9143	0	NO	2.443101	4.7708	0.177361156	0.970699266	0	2.430546339	3.08689502	0.87795862	1.914255358	0.314814931	0	6.804667316	0.760802246	0.11606276	0.91539822	0	3.457269107	0.070050902	0.725644752	0	0	6.23743736	0	0	0	0	0	0	0	0	0	0	0	2.283607781	0	0	0	0	0	0	0	35.9143	NO																																																																																		0	0	NO	0	4.7708	0.177361156	0.970699266	0	2.430546339	3.08689502	0.87795862	1.914255358	0.314814931	0	6.804667316	0.760802246	0.11606276	0.91539822	0	3.457269107	0.070050902	0.725644752	0	0	6.23743736	0	0	0	0	0	0	0	0	0	0	0	2.283607781	0	0	0	0	0	0	0	35.9143
H0108_012_0	2012	6	r.	s.									OP Facility - Other	OP Facility - Other									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	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	1513.8	60.73	527.72	2255.95	165.97	14.35	5.23	386.4	302.59	633.55	1319.56	98.57	0.63	5	4509.93	4711.1	93.19	734.73		2021.5	34.53	0		2.54	2.86				3.34	0.95	0.1	360.62									5000	"$0-$50/Day(Days 1-10): 1a. $50 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$50/Day(Days 1-10): 1b. $50 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$100/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$10/Visit: 7e, 7h. $10 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											40.848439	37.853598	23.252638	0	125	0.2	0.156243	65	54.601468	0	67.678235	100	0.2	0.2	0	9.763242	10	13.068001		0	0.2	0		0	0				0	0	0	83.084733									NO	39.303061	36.42152	22.805676	0	120.154125	0.192247	0.150186	62.480145	52.484732	0	65.054553	96.1233	0.192247	0.192247	0	9.38475	9.61233	12.561394		0	0.192247	0		0	0				0	0	0	79.863787										4.9581	0.184323242	1.002917612	0	1.661831677	2.75874445	0.78547278	2.011860669	1.323446255	0	7.153615496	0.789572807	0.12111561	0.961235	0	3.684374644	0.074647753	0.769102751	0	0	6.63828891	0	0	0	0	0	0	0	0	0	0	2.400039906	0	0	0	0	0	0	0	0	37.2787	0	NO	1.477497	4.9581	0.184323242	1.002917612	0	1.661831677	2.75874445	0.78547278	2.011860669	1.323446255	0	7.153615496	0.789572807	0.12111561	0.961235	0	3.684374644	0.074647753	0.769102751	0	0	6.63828891	0	0	0	0	0	0	0	0	0	0	2.400039906	0	0	0	0	0	0	0	0	37.2787	YES	$0-$225/Day(Days 1-10)	$0-$225/Day(Days 1-10)	"$50/Day(Days 1-20), $120 (Days 21-100)"	$0/Visit	$125/Trip	20% Coins	20% Coins	$65/Visit	25% Coins; $0-$200/Visit	20%-25% Coins	20%-25% Coins; $0-$35/Visit	20%-25% Coins	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins; $35/Visit		$0/Visit	20% Coins	$0/Service		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						20% Coins	20%-25% Coins									5000	1.04	0.0387	0.1425	0	0.9042	0.5653	0.2058	0.0801	0.229	0.0824	0.2019	0.0094	0.0049	0.0387	0.1456	0.3502	0.007	0.0588		0	0.1872	0		0	0				0		0	0.1364									4.4282	0	NO	0.894778	5.9981	0.222987242	1.145417612	0	2.565985677	3.32406745	0.99131378	2.092005669	1.552411255	0.082369	7.355564496	0.798948807	0.12600661	0.999922	0.145633	4.034540644	0.081669753	0.827937751	0	0	6.82550691	0	0	0	0	0	0	0	0	0	0.000013	2.536468906	0	0	0	0	0	0	0	0	41.7068
H0108_013_0	2012	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	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	1321.11	53	460.54	2192.13	219.51	13.95	3.97	332.47	260.36	545.13	1133.12	85.89	0.52	4.14	3826.88	3997.58	79.08	625.24		1715.34	28.19	0		2.54	2.86				3.34	0.49	676.45	0.09	310.29								3400	"$0-$50/Day(Days 1-10): 1a. $50 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$50/Day(Days 1-10): 1b. $50 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$10/Visit: 7e, 7h. $10 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										40.848439	37.853598	23.252638	0	125	0.2	0.2	65	13.650367	0	67.793267	100	0.2	0.2	0	9.763242	10	13.102071		0	0.2	0		0	0				0	0	0	0	83.084733								NO	38.782856	35.939455	22.560872	0	118.761375	0.190018	0.190018	61.755915	12.969091	0	64.409773	95.0091	0.190018	0.190018	0	9.275968	9.50091	12.44816		0	0.190018	0		0	0				0	0	0	0	78.938057									4.2697	0.158732593	0.865848666	0	2.172442452	2.6507511	0.75437146	1.710999088	0.281386044	0	6.082000165	0.680027633	0.09880936	0.78667452	0	3.09011868	0.062610997	0.64859063	0	0	5.35660742	0	0	0	0	0	0	0	0	0	0	0	2.041140809	0	0	0	0	0	0	0	31.7108	0	NO	1.650088	4.2697	0.158732593	0.865848666	0	2.172442452	2.6507511	0.75437146	1.710999088	0.281386044	0	6.082000165	0.680027633	0.09880936	0.78667452	0	3.09011868	0.062610997	0.64859063	0	0	5.35660742	0	0	0	0	0	0	0	0	0	0	0	2.041140809	0	0	0	0	0	0	0	31.7108	NO																																																																																		0	0	NO	0	4.2697	0.158732593	0.865848666	0	2.172442452	2.6507511	0.75437146	1.710999088	0.281386044	0	6.082000165	0.680027633	0.09880936	0.78667452	0	3.09011868	0.062610997	0.64859063	0	0	5.35660742	0	0	0	0	0	0	0	0	0	0	0	2.041140809	0	0	0	0	0	0	0	31.7108
H0108_014_0	2012	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	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	1347.29	54.05	469.67	2007.82	147.71	12.27	3.49	343.9	269.31	563.87	1174.42	87.73	0.54	4.28	4013.88	4192.92	82.94	653.92		1799.16	29.53	0		2.54	2.86				3.34	0.95	620.39	0.09	320.96								5000	"$0-$50/Day(Days 1-10): 1a. $50 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$50/Day(Days 1-10): 1b. $50 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$100/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$10/Visit: 7e, 7h. $10 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$25-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"										40.848439	37.853598	23.252638	0	125	0.2	0.2	65	54.601468	0	67.678235	100	0.2	0.2	0	9.763242	10	13.068001		0	0.2	0		0	0				0	0	0	0	83.084733								NO	39.703049	36.792183	22.947261	0	121.263875	0.194022	0.194022	63.057215	52.969484	0	65.6554	97.0111	0.194022	0.194022	0	9.471428	9.70111	12.677412		0	0.194022	0		0	0				0	0	0	0	80.601413									4.4576	0.165718124	0.898136673	0	1.492657248	2.38064994	0.67713678	1.807114687	1.188767645	0	6.425584572	0.709231984	0.10477188	0.83041416	0	3.309411657	0.067050839	0.690834438	0	0	5.72946966	0	0	0	0	0	0	0	0	0	0	0	2.155819126	0	0	0	0	0	0	0	33.0904	0	NO	0.994711	4.4576	0.165718124	0.898136673	0	1.492657248	2.38064994	0.67713678	1.807114687	1.188767645	0	6.425584572	0.709231984	0.10477188	0.83041416	0	3.309411657	0.067050839	0.690834438	0	0	5.72946966	0	0	0	0	0	0	0	0	0	0	0	2.155819126	0	0	0	0	0	0	0	33.0904	YES	$0-$225/Day(Days 1-10)	$0-$225/Day(Days 1-10)	"$50/Day(Days 1-20), $120 (Days 21-100)"	$0/Visit	$125/Trip	20% Coins	20% Coins	$65/Visit	25% Coins; $125-$200/Visit	20%-25% Coins	20%-25% Coins; $0-$35/Visit	20%-25% Coins	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins; $35/Visit		$0/Visit	20% Coins	$0/Service		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						20% Coins	20% Coins	20%-25% Coins								5000	0.9665	0.0359	0.1345	0	0.8231	0.4944	0.1406	0.073	0.2455	0.072	0.1771	0.0082	0.0043	0.0338	0.1326	0.3188	0.0064	0.053		0	0.1637	0		0	0				0		0.0394	0	0.1193								4.0423	0	NO	0.679202	5.4241	0.201650124	1.032678673	0	2.315734248	2.87509394	0.81778178	1.880072687	1.434251645	0.072042	6.602725572	0.717431984	0.10904988	0.86425116	0.132574	3.628177657	0.073442839	0.743865438	0	0	5.89321466	0	0	0	0	0	0	0	0	0	0.039388	0.000012	2.275143126	0	0	0	0	0	0	0	37.1327
H0108_801_0	2012	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	YES	267.95	3.11	47.83	26.63	9.15	14.81	4.5	25.82	68.62	9.25	31.85	0.71	0.51	20.06	40.77	102.28	0.7	8.07		16.58	35.37	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																					0.062	0.062	0.1545	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.05312	0.05312	0.121807	0	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206		0.199206	0.199206	0																				14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	0	NO	13.616527	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	NO																																																																																		0	0	NO	0	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258
H0108_802_0	2012	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	267.95	3.11	47.83	26.63	9.15	14.81	4.5	25.82	68.62	9.25	31.85	0.71	0.51	20.06	40.77	102.28	0.7	8.07		16.58	35.37	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																					0.062	0.062	0.1545	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.05312	0.05312	0.121807	0	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206		0.199206	0.199206	0																				14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	0	NO	13.616527	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	NO																																																																																		0	0	NO	0	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258
H0108_803_0	2012	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	267.95	3.11	47.83	26.63	9.15	14.81	4.5	25.82	68.62	9.25	31.85	0.71	0.51	20.06	40.77	102.28	0.7	8.07		16.58	35.37	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																					0.062	0.062	0.1545	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.05312	0.05312	0.121807	0	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206	0.199206		0.199206	0.199206	0																				14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	0	NO	13.616527	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258	NO																																																																																		0	0	NO	0	14.2335	0.1652032	5.82602881	0	1.8227349	2.95024086	0.896427	5.14349892	13.66951572	1.8426555	6.3447111	0.14143626	0.10159506	3.99607236	8.12162862	20.37478968	0.1394442	1.60759242	0	3.30283548	7.04591622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7258
H0117_005_0	2012	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	1733.002875	110.181145	1011.610056	165.6303036	626.9176909	9.11616491	9.381199238	661.3256794	339.966019	5888.646537	1642.954079	3.212571085	0.000163694	1784.686866	7968.84006	14366.4843	54.47463385	267.5434287	3279.368358	4660.486743	19.08174013	0	0	414	338.4	203.04	18	13.71428571	4994.33689	2039.518501											3600	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $150.00 , (5) $200.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	164.0176742	87.50689108	66.36102072	0	39.26362735	0.192102467	0.06018817	63.07356163	104.4859032	0.149382415	16.91309435	62.20186434	0.2	15.72715579	2.703641631	7.305367056	7.002795626	11.77822304	4.114318674	2.907099549	0.2	0	0	0	0	0	0	0	0	0											NO	154.0186456	82.17219825	62.31544605	0	36.86999425	0.180391302	0.056518912	59.22840071	98.1161169	0.140275597	15.8820194	58.40984481	0.187807377	14.76837935	2.53881921	6.860009109	6.575883377	11.06018585	3.863496983	2.729873699	0.187807377	0	0	0	0	0	0	0	0	0												22.2429	0.754485574	5.253244322	0	1.926204305	1.644476854	0.53021517	3.264105195	2.779678805	0.068836117	2.17445238	0.015637148	3.07E-05	2.196411054	1.685953685	8.212851099	0.02985157	0.246590004	1.055819147	1.060211682	3.583691554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7256	0	NO	3.812521414	22.2429	0.754485574	5.253244322	0	1.926204305	1.644476854	0.53021517	3.264105195	2.779678805	0.068836117	2.17445238	0.015637148	3.07E-05	2.196411054	1.685953685	8.212851099	0.02985157	0.246590004	1.055819147	1.060211682	3.583691554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7256	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	NO	0	22.2429	0.754485574	5.253244322	0	1.926204305	1.644476854	0.53021517	3.264105195	2.779678805	0.068836117	2.17445238	0.015637148	3.07E-05	2.196411054	1.685953685	8.212851099	0.02985157	0.246590004	1.055819147	1.060211682	3.583691554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7256
H0117_007_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1976.295944	410.7547753	1158.200393	526.9422499	22.19542263	18.17240668	13.86327235	55.78986827	34.25941039	8.031982403	23.36466066	0.554260822	0.133959949	32.55576379	9036.113232	115.6301591	4.592268388	2.158858648	17.17931373	23.77588095	14.01384014	0	1240	678.6	338.4	203.04	18	13.71428571	504	4393.908363											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	168.1869772	62.52548477	46.29919211	0	0.192480018	0.197808753	0.2	0.195278194	0.159476426	0.027144442	0.18339897	0.2	0.2	0.180233393	0	0.09102366	0.198239856	0.182635199	0.142536208	0.091060471	0.2	0	0	0	0	0	0	0	0	0											NO	162.1817146	60.29295786	44.64603912	0	0.185607351	0.190745819	0.192858826	0.188305616	0.153782181	0.026175226	0.17685055	0.192858826	0.192858826	0.173798003	0	0.087773581	0.191161529	0.17611405	0.137446829	0.087809078	0.192858826	0	0	0	0	0	0	0	0	0												26.7099	2.063801696	4.309088339	0	4.119633601	3.466310602	2.673654426	10.50554551	5.268486861	0.210238956	4.132053093	0.106894091	0.025835358	5.658126727	0	10.14927317	0.877865049	0.380205339	2.361242189	2.08773818	2.702692753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8086	0	NO	3.251376076	26.7099	2.063801696	4.309088339	0	4.119633601	3.466310602	2.673654426	10.50554551	5.268486861	0.210238956	4.132053093	0.106894091	0.025835358	5.658126727	0	10.14927317	0.877865049	0.380205339	2.361242189	2.08773818	2.702692753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8086	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	NO	0	26.7099	2.063801696	4.309088339	0	4.119633601	3.466310602	2.673654426	10.50554551	5.268486861	0.210238956	4.132053093	0.106894091	0.025835358	5.658126727	0	10.14927317	0.877865049	0.380205339	2.361242189	2.08773818	2.702692753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8086
H0141_001_0	2012	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	320.357088	2.150419738	50.02164877	0	13.8199121	17.15770404	10.42902927	40.57840345	60.63373359	14.17287931	24.51433759	5.45E-19	0.329705877	33.10613336	8.652769013	57.04957817	8.107852137	7.459139567	26.44822201	73.87008454	37.58157309	7.414055751	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost-Sharing; PBP 13a-e											0	NO	0.075231824	0.075231824	0.176785774	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075231824	0.075231824	0.176785774	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												24.101	0.161779999	8.8431159	0	3.09566031	3.843325705	2.336102555	9.089562372	13.58195632	3.174724964	5.49121162	1.22E-19	0.073854117	7.415773872	1.938220259	12.77910551	1.816158879	1.670847263	5.924401731	16.54689894	8.418272372	1.660748488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9628	0	NO	0	24.101	0.161779999	8.8431159	0	3.09566031	3.843325705	2.336102555	9.089562372	13.58195632	3.174724964	5.49121162	1.22E-19	0.073854117	7.415773872	1.938220259	12.77910551	1.816158879	1.670847263	5.924401731	16.54689894	8.418272372	1.660748488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9628	NO																																										0	0	0	0	0	0	0	0	0	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	24.101	0.161779999	8.8431159	0	3.09566031	3.843325705	2.336102555	9.089562372	13.58195632	3.174724964	5.49121162	1.22E-19	0.073854117	7.415773872	1.938220259	12.77910551	1.816158879	1.670847263	5.924401731	16.54689894	8.418272372	1.660748488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9628
H0150_001_0	2012	5																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN																																																												0	YES	1078.642083	55.66084633	113.1835294	279.0545261	259.5741365	19.56222104		430.6234646	484.4616721		899.5501425	3.781003888	0.578590454	495.3115094	5632.956032	7141.576584	179.6798804	337.4956949	1158.13793		23.9484168																				3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $75 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $100 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $35 per Urgent Care visit	9a/b. $200 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"	"5, 9c. $35 per visit"	12. 20% coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $35 per visit; $20 per chiro visit"	"7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script																						195	195	75	20	100	0.2		62.10822676	200		66.3254951	35	0.2	24.42873325	10	34.96	35	20	42.45432111		0.2																				NO	175.7423776	175.7423776	67.59322215	18.02485924	90.12429619	0.180248592		55.97460225	180.2485924		59.77538565	31.54350367	0.180248592	22.01622391	9.012429619	31.50745395	31.54350367	18.02485924	38.2616581		0.180248592																					15.7969	0.815164123	0.637536621	0.419159879	1.949494697	3.526062806	0	2.008664762	7.276961206	0	4.480913057	0.009938843	0.104290115	0.908740758	4.230551649	18.75107461	0.472311081	0.5069427	3.692689793	0	4.316668418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9041			7.66	15.7969	0.815164123	0.637536621	0.419159879	1.949494697	3.526062806	0	2.008664762	7.276961206	0	4.480913057	0.009938843	0.104290115	0.908740758	4.230551649	18.75107461	0.472311081	0.5069427	3.692689793	0	4.316668418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9041	NO																																																																																		0				15.7969	0.815164123	0.637536621	0.419159879	1.949494697	3.526062806	0	2.008664762	7.276961206	0	4.480913057	0.009938843	0.104290115	0.908740758	4.230551649	18.75107461	0.472311081	0.5069427	3.692689793	0	4.316668418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9041
H0150_007_0	2012	5																															D	D	D		COIN	COIN		V	V		COIN	V	COIN	COIN				V	COIN		COIN																																																												0	YES	1574.761433	76.71494878	218.6167483		15.87545594	33.67868804		699.7158613	526.8616211		32.24618251	7.824677541	2.030728893	9.972744671				443.5247302	36.82711972		15.3865474																				6700	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $45 per day days 6-35		10a. 20% coinsurance	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $35 per Urgent Care visit	9a/b. $50 per visit		8a/b. 20% coinsurance	"5, 9c. $5 per visit"	12. 20% coinsurance	3. 20% coinsurance; 9a. $65 per Observation Stay				7c/i. $15 per PT/OT/ST visit	8a/b. 20% coinsurance		15. 20% coinsurance per script																						195	195	45		0.2	0.2		59.06302948	50		0.2	5	0.2	0.2				15	0.2		0.2																				NO	191.7529206	191.7529206	44.25067398		0.196669662	0.196669662		58.07953026	49.16741553		0.196669662	4.916741553	0.196669662	0.196669662				14.75022466	0.196669662		0.196669662																					25.1638	1.225859623	0.806161538	0	3.122220557	6.623576198	0	3.386597379	2.158702021	0	6.341845819	0.003205993	0.399382765	1.961336325	0	0	0	0.545174118	7.242777194	0	3.02606708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0067			1.05	25.1638	1.225859623	0.806161538	0	3.122220557	6.623576198	0	3.386597379	2.158702021	0	6.341845819	0.003205993	0.399382765	1.961336325	0	0	0	0.545174118	7.242777194	0	3.02606708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0067	NO																																																																																		0				25.1638	1.225859623	0.806161538	0	3.122220557	6.623576198	0	3.386597379	2.158702021	0	6.341845819	0.003205993	0.399382765	1.961336325	0	0	0	0.545174118	7.242777194	0	3.02606708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0067
H0150_012_0	2012	2																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN			COIN																																																									0	YES	976.9729752	60.33844063	124.9921707	248.0223017	209.6297054	13.94240615		415.3370553	520.6349073		947.9039057	5.61642729	0.656072413	435.609971	4709.894428	6594.948085	110.2617142	293.7051468	1923.220029		13.30381652			22.79																	3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $75 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $100 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $35 per Urgent Care Visit	9a/b. $200 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA,CT,PET, and NUC Scans"	"5, 9c. $35 per visit"	12. 20% coinsurance	3. $20 per PT/ST/OT visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $35 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA,CT,PET, and NUC Scans"		15. 20% coinsurance per script			20% conisurance for basic services; 50% coinsurance for major services																			195	195	75	20	100	0.2		63.10725552	200		62.42147144	35	0.2	14.34911279	10	34.88	35	20	40.05958582		0.2			0.21																	NO	177.6970077	177.6970077	68.34500298	18.22533413	91.12667064	0.182253341		57.50754089	182.2533413		56.88260869	31.89433472	0.182253341	13.07586875	9.112667064	31.78498272	31.89433472	18.22533413	36.50496683		0.182253341			0.21																		14.4671	0.893496696	0.711882523	0.376690777	1.59190476	2.541050107	0	1.990417724	7.907287621	0	4.493270579	0.014927684	0.119571389	0.474664901	3.576641652	17.46835924	0.293060335	0.44607287	5.850590279	0	2.424665013	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4276			6.43	14.4671	0.893496696	0.711882523	0.376690777	1.59190476	2.541050107	0	1.990417724	7.907287621	0	4.493270579	0.014927684	0.119571389	0.474664901	3.576641652	17.46835924	0.293060335	0.44607287	5.850590279	0	2.424665013	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4276	NO																																																																																		0				14.4671	0.893496696	0.711882523	0.376690777	1.59190476	2.541050107	0	1.990417724	7.907287621	0	4.493270579	0.014927684	0.119571389	0.474664901	3.576641652	17.46835924	0.293060335	0.44607287	5.850590279	0	2.424665013	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4276
H0150_023_0	2012	3																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN			COIN																																																									0	YES	976.6670674	48.94379662	98.05724205	248.1322794	228.9029522	17.97472697		399.0085387	468.899747		1258.04175	3.759579991	0.448837479	456.265093	5239.745123	6809.27732	165.9145793	344.4638126	3661.461116		20.72769534			22.79																	3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $65 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $90 per trip	11a/b/c. 20% coinsurance		4a/b. $65 ER per visit; $35 per Urgent Care visit	9a/b. $175 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"	"5, 9c. $35 per visit"	12. 20% coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $5 per visit"	"7b/d/f, 17a, 18a. $35 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA,CT,PET, and NUC Scans"		15. 20% coinsurance per script			20% coinsurance for basic services; 50% coinsurance for major services																			195	195	65	20	90	0.2		60.67611336	175		66.56019256	35	0.2	11.82530273	5	34.93	35	20	42.46162551		0.2			0.21																	NO	174.9282693	174.9282693	58.30942309	17.94136095	80.73612428	0.17941361		54.43060254	156.9869083		59.70902198	31.39738166	0.17941361	10.60810123	4.485340238	31.3345869	31.39738166	17.94136095	38.09096749		0.17941361			0.21																		14.2372	0.713471136	0.476471768	0.370985899	1.540061433	3.224910645	0	1.809856265	6.134260133	0	6.259703544	0.009836747	0.080527552	0.403342191	1.958503303	17.78049099	0.434106947	0.515012466	11.62238303	0	3.718830637	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0759			8.18	14.2372	0.713471136	0.476471768	0.370985899	1.540061433	3.224910645	0	1.809856265	6.134260133	0	6.259703544	0.009836747	0.080527552	0.403342191	1.958503303	17.78049099	0.434106947	0.515012466	11.62238303	0	3.718830637	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0759	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1		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																					0.6146		0.0626	0.0569	0.0191	0.0551			0.1765	0.1573					0.6511						0.064																				1.8571				14.8518	0.713471136	0.539108804	0.427873173	1.559136679	3.279979136	0	1.809856265	6.310767156	0.157254137	6.259703544	0.009836747	0.080527552	0.403342191	2.609623303	17.78049099	0.434106947	0.515012466	11.62238303	0	3.782782726	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.933
H0150_802_0	2012	3																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	257.3696818	6.122472125	48.62264569		14.65503036	22.89208447		16.66526017	66.10321764	20.26567877	30.65986878	0.11060872	0.165784231	8.631564206	108.5975613	146.3454597	1.251828781	2.294287587	43.75693725		66.16959945																				6700	1a. FFS	1b. FFS	2. FFS		10a. FFS	11a/b/c. FFS		4a/b. FFS	9a/b. FFS	8a. FFS	8a/b. FFS	"5, 9c. FFS"	12. FFS	"3, 9a. FFS"	"7a, 17a, 18a. FFS"	"7b/d/f, 17a, 18a. FFS"	"5, 7e/h/g, 9c. FFS"	7c/i. FFS	8a/b. FFS		15. FFS																						0.091	0.091	0.185189661		0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224																				NO	0.083976228	0.083976228	0.170895926		0.206710716	0.206710716		0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716		0.206710716																					21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307			12.03	21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307	NO																																																																																		0				21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307
H0150_804_0	2012	3																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	257.3696818	6.122472125	48.62264569		14.65503036	22.89208447		16.66526017	66.10321764	20.26567877	30.65986878	0.11060872	0.165784231	8.631564206	108.5975613	146.3454597	1.251828781	2.294287587	43.75693725		66.16959945																				6700	1a. FFS	1b. FFS	2. FFS		10a. FFS	11a/b/c. FFS		4a/b. FFS	9a/b. FFS	8a. FFS	8a/b. FFS	"5, 9c. FFS"	12. FFS	"3, 9a. FFS"	"7a, 17a, 18a. FFS"	"7b/d/f, 17a, 18a. FFS"	"5, 7e/h/g, 9c. FFS"	7c/i. FFS	8a/b. FFS		15. FFS																						0.091	0.091	0.185189661		0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224																				NO	0.083976228	0.083976228	0.170895926		0.206710716	0.206710716		0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716		0.206710716																					21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307			12.03	21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307	NO																																																																																		0				21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307
H0151_001_0	2012	6																															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	1593.85953	128.2851825	648.1918056	2565.624477	246.6480706	11.98592983	13.24250297	466.9349536	67.40136436	18.67712497	38.91562147	0	0.099104131	25.38959784	5344.352081	3546.948212	687.5553636	426.8754845	0	0	32.19336015	658.7230541	706.557674	0	48.22770499	216.661517	5.689474694	0	76.65989601	0											4450	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $40 (16b, 18a); $0/$40 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	65.59003284	0	200	0.2	0.111523728	63.35782028	0.16	0.222194056	0.187263232	0	0.2	0.146035924	7.213206879	39.62728686	38.5	40	0	0	0.2	38.75698513	0	0	40	15	38.46288941	0	0	0											NO	141.948398	75.7957566	49.75672975	0	151.720399	0.151720399	0.084602123	48.08013769	0.121376319	0.168556854	0.142058261	0	0.151720399	0.110783144	6.915871441	37.99381136	36.91299237	38.3511609	0	0	0.151720399	29.40112623	0	0	40	15	38.46288941	0	0	0												18.8538	0.810289372	2.687658708	0	3.118461973	1.818510055	1.120343859	1.870858072	8.180929512	3.148157424	5.528285512	0	0.015036118	2.812739461	3.080070994	11.23017344	2.114977157	1.364264199	0	0	4.884389446	1.613933305	0	0	0.160759017	0.270826896	0.018236136	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7027	0	NO	18.73143147	18.8538	0.810289372	2.687658708	0	3.118461973	1.818510055	1.120343859	1.870858072	8.180929512	3.148157424	5.528285512	0	0.015036118	2.812739461	3.080070994	11.23017344	2.114977157	1.364264199	0	0	4.884389446	1.613933305	0	0	0.160759017	0.270826896	0.018236136	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7027	NO																																										0	0	0	0	0	0	0	0	0	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	18.8538	0.810289372	2.687658708	0	3.118461973	1.818510055	1.120343859	1.870858072	8.180929512	3.148157424	5.528285512	0	0.015036118	2.812739461	3.080070994	11.23017344	2.114977157	1.364264199	0	0	4.884389446	1.613933305	0	0	0.160759017	0.270826896	0.018236136	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7027
H0151_015_0	2012	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	287.4587542	10.153	39.42852795	5252.049896	17.42028864	22.07415636	24.85070204	29.52747285	71.72095943	21.41256345	38.99486372	0	0.058118505	30.6395582	36.31468753	102.7993806	4.8412	3.85381209	0	0	44.73947807	8.165925015	778.6870901	0	42.79069767	197.6190476	0	3.185381632	158.6427996	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.092035436	0.093153275	0.177831454	0	0.224	0.224	0.224	0.137563517	0.224	0.224	0.224	0	0.224	0.224	0.222906905	0.223777742	0.23204869	0.224	0	0	0.224	0.221488277	0	0	0	0	0	0	0	0											NO	0.074475992	0.075380558	0.143902984	0	0.181263032	0.181263032	0.181263032	0.111334506	0.181263032	0.181263032	0.181263032	0	0.181263032	0.181263032	0.180378488	0.181083178	0.187776112	0.181263032	0	0	0.181263032	0.181227236	0	0	0	0	0	0	0	0												21.4088	0.765338809	5.673882824	0	3.15765433	4.001228501	4.504513589	3.287426591	13.00035853	3.881306165	7.068327214	0	0.010534736	5.553819206	6.550388432	18.61523854	0.909061713	0.698553663	0	0	8.109613426	1.479888019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6759	150	YES	25.60210908	21.4088	0.765338809	5.673882824	0	3.15765433	4.001228501	4.504513589	3.287426591	13.00035853	3.881306165	7.068327214	0	0.010534736	5.553819206	6.550388432	18.61523854	0.909061713	0.698553663	0	0	8.109613426	1.479888019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6759	NO																																										0	0	0	0	0	0	0	0	0	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	21.4088	0.765338809	5.673882824	0	3.15765433	4.001228501	4.504513589	3.287426591	13.00035853	3.881306165	7.068327214	0	0.010534736	5.553819206	6.550388432	18.61523854	0.909061713	0.698553663	0	0	8.109613426	1.479888019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6759
H0151_025_0	2012	6																															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	1577.835423	161.1952234	641.6751114	2539.830584	244.168357	11.7406222	12.97147794	462.2797964	66.05737751	18.30470209	38.13964188	0	0.097127989	24.88541552	5422.113352	3531.288433	808.4110242	422.5838274	0	0	30.80363444	652.1004825	701.7391304	175.2941176	42.79069767	162.8571429	17.6381231	0	160.3920985	0											5900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $15 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$15 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	68.95865669	0	200	0.2	0.111523728	63.3360247	0.16	0.210408234	0.187688752	0	0.2	0.146027598	0.205987999	15	38.5	15	0	0	0.2	14.5878535	0	0	15	15	15	0	0	0											NO	163.844327	85.81502074	58.87827637	0	170.7639887	0.170763989	0.095221183	54.08852127	0.136611191	0.179650746	0.1602524	0	0.170763989	0.124681276	0.201053849	14.64273127	37.57778716	14.6406963	0	0	0.170763989	12.45540025	0	0	15	15	15	0	0	0												21.5433	1.15274762	3.148393713	0	3.47459688	2.004875477	1.235159477	2.083669217	9.024177014	3.288453388	6.111969136	0	0.016585963	3.102745356	0.09084473	4.30897563	2.531524784	0.51557679	0	0	5.260151484	0.676847709	0	0	0.053488372	0.203571429	0.022047654	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8497	0	NO	10.81766226	21.5433	1.15274762	3.148393713	0	3.47459688	2.004875477	1.235159477	2.083669217	9.024177014	3.288453388	6.111969136	0	0.016585963	3.102745356	0.09084473	4.30897563	2.531524784	0.51557679	0	0	5.260151484	0.676847709	0	0	0.053488372	0.203571429	0.022047654	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8497	NO																																										0	0	0	0	0	0	0	0	0	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	21.5433	1.15274762	3.148393713	0	3.47459688	2.004875477	1.235159477	2.083669217	9.024177014	3.288453388	6.111969136	0	0.016585963	3.102745356	0.09084473	4.30897563	2.531524784	0.51557679	0	0	5.260151484	0.676847709	0	0	0.053488372	0.203571429	0.022047654	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8497
H0151_801_0	2012	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	285.9209854	9.98	28.0494899	2894.396189	11.98654252	16.07998447	14.96292814	26.15826359	87.90757901	23.86126577	47.2053231	0	0.162302429	31.9821148	34.56906827	100.8246438	4.5924	3.686163832	0	0	50.05437652	8.734749519	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.091279649	0.091279649	0.185037625	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071502625	0.071502625	0.144946613	0	0.175467239	0.175467239	0.175467239	0.175467239	0.175467239	0.175467239	0.175467239	0	0.175467239	0.175467239	0.175467239	0.175467239	0.175467239	0.175467239	0	0	0.175467239	0.175467239	0	0	0	0	0	0	0	0												20.4441	0.713596199	4.065678556	0	2.103245527	2.821510485	2.625503695	4.5899183	15.42490021	4.186870434	8.282987731	0	0.028478759	5.611813396	6.065738979	17.69142192	0.80581575	0.646800992	0	0	8.78290327	1.532662385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4239	150	YES	29.43596756	20.4441	0.713596199	4.065678556	0	2.103245527	2.821510485	2.625503695	4.5899183	15.42490021	4.186870434	8.282987731	0	0.028478759	5.611813396	6.065738979	17.69142192	0.80581575	0.646800992	0	0	8.78290327	1.532662385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4239	NO																																										0	0	0	0	0	0	0	0	0	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	20.4441	0.713596199	4.065678556	0	2.103245527	2.821510485	2.625503695	4.5899183	15.42490021	4.186870434	8.282987731	0	0.028478759	5.611813396	6.065738979	17.69142192	0.80581575	0.646800992	0	0	8.78290327	1.532662385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4239
H0151_804_0	2012	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	283.5324378	9.9978	27.81516803	2881.697753	11.88640847	15.94565432	14.83792974	25.93974078	87.17321027	23.66193179	46.81097583	0	0.160946575	31.71526333	34.28028267	99.98236754	4.5945	3.655370088	0	0	49.63622862	8.661780532	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.093084218	0.093084218	0.178099239	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073061055	0.073061055	0.139788663	0	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0	0	0.175815802	0.175815802	0	0	0	0	0	0	0	0												20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232	150	YES	29.05679966	20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232	NO																																										0	0	0	0	0	0	0	0	0	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	20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232
H0151_805_0	2012	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	283.5324378	9.9978	27.81516803	2881.697753	11.88640847	15.94565432	14.83792974	25.93974078	87.17321027	23.66193179	46.81097583	0	0.160946575	31.71526333	34.28028267	99.98236754	4.5945	3.655370088	0	0	49.63622862	8.661780532	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.093084218	0.093084218	0.178099239	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073061055	0.073061055	0.139788663	0	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0.175815802	0	0	0.175815802	0.175815802	0	0	0	0	0	0	0	0												20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232	150	YES	29.05679966	20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232	NO																																										0	0	0	0	0	0	0	0	0	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	20.7152	0.730449817	3.888245148	0	2.089818432	2.803497996	2.608742511	4.560616316	15.32642784	4.160141503	8.230109237	0	0.028296951	5.576044443	6.027015374	17.57848009	0.8077857	0.642671822	0	0	8.72683332	1.522877887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0232
H0154_001_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1037.50189	27.93531014	753.9163544	26.68708294	161.5361636	18.75145838	4.974979905	288.8878413	275.6707893	10.43942931	1384.241359	0	2.964999395	627.2819838	3279.484257	4293.236414	128.4971873	187.3440422	22.55287672	38.08618815	22.73029938	0	0	0	197.6891949	0	135.5347827	0	3290.460633	0											6700	1a:  Acute - $235/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $235/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $50/day 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 - $7/service	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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 - $20/visit		12:  Renal Dialysis - $30/service with $750 OOP Max	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $40/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $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 - PCP -$20; SCP-$40/visit	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $3,000 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $3,000 annual out-of-pocket max"	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $40/visit		18a:  Routine Hearing Test - PCP -$20; SCP-$40/visit		14c:  Written health education materials - Newsletters  /14c:  Membership in Health Club/Fitness Classes - $20 Allowance per Month														235	235	50	0	200	0.2	0.116688595	48.23495308	350	0	25.65351091	0	21.8632729	40	20.0025261	36.0446244	40	40	0	26.99605468	0.193450105	0	0	0	40	0	26.66666667	0	0	0											NO	220.962523	220.962523	47.01330278	0	188.0532111	0.188053211	0.109718324	45.35368907	329.0931194	0	24.12112551	0	20.55729337	37.61064222	18.80769632	33.89153681	37.61064222	37.61064222	0	25.38347385	0.181894567	0	0	0	37.61064222	0	25.07376148	0	0	0												19.1041	0.514388051	2.95367482	0	2.531449523	3.526271961	0.545846459	1.091844111	7.560113331	0	2.782454962	0	0.005079364	1.966039855	5.139961999	12.125365	0.402738478	0.587177479	0	0.080563313	4.134517963	0	0	0	0.619601465	0	0.283197234	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9544			4.19	19.1041	0.514388051	2.95367482	0	2.531449523	3.526271961	0.545846459	1.091844111	7.560113331	0	2.782454962	0	0.005079364	1.966039855	5.139961999	12.125365	0.402738478	0.587177479	0	0.080563313	4.134517963	0	0	0	0.619601465	0	0.283197234	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9544	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.1041	0.514388051	2.95367482	0	2.531449523	3.526271961	0.545846459	1.091844111	7.560113331	0	2.782454962	0	0.005079364	1.966039855	5.139961999	12.125365	0.402738478	0.587177479	0	0.080563313	4.134517963	0	0	0	0.619601465	0	0.283197234	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9544
H0154_008_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1095.400656	29.49426634	678.0463871	26.11588565	156.801207	17.09145271	4.535727515	290.308817	313.2035207	10.94603802	403.2757656	0	3.170126778	667.5238287	3606.971384	4688.096843	140.5066592	204.8533983	24.78487739	41.84866772	18.40534068	0	0	27.81699346	397.9022029	0	131.1756324	0	3448.387505	0											6700	1a:  Acute - $150/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $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 / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $65/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 - $30/service with $750 OOP Max	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $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 - PCP -$15; SCP-$30/visit	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $3,000 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $3,000 annual out-of-pocket max"	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental & 16b:  Comprehensive Dental - $100 Allowance Per Year	17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Per Year	18a:  Routine Hearing Test - PCP -$15; SCP-$30/visit		14c:  Written health education materials - Newsletters  /14c:  Membership in Health Club/Fitness Classes - $20 Allowance per Month														150	150	50	0	150	0.2	0.107627013	41.14226983	250	0	40	0	21.82709863	30	15.00189547	28.842517	30	30	0	20.24584321	0.193450105	0	0	0	30	0	20	0	0	0											NO	144.549882	144.549882	48.20295515	0	144.560234	0.192670558	0.103675842	39.64711718	240.959957	0	38.55636835	0	21.03539454	28.91654713	14.45730624	27.79631547	28.91245805	28.91245805	0	19.51115229	0.18611248	0	0	0	28.93968868	0	19.26485876	0	0	0												13.195	0.355282727	2.723653299	0	1.888934931	3.293019722	0.47024537	0.959158974	6.289125572	0	1.295737414	0	0.005557072	1.608540354	4.345590825	10.85931824	0.338532741	0.49356794	0	0.068042977	3.425463607	0	0	0	0.959597156	0	0.210590003	0	0	0	0	0	0	0	0	0	0	0	0	0	52.785			1.99235099	13.195	0.355282727	2.723653299	0	1.888934931	3.293019722	0.47024537	0.959158974	6.289125572	0	1.295737414	0	0.005557072	1.608540354	4.345590825	10.85931824	0.338532741	0.49356794	0	0.068042977	3.425463607	0	0	0	0.959597156	0	0.210590003	0	0	0	0	0	0	0	0	0	0	0	0	0	52.785	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	13.195	0.355282727	2.723653299	0	1.888934931	3.293019722	0.47024537	0.959158974	6.289125572	0	1.295737414	0	0.005557072	1.608540354	4.345590825	10.85931824	0.338532741	0.49356794	0	0.068042977	3.425463607	0	0	0	0.959597156	0	0.210590003	0	0	0	0	0	0	0	0	0	0	0	0	0	52.785
H0154_011_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1168.87541	31.47261458	482.7318381	23.67980221	178.1865459	22.33737419	6.029140843	356.6065182	339.0762316	10.67903806	34.46552799	0	3.895740947	645.0607459	4572.270319	5712.437434	170.9918574	249.299665	29.37353632	52.29468104	31.07108369	0	0	27.81699346	362.7929222	0	206.5579468	0	3422.990607	0											6700	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $50/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $65/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 - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $30/service with $750 OOP Max	3:  Cardiac Rehabilitation Services - $30/visit/3:  Pulmonary Rehabilitation - $30/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $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 - PCP -$10; SCP-$30/visit	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $3,000 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $3,000 annual out-of-pocket max"	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental & 16b:  Comprehensive Dental - $100 Allowance Per Year	17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Per Year	18a:  Routine Hearing Test - PCP -$10; SCP-$30/visit		14c:  Written health education materials - Newsletters  /14c:  Membership in Health Club/Fitness Classes - $20 Allowance per Month														175	175	50	0	150	0.2	0.051170898	41.14375653	225	0	0	0	21.70889399	30	10.00242524	28.83840123	30	30	0	16.98589365	0.193450105	0	0	0	30	0	16.66666667	0	0	0											NO	166.8734752	166.8734752	47.67813576	0	143.0344073	0.190712543	0.04879466	39.23315219	214.5516109	0	0	0	20.7007919	28.60688146	9.537939772	27.49922418	28.60688146	28.60688146	0	16.19711487	0.184466807	0	0	0	28.60688146	0	15.89271192	0	0	0												16.2545	0.437662047	1.917979509	0	2.123900582	4.260017437	0.294189878	1.165899817	6.062445977	0	0	0	0.00672041	1.537764691	3.63416991	13.09063313	0.407628649	0.594307164	0	0.070585246	5.731583605	0	0	0	0.86486451	0	0.273563829	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7284			2.86	16.2545	0.437662047	1.917979509	0	2.123900582	4.260017437	0.294189878	1.165899817	6.062445977	0	0	0	0.00672041	1.537764691	3.63416991	13.09063313	0.407628649	0.594307164	0	0.070585246	5.731583605	0	0	0	0.86486451	0	0.273563829	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7284	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	16.2545	0.437662047	1.917979509	0	2.123900582	4.260017437	0.294189878	1.165899817	6.062445977	0	0	0	0.00672041	1.537764691	3.63416991	13.09063313	0.407628649	0.594307164	0	0.070585246	5.731583605	0	0	0	0.86486451	0	0.273563829	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7284
H0154_012_0	2012	8																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1548.834205	41.70321454	838.4787534	37.81937897	383.7389579	34.30126045	8.825322417	508.8484149	378.2597384	12.60587904	42.69960622	0	0	1112.424257	0.730615594	7479.864711	225.6613478	329.0057157	27.67001225	69.93582662	35.53296872	0	12000	21.03786816	379.8300054	0	237.2728851	0	3111.220865	0											6700	1a:  Acute - $125/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $125/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $30/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $75/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	3:  Cardiac Rehabilitation Services - $10/visit/3:  Pulmonary Rehabilitation - $10/visit/5:  Partial Hospitalization - $10/day/7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $10/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $10/visit/18a:  Hearing Exams - PCP -$0; SCP-$10/visit	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $3,000 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $3,000 annual out-of-pocket max"	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	16a:  Preventive Dental & 16b:  Comprehensive Dental - $150 Allowance Per Year	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Per Year	18a:  Routine Hearing Test - PCP -$0; SCP-$10/visit		14c:  Written health education materials - Newsletters  /14c:  Membership in Health Club/Fitness Classes - $20 Allowance per Month														125	125	30	0	50	0.1	0.0259777	26.15823173	75	0	0	0	0	10	10	10	10	10	0	3.490843704	0.193450105	0	0	0	10	0	3.333333333	0	0	0											NO	122.3992591	122.3992591	29.37582219	0	48.95970366	0.097919407	0.02543721	25.61398547	73.43955548	0	0	0	0	9.791940731	9.791940731	9.791940731	9.791940731	9.791940731	0	3.418213465	0.189425196	0	0	0	9.791940731	0	3.263980244	0	0	0												15.798	0.425370214	2.052583564	0	1.565645472	3.358759093	0.224491581	1.086136326	2.314935587	0	0	0	0	0.9077327	0.000596179	6.10353266	0.184138545	0.268467039	0	0.019921299	6.730839568	0	0	0	0.309939408	0	0.064537834	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4156			0.88	15.798	0.425370214	2.052583564	0	1.565645472	3.358759093	0.224491581	1.086136326	2.314935587	0	0	0	0	0.9077327	0.000596179	6.10353266	0.184138545	0.268467039	0	0.019921299	6.730839568	0	0	0	0.309939408	0	0.064537834	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4156	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	15.798	0.425370214	2.052583564	0	1.565645472	3.358759093	0.224491581	1.086136326	2.314935587	0	0	0	0	0.9077327	0.000596179	6.10353266	0.184138545	0.268467039	0	0.019921299	6.730839568	0	0	0	0.309939408	0	0.064537834	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4156
H0154_801_0	2012	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	231.973861	2.736524758	26.81976711	23.74309819	7.667227338	20.03997843	4.985015513	10.79357813	34.6956285	9.756734226	33.03438719	0	0.027364525	22.33442377	39.9485376	93.51704161	1.235854397	5.307458681	21.59582656	24.2179692	28.09632525	51.02539283	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													0.093606366	0.093606366	0.174214714	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.085481998	0.085481998	0.159094114	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0	0	0	0	0	0	0												19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472			10.25	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472
H0154_802_0	2012	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	231.973861	2.736524758	26.81976711	23.74309819	7.667227338	20.03997843	4.985015513	10.79357813	34.6956285	9.756734226	33.03438719	0	0.027364525	22.33442377	39.9485376	93.51704161	1.235854397	5.307458681	21.59582656	24.2179692	28.09632525	51.02539283	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													0.093606366	0.093606366	0.174214714	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.085481998	0.085481998	0.159094114	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0	0	0	0	0	0	0												19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472			10.25	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472
H0154_803_0	2012	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	231.973861	2.736524758	26.81976711	23.74309819	7.667227338	20.03997843	4.985015513	10.79357813	34.6956285	9.756734226	33.03438719	0	0.027364525	22.33442377	39.9485376	93.51704161	1.235854397	5.307458681	21.59582656	24.2179692	28.09632525	51.02539283	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													0.093606366	0.093606366	0.174214714	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.085481998	0.085481998	0.159094114	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0.204558391	0	0	0	0	0	0	0	0												19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472			10.25	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.8296	0.233923605	4.266867098	0	1.56839569	4.099345748	1.019726754	2.207916978	7.097281951	1.995821857	6.7574611	0	0.005597643	4.568693796	8.171808585	19.12969559	0.252804387	1.085685209	4.41760754	4.953988819	5.747339093	10.43767227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8472
H0248_001_0	2012	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	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	943.18	14.17	360.09	279.51	16.56	4.02	1.63	280.66	252.31	2748.24	899.02	257.73	0.16	5.54	3548.69	3749.04	42.04	893.49		1560.93	11.21	0		3.17	0.61				4.71	0.95	737.13	0	1521.12								6700	"$0-$195/Day(Days 1-5): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-5): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $146 (Days 21-100): 2. $0 SNF - Facility 1,2. $146 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$30/Visit: 7b. $5 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$30-$125/Visit: 3. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"										122.693444	100.845894	45.265135	0	100	0.2	0.2	65	125	14.722837	88.35888	50	0.2	0.2	5	29.173662	30	30		0	0.2	0		0	0				0	0	0	0	52.509969								NO	115.965181	95.315707	43.007174	0	97.0452	0.19409	0.19409	63.07938	121.3065	14.287806	85.748051	48.5226	0.19409	0.19409	4.85226	28.311639	29.11356	29.11356		0	0.19409	0		0	0				0	0	0	0	50.958404									9.1147	0.112551964	1.290537774	0	0.133922376	0.7802418	0.3163667	1.475321566	2.550570251	3.27219333	6.424101068	1.042144142	0.0310544	1.0752586	1.434930545	8.845122256	0.101994505	2.167722894	0	0	2.1757489	0	0	0	0	0	0	0	0	0	0	0	6.459487291	0	0	0	0	0	0	0	48.8039	0	NO	1.76885	9.1147	0.112551964	1.290537774	0	0.133922376	0.7802418	0.3163667	1.475321566	2.550570251	3.27219333	6.424101068	1.042144142	0.0310544	1.0752586	1.434930545	8.845122256	0.101994505	2.167722894	0	0	2.1757489	0	0	0	0	0	0	0	0	0	0	0	6.459487291	0	0	0	0	0	0	0	48.8039	YES	$0-$1000/Admit	$0-$1000/Admit	"30% Coins(Days 1-20), 30% (Days 21-100)"	25% Coins	$100/Trip	40% Coins	40% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						40% Coins	$0/Proc	25% Coins								10000	1.5093	0.0256	0.6883	0.6962	0.9428	0.3508	0.1428	0.1483	1.2587	0.4159	0.5557	0.0505	0.0032	0.1092	1.0553	1.7108	0.0157	0.2269		0.1568	0.2734	0		0	0				0	0	0.0911	0	0.5356								10.9629	0	NO	0.681654	10.6239	0.138186964	1.978854774	0.696177	1.076692376	1.1310578	0.4591527	1.623650566	3.809271251	3.68807033	6.979850068	1.092607142	0.0342284	1.1844466	2.490232545	10.55595426	0.117680505	2.394583894	0	0.156846	2.4491219	0	0	0	0	0	0	0	0	0	0.091094	0	6.995108291	0	0	0	0	0	0	0	59.7668
H0248_002_0	2012	9	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	Coin	V	V	V	V		V	Coin	O	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	1032.47	49.05	416.77	1017.64	22.1	8.71	4.14	316.49	296.75	1253.51	898.49	146.81	17.79	5.06	2652.7	3416.81	82.61	629.07		1378.69	15.64	0	1.95	6.71	2.86				4.71	0.95	521.9										2500	"$0-$125/Day(Days 1-5): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-5): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $75 (Days 21-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$45-$50/Visit: 5. $45 Partial Hospitalization,7h. $50 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$15/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN750: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$5-$50/Visit: 3. $5 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												78.649644	64.644804	23.252638	0	100	0.2	0.133704	65	50	33.313503	41.088008	45.626447	0	0.2	5	13.710853	5	5		0	0.2	0	0	0	0				0	0	46.062197										NO	62.129129	51.066033	17.512515	0	89.0825	0.178165	0.119107	57.903625	44.54125	29.676501	36.602225	40.64518	0	0.178165	4.454125	12.213971	4.454125	4.454125		0	0.178165	0	0	0	0				0	0	41.033356											5.3455	0.20873241	0.60822424	0	0.164060271	1.55181715	0.49310298	1.527159856	1.101467995	3.099982564	2.740561095	0.497259906	0	0.9015149	0.984621449	3.477734854	0.030662939	0.233496368	0	0	2.7865006	0	0	0	0	0	0	0	0	0	1.784609041	0	0	0	0	0	0	0	0	0	27.537	0	NO	4.295788	5.3455	0.20873241	0.60822424	0	0.164060271	1.55181715	0.49310298	1.527159856	1.101467995	3.099982564	2.740561095	0.497259906	0	0.9015149	0.984621449	3.477734854	0.030662939	0.233496368	0	0	2.7865006	0	0	0	0	0	0	0	0	0	1.784609041	0	0	0	0	0	0	0	0	0	27.537	YES	$0-$125/Day(Days 1-5)	$0-$125/Day(Days 1-5)	"$0/Day(Days 1-20), $75 (Days 21-100)"	25% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	$0-$50/Visit	$0-$45/Visit	$0-$50/Visit	$45-$50/Visit	$0/Proc	20% Coins	$5/Visit	$5-$15/Visit	$5/Visit	$5/Visit		$15/Visit	20% Coins	$0/Service		"DEN750: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$5-$50/Visit										2500	1.9925	0.0778	0.2225	2.0589	1.4266	1.1135	0.5292	0.5466	0.3943	1.1096	0.9882	0.1864	0	0.3258	0.3691	1.3036	0.0115	0.0864		0.5755	1.0964	0	0	0	0				0	0	0.6388										15.0531	0	NO	3.167028	7.338	0.28654141	0.83070924	2.058931	1.590655271	2.66535815	1.02229598	2.073789856	1.495720995	4.209580564	3.728810095	0.683697906	0	1.2272839	1.353700449	4.781342854	0.042156939	0.319870368	0	0.575465	3.8828926	0	0	0	0	0	0	0	0	0	2.423386041	0	0	0	0	0	0	0	0	0	42.5902
H0251_002_0	2012	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	230.8647182	21.5595	11.95337447	1111.796195	18.75699455	17.93333318	8.514441099	41.13023604	55.76366607	15.95840449	31.38448427	0	0.060782923	35.27450919	10.46356764	82.64463869	10.348	8.38338998	0	0	11.79917755	5.05112348	0	1465.405966	43.64651163	110.432	15.98456224	2.613989513	461.541255	5327.40798											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"$0 (7b, 7f, 7f1); $0 n/c (7b1); Medicare FFS (7d)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10); $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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.087888679	0.087888679	0.204318021	0	0.224	0.224	0.2237491	0.140233003	0.224	0.224	0.224	0	0.224	0.224	0.209498096	0.222702162	0.224	0.224	0	0	0.224	0.060014174	0	0	0	0	0	0	0	0											NO	0.073124902	0.073124902	0.169996129	0	0.186371876	0.186371876	0.186163123	0.116684863	0.186371876	0.186371876	0.186371876	0	0.186371876	0.186371876	0.174306041	0.185331199	0.186371876	0.186371876	0	0	0.186371876	0.054764961	0	0	0	0	0	0	0	0												16.882	1.576536322	2.032027389	0	3.495776266	3.342268951	1.585074946	4.799275968	10.39277907	2.974197786	5.849185218	0	0.011328227	6.574176461	1.823863047	15.31663002	1.928576175	1.56242812	0	0	2.199034857	0.276624579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6217	150	YES	16.64752319	16.882	1.576536322	2.032027389	0	3.495776266	3.342268951	1.585074946	4.799275968	10.39277907	2.974197786	5.849185218	0	0.011328227	6.574176461	1.823863047	15.31663002	1.928576175	1.56242812	0	0	2.199034857	0.276624579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6217	NO																																										0	0	0	0	0	0	0	0	0	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	16.882	1.576536322	2.032027389	0	3.495776266	3.342268951	1.585074946	4.799275968	10.39277907	2.974197786	5.849185218	0	0.011328227	6.574176461	1.823863047	15.31663002	1.928576175	1.56242812	0	0	2.199034857	0.276624579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6217
H0294_001_0	2012	7																															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	YES	497.9065915	10.96437914	73.43762324	0	35.13886785	65.4130261	46.37438276	80.73247411	109.6965628	13.87980091	34.69394963	0	1.352604049	42.25594652	93.52800732	82.20635015	3.559839634	6.372732418	34.11249424	105.2199084	44.18381762	7.688256248	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.082951101	0.082951101	0.164369486	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926615	0	15	0	0	0	0	0	0											YES	0.082951101	0.082951101	0.164369486	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223926615	0	15	0	0	0	0	0	0											6700	41.3019	0.909507326	12.07090438	0	7.871106397	14.65251785	10.38786174	18.0840742	24.57203008	3.109075404	7.771444717	0	0.302983307	9.46533202	20.95027364	18.41422243	0.797404078	1.427492062	7.641198709	23.56925949	9.897175148	1.721605198	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.2342	0	NO	0	41.3019	0.909507326	12.07090438	0	7.871106397	14.65251785	10.38786174	18.0840742	24.57203008	3.109075404	7.771444717	0	0.302983307	9.46533202	20.95027364	18.41422243	0.797404078	1.427492062	7.641198709	23.56925949	9.897175148	1.721605198	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.2342	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1802	0	NO	5.55E-17	41.3019	0.909507326	12.07090438	0	7.871106397	14.65251785	10.38786174	18.26424283	24.57203008	3.109075404	7.771444717	0	0.302983307	9.46533202	20.95027364	18.41422243	0.797404078	1.427492062	7.641198709	23.56925949	9.897175148	1.721605198	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.4144
H0294_002_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1518.988217	7.570347739	105.6198584	0	186.1945305	21.63316237	6.505564528	537.9070882	373.4338711	8.040556182	20.11452343	0	0.873652053	2439.472446	4006.246329	4875.849073	121.417669	248.5407434	12.62529979	45.93616591	28.6779745	525.3696561	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.48805645	150	0.2	0.2	0	0.2	29.98597586	25	49.0674627	39.26548803	50	0.2	0.177785138	0.2	49.78959045	0	10	10	0	0	0	0	0											YES	170.617465	974.9569431	126.7444026	0	155.9931109	0.194991389	0.194991389	62.87307838	146.2435415	0.194991389	0.194991389	0	0.194991389	29.23503536	24.37392358	47.83866344	38.28216018	48.74784715	0.194991389	0.173332854	0.194991389	48.54270691	0	10	10	0	0	0	0	0											6700	21.5972	0.615063591	1.115560488	0	2.420422004	4.21828037	1.268529061	2.818322877	4.551024317	1.567839215	3.922158856	0	0.170354627	5.943171935	8.137328487	19.4378419	0.387344221	1.009652181	2.461824738	7.962246759	5.59195807	2.12523877	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.542	0	NO	2.499826718	21.5972	0.615063591	1.115560488	0	2.420422004	4.21828037	1.268529061	2.818322877	4.551024317	1.567839215	3.922158856	0	0.170354627	5.943171935	8.137328487	19.4378419	0.387344221	1.009652181	2.461824738	7.962246759	5.59195807	2.12523877	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.542	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.6266	0	5.6244	0.195	0.0297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											9.4756	0	NO	0.243392597	21.5972	0.615063591	1.115560488	3.626575035	2.420422004	9.842654196	1.463491454	2.847984159	4.551024317	1.567839215	3.922158856	0	0.170354627	5.943171935	8.137328487	19.4378419	0.387344221	1.009652181	2.461824738	7.962246759	5.59195807	2.12523877	0	0.15006243	0.070592926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0176
H0294_004_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1124.454768	8.176744975	111.1179953	0	98.61656813	4.944510978	3.421072663	324.5264892	273.3477436	6.011587644	20.07795656	0	0	1993.883428	3080.600307	3719.765	188.3082214	225.7560151	12.65493387	36.09445655	32.94599708	340.1925877	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$165/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	165	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.49161293	35	48.05447343	39.7534037	50	0.2	0.178254853	0.2	49.55528216	0	10	10	0	0	0	0	0											YES	172.2247755	984.1415743	127.9384047	0	162.3833598	0.196828315	0.196828315	63.58136085	147.6212362	0.196828315	0.196828315	0	0	36.89705497	34.4449551	47.29240513	39.1229773	49.20707872	0.196828315	0.175428012	0.196828315	48.7694134	0	10	10	0	0	0	0	0											6700	16.1382	0.670589556	1.184688255	0	1.334474138	0.973219764	0.673363967	1.719486318	3.362660984	1.183250666	3.951910356	0	0	6.130702202	8.842594938	14.65971945	0.613931523	0.925732834	2.490849308	6.331978739	6.484705086	1.382582746	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2753	0	NO	1.273884704	16.1382	0.670589556	1.184688255	0	1.334474138	0.973219764	0.673363967	1.719486318	3.362660984	1.183250666	3.951910356	0	0	6.130702202	8.842594938	14.65971945	0.613931523	0.925732834	2.490849308	6.331978739	6.484705086	1.382582746	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2753	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	1.924	0	0.9732	0.5245	0.0171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.4389	0	NO	0.055413604	16.1382	0.670589556	1.184688255	1.92402852	1.334474138	1.946439527	1.197898483	1.736558812	3.362660984	1.183250666	3.951910356	0	0	6.130702202	8.842594938	14.65971945	0.613931523	0.925732834	2.490849308	6.331978739	6.484705086	1.382582746	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7142
H0294_005_0	2012	4																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1124.454768	8.176744975	111.1179953	0	98.84525896	4.944510978	3.421072663	324.5264892	273.3477436	6.011587644	20.07795656	0	0	1993.883428	3080.600307	3719.765	188.3082214	225.7560151	12.65493387	36.09445655	32.94599708	340.1925877	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	150	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.49161293	35	48.05447343	39.7534037	50	0.2	0.178254853	0.2	49.55528216	0	10	10	0	0	0	0	0											YES	172.23102	984.1772573	127.9430435	0	147.6265886	0.196835451	0.196835451	63.58366618	147.6265886	0.196835451	0.196835451	0	0	36.89839278	34.44620401	47.29411986	39.12439582	49.20886287	0.196835451	0.175434372	0.196835451	48.77118168	0	10	10	0	0	0	0	0											6700	16.1388	0.67061387	1.184731209	0	1.216015698	0.973255051	0.673388382	1.719548663	3.362782908	1.183293568	3.952053644	0	0	6.130924489	8.842915553	14.66025098	0.613953783	0.925766399	2.490939621	6.332208324	6.484940208	1.382632875	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1597	0	NO	1.269113091	16.1388	0.67061387	1.184731209	0	1.216015698	0.973255051	0.673388382	1.719548663	3.362782908	1.183293568	3.952053644	0	0	6.130924489	8.842915553	14.66025098	0.613953783	0.925766399	2.490939621	6.332208324	6.484940208	1.382632875	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1597	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	35% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	1.9241	0	0.9733	0.5246	0.0171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.439	0	NO	0.055288918	16.1388	0.67061387	1.184731209	1.924098281	1.216015698	1.946510101	1.197941916	1.736621777	3.362782908	1.183293568	3.952053644	0	0	6.130924489	8.842915553	14.66025098	0.613953783	0.925766399	2.490939621	6.332208324	6.484940208	1.382632875	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5987
H0302_001_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	P	P	P	P	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O																																																			0	YES	1196.307705	97.5593775	632.8069396		274.5097679	6.291016001	3.961481231	550.8259273	411.6214361		938.6053617		27.81566861	59.85730047	5064.426745	6634.983943	253.2921748	448.8514753		200.1971251	4.041266643	0.062601876			54.92936125		5.010040641														6700	"(1a) $125/day for days 1-4, $0/day for days 5+"	"(1b) $140/day for days 1-10, $0/day for days 11-90"	(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) $65/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"	(5) $20/visit	(12) $25/session	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9a) $0 chemotherapy; $150 Observation"	"(7a) $10/visit, (14a) $0"	"(7b) $20/visit, (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, (14a) $0, (14d) $0, (14e) $0"	(15) 20%	"(9d) $0 additional blood, (17b) 20% Medicare Covered Eyewear"			(17a) $20/exam		(18a) $20/exam		"(13d, 14c) $0"														82.27203668	77.55087327	14.64417132		94.80037615	0.15	0.126002797	56.91572197	150		59.78036023		25	112.3814542	10	26.63461627	20	10		23.64984528	0.2	0.2			20		20														NO	79.45363373	74.89420378	14.1425042		91.55278839	0.144861432	0.121686304	54.96595331	144.8614322		57.73245732		24.14357203	108.5315893	9.65742881	25.85713363	19.31485762	9.65742881		22.83966972	0.193148576	0.193148576			19.31485762		19.31485762															7.9209	0.608885992	0.745789567	0	2.094344558	0.911325588	0.482058011	2.523056017	4.969005895	0	4.515666165	0	0.055964133	0.541367329	4.075778396	14.29680554	0.407691858	0.361229264	0	0.381036351	0.780564898	0.012091463	0	0	0.088412733	0	0.008064018	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7801	0		1.546665233	7.9209	0.608885992	0.745789567	0	2.094344558	0.911325588	0.482058011	2.523056017	4.969005895	0	4.515666165	0	0.055964133	0.541367329	4.075778396	14.29680554	0.407691858	0.361229264	0	0.381036351	0.780564898	0.012091463	0	0	0.088412733	0	0.008064018	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7801	NO																																																																																		0	0		0	7.9209	0.608885992	0.745789567	0	2.094344558	0.911325588	0.482058011	2.523056017	4.969005895	0	4.515666165	0	0.055964133	0.541367329	4.075778396	14.29680554	0.407691858	0.361229264	0	0.381036351	0.780564898	0.012091463	0	0	0.088412733	0	0.008064018	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7801
H0302_006_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	P	P	P	P	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O																																																			0	YES	759.5101105	48.34899974	378.6685782		188.0410868	4.752889616	2.529531671	418.4752539	286.909487	139.4437513	643.5065471		1.720097662	31.22885358	3849.832858	4632.942492	139.0697952	277.2172564		50.11512985	2.456383552	0.114715027																			6700	"(1a) $265/day for days 1-6, $0/day for days 6+"	"(1b) $140/day for days 1-10, $0/day for days 11-30"	(2) $0/day for days 1-15; $50/day days 16-20; $120/day days 21-100	(6) $0/visit	(10a) $150/trip land; 20% air/water	(11a) 20%	"(11b) 20%, (11c) 0%-20%"	"(4a) $65/visit, (4b) $25/visit"	"(9a, 9b) $200 per visit"	(8a) $0 preventative; $5 lab; 20% genetic testing	"(8b) $20 Radiation Therapy, $5 diagnostic, $175-$300 complex radiology"	(5) $20/visit	(12) 20%	"(3) $15/visit, (9c) $20/visit, (9a) $0 chemotherapy; $200/visit other"	"(7a) $25/visit, (14b) $0/visit, (14c) $0 for initial preventative exam, $10 per routine physical, Section C: Travel Program"	"(7b) $20/visit, (7d) $50/visit, (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, (14a, 14b,14d, 14e) $0"	(15) 20%	"(9d) $0, (17b) 20% Medicare Covered Eyewear"							"(13d) $0, (14a) $0"														205.2117992	77.55087327	27.89439039		109.3257927	0.2	0.092707104	56.94502346	200	5	73.31671412		0.2	143.5122551	25	42.06722279	20	10		37.75758501	0.2	0.2																			NO	196.30389	74.18451645	26.68354044		104.5801385	0.191318326	0.08868284	54.47313294	191.3183265	4.782958162	70.13415524		0.191318326	137.2826224	23.91479081	40.50445847	19.13183265	9.565916323		36.11858988	0.191318326	0.191318326																				12.4246	0.298895597	0.842018193	0	1.638780242	0.909314887	0.224326053	1.899638178	4.574253575	0.055579469	3.760982339	0	0.329086206	0.357264909	7.672328953	15.63790223	0.221721671	0.220986423	0	0.150840652	0.46995119	0.021947087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7104	0		2.240252586	12.4246	0.298895597	0.842018193	0	1.638780242	0.909314887	0.224326053	1.899638178	4.574253575	0.055579469	3.760982339	0	0.329086206	0.357264909	7.672328953	15.63790223	0.221721671	0.220986423	0	0.150840652	0.46995119	0.021947087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7104	NO																																																																																		0	0		0	12.4246	0.298895597	0.842018193	0	1.638780242	0.909314887	0.224326053	1.899638178	4.574253575	0.055579469	3.760982339	0	0.329086206	0.357264909	7.672328953	15.63790223	0.221721671	0.220986423	0	0.150840652	0.46995119	0.021947087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7104
H0302_007_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	P	P	P	P	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O																																																			0	YES	1769.539242	96.21091491	864.0036443		381.8209387	11.39880447	6.357593803	833.8453845	671.3576127		1478.328019		38.24074418	130.7086494	7215.33304	10373.87864	396.7746322	789.9483193		437.7265139	7.013487187	0.165580188			81.48874622		9.178737291														6700	"(1a) $50/day for days 1-3, $0/day for days 4+"	"(1b) $140/day for days 1-10, $0/day for days 11-90"	(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%-20%"	"(4a) $65/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"	(5) $20/visit	(12) $25/session	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9a) $0 chemotherapy, $100 Observation"	"(7a) $5/visit, (14a) $0/visit, (14c) $0 for initial preventative exam"	"(7b) $20/visit, (7d) $15, (7f) $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, (14a, 14d, 14e) $0"	(15) 20%	"(9d) $10/visit, (17b) 20% Medicare Covered Eyewear"			(17a) $10/exam		(18a) $20 routine hearing exam		"(13d, 14c) $0"														28.51378737	77.55087327	10.26950362		68.43136812	0.1	0.109465423	54.71419117	100		50.29686849		25	81.94586566	5	14.87161008	20	10		19.92272359	0.2	0.2			10		20														NO	27.60113326	75.06866625	9.94080282		66.24105336	0.096799253	0.105961712	52.9629285	96.79925329		48.68699312		24.19981332	79.32298607	4.839962665	14.39615591	19.35985066	9.679925329		19.28504767	0.193598507	0.193598507			9.679925329		19.35985066															4.0701	0.601868755	0.715740822	0	2.107685098	1.103395761	0.673661524	3.680241123	5.4155763	0	5.997945507	0	0.077118239	0.864016698	2.910161877	12.44533119	0.640124802	0.637220062	0	0.703464724	1.357800645	0.032056077	0	0	0.065733748	0	0.014808249	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1141	0		1.458177772	4.0701	0.601868755	0.715740822	0	2.107685098	1.103395761	0.673661524	3.680241123	5.4155763	0	5.997945507	0	0.077118239	0.864016698	2.910161877	12.44533119	0.640124802	0.637220062	0	0.703464724	1.357800645	0.032056077	0	0	0.065733748	0	0.014808249	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1141	NO																																																																																		0	0		0	4.0701	0.601868755	0.715740822	0	2.107685098	1.103395761	0.673661524	3.680241123	5.4155763	0	5.997945507	0	0.077118239	0.864016698	2.910161877	12.44533119	0.640124802	0.637220062	0	0.703464724	1.357800645	0.032056077	0	0	0.065733748	0	0.014808249	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1141
H0303_013_0	2012	5																															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	1263.371452	4.611185464	1404.390481	1107.583439	556.0093854	8.620792288	13.30274955	344.6060378	46.73985635	15.57440925	37.07658378	0	3.483835931	21.81868638	6226.297208	5546.472204	2.984074835	751.3281892	0	0	25.47796888	1962.973058	0	0	64.74069401	389.7230726	0	4.431988648	84.92230684	0											5400	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-56 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	76.36178147	0	200	0.2	0.096994784	64.29939465	0.16	0.202889077	0.182120024	0	0.2	0.145142403	9.564448016	39.49100239	38.5	40	0	0	0.2	37.77279937	0	0	40	30	0	0	0	0											NO	148.0992442	83.9031292	60.49471465	0	158.442387	0.158442387	0.076840425	50.96090374	0.12675391	0.160731148	0.144277656	0	0.158442387	0.114983544	9.403644436	38.8270671	37.85271353	39.32749458	0	0	0.158442387	29.92406248	0	0	40	30	0	0	0	0												15.592	0.032241074	7.079850116	0	7.341287851	1.365898908	1.022188932	1.463452927	5.924459526	2.503292685	5.349322618	0	0.551987281	2.508789891	4.879157091	17.94610404	0.009412944	2.462321274	0	0	4.036790205	4.895010703	0	0	0.215802313	0.974307682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1537	0	NO	16.0816355	15.592	0.032241074	7.079850116	0	7.341287851	1.365898908	1.022188932	1.463452927	5.924459526	2.503292685	5.349322618	0	0.551987281	2.508789891	4.879157091	17.94610404	0.009412944	2.462321274	0	0	4.036790205	4.895010703	0	0	0.215802313	0.974307682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1537	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	NO	0	15.592	0.032241074	7.079850116	0	7.341287851	1.365898908	1.022188932	1.463452927	5.924459526	2.503292685	5.349322618	0	0.551987281	2.508789891	4.879157091	17.94610404	0.009412944	2.462321274	0	0	4.036790205	4.895010703	0	0	0.215802313	0.974307682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1537
H0303_015_0	2012	5																															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	1399.698952	4.680639603	912.033622	766.6087045	437.3142171	7.663525239	15.29851297	300.8952814	62.17063508	19.00772482	56.12020243	0	3.788616095	28.20309752	8752.817658	7835.774834	9.259480337	1010.196898	0	0	30.67242763	1909.056994	0	0	83.46255522	463.9784213	0	4.973889812	82.6452454	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	55.29917176	0	200	0.2	0.110330806	64.61541473	0.16	0.189442633	0.179403324	0	0.2	0.14518341	3.449203441	39.42399555	38.5	40	0	0	0.2	38.64092943	0	0	40	30	0	0	0	0											NO	153.7335526	87.0951516	45.47532681	0	164.4701914	0.164470191	0.090730644	53.15796344	0.131576153	0.155788331	0.147532495	0	0.164470191	0.119391716	3.40137139	38.87729841	37.96609878	39.44529743	0	0	0.164470191	31.77640529	0	0	40	30	0	0	0	0												17.9317	0.033971751	3.456252252	0	5.993762748	1.260421463	1.388043936	1.332915031	8.180172999	2.96118172	8.279553501	0	0.623114414	3.367216219	2.480965297	25.38614638	0.029295529	3.320626425	0	0	5.044700043	5.055247395	0	0	0.278208517	1.159946053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5635	0	NO	14.46019151	17.9317	0.033971751	3.456252252	0	5.993762748	1.260421463	1.388043936	1.332915031	8.180172999	2.96118172	8.279553501	0	0.623114414	3.367216219	2.480965297	25.38614638	0.029295529	3.320626425	0	0	5.044700043	5.055247395	0	0	0.278208517	1.159946053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5635	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	NO	0	17.9317	0.033971751	3.456252252	0	5.993762748	1.260421463	1.388043936	1.332915031	8.180172999	2.96118172	8.279553501	0	0.623114414	3.367216219	2.480965297	25.38614638	0.029295529	3.320626425	0	0	5.044700043	5.055247395	0	0	0.278208517	1.159946053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5635
H0303_034_0	2012	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	355.2044889	5.276507749	42.53488592	1260.389451	24.0516791	10.24762795	18.39838415	32.55126244	77.48156252	22.26289367	59.53098662	0	3.852084958	44.20120179	40.68750075	156.001292	1.898126755	3.481600031	0	0	33.61571584	18.96202974	0	503.1833258	78.20360852	574.7141954	0	0	81.19209852	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.081578831	0.082560707	0.14426205	0	0.224	0.224	0.224	0.104593941	0.224	0.224	0.224	0	0.224	0.224	0.21937083	0.223968344	0.226810228	0.224	0	0	0.224	0.221535079	0	0	0	0	0	0	0	0											NO	0.063529631	0.064294268	0.112344277	0	0.174440319	0.174440319	0.174440319	0.081475131	0.174440319	0.174440319	0.174440319	0	0.174440319	0.174440319	0.170835346	0.174415667	0.176628789	0.174440319	0	0	0.174440319	0.174548403	0	0	0	0	0	0	0	0												22.566	0.339249204	4.778551023	0	4.195582582	1.787599491	3.209420005	2.652118372	13.51590851	3.88354628	10.38460431	0	0.67195893	7.710471754	6.950863284	27.20906938	0.335263829	0.607331421	0	0	5.863936205	3.309792002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9713	150	YES	34.03434525	22.566	0.339249204	4.778551023	0	4.195582582	1.787599491	3.209420005	2.652118372	13.51590851	3.88354628	10.38460431	0	0.67195893	7.710471754	6.950863284	27.20906938	0.335263829	0.607331421	0	0	5.863936205	3.309792002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9713	NO																																										0	0	0	0	0	0	0	0	0	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	22.566	0.339249204	4.778551023	0	4.195582582	1.787599491	3.209420005	2.652118372	13.51590851	3.88354628	10.38460431	0	0.67195893	7.710471754	6.950863284	27.20906938	0.335263829	0.607331421	0	0	5.863936205	3.309792002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9713
H0303_801_0	2012	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	273.3664844	5.06669861	29.98087962	926.5083685	19.71274169	10.49621465	16.88743687	18.12797258	75.88453538	22.65251201	79.42623192	0	3.991854643	36.88033088	43.90940503	144.243609	1.884525135	8.77677927	0	0	61.2707172	17.98045844	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081241495	0.081241495	0.155021311	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061343153	0.061343153	0.117052204	0	0.169136059	0.169136059	0.169136059	0.169136059	0.169136059	0.169136059	0.169136059	0	0.169136059	0.169136059	0.169136059	0.169136059	0.169136059	0.169136059	0	0	0.169136059	0.169136059	0	0	0	0	0	0	0	0												16.7692	0.31080727	3.509328029	0	3.334135442	1.77528838	2.856274518	3.06609384	12.83481125	3.831356607	13.43383985	0	0.675166562	6.23779382	7.42666372	24.39679556	0.318741154	1.484469856	0	0	10.36308764	3.04114388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.665	150	YES	37.5191166	16.7692	0.31080727	3.509328029	0	3.334135442	1.77528838	2.856274518	3.06609384	12.83481125	3.831356607	13.43383985	0	0.675166562	6.23779382	7.42666372	24.39679556	0.318741154	1.484469856	0	0	10.36308764	3.04114388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.665	NO																																										0	0	0	0	0	0	0	0	0	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	16.7692	0.31080727	3.509328029	0	3.334135442	1.77528838	2.856274518	3.06609384	12.83481125	3.831356607	13.43383985	0	0.675166562	6.23779382	7.42666372	24.39679556	0.318741154	1.484469856	0	0	10.36308764	3.04114388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.665
H0303_804_0	2012	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	269.0618411	4.442498188	28.27937105	872.2924952	16.20104263	10.31932087	18.93648141	18.18783912	70.32225368	20.90180004	61.41523597	0	3.854152146	32.43219329	41.79421433	135.2089544	1.830748203	8.291956454	0	0	51.17635131	17.52257311	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081714495	0.081714495	0.146225569	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063367211	0.063367211	0.113393671	0	0.173705478	0.173705478	0.173705478	0.173705478	0.173705478	0.173705478	0.173705478	0	0.173705478	0.173705478	0.173705478	0.173705478	0.173705478	0.173705478	0	0	0.173705478	0.173705478	0	0	0	0	0	0	0	0												17.0497	0.281508722	3.206701709	0	2.814209857	1.792522566	3.289370558	3.15932729	12.2153607	3.63075717	10.66816293	0	0.669487341	5.633649643	7.259883984	23.48653607	0.318010992	1.440358261	0	0	8.889612574	3.04376694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8489	150	YES	31.51601629	17.0497	0.281508722	3.206701709	0	2.814209857	1.792522566	3.289370558	3.15932729	12.2153607	3.63075717	10.66816293	0	0.669487341	5.633649643	7.259883984	23.48653607	0.318010992	1.440358261	0	0	8.889612574	3.04376694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8489	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	NO	0	17.0497	0.281508722	3.206701709	0	2.814209857	1.792522566	3.289370558	3.15932729	12.2153607	3.63075717	10.66816293	0	0.669487341	5.633649643	7.259883984	23.48653607	0.318010992	1.440358261	0	0	8.889612574	3.04376694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8489
H0303_805_0	2012	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	249.211555	4.200365633	26.65941354	854.1253627	15.52914481	9.755451167	18.08792654	15.98335178	62.1569913	18.41152983	54.5973088	0	3.464797793	28.83347331	39.5534861	127.9313685	1.75462603	7.895243388	0	0	48.82137705	16.4217553	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081602484	0.081602484	0.162146715	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064696647	0.064696647	0.128554283	0	0.177593233	0.177593233	0.177593233	0.177593233	0.177593233	0.177593233	0.177593233	0	0.177593233	0.177593233	0.177593233	0.177593233	0.177593233	0.177593233	0	0	0.177593233	0.177593233	0	0	0	0	0	0	0	0												16.1232	0.271749573	3.427181798	0	2.757871036	1.732502114	3.212293356	2.83853512	11.03866105	3.269763111	9.696112592	0	0.615324642	5.120629749	7.02443148	22.71974536	0.31160971	1.4021418	0	0	8.670346199	2.916392617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1484	150	YES	26.95364948	16.1232	0.271749573	3.427181798	0	2.757871036	1.732502114	3.212293356	2.83853512	11.03866105	3.269763111	9.696112592	0	0.615324642	5.120629749	7.02443148	22.71974536	0.31160971	1.4021418	0	0	8.670346199	2.916392617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1484	NO																																										0	0	0	0	0	0	0	0	0	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	16.1232	0.271749573	3.427181798	0	2.757871036	1.732502114	3.212293356	2.83853512	11.03866105	3.269763111	9.696112592	0	0.615324642	5.120629749	7.02443148	22.71974536	0.31160971	1.4021418	0	0	8.670346199	2.916392617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1484
H0307_008_0	2012	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			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	1429.97	96.93	548.69	43.07	153.71	4.81	2.96	339.42	224.23	164.77	1406.89	66.61	0.35	1.54	3971.87	4586.94	54.91	651.09		1517.42	33.93	0			2.86				5.89	0.95	211.66	190.59									5000	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$150/Visit: 5. $35 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											145.768118	128.006658	6.843552	0	100	0.2	0.2	65	150	40.460655	58.43115	38.78386	0.2	0.2	15	34.949767	35	35		0	0.2	0			0				0	0	0	134.745574									NO	123.990944	108.882975	6.297238	0	91.3405	0.182681	0.182681	59.371325	137.01075	36.956965	53.371305	35.425372	0.182681	0.182681	13.701075	31.923292	31.969175	31.969175		0	0.182681	0			0				0	0	0	123.077281										14.7753	0.879502231	0.28793596	0	1.169995688	0.87869561	0.54073576	1.679317928	2.560160039	0.507449927	6.257296274	0.196640336	0.06393835	0.28132874	4.534907397	12.20251875	0.146285617	1.734567513	0	0	6.19836633	0	0	0	0	0	0	0	0	0	0	1.954774915	0	0	0	0	0	0	0	0	56.8497	0	NO	6.652622	14.7753	0.879502231	0.28793596	0	1.169995688	0.87869561	0.54073576	1.679317928	2.560160039	0.507449927	6.257296274	0.196640336	0.06393835	0.28132874	4.534907397	12.20251875	0.146285617	1.734567513	0	0	6.19836633	0	0	0	0	0	0	0	0	0	0	1.954774915	0	0	0	0	0	0	0	0	56.8497	YES	$0-$265/Day(Days 1-7)	$0-$265/Day(Days 1-7)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $0-$150/Visit	$40-$150/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20% Coins	$0/Service			"VIS752: Vision 17a,17b"						25% Coins	30% Coins; $100-$150/Visit									5000	1.0128	0.0603	0.2738	0.1858	0.7178	0.2538	0.156	0.0754	0.5052	0.0655	0.3895	0.0129	0.0029	0.0128	0.3665	0.4232	0.0051	0.0759		0	0.1971	0			0				0		0.0172	0.0934									4.9029	149	NO	1.358692	15.7881	0.939787231	0.56172196	0.185824	1.887770688	1.13245361	0.69678476	1.754750928	3.065312039	0.572938927	6.646812274	0.209539336	0.06686635	0.29408974	4.901378397	12.62573975	0.151351617	1.810460513	0	0	6.39546533	0	0	0	0	0	0	0	0	0	0.017227	2.048215915	0	0	0	0	0	0	0	0	61.7526
H0307_009_0	2012	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		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	982.66	52.61	371.95	713.41	135.54	6.21	2.19	385.47	300.79	365.78	1101.35	128.48	0.25	2.37	3539.67	3949.1	48.62	562.46		1915.95	31.88	0		2.54	2.86				5.89	0.95	420.54	320.9									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$150/Visit: 5. $40 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.206824	37.847069	0	100	0.2	0.2	65	150	41.126516	63.480496	44.646616	0.152994	0.2	10	34.943629	35	35		0	0.2	0		0	0				0	0	0	140.934612									NO	144.797977	115.852083	35.285276	0	92.5916	0.185183	0.185183	60.18454	138.8874	38.079699	58.777607	41.339016	0.141659	0.185183	9.25916	32.354865	32.40706	32.40706		0	0.185183	0		0	0				0	0	0	130.493612										11.8573	0.507914841	1.093696534	0	1.045822122	1.14998643	0.40555077	1.933277886	3.481328421	1.160732692	5.394559789	0.442603065	0.03541475	0.43888371	2.731197573	10.64771645	0.131302605	1.518972914	0	0	5.90363404	0	0	0	0	0	0	0	0	0	0	3.489616674	0	0	0	0	0	0	0	0	53.3695	0	NO	4.911533	11.8573	0.507914841	1.093696534	0	1.045822122	1.14998643	0.40555077	1.933277886	3.481328421	1.160732692	5.394559789	0.442603065	0.03541475	0.43888371	2.731197573	10.64771645	0.131302605	1.518972914	0	0	5.90363404	0	0	0	0	0	0	0	0	0	0	3.489616674	0	0	0	0	0	0	0	0	53.3695	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-7)			$100/Trip			$65/Visit	$0-$150/Visit	$50/Visit	$0-$150/Visit	$150/Visit	20% Coins	20% Coins				$35/Visit						"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"							$35-$150/Visit									5000	0.6935	0.0326			0.6351			0.086	0.0807	0.0516	0.0457	0.0028	0.0016	0.0197				0						0	0				0			0.1552									1.8043	0	NO	0.189119	12.5507	0.540515841	1.093696534	0	1.680945122	1.14998643	0.40555077	2.019241886	3.561991421	1.212344692	5.440217789	0.445396065	0.03697275	0.45862171	2.731197573	10.64771645	0.131302605	1.518972914	0	0	5.90363404	0	0	0	0	0	0	0	0	0	0	3.644781674	0	0	0	0	0	0	0	0	55.1738
H0307_011_0	2012	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	Inpatient Facility	OP Facility - Other	OP Facility - Other	Skilled Nursing Facility						Prosthetics/Supplies	Acute	Lab	Other							Coin	D	Coin	V	T	Coin	Coin	V	V	Coin	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				O	O	O	D	V	V	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	42.5	34.48	1.41	738.4	169.93	6.64	1.71	297.64	210.46	0.25	1135.41	73.15	0.36	1.64	3270.05	3335.48	57.81	485.32		1649.71	22.12	0		2.54	2.86				5.89	0.95	373.51	1049.01	185.25	171.94	351.24						5000	0% Coins: 1a. 0% IP Acute - Physician	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	0% Coins(Days 1-100) : 2. 0% SNF - Physician	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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% Coins: 8a. 0% Lab -- FSL	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$30-$150/Visit: 5. $30 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1	$50/Visit: 8a. $50 Lab -- OP	"$35-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3"								0	77.573765	0	0	100	0.2	0.2	65	150	0	60.170272	34.95721	0.19976	0.2	10	29.792135	30	30.491336		0	0.2	0		0	0				0	0	0	94.379573	50	132.952953	37.847069						NO	0	73.611141	0	0	96.379	0.192758	0.192758	62.64635	144.5685	0	57.991507	33.69141	0.192527	0.192758	9.6379	28.713361	28.9137	29.387245		0	0.192758	0		0	0				0	0	0	89.558475	48.1895	128.138726	36.874475							0	0.211509345	0	0	1.364806956	1.27991312	0.32961618	1.553838301	2.535490543	0	5.487011414	0.20537722	0.06930972	0.31612312	2.626367908	7.981070112	0.13929175	1.188518145	0	0	4.26380696	0	0	0	0	0	0	0	0	0	0	7.828977988	0.743925406	1.836014379	1.079315883	0	0	0	0	0	41.0403	0	NO	1.660589	0	0.211509345	0	0	1.364806956	1.27991312	0.32961618	1.553838301	2.535490543	0	5.487011414	0.20537722	0.06930972	0.31612312	2.626367908	7.981070112	0.13929175	1.188518145	0	0	4.26380696	0	0	0	0	0	0	0	0	0	0	7.828977988	0.743925406	1.836014379	1.079315883	0	0	0	0	0	41.0403	NO																																																																																		0	0	NO	0	0	0.211509345	0	0	1.364806956	1.27991312	0.32961618	1.553838301	2.535490543	0	5.487011414	0.20537722	0.06930972	0.31612312	2.626367908	7.981070112	0.13929175	1.188518145	0	0	4.26380696	0	0	0	0	0	0	0	0	0	0	7.828977988	0.743925406	1.836014379	1.079315883	0	0	0	0	0	41.0403
H0307_012_0	2012	6	r.	s.	t.	u.							Inpatient Facility	OP Facility - Other	OP Facility - Other	Skilled Nursing Facility							Acute	Lab	Other								Coin	D	Coin	V	T	Coin	Coin	V	V	Coin	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				O	O	D	V	V	D							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0	0							0	YES	41.68	55.32	2.92	2054.91	151.18	10.83	3.94	351.97	275.63	0.53	1201.97	89.78	0.48	3.77	4108.03	4291.27	84.89	669.25		1841.36	26.03	0		2.54	2.86				5.89	0.95	1378.9	408.52	328.48	480.69							5000	0% Coins: 1a. 0% IP Acute - Physician	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	0% Coins(Days 1-100) : 2. 0% SNF - Physician	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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% Coins: 8a. 0% Lab -- FSL	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$150/Visit: 5. $35 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$7/Visit: 4b, 7a, 8a, 8b. $7 Physician Services PCP,4b, 7a, 8a, 8b. $7 PCP Cap"	"$7-$35/Visit: 7b. $7 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1	$50/Visit: 8a. $50 Lab -- OP	"$35-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3"									0	131.206824	0	0	100	0.2	0.156243	65	200	0	66.864548	47.672465	0.199457	0.2	7	34.337077	35	35		0	0.2	0		0	0				0	0	163.989133	50	124.063257	37.847069							NO	0	109.647444	0	0	90.6684	0.181337	0.141663	58.93446	181.3368	0	60.625016	43.223861	0.180844	0.181337	6.346788	31.132878	31.73394	31.73394		0	0.181337	0		0	0				0	0	137.043094	45.3342	112.48617	33.763786								0	0.505474717	0	0	1.142270726	1.96387971	0.55815222	1.728596824	4.165155182	0	6.072454207	0.32338652	0.08680512	0.68364049	2.172732959	11.13329878	0.224491181	1.769828279	0	0	4.72020211	0	0	0	0	0	0	0	0	0	15.74739353	1.543327282	3.079121427	1.352492858	0	0	0	0	0	0	58.9727	0	NO	7.616856	0	0.505474717	0	0	1.142270726	1.96387971	0.55815222	1.728596824	4.165155182	0	6.072454207	0.32338652	0.08680512	0.68364049	2.172732959	11.13329878	0.224491181	1.769828279	0	0	4.72020211	0	0	0	0	0	0	0	0	0	15.74739353	1.543327282	3.079121427	1.352492858	0	0	0	0	0	0	58.9727	YES	$0/Day(Days 1-1)	$0-$265/Day(Days 1-7)	30% Coins(Days 1-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $0-$150/Visit	$40-$150/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$265/Day(Days 1-7)	30% Coins	30% Coins; $100-$150/Visit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"							5000	0	0.034	0.0156	1.2145	0.6796	0.5501	0.2003	0.0753	0.5265	0.0063	0.3279	0.0189	0.0038	0.0301	0.3649	0.3811	0.0075	0.0923		0	0.1602	0		0	0				0		0.965	0.0718	0.1501	0.2343							6.1102	149	NO	1.701894	0	0.539473717	0.015559	1.214511	1.821851726	2.51401871	0.75846522	1.803894824	4.691659182	0.006319	6.400375207	0.34232852	0.09060812	0.71371949	2.537602959	11.51444378	0.232031181	1.862166279	0	0	4.88036611	0	0	0	0	0	0	0	0	0	16.71242253	1.615123282	3.229230427	1.586757858	0	0	0	0	0	0	65.0829
H0307_013_0	2012	6	r.	s.	t.	u.							Inpatient Facility	OP Facility - Other	OP Facility - Other	Skilled Nursing Facility							Acute	Lab	Other								Coin	D	Coin	V	T	Coin	Coin	V	V	Coin	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				O	O	D	V	V	D							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0	0							0	YES	37.13	53.51	2.6	1987.51	146.22	9.65	3.51	340.42	266.59	0.47	1162.54	86.84	0.43	3.36	3973.29	4150.52	82.1	647.3		1780.96	23.19	0		2.54	2.86				5.89	0.95	1333.67	395.12	317.71	464.92							5000	0% Coins: 1a. 0% IP Acute - Physician	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	0% Coins(Days 1-100) : 2. 0% SNF - Physician	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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% Coins: 8a. 0% Lab -- FSL	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$150/Visit: 5. $35 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1	$50/Visit: 8a. $50 Lab -- OP	"$35-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3"									0	131.206824	0	0	100	0.2	0.156243	65	150	0	66.864548	47.672465	0.199456	0.2	5	34.289725	35	35		0	0.2	0		0	0				0	0	163.989133	50	124.063257	37.847069							NO	0	111.139922	0	0	91.7201	0.18344	0.143307	59.618065	137.58015	0	61.328231	43.725233	0.182941	0.18344	4.586005	31.45057	32.102035	32.102035		0	0.18344	0		0	0				0	0	138.908471	45.86005	113.790943	34.188014								0	0.495591436	0	0	1.117609419	1.770196	0.50300757	1.691265141	3.056457682	0	5.941376806	0.316424936	0.07866463	0.6163584	1.518460651	10.87801832	0.219631423	1.731637271	0	0	4.2539736	0	0	0	0	0	0	0	0	0	15.43817171	1.51001858	3.012710042	1.324557622	0	0	0	0	0	0	55.4741	0	NO	6.468441	0	0.495591436	0	0	1.117609419	1.770196	0.50300757	1.691265141	3.056457682	0	5.941376806	0.316424936	0.07866463	0.6163584	1.518460651	10.87801832	0.219631423	1.731637271	0	0	4.2539736	0	0	0	0	0	0	0	0	0	15.43817171	1.51001858	3.012710042	1.324557622	0	0	0	0	0	0	55.4741	YES	$0/Day(Days 1-1)	$0-$265/Day(Days 1-7)	30% Coins(Days 1-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $0-$150/Visit	$40-$150/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		"DEN756: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$265/Day(Days 1-7)	30% Coins	30% Coins; $100-$150/Visit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"							5000	0	0.0339	0.0149	1.1062	0.6721	0.5011	0.1825	0.0745	0.4796	0.0058	0.3223	0.0187	0.0035	0.0274	0.3608	0.3769	0.0075	0.0913		0	0.1459	0		0	0				0		0.9611	0.0654	0.1484	0.2239							5.8235	149	NO	1.469134	0	0.529451436	0.014871	1.10623	1.789696419	2.271287	0.68546057	1.765733141	3.536020682	0.005756	6.263661806	0.335157936	0.08212863	0.6437564	1.879306651	11.25496032	0.227088423	1.822956271	0	0	4.3998576	0	0	0	0	0	0	0	0	0	16.39926371	1.57541258	3.161154042	1.548459622	0	0	0	0	0	0	61.2977
H0307_801_0	2012	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	251.21	2.92	44.84	24.96	8.58	13.89	4.22	24.21	64.34	8.67	29.86	0.66	0.48	18.81	38.22	95.89	0.66	7.57		15.54	33.16	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																					0.0831	0.0831	0.1353	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070375	0.070375	0.109939	0	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136		0.200136	0.200136	0																				17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157	0	NO	13.075331	17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157	NO																																																																																		0	0	NO	0	17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157
H0307_802_0	2012	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	250.91	2.91	44.78	24.93	8.56	13.87	4.21	24.18	64.26	8.66	29.83	0.66	0.47	18.79	38.18	95.78	0.66	7.56		15.53	33.12	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																					0.0831	0.0831	0.1353	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070395	0.070395	0.109994	0	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173	0.200173		0.200173	0.200173	0																				17.6628	0.20484945	4.92553132	0	1.71348088	2.77639951	0.84272833	4.84018314	12.86311698	1.73349818	5.97116059	0.13211418	0.09408131	3.76125067	7.64260514	19.17256994	0.13211418	1.51330788	0	3.10868669	6.62972976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7202	0	NO	13.038747	17.6628	0.20484945	4.92553132	0	1.71348088	2.77639951	0.84272833	4.84018314	12.86311698	1.73349818	5.97116059	0.13211418	0.09408131	3.76125067	7.64260514	19.17256994	0.13211418	1.51330788	0	3.10868669	6.62972976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7202	NO																																																																																		0	0	NO	0	17.6628	0.20484945	4.92553132	0	1.71348088	2.77639951	0.84272833	4.84018314	12.86311698	1.73349818	5.97116059	0.13211418	0.09408131	3.76125067	7.64260514	19.17256994	0.13211418	1.51330788	0	3.10868669	6.62972976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7202
H0307_803_0	2012	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	251.21	2.92	44.84	24.96	8.58	13.89	4.22	24.21	64.34	8.67	29.86	0.66	0.48	18.81	38.22	95.89	0.66	7.57		15.54	33.16	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																					0.0831	0.0831	0.1353	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070375	0.070375	0.109939	0	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136		0.200136	0.200136	0																				17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157	0	NO	13.075397	17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157	NO																																																																																		0	0	NO	0	17.6789	0.205495	4.92966476	0	1.71716688	2.77988904	0.84457392	4.84529256	12.87675024	1.73517912	5.97606096	0.13208976	0.09606528	3.76455816	7.64919792	19.19104104	0.13208976	1.51502952	0	3.11011344	6.63650976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8157
H0316_002_0	2012	6																															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	911.1412303	87.11081813	546.23363	697.0806537	147.6043911	8.136312472	8.248087528	376.5343481	54.7679528	19.65142265	38.54489087	0	0.000881992	19.06536193	5295.300242	3284.149786	479.9572044	352.3616421	0	0	30.78219102	813.8707353	0	0	37.44186047	0	5.137993967	0	412.4484497	0											4900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$15/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	73.1274906	0	200	0.2	0.095206595	62.82346978	0.16	0.174618233	0.176262466	0	0.2	0.14595618	9.3326189	44.44037374	38.5	45	0	0	0.2	43.64517484	0	0	45	0	38.39672824	0	0	0											NO	170.9291939	89.52578703	60.0487317	0	164.2302538	0.164230254	0.078179016	51.60391696	0.131384203	0.143387984	0.144738148	0	0.164230254	0.119852102	9.05463831	43.11689759	37.35324228	43.65963384	0	0	0.164230254	35.8392907	0	0	45	0	38.39672824	0	0	0												12.9784	0.649888713	2.733386391	0	2.020092218	1.336228662	0.644827369	1.619220603	7.195643831	2.817777874	5.578916103	0	0.00014485	2.285023706	3.995585703	11.80019583	1.493996478	1.281998356	0	0	5.055367043	2.43071249	0	0	0.140406977	0	0.01644018	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0742	0	NO	10.8814628	12.9784	0.649888713	2.733386391	0	2.020092218	1.336228662	0.644827369	1.619220603	7.195643831	2.817777874	5.578916103	0	0.00014485	2.285023706	3.995585703	11.80019583	1.493996478	1.281998356	0	0	5.055367043	2.43071249	0	0	0.140406977	0	0.01644018	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0742	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$55 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$55 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$55 (7c, 7i)"	Included in h.2.	$25/$55 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $55 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$55 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$55 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.5871	0.014	0.2043	0.1492	0.171	0	0.172	0.137	0.9138	0.2386	0.6937	0	0	0.2897	1.098	2.1386	0.2485	0.2307	0	0	1.3192	0.5136	0	0	0.0245	0	0.0023	0	0	0											9.1458	0	NO	0	13.5654	0.663869913	2.93764042	0.149243758	2.191113348	1.336228662	0.816846307	1.756260498	8.1094193	3.05633112	6.272659489	0	0.000157113	2.574692602	5.093540699	13.93877668	1.742545745	1.512711336	0	0	6.374603801	2.944291653	0	0	0.164922481	0	0.018788777	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2201
H0316_014_0	2012	6																															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	757.6841133	82.86602841	467.5650108	245.7095306	144.8522666	10.08702498	8.728611071	456.4794936	55.32681875	14.33939848	35.70801672	0	0.022111366	23.63144221	5016.064942	2839.078383	471.9623481	417.5281141	0	0	18.19035021	692.4192284	0	0	43.37419194	221.1369521	6.541228819	0	90.15197224	0											3950	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	76.65800612	61.5298646	0	200	0.2	0.116444463	63.5596338	0.16	0.198071206	0.176233376	0	0.2	0.146170848	7.195050608	38.70560326	38.5	40	0	0	0.2	39.2968154	0	0	40	30	40	0	0	0											YES	137.1171501	62.41518649	50.09780672	0	162.8406207	0.162840621	0.094809443	51.76423497	0.130272497	0.161270191	0.143489761	0	0.162840621	0.119012758	6.971700422	37.5050321	37.30487538	38.75831208	0	0	0.162840621	31.99558906	0	0	40	30	40	0	0	0											4250	8.6576	0.431008218	1.951998462	0	1.965652751	1.642577408	0.827554757	1.969109314	7.207562805	2.312517531	5.123734796	0	0.003600629	2.812443116	2.914208506	8.873310491	1.467208048	1.348557079	0	0	2.962127918	1.846196757	0	0	0.14458064	0.55284238	0.021804096	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0362	0	NO	9.52942921	8.6576	0.431008218	1.951998462	0	1.965652751	1.642577408	0.827554757	1.969109314	7.207562805	2.312517531	5.123734796	0	0.003600629	2.812443116	2.914208506	8.873310491	1.467208048	1.348557079	0	0	2.962127918	1.846196757	0	0	0.14458064	0.55284238	0.021804096	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0362	NO	"$275 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-16 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-25 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$15 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$15/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1116	0.01	0.0832	0.0874	0.1175	0	0.1275	0.1178	0.6465	0.1383	0.4493	0	0.0002	0.2519	0.6542	1.4322	0.2317	0.212	0	0	0.546	0.2547	0	0	0.0232	0	0.0034	0	0	0											5.4988	0	NO	1.395786235	8.7692	0.441002928	2.035218367	0.087441344	2.083197593	1.642577408	0.955050572	2.086888286	7.854074633	2.450804678	5.573066345	0	0.003815944	3.064371472	3.568387633	10.30551309	1.698909799	1.560603498	0	0	3.508127189	2.100931278	0	0	0.167816814	0.55284238	0.025174373	0	0	0	0	0	0	0	0	0	0	0	0	0	60.535
H0316_801_0	2012	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	193.2440959	4.2657	18.09308049	785.7411882	11.18476162	8.602510199	9.326940948	22.45639422	61.75130984	22.15713802	43.45967627	0	0.000994453	21.48198347	36.70752431	84.71741157	2.013	3.692607076	0	0	37.19538453	9.230851997	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.076186708	0.076186708	0.159239807	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064279248	0.064279248	0.134351717	0	0.188990336	0.188990336	0.188990336	0.188990336	0.188990336	0.188990336	0.188990336	0	0.188990336	0.188990336	0.188990336	0.188990336	0.188990336	0.188990336	0	0	0.188990336	0.188990336	0	0	0	0	0	0	0	0												12.4216	0.274195987	2.430836433	0	2.113811854	1.625791291	1.762701701	4.244041482	11.67040078	4.187484953	8.213458811	0	0.000187942	4.059887268	6.937367344	16.01077206	0.380437546	0.697867051	0	0	7.02956821	1.744541818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8049	150	YES	15.89500355	12.4216	0.274195987	2.430836433	0	2.113811854	1.625791291	1.762701701	4.244041482	11.67040078	4.187484953	8.213458811	0	0.000187942	4.059887268	6.937367344	16.01077206	0.380437546	0.697867051	0	0	7.02956821	1.744541818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8049	NO																																										0	0	0	0	0	0	0	0	0	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	12.4216	0.274195987	2.430836433	0	2.113811854	1.625791291	1.762701701	4.244041482	11.67040078	4.187484953	8.213458811	0	0.000187942	4.059887268	6.937367344	16.01077206	0.380437546	0.697867051	0	0	7.02956821	1.744541818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8049
H0316_804_0	2012	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	193.2440959	4.2662	18.09308049	785.7411882	11.18476162	8.602510199	9.326940948	22.45639422	61.75130984	22.15713802	43.45967627	0	0.000994453	21.48118347	36.70752431	84.71741157	2.012	3.692607076	0	0	37.19538453	9.230851997	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.076186708	0.076186708	0.159239807	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064279314	0.064279314	0.134351856	0	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0	0	0.188990531	0.188990531	0	0	0	0	0	0	0	0												12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047	150	YES	15.89485768	12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047	NO																																										0	0	0	0	0	0	0	0	0	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	12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047
H0316_806_0	2012	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	193.2440959	4.2662	18.09308049	785.7411882	11.18476162	8.602510199	9.326940948	22.45639422	61.75130984	22.15713802	43.45967627	0	0.000994453	21.48118347	36.70752431	84.71741157	2.012	3.692607076	0	0	37.19538453	9.230851997	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.076186708	0.076186708	0.159239807	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064279314	0.064279314	0.134351856	0	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0.188990531	0	0	0.188990531	0.188990531	0	0	0	0	0	0	0	0												12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047	150	YES	15.89485768	12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047	NO																																										0	0	0	0	0	0	0	0	0	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	12.4216	0.274228411	2.430838949	0	2.113814042	1.625792974	1.762703526	4.244045875	11.67041286	4.187489287	8.213467312	0	0.000187942	4.059740278	6.937374525	16.01078863	0.380248949	0.697867773	0	0	7.029575486	1.744543624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8047
H0317_001_0	2012	8	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	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	315.37	13.58	555.68	1016	29.02	18.9	9.67	434.28	452.86	846.11	1557.45	455.87	0.38	6.97	3765.99	5827.21	127.33	1144.46		1569.76	41.5	0		4.04	0.61				5.89	0.95	1253.29	436.84									3400	"$0-$300/Admit: 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$300/Admit: 1b. $300 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$25-$150/Visit: 5. $25 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$15/Visit: 7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit: 7e, 7h. $15 Psych -- Other Provider"	"$15-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											300	300	37.847069	0	100	0.2	0.2	65	150	116.909234	66.306451	29.527394	0.199445	0.2	5	14.050331	15	17.550736		0	0.2	0		0	0				0	0	0	120.457721									NO	237.066	237.066	26.64146	0	85.9611	0.171922	0.171922	55.874715	128.94165	100.496463	56.997755	25.382072	0.171445	0.171922	4.298055	12.077819	12.894165	15.086806		0	0.171922	0		0	0				0	0	0	103.546782										6.2303	0.26827969	1.233677208	0	0.207882594	3.2493258	1.66248574	2.022105936	4.866042968	7.085921859	7.397596127	0.964243764	0.0651491	1.19829634	1.348869346	5.864998971	0.136817836	1.438853833	0	0	7.134763	0	0	0	0	0	0	0	0	0	0	3.769448021	0	0	0	0	0	0	0	0	56.1451	0	NO	10.150812	6.2303	0.26827969	1.233677208	0	0.207882594	3.2493258	1.66248574	2.022105936	4.866042968	7.085921859	7.397596127	0.964243764	0.0651491	1.19829634	1.348869346	5.864998971	0.136817836	1.438853833	0	0	7.134763	0	0	0	0	0	0	0	0	0	0	3.769448021	0	0	0	0	0	0	0	0	56.1451	YES	$0-$600/Admit	$0-$600/Admit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"	25% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	15% Coins	15% Coins	15%-20% Coins	15%-20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	15%-20% Coins		20% Coins	20% Coins	$0/Service		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins	15% Coins									3400	1.0702	0.0461	0.2776	1.4605	1.2944	0.8083	0.4134	0.1798	1.076	0.1074	0.4613	0.0586	0.0059	0.1076	0.7719	1.7065	0.0176	0.1781		0.1306	0.7588	0		0	0				0	0	0.0778	0.1706									11.1788	0	NO	5.014469	7.3004	0.31435669	1.511315208	1.460461	1.502288594	4.0575858	2.07587274	2.201866936	5.942033968	7.193297859	7.858925127	1.022860764	0.0710301	1.30584734	2.120765346	7.571525971	0.154384836	1.616988833	0	0.130616	7.893573	0	0	0	0	0	0	0	0	0	0.077773	3.940026021	0	0	0	0	0	0	0	0	67.3238
H0317_002_0	2012	9																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	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	295.13	6.19	23.36	17.84	0.88	10.64	4.11	24.51	69.21	5.61	31.38	1.62	0.57	11.86	37.17	94.46	0.65	8.33		7.23	32.77	0		3.17	0.79				5.89	0.95											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		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													0.0831	0.0831	0.1353	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0		0	0				0	0											NO	0.065226	0.065226	0.099219	0	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039	0.20039		0.20039	0.20039	0		0	0				0	0												19.2501	0.40374894	2.31775584	0	0.1763432	2.1321496	0.8236029	4.9115589	13.8689919	1.1241879	6.2882382	0.3246318	0.1142223	2.3766254	7.4484963	18.9288394	0.1302535	1.6692487	0	1.4488197	6.5667803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3046	0	NO	14.27982	19.2501	0.40374894	2.31775584	0	0.1763432	2.1321496	0.8236029	4.9115589	13.8689919	1.1241879	6.2882382	0.3246318	0.1142223	2.3766254	7.4484963	18.9288394	0.1302535	1.6692487	0	1.4488197	6.5667803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3046	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		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"																10000	2.5886	0.0541	0.3291	0	1.3286	0.5139	0.1984	0.5341	1.5741	0.1224	0.7093	0.0409	0.0125	0.2584	0.96	2.4397	0.0167	0.2093		0.1866	0.8464	0		0	0				0	0											12.9231	0	NO	0.970733	21.8388	0.45787594	2.64686384	0	1.5049752	2.6460506	1.0219699	5.4456979	15.4430699	1.2465489	6.9975082	0.3655298	0.1266833	2.6350284	8.4084933	21.3685394	0.1469535	1.8785117	0	1.6354647	7.4132253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2277
H0317_004_0	2012	9	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Skilled Nursing Facility								Prosthetics/Supplies	Other									D	D	Coin	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V				O	O	O	V	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	YES	1060.93	33.56	2.52	721.72	21.06	10.83	3.21	336.28	302.57	915.21	1056	218.11	0.29	7.77	2813.51	4579.88	94.61	702.69		1684.37	23.7	0		3.17	0.61				5.89	0.95	761.96	640.32	447.03								5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	0% Coins(Days 1-100) : 2. 0% SNF - Physician	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3"										163.989133	131.206824	0	0	100	0.2	0.2	65	100	77.98753	64.296325	49.874216	0.199381	0.2	15	38.436954	40	51.129928		0	0.2	0		0	0				0	0	0	93.526565	37.847069								NO	136.514885	109.224827	0	0	91.1632	0.182326	0.182326	59.25608	91.1632	71.095928	58.614587	45.466932	0.181762	0.182326	13.67448	35.040357	36.46528	46.611678		0	0.182326	0		0	0				0	0	0	85.26181	31.216262									12.0694	0.305465433	0	0	0.159991416	1.97459058	0.58526646	1.660552882	2.298604119	5.422308689	5.158083656	0.826399378	0.05271098	1.41667302	3.206107185	13.37338585	0.287498345	2.729463334	0	0	4.3211262	0	0	0	0	0	0	0	0	0	0	4.549570182	1.1628838	0	0	0	0	0	0	0	61.5601	0	NO	7.392496	12.0694	0.305465433	0	0	0.159991416	1.97459058	0.58526646	1.660552882	2.298604119	5.422308689	5.158083656	0.826399378	0.05271098	1.41667302	3.206107185	13.37338585	0.287498345	2.729463334	0	0	4.3211262	0	0	0	0	0	0	0	0	0	0	4.549570182	1.1628838	0	0	0	0	0	0	0	61.5601	YES	$0-$255/Day(Days 1-7)	$0-$255/Day(Days 1-7)	30% Coins(Days 1-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins; $0-$100/Visit	30% Coins; $100/Visit	$0-$100/Visit	$40-$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins	30% Coins; $100/Visit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"								7500	1.651	0.0459	0.0587	1.4325	1.1552	0.5695	0.1688	0.1712	0.4698	0.5784	0.5367	0.0945	0.0055	0.1473	1.0046	1.6353	0.0338	0.3064		0	0.5872	0		0	0				0	0	0.0681	0.5016	0.5566								11.7786	0	NO	1.447216	13.7204	0.351330433	0.058693	1.432533	1.315147416	2.54408558	0.75409346	1.831708882	2.768404119	6.000683689	5.694824656	0.920890378	0.05823598	1.56401702	4.210705185	15.00868685	0.321280345	3.035891334	0	0	4.9083302	0	0	0	0	0	0	0	0	0	0.068079	5.051156182	1.7194728	0	0	0	0	0	0	0	73.3386
H0317_006_0	2012	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	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	806.99	7.44	332.37	374.54	23.02	13.92	5.63	435.94	370.42	459.89	1327.6	71.12	0.32	2.72	3095.37	4347.29	80.58	884.93		1153.5	18.55	0			0.61				5.89	0.95	577.2	276.08									3400	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											127.547103	112.005826	37.847069	0	100	0.2	0.2	65	100	92.450815	62.197336	37.742892	0.2	0.2	15	32.857769	35	46.589376		0	0.2	0			0				0	0	0	95.241306									NO	104.597936	91.852954	30.11847	0	88.6211	0.177242	0.177242	57.603715	88.6211	81.930929	55.119963	33.448166	0.177242	0.177242	13.293165	29.118916	31.017385	41.288017		0	0.177242	0			0				0	0	0	84.403893										7.0341	0.056948831	0.834206323	0	0.17000481	2.46720864	0.99787246	2.09264696	2.735585655	3.139934578	6.09810524	0.19823613	0.05671744	0.48209824	3.428938679	10.54903103	0.20828174	3.044750407	0	0	3.2878391	0	0	0	0	0	0	0	0	0	0	1.941852232	0	0	0	0	0	0	0	0	48.8244	0	NO	7.02133	7.0341	0.056948831	0.834206323	0	0.17000481	2.46720864	0.99787246	2.09264696	2.735585655	3.139934578	6.09810524	0.19823613	0.05671744	0.48209824	3.428938679	10.54903103	0.20828174	3.044750407	0	0	3.2878391	0	0	0	0	0	0	0	0	0	0	1.941852232	0	0	0	0	0	0	0	0	48.8244	YES	$0-$175/Day(Days 1-7)	$0-$175/Day(Days 1-7)	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	0% Coins; $0-$100/Visit	30% Coins; $100/Visit	$0-$100/Visit	$40-$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service			"VIS775: Vision 17a,17b"						25% Coins	30% Coins; $100/Visit									5100	1.2631	0.0102	0.4375	1.199	1.8351	1.0641	0.4304	0.3226	0.4217	0.4895	0.9461	0.0395	0.0087	0.0749	1.6067	2.2566	0.0418	0.5571		0	0.6525	0			0				0	0	0.0714	0.3151									14.0438	500	NO	1.514762	8.2973	0.067180831	1.271685323	1.199042	2.00515381	3.53128564	1.42830846	2.41521196	3.157248655	3.629427578	7.04416924	0.23773013	0.06543044	0.55704224	5.035683679	12.80562503	0.25010974	3.601807407	0	0	3.9403391	0	0	0	0	0	0	0	0	0	0.071439	2.256952232	0	0	0	0	0	0	0	0	62.8681
H0317_007_0	2012	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		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	1235.59	58.71	490.47	1171.54	25.44	13.5	4.29	378.9	355.27	1500.7	1072.74	175.7	0.49	7.84	3108.82	3995.21	95.1	732.63		1615.75	24.41	0		3.17	0.61				5.89	0.95	1378.09	624.82									4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											163.989133	131.206824	37.847069	0	100	0.2	0.2	65	131.262655	74.030006	69.111526	47.519934	0.199088	0.2	15	33.203606	35	54.472682		0	0.2	0		0	0				0	0	0	92.561927									NO	126.620437	101.308332	28.471971	0	88.4416	0.176883	0.176883	57.48704	116.090792	65.473322	61.12334	42.02739	0.176076	0.176883	13.26624	29.3658	30.95456	48.176511		0	0.176883	0		0	0				0	0	0	81.863249										13.0376	0.495651014	1.163720635	0	0.187496192	2.3879205	0.75882807	1.815153288	3.436964639	8.187984527	5.464120979	0.615351035	0.08627724	1.38676272	3.436862686	9.776878152	0.245314888	2.941296438	0	0	4.31771403	0	0	0	0	0	0	0	0	0	0	4.262482937	0	0	0	0	0	0	0	0	64.0044	0	NO	10.821101	13.0376	0.495651014	1.163720635	0	0.187496192	2.3879205	0.75882807	1.815153288	3.436964639	8.187984527	5.464120979	0.615351035	0.08627724	1.38676272	3.436862686	9.776878152	0.245314888	2.941296438	0	0	4.31771403	0	0	0	0	0	0	0	0	0	0	4.262482937	0	0	0	0	0	0	0	0	64.0044	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-7)	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins; $0/Visit	30% Coins; $100/Visit	$0-$100/Visit	$40-$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins	30% Coins; $100/Visit									6000	1.6975	0.0708	0.5143	2.2103	1.5249	0.7755	0.2464	0.2108	1.8015	0.9911	0.6468	0.08	0.0101	0.1626	1.2132	1.5591	0.0371	0.3881		0	0.6674	0		0	0				0	0	0.1222	0.5353									15.465	250	NO	2.967587	14.735	0.566474014	1.678014635	2.210275	1.712391192	3.1634435	1.00521507	2.025928288	5.238507639	9.179049527	6.110966979	0.695386035	0.09641624	1.54935272	4.650061686	11.33598815	0.282427888	3.329383438	0	0	4.98509603	0	0	0	0	0	0	0	0	0	0.122168	4.797733937	0	0	0	0	0	0	0	0	79.4693
H0318_002_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1244.706696	263.0842652	759.7554707	603.9580581	156.5622873	12.21870231	0	300.9925382	387.4057464	2368.774521	2553.166709	122.5849494	0.008348245	331.2187792	3255.102391	4896.050442	405.5415547	774.262367	0	0	52.90173192	0.000935048	0	0	795.1205458	22.68028424	45.31925172	17.47508197	43.04141493	0											4900	$265/day 1-6; unlimited additional days	$235/day 1-6	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$265 per procedure	$0 to $45 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; $250 Complex Radiology	$45 per visit	20% per visit	$0 to 265 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	$150.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	178.5937298	102.795207	58.48044118	0	200	0.03	0.03	62	265	4.5	24.40504292	45	0.2	45	15	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	151.6897737	87.30979362	49.67075215	0	169.8713319	0.0254807	0	52.66011288	225.0795147	3.822104967	20.72858573	38.22104967	0.169871332	38.22104967	12.74034989	38.22104967	33.97426637	19.11052483	0	0	0.084935666	0	0	0	0	0	0	0	0	0												15.7341	1.914152742	3.14480214	0	2.216287022	0.311341085	0	1.32085842	7.266424782	0.754475405	4.410294584	0.390443787	0.001418127	1.054960784	3.455928616	15.59434893	1.148164734	1.233046683	0	0	4.49324383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4443	0	NO	12.2268796	15.7341	1.914152742	3.14480214	0	2.216287022	0.311341085	0	1.32085842	7.266424782	0.754475405	4.410294584	0.390443787	0.001418127	1.054960784	3.455928616	15.59434893	1.148164734	1.233046683	0	0	4.49324383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4443	NO																																																																																		0		NO		15.7341	1.914152742	3.14480214	0	2.216287022	0.311341085	0	1.32085842	7.266424782	0.754475405	4.410294584	0.390443787	0.001418127	1.054960784	3.455928616	15.59434893	1.148164734	1.233046683	0	0	4.49324383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4443
H0318_801_0	2012	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	0	0	0	0	0	0	0											0	YES	285.9828926	4.565912546	30.57369823	8.286003636	8.412652616	11.22779511	0	14.88951976	39.03912964	17.69399122	49.79776783	0.720979582	0.062966237	25.9881489	27.27741034	139.0505256	2.563664052	8.269180935	0	0	60.36513777	0.00027801	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	NO	0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067887591	0.067887591	0.110495202	0	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0.182939806	0	0	0	0	0	0	0	0												19.4147	0.309968804	3.378246954	0	1.539009039	2.054010662	0	2.72388586	7.141810812	3.236935326	9.109993998	0.131895865	0.011519031	4.754266924	4.990124162	25.43787622	0.468996205	1.512762358	0	0	11.04318661	5.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2592	0	NO	21.82949078	19.4147	0.309968804	3.378246954	0	1.539009039	2.054010662	0	2.72388586	7.141810812	3.236935326	9.109993998	0.131895865	0.011519031	4.754266924	4.990124162	25.43787622	0.468996205	1.512762358	0	0	11.04318661	5.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2592	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		19.4147	0.309968804	3.378246954	0	1.539009039	2.054010662	0	2.72388586	7.141810812	3.236935326	9.109993998	0.131895865	0.011519031	4.754266924	4.990124162	25.43787622	0.468996205	1.512762358	0	0	11.04318661	5.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2592
H0318_802_0	2012	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	0	0	0	0	0	0	0											0	YES	313.5919462	3.418122969	32.16922038	6.996305439	9.605594185	11.88977785	0	15.02770393	35.93885743	16.29483676	52.88229782	0.53973808	0.04713764	23.93083774	31.76563574	131.2991894	2.247766318	9.483293084	0	0	52.5940675	0.000208123	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	NO	0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067547318	0.067547318	0.109941367	0	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0.182022858	0	0	0	0	0	0	0	0												21.1823	0.23088504	3.536728063	0	1.748437703	2.16421134	0	2.735385612	6.541693527	2.966032751	9.625786965	0.098244668	0.008580128	4.355959471	5.782071791	23.89945365	0.409144848	1.726176107	0	0	9.57332246	3.79E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5844	0	NO	22.27379099	21.1823	0.23088504	3.536728063	0	1.748437703	2.16421134	0	2.735385612	6.541693527	2.966032751	9.625786965	0.098244668	0.008580128	4.355959471	5.782071791	23.89945365	0.409144848	1.726176107	0	0	9.57332246	3.79E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5844	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.1823	0.23088504	3.536728063	0	1.748437703	2.16421134	0	2.735385612	6.541693527	2.966032751	9.625786965	0.098244668	0.008580128	4.355959471	5.782071791	23.89945365	0.409144848	1.726176107	0	0	9.57332246	3.79E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5844
H0319_001_0	2012	3																															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	189.6448864	40.3824	9930.664605	4.115559786	18.48952705	90.77924275	4.291068651	9.455958426	76.34726898	42.43451189	19.69831894	0	0	12.05546243	3.005703679	152.0653285	18.163527	69.04987289	0	28264.17418	12.28564446	10.02469823	3185.197415	152	39.7630361	135.5347829	16.84440756	2.724297104	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.08132027	0.082307966	0	0	0.2	0.2	0.189741496	0.098183444	0.16	0	0.086606272	0	0	0.146494236	0	0.032976275	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.07430189	0.075204342	0	0	0.182738915	0.182738915	0.173365776	0.08970968	0.146191132	0	0.079131681	0	0	0.133850989	0	0.029858015	0.181087855	0	0	0	0.182738915	0.182973029	0	0	0	0	0	0	0	0												14.091	3.036931806	0	0	3.378756112	16.58890033	0.743924446	0.848291006	11.16129368	0	1.558761083	0	0	1.613635567	0	4.540368803	3.289194139	0	0	0	2.245065339	1.834249396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.9303	0	NO	6.208726577	14.091	3.036931806	0	0	3.378756112	16.58890033	0.743924446	0.848291006	11.16129368	0	1.558761083	0	0	1.613635567	0	4.540368803	3.289194139	0	0	0	2.245065339	1.834249396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.9303	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0.3559	0.0001	0.0772	0.3789	0.0179	0.0129	0.255	0	0.0631	0	0	0.0369	0.0233	1.9472	0.2325	0.006	0	0	0.1587	0.1296	0	0	0.0073	0	0.001	0	0	0											3.7035	0	NO	0.36997763	14.091	3.036931806	0.355948323	7.21E-05	3.45593582	16.9678346	0.761836392	0.861209143	11.41624709	0	1.621895807	0	0	1.650495262	0.023274452	6.487534601	3.521676447	0.005957714	0	0	2.403747968	1.963895296	0	0	0.007288725	0	0.001049261	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6338
H0320_005_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1443.599047	9.101962206	397.0449114		196.6472952	9.700630598	8.243864683	410.5591387	214.2396548		17.1532709	25.40919751	0.007259544	6.859848641		4119.873695	41.35439486	610.9633123			6.225477297				159.1037094																6000	"1a - IP Acute 220 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f (Podiatry) 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													220	142.4713977	60.09645318		250	0.2	0.2	64.68550489	400		0.2	400	0.2	0.199811891		29.18121911	40	20			0.2				5																NO	206.8990971	133.9872888	56.51773591		235.1126103	0.188090088	0.188090088	60.83351161	376.1801765		0.188090088	376.1801765	0.188090088	0.187913181		27.45589846	37.61801765	18.80900882			0.188090088				5																	24.8899	0.101628937	1.870006621	0	3.852854908	1.824592465	1.550589236	2.081312844	6.716059262	0	3.226360238	0.796536367	0.001365448	1.289055977	0	9.426236154	0.129639196	0.957634528	0	0	1.170950574	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9511	0		3.787388852	24.8899	0.101628937	1.870006621	0	3.852854908	1.824592465	1.550589236	2.081312844	6.716059262	0	3.226360238	0.796536367	0.001365448	1.289055977	0	9.426236154	0.129639196	0.957634528	0	0	1.170950574	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9511	NO																																																																																		0	0		0	24.8899	0.101628937	1.870006621	0	3.852854908	1.824592465	1.550589236	2.081312844	6.716059262	0	3.226360238	0.796536367	0.001365448	1.289055977	0	9.426236154	0.129639196	0.957634528	0	0	1.170950574	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9511
H0320_006_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	862.1697004	30.27987248	303.6006135		203.6947187	9.378126426	5.722820332	355.7031712	166.0045159		9.660059742	13.52514974	0.016204071	8.739417253	4187.35121	3588.896981	125.3444949	868.6557291			8.440816545				159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 225 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f (Podiatry) 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		225	0.2	0.2	63.45856067	400		0.2	400	0.2	0.199477608	5	29.41077412	40	20			0.2				5																NO	175.4474031	137.9444122	58.18690658		217.8506932	0.193645061	0.193645061	61.44218413	387.2901212		0.193645061	387.2901212	0.193645061	0.193139268	4.841126514	28.47625568	38.72901212	19.36450606			0.193645061				5																	12.6055	0.348078268	1.472131711	0	3.697919638	1.81602786	1.10819589	1.821264979	5.35765909	0	1.870622854	0.436513074	0.003137838	1.687924649	1.689291414	8.516529004	0.404539039	1.401757427	0	0	1.634522431	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9379	0		1.505388443	12.6055	0.348078268	1.472131711	0	3.697919638	1.81602786	1.10819589	1.821264979	5.35765909	0	1.870622854	0.436513074	0.003137838	1.687924649	1.689291414	8.516529004	0.404539039	1.401757427	0	0	1.634522431	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9379	NO																																																																																		0	0		0	12.6055	0.348078268	1.472131711	0	3.697919638	1.81602786	1.10819589	1.821264979	5.35765909	0	1.870622854	0.436513074	0.003137838	1.687924649	1.689291414	8.516529004	0.404539039	1.401757427	0	0	1.634522431	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9379
H0321_002_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	335.8039551	19.68496539	13.46092077	496.2847853	14.44205208	13.02323661	6.149712062	66.78197927	83.64743609	16.95228231	54.73787192	0	0	64.46714431	15.91474653	119.4454621	13.52578077	4.366181875	0	0	30.31033406	17.97298561	0	1857.647059	42.79069767	205.8666667	18.82673325	2.64	81.19209852	6817.269688											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"$0 (7b, 7f1); $0 n/c (7b1); Medicare FFS (7d, 7f)"	"Medicare FFS (7e, 7h)"	$0 (7c); Medicare FFS (7i)	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.077267133	0.077267133	0.147829073	0	0.224	0.224	0.224	0.110039912	0.224	0.224	0.224	0	0	0.224	0.214465342	0.222656783	0.224	0.215174194	0	0	0.224	0.223736352	0	0	0	0	0	0	0	0											NO	0.062634315	0.062634315	0.119833264	0	0.181578972	0.181578972	0.181578972	0.08921171	0.181578972	0.181578972	0.181578972	0	0	0.181578972	0.173849984	0.180529626	0.181578972	0.17468409	0	0	0.181578972	0.181365253	0	0	0	0	0	0	0	0												21.0329	1.232954324	1.613066066	0	2.622372966	2.364745913	1.116658393	5.957734566	15.18861543	3.078177991	9.939246499	0	0	11.70587778	2.766778426	21.56344459	2.455997365	0.762702508	0	0	5.503719291	3.25967509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1646	150	YES	26.19610464	21.0329	1.232954324	1.613066066	0	2.622372966	2.364745913	1.116658393	5.957734566	15.18861543	3.078177991	9.939246499	0	0	11.70587778	2.766778426	21.56344459	2.455997365	0.762702508	0	0	5.503719291	3.25967509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1646	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	21.0329	1.232954324	1.613066066	0	2.622372966	2.364745913	1.116658393	5.957734566	15.18861543	3.078177991	9.939246499	0	0	11.70587778	2.766778426	21.56344459	2.455997365	0.762702508	0	0	5.503719291	3.25967509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1646
H0332_001_0	2012	8																															A	A	D	V	T	Coin	Coin	V	V		P		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	142.2218556	1.770396543	256.0635579	183.1274881	157.2292037	6.208872349	1.300664163	262.2226861	272.0754051	0	507.0776545	0	1.600397237	0	2584.83574	4700.413014	130.5925831	78.41067655	0	0	2.445577966	0	0	0	0	0	12.35723233	0	0	0											3400	$500/Admit & $100/Day for Days 91-150 for IP Med/Surg; PBP 1a	$500/Admit & $100/Day for Days 91-150 for IP MH/SA; PBP 1b	$125/Day for Days 21-100 for SNF; PBP 2	$10/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0-10% for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$60/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b"	"$200/Procedure for OP Surg; $200/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Procedure for OP Rad - Complex Diagnostic; $25/Visit for OP Rad - Therapeutic; PBP 8b	$35/Visit for Partial Hospitalization; PBP 5	$25/Visit for Renal Dialysis; PBP 12	"$20/Visit for Pulmonary Rehabilitation Services; $20/Visit for Cardiac Rehabilitation Services; $20/Visit for Rehab Services (CORF);  PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Other; $20/Visit for Podiatry; $20/Visit for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$20/Visit for Group MH - Non Phys; $20/Visit for Group Psych Services; $35/Visit for Individual MH - Non Phys; $35/Visit for Individual Psych Services; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	500.9833476	500.9833476	125	10	100	0.2	0.2	59.92746198	200	0	62.89521295	0	25	0	10	20	32	20	0	0	0.2	0	0	0	0	0	20	0	0	0											NO	489.4320975	489.4320975	122.1178558	9.769428462	97.69428462	0.195388569	0.195388569	58.54570528	195.3885692	0	61.44502835	0	24.42357116	0	9.769604574	19.53885692	31.26217108	19.53885692	0	0	0.195388569	0	0	0	0	0	20	0	0	0												5.8007	0.072207408	2.60582772	0.149087575	1.280032881	1.213142685	0.25413491	1.279334342	4.430035343	0	2.596450071	0	0.003257285	0	2.104401923	7.653391447	0.340217306	0.127671249	0	0	0.47783798	0	0	0	0	0	0.020595387	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4083	0	NO	0.717151216	5.8007	0.072207408	2.60582772	0.149087575	1.280032881	1.213142685	0.25413491	1.279334342	4.430035343	0	2.596450071	0	0.003257285	0	2.104401923	7.653391447	0.340217306	0.127671249	0	0	0.47783798	0	0	0	0	0	0.020595387	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4083	NO																																										0	0	0	0	0	0	0	0	0	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	5.8007	0.072207408	2.60582772	0.149087575	1.280032881	1.213142685	0.25413491	1.279334342	4.430035343	0	2.596450071	0	0.003257285	0	2.104401923	7.653391447	0.340217306	0.127671249	0	0	0.47783798	0	0	0	0	0	0.020595387	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4083
H0332_002_0	2012	9																															A	A	D	V	T	Coin	Coin	V	V		P	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	191.3711713	5.330311157	397.4022507	713.5911425	232.3815619	4.902526891	1.365405028	349.4584761	351.7649684	0	599.693955	8.440401785	8.500360312	11.50701897	3072.481157	4809.537057	200.037257	53.65238506	0	0	3.786299167	0	0	0	0	0	1.091062643	0	0	0											3400	$500/Admit & $100/Day for Days 91-150 for IP Med/Surg; PBP 1a	$500/Admit & $100/Day for Days 91-150 for IP MH/SA; PBP 1b	$125/Day for Days 21-100 for SNF; PBP 2	$10/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0-10% for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$60/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b"	"$250/Procedure for OP Surg; $175/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Procedure for OP Rad - Complex Diagnostic; $25/Visit for OP Rad - Therapeutic; PBP 8b	$35/Visit for Partial Hospitalization; PBP 5	$25/Visit for Renal Dialysis; PBP 12	"$35/Visit for Pulmonary Rehabilitation Services; $35/Visit for Cardiac Rehabilitation Services; $35/Visit for Rehab Services (CORF);  PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Other; $35/Visit for Podiatry; $35/Visit for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$20/Visit for Group MH - Non Phys; $20/Visit for Group Psych Services; $35/Visit for Individual MH - Non Phys; $35/Visit for Individual Psych Services; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	500.9833476	500.9833476	125	10	100	0.2	0.2	59.86444295	194.7828406	0	83.54341505	35	25	30.38496105	10	34.79839818	32	35	0	0	0.2	0	0	0	0	0	35	0	0	0											NO	467.5370757	467.5370757	116.6548444	9.332387552	93.32387552	0.186647751	0.186647751	55.86781822	181.7788957	0	77.96595267	32.66335643	23.33096888	28.35642323	9.332564864	32.47521381	29.86364017	32.66335643	0	0	0.186647751	0	0	0	0	0	35	0	0	0												7.4561	0.207676508	3.863241477	0.554959091	1.807228996	0.915045619	0.254849778	1.626956885	5.328620624	0	3.89630921	0.022974321	0.016526803	0.027191492	2.389510808	13.01589535	0.497820055	0.146038915	0	0	0.706704224	0	0	0	0	0	0.003182266	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7368	0	NO	3.056994587	7.4561	0.207676508	3.863241477	0.554959091	1.807228996	0.915045619	0.254849778	1.626956885	5.328620624	0	3.89630921	0.022974321	0.016526803	0.027191492	2.389510808	13.01589535	0.497820055	0.146038915	0	0	0.706704224	0	0	0	0	0	0.003182266	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7368	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.4561	0.207676508	3.863241477	0.554959091	1.807228996	0.915045619	0.254849778	1.626956885	5.328620624	0	3.89630921	0.022974321	0.016526803	0.027191492	2.389510808	13.01589535	0.497820055	0.146038915	0	0	0.706704224	0	0	0	0	0	0.003182266	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7368
H0332_003_0	2012	6																															A	A	D	V	T	Coin	Coin	V	V		P		V	P	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	139.6658193	0.189266256	417.2697725	603.1322217	157.1585331	5.206372807	1.782055858	265.3753418	349.6708224	0	560.269762	0	15.02351621	11.44250402	37.38766393	1356.770113	131.8737984	14.09313947	0	0	4.872865333	0	0	0	0	0	8.679132821	0	0	0											3400	$500/Admit & $100/Day for Days 91-150 for IP Med/Surg; PBP 1a	$500/Admit & $100/Day for Days 91-150 for IP MH/SA; PBP 1b	$125/Day for Days 21-100 for SNF; PBP 2	$10/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0-10% for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$60/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b"	"$200/Procedure for OP Surg; $200/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Procedure for OP Rad - Complex Diagnostic; $25/Visit for OP Rad - Therapeutic; PBP 8b	$35/Visit for Partial Hospitalization; PBP 5	$25/Visit for Renal Dialysis; PBP 12	"$20/Visit for Pulmonary Rehabilitation Services; $20/Visit for Cardiac Rehabilitation Services; $20/Visit for Rehab Services (CORF);  PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Other; $20/Visit for Podiatry; $20/Visit for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$20/Visit for Group MH - Non Phys; $20/Visit for Group Psych Services; $35/Visit for Individual MH - Non Phys; $35/Visit for Individual Psych Services; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	500.9833476	500.9833476	125	10	100	0.2	0.2	59.71694693	200	0	72.86629753	0	25	20	10	20	32	20	0	0	0.2	0	0	0	0	0	20	0	0	0											YES	496.5624372	496.5624372	123.8969418	9.911755344	99.11755344	0.198235107	0.198235107	59.18997678	198.2351069	0	72.22329139	0	24.77938836	19.82351069	9.912381319	19.82351069	31.7176171	19.82351069	0	0	0.198235107	0	0	0	0	0	20	0	0	0											6700	5.7794	0.007831876	4.308204059	0.498174918	1.298097442	1.03208587	0.353266033	1.30896336	5.776419404	0	3.372043857	0	0.031022795	0.01890255	0.030883398	2.241328903	0.34856022	0.023281292	0	0	0.96597298	0	0	0	0	0	0.014465221	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4089	0	NO	0.243891547	5.7794	0.007831876	4.308204059	0.498174918	1.298097442	1.03208587	0.353266033	1.30896336	5.776419404	0	3.372043857	0	0.031022795	0.01890255	0.030883398	2.241328903	0.34856022	0.023281292	0	0	0.96597298	0	0	0	0	0	0.014465221	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4089	NO	$1000/Admit for IP Med/Surg; PBP 1a	No Cost Sharing: PBP 1b	No Cost Sharing: PBP 2	No Cost Sharing: PBP 6	20% Coinsurance for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"20% Coinsurance 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 - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for Pulmonary Rehabilitation Services; 20% Coinsurance for Cardiac Rehabilitation Services; 20% Coinsurance for Rehab Services (CORF);  20% for OP Services - Preventive; 20% for OP Services - Other; 20% for OP Services - Substance Abuse; PBP 3, 9a, 9c"	"20% Coinsurance for PCP OV; 20% Coinsurance for Immunizations; 20% Coinsurance for Routine Exams; 20% Coinsurance for Physical Exams (Initial Exam); PBP 7a, 14a-b"	"20% Coinsurance for Chiro (cvd); 20% Coinsurance for SCP OV; 20% Coinsurance for SCP - Other; 20% Coinsurance for Podiatry; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing Exams; 20% Coinsurance for SCP - Surgery; 20% Coinsurance for Pap Smears and Pelvic Exams Screening; 20% Coinsurance for Prostate Cancer Screening; 20% Coinsurance for Colorectal Screening; 20% Coinsurance for Diabetic Footcare; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"20% for Phys Rad - General Diagnostic; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; 20% Coinsurance for Bone Mass Measurement; 20% Coinsurance for Mammography Screening; PBP 8b, 14a"	"20% Coinsurance for Phys SCP OP Surgery; 20% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Blood; 20% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 20% Coinsurance for Health/Education Wellness; 20% Coinsurance for Kidney Disease Education Services; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost Sharing; PBP 13a-c, 14b"												3.3375	0	0	0	0.3008	0	0	0.0027	2.8025	0.6079	1.0811	0	0.0006	3.9862	0	0.4212	0	0	2.0191	0	0.094	0.4918	0	0	0	0	0	0	0	0											15.1455	0	NO	0.159270807	9.1169	0.007831876	4.308204059	0.498174918	1.598917528	1.03208587	0.353266033	1.311704457	8.578956464	0.607917357	4.453124291	0	0.031634412	4.005121778	0.030883398	2.662511088	0.34856022	0.023281292	2.019092403	0	1.059949054	0.491835436	0	0	0	0	0.014465221	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5544
H0332_004_0	2012	10																															A	A	D	V	T	Coin	Coin	V	V		P	V	V	P	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	180.1462584	3.500910589	529.0344105	655.5028893	197.696113	3.835080012	1.11466958	328.1857331	330.3115508	0	461.1154128	3.116961314	12.35592386	8.934988626	55.53163429	5685.081741	275.8500026	46.12739756	0	0	6.920986537	0	0	0	0	0	1.541859565	0	0	0											3400	$500/Admit & $100/Day for Days 91-150 for IP Med/Surg; PBP 1a	$500/Admit & $100/Day for Days 91-150 for IP MH/SA; PBP 1b	$125/Day for Days 21-100 for SNF; PBP 2	$10/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0-10% for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$60/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b"	"$250/Procedure for OP Surg; $175/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Procedure for OP Rad - Complex Diagnostic; $25/Visit for OP Rad - Therapeutic; PBP 8b	$35/Visit for Partial Hospitalization; PBP 5	$25/Visit for Renal Dialysis; PBP 12	"$35/Visit for Pulmonary Rehabilitation Services; $35/Visit for Cardiac Rehabilitation Services; $35/Visit for Rehab Services (CORF);  PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Other; $35/Visit for Podiatry; $35/Visit for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$20/Visit for Group MH - Non Phys; $20/Visit for Group Psych Services; $35/Visit for Individual MH - Non Phys; $35/Visit for Individual Psych Services; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	500.9833476	500.9833476	125	10	100	0.2	0.2	59.89856451	196.4504917	0	102.2184472	35	25	33.32503535	10	34.76145432	32	35	0	0	0.2	0	0	0	0	0	35	0	0	0											YES	489.4068567	489.4068567	122.111558	9.768924637	97.68924637	0.195378493	0.195378493	58.51445626	191.9110049	0	99.85643069	34.19123623	24.42231159	32.55497589	9.769303977	33.95820275	31.26055884	34.19123623	0	0	0.195378493	0	0	0	0	0	35	0	0	0											6700	7.3471	0.142780804	5.383434674	0.53362986	1.609398691	0.749292152	0.217782462	1.60030081	5.282535136	0	3.837111605	0.008881063	0.025146685	0.024239862	0.045208785	16.08792987	0.718602103	0.131429396	0	0	1.352211918	0	0	0	0	0	0.00449709	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1015	0	NO	1.066727884	7.3471	0.142780804	5.383434674	0.53362986	1.609398691	0.749292152	0.217782462	1.60030081	5.282535136	0	3.837111605	0.008881063	0.025146685	0.024239862	0.045208785	16.08792987	0.718602103	0.131429396	0	0	1.352211918	0	0	0	0	0	0.00449709	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1015	NO	$1000/Admit for IP Med/Surg; PBP 1a	No Cost Sharing: PBP 1b	No Cost Sharing: PBP 2	No Cost Sharing: PBP 6	20% Coinsurance for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"20% Coinsurance 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 - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for Pulmonary Rehabilitation Services; 20% Coinsurance for Cardiac Rehabilitation Services; 20% Coinsurance for Rehab Services (CORF);  20% for OP Services - Preventive; 20% for OP Services - Other; 20% for OP Services - Substance Abuse; PBP 3, 9a, 9c"	"20% Coinsurance for PCP OV; 20% Coinsurance for Immunizations; 20% Coinsurance for Routine Exams; 20% Coinsurance for Physical Exams (Initial Exam); PBP 7a, 14a-b"	"20% Coinsurance for Chiro (cvd); 20% Coinsurance for SCP OV; 20% Coinsurance for SCP - Other; 20% Coinsurance for Podiatry; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing Exams; 20% Coinsurance for SCP - Surgery; 20% Coinsurance for Pap Smears and Pelvic Exams Screening; 20% Coinsurance for Prostate Cancer Screening; 20% Coinsurance for Colorectal Screening; 20% Coinsurance for Diabetic Footcare; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"20% for Phys Rad - General Diagnostic; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; 20% Coinsurance for Bone Mass Measurement; 20% Coinsurance for Mammography Screening; PBP 8b, 14a"	"20% Coinsurance for Phys SCP OP Surgery; 20% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Blood; 20% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 20% Coinsurance for Health/Education Wellness; 20% Coinsurance for Kidney Disease Education Services; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost Sharing; PBP 13a-c, 14b"												4.3158	0	0	0	0.3478	0	0	0.0009	2.4019	0.637	0.3146	0	0.0118	7.2439	0.0304	0.0187	0	0	0.0636	0	0.179	0.0422	0	0	0	0	0	0	0	0											15.6075	0	NO	0.187529439	11.6628	0.142780804	5.383434674	0.53362986	1.957161072	0.749292152	0.217782462	1.601224527	7.684402979	0.637005331	4.151690059	0.008881063	0.036900121	7.268180953	0.075594544	16.10659133	0.718602103	0.131429396	0.063607138	0	1.531246329	0.042238396	0	0	0	0	0.00449709	0	0	0	0	0	0	0	0	0	0	0	0	0	60.709
H0332_801_0	2012	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	273.9127725	2.502676236	45.71932772	0	10.85901559	9.491610069	7.268818664	39.77996131	84.70550992	2.196977752	69.84372222	0.176896601	0.089696927	19.78009195	25.86186849	345.6760696	2.066750122	3.446554723	7.839471762	20.05600507	24.58735251	0.769220517	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.052760388	0.052760388	0.137885815	0	0.167241287	0.149322578	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.149322578	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.149322578	0.167241287	0	0	0	0	0	0	0	0												14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791	0	NO	45.16467027	14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791
H0332_803_0	2012	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	263.6909951	2.976558748	46.58945157	0	10.924863	8.040061216	6.296056967	39.58891999	90.09858757	1.503345551	67.77533119	0.251023681	0.07455854	15.87176867	24.52283626	321.6468242	2.16093206	2.216144091	6.852945692	18.4978474	25.6669792	0.740121369	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.053550053	0.053550053	0.139949554	0	0.16974439	0.151557491	0.16974439	0.16974439	0.16974439	0.16974439	0.16974439	0.16974439	0.151557491	0.16974439	0.16974439	0.16974439	0.16974439	0.16974439	0.16974439	0.16974439	0.151557491	0.16974439	0	0	0	0	0	0	0	0												14.1207	0.15939488	6.520172986	0	1.85443421	1.218531509	1.068720352	6.719997092	15.29372982	0.255184474	11.50448228	0.042609862	0.011299905	2.694143698	4.162613893	54.5977441	0.366806095	0.376178028	1.163249089	3.139905831	3.890022981	0.125631451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.2855	0	NO	41.32369058	14.1207	0.15939488	6.520172986	0	1.85443421	1.218531509	1.068720352	6.719997092	15.29372982	0.255184474	11.50448228	0.042609862	0.011299905	2.694143698	4.162613893	54.5977441	0.366806095	0.376178028	1.163249089	3.139905831	3.890022981	0.125631451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.2855	NO																																										0	0	0	0	0	0	0	0	0	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	14.1207	0.15939488	6.520172986	0	1.85443421	1.218531509	1.068720352	6.719997092	15.29372982	0.255184474	11.50448228	0.042609862	0.011299905	2.694143698	4.162613893	54.5977441	0.366806095	0.376178028	1.163249089	3.139905831	3.890022981	0.125631451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.2855
H0332_804_0	2012	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	NO	273.9138481	2.502676236	45.71943554	0	10.85908464	9.491887198	7.26954274	39.78075721	84.75427405	2.201057199	69.95781214	0.176896601	0.089747097	19.80408371	25.91815131	346.3967815	2.066777263	3.451616711	7.855712818	20.09971287	24.62101721	0.769552451	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, 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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.052736787	0.052736787	0.137824135	0	0.167166476	0.149255782	0.167166476	0.167166476	0.167166476	0.167166476	0.167166476	0.167166476	0.149255782	0.167166476	0.167166476	0.167166476	0.167166476	0.167166476	0.167166476	0.167166476	0.149255782	0.167166476	0	0	0	0	0	0	0	0												14.4453	0.131983103	6.301241669	0	1.815274913	1.416719048	1.215223842	6.650008996	14.16807332	0.367942976	11.69460093	0.029571181	0.013395273	3.310578885	4.332646019	57.90592928	0.345495872	0.576994602	1.313211828	3.359998169	3.674829182	0.128643371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1977	0	NO	45.2847651	14.4453	0.131983103	6.301241669	0	1.815274913	1.416719048	1.215223842	6.650008996	14.16807332	0.367942976	11.69460093	0.029571181	0.013395273	3.310578885	4.332646019	57.90592928	0.345495872	0.576994602	1.313211828	3.359998169	3.674829182	0.128643371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1977	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	NO	0	14.4453	0.131983103	6.301241669	0	1.815274913	1.416719048	1.215223842	6.650008996	14.16807332	0.367942976	11.69460093	0.029571181	0.013395273	3.310578885	4.332646019	57.90592928	0.345495872	0.576994602	1.313211828	3.359998169	3.674829182	0.128643371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1977
H0332_805_0	2012	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	NO	185.3056297	2.091735439	32.74009033	0	7.67748389	5.650670525	4.426267249	27.82290962	63.45758947	1.063283892	47.92532883	0.176403415	0.052558041	11.20263723	17.36944329	227.8054652	1.518633241	1.568064773	4.85377515	13.10210919	18.11186981	0.520882779	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, 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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.059672354	0.059672354	0.155949786	0	0.189151023	0.168884842	0.189151023	0.189151023	0.189151023	0.189151023	0.189151023	0.189151023	0.168884842	0.189151023	0.189151023	0.189151023	0.189151023	0.189151023	0.189151023	0.189151023	0.168884842	0.189151023	0	0	0	0	0	0	0	0												11.0576	0.124818778	5.105810087	0	1.452203933	0.954312599	0.837232979	5.26273182	12.00306797	0.201121236	9.06512498	0.033366886	0.008876256	2.118990293	3.285447969	43.0896368	0.287251031	0.296601056	0.918096535	2.478277358	3.058820272	0.098525511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7379	0	NO	18.74408595	11.0576	0.124818778	5.105810087	0	1.452203933	0.954312599	0.837232979	5.26273182	12.00306797	0.201121236	9.06512498	0.033366886	0.008876256	2.118990293	3.285447969	43.0896368	0.287251031	0.296601056	0.918096535	2.478277358	3.058820272	0.098525511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7379	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	NO	0	11.0576	0.124818778	5.105810087	0	1.452203933	0.954312599	0.837232979	5.26273182	12.00306797	0.201121236	9.06512498	0.033366886	0.008876256	2.118990293	3.285447969	43.0896368	0.287251031	0.296601056	0.918096535	2.478277358	3.058820272	0.098525511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7379
H0332_806_0	2012	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	273.9127725	2.502676236	45.71932772	0	10.85901559	9.491610069	7.268818664	39.77996131	84.70550992	2.196977752	69.84372222	0.176896601	0.089696927	19.78009195	25.86186849	345.6760696	2.066750122	3.446554723	7.839471762	20.05600507	24.58735251	0.769220517	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.052760388	0.052760388	0.137885815	0	0.167241287	0.149322578	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.149322578	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.167241287	0.149322578	0.167241287	0	0	0	0	0	0	0	0												14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791	0	NO	45.16467027	14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	14.4517	0.132042169	6.304046774	0	1.816075748	1.417311686	1.215646592	6.652851945	14.16625853	0.367425388	11.68075403	0.029584415	0.013393776	3.308048043	4.325172183	57.81131092	0.345645951	0.576406249	1.31108335	3.354192109	3.671446865	0.12864543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.0791
H0332_807_0	2012	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	258.2242524	1.187149913	37.1581329	0	12.29668996	6.41922899	5.147057298	27.42249482	70.5449664	1.974662477	57.77997335	0.100116533	0.066885908	14.671046	23.33077298	285.4364902	1.385414745	1.644686459	6.27976396	17.8070106	19.60493159	0.326771229	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.056140964	0.056140964	0.14672073	0	0.177957129	0.158890294	0.177957129	0.177957129	0.177957129	0.177957129	0.177957129	0.177957129	0.158890294	0.177957129	0.177957129	0.177957129	0.177957129	0.177957129	0.177957129	0.177957129	0.158890294	0.177957129	0	0	0	0	0	0	0	0												14.497	0.066647741	5.451868396	0	2.188283643	1.019953181	0.91595554	4.880028452	12.5539797	0.351405265	10.28235818	0.017816451	0.010627522	2.610817228	4.151877381	50.79545836	0.246544431	0.292683681	1.117528766	3.168884486	3.115033343	0.05815127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7929	0	NO	30.47656217	14.497	0.066647741	5.451868396	0	2.188283643	1.019953181	0.91595554	4.880028452	12.5539797	0.351405265	10.28235818	0.017816451	0.010627522	2.610817228	4.151877381	50.79545836	0.246544431	0.292683681	1.117528766	3.168884486	3.115033343	0.05815127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7929	NO																																										0	0	0	0	0	0	0	0	0	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	14.497	0.066647741	5.451868396	0	2.188283643	1.019953181	0.91595554	4.880028452	12.5539797	0.351405265	10.28235818	0.017816451	0.010627522	2.610817228	4.151877381	50.79545836	0.246544431	0.292683681	1.117528766	3.168884486	3.115033343	0.05815127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7929
H0332_808_0	2012	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	273.913848	2.502676236	45.71943553	0	10.85908464	9.491887173	7.269542676	39.78075714	84.75426969	2.201056835	69.95780195	0.176896601	0.089747092	19.80408157	25.91814628	346.3967172	2.066777261	3.451616258	7.855711367	20.09970896	24.6210142	0.769552421	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.052604659	0.052604659	0.137478829	0	0.166747655	0.148881835	0.166747655	0.166747655	0.166747655	0.166747655	0.166747655	0.166747655	0.148881835	0.166747655	0.166747655	0.166747655	0.166747655	0.166747655	0.166747655	0.166747655	0.148881835	0.166747655	0	0	0	0	0	0	0	0												14.4091	0.131652431	6.285454449	0	1.810726897	1.413169577	1.212179193	6.63334796	14.13257571	0.367021065	11.66529941	0.029497093	0.013361712	3.302284158	4.32179011	57.76084023	0.344630261	0.575548916	1.309921447	3.351579332	3.665621766	0.128321062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.864	0	NO	45.61847501	14.4091	0.131652431	6.285454449	0	1.810726897	1.413169577	1.212179193	6.63334796	14.13257571	0.367021065	11.66529941	0.029497093	0.013361712	3.302284158	4.32179011	57.76084023	0.344630261	0.575548916	1.309921447	3.351579332	3.665621766	0.128321062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.864	NO																																										0	0	0	0	0	0	0	0	0	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	14.4091	0.131652431	6.285454449	0	1.810726897	1.413169577	1.212179193	6.63334796	14.13257571	0.367021065	11.66529941	0.029497093	0.013361712	3.302284158	4.32179011	57.76084023	0.344630261	0.575548916	1.309921447	3.351579332	3.665621766	0.128321062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.864
H0332_809_0	2012	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	209.9529874	2.406919427	28.98841232	0	7.726272002	5.238347043	4.574825408	35.09552229	73.67690869	1.243703191	57.17563516	0.154593741	0.046682654	13.06282673	19.88746513	255.9078892	1.521470789	1.687983365	9.319276327	15.48240511	21.79761123	0.473699546	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.070666323	0.070666323	0.184681804	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.057511976	0.057511976	0.15030378	0	0.182302999	0.162770535	0.182302999	0.182302999	0.182302999	0.182302999	0.182302999	0.182302999	0.162770535	0.182302999	0.182302999	0.182302999	0.182302999	0.182302999	0.182302999	0.182302999	0.162770535	0.182302999	0	0	0	0	0	0	0	0												12.0748	0.138426693	4.357067948	0	1.408522559	0.852648551	0.834004393	6.398018976	13.43152143	0.226730822	10.42328978	0.028182903	0.007598561	2.381392493	3.625544542	46.65277576	0.277368688	0.30772443	1.698932026	2.822488888	3.548008843	0.086356848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5814	0	NO	25.52130471	12.0748	0.138426693	4.357067948	0	1.408522559	0.852648551	0.834004393	6.398018976	13.43152143	0.226730822	10.42328978	0.028182903	0.007598561	2.381392493	3.625544542	46.65277576	0.277368688	0.30772443	1.698932026	2.822488888	3.548008843	0.086356848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5814	NO																																										0	0	0	0	0	0	0	0	0	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	12.0748	0.138426693	4.357067948	0	1.408522559	0.852648551	0.834004393	6.398018976	13.43152143	0.226730822	10.42328978	0.028182903	0.007598561	2.381392493	3.625544542	46.65277576	0.277368688	0.30772443	1.698932026	2.822488888	3.548008843	0.086356848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5814
H0351_014_0	2012	5																															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	1051.6395	63.35824434	948.0074044	11.70947817	207.0390046	13.58780578	2.647340224	450.0426792	759.4539519	12.13394299	52.11662169	0	0.342156492	858.5294254	3371.937409	4446.131099	313.6198036	975.4891047	5.991377146	93.85392036	32.5790433	0	0	0	0	0	0	0	24000	0											5300	1a:  Acute - $195/$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 - $50/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - $175/visit (No charge for Medicare Covered Epidural Injections)	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%	3:  Cardiac Rehabilitation Services - $20/visit/3:  Pulmonary Rehabilitation - $20/visit/5:  Partial Hospitalization - $30/day/7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit (including 16b Medicare Covered Dental)/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														195	175	70.00065192	0	300	0.2	0.073268508	63.34355225	175	0	0.181975266	0	0.2	20	5.007820977	29.74608199	30	20	0	15.36701623	0.2	0	0	0	0	0	0	0	0	0											NO	177.9241261	159.6754978	63.87079396	0	273.7294248	0.182486283	0.066852488	57.79664708	159.6754978	0	0.16603995	0	0.182486283	18.24862832	4.569293186	27.14125971	27.37294248	18.24862832	0	14.02134838	0.182486283	0	0	0	0	0	0	0	0	0												15.5927	0.843063267	5.045832133	0	4.722722304	2.479588173	0.176981281	2.167579825	10.10551565	0	8.653441236	0	0.062438866	1.305582032	1.283947552	10.05613324	0.715391404	1.483444842	0	0.109663209	5.945228523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7492			6.79	15.5927	0.843063267	5.045832133	0	4.722722304	2.479588173	0.176981281	2.167579825	10.10551565	0	8.653441236	0	0.062438866	1.305582032	1.283947552	10.05613324	0.715391404	1.483444842	0	0.109663209	5.945228523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7492	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				15.5927	0.843063267	5.045832133	0	4.722722304	2.479588173	0.176981281	2.167579825	10.10551565	0	8.653441236	0	0.062438866	1.305582032	1.283947552	10.05613324	0.715391404	1.483444842	0	0.109663209	5.945228523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7492
H0351_029_0	2012	6																															Ded	Ded	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											19.43615137	1.003848627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											20.44	YES	2136.48941	213.8471632	61.07937438	17.40270289	27.60659235	24.82243262	6.314007347	33.26801825	60.46776122	13.16075046	55.83673531	0	0.552988714	39.69794231	69.73181815	143.7518765	7.992300091	5.887406919	8.695585789	30.90655211	29.57044027	0.185263969	560.8315098	2565.552644	315	236.25	0	0	24000	0											6700	"$1,200 calendar year deductible applies to IP Acute & IP Psych"	"$1,200 calendar year deductible applies to IP Acute & IP Psych"	2:  Skilled Nursing Services - 14.5% (FFS Medicare Cost Sharing Estimated Percentage from WS #4)	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - 20.0%/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - 20.0%/visit (No charge for Medicare Covered Epidural Injections)	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 - 20.0%		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0% (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service	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%	9d:  Blood - $0/service	10b:  Transportation - $0/trip; 12 trips/year	"16a: Dental - Prev/Diag 100% IN / 80% OON, 16b: Dental - Basic 50% IN / 50% OON, Major 50% IN / 50% OON; Deductible $100 IN & OON combined; Annual Max $1,000 IN & OON combined"	"17a:  Routine Eye Exams - $10/visit, 1 per year"	"17b:  Eye Glasses & Contact Lenses - $100 per year, Every two years"			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/												1200	NO	0	0	0.145447021	0	0.2	0.2	0.102930178	0.2	0.2	0	0.2	0	0.2	0.2	0.175190427	0.199973189	0.2	0.2	0.2	0.2	0.2	0	0	84.13522613	10	0	0	0	0	0											NO	0	0	0.123458325	0	0.169763979	0.169763979	0.087369183	0.169763979	0.169763979	0	0.169763979	0	0.169763979	0.169763979	0.14870512	0.169741221	0.169763979	0.169763979	0.169763979	0.169763979	0.169763979	0	0	84.13522613	10	0	0	0	0	0												0	0	7.540757271	0	4.686604972	4.213954936	0.551649662	5.647711161	10.26524776	0	9.479066376	0	0.093877565	6.739280656	10.36947842	24.40061907	1.356804667	0.999469626	1.476197246	5.246819273	5.019995609	0	0	17.98777932	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3378			17.47	19.4362	1.003848627	7.540757271	0	4.686604972	4.213954936	0.551649662	5.647711161	10.26524776	0	9.479066376	0	0.093877565	6.739280656	10.36947842	24.40061907	1.356804667	0.999469626	1.476197246	5.246819273	5.019995609	0	0	17.98777932	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.7778	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				19.4362	1.003848627	7.540757271	0	4.686604972	4.213954936	0.551649662	5.647711161	10.26524776	0	9.479066376	0	0.093877565	6.739280656	10.36947842	24.40061907	1.356804667	0.999469626	1.476197246	5.246819273	5.019995609	0	0	17.98777932	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.7778
H0351_030_0	2012	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	765.7526932	45.88506542	787.7446193	7.386190015	149.1340959	6.622646469	1.105245231	356.7970692	537.2525136	8.787324928	34.60068007	0	0.108141778	669.1756002	2624.572111	3465.471975	200.5111097	868.9793534	4.715139572	70.94198548	14.14894346	0	0	0	0	0	0	0	24000	0											6700	1a:  Acute - $195/$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 - $50/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - $175/visit (No charge for Medicare Covered Epidural Injections)	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $35/visit (including 16b Medicare Covered Dental)/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														195	175	70.00065192	0	300	0.2	0.052049002	63.33928379	175	0	0.178782672	0	0.2	25	5.007733712	32.97085425	35	25	0	15.41391203	0.2	0	0	0	0	0	0	0	0	0											NO	188.4904161	169.1836685	67.73599856	0	289.930695	0.192548064	0.049644032	61.25674546	169.1343572	0	0.172606183	0	0.191197101	24.17722117	4.843445782	31.88979505	33.80820098	24.2066577	0	14.90461345	0.192137	0	0	0	0	0	0	0	0	0												12.0281	0.646916975	4.446555699	0	3.603212671	1.275177758	0.05486883	1.821352271	7.572321545	0	5.972291331	0	0.020676394	1.348233874	1.05933106	9.209432586	0.564909991	1.752923813	0	0.088113573	2.718535555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1829			1.888282211	12.0281	0.646916975	4.446555699	0	3.603212671	1.275177758	0.05486883	1.821352271	7.572321545	0	5.972291331	0	0.020676394	1.348233874	1.05933106	9.209432586	0.564909991	1.752923813	0	0.088113573	2.718535555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1829	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				12.0281	0.646916975	4.446555699	0	3.603212671	1.275177758	0.05486883	1.821352271	7.572321545	0	5.972291331	0	0.020676394	1.348233874	1.05933106	9.209432586	0.564909991	1.752923813	0	0.088113573	2.718535555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1829
H0351_035_0	2012	5																															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	683.7971274	19.15932225	557.1088422	8.816520114	135.8853951	10.37978561	1.636424995	411.8722898	693.6899238	12.92316014	56.75524744	0	0.160385251	548.3598087	2945.879903	4636.375743	200.848873	694.1908164	5.916000582	138.2934941	27.44078774	0	0	0	0	0	0	0	24000	0											6700	1a:  Acute - $295/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $285/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $50/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $275/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - $275/visit (No charge for Medicare Covered Epidural Injections)	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $45/visit (including 16b Medicare Covered Dental)/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														295	285	70.00065192	0	300	0.2	0.043383593	63.34332467	275	0	0.165692236	0	0.2	35	15.00720105	37.80028459	40	35	0	15.26585853	0.2	0	0	0	0	0	0	0	0	0											NO	274.8075166	265.4920075	65.20917055	0	279.4652711	0.186310181	0.040414025	59.00753133	256.1764985	0	0.154350753	0	0.186310181	32.60428162	13.97997169	35.21288926	37.26203614	32.60428162	0	14.22092431	0.186310181	0	0	0	0	0	0	0	0	0												15.6594	0.423887244	3.027383792	0	3.164604065	1.933859734	0.066134521	2.025297254	14.80892131	0	8.760215153	0	0.029881405	1.48990647	3.431943139	13.60501547	0.62366983	1.88613274	0	0.163888443	5.112498123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2126			5.6	15.6594	0.423887244	3.027383792	0	3.164604065	1.933859734	0.066134521	2.025297254	14.80892131	0	8.760215153	0	0.029881405	1.48990647	3.431943139	13.60501547	0.62366983	1.88613274	0	0.163888443	5.112498123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2126	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				15.6594	0.423887244	3.027383792	0	3.164604065	1.933859734	0.066134521	2.025297254	14.80892131	0	8.760215153	0	0.029881405	1.48990647	3.431943139	13.60501547	0.62366983	1.88613274	0	0.163888443	5.112498123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2126
H0351_036_0	2012	5																															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	792.7478715	31.719434	666.7610275	11.41590365	168.7252815	10.60304488	2.568163289	434.130648	978.2999219	11.43016576	51.35644641	0	0.098122229	1324.199309	3061.023698	4094.348427	236.9021599	831.9459075	6.544133418	94.98680812	45.34325715	0	0	0	0	0	0	0	24000	0											6700	1a:  Acute - $295/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $285/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $50/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $275/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - $275/visit (No charge for Medicare Covered Epidural Injections)	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $45/visit (including 16b Medicare Covered Dental)/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														295	285	70.00065192	0	300	0.2	0.098058049	63.30851118	275	0	0.184956684	0	0.2	35	15.0039475	39.49287748	40	35	0	15.45655035	0.2	0	0	0	0	0	0	0	0	0											NO	266.8616822	257.7553816	63.3103132	0	271.3653883	0.180907561	0.088716579	57.2711039	248.7980753	0	0.167323329	0	0.180718014	31.66763352	13.57284255	35.72524487	36.17989531	31.65990499	0	13.98244926	0.180951652	0	0	0	0	0	0	0	0	0												17.6295	0.681321234	3.517737457	0	3.815516794	1.918170985	0.227838662	2.071928454	20.28326147	0	8.593131598	0	0.017732454	3.494521536	3.462232726	12.18930001	0.714257945	2.194944033	0	0.110679019	8.204937266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.127			9.394332132	17.6295	0.681321234	3.517737457	0	3.815516794	1.918170985	0.227838662	2.071928454	20.28326147	0	8.593131598	0	0.017732454	3.494521536	3.462232726	12.18930001	0.714257945	2.194944033	0	0.110679019	8.204937266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.127	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				17.6295	0.681321234	3.517737457	0	3.815516794	1.918170985	0.227838662	2.071928454	20.28326147	0	8.593131598	0	0.017732454	3.494521536	3.462232726	12.18930001	0.714257945	2.194944033	0	0.110679019	8.204937266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.127
H0351_038_0	2012	5																															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	1852.476	69.93998717	618.5806902	19.04877188	348.2737654	27.75336846	5.030385829	650.3878083	1134.08785	16.8040773	57.18792823	0	0.708771037	55.42455511	1.301499285	6544.905239	338.9906918	1078.600736	8.480684816	109.1629947	35.480656	0	673.9606127	0	0	0	0	0	24000	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 - $300/trip	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $175/visit (No charge for Medicare Covered Epidural Injections)/9b:  Ambulatory Surgical Center Services - $175/visit (No charge for Medicare Covered Epidural Injections)	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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $10/visit/5:  Partial Hospitalization - $20/day/7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental)/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/1-6 Additional Visits/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip; 12 trips/year						14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														175	175	100	0	300	0.2	0.063774195	63.34367356	175	0	0.152053783	0	0.2	0.017557445	20	20	20	10	0	15.11369079	0.2	0	0	0	0	0	0	0	0	0											NO	138.4360852	138.4360852	79.10633441	0	237.3190032	0.158212669	0.050449428	50.10885823	138.4360852	0	0.120284174	0	0.158212669	0.013889051	15.82126688	15.82126688	15.82126688	7.910633441	0	11.95588678	0.158212669	0	0	0	0	0	0	0	0	0												21.3708	0.806851502	4.077804245	0	6.887665238	4.390934493	0.253780089	2.715849207	13.08322352	0	6.87880273	0	0.112136557	0.769794497	0.001715947	8.629057708	0.446938517	0.711034588	0	0.1087617	5.613489276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8586			20.3	21.3708	0.806851502	4.077804245	0	6.887665238	4.390934493	0.253780089	2.715849207	13.08322352	0	6.87880273	0	0.112136557	0.769794497	0.001715947	8.629057708	0.446938517	0.711034588	0	0.1087617	5.613489276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8586	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				21.3708	0.806851502	4.077804245	0	6.887665238	4.390934493	0.253780089	2.715849207	13.08322352	0	6.87880273	0	0.112136557	0.769794497	0.001715947	8.629057708	0.446938517	0.711034588	0	0.1087617	5.613489276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8586
H0351_801_0	2012	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	262.0508019	5.362187596	41.25272127	9.174824865	12.60824665	12.97281859	3.137530748	21.05583401	52.61226115	12.40271676	66.78482915	0	0.142036074	37.6894315	54.27044555	129.1625369	1.593007275	7.884708673	5.540905721	25.91632881	35.76132209	0.227174063	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																					0.082351695	0.082351695	0.142452695	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070002588	0.070149328	0.121055354	0	0.19042158	0.190397744	0.190184072	0.190459907	0.190246261	0.190290521	0.19014882	0	0.192129763	0.190211083	0.190336635	0.190252216	0.191056376	0.189971549	0.190523291	0.190263009	0.19030451	0.190952637	0	0	0	0	0	0	0	0												18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977			20.36751603	18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977
H0351_803_0	2012	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	262.0508019	5.362187596	41.25272127	9.174824865	12.60824665	12.97281859	3.137530748	21.05583401	52.61226115	12.40271676	66.78482915	0	0.142036074	37.6894315	54.27044555	129.1625369	1.593007275	7.884708673	5.540905721	25.91632881	35.76132209	0.227174063	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																					0.082351695	0.082351695	0.142452695	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070002588	0.070149328	0.121055354	0	0.19042158	0.190397744	0.190184072	0.190459907	0.190246261	0.190290521	0.19014882	0	0.192129763	0.190211083	0.190336635	0.190252216	0.191056376	0.189971549	0.190523291	0.190263009	0.19030451	0.190952637	0	0	0	0	0	0	0	0												18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977			20.36751603	18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977
H0351_804_0	2012	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	262.0508019	5.362187596	41.25272127	9.174824865	12.60824665	12.97281859	3.137530748	21.05583401	52.61226115	12.40271676	66.78482915	0	0.142036074	37.6894315	54.27044555	129.1625369	1.593007275	7.884708673	5.540905721	25.91632881	35.76132209	0.227174063	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																					0.082351695	0.082351695	0.142452695	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070002588	0.070149328	0.121055354	0	0.19042158	0.190397744	0.190184072	0.190459907	0.190246261	0.190290521	0.19014882	0	0.192129763	0.190211083	0.190336635	0.190252216	0.191056376	0.189971549	0.190523291	0.190263009	0.19030451	0.190952637	0	0	0	0	0	0	0	0												18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977			20.36751603	18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				18.3442	0.376153859	4.993862773	0	2.400882249	2.469995391	0.596708374	4.010292196	10.00928595	2.360119437	12.69905647	0	0.027289357	7.168947569	10.32965401	24.57345889	0.304354197	1.497870321	1.055671591	4.93091871	6.80554086	0.043379486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9977
H0354_001_0	2012	10																															D	D	D	coin	T	coin	coin	V	V	V	V	O	coin	V	V	V	V	V	coin	V	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	967.4176658	17.59066285	366.167969	9.003123263	209.5701012	9.427094224	3.838314062	813.0107738	329.6145552	0	216.1828666	0	0.049491904	545.9763378	3946.841856	4780.137033	171.2816098	203.9275342	23.29237544	25.92324553	69.82951914	0	0	0	443.4617202	0	86.9327833	0	81.43671579	0											6700	1a:  Acute - $185/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $185/$0/day for 1-7/8-90	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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20 CMG / $35 non-CMG contracted/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services - $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%	3:  Cardiac Rehabilitation Services - $45/visit/3:  Pulmonary Rehabilitation - $45/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $45/visit/7i:  Physical/Speech Therapy - $45/visit/9a:  Outpatient Hospital Services - $250/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10 optometrist / $30 ophthalmologist / $45 non-CMG/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $30 CMG / $45 non-CMG contracted/visit/7b:  Chiropractic Services - $20/visit/12 Additional Visits/7f:  Podiatry Services - $10 Nail Tech / $30 CMG / $45 non-CMG/visit/Unlimited Visits/17a:  Vision Exams - $10 optometrist / $30 ophthalmologist / $45 non-CMG/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit/16b:  Comprehensive Dental - $45/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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit		"14c: Newsletter, Nutritional Benefit, Golden Vitality (gym), Nursing Hotline - $0/visit/"												0	NO	185	185	125	0	150	0.2	0.101251273	38.33978072	216.8456684	0	200.8076598	0	0.2	162.2164266	10.0008883	32.43823616	40	45	0	14.75792025	0.2	0	0	0	10	0	10	0	0	0											NO	173.3519356	173.3519356	117.1296862	0	140.5556234	0.187407498	0.094876238	35.92581187	203.1925207	0	188.1643054	0	0.187407498	152.0028731	9.371207263	30.39584338	37.48149958	42.16668703	0	13.82872454	0.187407498	0	0	0	9.370374896	0	9.370374896	0	0	0												13.9753	0.254114621	3.574094942	0	2.454688018	1.766708141	0.3641648	2.434006009	5.581267696	0	3.389824912	0	0.009275154	6.915831001	3.082222755	12.10802471	0.534990966	0.716579043	0	0.029873785	13.08657546	0	0	0	0.346283547	0	0.067882731	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6917	0	NO	4.75	13.9753	0.254114621	3.574094942	0	2.454688018	1.766708141	0.3641648	2.434006009	5.581267696	0	3.389824912	0	0.009275154	6.915831001	3.082222755	12.10802471	0.534990966	0.716579043	0	0.029873785	13.08657546	0	0	0	0.346283547	0	0.067882731	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6917	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	13.9753	0.254114621	3.574094942	0	2.454688018	1.766708141	0.3641648	2.434006009	5.581267696	0	3.389824912	0	0.009275154	6.915831001	3.082222755	12.10802471	0.534990966	0.716579043	0	0.029873785	13.08657546	0	0	0	0.346283547	0	0.067882731	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6917
H0354_012_0	2012	9																															D	D	D	coin	T	coin	coin	V	V	V	V	O	coin	V	V	V	V	V	coin	V	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1640.389479	18.87104111	765.285984	13.14402014	404.0619894	12.47256113	3.818733972	1458.175289	492.2265099	0	250.5832226	0	0.009308425	989.7910136	0.708587697	5740.938914	170.2154094	478.9628864	25.40964918	46.6949695	103.2498101	0	2183.84895	0	0	0	0	0	81.43671579	0											6700	1a:  Acute - $150/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$75/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0 CMG / $35 non-CMG contracted/visit	9a:  Outpatient Hospital Services - $100/visit/9b:  Ambulatory Surgical Center Services - $0 CMG / $100 non-CMG contracted/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0 CMG / $100 non-CMG contracted/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0 CMG / $35 non-CMG contracted/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $0 CMG / $35 non-CMG contracted/visit/7b:  Chiropractic Services - $0 CMG / $20 non-CMG contracted/visit/12 Additional Visits/7f:  Podiatry Services - $0 Nail Tech / $0 CMG / $35 non-CMG contracted/visit/Unlimited Visits/17a:  Vision Exams - $0 CMG / $35 non-CMG contracted/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $0 CMG / $35 non-CMG contracted/visit/18a:  Hearing Exams - $0 CMG / $35 non-CMG contracted/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	"10b:  Transportation - $0/trip, 24 trips"		17a:  Routine Eye Exams - $0/visit		18a:  Routine Hearing Test - $0/visit		"14c: Newsletter, Nutritional Benefit, Golden Vitality (gym), Nursing Hotline - $0/visit/"												0	NO	150	150	75	0	150	0.2	0.068680142	33.36450195	76.33586139	0	52.78321295	0	0	70.34812782	7.190773803	17.45434523	35	35	0	6.358897646	0.2	0	0	0	0	0	0	0	0	0											NO	138.7797466	138.7797466	69.38987332	0	138.7797466	0.185039662	0.063542752	30.86878085	70.62581002	0	48.83493947	0	0	65.08596904	6.652891777	16.14873073	32.38194088	32.38194088	0	5.883241362	0.185039662	0	0	0	0	0	0	0	0	0												18.9711	0.218243192	4.425258123	0	4.672968377	2.307918498	0.242652865	3.751007786	2.896991331	0	1.019768042	0	0	5.368458939	0.000392846	7.72573972	0.459325444	1.292478989	0	0.022893148	19.10530999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4805	0	NO	5.86	18.9711	0.218243192	4.425258123	0	4.672968377	2.307918498	0.242652865	3.751007786	2.896991331	0	1.019768042	0	0	5.368458939	0.000392846	7.72573972	0.459325444	1.292478989	0	0.022893148	19.10530999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4805	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	18.9711	0.218243192	4.425258123	0	4.672968377	2.307918498	0.242652865	3.751007786	2.896991331	0	1.019768042	0	0	5.368458939	0.000392846	7.72573972	0.459325444	1.292478989	0	0.022893148	19.10530999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4805
H0354_018_0	2012	10																															D	D	D	coin	T	coin	coin	V	V	V	V	O	coin	V	V	V	V	V	coin	V	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	735.9650516	13.38213426	366.167969	9.003123263	209.5701012	9.427094224	3.838314062	813.0107738	332.8544654	0	216.1914056	0	0.049491904	549.7240595	0.666397847	4922.6808	172.5981066	205.4416189	23.46060744	27.83548001	69.82951914	0	0	0	0	0	0	0	81.43671579	0											5000	1a:  Acute - $110/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $110/$0/day for 1-4/5-90	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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20 CMG / $35 non-CMG contracted/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services - $150/visit/9b:  Ambulatory Surgical Center Services - $100 CMG / $150 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 - $35/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services - $150/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0 optometrist / $20 ophthalmologist / $35 non-CMG contracted/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit	7d:  Physician Specialist Services - $20 CMG / $35 non-CMG contracted/visit/7b:  Chiropractic Services - $20/visit/12 Additional Visits/7f:  Podiatry Services - $0 Nail Tech / $20 CMG / $35 non-CMG contracted/visit/Unlimited Visits/17a:  Vision Exams - $0 optometrist / $20 ophthalmologist / $35 non-CMG contracted/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Additional Pelvic - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $20 CMG / $35 non-CMG contracted/visit/18a:  Hearing Exams - $0 CMG / $35 non-CMG contracted/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit		18a:  Routine Hearing Test - $0/visit		"14c: Newsletter, Nutritional Benefit, Golden Vitality (gym), Nursing Hotline - $0/visit/"												0	NO	110	110	125	0	150	0.2	0.101251273	38.33978072	133.4000357	0	200.630428	0	0.2	100.8311256	5.261071368	22.48799629	35	35	0	4.762128905	0.2	0	0	0	0	0	0	0	0	0											NO	106.1395174	106.1395174	120.6130879	0	144.7357055	0.192980941	0.097697829	36.99423474	128.7183219	0	193.5892436	0	0.192980941	97.29242737	5.076432509	21.69877339	33.77166462	33.77166462	0	4.595000579	0.192980941	0	0	0	0	0	0	0	0	0												6.5096	0.118364439	3.680387454	0	2.527689704	1.819249511	0.374994952	2.506392618	3.570372352	0	3.487694224	0	0.009550994	4.456999011	0.00028191	8.901344596	0.485743781	0.578175454	0	0.010658671	13.47576629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5132	0	NO	1.91	6.5096	0.118364439	3.680387454	0	2.527689704	1.819249511	0.374994952	2.506392618	3.570372352	0	3.487694224	0	0.009550994	4.456999011	0.00028191	8.901344596	0.485743781	0.578175454	0	0.010658671	13.47576629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5132	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	6.5096	0.118364439	3.680387454	0	2.527689704	1.819249511	0.374994952	2.506392618	3.570372352	0	3.487694224	0	0.009550994	4.456999011	0.00028191	8.901344596	0.485743781	0.578175454	0	0.010658671	13.47576629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5132
H0354_801_0	2012	2																															coin	coin	coin	coin	coin	coin	coin	coin	coin	V	V	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	364.4638042	3.87135261	36.54199851	10.18437946	10.87289137	9.863462244	3.124521662	16.6684082	47.2548008	16088.30521	1641.870804	0	0.014393475	44.22521016	110.8929504	202.8690353	1.611769243	8.203215212	39.10485166	31.93013915	107.2323063	13.28025864	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	NO	0.083017386	0.083017386	0.135394008	0	0.224	0.224	0.224	0.224	0.224	3.520219009	105.432801	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	94.64430341	0	0	0	0	0	0	0	0											NO	0.069836679	0.069836679	0.113897442	0	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	2.961312295	88.69318904	0	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	0.188435422	79.61758589	0	0	0	0	0	0	0	0												25.4529	0.270362409	4.162040148	0	2.048837872	1.85862567	0.588770558	3.140918532	8.904478325	3.970208002	12.1352298	0	0.00271224	8.333596135	20.8961599	38.22771226	0.303714417	1.545776319	7.36873922	6.016769241	20.20636487	0.088111844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	165.5221	0	NO	31.23999993	25.4529	0.270362409	4.162040148	0	2.048837872	1.85862567	0.588770558	3.140918532	8.904478325	3.970208002	12.1352298	0	0.00271224	8.333596135	20.8961599	38.22771226	0.303714417	1.545776319	7.36873922	6.016769241	20.20636487	0.088111844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	165.5221	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	25.4529	0.270362409	4.162040148	0	2.048837872	1.85862567	0.588770558	3.140918532	8.904478325	3.970208002	12.1352298	0	0.00271224	8.333596135	20.8961599	38.22771226	0.303714417	1.545776319	7.36873922	6.016769241	20.20636487	0.088111844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	165.5221
H0354_804_0	2012	2																															coin	coin	coin	coin	coin	coin	coin	coin	coin	V	V	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	330.6130902	3.511788278	33.1489053	9.239201348	9.862246325	8.946643861	2.834094531	15.1198217	42.86739456	14592.14413	1489.309938	0	0.013057296	40.11416161	100.5976701	184.0334192	1.462144918	7.44169141	35.47526325	28.96591469	97.2761374	12.04630925	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	NO	0.083019516	0.083019516	0.135391528	0	0.224	0.224	0.224	0.224	0.224	3.520243581	105.4335395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	94.64496644	0	0	0	0	0	0	0	0											NO	0.07106125	0.07106125	0.115889512	0	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	3.013181962	90.24672078	0	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	0.191734675	81.01215134	0	0	0	0	0	0	0	0												23.4938	0.249552063	3.841610462	0	1.890934596	1.715381855	0.543394194	2.898994104	8.219165972	3.664065456	11.20044485	0	0.002503536	7.691275747	19.28806159	35.28558785	0.280343881	1.426830286	6.801838077	5.553770245	18.65120861	0.081324786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7801	0	NO	25.71	23.4938	0.249552063	3.841610462	0	1.890934596	1.715381855	0.543394194	2.898994104	8.219165972	3.664065456	11.20044485	0	0.002503536	7.691275747	19.28806159	35.28558785	0.280343881	1.426830286	6.801838077	5.553770245	18.65120861	0.081324786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7801	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	23.4938	0.249552063	3.841610462	0	1.890934596	1.715381855	0.543394194	2.898994104	8.219165972	3.664065456	11.20044485	0	0.002503536	7.691275747	19.28806159	35.28558785	0.280343881	1.426830286	6.801838077	5.553770245	18.65120861	0.081324786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7801
H0354_805_0	2012	2																															coin	coin	coin	coin	coin	coin	coin	coin	coin	V	V	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	V	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	327.3152883	3.248544524	33.11636708	9.472797959	10.42396853	9.626381021	4.244187862	16.13300867	41.67639887	14909.42713	1591.450337	0	0.040950895	38.86958253	103.7683881	184.0612301	1.39039427	7.269379541	36.28320536	28.84525091	79.63341651	12.05204882	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	NO	0.083019269	0.083019269	0.135391816	0	0.224	0.224	0.224	0.224	0.224	3.434143736	113.5879916	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	86.79424903	0	0	0	0	0	0	0	0											NO	0.071121032	0.07107663	0.115996881	0	0.192004523	0.19203276	0.192474478	0.192019583	0.191865318	2.942141854	97.42976273	0	0.193063559	0.191859482	0.191965155	0.191913821	0.191826444	0.191873549	0.191951167	0.191906506	0.19153952	74.30274157	0	0	0	0	0	0	0	0												23.279	0.230895599	3.841395292	0	2.00144911	1.848580514	0.816897845	3.097853604	7.996255536	3.655470797	12.92121906	0	0.007906125	7.457497974	19.91991467	35.32389391	0.266714388	1.394801653	6.964603598	5.535591306	15.2529464	0.074625022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.8875	0	NO	25.40493344	23.279	0.230895599	3.841395292	0	2.00144911	1.848580514	0.816897845	3.097853604	7.996255536	3.655470797	12.92121906	0	0.007906125	7.457497974	19.91991467	35.32389391	0.266714388	1.394801653	6.964603598	5.535591306	15.2529464	0.074625022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.8875	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	23.279	0.230895599	3.841395292	0	2.00144911	1.848580514	0.816897845	3.097853604	7.996255536	3.655470797	12.92121906	0	0.007906125	7.457497974	19.91991467	35.32389391	0.266714388	1.394801653	6.964603598	5.535591306	15.2529464	0.074625022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.8875
H0401_002_0	2012	7																															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	1375.961668	79.93921504	503.8010389	566.9135191	140.0730887	12.35353663	10.77481121	315.6029567	53.75810602	16.77689251	25.98893835	0	0.050414145	28.42115109	4881.366725	3338.781651	398.0709586	464.2832716	0	0	17.49191217	674.670591	0	0	33.03170271	0	8.969123027	0	111.6346787	0											3950	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	157.9430369	97.17450918	64.28556748	0	200	0.2	0.096441264	64.00949942	0.16	0.201894435	0.188177522	0	0.2	0.145088659	3.460107679	33.08108955	38.5	35	0	0	0.2	33.30047248	0	0	35	0	35	0	0	0											YES	123.7567374	76.14137637	50.37114805	0	156.7105962	0.156710596	0.07556684	50.17607777	0.125368477	0.158194987	0.147447059	0	0.156710596	0.113684651	3.333255931	31.87286627	37.08854327	33.71685752	0	0	0.156710596	26.09268449	0	0	35	0	35	0	0	0											4350	14.1904	0.507223488	2.11475306	0	1.82924477	1.935930092	0.814218434	1.319643209	6.739571878	2.654020288	3.831992515	0	0.007900431	3.231048642	1.355903716	8.868045087	1.230322664	1.30451441	0	0	2.741167986	1.466997239	0	0	0.096342466	0	0.026159942	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2654	0	NO	12.4678498	14.1904	0.507223488	2.11475306	0	1.82924477	1.935930092	0.814218434	1.319643209	6.739571878	2.654020288	3.831992515	0	0.007900431	3.231048642	1.355903716	8.868045087	1.230322664	1.30451441	0	0	2.741167986	1.466997239	0	0	0.096342466	0	0.026159942	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2654	NO	"$295 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-25 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"25% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $17 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 25% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 25% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"25% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 25% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.8675	0.0408	0.6094	0.2996	0.2071	0	0.239	0.1495	0.9539	0.3005	0.5491	0	0.0009	0.4571	0.9534	2.0102	0.2406	0.2903	0	0	0.5269	0.2886	0	0	0.0219	0	0.0059	0	0	0											9.0121	0	NO	2.753208768	15.0579	0.548063965	2.724137103	0.299649083	2.036360182	1.935930092	1.053196829	1.46910237	7.693428098	2.954520534	4.381043961	0	0.008794953	3.688152667	2.309299248	10.87825784	1.470895522	1.594777909	0	0	3.268038654	1.755619831	0	0	0.118201681	0	0.032095391	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2774
H0401_801_0	2012	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	236.89039	4.2145	21.03752807	672.2348406	7.557062161	12.9450298	12.75786921	17.05369404	63.65205593	19.86460795	30.77209151	0	0.059692654	33.64019403	31.37789377	72.10492651	1.9732	5.194565493	0	0	21.56403903	7.752880912	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.084323713	0.084323713	0.186331061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070961563	0.070961563	0.156804568	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0	0.188504392	0.188504392	0	0	0	0	0	0	0	0												16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	150	YES	15.84993642	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	NO																																										0	0	0	0	0	0	0	0	0	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	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733
H0401_804_0	2012	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	236.89039	4.2145	21.03752807	672.2348406	7.557062161	12.9450298	12.75786921	17.05369404	63.65205593	19.86460795	30.77209151	0	0.059692654	33.64019403	31.37789377	72.10492651	1.9732	5.194565493	0	0	21.56403903	7.752880912	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.084323713	0.084323713	0.186331061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070961563	0.070961563	0.156804568	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0	0.188504392	0.188504392	0	0	0	0	0	0	0	0												16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	150	YES	15.84993642	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	NO																																										0	0	0	0	0	0	0	0	0	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	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733
H0401_805_0	2012	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	236.89039	4.2145	21.03752807	672.2348406	7.557062161	12.9450298	12.75786921	17.05369404	63.65205593	19.86460795	30.77209151	0	0.059692654	33.64019403	31.37789377	72.10492651	1.9732	5.194565493	0	0	21.56403903	7.752880912	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.084323713	0.084323713	0.186331061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070961563	0.070961563	0.156804568	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0.188504392	0	0	0.188504392	0.188504392	0	0	0	0	0	0	0	0												16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	150	YES	15.84993642	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733	NO																																										0	0	0	0	0	0	0	0	0	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	16.8101	0.299067508	3.298780507	0	1.424539406	2.440194967	2.404914376	3.21469622	11.99869208	3.744565837	5.80067439	0	0.011252327	6.341324312	5.914870778	13.59209531	0.371956866	0.979198408	0	0	4.06491606	1.4614521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1733
H0408_002_0	2012	4																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	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	197.3628091	41.140663	8216.519706	13.31747095	16.63144743	24.4603171	4.413069566	12.93528227	30.28686872	37.99104234	13.63735854	0	0	13.53479899	3.253593527	101.4361515	2579.387474	96.13714386	0	2669.670953	37.74047899	7.904322942	1507.893137	0	40.80948837	209.8208	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a); $0 (9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $0 (7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.101572308	0.102805979	0	0	0.2	0.2	0.192296332	0.111534174	0.16	0	0.088258899	0	0	0.144904701	0	0.03403548	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.094502635	0.09565044	0	0	0.186079526	0.186079526	0.178912052	0.103771131	0.148863621	0	0.082115871	0	0	0.134818991	0	0.03166653	0	0	0	0	0.186079526	0.186841868	0	0	0	0	0	0	0	0												18.6513	3.935122511	0	0	3.094771863	4.551564224	0.789551333	1.342308872	4.508612951	0	1.11984357	0	0	1.824747944	0	3.21213092	0	0	0	0	7.022730459	1.476858466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5295	0	NO	3.848411327	18.6513	3.935122511	0	0	3.094771863	4.551564224	0.789551333	1.342308872	4.508612951	0	1.11984357	0	0	1.824747944	0	3.21213092	0	0	0	0	7.022730459	1.476858466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5295	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.2975	0.062	0	0.0017	0.5238	0.7703	0.139	0.1514	0.763	0	0.3303	0	0	0.312	0.0505	2.1155	0.3719	0.0092	0	0	0.7871	0.1648	0	0	0.0156	0	0	0	0	0											6.8656	0	NO	0	18.9488	3.997143611	0	0.001678543	3.618524627	5.321861503	0.928526452	1.49375525	5.271641246	0	1.45015207	0	0	2.136773597	0.050485746	5.32764424	0.37189035	0.009153734	0	0	7.809831357	1.641707982	0	0	0.01555398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3952
H0423_001_0	2012	9																															Coin	Coin	Coin	P	P	P	P	V	V	P	P	V	P	P	P	V	V	V	P	V	Coin	P	P	P	V	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	379.10418	13.14144	12.51922932	2541.900305	1772.49	12342.78	0	731.2088748	538.1142141	5418.784447	3097.277456	1394.974258	0.416049772	0	4696.770891	1207.200654	1206.879279	128.5091997	203.7716718	17.16382363	19.29463669	0	379.38	234.09	231.2741853	629.1346838	0.82	0	64.25	0											6700	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	None	None	None	None	$50 copay per visit	None	None	None	$10 copay per visit	None	None	None	$10 copay per visit	$10 copay per visit	$25 copay per visit	None	$10 copay per visit	None	None	None	None	$10 per exam	None	$10 copay per visit	None	None	None											None		0.056986274	0.056986274	0.148606453	0	0	0	0	47.03576577	0	0	0	10	0	0	0	10	10	22.25856164	0	10	0	0	0	0	10	0	10	0	0	0											NO	0.054293078	0.054293078	0.141583248	0	0	0	0	44.81283519	0	0	0	9.527395687	0	0	0	9.527395687	9.527395687	21.20661242	0	9.527395687	0	0	0	0	9.527395687	0	9.527395687	0	0	0												20.5827	0.713489223	1.77251315	0	0	0	0	2.730628567	0	0	0	1.107539311	0	0	0	0.958456525	0.95820137	0.227103733	0	0.013627212	0	0	0	0	0.183620056	0	0.000651039	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2486	None		1.45086836	20.5827	0.713489223	1.77251315	0	0	0	0	2.730628567	0	0	0	1.107539311	0	0	0	0.958456525	0.95820137	0.227103733	0	0.013627212	0	0	0	0	0.183620056	0	0.000651039	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2486	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	None		0	20.5827	0.713489223	1.77251315	0	0	0	0	2.730628567	0	0	0	1.107539311	0	0	0	0.958456525	0.95820137	0.227103733	0	0.013627212	0	0	0	0	0.183620056	0	0.000651039	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2486
H0423_002_0	2012	7																															Coin	Coin	Coin	P	T	P	P	V	V	P	P	V	P	P	P	Coin	V	V	P	V	Coin	P	P	P	V	P	V	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	611.9240857	24.00798183	19.91115045	5310.459637	2466.240534	14638.20794	0	799.1201279	771.3479891	7396.899374	4490.233081	1924.606294	6085.556273	0	5206.992845	302.8257822	1553.168749	201.7383401	221.4298675	154.5384454	20.6530596	0	372.3693373	365.2361522	184.7474313	802.409431	0.804847005	0	89.62703657	0											6700	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	None	None	None	None	$50 copay per visit	$50 copay per visit	None	None	$10 copay per visit	None	None	None	5% Coinsurance	$10 copay per visit	$25 copay per visit	None	$10 copay per visit	None	None	None	None	$10 per exam	None	$10 copay per visit	None	None	None											None		0.056986274	0.056986274	0.148606453	0	0	0	0	46.3047027	50	0	0	10	0	0	0	0.05	10	23.53444444	0	10	0	0	0	0	10	0	10	0	0	0											NO	0.054956344	0.054956344	0.143312887	0	0	0	0	44.65526542	48.21893114	0	0	9.643786227	0	0	0	0.048218931	9.643786227	22.69611512	0	9.643786227	0	0	0	0	9.643786227	0	9.643786227	0	0	0												33.6291	1.319390909	2.853524446	0	0	0	0	2.973743451	3.099464631	0	0	1.546707639	0	0	0	14.60193554	1.248202282	0.381556383	0	0.124194644	0	0	0	0	0.148472061	0	0.000646814	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9269	None		2.287403697	33.6291	1.319390909	2.853524446	0	0	0	0	2.973743451	3.099464631	0	0	1.546707639	0	0	0	14.60193554	1.248202282	0.381556383	0	0.124194644	0	0	0	0	0.148472061	0	0.000646814	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9269	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	None		0	33.6291	1.319390909	2.853524446	0	0	0	0	2.973743451	3.099464631	0	0	1.546707639	0	0	0	14.60193554	1.248202282	0.381556383	0	0.124194644	0	0	0	0	0.148472061	0	0.000646814	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9269
H0423_003_0	2012	8																															Coin	Coin	Coin	P	T	P	P	V	P	P	P	V	P	P	P	V	V	V	P	V	Coin	P	P	P	P	P	V	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	1699.550275	204.1382433	299.3713861	11303.75411	2999.578233	15676.53764	0	712.5465838	550.1700169	6369.66028	2956.098141	1352.898985	0.355958381	0	5069.463986	1177.842781	1241.501703	186.7801868	192.6202639	14.68479801	20.95507908	0	324.5849403	268.272237	227.9515007	643.5524963	0.701564793	0	54.9701682	0											6700	None	None	None	None	None	None	None	$50 copay per visit	None	None	None	$20 copay per visit	None	None	None	$10 copay per visit	$20 copay per visit	$20 copay per visit	None	$10 copay per visit	None	None	None	None	None	None	$10 copay per visit	None	None	None											None		0	0	0	0	0	0	0	47.03576577	0	0	0	20	0	0	0	10	20	20	0	10	0	0	0	0	0	0	10	0	0	0											NO	0	0	0	0	0	0	0	47.03576577	0	0	0	20	0	0	0	10	20	20	0	10	0	0	0	0	0	0	10	0	0	0												0	0	0	0	0	0	0	2.792931184	0	0	0	2.254831641	0	0	0	0.98153565	2.069169506	0.311300311	0	0.012237332	0	0	0	0	0	0	0.000584637	0	0	0	0	0	0	0	0	0	0	0	0	0	8.4226	None		0	0	0	0	0	0	0	0	2.792931184	0	0	0	2.254831641	0	0	0	0.98153565	2.069169506	0.311300311	0	0.012237332	0	0	0	0	0	0	0.000584637	0	0	0	0	0	0	0	0	0	0	0	0	0	8.4226	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	None		0	0	0	0	0	0	0	0	2.792931184	0	0	0	2.254831641	0	0	0	0.98153565	2.069169506	0.311300311	0	0.012237332	0	0	0	0	0	0	0.000584637	0	0	0	0	0	0	0	0	0	0	0	0	0	8.4226
H0423_004_0	2012	9																															Coin	Coin	Coin	P	T	Coin	P	V	V	Coin	Coin	V	P	P	P	Coin	V	V	Coin	Coin	Coin	P	P	P	V	P	V	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	390.5848901	6.155716318	12.85379153	2006.702535	333.7990693	43.84476924	0	475.0772435	162.9418472	4.526575101	41.45899223	852.444561	0.152186022	0	3953.783736	157.861051	749.2597139	110.5628362	3.620221454	1.911765881	11.96522037	0	231.6544256	224.4814665	4.631678697	685.0611688	0.299946175	0	24.43888317	0											6700	Medicare Fee for Service	Medicare Fee for Service	Medicare Fee for Service	None	$75 copay per ride	20% Coinsurance	None	$50 copay per visit	$50 copay per visit	20% Coinsurance	20% Coinsurance	$40 copay per visit	None	None	None	20% Coinsurance	$40 copay per visit	$25 copay per visit	20% Coinsurance	20% Coinsurance	10% of costs	None	None	None	$20 per exam	None	$20 per visit	None	None	None											None		0.056986274	0.056986274	0.148606453	0	75	0.2	0	46.0165625	48.7975	0.2	0.2	40	0	0	0	0.2	40	25	0.2	0.2	0.1	0	0	0	20	0	20	0	0	0											NO	0.056033311	0.056033311	0.146121357	0	73.74580026	0.196655467	0	45.24704302	47.98147584	0.196655467	0.196655467	39.33109347	0	0	0	0.196655467	39.33109347	24.58193342	0.196655467	0.196655467	0.098327734	0	0	0	19.66554674	0	19.66554674	0	0	0												21.8858	0.344925169	1.878213467	0	2.051356624	8.622313586	0	1.79132004	0.651515859	0.890175742	8.153137493	2.793964726	0	0	0	31.04423877	2.455766987	0.226487356	0.711936342	0.375959213	1.176513002	0	0	0	0.007590374	0	0.00049155	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0617	None		1.446649506	21.8858	0.344925169	1.878213467	0	2.051356624	8.622313586	0	1.79132004	0.651515859	0.890175742	8.153137493	2.793964726	0	0	0	31.04423877	2.455766987	0.226487356	0.711936342	0.375959213	1.176513002	0	0	0	0.007590374	0	0.00049155	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0617	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	None		0	21.8858	0.344925169	1.878213467	0	2.051356624	8.622313586	0	1.79132004	0.651515859	0.890175742	8.153137493	2.793964726	0	0	0	31.04423877	2.455766987	0.226487356	0.711936342	0.375959213	1.176513002	0	0	0	0.007590374	0	0.00049155	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0617
H0490_001_0	2012	12																															D	D	D		T	Coin	Coin	V	V		V		Coin	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	901.8573842	6.83417537	970.4131799	0	196.1947912	9.338623678	6.21292086	241.7574417	312.0912764	0	774.6877586	0	0.281078329	907.0880039	4340.731846	5022.621337	99.76234301	396.0699956	2878.897096	78.37994041	35.16706883	0	0	0	50.57985114	0	21.7095062	0	0	0											3400	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$200/Days Custom for IP Psych; $200/Days Custom for IP Substance Abuse;	$75/Days Custom for SNF;	No Cost-Sharing;	$150/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $35/Visit for PCP Urgent Care;	$150/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	20% Coinsurance for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; $150/Case for OP Fac - Other; 20% Coinsurance for Prof - CORF; $35/Visit for OP Substance Abuse;	$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits;	$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $27/Proceedure for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; $35/Visit for Podiatry;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist;	$35/Visit for Occ Therapy; $35/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$10/Visit for PCP Office Visits; $35/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$30/Exam for Vision Exams (Refractions);	No Cost-Sharing;	$35/Exam for Hearing Exam;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	200	200	75	0	150	0.2	0.2	62.01030529	150	0	37.24533744	0	0.2	87.37831236	10	33.08640171	35	35	7.394212594	31.47473466	0.2	0	0	0	30	0	35	0	0	0											NO	180.6677218	180.6677218	67.75039568	0	135.5007914	0.180667722	0.180667722	56.01630293	135.5007914	0	33.64515132	0	0.180667722	78.93220315	9.033386091	29.9494328	31.61685132	31.61685132	6.67947772	28.43234303	0.180667722	0	0	0	30	0	35	0	0	0												13.578	0.102892908	5.478823076	0	2.215379122	1.687187865	1.122474258	1.128529841	3.524051244	0	2.172040572	0	0.050781781	5.966537883	3.267625557	12.53538835	0.262847597	1.043540513	1.602460751	0.185710446	6.353554208	0	0	0	0.126449628	0	0.063319393	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4676	0	NO	6.635658429	13.578	0.102892908	5.478823076	0	2.215379122	1.687187865	1.122474258	1.128529841	3.524051244	0	2.172040572	0	0.050781781	5.966537883	3.267625557	12.53538835	0.262847597	1.043540513	1.602460751	0.185710446	6.353554208	0	0	0	0.126449628	0	0.063319393	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4676	NO																																										0	0	0	0	0	0	0	0	0	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	13.578	0.102892908	5.478823076	0	2.215379122	1.687187865	1.122474258	1.128529841	3.524051244	0	2.172040572	0	0.050781781	5.966537883	3.267625557	12.53538835	0.262847597	1.043540513	1.602460751	0.185710446	6.353554208	0	0	0	0.126449628	0	0.063319393	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4676
H0490_004_0	2012	11																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	290.8318239	3.220595841	83.8765122	0	10.72193408	13.0327942	8.596793414	18.30107758	53.12515695	7.570134982	28.42472596	0	0.365313001	25.84770639	45.49648608	63.09140069	1.358648458	5.446294972	24.69866174	101.787411	49.43053162	0.177796106	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, 7c, 7i, 9a, 9c, 9d, 14a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8a, 14a, 14f-h"	"Medicare-FFS Cost Sharing; PBP 7a, 7d, 8a, 14a, 14b, 14d-e, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 13a, 14a, 14c"	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 13a-d, 14c"											0	NO	0.079146537	0.079146537	0.17167653	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.175193056	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07765262	0.07765262	0.168436079	0	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0	0.219771926	0.171886229	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0.219771926	0.22206152	0	0	0	0	0	0	0	0												22.5839	0.250087706	14.12783085	0	2.356380106	2.864242285	1.889333847	4.022063069	11.67541807	1.663703146	6.246956774	0	0.080285542	4.442864784	9.998850379	13.86571865	0.298592789	1.196942736	5.428072464	22.37001537	10.86344314	0.039481674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2641	0	NO	2.621097509	22.5839	0.250087706	14.12783085	0	2.356380106	2.864242285	1.889333847	4.022063069	11.67541807	1.663703146	6.246956774	0	0.080285542	4.442864784	9.998850379	13.86571865	0.298592789	1.196942736	5.428072464	22.37001537	10.86344314	0.039481674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2641	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	NO	0	22.5839	0.250087706	14.12783085	0	2.356380106	2.864242285	1.889333847	4.022063069	11.67541807	1.663703146	6.246956774	0	0.080285542	4.442864784	9.998850379	13.86571865	0.298592789	1.196942736	5.428072464	22.37001537	10.86344314	0.039481674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2641
H0504_015_0	2012	8																															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	1124.190944	31.86896545	911.8472457	1012.644341	244.5745843	11.59978228	1.385479483	391.8315369	139.9432379	1074.726249	2.362617435	22.22806108	0.140836177	1481.63793	4351.198601	5298.117555	323.9186051	3773.582712	2001.344025	11881.16449	36.94514284	0	0	3555.484083	320.9536586	89.78625181	0	0	0	0											3000	"$50 copay per day for days 1-5, $0 copay per day for days 6-90, $250 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	$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: $65 Copay, 4b.) Urgent Care: $10 Copay"	$0 Copay per visit for ASC/$100 Copay per visit for Hospital	$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 up to $500."	$30 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $20 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $20"	$0 Copay per visit	$5 Copay per visit	$30 Copay per visit	$20 copay per visit	$5 Copay	$0 Copay	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	"Oral Exams: $16, 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											0	NO	25.06034079	130.9521236	23.1145001	0	200	0.170674134	0.135237654	65	36.56	0	0.174	30	0.1	0	0	5	30	20	5	0	0.19960229	0	0	16	10	20	0	0	0	0											NO	24.76071977	127.6574478	16.18244054	0	194.9681216	0.166380077	0.131835157	63.36463952	35.64017263	0	0.169622266	29.24521824	0.097484061	0	0	4.87420304	29.24521824	19.49681216	4.87420304	0	0.194580418	0	0	16	10	20	0	0	0	0												2.3196	0.3390259	1.229659486	0	3.973687274	1.929972669	0.182654905	2.069022007	0.41563343	0	0.400752523	0.054172041	0.013729282	0	0	2.152008391	0.789422525	6.131069442	0.812913094	0	7.188801328	0	0	4.740645443	0.267461382	0.149643753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1599	0	NO	1.233424633	2.3196	0.3390259	1.229659486	0	3.973687274	1.929972669	0.182654905	2.069022007	0.41563343	0	0.400752523	0.054172041	0.013729282	0	0	2.152008391	0.789422525	6.131069442	0.812913094	0	7.188801328	0	0	4.740645443	0.267461382	0.149643753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1599	NO																																																																																		0	0	NO	0	2.3196	0.3390259	1.229659486	0	3.973687274	1.929972669	0.182654905	2.069022007	0.41563343	0	0.400752523	0.054172041	0.013729282	0	0	2.152008391	0.789422525	6.131069442	0.812913094	0	7.188801328	0	0	4.740645443	0.267461382	0.149643753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1599
H0504_017_0	2012	7																															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	905.1248506	59.38625928	339.8269624	550.5945529	178.4444703	8.953165323	0.543659739	468.4811953	137.0156778	2020.944622	2.799152007	60.4735472	0.230274883	1810.545111	4260.173158	5187.282923	317.1423494	3694.640777	1959.476658	11632.61499	35.746853	0	0	3481.104689	314.2394285	87.9079571	0	0	0	0											3400	"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	"$50 copay per day for days 1-20, $90 copay 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: $65 Copay, 4b.) Urgent Care: $10 Copay"	$0 Copay per visit for ASC/$100 Copay per visit for Hospital	$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"	$30 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $20 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $20"	$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: $16, 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											0	NO	98.43402052	130.9521236	52.63014406	0	200	0.191206024	0.090143791	65	36.56	0	0.077682787	30	0.1	0	0	10	30	20	10	0	0.2	0	0	16	10	20	0	0	0	0											NO	98.32174087	127.1708434	51.19467387	0	194.2249425	0.185684895	0.087540863	63.12310632	35.5043195	0	0.075439674	29.13374138	0.097112471	0	0	9.711247127	29.13374138	19.42249425	9.711247127	0	0.194224943	0	0	16	10	20	0	0	0	0												7.4161	0.629350057	1.449777543	0	2.88819725	1.66246756	0.047592443	2.464332358	0.405387367	0	0.211167116	0.14681839	0.022362563	0	0	4.197915532	0.769961932	5.979928271	1.585746839	0	6.942930469	0	0	4.641472919	0.26186619	0.146513262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8699	0	NO	0.874668466	7.4161	0.629350057	1.449777543	0	2.88819725	1.66246756	0.047592443	2.464332358	0.405387367	0	0.211167116	0.14681839	0.022362563	0	0	4.197915532	0.769961932	5.979928271	1.585746839	0	6.942930469	0	0	4.641472919	0.26186619	0.146513262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8699	NO																																																																																		0	0	NO	0	7.4161	0.629350057	1.449777543	0	2.88819725	1.66246756	0.047592443	2.464332358	0.405387367	0	0.211167116	0.14681839	0.022362563	0	0	4.197915532	0.769961932	5.979928271	1.585746839	0	6.942930469	0	0	4.641472919	0.26186619	0.146513262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8699
H0504_021_0	2012	10																															D	D	D	V	T	Coin	P	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	861.5713357	17.2122003	759.9399249	459.7064475	295.5960393	21.87011316	74.66827188	373.074022	139.6259641	879.8813224	0.063105979	3.43553927	13.58875247	1314.695254	4341.333736	5286.105873	323.1842297	3765.027395	1996.806657	11854.22799	36.26975912	0	0	3547.42323	320.2260052	89.58269198	0	0	0	0											2000	$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: $65 Copay, 4b.) Urgent Care: $0 Copay"	$0 Copay per visit for ASC/$50 Copay per visit for Hospital	$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 up to $500."	$30 Copay	$25 Copay	"$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	$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: $16, 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.	$500 allowance/every 2 years	No copay	Not covered											0	NO	0	130.9521236	16.31611772	0	60	0.031986148	0	65	21.71	0	0.077682787	30	25	0	0	0	30	10	0	0	0.2	0	0	16	10	0	0	0	0	0											NO	0	128.304913	11.24246915	0	58.78709386	0.031339545	0	63.68601834	21.27113013	0	0.076112422	29.39354693	24.49462244	0	0	0	29.39354693	9.797848976	0	0	0.19595698	0	0	16	10	0	0	0	0	0												0	0.184034155	0.711966763	0	1.448102675	0.685399389	0	1.979966584	0.247500171	0	0.004803149	0.008415224	0.027737613	0	0	0	0.791627569	3.074097484	0	0	7.107312446	0	0	4.72989764	0.266855004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2677	0	NO	0.639179368	0	0.184034155	0.711966763	0	1.448102675	0.685399389	0	1.979966584	0.247500171	0	0.004803149	0.008415224	0.027737613	0	0	0	0.791627569	3.074097484	0	0	7.107312446	0	0	4.72989764	0.266855004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2677	NO																																																																																		0	0	NO	0	0	0.184034155	0.711966763	0	1.448102675	0.685399389	0	1.979966584	0.247500171	0	0.004803149	0.008415224	0.027737613	0	0	0	0.791627569	3.074097484	0	0	7.107312446	0	0	4.72989764	0.266855004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2677
H0504_026_0	2012	11																															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	1131.495828	36.71445198	780.223043	1119.754609	275.5326696	11.42492239	4.934192186	466.8213176	125.4774804	1866.435017	15.92864266	854.5222856	0	1918.185631	4325.716628	5267.09013	322.021637	3751.483437	1989.623531	11811.5847	36.15438588	0	0	3534.662061	319.0740541	89.26043558	0	0	0	0											6700	"$250 copay per day for days 1-7, $0 copay per day for days 8-90, $1750 annual out-of-pocket max"	$900.00 per Admit	"$50 copay per day for days 1-20, $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: $65 Copay, 4b.) Urgent Care: $10 Copay"	$250 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"	$30 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $20 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $20"	"$5 Copay per visit.  $0 copay for Preventive/Wellness Screenings including 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j"	$10 Copay	$30 Copay per visit	$20 Copay	$10 Copay	$5 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	Not Covered	$15 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											0	NO	148.6815087	130.9521236	60.87741181	0	200	0.185170861	0.186493724	65	250	0	0.077682787	30	0.1	0	5	10	30	20	10	5	0.2	0	0	0	15	20	0	0	0	0											NO	148.3507472	130.5144511	59.5338278	0	199.3315533	0.184551977	0.185870419	64.78275483	249.1644416	0	0.077423153	29.899733	0.099665777	0	4.983288833	9.966577666	29.899733	19.93315533	9.966577666	4.983288833	0.199331553	0	0	0	15	20	0	0	0	0												13.9882	0.399313879	3.870805357	0	4.576862919	2.108492016	0.917120369	2.520164247	2.605377196	0	1.233245742	2.129165682	0	0	1.796357947	4.374571904	0.802363414	6.231575173	1.652478121	4.905044843	7.206709896	0	0	0	0.398842568	0.148767393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8654	0	NO	0.263632459	13.9882	0.399313879	3.870805357	0	4.576862919	2.108492016	0.917120369	2.520164247	2.605377196	0	1.233245742	2.129165682	0	0	1.796357947	4.374571904	0.802363414	6.231575173	1.652478121	4.905044843	7.206709896	0	0	0	0.398842568	0.148767393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8654	NO																																																																																		0	0	NO	0	13.9882	0.399313879	3.870805357	0	4.576862919	2.108492016	0.917120369	2.520164247	2.605377196	0	1.233245742	2.129165682	0	0	1.796357947	4.374571904	0.802363414	6.231575173	1.652478121	4.905044843	7.206709896	0	0	0	0.398842568	0.148767393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8654
H0504_803_0	2012	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											15.10757705	0.169665259	0	0	0.057619949	0.061325438	0.008539867	0.114498395	0.109926508	0.001330684	0.014818556	0.000285355	0.000659272	0.186738909	0.7760401	2.944114295	0.249859554	0.711712008	1.260612791	4.644548846	1.64673483	0.01735615	0	0	0	0	0	0	0	0											28.084	YES	250.7145536	2.815643406	25.07689431	10.17747676	8.685034582	9.243561545	1.28721114	17.25830266	16.56918369	0.200573552	2.23359568	0.043011476	0.099371847	28.14708976	23.31425717	88.44882864	7.506428969	21.38167447	37.8720775	139.5342924	49.47218491	0.521423753	0	0	0	0	0	0	0	0											6700	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	$0 days 1-20 and $141.50/day for days 21-100	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.004209416	0.004209416	0.148187562	0	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0	0	0	0	0	0	0	0											NO	0.003587926	0.003587926	0.126308735	0	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0	0	0	0	0	0	0	0												0.8995	0.01010232	3.167430792	0	1.609103602	1.712583644	0.238485646	3.197499873	3.069824639	0.037160891	0.413825278	0.007968871	0.018410934	5.214899616	3.789881393	14.37792195	1.220217967	3.475727733	6.156348056	22.68219033	8.042019597	0.084760761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4259			13.75792249	16.0071	0.179767579	3.167430792	0	1.666723551	1.773909082	0.247025513	3.311998268	3.179751147	0.038491575	0.428643834	0.008254226	0.019070206	5.401638525	4.565921493	17.32203624	1.47007752	4.187439741	7.416960848	27.32673918	9.688754427	0.102116911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5099	NO																																																																																		0				16.0071	0.179767579	3.167430792	0	1.666723551	1.773909082	0.247025513	3.311998268	3.179751147	0.038491575	0.428643834	0.008254226	0.019070206	5.401638525	4.565921493	17.32203624	1.47007752	4.187439741	7.416960848	27.32673918	9.688754427	0.102116911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5099
H0504_804_0	2012	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											11.95905003	0.134305807	0	0	0.055765318	0.056512028	0.007869576	0.089991122	0.125767177	0.002292025	0.025524092	0.000491507	0.001135557	0.321646809	0.774566255	2.938522874	0.249385024	0.710360335	1.258218653	4.635727983	1.851069391	0.005990634	0	0	0	0	0	0	0	0											25.2042	YES	239.1993429	2.686322125	33.15842267	6.423855772	8.40548665	8.518038074	1.186178449	13.56432996	18.9568422	0.345476169	3.847237443	0.074084743	0.171162173	48.48170983	23.26997906	88.28084785	7.492172863	21.34106669	37.80015137	139.2692908	55.61092504	0.179974184	0	0	0	0	0	0	0	0											6700	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	$0 days 1-20 and $141.50/day for days 21-100	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0		0.003492555	0.003492555	0.124428008	0	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0	0	0	0	0	0	0	0											NO	0.002976904	0.002976904	0.106057108	0	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0	0	0	0	0	0	0	0												0.7121	0.007996924	3.516686408	0	1.557310879	1.578163635	0.219767002	2.513105963	3.512193622	0.064007454	0.71278975	0.013725913	0.031711753	8.982358465	3.782683703	14.3506156	1.217900546	3.469126679	6.144656005	22.63911263	9.039911008	0.029255953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0952	0		14.56671526	12.6711	0.142302731	3.516686408	0	1.613076197	1.634675663	0.227636579	2.603097085	3.6379608	0.066299479	0.738313842	0.01421742	0.03284731	9.304005274	4.557249958	17.28913847	1.467285569	4.179487013	7.402874658	27.27484061	10.8909804	0.035246587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2993	NO																																																																																		0			0	12.6711	0.142302731	3.516686408	0	1.613076197	1.634675663	0.227636579	2.603097085	3.6379608	0.066299479	0.738313842	0.01421742	0.03284731	9.304005274	4.557249958	17.28913847	1.467285569	4.179487013	7.402874658	27.27484061	10.8909804	0.035246587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2993
H0504_805_0	2012	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											14.05722692	0.157869329	0	0	0.057009185	0.059740293	0.008319128	0.106427697	0.115143133	0.001647272	0.018344087	0.000353245	0.000816122	0.231166571	0.775554736	2.942272937	0.249703282	0.711266877	1.259824357	4.641643973	1.714025974	0.013613276	0	0	0	0	0	0	0	0											27.122	YES	246.9223821	2.77305552	27.73829082	8.941340061	8.592974286	9.004633269	1.253939209	16.04180924	17.35548373	0.24829266	2.764997708	0.053244477	0.123013727	34.84365563	23.29967557	88.39350947	7.50173417	21.36830158	37.8483909	139.4470225	51.49378539	0.408978105	0	0	0	0	0	0	0	0											6700	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	"$1132 Deductible to days 1-60, $283 days 61-90 and $566 days 91+"	$0 days 1-20 and $141.50/day for days 21-100	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	$162 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.00397691	0.00397691	0.140181725	0	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.217365605	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0.190713926	0	0	0	0	0	0	0	0											NO	0.003389748	0.003389748	0.119484902	0	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.185273137	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0.162556386	0	0	0	0	0	0	0	0												0.837	0.009399959	3.314306958	0	1.592047302	1.668316653	0.232321251	2.972116321	3.215504914	0.04600196	0.512279799	0.009864771	0.022791139	6.455593381	3.787511061	14.36892946	1.219454797	3.473553884	6.152497648	22.66800405	8.370643665	0.066482003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9946			14.02965094	14.8942	0.167269288	3.314306958	0	1.649056487	1.728056946	0.240640379	3.078544018	3.330648047	0.047649231	0.530623886	0.010218016	0.023607261	6.686759953	4.563065797	17.3112024	1.469158079	4.184820761	7.412322005	27.30964802	10.08466964	0.080095278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1166	NO																																																																																		0				14.8942	0.167269288	3.314306958	0	1.649056487	1.728056946	0.240640379	3.078544018	3.330648047	0.047649231	0.530623886	0.010218016	0.023607261	6.686759953	4.563065797	17.3112024	1.469158079	4.184820761	7.412322005	27.30964802	10.08466964	0.080095278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1166
H0523_002_0	2012	5																															D	D	D	V	T	O	O	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	1668.264214	100.1447149	1257.9919	1124.736149	262.7298351	1065.518527	0	420.7543187	376.891971	3250.193488	2749.625621	65.24065394	2.74747642	725.5790637	2692.822942	7969.723799	335.3011282	931.916016	0	0	302.6588014	0.007322949	0	0	1302.859798	150	55.952495	18	55	0											3400	$100/day 1-5; unlimited additional days	$100/day 1-5	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	$10 	$10 for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $15 Urgent Care Ctr	$100 per procedure	$0 to $10 per visit	$0 to $10 X-ray; $10 Therapeutic Radiology; $100 Complex Radiology	$10 per visit	$30 per visit	$0 to 100 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script		Not Covered		$0 per visit	$150.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	61.28387407	38.74210874	40.33133874	0	100	1.5	1.5	60	100	1	7.100757087	10	30	10	5	10	10	5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	56.69713247	35.84248719	37.31277257	0	92.51558151	1.387733723	0	55.50934891	92.51558151	0.925155815	6.569306711	9.251558151	27.75467445	9.251558151	4.625779075	9.251558151	9.251558151	4.625779075	0	0	46.25779075	0	0	0	0	0	0	0	0	0												7.8821	0.299119639	3.911597138	0	2.025550289	0.123221333	0	1.946316524	2.905698322	0.25057795	1.50526117	0.050298142	0.006354609	0.559394742	1.038033668	6.144363598	0.258504824	0.359236467	0	0	1.166693959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4324	0	NO	2.461948626	7.8821	0.299119639	3.911597138	0	2.025550289	0.123221333	0	1.946316524	2.905698322	0.25057795	1.50526117	0.050298142	0.006354609	0.559394742	1.038033668	6.144363598	0.258504824	0.359236467	0	0	1.166693959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4324	NO																																																																																		0		NO		7.8821	0.299119639	3.911597138	0	2.025550289	0.123221333	0	1.946316524	2.905698322	0.25057795	1.50526117	0.050298142	0.006354609	0.559394742	1.038033668	6.144363598	0.258504824	0.359236467	0	0	1.166693959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4324
H0523_022_0	2012	5																															D	D	D	V	T	O	O	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	1678.530416	100.7609877	1257.597829	1135.701494	264.2665014	1062.508305	0	396.5577868	377.4564068	3261.846576	2759.483998	65.47456467	2.75732709	728.1805202	2719.075973	8047.422708	338.5700661	941.0015076	0	0	305.6095007	0.007394342	0	0	1315.561717	150	56.49799042	18	55	0											3400	$100/day 1-5; unlimited additional days	$100/day 1-5	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	$10 	$10 for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $15 Urgent Care Ctr	$100 per procedure	$0 to $10 per visit	$0 to $10 X-ray; $10 Therapeutic Radiology; $100 Complex Radiology	$10 per visit	$30 per visit	$0 to 100 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script		Not Covered		$0 per visit	$150.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	61.28387407	38.74210874	40.33133874	0	100	1.5	1.5	60	100	1	7.100757087	10	30	10	5	10	10	5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	56.49864976	35.71701146	37.18214973	0	92.19170722	1.382875608	0	55.31502433	92.19170722	0.921917072	6.546309184	9.219170722	27.65751217	9.219170722	4.609585361	9.219170722	9.219170722	4.609585361	0	0	46.09585361	0	0	0	0	0	0	0	0	0												7.9029	0.29990678	3.896682565	0	2.030264994	0.122443068	0	1.827966969	2.899862545	0.250596004	1.50536962	0.050301766	0.006355067	0.559435044	1.0444844	6.182546985	0.26011127	0.361468898	0	0	1.173944234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3746	0	NO	2.572617726	7.9029	0.29990678	3.896682565	0	2.030264994	0.122443068	0	1.827966969	2.899862545	0.250596004	1.50536962	0.050301766	0.006355067	0.559435044	1.0444844	6.182546985	0.26011127	0.361468898	0	0	1.173944234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3746	NO																																																																																		0		NO		7.9029	0.29990678	3.896682565	0	2.030264994	0.122443068	0	1.827966969	2.899862545	0.250596004	1.50536962	0.050301766	0.006355067	0.559435044	1.0444844	6.182546985	0.26011127	0.361468898	0	0	1.173944234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3746
H0523_031_0	2012	5																															D	D	D	V	T	O	O	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	1699.34763	102.0106303	1290.923209	1141.625222	267.2522371	1069.4168	0	440.3336455	386.2349923	3317.071873	2806.203952	66.58309389	2.804010527	740.5091152	2733.258454	8089.397416	340.3360202	945.9096955	0	0	307.2035352	0.007432911	0	0	1322.423581	0	56.79267937	0	0	0											3400	$100/day 1-5; unlimited additional days	$100/day 1-5	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	$10 	$10 for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $15 Urgent Care Ctr	$75 per procedure	$0 to $0 per visit	$0 to $0 X-ray; 0% Therapeutic Radiology; $150 Complex Radiology	$0 per visit	$30 per visit	$0 to 75 per visit	$0 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$0 per visit; Chiropractic Visits $0 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	61.28387407	38.74210874	40.33133874	0	100	1.5	1.5	60	75	0	3.501261812	0	30	0	0	0	0	0	0	0	$50 	0	0	0	0	0	0	0	0	0											NO	59.44320536	37.57848473	39.11998201	0	96.99648767	1.454947315	0	58.1978926	72.74736575	0	3.396100982	0	29.0989463	0	0	0	0	0	0	0	48.49824383	0	0	0	0	0	0	0	0	0												8.4179	0.319450409	4.208407726	0	2.160210693	0.129662092	0	2.135540851	2.341464854	0	0.794179333	0	0.006799479	0	0	0	0	0	0	0	1.24156933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7552	0	NO	0.673652571	8.4179	0.319450409	4.208407726	0	2.160210693	0.129662092	0	2.135540851	2.341464854	0	0.794179333	0	0.006799479	0	0	0	0	0	0	0	1.24156933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7552	NO																																																																																		0		NO		8.4179	0.319450409	4.208407726	0	2.160210693	0.129662092	0	2.135540851	2.341464854	0	0.794179333	0	0.006799479	0	0	0	0	0	0	0	1.24156933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7552
H0523_032_0	2012	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	1399.77798	84.02767717	1016.282639	1105.543849	243.9838288	15.22464644	0	286.6224404	328.0010468	3001.994885	2539.652511	60.25860004	2.537667431	670.1707594	2646.873085	7833.729834	329.5796087	916.0139651	0	0	297.4942849	0.007197991	0	0	1280.628028	150	54.99773146	18	55	0											3400	$300/day 1-6; unlimited additional days	$295/day 1-6	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $25 Urgent Care Ctr	$300 per procedure	$0 to $10 per visit	$0 to $10 X-ray; $10 Therapeutic Radiology; $250 Complex Radiology	$10 per visit	$30 per visit	$0 to 300 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	202.1815809	129.0407918	58.48044118	0	200	0.03	0.03	61	300	1	10.6020189	10	30	10	5	10	10	5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	182.2804531	116.3390547	52.72409716	0	180.3136095	0.027047041	0	54.99565088	270.4704142	0.901568047	9.558441477	9.015680473	27.04704142	9.015680473	4.507840236	9.015680473	9.015680473	4.507840236	0	0	45.07840236	0	0	0	0	0	0	0	0	0												21.2627	0.814641711	4.465215382	0	3.666133736	0.411781643	0	1.313582306	7.392881583	0.225541889	2.022926658	0.04527269	0.0057197	0.503503786	0.994306749	5.885533758	0.24761537	0.344103717	0	0	1.117547256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.719	0	NO	5.53742901	21.2627	0.814641711	4.465215382	0	3.666133736	0.411781643	0	1.313582306	7.392881583	0.225541889	2.022926658	0.04527269	0.0057197	0.503503786	0.994306749	5.885533758	0.24761537	0.344103717	0	0	1.117547256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.719	NO																																																																																		0		NO		21.2627	0.814641711	4.465215382	0	3.666133736	0.411781643	0	1.313582306	7.392881583	0.225541889	2.022926658	0.04527269	0.0057197	0.503503786	0.994306749	5.885533758	0.24761537	0.344103717	0	0	1.117547256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.719
H0523_052_0	2012	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	1626.805872	97.6560001	1209.852959	1117.033055	257.09628	11.34839594	0	303.3385819	366.088031	3119.109115	2638.729777	62.60941668	2.636667256	696.3155516	2674.380333	7915.140745	333.0047175	925.5335086	0	0	300.5859515	0.007272796	0	0	1293.936771	150	55.56928748	18	55	0											3400	$200/day 1-5; unlimited additional days	$200/day 1-5	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $15 Urgent Care Ctr	$150 per procedure	$0 to $10 per visit	$0 to $10 X-ray; $10 Therapeutic Radiology; $250 Complex Radiology	$10 per visit	$30 per visit	$0 to 150 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script		Not Covered		$0 per visit	$125.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	122.5677481	77.48421749	40.33133874	0	100	0.03	0.03	60	150	1	10.6020189	10	30	10	5	10	10	5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	113.2718968	71.60761636	37.27250691	0	92.41574436	0.027724723	0	55.44944662	138.6236165	0.924157444	9.797934684	9.241574436	27.72472331	9.241574436	4.620787218	9.241574436	9.241574436	4.620787218	0	0	46.20787218	0	0	0	0	0	0	0	0	0												15.3559	0.582742782	3.757854398	0	1.979978674	0.314631137	0	1.401663042	4.229037236	0.240212326	2.1545085	0.048217465	0.006091739	0.536254333	1.029811872	6.095696864	0.256457324	0.356391117	0	0	1.157453102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.503	0	NO	3.241877014	15.3559	0.582742782	3.757854398	0	1.979978674	0.314631137	0	1.401663042	4.229037236	0.240212326	2.1545085	0.048217465	0.006091739	0.536254333	1.029811872	6.095696864	0.256457324	0.356391117	0	0	1.157453102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.503	NO																																																																																		0		NO		15.3559	0.582742782	3.757854398	0	1.979978674	0.314631137	0	1.401663042	4.229037236	0.240212326	2.1545085	0.048217465	0.006091739	0.536254333	1.029811872	6.095696864	0.256457324	0.356391117	0	0	1.157453102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.503
H0523_058_0	2012	5																															D	D	D	V	T	O	O	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	1635.185844	98.15904388	1227.022129	1115.486524	255.4348707	1006.440172	0	353.789206	365.0617131	3188.045566	2697.049208	63.9931679	2.694941102	711.7050495	2670.677657	7904.182242	332.5436728	924.2521085	0	0	300.1697905	0.007262726	0	0	1292.145317	0	55.49235187	0	0	0											3400	$250/day 1-8; unlimited additional days	$224/day 1-8	"$0/d 1-20, $130/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	$10 	$10 for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $15 Urgent Care Ctr	$250 per procedure	$0 to $10 per visit	$0 to $10 X-ray; $10 Therapeutic Radiology; $250 Complex Radiology	$10 per visit	$30 per visit	$0 to 250 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	190.4579715	116.0922059	52.43074037	0	200	1.5	1.5	60	250	1	10.6020189	10	30	10	5	10	10	5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	167.952388	102.3740989	46.23522963	0	176.3668768	1.322751576	0	52.91006304	220.458596	0.881834384	9.349224805	8.81834384	26.45503152	8.81834384	4.40917192	8.81834384	8.81834384	4.40917192	0	0	44.0917192	0	0	0	0	0	0	0	0	0												22.8861	0.837411972	4.727637491	0	3.754187531	0.110939194	0	1.559917432	6.706749393	0.23427735	2.101276613	0.047026146	0.005941229	0.523004987	0.981289744	5.808483065	0.244373704	0.33959887	0	0	1.102916843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9711	0	NO	6.964122216	22.8861	0.837411972	4.727637491	0	3.754187531	0.110939194	0	1.559917432	6.706749393	0.23427735	2.101276613	0.047026146	0.005941229	0.523004987	0.981289744	5.808483065	0.244373704	0.33959887	0	0	1.102916843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9711	NO																																																																																		0		NO		22.8861	0.837411972	4.727637491	0	3.754187531	0.110939194	0	1.559917432	6.706749393	0.23427735	2.101276613	0.047026146	0.005941229	0.523004987	0.981289744	5.808483065	0.244373704	0.33959887	0	0	1.102916843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9711
H0523_801_0	2012	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	0	0	0	0	0	0	0											0	YES	295.1860995	4.786256996	35.99208559	9.345009852	8.714427656	12.18331563	0	15.61301851	37.77361705	17.62420465	50.90089793	0.821835054	0.071774378	26.3766499	26.11279098	130.068007	2.981386278	8.547039198	0	0	63.31324245	0.00032956	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	NO	0.065225474	0.065225474	0.149124244	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.052623957	0.052623957	0.120313542	0	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0.180723353	0	0	0	0	0	0	0	0												15.5339	0.251871782	4.330335299	0	1.574900589	2.201809656	0	2.821637062	6.826574744	3.185105365	9.198980965	0.148524787	0.012971306	4.766876622	4.719191153	23.50632639	0.538806126	1.544649586	0	0	11.44218149	5.96E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6047	0	NO	22.17543669	15.5339	0.251871782	4.330335299	0	1.574900589	2.201809656	0	2.821637062	6.826574744	3.185105365	9.198980965	0.148524787	0.012971306	4.766876622	4.719191153	23.50632639	0.538806126	1.544649586	0	0	11.44218149	5.96E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6047	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.5339	0.251871782	4.330335299	0	1.574900589	2.201809656	0	2.821637062	6.826574744	3.185105365	9.198980965	0.148524787	0.012971306	4.766876622	4.719191153	23.50632639	0.538806126	1.544649586	0	0	11.44218149	5.96E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6047
H0523_805_0	2012	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	0	0	0	0	0	0	0											0	YES	292.9240513	2.587982228	35.73145505	9.211701831	8.810168673	11.98573388	0	15.72499876	37.30517415	17.8982926	49.8720263	0.833758894	0.072815738	26.27758857	26.37801112	131.2732427	3.001245556	8.606308044	0	0	62.28318454	0.000324155	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	NO	0.065528628	0.065528628	0.147774062	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.052913202	0.052913202	0.119324927	0	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0.180876016	0	0	0	0	0	0	0	0												15.4995	0.136938426	4.263653263	0	1.593548214	2.167931799	0	2.844275134	6.747611292	3.237371867	9.020653449	0.150806987	0.013170621	4.752985542	4.771149573	23.74418121	0.54285334	1.556674715	0	0	11.26553431	5.86E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3089	0	NO	22.00805627	15.4995	0.136938426	4.263653263	0	1.593548214	2.167931799	0	2.844275134	6.747611292	3.237371867	9.020653449	0.150806987	0.013170621	4.752985542	4.771149573	23.74418121	0.54285334	1.556674715	0	0	11.26553431	5.86E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3089	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.4995	0.136938426	4.263653263	0	1.593548214	2.167931799	0	2.844275134	6.747611292	3.237371867	9.020653449	0.150806987	0.013170621	4.752985542	4.771149573	23.74418121	0.54285334	1.556674715	0	0	11.26553431	5.86E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3089
H0524_002_0	2012	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	YES	847.4626109	48.83304017	545.0607799	0	223.3881936	7.665100938	0	495.2804159	78.13808528	4092.716911	1509.333545	0	0	58.66231045	10009.44393	3.056407062	274.9314406	931.2942758	0	0	163.9343393	51.31558861	0	0	642.3153698	0	0	0	178.9799789	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$5U/R OOA"	$0 to $125/procedure	$0 to $15/routine lab	"$15/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $5/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 to $5 Group Visit	$5/visit	0	0	"$8/generic, $45/brand"	0	0	0	$5/visit	0	0	0	$0 to $5/visit	0											0	NO	105.125	114.5510905	32.05	0	200	0.172	0	40.94625	111.25	9.75	30.4	0	0	5	4.7	4.7	4.67	5	0	0	14.29	0	0	0	3.1	0	0	0	3.75	0											NO	92.29975	100.5758575	12.8841	0	188.8	0.162368	0	38.65326	105.02	9.204	28.6976	0	0	4.72	4.4368	4.4368	4.40848	4.72	0	0	13.48976	0	0	0	2.9264	0	0	0	3.54	0												6.5184	0.409285407	0.585218133	0	3.514640912	1.244567109	0	1.595350224	0.683838476	3.139113871	3.609520862	0	0	0.023073842	3.700825068	0.001130056	0.10100248	0.366309082	0	0	0.184286241	0	0	0	0.156639308	0	0	0	0.052799094	0	0	0	0	0	0	0	0	0	0	0	25.886	0	NO	8.56358498	6.5184	0.409285407	0.585218133	0	3.514640912	1.244567109	0	1.595350224	0.683838476	3.139113871	3.609520862	0	0	0.023073842	3.700825068	0.001130056	0.10100248	0.366309082	0	0	0.184286241	0	0	0	0.156639308	0	0	0	0.052799094	0	0	0	0	0	0	0	0	0	0	0	25.886	NO																																																																																		0	0	NO	0	6.5184	0.409285407	0.585218133	0	3.514640912	1.244567109	0	1.595350224	0.683838476	3.139113871	3.609520862	0	0	0.023073842	3.700825068	0.001130056	0.10100248	0.366309082	0	0	0.184286241	0	0	0	0.156639308	0	0	0	0.052799094	0	0	0	0	0	0	0	0	0	0	0	25.886
H0524_003_0	2012	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	YES	899.9886929	51.85973213	542.2874871	0	204.8180518	7.31427665	0	511.6506294	75.49876039	4087.106175	1507.264388	0	0	58.58188985	10175.94586	3.107248816	279.5047833	946.7858755	0	0	159.9273135	51.31558861	0	0	642.3153698	0	0	0	202.2155169	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$5U/R OOA"	$0 to $125/procedure	$0 to $20/routine lab	"$20/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $5/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 to $5 Group Visit	$5/visit	0	0	"$7/generic, $40/brand"	0	0	0	$5/visit	0	0	0	$0 to $5/visit	0											0	NO	105.125	115.1353235	32.05	0	200	0.172	0	40.94625	111.25	13	34.7	0	0	5	4.7	4.7	4.67	5	0	0	12.61	0	0	0	3.1	0	0	0	3.75	0											NO	91.143375	99.82232547	12.53155	0	187.8	0.161508	0	38.44852875	104.46375	12.207	32.5833	0	0	4.695	4.4133	4.4133	4.38513	4.695	0	0	11.84079	0	0	0	2.9109	0	0	0	3.52125	0												6.8357	0.431396588	0.566308563	0	3.20540251	1.181314193	0	1.639351161	0.657240303	4.157608757	4.092637312	0	0	0.022920164	3.74245849	0.001142768	0.102138734	0.370429974	0	0	0.157805478	0	0	0	0.155809651	0	0	0	0.059337616	0	0	0	0	0	0	0	0	0	0	0	27.379	0	NO	9.607416774	6.8357	0.431396588	0.566308563	0	3.20540251	1.181314193	0	1.639351161	0.657240303	4.157608757	4.092637312	0	0	0.022920164	3.74245849	0.001142768	0.102138734	0.370429974	0	0	0.157805478	0	0	0	0.155809651	0	0	0	0.059337616	0	0	0	0	0	0	0	0	0	0	0	27.379	NO																																																																																		0	0	NO	0	6.8357	0.431396588	0.566308563	0	3.20540251	1.181314193	0	1.639351161	0.657240303	4.157608757	4.092637312	0	0	0.022920164	3.74245849	0.001142768	0.102138734	0.370429974	0	0	0.157805478	0	0	0	0.155809651	0	0	0	0.059337616	0	0	0	0	0	0	0	0	0	0	0	27.379
H0524_008_0	2012	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	YES	1080.387479	49.80042225	722.4069288	0	228.8675623	10.39234325	0	621.0839836	71.56181443	3735.698375	1316.854027	0	0	48.49957279	8444.186118	2.006888689	263.3713808	756.4118038	0	0	202.8438284	34.90028922	0	0	712.7144989	0	0	0	223.2123637	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	171.3878213	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	134.8822153	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												11.4626	0.55976594	0.716943726	0	3.501673703	1.73631114	0	1.978735142	0.871810749	5.286947125	3.576246323	0	0	0.092755433	15.18053559	0.003607884	0.447988793	1.446637575	0	0	0.247504968	0	0	0	0.749686564	0	0	0	0.320170234	0	0	0	0	0	0	0	0	0	0	0	48.18	0	NO	19.96906325	11.4626	0.55976594	0.716943726	0	3.501673703	1.73631114	0	1.978735142	0.871810749	5.286947125	3.576246323	0	0	0.092755433	15.18053559	0.003607884	0.447988793	1.446637575	0	0	0.247504968	0	0	0	0.749686564	0	0	0	0.320170234	0	0	0	0	0	0	0	0	0	0	0	48.18	NO																																																																																		0	0	NO	0	11.4626	0.55976594	0.716943726	0	3.501673703	1.73631114	0	1.978735142	0.871810749	5.286947125	3.576246323	0	0	0.092755433	15.18053559	0.003607884	0.447988793	1.446637575	0	0	0.247504968	0	0	0	0.749686564	0	0	0	0.320170234	0	0	0	0	0	0	0	0	0	0	0	48.18
H0524_010_0	2012	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	YES	968.9619669	44.66426724	825.3108532	0	247.3581884	8.019587588	0	498.1742377	106.078554	3602.322837	1269.838423	0	0	46.76799386	8420.265624	2.001203621	262.6253084	754.2690581	0	0	203.4183401	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	170.3964052	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	134.1019709	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												10.2804	0.499130522	0.81906944	0	3.784580283	1.339880616	0	1.587152297	1.292315244	5.098187395	3.448563698	0	0	0.089443788	15.13753253	0.003597664	0.446719741	1.442539574	0	0	0.248205973	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	46.5991	0	NO	19.02214385	10.2804	0.499130522	0.81906944	0	3.784580283	1.339880616	0	1.587152297	1.292315244	5.098187395	3.448563698	0	0	0.089443788	15.13753253	0.003597664	0.446719741	1.442539574	0	0	0.248205973	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	46.5991	NO																																																																																		0	0	NO	0	10.2804	0.499130522	0.81906944	0	3.784580283	1.339880616	0	1.587152297	1.292315244	5.098187395	3.448563698	0	0	0.089443788	15.13753253	0.003597664	0.446719741	1.442539574	0	0	0.248205973	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	46.5991
H0524_013_0	2012	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	YES	798.2228218	36.79405245	735.8971476	0	221.4832413	9.688791004	0	499.5246919	122.0604282	3583.708417	1263.276739	0	0	46.52632782	8181.466529	1.9444494	255.1772434	732.8779551	0	0	203.7681739	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	168.877242	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	132.9063895	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												8.4689	0.407513722	0.730331925	0	3.388693592	1.618764446	0	1.59145476	1.487016424	5.071843337	3.430743803	0	0	0.088981602	14.70823145	0.003495634	0.43405075	1.401629089	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	44.1621	0	NO	17.26458506	8.4689	0.407513722	0.730331925	0	3.388693592	1.618764446	0	1.59145476	1.487016424	5.071843337	3.430743803	0	0	0.088981602	14.70823145	0.003495634	0.43405075	1.401629089	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	44.1621	NO																																																																																		0	0	NO	0	8.4689	0.407513722	0.730331925	0	3.388693592	1.618764446	0	1.59145476	1.487016424	5.071843337	3.430743803	0	0	0.088981602	14.70823145	0.003495634	0.43405075	1.401629089	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	44.1621
H0524_015_0	2012	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	YES	919.7712944	52.99965803	560.6120981	0	229.3329495	8.898000221	0	467.8532651	118.7243691	4033.879204	1487.635068	0	0	57.81896948	9646.459708	2.945568983	264.9612789	897.5216578	0	0	163.8599524	51.31558861	0	0	642.3153698	0	0	0	184.0062817	0											3400	"$200/days 1-8, $0 after Day 8, Unlimited Coverage"	"$200/days 1-8, $0 after Day 8, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$15U/R OOA"	$0 to $150/procedure	$0 to $25/routine lab	"$25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $5 to $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0	0	0	$15/visit	0	0	0	$0 to $15/visit	0											0	NO	159.6	169.8303599	32.05	0	200	0.172	0	41.29625	133.5	16.25	39	0	0	15	14.1	14.1	14.12	15	0	0	15.95	0	0	0	9.3	0	0	0	11.25	0											NO	121.9344	129.7503949	8.74965	0	182.8	0.157208	0	37.7447725	122.019	14.8525	35.646	0	0	13.71	12.8874	12.8874	12.90568	13.71	0	0	14.5783	0	0	0	8.5002	0	0	0	10.2825	0												9.346	0.573060547	0.408763304	0	3.493505264	1.398836819	0	1.471584588	1.207219066	4.992765907	4.419019969	0	0	0.066058173	10.3598154	0.003163394	0.28495879	1.025418494	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.157670383	0	0	0	0	0	0	0	0	0	0	0	39.8619	0	NO	16.31527133	9.346	0.573060547	0.408763304	0	3.493505264	1.398836819	0	1.471584588	1.207219066	4.992765907	4.419019969	0	0	0.066058173	10.3598154	0.003163394	0.28495879	1.025418494	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.157670383	0	0	0	0	0	0	0	0	0	0	0	39.8619	NO																																																																																		0	0	NO	0	9.346	0.573060547	0.408763304	0	3.493505264	1.398836819	0	1.471584588	1.207219066	4.992765907	4.419019969	0	0	0.066058173	10.3598154	0.003163394	0.28495879	1.025418494	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.157670383	0	0	0	0	0	0	0	0	0	0	0	39.8619
H0524_029_0	2012	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	YES	1532.116773	88.28462633	1118.999569	0	439.7177053	21.61333573	0	1062.02378	81.85886429	5081.231871	1873.883261	0	0	72.83103325	11994.97174	3.662692611	329.4683384	1116.03088	0	0	163.8599524	51.31558861	0	270.4698122	1075.618017	0	0	0	234.0177352	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.09	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	54.09	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.219142679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2191	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	1.219142679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2191	NO																																																																																		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	1.219142679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2191
H0524_030_0	2012	10																															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	1504.903422	69.36846949	1337.792362	0	582.9344112	30.45630372	0	1170.248964	96.04992264	4716.827932	1662.70754	0	0	61.23731541	11700.65136	2.780836961	364.9394578	1048.118868	0	0	203.7681739	34.99267877	0	245.0902328	1055.077582	0	0	0	229.1335147	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.37	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	69.37	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.416825787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4168	0	NO	1.416825787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.416825787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4168	NO																																																																																		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	1.416825787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4168
H0524_031_0	2012	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	YES	895.3408189	41.27070306	547.1583387	0	171.5918971	8.296818337	0	477.7857279	77.3010728	3562.479961	1255.793592	0	0	46.25072446	8328.308787	1.979348686	259.757205	746.0317648	0	0	203.7681739	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$235/days 1-7, $0 after Day 7, Unlimited Coverage"	"$235/days 1-7, $0 after Day 7, Unlimited Coverage, $100/admit For TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $200/procedure	$0 to $25/routine lab	"$25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	168.965	176.931356	30.15	0	200	0.182	0	41.64625	182	18.5	39	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	130.609945	136.7679382	11.457	0	182.6	0.166166	0	38.02302625	166.166	16.8905	35.607	0	0	22.825	21.4555	21.4555	20.300555	22.825	0	0	14.56235	0	0	0	12.55375	0	0	0	17.11875	0												9.745	0.470375747	0.522399424	0	2.611056702	1.378649116	0	1.513904939	1.070400839	5.014338982	3.726253537	0	0	0.087972732	14.8906691	0.003538993	0.439434619	1.419014586	0	0	0.247278622	0	0	0	0.749000967	0	0	0	0.32687328	0	0	0	0	0	0	0	0	0	0	0	44.2162	0	NO	18.03491966	9.745	0.470375747	0.522399424	0	2.611056702	1.378649116	0	1.513904939	1.070400839	5.014338982	3.726253537	0	0	0.087972732	14.8906691	0.003538993	0.439434619	1.419014586	0	0	0.247278622	0	0	0	0.749000967	0	0	0	0.32687328	0	0	0	0	0	0	0	0	0	0	0	44.2162	NO																																																																																		0	0	NO	0	9.745	0.470375747	0.522399424	0	2.611056702	1.378649116	0	1.513904939	1.070400839	5.014338982	3.726253537	0	0	0.087972732	14.8906691	0.003538993	0.439434619	1.419014586	0	0	0.247278622	0	0	0	0.749000967	0	0	0	0.32687328	0	0	0	0	0	0	0	0	0	0	0	44.2162
H0524_032_0	2012	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	YES	942.8614223	43.46116357	702.256228	0	239.5455591	8.782599057	0	465.4094349	81.74280485	3494.01095	1231.657893	0	0	45.3618096	8215.002959	1.952419841	256.2232336	735.8820755	0	0	203.7681739	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	170.1641738	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	133.9192048	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												10.0035	0.485023705	0.696945415	0	3.665047054	1.46736152	0	1.482765662	0.995841938	4.944898997	3.344874923	0	0	0.086754461	14.76852157	0.003509963	0.435829955	1.407374469	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.1187	0	NO	18.15133011	10.0035	0.485023705	0.696945415	0	3.665047054	1.46736152	0	1.482765662	0.995841938	4.944898997	3.344874923	0	0	0.086754461	14.76852157	0.003509963	0.435829955	1.407374469	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.1187	NO																																																																																		0	0	NO	0	10.0035	0.485023705	0.696945415	0	3.665047054	1.46736152	0	1.482765662	0.995841938	4.944898997	3.344874923	0	0	0.086754461	14.76852157	0.003509963	0.435829955	1.407374469	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.1187
H0524_033_0	2012	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	YES	974.3543816	44.91283041	716.6957841	0	222.9694049	10.46781757	0	512.2308798	58.31996415	3821.978416	1347.268211	0	0	49.6197235	9168.181958	2.178957262	285.9525723	821.2657746	0	0	203.8823938	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	170.4443846	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	134.1397307	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												10.3377	0.502049581	0.711275772	0	3.411431895	1.748921089	0	1.631935889	0.710490253	5.409054954	3.658843645	0	0	0.094897721	16.48209912	0.00391722	0.486398892	1.570670794	0	0	0.2487722	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	48.0902	0	NO	19.08542517	10.3377	0.502049581	0.711275772	0	3.411431895	1.748921089	0	1.631935889	0.710490253	5.409054954	3.658843645	0	0	0.094897721	16.48209912	0.00391722	0.486398892	1.570670794	0	0	0.2487722	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	48.0902	NO																																																																																		0	0	NO	0	10.3377	0.502049581	0.711275772	0	3.411431895	1.748921089	0	1.631935889	0.710490253	5.409054954	3.658843645	0	0	0.094897721	16.48209912	0.00391722	0.486398892	1.570670794	0	0	0.2487722	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	48.0902
H0524_034_0	2012	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	YES	992.7250947	57.20344922	635.3090158	0	263.7792518	8.826901939	0	472.0175704	28.21868857	4065.900906	1499.444198	0	0	58.27794748	11327.82478	3.458977732	311.1436768	1053.958487	0	0	154.2600764	51.31558861	0	0	642.3153698	0	0	0	148.0603844	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$10U/R OOA"	$0 to $125/procedure	$0 to $20/routine lab	"$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	$10/visit	0	0	"$10/generic, $45/brand"	0	0	0	$10/visit	0	0	0	$0 to $10/visit	0											0	NO	105.125	116.1668047	32.05	0	200	0.172	0	41.12125	111.25	13	34.7	0	0	10	9.4	9.4	9.45	10	0	0	15.95	0	0	0	6.2	0	0	0	7.5	0											NO	89.77675	99.20645117	12.1149	0	187.4	0.161164	0	38.53061125	104.24125	12.181	32.5139	0	0	9.37	8.8078	8.8078	8.85465	9.37	0	0	14.94515	0	0	0	5.8094	0	0	0	7.0275	0												7.427	0.472912599	0.6413921	0	4.119352649	1.422578824	0	1.515593792	0.245129281	4.127228245	4.06273156	0	0	0.045505364	8.314434593	0.002538832	0.22958903	0.822965918	0	0	0.192119998	0	0	0	0.310955576	0	0	0	0.086707863	0	0	0	0	0	0	0	0	0	0	0	34.0387	0	NO	11.08682392	7.427	0.472912599	0.6413921	0	4.119352649	1.422578824	0	1.515593792	0.245129281	4.127228245	4.06273156	0	0	0.045505364	8.314434593	0.002538832	0.22958903	0.822965918	0	0	0.192119998	0	0	0	0.310955576	0	0	0	0.086707863	0	0	0	0	0	0	0	0	0	0	0	34.0387	NO																																																																																		0	0	NO	0	7.427	0.472912599	0.6413921	0	4.119352649	1.422578824	0	1.515593792	0.245129281	4.127228245	4.06273156	0	0	0.045505364	8.314434593	0.002538832	0.22958903	0.822965918	0	0	0.192119998	0	0	0	0.310955576	0	0	0	0.086707863	0	0	0	0	0	0	0	0	0	0	0	34.0387
H0524_035_0	2012	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	YES	918.0135996	52.898375	801.6323258	0	241.7802043	10.71414194	0	393.4331599	7.420721466	4469.236874	1648.188546	0	0	64.05909978	13281.04977	4.05539954	364.7933064	1235.689586	0	0	163.8599524	51.31558861	0	0	642.3153698	0	0	0	332.6850064	0											3400	"$150/days 1-5, $0 after day 5, Unlimited Coverage"	"$150/days 1-5, $0 after day 5, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$100/trip	0% to 20% coinsurance	0	"$65/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	$10/visit	0	0	"$10/generic, $45/brand"	0	0	0	$10/visit	0	0	0	$0 to $10/visit	0											0	NO	102.75	112.9608095	32.05	0	100	0.172	0	41.12125	89	3.25	14.8	0	0	10	9.4	9.4	9.45	10	0	0	15.95	0	0	0	6.2	0	0	0	7.5	0											NO	97.30425	106.9738866	15.8327	0	97	0.16684	0	39.8876125	86.33	3.1525	14.356	0	0	9.7	9.118	9.118	9.1665	9.7	0	0	15.4715	0	0	0	6.014	0	0	0	7.275	0												7.4439	0.471562064	1.05766701	0	1.954389985	1.787547441	0	1.307759119	0.053385907	1.174105771	1.971782897	0	0	0.051781106	10.09138432	0.003081428	0.278656487	0.998849082	0	0	0.211263271	0	0	0	0.321907053	0	0	0	0.201690285	0	0	0	0	0	0	0	0	0	0	0	29.3807	0	NO	9.766606273	7.4439	0.471562064	1.05766701	0	1.954389985	1.787547441	0	1.307759119	0.053385907	1.174105771	1.971782897	0	0	0.051781106	10.09138432	0.003081428	0.278656487	0.998849082	0	0	0.211263271	0	0	0	0.321907053	0	0	0	0.201690285	0	0	0	0	0	0	0	0	0	0	0	29.3807	NO																																																																																		0	0	NO	0	7.4439	0.471562064	1.05766701	0	1.954389985	1.787547441	0	1.307759119	0.053385907	1.174105771	1.971782897	0	0	0.051781106	10.09138432	0.003081428	0.278656487	0.998849082	0	0	0.211263271	0	0	0	0.321907053	0	0	0	0.201690285	0	0	0	0	0	0	0	0	0	0	0	29.3807
H0524_036_0	2012	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	YES	631.6496948	36.39732836	447.4930958	0	159.625623	6.785176877	0	257.8249318	5.381884827	2947.787905	1087.100639	0	0	42.25165164	8649.760416	2.641224529	237.5847359	804.787201	0	0	123.9845047	47.11603852	0	0	492.7214374	0	0	0	337.4945125	0											3400	"$250/days 1-7, $0 after day 7, Unlimited Coverage"	"$250/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$20U/R OOA"	$0 to $150/procedure	$0 to $30/routine lab	"$30/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $20/visit	$0 to $20/visit	$0 to $20/visit	$20 Individual & $5 to $10 Group Visit	$20/visit	0	0	"$10/generic, $45/brand"	0	0	0	$20/visit	0	0	0	$0 to $20/visit	0											0	NO	192.25	199.2756636	32.05	0	200	0.172	0	41.47125	133.5	19.5	32.8	0	0	20	18.8	18.8	18.9	20	0	0	15.95	0	0	0	12.4	0	0	0	15	0											NO	138.0355	143.0799264	7.27535	0	180.6	0.155316	0	37.44853875	120.5505	17.6085	29.6184	0	0	18.06	16.9764	16.9764	17.0667	18.06	0	0	14.40285	0	0	0	11.1972	0	0	0	13.545	0												7.2658	0.433977255	0.271305741	0	2.402365627	1.053846532	0	0.804597246	0.054065742	4.325510277	2.683181796	0	0	0.063588736	12.23681606	0.00373654	0.337898951	1.211204738	0	0	0.148810852	0	0	0	0.459758373	0	0	0	0.380946931	0	0	0	0	0	0	0	0	0	0	0	34.1375	0	NO	15.20994042	7.2658	0.433977255	0.271305741	0	2.402365627	1.053846532	0	0.804597246	0.054065742	4.325510277	2.683181796	0	0	0.063588736	12.23681606	0.00373654	0.337898951	1.211204738	0	0	0.148810852	0	0	0	0.459758373	0	0	0	0.380946931	0	0	0	0	0	0	0	0	0	0	0	34.1375	NO																																																																																		0	0	NO	0	7.2658	0.433977255	0.271305741	0	2.402365627	1.053846532	0	0.804597246	0.054065742	4.325510277	2.683181796	0	0	0.063588736	12.23681606	0.00373654	0.337898951	1.211204738	0	0	0.148810852	0	0	0	0.459758373	0	0	0	0.380946931	0	0	0	0	0	0	0	0	0	0	0	34.1375
H0524_037_0	2012	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	YES	860.849895	49.60445093	565.7976635	0	228.8142631	7.436496066	0	480.6226506	60.29924792	4039.735374	1489.794736	0	0	57.90290796	8909.966974	2.720679208	244.7318826	828.997225	0	0	163.8599524	51.31558861	0	0	642.3153698	0	0	0	204.8577747	0											3400	"$200/days 1-8, $0 after Day 8, Unlimited Coverage"	"$200/days 1-8, $0 after Day 8, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit,$15U/R OOA"	$0 to $150/procedure	$0 to $25/routine lab	"$25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $5 to $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0	0	0	$15/visit	0	0	0	$0 to $15/visit	0											0	NO	159.6	169.1749935	32.05	0	200	0.172	0	41.29625	133.5	16.25	39	0	0	15	14.1	14.1	14.12	15	0	0	15.95	0	0	0	9.3	0	0	0	11.25	0											NO	121.9344	129.2496951	8.74965	0	182.8	0.157208	0	37.7447725	122.019	14.8525	35.646	0	0	13.71	12.8874	12.8874	12.90568	13.71	0	0	14.5783	0	0	0	8.5002	0	0	0	10.2825	0												8.7473	0.534280013	0.412544294	0	3.485603941	1.169076673	0	1.511749384	0.613137828	5.000014136	4.425435265	0	0	0.066154072	9.568859031	0.002921873	0.263202614	0.94712933	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.175537506	0	0	0	0	0	0	0	0	0	0	0	37.577	0	NO	15.63276894	8.7473	0.534280013	0.412544294	0	3.485603941	1.169076673	0	1.511749384	0.613137828	5.000014136	4.425435265	0	0	0.066154072	9.568859031	0.002921873	0.263202614	0.94712933	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.175537506	0	0	0	0	0	0	0	0	0	0	0	37.577	NO																																																																																		0	0	NO	0	8.7473	0.534280013	0.412544294	0	3.485603941	1.169076673	0	1.511749384	0.613137828	5.000014136	4.425435265	0	0	0.066154072	9.568859031	0.002921873	0.263202614	0.94712933	0	0	0.199066629	0	0	0	0.454984092	0	0	0	0.175537506	0	0	0	0	0	0	0	0	0	0	0	37.577
H0524_038_0	2012	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	YES	920.7850563	42.44355427	579.4711232	0	236.2819146	9.826070877	0	456.3251097	136.3890181	3909.563738	1378.142514	0	0	50.75682029	9356.558667	2.22372784	291.8279797	838.1401499	0	0	210.6213636	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	"$150/days 1-7, $0 after Day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $15/UR OOA"	$0 to $100/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $5 to $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0	0	0	$15/visit	0	0	0	$0 to $15/visit	0											0	NO	107.85	116.0427478	30.15	0	200	0.182	0	41.29625	91	7.4	15.6	0	0	15	14.1	14.1	14.12	15	0	0	15.95	0	0	0	8.25	0	0	0	11.25	0											NO	98.3592	105.830986	16.7634	0	191.6	0.174356	0	39.5618075	87.178	7.0892	14.9448	0	0	14.37	13.5078	13.5078	13.52696	14.37	0	0	15.2801	0	0	0	7.9035	0	0	0	10.7775	0												7.5473	0.374320267	0.809492186	0	3.77263457	1.713234414	0	1.504420512	0.990843485	2.309639937	1.716338687	0	0	0.060781292	10.53221026	0.002503139	0.328962117	1.00367283	0	0	0.268192958	0	0	0	0.471550664	0	0	0	0.205790538	0	0	0	0	0	0	0	0	0	0	0	33.6119	0	NO	9.973220712	7.5473	0.374320267	0.809492186	0	3.77263457	1.713234414	0	1.504420512	0.990843485	2.309639937	1.716338687	0	0	0.060781292	10.53221026	0.002503139	0.328962117	1.00367283	0	0	0.268192958	0	0	0	0.471550664	0	0	0	0.205790538	0	0	0	0	0	0	0	0	0	0	0	33.6119	NO																																																																																		0	0	NO	0	7.5473	0.374320267	0.809492186	0	3.77263457	1.713234414	0	1.504420512	0.990843485	2.309639937	1.716338687	0	0	0.060781292	10.53221026	0.002503139	0.328962117	1.00367283	0	0	0.268192958	0	0	0	0.471550664	0	0	0	0.205790538	0	0	0	0	0	0	0	0	0	0	0	33.6119
H0524_039_0	2012	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	YES	916.8480089	42.26207621	613.209128	0	180.4864387	8.823816736	0	435.9540606	111.5890549	3613.084951	1273.632127	0	0	46.90771551	8631.638185	2.051439511	269.2179489	773.2033517	0	0	203.7681739	34.99267877	0	0	715.9622906	0	0	0	229.1335147	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	169.9327177	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	22.235	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	133.7370488	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	20.41173	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												9.7275	0.471000446	0.608571734	0	2.761442513	1.474248005	0	1.388922662	1.35944761	5.113418477	3.458866449	0	0	0.089711006	15.51752755	0.003687975	0.457933674	1.47875141	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.2415	0	NO	17.79883769	9.7275	0.471000446	0.608571734	0	2.761442513	1.474248005	0	1.388922662	1.35944761	5.113418477	3.458866449	0	0	0.089711006	15.51752755	0.003687975	0.457933674	1.47875141	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.2415	NO																																																																																		0	0	NO	0	9.7275	0.471000446	0.608571734	0	2.761442513	1.474248005	0	1.388922662	1.35944761	5.113418477	3.458866449	0	0	0.089711006	15.51752755	0.003687975	0.457933674	1.47875141	0	0	0.248632832	0	0	0	0.753102834	0	0	0	0.328663385	0	0	0	0	0	0	0	0	0	0	0	45.2415
H0524_040_0	2012	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	YES	1082.195546	49.88376504	1014.642227	0	353.6519009	12.22771697	0	650.4055262	108.9264857	3960.286294	1396.022492	0	0	51.41533768	8690.550791	2.065440984	271.0554137	778.4806147	0	0	194.5947948	34.86881346	0	0	711.6080238	0	0	0	227.7399937	0											3400	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	"$150/days 1-7, $0 after Day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $10/UR OOA"	$0 to $100/procedure	$0 to $20/routine lab	"$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	"$10/generic, $45/brand"	0	0	0	$10/visit	0	0	0	$0 to $10/visit	0											0	NO	107.85	117.4789087	30.15	0	200	0.182	0	41.12125	91	14.8	24.2	0	0	10	9.4	9.4	9.45	10	0	0	15.95	0	0	0	5.5	0	0	0	7.5	0											NO	96.6336	105.2611022	16.31115	0	190	0.1729	0	39.0651875	86.45	14.06	22.99	0	0	9.5	8.93	8.93	8.9775	9.5	0	0	15.1525	0	0	0	5.225	0	0	0	7.125	0												8.7147	0.437568341	1.37916513	0	5.599488431	2.114172265	0	2.117351153	0.784724558	4.640135441	2.674546424	0	0	0.040703809	6.467218214	0.001537032	0.202783331	0.616297153	0	0	0.245716469	0	0	0	0.309845994	0	0	0	0.135220621	0	0	0	0	0	0	0	0	0	0	0	36.4812	0	NO	22.12627597	8.7147	0.437568341	1.37916513	0	5.599488431	2.114172265	0	2.117351153	0.784724558	4.640135441	2.674546424	0	0	0.040703809	6.467218214	0.001537032	0.202783331	0.616297153	0	0	0.245716469	0	0	0	0.309845994	0	0	0	0.135220621	0	0	0	0	0	0	0	0	0	0	0	36.4812	NO																																																																																		0	0	NO	0	8.7147	0.437568341	1.37916513	0	5.599488431	2.114172265	0	2.117351153	0.784724558	4.640135441	2.674546424	0	0	0.040703809	6.467218214	0.001537032	0.202783331	0.616297153	0	0	0.245716469	0	0	0	0.309845994	0	0	0	0.135220621	0	0	0	0	0	0	0	0	0	0	0	36.4812
H0524_041_0	2012	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	YES	487.1266549	22.45408575	404.9300055	0	183.3041782	6.168814111	0	395.4297853	66.78356992	2336.70624	823.7016784	0	0	30.3368321	5247.486768	1.247144685	163.6673821	470.0584374	0	0	138.5980256	29.06011846	0	0	507.4135785	0	0	0	162.3904753	0											3400	"$225/days 1-7, $0 after Day 7, Unlimited Coverage"	"$225/days 1-7, $0 after Day 7, Unlimited Coverage, $100/admit TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $30/routine lab	"$30/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	166.1092426	30.15	0	200	0.182	0	41.64625	159.25	22.2	43.3	0	0	25	23.5	23.5	23.57	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	124.56675	127.9041168	11.5776	0	181.8	0.165438	0	37.85644125	144.75825	20.1798	39.3597	0	0	22.725	21.3615	21.3615	21.42513	22.725	0	0	14.49855	0	0	0	12.49875	0	0	0	17.04375	0												5.0566	0.239330834	0.390676469	0	2.7770583	1.020556269	0	1.247463703	0.805622726	3.929522048	2.701720913	0	0	0.057450376	9.341182382	0.002220073	0.292216245	0.890173166	0	0	0.167455867	0	0	0	0.528502955	0	0	0	0.230645222	0	0	0	0	0	0	0	0	0	0	0	29.6784	0	NO	11.63386538	5.0566	0.239330834	0.390676469	0	2.7770583	1.020556269	0	1.247463703	0.805622726	3.929522048	2.701720913	0	0	0.057450376	9.341182382	0.002220073	0.292216245	0.890173166	0	0	0.167455867	0	0	0	0.528502955	0	0	0	0.230645222	0	0	0	0	0	0	0	0	0	0	0	29.6784	NO																																																																																		0	0	NO	0	5.0566	0.239330834	0.390676469	0	2.7770583	1.020556269	0	1.247463703	0.805622726	3.929522048	2.701720913	0	0	0.057450376	9.341182382	0.002220073	0.292216245	0.890173166	0	0	0.167455867	0	0	0	0.528502955	0	0	0	0.230645222	0	0	0	0	0	0	0	0	0	0	0	29.6784
H0524_042_0	2012	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	YES	980.5501049	45.19842205	854.4248474	0	336.7112923	9.920451255	0	435.9525205	119.169328	3652.533642	1287.538005	0	0	47.41986731	9272.341845	2.203712437	289.2012848	830.5961904	0	0	210.3294203	34.96444811	0	0	714.9698917	0	0	0	228.8159116	0											3400	"$100/days 1-7, $0 after Day 7, Unlimited Coverage"	"$100/days 1-7, $0 after Day 7, Unlimited Coverage, $100/admit TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $15/UR OOA"	$0 to $50/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $5 to $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0	0	0	$15/visit	0	0	0	$0 to $15/visit	0											0	NO	71.9	80.62451144	30.15	0	200	0.182	0	41.29625	45.5	7.4	15.6	0	0	15	14.1	14.1	14.12	15	0	0	15.95	0	0	0	8.25	0	0	0	11.25	0											NO	68.5926	76.91578391	19.92915	0	193.8	0.176358	0	40.01606625	44.0895	7.1706	15.1164	0	0	14.535	13.6629	13.6629	13.68228	14.535	0	0	15.45555	0	0	0	7.99425	0	0	0	10.90125	0												5.6049	0.289706005	1.418996746	0	5.43788737	1.749550942	0	1.453758745	0.437843007	2.182571478	1.621911625	0	0	0.057437314	10.55725662	0.002509092	0.329744413	1.006059636	0	0	0.270896406	0	0	0	0.476304005	0	0	0	0.207864955	0	0	0	0	0	0	0	0	0	0	0	33.1052	0	NO	8.622229381	5.6049	0.289706005	1.418996746	0	5.43788737	1.749550942	0	1.453758745	0.437843007	2.182571478	1.621911625	0	0	0.057437314	10.55725662	0.002509092	0.329744413	1.006059636	0	0	0.270896406	0	0	0	0.476304005	0	0	0	0.207864955	0	0	0	0	0	0	0	0	0	0	0	33.1052	NO																																																																																		0	0	NO	0	5.6049	0.289706005	1.418996746	0	5.43788737	1.749550942	0	1.453758745	0.437843007	2.182571478	1.621911625	0	0	0.057437314	10.55725662	0.002509092	0.329744413	1.006059636	0	0	0.270896406	0	0	0	0.476304005	0	0	0	0.207864955	0	0	0	0	0	0	0	0	0	0	0	33.1052
H0524_043_0	2012	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	YES	588.4169569	27.1230586	523.7483136	0	206.3984586	6.081072701	0	267.2316917	69.94655031	2048.484501	722.1019453	0	0	26.59492636	5089.060919	1.209492384	158.7261321	455.8669949	0	0	120.67482	27.09304942	0	0	438.26473	0	0	0	140.260373	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	167.01048	30.15	0	200	0.182	0	41.64625	159.25	18.5	35.5	0	0	25	23.5	23.5	23.57	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	127.316925	131.4372478	11.90925	0	183.6	0.167076	0	38.2312575	146.1915	16.983	32.589	0	0	22.95	21.573	21.573	21.63726	22.95	0	0	14.6421	0	0	0	12.6225	0	0	0	17.2125	0												6.243	0.297081681	0.519787467	0	3.157896416	1.016001303	0	0.851383635	0.852132592	2.89911769	1.961048358	0	0	0.050862797	9.148859268	0.002174365	0.286199882	0.871845628	0	0	0.147244398	0	0	0	0.460999713	0	0	0	0.201185973	0	0	0	0	0	0	0	0	0	0	0	28.9668	0	NO	11.55954666	6.243	0.297081681	0.519787467	0	3.157896416	1.016001303	0	0.851383635	0.852132592	2.89911769	1.961048358	0	0	0.050862797	9.148859268	0.002174365	0.286199882	0.871845628	0	0	0.147244398	0	0	0	0.460999713	0	0	0	0.201185973	0	0	0	0	0	0	0	0	0	0	0	28.9668	NO																																																																																		0	0	NO	0	6.243	0.297081681	0.519787467	0	3.157896416	1.016001303	0	0.851383635	0.852132592	2.89911769	1.961048358	0	0	0.050862797	9.148859268	0.002174365	0.286199882	0.871845628	0	0	0.147244398	0	0	0	0.460999713	0	0	0	0.201185973	0	0	0	0	0	0	0	0	0	0	0	28.9668
H0524_046_0	2012	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	YES	523.5185821	24.13157034	334.0047456	0	136.191913	5.663706391	0	263.0238956	76.819508	2061.763402	726.7828303	0	0	26.76732277	4828.769011	1.14763007	150.6077133	432.5506126	0	0	113.6295078	26.36517787	0	0	412.6776869	0	0	0	132.071605	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage, $100/admit for TRR"	"$050/days 11-100, $0 Days 1 to 10"	0	$200/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	"$0 to $25/visit, Chiro $20/visit"	$0 to $25/visit	$25 Individual & $5 to $12 Group Visit	$25/visit	0	0	"$10/generic, $45/brand"	0	0	0	$25/visit	0	0	0	$0 to $25/visit	0											0	NO	161.775	166.4330423	30.15	0	200	0.182	0	41.64625	159.25	18.5	39	0	0	25	23.5	23.5	23.57	25	0	0	15.95	0	0	0	13.75	0	0	0	18.75	0											NO	126.669825	130.3170721	11.8188	0	183.2	0.166712	0	38.147965	145.873	16.946	35.724	0	0	22.9	21.526	21.526	21.59012	22.9	0	0	14.6102	0	0	0	12.595	0	0	0	17.175	0												5.5262	0.262062966	0.328961274	0	2.079196538	0.94420782	0	0.836152197	0.933824341	2.911553551	2.163632486	0	0	0.051080974	8.662006812	0.002058657	0.270969884	0.825450752	0	0	0.13834582	0	0	0	0.433139622	0	0	0	0.189027485	0	0	0	0	0	0	0	0	0	0	0	26.5578	0	NO	10.29552229	5.5262	0.262062966	0.328961274	0	2.079196538	0.94420782	0	0.836152197	0.933824341	2.911553551	2.163632486	0	0	0.051080974	8.662006812	0.002058657	0.270969884	0.825450752	0	0	0.13834582	0	0	0	0.433139622	0	0	0	0.189027485	0	0	0	0	0	0	0	0	0	0	0	26.5578	NO																																																																																		0	0	NO	0	5.5262	0.262062966	0.328961274	0	2.079196538	0.94420782	0	0.836152197	0.933824341	2.911553551	2.163632486	0	0	0.051080974	8.662006812	0.002058657	0.270969884	0.825450752	0	0	0.13834582	0	0	0	0.433139622	0	0	0	0.189027485	0	0	0	0	0	0	0	0	0	0	0	26.5578
H0524_801_0	2012	4																															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	1114.845689	64.24036132	772.7209286	0	325.4350777	13.39650294	0	613.3157389	82.72514963	4370.493285	1611.773369	0	0	62.64377416	10138.53712	3.09582597	278.4772697	943.3053078	0	0	157.3498913	51.31558828	0	0	0	0	0	0	212.2740739	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	164.900118	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	139.0107995	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												11.9435	0.744175332	0.461623483	0	3.819794224	2.088166499	0	1.998685021	1.440296558	2.188743037	1.967491751	0	0	0.122546883	17.85016192	0.005450589	0.513610249	1.845341008	0	0	0.214900933	0	0	0	0	0	0	0	0.311445868	0	0	0	0	0	0	0	0	0	0	0	47.5159	0	NO	25.42174477	11.9435	0.744175332	0.461623483	0	3.819794224	2.088166499	0	1.998685021	1.440296558	2.188743037	1.967491751	0	0	0.122546883	17.85016192	0.005450589	0.513610249	1.845341008	0	0	0.214900933	0	0	0	0	0	0	0	0.311445868	0	0	0	0	0	0	0	0	0	0	0	47.5159	NO																																																																																		0	0	NO	0	11.9435	0.744175332	0.461623483	0	3.819794224	2.088166499	0	1.998685021	1.440296558	2.188743037	1.967491751	0	0	0.122546883	17.85016192	0.005450589	0.513610249	1.845341008	0	0	0.214900933	0	0	0	0	0	0	0	0.311445868	0	0	0	0	0	0	0	0	0	0	0	47.5159
H0524_802_0	2012	4																															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	1149.71169	52.99591927	923.4095714	0	285.4365733	14.53412186	0	530.4034951	109.4911	3875.616863	1366.176056	0	0	50.3160971	9357.381287	2.223923348	291.853637	838.2138384	0	0	191.4279191	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	150.4796382	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	131.5192038	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												11.7442	0.580831759	0.768738468	0	3.371719522	2.69201005	0	1.739533679	1.961601489	2.227995244	1.678347285	0	0	0.099059816	17.31700374	0.004115648	0.54172048	1.650233494	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.9731	0	NO	25.30662283	11.7442	0.580831759	0.768738468	0	3.371719522	2.69201005	0	1.739533679	1.961601489	2.227995244	1.678347285	0	0	0.099059816	17.31700374	0.004115648	0.54172048	1.650233494	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.9731	NO																																																																																		0	0	NO	0	11.7442	0.580831759	0.768738468	0	3.371719522	2.69201005	0	1.739533679	1.961601489	2.227995244	1.678347285	0	0	0.099059816	17.31700374	0.004115648	0.54172048	1.650233494	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.9731
H0524_803_0	2012	4																															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	954.259983	54.98698761	648.9237564	0	246.9495993	10.84870821	0	503.9241297	77.41341603	4114.716175	1517.446549	0	0	58.97763342	9550.467987	2.916257687	262.3246547	888.5904383	0	0	157.3498913	51.31558828	0	0	0	0	0	0	248.8894164	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	163.1139679	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	137.505075	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												10.2231	0.630082488	0.387667052	0	2.898570921	1.691031544	0	1.64219756	1.347815956	2.060649861	1.852347002	0	0	0.115374995	16.8147927	0.005134436	0.483819133	1.738305045	0	0	0.214900933	0	0	0	0	0	0	0	0.365167441	0	0	0	0	0	0	0	0	0	0	0	42.471	0	NO	22.07538745	10.2231	0.630082488	0.387667052	0	2.898570921	1.691031544	0	1.64219756	1.347815956	2.060649861	1.852347002	0	0	0.115374995	16.8147927	0.005134436	0.483819133	1.738305045	0	0	0.214900933	0	0	0	0	0	0	0	0.365167441	0	0	0	0	0	0	0	0	0	0	0	42.471	NO																																																																																		0	0	NO	0	10.2231	0.630082488	0.387667052	0	2.898570921	1.691031544	0	1.64219756	1.347815956	2.060649861	1.852347002	0	0	0.115374995	16.8147927	0.005134436	0.483819133	1.738305045	0	0	0.214900933	0	0	0	0	0	0	0	0.365167441	0	0	0	0	0	0	0	0	0	0	0	42.471
H0524_804_0	2012	4																															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	1233.93663	56.87826486	768.6806009	0	242.7015301	13.65891069	0	520.8511214	96.58855487	3870.820394	1364.485275	0	0	50.25382583	9797.287796	2.32847379	305.574176	877.6197055	0	0	191.4279191	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	151.2290353	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	132.1741769	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												12.6045	0.626486487	0.6399266	0	2.866911824	2.529903437	0	1.708205311	1.730444328	2.225237874	1.67627016	0	0	0.09893722	18.13110573	0.004309132	0.567187687	1.727813795	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.7332	0	NO	25.07010374	12.6045	0.626486487	0.6399266	0	2.866911824	2.529903437	0	1.708205311	1.730444328	2.225237874	1.67627016	0	0	0.09893722	18.13110573	0.004309132	0.567187687	1.727813795	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.7332	NO																																																																																		0	0	NO	0	12.6045	0.626486487	0.6399266	0	2.866911824	2.529903437	0	1.708205311	1.730444328	2.225237874	1.67627016	0	0	0.09893722	18.13110573	0.004309132	0.567187687	1.727813795	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.7332
H0524_805_0	2012	4																															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	976.9409576	56.29392544	661.0228459	0	250.4499761	11.31432404	0	502.105296	81.04918639	4197.140049	1547.843256	0	0	60.15904298	9811.321408	2.995909888	269.4895689	912.8606475	0	0	157.3498913	51.31558828	0	0	0	0	0	0	263.5691301	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	163.3662421	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	137.7177421	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												10.4661	0.646056025	0.394895048	0	2.939656594	1.763608946	0	1.63627031	1.411116991	2.101927737	1.889452262	0	0	0.117686128	17.27405775	0.005274674	0.49703376	1.785783642	0	0	0.214900933	0	0	0	0	0	0	0	0.386705333	0	0	0	0	0	0	0	0	0	0	0	43.5305	0	NO	22.56973816	10.4661	0.646056025	0.394895048	0	2.939656594	1.763608946	0	1.63627031	1.411116991	2.101927737	1.889452262	0	0	0.117686128	17.27405775	0.005274674	0.49703376	1.785783642	0	0	0.214900933	0	0	0	0	0	0	0	0.386705333	0	0	0	0	0	0	0	0	0	0	0	43.5305	NO																																																																																		0	0	NO	0	10.4661	0.646056025	0.394895048	0	2.939656594	1.763608946	0	1.63627031	1.411116991	2.101927737	1.889452262	0	0	0.117686128	17.27405775	0.005274674	0.49703376	1.785783642	0	0	0.214900933	0	0	0	0	0	0	0	0.386705333	0	0	0	0	0	0	0	0	0	0	0	43.5305
H0524_806_0	2012	4																															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	972.437219	44.82445887	741.0698395	0	238.0036559	14.03310628	0	480.4117541	99.88956488	3748.906755	1321.510053	0	0	48.67105367	8984.222686	2.135236556	280.2149433	804.7871036	0	0	191.4279191	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	148.9023265	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	130.1406333	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												9.9333	0.486123622	0.616940641	0	2.811418186	2.599211945	0	1.575578656	1.789583986	2.155152771	1.6234751	0	0	0.095821137	16.62642711	0.003951522	0.520117464	1.58442461	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.0175	0	NO	21.67399402	9.9333	0.486123622	0.616940641	0	2.811418186	2.599211945	0	1.575578656	1.789583986	2.155152771	1.6234751	0	0	0.095821137	16.62642711	0.003951522	0.520117464	1.58442461	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.0175	NO																																																																																		0	0	NO	0	9.9333	0.486123622	0.616940641	0	2.811418186	2.599211945	0	1.575578656	1.789583986	2.155152771	1.6234751	0	0	0.095821137	16.62642711	0.003951522	0.520117464	1.58442461	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.0175
H0524_807_0	2012	4																															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	1042.539045	60.07386099	549.283656	0	246.5188539	9.061520814	0	476.0499018	76.43069391	3670.643526	1353.679115	0	0	52.61258835	8678.392563	2.649967421	238.3711809	807.4511806	0	0	157.3498913	51.31558828	0	0	0	0	0	0	210.3672293	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	164.0958713	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	138.3328195	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												11.1689	0.692515548	0.328142056	0	2.893515048	1.412455495	0	1.551360495	1.33070615	1.838258278	1.652436095	0	0	0.102923376	15.27939491	0.004665599	0.439640483	1.579576372	0	0	0.214900933	0	0	0	0	0	0	0	0.308648169	0	0	0	0	0	0	0	0	0	0	0	40.798	0	NO	21.61932676	11.1689	0.692515548	0.328142056	0	2.893515048	1.412455495	0	1.551360495	1.33070615	1.838258278	1.652436095	0	0	0.102923376	15.27939491	0.004665599	0.439640483	1.579576372	0	0	0.214900933	0	0	0	0	0	0	0	0.308648169	0	0	0	0	0	0	0	0	0	0	0	40.798	NO																																																																																		0	0	NO	0	11.1689	0.692515548	0.328142056	0	2.893515048	1.412455495	0	1.551360495	1.33070615	1.838258278	1.652436095	0	0	0.102923376	15.27939491	0.004665599	0.439640483	1.579576372	0	0	0.214900933	0	0	0	0	0	0	0	0.308648169	0	0	0	0	0	0	0	0	0	0	0	40.798
H0524_808_0	2012	4																															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	966.3319108	44.5430349	841.8980786	0	247.0628569	13.07778531	0	509.0934027	123.1684596	3775.472463	1330.874609	0	0	49.01594914	8945.995824	2.126151363	279.02266	801.3628245	0	0	191.4279191	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	148.8480041	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	130.0931556	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												9.871	0.482895331	0.70088015	0	2.918429998	2.422267396	0	1.669644201	2.206639933	2.170424732	1.634979458	0	0	0.09650015	16.55568352	0.003934709	0.517904423	1.577683061	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.4248	0	NO	22.46256708	9.871	0.482895331	0.70088015	0	2.918429998	2.422267396	0	1.669644201	2.206639933	2.170424732	1.634979458	0	0	0.09650015	16.55568352	0.003934709	0.517904423	1.577683061	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.4248	NO																																																																																		0	0	NO	0	9.871	0.482895331	0.70088015	0	2.918429998	2.422267396	0	1.669644201	2.206639933	2.170424732	1.634979458	0	0	0.09650015	16.55568352	0.003934709	0.517904423	1.577683061	0	0	0.257798204	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	43.4248
H0524_809_0	2012	4																															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	1307.640149	75.34968874	926.2888844	0	348.4158212	12.63712025	0	635.9286794	86.50154668	4446.414565	1639.772015	0	0	63.73197982	10013.02321	3.057500004	275.0297535	931.6272977	0	0	157.0535638	51.31558828	0	0	0	0	0	0	275.1290746	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	167.0445171	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	140.8185279	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												14.0089	0.884219354	0.55336498	0	4.089530702	1.969798481	0	2.072376503	1.506045991	2.226764414	2.001669699	0	0	0.124675686	17.62917899	0.005383111	0.507251813	1.822495901	0	0	0.214496223	0	0	0	0	0	0	0	0.403665939	0	0	0	0	0	0	0	0	0	0	0	50.0198	0	NO	28.71883531	14.0089	0.884219354	0.55336498	0	4.089530702	1.969798481	0	2.072376503	1.506045991	2.226764414	2.001669699	0	0	0.124675686	17.62917899	0.005383111	0.507251813	1.822495901	0	0	0.214496223	0	0	0	0	0	0	0	0.403665939	0	0	0	0	0	0	0	0	0	0	0	50.0198	NO																																																																																		0	0	NO	0	14.0089	0.884219354	0.55336498	0	4.089530702	1.969798481	0	2.072376503	1.506045991	2.226764414	2.001669699	0	0	0.124675686	17.62917899	0.005383111	0.507251813	1.822495901	0	0	0.214496223	0	0	0	0	0	0	0	0.403665939	0	0	0	0	0	0	0	0	0	0	0	50.0198
H0524_810_0	2012	5																															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	1259.713807	58.06646292	1286.016562	0	367.4481997	14.81958037	0	658.9094657	87.26642283	3848.594053	1356.650368	0	0	49.96526718	8650.368919	2.055891153	269.8021543	774.8812101	0	0	188.5053554	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	151.4583895	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	132.3746324	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												12.8678	0.640543891	1.070608788	0	4.340481859	2.744882677	0	2.160987281	1.563432506	2.212460506	1.666644977	0	0	0.09836912	16.00858898	0.003804684	0.500789896	1.525547382	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.997	0	NO	29.31592688	12.8678	0.640543891	1.070608788	0	4.340481859	2.744882677	0	2.160987281	1.563432506	2.212460506	1.666644977	0	0	0.09836912	16.00858898	0.003804684	0.500789896	1.525547382	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.997	NO																																																																																		0	0	NO	0	12.8678	0.640543891	1.070608788	0	4.340481859	2.744882677	0	2.160987281	1.563432506	2.212460506	1.666644977	0	0	0.09836912	16.00858898	0.003804684	0.500789896	1.525547382	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	47.997
H0524_811_0	2012	4																															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	1103.56579	63.59038363	810.4294837	0	304.0755817	13.12882127	0	600.1830032	79.95348594	4310.024108	1589.473229	0	0	61.77704878	10059.40504	3.071662804	276.3037327	935.9427355	0	0	157.0535638	51.31558828	0	0	0	0	0	0	253.1780332	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	152.5	164.7746548	41.2	0	150	0.166	0	41.64625	222.5	6.4	15.6	0	0	25	22.5	22.5	23.57	25	0	0	17.4537	0	0	0	0	0	0	0	18.75	0											NO	128.5575	138.905034	7.1688	0	140.85	0.155874	0	39.10582875	208.9275	6.0096	14.6484	0	0	23.475	21.1275	21.1275	22.13223	23.475	0	0	16.3890243	0	0	0	0	0	0	0	17.60625	0												11.8226	0.736085367	0.484150574	0	3.56908714	2.046441887	0	1.955887812	1.392040161	2.158460073	1.940269971	0	0	0.120851352	17.71084	0.005408046	0.50960148	1.830937976	0	0	0.214496223	0	0	0	0	0	0	0	0.371459646	0	0	0	0	0	0	0	0	0	0	0	46.8687	0	NO	25.50564871	11.8226	0.736085367	0.484150574	0	3.56908714	2.046441887	0	1.955887812	1.392040161	2.158460073	1.940269971	0	0	0.120851352	17.71084	0.005408046	0.50960148	1.830937976	0	0	0.214496223	0	0	0	0	0	0	0	0.371459646	0	0	0	0	0	0	0	0	0	0	0	46.8687	NO																																																																																		0	0	NO	0	11.8226	0.736085367	0.484150574	0	3.56908714	2.046441887	0	1.955887812	1.392040161	2.158460073	1.940269971	0	0	0.120851352	17.71084	0.005408046	0.50960148	1.830937976	0	0	0.214496223	0	0	0	0	0	0	0	0.371459646	0	0	0	0	0	0	0	0	0	0	0	46.8687
H0524_812_0	2012	4																															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	1131.635505	52.16269818	1129.877976	0	366.4547663	15.92639619	0	640.1703361	102.396909	3760.08155	1325.449229	0	0	48.81613303	8346.267069	1.983616744	260.3173179	747.6404287	0	0	188.5053554	34.98405649	0	0	0	0	0	0	229.0365115	0											3400	"$250/days 1-4, $0 after day 4, Unlimited Coverage"	"$250/days 1-4, $0 after day 4, Unlimited Coverage, $100/admit for TRR"	"$100/days 21-100, $0 Days 1 to 20"	0	$150/trip	0% to 20% coinsurance	0	"$65/ER visit, $25/UR OOA"	$0 to $250/procedure	$0 to $10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $25/visit	$0 to $25/visit	$0 to $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											0	NO	140.25	150.3188041	37	0	150	0.196	0	41.64625	227.5	7.3	15.6	0	0	25	23.5	23.5	23.57	25	0	0	17.1011	0	0	0	0	0	0	0	18.75	0											NO	122.5785	131.3786348	9.99	0	141.75	0.18522	0	39.35570625	214.9875	6.8985	14.742	0	0	23.625	22.2075	22.2075	22.27365	23.625	0	0	16.1605395	0	0	0	0	0	0	0	17.71875	0												11.5595	0.571088673	0.940623415	0	4.328746927	2.949887102	0	2.099529641	1.834504623	2.161576881	1.628314377	0	0	0.096106762	15.4458105	0.003670931	0.483184736	1.471917094	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.1665	0	NO	26.67071322	11.5595	0.571088673	0.940623415	0	4.328746927	2.949887102	0	2.099529641	1.834504623	2.161576881	1.628314377	0	0	0.096106762	15.4458105	0.003670931	0.483184736	1.471917094	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.1665	NO																																																																																		0	0	NO	0	11.5595	0.571088673	0.940623415	0	4.328746927	2.949887102	0	2.099529641	1.834504623	2.161576881	1.628314377	0	0	0.096106762	15.4458105	0.003670931	0.483184736	1.471917094	0	0	0.253862354	0	0	0	0	0	0	0	0.338186724	0	0	0	0	0	0	0	0	0	0	0	46.1665
H0543_001_0	2012	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	1180.612328	37.36855756	1094.163158	581.5830634	511.5168703	10.54094217	9.398374233	192.5794385	217.1358303	39.75438289	65.09737175	0	9.600254546	1217.714779	8619.754701	5499.394702	187.0521121	1153.805954	0	0	33.19162224	1031.955934	0	0	104.5411879	605.9177722	0	6.613091271	463.4274991	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 1-3/$50 Days 4-20/$146 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$0 (9b)	20% (8a1a); $14 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a); $150 (5); $30 (9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0	0	65.12025453	0	200	0.2	0.131632619	64.98933953	0	0.134106879	0.144590325	0	0	0.069296541	0.001350878	0	30	0	0	0	0.2	0	0	0	0	30	0	352.5	0	0											NO	0	0	57.12223766	0	175.4361621	0.175436162	0.115465607	57.0274361	0	0.117635981	0.126831858	0	0	0.060785596	0.001184965	0	26.31542432	0	0	0	0.175436162	0	0	0	0	30	0	352.5	0	0												0	0	5.20842066	0	7.478213049	1.849262439	1.08518899	0.915192635	0	4.676545813	8.256420635	0	0	0.006168293	0.000851175	0	0.410196308	0	0	0	5.823010822	0	0	0	0	1.51479443	0	0.194259556	0	0	0	0	0	0	0	0	0	0	0	0	37.4185	0	NO	4.999524253	0	0	5.20842066	0	7.478213049	1.849262439	1.08518899	0.915192635	0	4.676545813	8.256420635	0	0	0.006168293	0.000851175	0	0.410196308	0	0	0	5.823010822	0	0	0	0	1.51479443	0	0.194259556	0	0	0	0	0	0	0	0	0	0	0	0	37.4185	NO																																										0	0	0	0	0	0	0	0	0	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	5.20842066	0	7.478213049	1.849262439	1.08518899	0.915192635	0	4.676545813	8.256420635	0	0	0.006168293	0.000851175	0	0.410196308	0	0	0	5.823010822	0	0	0	0	1.51479443	0	0.194259556	0	0	0	0	0	0	0	0	0	0	0	0	37.4185
H0543_004_0	2012	3																															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	1155.849238	35.88788185	1016.910074	578.3686848	500.3927611	9.096670795	7.636696857	185.0397558	201.1699983	40.56894538	65.3864963	0	9.42120382	1283.549366	8962.143702	5798.195634	198.6669473	1192.150405	0	0	29.32903834	1061.233983	0	0	104.3900818	598.2077029	0	7.683101438	463.4070994	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 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$125 (9b)	20% (8a1a); $13 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$10 (3); $150 (5); $125 (9a); $30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $10 (16b, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	97.5740557	59.94903028	49.6170027	0	200	0.2	0.135310722	64.99070169	51.25	0.126234444	0.144775564	0	0	44.28555256	3.064823188	10	30	10	0	0	0.2	8.67765626	0	0	30	30	0	352.5	0	0											NO	87.80725249	53.94835339	44.65052367	0	179.9807374	0.179980737	0.121766617	58.50370668	46.12006396	0.113598842	0.130284063	0	0	39.85273203	3.043186939	9.929404575	29.78821373	9.929404575	0	0	0.179980737	7.809054863	0	0	30	30	0	352.5	0	0												8.4577	0.161341011	3.783797276	0	7.505088179	1.637225518	0.929894743	0.902125966	0.773164432	4.608585212	8.518818435	0	0	4.262745745	2.272789888	4.797719188	0.493161124	0.986445307	0	0	5.278661948	0.690602866	0	0	0.260975205	1.495519257	0	0.225691105	0	0	0	0	0	0	0	0	0	0	0	0	58.042	0	NO	5.344981672	8.4577	0.161341011	3.783797276	0	7.505088179	1.637225518	0.929894743	0.902125966	0.773164432	4.608585212	8.518818435	0	0	4.262745745	2.272789888	4.797719188	0.493161124	0.986445307	0	0	5.278661948	0.690602866	0	0	0.260975205	1.495519257	0	0.225691105	0	0	0	0	0	0	0	0	0	0	0	0	58.042	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.4577	0.161341011	3.783797276	0	7.505088179	1.637225518	0.929894743	0.902125966	0.773164432	4.608585212	8.518818435	0	0	4.262745745	2.272789888	4.797719188	0.493161124	0.986445307	0	0	5.278661948	0.690602866	0	0	0.260975205	1.495519257	0	0.225691105	0	0	0	0	0	0	0	0	0	0	0	0	58.042
H0543_007_0	2012	3																															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	1037.397051	29.04600213	916.1677492	475.6136052	415.6236596	8.9057133	7.378927997	211.9152479	211.3347335	39.69437309	66.51078512	0	8.387285186	914.6151676	7024.027247	4502.574106	144.4384078	934.2809607	0	0	28.46586241	856.1010152	0	0	93.86045371	555.6881288	0	5.793888794	184.4685906	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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$175 (9b)	20% (8a1a); $14 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$10 (3); $150 (5); $175 (9a); $30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $10 (16b, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	149.6947269	99.66616326	50	0	200	0.2	0.139006154	64.98494415	71.75	0.109627758	0.144629624	0	0	62.11117396	0.002576359	10	30	10	0	0	0.2	8.352712355	0	0	30	30	0	352.5	0	0											NO	134.892508	89.81090387	45.05586496	0	180.2234599	0.18022346	0.12526085	58.57484758	64.65516622	0.098787469	0.130328257	0	0	55.96945334	0.002558504	9.930698767	29.7920963	9.930698767	0	0	0.18022346	7.526773599	0	0	30	30	0	352.5	0	0												11.6614	0.217387309	3.439894199	0	6.242094494	1.605018463	0.924290795	1.034408612	1.13865686	3.921306666	8.668234669	0	0	4.265875912	0.001497584	3.72614226	0.35859358	0.773171899	0	0	5.130216211	0.53697321	0	0	0.234651134	1.389220322	0	0.170195483	0	0	0	0	0	0	0	0	0	0	0	0	55.4393	0	NO	5.387033455	11.6614	0.217387309	3.439894199	0	6.242094494	1.605018463	0.924290795	1.034408612	1.13865686	3.921306666	8.668234669	0	0	4.265875912	0.001497584	3.72614226	0.35859358	0.773171899	0	0	5.130216211	0.53697321	0	0	0.234651134	1.389220322	0	0.170195483	0	0	0	0	0	0	0	0	0	0	0	0	55.4393	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	NO	0	11.6614	0.217387309	3.439894199	0	6.242094494	1.605018463	0.924290795	1.034408612	1.13865686	3.921306666	8.668234669	0	0	4.265875912	0.001497584	3.72614226	0.35859358	0.773171899	0	0	5.130216211	0.53697321	0	0	0.234651134	1.389220322	0	0.170195483	0	0	0	0	0	0	0	0	0	0	0	0	55.4393
H0543_013_0	2012	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	1006.085727	30.62920492	878.5500477	511.9316104	433.6078025	7.41529436	5.880333562	242.142671	173.901452	37.19531975	60.50201821	0	8.379514663	1175.355379	8116.817036	5163.295093	182.2179858	1077.989001	0	0	27.25459015	953.6399985	0	0	117.4569856	695.7478993	0	4.964010637	83.34176179	0											5000	"$200 Days 1-8 (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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$200 (9b)	20% (8a1a); $15 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c); $150 (5); $200 (9a)"	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $40 (7d, 7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	156.5006987	99.66616326	50	0	200	0.2	0.137500091	64.98935006	82	0.143439998	0.161772286	0	0	70.83686272	12.22358085	39.69857302	30	30	0	0	0.2	34.93914732	0	0	30	30	0	352.5	0	0											NO	123.3387846	78.54727519	39.40518658	0	157.6207463	0.157620746	0.108364335	51.24741324	64.62450599	0.113045597	0.127493342	0	0	55.82679584	12.01300056	39.01467054	29.48317854	29.48317854	0	0	0.157620746	27.53567238	0	0	30	30	0	352.5	0	0												10.3408	0.200486716	2.884952379	0	5.695465454	1.168804231	0.637218436	1.034098794	0.936524619	4.204767139	7.713604515	0	0	5.468027067	8.12561063	16.78702141	0.447697117	2.648545181	0	0	4.29588884	2.188259881	0	0	0.293642464	1.739369748	0	0.145817812	0	0	0	0	0	0	0	0	0	0	0	0	76.9566	0	NO	13.06491248	10.3408	0.200486716	2.884952379	0	5.695465454	1.168804231	0.637218436	1.034098794	0.936524619	4.204767139	7.713604515	0	0	5.468027067	8.12561063	16.78702141	0.447697117	2.648545181	0	0	4.29588884	2.188259881	0	0	0.293642464	1.739369748	0	0.145817812	0	0	0	0	0	0	0	0	0	0	0	0	76.9566	NO																																										0	0	0	0	0	0	0	0	0	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	10.3408	0.200486716	2.884952379	0	5.695465454	1.168804231	0.637218436	1.034098794	0.936524619	4.204767139	7.713604515	0	0	5.468027067	8.12561063	16.78702141	0.447697117	2.648545181	0	0	4.29588884	2.188259881	0	0	0.293642464	1.739369748	0	0.145817812	0	0	0	0	0	0	0	0	0	0	0	0	76.9566
H0543_019_0	2012	3																															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	1071.612684	30.16685571	836.9385442	478.2624481	425.8474705	7.910931918	6.264378878	171.9413227	177.7956343	40.17067946	65.14316327	0	7.844830859	1066.79016	7605.060206	4904.234366	168.9139167	1018.729082	0	0	22.36618104	901.6471214	0	0	86.49948416	485.9066028	2.093065762	12.68130134	92.56737333	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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$185 (9b)	20% (8a1a); $15 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$20 (3); $150 (5); $185 (9a); $30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	149.6947269	99.66616326	30.37403122	0	200	0.2	0.13780144	64.98618993	75.85	0.124920242	0.1447478	0	0	65.48834234	6.138320914	20	30	20	0	0	0.2	17.33204596	0	0	30	30	10	352.5	0	0											NO	133.4792361	88.86995297	27.08380294	0	178.3352545	0.178335255	0.122874274	57.96600718	67.63364528	0.111388416	0.129068179	0	0	58.394401	6.089427481	19.84069444	29.76104166	19.84069444	0	0	0.178335255	15.45457414	0	0	30	30	10	352.5	0	0												11.9198	0.223410587	1.888956551	0	6.328634753	1.410798057	0.769731007	0.830562662	1.002080572	4.47454836	8.40790943	0	0	5.191214365	3.859205218	8.108617959	0.418921176	1.684357703	0	0	3.988678589	1.161214357	0	0	0.21624871	1.214766507	0.001744221	0.372513227	0	0	0	0	0	0	0	0	0	0	0	0	63.474	0	NO	5.894977026	11.9198	0.223410587	1.888956551	0	6.328634753	1.410798057	0.769731007	0.830562662	1.002080572	4.47454836	8.40790943	0	0	5.191214365	3.859205218	8.108617959	0.418921176	1.684357703	0	0	3.988678589	1.161214357	0	0	0.21624871	1.214766507	0.001744221	0.372513227	0	0	0	0	0	0	0	0	0	0	0	0	63.474	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	NO	0	11.9198	0.223410587	1.888956551	0	6.328634753	1.410798057	0.769731007	0.830562662	1.002080572	4.47454836	8.40790943	0	0	5.191214365	3.859205218	8.108617959	0.418921176	1.684357703	0	0	3.988678589	1.161214357	0	0	0.21624871	1.214766507	0.001744221	0.372513227	0	0	0	0	0	0	0	0	0	0	0	0	63.474
H0543_022_0	2012	3																															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	1329.53435	18.91403893	1264.099116	664.5194917	332.4502844	11.49332335	14.08129405	377.3123409	285.998333	31.30925732	50.20254343	0	18.07365961	230.3121365	4179.430516	3085.174302	51.84193595	554.8630312	0	0	28.20625903	585.8160438	0	0	61.3845847	381.5662442	0	6.785475038	83.16456753	0											5900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$260 (9b)	20% (8a1a); $16 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$20 (3); $150 (5); $260 (9a); $30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	70.22458751	0	200	0.2	0.114678047	64.99536096	106.6	0.097981142	0.141980041	0	0	89.03360477	6.413618724	20	30	20	0	0	0.2	14.18905105	0	0	30	30	0	0	0	0											NO	167.5217888	87.74112627	61.30492773	0	174.5967614	0.174596761	0.100112078	56.75234901	93.0600738	0.08553595	0.123946277	0	0	77.72489523	6.352947371	19.81080462	29.71620693	19.81080462	0	0	0.174596761	12.3868118	0	0	30	30	0	0	0	0												18.5605	0.138294923	6.457958748	0	4.837061915	2.006697034	1.409707611	1.784446805	2.217918831	2.678067078	6.22241834	0	0	1.49174889	2.212641842	5.093315443	0.128378808	0.916023592	0	0	4.924721476	0.604699424	0	0	0.153461462	0.95391561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.792	0	NO	7.839249869	18.5605	0.138294923	6.457958748	0	4.837061915	2.006697034	1.409707611	1.784446805	2.217918831	2.678067078	6.22241834	0	0	1.49174889	2.212641842	5.093315443	0.128378808	0.916023592	0	0	4.924721476	0.604699424	0	0	0.153461462	0.95391561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.792	NO																																										0	0	0	0	0	0	0	0	0	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	18.5605	0.138294923	6.457958748	0	4.837061915	2.006697034	1.409707611	1.784446805	2.217918831	2.678067078	6.22241834	0	0	1.49174889	2.212641842	5.093315443	0.128378808	0.916023592	0	0	4.924721476	0.604699424	0	0	0.153461462	0.95391561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.792
H0543_028_0	2012	3																															A	A	D	V	T	Coin	Coin	V	V	Coin	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	269.8916138	4.349288414	959.4015656	551.2571275	470.2706761	8.319458294	11.31323076	167.6659664	198.9896525	40.61904626	66.33412943	0	0.264115748	1289.091388	8707.484401	5517.138292	191.6278528	1148.081797	0	0	37.80010303	1020.922321	0	0	99.58671436	0	0.61112598	4.154837674	86.04470529	0											4900	"$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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$0 (9b)	20% (8a1a); $13 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); $0 (9a); $40/$30 (9c)	"$10 (7a); $20 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	197.6	200	0	0	200	0.2	0.112251367	64.96478859	0	0.121092596	0.169803752	0	0.2	0.028076582	6.05071782	20	38.5	20	0	0	0.2	17.35944147	0	0	20	0	0	0	0	0											NO	174.7949026	176.9179177	0	0	176.9179177	0.176917918	0.099296391	57.49154229	0	0.10711725	0.150206631	0	0.176917918	0.024836252	5.998601178	19.82835849	38.16838798	19.82773402	0	0	0.176917918	15.35598118	0	0	20	0	0	0	0	0												3.9313	0.064122254	0	0	6.93327573	1.471861237	1.123362981	0.80328125	0	4.351000525	9.96382611	0	0.046726808	0.002668017	4.352727182	9.116316326	0.60951052	1.896988374	0	0	6.687515515	1.306438663	0	0	0.165977857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8269	0	NO	4.924382808	3.9313	0.064122254	0	0	6.93327573	1.471861237	1.123362981	0.80328125	0	4.351000525	9.96382611	0	0.046726808	0.002668017	4.352727182	9.116316326	0.60951052	1.896988374	0	0	6.687515515	1.306438663	0	0	0.165977857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8269	NO																																										0	0	0	0	0	0	0	0	0	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	3.9313	0.064122254	0	0	6.93327573	1.471861237	1.123362981	0.80328125	0	4.351000525	9.96382611	0	0.046726808	0.002668017	4.352727182	9.116316326	0.60951052	1.896988374	0	0	6.687515515	1.306438663	0	0	0.165977857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8269
H0543_029_0	2012	4																															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	1199.498026	17.313202	1512.639065	899.0199575	355.2415706	12.38377774	15.05293069	334.2369037	92.55990152	42.07391535	76.24136223	0	0.188441941	31.94055722	4564.908985	2764.908425	53.48749802	593.8117025	0	0	43.04595157	587.9884141	0	0	61.31076152	0	0	4.772800252	83.38971169	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $20 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	69.30899593	0	200	0.2	0.120427844	64.9897306	0.16	0.07634119	0.159739376	0	0.2	0.14562524	5.885890555	20	38.5	20	0	0	0.2	14.50924898	0	0	20	0	0	0	0	0											NO	177.5894096	93.0141382	59.1307782	0	170.6294469	0.170629447	0.102742682	55.46192417	0.136503558	0.065130275	0.136281207	0	0.170629447	0.124239771	5.820777807	19.78035013	38.0740932	19.77874972	0	0	0.170629447	12.37852564	0	0	20	0	0	0	0	0												17.7515	0.134197714	7.453627087	0	5.051222725	2.113037146	1.546578474	1.544785151	12.63475584	2.740285683	10.39026484	0	0.032153744	3.968287501	2.214276743	4.557571393	0.169707332	0.978737754	0	0	7.344906907	0.606535805	0	0	0.102184603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3346	0	NO	12.70696573	17.7515	0.134197714	7.453627087	0	5.051222725	2.113037146	1.546578474	1.544785151	12.63475584	2.740285683	10.39026484	0	0.032153744	3.968287501	2.214276743	4.557571393	0.169707332	0.978737754	0	0	7.344906907	0.606535805	0	0	0.102184603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3346	NO																																										0	0	0	0	0	0	0	0	0	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	17.7515	0.134197714	7.453627087	0	5.051222725	2.113037146	1.546578474	1.544785151	12.63475584	2.740285683	10.39026484	0	0.032153744	3.968287501	2.214276743	4.557571393	0.169707332	0.978737754	0	0	7.344906907	0.606535805	0	0	0.102184603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3346
H0543_032_0	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	O	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	1024.101508	24.40624746	1340.13094	540.5776789	272.1130198	9.939322423	9.775973773	370.9016121	65.53876779	34.96634369	60.29612291	0	5.739136531	29.24809286	4735.444688	3065.643864	69.49218895	629.3274126	0	0	32.1440952	633.5600163	0	0	0	0	0	7.75910351	83.30209042	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	20% (9b)	20% (8a1a); $14 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$20 (3); $150 (5); 20% (9a); $30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	59.72103991	0	200	0.2	0.141882855	64.99429242	0.16	0.085766745	0.143365858	0	0	0.145395005	6.359712299	20	30	20	0	0	0.2	14.73276691	0	0	0	0	0	0	0	0											NO	184.7933182	96.78725363	53.01765918	0	177.5510248	0.177551025	0.125957232	57.70979515	0.14204082	0.076139867	0.127273775	0	0	0.129075161	6.307001182	19.83423427	29.75135141	19.83423427	0	0	0.177551025	13.07908931	0	0	0	0	0	0	0	0												15.7706	0.196851139	5.920883785	0	4.026162126	1.764736882	1.231354594	1.783721338	9.309180306	2.662332757	7.674115161	0	0	3.775202283	2.48887127	5.067058216	0.172290544	1.040185611	0	0	5.707217042	0.690532337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2813	0	NO	7.723959626	15.7706	0.196851139	5.920883785	0	4.026162126	1.764736882	1.231354594	1.783721338	9.309180306	2.662332757	7.674115161	0	0	3.775202283	2.48887127	5.067058216	0.172290544	1.040185611	0	0	5.707217042	0.690532337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2813	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.7706	0.196851139	5.920883785	0	4.026162126	1.764736882	1.231354594	1.783721338	9.309180306	2.662332757	7.674115161	0	0	3.775202283	2.48887127	5.067058216	0.172290544	1.040185611	0	0	5.707217042	0.690532337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2813
H0543_035_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1267.803948	14.09384164	1161.05157	403.1574499	372.0940308	10.6569331	13.53584511	313.3067087	287.0902002	32.19951758	63.28819485	0	0.142191384	911.0737051	3842.859596	2412.029784	45.25446003	502.0235365	0	0	22.62211495	511.8876728	0	0	52.26665572	0	7.642728425	4.202133088	116.6025524	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $19 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$10 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$10 (7a, 7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	69.22427551	0	200	0.2	0.135111304	64.9696057	92.25	0.102695793	0.156579251	0	0.2	80.08747619	6.199579541	10	38.5	10	0	0	0.2	7.159413465	0	0	10	0	0	0	0	0											NO	156.89504	83.7767698	58.04316934	0	167.6959965	0.167695997	0.113288124	54.49391542	77.34977841	0.086108367	0.131288568	0	0.167695997	67.15174566	6.12293981	9.877404183	38.02405972	9.876379148	0	0	0.167695997	6.003024879	0	0	10	0	0	0	0	0												16.576	0.098394711	5.615926076	0	5.199889942	1.787125016	1.533450496	1.422775774	1.850530281	2.772647872	8.309016469	0	0.023844926	5.098349143	1.960799834	1.985382756	0.143396524	0.413181232	0	0	3.793638111	0.25607287	0	0	0.043555546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.884	0	NO	10.52288553	16.576	0.098394711	5.615926076	0	5.199889942	1.787125016	1.533450496	1.422775774	1.850530281	2.772647872	8.309016469	0	0.023844926	5.098349143	1.960799834	1.985382756	0.143396524	0.413181232	0	0	3.793638111	0.25607287	0	0	0.043555546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.884	NO																																										0	0	0	0	0	0	0	0	0	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	16.576	0.098394711	5.615926076	0	5.199889942	1.787125016	1.533450496	1.422775774	1.850530281	2.772647872	8.309016469	0	0.023844926	5.098349143	1.960799834	1.985382756	0.143396524	0.413181232	0	0	3.793638111	0.25607287	0	0	0.043555546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.884
H0543_036_0	2012	3																															A	A	D	V	T	Coin	Coin	V	V	Coin	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	276.8091621	5.559465466	929.8006854	543.3641325	497.5826484	10.39289494	15.25739926	201.8098893	184.4450772	44.34740887	77.50785376	0	0.271678829	1256.339905	8915.616441	5551.851847	194.587562	1150.174949	0	0	43.85297982	1013.100318	0	0	101.6930174	0	0	6.798495275	83.26244955	0											4900	"$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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$0 (9b)	20% (8a1a); $13 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$10 (3); $60 (5); $0 (9a); $40/$30 (9c)	"$10 (7a, 7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	197.6	200	0	0	200	0.2	0.1116159	64.98537848	0	0.11124472	0.16804797	0	0.2	0.029217816	5.900854324	10	38.5	10	0	0	0.2	8.738191031	0	0	10	0	0	0	0	0											NO	172.7299582	174.827893	0	0	174.827893	0.174827893	0.097567863	56.82561119	0	0.0972434	0.146897363	0	0.174827893	0.025540446	5.845055633	9.905780284	38.13594261	9.90543964	0	0	0.174827893	7.638397631	0	0	10	0	0	0	0	0												3.9844	0.080995803	0	0	7.249277166	1.816967925	1.488631843	0.955664192	0	4.31249282	11.38569931	0	0.047497037	0.002673957	4.342689508	4.582952047	0.618398342	0.949415711	0	0	7.666724061	0.644871923	0	0	0.084744181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2141	0	NO	5.806512073	3.9844	0.080995803	0	0	7.249277166	1.816967925	1.488631843	0.955664192	0	4.31249282	11.38569931	0	0.047497037	0.002673957	4.342689508	4.582952047	0.618398342	0.949415711	0	0	7.666724061	0.644871923	0	0	0.084744181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2141	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	0	NO	0	3.9844	0.080995803	0	0	7.249277166	1.816967925	1.488631843	0.955664192	0	4.31249282	11.38569931	0	0.047497037	0.002673957	4.342689508	4.582952047	0.618398342	0.949415711	0	0	7.666724061	0.644871923	0	0	0.084744181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2141
H0543_060_0	2012	3																															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	1100.934518	34.75201492	974.6051683	564.4928528	475.8179242	8.024163726	6.482542053	232.3884381	191.4012589	42.22797939	67.18370908	0	9.241705955	1300.190333	8933.684127	5687.833178	200.899832	1188.535181	0	0	28.53546785	1051.3199	0	0	133.9086604	796.6472689	0	5.549415568	83.33247564	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); $0/15% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$125 (9b)	15% (8a1a); $15 (8a2)	"$10 (8b1); 15% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3); $20 (5, 9c); $125 (9a)"	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $30 (7d, 7f)"	"$20 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"15% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	117.375524	80.87940148	49.66064722	0	200	0.15	0.101687327	64.99196687	51.25	0.139305566	0.12423942	0	0	44.2418082	6.119899934	29.8480487	20	10	0	0	0.15	26.20598917	0	0	30	30	0	352.5	0	0											NO	91.43479771	63.00454696	38.68533301	0	155.7987468	0.11684906	0.079213791	50.65995358	39.92342886	0.108518163	0.096781729	0	0	34.46409137	6.009020945	29.30726838	19.63764444	9.818822219	0	0	0.11684906	20.41430136	0	0	30	30	0	352.5	0	0												8.3886	0.182461246	3.141910457	0	6.177653024	0.937615989	0.51350673	0.981065624	0.636782879	4.582502757	6.502155551	0	0	3.734156536	4.473557919	13.89123779	0.328766622	0.972501303	0	0	3.334342598	1.788496771	0	0	0.334771651	1.991618172	0	0.163014082	0	0	0	0	0	0	0	0	0	0	0	0	63.0568	0	NO	11.96609258	8.3886	0.182461246	3.141910457	0	6.177653024	0.937615989	0.51350673	0.981065624	0.636782879	4.582502757	6.502155551	0	0	3.734156536	4.473557919	13.89123779	0.328766622	0.972501303	0	0	3.334342598	1.788496771	0	0	0.334771651	1.991618172	0	0.163014082	0	0	0	0	0	0	0	0	0	0	0	0	63.0568	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.3886	0.182461246	3.141910457	0	6.177653024	0.937615989	0.51350673	0.981065624	0.636782879	4.582502757	6.502155551	0	0	3.734156536	4.473557919	13.89123779	0.328766622	0.972501303	0	0	3.334342598	1.788496771	0	0	0.334771651	1.991618172	0	0.163014082	0	0	0	0	0	0	0	0	0	0	0	0	63.0568
H0543_070_0	2012	3																															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	1486.923536	12.0719258	1563.462706	497.1433824	379.1654076	14.12255202	14.18443759	307.478331	88.96808146	43.31863188	81.53231888	0	0.192865283	42.8689188	4100.369191	2660.483667	50.15169274	558.1988895	0	0	34.0264421	583.972937	0	0	60.57631482	0	0	4.266001273	83.3892597	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $15 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$15 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	68.51381766	0	200	0.2	0.128828415	64.9208758	0.16	0.080483238	0.155195146	0	0.2	0.145467456	6.3171357	15	38.5	15	0	0	0.2	10.25428312	0	0	15	0	0	0	0	0											NO	175.3741583	91.8538793	57.7232388	0	168.5010142	0.168501014	0.108538593	54.71451277	0.134800811	0.067807536	0.130752698	0	0.168501014	0.122557069	6.241367609	14.8214416	38.03822877	14.82008913	0	0	0.168501014	8.63928553	0	0	15	0	0	0	0	0												21.7307	0.092404435	7.520677594	0	5.324146311	2.379664338	1.5395589	1.401960589	11.99296956	2.937329693	10.66057065	0	0.032497996	5.253889046	2.132659288	3.286016941	0.158973463	0.689379775	0	0	5.733490003	0.420425745	0	0	0.075720394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.363	0	NO	14.47311202	21.7307	0.092404435	7.520677594	0	5.324146311	2.379664338	1.5395589	1.401960589	11.99296956	2.937329693	10.66057065	0	0.032497996	5.253889046	2.132659288	3.286016941	0.158973463	0.689379775	0	0	5.733490003	0.420425745	0	0	0.075720394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.363	NO																																										0	0	0	0	0	0	0	0	0	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	21.7307	0.092404435	7.520677594	0	5.324146311	2.379664338	1.5395589	1.401960589	11.99296956	2.937329693	10.66057065	0	0.032497996	5.253889046	2.132659288	3.286016941	0.158973463	0.689379775	0	0	5.733490003	0.420425745	0	0	0.075720394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.363
H0543_078_0	2012	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	1156.377232	20.01793134	604.442207	556.0883561	472.6394501	22.91215586	19.34869886	281.3634754	192.6040092	48.59563725	98.31916157	0	8.483640792	1073.031435	10761.84037	8470.440044	171.4163598	1344.538509	0	0	43.97348055	1288.102629	1053.800005	211.0981167	121.9044477	1181.284309	0	0	180.2811981	3066.436402											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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$0 (3); $150 (5); $175 (9a); $30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	146.6708345	88.23565662	23.2323872	0	150	0.2	0.125906098	64.95387438	71.75	0	0.144630084	0	0	62.35318526	0.006062978	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	133.809146	80.49819786	21.19511967	0	136.8463741	0.182461832	0.114865287	59.2681443	65.4581823	0	0.131947351	0	0	56.88538212	0.005531311	0	27.36927483	0	0	0	0.182461832	0	0	0	0	0	0	0	0	0												12.8945	0.13428395	1.067602076	0	5.389916252	4.180593938	2.222493841	1.389657588	1.050625695	0	12.9729529	0	0	5.086650269	0.00496059	0	0.390961788	0	0	0	8.023481828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8087	0	NO	5.267929776	12.8945	0.13428395	1.067602076	0	5.389916252	4.180593938	2.222493841	1.389657588	1.050625695	0	12.9729529	0	0	5.086650269	0.00496059	0	0.390961788	0	0	0	8.023481828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8087	NO																																										0	0	0	0	0	0	0	0	0	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	12.8945	0.13428395	1.067602076	0	5.389916252	4.180593938	2.222493841	1.389657588	1.050625695	0	12.9729529	0	0	5.086650269	0.00496059	0	0.390961788	0	0	0	8.023481828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8087
H0543_079_0	2012	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	899.86704	22.09421518	680.7150688	469.1711812	438.1093427	11.80963208	12.39739911	219.9850894	180.8938767	39.05687109	72.60889284	0	7.451764176	965.9676566	8385.659977	6287.883361	154.748632	1081.829801	0	0	28.8213669	1003.178496	773.1394856	168.1994877	76.27137835	660.6455888	0	0	158.9205738	3009.162571											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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$0 (3); $150 (5); $175 (9a); $30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	146.6708345	88.23565662	14.99995391	0	150	0.2	0.124782091	64.98834541	71.75	0	0.14463417	0	0	62.17053878	0.001593257	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	128.9514471	77.57585646	13.1878009	0	131.8784142	0.175837886	0.109707095	57.15413561	63.08184145	0	0.127160833	0	0	54.65968042	0.001400775	0	26.37568284	0	0	0	0.175837886	0	0	0	0	0	0	0	0	0												9.6699	0.142831472	0.748094566	0	4.814763779	2.076580734	1.36008264	1.047754803	0.950926571	0	9.233007307	0	0	4.399956951	0.000978869	0	0.340133403	0	0	0	5.067888215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8529	0	NO	5.475887322	9.6699	0.142831472	0.748094566	0	4.814763779	2.076580734	1.36008264	1.047754803	0.950926571	0	9.233007307	0	0	4.399956951	0.000978869	0	0.340133403	0	0	0	5.067888215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8529	NO																																										0	0	0	0	0	0	0	0	0	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	9.6699	0.142831472	0.748094566	0	4.814763779	2.076580734	1.36008264	1.047754803	0.950926571	0	9.233007307	0	0	4.399956951	0.000978869	0	0.340133403	0	0	0	5.067888215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8529
H0543_081_0	2012	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	1322.208685	28.11075616	873.1361113	664.3043367	506.0095768	13.77610111	13.96034841	371.8110247	225.9209555	45.57138778	87.38375652	0	11.38208583	975.5566052	18072.02877	14987.33823	228.9352063	2005.885773	0	0	32.91415307	2230.618345	1145.958213	219.805182	177.54047	1869.083868	0	0	184.195908	3126.458722											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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$0 (3); $150 (5); $175 (9a); $30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	146.6708345	88.23565662	19.66210337	0	150	0.2	0.121387563	64.99087866	71.75	0	0.143945148	0	0	62.48280316	0.000974609	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	135.981355	81.80497637	18.22911466	0	139.0678885	0.185423851	0.112540747	60.26206236	66.52080666	0	0.133454318	0	0	57.92901002	0.000903579	0	27.8135777	0	0	0	0.185423851	0	0	0	0	0	0	0	0	0												14.983	0.191633312	1.326374857	0	5.864140283	2.554417725	1.571108044	1.86717493	1.25237035	0	11.66173964	0	0	4.70941903	0.001360792	0	0.530625596	0	0	0	6.103069025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6164	0	NO	4.135910734	14.983	0.191633312	1.326374857	0	5.864140283	2.554417725	1.571108044	1.86717493	1.25237035	0	11.66173964	0	0	4.70941903	0.001360792	0	0.530625596	0	0	0	6.103069025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6164	NO																																										0	0	0	0	0	0	0	0	0	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	14.983	0.191633312	1.326374857	0	5.864140283	2.554417725	1.571108044	1.86717493	1.25237035	0	11.66173964	0	0	4.70941903	0.001360792	0	0.530625596	0	0	0	6.103069025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6164
H0543_085_0	2012	3																															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	797.479018	3.079347312	730.9776924	251.2197567	204.7674773	8.936706888	9.249449766	211.1230742	58.74423787	25.33432754	46.33188295	0	0.11207199	23.22939701	2623.277224	1678.106495	31.43462117	349.2540311	0	0	22.32460373	365.5310504	0	0	47.41912003	0	7.569344105	4.169695934	116.4396807	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$10 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $10 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	61.66718673	0	200	0.2	0.1178321	64.96984984	0.16	0.095020757	0.15516444	0	0.2	0.145322074	3.121959309	10	38.5	10	0	0	0.2	6.927990799	0	0	10	0	0	0	0	0											NO	194.8536887	102.0564681	57.72576429	0	187.2171161	0.187217116	0.11030093	60.82784208	0.149773693	0.08894756	0.145247195	0	0.187217116	0.136033898	3.117708477	9.986546366	38.44757874	9.986384089	0	0	0.187217116	6.485192289	0	0	10	0	0	0	0	0												12.9493	0.026188943	3.516353831	0	3.194664714	1.673104491	1.020222913	1.070180085	8.798341441	2.253426623	6.729576047	0	0.020981795	3.159985414	0.681551136	1.396540693	0.100715423	0.290648742	0	0	4.179547928	0.197544929	0	0	0.039515933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2984	0	NO	3.33441074	12.9493	0.026188943	3.516353831	0	3.194664714	1.673104491	1.020222913	1.070180085	8.798341441	2.253426623	6.729576047	0	0.020981795	3.159985414	0.681551136	1.396540693	0.100715423	0.290648742	0	0	4.179547928	0.197544929	0	0	0.039515933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2984	NO																																										0	0	0	0	0	0	0	0	0	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	12.9493	0.026188943	3.516353831	0	3.194664714	1.673104491	1.020222913	1.070180085	8.798341441	2.253426623	6.729576047	0	0.020981795	3.159985414	0.681551136	1.396540693	0.100715423	0.290648742	0	0	4.179547928	0.197544929	0	0	0.039515933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2984
H0543_086_0	2012	3																															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	826.9482378	5.638065871	929.5730336	251.3467919	228.7195421	8.328850046	11.01961647	276.7822234	60.89671394	27.35929857	53.58647846	0	0.124508371	24.83812913	3196.776951	2015.238117	42.06496159	415.1740826	0	0	18.73525338	424.5247009	0	0	49.75986833	0	8.705260666	2.905424277	121.3693284	0											6300	"$240 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$240 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	179.6336723	95.91844845	69.41208861	0	200	0.2	0.136206294	64.96987147	0.16	0.0524493	0.157368225	0	0.2	0.14539903	6.115781784	29.79394752	38.5	30	0	0	0.2	21.47184518	0	0	30	0	0	0	0	0											NO	164.0992046	87.62355576	63.40942868	0	182.7042809	0.182704281	0.124427365	59.36244593	0.146163425	0.047913559	0.143759242	0	0.182704281	0.132825126	6.081111159	29.62642167	38.28174187	29.82992873	0	0	0.182704281	19.61499017	0	0	30	0	0	0	0	0												11.3085	0.041168948	4.911974582	0	3.482336624	1.521716559	1.371141843	1.369205814	8.900872265	1.310881354	7.703551538	0	0.022748212	3.299127637	1.619996333	4.975357851	0.134193333	1.032051108	0	0	3.423010997	0.693920653	0	0	0.124399671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2461	0	NO	4.71642003	11.3085	0.041168948	4.911974582	0	3.482336624	1.521716559	1.371141843	1.369205814	8.900872265	1.310881354	7.703551538	0	0.022748212	3.299127637	1.619996333	4.975357851	0.134193333	1.032051108	0	0	3.423010997	0.693920653	0	0	0.124399671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2461	NO																																										0	0	0	0	0	0	0	0	0	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	11.3085	0.041168948	4.911974582	0	3.482336624	1.521716559	1.371141843	1.369205814	8.900872265	1.310881354	7.703551538	0	0.022748212	3.299127637	1.619996333	4.975357851	0.134193333	1.032051108	0	0	3.423010997	0.693920653	0	0	0.124399671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2461
H0543_089_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1074.067807	40.76143513	912.6776919	548.0085143	635.9244003	10.45773612	14.23331202	180.7761354	186.2233971	39.50869476	75.1278024	0	0.271896262	1445.554578	8648.720909	5453.116929	188.2516207	1134.313524	0	0	30.35294943	987.0874679	0	0	97.73987889	0	0	5.477833341	83.3779933	0											4900	"$150 Days 1-3 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-3 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $13 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $75 (9a); $40/$30 (9c)	"$10 (7a); $15 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$15 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	72.56173759	40.91288451	0	0	200	0.2	0.116514982	64.95414532	30.75	0.121453448	0.169710368	0	0.2	26.63105193	5.928535065	15	38.5	15	0	0	0.2	13.08763648	0	0	15	0	0	0	0	0											NO	61.74826055	34.81586214	0	0	170.195099	0.170195099	0.099151394	55.30026649	26.16749646	0.103353908	0.144419364	0	0.170195099	22.66237259	5.860429023	14.82831445	38.05771829	14.82768245	0	0	0.170195099	11.13725793	0	0	15	0	0	0	0	0												5.5268	0.118262042	0	0	9.01926802	1.779855434	1.411252734	0.833080705	0.40608334	4.083378018	10.84990944	0	0.046275411	2.729974704	4.223767919	6.738377712	0.597035596	1.401603394	0	0	5.165923232	0.916120644	0	0	0.122174849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9692	0	NO	7.660189181	5.5268	0.118262042	0	0	9.01926802	1.779855434	1.411252734	0.833080705	0.40608334	4.083378018	10.84990944	0	0.046275411	2.729974704	4.223767919	6.738377712	0.597035596	1.401603394	0	0	5.165923232	0.916120644	0	0	0.122174849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9692	NO																																										0	0	0	0	0	0	0	0	0	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	5.5268	0.118262042	0	0	9.01926802	1.779855434	1.411252734	0.833080705	0.40608334	4.083378018	10.84990944	0	0.046275411	2.729974704	4.223767919	6.738377712	0.597035596	1.401603394	0	0	5.165923232	0.916120644	0	0	0.122174849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9692
H0543_121_0	2012	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	211.4447248	3.47619534	760.3648981	418.5769426	370.4447975	6.867024747	5.477342845	186.536868	153.1409719	28.38990021	50.1055682	0	6.763125208	943.1514116	6586.086175	5645.465169	144.814145	890.2621406	0	0	19.89789927	781.2857904	0	0	104.627761	456.9231805	1.096719371	8.43462279	468.0159145	1156.57227											6700	"$50 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-60 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$0 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$10 (3); $150 (5); $0 (9a); $30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7b1, 7d, 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 (9d, 9d1, 14a10, 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)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$10 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	49.4	50	48.24914732	0	200	0.2	0.138378188	64.98898856	0	0	0.144708746	0	0	0.063107619	3.065925497	10	30	10	0	0	0.2	8.637536872	0	0	10	0	5	342.5	0	10											NO	48.51322475	49.1024542	47.38303093	0	196.4098168	0.196409817	0.135894172	63.82598548	0	0	0.142111092	0	0	0.061974779	3.065925497	10	30	10	0	0	0.196409817	8.482485173	0	0	10	0	5	342.5	0	10												0.8548	0.014224144	3.002366124	0	6.063249568	1.348751073	0.744338973	0.992158286	0	0	7.120556996	0	0	0.004870967	1.682704127	4.704554308	0.362035362	0.741885117	0	0	3.908142749	0.552270428	0	0	0.087189801	0	0.000456966	0.240738192	0	0.963810225	0	0	0	0	0	0	0	0	0	0	33.3891	0	NO	0.44971243	0.8548	0.014224144	3.002366124	0	6.063249568	1.348751073	0.744338973	0.992158286	0	0	7.120556996	0	0	0.004870967	1.682704127	4.704554308	0.362035362	0.741885117	0	0	3.908142749	0.552270428	0	0	0.087189801	0	0.000456966	0.240738192	0	0.963810225	0	0	0	0	0	0	0	0	0	0	33.3891	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	0.8548	0.014224144	3.002366124	0	6.063249568	1.348751073	0.744338973	0.992158286	0	0	7.120556996	0	0	0.004870967	1.682704127	4.704554308	0.362035362	0.741885117	0	0	3.908142749	0.552270428	0	0	0.087189801	0	0.000456966	0.240738192	0	0.963810225	0	0	0	0	0	0	0	0	0	0	33.3891
H0543_125_0	2012	3																															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	933.9744379	19.56372946	694.9894609	290.2499162	252.9571245	9.699033571	11.58372572	254.7452355	62.25792421	24.34257344	48.72964379	0	0.472159593	26.37792037	2968.865917	1850.348932	33.90907244	375.7791145	0	0	15.23678195	386.7447494	0	0	49.15775564	0	5.351824274	5.491184057	106.7295992	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	73.60351618	0	200	0.2	0.119578894	64.9805775	0.16	0.104368968	0.156351501	0	0.2	0.145516209	9.092398428	34.66303329	38.5	35	0	0	0.2	25.1442904	0	0	35	0	0	0	0	0											NO	187.3363206	98.1191753	66.24109027	0	179.9943636	0.179994364	0.107617635	58.49423953	0.143995491	0.09392913	0.140711944	0	0.179994364	0.130960487	9.028276575	34.42044699	38.22848843	34.7531713	0	0	0.179994364	22.62915274	0	0	35	0	0	0	0	0												14.5806	0.15996475	3.836404968	0	3.794238053	1.745771375	1.246613165	1.241760735	8.964860358	2.286476737	6.856842928	0	0.084986066	3.454465305	2.233645218	5.307486443	0.108024382	1.088292995	0	0	2.742534871	0.729308834	0	0	0.143376787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6057	0	NO	5.810450947	14.5806	0.15996475	3.836404968	0	3.794238053	1.745771375	1.246613165	1.241760735	8.964860358	2.286476737	6.856842928	0	0.084986066	3.454465305	2.233645218	5.307486443	0.108024382	1.088292995	0	0	2.742534871	0.729308834	0	0	0.143376787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6057	NO																																										0	0	0	0	0	0	0	0	0	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	14.5806	0.15996475	3.836404968	0	3.794238053	1.745771375	1.246613165	1.241760735	8.964860358	2.286476737	6.856842928	0	0.084986066	3.454465305	2.233645218	5.307486443	0.108024382	1.088292995	0	0	2.742534871	0.729308834	0	0	0.143376787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6057
H0543_138_0	2012	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	1063.611644	36.72526792	929.1999058	529.2161517	473.2714953	7.882514207	6.325193145	174.9594055	182.1512569	36.73441417	58.75096733	0	8.632206259	1211.388742	8345.324221	5572.721503	194.3413346	1151.105896	0	0	28.52629027	982.1748455	785.60142	0	91.91729752	517.4159015	2.00780199	12.28232722	473.1593824	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 1-20/$120 Days 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$0 (9b)	20% (8a1a); $14 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a); $150 (5); $30 (9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0	0	28.0388341	0	200	0.2	0.136831193	64.95613746	0	0.13962841	0.144792348	0	0	0.066660793	0.005215704	0	30	0	0	0	0.2	0	0	0	0	30	0	352.5	0	0											NO	0	0	25.82897478	0	184.2371525	0.184237153	0.126046947	59.85237564	0	0.128623703	0.133380649	0	0	0.061406974	0.004804632	0	27.63557288	0	0	0	0.184237153	0	0	0	0	30	0	352.5	0	0												0	0	2.000023411	0	7.266182722	1.452251972	0.797271284	0.872644672	0	4.724916393	7.836242171	0	0	0.006198976	0.003341351	0	0.447561176	0	0	0	5.255602491	0	0	0	0	1.293539754	0	0.360793362	0	0	0	0	0	0	0	0	0	0	0	0	32.3166	0	NO	2.623131933	0	0	2.000023411	0	7.266182722	1.452251972	0.797271284	0.872644672	0	4.724916393	7.836242171	0	0	0.006198976	0.003341351	0	0.447561176	0	0	0	5.255602491	0	0	0	0	1.293539754	0	0.360793362	0	0	0	0	0	0	0	0	0	0	0	0	32.3166	NO																																										0	0	0	0	0	0	0	0	0	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	2.000023411	0	7.266182722	1.452251972	0.797271284	0.872644672	0	4.724916393	7.836242171	0	0	0.006198976	0.003341351	0	0.447561176	0	0	0	5.255602491	0	0	0	0	1.293539754	0	0.360793362	0	0	0	0	0	0	0	0	0	0	0	0	32.3166
H0543_140_0	2012	3																															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	931.6110595	6.615232702	751.7569704	179.816258	222.2311143	7.554711522	8.8675511	264.7807986	52.5701098	25.48871338	36.99264669	0	0.125225824	27.90173093	4802.453477	2863.71035	38.79773859	650.5977523	0	0	18.68937531	548.2706338	0	0	44.6548302	0	5.167611618	5.398949905	105.7911188	0											6700	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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/$35 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	55.945549	0	200	0.2	0.118137938	64.91972884	0.16	0.123281655	0.164756129	0	0.2	0.144603078	9.959996374	33.68473974	38.5	35	0	0	0.2	28.85197272	0	0	35	0	0	0	0	0											NO	174.6063683	91.45174199	50.90500747	0	181.9805449	0.181980545	0.107494032	59.08233751	0.145584436	0.112174314	0.149912051	0	0.181980545	0.131574735	9.899984107	33.48236934	38.26802479	34.78911345	0	0	0.181980545	26.25248859	0	0	35	0	0	0	0	0												13.5554	0.050414546	3.189016183	0	3.370144941	1.37481052	0.95320882	1.303655709	7.653389783	2.859178939	5.54564352	0	0.022788664	3.671162844	3.962017758	7.990317301	0.123726069	1.886143251	0	0	3.401102704	1.199455713	0	0	0.130243255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2419	0	NO	4.851897192	13.5554	0.050414546	3.189016183	0	3.370144941	1.37481052	0.95320882	1.303655709	7.653389783	2.859178939	5.54564352	0	0.022788664	3.671162844	3.962017758	7.990317301	0.123726069	1.886143251	0	0	3.401102704	1.199455713	0	0	0.130243255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2419	NO																																										0	0	0	0	0	0	0	0	0	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	13.5554	0.050414546	3.189016183	0	3.370144941	1.37481052	0.95320882	1.303655709	7.653389783	2.859178939	5.54564352	0	0.022788664	3.671162844	3.962017758	7.990317301	0.123726069	1.886143251	0	0	3.401102704	1.199455713	0	0	0.130243255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2419
H0543_142_0	2012	3																															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	680.3824173	10.78651708	611.975614	270.7961446	172.2326438	6.934227991	6.815050519	262.4057457	42.72427402	21.30357791	36.36237288	0	0.114467778	16.13014183	2995.981992	1902.514911	45.71660453	386.4118814	0	0	18.46131449	388.634113	0	0	37.86655886	0	12.39222305	2.761692477	137.4608443	0											6700	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	58.90078178	0	200	0.2	0.131895681	64.99348401	0.16	0.118753656	0.16029306	0	0.2	0.145297215	6.19115318	34.71313835	38.5	35	0	0	0.2	25.85098683	0	0	35	0	0	0	0	0											NO	175.6940172	93.81480276	55.30463328	0	187.7891315	0.187789132	0.123842877	61.03325856	0.150231305	0.11150323	0.150506473	0	0.187789132	0.13642619	6.185731164	34.68291061	38.46628292	34.96934811	0	0	0.187789132	24.27267183	0	0	35	0	0	0	0	0												9.9616	0.084327914	2.820423909	0	2.695284883	1.302172652	0.843995465	1.334623144	6.41852345	2.375417742	5.47277249	0	0.021495805	2.200573785	1.544361598	5.498729549	0.146545654	1.126047633	0	0	3.466834215	0.786099024	0	0	0.11044413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2103	0	NO	2.59401555	9.9616	0.084327914	2.820423909	0	2.695284883	1.302172652	0.843995465	1.334623144	6.41852345	2.375417742	5.47277249	0	0.021495805	2.200573785	1.544361598	5.498729549	0.146545654	1.126047633	0	0	3.466834215	0.786099024	0	0	0.11044413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2103	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	9.9616	0.084327914	2.820423909	0	2.695284883	1.302172652	0.843995465	1.334623144	6.41852345	2.375417742	5.47277249	0	0.021495805	2.200573785	1.544361598	5.498729549	0.146545654	1.126047633	0	0	3.466834215	0.786099024	0	0	0.11044413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2103
H0543_144_0	2012	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	1035.811789	29.0016165	914.7677396	474.8868129	414.9885389	8.979349083	7.434206218	211.604838	211.0117897	38.14666827	63.88901721	0	8.374468451	913.2175305	6970.857813	4495.693655	144.2176893	932.853272	0	0	28.65724749	854.7927944	0	0	42.79069767	162.6571429	17.6381231	65	540.608755	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 1-3/$50 Days 4-20/$146 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$0 (9b)	20% (8a1a); $14 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a); $150 (5); $30 (9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0	0	50.18121136	0	200	0.2	0.139072454	64.9849451	0	0.113901307	0.144620684	0	0	0.567912468	0.002592043	0	30	0	0	0	0.2	0	0	0	0	30	0	352.5	0	0											NO	0	0	45.6365116	0	181.8868471	0.181886847	0.126477251	59.11436845	0	0.103585748	0.131523001	0	0	0.516479041	0.002357292	0	27.28302707	0	0	0	0.181886847	0	0	0	0	30	0	352.5	0	0												0	0	3.478900713	0	6.290079745	1.633225494	0.940257967	1.042407196	0	3.951451177	8.402875286	0	0	0.03930481	0.001369363	0	0.32789126	0	0	0	5.212376394	0	0	0	0	0.406642857	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	33.6362	0	NO	3.118720037	0	0	3.478900713	0	6.290079745	1.633225494	0.940257967	1.042407196	0	3.951451177	8.402875286	0	0	0.03930481	0.001369363	0	0.32789126	0	0	0	5.212376394	0	0	0	0	0.406642857	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	33.6362	NO																																										0	0	0	0	0	0	0	0	0	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	3.478900713	0	6.290079745	1.633225494	0.940257967	1.042407196	0	3.951451177	8.402875286	0	0	0.03930481	0.001369363	0	0.32789126	0	0	0	5.212376394	0	0	0	0	0.406642857	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	33.6362
H0543_145_0	2012	3																															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	999.9411344	31.56406549	885.2005108	512.7095339	432.1691319	7.86530853	6.354664208	211.1391319	173.8432112	41.03804828	65.26101239	0	8.393925148	1180.91837	8020.432749	5166.064164	182.47044	1079.505818	0	0	27.52696736	954.8778751	0	0	42.79069767	132.8571429	17.6381231	65	540.608755	0											6700	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$275 (9b)	20% (8a1a); $14 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	$45 (3); $150 (5); $275 (9a); $30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $45 (7d, 7f)"	"$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$15/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	50	0	200	0.2	0.135578953	64.99196949	112.75	0.121515533	0.158780206	0	0	97.36035634	9.286526029	44.62012175	30	45	0	0	0.2	39.30898376	0	0	30	30	15	352.5	0	0											NO	159.7202825	83.65501329	41.6164432	0	166.4657728	0.166465773	0.112846276	54.12221705	93.84507943	0.101140885	0.132157349	0	0	81.0358348	9.166447315	44.04316467	29.61208729	44.41813094	0	0	0.166465773	32.7180018	0	0	30	30	15	352.5	0	0												13.3092	0.220041027	3.069908065	0	5.995114044	1.309304663	0.717100191	0.952276494	1.359527497	4.150624532	8.62472237	0	0	7.974725497	6.126572853	18.96081789	0.45027755	3.995802563	0	0	4.582297895	2.60347467	0	0	0.106976744	0.332142857	0.022047654	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	86.7724	0	NO	11.43943171	13.3092	0.220041027	3.069908065	0	5.995114044	1.309304663	0.717100191	0.952276494	1.359527497	4.150624532	8.62472237	0	0	7.974725497	6.126572853	18.96081789	0.45027755	3.995802563	0	0	4.582297895	2.60347467	0	0	0.106976744	0.332142857	0.022047654	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	86.7724	NO																																										0	0	0	0	0	0	0	0	0	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	13.3092	0.220041027	3.069908065	0	5.995114044	1.309304663	0.717100191	0.952276494	1.359527497	4.150624532	8.62472237	0	0	7.974725497	6.126572853	18.96081789	0.45027755	3.995802563	0	0	4.582297895	2.60347467	0	0	0.106976744	0.332142857	0.022047654	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	86.7724
H0543_146_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1001.933769	38.77943933	804.4429668	470.1066172	430.4974907	9.253594035	13.10240931	174.7221975	159.5777971	38.68894985	67.18639042	0	0.236838966	1086.95747	7641.239944	4806.03574	168.3528504	995.1059009	0	0	37.92218468	876.511965	0	0	42.79069767	0	17.6381231	2.376354103	160.3920985	0											4900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$195 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $195 (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	44.99631267	0	200	0.2	0.112734001	64.98538858	79.95	0.127295784	0.167895108	0	0.2	69.03930268	5.957297312	24.9222697	38.5	25	0	0	0.2	21.84547758	0	0	25	0	0	0	0	0											NO	137.4353555	79.42056209	35.92248979	0	159.6685936	0.159668594	0.090000397	51.92063182	63.82752028	0.101625694	0.134037879	0	0.159668594	55.1170418	5.858601299	24.51106405	37.86216101	24.58581884	0	0	0.159668594	17.4401834	0	0	25	0	0	0	0	0												11.4751	0.256657072	2.408132855	0	5.728077406	1.477508345	1.179222039	0.755973907	0.848787923	3.931791371	9.00552127	0	0.037815745	4.992490027	3.730581522	9.816754154	0.531183561	2.038791117	0	0	6.054981893	1.273877452	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6324	0	NO	12.75481849	11.4751	0.256657072	2.408132855	0	5.728077406	1.477508345	1.179222039	0.755973907	0.848787923	3.931791371	9.00552127	0	0.037815745	4.992490027	3.730581522	9.816754154	0.531183561	2.038791117	0	0	6.054981893	1.273877452	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6324	NO																																										0	0	0	0	0	0	0	0	0	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	11.4751	0.256657072	2.408132855	0	5.728077406	1.477508345	1.179222039	0.755973907	0.848787923	3.931791371	9.00552127	0	0.037815745	4.992490027	3.730581522	9.816754154	0.531183561	2.038791117	0	0	6.054981893	1.273877452	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6324
H0543_147_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1053.818749	40.78762641	846.1009175	494.4510133	452.7907346	9.625605724	14.01576118	183.7425448	167.8415079	46.56345628	81.26062816	0	0.285205839	1143.245389	8028.843474	5053.879838	177.0709759	1046.637301	0	0	40.36441366	921.9019972	0	0	42.79069767	0	17.6381231	2.376354103	160.3920985	0											4900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$70 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$195 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $195 (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	47.87546858	0	200	0.2	0.111865519	64.98538639	79.95	0.111245553	0.165154685	0	0.2	69.03930268	5.963305078	24.92236033	38.5	25	0	0	0.2	21.84547758	0	0	25	0	0	0	0	0											NO	134.5891776	77.77582484	37.42951598	0	156.3619828	0.156361983	0.087457572	50.84737805	62.50570264	0.086972876	0.12911957	0	0.156361983	53.9756113	5.854871298	24.47094605	37.7999351	24.5454124	0	0	0.156361983	17.07901095	0	0	25	0	0	0	0	0												11.8194	0.264357607	2.639095651	0	5.899938088	1.505078797	1.225784442	0.778568887	0.874254282	4.049757715	10.49233738	0	0.044595351	5.142280731	3.917320434	10.30610174	0.557772617	2.14084535	0	0	6.311459755	1.312097859	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3702	0	NO	14.9243583	11.8194	0.264357607	2.639095651	0	5.899938088	1.505078797	1.225784442	0.778568887	0.874254282	4.049757715	10.49233738	0	0.044595351	5.142280731	3.917320434	10.30610174	0.557772617	2.14084535	0	0	6.311459755	1.312097859	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3702	NO																																										0	0	0	0	0	0	0	0	0	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	11.8194	0.264357607	2.639095651	0	5.899938088	1.505078797	1.225784442	0.778568887	0.874254282	4.049757715	10.49233738	0	0.044595351	5.142280731	3.917320434	10.30610174	0.557772617	2.14084535	0	0	6.311459755	1.312097859	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3702
H0543_148_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1058.108767	40.95366981	849.5453315	496.4638867	454.634012	9.472602608	13.94872995	184.4883763	168.5247782	39.16077185	68.48088783	0	0.239920117	1147.899457	8060.891786	5074.372388	177.7918187	1050.898084	0	0	40.0925159	925.6549918	0	0	42.79069767	0	17.6381231	2.376354103	160.3920985	0											4900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$195 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $195 (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	44.98426624	0	200	0.2	0.111523647	64.98538622	79.95	0.132813131	0.168798672	0	0.2	69.03930268	5.963775959	24.92236743	38.5	25	0	0	0.2	21.84547758	0	0	25	0	0	0	0	0											NO	135.3856857	78.23610758	35.37727877	0	157.2873439	0.157287344	0.087706291	51.14701701	62.87561573	0.104449123	0.132749474	0	0.157287344	54.29504272	5.858054602	24.48227276	37.81750081	24.55681871	0	0	0.157287344	17.18008572	0	0	25	0	0	0	0	0												11.9377	0.267004643	2.504550169	0	5.959014683	1.489920504	1.223391368	0.786335843	0.883008266	4.090308293	9.090801811	0	0.037736398	5.193770836	3.935095352	10.35268074	0.560303521	2.150559477	0	0	6.306045336	1.325236009	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1826	0	NO	14.18048002	11.9377	0.267004643	2.504550169	0	5.959014683	1.489920504	1.223391368	0.786335843	0.883008266	4.090308293	9.090801811	0	0.037736398	5.193770836	3.935095352	10.35268074	0.560303521	2.150559477	0	0	6.306045336	1.325236009	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1826	NO																																										0	0	0	0	0	0	0	0	0	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	11.9377	0.267004643	2.504550169	0	5.959014683	1.489920504	1.223391368	0.786335843	0.883008266	4.090308293	9.090801811	0	0.037736398	5.193770836	3.935095352	10.35268074	0.560303521	2.150559477	0	0	6.306045336	1.325236009	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1826
H0543_149_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1163.919643	45.04903679	934.4998647	546.1102754	500.0974132	10.18326468	15.15825714	202.8838899	185.377256	41.96376263	73.52862756	0	0.25715206	1262.689402	8851.345381	5579.809627	195.5710006	1155.987892	0	0	43.48740697	1018.220491	0	0	42.79069767	0	17.6381231	2.376354103	160.3920985	0											4900	"$150 Days 1-3 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-3 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $14 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $75 (9a); $40/$30 (9c)	"$10 (7a); $15 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$15 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	72.56173759	40.91288451	0	0	200	0.2	0.111197991	64.98538237	30.75	0.127246926	0.169382977	0	0.2	26.57155815	5.97393068	15	38.5	15	0	0	0.2	13.10728655	0	0	15	0	0	0	0	0											NO	61.11145776	34.45681011	0	0	168.4398963	0.168439896	0.09365089	54.75761392	25.89763405	0.107167295	0.142654256	0	0.168439896	22.37855249	5.900421841	14.81608753	38.02625994	14.81542595	0	0	0.168439896	11.03894993	0	0	15	0	0	0	0	0												5.9274	0.129353842	0	0	7.019696367	1.715268047	1.41958428	0.925786476	0.400069361	4.497142934	10.48917164	0	0.043314666	2.354763422	4.352222634	6.889245653	0.619736142	1.427204418	0	0	7.325014319	0.936673751	0	0	0.053488372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5251	0	NO	8.255818424	5.9274	0.129353842	0	0	7.019696367	1.715268047	1.41958428	0.925786476	0.400069361	4.497142934	10.48917164	0	0.043314666	2.354763422	4.352222634	6.889245653	0.619736142	1.427204418	0	0	7.325014319	0.936673751	0	0	0.053488372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5251	NO																																										0	0	0	0	0	0	0	0	0	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	5.9274	0.129353842	0	0	7.019696367	1.715268047	1.41958428	0.925786476	0.400069361	4.497142934	10.48917164	0	0.043314666	2.354763422	4.352222634	6.889245653	0.619736142	1.427204418	0	0	7.325014319	0.936673751	0	0	0.053488372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5251
H0543_150_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1014.503324	39.26593886	814.5349415	476.0042436	435.8982089	9.386580176	13.35437291	176.9074494	161.5797477	39.19226288	68.11684603	0	0.239942951	1100.593673	7735.140027	4866.077973	170.4648867	1007.589798	0	0	38.61829539	887.5080665	0	0	42.79069767	0	17.6381231	2.376354103	160.3920985	0											4900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$195 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $195 (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	44.99212561	0	200	0.2	0.112583901	64.98538803	79.95	0.127237487	0.167881679	0	0.2	69.03930268	5.958808005	24.9222925	38.5	25	0	0	0.2	21.84547758	0	0	25	0	0	0	0	0											NO	136.8852565	79.10267321	35.77537705	0	159.0295038	0.159029504	0.08952081	51.71310581	63.57204413	0.101172572	0.133490701	0	0.159029504	54.89643023	5.858243686	24.5033874	37.85025155	24.57808542	0	0	0.159029504	17.37037729	0	0	25	0	0	0	0	0												11.5725	0.258836727	2.428357888	0	5.776722988	1.492743187	1.195494273	0.762369471	0.855996238	3.96518203	9.092965518	0	0.038158008	5.034888648	3.776194602	9.936282807	0.537678237	2.063719011	0	0	6.141448352	1.284695831	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3034	0	NO	13.13435927	11.5725	0.258836727	2.428357888	0	5.776722988	1.492743187	1.195494273	0.762369471	0.855996238	3.96518203	9.092965518	0	0.038158008	5.034888648	3.776194602	9.936282807	0.537678237	2.063719011	0	0	6.141448352	1.284695831	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3034	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	NO	0	11.5725	0.258836727	2.428357888	0	5.776722988	1.492743187	1.195494273	0.762369471	0.855996238	3.96518203	9.092965518	0	0.038158008	5.034888648	3.776194602	9.936282807	0.537678237	2.063719011	0	0	6.141448352	1.284695831	0	0	0.089147287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3034
H0543_802_0	2012	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	359.9715243	3.791927046	26.20891662	521.6216348	18.38565928	9.537732484	8.454789354	15.27774405	64.8308433	38.38171443	83.61505263	0	0.217040689	31.85892696	41.9603112	119.104746	0.99583103	7.768043702	0	0	32.26657445	20.00788395	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.064571978	0.064571978	0.144450159	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050402123	0.050402123	0.112751614	0	0.174844816	0.174844816	0.174844816	0.174844816	0.174844816	0.174844816	0.174844816	0	0.174844816	0.174844816	0.174844816	0.174844816	0.174844816	0.174844816	0	0	0.174844816	0.174844816	0	0	0	0	0	0	0	0												18.1433	0.191121173	2.955097648	0	3.21463721	1.667623079	1.478276087	2.671234344	11.33533685	6.710843789	14.61965848	0	0.037948439	5.570368216	7.336542883	20.82484738	0.174115893	1.35820217	0	0	5.641643267	3.498274784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4291	150	YES	30.20219507	18.1433	0.191121173	2.955097648	0	3.21463721	1.667623079	1.478276087	2.671234344	11.33533685	6.710843789	14.61965848	0	0.037948439	5.570368216	7.336542883	20.82484738	0.174115893	1.35820217	0	0	5.641643267	3.498274784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4291	NO																																										0	0	0	0	0	0	0	0	0	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	18.1433	0.191121173	2.955097648	0	3.21463721	1.667623079	1.478276087	2.671234344	11.33533685	6.710843789	14.61965848	0	0.037948439	5.570368216	7.336542883	20.82484738	0.174115893	1.35820217	0	0	5.641643267	3.498274784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4291
H0543_805_0	2012	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	373.4129172	3.115535987	28.45095811	528.2451282	18.86165372	9.912351364	10.0823444	15.44243031	65.70625487	39.22314416	85.90018011	0	0.363166416	34.49773805	42.97080249	120.9277984	1.127744712	8.027107154	0	0	38.17184536	20.35479953	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.06280989	0.06280989	0.14145467	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.048487275	0.048487275	0.109198591	0	0.172921009	0.172921009	0.172921009	0.172921009	0.172921009	0.172921009	0.172921009	0	0.172921009	0.172921009	0.172921009	0.172921009	0.172921009	0.172921009	0	0	0.172921009	0.172921009	0	0	0	0	0	0	0	0												18.1058	0.151063849	3.106804534	0	3.261576199	1.714053803	1.74344917	2.670320637	11.36199191	6.782505677	14.85394585	0	0.062799103	5.965383683	7.430554539	20.91095696	0.195010754	1.388055471	0	0	6.600714028	3.51977248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8247	150	YES	32.44103505	18.1058	0.151063849	3.106804534	0	3.261576199	1.714053803	1.74344917	2.670320637	11.36199191	6.782505677	14.85394585	0	0.062799103	5.965383683	7.430554539	20.91095696	0.195010754	1.388055471	0	0	6.600714028	3.51977248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8247	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	NO	0	18.1058	0.151063849	3.106804534	0	3.261576199	1.714053803	1.74344917	2.670320637	11.36199191	6.782505677	14.85394585	0	0.062799103	5.965383683	7.430554539	20.91095696	0.195010754	1.388055471	0	0	6.600714028	3.51977248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8247
H0543_806_0	2012	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	349.7763453	2.507172532	26.28090757	482.38518	17.47746042	9.184884097	9.806229502	14.64904639	68.59351543	39.3443434	85.77242202	0	0.268454708	41.75622913	43.09780456	121.5700518	1.099063832	8.197499227	0	0	32.93891759	20.44764581	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.062203998	0.062203998	0.148151004	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.048155254	0.048155254	0.114691169	0	0.173409706	0.173409706	0.173409706	0.173409706	0.173409706	0.173409706	0.173409706	0	0.173409706	0.173409706	0.173409706	0.173409706	0.173409706	0.173409706	0	0	0.173409706	0.173409706	0	0	0	0	0	0	0	0												16.8436	0.120733531	3.01418802	0	3.030761265	1.592748047	1.700495371	2.540286822	11.89478131	6.822691004	14.87377045	0	0.046552652	7.240935398	7.473577599	21.08142689	0.190588335	1.421525927	0	0	5.711928	3.54582024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1464	150	YES	31.84220556	16.8436	0.120733531	3.01418802	0	3.030761265	1.592748047	1.700495371	2.540286822	11.89478131	6.822691004	14.87377045	0	0.046552652	7.240935398	7.473577599	21.08142689	0.190588335	1.421525927	0	0	5.711928	3.54582024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1464	NO																																										0	0	0	0	0	0	0	0	0	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	16.8436	0.120733531	3.01418802	0	3.030761265	1.592748047	1.700495371	2.540286822	11.89478131	6.822691004	14.87377045	0	0.046552652	7.240935398	7.473577599	21.08142689	0.190588335	1.421525927	0	0	5.711928	3.54582024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1464
H0544_002_0	2012	9																															D	D	D	V	T	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	958.7423084	0	296.0252687	6.062389831	16.61796943	300.3514402	0	0	0	44.28087212	5.929043191	0.012819553	0	0	0	0	0	0	15.86709367	0	0	1415.016988	0	606.9073524	0	0	0	0											3400	1a:$0 days 1-90; Unlimited Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$15	12:$25	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$15	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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 / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Consult with Exercise Coach $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		0	0	1.639617608	0	14.18949259	0.038686464	50	65	0	0	0	15	25	15	0	0	0	0	0	0	0.160307222	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.638666102	0	14.18125812	0.038664013	49.97098392	64.9622791	0	0	0	14.99129518	24.98549196	14.99129518	0	0	0	0	0	0	0.156190152	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.130921543	0	0.349834229	0.234396319	0.069201357	1.625959507	0	0	0	0.055318969	0.012345005	1.60E-05	0	0	0	0	0	0	2.478283778	0	0	2.371196269	0	0.961562298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.289	0		0.0667648	0	0	0.130921543	0	0.349834229	0.234396319	0.069201357	1.625959507	0	0	0	0.055318969	0.012345005	1.60E-05	0	0	0	0	0	0	2.478283778	0	0	2.371196269	0	0.961562298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.289	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.130921543	0	0.349834229	0.234396319	0.069201357	1.625959507	0	0	0	0.055318969	0.012345005	1.60E-05	0	0	0	0	0	0	2.478283778	0	0	2.371196269	0	0.961562298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.289
H0544_003_0	2012	7																															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	19.95107736	13.91363367	0	641.9605169	0	0	0	0	0	0	0	0	0	0	0	0	22.60534159	0	0	1415.016988	0	608.1787956	0	0	0	0											3400	1a:$0 days 1-90; 240 Add'l Days	1b:$0 days 1-90; 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:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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 / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$150 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $30 per month Allowance											0		0	0	0	0	0.05675797	0.038686464	0	65	0	0	0	0	0	0	0	0	0	0	0	0	0.161044752	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	0	0	0.056656882	0.038617561	0	64.88423203	0	0	0	0	0	0	0	0	0	0	0	0	0.152116804	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0	0	1.130365833	0.5373106	0	3.471092928	0	0	0	0	0	0	0	0	0	0	0	0	3.438652313	0	0	2.371196269	0	0.963576727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.9122	0		0.210988031	0	0	0	0	1.130365833	0.5373106	0	3.471092928	0	0	0	0	0	0	0	0	0	0	0	0	3.438652313	0	0	2.371196269	0	0.963576727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.9122	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0	0	1.130365833	0.5373106	0	3.471092928	0	0	0	0	0	0	0	0	0	0	0	0	3.438652313	0	0	2.371196269	0	0.963576727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.9122
H0544_004_0	2012	8																															D	D	D	V	T	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	1285.694884	0	390.7841965	8.035983347	0	397.6080769	0	0	0	64.41895035	0	0.112733163	0	0	0	0	0	0	17.80874264	0	0	1415.016988	0	607.3313713	0	0	0	0											3400	1a:$0 days 1-90; 240 Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$15	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$15	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 50 Plan Approved Location Trips; $0 Unlimited CCC Trips	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $25 per month Allowance											0		0	0	1.639617608	0	14.18949259	0.038686464	0	65	0	0	0	15	0	15	0	0	0	0	0	0	0.160734183	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.638025482	0	14.1757141	0.038648898	0	64.93688274	0	0	0	14.98543448	0	14.98543448	0	0	0	0	0	0	0.155065854	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.175500082	0	0.461637087	0.310581898	0	2.151619089	0	0	0	0.080445497	0	0.00014078	0	0	0	0	0	0	2.761527886	0	0	2.371196269	0	0.962234098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2749	0		0.104036627	0	0	0.175500082	0	0.461637087	0.310581898	0	2.151619089	0	0	0	0.080445497	0	0.00014078	0	0	0	0	0	0	2.761527886	0	0	2.371196269	0	0.962234098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2749	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.175500082	0	0.461637087	0.310581898	0	2.151619089	0	0	0	0.080445497	0	0.00014078	0	0	0	0	0	0	2.761527886	0	0	2.371196269	0	0.962234098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2749
H0544_005_0	2012	6																															D	D	D	V	T	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	1940.450291	36.26976273	0	542.750633	0	0	0	0	0	0	0	0	0	0	0	0	6.935114987	0	0	0	0	577.0429763	0	0	0	0											3400	1a:$0 days 1-90; Unlimited Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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:$1500 Allowance Every 2 Years	14c:Newsletters $0 14c:Additional Smoking Cessation $0	13d:Comprehensive Health Assessment $0 13d:Incontinence Care Program $0 13b:OTC $24 per month Allowance											0		0	0	0	0	14.18949259	0.038686464	0	65	0	0	0	0	0	0	0	0	0	0	0	0	0.167816665	0	0	0	0	20.74104413	0	0	0	0											NO	0	0	0	0	14.18000274	0.03866059	0	64.95652837	0	0	0	0	0	0	0	0	0	0	0	0	0.167702278	0	0	0	0	20.74104413	0	0	0	0												0	0	0	0	2.29296587	1.402210435	0	2.937933074	0	0	0	0	0	0	0	0	0	0	0	0	1.16303458	0	0	0	0	0.997372819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7935	0		0.005232445	0	0	0	0	2.29296587	1.402210435	0	2.937933074	0	0	0	0	0	0	0	0	0	0	0	0	1.16303458	0	0	0	0	0.997372819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7935	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0	0	2.29296587	1.402210435	0	2.937933074	0	0	0	0	0	0	0	0	0	0	0	0	1.16303458	0	0	0	0	0.997372819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7935
H0544_007_0	2012	7																															D	D	D	V	T	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	316.6268313	74.828842	195.4621708	0	113.4794066	2.015279013	2.361074935	259.3934595	172.7907312	0	323.2259995	93.45941354	0	15.90628655	2692.402577	2409.109622	78.16355088	556.4301502	0	0.080828547	6.222396413	0	0	1415.016988	0	603.5053169	0	0	0	0											3400	1a:$100 days 1-4; Unlimited Add'l Days	1b:$100 days 1-4; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0	10a: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $0-$10; Therapeutic $10	5:$30	12:20% Coins	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$5; 14d:$0; 14e:$0	7b:$20; 7d:$0-$20; 7f:$0-$20; 16b:$0-$20; 17a:$0-$20  7b:Routine Chiro $20 12 visits per year	7e:$0-$20; 7h:$0-$20	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	0	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		73.31245325	48.298573	6.916407292	0	28.37898518	0.038686464	0.094842171	47.82597166	75	0	10	30	0	41.73456697	5	20	20	20	0	20	0.18976971	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	73.08387652	48.14798562	6.894843019	0	28.29050396	0.038565845	0.094546468	47.67685778	74.76616176	0	9.968821568	29.90646471	0	41.60444513	4.984410784	19.93764314	19.93764314	19.93764314	0	19.93764314	0.189388583	0	0	20.10884354	0	19.01237072	0	0	0	0												1.9284	0.300238167	0.112306749	0	0.267532467	0.077720938	0.223231295	1.030588756	1.07657498	0	0.268515193	0.232920054	0	0.055147686	1.118336703	4.002663994	0.129866415	0.924492147	0	0.000134294	1.178450837	0	0	2.371196269	0	0.956172235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.2544	0		0.039116474	1.9284	0.300238167	0.112306749	0	0.267532467	0.077720938	0.223231295	1.030588756	1.07657498	0	0.268515193	0.232920054	0	0.055147686	1.118336703	4.002663994	0.129866415	0.924492147	0	0.000134294	1.178450837	0	0	2.371196269	0	0.956172235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.2544	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	1.9284	0.300238167	0.112306749	0	0.267532467	0.077720938	0.223231295	1.030588756	1.07657498	0	0.268515193	0.232920054	0	0.055147686	1.118336703	4.002663994	0.129866415	0.924492147	0	0.000134294	1.178450837	0	0	2.371196269	0	0.956172235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.2544
H0544_008_0	2012	8																															D	D	D	V	T	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	661.6653082	19.4501819	745.1972854	0	222.7927378	3.955742366	2.261476339	298.6278087	289.5867537	0	428.9573191	14.53765955	1.94653825	15.42886256	0	2567.139417	134.5155662	1099.133565	0	0.035658646	9.851153725	0	0	1415.016988	0	603.0459844	0	0	0	0											3400	1a:$75 days 1-4; 240 Add'l Days	1b:$75 days 1-4; 60 Add'l Days	"2:$0 Days 1-20, $30 Days 21-100; 3 Day Waiver"	6:$0	10a: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $0-$10; Therapeutic $10	5:$30	12:$25	3:Cardiac Rehab $10; Intensive Cardiac Rehab $10; Pulmonary Rehab $10; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$10; 7d:$0-$10; 7f:$0-$10; 16b:$0-$10; 17a:$0-$10; 6 Routine Footcare Visits	7e:$0-$10; 7h:$0-$10	7c:$10; 7i: $0-$10	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		54.98433994	36.22392975	4.149844375	0	28.37898518	0.038686464	0.100989687	65	75	0	10	30	25	41.88310925	0	10	10	10	0	10	0.16297859	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	54.81823855	36.11450141	4.137308171	0	28.29325552	0.038569596	0.100684608	64.80364245	74.77343359	0	9.969791146	29.90937344	24.92447786	41.75658518	0	9.969791146	9.969791146	9.969791146	0	9.969791146	0.161461535	0	0	20.10884354	0	19.01237072	0	0	0	0												3.0226	0.058536135	0.256925901	0	0.525294321	0.152571386	0.22769586	1.612680812	1.804449658	0	0.356384574	0.036234357	0.004043037	0.053688051	0	2.13282032	0.111757675	0.913177674	0	2.96E-05	1.590582398	0	0	2.371196269	0	0.955444485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1861	0		0.049089948	3.0226	0.058536135	0.256925901	0	0.525294321	0.152571386	0.22769586	1.612680812	1.804449658	0	0.356384574	0.036234357	0.004043037	0.053688051	0	2.13282032	0.111757675	0.913177674	0	2.96E-05	1.590582398	0	0	2.371196269	0	0.955444485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1861	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	3.0226	0.058536135	0.256925901	0	0.525294321	0.152571386	0.22769586	1.612680812	1.804449658	0	0.356384574	0.036234357	0.004043037	0.053688051	0	2.13282032	0.111757675	0.913177674	0	2.96E-05	1.590582398	0	0	2.371196269	0	0.955444485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1861
H0544_010_0	2012	8																															D	D	D	V	T	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	975.2078452	31.68414042	1118.88172	0	362.5863494	8.411415219	6.55195491	448.0356377	0	0	0	15.09430141	0	0.023893903	0	0	0	0	0	0	10.87085853	0	0	1415.016988	0	601.1472766	0	0	0	0											3400	1a:$75 days 1-4; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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 / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $30 per month Allowance											0		54.98433994	36.22392975	1.967541129	0	28.37898518	0.038686464	0.08726429	65	0	0	0	30	0	30	0	0	0	0	0	0	0.163119389	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	54.88016276	36.15529735	1.963813288	0	28.32521637	0.038613165	0.087098953	64.87684645	0	0	0	29.9431599	0	29.9431599	0	0	0	0	0	0	0.161294184	0	0	20.10884354	0	19.01237072	0	0	0	0												4.46	0.09546246	0.183106233	0	0.8558614	0.324791367	0.570668411	2.422261606	0	0	0	0.037664257	0	5.96E-05	0	0	0	0	0	0	1.753406257	0	0	2.371196269	0	0.95243624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0269	0		0.036830728	4.46	0.09546246	0.183106233	0	0.8558614	0.324791367	0.570668411	2.422261606	0	0	0	0.037664257	0	5.96E-05	0	0	0	0	0	0	1.753406257	0	0	2.371196269	0	0.95243624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0269	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	4.46	0.09546246	0.183106233	0	0.8558614	0.324791367	0.570668411	2.422261606	0	0	0	0.037664257	0	5.96E-05	0	0	0	0	0	0	1.753406257	0	0	2.371196269	0	0.95243624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0269
H0544_012_0	2012	6																															D	D	D	V	T	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	602.5860331	64.43059556	911.1808274	0	222.4717124	8.782379262	6.163546764	514.3613544	287.3212536	0	713.9212862	0	0	6.176172869	0	3755.78271	113.159793	155.1027071	0	0	12.64707037	0	0	0	322.1605074	508.816844	0	0	0	0											3400	1a:$100 days 1-5; 240 Add'l Days	1b:$100 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$20; 7f:$0-$20; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$0-$20; 7h:$0-$20	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0 14c: Health Club $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	6.916407292	0	28.37898518	0.038686464	0.105549374	43.57642842	78.81944444	0	25	0	0	37.53811229	0	20	20	20	0	0	0.165119731	0	0	0	20	19.07532354	0	0	0	0											NO	78.59247524	57.59206542	6.846769719	0	28.09325249	0.03829695	0.104486654	43.13768088	78.02585399	0	24.74828849	0	0	37.16016129	0	19.79863079	19.79863079	19.79863079	0	0	0.160126413	0	0	0	20	19.07532354	0	0	0	0												3.9466	0.309224256	0.519887108	0	0.520829499	0.336338343	0.644008377	1.849029664	1.868207182	0	1.472360829	0	0	0.019125632	0	6.196612934	0.186700747	0.255901769	0	0	2.02513002	0	0	0	0.536934179	0.808820493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4957	0		0.247495602	3.9466	0.309224256	0.519887108	0	0.520829499	0.336338343	0.644008377	1.849029664	1.868207182	0	1.472360829	0	0	0.019125632	0	6.196612934	0.186700747	0.255901769	0	0	2.02513002	0	0	0	0.536934179	0.808820493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4957	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	3.9466	0.309224256	0.519887108	0	0.520829499	0.336338343	0.644008377	1.849029664	1.868207182	0	1.472360829	0	0	0.019125632	0	6.196612934	0.186700747	0.255901769	0	0	2.02513002	0	0	0	0.536934179	0.808820493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4957
H0544_013_0	2012	8																															D	D	D	V	T	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	2392.240989	0	735.1175789	13.0414046	0	527.2165895	0	0	0	41.082248	0	0	0	0	0	0	0	0	24.4526799	0	0	1415.016988	0	602.6073687	0	0	0	0											3400	1a:$0 days 1-90; 240 Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$15	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$15	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 50 Plan Approved Location Trips; $0 Unlimited CCC Trips	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $25 per month Allowance											0		0	0	1.639617608	0	14.18949259	0.038686464	0	65	0	0	0	15	0	0	0	0	0	0	0	0	0.160893779	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.636304844	0	14.16082345	0.0386083	0	64.86867082	0	0	0	14.96969327	0	0	0	0	0	0	0	0	0.150981892	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.32620296	0	0.867489187	0.503506455	0	2.849986616	0	0	0	0.051249054	0	0	0	0	0	0	0	0	3.691911867	0	0	2.371196269	0	0.954749557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6163	0		0.251681931	0	0	0.32620296	0	0.867489187	0.503506455	0	2.849986616	0	0	0	0.051249054	0	0	0	0	0	0	0	0	3.691911867	0	0	2.371196269	0	0.954749557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6163	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.32620296	0	0.867489187	0.503506455	0	2.849986616	0	0	0	0.051249054	0	0	0	0	0	0	0	0	3.691911867	0	0	2.371196269	0	0.954749557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6163
H0544_014_0	2012	7																															D	D	D	V	T	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	2462.413899	0	844.9856841	33.54796397	0	590.103657	0	0	0	97.42948635	0	0	0	0	0	0	0	0	32.69561478	0	0	1415.016988	0	614.208864	0	0	0	0											3400	1a:$0 days 1-90; 240 Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$15	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$15	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 50 Plan Approved Location Trips; $0 Unlimited CCC Trips	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $25 per month Allowance											0		0	0	1.639617608	0	14.18949259	0.038686464	0	65	0	0	0	15	0	0	0	0	0	0	0	0	0.162382288	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.633979102	0	14.14069613	0.038553424	0	64.7764705	0	0	0	14.94841627	0	0	0	0	0	0	0	0	0.148046329	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.335294404	0	0.995723816	1.293388881	0	3.185402678	0	0	0	0.121368043	0	0	0	0	0	0	0	0	4.840465742	0	0	2.371196269	0	0.973130552	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.116	0		0.489190192	0	0	0.335294404	0	0.995723816	1.293388881	0	3.185402678	0	0	0	0.121368043	0	0	0	0	0	0	0	0	4.840465742	0	0	2.371196269	0	0.973130552	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.116	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.335294404	0	0.995723816	1.293388881	0	3.185402678	0	0	0	0.121368043	0	0	0	0	0	0	0	0	4.840465742	0	0	2.371196269	0	0.973130552	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.116
H0544_016_0	2012	9																															D	D	D	V	T	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	248.2292276	51.49769643	166.8891323	0	86.27644526	1.377425669	1.520365259	199.5058219	135.8605145	0	458.5058592	64.57133131	0	13.53398941	2312.040609	1988.879863	69.20876891	451.1910122	0	0.070058454	4.540011496	0	0	0	311.6769167	485.2876553	0	0	0	0											3400	1a:$125 days 1-5; 240 Add'l Days	1b:$125 days 1-5; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$125; 9b:$75	8a:$0	8b: X-Rays $5; Diagnostic $0-$75; Therapeutic 20%	5:$35	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		99.2397859	72.72228321	17.29101823	0	28.37898518	0.038686464	0.096055378	49.13021157	96.88035404	0	48.35260909	35	0	69.54744765	10	32.49054745	35	20	0	35	0.189721783	0	0	0	20	11.79829863	0	0	0	0											NO	98.6599287	72.29736754	17.18998696	0	28.21316702	0.038460419	0.095494128	48.84314418	96.31428298	0	48.07008521	34.79549531	0	69.14108252	9.941570087	32.30070547	34.79549531	19.88314017	0	34.79549531	0.189706033	0	0	0	20	11.79829863	0	0	0	0												2.0409	0.310262324	0.239068501	0	0.202844313	0.052976368	0.145185954	0.812040969	1.090442337	0	1.83670131	0.187232621	0	0.077979557	1.915442813	5.353518556	0.200679449	0.747591178	0	0.000203143	0.861267569	0	0	0	0.519461528	0.477130723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0709	0		0.089483516	2.0409	0.310262324	0.239068501	0	0.202844313	0.052976368	0.145185954	0.812040969	1.090442337	0	1.83670131	0.187232621	0	0.077979557	1.915442813	5.353518556	0.200679449	0.747591178	0	0.000203143	0.861267569	0	0	0	0.519461528	0.477130723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0709	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	2.0409	0.310262324	0.239068501	0	0.202844313	0.052976368	0.145185954	0.812040969	1.090442337	0	1.83670131	0.187232621	0	0.077979557	1.915442813	5.353518556	0.200679449	0.747591178	0	0.000203143	0.861267569	0	0	0	0.519461528	0.477130723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0709
H0544_019_0	2012	7																															D	D	D	V	T	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	1993.051753	49.14149346	2106.15265	0	764.8705737	34.46142338	4.112222327	567.8896714	0	0	0	59.41534773	0	0	0	0	0	0	0	0	27.87476649	0	0	1415.016988	0	611.4925362	0	0	0	0											3400	1a:$75 days 1-4; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 9 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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 / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $30 per month Allowance											0		54.98433994	36.22392975	1.967541129	0	28.37898518	0.038686464	0.08726429	65	0	0	0	30	0	0	0	0	0	0	0	0	0.163704289	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	54.43172994	35.8598678	1.947766719	0	28.09376741	0.038297652	0.086387256	64.34672944	0	0	0	29.69849051	0	0	0	0	0	0	0	0	0.150035155	0	0	20.10884354	0	19.01237072	0	0	0	0												9.0404	0.146850622	0.341857836	0	1.790674666	1.319791612	0.355243603	3.045153587	0	0	0	0.147045512	0	0	0	0	0	0	0	0	4.182194905	0	0	2.371196269	0	0.968826899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7093	0		0.545360582	9.0404	0.146850622	0.341857836	0	1.790674666	1.319791612	0.355243603	3.045153587	0	0	0	0.147045512	0	0	0	0	0	0	0	0	4.182194905	0	0	2.371196269	0	0.968826899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7093	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	9.0404	0.146850622	0.341857836	0	1.790674666	1.319791612	0.355243603	3.045153587	0	0	0	0.147045512	0	0	0	0	0	0	0	0	4.182194905	0	0	2.371196269	0	0.968826899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7093
H0544_021_0	2012	6																															D	D	D	V	T	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	280.2764251	58.14621588	188.4350599	0	97.41501387	1.663755784	1.855591866	226.7481097	153.4005471	0	517.7004511	72.90769939	0	15.28127129	3187.536774	2173.649698	74.55635684	509.4412337	0	0.079103228	5.356968936	0	0	0	312.2223615	485.6143743	0	0	0	0											3400	1a:$175 days 1-5; 170 Add'l Days	1b:$175 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$150; 9b:$75	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic 20%	5:$30	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0 14c: Health Club $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		138.9357003	101.8111965	10.37461094	0	28.37898518	0.038686464	0.095397122	48.9393779	107.8205311	0	43.40004905	30	0	79.14396089	10	32.61984528	35	20	0	35	0.159897837	0	0	0	20	11.79829863	0	0	0	0											NO	137.6579317	100.8748558	10.27919737	0	28.11798838	0.038330671	0.09451977	48.48929058	106.8289236	0	43.00090601	29.72409499	0	78.41608704	9.908031663	32.31984599	34.67811082	19.81606333	0	34.67811082	0.159841981	0	0	0	20	11.79829863	0	0	0	0												3.2152	0.488790929	0.161413431	0	0.228259519	0.063772875	0.175390117	0.916237915	1.365634611	0	1.85513237	0.180592949	0	0.099858125	2.631851274	5.854335289	0.215456134	0.841259979	0	0.000228596	0.856268527	0	0	0	0.520370602	0.477451951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1475	0		0.17010226	3.2152	0.488790929	0.161413431	0	0.228259519	0.063772875	0.175390117	0.916237915	1.365634611	0	1.85513237	0.180592949	0	0.099858125	2.631851274	5.854335289	0.215456134	0.841259979	0	0.000228596	0.856268527	0	0	0	0.520370602	0.477451951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1475	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	3.2152	0.488790929	0.161413431	0	0.228259519	0.063772875	0.175390117	0.916237915	1.365634611	0	1.85513237	0.180592949	0	0.099858125	2.631851274	5.854335289	0.215456134	0.841259979	0	0.000228596	0.856268527	0	0	0	0.520370602	0.477451951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1475
H0544_022_0	2012	7																															D	D	D	V	T	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	2448.154684	328.7218396	0	0	1351.995968	36.19929526	12.74855004	154.9219426	106.4041714	0	0	0	0	4.00969375	0	0	0	0	0	0	5.201485895	0	0	0	323.9027733	515.6312425	0	0	0	0											3400	1a:$50 days 1-5; Unlimited Add'l Days	1b:$50 days 1-5; 60 Add'l Days	2:$0; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Additional Smoking Cessation $0	13d:Comprehensive Health Assessment $0 13b:OTC $24 per month Allowance											0		39.69591436	29.08891328	0	0	28.37898518	0.038686464	0.08726429	65	72.48289674	0	0	0	0	100	0	0	0	0	0	0	0.167846231	0	0	0	20	19.07532354	0	0	0	0											NO	39.43112698	28.89487878	0	0	28.18968618	0.03842841	0.086682203	64.56642441	71.99940728	0	0	0	0	99.33296063	0	0	0	0	0	0	0.167828706	0	0	0	20	19.07532354	0	0	0	0												8.0445	0.791531476	0	0	3.176028505	1.391081345	1.105072397	0.833562992	0.638419773	0	0	0	0	0.033191229	0	0	0	0	0	0	0.872958647	0	0	0	0.539837956	0.819652731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2458	0		0.107623762	8.0445	0.791531476	0	0	3.176028505	1.391081345	1.105072397	0.833562992	0.638419773	0	0	0	0	0.033191229	0	0	0	0	0	0	0.872958647	0	0	0	0.539837956	0.819652731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2458	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.0445	0.791531476	0	0	3.176028505	1.391081345	1.105072397	0.833562992	0.638419773	0	0	0	0	0.033191229	0	0	0	0	0	0	0.872958647	0	0	0	0.539837956	0.819652731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2458
H0544_024_0	2012	6																															D	D	D	V	T	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	2127.99025	52.48207141	2195.485998	0	750.096751	28.6697646	4.650321627	721.4279956	345.0648742	0	676.9675902	84.26172202	0	53.81273003	0	5271.927977	270.8941973	1428.845671	0	0	28.71693286	0	0	0	334.8536825	521.9068028	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	51.31524346	74.90214486	0	25	30	0	70.69016496	0	15	15	20	0	0	0.16225626	0	0	0	20	19.07532354	0	0	0	0											NO	76.07316574	55.74593146	3.142159692	0	27.19271338	0.037069328	0.08361655	49.17021164	71.77115544	0	23.95497338	28.74596805	0	67.73524078	0	14.37298403	14.37298403	19.1639787	0	0	0.145825307	0	0	0	20	19.07532354	0	0	0	0												13.4902	0.243805163	0.574880634	0	1.69976383	1.062768912	0.388843849	2.956063935	2.063808727	0	1.35139505	0.201848731	0	0.303751519	0	6.314444717	0.324463164	2.281864001	0	0	4.187655562	0	0	0	0.558089471	0.829628427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8333	0		1.922711945	13.4902	0.243805163	0.574880634	0	1.69976383	1.062768912	0.388843849	2.956063935	2.063808727	0	1.35139505	0.201848731	0	0.303751519	0	6.314444717	0.324463164	2.281864001	0	0	4.187655562	0	0	0	0.558089471	0.829628427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8333	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	13.4902	0.243805163	0.574880634	0	1.69976383	1.062768912	0.388843849	2.956063935	2.063808727	0	1.35139505	0.201848731	0	0.303751519	0	6.314444717	0.324463164	2.281864001	0	0	4.187655562	0	0	0	0.558089471	0.829628427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8333
H0544_025_0	2012	5																															D	D	D	V	T	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	1252.401688	29.67252034	1588.933048	0	433.5091639	8.353192802	5.578144788	583.0271849	321.2241486	0	525.3706628	43.11616344	0	56.07440733	0	4958.120469	307.8013277	939.4477963	0	0	14.09615675	0	0	0	338.4960533	513.6041826	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	46.72287957	72.74603857	0	25	30	0	42.2524073	0	15	15	20	0	0	0.161973903	0	0	0	20	19.07532354	0	0	0	0											NO	77.8852641	57.0738256	3.217007404	0	27.84045652	0.037952337	0.085608335	45.83625133	71.36558658	0	24.52559204	29.43071045	0	41.45061217	0	14.71535522	14.71535522	19.62047363	0	0	0.155332316	0	0	0	20	19.07532354	0	0	0	0												8.1286	0.141127021	0.425967448	0	1.005757753	0.317023187	0.477535687	2.226981715	1.910362482	0	1.073752212	0.105744943	0	0.193693209	0	6.080041995	0.37745049	1.536034226	0	0	2.189588677	0	0	0	0.564160089	0.816430496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5703	0		0.55786418	8.1286	0.141127021	0.425967448	0	1.005757753	0.317023187	0.477535687	2.226981715	1.910362482	0	1.073752212	0.105744943	0	0.193693209	0	6.080041995	0.37745049	1.536034226	0	0	2.189588677	0	0	0	0.564160089	0.816430496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5703	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.1286	0.141127021	0.425967448	0	1.005757753	0.317023187	0.477535687	2.226981715	1.910362482	0	1.073752212	0.105744943	0	0.193693209	0	6.080041995	0.37745049	1.536034226	0	0	2.189588677	0	0	0	0.564160089	0.816430496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5703
H0544_027_0	2012	5																															D	D	D	V	T	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	633.8678739	13.36928487	636.3932228	0	231.7580315	4.59039988	1.909516972	333.1237712	297.2947777	0	497.0106807	9.286716292	0	9.314850069	0	2920.187102	116.4703873	654.5843159	0	0.022778889	8.412420469	0	0	0	325.524533	510.7095891	0	0	0	0											3400	1a:$100 days 1-5; 240 Add'l Days	1b:$100 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$20; 7f:$0-$20; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$0-$20; 7h:$0-$20	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	6.916407292	0	28.37898518	0.038686464	0.103601171	52.45718418	100	0	25	30	0	58.00597203	0	20	20	20	0	20	0.162419399	0	0	0	20	19.07532354	0	0	0	0											NO	78.79569754	57.74098543	6.864473912	0	28.16589527	0.038395978	0.102823259	52.06329776	99.24912779	0	24.81228195	29.77473834	0	57.5704213	0	19.84982556	19.84982556	19.84982556	0	19.84982556	0.161209338	0	0	0	20	19.07532354	0	0	0	0												4.1622	0.06432964	0.364042056	0	0.543972704	0.176252891	0.196342758	1.445293508	2.458853949	0	1.027664095	0.023042462	0	0.04468832	0	4.830433714	0.192659739	1.08278204	0	3.77E-05	1.356160736	0	0	0	0.542540888	0.811829221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3231	0		0.135862406	4.1622	0.06432964	0.364042056	0	0.543972704	0.176252891	0.196342758	1.445293508	2.458853949	0	1.027664095	0.023042462	0	0.04468832	0	4.830433714	0.192659739	1.08278204	0	3.77E-05	1.356160736	0	0	0	0.542540888	0.811829221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3231	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	4.1622	0.06432964	0.364042056	0	0.543972704	0.176252891	0.196342758	1.445293508	2.458853949	0	1.027664095	0.023042462	0	0.04468832	0	4.830433714	0.192659739	1.08278204	0	3.77E-05	1.356160736	0	0	0	0.542540888	0.811829221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3231
H0544_028_0	2012	5																															D	D	D	V	T	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	239.1402877	49.61210272	160.7784687	0	83.11742391	1.293396917	1.480997116	195.5397035	130.8859672	0	441.7176177	62.20704505	0	13.03844093	3524.311871	1939.321874	67.93972928	434.6706047	0	0.067493257	4.593283897	0	0	0	311.5612636	485.2010483	0	0	0	0											3400	1a:$175 days 1-5; 170 Add'l Days	1b:$175 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic 20%	5:$35	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10; 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		138.9357003	101.8111965	10.37461094	0	28.37898518	0.038686464	0.095958622	48.63281793	100	0	41.03537775	35	0	59.95093441	10	32.4531274	35	20	0	35	0.189070343	0	0	0	20	11.79829863	0	0	0	0											NO	137.9617803	101.0975142	10.30188636	0	28.18005244	0.038415277	0.095285965	48.29190864	99.2990139	0	40.74772546	34.75465486	0	59.5306867	9.92990139	32.22563548	34.75465486	19.85980278	0	34.75465486	0.189048842	0	0	0	20	11.79829863	0	0	0	0												2.7494	0.417971688	0.138026793	0	0.19518778	0.049686201	0.14111824	0.786915458	1.083070623	0	1.499915685	0.180165365	0	0.064682278	2.916339112	5.207989983	0.196768487	0.719372707	0	0.000195475	0.868355004	0	0	0	0.519268773	0.477045572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2114	0		0.115496177	2.7494	0.417971688	0.138026793	0	0.19518778	0.049686201	0.14111824	0.786915458	1.083070623	0	1.499915685	0.180165365	0	0.064682278	2.916339112	5.207989983	0.196768487	0.719372707	0	0.000195475	0.868355004	0	0	0	0.519268773	0.477045572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2114	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	2.7494	0.417971688	0.138026793	0	0.19518778	0.049686201	0.14111824	0.786915458	1.083070623	0	1.499915685	0.180165365	0	0.064682278	2.916339112	5.207989983	0.196768487	0.719372707	0	0.000195475	0.868355004	0	0	0	0.519268773	0.477045572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2114
H0544_031_0	2012	5																															D	D	D	V	T	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	2028.953596	50.03955613	2093.308093	0	715.1872528	24.89141587	4.078901036	691.0237037	329.0055571	0	645.4615227	80.34018199	0	51.30828591	0	5170.458982	275.6132734	1362.347202	0	0	26.34376129	0	0	0	335.3511555	522.4932501	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	51.14860044	100	0	25	30	0	70.69016496	0	15	15	20	0	0	0.161946544	0	0	0	20	19.07532354	0	0	0	0											NO	76.24424856	55.87129986	3.149226172	0	27.25386775	0.037152694	0.083804597	49.12075547	96.03538524	0	24.00884631	28.81061557	0	67.88757224	0	14.40530779	14.40530779	19.20707705	0	0	0.146618819	0	0	0	20	19.07532354	0	0	0	0												12.8913	0.232981254	0.549358386	0	1.624301567	0.924783164	0.341830657	2.828633865	2.633014618	0	1.291398875	0.192887508	0	0.290266247	0	6.206837753	0.330857836	2.180558973	0	0	3.862491169	0	0	0	0.558918593	0.830560649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.771	0		1.746269016	12.8913	0.232981254	0.549358386	0	1.624301567	0.924783164	0.341830657	2.828633865	2.633014618	0	1.291398875	0.192887508	0	0.290266247	0	6.206837753	0.330857836	2.180558973	0	0	3.862491169	0	0	0	0.558918593	0.830560649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.771	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	12.8913	0.232981254	0.549358386	0	1.624301567	0.924783164	0.341830657	2.828633865	2.633014618	0	1.291398875	0.192887508	0	0.290266247	0	6.206837753	0.330857836	2.180558973	0	0	3.862491169	0	0	0	0.558918593	0.830560649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.771
H0544_032_0	2012	5																															D	D	D	V	T	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	1204.751558	16.90914612	1584.611842	0	429.2066215	9.238461577	7.164770912	541.2288473	327.0702889	0	519.1991213	32.91466417	0	30.67384427	0	4065.845058	186.4838923	978.3571316	0	0	15.1400572	0	0	0	336.6113437	512.5664271	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	52.22313375	100	0	25	30	0	53.03213217	0	15	15	20	0	0	0.162464995	0	0	0	20	19.07532354	0	0	0	0											NO	77.9563938	57.125949	3.219945377	0	27.86588217	0.037986997	0.085686518	51.27891933	98.19196139	0	24.54799035	29.45758842	0	52.07329074	0	14.72879421	14.72879421	19.63839228	0	0	0.155221964	0	0	0	20	19.07532354	0	0	0	0												7.8265	0.080495918	0.425196965	0	0.996685095	0.350941415	0.61392427	2.312802533	2.676306099	0	1.062107918	0.080798886	0	0.133107334	0	4.990416262	0.228890239	1.601113428	0	0	2.350069409	0	0	0	0.561018906	0.814780869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1052	0		0.540149992	7.8265	0.080495918	0.425196965	0	0.996685095	0.350941415	0.61392427	2.312802533	2.676306099	0	1.062107918	0.080798886	0	0.133107334	0	4.990416262	0.228890239	1.601113428	0	0	2.350069409	0	0	0	0.561018906	0.814780869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1052	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	7.8265	0.080495918	0.425196965	0	0.996685095	0.350941415	0.61392427	2.312802533	2.676306099	0	1.062107918	0.080798886	0	0.133107334	0	4.990416262	0.228890239	1.601113428	0	0	2.350069409	0	0	0	0.561018906	0.814780869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1052
H0544_034_0	2012	6																															D	D	D	V	T	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	739.4578287	0	228.3180794	4.54101028	5.047963651	345.1279254	0	0	223.1256845	34.15290768	0	15.088252	0	357.7028121	140.3633835	898.6696336	0	0	12.15876975	0	0	1415.016988	0	605.3223831	0	0	0	0											3400	1a:$0 days 1-90; Unlimited Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies 20%; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$10; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0-$100; Therapeutic 20%	5:$30	12:20% Coins	3:Cardiac Rehab $10; Intensive Cardiac Rehab $10; Pulmonary Rehab $10; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$10; 7d:$0; 7f:$0-$10; 16b:$0; 17a:$0; 4 Routine Footcare Visits	7e:$0-$10; 7h:$0	7c:$10; 7i: $0-$10	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		0	0	6.916407292	0	28.37898518	0.038686464	0.159012366	46.91678105	0	0	171.4008684	30	0	10.01310616	0	10	10	10	0	0	0.2	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	6.903084581	0	28.32432024	0.038611944	0.158706069	46.82640772	0	0	171.0707079	29.94221258	0	9.99381844	0	9.980737526	9.980737526	9.980737526	0	0	0.194318044	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.425378328	0	0.538912866	0.175337234	0.801142466	1.346758413	0	0	3.180855734	0.085217802	0	0.012565771	0	0.29751149	0.116744174	0.747448811	0	0	2.362668355	0	0	2.371196269	0	0.959051129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4208	0		0.084000119	0	0	0.425378328	0	0.538912866	0.175337234	0.801142466	1.346758413	0	0	3.180855734	0.085217802	0	0.012565771	0	0.29751149	0.116744174	0.747448811	0	0	2.362668355	0	0	2.371196269	0	0.959051129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4208	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.425378328	0	0.538912866	0.175337234	0.801142466	1.346758413	0	0	3.180855734	0.085217802	0	0.012565771	0	0.29751149	0.116744174	0.747448811	0	0	2.362668355	0	0	2.371196269	0	0.959051129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4208
H0544_035_0	2012	5																															D	D	D	V	T	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	1147.31796	0	348.7248279	6.962976343	4.502096061	354.8142669	0	0	297.4517217	57.4856598	0	0.100599905	0	0	0	0	0	0	15.84715053	0	0	1415.016988	0	606.6018614	0	0	0	0											3400	1a:$0 days 1-90; 240 Add'l Days	1b:$0 days 1-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0-$100; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 10 Plan Approved Location Trips; $0 Unlimited CCC Trips	"16a: $5-20 Oral Exams / $35-40 Prophylaxis / $5-10 Fluoride / $5-15 Dental X-Rays / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $30 per month Allowance											0		0	0	3.279235216	0	28.37898518	0.038686464	0.08726429	65	0	0	174.7054612	30	0	30	0	0	0	0	0	0	0.2	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	3.269837707	0	28.29765776	0.038575597	0.087014211	64.81372546	0	0	174.2047969	29.91402713	0	29.91402713	0	0	0	0	0	0	0.190584813	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.312628627	0	0.822341319	0.268600972	0.391746337	1.916402874	0	0	4.318126397	0.143302299	0	0.000250779	0	0	0	0	0	0	3.020226216	0	0	2.371196269	0	0.961078289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.5259	0		0.172694227	0	0	0.312628627	0	0.822341319	0.268600972	0.391746337	1.916402874	0	0	4.318126397	0.143302299	0	0.000250779	0	0	0	0	0	0	3.020226216	0	0	2.371196269	0	0.961078289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.5259	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0	0	0.312628627	0	0.822341319	0.268600972	0.391746337	1.916402874	0	0	4.318126397	0.143302299	0	0.000250779	0	0	0	0	0	0	3.020226216	0	0	2.371196269	0	0.961078289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.5259
H0544_036_0	2012	5																															D	D	D	V	T	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	1688.335251	24.01176651	1954.112997	0	599.056182	9.38937568	4.750425484	586.1002258	291.8957365	0	517.2978659	32.64978692	0	111.7501105	0	5141.273508	185.8289742	1424.829866	0	0	18.891286	0	0	0	338.4156544	511.2227315	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	51.51352385	100	0	25	30	0	47.63903234	0	15	15	20	0	0	0.160677086	0	0	0	20	19.07532354	0	0	0	0											NO	77.05539373	56.46570188	3.182730071	0	27.54381543	0.037547953	0.084696175	49.99752401	97.0570838	0	24.26427095	29.11712514	0	46.23705554	0	14.55856257	14.55856257	19.41141676	0	0	0.150138614	0	0	0	20	19.07532354	0	0	0	0												10.8413	0.112986771	0.518284517	0	1.375024409	0.35255184	0.402342867	2.441963343	2.36087908	0	1.045987965	0.079222328	0	0.430583006	0	6.237462671	0.225450229	2.304830528	0	0	2.836311488	0	0	0	0.564026091	0.812644917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9418	0		1.070187006	10.8413	0.112986771	0.518284517	0	1.375024409	0.35255184	0.402342867	2.441963343	2.36087908	0	1.045987965	0.079222328	0	0.430583006	0	6.237462671	0.225450229	2.304830528	0	0	2.836311488	0	0	0	0.564026091	0.812644917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9418	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	10.8413	0.112986771	0.518284517	0	1.375024409	0.35255184	0.402342867	2.441963343	2.36087908	0	1.045987965	0.079222328	0	0.430583006	0	6.237462671	0.225450229	2.304830528	0	0	2.836311488	0	0	0	0.564026091	0.812644917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9418
H0544_037_0	2012	5																															D	D	D	V	T	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	1854.489466	26.37483759	2146.423209	0	658.0111254	11.32736484	5.644907938	640.9094394	320.6220849	0	568.2067245	35.86295189	0	122.7477793	0	5497.752175	194.5094772	1565.051713	0	0	21.52289929	0	0	0	338.7811004	511.3461336	0	0	0	0											3400	1a:$100 days 1-5; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$15; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$25; Therapeutic $25	5:$30	12:$0	3:Cardiac Rehab $15; Intensive Cardiac Rehab $15; Pulmonary Rehab $15; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$15; 7d:$0-$15; 7f:$0-$15; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$15	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	3.279235216	0	28.37898518	0.038686464	0.08726429	51.67707142	77.46739799	0	25	30	0	47.63903234	0	15	15	20	0	0	0.1608607	0	0	0	20	19.07532354	0	0	0	0											NO	76.65352235	56.17121309	3.166130998	0	27.4001646	0.037352127	0.084254454	49.89467572	74.79546722	0	24.13772412	28.96526894	0	45.99591279	0	14.48263447	14.48263447	19.31017929	0	0	0.148404745	0	0	0	20	19.07532354	0	0	0	0												11.8461	0.123458885	0.566321421	0	1.502467762	0.423101174	0.475608636	2.664830721	1.99842322	0	1.142934763	0.086565004	0	0.470491346	0	6.635161263	0.234750805	2.518452431	0	0	3.194100375	0	0	0	0.564635167	0.812841078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2602	0		1.364384424	11.8461	0.123458885	0.566321421	0	1.502467762	0.423101174	0.475608636	2.664830721	1.99842322	0	1.142934763	0.086565004	0	0.470491346	0	6.635161263	0.234750805	2.518452431	0	0	3.194100375	0	0	0	0.564635167	0.812841078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2602	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	11.8461	0.123458885	0.566321421	0	1.502467762	0.423101174	0.475608636	2.664830721	1.99842322	0	1.142934763	0.086565004	0	0.470491346	0	6.635161263	0.234750805	2.518452431	0	0	3.194100375	0	0	0	0.564635167	0.812841078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2602
H0544_038_0	2012	6																															D	D	D	V	T	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	1733.760381	24.65780977	2006.688951	0	615.1739552	9.900896889	4.945165219	439.5274651	0	0	0	33.52823852	0	0	0	0	0	0	0	0	19.30713917	0	0	1415.016988	0	602.4581279	0	0	0	0											3400	1a:$75 days 1-4; 240 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: $100 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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 / $5-9999 Emergency / $5-9999 Diagnostic / $5-9999 Restorative / $5-9999 Endodontics,Periodontics,Extractions"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $30 per month Allowance											0		54.98433994	36.22392975	1.967541129	0	28.37898518	0.038686464	0.08726429	65	0	0	0	30	0	0	0	0	0	0	0	0	0.160609952	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	54.67519755	36.02026535	1.956478882	0	28.21942798	0.038468954	0.086773657	64.63454585	0	0	0	29.83132885	0	0	0	0	0	0	0	0	0.152600381	0	0	20.10884354	0	19.01237072	0	0	0	0												7.8995	0.074015071	0.32717038	0	1.44665476	0.380877146	0.429110073	2.367388174	0	0	0	0.083349326	0	0	0	0	0	0	0	0	2.946276801	0	0	2.371196269	0	0.954513106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.28	0		0.22819145	7.8995	0.074015071	0.32717038	0	1.44665476	0.380877146	0.429110073	2.367388174	0	0	0	0.083349326	0	0	0	0	0	0	0	0	2.946276801	0	0	2.371196269	0	0.954513106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.28	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	7.8995	0.074015071	0.32717038	0	1.44665476	0.380877146	0.429110073	2.367388174	0	0	0	0.083349326	0	0	0	0	0	0	0	0	2.946276801	0	0	2.371196269	0	0.954513106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.28
H0544_039_0	2012	5																															D	D	D	V	T	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	232.881112	48.31357259	156.5703083	0	80.94193702	1.389705727	1.534626703	187.3290996	127.4602028	0	430.1562526	60.57885923	0	12.69717725	2230.77241	1843.70008	61.7137279	423.2936856	0	0.065726711	4.389468762	0	0	0	310.6376981	485.0105403	0	0	0	0											3400	1a:$125 days 1-5; Unlimited Add'l Days	1b:$125 days 1-5; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$125; 9b:$75	8a:$0	8b: X-Rays $5; Diagnostic $0-$75; Therapeutic 20%	5:$35	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10; 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		99.2397859	72.72228321	17.29101823	0	28.37898518	0.038686464	0.095435177	49.10551694	96.88035404	0	50.21648713	35	0	69.54744765	10	32.34038225	35	20	0	35	0.189542819	0	0	0	20	11.79829863	0	0	0	0											NO	98.74415771	72.35909002	17.20466258	0	28.23725347	0.038493254	0.09495855	48.86027176	96.39650944	0	49.9656935	34.82520129	0	69.20011038	9.950057511	32.17886633	34.82520129	19.90011502	0	34.82520129	0.189531353	0	0	0	20	11.79829863	0	0	0	0												1.9163	0.291327179	0.224478277	0	0.190464833	0.053494295	0.145725926	0.762745893	1.02389322	0	1.791087956	0.175805914	0	0.073220506	1.849692814	4.944014869	0.179099416	0.701966086	0	0.000190745	0.831941954	0	0	0	0.517729497	0.476858266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.15	0		0.071944573	1.9163	0.291327179	0.224478277	0	0.190464833	0.053494295	0.145725926	0.762745893	1.02389322	0	1.791087956	0.175805914	0	0.073220506	1.849692814	4.944014869	0.179099416	0.701966086	0	0.000190745	0.831941954	0	0	0	0.517729497	0.476858266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.15	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	1.9163	0.291327179	0.224478277	0	0.190464833	0.053494295	0.145725926	0.762745893	1.02389322	0	1.791087956	0.175805914	0	0.073220506	1.849692814	4.944014869	0.179099416	0.701966086	0	0.000190745	0.831941954	0	0	0	0.517729497	0.476858266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.15
H0544_801_0	2012	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	161.1955942	2.174100069	24.90059455	3.206358665	6.671748407	4.802766988	5.643115467	15.82339199	30.74785288	5.463314052	21.31341953	0.780710857	0.126493651	3.359983021	135.0855898	94.95414631	3.284502883	9.523185821	6.137535145	16.37578673	11.99142197	13.39130634	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.061670882	0.061670882	0.149173029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050692946	0.050692946	0.122618974	0	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.195179451	0.184126114	0	0	0	0	0	0	0	0												8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438	0		17.69256558	8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438
H0544_802_0	2012	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	161.1955942	2.174100069	24.90059455	3.206358665	6.671748407	4.802766988	5.643115467	15.82339199	30.74785288	5.463314052	21.31341953	0.780710857	0.126493651	3.359983021	135.0855898	94.95414631	3.284502883	9.523185821	6.137535145	16.37578673	11.99142197	13.39130634	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.061670882	0.061670882	0.149173029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050692946	0.050692946	0.122618974	0	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.184126114	0.195179451	0.184126114	0	0	0	0	0	0	0	0												8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438	0		17.69256558	8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.1715	0.110211537	3.053285349	0	1.228443107	0.884314822	1.039044921	2.913499676	5.661482661	1.005938786	3.924357112	0.143749256	0.023290784	0.618660616	24.8727847	17.48353796	0.604762752	1.753467197	1.130080495	3.015209973	2.340479157	2.465689196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4438
H0544_803_0	2012	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	161.1943419	2.174100069	24.90044165	3.206357927	6.671748407	4.802766122	5.643089716	15.8233568	30.74785288	5.463314052	21.31341953	0.780710857	0.126493651	3.359983021	135.0555374	94.94925431	3.283854504	9.52184411	6.137505059	16.37313362	11.99126434	13.39026328	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.061670882	0.061670882	0.149173029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050694113	0.050694113	0.122621797	0	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.195182399	0.184130353	0	0	0	0	0	0	0	0												8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438	0		17.68904021	8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438
H0544_804_0	2012	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	161.1943419	2.174100069	24.90044165	3.206357927	6.671748407	4.802766122	5.643089716	15.8233568	30.74785288	5.463314052	21.31341953	0.780710857	0.126493651	3.359983021	135.0555374	94.94925431	3.283854504	9.52184411	6.137505059	16.37313362	11.99126434	13.39026328	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.061670882	0.061670882	0.149173029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050694113	0.050694113	0.122621797	0	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.184130353	0.195182399	0.184130353	0	0	0	0	0	0	0	0												8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438	0		17.68904021	8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.1716	0.110214074	3.05333689	0	1.228471387	0.88433502	1.0390641	2.913560268	5.661612995	1.005961943	3.924447455	0.143752566	0.023291321	0.618674859	24.86782373	17.48303969	0.604657288	1.753260514	1.130100971	3.014790868	2.340483743	2.4655539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.438
H0545_001_0	2012	6																															D	D	D	P	T	Coin	Coin	V	V	Coin	P	V	V	P	P	P	P	P	P	P	Coin	P	T	Coin	P	P	P	P	O	P																																																			0	YES	1208.810922	36.0700714	892.9014077		794.2084931	8.214420045	4.948342371	326.264468	351.5349068		1568.295062	135.7506802		83.57570087		7067.563827	941.3333156	1101.437221			4.070842325			4.337552172	553.407605	991.8608503			150												3400	(1a) $200/admit	(1b) $75 days 1-6; $0 after day 6	(2) $0 days 1-15; $40 days 16-100	(6) $0/visit	(10a) $55/trip	(11a) 10%	"(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"	(5) $10/visit	(12) $0/visit	"(3) $10/visit (9a) $50/visit, (9c) $10/visit, (9d) 0%"	(7a) $0/visit	"(7b) $10/visit Medicare covered; (7d) $10/visit; (7f) $10/visit; (7g) $10/visit, (17a) $10/ Medicare covered exam, $0/Glaucoma screening; (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"	"(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) $15/ Non-Medicare covered exam	(17b) $15 copay			(14c) $50/annual membership														57.34994706	47.62280982	5.143313515		55	0.1	0.2	49.9589206	50		50.68008966	10		35.56701031		12.39678806	10	10			0.094609138			0.550437684	15	15			50												NO	53.84071705	44.70878109	4.828595349		51.6345627	0.093881023	0.187762046	46.90194579	46.94051155		47.57898668	9.38810231		33.39067316		11.63823147	9.38810231	9.38810231			0.088820027			0.550437684	14.08215346	14.08215346			50													5.4236	0.134387411	0.359288299	0	3.41738402	0.771178158	0.929110889	1.275203199	1.375102363	0	6.218157489	0.10620344	0	0.232554076	0	6.85449531	0.736444456	0.861700444	0	0	0.361572326	0	0	2.387552172	0.649430902	1.163961392	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	33.8823	0		2.012030256	5.4236	0.134387411	0.359288299	0	3.41738402	0.771178158	0.929110889	1.275203199	1.375102363	0	6.218157489	0.10620344	0	0.232554076	0	6.85449531	0.736444456	0.861700444	0	0	0.361572326	0	0	2.387552172	0.649430902	1.163961392	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	33.8823	NO								(4a) $50/visit for Worldwide Coverage																																									0.0008																																	0.0008	0		0	5.4236	0.134387411	0.359288299	0	3.41738402	0.771178158	0.929110889	1.276017785	1.375102363	0	6.218157489	0.10620344	0	0.232554076	0	6.85449531	0.736444456	0.861700444	0	0	0.361572326	0	0	2.387552172	0.649430902	1.163961392	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	33.8831
H0545_011_0	2012	7																															D	D	D	P	T	Coin	Coin	V	V	P	P	V	V	P	P	P	P	P	P	P	Coin	P	T	Coin	P	P	P	P	P	P																																																			0	YES	623.8617229	55.55594535	287.3246154		356.3613195	4.558727167	2.379091618	214.6893443	251.5392181		1097.304458	64.27021223		56.13951444		4239.419698	627.9347658	796.3588025			1.542449381			3.872870432	524.3869411	1362.437096			127.1035491												3400	(1a) $75/day days 1-6; $0/day days 7+	(1b) $912/admit	(2) $0 days 1-15; $40 days 16-100	(6) $0/visit	(10a) $55/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"	(5) $10/visit	(12) $0/visit	"(3) $10/visit, (9a) $50/visit, (9c) $10/visit, (9d) 0%"	(7a) $0/visit	"(7b) $10/visit (7d) $10/visit; (7f) $10/visit; (7g) $10/visit; (17a) $10/ Medicare covered exam, $0/ preventive glaucoma screening; (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"	"(15) 10% (MOOP $1,500/year)"			"(16a) $4/exam, $10/cleaning,$20/fluoride (16b) min of $4/procedure, max of $580/procedure"	(17a) $15/ Non-Medicare covered exam	(17b) $15 copay (max benefit of $125 every other year)			(14c) $50/annual membership														68.67278353	82.84855724	3.623541753		55	0.2	0.2	49.87689486	50		62.16984067	10		33.81249933		10	10	10			0.099629934			0.550437684	15	15			50												NO	66.19471331	79.85895159	3.492785572		53.01531473	0.192782963	0.192782963	48.07707779	48.19574066		59.92643036	9.639148133		32.59236898		9.639148133	9.639148133	9.639148133			0.09603477			0.530575037	14.4587222	14.4587222			48.19574066													3.4414	0.369719962	0.083630273	0	1.574383959	0.878844929	0.458648331	0.860136359	1.01025991	0	5.479794933	0.051625841	0	0.152476647	0	3.405366205	0.504396352	0.639685039	0	0	0.148128771	0	0	2.054848375	0.631830426	1.641591624	0	0	0.510487474	0	0	0	0	0	0	0	0	0	0	0	23.8972	0		0.894618022	3.4414	0.369719962	0.083630273	0	1.574383959	0.878844929	0.458648331	0.860136359	1.01025991	0	5.479794933	0.051625841	0	0.152476647	0	3.405366205	0.504396352	0.639685039	0	0	0.148128771	0	0	2.054848375	0.631830426	1.641591624	0	0	0.510487474	0	0	0	0	0	0	0	0	0	0	0	23.8972	NO								(4a) $50/visit for Worldwide Coverage																																									0.0006																																	0.0006	0		0	3.4414	0.369719962	0.083630273	0	1.574383959	0.878844929	0.458648331	0.860703404	1.01025991	0	5.479794933	0.051625841	0	0.152476647	0	3.405366205	0.504396352	0.639685039	0	0	0.148128771	0	0	2.054848375	0.631830426	1.641591624	0	0	0.510487474	0	0	0	0	0	0	0	0	0	0	0	23.8978
H0545_012_0	2012	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	O	0											0	0	0	0	0	0	0	0	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	1.811594203	0	0	135.1359308	1.905659583	4.446539028	268.610639	0	0	9.057971014	0	0	0	0	0	169.384058	0	0	0	11.99549742	0	0	0	0	0	0	0	150	0											3400	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: $50 per year (gym)	"13b,13c,13d,13e: $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	50	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	50	0												0	0.137681159	0	0	1.126132756	0.190565958	0.889307806	1.119210996	0	0	0.011322464	0	0	0	0	0	0.282306763	0	0	0	2.399099485	0	0	0	0	0	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	6.7806	0	NO	0	0	0.137681159	0	0	1.126132756	0.190565958	0.889307806	1.119210996	0	0	0.011322464	0	0	0	0	0	0.282306763	0	0	0	2.399099485	0	0	0	0	0	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	6.7806	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	NO	0	0	0.137681159	0	0	1.126132756	0.190565958	0.889307806	1.119210996	0	0	0.011322464	0	0	0	0	0	0.282306763	0	0	0	2.399099485	0	0	0	0	0	0	0	0.625	0	0	0	0	0	0	0	0	0	0	0	6.7806
H0545_801_0	2012	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	YES	270.7715075	3.001177574	54.81583199		26.37920365	8.143482205	13.4912884	18.16068554	56.49058657	14.22965653	43.0348868	2.791700746	1.930060005	6.640281907	30.7585985	128.4200108	15.98496053	11.56286159	29.44107722	8.557642572	4.035687468																				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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.064259605	0.064259605	0.147652689		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.053848131	0.053848131	0.123729696		0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058																					14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713	0		19.40668303	14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713	NO																																																																																		0	0		0	14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713
H0545_802_0	2012	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	YES	270.7715075	3.001177574	54.81583199		26.37920365	8.143482205	13.4912884	18.16068554	56.49058657	14.22965653	43.0348868	2.791700746	1.930060005	6.640281907	30.7585985	128.4200108	15.98496053	11.56286159	29.44107722	8.557642572	4.035687468																				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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.064259605	0.064259605	0.147652689		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.053848131	0.053848131	0.123729696		0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058	0.187707058																					14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713	0		19.40668303	14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713	NO																																																																																		0	0		0	14.5805	0.161607803	6.782346215	0	4.951562714	1.528589088	2.532410056	3.408888857	10.60368182	2.671006966	8.077951999	0.524021934	0.362285886	1.246427782	5.773606037	24.10534243	3.000489915	2.170430733	5.526297993	1.606329912	0.757527022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3713
H0562_009_0	2012	7																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	1021.546504	3.974739868	595.1778148	42.94720727	548.968095	14.37147157	3.566255131	483.5389782	450.4928564	0.51676608	4.225298635	0	67.93448776	5.589253895	2896.553349	4670.437695	720.644836	3.867202701	62.95730046	37.16552624	29.42310577	0	0	0	739.4850503	0	107.7531584	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	75	0	175	0.2	0.029424358	39.17538003	180.8107485	0	0.044359538	0	25	0	10	10	25	0	0	12.12968415	0.2	0	0	0	10	0	10	0	0	0											NO	218.7373504	787.4544615	65.62120512	0	153.1161453	0.17498988	0.025744825	34.27647532	158.2002562	0	0.038812352	0	21.87373504	0	8.749494017	8.749494017	21.87373504	0	0	10.61285989	0.17498988	0	0	0	8.749494017	0	8.749494017	0	0	0												18.6209	0.26082722	3.254690456	0	7.00465655	2.51486209	0.091812614	1.381167654	5.939007108	0	0.163993776	0	0.123831749	0	2.111948017	3.405330555	1.313599517	0	0	0.032869377	5.148745758	0	0	0	0.539176669	0	0.078565468	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9859			7.43	18.6209	0.26082722	3.254690456	0	7.00465655	2.51486209	0.091812614	1.381167654	5.939007108	0	0.163993776	0	0.123831749	0	2.111948017	3.405330555	1.313599517	0	0	0.032869377	5.148745758	0	0	0	0.539176669	0	0.078565468	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9859	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	18.6209	0.26082722	3.254690456	0	7.00465655	2.51486209	0.091812614	1.381167654	5.939007108	0	0.163993776	0	0.123831749	0	2.111948017	3.405330555	1.313599517	0	0	0.032869377	5.148745758	0	0	0	0.539176669	0	0.078565468	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9859
H0562_011_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	1110.86911	9.76483403	674.5279397	33.43375712	497.1406974	16.62476276	3.946115414	552.0708124	528.1435559	0.379098244	9.954966768	0	91.14621108	5.846749633	3360.300255	4695.404954	624.7357442	3.360845847	57.61668439	20.003766	42.66481302	0	0	0	603.9314118	0	52.13607424	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/12 Additional visits at $20/visit /17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	75	0	175	0.2	0.021674333	41.66506561	193.8082098	0	0.03314109	0	25	0	10.00260839	19.10366131	25	0	0	21.1433983	0.2	0	0	0	20	0	20	0	0	0											NO	210.2225921	756.8013317	63.06677764	0	147.1558145	0.168178074	0.018225738	35.03575237	162.971457	0	0.027868023	0	21.02225921	0	8.411097055	16.0640848	21.02225921	0	0	17.77927998	0.168178074	0	0	0	16.81780737	0	16.81780737	0	0	0												19.4608	0.615836616	3.545025299	0	6.096428686	2.795920576	0.071920867	1.611851356	7.172693734	0	0.277425244	0	0.15967494	0	2.355317632	6.285615279	1.094446396	0	0	0.029637713	7.175286069	0	0	0	0.846400179	0	0.073067871	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6674			11.29	19.4608	0.615836616	3.545025299	0	6.096428686	2.795920576	0.071920867	1.611851356	7.172693734	0	0.277425244	0	0.15967494	0	2.355317632	6.285615279	1.094446396	0	0	0.029637713	7.175286069	0	0	0	0.846400179	0	0.073067871	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6674	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.4608	0.615836616	3.545025299	0	6.096428686	2.795920576	0.071920867	1.611851356	7.172693734	0	0.277425244	0	0.15967494	0	2.355317632	6.285615279	1.094446396	0	0	0.029637713	7.175286069	0	0	0	0.846400179	0	0.073067871	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6674
H0562_012_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	735.7280084	4.570152087	401.6254881	10.17906257	484.6561029	15.3751584	3.700124862	411.3910143	317.6699525	0.390827181	0.257628779	0	63.91467771	1.897568256	2556.951456	3752.474559	367.561613	5.621851734	39.19351746	16.02098651	43.58473677	0	0	0	450.2549332	0	45.04115248	0	24000	0											3400	1a:  Acute - $150/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/12 Additional visits at $25/visit /17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														150	900	75	0	175	0.2	0.024113948	44.21133096	114.106993	0	0.258632804	0	25	0	10.00383345	15.77548467	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0											NO	139.1441921	834.8651524	69.57209603	0	162.3348907	0.185525589	0.022368772	41.01166618	105.8488357	0	0.239915017	0	23.19069868	0	9.279835489	14.63378046	23.19069868	0	0	23.19069868	0.185525589	0	0	0	23.19069868	0	23.19069868	0	0	0												8.531	0.31795506	2.328493919	0	6.55638296	2.852485324	0.082767248	1.405985912	2.802082884	0	0.061809013	0	0.123518836	0	1.977340739	4.576074074	0.710334218	0	0	0.030961489	8.086083979	0	0	0	0.870143874	0	0.08704465	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4005			3.23	8.531	0.31795506	2.328493919	0	6.55638296	2.852485324	0.082767248	1.405985912	2.802082884	0	0.061809013	0	0.123518836	0	1.977340739	4.576074074	0.710334218	0	0	0.030961489	8.086083979	0	0	0	0.870143874	0	0.08704465	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4005	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	8.531	0.31795506	2.328493919	0	6.55638296	2.852485324	0.082767248	1.405985912	2.802082884	0	0.061809013	0	0.123518836	0	1.977340739	4.576074074	0.710334218	0	0	0.030961489	8.086083979	0	0	0	0.870143874	0	0.08704465	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4005
H0562_017_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	667.3499432	1.53720532	616.4142231	26.12676983	476.9985485	14.22337458	4.724012171	514.6143555	418.5731082	1.928929343	11.18892503	0	84.84324979	4.67740048	3640.1903	5663.819941	408.5181402	13.23286575	44.29590855	36.00845767	49.72480194	0	0	558.9655279	665.3121035	0	111.5660287	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/12 Additional visits at $25/visit /17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a: Preventive $0, 16b: Comprehensive $0 - $2,250; Deductible: $0, Annual Maximum: N/A"	17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	75	0	150	0.2	0.072555874	44.06680041	74.76604988	0	0.045868043	0	25	0	10.00530511	16.86369194	25	0	0	29.58464468	0.2	0	0	25.83250249	30	0	30	0	0	0											NO	91.09201405	837.1538922	68.29052529	0	136.7347243	0.18261543	0.065909729	40.28301527	68.14608173	0	0.042495541	0	22.79380129	0	9.152224737	15.4018307	22.82955417	0	0	26.94632813	0.182287594	0	0	25.83250249	27.3559393	0	27.31929574	0	0	0												5.0659	0.107239785	3.507937591	0	5.435188753	2.597407671	0.311358361	1.727518162	2.37700977	0	0.475479423	0	0.161158348	0	2.776319976	7.269432988	0.777190584	0	0	0.080857976	9.064214497	0	0	1.203289866	1.51668646	0	0.253992111	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7081			4.183390864	5.0659	0.107239785	3.507937591	0	5.435188753	2.597407671	0.311358361	1.727518162	2.37700977	0	0.475479423	0	0.161158348	0	2.776319976	7.269432988	0.777190584	0	0	0.080857976	9.064214497	0	0	1.203289866	1.51668646	0	0.253992111	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7081	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	5.0659	0.107239785	3.507937591	0	5.435188753	2.597407671	0.311358361	1.727518162	2.37700977	0	0.475479423	0	0.161158348	0	2.776319976	7.269432988	0.777190584	0	0	0.080857976	9.064214497	0	0	1.203289866	1.51668646	0	0.253992111	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7081
H0562_036_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	830.390264	4.041442634	662.8515742	21.79790156	569.094214	15.62109184	3.993743878	489.75114	422.8147342	0.576043415	5.183223526	0	72.93989571	8.884558895	3328.34154	5141.090998	463.1995893	9.483493247	45.21777429	37.55000625	56.05122462	0	0	0	683.9904863	0	115.4220362	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	75	0	175	0.2	0.034438498	36.95203824	181.4745852	0	0.070442896	0	25	0	10.00149127	11.19997328	25	0	0	15.90323571	0.2	0	0	0	15	0	15	0	0	0											NO	216.6521578	779.947768	64.99564733	0	151.6565104	0.173321726	0.029844699	32.02295527	157.2674418	0	0.061046422	0	21.66521578	0	8.667378655	9.705993508	21.66521578	0	0	13.78188133	0.173321726	0	0	0	12.99912947	0	12.99912947	0	0	0												14.9922	0.26267618	3.590205596	0	7.192236883	2.707474603	0.119192085	1.306939904	5.541249302	0	0.316417249	0	0.131688215	0	2.403999701	4.158282988	0.836276587	0	0	0.043125811	9.714895008	0	0	0	0.740940074	0	0.125032166	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1828			8.34	14.9922	0.26267618	3.590205596	0	7.192236883	2.707474603	0.119192085	1.306939904	5.541249302	0	0.316417249	0	0.131688215	0	2.403999701	4.158282988	0.836276587	0	0	0.043125811	9.714895008	0	0	0	0.740940074	0	0.125032166	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1828	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.9922	0.26267618	3.590205596	0	7.192236883	2.707474603	0.119192085	1.306939904	5.541249302	0	0.316417249	0	0.131688215	0	2.403999701	4.158282988	0.836276587	0	0	0.043125811	9.714895008	0	0	0	0.740940074	0	0.125032166	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1828
H0562_037_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	459.1203999	7.940742784	474.4097594	16.75816743	412.4200762	14.24840662	3.381817504	368.3004639	393.7027447	0.709130277	1.767195422	0	63.30551137	6.659340474	3286.403494	4924.852432	529.07134	9.91202466	48.58768672	45.37923245	54.92002838	0	0	0	608.4628943	0	140.2474113	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/12 Additional visits at $20/visit /17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	75	0	175	0.2	0.021661826	39.74950738	73.55123124	0	0.05795761	0	25	0	15.00268705	20.26322333	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0											NO	91.97529822	827.7776839	68.98147366	0	160.9567719	0.183950596	0.019923529	36.55972795	67.64896427	0	0.053306685	0	22.99382455	0	13.79876616	18.63716009	22.99382455	0	0	22.99382455	0.183950596	0	0	0	22.99382455	0	22.99382455	0	0	0												3.519	0.547764139	2.727123694	0	5.53181701	2.621002895	0.067377739	1.122080397	2.219465243	0	0.094203329	0	0.121302985	0	3.779026109	7.648771932	1.013781131	0	0	0.086953509	10.10257198	0	0	0	1.16590742	0	0.268735364	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6369			3.72	3.519	0.547764139	2.727123694	0	5.53181701	2.621002895	0.067377739	1.122080397	2.219465243	0	0.094203329	0	0.121302985	0	3.779026109	7.648771932	1.013781131	0	0	0.086953509	10.10257198	0	0	0	1.16590742	0	0.268735364	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6369	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	3.519	0.547764139	2.727123694	0	5.53181701	2.621002895	0.067377739	1.122080397	2.219465243	0	0.094203329	0	0.121302985	0	3.779026109	7.648771932	1.013781131	0	0	0.086953509	10.10257198	0	0	0	1.16590742	0	0.268735364	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6369
H0562_039_0	2012	6																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	469.9969644	1.108576846	55.80565606	2.639681154	479.3442105	20.54568348	8.012862575	371.6430059	291.1450134	4.799629508	31.47581528	0	55.17346507	17.76303241	2993.838282	4535.946327	126.3782767	5.25441966	47.72023852	26.80864177	31.85352593	0	0	0	600.059152	0	87.46029745	0	12000	0											3400	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $175/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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/12 Additional visits at $20/visit /17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														175	900	0	0	175	0.2	0.091467181	37.41886625	132.8567969	0	0.084716955	0	25	0	15.00145445	19.06854683	25	0	0	20.17258799	0.2	0	0	0	20	0	20	0	0	0											NO	161.8873979	832.5637609	0	0	161.8873979	0.185014169	0.084613623	34.61510224	122.9019494	0	0.078369185	0	23.12677114	0	13.87740815	17.63975674	23.12677114	0	0	18.66107303	0.185014169	0	0	0	18.50141691	0	18.50141691	0	0	0												6.3405	0.076913409	0	0	6.466648914	3.801242557	0.677997332	1.072038387	2.981857475	0	2.466734003	0	0.106332008	0	3.462226315	6.667749147	0.243560123	0	0	0.041689835	5.893353633	0	0	0	0.925162045	0	0.134844952	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3589			3.35	6.3405	0.076913409	0	0	6.466648914	3.801242557	0.677997332	1.072038387	2.981857475	0	2.466734003	0	0.106332008	0	3.462226315	6.667749147	0.243560123	0	0	0.041689835	5.893353633	0	0	0	0.925162045	0	0.134844952	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3589	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	6.3405	0.076913409	0	0	6.466648914	3.801242557	0.677997332	1.072038387	2.981857475	0	2.466734003	0	0.106332008	0	3.462226315	6.667749147	0.243560123	0	0	0.041689835	5.893353633	0	0	0	0.925162045	0	0.134844952	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3589
H0562_040_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	326.9591085	3.422379877	240.4666126	2.35138881	391.3270058	26.08686733	8.615010842	787.6287829	538.8716126	9.740858728	39.39736811	0	72.75641715	31.22248666	3442.883164	4812.954654	688.0169728	8.113213828	55.51346944	27.04961856	48.01157751	0	0	0	468.5150061	0	74.37850267	0	12000	0											5000	1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $25/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/12 Additional visits at $25/visit /17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														225	900	75	0	175	0.2	0.071827669	46.03372974	200	0	0.122158579	0	25	0	15.00197499	23.3655229	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0											NO	211.1649573	834.2450411	70.4402431	0	161.8463202	0.183629336	0.065715049	42.27815895	183.7288166	0	0.111576731	0	23.07411793	0	13.8842266	21.62786028	22.93255505	0	0	23.10521771	0.184393741	0	0	0	23.17466025	0	23.1447348	0	0	0												5.7535	0.237925287	1.411543888	0	5.277902991	4.790314126	0.566135859	2.774957907	8.250520305	0	4.395829545	0	0.139899179	0	3.983480832	8.674492567	1.314832259	0	0	0.052082277	8.853034403	0	0	0	0.904806341	0	0.143455893	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5247			4.77398397	5.7535	0.237925287	1.411543888	0	5.277902991	4.790314126	0.566135859	2.774957907	8.250520305	0	4.395829545	0	0.139899179	0	3.983480832	8.674492567	1.314832259	0	0	0.052082277	8.853034403	0	0	0	0.904806341	0	0.143455893	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5247	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	5.7535	0.237925287	1.411543888	0	5.277902991	4.790314126	0.566135859	2.774957907	8.250520305	0	4.395829545	0	0.139899179	0	3.983480832	8.674492567	1.314832259	0	0	0.052082277	8.853034403	0	0	0	0.904806341	0	0.143455893	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5247
H0562_044_0	2012	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	389.927136	2.150652529	337.7202896	5.39688693	296.1211275	9.195054501	2.453241512	258.0690274	179.5862558	1.119216103	4.511960478	0	23.97455625	4.027325242	2303.467221	2995.056451	162.0982193	7.188587343	34.96871071	12.0014766	19.43718658	0	0	1575.51801	291.2241705	246	36.54269073	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $7/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a: Preventive/Diagnostic 100% IN; Deductible: $35, Annual Maximum: $500"	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Every Two Years	18a:  Routine Hearing Test - $10/visit; 1 visit per year		7b: Routine Chiro - $10/service + 13a: Acupuncture - $10/service; 30 visits per year for Routine Chiro & Acupuncture (combined)/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	75	0	125	0.2	0.041349229	38.40265726	71.28578818	0	0.12250683	0	25	0	7.326146589	9.996801664	25	0	0	11.48346658	0.2	0	0	23.82275479	10	0	10	0	0	0											NO	98.44878286	886.1927192	73.82984693	0	123.0537767	0.196903395	0.040716023	37.8098176	70.18838534	0	0.120626961	0	24.62386602	0	7.229769263	9.842464083	24.61871381	0	0	11.30832713	0.19691518	0	0	23.82275479	9.846139509	0	9.847485571	0	0	0												3.199	0.158824384	2.077819774	0	3.036568591	1.810537447	0.099886239	0.813128571	1.050405777	0	0.544264079	0	0.049195522	0	1.38779471	2.456561296	0.332554139	0	0	0.011309719	3.827477102	0	0	3.127764935	0.238952818	0	0.029987802	0	0	0	0	0	0	0	0	0	0	0	0	0	24.252			0.328776384	3.199	0.158824384	2.077819774	0	3.036568591	1.810537447	0.099886239	0.813128571	1.050405777	0	0.544264079	0	0.049195522	0	1.38779471	2.456561296	0.332554139	0	0	0.011309719	3.827477102	0	0	3.127764935	0.238952818	0	0.029987802	0	0	0	0	0	0	0	0	0	0	0	0	0	24.252	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	3.199	0.158824384	2.077819774	0	3.036568591	1.810537447	0.099886239	0.813128571	1.050405777	0	0.544264079	0	0.049195522	0	1.38779471	2.456561296	0.332554139	0	0	0.011309719	3.827477102	0	0	3.127764935	0.238952818	0	0.029987802	0	0	0	0	0	0	0	0	0	0	0	0	0	24.252
H0562_045_0	2012	4																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	854.4357925	7.070892723	66.45757837	24.53779135	521.6104277	13.33889597	3.274022423	431.3611536	343.0660837	0.887663639	6.648600294	0	45.76376666	4.533635137	2748.729198	4173.434971	378.606649	6.835712867	45.01447811	29.91566289	29.85705394	0	0	0	562.2887107	0	91.71837523	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	0	0	125	0.2	0.027548721	37.91729791	184.6291848	0	0.075523878	0	25	0	10	10	25	0	0	11.39002884	0.2	0	0	0	10	0	10	0	0	0											NO	228.0824138	820.2734331	0	0	114.0024062	0.182513052	0.025218279	34.59576191	168.5216237	0	0.06900354	0	22.86230247	0	9.12870682	9.129276641	22.83191369	0	0	10.39458047	0.182664728	0	0	0	9.129088758	0	9.124316803	0	0	0												16.2401	0.483338787	0	0	4.955403653	2.434522614	0.08256521	1.243605647	4.817837788	0	0.458776957	0	0.087188756	0	2.091028582	3.175036866	0.720359528	0	0	0.025913397	5.453830637	0	0	0	0.427765296	0	0.069738959	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7671			4.096271427	16.2401	0.483338787	0	0	4.955403653	2.434522614	0.08256521	1.243605647	4.817837788	0	0.458776957	0	0.087188756	0	2.091028582	3.175036866	0.720359528	0	0	0.025913397	5.453830637	0	0	0	0.427765296	0	0.069738959	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7671	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	16.2401	0.483338787	0	0	4.955403653	2.434522614	0.08256521	1.243605647	4.817837788	0	0.458776957	0	0.087188756	0	2.091028582	3.175036866	0.720359528	0	0	0.025913397	5.453830637	0	0	0	0.427765296	0	0.069738959	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7671
H0562_053_0	2012	6																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	572.4830282	3.289707552	74.80996505	26.37418017	476.019589	12.45332684	3.16365793	531.7042033	397.9504471	0.946627717	13.86602733	0	164.3147256	7.963059237	3262.666872	4668.910849	591.1353268	7.714807564	47.54815576	38.53238844	32.50032624	0	0	0	595.2349658	0	115.5761476	0	12000	0											3400	1a:  Acute - $150/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/12 Additional visits at $20/visit /17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														150	900	0	0	175	0.2	0.033381182	41.26021982	109.2681149	0	0.081392608	0	25	0	10.00264776	19.09058553	25	0	0	20.56166057	0.2	0	0	0	20	0	20	0	0	0											NO	139.4067661	834.4318829	0	0	162.6593431	0.185754457	0.030916466	38.38647959	101.5832652	0	0.075883871	0	23.31690679	0	9.302797274	17.75294144	23.26990166	0	0	19.14388744	0.185856552	0	0	0	18.59460238	0	18.62175083	0	0	0												6.6507	0.228753072	0	0	6.45241947	2.313260963	0.097809123	1.700854379	3.368758817	0	1.052207831	0	0.319275928	0	2.529327373	6.907241742	1.146305077	0	0	0.061471642	6.040398589	0	0	0	0.922346459	0	0.179352519	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9705			3.02285072	6.6507	0.228753072	0	0	6.45241947	2.313260963	0.097809123	1.700854379	3.368758817	0	1.052207831	0	0.319275928	0	2.529327373	6.907241742	1.146305077	0	0	0.061471642	6.040398589	0	0	0	0.922346459	0	0.179352519	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9705	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	6.6507	0.228753072	0	0	6.45241947	2.313260963	0.097809123	1.700854379	3.368758817	0	1.052207831	0	0.319275928	0	2.529327373	6.907241742	1.146305077	0	0	0.061471642	6.040398589	0	0	0	0.922346459	0	0.179352519	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9705
H0562_055_0	2012	4																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	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	386.0856618	11.73218087	420.9290412	8.222352887	570.1110504	14.21737223	5.425900712	400.3793408	35.97702435	2.438673318	12.33809859	0	90.25038449	8.683469314	0	0	913.2889258	14.1541756	58.80648399	6.687305108	39.53927577	0.329880287	1600	609.6199949	0	246	0	0	12000	0											3400	1a:  Acute - 0/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$50/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $0/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/12 Additional visits at $0/visit /17a:  Vision Exams - $0/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	"16a: Preventive $0, 16b: Restorations $0; Deductible: $0, Annual Maximum: N/A"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Every Two Years	18a:  Routine Hearing Test - $0/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0	900	50	0	50	0.15	0.06906475	20	0	0	0	0	25	0	0	0	10	0	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	0	892.0804458	49.56002477	0	49.56002477	0.148680074	0.068457014	19.82400991	0	0	0	0	24.78001238	0	0	0	9.912004954	0	0	9.912004954	0.198240099	0	0	0	0	0	0	0	0	0												0	0.872170762	1.738437809	0	2.354559815	2.11383996	0.371440961	0.661427001	0	0	0	0	0.186367137	0	0	0	0.75437703	0	0	0.005523717	7.838269946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8964			0.15	0	0.872170762	1.738437809	0	2.354559815	2.11383996	0.371440961	0.661427001	0	0	0	0	0.186367137	0	0	0	0.75437703	0	0	0.005523717	7.838269946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8964	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0.872170762	1.738437809	0	2.354559815	2.11383996	0.371440961	0.661427001	0	0	0	0	0.186367137	0	0	0	0.75437703	0	0	0.005523717	7.838269946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8964
H0562_068_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	1152.099902	5.385987864	668.8113268	22.37951582	527.8221474	14.55062696	4.138501701	505.784816	412.3970666	0.793345799	8.932348876	0	82.03930615	7.576300297	3517.257326	4834.36326	482.4731153	7.853584214	44.47721657	29.62407287	38.71477866	0	0	0	535.7295655	0	88.16322077	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/12 Additional visits at $20/visit /17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	75	0	175	0.2	0.051178132	40.49516805	179.7789099	0	0.028885162	0	25	0	10.00221057	19.10144137	25	0	0	20.59626772	0.2	0	0	0	20	0	20	0	0	0											NO	212.2719185	764.1789066	63.68157555	0	148.590343	0.169817535	0.043454721	34.38394805	152.6480565	0	0.024526035	0	21.22719185	0	8.492753709	16.21879843	21.22719185	0	0	17.48803706	0.169817535	0	0	0	16.98175348	0	16.98175348	0	0	0												20.3799	0.342988193	3.549246587	0	6.535772825	2.4709516	0.179837437	1.449239903	5.245967559	0	0.219075104	0	0.145122008	0	2.489266684	6.533963603	0.853462448	0	0	0.04317224	6.574448273	0	0	0	0.758135618	0	0.12476384	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8953			10.29	20.3799	0.342988193	3.549246587	0	6.535772825	2.4709516	0.179837437	1.449239903	5.245967559	0	0.219075104	0	0.145122008	0	2.489266684	6.533963603	0.853462448	0	0	0.04317224	6.574448273	0	0	0	0.758135618	0	0.12476384	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8953	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	20.3799	0.342988193	3.549246587	0	6.535772825	2.4709516	0.179837437	1.449239903	5.245967559	0	0.219075104	0	0.145122008	0	2.489266684	6.533963603	0.853462448	0	0	0.04317224	6.574448273	0	0	0	0.758135618	0	0.12476384	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8953
H0562_070_0	2012	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	347.2436413	19.16990026	64.71350955	10.14892905	14.82708453	17.06607014	4.796462977	52.5535646	42.65089453	2.040776652	7.874784979	0	7.669425431	8.208150772	117.0534954	242.426999	11.50928348	8.811053496	61.92304841	56.03297164	38.46560564	0.251682696	1820	431.9906426	0	246	0	0	12000	0											3400	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	"Medicare FFS + 4a:  Worldwide Coverage - $0/visit ($50,000 Max)"	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	"Medicare FFS + 7f:  Routine Podiatry $0, 12 visits per year"	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	10b:  Transportation - $0/trip	"16a: Preventive $0, 16b: Comprehensive $0 - $2,250; Deductible: $0, Annual Maximum: N/A"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $100 Allowance Every Two Years			14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.062935695	0.062935695	0.145493261	0	0.224	0.224	0.224	0.219062752	0.224	0.224	0.224	0	0.224	0.224	0.199675476	0.220030283	0.224	0.224	0.224	0.224	0.224	0.224	0	25.83250249	0	0	0	0	0	0											NO	0.048011052	0.048011052	0.110990821	0	0.17088038	0.17088038	0.17088038	0.167113957	0.17088038	0.17088038	0.17088038	0	0.17088038	0.17088038	0.152324202	0.167852047	0.17088038	0.17088038	0.17088038	0.17088038	0.17088038	0.17088038	0	25.83250249	0	0	0	0	0	0												16.6715	0.920367072	7.182605525	0	2.533657844	2.916256555	0.819621417	8.782434124	7.288201076	0.34872869	1.345646252	0	1.310554334	1.402611925	17.83008029	40.69186792	1.966710738	1.505636172	10.58143406	9.574935503	6.573017319	0.043007635	0	0.929949946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.2189			43.61	16.6715	0.920367072	7.182605525	0	2.533657844	2.916256555	0.819621417	8.782434124	7.288201076	0.34872869	1.345646252	0	1.310554334	1.402611925	17.83008029	40.69186792	1.966710738	1.505636172	10.58143406	9.574935503	6.573017319	0.043007635	0	0.929949946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.2189	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	16.6715	0.920367072	7.182605525	0	2.533657844	2.916256555	0.819621417	8.782434124	7.288201076	0.34872869	1.345646252	0	1.310554334	1.402611925	17.83008029	40.69186792	1.966710738	1.505636172	10.58143406	9.574935503	6.573017319	0.043007635	0	0.929949946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.2189
H0562_079_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	588.2841245	1.801202068	339.9595684	1.940008241	229.8838045	10.73196834	3.317358034	377.4910141	246.4432454	3.740250855	13.69805018	0	44.14315343	11.52514502	3395.361518	4812.884967	201.2830158	8.901988095	47.14692599	10.31434409	34.08588545	0	0	0	358.1084501	0	29.87231289	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	75	0	175	0.2	0.063064762	34.08950325	69.34302984	0	0.124159697	0	25	0	5.000765352	9.997772661	25	0	0	12.1433827	0.2	0	0	0	10	0	10	0	0	0											NO	96.61742288	869.556806	72.46306716	0	169.08049	0.193234846	0.060931548	32.93639952	66.99744839	0	0.1199599	0	24.15435572	0	4.831610608	9.659590291	24.15435572	0	0	11.73262342	0.193234846	0	0	0	9.661742288	0	9.661742288	0	0	0												4.7365	0.130520626	2.052876086	0	3.239072193	2.073790248	0.202131761	1.036099571	1.375922384	0	1.643216725	0	0.088854119	0	1.367088727	3.874208075	0.40515513	0	0	0.010084526	6.586580817	0	0	0	0.288329296	0	0.024051549	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1345			1.02	4.7365	0.130520626	2.052876086	0	3.239072193	2.073790248	0.202131761	1.036099571	1.375922384	0	1.643216725	0	0.088854119	0	1.367088727	3.874208075	0.40515513	0	0	0.010084526	6.586580817	0	0	0	0.288329296	0	0.024051549	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1345	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	4.7365	0.130520626	2.052876086	0	3.239072193	2.073790248	0.202131761	1.036099571	1.375922384	0	1.643216725	0	0.088854119	0	1.367088727	3.874208075	0.40515513	0	0	0.010084526	6.586580817	0	0	0	0.288329296	0	0.024051549	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1345
H0562_081_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1538.122733	20.64496	636.9115055	16.3414928	1102.964176	28.09327374	7.070552045	1003.209135	334.8415015	1.907724793	6.609162213	0	9.308338262	161.3102611	4343.365224	4755.662347	1187.022116	579.0426419	85.5326688	8.691640547	40.61964887	0	500	431.9906426	519.0089975	0	0	0	12000	0											3400	1a:  Acute - $50/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$20/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/day	11a:  Durable Medical Equipment - 10.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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	3:  Cardiac Rehabilitation Services - $10/visit/3:  Pulmonary Rehabilitation - $10/visit/5:  Partial Hospitalization - $5/day/7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $0/visit/12 Additional visits at $0/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	"16a: Preventive $0, 16b: Comprehensive $0 - $2,250; Deductible: $0, Annual Maximum: N/A"	17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $0/visit; 1 visit per year		7b: Routine Chiro - $10/service + 13a: Acupuncture - $10/service; 30 visits per year for Routine Chiro & Acupuncture (combined)/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														50	900	20	0	150	0.1	0.021330219	46.42627122	25	0	0.036854268	0	0	9.98108484	10	10	25	10	0	25	0.1	0	0	25.83250249	10	0	0	0	0	0											NO	47.27090471	848.8875497	18.8885203	0	141.8651318	0.094500248	0.02011353	43.83800515	23.6292107	0	0.03473907	0	0	9.420873803	9.484965225	9.453806137	23.59252421	9.450630693	0	23.59252421	0.094507299	0	0	25.83250249	9.455657383	0	0	0	0	0												6.059	1.460437459	1.002526325	0	13.03934652	2.654821328	0.142213762	3.664890604	0.659336699	0	0.229596151	0	0	0.126640301	3.433055676	3.74659249	2.333737334	0.456026514	0	0.017088145	3.838853302	0	0	0.929949946	0.408964272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2031			2.499973335	6.059	1.460437459	1.002526325	0	13.03934652	2.654821328	0.142213762	3.664890604	0.659336699	0	0.229596151	0	0	0.126640301	3.433055676	3.74659249	2.333737334	0.456026514	0	0.017088145	3.838853302	0	0	0.929949946	0.408964272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2031	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	6.059	1.460437459	1.002526325	0	13.03934652	2.654821328	0.142213762	3.664890604	0.659336699	0	0.229596151	0	0	0.126640301	3.433055676	3.74659249	2.333737334	0.456026514	0	0.017088145	3.838853302	0	0	0.929949946	0.408964272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2031
H0562_082_0	2012	6																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	coin	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	259.6606553	3.59593678	367.4839693	5.854826086	332.3109919	11.45305168	3.298347946	370.1057474	33.21821692	1.920504557	7.700882748	0	37.24349369	7.951129499	0.603844155	750.5311696	273.7907382	10.19079997	44.02767007	20.98836002	29.06708656	0	0	0	416.0657183	0	64.14612463	0	24000	0											3400	1a:  Acute - 0/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $0/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/12 Additional visits at $0/visit /17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0	900	75	0	175	0.2	0.053021796	37.91997573	0	0	0.119523711	0	25	0	30	30	25	0	0	29.52241223	0.2	0	0	0	30	0	30	0	0	0											NO	0	886.6416483	73.88680403	0	172.4025427	0.197031477	0.052234814	37.35714421	0	0	0.117749666	0	24.62893468	0	29.55472161	29.55472161	24.62893468	0	0	29.08422249	0.197031477	0	0	0	29.55472161	0	29.55472161	0	0	0												0	0.265692276	2.262684669	0	4.774271666	2.256611694	0.172288592	1.152174482	0	0	0.906776374	0	0.076438964	0	0.001487204	1.848478315	0.561931184	0	0	0.050869178	5.727131009	0	0	0	1.02472554	0	0.157985071	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2395			0.32	0	0.265692276	2.262684669	0	4.774271666	2.256611694	0.172288592	1.152174482	0	0	0.906776374	0	0.076438964	0	0.001487204	1.848478315	0.561931184	0	0	0.050869178	5.727131009	0	0	0	1.02472554	0	0.157985071	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2395	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0.265692276	2.262684669	0	4.774271666	2.256611694	0.172288592	1.152174482	0	0	0.906776374	0	0.076438964	0	0.001487204	1.848478315	0.561931184	0	0	0.050869178	5.727131009	0	0	0	1.02472554	0	0.157985071	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2395
H0562_083_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	576.3452799	4.36543565	474.0802235	5.24936265	339.4552124	11.13587922	3.267160895	340.237683	220.5266474	2.458915872	10.03702705	0	103.4850081	8.929511316	3031.629198	4474.0218	345.4648674	8.983531257	46.10351501	20.65171905	30.43650358	0	0	0	446.2156824	0	61.23524445	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $8/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	75	0	175	0.2	0.05572796	38.07335768	73.89202378	0	0.117345626	0	25	0	8.00042723	9.99840759	25	0	0	11.83730766	0.2	0	0	0	10	0	10	0	0	0											NO	96.06603678	864.594331	72.04952759	0	168.1155644	0.192132074	0.053535643	36.5755658	70.98513874	0	0.112729292	0	24.0165092	0	7.685693365	9.605073913	24.0165092	0	0	11.37163233	0.192132074	0	0	0	9.606603678	0	9.606603678	0	0	0												4.6139	0.314527576	2.846438012	0	4.755642051	2.139559565	0.174909558	1.037032147	1.304509555	0	1.131466958	0	0.207112387	0	1.941681035	3.581109173	0.691405014	0	0	0.019570313	5.847828544	0	0	0	0.357218101	0	0.049021894	0	0	0	0	0	0	0	0	0	0	0	0	0	31.013			1.27	4.6139	0.314527576	2.846438012	0	4.755642051	2.139559565	0.174909558	1.037032147	1.304509555	0	1.131466958	0	0.207112387	0	1.941681035	3.581109173	0.691405014	0	0	0.019570313	5.847828544	0	0	0	0.357218101	0	0.049021894	0	0	0	0	0	0	0	0	0	0	0	0	0	31.013	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	4.6139	0.314527576	2.846438012	0	4.755642051	2.139559565	0.174909558	1.037032147	1.304509555	0	1.131466958	0	0.207112387	0	1.941681035	3.581109173	0.691405014	0	0	0.019570313	5.847828544	0	0	0	0.357218101	0	0.049021894	0	0	0	0	0	0	0	0	0	0	0	0	0	31.013
H0562_084_0	2012	6																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	641.1803249	5.694546694	68.83436691	7.854355989	514.0688611	14.82953654	4.275560723	412.1360303	307.7353345	2.506278524	15.07846166	0	78.12905676	9.852309166	3324.813296	5195.684468	367.0811805	9.395967214	64.37842035	30.79602906	35.60513134	0	0	0	771.3584642	0	94.97832015	0	12000	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $15/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $15/visit/12 Additional visits at $15/visit /17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														100	900	0	0	175	0.2	0.053187619	35.30713308	78.05390201	0	0.091441798	0	25	0	10.00168353	14.56127591	25	0	0	15.87279117	0.2	0	0	0	15	0	15	0	0	0											NO	94.04602648	846.4142383	0	0	164.5805463	0.188092053	0.050020842	33.20495572	73.40659336	0	0.085997378	0	23.51150662	0	9.406185945	13.6943014	23.51150662	0	0	14.92772939	0.188092053	0	0	0	14.10690397	0	14.10690397	0	0	0												5.025	0.401662117	0	0	7.050477835	2.789317973	0.213867148	1.14041322	1.882483547	0	1.29670816	0	0.153077653	0	2.606151008	5.929272423	0.7192193	0	0	0.038309566	6.697042249	0	0	0	0.906789982	0	0.11165417	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9615			2.34	5.025	0.401662117	0	0	7.050477835	2.789317973	0.213867148	1.14041322	1.882483547	0	1.29670816	0	0.153077653	0	2.606151008	5.929272423	0.7192193	0	0	0.038309566	6.697042249	0	0	0	0.906789982	0	0.11165417	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9615	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	5.025	0.401662117	0	0	7.050477835	2.789317973	0.213867148	1.14041322	1.882483547	0	1.29670816	0	0.153077653	0	2.606151008	5.929272423	0.7192193	0	0	0.038309566	6.697042249	0	0	0	0.906789982	0	0.11165417	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9615
H0562_085_0	2012	6																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	coin	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	228.4471931	3.435876708	279.949791	8.101204262	339.5893939	11.18404205	3.019320171	392.7929213	39.53582544	1.69272345	6.06651355	0	42.46491051	7.159034106	0.551951978	686.0332428	245.5887481	8.400787314	42.14596468	21.98190448	28.64646625	0	920	558.9655279	380.3105394	0	68.20111259	0	24000	0											3400	1a:  Acute - 0/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $0/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/12 Additional visits at $0/visit /17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	"16a: Preventive $0, 16b: Comprehensive $0 - $2,250; Deductible: $0, Annual Maximum: N/A"	17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0	900	75	0	175	0.2	0.0432102	39.15936707	0	0	0.12040215	0	25	0	25	25	25	0	0	25	0.2	0	0	25.83250249	25	0	25	0	0	0											NO	0	888.6459108	74.03163681	0	172.8090866	0.197486717	0.042653886	38.67486894	0	0	0.118855323	0	24.67940362	0	24.68442624	24.68442624	24.68124165	0	0	24.68913932	0.197480068	0	0	25.83250249	24.68442624	0	24.68984296	0	0	0												0	0.254439816	1.727095104	0	4.890344416	2.208699752	0.128785739	1.265934562	0	0	0.721037427	0	0.087334056	0	0.001135385	1.411194749	0.505119603	0	0	0.045226192	5.657106098	0	0	1.203289866	0.782312288	0	0.140322897	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0294			0.253108587	0	0.254439816	1.727095104	0	4.890344416	2.208699752	0.128785739	1.265934562	0	0	0.721037427	0	0.087334056	0	0.001135385	1.411194749	0.505119603	0	0	0.045226192	5.657106098	0	0	1.203289866	0.782312288	0	0.140322897	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0294	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0.254439816	1.727095104	0	4.890344416	2.208699752	0.128785739	1.265934562	0	0	0.721037427	0	0.087334056	0	0.001135385	1.411194749	0.505119603	0	0	0.045226192	5.657106098	0	0	1.203289866	0.782312288	0	0.140322897	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0294
H0562_086_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	721.3846763	3.443260319	456.5318061	11.82903603	414.6950586	14.65293846	3.787725438	397.5606568	397.3432816	1.85530814	7.849230672	0	137.6909811	7.166224617	2954.039651	4107.515435	315.8519403	16.39585164	65.03152295	22.7388826	33.36727166	0	0	0	357.9994506	0	69.02051121	0	12000	0											3400	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $25/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/12 Additional visits at $25/visit /17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														275	900	75	0	175	0.2	0.036252598	43.60829076	246.413704	0	0.104122466	0	25	0	15.00175885	23.31079305	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0											NO	240.6265731	791.1387797	65.64256491	0	153.1576899	0.175037536	0.031948379	38.1961849	215.0465936	0	0.091637032	0	21.72975888	0	13.17592591	20.48711857	21.9540786	0	0	21.93661541	0.175230563	0	0	0	22.04572953	0	21.93463815	0	0	0												14.4654	0.227008064	2.49732656	0	5.292811434	2.564814247	0.121011688	1.265441696	7.120609934	0	0.719280203	0	0.249332652	0	3.243517298	7.012596311	0.577853194	0	0	0.041567844	5.846965808	0	0	0	0.657696588	0	0.126161662	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0294			7.378181798	14.4654	0.227008064	2.49732656	0	5.292811434	2.564814247	0.121011688	1.265441696	7.120609934	0	0.719280203	0	0.249332652	0	3.243517298	7.012596311	0.577853194	0	0	0.041567844	5.846965808	0	0	0	0.657696588	0	0.126161662	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0294	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.4654	0.227008064	2.49732656	0	5.292811434	2.564814247	0.121011688	1.265441696	7.120609934	0	0.719280203	0	0.249332652	0	3.243517298	7.012596311	0.577853194	0	0	0.041567844	5.846965808	0	0	0	0.657696588	0	0.126161662	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0294
H0562_087_0	2012	6																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	762.9999558	4.677767869	73.32826412	20.37262254	521.147908	15.23322474	4.100471455	510.6192782	412.3616758	1.156731124	5.957315478	0	87.48771453	7.773374364	3237.441488	5079.146677	569.220584	7.670383315	78.82904888	33.3213059	37.64742122	0	0	0	663.0382965	0	98.50996882	0	12000	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $30/visit/12 Additional visits at $30/visit /17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $20/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														250	900	0	0	175	0.2	0.042751599	43.41681558	185.540431	0	0.079027945	0	25	0	25.00148617	28.11718736	25	0	0	20.62541967	0.2	0	0	0	30	0	20	0	0	0											NO	213.9873568	770.3544845	0	0	149.7911498	0.171189885	0.036593206	37.16259843	158.8132257	0	0.067643924	0	21.39873568	0	21.40000777	24.06689041	21.39873568	0	0	17.65431615	0.171189885	0	0	0	25.67848282	0	17.11898854	0	0	0												13.606	0.300294955	0	0	6.505278695	2.607773998	0.150049398	1.581328265	5.45737399	0	0.402976198	0	0.15601054	0	5.773439417	10.18660554	1.015050068	0	0	0.049022072	6.444857726	0	0	0	1.418818125	0	0.140532586	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7954			9.39	13.606	0.300294955	0	0	6.505278695	2.607773998	0.150049398	1.581328265	5.45737399	0	0.402976198	0	0.15601054	0	5.773439417	10.18660554	1.015050068	0	0	0.049022072	6.444857726	0	0	0	1.418818125	0	0.140532586	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7954	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	13.606	0.300294955	0	0	6.505278695	2.607773998	0.150049398	1.581328265	5.45737399	0	0.402976198	0	0.15601054	0	5.773439417	10.18660554	1.015050068	0	0	0.049022072	6.444857726	0	0	0	1.418818125	0	0.140532586	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7954
H0562_088_0	2012	6																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	863.7267268	4.938351058	83.17669432	17.23480376	532.8168944	20.9912124	5.426794787	400.0680772	335.2532917	1.435882921	4.344356157	0	89.39472781	4.062532219	3362.948367	5202.8704	581.6281684	7.184064476	65.41235903	32.70893093	33.56493036	0	0	0	666.8018267	0	96.13374832	0	12000	0											3400	1a:  Acute - $125/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $125/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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/12 Additional visits at $10/visit /17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														125	900	0	0	175	0.2	0.036272245	34.62255183	99.24948676	0	0.080881667	0	25	0	5.00143883	9.993520342	25	0	0	11.95304967	0.2	0	0	0	10	0	10	0	0	0											NO	117.2195034	843.9804242	0	0	164.1073047	0.187551205	0.034014516	32.46750664	93.07180437	0	0.075847271	0	23.44390067	0	4.690129406	9.37148393	23.44390067	0	0	11.20904436	0.187551205	0	0	0	9.377560269	0	9.377560269	0	0	0												8.4371	0.347322635	0	0	7.28659537	3.936927188	0.1845898	1.082434413	2.600219065	0	0.329507557	0	0.17464676	0	1.314388586	4.063218028	1.136302751	0	0	0.030552988	6.295143147	0	0	0	0.521081193	0	0.075125002	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8152			2.51	8.4371	0.347322635	0	0	7.28659537	3.936927188	0.1845898	1.082434413	2.600219065	0	0.329507557	0	0.17464676	0	1.314388586	4.063218028	1.136302751	0	0	0.030552988	6.295143147	0	0	0	0.521081193	0	0.075125002	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8152	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	8.4371	0.347322635	0	0	7.28659537	3.936927188	0.1845898	1.082434413	2.600219065	0	0.329507557	0	0.17464676	0	1.314388586	4.063218028	1.136302751	0	0	0.030552988	6.295143147	0	0	0	0.521081193	0	0.075125002	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8152
H0562_089_0	2012	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	509.3978188	7.874276036	470.4387866	16.75816743	408.9679783	14.24840662	3.375711359	354.6216936	385.5066334	0.697308632	1.73773517	0	60.7413034	6.548325106	3052.639842	4624.944741	507.641153	9.125308277	44.27629829	43.23943606	54.00947286	0	0	0	579.394074	0	133.5472052	0	12000	0											3400	1a:  Acute - $200/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/admit	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $60/visit/8b:  Outpatient Therapeutic Radiological Services - $60/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit (including 16b Medicare Covered Dental @ $0)/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $30/visit/12 Additional visits at $30/visit /17a:  Vision Exams - $30/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit; 1 visit per year		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														200	900	75	0	175	0.2	0.02133924	43.55974371	146.971123	0	0.05844683	0	25	0	20.00275462	28.26092029	25	0	0	29.5701769	0.2	0	0	0	30	0	30	0	0	0											NO	177.7396548	799.8284467	66.65237056	0	155.522198	0.177739655	0.018964145	38.71146906	130.6129834	0	0.051941597	0	22.21745685	0	17.77641351	25.11543109	22.21745685	0	0	26.27896518	0.177739655	0	0	0	26.66094822	0	26.66094822	0	0	0												7.545	0.524839164	2.612988361	0	5.300299908	2.532506874	0.064017481	1.143993893	4.196014291	0	0.09026074	0	0.112459774	0	4.522082343	9.679790076	0.939874618	0	0	0.094690636	9.599625064	0	0	0	1.287266284	0	0.296707927	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5424			6.33	7.545	0.524839164	2.612988361	0	5.300299908	2.532506874	0.064017481	1.143993893	4.196014291	0	0.09026074	0	0.112459774	0	4.522082343	9.679790076	0.939874618	0	0	0.094690636	9.599625064	0	0	0	1.287266284	0	0.296707927	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5424	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	7.545	0.524839164	2.612988361	0	5.300299908	2.532506874	0.064017481	1.143993893	4.196014291	0	0.09026074	0	0.112459774	0	4.522082343	9.679790076	0.939874618	0	0	0.094690636	9.599625064	0	0	0	1.287266284	0	0.296707927	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5424
H0562_801_0	2012	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	251.2280996	2.488677475	44.28455076	10.98971993	6.926555838	13.81540763	3.330955008	28.51775764	50.61264809	2.679567985	13.26867256	0	2.687644155	11.26789339	67.7513631	156.6770446	4.130986295	9.376638464	46.19449022	34.20290883	42.08352741	0.424725969	0	0	0	0	0	0	12000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.060785314	0.060785314	0.133266947	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.054654663	0.054654663	0.119825984	0	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0.201407933	0	0	0	0	0	0	0	0												13.7308	0.136017829	5.306439854	0	1.395063297	2.782532699	0.670880764	5.743702631	10.19378885	0.53968625	2.67241592	0	0.541312855	2.269443121	13.64566202	31.55599975	0.832013413	1.888529375	9.303936807	6.888737182	8.475956284	0.08554318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6584			13.31	13.7308	0.136017829	5.306439854	0	1.395063297	2.782532699	0.670880764	5.743702631	10.19378885	0.53968625	2.67241592	0	0.541312855	2.269443121	13.64566202	31.55599975	0.832013413	1.888529375	9.303936807	6.888737182	8.475956284	0.08554318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6584	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	13.7308	0.136017829	5.306439854	0	1.395063297	2.782532699	0.670880764	5.743702631	10.19378885	0.53968625	2.67241592	0	0.541312855	2.269443121	13.64566202	31.55599975	0.832013413	1.888529375	9.303936807	6.888737182	8.475956284	0.08554318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6584
H0562_803_0	2012	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	251.6198968	1.901568669	77.42122327	9.044864499	7.295576415	12.06654258	3.685611343	30.44315917	45.62452244	2.542917934	9.669186839	0	7.326628079	10.42691732	80.95368176	194.4147422	2.432905175	12.5760742	53.23509654	38.99758569	41.71859685	0.453400713	0	0	0	0	0	0	12000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.061692715	0.061692715	0.139759321	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05435235	0.05435235	0.123130382	0	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0.19734788	0	0	0	0	0	0	0	0												13.6761	0.103354727	9.532904801	0	1.439766536	2.381306592	0.727347583	6.00789291	9.00390276	0.501839462	1.90819352	0	1.445894516	2.057730023	15.97603744	38.36733714	0.480128678	2.481861577	10.50583342	7.696090845	8.233076628	0.089477669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.6161			17.91	13.6761	0.103354727	9.532904801	0	1.439766536	2.381306592	0.727347583	6.00789291	9.00390276	0.501839462	1.90819352	0	1.445894516	2.057730023	15.97603744	38.36733714	0.480128678	2.481861577	10.50583342	7.696090845	8.233076628	0.089477669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.6161	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	13.6761	0.103354727	9.532904801	0	1.439766536	2.381306592	0.727347583	6.00789291	9.00390276	0.501839462	1.90819352	0	1.445894516	2.057730023	15.97603744	38.36733714	0.480128678	2.481861577	10.50583342	7.696090845	8.233076628	0.089477669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.6161
H0562_804_0	2012	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	276.7407243	1.988420336	54.65528995	14.10797728	7.55758686	15.85149478	4.036507835	31.89208409	43.25615169	2.140652556	12.71419531	0	2.546697818	9.000259155	73.82469674	170.4618816	3.188525756	11.61093671	49.16812316	33.19812139	42.433478	0.324271313	0	0	0	0	0	0	12000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.062451284	0.062451284	0.131288339	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05565749	0.05565749	0.117006072	0	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0.199632049	0	0	0	0	0	0	0	0												15.4027	0.110670486	6.395000818	0	1.508736554	3.164466391	0.805816332	6.36668211	8.635314215	0.427342857	2.538160867	0	0.508402505	1.796740181	14.73777551	34.02965478	0.636531932	2.317915092	9.815533195	6.627409013	8.471082179	0.064734947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3607			15.18	15.4027	0.110670486	6.395000818	0	1.508736554	3.164466391	0.805816332	6.36668211	8.635314215	0.427342857	2.538160867	0	0.508402505	1.796740181	14.73777551	34.02965478	0.636531932	2.317915092	9.815533195	6.627409013	8.471082179	0.064734947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3607	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	15.4027	0.110670486	6.395000818	0	1.508736554	3.164466391	0.805816332	6.36668211	8.635314215	0.427342857	2.538160867	0	0.508402505	1.796740181	14.73777551	34.02965478	0.636531932	2.317915092	9.815533195	6.627409013	8.471082179	0.064734947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3607
H0564_006_0	2012	10	H.6										OP Facility - Other										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	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	YES	1371.623869	106.0080917	246.6759275	454.7765585	180.3753871	8.559018149	6.523668142	309.7928877	399.6060611	25770.03154	539.3748112	16.52619271	0	488.1850356	4647.15424	4596.425838	16.6177073	1933.630689	1403.875687	2037.109946	51.59676435	32.50795943	0	0	0	0	0	0	5872.8	297.3334221	21.81720848	0	0	0	0	0	0	0	0	0	3400	1A: $150/day (days1-7) $1500 yrly max	1B: $150/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $30 copay	9A: $0 - $125 copay; 9B: $0-$100 copay	8A: $0-$150 copay	8B: $40-$150 copay	5: $30 copay	12: 20% coin	3: $30 copay; 9A: $30-$125 copay; 9C: $40 copay	7A: $5 copay; 7G: $5 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $40-$150 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: $30 copay; 13A: Not covered	8B: 20% coinsurance										0	NO	83.74579529	74.76683938	146	0	200	0.2	0.144481021	49.88467467	91.2577607	5.589404511	73.38695177	30	0.2	53.16367707	5	28.75898159	40	50	69.29917634	0.653685037	0.2	0	0	0	0	0	0	0	0	24.65958153	0.2	0	0	0	0	0	0	0	0	0	NO	75.48971834	67.39595255	131.606594	0	180.2830054	0.180283005	0.130237363	44.96679538	82.26111684	5.03837322	66.15210113	27.04245082	0	47.92253741	4.507075136	25.92377817	36.05660109	45.07075136	62.46731893	0.589241516	0.180283005	0	0	0	0	0	0	0	0	24.65958153	0.180283005	0	0	0	0	0	0	0	0	0		8.6286	0.59537636	2.705348219	0	2.709884741	1.543045516	0.849625339	1.160866116	2.73933674	10.81991973	2.973398088	0.037242396	0	1.949588803	1.745422777	9.929726983	0.049931504	7.262515667	7.308029189	0.100029146	9.302019749	0	0	0	0	0	0	0	0	0.611009814	3.933271915	0	0	0	0	0	0	0	0	0	76.9542		NO	8.349420028	8.6286	0.59537636	2.705348219	0	2.709884741	1.543045516	0.849625339	1.160866116	2.73933674	10.81991973	2.973398088	0.037242396	0	1.949588803	1.745422777	9.929726983	0.049931504	7.262515667	7.308029189	0.100029146	9.302019749	0	0	0	0	0	0	0	0	0.611009814	3.933271915	0	0	0	0	0	0	0	0	0	76.9542	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	8.6286	0.59537636	2.705348219	0	2.709884741	1.543045516	0.849625339	1.160866116	2.73933674	10.81991973	2.973398088	0.037242396	0	1.949588803	1.745422777	9.929726983	0.049931504	7.262515667	7.308029189	0.100029146	9.302019749	0	0	0	0	0	0	0	0	0.611009814	3.933271915	0	0	0	0	0	0	0	0	0	76.9542
H0564_047_0	2012	9	H.6										OP Facility - Other										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	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	YES	1391.586989	80.98322883	346.6598045	347.9401809	199.6844354	10.76474374	6.394206654	383.0214935	413.5954504	23559.69713	604.8067938	13.15968418	0	328.9763217	4795.682098	4072.274061	7.743496063	1649.285483	1392.052947	1948.437537	51.34767212	30.96416056	0	0	0	0	0	0	5872.8	246.3863091	21.82401963	0	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: $146/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $35 copay	9A: $0 - $150 copay; 9B: $0-$125 copay	8A: $0-$150 copay	8B: $40-$150 copay	5: $35 copay	12: 20% coin	3: $35 copay; 9A: $35-$150 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $40-$150 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: $35 copay; 13A: Not covered	8B: 20% coinsurance										0	NO	122.6102789	87.27511127	146	0	200	0.2	0.152987281	59.03822738	114.0954158	5.801648204	66.48801975	35	0.2	55.81110029	9.979377707	33.03585367	40	50	75.61235604	0.783456879	0.2	0	0	0	0	0	0	0	0	28.04246656	0.2	0	0	0	0	0	0	0	0	0	NO	109.4187643	77.88527125	130.2920092	0	178.4822044	0.178482204	0.136527536	52.68636483	101.8200066	5.177454803	59.33464166	31.23438577	0	49.80644105	8.905706658	29.48155994	35.69644088	44.6205511	67.47729993	0.699165554	0.178482204	0	0	0	0	0	0	0	0	28.04246656	0.178482204	0	0	0	0	0	0	0	0	0		12.6888	0.525616729	3.76391687	0	2.970009851	1.921315193	0.872985277	1.681667512	3.509357625	10.16493892	2.990499532	0.034252888	0	1.365428314	3.559078166	10.00474932	0.023034604	6.132668933	7.827664518	0.113523368	9.164645712	0	0	0	0	0	0	0	0	0.57577332	3.895199132	0	0	0	0	0	0	0	0	0	83.7851		NO	10.03171198	12.6888	0.525616729	3.76391687	0	2.970009851	1.921315193	0.872985277	1.681667512	3.509357625	10.16493892	2.990499532	0.034252888	0	1.365428314	3.559078166	10.00474932	0.023034604	6.132668933	7.827664518	0.113523368	9.164645712	0	0	0	0	0	0	0	0	0.57577332	3.895199132	0	0	0	0	0	0	0	0	0	83.7851	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	12.6888	0.525616729	3.76391687	0	2.970009851	1.921315193	0.872985277	1.681667512	3.509357625	10.16493892	2.990499532	0.034252888	0	1.365428314	3.559078166	10.00474932	0.023034604	6.132668933	7.827664518	0.113523368	9.164645712	0	0	0	0	0	0	0	0	0.57577332	3.895199132	0	0	0	0	0	0	0	0	0	83.7851
H0564_801_0	2012	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	341.7830766	3.550787236	56.41847823	14.96649613	12.52000996	15.73326597	5.36445247	19.78302902	59.10866552	62.46579013	54.09764566	0.004791046	6.169441227	0.536239691	61.22426821	91.12935958	0.256363237	57.87218489	0	0.143591278	61.40648772	0.649439463																			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																				NO	0.065828215	0.065828215	0.154056178	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.052096105	0.052096105	0.121919253	0	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981	0.184394981																				17.8056	0.184982185	6.87849874	0	2.308627	2.90113528	0.989178112	3.647891261	10.89934126	11.51837819	9.975334348	0.000883445	1.137613998	0.098879908	11.28944778	16.80379653	0.047272094	10.67134044	0	0.026477511	11.32304814	0.119753378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6274		NO	31.26923117	17.8056	0.184982185	6.87849874	0	2.308627	2.90113528	0.989178112	3.647891261	10.89934126	11.51837819	9.975334348	0.000883445	1.137613998	0.098879908	11.28944778	16.80379653	0.047272094	10.67134044	0	0.026477511	11.32304814	0.119753378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6274	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		NO	0	17.8056	0.184982185	6.87849874	0	2.308627	2.90113528	0.989178112	3.647891261	10.89934126	11.51837819	9.975334348	0.000883445	1.137613998	0.098879908	11.28944778	16.80379653	0.047272094	10.67134044	0	0.026477511	11.32304814	0.119753378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6274
H0564_810_0	2012	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	366.1608414	3.804048037	37.32204966	18.987838	11.68983386	13.01275002	4.436858763	17.78627218	55.9250443	63.19306614	54.72749313	0.004846827	6.24127073	0.542483016	80.19255204	119.3627319	0.335788778	75.80193825	0	0.188078215	55.75162788	0.993125698																			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																				NO	0.065828215	0.065828215	0.154056178	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.050924649	0.050924649	0.119177723	0	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594																				18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261		NO	36.36611847	18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261	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		NO	0	18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261
H0564_811_0	2012	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	366.1608414	3.804048037	37.32204966	18.987838	11.68983386	13.01275002	4.436858763	17.78627218	55.9250443	63.19306614	54.72749313	0.004846827	6.24127073	0.542483016	80.19255204	119.3627319	0.335788778	75.80193825	0	0.188078215	55.75162788	0.993125698																			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																				NO	0.065828215	0.065828215	0.154056178	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.050924649	0.050924649	0.119177723	0	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594	0.180248594																				18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261		NO	36.36611847	18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261	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		NO	0	18.6466	0.19371981	4.447956888	0	2.107076111	2.345529889	0.799737552	3.205950545	10.08041058	11.39046129	9.864553665	0.000873634	1.124980271	0.097781801	14.45459472	21.51496454	0.060525455	13.66319276	0	0.033900834	10.04915251	0.17900951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.261
H0571_001_0	2012	4																															D		D		T	Coin	Coin	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	437.958555	0	180.5648015	0	120.9275033	2.985876297	0.479735943	153.1378156	192.8623843	0	88.65737848	0	0	0.317763117	5011.69371	2677.195715	133.1595942	283.9319235	399.0524632	130.3880491	0	0	0	0	64.77346953	0	0	0	0	100.0778792											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 Prosth/Supplies; 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 - Complex Diagnostic; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$25/Day for CORF; $15/Visit for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP OV; $15/Visit for PCP - Facility Visit; PBP 7a, 14a, 14b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$15/Visit for Phys Rad - General; $100/Case for OP Rad - Complex Diagnostic; PBP 7d, 14a, 14b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 14a, 14e"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	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 14c	$15/Visit for Acupuncture; PBP 13a-e											0	NO	232.5	0	135	0	150	0.2	0.2	49.94482922	221.25	0	100	0	0	221.25	15	15	15	25	33.32235014	15	0	0	0	0	15	0	0	0	0	15											NO	226.8950845	0	131.7455329	0	146.3839255	0.195178567	0.195178567	48.74080106	215.9162901	0	97.58928366	0	0	215.9162901	14.63839255	14.63839255	14.63839255	24.39732092	32.5190428	14.63839255	0	0	0	0	14.63839255	0	0	0	0	14.63839255												8.2809	0	1.982383834	0	1.475153553	0.582779058	0.093634174	0.622004984	3.470177543	0	0.721000838	0	0	0.005717519	6.113594988	3.265820151	0.162436868	0.577264855	1.081400344	0.159055954	0	0	0	0	0.079014956	0	0	0	0	0.122081607	0	0	0	0	0	0	0	0	0	0	28.7944	0	NO	0.711298901	8.2809	0	1.982383834	0	1.475153553	0.582779058	0.093634174	0.622004984	3.470177543	0	0.721000838	0	0	0.005717519	6.113594988	3.265820151	0.162436868	0.577264855	1.081400344	0.159055954	0	0	0	0	0.079014956	0	0	0	0	0.122081607	0	0	0	0	0	0	0	0	0	0	28.7944	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.2809	0	1.982383834	0	1.475153553	0.582779058	0.093634174	0.622004984	3.470177543	0	0.721000838	0	0	0.005717519	6.113594988	3.265820151	0.162436868	0.577264855	1.081400344	0.159055954	0	0	0	0	0.079014956	0	0	0	0	0.122081607	0	0	0	0	0	0	0	0	0	0	28.7944
H0571_002_0	2012	3																															D		D		T	Coin	Coin	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	501.9124431	0	206.9321849	0	138.5862153	3.41045553	1.411566889	198.0624292	221.02555	0	101.6037726	0	0	0.364165195	5922.029044	3474.835971	152.604525	325.3937245	477.7888163	346.7133183	0	0	0	0	61.7584286	0	0	0	0	95.41950741											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 Prosth/Supplies; 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 - Complex Diagnostic; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$25/Day for CORF; $15/Visit for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP OV; $15/Visit for PCP - Facility Visit; PBP 7a, 14a, 14b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$15/Visit for Phys Rad - General; $100/Case for OP Rad - Complex Diagnostic; PBP 7d, 14a, 14b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 14a, 14e"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	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 14c	$15/Visit for Acupuncture; PBP 13a-e											0	NO	232.5	0	135	0	150	0.2	0.2	49.95111401	221.25	0	100	0	0	221.25	15	15	15	25	33.32282055	15	0	0	0	0	15	0	0	0	0	15											NO	224.3394322	0	130.2616058	0	144.7351175	0.192980157	0.192980157	48.19786905	213.4842984	0	96.49007835	0	0	213.4842984	14.47351175	14.47351175	14.47351175	24.12251959	32.15321566	14.47351175	0	0	0	0	14.47351175	0	0	0	0	14.47351175												9.3832	0	2.246276557	0	1.671524347	0.658150243	0.272404399	0.795515586	3.932123705	0	0.816979665	0	0	0.006478629	7.14271308	4.191089939	0.184060282	0.654109708	1.280203904	0.418179941	0	0	0	0	0.074488445	0	0	0	0	0.115087947	0	0	0	0	0	0	0	0	0	0	33.8426	0	NO	1.231058484	9.3832	0	2.246276557	0	1.671524347	0.658150243	0.272404399	0.795515586	3.932123705	0	0.816979665	0	0	0.006478629	7.14271308	4.191089939	0.184060282	0.654109708	1.280203904	0.418179941	0	0	0	0	0.074488445	0	0	0	0	0.115087947	0	0	0	0	0	0	0	0	0	0	33.8426	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	NO	0	9.3832	0	2.246276557	0	1.671524347	0.658150243	0.272404399	0.795515586	3.932123705	0	0.816979665	0	0	0.006478629	7.14271308	4.191089939	0.184060282	0.654109708	1.280203904	0.418179941	0	0	0	0	0.074488445	0	0	0	0	0.115087947	0	0	0	0	0	0	0	0	0	0	33.8426
H0571_005_0	2012	3																																																						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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2221.164098	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; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 7i, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"No Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"Preventive Dental $0-$135 copay/service; Comprehensive Dental $27-$610 copay/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 14c	No Cost Sharing; PBP 13a-e											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	46.29023035	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	46.28001332	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.566292004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.5663	0	NO	0.001891142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.566292004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.5663	NO																																										0	0	0	0	0	0	0	0	0	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	8.566292004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.5663
H0571_801_0	2012	3																																						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	0	0	0	146.5352793	0	0	0	0	0	0	4762.367834	2487.41486	114.0402786	246.7021708	0	0	0	0	0	0	80.15189005	0	0	0	0	147.9577539											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"	"$20/Visit for OP ER; $20/Visit for OP ER; $5/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; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 7i, 9a, 9c"	"$5/Visit for PCP OV; $5/Visit for PCP - Facility Visit; PBP 7a, 14a, 14b"	"$5/Visit for Chiro (cvd); $5/Visit for SCP OV; $5/Visit for Podiatry; $5/Visit for Vision Exams; $5/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$5/Visit for MH - Non Phys; $5/Visit for Psych Services ; PBP 7e, 7h"	"$5/Visit for OP PT/OT/ST; $5/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$5/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 14c	$5/Visit for Acupuncture; PBP 13a-e											0	NO	0	0	0	0	0	0	0	19.97968433	0	0	0	0	0	0	5	5	5	5	0	0	0	0	0	0	5	0	0	0	0	5											NO	0	0	0	0	0	0	0	19.97968433	0	0	0	0	0	0	5	5	5	5	0	0	0	0	0	0	5	0	0	0	0	5												0	0	0	0	0	0	0	0.243977385	0	0	0	0	0	0	1.984319931	1.036422858	0.047516783	0.102792571	0	0	0	0	0	0	0.033396621	0	0	0	0	0.061649064	0	0	0	0	0	0	0	0	0	0	3.5101	0	NO	0	0	0	0	0	0	0	0	0.243977385	0	0	0	0	0	0	1.984319931	1.036422858	0.047516783	0.102792571	0	0	0	0	0	0	0.033396621	0	0	0	0	0.061649064	0	0	0	0	0	0	0	0	0	0	3.5101	NO																																										0	0	0	0	0	0	0	0	0	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	0.243977385	0	0	0	0	0	0	1.984319931	1.036422858	0.047516783	0.102792571	0	0	0	0	0	0	0.033396621	0	0	0	0	0.061649064	0	0	0	0	0	0	0	0	0	0	3.5101
H0609_002_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1524.936459	8.937916527	1725.895122	735.4017607	231.0092749	20.66417645	17.35236872	321.2968296	385.4443834	21.81651616	39.47337719	0	0.029573963	1417.094125	7194.508556	5536.098948	0.353200565	1580.671241	0	0	22.07248466	2459.324608	0	0	85.17325729	485.3410179	0	3.957366473	174.9425396	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)	$235 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	141.0897886	90.43796201	58.90457086	0	235	0.2	0.098212277	64.64217978	71.75	0	0.198983109	0	0.2	58.00059393	6.449738575	29.80115441	38.5	30	0	0	0.2	28.34196551	0	0	30	30	0	352.5	0	0											NO	119.6483962	76.69411952	49.95285273	0	199.2870879	0.169606032	0.083286973	54.83625129	60.84616408	0	0.168743678	0	0.169606032	49.18625303	6.375606109	29.4586311	38.05748595	29.65518386	0	0	0.169606032	24.03484159	0	0	30	30	0	352.5	0	0												15.2047	0.057123803	7.184448737	0	3.836430474	3.504768978	1.445226262	1.468226141	1.954401016	0	6.660882838	0	0.005015923	5.808462517	3.822446059	13.59049139	0.00112016	3.906258022	0	0	3.743626545	4.925789781	0	0	0.212933143	1.213352545	0	0.11624764	0	0	0	0	0	0	0	0	0	0	0	0	78.6619	0	NO	10.24672177	15.2047	0.057123803	7.184448737	0	3.836430474	3.504768978	1.445226262	1.468226141	1.954401016	0	6.660882838	0	0.005015923	5.808462517	3.822446059	13.59049139	0.00112016	3.906258022	0	0	3.743626545	4.925789781	0	0	0.212933143	1.213352545	0	0.11624764	0	0	0	0	0	0	0	0	0	0	0	0	78.6619	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.2047	0.057123803	7.184448737	0	3.836430474	3.504768978	1.445226262	1.468226141	1.954401016	0	6.660882838	0	0.005015923	5.808462517	3.822446059	13.59049139	0.00112016	3.906258022	0	0	3.743626545	4.925789781	0	0	0.212933143	1.213352545	0	0.11624764	0	0	0	0	0	0	0	0	0	0	0	0	78.6619
H0609_007_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1225.580932	2.551056862	1829.51658	895.2008643	481.7910075	24.35377538	13.70390924	338.8844496	395.9494673	34.27588664	60.30430375	0	0.058339381	844.9339004	6354.998078	4849.647171	1.662310694	1172.318786	0	0	41.81864523	2156.935543	0	0	67.05437124	361.0316553	0	5.3908509	175.0623366	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)	$225 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$150 (9b)	20% (8a1a); $0 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); $150 (9a); $40/$30 (9c)	"$10 (7a); $20 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	130.0987409	79.93204038	66.37485649	0	225	0.2	0.10647757	64.92018343	61.5	0	0.171984471	0	0.2	51.3297583	5.957907521	20	38.5	20	0	0	0.2	18.82905174	0	0	20	30	0	352.5	0	0											NO	109.8194213	67.47252398	56.02858472	0	189.9278165	0.168824726	0.089880232	54.81762367	51.91360317	0	0.145176156	0	0.168824726	43.32866184	5.887324597	19.76306572	38.04389313	19.76306136	0	0	0.168824726	15.89404748	0	0	20	30	0	352.5	0	0												11.216	0.014343854	8.542102058	0	7.625459503	4.11151945	1.231710547	1.548070019	1.712930293	0	8.754747003	0	0.00984913	3.050821271	3.117828041	7.986991313	0.005270064	1.930717342	0	0	7.060021312	2.856869661	0	0	0.111757285	0.902579138	0	0.158356245	0	0	0	0	0	0	0	0	0	0	0	0	71.948	0	NO	10.81706233	11.216	0.014343854	8.542102058	0	7.625459503	4.11151945	1.231710547	1.548070019	1.712930293	0	8.754747003	0	0.00984913	3.050821271	3.117828041	7.986991313	0.005270064	1.930717342	0	0	7.060021312	2.856869661	0	0	0.111757285	0.902579138	0	0.158356245	0	0	0	0	0	0	0	0	0	0	0	0	71.948	NO																																										0	0	0	0	0	0	0	0	0	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	11.216	0.014343854	8.542102058	0	7.625459503	4.11151945	1.231710547	1.548070019	1.712930293	0	8.754747003	0	0.00984913	3.050821271	3.117828041	7.986991313	0.005270064	1.930717342	0	0	7.060021312	2.856869661	0	0	0.111757285	0.902579138	0	0.158356245	0	0	0	0	0	0	0	0	0	0	0	0	71.948
H0609_012_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	781.7287842	2.523283851	677.7789104	445.4085477	237.2092816	16.98102215	12.31826849	266.6191792	361.3740886	23.50977553	44.6200174	0	0.056152209	717.8638926	5206.605201	3594.62227	1.540119688	943.6923702	0	0	27.34627364	2004.562522	0	0	55.50275903	316.4868145	0	5.22284082	177.1030385	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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)	$235 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$250 (9b)	20% (8a1a); $0 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $250 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	68.66757296	0	235	0.2	0.105078647	64.84594887	102.5	0	0.182011955	0	0.2	85.33937302	8.735835285	29.84704745	38.5	30	0	0	0.2	28.6610797	0	0	30	30	0	352.5	0	0											NO	169.7336972	96.15976369	62.34595871	0	213.3656349	0.181587774	0.095404989	58.88822248	93.06373435	0	0.165255729	0	0.181587774	77.48293406	8.681474882	29.66131891	38.2604264	29.81331927	0	0	0.181587774	26.02250836	0	0	30	30	0	352.5	0	0												11.0571	0.020219865	3.521397997	0	4.217692413	3.083546018	1.175224264	1.308394128	2.802568515	0	7.373713499	0	0.010196555	4.635183388	3.766751023	8.885103125	0.00491047	2.344550161	0	0	4.965748967	4.346978748	0	0	0.138756898	0.791217036	0	0.153420949	0	0	0	0	0	0	0	0	0	0	0	0	64.6027	0	NO	5.013156669	11.0571	0.020219865	3.521397997	0	4.217692413	3.083546018	1.175224264	1.308394128	2.802568515	0	7.373713499	0	0.010196555	4.635183388	3.766751023	8.885103125	0.00491047	2.344550161	0	0	4.965748967	4.346978748	0	0	0.138756898	0.791217036	0	0.153420949	0	0	0	0	0	0	0	0	0	0	0	0	64.6027	NO																																										0	0	0	0	0	0	0	0	0	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	11.0571	0.020219865	3.521397997	0	4.217692413	3.083546018	1.175224264	1.308394128	2.802568515	0	7.373713499	0	0.010196555	4.635183388	3.766751023	8.885103125	0.00491047	2.344550161	0	0	4.965748967	4.346978748	0	0	0.138756898	0.791217036	0	0.153420949	0	0	0	0	0	0	0	0	0	0	0	0	64.6027
H0609_015_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1092.518399	5.822262933	939.3889107	492.9351606	151.0093348	15.5747959	12.5111042	259.4639688	288.3608087	16.34077706	28.457384	0	0.019628338	940.2630803	5167.363754	3972.497819	0.139004067	1178.604562	0	0	17.03606319	1863.725662	0	395.1553501	71.73613692	265.9372187	10.03603095	38.38445439	382.8947771	0											5900	"$195 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 n/c (10b)	"$20 (16a1); $0 n/c (16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	137.5625439	88.17701296	50	0	200	0.2	0.110548894	64.53899827	71.75	0	0.177061614	0	0.2	58.49365009	6.54324493	29.80835649	38.5	30	0	0	0.2	28.42869994	0	20	30	0	10	342.5	0	0											NO	126.4048408	81.02497209	45.94449811	0	183.7779924	0.183777992	0.101582269	59.31555387	65.93035478	0	0.16270014	0	0.183777992	53.74922791	6.509494314	29.65496417	38.30141371	29.84525744	0	0	0.183777992	26.12284701	0	20	30	0	10	342.5	0	0												11.5083	0.039312391	3.596646002	0	2.312682699	2.862304724	1.270906353	1.282520752	1.584310869	0	4.630020354	0	0.003607257	4.21153455	2.803077081	9.817023373	0.000443671	2.931313048	0	0	3.130853491	4.057151694	0	0.65859225	0.179340342	0	0.008363359	1.095556302	0	0	0	0	0	0	0	0	0	0	0	0	57.9839	0	NO	3.654296122	11.5083	0.039312391	3.596646002	0	2.312682699	2.862304724	1.270906353	1.282520752	1.584310869	0	4.630020354	0	0.003607257	4.21153455	2.803077081	9.817023373	0.000443671	2.931313048	0	0	3.130853491	4.057151694	0	0.65859225	0.179340342	0	0.008363359	1.095556302	0	0	0	0	0	0	0	0	0	0	0	0	57.9839	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	0	NO	0	11.5083	0.039312391	3.596646002	0	2.312682699	2.862304724	1.270906353	1.282520752	1.584310869	0	4.630020354	0	0.003607257	4.21153455	2.803077081	9.817023373	0.000443671	2.931313048	0	0	3.130853491	4.057151694	0	0.65859225	0.179340342	0	0.008363359	1.095556302	0	0	0	0	0	0	0	0	0	0	0	0	57.9839
H0609_018_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	763.9023272	5.059575577	818.9408578	455.1585454	238.6189925	18.60600548	10.95516769	262.4537969	376.0183731	26.20535651	47.69309041	0	0.040120541	717.6230875	5232.063945	3726.649261	2.018352029	1022.800816	0	0	32.02674406	2120.214202	0	0	52.78960602	259.1965997	17.6381231	65	327.6073142	0											5900	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$250 (9b)	20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $250 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	67.4524244	0	200	0.2	0.12027231	64.91363984	102.5	0	0.166241882	0	0.2	81.90059289	8.732744192	29.80627062	38.5	30	0	0	0.2	28.48471554	0	0	30	30	15	342.5	0	0											NO	167.1159948	94.67674854	60.29816851	0	178.7872535	0.178787254	0.10751578	58.0434546	91.62846744	0	0.148609648	0	0.178787254	73.21391033	8.665401149	29.57684051	38.20310511	29.76865333	0	0	0.178787254	25.4635203	0	0	30	30	15	342.5	0	0												10.6384	0.03991868	4.11505282	0	3.555169526	3.326516619	1.177853395	1.269477087	2.871165604	0	7.087653367	0	0.007173041	4.378332698	3.778161077	9.185209236	0.00642561	2.537283577	0	0	5.72597361	4.499009781	0	0	0.131974015	0.647991499	0.022047654	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.856	0	NO	5.897185171	10.6384	0.03991868	4.11505282	0	3.555169526	3.326516619	1.177853395	1.269477087	2.871165604	0	7.087653367	0	0.007173041	4.378332698	3.778161077	9.185209236	0.00642561	2.537283577	0	0	5.72597361	4.499009781	0	0	0.131974015	0.647991499	0.022047654	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.856	NO																																										0	0	0	0	0	0	0	0	0	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	10.6384	0.03991868	4.11505282	0	3.555169526	3.326516619	1.177853395	1.269477087	2.871165604	0	7.087653367	0	0.007173041	4.378332698	3.778161077	9.185209236	0.00642561	2.537283577	0	0	5.72597361	4.499009781	0	0	0.131974015	0.647991499	0.022047654	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.856
H0609_020_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1040.441501	3.839759837	560.1978087	487.1510438	123.811381	16.92784665	16.90597111	301.9838414	312.8770599	18.06116285	32.7603985	0	0.011927236	1098.379523	6202.76935	3857.891887	0.430267089	1113.846827	0	0	22.00725174	2143.751643	0	0	66.18614239	389.5314293	0	3.744277413	178.3260813	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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)	$245 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$250 (9b)	20% (8a1a); $0 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $250 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	65.53338963	0	245	0.2	0.096812682	64.72116998	102.5	0	0.196806404	0	0.2	83.33813647	5.977335073	34.72590464	38.5	35	0	0	0.2	33.61237597	0	0	35	30	0	352.5	0	0											NO	168.1145118	95.24244152	58.93270484	0	220.3229952	0.179855506	0.08706147	58.2141475	92.17594695	0	0.176983577	0	0.179855506	74.94411363	5.934736183	34.47842228	38.22562066	34.75056423	0	0	0.179855506	30.22685448	0	0	35	30	0	352.5	0	0												14.5761	0.030475675	2.751164343	0	2.273207857	3.04456643	1.471858698	1.464977657	2.403311606	0	5.798052522	0	0.002145179	6.859756651	3.067649975	11.08450213	0.001370602	3.225567142	0	0	3.958125403	5.399905747	0	0	0.193042915	0.973828573	0	0.109988149	0	0	0	0	0	0	0	0	0	0	0	0	68.6896	0	NO	5.728371477	14.5761	0.030475675	2.751164343	0	2.273207857	3.04456643	1.471858698	1.464977657	2.403311606	0	5.798052522	0	0.002145179	6.859756651	3.067649975	11.08450213	0.001370602	3.225567142	0	0	3.958125403	5.399905747	0	0	0.193042915	0.973828573	0	0.109988149	0	0	0	0	0	0	0	0	0	0	0	0	68.6896	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	14.5761	0.030475675	2.751164343	0	2.273207857	3.04456643	1.471858698	1.464977657	2.403311606	0	5.798052522	0	0.002145179	6.859756651	3.067649975	11.08450213	0.001370602	3.225567142	0	0	3.958125403	5.399905747	0	0	0.193042915	0.973828573	0	0.109988149	0	0	0	0	0	0	0	0	0	0	0	0	68.6896
H0609_801_0	2012	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	209.4441354	8.807983005	48.43445643	769.0755931	9.590501206	21.78800519	13.34482282	15.49256552	78.96509891	28.84670933	61.08934003	0	0.101721721	39.17137917	40.86003866	111.6526634	3.590250803	5.567218823	0	0	42.95441878	25.25982959	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079249367	0.079249367	0.147429506	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062088895	0.062088895	0.115505466	0	0.175495565	0.175495565	0.175495565	0.175495565	0.175495565	0.175495565	0.175495565	0	0.175495565	0.175495565	0.175495565	0.175495565	0.175495565	0.175495565	0	0	0.175495565	0.175495565	0	0	0	0	0	0	0	0												13.0042	0.546877932	5.594444474	0	1.68309043	3.823698287	2.341957225	2.718876543	13.85802467	5.06246956	10.72090826	0	0.017851711	6.874403329	7.170755581	19.59454728	0.630073094	0.977022214	0	0	7.538310004	4.432988073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5905	150	YES	29.46005896	13.0042	0.546877932	5.594444474	0	1.68309043	3.823698287	2.341957225	2.718876543	13.85802467	5.06246956	10.72090826	0	0.017851711	6.874403329	7.170755581	19.59454728	0.630073094	0.977022214	0	0	7.538310004	4.432988073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5905	NO																																										0	0	0	0	0	0	0	0	0	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	13.0042	0.546877932	5.594444474	0	1.68309043	3.823698287	2.341957225	2.718876543	13.85802467	5.06246956	10.72090826	0	0.017851711	6.874403329	7.170755581	19.59454728	0.630073094	0.977022214	0	0	7.538310004	4.432988073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5905
H0609_804_0	2012	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	186.087866	8.158066299	34.53637557	635.2804505	8.015319642	20.88972075	13.74934759	13.33847371	73.49170987	27.00476037	59.0460812	0	0.134914102	36.88587012	38.3184656	102.3850943	3.400369253	5.424947528	0	0	45.83693337	23.95241116	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079021313	0.079021313	0.14736632	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063143157	0.063143157	0.117755253	0	0.178990536	0.178990536	0.178990536	0.178990536	0.178990536	0.178990536	0.178990536	0	0.178990536	0.178990536	0.178990536	0.178990536	0.178990536	0.178990536	0	0	0.178990536	0.178990536	0	0	0	0	0	0	0	0												11.7502	0.515126064	4.066839645	0	1.43466636	3.739062316	2.461003097	2.387460561	13.15432055	4.833596536	10.56868973	0	0.024148347	6.602221668	6.8586427	18.32596292	0.608633916	0.971014266	0	0	8.204377277	4.287254914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7932	150	YES	25.34574077	11.7502	0.515126064	4.066839645	0	1.43466636	3.739062316	2.461003097	2.387460561	13.15432055	4.833596536	10.56868973	0	0.024148347	6.602221668	6.8586427	18.32596292	0.608633916	0.971014266	0	0	8.204377277	4.287254914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7932	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	NO	0	11.7502	0.515126064	4.066839645	0	1.43466636	3.739062316	2.461003097	2.387460561	13.15432055	4.833596536	10.56868973	0	0.024148347	6.602221668	6.8586427	18.32596292	0.608633916	0.971014266	0	0	8.204377277	4.287254914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7932
H0609_805_0	2012	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	181.4257054	7.989872592	33.83408658	629.8594796	7.88358418	19.96780299	13.42461828	13.12364133	71.36866609	25.90452339	57.11385022	0	0.131409138	35.94630139	36.86981793	98.21198884	3.344209583	5.25131917	0	0	44.29358555	23.1129885	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080629674	0.080629674	0.146587987	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064935293	0.064935293	0.118054972	0	0.180398915	0.180398915	0.180398915	0.180398915	0.180398915	0.180398915	0.180398915	0	0.180398915	0.180398915	0.180398915	0.180398915	0.180398915	0.180398915	0	0	0.180398915	0.180398915	0	0	0	0	0	0	0	0												11.7809	0.51882472	3.99428215	0	1.422190031	3.602169989	2.42178657	2.367490655	12.87482991	4.673147907	10.3032766	0	0.023706066	6.484673761	6.651275144	17.71733621	0.60329178	0.947332279	0	0	7.990514765	4.169558042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5466	150	YES	23.81798966	11.7809	0.51882472	3.99428215	0	1.422190031	3.602169989	2.42178657	2.367490655	12.87482991	4.673147907	10.3032766	0	0.023706066	6.484673761	6.651275144	17.71733621	0.60329178	0.947332279	0	0	7.990514765	4.169558042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5466	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	11.7809	0.51882472	3.99428215	0	1.422190031	3.602169989	2.42178657	2.367490655	12.87482991	4.673147907	10.3032766	0	0.023706066	6.484673761	6.651275144	17.71733621	0.60329178	0.947332279	0	0	7.990514765	4.169558042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5466
H0609_806_0	2012	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	138.8894041	6.290153134	32.38564226	528.258607	7.854785911	14.16817485	10.20095077	9.963431083	49.27959306	19.2186767	48.30752598	0	0.084628581	26.5244498	28.34895804	75.18777764	2.693359298	4.010516026	0	0	30.27029446	17.57176501	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.078482205	0.078482205	0.14777835	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067853096	0.067853096	0.127764231	0	0.193662927	0.193662927	0.193662927	0.193662927	0.193662927	0.193662927	0.193662927	0	0.193662927	0.193662927	0.193662927	0.193662927	0.193662927	0.193662927	0	0	0.193662927	0.193662927	0	0	0	0	0	0	0	0												9.4241	0.426806366	4.137726672	0	1.521180829	2.743850209	1.975545984	1.929547225	9.543630227	3.72194518	9.355376871	0	0.016389419	5.136802582	5.490142187	14.56108508	0.521603845	0.776688272	0	0	5.862233822	3.402999442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5476	150	YES	12.61769298	9.4241	0.426806366	4.137726672	0	1.521180829	2.743850209	1.975545984	1.929547225	9.543630227	3.72194518	9.355376871	0	0.016389419	5.136802582	5.490142187	14.56108508	0.521603845	0.776688272	0	0	5.862233822	3.402999442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5476	NO																																										0	0	0	0	0	0	0	0	0	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	9.4241	0.426806366	4.137726672	0	1.521180829	2.743850209	1.975545984	1.929547225	9.543630227	3.72194518	9.355376871	0	0.016389419	5.136802582	5.490142187	14.56108508	0.521603845	0.776688272	0	0	5.862233822	3.402999442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5476
H0620_002_0	2012	3																															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	1276.635623	641.5261021	10045.55219	16.99520944	916.8088641	2801.710758	707.5918837	187.5192059	118.9664661	29752.16325	3418.505061	0	10.88464163	171.973098	237.9173109	12073.10436	2150.604235	117.0653219	0	18093.52024	551.2062829	665.1692164	1333.319067	170.7442099	58.57213692	280.2233764	12.64633698	58.99122788	0	6267.881362											2500	"$75 Days 1-34 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-26 (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)"	$65 (4a); $0 n/c (4a1); $10 (4b)	$25 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9c); $25 (5, 9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $10 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	72.7340496	66.127088	0	0	75	0	0	65	10.25	0	0	0	0	8.167752771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	69.36252487	63.06182332	0	0	71.52343907	0	0	61.98698053	9.774870006	0	0	0	0	7.789143568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.3792	3.371317142	0	0	5.464443578	0	0	0.968645781	0.096906812	0	0	0	0	0.111626929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3922	0	NO	0.845385992	7.3792	3.371317142	0	0	5.464443578	0	0	0.968645781	0.096906812	0	0	0	0	0.111626929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3922	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.4997	0.0581	0	0.0006	0.1377	0.1562	0.0527	0.0198	0.0831	0	0.0793	0	0	0.0549	0.0059	0.9519	0.0816	0.0047	0	0	0.1543	0.0469	0	0	0.0047	0	0.0003	0	0	0											2.3925	0	NO	0.190279548	7.8789	3.429460262	0	0.000627013	5.602107524	0.156245016	0.052746834	0.988414062	0.179959212	0	0.079335468	0	0	0.166567659	0.005943701	0.951881442	0.081618942	0.004674463	0	0	0.154311987	0.046918773	0	0	0.00472204	0	0.000251927	0	0	0	0	0	0	0	0	0	0	0	0	0	19.7847
H0621_006_0	2012	8																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	Coin	V	Coin	V																																																											0	YES	167.8805391	50.25575165	342.2154864	392.8630499	324.9603582	34.96360975	2.292206925	964.7428003	160.009821	0	32.52338739	139.1214437	0	25.63026149	5254.996462	1923.50039	4658.169718	613.8538061	13.36444476	228.4951739	19.42507876	5.367967549																			6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-40 per day	PBP(6)-0 per visit	PBP(10A)-300 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-65 per visit & PBP(4B)-40 per visit	PBP(9A)-750 per visit & PBP(9B)-750 per visit	PBP(8A)-0% of allowed cost	PBP(8B)-20% of allowed cost	PBP(5)-15 per visit	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(7A)-15 per visit	PBP(7D/7G)-40 per visit	PBP(7E) &PBP(5)&PBP(9C)-15 per visit & PBP(7H)-15 per visit	PBP(7C)-40 per visit & PBP(7I)-40 per visit & PBP(3)-40 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-20per visit & 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 (16A) & (16B) $500 per year																			1100	1100	40	0	300	0.2	0.2	63.374933	750	0	0.2	15	0	0.2	15	40	15	40	0.2	36.82325903	0.2	0																			NO	1057.129618	1084.219517	33.15463438	0	287.518504	0.196541631	0.196541631	61.37081116	722.0567014	0	0.178515284	14.46514081	0	0.191604574	14.79958275	38.26000344	14.46514081	39.82739368	0.193304019	36.47846105	0.055730313	0																				14.7893	4.540688898	0.945502444	0	7.786009671	6.871804884	0.450514088	4.933920685	9.628013626	0	5.80592175	0.167700939	0	4.910875326	6.480979581	6.132760961	5.615090076	2.037349767	2.583400882	0.694596025	1.082565728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.457			8.473834317	14.7893	4.540688898	0.945502444	0	7.786009671	6.871804884	0.450514088	4.933920685	9.628013626	0	5.80592175	0.167700939	0	4.910875326	6.480979581	6.132760961	5.615090076	2.037349767	2.583400882	0.694596025	1.082565728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.457	NO																																																																																		0				14.7893	4.540688898	0.945502444	0	7.786009671	6.871804884	0.450514088	4.933920685	9.628013626	0	5.80592175	0.167700939	0	4.910875326	6.480979581	6.132760961	5.615090076	2.037349767	2.583400882	0.694596025	1.082565728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.457
H0621_010_0	2012	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	267.1611235	57.77733207	29.36059193	7.509001768	29.64170555	63.63215816	10.34807176	133.0211836	38.80126217	27.40788675	34.94695037	2.816382683	0	34.58092268	67.51566368	29.50756536	39.85608221	7.965861544	18.84651437	84.28238274	74.15162085	1.010006039																			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 (16A) & (16B) $750 per year	Every 2 years	$100 every 2 years																	0.07929358	0.07929358	0.101397308	0	0.201743466	0.21968144	0.204953455	0.223735796	0.196417435	0	0.211390709	0.214132762	0	0.205745922	0.253921512	0.239851881	0.214132762	0.222996978	0.210124487	0.208115039	0.199836046	0.201433076																			NO	0.077720397	0.077720397	0.099824124	0	0.200170283	0.218108256	0.203380272	0.222162613	0.194844252	0	0.209817526	0.212559579	0	0.204172738	0.252348329	0.238278697	0.212559579	0.221423794	0.208551304	0.206541856	0.198262863	0.199859892																				20.7639	4.490477189	2.930895378	0	5.933388587	13.87869907	2.104593646	29.55233372	7.560202885	0	7.332482661	0.598649117	0	7.060481684	17.0374649	7.031024235	8.471792055	1.763831287	3.930465139	17.40783976	14.70151262	0.201859698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7519	Part B	YES	1.667794974	20.7639	4.490477189	2.930895378	0	5.933388587	13.87869907	2.104593646	29.55233372	7.560202885	0	7.332482661	0.598649117	0	7.060481684	17.0374649	7.031024235	8.471792055	1.763831287	3.930465139	17.40783976	14.70151262	0.201859698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7519	NO																																																																																		0				20.7639	4.490477189	2.930895378	0	5.933388587	13.87869907	2.104593646	29.55233372	7.560202885	0	7.332482661	0.598649117	0	7.060481684	17.0374649	7.031024235	8.471792055	1.763831287	3.930465139	17.40783976	14.70151262	0.201859698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7519
H0623_001_0	2012	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		V	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							0	YES	916.56	38.73	429.2	710.58	0.8	17.47	4.48	307.24	315.3	9.59	16.42	1.38	0.16	21.5	3128.8	3813.17	74.57	2.14		1252.35	23.18	0		3.56	0.61				6.13	1.38	849.19	426.36	297.12	652.44							4500	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									182.210148	128.006658	44.329117	0	0.2	0.2	0.2	65	250	0.25	0.234894	0.206332	0.2	0.240548	15	32.500516	35	0.25		0	0.2	0		0	0				0	0	0	0	10.047055	35							NO	150.096156	105.445869	35.556606	0	0.182339	0.182339	0.182339	59.260045	227.92325	0.227923	0.214151	0.188111	0.182339	0.219306	13.675395	29.630493	31.909255	0.227923		0	0.182339	0		0	0				0	0	0	0	9.159829	31.909255								11.4643	0.340326542	1.271741275	0	0.1458712	3.18546233	0.81687872	1.517254685	5.988683394	2.18578157	3.51635942	0.25959318	0.02917424	4.715079	3.565631323	9.415508916	0.198289429	0.48775522	0	0	4.22661802	0	0	0	0	0	0	0	0	0	0	0	0.226797366	1.734906194	0	0	0	0	0	0	55.2921	0	NO	6.92839	11.4643	0.340326542	1.271741275	0	0.1458712	3.18546233	0.81687872	1.517254685	5.988683394	2.18578157	3.51635942	0.25959318	0.02917424	4.715079	3.565631323	9.415508916	0.198289429	0.48775522	0	0	4.22661802	0	0	0	0	0	0	0	0	0	0	0	0.226797366	1.734906194	0	0	0	0	0	0	55.2921	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins							6000	1.2993	0.0482	0.4924	1.262	0.9983	1.0419	0.2671	0.1478	1.5089	0.2579	0.4418	0.0424	0.0029	0.5784	0.9957	1.7914	0.0188	0.0574		0.1809	0.665	0			0				0	0	0.0777	0.0376	0.2342	0.1531							12.6013	0	NO	2.373749	12.7636	0.388541542	1.764127275	1.261997	1.1441592	4.22737033	1.08395872	1.665075685	7.497620394	2.44366757	3.95811242	0.30203818	0.03205824	5.293517	4.561358323	11.20693092	0.217107429	0.54519522	0	0.180877	4.89166702	0	0	0	0	0	0	0	0	0	0.077717	0.03761	0.461036366	1.887964194	0	0	0	0	0	0	67.8933
H0623_009_0	2012	2	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			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	824.99	10.77	367.44	541.14	0.76	6.84	1.71	271.03	206.81	4.83	10.09	0.3	0.18	12.43	1644.37	2474.41	16.78	1.47		805.14	13.34	0			0.61				6.13	1.38	475.49	158.4	141.55	277.37							3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									145.768118	128.006658	44.329117	0	0.2	0.2	0.2	65	200	0.25	0.238089	0.21135	0.2	0.241406	10	31.194557	35	0.25		0	0.2	0			0				0	0	0	0	14.115478	35							NO	125.047034	109.810384	36.82433	0	0.187978	0.187978	0.187978	61.09298	187.9784	0.234973	0.223778	0.198647	0.187978	0.226896	9.39892	29.319515	32.89622	0.234973		0	0.187978	0			0				0	0	0	0	13.267025	32.89622								8.5969	0.09855482	1.127560985	0	0.14286328	1.28576952	0.32144238	1.379835864	3.239651075	1.13491959	2.25792002	0.0595941	0.03383604	2.82031728	1.28794184	6.045708426	0.045999881	0.34541031	0	0	2.50762652	0	0	0	0	0	0	0	0	0	0	0	0.156495616	0.760368712	0	0	0	0	0	0	33.6487	0	NO	3.19455	8.5969	0.09855482	1.127560985	0	0.14286328	1.28576952	0.32144238	1.379835864	3.239651075	1.13491959	2.25792002	0.0595941	0.03383604	2.82031728	1.28794184	6.045708426	0.045999881	0.34541031	0	0	2.50762652	0	0	0	0	0	0	0	0	0	0	0	0.156495616	0.760368712	0	0	0	0	0	0	33.6487	YES	$0-$225/Day(Days 1-15)	$0-$225/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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			"VIS775: Vision 17a,17b"						20% Coins	30% Coins	30% Coins	30% Coins							5100	1.743	0.0219	0.4353	0.9721	1.4791	0.4246	0.1063	0.2037	1.6081	0.203	0.4241	0.0143	0.0052	0.5225	0.8537	2.0036	0.0091	0.0616		0.1804	0.6479	0							0	0	0.0457	0.0223	0.2257	0.1098							12.323	500	NO	1.404366	10.3399	0.12040682	1.562845985	0.972136	1.62193128	1.71037952	0.42773938	1.583505864	4.847743075	1.33796659	2.68199502	0.0738991	0.03898904	3.34278128	2.14166284	8.049356426	0.055091881	0.40700131	0	0.180406	3.15554852	0	0	0	0	0	0	0	0	0	0.045675	0.022336	0.382182616	0.870181712	0	0	0	0	0	0	45.9717
H0623_011_0	2012	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			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	1182.03	53.6	366.08	1303.25	1.12	12.88	3.98	346.79	324.14	8.78	15.14	1.17	0.38	21.79	3051.38	3756.08	96.33	1.81		1644.2	21.8	0			0.61				6.13	1.38	1145.44	331	334.62	451.8							5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"									182.210148	128.006658	44.329117	0	0.2	0.2	0.2	65	250	0.25	0.237762	0.210823	0.2	0.237039	20	37.846114	40	0.25		0	0.2	0			0				0	0	0	0	19.990682	40							NO	147.778625	103.817752	36.043251	0	0.182868	0.182868	0.182868	59.432035	228.58475	0.228585	0.217395	0.192764	0.182868	0.216734	18.28678	34.604178	36.57356	0.228585		0	0.182868	0			0				0	0	0	0	18.278261	36.57356								14.5566	0.463719292	1.099559444	0	0.20481216	2.35533984	0.72781464	1.717536285	6.174455072	2.0069763	3.2913603	0.22553388	0.06948984	4.72263386	4.649992896	10.83133841	0.293594253	0.41373885	0	0	3.9865224	0	0	0	0	0	0	0	0	0	0	0	0.509689308	1.376994534	0	0	0	0	0	0	59.6777	0	NO	7.833246	14.5566	0.463719292	1.099559444	0	0.20481216	2.35533984	0.72781464	1.717536285	6.174455072	2.0069763	3.2913603	0.22553388	0.06948984	4.72263386	4.649992896	10.83133841	0.293594253	0.41373885	0	0	3.9865224	0	0	0	0	0	0	0	0	0	0	0	0.509689308	1.376994534	0	0	0	0	0	0	59.6777	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins							6700	2.3522	0.1024	0.4489	2.1966	1.8233	1.0054	0.3104	0.2183	2.1982	0.3092	0.5329	0.0463	0.0089	0.7671	1.2629	2.4023	0.0302	0.0637		0.3093	0.819	0							0	0	0.1334	0.0328	0.3868	0.1521							17.9125	500	NO	2.746847	16.9087	0.566126292	1.548447444	2.196596	2.02811616	3.36069584	1.03821164	1.935864285	8.372672072	2.3161363	3.8242853	0.27183688	0.07843184	5.48972286	5.912895896	13.23365541	0.323796253	0.47739585	0	0.309314	4.8055444	0	0	0	0	0	0	0	0	0	0.133438	0.032764	0.896464308	1.529067534	0	0	0	0	0	0	77.5902
H0624_001_0	2012	7																															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	338.0905567	22.5501	55.36133003	3805.505636	16.33720967	36.14812963	14.03098935	46.76121719	70.89801258	22.31695425	52.4568357	0	0.009705895	58.7125303	51.75322312	106.2667323	10.9561	8.902270422	0	742.6630185	38.20196029	10.45128423	913.6287767	208.2340167	76.98336956	268.6572856	0	0	176.6071682	3083.517313											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.079619689	0.08058673	0.146594375	0	0.224	0.224	0.224	0.123103019	0.224	0.224	0.224	0	0.224	0.224	0.220865251	0.223944257	0.2299135	0.224	0	0	0.224	0.220792193	0	0	0	0	0	0	0	0											NO	0.062675722	0.063436966	0.11539744	0	0.176330276	0.176330276	0.176330276	0.096920091	0.176330276	0.176330276	0.176330276	0	0.176330276	0.176330276	0.173862637	0.176286396	0.180985317	0.176330276	0	0	0.176330276	0.176649533	0	0	0	0	0	0	0	0												21.1901	1.430509926	6.388555781	0	2.880744695	6.374009685	2.474088228	4.532101427	12.50146615	3.935154708	9.249728331	0	0.001711443	10.35279669	8.997951834	18.73337924	1.982893234	1.569739803	0	0	6.736162212	1.846214477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1773	150	YES	32.72083296	21.1901	1.430509926	6.388555781	0	2.880744695	6.374009685	2.474088228	4.532101427	12.50146615	3.935154708	9.249728331	0	0.001711443	10.35279669	8.997951834	18.73337924	1.982893234	1.569739803	0	0	6.736162212	1.846214477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1773	NO																																										0	0	0	0	0	0	0	0	0	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	21.1901	1.430509926	6.388555781	0	2.880744695	6.374009685	2.474088228	4.532101427	12.50146615	3.935154708	9.249728331	0	0.001711443	10.35279669	8.997951834	18.73337924	1.982893234	1.569739803	0	0	6.736162212	1.846214477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1773
H0630_013_0	2012	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	560.8924251	34.46920288	396.0970676	305.9355578	6.595615176	10.31262723	0.450065136	217.9809253	59.04130791	0	300.3257281	0.179366691	1.706396182	152.0398998	3179.798288	3933.407917	311.2252156	622.6955353	1655.478743	4338.684709	0	6.477836363	0	0	21.13426695	0	74.65168486	0	88.11625816	0	739.3584679	32.89446388	0.954797477								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/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"	"7a:  Primary Care Physician Services - $20/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit; 7f:  Podiatry Services $15/visit; 14a:  Medicare-covered Preventive Services $0/visit; 14d:  Kidney Disease Education Services $20/visit; 14e:  Diabetes Self Management Training $20/visit"	Specialty Care OV $0-$40/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $20/visit.	"$10/Group Visit, $20/Individual Visit"	$30/visit	$10 Xray Copay	Specialty Care OV $0-$40/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $20/visit.		$0 Copay			$20 copay		$20 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	NO	169.1266272	169.1266272	30.13329611	0	0.2	0.2	0.2	43.55	267.1428571	0	244.8750726	0.2	0	19.15420023	14.14069291	36.17173682	18.58426966	30	10	0	0	0	0	0	20	0	20	0	0	0	10	45	0.2								NO	142.04	142.04	12.8	0	0.19	0.19	0.19	40.62	249.14	0	228.37	0.19	0	17.86	13.19	33.73	17.33	27.98	9.33	0	0	0	0	0	18.65	0	18.65	0	0	0	9.33	41.97	0.19									6.6391	0.408000465	0.422503539	0	1.253166883	1.959399174	0.085512376	0.737865432	1.225795954	0	5.715448877	0.034079671	0	0.226286051	3.495128285	11.05615409	0.449461082	1.451918423	1.287134723	0	0	0	0	0	0.032846173	0	0.11602116	0	0	0	0.574851209	0.115048387	0.181411521	0	0	0	0	0	0	0	37.4671	0	NO	4.014621113	6.6391	0.408000465	0.422503539	0	1.253166883	1.959399174	0.085512376	0.737865432	1.225795954	0	5.715448877	0.034079671	0	0.226286051	3.495128285	11.05615409	0.449461082	1.451918423	1.287134723	0	0	0	0	0	0.032846173	0	0.11602116	0	0	0	0.574851209	0.115048387	0.181411521	0	0	0	0	0	0	0	37.4671	NO																																																																																		0	0	NO	0	6.6391	0.408000465	0.422503539	0	1.253166883	1.959399174	0.085512376	0.737865432	1.225795954	0	5.715448877	0.034079671	0	0.226286051	3.495128285	11.05615409	0.449461082	1.451918423	1.287134723	0	0	0	0	0	0.032846173	0	0.11602116	0	0	0	0.574851209	0.115048387	0.181411521	0	0	0	0	0	0	0	37.4671
H0630_014_0	2012	8	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	1438.64828	173.5861668	1101.178869	1835.298115	23.62856909	52.0831817	2.225908097	628.7379517	74.93841835	0	487.7347906	0.218748085	2.116904473	169.3523579	7005.747071	6432.541869	1475.653362	754.7979675	2694.616015	6808.455865	0	6.477836363	0	0	0	0	80.34715249	0	184.7984507	0	2089.448844	130.246963	8.670393874								3350	$190/day days 1-5; $0 days 6-90	$190/day days 1-5; $0 days 6-90	"$0 days 1-10, $50/day days 11-100"	$0 Copay	"0%-20% Coinsurance, max $500/trip"	0%-20% Coinsurance; 0% Diabetic Supplies	0%-20% Coinsurance	$0 to $65/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	NO	118.3901421	118.3901421	30.13329611	0	0.2	0.133269794	0.133269794	29.01949769	133.2697942	0	0.355528341	0.071105668	0	0.355528341	0.550888676	0.695018731	0.711056683	0.711056683	0	0	0	0	0	0	0.711056683	0	0	0	0.711056683	0	0.355528341	1.066585024	0								NO	108.87	108.87	14.96	0	0.19	0.126606304	0.126606304	27.59351089	126.7129203	0	0.337751924	0.067550385	0	0.337751924	0.522626662	0.661282715	0.675503849	0.675503849	0	0	0	0	0	0	0.142211337	0	0	0	0.142211337	0	0.071105668	0.213317005	0									13.0521	1.574860498	1.37280299	0	4.489428127	6.594059161	0.281813998	1.445757293	0.791305486	0	0.01372778	0.014776517	0	0.00476659	0.305115851	0.354477396	0.08306746	0.042489078	0	0	0	0	0	0	0	0	0	0	0.002190036	0	0.012380971	0.002315324	0	0	0	0	0	0	0	0	30.4375	0	NO	3.495757804	13.0521	1.574860498	1.37280299	0	4.489428127	6.594059161	0.281813998	1.445757293	0.791305486	0	0.01372778	0.014776517	0	0.00476659	0.305115851	0.354477396	0.08306746	0.042489078	0	0	0	0	0	0	0	0	0	0	0.002190036	0	0.012380971	0.002315324	0	0	0	0	0	0	0	0	30.4375	NO																																																																																		0	0	NO	0	13.0521	1.574860498	1.37280299	0	4.489428127	6.594059161	0.281813998	1.445757293	0.791305486	0	0.01372778	0.014776517	0	0.00476659	0.305115851	0.354477396	0.08306746	0.042489078	0	0	0	0	0	0	0	0	0	0	0.002190036	0	0.012380971	0.002315324	0	0	0	0	0	0	0	0	30.4375
H0630_015_0	2012	9	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	891.6767813	32.22168675	739.5179084	760.7020152	9.310466347	19.25281169	0.849492982	274.5912912	75.01090022	0	394.9659462	0.753096802	1.038213152	209.4965824	4037.956904	5374.380553	183.3002798	654.4374042	2026.967416	5764.650742	0	6.477836363	0	0	0	0	77.99602941	0	92.43973855	0	973.0615748	50.70112263	2.625697086								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/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"	"7a: Primary Care Physician Services - $15/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit; 7f:  Podiatry Services $15/visit; 14a:  Medicare-covered Preventive Services $0/visit; 14d:  Kidney Disease Education Services $15/visit; 14e:  Diabetes Self Management Training $15/visit"	Specialty Care OV $0-$35/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.	"$10/Group Visit, $15/Individual Visit"	$25/visit	$10 Xray Copay	Specialty Care OV $0-$35/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.		$0 Copay			$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	NO	124.6212022	124.6212022	30.13329611	0	0.2	0.2	0.2	43.55	121.3772049	0	146.5114833	0.2	0	14.12082262	11.13531078	31.47348293	14.47151115	25	10	0	0	0	0	0	15	0	15	0	0	0	10	45	0.2								NO	115.04	115.04	16.62	0	0.19	0.19	0.19	41.83	116.6	0	140.74	0.19	0	13.56	10.7	30.23	13.9	24.02	9.61	0	0	0	0	0	14.41	0	14.41	0	0	0	9.61	43.23	0.19									8.5482	0.30889857	1.024232303	0	1.768988606	3.658034221	0.161403667	0.957179476	0.728855914	0	4.632292272	0.143088392	0	0.236731138	3.600511573	13.53896034	0.212322824	1.309965537	1.623263072	0	0	0	0	0	0	0	0.093660232	0	0	0	0.779260145	0.182650794	0.498882446	0	0	0	0	0	0	0	44.0074	0	NO	3.041719409	8.5482	0.30889857	1.024232303	0	1.768988606	3.658034221	0.161403667	0.957179476	0.728855914	0	4.632292272	0.143088392	0	0.236731138	3.600511573	13.53896034	0.212322824	1.309965537	1.623263072	0	0	0	0	0	0	0	0.093660232	0	0	0	0.779260145	0.182650794	0.498882446	0	0	0	0	0	0	0	44.0074	NO																																																																																		0	0	NO	0	8.5482	0.30889857	1.024232303	0	1.768988606	3.658034221	0.161403667	0.957179476	0.728855914	0	4.632292272	0.143088392	0	0.236731138	3.600511573	13.53896034	0.212322824	1.309965537	1.623263072	0	0	0	0	0	0	0	0.093660232	0	0	0	0.779260145	0.182650794	0.498882446	0	0	0	0	0	0	0	44.0074
H0630_016_0	2012	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	1421.365516	83.18701197	1414.245351	1391.406877	16.87130317	36.82395152	1.285929303	411.3688978	88.19565405	0	485.1849808	1.160665945	6.315244364	273.7331781	5394.660842	7212.303648	377.7571973	665.7488677	2576.212429	7451.266173	0	6.477836363	0	0	0	0	96.79163048	0	116.8024844	0	1588.035268	54.15981121	4.227673893								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$90 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $120/procedure, Radiation Therapy $25/visit"	20% coin	$0 Copay	"Pulmonary Rehab $5; $0-$150/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	"7a: Primary Care Physician Services - $15/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit; 7f:  Podiatry Services $15/visit; 14a:  Medicare-covered Preventive Services $0/visit; ; 14d:  Kidney Disease Education Services $15/visit; 14e:  Diabetes Self Management Training $15/visit"	Specialty Care OV $0-$25/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.	"$10/Group Visit, $15/Individual Visit"	$25/visit	$10 Xray Copay	Specialty Care OV $0-$25/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.		$0 Copay	$0 per trip		$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$40 Brand copay	20% coinsurance								0	NO	68.54166119	68.54166119	30.13329611	0	0.2	0.2	0.2	43.55	87.13780919	0	116.91163	0.2	0	14.21760391	11.49510185	23.27190714	14.68768415	25	10	0	0	0	0	0	15	0	15	0	0	0	10	40	0.2								NO	63.03	63.03	14.96	0	0.19	0.19	0.19	41.41	82.85	0	111.16	0.19	0	13.52	10.93	22.13	13.97	23.77	9.51	0	0	0	0	0	14.26	0	14.26	0	0	0	9.51	38.03	0.19									7.4657	0.43693978	1.763092538	0	3.205547602	6.996550788	0.244326568	1.419565505	0.608917495	0	4.494430206	0.22052653	0	0.308406047	4.913636917	13.30068998	0.439772337	1.318737549	2.04164835	0	0	0	0	0	0	0	0.115020721	0	0	0	1.25851795	0.171641468	0.80325804	0	0	0	0	0	0	0	51.5269	0	NO	4.652403737	7.4657	0.43693978	1.763092538	0	3.205547602	6.996550788	0.244326568	1.419565505	0.608917495	0	4.494430206	0.22052653	0	0.308406047	4.913636917	13.30068998	0.439772337	1.318737549	2.04164835	0	0	0	0	0	0	0	0.115020721	0	0	0	1.25851795	0.171641468	0.80325804	0	0	0	0	0	0	0	51.5269	NO																																																																																		0	0	NO	0	7.4657	0.43693978	1.763092538	0	3.205547602	6.996550788	0.244326568	1.419565505	0.608917495	0	4.494430206	0.22052653	0	0.308406047	4.913636917	13.30068998	0.439772337	1.318737549	2.04164835	0	0	0	0	0	0	0	0.115020721	0	0	0	1.25851795	0.171641468	0.80325804	0	0	0	0	0	0	0	51.5269
H0630_017_0	2012	6	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	856.2032957	21.2544238	624.6279617	426.9946	7.38527006	15.70859134	0.354117022	251.9693988	276.3535537	0	426.5121078	0.309146113	0.464141317	371.1482087	3707.579255	6033.207749	234.3819851	559.1762939	2009.379792	4695.61674	0	6.477836363	0	0	6.942100658	0	67.39868046	0	53.68826426	15.69414866	778.0492711	139.5771102	2.228468578								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/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"	"7a: Primary Care Physician Services - $20/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit;  14a:  Medicare-covered Preventive Services $0/visit; 14d:  Kidney Disease Education Services $20/visit; 14e:  Diabetes Self Management Training $20/visit"	Specialty Care OV $0-$40/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $20/visit.	"$10/Group Visit, $20/Individual Visit"	$30/visit	$10 Xray Copay	Specialty Care OV $0-$40/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $20/visit.		$0 Copay			$20 copay		$20 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	NO	130.8522623	130.8522623	30.13329611	0	0.2	0.2	0.2	43.55	225.3196347	0	221.6151685	0.2	0	16.7972973	14.61880089	37.65160294	14.77142857	30	10	0	0	0	0	0	15	0	15	0	0	0	10	45	0.2								NO	116.14	116.14	15.1	0	0.19	0.19	0.19	40.96	211.92	0	208.44	0.19	0	15.8	13.75	35.41	13.89	28.22	9.41	0	0	0	0	0	14.11	0	14.11	0	0	0	9.41	42.32	0.19									8.2866	0.205707398	0.785990185	0	1.403201311	2.984632354	0.067282234	0.860055548	4.880403758	0	7.408515313	0.058737761	0	0.488678475	4.248267896	17.80299053	0.271297148	1.314996251	1.575688654	0	0	0	0	0	0.008162753	0	0.079249615	0	0	0	0.610120303	0.492241942	0.42340903	0	0	0	0	0	0	0	54.2562	0	NO	4.532326536	8.2866	0.205707398	0.785990185	0	1.403201311	2.984632354	0.067282234	0.860055548	4.880403758	0	7.408515313	0.058737761	0	0.488678475	4.248267896	17.80299053	0.271297148	1.314996251	1.575688654	0	0	0	0	0	0.008162753	0	0.079249615	0	0	0	0.610120303	0.492241942	0.42340903	0	0	0	0	0	0	0	54.2562	NO																																																																																		0	0	NO	0	8.2866	0.205707398	0.785990185	0	1.403201311	2.984632354	0.067282234	0.860055548	4.880403758	0	7.408515313	0.058737761	0	0.488678475	4.248267896	17.80299053	0.271297148	1.314996251	1.575688654	0	0	0	0	0	0.008162753	0	0.079249615	0	0	0	0.610120303	0.492241942	0.42340903	0	0	0	0	0	0	0	54.2562
H0630_018_0	2012	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	1241.007014	33.38637415	943.7013493	868.8425363	10.60672604	23.28045513	1.473183221	296.7444503	251.1040597	0	540.9028881	0.425761915	1.220456775	429.5132642	4791.535081	7670.310926	278.6548031	649.715101	2591.046874	6348.642339	0	6.477836363	0	0	10.75005023	0	84.01542951	0	71.00202789	28.36760828	1004.719349	131.6780282	4.980367426								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/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"	"7a: Primary Care Physician Services - $15/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit; 7f:  Podiatry Services $30/visit; 14a:  Medicare-covered Preventive Services $0/visit; ; 14d:  Kidney Disease Education Services $15/visit; 14e:  Diabetes Self Management Training $15/visit"	Specialty Care OV $0-$30/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.	"$10/Group Visit, $15/Individual Visit"	$25/visit	$10 Xray Copay	Specialty Care OV $0-$30/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.		$0 Copay	$0 per trip		$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	NO	96.58143168	96.58143168	30.13329611	0	0.2	0.2	0.2	43.55	200.8928571	0	147.8854626	0.2	0	12.43801653	11.7876588	28.29746462	14.78632479	25	10	0	0	0	0	0	15	0	15	0	0	0	10	45	0.2								NO	87.89	87.89	15.4	0	0.19	0.19	0.19	41.35	190.75	0	140.42	0.19	0	11.81	11.19	26.87	14.04	23.74	9.5	0	0	0	0	0	14.24	0	14.24	0	0	0	9.5	42.73	0.19									9.0893	0.244527369	1.211083398	0	2.015277948	4.423286475	0.279904812	1.022531918	3.991508282	0	6.329465296	0.080894764	0	0.422712638	4.468106463	17.17510455	0.32602612	1.285353042	2.051245442	0	0	0	0	0	0.012756726	0	0.09969831	0	0	0	0.795402818	0.468883512	0.946269811	0	0	0	0	0	0	0	56.7394	0	NO	4.532326536	9.0893	0.244527369	1.211083398	0	2.015277948	4.423286475	0.279904812	1.022531918	3.991508282	0	6.329465296	0.080894764	0	0.422712638	4.468106463	17.17510455	0.32602612	1.285353042	2.051245442	0	0	0	0	0	0.012756726	0	0.09969831	0	0	0	0.795402818	0.468883512	0.946269811	0	0	0	0	0	0	0	56.7394	NO																																																																																		0	0	NO	0	9.0893	0.244527369	1.211083398	0	2.015277948	4.423286475	0.279904812	1.022531918	3.991508282	0	6.329465296	0.080894764	0	0.422712638	4.468106463	17.17510455	0.32602612	1.285353042	2.051245442	0	0	0	0	0	0.012756726	0	0.09969831	0	0	0	0.795402818	0.468883512	0.946269811	0	0	0	0	0	0	0	56.7394
H0630_019_0	2012	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	879.3121244	42.51957314	849.9804757	663.4617633	9.923812955	17.62986278	0.552625873	282.5179307	80.72587953	0	424.2943262	0.489916675	0.675395161	219.96245	4026.179761	5738.707313	259.4845192	708.9223194	2122.471532	5928.910314	0	6.477836363	0	0	25.46860433	0	124.2305059	0	114.8935914	126.8468641	1090.820977	47.82663369	2.503537564								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 1-10, $50/day days 11-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$65/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"	"7a: Primary Care Physician Services - $15/individual visit, $10/group visit, $30/In-Area Urgent Care Services visit; 7f:  Podiatry Services $15/visit; 14a:  Medicare-covered Preventive Services $0/visit; ; 14d:  Kidney Disease Education Services $15/visit; 14e:  Diabetes Self Management Training $15/visit"	Specialty Care OV $0-$35/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.	"$10/Group Visit, $15/Individual Visit"	$25/visit	$10 Xray Copay	Specialty Care OV $0-$35/visit; $0 copay for Routine Care $0 Copay; 7b Chiropractic Services $15/visit.		$0 Copay			$15 copay		$15 copay		$0 copay	$0-$5 copay	$10 Generic copay	$45 Brand copay	20% coinsurance								0	NO	109.0435519	109.0435519	30.13329611	0	0.2	0.2	0.2	43.55	123.0821918	0	147.9646018	0.2	0	13.94736842	11.46889952	30.8810143	14.42708333	25	10	0	0	0	0	0	15	0	15	0	0	0	10	45	0.2								NO	102.3	102.3	17.77	0	0.19	0.19	0.19	41.98	118.65	0	142.64	0.19	0	13.45	11.06	29.77	13.91	24.1	9.64	0	0	0	0	0	14.46	0	14.46	0	0	0	9.64	43.38	0.19									7.4961	0.362479361	1.258679421	0	1.885524461	3.349673929	0.104998916	0.988341894	0.798177134	0	5.043445224	0.093084168	0	0.246541246	3.71079568	14.23677639	0.300785805	1.423752325	1.705052131	0	0	0	0	0	0.030689668	0	0.14969776	0	0	0	0.876292852	0.172893281	0.475672137	0	0	0	0	0	0	0	44.7095	0	NO	2.811357783	7.4961	0.362479361	1.258679421	0	1.885524461	3.349673929	0.104998916	0.988341894	0.798177134	0	5.043445224	0.093084168	0	0.246541246	3.71079568	14.23677639	0.300785805	1.423752325	1.705052131	0	0	0	0	0	0.030689668	0	0.14969776	0	0	0	0.876292852	0.172893281	0.475672137	0	0	0	0	0	0	0	44.7095	NO															30% coinsurance OON Physician Benefits																																									3.1909																										3.1909	0	NO	0	7.4961	0.362479361	1.258679421	0	1.885524461	3.349673929	0.104998916	0.988341894	0.798177134	0	5.043445224	0.093084168	0	0.246541246	6.901735658	14.23677639	0.300785805	1.423752325	1.705052131	0	0	0	0	0	0.030689668	0	0.14969776	0	0	0	0.876292852	0.172893281	0.475672137	0	0	0	0	0	0	0	47.9004
H0630_805_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	694.745118	19.59746318	596.8760659	594.8981584	7.208587743	13.67545867	4.151635366	224.0264025	72.27122735	0	331.5198675	0.7791613	0.543422145	178.676535	3367.887911	4958.827914	103.928889	667.3297896	1756.969443	5002.366846	0	6.477836363	0	0	0	0	0	0	0	0	6.888006344	6.493556696	1.70870209								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.4985	0.126893574	0.533209286	0	1.369631671	2.598337146	0.78881072	0.766543674	1.100389662	0	2.552150447	0.148040647	0	0.262058918	3.845005366	10.78958307	0.154940652	1.048819986	0	0	0	0	0	0	0	0	0	0	0	0	1.308721205	1.233775772	0.324653397	0	0	0	0	0	0	0	33.45	0	NO	3.416454531	4.4985	0.126893574	0.533209286	0	1.369631671	2.598337146	0.78881072	0.766543674	1.100389662	0	2.552150447	0.148040647	0	0.262058918	3.845005366	10.78958307	0.154940652	1.048819986	0	0	0	0	0	0	0	0	0	0	0	0	1.308721205	1.233775772	0.324653397	0	0	0	0	0	0	0	33.45	NO																																																																																		0	0	NO	0	4.4985	0.126893574	0.533209286	0	1.369631671	2.598337146	0.78881072	0.766543674	1.100389662	0	2.552150447	0.148040647	0	0.262058918	3.845005366	10.78958307	0.154940652	1.048819986	0	0	0	0	0	0	0	0	0	0	0	0	1.308721205	1.233775772	0.324653397	0	0	0	0	0	0	0	33.45
H0630_806_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	744.2165206	33.58939628	591.3959446	607.344245	7.797713099	16.5036721	0.772837538	240.188489	80.79113277	0	384.5750704	0.779240323	1.213313102	203.2056783	3541.322942	5266.803265	150.0190235	706.814141	1891.718036	5331.416687	0	6.477836363	0	0	0	0	0	0	0	0	8.369166494	6.832995035	2.134710716								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186	0	NO	3.565620799	4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186	NO																																																																																		0	0	NO	0	4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186
H0630_807_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	744.2165206	33.58939628	591.3959446	607.344245	7.797713099	16.5036721	0.772837538	240.188489	80.79113277	0	384.5750704	0.779240323	1.213313102	203.2056783	3541.322942	5266.803265	150.0190235	706.814141	1891.718036	5331.416687	0	6.477836363	0	0	0	0	0	0	0	0	8.369166494	6.832995035	2.134710716								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186	0	NO	3.565620799	4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186	NO																																																																																		0	0	NO	0	4.8188	0.217491341	0.52831371	0	1.481565489	3.135697699	0.146839132	0.821844947	1.230112322	0	2.960587083	0.148055661	0	0.298034995	4.043010358	11.4596861	0.223653361	1.110876225	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	35.9186
H0630_808_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	658.2234379	27.234827	449.6276019	495.6467537	5.883335885	12.6019711	0.828140818	217.7258433	83.26832702	0	419.4931671	0.884963327	0.332964073	351.7771764	3224.892705	5108.068518	136.3501576	764.3888912	1784.445415	5161.828009	0	6.477836363	0	0	0	0	0	0	0	0	7.312986627	7.048280028	1.422495963								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.262	0.176345505	0.401667324	0	1.117833818	2.394374509	0.157346755	0.744985261	1.267829669	0	3.229398232	0.168143032	0	0.515939859	3.681752505	11.11430575	0.20327536	1.201364541	0	0	0	0	0	0	0	0	0	0	0	0	1.389467459	1.339173205	0.270274233	0	0	0	0	0	0	0	33.6355	0	NO	3.111300985	4.262	0.176345505	0.401667324	0	1.117833818	2.394374509	0.157346755	0.744985261	1.267829669	0	3.229398232	0.168143032	0	0.515939859	3.681752505	11.11430575	0.20327536	1.201364541	0	0	0	0	0	0	0	0	0	0	0	0	1.389467459	1.339173205	0.270274233	0	0	0	0	0	0	0	33.6355	NO																																																																																		0	0	NO	0	4.262	0.176345505	0.401667324	0	1.117833818	2.394374509	0.157346755	0.744985261	1.267829669	0	3.229398232	0.168143032	0	0.515939859	3.681752505	11.11430575	0.20327536	1.201364541	0	0	0	0	0	0	0	0	0	0	0	0	1.389467459	1.339173205	0.270274233	0	0	0	0	0	0	0	33.6355
H0630_809_0	2012	4	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	930.2165774	26.86331034	938.1731468	869.6965387	10.42163917	23.53674439	0.83453606	289.8946083	21.31739673	0	12.60133448	0.501697061	0.745621346	176.4161419	4199.991506	5914.193603	149.3274542	815.2358775	2039.135404	5916.629803	0	6.477836363	0	0	0	0	0	0	0	0	8.546486283	5.785294853	2.002414753								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	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	NO	115.685615	115.685615	37.19208048	0	0.2	0.2	0.2	43.55	0.190277778	0	0.2	0.2	0.2	24.04040404	18.80216669	36.86108475	21.93181818	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	109.03	109.03	12.49	0	0.19	0.19	0.19	42.1	0.18	0	0.19	0.19	0.19	23.24	18.18	35.63	21.2	24.17	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									8.4518	0.244075561	0.976481884	0	1.980111442	4.471981434	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426	0	NO	4.267705644	8.4518	0.244075561	0.976481884	0	1.980111442	4.471981434	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426	NO																																																																																		0	0	NO	0	8.4518	0.244075561	0.976481884	0	1.980111442	4.471981434	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426
H0630_810_0	2012	4	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	930.2165774	26.86331034	938.1731468	869.6965387	10.42163917	23.53673467	0.83453606	289.8946083	21.31739673	0	12.60133448	0.501697061	0.745621346	176.4161419	4199.991506	5914.193603	149.3274542	815.2358775	2039.135404	5916.629803	0	6.477836363	0	0	0	0	0	0	0	0	8.546486283	5.785294853	2.002414753								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	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	NO	115.685615	115.685615	37.19208048	0	0.2	0.2	0.2	43.55	0.190277778	0	0.2	0.2	0.2	24.04040404	18.80216669	36.86108475	21.93181818	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	109.03	109.03	12.49	0	0.19	0.19	0.19	42.1	0.18	0	0.19	0.19	0.19	23.24	18.18	35.63	21.2	24.17	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									8.4518	0.244075561	0.976481884	0	1.980111442	4.471979588	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426	0	NO	4.267705547	8.4518	0.244075561	0.976481884	0	1.980111442	4.471979588	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426	NO																																																																																		0	0	NO	0	8.4518	0.244075561	0.976481884	0	1.980111442	4.471979588	0.158561851	1.017046918	3.837131412	0	2.394253552	0.095322442	0.141668056	0.341659261	6.362987132	17.56022651	0.263811836	1.64202093	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	53.0426
H0630_811_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	928.4269987	41.90353413	720.1067499	739.5260221	8.21770552	17.39257595	0.814463321	299.6405908	100.7887716	0	479.7661278	0.753900144	1.51363563	253.5036953	4249.58753	6320.163918	180.0228282	848.1769692	2270.061644	6397.700025	0	6.477836363	0	0	0	0	0	0	0	0	8.369166494	6.832995035	2.134710716								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	0	NO	4.26711444	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	NO																																																																																		0	0	NO	0	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139
H0630_812_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	928.4269987	41.90353413	720.1067499	739.5260221	8.21770552	17.39257595	0.814463321	299.6405908	100.7887716	0	479.7661278	0.753900144	1.51363563	253.5036953	4249.58753	6320.163918	180.0228282	848.1769692	2270.061644	6397.700025	0	6.477836363	0	0	0	0	0	0	0	0	8.369166494	6.832995035	2.134710716								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	0	NO	4.26711444	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	NO																																																																																		0	0	NO	0	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139
H0630_813_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	1634.611783	10.18512656	1373.732978	418.8072074	6.613851081	36.74481307	0.26144167	333.0491538	494.40582	0	462.1874188	0.081402068	14.18482834	499.8733508	3846.884297	9732.228844	80.43781803	1014.712204	2559.879209	4823.551588	0	6.477836363	0	0	0	0	0	0	0	0	5.436845012	15.63497435	9.135493202								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									10.5841	0.065948694	1.22720146	0	1.256631705	6.981514484	0.049673917	1.139583188	7.527740614	0	3.558072812	0.015466393	0	0.733147581	4.391859573	21.17570793	0.11991938	1.594789348	0	0	0	0	0	0	0	0	0	0	0	0	1.033000552	2.970645127	1.735743708	0	0	0	0	0	0	0	66.1608	0	NO	7.237719476	10.5841	0.065948694	1.22720146	0	1.256631705	6.981514484	0.049673917	1.139583188	7.527740614	0	3.558072812	0.015466393	0	0.733147581	4.391859573	21.17570793	0.11991938	1.594789348	0	0	0	0	0	0	0	0	0	0	0	0	1.033000552	2.970645127	1.735743708	0	0	0	0	0	0	0	66.1608	NO																																																																																		0	0	NO	0	10.5841	0.065948694	1.22720146	0	1.256631705	6.981514484	0.049673917	1.139583188	7.527740614	0	3.558072812	0.015466393	0	0.733147581	4.391859573	21.17570793	0.11991938	1.594789348	0	0	0	0	0	0	0	0	0	0	0	0	1.033000552	2.970645127	1.735743708	0	0	0	0	0	0	0	66.1608
H0630_814_0	2012	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	928.4269987	41.90353413	720.1067499	739.5260221	8.21770552	17.39257595	0.814463321	299.6405908	100.7887716	0	479.7661278	0.753900144	1.51363563	253.5036953	4249.58753	6320.163918	180.0228282	848.1769692	2270.061644	6397.700025	0	6.477836363	0	0	0	0	0	0	0	0	8.369166494	6.832995035	2.134710716								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$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	NO	85.23271607	85.23271607	37.19208048	0	0.2	0.2	0.2	43.55	193.7788779	0	97.97186121	0.2	0	18.66467277	14.5328655	27.6884667	18.97169811	20	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.7	77.7	10.72	0	0.19	0.19	0.19	41.06	182.71	0	92.38	0.19	0	17.6	13.7	26.11	17.89	18.86	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	0	NO	4.26711444	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139	NO																																																																																		0	0	NO	0	6.0116	0.271325384	0.643295363	0	1.561364049	3.30458943	0.154748031	1.025270222	1.534593038	0	3.693399574	0.143241027	0	0.37180542	4.85161243	13.75162332	0.268384033	1.33305147	0	0	0	0	0	0	0	0	0	0	0	0	1.590141634	1.298269057	0.405595036	0	0	0	0	0	0	0	42.2139
H0630_815_0	2012	4	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	1160.466291	33.51258928	1142.356186	1058.976399	10.9829588	24.80445636	0.879484985	361.6501028	20.62417458	0	12.19155067	0.485382333	0.721374425	220.0831406	5039.989807	7097.032323	179.192945	978.2830529	2446.962485	7099.955764	0	6.477836363	0	0	0	0	0	0	0	0	8.546486283	5.785294853	2.002414753								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	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	NO	115.685615	115.685615	37.19208048	0	0.2	0.2	0.2	43.55	0.190277778	0	0.2	0.2	0.2	24.04040404	18.80216669	36.86108475	21.93181818	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	109.03	109.03	12.49	0	0.19	0.19	0.19	42.1	0.18	0	0.19	0.19	0.19	23.24	18.18	35.63	21.2	24.17	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									10.5438	0.304489801	1.189002397	0	2.086762172	4.712846709	0.167102147	1.268789111	3.712351425	0	2.316394627	0.092222643	0.137061141	0.426227682	7.635584558	21.07227181	0.316574203	1.970425116	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	61.0554	0	NO	5.016103046	10.5438	0.304489801	1.189002397	0	2.086762172	4.712846709	0.167102147	1.268789111	3.712351425	0	2.316394627	0.092222643	0.137061141	0.426227682	7.635584558	21.07227181	0.316574203	1.970425116	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	61.0554	NO																																																																																		0	0	NO	0	10.5438	0.304489801	1.189002397	0	2.086762172	4.712846709	0.167102147	1.268789111	3.712351425	0	2.316394627	0.092222643	0.137061141	0.426227682	7.635584558	21.07227181	0.316574203	1.970425116	0	0	0	0	0	0	0	0	0	0	0	0	1.623832394	1.099206022	0.380458803	0	0	0	0	0	0	0	61.0554
H0630_816_0	2012	4	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	1080.466249	26.63774208	1116.667104	930.107749	9.705665924	25.17424429	0.699065477	340.4639424	23.6414433	0	14.60155693	0.385809921	0.569906126	327.3115997	4775.895474	7497.147877	241.3089199	1097.765841	2580.618674	6806.425295	0	6.477836363	0	0	0	0	0	0	0	0	10.00802733	5.717000475	8.355312121								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	"$65/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	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	NO	115.685615	115.685615	37.19208048	0	0.2	0.2	0.2	43.55	0.190277778	0	0.2	0.2	0.2	24.04040404	18.80216669	36.86108475	21.93181818	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	109.03	109.03	12.49	0	0.19	0.19	0.19	42.1	0.18	0	0.19	0.19	0.19	23.24	18.18	35.63	21.2	24.17	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									9.8169	0.242026085	1.162264344	0	1.844076526	4.783106414	0.132822441	1.194460998	4.255459793	0	2.774295818	0.073303885	0.108282164	0.633893465	7.235481643	22.26028157	0.426312425	2.211083365	0	0	0	0	0	0	0	0	0	0	0	0	1.901525193	1.08623009	1.587509303	0	0	0	0	0	0	0	63.7294	0	NO	5.078220743	9.8169	0.242026085	1.162264344	0	1.844076526	4.783106414	0.132822441	1.194460998	4.255459793	0	2.774295818	0.073303885	0.108282164	0.633893465	7.235481643	22.26028157	0.426312425	2.211083365	0	0	0	0	0	0	0	0	0	0	0	0	1.901525193	1.08623009	1.587509303	0	0	0	0	0	0	0	63.7294	NO																																																																																		0	0	NO	0	9.8169	0.242026085	1.162264344	0	1.844076526	4.783106414	0.132822441	1.194460998	4.255459793	0	2.774295818	0.073303885	0.108282164	0.633893465	7.235481643	22.26028157	0.426312425	2.211083365	0	0	0	0	0	0	0	0	0	0	0	0	1.901525193	1.08623009	1.587509303	0	0	0	0	0	0	0	63.7294
H0710_001_0	2012	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	285.4445561	39.7914	7516.931411	169.8815817	25.70593551	32.24610008	8.714760629	10.98116684	18.49805795	29.04125391	33.64767901	0	0	13.94307016	7.244491082	104.4164217	17.821287	268.0896169	0	26401.2083	9.690620796	11.8273037	592.62	0	28.9974044	38.8549702	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.067879135	0.068703578	0	0	0.2	0.2	0.188854154	0.096916108	0.16	0	0.146356398	0	0	0.146402697	0.001451001	0.029659422	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.063902599	0.064678744	0	0	0.18828348	0.18828348	0.177790587	0.091238511	0.150626784	0	0.13778246	0	0	0.137826047	0.001345334	0.027499509	0.185435234	0	0	0	0.18828348	0.188586971	0	0	0	0	0	0	0	0												18.2406	2.573657771	0	0	4.840003007	6.071407954	1.549402405	1.001905309	2.786302986	0	4.636059995	0	0	1.921718237	0.00974626	2.871400318	3.304694518	0	0	0	1.824583812	2.230475375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.862	0	NO	3.448842185	18.2406	2.573657771	0	0	4.840003007	6.071407954	1.549402405	1.001905309	2.786302986	0	4.636059995	0	0	1.921718237	0.00974626	2.871400318	3.304694518	0	0	0	1.824583812	2.230475375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.862	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0	0.054	0.718	0.9007	0.2434	0.0991	0.4134	0	0.7656	0	0	0.2851	0.1137	2.0216	0.3446	0.0357	0	0	0.1903	0.2326	0	0	0.0084	0	0	0	0	0											6.4261	0	NO	0.437029995	18.2406	2.573657771	0	0.053991622	5.558025431	6.972111332	1.792824534	1.100994845	3.199655627	0	5.401679317	0	0	2.206808305	0.123398029	4.892964069	3.6493017	0.035724719	0	0	2.014847899	2.463065053	0	0	0.0084016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2881
H0710_002_0	2012	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	316.6557551	22.045876	65.94090697	1754.50173	22.93235943	28.29913554	11.82234806	36.23678924	31.57047687	16.4098047	31.15685789	0	0.092806627	25.89809891	23.78785267	71.28551928	9.9796975	3.907971361	0	953.126913	10.32311281	6.674212296	621.2667811	267.5550757	39.06362791	199.4848	0	0	143.1151062	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.067927374	0.068752403	0.15537379	0	0.224	0.224	0.224	0.12126022	0.224	0.224	0.224	0	0.224	0.224	0.218027811	0.223945544	0.228860064	0.224	0	0	0.224	0.223781494	0	0	0	0	0	0	0	0											NO	0.052930973	0.053573859	0.121071747	0	0.174547273	0.174547273	0.174547273	0.094503321	0.174547273	0.174547273	0.174547273	0	0.174547273	0.174547273	0.168865528	0.173448893	0.177255256	0.17349107	0	0	0.174547273	0.174578006	0	0	0	0	0	0	0	0												16.7609	1.181082654	7.983580812	0	4.002780801	4.939536935	2.063558614	3.424496934	5.510540644	2.86428666	5.438344579	0	0.016199144	4.520442539	4.016948297	12.36439442	1.76895384	0.677998134	0	0	1.801871189	1.165170674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5011	150	YES	22.95229952	16.7609	1.181082654	7.983580812	0	4.002780801	4.939536935	2.063558614	3.424496934	5.510540644	2.86428666	5.438344579	0	0.016199144	4.520442539	4.016948297	12.36439442	1.76895384	0.677998134	0	0	1.801871189	1.165170674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5011	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.1137	0.0785	0.6423	0.1978	0.342	0.4221	0.1707	0.1992	0.3849	0	0.3861	0	0.001	0.2914	0.6242	2.1302	0.2982	0.1168	0	0	0.3104	0.2006	0	0.0792	0.0251	0	0	0	0	0											8.0143	150	YES	2.258813995	17.8746	1.259564406	8.625869065	0.19776599	4.344804191	5.361602808	2.234246041	3.623674462	5.895489799	2.86428666	5.824448825	0	0.017162407	4.811859756	4.641130778	14.49462493	2.067164995	0.794775286	0	0	2.112222171	1.365777447	0	0.07915896	0.02512566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5154
H0712_001_0	2012	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	1324.660617	80.69982213	1312.657457	1842.065995	719.9012404	2.976829943	7.257426122	568.8854011	276.6635432	4107.018628	947.8543506	86.77981324	0.009757843	1036.155294	6649.524565	19306.86741	28.08234399	547.12076	2720.435636	6066.417722	11.71255332	0.049515087	0	287.1428571	338.4	203.04	18	13.71428571	4277.263386	2879.518501											3250	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 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) $50.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $25.00 and $150.00 , (5) $200.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $75.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $75.00 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	140.5876531	121.600143	69.22934953	3.443192674	40.87095473	0.199969044	0.048494958	46.13202333	90.43230719	0.062338461	18.57998135	23.65035803	0.2	12.88295019	5.204162291	4.284437067	15.82359073	7.167227695	9.658729392	5.515664793	0.2	0	0	0	0	0	0	0	0	0											YES	133.0431442	115.0745817	65.51421931	3.258416864	38.67765203	0.189237887	0.04589252	43.65639016	85.57933948	0.058993124	17.58290351	22.38118302	0.189267181	12.19159835	4.924885644	4.054516639	14.97443209	6.782604924	9.140402443	5.219671647	0.189267181	0	0	0	0	0	0	0	0	0											3250	14.6864	0.773874856	7.166477378	0.500184909	2.320340806	0.563329008	0.333061573	2.069623585	1.97305694	0.020190488	1.388835965	0.161852907	0.00184684	1.052699098	2.729012339	6.523334597	0.035043096	0.309241997	2.072156378	2.638725715	2.216801954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5361	0	NO	2.809055727	14.6864	0.773874856	7.166477378	0.500184909	2.320340806	0.563329008	0.333061573	2.069623585	1.97305694	0.020190488	1.388835965	0.161852907	0.00184684	1.052699098	2.729012339	6.523334597	0.035043096	0.309241997	2.072156378	2.638725715	2.216801954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5361	YES	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	Same as in-network	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											3250	0.2327	0	0.0247	0.0114	0.0227	0.017	0.0414	0	0.0579	0.0013	0.0755	0	0	0.0138	0	0.1923	0	0.0031	0.0392	0.0512	0.0147	0.0001	0	0	0	0	0	0	0	0											0.799	0	NO	0.045311096	14.9191	0.773874856	7.191188832	0.511629378	2.34303614	0.580307634	0.374454978	2.069623585	2.030958327	0.021468167	1.464361324	0.161852907	0.00184684	1.066456376	2.729012339	6.715610009	0.035043096	0.312387963	2.111400215	2.689971945	2.231463837	8.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3351
H0712_005_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2145.456063	431.152869	1676.720499	1862.503646	30.83815841	10.42238952	14.48589962	55.31265991	42.17322028	7.661814906	20.77036991	6.171182758	0.000461353	21.99401003	6813.341113	128.2356692	3.914292576	3.111735199	23.88570361	35.79462389	18.85019263	0.316650927	1350	287.1428571	338.4	203.04	18	13.71428571	4277.263386	2722.259676											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	131.3972599	50.99679806	62.44910048	0	0.188673206	0.19682479	0.083504227	0.191104028	0.178930734	0.011149494	0.184853851	0.197009034	0.2	0.182419789	0	0.080482244	0.195954916	0.195280601	0.154957117	0.069377406	0.2	0.199992745	0	0	0	0	0	0	0	0											NO	126.5758088	49.12553707	60.15761219	0	0.181750089	0.189602561	0.080440148	0.184091715	0.172365104	0.010740378	0.17807088	0.189780044	0.192661261	0.175726133	0	0.077529053	0.188764606	0.188115034	0.149271168	0.066831693	0.192661261	0.192654272	0	0	0	0	0	0	0	0												22.6302	1.765051354	8.405625128	0	5.604838043	1.976111748	1.165247914	10.18260245	7.2691915	0.082290789	3.698598049	1.171167338	8.89E-05	3.864922324	0	9.941989976	0.738879895	0.585364174	3.565446877	2.392215315	3.631701879	0.061004154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7326	0	NO	3.379948879	22.6302	1.765051354	8.405625128	0	5.604838043	1.976111748	1.165247914	10.18260245	7.2691915	0.082290789	3.698598049	1.171167338	8.89E-05	3.864922324	0	9.941989976	0.738879895	0.585364174	3.565446877	2.392215315	3.631701879	0.061004154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7326	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	NO	0	22.6302	1.765051354	8.405625128	0	5.604838043	1.976111748	1.165247914	10.18260245	7.2691915	0.082290789	3.698598049	1.171167338	8.89E-05	3.864922324	0	9.941989976	0.738879895	0.585364174	3.565446877	2.392215315	3.631701879	0.061004154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7326
H0712_019_0	2012	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	1588.553057	145.0364423	1727.822012	1382.156152	588.7381345	6.735898871	7.994813931	544.8172751	294.3696151	4317.014065	1075.530281	131.9316972	0.058208439	1636.3339	7060.614668	16804.24412	665.6357859	2264.79338	3217.097182	4932.901637	17.43472638	0.024018347	0	0	168	0	18	13.71428571	4277.263386	2039.518501											4900	"(1a) $320 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $320 days 1 - 4, $0 days 5 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $125.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $200.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $200.00	(8b) Copay between $0.00 and $200.00	(9a) $200.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $200.00 , (5) $320.00 copayment , (9a) $200.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $100.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $100.00 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	180.3546896	70.93130826	36.77430792	0	46.12697872	0.2	0.1150935	60.62105308	144.045101	0.083117948	24.33325084	79.59408856	0.2	18.31238691	3.963708157	7.959589242	22.79795504	10.23081915	11.58677032	6.994043885	0.2	0	0	0	0	0	0	0	0	0											NO	172.5768482	67.87237773	35.18840663	0	44.13774115	0.19137495	0.110130064	58.00675489	137.8331198	0.079533466	23.28387326	76.16157344	0.19137495	17.52266061	3.792772245	7.61632995	21.81478749	9.789612501	11.08708793	6.692423981	0.19137495	0	0	0	0	0	0	0	0	0												22.8456	0.820330683	5.066608628	0	2.165464282	1.289082307	0.880469372	2.633590178	3.381156868	0.028612257	2.086875897	0.837343803	0.011139637	2.389410298	2.231608612	10.66555565	1.210058601	1.847620799	2.972353277	2.751089101	3.336569883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4506	0	NO	3.130057566	22.8456	0.820330683	5.066608628	0	2.165464282	1.289082307	0.880469372	2.633590178	3.381156868	0.028612257	2.086875897	0.837343803	0.011139637	2.389410298	2.231608612	10.66555565	1.210058601	1.847620799	2.972353277	2.751089101	3.336569883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4506	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	NO	0	22.8456	0.820330683	5.066608628	0	2.165464282	1.289082307	0.880469372	2.633590178	3.381156868	0.028612257	2.086875897	0.837343803	0.011139637	2.389410298	2.231608612	10.66555565	1.210058601	1.847620799	2.972353277	2.751089101	3.336569883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4506
H0752_002_0	2012	5																															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	1009.148816	136.805568	1012.502053	2182.541974	194.2052461	5.789351423	10.2147541	272.1474037	49.12135461	18.4291619	34.89989011	0	0.007847567	13.75666241	5323.858507	3988.611424	850.1620602	619.0615389	0	0	23.21223036	584.9799534	0	0	39.79534884	8.685714286	20.96016023	2.673398366	104.5312091	0											4950	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	63.25096818	0	200	0.2	0.095600263	63.84337363	0.15	0.321489468	0.131158126	0	0.2	0.140069437	9.016810989	29.92641433	40	30	0	0	0.2	29.23822175	0	0	0	0	30	0	0	0											NO	136.2451632	71.35969686	41.39950942	0	130.9055359	0.130905536	0.062573018	41.82147492	0.098179152	0.210423756	0.085846624	0	0.130905536	0.091679324	8.485026236	28.16364409	37.64091871	28.23068903	0	0	0.130905536	19.13722543	0	0	0	0	30	0	0	0												11.4576	0.813533655	3.493090689	0	2.118545151	0.75785815	0.639167994	0.948467151	4.822692937	3.87793346	2.996037739	0	0.00102729	1.261201505	3.764423259	9.361152713	2.666740083	1.456377816	0	0	3.038609454	0.93290777	0	0	0	0	0.052400401	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4598	0	NO	20.69215295	11.4576	0.813533655	3.493090689	0	2.118545151	0.75785815	0.639167994	0.948467151	4.822692937	3.87793346	2.996037739	0	0.00102729	1.261201505	3.764423259	9.361152713	2.666740083	1.456377816	0	0	3.038609454	0.93290777	0	0	0	0	0.052400401	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4598	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (9d, 9d1); 30% (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.441	0.0563	0	0	0	0	0	0.0146	0	0	0.0694	0	0	0	0.5801	1.7219	0.203	0	0	0	0.5241	0.1723	0	0	0	0	0	0	0	0											4.7827	0	NO	0	12.8986	0.869866855	3.493090689	0	2.118545151	0.75785815	0.639167994	0.963092411	4.822692937	3.87793346	3.065392348	0	0.001043144	1.261201505	4.344496519	11.08304272	2.869733083	1.456377816	0	0	3.562756591	1.105165206	0	0	0	0	0.052400401	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2425
H0752_801_0	2012	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	215.0656391	7.4374	30.53823006	2292.863779	8.937429788	6.08198804	10.73108328	14.16609637	51.33151519	19.2583615	36.83855732	0	0.008283494	14.35253385	33.53079156	86.12537245	3.4933	3.901562975	0	0	26.22101943	8.902407514	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.067028004	0.067028004	0.154629223	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.046789206	0.046789206	0.10793964	0	0.15636423	0.15636423	0.15636423	0.15636423	0.15636423	0.15636423	0.15636423	0	0.15636423	0.15636423	0.15636423	0.15636423	0.15636423	0.15636423	0	0	0.15636423	0.15636423	0	0	0	0	0	0	0	0												10.0628	0.347990041	3.296285562	0	1.397494324	0.951005374	1.677957571	2.215070746	8.026412828	3.011318859	5.760232636	0	0.001295242	2.244222899	5.243016391	13.46692751	0.546227163	0.610064889	0	0	4.100029502	1.392018093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	150	YES	27.834905	10.0628	0.347990041	3.296285562	0	1.397494324	0.951005374	1.677957571	2.215070746	8.026412828	3.011318859	5.760232636	0	0.001295242	2.244222899	5.243016391	13.46692751	0.546227163	0.610064889	0	0	4.100029502	1.392018093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	NO																																										0	0	0	0	0	0	0	0	0	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	10.0628	0.347990041	3.296285562	0	1.397494324	0.951005374	1.677957571	2.215070746	8.026412828	3.011318859	5.760232636	0	0.001295242	2.244222899	5.243016391	13.46692751	0.546227163	0.610064889	0	0	4.100029502	1.392018093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503
H0752_802_0	2012	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	215.0656391	7.4381	30.53823006	2292.863779	8.937429788	6.08198804	10.73108328	14.16609637	51.33151519	19.2583615	36.83855732	0	0.008283494	14.35153385	33.53079156	86.12537245	3.4937	3.901562975	0	0	26.22101943	8.902407514	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.067028004	0.067028004	0.154629223	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.046789219	0.046789219	0.107939669	0	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0	0	0.156364272	0.156364272	0	0	0	0	0	0	0	0												10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	150	YES	27.83486135	10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	NO																																										0	0	0	0	0	0	0	0	0	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	10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503
H0752_803_0	2012	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	215.0656391	7.4381	30.53823006	2292.863779	8.937429788	6.08198804	10.73108328	14.16609637	51.33151519	19.2583615	36.83855732	0	0.008283494	14.35153385	33.53079156	86.12537245	3.4937	3.901562975	0	0	26.22101943	8.902407514	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.067028004	0.067028004	0.154629223	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.046789219	0.046789219	0.107939669	0	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0.156364272	0	0	0.156364272	0.156364272	0	0	0	0	0	0	0	0												10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	150	YES	27.83486135	10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503	NO																																										0	0	0	0	0	0	0	0	0	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	10.0628	0.348022886	3.296286445	0	1.397494698	0.951005629	1.67795802	2.215071339	8.026414978	3.011319666	5.760234179	0	0.001295243	2.244067136	5.243017796	13.46693112	0.546289855	0.610065052	0	0	4.100030601	1.392018466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3503
H0755_030_0	2012	7																															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	863.3388643	91.44989047	1528.063619	887.3032986	289.4263467	12.81791772	6.599363385	288.5021916	56.70388365	30.55111525	48.74821184	0	0.114026726	28.13012457	7377.128636	7713.103351	614.3320841	410.0973796	0	0	46.59794637	1353.212057	0	0	42.79069767	0	19.08840036	2.07930984	160.3920985	0											3400	"$175 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$25 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); $0/20% (11c)"	"$65 (4a, 4a1); $20 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $20 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	145.7068777	106.6104145	49.52985871	0	200	0.2	0.174526349	63.36028057	0.16	0.04619463	0.172889934	0	0.2	0.143258845	6.305527841	20	38.5	20	0	0	0.2	19.822926	0	0	20	0	20	0	0	0											NO	106.1160237	77.64268547	36.07181586	0	145.6568494	0.145656849	0.127104791	46.17697046	0.11652548	0.033642822	0.125913015	0	0.145656849	0.10433316	6.010298907	19.06601504	36.69740484	19.06358693	0	0	0.145656849	14.43672473	0	0	20	0	20	0	0	0												7.6345	0.591701257	4.593335791	0	3.513077484	1.867017511	0.838810701	1.110179765	6.607447233	1.027825722	6.138034333	0	0.016608774	2.934904798	3.694895681	12.25484537	1.878699433	0.65149392	0	0	6.787310058	1.627995831	0	0	0.071317829	0	0.031814001	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8718	0	NO	17.80182128	7.6345	0.591701257	4.593335791	0	3.513077484	1.867017511	0.838810701	1.110179765	6.607447233	1.027825722	6.138034333	0	0.016608774	2.934904798	3.694895681	12.25484537	1.878699433	0.65149392	0	0	6.787310058	1.627995831	0	0	0.071317829	0	0.031814001	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8718	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.6345	0.591701257	4.593335791	0	3.513077484	1.867017511	0.838810701	1.110179765	6.607447233	1.027825722	6.138034333	0	0.016608774	2.934904798	3.694895681	12.25484537	1.878699433	0.65149392	0	0	6.787310058	1.627995831	0	0	0.071317829	0	0.031814001	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8718
H0755_031_0	2012	6																															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	722.3507244	94.33998054	649.2685092	389.9817768	155.6182622	6.666235187	4.696728883	247.7191092	47.18419224	27.27346235	39.39982778	0	0.006778967	23.92152944	6085.316445	6548.702926	633.5637413	275.429549	0	0	20.70166484	1086.106677	0	0	42.79069767	0	17.85977834	0	160.3920985	0											5600	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-66 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$250 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $30 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	69.46198633	0	250	0.2	0.181018099	63.99625306	0.16	0.090840008	0.169214439	0	0.2	0.14403322	8.691278891	30.88844555	38.5	35	0	0	0.2	34.83255895	0	0	35	0	35	0	0	0											NO	161.1190288	84.38761997	58.32153148	0	209.9044908	0.167923593	0.151986047	53.75138695	0.134338874	0.076270902	0.142075483	0	0.167923593	0.120932879	8.461107534	30.07240602	37.48040353	34.07309412	0	0	0.167923593	29.2460422	0	0	35	0	35	0	0	0												9.6987	0.663427202	3.155527816	0	2.722081007	1.119418162	0.713837259	1.109603808	6.338671261	2.080171584	5.597749549	0	0.001138349	2.892899423	4.290709735	16.41127111	1.978852057	0.782061412	0	0	3.476297934	2.647026809	0	0	0.124806202	0	0.05209102	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8563	0	NO	8.700811491	9.6987	0.663427202	3.155527816	0	2.722081007	1.119418162	0.713837259	1.109603808	6.338671261	2.080171584	5.597749549	0	0.001138349	2.892899423	4.290709735	16.41127111	1.978852057	0.782061412	0	0	3.476297934	2.647026809	0	0	0.124806202	0	0.05209102	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8563	NO																																										0	0	0	0	0	0	0	0	0	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	9.6987	0.663427202	3.155527816	0	2.722081007	1.119418162	0.713837259	1.109603808	6.338671261	2.080171584	5.597749549	0	0.001138349	2.892899423	4.290709735	16.41127111	1.978852057	0.782061412	0	0	3.476297934	2.647026809	0	0	0.124806202	0	0.05209102	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8563
H0755_032_0	2012	4																															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	1024.364566	38.54447967	1209.661626	625.9495655	232.5797029	6.769875394	3.609253789	257.6982963	48.00036692	23.82591172	44.76722561	0	0.028656599	21.10956725	5016.949711	6756.340237	407.5464507	250.0777234	0	0	32.72278611	952.0646381	0	0	42.79069767	0	18.95679586	0	160.3920985	0											5200	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 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); $0/20% (11c)"	"$65 (4a, 4a1); $30 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	68.8989462	0	200	0.2	0.163533356	63.73361951	0.16	0.047522388	0.172537651	0	0.2	0.139616161	10.07677217	31.93899723	38.5	35	0	0	0.2	34.61794209	0	0	35	0	35	0	0	0											NO	159.1996033	83.38230266	57.159635	0	165.9231038	0.165923104	0.13566981	52.89832123	0.132738483	0.03942531	0.143139913	0	0.165923104	0.115827734	9.791946884	31.03827289	37.41177719	34.01070653	0	0	0.165923104	28.71958199	0	0	35	0	35	0	0	0												13.5899	0.267827289	5.761984753	0	3.215862181	1.123278738	0.489666776	1.135983938	6.371495889	0.939343964	6.407976773	0	0.004754792	2.44507333	4.093808758	17.47542767	1.270586417	0.708776672	0	0	5.429466236	2.278574869	0	0	0.124806202	0	0.055290655	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1899	0	NO	10.84138508	13.5899	0.267827289	5.761984753	0	3.215862181	1.123278738	0.489666776	1.135983938	6.371495889	0.939343964	6.407976773	0	0.004754792	2.44507333	4.093808758	17.47542767	1.270586417	0.708776672	0	0	5.429466236	2.278574869	0	0	0.124806202	0	0.055290655	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1899	NO																																										0	0	0	0	0	0	0	0	0	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	13.5899	0.267827289	5.761984753	0	3.215862181	1.123278738	0.489666776	1.135983938	6.371495889	0.939343964	6.407976773	0	0.004754792	2.44507333	4.093808758	17.47542767	1.270586417	0.708776672	0	0	5.429466236	2.278574869	0	0	0.124806202	0	0.055290655	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1899
H0755_807_0	2012	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	240.4474246	7.2687225	49.09223249	734.8672319	11.27590262	12.04223134	6.508811498	13.70093416	47.73527683	30.20113642	43.74083561	0	0.113041885	22.26800561	42.28548213	114.5929392	3.0904125	3.926392915	0	0	43.22706181	13.63495911	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.068029464	0.068029464	0.155562222	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05418057	0.05418057	0.123894109	0	0.178399872	0.178399872	0.178399872	0.178399872	0.178399872	0.178399872	0.178399872	0	0.178399872	0.178399872	0.178399872	0.178399872	0.178399872	0.178399872	0	0	0.178399872	0.178399872	0	0	0	0	0	0	0	0												13.0276	0.393823527	6.082238399	0	2.011619582	2.148332528	1.161171137	2.444244898	8.515967269	5.387878866	7.803359468	0	0.020166658	3.972609348	7.543724593	20.44336566	0.551329194	0.700467993	0	0	7.711702288	2.432474959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3521	150	YES	23.60576547	13.0276	0.393823527	6.082238399	0	2.011619582	2.148332528	1.161171137	2.444244898	8.515967269	5.387878866	7.803359468	0	0.020166658	3.972609348	7.543724593	20.44336566	0.551329194	0.700467993	0	0	7.711702288	2.432474959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3521	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.4194	0.0127	0.4875	0	0.3122	0.3334	0.1802	0.3793	1.3216	0.8361	1.211	0	0.0031	0.6165	1.2184	3.667	0.0989	0.1256	0	0	1.3833	0.4363	0	0	0	0	0	0	0	0											13.0425	150	YES	0	13.447	0.406502688	6.569699894	0	2.32379738	2.481726438	1.341370143	2.823560648	9.837537181	6.224009205	9.014341704	0	0.023296267	4.58910784	8.762143521	24.11033971	0.650222394	0.826112566	0	0	9.094968265	2.86879365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3945
H0755_808_0	2012	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	246.1321433	7.2548775	50.25288344	743.5034434	11.54249035	12.32693681	6.662694462	14.0248551	48.86384629	30.9151593	44.77496749	0	0.11571445	22.79403796	43.28520617	117.3021743	3.088575	4.019221687	0	0	44.24904691	13.95732026	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.066001716	0.066001716	0.141237196	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.052402699	0.052402699	0.112136634	0	0.17784696	0.17784696	0.17784696	0.17784696	0.17784696	0.17784696	0.17784696	0	0.17784696	0.17784696	0.17784696	0.17784696	0.17784696	0.17784696	0	0	0.17784696	0.17784696	0	0	0	0	0	0	0	0												12.898	0.380175164	5.635189184	0	2.052796823	2.192308242	1.184939958	2.494277848	8.690286532	5.49816711	7.963091866	0	0.020579463	4.053850365	7.698142343	20.86183515	0.549293675	0.71480636	0	0	7.86955849	2.482266982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2396	150	YES	24.19658363	12.898	0.380175164	5.635189184	0	2.052796823	2.192308242	1.184939958	2.494277848	8.690286532	5.49816711	7.963091866	0	0.020579463	4.053850365	7.698142343	20.86183515	0.549293675	0.71480636	0	0	7.86955849	2.482266982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2396	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.4165	0.0123	0.453	0	0.3196	0.3413	0.1845	0.3883	1.3528	0.8559	1.2396	0	0.0032	0.6311	1.2472	3.7537	0.0988	0.1286	0	0	1.416	0.4466	0	0	0	0	0	0	0	0											13.289	150	YES	0	13.3145	0.392452969	6.088225971	0	2.372355208	2.533584335	1.369399274	2.882561477	10.04310133	6.354065453	9.202704449	0	0.023783063	4.68491227	8.94536744	24.61550472	0.648128075	0.843421454	0	0	9.285527992	2.92890123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5285
H0755_810_0	2012	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	247.7449346	7.4456	52.46554617	828.2598567	12.72771903	13.59271556	7.346846348	15.46498283	53.88137978	34.08965044	49.37263869	0	0.127596469	25.13550356	47.94395566	131.5646078	3.504	4.507907272	0	0	49.62916104	15.65435062	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.067441484	0.067441484	0.149481411	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.053427709	0.053427709	0.118420427	0	0.177454678	0.177454678	0.177454678	0.177454678	0.177454678	0.177454678	0.177454678	0	0.177454678	0.177454678	0.177454678	0.177454678	0.177454678	0.177454678	0	0	0.177454678	0.177454678	0	0	0	0	0	0	0	0												13.2364	0.39780135	6.212992363	0	2.258593277	2.412090958	1.30373225	2.744333543	9.561502881	6.049367931	8.761405684	0	0.02264259	4.460412681	8.507879197	23.34675506	0.621801191	0.799949232	0	0	8.806926775	2.777937742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2826	150	YES	26.82811862	13.2364	0.39780135	6.212992363	0	2.258593277	2.412090958	1.30373225	2.744333543	9.561502881	6.049367931	8.761405684	0	0.02264259	4.460412681	8.507879197	23.34675506	0.621801191	0.799949232	0	0	8.806926775	2.777937742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2826	NO																																										0	0	0	0	0	0	0	0	0	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	13.2364	0.39780135	6.212992363	0	2.258593277	2.412090958	1.30373225	2.744333543	9.561502881	6.049367931	8.761405684	0	0.02264259	4.460412681	8.507879197	23.34675506	0.621801191	0.799949232	0	0	8.806926775	2.777937742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2826
H0755_811_0	2012	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	260.0855106	7.4382	69.28772964	1168.5025	13.5031956	15.22063938	7.697043804	16.92975702	50.64223351	31.3881077	52.79911784	0	0.050818447	24.17815864	51.97448813	145.2575586	3.4908	5.418397132	0	0	57.06133432	16.42013754	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.067450487	0.067450487	0.148417973	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.052350723	0.052350723	0.115192471	0	0.173854372	0.173854372	0.173854372	0.173854372	0.173854372	0.173854372	0.173854372	0	0.173854372	0.173854372	0.173854372	0.173854372	0.173854372	0.173854372	0	0	0.173854372	0.173854372	0	0	0	0	0	0	0	0												13.6157	0.38939515	7.981424773	0	2.347589594	2.646174704	1.338164718	2.943312278	8.804373711	5.456959757	9.179357483	0	0.008835009	4.20347859	9.035992003	25.25366165	0.606890842	0.942012032	0	0	9.920362454	2.854712703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5284	150	YES	31.01490724	13.6157	0.38939515	7.981424773	0	2.347589594	2.646174704	1.338164718	2.943312278	8.804373711	5.456959757	9.179357483	0	0.008835009	4.20347859	9.035992003	25.25366165	0.606890842	0.942012032	0	0	9.920362454	2.854712703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5284	NO																																										0	0	0	0	0	0	0	0	0	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	13.6157	0.38939515	7.981424773	0	2.347589594	2.646174704	1.338164718	2.943312278	8.804373711	5.456959757	9.179357483	0	0.008835009	4.20347859	9.035992003	25.25366165	0.606890842	0.942012032	0	0	9.920362454	2.854712703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5284
H0755_812_0	2012	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	235.3325535	7.4639	39.32180999	559.5866278	10.87099759	12.03523713	6.234029433	13.69399908	47.27679999	33.47790251	43.97702892	0	0.080404768	22.46954427	43.70603892	116.7454854	3.5246	3.965812642	0	0	42.09490635	13.48514244	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.068562516	0.068562516	0.152773926	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056150492	0.056150492	0.125116924	0	0.183448785	0.183448785	0.183448785	0.183448785	0.183448785	0.183448785	0.183448785	0	0.183448785	0.183448785	0.183448785	0.183448785	0.183448785	0.183448785	0	0	0.183448785	0.183448785	0	0	0	0	0	0	0	0												13.214	0.419101656	4.919823927	0	1.994271298	2.207849628	1.143625125	2.512147491	8.672871512	6.141480537	8.06753252	0	0.014750157	4.122010593	8.017819732	21.41681743	0.646583587	0.72752351	0	0	7.72225942	2.473832995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4343	150	YES	20.87463935	13.214	0.419101656	4.919823927	0	1.994271298	2.207849628	1.143625125	2.512147491	8.672871512	6.141480537	8.06753252	0	0.014750157	4.122010593	8.017819732	21.41681743	0.646583587	0.72752351	0	0	7.72225942	2.473832995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4343	NO																																										0	0	0	0	0	0	0	0	0	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	13.214	0.419101656	4.919823927	0	1.994271298	2.207849628	1.143625125	2.512147491	8.672871512	6.141480537	8.06753252	0	0.014750157	4.122010593	8.017819732	21.41681743	0.646583587	0.72752351	0	0	7.72225942	2.473832995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4343
H0838_020_0	2012	10																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	4056.421854	835.3657616	836.7777387	72.14047977	30.61194267	4.528222584	1.101851595	31.14738077	13.79188892	7.393296269	4.301464726	0.137118973	0.014181012	132.8354037	44344.79192	56200.89317	16631.16758	0	3000.513583	0	13.24292489	0	5209.045636	1526.408182	0	223.9593017	0	0	0	841.2821136											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $65,4a2: 20.0%, 4b:$0"	"9a1: 20.0%,9b: 20.0%"	$0 	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b6: 20.0%"	$0 	12: 20.0%	"3:$0, 5:$0, 9a2: 0-20.0%"	$0 	"7b1: 20.0%,16b1: $05,18a1: 20.0%"	$0 	$0 	$0 	$0 	"152: 20.0%, 153: 0%"	$0 	$0 	16b3. $0-$8; 16b5: $5-$450; 16b6: $0-$1900	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	42.71865533	36.37308093	35.10709913	0	0.2	0.2	0.2	0.232286835	0.2	0	0.194927696	0	0.2	0.000724755	0	0.03117206	0	0	0	0	0.051196105	0	0	4.55053791	0	0	0	0	0	0											NO	41.40532956	35.25484104	34.02778009	0	0.193851278	0.193851278	0.193851278	0.225145499	0.193851278	0	0.188934915	0	0.193851278	0.000702473	0	0.030213718	0	0	0	0	0.049622152	0	0	4.410637938	0	0	0	0	0	0												13.9965	2.454223928	2.372807407	0	5.934164197	0.877801733	0.213595339	7.012692582	2.673575288	0	0.812696872	0	0.002749007	0.09331333	0	0.141503162	0	0	0	0	0.657142432	0	0	0.561036153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8038	0	NO	1.199088392	13.9965	2.454223928	2.372807407	0	5.934164197	0.877801733	0.213595339	7.012692582	2.673575288	0	0.812696872	0	0.002749007	0.09331333	0	0.141503162	0	0	0	0	0.657142432	0	0	0.561036153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8038	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	13.9965	2.454223928	2.372807407	0	5.934164197	0.877801733	0.213595339	7.012692582	2.673575288	0	0.812696872	0	0.002749007	0.09331333	0	0.141503162	0	0	0	0	0.657142432	0	0	0.561036153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8038
H0838_022_0	2012	11																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	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	824.1285326	117.196721	170.6987974	1.163321792	851.3865809	4.484487922	1.424523971	518.7125238	209.4906081	773.7047898	1.595466167	0.545296488	1.956138912	5370.581771	47761.03864	10696.95142	15866.41021	2211.568014	2494.773199	5767.234237	18.59934768	0	0	0.126558999	618.0159648	618.0159648	0	0.071479838	0.050666757	832.7662325											3400	$100 days 1-3;$0 days 4-90	$100 days 1-8;$0 days 9-90	$0 days 1-20;$75 days 21-100	$0 	10a: $50	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"9a1: $50,9b: $25"	$0 	"8b3: 10.0%,8b4: 10.0%"	9c1: $15	12: $05	9a2: $50	7a: $0	"7b1: $05,7d1: $08,7f1: $05,7f2: $05,16b1: $05"	"7e1: $15,7h1: $10"	"7c: $10,7i: $10"	$0 	7g: $10	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $150,16a2: $150,16a3: $150"	17a2: $08	$0 	$0 	$0 	$0 	$0 											0	NO	47.86400256	56.21055872	7.797714694	0	50	0.2	0.193318894	49.6451634	33.80270907	0	0.029772607	15	5	0.037235701	0	6.403541728	10.05390782	10	0	10	0.199965591	0	0	0	7.5	0	0	0	0	0											NO	46.47297961	54.57696828	7.571097622	0	48.54690072	0.194187603	0.187700663	48.20237638	32.82033523	0	0.028907356	14.56407022	4.854690072	0.036153557	0	6.217442091	9.761721299	9.709380145	0	9.709380145	0.194154194	0	0	0	7.282035109	0	0	0	0	0												3.1916	0.533020144	0.107698105	0	3.444348318	0.87083196	0.267384094	2.083598026	0.572962665	0	0.046120708	0.000661811	0.000791371	0.01618047	0	5.542306332	12.90695621	1.78941288	0	4.6663558	3.61114135	0	0	0	0.375034496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0264	0	NO	1.198066209	3.1916	0.533020144	0.107698105	0	3.444348318	0.87083196	0.267384094	2.083598026	0.572962665	0	0.046120708	0.000661811	0.000791371	0.01618047	0	5.542306332	12.90695621	1.78941288	0	4.6663558	3.61114135	0	0	0	0.375034496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0264	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	3.1916	0.533020144	0.107698105	0	3.444348318	0.87083196	0.267384094	2.083598026	0.572962665	0	0.046120708	0.000661811	0.000791371	0.01618047	0	5.542306332	12.90695621	1.78941288	0	4.6663558	3.61114135	0	0	0	0.375034496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0264
H0838_023_0	2012	11																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	1210.281116	221.6847771	607.6098247	10.02027966	29.14869376	7.477196557	2.325741841	27.39015036	15.54949417	6.818751385	1.816220709	0.21724496	0	139.8299845	47979.14238	39551.79992	17934.29889	562.2315776	2172.732055	6989.954111	7.754806227	0	5181.89006	1614.236312	0	230.5966406	0	0	0	830.7638105											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $65,4a2: 20.0%, 4b:$0"	"9a1: 20.0%,9b: 20.0%"	$0 	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b6: 20.0%"	$0 	12: 20.0%	"3:$0, 5:$0, 9a2: 0-20.0%"	$0 	"7b1: 20.0%,16b1: $05,18a1: 20.0%"	$0 	$0 	$0 	$0 	"152: 20.0%, 153: 0%"	$0 	$0 	16b3. $0-$8; 16b5: $5-$450; 16b6: $0-$1900	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	144.2868416	58.39390449	75.94726995	0	0.2	0.2	0.198131716	0.141272302	0.2	0	0.185058305	0	0	0.00019562	0	0.040159329	0	0	0	0	0.020893066	0	0	4	0	0	0	0	0	0											NO	140.484455	56.85505176	73.94583394	0	0.194729406	0.194729406	0.192910358	0.137549357	0.194729406	0	0.180181469	0	0	0.000190465	0	0.039101011	0	0	0	0	0.020342471	0	0	3.894588126	0	0	0	0	0	0												14.1688	1.050324956	3.7441846	0	5.676107831	1.456030046	0.44865969	3.767497581	3.027943769	0	0.327249316	0	0	0.026632738	0	0.128876281	0	0	0	0	0.157751923	0	0	0.523898798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.504	0	NO	0.933892735	14.1688	1.050324956	3.7441846	0	5.676107831	1.456030046	0.44865969	3.767497581	3.027943769	0	0.327249316	0	0	0.026632738	0	0.128876281	0	0	0	0	0.157751923	0	0	0.523898798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.504	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	14.1688	1.050324956	3.7441846	0	5.676107831	1.456030046	0.44865969	3.767497581	3.027943769	0	0.327249316	0	0	0.026632738	0	0.128876281	0	0	0	0	0.157751923	0	0	0.523898798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.504
H0901_004_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1805.745754	91.9808464	1329.368172	892.0103272	277.5171516	11.97724781	0	390.6053775	375.02968	2860.242046	2473.092164	87.81978547	0.058098061	620.3662232	2621.566981	5725.371117	282.2602902	712.2954538	0	0	69.13380291	0.00484985	0	0	1184.118997		40.0587027		0	0											6700	$250/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $40 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 250 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	98.56078618	71.93854446	0	150	0.03	0.03	63.5	250	4	18.57427492	40	0.2	40	10	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	166.3335408	90.71784952	66.21406245	0	138.0638077	0.027612762	0	58.44701192	230.1063461	3.681701538	17.09623414	36.81701538	0.184085077	36.81701538	9.204253846	36.81701538	36.81701538	18.40850769	0	0	0.092042538	0	0	0	0	0	0	0	0	0												25.0297	0.695358715	7.335238931	0	3.192922888	0.330724888	0	1.90247643	7.191392446	0.877546462	3.523380223	0.269438533	0.010694986	1.903336065	2.01079733	17.56592304	0.865998454	1.092691362	0	0	6.363250714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1608	0	NO	7.480369155	25.0297	0.695358715	7.335238931	0	3.192922888	0.330724888	0	1.90247643	7.191392446	0.877546462	3.523380223	0.269438533	0.010694986	1.903336065	2.01079733	17.56592304	0.865998454	1.092691362	0	0	6.363250714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1608	NO																																																																																		0		NO		25.0297	0.695358715	7.335238931	0	3.192922888	0.330724888	0	1.90247643	7.191392446	0.877546462	3.523380223	0.269438533	0.010694986	1.903336065	2.01079733	17.56592304	0.865998454	1.092691362	0	0	6.363250714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1608
H0901_801_0	2012	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	0	0	0	0	0	0	0											0	YES	362.3311149	6.665564253	44.24545558	11.53304886	10.79873534	14.97264606	0	18.75705287	46.41586984	22.50833025	62.87983516	1.052524699	0.091921494	30.88853062	31.14992235	155.3028386	3.559456485	9.866768581	0	0	77.96763239	0.000405854	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	NO	0.070754255	0.070754255	0.150855138	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058845016	0.058845016	0.125463452	0	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0	0	0	0	0	0	0	0												21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446	0	NO	23.8497547	21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446
H0901_802_0	2012	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	0	0	0	0	0	0	0											0	YES	362.3311149	6.665564253	44.24545558	11.53304886	10.79873534	14.97264606	0	18.75705287	46.41586984	22.50833025	62.87983516	1.052524699	0.091921494	30.88853062	31.14992235	155.3028386	3.559456485	9.866768581	0	0	77.96763239	0.000405854	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	NO	0.070754255	0.070754255	0.150855138	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058845016	0.058845016	0.125463452	0	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0	0	0	0	0	0	0	0												21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446	0	NO	23.8497547	21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.3214	0.392235236	5.551187587	0	2.011768673	2.789354432	0	3.494376903	8.647123012	4.19322747	11.71430529	0.19608187	0.01712467	5.754431078	5.803127494	28.93240511	0.663114969	1.838146348	0	0	14.52511201	7.56E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8446
H0908_001_0	2012	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	249.3979211	7.087229068	51.00031825	0	19.59975378	9.439945194	8.30157688	42.28042714	22.59242011	9.609143222	20.76938548	0	1.778394547	27.89160294	26.24091989	39.10433828	3.523387381	4.675468249	9.916535922	43.14451935	18.34703447	15.20518744	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost Sharing; PBP 13a-e											0	YES	0.081778571	0.081778571	0.174279813	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079902934	0.079902934	0.17028261	0	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0.218862437	0	0	0	0	0	0	0	0												19.9276	0.566290397	8.684467298	0	4.289649873	2.066049408	1.816903345	9.253597312	4.944632119	2.103080501	4.545638317	0	0.389223764	6.104424185	5.743151671	8.558470765	0.771137148	1.023284374	2.170357217	9.44271464	4.015476672	3.327844374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.744	0	NO	2.341384888	19.9276	0.566290397	8.684467298	0	4.289649873	2.066049408	1.816903345	9.253597312	4.944632119	2.103080501	4.545638317	0	0.389223764	6.104424185	5.743151671	8.558470765	0.771137148	1.023284374	2.170357217	9.44271464	4.015476672	3.327844374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.744	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	YES	0	19.9276	0.566290397	8.684467298	0	4.289649873	2.066049408	1.816903345	9.253597312	4.944632119	2.103080501	4.545638317	0	0.389223764	6.104424185	5.743151671	8.558470765	0.771137148	1.023284374	2.170357217	9.44271464	4.015476672	3.327844374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.744
H0913_002_0	2012	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	1751.535488	118.0249475	854.9963906	412.3723003	422.9102848	3.201404674	7.653454788	388.3668246	207.3139119	464.929982	858.4780127	67.42095057	1.181924986	316.6548807	7768.60128	17558.9651	120.0944311	900.1212783	2706.326806	6005.591867	13.24502411	0.000583837	0	287.1428571	422.4	253.44	16.2	12.34285714	4821.723845	2039.518501											5000	"(1a) $250 days 1 - 6, $0 after day 6, unlimited coverage"	"(1b) $250 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $200.00 copayment , (9b) $150.00 copayment"	(8a) Copay between $0.00 and $200.00	(8b) Copay between $0.00 and $200.00	(9a) $200.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $200.00 , (5) $250.00 copayment , (9a) $200.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	147.6181096	91.06082171	51.56983006	0	38.40687065	0.19999119	0.045443642	64.89144552	125.8731202	0.225328835	20.66275201	56.63643455	0.2	24.4004442	7.676584074	5.286704408	23.8927821	8.054479811	8.802762117	6.566234241	0.2	0	0	0	0	0	0	0	0	0											NO	144.1638681	88.93001216	50.36310379	0	37.50815565	0.195311427	0.044380268	63.37299544	122.9277081	0.220056174	20.17924672	55.31115049	0.19532003	23.82947747	7.49695316	5.16299632	23.33369459	7.866006194	8.596778806	6.412585346	0.19532003	0	0	0	0	0	0	0	0	0												21.0423	0.874663335	3.588355996	0	1.321882066	0.625270914	0.339662372	2.050997417	2.123718671	0.008525893	1.443619968	0.310760862	0.230853624	0.628810029	4.853403326	7.554739348	0.233520565	0.590029963	1.938807744	3.209280867	2.587018508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5563	0	NO	1.331157147	21.0423	0.874663335	3.588355996	0	1.321882066	0.625270914	0.339662372	2.050997417	2.123718671	0.008525893	1.443619968	0.310760862	0.230853624	0.628810029	4.853403326	7.554739348	0.233520565	0.590029963	1.938807744	3.209280867	2.587018508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5563	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	NO	0	21.0423	0.874663335	3.588355996	0	1.321882066	0.625270914	0.339662372	2.050997417	2.123718671	0.008525893	1.443619968	0.310760862	0.230853624	0.628810029	4.853403326	7.554739348	0.233520565	0.590029963	1.938807744	3.209280867	2.587018508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5563
H0913_003_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2295.123468	418.9688908	909.1472285	435.580951	19.35225128	8.146595924	11.7052205	33.42787771	23.54774262	1.856180529	11.27113428	4.223748017	0.015926625	12.42302564	8946.380245	142.698974	5.8376406	7.384395558	23.62960066	43.63291017	8.28109656	0.003085317	540	424.2857143	422.4	253.44	16.2	12.34285714	4821.723845	4707.095528											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) 20% coinsurance; (7b) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	113.7603114	48.14094362	42.89266052	0	0.189718366	0.199999518	0.2	0.190531595	0.180571068	0.033332132	0.172186433	0.199999703	0.2	0.176864708	0	0.076537563	0.212679787	0.182554246	0.158291354	0.118305922	0.2	0.197387291	0	0	0	0	0	0	0	0											NO	111.2169394	47.06464267	41.93369695	0	0.185476778	0.195528071	0.195528542	0.186271825	0.176533989	0.032586916	0.168336811	0.195528252	0.195528542	0.172910492	0	0.074826391	0.207924844	0.178472828	0.154752388	0.115660922	0.195528542	0.192974247	0	0	0	0	0	0	0	0												21.2714	1.643218428	3.17699203	0	3.589393217	1.592888184	2.288704703	6.226671799	4.156976934	0.060487199	1.897346803	0.825862066	0.00311411	2.148071479	0	10.67764921	1.213790509	1.317913961	3.65673714	5.046622638	1.61919074	0.000595387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4136	0	NO	1.655995524	21.2714	1.643218428	3.17699203	0	3.589393217	1.592888184	2.288704703	6.226671799	4.156976934	0.060487199	1.897346803	0.825862066	0.00311411	2.148071479	0	10.67764921	1.213790509	1.317913961	3.65673714	5.046622638	1.61919074	0.000595387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4136	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	NO	0	21.2714	1.643218428	3.17699203	0	3.589393217	1.592888184	2.288704703	6.226671799	4.156976934	0.060487199	1.897346803	0.825862066	0.00311411	2.148071479	0	10.67764921	1.213790509	1.317913961	3.65673714	5.046622638	1.61919074	0.000595387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4136
H0979_021_0	2012	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	1422.483909	80.91882151	1416.593111	18.39684656	473.2541285	28.42618924	7.121761937	486.5848008	271.6411222	499.2616297	17.67189429	8.395939774	0.00843679	528.5607088	11206.81841	4308.451565	415.0736192	1227.774336	3763.710253	66.05796615	7.311054576	1.319766761	0	0	494.1919146	21.13689988	22.11050342	0	94.6563987	0												$265 days 1-5;$0 days 6-90	$250 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $265,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											0	NO	171.8369891	107.511159	70.37195739	20	100	0.2	0.200042413	64.0519633	175.7132779	15	0.2	118.69224	0.2	36.84266102	13.06768019	27.33794104	39.99731107	40	0	40	0.197072114	0	0	0	0	2.010315652	0	0	0	0											NO	138.6118366	86.72358197	56.76534671	16.13294523	80.66472614	0.161329452	0.161363665	51.66734078	141.7386344	12.09970892	0.161329452	95.74277033	0.161329452	29.71903161	10.54100844	22.05207527	32.26372144	32.26589046	0	32.26589046	0.158967681	0	0	0	0	2.010315652	0	0	0	0												16.4311	0.584797504	6.701116591	0.024732943	3.181242889	4.58598154	1.149193606	2.095045227	3.208503476	0.503410033	2.850997026	0.066987544	0.001361103	1.309026034	9.844263957	7.91752485	1.115984969	3.301269353	0	0.177618258	1.162221393	0	0	0	0	0.003540987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2159	0	NO	15.87105516	16.4311	0.584797504	6.701116591	0.024732943	3.181242889	4.58598154	1.149193606	2.095045227	3.208503476	0.503410033	2.850997026	0.066987544	0.001361103	1.309026034	9.844263957	7.91752485	1.115984969	3.301269353	0	0.177618258	1.162221393	0	0	0	0	0.003540987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2159	YES	"$265 days 1-5;$0 days 6-90,1a2: $172"	"$250 days 1-5;$0 days 6-90,1b2: $108"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $265,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	16.4311	0.584797504	6.701116591	0.024732943	3.181242889	4.58598154	1.149193606	2.095045227	3.208503476	0.503410033	2.850997026	0.066987544	0.001361103	1.309026034	9.844263957	7.91752485	1.115984969	3.301269353	0	0.177618258	1.162221393	0	0	0	0	0.003540987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2159
H0979_022_0	2012	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	1475.18258	40.29354055	1035.807447	13.5258127	392.4285035	27.23048817	6.556298164	409.0292732	316.4414754	534.3051845	26.00374123	7.016820167	0.029163624	464.8215506	12912.85437	4535.495102	286.0690718	1132.89854	4022.196165	72.00488569	17.46200039	0.513425866	0	0	471.1380691	25.0917239	19.81259102	0	93.00000915	0												$265 days 1-5;$0 days 6-90	$250 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $148	12: 20.0%	"31: $148,5: $265,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											0	NO	171.8369891	107.511159	70.37195739	20	100	0.2	0.199900262	63.93933054	173.9048134	15	0.2	147.5	0.2	48.98289254	12.84537736	28.86073681	39.96880351	45	0	45	0.198452381	0	0	0	0	2.354695134	0	0	0	0											NO	136.8901675	85.64640618	56.060276	15.93256123	79.66280615	0.159325612	0.159246158	50.93586494	138.5374544	11.94942092	0.159325612	117.5026391	0.159325612	39.02114673	10.23298807	22.99127282	31.84027046	35.84826277	0	35.84826277	0.158092735	0	0	0	0	2.354695134	0	0	0	0												16.8282	0.287583078	4.838970945	0.017958403	2.605162983	4.338514201	1.044065295	1.736188318	3.653249705	0.532053129	4.143061993	0.068707907	0.004646512	1.511489161	11.01142372	8.689733772	0.759043051	3.384370379	0	0.215104172	2.760615409	0	0	0	0	0.004923613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.435	0	NO	17.46958762	16.8282	0.287583078	4.838970945	0.017958403	2.605162983	4.338514201	1.044065295	1.736188318	3.653249705	0.532053129	4.143061993	0.068707907	0.004646512	1.511489161	11.01142372	8.689733772	0.759043051	3.384370379	0	0.215104172	2.760615409	0	0	0	0	0.004923613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.435	YES	"$265 days 1-5;$0 days 6-90,1a2: $172"	"$250 days 1-5;$0 days 6-90,1b2: $108"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $15,8b6: 20.0%"	9c1: $148	12: 20.0%	"31: $148,5: $265,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	16.8282	0.287583078	4.838970945	0.017958403	2.605162983	4.338514201	1.044065295	1.736188318	3.653249705	0.532053129	4.143061993	0.068707907	0.004646512	1.511489161	11.01142372	8.689733772	0.759043051	3.384370379	0	0.215104172	2.760615409	0	0	0	0	0.004923613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.435
H1013_011_0	2012	8																															D	D	D	V	T	O	O	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	1476.106932	0	595.2434287	0	0	0	0	239.0273075	286.9403625	0	0	0	1.036784171	0	0	0	0	0	0	0	31.49611166	0	0	0	0	0	0	0	0	0											3400	$0 	$0 	(2) $15 days 11-100	$0 	$0 	$0 	$0 	(4a) $50	(9a) $50 @ Hospital	$0 	$0 	(9a) $50 copay	(12) 20%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0.23648116	0	4.543241419	0	0	0	0	32.56735923	11.95383347	0	0	0	0.2	0	0	0	0	0	0	0	0.102560819	0	0	0	0	0	0	0	0	0											NO	0.23648116	0	4.543241419	0	0	0	0	32.56735923	11.95383347	0	0	0	0.2	0	0	0	0	0	0	0	0.102560819	0	0	0	0	0	0	0	0	0												0.0291	0	0.225361217	0	0	0	0	0.648707349	0.285836442	0	0	0	0.207356834	0	0	0	0	0	0	0	3.230267006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6266	0	NO	-1.18E-15	0.0291	0	0.225361217	0	0	0	0	0.648707349	0.285836442	0	0	0	0.207356834	0	0	0	0	0	0	0	3.230267006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6266	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	NO	0	0.0291	0	0.225361217	0	0	0	0	0.648707349	0.285836442	0	0	0	0.207356834	0	0	0	0	0	0	0	3.230267006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6266
H1013_021_0	2012	8																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	COIN	V	V	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	1711.896159	0	760.1241582	0	473.6812703	0	0	128.4591407	215.2470723	1968.760715	186.9166938	0	0.718753825	0	0	16472.54106	0	865.7043959	2199.436291	2264.470952	63.66679263	0	0	1.71742888	0	0	0.035110704	0.00059969	0	0											6700	(1a) $100 (days 1-10)	$0 	"(2) $35 days 1-20, $100 days 21-100"	$0 	(10a) $50	$0 	$0 	(4a) $65	"(9a,9b) $100 @ Hospital; $50 ASC"	$0 	"$150 (L.8a Diag, 8b MRI/CT @ Hosp); $25 (L.8a Diag, 8b MRI/CT, 8b Therapy @ freest.); $55 (L.8b Therapy @ Hosp)"	(9a) $150 copay	(12) 20%	"(7c,7i) $20 @ Hospital; (8b) $55 @ Hospital"	$0 	"(7b,7d,7g) $10; (7c,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	Not covered	Not covered	(14c) $0	$0 												NO	89.59266055	0	34.6365214	0	50	0	0	39.68421053	58.63787375	12.97722535	70.69017073	0	0.2	0	0	3.235130066	0	20	21.90070767	9.980846196	0.101024825	0	0	0.187000047	0	0	0.001913884	0.95981942	0	0											NO	82.96706562	0	32.07506649	0	46.30237851	0	0	36.74946674	54.30146052	12.01752801	65.46246085	0	0.185209514	0	0	2.995884337	0	18.52095141	20.28109713	9.242738369	0.093553793	0	0	0.173170939	0	0	0.001772348	0.888838442	0	0												11.8359	0	2.031752743	0	1.827714123	0	0	0.39340041	0.9740192	1.97163642	1.019668896	0	0.133120047	0	0	4.112485646	0	1.336139087	3.717248421	1.74415938	5.956269956	0	0	0.297408772	0	0	6.22E-05	0.000533028	0	0	0	0	0	0	0	0	0	0	0	0	37.3515	0	NO	2.982823845	11.8359	0	2.031752743	0	1.827714123	0	0	0.39340041	0.9740192	1.97163642	1.019668896	0	0.133120047	0	0	4.112485646	0	1.336139087	3.717248421	1.74415938	5.956269956	0	0	0.297408772	0	0	6.22E-05	0.000533028	0	0	0	0	0	0	0	0	0	0	0	0	37.3515	NO																																										0	0	0	0	0	0	0	0	0	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	11.8359	0	2.031752743	0	1.827714123	0	0	0.39340041	0.9740192	1.97163642	1.019668896	0	0.133120047	0	0	4.112485646	0	1.336139087	3.717248421	1.74415938	5.956269956	0	0	0.297408772	0	0	6.22E-05	0.000533028	0	0	0	0	0	0	0	0	0	0	0	0	37.3515
H1013_024_0	2012	8																															D	D	D	V	T	O	O	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	0	0	0	0	0	0	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	(12) 0%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	$0 	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H1013_802_0	2012	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	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	324.8713587	2.644607388	21.52836577	0	11.84619278	6.658326746	19.33249417	19.58880723	29.50742312	5.370753075	7.910369136	3.388235719	0.688474808	53.08588197	117.4841862	170.0583958	0.954774096	4.217390358	25.38105626	20.28473975	41.36847631	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												NO	0.078953459	0.078953459	0.167015387	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.059987781	0.059987781	0.126896055	0	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0	0	0	0	0	0	0	0	0											10000	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	0	NO	35.97683294	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	NO																																										0	0	0	0	0	0	0	0	0	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	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935
H1013_803_0	2012	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	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	324.8713587	2.644607388	21.52836577	0	11.84619278	6.658326746	19.33249417	19.58880723	29.50742312	5.370753075	7.910369136	3.388235719	0.688474808	53.08588197	117.4841862	170.0583958	0.954774096	4.217390358	25.38105626	20.28473975	41.36847631	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												NO	0.078953459	0.078953459	0.167015387	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.059987781	0.059987781	0.126896055	0	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0	0	0	0	0	0	0	0	0											10000	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	0	NO	35.97683294	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	NO																																										0	0	0	0	0	0	0	0	0	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	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935
H1013_805_0	2012	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	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	324.8713587	2.644607388	21.52836577	0	11.84619278	6.658326746	19.33249417	19.58880723	29.50742312	5.370753075	7.910369136	3.388235719	0.688474808	53.08588197	117.4841862	170.0583958	0.954774096	4.217390358	25.38105626	20.28473975	41.36847631	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												NO	0.078953459	0.078953459	0.167015387	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.059987781	0.059987781	0.126896055	0	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0.170192201	0	0	0	0	0	0	0	0	0											10000	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	0	NO	35.97683294	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935	NO																																										0	0	0	0	0	0	0	0	0	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	19.4883	0.158644129	2.731864681	0	2.016129618	1.133195281	3.290239725	3.333862208	5.021933271	0.914060284	1.34628313	0.576651293	0.117173043	9.034803068	19.99489217	28.94261259	0.162495104	0.717766945	4.319657816	3.452304495	7.040592014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7935
H1016_001_0	2012	7																															D	D	D	P	T	Coin	Coin	V	V	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	1457.67745	2.180743619	863.1475046		267.7791406	0.086929792		223.7967636	462.6705565		1325.807362	0.184994225	0.55051587	159.8350103	3.385468982	8652.990031	3.116780968	1028.244151	4950.093028		91.67508391				0.537376029	132.9688489															3400	(1a). $100/day for days 6 - 23	(1b). $150/day for days 1 - 10	(2). $135/day for days 21 - 100	(6). $0/visit	(10a). $100/Trip	(11a). 20% coin	(11b). $0;  (11c). 20%	(4a). $65 for ER; (4b). $25 for Urgent care	(9a). $25 - $100/visit	(8a). $0 Lab	"(8b). $25 for X-ray, $50 forTherapeutic Services, $100 for Diagnostic Services (CT, MRI, etc)"	(7e). $15  (9c). $15	(12). 20% coin	(5). $15 for Partial hospitalization; (9b). $25 for ASC; $100 for Hospital;  (3). $5 for Cardiac rehab;	(7a). $0; (14a). $0; (17a). $5	"(7d). $0 for tier1 specialists, $25 for tier2 specialists, (7b). $5;  (7f). $5; (18a). $5"	(7e). (7h). $15/visit	(7c). (7i). $5/visit	"(8b). $25 for X-ray, $50 forTherapeutic Services, $100 for Diagnostic Services (CT, MRI, etc)"	(7g). $0	(15). 20% coin	(9d). $0	(10b). Not Covered	(16a). $0 - $45	(17a). $5/visit	(17b). $10 one pair/year	(18a). Not covered	(18b). Not Covered	(14c). no cost sharing	Silver Sneakers Fitness													41.88	150	38.43		100	0.2		63.65261418	81.25		64.65854848	15	0.2	69.92513021	5	13.81451815	15	5	25		0.2				5	10															NO	34.97795357	125.2792033	32.09653189		83.51946888	0.167038938		53.16813168	67.85956846		54.00247627	12.52792033	0.167038938	58.40109736	4.175973444	11.53781219	12.52792033	4.175973444	20.87986722		0.167038938				5	10																4.2489	0.022766819	2.308670117	0	1.863730966	0.01452066	0	0.991571316	2.616385359	0	5.966406715	0.000193133	0.091957586	0.777878333	0.001178136	8.319714488	0.003253899	0.357826689	8.613107096	0	15.31330863	0	0	0	0.000223907	0.110807374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6224	0		10.16437973	4.2489	0.022766819	2.308670117	0	1.863730966	0.01452066	0	0.991571316	2.616385359	0	5.966406715	0.000193133	0.091957586	0.777878333	0.001178136	8.319714488	0.003253899	0.357826689	8.613107096	0	15.31330863	0	0	0	0.000223907	0.110807374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6224	NO																																																																																		0	0		0	4.2489	0.022766819	2.308670117	0	1.863730966	0.01452066	0	0.991571316	2.616385359	0	5.966406715	0.000193133	0.091957586	0.777878333	0.001178136	8.319714488	0.003253899	0.357826689	8.613107096	0	15.31330863	0	0	0	0.000223907	0.110807374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6224
H1016_801_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1208.894837	62.15009587	751.5108427		60.60445461	13.68268985	16.53371002	29.63688084	117.8676512	10.66678325	28.4809743	4.359023707	0.801046623	43.03662679	38.18450269	148.3494428	2.24162722	28.97297515	34.9291987	25.41174889	48.6480367	1.489491512																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													219.9002112	85.85600274	53.24645022		402.6680033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	169.1047026	66.02382839	40.94686894		309.6543316	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467																				17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	0		37.1583947	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	NO																																																																																		0	0		0	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705
H1016_802_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1208.894837	62.15009587	751.5108427		60.60445461	13.68268985	16.53371002	29.63688084	117.8676512	10.66678325	28.4809743	4.359023707	0.801046623	43.03662679	38.18450269	148.3494428	2.24162722	28.97297515	34.9291987	25.41174889	48.6480367	1.489491512																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													219.9002112	85.85600274	53.24645022		402.6680033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	169.1047026	66.02382839	40.94686894		309.6543316	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467																				17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	0		37.1583947	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	NO																																																																																		0	0		0	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705
H1016_803_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1208.894837	62.15009587	751.5108427		60.60445461	13.68268985	16.53371002	29.63688084	117.8676512	10.66678325	28.4809743	4.359023707	0.801046623	43.03662679	38.18450269	148.3494428	2.24162722	28.97297515	34.9291987	25.41174889	48.6480367	1.489491512																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													219.9002112	85.85600274	53.24645022		402.6680033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	169.1047026	66.02382839	40.94686894		309.6543316	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467																				17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	0		37.1583947	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	NO																																																																																		0	0		0	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705
H1016_804_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1208.894837	62.15009587	751.5108427		60.60445461	13.68268985	16.53371002	29.63688084	117.8676512	10.66678325	28.4809743	4.359023707	0.801046623	43.03662679	38.18450269	148.3494428	2.24162722	28.97297515	34.9291987	25.41174889	48.6480367	1.489491512																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													219.9002112	85.85600274	53.24645022		402.6680033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	169.1047026	66.02382839	40.94686894		309.6543316	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467	0.172257467																				17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	0		37.1583947	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705	NO																																																																																		0	0		0	17.0358	0.341948939	2.564334665	0	1.563869324	2.356945495	2.848055008	5.105174024	20.30358304	1.837433064	4.906060492	0.750874382	0.137986262	7.41338032	6.577565712	25.55429925	0.386137027	4.990811312	6.016815292	4.377363496	8.379987577	0.256576035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.705
H1019_001_0	2012	5																															D	D	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	1932.07	22.33	1724.05	2323.7	761.06	16.4	204.25	536.15	365.48	4625.55	1827.68	3.16	3.44	827.79	7631.41	10610.66	291.09	630.37		286.5	30.24	0	2.76	11.98	3.09		0.57		2.47	4.61											5000	"$0/Day(Days 1-5): 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Day(Days 1-5): 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$5-$10/Visit: 5. $5 Partial Hospitalization,7h. $10 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$100/Visit: 3. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $10 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $25 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$5/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN865: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													0	0	34.03605	0	150	0.045	0	65	38.55216	0	10.786501	10	0.13935	25.937281	0	5	5	5.163505		0	0.128734	0	0	0	0		0		0	0											NO	0	0	31.992934	0	146.751	0.044025	0	63.5921	37.71712	0	10.552865	9.7834	0.136332	25.375479	0	4.8917	4.8917	5.051664		0	0.125945	0	0	0	0		0		0	0												0	0	4.596451489	0	9.307193005	0.72201	0	2.841242035	1.148737751	0	1.607271692	0.002576295	0.46898208	1.75046398	0	4.325347127	0.118660413	0.26536812	0	0	3.8085768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9629	0	NO	0.877288	0	0	4.596451489	0	9.307193005	0.72201	0	2.841242035	1.148737751	0	1.607271692	0.002576295	0.46898208	1.75046398	0	4.325347127	0.118660413	0.26536812	0	0	3.8085768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9629	NO																																																																																		0	0	NO	0	0	0	4.596451489	0	9.307193005	0.72201	0	2.841242035	1.148737751	0	1.607271692	0.002576295	0.46898208	1.75046398	0	4.325347127	0.118660413	0.26536812	0	0	3.8085768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9629
H1019_004_0	2012	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	1050.51	8.13	1010.59	1361.15	353.92	15.3	106.88	336.38	239.79	3347.91	1230.8	5.66	3.25	513.87	5188.71	6803.8	111.33	334.58		218.1	25.3	0		11.98	1.58		0.57		2.3	2.21											5000	"$0-$220/Day(Days 1-8): 1a. $220 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$220/Day(Days 1-6): 1b. $220 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $45 (Days 8-100): 2. $0 SNF - Facility 1,2. $45 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25/Visit: 5. $25 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$25-$150/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN865: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													168.090679	128.485735	30.632445	0	150	0.045	0	65	95.331458	0	9.273382	25	0.146819	118.511176	0	24.882887	25	25		0	0.139308	0		0	0		0		0	0											NO	151.557616	115.848135	28.427185	0	142.77945	0.042834	0	61.871095	90.742488	0	8.82699	23.796575	0.139751	112.806403	0	23.6851	23.796575	23.796575		0	0.132602	0		0	0		0		0	0												13.2677	0.078487111	2.394019074	0	4.211041912	0.6553602	0	1.734349911	1.813261766	0	0.905354941	0.011224051	0.45419075	4.830652192	0	13.42905695	0.220772725	0.663488172	0	0	3.3548306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0238	0	NO	3.274301	13.2677	0.078487111	2.394019074	0	4.211041912	0.6553602	0	1.734349911	1.813261766	0	0.905354941	0.011224051	0.45419075	4.830652192	0	13.42905695	0.220772725	0.663488172	0	0	3.3548306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0238	NO																																																																																		0	0	NO	0	13.2677	0.078487111	2.394019074	0	4.211041912	0.6553602	0	1.734349911	1.813261766	0	0.905354941	0.011224051	0.45419075	4.830652192	0	13.42905695	0.220772725	0.663488172	0	0	3.3548306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0238
H1019_006_0	2012	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	335.63	7.47	1046.79	1750.11	626.51	16.59	6.05	381.11	373.32	4843.66	1904.16	12.06	3.82	1329.16	7297.89	13655.15	315.17	417.87		150.99	20.58	0	0.75	14.85	5.83		0.57		1.48	17.72	138.81										3000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $15 (Days 8-100): 2. $0 SNF - Facility 1,2. $15 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	0% Coins: 11c. 0% Diabetic Monitoring Supplies	"$50/Visit: 4a, 4b. $50 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$25/Visit: 8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$25/Visit: 3. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN871: Dental 16a, 16b"	"VIS902: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics"												0	0	10.210815	0	25	0.045	0	50	6.530717	0	1.957471	0	0.195158	0.974903	0	0	0	0		0	0.11047	0	0	0	0		0		0	0	0										NO	0	0	10.209385	0	24.928875	0.044872	0	49.85775	6.512137	0	1.951902	0	0.194603	0.972129	0	0	0	0		0	0.110156	0	0	0	0		0		0	0	0											0	0	0.890590177	0	1.30151579	0.74442648	0	1.583440592	0.202592582	0	0.309727809	0	0.74338346	0.107676248	0	0	0	0	0	0	2.26701048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1504	0	NO	0.020834	0	0	0.890590177	0	1.30151579	0.74442648	0	1.583440592	0.202592582	0	0.309727809	0	0.74338346	0.107676248	0	0	0	0	0	0	2.26701048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1504	NO																																																																																		0	0	NO	0	0	0	0.890590177	0	1.30151579	0.74442648	0	1.583440592	0.202592582	0	0.309727809	0	0.74338346	0.107676248	0	0	0	0	0	0	2.26701048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1504
H1019_010_0	2012	5																															D	D	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	1480.91	22.1	1580.26	1463.54	578.04	14.65	186.48	550.14	378.17	5252.23	2106.86	14.13	1.64	772.28	7017.7	8887.94	189.42	561.01		354.24	8.53	0	6.92	3.26	3.09		0.57		2.56	4.83											5000	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $75 Radiology OP -- Facility"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$125/Visit: 3. $20 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													77.612034	71.921835	34.03605	0	150	0.045	0	50	81.262967	0	15.385788	20	0.2	63.579545	0	20	20	20		0	0.050562	0	0	0	0		0		0	0											NO	71.585227	66.336889	30.375677	0	142.6584	0.042798	0	47.5528	77.285632	0	14.632746	19.02112	0.190211	60.467708	0	19.02112	19.02112	19.02112		0	0.048087	0	0	0	0		0		0	0												8.8343	0.122170437	4.000122278	0	6.871855128	0.6269907	0	2.180058116	2.435592288	0	2.569095603	0.022397369	0.31194604	3.891500128	0	14.08821444	0.300248379	0.889253211	0	0	0.41018211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5539	0	NO	3.0165	8.8343	0.122170437	4.000122278	0	6.871855128	0.6269907	0	2.180058116	2.435592288	0	2.569095603	0.022397369	0.31194604	3.891500128	0	14.08821444	0.300248379	0.889253211	0	0	0.41018211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5539	NO																																																																																		0	0	NO	0	8.8343	0.122170437	4.000122278	0	6.871855128	0.6269907	0	2.180058116	2.435592288	0	2.569095603	0.022397369	0.31194604	3.891500128	0	14.08821444	0.300248379	0.889253211	0	0	0.41018211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5539
H1019_014_0	2012	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	2564.59	78.6	1285.99	837	311.48	14.02	4.15	577.27	410.61	3772	2070.79	18.45	0.06	12.03	9973.69	9900.45	168.42	459.25		618.06	38.13	0		1.92	0.2				2.87	2.89	2.51	809.35									5000	"$0-$100/Day(Days 1-7): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-7): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c0%-20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $100 Radiology OP -- Facility"	"$25-$35/Visit: 5. $25 Partial Hospitalization,7h. $35 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$25-$100/Visit: 3. $35 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $35 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											72.884059	64.003329	34.03605	0	150	0.045	0.2	65	84.445484	0	19.326391	35	0.024609	0.2	0	24.94455	25	25.616935		0	0.2	0		0	0				0	0	0	68.115034									NO	62.974451	55.30118	29.250139	0	136.8972	0.041069	0.18253	59.32212	77.069002	0	17.638192	31.94268	0.02246	0.18253	0	22.765593	22.8162	23.379244		0	0.18253	0		0	0				0	0	0	62.16505										13.4586	0.362222729	3.134615521	0	3.553394988	0.57578738	0.7574995	2.853740018	2.637108576	0	3.043749301	0.049111871	0.0013476	2.1958359	0	18.78246793	0.320225367	0.894743151	0	0	6.9598689	0	0	0	0	0	0	0	0	0	0	4.192773601	0	0	0	0	0	0	0	0	63.7731	0	NO	7.168692	13.4586	0.362222729	3.134615521	0	3.553394988	0.57578738	0.7574995	2.853740018	2.637108576	0	3.043749301	0.049111871	0.0013476	2.1958359	0	18.78246793	0.320225367	0.894743151	0	0	6.9598689	0	0	0	0	0	0	0	0	0	0	4.192773601	0	0	0	0	0	0	0	0	63.7731	NO																																																																																		0	0	NO	0	13.4586	0.362222729	3.134615521	0	3.553394988	0.57578738	0.7574995	2.853740018	2.637108576	0	3.043749301	0.049111871	0.0013476	2.1958359	0	18.78246793	0.320225367	0.894743151	0	0	6.9598689	0	0	0	0	0	0	0	0	0	0	4.192773601	0	0	0	0	0	0	0	0	63.7731
H1019_023_0	2012	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	455.85	16.17	100.85	2446.5	2519.06	3840.29	299.35	1007.25	466.35	5144.54	2035.04	12.33	6.26	1123.32	8835.24	11460.94	600.87	868.55		296.49	373.52	0	6.31	4.18	3.09		0.57		37.18	7.74											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN863: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c   $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	24.946825	0	0	24.946825	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	5.236879082	0	0	2.093974123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3309	0	NO	0.015626	0	0	0	0	5.236879082	0	0	2.093974123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3309	NO																																																																																		0	0	NO	0	0	0	0	0	5.236879082	0	0	2.093974123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3309
H1019_024_0	2012	5																															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	438.86	18.18	90.24	2188.55	1266.7	3879.36	222.5	627.34	416.75	5382.15	2196.42	42.88	15.03	1272.36	11843.82	13431.96	442.41	481.14		193.25	346.82	0	3.78	21.14	5.38		0.57		70.08	9.17											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN869: Dental 16a, 16b"	"VIS843: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c   $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.306958333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.307	0	NO	0	0	0	0	0	0	0	0	1.306958333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.307	NO																																																																																		0	0	NO	0	0	0	0	0	0	0	0	1.306958333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.307
H1019_025_0	2012	5																															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	476.61	16.44	113.9	1522.49	994.43	2688.12	212.01	995.49	433.39	5464.38	2724.75	36.51	30.86	1021.86	8747.73	9962.93	300.41	782.91		324.59	648.79	0	12.42	11.98	1.58		0.57		1.71	3.15											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN865: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	2.071729167	0	0	2.0739375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1457	0	NO	0	0	0	0	0	2.071729167	0	0	2.0739375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1457	NO																																																																																		0	0	NO	0	0	0	0	0	2.071729167	0	0	2.0739375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1457
H1019_026_0	2012	5																															A	A	A	V	T	O	O	V	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											0	YES	536.9	50.91	102.93	1355.99	1809.14	4271.21	203.34	1262.81	425.56	4524.29	3094.99	82.87	5.97	1448.67	12905.74	10966.87	754.38	855.74		561.11	1346.76	0	5.02		0.2				1.45	3.42											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS842: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	24.96235	0	0	24.96235	0	0	0	0	0	0	0	0	0	0		0	0	0	0		0				0	0												0	0	0	0	3.76336549	0	0	2.6268921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3903	0	NO	0.009638	0	0	0	0	3.76336549	0	0	2.6268921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3903	NO																																																																																		0	0	NO	0	0	0	0	0	3.76336549	0	0	2.6268921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3903
H1019_027_0	2012	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	T	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	1766.4	47.36	570.41	552.73	284.59	11.79	4.68	635.16	320.64	2901.25	1533.79	60.16	1.37	6.43	8731.03	6864.61	141.96	330.9		472.23	15.21	0	2.34	3.26	3.28				2.12	3.99	46.29	609.92									6700	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$140/Day(Days 1-10): 1b. $140 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c0%-20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$40/Visit: 5. $30 Partial Hospitalization,7h. $40 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$150/Visit: 3. $40 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $40 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"											122.545317	105.990073	34.03605	0	150	0.045	0.2	65	120.998658	0	33.479785	38.96231	0.199891	0.2	0	29.880129	30	30.739194		0	0.2	0	0	0	0				0	0	0	85.161438									NO	112.220997	97.060515	32.503577	0	143.7234	0.043117	0.191631	62.28014	115.93559	0	32.078857	37.331971	0.191527	0.191631	0	28.629825	28.74468	29.452943		0	0.191631	0	0	0	0				0	0	0	81.597943										16.5189	0.383065499	1.545030446	0	3.408520201	0.50834943	0.89683308	3.29648781	3.097798965	0	4.10018584	0.187157615	0.26239199	1.23218733	0	16.37771525	0.340049564	0.812164903	0	0	2.91470751	0	0	0	0	0	0	0	0	0	0	4.14735145	0	0	0	0	0	0	0	0	60.0289	0	NO	3.443667	16.5189	0.383065499	1.545030446	0	3.408520201	0.50834943	0.89683308	3.29648781	3.097798965	0	4.10018584	0.187157615	0.26239199	1.23218733	0	16.37771525	0.340049564	0.812164903	0	0	2.91470751	0	0	0	0	0	0	0	0	0	0	4.14735145	0	0	0	0	0	0	0	0	60.0289	NO																																																																																		0	0	NO	0	16.5189	0.383065499	1.545030446	0	3.408520201	0.50834943	0.89683308	3.29648781	3.097798965	0	4.10018584	0.187157615	0.26239199	1.23218733	0	16.37771525	0.340049564	0.812164903	0	0	2.91470751	0	0	0	0	0	0	0	0	0	0	4.14735145	0	0	0	0	0	0	0	0	60.0289
H1019_028_0	2012	5																															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	588.68	24.48	78.04	1205.82	997.6	3002.81	224	1206.43	395.5	4333.31	2890.79	226.21	1.01	1306.33	10936.74	9508.92	338.39	656.26		393.67	797.5	0	1.16	1.92	0.2		0.57		2.01	3.8											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	24.99805	0	0	24.99805	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	2.078171223	0	0	2.513199788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5914	0	NO	0.000358	0	0	0	0	2.078171223	0	0	2.513199788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5914	NO																																																																																		0	0	NO	0	0	0	0	0	2.078171223	0	0	2.513199788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5914
H1019_032_0	2012	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	2326.66	23.61	2340.98	3055.85	843.71	19.93	304.97	599.81	420.35	5625.27	2128.35	4.58	3.73	1004.48	9651.93	12738.53	369.01	717.97		317.24	34.8	0		11.98	1.58		0.57		0.09	1.51											5000	"$0/Day(Days 1-5): 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Day(Days 1-5): 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$5-$10/Visit: 5. $5 Partial Hospitalization,7h. $10 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$100/Visit: 3. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $10 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$5/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN865: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													0	0	34.03605	0	150	0.045	0	65	57.080175	0	9.225945	10	0.148992	78.64423	0	5	5	5.142449		0	0.128888	0		0	0		0		0	0											NO	0	0	29.698428	0	144.0576	0.043217	0	62.42496	54.818887	0	8.86045	9.60384	0.143089	75.52866	0	4.80192	4.80192	4.938726		0	0.123782	0		0	0		0		0	0												0	0	5.793618832	0	10.12856981	0.86131481	0	3.120259605	1.920259929	0	1.571511563	0.003665466	0.53372197	6.322252366	0	5.097450165	0.147663042	0.295488092	0	0	4.3076136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1034	0	NO	2.261445	0	0	5.793618832	0	10.12856981	0.86131481	0	3.120259605	1.920259929	0	1.571511563	0.003665466	0.53372197	6.322252366	0	5.097450165	0.147663042	0.295488092	0	0	4.3076136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1034	NO																																																																																		0	0	NO	0	0	0	5.793618832	0	10.12856981	0.86131481	0	3.120259605	1.920259929	0	1.571511563	0.003665466	0.53372197	6.322252366	0	5.097450165	0.147663042	0.295488092	0	0	4.3076136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1034
H1019_043_0	2012	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	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	1286.48	10.98	1206.64	1019.16	264.64	13.11	3.72	541.3	383.84	4085.95	2027.16	25.36	0.11	1051.65	9660.54	9255.48	165.27	712.11		260.35	11.66	0	0.46		3.11				2.9	2.35	3.58										5500	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-8): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-8), $50 (Days 9-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$35/Visit: 5. $30 Partial Hospitalization,7h. $35 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$30-$150/Visit: 3. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $35 OP Other,8b. $60 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"	$0: Other - Transportation 10b		"VIS841: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												122.545317	102.868367	32.092728	0	150	0.2	0.2	65	101.074479	0	35.396204	35	0.2	71.441621	0	29.850222	30	30.238402		0	0.2	0	0		0				0	0	0										NO	109.990794	92.329708	29.172867	0	138.9708	0.185294	0.185294	60.22068	93.642675	0	32.793592	32.42652	0.185294	66.188662	0	27.655395	27.79416	28.015033		0	0.185294	0	0		0				0	0	0											11.7917	0.084481683	2.93342902	0	3.064769376	2.42920434	0.68929368	2.716454507	2.995317031	0	5.539821497	0.068528046	0.02038234	5.800608866	0	21.33032961	0.382795069	1.662482096	0	0	2.16052804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6702	0	NO	5.526875	11.7917	0.084481683	2.93342902	0	3.064769376	2.42920434	0.68929368	2.716454507	2.995317031	0	5.539821497	0.068528046	0.02038234	5.800608866	0	21.33032961	0.382795069	1.662482096	0	0	2.16052804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6702	NO																																																																																		0	0	NO	0	11.7917	0.084481683	2.93342902	0	3.064769376	2.42920434	0.68929368	2.716454507	2.995317031	0	5.539821497	0.068528046	0.02038234	5.800608866	0	21.33032961	0.382795069	1.662482096	0	0	2.16052804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6702
H1019_044_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	2410.51	73.88	1208.73	786.71	292.77	12.79	3.78	542.59	385.94	3545.38	1946.37	17.34	0.06	1067.41	9374.47	9305.63	158.3	431.66		580.92	34.78	0			1.6				0.09	1.15	2.36										6700	"$0-$225/Day(Days 1-6): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40/Visit: 5. $40 Partial Hospitalization,7h. $40 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$40-$150/Visit: 3. $40 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $40 OP Other,8b. $60 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS842: Vision 17a,17b"				$0: Additional Smoking Cessation 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												154.088642	131.405866	34.03605	0	150	0.2	0.2	65	103.336451	0	25.006074	40	0.024611	74.099647	10	39.778199	40	40		0	0.2	0			0				0	0	0										NO	126.319095	107.724163	29.013588	0	134.8761	0.179835	0.179835	58.44631	92.91745	0	22.484811	35.96696	0.02213	66.628476	8.99174	35.767522	35.96696	35.96696		0	0.179835	0			0				0	0	0											25.3745	0.663221764	2.922466185	0	3.29063965	2.30008965	0.6797763	2.642698612	2.988380054	0	3.646980132	0.051972257	0.0013278	5.926658464	7.02439974	27.73661048	0.474464147	1.293791496	0	0	6.2546613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2726	0	NO	13.441477	25.3745	0.663221764	2.922466185	0	3.29063965	2.30008965	0.6797763	2.642698612	2.988380054	0	3.646980132	0.051972257	0.0013278	5.926658464	7.02439974	27.73661048	0.474464147	1.293791496	0	0	6.2546613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2726	NO																																																																																		0	0	NO	0	25.3745	0.663221764	2.922466185	0	3.29063965	2.30008965	0.6797763	2.642698612	2.988380054	0	3.646980132	0.051972257	0.0013278	5.926658464	7.02439974	27.73661048	0.474464147	1.293791496	0	0	6.2546613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2726
H1019_045_0	2012	5	r.										Skilled Nursing Facility																				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	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	YES	367.39	11.81	127.86	1519.3	682.11	2321.75	193.92	572.15	409.69	5133.99	2648.14	13.1	0	932.14	8627.33	9319.91	274.41	743.57		360.8	754.72	0	2.51	3.26	3.11		0.57		1.31	2.16	1840.72										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Day(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 2"												0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0										NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0											0	0	0	0	1.4210625	0	0	1.191979167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.613	0	NO	0	0	0	0	0	1.4210625	0	0	1.191979167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.613	NO																																																																																		0	0	NO	0	0	0	0	0	1.4210625	0	0	1.191979167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.613
H1019_046_0	2012	5																															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	915.59	70.1	76.03	887.13	2354.08	2943.87	153.78	990.45	349.28	3723.28	2216.64	59.94	1.34	977.4	11187.16	8453.7	562.73	424.72		580.83	795.97	0	1.25	1.92	3.28		0.57		1.37	3.89											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	24.9529	0	0	24.9529	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	4.895093569	0	0	2.059549984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9546	0	NO	0.013128	0	0	0	0	4.895093569	0	0	2.059549984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9546	NO																																																																																		0	0	NO	0	0	0	0	0	4.895093569	0	0	2.059549984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9546
H1019_047_0	2012	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	405.63	14.95	90.63	1797.8	2598.58	3324.23	225.11	638.25	291.76	4204.26	1637.61	17.56	1.22	904	8173.36	8521.01	626.58	608.68		270.69	359.79	0	2.92	14.85	5.38		0.57		25.88	8.59											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN871: Dental 16a, 16b"	"VIS843: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c   $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	24.95645	0	0	24.95645	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	5.404277653	0	0	1.327371184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7316	0	NO	0.011747	0	0	0	0	5.404277653	0	0	1.327371184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7316	NO																																																																																		0	0	NO	0	0	0	0	0	5.404277653	0	0	1.327371184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7316
H1019_048_0	2012	5																															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	381.29	18.63	65.67	2037.94	888.57	3361.17	213.2	312.84	353.4	4878.22	2100.48	20.28	0	1336.64	12499.64	10956.68	363.41	466.67		223.27	281.89	0	2.92	21.14	5.38		0.57		70.17	18.92											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN869: Dental 16a, 16b"	"VIS843: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c   $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	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	0.65175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.6517	0	NO	0	0	0	0	0	0	0	0	0.65175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.6517	NO																																																																																		0	0	NO	0	0	0	0	0	0	0	0	0.65175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.6517
H1019_049_0	2012	5	r.										Skilled Nursing Facility																				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	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	YES	528.15	27.04	68.08	649.46	576.15	1853.18	1152.49	663.24	302.71	2694.77	2417.59	176.74	33.21	900.85	9165.82	7707.67	367.12	385.93		482.22	1266.8	0	2.91	1.92	0.2		0.57		1.83	1.41	0										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-100) : 2. $0 SNF - Physician												0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0										NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0											0	0	0	0	1.2003125	0	0	1.38175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5821	0	NO	0	0	0	0	0	1.2003125	0	0	1.38175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5821	NO																																																																																		0	0	NO	0	0	0	0	0	1.2003125	0	0	1.38175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5821
H1019_050_0	2012	5																															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	420.43	28.58	102.44	1479.25	749.51	2412.44	189.21	746.03	332.52	4326.75	2022	41.07	0	986.41	7264.97	7319.58	141.6	577.53		262.06	400.67	0	12.42	11.98	3.09		0.57		1.51	5.66											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN865: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	1.561479167	0	0	1.554229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1157	0	NO	0	0	0	0	0	1.561479167	0	0	1.554229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1157	NO																																																																																		0	0	NO	0	0	0	0	0	1.561479167	0	0	1.554229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1157
H1019_054_0	2012	5	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		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										0	YES	1911.01	58.57	958.26	623.69	232.1	10.83	104.79	430.15	305.97	2810.71	1543.05	13.75	0.05	9.29	7431.89	7377.32	125.5	342.21		460.55	29.45	0	3.87	3.26	3.78		0.57		2.87	6.3	603.08										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25/Visit: 5. $25 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS898: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $25 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	59.445484	0	16.971914	25	0.02461	0.2	0	24.94455	25	25		0	0.2	0	0	0	0		0		0	0	50.473103										NO	41.963706	34.49139	29.536416	0	137.3169	0.041195	0	59.50399	54.41913	0	15.536871	22.88615	0.022529	0.183089	0	22.835388	22.88615	22.88615		0	0.183089	0	0	0	0		0		0	0	46.205401											6.6828	0.168346726	2.3586305	0	2.655937708	0.44614185	0	2.132970108	1.387551767	0	1.9978474	0.026223714	0.00112645	1.70089681	0	14.03866372	0.239350985	0.652655783	0	0	5.39197105	0	0	0	0	0	0	0	0	0	2.322129436	0	0	0	0	0	0	0	0	0	42.2032	0	NO	4.259922	6.6828	0.168346726	2.3586305	0	2.655937708	0.44614185	0	2.132970108	1.387551767	0	1.9978474	0.026223714	0.00112645	1.70089681	0	14.03866372	0.239350985	0.652655783	0	0	5.39197105	0	0	0	0	0	0	0	0	0	2.322129436	0	0	0	0	0	0	0	0	0	42.2032	NO																																																																																		0	0	NO	0	6.6828	0.168346726	2.3586305	0	2.655937708	0.44614185	0	2.132970108	1.387551767	0	1.9978474	0.026223714	0.00112645	1.70089681	0	14.03866372	0.239350985	0.652655783	0	0	5.39197105	0	0	0	0	0	0	0	0	0	2.322129436	0	0	0	0	0	0	0	0	0	42.2032
H1019_055_0	2012	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	1480.91	22.1	1580.26	1463.54	578.04	14.65	4.47	550.14	378.17	5252.23	2106.86	14.13	1.64	1.95	7017.7	8887.94	189.42	561.01		354.24	8.53	0		3.26	3.09		0.57		2.56	2.3	0	740.46									6700	"$0-$150/Day(Days 1-8): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-8): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c0%-20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$50/Visit: 4a, 4b. $50 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25-$40/Visit: 5. $25 Partial Hospitalization,7h. $40 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$45/Visit: 7c, 7i. $45 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$25-$125/Visit: 3. $45 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $40 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"											114.607281	102.868367	34.03605	0	150	0.045	0.2	50	115.657418	0	15.737459	40	0.2	0.2	0	24.96688	25	25.336047		0	0.050562	0		0	0		0		0	0	0	94.320715									NO	106.109724	95.241192	31.6151	0	143.69355	0.043108	0.191591	47.89785	110.794833	0	15.075809	38.31828	0.191591	0.191591	0	23.917198	23.948925	24.270844		0	0.048436	0		0	0		0		0	0	0	90.355189										13.0949	0.175402529	4.163339827	0	6.921718304	0.6315322	0.85641177	2.195876933	3.491606833	0	2.646884912	0.045119775	0.31420924	0.37360245	0	17.71455173	0.378033781	1.134682183	0	0	0.41315908	0	0	0	0	0	0	0	0	0	0	5.575366937	0	0	0	0	0	0	0	0	60.1264	0	NO	3.255185	13.0949	0.175402529	4.163339827	0	6.921718304	0.6315322	0.85641177	2.195876933	3.491606833	0	2.646884912	0.045119775	0.31420924	0.37360245	0	17.71455173	0.378033781	1.134682183	0	0	0.41315908	0	0	0	0	0	0	0	0	0	0	5.575366937	0	0	0	0	0	0	0	0	60.1264	NO																																																																																		0	0	NO	0	13.0949	0.175402529	4.163339827	0	6.921718304	0.6315322	0.85641177	2.195876933	3.491606833	0	2.646884912	0.045119775	0.31420924	0.37360245	0	17.71455173	0.378033781	1.134682183	0	0	0.41315908	0	0	0	0	0	0	0	0	0	0	5.575366937	0	0	0	0	0	0	0	0	60.1264
H1019_056_0	2012	5	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	1179.86	23.18	811.42	1356.6	485.64	12.86	107.71	295.42	289.38	3754.57	1476.01	9.35	2.93	7.91	5656.97	10584.8	244.3	323.91		117.04	15.82	0	0.75	3.26	3.2				1.22	4.93	815.9										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$20-$75/Visit: 5. $20 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS898: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												47.189786	38.786882	34.03605	0	100	0.045	0	65	56.530717	0	17.560134	75	0.195158	0.2	0	20	20	35.490692		0	0.11047	0	0	0	0				0	0	64.973438										NO	43.492844	35.74824	30.942956	0	91.9848	0.041393	0	59.79012	51.999667	0	16.152654	68.9886	0.179516	0.18397	0	18.39696	18.39696	32.646042		0	0.101616	0	0	0	0				0	0	59.765687											4.2763	0.069053684	2.092311113	0	3.722624856	0.53231398	0	1.471933104	1.25397197	0	1.986789903	0.053753618	0.52598188	1.4552027	0	16.22734518	0.374531444	0.881198289	0	0	1.60756512	0	0	0	0	0	0	0	0	0	4.063568669	0	0	0	0	0	0	0	0	0	40.5944	0	NO	3.554825	4.2763	0.069053684	2.092311113	0	3.722624856	0.53231398	0	1.471933104	1.25397197	0	1.986789903	0.053753618	0.52598188	1.4552027	0	16.22734518	0.374531444	0.881198289	0	0	1.60756512	0	0	0	0	0	0	0	0	0	4.063568669	0	0	0	0	0	0	0	0	0	40.5944	NO																																																																																		0	0	NO	0	4.2763	0.069053684	2.092311113	0	3.722624856	0.53231398	0	1.471933104	1.25397197	0	1.986789903	0.053753618	0.52598188	1.4552027	0	16.22734518	0.374531444	0.881198289	0	0	1.60756512	0	0	0	0	0	0	0	0	0	4.063568669	0	0	0	0	0	0	0	0	0	40.5944
H1019_057_0	2012	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	T	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									0	YES	1420.02	20.45	512.7	41.01	246.38	8.28	0.58	267.28	234.07	95.07	1511.18	26.34	4.73	7.68	5949.14	5049.7	27.48	413.85		568.26	30.73	0	2.34	3.26	3.28		0.57		2.12	3.87	1321.8	209.08									3950	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	0% Coins: 11c. 0% Diabetic Monitoring Supplies	"$65/Visit: 4a, 4b. $65 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/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$30/Visit: 5. $20 Partial Hospitalization,7h. $30 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics"	"$20-$150/Visit: 3. $20 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $95 Observation"											77.612034	71.921835	34.03605	0	150	0.045	0	65	83.746301	0	50.527952	20.332195	0.199862	0.2	0	20	20	20		0	0.2	0	0	0	0		0		0	0	0	73.835531									NO	71.006008	65.800136	32.201711	0	141.5598	0.042468	0	61.34258	79.034064	0	47.684845	19.188143	0.188616	0.188746	0	18.87464	18.87464	18.87464		0	0.188746	0	0	0	0		0		0	0	0	69.680953										8.4025	0.112134398	1.375818102	0	2.906458627	0.35163504	0	1.366303732	1.54162528	0	6.005032006	0.042117974	0.89215368	1.44956928	0	7.942605801	0.043222926	0.650939147	0	0	5.80016458	0	0	0	0	0	0	0	0	0	0	1.214074471	0	0	0	0	0	0	0	0	40.0964	0	NO	2.67148	8.4025	0.112134398	1.375818102	0	2.906458627	0.35163504	0	1.366303732	1.54162528	0	6.005032006	0.042117974	0.89215368	1.44956928	0	7.942605801	0.043222926	0.650939147	0	0	5.80016458	0	0	0	0	0	0	0	0	0	0	1.214074471	0	0	0	0	0	0	0	0	40.0964	NO																																																																																		0	0	NO	0	8.4025	0.112134398	1.375818102	0	2.906458627	0.35163504	0	1.366303732	1.54162528	0	6.005032006	0.042117974	0.89215368	1.44956928	0	7.942605801	0.043222926	0.650939147	0	0	5.80016458	0	0	0	0	0	0	0	0	0	0	1.214074471	0	0	0	0	0	0	0	0	40.0964
H1019_059_0	2012	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	T	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										0	YES	2343.74	71.83	1175.25	764.92	284.66	13.3	128.52	527.56	375.25	3447.18	1892.46	16.86	0.06	11.41	9114.81	9047.89	153.91	419.7		564.83	36.18	0	3.87	3.26	5.61		0.57		2.87	6.71	739.65										3400	"$0-$125/Day(Days 1-7): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-7): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$125/Visit: 9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $125 Radiology OP -- Facility"	"$25-$125/Visit: 5. $25 Partial Hospitalization,7h. $125 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN861: Dental 16a, 16b"	"VIS840: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$125/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												91.105074	80.004161	34.03605	0	150	0.045	0	65	78.33645	0	23.703933	125	0.024609	0.2	0	24.94455	25	31.169349		0	0.2	0	0	0	0		0		0	0	125										NO	69.025759	60.615153	24.526548	0	128.0298	0.038409	0	55.47958	66.862667	0	20.232066	106.6915	0.021004	0.170706	0	21.290971	21.3383	26.604037		0	0.170706	0	0	0	0		0		0	0	106.6915											13.4815	0.362832203	2.402068795	0	3.037080239	0.5108397	0	2.439067269	2.090851316	0	3.190697969	0.149901558	0.00126024	1.94775546	0	16.05319697	0.273681479	0.930476194	0	0	6.17614308	0	0	0	0	0	0	0	0	0	6.576197331	0	0	0	0	0	0	0	0	0	59.6236	0	NO	12.803442	13.4815	0.362832203	2.402068795	0	3.037080239	0.5108397	0	2.439067269	2.090851316	0	3.190697969	0.149901558	0.00126024	1.94775546	0	16.05319697	0.273681479	0.930476194	0	0	6.17614308	0	0	0	0	0	0	0	0	0	6.576197331	0	0	0	0	0	0	0	0	0	59.6236	NO																																																																																		0	0	NO	0	13.4815	0.362832203	2.402068795	0	3.037080239	0.5108397	0	2.439067269	2.090851316	0	3.190697969	0.149901558	0.00126024	1.94775546	0	16.05319697	0.273681479	0.930476194	0	0	6.17614308	0	0	0	0	0	0	0	0	0	6.576197331	0	0	0	0	0	0	0	0	0	59.6236
H1019_060_0	2012	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	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	1246.83	38.21	625.21	406.92	151.43	7.08	6.36	280.65	199.63	1833.84	1006.76	8.97	0.03	6.07	4848.91	4813.31	81.88	223.27		300.48	19.25	0	1.14		3.28		0.57		2.87	2.89	393.48										4000	"$0-$150/Day(Days 1-7): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-7): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $150 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$150/Visit: 5. $30 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$150/Visit: 7c, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS841: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$150/Visit: 3. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"												109.326089	96.004993	34.03605	0	150	0.045	0.065838	65	118.890967	0	45.565576	150	0.02461	0.2	0	29.889099	30	37.40322		0	0.2	0	0		0		0		0	0	150										NO	97.770868	85.857746	31.520888	0	140.6859	0.042206	0.06175	60.96389	111.508551	0	42.736227	140.6859	0.023082	0.187581	0	28.033166	28.13718	35.080704		0	0.187581	0	0		0		0		0	0	140.6859											10.1586	0.273385373	1.642264532	0	1.77533882	0.29881848	0.39273	1.425792977	1.85503767	0	3.585426991	0.10516271	0.00069246	1.13861667	0	11.24435985	0.191989358	0.652705732	0	0	3.61093425	0	0	0	0	0	0	0	0	0	4.613090661	0	0	0	0	0	0	0	0	0	42.965	0	NO	3.409057	10.1586	0.273385373	1.642264532	0	1.77533882	0.29881848	0.39273	1.425792977	1.85503767	0	3.585426991	0.10516271	0.00069246	1.13861667	0	11.24435985	0.191989358	0.652705732	0	0	3.61093425	0	0	0	0	0	0	0	0	0	4.613090661	0	0	0	0	0	0	0	0	0	42.965	NO																																																																																		0	0	NO	0	10.1586	0.273385373	1.642264532	0	1.77533882	0.29881848	0.39273	1.425792977	1.85503767	0	3.585426991	0.10516271	0.00069246	1.13861667	0	11.24435985	0.191989358	0.652705732	0	0	3.61093425	0	0	0	0	0	0	0	0	0	4.613090661	0	0	0	0	0	0	0	0	0	42.965
H1019_061_0	2012	4																															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	431.15	11.15	72.5	68.9	483.74	643.42	3110.61	553.81	233.53	141.5	1855.76	50.9	100.82	356.6	6576.17	5344.01	66.88	324.31		633.2	2447.14	0	2.91	1.92	0.2		0.57		1.83	1.41											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Membership in health club/fitness class 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	1.007791667	0	0	1.153770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1616	0	NO	0	0	0	0	0	1.007791667	0	0	1.153770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1616	NO																																																																																		0	0	NO	0	0	0	0	0	1.007791667	0	0	1.153770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1616
H1026_001_0	2012	7	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	Dialysis	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	Coin	V	V	V	V	V	V	V			Coin			V						O	V	V	V	Coin	V	V	V	O	O	Coin																																									0	YES	1516.176145	33.04627992	636.213349	63.90475391	193.5410845	160.655494	44.44284917	260.2984715	182.219751	285.4664647	4.942603626	26.34806011	9.527126816	666.7312282	5032.955423	11315.17544	4.897193259	1357.850417	0	0	32.37393033	0	0	0	0	0	0	0	0	338.3261657	157.0565985	178.3037834	401.6017651	0	334.6925815	15.98097855	560.5307039	125.1529039	0	0.151004417	3400	50 Copay for 5 days(#1A)	50 Copay for 5 days(#1B)	70 Copay for days 7 to 25(#2)	0(#6)	175 Copay(#10A)	0 Copay(#11A)	0(#11B)	50 Copay(#4A)	50 Copay(#9A)	30 Copay(#8A)	0.2 Coins(#9A)	15 Copay(#7E/7H)	15 Copay(#9A)	50 Copay(#9A)	0 Copay(#14B)	0 Copay(#14C)	15 Copay(#7H)	0 Copay(#7I)			0.2 Coins(#15)			0(#16A)						(multiple)	0 Copay(#9B)	40 Copay(#8B)	25 Copay(#8B/#8A)	0.2 Coins(#9A/#12)	50 Copay(#9A)	25 Copay(#4B)	40 Copay(#8B)	5 Copay(#7G)	0 Copay(#7G)	0.2 Coins(#11A)	0	NO	29.05657973	16.09261127	32.83302064	0	173.294347	0	0	49.38094935	44.53304735	0.119363395	0.133037057	15	15	42.43211045	0	0	8.076923077	0	0	0	0.169886978	0	0	0	0	0	0	0	0	3.121568998	0	35.66878981	17.70199726	0	48.78485397	13.85098202	4.949290061	4.98489426	0	0.166448372	NO	27.91809284	16.09261127	29.38092163	0	163.7933858	0	0	48.15900446	43.7183834	0.039787798	0.116664972	15	14.29698267	39.99037204	0	0	8.076923077	0	0	0	0.112589712	0	0	0	0	0	0	0	0	2.015032514	0	35.6240663	17.60639497	0	45.77548736	13.85098202	4.787018256	4.98489426	0	0.166448372		3.5274	0.044316745	1.557711212	0	2.641729127	0	0	1.044642937	0.663862745	0.000946507	0.576628714	0.032935075	0.011350764	2.221902489	0	0	0.003296188	0	0	0	3.644971493	0	0	0	0	0	0	0	0	0.056811519	0	0.529325483	0.589229941	0	1.276726336	0.018446021	0.223605893	0.051989499	0	0.025134439	18.743	0	NO	2.719530881	3.5274	0.044316745	1.557711212	0	2.641729127	0	0	1.044642937	0.663862745	0.000946507	0.576628714	0.032935075	0.011350764	2.221902489	0	0	0.003296188	0	0	0	3.644971493	0	0	0	0	0	0	0	0	0.056811519	0	0.529325483	0.589229941	0	1.276726336	0.018446021	0.223605893	0.051989499	0	0.025134439	18.743	NO																																																																																		0	0	NO	0	3.5274	0.044316745	1.557711212	0	2.641729127	0	0	1.044642937	0.663862745	0.000946507	0.576628714	0.032935075	0.011350764	2.221902489	0	0	0.003296188	0	0	0	3.644971493	0	0	0	0	0	0	0	0	0.056811519	0	0.529325483	0.589229941	0	1.276726336	0.018446021	0.223605893	0.051989499	0	0.025134439	18.743
H1026_038_0	2012	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	Dialysis	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	Coin	V	V	V	V	V	V	V			Coin			V						O	V	V	V	Coin	V	V	V	O	O	Coin																																									0	YES	1744.686378	31.74130356	1283.991178	117.0381899	282.182451	136.8810178	51.58207316	232.0927543	141.893009	359.3901584	2.927555824	12.6580198	10.81493136	388.6285496	5719.41243	11466.8388	3.010206768	780.4508564	0	0	36.24479709	0	0	0	0	0	0	0	0	381.0852679	199.4042204	315.1624612	946.5800027	0.029529711	63.43031779	99.78768602	434.5770042	108.3343889	0	0.057586893	3400	125 Copay for 10 days(#1A)	125 Copay for 10 days(#1B)	70 Copay for days 7 to 25(#2)	0(#6)	175 Copay(#10A)	0 Copay(#11A)	0(#11B)	65 Copay(#4A)	150 Copay(#9A)	30 Copay(#8A)	0.2 Coins(#9A)	40 Copay(#7E/7H)	15 Copay(#9A)	150 Copay(#9A)	"0 Copay(#14B), 20 Copay(#7A)"	"30 Copay(#14C), 20 Copay(#7B)"	40 Copay(#7H)	30 Copay(#7I)			0.2 Coins(#15)			0(#16A)						(many)	100 Copay(#9B)	100 Copay(#8B)	50 Copay(#8B/#8A)	0.2 Coins(#9A/#12)	50 Copay(#9A)	25 Copay(#4B)	100 Copay(#8B)	5 Copay(#7G)	5 Copay(#7G)	0.2 Coins(#11A)	0	NO	96.95019629	90.83930322	34.01727862	0	173.1101512	0	0	63.63297322	143.3769515	0.276505399	0.109384109	40	15	75.38459768	0.02266126	14.21996026	40	4.171732824	0	0	0.189383993	0	0	0	0	0	0	0	0	34.81818498	97.6673428	92.40180296	28.96698804	0.2	49.32853168	23.37920499	4.897401601	4.90990991	5	0.168391123	NO	88.20178134	80.27743059	27.6293722	0	151.5541028	0	0	61.1182681	139.6995321	0.251327236	0.062972663	40	13.72841965	67.43354591	0.02266126	13.87802802	40	4.072312789	0	0	0.139267274	0	0	0	0	0	0	0	0	31.52142094	97.02042812	90.85640695	28.67763281	0.183045595	48.4558425	23.12229065	4.527715834	4.90990991	5	0.168391123		12.8237	0.212342524	2.956322514	0	3.563825683	0	0	1.182092265	1.65186558	0.007527045	0.184355987	0.042193399	0.01237266	2.183883428	0.010800758	13.26142585	0.010034023	0.264853334	0	0	5.047714072	0	0	0	0	0	0	0	0	1.001029095	1.612190236	2.386210736	2.262139479	0.005405284	0.256130791	0.192276657	0.163970099	0.044326007	0	0.009697122	51.3487	0	NO	5.326835682	12.8237	0.212342524	2.956322514	0	3.563825683	0	0	1.182092265	1.65186558	0.007527045	0.184355987	0.042193399	0.01237266	2.183883428	0.010800758	13.26142585	0.010034023	0.264853334	0	0	5.047714072	0	0	0	0	0	0	0	0	1.001029095	1.612190236	2.386210736	2.262139479	0.005405284	0.256130791	0.192276657	0.163970099	0.044326007	0	0.009697122	51.3487	NO																																																																																		0				12.8237	0.212342524	2.956322514	0	3.563825683	0	0	1.182092265	1.65186558	0.007527045	0.184355987	0.042193399	0.01237266	2.183883428	0.010800758	13.26142585	0.010034023	0.264853334	0	0	5.047714072	0	0	0	0	0	0	0	0	1.001029095	1.612190236	2.386210736	2.262139479	0.005405284	0.256130791	0.192276657	0.163970099	0.044326007	0	0.009697122	51.3487
H1026_040_0	2012	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	Dialysis	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	Coin	V	V	V	V	V	V	V			Coin			V						O	V	V	V	Coin	V	V	V	O	O	Coin																																									0	YES	1698.312143	18.68076664	989.0430613	86.0046207	276.831269	163.3707888	55.97497737	279.6831365	198.3702276	191.9904104	0.864260705	23.24754904	32.78160558	697.7118561	5307.373771	11204.61039	10.2167679	535.039602	0	0	25.07278612	0	0	0	0	0	0	0	0	104.9687569	125.3109386	187.4689762	564.3494096	0	191.5673337	52.54387758	492.7232998	130.4765207	0	0.054616989	3400	95 Copay for 8 days (#1A)	95 Copay for 8 days(#1B)	70 Copay for days 7 to 25(#2)	0(#6)	175 Copay(#10A)	0 Copay(#11A)	0(#11B)	65 Copay(#4A)	125 Copay(#9A)	30 Copay(#8A)	0.2 Coins(#9A)	40 Copay (#7E/7H)	15 Copay(#9A)	125 Copay(#9A)	0 Copay(#14B)	15 Copay(#14C)	40 Copay(#7H)	15 Copay(#7I)			0.2 Coins(#15)			0(#16A)						(multiple)	25 Copay(#9B)	75 Copay(#8B)	50 Copay(#8B/#8A)	0.2 Coins(#9A/#12)	50 Copay(#9A)	25 Copay(#4B)	75 Copay(#8B)	5 Copay(#7G)	5 Copay(#7G)	0.2 Coins(#11A)	0	NO	68.92072738	64.51643333	33.83179114	0	174.0256125	0	0	63.73383984	122.9990298	0.603516559	0.199082208	40	15	79.74821178	0	7.080323004	33.33333333	10.61875387	0	0	0.189047286	0	0	0	0	0	0	0	0	33.10327979	24.41212871	70.47146402	28.14305247	0	49.49881666	21.54681987	1.200564972	4.881376038	5	0.2	NO	62.26646163	64.51643333	27.88915186	0	148.7981164	0	0	61.3940381	117.2186731	0.510528137	0.11910265	40	13.86850224	72.80424355	0	6.93340557	33.33333333	10.396138	0	0	0.131955095	0	0	0	0	0	0	0	0	28.65050636	24.22648515	69.45552682	27.94002408	0	47.15460582	21.54681987	1.200564972	4.881376038	5	0.184913363		8.8123	0.100434703	2.298631011	0	3.432664283	0	0	1.430906428	1.937724572	0.008168042	0.102935741	0.07749183	0.037885981	4.233031991	0	6.473842339	0.028379911	0.463528795	0	0	3.308481869	0	0	0	0	0	0	0	0	0.250617336	0.252986966	1.085063042	1.313994674	0	0.752773509	0.094346122	0.049295528	0.053075413	0	0.010099411	36.6087	0	NO	4.324176652	8.8123	0.100434703	2.298631011	0	3.432664283	0	0	1.430906428	1.937724572	0.008168042	0.102935741	0.07749183	0.037885981	4.233031991	0	6.473842339	0.028379911	0.463528795	0	0	3.308481869	0	0	0	0	0	0	0	0	0.250617336	0.252986966	1.085063042	1.313994674	0	0.752773509	0.094346122	0.049295528	0.053075413	0	0.010099411	36.6087	NO																																																																																		0				8.8123	0.100434703	2.298631011	0	3.432664283	0	0	1.430906428	1.937724572	0.008168042	0.102935741	0.07749183	0.037885981	4.233031991	0	6.473842339	0.028379911	0.463528795	0	0	3.308481869	0	0	0	0	0	0	0	0	0.250617336	0.252986966	1.085063042	1.313994674	0	0.752773509	0.094346122	0.049295528	0.053075413	0	0.010099411	36.6087
H1026_801_0	2012	4																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	274.0329102		27.53667496		7.712099794	4.669697802		23.26887364	54.31434133					55.26149849						255.4426032	30.60158871	0								4.985915567											3400	8.1% coinsurance		15.9% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											0	NO	0.081226026		0.159382926		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224								0.224											YES	0.062339077		0.117861658		0.186192655	0.186192655		0.186192655	0.186192655					0.186192655						0.186192655	0.186192655	0.186192655								0.186192655											3400	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563	0	NO	22.81271	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563	YES																																									3400																																									0	0	NO	0	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563
H1026_802_0	2012	3																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	274.0329102		27.53667496		7.712099794	4.669697802		23.26887364	54.31434133					55.26149849						255.4426032	30.60158871	0								4.985915567											3400	8.1% coinsurance		15.9% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											0	NO	0.081226026		0.159382926		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224								0.224											YES	0.062339077		0.117861658		0.186192655	0.186192655		0.186192655	0.186192655					0.186192655						0.186192655	0.186192655	0.186192655								0.186192655											3400	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563	0	NO	22.81271	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563	YES																																									3400																																									0	0	NO	0	17.083	0	3.245518174	0	1.435936339	0.869463434	0	4.33249337	10.11293144	0	0	0	0	10.28928514	0	0	0	0	0	47.56153659	5.697791061	0	0	0	0	0	0	0	0	0.928340859	0	0	0	0	0	0	0	0	0	0	101.5563
H1032_002_0	2012	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	1891.770744	44.00021295	802.273808	719.2318615	545.2527643	617.6535744	12.14311102	426.3852767	326.2405306	3545.298498	910.4447441	12.22200947	0.000554206	606.7732915	12912.74602	12879.79349	429.1196154	336.1858037	4131.388717	3925.95103	22.9287812	0.035795703	0	288.8571429	508.8	305.28	18	13.71428571	6804.716649	2039.518501											3400	"(1a) $50 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $50 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 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) $30.00 copayment"	"(9a) , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $50.00	(8b) Copay between $0.00 and $50.00	(9a) $50.00 copayment	(12) 20% coinsurance	"(5) , (9a) $50.00 copayment ; (3) Copay between $20.00 and $50.00"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $20.00 copayment"	"(7e) , (7h) Copay between $10.00 and $20.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	35.15149115	38.35607259	49.8445493	1.393411345	47.17035251	0	0.126374644	44.3959561	50	0.299077952	24.19751746	41.66468691	0.2	24.13638363	0	6.263407487	15.60142652	5.310473546	7.172502887	7.802081189	0.2	0	0	0	0	0	0	0	0	0											YES	34.41855027	37.55631325	48.80524466	1.364357438	46.18680733	0	0.123739616	43.47025964	48.95745407	0.292841902	23.69297699	40.79593992	0.195829816	23.63311786	0	6.132809687	15.27612244	5.199745295	7.022949614	7.639400629	0.195829816	0	0	0	0	0	0	0	0	0											3400	5.426	0.137707148	3.26293079	0.081774112	2.098623698	0	1.502583897	1.54458989	1.330992149	0.086517663	1.797595531	0.041550697	0.00010853	1.194995393	0	6.582443523	0.546273649	0.145673379	2.417877899	2.499326064	4.490139011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1877	0	NO	0.749319951	5.426	0.137707148	3.26293079	0.081774112	2.098623698	0	1.502583897	1.54458989	1.330992149	0.086517663	1.797595531	0.041550697	0.00010853	1.194995393	0	6.582443523	0.546273649	0.145673379	2.417877899	2.499326064	4.490139011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1877	YES	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	Same as in-network	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											3400	0.0977	0	0.0125	0.0036	0.0149	0.0245	0.0854	0	0.0678	0.0029	0.0089	0	0	0.0212	0	0.0779	0	0.0004	0.0192	0.0136	0.0265	0.0001	0	0	0	0	0	0	0	0											0.477	0	NO	0.010156754	5.5237	0.137707148	3.275448065	0.08537098	2.113547127	0.024500259	1.58798472	1.54458989	1.398792439	0.089444842	1.806471521	0.041550697	0.00010853	1.216224393	0	6.660303525	0.546273649	0.146037271	2.437051572	2.512912571	4.516601106	5.32E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6647
H1032_008_0	2012	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	2015.965149	61.16918059	768.980962	2107.348665	426.2235928	630.6286914	1578.265414	457.8521215	246.0740739	2997.987011	811.2159191	154.5515138	0.256934171	1331.463231	12107.44131	16728.10751	566.5722801	1877.009716	4365.013394	5685.022073	4.652519376	0.130755067	0	658.6666667	508.8	305.28	18	13.71428571	6804.716649	4535.433205											3400	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $0.00 copayment	(11a) $0.00 copayment	"(11b) , (11c) $0.00 copayment"	"(4a) $25.00 copayment , (4b) $0.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(9a) $0.00 copayment	(12) 20% coinsurance	"(3) , (5) , (9a) $0.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) $0.00 copayment , (8a) $0.00 copayment , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment,(13c) $0.00 copayment"											0	NO	0	0	54.3892745	0	0	0	0	18.4586387	0	0	0	0	0.2	0	0	0	0	0	0	0.124633137	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	54.30221216	0	0	0	0	18.42909147	0	0	0	0	0.199679855	0	0	0	0	0	0	0.124433634	0.199679855	0	0	0	0	0	0	0	0	0												0	0	3.479780612	0	0	0	0	0.703149886	0	0	0	0	0.051304578	0	0	0	0	0	0	0.058950663	0.929014393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2222	0	NO	0.008372715	0	0	3.479780612	0	0	0	0	0.703149886	0	0	0	0	0.051304578	0	0	0	0	0	0	0.058950663	0.929014393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2222	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	NO	0	0	0	3.479780612	0	0	0	0	0.703149886	0	0	0	0	0.051304578	0	0	0	0	0	0	0.058950663	0.929014393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2222
H1032_012_0	2012	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	1217.785535	88.18272697	748.8171283	499.0871972	480.9079255	6.228043795	8.997154279	465.6083193	145.0079859	3655.495755	511.0552637	9.347819618	0.007947971	255.8757518	11997.92389	9667.326103	269.2536671	162.626882	3270.837703	3127.136442	25.27741608	0.047391717	0	0	252	0	18	13.71428571	6804.716649	2039.518501											5000	"(1a) $175 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $175 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(3) Copay between $30.00 and $125.00 , (5) $175.00 copayment , (9a) $125.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $30.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $20.00 and $30.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	144.2158215	162.6611425	57.93997971	0	44.12001246	0.183835609	0.094076267	59.16757586	116.0079512	0.488920883	9.897245647	28.19742537	0.2	21.4436375	0	8.952292348	11.3668174	9.128189258	8.724018321	6.590648369	0.2	0	0	0	0	0	0	0	0	0											YES	142.1100353	160.2860244	57.09396148	0	43.4757883	0.181151309	0.0927026	58.30363272	114.3140458	0.48178184	9.752729713	27.78569695	0.197079674	21.13052541	0	8.821574274	11.20084332	8.994902802	8.59663342	6.49441415	0.197079674	0	0	0	0	0	0	0	0	0											5000	14.4216	1.177871561	3.56274469	0	1.74232093	1.128218287	0.83405959	2.26222137	1.381370795	0.146762623	0.415348655	0.02164464	0.001566384	0.450565756	0	7.106752938	0.251322345	0.121901083	2.343182725	1.692409929	4.981664913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0436	0	NO	0.652637375	14.4216	1.177871561	3.56274469	0	1.74232093	1.128218287	0.83405959	2.26222137	1.381370795	0.146762623	0.415348655	0.02164464	0.001566384	0.450565756	0	7.106752938	0.251322345	0.121901083	2.343182725	1.692409929	4.981664913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0436	YES	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	Same as in-network	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											5000	0.0592	0	0.0111	0.0012	0.0123	0.0174	0.0535	0	0.0552	0.0023	0.0031	0	0	0.0097	0	0.0635	0	0.0002	0.0177	0.0107	0.0294	0.0001	0	0	0	0	0	0	0	0											0.3465	0	NO	0.005135174	14.4808	1.177871561	3.573838988	0.001173851	1.754631778	1.145596671	0.887606761	2.26222137	1.43656657	0.149100233	0.418403723	0.02164464	0.001566384	0.460268495	0	7.170219481	0.251322345	0.122139961	2.360865702	1.70314671	5.011023757	7.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3901
H1032_014_0	2012	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	1451.098689	108.4116983	1320.309584	570.6337813	541.8122012	6.0467777	7.831125359	572.387637	198.0263799	3471.756249	556.5780254	11.51963565	0.010337415	403.1923326	10094.85786	11660.67189	391.0706431	444.9439169	3098.564189	3307.28812	12.12126304	0.038877005	0	0	252	0	18	13.71428571	6804.716649	2039.518501											5000	"(1a) $175 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $175 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(3) Copay between $30.00 and $125.00 , (5) $175.00 copayment , (9a) $125.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $30.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $20.00 and $30.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	139.3505258	133.0626313	56.43073972	0	44.86746663	0.185493398	0.10351337	57.73689244	115.7144033	0.488920883	13.0265073	76.04550156	0.2	21.18237468	0	7.633567967	18.03952817	8.024902353	6.762717223	6.477281853	0.2	0	0	0	0	0	0	0	0	0											YES	136.9581803	130.7782353	55.46194664	0	44.0971898	0.182308879	0.10173627	56.74567556	113.7278386	0.480527175	12.80287049	74.73996567	0.196566435	20.81871937	0	7.502516206	17.72982871	7.887132231	6.646616075	6.366081009	0.196566435	0	0	0	0	0	0	0	0	0											5000	16.5617	1.181490882	6.102244973	0	1.991032956	1.102381266	0.796709485	2.706710262	1.876759348	0.139022768	0.593816365	0.071748098	0.002031989	0.699495669	0	7.290364983	0.577801293	0.292444292	1.716247212	1.754538675	2.382633463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8391	0	NO	0.835639895	16.5617	1.181490882	6.102244973	0	1.991032956	1.102381266	0.796709485	2.706710262	1.876759348	0.139022768	0.593816365	0.071748098	0.002031989	0.699495669	0	7.290364983	0.577801293	0.292444292	1.716247212	1.754538675	2.382633463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8391	YES	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	Same as in-network	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											5000	0.071	0	0.0194	0.0043	0.0148	0.0181	0.0491	0	0.063	0.0038	0.0036	0	0	0.0096	0	0.0712	0	0.0007	0.0143	0.0123	0.014	0.0001	0	0	0	0	0	0	0	0											0.3692	0	NO	0.006449147	16.6327	1.181490882	6.121679067	0.00426529	2.005787541	1.120482266	0.845787853	2.706710262	1.939721356	0.142816761	0.597431805	0.071748098	0.002031989	0.709052958	0	7.361555804	0.577801293	0.293144605	1.730578373	1.7668385	2.396675227	5.80E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2083
H1032_025_0	2012	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	1444.524865	175.3585164	949.7817224	1839.629298	429.2530833	13.60842578	14.22826731	334.732605	230.7436315	11290.10568	1663.704875	20.19755756	0	2944.529411	7922.456317	16755.11974	413.462232	1598.564712	3966.206192	5165.321444	35.74572286	0.090771976	0	0	252	0	18	13.71428571	6804.716649	2039.518501											6000	"(1a) $150 days 1 - 6, $0 after day 6, unlimited coverage"	"(1b) $150 days 1 - 6, $0 days 7 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $45.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(5) , (9a) $150.00 copayment ; (3) Copay between $35.00 and $150.00"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	89.66101706	86.2744169	35.53553308	0	40.16900836	0.194999094	0.092949577	64.70799917	149.8334503	0.58670506	23.10179388	91.25460187	0	18.81341225	6.537070308	12.35054969	28.65182121	9.353372622	5.477186719	5.846373063	0.2	0	0	0	0	0	0	0	0	0											YES	87.49257025	84.18787483	34.67610814	0	39.19752308	0.190283052	0.090701596	63.14303973	146.2097364	0.57251563	22.54307825	89.04761429	0	18.3584109	6.378971618	12.05185232	27.95887848	9.127161814	5.344721257	5.704978848	0.195163011	0	0	0	0	0	0	0	0	0											6000	10.5321	1.230255069	2.744561143	0	1.402138137	2.589452787	1.290526558	1.761336181	2.811413795	0.53864683	3.125419099	0.149878693	0	4.504740069	4.211426999	16.82751906	0.963328358	1.215863233	1.766522212	2.455670799	6.976242899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.097	0	NO	1.662956812	10.5321	1.230255069	2.744561143	0	1.402138137	2.589452787	1.290526558	1.761336181	2.811413795	0.53864683	3.125419099	0.149878693	0	4.504740069	4.211426999	16.82751906	0.963328358	1.215863233	1.766522212	2.455670799	6.976242899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.097	YES	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	Same as in-network	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											6000	0.0745	0	0.0161	0.0312	0.0123	0.1136	0.1187	0	0.0595	0.0352	0.0135	0	0	0.0312	0	0.1131	0	0.0027	0.0251	0.02	0.0411	0.0001	0	0	0	0	0	0	0	0											0.7078	0	NO	0.01754333	10.6066	1.230255069	2.760664794	0.031195002	1.414413653	2.703009726	1.409256825	1.761336181	2.870884779	0.573811609	3.138887936	0.149878693	0	4.535978471	4.211426999	16.94063138	0.963328358	1.2185761	1.791614179	2.475628858	7.017356549	0.000134565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8049
H1032_032_0	2012	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	913.0532792	99.71474504	437.809207	436.3338515	271.8338874	5.094479506	5.336364199	384.7470858	117.8254909	3863.187728	402.711756	0.123625645	0.000418774	152.2091847	17605.13584	7732.423468	197.3539402	92.49045593	2695.916082	2750.393543	9.965565974	0.011073586	0	0	252	0	18	13.71428571	6804.716649	2039.518501											5000	"(1a) $125 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $125 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(5) , (9a) $125.00 copayment ; (3) Copay between $25.00 and $125.00"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	87.47784121	83.73820344	52.30131688	0	42.65745963	0.19350729	0.121618145	49.05925662	95.82746508	0.488920883	12.79267656	76.04550156	0.2	27.58686962	0	7.018116813	5.011685858	6.246310655	8.933473844	10.77186674	0.2	0	0	0	0	0	0	0	0	0											NO	86.84593178	83.13330784	51.9235104	0	42.34931701	0.192109461	0.120739618	48.70486965	95.13524086	0.485389089	12.70026672	75.49617536	0.19855527	27.38759168	0	6.967420383	4.975483186	6.201189484	8.868941543	10.69405452	0.19855527	0	0	0	0	0	0	0	0	0												6.6079	0.690801383	1.894382576	0	0.959331623	0.978697712	0.644310574	1.561588055	0.934113038	0.156262431	0.426212226	0.000777772	8.31E-05	0.347386917	0	4.489587074	0.081827601	0.047795904	1.992493511	2.451071543	1.97871564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2434	0	NO	0.190952203	6.6079	0.690801383	1.894382576	0	0.959331623	0.978697712	0.644310574	1.561588055	0.934113038	0.156262431	0.426212226	0.000777772	8.31E-05	0.347386917	0	4.489587074	0.081827601	0.047795904	1.992493511	2.451071543	1.97871564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2434	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	NO	0	6.6079	0.690801383	1.894382576	0	0.959331623	0.978697712	0.644310574	1.561588055	0.934113038	0.156262431	0.426212226	0.000777772	8.31E-05	0.347386917	0	4.489587074	0.081827601	0.047795904	1.992493511	2.451071543	1.97871564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2434
H1032_035_0	2012	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	1338.285379	85.51968706	957.6157913	428.2177158	477.2896018	6.940734955	8.11471103	514.3635759	163.83881	4404.961974	519.3924247	20.70749884	0.538747773	157.6183894	12434.26696	11547.08754	312.8372361	39.94794489	3435.029976	3123.027797	14.80499296	0.036199936	0	0	252	0	18	13.71428571	6804.716649	2039.518501											5500	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $10.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(9a) $0.00 copayment	(12) 20% coinsurance	"(3) , (5) , (9a) $0.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	0	0	53.56336776	0	47.42830309	0.183904532	0.103296836	37.29206015	0	0	0.288309006	0	0.2	0	0	0	0	0	6.943316281	5.470823082	0.2	0	0	0	0	0	0	0	0	0											YES	0	0	53.35912903	0	47.24745754	0.183203298	0.102902962	37.1498644	0	0	0.287209675	0	0.199237394	0	0	0	0	0	6.916841207	5.449962669	0.199237394	0	0	0	0	0	0	0	0	0											5500	0	0	4.258128714	0	1.879226683	1.271565536	0.835027802	1.592378091	0	0	0.012431211	0	0.107338702	0	0	0	0	0	1.979963074	1.418365409	2.949708215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3041	0	NO	0.062406108	0	0	4.258128714	0	1.879226683	1.271565536	0.835027802	1.592378091	0	0	0.012431211	0	0.107338702	0	0	0	0	0	1.979963074	1.418365409	2.949708215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3041	YES	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	Same as in-network	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											5500	0.069	0	0.014	0.0007	0.0132	0.0148	0.0451	0	0.0602	0.0015	0.0033	0	0	0.0142	0	0.0797	0	0	0.0176	0.011	0.0174	0.0001	0	0	0	0	0	0	0	0											0.3617	0	NO	0.001384294	0.069	0	4.272114545	0.000661126	1.892467986	1.286339714	0.88009932	1.592378091	0.060192448	0.001466678	0.015700702	0	0.107338702	0.014154857	0	0.079727537	0	2.49E-05	1.997601007	1.429348306	2.967091966	5.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6658
H1032_037_0	2012	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	1467.410246	93.01760887	621.4762749	608.7812468	379.3005706	6.122429523	4.87512711	401.754793	195.0281683	2900.777847	761.4353807	8.529905778	0.000554412	584.7556059	11933.62418	13136.98898	151.9954162	444.2853212	3629.288438	4033.995993	9.578345067	0.027471683	0	288.8571429	508.8	305.28	18	13.71428571	6804.716649	2039.518501											6700	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $30.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) Copay between $0.00 and $20.00	(8b) Copay between $0.00 and $20.00	(9a) $0.00 copayment	(12) 20% coinsurance	"(5) , (9a) $0.00 copayment ; (3) $20.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $20.00 copayment"	"(7e) , (7h) Copay between $10.00 and $20.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	0	0	59.41365205	0	48.15430896	0.197858097	0.115549139	53.84708084	0	0	0.37422669	0	0.2	5.831001222	0	5.408268229	9.047408118	5.352585376	7.395206112	8.014950134	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	59.17511023	0	47.96097264	0.19706371	0.115085217	53.63088843	0	0	0.372724195	0	0.199197013	5.807590143	0	5.386554395	9.011083381	5.331095105	7.365514855	7.982770647	0.199197013	0	0	0	0	0	0	0	0	0												0	0	3.064660589	0	1.515968691	1.206508676	0.561055062	1.795538873	0	0	0.023650449	0	0.000110437	0.283001741	0	5.896925479	0.114136947	0.197377275	2.227631492	2.683538734	1.907977731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4781	0	NO	0.086580674	0	0	3.064660589	0	1.515968691	1.206508676	0.561055062	1.795538873	0	0	0.023650449	0	0.000110437	0.283001741	0	5.896925479	0.114136947	0.197377275	2.227631492	2.683538734	1.907977731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4781	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	NO	0	0	0	3.064660589	0	1.515968691	1.206508676	0.561055062	1.795538873	0	0	0.023650449	0	0.000110437	0.283001741	0	5.896925479	0.114136947	0.197377275	2.227631492	2.683538734	1.907977731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4781
H1032_040_0	2012	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	1196.196315	76.62738612	525.3938441	2170.947616	309.8778515	5.249448607	8.184475598	368.3821147	214.4334385	3100.939285	521.5759158	209.3525202	0.014448024	1144.162794	13126.30051	12449.27988	535.3625796	1407.909989	3443.95469	5017.777913	12.48452032	0.034609464	0	419.1428571	508.8	305.28	18	13.71428571	6804.716649	2144.158501											6700	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $0.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $0.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(9a) $0.00 copayment	(12) 20% coinsurance	"(3) , (5) , (9a) $0.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) $0.00 copayment , (8a) $0.00 copayment , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment,(13c) $0.00 copayment"											0	NO	0	0	58.60339495	0	0	0.192247694	0.11987743	36.0749442	0	0	0	0	0.2	0	0	0	0	0	0	0.011262653	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	58.53484054	0	0	0.192022802	0.119737197	36.03274364	0	0	0	0	0.199766039	0	0	0	0	0	0	0.011249478	0.199766039	0	0	0	0	0	0	0	0	0												0	0	2.562820407	0	0	1.008013831	0.979986171	1.106151525	0	0	0	0	0.002886225	0	0	0	0	0	0	0.004703948	2.49398318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1585	0	NO	0.009555065	0	0	2.562820407	0	0	1.008013831	0.979986171	1.106151525	0	0	0	0	0.002886225	0	0	0	0	0	0	0.004703948	2.49398318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1585	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	NO	0	0	0	2.562820407	0	0	1.008013831	0.979986171	1.106151525	0	0	0	0	0.002886225	0	0	0	0	0	0	0.004703948	2.49398318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1585
H1032_061_0	2012	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	2167.509293	224.9218352	818.8559769	873.1988251	698.4132617	664.4807867	18.71728234	763.5308017	287.1885998	3627.631472	924.3596854	97.26199162	0.032447296	513.3775904	17127.86484	17749.74592	1592.267862	159.1959312	5728.827952	5506.563657	12.6496446	0.041608672	0	419.1428571	508.8	305.28	18	13.71428571	6804.716649	2081.141327											6700	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 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	(9a) $0.00 copayment	(12) 20% coinsurance	"(3) , (5) , (9a) $0.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) $0.00 copayment , (8a) $0.00 copayment , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	0	0	57.45826363	0	46.90719113	0	0.113695717	43.0983421	0	0	0	0	0.2	0	0	0	0	0	0	0.011347811	0.2	0	0	0	0	0	0	0	0	0											YES	0	0	57.31214448	0	46.78790387	0	0.113406584	42.98874093	0	0	0	0	0.19949139	0	0	0	0	0	0	0.011318953	0.19949139	0	0	0	0	0	0	0	0	0											6700	0	0	3.910866005	0	2.723107713	0	2.122663044	2.735268985	0	0	0	0	0.006472956	0	0	0	0	0	0	0.005194045	2.523495189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0271	0	NO	0.035762459	0	0	3.910866005	0	2.723107713	0	2.122663044	2.735268985	0	0	0	0	0.006472956	0	0	0	0	0	0	0.005194045	2.523495189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0271	YES	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	Same as in-network	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											6700	0.105	0	0.0135	0.001	0.0191	0.0489	0.1401	0	0.0781	0.0033	0.0076	0	0	0.0205	0	0.1105	0	0	0.0313	0.021	0.0149	0.0001	0	0	0	0	0	0	0	0											0.6149	0	NO	0.001567735	0.105	0	3.924340684	0.001041258	2.742251801	0.048942788	2.26274582	2.735268985	0.078067147	0.003257849	0.007598829	0	0.006472956	0.020526094	0	0.110545714	0	2.65E-05	0.031274685	0.026185916	2.538367105	6.31E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.642
H1032_073_0	2012	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	1846.109327	118.9954794	1129.822291	1164.32263	484.7717231	4.037302197	11.47823087	400.2515948	156.8491083	4169.168245	831.4644513	0.791871785	0.000570977	332.9988353	13473.51669	13140.00902	190.9409745	235.4057706	4875.961804	4623.700743	29.82117953	0.03390867	0	0	252	0	0	0	6804.716649	2039.518501											6700	"(1a) $195 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $195 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $45.00 copayment"	"(9a) $175.00 copayment , (9b) $150.00 copayment"	(8a) Copay between $0.00 and $175.00	(8b) Copay between $0.00 and $175.00	(9a) $175.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $175.00 , (5) $195.00 copayment , (9a) $175.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	Not Covered	Not Covered	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	154.1141805	122.7469306	67.75493365	0	45.72158032	0.172341988	0.068095	62.47019504	166.3217411	0.684489236	13.64333031	106.4637022	0.2	70.34034543	1.931302322	9.660599945	13.18857939	13.32274183	10.44724898	10.34408395	0.2	0	0	0	0	0	0	0	0	0											YES	151.070673	120.3228759	66.41688256	0	44.81865256	0.168938511	0.066750233	61.23650904	163.0371539	0.670971673	13.37389646	104.3612151	0.196050321	68.95123661	1.893162204	9.469818616	12.92812613	13.05963908	10.24093259	10.13980491	0.196050321	0	0	0	0	0	0	0	0	0											6700	23.2411	1.193156525	6.253272865	0	1.810567952	0.682055821	0.766174584	2.042500867	2.131019351	0.23311615	0.926659957	0.006886725	0.00011194	1.913390124	2.12562938	10.3694585	0.205709084	0.256192867	4.161199679	3.906951959	5.846451829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0716	0	NO	1.371387198	23.2411	1.193156525	6.253272865	0	1.810567952	0.682055821	0.766174584	2.042500867	2.131019351	0.23311615	0.926659957	0.006886725	0.00011194	1.913390124	2.12562938	10.3694585	0.205709084	0.256192867	4.161199679	3.906951959	5.846451829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0716	YES	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	Same as in-network	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											6700	0.0838	0	0.0193	0.001	0.0128	0.0313	0.0947	0	0.053	0.0018	0.007	0	0	0.035	0	0.0894	0	0.0002	0.0371	0.0205	0.0345	0.0001	0	0	0	0	0	0	0	0											0.5213	0	NO	0.010502762	23.3249	1.193156525	6.272615853	0.000958142	1.823404962	0.713338504	0.860850015	2.042500867	2.184024602	0.23489553	0.93367645	0.006886725	0.00011194	1.948349475	2.12562938	10.45885646	0.205709084	0.256348966	4.198289377	3.927483862	5.88090719	5.05E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5929
H1032_079_0	2012	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	1485.310116	136.2730518	717.1766651	1164.942905	487.2963307	10.81540204	14.78905528	474.5930425	229.780974	6962.442941	1028.086352	31.51974228	0.014840308	1748.972351	7923.553259	12854.66713	367.22807	1171.040816	3387.807692	4181.960547	20.33352792	0.053085418	0	0	252	0	18	13.71428571	6804.716649	2039.518501											6000	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $45.00 copayment"	"(9a) $175.00 copayment , (9b) $150.00 copayment"	(8a) Copay between $0.00 and $175.00	(8b) Copay between $0.00 and $175.00	(9a) $175.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $175.00 , (5) $200.00 copayment , (9a) $175.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	144.1676147	164.2131037	57.19324496	0	43.01464312	0.191694819	0.084616608	49.82858502	125.5611769	0.684489236	12.35813766	104.4215392	0.2	28.83162516	6.677054829	9.951486081	28.55894298	8.270959467	7.177721938	7.536184575	0.2	0	0	0	0	0	0	0	0	0											NO	141.2392051	160.8775194	56.03150522	0	42.14090671	0.187801011	0.08289783	48.81644019	123.0107112	0.670585525	12.10711257	102.3004731	0.195937493	28.24598179	6.541426926	9.749346181	27.97883848	8.102955321	7.031924216	7.38310557	0.195937493	0	0	0	0	0	0	0	0	0												17.482	1.826939212	3.348707338	0	1.711259101	2.031143441	1.225980594	1.930661906	2.355460086	0.389076121	1.0372631	0.268707046	0.002907773	4.116786765	4.319278719	10.44371666	0.856217905	0.790740951	1.985233912	2.572988017	3.984100488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6792	0	NO	1.299570358	17.482	1.826939212	3.348707338	0	1.711259101	2.031143441	1.225980594	1.930661906	2.355460086	0.389076121	1.0372631	0.268707046	0.002907773	4.116786765	4.319278719	10.44371666	0.856217905	0.790740951	1.985233912	2.572988017	3.984100488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6792	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	NO	0	17.482	1.826939212	3.348707338	0	1.711259101	2.031143441	1.225980594	1.930661906	2.355460086	0.389076121	1.0372631	0.268707046	0.002907773	4.116786765	4.319278719	10.44371666	0.856217905	0.790740951	1.985233912	2.572988017	3.984100488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6792
H1032_091_0	2012	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	1578.115263	67.04502775	744.2323887	570.9780135	435.2459749	6.726389862	10.88832716	461.8921023	227.271577	3851.919267	774.5621824	15.85962108	0.068344688	364.9603002	14366.73054	11390.12576	366.3599324	265.2270272	3954.258038	3810.358651	12.76269923	0.10366961	0	0	508.8	305.28	18	13.71428571	6804.716649	2039.518501											4000	"(1a) $75 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $75 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $50.00 copayment , (9b) $25.00 copayment"	(8a) Copay between $0.00 and $50.00	(8b) Copay between $0.00 and $50.00	(9a) $50.00 copayment	(12) 20% coinsurance	"(3) Copay between $25.00 and $50.00 , (5) $75.00 copayment , (9a) $50.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	59.3033294	61.1640898	56.4081926	0	47.50301107	0.170901455	0.116769834	54.0483154	45.86058106	0.195568353	13.48512337	50	0.2	25.05123739	0	7.504729637	15.4237394	1.789425435	8.323729713	8.168543392	0.2	0	0	0	0	0	0	0	0	0											YES	58.41058901	60.2433379	55.55903502	0	46.7879103	0.168328739	0.115012005	53.23468293	45.1702051	0.192624307	13.28212103	49.24731006	0.19698924	24.67412111	0	7.391754947	15.19155353	1.762487784	8.198425961	8.045575783	0.19698924	0	0	0	0	0	0	0	0	0											4000	7.6816	0.336584688	3.445736112	0	1.697020802	1.132244723	1.252288333	2.049056635	0.855491979	0.061831106	0.857319055	0.065086973	0.013463168	0.750422887	0	7.016084872	0.463798044	0.03895495	2.701557646	2.554710774	2.514114424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4873	0	NO	0.542383924	7.6816	0.336584688	3.445736112	0	1.697020802	1.132244723	1.252288333	2.049056635	0.855491979	0.061831106	0.857319055	0.065086973	0.013463168	0.750422887	0	7.016084872	0.463798044	0.03895495	2.701557646	2.554710774	2.514114424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4873	YES	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	Same as in-network	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											4000	0.0839	0	0.0117	0.0009	0.0119	0.0163	0.0682	0	0.0545	0.0021	0.0069	0	0	0.0155	0	0.0708	0	0	0.0211	0.0138	0.0148	0.0002	0	0	0	0	0	0	0	0											0.3927	0	NO	0.006002152	7.7654	0.336584688	3.457444242	0.000901979	1.70895401	1.1485875	1.320483797	2.049056635	0.910027811	0.063935079	0.864253372	0.065086973	0.013463168	0.765882457	0	7.086894392	0.463798044	0.039001087	2.722673361	2.568485917	2.528931056	0.000155123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.88
H1032_101_0	2012	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	1936.876236	118.4592238	1118.607984	1709.239171	514.1867642	13.41122352	13.7126908	647.6385673	302.2725859	7939.463542	1671.261669	44.58398887	0.01751191	3223.573839	11861.47607	22918.45684	604.130906	2327.962742	5218.215725	6552.49444	28.7831966	0.068047307	0	0	630	0	18	13.71428571	504	1647.13996											3400	"(1a) $100 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $100 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 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) $35.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $75.00	(8b) Copay between $0.00 and $75.00	(9a) $75.00 copayment	(12) 20% coinsurance	"(3) Copay between $25.00 and $75.00 , (5) $100.00 copayment , (9a) $75.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	63.15564015	61.13899783	38.04546962	10.42711145	48.65413452	0.197812743	0.088745911	49.66437603	69.15616985	1.036341171	10.67014005	45.62730094	0.2	11.28180256	2.071220145	7.144433294	21.31247668	6.7024737	7.221687744	6.786590283	0.2	0	0	0	0	0	0	0	0	0											YES	58.75554647	56.87940491	35.39481752	9.700647952	45.26436998	0.184031004	0.082562927	46.20422731	64.33801545	0.964138622	9.926744596	42.44841782	0.186065873	10.49579219	1.926916918	6.646676075	19.82762285	6.235508088	6.718548159	6.313764215	0.186065873	0	0	0	0	0	0	0	0	0											3400	9.4835	0.561490846	3.299410454	1.381727288	1.939528328	2.468080924	1.132159883	2.493636632	1.620634858	0.637895286	1.382515645	0.157709982	0.003258369	2.81949676	1.904673242	12.69429656	0.998206646	1.209669209	2.921569471	3.44757541	5.355570593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9126	0	NO	4.336968846	9.4835	0.561490846	3.299410454	1.381727288	1.939528328	2.468080924	1.132159883	2.493636632	1.620634858	0.637895286	1.382515645	0.157709982	0.003258369	2.81949676	1.904673242	12.69429656	0.998206646	1.209669209	2.921569471	3.44757541	5.355570593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9126	YES	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	Same as in-network	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											3400	0.0937	0	0.0184	0.0241	0.0139	0.1067	0.1091	0	0.0764	0.0282	0.0118	0	0	0.036	0	0.1425	0	0.0037	0.0315	0.0238	0.0316	0.0001	0	0	0	0	0	0	0	0											0.7514	0	NO	0.056273627	9.5772	0.561490846	3.317857812	1.405792473	1.953434283	2.574777443	1.241254805	2.493636632	1.697054575	0.666067997	1.39435729	0.157709982	0.003258369	2.85550094	1.904673242	12.8367682	0.998206646	1.213361971	2.953060043	3.471332176	5.387133005	9.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6641
H1032_124_0	2012	6																															D	D	D	P	Coin	P	Coin	Coin	Coin	Coin	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	1866.05177	436.3573576	704.5976636	1021.887102	14.93470907	545.0861309	12.78303766	61.70790712	32.17811165	4.446543464	9.277791396	1.259269877	0.642973469	13.77760448	12847.34286	124.1567518	5.846983167	0.391754696	30.40317331	27.32375814	14.6408183	0.04030701	1160	508	508.8	305.28	18	13.71428571	6804.716649	2081.141327											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) $0.00 copayment	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	157.6113935	66.47313333	62.47437245	0	0.193791562	0	0.089735728	0.197949885	0.182594116	0.111929768	0.173697387	0.2	0.2	0.191085234	0	0.08940745	0.154879421	0.069638703	0.161881375	0.107130135	0	0.197959482	0	0	0	0	0	0	0	0											NO	153.685706	64.81746148	60.91829927	0	0.188964721	0	0.087500645	0.193019472	0.178046174	0.109141891	0.16937104	0.195018523	0.195018523	0.1863258	0	0.087180545	0.15102178	0.067904185	0.157849334	0.104461803	0	0.193028829	0	0	0	0	0	0	0	0												23.8988	2.356964685	3.576907612	0	2.822133138	0	1.118524044	11.91082763	5.729189672	0.485304161	1.571389177	0.245580952	0.125391736	2.567123182	0	10.82405325	0.883021806	0.026601783	4.799120653	2.854289044	0	0.007780415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.803	0	NO	1.936281964	23.8988	2.356964685	3.576907612	0	2.822133138	0	1.118524044	11.91082763	5.729189672	0.485304161	1.571389177	0.245580952	0.125391736	2.567123182	0	10.82405325	0.883021806	0.026601783	4.799120653	2.854289044	0	0.007780415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.803	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	NO	0	23.8988	2.356964685	3.576907612	0	2.822133138	0	1.118524044	11.91082763	5.729189672	0.485304161	1.571389177	0.245580952	0.125391736	2.567123182	0	10.82405325	0.883021806	0.026601783	4.799120653	2.854289044	0	0.007780415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.803
H1032_131_0	2012	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	1037.774976	91.2195408	402.858906	839.2164868	319.5995408	5.019544819	5.754541749	405.4886718	171.6001998	2060.906021	516.1036272	26.70735931	0.019486226	691.4793376	12316.72124	12172.44672	225.454225	956.956062	3034.134194	4367.494153	9.840029689	0.030956266	0	0	508.8	305.28	0	0	504	2039.518501											5500	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $45.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $150.00 , (5) $250.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	155.9898589	193.4405614	53.15392075	0	44.49871693	0.19998743	0.101882797	60.40895803	132.6346184	0.58670506	17.24643073	91.25460187	0.2	24.64596209	5.376312599	8.552484035	22.96521323	9.379150923	8.253647355	8.179160808	0.2	0	0	0	0	0	0	0	0	0											NO	153.7337673	190.6428179	52.3851521	0	43.85512906	0.197094998	0.100409259	59.5352593	130.7163152	0.578219506	16.99699447	89.93478057	0.197107387	24.28950592	5.298554637	8.428788896	22.63306585	9.243499646	8.13427431	8.060865068	0.197107387	0	0	0	0	0	0	0	0	0												13.2951	1.449195859	1.758652089	0	1.168006593	0.989327178	0.577809276	2.011739435	1.869245483	0.099304672	0.731017542	0.200160042	0.003840879	1.399640955	5.438401702	8.549915316	0.425226693	0.737135252	2.056706652	2.933815088	1.939542539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6338	0	NO	0.699040636	13.2951	1.449195859	1.758652089	0	1.168006593	0.989327178	0.577809276	2.011739435	1.869245483	0.099304672	0.731017542	0.200160042	0.003840879	1.399640955	5.438401702	8.549915316	0.425226693	0.737135252	2.056706652	2.933815088	1.939542539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6338	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	NO	0	13.2951	1.449195859	1.758652089	0	1.168006593	0.989327178	0.577809276	2.011739435	1.869245483	0.099304672	0.731017542	0.200160042	0.003840879	1.399640955	5.438401702	8.549915316	0.425226693	0.737135252	2.056706652	2.933815088	1.939542539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6338
H1032_132_0	2012	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	1419.561039	70.64627349	645.1009871	465.3713854	382.171822	7.273048179	10.11635643	534.0348358	226.848775	578.0857299	581.9974064	1.138060441	0	367.7615918	15002.70203	13741.141	155.5987955	122.3591816	3738.806384	4000.952699	8.790149858	0.051292917	0	0	252	0	18	13.71428571	6804.716649	2039.518501											6700	"(1a) $100 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $100 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $45.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $75.00	(8b) Copay between $0.00 and $75.00	(9a) $75.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $75.00 , (5) $100.00 copayment , (9a) $75.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	79.35901015	56.69893092	56.01271057	0	48.9578466	0.194404988	0.097634862	49.36119163	68.31170287	0.29335253	10.19389215	45.62730094	0	30.4587815	1.751282217	7.07381749	17.70885154	12.03009458	6.116338607	5.579445831	0.2	0	0	0	0	0	0	0	0	0											YES	78.73186041	56.25085678	55.57005942	0	48.57094786	0.192868666	0.096863284	48.97110538	67.77185659	0.291034255	10.11333296	45.26672247	0	30.21807516	1.737442374	7.017915295	17.56890395	11.93502446	6.068003072	5.535353194	0.198419462	0	0	0	0	0	0	0	0	0											6700	9.3137	0.331159451	2.987358349	0	1.546870637	1.402743098	0.979903502	2.179356352	1.281163554	0.014020229	0.490494463	0.004293022	0	0.926087285	2.172194187	8.036180297	0.227808358	0.121696652	1.890590719	1.845557191	1.744136804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4953	0	NO	0.298674403	9.3137	0.331159451	2.987358349	0	1.546870637	1.402743098	0.979903502	2.179356352	1.281163554	0.014020229	0.490494463	0.004293022	0	0.926087285	2.172194187	8.036180297	0.227808358	0.121696652	1.890590719	1.845557191	1.744136804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4953	YES	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	Same as in-network	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											6700	0.0708	0	0.0103	0.0008	0.0112	0.0133	0.0692	0	0.0703	0.0049	0.0043	0	0	0.0277	0	0.0675	0	0.0001	0.0203	0.0118	0.0103	0.0001	0	0	0	0	0	0	0	0											0.3927	0	NO	0.003128336	9.3845	0.331159451	2.997662691	0.000774609	1.558042192	1.416035586	1.049089791	2.179356352	1.351416113	0.018949577	0.494746138	0.004293022	0	0.953821687	2.172194187	8.103634144	0.227808358	0.121845817	1.910875483	1.857362021	1.754415664	7.73E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8881
H1032_133_0	2012	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	1596.916786	92.04311483	757.7830726	777.2692454	433.6771825	2.954527139	9.558771422	365.0217586	213.8613358	1655.337745	778.9265018	19.11043618	1.81E-05	434.8142982	14303.91959	19185.59254	253.315333	65.84465929	4123.312283	6023.342198	15.32757629	0.057773837	0	0	252	0	18	13.71428571	6804.716649	2039.518501											6700	"(1a) $175 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $175 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $25.00 and $150.00 , (5) $175.00 copayment , (9a) $150.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	111.7339801	103.2019207	58.12131875	0	45.97851167	0.146579925	0.0558958	61.67479527	128.7873374	0.58670506	16.98191203	114.1009163	0.2	23.61959363	0	5.315302123	7.485554775	5.803535037	8.610222252	6.98439498	0.2	0	0	0	0	0	0	0	0	0											NO	110.6120313	102.1656445	57.53770811	0	45.51682998	0.14510808	0.055334536	61.05550328	127.4941517	0.580813808	16.81139242	112.9552006	0.19799175	23.38242341	0	5.26192985	7.410390455	5.745260296	8.523764865	6.91426293	0.19799175	0	0	0	0	0	0	0	0	0												14.7199	0.783637012	3.633425104	0	1.644967548	0.42872576	0.528930184	1.857215598	2.272172465	0.080120252	1.09123659	0.179885263	3.59E-06	0.847251002	0	8.412770174	0.15643046	0.031524559	2.928845364	3.470580973	3.034733655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1023	0	NO	0.467620235	14.7199	0.783637012	3.633425104	0	1.644967548	0.42872576	0.528930184	1.857215598	2.272172465	0.080120252	1.09123659	0.179885263	3.59E-06	0.847251002	0	8.412770174	0.15643046	0.031524559	2.928845364	3.470580973	3.034733655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1023	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	NO	0	14.7199	0.783637012	3.633425104	0	1.644967548	0.42872576	0.528930184	1.857215598	2.272172465	0.080120252	1.09123659	0.179885263	3.59E-06	0.847251002	0	8.412770174	0.15643046	0.031524559	2.928845364	3.470580973	3.034733655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1023
H1032_170_0	2012	7																															D	D	D	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	Coin	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	2054.313354	381.0890217	1009.62261	10993.94244	14.8481474	1628.71772	22.23874152	18.05009765	24.22394382	0.952112846	7.128278746	65.24201806	0.250642357	62.89242369	8535.956716	28323.50657	2714.525366	14.94734062	5402.862121	8507.333129	30.62867272	0.015291739	1160	658.6666667	1101.6	220.32	18	13.71428571	6804.716649	5781.916845											3400	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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% coinsurance	"(8b) $0.00 copayment , 0% coinsurance"	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) $0.00 copayment , (8a) $0.00 copayment , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) $0.00 copayment	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	"(13b) $0.00 copayment,(13c) $0.00 copayment, (13d) $0.00 copayment"											0	NO	132.3910369	55.69113445	51.23279752	0	0.191827432	0	0.146642865	0.197703219	0.180815943	0.10262992	0.125967927	0.2	0.2	0.176924773	0	0	0	0	0	0.044511114	0	0.197942861	0	0	0	0	0	0	0	0											NO	121.7110487	51.19852924	47.09984646	0	0.176352709	0	0.134813182	0.181754495	0.166229516	0.094350762	0.115806091	0.183865995	0.183865995	0.162652247	0	0	0	0	0	0.040920402	0	0.181974806	0	0	0	0	0	0	0	0												20.8361	1.625933118	3.962755825	0	2.618511013	0	2.998075502	3.280686386	4.026734458	0.089832572	0.825498097	11.99578857	0.046084606	10.22959403	0	0	0	0	0	0.029010291	0	0.002782711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5673	0	NO	5.490203751	20.8361	1.625933118	3.962755825	0	2.618511013	0	2.998075502	3.280686386	4.026734458	0.089832572	0.825498097	11.99578857	0.046084606	10.22959403	0	0	0	0	0	0.029010291	0	0.002782711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5673	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	NO	0	20.8361	1.625933118	3.962755825	0	2.618511013	0	2.998075502	3.280686386	4.026734458	0.089832572	0.825498097	11.99578857	0.046084606	10.22959403	0	0	0	0	0	0.029010291	0	0.002782711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5673
H1032_173_0	2012	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	1634.251932	66.0506645	629.2067058	849.4112821	291.7120069	7.725202382	7.565961684	415.6022798	201.6402822	1860.359311	858.5951066	52.30655555	0.004334261	1456.277926	8116.499251	17358.25759	263.2390349	635.9156191	3450.370414	4842.020708	11.85587763	0.078756528	0	288.8571429	508.8	305.28	18	13.71428571	6804.716649	2039.518501											4000	"(1a) $50 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $50 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $25.00 copayment"	"(9a) $25.00 copayment , (9b) $15.00 copayment"	(8a) Copay between $0.00 and $25.00	(8b) Copay between $0.00 and $25.00	(9a) $25.00 copayment	(12) 20% coinsurance	"(3) Copay between $15.00 and $25.00 , (5) $50.00 copayment , (9a) $25.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $15.00 copayment"	"(7e) , (7h) Copay between $5.00 and $15.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	38.85338994	29.18674233	49.66543196	0	46.93251866	0.2	0.093700201	55.47140774	24.96153675	0.097784177	3.881820517	15.20910031	0.2	6.656581768	0	3.883764832	10.97832868	4.019124216	8.469497777	6.561557647	0.2	0	0	0	0	0	0	0	0	0											NO	38.45240127	28.88551886	49.15285697	0	46.44814886	0.197935888	0.092733162	54.89891183	24.70391975	0.096774989	3.841757962	15.0521339	0.197935888	6.587882127	0	3.843682211	10.8650262	3.97764461	8.382087831	6.493838708	0.197935888	0	0	0	0	0	0	0	0	0												5.2367	0.15899231	2.577275601	0	1.12912356	1.529094796	0.701615553	1.901342743	0.415108779	0.015003021	0.274876216	0.06561044	0.000857906	0.799482277	0	5.559968824	0.238341584	0.210787195	2.410108988	2.620275125	2.346703671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1913	0	NO	0.293984153	5.2367	0.15899231	2.577275601	0	1.12912356	1.529094796	0.701615553	1.901342743	0.415108779	0.015003021	0.274876216	0.06561044	0.000857906	0.799482277	0	5.559968824	0.238341584	0.210787195	2.410108988	2.620275125	2.346703671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1913	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	NO	0	5.2367	0.15899231	2.577275601	0	1.12912356	1.529094796	0.701615553	1.901342743	0.415108779	0.015003021	0.274876216	0.06561044	0.000857906	0.799482277	0	5.559968824	0.238341584	0.210787195	2.410108988	2.620275125	2.346703671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1913
H1032_174_0	2012	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	1077.030711	77.47064869	352.3763772	463.4615315	272.5236464	6.02416415	6.650361525	669.9183329	166.6833709	1039.695459	415.3044156	62.29350831	0.051397411	927.4256295	6497.392806	16979.61013	361.4614623	1322.470977	3273.775694	4685.991349	12.64077658	0.021243033	0	658.6666667	252	0	18	13.71428571	6804.716649	2639.518501											5500	"(1a) $0 per admission, unlimited coverage"	(1b) $0 per admission	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $10.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(9a) $0.00 copayment	(12) 20% coinsurance	"(3) , (5) , (9a) $0.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	0	0	49.66543196	0	46.93251866	0.2	0.073033314	47.56702715	0	0	0.403153272	0	0.2	0	0	0	0	0	8.419079653	6.002043949	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	49.51235352	0	46.78786358	0.199383561	0.072808211	47.4204164	0	0	0.401910676	0	0.199383561	0	0	0	0	0	8.393130425	5.983544491	0.199383561	0	0	0	0	0	0	0	0	0												0	0	1.453915313	0	1.062566599	1.201119303	0.484200923	2.647317191	0	0	0.013909607	0	0.010247799	0	0	0	0	0	2.289768866	2.33656981	2.520363053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.02	0	NO	0.043345878	0	0	1.453915313	0	1.062566599	1.201119303	0.484200923	2.647317191	0	0	0.013909607	0	0.010247799	0	0	0	0	0	2.289768866	2.33656981	2.520363053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.02	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	NO	0	0	0	1.453915313	0	1.062566599	1.201119303	0.484200923	2.647317191	0	0	0.013909607	0	0.010247799	0	0	0	0	0	2.289768866	2.33656981	2.520363053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.02
H1035_002_0	2012	7	f.2	h.6.	h.7.	h.8	h.9	h.10.					OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other					UCC	AIX	Echography	Mammography	Colonoscopy	Observation					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	V	V	V	V	V	V	V																																													0	YES	1222.073853	33.56243189	978.2696176	1311.243644	158.4109067	12.11371546	1.68098015	659.723023	524.2884082	5586.638263	298.2525769	0	13.41159592	1840.826103	4067.573704	8242.711505	227.9621191	1527.239275	1622.824488	2911.328389	23.63591117	4.687040113	0	0	0	0	0	0	0	231.8378179	58.97493373	836.585951	870.2640005	437.697647	148.5154093	107.6480414					4500	$200/day (days 1-8) (#1A)	$200/day (days 1-7) (#1B)	$50/day (days 8-100) (#2)	$0 Home Health (#6)	$175 Ambulance Medically Necessary (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	$65 ER Visit (#4A)	$175 OP Surgery;  $100 ASC Surgery (#9A/#9B)	0 Copay (#8A)	$25 X-rays at OP (#8B)		$0 Dialysis (#12)	$175 OP Sleep Study/OP Therapy;  $0 Anesthesia/Ancillary/Hospital Services/Hospice (#9A/#8A)	$0 Immunizations;  $8 Cancer Screening/PCP Visit/Surgical Services (#7A/#14A)	Various (Listed in Supporting Documentation)	$30 Mental Health/Substance Abuse (#7E/#9C)	$20 Therapy/Rehab (#7I)	$10 X-rays at PCP (#8B)	$20 Chiropractic;  $30 Endocrinologist;  $50 Colonoscopy at Office;  $15 Optometry;  $30 Opthamology (#7B/#7D/#8A/#17A/#17B)	0.2 Coins MedInj (#15)	0.2 Coins Chemotherapy (#15)	$175 Transportation (#10B)							Various (Listed in Supporting Documentation)	$30 Urgent Care Center (#4B)	$100 MRI/CT Scan/PET Scan/Nuclear (#8B)	$25 Echography/Ultrasound at OP;  $0 Echography/Ultrasound at Free-standing Facility (#8B)	$0 Mamm Screening;  $25 Mamm Diagnostic at Rad Facility;  $45 Mamm Diagnostic at OP (#8A/#14A)	$175 OP Colonoscopy;  $100 ASC Colonoscopy (#8A)	$200 Observation (#9A)					0	NO	162.2526082	141.4248021	24.15720127	0	154.4317614	0.195921137	0.199679884	33.77700071	165.8168395	0	24.93519568	0	0	0.857963454	6.163026778	22.03217461	28.39231763	11.02513128	4.861446125	21.83944259	0.199821787	0.187939359	0	0	0	0	0	0	0	25.62061791	29.90712074	62.65109292	17.12532227	4.696409451	133.3788106	200					NO	154.9581454	127.5084369	21.09776237	0	150.9636074	0.187596672	0.168884852	33.29835832	162.6571503	0	23.35433617	0	0	0.788040748	6.123521241	21.55474554	28.13764906	10.93822666	4.831596694	21.77139586	0.136506483	0.123076346	0	0	0	0	0	0	0	25.07353861	29.58204334	61.56668801	17.03004148	4.677060964	132.7996569	195.4929577						15.7809	0.356624436	1.719941661	0	1.992856828	2.272492709	0.283892083	1.830641134	7.106604866	0	0.580457579	0	0	0.120887165	2.075656165	14.80579575	0.534526509	1.392107446	0.653402786	5.281973569	3.226455095	0.576863772	0	0	0	0	0	0	0	0.484416206	0.145383254	4.292152187	1.235052669	0.170594882	1.643566283	1.753702835	0	0	0	0	70.3169	0	NO	3.7512027	15.7809	0.356624436	1.719941661	0	1.992856828	2.272492709	0.283892083	1.830641134	7.106604866	0	0.580457579	0	0	0.120887165	2.075656165	14.80579575	0.534526509	1.392107446	0.653402786	5.281973569	3.226455095	0.576863772	0	0	0	0	0	0	0	0.484416206	0.145383254	4.292152187	1.235052669	0.170594882	1.643566283	1.753702835	0	0	0	0	70.3169	NO																																																																																		0				15.7809	0.356624436	1.719941661	0	1.992856828	2.272492709	0.283892083	1.830641134	7.106604866	0	0.580457579	0	0	0.120887165	2.075656165	14.80579575	0.534526509	1.392107446	0.653402786	5.281973569	3.226455095	0.576863772	0	0	0	0	0	0	0	0.484416206	0.145383254	4.292152187	1.235052669	0.170594882	1.643566283	1.753702835	0	0	0	0	70.3169
H1035_006_0	2012	6	f.2	h.6.	h.7.	h.8	h.9	h.10.					OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other					UCC	AIX	Echography	Mammography	Colonoscopy	Observation					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	V	V	V	V	V	V	V																																													0	YES	953.3273646	31.45469702	677.6695484	839.2215059	120.9984607	7.255386693	0.821630335	545.0305323	447.6551053	4233.203776	323.4690514	0	5.59082311	1330.303334	3510.17593	6360.888413	244.8108695	1131.245781	1308.644496	2433.174402	24.79314885	4.216432105	0	0	0	0	0	0	0	258.6221353	54.70767557	698.4090159	647.8067023	361.4067796	139.3031391	81.86562412					6700	$200/day (days 1-8) (#1A)	$200/day (days 1-7) (#1B)	$50/day (days 8-100) (#2)	$0 Home Health (#6)	$175 Ambulance Medically Necessary (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	$65 ER Visit (#4A)	$175 OP Surgery;  $100 ASC Surgery (#9A/#9B)	0 Copay (#8A)	$25 X-rays at OP (#8B)		$0 Dialysis (#12)	$175 OP Sleep Study/OP Therapy;  $0 Anesthesia/Ancillary/Hospital Services/Hospice (#9A/#8A)	$0 Immunizations;  $10 Cancer Screening/PCP Visit/Surgical Services (#7A/#14A)	Various (Listed in Supporting Documentation)	$30 Mental Health/Substance Abuse (#7E/#9C)	$30 Therapy/Rehab (#7I)	$10 X-rays at PCP (#8B)	$20 Chiropractic;  $30 Endocrinologist;  $50 Colonoscopy at Office;  $15 Optometry;  $30 Opthamology (#7B/#7D/#8A/#17A/#17B)	0.2 Coins MedInj (#15)	0.2 Coins Chemotherapy (#15)	$175 Transportation (#10B)							Various (Listed in Supporting Documentation)	$30 Urgent Care Center (#4B)	$100 MRI/CT Scan/PET Scan/Nuclear (#8B)	$25 Echography/Ultrasound at OP;  $0 Echography/Ultrasound at Free-standing Facility (#8B)	$0 Mamm Screening;  $25 Mamm Diagnostic at Rad Facility;  $45 Mamm Diagnostic at OP (#8A/#14A)	$175 OP Colonoscopy;  $100 ASC Colonoscopy (#8A)	$200 Observation (#9A)					0	NO	156.6243091	156.5891473	23.99829497	0	154.0190736	0.19626435	0.2	33.93018383	165.9614512	0	24.9364676	0	0	0.663773169	7.802311777	21.42535597	29.20532857	13.43437542	4.850006428	21.18070554	0.199953518	0.179193293	0	0	0	0	0	0	0	26.99000865	30	64.00983426	17.44656268	5.021819708	133.2297758	200					NO	150.083553	156.5891473	22.48508099	0	152.1117166	0.192223612	0.2	33.75516146	165.2470466	0	24.45997459	0	0	0.663773169	7.771439728	21.16138233	28.86860514	13.41560902	4.829231561	21.17008886	0.154406356	0.179193293	0	0	0	0	0	0	0	26.66732615	30	63.3610582	17.40323512	4.978015446	133.2297758	200						11.9232	0.410455349	1.26978789	0	1.533773631	1.394656637	0.164326067	1.533132802	6.16447367	0	0.659337065	0	0	0.073584972	2.273260056	11.2170993	0.588945694	1.264695926	0.526645609	4.292543191	3.828219764	0.755556355	0	0	0	0	0	0	0	0.574730069	0.136769189	3.687661192	0.939494363	0.149924044	1.5466105	1.364427069	0	0	0	0	58.2733	0	NO	2.022656337	11.9232	0.410455349	1.26978789	0	1.533773631	1.394656637	0.164326067	1.533132802	6.16447367	0	0.659337065	0	0	0.073584972	2.273260056	11.2170993	0.588945694	1.264695926	0.526645609	4.292543191	3.828219764	0.755556355	0	0	0	0	0	0	0	0.574730069	0.136769189	3.687661192	0.939494363	0.149924044	1.5466105	1.364427069	0	0	0	0	58.2733	NO																																																																																		0				11.9232	0.410455349	1.26978789	0	1.533773631	1.394656637	0.164326067	1.533132802	6.16447367	0	0.659337065	0	0	0.073584972	2.273260056	11.2170993	0.588945694	1.264695926	0.526645609	4.292543191	3.828219764	0.755556355	0	0	0	0	0	0	0	0.574730069	0.136769189	3.687661192	0.939494363	0.149924044	1.5466105	1.364427069	0	0	0	0	58.2733
H1035_007_0	2012	4	f.2	h.6.	h.7.	h.8	h.9	h.10.					OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other					UCC	AIX	Echography	Mammography	Colonoscopy	Observation					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	V	V	V	V	V	V	V																																													0	YES	1343.026795	33.99537594	872.6644603	1230.453968	169.573455	9.957613608	1.398383498	680.5180569	466.6917519	5120.925977	424.9131059	0	8.985769268	1909.914426	3761.615307	7908.785771	198.2488256	1304.731689	1588.383387	2828.395846	18.18402966	5.973628683	38.61452458	0	0	0	0	0	0	206.5535036	61.15588631	824.2252566	922.6133965	365.3996926	155.7580699	124.0666215					6700	$200/day (days 1-8) (#1A)	$200/day (days 1-7) (#1B)	$50/day (days 8-100) (#2)	$0 Home Health (#6)	$175 Ambulance Medically Necessary (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	$65 ER Visit (#4A)	$175 OP Surgery;  $100 ASC Surgery (#9A/#9B)	$0 Copay (#8A)	$25 X-rays at OP (#8B)		$0 Dialysis (#12)	$175 OP Sleep Study/OP Therapy;  $0 Anesthesia/Ancillary/Hospital Services/Hospice (#9A/#8A)	$0 Immunizations;  $10 Cancer Screening/PCP Visit/Surgical Services (#7A/#14A)	Various (Listed in Supporting Documentation)	$30 Mental Health/Substance Abuse (#7E/#9C)	$30 Therapy/Rehab (#7I)	$10 X-rays at PCP (#8B)	$20 Chiropractic;  $30 Endocrinologist;  $50 Colonoscopy at Office;  $15 Optometry;  $30 Opthamology (#7B/#7D/#8A/#17A/#17B)	0.2 Coins MedInj (#15)	0.2 Coins Chemotherapy (#15)	$175 Transportation (#10B)							Various (Listed in Supporting Documentation)	$30 Urgent Care Center (#4B)	$100 MRI/CT Scan/PET Scan/Nuclear (#8B)	$25 Echography/Ultrasound at OP;  $0 Echography/Ultrasound at Free-standing Facility (#8B)	$0 Mamm Screening;  $25 Mamm Diagnostic at Rad Facility;  $45 Mamm Diagnostic at OP (#8A/#14A)	$175 OP Colonoscopy;  $100 ASC Colonoscopy (#8A)	$200 Observation (#9A)					0	NO	162.137882	141.8243849	24.11881356	0	154.4768356	0.19593702	0.199680923	33.94219539	166.3067093	0	24.93617435	0	0	0.817907047	6.702967516	22.04596065	28.39049739	13.82060787	4.853171747	21.82432562	0.199820846	0.18793622	0	0	0	0	0	0	0	28.11373324	29.90781628	62.22493354	17.11523098	4.345015385	133.1205225	200					NO	156.3504876	131.3066217	21.91183344	0	151.684822	0.189477284	0.172804435	33.57001396	163.8012849	0	23.54478705	0	0	0.771058834	6.672599866	21.66298176	28.17433816	13.75960466	4.830510459	21.77411747	0.145568208	0.132092093	0	0	0	0	0	0	0	27.6244033	29.66005981	61.29928065	17.0423567	4.332051899	132.6092548	196.6225581						17.4986	0.371984831	1.593473192	0	2.143476612	1.886741586	0.24164687	1.903750056	6.370392385	0	0.833707383	0	0	0.122721366	2.091646149	14.27732349	0.465460788	1.496049352	0.63939188	5.132151951	2.647016615	0.789069115	0	0	0	0	0	0	0	0.475493107	0.15115727	4.210367944	1.310292217	0.131910869	1.721246798	2.032858041	0	0	0	0	70.5379	0	NO	1.316416656	17.4986	0.371984831	1.593473192	0	2.143476612	1.886741586	0.24164687	1.903750056	6.370392385	0	0.833707383	0	0	0.122721366	2.091646149	14.27732349	0.465460788	1.496049352	0.63939188	5.132151951	2.647016615	0.789069115	0	0	0	0	0	0	0	0.475493107	0.15115727	4.210367944	1.310292217	0.131910869	1.721246798	2.032858041	0	0	0	0	70.5379	NO																																																																																		0				17.4986	0.371984831	1.593473192	0	2.143476612	1.886741586	0.24164687	1.903750056	6.370392385	0	0.833707383	0	0	0.122721366	2.091646149	14.27732349	0.465460788	1.496049352	0.63939188	5.132151951	2.647016615	0.789069115	0	0	0	0	0	0	0	0.475493107	0.15115727	4.210367944	1.310292217	0.131910869	1.721246798	2.032858041	0	0	0	0	70.5379
H1035_801_0	2012	3																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	277.0422277		28.09413903		6.07974504	12.77694004		32.85784568	51.15904339					136.76927						204.0076484	23.82168032	4.67727735																			6700	9.4% coinsurance		16.3% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance																			0	NO	0.093979576		0.163441833		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.083415962		0.133611134		0.211198981	0.211198981		0.211198981	0.211198981					0.211198981						0.211198981	0.211198981	0.211198981																				23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809	0	NO	12.03888089	23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809	NO																																																																																		0				23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809
H1035_802_0	2012	3																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	277.0422277		28.09413903		6.07974504	12.77694004		32.85784568	51.15904339					136.76927						204.0076484	23.82168032	4.67727735																			6700	9.4% coinsurance		16.3% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance																			0	NO	0.093979576		0.163441833		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.083415962		0.133611134		0.211198981	0.211198981		0.211198981	0.211198981					0.211198981						0.211198981	0.211198981	0.211198981																				23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809	0	NO	12.03888089	23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809	NO																																																																																		0				23.1097	0	3.753689778	0	1.284035954	2.698476711	0	6.93954351	10.80473781	0	0	0	0	28.88553039	0	0	0	0	0	43.08620736	5.031114598	0.987836208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5809
H1036_025_0	2012	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	T	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										0	YES	1143.14	17.55	575.94	896.37	253.83	8.72	4536.98	214.16	186.85	35.49	1830.73	31.47	8.46	4.33	6846.72	4068.24	26.12	405.91		292.46	37.13	0	1.73	3.36	3.21		0.4		4.09	2.66	68.86										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS899: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	58.539999	51.585583	11.497944	25.474235	0.2	0.2	0	24.998503	25	26.727753		0	0.2	0	0	0	0		0		0	0	75										NO	44.691181	36.733194	32.583596	0	142.51905	0.042756	0	61.758255	55.620434	49.012855	10.924507	24.203759	0.190025	0.190025	0	23.751753	23.753175	25.39476		0	0.190025	0	0	0	0		0		0	0	71.259525											4.2574	0.053722296	1.56384969	0	3.014634205	0.37283232	0	1.102178991	0.866056508	0.144955519	1.666651892	0.063474358	1.6076115	0.82280825	0	8.052319302	0.051702744	0.858998919	0	0	7.05562825	0	0	0	0	0	0	0	0	0	0.408910908	0	0	0	0	0	0	0	0	0	31.9637	0	NO	1.6801	4.2574	0.053722296	1.56384969	0	3.014634205	0.37283232	0	1.102178991	0.866056508	0.144955519	1.666651892	0.063474358	1.6076115	0.82280825	0	8.052319302	0.051702744	0.858998919	0	0	7.05562825	0	0	0	0	0	0	0	0	0	0.408910908	0	0	0	0	0	0	0	0	0	31.9637	NO																																																																																		0	0	NO	0	4.2574	0.053722296	1.56384969	0	3.014634205	0.37283232	0	1.102178991	0.866056508	0.144955519	1.666651892	0.063474358	1.6076115	0.82280825	0	8.052319302	0.051702744	0.858998919	0	0	7.05562825	0	0	0	0	0	0	0	0	0	0.408910908	0	0	0	0	0	0	0	0	0	31.9637
H1036_040_0	2012	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	T	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										0	YES	1180.54	19.88	647.82	788.54	254.58	8.33	7953.02	231.18	233.39	59.15	2073.48	25.16	7.59	3.8	8799.64	4890.66	39.23	487.82		315.77	44.79	0	1.73	3.36	3.21		0.4		4.09	2.66	73.78										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS899: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	58.545754	62.185322	12.098287	25.139932	0.2	0.2	0	24.999092	25	25.788492		0	0.2	0	0	0	0		0		0	0	75										NO	44.180163	36.313171	32.076186	0	140.6097	0.042183	0	60.93087	54.880673	58.292396	11.34091	23.566122	0.18748	0.18748	0	23.434099	23.43495	24.174081		0	0.18748	0	0	0	0		0		0	0	70.30485											4.3464	0.06015882	1.731632901	0	2.983034786	0.35138439	0	1.173833211	1.067383356	0.287332935	1.959595839	0.049410302	1.4229732	0.712424	0	9.550684218	0.076612757	0.982716683	0	0	8.3972292	0	0	0	0	0	0	0	0	0	0.432257653	0	0	0	0	0	0	0	0	0	35.585	0	NO	2.372528	4.3464	0.06015882	1.731632901	0	2.983034786	0.35138439	0	1.173833211	1.067383356	0.287332935	1.959595839	0.049410302	1.4229732	0.712424	0	9.550684218	0.076612757	0.982716683	0	0	8.3972292	0	0	0	0	0	0	0	0	0	0.432257653	0	0	0	0	0	0	0	0	0	35.585	NO																																																																																		0	0	NO	0	4.3464	0.06015882	1.731632901	0	2.983034786	0.35138439	0	1.173833211	1.067383356	0.287332935	1.959595839	0.049410302	1.4229732	0.712424	0	9.550684218	0.076612757	0.982716683	0	0	8.3972292	0	0	0	0	0	0	0	0	0	0.432257653	0	0	0	0	0	0	0	0	0	35.585
H1036_044_0	2012	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	T		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	1205.79	16.12	717.56	4.8	221.88	11.26	4.71	436.2	252.43	173.86	1961.27	12.19	5.83	331.44	5612.7	5597.43	17.99	192.31		614.7	36.55	0	2.15		2.3		0.4		5.03	2.18	197.99										3400	"$0-$100/Day(Days 1-10): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-10): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												81.696878	75.707195	34.03605	0	150	0.045	0.118313	65	88.613828	0	47.637018	22.104576	0.2	60.421429	0	20	20	22.00299		0	0.2	0	0		0		0		0	0	0										NO	72.636286	67.310889	30.550146	0	137.5299	0.041259	0.108477	59.59629	81.247006	0	43.676762	20.266934	0.183373	55.398354	0	18.33732	18.33732	20.173794		0	0.183373	0	0		0		0		0	0	0											7.2987	0.090420961	1.826796897	0	2.542927851	0.46457634	0.51092667	2.166325142	1.709098477	0	7.138493584	0.020587827	1.06906459	1.530102537	0	8.553488757	0.027490699	0.32330186	0	0	6.70228315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9746	0	NO	4.100477	7.2987	0.090420961	1.826796897	0	2.542927851	0.46457634	0.51092667	2.166325142	1.709098477	0	7.138493584	0.020587827	1.06906459	1.530102537	0	8.553488757	0.027490699	0.32330186	0	0	6.70228315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9746	NO																																																																																		0	0	NO	0	7.2987	0.090420961	1.826796897	0	2.542927851	0.46457634	0.51092667	2.166325142	1.709098477	0	7.138493584	0.020587827	1.06906459	1.530102537	0	8.553488757	0.027490699	0.32330186	0	0	6.70228315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9746
H1036_052_0	2012	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	T	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										0	YES	1312.05	23.94	761	799.85	274.64	9.23	5703.56	238.46	263	74.6	1989	32.74	10.19	5.3	8317.11	4486.32	39.69	532.94		253.18	55.87	0	1.73	3.36	3.21		0.4		4.09	2.66	87.03										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS899: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	57.911875	48.371354	14.276666	25.991422	0.199959	0.2	0	24.998538	25	26.108326		0	0.2	0	0	0	0		0		0	0	75										NO	43.530879	35.779503	31.262861	0	138.97755	0.041693	0	60.223605	53.656337	44.816882	13.227573	24.081494	0.185266	0.185303	0	23.161571	23.162925	24.189808		0	0.185303	0	0	0	0		0		0	0	69.488775											4.7596	0.071380108	1.982586435	0	3.180732861	0.38482639	0	1.196743404	1.175968053	0.278611616	2.192470225	0.065702343	1.88786054	0.9821059	0	8.659184934	0.076611374	1.07430969	0	0	10.35287861	0	0	0	0	0	0	0	0	0	0.503967341	0	0	0	0	0	0	0	0	0	38.8255	0	NO	3.120845	4.7596	0.071380108	1.982586435	0	3.180732861	0.38482639	0	1.196743404	1.175968053	0.278611616	2.192470225	0.065702343	1.88786054	0.9821059	0	8.659184934	0.076611374	1.07430969	0	0	10.35287861	0	0	0	0	0	0	0	0	0	0.503967341	0	0	0	0	0	0	0	0	0	38.8255	NO																																																																																		0	0	NO	0	4.7596	0.071380108	1.982586435	0	3.180732861	0.38482639	0	1.196743404	1.175968053	0.278611616	2.192470225	0.065702343	1.88786054	0.9821059	0	8.659184934	0.076611374	1.07430969	0	0	10.35287861	0	0	0	0	0	0	0	0	0	0.503967341	0	0	0	0	0	0	0	0	0	38.8255
H1036_053_0	2012	6	r.	s.									Inpatient Facility	Inpatient Facility									Acute	Mental Health									A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V		V		O	O	D	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	266.44	1.29	491.73	0	326.34	11.87	2468.88	218.51	213.8	102.6	1107.12	0	7.06	153.22	5972.47	5707.58	1.54	243.58		244.15	45.56	0			1.05		0.4		3.42	1.66	0	0									5000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$5-$25/Visit: 5. $5 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$100/Visit: 3. $25 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$5/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. $0 Other Part B"			"VIS830: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician											0	0	34.03605	0	150	0.045	0	65	51.737916	19.907466	4.179685	0	0.2	60.463633	0	5	5	10.838184		0	0.040927	0			0		0		0	0	0	0									NO	0	0	34.028154	0	149.41605	0.044825	0	64.746955	51.5365	19.829966	4.163414	0	0.199221	60.228248	0	4.980535	4.980535	10.795991		0	0.040768	0			0		0		0	0	0	0										0	0	1.394388681	0	4.06336948	0.53207275	0	1.178988095	0.918208642	0.169546209	0.384116576	0	1.40650026	0.769014347	0	2.368900163	0.000639169	0.219140624	0	0	1.85739008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2623	0	NO	0.05452	0	0	1.394388681	0	4.06336948	0.53207275	0	1.178988095	0.918208642	0.169546209	0.384116576	0	1.40650026	0.769014347	0	2.368900163	0.000639169	0.219140624	0	0	1.85739008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2623	NO																																																																																		0	0	NO	0	0	0	1.394388681	0	4.06336948	0.53207275	0	1.178988095	0.918208642	0.169546209	0.384116576	0	1.40650026	0.769014347	0	2.368900163	0.000639169	0.219140624	0	0	1.85739008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2623
H1036_054_0	2012	7	r.	s.									Inpatient Facility	Inpatient Facility									Acute	Mental Health									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	D	D									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0									0	YES	295.91	1.31	543.06	15.36	443.65	13.78	2347.86	263.85	282.14	84.06	1767.78	0.07	10	252.87	9106.67	7075.99	0.32	1007.12		419.09	52.43	0	3.19	12.72	4.69		0.4		3.42	17.72	0	0									3000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Day(Days 1-7), $15 (Days 8-100): 2. $0 SNF - Facility 1,2. $15 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$75/Trip: 10a. $75 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$0-$15/Visit: 5. $0 Partial Hospitalization,7h. $15 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$50/Visit: 3. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $15 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $20 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0-$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN859: Dental 16a, 16b"	"VIS901: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician											0	0	10.210815	0	75	0.045	0	50	10.201421	11.34153	1.881366	15.000001	0.2	21.209428	0	0	0	0.735529		0	0.044312	0	0	0	0		0		0	0	0	0									NO	0	0	10.207527	0	74.547075	0.044728	0	49.69805	10.139815	11.273039	1.870004	14.909416	0.198792	21.081344	0	0	0	0.731087		0	0.044045	0	0	0	0		0		0	0	0	0										0	0	0.461941634	0	2.756067485	0.61635184	0	1.092735874	0.23840395	0.078967638	0.275479639	8.70E-05	1.98792	0.444236621	0	0	0	0.061357695	0	0	2.30927935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3228	0	NO	0.060059	0	0	0.461941634	0	2.756067485	0.61635184	0	1.092735874	0.23840395	0.078967638	0.275479639	8.70E-05	1.98792	0.444236621	0	0	0	0.061357695	0	0	2.30927935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3228	NO																																																																																		0	0	NO	0	0	0	0.461941634	0	2.756067485	0.61635184	0	1.092735874	0.23840395	0.078967638	0.275479639	8.70E-05	1.98792	0.444236621	0	0	0	0.061357695	0	0	2.30927935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3228
H1036_056_0	2012	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	T		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	1263.88	22.49	604.83	9.76	233.76	8.01	5.6	320.22	223.34	137.39	1579.66	13.47	4.22	418.47	5268.94	4908.54	19.16	269.22		744.45	25.87	0	2.15		1.21		0.4		5.03	1.24	67.01										4000	"$0-$100/Day(Days 1-10): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-10): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $25 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$100/Visit: 3. $50 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS846: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												81.696878	75.707195	34.03605	0	150	0.045	0.152714	65	75	0	34.658715	23.762777	0.2	53.839276	0	20	20	23.087745		0	0.2	0	0		0		0		0	0	0										NO	75.65907	70.112055	32.361953	0	143.18895	0.042957	0.14578	62.048545	71.594475	0	33.084967	22.683781	0.190919	51.394596	0	19.09186	19.09186	22.0394		0	0.190919	0	0		0		0		0	0	0											7.9687	0.131401676	1.631123336	0	2.789320746	0.34408557	0.816368	1.655765423	1.332492504	0	4.355249914	0.025462544	0.80567818	1.792258049	0	7.809429874	0.030483336	0.494453939	0	0	4.93907453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9213	0	NO	2.024099	7.9687	0.131401676	1.631123336	0	2.789320746	0.34408557	0.816368	1.655765423	1.332492504	0	4.355249914	0.025462544	0.80567818	1.792258049	0	7.809429874	0.030483336	0.494453939	0	0	4.93907453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9213	NO																																																																																		0	0	NO	0	7.9687	0.131401676	1.631123336	0	2.789320746	0.34408557	0.816368	1.655765423	1.332492504	0	4.355249914	0.025462544	0.80567818	1.792258049	0	7.809429874	0.030483336	0.494453939	0	0	4.93907453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9213
H1036_062_0	2012	6																															D	D	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	1300.57	3.94	871.32	9.98	368.75	11.96	6226.59	258.64	272.22	111.48	1731.18	0.16	7	200.38	8922.27	6634.13	1.35	388.5		480.5	62	0	1.42	3.36	2.1		0.4		3.42	3.54											5000	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$125/Visit: 3. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS829: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													77.612034	71.921835	34.03605	0	150	0.045	0	50	91.994991	10.841276	17.084287	45.025029	0.199865	53.524952	0	20	20	21.967669		0	0.049401	0	0	0	0		0		0	0											NO	73.76954	68.361057	32.830527	0	145.70235	0.043711	0	48.56745	89.359242	10.530662	16.594805	43.735017	0.194139	51.991409	0	19.42698	19.42698	21.338273		0	0.047986	0	0	0	0		0		0	0												7.9952	0.022445214	2.383824565	0	4.477311797	0.52278356	0	1.046790439	2.027114405	0.09782985	2.394049543	0.000583134	1.358973	0.868169878	0	10.74009257	0.002185535	0.690826588	0	0	2.975132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6033	0	NO	1.307491	7.9952	0.022445214	2.383824565	0	4.477311797	0.52278356	0	1.046790439	2.027114405	0.09782985	2.394049543	0.000583134	1.358973	0.868169878	0	10.74009257	0.002185535	0.690826588	0	0	2.975132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6033	NO																																																																																		0	0	NO	0	7.9952	0.022445214	2.383824565	0	4.477311797	0.52278356	0	1.046790439	2.027114405	0.09782985	2.394049543	0.000583134	1.358973	0.868169878	0	10.74009257	0.002185535	0.690826588	0	0	2.975132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6033
H1036_063_0	2012	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	1119.92	14.88	719.14	0	307.18	10.32	1866.53	217.02	186.93	62.14	1141.41	0	11.82	66.99	6384.53	5344.33	1.1	262.47		266.67	43.39	0		3.36	1.05				3.42	1.78											6700	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$15-$25/Visit: 5. $15 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$95/Visit: 3. $25 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $95 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$15/Visit: 7b. $15 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit: 7e, 7h. $15 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: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN849: Dental 16a, 16b"	"VIS830: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													77.612034	71.921835	34.03605	0	150	0.045	0	50	15.369956	8.561328	0.717276	0	0.2	35.419874	0	15	15	15.475996		0	0.034379	0		0	0				0	0											NO	76.456391	70.850919	33.80001	0	149.2341	0.04477	0	49.7447	15.291477	8.517614	0.713613	0	0.198979	35.23902	0	14.92341	14.92341	15.396976		0	0.034204	0		0	0				0	0												7.1354	0.08785514	2.025578266	0	3.820144237	0.4620264	0	0.8996329	0.238202983	0.044107044	0.067877085	0	2.35193178	0.196721829	0	6.646302314	0.001367979	0.336770358	0	0	1.48411156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.798	0	NO	0.208256	7.1354	0.08785514	2.025578266	0	3.820144237	0.4620264	0	0.8996329	0.238202983	0.044107044	0.067877085	0	2.35193178	0.196721829	0	6.646302314	0.001367979	0.336770358	0	0	1.48411156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.798	NO																																																																																		0	0	NO	0	7.1354	0.08785514	2.025578266	0	3.820144237	0.4620264	0	0.8996329	0.238202983	0.044107044	0.067877085	0	2.35193178	0.196721829	0	6.646302314	0.001367979	0.336770358	0	0	1.48411156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.798
H1036_065_0	2012	6	r.	s.									Inpatient Facility	Inpatient Facility									Acute	Mental Health									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	D	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	YES	322.17	2.2	668.2	19.32	409.96	11.85	2157.19	297.98	220.41	95.76	1515.22	0.15	7.41	122.53	7428.18	6561.26	1.55	464.19		351.37	56.91	0		11	2.1		0.4		3.42	3.23	0	0									5000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$5-$25/Visit: 5. $5 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$100/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$5/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN853: Dental 16a, 16b"	"VIS829: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician											0	0	34.03605	0	150	0.045	0	65	42.874363	9.17599	14.830808	25.000001	0.199945	45.704178	0	5	5	6.836914		0	0.06042	0		0	0		0		0	0	0	0									NO	0	0	33.967059	0	148.78365	0.044635	0	64.472915	42.526695	9.101582	14.710545	24.797276	0.198324	45.333562	0	4.959455	4.959455	6.781474		0	0.05993	0		0	0		0		0	0	0	0										0	0	1.891399069	0	5.08294543	0.52892475	0	1.600969934	0.78110907	0.072630624	1.857476	0.000309966	1.46958084	0.462893446	0	2.711689476	0.000640596	0.262324368	0	0	3.4106163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1335	0	NO	0.152979	0	0	1.891399069	0	5.08294543	0.52892475	0	1.600969934	0.78110907	0.072630624	1.857476	0.000309966	1.46958084	0.462893446	0	2.711689476	0.000640596	0.262324368	0	0	3.4106163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1335	NO																																																																																		0	0	NO	0	0	0	1.891399069	0	5.08294543	0.52892475	0	1.600969934	0.78110907	0.072630624	1.857476	0.000309966	1.46958084	0.462893446	0	2.711689476	0.000640596	0.262324368	0	0	3.4106163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1335
H1036_067_0	2012	9	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		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										0	YES	1307.76	11.47	610.66	710.45	210.82	6.95	96642.84	266.26	267.52	49.15	1634.2	66.39	6.38	8.12	8403.71	4574.67	17.1	603.65		332.06	43.44	0	1.73	3.36	3.21		0.4		4.09	2.66	80.75										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS899: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	57.370265	68.716477	13.352441	25.233365	0.2	0.2	0	24.999447	25	27.687139		0	0.2	0	0	0	0		0		0	0	75										NO	44.022313	36.183429	32.119242	0	140.7123	0.042214	0	60.97533	53.818013	64.46169	12.525685	23.670965	0.187616	0.187616	0	23.451531	23.45205	25.972806		0	0.187616	0	0	0	0		0		0	0	70.35615											4.7976	0.034585328	1.634494693	0	2.472080591	0.2933873	0	1.352940947	1.199782903	0.264024339	1.705789536	0.130959614	1.19699008	1.52344192	0	8.940251277	0.033419171	1.306540362	0	0	8.15003904	0	0	0	0	0	0	0	0	0	0.473438259	0	0	0	0	0	0	0	0	0	35.5097	0	NO	2.362209	4.7976	0.034585328	1.634494693	0	2.472080591	0.2933873	0	1.352940947	1.199782903	0.264024339	1.705789536	0.130959614	1.19699008	1.52344192	0	8.940251277	0.033419171	1.306540362	0	0	8.15003904	0	0	0	0	0	0	0	0	0	0.473438259	0	0	0	0	0	0	0	0	0	35.5097	NO																																																																																		0	0	NO	0	4.7976	0.034585328	1.634494693	0	2.472080591	0.2933873	0	1.352940947	1.199782903	0.264024339	1.705789536	0.130959614	1.19699008	1.52344192	0	8.940251277	0.033419171	1.306540362	0	0	8.15003904	0	0	0	0	0	0	0	0	0	0.473438259	0	0	0	0	0	0	0	0	0	35.5097
H1036_068_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	1308.07	30.09	420.82	54.96	203.36	8.41	4.13	303.71	283.72	122.51	1817.61	29.71	3.3	234.1	8045.86	5110.69	39.26	669.61		398.45	35.35	0	2.46		2.3		0.4		4.16	0.79											6700	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$140/Day(Days 1-10): 1b. $140 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$125/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS884: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													122.545317	105.990073	34.03605	0	150	0.045	0.103805	65	122.013438	93.941555	38.636726	25.034897	0.2	95.720909	0	20	20	27.195787		0	0.2	0	0		0		0		0	0											NO	116.168426	100.474668	33.271158	0	146.1873	0.043856	0.101166	63.34783	118.9121	91.553749	37.654657	24.39856	0.194916	93.287875	0	19.49164	19.49164	26.504524		0	0.194916	0	0		0		0		0	0												12.663	0.25194023	1.166764059	0	2.477387444	0.36882896	0.41781558	1.603280787	2.811478418	0.934687482	5.703456759	0.060406768	0.6432228	1.819890961	0	8.301310803	0.063770149	1.478974526	0	0	6.8902806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6565	0	NO	1.61142	12.663	0.25194023	1.166764059	0	2.477387444	0.36882896	0.41781558	1.603280787	2.811478418	0.934687482	5.703456759	0.060406768	0.6432228	1.819890961	0	8.301310803	0.063770149	1.478974526	0	0	6.8902806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6565	NO																																																																																		0	0	NO	0	12.663	0.25194023	1.166764059	0	2.477387444	0.36882896	0.41781558	1.603280787	2.811478418	0.934687482	5.703456759	0.060406768	0.6432228	1.819890961	0	8.301310803	0.063770149	1.478974526	0	0	6.8902806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6565
H1036_074_0	2012	8	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		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										0	YES	1040.37	5.38	736.96	770.7	198.53	8.33	3951.56	238.99	221.75	57.37	2032.89	39.33	7.41	3.12	8001.3	4685.99	36.32	551.73		345.41	45.79	0	1.73	3.36	3.21		0.4		4.09	2.66	38.58										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS899: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$75/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"												47.189786	38.786882	34.03605	0	150	0.045	0	65	58.678128	44.88451	11.473949	25.043324	0.195929	0.2	0	24.994592	25	25.107552		0	0.2	0	0	0	0		0		0	0	75										NO	44.55721	36.623078	32.039393	0	141.40125	0.04242	0	61.273875	55.314404	42.311505	10.816205	23.607715	0.184697	0.188535	0	23.561777	23.566875	23.668261		0	0.188535	0	0	0	0		0		0	0	70.700625											3.863	0.016419347	1.967645922	0	2.339365847	0.3533586	0	1.220320282	1.022164091	0.202284253	1.832346249	0.077374286	1.36860477	0.5882292	0	9.200854284	0.071329075	1.08820747	0	0	8.63301765	0	0	0	0	0	0	0	0	0	0.227302509	0	0	0	0	0	0	0	0	0	34.0718	0	NO	2.068214	3.863	0.016419347	1.967645922	0	2.339365847	0.3533586	0	1.220320282	1.022164091	0.202284253	1.832346249	0.077374286	1.36860477	0.5882292	0	9.200854284	0.071329075	1.08820747	0	0	8.63301765	0	0	0	0	0	0	0	0	0	0.227302509	0	0	0	0	0	0	0	0	0	34.0718	NO																																																																																		0	0	NO	0	3.863	0.016419347	1.967645922	0	2.339365847	0.3533586	0	1.220320282	1.022164091	0.202284253	1.832346249	0.077374286	1.36860477	0.5882292	0	9.200854284	0.071329075	1.08820747	0	0	8.63301765	0	0	0	0	0	0	0	0	0	0.227302509	0	0	0	0	0	0	0	0	0	34.0718
H1036_077_0	2012	6	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	469.15	5.79	64.75	4.89	1011.52	982.12	2938.94	492.69	337.73	87.86	2682.97	0	1.43	265.18	23754.16	9165.25	4.98	1076.8		518.76	3164.63	0	3.19	16.22	4.8		0.4		72.42	6	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN884: Dental 16a, 16b"	"VIS833: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c                             $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	0	0	0	1.0264375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0264	0	NO	0	0	0	0	0	0	0	0	1.0264375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0264	NO																																																																																		0	0	NO	0	0	0	0	0	0	0	0	1.0264375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0264
H1036_081_0	2012	6	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	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	1708.91	46.34	718.74	9.33	318.96	8.52	3.92	330.12	180.27	168.37	1545.24	24.83	2.31	4.32	5233.61	3887.39	36.12	338.4		1120.54	22.33	0	2.46		2.3		0.4		4.16	0.79	695.01										6700	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$140/Day(Days 1-10): 1b. $140 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$200/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 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,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$20-$75/Visit: 5. $20 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS884: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$150/Visit: 3. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"												122.545317	105.990073	34.03605	0	150	0.045	0.101749	65	169.543659	47.210748	63.764357	27.980031	0.2	0.2	0	20	20	28.326319		0	0.2	0	0		0		0		0	0	87.045433										NO	113.286406	97.981993	32.640912	0	145.2003	0.04356	0.098493	62.92013	164.118601	45.700098	61.724025	27.084725	0.1936	0.1936	0	19.36004	19.36004	27.419933		0	0.1936	0	0		0		0		0	0	84.260153											16.133	0.378373796	1.955027424	0	3.859423974	0.3711312	0.38609256	1.730932776	2.465471684	0.641210458	7.948202699	0.05604281	0.447216	0.836352	0	6.271668825	0.05827372	0.773242111	0	0	4.323088	0	0	0	0	0	0	0	0	0	4.880137411	0	0	0	0	0	0	0	0	0	53.5149	0	NO	2.591638	16.133	0.378373796	1.955027424	0	3.859423974	0.3711312	0.38609256	1.730932776	2.465471684	0.641210458	7.948202699	0.05604281	0.447216	0.836352	0	6.271668825	0.05827372	0.773242111	0	0	4.323088	0	0	0	0	0	0	0	0	0	4.880137411	0	0	0	0	0	0	0	0	0	53.5149	NO																																																																																		0	0	NO	0	16.133	0.378373796	1.955027424	0	3.859423974	0.3711312	0.38609256	1.730932776	2.465471684	0.641210458	7.948202699	0.05604281	0.447216	0.836352	0	6.271668825	0.05827372	0.773242111	0	0	4.323088	0	0	0	0	0	0	0	0	0	4.880137411	0	0	0	0	0	0	0	0	0	53.5149
H1036_102_0	2012	4	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	439.15	20.45	80.85	1096.08	572.2	577.43	8884.21	735.95	332.98	62.78	2394.53	121.11	0.34	202.53	10744.64	6327.74	136.55	841.7		327.05	2998.43	0	1.73	5.1	5.65		0.4		4.09	3.41	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN851: Dental 16a, 16b"	"VIS848: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.192083333	0	0	1.533229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7253	0	NO	0	0	0	0	0	1.192083333	0	0	1.533229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7253	NO																																																																																		0	0	NO	0	0	0	0	0	1.192083333	0	0	1.533229167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7253
H1036_103_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	509.55	2.59	89.11	17.81	663.67	865.88	5160.83	672.57	279.48	119.95	2179.4	0	83.54	183.02	11012.18	7554.62	0.43	692.22		479.27	3009.22	0	0.77	11	4.8		0.4		40.42	3.45	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN853: Dental 16a, 16b"	"VIS833: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c                             $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.382645833	0	0	1.4011875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7838	0	NO	0	0	0	0	0	1.382645833	0	0	1.4011875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7838	NO																																																																																		0	0	NO	0	0	0	0	0	1.382645833	0	0	1.4011875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7838
H1036_104_0	2012	4	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	490.96	5.32	96.28	23.98	576.83	986.47	1961.35	655.05	383.85	128.09	2336.84	0.67	2.18	165.12	12391.61	8520.65	2.5	738.73		613.45	2919.38	0	1.42	11	1.05		0.4		3.42	2.53	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN853: Dental 16a, 16b"	"VIS830: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.201729167	0	0	1.3646875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5664	0	NO	0	0	0	0	0	1.201729167	0	0	1.3646875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5664	NO																																																																																		0	0	NO	0	0	0	0	0	1.201729167	0	0	1.3646875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5664
H1036_119_0	2012	5	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		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										0	YES	564.16	6.38	296.34	377.58	141.74	5.13	3274.85	120.61	116.89	22.91	906.62	15.77	5.56	2.7	3811.1	2277.71	11	199.51		129.32	27.23	0	1.39	1.8	1.21		0.4		4.09	1.43	27.06										6700	"$0-$125/Day(Days 1-5): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-5): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$125/Visit: 8a. $0 Lab -- FSL,8a. $125 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $125 Radiology OP -- Facility"	"$25-$125/Visit: 5. $25 Partial Hospitalization,7h. $125 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN848: Dental 16a, 16b"	"VIS846: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$125/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												78.649644	64.644804	34.03605	0	150	0.045	0	65	109.226622	87.912845	26.251347	25.716377	0.19994	0.2	0	24.999109	25	26.972173		0	0.2	0	0	0	0		0		0	0	125										NO	78.366112	64.411759	34.017364	0	149.3361	0.044801	0	64.71231	108.743185	87.523742	26.135159	25.602557	0.199055	0.199115	0	24.888463	24.88935	26.852794		0	0.199115	0	0	0	0		0		0	0	124.44675											3.6843	0.034245585	0.840058804	0	1.763908235	0.22982913	0	0.650412642	1.059249241	0.167097411	1.974554821	0.033646027	1.1067458	0.5376105	0	4.724058422	0.022815238	0.446450078	0	0	5.42190145	0	0	0	0	0	0	0	0	0	0.280627421	0	0	0	0	0	0	0	0	0	22.9775	0	NO	0.095803	3.6843	0.034245585	0.840058804	0	1.763908235	0.22982913	0	0.650412642	1.059249241	0.167097411	1.974554821	0.033646027	1.1067458	0.5376105	0	4.724058422	0.022815238	0.446450078	0	0	5.42190145	0	0	0	0	0	0	0	0	0	0.280627421	0	0	0	0	0	0	0	0	0	22.9775	NO																																																																																		0	0	NO	0	3.6843	0.034245585	0.840058804	0	1.763908235	0.22982913	0	0.650412642	1.059249241	0.167097411	1.974554821	0.033646027	1.1067458	0.5376105	0	4.724058422	0.022815238	0.446450078	0	0	5.42190145	0	0	0	0	0	0	0	0	0	0.280627421	0	0	0	0	0	0	0	0	0	22.9775
H1036_121_0	2012	6	r.	s.									Inpatient Facility	Inpatient Facility									Acute	Mental Health									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	D	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	YES	490.24	4.64	924.85	17.08	745.23	18.45	2311.88	411.18	348.68	135.49	2064.56	0.13	12.05	164.32	10306.75	9297.19	1.37	874.62		472.36	87.38	0		11	1.05		0.4		3.42	2.07	0	0									5000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$5-$25/Visit: 5. $5 Partial Hospitalization,7h. $25 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$175/Visit: 3. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $175 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$5/Visit: 7b. $5 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit: 7e, 7h. $5 Psych -- Other Provider"	"$5-$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"		"DEN853: Dental 16a, 16b"	"VIS830: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician											0	0	34.03605	0	150	0.045	0	65	67.46369	10.536867	22.116638	25.000002	0.19997	75.418667	0	5	5	5.862654		0	0.05254	0		0	0		0		0	0	0	0									NO	0	0	33.576938	0	146.3145	0.043894	0	63.40295	65.806107	10.277977	21.573232	24.385752	0.195057	73.56563	0	4.87715	4.87715	5.718608		0	0.051249	0		0	0		0		0	0	0	0										0	0	2.587802592	0	9.086496236	0.8098443	0	2.172502082	1.912106116	0.116046925	3.711602655	0.000264179	2.35043685	1.007358693	0	3.778649184	0.000556808	0.416800744	0	0	4.47813762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4286	0	NO	0.787058	0	0	2.587802592	0	9.086496236	0.8098443	0	2.172502082	1.912106116	0.116046925	3.711602655	0.000264179	2.35043685	1.007358693	0	3.778649184	0.000556808	0.416800744	0	0	4.47813762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4286	NO																																																																																		0	0	NO	0	0	0	2.587802592	0	9.086496236	0.8098443	0	2.172502082	1.912106116	0.116046925	3.711602655	0.000264179	2.35043685	1.007358693	0	3.778649184	0.000556808	0.416800744	0	0	4.47813762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4286
H1036_130_0	2012	5																															D	D	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	2154.61	3.31	1153.84	8.38	507.02	20.28	7629.87	385.7	397.46	161.17	2359.96	0.13	8.62	262.67	12450.58	10651.71	1.14	513.36		648.4	84.88	0	0.77	3.36	2.1		0.4		3.42	3.95											6700	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$100/Visit: 3. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS829: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													77.612034	71.921835	34.03605	0	150	0.045	0	50	92.105362	11.909178	17.843667	45.021501	0.199908	44.325128	0	20	20	22.412777		0	0.037034	0	0	0	0		0		0	0											NO	72.621425	67.297117	32.488533	0	144.8586	0.043458	0	48.2862	88.948359	11.500979	17.232058	43.478344	0.193056	42.80584	0	19.31448	19.31448	21.644556		0	0.035765	0	0	0	0		0		0	0												13.0392	0.018562788	3.123880743	0	6.120517281	0.88132824	0	1.551998945	2.946117897	0.154467732	3.388913966	0.000471015	1.66414272	0.936984166	0	17.14435331	0.001834876	0.925954106	0	0	3.0357332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9345	0	NO	2.421561	13.0392	0.018562788	3.123880743	0	6.120517281	0.88132824	0	1.551998945	2.946117897	0.154467732	3.388913966	0.000471015	1.66414272	0.936984166	0	17.14435331	0.001834876	0.925954106	0	0	3.0357332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9345	NO																																																																																		0	0	NO	0	13.0392	0.018562788	3.123880743	0	6.120517281	0.88132824	0	1.551998945	2.946117897	0.154467732	3.388913966	0.000471015	1.66414272	0.936984166	0	17.14435331	0.001834876	0.925954106	0	0	3.0357332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9345
H1036_136_0	2012	7	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	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	263.76	8.29	501.47	2386.95	239.02	14.35	4.08	362.01	283.49	593.57	1233.82	93.52	0.54	389.26	4166.97	4352.84	86.11	680.8		1867.78	29	0		2.29	0.6				3.47	1.28	736.57										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Admit: 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $5 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $20 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												0	100	49.537808	0	100	0.2	0.2	65	100	0	40.063217	20	0.2	19.39459	5	20	20	5		0	0.2	0		0	0				0	0	0										NO	0	97.7695	47.804084	0	94.863	0.189726	0.189726	61.66095	94.863	0	38.005169	18.9726	0.189726	18.39829	4.74315	18.9726	18.9726	4.74315		0	0.189726	0		0	0				0	0	0											0	0.06754243	1.997692834	0	1.889512855	2.7225681	0.77408208	1.860156709	2.241059323	0	3.907628135	0.147859796	0.10245204	0.596809864	1.64704698	6.882057682	0.136144216	0.26909471	0	0	5.502054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7438	0	NO	1.626951	0	0.06754243	1.997692834	0	1.889512855	2.7225681	0.77408208	1.860156709	2.241059323	0	3.907628135	0.147859796	0.10245204	0.596809864	1.64704698	6.882057682	0.136144216	0.26909471	0	0	5.502054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7438	NO																																																																																		0	0	NO	0	0	0.06754243	1.997692834	0	1.889512855	2.7225681	0.77408208	1.860156709	2.241059323	0	3.907628135	0.147859796	0.10245204	0.596809864	1.64704698	6.882057682	0.136144216	0.26909471	0	0	5.502054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7438
H1036_137_0	2012	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			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	1426.83	57.24	497.4	2126.35	156.43	11.14	1.55	364.2	285.21	597.16	1243.75	92.91	0.49	3.88	4250.83	4440.44	87.84	692.52		1905.37	26.81	0			0.61				3.99	0.81	9749.44	339.9									4700	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	195	0	60.273773	36.65293	0.2	0.2	10	34.644863	35	10		0	0.2	0			0				0	0	0	50.922548									NO	119.505178	104.943788	30.493714	0	181.4854	0.181485	0.181485	58.982755	176.948265	0	54.694049	33.259859	0.181485	0.181485	9.07427	31.437684	31.759945	9.07427		0	0.181485	0			0				0	0	0	46.208495										14.2095	0.500581869	1.263964445	0	2.365813427	2.0217429	0.28130175	1.790126614	4.205617888	0	5.668810287	0.257514458	0.08892765	0.7041618	3.214431595	11.6330958	0.232482797	0.523676122	0	0	4.86561285	0	0	0	0	0	0	0	0	0	0	1.308855621	0	0	0	0	0	0	0	0	55.1362	0	NO	6.926247	14.2095	0.500581869	1.263964445	0	2.365813427	2.0217429	0.28130175	1.790126614	4.205617888	0	5.668810287	0.257514458	0.08892765	0.7041618	3.214431595	11.6330958	0.232482797	0.523676122	0	0	4.86561285	0	0	0	0	0	0	0	0	0	0	1.308855621	0	0	0	0	0	0	0	0	55.1362	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	$0/Visit	$200/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins; $0/Visit	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									4700	1.8331	0.0264	0.1674	0	1.1394	0.5501	0.0764	0.0631	0.4392	0.0599	0.2103	0.0087	0.0032	0.0376	0.2924	0.5064	0.0039	0.0418		0.0561	0.1214	0			0				0		0.1238	0.1062									5.8669	0	NO	4.351431	16.0425	0.527007869	1.431364445	0	3.505192427	2.5718279	0.35774675	1.853248614	4.644781888	0.059901	5.879089287	0.266251458	0.09210865	0.7418058	3.506802595	12.1394508	0.236430797	0.565501122	0	0.056052	4.98706085	0	0	0	0	0	0	0	0	0	0.123848	1.415078621	0	0	0	0	0	0	0	0	61.0031
H1036_138_0	2012	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	1429.05	57.33	498.17	2129.66	156.68	10.58	1.47	364.77	285.65	598.09	1245.69	93.05	0.47	3.69	4257.45	4447.35	87.98	693.6		1908.33	25.45	0			0.61				3.99	0.81	9764.62	340.43									3400	"$0-$195/Day(Days 1-6): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-6): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											133.54349	113.885084	34.03605	0	200	0.2	0.2	65	195	0	60.273773	36.65293	0.2	0.2	10	34.644863	35	10		0	0.2	0			0				0	0	0	50.922547									NO	102.778809	87.649149	27.663685	0	172.1474	0.172147	0.172147	55.947905	167.843715	0	51.879866	31.548533	0.172147	0.172147	8.60737	29.820115	30.125795	8.60737		0	0.172147	0			0				0	0	0	43.830921										12.2397	0.418743809	1.14843483	0	2.247671219	1.82131526	0.25305609	1.700676442	3.995379766	0	5.38551919	0.244632583	0.08090909	0.63522243	3.053787284	11.05170737	0.220872287	0.497505986	0	0	4.38114115	0	0	0	0	0	0	0	0	0	0	1.243446703	0	0	0	0	0	0	0	0	50.6197	0	NO	10.009585	12.2397	0.418743809	1.14843483	0	2.247671219	1.82131526	0.25305609	1.700676442	3.995379766	0	5.38551919	0.244632583	0.08090909	0.63522243	3.053787284	11.05170737	0.220872287	0.497505986	0	0	4.38114115	0	0	0	0	0	0	0	0	0	0	1.243446703	0	0	0	0	0	0	0	0	50.6197	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	$0/Visit	$200/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins; $0/Visit	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									3400	1.3462	0.0194	0.1153	0	1.0413	0.4766	0.0662	0.0577	0.3805	0.0519	0.1822	0.0076	0.0028	0.0326	0.2533	0.4387	0.0034	0.0362		0.0486	0.1052	0			0				0		0.1073	0.092									4.8649	0	NO	4.923914	13.5859	0.438150809	1.26368883	0	3.288950219	2.29790026	0.31928609	1.758363442	4.375864766	0.051898	5.56770219	0.252202583	0.08366509	0.66783643	3.307093284	11.49040537	0.224292287	0.533742986	0	0.048563	4.48636115	0	0	0	0	0	0	0	0	0	0.1073	1.335475703	0	0	0	0	0	0	0	0	55.4846
H1036_140_0	2012	9	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	1116.44	18.05	608.4	762.57	237.36	7.69	8675.2	211.16	209.68	50.99	1789.28	29.36	7.68	4.09	7291.35	4100.1	31.11	442.21		266.04	40.33	0			2.3		0.4		4.09	1.05	69.68										4000	"$0-$125/Day(Days 1-7): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-7): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$125/Visit: 8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$30-$100/Visit: 5. $30 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	"$30-$125/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												91.105074	80.004161	34.03605	0	150	0.045	0	65	66.508038	71.265162	31.398325	30.762162	0.199885	0.2	0	29.9972	30	31.762243		0	0.2	0			0		0		0	0	112.798257										NO	83.727567	73.525584	32.116383	0	141.3984	0.04242	0	61.27264	62.694201	67.178533	29.597819	28.998137	0.188423	0.188531	0	28.277041	28.27968	29.940869		0	0.188531	0			0		0		0	0	106.329953											7.7897	0.110594733	1.628300618	0	2.796860352	0.3262098	0	1.078194222	1.095476672	0.285452783	4.413232132	0.070948775	1.44708864	0.77109179	0	9.661557984	0.07331507	1.103345973	0	0	7.60345523	0	0	0	0	0	0	0	0	0	0.617422594	0	0	0	0	0	0	0	0	0	40.8723	0	NO	2.700093	7.7897	0.110594733	1.628300618	0	2.796860352	0.3262098	0	1.078194222	1.095476672	0.285452783	4.413232132	0.070948775	1.44708864	0.77109179	0	9.661557984	0.07331507	1.103345973	0	0	7.60345523	0	0	0	0	0	0	0	0	0	0.617422594	0	0	0	0	0	0	0	0	0	40.8723	NO																																																																																		0	0	NO	0	7.7897	0.110594733	1.628300618	0	2.796860352	0.3262098	0	1.078194222	1.095476672	0.285452783	4.413232132	0.070948775	1.44708864	0.77109179	0	9.661557984	0.07331507	1.103345973	0	0	7.60345523	0	0	0	0	0	0	0	0	0	0.617422594	0	0	0	0	0	0	0	0	0	40.8723
H1036_141_0	2012	8	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	T	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										0	YES	730.89	11.82	398.3	499.23	155.39	5.47	3.68	138.24	137.27	33.38	1171.37	19.22	5.46	2.91	4773.38	2684.18	20.37	289.5		174.17	28.69	0	1.39	1.8	2.3		0.4		4.09	1.43	45.62										4000	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$150/Visit: 5. $30 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$150/Visit: 7c, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$150/Visit: 3. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"												94.379573	77.573765	34.03605	0	150	0.045	0.094318	65	116.508038	106.897743	32.428752	31.306564	0.199885	0.2	0	29.9972	30	33.020989		0	0.2	0	0	0	0		0		0	0	150										NO	90.612978	74.477873	33.33004	0	145.6872	0.043706	0.091606	63.13112	113.158199	103.824219	31.496361	30.406438	0.194138	0.19425	0	29.13472	29.13744	32.071569		0	0.19425	0	0	0	0		0		0	0	145.6872											5.519	0.073360705	1.106279578	0	1.886527834	0.23907182	0.33711008	0.727270502	1.294435498	0.288804369	3.074491032	0.048700978	1.05999348	0.5652675	0	6.516902727	0.049460804	0.773726602	0	0	5.5730325	0	0	0	0	0	0	0	0	0	0.553854172	0	0	0	0	0	0	0	0	0	29.6873	0	NO	0.936462	5.519	0.073360705	1.106279578	0	1.886527834	0.23907182	0.33711008	0.727270502	1.294435498	0.288804369	3.074491032	0.048700978	1.05999348	0.5652675	0	6.516902727	0.049460804	0.773726602	0	0	5.5730325	0	0	0	0	0	0	0	0	0	0.553854172	0	0	0	0	0	0	0	0	0	29.6873	NO																																																																																		0	0	NO	0	5.519	0.073360705	1.106279578	0	1.886527834	0.23907182	0.33711008	0.727270502	1.294435498	0.288804369	3.074491032	0.048700978	1.05999348	0.5652675	0	6.516902727	0.049460804	0.773726602	0	0	5.5730325	0	0	0	0	0	0	0	0	0	0.553854172	0	0	0	0	0	0	0	0	0	29.6873
H1036_143_0	2012	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	1694.05	44.92	684.65	19.5	307.53	7.81	3.24	338.12	209.81	165.55	1667.34	26.91	2.31	4.08	6050.31	4308.65	38.26	423.24		1012.83	23	0			2.3				4.16	1.05	68	617.09									3400	"$0-$150/Day(Days 1-7): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-7): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$75/Visit: 5. $30 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS855: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$200/Visit: 3. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											109.326089	96.004994	34.03605	0	125	0.2	0.2	65	133.783244	50.896223	69.510522	35.644165	0.2	0.2	5	29.996278	30	35.884044		0	0.2	0			0				0	0	0	94.201629									NO	87.605509	76.931009	27.918002	0	109.469625	0.175151	0.175151	56.924205	117.161613	44.572724	60.874326	31.215627	0.175151	0.175151	4.378785	26.269451	26.27271	31.425703		0	0.175151	0			0				0	0	0	82.497736										12.3673	0.28797841	1.592838339	0	2.805432815	1.36792931	0.56748924	1.60393435	2.048473169	0.614917872	8.458183226	0.070001044	0.40459881	0.71461608	2.207750556	9.432155838	0.083766157	1.108384545	0	0	4.028473	0	0	0	0	0	0	0	0	0	0	4.242377326	0	0	0	0	0	0	0	0	54.0066	0	NO	9.127339	12.3673	0.28797841	1.592838339	0	2.805432815	1.36792931	0.56748924	1.60393435	2.048473169	0.614917872	8.458183226	0.070001044	0.40459881	0.71461608	2.207750556	9.432155838	0.083766157	1.108384545	0	0	4.028473	0	0	0	0	0	0	0	0	0	0	4.242377326	0	0	0	0	0	0	0	0	54.0066	NO																																																																																		0	0	NO	0	12.3673	0.28797841	1.592838339	0	2.805432815	1.36792931	0.56748924	1.60393435	2.048473169	0.614917872	8.458183226	0.070001044	0.40459881	0.71461608	2.207750556	9.432155838	0.083766157	1.108384545	0	0	4.028473	0	0	0	0	0	0	0	0	0	0	4.242377326	0	0	0	0	0	0	0	0	54.0066
H1036_144_0	2012	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	O	V									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0	0									0	YES	1642.65	43.55	663.88	18.91	298.2	7.74	3.2	327.86	203.44	160.52	1616.75	26.09	2.29	4.04	5866.75	4177.93	37.1	410.4		982.1	22.77	0		3.36	2.3		0.4		4.16	0.79	65.94	598.37									3400	"$0-$100/Day(Days 1-7): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-7): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$25-$75/Visit: 5. $25 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN849: Dental 16a, 16b"	"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$25-$200/Visit: 3. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											72.884059	64.003329	34.03605	0	125	0.2	0.2	65	133.783244	50.896223	69.510522	31.271294	0.2	0.2	0	24.998139	25	31.537827		0	0.2	0		0	0		0		0	0	0	94.201629									NO	62.979407	55.305533	29.95894	0	112.768	0.180429	0.180429	58.63936	120.691751	45.915722	62.7085	28.21121	0.180429	0.180429	0	22.551921	22.5536	28.451661		0	0.180429	0		0	0		0		0	0	0	84.983435										8.6211	0.200712997	1.657428424	0	2.8022848	1.39652046	0.5773728	1.602125047	2.046127485	0.614199308	8.448663948	0.061335872	0.41318241	0.72893316	0	7.851695609	0.069728213	0.973046806	0	0	4.10836833	0	0	0	0	0	0	0	0	0	0	4.237628167	0	0	0	0	0	0	0	0	46.4104	0	NO	5.51048	8.6211	0.200712997	1.657428424	0	2.8022848	1.39652046	0.5773728	1.602125047	2.046127485	0.614199308	8.448663948	0.061335872	0.41318241	0.72893316	0	7.851695609	0.069728213	0.973046806	0	0	4.10836833	0	0	0	0	0	0	0	0	0	0	4.237628167	0	0	0	0	0	0	0	0	46.4104	NO																																																																																		0	0	NO	0	8.6211	0.200712997	1.657428424	0	2.8022848	1.39652046	0.5773728	1.602125047	2.046127485	0.614199308	8.448663948	0.061335872	0.41318241	0.72893316	0	7.851695609	0.069728213	0.973046806	0	0	4.10836833	0	0	0	0	0	0	0	0	0	0	4.237628167	0	0	0	0	0	0	0	0	46.4104
H1036_146_0	2012	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	T	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									0	YES	1455.16	20.96	525.38	42.03	252.48	8.54	0.6	273.89	239.86	97.42	1548.58	27	4.86	7.89	6096.36	5174.67	28.16	424.09		582.32	31.6	0	2.15	3.36	2.3		0.4		4.4	0.81	1354.51	214.26									3950	"$0-$95/Day(Days 1-10): 1a. $95 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$95/Day(Days 1-10): 1b. $95 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	0% Coins: 11c. 0% Diabetic Monitoring Supplies	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS860: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics"	"$20-$150/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $95 Observation"											77.612034	71.921835	34.03605	0	150	0.2	0	65	83.746301	71.754936	50.527952	22.657565	0.199862	0.2	0	20	20	24.403559		0	0.2	0	0	0	0		0		0	0	0	104.976737									NO	70.359655	65.201171	31.922684	0	140.13705	0.186849	0	60.726055	78.23973	67.036833	47.205587	21.167762	0.18672	0.186849	0	18.68494	18.68494	22.798952		0	0.186849	0	0	0	0		0		0	0	0	98.074202										8.532	0.113884712	1.39762831	0	2.948483532	1.59569046	0	1.3860216	1.563881803	0.544227356	6.091802326	0.047627465	0.9074592	1.47423861	0	8.057366539	0.043847326	0.805733963	0	0	5.9044284	0	0	0	0	0	0	0	0	0	0	1.751114877	0	0	0	0	0	0	0	0	43.1655	0	NO	3.314993	8.532	0.113884712	1.39762831	0	2.948483532	1.59569046	0	1.3860216	1.563881803	0.544227356	6.091802326	0.047627465	0.9074592	1.47423861	0	8.057366539	0.043847326	0.805733963	0	0	5.9044284	0	0	0	0	0	0	0	0	0	0	1.751114877	0	0	0	0	0	0	0	0	43.1655	NO																																																																																		0	0	NO	0	8.532	0.113884712	1.39762831	0	2.948483532	1.59569046	0	1.3860216	1.563881803	0.544227356	6.091802326	0.047627465	0.9074592	1.47423861	0	8.057366539	0.043847326	0.805733963	0	0	5.9044284	0	0	0	0	0	0	0	0	0	0	1.751114877	0	0	0	0	0	0	0	0	43.1655
H1036_149_0	2012	6	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	O			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	1492.19	59.87	520.18	2223.75	163.6	10.18	3.71	380.88	298.27	624.51	1300.72	97.16	0.45	3.55	4445.55	4643.84	91.86	724.24		1992.65	24.5	0			0.61				3.12	0.47	355.47										3700	"$0-$275/Day(Days 1-5): 1a. $275 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$275/Day(Days 1-5): 1b. $275 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$10/Visit: 8a. $0 Lab -- FSL,8a. $10 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $10 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $20 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$30-$50/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												173.029216	142.218568	49.537808	0	100	0.2	0.156243	65	102.300734	7.078897	25.523574	50	0.2	0.2	10	24.644863	25	30		0	0.2	0			0				0	0	45.489262										NO	130.492925	107.256551	38.850521	0	88.3153	0.176631	0.137987	57.404945	90.3472	6.251749	22.541221	44.15765	0.176631	0.176631	8.83153	21.765184	22.078825	26.49459		0	0.176631	0			0				0	0	40.173978											16.2267	0.535120809	1.684105334	0	1.204031923	1.79810358	0.51193177	1.822032954	2.245654945	0.325356647	2.443318082	0.357529773	0.07948395	0.62704005	3.271750683	8.422836006	0.169013405	1.599036822	0	0	4.3274595	0	0	0	0	0	0	0	0	0	1.190053663	0	0	0	0	0	0	0	0	0	48.8405	0	NO	9.948621	16.2267	0.535120809	1.684105334	0	1.204031923	1.79810358	0.51193177	1.822032954	2.245654945	0.325356647	2.443318082	0.357529773	0.07948395	0.62704005	3.271750683	8.422836006	0.169013405	1.599036822	0	0	4.3274595	0	0	0	0	0	0	0	0	0	1.190053663	0	0	0	0	0	0	0	0	0	48.8405	YES	20% Coins	20% Coins	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100)"	40% Coins	$100/Trip	40% Coins	40% Coins; $0/Service	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						20% Coins										3700	1.2172	0.0175	0.1161	1.2074	0.5832	0.6563	0.1867	0.0646	0.262	0.0389	0.1254	0.0052	0.0028	0.0225	0.1744	0.3021	0.0024	0.0249		0.0334	0.1087	0							0	0	0.0634										5.2152	0	NO	3.238448	17.4439	0.552668809	1.800252334	1.207387	1.787231923	2.45439758	0.69861577	1.886651954	2.507633945	0.364235647	2.568758082	0.362741773	0.08233095	0.64949605	3.446161683	8.724896006	0.171368405	1.623986822	0	0.033437	4.4361325	0	0	0	0	0	0	0	0	0	1.253419663	0	0	0	0	0	0	0	0	0	54.0557
H1036_151_0	2012	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	1349.61	54.14	470.48	2239.43	224.25	13.56	1.88	339.64	265.97	556.89	1157.57	87.74	0.51	365.2	3909.44	4083.82	80.79	638.73		1752.34	27.4	0			0.6				3.47	1.28	10254.36										4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												163.989133	116.360647	49.537808	0	200	0.2	0.2	65	250	0	80.370193	36.632192	0.2	51.779516	15	34.644863	35	15		0	0.2	0			0				0	0	0										NO	140.425862	99.641018	44.562528	0	183.427	0.183427	0.183427	59.613775	229.28375	0	73.710317	33.596665	0.183427	47.488807	13.757025	31.774016	32.099725	13.757025		0	0.183427	0			0				0	0	0											15.7933	0.44954706	1.747148181	0	3.427792063	2.48727012	0.34484276	1.687268545	5.081883249	0	7.110404304	0.245647616	0.09354777	1.445242693	4.481855318	10.81328017	0.216111399	0.732252048	0	0	5.0258998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1833	0	NO	6.823174	15.7933	0.44954706	1.747148181	0	3.427792063	2.48727012	0.34484276	1.687268545	5.081883249	0	7.110404304	0.245647616	0.09354777	1.445242693	4.481855318	10.81328017	0.216111399	0.732252048	0	0	5.0258998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1833	NO																																																																																		0	0	NO	0	15.7933	0.44954706	1.747148181	0	3.427792063	2.48727012	0.34484276	1.687268545	5.081883249	0	7.110404304	0.245647616	0.09354777	1.445242693	4.481855318	10.81328017	0.216111399	0.732252048	0	0	5.0258998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1833
H1036_152_0	2012	4	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	416.75	4.4	107.92	71.41	558.3	879.89	2617.59	408.06	272.91	145.68	1668.96	0.62	6.54	251.57	8445.23	5834.48	8.59	309.14		417.03	2221.72	0	1.42	11	2.1		0.4		3.42	3.6	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN853: Dental 16a, 16b"	"VIS829: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.163125	0	0	0.850125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0132	0	NO	0	0	0	0	0	1.163125	0	0	0.850125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0132	NO																																																																																		0	0	NO	0	0	0	0	0	1.163125	0	0	0.850125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0132
H1036_153_0	2012	5	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1510.1	60.58	526.43	2505.73	250.91	11.95	4.35	380.03	37.68	623.11	1295.22	98.18	0.45	3.55	4374.33	4569.45	90.39	714.68		1960.72	24.16	0			0.6				3.12	2.11	354.68	0									3200	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Physician,9b. 15% Surgery ASC -- Facility,9a. 20% Surgery OP -- Facility"	"$0-$10/Visit: 8a. $0 Lab -- FSL,8a. $10 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $20 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: N/A. $0 Lab -- Physician,14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: N/A. $0 Staff Model,9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$200/Visit: 3. $20 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"	$0/Visit: 9a. $0 Surgery OP -- Physician											157.299288	129.289608	49.537808	0	100	0.2	0.156243	65	0.185058	7.078897	22.807763	50	0.2	0.2	10	19.763242	20	20		0	0.2	0			0				0	0	67.935496	0									NO	119.408721	98.146068	38.324133	0	87.5395	0.175079	0.136775	56.900675	0.161999	6.196831	19.965802	43.76975	0.175079	0.175079	8.75395	17.300643	17.5079	17.5079		0	0.175079	0			0				0	0	59.470394	0										15.0266	0.495474067	1.681247778	0	1.830377995	2.09219405	0.59497125	1.80199696	6.10412232	0.321775614	2.155008839	0.358109505	0.07878555	0.62153045	3.191055509	6.587868596	0.131878257	1.042712164	0	0	4.22990864	0	0	0	0	0	0	0	0	0	1.757746612	0	0	0	0	0	0	0	0	0	50.1034	0	NO	10.100227	15.0266	0.495474067	1.681247778	0	1.830377995	2.09219405	0.59497125	1.80199696	6.10412232	0.321775614	2.155008839	0.358109505	0.07878555	0.62153045	3.191055509	6.587868596	0.131878257	1.042712164	0	0	4.22990864	0	0	0	0	0	0	0	0	0	1.757746612	0	0	0	0	0	0	0	0	0	50.1034	NO																																																																																		0	0	NO	0	15.0266	0.495474067	1.681247778	0	1.830377995	2.09219405	0.59497125	1.80199696	6.10412232	0.321775614	2.155008839	0.358109505	0.07878555	0.62153045	3.191055509	6.587868596	0.131878257	1.042712164	0	0	4.22990864	0	0	0	0	0	0	0	0	0	1.757746612	0	0	0	0	0	0	0	0	0	50.1034
H1036_154_0	2012	5	r.	s.									Inpatient Facility	Inpatient Facility									Acute	Mental Health									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	D	D									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0									0	YES	431.09	15.11	98.71	6.03	429.76	1171.61	34882.38	889.15	247.89	191.25	2098.93	28.64	2.32	484.97	5802.69	5529.55	57.6	193.02		646.91	3033.43	0	2.9	3.36	2.3		0.57		5.03	1.87	0	0									3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician											0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0									NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0										0	0	0	0	0.895333333	0	0	1.852395833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7477	0	NO	0	0	0	0	0	0.895333333	0	0	1.852395833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7477	NO																																																																																		0	0	NO	0	0	0	0	0	0.895333333	0	0	1.852395833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7477
H1036_156_0	2012	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	Coin	T		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	1456.17	19.47	866.56	5.8	267.96	13.57	5.68	526.78	304.84	209.96	2368.53	14.72	7.03	400.26	6778.17	6759.72	21.72	232.24		742.35	44.07	0	2.15		2.3		0.4		5.03	1.65	239.11										4000	"$0-$100/Day(Days 1-10): 1a. $100 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Day(Days 1-10): 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												81.696878	75.707195	34.03605	0	150	0	0.118313	65	100	0	47.637018	22.104576	0.2	60.421429	0	20	20	22.00299		0	0.2	0	0		0		0		0	0	0										NO	72.317341	67.015328	30.353349	0	137.1519	0	0.108179	59.43249	91.4346	0	43.556717	20.211231	0.182869	55.246092	0	18.28692	18.28692	20.118346		0	0.182869	0	0		0		0		0	0	0											8.7755	0.10873237	2.191916509	0	3.062601927	0	0.61445672	2.608987257	2.322743622	0	8.59711591	0.024792443	1.28556907	1.842733399	0	10.30120491	0.033099325	0.389357056	0	0	8.05903683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2179	0	NO	5.084866	8.7755	0.10873237	2.191916509	0	3.062601927	0	0.61445672	2.608987257	2.322743622	0	8.59711591	0.024792443	1.28556907	1.842733399	0	10.30120491	0.033099325	0.389357056	0	0	8.05903683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2179	NO																																																																																		0	0	NO	0	8.7755	0.10873237	2.191916509	0	3.062601927	0	0.61445672	2.608987257	2.322743622	0	8.59711591	0.024792443	1.28556907	1.842733399	0	10.30120491	0.033099325	0.389357056	0	0	8.05903683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2179
H1036_157_0	2012	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	810.16	10.83	482.12	3.23	149.08	7.59	3.17	293.08	169.6	116.81	1317.76	8.19	3.93	222.69	3771.12	3760.85	12.09	129.21		413.01	24.63	0			2.3		0.4		5.03	1.24	133.03										6700	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$140/Day(Days 1-10): 1b. $140 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$175/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$175/Visit: 3. $175 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $175 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$20-$175/Visit: 7c, 7i. $175 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												142.969537	105.990073	34.03605	0	150	0.045	0.118313	65	140.841483	0	47.637018	36.052288	0.2	71.291215	5	34.879877	35	23.880793		0	0.2	0			0		0		0	0	0										NO	138.325886	102.547515	33.574827	0	147.13995	0.044142	0.116057	63.760645	138.156059	0	46.728723	35.364879	0.196187	69.931906	4.904665	34.214822	34.332655	23.425458		0	0.196187	0			0		0		0	0	0											9.3388	0.092549132	1.348924633	0	1.827968646	0.33503778	0.36790069	1.557247486	1.952605634	0	5.131436835	0.02413653	0.77101491	1.297761346	1.541340023	10.72306778	0.03459015	0.252233619	0	0	4.83208581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4287	0	NO	0.930909	9.3388	0.092549132	1.348924633	0	1.827968646	0.33503778	0.36790069	1.557247486	1.952605634	0	5.131436835	0.02413653	0.77101491	1.297761346	1.541340023	10.72306778	0.03459015	0.252233619	0	0	4.83208581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4287	NO																																																																																		0	0	NO	0	9.3388	0.092549132	1.348924633	0	1.827968646	0.33503778	0.36790069	1.557247486	1.952605634	0	5.131436835	0.02413653	0.77101491	1.297761346	1.541340023	10.72306778	0.03459015	0.252233619	0	0	4.83208581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4287
H1036_159_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	441.21	11.41	74.19	70.5	495.03	658.44	3183.2	566.73	238.98	144.81	1899.07	52.09	103.17	364.92	6729.63	5468.72	68.44	331.88		647.97	2504.25	0	2.15	1.8	1.21		0.4		0.58	0.81	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN848: Dental 16a, 16b"	"VIS856: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.0313125	0	0	1.1806875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.212	0	NO	0	0	0	0	0	1.0313125	0	0	1.1806875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.212	NO																																																																																		0	0	NO	0	0	0	0	0	1.0313125	0	0	1.1806875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.212
H1036_160_0	2012	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	T	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										0	YES	1356.6	21.94	739.28	926.61	288.42	10.18	10541.34	256.59	254.79	61.96	2174.17	35.68	10.16	5.41	8859.8	4982.08	37.8	537.34		323.27	53.37	0	1.73	3.36	4.5		0.4		4.09	3.07	84.67										3400	"$0-$125/Day(Days 1-7): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-7): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$125/Visit: 9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$125/Visit: 8a. $0 Lab -- FSL,8a. $125 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $125 Radiology OP -- Facility"	"$25-$125/Visit: 5. $25 Partial Hospitalization,7h. $125 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS854: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$25-$125/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												91.105074	80.004161	34.03605	0	150	0.045	0	65	74.762057	89.081452	14.211044	26.088804	0.199885	0.2	0	24.9986	25	27.51749		0	0.2	0	0	0	0		0		0	0	125										NO	79.021626	69.393049	29.847233	0	136.4931	0.040948	0	59.14701	68.030033	81.060023	12.931397	23.739611	0.181887	0.181991	0	22.747576	22.74885	25.03965		0	0.181991	0	0	0	0		0		0	0	113.74425											8.9334	0.126873625	1.838788534	0	3.280611659	0.41685064	0	1.264710941	1.444447676	0.418539919	2.342921285	0.070585777	1.84797192	0.98457131	0	9.444186953	0.071658878	1.121233794	0	0	9.71285967	0	0	0	0	0	0	0	0	0	0.802560471	0	0	0	0	0	0	0	0	0	44.1228	0	NO	4.931242	8.9334	0.126873625	1.838788534	0	3.280611659	0.41685064	0	1.264710941	1.444447676	0.418539919	2.342921285	0.070585777	1.84797192	0.98457131	0	9.444186953	0.071658878	1.121233794	0	0	9.71285967	0	0	0	0	0	0	0	0	0	0.802560471	0	0	0	0	0	0	0	0	0	44.1228	NO																																																																																		0	0	NO	0	8.9334	0.126873625	1.838788534	0	3.280611659	0.41685064	0	1.264710941	1.444447676	0.418539919	2.342921285	0.070585777	1.84797192	0.98457131	0	9.444186953	0.071658878	1.121233794	0	0	9.71285967	0	0	0	0	0	0	0	0	0	0.802560471	0	0	0	0	0	0	0	0	0	44.1228
H1036_161_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	394.72	9.1	102.59	1360.5	481.55	446.68	8647.11	435.48	224.42	58.58	2252.57	80.3	13.55	110.49	8388.99	4385.52	92.58	345.03		288.2	1976.74	0	0.98	1.8	2.3		0.4		4.09	1.97	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.003229167	0	0	0.90725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9105	0	NO	0	0	0	0	0	1.003229167	0	0	0.90725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9105	NO																																																																																		0	0	NO	0	0	0	0	0	1.003229167	0	0	0.90725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9105
H1036_162_0	2012	6	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	440.08	2.83	75.89	19.44	596.33	819.57	5218.11	596.53	252.82	113.46	1898.23	0	91.19	145.23	7352.7	6688.37	0.47	725.46		419.12	2717.95	0	1.42	12.72	4.8		0.4		27.82	3.75	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN859: Dental 16a, 16b"	"VIS833: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c                             $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	1.242354167	0	0	1.242770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4851	0	NO	0	0	0	0	0	1.242354167	0	0	1.242770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4851	NO																																																																																		0	0	NO	0	0	0	0	0	1.242354167	0	0	1.242770833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4851
H1036_163_0	2012	6	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	426.99	1.55	53.04	5.81	902.55	1091.11	3189.66	438.38	327.38	81.34	2314.81	0	1.7	255.2	14086.49	7971.51	5.92	1125.71		471.08	2817.62	0	3.19	16.22	4.8		0.4		72.42	17.72	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN884: Dental 16a, 16b"	"VIS833: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c                             $0: Nutritional Training/Nutritional benefit 13c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0								NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0									0	0	0	0	0	0	0	0.913291667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9133	0	NO	0	0	0	0	0	0	0	0	0.913291667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9133	NO																																																																																		0	0	NO	0	0	0	0	0	0	0	0	0.913291667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9133
H1036_164_0	2012	5	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	1193.69	5.65	452.13	12.78	369.31	12.19	1954.46	219.67	234.87	69.99	1471.61	0.06	8.84	10.39	7580.63	5890.62	0.27	838.36		348.88	46.38	0	3.19	3.36	3.05				3.42	3.35	113.97										3400	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	"$20-$75/Visit: 5. $20 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 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: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS897: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $75 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												47.189786	38.786882	34.03605	0	100	0.045	0	65	60.201524	56.705857	16.787031	75.00001	0.2	0.2	0	20	20	22.696971		0	0.044313	0	0	0	0				0	0	84.998667										NO	44.794574	36.818176	32.854897	0	95.3442	0.042905	0	61.97373	57.398661	54.065746	16.00546	71.508159	0.190688	0.190688	0	19.06884	19.06884	21.640245		0	0.04225	0	0	0	0				0	0	81.041299											4.4559	0.017335225	1.237890382	0	2.934297209	0.52301195	0	1.134480772	1.123435292	0.315338464	1.962816249	0.000357541	1.68568192	1.98124832	0	9.360607523	0.000429049	1.51185965	0	0	1.959555	0	0	0	0	0	0	0	0	0	0.769689737	0	0	0	0	0	0	0	0	0	30.9739	0	NO	1.51728	4.4559	0.017335225	1.237890382	0	2.934297209	0.52301195	0	1.134480772	1.123435292	0.315338464	1.962816249	0.000357541	1.68568192	1.98124832	0	9.360607523	0.000429049	1.51185965	0	0	1.959555	0	0	0	0	0	0	0	0	0	0.769689737	0	0	0	0	0	0	0	0	0	30.9739	NO																																																																																		0	0	NO	0	4.4559	0.017335225	1.237890382	0	2.934297209	0.52301195	0	1.134480772	1.123435292	0.315338464	1.962816249	0.000357541	1.68568192	1.98124832	0	9.360607523	0.000429049	1.51185965	0	0	1.959555	0	0	0	0	0	0	0	0	0	0.769689737	0	0	0	0	0	0	0	0	0	30.9739
H1036_167_0	2012	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.863396554	0.218815288	0	1.764796472	0.218747048	0.828016119	0.051248451	0.028918873	0.593251772	1.584504654	2.587847444	0.050065501	0.177630163		0	1.02497119	0	0	0	0				0	0	0	0	0								9.9922	YES	389.74	8.37	50.49	5081.24	17.62	24.28	6.15	687.43	49.63	6.15	23.28	1.44	0.81	16.68	44.56	72.77	1.41	5		1728.14	28.82	0	2.9	2.45	1.52				1.34	0.84	1341.98	366.96	233.78								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								0	NO	0.0818	0.0818	0.1783	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.065418	0.065418	0.128522	0	0.179976	0.179976	0.179976	58.492265	0.179976	0.179976	0.179976	0.179976	0.179976	0.179976	0.179976	0.179976	0.179976	0.179976		0	0.179976	0	0	0	0				0	0	0	0	0									25.496	0.54754866	6.48907578	0	3.17117712	4.36981728	1.1068524	3.350778144	8.93220888	1.1068524	4.18984128	0.25916544	0.14578056	3.00199968	8.01973056	13.09685352	0.25376616	0.89988	0	0	5.18690832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6242	162	YES	15.387195	25.496	0.54754866	6.48907578	0	3.17117712	5.233213834	1.325667688	3.350778144	10.69700535	1.325599448	5.017857399	0.310413891	0.174699433	3.595251452	9.604235214	15.68470096	0.303831661	1.077510163	0	0	6.21187951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6165	NO																																																																																		0	0	NO	0	25.496	0.54754866	6.48907578	0	3.17117712	5.233213834	1.325667688	3.350778144	10.69700535	1.325599448	5.017857399	0.310413891	0.174699433	3.595251452	9.604235214	15.68470096	0.303831661	1.077510163	0	0	6.21187951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6165
H1036_168_0	2012	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.861675782	0.218379201	0	1.761279205	0.218311075	0.826365852	0.051146311	0.028861281	0.592069353	1.581346706	2.58268983	0.049965798	0.177276233		0	1.022928296	0	0	0	0				0	0	0	0	0								9.9723	YES	374.19	8.04	48.47	5070.44	16.92	23.31	5.91	685.97	47.65	5.91	22.36	1.38	0.78	16.02	42.78	69.87	1.35	4.8		1724.47	27.67	0	3.48	2.45	1.52				1.34	0.84	1339.13	366.18	233.28								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								0	NO	0.0851	0.0851	0.1975	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.06815	0.06815	0.14076	0	0.180573	0.180573	0.180573	58.686355	0.180573	0.180573	0.180573	0.180573	0.180573	0.180573	0.180573	0.180573	0.180573	0.180573		0	0.180573	0	0	0	0				0	0	0	0	0									25.501	0.547926	6.8226372	0	3.05529516	4.20915663	1.06718643	3.354756578	8.60430345	1.06718643	4.03761228	0.24919074	0.14084694	2.89277946	7.72491294	12.61663551	0.24377355	0.8667504	0	0	4.99645491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9985	162	YES	15.159331	25.501	0.547926	6.8226372	0	3.05529516	5.070832412	1.285565631	3.354756578	10.36558266	1.285497505	4.863978132	0.300337051	0.169708221	3.484848813	9.306259646	15.19932534	0.293739348	1.044026633	0	0	6.019383206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9707	NO																																																																																		0	0	NO	0	25.501	0.547926	6.8226372	0	3.05529516	5.070832412	1.285565631	3.354756578	10.36558266	1.285497505	4.863978132	0.300337051	0.169708221	3.484848813	9.306259646	15.19932534	0.293739348	1.044026633	0	0	6.019383206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9707
H1036_169_0	2012	4	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	O	T	V	V		V		O	O	O	V	V								0	0	0	0	0	0.866447676	0.21958852	0	1.771033032	0.219520087	0.830942178	0.05142955	0.029021073	0.595348177	1.590104171	2.596992587	0.050242447	0.178257912		0	1.028593283	0	0	0	0		0		0	0	0	0	0								10.0275	YES	443.06	9.51	57.39	4870.83	20.03	27.6	7	658.97	56.42	6.99	26.47	1.64	0.92	18.97	50.65	82.73	1.6	5.68		1656.58	32.77	0	3.56	3.97	1.52		0.21		1.34	1.28	1286.41	351.76	224.09								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0868	0.0868	0.1953	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0		0		0	0	0	0	0								NO	0.065514	0.065514	0.125918	0	0.175567	0.175567	0.175567	57.059405	0.175567	0.175567	0.175567	0.175567	0.175567	0.175567	0.175567	0.175567	0.175567	0.175567		0	0.175567	0	0	0	0		0		0	0	0	0	0									29.0266	0.62303814	7.22643402	0	3.51660701	4.8456492	1.228969	3.133369676	9.90549014	1.22721333	4.64725849	0.28792988	0.16152164	3.33050599	8.89246855	14.52465791	0.2809072	0.99722056	0	0	5.75333059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6092	162	YES	22.345643	29.0266	0.62303814	7.22643402	0	3.51660701	5.712096876	1.44855752	3.133369676	11.67652317	1.446733417	5.478200668	0.33935943	0.190542713	3.925854167	10.48257272	17.1216505	0.331149647	1.175478472	0	0	6.781923873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6367	NO																																																																																		0	0	NO	0	29.0266	0.62303814	7.22643402	0	3.51660701	5.712096876	1.44855752	3.133369676	11.67652317	1.446733417	5.478200668	0.33935943	0.190542713	3.925854167	10.48257272	17.1216505	0.331149647	1.175478472	0	0	6.781923873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6367
H1036_170_0	2012	4	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.864509177	0.219097228	0	1.767070639	0.219028926	0.829083132	0.051314483	0.028956238	0.594016241	1.586546622	2.591182319	0.050130062	0.177859137		0	1.026292072	0	0	0	0				0	0	0	0	0								10.0051	YES	418.75	8.99	54.24	4884.45	18.93	26.09	6.61	660.81	53.32	6.61	25.02	1.55	0.87	17.92	47.87	78.19	1.51	5.37		1661.21	30.97	0	3.56	2.29	1.52				1.34	1.28	1290.01	352.75	224.72								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.087	0.087	0.2215	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.06655	0.06655	0.141946	0	0.17688	0.17688	0.17688	57.48587	0.17688	0.17688	0.17688	0.17688	0.17688	0.17688	0.17688	0.17688	0.17688	0.17688		0	0.17688	0	0	0	0				0	0	0	0	0									27.8678	0.5982845	7.69915104	0	3.3483384	4.6147992	1.1691768	3.165603146	9.4312416	1.1691768	4.4255376	0.274164	0.1538856	3.1696896	8.4672456	13.8302472	0.2670888	0.9498456	0	0	5.4779736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0793	162	YES	20.894326	27.8678	0.5982845	7.69915104	0	3.3483384	5.479308377	1.388274028	3.165603146	11.19831224	1.388205726	5.254620732	0.325478483	0.182841838	3.763705841	10.05379222	16.42142952	0.317218862	1.127704737	0	0	6.504265672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0843	NO																																																																																		0	0	NO	0	27.8678	0.5982845	7.69915104	0	3.3483384	5.479308377	1.388274028	3.165603146	11.19831224	1.388205726	5.254620732	0.325478483	0.182841838	3.763705841	10.05379222	16.42142952	0.317218862	1.127704737	0	0	6.504265672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0843
H1036_171_0	2012	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	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	1445.76	58	504	2398.98	240.22	15.36	2.14	363.84	284.92	596.56	1240.04	93.99	0.58	391.22	4187.97	4374.78	86.54	684.23		1877.19	31.05	0			0.6				3.47	1.28	10984.95										3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												94.379573	77.573765	57.180564	0	200	0.2	0.2	65	175	0	60.094825	36.632192	0.2	48.820113	10	34.644863	35	10		0	0.2	0			0				0	0	0										NO	78.816098	64.781618	47.385934	0	176.8624	0.176862	0.176862	57.48028	154.7546	0	53.142575	32.394287	0.176862	43.172212	8.84312	30.636868	30.95092	8.84312		0	0.176862	0			0				0	0	0											9.4958	0.313111154	1.990209228	0	3.540490477	2.71660032	0.37848468	1.74280209	3.674390053	0	5.491576559	0.253728253	0.10257996	1.407486065	3.086226772	11.16912978	0.223207718	0.504227333	0	0	5.4915651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5816	0	NO	7.552693	9.4958	0.313111154	1.990209228	0	3.540490477	2.71660032	0.37848468	1.74280209	3.674390053	0	5.491576559	0.253728253	0.10257996	1.407486065	3.086226772	11.16912978	0.223207718	0.504227333	0	0	5.4915651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5816	NO																																																																																		0	0	NO	0	9.4958	0.313111154	1.990209228	0	3.540490477	2.71660032	0.37848468	1.74280209	3.674390053	0	5.491576559	0.253728253	0.10257996	1.407486065	3.086226772	11.16912978	0.223207718	0.504227333	0	0	5.4915651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5816
H1036_173_0	2012	7	r.	s.	t.								DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility								Prosthetics/Supplies	Acute	Mental Health								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V				O	O	O	D	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	YES	250.27	7.87	475.82	2034.09	149.65	12.51	1.74	348.4	272.83	571.25	1189.79	88.87	0.55	374.62	4066.39	4247.78	84.03	662.47		1822.7	30.1	0		2.91	1.69				3.47	1.28	9326.43	0	0								4900	$250/Admit: 1a. $250 IP Acute - Facility 1	$250/Admit: 1b. $250 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25-$50/Visit: 5. $25 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician										250	250	34.03605	0	200	0.2	0.2	65	100	0	60.273773	27.754884	0.2	47.499699	10	24.881621	25	10		0	0.2	0		0	0				0	0	0	0	0								NO	238.4075	238.4075	33.063674	0	190.0126	0.190013	0.190013	61.754095	95.0063	0	57.263881	26.368888	0.190013	45.127707	9.50063	23.639107	23.751575	9.50063		0	0.190013	0		0	0				0	0	0	0	0									4.9722	0.156355585	1.31102978	0	2.369615466	2.37706263	0.33062262	1.792927225	2.160047402	0	5.677666081	0.19528359	0.10450715	1.4088118	3.219438902	8.367810494	0.166320404	0.524490196	0	0	5.7193913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8536	0	NO	2.096869	4.9722	0.156355585	1.31102978	0	2.369615466	2.37706263	0.33062262	1.792927225	2.160047402	0	5.677666081	0.19528359	0.10450715	1.4088118	3.219438902	8.367810494	0.166320404	0.524490196	0	0	5.7193913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8536	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						20%-25% Coins	30% Coins	30% Coins								7300	2.3175	0.0368	0.2494	1.2113	1.1616	0.5487	0.0762	0.0644	0.5256	0.078	0.2517	0.0105	0.0038	0.1722	0.3499	0.6061	0.0047	0.0501		0.0671	0.1948	0							0	0	0.1148	0.2352	0								8.3305	0	NO	4.308978	7.2897	0.193154585	1.56047578	1.211286	3.531235466	2.92574063	0.40687162	1.857281225	2.685696402	0.078009	5.929355081	0.20574059	0.10831515	1.5810108	3.569387902	8.973881494	0.171045404	0.574552196	0	0.06709	5.9142023	0	0	0	0	0	0	0	0	0	0.11479	0.235205	0.000002	0	0	0	0	0	0	0	49.184
H1036_801_0	2012	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	464.18	2.65	42.91	18.24	16.2	10.62	5.67	44.88	85.23	8.14	41	0.61	7.62	31.21	56.37	133.5	0.55	9.58		6.93	46.16	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																					0.0862	0.0862	0.1674	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062403	0.062403	0.1134	0	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672	0.186672		0.186672	0.186672	0																				28.9662	0.16536795	4.865994	0	3.0240864	1.98245664	1.05843024	8.37783936	15.91005456	1.51951008	7.653552	0.11386992	1.42244064	5.82603312	10.52270064	24.920712	0.1026696	1.78831776	0	1.29363696	8.61677952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.1307	0	NO	32.249614	28.9662	0.16536795	4.865994	0	3.0240864	1.98245664	1.05843024	8.37783936	15.91005456	1.51951008	7.653552	0.11386992	1.42244064	5.82603312	10.52270064	24.920712	0.1026696	1.78831776	0	1.29363696	8.61677952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.1307	NO																																																																																		0	0	NO	0	28.9662	0.16536795	4.865994	0	3.0240864	1.98245664	1.05843024	8.37783936	15.91005456	1.51951008	7.653552	0.11386992	1.42244064	5.82603312	10.52270064	24.920712	0.1026696	1.78831776	0	1.29363696	8.61677952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.1307
H1036_806_0	2012	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	427.07	2.88	38.38	15.93	14.87	10.74	5	42.24	80.42	9.4	38.19	0.59	11.1	26.9	55.57	129.6	0.57	9.05		6.58	38.86	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																					0.0864	0.0864	0.1628	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064398	0.064398	0.116272	0	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058	0.189058		0.189058	0.189058	0																				27.5025	0.18546624	4.46251936	0	2.81129246	2.03048292	0.94529	7.98580992	15.20404436	1.7771452	7.22012502	0.11154422	2.0985438	5.0856602	10.50595306	24.5019168	0.10776306	1.7109749	0	1.24400164	7.34679388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8378	0	NO	28.006617	27.5025	0.18546624	4.46251936	0	2.81129246	2.03048292	0.94529	7.98580992	15.20404436	1.7771452	7.22012502	0.11154422	2.0985438	5.0856602	10.50595306	24.5019168	0.10776306	1.7109749	0	1.24400164	7.34679388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8378	NO																																																																																		0	0	NO	0	27.5025	0.18546624	4.46251936	0	2.81129246	2.03048292	0.94529	7.98580992	15.20404436	1.7771452	7.22012502	0.11154422	2.0985438	5.0856602	10.50595306	24.5019168	0.10776306	1.7109749	0	1.24400164	7.34679388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8378
H1036_807_0	2012	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	464.18	2.65	42.91	18.24	16.2	10.62	5.67	44.88	85.23	8.14	41	0.61	7.62	31.21	56.37	133.5	0.55	9.58		6.93	46.16	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																					0.0852	0.0852	0.1767	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.061744	0.061744	0.118551	0	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668	0.18668		0.18668	0.18668	0																				28.6603	0.1636216	5.08702341	0	3.024216	1.9825416	1.0584756	8.3781984	15.9107364	1.5195752	7.65388	0.1138748	1.4225016	5.8262828	10.5231516	24.92178	0.102674	1.7883944	0	1.2936924	8.6171488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0481	0	NO	32.264175	28.6603	0.1636216	5.08702341	0	3.024216	1.9825416	1.0584756	8.3781984	15.9107364	1.5195752	7.65388	0.1138748	1.4225016	5.8262828	10.5231516	24.92178	0.102674	1.7883944	0	1.2936924	8.6171488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0481	NO																																																																																		0	0	NO	0	28.6603	0.1636216	5.08702341	0	3.024216	1.9825416	1.0584756	8.3781984	15.9107364	1.5195752	7.65388	0.1138748	1.4225016	5.8262828	10.5231516	24.92178	0.102674	1.7883944	0	1.2936924	8.6171488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0481
H1045_001_0	2012	8																															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	1430.944083	0	622.2258276	114.504446	977.2252346	7.65011005	0.061824803	326.1471844	345.4345246	62.14809606	240.4835926	0	2.092551531	233.5911197	3148.958023	18793.02093	1.595246696	238.6269023	5143.020339	4.895757101	25.95594229	0.695039285	1826.31459	953.2437157	527.9887897	1.180413684	0.275042534	54.5632127	0	0											3400	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	153: 20.0%	$0 	$0 	"16a1: 35.3%,16a2: 35.3%,16a3: 35.3%,16b2: 35.3%"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	0	0	0	42.38145978	0	0	0	0	0	0	0	0	0	0	0	0	0.188171727	0	0	95.43569253	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	42.38145978	0	0	0	0	0	0	0	0	0	0	0	0	0.188171727	0	0	95.43569253	0	0	0	0	0	0												0	0	0	0	0	0	0	1.151882815	0	0	0	0	0	0	0	0	0	0	0	0	4.884174489	0	0	7.581122847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6172	0	NO	0	0	0	0	0	0	0	0	1.151882815	0	0	0	0	0	0	0	0	0	0	0	0	4.884174489	0	0	7.581122847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6172	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $40	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	153: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0025	0	0	0	0	0	0	0	0	0	0	0	0	0.001	0	0	0	0	0	0	0	0	0											0.0036	0	NO	0	0	0	0	0	0	0	0	1.154392679	0	0	0	0	0	0	0	0	0	0	0	0	4.885219832	0	0	7.581122847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6207
H1045_005_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1252.416879	0	820.5301716	50.02898368	539.6739734	7.6063838	0.308660479	265.5133143	306.3230216	50.46518833	112.5296311	0	1.51884678	165.4780589	2783.694288	15339.08404	4.282579822	152.5371343	4666.162307	10.03543482	19.82102714	0.137219554	374.9382654	323.4780861	444.7871065	5.761648128	0.054300836	33.18660884	0	0											3400	$0 	$0 	$0 days 1-6;$25 days 7-21;$0 days 22-100	$0 	10a: $100	$0 	$0 	"4a1: $50,4a2: $50"	"9a1: $100,9b: $25"	8a2: $50	"8b1: $50,8b2: $100,8b3: $40,8b4: $40"	$0 	$0 	"31: $100,9a2: $100"	$0 	$0 	$0 	$0 	$0 	$0 	153: 20.0%	$0 	$0 	"16a1: 84.9%,16a2: 84.9%,16a3: 84.9%,16b2: 84.9%"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	13.59281081	0	100	0	0	47.92763562	42.47876723	25.02349247	50.03051548	0	0	49.54077231	0	0	0	0	0	0	0.165058567	0	0	253.0222995	0	0	0	0	0	0											NO	0	0	13.59148041	0	99.9902125	0	0	47.92299903	42.47460962	25.0210433	50.02561874	0	0	49.53592351	0	0	0	0	0	0	0.165042412	0	0	253.0222995	0	0	0	0	0	0												0	0	0.929351646	0	4.49684294	0	0	1.060349525	1.084245897	0.105224305	0.469113702	0	0	0.683092372	0	0	0	0	0	0	3.271310132	0	0	6.820597431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9201	0	NO	0.001183156	0	0	0.929351646	0	4.49684294	0	0	1.060349525	1.084245897	0.105224305	0.469113702	0	0	0.683092372	0	0	0	0	0	0	3.271310132	0	0	6.820597431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9201	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	153: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0006	0	0	0	0	0	0	0	0	0	0	0	0	0.0002	0	0	0	0	0	0	0	0	0											0.0008	0	NO	5.16E-08	0	0	0.929351646	0	4.49684294	0	0	1.060968919	1.084245897	0.105224305	0.469113702	0	0	0.683092372	0	0	0	0	0	0	3.271516511	0	0	6.820597431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.921
H1045_012_0	2012	8																															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	1940.579724	0	1031.816069	138.0083674	1809.587281	8.83329705	0.442707186	560.509493	379.8272402	95.84288939	219.9941479	0	4.728740634	272.5574276	3579.831605	22602.49666	6.711048629	298.3615081	6774.667621	13.38753453	27.54554428	0.182307281	5045.182933	1116.613571	564.2554533	2.026603129	0	53.4001029	0	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 	"16a1: 38.7%,16a2: 38.7%,16a3: 38.7%,16b2: 38.7%"	$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	136.3875092	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	136.3875092	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.69101197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.691	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	12.69101197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.691	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	12.69101197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.691
H1045_016_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1530.143519	0	672.1913515	134.9842014	954.3165628	7.643563947	0.026286667	261.5566097	358.1908251	73.87148911	177.3774709	0	13.12942767	150.3198906	1749.234678	18843.82321	0.815793333	182.7377067	5045.27387	2.039483333	22.60475163	1.288456205	2101.50415	2.44738	524.4267513	6.763644557	0	53.30055223	0	0											3400	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"16a1: 88.9%,16a2: 88.9%,16a3: 88.9%,16b2: 88.9%"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	0	0	0	45.89490969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1807.946959	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	45.89490969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1807.522507	0	0	0	0	0	0												0	0	0	0	0	0	0	1.000343082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.368641203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.369	0	NO	8.66E-05	0	0	0	0	0	0	0	1.000343082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.368641203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.369	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $40	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	1.000343082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.368641203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.369
H1045_018_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2217.829496	0	1091.860476	152.0970896	1193.684119	8.28253518	0.262257864	515.0101183	380.526678	128.2147272	221.3590089	0	6.850649444	277.6123381	3875.704375	27436.84676	5.275004795	196.175583	7057.495602	13.00855794	38.97312608	0.371321736	2394.699936	813.1827632	522.0307074	0.902948805	0.220410428	44.78074665	0	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 	"16a1: 42.9%,16a2: 42.9%,16a3: 42.9%,16b2: 42.9%"	$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	119.6115619	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	119.6115619	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.105505036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1055	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	8.105505036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1055	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	8.105505036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1055
H1045_019_0	2012	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	904.3465021	0	330.422244	84.99244014	303.1193908	8.447461412	0.206543725	253.2873578	291.9606841	56.25211085	42.49480113	0.152858997	5.239335118	194.436644	5487.344709	15192.82434	3.484207381	229.2318106	4633.806073	4.645609842	20.8241544	0	0	477.9205492	595.8933201	4.106505903	0.871051845	71.22344053	0	0											5000	$50 days 1-7;$0 days 8-90	$0 	$0 days 1-10;$50 days 11-20;$75 days 21-100	$0 	10a: $100	11a: 0% to 20%	$0 	"4a1: $50,4a2: $50"	9a1: $150	8a2: $75	"8b1: $75,8b2: $150,8b3: $40,8b4: $40"	$0 	$0 	"31: $75,9a2: $150"	$0 	"7b1: $10,7d1: $10,7f1: $10"	$0 	"7c: $25,7i: $25"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: 76.5%,16a2: 76.5%,16a3: 76.5%,16b2: 76.5%"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	37.56065733	0	20.83348212	0	100	0.1	0	49.0042245	53.56020942	33.62771739	72.37410072	0	0	72.63719611	0	9.339691709	0	25	0	0	0.198368703	0	0	179.4351871	0	0	0	0	0	0											NO	37.52334944	0	20.81278884	0	99.90067297	0.099900673	0	48.95623942	53.50700966	33.59431598	72.30221368	0	0	72.56504775	0	9.330414871	0	24.97516824	0	0	0.198171669	0	0	179.4351871	0	0	0	0	0	0												2.8278	0	0.573084033	0	2.523485928	0.84390708	0	1.033333044	1.301828595	0.157479266	0.256039016	0	0	1.175775363	0	11.81294618	0	0.47709192	0	0	4.126757434	0	0	7.146313599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2559	0	NO	0.026939338	2.8278	0	0.573084033	0	2.523485928	0.84390708	0	1.033333044	1.301828595	0.157479266	0.256039016	0	0	1.175775363	0	11.81294618	0	0.47709192	0	0	4.126757434	0	0	7.146313599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2559	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0013	0	0	0	0	0	0	0	0	0	0	0	0	0.0259	0	0	0	0	0	0	0	0	0											0.0272	0	NO	2.14E-05	2.8278	0	0.573084033	0	2.523485928	0.84390708	0	1.034606869	1.301828595	0.157479266	0.256039016	0	0	1.175775363	0	11.81294618	0	0.47709192	0	0	4.152675814	0	0	7.146313599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2831
H1045_020_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1023.599304	0	373.9937934	96.20007635	343.0906148	8.507146787	0.233779876	286.6874174	330.460451	63.66986699	48.09843213	0.173015943	5.930226707	220.0762794	6208.767589	16877.02531	3.943656819	259.4597549	5192.974435	5.258209092	22.69491962	0	1.602763975	540.6096223	674.4715506	4.648015527	0.985914205	80.6154101	0	0											3400	$50 days 1-7;$0 days 8-90	$0 	$0 days 1-7;$50 days 8-20;$0 days 21-100	$0 	10a: $50	11a: 10.0%	$0 	"4a1: $65,4a2: $65"	9a1: $150	$0 	"8b2: $100,8b3: $60,8b4: $60,8b6: $150"	$0 	12: 20.0%	"31: $50,9a2: $150"	$0 	7d1: $15	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $12,16a2: $12,16a3: $12"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	37.56065733	0	20.05594239	0	50	0.1	0	63.70549185	53.56020942	0	66.83453237	0	8.178490403	65.64465409	0	13.99191591	0	0	0	0	0.198473148	0	0	9.016413374	0	0	0	0	0	0											NO	36.6412884	0	19.56503484	0	48.77615437	0.097552309	0	62.16826198	52.24922086	0	65.19862937	0	7.978306209	64.03787563	0	13.64943701	0	0	0	0	0.193615138	0	0	9.016413374	0	0	0	0	0	0												3.1255	0	0.6097668	0	1.394553399	0.82989181	0	1.485238206	1.438858424	0	0.261329321	0	0.003942764	1.174434784	0	19.19682449	0	0	0	0	4.394080001	0	0	0.406196652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3206	0	NO	0.850408052	3.1255	0	0.6097668	0	1.394553399	0.82989181	0	1.485238206	1.438858424	0	0.261329321	0	0.003942764	1.174434784	0	19.19682449	0	0	0	0	4.394080001	0	0	0.406196652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3206	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $65	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0019	0	0	0	0	0	0	0	0	0	0	0	0	0.0293	0	0	0	0	0	0	0	0	0											0.0312	0	NO	0.000773344	3.1255	0	0.6097668	0	1.394553399	0.82989181	0	1.487112545	1.438858424	0	0.261329321	0	0.003942764	1.174434784	0	19.19682449	0	0	0	0	4.423416141	0	0	0.406196652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3518
H1045_022_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1480.014371	0	621.4434421	124.0181177	956.4738558	8.01410634	0.060629796	283.0209215	285.6350783	64.89259922	195.9848761	0	2.136768271	229.5075932	2552.674688	17564.3156	4.016216927	188.0319743	4749.65116	4.235283305	12.66285052	0.615095727	0	674.9452387	386.4353369	1.49573779	0.36511063	38.86705038	0	0											3400	$0 	$0 	$0 days 1-10;$50 days 11-20;$75 days 21-100	$0 	10a: $100	11a: 10.0%	$0 	"4a1: $50,4a2: $50"	9a1: $200	8a2: $100	"8b3: 20.0%,8b4: 20.0%"	$0 	$0 	"31: $75,9a2: $200"	$0 	$0 	$0 	"7c: $25,7i: $25"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: 40.9%,16a2: 40.9%,16a3: 40.9%,16b2: 40.9%"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	20.83348212	0	100	0.1	0	43.34419995	58.95020188	35.18957346	54.85538531	0	0	104.0368509	0	0	0	25	0	0	0.199031343	0	0	114.2893101	0	0	0	0	0	0											NO	0	0	20.82289632	0	99.94918852	0.099949189	0	43.32232105	58.92024841	35.17169312	54.82751247	0	0	103.9839883	0	0	0	24.98729713	0	0	0.198930213	0	0	114.2893101	0	0	0	0	0	0												0	0	1.078354363	0	7.966565477	0.801003425	0	1.021760269	1.402474147	0.190198549	0.895446936	0	0	1.988759573	0	0	0	0.391534234	0	0	2.519023546	0	0	6.428252143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6834	0	NO	0.009276993	0	0	1.078354363	0	7.966565477	0.801003425	0	1.021760269	1.402474147	0.190198549	0.895446936	0	0	1.988759573	0	0	0	0.391534234	0	0	2.519023546	0	0	6.428252143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6834	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0019	0	0	0	0	0	0	0	0	0	0	0	0	0.0045	0	0	0	0	0	0	0	0	0											0.0064	0	NO	2.40E-06	0	0	1.078354363	0	7.966565477	0.801003425	0	1.023682443	1.402474147	0.190198549	0.895446936	0	0	1.988759573	0	0	0	0.391534234	0	0	2.523475908	0	0	6.428252143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6897
H1076_003_0	2012	8																															D	D	D	V	COIN	COIN	COIN	V	COIN	COIN	COIN	O	COIN	COIN	P	P	P	COIN	COIN	P	COIN	V	COIN	COIN	V	V	V	V	P	O											24.95121498	0.185124883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											25.1363	YES	1726.072868	0	1075.641894	0	13.7729147	6.576044992	16.22170527	122.812774	27.81115759	5.434832143	10.28938612	0	2.913685558	56.21522798	0	16125.92697	191.357405	2.832104495	22.82333836	2349.28842	59.98747842	0	0	1.978488598	0	0	0	0	0	0											6400	FFS	included in a.1.	FFS	FFS	FFS	FFS	included in e.1.	(4a) $65	FFS	included in h.5.	included in h.5.	included in h.5.	included in h.5.	FFS	$0 	"(7d,7g) $20; (7b) $15; (7c,7i) 20%"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0.182400451	0	9.29278448	0	0.2	0.2	0.2	44.41146888	0.187344199	0.083179714	0.195420896	0	0.2	0.00323602	0	6.189456466	1.854874283	0.2	0.161457285	19.95603178	0.14058703	0	0	0.187000047	0	0	0	0	0	0											NO	0.166816735	0	8.498838418	0	0.182912634	0.182912634	0.182912634	40.6170937	0.171338104	0.076073102	0.178724754	0	0.182912634	0.002959545	0	5.660648917	1.696399702	0.182912634	0.147662886	18.25105165	0.12857572	0	0	0.171023356	0	0	0	0	0	0												0.024	0	0.761808888	0	2.519240101	1.202841709	2.967154834	0.415691496	4.765111009	0.413444542	1.838968	0	0.532949899	0.166371505	0	7.606934254	0.027051554	0.518027692	3.370160012	3.573082024	7.712933215	0	0	0.338367759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7541	1132	NO	3.620340803	24.9752	0.185124883	0.761808888	0	2.519240101	1.202841709	2.967154834	0.415691496	4.765111009	0.413444542	1.838968	0	0.532949899	0.166371505	0	7.606934254	0.027051554	0.518027692	3.370160012	3.573082024	7.712933215	0	0	0.338367759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8905	NO																																										0	0	0	0	0	0	0	0	0	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	24.9752	0.185124883	0.761808888	0	2.519240101	1.202841709	2.967154834	0.415691496	4.765111009	0.413444542	1.838968	0	0.532949899	0.166371505	0	7.606934254	0.027051554	0.518027692	3.370160012	3.573082024	7.712933215	0	0	0.338367759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8905
H1076_010_0	2012	7																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	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	718.0639467	0	314.8527396	0	152.2239613	0	0	142.8636444	180.2270787	0	143.9478661	0	0.182741863	0	0	13074.45121	169.9353629	0	1312.276713	1189.045149	19.54714894	0	0	2.044268294	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) $65	"(9a,9b) $150 @ Hospital; $50 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $10 (L.8a Diag, 8b MRI/CT @ freest.); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)"	(9a) $150 copay	(12) 20%	(8b) $55 @ Hospital	$0 	"(7b) $20; (7d,7g) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	134.3989749	0	39.3053413	0	100	0	0	35.91726697	61.2412256	0	66.74658811	0	0.2	0	0	6.355317453	5.942600353	0	25.5928319	24.53201914	0.123482924	0	0	0.187000047	0	0	0	0	0	0											NO	131.844396	0	38.55824786	0	98.0992572	0	0	35.2345721	60.07718741	0	65.47790714	0	0.196198514	0	0	6.234519214	5.829646804	0	25.10637799	24.06572855	0.121135831	0	0	0.183445657	0	0	0	0	0	0												7.8894	0	1.011680831	0	1.244421461	0	0	0.419478282	0.902294665	0	0.785450417	0	0.035853682	0	0	6.792743109	0.082555262	0	2.745542933	2.38460315	2.36786013	0	0	0.375012141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0369	0	NO	0.525045063	7.8894	0	1.011680831	0	1.244421461	0	0	0.419478282	0.902294665	0	0.785450417	0	0.035853682	0	0	6.792743109	0.082555262	0	2.745542933	2.38460315	2.36786013	0	0	0.375012141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0369	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.8894	0	1.011680831	0	1.244421461	0	0	0.419478282	0.902294665	0	0.785450417	0	0.035853682	0	0	6.792743109	0.082555262	0	2.745542933	2.38460315	2.36786013	0	0	0.375012141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0369
H1076_011_0	2012	7																															D	D	D	V	T	O	O	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	1982.51022	0	0	0	0	0	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	(12) 0%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	$0 	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0.012094829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0.012094829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.002	0	NO	8.67E-19	0.002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.002	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	NO	0	0.002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.002
H1076_016_0	2012	7																															D	D	D	V	COIN	COIN	COIN	V	COIN	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	COIN	P	COIN	V	COIN	COIN	V	V	COIN	COIN	P	O											21.80297826	0.243586296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											22.0466	YES	1506.591765	0	918.8554659	0	8.722974366	5.63260434	22.5592931	283.6793217	29.28056686	8.86714695	7.71219106	0	0.048698319	33.71252265	0	190.416018	0	2.661740684	26.63630151	2129.740265	46.28451074	0	0	2.06440231	0	0	0.000373176	0.000142811	0	0											6700	FFS	included in a.1.	FFS	$0 	FFS	FFS	included in e.1.	(4a) $65	FFS	included in h.5.	included in h.5.	included in h.5.	included in h.5.	FFS	$0 	"(7b,7d,7g) $20; (7c,7i) 20%"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0.337131307	0	9.372396838	0	0.2	0.2	0.2	44.46807178	0.193188423	0.090020541	0.135952281	0	0.2	0.00381667	0	0.042860649	0	0.2	0.159143728	19.49656104	0.166357109	0	0	0.004879903	0	0	0.042881999	0.95981942	0	0											NO	0.324447574	0	9.019783524	0	0.192475493	0.192475493	0.192475493	42.79507026	0.185920185	0.08663374	0.130837412	0	0.192475493	0.003673077	0	0.041248123	0	0.192475493	0.153156337	18.76305102	0.160098333	0	0	0.004696309	0	0	0.04126867	0.923708582	0	0												0.0407	0	0.690656449	0	1.678958794	1.084138299	4.342111068	1.011673042	5.44384842	0.768194106	1.009043118	0	0.009373233	0.123828693	0	7.854303337	0	0.512319851	4.079518378	3.330035438	7.410073007	0	0	0.009695071	0	0	1.54E-05	0.000131915	0	0	0	0	0	0	0	0	0	0	0	0	39.3987	1132	NO	1.54069791	21.8437	0.243586296	0.690656449	0	1.678958794	1.084138299	4.342111068	1.011673042	5.44384842	0.768194106	1.009043118	0	0.009373233	0.123828693	0	7.854303337	0	0.512319851	4.079518378	3.330035438	7.410073007	0	0	0.009695071	0	0	1.54E-05	0.000131915	0	0	0	0	0	0	0	0	0	0	0	0	61.4452	NO																																										0	0	0	0	0	0	0	0	0	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	21.8437	0.243586296	0.690656449	0	1.678958794	1.084138299	4.342111068	1.011673042	5.44384842	0.768194106	1.009043118	0	0.009373233	0.123828693	0	7.854303337	0	0.512319851	4.079518378	3.330035438	7.410073007	0	0	0.009695071	0	0	1.54E-05	0.000131915	0	0	0	0	0	0	0	0	0	0	0	0	61.4452
H1076_802_0	2012	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	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	281.444677	2.376899897	18.65059442	0	10.39017719	5.962650611	16.92879523	17.1575444	25.83971918	4.786429408	7.006730561	2.967011475	0.602805401	46.48850306	106.7172704	157.5510931	0.863671808	3.89020042	23.37726542	18.62967816	36.70122814	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												NO	0.079180961	0.079180961	0.166506018	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.062369685	0.062369685	0.131154356	0	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0	0	0	0	0	0	0	0	0											10000	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	0	NO	28.53752971	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	NO																																										0	0	0	0	0	0	0	0	0	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	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874
H1076_803_0	2012	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	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	281.444677	2.376899897	18.65059442	0	10.39017719	5.962650611	16.92879523	17.1575444	25.83971918	4.786429408	7.006730561	2.967011475	0.602805401	46.48850306	106.7172704	157.5510931	0.863671808	3.89020042	23.37726542	18.62967816	36.70122814	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												NO	0.079180961	0.079180961	0.166506018	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.062369685	0.062369685	0.131154356	0	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0	0	0	0	0	0	0	0	0											10000	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	0	NO	28.53752971	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	NO																																										0	0	0	0	0	0	0	0	0	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	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874
H1076_805_0	2012	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	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	281.444677	2.376899897	18.65059442	0	10.39017719	5.962650611	16.92879523	17.1575444	25.83971918	4.786429408	7.006730561	2.967011475	0.602805401	46.48850306	106.7172704	157.5510931	0.863671808	3.89020042	23.37726542	18.62967816	36.70122814	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												NO	0.079180961	0.079180961	0.166506018	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.062369685	0.062369685	0.131154356	0	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0.176441525	0	0	0	0	0	0	0	0	0											10000	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	0	NO	28.53752971	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874	NO																																										0	0	0	0	0	0	0	0	0	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	17.5536	0.148246498	2.446106703	0	1.83325871	1.052059167	2.986942447	3.0273033	4.559199458	0.844524904	1.236278226	0.523504029	0.106359904	8.202502377	18.82935794	27.79855513	0.152387571	0.686392895	4.124720361	3.287048826	6.475620663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.874
H1080_004_0	2012	4																															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	1484.541201	82.95453557	1305.099839	2926.30561	226.5057332	10.93402851	9.988646448	408.7286278	64.03392453	21.90520435	44.6934359	0	0.141229052	20.45340408	6320.103992	5353.828811	484.6015819	630.1174192	0	0	31.44594829	1409.582003	0	258.3577597	57.30538074	0	5.511514128	65	491.4647494	0											4950	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $40 (16b, 18a); $0/$40 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	68.00675925	0	200	0.2	0.127020456	63.69597297	0.16	0.192516182	0.180344067	0	0.2	0.146128668	7.175975014	39.49730343	38.5	40	0	0	0.2	39.43393295	0	0	40	0	10	122.5	0	0											NO	145.1752939	76.03693757	52.33638216	0	153.9152365	0.153915236	0.097751918	49.03913975	0.123132189	0.148155869	0.138788499	0	0.153915236	0.112457143	6.894848254	37.95124813	36.99171991	38.43295575	0	0	0.153915236	30.34741558	0	0	40	0	10	122.5	0	0												17.9599	0.52563407	5.692016994	0	2.905223625	1.682913583	0.976409345	1.670308358	7.884637309	3.245384576	6.202934871	0	0.021737303	2.300131377	3.631346498	16.93204047	1.493853832	2.018106241	0	0	4.840010567	3.564764237	0	0	0.191017936	0	0.004592928	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	84.4065	0	NO	18.78703632	17.9599	0.52563407	5.692016994	0	2.905223625	1.682913583	0.976409345	1.670308358	7.884637309	3.245384576	6.202934871	0	0.021737303	2.300131377	3.631346498	16.93204047	1.493853832	2.018106241	0	0	4.840010567	3.564764237	0	0	0.191017936	0	0.004592928	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	84.4065	YES	"$395 Days 1-25 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-25 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	"$0 n/c (6a, 6a2)"	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$40/$45 (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9500	0.363	0.0182	0.2759	0	0.0593	0	0.0471	0.0341	0.2414	0.0662	0.1858	0	0.0004	0.0703	0.3758	0.4936	0.0433	0.0582	0	0	0.3103	0.1026	0	0.0453	0.0055	0	0.0005	0	0	0											2.7967	0	NO	0.570589676	18.3229	0.54378965	5.96788437	0	2.964513903	1.682913583	1.02347276	1.704396284	8.126003758	3.311616914	6.388716001	0	0.022180921	2.370431023	4.007191888	17.42560276	1.537132315	2.076320844	0	0	5.150267654	3.66740741	0	0.045325923	0.196528069	0	0.005044609	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	87.2032
H1080_036_0	2012	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	390.5499061	22.7504	47.67021727	4072.729586	20.65126604	27.3145506	20.46487103	56.98995259	80.7959779	26.75069793	53.02969657	0	0	61.20509344	51.34726629	121.7632231	10.7856	6.296586621	0	962.9293714	33.28116243	11.06216446	762.1813371	224.6564509	50.49700256	214.8941247	0	0	164.236126	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.091871364	0.092987211	0.16621872	0	0.224	0.224	0.224	0.104053502	0.224	0.224	0.224	0	0	0.224	0.22123214	0.223854814	0.227595862	0.224	0	0	0.224	0.222022639	0	0	0	0	0	0	0	0											NO	0.069969633	0.070819467	0.126592905	0	0.17059938	0.17059938	0.17059938	0.079260898	0.17059938	0.17059938	0.17059938	0	0	0.17059938	0.168491366	0.170488806	0.173338004	0.17059938	0	0	0.17059938	0.171057556	0	0	0	0	0	0	0	0												27.3266	1.611171194	6.034711267	0	3.523093185	4.6598454	3.491294311	4.517074804	13.78374375	4.563652485	9.046833362	0	0	10.441551	8.651571027	20.75926651	1.86955438	1.074193774	0	0	5.67774568	1.892266816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9242	150	YES	40.32602935	27.3266	1.611171194	6.034711267	0	3.523093185	4.6598454	3.491294311	4.517074804	13.78374375	4.563652485	9.046833362	0	0	10.441551	8.651571027	20.75926651	1.86955438	1.074193774	0	0	5.67774568	1.892266816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9242	NO																																										0	0	0	0	0	0	0	0	0	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	27.3266	1.611171194	6.034711267	0	3.523093185	4.6598454	3.491294311	4.517074804	13.78374375	4.563652485	9.046833362	0	0	10.441551	8.651571027	20.75926651	1.86955438	1.074193774	0	0	5.67774568	1.892266816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9242
H1080_042_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1203.628325	78.28636468	958.2898148	2041.481852	185.2605026	8.097375148	9.155532292	351.1477554	373.9158061	18.47170752	35.07693994	0	0.065395929	227.393424	5485.566805	4522.310501	480.9529767	601.9283445	0	0	28.92190301	1318.689229	0	485.0588235	41.72093023	0	13.26213021	65	133.3746483	0											3200	"$175 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	162.6905333	106.6104145	57.66313977	0	200	0.2	0.116494362	63.75999746	71.75	0.223311006	0.183523817	0	0.2	61.40521672	7.131228397	24.92461747	38.5	25	0	0	0.2	24.77320073	0	0	25	0	10	352.5	0	0											NO	125.0323973	81.93319815	44.31579671	0	153.7058054	0.153705805	0.089529299	49.02418374	55.1419577	0.17162099	0.14104338	0	0.153705805	47.19169147	6.851943524	23.95251224	36.99219979	24.02090896	0	0	0.153705805	19.03892386	0	0	25	0	10	352.5	0	0												12.541	0.534521019	3.538948052	0	2.372967897	1.244613569	0.819688388	1.434561007	1.71820413	3.170132731	4.947370178	0	0.010051734	0.894256692	3.132232828	9.0267248	1.482625717	1.204905497	0	0	4.445464396	2.092201984	0	0	0.086918605	0	0.011051775	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	56.6179	0	NO	12.57910181	12.541	0.534521019	3.538948052	0	2.372967897	1.244613569	0.819688388	1.434561007	1.71820413	3.170132731	4.947370178	0	0.010051734	0.894256692	3.132232828	9.0267248	1.482625717	1.204905497	0	0	4.445464396	2.092201984	0	0	0.086918605	0	0.011051775	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	56.6179	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)"	"$0 n/c (6a, 6a2)"	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$40/$50 (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.3157	0.0183	0.2067	0	0.0484	0	0.0431	0.0293	0.1786	0.0647	0.1478	0	0.0002	0.0469	0.3298	0.4628	0.043	0.0618	0	0	0.285	0.1067	0	0.0851	0.0045	0	0.0014	0	0	0											2.4796	0	NO	0.485347679	12.8567	0.552827926	3.745688486	0	2.421395813	1.244613569	0.862767729	1.463837762	1.896757215	3.234829317	5.095170879	0	0.010256871	0.941141511	3.462021537	9.489523392	1.52557891	1.266695522	0	0	4.730430063	2.198923508	0	0.085098039	0.091375969	0	0.012468669	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	59.0975
H1080_043_0	2012	4																															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	1504.762995	75.22063452	1336.376107	2936.504845	231.9338651	11.01412431	10.26716018	418.4914453	53.34205896	18.24765092	37.23088832	0	0.11764777	17.03632276	6545.426003	5517.430677	378.5713983	648.5267762	0	0	33.27626569	1450.764008	0	0	42.79069767	0	17.6381231	65	540.608755	0											5500	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$130 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	71.66153227	0	200	0.2	0.127020456	63.69587256	0.16	0.236642395	0.187492373	0	0.2	0.145890462	3.69868272	39.50158091	38.5	40	0	0	0.2	39.45956842	0	0	40	0	5	352.5	0	0											NO	151.5345496	79.36765802	57.56475446	0	160.6573363	0.160657336	0.102033841	51.18233845	0.128525869	0.190091684	0.150610126	0	0.160657336	0.117191865	3.576511727	38.19973736	37.22830855	38.67876213	0	0	0.160657336	31.69734578	0	0	40	0	5	352.5	0	0												19.002	0.497507133	6.410680206	0	3.105156415	1.769499874	1.047597786	1.784947566	6.855834487	3.468726692	5.607348776	0	0.018900977	1.996518444	1.950816072	17.56370023	1.174464402	2.090351076	0	0	5.346076209	3.832114033	0	0	0.142635659	0	0.007349218	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	85.5816	0	NO	15.65107747	19.002	0.497507133	6.410680206	0	3.105156415	1.769499874	1.047597786	1.784947566	6.855834487	3.468726692	5.607348776	0	0.018900977	1.996518444	1.950816072	17.56370023	1.174464402	2.090351076	0	0	5.346076209	3.832114033	0	0	0.142635659	0	0.007349218	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	85.5816	NO																																										0	0	0	0	0	0	0	0	0	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	19.002	0.497507133	6.410680206	0	3.105156415	1.769499874	1.047597786	1.784947566	6.855834487	3.468726692	5.607348776	0	0.018900977	1.996518444	1.950816072	17.56370023	1.174464402	2.090351076	0	0	5.346076209	3.832114033	0	0	0.142635659	0	0.007349218	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	85.5816
H1080_044_0	2012	4																															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	1419.549201	75.7032134	1260.697957	2770.212398	218.7995943	9.80199931	9.137239982	394.8227315	47.47166551	16.23946278	33.13355936	0	0.104700413	15.16401347	6183.616925	5206.11459	380.6390363	611.8011073	0	0	29.61415035	1368.608142	0	175.2941176	42.79069767	0	17.6381231	65	540.608755	0											4900	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$130 Days 21-45 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$10 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $10 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $10 (16b, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$10 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	65.87650353	0	200	0.2	0.127020456	63.6959723	0.16	0.250847747	0.189793594	0	0.2	0.145955968	0.090864318	10	38.5	10	0	0	0.2	9.871634219	0	0	10	0	0	352.5	0	0											NO	160.1459962	83.87798488	55.92494039	0	169.7872152	0.169787215	0.107832248	54.08707034	0.135829772	0.212953702	0.161122629	0	0.169787215	0.123907287	0.088607584	9.752591141	37.54380253	9.751637021	0	0	0.169787215	8.380386415	0	0	10	0	0	352.5	0	0												18.9446	0.529152749	5.87537151	0	3.095781149	1.664254166	0.985289123	1.779567071	6.448065508	3.458253714	5.338566197	0	0.017776792	1.878931768	0.045659613	4.231092252	1.190886401	0.497171861	0	0	5.028104116	0.955788757	0	0	0.035658915	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	63.9093	0	NO	10.11580834	18.9446	0.529152749	5.87537151	0	3.095781149	1.664254166	0.985289123	1.779567071	6.448065508	3.458253714	5.338566197	0	0.017776792	1.878931768	0.045659613	4.231092252	1.190886401	0.497171861	0	0	5.028104116	0.955788757	0	0	0.035658915	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	63.9093	NO																																										0	0	0	0	0	0	0	0	0	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	18.9446	0.529152749	5.87537151	0	3.095781149	1.664254166	0.985289123	1.779567071	6.448065508	3.458253714	5.338566197	0	0.017776792	1.878931768	0.045659613	4.231092252	1.190886401	0.497171861	0	0	5.028104116	0.955788757	0	0	0.035658915	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	63.9093
H1080_801_0	2012	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	236.4950628	4.7219	40.42112257	2575.825796	8.635926011	9.938034028	10.60334288	22.76715644	71.4584269	23.23169703	50.18851152	0	0.185149406	20.45266544	35.6771332	119.4531323	2.1791	6.156959473	0	0	33.04920097	12.28115467	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.091963919	0.091963919	0.165858037	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073800036	0.073800036	0.133099254	0	0.179757541	0.179757541	0.179757541	0.179757541	0.179757541	0.179757541	0.179757541	0	0.179757541	0.179757541	0.179757541	0.179757541	0.179757541	0.179757541	0	0	0.179757541	0.179757541	0	0	0	0	0	0	0	0												17.4533	0.348476389	5.38002127	0	1.552372825	1.78643656	1.906030844	4.092568059	12.84519111	4.176072734	9.021763423	0	0.033282002	3.676520849	6.413233737	21.47260135	0.391709658	1.106759896	0	0	5.940843102	2.207630165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8049	150	YES	24.56426753	17.4533	0.348476389	5.38002127	0	1.552372825	1.78643656	1.906030844	4.092568059	12.84519111	4.176072734	9.021763423	0	0.033282002	3.676520849	6.413233737	21.47260135	0.391709658	1.106759896	0	0	5.940843102	2.207630165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8049	NO																																										0	0	0	0	0	0	0	0	0	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	17.4533	0.348476389	5.38002127	0	1.552372825	1.78643656	1.906030844	4.092568059	12.84519111	4.176072734	9.021763423	0	0.033282002	3.676520849	6.413233737	21.47260135	0.391709658	1.106759896	0	0	5.940843102	2.207630165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8049
H1080_804_0	2012	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	236.4850037	4.7221	40.41940328	2575.716287	8.635558687	9.93761132	10.60289188	22.76618805	71.45538746	23.23070888	50.18637678	0	0.18514153	20.45119605	35.67561569	119.4480515	2.1782	6.156697591	0	0	33.04779524	12.2806323	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.091963908	0.091963908	0.16585803	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073800881	0.073800881	0.13310079	0	0.179759622	0.179759622	0.179759622	0.179759622	0.179759622	0.179759622	0.179759622	0	0.179759622	0.179759622	0.179759622	0.179759622	0.179759622	0.179759622	0	0	0.179759622	0.179759622	0	0	0	0	0	0	0	0												17.4528	0.348495139	5.379854494	0	1.552324767	1.786381256	1.905971838	4.092441362	12.84479345	4.175943452	9.021484129	0	0.033280972	3.676299275	6.413035198	21.4719366	0.391552409	1.106725633	0	0	5.940659187	2.207561822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8015	150	YES	24.56201173	17.4528	0.348495139	5.379854494	0	1.552324767	1.786381256	1.905971838	4.092441362	12.84479345	4.175943452	9.021484129	0	0.033280972	3.676299275	6.413035198	21.4719366	0.391552409	1.106725633	0	0	5.940659187	2.207561822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8015	NO																																										0	0	0	0	0	0	0	0	0	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	17.4528	0.348495139	5.379854494	0	1.552324767	1.786381256	1.905971838	4.092441362	12.84479345	4.175943452	9.021484129	0	0.033280972	3.676299275	6.413035198	21.4719366	0.391552409	1.106725633	0	0	5.940659187	2.207561822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8015
H1080_807_0	2012	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	234.7956092	4.7152	40.13065636	2566.499634	8.573868243	9.866619311	10.52714726	22.60355164	70.94492661	23.06475404	49.82785685	0	0.183818922	20.30518599	35.4207573	118.5947421	2.1791	6.11271556	0	0	32.8117094	12.19290229	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.089995623	0.089995623	0.163213624	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072443434	0.072443434	0.131381449	0	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0	0	0.180312427	0.180312427	0	0	0	0	0	0	0	0												17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334	150	YES	23.97038783	17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334	NO																																										0	0	0	0	0	0	0	0	0	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	17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334
H1080_808_0	2012	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	234.7956092	4.7152	40.13065636	2566.499634	8.573868243	9.866619311	10.52714726	22.60355164	70.94492661	23.06475404	49.82785685	0	0.183818922	20.30518599	35.4207573	118.5947421	2.1791	6.11271556	0	0	32.8117094	12.19290229	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.089995623	0.089995623	0.163213624	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072443434	0.072443434	0.131381449	0	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0.180312427	0	0	0.180312427	0.180312427	0	0	0	0	0	0	0	0												17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334	150	YES	23.97038783	17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334	NO																																										0	0	0	0	0	0	0	0	0	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	17.0094	0.341585279	5.272423784	0	1.545974991	1.779074073	1.89817547	4.075701253	12.79225189	4.158861777	8.984581796	0	0.033144836	3.661277365	6.386802712	21.38410576	0.392918809	1.102198578	0	0	5.916358952	2.198531802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9334
H1099_001_0	2012	12																															D	D	D	V	T	Coin	Coin	V	V	V	v	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1538.524213	57.70707837	1455.836949	2835.075801	17.10370429	0.021745903	8.278980433	232.443513	478.9037202	3441.815005	791.2757635	0	331.2622394	490.250568	10400.49296	13862.99222	366.4003613	491.5977166	3737.299533	355.9408354	6.381154191	0.917759743	0	386.4020696	572.8967587	39.4299383	37.08377359	0	12000.22516	67.56405475											5000	$200 days 1-6;$0 days 7-90	$200 days 1-6;$0 days 7-90	$0 days 1-14;$25 days 15-20;$75 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: 25"	"9a1: 150,9b: 150"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: 150,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: 25,9c2: 25"	12: $0	"31: $25,32: $25,33: $25,5: $15,9a2: $200,9a3:"	"7a: 10,14a1-16: $0,14b3: $0,14b4: $0,14b5: $0,14b6: $0,14b7: $0,14d: $0,14e: $0"	"7b1: 20,7d1: $25,7f1: $25,16b1: $0,17a1: $0-$15,18a1: $15"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	"7c: $25,7i: $25"	7d2: $25	7g: 25	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	n/a	"16a1: $0,16a2: $0-$45,16a4: $0-$35,16b2: $0-$700,16b3: $0-$35,16b4: $0-$583,16b5: $22-$435,16b6: $25-$700"	17a2: $0	17b3: $0 limited to $100 every year	18a2: $15	18b1: $0 limited to $250 every year	"14c1: $0,14c4: $0"	n/a											0	NO	141.2016597	96.47529629	10.97631375	0	150	0.2	1.42E-05	46.82340273	150	0	49.09320962	0	0	131.7477876	7.892651709	24.08111287	25	25	1.580091169	25	0.2	0	0	24.9999575	0	0	15	0	0	0											YES	128.5198537	87.81051861	9.990493319	0	136.5279849	0.182037313	1.29E-05	42.62198363	136.5279849	0	44.68397986	0	0	120.6047926	7.183785553	21.91830543	22.94646943	22.75466414	1.438177755	22.75466414	0.182037313	0	0	24.9999575	0	0	13.65279849	0	0	0											10000	16.4776	0.42227404	1.21204411	0	0.194594523	0.003958566	0.000107171	0.8256003	5.448646655	0	2.946445857	0	0	4.927214004	6.226242586	25.32110813	0.700632891	0.932178411	0.447908421	0.674942847	1.161608164	0	0	0.805002943	0	0	0.042191441	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7703	0	NO	6.669054067	16.4776	0.42227404	1.21204411	0	0.194594523	0.003958566	0.000107171	0.8256003	5.448646655	0	2.946445857	0	0	4.927214004	6.226242586	25.32110813	0.700632891	0.932178411	0.447908421	0.674942847	1.161608164	0	0	0.805002943	0	0	0.042191441	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7703	NO	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,11c1: 20.0%,11c2: 20.0%"	"4a1: $50,4b: $25"	"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%"	"9c1: 20.0%,9c2: 20.0%"	12: $0	"31: 20.0%,32: 20.0%,33: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,14a1-16: $0,14b3: 20.0%,14b4: 20.0%,14b5: 20.0%,14b6: 20.0%,14b7: 20.0%,14d: 20.0%,14e: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,17a1: 20.0%,18a1: 20.0%"	"7e1: 20.0%,7e2: 20.0%,7h1: 20.0%,7h2: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 20.0%	7g: 20.0%	"152: 20.0%,153: 20.0%"	"9d1: 20.0%,9d2: 20.0%"	n/a	n/a	17a2: 20.0%	n/a	"18a2: 20.0%,18a3: 20.0%"	n/a	"14c1: 20.0%,14c4: 20.0%"	n/a												2.2411	0.0059	0.1415	0.2956	1.4277	0.0323	0	0.1105	0.1955	0.4799	0.1433	0	0	0.2141	0.3446	2.2344	0.0538	0.0635	0.2548	0.0692	0.0233	0	0	0	0.0084	0	0.005	0	0	0											8.3446	0	NO	0.809225136	18.7186	0.428207255	1.353573881	0.295612047	1.622254538	0.036293461	0.000107171	0.936148633	5.644127522	0.479897083	3.089769513	0	0	5.141314776	6.570872819	27.5554886	0.754422212	0.995705085	0.702720651	0.74418081	1.18490816	0	0	0.805002943	0.008418197	0	0.047227056	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1149
H1099_006_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	v	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1155.981312	68.47323684	906.8050066	1969.067781	168.8821472	0.07653114	6.419708136	245.2670053	409.2259096	2975.579594	713.5718286	0	2.764080958	363.8724001	9077.650394	10612.2943	292.5897586	392.4811774	2987.107647	290.7477892	4.708079614	0.447567528	0	92.73421117	0	33.67156785	0	0	12000.12847	67.56351036											6000	$266 days 1-6;$0 days 7-90	$235 days 1-6;$0 days 7-90	$0 days 1-14;$50 days 15-20;$85 days 21-100	6: $0	10a: 175	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 10%,11c2: 0,17b1: $0"	"4a1: 60,4a2: 60,4b: 30"	"9a1: 250,9b: 250"	"8a1: $0,8a2: $0"	"8b1: 25,8b2: 200,8b3: $0,8b4: $0,8b5: $0,8b6: $25"	"9c1: 30,9c2: 30"	12: $0	"31: $30,32: $30,33: $30,5: 15,9a2: $266,9a3:"	"7a: $10,14a1-16: $0,14b3: $0,14b4: $0,14b5: $0,14b6: $0,14b7: $0,14d: $0,14e: $0"	"7b1: 20,7d1: $30,7f1: $30,16b1: $0,17a1: 0-$30,18a1: $30"	"7e1: 30,7e2: 30,7h1: 30,7h2: 30"	"7c: $30,7i: $30"	7d2: $30	7g: $10-$30	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	n/a	"16a1: $0 limited to $150 every year,16a2: $0 limited to $150 every year,16a4: $0 limited to $150 every year"	n/a	17b3: $0 limited to $100 every year	n/a	n/a	"14c1: $0,14c4: $0"	n/a											0	NO	187.7982074	113.3584731	15.19460811	0	175	0.2	0.099034477	56.38686131	250	0	72.49634121	0	0	169.9179992	7.781385112	29.4434919	29.90522985	30	5.38468836	20	0.2	0	0	0	0	0	0	0	0	0											NO	174.5087328	105.3367003	14.11936696	0	162.6161861	0.18584707	0.092026337	52.40041344	232.3088372	0	67.36616291	0	0	158.5205093	7.23073811	27.35993346	27.93033066	27.87706047	5.003642767	18.58470698	0.18584707	0	0	0	0	0	0	0	0	0												16.8107	0.601062069	1.066959388	0	2.288580889	0.014223088	0.590782224	1.071007707	7.922232935	0	4.005883005	0	0	4.806769848	5.469842721	24.19597217	0.681010725	0.911768459	1.245534964	0.450288539	0.874982801	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0076	0	NO	5.535555819	16.8107	0.601062069	1.066959388	0	2.288580889	0.014223088	0.590782224	1.071007707	7.922232935	0	4.005883005	0	0	4.806769848	5.469842721	24.19597217	0.681010725	0.911768459	1.245534964	0.450288539	0.874982801	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0076	NO																																										0	0	0	0	0	0	0	0	0	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	16.8107	0.601062069	1.066959388	0	2.288580889	0.014223088	0.590782224	1.071007707	7.922232935	0	4.005883005	0	0	4.806769848	5.469842721	24.19597217	0.681010725	0.911768459	1.245534964	0.450288539	0.874982801	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0076
H1099_009_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	v	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1326.790893	38.02975382	1231.6599	2458.771577	181.6592131	0.077579028	4.70642708	246.8030222	408.5739419	2888.813713	675.3973138	0	155.8184985	372.9051457	9235.609668	11634.75439	244.7457414	449.7703286	3221.932284	284.3516908	4.193554978	0.461684087	0	106.7506869	380.7456006	26.36771224	24.13528258	0	12001.56748	67.57161233											3400	$200 days 1-10;$0 days 11-90	$175 days 1-10;$0 days 11-90	$0 days 1-14;$75 days 15-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: $0 limited to $100 every year"	"4a1: $50,4a2: $50,4b: 25"	"9a1: $150,9b: $150"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: 150,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: $25,9c2: $25"	12: $0	"31: $25,32: $25,33: $25,5: $15,9a2: $200,9a3:"	"7a: $10,14a1-16: $0,14b2: $0,14b3: $0,14b4: $0,14b5: $0,14b6: $0,14b7: $0,14d: $0,14e: $0"	"7b1: 20,7d1: $25,7f1: $25,16b1: $0,17a1: $0-$15,18a1: $15"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	"7c: $25,7i: $25"	7d2: $25	7g: $10-$25	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	n/a	"16a1: $0 limited to $100 every year,16a2: $0 limited to $100 every year,16a4: $0 limited to $100 every year"	17a2: $0	17b3: $0 limited to $100 every year	18a2: $15	18b1: $0 limited to $250 every year	"14c1: $0,14c4: $0"	n/a											0	NO	167.824463	109.6813914	17.33351187	0	150	0.2	0.197260946	46.51118319	150	0	50.90661742	0	0	138.1830896	7.803313216	23.84453576	25	25	1.236044657	17.5	0.2	0	0	0	0	0	15	0	0	0											NO	140.9309732	92.10519709	14.55585589	0	125.9628401	0.167950453	0.165650326	39.06430978	125.9628401	0	42.74894739	0	0	117.140911	6.552849964	20.02350296	21.2768594	20.99380668	1.037971303	14.69566467	0.167950453	0	0	0	0	0	12.59628401	0	0	0												15.5822	0.291894831	1.493988668	0	1.906859201	0.013029433	0.779621181	0.803432476	4.288761175	0	2.406043686	0	0	3.640204041	5.04329704	19.41404491	0.433951727	0.786865944	0.278689438	0.348228091	0.70430946	0	0	0	0	0	0.025334573	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2407	0	NO	11.06613573	15.5822	0.291894831	1.493988668	0	1.906859201	0.013029433	0.779621181	0.803432476	4.288761175	0	2.406043686	0	0	3.640204041	5.04329704	19.41404491	0.433951727	0.786865944	0.278689438	0.348228091	0.70430946	0	0	0	0	0	0.025334573	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2407	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.5822	0.291894831	1.493988668	0	1.906859201	0.013029433	0.779621181	0.803432476	4.288761175	0	2.406043686	0	0	3.640204041	5.04329704	19.41404491	0.433951727	0.786865944	0.278689438	0.348228091	0.70430946	0	0	0	0	0	0.025334573	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2407
H1099_014_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	v	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	880.5267918	52.15700197	690.7257886	1499.865887	128.6398437	0.058294817	4.85076857	186.8232359	311.7129781	2266.539716	543.5374314	0	2.105438309	277.166589	6914.570588	8465.909524	222.869625	298.9582863	2275.320791	221.4665716	3.586208701	0.340918314	0	0	0	0	0	0	12000	67.56278703											6700	$322 days 1-5;$0 days 6-90	$285 days 1-5;$0 days 6-90	$48 days 1-100	6: $0	10a: $200	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: $0"	"4a1: 65,4a2: 65,4b: 35"	"9a1: 325,9b: 325"	"8a1: $0,8a2: $0"	"8b1: 35,8b2: 275,8b3: $0,8b4: $0,8b5: $0,8b6: $35"	"9c1: 35,9c2: 35"	12: $0	"31: $35,32: $35,33: $35,5: 20%,9a2: $322,9a3:"	"7a: 15,14a1-16: $0,14b3: $0,14b4: $0,14b5: $0,14b6: $0,14b7: $0,14d: $0,14e: 35"	"7b1: 20,7d1: $35,7f1: $35,16b1: $20,17a1: $0-35,18a1: 35"	"7e1: 35,7e2: 35,7h1: 35,7h2: 35"	"7c: $35,7i: $35"	7d2: $35	7g: 15-$35	"152: 20%,153: 20%"	"9d1: 0,9d2: 0"	n/a	n/a	n/a	n/a	n/a	n/a	"14c1: $0,14c4: $0"	n/a											0	NO	208.7981527	122.5627213	48	0	200	0.2	0.199583779	61.38686131	325	0	99.99163705	0	0	205.2969748	11.67207767	34.3000479	34.56866811	35	6.28213642	25	0.2	0	0	0	0	0	0	0	0	0											NO	197.6082084	115.9943201	45.42757625	0	189.2815677	0.189281568	0.188887653	58.10008235	307.5825476	0	94.6328691	0	0	194.848386	11.0465458	32.4618342	32.82374367	33.12427435	5.945463151	23.66019597	0.189281568	0	0	0	0	0	0	0	0	0												14.4999	0.504159665	2.614833203	0	2.02909594	0.011034134	0.916250291	0.904537116	7.989789325	0	4.286375549	0	0	4.500455209	6.365176723	22.90157928	0.609617954	0.825231358	1.12731966	0.436661874	0.678803205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2009	0	NO	4.016208224	14.4999	0.504159665	2.614833203	0	2.02909594	0.011034134	0.916250291	0.904537116	7.989789325	0	4.286375549	0	0	4.500455209	6.365176723	22.90157928	0.609617954	0.825231358	1.12731966	0.436661874	0.678803205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2009	NO																																										0	0	0	0	0	0	0	0	0	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	14.4999	0.504159665	2.614833203	0	2.02909594	0.011034134	0.916250291	0.904537116	7.989789325	0	4.286375549	0	0	4.500455209	6.365176723	22.90157928	0.609617954	0.825231358	1.12731966	0.436661874	0.678803205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2009
H1099_802_0	2012	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	197.9655622	2.764587992	37.4117914	17.5418634	6.520804874	0.024756293	9.501526191	9.220809342	70.70558342	22.67787593	30.24841836	0	0.053659245	38.32367331	56.1741516	262.7413451	1.722858547	4.584244392	46.83695744	3.777826356	5.221819238	0.003517627	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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.088597847	0.088597847	0.155142489	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07414774	0.07414774	0.129839103	0	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0	0.187466111	0.191955764	0.190203092	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0.187466111	0	0	0	0	0	0	0	0												14.6787	0.204987952	4.857513421	0	1.22242993	0.004640966	1.781214164	1.728589268	13.25490075	4.251333207	5.670553355	0	0.01005929	7.356449989	10.6844973	49.25509816	0.322977592	0.859390468	8.780342263	0.708214415	0.978914145	0.000659436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6115	0	NO	24.28507368	14.6787	0.204987952	4.857513421	0	1.22242993	0.004640966	1.781214164	1.728589268	13.25490075	4.251333207	5.670553355	0	0.01005929	7.356449989	10.6844973	49.25509816	0.322977592	0.859390468	8.780342263	0.708214415	0.978914145	0.000659436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6115	NO																																										0	0	0	0	0	0	0	0	0	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	14.6787	0.204987952	4.857513421	0	1.22242993	0.004640966	1.781214164	1.728589268	13.25490075	4.251333207	5.670553355	0	0.01005929	7.356449989	10.6844973	49.25509816	0.322977592	0.859390468	8.780342263	0.708214415	0.978914145	0.000659436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6115
H1099_803_0	2012	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	184.0171556	2.747432156	35.08054061	18.13618435	5.344770566	0.115310967	7.23440325	10.10069641	56.30077679	18.74784226	24.07036547	0	0.134857243	35.53405398	50.72496078	205.505443	2.120666749	3.513862139	35.00757079	4.276926936	5.25278566	0.016384558	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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.088597847	0.088597847	0.155142489	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.077725957	0.077725957	0.13610487	0	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0	0.196512839	0.198860859	0.19831152	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0.196512839	0	0	0	0	0	0	0	0												14.3029	0.213546794	4.774632411	0	1.050316036	0.022660085	1.421653119	1.984916525	11.06382547	3.684191702	4.730135847	0	0.02650118	7.066332509	10.05934408	40.38445797	0.416738243	0.690519024	6.879437111	0.840471053	1.032239821	0.003219776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.648	0	NO	15.27775019	14.3029	0.213546794	4.774632411	0	1.050316036	0.022660085	1.421653119	1.984916525	11.06382547	3.684191702	4.730135847	0	0.02650118	7.066332509	10.05934408	40.38445797	0.416738243	0.690519024	6.879437111	0.840471053	1.032239821	0.003219776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.648	NO																																										0	0	0	0	0	0	0	0	0	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	14.3029	0.213546794	4.774632411	0	1.050316036	0.022660085	1.421653119	1.984916525	11.06382547	3.684191702	4.730135847	0	0.02650118	7.066332509	10.05934408	40.38445797	0.416738243	0.690519024	6.879437111	0.840471053	1.032239821	0.003219776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.648
H1099_804_0	2012	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	164.5234161	2.70604638	32.2165457	17.20688555	0.471500631	0.01521015	6.731130311	8.630817059	51.77048139	16.04478945	21.97772695	0	0.114779629	32.34370745	46.12036336	184.9057192	1.809859026	3.068090604	31.75087366	3.766710988	4.822935911	0.015253099	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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.088597847	0.088597847	0.155142489	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079690178	0.079690178	0.13954439	0	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0	0.201478935	0.203378885	0.202974002	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0.201478935	0	0	0	0	0	0	0	0												13.1109	0.215645317	4.495638209	0	0.094997445	0.003064525	1.356180964	1.738927826	10.43066144	3.232687086	4.428049012	0	0.023125677	6.578027153	9.361234719	37.25460731	0.364648468	0.618155626	6.397132198	0.758912917	0.971719989	0.003073178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4374	0	NO	11.19356461	13.1109	0.215645317	4.495638209	0	0.094997445	0.003064525	1.356180964	1.738927826	10.43066144	3.232687086	4.428049012	0	0.023125677	6.578027153	9.361234719	37.25460731	0.364648468	0.618155626	6.397132198	0.758912917	0.971719989	0.003073178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4374	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0.7377	0.002	0.084	0	1.2378	0.0253	0.001	0.2981	0.1765	0.3872	0.1183	0	0.003	0.2024	0.3033	1.947	0.0452	0.0558	0.2306	0.0591	0.0184	0	0	0	0	0	0	0	0	0											5.9326	0	NO	0.65466189	13.8486	0.217609917	4.579667414	0	1.33281364	0.028395127	1.357195173	2.036982845	10.60716756	3.619838972	4.546357671	0	0.026084766	6.780459657	9.664489364	39.20158053	0.409822891	0.673972506	6.62772194	0.817965018	0.990169432	0.003073178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.37
H1108_001_0	2012	3																															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	741.5977356	40.213721	13678.05692	52.53623153	51.23673797	36.68860674	38.04539857	20.05111584	16.72108258	26.6046506	10.53884862	0	0.026814555	25.46280467	1.668482075	174.2680535	18.24	28.78831281	0	23961.27871	0.429332089	12.16802136	1392.145995	152	4.020578955	65.64851575	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.081136675	0.082122141	0	0	0.2	0.2	0.182359645	0.145358204	0.16	0	0.062695111	0	0.2	0.146220726	0	0.026095528	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.076296289	0.077222964	0	0	0.188068561	0.188068561	0.17148058	0.136686542	0.150454849	0	0.058954897	0	0.188068561	0.137497607	0	0.024387243	0.186907447	0	0	0	0.188068561	0.188411654	0	0	0	0	0	0	0	0												56.5812	3.105422739	0	0	9.636019587	6.899973479	6.524047014	2.740717684	2.515767953	0	0.621316733	0	0.005042975	3.501074718	0	4.249917349	3.409191828	0	0	0	0.080743868	2.292597032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.163	0	NO	6.5275798	56.5812	3.105422739	0	0	9.636019587	6.899973479	6.524047014	2.740717684	2.515767953	0	0.621316733	0	0.005042975	3.501074718	0	4.249917349	3.409191828	0	0	0	0.080743868	2.292597032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.163	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.0387	0.057	0.424	0.0584	1.5173	1.0865	1.1266	0.2877	0.3961	0	0.2338	0	0.0005	0.5513	0.0086	2.0357	0.2131	0.004	0	0	0.005	0.1433	0	0	0.0005	0	0	0	0	0											9.1882	0	NO	0.597547354	57.6198	3.162429799	0.424031174	0.058445716	11.15329339	7.986433392	7.65068561	3.02841733	2.911897161	0	0.855100649	0	0.005572348	4.052348914	0.008621704	6.285667156	3.622266317	0.003963262	0	0	0.08579036	2.435884346	0	0	0.000510402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3512
H1108_002_0	2012	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	486.6095026	22.228164	47.3361338	2725.083894	18.00862735	21.30412829	19.54354804	34.71716313	32.08664268	15.5828911	33.35161279	0	0.051191599	38.26533404	27.54087774	95.68092831	9.143361	9.218774424	0	1109.677409	15.60459994	5.33376189	780.709178	234.6446275	35.35367442	199.4848	0	0	469.8032165	3040.244242											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.080563909	0.081542418	0.178799213	0	0.224	0.224	0.224	0.146541262	0.224	0.224	0.224	0	0.224	0.224	0.221723401	0.223959218	0.234021178	0.224	0	0	0.224	0.222622663	0	0	0	0	0	0	0	0											NO	0.065439362	0.066234172	0.145232606	0	0.181947689	0.181947689	0.181947689	0.119045175	0.181947689	0.181947689	0.181947689	0	0.181947689	0.181947689	0.177780008	0.179572708	0.187640486	0.179605407	0	0	0.181947689	0.181906309	0	0	0	0	0	0	0	0												31.8434	1.472264035	6.874750055	0	3.276628126	3.876236907	3.5559034	4.132910758	5.838090479	2.835271021	6.068248868	0	0.009314193	6.962289094	4.896217452	17.18168342	1.715664705	1.655741736	0	0	2.839220895	0.970244938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0041	150	YES	24.90089273	31.8434	1.472264035	6.874750055	0	3.276628126	3.876236907	3.5559034	4.132910758	5.838090479	2.835271021	6.068248868	0	0.009314193	6.962289094	4.896217452	17.18168342	1.715664705	1.655741736	0	0	2.839220895	0.970244938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0041	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"75% (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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	2.3909	0.1105	0.9353	0.7173	0.4832	0.5717	0.5155	0.4086	0.7063	0	0.7443	0	0.001	0.7788	1.5078	6.011	0.5744	0.5791	0	0	0.9931	0.339	0	0.0709	0.0455	0	0	0	0	0											18.4843	150	YES	4.376769283	34.2343	1.582806028	7.810009482	0.717300289	3.759858536	4.447896392	4.07143829	4.541557339	6.544421124	2.835271021	6.812593261	0	0.010276588	7.741089422	6.403977758	23.19271285	2.290071861	2.234886538	0	0	3.832322649	1.309228173	0	0.070928263	0.04546548	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4884
H1109_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1083.962795	159.4597406	595.5440071	428.3824867	191.0616527	9.075190571	0	387.8088938	399.1889408	3716.844769	2486.443784	55.35343846	0	379.132649	2659.609093	3903.647587	241.7162575	693.0173063	0	0	48.27444146	0	0	0	746.8301253	94.48945624	51.33321421	5.905591015	34.47087211	0											6700	$230/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $105/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$300 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$40 per visit	20% per visit	$0 to 300 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness/Nursing Hotline	0											0	NO	166.2566679	98.56078618	63.87227671	0	175	0.03	0.03	63.5	300	4	20.59255098	40	0.2	40	15	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	151.8905821	90.04423924	58.35313199	0	159.8784109	0.027407728	0	58.01302337	274.0772758	3.654363677	18.81316758	36.54363677	0	36.54363677	13.70386379	36.54363677	36.54363677	18.27181838	0	0	0.091359092	0	0	0	0	0	0	0	0	0												13.7203	1.196535919	2.895988171	0	2.545552784	0.248730351	0	1.874830535	9.117384784	1.131891877	3.898156964	0.168567996	0	1.154573818	3.037243395	11.88778996	0.73609926	1.055223863	0	0	4.410309135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0792	0	NO	6.004951652	13.7203	1.196535919	2.895988171	0	2.545552784	0.248730351	0	1.874830535	9.117384784	1.131891877	3.898156964	0.168567996	0	1.154573818	3.037243395	11.88778996	0.73609926	1.055223863	0	0	4.410309135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0792	NO																																																																																		0		NO		13.7203	1.196535919	2.895988171	0	2.545552784	0.248730351	0	1.874830535	9.117384784	1.131891877	3.898156964	0.168567996	0	1.154573818	3.037243395	11.88778996	0.73609926	1.055223863	0	0	4.410309135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0792
H1109_003_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1682.123119	112.9758221	1089.063363	1336.215739	235.6374686	17.40993214	0	361.5093352	386.0858754	4092.314831	2961.446892	77.35481162	0.033173805	692.1231356	2833.016419	7106.304746	387.892068	1213.96259	0	0	78.75073328	0.003107763	0	0	1141.449197	130.2545364	58.51847937	12.91825233	65.54865638	0											6700	$195/day 1-7; unlimited additional days	$195/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$200 per procedure	$0 to $35 per visit	$0 to $35 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$35 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness/Nursing Hotline	0											0	NO	140.9567402	93.75294295	51.87372562	0	150	0.03	0.03	63.5	200	3.5	18.53068994	35	0.2	35	10	35	35	17.5	35	35	0.1	0	0	0	0	0	0	0	0	0											NO	133.4153556	88.73702817	49.09840808	0	141.9747883	0.028394958	0	60.10266037	189.2997177	3.31274506	17.53927187	33.1274506	0.189299718	33.1274506	9.464985885	33.1274506	33.1274506	16.5637253	0	0	0.094649859	0	0	0	0	0	0	0	0	0												18.7018	0.835428225	4.455939785	0	2.787881643	0.494354286	0	1.810639399	6.090495602	1.129732978	4.328468513	0.213547308	0.006279792	1.910689582	2.234538368	19.61781328	1.070822943	1.675645239	0	0	7.453745789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8178	0	NO	4.650448148	18.7018	0.835428225	4.455939785	0	2.787881643	0.494354286	0	1.810639399	6.090495602	1.129732978	4.328468513	0.213547308	0.006279792	1.910689582	2.234538368	19.61781328	1.070822943	1.675645239	0	0	7.453745789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8178	NO																																																																																		0		NO		18.7018	0.835428225	4.455939785	0	2.787881643	0.494354286	0	1.810639399	6.090495602	1.129732978	4.328468513	0.213547308	0.006279792	1.910689582	2.234538368	19.61781328	1.070822943	1.675645239	0	0	7.453745789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8178
H1109_801_0	2012	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	0	0	0	0	0	0	0											0	YES	302.3621726	6.713225547	34.55458801	7.878135978	7.755494053	10.64436965	0	13.721023	39.60526102	21.62318352	59.70703401	0.682457419	0.059601932	26.36759581	28.37724749	126.375742	3.044945404	9.023223471	0	0	71.11435825	0.000263156	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	NO	0.080615313	0.080615313	0.174031735	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065820231	0.065820231	0.142092222	0	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0.182889964	0	0	0	0	0	0	0	0												19.9015	0.441866056	4.909938192	0	1.418402026	1.946748378	0	2.509437398	7.243404751	3.95466325	10.91981728	0.124814613	0.010900595	4.822368641	5.189913763	23.11285488	0.556889954	1.650257013	0	0	13.0061024	4.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.72	0	NO	22.86463287	19.9015	0.441866056	4.909938192	0	1.418402026	1.946748378	0	2.509437398	7.243404751	3.95466325	10.91981728	0.124814613	0.010900595	4.822368641	5.189913763	23.11285488	0.556889954	1.650257013	0	0	13.0061024	4.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.72	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		19.9015	0.441866056	4.909938192	0	1.418402026	1.946748378	0	2.509437398	7.243404751	3.95466325	10.91981728	0.124814613	0.010900595	4.822368641	5.189913763	23.11285488	0.556889954	1.650257013	0	0	13.0061024	4.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.72
H1109_802_0	2012	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	0	0	0	0	0	0	0											0	YES	273.0753779	5.134100064	28.51833115	7.804498982	7.782081731	11.85512704	0	15.72391434	37.78517105	20.54171493	53.75267419	0.825688762	0.047329475	25.1615984	30.66581532	134.5590985	2.908070314	9.150634681	0	0	57.94285883	0.00020897	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	NO	0.080615313	0.080615313	0.174031735	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066051968	0.066051968	0.142592493	0	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0.183533874	0	0	0	0	0	0	0	0												18.0372	0.339117411	4.066499943	0	1.428275605	2.175817388	0	2.885870908	6.934858809	3.770100512	9.865436512	0.151541857	0.008686562	4.618005622	5.628215874	24.69615258	0.53372941	1.679451429	0	0	10.63447733	3.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4534	0	NO	21.48684177	18.0372	0.339117411	4.066499943	0	1.428275605	2.175817388	0	2.885870908	6.934858809	3.770100512	9.865436512	0.151541857	0.008686562	4.618005622	5.628215874	24.69615258	0.53372941	1.679451429	0	0	10.63447733	3.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4534	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.0372	0.339117411	4.066499943	0	1.428275605	2.175817388	0	2.885870908	6.934858809	3.770100512	9.865436512	0.151541857	0.008686562	4.618005622	5.628215874	24.69615258	0.53372941	1.679451429	0	0	10.63447733	3.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4534
H1110_001_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1098.927846	202.7039961	745.4572102	684.8867481	186.0391093	9.914341727	0	282.2493312	322.0789977	3093.059838	2186.226843	37.76343426	0.034113649	640.5651658	1916.531786	4978.847297	328.5240427	861.1600815	0	0	51.43083777	0.003488694	0	0	1002.288715	116.7607125	54.92267288	12.880622	73.05528761	0											6700	$230/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness/Nursing Hotline	0											0	NO	166.2566679	98.56078618	71.93854446	0	200	0.03	0.03	63.5	250	4.5	22.65441202	45	0.2	45	20	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	150.1323605	89.00192494	64.96162605	0	180.6031149	0.027090467	0	57.34148898	225.7538936	4.063570085	20.45728688	40.63570085	0.180603115	40.63570085	18.06031149	40.63570085	36.12062298	20.31785042	0	0	0.090301557	0	0	0	0	0	0	0	0	0												13.7487	1.503420487	4.035509377	0	2.799936886	0.26858415	0	1.348716409	6.059215649	1.047405452	3.727022476	0.127878635	0.006161031	2.169151204	2.884430086	16.85991245	0.988874424	1.458076811	0	0	4.644284751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6773	0	NO	7.337779988	13.7487	1.503420487	4.035509377	0	2.799936886	0.26858415	0	1.348716409	6.059215649	1.047405452	3.727022476	0.127878635	0.006161031	2.169151204	2.884430086	16.85991245	0.988874424	1.458076811	0	0	4.644284751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6773	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	$200 copay	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$65 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; 20% 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 ded; 35% coinsurance; $10000 max OOP		Not Covered	0	$0 ded; 35% coinsurance; $10000 max OOP	$100.00 Every 2 Years	$0 ded; 35% coinsurance; $10000 max OOP	Not Covered	Fitness/Nursing Hotline	0											10000	6.4615	0.4794	0.7966	0.2298	0.302	0.338	0	0.1489	1.1223	0.7391	1.4654	0.0268	0.0007	0.7491	0.8108	3.5505	0.1413	0.3181	0	0	1.7532	0	0	0	0.2043	0	0.0101	0	0	0											19.6476	0	NO	8.59533068	20.2102	1.982831205	4.832107128	0.229792475	3.10191877	0.606539882	0	1.4976158	7.181533868	1.786520871	5.192392507	0.154648642	0.006825518	2.918219629	3.695262841	20.41041198	1.130149657	1.776197155	0	0	6.397436593	0	0	0	0.204253045	0	0.010083192	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3249
H1110_801_0	2012	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	262.302354	4.196592375	24.71864264	26.14219335	10.26635778	16.27999948	0	16.92599585	36.48970382	22.54777355	44.71900092	0.398648405	0.034815674	24.30549299	33.59023939	118.6803139	2.624910951	10.69338996	0	0	68.04150295	0.000153719																			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	NO	0.082349835	0.082349835	0.184267781	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067277943	0.067277943	0.150542587	0	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0.183002907	0	0	0	0	0	0	0	0												17.6472	0.282338102	3.721208416	0	1.878773317	2.979287228	0	3.097506442	6.677721869	4.126308103	8.18370716	0.072953817	0.00637137	4.44797587	6.147111451	21.71884243	0.480366334	1.956921446	0	0	12.45179283	2.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8764	0	NO	24.97515775	17.6472	0.282338102	3.721208416	0	1.878773317	2.979287228	0	3.097506442	6.677721869	4.126308103	8.18370716	0.072953817	0.00637137	4.44797587	6.147111451	21.71884243	0.480366334	1.956921446	0	0	12.45179283	2.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8764	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	3.0827	0.0493	0.6501	0	0.3282	0.5204	0	0.5411	1.1665	0.7208	1.4296	0.0127	0.0011	0.777	1.0738	3.794	0.0839	0.3419	0	0	2.1752	0	0	0	0	0	0	0	0	0											16.7485	0	NO	2.355849451	20.7299	0.331659188	4.371258965	0	2.206972517	3.49973303	0	3.638603725	7.844239914	4.847124716	9.6133028	0.085697975	0.007484372	5.22498399	7.220938209	25.51286412	0.56428058	2.298772188	0	0	14.62697192	3.30E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.6248
H1110_802_0	2012	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	289.1639955	8.036465132	30.42862531	7.905572445	9.501147257	11.86492939	0	15.54416262	34.4517985	21.14063709	46.96305961	0.679711418	0.059362112	22.93210231	26.72077079	136.3070392	3.816774164	7.718681063	0	0	55.668553	0.000262097																			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	NO	0.081281317	0.081281317	0.177853263	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066324489	0.066324489	0.145125932	0	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0.182781064	0	0	0	0	0	0	0	0												19.1787	0.533014446	4.415982596	0	1.736629809	2.168684424	0	2.841178589	6.297136402	3.86410815	8.583958025	0.124238377	0.01085027	4.191554069	4.884050927	24.91434573	0.697634044	1.410828741	0	0	10.17515737	4.79E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0281	0	NO	25.18055204	19.1787	0.533014446	4.415982596	0	1.736629809	2.168684424	0	2.841178589	6.297136402	3.86410815	8.583958025	0.124238377	0.01085027	4.191554069	4.884050927	24.91434573	0.697634044	1.410828741	0	0	10.17515737	4.79E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0281	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	3.3518	0.0932	0.7718	0	0.3035	0.379	0	0.4965	1.1005	0.6753	1.5002	0.0217	0.0019	0.7325	0.8536	4.3542	0.1219	0.2466	0	0	1.7783	0	0	0	0	0	0	0	0	0											16.7825	0	NO	2.375223824	22.5304	0.626167739	5.187750279	0	2.040135254	2.547698725	0	3.337722625	7.397667545	4.539426435	10.08414994	0.145951135	0.012746538	4.92409907	5.737621472	29.26854923	0.819557399	1.657394936	0	0	11.9534383	5.63E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8106
H1110_805_0	2012	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	281.2586952	5.174128931	34.3454332	8.952502668	8.382493488	11.62248209	0	14.56011918	36.03021228	17.47203962	48.81032752	0.817019879	0.071353848	23.9771509	24.18005563	120.5534715	2.763019915	7.659056433	0	0	60.52219544	0.000315043																			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	NO	0.083328632	0.083328632	0.189345437	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062700539	0.062700539	0.14247277	0	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0	0	0	0	0	0	0	0												17.6351	0.324420674	4.893289006	0	1.412857194	1.958952602	0	2.454087099	6.072840341	2.944887092	8.226910343	0.137707523	0.012026588	4.04131422	4.075513521	20.31911385	0.465703024	1.290922921	0	0	10.2009288	5.31E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4666	0	NO	24.42912669	17.6351	0.324420674	4.893289006	0	1.412857194	1.958952602	0	2.454087099	6.072840341	2.944887092	8.226910343	0.137707523	0.012026588	4.04131422	4.075513521	20.31911385	0.465703024	1.290922921	0	0	10.2009288	5.31E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4666	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	3.1789	0.0585	0.8821	0	0.2547	0.3531	0	0.4424	1.0947	0.5309	1.483	0.0248	0.0022	0.7285	0.7347	3.6628	0.0839	0.2327	0	0	1.8388	0	0	0	0	0	0	0	0	0											15.5867	0	NO	2.304343592	20.814	0.382901613	5.775366386	0	1.667542615	2.312078644	0	2.896467411	7.167546804	3.475740325	9.709915232	0.16253105	0.014194533	4.769812343	4.810176502	23.98189172	0.549651898	1.523628144	0	0	12.03977554	6.27E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0533
H1110_806_0	2012	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	281.2586952	5.174128931	34.3454332	8.952502668	8.382493488	11.62248209	0	14.56011918	36.03021228	17.47203962	48.81032752	0.817019879	0.071353848	23.9771509	24.18005563	120.5534715	2.763019915	7.659056433	0	0	60.52219544	0.000315043																			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	NO	0.083328632	0.083328632	0.189345437	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062700539	0.062700539	0.14247277	0	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0.168548558	0	0	0	0	0	0	0	0												17.6351	0.324420674	4.893289006	0	1.412857194	1.958952602	0	2.454087099	6.072840341	2.944887092	8.226910343	0.137707523	0.012026588	4.04131422	4.075513521	20.31911385	0.465703024	1.290922921	0	0	10.2009288	5.31E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4666	0	NO	24.42912669	17.6351	0.324420674	4.893289006	0	1.412857194	1.958952602	0	2.454087099	6.072840341	2.944887092	8.226910343	0.137707523	0.012026588	4.04131422	4.075513521	20.31911385	0.465703024	1.290922921	0	0	10.2009288	5.31E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4666	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	3.1789	0.0585	0.8821	0	0.2547	0.3531	0	0.4424	1.0947	0.5309	1.483	0.0248	0.0022	0.7285	0.7347	3.6628	0.0839	0.2327	0	0	1.8388	0	0	0	0	0	0	0	0	0											15.5867	0	NO	2.304343592	20.814	0.382901613	5.775366386	0	1.667542615	2.312078644	0	2.896467411	7.167546804	3.475740325	9.709915232	0.16253105	0.014194533	4.769812343	4.810176502	23.98189172	0.549651898	1.523628144	0	0	12.03977554	6.27E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0533
H1111_002_0	2012	6																															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	1402.325018	109.9720501	454.8944929	652.6656139	149.3841166	8.847135745	13.30731283	365.7614465	52.61410846	17.93039864	27.69498337	0	0.122652684	22.85698749	5519.174125	3938.662798	549.5783874	591.2205764	0	0	18.41296732	741.686496	0	0	45.6873857	238.9213636	8.668184666	0	105.4451757	0											4250	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	65.98031366	0	200	0.2	0.097814329	64.09708266	0.16	0.225382317	0.187582865	0	0.2	0.14626	6.50639587	34.22383513	38.5	35	0	0	0.2	33.85750221	0	0	35	30	35	0	0	0											YES	150.9473905	79.06012789	51.90089791	0	157.322374	0.157322374	0.076941912	50.43716945	0.125857899	0.177288406	0.147554908	0	0.157322374	0.115049852	6.271488425	32.99223174	37.10999288	33.73635716	0	0	0.157322374	26.63271313	0	0	35	30	35	0	0	0											7000	17.6398	0.724533695	1.96745272	0	1.958455321	1.391852399	1.023890099	1.537331005	6.621901159	3.17885179	4.086530724	0	0.019296011	2.629693036	2.884453054	10.82877298	1.699570837	1.66213571	0	0	2.896771732	1.64609364	0	0	0.133254875	0.597303409	0.025282205	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1532	0	NO	13.47490576	17.6398	0.724533695	1.96745272	0	1.958455321	1.391852399	1.023890099	1.537331005	6.621901159	3.17885179	4.086530724	0	0.019296011	2.629693036	2.884453054	10.82877298	1.699570837	1.66213571	0	0	2.896771732	1.64609364	0	0	0.133254875	0.597303409	0.025282205	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1532	NO	"$325 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.7137	0.0491	0.0864	0.2585	0.2754	0	0.4415	0.2162	1.3966	0.447	0.8369	0	0.0027	0.5538	0.7095	1.6446	0.2248	0.2501	0	0	0.5017	0.2424	0	0	0.0201	0	0.0038	0	0	0											8.8748	0	NO	1.867831667	18.3534	0.773651992	2.053843321	0.258525806	2.23382818	1.391852399	1.465439788	1.753496436	8.018531327	3.625821142	4.923422067	0	0.022009169	3.183519611	3.593929788	12.47336237	1.924329919	1.912262611	0	0	3.398510088	1.888513103	0	0	0.153354772	0.597303409	0.029095722	0	0	0	0	0	0	0	0	0	0	0	0	0	74.028
H1111_004_0	2012	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	244.7059852	21.982237	29.65844853	1994.618031	12.27422514	21.0749101	14.71930171	27.10799885	43.52806016	16.96159553	34.50550915	0	0.018794213	32.08757894	29.6103665	62.62102354	9.496872	4.891194874	0	808.0739602	11.86215513	6.208529519	678.6909774	318.3127623	37.04136797	203.8630781	0	0	474.851444	2933.753474											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.077344574	0.078283982	0.201014899	0	0.224	0.224	0.224	0.146590994	0.224	0.224	0.224	0	0.224	0.224	0.220938674	0.223693516	0.237019461	0.224	0	0	0.224	0.22285763	0	0	0	0	0	0	0	0											NO	0.064626016	0.065410948	0.167959967	0	0.187165393	0.187165393	0.187165393	0.122499392	0.187165393	0.187165393	0.187165393	0	0.187165393	0.187165393	0.184607472	0.186909308	0.198043931	0.187165393	0	0	0.187165393	0.186993589	0	0	0	0	0	0	0	0												15.8144	1.437878954	4.981432042	0	2.297310173	3.944493831	2.754943889	3.320713387	8.146946485	3.174623693	6.45823718	0	0.003517626	6.005684322	5.466294912	11.70445215	1.880797861	0.915462411	0	0	2.220184926	1.16095522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6883	150	YES	16.07019231	15.8144	1.437878954	4.981432042	0	2.297310173	3.944493831	2.754943889	3.320713387	8.146946485	3.174623693	6.45823718	0	0.003517626	6.005684322	5.466294912	11.70445215	1.880797861	0.915462411	0	0	2.220184926	1.16095522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6883	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												2.2705	0.204	0.934	0.5111	0.5375	0.9229	0.6306	0.516	1.5669	0	1.2614	0	0.0006	1.0686	1.665	4.0193	0.6096	0.314	0	0	0.7615	0.3958	0	0	0.0383	0	0	0	0	0											18.2276	150	YES	0	18.0848	1.641837854	5.915427382	0.511147672	2.834841319	4.86743768	3.385516509	3.836712742	9.713820802	3.174623693	7.719596619	0	0.004096472	7.074331523	7.131339623	15.72375343	2.490441799	1.229448669	0	0	2.981666283	1.556738461	0	0	0.038298845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9159
H1111_006_0	2012	5																															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	1437.172648	139.5655136	553.9201803	1045.356804	194.3433039	9.819120904	16.71516202	458.7237646	60.85443489	23.71256744	38.86367426	0	0.428051146	29.37122757	6069.606884	5010.008527	697.3456324	1099.247491	0	0	18.05079989	830.9055877	0	0	42.79069767	152.8571429	17.6381231	0	540.608755	0											3900	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	64.24350242	0	200	0.2	0.100137452	63.57143652	0.16	0.206457709	0.18197831	0	0.2	0.146074479	3.510987889	34.18198357	38.5	35	0	0	0.2	34.18971878	0	0	35	30	35	0	0	0											NO	140.1332362	79.39012173	48.1569419	0	149.9200389	0.149920039	0.075063053	47.67208109	0.119936031	0.154760739	0.136410977	0	0.149920039	0.109497458	3.360426281	32.72034911	36.84900543	33.49909585	0	0	0.149920039	25.62861984	0	0	35	30	35	0	0	0												16.783	0.923343593	2.222925162	0	2.427996307	1.472082988	1.2546911	1.822359709	7.298639396	3.669774464	5.301431762	0	0.064173444	3.216074754	1.69970554	13.660769	2.141374416	3.068649756	0	0	2.706176621	1.774580286	0	0	0.124806202	0.382142857	0.051444526	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0661	0	NO	17.93415163	16.783	0.923343593	2.222925162	0	2.427996307	1.472082988	1.2546911	1.822359709	7.298639396	3.669774464	5.301431762	0	0.064173444	3.216074754	1.69970554	13.660769	2.141374416	3.068649756	0	0	2.706176621	1.774580286	0	0	0.124806202	0.382142857	0.051444526	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0661	NO																																										0	0	0	0	0	0	0	0	0	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	16.783	0.923343593	2.222925162	0	2.427996307	1.472082988	1.2546911	1.822359709	7.298639396	3.669774464	5.301431762	0	0.064173444	3.216074754	1.69970554	13.660769	2.141374416	3.068649756	0	0	2.706176621	1.774580286	0	0	0.124806202	0.382142857	0.051444526	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0661
H1111_801_0	2012	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	297.1418097	8.6853	15.87589745	818.7005905	7.227555163	10.14747504	17.44366005	17.24552818	68.96829082	23.50375182	36.30348823	0	0.160777142	29.94512635	36.28301266	86.11252241	4.0691	6.22678105	0	0	23.59695954	8.445063211	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080513404	0.080513404	0.179341012	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066299015	0.066299015	0.147678918	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0	0.184453501	0.184453501	0	0	0	0	0	0	0	0												19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	150	YES	19.70660251	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	NO																																										0	0	0	0	0	0	0	0	0	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	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159
H1111_804_0	2012	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	297.1418097	8.6853	15.87589745	818.7005905	7.227555163	10.14747504	17.44366005	17.24552818	68.96829082	23.50375182	36.30348823	0	0.160777142	29.94512635	36.28301266	86.11252241	4.0691	6.22678105	0	0	23.59695954	8.445063211	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080513404	0.080513404	0.179341012	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066299015	0.066299015	0.147678918	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0	0.184453501	0.184453501	0	0	0	0	0	0	0	0												19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	150	YES	19.70660251	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	NO																																										0	0	0	0	0	0	0	0	0	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	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159
H1111_805_0	2012	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	297.1418097	8.6853	15.87589745	818.7005905	7.227555163	10.14747504	17.44366005	17.24552818	68.96829082	23.50375182	36.30348823	0	0.160777142	29.94512635	36.28301266	86.11252241	4.0691	6.22678105	0	0	23.59695954	8.445063211	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080513404	0.080513404	0.179341012	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066299015	0.066299015	0.147678918	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0	0.184453501	0.184453501	0	0	0	0	0	0	0	0												19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	150	YES	19.70660251	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	NO																																										0	0	0	0	0	0	0	0	0	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	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159
H1111_807_0	2012	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	297.1418097	8.6853	15.87589745	818.7005905	7.227555163	10.14747504	17.44366005	17.24552818	68.96829082	23.50375182	36.30348823	0	0.160777142	29.94512635	36.28301266	86.11252241	4.0691	6.22678105	0	0	23.59695954	8.445063211	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080513404	0.080513404	0.179341012	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066299015	0.066299015	0.147678918	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0.184453501	0	0	0.184453501	0.184453501	0	0	0	0	0	0	0	0												19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	150	YES	19.70660251	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159	NO																																										0	0	0	0	0	0	0	0	0	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	19.7002	0.575826834	2.34453536	0	1.333147856	1.8717373	3.217544171	3.180998054	12.72144272	4.335349318	6.696305514	0	0.029655907	5.523483403	6.692528723	15.88375627	0.750559742	1.148551566	0	0	4.352541807	1.557721478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9159
H1112_006_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1650.950139	381.5459211	731.6558666	671.6275701	18.2715335	12.13801211	11.31656458	38.94312087	35.734816	3.240286596	17.38879273	1.75248093	0.001523541	11.7011877	11160.34871	120.775593	2.774780866	1.596483746	24.2914824	36.34288675	15.1483255	0.014847808	1210	777	508.8	305.28	18	13.71428571	4355.43668	2074.55139											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	159.2312255	58.01040237	72.48986816	0	0.193870885	0.179909283	0.083017854	0.196450255	0.164791288	0.047605239	0.162258142	0.2	0.2	0.173736135	0	0.093402619	0.266746536	0.131606551	0.163393419	0.083082151	0.2	0.179623532	0	0	0	0	0	0	0	0											NO	155.4658471	56.63861667	70.7756831	0	0.189286375	0.175654926	0.081054711	0.191804749	0.160894429	0.046479507	0.158421185	0.195270553	0.195270553	0.169627756	0	0.091193905	0.260438718	0.12849442	0.159529616	0.081117488	0.195270553	0.175375932	0	0	0	0	0	0	0	0												21.3889	1.800852764	4.315286979	0	3.458552335	2.132101616	0.917260873	7.469475522	5.749532817	0.150606923	2.754753157	0.34220792	0.000297503	1.984846209	0	11.01399799	0.722660371	0.205139253	3.875210865	2.948043684	2.958021893	0.002603948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1903	0	NO	1.796887375	21.3889	1.800852764	4.315286979	0	3.458552335	2.132101616	0.917260873	7.469475522	5.749532817	0.150606923	2.754753157	0.34220792	0.000297503	1.984846209	0	11.01399799	0.722660371	0.205139253	3.875210865	2.948043684	2.958021893	0.002603948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1903	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	NO	0	21.3889	1.800852764	4.315286979	0	3.458552335	2.132101616	0.917260873	7.469475522	5.749532817	0.150606923	2.754753157	0.34220792	0.000297503	1.984846209	0	11.01399799	0.722660371	0.205139253	3.875210865	2.948043684	2.958021893	0.002603948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1903
H1112_027_0	2012	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	1408.638417	86.35481891	453.4706696	637.068506	490.5107417	6.101493424	9.106638508	534.8819935	282.8831965	2441.764835	1071.883371	7.316455392	5.66E-05	805.1600164	9507.406188	18333.88797	80.82604039	324.5060751	3202.746405	6104.057014	21.58418413	0.069469547	0	333.3333333	252	0	18	13.71428571	4355.43668	2039.518501											4000	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $25.00 and $150.00 , (5) $200.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $25.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $15.00 and $25.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	129.2728511	97.14657179	89.83237016	0	43.14087031	0.184775657	0.062396278	64.12507086	107.9202536	0.165591448	13.26469212	34.38697334	0.2	14.34492534	4.45544049	4.249947886	22.44147781	6.999386325	5.444433298	4.369388281	0.2	0	0	0	0	0	0	0	0	0											YES	125.5947053	94.38250141	87.27640767	0	41.91340135	0.179518313	0.060620943	62.3005473	104.8496442	0.160879945	12.88727743	33.40857531	0.194309484	13.93677524	4.328671723	4.129025914	21.80295992	6.800235742	5.289525137	4.245067922	0.194309484	0	0	0	0	0	0	0	0	0											4000	14.7431	0.679198651	3.298107586	0	1.713247798	1.095329809	0.552053014	2.776953411	2.471683543	0.032735916	1.151138198	0.020369363	1.10E-05	0.935111182	3.429536694	6.308424877	0.14685391	0.183893151	1.411750635	2.159344719	4.194011691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3029	0	NO	1.385304417	14.7431	0.679198651	3.298107586	0	1.713247798	1.095329809	0.552053014	2.776953411	2.471683543	0.032735916	1.151138198	0.020369363	1.10E-05	0.935111182	3.429536694	6.308424877	0.14685391	0.183893151	1.411750635	2.159344719	4.194011691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3029	YES	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	Same as in-network	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											4000	0.2608	0	0.0109	0.0066	0.0311	0.0447	0.0667	0	0.1308	0.0009	0.1085	0	0	0.0233	0	0.2487	0	0.003	0.0535	0.0635	0.0378	0.0002	0	0	0	0	0	0	0	0											1.0909	0	NO	0.031947207	15.0039	0.679198651	3.309035722	0.006582716	1.744344318	1.140009998	0.618739365	2.776953411	2.602483286	0.033597815	1.259641892	0.020369363	1.10E-05	0.958421942	3.429536694	6.557109614	0.14685391	0.186843185	1.465236546	2.222800396	4.231816934	0.000229675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3938
H1170_002_0	2012	7																															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	1341.80995	37.15740273	927.2702733	557.7655831	298.3603965	6.767893635	0.464282034	275.2069691	234.6233963	439.0915557	776.9361045	0	11.07606131	310.9401603	4478.507435	6095.728789	280.7282578	420.4880654	3610.533856	0	955.9642926	0.558934245	0	0	60.37746059	0	56.28620524	0	20.67095213	0											3400	$175 per day;day 1-8	$175 per day;day 1-8	$50 per day;day 11-100	$0 per visit	$200 per trip	20% coinsuarance; 0% diabetic monitoring supplies	20% coinsuarance	$65 per visit	$175 per visit	$0 - 50 per visit	$0 - 50 per visit	$50 per visit	$0 per visit	$30 - $50 per visit	$15 per visit; $0 per visit for preventive services; $30 for urgent care visit in KP medical centers	$30 per visit; 20% coinsurance for Medicare covered chiropractic services	$15 group therapy;  $30 individual therapy per visit	$30 per visit	"$0 for mammography and low tech radiology procedures;  $150 for high tech radiology such as MRI, CT, PET in non KP medical offices; $100 for high tech radiology performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispenses through KP outpatient pharmacy - $10 Generic; $45 Brand; Part B drug dispensed through community pharmacy - $20 Generic; $ 50 Brand	20% coinsuarance for other Medicare Part B; $0 blood			$0 per visit		$30 per visit		$0 - 75 copay (varies by classes)												0	NO	131.6785902	131.6785902	30.13329611	0	200	0.149270673	0.2	65	175	5.18341903	5.404338722	50	0	34.17028671	13.42939457	30	27.75	30	11.41467618	0	1.77325	0.2	0	0	0	0	30	0	7.5	0											NO	118.1094795	118.1094795	15.4909452	0	189.7984021	0.141656677	0.189798402	61.68448069	166.0736019	4.919023247	5.12867427	47.44960053	0	32.42732909	12.74438816	28.46976032	26.3345283	28.46976032	10.8324365	0	1.682800083	0.189798402	0	0	0	0	28.46976032	0	7.11744008	0												13.2067	0.365720125	1.197024415	0	4.71902721	0.958717319	0.088119988	1.414666581	3.247062709	0.179991798	0.332054351	0	0	0.840246575	4.756319759	14.4619948	0.616070521	0.997599537	3.259239894	0	0.134058066	0.106084827	0	0	0	0	0.133537898	0	0.012260355	0	0	0	0	0	0	0	0	0	0	0	51.0265	0	NO	4.639535352	13.2067	0.365720125	1.197024415	0	4.71902721	0.958717319	0.088119988	1.414666581	3.247062709	0.179991798	0.332054351	0	0	0.840246575	4.756319759	14.4619948	0.616070521	0.997599537	3.259239894	0	0.134058066	0.106084827	0	0	0	0	0.133537898	0	0.012260355	0	0	0	0	0	0	0	0	0	0	0	51.0265	NO																																																																																		0	0	NO	0	13.2067	0.365720125	1.197024415	0	4.71902721	0.958717319	0.088119988	1.414666581	3.247062709	0.179991798	0.332054351	0	0	0.840246575	4.756319759	14.4619948	0.616070521	0.997599537	3.259239894	0	0.134058066	0.106084827	0	0	0	0	0.133537898	0	0.012260355	0	0	0	0	0	0	0	0	0	0	0	51.0265
H1170_008_0	2012	7																															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	1851.67362	66.75640739	1282.432931	1288.308262	638.1625504	17.97374516	1.175819402	432.0498378	278.3519247	465.7290137	1083.752508	0	20.73173272	323.0730112	6154.930283	7414.439613	549.1086194	692.7701762	4825.686299	0	1154.936449	0.558934245	0	0	128.713123	0	77.24957985	0	24.05953293	0											2700	$120 per day;day 1-8	$120 per day;day 1-8	$50 per day;day 21-100	$0 per visit	$100 per trip	0% coinsuarance; 0% diabetic monitoring supplies	0% coinsuarance	$50 per visit	$75 per visit	$0 - 3 per visit	$0 - 3 per visit	$3 per visit	$0 per visit	$3 per visit	$0 per visit; $0 per visit for preventive services; $3 for urgent care visit in KP medical centers	$3 per visit	$0 group therapy;  $3 individual therapy per visit	$3 per visit	"$0 for mammography and low tech radiology procedures;  $25 for high tech radiology such as MRI, CT, PET in non KP medical offices; $3 for high tech radiology performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispense through KP outpatient pharmacy - $11 Generic; $38 Brand; Part B drug dispensed through community pharmacy - $21 Generic; $ 48 Brand	0% coinsuarance for other Medicare Part B; $0 blood			$0 per visit		$3 per visit		$0 - 75 copay (varies by classes)												0	NO	90.29389042	90.29389042	18.59604024	0	100	0	0	50	75	0.254009874	0.38404006	3	0	3	0.005330767	3	2.55	3	0.505662928	0	1.65215	0	0	0	0	0	3	0	7.5	0											NO	85.9492475	85.9492475	9.327425399	0	96.18327826	0	0	48.09163913	72.1374587	0.244315024	0.36938232	2.885498348	0	2.885498348	0.005127306	2.885498348	2.452673596	2.885498348	0.486363181	0	1.589092032	0	0	0	0	0	2.885498348	0	7.21374587	0												13.2625	0.478138582	0.996816458	0	5.11504718	0	0	1.73149874	1.673300039	0.00948205	0.033359918	0	0	0.077685553	0.002629851	1.782862771	0.112232018	0.166582267	0.195586345	0	0.152941692	0	0	0	0	0	0.018575295	0	0.01446328	0	0	0	0	0	0	0	0	0	0	0	25.8237	0	NO	2.125027651	13.2625	0.478138582	0.996816458	0	5.11504718	0	0	1.73149874	1.673300039	0.00948205	0.033359918	0	0	0.077685553	0.002629851	1.782862771	0.112232018	0.166582267	0.195586345	0	0.152941692	0	0	0	0	0	0.018575295	0	0.01446328	0	0	0	0	0	0	0	0	0	0	0	25.8237	NO																																																																																		0	0	NO	0	13.2625	0.478138582	0.996816458	0	5.11504718	0	0	1.73149874	1.673300039	0.00948205	0.033359918	0	0	0.077685553	0.002629851	1.782862771	0.112232018	0.166582267	0.195586345	0	0.152941692	0	0	0	0	0	0.018575295	0	0.01446328	0	0	0	0	0	0	0	0	0	0	0	25.8237
H1170_009_0	2012	7																															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	657.8681453	19.74137987	262.3342247	307.9911383	160.4042662	5.743702625	0.131105417	186.4429786	168.104325	328.5322736	504.2944853	0	11.8535101	146.5524885	3977.645098	4475.885122	320.0206809	302.778335	3279.397492	0	691.1610185	0.558934245	0	0	9.500570254	0	48.8113623	0	5.82030308	0											3400	$220 per day;day 1-8	$220 per day;day 1-8	$50 per day;day 11-100	$0 per visit	$200 per trip	20% coinsuarance; 0% diabetic monitoring supplies	20% coinsuarance	$65 per visit	$200 per visit	$0  - 50 per visit	$0  - 50 per visit	$50 per visit	$0 per visit	$40 - $50 per visit	$30 per visit; $0 per visit for preventive services; $40 for urgent care visit in KP medical centers	$40 per visit; 20% coinsurance for Medicare covered chiropractic services	$20 group therapy;  $40 individual therapy per visit	$40 per visit	"$0 for mammography and low tech radiology procedures;  $225 for high tech radiology such as MRI, CT, PET in non KP medical offices; $175 for high tech radiology performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispenses through KP outpatient pharmacy - $10 Generic; $45 Brand; Part B drug dispensed through community pharmacy - $20 Generic; $ 50 Brand	20% coinsuarance for other Medicare Part B; $0 blood			$0 per visit		$40 per visit		$0 - 75 copay (varies by classes)												0	NO	165.5387991	165.5387991	30.13329611	0	200	0.154107877	0.2	65	200	5.166028618	5.555759247	50	0	42.61029412	27.26371996	40	37	40	17.48461811	0	1.77325	0.2	0	0	0	0	40	0	7.5	0											NO	137.8815597	137.8815597	12.95621372	0	185.8353491	0.143193456	0.185835349	60.39648846	185.8353491	4.800153659	5.162282296	46.45883727	0	39.59249441	25.33281458	37.16706982	34.37953958	37.16706982	16.24630055	0	1.647662664	0.185835349	0	0	0	0	37.16706982	0	6.968825591	0												7.559	0.226831021	0.28323819	0	2.484065234	0.822460628	0.024364021	0.938375101	2.603310493	0.131417116	0.216942541	0	0	0.483531548	8.397078812	13.86296124	0.916846972	0.93778196	4.439839773	0	0.094900017	0.10386974	0	0	0	0	0.151181276	0	0.003380056	0	0	0	0	0	0	0	0	0	0	0	44.6814	0	NO	4.727890738	7.559	0.226831021	0.28323819	0	2.484065234	0.822460628	0.024364021	0.938375101	2.603310493	0.131417116	0.216942541	0	0	0.483531548	8.397078812	13.86296124	0.916846972	0.93778196	4.439839773	0	0.094900017	0.10386974	0	0	0	0	0.151181276	0	0.003380056	0	0	0	0	0	0	0	0	0	0	0	44.6814	NO																																																																																		0	0	NO	0	7.559	0.226831021	0.28323819	0	2.484065234	0.822460628	0.024364021	0.938375101	2.603310493	0.131417116	0.216942541	0	0	0.483531548	8.397078812	13.86296124	0.916846972	0.93778196	4.439839773	0	0.094900017	0.10386974	0	0	0	0	0.151181276	0	0.003380056	0	0	0	0	0	0	0	0	0	0	0	44.6814
H1170_801_0	2012	6																															D	D	Coin	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											8.721636649	0.031173799	0.462712946	0	0	0.448511064	0.049834563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											9.7139	YES	1237.637319	20.70147724	10.06606443	454.0040034	269.6609288	8.537253504	1.089130786	251.4352963	242.8742769	523.1282329	725.9694558	0.109907422	5.223748044	342.9642447	4071.515451	5988.456112	239.1118393	640.5463369	3255.62922	0	850.8472869	0.558934245	0	0	63.52224236	0	58.63449423	0	0	0											2000	$250 per day for day 1-5 after $500 deductible	$250 per day for day 1-5 after $500 deductible	10% coinsuarance after $500 deductible	$0 per visit	$150 per trip	20% coinsuarance; 0% diabetic monitoring supplies	20% coinsuarance	$65 per visit	$300 per visit	$0 - $100 per visit	$0 - $100 per visit	$100 per visit	$0 per visit	$50 - $300 per visit	$35 per visit; $0 per visit for preventive services; $50 for urgent care visit in KP medical centers	$50 per visit; $20 for Medicare covered chiropractic services	$17 group therapy;  $35 individual therapy per visit	$50 per visit	"$0 for mammography and low tech radiology procedures;  $0 for high tech radiology such as MRI, CT, PET in non KP medical offices; $0 for high tech radiology performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispense through outpatient pharmacy - $20 Generic; $40 Brand	20% coinsuarance for other Medicare Part B; 10% blood			$50 per visit		$50 per visit		Not Covered												500	NO	155.7765027	155.7765027	0.060266592	0	150	0.144952695	0.2	65	300	10.10976102	16.02879279	100	0	103.3573141	29.63917661	50	32.3	50	36.99717037	0	2.249	0.2	0	0	50	0	50	0	0	0											NO	88.7117478	88.7117478	0.009672292	0	122.7294042	0.118599719	0.163639206	53.18274181	245.4588084	8.271766309	13.1146946	81.81960279	0	84.56654389	24.25065657	40.9098014	26.4277317	40.9098014	30.27093784	0	1.840122867	0.163639206	0	0	40.9098014	0	40.9098014	0	0	0												9.1494	0.153038686	0.097361919	0	2.757943761	1.012515869	0.178224497	1.11433487	4.967969215	0.360599541	0.793405642	0.000749382	0	2.416941737	8.228076912	20.41554585	0.526598628	2.183718619	8.212579146	0	0.130471962	0.091463556	0	0	0.21655686	0	0.199893793	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2074	500	NO	19.49790077	17.8711	0.184212485	0.560074865	0	2.757943761	1.461026934	0.228059059	1.11433487	4.967969215	0.360599541	0.793405642	0.000749382	0	2.416941737	8.228076912	20.41554585	0.526598628	2.183718619	8.212579146	0	0.130471962	0.091463556	0	0	0.21655686	0	0.199893793	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9213	NO																																																																																		0	500	NO	0	17.8711	0.184212485	0.560074865	0	2.757943761	1.461026934	0.228059059	1.11433487	4.967969215	0.360599541	0.793405642	0.000749382	0	2.416941737	8.228076912	20.41554585	0.526598628	2.183718619	8.212579146	0	0.130471962	0.091463556	0	0	0.21655686	0	0.199893793	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9213
H1170_802_0	2012	6																															D	D	Coin	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											8.610537658	0.062404669	0.892618052	0	0	0.517256452	0.057472939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.1403	YES	1276.326151	47.31116312	17.36599586	564.2573035	271.5126412	7.655553606	0.942723669	235.1822041	271.9117465	673.1135459	763.4275205	0.546935358	9.255829142	310.6487656	4296.745158	6281.553365	280.8320172	569.0784281	3480.90682	0	871.8766128	0.558934245	0	0	100.59	0	54.48394621	0	0	0											2000	$250 per day for day 1-5 after $500 deductible	$250 per day for day 1-5 after $500 deductible	10% coinsuarance after $500 deductible	$0 per visit	$150 per trip	20% coinsuarance; 0% diabetic monitoring supplies	20% coinsuarance	$65 per visit	$300 per visit	$0 - $100 per visit	$0 - $100 per visit	$100 per visit	$0 per visit	$50 - $300 per visit	$35 per visit; $0 per visit for preventive services; $50 for urgent care visit in KP medical centers	$50 per visit; $20 for Medicare covered chiropractic services	$17 group therapy;  $35 individual therapy per visit	$50 per visit	"$0 for mammography and low tech radiology procedures;  $300 for high tech radiology such as MRI, CT, PET in non KP medical offices; $300 for high tech radiology performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispense through outpatient pharmacy - $20 Generic; $40 Brand	20% coinsuarance for other Medicare Part B; 10% blood			$50 per visit		$50 per visit		Not Covered												500	NO	155.7765027	155.7765027	0.060266592	0	150	0.150695723	0.2	65	300	6.488187166	12.33726312	100	0	107.2625698	32.96252702	50	32.3	50	36.27647661	0	2.249	0.2	0	0	50	0	50	0	0	0											NO	90.98612569	90.98612569	0.009995522	0	123.4137591	0.123986171	0.164551679	53.47929559	246.8275181	5.33821045	10.15058678	82.27583937	0	88.25117966	27.12019578	41.13791968	26.57509612	41.13791968	29.84677562	0	1.850383627	0.164551679	0	0	41.13791968	0	41.13791968	0	0	0												9.6773	0.35872162	0.17358219	0	2.792366307	0.94918278	0.155126762	1.048114884	5.592941793	0.299435147	0.645769775	0.003749964	0	2.284593335	9.710714158	21.53416982	0.621928154	1.950891889	8.657820401	0	0.134442184	0.091973568	0	0	0.344838612	0	0.186779684	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2145	500	NO	20.30021417	18.2879	0.421126289	1.066200242	0	2.792366307	1.466439233	0.212599701	1.048114884	5.592941793	0.299435147	0.645769775	0.003749964	0	2.284593335	9.710714158	21.53416982	0.621928154	1.950891889	8.657820401	0	0.134442184	0.091973568	0	0	0.344838612	0	0.186779684	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3548	NO																																																																																		0	500	NO	0	18.2879	0.421126289	1.066200242	0	2.792366307	1.466439233	0.212599701	1.048114884	5.592941793	0.299435147	0.645769775	0.003749964	0	2.284593335	9.710714158	21.53416982	0.621928154	1.950891889	8.657820401	0	0.134442184	0.091973568	0	0	0.344838612	0	0.186779684	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3548
H1170_805_0	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	Coin	Coin	S	Coin	T	V	V	P	V	P	V	V											15.39418404	0.142185485	0	0	0	0.587403055	0.065267006	0	2.218794725	0.220655637	0.2401395	0	0	3.079714032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											21.9483	YES	1533.364472	51.99996761	929.2642985	714.3192693	323.2580212	8.305754066	1.287944976	281.6352919	47.94100436	0	9.212172935	0.241733328	25.36724584	14.21744478	4705.490336	6738.445675	309.9561859	568.3879421	43.40721531	0	941.8047912	0.558934245	0	0	144.6997149	0	70.86650019	0	0	0											2500	$250 per day;day 1-3 after $500 deductible	$250 per day;day 1-3 after $500 deductible	$0 per admit	$0 per visit	$125 per trip	20% coinsuarance; 0% diabetic monitoring supplies	20% coinsuarance	$65 per visit	20% coinsuarance	0% - 20% per visit	0% - 20% per visit	20% coinsuarance per visit	$0 per visit	$30 - 20% coinsurance	$20 per visit; $0 per visit for preventive services; $40 for urgent care in KP medical centers	$30 per visit; $20 for Medicare covered chiropractic services	$10 group therapy;  $20 individual therapy per visit	20% coinsuarance	"$0 for mammography;  20% for high tech radiology such as MRI, CT, PET in non KP medical offices; 20% for high tech radiology and and low tech radiology procedures performed in the KP medical offices"		Part B drug administered in the medical offices have $0 copay; Part B drug dispense through outpatient pharmacy - $20 Generic; $30 Brand	20% coinsuarance for other Medicare Part B; 20% blood			$30 per visit		$30 per visit		Not Covered												500	NO	115.685615	115.685615	0	0	125	0.086366619	0.2	65	0.2	0	0	0.2	0	7.349863553	15.9721959	30	18.5	0.2	0.169731526	0	1.9895	0.2	0	0	30	0	30	0	0	0											NO	86.98146041	86.98146041	0	0	107.7769729	0.074466662	0.172443157	56.04402591	0.172443157	0	0	0.172443157	0	6.337168361	13.7714794	25.8664735	15.95099199	0.172443157	0.146345201	0	1.715378301	0.172443157	0	0	25.8664735	0	25.8664735	0	0	0												11.1145	0.376919427	0	0	2.90331425	0.618501779	0.222097297	1.3153313	8.267098125	0	0	3.47E-06	0	0.900983412	5.40013027	14.52498554	0.412009053	0.008167884	6.352437629	0	0.134629292	0.096384386	0	0	0.311905945	0	0.152755537	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1122	500	NO	113.8946251	26.5087	0.519104912	0	0	2.90331425	1.205904833	0.287364303	1.3153313	10.48589285	0.220655637	0.2401395	3.47E-06	0	3.980697444	5.40013027	14.52498554	0.412009053	0.008167884	6.352437629	0	0.134629292	0.096384386	0	0	0.311905945	0	0.152755537	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0605	NO																																																																																		0	500	NO	0	26.5087	0.519104912	0	0	2.90331425	1.205904833	0.287364303	1.3153313	10.48589285	0.220655637	0.2401395	3.47E-06	0	3.980697444	5.40013027	14.52498554	0.412009053	0.008167884	6.352437629	0	0.134629292	0.096384386	0	0	0.311905945	0	0.152755537	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0605
H1216_001_0	2012	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	1617.092411	100.2761287	804.290095	351.052534	464.3953455	8.080872724	11.99310193	472.339066	205.344602	2376.485619	944.6283718	57.28905023	0.01366364	1120.555865	5970.045236	12236.22234	197.2339596	494.0753768	2375.777507	3607.443553	17.83787782	0.000837089	1740	402	338.4	203.04	18	13.71428571	4550.405331	2039.518501											3400	"(1a) $200 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $200 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $150.00 , (5) $200.00 copayment , (9a) $150.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $100.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $100.00 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	142.8469352	102.1791406	68.53457719	7.602355446	40.01205857	0.199997194	0.12624199	60.36431631	98.36252986	0.138979303	15.66114806	77.62841517	0.2	18.9564169	0	6.328871419	18.10522222	9.706982801	5.330695511	3.995211311	0.2	0	0	0	0	0	0	0	0	0											YES	136.4755609	97.62166411	65.47774269	7.263269055	38.22740846	0.191076758	0.120611243	57.67189838	93.97528495	0.132780436	14.9626169	74.16596998	0.191079439	18.1109075	0	6.046585991	17.2976785	9.274024124	5.092931529	3.817013673	0.191079439	0	0	0	0	0	0	0	0	0											3400	18.3911	0.815760213	4.388591657	0.212482417	1.47938588	1.54406696	1.446502928	2.270057551	1.608109791	0.0262959	1.177842703	0.354074832	0.002610841	1.691190302	0	6.165614216	0.284307468	0.381838914	1.008306014	1.147471781	3.408451681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8041	0	NO	2.23173861	18.3911	0.815760213	4.388591657	0.212482417	1.47938588	1.54406696	1.446502928	2.270057551	1.608109791	0.0262959	1.177842703	0.354074832	0.002610841	1.691190302	0	6.165614216	0.284307468	0.381838914	1.008306014	1.147471781	3.408451681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8041	YES	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	Same as in-network	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											3400	0.2773	0	0.0137	0.0065	0.0377	0.0897	0.1332	0	0.0831	0.001	0.0577	0	0	0.0394	0	0.1497	0	0.0023	0.0213	0.0357	0.0168	0	0	0	0	0	0	0	0	0											0.9652	0	NO	0.045059335	18.6685	0.815760213	4.402256968	0.21901054	1.517133353	1.633794215	1.579670242	2.270057551	1.691248221	0.027263408	1.235542868	0.354074832	0.002610841	1.730634935	0	6.315292935	0.284307468	0.38416083	1.02958079	1.18318672	3.42522304	3.70E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7693
H1216_003_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1937.475103	613.0884662	522.9488033	671.3976046	20.84074187	13.05975434	16.19931879	37.29140082	19.53292348	4.48164037	14.65344073	6.015354404	0.00100205	15.92188571	6085.46199	83.23840845	6.758479697	1.502795707	12.37542496	19.77921628	19.62050548	5.96E-05	1740	678.6	338.4	203.04	18	13.71428571	4550.405331	2689.131522											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	161.8119923	62.66886939	46.64146589	0	0.190360709	0.199997953	0.2	0.18924135	0.178574234	0.025172038	0.173475128	0.2	0.2	0.159345772	4.012764417	0.08275827	0.201979019	0.182082576	0.131528342	0.077481549	0.2	0.197387291	0	0	0	0	0	0	0	0											NO	158.011999	61.19715349	45.54613758	0	0.185890278	0.195301201	0.195303199	0.184797205	0.174380596	0.024580897	0.169401237	0.195303199	0.195303199	0.155603696	3.918528647	0.080814775	0.197235744	0.177806548	0.12843953	0.075661972	0.195303199	0.192751848	0	0	0	0	0	0	0	0												25.512	3.126605748	1.984858179	0	3.874091298	2.550585706	3.163778788	6.891346656	3.406162833	0.110162742	2.482310989	1.174817961	0.000195704	2.477504261	1.987171428	6.726893229	1.333013769	0.267206917	1.58949377	1.496534511	3.831947495	1.15E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9867	0	NO	1.779289156	25.512	3.126605748	1.984858179	0	3.874091298	2.550585706	3.163778788	6.891346656	3.406162833	0.110162742	2.482310989	1.174817961	0.000195704	2.477504261	1.987171428	6.726893229	1.333013769	0.267206917	1.58949377	1.496534511	3.831947495	1.15E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9867	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	NO	0	25.512	3.126605748	1.984858179	0	3.874091298	2.550585706	3.163778788	6.891346656	3.406162833	0.110162742	2.482310989	1.174817961	0.000195704	2.477504261	1.987171428	6.726893229	1.333013769	0.267206917	1.58949377	1.496534511	3.831947495	1.15E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9867
H1230_001_0	2012	10																															D	D	D	V	Coin	Coin	Coin	V	V	O	O	Coin	O	V	V	V	V	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	YES	1170.303548	13.1147754	550.0715827	360.9271934	18.17892651	8.751042319	0.382853944	286.7239841	159.5446394	0	212.3955827	0.43017695	1.284074784	214.9934123	8946.730677	3822.5027	220.4407674	354.0011149	3025.31424	4658.899236	1235.842412	0.598177338	0	0	351.5289805	0	53.03388503	0	0	237.3312147											3000	$50/day days 1-6	$50/day days 1-6 for up to 190 days	$50/day 11 to 100	0	0.2	0.2	0.2	$50/visit	$15-$50/visit	$0-$15/test	$15/$50 (routine/advanced)	0.2	0	$0-$15/visit	$0-$15/visit	$0-$15/visit	$0-$15/visit	$15/visit	$15/$50 (routine/advanced)	$0-$15/test	"$10/generic & $45/brand, 0-20% DMS"	0.2			$15/visit		$15/visit		$0-$15/visit	$0-$15/visit													50	50	50	0	0.2	0.2	0.2	46.21888149	30.8637084	0	14.97395833	0.2	0	15	11.46650119	12.39997481	14.94177823	15	17.42388518	0	5.331135751	0.056301931	0	0	15	0	15	0	15	0											NO	33.32120234	33.32120234	22.44400557	0	0.195929607	0.195929607	0.195929607	45.27823643	30.23557128	0	14.66920886	0.195929607	0	14.69472052	11.23313536	12.14761096	14.63768368	14.69472052	17.06927488	0	5.222636662	0.055156076	0	0	14.69472052	0	14.69472052	0	14.69472052	0												3.2497	0.036416674	1.028817472	0	3.561789927	1.714588282	0.075012423	1.081863028	0.40199361	0	0.259639597	0.084284401	0	0.263272342	8.37498639	3.869522973	0.268895185	0.433495621	4.303326696	0	0.537862991	0.032993115	0	0	0.430468344	0	0.064943177	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0738			3.443116435	3.2497	0.036416674	1.028817472	0	3.561789927	1.714588282	0.075012423	1.081863028	0.40199361	0	0.259639597	0.084284401	0	0.263272342	8.37498639	3.869522973	0.268895185	0.433495621	4.303326696	0	0.537862991	0.032993115	0	0	0.430468344	0	0.064943177	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0738	NO																																																																																		0				3.2497	0.036416674	1.028817472	0	3.561789927	1.714588282	0.075012423	1.081863028	0.40199361	0	0.259639597	0.084284401	0	0.263272342	8.37498639	3.869522973	0.268895185	0.433495621	4.303326696	0	0.537862991	0.032993115	0	0	0.430468344	0	0.064943177	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0738
H1230_003_0	2012	11																															D	D	D	V	Coin	Coin	Coin	V	V	O	Coin	Coin	O	V	V	V	V	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	YES	602.4026965	51.87675861	380.6082734	141.65996	10.63130582	3.34194095	0.206276605	192.3971542	113.5025428	0	3.957146648	0.213648137	1.676025733	138.898037	6563.970713	2712.481949	284.9954127	249.3075423	2092.43678	3474.633733	945.8587872	0.640198861	0	0	284.8559207	0	39.45469006	0	0	231.4906417											3400	$265/day days 1-8	$265/day days 1-6 for up to 190 days	$50/day 11 to 100	0	0.25	0.2	0-20%	$65/visit	$29-265/visit	"$0-$29/test, $20/day"	20% Radiation Therapy	0.2	0	$0-$29/visit	$0-$29/visit	Physician Specialist Services - $29/visit:  Chiropractic Services - $20/visit: End Stage Renal Disease - $0/visit : Other - 20%/visit	$0-$29/visit	$29/visit	"$29/$150 (routine/advanced), 20% rad therapy"	"$0-$29/test, $20/day"	"$10/generic & $45/brand, 0-20% DMS"	0.2			$35/visit		$35/visit		$0-$29/visit	$0-$29/visit													265	248.6726733	50	0	0.25	0.2	0.2	60.1389887	135.9667195	0	0.2	0.2	0	29	22.06440443	24.39947451	28.78466988	29	54.52286315	18.09020308	3.893764219	0.056301931	0	0	29	0	29	0	29	0											NO	144.7752906	135.8553152	9.987275804	0	0.226429147	0.181143317	0.181143317	54.46887958	123.1473131	0	0.181143317	0.181143317	0	26.26578102	19.98409707	22.09900877	26.07075296	26.26578102	49.38226152	16.38459699	3.526646839	0.050993593	0	0	26.26578102	0	26.26578102	0	26.26578102	0												7.2678	0.587311116	0.316769983	0	2.407237506	0.60537027	0.037365629	0.873304785	1.164794431	0	0.716810671	0.038700932	0	0.304022119	10.93125233	4.995263534	0.619170417	0.545688109	8.610771692	4.744206117	0.277975825	0.03264604	0	0	0.623496936	0	0.086359021	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7863			11.70771473	7.2678	0.587311116	0.316769983	0	2.407237506	0.60537027	0.037365629	0.873304785	1.164794431	0	0.716810671	0.038700932	0	0.304022119	10.93125233	4.995263534	0.619170417	0.545688109	8.610771692	4.744206117	0.277975825	0.03264604	0	0	0.623496936	0	0.086359021	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7863	NO																																																																																		0				7.2678	0.587311116	0.316769983	0	2.407237506	0.60537027	0.037365629	0.873304785	1.164794431	0	0.716810671	0.038700932	0	0.304022119	10.93125233	4.995263534	0.619170417	0.545688109	8.610771692	4.744206117	0.277975825	0.03264604	0	0	0.623496936	0	0.086359021	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7863
H1230_005_0	2012	10																															D	D	D	V	Coin	Coin	Coin	V	V	O	Coin	Coin	O	V	V	V	V	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	YES	619.6234166	20.51876548	324.1144435	179.9622323	10.06084259	4.309016411	0.2065843	166.1170108	91.72544468	0	4.508720286	0.226667696	0.988889551	122.944922	5119.84477	2161.306437	161.1974868	199.619344	1734.74144	2699.93949	755.6470472	0.551789536	0	0	210.1017557	0	30.69017836	0	0	160.1987999											3400	$275/day days 1-8	$275/day days 1-6 for up to 190 days	$50/day 11 to 100	0	0.25	0.2	0-20%	$65/visit	$29-275/visit	"$0-$29/test, $20/day"	20% Radiation Therapy	0.2	0	$0-$29/visit	$0-$29/visit	Physician Specialist Services - $29/visit:  Chiropractic Services - $20/visit: End Stage Renal Disease - $0/visit : Other - 20%/visit	$0-$29/visit	$29/visit	"$29/$150 (routine/advanced), 20% rad therapy"	"$0-$29/test, $20/day"	"$10/generic & $45/brand, 0-20% DMS"	0.2			$35/visit		$35/visit		$0-$29/visit	$0-$29/visit													275	255.2472214	50	0	0.25	0.2	0.2	60.1036806	140.6818671	0	0.2	0.2	0	29	22.12498073	24.1215785	28.84789998	29	56.63634712	18.30792614	4.762263156	0.056301931	0	0	29	0	29	0	29	0											NO	147.9894156	137.3595895	9.646959861	0	0.225829628	0.180663702	0.180663702	54.29276727	127.0805347	0	0.180663702	0.180663702	0	26.19623682	19.98590466	21.78946838	26.05884206	26.19623682	51.16066076	16.53788859	4.301840464	0.050858576	0	0	26.19623682	0	26.19623682	0	26.19623682	0												7.6415	0.234870767	0.260559919	0	2.272036338	0.778482858	0.037322284	0.75157935	0.971376547	0	0.814562099	0.040950625	0	0.268391191	8.527060786	3.924476521	0.350051654	0.435772967	7.395876525	3.72094154	0.27088942	0.02806323	0	0	0.458656279	0	0.066997265	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2504			11.17977309	7.6415	0.234870767	0.260559919	0	2.272036338	0.778482858	0.037322284	0.75157935	0.971376547	0	0.814562099	0.040950625	0	0.268391191	8.527060786	3.924476521	0.350051654	0.435772967	7.395876525	3.72094154	0.27088942	0.02806323	0	0	0.458656279	0	0.066997265	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2504	NO																																																																																		0				7.6415	0.234870767	0.260559919	0	2.272036338	0.778482858	0.037322284	0.75157935	0.971376547	0	0.814562099	0.040950625	0	0.268391191	8.527060786	3.924476521	0.350051654	0.435772967	7.395876525	3.72094154	0.27088942	0.02806323	0	0	0.458656279	0	0.066997265	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2504
H1230_801_0	2012	7																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	907.2502115	8.578675973	498.6990815	320.2637298	12.06275536	5.706935744	0.267482185	256.9389065	162.9597877	0	7.053877794	0.721164677	46.01617894	206.7351949	7790.953646	3351.082803	2.693077892	349.6747542	34.91654886	26.60438538	1520.579976	2.182603842	0	0	283.0567035	0	55.29335854	0	0	151.096648											3000	$75/day unlimited days	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													75	75	0	0	0.2	0.2	0.2	60.72171375	47.55625727	0.5	0.2	0.2	0	30	22.85561552	25.23041376	0.14964463	30	0.5	0.5	5.2787952	0	0	0	30	0	30	0	30	0											NO	56.5941079	56.5941079	0	0	0.182345377	0.182345377	0.182345377	55.36161884	43.35831824	0.455863442	0.182345377	0.182345377	0	27.35180651	20.83807911	23.00324651	0.136435032	27.35180651	0.455863442	0.455863442	4.812819497	0	0	0	27.35180651	0	27.35180651	0	27.35180651	0												4.2788	0.040458543	0	0	2.19958767	1.040633348	0.04877414	1.185379484	0.588805195	0	1.286242004	0.131501045	0	0.471215087	13.52904237	6.423815317	0.367430169	0.797019685	15.91717814	12.12796669	0.609856413	0	0	0	0.645176015	0	0.126031104	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8149			6.971432163	4.2788	0.040458543	0	0	2.19958767	1.040633348	0.04877414	1.185379484	0.588805195	0	1.286242004	0.131501045	0	0.471215087	13.52904237	6.423815317	0.367430169	0.797019685	15.91717814	12.12796669	0.609856413	0	0	0	0.645176015	0	0.126031104	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8149	NO																																																																																		0				4.2788	0.040458543	0	0	2.19958767	1.040633348	0.04877414	1.185379484	0.588805195	0	1.286242004	0.131501045	0	0.471215087	13.52904237	6.423815317	0.367430169	0.797019685	15.91717814	12.12796669	0.609856413	0	0	0	0.645176015	0	0.126031104	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8149
H1230_802_0	2012	6																															Coin	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	306.5942633	12.08264222	499.7819576	365.0712169	12.54426882	6.928811641	0.326986359	276.5430802	148.2551293	0	7.165904456	0.571566205	4.950753918	209.5142939	8282.73079	3472.585894	3.222801815	389.2114051	35.67145481	27.1350298	1590.616362	0.762443281	0	0	324.2077923	0	51.27975039	0	0	150.678105											3000	10% Room & Board	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													0.050080543	75	0	0	0.2	0.2	0.2	59.82070424	49.82571447	0.5	0.2	0.2	0	30	22.72266036	25.04152721	0.14964463	30	0.5	0.5	6.967267126	0	0	0	30	0	30	0	30	0											NO	0.03069619	45.97023429	0	0	0.179078995	0.179078995	0.179078995	53.56315807	44.61369444	0.447697488	0.179078995	0.179078995	0	26.8618493	20.34575594	22.42205767	0.13399105	26.8618493	0.447697488	0.447697488	6.238455985	0	0	0	26.8618493	0	26.8618493	0	26.8618493	0												9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641			12.84246489	9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641	NO																																																																																		0				9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641
H1230_803_0	2012	7																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1167.93716	13.48700674	494.9235486	350.253144	13.07189948	6.968752439	0.310823375	266.605478	145.6392405	0	7.829231655	0.465485598	3.711450975	197.0776239	8248.065652	3468.731228	3.320440885	389.6322016	35.57529876	27.20836378	1603.550166	0.723305286	0	0	317.3384016	0	50.95779478	0	0	158.2711084											3000	$75/day unlimited days	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													75	75	0	0	0.2	0.2	0.2	59.68277489	50.68306011	0.5	0.2	0.2	0	30	22.70805767	25.16507051	0.14964463	30	0.5	0.5	6.972652246	0	0	0	30	0	30	0	30	0											NO	56.5941079	56.5941079	0	0	0.182345377	0.182345377	0.182345377	54.41439035	46.20910844	0.455863442	0.182345377	0.182345377	0	27.35180651	20.70354665	22.94367131	0.136435032	27.35180651	0.455863442	0.455863442	6.357154502	0	0	0	27.35180651	0	27.35180651	0	27.35180651	0												5.5082	0.063607093	0	0	2.383600435	1.270719789	0.056677205	1.208931212	0.560821622	0	1.427624196	0.084879147	0	0.44920242	14.230351	6.632119096	0.453024459	0.888095382	16.21747813	12.40329836	0.849501346	0	0	0	0.72331488	0	0.116148979	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5276			7.616998064	5.5082	0.063607093	0	0	2.383600435	1.270719789	0.056677205	1.208931212	0.560821622	0	1.427624196	0.084879147	0	0.44920242	14.230351	6.632119096	0.453024459	0.888095382	16.21747813	12.40329836	0.849501346	0	0	0	0.72331488	0	0.116148979	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5276	NO																																																																																		0				5.5082	0.063607093	0	0	2.383600435	1.270719789	0.056677205	1.208931212	0.560821622	0	1.427624196	0.084879147	0	0.44920242	14.230351	6.632119096	0.453024459	0.888095382	16.21747813	12.40329836	0.849501346	0	0	0	0.72331488	0	0.116148979	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5276
H1230_804_0	2012	6																															Coin	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	306.5942633	12.08264222	499.7819576	365.0712169	12.54426882	6.928811641	0.326986359	276.5430802	148.2551293	0	7.165904456	0.571566205	4.950753918	209.5142939	8282.73079	3472.585894	3.222801815	389.2114051	35.67145481	27.1350298	1590.616362	0.762443281	0	0	324.2077923	0	51.27975039	0	0	150.678105											3000	10% Room & Board	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													0.050080543	75	0	0	0.2	0.2	0.2	59.82070424	49.82571447	0.5	0.2	0.2	0	30	22.72266036	25.04152721	0.14964463	30	0.5	0.5	6.967267126	0	0	0	30	0	30	0	30	0											NO	0.03069619	45.97023429	0	0	0.179078995	0.179078995	0.179078995	53.56315807	44.61369444	0.447697488	0.179078995	0.179078995	0	26.8618493	20.34575594	22.42205767	0.13399105	26.8618493	0.447697488	0.447697488	6.238455985	0	0	0	26.8618493	0	26.8618493	0	26.8618493	0												9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641			12.84246489	9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641	NO																																																																																		0				9.4113	0.046286824	0	0	2.246415058	1.240804628	0.058556389	1.234376726	0.551184086	0	1.28326297	0.102355502	0	0.468995116	14.0432016	6.488543432	0.431826599	0.871244842	15.97002072	12.14828469	0.826915847	0	0	0	0.725735071	0	0.114789077	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2641
H1230_805_0	2012	7																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1036.367236	5.061048569	535.8548457	438.5396291	9.452516012	6.980566736	0.440810102	334.4963023	159.4347386	0	3.426116649	1.097925916	1.049217381	284.7084871	8610.572889	3548.49464	2.624173982	399.2814865	36.52082035	26.8962873	1544.368634	0.606768318	0	0	377.3602879	0	52.83780663	0	0	107.817248											3000	$75/day unlimited days	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													75	75	0	0	0.2	0.2	0.2	60.62004563	44.85714286	0.5	0.2	0.2	0	30	22.80728725	24.32555725	0.148218562	30	0.5	0.5	6.936058761	0	0	0	30	0	30	0	30	0											NO	59.26373872	59.26373872	0	0	0.186680844	0.186680844	0.186680844	56.58300634	41.86984639	0.466702109	0.186680844	0.186680844	0	28.00212657	21.28841814	22.70557777	0.138347831	28.00212657	0.466702109	0.466702109	6.47414651	0	0	0	28.00212657	0	28.00212657	0	28.00212657	0												5.1182	0.024994722	0	0	1.764603665	1.303138088	0.082290802	1.577233866	0.556292334	0	0.639590347	0.204961736	0	0.664370257	15.27545634	6.714218416	0.363048778	0.93172756	17.0443439	12.55255402	0.833205733	0	0	0	0.880574212	0	0.123297579	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6542			5.754313564	5.1182	0.024994722	0	0	1.764603665	1.303138088	0.082290802	1.577233866	0.556292334	0	0.639590347	0.204961736	0	0.664370257	15.27545634	6.714218416	0.363048778	0.93172756	17.0443439	12.55255402	0.833205733	0	0	0	0.880574212	0	0.123297579	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6542	NO																																																																																		0				5.1182	0.024994722	0	0	1.764603665	1.303138088	0.082290802	1.577233866	0.556292334	0	0.639590347	0.204961736	0	0.664370257	15.27545634	6.714218416	0.363048778	0.93172756	17.0443439	12.55255402	0.833205733	0	0	0	0.880574212	0	0.123297579	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6542
H1230_806_0	2012	6																															Coin	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	Coin			V		V		V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	263.2556483	5.016678161	531.0376939	457.2789459	9.680603651	7.070524379	0.43684737	338.2138332	158.5370272	0	3.397584767	1.088870883	1.040018852	282.2124368	8627.249371	3535.843237	2.603657149	398.4418468	36.52844479	26.92651359	1540.942608	0.606318258	0	0	374.8845361	0	52.36281282	0	0	107.8803557											3000	10% Room & Board	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0.2	$65/visit	$30-$75/visit	0.5	20% Radiation Therapy	0.2	0	$0-$30/visit	$0-$30/visit	$0-$30/visit	"SMI $30/visit, NON-SMI 20%"	$30/visit	0.5	0.5	"$10/generic & $45/brand, 20% DMS"	0.2			$30/visit		$30/visit		$0-$30/visit	$0-$30/visit													0.054936554	75	0	0	0.2	0.2	0.2	60.62004563	44.85714286	0.5	0.2	0.2	0	30	22.80728725	24.32555725	0.148218562	30	0.5	0.5	6.936058761	0	0	0	30	0	30	0	30	0											NO	0.034978425	47.75293834	0	0	0.182904864	0.182904864	0.182904864	55.4385061	41.02294813	0.457262161	0.182904864	0.182904864	0	27.43572964	20.8578189	22.24631374	0.135549479	27.43572964	0.457262161	0.457262161	6.343194432	0	0	0	27.43572964	0	27.43572964	0	27.43572964	0												9.2083	0.019963427	0	0	1.770629497	1.293233302	0.079901509	1.562505805	0.541971354	0	0.621434781	0.199159781	0	0.645225343	14.99546708	6.554956498	0.352924371	0.910961899	16.70307559	12.31247578	0.814541548	0	0	0	0.857102565	0	0.119717665	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5635			10.90469608	9.2083	0.019963427	0	0	1.770629497	1.293233302	0.079901509	1.562505805	0.541971354	0	0.621434781	0.199159781	0	0.645225343	14.99546708	6.554956498	0.352924371	0.910961899	16.70307559	12.31247578	0.814541548	0	0	0	0.857102565	0	0.119717665	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5635	NO																																																																																		0				9.2083	0.019963427	0	0	1.770629497	1.293233302	0.079901509	1.562505805	0.541971354	0	0.621434781	0.199159781	0	0.645225343	14.99546708	6.554956498	0.352924371	0.910961899	16.70307559	12.31247578	0.814541548	0	0	0	0.857102565	0	0.119717665	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5635
H1264_004_0	2012	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	2423.258423	95.16087237	764.8979642	223.1318495	382.2013221	9.485918047	12.90666828	441.4738294	301.8773187	4358.927634	1197.558974	24.53545049	3.95E-05	1956.838619	10749.08238	18882.25366	81.81873881	150.8047835	3739.309737	6512.718156	14.02291957	0.045386172	0	247.7142857	338.4	203.04	18	13.71428571	504	2039.518501											5500	"(1a) $125 days 1 - 6, $0 after day 6, unlimited coverage"	"(1b) $125 days 1 - 6, $0 days 7 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $100.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $100.00	(8b) Copay between $0.00 and $100.00	(9a) $100.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $100.00 , (5) $125.00 copayment , (9a) $100.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	72.50692129	40.20647234	90.24239112	0	41.65089751	0.177177476	0.2	64.64767771	87.30785171	0.12600116	12.98029445	70.56307229	0.2	12.79593282	0	5.540396489	4.821964109	10.25831515	4.761608436	4.639589935	0.2	0	0	0	0	0	0	0	0	0											YES	71.31346474	39.54467789	88.75701055	0	40.96532797	0.174261152	0.19670802	63.58358352	85.87077336	0.123927193	12.76664012	69.4016113	0.19670802	12.58531307	0	5.449202127	4.74259507	10.08946433	4.683232846	4.563222757	0.19670802	0	0	0	0	0	0	0	0	0											5500	14.4009	0.313592171	5.657504723	0	1.304750209	1.65302701	2.538845166	2.339207342	2.160203234	0.045015806	1.274067037	0.141899983	7.76E-06	2.052285554	0	8.574434734	0.032336096	0.126794957	1.459338182	2.476581975	2.758420748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3092	0	NO	0.825207669	14.4009	0.313592171	5.657504723	0	1.304750209	1.65302701	2.538845166	2.339207342	2.160203234	0.045015806	1.274067037	0.141899983	7.76E-06	2.052285554	0	8.574434734	0.032336096	0.126794957	1.459338182	2.476581975	2.758420748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3092	YES	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	Same as in-network	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											5500	0.4535	0	0.0155	0.0433	0.0291	0.1322	0.1798	0	0.179	0.0019	0.0726	0	0	0.0894	0	0.3196	0	0.0017	0.0678	0.0834	0.0266	0.0002	0	0	0	0	0	0	0	0											1.6957	0	NO	0.028378275	14.8544	0.313592171	5.672996516	0.043349765	1.333848884	1.78520885	2.718693564	2.339207342	2.339232224	0.046947751	1.346648598	0.141899983	7.76E-06	2.141704479	0	8.894017787	0.032336096	0.128483045	1.527187661	2.559978569	2.785010908	0.000190217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0049
H1264_007_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2871.26489	386.6439009	762.2029294	696.5326002	11.87407925	12.38945383	14.82526726	37.40901434	38.67671135	8.112288011	14.80396385	6.783514882	0.907643802	21.72033552	9970.675996	22344.85466	4.782048024	2.961960596	26.21510155	33.38510867	7.521096467	0.049345569	1690	865.0909091	338.4	203.04	18	13.71428571	504	3315.160001											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) $0.00 copayment"	(8b) 20% coinsurance	"(7g) $0.00 copayment , (8a) 20% coinsurance , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	135.9087276	57.49081491	63.79482627	0	0.186907454	0.198386692	0.2	0.18710249	0.179255768	0.026191519	0.165238595	0.2	0.2	0.179027293	0	0	0.184111166	0	0.154748105	0.089871562	0.2	0.19964996	0	0	0	0	0	0	0	0											NO	132.5431399	56.06713606	62.21503749	0	0.182278955	0.193473926	0.195047282	0.182469161	0.174816752	0.025542923	0.161146694	0.195047282	0.195047282	0.174593935	0	0	0.179551913	0	0.150915987	0.08764602	0.195047282	0.19470591	0	0	0	0	0	0	0	0												31.7139	1.80650135	3.951706986	0	2.164394757	2.397036272	2.891628091	6.825991471	6.761337061	0.207211551	2.385609837	1.323106143	0.177033457	3.792238846	0	0	0.858625872	0	3.956277924	2.926071893	1.466969427	0.009607874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6152	0	NO	1.920051523	31.7139	1.80650135	3.951706986	0	2.164394757	2.397036272	2.891628091	6.825991471	6.761337061	0.207211551	2.385609837	1.323106143	0.177033457	3.792238846	0	0	0.858625872	0	3.956277924	2.926071893	1.466969427	0.009607874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6152	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	NO	0	31.7139	1.80650135	3.951706986	0	2.164394757	2.397036272	2.891628091	6.825991471	6.761337061	0.207211551	2.385609837	1.323106143	0.177033457	3.792238846	0	0	0.858625872	0	3.956277924	2.926071893	1.466969427	0.009607874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6152
H1264_008_0	2012	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	1239.987339	70.83868091	340.8220437	187.1342987	260.2438296	6.01367751	7.897857688	296.8273003	240.1111515	2677.847912	1188.451222	163.2525525	0.065295047	1590.374521	8855.888193	15731.53629	190.3328527	387.3857557	2804.308935	6073.551337	7.43202555	0.041397456	0	247.7142857	338.4	203.04	18	13.71428571	504	2039.518501											5500	"(1a) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $150 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $100.00	(8b) Copay between $0.00 and $100.00	(9a) $100.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $100.00 , (5) $150.00 copayment , (9a) $100.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	82.34569963	104.6180232	63.77281447	0	40.34234274	0.191593242	0.067909886	63.83328107	82.15776593	0.12600116	15.15669384	43.17077154	0.2	14.92541064	7.345068566	5.766151059	19.49341712	12.29783835	5.989208587	4.881557697	0.2	0	0	0	0	0	0	0	0	0											NO	81.4699914	103.5054592	63.09462023	0	39.91332069	0.189555737	0.067187696	63.1544438	81.28405629	0.124661196	14.99550945	42.71167046	0.197873093	14.76668584	7.266957177	5.704830723	19.28611369	12.16705656	5.925516138	4.829644601	0.197873093	0	0	0	0	0	0	0	0	0												8.4185	0.61101585	1.792003118	0	0.865599619	1.139927071	0.530638865	1.562163588	1.626434029	0.027818644	1.485119295	0.581065769	0.012920133	1.957046743	5.362946689	7.478812631	0.30589842	0.3927787	1.384748154	2.444424535	1.470597883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4504	0	NO	0.424046622	8.4185	0.61101585	1.792003118	0	0.865599619	1.139927071	0.530638865	1.562163588	1.626434029	0.027818644	1.485119295	0.581065769	0.012920133	1.957046743	5.362946689	7.478812631	0.30589842	0.3927787	1.384748154	2.444424535	1.470597883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4504	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	NO	0	8.4185	0.61101585	1.792003118	0	0.865599619	1.139927071	0.530638865	1.562163588	1.626434029	0.027818644	1.485119295	0.581065769	0.012920133	1.957046743	5.362946689	7.478812631	0.30589842	0.3927787	1.384748154	2.444424535	1.470597883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4504
H1264_014_0	2012	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	1477.062981	73.17387124	574.6505389	247.1392145	243.3415265	7.025733547	7.535715235	417.0667748	233.6426142	2640.403099	930.2468331	98.86766289	0.090145761	2077.274189	6880.26182	14026.98263	230.1650411	592.4751762	2890.449913	4426.80314	4.024988372	0.031066596	0	247.7142857	338.4	203.04	18	13.71428571	504	2039.518501											5500	"(1a) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $150 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $100.00	(8b) Copay between $0.00 and $100.00	(9a) $100.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $100.00 , (5) $150.00 copayment , (9a) $100.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $15.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	87.78890432	46.79498878	71.05778248	0	41.96132641	0.19542781	0.09256658	63.26485002	84.91378761	0.203475552	8.899973097	43.21366828	0.2	13.32405755	6.59493151	6.489297244	19.76320823	10.74279622	5.218757983	4.433142979	0.2	0	0	0	0	0	0	0	0	0											NO	86.8256346	46.28152758	70.27809613	0	41.50090291	0.193283465	0.091550887	62.57067216	83.9820653	0.201242903	8.802317537	42.73950337	0.197805486	13.17785842	6.522568176	6.418092989	19.54635508	10.62492016	5.161494806	4.384500016	0.197805486	0	0	0	0	0	0	0	0	0												10.6872	0.282216545	3.365445484	0	0.841574422	1.357958126	0.689901414	2.174679036	1.635149107	0.044280199	0.682360668	0.352129568	0.017831326	2.281168764	3.739748066	7.502206572	0.374907302	0.524583454	1.243253518	1.617443203	0.796164783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2102	0	NO	0.446104568	10.6872	0.282216545	3.365445484	0	0.841574422	1.357958126	0.689901414	2.174679036	1.635149107	0.044280199	0.682360668	0.352129568	0.017831326	2.281168764	3.739748066	7.502206572	0.374907302	0.524583454	1.243253518	1.617443203	0.796164783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2102	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	NO	0	10.6872	0.282216545	3.365445484	0	0.841574422	1.357958126	0.689901414	2.174679036	1.635149107	0.044280199	0.682360668	0.352129568	0.017831326	2.281168764	3.739748066	7.502206572	0.374907302	0.524583454	1.243253518	1.617443203	0.796164783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2102
H1286_002_0	2012	4																															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	839.554372	98.38993525	720.3755108	551.6032849	90.45432692	10.31469159	9.478555671	314.2876879	55.57674003	15.93659565	27.90900758	0	0.022810723	15.33463203	5405.035372	4003.007383	552.5993794	879.5440142	0	0	27.01004708	713.3851033	0	0	93.50625832	205.0498836	11.15308644	2.673398366	77.80414963	0											4200	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	65.33681106	0	200	0.2	0.107988088	62.72339838	0.16	0.200358098	0.178019666	0	0.2	0.14609277	6.600398213	32.21397109	38.5	35	0	0	0.2	33.98437193	0	0	35	0	35	0	0	0											YES	165.018103	86.42979709	51.79602692	0	158.5508263	0.158550826	0.085608003	49.74331579	0.126840661	0.15883471	0.141125826	0	0.158550826	0.115815647	6.36960138	31.08766539	37.15376636	33.77615124	0	0	0.158550826	26.94125126	0	0	35	0	35	0	0	0											5200	11.5451	0.708651845	3.109382446	0	1.195134023	1.635402876	0.811440225	1.302809309	7.049390445	2.531284549	3.938681747	0	0.003616659	1.775990335	2.868993397	10.37034617	1.710929019	2.475634304	0	0	4.282465285	1.601623943	0	0	0.272726587	0	0.032529835	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2222	0	NO	11.47753316	11.5451	0.708651845	3.109382446	0	1.195134023	1.635402876	0.811440225	1.302809309	7.049390445	2.531284549	3.938681747	0	0.003616659	1.775990335	2.868993397	10.37034617	1.710929019	2.475634304	0	0	4.282465285	1.601623943	0	0	0.272726587	0	0.032529835	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2222	NO	"$450 Days 1-12 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$450 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3849	0.0343	0.2729	0.5592	0.2149	0	0.4054	0.2343	1.9015	0.4552	1.0392	0	0.0007	0.4781	0.7117	1.4026	0.1763	0.3225	0	0	0.5239	0.185	0	0	0.0362	0	0.0033	0	0	0											9.3418	0	NO	3.06474817	11.93	0.742980307	3.382245936	0.559181305	1.410046044	1.635402876	1.216805022	1.537144053	8.950849252	2.986466533	4.977836664	0	0.004267016	2.254084816	3.58066652	11.77290991	1.887190041	2.798100515	0	0	4.806374707	1.786652435	0	0	0.308919811	0	0.03582881	0	0	0	0	0	0	0	0	0	0	0	0	0	68.564
H1286_003_0	2012	3																															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	671.9526942	98.34176506	693.9361235	460.8938153	75.41124245	8.827688813	7.873180182	258.9288135	47.61056349	13.89680633	26.62261023	0	0.013915171	12.7012234	4600.26049	3611.275297	539.6505193	752.8083001	0	0	20.36246162	616.1817036	0	0	53.44599448	192.0497252	14.57204327	5.307903434	134.5166316	0											3900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	64.08644485	0	200	0.2	0.114750881	63.08468421	0.16	0.125760399	0.176850076	0	0.2	0.146474208	6.448589066	31.76815827	38.5	35	0	0	0.2	34.10561299	0	0	35	0	35	0	0	0											YES	171.7528781	89.95719944	52.87825651	0	165.0216567	0.165021657	0.094681902	52.07164329	0.132017325	0.103765947	0.145920463	0	0.165021657	0.120857082	6.261104281	30.84814484	37.38065992	33.98241811	0	0	0.165021657	28.14082379	0	0	35	0	35	0	0	0											4900	9.6175	0.737212481	3.057844362	0	1.03704068	1.456759833	0.745447678	1.123570734	6.285419252	1.442015264	3.884783612	0	0.002296305	1.535032802	2.400225888	9.283428619	1.681041045	2.131853867	0	0	3.360247152	1.444988396	0	0	0.155884151	0	0.042501793	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4251	0	NO	8.035832225	9.6175	0.737212481	3.057844362	0	1.03704068	1.456759833	0.745447678	1.123570734	6.285419252	1.442015264	3.884783612	0	0.002296305	1.535032802	2.400225888	9.283428619	1.681041045	2.131853867	0	0	3.360247152	1.444988396	0	0	0.155884151	0	0.042501793	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4251	NO	"$450 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$450 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3227	0.0354	0.2642	0.493	0.1901	0	0.3573	0.206	1.7285	0.2644	1.0472	0	0.0004	0.4211	0.6096	1.2625	0.1736	0.2783	0	0	0.4191	0.1703	0	0	0.0207	0	0.0056	0	0	0											8.2699	0	NO	2.202778192	9.9401	0.772568925	3.322085946	0.492999751	1.227163949	1.456759833	1.10273851	1.329610656	8.013901766	1.706383539	4.932008223	0	0.002717292	1.956157359	3.009790949	10.54588812	1.854603082	2.410150073	0	0	3.779358059	1.615290213	0	0	0.176571352	0	0.048071855	0	0	0	0	0	0	0	0	0	0	0	0	0	59.695
H1286_008_0	2012	5																															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	753.1263391	100.8358398	598.2079075	270.4093114	80.05306948	8.927423914	8.545774257	298.4872714	54.46315458	15.01964746	32.04081205	0	0.009423086	30.86221689	5348.681048	3571.886327	552.1595196	748.1256041	0	0	15.3655754	668.7723574	0	0	52.5594026	0	10.00238958	0	113.808898	0											4250	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-45 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	71.83606538	0	200	0.2	0.108689305	63.68015654	0.16	0.199872861	0.174449193	0	0.2	0.145999831	10.24956215	32.04135836	38.5	35	0	0	0.2	33.94843734	0	0	35	0	35	0	0	0											YES	155.2095079	81.29245234	58.10262386	0	161.7644941	0.161764494	0.087910352	51.52478194	0.129411595	0.161661661	0.141098427	0	0.161764494	0.118087944	9.921369605	31.01940513	37.26722413	33.87929467	0	0	0.161764494	27.45825895	0	0	35	0	35	0	0	0											5500	9.741	0.683099392	2.896454086	0	1.079145357	1.444140213	0.751262023	1.281624298	7.048163717	2.428101157	4.520908192	0	0.001524321	3.644455747	4.422186798	9.233149088	1.714787714	2.112163982	0	0	2.485604531	1.530277047	0	0	0.153298258	0	0.029173636	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2006	0	NO	9.921375813	9.741	0.683099392	2.896454086	0	1.079145357	1.444140213	0.751262023	1.281624298	7.048163717	2.428101157	4.520908192	0	0.001524321	3.644455747	4.422186798	9.233149088	1.714787714	2.112163982	0	0	2.485604531	1.530277047	0	0	0.153298258	0	0.029173636	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2006	NO	"$325 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-32 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.285	0.0319	0.254	0.3055	0.2033	0	0.3906	0.2414	1.9914	0.4574	1.2529	0	0.0003	1.0287	0.6007	1.1488	0.1778	0.2492	0	0	0.3185	0.1667	0	0	0.0183	0	0.0035	0	0	0											9.1258	0	NO	2.484140655	10.026	0.714994186	3.150468337	0.305460298	1.282415175	1.444140213	1.141849964	1.523073766	9.039571472	2.885462788	5.773803449	0	0.001811445	4.673160459	5.022885239	10.38199638	1.892554192	2.36132671	0	0	2.804129327	1.69699678	0	0	0.171607886	0	0.032658075	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3264
H1286_804_0	2012	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	198.88657	7.166838	27.45518077	565.5477047	3.609392575	8.562774406	9.480305398	15.75039644	56.54942399	16.21551217	28.39746091	0	0.023209948	15.59267426	31.61465333	63.87982425	3.170658	7.605275986	0	0	27.34767673	7.306739082	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077394043	0.077394043	0.148437634	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06600597	0.06600597	0.126595919	0	0.191039732	0.191039732	0.191039732	0.191039732	0.191039732	0.191039732	0.191039732	0	0.191039732	0.191039732	0.191039732	0.191039732	0.191039732	0.191039732	0	0	0.191039732	0.191039732	0	0	0	0	0	0	0	0												13.1277	0.473054092	3.475713847	0	0.68953739	1.635830127	1.811115002	3.008951514	10.8031868	3.097807099	5.425043321	0	0.004434022	2.978820311	6.039654899	12.2035845	0.605721654	1.452909886	0	0	5.224492833	1.395877476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4534	150	YES	12.67299166	13.1277	0.473054092	3.475713847	0	0.68953739	1.635830127	1.811115002	3.008951514	10.8031868	3.097807099	5.425043321	0	0.004434022	2.978820311	6.039654899	12.2035845	0.605721654	1.452909886	0	0	5.224492833	1.395877476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4534	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.3141	0.0113	0.2145	0	0.1656	0.3929	0.435	0.7226	2.5945	0.744	1.3029	0	0.0011	0.7154	0.5799	1.3293	0.066	0.1583	0	0	0.5691	0.152	0	0	0	0	0	0	0	0											10.4683	150	YES	0	13.4418	0.4843739	3.690207641	0	0.855134582	2.02868609	2.246066845	3.731572112	13.39764712	3.841766983	6.727905143	0	0.005498883	3.694204692	6.619599067	13.53284336	0.671699062	1.611166121	0	0	5.793563615	1.547921533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9217
H1291_001_0	2012	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		V	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						0	NO	1171.51	121.66	475.06	895.26	1.38	12.15	7.38	355.48	32.06	14.26	12.63	3.07	0.11	24.5	2748.25	2873.87	107.33	1.55		1406.98	12.15	0		3.57	0.79				3.23	1.09	1657.28	409.8	242.77	0	399.79							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.24553	0.25	0.242042	0.217568	0.2	0.228225	15	38.82793	40	0.25		0	0.2	0		0	0				0	0	0	0	34.745464	0	40						NO	137.869308	97.826982	26.195029	0	0.176253	0.176253	0.176253	57.282095	0.216376	0.220316	0.213303	0.191735	0.176253	0.201127	13.218945	34.217618	35.25052	0.220316		0	0.176253	0		0	0				0	0	0	0	30.619892	0	35.25052							13.4596	0.991802553	1.03701754	0	0.24322914	2.14147395	1.30074714	1.696886594	6.93701456	3.14170616	2.69401689	0.58862645	0.01938783	4.9276115	3.0274138	8.19474882	0.315286526	0.3414898	0	0	2.14147395	0	0	0	0	0	0	0	0	0	0	0	0.619465932	0	1.174400449	0	0	0	0	0	54.9934	0	NO	10.281161	13.4596	0.991802553	1.03701754	0	0.24322914	2.14147395	1.30074714	1.696886594	6.93701456	3.14170616	2.69401689	0.58862645	0.01938783	4.9276115	3.0274138	8.19474882	0.315286526	0.3414898	0	0	2.14147395	0	0	0	0	0	0	0	0	0	0	0	0.619465932	0	1.174400449	0	0	0	0	0	54.9934	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						5000	5.3518	0.3944	0.4122	0	2.2258	1.2949	0.7868	0.6398	2.6407	1.1958	1.0253	0.231	0.0076	1.8758	1.1953	3.2355	0.1245	0.1304		0	0.8874	0			0				0	0	0	0	0.2446	0	0.4637						24.3631	0	NO	4.450491	18.8114	1.386174553	1.44925954	0	2.46898314	3.43640195	2.08758114	2.336638594	9.57768856	4.33749116	3.71928589	0.81964045	0.02699183	6.8034545	4.2226958	11.43020082	0.439773526	0.4718728	0	0	3.02891695	0	0	0	0	0	0	0	0	0	0	0	0.864045932	0	1.638081449	0	0	0	0	0	79.3565
H1291_003_0	2012	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			V				O	O	O	V									0	0	0	0	0	0.40960943	0.248890169	0	1.430358082	0.480903906	0.646226532	0.103459116	0.003822777	0.826376589	0.855049694	1.459309347	0.032591896	0.148871394		0	0.409819129	0			0				0	0	0	0									7.0553	NO	213.16	6.41	27.5	895.26	1.38	12.15	7.38	355.48	42.41	15.48	19.16	3.07	0.11	24.5	25.35	43.27	0.97	4.41		1406.98	12.15	0			0.79				3.23	1.09	1657.28	130.3										Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									162	YES	0.0884	0.0884	0.182	0	0.2	0.2	0.2	65	0.2	0.184203	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	0.071506	0.071506	0.124403	0	0.182744	0.182744	0.182744	59.39167	0.182744	0.168309	0.182744	0.182744	0.182744	0.182744	0.182744	0.182744	0.182744	0.182744		0	0.182744	0			0				0	0	0	0										15.2422	0.45835346	3.4210825	0	0.25218672	2.2203396	1.34865072	1.759379238	7.75017304	2.60542332	3.50137504	0.56102408	0.02010184	4.477228	4.6325604	7.90733288	0.17726168	0.80590104	0	0	2.2203396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3609	0	NO	9.093477	15.2422	0.45835346	3.4210825	0	0.25218672	2.62994903	1.597540889	1.759379238	9.180531122	3.086327226	4.147601572	0.664483196	0.023924617	5.303604589	5.487610094	9.366642227	0.209853576	0.954772434	0	0	2.630158729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4162	YES	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit									6700	6.1082	0.1829	1.3616	0	2.3017	1.6075	0.9768	0.6616	3.6085	1.1876	1.644	0.2643	0.0094	2.0407	2.2985	3.9229	0.0876	0.3887		0	1.1017	0							0	0	0	0									29.7542	0	NO	4.037981	21.3504	0.64128046	4.7826475	0	2.55391972	4.23746503	2.574312889	2.420970238	12.78903812	4.273880226	5.791607572	0.928820196	0.033364617	7.344273589	7.786137094	13.28952823	0.297466576	1.343494434	0	0	3.731825729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1704
H1291_007_0	2012	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			V				O	O	O	V									0	0	0	0	0	0.459722256	0.213821259	0	1.553944483	0.410049914	0.63724838	0.099248853	0.006140192	0.760127414	0.836948842	1.45054664	0.03663435	0.1329782		0	0.430156808	0			0				0	0	0	0									7.0276	NO	209.62	8.38	31.94	841.16	1.52	13.05	6.07	402.04	44.12	12.88	18.09	2.82	0.17	21.58	23.76	41.18	1.04	3.78		1298.02	12.21	0			0.79				3.23	1.09	2281.16	125.36										Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									162	YES	0.0884	0.0884	0.182	0	0.2	0.2	0.2	65	0.2	0.180761	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	0.071433	0.071433	0.118477	0	0.182972	0.182972	0.182972	59.4659	0.182972	0.165371	0.182972	0.182972	0.182972	0.182972	0.182972	0.182972	0.182972	0.182972		0	0.182972	0			0				0	0	0	0										14.9738	0.59860854	3.78415538	0	0.27811744	2.3877846	1.11064004	1.99230587	8.07272464	2.12997848	3.30996348	0.51598104	0.03110524	3.94853576	4.34741472	7.53478696	0.19029088	0.69163416	0	0	2.23408812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1319	0	NO	9.335795	14.9738	0.59860854	3.78415538	0	0.27811744	2.847506856	1.324461299	1.99230587	9.626669123	2.540028394	3.94721186	0.615229893	0.037245432	4.708663174	5.184363562	8.9853336	0.22692523	0.82461236	0	0	2.664244928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1595	YES	8% Coins	8% Coins	"18% Coins(Days 1-8), 18% (Days 9-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit									6700	6.0018	0.2387	1.5068	0	2.5337	1.7465	0.8123	0.7493	3.7923	0.9802	1.576	0.2432	0.0147	1.8171	2.1779	3.7747	0.0953	0.3365		0	1.1194	0							0	0	0	0									29.5163	0	NO	4.150939	20.9756	0.83732554	5.29098438	0	2.81182844	4.594003856	2.136774299	2.74160287	13.41896812	3.520236394	5.52321586	0.858397893	0.051923432	6.525718174	7.362295562	12.7599866	0.32225623	1.16109836	0	0	3.783610928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6758
H1302_001_0	2012	10																															D	D	D			Coin	Coin	V	V	Coin	Coin		Coin	O	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	395.6665987	0	108.9941236	0	0	8.763324265	5.93767739	335.8484514	314.4969643	5.923433263	12.88276169	0	0.030112264	71.58204009	2848.975816	2896.166774	225.5679368	1249.634678	9.097469885	6859.607557	20.24469193	0	0	0	284.3287859	0	0	0	0	0											3400	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for IP Med/Surg (non-cvd); 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 Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $60/Visit for ER (Worldwide); $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 - Complex Diagnostic; 10% Coinsurance for OP Rad - X-Ray; 10% Coinsurance for OP Rad - Therapeutic; PBP 8b	$20/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for Cardiac Rehab; $25/Visit for Pulmonary Rehabilitation Services; $25/Visit for CORF; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$20/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; 10% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 - Complex Diagnostic; 10% Coinsurance for Phys Rad - X-Ray; 10% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$20/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	$100/Year Max; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	125	0	50	0	0	0.1	0.1	58.95842727	175	0.1	0.1	0	0.2	25	20	20.70483861	25	25	0.1	20	0.2	0	0	0	25	0	0	0	0	0											NO	117.0185531	0	46.80742124	0	0	0.093614842	0.093614842	55.19383882	163.8259743	0.093614842	0.093614842	0	0.187229685	23.40371062	18.81129506	19.39448171	23.40371062	23.40371062	0.093968919	18.7234952	0.187229685	0	0	0	23.40371062	0	0	0	0	0												3.8584	0	0.425144488	0	0	0.820377221	0.555854734	1.544730441	4.2935643	0.554521272	1.206017706	0	0.00563791	0.139607113	4.466077059	4.68080446	0.439927226	2.437174033	0.854879411	10.70298577	3.790407293	0	0	0	0.554529052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3306	0	NO	2.77	3.8584	0	0.425144488	0	0	0.820377221	0.555854734	1.544730441	4.2935643	0.554521272	1.206017706	0	0.00563791	0.139607113	4.466077059	4.68080446	0.439927226	2.437174033	0.854879411	10.70298577	3.790407293	0	0	0	0.554529052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3306	YES	$150/Days 1-10 for IP Med/Surg; $150/Days 1-10 for IP Med/Surg (non-cvd); 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 Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$60/Case for OP ER; $60/Case for ER (Worldwide); $25/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	25% Coinsurance for OP Lab; PBP 8a	25% Coinsurance for OP Rad - General; 25% Coinsurance for OP Rad - Complex Diagnostic; 25% Coinsurance for OP Rad - X-Ray; 25% Coinsurance for OP Rad - Therapeutic; PBP 8b	25% Coinsurance for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for Cardiac Rehab; $30/Visit for Pulmonary Rehabilitation Services; $30/Visit for CORF; 25% Coinsurance for OP - Other; 25% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$30/Visit for PCP OV; PBP 7a, 14a-b"	"$30/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 - Complex Diagnostic; 25% Coinsurance for Phys Rad - X-Ray; 25% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"17% Coinsurance for SCP - IP/OP Surg; $30/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"25% Coinsurance for Blood; PBP 9d, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$30/Visit for Routine Eye Exams (non-cvd); PBP 17a	$50/Year Max; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-b											3400	0.0184	0	0.2234	0.0074	0.8922	0.1593	0.1492	0.0761	0.8775	0.0894	0.1642	0	0	0.1708	0.7757	1.43	0.2091	0.7874	0.2563	2.9199	0.1197	0	0	0	0.0299	0	0	0	0	0											9.356	0	NO	0.64	3.8768	0	0.648591775	0.00739568	0.89220743	0.979675515	0.705057491	1.620879871	5.171054501	0.643887896	1.370243633	0	0.00563791	0.310382122	5.241756224	6.110825412	0.648979367	3.224600976	1.111224894	13.6228505	3.910137922	0	0	0	0.584407672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6866
H1302_004_0	2012	5																															D	D	D			Coin	Coin	V	V	Coin	Coin		Coin	O	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	528.315094	0	104.0529376	0	0	13.87537965	3.671512119	338.4376516	352.9758261	9.229279784	16.40156756	0	0.006472516	46.25144129	2687.266064	3344.358306	118.0073237	828.9585468	8.109202467	3637.961923	17.48533805	0	0	0	81.78739348	0	0	0	0	0											3400	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for IP Med/Surg (non-cvd); 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 Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for ER (Worldwide); $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 - Complex Diagnostic; 10% Coinsurance for OP Rad - X-Ray; 10% Coinsurance for OP Rad - Therapeutic; PBP 8b	$20/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for Cardiac Rehab; $25/Visit for Pulmonary Rehabilitation Services; $25/Visit for CORF; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$20/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; 10% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 - Complex Diagnostic; 10% Coinsurance for Phys Rad - X-Ray; 10% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$20/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	$100/Year Max; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	125	0	50	0	0	0.1	0.1	49.04722801	175	0.1	0.1	0	0.2	25	20	20.69543634	25	25	0.1	20	0.2	0	0	0	25	0	0	0	0	0											NO	118.3040919	0	47.32163675	0	0	0.094643274	0.094643274	46.41990215	165.6257286	0.094643274	0.094643274	0	0.189286547	23.66081838	18.98445045	19.59246513	23.66081838	23.66081838	0.094837624	18.92878973	0.189286547	0	0	0	23.66081838	0	0	0	0	0												5.2085	0	0.41032961	0	0	1.313211351	0.347483926	1.309186889	4.871823199	0.873489251	1.552298045	0	0.00122516	0.091195579	4.251355787	5.460351957	0.232679154	1.634486468	0.769057492	5.738518025	3.309739262	0	0	0	0.161263055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5362	0	NO	2.11	5.2085	0	0.41032961	0	0	1.313211351	0.347483926	1.309186889	4.871823199	0.873489251	1.552298045	0	0.00122516	0.091195579	4.251355787	5.460351957	0.232679154	1.634486468	0.769057492	5.738518025	3.309739262	0	0	0	0.161263055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5362	YES	$150/Days 1-10 for IP Med/Surg; $150/Days 1-10 for IP Med/Surg (non-cvd); 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 Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for ER (Worldwide); $25/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	25% Coinsurance for OP Lab; PBP 8a	25% Coinsurance for OP Rad - General; 25% Coinsurance for OP Rad - Complex Diagnostic; 25% Coinsurance for OP Rad - X-Ray; 25% Coinsurance for OP Rad - Therapeutic; PBP 8b	25% Coinsurance for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for Cardiac Rehab; $30/Visit for Pulmonary Rehabilitation Services; $30/Visit for CORF; 25% Coinsurance for OP - Other; 25% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$30/Visit for PCP OV; PBP 7a, 14a-b"	"$30/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 - Complex Diagnostic; 25% Coinsurance for Phys Rad - X-Ray; 25% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"17% Coinsurance for SCP - IP/OP Surg; $30/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"25% Coinsurance for Blood; PBP 9d, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$30/Visit for Routine Eye Exams (non-cvd); PBP 17a	$50/Year Max; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-b											3400	0.1058	0	0.3768	0.0617	0.8272	0.1859	0.1072	0.0571	1.394	0.1331	0.1581	0.0001	0	0.3891	0.6802	1.3369	0.0823	0.4813	0.2061	1.4656	0.1727	0.0652	0	0	0.0099	0	0	0	0	0											8.2961	0	NO	0.48	5.3142	0	0.787121325	0.061696131	0.827198704	1.499144781	0.454642426	1.366258159	6.265777999	1.00663217	1.710436598	0.000102913	0.00122516	0.480282986	4.931529441	6.797268114	0.314947692	2.115738874	0.975169622	7.204156068	3.482435564	0.065154186	0	0	0.171152688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8323
H1303_001_0	2012	4																															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	715.9677132	108.8827466	692.8451789	188.9011514	101.8041663	10.09139356	8.923301764	517.1810076	59.51864487	16.87538103	28.51978872	0	0.021968362	51.74869165	3949.636534	2087.906484	495.8478218	732.3242783	0	0	3.002689984	565.5929318	0	0	32.94883721	0	9.500304291	10.659	676.653417	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	61.46081763	0	200	0.2	0.09711474	64.76541323	0.16	0.15603178	0.185744215	0	0.2	0.146102452	9.233990715	27.78618726	38.5	30	0	0	0.2	29.41509886	0	0	30	0	30	0	0	0											NO	149.1197525	79.62502303	48.9797983	0	159.3854432	0.159385443	0.077393379	51.6269095	0.127508355	0.124345972	0.14802462	0	0.159385443	0.116433021	8.924787762	26.85634794	37.21081594	28.99544099	0	0	0.159385443	23.44169285	0	0	30	0	30	0	0	0												8.8971	0.722482601	2.827951426	0	1.352175181	1.608421236	0.69060448	2.225038089	7.589124474	2.098385659	4.221630887	0	0.003501437	6.025256487	2.937472317	4.67279525	1.537575169	1.76950545	0	0	0.478585074	1.104871315	0	0	0.082372093	0	0.023750761	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8686	0	NO	10.53071437	8.8971	0.722482601	2.827951426	0	1.352175181	1.608421236	0.69060448	2.225038089	7.589124474	2.098385659	4.221630887	0	0.003501437	6.025256487	2.937472317	4.67279525	1.537575169	1.76950545	0	0	0.478585074	1.104871315	0	0	0.082372093	0	0.023750761	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8686	YES	"$395 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-46 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											7900	0.3601	0.0474	0.4094	0.1205	0.0787	0.234	0.1242	0.1295	0.6625	0.1221	0.3584	0	0.0002	0.5256	1.5753	1.99	0.5189	0.7047	0	0	0.2144	0.4405	0	0	0.0328	0	0.0094	0	0	0											8.6589	0	NO	1.139686008	9.2572	0.769872848	3.237396252	0.120525272	1.430873207	1.84245078	0.814768674	2.354537661	8.251667087	2.220513925	4.580009509	0	0.003705225	6.550855896	4.512814057	6.662827927	2.056497064	2.474243551	0	0	0.693016049	1.545407002	0	0	0.115178295	0	0.033111847	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5275
H1304_001_0	2012	8																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	454.4692033	6.03911964	915.9425741	20.25758577	0	16.80235961	0.996483557	281.2651592	323.9697619	0	22.69640032	0	0	359.2535468	3359.659893	2689.115745	74.3318972	1360.59161	19.74530225	0	56.89701776	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	22.17666539	0.043145914	0	0.111107702	0.152560586	65	175	0	0.097250232	0	0	35	15	34.13274736	35	35	0.082556934	0	0.121854174	0	0	0	0	0	0	0	0	0											NO	181.56978	181.56978	20.13306129	0.039169971	0	0.100869005	0.138501961	59.0101785	158.8735575	0	0.088288516	0	0	31.7747115	13.6177335	30.98737715	31.7747115	31.7747115	0.074949222	0	0.110625178	0	0	0	0	0	0	0	0	0												6.8765	0.091376802	1.536727332	0.793489038	0	1.694837302	0.138014926	1.383125604	4.289185717	0	2.003831497	0	0	0.951264817	3.812579423	6.94405365	0.196822882	3.602700491	1.479895044	0	6.294242725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0886	0	NO	4.392795744	6.8765	0.091376802	1.536727332	0.793489038	0	1.694837302	0.138014926	1.383125604	4.289185717	0	2.003831497	0	0	0.951264817	3.812579423	6.94405365	0.196822882	3.602700491	1.479895044	0	6.294242725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0886	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.5664	0.0836	0.1531	0.6358	1.0582	0.1818	0.0389	0.1469	0.6783	0	0.2564	0	0	0.2454	0.4565	0.4222	0.2512	0.1637	0.1097	0	0.3674	0	0	0.661	0	0	0	0	0	0											6.4764	0	NO	0.537204256	7.4429	0.174955406	1.689799781	1.429337506	1.058179106	1.876652491	0.176898431	1.529982755	4.967458837	0	2.260210384	0	0	1.196623494	4.269090943	7.366277802	0.448054279	3.766360735	1.589600349	0	6.661645427	0	0	0.66104753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.565
H1304_002_0	2012	8																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	1.285037526	0.021726904	0.243168895	0.126378952	0.002458212	0.115272602	0.007935063	0.120010088	0.338213172	0.031619518	0.163730275	0	0	0.144102744	0.29690634	0.60842619	0.006594193	0.080833264	0.127531128	0	0.09795532	0.009102189	0	0	0	0	0	0	0	0											3.827	YES	546.2491547	9.598410273	981.9007508	18.38027962	0.556187481	16.76499623	1.154058326	302.389615	415.5566298	0	23.81257469	0	0	380.3915392	4058.621116	3064.080286	90.37718661	1485.582452	18.54784948	0	42.48899579	0	0	0	0	0	0	0	0	0												$200/Admit for IP Med/Surg; PBP 1a	$200/Admit for IP MH/SA; PBP 1a	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	20.32483817	0.1	100	0.123410776	0.19543932	65	175	0	0.087252561	0	0	35	15	34.12178924	35	35	0.08397079	0	0.185527843	0	0	0	0	0	0	0	0	0											NO	174.7465806	174.7465806	17.75847986	0.08737329	87.3732903	0.107828055	0.170761764	56.79263869	152.903258	0	0.076235434	0	0	30.5806516	13.10599354	29.81332997	30.5806516	30.5806516	0.073368042	0	0.162101781	0	0	0	0	0	0	0	0	0												7.9546	0.139774115	1.453088725	1.605945507	0.004049661	1.807736942	0.197069036	1.431125346	5.294996883	0	1.815361956	0	0	0.969385094	4.432688512	7.612536385	0.230316105	3.78583995	1.360819405	0	6.8875419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9829	0	NO	7.052425832	9.2396	0.161501018	1.696257621	1.732324459	0.006507873	1.923009544	0.205004099	1.551135434	5.633210055	0.031619518	1.979092232	0	0	1.113487838	4.729594853	8.220962575	0.236910298	3.866673215	1.488350533	0	6.98549722	0.009102189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8099	YES	$300/Admit for IP Med/Surg; PBP 1a	$300/Admit for  IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.5372	0.1395	0.2358	0.7233	1.2747	0.129	0.0435	0.1555	0.7872	0.018	0.2549	0	0	0.434	0.9185	0.5624	0.322	0.0969	0.115	0	0.2069	0	0	1.3379	0	0	0	0	0	0											8.2921	0	NO	0.867574168	9.7769	0.300954063	1.932035273	2.455580892	1.281218296	2.051979987	0.248509168	1.706621027	6.420371207	0.049665807	2.233988146	0	0	1.547450342	5.648075483	8.783333098	0.558941067	3.963615757	1.603352849	0	7.192419052	0.009102189	0	1.337896632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.102
H1304_004_0	2012	7																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	620.2496633	4.863558875	1036.775829	26.5929448	0.623170168	20.38849399	1.033717364	317.4148517	510.5864882	0	26.25955631	0	0	576.5802781	4951.603404	3995.464699	101.3568878	2114.594271	25.22611342	0	84.72129619	0	0	0	0	0	0	0	0	0												$150/Admit for IP Med/Surg; PBP 1a	$150/Admit for IP MH/SA; PBP 1a	"$0/Days 1-10, $30/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $10/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"	See i.2.; 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	NO	150	150	13.40113729	0	100	0.1	0.1	65	100	0	0.107204517	0	0	25	10	24.31188607	25	25	0.081415527	0	0.086792225	0	0	0	0	0	0	0	0	0											NO	129.9290955	129.9290955	11.60798431	0	86.61939699	0.086619397	0.086619397	56.30260804	86.61939699	0	0.092859906	0	0	21.65484925	8.661939699	21.05880911	21.65484925	21.65484925	0.070521639	0	0.075178902	0	0	0	0	0	0	0	0	0												6.7157	0.052659817	1.002906463	0	0.004498219	1.766039055	0.089539975	1.489273665	3.68555781	0	2.438459937	0	0	1.040479917	3.574207508	7.011644034	0.182905677	3.815935013	1.778986854	0	6.369254002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0181	0	NO	6.448497607	6.7157	0.052659817	1.002906463	0	0.004498219	1.766039055	0.089539975	1.489273665	3.68555781	0	2.438459937	0	0	1.040479917	3.574207508	7.011644034	0.182905677	3.815935013	1.778986854	0	6.369254002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0181	YES	$200/Admit for IP Med/Surg; PBP 1a	$200/Admit for  IP MH/SA; PBP 1b	"$20/Days 1-10, $40/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; PBP 4a, 4b"	"$200/Case for OP Surg; $100/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"	See i.2.; 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												0.7698	0.0429	0.1369	0.6458	1.0132	0.2672	0.0397	0.1724	0.6677	0	0.3044	0	0	0.134	0.0353	0.3809	0.2113	0.2573	0.1221	0	0.5847	0	0	0	0	0	0	0	0	0											5.7854	0	NO	0.781502393	7.4855	0.095521997	1.139794993	0.645799367	1.017679339	2.033200636	0.129193167	1.661713715	4.353231326	0	2.7428564	0	0	1.17446882	3.609482174	7.392516836	0.394223263	4.073191204	1.901101054	0	6.953951336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8034
H1304_803_0	2012	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	201.4293116	2.886785244	36.24991447	22.128793	0.384107989	18.35176334	1.088094979	18.85122869	54.73756835	6.693822562	24.78728588	0	0	24.70190158	45.61946199	102.3420563	0.975538971	13.7588686	21.56809019	0	62.16851521	1.7168907	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	NO	0.084393403	0.084393403	0.163773971	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.077968095	0.077968095	0.151305007	0	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0	0	0	0	0	0	0	0												15.7051	0.225077145	5.484793575	0	0.079489503	3.797818804	0.225176594	3.90118102	11.32770527	1.385257903	5.129622624	0	0	5.11195271	9.440752225	21.17925012	0.201883611	2.847338914	4.463423868	0	12.86550789	0.355303175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7266	0	NO	8.619363899	15.7051	0.225077145	5.484793575	0	0.079489503	3.797818804	0.225176594	3.90118102	11.32770527	1.385257903	5.129622624	0	0	5.11195271	9.440752225	21.17925012	0.201883611	2.847338914	4.463423868	0	12.86550789	0.355303175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7266	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												0.8351	0.0606	0.987	0	1.6909	0.2436	0.0402	0.5383	1.3077	0.611	0.3944	0	0	1.5893	0.81	1.9521	0.2026	0.0793	0.2352	0.0005	0.6934	0.0082	0	0	0	0	0	0	0	0											12.2795	0	NO	0.940636101	16.5401	0.285646585	6.471794042	0	1.77040836	4.041426794	0.265395781	4.43949052	12.63544787	1.996233303	5.524058629	0	0	6.701236818	10.25075427	23.13137798	0.404467536	2.926649121	4.698593823	0.000545235	13.55889169	0.363551412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0061
H1304_804_0	2012	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	201.4293116	2.886785244	36.24991447	22.128793	0.384107989	18.35176334	1.088094979	18.85122869	54.73756835	6.693822562	24.78728588	0	0	24.70190158	45.61946199	102.3420563	0.975538971	13.7588686	21.56809019	0	62.16851521	1.7168907	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	NO	0.084393403	0.084393403	0.163773971	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.077968095	0.077968095	0.151305007	0	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0.206945716	0	0	0	0	0	0	0	0												15.7051	0.225077145	5.484793575	0	0.079489503	3.797818804	0.225176594	3.90118102	11.32770527	1.385257903	5.129622624	0	0	5.11195271	9.440752225	21.17925012	0.201883611	2.847338914	4.463423868	0	12.86550789	0.355303175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7266	0	NO	8.619363899	15.7051	0.225077145	5.484793575	0	0.079489503	3.797818804	0.225176594	3.90118102	11.32770527	1.385257903	5.129622624	0	0	5.11195271	9.440752225	21.17925012	0.201883611	2.847338914	4.463423868	0	12.86550789	0.355303175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7266	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												0.8351	0.0606	0.987	0	1.6909	0.2436	0.0402	0.5383	1.3077	0.611	0.3944	0	0	1.5893	0.81	1.9521	0.2026	0.0793	0.2352	0.0005	0.6934	0.0082	0	0	0	0	0	0	0	0											12.2795	0	NO	0.940636101	16.5401	0.285646585	6.471794042	0	1.77040836	4.041426794	0.265395781	4.43949052	12.63544787	1.996233303	5.524058629	0	0	6.701236818	10.25075427	23.13137798	0.404467536	2.926649121	4.698593823	0.000545235	13.55889169	0.363551412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0061
H1350_001_0	2012	10																															A	A	D		T			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	205.530706	0	293.8661728	0	147.8684131	0	0	394.3106909	615.6903695	0	0	0	0	74.2581427	4588.673933	6090.98132	264.1008982	2080.937672	0	24.16620468	63.44509908	0	0	0	426.6072769	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg (non-cvd); 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"	"$60/Visit for OP ER; $60/Visit for ER (Worldwide); $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	$25/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 7d, 14a"	"$25/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	$100/Year Max; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	100	0	50	0	150	0	0	58.11568105	175	0	0	0	0	15.13168095	15	24.52726084	25	15	0	25	0.1	0	0	0	25	0	0	0	0	0											NO	98.32801552	0	46.63323112	0	139.8996934	0	0	54.20243972	172.0740272	0	0	0	0	14.11278349	14.0152191	22.88253713	23.31661556	13.98996934	0	23.3177084	0.098328016	0	0	0	23.31661556	0	0	0	0	0												1.6841	0	1.141994096	0	1.723895471	0	0	1.781050121	8.828693447	0	0	0	0	0.087332424	5.359272544	11.61475885	0.513161593	2.426021185	0	0.046958376	6.238430687	0	0	0	0.828919822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2746	0	NO	2.09	1.6841	0	1.141994096	0	1.723895471	0	0	1.781050121	8.828693447	0	0	0	0	0.087332424	5.359272544	11.61475885	0.513161593	2.426021185	0	0.046958376	6.238430687	0	0	0	0.828919822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2746	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	1.6841	0	1.141994096	0	1.723895471	0	0	1.781050121	8.828693447	0	0	0	0	0.087332424	5.359272544	11.61475885	0.513161593	2.426021185	0	0.046958376	6.238430687	0	0	0	0.828919822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2746
H1350_006_0	2012	5																															A	A	D		T			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	147.6042722	0	186.0018493	0	93.68361338	0	0	279.7683679	444.1080261	0	0	0	0	38.55436626	2941.697324	4632.494968	143.46969	1407.619847	0	25.87231327	32.06272034	0	0	0	378.4371333	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg (non-cvd); 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 ER (Worldwide); $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	$25/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 7d, 14a"	"$25/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	$100/Year Max; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	100	0	50	0	150	0	0	48.49486114	175	0	0	0	0	15.78014184	15	24.47976979	25	15	0	25	0.1	0	0	0	25	0	0	0	0	0											NO	96.84342248	0	48.42171124	0	145.2651337	0	0	46.96408326	173.5625502	0	0	0	0	15.28202943	14.54195017	23.7107452	24.21085562	14.52651337	0	24.21110341	0.0991786	0	0	0	24.21085562	0	0	0	0	0												1.1912	0	0.750543986	0	1.134080219	0	0	1.094922077	6.423376797	0	0	0	0	0.04909908	3.564834658	9.153325654	0.289460329	1.703984045	0	0.052199771	3.179935718	0	0	0	0.7635239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3505	0	NO	0.72	1.1912	0	0.750543986	0	1.134080219	0	0	1.094922077	6.423376797	0	0	0	0	0.04909908	3.564834658	9.153325654	0.289460329	1.703984045	0	0.052199771	3.179935718	0	0	0	0.7635239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3505	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	1.1912	0	0.750543986	0	1.134080219	0	0	1.094922077	6.423376797	0	0	0	0	0.04909908	3.564834658	9.153325654	0.289460329	1.703984045	0	0.052199771	3.179935718	0	0	0	0.7635239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3505
H1350_009_0	2012	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											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 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"No Cost Sharing; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a-b, 14d-e"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$100/Year Max; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H1350_010_0	2012	7																															A	A	D		T			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	159.5680426	0	223.8170149	0	112.6208794	0	0	300.3184781	478.0040366	0	0	0	0	56.5571589	3494.867382	4639.068334	201.146917	1584.902589	0	18.40568358	49.25692354	0	0	0	418.5068375	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg (non-cvd); 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"	"$60/Visit for OP ER; $60/Visit for ER (Worldwide); $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	$25/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 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 7d, 14a"	"$25/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	$100/Year Max; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	100	0	50	0	150	0	0	58.11568105	175	0	0	0	0	15.13168095	15	24.52726084	25	15	0	25	0.1	0	0	0	25	0	0	0	0	0											NO	98.9574866	0	47.84015644	0	143.5204693	0	0	55.60526546	173.1756015	0	0	0	0	14.47803967	14.37008817	23.47210013	23.92007822	14.35204693	0	23.92077282	0.098957487	0	0	0	23.92007822	0	0	0	0	0												1.3159	0	0.892286751	0	1.346950123	0	0	1.391607391	6.898219714	0	0	0	0	0.068236399	4.185129369	9.07405637	0.400954166	1.895549695	0	0.036689848	4.874341351	0	0	0	0.834226357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2141	0	NO	1.03	1.3159	0	0.892286751	0	1.346950123	0	0	1.391607391	6.898219714	0	0	0	0	0.068236399	4.185129369	9.07405637	0.400954166	1.895549695	0	0.036689848	4.874341351	0	0	0	0.834226357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2141	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	0	NO	0	1.3159	0	0.892286751	0	1.346950123	0	0	1.391607391	6.898219714	0	0	0	0	0.068236399	4.185129369	9.07405637	0.400954166	1.895549695	0	0.036689848	4.874341351	0	0	0	0.834226357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2141
H1350_011_0	2012	9																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	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	598.1877915	0	415.2589641	0	130.9626918	16.87413517	7.476645024	345.2299947	560.1901727	9.898875331	18.54890743	0	0.027987813	2867.324013	4095.639055	5324.654057	230.3669301	1707.562923	19.2027731	21.07942238	57.48976933	0	0	0	0	0	0	0	0	0											6700	$265/Days 1-6 for IP Med/Surg; $265/Days 1-6 for IP Med/Surg (non-cvd); PBP 1a	$285/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-20, $100/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for ER (Worldwide); $40/Visit for Urgent Care; PBP 4a, 4b"	"$275/Case for OP Surg; $275/Case for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$100/Case for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for Cardiac Rehab; $40/Visit for Pulmonary Rehabilitation Services; $100/Case for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$45/Visit for OP PT/OT/ST; $45/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$40/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-b											0	NO	265	0	70	0	200	0.2	0.2	63.65906827	275	0.2	0.2	0	0.2	98.63072743	15	38.06931281	40	45	0.2	40	0.2	0	0	0	0	0	0	0	0	0											NO	232.7459871	0	62.59942243	0	175.6573487	0.178855493	0.178855493	55.91091578	245.9263024	0.175657349	0.175657349	0	0.175657349	86.62606043	13.34607449	33.50668746	35.13146975	39.52290347	0.177544133	35.143136	0.178855493	0	0	0	0	0	0	0	0	0												11.6022	0	2.16624761	0	1.917046602	3.018031759	1.337239029	1.60851043	11.48045815	1.738810196	3.258251901	0	0.004916265	20.6987486	4.55505866	14.86762661	0.674427403	5.623987048	3.409339695	0.061733084	10.28236102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3049	0	NO	12.7	11.6022	0	2.16624761	0	1.917046602	3.018031759	1.337239029	1.60851043	11.48045815	1.738810196	3.258251901	0	0.004916265	20.6987486	4.55505866	14.86762661	0.674427403	5.623987048	3.409339695	0.061733084	10.28236102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3049	NO																																										0	0	0	0	0	0	0	0	0	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	11.6022	0	2.16624761	0	1.917046602	3.018031759	1.337239029	1.60851043	11.48045815	1.738810196	3.258251901	0	0.004916265	20.6987486	4.55505866	14.86762661	0.674427403	5.623987048	3.409339695	0.061733084	10.28236102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3049
H1355_001_0	2012	10																															D	D	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	702.4955007	31.01415421	493.7802159	30.32151173	180.1523746	12.05996817	3.932172648	271.5377183	277.5509679	1.16875439	12.51678368	0	0.410309209	320.1811292	0	2626.345295	130.1155448	131.3976115	24.23672139	25.58802384	25.17675015	0.180954497	0	0	0	0	0	0	0	0											3400	1a:  Acute - $150/$0/day for 1-5/6-90	1b:  Psych - $150/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service													150	150	60	0	50	0.2	0.149843636	44.86500525	201.5491254	0	0.163587252	0	0.2	67.99205736	0	34.69460698	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	141.6581107	139.7582506	56.02492617	0	46.76319282	0.186903385	0.139570191	42.34897862	189.5162382	0	0.153179767	0	0.190527663	64.12838174	0	32.69876401	18.76751513	32.58535882	0	33.01085431	0.18687308	0	0	0	0	0	0	0	0	0												8.2928	0.361206995	2.305333345	0	0.702041686	2.25404887	0.548814088	0.958278752	4.383367946	0	1.917318007	0	0.078175255	1.71105814	0	7.156520418	0.203495455	0.356803193	0	0.070390211	4.704856841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0046			2.309159438	8.2928	0.361206995	2.305333345	0	0.702041686	2.25404887	0.548814088	0.958278752	4.383367946	0	1.917318007	0	0.078175255	1.71105814	0	7.156520418	0.203495455	0.356803193	0	0.070390211	4.704856841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0046	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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/16b:  Comprehensive Dental - Non-Routine Svcs - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  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:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service											5100	7.535	0.0537	0.8359	0.542	0.2399	0.7625	0.2604	0.2424	1.812	0.1523	0.5313	0	0.0186	0.3153	1.4056	2.4173	0.0097	0.2596	0.843	1.1464	1.3631	0.0094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7555			8.581512413	15.8279	0.414869982	3.141199749	0.542017774	0.941948618	3.016574144	0.80925985	1.20063628	6.195378258	0.152332958	2.448641769	0	0.096745801	2.026335898	1.40556684	9.573866569	0.213232807	0.616383847	0.842982048	1.216798182	6.067974129	0.009440105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7601
H1355_002_0	2012	8																															A	A	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	460.0232827	108.7493743	567.2081025	9.321524374	54.95632044	7.171817277	10.57677981	100.6601357	14.59525155	4.336354648	10.88892249	0	0.072617821	75.6493695	0	0	3.6259986	0.959319805	15.91609417	4.145313594	6.54259422	0.726454845	0	0	0	0	0	0	0	0											6700	1a:  Acute - $710/admit for 1-90	1b:  Psych - $710/$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 - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/7f:  Routine Footcare - $0/visit/12 Visits/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service													710	710	0	0	0.2	0.2	0.120014537	65	0.2	0	0.136726142	0	0.2	0.028906999	0	0	0	0	0	22.95721604	0.2	0.2	0	0	0	0	0	0	0	0											NO	686.9445977	686.9445977	0	0	0.19350552	0.19350552	0.116117378	62.88929416	0.19350552	0	0.132286316	0	0.19350552	0.02796832	0	0	0	0	0	22.21174019	0.19350552	0.193505521	0	0	0	0	0	0	0	0												26.3342	6.225399599	0	0	10.63435139	1.387786235	1.228147935	0.527537074	2.824261747	0	1.440455442	0	0.014051949	2.115785753	0	0	0	0	0	0.007672886	1.2660281	0.140573023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1463			1.817270002	26.3342	6.225399599	0	0	10.63435139	1.387786235	1.228147935	0.527537074	2.824261747	0	1.440455442	0	0.014051949	2.115785753	0	0	0	0	0	0.007672886	1.2660281	0.140573023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1463	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 - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/7f:  Routine Footcare - 50.0%/12 Visits/14e:  Diabetes Self-Management Training - $0/service/16b:  Comprehensive Dental - Non-Routine Svcs - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 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	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service											10000	2.1621	0	2.9905	0.0213	0.2992	0.0586	0.095	0.0168	0.0796	0.0723	0.0556	0	0.0004	0.4817	0.0465	0.3624	0	0.0045	0.0254	0.0414	0.0363	0.005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8548			7.6778	28.4963	6.225399599	2.990490977	0.021314476	10.93355886	1.446375979	1.32319339	0.544384994	2.903893624	0.072289373	1.496008777	0	0.014472009	2.597528063	0.046516074	0.362381607	0	0.004525767	0.025391902	0.049031594	1.302358231	0.145572533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.001
H1355_801_0	2012	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	246.9447848	2.913711344	54.23769889	40.1370824	7.245398879	11.73058493	2.932934513	7.623467382	36.96563892	4.539206869	18.17304239	0	0.023381163	16.07983194	40.77388171	84.38085783	1.047353719	4.489912607	18.28168918	21.00471829	29.98910343	0.619733947	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067443265	0.067443265	0.145838605	0	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0	0	0	0	0	0	0	0												16.6548	0.196510206	7.909950345	0	1.479803903	2.395860554	0.599024017	1.557020804	7.549880643	0.927089889	3.711671298	0	0.00477538	3.284152944	8.327678062	17.23398875	0.213912049	0.917022004	3.733861372	4.290014204	6.124989534	0.126574772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2385			8.44	16.6548	0.196510206	7.909950345	0	1.479803903	2.395860554	0.599024017	1.557020804	7.549880643	0.927089889	3.711671298	0	0.00477538	3.284152944	8.327678062	17.23398875	0.213912049	0.917022004	3.733861372	4.290014204	6.124989534	0.126574772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2385	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	4.5985	0.0542	2.4115	0	0.4801	0.7769	0.1942	0.5359	2.3564	0.3238	1.0732	0	0.0014	1.153	2.3316	4.9951	0.0638	0.2737	1.154	1.2603	1.8997	0.0453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.983			1.512	21.2532	0.250758885	10.32147895	0	1.959893504	3.172778967	0.793272713	2.092929314	9.906324274	1.250926771	4.784919479	0	0.006198554	4.437112605	10.65931771	22.22911525	0.277755242	1.190703569	4.887875595	5.550336011	8.024739192	0.171843426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2215
H1355_802_0	2012	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	246.9447848	2.913711344	54.23769889	40.1370824	7.245398879	11.73058493	2.932934513	7.623467382	36.96563892	4.539206869	18.17304239	0	0.023381163	16.07983194	40.77388171	84.38085783	1.047353719	4.489912607	18.28168918	21.00471829	29.98910343	0.619733947	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067443265	0.067443265	0.145838605	0	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0.204240502	0	0	0	0	0	0	0	0												16.6548	0.196510206	7.909950345	0	1.479803903	2.395860554	0.599024017	1.557020804	7.549880643	0.927089889	3.711671298	0	0.00477538	3.284152944	8.327678062	17.23398875	0.213912049	0.917022004	3.733861372	4.290014204	6.124989534	0.126574772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2385			8.44	16.6548	0.196510206	7.909950345	0	1.479803903	2.395860554	0.599024017	1.557020804	7.549880643	0.927089889	3.711671298	0	0.00477538	3.284152944	8.327678062	17.23398875	0.213912049	0.917022004	3.733861372	4.290014204	6.124989534	0.126574772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2385	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	4.5985	0.0542	2.4115	0	0.4801	0.7769	0.1942	0.5359	2.3564	0.3238	1.0732	0	0.0014	1.153	2.3316	4.9951	0.0638	0.2737	1.154	1.2603	1.8997	0.0453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.983			1.512	21.2532	0.250758885	10.32147895	0	1.959893504	3.172778967	0.793272713	2.092929314	9.906324274	1.250926771	4.784919479	0	0.006198554	4.437112605	10.65931771	22.22911525	0.277755242	1.190703569	4.887875595	5.550336011	8.024739192	0.171843426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2215
H1365_001_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	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	392.6711686	12.28465937	11.94760406	0	1.936597174	7.566722341	0.384968555	186.2439347	260.9595177	0	7.749717951	0	0	303.7954847	2104.206243	2357.673283	163.0839883	579.945543	1.7183819	3.534236525	3.301263419	0	0	0	0	0	0	0	0	0											3400	"1a - Acute (250.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (250.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/135.00 per day-1-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay (0.00/135.00 per day-1-20/21-100)"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($35 per visit)"	"9a - Outpatient Hospital Services ($325 per visit), 9b - Ambulatory Surgical Center Services ($325 per visit)"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($50 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($25 per service),3 - Intensive Cardiac Rehabilitation Services ($25 per service),3 - Pulmonary Rehabilitation Services ($25 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($35 per visit),9c - Outpatient Substance Abuse Svcs - Group ($25 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7a - Primary Care (min 0.00/ max 20.00 per visit),7a - In-Area Network Urgent Care Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($35 per visit),7f - Podiatry Services ($35 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($35 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 35.00 per visit),17a - Routine Eye Exams - Not covered,18a - Hearing Exams ($35 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($35 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($25 per visit),7h - Psychiatric Services - Individual ($35 per visit),7h - Psychiatric Services - Group ($25 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic/Therapeutic Radiological Services - no cost sharing,8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($35 per visit)	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($35 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($35 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 35.00 per visit),17a - Routine Eye Exams - Not covered"	"17b - Eye Wear (20% coins per service),17b - Contact Lenses - Not covered,17b - Eye Glasses - Not covered,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($35 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	250	250	135	0	150	0.199767736	0.2	50	325	0	0.2	0	0	21.91845774	20	30.15695131	34	20	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	245.2407164	245.2407164	132.4299869	0	147.1444299	0.195964731	0.196192573	49.04814328	318.8129313	0	0.196192573	0	0	21.50119312	19.61925731	29.58284938	33.35273743	19.61925731	0.196192573	24.52407164	0.196192573	0	0	0	0	0	0	0	0	0												8.0249	0.251058222	0.131851754	0	0.023746624	1.48281071	0.075527971	0.761243266	6.933105734	0	1.520437106	0	0	0.544330449	3.440246977	5.812224468	0.453274787	0.94817507	0.337133767	0.007222822	0.647683365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.395	0	NO	0.609269313	8.0249	0.251058222	0.131851754	0	0.023746624	1.48281071	0.075527971	0.761243266	6.933105734	0	1.520437106	0	0	0.544330449	3.440246977	5.812224468	0.453274787	0.94817507	0.337133767	0.007222822	0.647683365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.395	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; 30% Coinsurance for IP Surg; 30% Coinsurance for IP Medical; 30% Coinsurance for IP Medical; PBP 1a	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, 20% Coinsurance for Diabetes Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"30% Coinsurance for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for Renal Dialysis; PBP 12	30% Coinsurance for Partial Hospitalization; PBP 5	No Cost Sharing; PBP 12	"30% Coinsurance for OP PT/OT/ST; PBP 3, 9c, 9d"	"$25/Visit for OV; PBP 4b, 7a, 14b-c"	"30% Coinsurance for OV; 30% Coinsurance for OV; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; 30% Coinsurance for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"30% Coinsurance for OP Psych; 30% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; 30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; PBP 8b	No Cost Sharing; PBP 7g	20% Coinsurance for Part B Rx; 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, 14b"	No Cost Sharing; PBP 13a-13e											5100	3.2891	0.0077	0.1499	0.2958	0.7696	0.3215	0.0243	0.0621	0.937	0	0.9356	0	0	0.0496	0.382	1.013	0.2147	0.1253	0.2237	0.1224	0.1484	0	0	0	0	0	0	0	0	0											9.0716	0	NO	0.176049296	11.314	0.25875467	0.28177581	0.295770608	0.793353813	1.80428077	0.099810543	0.823341306	7.870155235	0	2.455987352	0	0	0.593956695	3.822201147	6.825175166	0.668003071	1.073451651	0.560802654	0.129668062	0.796091916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4666
H1365_002_0	2012	6																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	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	400.1310715	14.43474849	9.86357805	0	2.808909707	6.534158973	0.376275251	200.6143699	266.3787868	0	8.595244369	0	0	267.6853266	2037.463405	2165.009182	197.2164929	549.1154869	1.513930321	3.551668864	4.375305571	0	0	0	0	0	0	0	0	0											3400	"1a - Acute (250.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (250.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/135.00 per day-1-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay (0.00/135.00 per day-1-20/21-100)"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($35 per visit)"	"9a - Outpatient Hospital Services ($325 per visit), 9b - Ambulatory Surgical Center Services ($325 per visit)"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($50 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($25 per service),3 - Intensive Cardiac Rehabilitation Services ($25 per service),3 - Pulmonary Rehabilitation Services ($25 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($35 per visit),9c - Outpatient Substance Abuse Svcs - Group ($25 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7a - Primary Care (min 0.00/ max 20.00 per visit),7a - In-Area Network Urgent Care Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($35 per visit),7f - Podiatry Services ($35 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($35 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 35.00 per visit),17a - Routine Eye Exams - Not covered,18a - Hearing Exams ($35 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($35 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($25 per visit),7h - Psychiatric Services - Individual ($35 per visit),7h - Psychiatric Services - Group ($25 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic/Therapeutic Radiological Services - no cost sharing,8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($35 per visit)	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($35 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($35 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 35.00 per visit),17a - Routine Eye Exams - Not covered"	"17b - Eye Wear (20% coins per service),17b - Contact Lenses - Not covered,17b - Eye Glasses - Not covered,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($35 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	250	250	135	0	150	0.196899961	0.2	50	325	0	0.2	0	0	21.94216977	20	30.18736186	34	20	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	245.7395197	245.7395197	132.6993407	0	147.4437118	0.193544408	0.196591616	49.14790395	319.4613757	0	0.196591616	0	0	21.56823305	19.65916158	29.67291122	33.42057468	19.65916158	0.196591616	24.57395197	0.196591616	0	0	0	0	0	0	0	0	0												8.194	0.295599014	0.109074192	0	0.034513006	1.264649928	0.07397256	0.821647982	7.091477807	0	1.689752979	0	0	0.481124959	3.337901858	5.353510438	0.549257377	0.89959584	0.297626008	0.007273212	0.860148392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3611	0	NO	0.543719882	8.194	0.295599014	0.109074192	0	0.034513006	1.264649928	0.07397256	0.821647982	7.091477807	0	1.689752979	0	0	0.481124959	3.337901858	5.353510438	0.549257377	0.89959584	0.297626008	0.007273212	0.860148392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3611	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; 30% Coinsurance for IP Surg; 30% Coinsurance for IP Medical; 30% Coinsurance for IP Medical; PBP 1a	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, 20% Coinsurance for Diabetes Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"30% Coinsurance for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for Renal Dialysis; PBP 12	30% Coinsurance for Partial Hospitalization; PBP 5	No Cost Sharing; PBP 12	"30% Coinsurance for OP PT/OT/ST; PBP 3, 9c, 9d"	"$25/Visit for OV; PBP 4b, 7a, 14b-c"	"30% Coinsurance for OV; 30% Coinsurance for OV; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; 30% Coinsurance for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$34/Visit for OP Psych; $34/Visit for OP Substance Abuse; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; 30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; PBP 8b	No Cost Sharing; PBP 7g	20% Coinsurance for Part B Rx; 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, 14b"	No Cost Sharing; PBP 13a-13e											5100	3.0321	0.0075	0.172	0.2558	0.6825	0.226	0.0239	0.0602	0.3271	0	0.9524	0	0	0.0217	0.0984	0.7438	0.3263	0.0617	0.1985	0.0096	0.0618	0	0	0	0	0	0	0	0	0											7.2614	0	NO	0.12589286	11.2261	0.303092974	0.281108668	0.255806963	0.717023071	1.490668851	0.097918087	0.881816503	7.418539692	0	2.642133346	0	0	0.502779165	3.436351524	6.097302746	0.875525794	0.961283246	0.496158258	0.016903551	0.921994215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6225
H1365_802_0	2012	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	194.0419085	2.195697935	57.05104815	0	8.440418107	10.2024886	6.566001411	17.87695827	36.30897948	10.13502447	25.11922719	0	0.88954699	38.67832074	22.77804385	38.48090199	0.842598572	3.157372193	12.94878507	51.58303308	34.78345502	6.509309995	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"	"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 8b	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing;	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b"	PBP 13a-13e											0	NO	0.081834911	0.081834911	0.136725415	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.078487311	0.078487311	0.131132423	0	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0.214836889	0	0	0	0	0	0	0	0											3300	15.2298	0.172334427	7.481242192	0	1.813313164	2.191870907	1.410619313	3.840630092	7.800508177	2.177377122	5.396536612	0	0.191107507	8.309530083	4.893564068	8.267117251	0.181021256	0.678320018	2.781876695	11.08193833	7.472769249	1.398439906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7699	0	NO	3.956775499	15.2298	0.172334427	7.481242192	0	1.813313164	2.191870907	1.410619313	3.840630092	7.800508177	2.177377122	5.396536612	0	0.191107507	8.309530083	4.893564068	8.267117251	0.181021256	0.678320018	2.781876695	11.08193833	7.472769249	1.398439906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7699	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"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 8b	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing;	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, 14b"	Medicare-FFS Cost Sharing; PBP 13a-13e											10000	3.8075	0.0431	1.8703	0	0.4533	0.548	0.3527	0.9602	1.9501	0.5443	1.3491	0	0.0478	2.0774	1.2234	2.0668	0.0453	0.1696	0.6955	2.7705	1.8682	0.3496	0	0	0	0	0	0	0	0											23.1925	0	NO	0.989193875	19.0373	0.215418034	9.351552739	0	2.266641455	2.739838634	1.763274142	4.800787615	9.750635221	2.721721403	6.745670765	0	0.238884384	10.3869126	6.116955084	10.33389656	0.226276569	0.847900022	3.477345869	13.85242291	9.340961561	1.748049882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.9624
H1406_013_0	2012	6	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			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	1769.4	125.89	766.11	2101.79	451.63	12.13	6.57	421.85	314.02	837.1	820.1	216.39	4.43	6.46	5427.54	3385.36	165.28	588.35		1175.5	26.22	0			0.6		0.31		4.13	2.42	412.04										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-13), $100 (Days 14-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"		"HER865: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												163.989133	144.00749	47.51773	0	100	0.2	0.134514	65	110.665283	40.543012	39.931648	44.484723	0.2	0.2	5	33.359517	35	40.844221		0	0.2	0			0		0		0	0	90.475726										NO	117.237799	102.952683	33.504371	0	85.6271	0.171254	0.11518	55.657615	94.759472	34.715805	34.192312	38.090978	0.171254	0.171254	4.281355	28.564787	29.969485	34.973722		0	0.171254	0			0		0		0	0	77.471741											17.2867	1.080059439	2.139002806	0	3.222647264	2.07731102	0.7567326	1.956597074	2.47969745	2.421716697	2.336759589	0.686875561	0.75865522	1.10630084	1.93643546	8.058507277	0.412779707	1.714732445	0	0	4.49027988	0	0	0	0	0	0	0	0	0	2.660121347	0	0	0	0	0	0	0	0	0	57.5819	0	NO	14.442229	17.2867	1.080059439	2.139002806	0	3.222647264	2.07731102	0.7567326	1.956597074	2.47969745	2.421716697	2.336759589	0.686875561	0.75865522	1.10630084	1.93643546	8.058507277	0.412779707	1.714732445	0	0	4.49027988	0	0	0	0	0	0	0	0	0	2.660121347	0	0	0	0	0	0	0	0	0	57.5819	NO																																																																																		0	0	NO	0	17.2867	1.080059439	2.139002806	0	3.222647264	2.07731102	0.7567326	1.956597074	2.47969745	2.421716697	2.336759589	0.686875561	0.75865522	1.10630084	1.93643546	8.058507277	0.412779707	1.714732445	0	0	4.49027988	0	0	0	0	0	0	0	0	0	2.660121347	0	0	0	0	0	0	0	0	0	57.5819
H1406_022_0	2012	5	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			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	1223.68	40.32	989.77	1235.81	418.81	7.86	2.9	411.91	378.35	193.15	527.47	84.2	4.58	0.12	5339.29	4833.37	129.84	1011.94		3116.82	26.97	0			1.52		0.31		4.13	1.24	124.25										6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS734: Vision 17a,17b"		"HER865: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.188438	65	50.095991	39.147654	35.99638	35.592414	0.2	0.2	5	34.963554	35	37.287111		0	0.2	0			0		0		0	0	75.966029										NO	151.051374	120.855393	40.067855	0	96.4048	0.19281	0.181663	62.66312	48.29494	37.740218	34.702238	34.312796	0.19281	0.19281	4.82024	33.706544	33.74168	35.946565		0	0.19281	0			0		0		0	0	73.234899											15.4032	0.40607412	3.30483007	0	3.364607857	1.5154866	0.5268227	2.150963813	1.522699212	0.607460259	1.52536579	0.240761452	0.8830698	0.0231372	2.144721602	13.57634988	0.365084978	3.031313916	0	0	5.2000857	0	0	0	0	0	0	0	0	0	0.75828635	0	0	0	0	0	0	0	0	0	56.5503	0	NO	2.948763	15.4032	0.40607412	3.30483007	0	3.364607857	1.5154866	0.5268227	2.150963813	1.522699212	0.607460259	1.52536579	0.240761452	0.8830698	0.0231372	2.144721602	13.57634988	0.365084978	3.031313916	0	0	5.2000857	0	0	0	0	0	0	0	0	0	0.75828635	0	0	0	0	0	0	0	0	0	56.5503	NO																																																																																		0	0	NO	0	15.4032	0.40607412	3.30483007	0	3.364607857	1.5154866	0.5268227	2.150963813	1.522699212	0.607460259	1.52536579	0.240761452	0.8830698	0.0231372	2.144721602	13.57634988	0.365084978	3.031313916	0	0	5.2000857	0	0	0	0	0	0	0	0	0	0.75828635	0	0	0	0	0	0	0	0	0	56.5503
H1406_025_0	2012	4	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			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	1335.18	53.57	465.45	2215.48	221.85	12.36	4.5	336.01	263.13	550.93	1145.19	86.8	0.46	3.67	3867.63	4040.15	79.92	631.89		1733.6	24.98	0			0.6				2.8	1.24	313.59										3400	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-10): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $20 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $20 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												122.545317	113.560793	42.474818	0	50	0.2	0.156243	65	100	0	23.868194	28.705021	0.199456	0.2	10	19.763242	20	20		0	0.2	0			0				0	0	74.850273										NO	104.512283	96.849868	37.751406	0	46.20165	0.184807	0.144374	60.062145	92.4033	0	22.054999	26.524387	0.184304	0.184807	9.24033	18.261888	18.48066	18.48066		0	0.184807	0			0				0	0	69.164122											11.6286	0.432353952	1.46428266	0	0.854153004	2.28421452	0.649683	1.681790112	2.026173361	0	2.104763692	0.191859733	0.08477984	0.67824169	2.97818146	6.148397234	0.123081196	0.973145354	0	0	4.61647886	0	0	0	0	0	0	0	0	0	1.807431418	0	0	0	0	0	0	0	0	0	40.7276	0	NO	4.500727	11.6286	0.432353952	1.46428266	0	0.854153004	2.28421452	0.649683	1.681790112	2.026173361	0	2.104763692	0.191859733	0.08477984	0.67824169	2.97818146	6.148397234	0.123081196	0.973145354	0	0	4.61647886	0	0	0	0	0	0	0	0	0	1.807431418	0	0	0	0	0	0	0	0	0	40.7276	NO																																																																																		0	0	NO	0	11.6286	0.432353952	1.46428266	0	0.854153004	2.28421452	0.649683	1.681790112	2.026173361	0	2.104763692	0.191859733	0.08477984	0.67824169	2.97818146	6.148397234	0.123081196	0.973145354	0	0	4.61647886	0	0	0	0	0	0	0	0	0	1.807431418	0	0	0	0	0	0	0	0	0	40.7276
H1406_026_0	2012	5	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			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	1385.02	55.57	482.83	2298.19	230.13	12.11	4.41	348.55	272.95	571.5	1187.95	90.04	0.46	3.59	4012.03	4190.99	82.91	655.49		1798.33	24.48	0			0.6				2.8	1.24	325.3										3400	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-10): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $0 Radiology OP -- Facility"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $20 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												142.969537	132.487591	42.474818	0	100	0.2	0.156243	65	109.202935	0	12.21778	42.07283	0.199456	0.2	10	19.763242	20	20		0	0.2	0			0				0	0	78.220116										NO	117.950868	109.30319	36.656023	0	91.4891	0.182978	0.142946	59.467915	99.908783	0	11.177937	38.492054	0.18248	0.182978	9.14891	18.081212	18.29782	18.29782		0	0.182978	0			0				0	0	71.562881											13.6137	0.506164856	1.474885632	0	1.754532215	2.21586358	0.63039186	1.727295148	2.272508527	0	1.106569188	0.288818712	0.0839408	0.65689102	3.058808449	6.314848223	0.126422688	0.999503169	0	0	4.47930144	0	0	0	0	0	0	0	0	0	1.939950432	0	0	0	0	0	0	0	0	0	43.2504	0	NO	5.801744	13.6137	0.506164856	1.474885632	0	1.754532215	2.21586358	0.63039186	1.727295148	2.272508527	0	1.106569188	0.288818712	0.0839408	0.65689102	3.058808449	6.314848223	0.126422688	0.999503169	0	0	4.47930144	0	0	0	0	0	0	0	0	0	1.939950432	0	0	0	0	0	0	0	0	0	43.2504	NO																																																																																		0	0	NO	0	13.6137	0.506164856	1.474885632	0	1.754532215	2.21586358	0.63039186	1.727295148	2.272508527	0	1.106569188	0.288818712	0.0839408	0.65689102	3.058808449	6.314848223	0.126422688	0.999503169	0	0	4.47930144	0	0	0	0	0	0	0	0	0	1.939950432	0	0	0	0	0	0	0	0	0	43.2504
H1406_027_0	2012	4																															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	1451.11	46.71	818.7	1815.66	247.24	14.32	4.07	370.08	248.09	339.95	827.09	92.48	0.54	688.07	3648.65	3781.17	100.09	552.56		2413.46	23.77	0			0.6				2.8	2.42											3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													145.768118	128.006658	44.690621	5	150	0.2	0.168202	65	225	0	46.626606	36.07706	0.2	37.614564	5	33.666565	35	35		0	0.2	0			0				0	0											NO	114.81076	100.821372	34.266757	4.4245	132.735	0.17698	0.148842	57.5185	199.1025	0	41.259884	31.92459	0.17698	33.285128	4.4245	29.791543	30.9715	30.9715		0	0.17698	0			0				0	0												13.8836	0.392447191	2.337849496	0.669448973	2.73478345	2.5343536	0.60578694	1.77387054	4.116278269	0	2.843803121	0.246032174	0.0955692	1.908541502	1.34528766	9.38724072	0.25832812	1.426134337	0	0	4.2068146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7662	0	NO	9.002826	13.8836	0.392447191	2.337849496	0.669448973	2.73478345	2.5343536	0.60578694	1.77387054	4.116278269	0	2.843803121	0.246032174	0.0955692	1.908541502	1.34528766	9.38724072	0.25832812	1.426134337	0	0	4.2068146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7662	NO																																																																																		0	0	NO	0	13.8836	0.392447191	2.337849496	0.669448973	2.73478345	2.5343536	0.60578694	1.77387054	4.116278269	0	2.843803121	0.246032174	0.0955692	1.908541502	1.34528766	9.38724072	0.25832812	1.426134337	0	0	4.2068146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7662
H1406_801_0	2012	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	331.79	5.73	40.05	24.08	15.88	13.63	6.92	26.4	56.89	10.97	23.69	1.58	5	27.04	68.75	66.9	1.19	7.18		6.94	29.28	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																					0.0753	0.0753	0.1706	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.061991	0.061991	0.132353	0	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601	0.198601		0.198601	0.198601	0																				20.568	0.35520843	5.30073765	0	3.15378388	2.70693163	1.37431892	5.2430664	11.29841089	2.17865297	4.70485769	0.31378958	0.993005	5.37017104	13.65381875	13.2864069	0.23633519	1.42595518	0	1.37829094	5.81503728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3568	0	NO	15.376933	20.568	0.35520843	5.30073765	0	3.15378388	2.70693163	1.37431892	5.2430664	11.29841089	2.17865297	4.70485769	0.31378958	0.993005	5.37017104	13.65381875	13.2864069	0.23633519	1.42595518	0	1.37829094	5.81503728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3568	NO																																																																																		0	0	NO	0	20.568	0.35520843	5.30073765	0	3.15378388	2.70693163	1.37431892	5.2430664	11.29841089	2.17865297	4.70485769	0.31378958	0.993005	5.37017104	13.65381875	13.2864069	0.23633519	1.42595518	0	1.37829094	5.81503728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3568
H1406_802_0	2012	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	314.11	5	38.42	23.99	15.21	14.37	7.86	26.32	54.8	10.85	22.41	1.54	4.85	25.15	67.2	64.12	1.12	6.58		6.66	30.76	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																					0.0818	0.0818	0.18	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067228	0.067228	0.139314	0	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954	0.198954		0.198954	0.198954	0																				21.117	0.33614	5.35244388	0	3.02609034	2.85896898	1.56377844	5.23646928	10.9026792	2.1586509	4.45855914	0.30638916	0.9649269	5.0036931	13.3697088	12.75693048	0.22282848	1.30911732	0	1.32503364	6.11982504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3892	0	NO	15.224694	21.117	0.33614	5.35244388	0	3.02609034	2.85896898	1.56377844	5.23646928	10.9026792	2.1586509	4.45855914	0.30638916	0.9649269	5.0036931	13.3697088	12.75693048	0.22282848	1.30911732	0	1.32503364	6.11982504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3892	NO																																																																																		0	0	NO	0	21.117	0.33614	5.35244388	0	3.02609034	2.85896898	1.56377844	5.23646928	10.9026792	2.1586509	4.45855914	0.30638916	0.9649269	5.0036931	13.3697088	12.75693048	0.22282848	1.30911732	0	1.32503364	6.11982504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3892
H1406_803_0	2012	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	331.79	5.73	40.05	24.08	15.88	13.63	6.92	26.4	56.89	10.97	23.69	1.58	5	27.04	68.75	66.9	1.19	7.18		6.94	29.28	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																					0.0852	0.0852	0.1853	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.068692	0.068692	0.138855	0	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608	0.197608		0.197608	0.197608	0																				22.7913	0.39360516	5.56114275	0	3.13801504	2.69339704	1.36744736	5.2168512	11.24191912	2.16775976	4.68133352	0.31222064	0.98804	5.34332032	13.58555	13.2199752	0.23515352	1.41882544	0	1.37139952	5.78596224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5132	0	NO	17.150753	22.7913	0.39360516	5.56114275	0	3.13801504	2.69339704	1.36744736	5.2168512	11.24191912	2.16775976	4.68133352	0.31222064	0.98804	5.34332032	13.58555	13.2199752	0.23515352	1.41882544	0	1.37139952	5.78596224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5132	NO																																																																																		0	0	NO	0	22.7913	0.39360516	5.56114275	0	3.13801504	2.69339704	1.36744736	5.2168512	11.24191912	2.16775976	4.68133352	0.31222064	0.98804	5.34332032	13.58555	13.2199752	0.23515352	1.41882544	0	1.37139952	5.78596224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5132
H1415_005_0	2012	7																															COIN	COIN	COIN		COIN	COIN	COIN	COIN	COIN		COIN	COIN	COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN			P																																																									0	YES	431.5775013		65.50757422		23.92984111	28.34098779		36.68534756	20.61873432		59.63775362					68.19213795	9.655152215	2.246660006	15.96939504	1.04	25.46689338			263.03																	6700	1a. Standard Medicare FFS	1b. Included in a1	2. Standard Medicare FFS	6. No Cost Share	10a. Standard Medicare FFS	11a. Standard Medicare FFS	11b/c. Included in e1	4a/b. Standard Medicare FFS	9a/b. Standard Medicare FFS	8a. No Cost Share	8a/b. Standard Medicare FFS	5/9c. Included in h2	12. Included in h2	3/9a. Included in h2	7a/17a/18aNo Cost Share	7b./d/f/16b/17a/18a 20% Coinsurance	7e/h 20% Coinsurance	7c/I 20% Coinsurance	7d. 20% Coinsurance	7g. 20% Coinsurance	15. Standard Medicare FFS			"16a./16b. $20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																	0		0.07291913		0.167442342		0.224	0.224		0.224	0.224		0.224					0.2	0.2	0.2	0.2	0.2	0.224			32.73																	NO	0.069120043		0.158718596		0.2123296	0.2123296		0.2123296	0.2123296		0.2123296					0.18958	0.18958	0.18958	0.18958	0.18958	0.2123296			31.024767																		29.8307	0	10.39727018	0	5.08101359	6.017630602	0	7.789385173	4.377967612	0	12.66286037	0	0	0	0	12.92786551	1.830423757	0.425921804	3.027477912	0.1971632	5.407375284	0	0	0.680037039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.653	0		5.53	29.8307	0	10.39727018	0	5.08101359	6.017630602	0	7.789385173	4.377967612	0	12.66286037	0	0	0	0	12.92786551	1.830423757	0.425921804	3.027477912	0.1971632	5.407375284	0	0	0.680037039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.653	NO																																																																																		0	0		0	29.8307	0	10.39727018	0	5.08101359	6.017630602	0	7.789385173	4.377967612	0	12.66286037	0	0	0	0	12.92786551	1.830423757	0.425921804	3.027477912	0.1971632	5.407375284	0	0	0.680037039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.653
H1415_013_0	2012	3																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN			P																																																									0	YES	653.5171983	53.74319065	478.8959093		193.9738485	1.73	5.84	305.8915035	127.2324044		491.0348121	8.963172768	12.23761912	195.2231963	2632.526475	3388.600179	0.965092343	188.3535694	297.2124556	60.69719921	9.84			704																	3400	1a. $225/days 1-5	1b. $275 days 1-5	2. $0/days 0-3; $100/days 4-20; 21 - 100 $0	6. 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. 65 COPAY; waived if admitted	9a/b. $250 COPAY	8a.  No Cost Sharing	8a/b. $25 Xray; $30 radiation $100/$200 Hi-tech	5./9c. $15 Copay	12.   $30 Copay	9a./3.   Observation $250 Copay	7a/17a/18a  $5 Copay	"7b/d/f/ 16b. 17a, 18a. $15 Copay"	7e/h 20% Coinsurance	7c/i. $15 Copay	7d. $15 Copay	7g. $15 Copay	15. 20% Coinsurance			16 a-b. $0-195 copay for select dental services																	0		225	275	100		100	0.2	0.2	65	250		38.20171937	15	30	250	5	15	0.2	15	15	15	0.2			17.4																	NO	219.2175	267.9325	97.43		97.43	0.19486	0.19486	63.3295	243.575		37.21993518	14.6145	29.229	243.575	4.8715	14.6145	0.19486	14.6145	14.6145	14.6145	0.19486			16.95282																		11.9385	1.199962286	3.888235704	0	1.574906005	0.3371078	1.1379824	1.614329664	2.582552741	0	1.523023657	0.010916024	0.029807781	3.96262417	1.06869606	4.126891443	0.188057894	0.229391103	0.361967619	0.073921601	1.9174224	0	0	0.99456544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7609	0		1.02	11.9385	1.199962286	3.888235704	0	1.574906005	0.3371078	1.1379824	1.614329664	2.582552741	0	1.523023657	0.010916024	0.029807781	3.96262417	1.06869606	4.126891443	0.188057894	0.229391103	0.361967619	0.073921601	1.9174224	0	0	0.99456544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7609	NO																																																																																		0	0		0	11.9385	1.199962286	3.888235704	0	1.574906005	0.3371078	1.1379824	1.614329664	2.582552741	0	1.523023657	0.010916024	0.029807781	3.96262417	1.06869606	4.126891443	0.188057894	0.229391103	0.361967619	0.073921601	1.9174224	0	0	0.99456544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7609
H1415_021_0	2012	9																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	YES	1077.601697	55.58654095	785.9551053		256.6209464	3.389327583	11.46067242	442.5613907	212.0873937		837.3718688	25.19001087	34.39248205	197.2192285	4143.704869	6716.908545	1.379959479	335.035843	600.6733118	171.4385	9.789148063																				3400	1a. $225/days 1-7	1b. $275 days 1-5	2. $0/days 0-3; $100/days 4-20; $146 days 21 - 100	6. 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. 65 COPAY; waived if admitted	9a./b. $250 COPAY	8a.  No Cost Sharing	8a./b. $25 Xray; $30 radiation $100/$200 Hi-tech	5./9c. $40 Copay	12.   $30 Copay	9a./3.   Observation $250 Copay	7a./17a./18a.  $5 Copay	7b./d./f./16b./17a./18a. $40 Copay; $20 Copay Chiropractic	7e./h. 20% Coinsurance	7c./i. $15 Copay	7d. $40 Copay	7g. $40 Copay	15. 20% Coinsurance																				0		225	275	110.622852		100	0.2	0.2	65	250		65.08436087	40	30	250	5	39.77912184	0.2	15	40	40	0.2																				NO	201.5325	246.3175	99.08488851		89.57	0.17914	0.17914	58.2205	223.925		58.29606203	35.828	26.871	223.925	4.4785	35.63015943	0.17914	13.4355	35.828	35.828	0.17914																					18.0976	1.140994817	6.489689499	0	1.915461514	0.607164143	2.053064857	2.147178787	3.957639136	0	4.067956867	0.075208976	0.077013365	3.680192979	1.546465188	19.9437102	0.247205941	0.375114506	1.793410285	0.511858215	1.753627984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4806	0		8.207	18.0976	1.140994817	6.489689499	0	1.915461514	0.607164143	2.053064857	2.147178787	3.957639136	0	4.067956867	0.075208976	0.077013365	3.680192979	1.546465188	19.9437102	0.247205941	0.375114506	1.793410285	0.511858215	1.753627984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4806	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	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																					0.5182		0.07		0.01	0.0225			0.032	0.054					0.3033						0.0148																				1.0248	0		0	18.6159	1.140994817	6.559716942	0	1.925461514	0.629629537	2.053064857	2.147178787	3.989639005	0.054011482	4.067956867	0.075208976	0.077013365	3.680192979	1.849768218	19.9437102	0.247205941	0.375114506	1.793410285	0.511858215	1.768430123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5055
H1415_024_0	2012	5																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	YES	1008.148281	36.64936049	725.5721072		332.8287745	3.54	11.98	478.750841	211.8793803		1017.463745	38.17968907	28.26099896	127.7664634	4608.342002	7728.963571	1.289151818	311.1588132	661.1496632	175.84	9.607945437																				3400	1a. $225/days 1-5	1b. $275 days 1-5	2. $0/days 0-3; $100/days 4-20; 21 - 100 $0	6. 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. 65 COPAY; waived if admitted	9a/b. $250 COPAY	8a.  No Cost Sharing	8a/b. $25 Xray; $30 radiation $100/$200 Hi-tech	5./9c. $35 Copay	12.   $30 Copay	9a./3..   Observation $250 Copay	7a./17a./18a.  $5 Copay	"7b/d/f/ 16b. 17a, 18a. $35 Copay; $20 Copay Chiropractic"	7e/h. 20% Coinsurance	7c/i. $15 Copay	7d. $35 Copay	7g. $35 Copay	15. 20% Coinsurance																				0		225	275	100		100	0.2	0.2	65	250		65.08436087	35	30	250	5	34.63	0.2	15	35	35	0.2																				NO	203.6925	248.9575	90.53		90.53	0.18106	0.18106	58.8445	226.325		58.9208719	31.6855	27.159	226.325	4.5265	31.350539	0.18106	13.5795	31.6855	31.6855	0.18106																					17.1127	0.76034443	5.473836905	0	2.510915746	0.6409524	2.1690988	2.347654488	3.996133396	0	4.995820913	0.100811878	0.063961706	2.409728736	1.738305006	20.19226449	0.233413828	0.352115092	1.745738138	0.464298193	1.739614601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0477	0		7.29	17.1127	0.76034443	5.473836905	0	2.510915746	0.6409524	2.1690988	2.347654488	3.996133396	0	4.995820913	0.100811878	0.063961706	2.409728736	1.738305006	20.19226449	0.233413828	0.352115092	1.745738138	0.464298193	1.739614601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0477	NO																																																																																		0	0		0	17.1127	0.76034443	5.473836905	0	2.510915746	0.6409524	2.1690988	2.347654488	3.996133396	0	4.995820913	0.100811878	0.063961706	2.409728736	1.738305006	20.19226449	0.233413828	0.352115092	1.745738138	0.464298193	1.739614601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0477
H1415_802_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	341.3459351		46.68496213	29.88238744	9.778115072	14.9769289		13.85786822	21.3332457	36.00405402					202.2020202						9.868092806																				6700	1a.  Equiv to Medicare FFS	1b.  Included in line 1a	2.  Equiv to Medicare FFS	6. Equiv to Medicare FFS	10a.  Equiv to Medicare FFS	11a.  Equiv to Medicare FFS	11b./c.  Included in e1	4a./4b.  Equiv to Medicare FFS	9a./b. Equiv to Medicare FFS	8a.   Equiv to Medicare FFS	8a./b.  Included in h1	5./9c. Included in h1	12.    Included in h1	9a./3.    Included in h1	7a./17a./18a.   Equiv to Medicare FFS	7b./d./f./16b./17a./18a.  Included in i1	7e./h.Included in i1	7c./i.  Included in i1	7d.  Included in i1	7g. Included in i1	15.  Equiv to Medicare FFS																				0		0.073829104		0.168638	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224																				NO	0.070189329		0.160324146	0	0.2129568	0.2129568		0.2129568	0.2129568	0.2129568					0.2129568						0.2129568																					23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386	0		5.05	23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386	NO																																																																																		0	0		0	23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386
H1415_804_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	341.3459351		46.68496213	29.88238744	9.778115072	14.9769289		13.85786822	21.3332457	36.00405402					202.2020202						9.868092806																				6700	1a.  Equiv to Medicare FFS	1b.  Included in line 1a	2.  Equiv to Medicare FFS	6. Equiv to Medicare FFS	10a.  Equiv to Medicare FFS	11a.  Equiv to Medicare FFS	11b./c.  Included in e1	4a./4b.  Equiv to Medicare FFS	9a./b. Equiv to Medicare FFS	8a.   Equiv to Medicare FFS	8a./b.  Included in h1	5./9c. Included in h1	12.    Included in h1	9a./3.    Included in h1	7a./17a./18a.   Equiv to Medicare FFS	7b./d./f./16b./17a./18a.  Included in i1	7e./h.Included in i1	7c./i.  Included in i1	7d.  Included in i1	7g. Included in i1	15.  Equiv to Medicare FFS																				0		0.073829104		0.168638	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224																				NO	0.070189329		0.160324146	0	0.2129568	0.2129568		0.2129568	0.2129568	0.2129568					0.2129568						0.2129568																					23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386	0		5.05	23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386	NO																																																																																		0	0		0	23.9588	0	7.484726699	0	2.082316096	3.189438852	0	2.951127272	4.543059738	7.667308131	0	0	0	0	43.06029518	0	0	0	0	0	2.101477466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0386
H1416_007_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2041.464979	839.5524008	695.2527647	232.4932248	24.16557548	9.845522374	13.50048755	41.87163906	26.93030786	5.423474693	12.99412564	1.125436157	0.421050254	12.40173896	8530.720302	101.4496698	14.56847425	3.386388974	15.45477472	21.94266234	3.610583385	0.074013172	757.3507948	384	338.4	203.04	18	13.71428571	3764.352748	2473.603526											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	140.8966995	68.14214708	75.79215183	0	0.19071985	0.187822038	0.079845174	0.191435785	0.176601793	0.017662017	0.182556567	0.2	0.2	0.19105256	0	0.07128477	0.020825615	0.184760062	0.126241441	0.065544398	0.2	0.199945426	0	0	0	0	0	0	0	0											NO	138.030737	66.75607601	74.25047295	0	0.186840441	0.184001573	0.078221053	0.187541813	0.173009558	0.017302756	0.178843206	0.195931825	0.195931825	0.187166383	0	0.069834775	0.020402004	0.18100188	0.123673579	0.064211167	0.195931825	0.19587836	0	0	0	0	0	0	0	0												23.4821	4.670435323	4.301903884	0	4.515106771	1.811591604	1.05602235	7.852683113	4.659200647	0.093841058	2.323911089	0.22050876	0.082497144	2.321188631	0	7.084714903	0.297226072	0.61294277	1.911347308	1.408963961	0.70742819	0.014497579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4281	0	NO	1.441550625	23.4821	4.670435323	4.301903884	0	4.515106771	1.811591604	1.05602235	7.852683113	4.659200647	0.093841058	2.323911089	0.22050876	0.082497144	2.321188631	0	7.084714903	0.297226072	0.61294277	1.911347308	1.408963961	0.70742819	0.014497579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4281	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	NO	0	23.4821	4.670435323	4.301903884	0	4.515106771	1.811591604	1.05602235	7.852683113	4.659200647	0.093841058	2.323911089	0.22050876	0.082497144	2.321188631	0	7.084714903	0.297226072	0.61294277	1.911347308	1.408963961	0.70742819	0.014497579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4281
H1416_009_0	2012	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	1771.194646	162.771781	1105.163486	476.2666096	507.9592546	9.492705061	13.80447954	374.6131147	278.9572064	3669.327166	1150.947523	33.8091396	0.400813635	1887.204423	8806.639719	15713.74033	775.1540022	1785.390998	3413.73879	5014.316537	11.24984127	0.09793501	757.3507948	384	338.4	203.04	18	13.71428571	3764.352748	2039.518501											3900	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $150.00 , (5) $200.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment"											0	NO	118.2099033	140.451091	74.44188034	0	30.08708965	0.190070584	0.078888556	63.66923614	93.39214853	0.064173909	15.13818342	27.59048225	0.2	18.5835146	2.123988124	7.52411948	9.436198691	8.380088764	2.215343502	3.016743873	0.2	0	0	0	0	0	0	0	0	0											YES	112.923738	134.1703339	71.11295376	0	28.7416412	0.181570919	0.07536078	60.82204567	89.21579506	0.06130415	14.4612271	26.35667825	0.191056307	17.75248836	2.029006637	7.18765241	9.014226375	8.005344062	2.116276742	2.88183972	0.191056307	0	0	0	0	0	0	0	0	0											3900	16.6675	1.819928685	6.549286657	0	1.216631887	1.723599184	1.040316352	1.898727997	2.07394908	0.018745415	1.38700946	0.074258051	0.076577973	2.791881213	1.48906087	9.412075296	0.582284471	1.191055768	0.602034667	1.204204714	2.149353128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9685	0	NO	2.526362342	16.6675	1.819928685	6.549286657	0	1.216631887	1.723599184	1.040316352	1.898727997	2.07394908	0.018745415	1.38700946	0.074258051	0.076577973	2.791881213	1.48906087	9.412075296	0.582284471	1.191055768	0.602034667	1.204204714	2.149353128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9685	YES	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	Same as in-network	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											3900	0.4556	0	0.0835	0.006	0.0967	0.0595	0.0865	0	0.281	0.0038	0.1467	0	0	0.1313	0	0.4752	0	0.0184	0.0813	0.1278	0.0271	0.0009	0	0	0	0	0	0	0	0											2.0811	0	NO	0.097422081	17.123	1.819928685	6.632770444	0.006040315	1.313320173	1.783095572	1.126837176	1.898727997	2.354922542	0.022554371	1.533690083	0.074258051	0.076577973	2.923181847	1.48906087	9.88724154	0.582284471	1.209454686	0.683299874	1.332034133	2.176440564	0.000851004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0496
H1416_019_0	2012	9																															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	1802.232258	149.7616321	912.6125004	346.1511621	495.8380618	10.38321568	13.70521372	398.9147548	281.8216146	3708.360397	1231.469099	33.74463804	0.115092992	2003.564498	8974.380735	16419.09844	938.0372397	1876.651201	3539.509872	5251.565739	11.60706473	0.058320629	757.3507948	384	338.4	203.04	18	13.71428571	3764.352748	2729.504562											3000	"(1a) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $175 days 1 - 7, $0 days 8 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $125.00 , (5) $175.00 copayment , (9a) $125.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	115.5872276	91.31798222	45.95532768	6.597217863	33.38966811	0.193604968	0.088482676	63.61096124	81.17907446	0.053478257	14.62366462	59.76588	0.2	18.50729399	2.192396846	8.002489789	18.74363968	13.60735509	2.572446241	3.024136048	0.2	0	0	0	0	0	0	0	0	0											NO	107.4007653	84.85038859	42.70054284	6.129970086	31.02484577	0.179892901	0.082215893	59.10571663	75.42956871	0.049690661	13.58794397	55.53296317	0.185835005	17.19651539	2.037120398	7.435713666	17.41612191	12.64361453	2.390252805	2.809951694	0.185835005	0	0	0	0	0	0	0	0	0												16.1301	1.05894439	3.247420764	0.176824689	1.281941616	1.867866794	1.126786387	1.964845205	1.77147357	0.015355907	1.394427761	0.156161645	0.021388307	2.871193977	1.523491172	10.17397622	1.361414243	1.977304533	0.70502695	1.229720504	2.156998936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2127	0	NO	3.979831495	16.1301	1.05894439	3.247420764	0.176824689	1.281941616	1.867866794	1.126786387	1.964845205	1.77147357	0.015355907	1.394427761	0.156161645	0.021388307	2.871193977	1.523491172	10.17397622	1.361414243	1.977304533	0.70502695	1.229720504	2.156998936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2127	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	NO	0	16.1301	1.05894439	3.247420764	0.176824689	1.281941616	1.867866794	1.126786387	1.964845205	1.77147357	0.015355907	1.394427761	0.156161645	0.021388307	2.871193977	1.523491172	10.17397622	1.361414243	1.977304533	0.70502695	1.229720504	2.156998936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2127
H1417_001_0	2012	7																															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	293.5811281	3.258899196	1336.312368	0	129.6480654	14.32850321	1.407032835	386.2837402	396.7294992	0	0	0	0	1577.54076	4382.206166	7389.546947	168.4583972	319.5091302	330.6476543	763.3912137	0	0	0	0	35.28688751	0	0.171525574	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$100/Visit for OP Hospital, ASC Services; PBP 9a-b"	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	285.9685	404.3074	20.00025211	0	50	0.1	0.1	60.93580507	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	250.5417687	354.2204512	17.52255419	0	43.80583328	0.087611667	0.087611667	53.38687435	87.61166656	0	0	0	0	17.52233331	17.52233331	17.52233331	17.52233331	17.52233331	17.52233331	17.52233331	0	0	0	0	17.52233331	0	17.52233331	0	0	0												6.1295	0.096197395	1.951300491	0	0.473278461	1.255344045	0.123272492	1.718540125	2.89651105	0	0	0	0	2.303516251	6.398873091	10.79017539	0.245982015	0.466545456	0.482809867	1.114699608	0	0	0	0	0.051525717	0	0.000250461	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4983	0	NO	5.160884909	6.1295	0.096197395	1.951300491	0	0.473278461	1.255344045	0.123272492	1.718540125	2.89651105	0	0	0	0	2.303516251	6.398873091	10.79017539	0.245982015	0.466545456	0.482809867	1.114699608	0	0	0	0	0.051525717	0	0.000250461	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4983	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$200/Visit for OP Hospital, ASC Services; PBP 9a-b"	$30/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$30/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$30/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$30/Visit for PCP and Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											5100	0.3858	0.0092	0.471	0.0698	0.4829	0.2978	0.0101	0.1182	0.2212	0.1871	0.0596	0	0	0.3458	0.3524	2.2223	0.0247	0.4093	0.0299	0.0979	0.3658	0	0	0	0.0094	0.0001	0	0	0	0											6.1702	110	NO	0.627666126	6.5153	0.10543521	2.422264959	0.069764173	0.956162928	1.553167456	0.133391003	1.836699918	3.117716227	0.187128452	0.059557406	0	0	2.649286478	6.751245079	13.01250004	0.270641175	0.875819951	0.512675135	1.212648676	0.365839738	0	0	0	0.060926242	0.000149201	0.000250461	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6686
H1417_002_0	2012	11																															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	261.603525	3.401408609	1476.104551	0	145.5853401	15.85982443	2.141831902	414.7613549	416.506292	0	0	0	0	1834.104419	4743.221124	7603.100503	243.97178	276.2132822	339.9982749	807.3338643	0	0	0	0	35.92642038	0	0.332652041	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$100/Visit for OP Hospital, ASC Services; PBP 9a-b"	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	285.9685	404.3074	20.00025211	0	50	0.1	0.1	60.93580507	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	249.1437016	352.2438388	17.42477526	0	43.56138904	0.087122778	0.087122778	53.08896622	87.12277807	0	0	0	0	17.42455561	17.42455561	17.42455561	17.42455561	17.42455561	17.42455561	17.42455561	0	0	0	0	17.42455561	0	17.42455561	0	0	0												5.4314	0.099843769	2.143399172	0	0.528491637	1.381751964	0.186602345	1.83493763	3.023932104	0	0	0	0	2.663204538	6.887376688	11.04005396	0.354258321	0.401074475	0.493693237	1.172286152	0	0	0	0	0.052166826	0	0.000483026	0	0	0	0	0	0	0	0	0	0	0	0	0	37.695	0	NO	5.571521001	5.4314	0.099843769	2.143399172	0	0.528491637	1.381751964	0.186602345	1.83493763	3.023932104	0	0	0	0	2.663204538	6.887376688	11.04005396	0.354258321	0.401074475	0.493693237	1.172286152	0	0	0	0	0.052166826	0	0.000483026	0	0	0	0	0	0	0	0	0	0	0	0	0	37.695	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$200/Visit for OP Hospital, ASC Services; PBP 9a-b"	$30/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$30/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$30/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$30/Visit for PCP and Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											5100	0.4259	0.0175	0.357	0.1222	0.4322	0.3745	0.0162	0.116	0.2592	0.2127	0.0807	0	0	0.5332	0.3065	2.3168	0.0408	0.3596	0.0309	0.0945	0.3556	0	0	0	0.0031	0.0002	0	0	0	0											6.4554	110	NO	0.637545602	5.8573	0.117338951	2.500379936	0.122178768	0.960670727	1.756235944	0.202759316	1.950922015	3.283150276	0.212678245	0.080746234	0	0	3.19642965	7.193923261	13.35690047	0.39501396	0.760628844	0.524579971	1.266803326	0.355641033	0	0	0	0.055312636	0.000228185	0.000483026	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1503
H1417_003_0	2012	8																															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	198.0603575	2.350227917	990.0957797	0	102.2654513	10.90244267	1.311430862	294.9190947	304.1656021	2315.413184	425.8920623	0	0	1296.938195	3434.854129	5365.210455	156.516838	204.6423179	246.0070023	577.7499855	1592.97956	0	0	0	25.8347472	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"	"$65/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	"$150/Visit for OP Hospital, ASC Services; PBP 9a-b"	$40/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$40/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$40/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiropractic, $40/Visit for 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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	428.95275	606.4611	56.00070592	0	100	0.2	0.2	62.74211393	150	40	40	0	0	40	20	38.70609098	40	40	40	40	40	0	0	0	40	0	0	0	0	0											NO	381.4342183	539.2785466	49.7970592	0	88.92219907	0.177844398	0.177844398	55.79166744	133.3832986	35.56887963	35.56887963	0	0	35.56887963	17.78443981	34.41830727	35.56887963	35.56887963	35.56887963	35.56887963	35.56887963	0	0	0	35.56887963	0	0	0	0	0												6.2956	0.105618958	4.108654846	0	0.757805735	1.938938356	0.233230632	1.371169004	3.380884278	6.863054402	1.262375292	0	0	3.844219879	5.090579711	15.38845517	0.463927381	0.606574831	0.729182788	1.712493307	4.721708186	0	0	0	0.076576084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.951	0	NO	7.344035615	6.2956	0.105618958	4.108654846	0	0.757805735	1.938938356	0.233230632	1.371169004	3.380884278	6.863054402	1.262375292	0	0	3.844219879	5.090579711	15.38845517	0.463927381	0.606574831	0.729182788	1.712493307	4.721708186	0	0	0	0.076576084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.951	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"	"$65/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	"$200/Visit for OP Hospital, ASC Services; PBP 9a-b"	$50/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$50/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$50/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$50/Visit for PCP and Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											5100	0.416	0.0121	0.6239	0.1301	0.6344	0.2841	0.0102	0.1122	0.2274	0.2571	0.0922	0	0	0.5875	0.3886	2.7721	0.0433	0.4823	0.0409	0.1351	0.4397	0	0	0	0.0067	0.0004	0	0	0	0											7.6964	200	NO	0.930255567	6.7115	0.117755175	4.732522627	0.130121297	1.392192689	2.22304073	0.243415042	1.483326529	3.608308005	7.120131846	1.35454792	0	0	4.431762607	5.479175897	18.16058416	0.507259038	1.088834489	0.770095787	1.847605744	5.16144425	0	0	0	0.08332186	0.000402841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6474
H1417_004_0	2012	12																															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	221.7728474	2.573201312	855.7550945	0	101.2480063	10.55961099	0.979722984	321.6068021	308.6730222	2338.446852	480.4060609	0	0	1194.171502	3590.6434	5506.561414	170.085018	194.7574552	277.0663317	595.7312681	1532.928939	0	0	0	25.80734783	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"	"$65/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	"$150/Visit for OP Hospital, ASC Services; PBP 9a-b"	$40/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$40/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$40/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiropractic, $40/Visit for 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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	428.95275	606.4611	56.00070592	0	100	0.2	0.2	62.74211393	150	40	40	0	0	40	20	38.70609098	40	40	40	40	40	0	0	0	40	0	0	0	0	0											NO	380.5474194	538.0247744	49.68128569	0	88.71546327	0.177430927	0.177430927	55.66195704	133.0731949	35.48618531	35.48618531	0	0	35.48618531	17.74309265	34.33828792	35.48618531	35.48618531	35.48618531	35.48618531	35.48618531	0	0	0	35.48618531	0	0	0	0	0												7.0329	0.115370505	3.542917778	0	0.748521982	1.873601562	0.173833157	1.491772	3.42300877	6.915213194	1.420648208	0	0	3.531382602	5.309093212	15.75715761	0.502972372	0.575933262	0.819335599	1.761685848	4.533150032	0	0	0	0.076317027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6048	0	NO	7.581688284	7.0329	0.115370505	3.542917778	0	0.748521982	1.873601562	0.173833157	1.491772	3.42300877	6.915213194	1.420648208	0	0	3.531382602	5.309093212	15.75715761	0.502972372	0.575933262	0.819335599	1.761685848	4.533150032	0	0	0	0.076317027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6048	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"	"$65/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	"$200/Visit for OP Hospital, ASC Services; PBP 9a-b"	$50/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$50/Visit for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$50/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$50/Visit for PCP and Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											5100	0.4283	0.0077	1.3172	0.0931	0.7136	0.3592	0.0064	0.1305	0.2038	0.3016	0.0872	0	0	0.5022	0.4596	3.0971	0.0275	0.5603	0.0433	0.1417	0.4207	0	0	0	0.0083	0.0007	0	0	0	0											8.9098	200	NO	1.323692056	7.4612	0.123059778	4.860092223	0.093057513	1.462090482	2.232758811	0.180270585	1.622233976	3.626793947	7.216820486	1.507807272	0	0	4.033620311	5.768666929	18.85429154	0.530509069	1.13625521	0.862648835	1.903382146	4.953857967	0	0	0	0.084612838	0.00066222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5147
H1417_801_0	2012	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	186.140533	1.408172446	44.36897777	0	5.083616908	12.04543521	1.448918922	19.4922892	42.0415744	10.74773136	13.70607616	0	0.531338003	27.72559927	31.65959367	73.30897397	1.298746672	1.459878555	28.82726196	49.65685805	31.04894849	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	0.085209575	0.085209575	0.189676418	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.073755497	0.073755497	0.164179652	0	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0.193889375	0	0	0	0	0	0	0	0	0												13.7289	0.103860458	7.284483344	0	0.985659303	2.3354819	0.280929984	3.779347763	8.151414571	2.083870912	2.657462536	0	0.103020793	5.375699104	6.138458819	14.21383112	0.25181318	0.28305494	5.589299794	9.627937155	6.020061206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9946	0	NO	13.8206763	13.7289	0.103860458	7.284483344	0	0.985659303	2.3354819	0.280929984	3.779347763	8.151414571	2.083870912	2.657462536	0	0.103020793	5.375699104	6.138458819	14.21383112	0.25181318	0.28305494	5.589299794	9.627937155	6.020061206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9946	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											10000	0.4755	0.0052	0.7768	0	0.7272	0.3249	0.0116	0.2407	0.462	0.0919	0.1022	0	0	0.4818	0.2106	1.5534	0.0206	0.1735	0.1032	0.5277	0.5622	0	0	0	0	0	0	0	0	0											6.851	0	NO	0.591664222	14.2044	0.109014768	8.061303331	0	1.712826522	2.660367083	0.292576363	4.020041232	8.613367959	2.175820421	2.75963586	0	0.103020793	5.857483413	6.349099948	15.76727955	0.272423046	0.456511151	5.692461078	10.15564305	6.5823061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8456
H1417_802_0	2012	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	176.8289367	0.937680442	40.93151458	0	4.720222133	12.73331621	1.093023211	17.59393586	44.17118073	10.26464668	12.20306899	0	0.353849609	26.72810946	30.81167227	74.77091231	1.088968606	1.728585222	25.83352862	52.88043964	27.6972535	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	0.085762087	0.085762087	0.188687067	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.074793606	0.074793606	0.164555068	0	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0.195351678	0	0	0	0	0	0	0	0	0												13.2257	0.070132501	6.735488171	0	0.922103316	2.487474692	0.213523919	3.437004899	8.62891429	2.005215957	2.383890008	0	0.069125115	5.221381042	6.019111891	14.60662321	0.212731845	0.337682024	5.046623174	10.33028264	5.410704957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3637	0	NO	12.81188387	13.2257	0.070132501	6.735488171	0	0.922103316	2.487474692	0.213523919	3.437004899	8.62891429	2.005215957	2.383890008	0	0.069125115	5.221381042	6.019111891	14.60662321	0.212731845	0.337682024	5.046623174	10.33028264	5.410704957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3637	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											10000	0.425	0.0035	0.5167	0	0.5867	0.2327	0.0078	0.3327	0.4506	0.0915	0.1062	0	0	0.4919	0.2204	1.6295	0.026	0.2204	0.1071	0.5791	0.4121	0	0	0	0	0	0	0	0	0											6.4399	0	NO	0.530701511	13.6507	0.073599549	7.252161761	0	1.508774226	2.720185241	0.221308263	3.769737881	9.07954468	2.096722745	2.490050363	0	0.069125115	5.713290756	6.239504486	16.23611744	0.238774871	0.558055495	5.15377141	10.90940457	5.822770527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8036
H1418_002_0	2012	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	1509.07	87.24	689.51	1303.51	33.17	9.81	3.2	305.1	250.49	1246.79	939.83	337.09	0.78	14.75	3020.34	3692.29	153.59	1067.79		1263.41	22.26	0		3.21	0.61				2.8	1.24	894.54	512.6									4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"											163.989133	131.206824	42.474818	0	100	0.2	0.2	65	134.888479	38.516399	38.835343	31.871647	0.2	0.2	5	32.844715	35	39.148976		0	0.2	0		0	0				0	0	0	50									NO	124.967919	99.986161	29.9738	0	90.6427	0.181285	0.181285	58.917755	122.26656	34.912304	35.201403	28.889322	0.181285	0.181285	4.532135	29.771336	31.724945	35.485689		0	0.181285	0		0	0				0	0	0	45.32135										15.7154	0.72689939	1.72226957	0	0.25055153	1.77840585	0.580112	1.497983921	2.552212551	3.627359292	2.756944548	0.811525129	0.1414023	2.67395375	1.140715719	9.160367183	0.406052859	3.157605321	0	0	4.0354041	0	0	0	0	0	0	0	0	0	0	1.935977001	0	0	0	0	0	0	0	0	54.6712	0	NO	9.621241	15.7154	0.72689939	1.72226957	0	0.25055153	1.77840585	0.580112	1.497983921	2.552212551	3.627359292	2.756944548	0.811525129	0.1414023	2.67395375	1.140715719	9.160367183	0.406052859	3.157605321	0	0	4.0354041	0	0	0	0	0	0	0	0	0	0	1.935977001	0	0	0	0	0	0	0	0	54.6712	YES	$0-$250/Day(Days 1-10)	$0-$250/Day(Days 1-10)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									6000	2.0675	0.1108	0.5547	1.9059	1.6595	0.5646	0.1843	0.1417	1.407	0.3585	0.6731	0.0801	0.0135	0.2554	0.9838	1.2027	0.05	0.3472		0.4115	0.5148	0		0	0				0	0	0.0821	0.5102									14.0788	0	NO	4.265028	17.7829	0.83765539	2.27700657	1.905939	1.91009853	2.34298385	0.764366	1.639647921	3.959233551	3.985870292	3.430055548	0.891648129	0.1548923	2.92933675	2.124538719	10.36306518	0.456081859	3.504757321	0	0.411535	4.5501891	0	0	0	0	0	0	0	0	0	0.082056	2.446138001	0	0	0	0	0	0	0	0	68.75
H1418_007_0	2012	5	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		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	964.06	41.23	620.43	683.68	20.97	14.85	4.87	319.86	377.99	2224.78	957.54	169.8	1.56	7.16	2932.12	4017.27	98.28	728.06		1305.64	26.5	0		3.21	0.61		0.24		2.8	1.24	504.53										4500	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$143/Day(Days 1-10): 1b. $143 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												142.969537	108.261289	42.474818	0	100	0.2	0.107532	65	100	0	36.910521	31.926648	0.199999	0.2	10	27.160498	30	30		0	0.2	0		0	0		0		0	0	46.538987										NO	124.019067	93.911363	34.642929	0	94.0304	0.188061	0.101113	61.11976	94.0304	0	34.70711	30.020755	0.188059	0.188061	9.40304	25.539125	28.20912	28.20912		0	0.188061	0		0	0		0		0	0	43.760796											9.9635	0.322663791	1.791126037	0	0.164318124	2.79270585	0.49242031	1.629147203	2.961879241	0	2.769453842	0.424793683	0.29337204	1.34651676	2.297570137	8.549796724	0.231032693	1.711494326	0	0	4.9836165	0	0	0	0	0	0	0	0	0	1.8398862	0	0	0	0	0	0	0	0	0	44.5653	0	NO	4.039278	9.9635	0.322663791	1.791126037	0	0.164318124	2.79270585	0.49242031	1.629147203	2.961879241	0	2.769453842	0.424793683	0.29337204	1.34651676	2.297570137	8.549796724	0.231032693	1.711494326	0	0	4.9836165	0	0	0	0	0	0	0	0	0	1.8398862	0	0	0	0	0	0	0	0	0	44.5653	YES	$0-$200/Day(Days 1-10)	$0-$200/Day(Days 1-10)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6000	1.2298	0.0487	0.5709	1.033	1.0933	0.8904	0.2924	0.1548	1.9082	0.3789	0.6459	0.0344	0.0282	0.1292	0.8708	1.1931	0.0292	0.1706		0.3878	0.6403	0		0	0		0		0	0	0.4026										12.1325	0	NO	2.43014	11.1933	0.371406791	2.362026037	1.033036	1.257574124	3.68313285	0.78478531	1.783909203	4.870104241	0.378857	3.415373842	0.459151683	0.32154004	1.47569376	3.168406137	9.742922724	0.260220693	1.882136326	0	0.387773	5.6239345	0	0	0	0	0	0	0	0	0	2.2424562	0	0	0	0	0	0	0	0	0	56.6978
H1418_008_0	2012	8	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	1156.32	53.92	536.65	1057.53	19.37	11.99	3.42	344.66	343.1	1441.36	908.2	185.96	0.27	538.72	3093.64	3713.76	93.06	703.42		1545.29	18.56	0		3.15	0.61				5.09	0.95	1105.48	0.11									3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											145.768118	128.006658	44.690621	0	100	0.2	0.2	65	150	26.755985	37.453694	32.881356	0.2	50	10	26.914539	30	36.079196		0	0.2	0		0	0				0	0	0	0									NO	111.835924	98.209012	30.934893	0	89.7124	0.179425	0.179425	58.31306	134.5686	24.003436	33.600608	29.498654	0.179425	44.8562	8.97124	24.145679	26.91372	32.367513		0	0.179425	0		0	0				0	0	0	0										10.7765	0.441285827	1.383434194	0	0.144810766	2.15130575	0.6136335	1.674848272	3.847540555	2.883132709	2.543006015	0.457130808	0.04844475	2.013744339	2.312815576	7.472604737	0.208715899	1.897329666	0	0	3.330128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2004	0	NO	7.642323	10.7765	0.441285827	1.383434194	0	0.144810766	2.15130575	0.6136335	1.674848272	3.847540555	2.883132709	2.543006015	0.457130808	0.04844475	2.013744339	2.312815576	7.472604737	0.208715899	1.897329666	0	0	3.330128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2004	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									5100	3.5227	0.0697	0.2898	1.2258	0.9133	0.6504	0.1857	0.1508	1.3781	0.186	0.4507	0.0339	0.0044	0.3817	0.8311	0.9977	0.025	0.1705		0.4151	0.4718	0		0	0				0	0	0.0889	0									12.4433	0	NO	6.76825	14.2992	0.511003827	1.673222194	1.225788	1.058102766	2.80166775	0.7992975	1.825694272	5.225677555	3.069157709	2.993693015	0.491031808	0.05288075	2.395491339	3.143935576	8.470319737	0.233715899	2.067792666	0	0.415149	3.801971	0	0	0	0	0	0	0	0	0	0.088868	0	0	0	0	0	0	0	0	0	56.6437
H1418_009_0	2012	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	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	999.36	26.81	386.89	840.88	20.77	6.49	2.39	290.71	255.29	883.59	651.86	58.44	0.2	500.9	2000.69	2916.75	33.17	456.48		1000.88	11.65	0		3.15	0.61				1.34	0.95	722.73	0									3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											145.768118	128.006658	44.690621	0	100	0.2	0.2	65	150	39.347559	40.0362	34.067479	0.2	50	10	27.839999	30	36.834919		0	0.2	0		0	0				0	0	0	0									NO	120.281291	105.625334	35.504911	0	93.0202	0.18604	0.18604	60.46313	139.5303	36.601178	37.241753	31.689637	0.18604	46.5101	9.30202	25.896823	27.90606	34.263915		0	0.18604	0		0	0				0	0	0	0										10.017	0.2359846	1.144707918	0	0.161002463	1.2073996	0.4446356	1.46476971	2.968390857	2.695036239	2.023034093	0.154328532	0.037208	1.941409091	1.550871533	6.29454654	0.077137001	1.303399327	0	0	2.167366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8883	0	NO	4.306299	10.017	0.2359846	1.144707918	0	0.161002463	1.2073996	0.4446356	1.46476971	2.968390857	2.695036239	2.023034093	0.154328532	0.037208	1.941409091	1.550871533	6.29454654	0.077137001	1.303399327	0	0	2.167366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8883	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									5100	3.7466	0.0335	0.2895	1.7375	1.5126	0.5435	0.1999	0.1965	1.7745	0.278	0.6169	0.0184	0.0051	0.6123	0.8299	1.2099	0.0138	0.1749		0.4152	0.501	0		0	0				0	0	0.084	0									14.7932	500	NO	5.547516	13.7636	0.2694716	1.434178918	1.737506	1.673566463	1.7509346	0.6444986	1.66122171	4.742840857	2.972993239	2.639945093	0.172744532	0.042295	2.553727091	2.380790533	7.50446554	0.090895001	1.478299327	0	0.415181	2.668322	0	0	0	0	0	0	0	0	0	0.08399	0	0	0	0	0	0	0	0	0	50.6815
H1418_016_0	2012	5	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			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	1234.91	58.67	498.48	1217.17	26.43	13.23	6.29	378.55	354.93	1499.29	1074.66	175.59	0.46	7.37	3172.81	4086.75	98.81	752.41		1649.01	22.94	0			0.61				2.8	1.24	624.23										4500	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$143/Day(Days 1-10): 1b. $143 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												142.969537	108.261289	42.474818	0	100	0.2	0.133704	65	100	0	38.500037	32.505789	0.199087	0.2	10	28.175438	30	30		0	0.2	0			0				0	0	48.249865										NO	119.517386	90.50254	34.469037	0	93.1699	0.18634	0.124572	60.560435	93.1699	0	35.870446	30.285612	0.185489	0.18634	9.31699	26.251028	27.95097	27.95097		0	0.18634	0			0				0	0	44.954351											12.2994	0.442482002	1.431843797	0	0.205206705	2.4652782	0.78355788	1.910429389	2.755732717	0	3.212377792	0.443154218	0.08532494	1.3733258	2.46341992	8.940115723	0.230152945	1.752549111	0	0	4.2746396	0	0	0	0	0	0	0	0	0	2.338487877	0	0	0	0	0	0	0	0	0	47.4075	0	NO	5.269123	12.2994	0.442482002	1.431843797	0	0.205206705	2.4652782	0.78355788	1.910429389	2.755732717	0	3.212377792	0.443154218	0.08532494	1.3733258	2.46341992	8.940115723	0.230152945	1.752549111	0	0	4.2746396	0	0	0	0	0	0	0	0	0	2.338487877	0	0	0	0	0	0	0	0	0	47.4075	YES	$0-$200/Day(Days 1-10)	$0-$200/Day(Days 1-10)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins										6000	1.5173	0.0668	0.5057	1.8601	1.3597	0.7832	0.3722	0.1807	1.7598	0.3166	0.6531	0.0379	0.0082	0.1311	0.9298	1.1976	0.029	0.2041		0.4833	0.5381	0			0				0	0	0.4569										13.3912	0	NO	2.785127	13.8168	0.509289002	1.937570797	1.860107	1.564893705	3.2484682	1.15575688	2.091152389	4.515528717	0.316575	3.865427792	0.481099218	0.09349994	1.5044308	3.39322892	10.13775672	0.259108945	1.956659111	0	0.48325	4.8127856	0	0	0	0	0	0	0	0	0	2.795353877	0	0	0	0	0	0	0	0	0	60.7987
H1419_001_0	2012	4																															D	D	D	V	T	O	O	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	1404.733657	89.63491333	896.1163726	813.970379	177.5767963	719.1092225	0	373.9490697	371.2696811	2513.945446	2096.099685	87.15766654	1.040555543	490.9613908	2499.639538	4560.070856	225.3367608	557.2352258	0	0	229.6432636	0.003063043	0	0	816.8981571	18.51493001	37.29000394	1.157183126	55	0											3400	$225/day 1-8; unlimited additional days	$230/day 1-7	"$0/d 1-7, $75/day 8-15, $100/d 16-100; includes non-Medicare covered stays"	$15 per visit	$200 per trip	$20 	$20 copay for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$225 per procedure	$0 to $40 per visit	$0 to $50 X-ray; $60 Therapeutic Radiology; $250 Complex Radiology	$40 per visit	$30 per visit	$0 to 225 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	171.4121744	98.56078618	67.18706018	15	200	3	3	62.5	225	4	30.31120955	40	30	40	10	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0												NO	147.3553854	84.72830288	57.75771284	12.8948296	171.9310614	2.578965921	0	53.72845668	193.422444	3.438621227	26.05719215	34.38621227	25.78965921	34.38621227	8.596553068	34.38621227	34.38621227	17.19310614	0	0	42.98276534	0	0	0	0	0	0	0	0													17.2496	0.632884507	4.31313601	0.874667445	2.544247255	0.154546515	0	1.674308866	5.984324093	0.720375514	4.551539355	0.249751835	0.002236298	1.40685855	1.790690328	13.0669637	0.645706474	0.798383698	0	0	0.822558543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4828	0	NO	9.384460711	17.2496	0.632884507	4.31313601	0.874667445	2.544247255	0.154546515	0	1.674308866	5.984324093	0.720375514	4.551539355	0.249751835	0.002236298	1.40685855	1.790690328	13.0669637	0.645706474	0.798383698	0	0	0.822558543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4828	NO																																																																																		0		NO		17.2496	0.632884507	4.31313601	0.874667445	2.544247255	0.154546515	0	1.674308866	5.984324093	0.720375514	4.551539355	0.249751835	0.002236298	1.40685855	1.790690328	13.0669637	0.645706474	0.798383698	0	0	0.822558543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4828
H1419_801_0	2012	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	0	0	0	0	0	0	0											0	YES	385.2784304	7.087710736	47.04762847	12.26346504	11.48264566	15.92090034	0	19.94498289	49.35550037	23.93383784	66.86216888	1.119183662	0.097743107	32.84477679	33.12272311	165.1385471	3.784885568	10.49165516	0	0	82.9055132	0.000431557	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	NO	0.07291913	0.07291913	0.167442342	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060776849	0.060776849	0.139560331	0	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0	0	0	0	0	0	0	0												23.416	0.430768724	6.565982595	0	2.143811929	2.972434847	0	3.723731754	9.214680453	4.468451663	12.48317849	0.208951783	0.018248655	6.132125505	6.184018131	30.8313953	0.70663879	1.958793833	0	0	15.47847365	8.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9378	0	NO	25.36021799	23.416	0.430768724	6.565982595	0	2.143811929	2.972434847	0	3.723731754	9.214680453	4.468451663	12.48317849	0.208951783	0.018248655	6.132125505	6.184018131	30.8313953	0.70663879	1.958793833	0	0	15.47847365	8.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9378	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		23.416	0.430768724	6.565982595	0	2.143811929	2.972434847	0	3.723731754	9.214680453	4.468451663	12.48317849	0.208951783	0.018248655	6.132125505	6.184018131	30.8313953	0.70663879	1.958793833	0	0	15.47847365	8.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9378
H1419_802_0	2012	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	0	0	0	0	0	0	0											0	YES	382.404937	7.03484899	46.69673664	12.17200135	11.39700549	15.80215868	0	19.79622871	48.98739591	23.75533388	66.36349574	1.110836538	0.097014116	32.59981303	32.87568636	163.9069066	3.756657037	10.41340603	0	0	82.28718517	0.000428339	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	NO	0.07291913	0.07291913	0.167442342	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060776849	0.060776849	0.139560331	0	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0.186700173	0	0	0	0	0	0	0	0												23.2414	0.427555954	6.517012015	0	2.127822896	2.950265757	0	3.695959323	9.145955287	4.435124942	12.39007613	0.207393374	0.018112552	6.08639073	6.137896328	30.6014478	0.701368518	1.944184706	0	0	15.3630317	8.00E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.991	0	NO	25.17107576	23.2414	0.427555954	6.517012015	0	2.127822896	2.950265757	0	3.695959323	9.145955287	4.435124942	12.39007613	0.207393374	0.018112552	6.08639073	6.137896328	30.6014478	0.701368518	1.944184706	0	0	15.3630317	8.00E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.991	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		23.2414	0.427555954	6.517012015	0	2.127822896	2.950265757	0	3.695959323	9.145955287	4.435124942	12.39007613	0.207393374	0.018112552	6.08639073	6.137896328	30.6014478	0.701368518	1.944184706	0	0	15.3630317	8.00E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.991
H1463_001_0	2012	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	304.5142739	1.050932632	1957.760449	0	281.2995354	10.20943516	0.965807148	428.1487796	376.6039378	0	0	0	0	2112.075315	4479.111604	6126.757717	128.8180887	113.8754041	319.0882679	828.3606671	0	0	0	0	41.4893257	0	0	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$100/Visit for OP Hospital, ASC Services; PBP 9a-b"	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	285.305	317.1298	20.00025211	0	50	0.1	0.1	60.93580507	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	0	0	0	0											NO	252.0206895	280.1327382	17.6669786	0	44.16688973	0.088333779	0.088333779	53.82689966	88.33377947	0	0	0	0	17.66675589	17.66675589	17.66675589	17.66675589	17.66675589	17.66675589	17.66675589	0	0	0	0	17.66675589	0	0	0	0	0												6.3953	0.024533386	2.882309329	0	1.035343797	0.901837994	0.085313396	1.92049345	2.772237432	0	0	0	0	3.109459918	6.594280944	9.019994416	0.189649811	0.167650747	0.469771211	1.219537141	0	0	0	0	0.061081816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8488	0	NO	4.866614538	6.3953	0.024533386	2.882309329	0	1.035343797	0.901837994	0.085313396	1.92049345	2.772237432	0	0	0	0	3.109459918	6.594280944	9.019994416	0.189649811	0.167650747	0.469771211	1.219537141	0	0	0	0	0.061081816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8488	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.3953	0.024533386	2.882309329	0	1.035343797	0.901837994	0.085313396	1.92049345	2.772237432	0	0	0	0	3.109459918	6.594280944	9.019994416	0.189649811	0.167650747	0.469771211	1.219537141	0	0	0	0	0.061081816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8488
H1463_003_0	2012	9																															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	338.9025117	3.207249656	2427.165543	0	376.9586968	15.20565708	1.413956886	533.5658766	393.3690075	0	0	0	0	2842.12931	5263.225887	6698.960942	185.848693	154.1771389	365.1643149	948.3527831	0	0	0	0	36.30097931	0	0	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"	"$65/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	"$100/Visit for OP Hospital, ASC Services; PBP 9a-b"	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b		No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for Cardiac and Pulmonary Rehabilitation, Partial Hospitalization, OP Substance Abuse; PBP 3, 5, 9c"	"$20/Visit for PCP, No Cost Sharing for Preventive Services; PBP 7a, 14a-b, 14d-e"	"$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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	285.305	317.1298	20.00025211	0	50	0.1	0.1	60.93580507	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	0	0	0	0											NO	246.550602	274.052481	17.28351834	0	43.20825117	0.086416502	0.086416502	52.65859141	86.41650233	0	0	0	0	17.28330047	17.28330047	17.28330047	17.28330047	17.28330047	17.28330047	17.28330047	0	0	0	0	17.28330047	0	0	0	0	0												6.9631	0.073246227	3.495830014	0	1.357310504	1.3140197	0.122189209	2.34140229	2.832797813	0	0	0	0	4.093447902	7.580492869	9.648346232	0.267673234	0.222057485	0.525937048	1.365888842	0	0	0	0	0.052283394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.256	0	NO	6.642063872	6.9631	0.073246227	3.495830014	0	1.357310504	1.3140197	0.122189209	2.34140229	2.832797813	0	0	0	0	4.093447902	7.580492869	9.648346232	0.267673234	0.222057485	0.525937048	1.365888842	0	0	0	0	0.052283394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.256	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.9631	0.073246227	3.495830014	0	1.357310504	1.3140197	0.122189209	2.34140229	2.832797813	0	0	0	0	4.093447902	7.580492869	9.648346232	0.267673234	0.222057485	0.525937048	1.365888842	0	0	0	0	0.052283394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.256
H1463_801_0	2012	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	269.2333628	0.924218073	75.02528852	0	13.79863317	11.96353961	1.166947854	25.91152006	49.48671081	18.22889241	7.260941799	0	0.977944021	27.51698402	43.54756686	97.69905093	1.270513234	0.637018035	31.90684666	61.3089236	47.97134909	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	0.085960024	0.085960024	0.188356456	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.070208336	0.070208336	0.153841202	0	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0.182953268	0	0	0	0	0	0	0	0	0												18.9024	0.064887813	11.54198055	0	2.524505035	2.188768671	0.213496924	4.74059728	9.053755475	3.335035442	1.328413032	0	0.178918055	5.034322158	7.967169679	17.87436067	0.232444549	0.116544531	5.837461874	11.21666794	8.776515096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1283	0	NO	24.93233594	18.9024	0.064887813	11.54198055	0	2.524505035	2.188768671	0.213496924	4.74059728	9.053755475	3.335035442	1.328413032	0	0.178918055	5.034322158	7.967169679	17.87436067	0.232444549	0.116544531	5.837461874	11.21666794	8.776515096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1283	NO																																										0	0	0	0	0	0	0	0	0	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	18.9024	0.064887813	11.54198055	0	2.524505035	2.188768671	0.213496924	4.74059728	9.053755475	3.335035442	1.328413032	0	0.178918055	5.034322158	7.967169679	17.87436067	0.232444549	0.116544531	5.837461874	11.21666794	8.776515096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1283
H1463_802_0	2012	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	303.1689165	0.748164885	75.75626773	0	14.65826691	12.93082401	1.412701065	25.67954008	46.893485	20.22603102	8.140407868	0	0.791641553	28.01093799	47.910904	105.8857644	1.154161958	0.668076822	40.92335568	63.60158429	53.62502763	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 9a-b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b		Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 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 14c	No Coverage; PBP 13a-e											0	NO	0.085866358	0.085866358	0.188522542	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.06851568	0.06851568	0.15042853	0	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0.178737197	0	0	0	0	0	0	0	0	0												20.7718	0.051261026	11.395904	0	2.619977547	2.311219244	0.252502229	4.589889024	8.381610086	3.615144099	1.454993688	0	0.141495792	5.006596554	8.563460706	18.92572478	0.206291674	0.119410179	7.314525903	11.36796893	9.584787149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6746	0	NO	29.54627729	20.7718	0.051261026	11.395904	0	2.619977547	2.311219244	0.252502229	4.589889024	8.381610086	3.615144099	1.454993688	0	0.141495792	5.006596554	8.563460706	18.92572478	0.206291674	0.119410179	7.314525903	11.36796893	9.584787149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6746	NO																																										0	0	0	0	0	0	0	0	0	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	20.7718	0.051261026	11.395904	0	2.619977547	2.311219244	0.252502229	4.589889024	8.381610086	3.615144099	1.454993688	0	0.141495792	5.006596554	8.563460706	18.92572478	0.206291674	0.119410179	7.314525903	11.36796893	9.584787149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6746
H1468_007_0	2012	4	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		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	1222.85	25.68	892.97	1490.64	239.04	15.68	5.96	372.83	346.21	1565.04	1238.99	113.89	1.9	4.15	4128.02	4474.8	17.32	1054.52		2115.19	32.34	0		2.7	0.6		0.26		5.16	1.24	641.94										3400	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-10): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-13), $75 (Days 14-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $20 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"		"HER834: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												122.545317	113.560793	35.638298	0	50	0.2	0.146881	65	100	0	21.613418	27.456235	0.2	0.2	10	19.691019	20	20		0	0.2	0		0	0		0		0	0	74.305865										NO	103.215386	95.648054	29.646074	0	45.16195	0.180648	0.132668	58.710535	90.3239	0	19.522082	24.799542	0.180648	0.180648	9.03239	17.785696	18.06478	18.06478		0	0.180648	0		0	0		0		0	0	67.115955											10.5181	0.204686836	2.206087892	0	0.899626044	2.83256064	0.79070128	1.824087397	2.605919785	0	2.015638698	0.23536832	0.3432312	0.7496892	3.107157214	6.632286038	0.026073499	1.58747265	0	0	5.84215632	0	0	0	0	0	0	0	0	0	3.590368013	0	0	0	0	0	0	0	0	0	46.0112	0	NO	5.998144	10.5181	0.204686836	2.206087892	0	0.899626044	2.83256064	0.79070128	1.824087397	2.605919785	0	2.015638698	0.23536832	0.3432312	0.7496892	3.107157214	6.632286038	0.026073499	1.58747265	0	0	5.84215632	0	0	0	0	0	0	0	0	0	3.590368013	0	0	0	0	0	0	0	0	0	46.0112	NO																																																																																		0	0	NO	0	10.5181	0.204686836	2.206087892	0	0.899626044	2.83256064	0.79070128	1.824087397	2.605919785	0	2.015638698	0.23536832	0.3432312	0.7496892	3.107157214	6.632286038	0.026073499	1.58747265	0	0	5.84215632	0	0	0	0	0	0	0	0	0	3.590368013	0	0	0	0	0	0	0	0	0	46.0112
H1468_802_0	2012	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	226.89	2.63	40.5	22.55	7.74	12.54	3.81	21.86	58.11	7.83	26.97	0.6	0.43	16.99	34.52	86.61	0.59	6.84		14.04	29.95	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																					0.0832	0.0832	0.193	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071435	0.071435	0.152216	0	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467		0.202467	0.202467	0																				16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	0	NO	11.445408	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	NO																																																																																		0	0	NO	0	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592
H1468_803_0	2012	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	226.89	2.63	40.5	22.55	7.74	12.54	3.81	21.86	58.11	7.83	26.97	0.6	0.43	16.99	34.52	86.61	0.59	6.84		14.04	29.95	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																					0.0832	0.0832	0.193	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071435	0.071435	0.152216	0	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467		0.202467	0.202467	0																				16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	0	NO	11.445408	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	NO																																																																																		0	0	NO	0	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592
H1468_804_0	2012	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	226.89	2.63	40.5	22.55	7.74	12.54	3.81	21.86	58.11	7.83	26.97	0.6	0.43	16.99	34.52	86.61	0.59	6.84		14.04	29.95	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																					0.0832	0.0832	0.193	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071435	0.071435	0.152216	0	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467	0.202467		0.202467	0.202467	0																				16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	0	NO	11.445408	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592	NO																																																																																		0	0	NO	0	16.2079	0.18787405	6.164748	0	1.56709458	2.53893618	0.77139927	4.42592862	11.76535737	1.58531661	5.46053499	0.1214802	0.08706081	3.43991433	6.98916084	17.53566687	0.11945553	1.38487428	0	2.84263668	6.06388665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2592
H1509_001_0	2012	5																															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	1151.026588	84.90470056	1020.517736	195.9882096	107.9846504	7.307672522	10.56836434	357.0074397	59.12883395	15.16234453	31.17987838	0	0.052670684	25.6153507	4686.355666	3161.936453	419.9834203	405.291719	0	0	26.40086587	673.7857262	0	0	35.30232558	0	4.481680657	0	680.7194257	0											4400	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	73.32796136	0	200	0.2	0.094653381	63.55147978	0.16	0.207834421	0.18362273	0	0.2	0.145397976	12.73518851	37.7522597	38.5	40	0	0	0.2	39.35448163	0	0	40	0	39.42980676	0	0	0											NO	161.2939948	84.47926009	56.81915009	0	154.9726708	0.154972671	0.073343436	49.26429975	0.123978137	0.161043277	0.142282524	0	0.154972671	0.112663564	12.24794017	36.31014194	37.02698989	38.46959989	0	0	0.154972671	30.49434564	0	0	40	0	39.42980676	0	0	0												15.4711	0.597723857	4.832079202	0	1.394555806	1.132489528	0.775120153	1.46564346	7.330682656	2.441793645	4.436351809	0	0.008162517	2.885916694	4.78318365	9.567530118	1.295893488	1.299284189	0	0	4.091412696	1.712221235	0	0	0.117674419	0	0.014725984	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6536	0	NO	14.78628394	15.4711	0.597723857	4.832079202	0	1.394555806	1.132489528	0.775120153	1.46564346	7.330682656	2.441793645	4.436351809	0	0.008162517	2.885916694	4.78318365	9.567530118	1.295893488	1.299284189	0	0	4.091412696	1.712221235	0	0	0.117674419	0	0.014725984	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6536	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-51 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$30/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											8800	1.3244	0.0301	1.6107	0.135	0.155	0.3146	0.273	0.1628	1.2218	0.2713	0.7186	0	0.0009	0.4804	1.5743	2.5843	0.3106	0.3445	0	0	1.3018	0.451	0	0	0.0312	0	0.0031	0	0	0											13.2994	0	NO	2.645321924	16.7955	0.627871465	6.442807254	0.135023475	1.549506452	1.447069953	1.048088094	1.628492733	8.552463099	2.713104051	5.154994905	0	0.009069463	3.366312099	6.35743963	12.15180929	1.606479531	1.643791361	0	0	5.393225827	2.163237403	0	0	0.148875969	0	0.017849677	0	0	0	0	0	0	0	0	0	0	0	0	0	78.953
H1509_004_0	2012	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	240.7024938	21.5364555	34.57604655	1429.495098	11.57415317	26.56671788	18.43532209	33.0217331	55.35576721	16.73561547	29.92376408	0	0.008094324	38.42309007	29.07919417	59.87303353	8.9312	4.37115672	0	684.257104	18.71447587	5.853631557	693.7244196	568.338842	34.9172093	199.4848	0	0	154.5606324	2958.81263											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.078729626	0.079685856	0.192672848	0	0.224	0.224	0.224	0.135716716	0.224	0.224	0.224	0	0.224	0.224	0.221420593	0.223829188	0.228455489	0.224	0	0	0.224	0.22293505	0	0	0	0	0	0	0	0											NO	0.059104365	0.059822231	0.144644486	0	0.168162588	0.168162588	0.168162588	0.101901725	0.168162588	0.168162588	0.168162588	0	0.168162588	0.168162588	0.164888834	0.166682481	0.170127623	0.166809683	0	0	0.168162588	0.168469205	0	0	0	0	0	0	0	0												14.2266	1.288358825	5.001234473	0	1.946339551	4.467528035	3.100131473	3.364971572	9.308769078	2.81430441	5.032057612	0	0.001361162	6.461326267	4.79483442	9.979785803	1.519443831	0.729151266	0	0	3.147074696	0.986156653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1694	150	YES	26.13029105	14.2266	1.288358825	5.001234473	0	1.946339551	4.467528035	3.100131473	3.364971572	9.308769078	2.81430441	5.032057612	0	0.001361162	6.461326267	4.79483442	9.979785803	1.519443831	0.729151266	0	0	3.147074696	0.986156653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1694	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	3.1172	0.2823	1.4833	0.4745	0.3171	0.7279	0.4941	0.3737	1.2396	0	0.6775	0	0.0002	0.7951	1.5737	3.6618	0.5461	0.2673	0	0	1.1537	0.3615	0	0.1685	0.0479	0	0	0	0	0											17.7629	150	YES	5.878506187	17.3438	1.570656778	6.484499134	0.47453818	2.263445657	5.195397135	3.594264488	3.738641496	10.54834753	2.81430441	5.709592786	0	0.001515411	7.256457638	6.368574271	13.64159778	2.065578297	0.996443381	0	0	4.300728668	1.347613529	0	0.168468551	0.0478584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9323
H1509_006_0	2012	3																															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	214.2931095	39.9517375	8561.686977	13.87692376	18.0581367	26.55858738	4.79163427	14.04282704	32.88009106	41.24391145	14.80501649	0	0	14.68531244	3.553060346	110.7834914	17.827458	100.1757632	0	46535.40029	41.23898607	8.637046282	1306.840719	152	40.80948837	209.8208	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.07501419	0.075925293	0	0	0.2	0.2	0.192296332	0.107053473	0.16	0	0.088258899	0	0	0.146379975	0	0.034052591	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.069636416	0.070482203	0	0	0.185661983	0.185661983	0.178510592	0.099378801	0.148529586	0	0.081931611	0	0	0.135885982	0	0.031200065	0.183246349	0	0	0	0.185661983	0.186447191	0	0	0	0	0	0	0	0												14.9226	2.815886453	0	0	3.35270947	4.930920002	0.85535747	1.395559309	4.883666328	0	1.212998853	0	0	1.995528108	0	3.456452144	3.266816598	0	0	0	7.656511935	1.61035302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3554	0	NO	4.131387145	14.9226	2.815886453	0	0	3.35270947	4.930920002	0.85535747	1.395559309	4.883666328	0	1.212998853	0	0	1.995528108	0	3.456452144	3.266816598	0	0	0	7.656511935	1.61035302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3554	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2963	0.0559	0	0.0017	0.5279	0.7764	0.1401	0.1465	0.769	0	0.3329	0	0	0.3142	0.0505	2.118	0.3407	0.0092	0	0	0.7984	0.1679	0	0	0.0156	0	0	0	0	0											6.8611	0	NO	0.562466341	15.2189	2.871797399	0	0.001691875	3.880622288	5.707335582	0.995436438	1.542054485	5.652641413	0	1.545881667	0	0	2.309741098	0.05054403	5.574416643	3.607473943	0.009164403	0	0	8.45491826	1.778277533	0	0	0.01555398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2165
H1509_007_0	2012	4																															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	1220.555863	83.78558055	1269.732296	110.3015755	138.9442286	11.04716676	12.25018177	367.024651	54.65668283	15.16479227	29.92072233	0	0.091809244	34.71523695	4786.215719	3141.643147	417.9608986	389.7452803	0	0	13.18893072	573.9343228	0	0	46.14692659	0	4.456876429	0	587.569547	0											4900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	69.7052965	0	200	0.2	0.095689448	63.61460027	0.16	0.189189023	0.182973113	0	0.2	0.144969679	6.406905315	33.97286026	38.5	35	0	0	0.2	34.29184807	0	0	35	0	35	0	0	0											NO	155.4558401	81.42147114	56.46868925	0	162.0212296	0.16202123	0.07751861	51.55075111	0.129616984	0.15326319	0.148227644	0	0.16202123	0.117440828	6.202094957	32.88801241	37.26926559	33.88115054	0	0	0.16202123	27.78003695	0	0	35	0	35	0	0	0												15.8119	0.568495436	5.975009869	0	1.875992897	1.789875542	0.949617061	1.576699703	7.084434367	2.324204443	4.435078169	0	0.014875047	4.076986174	2.473713698	8.610199901	1.298091312	1.100418209	0	0	2.136886772	1.328659725	0	0	0.134595203	0	0.012999223	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5787	0	NO	12.15258099	15.8119	0.568495436	5.975009869	0	1.875992897	1.789875542	0.949617061	1.576699703	7.084434367	2.324204443	4.435078169	0	0.014875047	4.076986174	2.473713698	8.610199901	1.298091312	1.100418209	0	0	2.136886772	1.328659725	0	0	0.134595203	0	0.012999223	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5787	YES	"$395 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-54 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9400	0.7968	0.0489	2.1353	0.1896	0.2084	0.4972	0.3308	0.1752	1.1807	0.2582	0.7172	0	0.0017	0.6789	1.3634	2.3842	0.3111	0.3001	0	0	0.6799	0.3611	0	0	0.0367	0	0.0031	0	0	0											12.6586	0	NO	2.078139881	16.6087	0.617363385	8.110333553	0.189565804	2.084436552	2.287063192	1.280415313	1.751888559	8.265173428	2.582449381	5.152251335	0	0.01652783	4.755844354	3.837077942	10.99444507	1.609204105	1.400532267	0	0	2.81680529	1.689799838	0	0	0.171302985	0	0.016107426	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2373
H1509_009_0	2012	4																															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	1392.78734	86.73779201	1102.659999	112.5296671	132.8584185	8.929211226	12.2108619	415.3348994	61.12947106	15.90693272	32.84185451	0	0.039423801	35.81908446	5128.090926	3152.732325	443.4873512	449.9584072	0	0	24.76063917	684.8775791	0	0	45.51621952	0	8.672717608	0	112.5628474	0											4900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	68.79935719	0	200	0.2	0.086300706	62.42470939	0.16	0.172866172	0.184492168	0	0.2	0.145589453	10.05813091	33.46379064	38.5	35	0	0	0.2	34.16251532	0	0	35	0	35	0	0	0											NO	148.8566776	77.96509719	53.36881849	0	155.1433637	0.155143364	0.066944909	48.43866272	0.124114691	0.134095197	0.143113677	0	0.155143364	0.112936187	9.666888378	32.1643485	37.00242181	33.63856528	0	0	0.155143364	26.5004377	0	0	35	0	35	0	0	0												17.2771	0.563543365	4.903971777	0	1.717675162	1.385307865	0.817455036	1.676522259	7.587065411	2.133043281	4.700118574	0	0.006116341	4.045270822	4.131056881	8.450465101	1.367508836	1.261329604	0	0	3.84144885	1.512462968	0	0	0.13275564	0	0.025295426	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5356	0	NO	15.69742806	17.2771	0.563543365	4.903971777	0	1.717675162	1.385307865	0.817455036	1.676522259	7.587065411	2.133043281	4.700118574	0	0.006116341	4.045270822	4.131056881	8.450465101	1.367508836	1.261329604	0	0	3.84144885	1.512462968	0	0	0.13275564	0	0.025295426	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5356	YES	"$395 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-19 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-43 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											7500	0.8517	0.0454	1.6524	0.1087	0.1909	0.3848	0.3157	0.1863	1.2645	0.237	0.761	0	0.0007	0.6736	1.4778	2.3531	0.3278	0.344	0	0	1.2223	0.4113	0	0	0.0362	0	0.0069	0	0	0											12.8519	0	NO	2.581286625	18.1288	0.608968636	6.556384542	0.108698465	1.908527958	1.770115605	1.133194068	1.86280251	8.851576313	2.37004809	5.461070233	0	0.006795934	4.718868212	5.608825339	10.80356051	1.695258888	1.605328587	0	0	5.063728029	1.923750732	0	0	0.168961724	0	0.032194179	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3875
H1509_801_0	2012	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	251.8726679	3.58209136	39.41996352	254.4428578	7.666381762	14.32224642	14.91056017	18.06675714	70.89401141	27.95190095	42.30716139	0	0.076527243	33.2470881	30.79271086	96.13595738	1.511358534	10.34780113	0	0	34.9149022	10.25201841	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082179253	0.082179253	0.181152746	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065074875	0.065074875	0.143448522	0	0.177377763	0.177377763	0.177377763	0.177377763	0.177377763	0.177377763	0.177377763	0	0.177377763	0.177377763	0.178090381	0.178090381	0.178090381	0.178090381	0	0	0.177377763	0.177377763	0	0	0	0	0	0	0	0												16.3906	0.233104148	5.654735486	0	1.359845647	2.540448031	2.644801807	3.204640965	12.57502115	4.958045661	7.504349642	0	0.013574231	5.897294111	5.483885597	17.12088924	0.269158417	1.842843841	0	0	6.193127245	1.818480091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7048	150	YES	25.03030199	16.3906	0.233104148	5.654735486	0	1.359845647	2.540448031	2.644801807	3.204640965	12.57502115	4.958045661	7.504349642	0	0.013574231	5.897294111	5.483885597	17.12088924	0.269158417	1.842843841	0	0	6.193127245	1.818480091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7048	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4203	0.006	0.8825	0	0.1511	0.2823	0.2939	0.3561	1.3972	0.5509	0.8338	0	0.0015	0.6553	1.0085	3.6317	0.0571	0.3909	0	0	1.3137	0.3857	0	0	0	0	0	0	0	0											12.6185	150	YES	3.290944328	16.8109	0.239081178	6.537266457	0	1.510939607	2.822720034	2.938668674	3.560712183	13.97224572	5.508939623	8.338166269	0	0.015082479	6.552549012	6.492432531	20.75259302	0.326252626	2.23375011	0	0	7.506820903	2.204218292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3233
H1509_803_0	2012	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	254.5077061	3.060563054	53.05194783	228.4352876	7.172251104	10.90053256	8.783909596	16.14322907	65.01018963	24.307817	39.42260074	0	0.117409148	36.15798828	26.68508257	85.50236723	1.406063171	9.82252431	0	0	27.29778726	11.61025186	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.078291003	0.078291003	0.162242193	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063220132	0.063220132	0.131010876	0	0.180880421	0.180880421	0.180880421	0.180880421	0.180880421	0.180880421	0.180880421	0	0.180880421	0.180880421	0.181596931	0.181596931	0.181596931	0.181596931	0	0	0.180880421	0.180880421	0	0	0	0	0	0	0	0												16.09	0.193489201	6.950382185	0	1.297319802	1.971692923	1.58883727	2.919994078	11.7590705	4.396808184	7.130776636	0	0.021237016	6.540272159	4.845929093	15.52696746	0.255336756	1.783740267	0	0	4.937635265	2.10006725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3096	150	YES	21.41913644	16.09	0.193489201	6.950382185	0	1.297319802	1.971692923	1.58883727	2.919994078	11.7590705	4.396808184	7.130776636	0	0.021237016	6.540272159	4.845929093	15.52696746	0.255336756	1.783740267	0	0	4.937635265	2.10006725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3096	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4126	0.005	1.0847	0	0.1441	0.2191	0.1765	0.3244	1.3066	0.4885	0.7923	0	0.0024	0.7267	0.8978	3.2936	0.0542	0.3784	0	0	1.0474	0.4455	0	0	0	0	0	0	0	0											11.7998	150	YES	2.790317282	16.5026	0.198450463	8.035123913	0	1.441466447	2.190769915	1.765374744	3.244437864	13.06563389	4.885342426	7.923085151	0	0.023596685	7.266969066	5.743773432	18.82056662	0.309499099	2.162109415	0	0	5.985012442	2.54553606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1093
H1509_804_0	2012	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	265.8598914	3.781015335	42.16106109	261.0518481	8.116851934	15.16380963	15.7866922	19.12834466	75.05968415	29.59433125	44.79309476	0	0.08102392	35.20065915	32.13913153	100.3395314	1.577443147	10.80026189	0	0	36.44156695	10.70029104	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077672634	0.077672634	0.167937565	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06078121	0.06078121	0.131416279	0	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0	0.175286848	0.175286848	0.175976064	0.175976064	0.175976064	0.175976064	0	0	0.175286848	0.175286848	0	0	0	0	0	0	0	0												16.1593	0.229814689	5.540649747	0	1.42277739	2.658016391	2.767199513	3.35294724	13.15697543	5.187497038	7.851640384	0	0.014202427	6.170212584	5.655717869	17.65735581	0.277592236	1.900587577	0	0	6.3877274	1.875620288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2658	150	YES	27.18101407	16.1593	0.229814689	5.540649747	0	1.42277739	2.658016391	2.767199513	3.35294724	13.15697543	5.187497038	7.851640384	0	0.014202427	6.170212584	5.655717869	17.65735581	0.277592236	1.900587577	0	0	6.3877274	1.875620288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2658	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4143	0.0059	0.8647	0	0.1581	0.2953	0.3075	0.3725	1.4619	0.5764	0.8724	0	0.0016	0.6856	1.0401	3.7455	0.0589	0.4032	0	0	1.355	0.3979	0	0	0	0	0	0	0	0											13.0168	150	YES	3.591160312	16.5736	0.235707373	6.405375431	0	1.580863766	2.953351545	3.074666125	3.725496933	14.61886159	5.763885597	8.724044871	0	0.015780475	6.85579176	6.69586665	21.40285553	0.336475438	2.303742518	0	0	7.742699879	2.273479137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2826
H1509_806_0	2012	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	251.8029702	3.581100132	39.40681884	253.5674025	7.67963238	14.34700108	14.93633167	18.09798383	71.01654502	28.00021318	42.38028532	0	0.076659513	33.30455256	29.28816574	91.43871308	1.437512904	9.842203104	0	0	33.20894503	9.751100374	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08184356	0.08184356	0.178613224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065108997	0.065108997	0.142092154	0	0.17819869	0.17819869	0.17819869	0.17819869	0.17819869	0.17819869	0.17819869	0	0.17819869	0.17819869	0.178919565	0.178919565	0.178919565	0.178919565	0	0	0.17819869	0.17819869	0	0	0	0	0	0	0	0												16.3946	0.233161836	5.599399778	0	1.368500433	2.556616804	2.661634743	3.225037018	12.65505532	4.989601321	7.552111345	0	0.013660625	5.934827651	5.240225883	16.3601748	0.257199184	1.760962701	0	0	5.917790516	1.737633317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4582	150	YES	24.15839769	16.3946	0.233161836	5.599399778	0	1.368500433	2.556616804	2.661634743	3.225037018	12.65505532	4.989601321	7.552111345	0	0.013660625	5.934827651	5.240225883	16.3601748	0.257199184	1.760962701	0	0	5.917790516	1.737633317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4582	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4204	0.006	0.8739	0	0.1521	0.2841	0.2957	0.3583	1.4061	0.5544	0.8391	0	0.0015	0.6594	0.9637	3.4703	0.0546	0.3735	0	0	1.2553	0.3686	0	0	0	0	0	0	0	0											12.3371	150	YES	3.146298427	16.815	0.239140345	6.473294541	0	1.520556037	2.840685337	2.957371937	3.583374464	14.06117258	5.544001468	8.391234828	0	0.015178472	6.594252946	6.203961113	19.83051491	0.311756587	2.134500244	0	0	7.173079413	2.106222202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7953
H1509_807_0	2012	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	259.6891055	3.122871579	54.85013004	230.2651831	7.34063586	11.15644712	8.990131666	16.52222775	66.53645032	24.87849778	40.34813512	0	0.120165592	37.00687853	26.92376413	86.26713302	1.418639537	9.910380715	0	0	27.54194909	11.71409838	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077672634	0.077672634	0.167937565	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062391243	0.062391243	0.134897362	0	0.179930018	0.179930018	0.179930018	0.179930018	0.179930018	0.179930018	0.179930018	0	0.179930018	0.179930018	0.18062345	0.18062345	0.18062345	0.18062345	0	0	0.179930018	0.179930018	0	0	0	0	0	0	0	0												16.2023	0.194839839	7.399137858	0	1.320800745	2.007379735	1.617594555	2.972844741	11.97190472	4.476388561	7.259840691	0	0.021621397	6.658648332	4.863063158	15.58186717	0.256239567	1.790047153	0	0	4.955623403	2.107717936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6579	150	YES	22.34212985	16.2023	0.194839839	7.399137858	0	1.320800745	2.007379735	1.617594555	2.972844741	11.97190472	4.476388561	7.259840691	0	0.021621397	6.658648332	4.863063158	15.58186717	0.256239567	1.790047153	0	0	4.955623403	2.107717936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6579	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4154	0.005	1.1548	0	0.1468	0.223	0.1797	0.3303	1.3302	0.4974	0.8066	0	0.0024	0.7398	0.901	3.3052	0.0544	0.3797	0	0	1.0512	0.4471	0	0	0	0	0	0	0	0											11.9702	150	YES	2.909655719	16.6178	0.199835733	8.553916599	0	1.467556383	2.230421928	1.797327284	3.303160823	13.30211636	4.973765067	8.066489656	0	0.024023775	7.398498146	5.764082064	18.88711172	0.310593415	2.169754125	0	0	6.006816247	2.55480962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.628
H1509_808_0	2012	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	265.8598914	3.781015335	42.16106109	261.0518481	8.116851934	15.16380963	15.7866922	19.12834466	75.05968415	29.59433125	44.79309476	0	0.08102392	35.20065915	32.13913153	100.3395314	1.577443147	10.80026189	0	0	36.44156695	10.70029104	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077672634	0.077672634	0.167937565	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06078121	0.06078121	0.131416279	0	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0.175286848	0	0.175286848	0.175286848	0.175976064	0.175976064	0.175976064	0.175976064	0	0	0.175286848	0.175286848	0	0	0	0	0	0	0	0												16.1593	0.229814689	5.540649747	0	1.42277739	2.658016391	2.767199513	3.35294724	13.15697543	5.187497038	7.851640384	0	0.014202427	6.170212584	5.655717869	17.65735581	0.277592236	1.900587577	0	0	6.3877274	1.875620288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2658	150	YES	27.18101407	16.1593	0.229814689	5.540649747	0	1.42277739	2.658016391	2.767199513	3.35294724	13.15697543	5.187497038	7.851640384	0	0.014202427	6.170212584	5.655717869	17.65735581	0.277592236	1.900587577	0	0	6.3877274	1.875620288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2658	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4143	0.0059	0.8647	0	0.1581	0.2953	0.3075	0.3725	1.4619	0.5764	0.8724	0	0.0016	0.6856	1.0401	3.7455	0.0589	0.4032	0	0	1.355	0.3979	0	0	0	0	0	0	0	0											13.0168	150	YES	3.591160312	16.5736	0.235707373	6.405375431	0	1.580863766	2.953351545	3.074666125	3.725496933	14.61886159	5.763885597	8.724044871	0	0.015780475	6.85579176	6.69586665	21.40285553	0.336475438	2.303742518	0	0	7.742699879	2.273479137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2826
H1509_809_0	2012	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	263.280417	3.744330478	41.2053639	260.1911608	8.013605626	14.97092606	15.58588557	18.88503223	74.10492541	29.21789153	44.22332686	0	0.079993296	34.75290698	32.18736363	100.4901138	1.57981046	10.81647014	0	0	36.49625583	10.71634927	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075289463	0.075289463	0.151074361	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059271276	0.059271276	0.118932579	0	0.176342946	0.176342946	0.176342946	0.176342946	0.176342946	0.176342946	0.176342946	0	0.176342946	0.176342946	0.177008317	0.177008317	0.177008317	0.177008317	0	0	0.176342946	0.176342946	0	0	0	0	0	0	0	0												15.605	0.221931244	4.900660217	0	1.413142824	2.640017206	2.748460977	3.330242219	13.06788086	5.152369069	7.798471741	0	0.014106253	6.12843	5.697431068	17.78758593	0.279639591	1.914605177	0	0	6.435857273	1.889752601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0256	150	YES	26.09874538	15.605	0.221931244	4.900660217	0	1.413142824	2.640017206	2.748460977	3.330242219	13.06788086	5.152369069	7.798471741	0	0.014106253	6.12843	5.697431068	17.78758593	0.279639591	1.914605177	0	0	6.435857273	1.889752601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0256	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4001	0.0057	0.7648	0	0.157	0.2933	0.3054	0.37	1.452	0.5725	0.8665	0	0.0016	0.6809	1.0478	3.7731	0.0593	0.4061	0	0	1.3652	0.4009	0	0	0	0	0	0	0	0											12.9223	150	YES	3.46704401	16.0051	0.227621789	5.665503141	0	1.570158694	2.933352452	3.05384553	3.700269133	14.51986763	5.724854521	8.664968602	0	0.015673615	6.809366666	6.745251365	21.56071022	0.33895708	2.320733548	0	0	7.801039119	2.290609214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9479
H1509_810_0	2012	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	263.5731748	3.169579158	55.82047998	232.0294749	7.462843176	11.34218028	9.13979988	16.79729072	67.64415286	25.2926764	41.01985313	0	0.122166116	37.62297111	27.17082337	87.05874195	1.43165733	10.00132086	0	0	27.79468095	11.8215899	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077098492	0.077098492	0.166041839	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061744149	0.061744149	0.132974221	0	0.179389879	0.179389879	0.179389879	0.179389879	0.179389879	0.179389879	0.179389879	0	0.179389879	0.179389879	0.180071336	0.180071336	0.180071336	0.180071336	0	0	0.179389879	0.179389879	0	0	0	0	0	0	0	0												16.2741	0.195702966	7.422684837	0	1.338758537	2.034672352	1.639587598	3.013263956	12.13467642	4.537250168	7.358546505	0	0.021915365	6.74918025	4.892686457	15.67678395	0.257800448	1.800951207	0	0	4.986084462	2.120673586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.4553	150	YES	22.88457461	16.2741	0.195702966	7.422684837	0	1.338758537	2.034672352	1.639587598	3.013263956	12.13467642	4.537250168	7.358546505	0	0.021915365	6.74918025	4.892686457	15.67678395	0.257800448	1.800951207	0	0	4.986084462	2.120673586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.4553	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4173	0.005	1.1585	0	0.1488	0.2261	0.1822	0.3348	1.3483	0.5041	0.8176	0	0.0024	0.7499	0.9065	3.3254	0.0547	0.382	0	0	1.0577	0.4498	0	0	0	0	0	0	0	0											12.071	150	YES	2.979729428	16.6914	0.200720991	8.58113854	0	1.487509486	2.260747058	1.821763998	3.348071062	13.4829738	5.041389076	8.176162783	0	0.024350405	7.499089166	5.79919391	19.00216236	0.312485391	2.18297116	0	0	6.043738742	2.570513437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5264
H1509_811_0	2012	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	269.8362547	3.837566516	42.90692957	263.0520273	8.251981738	15.41625758	16.04950993	19.44679441	76.30928196	30.08701932	45.5388127	0	0.08237281	35.78668169	32.4340483	101.2602722	1.591918162	10.89936781	0	0	36.77596394	10.79847961	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077098492	0.077098492	0.166041839	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060101509	0.060101509	0.129436578	0	0.174617396	0.174617396	0.174617396	0.174617396	0.174617396	0.174617396	0.174617396	0	0.174617396	0.174617396	0.175309061	0.175309061	0.175309061	0.175309061	0	0	0.174617396	0.174617396	0	0	0	0	0	0	0	0												16.2176	0.230643538	5.553726155	0	1.440939563	2.691946754	2.802523631	3.3957486	13.32492811	5.253716968	7.95186889	0	0.014383726	6.248977168	5.685982541	17.75184321	0.279077678	1.910757932	0	0	6.421723058	1.88560239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.062	150	YES	27.8854713	16.2176	0.230643538	5.553726155	0	1.440939563	2.691946754	2.802523631	3.3957486	13.32492811	5.253716968	7.95186889	0	0.014383726	6.248977168	5.685982541	17.75184321	0.279077678	1.910757932	0	0	6.421723058	1.88560239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.062	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4158	0.0059	0.8668	0	0.1601	0.2991	0.3114	0.3773	1.4805	0.5837	0.8835	0	0.0016	0.6943	1.0457	3.7655	0.0592	0.4053	0	0	1.3622	0.4	0	0	0	0	0	0	0	0											13.1181	150	YES	3.683161368	16.6334	0.236557475	6.420492665	0	1.601043959	2.991051949	3.113915145	3.773054	14.80547567	5.837463297	8.835409878	0	0.015981917	6.943307965	6.731697328	21.51738571	0.338275973	2.316070221	0	0	7.783906737	2.285578654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1801
H1509_812_0	2012	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	250.0688953	3.556438405	39.60849802	253.7363031	7.611479381	14.21967842	14.80377899	17.93737303	70.38630775	27.75172492	42.00418092	0	0.075979197	33.00899086	30.58232941	95.47913888	1.501032655	10.27710305	0	0	34.67635718	10.18197474	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.085058934	0.085058934	0.184908395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067345664	0.067345664	0.146401772	0	0.177352666	0.177352666	0.177352666	0.177352666	0.177352666	0.177352666	0.177352666	0	0.177352666	0.177352666	0.178087811	0.178087811	0.178087811	0.178087811	0	0	0.177352666	0.177352666	0	0	0	0	0	0	0	0												16.8411	0.239510706	5.798754279	0	1.349916161	2.52189788	2.625489673	3.18124093	12.48319934	4.921842403	7.449553473	0	0.013475113	5.854232535	5.44634011	17.00367087	0.26731562	1.830226789	0	0	6.149944396	1.805800366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7835	150	YES	25.06500208	16.8411	0.239510706	5.798754279	0	1.349916161	2.52189788	2.625489673	3.18124093	12.48319934	4.921842403	7.449553473	0	0.013475113	5.854232535	5.44634011	17.00367087	0.26731562	1.830226789	0	0	6.149944396	1.805800366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7835	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4318	0.0061	0.905	0	0.15	0.2802	0.2917	0.3535	1.387	0.5469	0.8277	0	0.0015	0.6505	1.0016	3.6068	0.0567	0.3882	0	0	1.3045	0.383	0	0	0	0	0	0	0	0											12.573	150	YES	3.280592875	17.2729	0.245652006	6.703762173	0	1.499906846	2.802108755	2.917210747	3.534712144	13.87022148	5.468713781	8.277281637	0	0.014972348	6.504702816	6.447982015	20.61051015	0.324018934	2.218456714	0	0	7.454478056	2.188848929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3564
H1509_813_0	2012	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	221.9143528	3.156029165	34.7316803	238.8728002	6.754524662	12.61872545	13.13706381	15.91785544	62.46171444	24.62723749	37.27505019	0	0.067424916	29.29260288	27.12948636	84.69923795	1.331561255	9.116785162	0	0	30.76128527	9.032397144	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.083752222	0.083752222	0.165023863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068550679	0.068550679	0.135071017	0	0.183342623	0.183342623	0.183342623	0.183342623	0.183342623	0.183342623	0.183342623	0	0.183342623	0.183342623	0.184094612	0.184094612	0.184094612	0.184094612	0	0	0.183342623	0.183342623	0	0	0	0	0	0	0	0												15.2124	0.216347941	4.691243391	0	1.23839227	2.313550226	2.40858374	2.918421373	11.45189458	4.515222324	6.834105482	0	0.012361861	5.370582653	4.994392269	15.59267336	0.245133253	1.678351029	0	0	5.639854734	1.656023386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9895	150	YES	19.17812854	15.2124	0.216347941	4.691243391	0	1.23839227	2.313550226	2.40858374	2.918421373	11.45189458	4.515222324	6.834105482	0	0.012361861	5.370582653	4.994392269	15.59267336	0.245133253	1.678351029	0	0	5.639854734	1.656023386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9895	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.3901	0.0055	0.7322	0	0.1376	0.2571	0.2676	0.3243	1.2724	0.5017	0.7593	0	0.0014	0.5967	0.9185	3.3075	0.052	0.356	0	0	1.1963	0.3513	0	0	0	0	0	0	0	0											11.4276	150	YES	2.511009395	15.6024	0.221895324	5.423402764	0	1.375991411	2.570611363	2.676204155	3.242690414	12.72432731	5.016913693	7.593450535	0	0.013735401	5.967314059	5.912915991	18.90021014	0.297131216	2.034364883	0	0	6.836187556	2.007301074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4171
H1509_814_0	2012	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	231.4422444	3.291533261	36.22250949	243.9514248	7.04461457	13.16066809	13.70126778	16.60148745	65.14428856	25.68491563	38.87592019	0	0.070320648	30.55064677	28.29437118	88.33605051	1.38873578	9.508241326	0	0	32.08211213	9.420229858	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.086027076	0.086027076	0.198016292	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069375492	0.069375492	0.159687836	0	0.180642082	0.180642082	0.180642082	0.180642082	0.180642082	0.180642082	0.180642082	0	0.180642082	0.180642082	0.181434563	0.181434563	0.181434563	0.181434563	0	0	0.180642082	0.180642082	0	0	0	0	0	0	0	0												16.0564	0.228351738	5.784294148	0	1.272553842	2.377370484	2.475025537	2.998927256	11.76779991	4.639776633	7.02262716	0	0.012702868	5.518732438	5.133576865	16.0272127	0.251964669	1.725123608	0	0	5.795379528	1.701689934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7895	150	YES	21.66608572	16.0564	0.228351738	5.784294148	0	1.272553842	2.377370484	2.475025537	2.998927256	11.76779991	4.639776633	7.02262716	0	0.012702868	5.518732438	5.133576865	16.0272127	0.251964669	1.725123608	0	0	5.795379528	1.701689934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7895	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4117	0.0059	0.9028	0	0.1414	0.2642	0.275	0.3332	1.3075	0.5155	0.7803	0	0.0014	0.6132	0.9441	3.3997	0.0534	0.3659	0	0	1.2293	0.361	0	0	0	0	0	0	0	0											11.9055	150	YES	2.831781647	16.4681	0.234206911	6.687045258	0	1.413948714	2.64152276	2.750028374	3.332141395	13.07533324	5.15530737	7.802919067	0	0.014114298	6.131924931	6.077698166	19.42692449	0.30541172	2.091058919	0	0	7.024702458	2.062654465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.6951
H1509_815_0	2012	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	251.8899799	3.582337568	39.82525755	254.3905214	7.667912322	14.3251058	14.913537	18.07036409	70.90816509	27.95748143	42.31560783	0	0.076542521	33.25372574	30.540356	95.34809639	1.498972529	10.26299801	0	0	34.62876483	10.16800026	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079560704	0.079560704	0.165436218	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063202692	0.063202692	0.131421843	0	0.177944667	0.177944667	0.177944667	0.177944667	0.177944667	0.177944667	0.177944667	0	0.177944667	0.177944667	0.178650387	0.178650387	0.178650387	0.178650387	0	0	0.177944667	0.177944667	0	0	0	0	0	0	0	0												15.9201	0.226413378	5.233908743	0	1.364464107	2.549076185	2.653784379	3.215524926	12.61772985	4.974884732	7.529836757	0	0.013620333	5.917323163	5.456046433	17.03397436	0.267792023	1.833488571	0	0	6.162004037	1.809341423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7793	150	YES	24.4083403	15.9201	0.226413378	5.233908743	0	1.364464107	2.549076185	2.653784379	3.215524926	12.61772985	4.974884732	7.529836757	0	0.013620333	5.917323163	5.456046433	17.03397436	0.267792023	1.833488571	0	0	6.162004037	1.809341423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7793	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4082	0.0058	0.8169	0	0.1516	0.2832	0.2949	0.3573	1.402	0.5528	0.8366	0	0.0015	0.6575	1.0034	3.6133	0.0568	0.3889	0	0	1.3071	0.3838	0	0	0	0	0	0	0	0											12.5215	150	YES	3.215629336	16.3283	0.232218849	6.050761552	0	1.51607123	2.832306873	2.94864931	3.572805474	14.01969983	5.527649702	8.366485285	0	0.015133704	6.574803514	6.459473438	20.64724165	0.324596392	2.222410389	0	0	7.469095803	2.193141119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3009
H1509_816_0	2012	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	250.0353141	3.555960819	39.05595292	253.3053562	7.610457252	14.2177689	14.80179103	17.93496426	70.37685573	27.7479982	41.99854027	0	0.075968994	33.00455816	30.27740597	94.52715687	1.486066495	10.17463441	0	0	34.33061392	10.08045459	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079930353	0.079930353	0.168289641	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063606149	0.063606149	0.133919789	0	0.178252402	0.178252402	0.178252402	0.178252402	0.178252402	0.178252402	0.178252402	0	0.178252402	0.178252402	0.178964465	0.178964465	0.178964465	0.178964465	0	0	0.178252402	0.178252402	0	0	0	0	0	0	0	0												15.9038	0.226180973	5.230364957	0	1.356582283	2.534351453	2.6384548	3.196950454	12.54484356	4.946147322	7.486340673	0	0.013541656	5.88314176	5.418579752	16.91700203	0.265953095	1.820898001	0	0	6.119514385	1.796865241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2995	150	YES	24.07938917	15.9038	0.226180973	5.230364957	0	1.356582283	2.534351453	2.6384548	3.196950454	12.54484356	4.946147322	7.486340673	0	0.013541656	5.88314176	5.418579752	16.91700203	0.265953095	1.820898001	0	0	6.119514385	1.796865241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2995	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4078	0.0058	0.8163	0	0.1507	0.2816	0.2932	0.3552	1.3939	0.5496	0.8318	0	0.0015	0.6537	0.9965	3.5885	0.0564	0.3863	0	0	1.2981	0.3812	0	0	0	0	0	0	0	0											12.4479	150	YES	3.169561241	16.3116	0.231980485	6.04666469	0	1.507313648	2.815946059	2.931616445	3.552167171	13.93871507	5.495719247	8.318156303	0	0.015046284	6.536824178	6.415116222	20.50545701	0.322367388	2.207149092	0	0	7.417593194	2.178018474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7474
H1509_817_0	2012	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	247.3560327	3.517856522	38.71307617	252.1996731	7.528906549	14.06541681	14.64318079	17.74278015	69.62272469	27.45066143	41.54850023	0	0.07515494	32.65089414	30.24052909	94.41202592	1.484256515	10.16224204	0	0	34.28880037	10.06817693	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082921028	0.082921028	0.172555131	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065984079	0.065984079	0.137310061	0	0.178247111	0.178247111	0.178247111	0.178247111	0.178247111	0.178247111	0.178247111	0	0.178247111	0.178247111	0.178983846	0.178983846	0.178983846	0.178983846	0	0	0.178247111	0.178247111	0	0	0	0	0	0	0	0												16.3216	0.232122522	5.31569484	0	1.342005839	2.507119907	2.610104667	3.162599298	12.41004952	4.893001088	7.405900122	0	0.013396151	5.819927543	5.412566215	16.89822755	0.26565794	1.81887717	0	0	6.111879596	1.794623447	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3353	150	YES	24.08801949	16.3216	0.232122522	5.31569484	0	1.342005839	2.507119907	2.610104667	3.162599298	12.41004952	4.893001088	7.405900122	0	0.013396151	5.819927543	5.412566215	16.89822755	0.26565794	1.81887717	0	0	6.111879596	1.794623447	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3353	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4185	0.006	0.8296	0	0.1491	0.2786	0.29	0.3514	1.3789	0.5437	0.8229	0	0.0015	0.6467	0.9954	3.5845	0.0564	0.3858	0	0	1.2965	0.3807	0	0	0	0	0	0	0	0											12.416	150	YES	3.160980609	16.7401	0.238074381	6.145311954	0	1.491117599	2.785688786	2.900116296	3.51399922	13.78894391	5.436667875	8.228777913	0	0.014884612	6.466586159	6.40799673	20.48270006	0.322009624	2.2046996	0	0	7.408338905	2.175301148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7513
H1510_001_0	2012	9	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	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	1337.76	63.51	738.52	1041.73	1.27	14.01	4.27	405.82	394.09	1667	1047.32	117.44	0.15	4.71	3023.36	3818.89	77.85	540.66		1781.15	21.1	0		3.23	0.61				4.32	1.09	1771.38	659.5									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	199.347054	37.711345	87.269612	42.561927	0.192966	0.2	15	38.162257	40	44.639651		0	0.2	0		0	0				0	0	0	106.152776									NO	129.001067	103.369636	25.545043	0	0.179392	0.179392	0.179392	58.30253	178.806732	33.825644	78.277526	38.176431	0.173083	0.179392	13.45443	34.230094	35.87848	40.040071		0	0.179392	0		0	0				0	0	0	95.215006										14.381	0.547083799	1.572127096	0	0.22782784	2.51328192	0.76600384	1.971694394	5.872162084	4.698945712	6.831801544	0.373620005	0.02596245	0.84493632	3.38979879	10.89341364	0.232761639	1.804005399	0	0	3.7851712	0	0	0	0	0	0	0	0	0	0	5.232858038	0	0	0	0	0	0	0	0	65.9645	0	NO	10.253518	14.381	0.547083799	1.572127096	0	0.22782784	2.51328192	0.76600384	1.971694394	5.872162084	4.698945712	6.831801544	0.373620005	0.02596245	0.84493632	3.38979879	10.89341364	0.232761639	1.804005399	0	0	3.7851712	0	0	0	0	0	0	0	0	0	0	5.232858038	0	0	0	0	0	0	0	0	65.9645	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7500	5.338	0.0854	0.5052	2.5811	2.305	1.2157	0.3703	0.2841	2.8234	0.3925	1.0743	0.0346	0.0038	0.1843	1.3465	2.5625	0.0298	0.1983		0.3214	0.8731	0		0	0				0	0	0.2053	0.7912									23.5257	1000	NO	9.070848	19.7191	0.632492799	2.077296096	2.581114	2.53280084	3.72903092	1.13630084	2.255829394	8.695530084	5.091443712	7.906102544	0.408189005	0.02973145	1.02923832	4.73626279	13.45591564	0.262573639	2.002329399	0	0.321437	4.6582312	0	0	0	0	0	0	0	0	0	0.205269	6.024029038	0	0	0	0	0	0	0	0	89.4902
H1510_004_0	2012	13	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	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	1533.45	34.59	516.25	936.36	0.88	13.07	3.42	335.98	373.09	1895.69	882.18	121.82	0.71	7.17	3178.03	3485.31	95.77	538.43		1625.1	24.67	0		3.23	2.86				4.43	1.28	1366.62	504.7									4200	"$0-$235/Day(Days 1-7): 1a. $235 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$235/Day(Days 1-6): 1b. $235 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											171.277539	137.246126	34.03605	0	0.2	0.2	0.2	65	210.643832	41.964415	91.997167	41.161456	0.2	0.2	15	38.383581	40	42.754063		0	0.2	0		0	0				0	0	0	74.861629									NO	122.348342	98.038751	23.970331	0	0.174103	0.174103	0.174103	56.58354	183.368826	36.530695	80.085006	35.831706	0.174103	0.174103	13.05774	33.413522	34.82064	37.218096		0	0.174103	0		0	0				0	0	0	65.168246										15.6346	0.2825967	1.031223615	0	0.15321064	2.27552621	0.59543226	1.584244814	5.701089608	5.7709061	5.887449216	0.363751535	0.12361313	1.24831851	3.458157454	9.704706863	0.277897724	1.669944952	0	0	4.29512101	0	0	0	0	0	0	0	0	0	0	2.740867813	0	0	0	0	0	0	0	0	62.7986	0	NO	13.618236	15.6346	0.2825967	1.031223615	0	0.15321064	2.27552621	0.59543226	1.584244814	5.701089608	5.7709061	5.887449216	0.363751535	0.12361313	1.24831851	3.458157454	9.704706863	0.277897724	1.669944952	0	0	4.29512101	0	0	0	0	0	0	0	0	0	0	2.740867813	0	0	0	0	0	0	0	0	62.7986	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins	30% Coins									6300	4.7329	0.0432	0.3725	1.7299	1.5709	1.1231	0.2935	0.2329	2.5036	0.4451	0.9259	0.0342	0.0183	0.2777	1.292	2.4238	0.0244	0.1915		0.3198	1.0398	0		0	0				0	0	0.1752	0.8721									20.6422	1000	NO	9.127329	20.3675	0.3258277	1.403762615	1.729877	1.72411764	3.39865521	0.88895126	1.817117814	8.204644608	6.2160401	6.813348216	0.397947535	0.14188913	1.52603551	4.750124454	12.12846886	0.302261724	1.861419952	0	0.319823	5.33488901	0	0	0	0	0	0	0	0	0	0.175183	3.613014813	0	0	0	0	0	0	0	0	83.4409
H1510_005_0	2012	9	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	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	1142.87	46.91	710.96	731.66	1.06	12.18	3.84	361.75	364.33	1715.42	1069.99	135.85	1.37	5.57	3154.03	4805.68	82.04	614.94		1516.79	37.86	0		3.23	0.61		0.24		4.32	1.09	1556.96	449.12									4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	204.609944	29.848487	81.438124	41.385595	0.2	0.2	15	38.161611	40	42.463105		0	0.2	0		0	0		0		0	0	0	94.038147									NO	127.553699	102.209848	24.774058	0	0.176513	0.176513	0.176513	57.366855	180.581985	26.34329	71.874601	36.52556	0.176513	0.176513	13.238505	33.680178	35.30268	37.476535		0	0.176513	0		0	0		0		0	0	0	82.994965										12.1481	0.399555331	1.467780356	0	0.18710378	2.14992834	0.67780992	1.72937165	5.48261955	3.765817211	6.408758694	0.413499777	0.24182281	0.98317741	3.479553494	13.48801315	0.241352656	1.920485036	0	0	6.68278218	0	0	0	0	0	0	0	0	0	0	3.10622489	0	0	0	0	0	0	0	0	64.9738	0	NO	10.913402	12.1481	0.399555331	1.467780356	0	0.18710378	2.14992834	0.67780992	1.72937165	5.48261955	3.765817211	6.408758694	0.413499777	0.24182281	0.98317741	3.479553494	13.48801315	0.241352656	1.920485036	0	0	6.68278218	0	0	0	0	0	0	0	0	0	0	3.10622489	0	0	0	0	0	0	0	0	64.9738	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 0% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									6750	4.5981	0.0532	0.4692	1.3059	1.6303	0.8961	0.2829	0.2147	2.1415	0.3954	0.8978	0.0357	0.0303	0.1847	1.1065	1.9152	0.0273	0.1572		0.2087	1.3935	0			0		0		0	0	0.1645	0.537									18.6455	500	NO	8.049614	16.7462	0.452728331	1.936942356	1.305905	1.81737978	3.04599734	0.96066092	1.94407965	7.62409455	4.161260211	7.306529694	0.449173777	0.27207681	1.16787641	4.586038494	15.40324415	0.268644656	2.077665036	0	0.208679	8.07625318	0	0	0	0	0	0	0	0	0	0.164522	3.64323489	0	0	0	0	0	0	0	0	83.6192
H1510_007_0	2012	12	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	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	1246.97	55.34	569.92	1141.23	1.15	12.45	3.82	386.31	344.47	1549.81	1077.74	153.62	0.58	8.05	3105.61	3828.23	108.03	574.64		1503.98	19.34	0		3.23	2.86		0.24		4.32	1.09	1654.23	521.35									4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	41.183744	0.199634	0.2	15	37.959557	40	42.586041		0	0.2	0		0	0		0		0	0	0	80.952501									NO	127.758358	102.373842	25.793472	0	0.178472	0.178472	0.178472	58.00327	185.137134	32.133023	71.998361	36.750643	0.178145	0.178472	13.38537	33.873515	35.69432	38.001994		0	0.178472	0		0	0		0		0	0	0	72.238612										13.2759	0.472114035	1.225017964	0	0.2052428	2.2219764	0.68176304	1.867270269	5.314515712	4.150006698	6.466292799	0.470469481	0.1033241	1.4366996	3.46414491	10.80630053	0.321338116	1.819788819	0	0	3.45164848	0	0	0	0	0	0	0	0	0	0	3.138466697	0	0	0	0	0	0	0	0	60.8923	0	NO	9.829619	13.2759	0.472114035	1.225017964	0	0.2052428	2.2219764	0.68176304	1.867270269	5.314515712	4.150006698	6.466292799	0.470469481	0.1033241	1.4366996	3.46414491	10.80630053	0.321338116	1.819788819	0	0	3.45164848	0	0	0	0	0	0	0	0	0	0	3.138466697	0	0	0	0	0	0	0	0	60.8923	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins	30% Coins									6750	4.5605	0.0657	0.4218	2.1851	1.8164	0.9408	0.2887	0.2354	2.0111	0.3599	0.8012	0.0373	0.0132	0.2743	1.0917	2.0087	0.0273	0.1633		0.2108	0.7025	0		0	0		0		0	0	0.1719	0.5363									18.9238	500	NO	6.975515	17.8364	0.537813035	1.646797964	2.18509	2.0216188	3.1627764	0.97045504	2.102699269	7.325638712	4.509864698	7.267514799	0.507802481	0.1165341	1.7110266	4.55581691	12.81495553	0.348631116	1.983081819	0	0.210797	4.15411448	0	0	0	0	0	0	0	0	0	0.171862	3.674812697	0	0	0	0	0	0	0	0	79.8161
H1510_008_0	2012	9	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	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	1252.92	55.6	572.64	1146.67	1.24	13.37	4.1	388.16	346.11	1557.2	1082.88	154.35	0.63	8.64	3120.42	3846.48	108.54	577.38		1511.15	20.76	0		3.23	0.61				4.32	1.09	1662.12	523.84									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	41.183744	0.199634	0.2	15	37.959557	40	42.586041		0	0.2	0		0	0				0	0	0	80.952501									NO	132.231981	105.958594	26.985108	0	0.181164	0.181164	0.181164	58.878365	187.930297	32.617814	73.0846	37.3051	0.180833	0.181164	13.587315	34.384564	36.23284	38.57533		0	0.181164	0		0	0				0	0	0	73.328475										13.8063	0.490941486	1.287729354	0	0.22464336	2.42216268	0.7427724	1.904518847	5.420379591	4.232704997	6.595154304	0.479836849	0.11392479	1.56525696	3.533177456	11.02162814	0.327726038	1.856052003	0	0	3.76096464	0	0	0	0	0	0	0	0	0	0	3.201032362	0	0	0	0	0	0	0	0	62.9869	0	NO	8.698359	13.8063	0.490941486	1.287729354	0	0.22464336	2.42216268	0.7427724	1.904518847	5.420379591	4.232704997	6.595154304	0.479836849	0.11392479	1.56525696	3.533177456	11.02162814	0.327726038	1.856052003	0	0	3.76096464	0	0	0	0	0	0	0	0	0	0	3.201032362	0	0	0	0	0	0	0	0	62.9869	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7500	5.1611	0.0744	0.4721	2.7595	2.2939	1.1881	0.3646	0.2784	2.5398	0.4545	1.0119	0.0471	0.0167	0.3464	1.3787	2.5367	0.0345	0.2062		0.2662	0.8871	0			0				0	0	0.217	0.6773									23.2122	1000	NO	7.549639	18.9674	0.565292486	1.759804354	2.759521	2.51852136	3.61028668	1.1073584	2.182873847	7.960198591	4.687163997	7.607006304	0.526983849	0.13060779	1.91170096	4.911835456	13.55833114	0.362193038	2.062273003	0	0.266213	4.64810064	0	0	0	0	0	0	0	0	0	0.217042	3.878376362	0	0	0	0	0	0	0	0	86.1991
H1510_009_0	2012	10																															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	216.99	7.31	40.79	1013.69	26.66	10.93	13017.77	343.14	305.97	1376.62	957.3	136.45	0.53	572.15	2758.56	3400.42	95.96	510.42		1335.91	17.59	0		3.23	0.61		0.24		4.32	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199894	0	0	0	0	0	0	0.199894	0	0	0	0	0		0	0.199894	0		0	0		0		0	0												0	0	0	0	0	2.18484142	0	0	0	0	0	0	0.10594382	0	0	0	0	0	0	0	3.51613546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8069	0	NO	0.003068	0	0	0	0	0	2.18484142	0	0	0	0	0	0	0.10594382	0	0	0	0	0	0	0	3.51613546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8069	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% Coins	30% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"																7500	14.4681	0.2083	1.2958	3.3166	0	1.8342	0.8979	0	8.3654	1.5327	3.3099	0.1467	0.0564	3.4527	4.2413	7.8038	0.106	0.6491		0.819	2.023	0		0	0		0		0	0											54.5267	1000	NO	19.858836	14.4681	0.208263	1.295784	3.316551	0	4.01905342	0.89791	0	8.365383	1.532657	3.309861	0.146653	0.16231182	3.452719	4.241251	7.803814	0.106036	0.649076	0	0.818965	5.53917346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3336
H1517_004_0	2012	11	H.6										OP Facility - Other										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	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	YES	872.3398321	71.23171885	186.0539256	187.4670585	50.80951632	5.732579159	3.787235425	207.2567141	280.9051702	3938.541088	557.3423008	0.457129484	0.00145536	482.2875246	2045.084312	1797.930496	4.356023105	666.7286512	393.9989194	1152.511879	16.7973887	7.108027659	0	0	0	0	0	0	5872.8	178.2131609	8.537571297	0	0	0	0	0	0	0	0	0	4500	1A: $205/day (days1-7) $1435 yrly max	1B: $205/day (days1-7) $1435 yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$150 copay	8B: $105-$150 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $45-$200 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $105-$150 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	128.255428	98.49243425	146	0	150	0.2	0.123906859	63.93573289	167.493314	21.88529832	123.4865411	40	0.2	66.274274	0	43.17629141	40	50	115.0015171	0.806272356	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	117.2029551	90.00480155	133.4183801	0	137.0736782	0.182764904	0.113229126	58.42604049	153.0594975	19.99932226	112.8450293	36.55298084	0.182764904	60.5630567	0	39.45555382	36.55298084	45.69122605	105.0912063	0.73679145	0.182764904	0	0	0	0	0	0	0	0	0	0.182764904	0	0	0	0	0	0	0	0	0		8.5201	0.534266393	2.068584447	0	0.580387274	1.047714281	0.428825356	1.009099098	3.582933683	6.564012703	5.24110902	0.001392454	0.000265989	2.434067225	0	5.911528622	0.013268802	2.53863746	3.450485143	0.070763408	3.069973136	0	0	0	0	0	0	0	0	0	1.5603684	0	0	0	0	0	0	0	0	0	48.6278		NO	4.585694032	8.5201	0.534266393	2.068584447	0	0.580387274	1.047714281	0.428825356	1.009099098	3.582933683	6.564012703	5.24110902	0.001392454	0.000265989	2.434067225	0	5.911528622	0.013268802	2.53863746	3.450485143	0.070763408	3.069973136	0	0	0	0	0	0	0	0	0	1.5603684	0	0	0	0	0	0	0	0	0	48.6278	YES	1A: 25% coin	1B: 25% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $150 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $65 copay; 4B: $45 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $50-$275 copay; 9C: $50 copay	7A: $25 copay; 7G: $25 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $50 copay; 7H: $50 copay	7C: $90 copay; 7I: $90 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$50; 17B: $0; 18A: $50	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4500	12.1327	0.7935	1.2493	0	1.0531	0.9909	0.5859	0.4473	2.3855	3.1148	1.6614	0.0017	0.0051	1.5639	2.3443	5.444	0.0135	2.3834	2.3791	0.9607	2.4749	0	0	0	0	0	0	0	0	0	0.3686	0	0	0	0	0	0	0	0	0	42.3535		NO	3.994018405	20.6528	1.32773203	3.317883485	0	1.633526392	2.038634781	1.014676622	1.4563714	5.968460968	9.678828662	6.902530416	0.003103011	0.005319776	3.998015735	2.344317827	11.35554436	0.026751023	4.921995008	5.829535337	1.031454183	5.544826499	0	0	0	0	0	0	0	0	0	1.928962105	0	0	0	0	0	0	0	0	0	90.9812
H1517_801_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H1517_802_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H1517_803_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H1517_805_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H1537_001_0	2012	4																															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	1382.835269	59.09991729	750.9758502	1439.479869	175.2862425	11.44871011	12.81351259	393.6815407	51.45948699	17.03506903	31.36264936	0	0.030729727	31.48712595	6349.945881	3848.491708	257.5805747	386.1845487	0	0	18.98002638	897.7551343	0	0	42.79069767	0	15.43335771	10.659	160.3920985	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	63.37768474	0	200	0.2	0.103685176	62.99149443	0.16	0.155432387	0.185046157	0	0.2	0.145521416	12.66386556	44.101075	38.5	45	0	0	0.2	43.04599974	0	0	45	0	45	0	0	0											NO	173.6851516	90.96924603	52.88177035	0	166.8782019	0.166878202	0.086513979	52.57251336	0.133502562	0.129691387	0.15440085	0	0.166878202	0.121421761	11.79773329	41.09243999	35.86683147	41.92227055	0	0	0.166878202	35.91719518	0	0	45	0	45	0	0	0												20.0148	0.44802291	3.309411037	0	2.43762108	1.910540157	1.108547957	1.724735671	6.869973328	2.209301723	4.842419711	0	0.005128122	3.823222292	6.242913994	13.17865955	0.769883255	1.349144428	0	0	3.167352675	2.687070532	0	0	0.160465116	0	0.057875091	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3171	0	NO	12.40692079	20.0148	0.44802291	3.309411037	0	2.43762108	1.910540157	1.108547957	1.724735671	6.869973328	2.209301723	4.842419711	0	0.005128122	3.823222292	6.242913994	13.17865955	0.769883255	1.349144428	0	0	3.167352675	2.687070532	0	0	0.160465116	0	0.057875091	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3171	YES	"40% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"40% (1b); $0 n/c (1b1, 1b2)"	"40% (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"40% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $10 (8a2)	"40% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"40% (3, 9a); $75 (5); $45/$35 (9c)"	"40% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"40% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"40% (7c, 7i)"	Included in h.2.	40% (7g)	"40% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 40% (14a10, 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)"	40% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.8651	0.0328	0.4096	0.5937	0.3013	0.5903	0.5286	0.2132	1.6982	0.2731	1.0508	0	0.0006	0.9442	1.4412	3.5596	0.1243	0.1824	0	0	0.905	0.374	0	0	0	0	0.0039	0	0	0											15.092	0	NO	2.325619421	21.88	0.480826992	3.71902892	0.593735659	2.73890009	2.500875599	1.637115493	1.937905249	8.568168982	2.482361486	5.893257083	0	0.005761934	4.767459071	7.684163648	16.73825093	0.894150126	1.531576756	0	0	4.072310582	3.061072408	0	0	0.160465116	0	0.061761243	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4091
H1537_801_0	2012	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	265.8538379	3.780929244	45.81560121	258.1453941	8.026481928	14.99498142	15.61092905	18.9153768	74.22399758	29.26483898	44.29438512	0	0.080121829	34.80874812	33.82714418	106.418292	1.673007667	11.45456239	0	0	38.64926672	11.34853513	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060692782	0.060692782	0.131242781	0	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0	0.175030584	0.175030584	0.175334382	0.175334382	0.175334382	0.175334382	0	0	0.175030584	0.175030584	0	0	0	0	0	0	0	0												16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	150	YES	27.93657492	16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4137	0.0059	0.3838	0	0.1736	0.3244	0.3377	0.4092	1.6057	0.6331	0.9582	0	0.0017	0.753	0.7402	2.6655	0.0419	0.2869	0	0	0.9664	0.2838	0	0	0	0	0	0	0	0											10.9849	150	YES	3.065020315	16.5491	0.23535909	6.396773303	0	1.578516648	2.948966686	3.07010115	3.719965665	14.59715688	5.755327921	8.711092229	0	0.015757046	6.845612924	6.671298828	21.32432626	0.335240875	2.29528985	0	0	7.731204245	2.270103688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0512
H1537_802_0	2012	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	259.6831925	3.122800473	59.60456447	227.7014963	7.258907955	11.0322354	8.890038889	16.33827542	65.79565827	24.60150985	39.89891401	0	0.118827713	36.59485773	28.34837086	91.49336082	1.504583431	10.51077052	0	0	29.210493	12.42376085	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062303684	0.062303684	0.134726215	0	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0	0.17967623	0.17967623	0.180001033	0.180001033	0.180001033	0.180001033	0	0	0.17967623	0.17967623	0	0	0	0	0	0	0	0												16.1792	0.194561974	8.030297361	0	1.304253214	1.982230462	1.59732867	2.935599728	11.82191581	4.420306537	7.168886442	0	0.021350516	6.575226067	5.102736029	16.46889943	0.270826571	1.891949547	0	0	5.248431253	2.232254509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4463	150	YES	22.99857803	16.1792	0.194561974	8.030297361	0	1.304253214	1.982230462	1.59732867	2.935599728	11.82191581	4.420306537	7.168886442	0	0.021350516	6.575226067	5.102736029	16.46889943	0.270826571	1.891949547	0	0	5.248431253	2.232254509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4463	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4149	0.005	0.5126	0	0.1612	0.245	0.1974	0.3628	1.4611	0.5463	0.886	0	0.0026	0.8127	0.6414	2.3527	0.0387	0.2703	0	0	0.7498	0.3189	0	0	0	0	0	0	0	0											9.9794	150	YES	2.454347314	16.5941	0.199550743	8.542869533	0	1.465453049	2.227225238	1.794751315	3.298426661	13.28305148	4.966636558	8.054928587	0	0.023989343	7.387894457	5.744088605	18.82159935	0.309516082	2.162228054	0	0	5.998207146	2.551148011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4256
H1537_803_0	2012	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	265.8538379	3.780929244	45.81560121	258.1453941	8.026481928	14.99498142	15.61092905	18.9153768	74.22399758	29.26483898	44.29438512	0	0.080121829	34.80874812	33.82714418	106.418292	1.673007667	11.45456239	0	0	38.64926672	11.34853513	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060692782	0.060692782	0.131242781	0	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0	0.175030584	0.175030584	0.175334382	0.175334382	0.175334382	0.175334382	0	0	0.175030584	0.175030584	0	0	0	0	0	0	0	0												16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	150	YES	27.93657492	16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4137	0.0059	0.3838	0	0.1736	0.3244	0.3377	0.4092	1.6057	0.6331	0.9582	0	0.0017	0.753	0.7402	2.6655	0.0419	0.2869	0	0	0.9664	0.2838	0	0	0	0	0	0	0	0											10.9849	150	YES	3.065020315	16.5491	0.23535909	6.396773303	0	1.578516648	2.948966686	3.07010115	3.719965665	14.59715688	5.755327921	8.711092229	0	0.015757046	6.845612924	6.671298828	21.32432626	0.335240875	2.29528985	0	0	7.731204245	2.270103688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0512
H1537_804_0	2012	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	265.8538379	3.780929244	45.81560121	258.1453941	8.026481928	14.99498142	15.61092905	18.9153768	74.22399758	29.26483898	44.29438512	0	0.080121829	34.80874812	33.82714418	106.418292	1.673007667	11.45456239	0	0	38.64926672	11.34853513	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060692782	0.060692782	0.131242781	0	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0	0.175030584	0.175030584	0.175334382	0.175334382	0.175334382	0.175334382	0	0	0.175030584	0.175030584	0	0	0	0	0	0	0	0												16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	150	YES	27.93657492	16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4137	0.0059	0.3838	0	0.1736	0.3244	0.3377	0.4092	1.6057	0.6331	0.9582	0	0.0017	0.753	0.7402	2.6655	0.0419	0.2869	0	0	0.9664	0.2838	0	0	0	0	0	0	0	0											10.9849	150	YES	3.065020315	16.5491	0.23535909	6.396773303	0	1.578516648	2.948966686	3.07010115	3.719965665	14.59715688	5.755327921	8.711092229	0	0.015757046	6.845612924	6.671298828	21.32432626	0.335240875	2.29528985	0	0	7.731204245	2.270103688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0512
H1537_805_0	2012	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	259.6831925	3.122800473	59.60456447	227.7014963	7.258907955	11.0322354	8.890038889	16.33827542	65.79565827	24.60150985	39.89891401	0	0.118827713	36.59485773	28.34837086	91.49336082	1.504583431	10.51077052	0	0	29.210493	12.42376085	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062303684	0.062303684	0.134726215	0	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0.17967623	0	0.17967623	0.17967623	0.180001033	0.180001033	0.180001033	0.180001033	0	0	0.17967623	0.17967623	0	0	0	0	0	0	0	0												16.1792	0.194561974	8.030297361	0	1.304253214	1.982230462	1.59732867	2.935599728	11.82191581	4.420306537	7.168886442	0	0.021350516	6.575226067	5.102736029	16.46889943	0.270826571	1.891949547	0	0	5.248431253	2.232254509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4463	150	YES	22.99857803	16.1792	0.194561974	8.030297361	0	1.304253214	1.982230462	1.59732867	2.935599728	11.82191581	4.420306537	7.168886442	0	0.021350516	6.575226067	5.102736029	16.46889943	0.270826571	1.891949547	0	0	5.248431253	2.232254509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4463	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4149	0.005	0.5126	0	0.1612	0.245	0.1974	0.3628	1.4611	0.5463	0.886	0	0.0026	0.8127	0.6414	2.3527	0.0387	0.2703	0	0	0.7498	0.3189	0	0	0	0	0	0	0	0											9.9794	150	YES	2.454347314	16.5941	0.199550743	8.542869533	0	1.465453049	2.227225238	1.794751315	3.298426661	13.28305148	4.966636558	8.054928587	0	0.023989343	7.387894457	5.744088605	18.82159935	0.309516082	2.162228054	0	0	5.998207146	2.551148011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4256
H1537_806_0	2012	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	265.8538379	3.780929244	45.81560121	258.1453941	8.026481928	14.99498142	15.61092905	18.9153768	74.22399758	29.26483898	44.29438512	0	0.080121829	34.80874812	33.82714418	106.418292	1.673007667	11.45456239	0	0	38.64926672	11.34853513	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077673186	0.077673186	0.167961406	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060692782	0.060692782	0.131242781	0	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0.175030584	0	0.175030584	0.175030584	0.175334382	0.175334382	0.175334382	0.175334382	0	0	0.175030584	0.175030584	0	0	0	0	0	0	0	0												16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	150	YES	27.93657492	16.1354	0.229475113	6.012966905	0	1.404879817	2.624580351	2.732390023	3.310769442	12.99146962	5.12224185	7.752872084	0	0.014023771	6.092595503	5.931061422	18.65878547	0.293335766	2.008378619	0	0	6.764803714	1.986340727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0664	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4137	0.0059	0.3838	0	0.1736	0.3244	0.3377	0.4092	1.6057	0.6331	0.9582	0	0.0017	0.753	0.7402	2.6655	0.0419	0.2869	0	0	0.9664	0.2838	0	0	0	0	0	0	0	0											10.9849	150	YES	3.065020315	16.5491	0.23535909	6.396773303	0	1.578516648	2.948966686	3.07010115	3.719965665	14.59715688	5.755327921	8.711092229	0	0.015757046	6.845612924	6.671298828	21.32432626	0.335240875	2.29528985	0	0	7.731204245	2.270103688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0512
H1537_807_0	2012	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	269.8360638	3.837563801	46.6271506	260.129043	8.16028728	15.24495504	15.87117081	19.23070531	75.46134767	29.75269806	45.03279403	0	0.081457499	35.38902686	34.13830373	107.3971825	1.688396856	11.55992738	0	0	39.00478265	11.45292482	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077098755	0.077098755	0.166043373	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060014323	0.060014323	0.129249566	0	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0	0.174363494	0.174363494	0.17466657	0.17466657	0.17466657	0.17466657	0	0	0.174363494	0.174363494	0	0	0	0	0	0	0	0												16.194	0.230308792	6.026538956	0	1.422856203	2.658163629	2.767352799	3.353132973	13.15770425	5.187784394	7.852075319	0	0.014203214	6.170554378	5.962820406	18.75869745	0.294906487	2.01913286	0	0	6.801010191	1.996971989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8682	150	YES	28.65415752	16.194	0.230308792	6.026538956	0	1.422856203	2.658163629	2.767352799	3.353132973	13.15770425	5.187784394	7.852075319	0	0.014203214	6.170554378	5.962820406	18.75869745	0.294906487	2.01913286	0	0	6.801010191	1.996971989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8682	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4152	0.0059	0.3847	0	0.1759	0.3285	0.342	0.4144	1.6262	0.6412	0.9705	0	0.0018	0.7627	0.7442	2.6798	0.0421	0.2884	0	0	0.9716	0.2853	0	0	0	0	0	0	0	0											11.0804	150	YES	3.145924005	16.6093	0.236214146	6.411211655	0	1.598714835	2.986700707	3.109385168	3.767565138	14.78393736	5.82897123	8.822556538	0	0.015958668	6.933207166	6.707021552	21.43851137	0.337035985	2.307580411	0	0	7.772583075	2.282253702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.9487
H1537_808_0	2012	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	263.5729883	3.169576916	60.66036308	229.4512073	7.379917476	11.21614812	9.038240155	16.6106424	66.89250384	25.01162897	40.56404829	0	0.120808629	37.20491178	28.60913383	92.33496403	1.518423367	10.60745402	0	0	29.47918621	12.53804102	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077098755	0.077098755	0.166043373	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061658142	0.061658142	0.132789769	0	0.179139389	0.179139389	0.179139389	0.179139389	0.179139389	0.179139389	0.179139389	0	0.179139389	0.179139389	0.179456421	0.179456421	0.179456421	0.179456421	0	0	0.179139389	0.179139389	0	0	0	0	0	0	0	0												16.2514	0.195430224	8.055075624	0	1.322033906	2.009253919	1.619104818	2.975620329	11.98308226	4.480567928	7.26661882	0	0.021641584	6.66486516	5.134092751	16.57010213	0.272490822	1.903575729	0	0	5.280883402	2.246057006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2519	150	YES	23.55008943	16.2514	0.195430224	8.055075624	0	1.322033906	2.009253919	1.619104818	2.975620329	11.98308226	4.480567928	7.26661882	0	0.021641584	6.66486516	5.134092751	16.57010213	0.272490822	1.903575729	0	0	5.280883402	2.246057006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2519	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4167	0.005	0.5142	0	0.1634	0.2483	0.2001	0.3678	1.4811	0.5538	0.8981	0	0.0027	0.8237	0.6453	2.3672	0.0389	0.2719	0	0	0.7544	0.3209	0	0	0	0	0	0	0	0											10.0735	150	YES	2.515283927	16.6681	0.200441255	8.569229387	0	1.485431356	2.257588673	1.819218896	3.343393628	13.46413737	5.034345986	8.164740248	0	0.024316387	7.488612539	5.77938649	18.93725958	0.311418083	2.175515119	0	0	6.035295317	2.566922293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3254
H1537_809_0	2012	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	269.8360638	3.837563801	46.6271506	260.129043	8.16028728	15.24495504	15.87117081	19.23070531	75.46134767	29.75269806	45.03279403	0	0.081457499	35.38902686	34.13830373	107.3971825	1.688396856	11.55992738	0	0	39.00478265	11.45292482	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077098755	0.077098755	0.166043373	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060014323	0.060014323	0.129249566	0	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0.174363494	0	0.174363494	0.174363494	0.17466657	0.17466657	0.17466657	0.17466657	0	0	0.174363494	0.174363494	0	0	0	0	0	0	0	0												16.194	0.230308792	6.026538956	0	1.422856203	2.658163629	2.767352799	3.353132973	13.15770425	5.187784394	7.852075319	0	0.014203214	6.170554378	5.962820406	18.75869745	0.294906487	2.01913286	0	0	6.801010191	1.996971989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8682	150	YES	28.65415752	16.194	0.230308792	6.026538956	0	1.422856203	2.658163629	2.767352799	3.353132973	13.15770425	5.187784394	7.852075319	0	0.014203214	6.170554378	5.962820406	18.75869745	0.294906487	2.01913286	0	0	6.801010191	1.996971989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8682	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											10000	0.4152	0.0059	0.3847	0	0.1759	0.3285	0.342	0.4144	1.6262	0.6412	0.9705	0	0.0018	0.7627	0.7442	2.6798	0.0421	0.2884	0	0	0.9716	0.2853	0	0	0	0	0	0	0	0											11.0804	150	YES	3.145924005	16.6093	0.236214146	6.411211655	0	1.598714835	2.986700707	3.109385168	3.767565138	14.78393736	5.82897123	8.822556538	0	0.015958668	6.933207166	6.707021552	21.43851137	0.337035985	2.307580411	0	0	7.772583075	2.282253702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.9487
H1595_001_0	2012	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	O																																																			0	YES	211.3016558	6.047465588	500.7734756		211.8353999	6.018874954	6.059392157	231.8373751	342.8145393			8.859746705		111.2987986	3489.644328	2899.070456	431.0697031	559.1882648				847.1821157			67.20260288		1.426899613														3400	1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $0 per day for days 1-20 plus $120 per day for days 21-100	6 HH: $0	10A Ambulance: $50	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC $45"	"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: $20,  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	NO	400	400	37.2		50	0.2	0.2	58.14643155	173.6695351			35		35	15	32.98523333	35	35				35			35		9.498323917														NO	375.8792515	375.8792515	34.95677039		46.98490644	0.187939626	0.187939626	54.64009292	163.1969372			32.88943451		32.88943451	14.09547193	30.99616204	32.88943451	32.88943451				32.88943451			32.88943451		9.498323917															6.6187	0.189426403	1.458785284	0	0.829422204	1.131185106	1.138799894	1.055634643	4.662190236	0	0	0.024282672	0	0.305046212	4.099015306	7.488338136	1.181469897	1.532615484	0	0	0	2.321945059	0	0	0.184187967	0	0.00112943	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2221	0		2.196014321	6.6187	0.189426403	1.458785284	0	0.829422204	1.131185106	1.138799894	1.055634643	4.662190236	0	0	0.024282672	0	0.305046212	4.099015306	7.488338136	1.181469897	1.532615484	0	0	0	2.321945059	0	0	0.184187967	0	0.00112943	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2221	YES	1A IP Acute: $600 per admit	1B IP Psych: $600 per admit	"2 SNF: $100 Days 1-20, $139 Days 21-100"	6 HH: $0	10A Ambulance: $50	11A DME: 50%	11B Prosthetics/Supplies: 50%	"4A ER: $60, 4B UC: $45"	"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%														5100	1.2613	0.034	0.5362		0.0924	0.3142	0.3838	0.1218	1.4074	0.1748	0.3556	0.0058	0.0095	0.8311	1.9859	1.3248	0.089	0.1063	0.6372	1.4324	0.5455	0.1878			0.0084			0.0083													11.8537	500	NO	0.760670192	7.8799	0.223413441	1.995006232	0	0.921855147	1.445403191	1.522641248	1.177461926	6.069596948	0.174818091	0.355632612	0.030124924	0.009527008	1.136182988	6.084940081	8.813160365	1.270440352	1.638872604	0.637233452	1.432369132	0.545507473	2.509704544	0	0	0.192561105	0	0.00112943	0.008287636	0	0	0	0	0	0	0	0	0	0	0	0	46.0758
H1595_002_0	2012	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	O																																																			0	YES	215.2214939	5.133871023	460.6108323		219.8331984	8.03493808	7.572622066	276.9387729	417.4822424			8.122764719		151.4847451	5333.52439	2937.239787	406.8083059	1110.813364				1125.021262			220.2483795		2.076813536														3400	1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $0 per day for days 1-20 plus $100 per day for days 21-100	6 HH: $0	10A Ambulance: $25	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC: $35"	"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: $20,  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 $100/2 yrs	18A Routine Hearing Exams: $25														0	NO	300	300	31		25	0.2	0.2	57.47146127	90.05028807			25		25	10	23.92739544	25	25				25			25		25														NO	286.3551369	286.3551369	29.59003082		23.86292808	0.190903425	0.190903425	54.85749387	85.95454191			23.86292808		23.86292808	9.545171232	22.83910866	23.86292808	23.86292808				23.86292808			23.86292808		23.86292808															5.1358	0.122509195	1.135790727	0	0.437155317	1.533897196	1.445639486	1.26601392	2.990374575	0	0	0.016152746	0	0.301239131	4.242450297	5.590328221	0.808969779	2.208938285	0	0	0	2.237191788	0	0	0.437980937	0	0.004129904	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9146	0		1.425433832	5.1358	0.122509195	1.135790727	0	0.437155317	1.533897196	1.445639486	1.26601392	2.990374575	0	0	0.016152746	0	0.301239131	4.242450297	5.590328221	0.808969779	2.208938285	0	0	0	2.237191788	0	0	0.437980937	0	0.004129904	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9146	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%														5100	1.0661	0.0245	0.5009		0.0487	0.4261	0.4435	0.1182	1.1232	0.1206	0.2514	0.0036	0.005	0.4604	2.137	0.8401	0.0577	0.0967	0.5819	1.1442	0.7549	0.1825		0.2086	0.0159		0.0001														10.6119	0		0.505657558	6.2019	0.147053352	1.636738011	0	0.485856282	1.959979751	1.889135309	1.384222404	4.113622825	0.120625015	0.251374469	0.019770108	0.005045781	0.761604529	6.379421572	6.430428427	0.866660019	2.305588978	0.581864442	1.144234791	0.754886933	2.419666243	0	0.208628589	0.4539294	0	0.004237003	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5265
H1595_801_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.070986654	0.070986654	0.172773485		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.058622505	0.058622505	0.142680547		0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184924411	0.184584966	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649																				15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	0		22.18839614	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	NO																																																																																		0	0		0	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608
H1595_802_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.070986654	0.070986654	0.172773485		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.058622505	0.058622505	0.142680547		0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184924411	0.184584966	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649																				15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	0		22.18839614	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	NO																																																																																		0	0		0	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608
H1595_804_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.070986654	0.070986654	0.172773485		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.058622505	0.058622505	0.142680547		0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184924411	0.184584966	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649																				15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	0		22.18839614	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	NO																																																																																		0	0		0	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608
H1607_001_0	2012	9	H.6										OP Facility - Other										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	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	YES	1074.659835	55.54652398	440.8419738	300.7472317	21.24450684	10.9607698	5.809595544	351.6693004	421.084207	6252.534285	742.9845217	3.18710411	0	526.8991338	2471.363005	3006.418263	3.299615825	1252.24888	579.0906808	1784.661283	32.23620296	8.872589525	0	0	0	0	129.6	0	5872.8	136.9614716	12.32188383	0	0	0	0	0	0	0	0	0	4000	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/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: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$125 copay	8B: $85-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $30-$200 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $85-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $30 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	161.2337662	142.1165644	146	0	100	0.2	0.138613614	49.97973658	179.7274168	18.89090556	100.9976728	40	0.2	112.421981	15	29.01642621	40	50	95.21129488	0.596442487	0.2	0	0	0	0	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	144.851719	127.6769075	131.1657693	0	89.83956799	0.179679136	0.124529872	44.90157942	161.4663348	16.97150794	90.73587295	35.93582719	0	100.9994221	13.4759352	26.06823195	35.93582719	44.91978399	85.537416	0.535841354	0.179679136	0	0	0	0	0	30	0	0	0	0.179679136	0	0	0	0	0	0	0	0	0		12.9722	0.5910007	4.818614718	0	0.159049776	1.969421647	0.72346819	1.315875585	5.665910296	8.842911274	5.617945764	0.009544269	0	4.434709	2.775327309	6.531000719	0.009881202	4.687562432	4.127826705	0.079691276	5.792173095	0	0	0	0	0	0.324	0	0	0	2.21398544	0	0	0	0	0	0	0	0	0	73.6621		NO	8.294192923	12.9722	0.5910007	4.818614718	0	0.159049776	1.969421647	0.72346819	1.315875585	5.665910296	8.842911274	5.617945764	0.009544269	0	4.434709	2.775327309	6.531000719	0.009881202	4.687562432	4.127826705	0.079691276	5.792173095	0	0	0	0	0	0.324	0	0	0	2.21398544	0	0	0	0	0	0	0	0	0	73.6621	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: 30% coin	4A: $50 copay; 4B: $30 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $40-$275 copay; 9C: $50 copay	7A: $30 copay; 7G: $30 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $80 copay; 7I: $80 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $40 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4000	3.2693	0.1142	0.4284	0	1.3458	0.3881	0.5659	0.1486	2.2588	1.6915	0.5334	0	0	0.4306	1.4893	1.9335	0.0012	0.7558	1.7582	0.0215	1.1632	0	0	0	0	0	0.108	0	0	0	0.6864	0	0	0	0	0	0	0	0	0	19.0918		NO	2.146974275	16.2414	0.705210327	5.247032005	0	1.504884941	2.35754811	1.28935803	1.464500279	7.924742029	10.53444249	6.151296151	0.009544269	0	4.865268187	4.26466042	8.464471738	0.011048757	5.443374654	5.886057966	0.101174288	6.955381039	0	0	0	0	0	0.432	0	0	0	2.900416934	0	0	0	0	0	0	0	0	0	92.7539
H1607_004_0	2012	9	H.6										OP Facility - Other										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	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	YES	1156.193586	75.1368937	417.1124361	278.7689391	24.08146705	14.22165751	6.371969927	397.7282684	489.5141789	6549.962057	784.9083651	2.916069262	0	567.6792133	2734.44393	3450.777571	11.09680084	1339.725269	649.9369517	1831.124596	42.32128434	8.398745028	0	456.2721669	234.4	234.4	259.2	0	5872.8	171.4163426	7.658618022	0	0	0	0	0	0	0	0	0	3400	1A: $185/day (days1-7) $1295 yrly max	1B: $185/day (days1-7) $1295 yrly max	2: $146/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: $0 - $150 copay; 9B: $0-$150 copay	8A: $0-$125 copay	8B: $75-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $20-$150 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $75-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $20 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	116.3332431	101.6712657	146	0	100	0.2	0.128160489	49.98312653	136.1991887	17.16821766	94.72443189	40	0.2	96.31716435	10	19.14987768	40	40	87.43466416	0.367688405	0.2	0	0	0	0	0	20	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	103.5745937	90.52064354	129.9876998	0	89.03267107	0.178065342	0.114104706	44.50131264	121.2617757	15.28532276	84.33569186	35.61306843	0	85.75374412	8.903267107	17.0496476	35.61306843	35.61306843	77.84541694	0.327362809	0.178065342	0	0	0	0	0	20	0	0	0	0.178065342	0	0	0	0	0	0	0	0	0		9.9794	0.566786664	4.518290509	0	0.178669778	2.532384311	0.727071758	1.474952501	4.946613213	8.343190341	5.516315835	0.008654181	0	4.056718167	2.028790392	4.902878461	0.032932594	3.975977308	4.21621775	0.049953508	7.535953976	0	0	0	0	0	0.432	0	0	0	1.363734438	0	0	0	0	0	0	0	0	0	67.3874		NO	8.247785358	9.9794	0.566786664	4.518290509	0	0.178669778	2.532384311	0.727071758	1.474952501	4.946613213	8.343190341	5.516315835	0.008654181	0	4.056718167	2.028790392	4.902878461	0.032932594	3.975977308	4.21621775	0.049953508	7.535953976	0	0	0	0	0	0.432	0	0	0	1.363734438	0	0	0	0	0	0	0	0	0	67.3874	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: $225 copay; 9B: $225 copay	8A: 0% - 25% coin	8B: 25% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $30-$225 copay; 9C: $50 copay	7A: $20 copay; 7G: $20 copay	7B: $30 copay; 7D: $30 copay; 7F: $30 copay	7E: $50 copay; 7H: $50 copay	7C: $60 copay; 7I: $60 copay	8B: 25% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $30 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	2.4882	0.1556	0.2549	0	1.2292	0.3706	0.5563	0.1754	1.6483	1.4669	0.4073	0	0	0.273	1.1649	1.9263	0.0166	1.2721	1.8854	0.0138	2.3685	0	0	0.2354	0	0	0.162	0	0	0	0.6121	0	0	0	0	0	0	0	0	0	18.683		NO	2.252475262	12.4676	0.722415714	4.773198776	0	1.407844012	2.903010274	1.283360837	1.650364	6.59491784	9.81011613	5.923601047	0.008654181	0	4.329722639	3.19364267	6.829174887	0.04958065	5.248074367	6.101660352	0.063800095	9.904444946	0	0	0.235384615	0	0	0.594	0	0	0	1.975846379	0	0	0	0	0	0	0	0	0	86.0704
H1607_804_0	2012	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	289.675846	3.367937058	73.4342725	0	11.13719843	15.22013335	9.482156984	17.45288194	56.06615745	7.883711627	26.37697411	0	0.450239737	27.38436152	34.39884881	69.97437863	1.676004263	6.382064388	30.32200826	103.5494267	47.92758632	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060796111	0.060796111	0.131439358	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0	0	0	0	0	0	0	0												17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	0	NO	30.07764459	17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1553	0.0251	1.1812	0	0.243	0.3321	0.2069	0.3771	1.2112	0.1703	0.5698	0	0.0097	0.5917	0.7503	1.5225	0.0362	0.1392	0.6596	2.2394	1.0432	0	0	0	0	0	0	0	0	0											13.4639	0	NO	1.894584363	19.7665	0.22981607	10.83340184	0	2.199233109	3.005479466	1.872416454	3.442653874	11.05912402	1.555072589	5.202893176	0	0.088810386	5.401754868	6.792417081	13.81345665	0.330594067	1.26024937	5.985635127	20.42771011	9.461593847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7288
H1607_805_0	2012	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	289.675846	3.367937058	73.4342725	0	11.13719843	15.22013335	9.482156984	17.45288194	56.06615745	7.883711627	26.37697411	0	0.450239737	27.38436152	34.39884881	69.97437863	1.676004263	6.382064388	30.32200826	103.5494267	47.92758632	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060796111	0.060796111	0.131439358	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0	0	0	0	0	0	0	0												17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	0	NO	30.07764459	17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1553	0.0251	1.1812	0	0.243	0.3321	0.2069	0.3771	1.2112	0.1703	0.5698	0	0.0097	0.5917	0.7503	1.5225	0.0362	0.1392	0.6596	2.2394	1.0432	0	0	0	0	0	0	0	0	0											13.4639	0	NO	1.894584363	19.7665	0.22981607	10.83340184	0	2.199233109	3.005479466	1.872416454	3.442653874	11.05912402	1.555072589	5.202893176	0	0.088810386	5.401754868	6.792417081	13.81345665	0.330594067	1.26024937	5.985635127	20.42771011	9.461593847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7288
H1607_806_0	2012	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	289.675846	3.367937058	73.4342725	0	11.13719843	15.22013335	9.482156984	17.45288194	56.06615745	7.883711627	26.37697411	0	0.450239737	27.38436152	34.39884881	69.97437863	1.676004263	6.382064388	30.32200826	103.5494267	47.92758632	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060796111	0.060796111	0.131439358	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0	0	0	0	0	0	0	0												17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	0	NO	30.07764459	17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1553	0.0251	1.1812	0	0.243	0.3321	0.2069	0.3771	1.2112	0.1703	0.5698	0	0.0097	0.5917	0.7503	1.5225	0.0362	0.1392	0.6596	2.2394	1.0432	0	0	0	0	0	0	0	0	0											13.4639	0	NO	1.894584363	19.7665	0.22981607	10.83340184	0	2.199233109	3.005479466	1.872416454	3.442653874	11.05912402	1.555072589	5.202893176	0	0.088810386	5.401754868	6.792417081	13.81345665	0.330594067	1.26024937	5.985635127	20.42771011	9.461593847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7288
H1607_807_0	2012	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	289.675846	3.367937058	73.4342725	0	11.13719843	15.22013335	9.482156984	17.45288194	56.06615745	7.883711627	26.37697411	0	0.450239737	27.38436152	34.39884881	69.97437863	1.676004263	6.382064388	30.32200826	103.5494267	47.92758632	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060796111	0.060796111	0.131439358	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0.175648702	0	0	0	0	0	0	0	0	0												17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	0	NO	30.07764459	17.6112	0.204757475	9.652153635	0	1.956234448	2.673396667	1.665528566	3.065576059	9.847947781	1.384763714	4.633081266	0	0.079084025	4.810027556	6.042113144	12.29090878	0.294387973	1.121001326	5.326021393	18.1883224	8.418418326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2649	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1553	0.0251	1.1812	0	0.243	0.3321	0.2069	0.3771	1.2112	0.1703	0.5698	0	0.0097	0.5917	0.7503	1.5225	0.0362	0.1392	0.6596	2.2394	1.0432	0	0	0	0	0	0	0	0	0											13.4639	0	NO	1.894584363	19.7665	0.22981607	10.83340184	0	2.199233109	3.005479466	1.872416454	3.442653874	11.05912402	1.555072589	5.202893176	0	0.088810386	5.401754868	6.792417081	13.81345665	0.330594067	1.26024937	5.985635127	20.42771011	9.461593847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7288
H1608_001_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	V	COIN	COIN	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	913.9585321	43.23644578	594.1471219	0	112.9017144	7.127773862	4.891907158	271.1408687	41.32516035	10.4993409	17.4439063	1.409890779	0.06582164	16.02077026	3598.714529	100.6286353	237.734334	643.6060549	9.662930858	0	17.03258437	0	0	0	0	0	0	0	0	0											3300	1a $200 days 1-9	1b $190 days 1-9	"2 $50 days 1-20, $100 Days 21 to 44"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a 20%, 9b 20%"	"8a $0, 8a 20%, 14a $0"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	9a 20%	12 20%	"3 20%, 9a 20%, 9d $0"	"7a $15, 14a $0"	"7d $40, 17a $40, 17b 20%, 18a 20%, 7b $20 , 7f$40, 14a $0, 8a $0"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	14a $0	"15 20%, 11c 20%"				17a $0				14c $0													NO	176.5389082	144.8514851	58.24686941	0	150	0.2	0.2	64.67257319	0.2	0.053988493	0.469241398	0.2	0.2	0.20954049	14.28536346	0.116335581	39.96701416	39.99038444	0.285978622	0	0.228064062	0	0	0	0	0	0	0	0	0											NO	149.0632148	122.3074747	49.18159795	0	126.6546987	0.168872932	0.168872932	54.60723513	0.168872932	0.045585975	0.396210852	0.168872932	0.168872932	0.176928584	12.06205603	0.098229653	33.74673423	33.76646727	0.241470241	0	0.192569234	0	0	0	0	0	0	0	0	0												11.3531	0.440678375	2.435092073	0	1.191627718	1.203688067	0.826110703	1.233854431	6.978700976	0.478622695	6.911464978	0.238092389	0.011115493	2.8345322	3.617324689	9.884715933	0.668563116	1.811025232	2.333310248	0	3.279951726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7316	0	NO	10.64122934	11.3531	0.440678375	2.435092073	0	1.191627718	1.203688067	0.826110703	1.233854431	6.978700976	0.478622695	6.911464978	0.238092389	0.011115493	2.8345322	3.617324689	9.884715933	0.668563116	1.811025232	2.333310248	0	3.279951726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7316	YES	0.2	0.2	0.2	0.2	150	0.2	0.2	"$65 ER,$40 UC"	0.2	"20%, 14a $0"	0.2	0.2	0.2	0.2	0.2	"20%, 17a $0 Glaucoma Scrn"	0.2	0.2	0.2	"20%, $14a $0"	"20%, $14a $0"				17a $0				14c $50												5100	4.1714	0.0669	0.4336	0.2233	0.1568	0.1584	0.1087	0.1624	0.9183	0.2324	0.361	0.0313	0.0015	0.3466	0.6445	2.2362	0.0376	0.1089	0.2147	0.1435	0.4316	0	0	0	0.005	0	0	0	0	0											11.1946	0	NO	0	15.5245	0.507569485	2.868707506	0.223334835	1.348435655	1.362083042	0.934819751	1.396219039	7.897037872	0.710975301	7.272512447	0.269423295	0.012578196	3.181106761	4.261785249	12.12090783	0.706164149	1.91992844	2.548042045	0.143525444	3.711565102	0	0	0	0.005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9262
H1608_801_0	2012	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	173.083635	3.864692634	21.92593645	0	4.769054299	6.768706794	4.795815016	13.18759124	43.00562453	9.272952187	18.50400264	0.920198551	0.045211245	12.60886152	27.168766	96.09505777	2.987092932	4.838847448	8.984457959	6.386191655	21.1700504	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.084216318	0.084216318	0.128707976	0	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0	0	0	0	0	0	0	0	0												14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	0	NO	5.552704299	14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.7371	0.0284	0.3363	0	0.1187	0.1685	0.1194	0.3282	1.0704	0.2308	0.4605	0.0229	0.0011	0.3138	0.6762	2.3917	0.0409	0.1204	0.2236	0.1589	0.5269	0	0	0	0	0	0	0	0	0											9.0749	0	NO	0	16.3136	0.353884914	3.158358218	0	1.114685909	1.582070913	1.120940775	3.082376758	10.05183852	2.167395985	4.324998147	0.215080872	0.010567365	2.94710846	6.350240266	22.46059704	0.664773798	1.13099888	2.099965331	1.492664458	4.948141792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5903
H1608_802_0	2012	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	173.083635	3.864692634	21.92593645	0	4.769054299	6.768706794	4.795815016	13.18759124	43.00562453	9.272952187	18.50400264	0.920198551	0.045211245	12.60886152	27.168766	96.09505777	2.987092932	4.838847448	8.984457959	6.386191655	21.1700504	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.084216318	0.084216318	0.128707976	0	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0	0	0	0	0	0	0	0	0												14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	0	NO	5.552704299	14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.7371	0.0284	0.3363	0	0.1187	0.1685	0.1194	0.3282	1.0704	0.2308	0.4605	0.0229	0.0011	0.3138	0.6762	2.3917	0.0409	0.1204	0.2236	0.1589	0.5269	0	0	0	0	0	0	0	0	0											9.0749	0	NO	0	16.3136	0.353884914	3.158358218	0	1.114685909	1.582070913	1.120940775	3.082376758	10.05183852	2.167395985	4.324998147	0.215080872	0.010567365	2.94710846	6.350240266	22.46059704	0.664773798	1.13099888	2.099965331	1.492664458	4.948141792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5903
H1608_803_0	2012	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	173.083635	3.864692634	21.92593645	0	4.769054299	6.768706794	4.795815016	13.18759124	43.00562453	9.272952187	18.50400264	0.920198551	0.045211245	12.60886152	27.168766	96.09505777	2.987092932	4.838847448	8.984457959	6.386191655	21.1700504	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.084216318	0.084216318	0.128707976	0	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0.208844225	0	0	0	0	0	0	0	0	0												14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	0	NO	5.552704299	14.5765	0.325470183	2.822042899	0	0.995989447	1.413605322	1.001578268	2.754152265	8.981476306	1.936602509	3.864454082	0.192178153	0.009442107	2.633287907	5.674039867	20.06889782	0.623837107	1.010565343	1.876352155	1.333719244	4.421242759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5154	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.7371	0.0284	0.3363	0	0.1187	0.1685	0.1194	0.3282	1.0704	0.2308	0.4605	0.0229	0.0011	0.3138	0.6762	2.3917	0.0409	0.1204	0.2236	0.1589	0.5269	0	0	0	0	0	0	0	0	0											9.0749	0	NO	0	16.3136	0.353884914	3.158358218	0	1.114685909	1.582070913	1.120940775	3.082376758	10.05183852	2.167395985	4.324998147	0.215080872	0.010567365	2.94710846	6.350240266	22.46059704	0.664773798	1.13099888	2.099965331	1.492664458	4.948141792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5903
H1609_001_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	P	COIN	COIN	COIN	V	T	COIN	V	COIN	COIN	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	1021.93332	28.93144559	611.0328204	0	144.3618201	7.601270901	5.068759898	307.8958028	49.30026898	10.17002223	21.93774032	0.766096175	0.062416957	13.01458769	31.41927691	109.880585	108.4566212	763.0871686	11.98570093	0	18.51432968	0	0	0	0	0	0	0	0	0											3300	1a $200 days 1-9	1b $190 days 1-9	"2 $50 days 1-20, $100 Days 21 to 44"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a 20%, 9b 20%"	"8a $0, 8a 20%, 14a $0"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	9a 20%	12 20%	"3 20%, 9a 20%, 9d $0"	"7a $10, 14a $0"	"7d $35, 17a $35, 17b 20%, 18a 20%, 7b $20 , 7f$35, 14a $0, 8a $0"	"7e $40, 7h $40, 9c $40"	"7c $35, 7i $35"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	14a $0	"15 20%, 11c 20%"	0	0	0	17a $0	0	0	0	14c $0	0												NO	177.9741672	179.2741935	56.96923661	0	150	0.2	0.2	64.07338769	0.2	0.0632642	0.413675588	0.2	0.2	0.188735269	0.100854949	0.094212215	35	35	0.250965055	0	0.225359166	0	0	0	0	0	0	0	0	0											NO	151.9423821	153.0522572	48.63650523	0	128.0599183	0.170746558	0.170746558	54.70155195	0.170746558	0.054010722	0.353168414	0.170746558	0.170746558	0.161129487	0.086103177	0.080432057	29.8806476	29.8806476	0.214257096	0	0.192396509	0	0	0	0	0	0	0	0	0												12.9396	0.369001921	2.476541747	0	1.54058024	1.297890841	0.865473304	1.403531521	8.417851223	0.549290241	7.747716945	0.130808285	0.010657481	2.097033839	2.705299568	8.837921457	0.27006284	1.900128231	2.568021478	0	3.562092396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6895	0	NO	10.22640188	12.9396	0.369001921	2.476541747	0	1.54058024	1.297890841	0.865473304	1.403531521	8.417851223	0.549290241	7.747716945	0.130808285	0.010657481	2.097033839	2.705299568	8.837921457	0.27006284	1.900128231	2.568021478	0	3.562092396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6895	NO																																										0	0	0	0	0	0	0	0	0	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	12.9396	0.369001921	2.476541747	0	1.54058024	1.297890841	0.865473304	1.403531521	8.417851223	0.549290241	7.747716945	0.130808285	0.010657481	2.097033839	2.705299568	8.837921457	0.27006284	1.900128231	2.568021478	0	3.562092396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6895
H1609_801_0	2012	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	189.0131816	4.200984619	22.3196181	0	3.608050403	6.997578488	4.93843381	14.61436313	46.59474792	9.780613631	19.9758469	0.935731177	0.050620723	12.98871445	29.40665897	101.2126913	3.168384107	5.012495991	9.810041096	6.860269411	22.86627312	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.083295855	0.083295855	0.12730123	0	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0	0	0	0	0	0	0	0	0												15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	0	NO	6.80952219	15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.4182	0	0.3052	0	0.3879	0.1301	0.0966	0.0338	0.3486	0.1348	0.1662	0.0212	0	0.2528	0.1749	1.2453	0.0003	0.0815	0.0387	0.0528	0.1874	0	0	0	0	0	0	0	0	0											4.0766	0	NO	0	16.1622	0.349924606	3.146502975	0	1.133166731	1.575574391	1.116678611	3.052614901	9.97333189	2.155110899	4.292482485	0.214469406	0.010456298	2.935817395	6.249199204	22.15200581	0.654793991	1.116925507	2.065060439	1.469820094	4.91072652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7369
H1609_802_0	2012	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	189.0131816	4.200984619	22.3196181	0	3.608050403	6.997578488	4.93843381	14.61436313	46.59474792	9.780613631	19.9758469	0.935731177	0.050620723	12.98871445	29.40665897	101.2126913	3.168384107	5.012495991	9.810041096	6.860269411	22.86627312	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.083295855	0.083295855	0.12730123	0	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0	0	0	0	0	0	0	0	0												15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	0	NO	6.80952219	15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.4182	0	0.3052	0	0.3879	0.1301	0.0966	0.0338	0.3486	0.1348	0.1662	0.0212	0	0.2528	0.1749	1.2453	0.0003	0.0815	0.0387	0.0528	0.1874	0	0	0	0	0	0	0	0	0											4.0766	0	NO	0	16.1622	0.349924606	3.146502975	0	1.133166731	1.575574391	1.116678611	3.052614901	9.97333189	2.155110899	4.292482485	0.214469406	0.010456298	2.935817395	6.249199204	22.15200581	0.654793991	1.116925507	2.065060439	1.469820094	4.91072652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7369
H1609_803_0	2012	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	189.0131816	4.200984619	22.3196181	0	3.608050403	6.997578488	4.93843381	14.61436313	46.59474792	9.780613631	19.9758469	0.935731177	0.050620723	12.98871445	29.40665897	101.2126913	3.168384107	5.012495991	9.810041096	6.860269411	22.86627312	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.090327876	0.090327876	0.138048283	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.083295855	0.083295855	0.12730123	0	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0.20656161	0	0	0	0	0	0	0	0	0												15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	0	NO	6.80952219	15.744	0.349924606	2.841314847	0	0.745284701	1.445431081	1.02009084	3.018766383	9.624686163	2.020299302	4.126243104	0.193286139	0.010456298	2.682969773	6.074286832	20.90665651	0.654466523	1.035389244	2.026377886	1.417068297	4.723294198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6603	YES	Medicare FFS 9%	Medicare FFS 9%	Medicare FFS 13.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.4182	0	0.3052	0	0.3879	0.1301	0.0966	0.0338	0.3486	0.1348	0.1662	0.0212	0	0.2528	0.1749	1.2453	0.0003	0.0815	0.0387	0.0528	0.1874	0	0	0	0	0	0	0	0	0											4.0766	0	NO	0	16.1622	0.349924606	3.146502975	0	1.133166731	1.575574391	1.116678611	3.052614901	9.97333189	2.155110899	4.292482485	0.214469406	0.010456298	2.935817395	6.249199204	22.15200581	0.654793991	1.116925507	2.065060439	1.469820094	4.91072652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7369
H1659_001_0	2012	4																															D	D	D		T	Coin	Coin	V	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	805.7968059	21.38323602	702.9425142	0	300.2878828	12.87560194	7.414050556	264.3765869	382.9227292	6.082856835	18.35218199	0	0.305209073	440.6338255	3999.04401	4598.615634	141.5944028	521.2008341	0	2.174179324	34.64101038	0	0	0	351.1508134	0	0	0	0	0											3400	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical; $175/Day for IP Substance Abuse; PBP 1a	$175/Days 1-5 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 DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/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	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Case for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - Partial Hospitalization; $30/Visit for Prof - CORF; PBP 3, 5, 9c"	"$15/Visit for PCP Office Visits; PBP 7a, 17a, 14a-b"	"$30/Visit for Speclst Office Visits; $15/Visit for Chiropractor; $30/Visit for Vision Exams; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 14a-b"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Case 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	"$15/Visit for Allergy Testing; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"	PBP 10b	"PBP 16a, 16b"	$20/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14a	PBP 13b											0	NO	175	175	100	0	100	0.2	0.2	48.03081716	150	0.2	0.2	0	0.2	30	15	28.29269871	15	30	0	15	0.2	0	0	0	20	0	0	0	0	0											NO	157.0835151	157.0835151	89.76200864	0	89.76200864	0.179524017	0.179524017	43.11342625	134.643013	0.179524017	0.179524017	0	0.179524017	26.92860259	13.4643013	25.39609466	13.4643013	26.92860259	0	13.4643013	0.179524017	0	0	0	20	0	0	0	0	0												10.5481	0.279912823	5.25812767	0	2.246203628	2.311479785	1.33100014	0.949848373	4.296489167	1.092018896	3.294657438	0	0.054792359	0.988804431	4.487027788	9.732239829	0.158872475	1.169600844	0	0.002439484	6.218893346	0	0	0	0.585251356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0058	0	NO	6.207045385	10.5481	0.279912823	5.25812767	0	2.246203628	2.311479785	1.33100014	0.949848373	4.296489167	1.092018896	3.294657438	0	0.054792359	0.988804431	4.487027788	9.732239829	0.158872475	1.169600844	0	0.002439484	6.218893346	0	0	0	0.585251356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0058	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Surgical; 30% Coinsurance for IP Substance Abuse; PBP 1a	30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	30% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for DME / Medical Supplies; 30% Coinsurance for Diabetes Monitoring Supplies; 30% 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"	"30% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	30% Coinsurance for OP Fac - Pathology; PBP 8a	30% Coinsurance for OP Fac - Radiology; 30% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	30% Coinsurance for Renal Dialysis - Fac; PBP 12	"30% Coinsurance for OP Fac - Cardiovascular; 30% Coinsurance for OP Fac - Occ Therapy; 30% Coinsurance for OP Fac - Physical/Speech Therapy; 30% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; 30% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"30% Coinsurance for Prof - PCP Asst Surgeon (OP); 30% Coinsurance for PCP Office Visits; 30% Coinsurance for PCP Immunizations; 30% Coinsurance for Physical Exams; PBP 7a, 17a, 14a-b"	"30% Coinsurance for Prof - Speclst Asst Surgeon (OP); 30% Coinsurance for Speclst Office Visits; 30% Coinsurance for Cardio; 30% Coinsurance for Chiropractor; 30% Coinsurance for Speclst Immunizations; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 14a-b"	"30% Coinsurance for OP Psych - Non-Physician; 30% Coinsurance for OP Psych - Psychiatrist; 30% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"30% Coinsurance for Occ Therapy; 30% Coinsurance for PT/ST; PBP 7c, 7i"	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	"30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); 30% Coinsurance for Allergy Testing; 30% Coinsurance for Allergy Tx; 30% Coinsurance for Renal Dialysis - Prof; 30% Coinsurance for Prof - ER Visits; 30% Coinsurance for Prof Path (OP); 30% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14e"	30% Coinsurance for Part B Rx; 30% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"							30% Coinsurance for Health Ed/Wellness; PBP 14a												5100	3.2967	0.0381	0.9859	0.3177	0.1566	0.1934	0.1214	0.0572	0.6866	0.0902	0.271	0	0.0045	0.2638	0.4189	0.7974	0.0183	0.0729	0.2516	0.6669	0.5088	0	0	0	0	0	0	0	0.0002	0											9.2181	100	NO	1.005340381	13.8448	0.318038622	6.244004984	0.317672849	2.4027946	2.504851251	1.452381043	1.007087052	4.983089911	1.182183131	3.565677837	0	0.059245306	1.252597453	4.905967838	10.52968601	0.177172932	1.242543494	0.251587476	0.66938274	6.727678328	0	0	0	0.585251356	0	0	0	0.000156	0	0	0	0	0	0	0	0	0	0	0	64.2239
H1659_002_0	2012	4																															D	D	D		T	Coin	Coin	V	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	979.1867463	24.76514677	702.9425142	0	298.0352957	12.87560194	7.414050556	263.9916456	377.1454665	6.082856835	18.35218199	0	0.305209073	436.6955118	3791.637631	4516.079262	134.1769676	510.5067671	0	2.129473937	34.64101038	0	0	0	351.1508134	0	0	0	0	0											3400	$250/Days Custom for IP Medical; $250/Days Custom for IP Surgical; $250/Days Custom for IP Substance Abuse; PBP 1a	$250/Days Custom for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Case 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/Case for ER - Worldwide; $40/Visit for 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	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$45/Case for OP Fac - Cardiovascular; $45/Visit for OP Fac - Occ Therapy; $45/Visit for OP Fac - Physical/Speech Therapy; $40/Visit for OP Fac - Partial Hospitalization; $45/Visit for Prof - CORF; PBP 3, 5, 9c"	"$25/Visit for PCP Office Visits; PBP 7a, 17a, 14a-b"	"$45/Visit for Speclst Office Visits; $15/Visit for Chiropractor; $45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 14a-b"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Case for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Occ Therapy; $45/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"$25/Visit for Allergy Testing; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"	PBP 10b	"PBP 16a, 16b"	$20/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14a	PBP 13b											0	NO	250	250	100	0	150	0.2	0.2	49.02855446	250	0.2	0.2	0	0.2	44.69876497	25	41.52299176	25	45	0	25	0.2	0	0	0	20	0	0	0	0	0											NO	210.5241525	210.5241525	84.20966099	0	126.3144915	0.168419322	0.168419322	41.2867795	210.5241525	0.168419322	0.168419322	0	0.168419322	37.64067845	21.05241525	34.96637059	21.05241525	37.89434745	0	21.05241525	0.168419322	0	0	0	20	0	0	0	0	0												17.1785	0.434471795	4.932879235	0	3.137181402	2.168500148	1.248669368	0.908280405	6.616519141	1.024470624	3.090862048	0	0.051403105	1.369792945	6.65192749	13.15924176	0.23539577	1.612110067	0	0.003735881	5.83421548	0	0	0	0.585251356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2434	0	NO	13.06176157	17.1785	0.434471795	4.932879235	0	3.137181402	2.168500148	1.248669368	0.908280405	6.616519141	1.024470624	3.090862048	0	0.051403105	1.369792945	6.65192749	13.15924176	0.23539577	1.612110067	0	0.003735881	5.83421548	0	0	0	0.585251356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2434	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Surgical; 30% Coinsurance for IP Substance Abuse; PBP 1a	30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	30% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for DME / Medical Supplies; 30% Coinsurance for Diabetes Monitoring Supplies; 30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $40/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	30% Coinsurance for OP Fac - Pathology; PBP 8a	30% Coinsurance for OP Fac - Radiology; 30% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	30% Coinsurance for Renal Dialysis - Fac; PBP 12	"30% Coinsurance for OP Fac - Cardiovascular; 30% Coinsurance for OP Fac - Occ Therapy; 30% Coinsurance for OP Fac - Physical/Speech Therapy; 30% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; 30% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"30% Coinsurance for Prof - PCP Asst Surgeon (OP); 30% Coinsurance for PCP Office Visits; 30% Coinsurance for PCP Immunizations; 30% Coinsurance for Physical Exams; PBP 7a, 17a, 14a-b"	"30% Coinsurance for Prof - Speclst Asst Surgeon (OP); 30% Coinsurance for Speclst Office Visits; 30% Coinsurance for Cardio; 30% Coinsurance for Chiropractor; 30% Coinsurance for Speclst Immunizations; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 14a-b"	"30% Coinsurance for OP Psych - Non-Physician; 30% Coinsurance for OP Psych - Psychiatrist; 30% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"30% Coinsurance for Occ Therapy; 30% Coinsurance for PT/ST; PBP 7c, 7i"	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	"30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); 30% Coinsurance for Allergy Testing; 30% Coinsurance for Allergy Tx; 30% Coinsurance for Renal Dialysis - Prof; 30% Coinsurance for Prof - ER Visits; 30% Coinsurance for Prof Path (OP); 30% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14e"	30% Coinsurance for Part B Rx; 30% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"			30% Coinsurance for Vision (Refractions); PBP 17a				30% Coinsurance for Health Ed/Wellness; PBP 14a												5100	3.2504	0.0376	0.972	0.3132	0.1544	0.1907	0.1197	0.065	0.6769	0.0889	0.2672	0	0.0044	0.2601	0.413	0.7862	0.018	0.0719	0.2494	0.6869	0.5016	0	0	0	0.0352	0	0	0	0.0002	0											9.163	250	NO	1.524363634	20.4289	0.472061562	5.904895569	0.313206516	3.291570777	2.359152901	1.368343711	0.973307766	7.293466597	1.113367192	3.358072026	0	0.055793445	1.629877158	7.064977436	13.94547621	0.253438931	1.684027177	0.249416175	0.690606338	6.33584718	0	0	0	0.620491103	0	0	0	0.000156	0	0	0	0	0	0	0	0	0	0	0	79.4065
H1681_001_0	2012	10	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	1235.71	71.29	493.42	1383.44	32.42	12.68	3.85	385.51	416.79	1794.39	898.75	94.54	0.45	1.68	3597.43	4522.71	72.11	885.95		1473.04	27.5	0			0.61				3.47	1.15	1754.16	436.07									4900	"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											148.989465	124.806492	34.03605	0	200	0.2	0.2	65	225	70.434635	90.185199	39.270754	0.2	0.2	15	33.672779	35	15		0	0.2	0			0				0	0	0	82.287584									NO	119.787083	100.344045	27.037966	0	178.8344	0.178834	0.178834	58.12118	201.1887	62.980679	80.64108	35.114809	0.178834	0.178834	13.41258	30.109256	31.29602	13.41258		0	0.178834	0			0				0	0	0	73.579253										12.3352	0.596127247	1.111756099	0	0.483150937	2.26761512	0.6885109	1.867191342	6.987786523	9.417658383	6.039680888	0.27664617	0.0804753	0.30044112	4.020901472	11.34795277	0.188063	0.990239604	0	0	4.917935	0	0	0	0	0	0	0	0	0	0	2.673808738	0	0	0	0	0	0	0	0	66.5911	0	NO	9.659614	12.3352	0.596127247	1.111756099	0	0.483150937	2.26761512	0.6885109	1.867191342	6.987786523	9.417658383	6.039680888	0.27664617	0.0804753	0.30044112	4.020901472	11.34795277	0.188063	0.990239604	0	0	4.917935	0	0	0	0	0	0	0	0	0	0	2.673808738	0	0	0	0	0	0	0	0	66.5911	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	30% Coins									7300	4.468	0.0945	0.4382	2.1318	3.0874	0.5787	0.1757	0.1704	1.9552	0.3098	0.6204	0.0172	0.0075	0.0416	1.104	1.9158	0.0151	0.2036		0.1474	0.7545	0			0				0	0	0.1239	0.4145									18.7751	0	NO	8.355208	16.8031	0.690627247	1.549907099	2.131849	3.570585937	2.84630212	0.8642249	2.037546342	8.943029523	9.727423383	6.660046888	0.29382517	0.0879703	0.34207012	5.124907472	13.26379077	0.203114	1.193794604	0	0.147402	5.672398	0	0	0	0	0	0	0	0	0	0.123946	3.088330738	0	0	0	0	0	0	0	0	85.3662
H1681_002_0	2012	10	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	1526.25	193.26	407.33	1582.37	29.4	16.58	4.2	405.96	369.43	1176.9	959.51	161.05	5.68	8.81	3275.21	3800.01	118.59	682.38		1824.6	23.13	0			0.61				3.47	1.15	1946.17	370.44									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	250	53.662204	97.294695	38.246121	0.2	0.2	15	33.957665	35	15		0	0.2	0			0				0	0	0	74.820119									NO	124.241611	88.15727	26.245811	0	178.167	0.178167	0.178167	57.904275	222.70875	47.80417	86.67352	34.070984	0.178167	0.178167	13.362525	30.250676	31.179225	13.362525		0	0.178167	0			0				0	0	0	66.652381										15.802	1.419772833	0.890892183	0	0.43650915	2.95400886	0.7483014	1.958901623	6.856274459	4.688393973	6.930342431	0.457260998	1.01198856	1.56965127	3.647089625	9.579405942	0.308128691	0.759859984	0	0	4.12100271	0	0	0	0	0	0	0	0	0	0	2.057559001	0	0	0	0	0	0	0	0	66.1973	0	NO	11.666067	15.802	1.419772833	0.890892183	0	0.43650915	2.95400886	0.7483014	1.958901623	6.856274459	4.688393973	6.930342431	0.457260998	1.01198856	1.56965127	3.647089625	9.579405942	0.308128691	0.759859984	0	0	4.12100271	0	0	0	0	0	0	0	0	0	0	2.057559001	0	0	0	0	0	0	0	0	66.1973	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7300	4.6165	0.2217	0.3379	2.5503	2.7741	0.8997	0.2278	0.1778	1.7194	0.2198	0.6845	0.0334	0.0927	0.2157	1.1874	1.8932	0.0261	0.1693		0.2293	0.6011	0			0						0.1645	0.319									19.3609	0	NO	8.945917	20.4185	1.641436833	1.228760183	2.550292	3.21063915	3.85370786	0.9760614	2.136671623	8.575660459	4.908203973	7.614807431	0.490704998	1.10464056	1.78530427	4.834467625	11.47256994	0.334258691	0.929182984	0	0.229297	4.72207071	0	0	0	0	0	0	0	0	0	0.164452	2.376606001	0	0	0	0	0	0	0	0	85.5583
H1681_004_0	2012	9	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	1309.47	66.32	283.42	1558.58	30.84	12.35	4.15	390.04	364.36	1040.68	962.48	132.27	0.36	8.01	3298.36	4079.79	73.56	698.64		2126.98	19.97	0			0.61				3.47	1.15	1845.48	484.45									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	125	59.480366	96.525007	39.871758	0.2	0.2	15	34.217714	35	15		0	0.2	0			0				0	0	0	74.100437									NO	132.377932	93.930503	28.302814	0	182.1072	0.182107	0.182107	59.18484	113.817	54.159014	87.889494	36.304671	0.182107	0.182107	13.65804	31.15646	31.86876	13.65804		0	0.182107	0			0				0	0	0	67.471116										14.4454	0.51912258	0.668465295	0	0.468015504	2.24902145	0.75574405	1.923704583	3.45586351	4.696850224	7.049323349	0.400168236	0.06555852	1.45867707	3.754094401	10.59265116	0.195355499	0.795171089	0	0	3.63667679	0	0	0	0	0	0	0	0	0	0	2.723865179	0	0	0	0	0	0	0	0	59.8537	0	NO	8.053782	14.4454	0.51912258	0.668465295	0	0.468015504	2.24902145	0.75574405	1.923704583	3.45586351	4.696850224	7.049323349	0.400168236	0.06555852	1.45867707	3.754094401	10.59265116	0.195355499	0.795171089	0	0	3.63667679	0	0	0	0	0	0	0	0	0	0	2.723865179	0	0	0	0	0	0	0	0	59.8537	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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			"VIS775: Vision 17a,17b"						35% Coins	30% Coins									7300	4.6101	0.0804	0.3229	2.2687	2.9594	0.7955	0.2676	0.1737	1.5927	0.2082	0.6758	0.0284	0.006	0.1993	1.0485	1.9412	0.0163	0.159		0.271	0.5323	0			0						0.1721	0.4291									18.7581	0	NO	7.779413	19.0555	0.59956158	0.991356295	2.268698	3.427461504	3.04448345	1.02332705	2.097407583	5.04855051	4.905024224	7.725112349	0.428582236	0.07157452	1.65802407	4.802621401	12.53383716	0.211668499	0.954134089	0	0.270957	4.16897579	0	0	0	0	0	0	0	0	0	0.172142	3.152921179	0	0	0	0	0	0	0	0	78.6119
H1681_005_0	2012	9	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	1269.55	91.23	257.74	1288.43	24.39	13.07	6.79	392.27	336.09	1010.22	916.29	121.5	0.37	5.31	3046.45	4092.57	63.7	660.78		1727.78	21.36	0			0.61				3.47	1.15	1987.64	365.05									4900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-5): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	100.845894	34.03605	0	200	0.2	0.2	65	125	59.453445	95.56302	39.406995	0.2	0.2	15	34.249027	35	15		0	0.2	0			0				0	0	0	74.714987									NO	118.741689	84.254727	29.237069	0	183.9348	0.183935	0.183935	59.77881	114.95925	54.677788	87.886825	36.241589	0.183935	0.183935	13.79511	31.49794	32.18859	13.79511		0	0.183935	0			0				0	0	0	68.713431										12.5624	0.640546562	0.627963514	0	0.373847481	2.40403045	1.24891865	1.954119483	3.219721194	4.603049583	6.71081824	0.366946089	0.06805595	0.97669485	3.502176072	10.74229369	0.170867765	0.759627732	0	0	3.9288516	0	0	0	0	0	0	0	0	0	0	2.090319832	0	0	0	0	0	0	0	0	56.9512	0	NO	6.46912	12.5624	0.640546562	0.627963514	0	0.373847481	2.40403045	1.24891865	1.954119483	3.219721194	4.603049583	6.71081824	0.366946089	0.06805595	0.97669485	3.502176072	10.74229369	0.170867765	0.759627732	0	0	3.9288516	0	0	0	0	0	0	0	0	0	0	2.090319832	0	0	0	0	0	0	0	0	56.9512	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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			"VIS775: Vision 17a,17b"						35% Coins	30% Coins									7300	4.5442	0.1174	0.2825	2.5013	2.3526	0.8463	0.4395	0.1756	1.563	0.2387	0.6653	0.0275	0.0062	0.1329	1.0124	2.0578	0.0149	0.1589		0.2234	0.5752	0			0				0	0	0.1978	0.3021									18.4351	0	NO	7.346412	17.1066	0.757917562	0.910445514	2.501265	2.726424481	3.25032545	1.68837065	2.129709483	4.782714194	4.841704583	7.37607524	0.394433089	0.07421795	1.10954985	4.514557072	12.80010269	0.185779765	0.918504732	0	0.223424	4.5040316	0	0	0	0	0	0	0	0	0	0.19777	2.392433832	0	0	0	0	0	0	0	0	75.3864
H1681_006_0	2012	9	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	1490.81	56.34	331.08	1857.35	26.17	12.8	3.99	421.55	398.37	956.47	915.74	120.64	0.28	7.59	3365.83	3683.76	84.01	620.72		1936.28	18.01	0			0.79				3.47	1.15	2094.48	472.58									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$20-$175/Visit: 3. $20 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	225	60.180701	104.909448	43.463122	0.2	0.2	20	38.99905	40	20		0	0.2	0			0				0	0	0	79.824504									NO	127.046645	90.147618	27.057537	0	178.9812	0.178981	0.178981	58.16889	201.35385	53.856071	93.884094	38.895409	0.178981	0.178981	17.89812	34.900484	35.79624	17.89812		0	0.178981	0			0				0	0	0	71.435428										15.7835	0.423243067	0.746517446	0	0.390328167	2.2909568	0.71413419	2.043424632	6.684444435	4.292643019	7.164451687	0.391028512	0.05011468	1.35846579	5.020169103	10.71375058	0.25060351	0.925810087	0	0	3.22344781	0	0	0	0	0	0	0	0	0	0	2.813246214	0	0	0	0	0	0	0	0	65.2803	0	NO	10.580332	15.7835	0.423243067	0.746517446	0	0.390328167	2.2909568	0.71413419	2.043424632	6.684444435	4.292643019	7.164451687	0.391028512	0.05011468	1.35846579	5.020169103	10.71375058	0.25060351	0.925810087	0	0	3.22344781	0	0	0	0	0	0	0	0	0	0	2.813246214	0	0	0	0	0	0	0	0	65.2803	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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			"VIS776: Vision 17a,17b"						25% Coins	30% Coins									7300	4.7847	0.0605	0.2789	2.423	2.5428	0.5958	0.1858	0.19	1.598	0.1703	0.6175	0.0243	0.0046	0.1914	0.9838	1.7047	0.0202	0.1344		0.2389	0.4801	0			0				0	0	0.1384	0.4155									17.7836	0	NO	7.24675	20.5682	0.483790067	1.025428446	2.422995	2.933148167	2.8867788	0.89994819	2.233466632	8.282402435	4.462955019	7.781976687	0.415299512	0.05476168	1.54983579	6.003967103	12.41840758	0.27082251	1.060174087	0	0.238944	3.70350481	0	0	0	0	0	0	0	0	0	0.138425	3.228721214	0	0	0	0	0	0	0	0	83.064
H1716_001_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0										0	YES	1076.98	40.5	484.58	1029.14	20.33	11.78	2.9	322.75	365.93	1156.22	993.35	190.72	0.22	783.35	3074.24	4556.96	115.03	740.71		1901.09	21.19	0		3.11	0.61				4.73	1.19	814.71										5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329117	0	150	0.2	0.2	65	225	0	47.69848	36.542555	0.2	42.109575	10	31.177667	35	35		0	0.2	0		0	0				0	0	0										NO	139.788272	109.115947	36.961307	0	140.27205	0.187029	0.187029	60.784555	210.408075	0	44.605091	34.172661	0.187029	39.378643	9.35147	29.155702	32.730145	32.730145		0	0.187029	0		0	0				0	0	0											12.5458	0.368266321	1.492559179	0	0.237644231	2.20320162	0.5423841	1.634851261	6.416218907	0	3.692372262	0.543117492	0.04114638	2.570605	2.395721928	11.07178065	0.313745715	2.020295475	0	0	3.96314451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0528	0	NO	5.144209	12.5458	0.368266321	1.492559179	0	0.237644231	2.20320162	0.5423841	1.634851261	6.416218907	0	3.692372262	0.543117492	0.04114638	2.570605	2.395721928	11.07178065	0.313745715	2.020295475	0	0	3.96314451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0528	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6700	1.809	0.0653	0.5132	1.2593	1.5698	0.6978	0.1718	0.1542	1.8628	0.3238	0.7453	0.0414	0.0039	0.6907	1.0149	2.2134	0.0241	0.1864		0.2689	0.5916	0			0				0	0	0.0726										14.2802	0	NO	2.892894	14.3548	0.433579321	2.005723179	1.25932	1.807440231	2.90098162	0.7142201	1.789025261	8.278972907	0.323814	4.437686262	0.584468492	0.04504138	3.26128	3.410625928	13.28521065	0.337868715	2.206695475	0	0.26893	4.55470051	0	0	0	0	0	0	0	0	0	0.072622	0	0	0	0	0	0	0	0	0	66.333
H1716_002_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0										0	YES	1268.3	46.49	507.4	1183.95	21.94	11.56	3.48	320.7	341.9	1036.77	988.87	187.7	0.19	769.73	3102.05	4183.1	137.98	681.49		1690.07	35.91	0		3.11	0.61				5.82	1.19	1372.29										5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329117	0	150	0.2	0.2	65	225	0	51.283728	41.73964	0.199372	58.311027	15	34.678293	40	43.238837		0	0.2	0		0	0				0	0	0										NO	133.8804	104.50438	35.210883	0	137.64495	0.183527	0.183527	59.646145	206.467425	0	47.059641	38.301671	0.18295	53.508122	13.764495	31.821946	36.70532	39.677384		0	0.183527	0		0	0				0	0	0											14.15	0.404867386	1.488833503	0	0.25166085	2.12157212	0.63867396	1.594043225	5.882601051	0	3.877988933	0.599101971	0.0347605	3.432233896	3.55817931	11.09286519	0.422050004	2.253311702	0	0	6.59045457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3932	0	NO	7.460236	14.15	0.404867386	1.488833503	0	0.25166085	2.12157212	0.63867396	1.594043225	5.882601051	0	3.877988933	0.599101971	0.0347605	3.432233896	3.55817931	11.09286519	0.422050004	2.253311702	0	0	6.59045457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3932	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6700	2.0559	0.0723	0.5738	1.5361	1.6876	0.6818	0.2054	0.1526	1.7858	0.2137	0.7923	0.0373	0.0034	0.5877	0.9773	1.7137	0.0272	0.1427		0.2076	1.0631	0			0				0	0	0.125										14.6423	0	NO	3.374708	16.2059	0.477210386	2.062672503	1.536107	1.93922285	2.80340712	0.84407696	1.746630225	7.668352051	0.213723	4.670253933	0.636402971	0.0381995	4.019978896	4.53552231	12.80651819	0.449273004	2.395982702	0	0.20759	7.65352057	0	0	0	0	0	0	0	0	0	0.124959	0	0	0	0	0	0	0	0	0	73.0355
H1716_004_0	2012	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	950.53	39.26	500.88	650.43	20.86	12.06	2.79	366.11	299.67	1301.13	962.98	147.46	1.36	1587.43	2891.48	3026.28	57.6	594.83		2020.75	24.87	0		3.11	0.61				4.73	1.19	1182.07										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	144.00749	44.329117	0	150	0.2	0.2	65	225	0	40.905896	38.696877	0.199981	42.769209	10	32.160216	35	44.968264		0	0.2	0		0	0				0	0	0										NO	126.867405	111.408947	31.279689	0	133.82325	0.178431	0.178431	57.990075	200.734875	0	36.4944	34.523613	0.178414	38.156764	8.92155	28.691897	31.225425	40.118662		0	0.178431	0		0	0				0	0	0											10.0493	0.364492938	1.305614219	0	0.232629416	2.15187786	0.49782249	1.769228863	5.012851666	0	2.928614776	0.424237664	0.24264304	5.047599323	2.14970695	7.235809504	0.14988204	1.988648643	0	0	4.43757897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9885	0	NO	7.734255	10.0493	0.364492938	1.305614219	0	0.232629416	2.15187786	0.49782249	1.769228863	5.012851666	0	2.928614776	0.424237664	0.24264304	5.047599323	2.14970695	7.235809504	0.14988204	1.988648643	0	0	4.43757897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9885	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 30% (Days 22-100)"	25% Coins	$150/Trip	25% Coins	25% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins										5100	2.1321	0.0846	0.4002	1.0641	2.4496	0.9046	0.2091	0.2659	2.8709	0.4922	1.1693	0.0464	0.0368	1.6871	1.2838	1.9906	0.035	0.1922		0.3751	1.0986	0			0				0	0	0.137										18.9251	1000	NO	3.749163	12.1813	0.449045938	1.705851219	1.064134	2.682235416	3.05647386	0.70696449	2.035169863	7.883721666	0.492239	4.097870776	0.470663664	0.27949204	6.734664323	3.43347695	9.226406504	0.18488004	2.180833643	0	0.375057	5.53613797	0	0	0	0	0	0	0	0	0	0.136959	0	0	0	0	0	0	0	0	0	64.9136
H1716_006_0	2012	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	1462.77	78.45	615.52	1286.04	27.63	13	3.06	411.42	303.05	1239.68	989.03	233.83	0.91	613.02	3146.51	3803.73	121.5	516.78		1493.94	21.87	0		3.11	0.61				4.73	1.19	1026.01										4000	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-7): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												145.768118	96.004994	44.329117	0	150	0.2	0.2	65	200	0	39.684529	37.192435	0.199823	42.914634	10	32.048931	35	41.336721		0	0.2	0		0	0				0	0	0										NO	111.870034	73.679224	31.130166	0	135.9156	0.181221	0.181221	58.89676	181.2208	0	35.95831	33.700214	0.18106	38.885122	9.06104	29.039665	31.71364	37.455369		0	0.181221	0		0	0				0	0	0											13.6367	0.481677927	1.596769981	0	0.312945669	2.355873	0.55453626	2.019275417	4.576580287	0	2.963653945	0.656676753	0.1647646	1.986446457	2.375887748	9.204920413	0.321100605	1.613015466	0	0	3.96330327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7841	0	NO	8.381951	13.6367	0.481677927	1.596769981	0	0.312945669	2.355873	0.55453626	2.019275417	4.576580287	0	2.963653945	0.656676753	0.1647646	1.986446457	2.375887748	9.204920413	0.321100605	1.613015466	0	0	3.96330327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7841	YES	$0-$200/Day(Days 1-15)	$0-$200/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins										5100	1.7124	0.0882	0.419	1.6178	2.0218	0.7298	0.1715	0.1863	1.5236	0.2651	0.6547	0.0453	0.0154	0.6098	0.9265	1.6505	0.0263	0.1169		0.1883	0.5897	0		0					0	0	0.0711										13.63	0	NO	4.126641	15.3491	0.569848927	2.015803981	1.617765	2.334761669	3.085665	0.72602126	2.205536417	6.100156287	0.265091	3.618328945	0.701938753	0.1801866	2.596281457	3.302434748	10.85542941	0.347376605	1.729965466	0	0.188313	4.55304227	0	0	0	0	0	0	0	0	0	0.07106	0	0	0	0	0	0	0	0	0	62.4141
H1716_019_0	2012	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	Skilled Nursing Facility							Prosthetics/Supplies	Acute	Mental Health								A	A	A	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O	O	D	D	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	YES	272.72	10.12	34.46	1527.17	25.53	14.43	4.46	406.37	379.83	1327.4	1134.31	177.62	0.43	743.75	3575.65	4401.43	112.88	778.98		1926.7	24.43	0			0.61				4.73	1.71	1342.24	0	0	0							3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician									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	0	0	0	0							NO	0	0	0	0	0	0.199539	0.199539	0	0	0	0	0	0.199539	0	0	0	0	0		0	0.199539	0			0				0	0	0	0	0	0								0	0	0	0	0	2.87934777	0.88994394	0	0	0	0	0	0.08580177	0	0	0	0	0	0	0	4.87473777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7298	0	NO	0.020186	0	0	0	0	0	2.87934777	0.88994394	0	0	0	0	0	0.08580177	0	0	0	0	0	0	0	4.87473777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7298	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			"VIS775: Vision 17a,17b"						25% Coins	30% Coins	30% Coins	30% Coins(Days 1-100)							5100	3.3948	0.0595	0.2167	2.7177	0	1.2439	0.384	0	2.7197	0.423	1.1379	0.0573	0.0111	0.9491	1.5625	2.9722	0.0374	0.2669		0.3827	1.0133	0							0	0	0.1376	0.613	0	0.0215							20.3218	1000	NO	10.848356	3.3948	0.059495	0.2167	2.717696	0	4.12320477	1.27397694	0	2.719702	0.423039	1.137881	0.057288	0.09686477	0.949065	1.562502	2.97222	0.037368	0.266908	0	0.382693	5.88805577	0	0	0	0	0	0	0	0	0	0.137578	0.613028	0.000024	0.021491	0	0	0	0	0	0	29.0516
H1716_020_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1276.61	57.89	395.37	1407.54	23.53	13.19	4.07	374.53	350.08	1223.42	1045.45	163.71	0.39	685.49	3295.54	4056.63	104.04	717.95		1775.77	22.32	0			0.61				4.73	1.19	1237.1										5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	128.006658	44.329116	0	150	0.2	0.2	65	250	0	39.421917	37.015514	0.199029	46.179491	15	32.846114	35	35		0	0.2	0			0				0	0	0										NO	147.487635	103.613325	35.944175	0	138.4182	0.184558	0.184558	59.98122	230.697	0	36.378072	34.157472	0.183662	42.613881	13.84182	30.31	32.29758	32.29758		0	0.184558	0			0				0	0	0											15.6903	0.499847949	1.184270706	0	0.271415021	2.43432002	0.75115106	1.872063861	6.73020048	0	3.169287948	0.465993312	0.07162818	2.434282441	3.801355957	10.24637128	0.280020019	1.932337297	0	0	4.11933456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9542	0	NO	7.315984	15.6903	0.499847949	1.184270706	0	0.271415021	2.43432002	0.75115106	1.872063861	6.73020048	0	3.169287948	0.465993312	0.07162818	2.434282441	3.801355957	10.24637128	0.280020019	1.932337297	0	0	4.11933456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9542	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										6700	2.4474	0.1066	0.4429	2.1932	2.3349	1.0038	0.3099	0.23	2.1948	0.3414	0.9183	0.0462	0.0089	0.7659	1.261	2.3986	0.0302	0.2154		0.3088	0.8178	0			0				0	0	0.1332										18.5091	500	NO	3.130831	18.1378	0.606402949	1.627122706	2.19321	2.606329021	3.43812602	1.06107006	2.102042861	8.92502948	0.341398	4.087568948	0.512225312	0.08051318	3.200188441	5.062311957	12.64498528	0.310176019	2.147735297	0	0.308838	4.93709356	0	0	0	0	0	0	0	0	0	0.133232	0	0	0	0	0	0	0	0	0	74.4634
H1717_001_0	2012	5																															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	1560.910789	102.7278753	953.0177133	1353.06179	174.4013271	10.02069222	14.12087509	405.2854419	55.17664329	14.40729485	27.74718612	0	0.016352584	29.71019672	5361.235796	3571.560818	413.3983263	465.8238023	0	0	23.94747681	807.0431984	0	0	41.44217509	0	10.24137086	0	119.8903957	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-63 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$25 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	81.71412937	0	200	0.2	0.107781674	63.92024103	0.16	0.236726084	0.189837238	0	0.2	0.145781015	16.31153999	43.56230209	38.5	45	0	0	0.2	43.47736712	0	0	45	0	45	0	0	0											NO	170.2798298	89.18567639	66.84474779	0	163.6063391	0.163606339	0.088168826	52.3031256	0.130885071	0.19364944	0.155292878	0	0.163606339	0.119253491	15.81201602	42.2319251	37.32097748	43.62192173	0	0	0.163606339	35.56586433	0	0	45	0	45	0	0	0												22.1493	0.76348792	5.308685724	0	2.377763555	1.639448769	1.245020973	1.766474614	7.221798889	2.789964582	4.308940378	0	0.002675386	3.543044671	7.064328858	12.56949075	1.285702469	1.693344121	0	0	3.917959011	2.391932409	0	0	0.155408157	0	0.038405141	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2332	0	NO	13.9318704	22.1493	0.76348792	5.308685724	0	2.377763555	1.639448769	1.245020973	1.766474614	7.221798889	2.789964582	4.308940378	0	0.002675386	3.543044671	7.064328858	12.56949075	1.285702469	1.693344121	0	0	3.917959011	2.391932409	0	0	0.155408157	0	0.038405141	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2332	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$55 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$35 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$55 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$55 (7c, 7i)"	Included in h.2.	$35/$55 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $55 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$55 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$55 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.5314	0.0334	0.6753	0.4475	0.2939	0.5066	0.4283	0.2183	1.3389	0.3448	0.7737	0	0.0003	0.6562	1.4761	2.2297	0.2075	0.2957	0	0	0.8396	0.4171	0	0	0.0271	0	0.0061	0	0	0											12.7474	0	NO	2.023733151	23.6807	0.796905333	5.983968092	0.447510867	2.671644444	2.146020018	1.67332847	1.984802937	8.560671717	3.134791665	5.082654336	0	0.003006052	4.19921984	8.54046085	14.79914453	1.493227728	1.98900738	0	0	4.757521656	2.809041928	0	0	0.182542914	0	0.04445873	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9806
H1717_009_0	2012	3																															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	198.1327945	40.456501	11401.72263	9.139312347	20.04957864	17.20935861	3.104869671	9.099431492	21.30554874	34.47969959	10.21871644	0	0	11.95741087	4.756819348	103.5742447	17.839239	65.97554367	0	40668.81954	26.66724885	5.585742406	1306.840719	0	32.21685379	165.6420187	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.086289289	0.087337337	0	0	0.2	0.2	0.192296332	0.108808135	0.16	0	0.093016792	0	0	0.146464155	0	0.034050384	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.079904805	0.080875308	0	0	0.185202139	0.185202139	0.17806846	0.100757497	0.148161711	0	0.086134544	0	0	0.135627374	0	0.031034609	0.182286393	0	0	0	0.185202139	0.186012445	0	0	0	0	0	0	0	0												15.8318	3.271931996	0	0	3.713224848	3.187210023	0.552879362	0.916835939	3.156666559	0	0.880184486	0	0	1.621752239	0	3.214386164	3.251850539	0	0	0	4.938831526	1.039017603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5765	0	NO	3.748423232	15.8318	3.271931996	0	0	3.713224848	3.187210023	0.552879362	0.916835939	3.156666559	0	0.880184486	0	0	1.621752239	0	3.214386164	3.251850539	0	0	0	4.938831526	1.039017603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5765	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2733	0.0565	0	0.0011	0.5847	0.5019	0.0905	0.0962	0.497	0	0.2303	0	0	0.2554	0.0793	1.9699	0.3391	0.0059	0	0	0.515	0.1083	0	0	0.0123	0	0	0	0	0											5.6167	0	NO	0.487387803	16.105	3.32840911	0	0.001093581	4.297903898	3.689063535	0.643422524	1.013078385	3.653710741	0	1.110488092	0	0	1.877111017	0.079267031	5.184284339	3.590947253	0.005895129	0	0	5.45384337	1.147364359	0	0	0.012279014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1932
H1777_007_0	2012	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	607.5883814		619.3527642		75.78586618	67.95745797		15.97719686	9.461690394					67.20864771							58.54777126	0.231846935																			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	$0 PCP; $0 Specialist	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																					0.056986274		0.148606453		0.224	0.224		0.224	0.224					0.224							0.224	0.224																			NO	0.030962135		0.080741778		0.121705067	0.121705067		0.121705067	0.121705067					0.121705067							0.121705067	0.121705067																				18.8122	0	50.00764335	0	9.223523884	8.270766942	0	1.944505806	1.151535659	0	0	0	0	8.179632939	0	0	0	0	0	0	7.125560395	0.028216947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7436	0		88.0385828	18.8122	0	50.00764335	0	9.223523884	8.270766942	0	1.944505806	1.151535659	0	0	0	0	8.179632939	0	0	0	0	0	0	7.125560395	0.028216947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7436	NO																																																																																		0	0		0	18.8122	0	50.00764335	0	9.223523884	8.270766942	0	1.944505806	1.151535659	0	0	0	0	8.179632939	0	0	0	0	0	0	7.125560395	0.028216947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7436
H1777_008_0	2012	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	663.2968504		550.0730419		102.7866382	46.36998251		20.20969657	13.25553216					85.59254641							48.43052874	0.024759199																			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	$0 PCP; $0 Spec.	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																					0.070909493		0.167034429		0.224	0.224		0.224	0.224					0.224							0.224	0.224																			NO	0.037009891		0.087180513		0.116912633	0.116912633		0.116912633	0.116912633					0.116912633							0.116912633	0.116912633																				24.5485	0	47.9556501	0	12.01705653	5.421236755	0	2.362768842	1.549739169	0	0	0	0	10.00684998	0	0	0	0	0	0	5.662140641	0.002894663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5269	0		100.3223086	24.5485	0	47.9556501	0	12.01705653	5.421236755	0	2.362768842	1.549739169	0	0	0	0	10.00684998	0	0	0	0	0	0	5.662140641	0.002894663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5269	NO																																																																																		0	0		0	24.5485	0	47.9556501	0	12.01705653	5.421236755	0	2.362768842	1.549739169	0	0	0	0	10.00684998	0	0	0	0	0	0	5.662140641	0.002894663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5269
H1777_009_0	2012	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	434.0831389		35.52917142		22.50984605	39.75138889		20.73126824	33.72102433					87.37351122							23.48466012																				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	$0 PCP; $0 Specialist	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																					0.056986274		0.148606453		0.224	0.224		0.224	0.224					0.224							0.224																				NO	0.056986274		0.148606453		0.224	0.224		0.224	0.224					0.224							0.224																					24.7368	0	5.279864146	0	5.042205514	8.904311112	0	4.643804085	7.553509451	0	0	0	0	19.57166651	0	0	0	0	0	0	5.260563867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9927	0		1.08E-09	24.7368	0	5.279864146	0	5.042205514	8.904311112	0	4.643804085	7.553509451	0	0	0	0	19.57166651	0	0	0	0	0	0	5.260563867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9927	NO																																																																																		0	0		0	24.7368	0	5.279864146	0	5.042205514	8.904311112	0	4.643804085	7.553509451	0	0	0	0	19.57166651	0	0	0	0	0	0	5.260563867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9927
H1777_010_0	2012	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	385.5525969		31.5570062		19.99324282	35.3071793		18.4135102	29.95101015					77.60514318							20.85907257																				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	$0 PCP; $0 Specialist	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																					0.070909493		0.167034429		0.224	0.224		0.224	0.224					0.224							0.224																				NO	0.070909493		0.167034429		0.224	0.224		0.224	0.224					0.224							0.224																					27.3393	0	5.271106521	0	4.478486391	7.908808163	0	4.124626285	6.709026274	0	0	0	0	17.38355207	0	0	0	0	0	0	4.672432255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8874	0		2.15E-09	27.3393	0	5.271106521	0	4.478486391	7.908808163	0	4.124626285	6.709026274	0	0	0	0	17.38355207	0	0	0	0	0	0	4.672432255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8874	NO																																																																																		0	0		0	27.3393	0	5.271106521	0	4.478486391	7.908808163	0	4.124626285	6.709026274	0	0	0	0	17.38355207	0	0	0	0	0	0	4.672432255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8874
H1804_128_0	2012	7	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	1816.12	95.85	440.42	3658.45	9.85	25.35	18.58	478.03	48.53	7.48	16.14	3.17	0.25	41.33	3469.47	3703.84	68.61	2.55		2217.54	22.99	0							3.47	1.28	205.76	332.03	0	0	610.85							"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 20% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit: 3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"								148.989465	124.806492	49.537808	0	0.2	0.2	0.2	65	0.236896	0.25	0.244437	0.241714	0.2	0.232327	15	34.674648	35	0.25		0	0.2	0							0	0	0	21.811883	0	0	15						NO	119.618129	100.202514	40.357115	0	0.180251	0.180251	0.180251	58.581575	0.213504	0.225314	0.2203	0.217846	0.180251	0.209386	13.518825	31.2507	31.543925	0.225314		0	0.180251	0							0	0	0	19.658068	0	0	13.518825							18.1034	0.800367581	1.481173382	0	1.77547235	4.56936285	3.34906358	2.333645858	10.36134912	1.68534872	3.555642	0.69057182	0.04506275	8.65392338	3.908596481	9.645632724	0.180352391	0.5745507	0	0	4.14397049	0	0	0	0	0	0	0	0	0	0	0.54392236	0	0	0.688164521	0	0	0	0	0	77.0896	0	NO	11.191627	18.1034	0.800367581	1.481173382	0	1.77547235	4.56936285	3.34906358	2.333645858	10.36134912	1.68534872	3.555642	0.69057182	0.04506275	8.65392338	3.908596481	9.645632724	0.180352391	0.5745507	0	0	4.14397049	0	0	0	0	0	0	0	0	0	0	0.54392236	0	0	0.688164521	0	0	0	0	0	77.0896	YES																																									5000																																									0	0	NO	0	18.1034	0.800367581	1.481173382	0	1.77547235	4.56936285	3.34906358	2.333645858	10.36134912	1.68534872	3.555642	0.69057182	0.04506275	8.65392338	3.908596481	9.645632724	0.180352391	0.5745507	0	0	4.14397049	0	0	0	0	0	0	0	0	0	0	0.54392236	0	0	0.688164521	0	0	0	0	0	77.0896
H1806_001_0	2012	9	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	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	1617.85	89.68	754.5	1240.66	1.41	15.21	5.64	368.91	432.77	898.82	930.49	180.41	1.14	19.97	3137.36	4095.84	143.28	515.91		1842.84	12.75	0		3.23	0.61		0.24		4.43	1.09	1535.17	387.75									6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $175 Advanced Imaging -- FSR,8b. $175 Advanced Imaging -- Office,8b, 9a. $200 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$200/Visit: 3. $50 Cardiac Rehab,8b. $200 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289607	34.03605	0	0.2	0.2	0.2	65	243.427227	37.012235	104.324896	40.688254	0.2	0.2	15	37.897667	40	41.544781		0	0.2	0		0	0		0		0	0	0	98.052267									NO	148.735957	105.537555	27.587818	0	0.184845	0.184845	0.184845	60.074625	224.981529	34.207633	96.419677	37.605102	0.184845	0.184845	13.863375	35.025971	36.969	38.396725		0	0.184845	0		0	0		0		0	0	0	90.622356										20.0527	0.788717328	1.734584057	0	0.26063145	2.81149245	1.0425258	1.846844159	8.113771359	2.562208724	7.476462104	0.565361371	0.2107233	3.69135465	3.624533183	11.95506442	0.44140986	1.6507712	0	0	2.35677375	0	0	0	0	0	0	0	0	0	0	2.928234878	0	0	0	0	0	0	0	0	74.1142	0	NO	9.321317	20.0527	0.788717328	1.734584057	0	0.26063145	2.81149245	1.0425258	1.846844159	8.113771359	2.562208724	7.476462104	0.565361371	0.2107233	3.69135465	3.624533183	11.95506442	0.44140986	1.6507712	0	0	2.35677375	0	0	0	0	0	0	0	0	0	0	2.928234878	0	0	0	0	0	0	0	0	74.1142	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									10000	6.9813	0.1181	0.6555	3.3473	2.5762	1.3336	0.4946	0.261	2.6974	0.4228	1.0888	0.06	0.0301	0.7898	1.4669	2.7243	0.0407	0.171		0.3376	0.4928	0		0	0		0		0	0	0.1754	0.8158									27.0811	1000	NO	8.915597	27.034	0.906860328	2.390070057	3.347348	2.83685545	4.14506645	1.5371558	2.107834159	10.81116136	2.984995724	8.565298104	0.625380371	0.2407893	4.48120365	5.091397183	14.67941442	0.48212986	1.8217302	0	0.337574	2.84954375	0	0	0	0	0	0	0	0	0	0.175413	3.744070878	0	0	0	0	0	0	0	0	101.1953
H1806_002_0	2012	6	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	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	1223.27	60.53	334.21	1633.65	1.29	16.03	4.33	457.68	433.76	1584.91	934.11	249.84	0.29	10.28	3729.15	4291.81	85.27	797.93		1693.06	17.44	0		3.23	0.61		0.24		4.43	1.09	1574.19	285.99									6000	"$0-$235/Day(Days 1-7): 1a. $235 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$235/Day(Days 1-6): 1b. $235 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											171.277539	137.246126	34.03605	0	0.2	0.2	0.2	65	202.096735	22.99251	95.678008	40.715196	0.2	0.2	15	37.667853	40	41.357263		0	0.2	0		0	0		0		0	0	0	81.452321									NO	145.457964	116.556685	29.613644	0	0.185329	0.185329	0.185329	60.231925	187.271929	21.305895	88.659548	37.728533	0.185329	0.185329	13.899675	34.904728	37.0658	38.323501		0	0.185329	0		0	0		0		0	0	0	75.477386										14.8279	0.587931345	0.824764663	0	0.23907441	2.97082387	0.80247457	2.29724562	6.769255994	2.813993837	6.901480865	0.785508057	0.05374541	1.90518212	4.319497752	12.48370506	0.263383397	2.548289263	0	0	3.23213776	0	0	0	0	0	0	0	0	0	0	1.798814802	0	0	0	0	0	0	0	0	66.4252	0	NO	6.83235	14.8279	0.587931345	0.824764663	0	0.23907441	2.97082387	0.80247457	2.29724562	6.769255994	2.813993837	6.901480865	0.785508057	0.05374541	1.90518212	4.319497752	12.48370506	0.263383397	2.548289263	0	0	3.23213776	0	0	0	0	0	0	0	0	0	0	1.798814802	0	0	0	0	0	0	0	0	66.4252	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									9000	5.8138	0.0836	0.4463	3.7451	2.343	1.397	0.3776	0.3217	2.929	0.4071	1.1125	0.0712	0.0075	0.4041	1.6918	2.9976	0.0269	0.285		0.3158	0.721	0		0	0		0		0	0	0.2087	0.4414									26.1477	1000	NO	6.79441	20.6416	0.671509345	1.271037663	3.745104	2.58205041	4.36777687	1.18009957	2.61894662	9.698302994	3.221106837	8.013960865	0.856674057	0.06128041	2.30926512	6.011334752	15.48132806	0.290274397	2.833289263	0	0.315777	3.95316576	0	0	0	0	0	0	0	0	0	0.208734	2.240183802	0	0	0	0	0	0	0	0	92.5728
H1806_005_0	2012	8	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	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	1248.46	55.81	423.52	1331.56	1.26	16.65	3.82	367.09	350.93	1124.86	1072.21	179.38	0.46	5.72	3529.98	3967.09	149.87	597.47		1815.07	19.55	0		3.23	0.61				4.43	1.09	2044.38	479.71									6700	"$0-$235/Day(Days 1-7): 1a. $235 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$235/Day(Days 1-6): 1b. $235 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											171.277539	137.246126	34.03605	0	0.2	0.2	0.2	65	209.383532	36.624448	83.363062	40.846751	0.199678	0.2	15	37.945926	40	41.910048		0	0.2	0		0	0				0	0	0	76.761652									NO	149.49429	119.791027	30.286162	0	0.188335	0.188335	0.188335	61.20894	197.171447	34.488364	78.500995	38.464405	0.188032	0.188335	14.12514	35.732767	37.66704	39.465687		0	0.188335	0		0	0				0	0	0	72.284606										15.5531	0.557128101	1.068899611	0	0.2373021	3.13577775	0.7194397	1.872432482	5.766114658	3.232881761	7.014129321	0.574978747	0.08649472	1.0772762	4.155121808	11.81292522	0.47042994	1.964963668	0	0	3.68194925	0	0	0	0	0	0	0	0	0	0	2.889637362	0	0	0	0	0	0	0	0	65.871	0	NO	5.495736	15.5531	0.557128101	1.068899611	0	0.2373021	3.13577775	0.7194397	1.872432482	5.766114658	3.232881761	7.014129321	0.574978747	0.08649472	1.0772762	4.155121808	11.81292522	0.47042994	1.964963668	0	0	3.68194925	0	0	0	0	0	0	0	0	0	0	2.889637362	0	0	0	0	0	0	0	0	65.871	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						20% Coins	30% Coins									10000	6.1424	0.0785	0.5493	2.153	2.5754	1.0835	0.2487	0.289	2.9464	0.3654	1.0528	0.0582	0.0136	0.2517	1.6821	2.8525	0.0455	0.2285		0.3721	0.9237	0		0	0				0	0	0.2054	0.6076									24.7253	1000	NO	4.954137	21.6955	0.635594101	1.618192611	2.153022	2.8126661	4.21929375	0.9681337	2.161448482	8.712471658	3.598297761	8.066964321	0.633174747	0.10010372	1.3289942	5.837219808	14.66545622	0.51594094	2.193499668	0	0.372063	4.60564125	0	0	0	0	0	0	0	0	0	0.205434	3.497191362	0	0	0	0	0	0	0	0	90.5963
H1837_001_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											4.882842688	0.031007699	0.587158498	0.43545457	0.136465991	0.214852047	0.135957996	0.289746317	0.49152827	0.935097713	2.653263325	0	0	0.011599121	0	3.044670726	0.033366917	0.230431316	0	0.034644292	0.503719501	0.016179172	0	0	0	0	0	0	0	0											14.668	YES	516.7533449	11.00512678	485.5093215	558.2974401	96.3903731	6.314827761	3.996011853	82.26361149	154.9404235	4665.957362	77.98343637	0	0	79.53672146	3342.420764	3097.434069	110.8916834	813.472029	0	1789.40616	14.8050807	9.593448517	134.8597091	437.95364	150.5126033	176.0508429	33.78093019	0	120.0840626	0											3400	1a: $345 Days 1-5	1b: $250 Days 1-6	2: $75 Days 1-20	6: none	10a: $175	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $30"	"8a1: 30%, 9a2: $250, 9b: $50"	8a2: $20	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 30%"	5: none	12: 20%	"3: $45, 9c: $30, 9c: $30, 9d: $45"	7a: $10	7d: $45	"7h1: $30, 7h2: $30"	"7c: $45, 7i: $45"	i5: none	"7b: $15, 7f: $45, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													250.7053221	108.6956522	51.80318737	0	173.7410012	0.199999978	0.089165245	57.24190924	63.68310885	16.59115302	0.243391288	0	0	45	9.999276941	43.92082017	30	44.47863457	0	8.008477295	0.181552741	0	0	24.98709198	25	25	20	0	0	0											NO	201.4799021	87.35350798	41.6317493	0	139.6273506	0.160730437	0.071657852	46.00259049	51.1790752	13.33351784	0.195601962	0	0	36.1643523	8.035941645	35.29706697	24.1095682	35.74535578	0	6.436030984	0.145905273	0	0	20.08093327	20.09130683	20.09130683	16.07304547	0	0	0												8.6763	0.080111369	1.684383529	0	1.121561035	1.014985024	0.286345626	0.315361603	0.660808966	5.184468809	15.25371317	0	0	0.239699501	2.238291518	9.11086148	0.222795884	2.423153925	0	0.959722791	2.160139344	0	0	0.732876485	0.251999575	0.294757625	0.045246869	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9576	275	NO	12.93855383	13.5591	0.111119068	2.271542027	0.43545457	1.258027026	1.229837071	0.422303621	0.60510792	1.152337236	6.119566522	17.9069765	0	0	0.251298622	2.238291518	12.15553221	0.256162801	2.65358524	0	0.994367082	2.663858845	0.016179172	0	0.732876485	0.251999575	0.294757625	0.045246869	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6256	NO																																																																																		0				13.5591	0.111119068	2.271542027	0.43545457	1.258027026	1.229837071	0.422303621	0.60510792	1.152337236	6.119566522	17.9069765	0	0	0.251298622	2.238291518	12.15553221	0.256162801	2.65358524	0	0.994367082	2.663858845	0.016179172	0	0.732876485	0.251999575	0.294757625	0.045246869	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6256
H1837_002_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	684.4983257	22.99126233	962.085587	583.3181802	122.9007128	9.312438673	4.941084632	176.1654613	253.9791188	5623.777813	102.3444206	0	0.126570084	87.18950115	4275.984302	3985.105662	200.4320495	1279.147234	0	2086.758789	28.27419887	15.51576625	21.12591774	410.4083182	122.6285703	236.153464	11.0205992	0	48.6974845	0											3400	1a: $330 Days 1-5	1b: $295 Days 1-6	2: $75 Days 1-45	6: none	10a: $200	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $30"	"8a1: 20%, 9a2: $300, 9b: $300"	8a2: none	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $45, 9c: $30, 9c: $30, 9d: $45"	7a: $15	7d: $45	"7h1: $30, 7h2: $30"	"7c: $45, 7i: $45"	i5: none	"7b: $15, 7f: $45, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													246.9076832	108.4581468	39.73935592	0	200	0.200000038	0.079167747	44.00999089	278.9996321	0	0.166264943	0	0.200000122	44.02437067	14.9977825	43.89879475	29.95824485	44.5480311	0	10.1474954	0.17949883	0	0	25	25	25	19.91433724	0	0	0											NO	210.8564071	92.62204747	33.93696664	0	170.7977689	0.170797802	0.067608373	37.58404127	238.2625734	0	0.141988406	0	0.170797874	37.59632144	12.80793894	37.489081	25.5840069	38.0435216	0	8.665847868	0.153289999	0	0	21.34972111	21.34972111	21.34972111	17.00662183	0	0	0												12.0276	0.177458149	2.720855539	0	1.749263962	1.590544052	0.334058692	0.551750831	5.04280987	0	14.53172118	0	0.021617901	0.273167043	4.563878822	12.44982908	0.427321245	4.055272118	0	1.506961184	4.334151907	0	0	0.730175261	0.218173815	0.420150883	0.015618597	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7424	0	NO	11.58228131	12.0276	0.177458149	2.720855539	0	1.749263962	1.590544052	0.334058692	0.551750831	5.04280987	0	14.53172118	0	0.021617901	0.273167043	4.563878822	12.44982908	0.427321245	4.055272118	0	1.506961184	4.334151907	0	0	0.730175261	0.218173815	0.420150883	0.015618597	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7424	NO																																																																																		0				12.0276	0.177458149	2.720855539	0	1.749263962	1.590544052	0.334058692	0.551750831	5.04280987	0	14.53172118	0	0.021617901	0.273167043	4.563878822	12.44982908	0.427321245	4.055272118	0	1.506961184	4.334151907	0	0	0.730175261	0.218173815	0.420150883	0.015618597	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7424
H1837_003_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	718.7338816	15.72609027	758.7300448	939.7788614	149.8078583	7.485847573	7.383227251	122.919444	238.9432716	6778.979094	97.724822	0	0.000527971	52.36129158	4280.323989	5088.431269	115.205007	1282.267012	2.494022969	2176.355306	40.62789998	27.27184094	191.3688452	485.2209781	148.31267	200.4394177	47.98388802	0	2528.574661	0											2500	1a: $300 Days 1-6	1b: $295 Days 1-6	2: $50 Days 1-20	6: none	10a: $125	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $25"	"8a1: 20%, 9a2: $150, 9b: $50"	8a2: $20	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $35, 9c: $30, 9c: $30, 9d: $35"	7a: $10	7d: $35	"7h1: $30, 7h2: $30"	"7c: $35, 7i: $35"	i5: none	"7b: $15, 7f: $35, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													252.5837206	165.152179	34.91861787	0	123.0925608	0.199999981	0.061896916	54.45922954	55.00016477	16.36486843	0.17828924	0	0.19999994	35	10.00208596	34.08863354	29.99198272	34.85109954	0	8.367004472	0.191054619	0	0	24.96990428	25	25	20	0	0	0											NO	191.1331943	125.3065026	26.44357776	0	93.18459462	0.151154744	0.046835051	41.19216012	41.62681907	12.38064807	0.134880952	0	0.153499935	26.0049543	7.550655246	25.8258773	22.55326062	26.3932108	0	6.321263243	0.14571474	0	0	18.80117081	18.77826881	18.83331522	15.12288669	0	0	0												11.4478	0.164215114	1.671961412	0	1.163315379	1.131521372	0.345793826	0.421943118	0.828870694	6.99401287	13.18121698	0	8.10E-05	0.113471083	2.693270898	10.95110013	0.216520712	2.820261962	0	1.1464429	5.920083879	0	0	0.760226874	0.232087932	0.314578228	0.060471242	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5793	0	NO	20.06834424	11.4478	0.164215114	1.671961412	0	1.163315379	1.131521372	0.345793826	0.421943118	0.828870694	6.99401287	13.18121698	0	8.10E-05	0.113471083	2.693270898	10.95110013	0.216520712	2.820261962	0	1.1464429	5.920083879	0	0	0.760226874	0.232087932	0.314578228	0.060471242	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5793	NO																																																																																		0				11.4478	0.164215114	1.671961412	0	1.163315379	1.131521372	0.345793826	0.421943118	0.828870694	6.99401287	13.18121698	0	8.10E-05	0.113471083	2.693270898	10.95110013	0.216520712	2.820261962	0	1.1464429	5.920083879	0	0	0.760226874	0.232087932	0.314578228	0.060471242	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5793
H1837_005_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	627.7975303	88.24638325	571.679569	965.2635046	106.998683	13.06358607	3.312304127	135.6206649	223.0052545	4785.520739	78.03211902	0	0.014726359	14.93528879	3790.924372	3094.255943	124.2909514	1003.646173	0.787396501	1749.118001	20.43145167	4.635227968	14.0883639	375.0192761	143.1563093	175.1144367	20.65048896	0	186.7591857	0											3400	1a: $300 Days 1-7	1b: $295 Days 1-6	2: $75 Days 1-20	6: none	10a: $125	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $35"	"8a1: 20%, 9a2: $150, 9b: $75"	8a2: none	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $40, 9c: $30, 9c: $30, 9d: $40"	7a: $5	7d: $40	"7h1: $30, 7h2: $30"	"7c: $40, 7i: $40"	i5: none	"7b: $15, 7f: $40, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													245.5705307	87.40746648	34.06937773	0	124.8981896	0.20000002	0.050927574	49.95875927	67.3663142	0	0.184631679	0	0.199999986	39.57427818	5.000043508	39.60281053	29.90484974	39.79927836	0	7.982332369	0.185598074	0	0	24.9958768	25	25	19.99605134	0	0	0											NO	216.3266479	77.28652508	29.90070805	0	109.9901375	0.176566958	0.044531062	44.00338365	59.30679824	0	0.162535031	0	0.172149245	34.06341309	4.404506462	34.84888303	26.29900267	35.04550938	0	7.021362317	0.163122824	0	0	22.01224191	22.03393295	22.00134101	17.61518407	0	0	0												11.3174	0.568354693	1.424468658	0	0.980733321	2.306597646	0.147500419	0.497314012	1.10214397	0	12.68295287	0	0.002535132	0.042395576	1.391429241	8.985946951	0.272394005	2.931107614	0	1.023432601	3.332836097	0	0	0.687917919	0.262858043	0.321062703	0.030313514	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3117	0	NO	6.836449813	11.3174	0.568354693	1.424468658	0	0.980733321	2.306597646	0.147500419	0.497314012	1.10214397	0	12.68295287	0	0.002535132	0.042395576	1.391429241	8.985946951	0.272394005	2.931107614	0	1.023432601	3.332836097	0	0	0.687917919	0.262858043	0.321062703	0.030313514	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3117	NO																																																																																		0				11.3174	0.568354693	1.424468658	0	0.980733321	2.306597646	0.147500419	0.497314012	1.10214397	0	12.68295287	0	0.002535132	0.042395576	1.391429241	8.985946951	0.272394005	2.931107614	0	1.023432601	3.332836097	0	0	0.687917919	0.262858043	0.321062703	0.030313514	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3117
H1837_006_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	1021.910629	43.86831287	1138.566134	1104.635617	178.5624942	13.59032062	5.83811367	231.4724663	361.3776885	8545.329812	110.8345777	0	0.060843664	89.05446253	6321.136501	6066.111312	246.7723726	1734.229173	4.694998124	2909.831716	36.95433888	17.79402737	84.00452503	627.7389117	218.3215682	306.0779784	29.11514114	0	3117.333619	0											2800	1a: $150 Days 1-5	1b: $295 Days 1-6	2: $50 Days 1-20	6: none	10a: $125	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $30"	"8a1: 20%, 9a2: $100, 9b: $50"	8a2: none	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $30, 9c: $30, 9c: $30, 9d: $30"	7a: $5	7d: $30	"7h1: $30, 7h2: $30"	"7c: $30, 7i: $30"	i5: none	"7b: $15, 7f: $30, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													112.9137208	145.5631101	28.89393722	0	124.5048512	0.199999974	0.069888951	46.52487042	52.11190134	0	0.163697879	0	0.19999998	29.94661632	5.000122559	29.47789868	29.90939374	29.79353016	0	8.591015272	0.186106074	0	0	24.91931534	25	25	19.90836002	0	0	0											NO	93.31916163	123.7038886	23.71304791	0	102.3474332	0.170747869	0.057344515	38.40990091	43.17568249	0	0.13496688	0	0.158953972	23.80067042	4.132823708	24.34768287	24.52406025	24.55319776	0	7.031208388	0.155901116	0	0	20.49686228	20.6699967	20.42198747	16.1395674	0	0	0												7.947	0.452223407	2.249906107	0	1.522951079	2.320518283	0.334783796	0.740902874	1.300227361	0	14.95899711	0	0.009671342	0.176629659	2.177011899	12.30797954	0.504321711	3.548405988	0	1.704969431	5.761222654	0	0	1.072223169	0.376058841	0.520893387	0.039158815	0	0	0	0	0	0	0	0	0	0	0	0	0	60.026	0	NO	12.54753997	7.947	0.452223407	2.249906107	0	1.522951079	2.320518283	0.334783796	0.740902874	1.300227361	0	14.95899711	0	0.009671342	0.176629659	2.177011899	12.30797954	0.504321711	3.548405988	0	1.704969431	5.761222654	0	0	1.072223169	0.376058841	0.520893387	0.039158815	0	0	0	0	0	0	0	0	0	0	0	0	0	60.026	NO																																																																																		0				7.947	0.452223407	2.249906107	0	1.522951079	2.320518283	0.334783796	0.740902874	1.300227361	0	14.95899711	0	0.009671342	0.176629659	2.177011899	12.30797954	0.504321711	3.548405988	0	1.704969431	5.761222654	0	0	1.072223169	0.376058841	0.520893387	0.039158815	0	0	0	0	0	0	0	0	0	0	0	0	0	60.026
H1837_801_0	2012	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	185.5016225	2.293555564	29.28383494	15.59276895	5.268927673	9.548345073	6.100766303	10.12066961	18.88161664	28.10017526	87.56123897	0	0.056979679	0.262007369	38.84011989	100.1858495	1.419392211	8.804090341	1.766344354	24.7348219	24.2351657	0.724073101	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share																					0.074070038	0.074070038	0.147037208	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073147726	0.073147726	0.145206316	0	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0	0	0	0	0	0	0	0												13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872		NO	1.249381211	13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872	NO																																																																																		0				13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872
H1837_803_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	185.5016225	2.293555564	29.28383494	15.59276895	5.268927673	9.548345073	6.100766303	10.12066961	18.88161664	28.10017526	87.56123897	0	0.056979679	0.262007369	38.84011989	100.1858495	1.419392211	8.804090341	1.766344354	24.7348219	24.2351657	0.724073101	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share																					0.074070038	0.074070038	0.147037208	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073147726	0.073147726	0.145206316	0	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0.221210774	0	0	0	0	0	0	0	0												13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872		NO	1.249381211	13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872	NO																																																																																		0				13.569	0.167768373	4.252197779	0	1.165543569	2.112196805	1.349555236	2.238801159	4.176817032	6.216061522	19.36948945	0	0.012604519	0.057958853	8.591852985	22.16218932	0.31398485	1.947559639	0.390734402	5.471609099	5.361079765	0.160172771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0872
H1846_001_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V	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	1047.020771	13.44265239	1199.302714	0	259.0700132	18.20642066	0.65889936	276.115734	193.2643964	0	1333.296651	4.92837165	4.197675583	2028.892817	4849.695093	5743.702446	421.6405895	274.5119894	770.1143906	521.8531784	44.30633453	0	0	0	182.1684309	0	54.05916989	0	0	0											3400	$200/Days Custom: IP 1-7 for Inpatient; $200/Days Custom: IP 1-7 for Inpatient; PBP 1a	$200/Days Custom: IP 1-7 for Inpatient Mental Health; $200/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $30/Visit for Urgent Care; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$47/Case for OP Radiology; $45/Case for Diagnostic Radiology; PBP 8b	$30/Visit for OP Mental Health; PBP 9a	$30/Case for OP Dialysis; PBP 12	"$45/Case for OP Other; $30/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$15/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$18/Visit for Office Surgery; $30/Visit for Specialty Physician, Podiatrist; $30/Visit for Vision Exam; $30/Visit for Hearing Exam; PBP 7d, 7f, 17a-1, 18a-1"	"$30/Visit for OP Mental Health; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$45/Visit for Radiology; PBP 7d	"$30/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7b, 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$30/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$30/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											0	NO	200	200	50	0	150	0.2	0.2	64.99953969	250	0	46.36511944	30	30	44.99985594	15	27.44541541	30	30	45	21.30675409	0.2	0	0	0	30	0	30	0	0	0											NO	197.4321224	197.4321224	49.35803061	0	148.0740918	0.197432122	0.197432122	64.16498538	246.790153	0	45.76981968	29.61481836	29.61481836	44.42208533	14.80740918	27.09303308	29.61481836	29.61481836	44.42222755	21.03318841	0.197432122	0	0	0	29.61481836	0	29.61481836	0	0	0												17.2263	0.221167616	4.932935005	0	3.19679641	3.594532272	0.130087899	1.476413503	3.974645831	0	5.085395608	0.012162736	0.01035945	7.510637486	5.984284971	12.96786003	1.040567456	0.677468559	2.850849725	0.914686352	8.747493663	0	0	0	0.449573749	0	0.133412708	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1376	0	NO	1.05530694	17.2263	0.221167616	4.932935005	0	3.19679641	3.594532272	0.130087899	1.476413503	3.974645831	0	5.085395608	0.012162736	0.01035945	7.510637486	5.984284971	12.96786003	1.040567456	0.677468559	2.850849725	0.914686352	8.747493663	0	0	0	0.449573749	0	0.133412708	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1376	YES	$250/Days Custom: IP 1-7 for Inpatient; $250/Days Custom: IP 1-7 for Inpatient; PBP 1a	$250/Days Custom: IP 1-7 for Inpatient Mental Health; $250/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$75/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $40/Visit for Urgent Care; PBP 4a, 4b"	"$300/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$59/Case for OP Radiology; $100/Case for Diagnostic Radiology; PBP 8b	$40/Visit for OP Mental Health; PBP 9a	$60/Case for OP Dialysis; PBP 12	"$60/Case for OP Other; $40/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$20/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$24/Visit for Office Surgery; $40/Visit for Specialty Physician, Podiatrist; $40/Visit for Vision Exam; $40/Visit for Hearing Exam; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"$40/Visit for OP Mental Health; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$100/Visit for Radiology; PBP 7d	"$40/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$40/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											5100	9.9042	0.0705	0.9681	0	0.3519	0.4239	0.0152	0.164	0.526	0	0.8491	0.0018	0.0023	1.0996	0.9248	2.1764	0.1859	0.1156	0.7095	0.129	0.9553	0	0	0	0.0317	0	0.0055	0	0	0											19.6103	0	NO	0.25725104	27.1305	0.291651404	5.901067741	0	3.548648713	4.018452965	0.145290741	1.640459436	4.500639332	0	5.934475825	0.013950711	0.01266155	8.610224976	6.909128805	15.14422564	1.226487174	0.793053581	3.560316546	1.043718315	9.702812771	0	0	0	0.481241189	0	0.138940151	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7479
H1846_003_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V	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	880.8176683	23.5171802	984.9017638	0	181.7242202	8.796747456	0.43543601	200.4294713	124.1127543	0	748.0995102	1.69026618	7.07291987	1021.170075	3304.936599	3346.19177	83.20075389	99.509277	476.1409052	199.7827314	17.71870503	0	0	0	203.9102372	0	41.19221583	0	0	0											3400	$225/Days Custom: IP 1-7 for Inpatient; $225/Days Custom: IP 1-7 for Inpatient; PBP 1a	$225/Days Custom: IP 1-7 for Inpatient Mental Health; $225/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $40/Visit for Urgent Care; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$48/Case for OP Radiology; $45/Case for Diagnostic Radiology; PBP 8b	$40/Visit for OP Mental Health; PBP 9a	$30/Case for OP Dialysis; PBP 12	"$45/Case for OP Other; $45/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$20/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$25/Visit for Office Surgery; $45/Visit for Specialty Physician, Podiatrist; $45/Visit for Vision Exam; $45/Visit for Hearing Exam; PBP 7d, 7f, 17a-1, 18a-1"	"$40/Visit for OP Mental Health; $45/Visit for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$45/Visit for Radiology; PBP 7d	"$45/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7b, 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$45/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$45/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											0	NO	225	225	50	0	150	0.2	0.2	64.99894248	250	0	47.07498677	40	30	45	20	40.80988323	40.03332586	45	45	24.21922609	0.2	0	0	0	45	0	35.11406648	0	0	0											NO	223.5643857	223.5643857	49.68097461	0	149.0429238	0.198723898	0.198723898	64.58421621	248.404873	0	46.77462444	39.74477969	29.80858476	44.71287715	19.87238984	40.54949545	39.77789291	44.71287715	44.71287715	24.06469513	0.198723898	0	0	0	44.71287715	0	34.8900209	0	0	0												16.41	0.438133662	4.077573293	0	2.257059093	1.748123948	0.086531541	1.078715026	2.569184415	0	2.916006136	0.005598271	0.017569478	3.804954341	5.473082375	11.307199	0.27579589	0.37077884	1.774135817	0.400642544	3.521130138	0	0	0	0.759784449	0	0.119766439	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4117	0	NO	0.38151118	16.41	0.438133662	4.077573293	0	2.257059093	1.748123948	0.086531541	1.078715026	2.569184415	0	2.916006136	0.005598271	0.017569478	3.804954341	5.473082375	11.307199	0.27579589	0.37077884	1.774135817	0.400642544	3.521130138	0	0	0	0.759784449	0	0.119766439	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4117	YES	$225/Days Custom: IP 1-7 for Inpatient; $225/Days Custom: IP 1-7 for Inpatient; PBP 1a	$225/Days Custom: IP 1-7 for Inpatient Mental Health; $225/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $45/Visit for Urgent Care; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$48/Case for OP Radiology; $45/Case for Diagnostic Radiology; PBP 8b	$40/Visit for OP Mental Health; PBP 9a	$45/Case for OP Dialysis; PBP 12	"$45/Case for OP Other; $45/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$20/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$25/Visit for Office Surgery; $45/Visit for Specialty Physician, Podiatrist; $45/Visit for Vision Exam; $45/Visit for Hearing Exam; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"$40/Visit for OP Mental Health; $45/Visit for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$45/Visit for Radiology; PBP 7d	"$45/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$45/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$45/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											5100	1.3222	0.0353	0.4531	0	0.2508	0.1942	0.0096	0.1199	0.2855	0	0.324	0.0006	0.0029	0.4228	0.6081	1.257	0.0306	0.0412	0.1971	0.0445	0.3912	0	0	0	0.0844	0	0.0131	0	0	0											6.0882	0	NO	0.039095294	17.7322	0.473435517	4.530636992	0	2.507843436	1.942359942	0.096146157	1.198572243	2.85464935	0	3.240006818	0.006220302	0.020497724	4.227727046	6.081202639	12.56415298	0.306439878	0.411976489	1.971262018	0.445158382	3.91236682	0	0	0	0.844204943	0	0.132907479	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4999
H1846_801_0	2012	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	205.6761622	2.128592262	29.85713931	0	9.330794876	16.05314184	0.971451563	13.53263525	43.93104924	8.847569416	22.18848533	0.052192349	0.251643792	54.43443962	51.16425182	124.5758301	0.764310567	1.129543189	20.04195717	10.41117415	34.20935395	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078522923	0.078522923	0.169293913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071433477	0.071433477	0.154009202	0	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0	0	0	0	0	0	0	0	0												14.6922	0.152052746	4.598274211	0	1.901393428	3.271247392	0.197958657	2.757628269	8.952099948	1.802923606	4.521484049	0.010635556	0.051279002	11.09244037	10.4260541	25.38558266	0.155748262	0.230173959	4.084072811	2.121548954	6.97105034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3758	0	NO	10.25957772	14.6922	0.152052746	4.598274211	0	1.901393428	3.271247392	0.197958657	2.757628269	8.952099948	1.802923606	4.521484049	0.010635556	0.051279002	11.09244037	10.4260541	25.38558266	0.155748262	0.230173959	4.084072811	2.121548954	6.97105034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3758	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a-2	Medicare-FFS Cost Sharing; PBP 17b-2	Medicare-FFS Cost Sharing; PBP 18a-2	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14c	"Medicare-FFS Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											10000	1.6325	0.0169	0.5109	0	0.2113	0.3635	0.022	0.3064	0.9947	0.2003	0.5024	0.0012	0.0057	1.2325	1.1585	2.8206	0.0173	0.0256	0.4538	0.2357	0.7746	0	0	0	0	0	0	0	0	0											11.4862	0	NO	1.13995308	16.3246	0.168947495	5.109193568	0	2.112659365	3.634719324	0.219954063	3.06403141	9.94677772	2.003248451	5.023871166	0.011817284	0.056976669	12.32493375	11.58450456	28.20620296	0.173053625	0.255748843	4.537858679	2.357276615	7.745611488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.862
H1846_802_0	2012	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	205.6761622	2.128592262	29.85713931	0	9.330794876	16.05314184	0.971451563	13.53263525	43.93104924	8.847569416	22.18848533	0.052192349	0.251643792	54.43443962	51.16425182	124.5758301	0.764310567	1.129543189	20.04195717	10.41117415	34.20935395	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078522923	0.078522923	0.169293913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071433477	0.071433477	0.154009202	0	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0.203776147	0	0	0	0	0	0	0	0	0												14.6922	0.152052746	4.598274211	0	1.901393428	3.271247392	0.197958657	2.757628269	8.952099948	1.802923606	4.521484049	0.010635556	0.051279002	11.09244037	10.4260541	25.38558266	0.155748262	0.230173959	4.084072811	2.121548954	6.97105034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3758	0	NO	10.25957772	14.6922	0.152052746	4.598274211	0	1.901393428	3.271247392	0.197958657	2.757628269	8.952099948	1.802923606	4.521484049	0.010635556	0.051279002	11.09244037	10.4260541	25.38558266	0.155748262	0.230173959	4.084072811	2.121548954	6.97105034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3758	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a-2	Medicare-FFS Cost Sharing; PBP 17b-2	Medicare-FFS Cost Sharing; PBP 18a-2	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14c	"Medicare-FFS Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											10000	1.6325	0.0169	0.5109	0	0.2113	0.3635	0.022	0.3064	0.9947	0.2003	0.5024	0.0012	0.0057	1.2325	1.1585	2.8206	0.0173	0.0256	0.4538	0.2357	0.7746	0	0	0	0	0	0	0	0	0											11.4862	0	NO	1.13995308	16.3246	0.168947495	5.109193568	0	2.112659365	3.634719324	0.219954063	3.06403141	9.94677772	2.003248451	5.023871166	0.011817284	0.056976669	12.32493375	11.58450456	28.20620296	0.173053625	0.255748843	4.537858679	2.357276615	7.745611488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.862
H1849_015_0	2012	9	H.6										OP Facility - Other										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	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	YES	2551.007255	104.7845584	1015.567976	1737.287384	502.9873093	14.10617247	7.520156687	445.3131429	420.6372751	10135.61265	732.7757884	5.287076935	0.016168807	643.261027	3443.426346	4277.765964	1.255562178	1832.48602	936.9256075	1888.222036	37.65312933	13.80921328	0	0	0	0	0	0	5872.8	287.5833365	12.12274055	0	0	0	0	0	0	0	0	0	3400	1A: $220/day (days1-8) no yrly max	1B: $220/day (days1-8) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $40 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$150 copay	8B: $95-$150 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $40-$200 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $95-$150 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	172.1816445	165.2951699	146	0	150	0.2	0.1421875	59.99142278	187.4653004	22.87958321	117.785507	40	0.2	46.28310502	10	39.44202638	40	50	106.5335856	0.64549339	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	145.8992068	140.063909	123.7140245	0	127.1034498	0.169471266	0.120483478	50.83411198	158.8499094	19.38715971	99.80629524	33.89425329	0.169471266	39.21828212	8.473563323	33.42145081	33.89425329	42.36781661	90.27190838	0.546962911	0.169471266	0	0	0	0	0	0	0	0	0	0.169471266	0	0	0	0	0	0	0	0	0		31.0158	1.223044571	10.47000013	0	5.32761852	2.390590914	0.906054634	1.886424847	5.568182752	16.37506177	6.09463639	0.01493346	0.002740148	2.10229937	2.431507599	11.91409539	0.003546362	6.469869304	7.048171883	0.086065619	6.381123514	0	0	0	0	0	0	0	0	0	2.054456193	0	0	0	0	0	0	0	0	0	119.7663		NO	21.57481943	31.0158	1.223044571	10.47000013	0	5.32761852	2.390590914	0.906054634	1.886424847	5.568182752	16.37506177	6.09463639	0.01493346	0.002740148	2.10229937	2.431507599	11.91409539	0.003546362	6.469869304	7.048171883	0.086065619	6.381123514	0	0	0	0	0	0	0	0	0	2.054456193	0	0	0	0	0	0	0	0	0	119.7663	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	31.0158	1.223044571	10.47000013	0	5.32761852	2.390590914	0.906054634	1.886424847	5.568182752	16.37506177	6.09463639	0.01493346	0.002740148	2.10229937	2.431507599	11.91409539	0.003546362	6.469869304	7.048171883	0.086065619	6.381123514	0	0	0	0	0	0	0	0	0	2.054456193	0	0	0	0	0	0	0	0	0	119.7663
H1849_016_0	2012	8	H.6										OP Facility - Other										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	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	YES	2463.919139	97.53677316	918.1211595	1597.434456	479.925	13.61264263	7.199931267	434.9331775	415.2090638	10056.2731	679.1984914	7.474433159	0	422.0794472	3181.945295	4586.77583	1.476175407	1933.948898	1034.20849	1895.896431	41.72556886	11.88289941	0	1004.272118	293	293	324	0	5872.8	251.4447586	14.94965629	0	0	0	0	0	0	0	0	0	3000	1A: $135/day (days1-7); no yrly max	1B: $135/day (days1-7); no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $25 copay	9A: $0 - $125 copay; 9B: $0-$125 copay	8A: $0-$125 copay	8B: $75-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $25-$125 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $75-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $25 copay, $75 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	101.5556274	97.94117647	146	0	150	0.2	0.139289296	60	118.8421474	17.89844702	99.3062201	40	0.2	38.00992811	15	24.79449791	40	40	84.33485584	0.422263407	0.2	0	0	0	0	0	25	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	87.55386696	84.43775054	125.8705687	0	129.3190774	0.172425437	0.120085088	51.72763096	102.4570458	15.4307377	85.61459175	34.48508731	0	32.76939224	12.93190774	21.37601063	34.48508731	34.48508731	72.70737166	0.364044761	0.172425437	0	0	0	0	0	25	0	0	0	0.172425437	0	0	0	0	0	0	0	0	0		17.9771	0.686315477	9.630369371	0	5.171954851	2.347165849	0.864604383	1.874838575	3.545091171	12.93130938	4.84577513	0.021479707	0	1.152607247	3.429051915	8.170580742	0.00424217	5.557699715	6.266215088	0.05751593	7.194549425	0	0	0	0	0	0.675	0	0	0	2.577701012	0	0	0	0	0	0	0	0	0	94.9812		NO	15.08160555	17.9771	0.686315477	9.630369371	0	5.171954851	2.347165849	0.864604383	1.874838575	3.545091171	12.93130938	4.84577513	0.021479707	0	1.152607247	3.429051915	8.170580742	0.00424217	5.557699715	6.266215088	0.05751593	7.194549425	0	0	0	0	0	0.675	0	0	0	2.577701012	0	0	0	0	0	0	0	0	0	94.9812	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	17.9771	0.686315477	9.630369371	0	5.171954851	2.347165849	0.864604383	1.874838575	3.545091171	12.93130938	4.84577513	0.021479707	0	1.152607247	3.429051915	8.170580742	0.00424217	5.557699715	6.266215088	0.05751593	7.194549425	0	0	0	0	0	0.675	0	0	0	2.577701012	0	0	0	0	0	0	0	0	0	94.9812
H1849_801_0	2012	10																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	348.0864551	3.616273088	72.71673382	11.89470214	14.43905104	14.90311006	5.081400499	16.49782755	53.7208158	54.76634878	47.42964949	0.004200509	5.409004983	0.470143576	57.04858451	84.91405652	0.238878474	53.9251236	0	0.133797911	32.3133084	0.514290484																			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																				NO	0.07958396	0.07958396	0.18124656	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.063767132	0.063767132	0.145224909	0	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668	0.186692668																				22.1965	0.230599365	10.56028104	0	2.695664959	2.782301374	0.948660215	3.080023438	10.02928242	10.22447576	8.854767794	0.000784204	1.00982157	0.087772358	10.65055244	15.85283174	0.04459686	10.06742518	0	0.024979089	6.032657751	0.096014263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.47		NO	28.64122186	22.1965	0.230599365	10.56028104	0	2.695664959	2.782301374	0.948660215	3.080023438	10.02928242	10.22447576	8.854767794	0.000784204	1.00982157	0.087772358	10.65055244	15.85283174	0.04459686	10.06742518	0	0.024979089	6.032657751	0.096014263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.47	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		NO	0	22.1965	0.230599365	10.56028104	0	2.695664959	2.782301374	0.948660215	3.080023438	10.02928242	10.22447576	8.854767794	0.000784204	1.00982157	0.087772358	10.65055244	15.85283174	0.04459686	10.06742518	0	0.024979089	6.032657751	0.096014263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.47
H1849_803_0	2012	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	384.1628738	3.991071302	79.83780548	15.52084709	17.18715451	17.04046181	5.810157129	21.21342237	51.74179391	50.92903674	44.10639772	0.003906192	5.0300124	0.437202041	56.72085928	84.42625338	0.237506196	53.61534161	0	0.133029286	36.77223259	0.558184669																			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																				NO	0.07958396	0.07958396	0.18124656	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.063064332	0.063064332	0.143624333	0	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061																				24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857		NO	30.98480587	24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857	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		NO	0	24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857
H1849_804_0	2012	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	384.1628738	3.991071302	79.83780548	15.52084709	17.18715451	17.04046181	5.810157129	21.21342237	51.74179391	50.92903674	44.10639772	0.003906192	5.0300124	0.437202041	56.72085928	84.42625338	0.237506196	53.61534161	0	0.133029286	36.77223259	0.558184669																			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																				NO	0.07958396	0.07958396	0.18124656	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.063064332	0.063064332	0.143624333	0	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061	0.184635061																				24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857		NO	30.98480587	24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857	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		NO	0	24.227	0.251694245	11.46665156	0	3.17335132	3.146266704	1.072758716	3.916741532	9.553349273	9.403285803	8.143587432	0.00072122	0.928716646	0.080722825	10.47265931	15.58804644	0.043851971	9.899271867	0	0.02456187	6.789443405	0.10306046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2857
H1903_011_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2206.92335	587.4139916	417.4635076	2035.224598	16.29212606	19.32841865	20.90038555	39.16774751	48.62690306	11.56772047	22.79095041	27.63727192	6.87E-05	22.70688433	14474.15729	119.0575596	2.418731833	5.162894446	27.05402589	30.85120329	23.3795593	0.004981571	0	847.6363636	734.4	440.64	18	13.71428571	504	4199.209572											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 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) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	Not Covered	"(16a) $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"	(14c) $0.00 copayment	"(13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	148.1571786	51.89118168	43.61122791	0	0.194218761	0.199999959	0.114441521	0.195351244	0.184074886	0.011995465	0.17255291	0.2	0.2	0.165520397	0	0.078729069	0.20836415	0.189440726	0.155634562	0.095750133	0.2	0.197387291	0	0	0	0	0	0	0	0											NO	142.5484432	49.92675508	41.96025266	0	0.186866288	0.192428629	0.110109148	0.187955899	0.177106426	0.011541357	0.166020634	0.192428669	0.192428669	0.159254349	0	0.07574865	0.20047618	0.182269134	0.149742758	0.092125354	0.192428669	0.189914869	0	0	0	0	0	0	0	0												26.2161	2.443972874	1.459739521	0	3.044449127	3.719341103	2.301323644	7.361809193	8.612137029	0.133507189	3.783768041	5.318203445	1.32E-05	3.616170076	0	9.018449398	0.484898119	0.941036297	4.051144442	2.842178013	4.498897475	0.000946074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.8481	0	NO	3.535178966	26.2161	2.443972874	1.459739521	0	3.044449127	3.719341103	2.301323644	7.361809193	8.612137029	0.133507189	3.783768041	5.318203445	1.32E-05	3.616170076	0	9.018449398	0.484898119	0.941036297	4.051144442	2.842178013	4.498897475	0.000946074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.8481	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	NO	0	26.2161	2.443972874	1.459739521	0	3.044449127	3.719341103	2.301323644	7.361809193	8.612137029	0.133507189	3.783768041	5.318203445	1.32E-05	3.616170076	0	9.018449398	0.484898119	0.941036297	4.051144442	2.842178013	4.498897475	0.000946074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.8481
H1903_022_0	2012	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	1824.117494	99.80576721	212.3922503	550.3219696	436.0114723	12.16193011	14.75588907	639.6845941	393.3443114	8338.155157	1366.464051	28.33646468	2.129179899	1257.792943	20348.30833	15721.40268	53.48901691	1382.270336	4216.917692	5203.731769	30.15347793	0.061731182	0	220.2857143	363.6	0	18	13.71428571	504	2039.518501											4000	"(1a) $50 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $50 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $30.00 copayment"	"(9a) , (9b) $25.00 copayment"	(8a) Copay between $0.00 and $25.00	(8b) Copay between $0.00 and $25.00	(9a) $25.00 copayment	(12) 20% coinsurance	"(3) Copay between $20.00 and $25.00 , (5) $50.00 copayment , (9a) $25.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7f), (7g) $20.00 copayment"	"(7e) , (7h) Copay between $10.00 and $20.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	39.62905014	26.84486198	59.47800254	0	45.34452981	0.189022192	0.103305941	58.86387256	24.70451801	0.033882633	6.173808869	6.121040475	0.2	7.576046812	1.984489256	4.781111725	12.02173178	8.260896258	5.921289742	6.123397561	0.2	0	0	0	0	0	0	0	0	0											YES	38.85444248	26.32013995	58.31541812	0	44.45820475	0.185327477	0.101286676	57.71329221	24.22163213	0.033220347	6.053132758	6.0013958	0.196090708	7.427961913	1.945699515	4.687657915	11.78674948	8.099424977	5.805549487	6.003706813	0.196090708	0	0	0	0	0	0	0	0	0											4000	5.9063	0.21890848	1.03214524	0	1.615357276	2.253939824	1.494574953	3.076525325	0.793953434	0.023083034	0.689282359	0.014171528	0.417512394	0.778569839	3.299307803	6.14137981	0.05253847	0.93296624	2.040127028	2.603473323	5.912816833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2969	0	NO	0.783428332	5.9063	0.21890848	1.03214524	0	1.615357276	2.253939824	1.494574953	3.076525325	0.793953434	0.023083034	0.689282359	0.014171528	0.417512394	0.778569839	3.299307803	6.14137981	0.05253847	0.93296624	2.040127028	2.603473323	5.912816833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2969	YES	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	Same as in-network	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											4000	0.4868	0	0.0073	0.0617	0.0232	0.0698	0.0847	0	0.1542	0.0081	0.223	0	0	0.0313	0	0.2449	0	0.0096	0.0636	0.0504	0.0799	0.0002	0	0	0	0	0	0	0	0											1.599	0	NO	0.031876961	6.3931	0.21890848	1.039442906	0.061734941	1.638594949	2.323738067	1.579260124	3.076525325	0.948187958	0.031177026	0.912245308	0.014171528	0.417512394	0.809888554	3.299307803	6.386312252	0.05253847	0.942599931	2.103748211	2.653919363	5.992764921	0.000158936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8958
H1903_024_0	2012	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	1669.176477	187.641368	352.5744758	3646.891014	441.2658937	12.00687129	11.57463157	539.2389814	357.4253336	6353.734259	1450.162999	809.9277437	0.020519979	2706.814833	7363.713591	17082.55671	286.385473	3302.44322	4254.136292	5677.703145	28.87640144	0.053837899	0	0	734.4	440.64	0	0	504	2039.518501											6000	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $40.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) Copay between $0.00 and $150.00	(8b) Copay between $0.00 and $150.00	(9a) $150.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $150.00 , (5) $250.00 copayment , (9a) $150.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	145.5533679	73.75918892	39.66453833	0	43.6435508	0.2	0.132373873	62.32263971	136.0946655	0.203295798	29.39879224	78.32379709	0.2	17.58559786	3.822586229	9.590879971	23.28750828	12.52937204	6.259372062	6.876099558	0.2	0	0	0	0	0	0	0	0	0											YES	140.5643728	71.23101501	38.30499449	0	42.14762211	0.193144789	0.127836619	60.18646557	131.4298774	0.19632762	28.39111766	75.63916642	0.193144789	16.98283297	3.691563058	9.262142455	22.48930439	12.09991461	6.04482549	6.640414001	0.193144789	0	0	0	0	0	0	0	0	0											6000	19.5522	1.113823758	1.125446946	0	1.549859012	2.319064626	1.479661769	2.704574032	3.914697315	0.103951127	3.430979028	5.105188283	0.003963327	3.830782016	2.265301089	13.18508947	0.536717506	3.32994008	2.142959291	3.141858288	5.577326472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4134	0	NO	2.712110666	19.5522	1.113823758	1.125446946	0	1.549859012	2.319064626	1.479661769	2.704574032	3.914697315	0.103951127	3.430979028	5.105188283	0.003963327	3.830782016	2.265301089	13.18508947	0.536717506	3.32994008	2.142959291	3.141858288	5.577326472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4134	YES	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	Same as in-network	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											6000	0.4464	0	0.0068	0.0556	0.0189	0.0679	0.0654	0	0.1425	0.0037	0.1912	0	0	0.0467	0	0.3046	0	0.0179	0.074	0.0692	0.0754	0.0001	0	0	0	0	0	0	0	0											1.5864	0	NO	0.056305694	19.9986	1.113823758	1.132202287	0.055642162	1.568786719	2.386937748	1.545091502	2.704574032	4.057184396	0.107670585	3.622206462	5.105188283	0.003963327	3.877483362	2.265301089	13.48971221	0.536717506	3.347885814	2.216925823	3.211056463	5.652738344	0.000136531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9998
H1906_001_0	2012	8	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	2002.68	137.23	276.96	5381.99	13.17	23.54	18.85	539.48	66.1	13.45	5.59	0.95	0.23	33.9	3598.45	5354.24	68.02	0.98		2099.18	18.41	0							4.84	1.28	503.56	744.56	57.31	0	800.85							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 20% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	116.360647	49.537808	0	0.2	0.2	0.2	65	0.243138	0.25	0.24462	0.213081	0.2	0.235343	15	39.284586	40	0.25		0	0.2	0							0	0	0	109.981245	150	0	15						NO	123.084011	87.33588	38.914128	0	0.174287	0.174287	0.174287	56.64334	0.211879	0.217859	0.21317	0.185686	0.174287	0.205087	13.07154	34.234003	34.85744	0.217859		0	0.174287	0							0	0	0	95.841616	130.7154	0	13.07154							20.5415	0.998758568	0.898138074	0	2.29535979	4.10271598	3.28530995	2.546495755	14.0052019	2.93020355	1.1916203	0.1764017	0.04008601	6.9524493	3.919773593	15.27475569	0.197583589	0.21350182	0	0	3.20862367	0	0	0	0	0	0	0	0	0	0	5.946652801	0.624274965	0	0.872361901	0	0	0	0	0	90.2218	0	NO	17.403845	20.5415	0.998758568	0.898138074	0	2.29535979	4.10271598	3.28530995	2.546495755	14.0052019	2.93020355	1.1916203	0.1764017	0.04008601	6.9524493	3.919773593	15.27475569	0.197583589	0.21350182	0	0	3.20862367	0	0	0	0	0	0	0	0	0	0	5.946652801	0.624274965	0	0.872361901	0	0	0	0	0	90.2218	YES																																									5000																																									0	0	NO	0	20.5415	0.998758568	0.898138074	0	2.29535979	4.10271598	3.28530995	2.546495755	14.0052019	2.93020355	1.1916203	0.1764017	0.04008601	6.9524493	3.919773593	15.27475569	0.197583589	0.21350182	0	0	3.20862367	0	0	0	0	0	0	0	0	0	0	5.946652801	0.624274965	0	0.872361901	0	0	0	0	0	90.2218
H1906_010_0	2012	4	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	O							O	O	V	V									0	0	0	0	0	0.716742572	0.573856627	0	2.583146214	0.409474577	0.960849406	0.028845726	0.007052004	1.128327232	0.974611919	2.334009733	0.014015033	0.204254278		0	0.560571142	0							0	0	0	0									10.4958	NO	323.68	8.32	14.72	5381.99	13.17	23.54	18.85	539.48	84.83	13.45	31.56	0.95	0.23	37.06	32.01	76.65	0.46	6.71		2099.18	18.41	0							4.84	1.28	503.56	198.64										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 20% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									0	NO	0.0832	0.0832	0.2235	0	0.2	0.2	0.2	65	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	0.068689	0.068689	0.181998	0	0.182843	0.182843	0.182843	59.42404	0.182843	0.182843	0.182843	0.182843	0.182843	0.182843	0.182843	0.182843	0.182843	0.182843		0	0.182843	0							0	0	0	0										22.2333	0.57149248	2.67901056	0	2.40804231	4.30412422	3.44659055	2.671506758	15.51057169	2.45923835	5.77052508	0.17370085	0.04205389	6.77616158	5.85280443	14.01491595	0.08410778	1.22687653	0	0	3.36613963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5911	162	YES	11.819396	22.2333	0.57149248	2.67901056	0	2.40804231	5.020866792	4.020447177	2.671506758	18.0937179	2.868712927	6.731374486	0.202546576	0.049105894	7.904488812	6.827416349	16.34892568	0.098122813	1.431130808	0	0	3.926710772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0869	YES																																									6700																													0												0	0	NO	0	22.2333	0.57149248	2.67901056	0	2.40804231	5.020866792	4.020447177	2.671506758	18.0937179	2.868712927	6.731374486	0.202546576	0.049105894	7.904488812	6.827416349	16.34892568	0.098122813	1.431130808	0	0	3.926710772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0869
H1944_001_0	2012	4																															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	1267.241321	152.5518311	738.2436114	895.9052171	183.1313753	10.08689353	9.569598378	317.6933523	52.79058883	21.6843567	40.91310085	0	0.013692619	44.50047181	5360.964251	3245.896105	760.9950175	609.5174625	0	0	12.43353868	812.1067907	0	0	39.28432909	0	9.472520418	0	115.2188206	0											5250	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-63 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	66.18787317	0	200	0.2	0.091251024	63.84599129	0.16	0.132221362	0.175240872	0	0.2	0.145794324	6.244686538	38.31486713	38.5	40	0	0	0.2	38.9790612	0	0	40	0	40	0	0	0											YES	167.8341009	87.9047027	53.36611113	0	161.2564616	0.161256462	0.073574086	51.49578947	0.129005169	0.106607745	0.141293615	0	0.161256462	0.117551384	6.041837992	37.07296384	37.24938975	38.70066467	0	0	0.161256462	31.42812742	0	0	40	0	40	0	0	0											8250	17.7239	1.117501946	3.283099218	0	2.460926465	1.626576758	0.704074454	1.363322499	6.810258847	2.311720367	5.780759901	0	0.002208023	5.231092051	2.699173124	10.02791574	2.362216667	1.965727577	0	0	2.004988453	2.126916308	0	0	0.130947764	0	0.031575068	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7649	0	NO	13.19629995	17.7239	1.117501946	3.283099218	0	2.460926465	1.626576758	0.704074454	1.363322499	6.810258847	2.311720367	5.780759901	0	0.002208023	5.231092051	2.699173124	10.02791574	2.362216667	1.965727577	0	0	2.004988453	2.126916308	0	0	0.130947764	0	0.031575068	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7649	NO	"$420 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$420 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-48 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.6641	0.0689	0.1158	0.7569	0.5067	0	0.4766	0.2807	2.1032	0.4759	1.7465	0	0.0005	1.6139	1.1031	1.8955	0.397	0.3655	0	0	0.4362	0.3832	0	0	0.0245	0	0.0057	0	0	0											13.4203	0	NO	2.816493579	18.388	1.186435575	3.398927231	0.756934955	2.967589223	1.626576758	1.180639782	1.644022591	8.913432945	2.787664137	7.527300835	0	0.002662618	6.844969827	3.802233686	11.92344418	2.759236857	2.331236244	0	0	2.441166175	2.510082803	0	0	0.155406398	0	0.037242048	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1852
H1951_001_0	2012	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	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	1468.11	68.07	294.38	4092.27	224.8	12.31	1.92	405.41	508.62	2765.96	1442.08	121.81	0.25	825.73	3527.94	8652.07	54.6	1902.91		895.66	16.18	0		2.34	1.9		0.21		4.84	1.28	14402.8										6700	"$0-$50/Day(Days 1-10): 1a. $50 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$50/Day(Days 1-10): 1b. $50 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"15%-20% Coins: 15. 15%-20% Part B Rx,15. 15%-20% Part B Rx at Pharmacy,15. 15%-20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS767: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												40.848439	37.853598	49.537808	0	200	0.2	0.2	65	100	0	28.006032	23.378273	0.2	34.590969	10	20	20	10		0	0.153129	0		0	0		0		0	0	0										NO	40.041315	37.105648	49.097367	0	194.745	0.194745	0.194745	63.292125	97.3725	0	27.270174	22.764009	0.194745	33.682091	9.73725	19.4745	19.4745	9.73725		0	0.149106	0		0	0		0		0	0	0											4.8988	0.210481788	1.204440241	0	3.648223	2.39731095	0.3739104	2.1382717	4.127133413	0	3.27714771	0.231073661	0.04868625	2.31769275	2.862702814	14.0412281	0.088608975	1.544092533	0	0	2.41253508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8223	0	NO	1.179935	4.8988	0.210481788	1.204440241	0	3.648223	2.39731095	0.3739104	2.1382717	4.127133413	0	3.27714771	0.231073661	0.04868625	2.31769275	2.862702814	14.0412281	0.088608975	1.544092533	0	0	2.41253508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8223	NO																																																																																		0	0	NO	0	4.8988	0.210481788	1.204440241	0	3.648223	2.39731095	0.3739104	2.1382717	4.127133413	0	3.27714771	0.231073661	0.04868625	2.31769275	2.862702814	14.0412281	0.088608975	1.544092533	0	0	2.41253508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8223
H1951_005_0	2012	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	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	1573.68	82.64	281.52	4404.4	246.09	16.52	3.66	375.98	492.3	2073.55	1054.47	122.72	0.21	380.4	4097.44	8994.45	54.99	2038.09		1685.94	31.33	0		2.34	1.9		0.21		4.84	1.28	20449.29										6700	"$0-$35/Day(Days 1-10): 1a. $35 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$35/Day(Days 1-10): 1b. $35 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$15-$50/Visit: 5. $15 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$150/Visit: 3. $5 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$15/Visit: 7b. $15 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit: 7e, 7h. $15 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"15%-20% Coins: 15. 15%-20% Part B Rx,15. 15%-20% Part B Rx at Pharmacy,15. 15%-20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS767: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												28.593907	26.497518	49.537808	0	200	0.2	0.2	65	100	0	91.182932	18.644785	0.2	48.094574	5	15	15	5		0	0.161007	0		0	0		0		0	0	0										NO	28.107954	26.047193	49.157308	0	194.2988	0.194299	0.194299	63.14711	97.1494	0	88.583671	18.113297	0.194299	46.72359	4.85747	14.57241	14.57241	4.85747		0	0.156417	0		0	0		0		0	0	0											3.6861	0.179378336	1.153230446	0	3.984582641	3.20981948	0.71113434	1.978504201	3.985554135	0	7.78406863	0.185238651	0.04080279	1.481137803	1.658599323	10.92256776	0.066778069	0.824996753	0	0	4.90054461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.753	0	NO	1.300363	3.6861	0.179378336	1.153230446	0	3.984582641	3.20981948	0.71113434	1.978504201	3.985554135	0	7.78406863	0.185238651	0.04080279	1.481137803	1.658599323	10.92256776	0.066778069	0.824996753	0	0	4.90054461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.753	NO																																																																																		0	0	NO	0	3.6861	0.179378336	1.153230446	0	3.984582641	3.20981948	0.71113434	1.978504201	3.985554135	0	7.78406863	0.185238651	0.04080279	1.481137803	1.658599323	10.92256776	0.066778069	0.824996753	0	0	4.90054461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.753
H1951_013_0	2012	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	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	1998.67	74.93	449.49	4042.45	199.44	14.13	2.01	385.97	439.07	2202.21	1162.84	170.79	0.35	533.73	3943.77	5024.42	47.72	786.84		1776.07	17.03	0		2.34	0.6				4.84	1.28	15932.7										4900	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25-$50/Visit: 5. $25 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												127.547103	112.005826	53.717902	0	200	0.2	0.2	65	250	0	75.637614	29.912102	0.2	51.864015	10	24.932393	25	10		0	0.2	0		0	0				0	0	0										NO	107.155127	94.098558	47.574562	0	183.0362	0.183036	0.183036	59.486765	228.79525	0	69.222107	27.374987	0.183036	47.464961	9.15181	22.817652	22.879525	9.15181		0	0.183036	0		0	0				0	0	0											17.8473	0.587567079	1.782024156	0	3.042061644	2.58629868	0.36790236	1.913342224	8.371427535	0	6.707852909	0.389614502	0.0640626	2.111122803	3.007719477	9.553788922	0.090984244	0.600084182	0	0	3.11710308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1403	0	NO	7.623754	17.8473	0.587567079	1.782024156	0	3.042061644	2.58629868	0.36790236	1.913342224	8.371427535	0	6.707852909	0.389614502	0.0640626	2.111122803	3.007719477	9.553788922	0.090984244	0.600084182	0	0	3.11710308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1403	NO																																																																																		0	0	NO	0	17.8473	0.587567079	1.782024156	0	3.042061644	2.58629868	0.36790236	1.913342224	8.371427535	0	6.707852909	0.389614502	0.0640626	2.111122803	3.007719477	9.553788922	0.090984244	0.600084182	0	0	3.11710308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1403
H1951_017_0	2012	8	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery					Lab	Radiology	Mental Health	Renal Dialysis	Other						Coin	D	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	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	475.28	185.33	400.09	8287.68	500.19	13071.33	30432.15	1049.02	97.17	22.44	26.96	0.87	0.05	48.02	6462.85	9743.95	161.31	2167.9		1326	3176.03	0	4.98	3.82	3.2				4.84	1.8	128.29	797.18	298.43	0.02	104.78	182.98					3400	"8% Coins: 1a. 8% IP Acute - Facility 1,1a. 8% IP Acute - Physician"	"$0-$119.73/Day(Days 1-15): 1b. $119.73 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $0 (Days 8-20),  $0 (Days 21-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"5% Coins: 9a. 5% Surgery OP -- Physician,9a. 5% Surgery OP -- Facility"	5% Coins: 8a. 5% Lab -- OP	"5% Coins: 8b, 9a. 5% DMAM -- OP,8b, 9a. 5% Advanced Imaging -- OP,8b. 5% Radiology OP -- Physician,8b. 5% Radiology OP -- Facility"	5% Coins: 7h. 5% Psych -- OP	"5% Coins: 9a, 12. 5% Dialysis -- OP Hosp"	"5% Coins: 8b. 5% Nuclear Medicine,9a, 9c, 9d, 14d. 5% OP Other,8b. 5% Rad therapy,9a. 5% Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS766: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office"	$0/Visit: 5. $0 Partial Hospitalization	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0/Visit: 3. $0 Cardiac Rehab,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility"							0.08	102.865986	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	0.056232	72.304605	0	0	0	0	0	0	0.046216	0.046216	0.046216	0.046216	0.046216	0.046216	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0	0	0	0						26.7259	1.11668437	0	0	0	0	0	0	4.49080872	1.03708704	1.24598336	0.04020792	0.0023108	2.21929232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8783	0	NO	12.508341	26.7259	1.11668437	0	0	0	0	0	0	4.49080872	1.03708704	1.24598336	0.04020792	0.0023108	2.21929232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8783	NO																																																																																		0	0	NO	0	26.7259	1.11668437	0	0	0	0	0	0	4.49080872	1.03708704	1.24598336	0.04020792	0.0023108	2.21929232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8783
H1951_019_0	2012	5	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery					Lab	Radiology	Mental Health	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	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	YES	444.44	15.28	341.43	8074.29	555.88	17229.52	38125.11	982.41	72.19	18.03	18.97	0.6	0.1	19.5	7042.46	10827.99	167.51	2971.7		2079.05	3988.25	0	4.98	3.82	3.2		0.21		4.84	1.8	68.84	1133.92	235.68	0.06	36.81	355.15					3400	"8% Coins: 1a. 8% IP Acute - Facility 1,1a. 8% IP Acute - Physician"	"2% Coins: 1b. 2% IP Psych - Facility 1,1b. 2% IP Psych - Physician"	"$0/Day(Days 1-7), $0 (Days 8-20),  $0 (Days 21-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"5% Coins: 9a. 5% Surgery OP -- Physician,9a. 5% Surgery OP -- Facility"	5% Coins: 8a. 5% Lab -- OP	"5% Coins: 8b, 9a. 5% DMAM -- OP,8b, 9a. 5% Advanced Imaging -- OP,8b. 5% Radiology OP -- Physician,8b. 5% Radiology OP -- Facility"	5% Coins: 7h. 5% Psych -- OP	"5% Coins: 9a, 12. 5% Dialysis -- OP Hosp"	"5% Coins: 8b. 5% Nuclear Medicine,9a, 9c, 9d, 14d. 5% OP Other,8b. 5% Rad therapy,9a. 5% Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS766: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office"	$0/Visit: 5. $0 Partial Hospitalization	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0/Visit: 3. $0 Cardiac Rehab,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility"							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	0					NO	0.058955	0.014739	0	0	0	0	0	0	0.046985	0.046985	0.046985	0.046985	0.046985	0.046985	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0	0	0	0						26.202	0.22521192	0	0	0	0	0	0	3.39184715	0.84713955	0.89130545	0.028191	0.0046985	0.9162075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5066	0	NO	9.823669	26.202	0.22521192	0	0	0	0	0	0	3.39184715	0.84713955	0.89130545	0.028191	0.0046985	0.9162075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5066	NO																																																																																		0	0	NO	0	26.202	0.22521192	0	0	0	0	0	0	3.39184715	0.84713955	0.89130545	0.028191	0.0046985	0.9162075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5066
H1951_024_0	2012	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	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	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	2066.25	128.19	175.93	5120.28	251.33	17.98	8.28	469.68	82.3	17.28	24.96	0.85	0.12	20.31	3476.6	7451.8	42.81	4.01		1128.66	21.96	0			1.9				4.84	1.28	1732.52	109.23	139.92	359.89	658.02						6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 25% 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"	$65/Visit: 9a. $65 Observation	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	49.537808	0	200	0.2	0.2	65	0.239846	0.25	0.245453	0.203138	0.2	0.225753	15	34.617417	35	0.25		0	0.2	0			0				0	0	0	0	0	65	35						NO	148.199166	105.156668	43.905508	0	177.4266	0.177427	0.177427	57.663645	0.212775	0.221783	0.21775	0.18021	0.177427	0.200273	13.306995	30.710253	31.049655	0.221783		0	0.177427	0			0				0	0	0	0	0	57.663645	31.049655							25.518	1.123336106	0.643691335	0	3.716052282	3.19013746	1.46909556	2.256955065	17.5113825	3.83241024	5.43504	0.1531785	0.02129124	4.06754463	3.855258235	19.07055528	0.110769644	0.88934983	0	0	3.89629692	0	0	0	0	0	0	0	0	0	0	0	0	1.729380767	1.702607832	0	0	0	0	0	100.1924	0	NO	15.472418	25.518	1.123336106	0.643691335	0	3.716052282	3.19013746	1.46909556	2.256955065	17.5113825	3.83241024	5.43504	0.1531785	0.02129124	4.06754463	3.855258235	19.07055528	0.110769644	0.88934983	0	0	3.89629692	0	0	0	0	0	0	0	0	0	0	0	0	1.729380767	1.702607832	0	0	0	0	0	100.1924	NO																																																																																		0	0	NO	0	25.518	1.123336106	0.643691335	0	3.716052282	3.19013746	1.46909556	2.256955065	17.5113825	3.83241024	5.43504	0.1531785	0.02129124	4.06754463	3.855258235	19.07055528	0.110769644	0.88934983	0	0	3.89629692	0	0	0	0	0	0	0	0	0	0	0	0	1.729380767	1.702607832	0	0	0	0	0	100.1924
H1951_025_0	2012	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	O		V	V				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0										0	YES	1825.34	88.24	308.83	3470.33	195.52	11.92	1.56	415.33	438.37	1663.86	1018.22	123.07	0.26	522.74	4137.11	4538.1	49.28	730.75		2006.81	14.61	0		2.34	1.9				4.84	1.28	20146.36										4900	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												127.547103	112.005826	49.537808	0	200	0.2	0.2	65	250	0	81.540896	37.928725	0.2	53.283307	5	34.815598	35	15		0	0.2	0		0	0				0	0	0										NO	108.862218	95.597644	45.049782	0	183.7434	0.183743	0.183743	59.716605	229.67925	0	74.913008	34.845764	0.183743	48.95228	4.593585	31.985681	32.155095	13.780755		0	0.183743	0		0	0				0	0	0											16.5592	0.702961342	1.159393681	0	2.993792464	2.19021656	0.28663908	2.066841463	8.390374402	0	6.356493584	0.357372348	0.04777318	2.132442904	1.583680537	12.09618491	0.132050257	0.83919056	0	0	2.68448523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5791	0	NO	6.808387	16.5592	0.702961342	1.159393681	0	2.993792464	2.19021656	0.28663908	2.066841463	8.390374402	0	6.356493584	0.357372348	0.04777318	2.132442904	1.583680537	12.09618491	0.132050257	0.83919056	0	0	2.68448523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5791	NO																																																																																		0	0	NO	0	16.5592	0.702961342	1.159393681	0	2.993792464	2.19021656	0.28663908	2.066841463	8.390374402	0	6.356493584	0.357372348	0.04777318	2.132442904	1.583680537	12.09618491	0.132050257	0.83919056	0	0	2.68448523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5791
H1951_028_0	2012	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	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	1406.59	65.22	282.04	3920.8	215.39	12.95	2.02	388.42	487.31	2650.07	1381.66	116.7	0.26	791.13	3380.12	8289.55	52.31	1823.18		858.14	17.03	0		2.34	1.9		0.21		4.84	1.28	13799.33										6700	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-9): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS767: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												122.545317	108.634025	49.537808	0	200	0.2	0.2	65	100	0	28.006032	23.378273	0.2	34.590969	10	20	20	10		0	0.2	0		0	0		0		0	0	0										NO	114.792242	101.761076	48.036664	0	193.2852	0.193285	0.193285	62.81769	96.6426	0	27.065758	22.593371	0.193285	33.429612	9.66426	19.32852	19.32852	9.66426		0	0.193285	0		0	0		0		0	0	0											13.4555	0.553071448	1.129021726	0	3.469308269	2.50304075	0.3904357	2.033303929	3.924575451	0	3.116306267	0.219720533	0.0502541	2.203930745	2.722196543	13.35206108	0.08425624	1.468307129	0	0	3.29164355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9669	0	NO	2.330415	13.4555	0.553071448	1.129021726	0	3.469308269	2.50304075	0.3904357	2.033303929	3.924575451	0	3.116306267	0.219720533	0.0502541	2.203930745	2.722196543	13.35206108	0.08425624	1.468307129	0	0	3.29164355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9669	NO																																																																																		0	0	NO	0	13.4555	0.553071448	1.129021726	0	3.469308269	2.50304075	0.3904357	2.033303929	3.924575451	0	3.116306267	0.219720533	0.0502541	2.203930745	2.722196543	13.35206108	0.08425624	1.468307129	0	0	3.29164355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9669
H1951_030_0	2012	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	1576.68	82.8	282.05	4412.8	246.56	16.52	3.66	376.69	493.24	2077.51	1056.48	122.95	0.21	381.12	4105.26	9011.61	55.09	2041.98		1689.15	31.33	0		2.34	1.9		0.21		4.84	1.28	20488.31										6700	"$0-$35/Day(Days 1-10): 1a. $35 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$35/Day(Days 1-10): 1b. $35 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$15-$50/Visit: 5. $15 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$150/Visit: 3. $5 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$15/Visit: 7b. $15 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit: 7e, 7h. $15 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"15%-20% Coins: 15. 15%-20% Part B Rx,15. 15%-20% Part B Rx at Pharmacy,15. 15%-20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS767: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												28.593907	26.497518	49.537808	0	200	0.2	0.2	65	100	0	91.182932	18.644785	0.2	48.094573	5	15	15	5		0	0.161007	0		0	0		0		0	0	0										NO	28.106038	26.045418	49.155178	0	194.281	0.194281	0.194281	63.141325	97.1405	0	88.575556	18.111638	0.194281	46.719309	4.857025	14.571075	14.571075	4.857025		0	0.156403	0		0	0		0		0	0	0											3.6929	0.179713384	1.155351496	0	3.991826947	3.20952212	0.71106846	1.98205881	3.992798352	0	7.79819195	0.185568824	0.04079901	1.483805254	1.661612538	10.94240377	0.066893377	0.826495659	0	0	4.90010599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8211	0	NO	1.30649	3.6929	0.179713384	1.155351496	0	3.991826947	3.20952212	0.71106846	1.98205881	3.992798352	0	7.79819195	0.185568824	0.04079901	1.483805254	1.661612538	10.94240377	0.066893377	0.826495659	0	0	4.90010599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8211	NO																																																																																		0	0	NO	0	3.6929	0.179713384	1.155351496	0	3.991826947	3.20952212	0.71106846	1.98205881	3.992798352	0	7.79819195	0.185568824	0.04079901	1.483805254	1.661612538	10.94240377	0.066893377	0.826495659	0	0	4.90010599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8211
H1951_032_0	2012	4	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.80157333	0.243717518	0	2.228394541	0.372510276	0.895483719	0.074806896	0.001288953	0.389289695	1.060896878	2.554599047	0.026150856	0.46074692		0	0.935023038	0	0	0	0				0	0	0	0	0								10.0445	YES	427	16.67	23	7565.46	26.19	34.42	10.47	964.96	95.7	16	38.46	3.21	0.06	16.72	45.56	109.71	1.12	19.79		1801.79	40.16	0	4.98	3.82	1.9				1.34	1.28	2873.77	44.94	144.48								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0824	0.0824	0.2088	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.062531	0.062531	0.158399	0	0.171284	0.171284	0.171284	55.667235	0.171284	0.171284	0.171284	0.171284	0.171284	0.171284	0.171284	0.171284	0.171284	0.171284		0	0.171284	0	0	0	0				0	0	0	0	0									26.7007	1.04239177	3.643177	0	4.48592796	5.89559528	1.79334348	4.476387924	16.3918788	2.740544	6.58758264	0.54982164	0.01027704	2.86386848	7.80369904	18.79156764	0.19183808	3.38971036	0	0	6.87876544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2371	162	YES	23.864193	26.7007	1.04239177	3.643177	0	4.48592796	6.69716861	2.037060998	4.476387924	18.62027334	3.113054276	7.483066359	0.624628536	0.011565993	3.253158175	8.864595918	21.34616669	0.217988936	3.85045728	0	0	7.813788478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2816	NO																																																																																		0	0	NO	0	26.7007	1.04239177	3.643177	0	4.48592796	6.69716861	2.037060998	4.476387924	18.62027334	3.113054276	7.483066359	0.624628536	0.011565993	3.253158175	8.864595918	21.34616669	0.217988936	3.85045728	0	0	7.813788478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2816
H1951_033_0	2012	4	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.691055583	0.190510676	0	2.440644948	0.48552999	0.850833593	0.112304784	0	1.032297884	0.870429613	2.436623152	0.030439763	0.29812357		0	0.581266188	0	0	0	0				0	0	0	0	0								10.0201	YES	436.95	11.45	30.41	8024.25	20.18	28.69	7.91	1058.32	101.32	20.16	35.32	4.66	0	42.85	36.13	101.15	1.26	12.38		1285.17	24.13	0	4.98	3.82	1.9				1.34	1.28	3150.03	120.71	266.94								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.078	0.078	0.2131	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.059669	0.059669	0.155385	0	0.172174	0.172174	0.172174	55.95642	0.172174	0.172174	0.172174	0.172174	0	0.172174	0.172174	0.172174	0.172174	0.172174		0	0.172174	0	0	0	0				0	0	0	0	0									26.0724	0.68321005	4.72525785	0	3.47447132	4.93967206	1.36189634	4.934983201	17.44466968	3.47102784	6.08118568	0.80233084	0	7.3776559	6.22064662	17.4154001	0.21693924	2.13151412	0	0	4.15455862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5078	162	YES	22.908302	26.0724	0.68321005	4.72525785	0	3.47447132	5.630727643	1.552407016	4.934983201	19.88531463	3.95655783	6.932019273	0.914635624	0	8.409953784	7.091076233	19.85202325	0.247379003	2.42963769	0	0	4.735824808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5278	NO																																																																																		0	0	NO	0	26.0724	0.68321005	4.72525785	0	3.47447132	5.630727643	1.552407016	4.934983201	19.88531463	3.95655783	6.932019273	0.914635624	0	8.409953784	7.091076233	19.85202325	0.247379003	2.42963769	0	0	4.735824808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5278
H1951_034_0	2012	4	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.6921725	0.190818563	0	2.444589817	0.486314751	0.852208743	0.112486284	0	1.033966442	0.871836485	2.440561428	0.030488928	0.298605387		0	0.582205725	0	0	0	0				0	0	0	0	0								10.0363	YES	518.85	13.6	36.11	8560.81	23.96	34.06	9.39	1129.09	120.31	23.93	41.94	5.54	0	50.89	42.91	120.11	1.5	14.7		1371.1	28.65	0	4.98	3.82	1.9				1.34	1.28	3360.66	128.78	284.79								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0779	0.0779	0.2128	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.0556	0.0556	0.14074	0	0.166392	0.166392	0.166392	54.07753	0.166392	0.166392	0.166392	0.166392	0	0.166392	0.166392	0.166392	0.166392	0.166392		0	0.166392	0	0	0	0				0	0	0	0	0									28.8481	0.75616	5.0821214	0	3.98675232	5.66731152	1.56242088	5.088199862	20.01862152	3.98176056	6.97848048	0.92181168	0	8.46768888	7.13988072	19.98534312	0.249588	2.4459624	0	0	4.7671308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9473	162	YES	32.908551	28.8481	0.75616	5.0821214	0	3.98675232	6.35948402	1.753239443	5.088199862	22.46321134	4.468075311	7.830689223	1.034297964	0	9.501655322	8.011717205	22.42590455	0.280076928	2.744567787	0	0	5.349336525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9835	NO																																																																																		0	0	NO	0	28.8481	0.75616	5.0821214	0	3.98675232	6.35948402	1.753239443	5.088199862	22.46321134	4.468075311	7.830689223	1.034297964	0	9.501655322	8.011717205	22.42590455	0.280076928	2.744567787	0	0	5.349336525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9835
H1951_035_0	2012	4	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.787851061	0.30498806	0	2.291283811	0.406734779	0.713981618	0.094536265	0.005744843	1.431932641	1.363769458	2.144120038	0.025096135	0.103639759		0	0.416556201	0	0	0	0				0	0	0	0	0								10.0902	YES	442.74	4.85	45.03	8272.69	15.09	21.69	8.39	647.22	63.07	11.2	19.65	2.6	0.16	39.41	37.54	59.02	0.69	2.85		1653.31	11.47	0	4.32	3.82	1.9				1.34	1.28	2762.51	587.09	269.5								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS767: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0832	0.0832	0.2235	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.064687	0.064687	0.153378	0	0.179057	0.179057	0.179057	58.193655	0.179057	0.179057	0.179057	0.179057	0.179057	0.179057	0.179057	0.179057	0.179057	0.179057		0	0.179057	0	0	0	0				0	0	0	0	0									28.6395	0.31373195	6.90661134	0	2.70197013	3.88374633	1.50228823	3.138674782	11.29312499	2.0054384	3.51847005	0.4655482	0.02864912	7.05663637	6.72179978	10.56794414	0.12354933	0.51031245	0	0	2.05378379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4318	162	YES	17.943104	28.6395	0.31373195	6.90661134	0	2.70197013	4.671597391	1.80727629	3.138674782	13.5844088	2.412173179	4.232451668	0.560084465	0.034393963	8.488569011	8.085569238	12.71206418	0.148645465	0.613952209	0	0	2.470339991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.522	NO																																																																																		0	0	NO	0	28.6395	0.31373195	6.90661134	0	2.70197013	4.671597391	1.80727629	3.138674782	13.5844088	2.412173179	4.232451668	0.560084465	0.034393963	8.488569011	8.085569238	12.71206418	0.148645465	0.613952209	0	0	2.470339991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.522
H1951_801_0	2012	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	323.35	2.79	22.39	50.11	10.87	14.05	6.56	28.91	105.66	19.16	36.37	0.98	1.99	48.45	56.77	81.95	0.33	14.34		5.61	27.46	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																					0.0784	0.0784	0.2112	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.063361	0.063361	0.168729	0	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632	0.193632		0.193632	0.193632	0																				20.4878	0.17677719	3.77784231	0	2.10477984	2.7205296	1.27022592	5.59790112	20.45915712	3.70998912	7.04239584	0.18975936	0.38532768	9.3814704	10.99248864	15.8681424	0.06389856	2.77668288	0	1.08627552	5.31713472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4086	0	NO	19.808868	20.4878	0.17677719	3.77784231	0	2.10477984	2.7205296	1.27022592	5.59790112	20.45915712	3.70998912	7.04239584	0.18975936	0.38532768	9.3814704	10.99248864	15.8681424	0.06389856	2.77668288	0	1.08627552	5.31713472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4086	NO																																																																																		0	0	NO	0	20.4878	0.17677719	3.77784231	0	2.10477984	2.7205296	1.27022592	5.59790112	20.45915712	3.70998912	7.04239584	0.18975936	0.38532768	9.3814704	10.99248864	15.8681424	0.06389856	2.77668288	0	1.08627552	5.31713472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4086
H1951_804_0	2012	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	YES	323.35	2.79	22.39	50.11	10.87	14.05	6.56	28.91	105.66	19.16	36.37	0.98	1.99	48.45	56.77	81.95	0.33	14.34		5.61	27.46	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																					0.0812	0.0812	0.2164	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065239	0.065239	0.171445	0	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366		0.193366	0.193366	0																				21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596	0	NO	20.287381	21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596	NO																																																																																		0	0	NO	0	21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596
H1951_805_0	2012	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	YES	323.35	2.79	22.39	50.11	10.87	14.05	6.56	28.91	105.66	19.16	36.37	0.98	1.99	48.45	56.77	81.95	0.33	14.34		5.61	27.46	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																					0.0812	0.0812	0.2164	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065239	0.065239	0.171445	0	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366	0.193366		0.193366	0.193366	0																				21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596	0	NO	20.287381	21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596	NO																																																																																		0	0	NO	0	21.095	0.18201681	3.83865355	0	2.10188842	2.7167923	1.26848096	5.59021106	20.43105156	3.70489256	7.03272142	0.18949868	0.38479834	9.3685827	10.97738782	15.8463437	0.06381078	2.77286844	0	1.08478326	5.30983036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9596
H1961_001_0	2012	8																															A	A	A		T	Coin	Coin	V	V	V	V				V	V	V	V	V	V	Coin		T	V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	275.0286012	13.26640287	26.58211424	0	259.4508764	12.45194572	2.765078428	317.1729436	438.8052449	739.2459079	443.1310741	0	0	0	3523.242653	21188.15158	161.9971169	868.7547853	3025.051221	5002.988748	31.07348574	0	196.818591	1791.491624	144.2100255	0	0	0	0	0											6700	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1a	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1b	$0/Day for Days 1-7; $50/Day for Days 8-20; $100/Day for Days 21+; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"$0 for Diabetes Monitoring Supplies, 20% coinsurance for Prosthetic Devices/Other Medical Supplies; PBP 11b, 11c"	"$65/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"$100/Visit for Surgery; $100/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	20% coinsurance for OP Hosp Lab Services; PBP 8a	$100/Visit for Advanced Imaging; PBP 8b	No Cost Sharing;	10% coinsurance for Renal Dialysis Services; PBP 12	"No Cost Sharing; PBP 3, 9a"	"$5/Visit for Consults/Office Visits/Home Visits; PBP 7a, 14a-b"	"$20/Visit for Chiropractic Services; $20/Visit for Consults/Office Visits/Home Visits; $20/Visit for Podiatry Services; $20/Visit for Vision Exams; $20/Visit for Hearing Exams; Additional $10/Office Visit Radiology; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $20 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"$10/Visit for Occupational Therapy Services; $10/Visit for Physical and Speech Therapy; PBP 7c, 7i"	"$10/Office Visit for Radiology; PBP 7d, 8b, 14a-b"	"$20/Visit for Outpatient Surgery; Additional $10/Office Visit for Lab Services; PBP 7d, 8a-b, 14a, 14e"	"$50 copay per service for Chemo Drugs, 20% coinsurance for diabetes monitoring supplies, 0% for immunizations, 15% coinsurance for other Part B Rx; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	$5 / Trip; PBP 10b	"Varies by service; PBP 16a, 16b"	$20/visit for vision exams; PBP 17a-b				No Cost Sharing; PBP 14c												0	NO	243.5246554	243.5246554	685.6948229	0	100	0.2	0.2	62.90739736	100	10.31172099	100	0	0	0	5	6.937565128	20	10	2.334776182	1.677641414	0.126429508	0	5	19.65540079	20	0	0	0	0	0											NO	243.1364448	243.1364448	684.6017345	0	99.84058676	0.199681174	0.199681174	62.80711463	99.84058676	10.29528274	99.84058676	0	0	0	4.992029338	6.92650573	19.96811735	9.984058676	2.33105424	1.674967031	0.126227963	0	4.992029338	19.62406748	19.96811735	0	0	0	0	0												5.5725	0.268795502	1.51651346	0	2.158643978	2.486419134	0.552134105	1.660059785	3.650881094	0.634228803	3.686872204	0	0	0	1.465677557	12.22998778	0.269564787	0.722808229	0.587629873	0.698320101	3.922342803	0	0.081877015	2.929696043	0.239966893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3349	0	NO	0.072544854	5.5725	0.268795502	1.51651346	0	2.158643978	2.486419134	0.552134105	1.660059785	3.650881094	0.634228803	3.686872204	0	0	0	1.465677557	12.22998778	0.269564787	0.722808229	0.587629873	0.698320101	3.922342803	0	0.081877015	2.929696043	0.239966893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3349	NO	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1a	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1b	$0/Day for Days 1-7; $50/Day for Days 8-20; $100/Day for Days 21+; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"$0 for Diabetes Monitoring Supplies, 20% coinsurance for Prosthetic Devices/Other Medical Supplies; PBP 11b, 11c"	"$65/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"$100/Visit for Surgery; $100/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	20% coinsurance for OP Hosp Lab Services; PBP 8a	$100/Visit for Advanced Imaging; PBP 8b	No Cost Sharing;	10% coinsurance for Renal Dialysis Services; PBP 12	"No Cost Sharing; PBP 3, 9a"	"$5/Visit for Consults/Office Visits/Home Visits; PBP 7a, 14a-b"	"$20/Visit for Chiropractic Services; $20/Visit for Consults/Office Visits/Home Visits; $20/Visit for Podiatry Services; $20/Visit for Vision Exams; $20/Visit for Hearing Exams; Additional $10/Office Visit Radiology; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $20 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"$10/Visit for Occupational Therapy Services; $10/Visit for Physical and Speech Therapy; PBP 7c, 7i"	"$10/Office Visit for Radiology; PBP 7d, 8b, 14a-b"	"$20/Visit for Outpatient Surgery; Additional $10/Office Visit for Lab Services; PBP 7d, 8a-b, 14a, 14e"	"$50 copay per service for Chemo Drugs, 20% coinsurance for diabetes monitoring supplies, 0% for immunizations, 15% coinsurance for other Part B Rx; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	$5 / Trip; PBP 10b	"Varies by service; PBP 16a, 16b"	$20/visit for vision exams; PBP 17a-b				No Cost Sharing; PBP 14c													0.0123	0.0006	0.0033	0	0.0048	0.0055	0.0012	0.0037	0.0081	0.0014	0.0081	0	0	0	0.0032	0.027	0.0006	0.0016	0.0013	0.0015	0.0087	0	0.0002	0.0065	0.0005	0	0	0	0	0											0.1	0	NO	0	5.5847	0.269388414	1.519858596	0	2.163405531	2.491903696	0.553352007	1.663721557	3.658934234	0.63562779	3.695004734	0	0	0	1.46891056	12.25696477	0.270159395	0.724402605	0.588926071	0.699860461	3.930994735	0	0.08205762	2.936158388	0.240496213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4349
H1961_002_0	2012	7																															A	A	A		T	Coin	Coin	V	V	V	V				V	V	V	V	V	V	Coin		T	V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	270.162915	10.97509073	22.00404448	0	221.3404161	11.33395585	2.500197376	311.9989748	517.4219949	1665.683538	461.6530907	0	0	0	3611.586405	14550.58638	122.4093796	923.497592	2683.592464	7368.89395	34.78830638	0	104.8086244	1652.247176	130.8049023	0	0	0	0	0											6700	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1a	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1b	$0/Day for Days 1-7; $50/Day for Days 8-20; $100/Day for Days 21+; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"$0 for Diabetes Monitoring Supplies, 20% coinsurance for Prosthetic Devices/Other Medical Supplies; PBP 11b, 11c"	"$65/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"$100/Visit for Surgery; $100/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	20% coinsurance for OP Hosp Lab Services; PBP 8a	$100/Visit for Advanced Imaging; PBP 8b	No Cost Sharing;	10% coinsurance for Renal Dialysis Services; PBP 12	"No Cost Sharing; PBP 3, 9a"	"$5/Visit for Consults/Office Visits/Home Visits; PBP 7a, 14a-b"	"$20/Visit for Chiropractic Services; $25/Visit for Consults/Office Visits/Home Visits; $25/Visit for Podiatry Services; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; Additional $10/Office Visit Radiology; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $25 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"$10/Visit for Occupational Therapy Services; $10/Visit for Physical and Speech Therapy; PBP 7c, 7i"	"$10/Office Visit for Radiology; PBP 7d, 8b, 14a-b"	"$25/Visit for Outpatient Surgery; Additional $10/Office Visit for Lab Services; PBP 7d, 8a-b, 14a, 14e"	"$50 copay per service for Chemo Drugs, 20% coinsurance for diabetes monitoring supplies, 0% for immunizations, 15% coinsurance for other Part B Rx; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	$5 / Trip; PBP 10b	"Varies by service; PBP 16a, 16b"	$25/visit for vision exams; PBP 17a-b				No Cost Sharing; PBP 14c												0	NO	241.7858453	241.7858453	542.3076923	0	100	0.2	0.2	63.5074727	100	7.765472356	99.8611287	0	0	0	5	11.46013148	25	10	3.141505534	2.573653453	0.142020896	0	5	19.13965898	25	0	0	0	0	0											NO	241.2982899	241.2982899	541.2141419	0	99.7983524	0.199596705	0.199596705	63.3794114	99.7983524	7.749813467	99.65976113	0	0	0	4.98991762	11.4370224	24.9495881	9.97983524	3.135170764	2.568463742	0.141734514	0	4.98991762	19.10106432	24.9495881	0	0	0	0	0												5.4325	0.220689219	0.992408338	0	1.840784071	2.262220241	0.499031158	1.647859282	4.303155215	1.07572806	3.834019729	0	0	0	1.50179322	13.86794853	0.2545053	0.768029484	0.701126719	1.577228078	4.93070369	0	0.0435822	2.629973299	0.271960703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6552	0	NO	0.098310353	5.4325	0.220689219	0.992408338	0	1.840784071	2.262220241	0.499031158	1.647859282	4.303155215	1.07572806	3.834019729	0	0	0	1.50179322	13.86794853	0.2545053	0.768029484	0.701126719	1.577228078	4.93070369	0	0.0435822	2.629973299	0.271960703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6552	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	20% Coinsurance; PBP 2	20% Coinsurance; PBP 6	$100/Trip; PBP 10a	20% Coinsurance; PBP 11a	"20% Coinsurance; PBP 11b, 11c"	"$65/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"20% Coinsurance; PBP 9a, 9b"	20% Coinsurance; PBP 8a	20% Coinsurance; PBP 8b	20% Coinsurance;	20% Coinsurance; PBP 12	"20% Coinsurance; PBP 3, 9a"	"20% Coinsurance; PBP 7a, 14a-b"	"20% Coinsurance; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"20% Coinsurance; PBP 5, 7e, 7h, 9c"	"20% Coinsurance; PBP 7c, 7i"	"20% Coinsurance; PBP 7d, 8b, 14a-b"	"20% Coinsurance; PBP 7d, 8a-b, 14a, 14e"	"20% Coinsurance; PBP 11c, 14b, 15"	"20% Coinsurance; PBP 9d, 14a, 14d"		"Varies by service; PBP 16a, 16b"																		0.1588	0	0	0.0175	0	0.3359	0.2074	0.0035	0.4176	0.0334	0.1502	0	0.0037	0.0559	0.2966	0.7764	0.003	0.3771	0.175	0.7754	0.0719	0	0	0	0	0	0	0	0	0											3.8591	0	NO	2.66E-15	5.5913	0.220689219	0.992408338	0.017519707	1.840784071	2.598108073	0.706454796	1.651324066	4.720764417	1.109133686	3.984191771	0	0.003715481	0.055906973	1.798343349	14.64434255	0.257464385	1.145093922	0.876138635	2.35258802	5.002608906	0	0.0435822	2.629973299	0.271960703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5144
H1961_003_0	2012	7																																			T			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	0	0	0	0	337.7088939	0	0	506.5435099	0	0	0	0	0	0	0	0	226.4046559	0	0	0	0	0	0	1196.353335	0	0	0	50.2	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$25/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for Emergency Care / Post Stabilization 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, 9a"	"No Cost Sharing; PBP 7a, 14a-b"	"No Cost Sharing; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $10 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 8b, 14a-b"	"No Cost Sharing; PBP 7d, 8a-b, 14a, 14e"	"No Cost Sharing; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"Varies by service; PBP 16a, 16b"	No Cost Sharing; PBP 17a-b			"Hearing Aids $25 Copay, $500/year benefit max; PBP 18b"	No Cost Sharing; PBP 14c												0	NO	0	0	0	0	25	0	0	50	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	18.28137036	0	0	0	25	0	0											NO	0	0	0	0	25	0	0	50	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	18.28137036	0	0	0	25	0	0												0	0	0	0	0.703560196	0	0	2.110597958	0	0	0	0	0	0	0	0	0.188670547	0	0	0	0	0	0	1.822581532	0	0	0	0.104583333	0	0	0	0	0	0	0	0	0	0	0	0	4.93	0	NO	8.88E-16	0	0	0	0	0.703560196	0	0	2.110597958	0	0	0	0	0	0	0	0	0.188670547	0	0	0	0	0	0	1.822581532	0	0	0	0.104583333	0	0	0	0	0	0	0	0	0	0	0	0	4.93	NO	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$25/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for Emergency Care / Post Stabilization 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, 9a"	"No Cost Sharing; PBP 7a, 14a-b"	"No Cost Sharing; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $10 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 8b, 14a-b"	"No Cost Sharing; PBP 7d, 8a-b, 14a, 14e"	"No Cost Sharing; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"Varies by service; PBP 16a, 16b"	No Cost Sharing; PBP 17a-b			"Hearing Aids $25 Copay, $500/year benefit max; PBP 18b"	No Cost Sharing; PBP 14c													0	0	0	0	0.0171	0	0	0.0514	0	0	0	0	0	0	0	0	0.0046	0	0	0	0	0	0	0.027	0	0	0	0	0	0											0.1	0	NO	0	0	0	0	0	0.720615927	0	0	2.162	0	0	0	0	0	0	0	0	0.193244305	0	0	0	0	0	0	1.84955	0	0	0	0.104583333	0	0	0	0	0	0	0	0	0	0	0	0	5.03
H1961_007_0	2012	7																															A	A	A		T	Coin	Coin	V	V	V	V				V	V	V	V	V	V	Coin		T	V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	328.0190752	10.14295061	19.30229643	0	241.8157083	15.31563216	5.450242812	368.6401992	566.9628312	1780.717009	558.0642594	0	0	0	4075.628013	15944.10501	123.9354303	807.4879034	3752.296718	8591.198497	43.21087651	0	69.37012298	1530.758404	236.890543	0	0	0	0	0											6700	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1a	$50/ Day for Days 1-10; $0/Day for Days 11+; PBP 1b	$0/Day for Days 1-7; $50/Day for Days 8-20; $100/Day for Days 21+; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"$0 for Diabetes Monitoring Supplies, 20% coinsurance for Prosthetic Devices/Other Medical Supplies; PBP 11b, 11c"	"$50/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"$50/Visit for Surgery; $50/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	20% coinsurance for OP Hosp Lab Services; PBP 8a	$75/Visit for Advanced Imaging; PBP 8b	No Cost Sharing;	10% coinsurance for Renal Dialysis Services; PBP 12	"No Cost Sharing; PBP 3, 9a"	"$5/Visit for Consults/Office Visits/Home Visits; PBP 7a, 14a-b"	"$15/Visit for Chiropractic Services; $15/Visit for Consults/Office Visits/Home Visits; $15/Visit for Podiatry Services; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; Additional $10/Office Visit Radiology; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"Outpatient Mental Health and Substance Abuse (including Partial Hospitalization) $15 / Visit for visits 1-20, 45% coinsurance for visits 21+; PBP 5, 7e, 7h, 9c"	"$10/Visit for Occupational Therapy Services; $10/Visit for Physical and Speech Therapy; PBP 7c, 7i"	"$10/Office Visit for Radiology; PBP 7d, 8b, 14a-b"	"$15/Visit for Outpatient Surgery; Additional $10/Office Visit for Lab Services; PBP 7d, 8a-b, 14a, 14e"	"$50 copay per service for Chemo Drugs, 20% coinsurance for diabetes monitoring supplies, 0% for immunizations, 15% coinsurance for other Part B Rx; PBP 11c, 14b, 15"	"No Cost Sharing; PBP 9d, 14a, 14d"	$5 / Trip; PBP 10b	"Varies by service; PBP 16a, 16b"	$15/visit for vision exams; PBP 17a-b				No Cost Sharing; PBP 14c												0	NO	241.7858453	241.7858453	542.3076923	0	100	0.2	0.2	49.62738202	50	10.00645963	75	0	0	0	5	7.974285843	15	10	2.353257943	2.215677967	0.140264462	0	5	19.38573482	15	0	0	0	0	0											NO	241.3484052	241.3484052	541.3265469	0	99.81907956	0.199638159	0.199638159	49.53759595	49.90953978	9.988355899	74.86430967	0	0	0	4.990953978	7.95985873	14.97286193	9.981907956	2.349000418	2.211669353	0.140010695	0	4.990953978	19.35066206	14.97286193	0	0	0	0	0												6.5972	0.203998746	0.870737123	0	2.011485119	3.05758461	1.088076442	1.52179577	2.358071165	1.482202936	3.481591295	0	0	0	1.695105987	10.57606862	0.154639007	0.671689161	0.734512213	1.583407535	6.049984849	0	0.028851924	2.468432381	0.29557745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9311	0	NO	0.085061758	6.5972	0.203998746	0.870737123	0	2.011485119	3.05758461	1.088076442	1.52179577	2.358071165	1.482202936	3.481591295	0	0	0	1.695105987	10.57606862	0.154639007	0.671689161	0.734512213	1.583407535	6.049984849	0	0.028851924	2.468432381	0.29557745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9311	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	20% Coinsurance; PBP 2	20% Coinsurance; PBP 6	$100/Trip; PBP 10a	20% Coinsurance; PBP 11a	"20% Coinsurance; PBP 11b, 11c"	"$50/Visit for Emergency Care / Post Stabilization Care; $25/Visit for Urgently Needed Care / Urgent Care Centers; PBP 4a, 4b"	"20% Coinsurance; PBP 9a, 9b"	20% Coinsurance; PBP 8a	20% Coinsurance; PBP 8b	20% Coinsurance;	20% Coinsurance; PBP 12	"20% Coinsurance; PBP 3, 9a"	"20% Coinsurance; PBP 7a, 14a-b"	"20% Coinsurance; PBP 7b, 7d, 7f, 8a-b, 14a-b, 17a, 18a"	"20% Coinsurance; PBP 5, 7e, 7h, 9c"	"20% Coinsurance; PBP 7c, 7i"	"20% Coinsurance; PBP 7d, 8b, 14a-b"	"20% Coinsurance; PBP 7d, 8a-b, 14a, 14e"	"20% Coinsurance; PBP 11c, 14b, 15"	"20% Coinsurance; PBP 9d, 14a, 14d"		"Varies by service; PBP 16a, 16b"																		0.3323	0	0	0.0506	0	0.3691	0.1444	0.0009	0.1954	0.0253	0.0957	0	0.0014	0.0361	0.206	0.9156	0.0011	0.4042	0.1272	1.5739	0.0655	0	0	0	0	0	0	0	0	0											4.5446	0	NO	8.88E-16	6.9295	0.203998746	0.870737123	0.050640821	2.011485119	3.426659966	1.232509552	1.522732707	2.553439049	1.507528536	3.577263447	0	0.001364452	0.036083053	1.901062299	11.49164954	0.155725684	1.075864338	0.861758111	3.15731308	6.115469464	0	0.028851924	2.468432381	0.29557745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4757
H1961_801_0	2012	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	237.2506343	4.659638835	13.25081273	0	8.891990405	9.702176168	5.035284185	7.952924398	62.32418287	5.38580084	32.41378337	0	0.061109769	18.55251815	34.39422403	85.27622315	3.33800545	9.820961754	22.28956556	58.9792384	40.61820796	1.295882205	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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																			0	NO	0.079042304	0.079042304	0.210308143	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078714878	0.078714878	0.209436961	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0	0	0	0	0	0	0												18.6752	0.366782904	2.775209953	0	1.98355498	2.16428482	1.123231421	1.774075553	13.9027864	1.201421908	7.230610752	0	0.013631885	4.138549198	7.672391811	19.02274625	0.744615888	2.19078257	4.972180216	13.15662261	9.060788981	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4585	0	NO	0.467786641	18.6752	0.366782904	2.775209953	0	1.98355498	2.16428482	1.123231421	1.774075553	13.9027864	1.201421908	7.230610752	0	0.013631885	4.138549198	7.672391811	19.02274625	0.744615888	2.19078257	4.972180216	13.15662261	9.060788981	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4585	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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																				0.1343	0	0	0	0.0055	0.248	0.1612	0.0013	0.2915	0.0257	0.0988	0	0.002	0.0464	0.2586	0.7338	0.0016	0.3106	0.1872	1.0091	0.0614	0	0	0	0	0	0	0	0	0											3.5773	0	NO	4.44E-16	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358
H1961_802_0	2012	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	237.2506343	4.659638835	13.25081273	0	8.891990405	9.702176168	5.035284185	7.952924398	62.32418287	5.38580084	32.41378337	0	0.061109769	18.55251815	34.39422403	85.27622315	3.33800545	9.820961754	22.28956556	58.9792384	40.61820796	1.295882205	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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																			0	NO	0.079042304	0.079042304	0.210308143	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078714878	0.078714878	0.209436961	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0	0	0	0	0	0	0												18.6752	0.366782904	2.775209953	0	1.98355498	2.16428482	1.123231421	1.774075553	13.9027864	1.201421908	7.230610752	0	0.013631885	4.138549198	7.672391811	19.02274625	0.744615888	2.19078257	4.972180216	13.15662261	9.060788981	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4585	0	NO	0.467786641	18.6752	0.366782904	2.775209953	0	1.98355498	2.16428482	1.123231421	1.774075553	13.9027864	1.201421908	7.230610752	0	0.013631885	4.138549198	7.672391811	19.02274625	0.744615888	2.19078257	4.972180216	13.15662261	9.060788981	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4585	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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																				0.1343	0	0	0	0.0055	0.248	0.1612	0.0013	0.2915	0.0257	0.0988	0	0.002	0.0464	0.2586	0.7338	0.0016	0.3106	0.1872	1.0091	0.0614	0	0	0	0	0	0	0	0	0											3.5773	0	NO	4.44E-16	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358
H1961_803_0	2012	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	238.9569977	4.659638835	13.25081273	0	8.916714928	10.81410505	5.757992284	7.958632	63.63102234	5.501224895	32.8568743	0	0.070178628	18.76059565	35.55333832	88.56567903	3.345228073	11.21331864	23.1287901	63.50310605	40.89367251	1.295882205																			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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																			0	NO	0.079042304	0.079042304	0.210308143	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078714878	0.078714878	0.209436961	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0	0	0	0	0	0	0												18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358	0	NO	0.467786641	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358	NO																																																																																		0	0	NO	4.44E-16	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358
H1961_804_0	2012	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	238.9569977	4.659638835	13.25081273	0	8.916714928	10.81410505	5.757992284	7.958632	63.63102234	5.501224895	32.8568743	0	0.070178628	18.76059565	35.55333832	88.56567903	3.345228073	11.21331864	23.1287901	63.50310605	40.89367251	1.295882205																			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, 9a, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 5, 7e, 7h, 9c"	"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 11c, 15"	"Medicare-FFS Cost Sharing; PBP 7g, 14a"																			0	NO	0.079042304	0.079042304	0.210308143	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078714878	0.078714878	0.209436961	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0.223072101	0	0	0	0	0	0	0	0												18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358	0	NO	0.467786641	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358	NO																																																																																		0	0	NO	4.44E-16	18.8095	0.366782904	2.775209953	0	1.989070331	2.412325132	1.284447435	1.77534876	14.19430583	1.227169794	7.329451976	0	0.015654894	4.184965484	7.930957871	19.75653208	0.746227054	2.501378546	5.159387797	14.16577128	9.122237437	0.289075166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0358
H2001_001_0	2012	6																															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	870.6696755	153.5120193	467.3174878	375.5412719	128.0171345	5.979277079	7.397152641	277.1301044	43.53872266	15.03691969	21.94626641	0	0.006713278	30.87189541	4562.288679	2343.981239	665.8701269	752.5713097	0	0	7.658272584	658.18115	0	0	36.23054225	0	7.353342291	10.659	102.1170597	0											3975	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	61.00117515	0	200	0.2	0.093747311	63.87954433	0.16	0.169723799	0.180094084	0	0.2	0.145566385	3.118054072	32.98091367	38.5	35	0	0	0.2	34.27895251	0	0	35	0	35	0	0	0											NO	153.2145214	81.81149438	49.94840391	0	163.7621039	0.163762104	0.076761284	52.32430953	0.131009683	0.138971632	0.14746293	0	0.163762104	0.119191288	3.027106406	32.02065963	37.37702873	33.97911703	0	0	0.163762104	28.06796691	0	0	35	0	35	0	0	0												11.1166	1.046587309	1.945146886	0	1.747029607	0.979178994	0.567814936	1.20838678	5.703994259	2.089705266	3.236260757	0	0.001099381	3.679660964	1.150877774	6.254652119	2.074020572	2.130975717	0	0	1.254134831	1.539483895	0	0	0.105672415	0	0.021447248	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8527	0	NO	8.339627186	11.1166	1.046587309	1.945146886	0	1.747029607	0.979178994	0.567814936	1.20838678	5.703994259	2.089705266	3.236260757	0	0.001099381	3.679660964	1.150877774	6.254652119	2.074020572	2.130975717	0	0	1.254134831	1.539483895	0	0	0.105672415	0	0.021447248	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8527	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9375	0.5793	0.0433	0.1323	0.2076	0.2611	0.3658	0.2715	0.1806	1.2785	0.3123	0.7014	0	0.0002	0.8235	1.8026	2.0827	0.5858	0.685	0	0	0.4703	0.4931	0	0	0.034	0	0.0069	0	0	0											11.3177	0	NO	1.506014569	11.6959	1.089878231	2.077472859	0.20761244	2.008080008	1.344964251	0.839329636	1.388950322	6.98247573	2.401960076	3.937698705	0	0.001263656	4.503166234	2.953452387	8.337375563	2.659864045	2.815932198	0	0	1.724435392	2.032613405	0	0	0.139638548	0	0.028341007	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1704
H2012_001_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1112.24	66.9	294.76	1014.32	156.83	17.95	5.7	418.57	319.92	1274.29	862.43	82.4	0.36	582.39	4217.42	3658.1	62.91	515.9		1916.45	21.03	0			0.6				3.93	1.19	1060.02										3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												94.379572	77.573765	44.329117	5	100	0.2	0.2	65	150	0	39.95587	36.857055	0.2	40.201608	5	34.07387	35	35		0	0.2	0			0				0	0	0										NO	83.728177	68.819022	41.007846	4.583865	91.6773	0.183355	0.183355	59.590245	137.51595	0	36.630463	33.789553	0.183355	36.855749	4.583865	31.238004	32.087055	32.087055		0	0.183355	0			0				0	0	0											7.7605	0.383666048	1.007289391	0.387458829	1.198145913	3.29122225	1.0451235	2.078557404	3.666175227	0	2.63260085	0.232021597	0.0660078	1.788701638	1.611006994	9.522645203	0.168216386	1.379475973	0	0	3.85595565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0748	0	NO	4.106588	7.7605	0.383666048	1.007289391	0.387458829	1.198145913	3.29122225	1.0451235	2.078557404	3.666175227	0	2.63260085	0.232021597	0.0660078	1.788701638	1.611006994	9.522645203	0.168216386	1.379475973	0	0	3.85595565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0748	NO																																																																																		0	0	NO	0	7.7605	0.383666048	1.007289391	0.387458829	1.198145913	3.29122225	1.0451235	2.078557404	3.666175227	0	2.63260085	0.232021597	0.0660078	1.788701638	1.611006994	9.522645203	0.168216386	1.379475973	0	0	3.85595565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0748
H2012_002_0	2012	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	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	1410.48	76.85	428.01	1975.82	241.64	12.64	1.5	454.39	267	484.4	951.45	69.6	0.4	288.12	3809.71	3482.4	56.84	506.06		1878.27	21.75	0		2.27	0.6				3.47	1.15	9958.28										4900	"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												148.989465	124.806492	34.03605	0	200	0.2	0.2	65	225	0	61.570066	36.614169	0.2	52.907656	10	34.647919	35	10		0	0.2	0		0	0				0	0	0										NO	130.499873	109.318006	31.576231	0	187.2706	0.187271	0.187271	60.862945	210.679425	0	57.651316	34.283787	0.187271	49.540242	9.36353	32.442683	32.772355	9.36353		0	0.187271	0		0	0				0	0	0											15.339	0.70009073	1.126245219	0	3.771005649	2.36710544	0.2809065	2.304626132	4.687617206	0	4.571028717	0.198845965	0.0749084	1.18946121	2.97269449	9.414866607	0.155231722	0.394875666	0	0	4.07314425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6216	0	NO	4.838376	15.339	0.70009073	1.126245219	0	3.771005649	2.36710544	0.2809065	2.304626132	4.687617206	0	4.571028717	0.198845965	0.0749084	1.18946121	2.97269449	9.414866607	0.155231722	0.394875666	0	0	4.07314425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6216	NO																																																																																		0	0	NO	0	15.339	0.70009073	1.126245219	0	3.771005649	2.36710544	0.2809065	2.304626132	4.687617206	0	4.571028717	0.198845965	0.0749084	1.18946121	2.97269449	9.414866607	0.155231722	0.394875666	0	0	4.07314425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6216
H2012_003_0	2012	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	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	1356.62	71.39	269.59	1556.71	206.82	13.35	0.69	352.23	364.92	878.27	918.36	44.05	3.28	373.33	3827.99	4603.17	43.43	986.43		2178.76	18.68	0			0.6				3.47	1.15	16550.56										3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												94.379573	77.573765	57.180564	0	200	0.2	0.2	65	175	0	63.022412	36.300649	0.2	40.56285	10	34.627697	35	10		0	0.2	0			0				0	0	0										NO	80.798258	66.410822	51.14487	0	179.434	0.179434	0.179434	58.31605	157.00475	0	56.541817	32.567853	0.179434	36.391772	8.9717	31.066931	31.40095	8.9717		0	0.179434	0			0				0	0	0											9.1344	0.395089049	1.149012125	0	3.09254499	2.3954439	0.12380946	1.711721858	4.774514448	0	4.327145255	0.11955116	0.58854352	1.132178353	2.861964824	11.91719706	0.113645272	0.737496169	0	0	3.35182712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9261	0	NO	6.006456	9.1344	0.395089049	1.149012125	0	3.09254499	2.3954439	0.12380946	1.711721858	4.774514448	0	4.327145255	0.11955116	0.58854352	1.132178353	2.861964824	11.91719706	0.113645272	0.737496169	0	0	3.35182712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9261	NO																																																																																		0	0	NO	0	9.1344	0.395089049	1.149012125	0	3.09254499	2.3954439	0.12380946	1.711721858	4.774514448	0	4.327145255	0.11955116	0.58854352	1.132178353	2.861964824	11.91719706	0.113645272	0.737496169	0	0	3.35182712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9261
H2012_006_0	2012	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	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	1437.14	57.66	500.99	2384.67	238.79	13.14	1.83	361.67	283.22	593	1232.64	93.43	0.49	3.9	4162.99	4348.68	86.02	680.15		1865.99	26.56	0			0.6				1.34	0.81	10919.42	337.54									3900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	38.216144	0	200	0.2	0.2	65	195	0	70.110629	36.632192	0.2	0.2	15	34.644863	35	15		0	0.2	0			0				0	0	0	53.918697									NO	116.24315	102.079229	32.888087	0	177.616	0.177616	0.177616	57.7252	173.1756	0	62.263848	32.532317	0.177616	0.177616	13.3212	30.76741	31.0828	13.3212		0	0.177616	0			0				0	0	0	47.884117										13.9215	0.490490695	1.373050226	0	3.534410387	2.33387424	0.32503728	1.739789424	4.087232786	0	6.395742467	0.253291198	0.08703184	0.6927024	4.621335199	11.14980171	0.222811871	0.755034515	0	0	4.71748096	0	0	0	0	0	0	0	0	0	0	1.346900404	0	0	0	0	0	0	0	0	58.0475	0	NO	8.757284	13.9215	0.490490695	1.373050226	0	3.534410387	2.33387424	0.32503728	1.739789424	4.087232786	0	6.395742467	0.253291198	0.08703184	0.6927024	4.621335199	11.14980171	0.222811871	0.755034515	0	0	4.71748096	0	0	0	0	0	0	0	0	0	0	1.346900404	0	0	0	0	0	0	0	0	58.0475	NO																																																																																		0	0	NO	0	13.9215	0.490490695	1.373050226	0	3.534410387	2.33387424	0.32503728	1.739789424	4.087232786	0	6.395742467	0.253291198	0.08703184	0.6927024	4.621335199	11.14980171	0.222811871	0.755034515	0	0	4.71748096	0	0	0	0	0	0	0	0	0	0	1.346900404	0	0	0	0	0	0	0	0	58.0475
H2012_007_0	2012	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			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	1226.93	77.16	319.97	1504.2	236.82	12.98	2.15	414.46	312.5	1054.72	1109.57	86.06	0.31	10.87	4485.19	4040.6	90.82	638.07		2035.35	17.39	0			0.6				4.09	0.81	7557.67	303.53									3900	"$0-$150/Day(Days 1-7): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-7): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	"$5-$150/Visit: 3. $5 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											109.326089	96.004994	34.03605	0	200	0.2	0.2	65	195	0	62.273043	33.052076	0.2	0.2	5	29.829132	30	5		0	0.2	0			0				0	0	0	59.868805									NO	96.350503	84.610449	31.582425	0	183.6568	0.183657	0.183657	59.68846	179.06538	0	57.184339	30.351193	0.183657	0.183657	4.59142	27.391614	27.54852	4.59142		0	0.183657	0			0				0	0	0	54.976566										9.8513	0.544045187	0.842119044	0	3.624466948	2.38386786	0.39486255	2.061539928	4.663160938	0	5.287502252	0.217668639	0.05693367	1.99635159	1.716115922	9.223212961	0.208496382	0.24413728	0	0	3.19379523	0	0	0	0	0	0	0	0	0	0	1.390586423	0	0	0	0	0	0	0	0	47.9001	0	NO	4.72793	9.8513	0.544045187	0.842119044	0	3.624466948	2.38386786	0.39486255	2.061539928	4.663160938	0	5.287502252	0.217668639	0.05693367	1.99635159	1.716115922	9.223212961	0.208496382	0.24413728	0	0	3.19379523	0	0	0	0	0	0	0	0	0	0	1.390586423	0	0	0	0	0	0	0	0	47.9001	NO																																																																																		0	0	NO	0	9.8513	0.544045187	0.842119044	0	3.624466948	2.38386786	0.39486255	2.061539928	4.663160938	0	5.287502252	0.217668639	0.05693367	1.99635159	1.716115922	9.223212961	0.208496382	0.24413728	0	0	3.19379523	0	0	0	0	0	0	0	0	0	0	1.390586423	0	0	0	0	0	0	0	0	47.9001
H2012_008_0	2012	8	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	Coin	T	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									0	YES	1378.17	69.22	502.03	1762.38	7.16	8.04	2.89	403.25	194.67	999.65	848.67	59.28	0.28	2.22	4001.9	2876.24	103.57	446.72		1743.81	16.37	0	2.75	3.08	2.5		0.24		3.55	1.28	455.88	263.95									3400	"$0-$215/Day(Days 1-7): 1a. $215 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$215/Day(Days 1-6): 1b. $215 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$35/Visit: 7b. $0 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"VIS735: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											156.700727	125.565605	44.690621	0	0.2	0.2	0.2	65	205.170303	41.45953	81.988241	37.292004	0.199628	0.2	0	34.364767	35	38.160641		0	0.2	0	0	0	0		0		0	0	0	71.019077									NO	125.609422	100.651882	37.252806	0	0.179991	0.179991	0.179991	58.49701	184.643835	37.31167	73.785646	33.561088	0.179656	0.179991	0	30.92671	31.49839	34.342822		0	0.179991	0	0	0	0		0		0	0	0	63.913903										14.4259	0.580593606	1.558502183	0	1.28873556	1.44712764	0.52017399	1.965743274	2.995384613	3.108217576	5.218305349	0.165791775	0.05030368	0.39958002	0	7.412720031	0.271857354	1.278468787	0	0	2.94645267	0	0	0	0	0	0	0	0	0	0	1.405839558	0	0	0	0	0	0	0	0	47.0397	0	NO	7.413486	14.4259	0.580593606	1.558502183	0	1.28873556	1.44712764	0.52017399	1.965743274	2.995384613	3.108217576	5.218305349	0.165791775	0.05030368	0.39958002	0	7.412720031	0.271857354	1.278468787	0	0	2.94645267	0	0	0	0	0	0	0	0	0	0	1.405839558	0	0	0	0	0	0	0	0	47.0397	NO																																																																																		0	0	NO	0	14.4259	0.580593606	1.558502183	0	1.28873556	1.44712764	0.52017399	1.965743274	2.995384613	3.108217576	5.218305349	0.165791775	0.05030368	0.39958002	0	7.412720031	0.271857354	1.278468787	0	0	2.94645267	0	0	0	0	0	0	0	0	0	0	1.405839558	0	0	0	0	0	0	0	0	47.0397
H2012_009_0	2012	14	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	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	1331.6	98.74	514.64	1880.73	8.65	10.6	3.41	392.79	277.92	1182.89	1046.68	91.66	0.31	3.55	4025.19	3385.8	76.78	450.5		2119.84	22.83	0		2.59	2.5				4.32	1.28	550.46	427.56									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS735: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	197.445644	27.141583	80.51126	36.458201	0.199618	0.2	10	34.67235	35	40.406765		0	0.2	0		0	0				0	0	0	98.171657									NO	133.0393	106.605505	29.302861	0	0.178256	0.178256	0.178256	57.93307	175.978959	24.190695	71.757914	32.494393	0.177915	0.178256	8.91278	30.902703	31.19473	36.013661		0	0.178256	0		0	0				0	0	0	87.498238										14.7629	0.87718563	1.256702032	0	1.5419144	1.8895136	0.60785296	1.896294214	4.07567269	2.384577601	6.258964452	0.248203005	0.05515365	0.6328088	2.989636077	8.719197651	0.199594281	1.352012857	0	0	4.06958448	0	0	0	0	0	0	0	0	0	0	3.11756222	0	0	0	0	0	0	0	0	56.9354	0	NO	8.725431	14.7629	0.87718563	1.256702032	0	1.5419144	1.8895136	0.60785296	1.896294214	4.07567269	2.384577601	6.258964452	0.248203005	0.05515365	0.6328088	2.989636077	8.719197651	0.199594281	1.352012857	0	0	4.06958448	0	0	0	0	0	0	0	0	0	0	3.11756222	0	0	0	0	0	0	0	0	56.9354	NO																																																																																		0	0	NO	0	14.7629	0.87718563	1.256702032	0	1.5419144	1.8895136	0.60785296	1.896294214	4.07567269	2.384577601	6.258964452	0.248203005	0.05515365	0.6328088	2.989636077	8.719197651	0.199594281	1.352012857	0	0	4.06958448	0	0	0	0	0	0	0	0	0	0	3.11756222	0	0	0	0	0	0	0	0	56.9354
H2012_011_0	2012	12	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	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	1514.78	60.77	528.06	2513.5	8.89	13.06	3.72	381.21	298.53	625.04	1299.24	98.48	0.49	3.87	4387.89	4583.62	90.67	716.9		1966.8	26.39	0		2.5	0.6		0.24		4.43	1.61	775.62	355.78									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0		0		0	0	0	75.810065									NO	127.734907	102.355051	28.138692	0	0.173779	0.173779	0.173779	56.47811	175.777894	30.754054	71.717392	35.701228	0.173306	0.173779	8.68894	34.138606	34.75576	36.552674		0	0.173779	0		0	0		0		0	0	0	65.87091										16.1242	0.518343037	1.238243141	0	1.54489531	2.26955374	0.64645788	1.794168359	4.372914558	1.601876159	7.764842032	0.292988078	0.08491994	0.67252473	3.177176078	13.03986644	0.26260873	2.183717666	0	0	4.58602781	0	0	0	0	0	0	0	0	0	0	1.952962697	0	0	0	0	0	0	0	0	64.1283	0	NO	11.961508	16.1242	0.518343037	1.238243141	0	1.54489531	2.26955374	0.64645788	1.794168359	4.372914558	1.601876159	7.764842032	0.292988078	0.08491994	0.67252473	3.177176078	13.03986644	0.26260873	2.183717666	0	0	4.58602781	0	0	0	0	0	0	0	0	0	0	1.952962697	0	0	0	0	0	0	0	0	64.1283	NO																																																																																		0	0	NO	0	16.1242	0.518343037	1.238243141	0	1.54489531	2.26955374	0.64645788	1.794168359	4.372914558	1.601876159	7.764842032	0.292988078	0.08491994	0.67252473	3.177176078	13.03986644	0.26260873	2.183717666	0	0	4.58602781	0	0	0	0	0	0	0	0	0	0	1.952962697	0	0	0	0	0	0	0	0	64.1283
H2012_012_0	2012	11	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	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	1530.32	61.4	533.48	2539.29	9.52	13.98	3.98	385.12	301.59	631.45	1312.57	99.49	0.53	4.15	4432.92	4630.65	91.6	724.25		1986.98	28.25	0		2.5	0.6		0.24		4.43	1.28	783.58	359.43									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $200 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-$200/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $175 Advanced Imaging -- FSR,8b. $175 Advanced Imaging -- Office,8b, 9a. $200 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$200/Visit: 3. $50 Cardiac Rehab,8b. $200 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	213.650367	35.394484	92.554516	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0		0		0	0	0	77.67853									NO	126.55353	101.408403	27.867186	0	0.172546	0.172546	0.172546	56.07745	184.322581	30.535883	79.849558	35.44796	0.172077	0.172546	8.6273	33.896425	34.5092	36.293367		0	0.172546	0		0	0		0		0	0	0	67.015599										16.1389	0.518872995	1.238882199	0	1.64263792	2.41219308	0.68673308	1.799712295	4.632487267	1.60682361	8.734011195	0.293893128	0.09120081	0.7160659	3.187010893	13.0802067	0.263420227	2.190455921	0	0	4.8744245	0	0	0	0	0	0	0	0	0	0	2.007284729	0	0	0	0	0	0	0	0	66.1153	0	NO	12.873808	16.1389	0.518872995	1.238882199	0	1.64263792	2.41219308	0.68673308	1.799712295	4.632487267	1.60682361	8.734011195	0.293893128	0.09120081	0.7160659	3.187010893	13.0802067	0.263420227	2.190455921	0	0	4.8744245	0	0	0	0	0	0	0	0	0	0	2.007284729	0	0	0	0	0	0	0	0	66.1153	NO																																																																																		0	0	NO	0	16.1389	0.518872995	1.238882199	0	1.64263792	2.41219308	0.68673308	1.799712295	4.632487267	1.60682361	8.734011195	0.293893128	0.09120081	0.7160659	3.187010893	13.0802067	0.263420227	2.190455921	0	0	4.8744245	0	0	0	0	0	0	0	0	0	0	2.007284729	0	0	0	0	0	0	0	0	66.1153
H2012_013_0	2012	7	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	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	1434.92	57.57	500.22	2380.99	7.5	11.01	3.13	361.11	282.79	592.09	1230.74	93.29	0.41	3.27	4156.57	4341.98	85.89	679.1		1863.12	22.25	0		2.68	0.6				3.55	1.28	734.73	337.02									3400	"$0-$215/Day(Days 1-7): 1a. $215 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$215/Day(Days 1-6): 1b. $215 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											156.700727	125.565605	44.690621	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	36.632192	0.199457	0.2	5	34.289725	35	38.102071		0	0.2	0		0	0				0	0	0	75.810065									NO	120.775832	96.778686	35.656546	0	0.173646	0.173646	0.173646	56.435015	175.643768	30.730588	71.662669	31.805204	0.173174	0.173646	4.341155	29.771402	30.388085	33.0814		0	0.173646	0		0	0				0	0	0	65.820648										14.442	0.464295746	1.48634312	0	1.302345	1.91184246	0.54351198	1.698270689	4.139191763	1.516272821	7.34984277	0.247258957	0.07100134	0.56782242	1.503692887	10.772236	0.217502718	1.872131562	0	0	3.8636235	0	0	0	0	0	0	0	0	0	0	1.848572899	0	0	0	0	0	0	0	0	55.8177	0	NO	10.793861	14.442	0.464295746	1.48634312	0	1.302345	1.91184246	0.54351198	1.698270689	4.139191763	1.516272821	7.34984277	0.247258957	0.07100134	0.56782242	1.503692887	10.772236	0.217502718	1.872131562	0	0	3.8636235	0	0	0	0	0	0	0	0	0	0	1.848572899	0	0	0	0	0	0	0	0	55.8177	NO																																																																																		0	0	NO	0	14.442	0.464295746	1.48634312	0	1.302345	1.91184246	0.54351198	1.698270689	4.139191763	1.516272821	7.34984277	0.247258957	0.07100134	0.56782242	1.503692887	10.772236	0.217502718	1.872131562	0	0	3.8636235	0	0	0	0	0	0	0	0	0	0	1.848572899	0	0	0	0	0	0	0	0	55.8177
H2012_014_0	2012	7	r.	s.	t.								DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility								Prosthetics/Supplies	Acute	Mental Health								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O	O	D	D								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0	0	0								0	YES	261.96	8.24	498.05	2370.66	237.39	12.89	1.79	359.54	281.56	589.52	1225.4	92.88	0.48	386.6	4138.53	4323.13	85.52	676.15		1855.03	26.04	0		2.27	1.52		0.21		3.47	1.15	10855.26	0	0								2800	$250/Admit: 1a. $250 IP Acute - Facility 1	$250/Admit: 1b. $250 IP Psych - Facility 1	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25-$50/Visit: 5. $25 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician										250	250	57.180564	0	100	0.2	0.2	65	75	0	60.094825	27.720319	0.2	47.499699	10	24.881621	25	10		0	0.2	0		0	0		0		0	0	0	0	0								NO	220.7685	220.7685	48.52457	0	89.9627	0.179925	0.179925	58.475755	67.472025	0	54.062927	24.937948	0.179925	42.732012	8.99627	22.384178	22.490675	8.99627		0	0.179925	0		0	0		0		0	0	0	0	0									4.8194	0.15159437	2.013971841	0	1.779687113	2.31923325	0.32206575	1.752031079	1.583118613	0	5.520725895	0.193019718	0.086364	1.376682987	3.102611107	8.06414262	0.160283544	0.50690233	0	0	4.685247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4371	0	NO	4.526707	4.8194	0.15159437	2.013971841	0	1.779687113	2.31923325	0.32206575	1.752031079	1.583118613	0	5.520725895	0.193019718	0.086364	1.376682987	3.102611107	8.06414262	0.160283544	0.50690233	0	0	4.685247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4371	NO																																																																																		0	0	NO	0	4.8194	0.15159437	2.013971841	0	1.779687113	2.31923325	0.32206575	1.752031079	1.583118613	0	5.520725895	0.193019718	0.086364	1.376682987	3.102611107	8.06414262	0.160283544	0.50690233	0	0	4.685247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4371
H2012_015_0	2012	7	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	277.97	8.74	528.48	2515.51	251.89	12.75	3.63	381.51	298.76	625.54	1300.28	98.56	0.48	410.23	4391.41	4587.29	90.74	717.47		1968.38	25.76	0			1.52				3.55	1.18	776.24										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Admit: 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$75/Visit: 3. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $20 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												0	100	68.0721	0	50	0.2	0.2	65	100	0	30.047413	20	0.2	28.042276	10	20	20	10		0	0.2	0			0				0	0	0										NO	0	97.1626	63.062402	0	47.2801	0.18912	0.18912	61.46413	94.5602	0	28.412893	18.91204	0.18912	26.516832	9.45602	18.91204	18.91204	9.45602		0	0.18912	0			0				0	0	0											0	0.07076676	2.777268184	0	0.992448699	2.41128	0.6865056	1.954098353	2.354233779	0	3.078726376	0.155330889	0.0907776	0.906499999	3.460438399	7.229584331	0.143006542	0.565367556	0	0	4.8717312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7481	0	NO	1.885097	0	0.07076676	2.777268184	0	0.992448699	2.41128	0.6865056	1.954098353	2.354233779	0	3.078726376	0.155330889	0.0907776	0.906499999	3.460438399	7.229584331	0.143006542	0.565367556	0	0	4.8717312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7481	NO																																																																																		0	0	NO	0	0	0.07076676	2.777268184	0	0.992448699	2.41128	0.6865056	1.954098353	2.354233779	0	3.078726376	0.155330889	0.0907776	0.906499999	3.460438399	7.229584331	0.143006542	0.565367556	0	0	4.8717312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7481
H2012_016_0	2012	7	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	270.42	8.5	514.12	2447.17	245.05	12.14	3.45	371.15	290.65	608.55	1264.95	95.88	0.46	399.08	4272.09	4462.65	88.28	697.98		1914.9	24.54	0			0.6				3.55	1.15	755.15										3400	"$0-$500/Admit: 1a. $500 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$500/Admit: 1b. $500 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$25/Visit: 5. $20 Partial Hospitalization,7h. $25 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $25 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												500	500	68.0721	0	100	0.2	0.2	65	100	17.697242	50.200901	20.544064	0.2	38.627671	15	20	20	15		0	0.2	0			0				0	0	0										NO	425.7525	425.7525	56.408763	0	90.6547	0.181309	0.181309	58.925555	90.6547	16.043382	45.509476	18.624159	0.181309	35.017799	13.598205	18.13094	18.13094	13.598205		0	0.181309	0			0				0	0	0											9.5943	0.301574688	2.416739436	0	1.85124452	2.20109126	0.62551605	1.822518312	2.19573238	0.81360001	4.797267639	0.14880703	0.08340214	1.164575269	4.841062967	6.742669949	0.133383282	0.790939594	0	0	4.44932286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9738	0	NO	5.592449	9.5943	0.301574688	2.416739436	0	1.85124452	2.20109126	0.62551605	1.822518312	2.19573238	0.81360001	4.797267639	0.14880703	0.08340214	1.164575269	4.841062967	6.742669949	0.133383282	0.790939594	0	0	4.44932286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9738	NO																																																																																		0	0	NO	0	9.5943	0.301574688	2.416739436	0	1.85124452	2.20109126	0.62551605	1.822518312	2.19573238	0.81360001	4.797267639	0.14880703	0.08340214	1.164575269	4.841062967	6.742669949	0.133383282	0.790939594	0	0	4.44932286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9738
H2012_021_0	2012	6	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	1433.5	46.14	808.77	1793.63	244.24	14.14	3.38	365.59	245.08	335.83	817.06	91.36	0.54	679.72	3604.37	3735.29	98.88	545.86		2384.17	23.64	0			0.6				5.07	0.95	430.54	0.34									3400	"$0-$300/Day(Days 1-5): 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$50/Day(Days 1-20), $125 (Days 21-100): 2. $50 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$60/Visit: 8a. $0 Lab -- FSL,8a. $60 Lab -- OP"	"$0-$60/Visit: 8b, 9a. $60 DMAM -- OP,8b. $60 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $60 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b, 9a. $60 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $60 Radiology OP -- Facility"	"$35-$60/Visit: 5. $35 Partial Hospitalization,7h. $60 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$100/Visit: 3. $60 Cardiac Rehab,8b. $60 Nuclear Medicine,9a, 9c, 9d, 14d. $60 OP Other,8b. $60 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$60/Visit: 7c, 7i. $60 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											188.759145	131.206824	73.252638	0	150	0.2	0.2	65	250	53.111159	42.092857	36.7951	0.2	63.368707	10	33.888804	35	44.520322		0	0.2	0			0				0	0	0	0									NO	137.158058	95.338815	47.325966	0	128.90385	0.171872	0.171872	55.858335	214.83975	45.641552	36.172876	31.6202	0.171872	54.456469	8.59359	29.122649	30.077565	38.25894		0	0.171872	0			0				0	0	0	0										16.3847	0.366577744	3.189651793	0	2.623623027	2.43027008	0.58092736	1.701770724	4.387743828	1.277316867	2.462950839	0.240735123	0.09281088	3.084595926	2.581206499	9.065128299	0.247839136	1.740335416	0	0	4.06305408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5212	0	NO	14.036091	16.3847	0.366577744	3.189651793	0	2.623623027	2.43027008	0.58092736	1.701770724	4.387743828	1.277316867	2.462950839	0.240735123	0.09281088	3.084595926	2.581206499	9.065128299	0.247839136	1.740335416	0	0	4.06305408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5212	NO																																																																																		0	0	NO	0	16.3847	0.366577744	3.189651793	0	2.623623027	2.43027008	0.58092736	1.701770724	4.387743828	1.277316867	2.462950839	0.240735123	0.09281088	3.084595926	2.581206499	9.065128299	0.247839136	1.740335416	0	0	4.06305408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5212
H2012_022_0	2012	5	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	O			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	1396.28	56.02	486.75	2316.87	232	11.57	4.21	351.39	275.17	576.15	1197.6	90.78	0.43	3.43	4044.63	4225.05	83.58	660.81		1812.94	23.37	0			0.6				4.84	0.47	327.94										3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c15% Coins: DME 11a	"0%-15% Coins: 11b. 15% Supplies,11b. 15% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$20/Visit: 7b. $5 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$30-$125/Visit: 3. $30 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												94.379573	77.573765	49.537808	0	150	0.15	0.117183	65	127.300734	0	30.047413	50	0.2	0.2	5	19.644863	20	22.068048		0	0.2	0			0				0	0	59.70853										NO	82.424606	67.747573	44.141803	0	138.9693	0.138969	0.108565	60.22003	117.939292	0	27.837786	46.3231	0.185292	0.185292	4.63231	18.200219	18.52924	20.445208		0	0.185292	0			0				0	0	55.317684											9.5907	0.316268253	1.790501884	0	2.6867398	1.60787133	0.45705865	1.763393028	2.704446248	0	2.778211043	0.350434252	0.07967556	0.63555156	1.561331666	6.408069607	0.129056157	1.125866492	0	0	4.33027404	0	0	0	0	0	0	0	0	0	1.511740108	0	0	0	0	0	0	0	0	0	39.8271	0	NO	3.888654	9.5907	0.316268253	1.790501884	0	2.6867398	1.60787133	0.45705865	1.763393028	2.704446248	0	2.778211043	0.350434252	0.07967556	0.63555156	1.561331666	6.408069607	0.129056157	1.125866492	0	0	4.33027404	0	0	0	0	0	0	0	0	0	1.511740108	0	0	0	0	0	0	0	0	0	39.8271	NO																																																																																		0	0	NO	0	9.5907	0.316268253	1.790501884	0	2.6867398	1.60787133	0.45705865	1.763393028	2.704446248	0	2.778211043	0.350434252	0.07967556	0.63555156	1.561331666	6.408069607	0.129056157	1.125866492	0	0	4.33027404	0	0	0	0	0	0	0	0	0	1.511740108	0	0	0	0	0	0	0	0	0	39.8271
H2012_023_0	2012	5	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	O			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	1412.14	56.65	492.28	2343.19	234.64	11.12	4.05	355.38	278.3	582.69	1211.21	91.81	0.42	3.3	4090.58	4273.04	84.53	668.32		1833.54	22.47	0			0.6				4.84	0.47	331.67										3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c15% Coins: DME 11a	"0%-15% Coins: 11b. 15% Supplies,11b. 15% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$20/Visit: 7b. $5 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$30-$125/Visit: 3. $30 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"												94.379572	77.573765	49.537808	0	150	0.15	0.117183	65	127.300734	0	30.047413	50	0.2	0.2	5	19.644863	20	22.068048		0	0.2	0			0				0	0	59.70853										NO	82.302102	67.646883	44.049118	0	138.93525	0.138935	0.108539	60.205275	117.910395	0	27.830965	46.31175	0.185247	0.185247	4.631175	18.195759	18.5247	20.440198		0	0.185247	0			0				0	0	55.30413											9.6852	0.31934966	1.807041651	0	2.716647255	1.5449572	0.43958295	1.782979219	2.734538577	0	2.80909526	0.354323481	0.07780374	0.6113151	1.578682653	6.47926717	0.130491074	1.138382761	0	0	4.16250009	0	0	0	0	0	0	0	0	0	1.528560066	0	0	0	0	0	0	0	0	0	39.9007	0	NO	3.930205	9.6852	0.31934966	1.807041651	0	2.716647255	1.5449572	0.43958295	1.782979219	2.734538577	0	2.80909526	0.354323481	0.07780374	0.6113151	1.578682653	6.47926717	0.130491074	1.138382761	0	0	4.16250009	0	0	0	0	0	0	0	0	0	1.528560066	0	0	0	0	0	0	0	0	0	39.9007	NO																																																																																		0	0	NO	0	9.6852	0.31934966	1.807041651	0	2.716647255	1.5449572	0.43958295	1.782979219	2.734538577	0	2.80909526	0.354323481	0.07780374	0.6113151	1.578682653	6.47926717	0.130491074	1.138382761	0	0	4.16250009	0	0	0	0	0	0	0	0	0	1.528560066	0	0	0	0	0	0	0	0	0	39.9007
H2012_026_0	2012	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	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	1385.9	55.6	483.13	2299.65	230.28	12.5	3.56	348.77	273.13	571.86	1188.7	90.1	0.47	375.02	4014.56	4193.63	82.96	655.9		1799.46	25.27	0			0.6				1.34	1.15	709.63										4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$175/Visit: 3. $20 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $40 Rad therapy,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	116.360647	34.03605	0	200	0.2	0.2	65	175	0	70.110629	41.088128	0.2	58.062297	20	39.526483	40	20		0	0.2	0			0				0	0	0										NO	139.866987	99.244461	30.83513	0	182.6662	0.182666	0.182666	59.366515	159.832925	0	64.034211	37.527061	0.182666	53.030096	18.26662	36.100763	36.53324	18.26662		0	0.182666	0			0				0	0	0											16.1535	0.459832669	1.24144803	0	3.505364378	2.283325	0.65029096	1.725438286	3.637930567	0	6.343122218	0.281765683	0.08585302	1.657278883	6.111036832	12.61610356	0.252566466	0.998423005	0	0	4.61596982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6192	0	NO	7.241831	16.1535	0.459832669	1.24144803	0	3.505364378	2.283325	0.65029096	1.725438286	3.637930567	0	6.343122218	0.281765683	0.08585302	1.657278883	6.111036832	12.61610356	0.252566466	0.998423005	0	0	4.61596982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6192	NO																																																																																		0	0	NO	0	16.1535	0.459832669	1.24144803	0	3.505364378	2.283325	0.65029096	1.725438286	3.637930567	0	6.343122218	0.281765683	0.08585302	1.657278883	6.111036832	12.61610356	0.252566466	0.998423005	0	0	4.61596982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6192
H2012_027_0	2012	9	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	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	1412.81	56.68	492.51	2344.3	8.95	13.15	3.74	355.55	278.43	582.97	1211.78	91.85	0.49	3.9	4092.52	4275.07	84.57	668.64		1834.41	26.57	0		2.59	0.6				4.32	1.61	723.41	331.83									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	36.632192	0.199456	0.2	10	34.408104	35	38.102071		0	0.2	0		0	0				0	0	0	75.810065									NO	131.12653	105.072787	28.966414	0	0.176424	0.176424	0.176424	57.337865	178.453726	31.222217	72.809131	32.314025	0.175945	0.176424	8.82121	30.352111	30.874235	33.610637		0	0.176424	0		0	0				0	0	0	66.87365										15.4381	0.496293797	1.188854047	0	1.5789948	2.3199756	0.65982576	1.698873158	4.140572578	1.51680132	7.352387397	0.247336933	0.08621305	0.6880536	3.008414862	10.8131166	0.217586171	1.872784694	0	0	4.68758568	0	0	0	0	0	0	0	0	0	0	1.849223607	0	0	0	0	0	0	0	0	59.861	0	NO	9.912812	15.4381	0.496293797	1.188854047	0	1.5789948	2.3199756	0.65982576	1.698873158	4.140572578	1.51680132	7.352387397	0.247336933	0.08621305	0.6880536	3.008414862	10.8131166	0.217586171	1.872784694	0	0	4.68758568	0	0	0	0	0	0	0	0	0	0	1.849223607	0	0	0	0	0	0	0	0	59.861	NO																																																																																		0	0	NO	0	15.4381	0.496293797	1.188854047	0	1.5789948	2.3199756	0.65982576	1.698873158	4.140572578	1.51680132	7.352387397	0.247336933	0.08621305	0.6880536	3.008414862	10.8131166	0.217586171	1.872784694	0	0	4.68758568	0	0	0	0	0	0	0	0	0	0	1.849223607	0	0	0	0	0	0	0	0	59.861
H2012_028_0	2012	9	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	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	1531.51	61.44	533.89	2541.26	8.61	12.64	3.6	385.42	301.82	631.94	1313.59	99.57	0.48	3.75	4436.35	4634.24	91.67	724.81		1988.52	25.55	0		2.59	1.52		0.24		4.32	1.09	784.18	359.7									3600	"$0-$215/Day(Days 1-7): 1a. $215 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$215/Day(Days 1-6): 1b. $215 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											156.700727	125.565605	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	36.632192	0.199457	0.2	5	34.289725	35	38.102071		0	0.2	0		0	0		0		0	0	0	75.810065									NO	120.674133	96.697193	27.731586	0	0.173276	0.173276	0.173276	56.314635	175.269107	30.665037	71.509807	31.737362	0.172805	0.173276	4.331895	29.707898	30.323265	33.010835		0	0.173276	0		0	0		0		0	0	0	65.680248										15.4011	0.495089628	1.233801371	0	1.49190636	2.19020864	0.6237936	1.808732218	4.408310156	1.614871957	7.827880615	0.263340761	0.0829464	0.649785	1.601483532	11.4727941	0.231644475	1.993881943	0	0	4.4272018	0	0	0	0	0	0	0	0	0	0	1.968765434	0	0	0	0	0	0	0	0	59.7876	0	NO	11.605245	15.4011	0.495089628	1.233801371	0	1.49190636	2.19020864	0.6237936	1.808732218	4.408310156	1.614871957	7.827880615	0.263340761	0.0829464	0.649785	1.601483532	11.4727941	0.231644475	1.993881943	0	0	4.4272018	0	0	0	0	0	0	0	0	0	0	1.968765434	0	0	0	0	0	0	0	0	59.7876	NO																																																																																		0	0	NO	0	15.4011	0.495089628	1.233801371	0	1.49190636	2.19020864	0.6237936	1.808732218	4.408310156	1.614871957	7.827880615	0.263340761	0.0829464	0.649785	1.601483532	11.4727941	0.231644475	1.993881943	0	0	4.4272018	0	0	0	0	0	0	0	0	0	0	1.968765434	0	0	0	0	0	0	0	0	59.7876
H2012_029_0	2012	8	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	Coin	T	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									0	YES	1554.73	62.37	541.99	2579.79	8.53	12.53	3.56	391.26	306.4	641.53	1333.5	101.08	0.47	3.72	4503.62	4704.5	93.06	735.8		2018.67	25.32	0	2.75	3.08	2.5		0.24		3.55	1.28	796.07	365.16									3400	"$0-$215/Day(Days 1-7): 1a. $215 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$215/Day(Days 1-6): 1b. $215 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$35/Visit: 7b. $0 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"VIS735: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											156.700727	125.565605	44.690621	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	36.632192	0.199456	0.2	0	34.171346	35	38.102071		0	0.2	0	0	0	0		0		0	0	0	75.810065									NO	117.573966	94.213004	34.49821	0	0.171635	0.171635	0.171635	55.781375	173.609432	30.374661	70.832659	31.436831	0.171168	0.171635	0	29.324995	30.036125	32.698245		0	0.171635	0	0	0	0		0		0	0	0	65.058302										15.233	0.489672088	1.558140403	0	1.46404655	2.15058655	0.6110206	1.818751732	4.432827497	1.623854689	7.871279231	0.264802906	0.08044896	0.6384822	0	11.49661991	0.232930149	2.004947389	0	0	4.3457982	0	0	0	0	0	0	0	0	0	0	1.97972413	0	0	0	0	0	0	0	0	58.2969	0	NO	12.471194	15.233	0.489672088	1.558140403	0	1.46404655	2.15058655	0.6110206	1.818751732	4.432827497	1.623854689	7.871279231	0.264802906	0.08044896	0.6384822	0	11.49661991	0.232930149	2.004947389	0	0	4.3457982	0	0	0	0	0	0	0	0	0	0	1.97972413	0	0	0	0	0	0	0	0	58.2969	NO																																																																																		0	0	NO	0	15.233	0.489672088	1.558140403	0	1.46404655	2.15058655	0.6110206	1.818751732	4.432827497	1.623854689	7.871279231	0.264802906	0.08044896	0.6384822	0	11.49661991	0.232930149	2.004947389	0	0	4.3457982	0	0	0	0	0	0	0	0	0	0	1.97972413	0	0	0	0	0	0	0	0	58.2969
H2012_030_0	2012	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	O			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	1204.84	48.34	420.01	1795.52	132.1	8.6	3.13	307.54	240.83	504.25	1050.24	78.45	0.38	3	3589.47	3749.58	74.17	584.77		1608.92	20.69	0			0.79				4.93	0.93	287.02										3500	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$75/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$100/Visit: 3. $30 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												94.379573	77.573765	49.537808	0	125	0.2	0.156243	65	127.300734	35.394484	45.048522	50	0.2	0.2	10	19.763242	20	22.045334		0	0.2	0			0				0	0	55.591596										NO	82.448768	67.767432	44.537511	0	115.0575	0.184092	0.143816	59.8299	117.175233	32.579206	41.465363	46.023	0.184092	0.184092	9.2046	18.191273	18.4092	20.291848		0	0.184092	0			0				0	0	51.16984											8.2781	0.272989805	1.55885	0	1.266591313	1.5831912	0.45014408	1.533340621	2.35160928	1.369005385	3.62904857	0.300875363	0.06995496	0.552276	2.753302964	5.684136118	0.113784197	0.988838663	0	0	3.80886348	0	0	0	0	0	0	0	0	0	1.22389729	0	0	0	0	0	0	0	0	0	37.7888	0	NO	3.80429	8.2781	0.272989805	1.55885	0	1.266591313	1.5831912	0.45014408	1.533340621	2.35160928	1.369005385	3.62904857	0.300875363	0.06995496	0.552276	2.753302964	5.684136118	0.113784197	0.988838663	0	0	3.80886348	0	0	0	0	0	0	0	0	0	1.22389729	0	0	0	0	0	0	0	0	0	37.7888	YES	$0-$150/Day(Days 1-5)	$0-$150/Day(Days 1-5)	"$50/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	40% Coins	$125/Trip	40% Coins	40% Coins	$65/Visit	$0-$150/Visit	$0-$50/Visit	$0-$75/Visit	$50/Visit	20% Coins	20% Coins	$10/Visit	$10-$20/Visit	$20/Visit	$20-$30/Visit		$0/Visit	20% Coins	0			"VIS776: Vision 17a,17b"						$30-$100/Visit										3500	0.4316	0.0142	0.1005	1.1774	0.6797	0.64	0.1821	0.0602	0.0924	0.0538	0.1315	0.0154	0.0028	0.0219	0.073	0.1507	0.003	0.0297		0	0.106	0			0				0		0.0481										4.0139	0	NO	0.950575	8.7097	0.287221805	1.659321	1.17743	1.946294313	2.2232022	0.63219608	1.593589621	2.44401328	1.422798385	3.76051157	0.316237363	0.07273096	0.574175	2.826289964	5.834816118	0.116800197	1.018570663	0	0	3.91483948	0	0	0	0	0	0	0	0	0	1.27198829	0	0	0	0	0	0	0	0	0	41.8028
H2012_031_0	2012	7	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1564.09	62.75	545.25	2595.32	259.89	12.6	4.59	393.62	34.8	645.39	1341.53	101.69	0.47	3.74	4530.73	4732.83	93.62	740.23		2030.83	25.46	0			0.6				4.93	2.11	367.36	0									4500	"$0-$300/Day(Days 1-5): 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$285/Day(Days 1-5): 1b. $285 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Facility,9a. 20% Surgery OP -- Facility"	"$0-$10/Visit: 8a. $0 Lab -- FSL,8a. $10 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $20 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$250/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $250 Observation"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"											188.759145	147.390153	49.537808	0	100	0.2	0.156243	65	0.190009	7.078897	22.807763	50	0.2	0.2	10	39.289725	40	40		0	0.2	0			0				0	0	78.424734	0									NO	149.823607	116.987838	41.197969	0	89.2888	0.178578	0.139508	58.03772	0.169657	6.320662	20.364778	44.6444	0.178578	0.178578	8.92888	35.081324	35.71552	35.71552		0	0.178578	0			0				0	0	70.024504	0										19.5281	0.611748903	1.871932716	0	1.933772186	2.2500828	0.64034172	1.903733946	5.9040636	0.339941004	2.276663386	0.378324086	0.08393166	0.66788172	3.371195374	13.83616189	0.278640582	2.203141614	0	0	4.54659588	0	0	0	0	0	0	0	0	0	2.143683482	0	0	0	0	0	0	0	0	0	64.77	0	NO	10.74196	19.5281	0.611748903	1.871932716	0	1.933772186	2.2500828	0.64034172	1.903733946	5.9040636	0.339941004	2.276663386	0.378324086	0.08393166	0.66788172	3.371195374	13.83616189	0.278640582	2.203141614	0	0	4.54659588	0	0	0	0	0	0	0	0	0	2.143683482	0	0	0	0	0	0	0	0	0	64.77	NO																																																																																		0	0	NO	0	19.5281	0.611748903	1.871932716	0	1.933772186	2.2500828	0.64034172	1.903733946	5.9040636	0.339941004	2.276663386	0.378324086	0.08393166	0.66788172	3.371195374	13.83616189	0.278640582	2.203141614	0	0	4.54659588	0	0	0	0	0	0	0	0	0	2.143683482	0	0	0	0	0	0	0	0	0	64.77
H2012_032_0	2012	6	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	O			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	1490.4	59.79	519.56	2221.09	163.4	10.36	3.77	380.43	297.92	623.76	1299.17	97.05	0.46	3.61	4440.24	4638.3	91.75	723.38		1990.27	24.91	0			0.61				4.93	0.93	355.05										2900	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$10/Visit: 8a. $0 Lab -- FSL,8a. $10 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $10 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $20 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$150/Visit: 3. $20 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"												125.83943	103.431686	49.537808	0	100	0.2	0.156243	65	102.300734	7.078897	25.523575	50	0.2	0.2	10	19.763242	20	20		0	0.2	0			0				0	0	59.701629										NO	94.09656	77.341147	36.88496	0	86.4832	0.172966	0.135124	56.21408	88.472948	6.122056	22.073604	43.2416	0.172966	0.172966	8.64832	17.091884	17.29664	17.29664		0	0.172966	0			0				0	0	51.631879											11.6868	0.385352265	1.596995818	0	1.177612907	1.79192776	0.50941748	1.782126871	2.196488389	0.318224471	2.389780342	0.34971644	0.07956436	0.62440726	3.200051366	6.606440463	0.132247227	1.042670287	0	0	4.30858306	0	0	0	0	0	0	0	0	0	1.52765822	0	0	0	0	0	0	0	0	0	41.7061	0	NO	9.002265	11.6868	0.385352265	1.596995818	0	1.177612907	1.79192776	0.50941748	1.782126871	2.196488389	0.318224471	2.389780342	0.34971644	0.07956436	0.62440726	3.200051366	6.606440463	0.132247227	1.042670287	0	0	4.30858306	0	0	0	0	0	0	0	0	0	1.52765822	0	0	0	0	0	0	0	0	0	41.7061	YES	20% Coins	20% Coins	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100)"	40% Coins	$100/Trip	40% Coins	40% Coins; $0/Service	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						20% Coins										2900	0.9849	0.0142	0.0889	1.1196	0.5312	0.6086	0.1731	0.0589	0.2429	0.0361	0.1163	0.0048	0.0026	0.0208	0.1617	0.2801	0.0022	0.0231		0.031	0.1008	0			0				0		0.0588										4.6608	0	NO	3.918232	12.6717	0.399551265	1.685893818	1.119635	1.708862907	2.40052376	0.68253348	1.840989871	2.439426389	0.354277471	2.506103342	0.35454944	0.08220436	0.64523126	3.361786366	6.886547463	0.134431227	1.065807287	0	0.031007	4.40935806	0	0	0	0	0	0	0	0	0	1.58641922	0	0	0	0	0	0	0	0	0	46.3669
H2012_033_0	2012	6	r.	s.	t.								OP Facility - Other	OP Facility - Other	OP Facility - Surgery								Radiology	Other									D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1436.17	57.62	500.66	2383.07	238.63	12.44	4.53	361.43	39.22	592.61	14.37	93.37	0.47	5.51	4160.19	4345.76	85.97	679.69		1864.74	25.14	0			0.6				4.93	2.11	738.31	312.1	0								4900	"$0-$300/Day(Days 1-5): 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$285/Day(Days 1-5): 1b. $285 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$50/Day(Days 1-20), $100 (Days 21-100): 2. $50 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Physician,9b. 15% Surgery ASC -- Facility,9a. 20% Surgery OP -- Facility"	"$10/Visit: 8a. $10 Lab -- FSL,8a. $10 Lab -- OP"	"20% Coins: 8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0-$15/Visit: 8b, 9a. $15 DMAM -- OP,8b. $15 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	"$40-$250/Visit: 3. $40 Cardiac Rehab,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $250 Observation"	$0/Visit: 9a. $0 Surgery OP -- Physician										188.759145	147.390153	65.501759	0	200	0.2	0.156243	65	0.185058	10	0.2	50	0.2	0.2	10	39.289725	40	40		0	0.2	0			0				0	0	10.148376	83.158309	0								NO	155.296301	121.261121	55.680687	0	180.8766	0.180877	0.141304	58.784895	0.167363	9.04383	0.180877	45.21915	0.180877	0.180877	9.04383	35.532959	36.17532	36.17532		0	0.180877	0			0				0	0	9.178019	75.206961	0									18.586	0.582255483	2.323091063	0	3.596881922	2.25010988	0.64010712	1.77055205	6.56397686	0.446622008	2.59920249	0.35184267	0.08501219	0.99663227	3.135337594	12.86814266	0.259166022	2.049000271	0	0	4.54724778	0	0	0	0	0	0	0	0	0	0.564685267	1.956007711	0	0	0	0	0	0	0	0	66.1719	0	NO	9.26395	18.586	0.582255483	2.323091063	0	3.596881922	2.25010988	0.64010712	1.77055205	6.56397686	0.446622008	2.59920249	0.35184267	0.08501219	0.99663227	3.135337594	12.86814266	0.259166022	2.049000271	0	0	4.54724778	0	0	0	0	0	0	0	0	0	0.564685267	1.956007711	0	0	0	0	0	0	0	0	66.1719	NO																																																																																		0	0	NO	0	18.586	0.582255483	2.323091063	0	3.596881922	2.25010988	0.64010712	1.77055205	6.56397686	0.446622008	2.59920249	0.35184267	0.08501219	0.99663227	3.135337594	12.86814266	0.259166022	2.049000271	0	0	4.54724778	0	0	0	0	0	0	0	0	0	0.564685267	1.956007711	0	0	0	0	0	0	0	0	66.1719
H2012_034_0	2012	4	r.	s.									OP Facility - Other	OP Facility - Other									Radiology	Other									D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1452.01	58.25	506.18	2163.87	159.2	10.85	3.95	370.63	47.93	607.69	17.88	94.55	0.48	5.64	4325.84	4518.8	89.39	704.74		1938.99	26.11	0			0.61				4.93	0.47	757.11	320.05									3700	"$0-$275/Day(Days 1-5): 1a. $275 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$275/Day(Days 1-5): 1b. $275 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$50/Day(Days 1-20), $100 (Days 21-100): 2. $50 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"$50/Visit: 8a. $50 Lab -- FSL,8a. $50 Lab -- OP"	"20% Coins: 8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Radiology OP -- Facility"	"$40-$225/Visit: 3. $40 Cardiac Rehab,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $225 Observation"											173.029216	142.218568	65.501759	0	200	0.2	0.156243	65	0.2	50	0.2	50	0.2	0.2	15	39.408104	40	40		0	0.2	0			0				0	0	33.827922	78.708827									NO	121.412179	99.792778	45.280318	0	164.351	0.164351	0.128394	53.414075	0.164351	41.08775	0.164351	41.08775	0.164351	0.164351	12.326325	32.383807	32.8702	32.8702		0	0.164351	0			0				0	0	27.798264	64.679372										14.691	0.484410777	1.90999928	0	2.180389933	1.78320835	0.5071563	1.649738218	7.87734343	2.0807179	2.93859588	0.32373723	0.07888848	0.92693964	4.443475812	12.19466226	0.244855598	1.930412062	0	0	4.29120461	0	0	0	0	0	0	0	0	0	1.753861971	1.725052751	0	0	0	0	0	0	0	0	64.0156	0	NO	17.484151	14.691	0.484410777	1.90999928	0	2.180389933	1.78320835	0.5071563	1.649738218	7.87734343	2.0807179	2.93859588	0.32373723	0.07888848	0.92693964	4.443475812	12.19466226	0.244855598	1.930412062	0	0	4.29120461	0	0	0	0	0	0	0	0	0	1.753861971	1.725052751	0	0	0	0	0	0	0	0	64.0156	YES	20% Coins; $0/Day(Days 1-1)	20% Coins; $0/Day(Days 1-1)	"20% Coins(Days 1-7), 20% (Days 8-100)"	40% Coins	$200/Trip	40% Coins	40% Coins; $0/Service	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						20% Coins	20% Coins									3700	1.1321	0.018	0.1156	1.2359	1.0904	0.6718	0.1911	0.0604	0.2682	0.0398	0.0946	0.0053	0.0029	0.0343	0.1785	0.3092	0.0024	0.0255		0.0342	0.1112	0							0	0	0.0338	0.0536									5.7088	0	NO	3.754281	15.823	0.502385777	2.02559328	1.235883	3.270819933	2.45499235	0.6982463	1.710148218	8.14550543	2.1205139	3.03320088	0.32907223	0.08180248	0.96123264	4.622002812	12.50385126	0.247266598	1.955951062	0	0.034226	4.40244261	0	0	0	0	0	0	0	0	0	1.787657971	1.778607751	0	0	0	0	0	0	0	0	69.7244
H2012_035_0	2012	5	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1467.48	58.87	511.57	2435.01	243.83	12.54	4.56	369.3	34.62	605.52	1258.66	95.4	0.47	3.72	4250.87	4440.48	87.84	694.51		1905.38	25.33	0			0.6				4.93	2.11	344.66	0									4900	"$0-$300/Day(Days 1-5): 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$285/Day(Days 1-5): 1b. $285 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Facility,9a. 20% 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,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$30-$40/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$250/Visit: 3. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $250 Observation"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"											188.759145	147.390153	49.537808	0	100	0.2	0.156243	65	0.190009	35.394484	47.003604	50	0.2	0.2	10	39.289725	40	37.931952		0	0.2	0			0				0	0	82.161665	0									NO	155.211171	121.194648	42.93962	0	90.4001	0.1808	0.141244	58.760065	0.171768	31.996649	42.491305	45.20005	0.1808	0.1808	9.04001	35.517951	36.16004	34.290523		0	0.1808	0			0				0	0	74.274228	0										18.9808	0.594560744	1.830551784	0	1.836854699	2.267232	0.64407264	1.808341	5.94660816	1.614550909	4.456842163	0.359340398	0.084976	0.672576	3.202325609	13.14306259	0.264691493	1.984592594	0	0	4.579664	0	0	0	0	0	0	0	0	0	2.133279619	0	0	0	0	0	0	0	0	0	66.4049	0	NO	9.291039	18.9808	0.594560744	1.830551784	0	1.836854699	2.267232	0.64407264	1.808341	5.94660816	1.614550909	4.456842163	0.359340398	0.084976	0.672576	3.202325609	13.14306259	0.264691493	1.984592594	0	0	4.579664	0	0	0	0	0	0	0	0	0	2.133279619	0	0	0	0	0	0	0	0	0	66.4049	NO																																																																																		0	0	NO	0	18.9808	0.594560744	1.830551784	0	1.836854699	2.267232	0.64407264	1.808341	5.94660816	1.614550909	4.456842163	0.359340398	0.084976	0.672576	3.202325609	13.14306259	0.264691493	1.984592594	0	0	4.579664	0	0	0	0	0	0	0	0	0	2.133279619	0	0	0	0	0	0	0	0	0	66.4049
H2012_036_0	2012	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			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	1385.42	55.58	482.96	2064.63	151.89	10.21	2.9	353.63	276.93	579.83	1207.66	90.21	0.45	3.56	4127.46	4311.57	85.29	672.42		1850.07	24.56	0			0.61				4.93	0.93	637.95	330.04									2900	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$175/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 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. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$150/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											125.83943	103.431686	49.537808	0	100	0.2	0.2	65	140.951101	35.394484	35.002894	50	0.2	0.2	10	24.644863	25	26.022667		0	0.2	0			0				0	0	0	61.956998									NO	94.635404	77.784041	37.273188	0	85.6524	0.171305	0.171305	55.67406	120.728001	30.316225	29.980819	42.8262	0.171305	0.171305	8.56524	21.108916	21.4131	22.289039		0	0.171305	0			0				0	0	0	53.067656										10.9258	0.36026975	1.500121573	0	1.084145253	1.74902405	0.4967845	1.640668153	2.786100443	1.464854728	3.017219656	0.321945959	0.07708725	0.6098458	2.946057124	7.584380747	0.152193608	1.2489663	0	0	4.2072508	0	0	0	0	0	0	0	0	0	0	1.459537432	0	0	0	0	0	0	0	0	43.6323	0	NO	9.382077	10.9258	0.36026975	1.500121573	0	1.084145253	1.74902405	0.4967845	1.640668153	2.786100443	1.464854728	3.017219656	0.321945959	0.07708725	0.6098458	2.946057124	7.584380747	0.152193608	1.2489663	0	0	4.2072508	0	0	0	0	0	0	0	0	0	0	1.459537432	0	0	0	0	0	0	0	0	43.6323	YES	20% Coins; $0/Day(Days 1-1)	20% Coins; $0/Day(Days 1-1)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/Visit	20% Coins; $0/Visit	20% Coins	20% Coins; $0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS775: Vision 17a,17b"						40% Coins	20% Coins									2900	0.9454	0.015	0.0929	1.1231	0.5025	0.6105	0.1737	0.0557	0.214	0.0362	0.1047	0.0048	0.0026	0.0209	0.1622	0.281	0.0022	0.0232		0.0311	0.1011	0			0				0		0.0486	0.0589									4.6105	0	NO	3.559512	11.8712	0.37528075	1.593068573	1.123136	1.586645253	2.35952205	0.6704415	1.696346153	3.000110443	1.501020728	3.121952656	0.326793959	0.07973525	0.6307348	3.108298124	7.865363747	0.154384608	1.2721763	0	0.031104	4.3083398	0	0	0	0	0	0	0	0	0	0.048633	1.518482432	0	0	0	0	0	0	0	0	48.2428
H2012_037_0	2012	4	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1476.25	59.23	514.63	2449.57	245.29	12.61	4.59	371.51	34.82	609.14	1266.19	95.97	0.47	3.74	4276.29	4467.04	88.37	698.66		1916.78	25.48	0			0.6				4.93	2.11	346.73	0									4900	"$0-$300/Day(Days 1-5): 1a. $300 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$285/Day(Days 1-5): 1b. $285 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Facility,9a. 20% 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,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$250/Visit: 3. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $250 Observation"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"											188.759145	147.390153	49.537808	0	100	0.2	0.156243	65	0.190009	35.394484	47.003604	50	0.2	0.2	10	39.289725	40	40		0	0.2	0			0				0	0	82.161665	0									NO	154.912176	120.961182	42.847232	0	90.2929	0.180586	0.141077	58.690385	0.171564	31.958706	42.440917	45.14645	0.180586	0.180586	9.02929	35.475832	36.11716	36.11716		0	0.180586	0			0				0	0	74.18615	0										19.0574	0.597044234	1.83753925	0	1.84566212	2.27718946	0.64754343	1.817005411	5.97385848	1.622277181	4.478188725	0.361058734	0.08487542	0.67539164	3.217655211	13.20599671	0.265972786	2.10280125	0	0	4.60133128	0	0	0	0	0	0	0	0	0	2.143546982	0	0	0	0	0	0	0	0	0	66.8124	0	NO	9.45344	19.0574	0.597044234	1.83753925	0	1.84566212	2.27718946	0.64754343	1.817005411	5.97385848	1.622277181	4.478188725	0.361058734	0.08487542	0.67539164	3.217655211	13.20599671	0.265972786	2.10280125	0	0	4.60133128	0	0	0	0	0	0	0	0	0	2.143546982	0	0	0	0	0	0	0	0	0	66.8124	NO																																																																																		0	0	NO	0	19.0574	0.597044234	1.83753925	0	1.84566212	2.27718946	0.64754343	1.817005411	5.97385848	1.622277181	4.478188725	0.361058734	0.08487542	0.67539164	3.217655211	13.20599671	0.265972786	2.10280125	0	0	4.60133128	0	0	0	0	0	0	0	0	0	2.143546982	0	0	0	0	0	0	0	0	0	66.8124
H2012_038_0	2012	6	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	O			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	1428.19	57.3	497.87	2128.38	156.58	10.52	3.83	364.55	285.48	597.73	1244.94	92.99	0.47	3.67	4254.89	4444.68	87.92	693.18		1907.19	25.31	0			0.61				4.93	0.47	340.23										2900	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$175/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 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. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$30-$150/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"												125.83943	103.431686	49.537808	0	100	0.2	0.156243	65	140.951101	35.394484	35.002894	50	0.2	0.2	10	24.644863	25	26.022667		0	0.2	0			0				0	0	61.956998										NO	93.420802	76.785718	36.623054	0	85.1189	0.170238	0.132993	55.327285	119.976027	30.127395	29.794078	42.55945	0.170238	0.170238	8.51189	20.977436	21.279725	22.150208		0	0.170238	0			0				0	0	52.737115											11.1186	0.366651803	1.519459991	0	1.11065978	1.79090376	0.50936319	1.680796812	2.854229682	1.500670651	3.090986622	0.329800271	0.08001186	0.62477346	3.018096304	7.76983252	0.155909452	1.279506765	0	0	4.30872378	0	0	0	0	0	0	0	0	0	1.495229053	0	0	0	0	0	0	0	0	0	44.6042	0	NO	10.04572	11.1186	0.366651803	1.519459991	0	1.11065978	1.79090376	0.50936319	1.680796812	2.854229682	1.500670651	3.090986622	0.329800271	0.08001186	0.62477346	3.018096304	7.76983252	0.155909452	1.279506765	0	0	4.30872378	0	0	0	0	0	0	0	0	0	1.495229053	0	0	0	0	0	0	0	0	0	44.6042	YES	20% Coins; $0/Day(Days 1-1)	20% Coins; $0/Day(Days 1-1)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/Visit	20% Coins; $0/Visit	20% Coins	20% Coins; $0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS775: Vision 17a,17b"						20% Coins										3700	1.1688	0.0186	0.1207	1.2485	0.5588	0.6786	0.2471	0.0619	0.2379	0.0402	0.1164	0.0054	0.0029	0.0232	0.1804	0.3123	0.0024	0.0258		0.0346	0.1124	0							0	0	0.0655										5.2624	0	NO	3.157616	12.2873	0.385209803	1.640173991	1.248502	1.66941278	2.46954676	0.75646619	1.742706812	3.092127682	1.540873651	3.207410622	0.335189271	0.08295586	0.64799446	3.198446304	8.08217852	0.158344452	1.305306765	0	0.034576	4.42109778	0	0	0	0	0	0	0	0	0	1.560753053	0	0	0	0	0	0	0	0	0	49.8666
H2012_039_0	2012	6	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	1519.16	60.95	529.59	2520.76	252.42	13.1	4.77	382.31	36.18	626.85	1302.99	98.76	0.49	3.89	4400.57	4596.86	90.93	718.97		1972.49	26.47	0			0.6				4.93	2.11	356.8	0									4000	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Facility,9a. 20% 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,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$250/Visit: 3. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $250 Observation"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"											157.299288	129.289608	49.537808	0	100	0.2	0.156243	65	0.190009	35.394484	47.003604	50	0.2	0.2	10	39.289725	40	40		0	0.2	0			0				0	0	82.161666	0									NO	124.228213	102.107373	40.409575	0	87.5589	0.175118	0.136805	56.913285	0.16637	30.991021	41.155838	43.77945	0.175118	0.175118	8.75589	34.401651	35.02356	35.02356		0	0.175118	0			0				0	0	71.939851	0										15.7269	0.518620365	1.783375569	0	1.841801462	2.2940458	0.65255985	1.813209832	6.0192666	1.618893459	4.46880378	0.360304874	0.08580782	0.68120902	3.210908905	13.17829778	0.265391026	2.098407411	0	0	4.63537346	0	0	0	0	0	0	0	0	0	2.13901157	0	0	0	0	0	0	0	0	0	63.3922	0	NO	11.173294	15.7269	0.518620365	1.783375569	0	1.841801462	2.2940458	0.65255985	1.813209832	6.0192666	1.618893459	4.46880378	0.360304874	0.08580782	0.68120902	3.210908905	13.17829778	0.265391026	2.098407411	0	0	4.63537346	0	0	0	0	0	0	0	0	0	2.13901157	0	0	0	0	0	0	0	0	0	63.3922	NO																																																																																		0	0	NO	0	15.7269	0.518620365	1.783375569	0	1.841801462	2.2940458	0.65255985	1.813209832	6.0192666	1.618893459	4.46880378	0.360304874	0.08580782	0.68120902	3.210908905	13.17829778	0.265391026	2.098407411	0	0	4.63537346	0	0	0	0	0	0	0	0	0	2.13901157	0	0	0	0	0	0	0	0	0	63.3922
H2012_040_0	2012	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			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	1434.21	57.54	499.97	2137.35	157.24	10.67	3.03	366.09	286.68	600.25	1250.19	93.39	0.47	3.72	4272.82	4463.42	88.29	696.1		1915.23	25.67	0			0.61				4.93	0.93	660.42	341.66									2900	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$175/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 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. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$150/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											125.83943	103.431686	49.537808	0	100	0.2	0.2	65	140.951101	35.394484	35.002894	50	0.2	0.2	10	24.644863	25	26.022667		0	0.2	0			0				0	0	0	61.956998									NO	93.214299	76.615987	36.518182	0	85.0128	0.170026	0.170026	55.25832	119.826477	30.089842	29.75694	42.5064	0.170026	0.170026	8.50128	20.951288	21.2532	22.122598		0	0.170026	0			0				0	0	0	52.671379										11.1407	0.367373658	1.521499621	0	1.113951056	1.81417742	0.51517878	1.685793197	2.862654536	1.505118972	3.100152402	0.330806058	0.07991222	0.63249672	3.027036601	7.79286649	0.156370419	1.283295039	0	0	4.36456742	0	0	0	0	0	0	0	0	0	0	1.499641946	0	0	0	0	0	0	0	0	44.7936	0	NO	10.170153	11.1407	0.367373658	1.521499621	0	1.113951056	1.81417742	0.51517878	1.685793197	2.862654536	1.505118972	3.100152402	0.330806058	0.07991222	0.63249672	3.027036601	7.79286649	0.156370419	1.283295039	0	0	4.36456742	0	0	0	0	0	0	0	0	0	0	1.499641946	0	0	0	0	0	0	0	0	44.7936	YES	20% Coins; $0/Day(Days 1-1)	20% Coins; $0/Day(Days 1-1)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/Visit	20% Coins; $0/Visit	20% Coins	20% Coins; $0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS775: Vision 17a,17b"						40% Coins	20% Coins									2900	0.9529	0.0151	0.089	1.1571	0.5128	0.629	0.1789	0.0568	0.2004	0.0373	0.1079	0.005	0.0027	0.0215	0.1671	0.2895	0.0023	0.0239		0.032	0.1041	0			0				0		0.0501	0.0607									4.6963	0	NO	3.784321	12.0936	0.382504658	1.610499621	1.157117	1.626782056	2.44314742	0.69409078	1.742615197	3.063037536	1.542378972	3.208054402	0.335801058	0.08264022	0.65401772	3.194185601	8.08235049	0.158627419	1.307206039	0	0.032045	4.46871542	0	0	0	0	0	0	0	0	0	0.050105	1.560369946	0	0	0	0	0	0	0	0	49.4899
H2012_042_0	2012	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	T	V	V		V		O	O	O	V									0	0	0	0	0	1.052881544	0.266837533	0	2.152106758	0.266754254	1.009736391	0.062495668	0.035265581	0.723449549	0	3.155788507	0.061053154	0.216613745		0	1.18742021	0	0	0	0		0		0	0	0	0									10.1904	YES	349.67	7.51	45.3	4922.33	15.81	21.78	5.52	665.93	44.53	6.5	20.89	1.29	0.73	14.97	39.98	65.29	1.26	4.48		1674.1	25.86	0	2.75	4.45	2.5		0.24		3.55	1.61	1300.01	226.46									6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"0% Coins: 4b, 7a, 8a, 8b. 0% Physician Services PCP,4b, 7a, 8a, 8b. 0% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"19% Coins: 15. 19% Part B Rx,15. 19% Part B Rx at Pharmacy,15. 19% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"											0.0822	0.0822	0.1788	0	0.2	0.2	0.2	65	0.2	0.169806	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2		0	0.19	0	0	0	0		0		0	0	0	0									NO	0.068565	0.068565	0.138089	0	0.185533	0.185533	0.185533	60.298095	0.185533	0.157523	0.185533	0.185533	0.185533	0.185533	0	0.185533	0.185533	0.185533		0	0.176256	0	0	0	0		0		0	0	0	0										23.9751	0.51492315	6.2554317	0	2.93327673	4.04090874	1.02414216	3.346192534	8.26178449	1.0238995	3.87578437	0.23933757	0.13543909	2.77742901	0	12.11344957	0.23377158	0.83118784	0	0	4.55798016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1401	162	YES	10.254123	23.9751	0.51492315	6.2554317	0	2.93327673	5.093790284	1.290979693	3.346192534	10.41389125	1.290653754	4.885520761	0.301833238	0.170704671	3.500878559	0	15.26923808	0.294824734	1.047801585	0	0	5.74540037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3305	NO																																																																																		0	0	NO	0	23.9751	0.51492315	6.2554317	0	2.93327673	5.093790284	1.290979693	3.346192534	10.41389125	1.290653754	4.885520761	0.301833238	0.170704671	3.500878559	0	15.26923808	0.294824734	1.047801585	0	0	5.74540037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3305
H2012_046_0	2012	9	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	1369.88	54.96	477.55	2041.47	150.19	10.58	1.47	349.66	273.82	573.32	1194.11	89.2	0.47	3.69	4081.16	4263.2	84.33	664.88		1829.31	25.45	0			0.61				3.99	0.81	9360.29	326.34									4700	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	195	0	60.273773	36.65293	0.2	0.2	10	34.644863	35	10		0	0.2	0			0				0	0	0	50.922547									NO	120.782872	106.065798	30.784756	0	182.6642	0.182664	0.182664	59.365865	178.097595	0	55.049302	33.475891	0.182664	0.182664	9.13321	31.641881	31.966235	9.13321		0	0.182664	0			0				0	0	0	46.508632										13.7882	0.485781355	1.225105019	0	2.286194683	1.93258512	0.26851608	1.729822363	4.063890289	0	5.477910168	0.248837456	0.08585208	0.67403016	3.106174277	11.24130559	0.224642716	0.506040722	0	0	4.6487988	0	0	0	0	0	0	0	0	0	0	1.264802247	0	0	0	0	0	0	0	0	53.2585	0	NO	6.23496	13.7882	0.485781355	1.225105019	0	2.286194683	1.93258512	0.26851608	1.729822363	4.063890289	0	5.477910168	0.248837456	0.08585208	0.67403016	3.106174277	11.24130559	0.224642716	0.506040722	0	0	4.6487988	0	0	0	0	0	0	0	0	0	0	1.264802247	0	0	0	0	0	0	0	0	53.2585	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	$0/Visit	$200/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins; $0/Visit	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									4700	1.8158	0.0262	0.1678	0	1.1103	0.5301	0.0737	0.0615	0.4232	0.0577	0.2027	0.0084	0.0031	0.0363	0.2818	0.488	0.0038	0.0403		0.054	0.117	0							0	0	0.1194	0.1024									5.7235	0	NO	3.996699	15.604	0.511958355	1.392911019	0	3.396471683	2.46272612	0.34218908	1.791332363	4.487132289	0.05773	5.680566168	0.257257456	0.08891808	0.71030916	3.387945277	11.72930159	0.228447716	0.546348722	0	0.05402	4.7658438	0	0	0	0	0	0	0	0	0	0.119358	1.367174247	0	0	0	0	0	0	0	0	58.9819
H2012_051_0	2012	7	r.	s.	t.								DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility								Prosthetics/Supplies	Acute	Mental Health								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V				O	O	O	D	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	YES	249.11	7.83	473.61	2024.65	148.95	10.83	1.5	346.78	271.57	568.6	1184.27	88.46	0.48	372.88	4047.53	4228.07	83.64	659.4		1814.24	26.05	0		2.96	1.69				3.47	1.15	9283.17	0	0								4900	$250/Admit: 1a. $250 IP Acute - Facility 1	$250/Admit: 1b. $250 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$25-$50/Visit: 5. $25 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $25 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$25/Visit: 7b. $20 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician										250	250	34.03605	0	200	0.2	0.2	65	100	0	60.273773	27.754884	0.2	47.499699	10	24.881621	25	10		0	0.2	0		0	0				0	0	0	0	0								NO	238.9185	238.9185	33.123101	0	190.6778	0.190678	0.190678	61.970285	95.3389	0	57.464352	26.461201	0.190678	45.285691	9.53389	23.721864	23.834725	9.53389		0	0.190678	0		0	0				0	0	0	0	0									4.9597	0.155894321	1.307285989	0	2.366788193	2.06504274	0.286017	1.790837953	2.157598756	0	5.671109012	0.195063153	0.09152544	1.407177372	3.215725483	8.358141794	0.166128033	0.523887256	0	0	4.9671619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6851	0	NO	1.89955	4.9597	0.155894321	1.307285989	0	2.366788193	2.06504274	0.286017	1.790837953	2.157598756	0	5.671109012	0.195063153	0.09152544	1.407177372	3.215725483	8.358141794	0.166128033	0.523887256	0	0	4.9671619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6851	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						20%-25% Coins	30% Coins	30% Coins								7300	2.1968	0.0349	0.243	1.0836	1.1952	0.4908	0.0682	0.0662	0.4702	0.0698	0.2252	0.0094	0.0034	0.154	0.3131	0.5422	0.0042	0.0448		0.06	0.1743	0							0	0	0.1027	0.223	0								7.7749	0	NO	3.370893	7.1566	0.190776321	1.550295989	1.083596	3.561939193	2.55588074	0.354228	1.857049953	2.627835756	0.069785	5.896267012	0.204418153	0.09493144	1.561224372	3.528783483	8.900322794	0.170355033	0.568672256	0	0.060018	5.1414359	0	0	0	0	0	0	0	0	0	0.102689	0.222957	0.000002	0	0	0	0	0	0	0	47.46
H2012_053_0	2012	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.861789943	0.218408119	0	1.761512619	0.218340045	0.826475441	0.051153108	0.028865162	0.592147796	1.581556367	2.583032088	0.049972326	0.177299675		0	1.023063903	0	0	0	0				0	0	0	0	0								9.9736	YES	362.94	7.79	47.01	4945.86	16.41	22.61	5.73	669.12	46.22	5.73	21.68	1.34	0.76	15.54	41.49	67.77	1.31	4.65		1682.1	26.84	0	2.65	2.33	1.52				1.34	0.84	1306.23	357.18	227.55								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0806	0.0806	0.1847	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.065896	0.065896	0.137229	0	0.18196	0.18196	0.18196	59.13687	0.18196	0.18196	0.18196	0.18196	0.18196	0.18196	0.18196	0.18196	0.18196	0.18196		0	0.18196	0	0	0	0				0	0	0	0	0									23.9163	0.51332984	6.45113529	0	2.9859636	4.1141156	1.0426308	3.297471871	8.4101912	1.0426308	3.9448928	0.2438264	0.1382896	2.8276584	7.5495204	12.3314292	0.2383676	0.846114	0	0	4.8838064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7777	162	YES	13.026569	23.9163	0.51332984	6.45113529	0	2.9859636	4.975905543	1.261038919	3.297471871	10.17170382	1.260970845	4.771368241	0.294979508	0.167154762	3.419806196	9.131076767	14.91446129	0.288339926	1.023413675	0	0	5.906870303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7513	NO																																																																																		0	0	NO	0	23.9163	0.51332984	6.45113529	0	2.9859636	4.975905543	1.261038919	3.297471871	10.17170382	1.260970845	4.771368241	0.294979508	0.167154762	3.419806196	9.131076767	14.91446129	0.288339926	1.023413675	0	0	5.906870303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7513
H2012_054_0	2012	7	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	O		V	V				O	O	O	V	V								0	0	0	0	0	0.860243725	0.218016299	0	1.758352154	0.21794829	0.824992578	0.051061331	0.028813305	0.591085354	1.578718698	2.578397686	0.049882709	0.176981545		0	1.021228372	0		0	0				0	0	0	0	0								9.9557	YES	355.73	7.64	46.08	4931.97	16.08	22.16	5.62	667.24	45.3	5.61	21.25	1.32	0.74	15.23	40.67	66.42	1.29	4.56		1677.38	26.31	0		2.68	1.52				3.55	1.15	1302.56	356.18	226.91								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0885	0.0885	0.1899	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0		0	0				0	0	0	0	0								NO	0.071571	0.071571	0.139534	0	0.181777	0.181777	0.181777	59.07746	0.181777	0.181777	0.181777	0.181777	0.181777	0.181777	0.181777	0.181777	0.181777	0.181777		0	0.181777	0		0	0				0	0	0	0	0									25.46	0.54680244	6.42972672	0	2.92297416	4.02817832	1.02158674	3.284903701	8.2344981	1.01976897	3.86276125	0.23994564	0.13451498	2.76846371	7.39287059	12.07362834	0.23449233	0.82890312	0	0	4.78255287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2665	162	YES	13.76865	25.46	0.54680244	6.42972672	0	2.92297416	4.888422045	1.239603039	3.284903701	9.992850254	1.23771726	4.687753828	0.291006971	0.163328285	3.359549064	8.971589288	14.65202603	0.284375039	1.005884665	0	0	5.803781242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2222	NO																																																																																		0	0	NO	0	25.46	0.54680244	6.42972672	0	2.92297416	4.888422045	1.239603039	3.284903701	9.992850254	1.23771726	4.687753828	0.291006971	0.163328285	3.359549064	8.971589288	14.65202603	0.284375039	1.005884665	0	0	5.803781242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2222
H2012_801_0	2012	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	228.37	2.65	40.76	22.69	7.8	12.62	3.83	22	58.49	7.88	27.15	0.6	0.43	17.1	34.75	87.17	0.6	6.88		14.13	30.15	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																					0.0821	0.0821	0.1881	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070546	0.070546	0.148977	0	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397	0.202397		0.202397	0.202397	0																				16.1106	0.1869469	6.07230252	0	1.5786966	2.55425014	0.77518051	4.452734	11.83820053	1.59488836	5.49507855	0.1214382	0.08703071	3.4609887	7.03329575	17.64294649	0.1214382	1.39249136	0	2.85986961	6.10226955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4806	0	NO	11.426911	16.1106	0.1869469	6.07230252	0	1.5786966	2.55425014	0.77518051	4.452734	11.83820053	1.59488836	5.49507855	0.1214382	0.08703071	3.4609887	7.03329575	17.64294649	0.1214382	1.39249136	0	2.85986961	6.10226955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4806	NO																																																																																		0	0	NO	0	16.1106	0.1869469	6.07230252	0	1.5786966	2.55425014	0.77518051	4.452734	11.83820053	1.59488836	5.49507855	0.1214382	0.08703071	3.4609887	7.03329575	17.64294649	0.1214382	1.39249136	0	2.85986961	6.10226955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4806
H2012_802_0	2012	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	222.16	2.58	39.65	22.08	7.58	12.28	3.73	21.41	56.9	7.67	26.41	0.59	0.42	16.64	33.8	84.8	0.58	6.69		13.75	29.32	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																					0.0851	0.0851	0.186	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073334	0.073334	0.148982	0	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082		0.203082	0.203082	0																				16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964	0	NO	10.859314	16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964	NO																																																																																		0	0	NO	0	16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964
H2012_803_0	2012	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	222.16	2.58	39.65	22.08	7.58	12.28	3.73	21.41	56.9	7.67	26.41	0.59	0.42	16.64	33.8	84.8	0.58	6.69		13.75	29.32	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																					0.0851	0.0851	0.186	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073334	0.073334	0.148982	0	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082	0.203082		0.203082	0.203082	0																				16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964	0	NO	10.859314	16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964	NO																																																																																		0	0	NO	0	16.2919	0.18920172	5.9071363	0	1.53936156	2.49384696	0.75749586	4.34798562	11.5553658	1.55763894	5.36339562	0.11981838	0.08529444	3.37928448	6.8641716	17.2213536	0.11778756	1.35861858	0	2.7923775	5.95436424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8964
H2029_001_0	2012	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	S	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	1044.71	0	39.91	145.91	14.1	6.47	5.3	414.24	173.97	3002.32	1909.09	9.18	0.17	249.38	4291.6	5910.6	4.64	1446.24		543.4	1819.73	0		3.24	1.87		0.34		1.71	1.03	11250.38										3400	"$0-$25/Day(Days 1-6): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-6): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $25 (Days 8-100): 2. $0 SNF - Facility 1,2. $25 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c. 0% - 10% Coins: DME 11a.	10% Coins: 11b. 10% Prosthetics	"$35/Visit: 4a, 4b. $35 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,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $10 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $25 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $10 Radiology OP -- Facility"	"$8-$10/Visit: 5. $8 Partial Hospitalization,7h. $10 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$8-$30/Visit: 3. $30 Cardiac Rehab,8b. $15 Nuclear Medicine,9a, 9c, 9d, 14d. $10 OP Other,8b. $10 Rad therapy,3, 7c, 7i. $8 Therapy (AT,PT,ST,OT) -- CORF,9a. $15 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$8/Visit: 7b. $8 Chiropractic,7f. $8 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $8 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $8 Spec Cap"	"$8/Visit: 7e, 7h. $8 Psych -- Other Provider"	"$8-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $8 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$10/Script: 15. $10 Part B Rx,15. $10 Part B Rx at Pharmacy,15. $10 Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN784: Dental 16a, 16b"	"VIS751: Vision 17a,17b"		"HER768: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												17.12096	0	17.018025	0	25	0.014	0.1	35	7.288931	0.864729	4.859612	8.149037	0.2	11.450395	0	8	8	9.388041		0	10	0		0	0		0		0	0	0										NO	17.082883	0	17.005125	0	24.915575	0.013953	0.099662	34.881805	7.264317	0.861809	4.843201	8.121518	0.199325	11.411727	0	7.972984	7.972984	9.356338		0	9.96623	0		0	0		0		0	0	0											1.4872	0	0.056556212	0	0.029275801	0.09027591	0.5282086	1.204119909	0.105314436	0.215618866	0.770508883	0.006212961	0.03388525	0.237154707	0	3.927093269	0.003082887	1.127625856	0	0	1.511320643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3335	0	NO	0.03653	1.4872	0	0.056556212	0	0.029275801	0.09027591	0.5282086	1.204119909	0.105314436	0.215618866	0.770508883	0.006212961	0.03388525	0.237154707	0	3.927093269	0.003082887	1.127625856	0	0	1.511320643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3335	YES	$0/Day(Days 1-1); $500/Admit	$0/Day(Days 1-1); $500/Admit	"20% Coins(Days 1-7), 20% (Days 8-100)"	$0/Visit	$25/Trip	20% Coins	20% Coins	$35/Visit	$0-$25/Visit	$10-$15/Visit	$0-$35/Visit	$20-$25/Visit	0%-20% Coins	$15-$50/Visit	$10/Visit	$20/Visit	$20/Visit	$20-$50/Visit		$10/Visit	20% Coins	20% Coins		"DEN784: Dental 16a, 16b"	"VIS751: Vision 17a,17b"						20% Coins										5100	1.1866	0	0.0749	0	0.3783	0.5322	0.436	0.2222	0.0558	0.48	0.3011	0.0033	0.0063	0.088	0.7497	2.065	0.0016	0.5433		0.0949	1.7162	0		0	0		0		0	0	0.4058										9.341	500	NO	0.258189	2.6738	0	0.131415212	0	0.407579801	0.62250291	0.9641626	1.426283909	0.161119436	0.695569866	1.071599883	0.009502961	0.04017225	0.325152707	0.749681	5.992088269	0.004702887	1.670934856	0	0.094924	3.227489643	0	0	0	0	0	0	0	0	0	0.405779	0	0	0	0	0	0	0	0	0	20.6745
H2029_002_0	2012	6	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									A	A	A	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V				O	O	D	D	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	YES	176.63	0	4.36	145.44	14.09	6.49	11307.84	413.23	173.91	3002.62	1909.26	9.13	0.17	248.63	4289.41	5911.36	4.66	1447.71		543.15	39.14	0		6.28	1.69				1.71	1.03	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	0% Coins: 11a. $0: Diabetic Shoes 11c. 0% DME	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"0% Coins: 15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN842: Dental 16a, 16b"	"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0								NO	0	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	0	0	0	0	0	0	0	0	0	0	0.034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.034	0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0.034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.034	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 0% (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		"DEN842: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						30% Coins	30% Coins	30% Coins(Days 1-100)								5100	2.1968	0.002	0.0669	1.0187	0	0.4891	0.7727	0	1.1925	0.5608	0.9961	0.0039	0.0039	0.3786	1.3382	2.9118	0.0027	0.4056		0.1147	1.4729	0		0	0				0	0	0.8206	0	0.0055								14.754	500	NO	4.12847	2.1968	0.001999	0.066891	1.018732	0	0.489086	0.772684	0	1.192507	0.560836	0.996053	0.003895	0.037864	0.378605	1.338187	2.911821	0.002702	0.405601	0	0.114741	1.472949	0	0	0	0	0	0	0	0	0	0.82055	0	0.005509	0	0	0	0	0	0	0	14.788
H2029_801_0	2012	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	146.25	0.07	2.22	8.45	0.33	7	11.18	14.14	30.07	16.66	29.54	0.07	0.13	9.64	58.28	75.92	0.1	9.48		3.11	31.97	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																					0.1525	0.1525	0.1222	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.127084	0.127084	0.106778	0	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705	0.205705		0.205705	0.205705	0																				18.586	0.00889588	0.23704716	0	0.06788265	1.439935	2.2997819	2.9086687	6.18554935	3.4270453	6.0765257	0.01439935	0.02674165	1.9829962	11.9884874	15.6171236	0.0205705	1.9500834	0	0.63974255	6.57638885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0539	0	NO	9.198084	18.586	0.00889588	0.23704716	0	0.06788265	1.439935	2.2997819	2.9086687	6.18554935	3.4270453	6.0765257	0.01439935	0.02674165	1.9829962	11.9884874	15.6171236	0.0205705	1.9500834	0	0.63974255	6.57638885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0539	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	2.435	0.0011	0.0304	0	0.5108	0.3427	0.5472	0.3122	0.7045	0.3679	0.6713	0.0019	0.0028	0.2128	1.5249	1.9865	0.0026	0.2457		0.0814	0.8366	0																			10.8183	0	NO	0.605224	21.0211	0.00997588	0.26749516	0	0.57873065	1.782661	2.8469559	3.2209067	6.89001335	3.7949233	6.7478517	0.01627035	0.02952565	2.1957922	13.5133844	17.6035876	0.0231965	2.1958064	0	0.72112955	7.41296185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8722
H2029_802_0	2012	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	135.05	0.09	3.07	8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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																					0.1502	0.1502	0.1195	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.127769	0.127769	0.105915	0	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363	0.207363		0.207363	0.207363	0																				17.2552	0.01149921	0.32515905	0	0.05806164	1.37274306	2.16901698	2.93626008	6.99435399	3.48991929	6.00315885	0.0207363	0.03525171	2.35564368	7.02753207	15.28887399	0.01451541	2.15242794	0	0.60342633	8.2737837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3876	0	NO	7.790338	17.2552	0.01149921	0.32515905	0	0.05806164	1.37274306	2.16901698	2.93626008	6.99435399	3.48991929	6.00315885	0.0207363	0.03525171	2.35564368	7.02753207	15.28887399	0.01451541	2.15242794	0	0.60342633	8.2737837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3876	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	2.2432	0.0015	0.0414	0	0.4342	0.3257	0.5146	0.3143	0.7942	0.3735	0.6633	0.0026	0.0039	0.2521	0.8912	1.9392	0.0018	0.2701		0.0764	1.0495	0																			10.1926	0	NO	0.493849	19.4984	0.01298521	0.36657005	0	0.49221464	1.69845906	2.68359898	3.25060408	7.78852399	3.86341729	6.66649785	0.0233303	0.03911171	2.60778268	7.91872107	17.22805199	0.01631441	2.42254394	0	0.67984033	9.3232617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5802
H2029_803_0	2012	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	135.05	0.09	3.07	8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.127411	0.127411	0.105423	0	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385		0.207385	0.207385	0																				17.2069	0.01146699	0.32364861	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3439	0	NO	7.764613	17.2069	0.01146699	0.32364861	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3439	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	2.2364	0.0015	0.0412	0	0.4342	0.3257	0.5146	0.3144	0.7942	0.3735	0.6634	0.0026	0.0039	0.2522	0.8912	1.9393	0.0018	0.2701		0.0764	1.0495	0																			10.1861	0	NO	0.492009	19.4433	0.01294899	0.36486161	0	0.4922458	1.6986237	2.6838591	3.2509336	7.78931205	3.86380955	6.66717375	0.0233325	0.03911545	2.6080476	7.91951865	17.22978605	0.01631695	2.4227883	0	0.67990835	9.3241995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5301
H2029_805_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385		0.207385	0.207385	0																				0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	0	NO	4.7111	0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	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	0.4342	0.3257	0.5146	0.3144	0.7942	0.3735	0.6634	0.0026	0.0039	0.2522	0.8912	1.9393	0.0018	0.2701		0.0764	1.0495	0																			7.907	0	NO	0.298521459	0	0	0	0	0.4922458	1.6986237	2.6838591	3.2509336	7.78931205	3.86380955	6.66717375	0.0233325	0.03911545	2.6080476	7.91951865	17.22978605	0.01631695	2.4227883	0	0.67990835	9.3241995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.709
H2029_806_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385		0.207385	0.207385	0																				0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	0	NO	4.7111	0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	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	0.4342	0.3257	0.5146	0.3144	0.7942	0.3735	0.6634	0.0026	0.0039	0.2522	0.8912	1.9393	0.0018	0.2701		0.0764	1.0495	0																			7.907	0	NO	0.298521459	0	0	0	0	0.4922458	1.6986237	2.6838591	3.2509336	7.78931205	3.86380955	6.66717375	0.0233325	0.03911545	2.6080476	7.91951865	17.22978605	0.01631695	2.4227883	0	0.67990835	9.3241995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.709
H2029_807_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385	0.207385		0.207385	0.207385	0																				0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	0	NO	4.7111	0	0	0	0	0.0580678	1.3728887	2.1692471	2.9365716	6.99509605	3.49028955	6.00379575	0.0207385	0.03525545	2.3558936	7.02827765	15.29049605	0.01451695	2.1526563	0	0.60349035	8.2746615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8019	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	0.4342	0.3257	0.5146	0.3144	0.7942	0.3735	0.6634	0.0026	0.0039	0.2522	0.8912	1.9393	0.0018	0.2701		0.0764	1.0495	0																			7.907	0	NO	0.298521459	0	0	0	0	0.4922458	1.6986237	2.6838591	3.2509336	7.78931205	3.86380955	6.66717375	0.0233325	0.03911545	2.6080476	7.91951865	17.22978605	0.01631695	2.4227883	0	0.67990835	9.3241995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.709
H2029_808_0	2012	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	135.05	0.09	3.07	8.88	0.28	6.62	10.46	14.16	33.73	16.83	28.95	0.1	0.17	11.36	33.89	73.73	0.07	10.38		2.91	39.9	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																					0.1525	0.1525	0.1222	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.129401	0.129401	0.108099	0	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263	0.207263		0.207263	0.207263	0																				17.4756	0.01164609	0.33186393	0	0.05803364	1.37208106	2.16797098	2.93484408	6.99098099	3.48823629	6.00026385	0.0207263	0.03523471	2.35450768	7.02414307	15.28150099	0.01450841	2.15138994	0	0.60313533	8.2697937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5865	0	NO	7.910609	17.4756	0.01164609	0.33186393	0	0.05803364	1.37208106	2.16797098	2.93484408	6.99098099	3.48823629	6.00026385	0.0207263	0.03523471	2.35450768	7.02414307	15.28150099	0.01450841	2.15138994	0	0.60313533	8.2697937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5865	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	2.2741	0.0015	0.0423	0	0.434	0.3256	0.5144	0.3143	0.794	0.3734	0.6632	0.0026	0.0039	0.2521	0.8909	1.9386	0.0018	0.27		0.0764	1.0492	0																			10.2223	0	NO	0.50247	19.7497	0.01315309	0.37416693	0	0.49206664	1.69770706	2.68241198	3.24910208	7.78493299	3.86163229	6.66342085	0.0233193	0.03909371	2.60657768	7.91508707	17.22014499	0.01630741	2.42143194	0	0.67952833	9.3189827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8088
H2034_001_0	2012	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	712.3570868	26.673136	476.9453389	0	43.03273105	42.18494762	31.17313125	35.65769082	69.17502408	20.75192945	41.17607199	0	12.5586179	113.2328561	58.0059161	91.22850959	6.441194311	11.77203734	30.60393478	151.6291068	147.6238569	16.80093585	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 13e:  Home Modification											0	NO	0.08158008	0.08158008	0.163793745	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.08158008	0.08158008	0.163793745	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												58.1141	2.175996558	78.12066325	0	9.639331754	9.449428268	6.9827814	7.987322743	15.49520539	4.648432197	9.223440127	0	2.81313041	25.36415977	12.99332521	20.43518615	1.442827526	2.636936365	6.855281391	33.96491992	33.06774395	3.763409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	345.1737	0	NO	5.68E-14	58.1141	2.175996558	78.12066325	0	9.639331754	9.449428268	6.9827814	7.987322743	15.49520539	4.648432197	9.223440127	0	2.81313041	25.36415977	12.99332521	20.43518615	1.442827526	2.636936365	6.855281391	33.96491992	33.06774395	3.763409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	345.1737	NO																																										0	0	0	0	0	0	0	0	0	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	58.1141	2.175996558	78.12066325	0	9.639331754	9.449428268	6.9827814	7.987322743	15.49520539	4.648432197	9.223440127	0	2.81313041	25.36415977	12.99332521	20.43518615	1.442827526	2.636936365	6.855281391	33.96491992	33.06774395	3.763409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	345.1737
H2034_002_0	2012	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	498.4057255	54.85472137	241.8077992	0	28.91254081	31.00392345	23.79527364	34.44110178	51.54958956	15.05058539	34.40080731	0	8.888925371	96.11841686	48.01906808	68.90831365	13.31074954	7.200830961	23.1145337	113.665576	364.2627657	11.00382656	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 13e:  Home Modification											0	NO	0.080423642	0.080423642	0.16281769	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080423642	0.080423642	0.16281769	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												40.0836	4.411616466	39.37058724	0	6.476409143	6.944878853	5.330141296	7.714806799	11.54710806	3.371331127	7.705780837	0	1.991119283	21.53052538	10.75627125	15.43546226	2.981607898	1.612986135	5.177655549	25.46108903	81.59485952	2.46485715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	301.9627	0	NO	0	40.0836	4.411616466	39.37058724	0	6.476409143	6.944878853	5.330141296	7.714806799	11.54710806	3.371331127	7.705780837	0	1.991119283	21.53052538	10.75627125	15.43546226	2.981607898	1.612986135	5.177655549	25.46108903	81.59485952	2.46485715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	301.9627	NO																																										0	0	0	0	0	0	0	0	0	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	40.0836	4.411616466	39.37058724	0	6.476409143	6.944878853	5.330141296	7.714806799	11.54710806	3.371331127	7.705780837	0	1.991119283	21.53052538	10.75627125	15.43546226	2.981607898	1.612986135	5.177655549	25.46108903	81.59485952	2.46485715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	301.9627
H2108_001_0	2012	8																															D	D	D	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	0.550210195	0.694596732	0.349124658	1.232524691	1.517275908	0.065178231	0.349841755	0	0.006807911	0.693213764	1.756332829	2.798629606	0.000148956	0.043528429	0.784921555	0.542564081	1.215552161	0.009548538	0	0	0	0	0	0	0	0											12.61	YES	2020.123946	129.9664308	1322.962157	21.0540605	17.27660038	21.8103377	10.96251442	39.00878022	47.64246423	7.742496498	10.98503128	0	0.213768399	21.76691251	101.7685423	91.41598275	6.299204832	1.366792699	24.64653719	17.08111183	39.20792345	0.299824086	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - 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 - 20.0%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													250	200	60	0	0.2	0.2	0.167463961	0.135444296	0.2	0	0.2	0	0.2	0.2	0.098172578	0.19067432	0.2	0.2	0.2	0.199477792	0.2	0.2	0	0	0	0	0	0	0	0											NO	210.1355019	168.1084015	50.43252046	0	0.168108402	0.168108402	0.140760494	0.11384662	0.168108402	0	0.168108402	0	0.168108402	0.168108402	0.082518176	0.160269775	0.168108402	0.168108402	0.168108402	0.167669464	0.168108402	0.168108402	0	0	0	0	0	0	0	0												35.375	1.820704078	5.560026337	0	2.904341674	3.666501007	1.543088947	4.441017795	8.009098507	0	1.84667605	0	0.035936264	3.659200869	8.397754497	14.65121902	1.058949255	0.229769336	4.14328997	2.863980868	6.591181339	0.050402948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8481	162	YES	20.27	35.375	1.820704078	5.560026337	0	3.454551869	4.361097739	1.892213605	5.673542486	9.526374416	0.065178231	2.196517805	0	0.042744175	4.352414633	10.15408733	17.44984863	1.059098211	0.273297765	4.928211525	3.406544949	7.8067335	0.059951485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4581	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	35.375	1.820704078	5.560026337	0	3.454551869	4.361097739	1.892213605	5.673542486	9.526374416	0.065178231	2.196517805	0	0.042744175	4.352414633	10.15408733	17.44984863	1.059098211	0.273297765	4.928211525	3.406544949	7.8067335	0.059951485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4581
H2108_020_0	2012	7																															D	D	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	2492.376411	97.4032975	450.1260392	4.124885974	45.84451547	24.51515648	8.10306331	95.400834	36.36482918	26.41598146	19.57293652	0	0.104483809	113.9857122	0	0	5.390918408	0.582746407	41.3720512	2.287973939	5.266761478	0.97334121	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	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 - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													249.7441674	200	0	0	0.2	0.2	0.110750869	65	0.2	0	0.2	0	0.2	0.014843711	0	0	0.2	0	0	25.03262019	0.2	0.2	0	0	0	0	0	0	0	0											NO	230.1664637	184.5899539	0	0	0.185046703	0.182728327	0.102775419	60.19784015	0.184142974	0	0.183313199	0	0.184421482	0.013864107	0	0	0.184589954	0	0	23.50095287	0.186427984	0.184674375	0	0	0	0	0	0	0	0												47.8051	1.49830585	0	0	8.483376427	4.479613535	0.832795728	0.478577013	6.696327788	0	3.587977608	0	0.019269059	1.580310089	0	0	0.995109381	0	0	0.004480797	0.981871724	0.17975118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6229			6.58938079	47.8051	1.49830585	0	0	8.483376427	4.479613535	0.832795728	0.478577013	6.696327788	0	3.587977608	0	0.019269059	1.580310089	0	0	0.995109381	0	0	0.004480797	0.981871724	0.17975118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6229	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	47.8051	1.49830585	0	0	8.483376427	4.479613535	0.832795728	0.478577013	6.696327788	0	3.587977608	0	0.019269059	1.580310089	0	0	0.995109381	0	0	0.004480797	0.981871724	0.17975118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6229
H2108_022_0	2012	7																															D	D	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	1413.243101	37.52348358	1106.360729	16.5066535	233.3166394	12.00618724	3.358915531	450.9369885	288.8615204	7.232858765	22.44761083	0	0.181459857	560.8739677	3509.960825	2554.223152	165.4431165	60.06625137	24.8447347	21.21950727	38.74923587	0.546149276	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													250	200	60	0	150	0.2	0.141545427	48.24165994	229.2158969	0	0.2	0	0.2	71.03164621	5	39.94498866	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	234.0287609	187.2230088	56.16690263	0	140.4172566	0.187223009	0.132502803	45.17428157	214.5724493	0	0.187223009	0	0.187223009	66.4937926	4.680575219	37.39310481	18.72230088	37.44460175	0	37.44460175	0.187223009	0	0	0	0	0	0	0	0	0												27.5616	0.585438291	5.178404609	0	2.730140202	2.247834499	0.445065724	1.697562874	5.165143663	0	4.202709238	0	0.03397346	3.107886441	1.369052971	7.959194503	0.258122984	0.187429738	0	0.066213	7.254748526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0505			4.78	27.5616	0.585438291	5.178404609	0	2.730140202	2.247834499	0.445065724	1.697562874	5.165143663	0	4.202709238	0	0.03397346	3.107886441	1.369052971	7.959194503	0.258122984	0.187429738	0	0.066213	7.254748526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0505	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	27.5616	0.585438291	5.178404609	0	2.730140202	2.247834499	0.445065724	1.697562874	5.165143663	0	4.202709238	0	0.03397346	3.107886441	1.369052971	7.959194503	0.258122984	0.187429738	0	0.066213	7.254748526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0505
H2108_028_0	2012	7																															D	D	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	1083.382188	45.19240911	738.5358412	8.3718161	210.9601502	9.36041652	2.098781381	375.5304738	195.2208616	6.725723233	13.68545413	0	0.266505377	378.587871	2800.655349	2040.288557	210.2988574	34.72310695	13.45395302	15.65879978	15.63367158	0.188157931	0	0	0	0	0	0	0	0											6700	1a:  Acute - $150/$0/day for 1-7/8-90	1b:  Psych - $150/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $45/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit	7a:  Primary Care - $5/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													150	150	60	0	100	0.2	0.127064253	48.32516991	180.8837621	0	0.142890072	0	0.2	68.02961738	5	39.53290556	20	40	0	39.74046753	0.2	0	0	0	0	0	0	0	0	0											NO	146.44566	146.4739437	58.59667517	0	97.70323084	0.195234581	0.123869765	47.19739098	176.7175137	0	0.139313054	0	0.195600043	66.46640766	4.881635363	38.59900569	19.5278755	39.01815056	0	38.77478432	0.194709914	0	0	0	0	0	0	0	0	0												13.2214	0.551625866	3.606312066	0	1.717624021	1.827476998	0.259975557	1.477004883	2.874912108	0	1.906562405	0	0.052128463	2.09694798	1.139314849	6.562759136	0.342224159	0.112902618	0	0.050597215	3.04403085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8438			0.996230335	13.2214	0.551625866	3.606312066	0	1.717624021	1.827476998	0.259975557	1.477004883	2.874912108	0	1.906562405	0	0.052128463	2.09694798	1.139314849	6.562759136	0.342224159	0.112902618	0	0.050597215	3.04403085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8438	NO	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%			4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				5.5809	0.0505	0.8738	0.2564	0.2271	0	0	0.2387	0.4634	0.0235	0.3688	0	0.0071	0.1616	0.5339	0.794	0.0001	0.0375	0.2271	0.2985	0.4575	0.0056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6058			0	18.8023	0.602112607	4.480068596	0.256388886	1.944736737	1.827476998	0.259975557	1.715727848	3.338271887	0.023529083	2.275333276	0	0.059209253	2.258556086	1.673168748	7.356735659	0.342350395	0.150416963	0.227067246	0.349056108	3.501509	0.005575628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4495
H2108_029_0	2012	9																															D	D	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	1224.597839	43.33889387	549.9257049	20.76743472	270.1736182	26.90773744	5.925344406	481.1400012	386.62108	6.695465981	17.71686358	0	0.058151728	362.1845735	4693.53985	3277.022596	199.318993	68.80340312	24.63917415	40.39389577	23.87363189	0.277356271	0	0	0	0	0	0	0	0											6700	1a:  Acute - $150/$0/day for 1-7/8-90	1b:  Psych - $150/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - $0/service	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/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 - $15/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit	7a:  Primary Care - $5/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													150	150	60	0	100	0.2	0.046723994	48.24728392	177.1547422	0	0.164182263	0	0.2	63.29747447	5	39.83910409	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	143.0166843	143.0891903	57.07611944	0	95.22082059	0.190549554	0.04436744	45.99139252	168.8511458	0	0.156423168	0	0.189912878	60.65779216	4.765756944	37.99313783	19.08035197	37.98257553	0	37.98257553	0.190867424	0	0	0	0	0	0	0	0	0												14.5948	0.516777269	2.615635435	0	2.143846135	5.127257371	0.262892365	1.844024888	5.440117697	0	2.771327933	0	0.011043762	1.830776382	1.864022511	10.37536426	0.316923045	0.217777538	0	0.12785535	4.556698613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6172			2.670541799	14.5948	0.516777269	2.615635435	0	2.143846135	5.127257371	0.262892365	1.844024888	5.440117697	0	2.771327933	0	0.011043762	1.830776382	1.864022511	10.37536426	0.316923045	0.217777538	0	0.12785535	4.556698613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6172	NO	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%			4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				7.4096	0.0058	0.7923	0.6267	0.262	0	0	0.3155	1.6302	0.0246	0.423	0	0.0016	0.3119	0.9077	1.4323	0	0.0589	0.4931	0.4709	0.6795	0.008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8537			0	22.0044	0.522605894	3.407887064	0.626746361	2.405839942	5.127257371	0.262892365	2.159566659	7.070363197	0.024594681	3.194282911	0	0.012683276	2.142721603	2.771695264	11.8076899	0.316923045	0.276627605	0.493093178	0.598756828	5.23624253	0.007991961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4709
H2108_030_0	2012	8																															D	D	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	1621.824961	37.58625583	1302.333315	28.1350908	329.7152956	30.73827207	6.928561205	560.9383747	426.0473142	7.084505518	14.69990222	0	0.336384932	620.8295687	5355.238508	4079.631469	160.3979523	111.1338707	31.05861095	36.78227099	23.14768277	0.34317409	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													250	200	60	0	150	0.2	0.050256843	48.16682718	229.5292635	0	0.2	0	0.2	69.5938182	5	39.92118299	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	228.4212094	182.7693163	54.76892782	0	137.2262229	0.182850355	0.045965623	44.07395951	210.2109322	0	0.18297401	0	0.182083325	63.50022336	4.572008816	36.48206609	18.2833417	36.55940623	0	36.65554351	0.183004325	0	0	0	0	0	0	0	0	0												30.8716	0.572467857	5.943949944	0	3.770465389	5.620503952	0.318475635	2.060231268	7.463316924	0	2.689700049	0	0.061250087	3.28523469	2.040349806	12.40278207	0.244384214	0.33858236	0	0.112356178	4.236126063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0318			7.713389977	30.8716	0.572467857	5.943949944	0	3.770465389	5.620503952	0.318475635	2.060231268	7.463316924	0	2.689700049	0	0.061250087	3.28523469	2.040349806	12.40278207	0.244384214	0.33858236	0	0.112356178	4.236126063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0318	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	30.8716	0.572467857	5.943949944	0	3.770465389	5.620503952	0.318475635	2.060231268	7.463316924	0	2.689700049	0	0.061250087	3.28523469	2.040349806	12.40278207	0.244384214	0.33858236	0	0.112356178	4.236126063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0318
H2111_001_0	2012	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	686.9925922	39.6224	11610.27558	45.00487823	15.86985313	36.10831508	37.17825328	10.80359149	24.7404112	46.53800787	16.45833024	0	0.26354198	21.39064655	2.174637915	182.3907904	18.740502	25.44618018	0	19685.78439	5.079922627	3.363888534	1035.450582	172.200505	23.22545297	73.54726774	12.52699028	5.551189835	0	2722.667704											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.063990461	0.064767673	0	0	0.2	0.2	0.184415689	0.070164356	0.16	0	0.071899437	0	0.2	0.146272957	0.077823092	0.027054714	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.059906037	0.06063364	0	0	0.187234271	0.187234271	0.172644686	0.065685861	0.149787417	0	0.067310194	0	0.187234271	0.136936552	0.072741601	0.025288165	0.186940917	0	0	0	0.187234271	0.189657316	0	0	0	0	0	0	0	0												41.155	2.402450348	0	0	2.971380382	6.760714055	6.418627851	0.709643204	3.705802286	0	1.107813398	0	0.049344091	2.92916139	0.158186644	4.612328457	3.503366634	0	0	0	0.95113561	0.637986072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0729	0	NO	5.328215762	41.155	2.402450348	0	0	2.971380382	6.760714055	6.418627851	0.709643204	3.705802286	0	1.107813398	0	0.049344091	2.92916139	0.158186644	4.612328457	3.503366634	0	0	0	0.95113561	0.637986072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0729	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0.4073	0.0056	0.2346	0.5337	0.5496	0.0373	0.2926	0	0.184	0	0.0026	0.2312	0.003	0.5166	0.0531	0.0021	0	0	0.0144	0.0097	0	0	0.0008	0	0.0001	0	0	0											3.0783	0	NO	0.210631429	41.155	2.402450348	0.407320422	0.005616811	3.205963044	7.294454638	6.968183889	0.746992846	3.998365624	0	1.291808716	0	0.051941148	3.160410973	0.161140326	5.128943411	3.556447946	0.002084106	0	0	0.965546756	0.647652527	0	0	0.000804172	0	0.00012037	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1513
H2111_008_0	2012	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	456.5627885	21.839259	83.31407985	2973.779608	26.38622073	26.54557481	23.57123062	50.61940549	64.42373983	22.44094809	37.53547871	0	0.031851479	57.41190719	39.94713166	106.8742748	9.421608	5.800633003	0	694.8823177	27.24602249	11.2533371	734.8217686	561.3196535	36.66306977	199.4848	0	0	160.9397027	3030.685828											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.069905204	0.070754255	0.150855138	0	0.224	0.224	0.224	0.131456619	0.224	0.224	0.224	0	0.224	0.224	0.221490601	0.223820422	0.227606929	0.224	0	0	0.224	0.222229277	0	0	0	0	0	0	0	0											NO	0.069905204	0.070754255	0.150855138	0	0.224	0.224	0.224	0.131456619	0.224	0.224	0.224	0	0.224	0.224	0.221490601	0.223820422	0.227606929	0.224	0	0	0.224	0.222229277	0	0	0	0	0	0	0	0												31.9161	1.545220494	12.56835702	0	5.910513443	5.946208758	5.279955659	6.654255878	14.43091772	5.026772372	8.407947231	0	0.007134731	12.86026721	8.847914214	23.92064523	2.144423265	1.299341793	0	0	6.103109039	2.500820964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.3699	150	YES	0	31.9161	1.545220494	12.56835702	0	5.910513443	5.946208758	5.279955659	6.654255878	14.43091772	5.026772372	8.407947231	0	0.007134731	12.86026721	8.847914214	23.92064523	2.144423265	1.299341793	0	0	6.103109039	2.500820964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.3699	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	4.1853	0.2026	2.6237	1.1897	1.1233	1.1301	0.9806	0.8641	2.2403	0	1.3144	0	0.0009	1.841	2.1856	6.6686	0.5879	0.362	0	0	1.7002	0.6971	0	0.1741	0.0383	0	0	0	0	0											30.1097	150	YES	0	36.1014	1.747852794	15.19206009	1.189651838	7.033785201	7.076264281	6.260522596	7.518369325	16.67117479	5.026772372	9.722310497	0	0.008076772	14.70128767	11.03352469	30.58929049	2.732344039	1.661308948	0	0	7.803296803	3.197915612	0	0.174086448	0.03828672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.4796
H2112_001_0	2012	2																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1510.611686	49.79669122	1180.488654	873.9942175	210.4435363	11.62104548	0	308.2762209	390.7009984	2793.84673	2500.43327	30.12702971	0.046321046	489.2387722	2639.509875	5392.718034	205.2621118	795.8722699	0	0	57.91700193	0.00370844	0	0	1161.655322	103.3308486	43.76141548	9.191027302	76.62641526	0											6700	$265/day 1-6; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	178.5937298	98.56078618	71.93854446	0	200	0.03	0.03	63.5	300	5	24.71627306	50	0.2	50	25	50	40	25	50	50	0.1	0	0	0	0	0	0	0	0	0											NO	157.1050711	86.70180826	63.2827936	0	175.9357075	0.026390356	0	55.85958714	263.9035613	4.398392689	21.74237494	43.98392689	0.175935708	43.98392689	21.99196344	43.98392689	35.18714151	21.99196344	0	0	0.087967854	0	0	0	0	0	0	0	0	0												19.7771	0.359788598	6.225384985	0	3.085377705	0.306683529	0	1.435015202	8.592282075	1.024036252	4.530446473	0.110425423	0.008149526	1.793220199	4.837333723	19.76607631	0.601882248	1.458566155	0	0	5.094834356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0066	0	NO	11.50329696	19.7771	0.359788598	6.225384985	0	3.085377705	0.306683529	0	1.435015202	8.592282075	1.024036252	4.530446473	0.110425423	0.008149526	1.793220199	4.837333723	19.76607631	0.601882248	1.458566155	0	0	5.094834356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0066	NO																																																																																		0		NO		19.7771	0.359788598	6.225384985	0	3.085377705	0.306683529	0	1.435015202	8.592282075	1.024036252	4.530446473	0.110425423	0.008149526	1.793220199	4.837333723	19.76607631	0.601882248	1.458566155	0	0	5.094834356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0066
H2112_007_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1300.792738	95.19538393	1204.05292	694.2204958	180.7053678	13.31635829	0	362.9059592	424.6373098	2547.696012	2386.288497	43.52419107	0.063082798	403.7776192	3252.881336	4500.551767	284.7334988	762.2495225	0	0	54.30088426	0	0	0	991.6531603	119.6059013	54.10743153	0	23.77807133	0											6700	$255/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $140/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	184.3280449	98.56078618	77.98824527	0	175	0.03	0.03	63.5	300	5	24.71627306	50	0.2	50	25	50	40	25	50	50	0.1	0	0	0	0	0	0	0	0	0											NO	162.6477984	86.96829007	68.81544477	0	154.416897	0.026471468	0	56.03127404	264.7146805	4.411911342	21.80920108	44.11911342	0.176476454	44.11911342	22.05955671	44.11911342	35.29529073	22.05955671	0	0	0.088238227	0	0	0	0	0	0	0	0	0												17.6309	0.68991498	6.904786432	0	2.32533018	0.352503553	0	1.694506937	9.367310816	0.936684078	4.336920472	0.160020727	0.011132628	1.484525881	5.979760025	16.54669616	0.837479302	1.401240547	0	0	4.791413742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4511	0	NO	10.69598585	17.6309	0.68991498	6.904786432	0	2.32533018	0.352503553	0	1.694506937	9.367310816	0.936684078	4.336920472	0.160020727	0.011132628	1.484525881	5.979760025	16.54669616	0.837479302	1.401240547	0	0	4.791413742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4511	NO																																																																																		0		NO		17.6309	0.68991498	6.904786432	0	2.32533018	0.352503553	0	1.694506937	9.367310816	0.936684078	4.336920472	0.160020727	0.011132628	1.484525881	5.979760025	16.54669616	0.837479302	1.401240547	0	0	4.791413742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4511
H2112_014_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1779.706868	60.8199255	1620.407124	663.8213584	234.7613659	14.4208395	0	414.6668637	429.6915814	3081.537779	2912.61029	58.85002781	0	648.3723306	4109.301144	6028.774056	303.5856978	1127.189002	0	0	76.27094824	0	0	0	1128.157378	96.35335545	43.09270671	0	36.34014375	0											6700	$175/day 1-10; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $35 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $150 Complex Radiology	$35 per visit	20% per visit	$0 to 250 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	143.44	96.15686456	61.85570977	0	150	0.03	0.03	63.5	250	3.5	24.13272942	35	0.2	35	10	35	35	17.5	35	35	0.1	0	0	0	0	0	0	0	0	0											NO	131.4715023	88.13362692	56.69452798	0	137.4841422	0.027496828	0	58.20162018	229.1402369	3.207963317	22.11911735	32.07963317	0	32.07963317	9.165609478	32.07963317	32.07963317	16.03981659	0	0	0.091656095	0	0	0	0	0	0	0	0	0												19.4984	0.446690052	7.65568475	0	2.68966375	0.39652735	0	2.011190275	8.204969232	0.823788346	5.3686974	0.157323942	0	1.733295544	3.138687459	16.11673835	0.811576485	1.506658738	0	0	6.990697261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5506	0	NO	7.696208708	19.4984	0.446690052	7.65568475	0	2.68966375	0.39652735	0	2.011190275	8.204969232	0.823788346	5.3686974	0.157323942	0	1.733295544	3.138687459	16.11673835	0.811576485	1.506658738	0	0	6.990697261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5506	NO																																																																																		0		NO		19.4984	0.446690052	7.65568475	0	2.68966375	0.39652735	0	2.011190275	8.204969232	0.823788346	5.3686974	0.157323942	0	1.733295544	3.138687459	16.11673835	0.811576485	1.506658738	0	0	6.990697261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5506
H2112_801_0	2012	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	0	0	0	0	0	0	0											0	YES	333.3843941	5.044254515	40.2142939	9.393236984	9.386051726	13.3712583	0	20.10095431	47.73788309	22.57829674	58.60615313	0.796512083	0.069562814	31.7833445	33.51227327	150.252344	2.845839668	11.58597953	0	0	70.37496789	0.000307135	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	NO	0.064956556	0.064956556	0.153423559	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.054037866	0.054037866	0.127634257	0	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0.186347349	0	0	0	0	0	0	0	0												18.0154	0.27258075	5.132721526	0	1.749065858	2.491698539	0	3.745759549	8.895827966	4.207405745	10.92110128	0.148427915	0.012962846	5.922741993	6.244923286	27.999126	0.530314678	2.159016572	0	0	13.11418871	5.72E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5633	0	NO	22.54206498	18.0154	0.27258075	5.132721526	0	1.749065858	2.491698539	0	3.745759549	8.895827966	4.207405745	10.92110128	0.148427915	0.012962846	5.922741993	6.244923286	27.999126	0.530314678	2.159016572	0	0	13.11418871	5.72E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5633	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.0154	0.27258075	5.132721526	0	1.749065858	2.491698539	0	3.745759549	8.895827966	4.207405745	10.92110128	0.148427915	0.012962846	5.922741993	6.244923286	27.999126	0.530314678	2.159016572	0	0	13.11418871	5.72E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5633
H2112_802_0	2012	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	0	0	0	0	0	0	0											0	YES	306.8067586	4.942163502	35.94389972	8.622311896	8.907198312	14.16557932	0	17.05214843	46.95318774	22.15164012	63.73893811	0.697139999	0.060884224	31.26544274	31.88911214	136.8352141	2.537853301	11.73300749	0	0	64.67137763	0.000268817	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	NO	0.063738306	0.063738306	0.15134952	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.053084392	0.053084392	0.126051313	0	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0.186558201	0	0	0	0	0	0	0	0												16.2867	0.262351744	4.530775771	0	1.661710893	2.642704994	0	3.181218136	8.759502238	4.13257013	11.89102163	0.130057184	0.011358451	5.832824752	5.949175393	25.52773137	0.473457346	2.18888877	0	0	12.06497587	5.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.527	0	NO	21.17902958	16.2867	0.262351744	4.530775771	0	1.661710893	2.642704994	0	3.181218136	8.759502238	4.13257013	11.89102163	0.130057184	0.011358451	5.832824752	5.949175393	25.52773137	0.473457346	2.18888877	0	0	12.06497587	5.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.527	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		16.2867	0.262351744	4.530775771	0	1.661710893	2.642704994	0	3.181218136	8.759502238	4.13257013	11.89102163	0.130057184	0.011358451	5.832824752	5.949175393	25.52773137	0.473457346	2.18888877	0	0	12.06497587	5.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.527
H2161_001_0	2012	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	305.6673182	6.725000337	148.422469	0	18.95575296	23.13530288	17.15981903	31.32741472	46.52442122	17.99305231	34.22656631	0	11.06658631	69.31812842	44.3060341	51.57289337	2.447191623	5.513447095	14.18289947	80.45333756	41.81460777	0.191788452	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"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 14a	Not Covered	Not Covered	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	Not Covered	No Cost Sharing; PBP 18b	Not Covered	Not Covered											0	NO	0.080460577	0.080460577	0.180194296	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080460577	0.080460577	0.180194296	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												24.5942	0.541097408	26.74488238	0	4.246088663	5.182307846	3.843799463	7.017340897	10.42147035	4.030443717	7.666750854	0	2.478915333	15.52726077	9.924551639	11.55232812	0.548170924	1.235012149	3.176969481	18.02154761	9.366472141	0.042960613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.1625	0	NO	0	24.5942	0.541097408	26.74488238	0	4.246088663	5.182307846	3.843799463	7.017340897	10.42147035	4.030443717	7.666750854	0	2.478915333	15.52726077	9.924551639	11.55232812	0.548170924	1.235012149	3.176969481	18.02154761	9.366472141	0.042960613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.1625	NO																																										0	0	0	0	0	0	0	0	0	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	24.5942	0.541097408	26.74488238	0	4.246088663	5.182307846	3.843799463	7.017340897	10.42147035	4.030443717	7.666750854	0	2.478915333	15.52726077	9.924551639	11.55232812	0.548170924	1.235012149	3.176969481	18.02154761	9.366472141	0.042960613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.1625
H2165_004_0	2012	4																															D	D	D		T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	523.1439859	47.42274431	428.3848529		242.2725629	3.379347561	3.735068356	303.8174561	396.7831891		590.0468447	5.599714002	0	322.57785	3850.116933	3204.122829	96.12076287	237.1603903			15.89395907																				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/c; 0%-20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 CP Per ER Visit, Waived If Admitted; $30 CP Per Visit, Waived if Admitted"	9a/b; $100 CP Per Surg	8a; No Cost Sharing	8a/b; $100 CP Per Radiology Test Type; $30 CP Per Radiation Therapy	"5, 9c; $30 CP Per Visit"	12; 20% Coins.	"3, 9a; OBS $100 CP Per Visit; $15 per Rehab Therapy visit"	7a; $15 CP Per Visit	"7b/d/f/g,16b,17a,18a; $30 CP Per Visit; $20 CP Per Chiro Visit"	7e/h; $30 CP Per Visit	7c/i; $15 CP Per Visit Per PT/OT/ST	8a; No Cost Sharing	14; No Cost Sharing	15; 20% Coins.																						150	225	50	0	103.2531458	0.2	0.2	65	100	0	70.77376456	30	0.2	18.07029241	15	29.98692165	30	15	30	0	0.2																				NO	146.055	219.0825	48.685	0	100.537588	0.19474	0.19474	63.2905	97.37	0	68.91241455	29.211	0.19474	17.59504372	14.6055	29.19826561	29.211	14.6055	29.211	0	0.19474																					6.3673	0.865791115	1.737993047	0	2.029791594	0.658094144	0.727367212	1.602396559	3.219564927	0	3.388462731	0.013631104	0	0.472980948	4.686073572	7.796235783	0.233981967	0.28865384	0	0	3.095189588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1835			1.015	6.3673	0.865791115	1.737993047	0	2.029791594	0.658094144	0.727367212	1.602396559	3.219564927	0	3.388462731	0.013631104	0	0.472980948	4.686073572	7.796235783	0.233981967	0.28865384	0	0	3.095189588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1835	NO																																																																																		0				6.3673	0.865791115	1.737993047	0	2.029791594	0.658094144	0.727367212	1.602396559	3.219564927	0	3.388462731	0.013631104	0	0.472980948	4.686073572	7.796235783	0.233981967	0.28865384	0	0	3.095189588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1835
H2165_005_0	2012	6																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	805.747081	41.08479671	459.1580088	661.3431174	240.5760618	3.777349167	7.64590808	413.8455309	608.9785241		973.5124348	6.26242343	0	412.9025712	6350.7728	4304.556742	260.781495	418.6011763			21.11673095																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-30 Days); $0 (31-100)	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/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit, Waived if Admitted; $40 Per Urgent Visit, Waived if Admitted"	9a/b; $300 CP Per Surg	8a; No Cost Sharing	"8a/b; $200 Per MRI/MRA, CT & Nuclear Med; $225 Per PET, Sleep, & Other; $40 Per Radiation Therapy"	"5, 9c; $40 CP Per Visit"	12; 20% Coins.	"3,9a; $200 CP Per OBS; $10 CP Per Rehab Therapy Visit"	7a; $10 CP Per Visit	"7b/d/f/g,16b,17a,18a; $40 CP Per Visit, Chrio $20 Per Visit"	"7e/h, $40 CP Per Visit"	7c/i; $10 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						300	225	100	10	103.2227356	0.2	0.2	65	300	0	148.3519818	40	0.2	17.10125874	10	39.97483418	40	10	0	0	0.2																				NO	265.32	198.99	88.44	8.844	91.29018735	0.17688	0.17688	57.486	265.32	0	131.2024927	35.376	0.17688	15.12435323	8.844	35.35374335	35.376	8.844	0	0	0.17688																					17.8151	0.681288641	3.383994525	0.487409877	1.830186146	0.668137521	1.352408221	1.982527016	13.46451517	0	10.64393818	0.018461624	0	0.520407028	4.680519554	12.68184953	0.768783847	0.308509067	0	0	3.73512737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0231			9.976	17.8151	0.681288641	3.383994525	0.487409877	1.830186146	0.668137521	1.352408221	1.982527016	13.46451517	0	10.64393818	0.018461624	0	0.520407028	4.680519554	12.68184953	0.768783847	0.308509067	0	0	3.73512737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0231	NO																																																																																		0				17.8151	0.681288641	3.383994525	0.487409877	1.830186146	0.668137521	1.352408221	1.982527016	13.46451517	0	10.64393818	0.018461624	0	0.520407028	4.680519554	12.68184953	0.768783847	0.308509067	0	0	3.73512737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0231
H2165_011_0	2012	6																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN			P																																																									0	YES	597.3940158	36.0424943	415.0237464	977.6314356	184.5292421	5.723165288	8.01188743	317.6397336	612.1107582		776.3397608	10.85017977	0.184539796	582.8936111	5940.354822	5084.211349	202.4578598	560.2086511			25.09059795			260.8																	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; $5 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	11bc; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $35 Per Urgent Visit, Waived if admitted"	9a/b; $300 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 Per MRI/MRA, CT, Nuclear Med; $200 Per Pet, Sleep, & Other; $35 CP Per Radiation Therapy"	"5, 9c; $35 CP Per Visit"	12; 20% Coins.	"3,9a; OBS $200 CP Per Visit;  $5 CP Per Rehab Therapy Visit"	7a; $5 CP Per Visit	"7b/d/f/g,16b,17a,18a; $35 CP Per Visit, Chrio $20 Per Visit"	"7e/h, $35 CP Per Visit"	7c/i; $5 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.			"$20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																			300	225	100	5	104.5855258	0.2	0.2	65	300	0	120.9713557	35	0.2	11.70427451	5	34.97517739	35	5	0	0	0.2			31.132																	NO	271.8	203.85	90.6	4.53	94.75448637	0.1812	0.1812	58.89	271.8	0	109.6000483	31.71	0.1812	10.6040727	4.53	31.68751071	31.71	4.53	0	0	0.1812			31.132																		13.531	0.612271872	3.133429285	0.369055867	1.45708113	1.03703755	1.451754002	1.558816993	13.86430867	0	7.09057294	0.0286716	0.033438611	0.515087186	2.242483945	13.42550013	0.534994894	0.211478766	0	0	4.546416348	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.32			6.80775	13.531	0.612271872	3.133429285	0.369055867	1.45708113	1.03703755	1.451754002	1.558816993	13.86430867	0	7.09057294	0.0286716	0.033438611	0.515087186	2.242483945	13.42550013	0.534994894	0.211478766	0	0	4.546416348	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.32	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 Copay; 20% air	30% Coinsurance	Included in Line e1		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																					0.5543		0.0653		0.02	0.0592			0.2051	0.2148					0.6142						0.075																				1.8079				14.0853	0.612271872	3.198715837	0.369055867	1.47708113	1.096242708	1.451754002	1.558816993	14.06936053	0.214819221	7.09057294	0.0286716	0.033438611	0.515087186	2.856694856	13.42550013	0.534994894	0.211478766	0	0	4.621413534	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1278
H2165_013_0	2012	6																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	678.7505525	55.63821844	614.4253838		242.523779	5.992721677	9.409855742	292.1132213	381.3579461		771.8014998	15.37880653	0	141	2926.928258	5286.111942	238.2600357	462.3918778			7.59390393																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-8 Days); $50 (9-20 Days); $0 (21-100)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $35 Per Urgent Visit, Waived if Admitted"	9a/b; $200 CP Per Surg	8a; No Cost Sharing	8a/b; $150 Per Diagnostic Radiology Test Type; $35 CP Per Radiation Therapy	"5, 9c; $35 CP Per Visit"	12; 20% Coins.	"3, 9a; $200 Per Obs Visit; $10 CP Per Rehab Therapy"	7a; $10 CP Per Visit	"7b/d/f/g,16b,17a,18a; $35 CP Per Visit, Chrio $20 Per Visit"	7e/h; $35 CP Per Visit	7c/i; $10 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						300	225	50	0	103.2227356	0.2	0.2	65	200	0	134.012975	35	0.2	22.31481481	10	34.2019757	35	10	0	0	0.2																				NO	279.12	209.34	46.52	0	96.03843319	0.18608	0.18608	60.476	186.08	0	124.6856719	32.564	0.18608	20.7617037	9.304	31.82151819	32.564	9.304	0	0	0.18608																					15.7877	0.970608721	2.381922405	0	1.940966979	1.11512565	1.750985956	1.472153264	5.913590551	0	8.019382383	0.041732955	0	0.243950019	2.269345043	14.01767561	0.646558317	0.358507836	0	0	1.413073643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3433			4.40075	15.7877	0.970608721	2.381922405	0	1.940966979	1.11512565	1.750985956	1.472153264	5.913590551	0	8.019382383	0.041732955	0	0.243950019	2.269345043	14.01767561	0.646558317	0.358507836	0	0	1.413073643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3433	NO																																																																																		0				15.7877	0.970608721	2.381922405	0	1.940966979	1.11512565	1.750985956	1.472153264	5.913590551	0	8.019382383	0.041732955	0	0.243950019	2.269345043	14.01767561	0.646558317	0.358507836	0	0	1.413073643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3433
H2165_014_0	2012	4																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	615.6570737	55.63821844	722.8477586		242.523779	5.992721677	9.409855742	292.1132213	381.3579461		771.8014998	15.37880653	0	141	2926.928258	5286.111942	238.2600357	462.3918778			7.59390393																				3400	1a; $225/days 1-7 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-5 Days); $50 (6-20 Days); $0 (21-100 days)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit, Waived if Admitted; $30 Per Urgent Visit, Waived if Admitted"	9a/b; $150 CP Per Surg	8a; No Cost Sharing	8a/b; $150 Per Diagnostic Radiology Test Type; $30 CP per Radiation Therapy	"5, 9c; $30 CP Per Visit"	12; 20% Coins.	"3, 9a; $200 Per Obs Visit; $15 CP Per Rehab Therapy"	7a; $15 CP Per Visit	"7b/d/f/g,16b,17a,18a; $30 CP Per Visit, Chrio $20 Per Visit"	7e/h; $30 CP Per Visit	7c/i;  $15 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						225	225	50	0	103.2227356	0.2	0.2	65	150	0	133.3178869	30	0.2	26.99074074	15	29.4679838	30	15	0	0	0.2																				NO	212.355	212.355	47.19	0	97.42161785	0.18876	0.18876	61.347	141.57	0	125.8254217	28.314	0.18876	25.47386111	14.157	27.81188311	28.314	14.157	0	0	0.18876																					10.8948	0.984587823	2.842598811	0	1.968921576	1.131186144	1.77620437	1.493355815	4.499070369	0	8.092687431	0.036286294	0	0.299317868	3.453043612	12.25139395	0.562174554	0.545506818	0	0	1.433425306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2646			3.132	10.8948	0.984587823	2.842598811	0	1.968921576	1.131186144	1.77620437	1.493355815	4.499070369	0	8.092687431	0.036286294	0	0.299317868	3.453043612	12.25139395	0.562174554	0.545506818	0	0	1.433425306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2646	NO																																																																																		0				10.8948	0.984587823	2.842598811	0	1.968921576	1.131186144	1.77620437	1.493355815	4.499070369	0	8.092687431	0.036286294	0	0.299317868	3.453043612	12.25139395	0.562174554	0.545506818	0	0	1.433425306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2646
H2165_015_0	2012	7																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN			P																																																									0	YES	678.7505525	55.63821844	614.4253838		242.523779	5.992721677	9.409855742	292.1132213	381.3579461		771.8014998	15.37880653	0	141	2926.928258	5286.111942	238.2600357	462.3918778			7.59390393			260.8																	3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-8 Days); $50 (9-20 Days); $0 (21-100 days)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit; Waived if Admitted, $35 Per Urgent Visit, waived if Admitted"	9a/b; $200 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 Per Diagnostic Radiology Test Type, $35 CP Per Radiation Therapy"	"5, 9c; $35 CP Per Visit"	12; 20% Coins.	"3,9a; $200 Per Obs Visit; $5 CP Per Rehab Therapy"	7a; $5 CP Per Visit	"7b/d/f/g,16b,17a,18a; $35 CP Per Visit, Chrio $20 Per Visit"	7e/h; $35 CP Per Visit	7c/i; $5 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.			"$20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																			300	225	50	0	103.2227356	0.2	0.2	65	200	0	134.012975	35	0.2	17.63888889	5	34.2	35	5	0	0	0.2			31.132																	NO	279.09	209.3175	46.515	0	96.02811092	0.18606	0.18606	60.4695	186.06	0	124.6722706	32.5605	0.18606	16.40945833	4.6515	31.81626	32.5605	4.6515	0	0	0.18606			31.132																		15.786	0.970504399	2.381666394	0	1.940758362	1.115005795	1.750797759	1.471995036	5.912954954	0	8.018520454	0.041728469	0	0.192811135	1.134550566	14.01535933	0.646488824	0.179234652	0	0	1.412921765	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6479			4.408	15.786	0.970504399	2.381666394	0	1.940758362	1.115005795	1.750797759	1.471995036	5.912954954	0	8.018520454	0.041728469	0	0.192811135	1.134550566	14.01535933	0.646488824	0.179234652	0	0	1.412921765	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6479	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																					0.6365		0.1715		0.02	0.0642		0.0501	0.0954	0.1458					0.432						0.0229																				1.6385				16.4225	0.970504399	2.553185558	0	1.960758362	1.179213528	1.750797759	1.522130502	6.008400553	0.145771358	8.018520454	0.041728469	0	0.192811135	1.566548333	14.01535933	0.646488824	0.179234652	0	0	1.435793477	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2864
H2165_016_0	2012	5																															D	D	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	1989.701108	199.9428872	435.9294231	2.30864686	62.52331496	8.146471731	12.01417073	116.3023398	12.21567625	13.20484776	9.777987201	0	0.049687239	34.39474174	0	0	5.763073678	0.656394659	11.9430358	3.502762305	5.332753747	0.708610666	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	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 - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/7f:  Routine Footcare - $0/visit/12 Visits14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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 & Upgrades - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Nutritional Benefit - $0/service	14b:  Member Quality Incentive Program - $0/service													225	200	0	0	0.2	0.2	0.120014537	65	0.2	0	0.2	0	0.2	0.05880411	0	0	0.2	0	0	18.96682145	0.2	0.2	0	0	0	0	0	0	0	0											NO	213.5173875	189.7932333	0	0	0.189793233	0.189793233	0.113889735	61.68280082	0.189793233	0	0.189793233	0	0.189793233	0.055803111	0	0	0.189793233	0	0	17.99887184	0.189793233	0.189793233	0	0	0	0	0	0	0	0												35.403	3.162317254	0	0	11.8665021	1.54614521	1.368290726	0.597821172	2.318452692	0	1.855795806	0	0.009430302	1.919333576	0	0	1.093792387	0	0	0.005253814	1.012120576	0.134489509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2927			3.35	35.403	3.162317254	0	0	11.8665021	1.54614521	1.368290726	0.597821172	2.318452692	0	1.855795806	0	0.009430302	1.919333576	0	0	1.093792387	0	0	0.005253814	1.012120576	0.134489509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2927	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	35.403	3.162317254	0	0	11.8665021	1.54614521	1.368290726	0.597821172	2.318452692	0	1.855795806	0	0.009430302	1.919333576	0	0	1.093792387	0	0	0.005253814	1.012120576	0.134489509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2927
H2165_801_0	2012	1																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	208.8840392	3.284861927	57.17305473	26.50299584	11.67825715	11.2772897	10.12528772	16.71182185	31.81519945	6.169110238	14.0296094	18.71962521	0	9.672107818	30.79611419	91.50814824	0.743141429	3.179979946	17.77187189	0	7.62390393																				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																						0.084146158	0.084146158	0.193486437	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.080788727	0.080788727	0.185766328	0	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624																					16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709			3.6685	16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709	NO																																																																																		0				16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709
H2165_802_0	2012	1																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	208.8840392	3.284861927	57.17305473	26.50299584	11.67825715	11.2772897	10.12528772	16.71182185	31.81519945	6.169110238	14.0296094	18.71962521	0	9.672107818	30.79611419	91.50814824	0.743141429	3.179979946	17.77187189	0	7.62390393																				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																						0.084146158	0.084146158	0.193486437	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.080788727	0.080788727	0.185766328	0	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624	0.2150624																					16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709			3.6685	16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709	NO																																																																																		0				16.8755	0.265379812	10.62082846	0	2.511554011	2.425320988	2.177568678	3.594084515	6.842253151	1.326743654	3.01724147	4.025887524	0	2.08010672	6.623086229	19.67996198	0.159821779	0.683894119	3.822061421	0	1.639615076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3709
H2174_001_0	2012	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	305.9858834	33.48209202	48.36783797	0	17.78496782	35.87858073	13.50830926	80.53683893	62.45916152	2.129634977	5.360965491	0	0.041677487	15.31219766	54.64041286	67.54087278	7.07640869	15.41680825	28.87448909	80.24471254	29.4306225	0.40136362	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	No Cost-Sharing; PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.082417494	0.082417494	0.126457503	0	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0.222682689	0	0	0	0	0	0	0	0												25.2186	2.759510131	6.116476032	0	3.960404457	7.989538834	3.008066629	17.93415986	13.90857404	0.474232843	1.193794211	0	0.009280855	3.409761349	12.16747406	15.04018317	1.575793716	3.433056316	6.429848873	17.86910836	6.553690156	0.08937673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1409	0	NO	0.882264258	25.2186	2.759510131	6.116476032	0	3.960404457	7.989538834	3.008066629	17.93415986	13.90857404	0.474232843	1.193794211	0	0.009280855	3.409761349	12.16747406	15.04018317	1.575793716	3.433056316	6.429848873	17.86910836	6.553690156	0.08937673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1409	NO																																										0	0	0	0	0	0	0	0	0	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	25.2186	2.759510131	6.116476032	0	3.960404457	7.989538834	3.008066629	17.93415986	13.90857404	0.474232843	1.193794211	0	0.009280855	3.409761349	12.16747406	15.04018317	1.575793716	3.433056316	6.429848873	17.86910836	6.553690156	0.08937673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1409
H2174_002_0	2012	6																															D	D	D		T	Coin	Coin	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	670.8916664	4.656335609	870.8625843	0	287.597736	14.10061454	5.017157559	376.4911994	384.225735	0	85.87669274	0	0	104.3016384	4912.67695	5390.371535	205.0072204	829.5601197	0	0	62.00589586	0	0	0	0	0	0	0	0	0											2500	"$200/Days 1-5 for IP Medical, IP Surgical; PBP 1a"	"$200/Days 1-5 for IP Psych, IP Substance Abuse; PBP 1b"	$50/Days 5-100 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/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for PCP Urgent Care; $30/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$125/Case for OP Surg; $150/Visit for ASC services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 5	No Cost-Sharing; PBP 12	"$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP Office Visits; PBP 7a, 14a, 14b"	"$20/Visit for Speclst Office Visits; $10/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14a, 14b"	"No Cost-Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	200	200	50	0	100	0.2	0.2	45.8663761	137.6248572	0	100	0	0	24.94703125	15	19.64123303	20	25	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	169.6703583	169.6703583	42.41758957	0	84.83517913	0.169670358	0.169670358	38.91082232	116.7542942	0	84.83517913	0	0	21.16385865	12.72527687	16.66267522	16.96703583	21.20879478	0	0	0.169670358	0	0	0	0	0	0	0	0	0												9.4859	0.065836844	3.078324306	0	2.033200454	2.39245632	0.851262921	1.220798514	3.738333707	0	0.607113718	0	0	0.183952094	5.209597864	7.484834185	0.289863738	1.466164195	0	0	10.52056257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6282	0	NO	8.692590772	9.4859	0.065836844	3.078324306	0	2.033200454	2.39245632	0.851262921	1.220798514	3.738333707	0	0.607113718	0	0	0.183952094	5.209597864	7.484834185	0.289863738	1.466164195	0	0	10.52056257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6282	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	9.4859	0.065836844	3.078324306	0	2.033200454	2.39245632	0.851262921	1.220798514	3.738333707	0	0.607113718	0	0	0.183952094	5.209597864	7.484834185	0.289863738	1.466164195	0	0	10.52056257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6282
H2174_003_0	2012	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	632.7496838	42.66026299	613.1820072	0	91.85365284	8.711000752	39.51210096	72.47215808	37.43642281	28.74384167	21.44676101	0	8.943627243	279.1726854	14.91726108	24.22919638	10.53351758	1.116220079	27.48426261	246.351637	13.89634378	8.031856462	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	PBP 13a-e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081886294	0.081886294	0.125642455	0	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0.221247446	0	0	0	0	0	0	0	0												51.8135	3.493290842	77.04169261	0	20.32238612	1.927286671	8.741951436	16.0342799	8.282712945	6.359501567	4.745041105	0	1.978754688	61.76624372	3.30040592	5.360647826	2.330513865	0.246960842	6.080822916	54.50467058	3.074530575	1.777027731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	339.1822	0	NO	4.219788157	51.8135	3.493290842	77.04169261	0	20.32238612	1.927286671	8.741951436	16.0342799	8.282712945	6.359501567	4.745041105	0	1.978754688	61.76624372	3.30040592	5.360647826	2.330513865	0.246960842	6.080822916	54.50467058	3.074530575	1.777027731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	339.1822	NO																																										0	0	0	0	0	0	0	0	0	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	51.8135	3.493290842	77.04169261	0	20.32238612	1.927286671	8.741951436	16.0342799	8.282712945	6.359501567	4.745041105	0	1.978754688	61.76624372	3.30040592	5.360647826	2.330513865	0.246960842	6.080822916	54.50467058	3.074530575	1.777027731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	339.1822
H2174_004_0	2012	3																															D	D	D		T	Coin	Coin	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	397.5738593	5.279201078	539.5179625	0	209.0705024	8.188871766	5.961865777	252.8010154	267.0253774	0	86.33964842	0	0	117.0011183	3974.542056	4403.386833	82.30870554	407.5680618	0	0	62.20444888	0	0	0	0	0	0	0	0	0											2500	"$200/Days 1-5 for IP Medical, IP Surgical; PBP 1a"	"$200/Days 1-5 for IP Psych, IP Substance Abuse; PBP 1b"	$50/Days 5-100 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/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for PCP Urgent Care; $30/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$125/Case for OP Surg; $150/Visit for ASC services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 5	No Cost-Sharing; PBP 12	"$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP Office Visits; PBP 7a, 14a, 14b"	"$20/Visit for Speclst Office Visits; $10/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14a, 14b"	"No Cost-Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	200	200	50	0	100	0.2	0.2	47.78857914	137.3894817	0	100	0	0	25	15	19.55691115	20	25	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	178.5343689	178.5343689	44.63359224	0	89.26718447	0.178534369	0.178534369	42.6595191	122.643722	0	89.26718447	0	0	22.31679612	13.39007767	17.45790396	17.85343689	22.31679612	0	0	0.178534369	0	0	0	0	0	0	0	0	0												5.915	0.078543236	2.006718729	0	1.555261259	1.461995053	1.064397944	0.898697479	2.72908218	0	0.642274777	0	0	0.217590842	4.434952236	6.406158701	0.122457773	0.757967778	0	0	11.10563203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3968	0	NO	4.736772791	5.915	0.078543236	2.006718729	0	1.555261259	1.461995053	1.064397944	0.898697479	2.72908218	0	0.642274777	0	0	0.217590842	4.434952236	6.406158701	0.122457773	0.757967778	0	0	11.10563203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3968	NO																																										0	0	0	0	0	0	0	0	0	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	5.915	0.078543236	2.006718729	0	1.555261259	1.461995053	1.064397944	0.898697479	2.72908218	0	0.642274777	0	0	0.217590842	4.434952236	6.406158701	0.122457773	0.757967778	0	0	11.10563203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3968
H2174_005_0	2012	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	499.1180682	33.65077804	357.5311008	0	61.76604467	5.857557016	26.56955147	58.7970861	34.70734122	19.11659665	14.26354322	0	5.948115599	185.6696905	10.977769	16.96086234	7.083171905	0.750592258	18.48149648	177.2079205	95.46072871	5.400939657	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	PBP 13a-e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.082075923	0.082075923	0.125933412	0	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0.221759801	0	0	0	0	0	0	0	0												40.9656	2.761918652	45.02511131	0	13.69722576	1.298970677	5.89205844	13.0388301	7.696693073	4.239292664	3.163080502	0	1.31905293	41.17407357	2.434427867	3.761237452	1.57076279	0.16645119	4.098452977	39.29759314	21.16935218	1.197711302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	253.9679	0	NO	2.565562547	40.9656	2.761918652	45.02511131	0	13.69722576	1.298970677	5.89205844	13.0388301	7.696693073	4.239292664	3.163080502	0	1.31905293	41.17407357	2.434427867	3.761237452	1.57076279	0.16645119	4.098452977	39.29759314	21.16935218	1.197711302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	253.9679	NO																																										0	0	0	0	0	0	0	0	0	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	40.9656	2.761918652	45.02511131	0	13.69722576	1.298970677	5.89205844	13.0388301	7.696693073	4.239292664	3.163080502	0	1.31905293	41.17407357	2.434427867	3.761237452	1.57076279	0.16645119	4.098452977	39.29759314	21.16935218	1.197711302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	253.9679
H2174_008_0	2012	7																															D	D	D		T	Coin	Coin	V	V	V	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	535.6829876	8.72963898	877.9930335	0	205.8848961	10.55010562	6.675506463	216.8427906	233.1857684	718.3280597	21.0074562	0	0	165.265603	4355.831645	4618.129471	115.0599691	392.2921146	0	0	41.16278655	0	0	0	0	0	0	0	0	0											6700	"$200/Days 1-7 for IP Medical, IP Surgical; PBP 1a"	"$200/Days 1-7 for IP Psych, IP Substance Abuse; PBP 1b"	$50/Days 1-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Case for ER - Facility; $65/Case for ER - Worldwide; $40/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Case for OP Fac - Surgery; PBP 9a, 9b"	$10/Case for OP Fac - Pathology; PBP 8a	$20/Case for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 5	No Cost-Sharing; PBP 12	"$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP Office Visits; PBP 7a, 14a, 14b"	"$30/Visit for Speclst Office Visits; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 14a, 14b, 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, 14a, 14b"	"No Cost-Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	200	200	50	0	200	0.2	0.2	61.91878256	175	10	0.107846337	0	0	30	15	29.55397499	30	30	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	194.0494762	194.0494762	48.51236904	0	194.0494762	0.194049476	0.194049476	60.07653661	169.7932917	9.702473809	0.104637626	0	0	29.10742143	14.55371071	28.67466683	29.10742143	29.10742143	0	0	0.194049476	0	0	0	0	0	0	0	0	0												8.6624	0.141165156	3.549460172	0	3.329321354	2.047242468	1.295378532	1.085596987	3.299448265	0.580796599	2.198170352	0	0	0.400871296	5.282792807	11.035277	0.279091584	0.951550992	0	0	7.987617168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1262	0	NO	1.598448947	8.6624	0.141165156	3.549460172	0	3.329321354	2.047242468	1.295378532	1.085596987	3.299448265	0.580796599	2.198170352	0	0	0.400871296	5.282792807	11.035277	0.279091584	0.951550992	0	0	7.987617168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1262	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.6624	0.141165156	3.549460172	0	3.329321354	2.047242468	1.295378532	1.085596987	3.299448265	0.580796599	2.198170352	0	0	0.400871296	5.282792807	11.035277	0.279091584	0.951550992	0	0	7.987617168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1262
H2182_001_0	2012	7																															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	1354.37402	106.6737567	483.5439185	850.3240615	158.0845764	9.673514508	13.50318205	373.1655723	49.16066692	19.15596837	31.39564354	0	0.34579698	23.72995222	5189.179648	4209.105563	530.6878784	926.8735196	0	0	15.115658	700.6105473	0	0	54.76617283	261.2545683	4.954871418	0	79.46486681	0											4250	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	66.32611714	0	200	0.2	0.100137452	63.57153655	0.16	0.220879001	0.18224794	0	0.2	0.146154945	6.638331529	34.21648825	38.5	35	0	0	0.2	34.18971878	0	0	35	30	35	0	0	0											YES	147.8979883	77.46297457	51.11892668	0	154.144186	0.154144186	0.07717803	49.01428017	0.123315349	0.170236069	0.140462302	0	0.154144186	0.112644675	6.379452252	32.88245748	36.99859078	33.63508253	0	0	0.154144186	26.35073185	0	0	35	30	35	0	0	0											7000	16.6924	0.688605542	2.059853843	0	2.030651529	1.491116019	1.04214899	1.524203493	6.062264788	3.261036755	4.409904363	0	0.053302594	2.673052754	2.758676983	11.53381123	1.636225304	2.59795561	0	0	2.329990797	1.538466722	0	0	0.159734671	0.653136421	0.014451708	0	0	0	0	0	0	0	0	0	0	0	0	0	65.211	0	NO	14.39280089	16.6924	0.688605542	2.059853843	0	2.030651529	1.491116019	1.04214899	1.524203493	6.062264788	3.261036755	4.409904363	0	0.053302594	2.673052754	2.758676983	11.53381123	1.636225304	2.59795561	0	0	2.329990797	1.538466722	0	0	0.159734671	0.653136421	0.014451708	0	0	0	0	0	0	0	0	0	0	0	0	0	65.211	NO	"$325 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.398	0.0966	0.6035	0.6179	0.4424	0	0.6803	0.3321	1.9813	0.7105	1.4025	0	0.0116	0.8725	1.0156	2.6442	0.3259	0.5888	0	0	0.6122	0.3431	0	0	0.0362	0	0.0028	0	0	0											14.7181	0	NO	3.292842709	18.0904	0.785239511	2.663353974	0.617871614	2.473100458	1.491116019	1.722420489	1.856308939	8.043581514	3.971568423	5.812392234	0	0.064916441	3.545518597	3.774282729	14.17802732	1.962115286	3.18676615	0	0	2.942181727	1.88161477	0	0	0.195976991	0.653136421	0.01725472	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9291
H2224_001_0	2012	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	YES	454.4516212	15.44135925	101.7110677	0	35.43757145	54.48240026	8.041919153	32.87219382	48.34784866	44.10341147	16.00802668	31.20067589	0.003156923	119.8258364	81.25272323	141.3494479	12.08496863	10.75167082	12.16317171	5.820461471	22.73435637	6.961919089	0	10.19874325	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 16b, 17a"	PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	0.071956869	0.071956869	0.151508423	0	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0.223995595	0	0.223995595	0	0	0	0	0	0											NO	0.060497405	0.060497405	0.127380007	0	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0.188323262	0	0.188323262	0	0	0	0	0	0												27.4931	0.934162168	12.95595655	0	6.673719046	10.26030333	1.514480446	6.190598762	9.105024561	8.305698305	3.0146838	5.875813054	0.000594522	22.56599236	15.30177787	26.61938908	2.275880712	2.024789719	2.29060817	1.096128289	4.281408146	1.311091311	0	1.920660595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.0119	0	NO	32.58262334	27.4931	0.934162168	12.95595655	0	6.673719046	10.26030333	1.514480446	6.190598762	9.105024561	8.305698305	3.0146838	5.875813054	0.000594522	22.56599236	15.30177787	26.61938908	2.275880712	2.024789719	2.29060817	1.096128289	4.281408146	1.311091311	0	1.920660595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.0119	NO																																										0	0	0	0	0	0	0	0	0	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	27.4931	0.934162168	12.95595655	0	6.673719046	10.26030333	1.514480446	6.190598762	9.105024561	8.305698305	3.0146838	5.875813054	0.000594522	22.56599236	15.30177787	26.61938908	2.275880712	2.024789719	2.29060817	1.096128289	4.281408146	1.311091311	0	1.920660595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.0119
H2225_001_0	2012	6																															Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	YES	475.6338811		118.5367525	169.1199144	55.47019668	102.0503029		40.61513414	31.31524238	144.6368416					402.1497779						45.08980658																				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																				0	NO	0.073213315		0.151364636	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224																				NO	0.073213315		0.151364636	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224																					34.8227	0	17.94227235	0	12.42532406	22.85926785	0	9.097790047	7.014614293	32.39865252	0	0	0	0	90.08155025	0	0	0	0	0	10.10011667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.7423	0	NO	0	34.8227	0	17.94227235	0	12.42532406	22.85926785	0	9.097790047	7.014614293	32.39865252	0	0	0	0	90.08155025	0	0	0	0	0	10.10011667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.7423	NO																																																																																		0	0	NO	0	34.8227	0	17.94227235	0	12.42532406	22.85926785	0	9.097790047	7.014614293	32.39865252	0	0	0	0	90.08155025	0	0	0	0	0	10.10011667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.7423
H2226_001_0	2012	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	130.8254574	22.3471	91.87301082	353.4463664	9.860927697	9.971077825	22.88724238	27.06075395	38.78041476	19.54080451	54.44149051	0	0	72.22238892	23.53144883	69.20443596	10.9846	3.111854588	0	6871.030857	13.06642822	6.204410675	0	0	0	0	10.87587464	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	$65 (4a); $0 n/c (4a1); Medicare FFS (4b)	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.070739309	0.070739309	0.150101152	0	0.224	0.224	0.224	0.085908597	0.224	0.224	0.224	0	0	0.224	0.217551538	0.224	0.227796449	0.224	0	0	0.224	0.211802999	0	0	0	0	0	0	0	0											NO	0.053973474	0.053973474	0.114525865	0	0.170910039	0.170910039	0.170910039	0.065547507	0.170910039	0.170910039	0.170910039	0	0	0.170910039	0.165989918	0.170910039	0.173806696	0.170910039	0	0	0.170910039	0.165899009	0	0	0	0	0	0	0	0												7.0611	1.206150611	10.521836	0	1.685331534	1.704157296	3.91165948	1.773764961	6.627962184	3.339719653	9.304597247	0	0	12.34353128	3.905983272	11.82773282	1.909197034	0.531847188	0	0	2.233183753	1.029305584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9171	150	YES	25.10042398	7.0611	1.206150611	10.521836	0	1.685331534	1.704157296	3.91165948	1.773764961	6.627962184	3.339719653	9.304597247	0	0	12.34353128	3.905983272	11.82773282	1.909197034	0.531847188	0	0	2.233183753	1.029305584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9171	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.0611	1.206150611	10.521836	0	1.685331534	1.704157296	3.91165948	1.773764961	6.627962184	3.339719653	9.304597247	0	0	12.34353128	3.905983272	11.82773282	1.909197034	0.531847188	0	0	2.233183753	1.029305584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9171
H2228_001_0	2012	3																															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	233.5186244	39.7433845	12026.19272	8.538392111	26.0549492	41.58799052	19.72586745	26.43296681	16.3909088	49.70552273	10.93537229	0	0	22.39402848	0.898287106	113.6752542	17.9859015	30.98546179	0	27074.02688	3.501611693	8.30432862	2122.247866	0	97.96983684	138.9269319	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.070293668	0.071147437	0	0	0.2	0.2	0.193671195	0.054139281	0.16	0	0.088592916	0	0	0.146269863	0	0.029417188	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.066352507	0.067158408	0	0	0.188786583	0.188786583	0.182812616	0.05110385	0.151029267	0	0.08362577	0	0	0.138068938	0	0.027291469	0.185547772	0	0	0	0.188786583	0.189234203	0	0	0	0	0	0	0	0												15.4945	2.669102433	0	0	4.918824842	7.851254642	3.606137433	1.350826361	2.475506938	0	0.914478926	0	0	3.091919733	0	3.102364625	3.337243949	0	0	0	0.661057308	1.571463007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0447	0	NO	3.14706442	15.4945	2.669102433	0	0	4.918824842	7.851254642	3.606137433	1.350826361	2.475506938	0	0.914478926	0	0	3.091919733	0	3.102364625	3.337243949	0	0	0	0.661057308	1.571463007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0447	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.3283	0.0566	0	0.0001	0.0745	0.119	0.0564	0.0136	0.0375	0	0.0241	0	0	0.0468	0.0114	1.8433	0.2913	0.0045	0	0	0.0577	0.1372	0	0	0.0168	0	0	0	0	0											3.1191	0	NO	0.221516937	15.8229	2.725657844	0	0.00011432	4.993352491	7.970213046	3.662561359	1.364471072	2.513014618	0	0.938544801	0	0	3.138767001	0.011380592	4.945645996	3.628590643	0.004493362	0	0	0.71876866	1.708654222	0	0	0.016782824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1639
H2228_002_0	2012	3																															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	531.0236899	39.9784035	10093.7066	37.39321317	42.94479381	89.51893085	12.88146846	17.36590201	234.1606561	69.53430094	22.78077535	0	0	28.5789709	2.348483427	132.1479249	18.0017775	19.8722711	0	17413.31879	7.325034719	6.891879605	1339.194707	0	27.68150778	201.6621942	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.075539872	0.07645736	0	0	0.2	0.2	0.192048286	0.073619803	0.16	0	0.108550552	0	0	0.146212617	0.029494806	0.027680053	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068729301	0.06956407	0	0	0.181968276	0.181968276	0.174733478	0.066982343	0.14557462	0	0.098763783	0	0	0.133030289	0.026330248	0.024710204	0.17854159	0	0	0	0.181968276	0.182188093	0	0	0	0	0	0	0	0												36.4969	2.781060462	0	0	7.814590075	16.28960548	2.25082378	1.163208809	34.08784865	0	2.249915563	0	0	3.801868763	0.06183615	3.265402138	3.214065973	0	0	0	1.332923937	1.255618403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0657	0	NO	11.63757749	36.4969	2.781060462	0	0	7.814590075	16.28960548	2.25082378	1.163208809	34.08784865	0	2.249915563	0	0	3.801868763	0.06183615	3.265402138	3.214065973	0	0	0	1.332923937	1.255618403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0657	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.7196	0.0548	0	0.0007	0.1184	0.2468	0.0355	0.0117	0.5165	0	0.0493	0	0	0.0576	0.0294	2.064	0.2806	0.0013	0	0	0.1164	0.1096	0	0	0.0057	0	0	0	0	0											4.4181	0	NO	0.481642588	37.2165	2.835895647	0	0.000728242	7.932992955	16.53641768	2.286339213	1.174958393	34.6043312	0	2.299221037	0	0	3.859472835	0.091259151	5.329438707	3.494659034	0.00132782	0	0	1.449290312	1.365235883	0	0	0.005715708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4838
H2230_002_0	2012	10																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin		V		V	V		V														0	0	0	0	0	0.082916929	1.661378182	0	0	5.569964836	2.405950182	0	0	0	0	0	0	0	0.304216024	4.84706545	0	0	0	0	0	0	0	0	0	0											14.8715	YES	570.2371498	15.45591922	879.6577509	0	103.6006363	0.475662295	9.035225499	240.4957171	268.2889112	5.455027252	13.89154334	0	0	1262.598052	3567.874176	5848.991358	361.1030202	733.7957401	1.030873355	9.155157766	0	139.0780719	0	618.4324082	40.30343046	0	0.081764039	0	0	0											3400	$100/Day for IP Med; $100/Day for IP Surg; PBP 1a	$100/Day for IP MH; $100/Day for IP SA; PBP 1b	$30/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care PCP; $65/Case for OP ER Worldwide; PBP 4a, 4b"	"$100/Case for Surg; $100/Case for ASC; PBP 9a, 9b"	10% Coinsurance for Path; PBP 8a	10% Coinsurance for Rad CT/MRI/PET; PBP 8b		No Cost Sharing; PBP 12	"$15/Visit for Cardio; $15/Visit for Occ Therapy; $15/Visit for PT/ST; $15/Visit for CORF; $15/Visit for Other; $15/Visit for CORF; PBP 3, 5, 9c, 9d"	"$15/Visit for OP Surg Office PCP; $15/Visit for Office Visit PCP if POC; $30/Visit for Office Visit PCP if non-POC; PBP 7a, 14a"	"$30/Visit for OP Surg Office Spec; $30/Visit for Office Visit Spec; $15/Visit for Cardio; $20/Visit for Chiro; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"$30/Visit for OP MH Non-Phys; $30/Visit for OP MH Psych; $30/Visit for OP SA; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for OP Rad CT/MRI/PET; 10% Coinsurance for Office Rad CT/MRI/PET; PBP 8b	"$100/Visit for OP Surg Fac; 10% Coinsurance for OP Path; 10% Coinsurance for Office Path; PBP 7d, 7g, 8a"	No Cost Sharing; PBP 15	"$30/Case for Misc Med; PBP 7g, 14a"	N/C	"$30/Visit for Prev Dental; PBP 16a, 16b"	$30/Exam for Routine Vision Exams; PBP 17a	$150 per 2 yrs for Vision Hardware; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$400 per 3 yrs for Hearing Aids; PBP 18b	"$150 per yr for Fitness Club; $150 per yr for Weight Loss; PBP 13e, 14c"	$500 per yr for Wigs; PBP 13d											0	NO	100	99.99489674	30	0	100	0.1	0.1	64.96694756	100	0.1	0.1	0	0	15	15	28.62084503	30	15	0.1	0.150087634	0	30	0	30	30	0	30	0	0	0											NO	99.3851858	99.38011392	29.81572785	0	99.3851858	0.099385186	0.099385186	64.56789145	99.3851858	0.099385186	0.099385186	0	0	14.90777787	14.90777787	28.44488001	29.81555574	14.90777787	0.099385186	0.149164941	0	29.81555574	0	30	30	0	30	0	0	0												4.7228	0.128000918	2.185636342	0	0.858030707	0.047273786	0.897967565	1.294025113	2.221995274	0.542148897	1.380613616	0	0	1.568544275	4.432422974	13.86448811	0.897207269	0.911605325	0.10245354	1.365628568	0	0.345557501	0	1.54608102	0.100758576	0	0.00020441	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4134	250	NO	0.233608557	4.7228	0.128000918	2.185636342	0	0.858030707	0.130190715	2.559345747	1.294025113	2.221995274	6.112113733	3.786563799	0	0	1.568544275	4.432422974	13.86448811	0.897207269	0.911605325	0.406669564	6.212694018	0	0.345557501	0	1.54608102	0.100758576	0	0.00020441	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2849	YES	20% Coinsurance for IP Med; 20% Coinsurance for IP Surg; PBP 1a	20% Coinsurance for IP MH; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Supplies; 20% Coinsurance for Diab Monitor Supp; PBP 11b, 11c"	"$65/Visit for ER; $65/Visit for OP ER Worldwide; PBP 4a, 4b"	"20% Coinsurance for Surg; 20% Coinsurance for ASC; PBP 9a, 9b"	20% Coinsurance for Path; PBP 8a	20% Coinsurance for Rad General; 20% Coinsurance for Rad CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"20% Coinsurance for Cardio; 20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; 20% Coinsurance for CORF; 20% Coinsurance for Other; 20% Coinsurance for CORF; PBP 3, 5, 9c, 9d"	"20% Coinsurance for OP Surg Office PCP; $40/Visit for Office Visit PCP; 20% Coinsurance for Immunization PCP; $40/Visit for Physical Exams; PBP 7a, 14a"	"20% Coinsurance for OP Surg Office Spec; $40/Visit for Office Visit Spec; 20% Coinsurance for Cardio; 20% Coinsurance for Chiro; 20% Coinsurance for Immunization Spec; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"20% Coinsurance for OP MH Non-Phys; 20% Coinsurance for OP MH Psych; 20% Coinsurance for OP SA; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad General; 20% Coinsurance for OP Rad CT/MRI/PET; 20% Coinsurance for Office Rad General; 20% Coinsurance for Office Rad CT/MRI/PET; PBP 8b	"20% Coinsurance for OP Surg Fac; 20% Coinsurance for OP Surg Anesth; $40/Visit for Allergy Testing; 20% Coinsurance for OP Path; 20% Coinsurance for Office Path; PBP 7d, 7g, 8a"	No Cost Sharing; PBP 15	"20% Coinsurance for Misc Med; PBP 7g, 14a"	N/C	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$150 per 2 yrs for Vision Hardware; PBP 17b	No Cost Sharing; PBP 18a	$500 per yr for Wigs; PBP 13d	$500 per yr for Wigs; PBP 13d	$500 per yr for Wigs; PBP 13d											5100	0.522	0.0397	0.1805	0.0418	0.0003	0.0135	0.2901	0.0116	1.5069	0.2094	0.4323	0	0	1.7158	0.3328	2.1986	0.5663	0.0805	0.395	1.2472	0	1.7138	0	0	0	0	0	0	0	0											11.498	250	NO	0.003891866	5.2448	0.167677278	2.366161874	0.041752348	0.858339905	0.143654271	2.849430977	1.305588047	3.728917016	6.321485923	4.218887595	0	0	3.284309684	4.765271524	16.06308663	1.463516451	0.992128092	0.801636676	7.459898909	0	2.059335587	0	1.54608102	0.100758576	0	0.00020441	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7829
H2230_801_0	2012	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	313.3745044	8.215271109	74.38877259	0	19.56596577	0.792270662	16.0637497	27.97439936	37.18455279	13.25977906	41.43912958	0	0.008830562	43.19394105	32.86139065	61.79631303	3.157945655	4.054360725	18.190977	90.86591529	76.14486515	10.42777077	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											0	NO	0.070628209	0.070628209	0.150881611	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059320756	0.059320756	0.126725727	0	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0	0	0	0	0	0	0	0												18.5896	0.487336089	9.426971317	0	3.681101463	0.14905621	3.022201574	5.263047255	6.995827005	2.494668174	7.796274529	0	0.001661364	8.126421232	6.182475972	11.6262341	0.594129547	0.762779276	3.422413842	17.09533062	14.32574185	1.961859829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0051	0	NO	23.25606722	18.5896	0.487336089	9.426971317	0	3.681101463	0.14905621	3.022201574	5.263047255	6.995827005	2.494668174	7.796274529	0	0.001661364	8.126421232	6.182475972	11.6262341	0.594129547	0.762779276	3.422413842	17.09533062	14.32574185	1.961859829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0051	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											10000	0.8277	0.0217	0.4198	0	0.1639	0.0066	0.1346	0.2343	0.3115	0.1111	0.3471	0	0.0001	0.3618	0.2753	0.5177	0.0265	0.034	0.1524	0.7612	0.6379	0.0874	0	0	0	0	0	0	0	0											5.4325	0	NO	0.620023454	19.4174	0.509035719	9.846726376	0	3.845009988	0.15569324	3.156771241	5.497395132	7.307330421	2.605748345	8.143419498	0	0.00173534	8.488266654	6.45776328	12.1439158	0.620584372	0.796743573	3.574803774	17.85653497	14.96362462	2.049215625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4377
H2230_809_0	2012	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	313.3745044	8.215271109	74.38877259	0	19.56596577	0.792270662	16.0637497	27.97439936	37.18455279	13.25977906	41.43912958	0	0.008830562	43.19394105	32.86139065	61.79631303	3.157945655	4.054360725	18.190977	90.86591529	76.14486515	10.42777077	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											0	NO	0.070628209	0.070628209	0.150881611	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059320756	0.059320756	0.126725727	0	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0.18813799	0	0	0	0	0	0	0	0												18.5896	0.487336089	9.426971317	0	3.681101463	0.14905621	3.022201574	5.263047255	6.995827005	2.494668174	7.796274529	0	0.001661364	8.126421232	6.182475972	11.6262341	0.594129547	0.762779276	3.422413842	17.09533062	14.32574185	1.961859829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0051	0	NO	23.25606722	18.5896	0.487336089	9.426971317	0	3.681101463	0.14905621	3.022201574	5.263047255	6.995827005	2.494668174	7.796274529	0	0.001661364	8.126421232	6.182475972	11.6262341	0.594129547	0.762779276	3.422413842	17.09533062	14.32574185	1.961859829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0051	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											10000	0.8277	0.0217	0.4198	0	0.1639	0.0066	0.1346	0.2343	0.3115	0.1111	0.3471	0	0.0001	0.3618	0.2753	0.5177	0.0265	0.034	0.1524	0.7612	0.6379	0.0874	0	0	0	0	0	0	0	0											5.4325	0	NO	0.620023454	19.4174	0.509035719	9.846726376	0	3.845009988	0.15569324	3.156771241	5.497395132	7.307330421	2.605748345	8.143419498	0	0.00173534	8.488266654	6.45776328	12.1439158	0.620584372	0.796743573	3.574803774	17.85653497	14.96362462	2.049215625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4377
H2237_001_0	2012	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	331.0719376	28.12955028	28.95756408	0	23.71937141	17.36521632	9.252379575	26.03289697	3.979542138	20.94666807	7.272295443	0	0.15218389	71.90359654	132.4344928	78.28081065	17.31181025	6.100272936	13.72812301	2.240215281	87.58743687	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	No coinsurance or Part B Deductible for Diabetic Supplies; PBP 11c	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Part B Deductible Does Not Apply to Part B Rx; PBP 15	Medicare-FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Wellness Benefit Card; No Cost Sharing; PBP 13B											0	NO	0.077006688	0.077006688	0.161547758	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.195	0	0	0	0	0	0	0	0	0											NO	0.06853287	0.06853287	0.143771038	0	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.199351033	0.173542194	0	0	0	0	0	0	0	0	0												22.6893	1.9277988	4.163259039	0	4.728481197	3.461773816	1.844471428	5.189684908	0.793325837	4.175739921	1.44973961	0	0.030338016	14.33405626	26.40095297	15.60536048	3.451127259	1.216095712	2.736715506	0.446589231	15.20011597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8449	0	NO	16.05481279	22.6893	1.9277988	4.163259039	0	4.728481197	3.461773816	1.844471428	5.189684908	0.793325837	4.175739921	1.44973961	0	0.030338016	14.33405626	26.40095297	15.60536048	3.451127259	1.216095712	2.736715506	0.446589231	15.20011597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8449	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	NO	0	22.6893	1.9277988	4.163259039	0	4.728481197	3.461773816	1.844471428	5.189684908	0.793325837	4.175739921	1.44973961	0	0.030338016	14.33405626	26.40095297	15.60536048	3.451127259	1.216095712	2.736715506	0.446589231	15.20011597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8449
H2237_007_0	2012	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	509.9163845	43.3250812	44.60038651	0	36.53253188	26.74587399	14.25049787	40.09581965	6.129283424	32.26201933	11.20077596	0	0.234393346	110.7457861	203.9753603	120.5679594	26.66361805	9.395629067	21.14402961	3.450375422	134.9020079	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	No coinsurance or Part B Deductible for Diabetic Supplies; PBP 11c	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Part B Deductible Does Not Apply to Part B Rx; PBP 15	Medicare-FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Wellness Benefit Card; No Cost Sharing; PBP 13B											0	NO	0.077079904	0.077079904	0.161546946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.195	0	0	0	0	0	0	0	0	0											NO	0.077079904	0.077079904	0.161546946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.195	0	0	0	0	0	0	0	0	0												39.3043	3.339493105	7.205056242	0	8.18328714	5.991075774	3.192111523	8.981463602	1.372959487	7.226692329	2.508973815	0	0.052504109	24.80705609	45.6904807	27.00722291	5.972650444	2.104620911	4.736262633	0.772884095	26.30589154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	224.755	0	NO	0	39.3043	3.339493105	7.205056242	0	8.18328714	5.991075774	3.192111523	8.981463602	1.372959487	7.226692329	2.508973815	0	0.052504109	24.80705609	45.6904807	27.00722291	5.972650444	2.104620911	4.736262633	0.772884095	26.30589154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	224.755	NO																																										0	0	0	0	0	0	0	0	0	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	39.3043	3.339493105	7.205056242	0	8.18328714	5.991075774	3.192111523	8.981463602	1.372959487	7.226692329	2.508973815	0	0.052504109	24.80705609	45.6904807	27.00722291	5.972650444	2.104620911	4.736262633	0.772884095	26.30589154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	224.755
H2241_001_0	2012	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			575.406874		571.1235003	16.22386281	15.63206069	203.1999714													28.38404141			650.5091007																	5000			"$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	47.39474592													0.2			8																	NO			15.47061708		49.90521638	0.019962087	0.019962087	47.30490101													0.199620866			7.984834621																		0	0	0.741824951	0	2.375170155	0.323862154	0.312048549	0.801029544	0	0	0	0	0	0	0	0	0	0	0	0	5.666046914	0	0	0.432850632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6528	0		0.020232635	0	0	0.741824951	0	2.375170155	0.323862154	0.312048549	0.801029544	0	0	0	0	0	0	0	0	0	0	0	0	5.666046914	0	0	0.432850632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6528	NO																																																																																		0	0		0	0	0	0.741824951	0	2.375170155	0.323862154	0.312048549	0.801029544	0	0	0	0	0	0	0	0	0	0	0	0	5.666046914	0	0	0.432850632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6528
H2256_001_1	2012	12																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	199.1198474	0	0	0	536.1175715	0	0	361.0021585	474.230043	0	0	0	0	0	3447.623982	6006.388519	333.9741158	1314.257373	0	48.114463	0	0	0	0	176.0342169	0	10.44191553	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.3666796	0	0	0	49.72777993	0	0	64.6461139	49.72777993	0	0	0	0	0	9.945555985	14.91833398	14.91833398	14.91833398	0	14.91833398	0	0	0	0	14.91833398	0	14.91833398	0	0	0												4.9509	0	0	0	2.221661384	0	0	1.944782222	1.965200601	0	0	0	0	0	2.857378111	7.46710916	0.415194783	1.633877535	0	0.059815636	0	0	0	0	0.21884477	0	0.012981332	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7477			0.13	4.9509	0	0	0	2.221661384	0	0	1.944782222	1.965200601	0	0	0	0	0	2.857378111	7.46710916	0.415194783	1.633877535	0	0.059815636	0	0	0	0	0.21884477	0	0.012981332	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7477	NO																																																																																		0				4.9509	0	0	0	2.221661384	0	0	1.944782222	1.965200601	0	0	0	0	0	2.857378111	7.46710916	0.415194783	1.633877535	0	0.059815636	0	0	0	0	0.21884477	0	0.012981332	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7477
H2256_001_2	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	184.6355016	0	0	0	485.1476908	0	0	357.0774672	437.2383874	0	0	0	0	0	3721.679064	5456.941771	330.497344	1176.754052	0	43.8909509	0	0	0	0	195.7859361	0	13.76634158	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.2679605	0	0	0	49.71132675	0	0	64.62472478	49.71132675	0	0	0	0	0	9.942265351	14.91339803	14.91339803	14.91339803	0	14.91339803	0	0	0	0	14.91339803	0	14.91339803	0	0	0												4.5892	0	0	0	2.009777949	0	0	1.923002753	1.811308362	0	0	0	0	0	3.083493401	6.781795386	0.410736537	1.46245013	0	0.054546935	0	0	0	0	0.243319466	0	0.017108578	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3868			0.13	4.5892	0	0	0	2.009777949	0	0	1.923002753	1.811308362	0	0	0	0	0	3.083493401	6.781795386	0.410736537	1.46245013	0	0.054546935	0	0	0	0	0.243319466	0	0.017108578	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3868	NO																																																																																		0				4.5892	0	0	0	2.009777949	0	0	1.923002753	1.811308362	0	0	0	0	0	3.083493401	6.781795386	0.410736537	1.46245013	0	0.054546935	0	0	0	0	0.243319466	0	0.017108578	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3868
H2256_001_6	2012	12																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	210.1203854	0	0	0	552.1116953	0	0	406.3641845	497.5895627	0	0	0	0	0	4235.375281	6210.152968	376.115258	1339.179155	0	49.9491346	0	0	0	0	222.809893	0	15.66648329	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.2679605	0	0	0	49.71132675	0	0	64.62472478	49.71132675	0	0	0	0	0	9.942265351	14.91339803	14.91339803	14.91339803	0	14.91339803	0	0	0	0	14.91339803	0	14.91339803	0	0	0												5.2227	0	0	0	2.287183741	0	0	2.188431132	2.061319778	0	0	0	0	0	3.509102076	7.717873585	0.467429712	1.664309314	0	0.062075944	0	0	0	0	0.276904385	0	0.019470042	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4768			0.13	5.2227	0	0	0	2.287183741	0	0	2.188431132	2.061319778	0	0	0	0	0	3.509102076	7.717873585	0.467429712	1.664309314	0	0.062075944	0	0	0	0	0.276904385	0	0.019470042	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4768	NO																																																																																		0				5.2227	0	0	0	2.287183741	0	0	2.188431132	2.061319778	0	0	0	0	0	3.509102076	7.717873585	0.467429712	1.664309314	0	0.062075944	0	0	0	0	0.276904385	0	0.019470042	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4768
H2256_001_7	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	177.4728949	0	0	0	466.3272469	0	0	343.2252804	420.2764999	0	0	0	0	0	3577.303128	5245.249396	317.6762859	1131.103966	0	42.18827933	0	0	0	0	188.1907681	0	13.23230079	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.2679605	0	0	0	49.71132675	0	0	64.62472478	49.71132675	0	0	0	0	0	9.942265351	14.91339803	14.91339803	14.91339803	0	14.91339803	0	0	0	0	14.91339803	0	14.91339803	0	0	0												4.4112	0	0	0	1.931812179	0	0	1.848403273	1.741041868	0	0	0	0	0	2.963874745	6.518707666	0.394802741	1.405716972	0	0.052430883	0	0	0	0	0.233880319	0	0.016444881	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5183			0.13	4.4112	0	0	0	1.931812179	0	0	1.848403273	1.741041868	0	0	0	0	0	2.963874745	6.518707666	0.394802741	1.405716972	0	0.052430883	0	0	0	0	0.233880319	0	0.016444881	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5183	NO																																																																																		0				4.4112	0	0	0	1.931812179	0	0	1.848403273	1.741041868	0	0	0	0	0	2.963874745	6.518707666	0.394802741	1.405716972	0	0.052430883	0	0	0	0	0.233880319	0	0.016444881	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5183
H2256_001_8	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	185.6625955	0	0	0	487.8464796	0	0	359.0638245	439.6706654	0	0	0	0	0	3742.382091	5487.29775	332.335841	1183.300122	0	44.13510832	0	0	0	0	196.8750578	0	13.84292125	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.2679605	0	0	0	49.71132675	0	0	64.62472478	49.71132675	0	0	0	0	0	9.942265351	14.91339803	14.91339803	14.91339803	0	14.91339803	0	0	0	0	14.91339803	0	14.91339803	0	0	0												4.6148	0	0	0	2.02095798	0	0	1.93370007	1.821384343	0	0	0	0	0	3.100646316	6.819521286	0.41302139	1.470585475	0	0.05485037	0	0	0	0	0.244673008	0	0.01720375	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5113			0.13	4.6148	0	0	0	2.02095798	0	0	1.93370007	1.821384343	0	0	0	0	0	3.100646316	6.819521286	0.41302139	1.470585475	0	0.05485037	0	0	0	0	0.244673008	0	0.01720375	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5113	NO																																																																																		0				4.6148	0	0	0	2.02095798	0	0	1.93370007	1.821384343	0	0	0	0	0	3.100646316	6.819521286	0.41302139	1.470585475	0	0.05485037	0	0	0	0	0.244673008	0	0.01720375	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5113
H2256_015_1	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	195.57269	0	0	0	545.8841918	0	0	348.8923144	420.5291663	0	0	0	0	0	3420.284183	5516.39691	386.9383137	1258.967886	0	93.99195493	0	0	0	0	170.0425299	0	23.02060997	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.3019711	0	0	0	49.71699519	0	0	64.63209375	49.71699519	0	0	0	0	0	9.943399038	14.91509856	14.91509856	14.91509856	0	14.91509856	0	0	0	0	14.91509856	0	14.91509856	0	0	0												4.8616	0	0	0	2.261643478	0	0	1.879136731	1.742287212	0	0	0	0	0	2.834104205	6.856466966	0.480935257	1.564802508	0	0.116824939	0	0	0	0	0.211350091	0	0.028612889	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8378			0.13	4.8616	0	0	0	2.261643478	0	0	1.879136731	1.742287212	0	0	0	0	0	2.834104205	6.856466966	0.480935257	1.564802508	0	0.116824939	0	0	0	0	0.211350091	0	0.028612889	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8378	NO																																																																																		0				4.8616	0	0	0	2.261643478	0	0	1.879136731	1.742287212	0	0	0	0	0	2.834104205	6.856466966	0.480935257	1.564802508	0	0.116824939	0	0	0	0	0.211350091	0	0.028612889	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8378
H2256_015_2	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	170.1586042	0	0	0	458.5340068	0	0	338.3517394	388.7304385	0	0	0	0	0	3483.606006	5170.96694	363.6857022	1154.591064	0	64.85922416	0	0	0	0	198.2794158	0	16.80675959	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.1632082	0	0	0	49.69386803	0	0	64.60202845	49.69386803	0	0	0	0	0	9.938773607	14.90816041	14.90816041	14.90816041	0	14.90816041	0	0	0	0	14.90816041	0	14.90816041	0	0	0												4.2279	0	0	0	1.898860702	0	0	1.821517391	1.609793259	0	0	0	0	0	2.885230953	6.424133718	0.451823732	1.434402399	0	0.080577643	0	0	0	0	0.246331778	0	0.020879822	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1015			0.13	4.2279	0	0	0	1.898860702	0	0	1.821517391	1.609793259	0	0	0	0	0	2.885230953	6.424133718	0.451823732	1.434402399	0	0.080577643	0	0	0	0	0.246331778	0	0.020879822	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1015	NO																																																																																		0				4.2279	0	0	0	1.898860702	0	0	1.821517391	1.609793259	0	0	0	0	0	2.885230953	6.424133718	0.451823732	1.434402399	0	0.080577643	0	0	0	0	0.246331778	0	0.020879822	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1015
H2256_015_6	2012	12																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	214.7458309	0	0	0	578.6852021	0	0	427.0111743	490.5907719	0	0	0	0	0	4396.426908	6525.932656	458.9834799	1457.132412	0	81.85450301	0	0	0	0	250.2352325	0	21.21069087	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.1632082	0	0	0	49.69386803	0	0	64.60202845	49.69386803	0	0	0	0	0	9.938773607	14.90816041	14.90816041	14.90816041	0	14.90816041	0	0	0	0	14.90816041	0	14.90816041	0	0	0												5.3358	0	0	0	2.396425506	0	0	2.298815669	2.031612756	0	0	0	0	0	3.641257643	8.107470905	0.570216612	1.810263644	0	0.101691672	0	0	0	0	0.310878916	0	0.026351032	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6308			0.13	5.3358	0	0	0	2.396425506	0	0	2.298815669	2.031612756	0	0	0	0	0	3.641257643	8.107470905	0.570216612	1.810263644	0	0.101691672	0	0	0	0	0.310878916	0	0.026351032	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6308	NO																																																																																		0				5.3358	0	0	0	2.396425506	0	0	2.298815669	2.031612756	0	0	0	0	0	3.641257643	8.107470905	0.570216612	1.810263644	0	0.101691672	0	0	0	0	0.310878916	0	0.026351032	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6308
H2256_015_7	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	164.4976544	0	0	0	443.2791919	0	0	327.0952283	375.7978952	0	0	0	0	0	3367.71108	4998.935766	351.5863639	1116.179359	0	62.70144427	0	0	0	0	191.6829241	0	16.24762112	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.1632082	0	0	0	49.69386803	0	0	64.60202845	49.69386803	0	0	0	0	0	9.938773607	14.90816041	14.90816041	14.90816041	0	14.90816041	0	0	0	0	14.90816041	0	14.90816041	0	0	0												4.0873	0	0	0	1.835688139	0	0	1.760917937	1.556237584	0	0	0	0	0	2.789243167	6.210411357	0.436792159	1.386681744	0	0.077896932	0	0	0	0	0.238136648	0	0.020185178	0	0	0	0	0	0	0	0	0	0	0	0	0	20.3995			0.13	4.0873	0	0	0	1.835688139	0	0	1.760917937	1.556237584	0	0	0	0	0	2.789243167	6.210411357	0.436792159	1.386681744	0	0.077896932	0	0	0	0	0.238136648	0	0.020185178	0	0	0	0	0	0	0	0	0	0	0	0	0	20.3995	NO																																																																																		0				4.0873	0	0	0	1.835688139	0	0	1.760917937	1.556237584	0	0	0	0	0	2.789243167	6.210411357	0.436792159	1.386681744	0	0.077896932	0	0	0	0	0.238136648	0	0.020185178	0	0	0	0	0	0	0	0	0	0	0	0	0	20.3995
H2256_015_8	2012	11																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	138.6913686	0	0	0	373.7378386	0	0	275.7807402	316.8429642	0	0	0	0	0	2839.386741	4214.705952	296.4297223	941.0738622	0	52.8648822	0	0	0	0	161.6118308	0	13.69870481	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.1632082	0	0	0	49.69386803	0	0	64.60202845	49.69386803	0	0	0	0	0	9.938773607	14.90816041	14.90816041	14.90816041	0	14.90816041	0	0	0	0	14.90816041	0	14.90816041	0	0	0												3.4461	0	0	0	1.547706569	0	0	1.484666268	1.312096037	0	0	0	0	0	2.3516685	5.236126035	0.368268487	1.169140008	0	0.065676512	0	0	0	0	0.200777925	0	0.017018541	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1992			0.13	3.4461	0	0	0	1.547706569	0	0	1.484666268	1.312096037	0	0	0	0	0	2.3516685	5.236126035	0.368268487	1.169140008	0	0.065676512	0	0	0	0	0.200777925	0	0.017018541	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1992	NO																																																																																		0				3.4461	0	0	0	1.547706569	0	0	1.484666268	1.312096037	0	0	0	0	0	2.3516685	5.236126035	0.368268487	1.169140008	0	0.065676512	0	0	0	0	0.200777925	0	0.017018541	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1992
H2256_016_1	2012	10																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	168.260688	0	0	0	450.6057781	0	0	357.852119	529.3475179	0	0	0	0	0	2951.906443	5814.722387	112.0834515	1066.961802	0	47.75633465	0	0	0	0	154.4259751	0	5.699158551	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	298.2019368	0	0	0	49.7003228	0	0	64.61041964	49.7003228	0	0	0	0	0	9.94006456	14.91009684	14.91009684	14.91009684	0	14.91009684	0	0	0	0	14.91009684	0	14.91009684	0	0	0												4.1813	0	0	0	1.866271052	0	0	1.926747965	2.19239521	0	0	0	0	0	2.445178385	7.224839491	0.139264593	1.325708649	0	0.059337631	0	0	0	0	0.19187552	0	0.00708125	0	0	0	0	0	0	0	0	0	0	0	0	0	21.56			0.13	4.1813	0	0	0	1.866271052	0	0	1.926747965	2.19239521	0	0	0	0	0	2.445178385	7.224839491	0.139264593	1.325708649	0	0.059337631	0	0	0	0	0.19187552	0	0.00708125	0	0	0	0	0	0	0	0	0	0	0	0	0	21.56	NO																																																																																		0				4.1813	0	0	0	1.866271052	0	0	1.926747965	2.19239521	0	0	0	0	0	2.445178385	7.224839491	0.139264593	1.325708649	0	0.059337631	0	0	0	0	0.19187552	0	0.00708125	0	0	0	0	0	0	0	0	0	0	0	0	0	21.56
H2256_016_2	2012	9																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	170.721223	0	0	0	403.011071	0	0	321.3741471	381.7602878	0	0	0	0	0	2943.447548	4814.525671	148.7525872	953.4926173	0	22.77734144	0	0	0	0	179.6866415	0	7.675805561	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	297.9886746	0	0	0	49.6647791	0	0	64.56421283	49.6647791	0	0	0	0	0	9.93295582	14.89943373	14.89943373	14.89943373	0	14.89943373	0	0	0	0	14.89943373	0	14.89943373	0	0	0												4.2394	0	0	0	1.667954651	0	0	1.729105736	1.580003364	0	0	0	0	0	2.436427871	5.977808848	0.18469411	1.183875005	0	0.028280791	0	0	0	0	0.223102434	0	0.00953043	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2602			0.13	4.2394	0	0	0	1.667954651	0	0	1.729105736	1.580003364	0	0	0	0	0	2.436427871	5.977808848	0.18469411	1.183875005	0	0.028280791	0	0	0	0	0.223102434	0	0.00953043	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2602	NO																																																																																		0				4.2394	0	0	0	1.667954651	0	0	1.729105736	1.580003364	0	0	0	0	0	2.436427871	5.977808848	0.18469411	1.183875005	0	0.028280791	0	0	0	0	0.223102434	0	0.00953043	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2602
H2256_016_6	2012	10																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	203.9076106	0	0	0	481.3521312	0	0	383.8458587	455.9704221	0	0	0	0	0	3515.622405	5750.418188	177.6685059	1138.841428	0	27.20501405	0	0	0	0	214.6158109	0	9.167900417	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	297.9886746	0	0	0	49.6647791	0	0	64.56421283	49.6647791	0	0	0	0	0	9.93295582	14.89943373	14.89943373	14.89943373	0	14.89943373	0	0	0	0	14.89943373	0	14.89943373	0	0	0												5.0635	0	0	0	1.992187272	0	0	2.065225476	1.887139191	0	0	0	0	0	2.910043502	7.139831226	0.220596678	1.414007698	0	0.033778275	0	0	0	0	0.266471171	0	0.011383044	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0042			0.13	5.0635	0	0	0	1.992187272	0	0	2.065225476	1.887139191	0	0	0	0	0	2.910043502	7.139831226	0.220596678	1.414007698	0	0.033778275	0	0	0	0	0.266471171	0	0.011383044	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0042	NO																																																																																		0				5.0635	0	0	0	1.992187272	0	0	2.065225476	1.887139191	0	0	0	0	0	2.910043502	7.139831226	0.220596678	1.414007698	0	0.033778275	0	0	0	0	0.266471171	0	0.011383044	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0042
H2256_016_7	2012	9																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	170.5208059	0	0	0	402.5379588	0	0	320.996872	381.3121228	0	0	0	0	0	2939.992107	4808.87369	148.57796	952.3732708	0	22.75060213	0	0	0	0	179.4756995	0	7.666794599	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	297.9886746	0	0	0	49.6647791	0	0	64.56421283	49.6647791	0	0	0	0	0	9.93295582	14.89943373	14.89943373	14.89943373	0	14.89943373	0	0	0	0	14.89943373	0	14.89943373	0	0	0												4.2344	0	0	0	1.665996567	0	0	1.727075863	1.578148529	0	0	0	0	0	2.433567642	5.970791238	0.184477289	1.182485203	0	0.028247591	0	0	0	0	0.222840524	0	0.009519242	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2376			0.13	4.2344	0	0	0	1.665996567	0	0	1.727075863	1.578148529	0	0	0	0	0	2.433567642	5.970791238	0.184477289	1.182485203	0	0.028247591	0	0	0	0	0.222840524	0	0.009519242	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2376	NO																																																																																		0				4.2344	0	0	0	1.665996567	0	0	1.727075863	1.578148529	0	0	0	0	0	2.433567642	5.970791238	0.184477289	1.182485203	0	0.028247591	0	0	0	0	0.222840524	0	0.009519242	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2376
H2256_016_8	2012	9																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	152.2893678	0	0	0	359.5001262	0	0	286.6771033	340.5436761	0	0	0	0	0	2625.659296	4294.727145	132.6925678	850.549131	0	20.31819399	0	0	0	0	160.2868381	0	6.847089984	0	0	0											3400	(1a) $300 deductible	(1b) No cost sharing	(2) No cost sharing	(6) No cost sharing	"(10a) $50 per trip, max one copay per day"	"(11 a, b) No cost sharing"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $50 per day"	(8a) No cost sharing	(8b) No cost sharing	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $10 per visit, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $15 per visit"	"(7e,7h, 9c) $15 per visit"	"(7c, 7i) $15 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $15 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $15 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $15 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													300	0	0	0	50	0	0	65	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	297.9886746	0	0	0	49.6647791	0	0	64.56421283	49.6647791	0	0	0	0	0	9.93295582	14.89943373	14.89943373	14.89943373	0	14.89943373	0	0	0	0	14.89943373	0	14.89943373	0	0	0												3.7817	0	0	0	1.487874529	0	0	1.542423459	1.409418871	0	0	0	0	0	2.173379815	5.332416873	0.164753677	1.056058368	0	0.025227465	0	0	0	0	0.19901526	0	0.00850148	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1808			0.13	3.7817	0	0	0	1.487874529	0	0	1.542423459	1.409418871	0	0	0	0	0	2.173379815	5.332416873	0.164753677	1.056058368	0	0.025227465	0	0	0	0	0.19901526	0	0.00850148	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1808	NO																																																																																		0				3.7817	0	0	0	1.487874529	0	0	1.542423459	1.409418871	0	0	0	0	0	2.173379815	5.332416873	0.164753677	1.056058368	0	0.025227465	0	0	0	0	0.19901526	0	0.00850148	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1808
H2256_018_1	2012	11																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	607.4725578	31.86852409	666.803092	0	288.5728286	10.62089667	0	271.0517596	332.57741	0	198.6484078	0	0	0	3003.923916	4802.837216	523.800231	1203.881762	0	51.00734027	0	0	0	0	196.7918388	0	18.83528828	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.9242711	122.9242711	34.41879591	0	98.3394169	0.098339417	0	63.92062098	147.5091253	0	98.3394169	0	0	0	14.75091253	19.39630706	19.66788338	19.66788338	0	19.66788338	0	0	0	0	19.66788338	0	19.66788338	0	0	0												6.2228	0.326451258	1.912546628	0	2.364840308	1.044452786	0	1.443816399	4.088183571	0	1.627914049	0	0	0	3.692551579	7.763108782	0.858503488	1.973150509	0	0.083600535	0	0	0	0	0.322539911	0	0.030870854	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7553			0.57	6.2228	0.326451258	1.912546628	0	2.364840308	1.044452786	0	1.443816399	4.088183571	0	1.627914049	0	0	0	3.692551579	7.763108782	0.858503488	1.973150509	0	0.083600535	0	0	0	0	0.322539911	0	0.030870854	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7553	NO																																																																																		0				6.2228	0.326451258	1.912546628	0	2.364840308	1.044452786	0	1.443816399	4.088183571	0	1.627914049	0	0	0	3.692551579	7.763108782	0.858503488	1.973150509	0	0.083600535	0	0	0	0	0.322539911	0	0.030870854	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7553
H2256_018_7	2012	11																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	565.0477548	29.64288304	620.23475	0	268.4194155	9.87915214	0	252.1219868	309.3507952	0	184.7751563	0	0	0	2794.135212	4467.415607	487.2189544	1119.804801	0	47.44507835	0	0	0	0	183.0482467	0	17.51986525	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.7684217	122.7684217	34.37515806	0	98.21473733	0.098214737	0	63.83957926	147.322106	0	98.21473733	0	0	0	14.7322106	19.37171546	19.64294747	19.64294747	0	19.64294747	0	0	0	0	19.64294747	0	19.64294747	0	0	0												5.7808	0.303267497	1.776722297	0	2.196895199	0.970278332	0	1.34128013	3.797850886	0	1.51230362	0	0	0	3.430315699	7.211791999	0.797534694	1.83302224	0	0.077663432	0	0	0	0	0.299633925	0	0.028678483	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3581			0.57	5.7808	0.303267497	1.776722297	0	2.196895199	0.970278332	0	1.34128013	3.797850886	0	1.51230362	0	0	0	3.430315699	7.211791999	0.797534694	1.83302224	0	0.077663432	0	0	0	0	0.299633925	0	0.028678483	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3581	NO																																																																																		0				5.7808	0.303267497	1.776722297	0	2.196895199	0.970278332	0	1.34128013	3.797850886	0	1.51230362	0	0	0	3.430315699	7.211791999	0.797534694	1.83302224	0	0.077663432	0	0	0	0	0.299633925	0	0.028678483	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3581
H2256_018_8	2012	12																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	664.8766116	34.87998929	729.8136759	0	315.8419619	11.62453464	0	296.6652126	364.0048239	0	217.4199947	0	0	0	3287.784327	5256.688707	573.2975395	1317.644421	0	55.82735735	0	0	0	0	215.3879863	0	20.61515782	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.7684217	122.7684217	34.37515806	0	98.21473733	0.098214737	0	63.83957926	147.322106	0	98.21473733	0	0	0	14.7322106	19.37171546	19.64294747	19.64294747	0	19.64294747	0	0	0	0	19.64294747	0	19.64294747	0	0	0												6.8022	0.356846769	2.090621705	0	2.585027944	1.141700616	0	1.578248529	4.468829771	0	1.779487306	0	0	0	4.036360926	8.485923158	0.938437788	2.156868346	0	0.091384487	0	0	0	0	0.352571242	0	0.033745205	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8982			0.57	6.8022	0.356846769	2.090621705	0	2.585027944	1.141700616	0	1.578248529	4.468829771	0	1.779487306	0	0	0	4.036360926	8.485923158	0.938437788	2.156868346	0	0.091384487	0	0	0	0	0.352571242	0	0.033745205	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8982	NO																																																																																		0				6.8022	0.356846769	2.090621705	0	2.585027944	1.141700616	0	1.578248529	4.468829771	0	1.779487306	0	0	0	4.036360926	8.485923158	0.938437788	2.156868346	0	0.091384487	0	0	0	0	0.352571242	0	0.033745205	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8982
H2256_018_9	2012	11																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	596.421275	31.28876445	654.6724542	0	283.3230442	10.42767884	0	266.1207226	326.527084	0	195.0345495	0	0	0	2949.27583	4715.462878	514.2711347	1181.980464	0	50.07940281	0	0	0	0	193.2117556	0	18.49263231	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.7684217	122.7684217	34.37515806	0	98.21473733	0.098214737	0	63.83957926	147.322106	0	98.21473733	0	0	0	14.7322106	19.37171546	19.64294747	19.64294747	0	19.64294747	0	0	0	0	19.64294747	0	19.64294747	0	0	0												6.1018	0.320106019	1.875372424	0	2.318874864	1.024151738	0	1.415752914	4.008721473	0	1.596272254	0	0	0	3.620779386	7.612217095	0.84181674	1.934798346	0	0.08197559	0	0	0	0	0.316270697	0	0.030270817	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0992			0.57	6.1018	0.320106019	1.875372424	0	2.318874864	1.024151738	0	1.415752914	4.008721473	0	1.596272254	0	0	0	3.620779386	7.612217095	0.84181674	1.934798346	0	0.08197559	0	0	0	0	0.316270697	0	0.030270817	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0992	NO																																																																																		0				6.1018	0.320106019	1.875372424	0	2.318874864	1.024151738	0	1.415752914	4.008721473	0	1.596272254	0	0	0	3.620779386	7.612217095	0.84181674	1.934798346	0	0.08197559	0	0	0	0	0.316270697	0	0.030270817	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0992
H2256_019_1	2012	8																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	601.3294368	31.54625077	660.0599856	0	285.6546098	10.5134919	0	268.3107242	329.214191	0	196.6395579	0	0	0	2973.546465	4754.268092	518.5032539	1191.7074	0	50.49152395	0	0	0	0	194.8017636	0	18.64481473	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.9030657	122.9030657	34.41285839	0	98.32245255	0.098322453	0	63.90959415	147.4836788	0	98.32245255	0	0	0	14.74836788	19.39296104	19.66449051	19.66449051	0	19.66449051	0	0	0	0	19.66449051	0	19.66449051	0	0	0												6.1588	0.323094244	1.892879235	0	2.340521818	1.033712308	0	1.428969124	4.046143333	0	1.611173633	0	0	0	3.654579765	7.683277988	0.849675193	1.952859904	0	0.082740841	0	0	0	0	0.319223119	0	0.030553399	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4082			0.57	6.1588	0.323094244	1.892879235	0	2.340521818	1.033712308	0	1.428969124	4.046143333	0	1.611173633	0	0	0	3.654579765	7.683277988	0.849675193	1.952859904	0	0.082740841	0	0	0	0	0.319223119	0	0.030553399	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4082	NO																																																																																		0				6.1588	0.323094244	1.892879235	0	2.340521818	1.033712308	0	1.428969124	4.046143333	0	1.611173633	0	0	0	3.654579765	7.683277988	0.849675193	1.952859904	0	0.082740841	0	0	0	0	0.319223119	0	0.030553399	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4082
H2256_019_7	2012	8																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	589.8166778	30.94228169	647.4228003	0	280.1856065	6.187323439	0	263.1737785	322.9112172	0	192.8747932	0	0	0	2916.6164	4663.245203	508.5762445	1168.891553	0	49.52483795	0	0	0	0	191.0721844	0	18.28785024	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.8353437	122.8353437	34.39389625	0	98.26827499	0.098268275	0	63.87437874	147.4024125	0	98.26827499	0	0	0	14.74024125	19.38227514	19.653655	19.653655	0	19.653655	0	0	0	0	19.653655	0	19.653655	0	0	0												6.0375	0.316733817	1.855616052	0	2.294446353	0.608017601	0	1.400838467	3.966491037	0	1.579456102	0	0	0	3.582635781	7.532025132	0.832948504	1.914415943	0	0.081112007	0	0	0	0	0.312938899	0	0.029951925	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3452			0.57	6.0375	0.316733817	1.855616052	0	2.294446353	0.608017601	0	1.400838467	3.966491037	0	1.579456102	0	0	0	3.582635781	7.532025132	0.832948504	1.914415943	0	0.081112007	0	0	0	0	0.312938899	0	0.029951925	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3452	NO																																																																																		0				6.0375	0.316733817	1.855616052	0	2.294446353	0.608017601	0	1.400838467	3.966491037	0	1.579456102	0	0	0	3.582635781	7.532025132	0.832948504	1.914415943	0	0.081112007	0	0	0	0	0.312938899	0	0.029951925	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3452
H2256_019_8	2012	9																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	526.9651867	27.64503932	578.4327397	0	250.328731	5.527995687	0	235.1297014	288.5014553	0	172.3218506	0	0	0	2605.818661	4166.324845	454.3818202	1044.333229	0	44.24741867	0	0	0	0	170.7113296	0	16.33907751	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.8353437	122.8353437	34.39389625	0	98.26827499	0.098268275	0	63.87437874	147.4024125	0	98.26827499	0	0	0	14.74024125	19.38227514	19.653655	19.653655	0	19.653655	0	0	0	0	19.653655	0	19.653655	0	0	0												5.3942	0.282982326	1.657879636	0	2.049947715	0.5432266	0	1.251563633	3.543817543	0	1.411147583	0	0	0	3.20086631	6.729404541	0.744188628	1.710413749	0	0.072468625	0	0	0	0	0.279591798	0	0.026760216	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8984			0.57	5.3942	0.282982326	1.657879636	0	2.049947715	0.5432266	0	1.251563633	3.543817543	0	1.411147583	0	0	0	3.20086631	6.729404541	0.744188628	1.710413749	0	0.072468625	0	0	0	0	0.279591798	0	0.026760216	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8984	NO																																																																																		0				5.3942	0.282982326	1.657879636	0	2.049947715	0.5432266	0	1.251563633	3.543817543	0	1.411147583	0	0	0	3.20086631	6.729404541	0.744188628	1.710413749	0	0.072468625	0	0	0	0	0.279591798	0	0.026760216	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8984
H2256_019_9	2012	8																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	544.8974901	28.58578312	598.1164524	0	258.8472648	5.716110003	0	243.1310215	298.3189835	0	178.1858579	0	0	0	2694.493078	4308.102334	469.8441559	1079.871251	0	45.75313129	0	0	0	0	176.5205319	0	16.89508634	0	0	0											3400	(1a) $125 per day for days 1-5	(1b) $125 per day for days 1-5	(2) $35 per day for days 1-20	(6) No cost sharing	"(10a) $100 per trip, max one copay per day"	"(11 a, b) 10% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $150 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $15 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $20 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $20 per visit"	"(7c, 7i) $20 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $20 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $20 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $20 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													125	125	35	0	100	0.1	0	65	150	0	100	0	0	0	15	19.72383778	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.8353437	122.8353437	34.39389625	0	98.26827499	0.098268275	0	63.87437874	147.4024125	0	98.26827499	0	0	0	14.74024125	19.38227514	19.653655	19.653655	0	19.653655	0	0	0	0	19.653655	0	19.653655	0	0	0												5.5777	0.292612041	1.714296267	0	2.119706183	0.56171227	0	1.294153579	3.664411489	0	1.459168073	0	0	0	3.309789835	6.958402066	0.769512912	1.768618084	0	0.074934688	0	0	0	0	0.289106136	0	0.02767085	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8818			0.57	5.5777	0.292612041	1.714296267	0	2.119706183	0.56171227	0	1.294153579	3.664411489	0	1.459168073	0	0	0	3.309789835	6.958402066	0.769512912	1.768618084	0	0.074934688	0	0	0	0	0.289106136	0	0.02767085	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8818	NO																																																																																		0				5.5777	0.292612041	1.714296267	0	2.119706183	0.56171227	0	1.294153579	3.664411489	0	1.459168073	0	0	0	3.309789835	6.958402066	0.769512912	1.768618084	0	0.074934688	0	0	0	0	0.289106136	0	0.02767085	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8818
H2256_026_1	2012	10																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	558.9906723	54.86941591	205.4420823	0	186.7220324	5.171816187	0	240.3994008	313.9120435	0	156.0724319	0	0	0	2847.496444	4093.734854	567.7915907	692.8011545	0	22.27670034	0	0	0	0	225.5886782	0	15.49954009	0	0	0											3400	(1a) $200 per day for days 1-10	(1b) $179 per day for days 1-10	(2) $65 per day for days 1-20	(6) No cost sharing	"(10a) $150 per trip, max one copay per day"	"(11 a, b) 20% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $165 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $20 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $30 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $30 per visit"	"(7c, 7i) $30 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $30 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $30 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $30 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													200	179	65	0	150	0.2	0	65	165	0	100	0	0	0	20	29.17151333	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	184.8661412	165.4551964	60.08149589	0	138.6496059	0.184866141	0	60.08149589	152.5145665	0	92.4330706	0	0	0	18.48661412	26.96412551	27.72992118	27.72992118	0	27.72992118	0	0	0	0	27.72992118	0	27.72992118	0	0	0												8.6115	0.756535832	1.028605635	0	2.15741135	0.956093702	0	1.203629634	3.989679936	0	1.202187843	0	0	0	4.386713997	9.198665034	1.312068005	1.600943451	0	0.051477595	0	0	0	0	0.521296356	0	0.035816752	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0127			3.03	8.6115	0.756535832	1.028605635	0	2.15741135	0.956093702	0	1.203629634	3.989679936	0	1.202187843	0	0	0	4.386713997	9.198665034	1.312068005	1.600943451	0	0.051477595	0	0	0	0	0.521296356	0	0.035816752	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0127	NO																																																																																		0				8.6115	0.756535832	1.028605635	0	2.15741135	0.956093702	0	1.203629634	3.989679936	0	1.202187843	0	0	0	4.386713997	9.198665034	1.312068005	1.600943451	0	0.051477595	0	0	0	0	0.521296356	0	0.035816752	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0127
H2256_026_2	2012	10																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	535.0783927	52.52223396	196.653763	0	178.7345119	4.950578301	0	230.1156913	300.4836396	0	149.3960278	0	0	0	2725.687379	3918.614701	543.5028289	663.1647835	0	21.32375655	0	0	0	0	215.9385359	0	14.83650695	0	0	0											3400	(1a) $200 per day for days 1-10	(1b) $179 per day for days 1-10	(2) $65 per day for days 1-20	(6) No cost sharing	"(10a) $150 per trip, max one copay per day"	"(11 a, b) 20% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $165 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $20 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $30 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $30 per visit"	"(7c, 7i) $30 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $30 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $30 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $30 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													200	179	65	0	150	0.2	0	65	165	0	100	0	0	0	20	29.17151333	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	184.1898196	164.8498886	59.86169138	0	138.1423647	0.18418982	0	59.86169138	151.9566012	0	92.09490981	0	0	0	18.41898196	26.86547889	27.62847294	27.62847294	0	27.62847294	0	0	0	0	27.62847294	0	27.62847294	0	0	0												8.213	0.721523701	0.981002239	0	2.057567344	0.911846124	0	1.147926208	3.805039382	0	1.146551142	0	0	0	4.183698889	8.772955043	1.2513461	1.526852523	0	0.049095236	0	0	0	0	0.497171	0	0.034159169	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2997			3.03	8.213	0.721523701	0.981002239	0	2.057567344	0.911846124	0	1.147926208	3.805039382	0	1.146551142	0	0	0	4.183698889	8.772955043	1.2513461	1.526852523	0	0.049095236	0	0	0	0	0.497171	0	0.034159169	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2997	NO																																																																																		0				8.213	0.721523701	0.981002239	0	2.057567344	0.911846124	0	1.147926208	3.805039382	0	1.146551142	0	0	0	4.183698889	8.772955043	1.2513461	1.526852523	0	0.049095236	0	0	0	0	0.497171	0	0.034159169	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2997
H2256_027_1	2012	8																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	537.8911452	52.79832817	197.687515	0	179.6740676	4.976602061	0	231.325343	302.0631952	0	150.1813595	0	0	0	2740.01553	3939.213726	546.3598662	666.6508491	0	21.43584938	0	0	0	0	217.0736624	0	14.91449818	0	0	0											3400	(1a) $200 per day for days 1-10	(1b) $179 per day for days 1-10	(2) $65 per day for days 1-20	(6) No cost sharing	"(10a) $150 per trip, max one copay per day"	"(11 a, b) 20% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $165 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $20 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $30 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $30 per visit"	"(7c, 7i) $30 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $30 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $30 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $30 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													200	179	65	0	150	0.2	0	65	165	0	100	0	0	0	20	29.17151333	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	184.2724946	164.9238826	59.88856074	0	138.2043709	0.184272495	0	59.88856074	152.024808	0	92.13624729	0	0	0	18.42724946	26.87753766	27.64087419	27.64087419	0	27.64087419	0	0	0	0	27.64087419	0	27.64087419	0	0	0												8.2599	0.725642107	0.986601729	0	2.06931179	0.917050876	0	1.154478488	3.826758272	0	1.153095573	0	0	0	4.20757914	8.823030437	1.258488694	1.535567687	0	0.049375468	0	0	0	0	0.500008816	0	0.034354147	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5012			3.03	8.2599	0.725642107	0.986601729	0	2.06931179	0.917050876	0	1.154478488	3.826758272	0	1.153095573	0	0	0	4.20757914	8.823030437	1.258488694	1.535567687	0	0.049375468	0	0	0	0	0.500008816	0	0.034354147	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5012	NO																																																																																		0				8.2599	0.725642107	0.986601729	0	2.06931179	0.917050876	0	1.154478488	3.826758272	0	1.153095573	0	0	0	4.20757914	8.823030437	1.258488694	1.535567687	0	0.049375468	0	0	0	0	0.500008816	0	0.034354147	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5012
H2256_027_2	2012	8																															D	D	D		T	COIN		V	V		V				V	V	V	V		V					V		V																																																						0	YES	511.4087024	50.1988641	187.954601	0	170.8280246	4.731584867	0	219.9363097	287.1914663	0	142.7873555	0	0	0	2605.114063	3745.271135	519.4604759	633.8290727	0	20.38048035	0	0	0	0	206.386294	0	14.18020027	0	0	0											3400	(1a) $200 per day for days 1-10	(1b) $179 per day for days 1-10	(2) $65 per day for days 1-20	(6) No cost sharing	"(10a) $150 per trip, max one copay per day"	"(11 a, b) 20% per item"	(11c) No cost sharing	(4a) $65 per visit	"(9a, 9b) $165 per day"	(8a) No cost sharing	"(8b) 20% up to $100 /Day for diagnostic, no cost sharing for therapeutic"	(5) No cost sharing	(12) No cost sharing	"(3, 5) No cost sharing"	"(14 a, b, d, e) No copay, (4b, 7a) $20 per visit may apply, $0 for annual physical, $0 copay for anticoagulant visit"	"(14 a, b, d, e) No copay, (4b, 7b, 7d, 7f) $30 per visit may apply, $15 for chiro"	"(7e,7h, 9c) $30 per visit"	"(7c, 7i) $30 per visit"	(7d) No cost sharing	"(7g, 4b, 16b) $30 per visit, $0 copay for anticoagulant visit"	(15) No cost sharing	(9d) No cost sharing	(10b) Not covered	(16a) Not covered	"(17a) $30 per visit, $0 for glaucoma"	(17b) No cost sharing	(18a) $30 per visit	(18b) Not covered	(14c) No cost sharing	"(13 a, b, c) Not covered, (13 d, e) No cost sharing"													200	179	65	0	150	0.2	0	65	165	0	100	0	0	0	20	29.17151333	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	183.4580721	164.1949745	59.62387342	0	137.593554	0.183458072	0	59.62387342	151.3529095	0	91.72903603	0	0	0	18.34580721	26.75874797	27.51871081	27.51871081	0	27.51871081	0	0	0	0	27.51871081	0	27.51871081	0	0	0												7.8185	0.686866768	0.933881778	0	1.958736253	0.868047437	0	1.092787891	3.622272	0	1.091478873	0	0	0	3.982743363	8.351563866	1.191240218	1.453513246	0	0.046737045	0	0	0	0	0.473290395	0	0.032518403	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6042			3.03	7.8185	0.686866768	0.933881778	0	1.958736253	0.868047437	0	1.092787891	3.622272	0	1.091478873	0	0	0	3.982743363	8.351563866	1.191240218	1.453513246	0	0.046737045	0	0	0	0	0.473290395	0	0.032518403	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6042	NO																																																																																		0				7.8185	0.686866768	0.933881778	0	1.958736253	0.868047437	0	1.092787891	3.622272	0	1.091478873	0	0	0	3.982743363	8.351563866	1.191240218	1.453513246	0	0.046737045	0	0	0	0	0.473290395	0	0.032518403	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6042
H2256_801_0	2012	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	264.3490582	5.716651542	61.32069908	22.80845221	16.92478609	14.01587238	0.425327657	14.04523947	54.58491049	15.52391042	52.70041031	0.102100657	0.409068257	11.76246013	40.68319349	145.0331883	4.630476164	23.02483549	21.20662609	60.27640799	45.26491204	1.719321824	0	0	0	0	0	0	0	0											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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.071482433	0.071482433	0.148162718	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.053611825	0.053611825	0.111122039	0	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0	0	0	0	0	0	0	0												14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447			36.3482495	14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447	NO																																																																																		0				14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447
H2256_802_0	2012	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	264.3490582	5.716651542	61.32069908	22.80845221	16.92478609	14.01587238	0.425327657	14.04523947	54.58491049	15.52391042	52.70041031	0.102100657	0.409068257	11.76246013	40.68319349	145.0331883	4.630476164	23.02483549	21.20662609	60.27640799	45.26491204	1.719321824	0	0	0	0	0	0	0	0											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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.071482433	0.071482433	0.148162718	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.053611825	0.053611825	0.111122039	0	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0.168	0	0	0	0	0	0	0	0												14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447			36.3482495	14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447	NO																																																																																		0				14.1722	0.30648012	6.814081106	0	2.843364063	2.35466656	0.071455046	2.359600231	9.170264963	2.60801695	8.853668932	0.01715291	0.068723467	1.976093302	6.834776506	24.36557563	0.777919996	3.868172363	3.562713183	10.12643654	7.604505223	0.288846066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.0447
H2256_803_0	2012	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	176.3387842	3.908228075	55.9091865	19.63368399	13.54535271	10.46416643	0.15486141	11.74977762	46.37994234	14.83757309	37.00790088	0.031000508	9.83E-05	10.83164707	37.78458523	134.149008	4.480097016	20.0923266	24.09379327	50.95817023	42.87717503	1.27640493	0	0	0	0	0	0	0	0											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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.071081476	0.071081476	0.142238077	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056154366	0.056154366	0.112368081	0	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0.17696	0	0	0	0	0	0	0	0												9.9022	0.219464069	6.28240797	0	2.396985616	1.851738891	0.027404275	2.079240648	8.207394597	2.625656934	6.548918139	0.00548585	1.74E-05	1.916768266	6.686360202	23.73900846	0.792797968	3.555538116	4.263637657	9.017557804	7.587544893	0.225872616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.932			26.03255509	9.9022	0.219464069	6.28240797	0	2.396985616	1.851738891	0.027404275	2.079240648	8.207394597	2.625656934	6.548918139	0.00548585	1.74E-05	1.916768266	6.686360202	23.73900846	0.792797968	3.555538116	4.263637657	9.017557804	7.587544893	0.225872616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.932	NO																																																																																		0				9.9022	0.219464069	6.28240797	0	2.396985616	1.851738891	0.027404275	2.079240648	8.207394597	2.625656934	6.548918139	0.00548585	1.74E-05	1.916768266	6.686360202	23.73900846	0.792797968	3.555538116	4.263637657	9.017557804	7.587544893	0.225872616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.932
H2261_005_0	2012	8																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	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	877.7036543	18.48708696	1892.523186	0	182.8345769	0.822925173	14.86086284	301.8087008	319.7855451	10.60918114	15.73297956	0	0	1489.885374	3847.573445	6070.671541	292.4267072	530.9134209	1.812281364	16.53265235	0	258.0288096	0	323.2229956	147.2667255	0	0.074070985	0	0	0											3400	$150/Day for IP Med; $150/Day for IP Surg; PBP 1a	$150/Day for IP MH; PBP 1b	$50/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care PCP; $65/Case for OP ER Worldwide; PBP 4a, 4b"	"$150/Case for Surg; $150/Case for ASC; PBP 9a, 9b"	10% Coinsurance for Path; PBP 8a	10% Coinsurance for Rad CT/MRI/PET; PBP 8b		No Cost Sharing; PBP 12	"$15/Visit for Cardio; $15/Visit for Occ Therapy; $15/Visit for PT/ST; $15/Visit for CORF; $15/Visit for Other; $15/Visit for CORF; PBP 3, 5, 9c, 9d"	"$15/Visit for OP Surg Office PCP; $15/Visit for Office Visit PCP; PBP 7a, 14a"	"$30/Visit for OP Surg Office Spec; $30/Visit for Office Visit Spec; $15/Visit for Cardio; $20/Visit for Chiro; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"$30/Visit for OP MH Non-Phys; $30/Visit for OP MH Psych; $30/Visit for OP SA; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for OP Rad CT/MRI/PET; 10% Coinsurance for Office Rad CT/MRI/PET; PBP 8b	"$150/Visit for OP Surg Fac; 10% Coinsurance for OP Path; 10% Coinsurance for Office Path; PBP 7d, 7g, 8a"	No Cost Sharing; PBP 15	"$30/Case for Misc Med; PBP 7g, 14a"	N/C	"$30/Visit for Prev Dental; PBP 16a, 16b"	$30/Exam for Routine Vision Exams; PBP 17a	$150 per 2 yrs for Vision Hardware; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$400 per 3 yrs for Hearing Aids; PBP 18b	"$150 per yr for Fitness Club; $150 per yr for Weight Loss; PBP 13e, 14c"	$500 per yr for Wigs; PBP 13d											0	NO	150	150	50	0	100	0.1	0.1	64.92663362	150	0.1	0.1	0	0	15	15	28.5993912	30	15	0.1	0.140142198	0	30	0	30	30	0	30	0	0	0											NO	149.1051136	149.1051136	49.70172565	0	99.40340904	0.099403409	0.099403409	64.54012707	149.1051136	0.099403409	0.099403409	0	0	14.91051136	14.91051136	28.42876982	29.82102271	14.91051136	0.099403409	0.139306283	0	29.82102271	0	30	30	0	30	0	0	0												10.9058	0.229709933	7.838472349	0	1.514531686	0.081801568	1.477220428	1.623230992	3.973471668	1.054588772	1.563911803	0	0	1.851246065	4.780773962	14.38181032	0.72670529	0.659682549	0.180146946	2.303102339	0	0.641223583	0	0.808057489	0.368166814	0	0.000185177	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9639	0	NO	0.334793259	10.9058	0.229709933	7.838472349	0	1.514531686	0.081801568	1.477220428	1.623230992	3.973471668	1.054588772	1.563911803	0	0	1.851246065	4.780773962	14.38181032	0.72670529	0.659682549	0.180146946	2.303102339	0	0.641223583	0	0.808057489	0.368166814	0	0.000185177	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9639	NO																																										0	0	0	0	0	0	0	0	0	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	10.9058	0.229709933	7.838472349	0	1.514531686	0.081801568	1.477220428	1.623230992	3.973471668	1.054588772	1.563911803	0	0	1.851246065	4.780773962	14.38181032	0.72670529	0.659682549	0.180146946	2.303102339	0	0.641223583	0	0.808057489	0.368166814	0	0.000185177	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9639
H2261_019_0	2012	8																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	V		V		V	V		V														11.22375056	0.244031651	3.155245355	0	0	0	0	0	8.997296531	6.237208769	10.46303466	0	0	0	0	0	0	0	6.427477759	7.776360958	0	0	0	0	0	0	0	0	0	0											54.5244	YES	658.4406145	15.79071082	1290.571537	0	144.9590326	0.66560104	12.26712925	272.7456998	195.7389268	4.982660675	11.58502538	0	0	1437.118263	3689.101808	6084.714641	389.8545487	623.546423	1.053036106	4584.339923	0	218.5476143	0	464.4752542	87.55994361	0	0.081261511	0	0	0											3400	$250/Day for IP Med; $250/Day for IP Surg; PBP 1a	$250/Day for IP MH; $250/Day for IP SA; PBP 1b	$100/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 Supplies; PBP 11b, 11c"	"$65/Visit for ER; $20/Visit for Urgent Care PCP; $65/Case for OP ER Worldwide; PBP 4a, 4b"	"$200/Case for Surg; $200/Case for ASC; PBP 9a, 9b"	10% Coinsurance for Path; PBP 8a	10% Coinsurance for Rad CT/MRI/PET; PBP 8b		No Cost Sharing; PBP 12	"$20/Visit for Cardio; $20/Visit for Occ Therapy; $20/Visit for PT/ST; $20/Visit for CORF; $20/Visit for Other; $20/Visit for CORF; PBP 3, 5, 9c, 9d"	"$20/Visit for OP Surg Office PCP; $20/Visit for Office Visit PCP; PBP 7a, 14a"	"$40/Visit for OP Surg Office Spec; $40/Visit for Office Visit Spec; $20/Visit for Cardio; $20/Visit for Chiro; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"$40/Visit for OP MH Non-Phys; $40/Visit for OP MH Psych; $40/Visit for OP SA; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for OP Rad CT/MRI/PET; 10% Coinsurance for Office Rad CT/MRI/PET; PBP 8b	"$200/Visit for OP Surg Fac; 10% Coinsurance for OP Path; 10% Coinsurance for Office Path; PBP 7d, 7g, 8a"	No Cost Sharing; PBP 15	"$40/Case for Misc Med; PBP 7g, 14a"	N/C	"$40/Visit for Prev Dental; PBP 16a, 16b"	$40/Exam for Routine Vision Exams; PBP 17a	$150 per 2 yrs for Vision Hardware; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	N/C	"$150 per yr for Fitness Club; $150 per yr for Weight Loss; PBP 13e, 14c"	$500 per yr for Wigs; PBP 13d											0	NO	250	249.9855982	100	0	100	0.2	0.2	64.95324159	200	0.1	0.1	0	0	20	20	37.61653073	40	20	0.1	4.89399154	0	40	0	40	40	0	40	0	0	0											NO	216.6166876	216.604209	86.65095787	0	86.64667505	0.17329335	0.17329335	56.29419342	173.2933501	0.086646675	0.086646675	0	0	17.32933501	17.32933501	32.59347315	34.65867002	17.32933501	0.086646675	4.240573902	0	34.65867002	0	40	40	0	40	0	0	0												11.8858	0.285027869	9.319104992	0	1.046684849	0.115344234	2.125811924	1.279499931	2.826687863	0.43173098	1.00380393	0	0	2.075358652	5.327473426	16.52683194	1.12598668	0.900470405	0.091242077	1.620019353	0	0.631214137	0	1.548250847	0.291866479	0	0.000270872	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4585	1000	NO	9.032819295	23.1095	0.52905952	12.47435035	0	1.046684849	0.115344234	2.125811924	1.279499931	11.82398439	6.66893975	11.46683859	0	0	2.075358652	5.327473426	16.52683194	1.12598668	0.900470405	6.518719837	9.396380311	0	0.631214137	0	1.548250847	0.291866479	0	0.000270872	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9829	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	23.1095	0.52905952	12.47435035	0	1.046684849	0.115344234	2.125811924	1.279499931	11.82398439	6.66893975	11.46683859	0	0	2.075358652	5.327473426	16.52683194	1.12598668	0.900470405	6.518719837	9.396380311	0	0.631214137	0	1.548250847	0.291866479	0	0.000270872	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9829
H2261_801_0	2012	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	328.9566411	8.666436353	78.24341241	0	20.51961886	0.822137593	16.6678707	29.25828005	38.97527462	13.8373636	43.25126156	0	0.009315518	45.28521099	34.27144911	64.52415251	3.318324506	4.244834404	19.0423749	95.09226075	80.15389223	10.89107369	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											0	NO	0.070635719	0.070635719	0.15081405	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059241104	0.059241104	0.126485453	0	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0	0	0	0	0	0	0	0												19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188	0	NO	24.54658164	19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188	NO																																										0	0	0	0	0	0	0	0	0	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	19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188
H2261_809_0	2012	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	328.9566411	8.666436353	78.24341241	0	20.51961886	0.822137593	16.6678707	29.25828005	38.97527462	13.8373636	43.25126156	0	0.009315518	45.28521099	34.27144911	64.52415251	3.318324506	4.244834404	19.0423749	95.09226075	80.15389223	10.89107369	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	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, 14a"	N/C	N/C	N/C	N/C	N/C	N/C	N/C	N/C											0	NO	0.070635719	0.070635719	0.15081405	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059241104	0.059241104	0.126485453	0	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0.187865398	0	0	0	0	0	0	0	0												19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188	0	NO	24.54658164	19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188	NO																																										0	0	0	0	0	0	0	0	0	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	19.4878	0.513409261	9.896653495	0	3.854926356	0.154451206	3.131316157	5.496618416	7.322105465	2.599561815	8.125415452	0	0.001750063	8.50752417	6.438419415	12.12185557	0.623398353	0.797457503	3.577403333	17.86454538	15.05814284	2.04605589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6188
H2312_004_0	2012	7																															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	315.0369207	6.722938983	44.50846714	0	346.415165	10.49681827	0	435.5097115	213.2924921	0	367.4807011	0	0.580496966	926.8179091	3228.770035	2695.115871	112.5824188	3.902048166	0	0.501959829	0	0	0	0	40.14404637	0	0	0	0	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	18% 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"	"$65/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"	"$20/Visit for PCP; $20/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	0.176668245	0	75	0.2	0	62.24451707	50	0	47.98437286	0	25	49.64604422	20	34.18681616	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	392.8043219	392.8043219	0.173490125	0	73.65081036	0.196402161	0	61.1247883	49.10054024	0	47.12117261	0	24.55027012	48.75295183	19.6402161	33.57182285	34.37037817	14.73016207	0	34.37037817	0	0	0	0	34.37037817	0	0	0	0	0												10.3123	0.220066624	7.721779527	0	2.126146468	2.061597792	0	2.21836991	0.872731383	0	1.443010129	0	0.001187613	3.76542574	5.284478434	7.539996047	0.322458359	0.004789817	0	0.001437712	0	0	0	0	0.114980505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0108	0	NO	0.806221758	10.3123	0.220066624	7.721779527	0	2.126146468	2.061597792	0	2.21836991	0.872731383	0	1.443010129	0	0.001187613	3.76542574	5.284478434	7.539996047	0.322458359	0.004789817	0	0.001437712	0	0	0	0	0.114980505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0108	NO																																										0	0	0	0	0	0	0	0	0	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	10.3123	0.220066624	7.721779527	0	2.126146468	2.061597792	0	2.21836991	0.872731383	0	1.443010129	0	0.001187613	3.76542574	5.284478434	7.539996047	0.322458359	0.004789817	0	0.001437712	0	0	0	0	0.114980505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0108
H2312_006_0	2012	4																															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	279.9109647	5.04683823	39.19311758	0	302.8028845	8.921366992	0	384.6968645	185.2942019	0	336.51145	0	0.524613592	851.4686311	2818.292597	2469.796018	98.12303751	13.37373964	0	0.251804499	0	0	0	0	36.49088746	0	0	0	0	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	18% 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"	"$65/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"	"$20/Visit for PCP; $20/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	0.176668245	0	75	0.2	0	62.35773423	50	0	47.98437286	0	25	49.57114348	20	34.09804817	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	394.0841952	394.0841952	0.174055407	0	73.89078661	0.197042098	0	61.43549378	49.26052441	0	47.2747074	0	24.6302622	48.83801047	19.70420976	33.59375468	34.48236708	14.77815732	0	34.48236708	0	0	0	0	34.48236708	0	0	0	0	0												9.1924	0.165739932	6.821774048	0	1.86452861	1.757884866	0	1.969503485	0.760640796	0	1.325706695	0	0.001076781	3.46533616	4.627685708	6.914143461	0.28195955	0.016469936	0	0.000723568	0	0	0	0	0.104857681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2704	0	NO	0.58950867	9.1924	0.165739932	6.821774048	0	1.86452861	1.757884866	0	1.969503485	0.760640796	0	1.325706695	0	0.001076781	3.46533616	4.627685708	6.914143461	0.28195955	0.016469936	0	0.000723568	0	0	0	0	0.104857681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2704	NO																																										0	0	0	0	0	0	0	0	0	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	9.1924	0.165739932	6.821774048	0	1.86452861	1.757884866	0	1.969503485	0.760640796	0	1.325706695	0	0.001076781	3.46533616	4.627685708	6.914143461	0.28195955	0.016469936	0	0.000723568	0	0	0	0	0.104857681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2704
H2312_007_0	2012	6																															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	253.5761472	9.185524542	28.89718808	0	324.2812813	9.12042606	0	313.5589902	208.8178983	0	312.1872135	0	0.44003166	646.4113244	4150.202647	3709.768171	271.3800953	88.46752006	0	25.40452434	0	0	0	0	24.01572653	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"	"$65/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"	"$15/Visit for PCP; $15/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$30/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	350	350	0.173818159	0	75	0.2	0	58.83299747	75	0	70.96874571	0	25	73.8643793	15	29.59607417	30	15	0	30	0	0	0	0	30	0	0	0	0	0											YES	344.6544569	344.6544569	0.171163438	0	73.85452648	0.196945404	0	57.93444226	73.85452648	0	69.88484146	0	24.61817549	72.73625009	14.7709053	29.14405391	29.54181059	14.7709053	0	29.54181059	0	0	0	0	29.54181059	0	0	0	0	0											3400	7.283	0.263819331	4.946142054	0	1.995803373	1.796225994	0	1.513822101	1.285178916	0	1.81809616	0	0.000902731	3.918127979	5.108520855	9.009806965	0.668088281	0.108895447	0	0.062541304	0	0	0	0	0.059122337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8381	0	NO	0.617883536	7.283	0.263819331	4.946142054	0	1.995803373	1.796225994	0	1.513822101	1.285178916	0	1.81809616	0	0.000902731	3.918127979	5.108520855	9.009806965	0.668088281	0.108895447	0	0.062541304	0	0	0	0	0.059122337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8381	NO	20% Coinsurance for IP Acute; PBP 1a	No Cost Sharing; PBP 1b	20% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; 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; 20% Coinsurance for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for OP Hospital; 20% Coinsurance for Partial Hosp; PBP 3, 5, 9d"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"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"	"No Cost Sharing; 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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"												0.1396	0	0.0161	0	0.0119	0	0	0.0146	0.0192	0.0005	0.0095	0	0.0001	0.0303	0.0257	0.0834	0	0.0009	0	0.0335	0.004	0.0002	0	0	0	0	0	0	0	0											0.3895	0	NO	0.032143406	7.4226	0.263819331	4.962247026	0	2.007748182	1.796225994	0	1.52839028	1.304350987	0.00047852	1.827627912	0	0.001021369	3.948471255	5.134254905	9.093177236	0.668088281	0.109778179	0	0.096042264	0.003963257	0.000228378	0	0	0.059122337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2276
H2312_008_0	2012	4																															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	254.3877686	5.327911935	29.46087615	0	289.1946686	7.893603986	0	247.3889359	163.2612535	0	261.7304054	0	0.382500427	611.1204718	3445.960281	3263.993862	178.4686632	75.914931	0	27.58791559	0	0	0	0	20.96984172	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"	"$65/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"	"$20/Visit for PCP; $20/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	350	350	0.173818159	0	75	0.2	0	59.70338435	75	0	70.96874571	0	25	74.25441074	20	34.44661054	35	15	0	35	0	0	0	0	35	0	0	0	0	0											YES	344.8731597	344.8731597	0.171272051	0	73.90139137	0.197070377	0	58.8288423	73.90139137	0	69.92918736	0	24.63379712	73.16672359	19.7070377	33.94203263	34.48731597	14.78027827	0	34.48731597	0	0	0	0	34.48731597	0	0	0	0	0											3400	7.311	0.153121152	5.045824674	0	1.780990699	1.555595513	0	1.212800392	1.005436149	0	1.525216213	0	0.000785203	3.72614022	5.659139097	9.232215514	0.512908765	0.09350365	0	0.079286097	0	0	0	0	0.06026613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9542	0	NO	0.579087987	7.311	0.153121152	5.045824674	0	1.780990699	1.555595513	0	1.212800392	1.005436149	0	1.525216213	0	0.000785203	3.72614022	5.659139097	9.232215514	0.512908765	0.09350365	0	0.079286097	0	0	0	0	0.06026613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9542	NO	20% Coinsurance for IP Acute; PBP 1a	No Cost Sharing; PBP 1b	20% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; 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; 20% Coinsurance for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for OP Hospital; 20% Coinsurance for Partial Hosp; PBP 3, 5, 9d"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; 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	"20% Coinsurance for Other Medicare Part B; PBP 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"												0.1373	0	0.0255	0	0.0111	0	0	0.011	0.0156	0.0004	0.0076	0	0.0001	0.0255	0.0232	0.088	0	0.0016	0	0.0334	0	0.0001	0	0	0	0	0	0	0	0											0.3805	0	NO	0.028400927	7.4482	0.153121152	5.071276455	0	1.792080913	1.555595513	0	1.223810119	1.02101967	0.000419745	1.532853141	0	0.000881506	3.751636458	5.682346757	9.320228224	0.512908765	0.09513002	0	0.112718697	0	0.000149831	0	0	0.06026613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3347
H2312_009_0	2012	6																															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	392.5492436	9.088406351	47.10897288	0	390.328751	16.70261348	0	453.791736	290.2936415	0	480.3446776	0	0.740993593	1261.879722	3863.692201	3744.82023	251.5951891	11.62362275	0	0.749911145	0	0	0	0	29.89951078	0	0	0	0	0											3400	$350/Admit for IP Acute; PBP 1a	$350/Admit for IP Psych; PBP 1b	18% 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"	"$65/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"	"$15/Visit for PCP; $15/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	350	350	0.176668245	0	75	0.2	0	62.4378882	50	0	47.98437286	0	25	49.64608436	15	34.31908426	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	341.5519702	341.5519702	0.172403963	0	73.1897079	0.195172554	0	60.93081065	48.7931386	0	46.82616311	0	24.3965693	48.4477655	14.63794158	33.4907167	34.15519702	14.63794158	0	34.15519702	0	0	0	0	34.15519702	0	0	0	0	0												11.173	0.258680258	8.121773609	0	2.380670606	3.259891738	0	2.304158195	1.18036149	0	1.874391518	0	0.001506475	5.094604404	4.713041727	10.45139279	0.716106938	0.014178826	0	0.002134447	0	0	0	0	0.085101973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.631	0	NO	1.277053568	11.173	0.258680258	8.121773609	0	2.380670606	3.259891738	0	2.304158195	1.18036149	0	1.874391518	0	0.001506475	5.094604404	4.713041727	10.45139279	0.716106938	0.014178826	0	0.002134447	0	0	0	0	0.085101973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.631	NO																																										0	0	0	0	0	0	0	0	0	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	11.173	0.258680258	8.121773609	0	2.380670606	3.259891738	0	2.304158195	1.18036149	0	1.874391518	0	0.001506475	5.094604404	4.713041727	10.45139279	0.716106938	0.014178826	0	0.002134447	0	0	0	0	0.085101973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.631
H2312_010_0	2012	6																															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	366.7924957	10.23139954	33.84231231	0	421.9241008	14.85185989	0	406.4240379	279.3308125	0	431.4395848	0	0.624872192	985.9419962	5214.722371	5121.043223	342.0775458	105.1091798	0	13.10565439	0	0	0	0	17.17841188	0	0	0	0	0											3400	$325/Admit for IP Acute; PBP 1a	$325/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"	"$65/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"	"$15/Visit for PCP; $15/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	325	325	0.173818159	0	75	0.2	0	60.2391622	75	0	70.96874571	0	25	74.01569726	15	34.56958939	35	15	0	35	0	0	0	0	35	0	0	0	0	0											YES	316.2195387	316.2195387	0.169122148	0	72.97373971	0.194596639	0	58.61169257	72.97373971	0	69.05139703	0	24.3245799	72.01602968	14.59474794	33.63562958	34.05441186	14.59474794	0	34.05441186	0	0	0	0	34.05441186	0	0	0	0	0											3400	9.6656	0.269614037	5.723484551	0	2.565781626	2.89012202	0	1.985100063	1.698651167	0	2.482625505	0	0.001266646	5.916969005	6.34229655	14.35412607	0.970770803	0.127836832	0	0.037192113	0	0	0	0	0.048750059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0802	0	NO	1.529409823	9.6656	0.269614037	5.723484551	0	2.565781626	2.89012202	0	1.985100063	1.698651167	0	2.482625505	0	0.001266646	5.916969005	6.34229655	14.35412607	0.970770803	0.127836832	0	0.037192113	0	0	0	0	0.048750059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0802	NO	20% Coinsurance for IP Acute; PBP 1a	No Cost Sharing; PBP 1b	20% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; 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; 20% Coinsurance for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for OP Hospital; 20% Coinsurance for Partial Hosp; PBP 3, 5, 9d"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"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"	"No Cost Sharing; 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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"												0.1523	0	0.0138	0	0.0099	0	0	0.0153	0.0198	0.0005	0.0094	0	0.0001	0.0373	0.0229	0.0753	0	0.0008	0	0.0365	0.0051	0.0002	0	0	0	0	0	0	0	0											0.3993	0	NO	0.040598715	9.8179	0.269614037	5.737310328	0	2.575688208	2.89012202	0	2.000372734	1.718457946	0.000499829	2.492000512	0	0.001398371	5.954281916	6.365182507	14.42947485	0.970770803	0.12867196	0	0.07372394	0.005122397	0.00015686	0	0	0.048750059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4795
H2312_801_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	301.18432	1.878361064	53.97518568	0	14.23235712	24.95068043	0	34.84718439	37.552425	2.035615456	21.00001808	0	0	159.7743866	27.06568069	97.86221337	1.36316835	5.557250171	0	54.36613073	0.600135677	0.475559501	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a, 13b"											0	NO	0.069560432	0.069560432	0.176668245	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06884884	0.06884884	0.174860956	0	0.221708516	0.221708516	0	0.221708516	0.221708516	0.221708516	0.221708516	0	0	0.221708516	0.221708516	0.221708516	0.221708516	0.221708516	0	0.221708516	0.221708516	0.221708516	0	0	0	0	0	0	0	0												20.7362	0.12932298	9.43815259	0	3.155434769	5.531778319	0	7.725917521	8.325692401	0.451313281	4.655882833	0	0	35.42334207	6.000691888	21.69688605	0.302226031	1.232089686	0	12.05343414	0.13305519	0.105435591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0968	0	NO	1.41697443	20.7362	0.12932298	9.43815259	0	3.155434769	5.531778319	0	7.725917521	8.325692401	0.451313281	4.655882833	0	0	35.42334207	6.000691888	21.69688605	0.302226031	1.232089686	0	12.05343414	0.13305519	0.105435591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0968	NO																																										0	0	0	0	0	0	0	0	0	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	20.7362	0.12932298	9.43815259	0	3.155434769	5.531778319	0	7.725917521	8.325692401	0.451313281	4.655882833	0	0	35.42334207	6.000691888	21.69688605	0.302226031	1.232089686	0	12.05343414	0.13305519	0.105435591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0968
H2312_803_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	193.0395875	3.269370045	31.09305046	0	8.773445657	17.93645529	0	21.90176393	24.76141978	1.590297485	15.10500111	0	0	104.5614562	21.44748814	66.65963034	1.510259042	3.822799518	0	36.24663508	2.284383254	0.515431733	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	0.069560432	0.069560432	0.176668245	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069175368	0.069175368	0.175690267	0	0.222760009	0.222760009	0	0.222760009	0.222760009	0.222760009	0.222760009	0	0	0.222760009	0.222760009	0.222760009	0.222760009	0.222760009	0	0.222760009	0.222760009	0.222760009	0	0	0	0	0	0	0	0												13.3536	0.226159876	5.462746334	0	1.954372836	3.995524946	0	4.878837135	5.5158541	0.354254682	3.364790188	0	0	23.29211096	4.777642656	14.84909987	0.336425318	0.851566856	0	8.074300766	0.508869235	0.114817578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.911	0	NO	0.511621176	13.3536	0.226159876	5.462746334	0	1.954372836	3.995524946	0	4.878837135	5.5158541	0.354254682	3.364790188	0	0	23.29211096	4.777642656	14.84909987	0.336425318	0.851566856	0	8.074300766	0.508869235	0.114817578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.911	NO																																										0	0	0	0	0	0	0	0	0	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	13.3536	0.226159876	5.462746334	0	1.954372836	3.995524946	0	4.878837135	5.5158541	0.354254682	3.364790188	0	0	23.29211096	4.777642656	14.84909987	0.336425318	0.851566856	0	8.074300766	0.508869235	0.114817578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.911
H2312_805_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin		Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	299.5943851	2.558899701	58.8759312	0	17.09282135	28.52283588	0	36.03832846	35.62695824	1.653332983	17.5095894	0	0	136.9518072	30.81521223	104.617269	2.328155556	4.752520419	0	58.63653333	0	1.291181468	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	0.071702478	0.071702478	0.173818159	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0	0.224	0	0	0	0	0	0	0	0											NO	0.07096918	0.07096918	0.172040528	0	0.221709161	0.221709161	0	0.221709161	0.221709161	0.221709161	0.221709161	0	0	0.221709161	0.221709161	0.221709161	0.221709161	0.221709161	0	0.221709161	0	0.221709161	0	0	0	0	0	0	0	0												21.262	0.181603013	10.1290463	0	3.789635089	6.323774026	0	7.990027584	7.898823036	0.366559069	3.882036383	0	0	30.36347033	6.832014863	23.19460698	0.516173416	1.053677317	0	13.00025664	0	0.286266761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0699	0	NO	1.416292839	21.262	0.181603013	10.1290463	0	3.789635089	6.323774026	0	7.990027584	7.898823036	0.366559069	3.882036383	0	0	30.36347033	6.832014863	23.19460698	0.516173416	1.053677317	0	13.00025664	0	0.286266761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0699	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	0	0	0	0	0	0											0	0	NO	0	21.262	0.181603013	10.1290463	0	3.789635089	6.323774026	0	7.990027584	7.898823036	0.366559069	3.882036383	0	0	30.36347033	6.832014863	23.19460698	0.516173416	1.053677317	0	13.00025664	0	0.286266761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0699
H2312_807_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	260.112798	1.558319326	42.35947983	0	17.55761296	24.06111082	0	30.58218838	33.25001285	1.460284894	17.44331806	0	0	129.3508578	32.98783052	107.0555556	2.660825881	5.15693025	0	48.24418151	14.34078697	3.479231909	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	"PBP 13a, 13b"											0	NO	0.071702478	0.071702478	0.173818159	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071029555	0.071029555	0.172186888	0	0.221897776	0.221897776	0	0.221897776	0.221897776	0.221897776	0.221897776	0	0	0.221897776	0.221897776	0.221897776	0.221897776	0.221897776	0	0.221897776	0.221897776	0.221897776	0	0	0	0	0	0	0	0												18.4757	0.110686729	7.293747018	0	3.895995271	5.339106983	0	6.78611959	7.378103909	0.324033971	3.870633487	0	0	28.7026677	7.319926233	23.75538972	0.590431346	1.144311354	0	10.70527659	3.182188737	0.772033823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6463	0	NO	1.228248663	18.4757	0.110686729	7.293747018	0	3.895995271	5.339106983	0	6.78611959	7.378103909	0.324033971	3.870633487	0	0	28.7026677	7.319926233	23.75538972	0.590431346	1.144311354	0	10.70527659	3.182188737	0.772033823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6463	NO																																										0	0	0	0	0	0	0	0	0	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	18.4757	0.110686729	7.293747018	0	3.895995271	5.339106983	0	6.78611959	7.378103909	0.324033971	3.870633487	0	0	28.7026677	7.319926233	23.75538972	0.590431346	1.144311354	0	10.70527659	3.182188737	0.772033823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6463
H2320_007_0	2012	6																															D	D	D		P	Coin		P	P	P	P	P		P	P	P	P	P	P	P	Coin			Coin	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	608.4050011	10.19812144	144.8203648	0	36.65185923	13.22030941	0	351.7971403	427.8513161	4139.962565	1181.341522	0.33497802	0	1101.286345	4087.424913	4952.139562	79.60429901	8.774909135	645.3822532	894.5746883	24.01167522	0	0	7.098084	7.258105569	0	4.035162078	0	0	0											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	$75 copay; PBP 10a	"20% coinsurance; PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$70 copay OP Hospital, $50 copay Amb Surg; PBP 9a, 9b"	$10 copay; PBP 8a	$0 - $100 copay; PBP 8b	"$40 copay individual visit, $30 copay group visit; PBP 9a, 9c"	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$10 PCP, $0 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit; PBP 7e, 7h, 9c"	"$20 copay; PBP 3, 7c, 7i"	$0 - $100 copay; PBP 8b	"$0 - $30 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"											0	NO	75	75	120	0	75	0.2	0	63.75923265	64.48818522	10	41.77348146	39.125	0	26.16872843	10	28.99863355	39.125	20	25.95936072	10.00135712	0.2	0	0	0.2238	30	0	30	0	0	0											YES	68.6468648	68.6468648	109.8349837	0	68.6468648	0.183058306	0	58.35828565	59.02548977	9.152915307	38.23491379	35.81078114	0	23.9520155	9.152915307	26.54220369	35.81078114	18.30583061	23.76038301	9.154157464	0.183058306	0	0	0.2238	27.45874592	0	27.45874592	0	0	0											3400	3.4804	0.058339089	1.325528534	0	0.209669602	2.420087448	0	1.710856501	2.104511123	3.157727228	3.764040938	0.000999652	0	2.198168967	3.117654504	10.95339141	0.237557677	0.013386	1.27787746	0.68242313	4.395536593	0	0	1.588551199	0.016608206	0	0.009233374	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7226	0	NO	3.806874565	3.4804	0.058339089	1.325528534	0	0.209669602	2.420087448	0	1.710856501	2.104511123	3.157727228	3.764040938	0.000999652	0	2.198168967	3.117654504	10.95339141	0.237557677	0.013386	1.27787746	0.68242313	4.395536593	0	0	1.588551199	0.016608206	0	0.009233374	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7226	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	$75 copay; PBP 10a	"30% coinsurance; PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$150 copay OP Hospital, $75 copay Amb Surg; PBP 9a, 9b"	$20 copay; PBP 8a	$10 - $150 copay; PBP 8b	"$50 copay; PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$35 PCP, $10 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$35 Specialist, $10 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	"$25 copay; PBP 3, 7c, 7i"	$10 - $150 copay; PBP 8b	"$0 - $35 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"												0.3987	0	0.3926	0	0.5388	0.379	0.0349	0.3559	0.0889	0.0597	0.1096	0	0	0.1564	0.0413	3.1464	0.1371	0.0038	0.1676	0.3019	0.0779	0	0	0.1034	0	0	0.0043	0	0	0											6.4981	500	NO	0.591820317	3.8791	0.058339089	1.718152592	0	0.748425941	2.799046396	0.034854602	2.066743085	2.193404701	3.217428239	3.873652568	0.000999652	0	2.35458976	3.158994706	14.09977793	0.374611976	0.01722209	1.445453309	0.98429229	4.473486454	0	0	1.691928	0.016608206	0	0.013542282	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2207
H2320_008_0	2012	5																															D	D	D		P	Coin		P	P	P	P	P	P	P	P	P	P	P	P	P	Coin			Coin	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	688.3912291	4.985282868	102.9549779	0	61.74804861	9.165808692	0	302.0939864	397.4980018	3726.965615	1126.207836	4.702615973	0.972971188	982.9699938	3900.868271	5392.115901	91.41060587	8.389336432	552.4097104	528.4598131	16.88182231	0	0	7.098084	10.3713021	0	3.728205552	0	0	0											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	$75 copay; PBP 10a	"20% coinsurance; PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$70 copay OP Hospital, $50 copay Amb Surg; PBP 9a, 9b"	$10 copay; PBP 8a	$0 - $100 copay; PBP 8b	"$40 copay individual visit, $30 copay group visit; PBP 9a, 9c"	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$10 PCP, $0 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit; PBP 7e, 7h, 9c"	"$20 copay; PBP 3, 7c, 7i"	$0 - $100 copay; PBP 8b	"$0 - $30 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"											0	NO	75	75	120	0	75	0.2	0	61.84843642	60.7495886	10	38.68222287	39.125	10	20.69172271	10	28.72617218	39.125	20	25.14389705	10.00266783	0.2	0	0	0.2238	30	0	30	0	0	0											YES	68.6468648	68.6468648	109.8349837	0	68.6468648	0.183058306	0	56.60935004	55.60358394	9.152915307	35.40551098	35.81078114	9.152915307	18.93895855	9.152915307	26.2928221	35.81078114	18.30583061	23.01399602	9.155357152	0.183058306	0	0	0.2238	27.45874592	0	27.45874592	0	0	0											3400	3.938	0.02851867	0.942338194	0	0.353234162	1.677877414	0	1.425112018	1.841859459	2.842716719	3.322830326	0.014033696	0.000742127	1.551368998	2.975359742	11.81449535	0.272790433	0.012797814	1.059429573	0.403186527	3.090357796	0	0	1.588551199	0.023731912	0	0.008530987	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1879	0	NO	3.479743168	3.938	0.02851867	0.942338194	0	0.353234162	1.677877414	0	1.425112018	1.841859459	2.842716719	3.322830326	0.014033696	0.000742127	1.551368998	2.975359742	11.81449535	0.272790433	0.012797814	1.059429573	0.403186527	3.090357796	0	0	1.588551199	0.023731912	0	0.008530987	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1879	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	$75 copay; PBP 10a	"30% coinsurance; PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$150 copay OP Hospital, $75 copay Amb Surg; PBP 9a, 9b"	$20 copay; PBP 8a	$10 - $150 copay; PBP 8b	"$50 copay; PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$35 PCP, $10 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$35 Specialist, $10 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	"$25 copay; PBP 3, 7c, 7i"	$10 - $150 copay; PBP 8b	"$0 - $35 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"												0.9078	0.0013	0.4667	0	0.3564	0.296	0.0211	0.3422	0.1253	0.1096	0.1682	0	0	0.0678	0.2349	3.2085	0.1121	0.016	0.5314	1.2018	0.2573	0	0	0.1034	0	0	0.008	0	0	0											8.5357	500	NO	0.78039675	4.8458	0.029833588	1.409006676	0	0.709602388	1.973854782	0.021135847	1.76731095	1.967117307	2.952293143	3.491037803	0.014033696	0.000742127	1.619123809	3.210284006	15.02301473	0.384913621	0.028823881	1.590797285	1.604992209	3.347660591	0	0	1.691928	0.023773498	0	0.016486308	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7236
H2320_011_0	2012	6																															D	D	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	162.9843791	5.480890625	167.98658	0	39.54395373	9.597281992	0	328.8995046	331.944669	3251.682365	993.6849797	0.440179075	0	921.43994	3258.496101	3659.303127	59.97953905	25.71324427	489.4845187	691.2634048	17.88256968	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $125 copay;  PBP 8b	"$40 copay individual visit, $30 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $125 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	600	600	120	0	75	0.2	0	63.56609053	148.5075303	10	46.43633737	39.125	0	32.3166596	15	38.34510976	39.125	30	28.71947196	10.00184471	0.2	0	0	0.2238	0	0	0	0	0	0											YES	546.4259873	546.4259873	109.2851975	0	68.30324841	0.182141996	0	57.89027296	135.2472898	9.107099788	42.29003582	35.63152792	0	29.43110438	13.66064968	34.9212741	35.63152792	27.32129936	26.1551097	9.108779783	0.182141996	0	0	0.2238	0	0	0	0	0	0											3400	7.4216	0.249575089	1.529870547	0	0.225081708	1.748068096	0	1.586673508	3.741218071	2.467782981	3.501914449	0.001307021	0	2.259916254	3.709431144	10.64896063	0.178096885	0.05854327	1.066876774	0.524713844	3.257166931	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7653	0	NO	4.331285503	7.4216	0.249575089	1.529870547	0	0.225081708	1.748068096	0	1.586673508	3.741218071	2.467782981	3.501914449	0.001307021	0	2.259916254	3.709431144	10.64896063	0.178096885	0.05854327	1.066876774	0.524713844	3.257166931	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7653	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$200 copay OP Hospital, $100 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $175 copay;  PBP 8b	"$50 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $100 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$45 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$45 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay;  PBP 7e, 7h, 9c"	"$35 copay;  PBP 3, 7c, 7i"	$10 - $175 copay;  PBP 8b	"$0 - $45 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"												0.9643	0.0113	0.1055	0	0.6485	0.5826	0.0613	0.3125	0.1423	0.0246	0.0906	0	0	0.169	0.0532	3.9959	0.3416	0.0225	0.2047	0.2934	0.0664	0	0	0.1034	0	0	0	0	0	0											8.1938	750	NO	0.793216192	8.3859	0.260920375	1.635354904	0	0.873597575	2.330694172	0.06132273	1.899141984	3.883478251	2.492385624	3.592547282	0.001307021	0	2.428896323	3.762680522	14.64481209	0.519725312	0.081050555	1.271618351	0.81815668	3.32353483	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9591
H2320_012_0	2012	5																															D	D	D		P	Coin		P	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	131.5730566	4.536445254	88.57572783	0	61.9895992	8.196461582	0	265.5319064	284.7864882	2689.502772	861.2116457	2.109893814	0.194463668	617.3347733	2756.189897	3617.076241	57.8384541	11.73873516	410.5662897	597.4523477	10.99573943	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $125 copay;  PBP 8b	"$40 copay individual visit, $30 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $125 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	600	600	120	0	75	0.2	0	62.70970413	135.0674745	10	45.90265583	39.125	10	28.53953178	15	37.72986798	39.125	30	28.45735941	10.00234401	0.2	0	0	0.2238	0	0	0	0	0	0											YES	546.4259873	546.4259873	109.2851975	0	68.30324841	0.182141996	0	57.11035332	123.0072968	9.107099788	41.80400672	35.63152792	9.107099788	25.99123638	13.66064968	34.36096727	35.63152792	27.32129936	25.91640119	9.109234499	0.182141996	0	0	0.2238	0	0	0	0	0	0											3400	5.9912	0.206569298	0.806667992	0	0.352840916	1.492919871	0	1.263718416	2.919234674	2.041130844	3.000174785	0.006264895	0.000147583	1.337107835	3.137612053	10.35718653	0.171739374	0.026726458	0.886700057	0.453527795	2.002785925	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0429	0	NO	3.574140289	5.9912	0.206569298	0.806667992	0	0.352840916	1.492919871	0	1.263718416	2.919234674	2.041130844	3.000174785	0.006264895	0.000147583	1.337107835	3.137612053	10.35718653	0.171739374	0.026726458	0.886700057	0.453527795	2.002785925	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0429	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$200 copay OP Hospital, $100 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $175 copay;  PBP 8b	"$50 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $100 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$45 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$45 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay;  PBP 7e, 7h, 9c"	"$35 copay;  PBP 3, 7c, 7i"	$10 - $175 copay;  PBP 8b	"$0 - $45 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"												0.4641	0.0275	0.1142	0	0.2941	1.3677	0.0294	0.3263	0.0866	0.0466	0.0843	0	0	0.0764	0.1558	3.0946	0.1629	0.0048	0.4659	0.734	0.0343	0	0	0.1034	0	0	0	0	0	0											7.6729	750	NO	0.742145499	6.4554	0.234078599	0.92086481	0	0.64698551	2.860630827	0.029413514	1.589988148	3.005858183	2.087703479	3.084466078	0.006264895	0.000147583	1.413544554	3.29338503	13.45177959	0.33467666	0.031517021	1.352565019	1.187482612	2.037063747	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7157
H2320_013_0	2012	5																															D	D	D		P	Coin		P	P	P	P	P	P	P	P	P	P	P	P	P	Coin			Coin	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	670.3167497	21.84467563	233.2159331	0	160.3885315	11.51926164	0	321.0837322	401.9317287	3632.152082	1046.580092	7.301146532	1.993900145	606.1074369	3974.308449	5480.613667	96.97759975	6.650327828	643.7452404	1322.275711	17.36543257	0	0	7.098084	12.15436722	0	10.52387362	0	0	0											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	$75 copay; PBP 10a	"20% coinsurance; PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$70 copay OP Hospital, $50 copay Amb Surg; PBP 9a, 9b"	$10 copay; PBP 8a	$0 - $100 copay; PBP 8b	"$40 copay individual visit, $30 copay group visit; PBP 9a, 9c"	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$10 PCP, $0 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit; PBP 7e, 7h, 9c"	"$20 copay; PBP 3, 7c, 7i"	$0 - $100 copay; PBP 8b	"$0 - $30 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"											0	NO	75	75	120	0	75	0.2	0	63.12311146	64.29486657	10	41.13302926	39.125	10	26.6487455	10	28.96587921	39.125	20	24.83997655	10.00120793	0.2	0	0	0.2238	30	0	30	0	0	0											YES	68.6468648	68.6468648	109.8349837	0	68.6468648	0.183058306	0	57.77604931	58.84854684	9.152915307	37.64871331	35.81078114	9.152915307	24.39137106	9.152915307	26.51222392	35.81078114	18.30583061	22.73582016	9.154020915	0.183058306	0	0	0.2238	27.45874592	0	27.45874592	0	0	0											3400	3.8346	0.124964041	2.134605684	0	0.917514153	2.108696523	0	1.545912462	1.971091513	2.770398366	3.283532819	0.021788313	0.001520833	1.231982616	3.03137572	12.10860473	0.289403633	0.010144981	1.219673001	1.008678293	3.178886672	0	0	1.588551199	0.027811973	0	0.024081031	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4338	0	NO	3.780150433	3.8346	0.124964041	2.134605684	0	0.917514153	2.108696523	0	1.545912462	1.971091513	2.770398366	3.283532819	0.021788313	0.001520833	1.231982616	3.03137572	12.10860473	0.289403633	0.010144981	1.219673001	1.008678293	3.178886672	0	0	1.588551199	0.027811973	0	0.024081031	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4338	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	$75 copay; PBP 10a	"30% coinsurance; PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$150 copay OP Hospital, $75 copay Amb Surg; PBP 9a, 9b"	$20 copay; PBP 8a	$10 - $150 copay; PBP 8b	"$50 copay; PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$35 PCP, $10 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$35 Specialist, $10 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	"$25 copay; PBP 3, 7c, 7i"	$10 - $150 copay; PBP 8b	"$0 - $35 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"												0.5552	0.0201	0.4877	0	0.1425	0.6256	0.0296	0.3711	0.0572	0.0482	0.072	0	0	0.0953	0.0287	3.1664	0.0871	0.0016	0.2745	0.2852	0.0369	0	0	0.1034	0	0	0.0052	0	0	0											6.4934	500	NO	0.591381216	4.3898	0.145032016	2.622279433	0	1.060007969	2.734293825	0.029598208	1.916986602	2.028279453	2.818599772	3.355515254	0.021788313	0.001520833	1.327325898	3.060103187	15.27500686	0.37651329	0.01170809	1.494143338	1.293865203	3.215817786	0	0	1.691928	0.027811973	0	0.029245468	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9272
H2320_015_0	2012	5																															D	D	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	149.3548713	4.93152877	179.3621988	0	135.9046139	10.01359285	0	328.7167592	319.2782352	2878.282438	878.7718083	2.150034288	0	558.3122786	3045.105678	3944.738792	68.03734197	10.2903589	504.2977778	960.8716014	12.76677606	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $125 copay;  PBP 8b	"$40 copay individual visit, $30 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $125 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	600	600	120	0	75	0.2	0	63.16171689	145.2525342	10	48.61982506	39.125	0	31.62517331	15	38.14967351	39.125	30	27.76140452	10.00172773	0.2	0	0	0.2238	0	0	0	0	0	0											YES	546.4259873	546.4259873	109.2851975	0	68.30324841	0.182141996	0	57.52200585	132.2829323	9.107099788	44.27855985	35.63152792	0	28.80136092	13.66064968	34.74328836	35.63152792	27.32129936	25.28258813	9.108673246	0.182141996	0	0	0.2238	0	0	0	0	0	0											3400	6.8009	0.224559623	1.633469443	0	0.77356055	1.823895786	0	1.575703946	3.519588432	2.184400448	3.242562509	0.006384084	0	1.340012787	3.466510159	11.42109978	0.202022871	0.023428831	1.062496084	0.729355454	2.325366071	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9439	0	NO	4.152706752	6.8009	0.224559623	1.633469443	0	0.77356055	1.823895786	0	1.575703946	3.519588432	2.184400448	3.242562509	0.006384084	0	1.340012787	3.466510159	11.42109978	0.202022871	0.023428831	1.062496084	0.729355454	2.325366071	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9439	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$200 copay OP Hospital, $100 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $175 copay;  PBP 8b	"$50 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $100 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$45 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$45 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay;  PBP 7e, 7h, 9c"	"$35 copay;  PBP 3, 7c, 7i"	$10 - $175 copay;  PBP 8b	"$0 - $45 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"												0.8557	0.1076	0.1705	0	0.1646	0.3716	0.0453	0.3337	0.0455	0.0353	0.0726	0	0	0.0319	0.0287	3.6516	0.1464	0.0097	0.2867	0.2644	0.0584	0	0	0.1034	0	0	0	0	0	0											6.7836	750	NO	0.654961042	7.6566	0.332130928	1.803951099	0	0.938124881	2.195512941	0.045331765	1.909392275	3.565049079	2.219744704	3.315203102	0.006384084	0	1.37191913	3.495218181	15.07274143	0.348392211	0.033129048	1.349206882	0.993753188	2.383799894	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7275
H2320_016_0	2012	5																															D	D	D		P	Coin		P	P	P	P	P	P	P	P	P	P	P	P	P	Coin			Coin	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	670.198126	10.66879943	181.3854127	0	77.56695772	12.35902979	0	304.5733908	418.9304741	3676.313693	1230.974908	3.386333467	1.510750297	520.8649348	4160.562191	5717.202779	66.15544291	4.649206338	625.0468024	981.3546565	18.99110578	0	0	7.098084	8.671256088	0	4.909908177	0	0	0											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	$75 copay; PBP 10a	"20% coinsurance; PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$70 copay OP Hospital, $50 copay Amb Surg; PBP 9a, 9b"	$10 copay; PBP 8a	$0 - $100 copay; PBP 8b	"$40 copay individual visit, $30 copay group visit; PBP 9a, 9c"	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$10 PCP, $0 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit; PBP 7e, 7h, 9c"	"$20 copay; PBP 3, 7c, 7i"	$0 - $100 copay; PBP 8b	"$0 - $30 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"											0	NO	75	75	120	0	75	0.2	0	63.88557401	64.51258146	10	37.52707329	39.125	10	29.23233691	10	28.8943239	39.125	20	25.48474729	10.00149332	0.2	0	0	0.2238	30	0	30	0	0	0											YES	68.6468648	68.6468648	109.8349837	0	68.6468648	0.183058306	0	58.47392483	59.04781943	9.152915307	34.34821236	35.81078114	9.152915307	26.75611039	9.152915307	26.44672995	35.81078114	18.30583061	23.32597336	9.154282126	0.183058306	0	0	0.2238	27.45874592	0	27.45874592	0	0	0											3400	3.8339	0.061031636	1.660205321	0	0.443727372	2.262423059	0	1.484133463	2.061410916	2.804082323	3.523482295	0.010105604	0.001152314	1.161359975	3.173439447	12.60010983	0.197423174	0.007092299	1.214985422	0.748633116	3.476479656	0	0	1.588551199	0.019841818	0	0.011234993	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3448	0	NO	3.771914402	3.8339	0.061031636	1.660205321	0	0.443727372	2.262423059	0	1.484133463	2.061410916	2.804082323	3.523482295	0.010105604	0.001152314	1.161359975	3.173439447	12.60010983	0.197423174	0.007092299	1.214985422	0.748633116	3.476479656	0	0	1.588551199	0.019841818	0	0.011234993	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3448	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	$75 copay; PBP 10a	"30% coinsurance; PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$150 copay OP Hospital, $75 copay Amb Surg; PBP 9a, 9b"	$20 copay; PBP 8a	$10 - $150 copay; PBP 8b	"$50 copay; PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$35 PCP, $10 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$35 Specialist, $10 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	"$25 copay; PBP 3, 7c, 7i"	$10 - $150 copay; PBP 8b	"$0 - $35 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"												0.517	0.0072	0.6185	0	0.5044	0.9117	0.0521	0.3615	0.1491	0.1074	0.0983	0	0	0.1528	0.1057	3.7915	0.0819	0.0009	0.3214	0.68	0.0736	0	0	0.1034	0.0002	0	0.0121	0	0	0											8.6505	500	NO	0.791019868	4.3509	0.068211657	2.27865635	0	0.948108533	3.174150564	0.052095112	1.845591255	2.210510057	2.911442147	3.621765687	0.010105604	0.001152314	1.314193974	3.279154916	16.39162282	0.279292952	0.007987816	1.536412101	1.428633026	3.550047541	0	0	1.691928	0.020059937	0	0.023299892	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9953
H2320_018_0	2012	5																															D	D	D		P	Coin		P	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	159.8157342	3.349150653	132.0151781	0	77.84086253	8.350114287	0	304.9819969	351.3434873	3221.671694	950.6836198	1.539831398	0.316896387	559.4131843	3326.629647	4200.407661	53.4847587	22.47427259	511.7149686	800.2603684	11.61714456	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $125 copay;  PBP 8b	"$40 copay individual visit, $30 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $125 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	600	600	120	0	75	0.2	0	63.51997327	141.7761986	10	46.69851193	39.125	10	34.54037983	15	38.13391759	39.125	30	28.25633742	10.00196382	0.2	0	0	0.2238	0	0	0	0	0	0											YES	546.4259873	546.4259873	109.2851975	0	68.30324841	0.182141996	0	57.84827351	129.1169988	9.107099788	42.52880081	35.63152792	9.107099788	31.45626858	13.66064968	34.72893928	35.63152792	27.32129936	25.73332845	9.108888257	0.182141996	0	0	0.2238	0	0	0	0	0	0											3400	7.2773	0.152505246	1.202275401	0	0.443065314	1.520906481	0	1.470223498	3.780368053	2.445007133	3.369286192	0.004572212	0.000240501	1.466420948	3.78699352	12.15630855	0.158811973	0.051168861	1.097344113	0.607456856	2.115969895	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6948	0	NO	4.22632325	7.2773	0.152505246	1.202275401	0	0.443065314	1.520906481	0	1.470223498	3.780368053	2.445007133	3.369286192	0.004572212	0.000240501	1.466420948	3.78699352	12.15630855	0.158811973	0.051168861	1.097344113	0.607456856	2.115969895	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6948	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$200 copay OP Hospital, $100 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $175 copay;  PBP 8b	"$50 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $100 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$45 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$45 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay;  PBP 7e, 7h, 9c"	"$35 copay;  PBP 3, 7c, 7i"	$10 - $175 copay;  PBP 8b	"$0 - $45 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"												0.7482	0.0448	0.3615	0	0.4288	0.2865	0.071	0.3384	0.0872	0.0507	0.1399	0	0	0.1973	0.0683	3.7721	0.1287	0.0078	0.2931	0.4875	0.1196	0	0	0.1034	0	0	0	0	0	0											7.7349	750	NO	0.748224052	8.0255	0.197334176	1.563803995	0	0.871871042	1.807427543	0.071023837	1.808643894	3.867537772	2.495731172	3.50917499	0.004572212	0.000240501	1.663694386	3.855341791	15.92836589	0.287538496	0.058975523	1.390401195	1.094935473	2.235611591	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4296
H2320_019_0	2012	5																															D	D	D		P	Coin		P	P	P	P	P	P	P	P	P	P	P	P	P	Coin			Coin	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	733.5131504	18.0427676	253.588875	0	125.5217982	11.89245131	0	350.3113699	475.6226577	3604.904253	1271.789578	7.113282071	2.554937571	649.2511955	4404.371986	6681.339512	106.7416737	5.812009275	728.489616	1493.392399	20.77505133	0	0	7.098084	12.35846939	0	7.578528483	0	0	0											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	$75 copay; PBP 10a	"20% coinsurance; PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$70 copay OP Hospital, $50 copay Amb Surg; PBP 9a, 9b"	$10 copay; PBP 8a	$0 - $100 copay; PBP 8b	"$40 copay individual visit, $30 copay group visit; PBP 9a, 9c"	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$10 PCP, $0 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit; PBP 7e, 7h, 9c"	"$20 copay; PBP 3, 7c, 7i"	$0 - $100 copay; PBP 8b	"$0 - $30 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"											0	NO	75	75	120	0	75	0.2	0	63.49727169	64.60506215	10	40.82353798	39.125	10	28.46201504	10	29.0347811	39.125	20	24.97656694	10.00122088	0.2	0	0	0.2238	30	0	30	0	0	0											YES	68.6468648	68.6468648	109.8349837	0	68.6468648	0.183058306	0	58.118515	59.13246623	9.152915307	37.36543856	35.81078114	9.152915307	26.05104131	9.152915307	26.57528924	35.81078114	18.30583061	22.86084018	9.154032766	0.183058306	0	0	0.2238	27.45874592	0	27.45874592	0	0	0											3400	4.1961	0.103214952	2.321077496	0	0.718056492	2.177011993	0	1.696631384	2.343728395	2.749615276	3.960081279	0.021227682	0.001948761	1.409472476	3.359403648	14.79654417	0.318541893	0.008866138	1.387823724	1.139213579	3.803045707	0	0	1.588551199	0.028279006	0	0.017341407	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1458	0	NO	4.30878297	4.1961	0.103214952	2.321077496	0	0.718056492	2.177011993	0	1.696631384	2.343728395	2.749615276	3.960081279	0.021227682	0.001948761	1.409472476	3.359403648	14.79654417	0.318541893	0.008866138	1.387823724	1.139213579	3.803045707	0	0	1.588551199	0.028279006	0	0.017341407	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1458	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	$75 copay; PBP 10a	"30% coinsurance; PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp; PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care; PBP 4a, 4b"	"$150 copay OP Hospital, $75 copay Amb Surg; PBP 9a, 9b"	$20 copay; PBP 8a	$10 - $150 copay; PBP 8b	"$50 copay; PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other; PBP 3, 5, 9a, 9c, 9d"	"$35 PCP, $10 Preventive/Physical Exams/Immun/Screenings; PBP 7a, 14a-e"	"$35 Specialist, $10 Screenings/Exams; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	"$25 copay; PBP 3, 7c, 7i"	$10 - $150 copay; PBP 8b	"$0 - $35 copay; PBP 7g, 8a"	0% - 20% coinsurance; PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays; PBP 16a"	$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"$0 copay; PBP 13d, 13e, 14c"												1.4973	0.0121	0.5523	0	0.5265	0.5674	0.0301	0.6791	0.3486	0.2268	0.1826	0	0	0.1567	0.5295	5.935	0.7278	0.0087	0.8278	1.6867	0.1969	0	0	0.1034	0.0003	0	0.0041	0	0	0											14.7998	500	NO	1.360128068	5.6934	0.115357598	2.873419714	0	1.24454234	2.744451328	0.030067787	2.375730908	2.692310246	2.976435723	4.142641748	0.021227682	0.001948761	1.56622171	3.888907045	20.73158071	1.046365231	0.017525202	2.21561078	2.825961003	3.999963979	0	0	1.691928	0.028615676	0	0.021401654	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9456
H2320_021_0	2012	5																															D	D	D		P	Coin		P	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	180.1082454	4.956147676	193.1997475	0	108.2337946	12.15043241	0	346.6528896	398.3452512	3127.16575	1064.345745	2.278676773	0.468950326	636.7344596	3891.167526	5118.447746	65.97902041	22.84973656	559.8720868	1034.644326	15.00957547	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $125 copay;  PBP 8b	"$40 copay individual visit, $30 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay individual visit, $30 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $125 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	600	600	120	0	75	0.2	0	63.40947831	143.6144677	10	48.34137708	39.125	10	33.39596269	15	38.49202322	39.125	30	28.96724482	10.00187262	0.2	0	0	0.2238	0	0	0	0	0	0											YES	546.4259873	546.4259873	109.2851975	0	68.30324841	0.182141996	0	57.74764465	130.7911288	9.107099788	44.02497449	35.63152792	9.107099788	30.41403648	13.66064968	35.05506965	35.63152792	27.32129936	26.38075891	9.108805198	0.182141996	0	0	0.2238	0	0	0	0	0	0											3400	8.2013	0.225680657	1.75948938	0	0.61605998	2.213104009	0	1.66819899	4.341668755	2.373284212	3.90481619	0.006766061	0.000355898	1.613805424	4.429656369	14.95229519	0.195911109	0.052023708	1.230820879	0.785364468	2.733874031	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.893	0	NO	5.030118781	8.2013	0.225680657	1.75948938	0	0.61605998	2.213104009	0	1.66819899	4.341668755	2.373284212	3.90481619	0.006766061	0.000355898	1.613805424	4.429656369	14.95229519	0.195911109	0.052023708	1.230820879	0.785364468	2.733874031	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.893	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$200 copay OP Hospital, $100 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $175 copay;  PBP 8b	"$50 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $100 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$45 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$45 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$50 copay;  PBP 7e, 7h, 9c"	"$35 copay;  PBP 3, 7c, 7i"	$10 - $175 copay;  PBP 8b	"$0 - $45 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"												2.3081	0.0663	0.6682	0	0.4952	0.4924	0.0561	0.4569	0.1431	0.1077	0.1504	0	0	0.1339	0.3434	5.4792	0.2589	0.0116	0.7579	1.2209	0.0991	0	0	0.1034	0	0	0	0	0	0											13.3528	750	NO	1.29902952	10.5094	0.292019505	2.427737826	0	1.111269569	2.705522689	0.056115085	2.125143077	4.484809976	2.480980282	4.055264402	0.006766061	0.000355898	1.747685154	4.773029608	20.43147703	0.454816633	0.06357618	1.988716339	2.006227734	2.832933416	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2458
H2320_802_0	2012	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	171.4531623	1.111005294	30.94799623	0	3.354958343	12.96377913	1.633612805	8.638199841	44.57249763	16.76602541	34.78001369	0.259370351	0	35.82165159	43.31584318	70.11621046	0.697428252	0.073767583	13.01988503	61.98427639	56.10083056	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																			0	YES	0.079315164	0.079315164	0.18203472	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.067584439	0.067584439	0.155111757	0	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0.190870366	0	0	0	0	0	0	0	0	0											6700	11.5876	0.075086669	4.800398062	0	0.640362125	2.474401262	0.311808273	1.648776361	8.507568915	3.200137399	6.638473926	0.049506114	0	6.837291732	8.267710821	13.38310672	0.133118385	0.014080046	2.485110215	11.83096149	10.70798603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5935	0	YES	16.24514517	11.5876	0.075086669	4.800398062	0	0.640362125	2.474401262	0.311808273	1.648776361	8.507568915	3.200137399	6.638473926	0.049506114	0	6.837291732	8.267710821	13.38310672	0.133118385	0.014080046	2.485110215	11.83096149	10.70798603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5935	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																				0.4773	0.0011	0.2509	0	0.3269	0.0508	0.0112	0.1341	0.1494	0.0702	0.0917	0	0	0.4836	0.0747	1.6488	0.025	0.0004	0.1624	1.4639	0.0792	0	0	0	0	0	0	0	0	0											5.5017	0	YES	0.954933035	12.0649	0.076229282	5.051327316	0	0.967226298	2.525214062	0.323056564	1.782859201	8.656979229	3.270299554	6.730174295	0.049506114	0	7.320933431	8.342387918	15.0319303	0.158102854	0.014444526	2.647555051	13.29483673	10.78720149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0951
H2320_803_0	2012	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	153.5028084	1.482069047	23.3400888	0	2.827890352	11.87887999	1.827395625	7.265450803	46.46602335	14.61152962	29.54741899	0.384943168	0	32.30578892	41.03983479	60.73734249	0.622289483	0.066106116	12.62703621	63.07156496	45.9577682	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																			0	YES	0.078750034	0.078750034	0.183117533	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.068780492	0.068780492	0.159935347	0	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0.195642204	0	0	0	0	0	0	0	0	0											6700	10.558	0.101937438	3.732905207	0	0.553254701	2.324010262	0.357515707	1.421428808	9.090715216	2.858631857	5.780722172	0.07531113	0	6.320375743	8.029123728	11.88278755	0.121746086	0.012933146	2.470381193	12.33945997	8.991279059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0225	0	YES	12.61367311	10.558	0.101937438	3.732905207	0	0.553254701	2.324010262	0.357515707	1.421428808	9.090715216	2.858631857	5.780722172	0.07531113	0	6.320375743	8.029123728	11.88278755	0.121746086	0.012933146	2.470381193	12.33945997	8.991279059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0225	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																				0.5851	0.0062	0.072	0	0.1529	0.0975	0.0279	0.1618	0.1364	0.0764	0.1019	0	0	0.1497	0.0526	1.6299	0.0477	0.0001	0.1675	1.629	0.2081	0	0	0	0	0	0	0	0	0											5.3026	0	YES	0.768601449	11.1431	0.108107637	3.804899397	0	0.706113409	2.421515803	0.385424447	1.583202828	9.227111148	2.935058152	5.882579143	0.07531113	0	6.470096312	8.081732881	13.51269009	0.16948025	0.013036237	2.637911496	13.96842635	9.199381184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3251
H2320_804_0	2012	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	174.3796225	1.173925656	28.41678565	0	4.508592913	14.25169781	2.59078005	9.580973774	49.115493	17.83300024	32.16064159	0.284202449	0	35.82952342	42.371524	73.6447925	0.793019702	0.202967535	13.46035357	72.01114928	59.34083233	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																			0	YES	0.080099753	0.080099753	0.180934334	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.068441242	0.068441242	0.154599361	0	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0.191396824	0	0	0	0	0	0	0	0	0												11.9348	0.08034493	4.39321691	0	0.862930363	2.727729695	0.495867073	1.833767949	9.400549358	3.413179604	6.155444649	0.054395446	0	6.85765698	8.109775112	14.09537937	0.151781452	0.038847341	2.57626892	13.78270525	11.35764683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3222	0	YES	16.74854069	11.9348	0.08034493	4.39321691	0	0.862930363	2.727729695	0.495867073	1.833767949	9.400549358	3.413179604	6.155444649	0.054395446	0	6.85765698	8.109775112	14.09537937	0.151781452	0.038847341	2.57626892	13.78270525	11.35764683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3222	NO																																										0	0	0	0	0	0	0	0	0	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	11.9348	0.08034493	4.39321691	0	0.862930363	2.727729695	0.495867073	1.833767949	9.400549358	3.413179604	6.155444649	0.054395446	0	6.85765698	8.109775112	14.09537937	0.151781452	0.038847341	2.57626892	13.78270525	11.35764683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3222
H2320_805_0	2012	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	165.9742925	1.462843221	25.92257506	0	3.963677715	12.58055268	1.901558126	8.3938382	46.70363056	15.5164985	31.32384271	0.354148173	0	34.34783243	41.88009629	71.40537025	0.856677793	0.068814272	13.57269288	70.94440366	49.3201987	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, 11b"	"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, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 3, 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;																			0	YES	0.078869384	0.078869384	0.183154177	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.068498346	0.068498346	0.159070066	0	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0.194544811	0	0	0	0	0	0	0	0	0												11.369	0.100202341	4.12350573	0	0.771112932	2.447481244	0.369938266	1.632977667	9.085948984	3.01865427	6.093891063	0.068897689	0	6.682192571	8.147555421	13.89154427	0.166662219	0.01338746	2.640496973	13.80186561	9.594988738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0203	0	YES	14.23520236	11.369	0.100202341	4.12350573	0	0.771112932	2.447481244	0.369938266	1.632977667	9.085948984	3.01865427	6.093891063	0.068897689	0	6.682192571	8.147555421	13.89154427	0.166662219	0.01338746	2.640496973	13.80186561	9.594988738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0203	NO																																										0	0	0	0	0	0	0	0	0	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	11.369	0.100202341	4.12350573	0	0.771112932	2.447481244	0.369938266	1.632977667	9.085948984	3.01865427	6.093891063	0.068897689	0	6.682192571	8.147555421	13.89154427	0.166662219	0.01338746	2.640496973	13.80186561	9.594988738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0203
H2322_001_0	2012	7																															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	868.3286298	35.48851884	23.93384949	0	159.1676573	8.716614304	0	210.7379356	231.7381533	0	317.7608725	0	0.416783626	651.7537204	3277.811005	4822.607787	231.6222943	102.6250854	0	245.4936869	0	0	0	0	29.14493213	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"	"$65/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"	"$20/Visit for PCP; $20/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$35/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	75	75	0.173818159	0	75	0.2	0	57.99019124	75	0	70.96874571	0	25	73.08959701	20	34.09492825	35	15	0	35	0	0	0	0	35	0	0	0	0	0											YES	74.90864789	74.90864789	0.173606444	0	74.90864789	0.199756394	0	57.91955755	74.90864789	0	70.88230379	0	24.9695493	73.00057183	19.97563944	34.05339967	34.95736902	14.98172958	0	34.95736902	0	0	0	0	34.95736902	0	0	0	0	0											10000	5.4204	0.22153308	4.155070494	0	0.993586166	1.741199445	0	1.017153999	1.446599311	0	1.876968558	0	0.000867242	3.96486619	5.456364232	13.68551587	0.674742168	0.128125106	0	0.715151117	0	0	0	0	0.084902512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5831	0	NO	0.050711138	5.4204	0.22153308	4.155070494	0	0.993586166	1.741199445	0	1.017153999	1.446599311	0	1.876968558	0	0.000867242	3.96486619	5.456364232	13.68551587	0.674742168	0.128125106	0	0.715151117	0	0	0	0	0.084902512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5831	NO	$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"	"$65/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"	"20% Coinsurance for PCP; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"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	"20% Coinsurance for Other Medicare Part B; PBP 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"												0.1656	0	0.1952	0	1.206	0.4547	0	0.605	0.0929	0.0002	0.0259	0	0.0011	0.0753	1.2997	0.8792	0.7369	0.002	0	0.2325	0	0	0	0	0.0009	0.0017	0	0	0	0											5.9749	0	NO	0.002780107	5.5861	0.22153308	4.350298416	0	2.199555954	2.195870473	0	1.622180241	1.539488423	0.000170646	1.902871333	0	0.001982849	4.040158625	6.756060826	14.56475268	1.411675482	0.130149069	0	0.947608193	0	1.23E-06	0	0	0.085767813	0.001721424	1.71E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5579
H2322_004_0	2012	6																															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	1466.470164	13.73404308	41.86141243	0	208.6568227	17.90620097	0	241.5439463	221.9057284	0	437.3493442	0	0.613728553	1165.002229	4356.60048	6496.765393	362.6704241	150.5857605	0	461.0282581	0	0	0	0	37.02571424	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"	"$65/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"	"$15/Visit for PCP; $15/Visit for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"$30/Visit for Physician Specialist; $20/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 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	75	75	0.173818159	0	75	0.2	0	60.24139926	75	0	70.96874571	0	25	73.8977783	15	29.6330145	30	15	0	30	0	0	0	0	30	0	0	0	0	0											YES	74.80083461	74.80083461	0.173356578	0	74.80083461	0.199468892	0	60.0814259	74.80083461	0	70.78028547	0	24.93361154	73.7015399	14.96016692	29.55432288	29.92033384	14.96016692	0	29.92033384	0	0	0	0	29.92033384	0	0	0	0	0											10000	9.1411	0.085609824	7.256951222	0	1.300642041	3.571730072	0	1.209358726	1.383227807	0	2.579642619	0	0.001275206	7.155204852	5.4312892	16.00062518	0.904268347	0.187732343	0	1.149509949	0	0	0	0	0.092318478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4505	0	NO	0.152968192	9.1411	0.085609824	7.256951222	0	1.300642041	3.571730072	0	1.209358726	1.383227807	0	2.579642619	0	0.001275206	7.155204852	5.4312892	16.00062518	0.904268347	0.187732343	0	1.149509949	0	0	0	0	0.092318478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4505	NO	$250/Days 1-5 for IP Acute; PBP 1a	$250/Days 1-5 for IP Psych; 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"	"$65/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	50% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for OP Hospital; 20% Coinsurance for Partial Hosp; PBP 3, 5, 9d"	"20% Coinsurance for PCP; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14a-b, 14d-e"	"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	"20% Coinsurance for Other Medicare Part B; PBP 13c, 13d, 13e"	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 14c	"No Cost Sharing; PBP 13a, 13b"												0.3803	0.031	1.5834	0	2.0964	0.8639	0	0.7347	0.2284	0.0002	0.0339	0	0.0042	0.1807	1.5907	1.0642	0.8746	0.0272	0	0.4746	0	0.0004	0	0	0.0008	0.0001	0	0	0	0											10.1698	0	NO	0.009061964	9.5214	0.116588763	8.840400679	0	3.39706709	4.43559037	0	1.944093768	1.61161285	0.000217972	2.613492646	0	0.005469216	7.335898657	7.021967814	17.06485906	1.778862219	0.214920524	0	1.624113471	0	0.000415367	0	0	0.093142161	0.000142997	1.83E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6203
H2322_801_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	370.5013967	2.642706589	61.78969313	0	18.92693377	31.46551735	0	43.15247537	41.09840863	1.784982596	20.01031588	0	0	150.8624054	38.3869458	126.0514554	2.628491303	5.45761371	0	75.40139178	2.02503175	1.719184452	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	0.071702478	0.071702478	0.173818159	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070799632	0.070799632	0.171629517	0	0.22117949	0.22117949	0	0.22117949	0.22117949	0.22117949	0.22117949	0	0	0.22117949	0.22117949	0.22117949	0.22117949	0.22117949	0	0.22117949	0.22117949	0.22117949	0	0	0	0	0	0	0	0												26.2314	0.187102653	10.60493519	0	4.186249561	6.959527085	0	9.544442502	9.090125067	0.394801541	4.425871464	0	0	33.36766991	8.490405101	27.87999664	0.581368366	1.207112218	0	16.67724139	0.44789549	0.380248341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.6564	0	NO	2.048710892	26.2314	0.187102653	10.60493519	0	4.186249561	6.959527085	0	9.544442502	9.090125067	0.394801541	4.425871464	0	0	33.36766991	8.490405101	27.87999664	0.581368366	1.207112218	0	16.67724139	0.44789549	0.380248341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.6564	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 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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	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 14c	"Medicare-FFS Cost Sharing; PBP 13a, 13b"											6700	0	0	0	0	0.1106	0.0528	0	0.0826	0.0008	0	0.0005	0	0	0.0274	0.0788	0.19	0	0.0001	0	0.0007	0	0	0	0	0	0	0	0	0	0											0.5443	0	NO	0.002235478	26.2314	0.187102653	10.60493519	0	4.296887409	7.012307685	0	9.626993076	9.090936789	0.394801541	4.426339812	0	0	33.39506434	8.569198818	28.07000705	0.581368366	1.207222501	0	16.67797063	0.44789549	0.380248341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	161.2006
H2322_803_0	2012	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	291.7222192	2.397512058	56.05674688	0	16.95963921	27.62836123	0	34.98363645	34.92113726	1.606214444	17.28482348	0	0	134.2403447	30.82366495	103.7736683	2.343590598	4.745498636	0	56.77296824	1.837146076	1.559675778	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"No Cost Sharing; PBP 13a, 13b"											0	NO	0.071702478	0.071702478	0.173818159	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070988038	0.070988038	0.172086244	0	0.221768076	0.221768076	0	0.221768076	0.221768076	0.221768076	0.221768076	0	0	0.221768076	0.221768076	0.221768076	0.221768076	0.221768076	0	0.221768076	0.221768076	0.221768076	0	0	0	0	0	0	0	0												20.7088	0.170194678	9.646595049	0	3.761106561	6.12708852	0	7.758253756	7.74439343	0.356207087	3.833222052	0	0	29.770223	6.835704878	23.01368678	0.519733579	1.052400103	0	12.59043195	0.407420351	0.345886297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6413	0	NO	1.355060665	20.7088	0.170194678	9.646595049	0	3.761106561	6.12708852	0	7.758253756	7.74439343	0.356207087	3.833222052	0	0	29.770223	6.835704878	23.01368678	0.519733579	1.052400103	0	12.59043195	0.407420351	0.345886297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6413	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 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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 13c, 13d, 13e"	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 14c	"Medicare-FFS Cost Sharing; PBP 13a, 13b"											6700	0	0	0	0	0.002	0.0009	0	0.0012	0	0	0	0	0	0.0005	0.0012	0.0032	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0089	0	NO	2.50E-05	20.7088	0.170194678	9.646595049	0	3.763084971	6.127943143	0	7.759440701	7.744407717	0.356207087	3.833230295	0	0	29.77070516	6.836950999	23.0168397	0.519733579	1.052401849	0	12.59044348	0.407420351	0.345886297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6503
H2323_005_0	2012	8																															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	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	474.9633976	18.76229635	0	0	41.91447363	33.979765	19.00418335	36.64558076	82.44407268	25.20530222	35.19951985	13.69680095	2.910952208	3.552264778	0	97.31723568	9.304663573	5264.976755	25.47815575	62.34418893	52.72255917	31.90701693	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 Copay for Visits 1-4; 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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	Not Covered; PBP 13b											0	NO	0.07351333	0.07351333	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	5	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064160007	0.064160007	0	0	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0.195499804	0	0.195499804	0.195499804	4.335818573	0.195499804	0.195499804	0.195499804	0.195499804	0	0	0	0	0	0	0	0												30.4737	1.203789065	0	0	8.194271364	6.643037386	3.715314113	7.164203844	16.11780002	4.927631635	6.88149922	2.677721896	0.569090585	0.694467067	0	19.02550047	1.819059902	1.902332	4.980974446	12.1882767	10.30724997	6.237815545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7237	0	NO	20.96645045	30.4737	1.203789065	0	0	8.194271364	6.643037386	3.715314113	7.164203844	16.11780002	4.927631635	6.88149922	2.677721896	0.569090585	0.694467067	0	19.02550047	1.819059902	1.902332	4.980974446	12.1882767	10.30724997	6.237815545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7237	NO																																										0	0	0	0	0	0	0	0	0	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	30.4737	1.203789065	0	0	8.194271364	6.643037386	3.715314113	7.164203844	16.11780002	4.927631635	6.88149922	2.677721896	0.569090585	0.694467067	0	19.02550047	1.819059902	1.902332	4.980974446	12.1882767	10.30724997	6.237815545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7237
H2323_006_0	2012	7																															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	1666.561856	40.59409213	0	0	419.9954179	29.79629108	0	530.3380115	2012.777249	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"	"$65/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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	75	75	0	0	50	0.2	0	61.0477754	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	59.90533815	59.90533815	0	0	39.9368921	0.159747568	0	48.76116839	39.9368921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												8.3197	0.202650235	0	0	1.397775974	4.759885047	0	2.154991757	6.698672319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5336	0	NO	5.929894029	8.3197	0.202650235	0	0	1.397775974	4.759885047	0	2.154991757	6.698672319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5336	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.3197	0.202650235	0	0	1.397775974	4.759885047	0	2.154991757	6.698672319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5336
H2323_007_0	2012	8																															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	1734.335323	43.00126007	0	0	421.820857	0	0	1280.814706	2052.599831	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"	"$65/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	NO	65	65	0	0	50	0	0	60.90687663	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	48.98061304	48.98061304	0	0	37.67739465	0	0	45.89624855	37.67739465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.0791	0.175519007	0	0	1.324425908	0	0	4.898715841	6.444717824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9224	0	NO	6.515748772	7.0791	0.175519007	0	0	1.324425908	0	0	4.898715841	6.444717824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.0791	0.175519007	0	0	1.324425908	0	0	4.898715841	6.444717824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9224
H2323_011_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	419.3536634	4.561652095	345.0140513	0	18.32251573	32.74285536	3.577657256	75.48982555	132.2656504	20.65038989	49.86453996	29.75536446	0.965038847	26.71770414	0	111.4953018	2.94044445	11.21271046	50.43579858	130.8504405	95.69224891	23.20497639	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	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"	"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 Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	0.0718734	0.0718734	0.174848276	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.057218503	0.057218503	0.139196929	0	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0.178326678	0	0	0	0	0	0	0	0												23.9948	0.261010903	48.02489653	0	3.267393369	5.838924633	0.637991735	13.46184983	23.58649409	3.682515434	8.892177776	5.306175305	0.172092172	4.76447943	0	19.88258682	0.524359691	1.999525411	8.994048428	23.3341244	17.06448089	4.138066359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.828	0	NO	55.79046047	23.9948	0.261010903	48.02489653	0	3.267393369	5.838924633	0.637991735	13.46184983	23.58649409	3.682515434	8.892177776	5.306175305	0.172092172	4.76447943	0	19.88258682	0.524359691	1.999525411	8.994048428	23.3341244	17.06448089	4.138066359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.828	NO																																										0	0	0	0	0	0	0	0	0	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	23.9948	0.261010903	48.02489653	0	3.267393369	5.838924633	0.637991735	13.46184983	23.58649409	3.682515434	8.892177776	5.306175305	0.172092172	4.76447943	0	19.88258682	0.524359691	1.999525411	8.994048428	23.3341244	17.06448089	4.138066359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.828
H2323_012_0	2012	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	449.410884	4.345406722	17.19088783	0	14.34386574	27.09380517	3.101193649	18.93817135	80.40773275	10.48639542	27.81199292	17.97614152	0.583009995	15.25936927	0	87.9706024	2.382902329	8.902552332	40.79873249	107.3973218	74.71461058	19.19200262	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	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"	"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 Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	0.069973114	0.069973114	0.176034081	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069973114	0.069973114	0.176034081	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												31.4467	0.304061639	3.026182143	0	3.213025927	6.069012357	0.694667377	4.242150381	18.01133214	2.348952573	6.229886415	4.026655701	0.130594239	3.418098717	0	19.70541494	0.533770122	1.994171722	9.138916078	24.05700008	16.73607277	4.299008588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.6257	0	NO	0	31.4467	0.304061639	3.026182143	0	3.213025927	6.069012357	0.694667377	4.242150381	18.01133214	2.348952573	6.229886415	4.026655701	0.130594239	3.418098717	0	19.70541494	0.533770122	1.994171722	9.138916078	24.05700008	16.73607277	4.299008588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.6257	NO																																										0	0	0	0	0	0	0	0	0	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	31.4467	0.304061639	3.026182143	0	3.213025927	6.069012357	0.694667377	4.242150381	18.01133214	2.348952573	6.229886415	4.026655701	0.130594239	3.418098717	0	19.70541494	0.533770122	1.994171722	9.138916078	24.05700008	16.73607277	4.299008588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.6257
H2323_013_0	2012	9																															D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											20.97071163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											20.9707	YES	14.1846829	0.336016448	10.60072005	0	15.38287042	29.10486588	3.316513119	17.46804127	0	9.721001838	0	19.9642063	0.647487772	14.012686	0	85.44963698	2.247725591	9.697027184	0	107.7609068	80.64374696	20.93793467	0	0	0	0	0	0	0	0											6700	$275/Days 61-90 and $550/Days 91-150; PBP 1a	$275/Days 61-90 and $550/Days 91-150; PBP 1b	Medicare-FFS 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"	No Cost-Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	No Cost-Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"10% Coinsurance PBP 3, 9a; Medicare-FFS Cost Sharing; PBP 5, 9c, 9d"	"No 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"	No 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"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b, 13d"											0	NO	333.2398219	357.9420278	0.179708307	0	0.224	0.224	0.224	0.224	0	0.224	0	0.224	0.224	0.186783329	0	0.200905327	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	333.2398219	357.9420278	0.179708307	0	0.224	0.224	0.224	0.224	0	0.224	0	0.224	0.224	0.186783329	0	0.200905327	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0												0.3939	0.010022867	1.905037453	0	3.445762975	6.519489957	0.742898939	3.912841245	0	2.177504412	0	4.471982212	0.145037261	2.617336138	0	17.1672873	0.503490532	2.172134089	0	24.13844311	18.06419932	4.690097367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0775	300	NO	0	21.3646	0.010022867	1.905037453	0	3.445762975	6.519489957	0.742898939	3.912841245	0	2.177504412	0	4.471982212	0.145037261	2.617336138	0	17.1672873	0.503490532	2.172134089	0	24.13844311	18.06419932	4.690097367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.0482	NO																																										0	0	0	0	0	0	0	0	0	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	21.3646	0.010022867	1.905037453	0	3.445762975	6.519489957	0.742898939	3.912841245	0	2.177504412	0	4.471982212	0.145037261	2.617336138	0	17.1672873	0.503490532	2.172134089	0	24.13844311	18.06419932	4.690097367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.0482
H2323_014_0	2012	8																															D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											22.67265464	0.248336293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											22.921	YES	15.36977956	0.403400248	364.5968556	0	21.55515381	38.57359627	4.187401245	72.11118065	0	18.25236294	0	36.24570837	1.175536488	24.30294589	0	118.9759324	3.021972867	13.34107284	0	147.7311005	111.9484753	27.61232981	0	0	0	0	0	0	0	0											6700	$275/Days 61-90 and $550/Days 91-150; PBP 1a	$275/Days 61-90 and $550/Days 91-150; PBP 1b	Medicare-FFS 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"	No Cost-Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	No Cost-Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"No Cost-Sharing; PBP 3; Medicare-FFS Cost Sharing; PBP 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14c; Medicare-FFS Cost Sharing; PBP 14b, 14d-j"	"No Cost-Sharing; PBP 7f; Medicare-FFS Cost Sharing; PBP 7b, 7d"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	No 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"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	339.5807381	339.5807381	0.179708307	0	0.224	0.224	0.224	0.224	0	0.224	0	0.224	0.224	0.185586975	0	0.201062498	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	282.617293	282.617293	0.149562886	0	0.186424807	0.186424807	0.186424807	0.186424807	0	0.186424807	0	0.186424807	0.186424807	0.154455429	0	0.167334989	0.186424807	0.186424807	0	0.186424807	0.186424807	0.186424807	0	0	0	0	0	0	0	0												0.362	0.009500657	54.53015798	0	4.018415395	7.191075249	0.78063547	13.44331295	0	3.402693242	0	6.757099197	0.219149163	3.753721935	0	19.90883634	0.563370709	2.487106933	0	27.54074193	20.86997292	5.147623263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.9854	300	NO	34.46327354	23.0346	0.25783695	54.53015798	0	4.018415395	7.191075249	0.78063547	13.44331295	0	3.402693242	0	6.757099197	0.219149163	3.753721935	0	19.90883634	0.563370709	2.487106933	0	27.54074193	20.86997292	5.147623263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	193.9064	NO																																										0	0	0	0	0	0	0	0	0	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	23.0346	0.25783695	54.53015798	0	4.018415395	7.191075249	0.78063547	13.44331295	0	3.402693242	0	6.757099197	0.219149163	3.753721935	0	19.90883634	0.563370709	2.487106933	0	27.54074193	20.86997292	5.147623263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	193.9064
H2354_001_0	2012	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	270.822115	3.272283125	1082.824813		479.9810352	9.020156389	7.160019876	255.1191518	403.4186799			4.059541889		99.33787397	3768.779924	3102.043662	251.8940467	855.0117187				1151.20299			251.7459754		1.047509444														3400	1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $0 per day for days 1-20 plus $120 per day for days 21-100	6 HH: $0	10A Ambulance: $50	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC $45"	"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: $20,  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	37.2		50	0.2	0.2	59.10446382	192.7481498			35		35	15	34.40503821	35	35				35			34.5249137		23.9074153														NO	354.3029966	354.3029966	32.95017868		44.28787457	0.177151498	0.177151498	52.3522216	170.7281176			31.0015122		31.0015122	13.28636237	30.47452034	31.0015122	31.0015122				31.0015122			30.96288963		23.9074153															7.9961	0.096614976	2.973272589	0	1.77144499	1.597934219	1.268408249	1.113004531	5.739575986	0	0	0.010487661	0	0.256635359	4.172781314	7.87777439	0.65075803	2.208888019	0	0	0	2.974086129	0	0	0.649565238	0	0.002086937	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3594	0		5.325099045	7.9961	0.096614976	2.973272589	0	1.77144499	1.597934219	1.268408249	1.113004531	5.739575986	0	0	0.010487661	0	0.256635359	4.172781314	7.87777439	0.65075803	2.208888019	0	0	0	2.974086129	0	0	0.649565238	0	0.002086937	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3594	NO	1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $0 per day for days 1-20 plus $120 per day for days 21-100	6 HH: $0	10A Ambulance: $50	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC $45"	"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: $20,  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															0.028	0.0003	0.0104		0.0061	0.0055	0.0044	0.0039	0.0199					0.0009	0.0144	0.0273	0.0023	0.0076				0.0103			0.0022																0.1434	0		0	8.0241	0.096961923	2.983642223	0	1.777535534	1.603425869	1.27276741	1.116872095	5.759487105	0	0	0.010487661	0	0.25753471	4.187195141	7.905045373	0.653020692	2.216506562	0	0	0	2.984360004	0	0	0.651780457	0	0.002086937	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5028
H2354_013_0	2012	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	266.9993004	3.004815278	973.2732565		508.4564722	10.40963393	9.02247482	286.6382913	528.5436372			0.868600883		134.6331368	4303.853263	3470.300654	264.1224698	1189.446445				1238.689617			329.4815895		0.895330406														3400	1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $0 per day for days 1-20 plus $100 per day for days 21-100	6 HH: $0	10A Ambulance: $25	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC: $35"	"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: $35"	"7B Chiropractic: $20,  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: $100/2 yrs	18A Routine Hearing Exams: $25																300	300	31		25	0.2	0.2	59.77272727	100			25		25	9.994755612	24.47011314	25	25				25			25		25														NO	276.2120504	276.2120504	28.54191188		23.01767087	0.184141367	0.184141367	55.03315854	92.07068348			23.01767087		23.01767087	9.202153867	22.52225485	23.01767087	23.01767087				23.01767087			23.01767087		23.01767087															6.1457	0.069163849	2.314923293	0	0.975290311	1.916844222	1.661410847	1.314550877	4.055281161	0	0	0.001666097	0	0.258245103	3.300393329	6.513249645	0.506623673	2.281523898	0	0	0	2.37597916	0	0	0.631991565	0	0.001717368	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3246	0		2.958504874	6.1457	0.069163849	2.314923293	0	0.975290311	1.916844222	1.661410847	1.314550877	4.055281161	0	0	0.001666097	0	0.258245103	3.300393329	6.513249645	0.506623673	2.281523898	0	0	0	2.37597916	0	0	0.631991565	0	0.001717368	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3246	NO	1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $0 per day for days 1-20 plus $100 per day for days 21-100	6 HH: $0	10A Ambulance: $25	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $60, 4B UC: $35"	"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: $35"	"7B Chiropractic: $20,  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: $100/2 yrs	18A Routine Hearing Exams: $25															0.0183	0.0002	0.0069		0.0029	0.0057	0.005	0.0039	0.0121					0.0008	0.0098	0.0194	0.0015	0.0068				0.0071			0.0019																0.1024	0		0	6.164	0.069370136	2.321827745	0	0.978199195	1.922561369	1.666366143	1.318471635	4.067376374	0	0	0.001666097	0	0.25901534	3.310237119	6.532682462	0.508134721	2.288328733	0	0	0	2.383065715	0	0	0.633876533	0	0.001717368	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4269
H2354_015_0	2012	6																															A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	Coin	Coin																																																											0	YES	250.6046542	2.820309613	913.5110374		8.81799892	9.755861398	8.455822211	20.37275006	81.94403072	2.680399069	11.15986527	0.815265896	0.088564769	13.39112672	6503.964396	13133.89482	247.9044706	2.451624173	28.62418454	79.12398514	49.42673509	10.84861009																			6700	$600 per Admit	$600 per Admit	"$50 Days 1-20, $146 Days 21-100"		0.2	0.2	0.2	"$60 ER, 20% UC"	0.2	0.2	0.2	40	0.2	0.2	35	"$20 Chiro, $50 Other Specialists"	40	0.2	0.2	"$0 Lab, 20% all other"	0.2	0.2																					600	600	79.71		0.2	0.2	0.2	0.065621745	0.2	0.2	0.2	40	0.2	0.2	27.3713553	22.79654441	40	0.2	0.2	0.201238976	0.2	0.2																			NO	498.2876773	498.2876773	66.19751793		0.166095892	0.166095892	0.166095892	0.054497512	0.166095892	0.166095892	0.166095892	33.21917849	0.166095892	0.166095892	22.73123448	18.92763325	33.21917849	0.166095892	0.166095892	0.167124836	0.166095892	0.166095892																				10.4061	0.117110461	5.03934694	0	1.4646334	1.620408505	1.404477336	1.110264187	13.61056691	0.445203275	1.853607782	0.002256872	0.014710244	2.224211143	12.32026165	20.71612868	0.686265238	0.407204705	4.754359476	13.22358307	8.209577675	1.801909575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4322	0		20.71062413	10.4061	0.117110461	5.03934694	0	1.4646334	1.620408505	1.404477336	1.110264187	13.61056691	0.445203275	1.853607782	0.002256872	0.014710244	2.224211143	12.32026165	20.71612868	0.686265238	0.407204705	4.754359476	13.22358307	8.209577675	1.801909575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4322	NO	$600 per Admit	$600 per Admit	"$50 Days 1-20, $146 Days 21-100"		0.2	0.2	0.2	"$60 ER, 20% UC"	0.2	0.2	0.2	40	0.2	0.2	35	"$20 Chiro, $50 Other Specialists"	40	0.2	0.2	"$0 Lab, 20% all other"	0.2	0.2																				0.0363	0.0004	0.0176		0.0051	0.0057	0.0049	0.0039	0.0475	0.0016	0.0065		0.0001	0.0078	0.043	0.0723	0.0024	0.0014	0.0166	0.0462	0.0287	0.0063																			0.3541	0		0	10.4424	0.117519336	5.056941124	0	1.469746965	1.626065938	1.409380875	1.114140521	13.65808633	0.446757641	1.860079397	0.002256872	0.014761603	2.231976669	12.36327636	20.78847311	0.688661238	0.408626404	4.770958665	13.26975138	8.238240282	1.808200693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7863
H2354_801_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.070986654	0.070986654	0.172773485		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.058622505	0.058622505	0.142680547		0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184924411	0.184584966	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649																				15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	0		22.18839614	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	NO																																																																																		0	0		0	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608
H2354_802_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.065679955	0.065679955	0.16696708		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.054434071	0.054434071	0.138378564		0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185585977	0.185246808	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166	0.185646166																				14.4692	0.127453175	3.165191868	0	1.595836145	2.182983049	2.053818861	4.28816579	14.95553965	0.55256547	2.79712056	0.02724324	0.107516449	3.54943351	8.34004618	14.49177331	0.53464997	0.687286826	6.220637443	14.80667406	7.79670117	1.497816566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2476	0		21.54579474	14.4692	0.127453175	3.165191868	0	1.595836145	2.182983049	2.053818861	4.28816579	14.95553965	0.55256547	2.79712056	0.02724324	0.107516449	3.54943351	8.34004618	14.49177331	0.53464997	0.687286826	6.220637443	14.80667406	7.79670117	1.497816566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2476	NO																																																																																		0	0		0	14.4692	0.127453175	3.165191868	0	1.595836145	2.182983049	2.053818861	4.28816579	14.95553965	0.55256547	2.79712056	0.02724324	0.107516449	3.54943351	8.34004618	14.49177331	0.53464997	0.687286826	6.220637443	14.80667406	7.79670117	1.497816566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2476
H2354_805_0	2012	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	265.8106056	2.341422794	22.87342619		8.596116899	11.75883723	11.06308256	23.09859601	80.55937794	2.976444286	15.06694493	0.146748199	0.579147154	19.11934723	44.93898895	78.22954417	2.879940813	3.702133156	33.50803077	79.75749987	41.99764174	8.0681255																			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																					0.070986654	0.070986654	0.172773485		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223942646	0.22361945	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.058622505	0.058622505	0.142680547		0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184924411	0.184584966	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649	0.184984649																				15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	0		22.18839614	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608	NO																																																																																		0	0		0	15.5825	0.13726007	3.263592961	0	1.590149666	2.175204376	2.046500442	4.272885671	14.90224824	0.550596501	2.787153517	0.027146164	0.107133333	3.536785733	8.310316069	14.43999775	0.53274484	0.684837802	6.198471304	14.7539131	7.768919008	1.492479362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1608
H2406_001_0	2012	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	210.6111467	40.3776	8415.847833	14.16353572	18.22051835	26.79740645	4.834721412	14.22927462	33.31664228	41.79150969	15.0015837	0	0	14.88148106	3.602897513	107.5944076	17.57522	97.37653672	0	26302.21209	40.27025904	8.434157197	740.2951525	152	21.46039377	41.13485123	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.081209284	0.082195631	0	0	0.2	0.2	0.192296332	0.107832836	0.16	0	0.088258899	0	0	0.146384266	0	0.034238281	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.075304754	0.076219387	0	0	0.185458487	0.185458487	0.178314935	0.099992573	0.14836679	0	0.081841809	0	0	0.135741022	0	0.031244827	0.18251399	0	0	0	0.185458487	0.18625484	0	0	0	0	0	0	0	0												15.86	3.077555921	0	0	3.379149771	4.969806464	0.862103032	1.422821784	4.943083264	0	1.227756756	0	0	2.020027452	0	3.36176863	3.207723525	0	0	0	7.468461326	1.570902597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3712	0	NO	4.291804197	15.86	3.077555921	0	0	3.379149771	4.969806464	0.862103032	1.422821784	4.943083264	0	1.227756756	0	0	2.020027452	0	3.36176863	3.207723525	0	0	0	7.468461326	1.570902597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3712	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0.2342	0.0011	0.3524	0.5182	0.0935	0.0989	0.5155	0	0.2231	0	0	0.2106	0.0646	2.5614	0.4184	0.0111	0	0	0.9741	0.2049	0	0	0.0061	0	0	0	0	0											6.4883	0	NO	0.560121834	15.86	3.077555921	0.234213292	0.001129293	3.731521004	5.488048314	0.955602938	1.521734528	5.45853847	0	1.450892958	0	0	2.230672026	0.064615875	5.923179667	3.626122245	0.011149153	0	0	8.442608456	1.775802936	0	0	0.006053276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8595
H2410_016_0	2012	5																															A	A	D		Coin	Coin	Coin	V	Coin	Coin	Coin	V		Coin	V	V	V	V	P	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	172.1159652	4.816368276	337.5830306	0	6.115955274	6.063759516	3.789267405	291.6544823	46.27025961	8.66659956	14.55047498	0.119708533	0	12.53977925	2641.196112	3144.523909	159.2218333	426.5860127	1294.253317	2265.65855	21.93308674	0	0	0	0	0	0	0	0	0											3350	$550/Admit for IP Med/Surg; PBP 1a	$550/Admit for IP MH/SA; PBP 1b	$120/Day for Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Supplies and Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Case for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surgery and ASC services; PBP 9a, 9b"	20% Coinsurance for OP Diagnostic Procedures/Tests; No Cost Sharing for Lab Services; PBP 8a	"20% Coinsurance for OP Radiology - General, Complex Diagnostic, X-Ray, and Therapeutic; PBP 8b"	$30/Visit for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$30/Visit for Cardiac Rehab; $30/Visit for Pulmonary Rehabilitation Services; $30/Visit for CORF; 20% Coinsurance for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV, SCP - Office Surg, and Podiatry; $30/Exam for Vision Exams (cvd) and Hearing Exams (cvd); PBP 7b, 7d, 7f, 17a, 18a"	"$30/Visit for Mental Health and Psychiatric Services ; PBP 7e, 7h"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	"$30/Visit for Phys Radiology - General, Complex Diagnostic, X-Ray, and Theraputic; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; PBP 7d, 14a, 14b"	"$30/Visit for SCP - Other; $15 or $30/Visit for Kidney Disease Education Services; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; 20% Coinsurance for Eye Wear after Cataract; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a											0	NO	550	550	120	0	0.2	0.2	0.2	42.96987018	0.2	0.1	0.2	30	0	0.194037394	15	27.77254522	30	30	30	29.96656755	0.2	0	0	0	0	0	0	0	0	0											NO	491.7847231	491.7847231	107.298485	0	0.178830808	0.178830808	0.178830808	38.42168311	0.178830808	0.089415404	0.178830808	26.82462126	0	0.17349932	13.41231063	24.83293356	26.82462126	26.82462126	26.82462126	26.79472751	0.178830808	0	0	0	0	0	0	0	0	0												7.0537	0.197384695	3.018512313	0	1.093721226	1.084387016	0.677637753	0.933821341	8.274547931	0.774927503	2.602073204	0.000267595	0	2.175643171	2.952045225	6.507312776	0.355922115	0.953584019	2.893154588	5.058975288	3.922311632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5299	0	NO	5.981503211	7.0537	0.197384695	3.018512313	0	1.093721226	1.084387016	0.677637753	0.933821341	8.274547931	0.774927503	2.602073204	0.000267595	0	2.175643171	2.952045225	6.507312776	0.355922115	0.953584019	2.893154588	5.058975288	3.922311632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5299	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.0537	0.197384695	3.018512313	0	1.093721226	1.084387016	0.677637753	0.933821341	8.274547931	0.774927503	2.602073204	0.000267595	0	2.175643171	2.952045225	6.507312776	0.355922115	0.953584019	2.893154588	5.058975288	3.922311632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5299
H2411_801_0	2012	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	284.5153659	5.738525956	57.52609827	0	12.96595292	18.31695977	11.3352887	19.1092935	61.32938158	58.09676106	42.74349919	79.48606253	0.084019621	1.276355957	73.68980551	50.54241569	3.448368877	7.30952935	0	0.345430214	4.268849124	1.276956973	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d		"PBP 16a, 16b"	PBP 17a	PBP 17b			"PBP 13e, 14c"	"PBP 13a, 13b"											0	NO	0.064906198	0.064906198	0.15205026	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061726894	0.061726894	0.144602373	0	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0.213027795	0	0.213027795	0.213027795	0.213027795	0	0	0	0	0	0	0	0												17.5622	0.354221383	8.318410322	0	2.762108358	3.902021547	2.414731555	4.070810655	13.06486292	12.3762249	9.105553377	16.93274062	0.017898515	0.271899295	15.69797677	10.76693936	0.734598418	1.557132919	0	0.073586237	0.909383515	0.272027328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1654	0	NO	6.24074143	17.5622	0.354221383	8.318410322	0	2.762108358	3.902021547	2.414731555	4.070810655	13.06486292	12.3762249	9.105553377	16.93274062	0.017898515	0.271899295	15.69797677	10.76693936	0.734598418	1.557132919	0	0.073586237	0.909383515	0.272027328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1654	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	Medicare-FFS Cost Sharing;	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	"Medicare-FFS Cost Sharing; PBP 13e, 14c"	"Medicare-FFS Cost Sharing; PBP 13a, 13b"											10000	0.9243	0.0186	0.4378	0	0.1454	0.2054	0.1271	0.2143	0.6876	0.6514	0.4792	0.8912	0.0009	0.0143	0.9398	0.5667	0.0387	0.082	0	0.0039	0.0479	0.0143	0	0	0	0	0	0	0	0											6.4907	0	NO	0.334310755	18.4866	0.372864614	8.756221392	0	2.907482483	4.107391102	2.541822689	4.285063847	13.75248728	13.02760515	9.584793028	17.82393749	0.018840542	0.286209784	16.63777831	11.33362038	0.773261492	1.639087283	0	0.077459197	0.957245806	0.286344556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.6561
H2411_803_0	2012	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	311.1711028	5.280649545	69.71257664	0	15.17625075	18.02879235	12.04124048	20.76123016	58.93569717	61.04515418	46.61238522	89.77393585	0.310944885	1.271688028	69.80612977	46.47277104	3.076542783	7.127805643	0	0.408011725	5.702254455	1.286444292	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d		"PBP 16a, 16b"	PBP 17a	PBP 17b			"PBP 13e, 14c"	"PBP 13a, 13b"											0	NO	0.065065299	0.065065299	0.152022142	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061560204	0.061560204	0.143832644	0	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0.211933024	0	0.211933024	0.211933024	0.211933024	0	0	0	0	0	0	0	0												19.1558	0.325077861	10.02694423	0	3.216348712	3.820896479	2.551936506	4.399990288	12.49042051	12.93748412	9.878703749	19.02606169	0.06589949	0.269512689	14.79422417	9.849114895	0.652021015	1.510617404	0	0.086471159	1.20849603	0.272640029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5386	0	NO	7.204816167	19.1558	0.325077861	10.02694423	0	3.216348712	3.820896479	2.551936506	4.399990288	12.49042051	12.93748412	9.878703749	19.02606169	0.06589949	0.269512689	14.79422417	9.849114895	0.652021015	1.510617404	0	0.086471159	1.20849603	0.272640029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5386	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	Medicare-FFS Cost Sharing;	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	"Medicare-FFS Cost Sharing; PBP 13e, 14c"	"Medicare-FFS Cost Sharing; PBP 13a, 13b"											10000	1.0082	0.0171	0.5277	0	0.1693	0.2011	0.1343	0.2316	0.6574	0.6809	0.5199	1.0014	0.0035	0.0142	0.8847	0.5184	0.0343	0.0795	0	0.0046	0.0636	0.0143	0	0	0	0	0	0	0	0											6.766	0	NO	0.385238366	20.164	0.342187223	10.55467814	0	3.385630224	4.021996293	2.686248953	4.631568724	13.14781107	13.61840433	10.39863553	20.02743336	0.069367884	0.283697568	15.67890478	10.36748936	0.686337911	1.590123583	0	0.091022272	1.272101084	0.286989504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3046
H2416_001_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	448.5914386	11.6629549	144.4448155		25.00097561	36.38086923	7.711617434	51.07313338	40.05852889	41.79820765	46.45482427			74.89701491		138.2018737	3.808030737	0.762602853	14.64130529		20.94425105																				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																						0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					36.7096	0.954415921	21.87701429	0	5.600218538	8.149314707	1.727402305	11.44038188	8.973110472	9.362798514	10.40588064	0	0	16.77693134	0	30.95721971	0.852998885	0.170823039	3.279652385	0	4.691512234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.9293	Medicare FFS	YES	0	36.7096	0.954415921	21.87701429	0	5.600218538	8.149314707	1.727402305	11.44038188	8.973110472	9.362798514	10.40588064	0	0	16.77693134	0	30.95721971	0.852998885	0.170823039	3.279652385	0	4.691512234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.9293	NO																																																																																		0				36.7096	0.954415921	21.87701429	0	5.600218538	8.149314707	1.727402305	11.44038188	8.973110472	9.362798514	10.40588064	0	0	16.77693134	0	30.95721971	0.852998885	0.170823039	3.279652385	0	4.691512234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.9293
H2417_001_0	2012	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	368.3311312	10.10455328	123.1537582		17.11452172	31.28351839	15.59915157	36.41944994	56.28813125	33.76117064	42.71265092			71.45176809		160.907707	4.638853402	2.232326717	24.40109563		31.03531687																				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																						0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					30.1417	0.826887064	18.65235883	0	3.833652866	7.007508119	3.494209951	8.157956787	12.6085414	7.562502223	9.567633806	0	0	16.00519605	0	36.04332636	1.039103162	0.500041185	5.46584542	0	6.951910978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.8584	Medicare FFS	YES	0	30.1417	0.826887064	18.65235883	0	3.833652866	7.007508119	3.494209951	8.157956787	12.6085414	7.562502223	9.567633806	0	0	16.00519605	0	36.04332636	1.039103162	0.500041185	5.46584542	0	6.951910978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.8584	NO																																																																																		0				30.1417	0.826887064	18.65235883	0	3.833652866	7.007508119	3.494209951	8.157956787	12.6085414	7.562502223	9.567633806	0	0	16.00519605	0	36.04332636	1.039103162	0.500041185	5.46584542	0	6.951910978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.8584
H2419_001_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	387.2085226	18.47101994	129.8006771		30.47916949	63.29810237	11.92788586	64.31533584	45.62142346	52.11827921	31.37135278			92.06695646		138.1702136	4.656548805	1.979444458	19.14057452		24.97546517																				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																						0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					31.6865	1.511541086	19.65907366	0	6.827333965	14.17877493	2.671846433	14.40663523	10.21919886	11.67449454	7.027183023	0	0	20.62299825	0	30.95012784	1.043066932	0.443395559	4.287488693	0	5.594504199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	182.8041	Medicare FFS	YES	0	31.6865	1.511541086	19.65907366	0	6.827333965	14.17877493	2.671846433	14.40663523	10.21919886	11.67449454	7.027183023	0	0	20.62299825	0	30.95012784	1.043066932	0.443395559	4.287488693	0	5.594504199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	182.8041	NO																																																																																		0				31.6865	1.511541086	19.65907366	0	6.827333965	14.17877493	2.671846433	14.40663523	10.21919886	11.67449454	7.027183023	0	0	20.62299825	0	30.95012784	1.043066932	0.443395559	4.287488693	0	5.594504199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	182.8041
H2422_002_0	2012	9																															Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin		Coin	Coin					Coin																																																			0	NO	481.7953089		142.6677151	71.63908588	40.24248785	59.72159763		37.52954031	47.64561724	111.0561772					197.1787932						25.46659389	0.866157043		1.48	0.086755743					0.001026719												Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing						Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		0% Member Cost Sharing	0% Member Cost Sharing					0% Member Cost Sharing													0.080359982		0.133221223	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224	0.224		0	0					0											NO	0.080359982		0.133221223	0	0.224	0.224		0.224	0.224	0.224					0.224						0.224	0.224		0	0					0												38.7171	0	19.00636747	0	9.014317278	13.37763787	0	8.406617029	10.67261826	24.8765837	0	0	0	0	44.16804969	0	0	0	0	0	5.704517032	0.194019178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.1378				38.7171	0	19.00636747	0	9.014317278	13.37763787	0	8.406617029	10.67261826	24.8765837	0	0	0	0	44.16804969	0	0	0	0	0	5.704517032	0.194019178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.1378	NO																																																																																		0				38.7171	0	19.00636747	0	9.014317278	13.37763787	0	8.406617029	10.67261826	24.8765837	0	0	0	0	44.16804969	0	0	0	0	0	5.704517032	0.194019178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.1378
H2425_001_0	2012	6																															Coin		Coin	Coin	Coin	Coin		V	Coin					Coin						Coin	Coin	Coin																																																											0	YES	434.0841495		248.2119384	17.58128409	29.10320367	42.45256958		756	55.99687794					153.1091459						214.3725574	26.56025409	2.188085649																			0	Medicare FFS	included in a.1	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	included in e.1	65 copay (max allowed)	Medicare FFS	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS	included in i.6	included in i.6	included in i.6	included in i.6	included in i.6	Medicare FFS	Medicare FFS	Medicare FFS																					0.08149984		0.147629121	0	0.224	0.224		65	0.224					0.224						0.224	0.224	0.224																			NO	0.081235237		0.147149817	0	0.223272745	0.223272745		64.78896606	0.223272745					0.223272745						0.223272745	0.223272745	0.223272745																				35.2629	0	36.52434126	0	6.49795216	9.478501725	0	4.081704862	12.50257663	0	0	0	0	34.18509922	0	0	0	0	0	47.86354925	5.930180828	0.488539888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.8154	Medicare FFS	YES	0.628048103	35.2629	0	36.52434126	0	6.49795216	9.478501725	0	4.081704862	12.50257663	0	0	0	0	34.18509922	0	0	0	0	0	47.86354925	5.930180828	0.488539888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.8154	NO																																																																																		0				35.2629	0	36.52434126	0	6.49795216	9.478501725	0	4.081704862	12.50257663	0	0	0	0	34.18509922	0	0	0	0	0	47.86354925	5.930180828	0.488539888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.8154
H2456_002_0	2012	10																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin																																																												0	YES	407.2503039		188.746458		26.28131692	49.86029836		44.14097085	34.33636807					82.202632	312.8706339						38.34300457																				6700	FFS		FFS		FFS	FFS		FFS	FFS					FFS	FFS						FFS																						0.080847666		0.139651879		0.224	0.224		0.224	0.224					0.224	0.224						0.224																				NO	0.080847666		0.139651879		0.224	0.224		0.224	0.224					0.224	0.224						0.224																					32.9252	0	26.3587975	0	5.88701499	11.16870683	0	9.88757747	7.691346447	0	0	0	0	18.41338957	70.08302199	0	0	0	0	0	8.588833023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	191.0039				32.9252	0	26.3587975	0	5.88701499	11.16870683	0	9.88757747	7.691346447	0	0	0	0	18.41338957	70.08302199	0	0	0	0	0	8.588833023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	191.0039	NO																																																																																		0				32.9252	0	26.3587975	0	5.88701499	11.16870683	0	9.88757747	7.691346447	0	0	0	0	18.41338957	70.08302199	0	0	0	0	0	8.588833023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	191.0039
H2457_002_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	487.0726134	12.28886513	120.2143291		22.60519314	32.46339164	13.56328319	33.05016336	46.14485538	34.31917279	36.99348576			77.4533514		197.0244578	7.868143902	3.07160703	33.12974122		34.90850462																				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																						0.080342287	0.080342287	0.132979808		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.080342287	0.080342287	0.132979808		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					39.1325	0.987315525	15.98607844	0	5.063563262	7.271799727	3.038175436	7.403236593	10.33644761	7.687494704	8.28654081	0	0	17.34955071	0	44.13347854	1.762464234	0.688039975	7.421062032	0	7.819505034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.3673	Medicare FFS	YES	0	39.1325	0.987315525	15.98607844	0	5.063563262	7.271799727	3.038175436	7.403236593	10.33644761	7.687494704	8.28654081	0	0	17.34955071	0	44.13347854	1.762464234	0.688039975	7.421062032	0	7.819505034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.3673	NO																																																																																		0				39.1325	0.987315525	15.98607844	0	5.063563262	7.271799727	3.038175436	7.403236593	10.33644761	7.687494704	8.28654081	0	0	17.34955071	0	44.13347854	1.762464234	0.688039975	7.421062032	0	7.819505034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.3673
H2458_002_0	2012	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	406.1540836	18.93681838	239.6626828	0	42.80411899	29.98534815	15.96852862	60.76022624	70.37497614	29.77340411	32.93134508	0.013274822	1.180742086	23.53113551	76.57313846	66.18322155	4.203083757	35.05989912	25.38634195	66.20155978	46.53095401	4.170347389	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 17a, 18a; No Cost Sharing; PBP 7f"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13a											0	NO	0.080853985	0.080853985	0.13973247	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080853985	0.080853985	0.13973247	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												32.8392	1.531117221	33.48865866	0	9.588122654	6.716717987	3.576950412	13.61029068	15.76399466	6.66924252	7.376621297	0.00297356	0.264486227	5.270974353	17.15238302	14.82504163	0.941490762	7.853417402	5.686540597	14.82914939	10.4229337	0.934157815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	209.3444	0	NO	5.68E-14	32.8392	1.531117221	33.48865866	0	9.588122654	6.716717987	3.576950412	13.61029068	15.76399466	6.66924252	7.376621297	0.00297356	0.264486227	5.270974353	17.15238302	14.82504163	0.941490762	7.853417402	5.686540597	14.82914939	10.4229337	0.934157815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	209.3444	NO																																										0	0	0	0	0	0	0	0	0	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	32.8392	1.531117221	33.48865866	0	9.588122654	6.716717987	3.576950412	13.61029068	15.76399466	6.66924252	7.376621297	0.00297356	0.264486227	5.270974353	17.15238302	14.82504163	0.941490762	7.853417402	5.686540597	14.82914939	10.4229337	0.934157815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	209.3444
H2459_001_0	2012	10																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	182.5593547	4.974958719	163.0420927		122.4188871	4.107888213	4.797834743	243.8942761	296.7301734	738.510358	590.2939709			197.7781764	37.62380779	1001.344501	59.2369633	246.0441659		414.7147142	747.6533402																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	"#4a $65, #4b $25"	"#9a $200, #9b $200"	#8a $25	#8b $25			"#3 $25, #9a $25, #9c $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7I $30"		"#7f $30, #17a $30"	#15 $50; $25/$50																						300	300	125		100	0.2	0.044885152	48.73247687	200	25	25			25	25	30	30	30		30	47.16187714																				YES	296.1	296.1	123.375		98.7	0.1974	0.044301645	48.09895467	197.4	24.675	24.675			24.675	24.675	29.61	29.61	29.61		29.61	46.54877274																				20000	4.5047	0.122757106	1.676276515	0	1.006895347	0.810897133	0.212551969	0.977588311	4.881211353	1.518561924	1.213791978	0	0	0.406681375	0.077363955	2.470817557	0.146167207	0.607113979	0	1.023308557	2.900195452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5568			0.32	4.5047	0.122757106	1.676276515	0	1.006895347	0.810897133	0.212551969	0.977588311	4.881211353	1.518561924	1.213791978	0	0	0.406681375	0.077363955	2.470817557	0.146167207	0.607113979	0	1.023308557	2.900195452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5568	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.0497	0.0204		0.0511	0.0999							0.0264		0.1758				0.0965																					0.5199			0	4.5047	0.122757106	1.726003981	0.020437852	1.006895347	0.861991537	0.312431032	0.977588311	4.881211353	1.518561924	1.213791978	0	0	0.43308079	0.077363955	2.646667281	0.146167207	0.607113979	0	1.119772376	2.900195452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.0767
H2459_002_0	2012	11																															A	A	D		T	Coin	Coin	V	V					V	V	V	V	V		V	O																																																												0	YES	264.6395183	8.971909612	414.7130869		183.4853524	8.807686707	12.39061759	329.6398894	428.1247792						88.09981929	2139.379339	306.0168521	658.3239811		700.0688219	1310.479562																				3400	#1a $150	#1b $150	#2 $75/day days 21-100		#10a $100	#11a 20%	#11b 10%/10% #11C 0%	"#4a $65, #4b $20"	"#9a $100, #9b $100"						#7a $0/$20	#7d $15	"#7e $15, #7h $15"	"#7c $15, #7I $15"		"#7f $15, #17a $15"	#15 $50; $25/$50																						150	150	75		100	0.2	0.031383064	45.30698935	100						20	15	15	15		15	46.8432082																				YES	149.25	149.25	74.625		99.5	0.199	0.031226149	45.08045441	99.5						19.9	14.925	14.925	14.925		14.925	46.60899216																				20000	3.2915	0.111588126	2.578997009	0	1.52139938	1.752729655	0.386911266	1.238359667	3.549867961	0	0	0	0	0	0.146098867	2.660853053	0.38060846	0.818790451	0	0.870710597	5.090010969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.3984			0.12	3.2915	0.111588126	2.578997009	0	1.52139938	1.752729655	0.386911266	1.238359667	3.549867961	0	0	0	0	0	0.146098867	2.660853053	0.38060846	0.818790451	0	0.870710597	5.090010969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.3984	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.0694	0.0083		0.0858	0.1178							0.0131		0.1539				0.0935																					0.5416			0	3.2915	0.111588126	2.648348967	0.008293418	1.52139938	1.838485836	0.504681722	1.238359667	3.549867961	0	0	0	0	0.013055188	0.146098867	2.814790857	0.38060846	0.818790451	0	0.964166331	5.090010969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94
H2459_013_0	2012	11																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	192.6039487	6.792963835	165.2491401		113.604801	7.362540249	9.281143911	300.7749368	381.2370218	1348.748154	867.4379048			322.0423177	47.79943056	1337.833878	159.4863301	336.5263761		696.4194283	1017.270172																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	"#4a $65, #4b $25"	"#9a $200, #9b $200"	#8a $25	#8b $25			"#3 $25, #9a $25, #9c $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $50; $25/$50																						300	300	125		100	0.2	0.035630721	47.20459877	200	25	25			25	25	30	30	30		30	46.10844545																				YES	294.3	294.3	122.625		98.1	0.1962	0.034953737	46.3077114	196.2	24.525	24.525			24.525	24.525	29.43	29.43	29.43		29.43	45.23238499																				20000	4.7236	0.166597438	1.688639651	0	0.928719248	1.444530397	0.324410663	1.160683247	6.233225307	2.75650404	1.772826218	0	0	0.658173987	0.097690086	3.281037585	0.391140224	0.825330937	0	1.707968648	3.834463006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9956			0.62	4.7236	0.166597438	1.688639651	0	0.928719248	1.444530397	0.324410663	1.160683247	6.233225307	2.75650404	1.772826218	0	0	0.658173987	0.097690086	3.281037585	0.391140224	0.825330937	0	1.707968648	3.834463006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9956	NO			Section C POS			Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.1752			0.0892	0.2298							0.0174		0.2132				0.117																					0.8417			0	4.7236	0.166597438	1.86379567	0	0.928719248	1.533727803	0.55424487	1.160683247	6.233225307	2.75650404	1.772826218	0	0	0.67553041	0.097690086	3.494219664	0.391140224	0.825330937	0	1.824989723	3.834463006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8373
H2459_018_0	2012	11																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	192.6039487	6.792963835	165.2491401	0	113.604801	7.362540249	9.281143911	300.7749368	381.2370218	1348.748154	867.4379048	0	0	322.0423177	47.79943056	1337.833878	159.4863301	336.5263761	0	696.4194283	1017.270172																				3400	#1a $500	#1b $500	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	"#4a $65, #4b $25"	"#9a $250, #9b $250"	#8a $35	#8b $35			"#3 $35, #9a $35, #9c $35"	#7a $0/$25	#7d $35	"#7e $35, #7h $35"	"#7c $35, #7i $35"		"#7f $35, #17a $35, #18a $35"	#15 $50; $25/$50																						500	500	125		100	0.2	0.2	47.20459877	250	35	35			35	25	35	35	35		35	46.10844545																				YES	485.5	485.5	121.375		97.1	0.1942	0.1942	45.83566541	242.75	33.985	33.985			33.985	24.275	33.985	33.985	33.985		33.985	44.77130053																				20000	7.7924	0.274831995	1.671426198	0	0.919252181	1.429805316	1.802398147	1.148851614	7.712107254	3.819767168	2.456656433	0	0	0.912050681	0.096694265	3.788857028	0.451678577	0.953070741	0	1.972317856	3.795375717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9976			1.22	7.7924	0.274831995	1.671426198	0	0.919252181	1.429805316	1.802398147	1.148851614	7.712107254	3.819767168	2.456656433	0	0	0.912050681	0.096694265	3.788857028	0.451678577	0.953070741	0	1.972317856	3.795375717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9976	NO			Section C POS			Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.1752			0.0892	0.2298							0.0174		0.2132				0.117																					0.8417			0	7.7924	0.274831995	1.846582218	0	0.919252181	1.519002723	2.032232354	1.148851614	7.712107254	3.819767168	2.456656433	0	0	0.929407104	0.096694265	4.002039107	0.451678577	0.953070741	0	2.089338931	3.795375717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8393
H2459_801_0	2012	6																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin																																																												0	YES	231.6609377		62.0361793		8.49910503	23.52367959		17.09471046	49.02744291					54.64981017	248.3723039						64.69460166																				6700	FFS		FFS		FFS	FFS		FFS	FFS					FFS	FFS						FFS																						0.079577336		0.135428602		0.224	0.218786911		0.221487672	0.223956627					0.223692345	0.218247609						0.22399579																				NO	0.076792129		0.130688601		0.21616	0.211129369		0.213735603	0.216118145					0.215863113	0.210608942						0.216155938																					17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408			4.535157144	17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408	NO																																																																																		0			0	17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408
H2459_804_0	2012	8																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin																																																												0	YES	231.6609377		62.0361793		8.49910503	23.52367959		17.09471046	49.02744291					54.64981017	248.3723039						64.69460166																				6700	FFS		FFS		FFS	FFS		FFS	FFS					FFS	FFS						FFS																						0.079577336		0.135428602		0.224	0.218786911		0.221487672	0.223956627					0.223692345	0.218247609						0.22399579																				NO	0.076792129		0.130688601		0.21616	0.211129369		0.213735603	0.216118145					0.215863113	0.210608942						0.216155938																					17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408			4.535157144	17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408	NO																																																																																		0			0	17.7897	0	8.107421508	0	1.837166543	4.966539621	0	3.653748252	10.59572	0	0	0	0	11.79687814	52.3094282	0	0	0	0	0	13.98412229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0408
H2486_003_0	2012	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	859.92	39.45	520.06	1681.96	80.58	13.86	1.61	307.44	285.48	485.59	782.27	55.41	0.65	0.81	3593	2857.27	37.34	582.01		1908.32	20.43	0			0.61				4.86	2.11	550.42	268.43									4000	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$30-$35/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$150/Visit: 3. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $125 Observation"											127.547103	112.005826	49.537808	0	150	0.2	0.2	65	148.553356	39.774723	68.319621	50	0.2	0.2	10	34.621721	35	34.289172		0	0.2	0			0				0	0	0	60.207375									NO	113.237084	99.439444	44.808384	0	138.54795	0.184731	0.184731	60.037445	137.211753	36.738042	63.103623	46.18265	0.184731	0.184731	9.23653	31.978457	32.327855	31.671297		0	0.184731	0			0				0	0	0	55.610723										8.1146	0.326907172	1.941920682	0	0.930349484	2.56037166	0.29741691	1.538159341	3.264267604	1.486635485	4.113672597	0.213248386	0.12007515	0.14963211	2.765571024	7.614257153	0.100593509	1.536084297	0	0	3.77405433	0	0	0	0	0	0	0	0	0	0	1.243965531	0	0	0	0	0	0	0	0	42.0918	0	NO	3.892733	8.1146	0.326907172	1.941920682	0	0.930349484	2.56037166	0.29741691	1.538159341	3.264267604	1.486635485	4.113672597	0.213248386	0.12007515	0.14963211	2.765571024	7.614257153	0.100593509	1.536084297	0	0	3.77405433	0	0	0	0	0	0	0	0	0	0	1.243965531	0	0	0	0	0	0	0	0	42.0918	YES	$0-$200/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins	20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	$0/Service			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									4000	0.4271	0.0172	0.2394	1.5081	0.4635	0.9607	0.1113	0.0561	0.4856	0.0938	0.17	0.0077	0.0044	0.0055	0.2722	0.2165	0.0028	0.0465		0.1446	0.1182	0			0				0		0.0575	0.0775									5.4863	0	NO	1.97856	8.5417	0.344114172	2.181318682	1.508105	1.393811484	3.52110766	0.40868791	1.594263341	3.749855604	1.580447485	4.283661597	0.220930386	0.12450015	0.15516711	3.037790024	7.830735153	0.103422509	1.582587297	0	0.144581	3.89224333	0	0	0	0	0	0	0	0	0	0.057467	1.321492531	0	0	0	0	0	0	0	0	47.578
H2486_801_0	2012	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	227.27	2.64	40.56	22.58	7.76	12.56	3.82	21.9	58.2	7.84	27.02	0.6	0.43	17.02	34.58	86.75	0.59	6.85		14.06	30	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																					0.0834	0.0834	0.1589	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071999	0.071999	0.130522	0	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842		0.202842	0.202842	0																				16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	0	NO	10.75388	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	NO																																																																																		0	0	NO	0	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811
H2486_802_0	2012	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	227.27	2.64	40.56	22.58	7.76	12.56	3.82	21.9	58.2	7.84	27.02	0.6	0.43	17.02	34.58	86.75	0.59	6.85		14.06	30	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																					0.0834	0.0834	0.1589	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071999	0.071999	0.130522	0	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842		0.202842	0.202842	0																				16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	0	NO	10.75388	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	NO																																																																																		0	0	NO	0	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811
H2486_803_0	2012	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	227.27	2.64	40.56	22.58	7.76	12.56	3.82	21.9	58.2	7.84	27.02	0.6	0.43	17.02	34.58	86.75	0.59	6.85		14.06	30	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																					0.0834	0.0834	0.1589	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.071999	0.071999	0.130522	0	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842	0.202842		0.202842	0.202842	0																				16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	0	NO	10.75388	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811	NO																																																																																		0	0	NO	0	16.3632	0.19007736	5.29397232	0	1.57405392	2.54769552	0.77485644	4.4422398	11.8054044	1.59028128	5.48079084	0.1217052	0.08722206	3.45237084	7.01427636	17.5965435	0.11967678	1.3894677	0	2.85195852	6.08526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7811
H2491_001_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2045.01575	166.5247435	791.8727301	363.3755362	15.26100625	12.52109576	18.8726889	35.10959139	35.41392049	3.137480995	17.80150179	2.89947204	0	19.54943242	12705.39468	118.1774424	11.75482135	5.652687377	18.69800857	32.4295985	22.18815727	0.005323755	1630	778.8	338.4	203.04	18	13.71428571	1318.50155	1465.725304											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment"											0	NO	124.7582	55.3906945	54.32328128	0	0.192153259	0.199998762	0.2	0.195612979	0.183669887	0.016806105	0.180806935	0.2	0	0.143126151	0	0.088015551	0.213906927	0.186020693	0.159340012	0.07332594	0.2	0.159865188	0	0	0	0	0	0	0	0											YES	121.3766854	53.88935476	52.85087329	0	0.186945032	0.194577886	0.19457909	0.190310978	0.178691597	0.016350583	0.175906245	0.19457909	0	0.139246782	0	0.085629929	0.208109077	0.180978687	0.155021173	0.071338473	0.19457909	0.155532114	0	0	0	0	0	0	0	0											6700	20.6848	0.747825915	3.48759711	0	2.852969306	2.436328349	3.67223064	6.68174067	6.328170016	0.051299643	3.131395337	0.564176632	0	2.72219555	0	10.11952604	2.446285017	1.023015937	2.898587228	2.313478039	4.317351459	0.000828015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4798	0	NO	2.13070131	20.6848	0.747825915	3.48759711	0	2.852969306	2.436328349	3.67223064	6.68174067	6.328170016	0.051299643	3.131395337	0.564176632	0	2.72219555	0	10.11952604	2.446285017	1.023015937	2.898587228	2.313478039	4.317351459	0.000828015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4798	YES	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	Same as in-network	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											6700	0.5192	0	0.0216	0.0125	0.0758	0.1377	0.2076	0	0.1759	0.0015	0.1762	0	0	0.0971	0	0.4487	0	0.0215	0.0709	0.0924	0.0581	0	0	0	0	0	0	0	0	0											2.1167	0	NO	0.058969687	21.204	0.747825915	3.509214907	0.012478754	2.928756433	2.574053931	3.879820464	6.68174067	6.504037796	0.05282564	3.307586792	0.564176632	0	2.819279274	0	10.56820587	2.446285017	1.044470513	2.969479382	2.405861969	4.375498873	0.000854453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5964
H2491_002_0	2012	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	1054.463138	116.8012634	318.0591196	387.7723279	330.847344	4.479656541	4.479289488	410.4678455	330.5578192	1694.249248	1210.809183	20.29641256	0	1570.524052	9719.009558	18508.37968	298.7887152	2424.758656	3168.539944	6299.146095	18.35572546	0.019917209	0	343.3333333	168	0	18	13.71428571	1151.438663	2039.518501											3900	"(1a) $175 days 1 - 6, $0 after day 6, unlimited coverage"	"(1b) $175 days 1 - 6, $0 days 7 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(3) Copay between $30.00 and $125.00 , (5) $175.00 copayment , (9a) $125.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $30.00 copayment; (7b) $20.00 copayment"	"(7e) , (7h) Copay between $20.00 and $30.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	(13b) $0.00 copayment											0	NO	108.8392722	104.805212	41.6958557	0	44.88520927	0.199997246	0.125733035	64.03295928	91.98675335	0.112221665	17.0073359	43.54978221	0	11.35247175	0	6.254674722	17.04127377	9.900170956	6.618434572	3.615173452	0.2	0	0	0	0	0	0	0	0	0											YES	106.4549769	102.5092891	40.78244246	0	43.90192822	0.195615992	0.122978656	62.63021668	89.97163896	0.109763273	16.63476348	42.59575579	0	11.10377802	0	6.117656243	16.66795789	9.683292153	6.473447362	3.535977396	0.195618686	0	0	0	0	0	0	0	0	0											3900	9.3544	0.997767874	1.080935645	0	1.210403029	0.876292459	0.550857	2.142307509	2.478402397	0.015497195	1.678460366	0.072045086	0	1.453229204	0	9.435658709	0.415016477	1.956637206	1.709281378	1.856136517	3.590722889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8741	0	NO	0.91546511	9.3544	0.997767874	1.080935645	0	1.210403029	0.876292459	0.550857	2.142307509	2.478402397	0.015497195	1.678460366	0.072045086	0	1.453229204	0	9.435658709	0.415016477	1.956637206	1.709281378	1.856136517	3.590722889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8741	YES	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	Same as in-network	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											3900	0.2272	0	0.006	0.007	0.0259	0.033	0.033	0	0.1163	0.0005	0.1127	0	0	0.0406	0	0.2545	0	0.0164	0.0628	0.0651	0.0324	0.0001	0	0	0	0	0	0	0	0											1.0336	0	NO	0.023149029	9.5816	0.997767874	1.086959733	0.007015472	1.236273807	0.909317237	0.583879072	2.142307509	2.594699647	0.015993014	1.791178057	0.072045086	0	1.493822256	0	9.690176295	0.415016477	1.973083183	1.772063045	1.921226008	3.623090026	6.63E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9076
H2491_004_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1890.280694	167.2204471	665.3490549	457.6355398	18.04778727	9.819571752	12.87004476	41.48341171	26.98051328	1.927681491	14.86224536	1.015479653	0	21.35421856	10326.51963	100.5812428	14.28687857	6.065722041	16.35352836	25.74661595	14.65274435	0.00482301	1630	778.8	338.4	203.04	18	13.71428571	1318.50155	3047.137548											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7b) , (7d) , (7f), (7g) 20% coinsurance"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	109.8333445	54.76762062	43.01171355	0	0.191432881	0.2	0.2	0.195415886	0.180050849	0.020558779	0.177836711	0.2	0	0.156315819	0	0.088495725	0.219172698	0.181944915	0.155022023	0.082991647	0.2	0.159865188	0	0	0	0	0	0	0	0											YES	107.6496455	53.67873455	42.15655761	0	0.187626825	0.196023614	0.196023614	0.19153064	0.176471091	0.020150031	0.174300974	0.196023614	0	0.153207959	0	0.086736259	0.214815122	0.178327499	0.151939886	0.081341612	0.196023614	0.156686759	0	0	0	0	0	0	0	0											6700	16.9573	0.748015166	2.337402147	0	3.38624903	1.92486794	2.522832683	7.945344412	4.76128061	0.038842842	2.590503835	0.199057991	0	3.271636232	0	8.724040731	3.06903756	1.081685042	2.484753236	2.094271255	2.872283899	0.000755702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0102	0	NO	1.359318015	16.9573	0.748015166	2.337402147	0	3.38624903	1.92486794	2.522832683	7.945344412	4.76128061	0.038842842	2.590503835	0.199057991	0	3.271636232	0	8.724040731	3.06903756	1.081685042	2.484753236	2.094271255	2.872283899	0.000755702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0102	YES	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	Same as in-network	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											6700	0.4304	0	0.0166	0.0097	0.0903	0.1088	0.1426	0	0.135	0.0009	0.1482	0	0	0.1068	0	0.3851	0	0.0232	0.0624	0.0751	0.0388	0	0	0	0	0	0	0	0	0											1.7741	0	NO	0.035987157	17.3878	0.748015166	2.353976796	0.009692491	3.47654086	2.033680005	2.665447471	7.945344412	4.896262251	0.039787381	2.738695866	0.199057991	0	3.37846991	0	9.109151608	3.06903756	1.104909805	2.547198658	2.169322907	2.911120483	0.000779831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7843
H2542_001_0	2012	13	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	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	1154.49	45.28	439.98	1065.59	0.77	13.72	3.93	415.97	275.75	1042.29	747.67	152.85	0.21	6.68	2910.85	3697.17	204.28	615.64		1558.27	18.13	0		3.41	2.86				3.55	1.09	2128.74	531.07									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	205.919476	38.147063	77.406233	35.588047	0.2	0.2	10	33.165694	35	38.188784		0	0.2	0		0	0				0	0	0	62.197771									NO	127.412013	102.096313	26.156875	0	0.179423	0.179423	0.179423	58.31241	184.733245	34.222264	69.442215	31.926535	0.179423	0.179423	8.97114	29.753408	31.39899	34.259693		0	0.179423	0		0	0				0	0	0	55.798491										12.258	0.385243421	0.959041822	0	0.13815571	2.46168356	0.70513239	2.021351099	4.245016026	2.972460295	4.326655074	0.40666424	0.03767883	1.19854564	2.176136906	9.166950621	0.534515473	1.75763645	0	0	3.25293899	0	0	0	0	0	0	0	0	0	0	2.469408718	0	0	0	0	0	0	0	0	51.4732	0	NO	8.261675	12.258	0.385243421	0.959041822	0	0.13815571	2.46168356	0.70513239	2.021351099	4.245016026	2.972460295	4.326655074	0.40666424	0.03767883	1.19854564	2.176136906	9.166950621	0.534515473	1.75763645	0	0	3.25293899	0	0	0	0	0	0	0	0	0	0	2.469408718	0	0	0	0	0	0	0	0	51.4732	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	40% Coins	40% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						40% Coins	30% Coins									5850	4.0542	0.0532	0.3437	2.1151	1.1417	1.3012	0.373	0.2388	1.8615	0.2989	0.6508	0.0369	0.0046	0.2143	1.0998	2.246	0.0489	0.1817		0.2756	0.6334	0		0	0				0	0	0.3226	0.432									17.9278	500	NO	8.000903	16.3122	0.438422421	1.302724822	2.115126	1.27981171	3.76287156	1.07816839	2.260134099	6.106525026	3.271404295	4.977500074	0.44360224	0.04223883	1.41282764	3.275967906	11.41295762	0.583378473	1.93934245	0	0.275595	3.88629099	0	0	0	0	0	0	0	0	0	0.322591	2.901365718	0	0	0	0	0	0	0	0	69.401
H2542_002_0	2012	10	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	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	1346.03	63.04	591.22	1516.52	1.16	15.24	4.53	501.37	259.65	1470.22	918.19	160.7	0.9	8.6	3479.93	4453.84	206.59	708.18		2117.55	25.61	0		3.41	2.86		0.24		3.55	1.09	3128.26	417.82									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	210.849709	43.480024	77.625292	36.050997	0.2	0.2	10	33.744882	35	39.131231		0	0.2	0		0	0		0		0	0	0	79.912464									NO	119.584483	95.824048	23.675817	0	0.174098	0.174098	0.174098	56.581785	183.542352	37.848882	67.571963	31.381996	0.174098	0.174098	8.70489	29.374549	30.467115	34.063306		0	0.174098	0		0	0		0		0	0	0	69.562921										13.4137	0.503395665	1.166468044	0	0.20195368	2.65325352	0.78866394	2.364034129	3.971397641	4.637181941	5.170325059	0.42025723	0.1566882	1.4972428	2.524367321	10.90246178	0.524516774	2.010246004	0	0	4.45864978	0	0	0	0	0	0	0	0	0	0	2.422064971	0	0	0	0	0	0	0	0	59.7869	0	NO	12.329221	13.4137	0.503395665	1.166468044	0	0.20195368	2.65325352	0.78866394	2.364034129	3.971397641	4.637181941	5.170325059	0.42025723	0.1566882	1.4972428	2.524367321	10.90246178	0.524516774	2.010246004	0	0	4.45864978	0	0	0	0	0	0	0	0	0	0	2.422064971	0	0	0	0	0	0	0	0	59.7869	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	40% Coins	40% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						40% Coins	30% Coins									6000	3.9474	0.0604	0.351	2.4532	1.279	1.0722	0.3187	0.2134	1.4356	0.3167	0.5981	0.0314	0.0142	0.2046	0.9231	1.7833	0.0364	0.1545		0.2251	0.6773	0		0	0		0		0	0	0.3503	0.3211									16.7668	0	NO	9.20674	17.3611	0.563788665	1.517479044	2.453201	1.48098168	3.72541852	1.10736194	2.577401129	5.406979641	4.953891941	5.768415059	0.45164223	0.1709002	1.7018408	3.447448321	12.68580978	0.560877774	2.164773004	0	0.225055	5.13595378	0	0	0	0	0	0	0	0	0	0.350283	2.743128971	0	0	0	0	0	0	0	0	76.5537
H2542_003_0	2012	9	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	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	1188.22	52.73	543.07	1087.45	1.18	12.8	3.93	368.11	328.23	1476.79	1026.95	146.38	0.6	8.27	2959.27	3647.84	102.94	547.56		1433.11	19.88	0		3.41	2.86				3.55	1.09	1576.28	496.78									4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	36.775615	0.199634	0.2	10	32.959557	35	38.879061		0	0.2	0		0	0				0	0	0	80.9525									NO	130.974513	104.950974	26.637736	0	0.180945	0.180945	0.180945	58.80719	187.703118	32.578384	72.996252	33.271855	0.180614	0.180945	9.04726	29.819368	31.66541	35.174898		0	0.180945	0		0	0				0	0	0	73.239832										12.9689	0.461172072	1.205512941	0	0.2135151	2.316096	0.71111385	1.803959559	5.134149535	4.009285976	6.246958416	0.405861178	0.1083684	1.49641515	2.231107092	9.06469028	0.271636442	1.605030596	0	0	3.5971866	0	0	0	0	0	0	0	0	0	0	3.032006978	0	0	0	0	0	0	0	0	56.8829	0	NO	8.169181	12.9689	0.461172072	1.205512941	0	0.2135151	2.316096	0.71111385	1.803959559	5.134149535	4.009285976	6.246958416	0.405861178	0.1083684	1.49641515	2.231107092	9.06469028	0.271636442	1.605030596	0	0	3.5971866	0	0	0	0	0	0	0	0	0	0	3.032006978	0	0	0	0	0	0	0	0	56.8829	YES	20% Coins	20% Coins	"20% Coins(Days 1-7), 20% (Days 8-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						20% Coins	20% Coins									6750	3.7132	0.0535	0.4116	1.1966	1.4921	0.5152	0.1581	0.1793	1.1014	0.1971	0.4388	0.0204	0.0109	0.1502	0.5978	1.1	0.0149	0.0894		0.1154	0.4278	0		0	0				0	0	0.0941	0.2937									12.3717	0	NO	3.318996	16.682	0.514664072	1.617159941	1.196647	1.7056011	2.831318	0.86921385	1.983260559	6.235523535	4.206358976	6.685740416	0.426306178	0.1192204	1.64664815	2.828952092	10.16471428	0.286583442	1.694456596	0	0.115441	4.0249366	0	0	0	0	0	0	0	0	0	0.094119	3.325732978	0	0	0	0	0	0	0	0	69.2546
H2542_004_0	2012	8	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	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	1212.72	53.82	554.27	1109.88	1.08	11.68	3.59	375.7	335	1507.24	1048.13	149.4	0.55	7.55	3020.3	3723.07	105.06	558.85		1462.67	18.15	0		3.41	2.86		0.24		3.55	1.09	1608.79	507.03									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	36.775615	0.199634	0.2	10	32.959557	35	38.879061		0	0.2	0		0	0		0		0	0	0	80.952501									NO	124.748993	99.962413	24.959691	0	0.177287	0.177287	0.177287	57.618145	183.907877	31.919669	71.520313	32.599119	0.176963	0.177287	8.86433	29.216439	31.025155	34.463683		0	0.177287	0		0	0		0		0	0	0	71.758968										12.6071	0.448331422	1.152867328	0	0.19146996	2.07071216	0.63646033	1.80392809	5.1340949	4.009216825	6.246882139	0.405859032	0.09732965	1.33851685	2.231077992	9.064570629	0.271625232	1.605002437	0	0	3.21775905	0	0	0	0	0	0	0	0	0	0	3.031995795	0	0	0	0	0	0	0	0	55.5648	0	NO	9.824305	12.6071	0.448331422	1.152867328	0	0.19146996	2.07071216	0.63646033	1.80392809	5.1340949	4.009216825	6.246882139	0.405859032	0.09732965	1.33851685	2.231077992	9.064570629	0.271625232	1.605002437	0	0	3.21775905	0	0	0	0	0	0	0	0	0	0	3.031995795	0	0	0	0	0	0	0	0	55.5648	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins	30% Coins									6000	3.9744	0.0573	0.3708	1.5143	1.2588	0.652	0.2001	0.1691	1.3937	0.2494	0.5553	0.0259	0.0092	0.1901	0.7566	1.392	0.0189	0.1132		0.1461	0.4868	0		0	0		0		0	0	0.1191	0.3717									14.0246	0	NO	6.545477	16.5815	0.505585422	1.523655328	1.514313	1.45025696	2.72270716	0.83653033	1.97305509	6.5278439	4.258604825	6.802146139	0.431731032	0.10648465	1.52863085	2.987629992	10.45661063	0.290540232	1.718168437	0	0.146087	3.70458305	0	0	0	0	0	0	0	0	0	0.119104	3.403694795	0	0	0	0	0	0	0	0	69.5895
H2542_005_0	2012	9																															A	A	A	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	259.69	8.75	48.82	1213.18	31.91	13.66	15579.54	410.67	366.18	1647.53	1145.69	163.3	0.64	684.74	3301.41	4069.59	114.84	610.87		1598.8	21.22	0		3.41	0.79				5.55	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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											NO	0	0	0	0	0	0.199897	0	0	0	0	0	0	0.199897	0	0	0	0	0		0	0.199897	0		0	0				0	0												0	0	0	0	0	2.73059302	0	0	0	0	0	0	0.12793408	0	0	0	0	0	0	0	4.24181434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1003	0	NO	0.003645	0	0	0	0	0	2.73059302	0	0	0	0	0	0	0.12793408	0	0	0	0	0	0	0	4.24181434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1003	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		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"																7500	5.3801	0.0775	0.4921	2.1845	0	0.9405	0.4604	0	3.0159	0.5396	1.2015	0.056	0.0198	1.2157	1.6371	3.0122	0.0409	0.2449		0.3161	1.0534	0		0	0				0	0											21.8883	1000	NO	6.782606	5.3801	0.077506	0.49215	2.184497	0	3.67113802	0.46043	0	3.015865	0.539639	1.201506	0.055984	0.14778108	1.215679	1.637064	3.012164	0.040928	0.244874	0	0.31611	5.29522834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9886
H2542_006_0	2012	9																															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	271.14	9.13	50.97	1266.68	33.32	13.75	16266.58	428.78	382.33	1720.18	1196.21	170.5	0.64	714.94	3447	4249.06	119.9	637.81		1669.31	21.35	0		3.41	0.79		0.24		5.55	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199897	0	0	0	0	0	0	0.199897	0	0	0	0	0		0	0.199897	0		0	0		0		0	0												0	0	0	0	0	2.74858375	0	0	0	0	0	0	0.12793408	0	0	0	0	0	0	0	4.26780095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1443	0	NO	0.003696	0	0	0	0	0	2.74858375	0	0	0	0	0	0	0.12793408	0	0	0	0	0	0	0	4.26780095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1443	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		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"																7500	5.3899	0.0776	0.4918	2.1916	0	0.9436	0.4619	0	3.0257	0.5414	1.2054	0.0562	0.0199	1.2196	1.6424	3.0219	0.0411	0.2457		0.3171	1.0568	0		0	0		0		0	0											21.9497	1000	NO	6.858891	5.3899	0.077647	0.491799	2.191588	0	3.69218175	0.461924	0	3.025654	0.541391	1.205406	0.056167	0.14784508	1.219625	1.642378	3.021941	0.041061	0.245668	0	0.317135	5.32463395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.094
H2542_007_0	2012	10																															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	254.67	8.58	47.88	1189.71	31.29	12.24	15278.18	402.73	359.1	1615.66	1123.53	160.14	0.57	671.5	3237.55	3990.87	112.62	599.05		1567.88	19	0		3.41	0.61		0.24		5.55	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199915	0	0	0	0	0	0	0.199915	0	0	0	0	0		0	0.199915	0		0	0		0		0	0												0	0	0	0	0	2.4469596	0	0	0	0	0	0	0.11395155	0	0	0	0	0	0	0	3.798385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3593	0	NO	0.002716	0	0	0	0	0	2.4469596	0	0	0	0	0	0	0.11395155	0	0	0	0	0	0	0	3.798385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3593	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% Coins	30% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"																7500	5.204	0.075	0.4981	2.0826	0	0.8967	0.4389	0	2.8751	0.5145	1.1454	0.0534	0.0189	1.159	1.5607	2.8716	0.039	0.2334		0.3014	0.7444	0		0	0				0	0											20.712	1000	NO	5.482897	5.204	0.074969	0.498078	2.082565	0	3.3436176	0.438944	0	2.875139	0.514459	1.14544	0.053372	0.13287255	1.158954	1.560676	2.871611	0.039018	0.233448	0	0.301359	4.542814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0713
H2593_001_0	2012	5																															D	D	D	V	T	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	997.0957935	38.36273355	704.0485827	0	233.1161594	4.521485721	3.557954771	376.7993962	167.7084018	0	1129.86019	0	0	33.24764614	0	2941.432869	181.870762	811.461539	0	0	22.22179177	0	0	0	271.9480348	473.9558508	0	0	0	0											3400	1a:$125 days 1-5; Unlimited Add'l Days	1b:$125 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$0	8a:$0	8b: X-Rays $15; Diagnostic $0-$75; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$30; 7f:$0-$30; 16b:$0-$30; 17a:$0-$30; 4 Routine Footcare Visits	7e:$0-$25; 7h:$0-$30	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		99.2397859	72.72228321	10.37461094	0	28.37898518	0.038686464	0.10186655	65	100	0	70.21778029	0	0	25.0049132	0	29.87776552	25.4297659	15	0	0	0.162868321	0	0	0	20	19.01622718	0	0	0	0											NO	96.37113544	70.62015442	10.0747198	0	27.55865503	0.037568183	0.09892197	63.12109349	97.1093746	0	68.1880473	0	0	24.28211483	0	29.01411124	24.69468663	14.56640619	0	0	0.150200062	0	0	0	20	19.01622718	0	0	0	0												8.0076	0.225765181	0.591091016	0	0.535363985	0.169864002	0.351959895	1.981999159	1.357171501	0	6.420246673	0	0	0.06727693	0	7.111921706	0.374270123	0.985006532	0	0	3.337714494	0	0	0	0.453246725	0.751071011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7216	0		1.120323315	8.0076	0.225765181	0.591091016	0	0.535363985	0.169864002	0.351959895	1.981999159	1.357171501	0	6.420246673	0	0	0.06727693	0	7.111921706	0.374270123	0.985006532	0	0	3.337714494	0	0	0	0.453246725	0.751071011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7216	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.0076	0.225765181	0.591091016	0	0.535363985	0.169864002	0.351959895	1.981999159	1.357171501	0	6.420246673	0	0	0.06727693	0	7.111921706	0.374270123	0.985006532	0	0	3.337714494	0	0	0	0.453246725	0.751071011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7216
H2593_003_0	2012	6																															D	D	D	V	T	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	2516.574278	337.9087652	0	0	1402.697837	37.12687006	13.07522031	169.4883694	71.6827699	0	113.2053625	0	0	4.622320874	0	0	0	0	0	0	5.143564278	0	0	0	265.9735438	480.3621939	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; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a: $50 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$75; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0-$50; Therapeutic $0	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	18b:$1500 Allowance Every 2 Years	14c:Newsletters $0 14c:Additional Smoking Cessation $0	13d:Comprehensive Health Assessment $0 13b:OTC $24 per month Allowance											0		79.39182872	58.17782656	0	0	14.18949259	0.038686464	0.08726429	65	75	0	50	0	0	75	0	0	0	0	0	0	0.167847845	0	0	0	20	19.01622718	0	0	0	0											NO	78.00792634	57.16371171	0	0	13.94215136	0.038012108	0.08574316	63.86696583	73.69265288	0	49.12843525	0	0	73.69265288	0	0	0	0	0	0	0.167431574	0	0	0	20	19.01622718	0	0	0	0												16.3594	1.609676603	0	0	1.629718796	1.411270608	1.12111071	0.902058991	0.44020779	0	0.46346686	0	0	0.028385924	0	0	0	0	0	0	0.861195062	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.031	0		0.427298219	16.3594	1.609676603	0	0	1.629718796	1.411270608	1.12111071	0.902058991	0.44020779	0	0.46346686	0	0	0.028385924	0	0	0	0	0	0	0.861195062	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.031	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	16.3594	1.609676603	0	0	1.629718796	1.411270608	1.12111071	0.902058991	0.44020779	0	0.46346686	0	0	0.028385924	0	0	0	0	0	0	0.861195062	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.031
H2593_005_0	2012	6																															D	D	D	V	T	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	2484.625843	92.83490181	2798.612453	0	769.4129398	41.5003382	8.288026529	614.1768878	224.5806847	0	1684.976372	53.64231776	0	42.63429304	0	5443.191047	421.680938	1347.524288	0	0	40.65183745	0	0	0	281.5407211	481.8292322	0	0	0	0											3400	1a:$125 days 1-5; 240 Add'l Days	1b:$125 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$0	8a:$0	8b: X-Rays $15; Diagnostic $0-$75; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$30; 7f:$0-$30; 16b:$0-$30; 17a:$0-$30; 9 Routine Footcare Visits	7e:$0-$25; 7h:$0-$30	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		99.2397859	72.72228321	4.918852823	0	28.37898518	0.038686464	0.08726429	65	100	0	53.25675642	30	0	64.48426022	0	29.71252118	25.63349757	15	0	0	0.163792828	0	0	0	20	19.01622718	0	0	0	0											NO	90.16850423	66.07490576	4.469231746	0	25.78492711	0.035150222	0.079287661	59.05849879	90.8592289	0	48.38867822	27.25776867	0	58.5899016	0	26.99656764	23.29039823	13.62888434	0	0	0.140830941	0	0	0	20	19.01622718	0	0	0	0												18.6696	0.511171449	1.042303968	0	1.653271381	1.45874612	0.657138236	3.022697082	1.700435653	0	6.794481623	0.121847491	0	0.208161586	0	12.24562294	0.818426414	1.530437721	0	0	5.725036512	0	0	0	0.469234535	0.763547845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3921	0		6.007320629	18.6696	0.511171449	1.042303968	0	1.653271381	1.45874612	0.657138236	3.022697082	1.700435653	0	6.794481623	0.121847491	0	0.208161586	0	12.24562294	0.818426414	1.530437721	0	0	5.725036512	0	0	0	0.469234535	0.763547845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3921	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	0.511171449	1.042303968	0	1.653271381	1.45874612	0.657138236	3.022697082	1.700435653	0	6.794481623	0.121847491	0	0.208161586	0	12.24562294	0.818426414	1.530437721	0	0	5.725036512	0	0	0	0.469234535	0.763547845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3921
H2593_006_0	2012	6																															D	D	D	V	T	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	1345.107306	27.44311852	1229.071081	0	377.1722633	12.57741652	7.711520283	428.5274129	185.4082222	0	1124.603554	22.34110759	0	31.38193606	0	4532.067006	297.3621854	1024.555375	0	0	61.17043142	0	0	0	279.3969654	476.7588477	0	0	0	0											3400	1a:$125 days 1-5; 240 Add'l Days	1b:$125 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$0	8a:$0	8b: X-Rays $15; Diagnostic $0-$75; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$30; 7f:$0-$30; 16b:$0-$30; 17a:$0-$30; 12 Routine Footcare Visits	7e:$0-$25; 7h:$0-$30	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		99.2397859	72.72228321	4.918852823	0	28.37898518	0.038686464	0.08726429	65	100	0	50.92242616	30	0	47.25341023	0	29.76937659	25.58149512	15	0	0	0.159506202	0	0	0	20	19.01622718	0	0	0	0											NO	94.50170642	69.25024873	4.684008347	0	27.02406602	0.036839427	0.083097965	61.89665628	95.22562505	0	48.4911986	28.56768752	0	44.99735525	0	28.34807494	24.36013862	14.28384376	0	0	0.135482938	0	0	0	20	19.01622718	0	0	0	0												10.5929	0.158370232	0.479748267	0	0.849394012	0.463344814	0.640811645	2.210367832	1.471301154	0	4.544447855	0.053186148	0	0.117675344	0	10.70628126	0.603648672	1.219549075	0	0	8.287549793	0	0	0	0.465661609	0.75551288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6198	0		3.179755618	10.5929	0.158370232	0.479748267	0	0.849394012	0.463344814	0.640811645	2.210367832	1.471301154	0	4.544447855	0.053186148	0	0.117675344	0	10.70628126	0.603648672	1.219549075	0	0	8.287549793	0	0	0	0.465661609	0.75551288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6198	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	10.5929	0.158370232	0.479748267	0	0.849394012	0.463344814	0.640811645	2.210367832	1.471301154	0	4.544447855	0.053186148	0	0.117675344	0	10.70628126	0.603648672	1.219549075	0	0	8.287549793	0	0	0	0.465661609	0.75551288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6198
H2593_007_0	2012	6																															D	D	D	V	T	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	647.6133304	31.37107752	721.0972791	0	222.6489996	4.36901545	2.212414956	335.3788855	216.4215857	0	217.5855306	33.30489968	0	30.58265601	0	3089.022956	169.112792	876.3558953	0	0.081691804	11.73117052	0	0	0	273.7715464	478.7691575	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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$150; Therapeutic 20%	5:$30	12:20% Coins	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 4 Routine Footcare Visits	7e:$0-$25; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0 14c: Health Club $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		79.39182872	58.17782656	10.37461094	0	28.37898518	0.038686464	0.110803511	50.31087541	71.1434936	0	220.4509006	30	0	63.91834375	0	24.80747429	25	15	0	25	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	78.34091932	57.40772685	10.23728224	0	28.00333264	0.038174371	0.109336805	49.6449105	70.20176739	0	217.5327927	29.60289009	0	63.07225683	0	24.47909783	24.66907508	14.80144505	0	24.66907508	0.192192105	0	0	0	20	19.01622718	0	0	0	0												4.2279	0.150078521	0.615173031	0	0.519576166	0.166784416	0.241898383	1.387487896	1.266098152	0	3.944332343	0.082160107	0	0.160743095	0	6.301374594	0.34765468	1.080944469	0	0.000167938	2.254638356	0	0	0	0.456285911	0.758698589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.962	0		0.366491842	4.2279	0.150078521	0.615173031	0	0.519576166	0.166784416	0.241898383	1.387487896	1.266098152	0	3.944332343	0.082160107	0	0.160743095	0	6.301374594	0.34765468	1.080944469	0	0.000167938	2.254638356	0	0	0	0.456285911	0.758698589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.962	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	4.2279	0.150078521	0.615173031	0	0.519576166	0.166784416	0.241898383	1.387487896	1.266098152	0	3.944332343	0.082160107	0	0.160743095	0	6.301374594	0.34765468	1.080944469	0	0.000167938	2.254638356	0	0	0	0.456285911	0.758698589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.962
H2593_009_0	2012	6																															D	D	D	V	T	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	2475.031995	332.3307452	0	0	1495.043768	40.84780872	14.38564839	180.9158334	141.6849893	0	121.2847484	0	0	4.93397297	0	0	0	0	0	0	5.705093716	0	0	0	265.9735438	480.3621939	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; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a: $50 (waived if admitted)	11a:$0-$499 0%; >$500 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$150; Therapeutic 20%	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $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	18b:$1500 Allowance Every 2 Years	14c:Newsletters $0 14c:Additional Smoking Cessation $0	13d:Comprehensive Health Assessment $0 13b:OTC $24 per month Allowance											0		79.39182872	58.17782656	0	0	14.18949259	0.038686464	0.08726429	65	75	0	399.7325241	0	0	100	0	0	0	0	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	77.40327851	56.72062963	0	0	13.83408425	0.037717472	0.085078556	63.37192611	73.1214532	0	389.7203074	0	0	97.49527093	0	0	0	0	0	0	0.197484543	0	0	0	20	19.01622718	0	0	0	0												15.9646	1.570834093	0	0	1.723546786	1.540676099	1.223910188	0.955415402	0.863351026	0	3.938927454	0	0	0.040086586	0	0	0	0	0	0	1.126667826	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1526	0		0.729103736	15.9646	1.570834093	0	0	1.723546786	1.540676099	1.223910188	0.955415402	0.863351026	0	3.938927454	0	0	0.040086586	0	0	0	0	0	0	1.126667826	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1526	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	15.9646	1.570834093	0	0	1.723546786	1.540676099	1.223910188	0.955415402	0.863351026	0	3.938927454	0	0	0.040086586	0	0	0	0	0	0	1.126667826	0	0	0	0.44328924	0.761223051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1526
H2593_011_0	2012	6																															D	D	D	V	T	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	952.048379	27.85527405	1082.179888	0	328.926251	6.479955208	4.178299967	489.4417336	297.6182964	0	280.5641349	54.22195683	0	41.51443878	0	4351.898671	256.9523108	1156.373085	0	0	14.98060485	0	0	0	285.6341809	479.7762261	0	0	0	0											3400	1a:$100 days 1-5; 240 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$150; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 12 Routine Footcare Visits	7e:$0-$25; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Unlimited CCC Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	4.918852823	0	28.37898518	0.038686464	0.08726429	50.77005387	71.12854251	0	223.7115268	30	0	65.82701448	0	24.82828484	25	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	77.20856384	56.57794396	4.783585016	0	27.59856681	0.037622591	0.084864533	49.37388405	69.17251692	0	217.5594891	29.17500393	0	64.01678021	0	24.14551027	24.31250328	14.58750197	0	0	0.187297593	0	0	0	20	19.01622718	0	0	0	0												6.1255	0.131332845	0.431391625	0	0.756491093	0.243792704	0.354589476	2.013803283	1.715583887	0	5.086615822	0.13182715	0	0.221468392	0	8.756567836	0.520596158	1.405716221	0	0	2.805831224	0	0	0	0.476056968	0.760294476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9375	0		0.979099003	6.1255	0.131332845	0.431391625	0	0.756491093	0.243792704	0.354589476	2.013803283	1.715583887	0	5.086615822	0.13182715	0	0.221468392	0	8.756567836	0.520596158	1.405716221	0	0	2.805831224	0	0	0	0.476056968	0.760294476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9375	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	6.1255	0.131332845	0.431391625	0	0.756491093	0.243792704	0.354589476	2.013803283	1.715583887	0	5.086615822	0.13182715	0	0.221468392	0	8.756567836	0.520596158	1.405716221	0	0	2.805831224	0	0	0	0.476056968	0.760294476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9375
H2593_013_0	2012	6																															D	D	D	V	T	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	1987.31624	28.26392064	2300.159575	0	705.1408057	11.86243804	5.894586551	503.8066847	188.7485225	0	1191.458756	38.43161584	0	131.5395206	0	5929.434712	210.8774743	1677.14767	0	0	22.57680542	0	0	0	282.6165453	476.3523018	0	0	0	0											3400	1a:$125 days 1-5; 240 Add'l Days	1b:$125 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$100; 9b:$0	8a:$0	8b: X-Rays $15; Diagnostic $0-$75; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$30; 7f:$0-$30; 16b:$0-$30; 17a:$0-$30; 12 Routine Footcare Visits	7e:$0-$25; 7h:$0-$30	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		99.2397859	72.72228321	4.918852823	0	28.37898518	0.038686464	0.08726429	65	100	0	49.09146257	30	0	53.79914618	0	29.66557073	26.25239642	15	0	0	0.16071975	0	0	0	20	19.01622718	0	0	0	0											NO	92.35459579	67.67685974	4.577586098	0	26.41007013	0.036002423	0.081209952	60.49034339	93.06206675	0	45.68552966	27.91862002	0	50.06659733	0	27.60739323	24.43102268	13.95931001	0	0	0.14523544	0	0	0	20	19.01622718	0	0	0	0												15.2948	0.159401116	0.877431541	0	1.551901511	0.427076506	0.478699088	2.539619946	1.4637773	0	4.536035363	0.08941314	0	0.548811351	0	13.64135298	0.429329363	1.950985355	0	0	3.278952272	0	0	0	0.471027576	0.754868632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4935	0		3.629013943	15.2948	0.159401116	0.877431541	0	1.551901511	0.427076506	0.478699088	2.539619946	1.4637773	0	4.536035363	0.08941314	0	0.548811351	0	13.64135298	0.429329363	1.950985355	0	0	3.278952272	0	0	0	0.471027576	0.754868632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4935	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	15.2948	0.159401116	0.877431541	0	1.551901511	0.427076506	0.478699088	2.539619946	1.4637773	0	4.536035363	0.08941314	0	0.548811351	0	13.64135298	0.429329363	1.950985355	0	0	3.278952272	0	0	0	0.471027576	0.754868632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4935
H2593_014_0	2012	6																															D	D	D	V	T	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	1997.827232	28.4134096	2312.325207	0	708.8703224	12.10691721	6.016830995	689.5296795	345.4037051	0	422.127548	38.63488213	0	132.2352381	0	5935.647137	210.3765496	1686.018168	0	0	23.09854312	0	0	0	282.4756696	476.3404442	0	0	0	0											3400	1a:$100 days 1-5; 240 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$150; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 12 Routine Footcare Visits	7e:$0-$25; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Unlimited CCC Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	4.918852823	0	28.37898518	0.038686464	0.08726429	53.0532693	77.46739799	0	187.2924581	30	0	53.79914618	0	24.8320769	25	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	74.35294525	54.48536484	4.606660415	0	26.57781242	0.03623109	0.081725753	49.68605575	72.55065533	0	175.4052792	28.09594379	0	50.38459291	0	23.25602123	23.4132865	14.0479719	0	0	0.178213228	0	0	0	20	19.01622718	0	0	0	0												12.3787	0.129009582	0.88767475	0	1.570018538	0.438646809	0.491730042	2.855000841	2.088272096	0	6.170283368	0.090456956	0	0.55521822	0	11.50329465	0.410467202	1.97376132	0	0	4.116465941	0	0	0	0.470792783	0.754849842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8846	0		3.318571159	12.3787	0.129009582	0.88767475	0	1.570018538	0.438646809	0.491730042	2.855000841	2.088272096	0	6.170283368	0.090456956	0	0.55521822	0	11.50329465	0.410467202	1.97376132	0	0	4.116465941	0	0	0	0.470792783	0.754849842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8846	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	12.3787	0.129009582	0.88767475	0	1.570018538	0.438646809	0.491730042	2.855000841	2.088272096	0	6.170283368	0.090456956	0	0.55521822	0	11.50329465	0.410467202	1.97376132	0	0	4.116465941	0	0	0	0.470792783	0.754849842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8846
H2593_015_0	2012	6																															D	D	D	V	T	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	1502.422006	37.05384413	1550.075936	0	529.5897693	20.08320529	3.263766142	509.9772248	243.6256748	0	312.0905951	59.49118679	0	37.99332719	0	3730.707003	192.2916371	1008.805928	0	0	20.46118355	0	0	0	272.4702368	482.6640269	0	0	0	0											3400	1a:$100 days 1-5; 240 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $0-$150; Therapeutic 20%	5:$30	12:$0	3:Cardiac Rehab $25; Intensive Cardiac Rehab $25; Pulmonary Rehab $25; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 9 Routine Footcare Visits	7e:$0-$25; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Unlimited CCC Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		79.39182872	58.17782656	4.918852823	0	28.37898518	0.038686464	0.08726429	52.64344475	74.90214486	0	197.1290526	30	0	74.13838084	0	24.78230717	25	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	76.61622623	56.14388273	4.746885754	0	27.38683293	0.037333954	0.08421346	50.80298738	72.28350535	0	190.2372616	28.95117576	0	71.54644314	0	23.91589769	24.1259798	14.47558788	0	0	0.182042412	0	0	0	20	19.01622718	0	0	0	0												9.5925	0.173362223	0.613169448	0	1.208648878	0.749785452	0.274853038	2.159030543	1.467509814	0	4.947605017	0.143528317	0	0.226523952	0	7.43526725	0.386602013	1.216921572	0	0	3.724803202	0	0	0	0.454117061	0.764870732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5391	0		1.475819992	9.5925	0.173362223	0.613169448	0	1.208648878	0.749785452	0.274853038	2.159030543	1.467509814	0	4.947605017	0.143528317	0	0.226523952	0	7.43526725	0.386602013	1.216921572	0	0	3.724803202	0	0	0	0.454117061	0.764870732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5391	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	9.5925	0.173362223	0.613169448	0	1.208648878	0.749785452	0.274853038	2.159030543	1.467509814	0	4.947605017	0.143528317	0	0.226523952	0	7.43526725	0.386602013	1.216921572	0	0	3.724803202	0	0	0	0.454117061	0.764870732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5391
H2593_016_0	2012	5																															D	D	D	V	T	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	220.2452198	45.69212729	148.0749626	0	76.55010987	1.296733679	1.427150126	176.6880141	120.5443419	0	406.8164119	57.29191196	0	12.00824133	1924.525116	1762.837469	58.90810302	400.3262009	0	0.062160447	4.108647837	0	0	0	268.7687268	475.6587347	0	0	0	0											3400	1a:$150 days 1-5; Unlimited Add'l Days	1b:$150 days 1-5; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$125; 9b:$75	8a:$0	8b: X-Rays $15; Diagnostic $0-$150; Therapeutic 20%	5:$35	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10; 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0 14c: Health Club $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		119.0877431	87.26673985	17.29101823	0	28.37898518	0.038686464	0.095573783	49.18405925	96.88035404	0	77.20735317	35	0	69.54744765	10	32.25923058	35	20	0	35	0.189635335	0	0	0	20	19.01622718	0	0	0	0											NO	118.4445379	86.7954032	17.19762766	0	28.22570736	0.038477514	0.095057579	48.91841108	96.35709328	0	76.7903483	34.8109614	0	69.17181473	9.94598897	32.08499515	34.8109614	19.89197794	0	34.8109614	0.189621811	0	0	0	20	19.01622718	0	0	0	0												2.1739	0.330488884	0.212211506	0	0.18005675	0.049895088	0.135661435	0.720274742	0.967941866	0	2.603297831	0.166198878	0	0.06921932	1.595108798	4.713385971	0.170887308	0.663606663	0	0.000180322	0.779089242	0	0	0	0.447947878	0.753769547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7331	0		0.08016705	2.1739	0.330488884	0.212211506	0	0.18005675	0.049895088	0.135661435	0.720274742	0.967941866	0	2.603297831	0.166198878	0	0.06921932	1.595108798	4.713385971	0.170887308	0.663606663	0	0.000180322	0.779089242	0	0	0	0.447947878	0.753769547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7331	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	2.1739	0.330488884	0.212211506	0	0.18005675	0.049895088	0.135661435	0.720274742	0.967941866	0	2.603297831	0.166198878	0	0.06921932	1.595108798	4.713385971	0.170887308	0.663606663	0	0.000180322	0.779089242	0	0	0	0.447947878	0.753769547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7331
H2593_801_0	2012	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	167.0049225	2.622744861	20.2883162	3.241295421	7.575359698	3.990898996	4.336232897	17.42165844	34.33542922	10.9787233	30.82646032	0	0.119991635	0.135971807	96.0789082	118.9485145	0.525325557	5.048550485	12.97322158	12.57324928	19.63728396	20.9219523	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.08164633	0.08164633	0.161243275	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066254167	0.066254167	0.130845304	0	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.188878183	0.18177098	0	0	0	0	0	0	0	0												11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918	0		19.82884877	11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918
H2593_802_0	2012	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	167.0049225	2.622744861	20.2883162	3.241295421	7.575359698	3.990898996	4.336232897	17.42165844	34.33542922	10.9787233	30.82646032	0	0.119991635	0.135971807	96.0789082	118.9485145	0.525325557	5.048550485	12.97322158	12.57324928	19.63728396	20.9219523	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.08164633	0.08164633	0.161243275	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066254167	0.066254167	0.130845304	0	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.18177098	0.188878183	0.18177098	0	0	0	0	0	0	0	0												11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918	0		19.82884877	11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	11.0648	0.173767776	2.6546309	0	1.376980557	0.725429622	0.788201304	3.16675193	6.24118462	1.995613294	5.603355904	0	0.021810997	0.024715729	17.46435731	21.62138805	0.095488941	0.91767997	2.358155201	2.285451844	3.709054515	3.803003775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0918
H2593_803_0	2012	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	167.0038133	2.622744861	20.28825241	3.241265927	7.575359698	3.990898996	4.336218404	17.42165844	34.33542922	10.9787233	30.82646032	0	0.119991635	0.135971807	96.00373247	118.930591	0.525325557	5.048550485	12.97320612	12.56624574	19.63719385	20.91609645	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.08164633	0.08164633	0.161243275	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066258039	0.066258039	0.130852951	0	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.188884158	0.181781604	0	0	0	0	0	0	0	0												11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774	0		19.81941955	11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774
H2593_804_0	2012	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	167.0038133	2.622744861	20.28825241	3.241265927	7.575359698	3.990898996	4.336218404	17.42165844	34.33542922	10.9787233	30.82646032	0	0.119991635	0.135971807	96.00373247	118.930591	0.525325557	5.048550485	12.97320612	12.56624574	19.63719385	20.91609645	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.08164633	0.08164633	0.161243275	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066258039	0.066258039	0.130852951	0	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.181781604	0.188884158	0.181781604	0	0	0	0	0	0	0	0												11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774	0		19.81941955	11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	11.0653	0.173777932	2.654777709	0	1.377061037	0.725472021	0.788244737	3.166937018	6.2415494	1.995729932	5.603683405	0	0.021812272	0.024717173	17.45171249	21.6193936	0.095494522	0.917733605	2.358290218	2.284312308	3.709154831	3.802161564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0774
H2610_005_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	1082.662617	35.29895102	957.9942084	1326.247752	229.3331991	10.24150699	4.533019328	93.49119103	169.7759444	5202.126705	73.64189401	15.02553158	0.282828186	49.60190408	3064.860238	3161.691146	164.4539289	631.7143139	0	1734.677858	34.00309437	13.90235398	159.9189184	530.8407229	187.6907295	203.8234409	11.28312896	0	9447.238072	0											2250	1a: $325 Days 1-6	1b: $295 Days 1-6	2: $75 Days 1-20	6: none	10a: $150	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $25"	"8a1: 20%, 9a2: $175, 9b: $75"	8a2: none	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $35, 9c: $25, 9c: $35, 9d: $35"	7a: $5	7d: $35	"7h1: $25, 7h2: $35"	"7c: $35, 7i: $35"	i5: none	"7b: $15, 7f: $35, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													222.4344921	188.2232987	46.97110627	0	149.9536614	0.20000028	0.049958782	40.99749309	87.79206388	0	0.165735211	0	0.200000059	34.99445039	5.000719017	34.83955353	34.76537017	34.8998687	0	11.66645226	0.184239547	0	0	24.9888521	24.99394383	24.99901575	19.90079884	0	0	0											NO	167.3332006	141.5967762	35.33546201	0	112.8072623	0.150456373	0.037583033	30.84162743	66.04428518	0	0.124679419	0	0.150456207	26.32565358	3.761944968	26.20912765	26.15332093	26.2545016	0	8.776448189	0.138599876	0	0	18.79863397	18.80246438	18.80627989	14.97098913	0	0	0												15.0971	0.416518139	2.820930663	0	2.155870862	1.540900001	0.170364614	0.24028504	0.934394241	0	9.181628568	0	0.042553256	0.108816879	0.960819629	6.905430571	0.358418032	1.382112039	0	1.268692529	4.71282466	0	0	0.831590037	0.294087355	0.319430057	0.014076633	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7569	0	NO	16.38447882	15.0971	0.416518139	2.820930663	0	2.155870862	1.540900001	0.170364614	0.24028504	0.934394241	0	9.181628568	0	0.042553256	0.108816879	0.960819629	6.905430571	0.358418032	1.382112039	0	1.268692529	4.71282466	0	0	0.831590037	0.294087355	0.319430057	0.014076633	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7569	NO																																																																																		0				15.0971	0.416518139	2.820930663	0	2.155870862	1.540900001	0.170364614	0.24028504	0.934394241	0	9.181628568	0	0.042553256	0.108816879	0.960819629	6.905430571	0.358418032	1.382112039	0	1.268692529	4.71282466	0	0	0.831590037	0.294087355	0.319430057	0.014076633	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7569
H2610_006_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	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	1442.053043	106.3537536	1163.312294	2104.174952	274.9627759	18.41438456	8.514562959	123.5980239	218.8582049	6902.463403	87.24923595	39.99673189	0.113386777	62.48434166	3581.638334	4455.819026	450.8773029	884.2428092	1.387618803	1908.22351	48.18707897	14.49181494	153.0329808	551.8676397	203.9278964	228.1506787	10.10975019	0	9705.287167	0											1975	1a: $275 Days 1-6	1b: $295 Days 1-6	2: $50 Days 1-20	6: none	10a: $150	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $25"	"8a1: 20%, 9a2: $125, 9b: $50"	8a2: none	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $25, 9c: $25, 9c: $35, 9d: $25"	7a: $5	7d: $25	"7h1: $25, 7h2: $35"	"7c: $25, 7i: $25"	i5: none	"7b: $15, 7f: $25, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													187.7940996	159.3951004	32.36777087	0	149.9387357	0.199999985	0.027241647	44.93696234	68.23214892	0	0.174286545	0	0.199999927	25.03563243	5.003436459	24.91302669	34.8459416	24.99519078	0	10.9836903	0.1896273	0	0	24.99033701	24.99829091	24.99976492	19.9662147	0	0	0											NO	132.5206496	113.2638267	22.82132978	0	105.6392738	0.141600483	0.019122859	31.74903544	48.14888871	0	0.122781957	0	0.136036464	17.6518055	3.52372374	17.59434032	24.77511081	17.65151599	0	7.733170376	0.133904316	0	0	17.5631042	17.58303449	17.59329274	13.99072375	0	0	0												15.9252	1.003836093	2.212361125	0	2.42057233	2.607485749	0.162822788	0.327009837	0.878148279	0	10.71263194	0	0.015424736	0.091913454	1.051725336	6.533099696	0.930877929	1.300685507	0	1.229718127	6.452457867	0	0	0.807709072	0.298805936	0.334493473	0.011786894	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3087	0	NO	23.07190384	15.9252	1.003836093	2.212361125	0	2.42057233	2.607485749	0.162822788	0.327009837	0.878148279	0	10.71263194	0	0.015424736	0.091913454	1.051725336	6.533099696	0.930877929	1.300685507	0	1.229718127	6.452457867	0	0	0.807709072	0.298805936	0.334493473	0.011786894	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3087	NO																																																																																		0				15.9252	1.003836093	2.212361125	0	2.42057233	2.607485749	0.162822788	0.327009837	0.878148279	0	10.71263194	0	0.015424736	0.091913454	1.051725336	6.533099696	0.930877929	1.300685507	0	1.229718127	6.452457867	0	0	0.807709072	0.298805936	0.334493473	0.011786894	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3087
H2610_011_0	2012	11																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											3.667265684	0.112980196	0.520809639	0.222903732	0.103291672	0.213956478	0.117907874	0.246493949	0.826907927	0.699489124	2.035235284	0	0.000643781	0.004219387	0	2.418532041	0.039518157	0.158350064	0.021886308	0.036324863	0.778406253	0.008741821	0	0	0	0	0	0	0	0											12.2339	YES	697.5059344	86.39023245	608.413242	563.2898018	112.7770139	8.722354185	4.795386632	161.5120835	207.6449862	5169.866999	82.86833919	0	0.026998763	46.12297611	3619.118961	3533.464951	185.50013	848.7055443	1.933385922	1891.161694	31.39943739	7.738737021	50.56578886	351.1953335	179.537212	207.7980015	19.15321433	0	331.047033	0											3400	1a: $265 Days 1-7	1b: $260 Days 1-6	2: $75 Days 1-20	6: none	10a: $150	11a: 20%	"11b: 20%, 11c: none"	"4a: $65, 4b: $25"	"8a1: 20%, 9a2: $200, 9b: $100"	8a2: $10	"8b: 20%, 8b3-1: $20, 8b3-2: 20%, 9a1: 20%"	5: none	12: 20%	"3: $40, 9c: $25, 9c: $35, 9d: $40"	7a: $10	7d: $40	"7h1: $25, 7h2: $35"	"7c: $40, 7i: $40"	i5: none	"7b: $15, 7f: $40, 14a - 14j: $0.00, 16b: $25"	15: 20%	13a: none	10b: none	16b: $25	17a: $25	17b: $25	18a: $20	18b: 100%	none	none													215.6513041	92.79448317	46.99515129	0	149.6226097	0.199999904	0.053478177	43.12436628	98.93556505	9.323976204	0.15718932	0	0.199999991	39.59565817	10.00005456	39.39869533	34.83490975	39.7291518	0	8.183503661	0.191481642	0	0	24.98803074	25	25	19.97025207	0	0	0											NO	186.7597873	80.34769516	40.69909453	0	129.5808048	0.173204422	0.046316994	37.3461806	85.68342173	8.074931759	0.136130667	0	0.173250881	34.29383462	8.660440791	34.12125074	30.16667725	34.40952393	0	7.08750763	0.165809106	0	0	21.64149861	21.64902112	21.6506093	17.29539623	0	0	0												10.8555	0.578438005	2.063489004	0	1.217811352	1.510750311	0.222107894	0.502654953	1.48264441	3.478860268	11.28092226	0	0.004677559	0.131811143	2.611930457	10.04718696	0.466326879	2.433629478	0	1.116968578	5.206312633	0	0	0.63336611	0.323900408	0.374912779	0.027605203	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5718	200	NO	8.751527231	14.5228	0.691418201	2.584298644	0.222903732	1.321103024	1.724706789	0.340015768	0.749148902	2.309552337	4.178349393	13.31615754	0	0.00532134	0.13603053	2.611930457	12.465719	0.505845036	2.591979542	0.021886308	1.153293441	5.984718886	0.008741821	0	0.63336611	0.323900408	0.374912779	0.027605203	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8057	NO																																																																																		0				14.5228	0.691418201	2.584298644	0.222903732	1.321103024	1.724706789	0.340015768	0.749148902	2.309552337	4.178349393	13.31615754	0	0.00532134	0.13603053	2.611930457	12.465719	0.505845036	2.591979542	0.021886308	1.153293441	5.984718886	0.008741821	0	0.63336611	0.323900408	0.374912779	0.027605203	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8057
H2610_803_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	189.3597331	2.282070911	30.9518613	13.71711908	8.462907755	11.67350357	8.827441105	10.18912641	25.25968354	28.81442252	70.83990891	0.696568145	0.350522401	0.404862162	35.58764879	116.3838269	1.163840657	5.000430069	2.369809459	19.86244521	32.44836741	1.417573432	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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													0.085034307	0.085034307	0.185290645	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.084069718	0.084069718	0.183188795	0	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0	0	0	0	0	0	0	0												15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881		NO	1.214844965	15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881	NO																																																																																		0				15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881
H2610_804_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	189.3597331	2.282070911	30.9518613	13.71711908	8.462907755	11.67350357	8.827441105	10.18912641	25.25968354	28.81442252	70.83990891	0.696568145	0.350522401	0.404862162	35.58764879	116.3838269	1.163840657	5.000430069	2.369809459	19.86244521	32.44836741	1.417573432	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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													0.085034307	0.085034307	0.185290645	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.084069718	0.084069718	0.183188795	0	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0.22145905	0	0	0	0	0	0	0	0												15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881		NO	1.214844965	15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881	NO																																																																																		0				15.9194	0.191853057	5.67003418	0	1.874187509	2.585203007	1.954916718	2.256474251	5.593985512	6.381214629	15.68813891	0.154261319	0.077626358	0.08966039	7.881206881	25.7742517	0.257743046	1.107390491	0.524815751	4.398718242	7.18598461	0.313934465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.881
H2611_001_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	V	COIN	V	P	O											8.923534254	0.097422172	1.212775534	0	0.989640197	0	1.533591768	0.002209199	11.02034454	0.931298537	6.49679314	0	0.039347826	1.168650992	0	0	0	0.057823786	3.656505824	0	0	0	0	0	0	0.191187391	0	0	0	0											36.3211	YES	1839.433639	114.4680926	1211.231892	0	85.91585706	8.317325971	12.35205829	366.5227226	56.88695684	0	35.77025011	61.95610434	0.181175604	0	3758.279401	163.6845488	0	1284.997223	13.54345657	2218.094933	40.43381775	0	0	0	0	56.20163736	0	0	0	0											3125	1a $200 days 1-5	1b $280 days 1-5	"2 $0 days 1-20, $100 Days 21 to 52, $0 Days 53 to 100"	6 $0	10a $150	11a 15%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a 20%, 9b 20%"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  20%, Other 20% 14a $0"	5 $30	12 20%	"3 $0, 14b $0"	"7a $15, 14a $0"	"7b $20, 7d $30, 7f $30, 17a 0%"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b Ther. 20% , X-Ray $0 , CT  20%, Other 20% 14a $0"	"7g $30, 14a $0"	15 15%				17a 0%	17b $15			14c $0													NO	132.0663719	111.6808676	9.046126288	0	150	0.15	0.160566312	65	0.2	0	0.19032314	30	0.2	0	14.33871285	0.080830936	0	29.56828321	0.154394211	27.5464777	0.15	0	0	0	0	15	0	0	0	0											YES	105.1125592	88.88759215	7.199875874	0	119.3860606	0.119386061	0.127795863	51.73395959	0.159181414	0	0.151479533	23.87721212	0.159181414	0	11.41228294	0.064333914	0	23.53360567	0.122883444	21.92443637	0.119386061	0	0	0	0	11.93860606	0	0	0	0											5100	16.1123	0.847899427	0.726726607	0	0.854762976	0.992972782	1.578541947	1.58013931	9.055346235	0	5.418460764	0.123278254	0.028839789	0	3.574212325	10.53046763	0	2.520051494	1.664266592	4.052540102	4.827234215	0	0	0	0	0.055914101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.544	750	NO	16.55088246	25.0358	0.9453216	1.939502141	0	1.844403174	0.992972782	3.112133715	1.582348509	20.07569078	0.931298537	11.9152539	0.123278254	0.068187615	1.168650992	3.574212325	10.53046763	0	2.57787528	5.320772416	4.052540102	4.827234215	0	0	0	0	0.247101491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8651	YES	0.3	0.3	0.3	0.3	10a $150	0.3	0.3	"4a $65, 4b $40"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3								14c $0												5100	10.5411	0.2314	0.9739	0.0614	2.1884	0.2802	0.6493	0.3703	0.7944	0.3661	0.345	0	0.0004	0.704	0.3748	3.9738	0	0.2552	0.2055	0.2872	0.0481	0	0	0	0.0807	0.2923	0	0	0	0											23.0236	1250	NO	0.390816733	35.577	1.17668392	2.913447127	0.061419166	4.03276461	1.27317882	3.761403661	1.952625464	20.87007058	1.297444442	12.26026493	0.123278254	0.068602714	1.872608443	3.948998729	14.50429241	0	2.833085224	5.526286864	4.339766242	4.875351104	0	0	0	0.080679358	0.539438943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8887
H2611_008_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	COIN	COIN	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	1283.215945	40.73184248	475.8436886	0	133.2671394	13.22401258	13.42443047	327.3687313	358.1984008	0	25.84729352	9.98461084	0.140895294	16.57614693	3939.193951	126.4038776	0	1113.416658	11.20388009	2030.42646	26.7181288	0	0	0	0	0	0	0	0	0											4800	1a $210 days 1-7	1b $200 days 1-7	"2 $0 days 1-20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a $350, 9b $350"	8a 0%	"8a X-Ray $0, Ther. $150 , CT  $350, Other $350"	5 0%	12 20%	"3 $40, 4a $40 , 9d $40, 13a $0, 14b $0"	"7a 0%, 14b $0, 14c $0, 14d - 14g 0%, 14i - 14j 0%"	"17a $40, 18a $10, 7b $20 , 7f$40, 14d - 14g 0%, 14i - 14j 0%"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $350, 14h $0"	7g $40	15 20%			16a $0					14a $0													NO	167.1812528	156.4986737	8.182714427	0	150	0.2	0.2	65	350	0	0.362305657	40	0.2	0.057645775	9.648817028	0.112833111	0	40	0.266683626	33.03014438	0.2	0	0	0	0	0	0	0	0	0											YES	153.3660564	143.5662433	7.506527324	0	137.6045943	0.183472792	0.183472792	59.62865751	321.0773866	0	0.332366153	36.69455847	0.183472792	0.052882156	8.851477014	0.103509029	0	36.69455847	0.244645948	30.3006641	0.183472792	0	0	0	0	0	0	0	0	0											10000	16.4001	0.487309801	0.297661138	0	1.528180887	2.426246514	2.463017744	1.626713163	9.5841172	0	8.590765513	0.030531741	0.025850453	0.87658239	2.905640393	13.08394269	0	3.404694389	2.740983868	5.126939178	4.902049697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5014	0	NO	6.891234834	16.4001	0.487309801	0.297661138	0	1.528180887	2.426246514	2.463017744	1.626713163	9.5841172	0	8.590765513	0.030531741	0.025850453	0.87658239	2.905640393	13.08394269	0	3.404694389	2.740983868	5.126939178	4.902049697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5014	YES																																									10000	4.5872	0.0578	0.3559	0.1462	0.1851	0.4421	0.4488	0.197	1.4793	0.2686	0.8335	0.0049	0.0047	0.4625	0.9785	3.0603	0	0.3086	0.3735	0.7058	0.6377	0	0	0.0023	0	0	0	0	0	0											15.5404	0	NO	0	20.9874	0.545136845	0.653557974	0.146224403	1.713274136	2.868358916	2.911830627	1.82374064	11.0633961	0.268634697	9.42428513	0.035407276	0.030560941	1.339104135	3.884151055	16.14423213	0	3.713247095	3.114446538	5.832776893	5.539799395	0	0	0.002282918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0418
H2611_018_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	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	1099.208559	31.11405722	551.5700676	0	141.585716	9.988009172	23.14764625	323.2327285	396.0633764	0	37.48035222	5.774200206	0.807829179	21.4647591	3929.148667	102.8862252	0	897.5243051	6.85746762	1627.839573	8.037982704	0	0	0	0	0	0	0	0	0											3900	1a $195 days 1-7	1b $195 days 1-7	"2 $0 days 1-20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $65, 4b $35"	"9a $200, 9b $200"	8a 0% 14a $0	"8b X-Ray $0, Ther. 20% , CT  $150, Other $200 14a $0"	"7e $35, 7h $35, 9c $35"	12 20%	"3 $35, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $35 , 7f $35, 17a $35, 18a $10"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b X-Ray $0, Ther. 20% , CT  $150, Other $200 14a $0"	"7g $35, 14a $0"	15 20%				17a $0	17b $0			14c $0													NO	155.4631488	152.5862069	8.182714427	0	150	0.2	0.2	65	200	0	0.269882491	35	0.2	0.060242	9.420900402	0.100800413	0	35	0.132340202	26.92062528	0.2	0	0	0	0	0	0	0	0	0											YES	143.5687311	140.9119027	7.556658514	0	138.5235654	0.184698087	0.184698087	60.02687834	184.6980872	0	0.249233899	32.32216526	0.184698087	0.05563291	8.700111421	0.093088217	0	32.32216526	0.122214911	24.86093998	0.184698087	0	0	0	0	0	0	0	0	0											10000	13.151	0.36536175	0.347335554	0	1.634413183	1.844766189	4.275325986	1.616887639	6.096012337	0	9.341374327	0.015552888	0.149204504	1.19414702	2.848669266	9.577495288	0	2.417494076	0.838084794	3.372468494	1.484600031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5702	0	NO	5.018134197	13.151	0.36536175	0.347335554	0	1.634413183	1.844766189	4.275325986	1.616887639	6.096012337	0	9.341374327	0.015552888	0.149204504	1.19414702	2.848669266	9.577495288	0	2.417494076	0.838084794	3.372468494	1.484600031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5702	YES	0.3	0.3	0.3	0	10a $150	0.25	0.25	"4a $65, 4b $35"	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25					17b $0			$50/visit												10000	6.6308	0.0676	0.6385	0.1644	0.1966	0.2774	0.643	0.1945	1.4689	0.2878	1.003	0.0025	0.0224	0.4908	0.7538	2.0476	0	0.2393	0.1905	0.2311	0.1555	0	0	0	0.0501	0.0393	0	0	0	0											15.7955	0	NO	0	19.7818	0.432977401	0.98585661	0.164391136	1.83106001	2.122210888	4.91831616	1.811425855	7.564862422	0.287834098	10.34438396	0.018071276	0.171644203	1.684972947	3.602425809	11.62509658	0	2.656777362	1.028570005	3.603563099	1.640101223	0	0	0	0.050058642	0.039283944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3657
H2611_807_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	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	339.4658223	4.548327642	49.53762365	0	5.284668349	8.903360963	12.38582631	18.93334925	64.7539059	17.09997862	39.13172793	2.368890067	0.159353146	27.47581311	42.1181237	185.3005076	0	12.32285952	14.40844114	20.0193915	49.60485541	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 0.085%	Medicare FFS 0.085%	Medicare FFS 0.185%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.085047252	0.085047252	0.185089906	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.075045583	0.075045583	0.163323088	0	0.197657304	0.224	0.203183042	0.197657304	0.197657304	0.197776576	0.197657304	0.224	0.224	0.197860639	0.203708837	0.216513147	0	0.204111204	0.224	0.224	0.197657304	0	0	0	0	0	0	0	0	0											10000	25.4754	0.341331899	8.090637688	0	1.0445533	1.994352856	2.516589863	3.742314774	12.79908248	3.381975214	7.734671855	0.530631375	0.035695105	5.436381939	8.579834016	40.11999599	0	2.515233687	3.227490816	4.484343697	9.804762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.8553	0	NO	13.11179889	25.4754	0.341331899	8.090637688	0	1.0445533	1.994352856	2.516589863	3.742314774	12.79908248	3.381975214	7.734671855	0.530631375	0.035695105	5.436381939	8.579834016	40.11999599	0	2.515233687	3.227490816	4.484343697	9.804762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.8553	NO	Medicare FFS 0.085%	Medicare FFS 0.085%	Medicare FFS 0.185%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					1.7525	0.0419	0.2964	0	1.152	0.1489	0.345	0.6641	0.4362	0.1991	0.1876	0	0.0002	0.3828	0.211	2.1637	0	0.1388	0.1118	0.1496	0.0284	0	0	0	0	0	0	0	0	0											8.41	0	NO	0	27.2279	0.383245744	8.387060184	0	2.196546079	2.143229284	2.861553846	4.406366114	13.23531276	3.58109895	7.922305587	0.530631375	0.035920856	5.819228148	8.790829133	42.28372098	0	2.654029234	3.339259542	4.633916984	9.833129876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2652
H2611_809_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	V	T	COIN	COIN	COIN	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	176.2082944	1.364963738	19.25135632	0	7.312104362	6.066147657	22.2702817	18.07417048	58.15979775	7.802196137	40.15173155	0.076332463	0.369775158	20.29816153	26.84957149	101.4043278	0	6.438402683	6.444743979	9.792772672	6.647691207	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.079620318	0.079620318	0.189038407	0	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0.212216407	0	0.212216407	0.212216407	0.212216407	0.212216407	0	0	0	0	0	0	0	0	0											10000	14.0298	0.108678847	3.639245732	0	1.551748518	1.287336063	4.726119173	3.835635525	12.34246333	1.655754034	8.52085622	0.016199001	0.078472356	4.307602916	5.6979196	21.51966214	0	1.366334687	1.367680414	2.078187035	1.410749145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5404	0	NO	4.971847703	14.0298	0.108678847	3.639245732	0	1.551748518	1.287336063	4.726119173	3.835635525	12.34246333	1.655754034	8.52085622	0.016199001	0.078472356	4.307602916	5.6979196	21.51966214	0	1.366334687	1.367680414	2.078187035	1.410749145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5404	NO	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					1.6454	0.0127	0.4268	0	0.182	0.151	0.5543	0.4498	1.4475	0.1942	0.9993	0.0019	0.0092	0.5052	0.6683	2.5238	0	0.1602	0.1604	0.2437	0.1308	0	0	0	0	0	0	0	0	0											10.4667	0	NO	0	15.6752	0.121424779	4.06605902	0	1.733738671	1.438315738	5.28040174	4.285481546	13.78999608	1.849942027	9.520188206	0.018098831	0.087675648	4.812801602	6.366175602	24.04350319	0	1.526579376	1.528082931	2.321918266	1.541586171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0072
H2643_001_0	2012	7																															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	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	233.9303993	9.657562979	8.084007879	2.349360273	7.550881824	5.429358054	2.798294967	14.16678232	29.0898161	4.888389017	2.464557424	0.68476805	0.010820064	1.466651153	119.8496613	314.9059614	8.965066321	0.496810984	55.85682386	6.269926189	5.831708386	0	1960.432461	1889.836423	217.8658799	4.819155508	0	0	0	0											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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.059843193	0.059843193	0.158469945	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.186474518	0.195018632	0.195244515	0.195244515	0.195244515	0.195244515	0.195244515	0	0	0	0	0	0	0	0	0											NO	0.059843193	0.059843193	0.158469945	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.186474518	0.195018632	0.195244515	0.195244515	0.195244515	0.195244515	0.195244515	0	0	0	0	0	0	0	0	0												13.9991	0.577939407	1.281072287	0	1.691397529	1.216176204	0.626818073	3.173359239	6.516118807	1.09499914	0.552060863	0.153388043	0.002423694	0.328529858	22.34890783	61.41252971	1.750380029	0.09699962	10.9057385	1.2241687	1.138609078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.0908	0	NO	0	13.9991	0.577939407	1.281072287	0	1.691397529	1.216176204	0.626818073	3.173359239	6.516118807	1.09499914	0.552060863	0.153388043	0.002423694	0.328529858	22.34890783	61.41252971	1.750380029	0.09699962	10.9057385	1.2241687	1.138609078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.0908	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	13.9991	0.577939407	1.281072287	0	1.691397529	1.216176204	0.626818073	3.173359239	6.516118807	1.09499914	0.552060863	0.153388043	0.002423694	0.328529858	22.34890783	61.41252971	1.750380029	0.09699962	10.9057385	1.2241687	1.138609078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.0908
H2649_004_0	2012	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	1538.33	49.52	867.91	1924.8	262.1	15.38	3.68	392.33	263	360.39	876.81	98.04	0.58	729.43	3867.96	4008.45	106.11	585.78		2558.53	25.72	0		2.44	3.4				4.73	1.19	462.02										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS993: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329117	5	100	0.2	0.2	65	225	0	43.224869	36.07706	0.2	36.069493	10	33.888804	35	35		0	0.2	0		0	0				0	0	0										NO	123.276207	96.226957	32.320713	4.349675	86.9935	0.173987	0.173987	56.545775	195.735375	0	37.602827	31.384697	0.173987	31.378115	8.69935	29.481057	30.447725	30.447725		0	0.173987	0		0	0				0	0	0											15.8033	0.397096576	2.337622502	0.69768787	1.900083029	2.67592006	0.64027216	1.848716992	4.289866969	0	2.747544562	0.256412974	0.10091246	1.907344869	2.804061486	9.847778578	0.269234008	1.486305696	0	0	4.47494564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4851	0	NO	11.593582	15.8033	0.397096576	2.337622502	0.69768787	1.900083029	2.67592006	0.64027216	1.848716992	4.289866969	0	2.747544562	0.256412974	0.10091246	1.907344869	2.804061486	9.847778578	0.269234008	1.486305696	0	0	4.47494564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4851	NO																																																																																		0	0	NO	0	15.8033	0.397096576	2.337622502	0.69768787	1.900083029	2.67592006	0.64027216	1.848716992	4.289866969	0	2.747544562	0.256412974	0.10091246	1.907344869	2.804061486	9.847778578	0.269234008	1.486305696	0	0	4.47494564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4851
H2649_012_0	2012	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	1052.54	21.41	504.87	1190	175.19	8	3.26	318.43	209.35	487.35	600.4	29.8	0.23	639.7	2552.69	3201.06	30.94	492		1463.33	10.61	0		2.44	3.4				4.73	1.19	417.03										3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$15-$50/Visit: 5. $15 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$15/Visit: 7b. $0 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit: 7e, 7h. $15 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS993: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												145.768118	128.006658	44.329117	5	100	0.2	0.2	65	200	0	45.681085	24.024035	0.2	34.719603	0	13.226928	15	15		0	0.2	0		0	0				0	0	0										NO	128.571853	112.905713	40.393622	4.77114	95.4228	0.190846	0.190846	62.02482	190.8456	0	43.590171	22.924407	0.190846	33.130418	0	12.621505	14.31342	14.31342		0	0.190846	0		0	0				0	0	0											11.2773	0.20144261	1.699460662	0.47313805	1.393093361	1.526768	0.62215796	1.645880286	3.32946053	0	2.180961556	0.056928944	0.04389458	1.766127366	0	3.366849566	0.036904768	0.58685022	0	0	2.02487606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.232	0	NO	2.61475	11.2773	0.20144261	1.699460662	0.47313805	1.393093361	1.526768	0.62215796	1.645880286	3.32946053	0	2.180961556	0.056928944	0.04389458	1.766127366	0	3.366849566	0.036904768	0.58685022	0	0	2.02487606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.232	NO																																																																																		0	0	NO	0	11.2773	0.20144261	1.699460662	0.47313805	1.393093361	1.526768	0.62215796	1.645880286	3.32946053	0	2.180961556	0.056928944	0.04389458	1.766127366	0	3.366849566	0.036904768	0.58685022	0	0	2.02487606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.232
H2649_020_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1492.76	48.05	842.2	1867.78	254.34	13.21	3.16	380.7	255.21	349.71	850.83	95.13	0.5	707.82	3753.38	3889.71	102.96	568.42		2482.74	22.09	0			0.6				4.73	1.19	448.34										2900	"$0-$175/Day(Days 1-5): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-5): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												110.109501	90.502725	44.329117	0	100	0.2	0.2	65	175	0	43.224869	36.07706	0.2	36.069493	10	33.888804	35	35		0	0.2	0			0				0	0	0										NO	86.61896	71.195055	32.657304	0	87.3792	0.174758	0.174758	56.79648	152.9136	0	37.769545	31.523846	0.174758	31.517235	8.73792	29.611766	30.58272	30.58272		0	0.174758	0			0				0	0	0											10.7751	0.285076866	2.291998452	0	1.852002144	2.30855318	0.55223528	1.801868328	3.252089988	0	2.677955164	0.249905289	0.087379	1.859044106	2.733061181	9.598431861	0.262399738	1.448652475	0	0	3.86040422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8962	0	NO	8.519178	10.7751	0.285076866	2.291998452	0	1.852002144	2.30855318	0.55223528	1.801868328	3.252089988	0	2.677955164	0.249905289	0.087379	1.859044106	2.733061181	9.598431861	0.262399738	1.448652475	0	0	3.86040422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8962	NO																																																																																		0	0	NO	0	10.7751	0.285076866	2.291998452	0	1.852002144	2.30855318	0.55223528	1.801868328	3.252089988	0	2.677955164	0.249905289	0.087379	1.859044106	2.733061181	9.598431861	0.262399738	1.448652475	0	0	3.86040422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8962
H2649_021_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1442.44	46.43	813.81	1911.71	260.32	14.42	3.45	373.12	250.13	344.49	837.34	92.02	0.52	693.72	3730.13	3865.61	102.33	561.93		2467.36	23.41	0			0.6				5.82	1.19	458.88										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$275/Visit: 9b. $0 Surgery ASC -- Physician,9b. $275 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $275 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $40 DMAM -- OP,8b. $40 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $40 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $40 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329116	0	100	0.2	0.2	65	275	0	46.219345	40.727547	0.2	36.584517	10	38.666565	40	40		0	0.2	0			0				0	0	0										NO	118.996746	92.886495	31.068372	0	85.3204	0.170641	0.170641	55.45826	234.6311	0	39.43453	34.748906	0.170641	31.214056	8.53204	32.990468	34.12816	34.12816		0	0.170641	0			0				0	0	0											14.3038	0.35939333	2.106979318	0	1.850883877	2.46064322	0.58871145	1.724382164	4.890689754	0	2.751675779	0.266466194	0.08873332	1.804484577	2.652134864	10.62735692	0.291027884	1.598136412	0	0	3.99470581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3602	0	NO	12.566867	14.3038	0.35939333	2.106979318	0	1.850883877	2.46064322	0.58871145	1.724382164	4.890689754	0	2.751675779	0.266466194	0.08873332	1.804484577	2.652134864	10.62735692	0.291027884	1.598136412	0	0	3.99470581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3602	YES	30% Coins; $250/Day(Days 1-7)	30% Coins; $225/Day(Days 1-7)	"0% Coins(Days 1-14), 0% (Days 15-21), 0% (Days 22-100)"	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins; $300/Visit	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	30% Coins	30% Coins			"VIS768: Vision 17a,17b"						30% Coins										5000	1.1637	0.0226	0.0367	0	0	0	0	0.2798	0.3165	0.0721	0.2128	0.0097	0.0056	0.1951	0.2448	0.4634	0.0044	0.0389		0.0885	0.1696	0			0				0	0	0										3.3243	0	NO	1.05699	15.4675	0.38199733	2.143686318	0	1.850883877	2.46064322	0.58871145	2.004154164	5.207217754	0.072103	2.964494779	0.276165194	0.09436232	1.999573577	2.896981864	11.09073692	0.295458884	1.637049412	0	0.088476	4.16434681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6846
H2649_022_0	2012	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	1497.09	48.19	844.64	1873.19	255.08	12.65	3.03	381.81	255.95	350.72	853.3	95.41	0.48	709.87	3764.25	3900.98	103.26	570.07		2489.93	21.15	0			0.6				4.73	1.19	449.63										3400	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	128.006658	44.329116	5	150	0.2	0.2	65	250	0	43.224869	36.07706	0.2	36.069493	10	33.888804	35	35		0	0.2	0			0				0	0	0										NO	135.035211	94.865222	32.118794	4.34461	130.3383	0.173784	0.173784	56.47993	217.2305	0	37.55904	31.348151	0.173784	31.341576	8.68922	29.446727	30.41227	30.41227		0	0.173784	0			0				0	0	0											16.8467	0.380962921	2.260734847	0.67819	2.770557797	2.1983676	0.52656552	1.797050173	4.63334554	0	2.670760736	0.249243924	0.08341632	1.854037046	2.725699699	9.572591091	0.261697583	1.44476023	0	0	3.6755316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6302	0	NO	12.179031	16.8467	0.380962921	2.260734847	0.67819	2.770557797	2.1983676	0.52656552	1.797050173	4.63334554	0	2.670760736	0.249243924	0.08341632	1.854037046	2.725699699	9.572591091	0.261697583	1.44476023	0	0	3.6755316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6302	NO																																																																																		0	0	NO	0	16.8467	0.380962921	2.260734847	0.67819	2.770557797	2.1983676	0.52656552	1.797050173	4.63334554	0	2.670760736	0.249243924	0.08341632	1.854037046	2.725699699	9.572591091	0.261697583	1.44476023	0	0	3.6755316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6302
H2649_023_0	2012	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	1623.15	52.25	915.77	2030.93	276.55	15.9	3.81	413.96	277.5	380.26	925.15	103.44	0.6	769.65	4081.23	4229.46	111.96	618.07		2699.6	26.6	0		2.44	0.6				4.73	1.38	487.5										2500	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$5/Visit: 6. $5 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												145.768118	128.006658	44.329117	5	150	0.2	0.2	65	200	0	43.224869	36.07706	0.2	36.069493	5	33.666565	35	35		0	0.2	0		0	0				0	0	0										NO	96.685515	84.90464	26.672519	4.08207	122.4621	0.163283	0.163283	53.06691	163.2828	0	35.289388	29.453817	0.163283	29.447639	4.08207	27.485855	28.57449	28.57449		0	0.163283	0		0	0				0	0	0											13.0779	0.369688953	2.03549106	0.690866535	2.822241146	2.5961997	0.62210823	1.830631505	3.77591475	0	2.720664776	0.253891903	0.0979698	1.888697946	1.388322212	9.687527024	0.266599992	1.47175292	0	0	4.3433278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9398	0	NO	15.922435	13.0779	0.369688953	2.03549106	0.690866535	2.822241146	2.5961997	0.62210823	1.830631505	3.77591475	0	2.720664776	0.253891903	0.0979698	1.888697946	1.388322212	9.687527024	0.266599992	1.47175292	0	0	4.3433278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9398	NO																																																																																		0	0	NO	0	13.0779	0.369688953	2.03549106	0.690866535	2.822241146	2.5961997	0.62210823	1.830631505	3.77591475	0	2.720664776	0.253891903	0.0979698	1.888697946	1.388322212	9.687527024	0.266599992	1.47175292	0	0	4.3433278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9398
H2649_024_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1526.27	49.13	861.11	1909.71	260.05	15.15	3.63	389.25	260.94	357.56	869.93	97.27	0.58	723.71	3837.64	3977.03	105.28	581.18		2538.47	25.33	0			3.4				6.73	1.19	458.4										4100	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $40 DMAM -- OP,8b. $40 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $40 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $40 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS993: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	128.006658	44.329117	0	100	0.2	0.2	65	250	0	46.245119	40.71804	0.2	36.584517	15	38.888804	40	40		0	0.2	0			0				0	0	0										NO	142.37245	100.019794	34.6151	0	88.7249	0.17745	0.17745	57.671185	221.81225	0	41.030935	36.12704	0.17745	32.459576	13.308735	34.504052	35.48996	35.48996		0	0.17745	0			0				0	0	0											18.1082	0.409497707	2.48395073	0	1.92274252	2.6883675	0.6441435	1.870709063	4.823307376	0	2.97450344	0.292839765	0.102921	1.957609979	4.256177815	11.43530416	0.311365249	1.718837913	0	0	4.4948085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4953	0	NO	10.897296	18.1082	0.409497707	2.48395073	0	1.92274252	2.6883675	0.6441435	1.870709063	4.823307376	0	2.97450344	0.292839765	0.102921	1.957609979	4.256177815	11.43530416	0.311365249	1.718837913	0	0	4.4948085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4953	NO																																																																																		0	0	NO	0	18.1082	0.409497707	2.48395073	0	1.92274252	2.6883675	0.6441435	1.870709063	4.823307376	0	2.97450344	0.292839765	0.102921	1.957609979	4.256177815	11.43530416	0.311365249	1.718837913	0	0	4.4948085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4953
H2649_801_0	2012	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	247.09	2.87	44.1	24.55	8.43	13.66	4.15	23.81	63.28	8.53	29.37	0.65	0.47	18.5	37.6	94.32	0.65	7.44		15.29	32.62	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																					0.0873	0.0873	0.1783	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073177	0.073177	0.136931	0	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785		0.199785	0.199785	0																				18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068	0	NO	14.041976	18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068	NO																																																																																		0	0	NO	0	18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068
H2649_802_0	2012	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	252.22	2.2	44.12	19.6	8.28	14.37	3.58	22.53	78.46	13	30.09	0.87	0.39	22.22	47.82	86.38	0.65	7.58		15.62	28.79	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																					0.0871	0.0871	0.1795	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072376	0.072376	0.136172	0	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253	0.198253		0.198253	0.198253	0																				18.2547	0.1592272	6.00790864	0	1.64153484	2.84889561	0.70974574	4.46664009	15.55493038	2.577289	5.96543277	0.17248011	0.07731867	4.40518166	9.48045846	17.12509414	0.12886445	1.50275774	0	3.09671186	5.70770387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8828	0	NO	15.457695	18.2547	0.1592272	6.00790864	0	1.64153484	2.84889561	0.70974574	4.46664009	15.55493038	2.577289	5.96543277	0.17248011	0.07731867	4.40518166	9.48045846	17.12509414	0.12886445	1.50275774	0	3.09671186	5.70770387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8828	NO																																																																																		0	0	NO	0	18.2547	0.1592272	6.00790864	0	1.64153484	2.84889561	0.70974574	4.46664009	15.55493038	2.577289	5.96543277	0.17248011	0.07731867	4.40518166	9.48045846	17.12509414	0.12886445	1.50275774	0	3.09671186	5.70770387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8828
H2649_803_0	2012	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	247.09	2.87	44.1	24.55	8.43	13.66	4.15	23.81	63.28	8.53	29.37	0.65	0.47	18.5	37.6	94.32	0.65	7.44		15.29	32.62	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																					0.0873	0.0873	0.1783	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073177	0.073177	0.136931	0	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785	0.199785		0.199785	0.199785	0																				18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068	0	NO	14.041979	18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068	NO																																																																																		0	0	NO	0	18.0813	0.21001799	6.0386571	0	1.68418755	2.7290631	0.82910775	4.75688085	12.6423948	1.70416605	5.86768545	0.12986025	0.09389895	3.6960225	7.511916	18.8437212	0.12986025	1.4864004	0	3.05471265	6.5169867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0068
H2654_004_0	2012	4																															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	1452.686061	81.4947874	1202.368206	1550.112434	246.8253513	7.874695293	6.807696768	355.5787676	48.3098793	14.4334643	35.03341114	0	0.512042101	30.72737638	4715.727795	2587.963847	463.6959278	365.5634264	0	0	21.70650148	1400.863079	355.9554543	0	39.28348135	213.5286048	19.39703816	58.97138758	75.44276759	0											4500	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	67.12238225	0	200	0.2	0.093443182	62.57874306	0.16	0.197881511	0.180482149	0	0.2	0.144979644	11.39535175	34.83359177	38.5	35	0	0	0.2	34.43703736	0	0	35	13.1377597	15	122.5	0	0											NO	149.724851	84.82408931	53.75882775	0	160.181525	0.160181525	0.074839357	50.13987264	0.12814522	0.158484811	0.144549529	0	0.160181525	0.116115302	11.0139859	33.66876545	37.21152855	33.82866232	0	0	0.160181525	27.58088581	0	0	35	13.1377597	15	122.5	0	0												18.1253	0.576060094	5.386492106	0	3.294738431	1.261380701	0.509483646	1.485722843	6.190680111	2.287484867	5.064063089	0	0.082019685	3.567918591	4.328246618	7.261128979	1.437902855	1.030543476	0	0	3.47698051	3.219753717	0	0	0.114576821	0.233773958	0.024246298	0.601999582	0	0	0	0	0	0	0	0	0	0	0	0	69.5605	0	NO	14.04057662	18.1253	0.576060094	5.386492106	0	3.294738431	1.261380701	0.509483646	1.485722843	6.190680111	2.287484867	5.064063089	0	0.082019685	3.567918591	4.328246618	7.261128979	1.437902855	1.030543476	0	0	3.47698051	3.219753717	0	0	0.114576821	0.233773958	0.024246298	0.601999582	0	0	0	0	0	0	0	0	0	0	0	0	69.5605	NO																																										0	0	0	0	0	0	0	0	0	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	18.1253	0.576060094	5.386492106	0	3.294738431	1.261380701	0.509483646	1.485722843	6.190680111	2.287484867	5.064063089	0	0.082019685	3.567918591	4.328246618	7.261128979	1.437902855	1.030543476	0	0	3.47698051	3.219753717	0	0	0.114576821	0.233773958	0.024246298	0.601999582	0	0	0	0	0	0	0	0	0	0	0	0	69.5605
H2654_010_0	2012	5																															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	960.9157204	81.16303138	772.265437	1376.718791	64.45434303	10.09652508	7.83655108	422.8321423	57.33834222	16.63609837	32.94566883	0	0.102731471	53.2566326	4489.249797	2718.259878	443.1970331	554.430518	0	0	6.511995089	584.3760849	0	0	40.4372093	198.5714286	18.42399667	0	591.4701461	0											3975	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	64.75296731	0	200	0.2	0.078913403	62.26694224	0.16	0.18043231	0.179024607	0	0.2	0.145728523	11.71921185	33.70715847	38.5	35	0	0	0.2	33.41333894	0	0	35	13	35	0	0	0											YES	149.6345949	84.77295624	51.82988268	0	160.0849655	0.160084965	0.063164247	49.85564506	0.128067972	0.1444225	0.14329574	0	0.160084965	0.116644727	11.32596964	32.5777723	37.20811919	33.8255629	0	0	0.160084965	26.74486605	0	0	35	13	35	0	0	0											3975	11.9822	0.573369176	3.335535583	0	0.859847606	1.616301869	0.494989851	1.756714101	7.343205228	2.402626925	4.720973999	0	0.016445764	6.212105395	4.237092244	7.379570947	1.374210669	1.56282703	0	0	1.042472509	1.302421676	0	0	0.11794186	0.215119048	0.053736657	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5997	0	NO	11.39006436	11.9822	0.573369176	3.335535583	0	0.859847606	1.616301869	0.494989851	1.756714101	7.343205228	2.402626925	4.720973999	0	0.016445764	6.212105395	4.237092244	7.379570947	1.374210669	1.56282703	0	0	1.042472509	1.302421676	0	0	0.11794186	0.215119048	0.053736657	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5997	NO	"$315 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$315 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-27 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $19 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1504	0.0099	0.0209	0.159	0.0341	0	0.0746	0.0697	0.4367	0.0953	0.2738	0	0.0007	0.3692	0.363	0.5496	0.0882	0.1141	0	0	0.0766	0.0818	0	0	0.0088	0	0.0034	0	0	0											2.9796	0	NO	0.964769948	12.1326	0.583270003	3.356404868	0.158991322	0.893937423	1.616301869	0.569595197	1.826382034	7.779902118	2.497882305	4.994764003	0	0.017097778	6.581332197	4.600067532	7.929192447	1.462386373	1.676936706	0	0	1.119046412	1.384180476	0	0	0.126767442	0.215119048	0.057173777	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5793
H2654_013_0	2012	4																															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	995.7734208	79.72448935	661.0561506	1113.790833	166.587908	5.961902425	7.13086484	305.0699904	44.31007146	14.46948354	33.63265466	0	0.300077793	30.62259251	6058.564181	2412.483978	463.8691624	366.7433467	0	0	17.82136033	1410.80166	357.5549615	0	39.55116252	213.6830865	19.42721468	58.22854414	75.78177419	0											2700	"$190 Days 1-12/$270 Days 1-8/$315 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$19 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.2513739	109.398001	64.93690795	0	200	0.2	0.093481604	63.54270951	0.16	0.203825041	0.183776185	0	0.2	0.145012958	7.451652896	34.82870091	38.5	35	0	0	0.2	34.41897598	0	0	35	13.14958078	10	122.5	0	0											YES	146.598776	77.01083901	45.71240534	0	140.7902125	0.140790213	0.065806474	44.76470765	0.11263217	0.143482854	0.129369441	0	0.140790213	0.102082026	7.069177058	33.04248935	36.52388545	33.20353222	0	0	0.140790213	24.22927471	0	0	35	13.14958078	10	122.5	0	0											2700	12.1649	0.511637485	2.518205559	0	1.95449558	0.839377509	0.469257075	1.138030744	4.990739501	2.076122795	4.351037722	0	0.042248016	3.126016289	3.569088576	6.642873013	1.411858679	1.014764544	0	0	2.509073108	2.848558416	0	0	0.115357557	0.234153584	0.016189346	0.594416388	0	0	0	0	0	0	0	0	0	0	0	0	53.1384	0	NO	17.31084176	12.1649	0.511637485	2.518205559	0	1.95449558	0.839377509	0.469257075	1.138030744	4.990739501	2.076122795	4.351037722	0	0.042248016	3.126016289	3.569088576	6.642873013	1.411858679	1.014764544	0	0	2.509073108	2.848558416	0	0	0.115357557	0.234153584	0.016189346	0.594416388	0	0	0	0	0	0	0	0	0	0	0	0	53.1384	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)"	"$65 (4a, 4a1); $40 (4b)"	35% (9b)	35% (8a1a); $20 (8a2)	"$24 (8b1); 35% (8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"35% (3, 9a); $0 n/c (5); $45/$35 (9c)"	"$0 n/c (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7, 14d, 14e)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												3.1874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.1874	0	NO	0.885410897	15.3523	0.511637485	2.518205559	0	1.95449558	0.839377509	0.469257075	1.138030744	4.990739501	2.076122795	4.351037722	0	0.042248016	3.126016289	3.569088576	6.642873013	1.411858679	1.014764544	0	0	2.509073108	2.848558416	0	0	0.115357557	0.234153584	0.016189346	0.594416388	0	0	0	0	0	0	0	0	0	0	0	0	56.3258
H2654_020_0	2012	3																															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	1174.118738	73.30263339	819.1228387	1132.026502	181.9909228	6.394163854	5.134923138	281.6599659	40.88443546	12.14335996	27.05833207	0	0.291546296	21.8356554	4009.263221	2087.508767	470.1260848	322.2309813	0	0	14.78895218	1229.12732	352.4805075	0	41.79114751	204.6951213	18.23233622	65	135.5834999	0											3800	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $150 (18b2); $100 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	63.01025825	0	200	0.2	0.09932957	62.8399903	0.16	0.103296917	0.182174169	0	0.2	0.144566201	10.94359433	34.74159273	38.5	35	0	0	0.2	34.44086754	0	0	35	13.02666794	15	112.5	0	0											NO	153.5449628	86.98830923	51.75298117	0	164.2684306	0.164268431	0.081583563	51.63543046	0.131414744	0.084842112	0.149627324	0	0.164268431	0.118738315	10.61800592	33.71495588	37.35456702	33.95869729	0	0	0.164268431	28.28773629	0	0	35	13.02666794	15	112.5	0	0												15.0233	0.531372678	3.532670737	0	2.491280273	1.050359261	0.418925323	1.211969465	5.372817639	1.030268306	4.048665826	0	0.047891852	2.592728926	3.547531718	5.865022165	1.463446362	0.911878696	0	0	2.429357964	2.897435792	0	0	0.121890847	0.222207948	0.02279042	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	55.4432	0	NO	9.643100235	15.0233	0.531372678	3.532670737	0	2.491280273	1.050359261	0.418925323	1.211969465	5.372817639	1.030268306	4.048665826	0	0.047891852	2.592728926	3.547531718	5.865022165	1.463446362	0.911878696	0	0	2.429357964	2.897435792	0	0	0.121890847	0.222207948	0.02279042	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	55.4432	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.0233	0.531372678	3.532670737	0	2.491280273	1.050359261	0.418925323	1.211969465	5.372817639	1.030268306	4.048665826	0	0.047891852	2.592728926	3.547531718	5.865022165	1.463446362	0.911878696	0	0	2.429357964	2.897435792	0	0	0.121890847	0.222207948	0.02279042	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	55.4432
H2654_024_0	2012	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	330.254781	5.055	43.99001828	3176.688632	21.31037908	21.86598446	13.92134485	45.56017408	65.34541234	22.59852865	55.00265764	0	0	55.91205761	33.1730824	130.9004005	2.4494	5.086810458	0	768.8763721	26.22555945	10.49742974	265.3857449	963.9	36.2725081	180.7195289	0	0	169.9475905	3108.633514											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.084028403	0.085048991	0.185062905	0	0.224	0.224	0.224	0.119713773	0.224	0.224	0.224	0	0	0.224	0.220390624	0.223825455	0.232374216	0.224	0	0	0.224	0.223360519	0	0	0	0	0	0	0	0											NO	0.067440848	0.068259967	0.14853072	0	0.179781471	0.179781471	0.179781471	0.096093499	0.179781471	0.179781471	0.179781471	0	0	0.179781471	0.176884601	0.179641382	0.186502582	0.179781471	0	0	0.179781471	0.179643024	0	0	0	0	0	0	0	0												22.2727	0.345054136	6.533869099	0	3.831211296	3.931098848	2.502799853	4.378036527	11.74789435	4.06279672	9.888458692	0	0	10.05195196	5.867807429	23.51512883	0.456819424	0.914514266	0	0	4.714869652	1.885790025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9008	150	YES	28.74700524	22.2727	0.345054136	6.533869099	0	3.831211296	3.931098848	2.502799853	4.378036527	11.74789435	4.06279672	9.888458692	0	0	10.05195196	5.867807429	23.51512883	0.456819424	0.914514266	0	0	4.714869652	1.885790025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9008	NO																																										0	0	0	0	0	0	0	0	0	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	22.2727	0.345054136	6.533869099	0	3.831211296	3.931098848	2.502799853	4.378036527	11.74789435	4.06279672	9.888458692	0	0	10.05195196	5.867807429	23.51512883	0.456819424	0.914514266	0	0	4.714869652	1.885790025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9008
H2654_029_0	2012	4																															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	1000.173992	79.57001162	663.9775229	1118.712953	167.3241016	6.014901282	7.194255292	306.4139979	44.70396974	14.59811129	33.9316351	0	0.302745361	30.88961384	6178.839727	2440.265412	396.5817786	368.3640772	0	0	17.97978489	1417.036346	349.5652174	0	42.79069767	198.5714286	17.6381231	65	160.3920985	0											2700	"$190 Days 1-12/$270 Days 1-8/$315 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$19 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.2513739	109.398001	64.78085371	0	200	0.2	0.093481604	63.54268966	0.16	0.202921902	0.183587003	0	0.2	0.14483302	7.338890826	34.75666931	38.5	35	0	0	0.2	34.41897598	0	0	35	13	10	122.5	0	0											YES	146.4677472	76.94200737	45.56179162	0	140.6643754	0.140664375	0.065747657	44.72452309	0.1125315	0.142719413	0.129120755	0	0.140664375	0.101864231	6.961346598	32.97895766	36.51939379	33.1994489	0	0	0.140664375	24.20761879	0	0	35	13	10	122.5	0	0											2700	12.2078	0.510189702	2.521000462	0	1.961378353	0.846082332	0.47300543	1.142018327	5.030604785	2.083433879	4.38127835	0	0.042585487	3.146546769	3.584420409	6.70645081	1.206910512	1.019123696	0	0	2.52911521	2.858589639	0	0	0.124806202	0.215119048	0.014698436	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	53.2687	0	NO	17.43600481	12.2078	0.510189702	2.521000462	0	1.961378353	0.846082332	0.47300543	1.142018327	5.030604785	2.083433879	4.38127835	0	0.042585487	3.146546769	3.584420409	6.70645081	1.206910512	1.019123696	0	0	2.52911521	2.858589639	0	0	0.124806202	0.215119048	0.014698436	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	53.2687	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)"	"$65 (4a, 4a1); $40 (4b)"	35% (9b)	35% (8a1a); $20 (8a2)	"$24 (8b1); 35% (8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"35% (3, 9a); $0 n/c (5); $45/$35 (9c)"	"$0 n/c (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7, 14d, 14e)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												3.1975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.1975	0	NO	0.893289613	15.4053	0.510189702	2.521000462	0	1.961378353	0.846082332	0.47300543	1.142018327	5.030604785	2.083433879	4.38127835	0	0.042585487	3.146546769	3.584420409	6.70645081	1.206910512	1.019123696	0	0	2.52911521	2.858589639	0	0	0.124806202	0.215119048	0.014698436	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	56.4662
H2654_031_0	2012	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	324.7354943	5.0441	48.19185454	2934.712397	18.38852022	25.73472583	14.96083731	47.05785369	83.58891764	22.72185231	56.72840203	0	0.064207083	53.09420308	31.65524688	99.6765899	2.4348	7.39899393	0	0	18.41329343	9.342544843	349.5652174	963.9	42.79069767	204.7619048	0	0	160.3920985	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.084039071	0.085059789	0.184895105	0	0.224	0.224	0.224	0.110124375	0.224	0.224	0.224	0	0.224	0.224	0.22024208	0.223770779	0.23297554	0.224	0	0	0.224	0.223257508	0	0	0	0	0	0	0	0											NO	0.06736353	0.068181711	0.1482071	0	0.179552565	0.179552565	0.179552565	0.088283864	0.179552565	0.179552565	0.179552565	0	0.179552565	0.179552565	0.176540314	0.179368828	0.186747125	0.179552565	0	0	0.179552565	0.17948278	0	0	0	0	0	0	0	0												21.8753	0.343915369	7.14237501	0	3.30170598	4.620736044	2.686256721	4.154449166	15.00860461	4.079766875	10.18573012	0	0.011528546	9.533200374	5.588427238	17.87887307	0.454691899	1.328508342	0	0	3.306154074	1.676825917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1771	150	YES	28.00970852	21.8753	0.343915369	7.14237501	0	3.30170598	4.620736044	2.686256721	4.154449166	15.00860461	4.079766875	10.18573012	0	0.011528546	9.533200374	5.588427238	17.87887307	0.454691899	1.328508342	0	0	3.306154074	1.676825917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1771	NO																																										0	0	0	0	0	0	0	0	0	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	21.8753	0.343915369	7.14237501	0	3.30170598	4.620736044	2.686256721	4.154449166	15.00860461	4.079766875	10.18573012	0	0.011528546	9.533200374	5.588427238	17.87887307	0.454691899	1.328508342	0	0	3.306154074	1.676825917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1771
H2654_801_0	2012	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	217.5973976	4.9688	27.15169671	1332.697015	6.887056133	7.106395943	8.549526696	14.8325651	66.36651178	18.51194337	46.99982728	0	0.499295425	37.89941849	110.1098013	118.359059	2.3006	11.07333383	0	0	30.34459184	13.209624	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	$0 n/c (8a1a); Medicare FFS (8a2)	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.085059789	0.085059789	0.184895105	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066984362	0.066984362	0.145604414	0	0.176399417	0.176399417	0.176399417	0.176399417	0.176399417	0.176399417	0.176399417	0	0.176399417	0.176399417	0.176399417	0.176399417	0.176399417	0.176399417	0	0	0.176399417	0.176399417	0	0	0	0	0	0	0	0												14.5756	0.332831899	3.953406888	0	1.214872688	1.253564102	1.508131526	2.616455838	11.707014	3.26549602	8.290742137	0	0.088075422	6.685435331	19.42330476	20.87846901	0.405824499	1.953329633	0	0	5.352768314	2.330169973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8355	150	YES	28.55923382	14.5756	0.332831899	3.953406888	0	1.214872688	1.253564102	1.508131526	2.616455838	11.707014	3.26549602	8.290742137	0	0.088075422	6.685435331	19.42330476	20.87846901	0.405824499	1.953329633	0	0	5.352768314	2.330169973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8355	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	NO	0	14.5756	0.332831899	3.953406888	0	1.214872688	1.253564102	1.508131526	2.616455838	11.707014	3.26549602	8.290742137	0	0.088075422	6.685435331	19.42330476	20.87846901	0.405824499	1.953329633	0	0	5.352768314	2.330169973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8355
H2654_802_0	2012	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	287.0383789	4.9595	41.02099358	1566.113201	9.627676963	8.635099644	6.358997621	16.8676022	66.81271617	18.9333943	46.74421222	0	0.609901138	53.46363977	101.1812361	119.4789301	2.2879	9.129050072	0	0	36.07051315	6.547339177	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.085054914	0.085054914	0.184970893	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065232441	0.065232441	0.141862501	0	0.171795679	0.171795679	0.171795679	0.171795679	0.171795679	0.171795679	0.171795679	0	0.171795679	0.171795679	0.171795679	0.171795679	0.171795679	0.171795679	0	0	0.171795679	0.171795679	0	0	0	0	0	0	0	0												18.7242	0.323520291	5.819340734	0	1.653993305	1.48347281	1.092448317	2.89778118	11.47813597	3.252675337	8.030453696	0	0.10477838	9.184822318	17.3824992	20.52596397	0.393051335	1.568331359	0	0	6.196758313	1.124804582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.237	150	YES	33.80209788	18.7242	0.323520291	5.819340734	0	1.653993305	1.48347281	1.092448317	2.89778118	11.47813597	3.252675337	8.030453696	0	0.10477838	9.184822318	17.3824992	20.52596397	0.393051335	1.568331359	0	0	6.196758313	1.124804582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.237	NO																																										0	0	0	0	0	0	0	0	0	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	18.7242	0.323520291	5.819340734	0	1.653993305	1.48347281	1.092448317	2.89778118	11.47813597	3.252675337	8.030453696	0	0.10477838	9.184822318	17.3824992	20.52596397	0.393051335	1.568331359	0	0	6.196758313	1.124804582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.237
H2654_803_0	2012	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	170.9305608	4.9983	20.95244516	1403.561168	4.134442534	11.37125567	8.420978829	24.17211891	62.82374941	17.75273068	37.4958131	0	0.069970245	60.59790598	24.12395615	58.11176245	2.3488	5.790824887	0	0	8.251336713	7.264531413	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072453305	0.072453305	0.172022137	0	0.193113772	0.193113772	0.193113772	0.193113772	0.193113772	0.193113772	0.193113772	0	0.193113772	0.193113772	0.193113772	0.193113772	0.193113772	0.193113772	0	0	0.193113772	0.193113772	0	0	0	0	0	0	0	0												12.3845	0.362143353	3.604284393	0	0.798417795	2.19594608	1.626206989	4.667969072	12.13213125	3.428296793	7.24095792	0	0.013512218	11.70229023	4.658668179	11.22218167	0.453585629	1.11828804	0	0	1.593446761	1.402881066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6057	150	YES	12.89191182	12.3845	0.362143353	3.604284393	0	0.798417795	2.19594608	1.626206989	4.667969072	12.13213125	3.428296793	7.24095792	0	0.013512218	11.70229023	4.658668179	11.22218167	0.453585629	1.11828804	0	0	1.593446761	1.402881066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6057	NO																																										0	0	0	0	0	0	0	0	0	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	12.3845	0.362143353	3.604284393	0	0.798417795	2.19594608	1.626206989	4.667969072	12.13213125	3.428296793	7.24095792	0	0.013512218	11.70229023	4.658668179	11.22218167	0.453585629	1.11828804	0	0	1.593446761	1.402881066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6057
H2654_804_0	2012	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	166.670754	5.0003	20.43028359	1387.511376	4.030269349	11.08474064	8.208800239	23.54483403	61.19342529	17.2920338	36.52276821	0	0.068154464	59.02551269	23.51611862	56.64755359	2.3517	5.644916782	0	0	8.043432498	7.081491168	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072842922	0.072842922	0.172947184	0	0.19415224	0.19415224	0.19415224	0.19415224	0.19415224	0.19415224	0.19415224	0	0.19415224	0.19415224	0.19415224	0.19415224	0.19415224	0.19415224	0	0	0.19415224	0.19415224	0	0	0	0	0	0	0	0												12.1408	0.364236461	3.533360022	0	0.782485821	2.152127222	1.593756952	4.571282261	11.88084058	3.357287092	7.090977249	0	0.013232342	11.45993549	4.565707099	10.9982494	0.456587822	1.095973236	0	0	1.561650435	1.374887371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9934	150	YES	12.1439491	12.1408	0.364236461	3.533360022	0	0.782485821	2.152127222	1.593756952	4.571282261	11.88084058	3.357287092	7.090977249	0	0.013232342	11.45993549	4.565707099	10.9982494	0.456587822	1.095973236	0	0	1.561650435	1.374887371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9934	NO																																										0	0	0	0	0	0	0	0	0	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	12.1408	0.364236461	3.533360022	0	0.782485821	2.152127222	1.593756952	4.571282261	11.88084058	3.357287092	7.090977249	0	0.013232342	11.45993549	4.565707099	10.9982494	0.456587822	1.095973236	0	0	1.561650435	1.374887371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9934
H2654_805_0	2012	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	217.8330734	4.9703	27.18110422	1335.279393	6.921951799	7.14240297	8.592845848	13.66550003	61.1446208	17.05537517	43.30175776	0	0.460009553	34.91849453	110.6677109	118.9587663	2.3032	11.12944073	0	0	30.49834328	13.27655515	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.085015265	0.085015265	0.185585159	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067306758	0.067306758	0.146928147	0	0.177341255	0.177341255	0.177341255	0.177341255	0.177341255	0.177341255	0.177341255	0	0.177341255	0.177341255	0.177341255	0.177341255	0.177341255	0.177341255	0	0	0.177341255	0.177341255	0	0	0	0	0	0	0	0												14.6616	0.334534779	3.993669277	0	1.227547619	1.266642706	1.523866067	2.423456925	10.84346379	3.024621638	7.679188064	0	0.081578671	6.192489642	19.62595073	21.09629691	0.408452378	1.973708986	0	0	5.408614471	2.354480953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1202	150	YES	27.39417816	14.6616	0.334534779	3.993669277	0	1.227547619	1.266642706	1.523866067	2.423456925	10.84346379	3.024621638	7.679188064	0	0.081578671	6.192489642	19.62595073	21.09629691	0.408452378	1.973708986	0	0	5.408614471	2.354480953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1202	NO																																										0	0	0	0	0	0	0	0	0	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	14.6616	0.334534779	3.993669277	0	1.227547619	1.266642706	1.523866067	2.423456925	10.84346379	3.024621638	7.679188064	0	0.081578671	6.192489642	19.62595073	21.09629691	0.408452378	1.973708986	0	0	5.408614471	2.354480953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1202
H2654_807_0	2012	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	171.361408	4.9984	21.00525785	1407.098982	4.144863801	11.39991803	8.442204731	24.23304711	62.98210283	17.79747817	37.59032497	0	0.070146612	60.74961315	24.18476295	58.25823884	2.3474	5.805421229	0	0	8.272135016	7.282842377	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072415944	0.072415944	0.171933433	0	0.193014192	0.193014192	0.193014192	0.193014192	0.193014192	0.193014192	0.193014192	0	0.193014192	0.193014192	0.193014192	0.193014192	0.193014192	0.193014192	0	0	0.193014192	0.193014192	0	0	0	0	0	0	0	0												12.4093	0.361963853	3.61150609	0	0.800017539	2.200345971	1.629465327	4.677322013	12.1564397	3.435165874	7.255466211	0	0.013539292	11.72553751	4.668002485	11.24466691	0.453081515	1.120528689	0	0	1.596639458	1.405691939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7647	150	YES	12.96567247	12.4093	0.361963853	3.61150609	0	0.800017539	2.200345971	1.629465327	4.677322013	12.1564397	3.435165874	7.255466211	0	0.013539292	11.72553751	4.668002485	11.24466691	0.453081515	1.120528689	0	0	1.596639458	1.405691939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7647	NO																																										0	0	0	0	0	0	0	0	0	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	12.4093	0.361963853	3.61150609	0	0.800017539	2.200345971	1.629465327	4.677322013	12.1564397	3.435165874	7.255466211	0	0.013539292	11.72553751	4.668002485	11.24466691	0.453081515	1.120528689	0	0	1.596639458	1.405691939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7647
H2663_002_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	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	2046.159533	40.86128112	1923.00105	0	432.9430434	26.24816015	19.49868789	280.4011675	45.9177255	15.23657644	47.391972	2.583345548	0.290011827	31.69757798	4243.36552	183.3241613	160.8827539	9.719428207	16.20264491	2453.48637	38.32271235	0	0	0	0	47.64396168	8.365422268	0	0	0											2675	1a $220 days 1-10	1b $175 days 1-10	"2 $0/day days 1-15, $100/day days 16 - 41"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	8a 0%	"8a Ther. 20%. 8b. CT  20%, Other 20%. 8b X-rays $15"	5 $30	12 20%	"3 0%, 4a $65 , 9d 0%, 14b $0"	"7a PCP $10, UC $35, 14a $0, 14c - 14e 0%"	"17a $25, 17b $15, 18a $25, 7b $20, 7d $25, 7f$25, 14c - 14e 0%"	"7e Ind. $30, Grp. $20, 7h Ind. $30, Grp. $20, 9c Ind. $30, Grp. $20"	"7c 20%, 7i 20%"	"8a 20%, 8b X-ray $15, Other 20%"	7g $25	15 20%		10b $0	16a $0	17a $0	17b $15	18a $25		14a $0													NO	195.2233364	175	29.31870142	0	150	0.2	0.2	59.45124082	0.2	0.093837449	0.19547621	0.2	0.2	0.178234557	9.508749012	0.062112001	29.85996992	0.2	0.272198116	21.58885764	0.194332472	0	0	0	0	15	25	0	0	0											NO	133.5309064	119.6983365	20.05371308	0	102.5985742	0.136798099	0.136798099	40.68151092	0.136798099	0.064183923	0.13370387	0.136798099	0.136798099	0.121910743	6.503893938	0.042484018	20.42393559	0.136798099	0.186180924	14.76657341	0.132921564	0	0	0	0	15	25	0	0	0												22.7688	0.407585615	3.213609275	0	3.701611578	3.590698407	2.667383434	0.950595263	6.281457552	0.977943249	6.33649005	0.35339676	0.039673067	3.864275274	2.299866607	7.788346978	0.273821584	1.329599301	3.016623394	3.019132215	5.093914851	0	0	0	0	0.059554952	0.017427963	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0518	0	NO	36.0244434	22.7688	0.407585615	3.213609275	0	3.701611578	3.590698407	2.667383434	0.950595263	6.281457552	0.977943249	6.33649005	0.35339676	0.039673067	3.864275274	2.299866607	7.788346978	0.273821584	1.329599301	3.016623394	3.019132215	5.093914851	0	0	0	0	0.059554952	0.017427963	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0518	NO	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3																					1.0698	0.0033	0.181	0.0701	0.0442	0.0795	0.0549	0.0307	0.1389	0.044	0.0774	0.0078	0.0009	0.0946	0.0793	0.5337	0.0002	0.0293	0.0433	0.0246	0.1143	0	0	0	0.0001	0	0.0003	0	0	0											2.7218	0	NO	0	23.8386	0.410857601	3.394622348	0.070052662	3.745764311	3.670238286	2.722244231	0.981273349	6.420355657	1.021932991	6.413845888	0.361193464	0.04055189	3.958826346	2.379154539	8.322058724	0.274034237	1.358880339	3.059948681	3.043702781	5.208178911	0	0	0	6.82E-05	0.059554952	0.017723237	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7736
H2663_005_0	2012	6																															D	D	D	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	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	1491.344862	77.84053062	1006.860556	0	270.3810151	16.42323592	12.36328647	315.5037595	40.47832038	7.709466604	35.3193132	2.779336822	0.011082486	16.16968624	3321.436834	141.0827404	219.01018	9.305987254	14.60175295	2104.33114	20.92251315	0	0	0.220703625	0	45.21084223	2.910298592	0	0	0											2700	1a $220 days 1-10	1b $175 days 1-10	"2 $0 days 1-15, $75 Days 16 to 51"	6 $0	10a $100	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	8a $0	"8a Ther. 20% , CT  20%, Other 20%, 8b X-ray $15"	5 $30	12 20%	"3 0%, 4a $65 , 9d $0, 14b $0"	"7a PCP $10, UC $35, 14a $0, 14c - 14e 0%"	"17a $30, 17b $15, 18a $30, 7b $20, 7d $30, 7f $30, 14c - 14e 0%"	"7e Ind. $30, Grp. $20, 7h Ind. $30, Grp. $20, 9c Ind. $30, Grp. $20"	"7c 20%, 7i 20%"	"8a 20%, 8b X-ray $15, Other 20%"	7g $30	15 20%		10b $0	16a $0	17a 0%	17b $15	18a $30		14a $0													NO	194.7168759	175	20.46155428	0	100	0.073307209	0.2	59.82099331	0.2	0.11896373	0.18808275	0.2	0.2	0.189996587	9.183587258	0.059541452	29.95392535	0.2	0.256769069	26.17677584	0.225511016	0	0	30	0	15	30	0	0	0											NO	142.6725107	128.2256058	14.99254396	0	73.27177474	0.053713493	0.146543549	43.84433459	0.146543549	0.087166836	0.137811569	0.146543549	0.146543549	0.139213871	6.728977369	0.043627079	21.94777271	0.146543549	0.188139254	19.18018823	0.165235924	0	0	30	0	15	30	0	0	0												17.7312	0.831762433	1.257950096	0	1.650941403	0.882149364	1.811759883	1.152754366	5.931836745	0.672009813	4.867409963	0.407293883	0.001624067	2.25104462	1.862489441	6.155027847	0.400565471	1.363732404	2.747162907	3.363455614	3.457150783	0	0	0.000551759	0	0.056513553	0.007275746	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8636	0	NO	21.44847375	17.7312	0.831762433	1.257950096	0	1.650941403	0.882149364	1.811759883	1.152754366	5.931836745	0.672009813	4.867409963	0.407293883	0.001624067	2.25104462	1.862489441	6.155027847	0.400565471	1.363732404	2.747162907	3.363455614	3.457150783	0	0	0.000551759	0	0.056513553	0.007275746	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8636	NO																																										0	0	0	0	0	0	0	0	0	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	17.7312	0.831762433	1.257950096	0	1.650941403	0.882149364	1.811759883	1.152754366	5.931836745	0.672009813	4.867409963	0.407293883	0.001624067	2.25104462	1.862489441	6.155027847	0.400565471	1.363732404	2.747162907	3.363455614	3.457150783	0	0	0.000551759	0	0.056513553	0.007275746	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8636
H2663_006_0	2012	6																															D	D	D	V	T	COIN	COIN	V	COIN	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	1421.36979	73.28598985	841.1105979	0	271.3996441	25.17630612	13.49243152	375.8219028	42.78262462	9.943756996	42.09265083	1.74635557	0.465078672	24.03514928	3406.22518	15152.44568	235.4137502	7.798448654	13.67685199	1770.746695	20.98129622	0	0	0	0	47.81292857	6.319711615	0	0	0											3350	1a $220 days 1-10	1b $175 days 1-10	"2 $0 days 1-7, $100 Days 8 to 40"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	8a $0	"8a Ther. 20% , CT  20%, Other 20%, 8b X-ray $15"	5 $40	12 20%	"3 0%, 4a $65 , 9d $0, 14b $0"	"7a PCP $20, UC $35, 14a $0, 14c - 14e 0%"	"17a $45, 17b $15, 18a $45, 7b $20, 7d $45, 7f $45, 14c - 14e 0%"	"7e Ind. $40, Grp. $30, 7h Ind. $40, Grp. $30, 9c Ind. $40, Grp. $30"	"7c 20%, 7i 20%"	"8a 20%, 8b X-ray $15, Other 20%"	7g $45	15 20%		10b $0	16a $0	17a $0	17b $15	18a $45		14a $0													NO	194.1425339	175	57.82735209	0	150	0.053483288	0.2	59.67736914	0.2	0.123508058	0.194343965	0.2	0.2	0.192400955	18.87405149	11.93070562	39.96914476	0.2	0.266259711	38.66913694	0.222328204	0	0	0	0	15	38.66519556	0	0	0											NO	140.0125957	126.207296	41.70419282	0	108.1776823	0.038571321	0.14423691	43.04983089	0.14423691	0.089072103	0.140157865	0.14423691	0.14423691	0.138756596	13.61167431	8.60424055	28.82512963	0.14423691	0.19202239	27.88758407	0.160339666	0	0	0	0	15	38.66519556	0	0	0												16.5841	0.770768885	2.923153213	0	2.446615373	0.971083391	1.946106628	1.34825578	6.170833567	0.885711347	5.89961606	0.251888931	0.06708151	3.335035502	3.863702314	10.86460729	0.565485989	1.124824135	2.626261804	4.115153945	3.364134025	0	0	0	0	0.059766161	0.02036274	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2046	0	NO	27.11015461	16.5841	0.770768885	2.923153213	0	2.446615373	0.971083391	1.946106628	1.34825578	6.170833567	0.885711347	5.89961606	0.251888931	0.06708151	3.335035502	3.863702314	10.86460729	0.565485989	1.124824135	2.626261804	4.115153945	3.364134025	0	0	0	0	0.059766161	0.02036274	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2046	NO																																										0	0	0	0	0	0	0	0	0	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	16.5841	0.770768885	2.923153213	0	2.446615373	0.971083391	1.946106628	1.34825578	6.170833567	0.885711347	5.89961606	0.251888931	0.06708151	3.335035502	3.863702314	10.86460729	0.565485989	1.124824135	2.626261804	4.115153945	3.364134025	0	0	0	0	0.059766161	0.02036274	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2046
H2663_802_0	2012	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	306.0503818	2.837563016	32.83828227	0	8.697754917	27.26626319	13.99085473	8.426259694	43.72414036	15.78933149	43.46790668	2.116419957	0.65187718	26.07790666	34.92080602	169.4381173	1.546992962	10.84230945	15.88940993	10.50299682	41.71509679	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.5%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.085091188	0.085091188	0.184917202	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069145884	0.069145884	0.150265425	0	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0.182024467	0	0	0	0	0	0	0	0	0												21.1621	0.196205804	4.934458433	0	1.583204201	4.963127019	2.546677873	1.533785428	7.958863334	2.874044646	7.912222535	0.385240214	0.118657596	4.746817055	6.356441096	30.84188295	0.281590569	1.973565597	2.89226137	1.911802396	7.59316825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7661	0	NO	26.00430023	21.1621	0.196205804	4.934458433	0	1.583204201	4.963127019	2.546677873	1.533785428	7.958863334	2.874044646	7.912222535	0.385240214	0.118657596	4.746817055	6.356441096	30.84188295	0.281590569	1.973565597	2.89226137	1.911802396	7.59316825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7661	NO																																										0	0	0	0	0	0	0	0	0	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	21.1621	0.196205804	4.934458433	0	1.583204201	4.963127019	2.546677873	1.533785428	7.958863334	2.874044646	7.912222535	0.385240214	0.118657596	4.746817055	6.356441096	30.84188295	0.281590569	1.973565597	2.89226137	1.911802396	7.59316825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7661
H2663_804_0	2012	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	300.54663	2.127082802	26.67064481	0	6.63363383	19.96128323	14.45478313	6.839219409	40.7412709	11.82868276	35.36692167	2.252630913	0.328977345	25.18487281	33.60887847	163.3458621	1.592803837	8.459107894	17.1355168	9.19123857	26.94247825	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.5%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.085090647	0.085090647	0.184917296	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071076409	0.071076409	0.154461833	0	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0.187107704	0	0	0	0	0	0	0	0	0												21.3618	0.151185407	4.119596695	0	1.241203992	3.734909866	2.704601277	1.279670638	7.623005639	2.213237668	6.617423497	0.421484597	0.061554196	4.712283716	6.28848007	30.56326914	0.298025868	1.582764252	3.206187198	1.719751542	5.041145234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9416	0	NO	20.69147823	21.3618	0.151185407	4.119596695	0	1.241203992	3.734909866	2.704601277	1.279670638	7.623005639	2.213237668	6.617423497	0.421484597	0.061554196	4.712283716	6.28848007	30.56326914	0.298025868	1.582764252	3.206187198	1.719751542	5.041145234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9416	NO																																										0	0	0	0	0	0	0	0	0	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	21.3618	0.151185407	4.119596695	0	1.241203992	3.734909866	2.704601277	1.279670638	7.623005639	2.213237668	6.617423497	0.421484597	0.061554196	4.712283716	6.28848007	30.56326914	0.298025868	1.582764252	3.206187198	1.719751542	5.041145234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9416
H2663_805_0	2012	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	367.0210825	3.277600313	38.12681973	0	10.08288376	31.61122963	17.16931715	9.784243484	52.37501316	18.18658936	51.48600404	2.568865604	0.713683836	32.51520758	41.89471294	203.4843528	1.872330738	12.47329553	20.63226529	12.5454925	47.82734535	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.5%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.085103512	0.085103512	0.184888841	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.065410988	0.065410988	0.142106494	0	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0.172167527	0	0	0	0	0	0	0	0	0												24.0072	0.214391075	5.418068671	0	1.735945166	5.442427246	2.955998882	1.684529009	9.017276518	3.131140124	8.864218015	0.44227524	0.122873181	5.598062893	7.212909141	35.03339789	0.322354554	2.14749645	3.552206101	2.159926425	8.234315794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.297	0	NO	38.32383259	24.0072	0.214391075	5.418068671	0	1.735945166	5.442427246	2.955998882	1.684529009	9.017276518	3.131140124	8.864218015	0.44227524	0.122873181	5.598062893	7.212909141	35.03339789	0.322354554	2.14749645	3.552206101	2.159926425	8.234315794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.297	NO																																										0	0	0	0	0	0	0	0	0	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	24.0072	0.214391075	5.418068671	0	1.735945166	5.442427246	2.955998882	1.684529009	9.017276518	3.131140124	8.864218015	0.44227524	0.122873181	5.598062893	7.212909141	35.03339789	0.322354554	2.14749645	3.552206101	2.159926425	8.234315794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.297
H2667_001_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	V	V	COIN	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	1302.123601	34.2026556	955.8102465	0	213.9782074	9.191389996	29.29435064	318.2875921	539.0114874	0	43.74579236	6.618289734	0	27.3721565	4564.989745	123.8301251	0	1230.341339	9.043768386	2099.378782	8.031593331	0	0	418.468382	0	0	0	0	0	0											3100	1a $150 days 1-5	1b $150 days 1-5	"2 $0 days 1-30, $100 Days 31 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $65, 4b $15"	"9a $125, 9b $125"	8a 0% 14a $0	"8b X-Ray $0, Ther. 20% , CT  $125, Other $125 14a $0"	"7e $30, 7h $30, 9c $30"	12 0%	"3 $0, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $30 , 7f $10, 17a $30, 18a $10"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b X-Ray $0, Ther. 20% , CT  $125, Other $125 14a $0"	"7g $30, 14a $0"	15 20%			16a $0	17a $0	17b $0			14c $0													NO	104.1439633	97.08222812	0.42720999	0	150	0.2	0.2	65	125	0	0.229506735	30	0	0.026435611	9.113044629	0.074425743	0	30	0.131053562	22.18329617	0.2	0	0	30	0	0	0	0	0	0											YES	92.33933063	86.07803733	0.378786089	0	132.9976233	0.177330164	0.177330164	57.63230341	110.8313527	0	0.203492335	26.59952465	0	0.023439156	8.080088508	0.065989646	0	26.59952465	0.116198748	19.66883777	0.177330164	0	0	26.59952465	0	0	0	0	0	0											10000	10.0198	0.245341455	0.030170635	0	2.371549418	1.629910699	5.194772014	1.528637257	4.978281023	0	8.901933426	0.01467028	0	0.641580249	3.073793432	8.171506137	0	2.727207897	1.050874567	3.441028391	1.424243765	0	0	0.927588337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3729	0	NO	7.206689392	10.0198	0.245341455	0.030170635	0	2.371549418	1.629910699	5.194772014	1.528637257	4.978281023	0	8.901933426	0.01467028	0	0.641580249	3.073793432	8.171506137	0	2.727207897	1.050874567	3.441028391	1.424243765	0	0	0.927588337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3729	NO																																										0	0	0	0	0	0	0	0	0	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	10.0198	0.245341455	0.030170635	0	2.371549418	1.629910699	5.194772014	1.528637257	4.978281023	0	8.901933426	0.01467028	0	0.641580249	3.073793432	8.171506137	0	2.727207897	1.050874567	3.441028391	1.424243765	0	0	0.927588337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3729
H2667_003_0	2012	8																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	V	COIN	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	2477.107138	56.59681634	1808.648238	0	357.2240234	9.505558292	11.54742641	453.8864961	73.52820238	17.32963053	42.08766308	61.82633337	0.092615635	26.59781437	4333.916013	207.4722446	0	1880.014666	14.35994462	2386.431958	67.1056941	0	0	0	0	111.5240112	0	0	0	0											4450	1a $175 days 1-10	1b $140 days 1-10	"2 $50 days 1-20, $100 Days 21 to 55, $0 Days 56 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	8a 0% 14a $0	"8b X-Ray 20%, Ther. 20% , CT  20%, Other 20% 14a $0"	5 0%	12 20%	"3 $0, 14b $0"	"7a $20, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a 0%, 18a $40"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b X-Ray 20%, Ther. 20% , CT  20%, Other 20% 14a $0"	"7g $40, 14a $0"	15 20%				17a 0%	17b $15			14c $0													NO	151.0463915	99.66709347	54.50515002	0	150	0.2	0.2	65	0.2	0.052505775	0.189155911	30	0.2	0.106223125	18.93956044	0.098529375	0	30	0.298671163	34.41875935	0.230370001	0	0	0	0	15	0	0	0	0											NO	112.5599	74.27200323	40.61728438	0	111.7801282	0.149040171	0.149040171	48.4472004	0.149040171	0.039127348	0.140959147	22.35602564	0.149040171	0.079157564	14.11377663	0.073424175	0	22.35602564	0.222570006	25.64888889	0.171671922	0	0	0	0	11.17801282	0	0	0	0												23.2352	0.350296577	6.121864986	0	3.327545594	1.416710033	1.721030406	1.832460836	10.95865585	0.678062489	5.932641075	0.115182591	0.01380345	2.105418187	5.097326877	15.23347835	0	3.50247134	3.196092964	5.100777345	11.52016346	0	0	0	0	0.103884736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5631	0	NO	34.72600433	23.2352	0.350296577	6.121864986	0	3.327545594	1.416710033	1.721030406	1.832460836	10.95865585	0.678062489	5.932641075	0.115182591	0.01380345	2.105418187	5.097326877	15.23347835	0	3.50247134	3.196092964	5.100777345	11.52016346	0	0	0	0	0.103884736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5631	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	23.2352	0.350296577	6.121864986	0	3.327545594	1.416710033	1.721030406	1.832460836	10.95865585	0.678062489	5.932641075	0.115182591	0.01380345	2.105418187	5.097326877	15.23347835	0	3.50247134	3.196092964	5.100777345	11.52016346	0	0	0	0	0.103884736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5631
H2667_012_0	2012	3																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	V	V	COIN	COIN	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	1244.353003	38.7928888	758.2848538	0	219.3538689	7.794849228	27.73072098	337.67654	419.1400093	0	35.96362308	0	0	19.63179335	3816.776742	113.5772815	0	981.3998663	6.749378734	1624.096727	5.935554975	0	0	307.9229069	161.744234	0	0	0	0	0											3100	1a $150 days 1-5	1b $150 days 1-5	"2 $0 days 1-30, $100 Days 31 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $65, 4b $15"	"9a $125, 9b $125"	8a 0% 14a $0	"8b X-Ray $0, Ther. 20% , CT  $125, Other $125 14a $0"	"7e $30, 7h $30, 9c $30"	12 0%	"3 $0, 13a $0, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $30 , 7f $10, 17a $30, 18a $10"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b X-Ray $0, Ther. 20% , CT  $125, Other $125 14a $0"	"7g $30, 14a $0"	15 20%			16a $0	17a $30	17b $0			14c $0													NO	104.1439633	97.08222812	0.42720999	0	150	0.2	0.2	65	125	0	0.242831203	0	0	0.00103928	9.161972834	0.070543709	0	30	0.119141244	21.81748062	0.2	0	0	30	30	0	0	0	0	0											NO	95.09362689	88.64557183	0.390084515	0	136.9646745	0.182619566	0.182619566	59.35135895	114.1372288	0	0.221728645	0	0	0.000948964	8.365777513	0.064413308	0	27.3929349	0.108787611	19.92149421	0.182619566	0	0	27.3929349	27.3929349	0	0	0	0	0												9.8608	0.286568151	0.024649598	0	2.503644271	1.423491983	5.06417223	1.670130128	3.98662326	0	7.974165405	0	0	0.018629873	2.660858753	7.31588837	0	2.240285221	0.734248791	2.696202795	1.083948474	0	0	0.702909345	0.369220773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6165	0	NO	4.817316713	9.8608	0.286568151	0.024649598	0	2.503644271	1.423491983	5.06417223	1.670130128	3.98662326	0	7.974165405	0	0	0.018629873	2.660858753	7.31588837	0	2.240285221	0.734248791	2.696202795	1.083948474	0	0	0.702909345	0.369220773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6165	NO																																										0.576	0.0317	0.0903	0	0.1369	0	0	0.024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.8589	0	NO	0	10.4368	0.318282057	0.114928297	0	2.640586581	1.423491983	5.06417223	1.694096876	3.98662326	0	7.974165405	0	0	0.018629873	2.660858753	7.31588837	0	2.240285221	0.734248791	2.696202795	1.083948474	0	0	0.702909345	0.369220773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4753
H2667_016_0	2012	8																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	O	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	1429.75059	74.13935637	905.7912561	0	251.0506719	14.92064963	11.64202815	300.1604239	387.4491889	8.934165884	33.25511836	19.38832225	0.009616548	16.8440958	3536.493426	14557.34761	201.8458703	9.492211005	14.13255514	2162.657653	19.0882191	0	0	0	0	44.54498584	2.919971322	0	0	0											2660	1a $220 days 1-10	1b $175 days 1-10	"2 $0 days 1-10, $100 Days 11 to 37, $0 Days 38 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a $175, 9b $175"	8a $0 14a $0	"8b X-Ray $15, Ther. 20% , CT  20%, Other 20% 14a $0"	5 $30	12 20%	"3 20%, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $30 , 7f $30, 17a $30 $, 18a $30"	"7e $20, 7h $20, 9c $20"	"7c 20%, 7i 20%"	"8b X-Ray $15, Ther. 20% , CT  20%, Other 20% 14a $0"	"7g $30, 14a $0"	15 20%		10b $0	16a $0	17a $0	17b $15	18a $0		14c $0													NO	193.5777965	175	42.3797881	0	150	0.066623686	0.2	59.6325784	175	0.095032281	0.187944056	20.1158707	0.059000553	0.190850347	4.598634215	8.283505059	29.97607656	0.2	0.26178294	26.07929742	0.224886715	0	0	0	0	15	30	0	0	0											NO	143.5327794	129.7578382	31.42348394	0	111.2210042	0.049399689	0.148294672	44.21596835	129.7578382	0.070463905	0.139355511	14.91538226	0.043747338	0.141510448	3.409764769	6.14199834	22.22646224	0.148294672	0.194105076	19.33710432	0.166747508	0	0	0	0	11.12210042	22.24420084	0	0	0												17.1013	0.801680218	2.371926416	0	2.32684232	0.737075446	1.72645075	1.105990317	4.189547432	0.629536217	4.634284	0.024098686	0.000420698	2.383615549	1.004884224	7.450933738	0.373859968	1.40764432	2.743200696	3.484961387	3.182912974	0	0	0	0	0.04128615	0.005412702	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7279	0	NO	20.12776416	17.1013	0.801680218	2.371926416	0	2.32684232	0.737075446	1.72645075	1.105990317	4.189547432	0.629536217	4.634284	0.024098686	0.000420698	2.383615549	1.004884224	7.450933738	0.373859968	1.40764432	2.743200696	3.484961387	3.182912974	0	0	0	0	0.04128615	0.005412702	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7279	NO	0.3	0.3	0.3	0.3	10a $150	0.3	0.3	"4a $65, 4b $35"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3								$50/visit													0.6789	0.0025	0.0711	0.0443	0.0225	0	0.0219	0.0279	0.0982	0.0169	0.0362	0	0	0.0165	0.0273	0.0941	0	0.0199	0	0	0.0481	0	0	0	0	0	0	0	0	0											1.2263	0	NO	0	17.7802	0.804183706	2.443059242	0.044313798	2.349379569	0.737075446	1.748300924	1.133881949	4.287736314	0.646475442	4.670480748	0.024098686	0.000420698	2.400084781	1.032183932	7.545025658	0.373859968	1.427550473	2.743200696	3.484961387	3.23097695	0	0	5.82E-06	0	0.04128615	0.005412702	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9542
H2667_017_0	2012	6																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	COIN	COIN	COIN	V	T	V	COIN	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	977.0661589	31.12642775	711.9502247	0	131.3743131	9.929768468	6.363886539	410.8040226	394.6946459	0	28.01711426	4.647104328	0	26.4474556	3047.201729	98.3905022	114.8186865	5.702417252	7.399670712	0	5.680873529	0	0	0	0	0	0	0	0	0											2900	1a $220 days 1-9	1b $220 days 1-8	"2 $0 days 1-3, $50 Days 4 to 21, $100 Days 22 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $65, 4b $40"	"9a $350, 9b $350"	8a 0% 14a $0	"8b X-Ray $0, Ther. 20% , CT  $150, Other $350 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b X-Ray $0, Ther. 20% , CT  $150, Other $350 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	196.0379073	179.958159	50.66426882	0	150	0.2	0.2	59.6969697	350	0	0.253605	40	0	0.169396549	4.863683128	0.055602365	40	0.416118062	0.201532453	0	0.158074615	0	0	0	0	0	0	0	0	0											NO	165.6619557	152.0737543	42.81387192	0	126.7575934	0.169010125	0.169010125	50.44696142	295.767718	0	0.214309063	33.80202491	0	0.143148659	4.110058456	0.046986813	33.80202491	0.351640827	0.170305125	0	0.133581052	0	0	0	0	0	0	0	0	0												13.4886	0.394459394	2.540112144	0	1.387724314	1.678231406	1.075561257	1.726984556	9.728161226	0	6.004321512	0.013090128	0	3.785917803	1.043681436	4.62305614	0.323425342	2.005202721	1.260201846	0	0.758857063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8375	0	NO	9.50498731	13.4886	0.394459394	2.540112144	0	1.387724314	1.678231406	1.075561257	1.726984556	9.728161226	0	6.004321512	0.013090128	0	3.785917803	1.043681436	4.62305614	0.323425342	2.005202721	1.260201846	0	0.758857063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8375	NO	0.3	0.3	0.3	0	10a $150	0.3	0.3	"4a $65, 4b $40"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3								$50/visit													7.0972	0.0664	0.8208	0	0.203	0.3682	0.236	0.2526	1.7192	0.5405	0.9862	0.0015	0.0157	0.9651	0.8067	2.715	0.0262	0.2114	0.2744	0.0091	0.2567	0	0	0	0	0	0	0	0	0											17.5719	0	NO	0	20.5858	0.460872296	3.360901283	0	1.590690247	2.046413832	1.311525589	1.979570051	11.44735914	0.540546645	6.990546782	0.014586539	0.015697682	4.751001533	1.850375847	7.338032728	0.349589453	2.216640664	1.534571659	0.009090587	1.015598155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4094
H2667_803_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	V	T	COIN	COIN	COIN	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	163.7940125	1.078574576	22.32128151	0	9.08839177	7.669380429	27.16659974	20.96058251	67.16795035	11.17478738	49.45715072	0.07404467	3.800965069	28.18226487	29.4919023	104.9127915	0	8.203536576	7.70699333	12.41592265	9.43356771	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.078090504	0.078090504	0.185406249	0	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0.20813891	0	0.20813891	0.20813891	0.20813891	0.20813891	0	0	0	0	0	0	0	0	0											10000	12.7908	0.084226432	4.138505069	0	1.891647957	1.596296483	5.654426458	4.362712797	13.98026397	2.325908064	10.29395744	0.015411577	0.791128726	5.865825892	6.1384124	21.83643407	0	1.707475161	1.604125191	2.584236606	1.963492501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6252	0	NO	7.591876769	12.7908	0.084226432	4.138505069	0	1.891647957	1.596296483	5.654426458	4.362712797	13.98026397	2.325908064	10.29395744	0.015411577	0.791128726	5.865825892	6.1384124	21.83643407	0	1.707475161	1.604125191	2.584236606	1.963492501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6252	NO	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.3841	0.0211	0.1427	0	0.2277	0.0451	0.1388	0.104	0.1393	0.0741	0.0963	0.0001	0.0012	0.1284	0.0924	0.6026	0	0.0824	0.0271	0.1236	0.0327	0	0	0	0	0	0	0	0	0											2.4637	0	NO	0	13.1748	0.105375147	4.281184462	0	2.119350555	1.641361032	5.793244657	4.466702158	14.11961217	2.400007931	10.39029403	0.015488833	0.792357794	5.994218716	6.230800851	22.4389868	0	1.789863872	1.631265744	2.707789655	1.996193462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0889
H2667_807_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	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	209.7681996	1.493481574	28.99551592	0	8.381697297	9.471263705	31.00892979	22.91790924	74.95305508	9.329398354	48.23091446	0.221539136	0.974723374	31.5896118	34.50262741	130.402289	0	8.89041963	9.859284806	11.92572716	12.19855277	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.075917082	0.075917082	0.180246005	0	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0.202345969	0	0.202345969	0.202345969	0.202345969	0.202345969	0	0	0	0	0	0	0	0	0											10000	15.925	0.113380764	5.226325919	0	1.696002664	1.916472035	6.274531956	4.637346561	15.16644858	1.887766153	9.759331138	0.044827551	0.197231346	6.39203062	6.981467587	26.38637756	0	1.798940578	1.994986541	2.413122821	2.468327985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2799	0	NO	11.90860659	15.925	0.113380764	5.226325919	0	1.696002664	1.916472035	6.274531956	4.637346561	15.16644858	1.887766153	9.759331138	0.044827551	0.197231346	6.39203062	6.981467587	26.38637756	0	1.798940578	1.994986541	2.413122821	2.468327985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2799	NO	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.35	0.0193	0.13	0	0.2075	0.0411	0.1265	0.0948	0.127	0.0675	0.0878	0.0001	0.0011	0.117	0.0842	0.549	0	0.0751	0.0247	0.1126	0.0298	0	0	0	0	0	0	0	0	0											2.2448	0	NO	0	16.275	0.132650502	5.356328835	0	1.903474824	1.957532784	6.40101673	4.732096895	15.29341627	1.955282552	9.847108618	0.044897943	0.198351216	6.50901627	7.065647705	26.93539596	0	1.87400939	2.019715767	2.52569869	2.4981236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5247
H2667_808_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	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	244.5262743	1.62850977	27.67738093	0	8.228701355	10.05597192	28.47014203	23.53806242	71.13773642	8.539622226	42.93158121	0.111164783	0.511352897	32.25731594	36.15111049	132.1982446	0	10.78582272	8.923401145	12.29456482	10.18868276	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.08404134	0.08404134	0.199535011	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.075704204	0.075704204	0.179740578	0	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0.201778572	0	0.201778572	0.201778572	0.201778572	0.201778572	0	0	0	0	0	0	0	0	0											10000	18.5117	0.123285035	4.97474846	0	1.660375609	2.029079655	5.744664604	4.749476624	14.35407087	1.723112779	8.662673152	0.022430671	0.103180057	6.508835149	7.294519453	26.67477302	0	2.176347907	1.800551141	2.480779734	2.055857859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6504	0	NO	12.29581482	18.5117	0.123285035	4.97474846	0	1.660375609	2.029079655	5.744664604	4.749476624	14.35407087	1.723112779	8.662673152	0.022430671	0.103180057	6.508835149	7.294519453	26.67477302	0	2.176347907	1.800551141	2.480779734	2.055857859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6504	NO	Medicare FFS 8.4%	Medicare FFS 8.4%	Medicare FFS 20%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.5799	0.0319	0.2154	0	0.3438	0.068	0.2096	0.157	0.2104	0.1119	0.1455	0.0001	0.0019	0.1939	0.1395	0.9098	0	0.1244	0.041	0.1865	0.0494	0	0	0	0	0	0	0	0	0											3.7199	0	NO	0	19.0916	0.155216891	5.190176109	0	2.004177433	2.097121365	5.954262344	4.90648727	14.56446884	1.834994108	8.808129091	0.022546657	0.105035792	6.702691905	7.434014207	27.58455063	0	2.300744331	1.841529907	2.667329047	2.105232131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.3703
H2667_809_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	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	373.7197323	3.68842914	41.62540605	0	9.482594668	7.823719289	20.53927198	18.6818517	77.48649821	17.14910044	56.17262565	0.499570334	0.100160204	26.99140261	43.42862506	229.0952912	0	23.51935106	18.23159271	25.30299159	75.21555948	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.085058916	0.085058916	0.184908676	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.071976395	0.071976395	0.156468721	0	0.189547588	0.224	0.195247607	0.189547588	0.189547588	0.189630458	0.189547588	0.224	0.224	0.2043515	0.199136051	0.212891389	0	0.200045947	0.207472164	0.224	0.189547588	0	0	0	0	0	0	0	0	0											10000	26.899	0.265479831	6.513074035	0	1.797402947	1.752513121	4.010243712	3.541099926	14.68737883	3.251991769	10.6473857	0.111903755	0.022435886	5.515733613	8.6482049	48.77241472	0	4.70495085	3.782547985	5.667870116	14.25692787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.8486	0	NO	20.48759557	26.899	0.265479831	6.513074035	0	1.797402947	1.752513121	4.010243712	3.541099926	14.68737883	3.251991769	10.6473857	0.111903755	0.022435886	5.515733613	8.6482049	48.77241472	0	4.70495085	3.782547985	5.667870116	14.25692787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.8486	NO	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					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	0	NO	0	26.899	0.265479831	6.513074035	0	1.797402947	1.752513121	4.010243712	3.541099926	14.68737883	3.251991769	10.6473857	0.111903755	0.022435886	5.515733613	8.6482049	48.77241472	0	4.70495085	3.782547985	5.667870116	14.25692787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.8486
H2667_810_0	2012	3																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	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	347.6143709	5.509096232	36.97172001	0	6.922611135	14.15209178	23.9429596	19.54190733	80.05304596	16.5097645	42.93268193	2.986156593	0.057790347	26.99291206	49.33967953	215.3368204	0	14.32355197	13.07050965	25.47298188	54.37265994	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.085045288	0.085045288	0.185120394	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.073518834	0.073518834	0.160030448	0	0.193640579	0.224	0.202765325	0.193640579	0.193640579	0.193893438	0.193640579	0.224	0.224	0.193822776	0.200250632	0.214850041	0	0.193640579	0.224	0.224	0.193640579	0	0	0	0	0	0	0	0	0											10000	25.5562	0.40502233	5.91660093	0	1.340498431	3.170068558	4.854801997	3.784106258	15.5015182	3.201135006	8.313509403	0.668899077	0.012945038	5.231841143	9.880302023	46.26512474	0	2.773620902	2.927794161	5.705947942	10.52875337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.0387	0	NO	16.58283346	25.5562	0.40502233	5.91660093	0	1.340498431	3.170068558	4.854801997	3.784106258	15.5015182	3.201135006	8.313509403	0.668899077	0.012945038	5.231841143	9.880302023	46.26512474	0	2.773620902	2.927794161	5.705947942	10.52875337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.0387	NO	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.5707	0.0136	0.0965	0	0.3751	0.0485	0.1123	0.2162	0.1421	0.0648	0.0611	0	0.0001	0.1247	0.0687	0.7046	0	0.0452	0.0364	0.0487	0.0092	0	0	0	0	0	0	0	0	0											2.7387	0	NO	0	26.1269	0.41867134	6.013147394	0	1.715647123	3.218550457	4.96714019	4.00035587	15.64357744	3.265980038	8.374612693	0.668899077	0.013018554	5.356515756	9.949012994	46.969746	0	2.818819942	2.964191864	5.754656775	10.53799143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.7774
H2672_001_0	2012	8																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	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	1363.070013	59.94135212	2351.367725	0	242.8481859	7.845846792	4.007794857	363.9458708	384.3593795	0	20.83366138	6.621088833	0	14.20988127	3494.455431	122.2083554	125.5516245	683.1211641	13.81449995	9.226022199	18.49840084	0	0	0	0	0	2.805253859	0	0	0											3400	1a $200 days 1-7	1b $200 days 1-7	"2 $0 days 1-20, $100 Days 21 to 100, $0 Days 101 to 100"	6 $	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $30"	"9a $200, 9b $200"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $250 14a $0"	"7e $30, 7h $30, 9c $30"	12 0%	"3 $30 , 9d $30, 13a $0, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $30 , 7f $5, 17a $30, 18a $5"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $250 14a $0"	"7g $30, 14a $0"	15 20%			16a $0	17a $0	17b $0	18a $5		14c $0													NO	168.4869473	160.2446483	21.71132518	0	150	0.2	0.2	64.14715719	200	0	0.276518666	30	0	0.003559337	4.494994438	0.078988171	30	30	0.140517562	0.268271336	0.168910793	0	0	0	0	0	5	0	0	0											YES	147.2469384	140.0436903	18.97432539	0	131.0905154	0.174787354	0.174787354	56.06055932	174.7873539	0	0.24165983	26.21810308	0	0.003110636	3.928340918	0.069030667	26.21810308	26.21810308	0.122803464	0.234452185	0.147617352	0	0	0	0	0	4.369683847	0	0	0											10000	16.7257	0.699534013	3.717968028	0	2.652924487	1.3713548	0.700511858	1.700250757	5.598429906	0	5.034659064	0.014466032	0	0.044201766	1.143951021	8.436124273	0.274310453	1.492511758	1.696468454	2.163061063	2.730684957	0	0	0	0	0	0.001021506	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1981	0	NO	8.106436536	16.7257	0.699534013	3.717968028	0	2.652924487	1.3713548	0.700511858	1.700250757	5.598429906	0	5.034659064	0.014466032	0	0.044201766	1.143951021	8.436124273	0.274310453	1.492511758	1.696468454	2.163061063	2.730684957	0	0	0	0	0	0.001021506	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1981	NO																																										0	0	0	0	0	0	0	0	0	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	16.7257	0.699534013	3.717968028	0	2.652924487	1.3713548	0.700511858	1.700250757	5.598429906	0	5.034659064	0.014466032	0	0.044201766	1.143951021	8.436124273	0.274310453	1.492511758	1.696468454	2.163061063	2.730684957	0	0	0	0	0	0.001021506	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1981
H2672_008_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	V	COIN	COIN	COIN	P	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1292.978239	74.09230832	1483.776684	0	230.8035449	9.390660857	4.037980107	379.3188336	353.202231	0	24.22882921	29.38491434	0	16.08088959	3850.997026	123.2811859	149.9255263	692.905296	13.73075751	9.188189522	19.78772391	0	0	0	0	0	0	0	0	0											3400	1a $200 days 1-5	1b $200 days 1-5	"2 $0 days 1-22, $100 Days 23 to 100, $50 Days 101 to 100"	6 $	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $15"	"9a $200, 9b $200"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $150 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $40 , 7f $5, 17a $10, 18a $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $150 14a $0"	"7g $40, 14a $0"	15 20%				17a $0	17b $0			14c $0													NO	149.2924834	127.6150628	17.11221283	0	150	0.2	0.2	63.80173277	200	0	0.259332246	40	0	0.003458656	4.700646182	0.095258473	40	40	0.152068275	0.562944016	0.174522555	0	0	0	0	0	0	0	0	0											YES	128.5977744	109.9252466	14.74014253	0	129.2072161	0.172276288	0.172276288	54.95762848	172.2762881	0	0.223383983	34.45525762	0	0.002979222	4.04904938	0.082053881	34.45525762	34.45525762	0.13098879	0.484909527	0.15033049	0	0	0	0	0	0	0	0	0											10000	13.8562	0.678717939	1.822589984	0	2.485123624	1.617788195	0.695648224	1.737205295	5.070697442	0	5.412332383	0.084372066	0	0.04790854	1.299406427	10.11569976	0.430476886	1.989519207	1.798575307	4.455440638	2.974698227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5724	0	NO	9.103959126	13.8562	0.678717939	1.822589984	0	2.485123624	1.617788195	0.695648224	1.737205295	5.070697442	0	5.412332383	0.084372066	0	0.04790854	1.299406427	10.11569976	0.430476886	1.989519207	1.798575307	4.455440638	2.974698227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5724	NO																																										0	0	0	0	0	0	0	0	0	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	13.8562	0.678717939	1.822589984	0	2.485123624	1.617788195	0.695648224	1.737205295	5.070697442	0	5.412332383	0.084372066	0	0.04790854	1.299406427	10.11569976	0.430476886	1.989519207	1.798575307	4.455440638	2.974698227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5724
H2672_009_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	COIN	COIN	COIN	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	962.9602655	42.05314821	814.8650439	0	112.0930446	11.36748734	7.294831105	276.9637898	366.0360821	0	9.766276587	0.573834417	0	7.572590825	0	133.2094912	248.9410455	772.0794358	15.00546532	10.88212997	28.53567135	0	0	0	0	0	0	0	0	0											2900	1a $250 days 1-7	1b $200 days 1-7	"2 $0 days 1-24, $100 Days 25 to 100, $0 Days 101 to 100"	6 $	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $30"	"9a $200, 9b $200"	8a 0% 14a $0	"8b Ther. 20% ,  X-Ray $0 , CT  $150, Other $200 14a $0"	"7e $30, 7h $30, 9c $30"	12 0%	"3 $30, 14b $0"	"7a $0, 14a $0"	"7b $20 , 7d $30 , 7f $0, 17a 0%, 18a 0%"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b Ther. 20% ,  X-Ray $0 , CT  $150, Other $200 14a $0"	"7g $30, 14a $0"	15 20%				17a 0%	17b $0			14c $0													NO	210.0913064	154.6722455	13.91724183	0	149.7938355	0.2	0.2	64.38295788	200	0	0.302554041	30	0	0.014397786	0	0.080102102	30	29.27493589	0.157301519	0.382004589	0.187134631	0	0	0	0	0	0	0	0	0											YES	182.4589295	134.3288917	12.08676879	0	130.0921173	0.173694888	0.173694888	55.91495325	173.6948879	0	0.262760451	26.05423318	0	0.012504109	0	0.069566628	26.05423318	25.42453354	0.136612349	0.331761222	0.162521643	0	0	0	0	0	0	0	0	0											10000	14.6417	0.470746066	0.820757115	0	1.215201792	1.974474438	1.267074871	1.29053478	5.298216352	0	2.566191245	0.001245901	0	0.0946885	0	9.266935131	0.540497337	1.635813292	2.049931861	3.610268733	4.637664204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.382	0	NO	7.781509339	14.6417	0.470746066	0.820757115	0	1.215201792	1.974474438	1.267074871	1.29053478	5.298216352	0	2.566191245	0.001245901	0	0.0946885	0	9.266935131	0.540497337	1.635813292	2.049931861	3.610268733	4.637664204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.382	NO																																										0	0	0	0	0	0	0	0	0	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	14.6417	0.470746066	0.820757115	0	1.215201792	1.974474438	1.267074871	1.29053478	5.298216352	0	2.566191245	0.001245901	0	0.0946885	0	9.266935131	0.540497337	1.635813292	2.049931861	3.610268733	4.637664204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.382
H2672_010_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	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	908.4306148	56.8240024	1267.079328	0	157.8936255	6.569659126	4.641983172	285.4194397	327.0625504	0	14.69100853	0	0	12.85677297	2835.998732	100.8472817	152.4715535	640.1903796	13.45770659	7.775722873	12.00717019	0	0	0	17.91252969	0	0	0	0	0											2900	1a $175 days 1-7	1b $175 days 1-10	"2 $0 days 1-21, $100 Days 22 to 100, $50 Days 101 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $10"	"9a $200, 9b $200"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7g $40, 14a $0"	15 20%				17a $40	17b $0			14c $0													NO	147.0639145	153.1555091	18.90411847	0	150	0.2	0.2	62.36103429	200	0	0.264405271	0	0	0.005815188	4.541952055	0.121410082	39.99542709	34.03561209	0.164645835	0.431575364	0.16991401	0	0	0	40	0	0	0	0	0											YES	130.6257618	136.0364649	16.79109987	0	133.2336647	0.177644886	0.177644886	55.39059422	177.6448863	0	0.234851221	0	0	0.005165192	4.034272781	0.107839401	35.52491548	30.2312622	0.146242453	0.383335782	0.150921775	0	0	0	35.52897725	0	0	0	0	0											10000	9.8887	0.644178034	1.772971295	0	1.753062196	1.167066348	0.824624573	1.317462697	4.84174913	0	3.450201295	0	0	0.0664077	0.953432708	10.87531042	0.451378254	1.612813602	1.968088025	2.98071281	1.812143439	0	0	0	0.053034488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4333	0	NO	5.843245078	9.8887	0.644178034	1.772971295	0	1.753062196	1.167066348	0.824624573	1.317462697	4.84174913	0	3.450201295	0	0	0.0664077	0.953432708	10.87531042	0.451378254	1.612813602	1.968088025	2.98071281	1.812143439	0	0	0	0.053034488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4333	NO																																										0	0	0	0	0	0	0	0	0	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	9.8887	0.644178034	1.772971295	0	1.753062196	1.167066348	0.824624573	1.317462697	4.84174913	0	3.450201295	0	0	0.0664077	0.953432708	10.87531042	0.451378254	1.612813602	1.968088025	2.98071281	1.812143439	0	0	0	0.053034488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4333
H2672_801_0	2012	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	245.0425267	13.25294612	51.26488689	0	9.870958604	9.615027187	6.471534428	20.73570332	73.49596093	5.875483682	23.02038228	0.23255583	1.341103251	19.66943644	30.39629284	146.4418656	1.218801055	9.341189381	17.47470052	14.25984729	34.94341659	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.7%	Medicare FFS 8.7%	Medicare FFS 17.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.087277558	0.087277558	0.178338041	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.075013646	0.075013646	0.153278655	0	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.19253443	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.192524369	0.192526291	0.192524369	0	0	0	0	0	0	0	0	0											10000	18.3815	0.99415181	7.857812934	0	1.900400077	1.851127043	1.245928083	3.992128199	14.14976351	1.1312329	4.431984574	0.044772664	0.258195057	3.78684584	5.852027101	28.19362777	0.234648904	1.798406592	3.364305692	2.745395509	6.727459231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9417	0	NO	17.81068472	18.3815	0.99415181	7.857812934	0	1.900400077	1.851127043	1.245928083	3.992128199	14.14976351	1.1312329	4.431984574	0.044772664	0.258195057	3.78684584	5.852027101	28.19362777	0.234648904	1.798406592	3.364305692	2.745395509	6.727459231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9417	NO																																										0	0	0	0	0	0	0	0	0	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	18.3815	0.99415181	7.857812934	0	1.900400077	1.851127043	1.245928083	3.992128199	14.14976351	1.1312329	4.431984574	0.044772664	0.258195057	3.78684584	5.852027101	28.19362777	0.234648904	1.798406592	3.364305692	2.745395509	6.727459231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9417
H2672_802_0	2012	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	320.0737084	5.960512005	67.2035414	0	11.85504317	11.88934964	8.318220751	20.32508482	55.32156635	9.415065675	57.28719853	0.334755818	0.151706949	28.39769974	38.49949898	170.6913854	1.549432674	9.572580656	23.42275328	12.79219031	28.79172507	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.7%	Medicare FFS 8.7%	Medicare FFS 17.9%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.087253769	0.087253769	0.178566525	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.07132717	0.07132717	0.145972434	0	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183134936	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183112849	0.183120386	0.183112849	0	0	0	0	0	0	0	0	0											10000	22.83	0.425146456	9.809864481	0	2.17081073	2.177092685	1.5231731	3.721784186	10.13008962	1.724227454	10.49002213	0.061298092	0.027779492	5.199983703	7.049752941	31.25578587	0.283721031	1.752862516	4.289007083	2.34251083	5.272134803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.537	0	NO	27.36083592	22.83	0.425146456	9.809864481	0	2.17081073	2.177092685	1.5231731	3.721784186	10.13008962	1.724227454	10.49002213	0.061298092	0.027779492	5.199983703	7.049752941	31.25578587	0.283721031	1.752862516	4.289007083	2.34251083	5.272134803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.537	NO																																										0	0	0	0	0	0	0	0	0	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	22.83	0.425146456	9.809864481	0	2.17081073	2.177092685	1.5231731	3.721784186	10.13008962	1.724227454	10.49002213	0.061298092	0.027779492	5.199983703	7.049752941	31.25578587	0.283721031	1.752862516	4.289007083	2.34251083	5.272134803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.537
H2672_803_0	2012	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	240.9998955	7.042033632	45.65071258	0	8.633928684	9.570686721	6.76169971	18.4510597	52.18598237	8.004868965	22.54707991	0.462611349	0.188602426	19.73196589	31.10093296	141.2998785	1.289295394	7.571867601	18.85554484	10.89436158	20.89398846	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.7%	Medicare FFS 8.7%	Medicare FFS 17.8%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.087277558	0.087277558	0.178338041	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.076923256	0.076923256	0.157180644	0	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.197448763	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.19742543	0.197433379	0.19742543	0	0	0	0	0	0	0	0	0											10000	18.5385	0.541696155	7.175408421	0	1.704557079	1.889496937	1.33493147	3.642708386	10.30283999	1.580551477	4.451366936	0.091331244	0.037234915	3.895591841	6.140115049	27.89618921	0.254539697	1.494879214	3.722564038	2.150910616	4.125004646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9704	0	NO	13.59087402	18.5385	0.541696155	7.175408421	0	1.704557079	1.889496937	1.33493147	3.642708386	10.30283999	1.580551477	4.451366936	0.091331244	0.037234915	3.895591841	6.140115049	27.89618921	0.254539697	1.494879214	3.722564038	2.150910616	4.125004646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9704	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	18.5385	0.541696155	7.175408421	0	1.704557079	1.889496937	1.33493147	3.642708386	10.30283999	1.580551477	4.451366936	0.091331244	0.037234915	3.895591841	6.140115049	27.89618921	0.254539697	1.494879214	3.722564038	2.150910616	4.125004646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9704
H2701_001_0	2012	10																															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	YES	264.8132221	4.958504348	660.9153482		15.23269875	13.36515271	3.32298069	372.8633228	592.2372777	3268.165124	929.9862876	72.76264843		5108.657732	1946.618567	9499.714613	241.8895766	1085.069243			44.32725988			2.486692401						248.6692401											3400	$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 mental health $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	Chiro - $15 per visit											0	NO	600	600	23.92241379		100	0.2	0.2	46.70873786	125	15	31.09186454	25		22.05001877	14.98129186	24.30912823	24.48126801	15			0.2			25						15											NO	455.345986	455.345986	18.15495849		75.89099766	0.151781995	0.151781995	35.44772716	94.86374708	11.38364965	23.59592619	18.97274942		16.73397923	11.38364965	18.44843994	18.57907853	11.38364965			0.151781995			18.97274942						15												10.0485	0.188152921	0.999907559	0	0.096335392	2.028589546	0.50436864	1.101429778	4.681820611	3.100303898	1.828657317	0.115042291	0	7.124014366	1.846635314	14.60457621	0.37450712	1.029337342	0	0	6.728079952	0	0	0.003931616	0	0	0	0	0	0.31083655	0	0	0	0	0	0	0	0	0	0	56.715	0		17.91540163	10.0485	0.188152921	0.999907559	0	0.096335392	2.028589546	0.50436864	1.101429778	4.681820611	3.100303898	1.828657317	0.115042291	0	7.124014366	1.846635314	14.60457621	0.37450712	1.029337342	0	0	6.728079952	0	0	0.003931616	0	0	0	0	0	0.31083655	0	0	0	0	0	0	0	0	0	0	56.715	YES	$800 per Admission	$800 per Admission	$100 per day	No cost sharing	$100 per segment	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$200 Per Visit	"$35 Copay, $0 Copay for preventive services"	"$150 Copay for CT/MRI/PET, $35 Copay for other Radiology"	$35 Copay	20% Coinsurance	$35 Copay	"$35 Copay, $0 Copay for preventive services"	"Chiropractic: $15, $35 Copay all other specialist visits, $0 Copay for preventive services"	$35 Copay	$35 Copay	No cost share	$35 Copay	20% Coinsurance	Medicare covered hearing exam: $0 copay	not covered	$200 annual allowance	$0 copay	$100 annual allowance	$0 Copay for hearing routine	not covered	$0 Copay	Chiro - $15 per visit											3400					0.5074	0.3602	0.0887	0.1034	0.6502						0.5434	3.8075	0.1983	0.2407			0.516			1.3855	0.1979					0.0706											8.6697	0		2.681054739	10.0485	0.188152921	0.999907559	0	0.60370179	2.388828035	0.593086377	1.204796135	5.332009879	3.100303898	1.828657317	0.115042291	0	7.124014366	2.389993061	18.4120833	0.572782079	1.270044685	0	0	7.244059988	0	0	1.389433088	0.197856538	0	0	0	0	0.381440852	0	0	0	0	0	0	0	0	0	0	65.3847
H2701_003_0	2012	9																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	175.0547974	2.928908549	614.0323894		8.997709483	6.851146195	2.157947327	281.8974575	378.9561012	2038.653632	692.825506	24.32965834		3425.254836	1420.670129	5969.403098	107.4121563	536.0833073			29.23498532									180.9170352											5000	$700 per admission	$700 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	$200 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, $30 copay for X-Rays"	$30 copay	20% Coinsurance	"OP Partial Hospitalization: $30 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: $30 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,$30 Copay for specialist"	$20 copay	No cost sharing for test performing in PCP or specialist office	"$20 copay for PCP, $30 copay for specialist"	20% Coinsurance	Medicare covered hearing exam: $0 copay	not covered	not covered	$0 copay for routine vision one annually	not covered	$0 copay for Hearing routine; $30 copay for diagnostic hearing exams	not covered	No cost sharing	Chiro-$20 per visit											0	NO	700	700	39.87068966		100	0.2	0.2	48.9815571	200	20	46.56645958	30		29.02970035	19.46839003	29.22887743	29.04747302	20			0.2									20											NO	621.1736884	621.1736884	35.3808905		88.73909834	0.177478197	0.177478197	43.46579212	177.4781967	17.74781967	41.32265636	26.6217295		25.76069434	17.44831426	25.96036138	25.77646564	17.74781967			0.177478197									17.74781967												9.0616	0.151613411	1.810417728	0	0.066537386	1.215929072	0.3829886	1.02107469	5.604703788	3.015138086	2.385782525	0.053974799	0	7.353078572	2.065691573	12.91398847	0.23072548	0.792859155	0	0	5.188572473	0	0	0	0	0	0	0	0	0.267573576	0	0	0	0	0	0	0	0	0	0	53.5823	0		6.76370867	9.0616	0.151613411	1.810417728	0	0.066537386	1.215929072	0.3829886	1.02107469	5.604703788	3.015138086	2.385782525	0.053974799	0	7.353078572	2.065691573	12.91398847	0.23072548	0.792859155	0	0	5.188572473	0	0	0	0	0	0	0	0	0.267573576	0	0	0	0	0	0	0	0	0	0	53.5823	YES	"$1,000 per admission"	"$1,000 per admission"	$130 per day	No Cost Sharing	$100 per segment	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $45 per Visit	$400 copay per visit	"$45 Copay, $0 Copay for preventive services"	"$200 copay for CT/MRI/PET, $45 copay for other radialogy"	$45 Copay	20% Coinsurance	$45 Copay	"$45 Copay, $0 Copay for preventive services"	"Chiropractic:$20,  $45 Copay all other specialist visits, $0 Copay all preventive services"	$45 Copay	$45 Copay	No cost sharing	$45 Copay	30% Coinsurance	Medicare covered hearing exam: $0 copay	not covered	not covered	$0 copay	not covered	$0 copay for Hearing routine	not covered	$0 Copay	Chiro-$20 per visit											5000					0.6094	0.3641	0.2163	0.1128	0.6155						0.6113	4.5554	0.143	0.3632			0.2635									0.075											7.9296	0		0.991069308	9.0616	0.151613411	1.810417728	0	0.675959949	1.580054938	0.599301921	1.133895732	6.22018495	3.015138086	2.385782525	0.053974799	0	7.353078572	2.677021128	17.46935817	0.373710954	1.156044154	0	0	5.452089283	0	0	0	0	0	0	0	0	0.342607948	0	0	0	0	0	0	0	0	0	0	61.5119
H2701_806_0	2012	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	NO	918.2837492	25.41529226	874.5498856		16.48725486	10.91204781	2.63612102	359.6636262	535.9934122	2673.356455	1032.81528	46.10378144	0.613681896	4033.486417	2323.786525	12033.59709	175.4050294	1004.197348	1503.445239		42.45104308	0.208491522																				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	not covered											0	NO	215.2689745	72.10615104	67.90382119		270.048558	0.224	0.224	122.4600692	269.3692727	11.72469593	56.61765958	24.68240653	37.66628212	33.66730729	14.29284374	20.13358644	19.39412455	25.20225638	12.91367346		0.224																				NO	186.0333043	62.31341777	58.68180615		233.373275	0.19357857	0.19357857	105.8287725	232.7862433	10.13236548	48.92841767	21.33028996	32.55082596	29.09495174	12.35173325	17.39924493	16.76020933	21.77953903	11.15986803		0.19357857																					14.2359	0.131976144	4.276680572	0	0.320640389	2.112338606	0.510296536	3.171896672	10.39765774	2.257285388	4.211168117	0.081950586	0.001664654	9.779507719	2.391899273	17.4479586	0.244985417	1.82257961	1.398187537	0	8.217612199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0122	0		13.04561168	14.2359	0.131976144	4.276680572	0	0.320640389	2.112338606	0.510296536	3.171896672	10.39765774	2.257285388	4.211168117	0.081950586	0.001664654	9.779507719	2.391899273	17.4479586	0.244985417	1.82257961	1.398187537	0	8.217612199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0122	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	not covered											6700					0.6449	0.3622	0.1254	0.0642	0.2892				0.0002		0.6163	4.2788	0.1124	0.116	0.8738		0.6041																				8.0875	0		1.270969619	14.2359	0.131976144	4.276680572	0	0.965506022	2.474556651	0.635737607	3.23610143	10.68684758	2.257285388	4.211168117	0.081950586	0.001885645	9.779507719	3.008191506	21.72672099	0.357394883	1.938546301	2.272033987	0	8.821667119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.0997
H2701_807_0	2012	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	NO	782.3609204	14.95990993	460.8632461		7.491265363	8.441177516	1.829205392	386.0167024	586.1761704	2572.693097	861.3413068	27.13753636	0.361224486	3919.686572	2335.696635	11005.99998	167.2048095	1224.610613	1423.929001		23.04388168	0.122721957																				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	not covered											0	NO	237.5796833	72.10628195	55.82835401		426.3665519	0.224	0.224	84.56321028	225.5360481	11.23394614	49.74582864	24.68240653	37.66628212	36.38982605	15.41277598	19.74200505	23.73156143	23.67269264	14.70514809		0.224																				NO	211.7555063	64.26855202	49.75998453		380.0218259	0.199651893	0.199651893	75.37145075	201.0209769	10.01285093	44.33861086	21.99950525	33.5720737	32.43436446	13.74013208	17.59611014	21.15201407	21.09954413	13.10674395		0.199651893																					13.8058	0.080120979	1.911045667	0	0.237237028	1.685297066	0.365204318	2.42455324	9.819475535	2.146666039	3.182556419	0.049751031	0.001010588	10.59437857	2.674398356	16.13856565	0.29472654	2.15322714	1.555256068	0	4.600754589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.72	0		8.989775128	13.8058	0.080120979	1.911045667	0	0.237237028	1.685297066	0.365204318	2.42455324	9.819475535	2.146666039	3.182556419	0.049751031	0.001010588	10.59437857	2.674398356	16.13856565	0.29472654	2.15322714	1.555256068	0	4.600754589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.72	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	not covered											6700					0.5549	0.2528	0.1395	0.0709	0.3179				0.0001		0.4972	3.9735	0.0752	0.2323	0.7024		0.3273																				7.1441	0		0.871176349	13.8058	0.080120979	1.911045667	0	0.792133178	1.938084627	0.504679111	2.495488464	10.13739305	2.146666039	3.182556419	0.049751031	0.001144748	10.59437857	3.171597968	20.11210037	0.369924963	2.385517719	2.257676953	0	4.928031754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8641
H2773_001_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	O	O																																																			0	YES	2087.164531	207.5472769	1102.885386		129.8357745		8.27998966	125.0223362	214.3844761	2492.870967	535.3256065	41.66887479	0.50625691	955.4690803		7688.768721	763.5513916	2453.576488	3770.713345	7.119331795	23.62897946				167.2939201		2.595851689														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%	10a: $100/visit	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;8a: 0%	8b: $5/visit;8b: $40 Ultrasounds; $100 CT; $200 MRI and PET;8b: 20%	9c: $25/visit	12: 20%	3: $30/visit;5: $25/visit;9a: $200/visit	7a: 0%	7b: $15/visit;7d: $15/visit;7f: $15/visit;16b: 0%;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%	7g: $30/visit;17b: $30/visit	15: 20%	9d: 20%;14a: 0%;14d: 20%;14e: 0-20%	10b: $10/trip	16a: 1 Exam/yr; 2 cleanings/yr; x-rays	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $1000 allowance/two years	14c: Newsletters and Nurseline	13a: 4 visits/year;13b: $30/quarter allowance													74.8688268	41.78826243	31.06284467		100		0.2	50	156.6829566	10	68.64685092	200	0.2	142.8052351		15	24.90170315	15	6.097886375	28.30687275	0.2				30		15														NO	66.34880542	37.03278669	27.52791415		88.62006826		0.177240137	44.31003413	138.8525431	8.862006826	62.24609879	177.2401365	0.2	131.176543		13.29316371	24.90170315	13.29301024	5.403951068	25.08556996	0.177240137				30		15															11.5401	0.640504503	2.530011186	0	0.958837934	0	1.467546498	0.461645332	2.480652476	1.840986627	2.776827549	0.615449755	0.101251382	10.44459424	0	8.517338442	1.584477508	2.717951448	1.698062534	0.014882708	4.188003545	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0006	0		6.305711201	11.5401	0.640504503	2.530011186	0	0.958837934	0	1.467546498	0.461645332	2.480652476	1.840986627	2.776827549	0.615449755	0.101251382	10.44459424	0	8.517338442	1.584477508	2.717951448	1.698062534	0.014882708	4.188003545	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0006	NO																																																																																		0	0		0	11.5401	0.640504503	2.530011186	0	0.958837934	0	1.467546498	0.461645332	2.480652476	1.840986627	2.776827549	0.615449755	0.101251382	10.44459424	0	8.517338442	1.584477508	2.717951448	1.698062534	0.014882708	4.188003545	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0006
H2773_002_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	O	O																																																			0	YES	1785.97084	177.5966287	943.7306497		111.0994863		6.738572865	106.9806636	183.4471682	2133.130755	458.0740563	35.65573973	0.412011273	817.5876362		6579.221006	653.3651274	2099.506768	3226.570775	6.091958153	19.23016892				167.2939201		2.595851689														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%	10a: $100/visit	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;8a: 0%	"8b: $5/visit;8b: $40 Ultrasounds, $100 CT; $250 MRI and PET;8b: 20%"	9c: $30/visit	12: 20%	3: $30/visit;5: $30/visit;9a: $200/visit	7a: 0%	7b: $15/visit;7d: $25/visit;7f: $15/visit;16b: 0%;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%"	7g: $25/visit;17b: $30/visit	15: 20%	9d: 20%;14a: 0%;14d: 20%;14e: 0-20%		16a: 1 Exam/yr; 2 cleanings/yr; x-rays	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance/two years	14c: Newsletters and Nurseline	13a: 4 visits/year;13b: $30/quarter allowance													112.3032402	62.68239364	37.27541361		100		0.2	50	156.6829566	10	84.15649416	200	0.2	142.1958488		21.84218571	29.88327035	30	6.031823821	26.92231177	0.2				30		15														NO	98.36426332	54.90231148	32.64882289		87.58809019		0.17517618	43.79404509	137.2356093	8.758809019	75.17496755	175.1761804	0.2	129.3891551		19.1313207	29.88327035	26.27642706	5.283159288	23.58073871	0.17517618				30		15															14.6396	0.812538786	2.567641237	0	0.810915986	0	1.180437456	0.390426334	2.097956992	1.556973742	2.86964186	0.520503025	0.082402255	8.815581121	0	10.48909892	1.627057229	4.597294704	1.420540613	0.011971073	3.368667539	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2808	0		7.516274056	14.6396	0.812538786	2.567641237	0	0.810915986	0	1.180437456	0.390426334	2.097956992	1.556973742	2.86964186	0.520503025	0.082402255	8.815581121	0	10.48909892	1.627057229	4.597294704	1.420540613	0.011971073	3.368667539	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2808	NO																																																																																		0	0		0	14.6396	0.812538786	2.567641237	0	0.810915986	0	1.180437456	0.390426334	2.097956992	1.556973742	2.86964186	0.520503025	0.082402255	8.815581121	0	10.48909892	1.627057229	4.597294704	1.420540613	0.011971073	3.368667539	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2808
H2773_003_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	O	O																																																			0	YES	3180.071654	204.1458815	1218.455962		197.2613527		13.39650514	151.4761678	241.3084275	3187.58135	570.0292196	53.7174304	1.131129767	1128.415771		9720.546819	737.0660831	3046.221305	4604.600954	14.27607826	26.84733408				167.2939201		2.595851689														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%	10a: $100/visit	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%	9c: $30/visit	12: 20%	3: $50/visit;5: $30/visit;9a: $300/visit	7a: 0%	7b: $20/visit;7d: $20/visit;7f: $20/visit;16b: 0%;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%	7g: $30/visit;17b: $30/visit	15: 20%	9d: 20%;14a: 0%;14d: 20%;14e: 0-20%		16a: 1 Exam/yr; 2 cleanings/yr; x-rays	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance/two years	14c: Newsletters and Nurseline	13a: 4 visits/year;13b: $30/quarter allowance													147.2623513	81.63737463	27.07633681		100		0.2	50	173.0146455	13.95303735	86.53016326	300	0.2	166.283184		19.43354867	29.945968	30	5.94975424	29.38382952	0.2				30		15														NO	114.9278588	63.71220196	21.13116752		78.04293346		0.156085867	39.02146673	135.0257047	13.95303735	69.98140411	234.1288004	0.2	159.2017868		15.16682979	29.945968	23.41288004	4.643362742	22.93200252	0.156085867				30		15															30.4566	1.083881969	2.145616421	0	1.282904552	0	2.091005118	0.49256852	2.715236706	3.706370137	3.324287098	1.048066461	0.226225953	14.97048391	0	12.28582325	1.839346445	5.943401166	1.781736043	0.027281589	4.190489414	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0328	0		19.89237755	30.4566	1.083881969	2.145616421	0	1.282904552	0	2.091005118	0.49256852	2.715236706	3.706370137	3.324287098	1.048066461	0.226225953	14.97048391	0	12.28582325	1.839346445	5.943401166	1.781736043	0.027281589	4.190489414	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0328	NO																																																																																		0	0		0	30.4566	1.083881969	2.145616421	0	1.282904552	0	2.091005118	0.49256852	2.715236706	3.706370137	3.324287098	1.048066461	0.226225953	14.97048391	0	12.28582325	1.839346445	5.943401166	1.781736043	0.027281589	4.190489414	0	0	0	0.4182348	0	0.003244815	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0328
H2773_004_0	2012	8																															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	381.9114332	3.596286135	36.63068285		3.976219808	12.03728665	14.05144316	14.41200268	27.61033488	5.229531359	12.01244379	2.250957976	7.64378558	51.45016003	80.48493532	158.6145593	0.908099419	40.40931772	36.86226171	25.75454288	11.7909686																				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 12 trips/yr	16a: 1 Exam/yr; 2 cleanings/yr; x-rays;16b1: $1500/year	17a1: 0%	17b1: $0 for 1 pair of glasses/contacts/yr	18a1: $0 for 1 Exam/yr	18b: $1000/two years	14c: Newsletters and Nurseline	13a: 4 visits/year;13b: $34/month allowance													0.060567079	0.060567079	0.148257175		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.060567079	0.060567079	0.148257175		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																					23.1313	0.217816547	5.430761542	0	0.890673237	2.696352209	3.147523268	3.228288601	6.184715014	1.171415024	2.690787408	0.504214587	1.71220797	11.52483585	18.02862551	35.52966129	0.20341427	9.051687168	8.257146624	5.769017604	2.641176967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.0116	0		0	23.1313	0.217816547	5.430761542	0	0.890673237	2.696352209	3.147523268	3.228288601	6.184715014	1.171415024	2.690787408	0.504214587	1.71220797	11.52483585	18.02862551	35.52966129	0.20341427	9.051687168	8.257146624	5.769017604	2.641176967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.0116	NO																																																																																		0	0		0	23.1313	0.217816547	5.430761542	0	0.890673237	2.696352209	3.147523268	3.228288601	6.184715014	1.171415024	2.690787408	0.504214587	1.71220797	11.52483585	18.02862551	35.52966129	0.20341427	9.051687168	8.257146624	5.769017604	2.641176967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.0116
H2775_082_0	2012	6																															A	A	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	243.270083	0.863680768	1014.787922	70.95578932	349.6642991	23.39072922	0.582461729	195.945403	462.6126425	11.43935345	18.61864015	21.75024848	0.051569543	557.3783374	4091.922658	8342.954958	3.950714932	1750.740826	25.50870957	17903.72682	5.477637741	10.73746444	0	0	0	0	0.266340333	0	0	0											3400	1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	0.2	56.98944024	106.2538126	0.2	0.2	200	0.2	2.744337737	5.168957327	14.6485263	0	0	0.187365434	3.017441777	0.2	0	0	0	0	0	20	0	0	0											NO	299.9847838	299.9847838	44.99771756	0	112.4942939	0.149992392	0.149992392	42.73991227	79.6863175	0.149992392	0.149992392	149.9923919	0.149992392	2.058148906	3.876521365	10.98583749	0	0	0.140516948	2.262966547	0.149992392	0	0	0	0	0	20	0	0	0												6.0814	0.021590924	3.805261692	0	3.277936536	3.508431424	0.087364828	0.697890778	3.071991493	1.715815986	2.79265437	0.271864316	0.007735039	0.095597301	1.321868801	7.637862276	0	0	3.58440601	3.376294572	0.821603987	0	0	0	0	0	0.000443901	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1781	0		14.06205717	6.0814	0.021590924	3.805261692	0	3.277936536	3.508431424	0.087364828	0.697890778	3.071991493	1.715815986	2.79265437	0.271864316	0.007735039	0.095597301	1.321868801	7.637862276	0	0	3.58440601	3.376294572	0.821603987	0	0	0	0	0	0.000443901	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1781	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	1.907	0.005	0.655	0.263	0.403	0.539	0.016	0.086	0.601	0.303	0.338	0.046	0.001	0.029	0.354	1.076	0	0	0.447	0.487	0.101	0.022	0	0	0	0	0	0	0	0											7.679	0		1.566	7.9884	0.026590924	4.460261692	0.263	3.680936536	4.047431424	0.103364828	0.783890778	3.672991493	2.018815986	3.13065437	0.317864316	0.008735039	0.124597301	1.675868801	8.713862276	0	0	4.03140601	3.863294572	0.922603987	0.022	0	0	0	0	0.000443901	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8571
H2775_083_0	2012	6																															A	A	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	279.7671986	1.968163883	1258.652532	68.08220565	368.2286709	22.15480783	1.262629619	282.287542	515.1283671	14.48923611	33.00007423	52.25204012	0.108883158	609.5681151	4377.288523	7952.316057	26.44795005	1237.480009	20.12417322	15155.92865	5.838605881	11.42303087	0	0	0	0	0.060573642	0	0	0											3400	1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	0.2	59.62634117	108.2204484	0.2	0.2	191.570284	0.2	2.60651954	6.53989068	13.44754946	0	0	0.18044176	2.832979281	0.2	0	0	0	0	0	20	0	0	0											NO	307.7467631	307.7467631	46.16201446	0	115.4050362	0.153873382	0.153873382	45.87453373	83.26123172	0.153873382	0.153873382	147.387837	0.153873382	2.005369878	5.031575469	10.34609954	0	0	0.138825919	2.179600509	0.153873382	0	0	0	0	0	20	0	0	0												7.1748	0.050474672	4.841828033	0	3.541286923	3.409035198	0.194285089	1.07915078	3.574185195	2.229507756	5.077833012	0.641776264	0.01675422	0.101867461	1.83538813	6.856287793	0	0	2.793756841	2.752822484	0.89840603	0	0	0	0	0	0.000100956	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0695	0		14.11000247	7.1748	0.050474672	4.841828033	0	3.541286923	3.409035198	0.194285089	1.07915078	3.574185195	2.229507756	5.077833012	0.641776264	0.01675422	0.101867461	1.83538813	6.856287793	0	0	2.793756841	2.752822484	0.89840603	0	0	0	0	0	0.000100956	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0695	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.067	0.021	0.823	0.267	0.43	0.518	0.035	0.131	0.684	0.389	0.606	0.088	0.003	0.03	0.399	0.954	0	0	0.338	0.381	0.109	0.043	0	0	0	0	0	0	0	0											8.316	0		1.569	9.2418	0.071474672	5.664828033	0.267	3.971286923	3.927035198	0.229285089	1.21015078	4.258185195	2.618507756	5.683833012	0.729776264	0.01975422	0.131867461	2.23438813	7.810287793	0	0	3.131756841	3.133822484	1.00740603	0.043	0	0	0	0	0.000100956	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3855
H2775_084_0	2012	9																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	949.5118622	7.518653762	450.9407674	91.44817955	282.371879	20.11733276	0.697276877	237.9924018	521.7890136	7.442430937	21.2276455	3.299991501	4.928998373	373.6680557	4317.426503	6300.742327	0.126048403	673.9907989	37.17432649	13280.46191	6.040674428	16.00050335	0	0	0	0	0.048129729	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	62.55571094	190.9320836	0.2	0.2	0.35500747	30	8.018591763	18.43645926	17.70940404	0.4	0	0.190354168	3.140380058	0.2	0	0	0	0	0	20	0	0	0											NO	203.5530094	203.5530094	116.9347075	0	129.9274528	0.173236604	0.173236604	54.18469455	165.3821285	0.173236604	0.173236604	0.307501442	25.98549057	6.945568021	15.96934794	15.33958505	0.346473208	0	0.164881548	2.720143879	0.173236604	0	0	0	0	0	20	0	0	0												16.1063	0.12753705	4.394218896	0	3.057321583	3.485058404	0.120793878	1.0746288	7.19121481	1.289301459	3.677405212	1.014752146	0.010673537	0.216278075	5.745540502	8.054231069	0.043672394	0	6.129360482	3.010397264	1.046465922	0	0	0	0	0	8.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7953	0		10.16472591	16.1063	0.12753705	4.394218896	0	3.057321583	3.485058404	0.120793878	1.0746288	7.19121481	1.289301459	3.677405212	1.014752146	0.010673537	0.216278075	5.745540502	8.054231069	0.043672394	0	6.129360482	3.010397264	1.046465922	0	0	0	0	0	8.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7953	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.048	0.032	1.104	0	0.768	0.876	0.03	0.27	1.808	0.324	0.92	0.256	0.002	0.054	1.706	2.376	0.01	0	1.536	0.756	0.264	0	0	0	0	0	0	0	0	0											17.14	0		2.542	20.1543	0.15953705	5.498218896	0	3.825321583	4.361058404	0.150793878	1.3446288	8.99921481	1.613301459	4.597405212	1.270752146	0.012673537	0.270278075	7.451540502	10.43023107	0.053672394	0	7.665360482	3.766397264	1.310465922	0	0	0	0	0	8.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9353
H2775_085_0	2012	5																															A	A	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	322.3579772	4.051797394	1691.259072	84.59846571	428.9844169	23.88283194	1.342901794	295.7803485	573.135553	10.71662507	32.89661222	46.40059212	0.186091905	458.9316927	5168.897096	8228.172632	54.32393484	927.0937872	21.27319926	14523.17868	4.486167175	6.851391767	0	0	0	0	0.124701061	0	0	0											3400	1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	0.2	60.50234784	100.3407979	0.2	0.2	180.4575444	0.2	3.218978664	7.423177564	12.29787053	0	0	0.17990314	3.361952726	0.2	0	0	0	0	0	20	0	0	0											NO	310.7605883	310.7605883	46.61408824	0	116.5352206	0.155380294	0.155380294	47.00436301	77.95491347	0.155380294	0.155380294	140.1977317	0.155380294	2.500829258	5.767077566	9.554233702	0	0	0.139767014	2.611906017	0.155380294	0	0	0	0	0	20	0	0	0												8.348	0.104928245	6.569708302	0	4.165982804	3.710921452	0.208660476	1.158580573	3.723227703	1.665152355	5.111485283	0.542104814	0.028915015	0.095642484	2.484119207	6.551157023	0	0	2.973291532	3.161098148	0.697061975	0	0	0	0	0	0.000207835	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3003	0		14.73155375	8.348	0.104928245	6.569708302	0	4.165982804	3.710921452	0.208660476	1.158580573	3.723227703	1.665152355	5.111485283	0.542104814	0.028915015	0.095642484	2.484119207	6.551157023	0	0	2.973291532	3.161098148	0.697061975	0	0	0	0	0	0.000207835	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3003	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.455	0.043	1.117	0.324	0.506	0.564	0.038	0.141	0.744	0.293	0.611	0.078	0.005	0.028	0.509	0.914	0	0	0.36	0.436	0.085	0.016	0	0	0	0	0	0	0	0											9.267	0		1.636	10.803	0.147928245	7.686708302	0.324	4.671982804	4.274921452	0.246660476	1.299580573	4.467227703	1.958152355	5.722485283	0.620104814	0.033915015	0.123642484	2.993119207	7.465157023	0	0	3.333291532	3.597098148	0.782061975	0.016	0	0	0	0	0.000207835	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5673
H2775_088_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1059.069482	3.821099482	1431.59012	79.60272264	48.52017466	20.29056444	0.848668716	197.3593186	385.0264526	7.607383116	24.87707453	22.17102224	0.057393125	312.3131407	3993.269714	6250.664857	0.353511852	232.9924832	47.56684295	11727.96535	5.771942708	9.6349236	0	0	0	0	0	0	0	0											4400	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $275; 9b: $225	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $40; 7e: $40; 7h: $40	12: 20%	3: $35; 7c: $35; 7i: $35	7a : $15; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $35; 7f: $45; 7g: $35; 14d: $0; 14e: $0	7e: $40; 7h: $40	7c: $35; 7i: $35; 3: $35	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	60	0	150	0.2	0.2	59.9871955	248.3681944	0.2	0.2	200	0.2	8.330559061	10.51246425	10.84759442	0	0	0.191639661	2.860010034	0.2	0	0	0	0	0	0	0	0	0											NO	163.2861238	163.2861238	41.69007417	0	104.2251854	0.138966914	0.138966914	41.68117715	172.5748074	0.138966914	0.138966914	138.9669139	0.138966914	5.788360418	7.30442357	7.537283596	0	0	0.133157861	1.987233841	0.138966914	0	0	0	0	0	0	0	0	0												14.4109	0.051994377	4.973591525	0	0.421418683	2.819717121	0.117936872	0.68551406	5.537155492	1.057174554	3.457090274	0.256753212	0.007975745	0.150648418	2.430711118	3.926086141	0	0	6.333899076	1.942184136	0.802109065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3829	0		21.68855201	14.4109	0.051994377	4.973591525	0	0.421418683	2.819717121	0.117936872	0.68551406	5.537155492	1.057174554	3.457090274	0.256753212	0.007975745	0.150648418	2.430711118	3.926086141	0	0	6.333899076	1.942184136	0.802109065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3829	YES	1a: $350 Per Day (Days 1-7)	1b: $350 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $275; 9b: $275	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $50; 7e: $50; 7h: $50	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $20; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $40; 7f: $50; 7g: $40; 14d: 20%; 14e: 20%	7e: $50; 7h: $50	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												6000	3.322	0.013	1.027	0.343	0.062	0.624	0.026	0.101	0.905	0.226	0.507	0.046	0.002	0.025	0.546	0.648	0	0	0.942	0.355	0.118	0.018	0	0	0	0	0	0	0	0											9.856	0		0.821	17.7329	0.064994377	6.000591525	0.343	0.483418683	3.443717121	0.143936872	0.78651406	6.442155492	1.283174554	3.964090274	0.302753212	0.009975745	0.175648418	2.976711118	4.574086141	0	0	7.275899076	2.297184136	0.920109065	0.018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2389
H2775_089_0	2012	7																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	860.2751208	0	380.4444429	49.26425531	193.9680755	16.76708205	1.45278542	219.249976	414.8199827	12.36639065	28.22076616	2.15258557	2.445043422	383.7059948	4543.569227	5851.677592	0.010209256	460.0141268	18.43491233	8473.707917	4.584258712	6.536908138	0	0	0	0	0	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $350; 9b: $200	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		234.1290558	0	135	0	150	0.2	0.2	59.15363735	257.854176	0.2	0.2	0.285027911	30	8.560010816	18.23423785	17.51247375	0.4	0	0.180871832	3.616520884	0.2	0	0	0	0	0	0	0	0	0											NO	194.9099608	0	112.3860711	0	124.8734123	0.166497883	0.166497883	49.24477699	214.6608723	0.166497883	0.166497883	0.237282719	24.97468247	7.126118401	15.17981001	14.57894904	0.332995766	0	0.150573886	3.010715357	0.166497883	0	0	0	0	0	0	0	0	0												13.973	0	3.563054684	0	2.018454623	2.791683667	0.241885697	0.899743014	7.420468278	2.058977864	4.698697825	0.510771357	0.005088682	0.227861196	5.747543136	7.109275783	0.003399639	0	2.775816383	2.125993547	0.763269371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.935	0		11.45626004	13.973	0	3.563054684	0	2.018454623	2.791683667	0.241885697	0.899743014	7.420468278	2.058977864	4.698697825	0.510771357	0.005088682	0.227861196	5.747543136	7.109275783	0.003399639	0	2.775816383	2.125993547	0.763269371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.935	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $350; 9b: $200	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.52	0	0.898	0	0.508	0.704	0.06	0.226	1.87	0.518	1.18	0.128	0.002	0.058	1.712	2.11	0	0	0.696	0.534	0.192	0	0	0	0	0	0	0	0	0											14.916	0		2.866	17.493	0	4.461054684	0	2.526454623	3.495683667	0.301885697	1.125743014	9.290468278	2.576977864	5.878697825	0.638771357	0.007088682	0.285861196	7.459543136	9.219275783	0.003399639	0	3.471816383	2.659993547	0.955269371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.851
H2775_091_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1027.98005	13.29331536	566.3890289	63.83200209	282.6548226	18.08828955	1.180327331	229.765192	526.6016007	8.441057251	21.62990089	2.884837109	4.163518398	345.2749485	3979.02968	6347.988013	0.221558911	455.5009576	21.0959539	10649.64539	4.512719317	15.16810933	0	0	0	0	0.085095509	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	61.25598625	195.007196	0.2	0.2	0.238573942	30	9.98614883	18.6358986	17.40635739	0.4	0	0.178969764	3.900088938	0.2	0	0	0	0	0	20	0	0	0											NO	206.0284907	206.0284907	118.3567925	0	131.5075472	0.175343396	0.175343396	53.70416336	170.9661202	0.175343396	0.175343396	0.209161826	26.30150945	8.75502626	16.33840877	15.26044911	0.350686793	0	0.156905832	3.419274202	0.175343396	0	0	0	0	0	20	0	0	0												17.6494	0.228233475	5.586332397	0	3.097603536	3.171662122	0.206962603	1.028278951	7.502586049	1.480083647	3.792660283	0.603397799	0.009125568	0.251907603	5.41758445	8.072762338	0.077697784	0	3.310078192	3.034504812	0.791275532	0	0	0	0	0	0.000141826	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3123	0		9.184128361	17.6494	0.228233475	5.586332397	0	3.097603536	3.171662122	0.206962603	1.028278951	7.502586049	1.480083647	3.792660283	0.603397799	0.009125568	0.251907603	5.41758445	8.072762338	0.077697784	0	3.310078192	3.034504812	0.791275532	0	0	0	0	0	0.000141826	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3123	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.434	0.058	1.404	0	0.778	0.796	0.052	0.258	1.886	0.372	0.95	0.152	0.002	0.064	1.608	2.398	0.02	0	0.828	0.762	0.198	0	0	0	0	0	0	0	0	0											17.02	0		2.296	22.0834	0.286233475	6.990332397	0	3.875603536	3.967662122	0.258962603	1.286278951	9.388586049	1.852083647	4.742660283	0.755397799	0.011125568	0.315907603	7.02558445	10.47076234	0.097697784	0	4.138078192	3.796504812	0.989275532	0	0	0	0	0	0.000141826	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3323
H2775_094_0	2012	2																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1028.109529	26.30442364	1704.338551	81.18080707	433.2544317	22.38161664	1.635213281	288.6003445	472.2293906	8.654152476	18.66200618	61.02885622	0.214198635	355.8940276	4909.528468	7341.914095	71.50455917	691.6137615	21.54905122	13613.80983	4.450276145	9.251470716	0	0	0	0	0.168384505	0	0	0											4400	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $40; 7e: $40; 7h: $40	12: 20%	3: $35; 7c: $35; 7i: $35	7a : $15; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $35; 7f: $45; 7g: $35; 14d: $0; 14e: $0	7e: $40; 7h: $40	7c: $35; 7i: $35; 3: $35	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	60	0	150	0.2	0.2	59.46825549	167.9731794	0.2	0.2	180.6926865	0.2	7.902135892	11.57798704	13.99069874	0	0	0.184482485	3.108092555	0.2	0	0	0	0	0	20	0	0	0											NO	159.3820184	159.3820184	40.69328129	0	101.7332032	0.135644271	0.135644271	40.33264081	113.9229973	0.135644271	0.135644271	122.5496386	0.135644271	5.359397311	7.852438055	9.488790658	0	0	0.125119961	2.107974744	0.135644271	0	0	0	0	0	20	0	0	0												13.6552	0.349371011	5.779594007	0	3.673030096	3.035938073	0.221807313	0.970001169	4.483148966	1.173886204	2.531394224	0.623255356	0.029054818	0.158948125	3.212647348	5.80549049	0	0	2.696216449	2.391463941	0.603654463	0	0	0	0	0	0.000280641	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3944	0		24.38365924	13.6552	0.349371011	5.779594007	0	3.673030096	3.035938073	0.221807313	0.970001169	4.483148966	1.173886204	2.531394224	0.623255356	0.029054818	0.158948125	3.212647348	5.80549049	0	0	2.696216449	2.391463941	0.603654463	0	0	0	0	0	0.000280641	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3944	YES	1a: $350 Per Day (Days 1-7)	1b: $350 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $200	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $50; 7e: $50; 7h: $50	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $20; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $40; 7f: $50; 7g: $40; 14d: 20%; 14e: 20%	7e: $50; 7h: $50	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												6000	3.213	0.087	1.218	0.346	0.553	0.686	0.05	0.146	0.8	0.257	0.379	0.097	0.007	0.027	0.682	0.985	0	0	0.409	0.426	0.091	0.023	0	0	0	0	0	0	0	0											10.482	0		0.918	16.8682	0.436371011	6.997594007	0.346	4.226030096	3.721938073	0.271807313	1.116001169	5.283148966	1.430886204	2.910394224	0.720255356	0.036054818	0.185948125	3.894647348	6.79049049	0	0	3.105216449	2.817463941	0.694654463	0.023	0	0	0	0	0.000280641	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8764
H2775_095_0	2012	3																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	916.743559	23.45509916	612.8690447	72.3872116	386.3238289	20.2862289	1.482123095	257.3388336	421.0769768	7.716052312	16.81764004	4.350079254	7.346228856	316.5182298	4196.055424	6530.309788	0.383510827	609.5275363	19.16050437	11958.28763	4.032491037	8.2493411	0	0	0	0	0.150144908	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.46825549	203.9195381	0.2	0.2	0.261779771	30	10.06908316	19.04971935	19.22032888	0.4	0	0.182948305	3.146393798	0.2	0	0	0	0	0	20	0	0	0											NO	197.8615885	197.8615885	113.6651679	0	126.294631	0.168392841	0.168392841	50.07014254	171.6929521	0.168392841	0.168392841	0.220409197	25.25892619	8.477807611	16.03918184	16.18282895	0.336785683	0	0.154035924	2.649150957	0.168392841	0	0	0	0	0	20	0	0	0												15.1157	0.386738598	5.805155237	0	4.06588545	3.416055723	0.249578919	1.07374934	6.024662434	1.299327972	2.831970189	0.958797475	0.015463154	0.223615055	5.608441329	8.80657386	0.129160956	0	2.951406	2.639942427	0.679042623	0	0	0	0	0	0.000250242	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2815	0		11.6901271	15.1157	0.386738598	5.805155237	0	4.06588545	3.416055723	0.249578919	1.07374934	6.024662434	1.299327972	2.831970189	0.958797475	0.015463154	0.223615055	5.608441329	8.80657386	0.129160956	0	2.951406	2.639942427	0.679042623	0	0	0	0	0	0.000250242	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2815	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.806	0.098	1.462	0	1.024	0.86	0.062	0.27	1.518	0.326	0.71	0.242	0.004	0.056	1.67	2.61	0.032	0	0.74	0.664	0.172	0	0	0	0	0	0	0	0	0											16.326	0		2.922	18.9217	0.484738598	7.267155237	0	5.08988545	4.276055723	0.311578919	1.34374934	7.542662434	1.625327972	3.541970189	1.200797475	0.019463154	0.279615055	7.278441329	11.41657386	0.161160956	0	3.691406	3.303942427	0.851042623	0	0	0	0	0	0.000250242	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6075
H2775_096_0	2012	3																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	933.2351631	23.87704072	623.8941493	73.68940917	393.2735365	21.17392902	1.546978956	261.9681873	428.6518703	8.053697154	17.55355902	4.540438884	7.478382605	322.2121812	4271.539657	6646.942271	0.400292783	620.4925294	19.99894418	12173.40924	4.207080673	8.397741234	0	0	0	0	0.152845914	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.46825549	203.9195381	0.2	0.2	0.255782489	30	10.06908316	19.04971935	19.23492159	0.4	0	0.182948305	3.194559586	0.2	0	0	0	0	0	20	0	0	0											NO	200.3945576	200.3945576	115.1202777	0	127.9114197	0.17054856	0.17054856	50.71112659	173.8909175	0.17054856	0.17054856	0.218116675	25.58228394	8.586338148	16.24451099	16.40244086	0.341097119	0	0.156007849	2.72413768	0.17054856	0	0	0	0	0	20	0	0	0												15.5846	0.398735751	5.985238979	0	4.192014699	3.611183095	0.263835033	1.107058492	6.211555585	1.373546449	2.993734208	0.990345435	0.015942842	0.230551895	5.782422741	9.085506459	0.136538715	0	3.119992271	2.763503566	0.717511549	0	0	0	0	0	0.000254743	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5641	0		11.14930287	15.5846	0.398735751	5.985238979	0	4.192014699	3.611183095	0.263835033	1.107058492	6.211555585	1.373546449	2.993734208	0.990345435	0.015942842	0.230551895	5.782422741	9.085506459	0.136538715	0	3.119992271	2.763503566	0.717511549	0	0	0	0	0	0.000254743	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5641	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.922	0.1	1.506	0	1.056	0.908	0.066	0.278	1.564	0.346	0.75	0.25	0.004	0.058	1.72	2.692	0.034	0	0.782	0.694	0.18	0	0	0	0	0	0	0	0	0											16.91	0		2.786	19.5066	0.498735751	7.491238979	0	5.248014699	4.519183095	0.329835033	1.385058492	7.775555585	1.719546449	3.743734208	1.240345435	0.019942842	0.288551895	7.502422741	11.77750646	0.170538715	0	3.901992271	3.457503566	0.897511549	0	0	0	0	0	0.000254743	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4741
H2775_097_0	2012	3																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	965.1054615	24.69244979	645.2003468	76.20592757	406.7039616	21.76926602	1.590474606	270.91449	443.2904775	8.280139015	18.04710385	4.668098827	7.733771916	333.2158369	4417.41419	6874.143739	0.41154762	641.6825605	20.56124471	12589.1353	4.325822757	8.684526955	0	0	0	0	0.158065654	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.46825549	203.9195381	0.2	0.2	0.2571729	30	10.06908316	19.04971935	19.23148211	0.4	0	0.182948305	3.183176933	0.2	0	0	0	0	0	20	0	0	0											NO	201.1175244	201.1175244	115.5355992	0	128.3728879	0.171163851	0.171163851	50.89407799	174.5182668	0.171163851	0.171163851	0.220093519	25.67457759	8.617315228	16.30311659	16.45867265	0.342327701	0	0.156570682	2.724224105	0.171163851	0	0	0	0	0	20	0	0	0												16.175	0.413840364	6.211967386	0	4.350813507	3.726111396	0.272231758	1.148995265	6.446857151	1.417260477	3.089011787	1.027418297	0.016546777	0.239285492	6.001468213	9.428273464	0.140884151	0	3.219288098	2.857968821	0.74042448	0	0	0	0	0	0.000263443	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9239	0		11.27469009	16.175	0.413840364	6.211967386	0	4.350813507	3.726111396	0.272231758	1.148995265	6.446857151	1.417260477	3.089011787	1.027418297	0.016546777	0.239285492	6.001468213	9.428273464	0.140884151	0	3.219288098	2.857968821	0.74042448	0	0	0	0	0	0.000263443	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9239	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.07	0.104	1.564	0	1.094	0.938	0.068	0.29	1.622	0.356	0.774	0.258	0.004	0.06	1.784	2.792	0.036	0	0.808	0.718	0.186	0	0	0	0	0	0	0	0	0											17.526	0		2.82	20.245	0.517840364	7.775967386	0	5.444813507	4.664111396	0.340231758	1.438995265	8.068857151	1.773260477	3.863011787	1.285418297	0.020546777	0.299285492	7.785468213	12.22027346	0.176884151	0	4.027288098	3.575968821	0.92642448	0	0	0	0	0	0.000263443	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4499
H2775_098_0	2012	3																															A	A	D	V	T	Coin	Coin	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	295.5830608	5.587067651	1740.444183	82.90058531	442.4327285	23.82067014	1.740351325	294.7142107	487.5508806	9.360754357	20.20434937	62.15644094	0.227970799	371.8218082	5138.366062	7552.135996	71.41452963	763.6816679	23.39792777	14179.22028	4.732965757	9.447458889	0	0	0	0	0.171951654	0	0	0											3400	1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	0.2	59.46825549	101.872976	0.2	0.2	179.8834859	0.2	3.55757441	7.774080953	11.97349924	0	0	0.184413686	3.165140745	0.2	0	0	0	0	0	20	0	0	0											NO	302.765653	302.765653	45.41484795	0	113.5371199	0.151382827	0.151382827	45.01236302	77.10909527	0.151382827	0.151382827	136.1563527	0.151382827	2.692778349	5.884311741	9.062910789	0	0	0.139585325	2.395739762	0.151382827	0	0	0	0	0	20	0	0	0												7.4577	0.140964349	6.586833996	0	4.186044811	3.606040375	0.263459303	1.10548192	3.132883942	1.417057453	3.058591515	0.705249524	0.034510864	0.083436143	2.519645646	5.703694567	0	0	3.266007355	2.83081015	0.716489734	0	0	0	0	0	0.000286586	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8152	0		15.0347846	7.4577	0.140964349	6.586833996	0	4.186044811	3.606040375	0.263459303	1.10548192	3.132883942	1.417057453	3.058591515	0.705249524	0.034510864	0.083436143	2.519645646	5.703694567	0	0	3.266007355	2.83081015	0.716489734	0	0	0	0	0	0.000286586	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8152	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.156	0.058	1.131	0.334	0.514	0.553	0.049	0.136	0.627	0.25	0.369	0.093	0.006	0.025	0.507	0.804	0	0	0.4	0.415	0.088	0.022	0	0	0	0	0	0	0	0											8.537	0		1.669	9.6137	0.198964349	7.717833996	0.334	4.700044811	4.159040375	0.312459303	1.24148192	3.759883942	1.667057453	3.427591515	0.798249524	0.040510864	0.108436143	3.026645646	6.507694567	0	0	3.666007355	3.24581015	0.804489734	0.022	0	0	0	0	0.000286586	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3522
H2775_801_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	281.9941302	4.200706641	56.82010775	23.18435038	11.50186713	27.91736655	2.039658229	13.48923472	48.48604841	10.77808898	23.25891405	5.986670921	0.267177386	16.33503012	32.03529673	82.05459185	0.52777736	3.069109071	26.8365075	57.8541007	5.547209312	1.381439431																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.070962016	0.070962016	0.156201419	0	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.177857326	0.1699689	0.1699689	0.157158901	0.167373725	0.339937801	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689																				20.0109	0.298090611	8.875381482	0	1.954959708	4.745084093	0.346678466	2.292750392	8.241120331	1.831939932	3.953292044	1.064773283	0.045411846	2.776447107	5.034632041	13.73378266	0.179411475	0.521653094	4.561371669	9.833397877	0.942853067	0.234801741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4787	0		16.16299274	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143
H2775_802_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	281.9941302	4.200706641	56.82010775	23.18435038	11.50186713	27.91736655	2.039658229	13.48923472	48.48604841	10.77808898	23.25891405	5.986670921	0.267177386	16.33503012	32.03529673	82.05459185	0.52777736	3.069109071	26.8365075	57.8541007	5.547209312	1.381439431																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.070962016	0.070962016	0.156201419	0	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.177857326	0.1699689	0.1699689	0.157158901	0.167373725	0.339937801	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689																				20.0109	0.298090611	8.875381482	0	1.954959708	4.745084093	0.346678466	2.292750392	8.241120331	1.831939932	3.953292044	1.064773283	0.045411846	2.776447107	5.034632041	13.73378266	0.179411475	0.521653094	4.561371669	9.833397877	0.942853067	0.234801741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4787	0		16.16299274	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143
H2775_803_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	281.9941302	4.200706641	56.82010775	23.18435038	11.50186713	27.91736655	2.039658229	13.48923472	48.48604841	10.77808898	23.25891405	5.986670921	0.267177386	16.33503012	32.03529673	82.05459185	0.52777736	3.069109071	26.8365075	57.8541007	5.547209312	1.381439431																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.070962016	0.070962016	0.156201419	0	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689	0.177857326	0.1699689	0.1699689	0.157158901	0.167373725	0.339937801	0.1699689	0.1699689	0.1699689	0.1699689	0.1699689																				20.0109	0.298090611	8.875381482	0	1.954959708	4.745084093	0.346678466	2.292750392	8.241120331	1.831939932	3.953292044	1.064773283	0.045411846	2.776447107	5.034632041	13.73378266	0.179411475	0.521653094	4.561371669	9.833397877	0.942853067	0.234801741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4787	0		16.16299274	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.0109	0.298090611	8.875381482	0	2.293075719	5.565760295	0.406637523	2.292750392	9.666446246	2.148779312	4.637025489	1.248928943	0.053265958	3.256641772	5.905386408	15.96723786	0.210441216	0.611874525	5.350274267	11.53411286	1.105922268	0.27541139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7143
H2802_001_0	2012	6																															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	1513.780599	74.83249579	2055.107987	2132.353392	180.0489848	10.31318954	9.954584122	308.2697174	70.65694439	18.56612938	42.21105579	0	0.426611069	27.03182352	5621.079315	3567.125018	421.4763773	395.4289901	0	0	45.23406235	1109.995571	0	0	42.79069767	162.8571429	5.747389417	2.07930984	79.12724167	0											4900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	66.25287204	0	200	0.2	0.104261172	64.33173406	0.16	0.187568798	0.186659548	0	0.2	0.144741189	12.64121702	39.05956459	38.5	40	0	0	0.2	39.17205164	0	0	40	15	38.52329309	0	0	0											NO	156.9828745	82.2212699	49.96477205	0	150.830509	0.150830509	0.078628828	48.54387572	0.120664407	0.141455487	0.140769773	0	0.150830509	0.109156936	12.10976313	37.41831418	36.88140782	38.31834578	0	0	0.150830509	29.54170243	0	0	40	15	38.52329309	0	0	0												19.8031	0.512735236	8.556916841	0	2.263073335	1.555543627	0.782717286	1.247050571	8.525778308	2.626280867	5.942040756	0	0.064345965	2.950711025	5.672494919	11.12298372	1.295386846	1.262682065	0	0	6.822676647	2.732596572	0	0	0.142635659	0.203571429	0.018450697	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1038	0	NO	21.83730788	19.8031	0.512735236	8.556916841	0	2.263073335	1.555543627	0.782717286	1.247050571	8.525778308	2.626280867	5.942040756	0	0.064345965	2.950711025	5.672494919	11.12298372	1.295386846	1.262682065	0	0	6.822676647	2.732596572	0	0	0.142635659	0.203571429	0.018450697	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1038	NO																																										0	0	0	0	0	0	0	0	0	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	19.8031	0.512735236	8.556916841	0	2.263073335	1.555543627	0.782717286	1.247050571	8.525778308	2.626280867	5.942040756	0	0.064345965	2.950711025	5.672494919	11.12298372	1.295386846	1.262682065	0	0	6.822676647	2.732596572	0	0	0.142635659	0.203571429	0.018450697	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1038
H2803_001_0	2012	7																															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	1281.058676	68.96343089	1116.758652	1235.321093	125.0325816	10.74399086	10.02926052	287.0550795	68.39517875	17.21303575	37.35281082	0	0.685567686	36.51361197	5158.416392	2994.418433	412.5769788	385.997036	0	0	28.13956401	902.9871794	0	0	41.07906977	137.9310345	5.516725369	2.07930984	79.1162209	0											5500	"$395 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-3 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$45/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	228.6871012	107.7372625	67.82324045	0	200	0.2	0.094252616	63.89133968	0.16	0.175126163	0.184761565	0	0.2	0.144068068	12.25936175	42.78252576	38.5	45	0	0	0.2	44.19408847	0	0	45	15	38.51792761	0	0	0											YES	184.7469014	87.03650235	54.79160587	0	161.5717725	0.161571772	0.076142812	51.63674859	0.129257418	0.141477223	0.149261268	0	0.161571772	0.116386666	11.86466226	41.4054034	37.26046317	43.55119072	0	0	0.161571772	35.70258604	0	0	45	15	38.51792761	0	0	0											8400	19.7226	0.500194651	5.099083328	0	1.683477986	1.735925647	0.763656094	1.235215914	8.840584208	2.43525249	5.575327895	0	0.110768386	4.249697549	5.100239025	10.33209193	1.281067444	1.400885877	0	0	4.546559233	2.686581455	0	0	0.154046512	0.172413793	0.017707736	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6434	0	NO	14.67844009	19.7226	0.500194651	5.099083328	0	1.683477986	1.735925647	0.763656094	1.235215914	8.840584208	2.43525249	5.575327895	0	0.110768386	4.249697549	5.100239025	10.33209193	1.281067444	1.400885877	0	0	4.546559233	2.686581455	0	0	0.154046512	0.172413793	0.017707736	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6434	NO	"$495 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$495 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-48 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $19 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1936	0.0087	0.1174	0.1041	0.051	0	0.0737	0.0375	0.4021	0.0738	0.2471	0	0.0034	0.1931	0.2795	0.4948	0.0601	0.0647	0	0	0.2786	0.1216	0	0	0.0071	0	0.0007	0	0	0											2.8126	0	NO	0.532958009	19.9163	0.508913718	5.216444939	0.104102449	1.734521211	1.735925647	0.837354199	1.272669419	9.242655334	2.509089594	5.822393867	0	0.114126895	4.442821505	5.379725258	10.82686987	1.341195878	1.465546461	0	0	4.825135434	2.808200637	0	0	0.161178295	0.172413793	0.018445558	0	0	0	0	0	0	0	0	0	0	0	0	0	80.456
H2803_002_0	2012	6																															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	1114.167911	69.98481376	806.1993964	864.4407933	116.2236878	10.25270833	10.34163263	284.2077235	66.08916742	18.84731616	40.62359952	0	0.330257403	41.55135696	4811.754912	2748.774623	411.6696236	429.1918088	0	0	40.20150352	807.6094153	0	0	41.07906977	137.9310345	10.54774882	2.07930984	115.0037023	0											5500	"$395 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-3 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$45/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	228.6871012	107.7372625	66.27865186	0	200	0.2	0.093635626	63.83532665	0.16	0.168702146	0.180097514	0	0.2	0.14417134	12.0560021	42.50563515	38.5	45	0	0	0.2	43.98681027	0	0	45	15	45	0	0	0											YES	186.5304029	87.87673152	54.06069504	0	163.131547	0.163131547	0.076374622	52.08875843	0.130505238	0.13760321	0.146897931	0	0.163131547	0.117594468	11.68493552	41.2001779	37.31502484	43.6149641	0	0	0.163131547	35.87818203	0	0	45	15	45	0	0	0											8400	17.3188	0.512503057	3.631974976	0	1.579979166	1.67254017	0.789838287	1.233668955	8.624982494	2.593451205	5.967522705	0	0.053875401	4.886209726	4.685420492	9.437500288	1.280121852	1.559932111	0	0	6.558133459	2.414629801	0	0	0.154046512	0.172413793	0.039554058	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1671	0	NO	13.6090839	17.3188	0.512503057	3.631974976	0	1.579979166	1.67254017	0.789838287	1.233668955	8.624982494	2.593451205	5.967522705	0	0.053875401	4.886209726	4.685420492	9.437500288	1.280121852	1.559932111	0	0	6.558133459	2.414629801	0	0	0.154046512	0.172413793	0.039554058	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1671	NO	"$495 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$495 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-48 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $20 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.17	0.0089	0.0864	0.1001	0.0479	0	0.0767	0.0374	0.3922	0.0786	0.2652	0	0.0016	0.2221	0.2604	0.4539	0.0601	0.072	0	0	0.4018	0.1093	0	0	0.0071	0	0.0018	0	0	0											2.8536	0	NO	0.530064275	17.4889	0.521435904	3.718326339	0.100057685	1.627880158	1.67254017	0.866558794	1.271072338	9.017214139	2.672078119	6.232764889	0	0.055508768	5.108265386	4.945806665	9.891394963	1.340204814	1.631932473	0	0	6.959927873	2.523942781	0	0	0.161178295	0.172413793	0.041337408	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0207
H2803_010_0	2012	6																															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	241.3800484	22.073708	34.52282802	3360.210798	13.74753502	21.43042123	13.90989702	32.74229232	46.39364068	17.10576322	35.77520879	0	0	38.03996386	33.78892585	65.54850552	9.436896	4.886186296	0	653.6477795	15.56454831	7.123248471	701.7391304	0	49.29241013	184.6481699	0	0	160.3920985	3591.254769											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.081050056	0.082034469	0.163647743	0	0.224	0.224	0.224	0.130175658	0.224	0.224	0.224	0	0	0.224	0.220720769	0.223788783	0.231622639	0.224	0	0	0.224	0.223276984	0	0	0	0	0	0	0	0											NO	0.06442317	0.065205638	0.130076486	0	0.178047875	0.178047875	0.178047875	0.103485695	0.178047875	0.178047875	0.178047875	0	0	0.178047875	0.175441357	0.177879988	0.18410678	0.178047875	0	0	0.178047875	0.178091189	0	0	0	0	0	0	0	0												15.5505	1.439330212	4.490608152	0	2.447719392	3.815640954	2.476627602	3.388358861	8.260289123	3.045644786	6.369699893	0	0	6.772934719	5.927974994	11.65976735	1.737396531	0.869975086	0	0	2.771234748	1.268587789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2923	150	YES	21.23254845	15.5505	1.439330212	4.490608152	0	2.447719392	3.815640954	2.476627602	3.388358861	8.260289123	3.045644786	6.369699893	0	0	6.772934719	5.927974994	11.65976735	1.737396531	0.869975086	0	0	2.771234748	1.268587789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2923	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												2.2396	0.2048	1.0872	0.779	0.5924	0.9235	0.5832	0.5533	1.6375	0	1.2784	0	0	1.2401	1.8593	4.1401	0.5961	0.3086	0	0	0.9832	0.4479	0	0	0	0	0	0	0	0											19.4542	150	YES	0	17.7901	1.644137812	5.577791134	0.778978655	3.040131022	4.739125108	3.059813969	3.941705647	9.897780375	3.045644786	7.648078472	0	0	8.01305709	7.787246649	15.79984618	2.333489551	1.178616989	0	0	3.754388383	1.716513566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7464
H2803_012_0	2012	6																															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	233.9446925	22.277505	28.6440209	1935.672036	12.17041531	22.77777115	13.37759474	31.42426683	63.09581138	17.14859036	29.95663523	0	0	37.90759662	37.54065523	61.62891459	9.49452	3.747179415	0	607.8041046	12.57969215	7.774827815	701.7391304	0	70.66019223	217.1922709	0	0	160.3920985	3741.993287											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.089243941	0.090327876	0.138048283	0	0.224	0.224	0.124069029	0.123792144	0.224	0.224	0.224	0	0	0.224	0.221082104	0.223688583	0.235318208	0.224	0	0	0.224	0.220263145	0	0	0	0	0	0	0	0											NO	0.074046934	0.074946289	0.114540571	0	0.185855901	0.185855901	0.102941791	0.102724683	0.185855901	0.185855901	0.185855901	0	0	0.185855901	0.183434882	0.185597513	0.195246774	0.185855901	0	0	0.185855901	0.185406775	0	0	0	0	0	0	0	0												17.3229	1.669616328	3.280902515	0	2.261943498	4.233383171	1.377113559	3.228047844	11.72672885	3.187166706	5.567617419	0	0	7.04535051	6.886265655	11.43817329	1.853774402	0.696435405	0	0	2.338010013	1.44150575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5549	150	YES	17.53352454	17.3229	1.669616328	3.280902515	0	2.261943498	4.233383171	1.377113559	3.228047844	11.72672885	3.187166706	5.567617419	0	0	7.04535051	6.886265655	11.43817329	1.853774402	0.696435405	0	0	2.338010013	1.44150575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5549	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												2.1706	0.2067	0.902	0.5713	0.5303	0.9925	0.5711	0.5051	2.2573	0	1.0816	0	0	1.2539	2.0723	3.9357	0.6064	0.2393	0	0	0.8035	0.4879	0	0	0	0	0	0	0	0											19.1876	150	YES	0	19.4935	1.876314828	4.182951792	0.571252238	2.792237975	5.225865838	1.948243646	3.73313658	13.98403275	3.187166706	6.64924992	0	0	8.299289306	8.958598648	15.37384398	2.460190674	0.935768259	0	0	3.141476646	1.929416177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7425
H2803_801_0	2012	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	243.3123127	3.3777265	36.66051564	1303.012195	5.398170974	11.02752817	10.61230502	13.96090529	72.76420591	18.31259017	39.73887732	0	0.72936118	38.83504728	27.6953764	70.76204966	1.526496	5.017577947	0	0	29.77543916	9.570388383	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082792083	0.082792083	0.160109469	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068053575	0.068053575	0.131607049	0	0.184123895	0.184123895	0.184123895	0.184123895	0.184123895	0.184123895	0.184123895	0	0.184123895	0.184123895	0.184123895	0.184123895	0.184123895	0.184123895	0	0	0.184123895	0.184123895	0	0	0	0	0	0	0	0												16.5583	0.229866363	4.824782284	0	0.993932264	2.030431437	1.953978933	2.570536255	13.39762899	3.371785424	7.316876864	0	0.134292821	7.150460157	5.099380568	13.02898418	0.281064389	0.923855994	0	0	5.482369824	1.762137183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1106	150	YES	18.86573669	16.5583	0.229866363	4.824782284	0	0.993932264	2.030431437	1.953978933	2.570536255	13.39762899	3.371785424	7.316876864	0	0.134292821	7.150460157	5.099380568	13.02898418	0.281064389	0.923855994	0	0	5.482369824	1.762137183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1106	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.1012	0.0014	0.0593	0	0.0374	0.0764	0.0735	0.0967	0.5041	0.1269	0.2753	0	0.0051	0.269	0.2269	0.6604	0.0142	0.0468	0	0	0.2779	0.0893	0	0	0	0	0	0	0	0											2.942	150	YES	0	16.6595	0.231271634	4.88407214	0	1.031329902	2.106828333	2.027499232	2.667255104	13.9017274	3.498652028	7.592181251	0	0.139345715	7.419502959	5.326315761	13.68942998	0.295311685	0.970686721	0	0	5.760273923	1.851460808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0526
H2810_001_0	2012	10																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V	P	V		V					V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	320.2622191	6.559911158	356.0384096	0	110.6770821	4.610164202	2.787470551	219.2910808	482.0247631	0	165.3979632	0	0	0	1878.826059	1967.601527	194.2806318	276.5231588	93.3156827	415.8721802	0	321.5984546	0	0	0	0	37.90042558	0	0	0.294828898												$200/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$200/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$50/Day 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$45/Visit for Phys - Specialist; PBP 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"	$75/Procedure for Phys Rad - Diag; PBP 8b	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; $20/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$20/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	200	200	50	0	150	0.2	0.2	65	200	0	75	0	0	0	20	43.1527671	20	20	75	20	0	20	0	0	0	0	20	0	0	20											NO	192.0160335	192.0160335	48.00400839	0	144.0120252	0.192016034	0.192016034	62.4052109	192.0160335	0	72.00601258	0	0	0	19.20160335	41.43011588	19.20160335	19.20160335	72.00601258	19.20160335	0	19.20160335	0	0	0	0	19.20160335	0	0	19.20160335												5.1246	0.104967343	1.424272567	0	1.328235894	0.885225444	0.535239039	1.140408845	7.713040257	0	0.992470652	0	0	0	3.006372731	6.793163273	0.310874969	0.442474001	0.559940852	0.665451054	0	0.514600497	0	0	0	0	0.060645745	0	0	0.000471766	0	0	0	0	0	0	0	0	0	0	31.6025	0	NO	1.312511258	5.1246	0.104967343	1.424272567	0	1.328235894	0.885225444	0.535239039	1.140408845	7.713040257	0	0.992470652	0	0	0	3.006372731	6.793163273	0.310874969	0.442474001	0.559940852	0.665451054	0	0.514600497	0	0	0	0	0.060645745	0	0	0.000471766	0	0	0	0	0	0	0	0	0	0	31.6025	YES	$400/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$400/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$75/Day for SNF; PBP 2	20% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"40% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$65/Case for OP Emergency; PBP 4a	"$400/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Diag; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$35/Visit for Phys - Primary Care; $35/Exam for Physical Exams; $35/Exam for Routine Physical Exams; PBP 4b, 7a"	"$60/Visit for Phys - Specialist; PBP 7d, 7f"	"$35/Visit for Phys - SA; $35/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$35/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	$150/Procedure for Phys Rad - Diag; PBP 8b	"$35/Visit for Phys - Chiro; $35/Visit for Phys - Other; $20/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$35/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	$35/Exam for Routine Eye Exams; PBP 17a	No Cost Sharing; PBP 17b	$35/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"$20/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											3200	1.169	0.0264	0.2594	0.1072	0.1064	0.1762	0.1101	0.073	2.2191	0	0.2786	0	0	0.0053	0.414	0.6876	0.0301	0.0699	0.0981	0.072	0	0.0967	0	0	0.0478	0	0.0113	0	0	0.0001											6.0581	0	NO	0.251717143	6.2936	0.13133847	1.683688768	0.107208729	1.43464869	1.061444713	0.645325276	1.213398288	9.932116535	0	1.271098817	0	0	0.005312929	3.420346134	7.480713656	0.340987562	0.512368444	0.657996146	0.73742483	0	0.611305244	0	0	0.04775286	0	0.071946322	0	0	0.00052651	0	0	0	0	0	0	0	0	0	0	37.6606
H2810_002_0	2012	9																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V	P	V		V					V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	502.747435	8.981981457	276.1330595	0	140.2364725	6.09718491	3.412978793	400.223459	707.4567362	0	399.0136706	0	0	0	2851.711046	2881.327324	226.082448	360.5060517	74.4706686	734.0442184	0	409.1204038	0	0	0	0	32.21631155	0	0	0.251505039												$100/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$100/Days Custom: IP 1-5 for IP MH/SA; 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 Prosth/Supplies; PBP 11b, 11c"	$65/Case for OP Emergency; PBP 4a	"$100/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Case for OP Rad - Diag; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$35/Visit for Phys - Specialist; PBP 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"	$50/Procedure for Phys Rad - Diag; PBP 8b	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	100	100	25	0	100	0.2	0.2	65	100	0	50	0	0	0	10	33.9902455	10	10	50	10	0	10	0	0	0	0	10	0	0	10											NO	95.17864936	95.17864936	23.79466234	0	95.17864936	0.190357299	0.190357299	61.86612208	95.17864936	0	47.58932468	0	0	0	9.517864936	32.35145658	9.517864936	9.517864936	47.58932468	9.517864936	0	9.517864936	0	0	0	0	9.517864936	0	0	9.517864936												3.9876	0.071241072	0.547541076	0	1.112293171	1.160643649	0.649685424	2.063356115	5.611231386	0	1.58239926	0	0	0	2.261850047	7.767927983	0.179318517	0.285937326	0.295334069	0.582211144	0	0.324496062	0	0	0	0	0.025552542	0	0	0.000199483	0	0	0	0	0	0	0	0	0	0	28.5088	0	NO	1.399140446	3.9876	0.071241072	0.547541076	0	1.112293171	1.160643649	0.649685424	2.063356115	5.611231386	0	1.58239926	0	0	0	2.261850047	7.767927983	0.179318517	0.285937326	0.295334069	0.582211144	0	0.324496062	0	0	0	0	0.025552542	0	0	0.000199483	0	0	0	0	0	0	0	0	0	0	28.5088	YES	$300/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$300/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$50/Day for SNF; PBP 2	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"40% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$65/Case for OP Emergency; PBP 4a	"$300/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Diag; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$25/Visit for Phys - Primary Care; $25/Exam for Physical Exams; $25/Exam for Routine Physical Exams; PBP 4b, 7a"	"$50/Visit for Phys - Specialist; PBP 7d, 7f"	"$25/Visit for Phys - SA; $25/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$25/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	$100/Procedure for Phys Rad - Diag; PBP 8b	"$25/Visit for Phys - Chiro; $25/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$25/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	$25/Exam for Routine Eye Exams; PBP 17a	No Cost Sharing; PBP 17b	$25/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											2500	1.3545	0.0256	0.1245	0.0761	0.0577	0.1414	0.0872	0.0661	2.4519	0	0.4608	0	0	0.0031	0.3465	0.6649	0.0228	0.0391	0.0638	0.0659	0	0.0852	0	0	0.0375	0	0.0067	0	0	0											6.1812	0	NO	0.307963015	5.3421	0.09688624	0.672034523	0.076090512	1.169999963	1.302007444	0.736860247	2.129479411	8.063098849	0	2.04324116	0	0	0.003088139	2.608381358	8.432828567	0.202105319	0.324992565	0.359133462	0.648089954	0	0.409683214	0	0	0.037506731	0	0.032211436	0	0	0.000223204	0	0	0	0	0	0	0	0	0	0	34.69
H2816_001_0	2012	2																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	295.3834022	5.583293733	1739.268559	82.84458814	442.1338768	23.87210584	31.08738256	294.515139	487.2215528	9.078278545	19.59465064	62.11445589	0.221091414	371.5706523	5134.89523	7548.440329	71.36629099	763.1658209	22.52637695	14169.64258	4.592576765	9.441077377	0	0	0	0	0.171835505	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	134.6482671	59.46825549	101.872976	0.2	0.2	0	0.2	3.55757441	7.774080953	11.95339676	0	0	0.184602004	3.093263839	0.2	0	0	0	0	0	20	0	0	0											NO	297.2027405	297.2027405	44.58041108	0	111.4510277	0.14860137	100.0445849	44.18532127	75.69231914	0.14860137	0.14860137	0	0.14860137	2.643302161	5.776195411	8.881455691	0	0	0.137160554	2.298316225	0.14860137	0	0	0	0	0	20	0	0	0												7.3157	0.13828085	6.461442277	0	4.106356245	3.547427638	0.259177024	1.084437169	3.073244105	1.349044631	2.911791935	0	0.032854487	0.081847792	2.471679855	5.586761527	0	0	3.089730332	2.713859955	0.6824632	0	0	0	0	0	0.000286393	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9064	0		15.77153885	7.3157	0.13828085	6.461442277	0	4.106356245	3.547427638	0.259177024	1.084437169	3.073244105	1.349044631	2.911791935	0	0.032854487	0.081847792	2.471679855	5.586761527	0	0	3.089730332	2.713859955	0.6824632	0	0	0	0	0	0.000286393	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9064	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.1268	0.0574	1.1156	0.3147	0.5069	0.5205	0.0456	0.1339	0.6187	0.2349	0.3472	0.0874	0.006	0.0248	0.4979	0.7917	0	0	0.3768	0.3911	0.0828	0.0206	0	0	0	0	0	0	0	0											8.3011	0		1.752393205	9.4425	0.195668063	7.577092101	0.314662511	4.613226115	4.067894571	0.304807746	1.218295143	3.691908551	1.583976907	3.258968183	0.087372806	0.038831713	0.106627139	2.969529872	6.378438499	0	0	3.466516637	3.104964212	0.765262128	0.020603478	0	0	0	0	0.000313732	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2075
H2816_002_0	2012	2																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	328.3786376	3.300892201	2533.320522	78.3515257	485.2877136	19.37435275	14.8061297	247.0518224	545.6765695	12.34001052	25.73170153	51.685762	0.191109143	507.9858795	6255.072912	8811.100101	56.66638965	975.9149456	20.58663292	11881.33429	4.22068609	9.656929431	0	0	0	0	0.538900539	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	110.9551019	62.20616592	102.1062434	0.2	0.2	0	0.2	3.247630839	7.622493732	12.2670269	0	0	0.17814948	3.642187883	0.2	0	0	0	0	0	20	0	0	0											NO	306.2187022	306.2187022	45.93280533	0	114.8320133	0.153109351	84.94131824	47.62172849	78.16710333	0.153109351	0.153109351	0	0.153109351	2.486213251	5.835375345	9.390982642	0	0	0.136381756	2.788265117	0.153109351	0	0	0	0	0	20	0	0	0												8.3796	0.08423291	9.696876532	0	4.643880433	2.966394577	0.104804348	0.980419567	3.5544964	1.889371003	3.939764124	0	0.029260597	0.105246769	3.041724854	6.895407342	0	0	2.807641152	2.760692495	0.646226508	0	0	0	0	0	0.000898168	0	0	0	0	0	0	0	0	0	0	0	0	0	52.527	0		16.26478588	8.3796	0.08423291	9.696876532	0	4.643880433	2.966394577	0.104804348	0.980419567	3.5544964	1.889371003	3.939764124	0	0.029260597	0.105246769	3.041724854	6.895407342	0	0	2.807641152	2.760692495	0.646226508	0	0	0	0	0	0.000898168	0	0	0	0	0	0	0	0	0	0	0	0	0	52.527	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.5988	0.0333	1.6587	0.2426	0.5679	0.4525	0.0192	0.1199	0.7079	0.3295	0.4705	0.0703	0.0053	0.0315	0.6107	0.9633	0	0	0.3381	0.3729	0.0785	0.0187	0	0	0	0	0.0001	0	0	0											9.6901	0		1.807198431	10.9784	0.117531596	11.3555475	0.242572019	5.211752919	3.418919477	0.123989892	1.100309238	4.262412961	2.218914834	4.410242275	0.070306308	0.034592321	0.136772591	3.652451187	7.85866426	0	0	3.14569616	3.133571443	0.724736308	0.018717224	0	0	0	0	0.001004093	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2171
H2816_007_0	2012	4																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1101.041329	23.52419326	1686.129776	58.96582623	478.4490708	20.97550662	17.58476904	261.9888173	408.3680521	10.55340729	16.66091216	63.37743532	0.025416412	435.8194786	5571.633828	8046.619311	93.80606194	1260.299552	26.07241127	13273.31224	4.625934628	12.17085033	0	0	0	0	0.404464298	0	0	0											4400	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $40; 7e: $40; 7h: $40	12: 20%	3: $35; 7c: $35; 7i: $35	7a : $15; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $35; 7f: $45; 7g: $35; 14d: $0; 14e: $0	7e: $40; 7h: $40	7c: $35; 7i: $35; 3: $35	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	60	0	150	0.2	119.0315747	58.07760243	173.4736694	0.2	0.2	0	0.2	6.469898601	11.16220966	15.65372368	0	0	0.184845606	3.300063318	0.2	0	0	0	0	0	20	0	0	0											NO	155.5461998	155.5461998	39.71392336	0	99.2848084	0.132379745	78.78684723	38.44149087	114.8220002	0.132379745	0.132379745	0	0.132379745	4.28241762	7.388252319	10.36117971	0	0	0.122349071	2.184307695	0.132379745	0	0	0	0	0	20	0	0	0												14.2719	0.304924906	5.580235724	0	3.95856036	2.776732208	0.115454043	0.839270061	3.907469713	1.39705736	2.205567295	0	0.003364618	0.155530085	3.430386379	6.947705727	0	0	3.189935292	2.416083172	0.612380044	0	0	0	0	0	0.000674107	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1132	0		26.92928723	14.2719	0.304924906	5.580235724	0	3.95856036	2.776732208	0.115454043	0.839270061	3.907469713	1.39705736	2.205567295	0	0.003364618	0.155530085	3.430386379	6.947705727	0	0	3.189935292	2.416083172	0.612380044	0	0	0	0	0	0.000674107	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1132	YES	1a: $350 Per Day (Days 1-7)	1b: $350 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $200	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $50; 7e: $50; 7h: $50	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $20; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $40; 7f: $50; 7g: $40; 14d: 20%; 14e: 20%	7e: $50; 7h: $50	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												6000	3.4534	0.078	1.2091	0.2146	0.6132	0.6135	0.0255	0.13	0.6949	0.3085	0.3338	0.0827	0.0008	0.0272	0.7683	1.1896	0	0	0.496	0.4296	0.0932	0.0197	0	0	0	0	0	0	0	0											10.7816	0		0.900913361	17.7253	0.382971708	6.789293003	0.214609371	4.571719239	3.390198549	0.140961425	0.969268303	4.602409626	1.70560147	2.539321504	0.082745974	0.004132751	0.182745998	4.198665441	8.137340675	0	0	3.685887637	2.845701561	0.705611911	0.019692603	0	0	0	0	0.000718047	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8949
H2816_008_0	2012	4																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1043.561081	15.88258583	425.0287517	55.2332541	389.7171558	16.72942118	39.21385586	261.2652716	349.7935569	9.522285035	16.35482803	2.900051085	13.57527915	319.0752637	3839.656308	5771.581137	0.501652382	348.9203097	13.46850306	7998.520352	3.221316893	11.76861884	0	0	0	0	0.019235618	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	138.8606664	61.40167525	211.0120124	0.2	0.2	0.31101568	30	7.898515506	18.55690198	16.7104928	0.4	0	0.173632262	3.653964882	0.2	0	0	0	0	0	20	0	0	0											NO	200.170036	200.170036	114.9912973	0	127.7681081	0.170357477	118.2797642	52.30117253	179.7373707	0.170357477	0.170357477	0.264919234	25.55362161	6.727855885	15.80653505	14.233787	0.340714955	0	0.147897771	3.1124012	0.170357477	0	0	0	0	0	20	0	0	0												17.4075	0.264934815	4.072883961	0	4.149451973	2.849981992	0.386517135	1.13870667	5.239247851	1.622192458	2.786167246	0.768279311	0.028908129	0.178891033	5.057638501	6.845954715	0.170920469	0	1.991961579	2.074550362	0.54877542	0	0	0	0	0	3.21E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5835	0		10.0196264	17.4075	0.264934815	4.072883961	0	4.149451973	2.849981992	0.386517135	1.13870667	5.239247851	1.622192458	2.786167246	0.768279311	0.028908129	0.178891033	5.057638501	6.845954715	0.170920469	0	1.991961579	2.074550362	0.54877542	0	0	0	0	0	3.21E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5835	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.3775	0.0666	1.0242	0	1.0435	0.7153	0.097	0.2864	1.3175	0.4045	0.6933	0.1932	0.0073	0.045	1.5031	2.0249	0.0423	0	0.4916	0.5166	0.1371	0	0	0	0	0	0	0	0	0											14.9868	0		2.5049066	21.7849	0.331557899	5.097090953	0	5.192913501	3.565238087	0.483520814	1.425056919	6.556760045	2.026685442	3.479496501	0.961457278	0.036177648	0.223876711	6.560725613	8.870893107	0.213257494	0	2.483596956	2.591165864	0.685881235	0	0	0	0	0	4.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5703
H2816_009_0	2012	4																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	942.3879007	29.77843909	948.0427171	68.38192054	441.2647572	15.48896284	11.58513276	243.054983	466.5994363	12.04235556	21.85283389	8.287508377	2.67839763	477.6246658	4844.253822	6840.049713	0.508312597	898.4918769	16.60982263	11505.1601	3.511588775	7.680537708	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	110.0238998	62.73440657	209.9684258	0.2	0.2	0.475497958	30	7.910269311	19.23202247	18.20683317	0.4	0	0.179334494	3.476224849	0.2	0	0	0	0	0	0	0	0	0											NO	199.6642108	199.6642108	114.7007168	0	127.4452409	0.169926988	93.48014945	53.30134373	178.3965107	0.169926988	0.169926988	0.403999679	25.48904818	6.720841186	16.34019825	15.4691616	0.339853976	0	0.152368852	2.953522089	0.169926988	0	0	0	0	0	0	0	0	0												15.6801	0.495474045	9.061764935	0	4.68642444	2.631992802	0.090248328	1.079596433	6.936642612	2.046321208	3.71338624	3.348150721	0.005689151	0.267503294	6.596338985	8.817486195	0.172752057	0	2.530819604	2.831728707	0.596713703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5891	0		12.66956324	15.6801	0.495474045	9.061764935	0	4.68642444	2.631992802	0.090248328	1.079596433	6.936642612	2.046321208	3.71338624	3.348150721	0.005689151	0.267503294	6.596338985	8.817486195	0.172752057	0	2.530819604	2.831728707	0.596713703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5891	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.9429	0.1246	2.2787	0	1.1784	0.6718	0.023	0.2715	1.7443	0.5105	0.9245	0.8419	0.0014	0.0673	1.9603	2.5629	0.0424	0	0.6182	0.7017	0.1491	0	0	0	0	0	0	0	0	0											18.6152	0		3.167390809	19.623	0.620065063	11.34042015	0	5.864864352	3.303759427	0.113282516	1.351069822	8.680918363	2.556784783	4.637839174	4.190004745	0.007119734	0.334769194	8.556625069	11.38042649	0.215102869	0	3.149031768	3.533407387	0.745855527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2043
H2816_010_0	2012	5																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1234.782854	29.31588315	789.6747947	84.74970674	466.6527671	24.32515122	16.71805097	239.086949	580.4328685	13.41497587	25.21747907	6.826919884	9.331945604	407.286503	4720.469641	8079.508702	0.368213484	956.8954465	17.19345193	12085.56597	4.177921637	10.35763752	0	0	0	0	0.058601871	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		234.8956691	235	135	0	150	0.2	121.9846976	62.21967589	194.3730503	0.2	0.2	0.18672401	30	8.607959349	19.09282561	18.60885838	0.4	0	0.170705144	3.651050513	0.2	0	0	0	0	0	20	0	0	0											NO	206.6159464	206.7077166	118.7469861	0	131.9410957	0.175921461	107.2986311	54.72888141	170.9719549	0.175921461	0.175921461	0.164243803	26.38821914	7.571623922	16.79418887	16.36848777	0.351842922	0	0.150153492	3.211490701	0.175921461	0	0	0	0	0	20	0	0	0												21.2605	0.504984939	7.814291825	0	5.130889784	4.27931614	0.149485332	1.09041344	8.269811851	2.359982154	4.436295759	1.121279283	0.020521119	0.256985019	6.60637156	11.02077828	0.129553308	0	2.581656844	3.234390228	0.734986078	0	0	0	0	0	9.77E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0026	0		11.08688692	21.2605	0.504984939	7.814291825	0	5.130889784	4.27931614	0.149485332	1.09041344	8.269811851	2.359982154	4.436295759	1.121279283	0.020521119	0.256985019	6.60637156	11.02077828	0.129553308	0	2.581656844	3.234390228	0.734986078	0	0	0	0	0	9.77E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0026	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.3362	0.1267	1.9613	0	1.2878	0.9206	0.0322	0.2737	2.0756	0.5894	1.1058	0.2814	0.0052	0.0645	1.9596	3.2512	0.0323	0	0.6417	0.8081	0.1839	0	0	0	0	0	0	0	0	0											20.9373	0		2.77172173	26.5966	0.631731605	9.775608609	0	6.418696853	5.199927722	0.181644192	1.364097381	10.34546005	2.949422713	5.542103737	1.402651904	0.025671735	0.321485942	8.565991194	14.27196171	0.161873739	0	3.223404402	4.042451223	0.918912005	0	0	0	0	0	0.000122087	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9399
H2816_013_0	2012	5																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	262.9744589	2.529683829	1031.496975	61.91305311	382.1760254	22.06543954	20.29276445	250.8226046	495.6163998	11.59658385	15.35557715	61.18149843	0.047465909	462.4022853	6486.383182	8191.935613	76.54199531	1662.217818	23.2918442	15240.73067	5.938222943	5.495296134	0	0	0	0	0	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		399.73071	400	60	0	150	0.2	112.9889072	56.52594726	108.8071478	0.2	0.2	0	0.2	3.177690578	7.276766012	14.36458504	0	0	0.184680215	3.428376056	0.2	0	0	0	0	0	0	0	0	0											NO	298.5414353	298.7425562	44.81138343	0	112.0284586	0.149371278	84.38648741	42.21676494	81.2633137	0.149371278	0.149371278	0	0.149371278	2.373278515	5.434699198	10.72828213	0	0	0.137929599	2.560504567	0.149371278	0	0	0	0	0	0	0	0	0												6.5424	0.062977018	3.851900539	0	3.567882586	3.295942905	0.142702926	0.882409912	3.356285914	1.732196551	2.293682185	0	0.007090044	0.091450784	2.937628456	7.323783038	0	0	3.21263472	3.251996706	0.886999951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.44	0		14.91385482	6.5424	0.062977018	3.851900539	0	3.567882586	3.295942905	0.142702926	0.882409912	3.356285914	1.732196551	2.293682185	0	0.007090044	0.091450784	2.937628456	7.323783038	0	0	3.21263472	3.251996706	0.886999951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.44	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.0182	0.0354	0.6631	0.2149	0.4391	0.4821	0.0251	0.1086	0.6484	0.3008	0.2727	0.0725	0.0013	0.0276	0.6261	1.0332	0	0	0.3979	0.4727	0.1073	0.0241	0	0	0	0	0	0	0	0											7.971	0		1.65709498	8.5606	0.098332554	4.515020322	0.214896215	4.006988103	3.778088013	0.167753184	0.991009635	4.004682838	2.032964827	2.56635472	0.072538303	0.008376136	0.119091713	3.563724912	8.356982154	0	0	3.610554412	3.724689842	0.99429507	0.024084847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.411
H2816_014_0	2012	4																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	297.976836	1.697602042	1437.267586	65.77364325	363.3029734	23.36308093	14.87582003	246.9780983	608.5067646	14.39706074	28.34279457	39.47087572	2.342297944	541.317076	6839.555303	8408.661958	82.17953051	1424.099727	20.16462166	12978.08999	6.213075612	10.94571862	0	0	0	0	0.523806814	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	106.778217	61.8616095	105.75204	0.2	0.2	0	0.2	3.155043698	7.491546231	13.73897132	0	0	0.180912363	3.48643266	0.2	0	0	0	0	0	20	0	0	0											NO	309.5840139	309.5840139	46.43760209	0	116.0940052	0.154792007	82.64207258	47.87841344	81.84785255	0.154792007	0.154792007	0	0.154792007	2.44187773	5.798157381	10.63341472	0	0	0.140018939	2.698359543	0.154792007	0	0	0	0	0	20	0	0	0												7.6874	0.043795871	5.561938355	0	3.514774774	3.616418187	0.102447383	0.985409958	4.150414329	2.228549927	4.387238054	0	0.362569	0.110152509	3.304734839	7.45106582	0	0	2.823428922	2.918296081	0.961734443	0	0	0	0	0	0.000873011	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2112	0		14.79254811	7.6874	0.043795871	5.561938355	0	3.514774774	3.616418187	0.102447383	0.985409958	4.150414329	2.228549927	4.387238054	0	0.362569	0.110152509	3.304734839	7.45106582	0	0	2.823428922	2.918296081	0.961734443	0	0	0	0	0	0.000873011	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2112	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.17	0.0192	0.9424	0.237	0.4258	0.5465	0.0186	0.1194	0.8022	0.3851	0.519	0.0583	0.0654	0.0327	0.6671	1.0321	0	0	0.3385	0.3988	0.1157	0.0125	0	0	0	0	0.0001	0	0	0											8.9063	0		1.643616457	9.8574	0.062973122	6.504387591	0.236969725	3.940540517	4.162925055	0.121025389	1.104778575	4.952663172	2.613604003	4.906233869	0.05826788	0.428014321	0.142862266	3.971794473	8.483126438	0	0	3.161938496	3.317080529	1.077477889	0.012500242	0	0	0	0	0.00097069	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1175
H2816_019_0	2012	6																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	825.0068235	34.09379634	1423.211069	59.01180395	415.0409365	21.50361258	15.86062051	283.4182329	396.9193099	7.735848196	12.06878701	61.743795	0.101406436	341.9516476	4880.651724	6136.836091	84.66480648	481.5163879	19.60747143	11506.95628	3.207460688	5.293411155	0	0	0	0	0.053716208	0	0	0											4400	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $40; 7e: $40; 7h: $40	12: 20%	3: $35; 7c: $35; 7i: $35	7a : $15; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $35; 7f: $45; 7g: $35; 14d: $0; 14e: $0	7e: $40; 7h: $40	7c: $35; 7i: $35; 3: $35	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	60	0	150	0.2	239.9082824	58.00678226	171.6269201	0.2	0.2	0	0.2	4.933369684	11.24615071	14.74292642	0	0	0.18598051	3.206283077	0.2	0	0	0	0	0	20	0	0	0											NO	139.3576286	139.3576286	35.58067114	0	88.95167785	0.118602237	142.268295	34.39867073	101.7766834	0.118602237	0.118602237	0	0.118602237	2.925543406	6.669093168	8.742720274	0	0	0.110288522	1.901361729	0.118602237	0	0	0	0	0	20	0	0	0												9.5809	0.395935884	4.219900417	0	3.076548973	2.550376559	0.18803862	0.812434206	3.366427579	0.917488902	1.431385139	0	0.01202703	0.083366199	2.712460089	4.471053443	0	0	2.162479054	1.823240524	0.380412013	0	0	0	0	0	8.95E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1846	0		26.55459383	9.5809	0.395935884	4.219900417	0	3.076548973	2.550376559	0.18803862	0.812434206	3.366427579	0.917488902	1.431385139	0	0.01202703	0.083366199	2.712460089	4.471053443	0	0	2.162479054	1.823240524	0.380412013	0	0	0	0	0	8.95E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1846	YES	1a: $350 Per Day (Days 1-7)	1b: $350 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $200	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $50; 7e: $50; 7h: $50	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $20; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $40; 7f: $50; 7g: $40; 14d: 20%; 14e: 20%	7e: $50; 7h: $50	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												6000	2.5744	0.1125	1.0153	0.2328	0.5292	0.6257	0.0461	0.1397	0.6718	0.225	0.2405	0.0645	0.003	0.0162	0.6737	0.8641	0	0	0.3734	0.3658	0.0643	0.0098	0	0	0	0	0	0	0	0											8.848	0		0.788407854	12.1553	0.508470305	5.235201452	0.232784777	3.605722219	3.176066748	0.234170599	0.952174691	4.038232421	1.142499067	1.671910701	0.064546526	0.015076031	0.099565882	3.386148031	5.335178131	0	0	2.53584464	2.189051805	0.444719606	0.009814955	0	0	0	0	9.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0325
H2816_020_0	2012	6																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	894.103551	9.646282336	385.9342586	53.87974764	364.9816827	17.78448009	27.49064021	264.1464109	528.8724912	11.31440822	24.87814304	4.271167427	1.7665257	429.6473523	5088.905842	6588.167412	0.333627737	602.2447563	16.55887875	9961.831416	3.330933336	9.832309855	0	0	0	0	0.036104897	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	101.7851356	61.36332634	203.0933121	0.2	0.2	0.261572018	30	7.723580516	18.16545216	19.1605205	0.4	0	0.179320104	3.660197657	0.2	0	0	0	0	0	20	0	0	0											NO	195.8728509	195.8728509	112.5227016	0	125.025224	0.166700299	84.83806246	51.14642413	169.2785789	0.166700299	0.166700299	0.218020667	25.0050448	6.437615893	15.1409315	15.97032245	0.333400597	0	0.149463575	3.050780212	0.166700299	0	0	0	0	0	20	0	0	0												14.5942	0.157453735	3.618863784	0	3.802659719	2.964678143	0.194354388	1.125845364	7.460565309	1.886115229	4.147193874	0.931202772	0.003681005	0.230492052	6.420897899	8.767929827	0.111231687	0	2.474949214	2.53261318	0.555267582	0	0	0	0	0	6.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9803	0		12.38103699	14.5942	0.157453735	3.618863784	0	3.802659719	2.964678143	0.194354388	1.125845364	7.460565309	1.886115229	4.147193874	0.931202772	0.003681005	0.230492052	6.420897899	8.767929827	0.111231687	0	2.474949214	2.53261318	0.555267582	0	0	0	0	0	6.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9803	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	1.6346	0.0176	0.4053	0	0.4259	0.3314	0.0217	0.1261	0.8356	0.2095	0.4597	0.1042	0.0004	0.0258	0.8499	1.1576	0.0123	0	0.2721	0.2811	0.0618	0	0	0	0	0	0	0	0	0											7.2326	0		1.375670776	16.2288	0.175089009	4.024186996	0	4.228568608	3.296069016	0.216079265	1.251943301	8.296170205	2.095584526	4.606847004	1.035405202	0.004093288	0.256307829	7.270813245	9.925552553	0.123503206	0	2.747015488	2.813676466	0.617053643	0	0	0	0	0	6.69E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2128
H2816_021_0	2012	8																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	926.3319307	20.78940772	418.4209747	67.6307897	321.0172253	15.54890731	10.88474304	244.3874058	422.1794834	9.675033346	21.43564753	4.411105954	9.899519507	442.4905453	4502.388718	6311.009305	0.589962466	765.3416214	17.59958452	11300.24568	4.225778702	13.19990588	0	0	0	0	0.038685072	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	111.9907464	61.24966609	207.0331683	0.2	0.2	0.507126679	30	7.921195218	18.91892653	18.6033293	0.4	0	0.179483007	3.352116397	0.2	0	0	0	0	0	20	0	0	0											NO	203.4752111	203.4752111	116.8900149	0	129.8777943	0.173170392	96.96740756	53.03314358	179.2600751	0.173170392	0.173170392	0.43909663	25.97555887	6.858582424	16.38098966	16.10772918	0.346340785	0	0.155405714	2.90243656	0.173170392	0	0	0	0	0	20	0	0	0												15.7071	0.35251076	4.075769498	0	3.474417431	2.692610382	0.087955443	1.080052698	6.306660491	1.675429322	3.712019496	1.936901759	0.021428796	0.252904823	6.146131919	8.471335727	0.204328063	0	2.735075994	2.733187184	0.731779756	0	0	0	0	0	6.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3977	0		9.667379881	15.7071	0.35251076	4.075769498	0	3.474417431	2.692610382	0.087955443	1.080052698	6.306660491	1.675429322	3.712019496	1.936901759	0.021428796	0.252904823	6.146131919	8.471335727	0.204328063	0	2.735075994	2.733187184	0.731779756	0	0	0	0	0	6.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3977	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.9499	0.0886	1.0249	0	0.8737	0.6873	0.0225	0.2716	1.5859	0.418	0.9242	0.487	0.0054	0.0636	1.8266	2.5038	0.0501	0	0.6681	0.6762	0.1829	0	0	0	0	0	0	0	0	0											16.3102	0		2.41684497	19.657	0.44115666	5.100703465	0	4.348129363	3.379880862	0.110405471	1.351653607	7.892596732	2.093392009	4.636175688	2.423861778	0.026817496	0.316502812	7.972712416	10.97508996	0.25442221	0	3.403212229	3.409388155	0.914689015	0	0	0	0	0	8.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7079
H2816_022_0	2012	9																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1079.719897	28.51743018	519.0058982	71.29594428	472.7453258	24.67838728	32.00226232	240.470028	495.7396445	7.755502117	22.90332415	3.250218946	3.88096719	349.0182967	4692.54482	7585.813747	0.77472022	1189.088202	14.82053379	12626.69963	4.5285153	5.198174807	0	0	0	0	0.079320625	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		230.9176312	235	135	0	150	0.2	150.1187047	61.57604046	197.1037912	0.2	0.2	0.260462552	30	8.289697836	19.01997379	18.33591756	0.4	0	0.169884664	3.540256241	0.2	0	0	0	0	0	20	0	0	0											NO	204.1816306	207.7913364	119.3694911	0	132.6327679	0.176843691	132.7377288	54.44667122	174.2828093	0.176843691	0.176843691	0.230305795	26.52655358	7.329903795	16.8178118	16.21295665	0.353687381	0	0.150215155	3.130359896	0.176843691	0	0	0	0	0	20	0	0	0												18.3716	0.493806244	5.162789163	0	5.225126757	4.364217083	0.353992302	1.091066046	7.199908161	1.371511617	4.050308368	0.748544257	0.008579057	0.213189211	6.57652797	10.24903912	0.274008766	0	2.226268776	3.293842845	0.800839358	0	0	0	0	0	0.000132201	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0753	0		9.437681239	18.3716	0.493806244	5.162789163	0	5.225126757	4.364217083	0.353992302	1.091066046	7.199908161	1.371511617	4.050308368	0.748544257	0.008579057	0.213189211	6.57652797	10.24903912	0.274008766	0	2.226268776	3.293842845	0.800839358	0	0	0	0	0	0.000132201	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0753	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.611	0.1239	1.2958	0	1.3115	0.9389	0.0762	0.2739	1.8071	0.3426	1.0096	0.1878	0.0022	0.0535	1.9508	3.0275	0.0683	0	0.5534	0.8224	0.2004	0	0	0	0	0	0	0	0	0											18.6569	0		2.35942031	22.9826	0.617748585	6.458617605	0	6.536601553	5.303104259	0.430147732	1.364916937	9.007040988	1.714066492	5.05991528	0.936393314	0.010732348	0.266698397	8.527317683	13.27653619	0.342346894	0	2.779680107	4.116272926	1.001244281	0	0	0	0	0	0.000165251	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7322
H2816_025_0	2012	2																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	277.5111135	5.245474354	1634.033432	77.83204381	415.382393	21.78921067	29.20642827	276.6953849	457.7420215	8.744613153	18.8744638	58.35619635	0.212965363	349.0886241	4824.206379	7089.881144	67.04824554	716.9901733	22.28230567	13312.3028	4.42183002	8.869841284	0	0	0	0	0.16143853	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	130.814909	59.46825549	101.872976	0.2	0.2	0	0.2	3.55757441	7.774080953	11.98131371	0	0	0.184343623	3.193296048	0.2	0	0	0	0	0	20	0	0	0											NO	298.3557041	298.3557041	44.75335561	0	111.883389	0.149177852	97.5734357	44.35673309	75.98595871	0.149177852	0.149177852	0	0.149177852	2.653556545	5.79860349	8.936733219	0	0	0.137499929	2.381845227	0.149177852	0	0	0	0	0	20	0	0	0												6.8998	0.130418099	6.094039938	0	3.872865822	3.250467645	0.237480963	1.022775278	2.898497195	1.304502607	2.815651967	0	0.031769715	0.077193867	2.331138329	5.280031362	0	0	3.06381544	2.642320406	0.659639104	0	0	0	0	0	0.000269064	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6126	0		14.73953656	6.8998	0.130418099	6.094039938	0	3.872865822	3.250467645	0.237480963	1.022775278	2.898497195	1.304502607	2.815651967	0	0.031769715	0.077193867	2.331138329	5.280031362	0	0	3.06381544	2.642320406	0.659639104	0	0	0	0	0	0.000269064	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6126	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	4.511	0.1217	2.3663	0.6921	1.0751	1.1448	0.1004	0.2839	1.3122	0.5168	0.7637	0.192	0.0131	0.0526	1.0599	1.6813	0	0	0.8274	0.8595	0.182	0.0453	0	0	0	0	0.0001	0	0	0											17.8013	0		3.684884141	11.4108	0.252139238	8.460388805	0.692134538	4.947962072	4.395291471	0.337850716	1.30669471	4.210715312	1.82126179	3.579304018	0.192005532	0.044917275	0.129752096	3.391074523	6.961335912	0	0	3.891234864	3.501828615	0.84164885	0.045319598	0	0	0	0	0.000328778	0	0	0	0	0	0	0	0	0	0	0	0	0	60.414
H2816_026_0	2012	2																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	344.2797857	6.507526	2027.178921	96.55829284	515.3226458	33.25920261	36.23344211	343.2677942	567.8739243	10.93615128	24.25318327	72.39659169	0.273654819	433.0787159	5984.901712	8794.826418	83.17993219	889.4967127	28.17141608	16507.57062	5.678298932	11.00390906	0	0	0	0	0.200280349	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	160.952021	59.46825549	101.872976	0.2	0.2	0	0.2	3.55757441	7.774080953	11.99182129	0	0	0.184252021	3.228822899	0.2	0	0	0	0	0	20	0	0	0											NO	322.3262269	322.3262269	48.34893404	0	120.8723351	0.161163113	129.6976441	47.92044604	82.09082996	0.161163113	0.161163113	0	0.161163113	2.866748842	6.264475453	9.663196275	0	0	0.148473147	2.601835756	0.161163113	0	0	0	0	0	20	0	0	0												9.2475	0.174795525	8.167661663	0	5.190687627	5.360156644	0.391616007	1.370795484	3.884770146	1.762504189	3.908718527	0	0.044103063	0.103460659	3.124355822	7.082177824	0	0	4.182698802	3.579165623	0.915132335	0	0	0	0	0	0.000333801	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4907	0		14.30566568	9.2475	0.174795525	8.167661663	0	5.190687627	5.360156644	0.391616007	1.370795484	3.884770146	1.762504189	3.908718527	0	0.044103063	0.103460659	3.124355822	7.082177824	0	0	4.182698802	3.579165623	0.915132335	0	0	0	0	0	0.000333801	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4907	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.6042	0.0703	1.3661	0.4151	0.6206	0.6867	0.0602	0.1639	0.7575	0.3065	0.458	0.1151	0.0079	0.0303	0.6135	0.9719	0	0	0.4955	0.5147	0.1091	0.0272	0	0	0	0	0	0	0	0											10.3943	0		1.589518409	11.8517	0.245063454	9.533722111	0.415142215	5.811325811	6.04682184	0.451817773	1.534698242	4.642295503	2.068993135	4.366756938	0.115055183	0.051988968	0.133801797	3.737892709	8.054089853	0	0	4.67815626	4.09387742	1.02422609	0.027182689	0	0	0	0	0.000367872	0	0	0	0	0	0	0	0	0	0	0	0	0	68.885
H2816_027_0	2012	3																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	312.2000027	5.901158648	1838.287611	87.56104929	467.3051921	24.51286201	32.85723181	311.282308	514.9597741	9.837689797	21.23377177	65.65072089	0.239586034	392.7247021	5427.232176	7976.116287	75.42927623	806.6139449	25.06759388	14976.34065	4.974558772	9.978571445	0	0	0	0	0.181618346	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	130.814909	59.46825549	101.872976	0.2	0.2	0	0.2	3.55757441	7.774080953	11.98131371	0	0	0.184343623	3.193296048	0.2	0	0	0	0	0	20	0	0	0											NO	307.7326486	307.7326486	46.15989728	0	115.3997432	0.153866324	100.640046	45.75080942	78.37410181	0.153866324	0.153866324	0	0.153866324	2.736954489	5.980846304	9.217603503	0	0	0.141821378	2.456703626	0.153866324	0	0	0	0	0	20	0	0	0												8.0062	0.151331598	7.071263941	0	4.493908264	3.771703974	0.275562777	1.186784796	3.363292481	1.513689168	3.267162413	0	0.036864222	0.08957247	2.704953458	6.126723119	0	0	3.555120718	3.066035865	0.765417073	0	0	0	0	0	0.000302697	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4459	0		15.05224898	8.0062	0.151331598	7.071263941	0	4.493908264	3.771703974	0.275562777	1.186784796	3.363292481	1.513689168	3.267162413	0	0.036864222	0.08957247	2.704953458	6.126723119	0	0	3.555120718	3.066035865	0.765417073	0	0	0	0	0	0.000302697	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4459	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.2987	0.062	1.2058	0.3527	0.5478	0.5834	0.0511	0.1447	0.6687	0.2633	0.3891	0.0978	0.0067	0.0268	0.5398	0.8567	0	0	0.4216	0.438	0.0927	0.0231	0	0	0	0	0	0	0	0											9.0706	0		1.672472109	10.3049	0.213356617	8.277076136	0.352688599	5.041741335	4.355067885	0.326707844	1.331460637	4.03195492	1.777012355	3.656293943	0.097839594	0.043563779	0.116354384	3.244734767	6.983459654	0	0	3.976745968	3.504012485	0.858163148	0.02309335	0	0	0	0	0.000332554	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5165
H2816_028_0	2012	3																															A	A	D	V	T	Coin	P	P	P	Coin	Coin	P	Coin	P	V	V	V	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	344.2797857	6.507526	2027.178921	96.55829284	515.3226458	33.25920261	36.23344211	343.2677942	567.8739243	10.93615128	24.25318327	72.39659169	0.273654819	433.0787159	5984.901712	8794.826418	83.17993219	889.4967127	28.17141608	16507.57062	5.678298932	11.00390906	0	0	0	0	0.200280349	0	0	0												1a: $400 Per Stay	1b: $400 Per Stay	"2: $50 Per Day (Days 1-20), $75 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: 20%	"8b: 0%-20%, $15 X-rays"	5: $200; 9c: $30; 7e: $30; 7h: $30	12: 20%	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $25; 14d: $0; 14e: $0	7e: $30; 7h: $30	7c: $15; 7i: $15; 3: $15	"8b: 0%-20%, $15 X-rays"	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		400	400	60	0	150	0.2	160.952021	59.46825549	101.872976	0.2	0.2	0	0.2	3.55757441	7.774080953	11.99182129	0	0	0.184252021	3.228822899	0.2	0	0	0	0	0	20	0	0	0											NO	322.3262269	322.3262269	48.34893404	0	120.8723351	0.161163113	129.6976441	47.92044604	82.09082996	0.161163113	0.161163113	0	0.161163113	2.866748842	6.264475453	9.663196275	0	0	0.148473147	2.601835756	0.161163113	0	0	0	0	0	20	0	0	0												9.2475	0.174795525	8.167661663	0	5.190687627	5.360156644	0.391616007	1.370795484	3.884770146	1.762504189	3.908718527	0	0.044103063	0.103460659	3.124355822	7.082177824	0	0	4.182698802	3.579165623	0.915132335	0	0	0	0	0	0.000333801	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4907	0		14.30566568	9.2475	0.174795525	8.167661663	0	5.190687627	5.360156644	0.391616007	1.370795484	3.884770146	1.762504189	3.908718527	0	0.044103063	0.103460659	3.124355822	7.082177824	0	0	4.182698802	3.579165623	0.915132335	0	0	0	0	0	0.000333801	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4907	YES	1a: $250 Per Day (Days 1-7)	1b: $250 Per Day (Days 1-7)	"2: $75 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 20%	10a: $150	11a: 25%	11b: 30%; 11c: 20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $200; 9b: $150	8a: 30%	"8b: 0%-20%, $25 X-rays"	5: 20%; 9c: $40; 7e: $40; 7h: $40	12: 30%	3: $40; 7c: $40; 7i: $40	7a : $15; 14a: 20%; 14d: 20%; 14e: 20%	7b: 50%; 7d: $35; 7f: $40; 7g: $35; 14d: 20%; 14e: 20%	7e: $40; 7h: $40	7c: $40; 7i: $40; 3: $40	"8b: 0%-20%, $25 X-rays"	8a: 30%; 17a: 20%; 18a: 20%	15: 20%	9d: 20%			17a: 20%		18a: 20%		14c: 20%  Writen Health Materials;   Nursing Hotline												3400	2.6042	0.0703	1.3661	0.4151	0.6206	0.6867	0.0602	0.1639	0.7575	0.3065	0.458	0.1151	0.0079	0.0303	0.6135	0.9719	0	0	0.4955	0.5147	0.1091	0.0272	0	0	0	0	0	0	0	0											10.3943	0		1.589518409	11.8517	0.245063454	9.533722111	0.415142215	5.811325811	6.04682184	0.451817773	1.534698242	4.642295503	2.068993135	4.366756938	0.115055183	0.051988968	0.133801797	3.737892709	8.054089853	0	0	4.67815626	4.09387742	1.02422609	0.027182689	0	0	0	0	0.000367872	0	0	0	0	0	0	0	0	0	0	0	0	0	68.885
H2816_801_0	2012	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	0.345111754	0.838004929	0.061225103	0	1.421968993	0.307601065	0.681820841	0.183735726	0.007836211	0.478936317	0.877424862	2.227213944	0.030955994	0.089880678	0.786317605	1.694408523	0.162651986	0.040517091																			10.2356	YES	292.8946931	4.364561311	58.64696821	24.64467985	12.22125698	29.67581794	2.168131659	14.01420994	50.35542329	10.89291109	24.1449548	6.217952736	0.277499515	16.96031423	33.59308995	85.18332203	0.548113979	3.182896113	27.8454425	60.00317789	5.759907321	1.434809952																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.20928221	0.2	0.2	0.184989085	0.196945109	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071451803	0.071451803	0.157279539	0	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.179084926	0.171142044	0.171142044	0.15829705	0.168527942	0.342284088	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044																				20.9279	0.311855777	9.223968095	0	2.091570901	5.078780141	0.371058484	2.398420535	8.617930073	1.86423507	4.132216918	1.113541605	0.047491834	2.902622846	5.317687054	14.35576999	0.187610693	0.544727347	4.765525947	10.26906651	0.985762313	0.245556308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7533	0		16.14590473	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889
H2816_802_0	2012	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	0.345111754	0.838004929	0.061225103	0	1.421968993	0.307601065	0.681820841	0.183735726	0.007836211	0.478936317	0.877424862	2.227213944	0.030955994	0.089880678	0.786317605	1.694408523	0.162651986	0.040517091																			10.2356	YES	292.8946931	4.364561311	58.64696821	24.64467985	12.22125698	29.67581794	2.168131659	14.01420994	50.35542329	10.89291109	24.1449548	6.217952736	0.277499515	16.96031423	33.59308995	85.18332203	0.548113979	3.182896113	27.8454425	60.00317789	5.759907321	1.434809952																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.20928221	0.2	0.2	0.184989085	0.196945109	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071451803	0.071451803	0.157279539	0	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.179084926	0.171142044	0.171142044	0.15829705	0.168527942	0.342284088	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044																				20.9279	0.311855777	9.223968095	0	2.091570901	5.078780141	0.371058484	2.398420535	8.617930073	1.86423507	4.132216918	1.113541605	0.047491834	2.902622846	5.317687054	14.35576999	0.187610693	0.544727347	4.765525947	10.26906651	0.985762313	0.245556308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7533	0		16.14590473	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889
H2816_803_0	2012	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	0.345111754	0.838004929	0.061225103	0	1.421968993	0.307601065	0.681820841	0.183735726	0.007836211	0.478936317	0.877424862	2.227213944	0.030955994	0.089880678	0.786317605	1.694408523	0.162651986	0.040517091																			10.2356	YES	292.8946931	4.364561311	58.64696821	24.64467985	12.22125698	29.67581794	2.168131659	14.01420994	50.35542329	10.89291109	24.1449548	6.217952736	0.277499515	16.96031423	33.59308995	85.18332203	0.548113979	3.182896113	27.8454425	60.00317789	5.759907321	1.434809952																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.20928221	0.2	0.2	0.184989085	0.196945109	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071451803	0.071451803	0.157279539	0	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044	0.179084926	0.171142044	0.171142044	0.15829705	0.168527942	0.342284088	0.171142044	0.171142044	0.171142044	0.171142044	0.171142044																				20.9279	0.311855777	9.223968095	0	2.091570901	5.078780141	0.371058484	2.398420535	8.617930073	1.86423507	4.132216918	1.113541605	0.047491834	2.902622846	5.317687054	14.35576999	0.187610693	0.544727347	4.765525947	10.26906651	0.985762313	0.245556308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7533	0		16.14590473	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9279	0.311855777	9.223968095	0	2.436682655	5.916785071	0.432283587	2.398420535	10.03989907	2.171836135	4.814037759	1.297277331	0.055328045	3.381559163	6.195111916	16.58298394	0.218566687	0.634608025	5.551843552	11.96347504	1.148414299	0.286073399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889
H2836_001_0	2012	7	H.6										OP Facility - Other										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	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	YES	1045.405508	44.84588592	513.9539822	588.7174033	84.67826193	5.311450486	8.186556742	157.0053831	208.8233284	14637.70919	256.6808295	2.387127344	0.059574065	176.6372431	3995.131404	4079.870421	8.166128138	1202.392943	1381.922679	2784.651708	25.75281379	21.11656757	0.048148966	0	0	0	0	0	5872.8	403.4883324	15.49178542	0	0	0	0	0	0	0	0	0	3400	1A: $250/day (days 1-6); no yrly max	1B: $299/day (days 1-6); no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $225 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $65 copay; 4B: $0-$35 copay	9A: $0 - $250 copay; 9B: $0-$250 copay	8A: $0 copay	8B: $100 copay	5: $40 copay	12: 20% coin	3: $35 copay; 9A: $35 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $50 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not covered; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	163.0606004	157.6720257	60	0	225	0.2	0.2	63.77009313	212.6284757	0	100	40	0.2	37.11821843	0	34.24127189	40	35	50	12.4234485	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	144.6450395	139.8650338	53.22378518	0	199.5891944	0.177412617	0.177412617	56.56809562	188.6148719	0	88.70630863	35.48252345	0.177412617	32.9262014	0	30.37416832	35.48252345	31.04720802	44.35315431	11.02038256	0.177412617	0	0	0	0	0	0	0	0	0	0.177412617	0	0	0	0	0	0	0	0	0		12.6011	0.522697612	2.279548028	0	1.408405507	0.942318332	1.452398458	0.740124627	3.282265445	0	1.897434073	0.007058442	0.010569191	0.48466612	0	10.32688924	0.024146236	3.110911985	5.107719154	2.55732726	4.568874097	0	0	0	0	0	0	0	0	0	2.748438198	0	0	0	0	0	0	0	0	0	54.0729		NO	6.884314235	12.6011	0.522697612	2.279548028	0	1.408405507	0.942318332	1.452398458	0.740124627	3.282265445	0	1.897434073	0.007058442	0.010569191	0.48466612	0	10.32688924	0.024146236	3.110911985	5.107719154	2.55732726	4.568874097	0	0	0	0	0	0	0	0	0	2.748438198	0	0	0	0	0	0	0	0	0	54.0729	YES	1A: $250/day (days1-6) no yrly max	1B: $299/day (days1-6) no yrly max	2: $145/day (for days 1-100)	6: $50 copay	10A: $225 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $40-$50 copay	9A: $250 copay; 9B: $250 copay	8A: $50 copay	8B: $200 copay	5: $50 copay	12: 20% coin	3: $50 copay; 9A: $50 copay; 9C: $50 copay	7A: $40 copay; 7G: $40 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $50 copay; 7H: $50 copay	7C: $50 copay; 7I: $50 copay	8B: $100 copay	14A: $0-$100 copay; 14D: $0; 14E: $0; 17A: $0-$50; 17B: $0; 18A: $50	15: 20% coinsurance	9D: $0 copay; 14A $40 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not covered; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	2.9558	0.1226	1.2922	0.5104	0.3304	0.3316	0.511	0.1757	0.9052	12.6907	0.8902	0.0021	0.0025	0.1531	2.771	3.5372	0.0071	1.0425	2.3962	2.1513	1.0717	0.0005	0	0	0	0	0	0	0	0	0.6447	0	0	0	0	0	0	0	0	0	34.4956		NO	4.391825625	15.5569	0.645305694	3.571760954	0.510409468	1.738772231	1.273874782	1.963427545	0.91579462	4.187499462	12.69068201	2.78758833	0.009128047	0.013048384	0.637808053	2.770976884	13.86407785	0.031226151	4.153369263	7.503933078	4.708655308	5.640585305	0.000528951	0	0	0	0	0	0	0	0	3.393133578	0	0	0	0	0	0	0	0	0	88.5685
H2836_801_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.061329761	0.061329761	0.134119505	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	0.051306256	0.051306256	0.112199518	0	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422																				12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484		NO	18.373869	12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484	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	1.3494	0.014	0.6331	0	0.1384	0.2548	0.0869	0.3086	1.1319	1.372	1.1882	0.0001	0.1355	0.0118	0.8747	1.302	0.0037	0.8268	0	0.0021	0.8066	0.0091																			10.4498		NO	2.041541	13.4943	0.140192848	6.33122193	0	1.383541861	2.547949919	0.868755175	3.086358488	11.31940045	13.72020606	11.88219735	0.001052322	1.355077792	0.117781574	8.747289949	13.01991766	0.036627364	8.268368018	0	0.020515305	8.066370409	0.091031754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4982
H2836_802_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.061329761	0.061329761	0.134119505	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	0.051306256	0.051306256	0.112199518	0	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422																				12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484		NO	18.373869	12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484	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	1.3494	0.014	0.6331	0	0.1384	0.2548	0.0869	0.3086	1.1319	1.372	1.1882	0.0001	0.1355	0.0118	0.8747	1.302	0.0037	0.8268	0	0.0021	0.8066	0.0091																			10.4498		NO	2.041541	13.4943	0.140192848	6.33122193	0	1.383541861	2.547949919	0.868755175	3.086358488	11.31940045	13.72020606	11.88219735	0.001052322	1.355077792	0.117781574	8.747289949	13.01991766	0.036627364	8.268368018	0	0.020515305	8.066370409	0.091031754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4982
H2836_803_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.061329761	0.061329761	0.134119505	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	0.051306256	0.051306256	0.112199518	0	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422																				12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484		NO	18.373869	12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484	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	1.3494	0.014	0.6331	0	0.1384	0.2548	0.0869	0.3086	1.1319	1.372	1.1882	0.0001	0.1355	0.0118	0.8747	1.302	0.0037	0.8268	0	0.0021	0.8066	0.0091																			10.4498		NO	2.041541	13.4943	0.140192848	6.33122193	0	1.383541861	2.547949919	0.868755175	3.086358488	11.31940045	13.72020606	11.88219735	0.001052322	1.355077792	0.117781574	8.747289949	13.01991766	0.036627364	8.268368018	0	0.020515305	8.066370409	0.091031754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4982
H2836_804_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.061329761	0.061329761	0.134119505	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	0.051306256	0.051306256	0.112199518	0	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422	0.175427422																				12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484		NO	18.373869	12.1449	0.126173563	5.698099737	0	1.245187675	2.293154927	0.781879658	2.777722639	10.1874604	12.34818546	10.69397762	0.00094709	1.219570012	0.106003416	7.872560954	11.7179259	0.032964628	7.441531216	0	0.018463775	7.259733368	0.081928578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0484	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	1.3494	0.014	0.6331	0	0.1384	0.2548	0.0869	0.3086	1.1319	1.372	1.1882	0.0001	0.1355	0.0118	0.8747	1.302	0.0037	0.8268	0	0.0021	0.8066	0.0091																			10.4498		NO	2.041541	13.4943	0.140192848	6.33122193	0	1.383541861	2.547949919	0.868755175	3.086358488	11.31940045	13.72020606	11.88219735	0.001052322	1.355077792	0.117781574	8.747289949	13.01991766	0.036627364	8.268368018	0	0.020515305	8.066370409	0.091031754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4982
H2899_001_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1535.68024	46.82691937	772.6490919		280.3581004	8.820908878	8.352941374	436.8058127	222.4254651		8.151041237	142.3345205	0.030134292	9.022732041	4877.094403	3405.507828	173.3704595	480.2496714			14.79795468				159.1037094																5900	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 45 copay,7f - Podiatry 45 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 45 copay,18a - Hearing Exam (M/C) 45 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 45 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 45 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	64.11489042	400		0.2	400	0.2	0.198719229	10	44.15906645	40	20			0.2				20																NO	165.6297512	131.3713064	55.41427748		230.5222461	0.184417797	0.184417797	59.11963419	368.8355938		0.184417797	368.8355938	0.184417797	0.183236812	9.220889844	40.78050917	36.88355938	18.44177969			0.184417797				20																	21.1962	0.512642798	3.567982598	0	5.385731586	1.626732582	1.540431046	2.151983322	6.836535708	0	1.503197067	4.37483645	0.0055573	1.653296657	3.747595854	11.57319527	0.532876636	0.738054886	0	0	2.729006201	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.941	0		5.86813619	21.1962	0.512642798	3.567982598	0	5.385731586	1.626732582	1.540431046	2.151983322	6.836535708	0	1.503197067	4.37483645	0.0055573	1.653296657	3.747595854	11.57319527	0.532876636	0.738054886	0	0	2.729006201	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.941	NO																																																																																		0	0		0	21.1962	0.512642798	3.567982598	0	5.385731586	1.626732582	1.540431046	2.151983322	6.836535708	0	1.503197067	4.37483645	0.0055573	1.653296657	3.747595854	11.57319527	0.532876636	0.738054886	0	0	2.729006201	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.941
H2899_002_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	219.6500981	9.509800481	101.1364567		14.51944922	13.70714149	6.937729947	20.60501344	39.87452655	6.248557385	14.96711238	2.718335733	0.307667162	21.58098639		4336.204339	3.382159571	456.2847476		2813.55394	14.58775724	0.051722913			159.1037094		1.153264868														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													0.080627533	0.080627533	0.185273861		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		9.96869112	0.224	10		2.917206472	0.224	1261.105306			5		10														NO	0.067981864	0.067981864	0.156215401		0.18886771	0.18886771	0.18886771	0.18886771	0.18886771	0.18886771	0.18886771	0.18886771	0.18886771	0.18886771		8.407275199	0.18886771	8.431594188		2.459670114	0.18886771	1063.312817			5		10															14.9322	0.646493964	15.79907212	0	2.742255121	2.588836422	1.310313166	3.891621698	7.531010508	1.180150723	2.826804238	0.513405844	0.058108392	4.075951474	0	3.037971933	0.638780732	0.320600652	0	0.576701212	2.755156301	0.004583136	0	0	0.066293212	0	0.000961054	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4973	0		12.17009975	14.9322	0.646493964	15.79907212	0	2.742255121	2.588836422	1.310313166	3.891621698	7.531010508	1.180150723	2.826804238	0.513405844	0.058108392	4.075951474	0	3.037971933	0.638780732	0.320600652	0	0.576701212	2.755156301	0.004583136	0	0	0.066293212	0	0.000961054	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4973	NO																																																																																		0	0		0	14.9322	0.646493964	15.79907212	0	2.742255121	2.588836422	1.310313166	3.891621698	7.531010508	1.180150723	2.826804238	0.513405844	0.058108392	4.075951474	0	3.037971933	0.638780732	0.320600652	0	0.576701212	2.755156301	0.004583136	0	0	0.066293212	0	0.000961054	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4973
H2899_003_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1159.512981	51.88689453	758.0387016		88.97211928	6.459168117	5.335660013	262.2882964	229.0219688		9.154399219	59.54013675	0.048354753	12.84195452	4194.987828	4096.929862	253.3115461	574.5184176			23.27723009				159.1037094																4950	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 450 copay,9b - OP Ambulatory Surgical Center (ASC) 450 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 450 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 15 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 40 copay,7f (Podiatry)40 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 40 copay,18a - Hearing Exam (M/C) 40 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) n/a,16b1 - Routine Comprehensive Dental n/a"	"17a - Eye Exam (M/C) 40 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 40 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	61.92731576	450		0.2	450	0.2	0.198824475	15	39.29782589	40	20			0.2				20																NO	164.3377017	130.3465013	54.98200015		228.7239814	0.182979185	0.182979185	56.65704886	411.7031665		0.182979185	411.7031665	0.182979185	0.181903702	13.72343888	35.97908942	36.59583702	18.29791851			0.182979185				20																	15.8793	0.563606264	3.473207	0	1.695838113	1.181893318	0.976314721	1.238373402	7.857422479	0	1.675064509	2.042738569	0.008847913	2.33599907	4.797471589	12.28365049	0.772512338	0.876040932	0	0	4.259248593	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1827	0		5.750021431	15.8793	0.563606264	3.473207	0	1.695838113	1.181893318	0.976314721	1.238373402	7.857422479	0	1.675064509	2.042738569	0.008847913	2.33599907	4.797471589	12.28365049	0.772512338	0.876040932	0	0	4.259248593	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1827	NO																																																																																		0	0		0	15.8793	0.563606264	3.473207	0	1.695838113	1.181893318	0.976314721	1.238373402	7.857422479	0	1.675064509	2.042738569	0.008847913	2.33599907	4.797471589	12.28365049	0.772512338	0.876040932	0	0	4.259248593	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1827
H2899_006_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1476.185197	86.67457723	542.013891		184.6441889	7.974603073	6.491352639	312.2367315	240.2727799		10.30877127	98.50591128	0.042042258	24.94056285	4943.817713	4152.847901	226.3830123	553.3141245			14.6455105				159.1037094																6700	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 20 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 50 copay,7f (Podiatry) 50 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 50 copay,18a - Hearing Exam (M/C) 50 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 50 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 50 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	62.87713392	400		0.2	400	0.2	0.199337083	20	48.62718378	40	20			0.2				20																NO	166.4253608	132.0023541	55.68046233		231.6295696	0.185303656	0.185303656	58.25681387	370.6073113		0.185303656	370.6073113	0.185303656	0.184689451	18.53036557	45.0966078	37.06073113	18.53036557			0.185303656				20																	20.4729	0.953437353	2.514965337	0	3.564087833	1.477723102	1.202871374	1.515826429	7.420570747	0	1.910253001	3.042250911	0.007790584	4.606258848	7.634229126	15.60661275	0.699159996	0.854426083	0	0	2.713866635	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4624	0		6.027240682	20.4729	0.953437353	2.514965337	0	3.564087833	1.477723102	1.202871374	1.515826429	7.420570747	0	1.910253001	3.042250911	0.007790584	4.606258848	7.634229126	15.60661275	0.699159996	0.854426083	0	0	2.713866635	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4624	NO																																																																																		0	0		0	20.4729	0.953437353	2.514965337	0	3.564087833	1.477723102	1.202871374	1.515826429	7.420570747	0	1.910253001	3.042250911	0.007790584	4.606258848	7.634229126	15.60661275	0.699159996	0.854426083	0	0	2.713866635	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4624
H2899_009_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1452.220625	40.89402809	592.9098975		199.4275869	6.949203275	5.777843051	418.7981923	216.8236623		11.50910075	73.13843502	0.035591306	15.00170014	4855.315862	3779.900563	149.4085996	651.7765136			13.95465631				159.1037094																4950	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 450 copay,9b - OP Ambulatory Surgical Center (ASC) 450 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 450 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 15 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 45 copay,7f - Podiatry 45 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 45 copay,18a - Hearing Exam (M/C) 45 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 45 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 45 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	60.22726536	450		0.2	450	0.2	0.199291983	15	44.24948244	40	19.24358794			0.2				20																NO	162.3230056	128.7485199	54.30794897		225.9199424	0.180735954	0.180735954	54.42616129	406.6558963		0.180735954	406.6558963	0.180735954	0.180096134	13.55519654	40.03001539	36.14719079	17.41482359			0.180735954				20																	19.6441	0.438753799	2.683310038	0	3.754555746	1.255970883	1.044263975	1.89946483	7.347718396	0	2.080108303	2.478514654	0.006432629	2.701748194	5.484563399	12.60912314	0.450058429	0.945881084	0	0	2.52210812	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6118	0		7.161898453	19.6441	0.438753799	2.683310038	0	3.754555746	1.255970883	1.044263975	1.89946483	7.347718396	0	2.080108303	2.478514654	0.006432629	2.701748194	5.484563399	12.60912314	0.450058429	0.945881084	0	0	2.52210812	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6118	NO																																																																																		0	0		0	19.6441	0.438753799	2.683310038	0	3.754555746	1.255970883	1.044263975	1.89946483	7.347718396	0	2.080108303	2.478514654	0.006432629	2.701748194	5.484563399	12.60912314	0.450058429	0.945881084	0	0	2.52210812	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6118
H2905_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	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	745.2539041	37.90750214	944.1736737	361.1534638	121.6637596	10.86266234	19.99701694	215.8839668	46.96616828	4417.090136	32.0661253	0	1.446935892	28.95710864	3957.681724	4121.91392	130.6264679	851.297656	0	0	10.33651678	6.75911781	0	0	0	0	0	0	213.2	0											5900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	$320 Days 1-4 (1b); $0 (1b1); $0 n/c (1b2)	"$50 Days 1-20/$135 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1); $0/20%/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	$15 (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9c); $0 (5); 20% (9a)"	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10); $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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	74.98910764	0	148.503	0.2	0.169476837	63.22034042	0.16	2.4	0.169477155	0	0.2	0.144081818	7.211329481	33.51098402	35	35	0	0	0.2	0.276835239	0	0	0	0	0	0	0	0											NO	184.859087	96.82170069	66.59565782	0	131.8812196	0.177614216	0.150507477	56.16102734	0.142091373	2.131370592	0.15050776	0	0.177614216	0.127954896	7.082379983	32.91357284	34.37414697	34.37414697	0	0	0.177614216	0.24584937	0	0	0	0	0	0	0	0												11.4806	0.305855736	5.239822242	0	1.337097083	1.929363256	3.009700576	1.010355447	6.673487328	0.784538002	4.826200698	0	0.256996384	3.705203823	2.335817152	11.30557617	0.374181117	2.438552562	0	0	1.835912324	1.661724854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.511	0	NO	5.851352009	11.4806	0.305855736	5.239822242	0	1.337097083	1.929363256	3.009700576	1.010355447	6.673487328	0.784538002	4.826200698	0	0.256996384	3.705203823	2.335817152	11.30557617	0.374181117	2.438552562	0	0	1.835912324	1.661724854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.511	YES	"$400 Days 1-25 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-25 (1b); $0 n/c (1b1, 1b2)"	"40% (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$150/30% (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $0 n/c (4b)"	30% (9b)	"30% (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9c); $0 (5); 30% (9a)"	"$20 (7a); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10); $40 (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9900	1.112	0.0509	0.209	0.2925	0.1084	0.3911	0.432	0.0782	0.8116	0.0913	0.5634	0	0.0208	0.4506	0.8256	2.2683	0.0725	0.4726	0	0	0.3114	0.3227	0	0	0	0	0	0	0	0											8.8848	0	NO	0.726864246	12.5926	0.356729568	5.448862275	0.292474231	1.44551036	2.320450403	3.441670717	1.088587544	7.485127678	0.875794466	5.389567458	0	0.277833929	4.155773297	3.161369144	13.57382691	0.446704107	2.911187645	0	0	2.147265876	1.98444326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3958
H2906_003_0	2012	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	1385.812594	27.2164591	1188.261154	700.519729	7.943798331	7.419500388	3.12347422	475.9601055	654.8471949	211.6271436	1145.29774	0	0	319.6999553	3916.742234	12767.80644	309.4606309	595.1110849	2177.993987	2658.467728	24.62456213	146.8015227	0.667164732	65.68431967	178.6589161	175.6	14.57240212	22.31196911	12000	77.08905173											2000	PBP: 1A IP Acute: $50 per admit	1B IP Psych: $50 per admit	2 SNF: $50 per day for days 1-15	6 Home Health: $0	10A Ambulance: $100	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: 10%	"3 CORF: 10%, 3 Cardiac Rehab: $10, 9C Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $10, 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"	"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%	"9D Blood: 10%, 17A Medicare Covered Eye Exams: $15, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $20"	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: $20	"18B Hearing Aids: $1,000 allowance every 36 months"	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $10													9.203723244	4.595310399	37.76670126	0	0.217972208	0.1	0.097289453	29.76208217	50	0	25.65693959	0	0	2.54385733	7.76008925	10.55051597	17.96149996	10	0	0.030445425	0.1	38.42044387	0	0.340612061	15	0	20	0	0	10											YES	7.381386042	3.68543894	30.28889441	0	0.174813711	0.0802	0.078026141	23.8691899	40.1	0	20.57686556	0	0	2.040173579	6.223591578	8.461513806	14.40512297	8.02	0	0.024417231	0.0802	30.81319598	0	0.273170873	12.03	0	16.04	0	0	8.02											5100	0.8524	0.008358717	2.999259718	0	1.388684867	0.595043931	0.24371264	0.946731845	2.188281043	0	1.963886468	0	0	0.054353617	2.031350332	9.002914208	0.37148487	0.397732575	0	0.005409368	1.974889883	0.376952007	0	17.94304292	0.179105563	0	0.019478444	0	0	0.051521183	0	0	0	0	0	0	0	0	0	0	43.5946			10.76276377	0.8524	0.008358717	2.999259718	0	1.388684867	0.595043931	0.24371264	0.946731845	2.188281043	0	1.963886468	0	0	0.054353617	2.031350332	9.002914208	0.37148487	0.397732575	0	0.005409368	1.974889883	0.376952007	0	17.94304292	0.179105563	0	0.019478444	0	0	0.051521183	0	0	0	0	0	0	0	0	0	0	43.5946	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	9c Substance Abuse: $40; All other services 30% Coinsurance	7A PCP: $20	"7B Chiropractic: $20, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $40, 7F Podiatry: $40; all other services 30%"	"7E Mental Health: $40, 7H Psychiatric: $40"	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	2.3116	0	0	0.7659	0	0.2675	0.137	0.169	0.55	0.0672	0.1491	0	0	0.0341	0.7792	2.2591	0.2218	0.0558	0.0483	0.218	0.0357	0.0352	0	0	0	0	0	0	0	0											8.1046			0.518692391	3.1641	0.008358717	2.999259718	0.765927378	1.388684867	0.862560312	0.380668991	1.115721966	2.738287056	0.067176994	2.112988611	0	0	0.088497099	2.810593071	11.26200461	0.593238156	0.453526411	0.048310217	0.223448168	2.01056305	0.4121616	0	17.94304292	0.179105563	0	0.019478444	0	0	0.051521183	0	0	0	0	0	0	0	0	0	0	51.6992
H2906_005_0	2012	9																															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	1179.889827	35.32431699	1084.74469	837.424225	7.49758098	8.398036057	3.284697	290.381637	319.2391699	127.1508183	539.2283828	0	0	175.9648084	3340.272599	8648.260891	159.4166038	364.5528818	1752.29433	2419.400848	15.34658551	92.59871898	0.757012694	62.52476761	166.5371183	160.5333333	4.780863208	37	12000	100											3000	PBP: 1A IP Acute: $175 per day (days 1-5)	1B IP Psych: $175 per day (days 1-5)	2 SNF: $50 per day for days 1-20	6 Home Health: $0	10A Ambulance: $150	11A DME: 15%	11B Prosthetic and Medical Supplies: 15%	"4A ER: $50, 4B Urgent Care: $20/$40"	"9B ASC Services including Colonoscopies: $175, 9A OP Hosp - Surgery including Colonoscopies $175"	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, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"9D 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: $150 allowance	18A Routine Hearing Exams: $40	18B Hearing Aids: $600 allowance every 36 months	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													97.77981405	75.10776613	43.89352524	0	0.243312851	0.15	0.146905649	33.75307015	175	0	45.62412652	0	0	3.581686494	7.875464135	18.82185304	28.55853393	15	0	0.103908361	0.2	79.91491257	0	0.340612061	20	0	40	0	0	20											YES	85.36177767	65.56907983	38.31904753	0	0.212412119	0.13095	0.128248632	29.46643024	152.775	0	39.82986245	0	0	3.12681231	6.87528019	16.4314777	24.93160012	13.095	0	0.090711999	0.1746	69.76571867	0	0.297354329	17.46	0	34.92	0	0	17.46											5100	8.3931	0.193015247	3.46386528	0	1.592577063	1.099722822	0.421257897	0.713042521	4.064313682	0	1.789782693	0	0	0.045850744	1.913775836	11.8419755	0.331209252	0.397818332	0	0.018289057	2.67951383	0.538351348	0	18.59201032	0.242311507	0	0.013912312	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	58.4912			8.509031954	8.3931	0.193015247	3.46386528	0	1.592577063	1.099722822	0.421257897	0.713042521	4.064313682	0	1.789782693	0	0	0.045850744	1.913775836	11.8419755	0.331209252	0.397818332	0	0.018289057	2.67951383	0.538351348	0	18.59201032	0.242311507	0	0.013912312	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	58.4912	YES	"30% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	"30% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	9c Substance Abuse: $60; All other services 30% Coinsurance	7A PCP: $20	"7B Chiropractic: $40, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $60, 7F Podiatry: $60; all other services 30%"	"7E Mental Health: $60, 7H Psychiatric: $60"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance											5100	3.9985	0	0	2.0379	0	0.4611	0.2374	0.1163	0.6956	0.0214	0.1407	0	0	0.0066	0.6921	2.0759	0.1314	0.0386	0.0299	0.2833	0.0057	0.0027	0	0	0	0	0	0	0	0											10.9752			0.702409893	12.3916	0.193015247	3.46386528	2.037925803	1.592577063	1.560868956	0.658624263	0.829385134	4.759936034	0.0214323	1.930459709	0	0	0.052415225	2.605894115	13.91784643	0.462627229	0.43637259	0.029939246	0.30158079	2.685224288	0.541067424	0	18.59201032	0.242311507	0	0.013912312	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	69.4664
H2906_006_0	2012	6																															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	1218.117024	36.59743549	1136.842975	877.7091039	7.858257365	8.802029463	3.4385147	303.676286	326.5893512	133.2674975	552.6763597	0	0	184.4297187	3363.223624	9047.963788	167.0854512	363.9695896	1815.039719	2512.891924	16.08484375	97.05324522	0.79342932	0	153.2584112	221.6	5.010849982	37	12000	100											3400	PBP: 1A IP Acute: $250 per day (days 1-5)	1B IP Psych: $250 per day (days 1-5)	2 SNF: $50 per day for days 1-34	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	11B Prosthetic and Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services including Colonoscopies: $250, 9A OP Hosp - Surgery including Colonoscopies $250"	8A OP Lab: $0	"8B: $50 Routine Imaging, $60 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $15, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"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%	"9D 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	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													138.0071414	105.6350091	50	0	0.243312851	0.2	0.195869166	36.09335405	250	0	67.03470159	0	0	3.581686494	11.64185808	18.85581853	28.55853393	20	0	0.104855108	0.2	79.91491257	0	0	20	0	40	0	0	20											YES	122.7435516	93.95177714	44.47	0	0.21640245	0.17788	0.174206036	32.1014291	222.35	0	59.62066359	0	0	3.185551968	10.35426858	16.770365	25.39996008	17.788	0	0.093258133	0.17788	71.07632324	0	0	17.788	0	35.576	0	0	17.788											5100	12.4597	0.286532842	4.212950593	0	1.700546145	1.565705001	0.599010016	0.81237023	6.05142852	0	2.745910943	0	0	0.048959204	2.901976725	12.6448046	0.353663649	0.539524255	0	0.019528968	2.861172007	0.574848986	0	0	0.227180052	0	0.0148555	0	0	0.148233333	0	0	0	0	0	0	0	0	0	0	50.7689			6.313286392	12.4597	0.286532842	4.212950593	0	1.700546145	1.565705001	0.599010016	0.81237023	6.05142852	0	2.745910943	0	0	0.048959204	2.901976725	12.6448046	0.353663649	0.539524255	0	0.019528968	2.861172007	0.574848986	0	0	0.227180052	0	0.0148555	0	0	0.148233333	0	0	0	0	0	0	0	0	0	0	50.7689	YES	"30% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	"30% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	9c Substance Abuse: $60; All other services 30% Coinsurance	7A PCP: $25	"7B Chiropractic: $40, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $60, 7F Podiatry: $60; all other services 30%"	"7E Mental Health: $60, 7H Psychiatric: $60"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance											5100	4.0927	0	0	2.136	0	0.4833	0.2488	0.1219	0.7291	0.0225	0.1474	0	0	0.0069	0.8563	2.1757	0.1377	0.0404	0.0314	0.2969	0.006	0.0028	0	0	0	0	0	0	0	0											11.5359			0.73829758	16.5523	0.286532842	4.212950593	2.135961651	1.700546145	2.049034893	0.847795058	0.934309587	6.780514273	0.022463316	2.893355326	0	0	0.055839474	3.758308225	14.82053676	0.491403581	0.579933193	0.031379494	0.316448648	2.867157171	0.577695721	0	0	0.227180052	0	0.0148555	0	0	0.148233333	0	0	0	0	0	0	0	0	0	0	62.3048
H2906_801_0	2012	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	129.6800903	2.7	37.24	8.52	6.38	4.112620317	1.605651399	9.457746216	31.65331968	0.904755837	22.88094133	0	0	1.940538311	20.51780432	95.35739192	1.292638359	1.515977256	13.57894757	26.19169894	12.62	2.373960957																			2000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.075942663	0.075942663	0.155132539	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			YES	0.060906016	0.060906016	0.124416296	0	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648	0	0	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648	0.179648																			5100	7.8983	0.164446243	4.633262864	0	1.14615424	0.738824015	0.288452063	1.699065192	5.686455573	0.162537577	4.110515348	0	0	0.348613826	3.68598251	17.13076474	0.232219896	0.272342282	2.439430773	4.705286331	2.26715776	0.426477338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0363			14.32816044	7.8983	0.164446243	4.633262864	0	1.14615424	0.738824015	0.288452063	1.699065192	5.686455573	0.162537577	4.110515348	0	0	0.348613826	3.68598251	17.13076474	0.232219896	0.272342282	2.439430773	4.705286331	2.26715776	0.426477338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0363	YES																																									5100																																									0				7.8983	0.164446243	4.633262864	0	1.14615424	0.738824015	0.288452063	1.699065192	5.686455573	0.162537577	4.110515348	0	0	0.348613826	3.68598251	17.13076474	0.232219896	0.272342282	2.439430773	4.705286331	2.26715776	0.426477338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0363
H2926_001_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	310.1953808	12.19998223	83.92225163		16.96984878	35.10210249	11.98705903	45.12336753	39.65539631	33.65631635	39.84746091			73.52927054		127.8476894	19.46690411	1.169081173	14.55016926		7.425211844																				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																						0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					25.3843	0.99836254	12.71051711	0	3.801246127	7.862870957	2.685101224	10.10763433	8.882808773	7.539014863	8.925831243	0	0	16.4705566	0	28.63788243	4.360586521	0.261874183	3.259237913	0	1.663247453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.551	Medicare FFS	YES	0	25.3843	0.99836254	12.71051711	0	3.801246127	7.862870957	2.685101224	10.10763433	8.882808773	7.539014863	8.925831243	0	0	16.4705566	0	28.63788243	4.360586521	0.261874183	3.259237913	0	1.663247453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.551	NO																																																																																		0				25.3843	0.99836254	12.71051711	0	3.801246127	7.862870957	2.685101224	10.10763433	8.882808773	7.539014863	8.925831243	0	0	16.4705566	0	28.63788243	4.360586521	0.261874183	3.259237913	0	1.663247453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.551
H2931_002_0	2012	7																															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	1363.114746	88.32741473	1776.515543	1387.78886	370.0064371	14.72717461	28.62965246	218.3741422	95.81600859	3560.664581	23.82874281	0	8.753063192	173.7948731	4830.427978	5421.532544	539.6069276	433.2801333	0	0	12.62310137	9.378819874	701.7391304	501.6	0.304187631	209.8466069	15.87431079	65	325.2	0											2950	"$75 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-79 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$125 (10a)	20% (11a)	"20% (11b, 11b1); $0/20%/$10 (11c)"	"$65 (4a, 4a1); $40 (4b)"	$50 (9b)	$5/$50 (8a1a); $5/50%/50% (8a2)	$5 (8b1); $5/$200 (8b2); 20% (8b3)	Included in h.5.	20% (12)	"$30 (3, 9c); $0 (5); $100 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$0/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10); $30 (16b, 18a); $0/$30 (17a); 20% (17b)"	$0 (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $0 (17b2)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c3, 14c4, 14c5); $0 n/c (14c2, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	52.90867074	33.91423575	21.8639799	0	125	0.2	0.103326719	64.99372297	20.5	1.2	0.05007403	0	0.2	35.59844338	0.001001949	29.68039172	30	30	0	0	0.2	0.232250544	0	25	30	0	0	342.5	0	0											NO	44.25299038	28.36598099	18.28710641	0	104.5504209	0.167280674	0.086422816	54.38625055	17.14626904	1.003684041	0.041882087	0	0.167280674	29.77465792	0.000989371	29.30894278	29.62340533	29.62340533	0	0	0.167280674	0.194255137	0	25	30	0	0	342.5	0	0												5.0268	0.208791147	2.707277398	0	3.223694063	2.463571687	2.47425518	0.989712568	0.136907255	0.297815185	0.997997486	0	1.464218306	0.431223575	0.000398257	13.24161559	1.332082895	1.069602751	0	0	2.111600899	1.821883939	0	1.045	0.000760469	0	0	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	42.9004	0	NO	4.961682363	5.0268	0.208791147	2.707277398	0	3.223694063	2.463571687	2.47425518	0.989712568	0.136907255	0.297815185	0.997997486	0	1.464218306	0.431223575	0.000398257	13.24161559	1.332082895	1.069602751	0	0	2.111600899	1.821883939	0	1.045	0.000760469	0	0	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	42.9004	NO	"40% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"40% (1b); $0 n/c (1b1, 1b2)"	"40% (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$175/40% (10a)	$0 n/c (11a)	"40% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); 40%/50% (8a2)	"40% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$50 (3, 9c); 40% (5, 9a)"	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 40% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$50 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$40/$50 (7g)	"40% (15, 15a1); $0 n/c (15a2)"	"40% (9d, 9d1, 17b); $0 n/c (14a10); $50 (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)"	$50 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0.2239	0.2376	0.0704	0	0.1509	0.0156	0.07	0.0107	0.1004	0	0.0231	0.0314	1.2793	2.4134	0.2411	0.1868	0	0	0.3622	0.2736	0	0	0	0	0.0073	0	0	0											5.6976	0	NO	0	5.0268	0.208791147	2.931206332	0.237622728	3.294072059	2.463571687	2.625124752	1.005314688	0.206894043	0.308530229	1.098418609	0	1.487281298	0.462581265	1.279683736	15.654992	1.57317644	1.256409714	0	0	2.473764855	2.095479079	0	1.045	0.000760469	0	0.007349218	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	48.5981
H2931_004_0	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	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	1256.405497	47.79409958	1178.611079	389.700705	232.0499123	16.44684909	6.134499819	298.4440633	57.90799495	9.212717813	36.49535869	0	0.126091543	29.0104624	4923.330639	3829.179755	170.8454792	854.2434726	0	0	11.69564615	6.991342889	0	0	0	0	0	0	325.2	0											4600	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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)	$175/30% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); 20%/50%/50% (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9c); $0 (5); 20% (9a)"	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $40 (7d, 7f)"	"$40 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10); $40 (16b, 18a); $0/$40 (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 (14c1, 14c3, 14c4, 14c5); $0 n/c (14c2, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	65.58645853	0	173.253	0.2	0.2	64.85011044	0.16	0.048	0.162481858	0	0.2	0.149307335	11.28914788	39.56461916	40	40	0	0	0.2	0.291235678	0	0	0	0	0	0	0	0											NO	149.674332	84.79546862	52.5109709	0	138.7128295	0.160127478	0.160127478	51.94424627	0.128101982	0.038430595	0.13008905	0	0.160127478	0.119541035	10.91077682	38.23855741	38.65934587	38.65934587	0	0	0.160127478	0.233174173	0	0	0	0	0	0	0	0												15.671	0.337726923	5.157501004	0	2.682358327	2.633592461	0.982301983	1.291870994	7.418128939	0.354050224	4.74764655	0	0.020190721	3.467940691	4.476446816	12.20185916	0.550397873	2.752041155	0	0	1.872794319	1.630200595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.248	0	NO	12.71098304	15.671	0.337726923	5.157501004	0	2.682358327	2.633592461	0.982301983	1.291870994	7.418128939	0.354050224	4.74764655	0	0.020190721	3.467940691	4.476446816	12.20185916	0.550397873	2.752041155	0	0	1.872794319	1.630200595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.248	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.671	0.337726923	5.157501004	0	2.682358327	2.633592461	0.982301983	1.291870994	7.418128939	0.354050224	4.74764655	0	0.020190721	3.467940691	4.476446816	12.20185916	0.550397873	2.752041155	0	0	1.872794319	1.630200595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.248
H2931_801_0	2012	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	285.7964102	6.817246319	87.48097327	1696.685101	12.89717898	17.11229396	31.90339666	25.26587229	15.59797632	7.994140527	22.94812781	0	7.757778255	6.752652346	70.92523502	148.1834367	4.742882305	4.1453151	0	0	16.04615902	10.97989228	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075609981	0.075609981	0.148602837	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060541194	0.060541194	0.118986847	0	0.179357637	0.179357637	0.179357637	0.179357637	0.179357637	0.179357637	0.179357637	0	0.179357637	0.179357637	0.179357637	0.179357637	0.179357637	0.179357637	0	0	0.179357637	0.179357637	0	0	0	0	0	0	0	0												17.3025	0.412724234	10.4090852	0	2.31320755	3.069220615	5.722117849	4.53162716	2.797616181	1.433810158	4.115921986	0	1.391416779	1.211139771	12.72098258	26.57783111	0.850672165	0.743493923	0	0	2.878001171	1.969327538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4507	150	YES	25.00230543	17.3025	0.412724234	10.4090852	0	2.31320755	3.069220615	5.722117849	4.53162716	2.797616181	1.433810158	4.115921986	0	1.391416779	1.211139771	12.72098258	26.57783111	0.850672165	0.743493923	0	0	2.878001171	1.969327538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4507	NO																																										0	0	0	0	0	0	0	0	0	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	17.3025	0.412724234	10.4090852	0	2.31320755	3.069220615	5.722117849	4.53162716	2.797616181	1.433810158	4.115921986	0	1.391416779	1.211139771	12.72098258	26.57783111	0.850672165	0.743493923	0	0	2.878001171	1.969327538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4507
H2931_803_0	2012	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	296.639362	10.1305608	96.73774949	1447.353242	14.92401611	15.52336041	30.85865863	24.25776658	10.87671838	5.583684022	15.5794661	0	5.763352068	5.269822234	67.68330516	142.8702684	4.594755198	3.193732228	0	0	15.43742627	10.61032831	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075676297	0.075676297	0.150123735	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060968116	0.060968116	0.120946211	0	0.180464143	0.180464143	0.180464143	0.180464143	0.180464143	0.180464143	0.180464143	0	0.180464143	0.180464143	0.180464143	0.180464143	0.180464143	0.180464143	0	0	0.180464143	0.180464143	0	0	0	0	0	0	0	0												18.0855	0.617641208	11.70006421	0	2.693249774	2.801409928	5.568881375	4.37765705	1.962857658	1.00765475	2.811534994	0	1.04007839	0.951013952	12.21440964	25.78296051	0.829188558	0.576354149	0	0	2.785901898	1.914783802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7212	150	YES	23.57463093	18.0855	0.617641208	11.70006421	0	2.693249774	2.801409928	5.568881375	4.37765705	1.962857658	1.00765475	2.811534994	0	1.04007839	0.951013952	12.21440964	25.78296051	0.829188558	0.576354149	0	0	2.785901898	1.914783802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7212	NO																																										0	0	0	0	0	0	0	0	0	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	18.0855	0.617641208	11.70006421	0	2.693249774	2.801409928	5.568881375	4.37765705	1.962857658	1.00765475	2.811534994	0	1.04007839	0.951013952	12.21440964	25.78296051	0.829188558	0.576354149	0	0	2.785901898	1.914783802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7212
H2931_804_0	2012	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	225.0071788	6.087529837	66.07077451	1276.406767	12.74323776	12.10507983	24.3914181	26.7747016	17.9101362	7.080251213	20.88902595	0	5.575270071	8.259953538	53.33184847	113.1898103	3.495146304	3.934104391	0	0	13.63996483	8.063482642	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075628537	0.075628537	0.14904167	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064046198	0.064046198	0.126216276	0	0.189694907	0.189694907	0.189694907	0.189694907	0.189694907	0.189694907	0.189694907	0	0.189694907	0.189694907	0.189694907	0.189694907	0.189694907	0.189694907	0	0	0.189694907	0.189694907	0	0	0	0	0	0	0	0												14.4109	0.389883142	8.339207086	0	2.417327307	2.296271998	4.6269278	5.079024542	3.39746163	1.343087599	3.962541844	0	1.05760034	1.566871122	10.11678006	21.4715306	0.663011455	0.746279568	0	0	2.587431865	1.529601593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0017	150	YES	15.55284804	14.4109	0.389883142	8.339207086	0	2.417327307	2.296271998	4.6269278	5.079024542	3.39746163	1.343087599	3.962541844	0	1.05760034	1.566871122	10.11678006	21.4715306	0.663011455	0.746279568	0	0	2.587431865	1.529601593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0017	NO																																										0	0	0	0	0	0	0	0	0	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	14.4109	0.389883142	8.339207086	0	2.417327307	2.296271998	4.6269278	5.079024542	3.39746163	1.343087599	3.962541844	0	1.05760034	1.566871122	10.11678006	21.4715306	0.663011455	0.746279568	0	0	2.587431865	1.529601593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0017
H2944_004_0	2012	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	1193.96	54.74	645.45	771.02	7.8	11.18	6.12	345.27	65.69	18.27	23.61	0.5	0.8	33.11	2858.44	3641.08	120.44	3.77		1786.38	24.89	0							5.09	0.95	973.55	279.37	309.23	176.65	420.12							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $50 (Days 21-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.206824	15.501758	0	0.2	0.2	0.2	65	0.243357	0.25	0.248068	0.25	0.2	0.239299	15	31.458905	35	0.25		0	0.2	0							0	0	0	0	16.099008	35	35						NO	137.095079	109.689036	13.493676	0	0.180927	0.180927	0.180927	58.80121	0.220149	0.226159	0.224411	0.226159	0.180927	0.216478	13.56951	28.458795	31.66219	0.226159		0	0.180927	0							0	0	0	0	14.56371	31.66219	31.66219							13.6405	0.500364819	0.725791098	0	1.4112306	2.02276386	1.10727324	1.691857815	14.46158781	4.13192493	5.29834371	0.1130795	0.1447416	7.16758658	3.232302514	8.635062442	0.317782847	0.85261943	0	0	4.50327303	0	0	0	0	0	0	0	0	0	0	0	0.37529467	0.466093822	1.108493272	0	0	0	0	0	71.908	0	NO	8.895383	13.6405	0.500364819	0.725791098	0	1.4112306	2.02276386	1.10727324	1.691857815	14.46158781	4.13192493	5.29834371	0.1130795	0.1447416	7.16758658	3.232302514	8.635062442	0.317782847	0.85261943	0	0	4.50327303	0	0	0	0	0	0	0	0	0	0	0	0.37529467	0.466093822	1.108493272	0	0	0	0	0	71.908	YES						30% Coins																									30% Coins										5000						0.6681																									0.1042										0.7722	0	NO	0.111368	13.6405	0.500364819	0.725791098	0	1.4112306	2.69084286	1.10727324	1.691857815	14.46158781	4.13192493	5.29834371	0.1130795	0.1447416	7.16758658	3.232302514	8.635062442	0.317782847	0.85261943	0	0	4.50327303	0	0	0	0	0	0	0	0	0	0.104156	0	0.37529467	0.466093822	1.108493272	0	0	0	0	0	72.6802
H2944_013_0	2012	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	1520.34	56.63	451.61	2064.98	12.72	15.05	7.77	400.83	50.8	12.49	17.59	1.39	0.57	37.54	2841.83	3326.86	96.91	2.39		1605.67	24.95	0							4.72	1.38	1672.76	247	363.71	0	293.99							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	128.006658	44.329117	0	0.2	0.2	0.2	65	0.242678	0.25	0.243386	0.220791	0.2	0.238036	15	33.008896	35	0.25		0	0.2	0							0	0	0	0	20.339675	0	35						NO	144.016532	101.174798	35.90951	0	0.179683	0.179683	0.179683	58.396845	0.218025	0.224603	0.218661	0.198361	0.179683	0.213854	13.476195	29.655621	31.444455	0.224603		0	0.179683	0							0	0	0	0	18.273428	0	31.444455							18.2462	0.477460734	1.351424484	0	2.28556776	2.70422915	1.39613691	1.950600615	11.07567	2.80529147	3.84624699	0.27572179	0.10241931	8.02807916	3.19142127	8.22167494	0.253940178	0.53680117	0	0	4.48309085	0	0	0	0	0	0	0	0	0	0	0	0.553852375	0	0.770362944	0	0	0	0	0	72.5562	0	NO	11.216381	18.2462	0.477460734	1.351424484	0	2.28556776	2.70422915	1.39613691	1.950600615	11.07567	2.80529147	3.84624699	0.27572179	0.10241931	8.02807916	3.19142127	8.22167494	0.253940178	0.53680117	0	0	4.48309085	0	0	0	0	0	0	0	0	0	0	0	0.553852375	0	0.770362944	0	0	0	0	0	72.5562	YES						20% Coins																									20% Coins	$0/Visit									5000						0.6318																							0		0.1249	0									0.7566	0	NO	0.065013	18.2462	0.477460734	1.351424484	0	2.28556776	3.33598815	1.39613691	1.950600615	11.07567	2.80529147	3.84624699	0.27572179	0.10241931	8.02807916	3.19142127	8.22167494	0.253940178	0.53680117	0	0	4.48309085	0	0	0	0	0	0	0	0	0	0.124857	0	0.553852375	0	0.770362944	0	0	0	0	0	73.3128
H2944_019_0	2012	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	1134.71	77.18	519.03	397.67	114.41	9.04	4.05	310.52	57.97	15.57	22.46	0.61	0.15	37.86	2364.43	3408.54	86.27	3.41		1795.47	20.17	0							4.67	0.95	739.53	337.15	260.79	153.77	360.46							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	131.206824	31.003517	0	150	0.2	0.2	65	0.240751	0.25	0.248511	0.25	0.2	0.23592	15	30.737081	35	0.25		0	0.2	0							0	0	0	0	20.076506	35	35						NO	155.631335	112.067816	27.2604	0	138.3375	0.18445	0.18445	59.94625	0.222032	0.230563	0.229189	0.230563	0.18445	0.217578	13.83375	28.347273	32.27875	0.230563		0	0.18445	0							0	0	0	0	18.515557	32.27875	32.27875							14.7164	0.720782837	1.179080451	0	1.318932781	1.667428	0.7470225	1.551209129	12.87119504	3.58986591	5.14758494	0.14064343	0.0276675	8.23750308	2.725744459	8.051901159	0.232057314	0.78621983	0	0	3.7203565	0	0	0	0	0	0	0	0	0	0	0	0.402389343	0.413625282	0.969599852	0	0	0	0	0	69.2172	0	NO	7.232696	14.7164	0.720782837	1.179080451	0	1.318932781	1.667428	0.7470225	1.551209129	12.87119504	3.58986591	5.14758494	0.14064343	0.0276675	8.23750308	2.725744459	8.051901159	0.232057314	0.78621983	0	0	3.7203565	0	0	0	0	0	0	0	0	0	0	0	0.402389343	0.413625282	0.969599852	0	0	0	0	0	69.2172	YES						30% Coins																									30% Coins	$0/Visit									5400						0.5637																									0.0849	0									0.6486	0	NO	0.063	14.7164	0.720782837	1.179080451	0	1.318932781	2.231093	0.7470225	1.551209129	12.87119504	3.58986591	5.14758494	0.14064343	0.0276675	8.23750308	2.725744459	8.051901159	0.232057314	0.78621983	0	0	3.7203565	0	0	0	0	0	0	0	0	0	0.084931	0	0.402389343	0.413625282	0.969599852	0	0	0	0	0	69.8658
H2944_024_0	2012	6	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	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	1815.6	72.1	643.79	4184.93	14.41	17.37	8.73	418.03	77.98	11.7	25.47	1.79	0.41	31.64	2963.18	4700.36	104.02	1.73		1593.35	26.74	0							3.7	1.43	1791.63	569.41	333.34	444.16								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	128.006658	31.003517	0	0.2	0.2	0.2	65	0.238879	0.25	0.240538	0.228515	0.2	0.239208	15	34.029499	35	0.25		0	0.2	0							0	0	0	0	20.766801	35							NO	123.650594	96.519196	23.910935	0	0.174577	0.174577	0.174577	56.73759	0.208514	0.218222	0.209962	0.199468	0.174577	0.208801	13.09329	29.703873	30.55101	0.218222		0	0.174577	0							0	0	0	0	18.12705	30.55101								18.7083	0.579919503	1.282801737	0	2.51565457	3.03240249	1.52405721	1.976501229	16.25992172	2.5531974	5.34773214	0.35704772	0.07157657	6.60646364	3.233147922	11.63490804	0.264826338	0.37752406	0	0	4.66818898	0	0	0	0	0	0	0	0	0	0	0	0.503539237	1.130794717	0	0	0	0	0	0	82.6285	0	NO	15.709896	18.7083	0.579919503	1.282801737	0	2.51565457	3.03240249	1.52405721	1.976501229	16.25992172	2.5531974	5.34773214	0.35704772	0.07157657	6.60646364	3.233147922	11.63490804	0.264826338	0.37752406	0	0	4.66818898	0	0	0	0	0	0	0	0	0	0	0	0.503539237	1.130794717	0	0	0	0	0	0	82.6285	YES						20% Coins	20% Coins																								20% Coins	$0/Visit									5000	0	0	0	0	0	0.7067	0.3551	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0.128	0	0	0							1.1898	0	NO	0.143544	18.7083	0.579919503	1.282801737	0	2.51565457	3.73907349	1.87915821	1.976501229	16.25992172	2.5531974	5.34773214	0.35704772	0.07157657	6.60646364	3.233147922	11.63490804	0.264826338	0.37752406	0	0	4.66818898	0	0	0	0	0	0	0	0	0	0.128003	0	0.503539237	1.130794717	0	0	0	0	0	0	83.8183
H2944_041_0	2012	6	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	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	NO	1685.35	63.74	861.47	1330.93	13.01	14.48	8.33	456.56	48.8	16.23	17.78	2.23	0.66	30.34	2977.45	4090.22	130.24	3.13		1239.12	27.39	0							2.8	1.24	440.3	275.88	0	580.07								"$0-$225/Day(Days 1-9): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$199/Day(Days 1-9): 1b. $199 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									178.386262	144.121139	57.180564	0	0.2	0.2	0.143356	65	0.243568	0.25	0.24583	0.207497	0.2	0.236627	15	33.483616	35	0.25		0	0.2	0							0	0	0	17.216567	0	35							NO	111.657134	90.209601	28.635054	0	0.162684	0.162684	0.116609	52.8723	0.198123	0.203355	0.199963	0.168782	0.162684	0.192477	12.2013	27.236243	28.4697	0.203355		0	0.162684	0							0	0	0	14.0043	0	28.4697								15.6818	0.479163331	2.055686664	0	2.11651884	2.35566432	0.97135297	2.011614774	9.6684024	3.30045165	3.55534214	0.37638386	0.10737144	5.83975218	3.027396724	9.28351882	0.308991144	0.63650115	0	0	4.45591476	0	0	0	0	0	0	0	0	0	0	0.321958857	0	1.376201573	0	0	0	0	0	0	67.93	0	NO	23.1105	15.6818	0.479163331	2.055686664	0	2.11651884	2.35566432	0.97135297	2.011614774	9.6684024	3.30045165	3.55534214	0.37638386	0.10737144	5.83975218	3.027396724	9.28351882	0.308991144	0.63650115	0	0	4.45591476	0	0	0	0	0	0	0	0	0	0	0.321958857	0	1.376201573	0	0	0	0	0	0	67.93	YES						20% Coins	20% Coins																								$0/Visit										3400						0.5749	0.0937																						0		0										0.6687	0	NO	0.098952	15.6818	0.479163331	2.055686664	0	2.11651884	2.93061032	1.06509397	2.011614774	9.6684024	3.30045165	3.55534214	0.37638386	0.10737144	5.83975218	3.027396724	9.28351882	0.308991144	0.63650115	0	0	4.45591476	0	0	0	0	0	0	0	0	0	0	0.321958857	0	1.376201573	0	0	0	0	0	0	68.5987
H2944_044_0	2012	6	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	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	NO	1279.25	55.37	660.04	1362.72	11.21	12.89	8.01	428.88	40.62	17.04	15.08	2.69	0.17	31.1	2565.66	3051.83	120.52	2.53		1321.46	18.49	0							3.56	1.24	249.63	388.54	0	526.13								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	131.206824	42.474818	0	0.2	0.2	0.12866	65	0.242834	0.25	0.248023	0.210241	0.2	0.232752	15	37.282678	40	0.25		0	0.2	0							0	0	0	6.228903	0	40							NO	143.941297	115.166659	37.455569	0	0.187703	0.187703	0.12075	61.003605	0.227903	0.234629	0.232774	0.197315	0.187703	0.218441	14.077755	34.990427	37.54068	0.234629		0	0.187703	0							0	0	0	5.845931	0	37.54068								15.3447	0.531398159	2.060181147	0	2.10415063	2.41949167	0.9672075	2.180268843	9.25741986	3.99807816	3.51023192	0.53077735	0.03190951	6.7935151	3.009894408	8.898736236	0.377033563	0.59361137	0	0	3.47062847	0	0	0	0	0	0	0	0	0	0	0.189281503	0	1.645939831	0	0	0	0	0	0	67.9145	0	NO	5.761439	15.3447	0.531398159	2.060181147	0	2.10415063	2.41949167	0.9672075	2.180268843	9.25741986	3.99807816	3.51023192	0.53077735	0.03190951	6.7935151	3.009894408	8.898736236	0.377033563	0.59361137	0	0	3.47062847	0	0	0	0	0	0	0	0	0	0	0.189281503	0	1.645939831	0	0	0	0	0	0	67.9145	YES						20% Coins	20% Coins																								$0/Visit										6000						0.5576	0.1237																						0		0										0.6812	0	NO	0.036543	15.3447	0.531398159	2.060181147	0	2.10415063	2.97704467	1.0908845	2.180268843	9.25741986	3.99807816	3.51023192	0.53077735	0.03190951	6.7935151	3.009894408	8.898736236	0.377033563	0.59361137	0	0	3.47062847	0	0	0	0	0	0	0	0	0	0	0.189281503	0	1.645939831	0	0	0	0	0	0	68.5957
H2944_052_0	2012	8	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		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	1058.34	31.49	491.89	737.42	8.21	13.36	8.24	330.85	8.97	0.77	28.76	2.02	0.14	42.99	2181.25	3150.26	31.73	3.77		1114.06	19.21	0							5.18	0.93	2089.77	361.42	314.89	599.97								"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	25% Coins: 9a. 25% Surgery OP -- Physician	0% Coins: 8a. 0% 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$30/Visit: 7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$100/Visit: 8a. $100 Lab -- OP	"$0-$30/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $30 Advanced Imaging -- Office"	"$0-$125/Visit: 9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $125 Surgery OP -- Facility"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"									182.210148	160.008323	49.537808	0	0.2	0.2	0.16208	65	0.25	0	0.24498	0.220246	0.2	0.238807	15	27.970472	30	0.25		0	0.2	0							0	0	100	10.535738	104.822904	30							NO	130.069074	114.220501	33.064555	0	0.166778	0.166778	0.135157	54.20298	0.208473	0	0.204287	0.183661	0.166778	0.19914	12.50838	23.324353	25.01676	0.208473		0	0.166778	0							0	0	83.3892	8.785668	87.410981	25.01676								11.4714	0.299733631	1.355343663	0	1.36924738	2.22815408	1.11369368	1.494421328	1.87000281	0	5.87529412	0.37099522	0.02334892	8.5610286	2.273658656	6.123148023	0.066148483	0.78594321	0	0	3.20380538	0	0	0	0	0	0	0	0	0	14.52202071	0.264609677	2.293736984	1.250775458	0	0	0	0	0	0	66.8166	0	NO	16.089034	11.4714	0.299733631	1.355343663	0	1.36924738	2.22815408	1.11369368	1.494421328	1.87000281	0	5.87529412	0.37099522	0.02334892	8.5610286	2.273658656	6.123148023	0.066148483	0.78594321	0	0	3.20380538	0	0	0	0	0	0	0	0	0	14.52202071	0.264609677	2.293736984	1.250775458	0	0	0	0	0	0	66.8166	YES	0	0	0	0	0	40% Coins	40% Coins	0	0	0% Coins	0	0	0	0	0	0	0	0		0	0	0									0	0	0	0							3400	0	0	0	0	0	0.8988	0.105	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0							1.0038	0	NO	0.356783	11.4714	0.299733631	1.355343663	0	1.36924738	3.12691808	1.21873768	1.494421328	1.87000281	0	5.87529412	0.37099522	0.02334892	8.5610286	2.273658656	6.123148023	0.066148483	0.78594321	0	0	3.20380538	0	0	0	0	0	0	0	0	0	14.52202071	0.264609677	2.293736984	1.250775458	0	0	0	0	0	0	67.8204
H2944_053_0	2012	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	NO	1341.91	94.77	526.36	694.92	247.92	16.29	5	430.2	307.24	2127.25	1115.25	277.03	0.36	4.8	2921.35	4457.17	94.88	834.13		1167.04	31.39	0							4.11	0.93	887.83	737.82										"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$125/Visit: 8a. $0 Lab -- FSL,8a. $125 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50-$125/Visit: 5. $50 Partial Hospitalization,7h. $125 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$50-$175/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF,9a. $175 Observation"											163.989133	131.206824	49.537808	0	100	0.2	0.2	65	100.709456	75.905201	74.526315	71.31024	0.2	0.2	15	33.88051	35	61.348575		0	0.2	0							0	0	0	130.285519									NO	130.524198	104.43171	38.949597	0	88.4283	0.176857	0.176857	57.478395	89.05566	67.121679	65.902354	63.058433	0.176857	0.176857	13.264245	29.959959	30.949905	54.249502		0	0.176857	0							0	0	0	115.209269										14.596	0.82474943	1.708459156	0	1.826928678	2.88100053	0.884285	2.060600461	2.280121748	11.89871597	6.124800025	1.455756474	0.06366852	0.8489136	3.229125178	11.12805254	0.244710582	3.770928092	0	0	5.55154123	0	0	0	0	0	0	0	0	0	0	7.083641904	0	0	0	0	0	0	0	0	78.462	0	NO	12.444442	14.596	0.82474943	1.708459156	0	1.826928678	2.88100053	0.884285	2.060600461	2.280121748	11.89871597	6.124800025	1.455756474	0.06366852	0.8489136	3.229125178	11.12805254	0.244710582	3.770928092	0	0	5.55154123	0	0	0	0	0	0	0	0	0	0	7.083641904	0	0	0	0	0	0	0	0	78.462	YES	0	0	0	$0/Visit	0	20% Coins	20% Coins	0	0	$0/Visit	0	0	0	0	0	0	0	0		0	0	0									20% Coins	0									5000	0	0	0	0	0	0.7304	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0.0757	0									0.8061	0	NO	0.013784	14.596	0.82474943	1.708459156	0	1.826928678	3.61138053	0.884285	2.060600461	2.280121748	11.89871597	6.124800025	1.455756474	0.06366852	0.8489136	3.229125178	11.12805254	0.244710582	3.770928092	0	0	5.55154123	0	0	0	0	0	0	0	0	0	0.075688	7.083641904	0	0	0	0	0	0	0	0	79.268
H2944_065_0	2012	7	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	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	NO	1301.13	61.55	870.96	739.55	9.07	8.8	5.8	353.87	52.22	16.4	18.08	2.23	0.49	32.99	2485.29	3530.48	128.36	3.34		1615.45	32.58	0							5.23	1.24	525.68	264.18	0	448.27								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	131.206824	42.474818	0	0.2	0.2	0.155202	65	0.24427	0.25	0.247404	0.217012	0.2	0.238326	15	32.556522	35	0.25		0	0.2	0							0	0	0	18.161642	0	35							NO	134.480436	107.597075	33.028036	0	0.181067	0.181067	0.14051	58.84671	0.221146	0.226334	0.223983	0.196469	0.181067	0.215765	13.58001	29.474526	31.68669	0.226334		0	0.181067	0							0	0	0	16.442352	0	31.68669								14.5814	0.551883331	2.397174853	0	1.64227769	1.5933896	0.814958	1.735340439	11.54824412	3.7118776	4.04961264	0.43812587	0.08872283	7.11808735	2.812521921	8.671602046	0.338941961	0.75595556	0	0	5.89916286	0	0	0	0	0	0	0	0	0	0	0.361978379	0	1.183682711	0	0	0	0	0	0	70.2949	0	NO	9.523566	14.5814	0.551883331	2.397174853	0	1.64227769	1.5933896	0.814958	1.735340439	11.54824412	3.7118776	4.04961264	0.43812587	0.08872283	7.11808735	2.812521921	8.671602046	0.338941961	0.75595556	0	0	5.89916286	0	0	0	0	0	0	0	0	0	0	0.361978379	0	1.183682711	0	0	0	0	0	0	70.2949	YES						20% Coins	20% Coins																								$0/Visit										5000						0.3757	0.0554																						0		0										0.4311	0	NO	0.029367	14.5814	0.551883331	2.397174853	0	1.64227769	1.9690836	0.870403	1.735340439	11.54824412	3.7118776	4.04961264	0.43812587	0.08872283	7.11808735	2.812521921	8.671602046	0.338941961	0.75595556	0	0	5.89916286	0	0	0	0	0	0	0	0	0	0	0.361978379	0	1.183682711	0	0	0	0	0	0	70.7261
H2944_071_0	2012	7	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Therapy (PT/OT/ST)								D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							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	NO	990.52	43.54	431.24	669.17	11.4	18.25	7.35	329.06	49.84	12.38	17.15	1.94	0.21	23.89	2202.85	2810.57	44.31	1.98		784.24	11.31	0							3.06	0.93	150.65	333.82	694.26									"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins: 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. 20% Radiology OP -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"										163.989133	144.00749	49.537808	0	0.2	0.2	0.150946	65	0.231091	0.25	0.234246	0.202476	0.2	0.240036	20	33.926778	35	0.25		0	0.2	0							0	0	0	17.261429	35								NO	127.245892	111.741316	37.030354	0	0.174694	0.174694	0.131846	56.77542	0.201851	0.218367	0.204607	0.176856	0.174694	0.209664	17.46936	29.633955	30.57138	0.218367		0	0.174694	0							0	0	0	15.077306	30.57138									10.5033	0.405434742	1.330747488	0	1.9915116	3.1881655	0.9690681	1.556876642	10.06025384	2.70338346	3.50901005	0.34310064	0.03668574	5.00887296	3.206864973	6.940692075	0.112884821	0.43236666	0	0	1.97578914	0	0	0	0	0	0	0	0	0	0	0.419425524	1.76870719	0	0	0	0	0	0	0	56.4631	0	NO	10.005847	10.5033	0.405434742	1.330747488	0	1.9915116	3.1881655	0.9690681	1.556876642	10.06025384	2.70338346	3.50901005	0.34310064	0.03668574	5.00887296	3.206864973	6.940692075	0.112884821	0.43236666	0	0	1.97578914	0	0	0	0	0	0	0	0	0	0	0.419425524	1.76870719	0	0	0	0	0	0	0	56.4631	YES	0	0	0	0	0	40% Coins	40% Coins	0	0	0	0	0	0	0	0	0	0	0		0	0	0									$0/Visit	0	0								3400	0	0	0	0	0	1.3104	0.1294	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0								1.4398	0	NO	0.38809	10.5033	0.405434742	1.330747488	0	1.9915116	4.4985575	1.0984681	1.556876642	10.06025384	2.70338346	3.50901005	0.34310064	0.03668574	5.00887296	3.206864973	6.940692075	0.112884821	0.43236666	0	0	1.97578914	0	0	0	0	0	0	0	0	0	0	0.419425524	1.76870719	0	0	0	0	0	0	0	57.9029
H2944_078_0	2012	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	1561.01	92.27	650.16	1574.46	11.88	12.21	8.73	476.72	44.13	11.44	14.6	1.43	0.74	30.22	3522.46	3893.29	211.63	2.33		2085.84	23.17	0							3.55	1.09	3120.87	342.98	277.24	0	443.28							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.242835	0.25	0.246247	0.213681	0.2	0.233701	15	38.672474	40	0.25		0	0.2	0							0	0	0	0	30.472942	0	40						NO	156.021083	110.706812	30.024663	0	0.186747	0.186747	0.186747	60.692905	0.226744	0.233434	0.22993	0.199522	0.186747	0.218215	14.006055	36.10992	37.34948	0.233434		0	0.186747	0							0	0	0	0	28.453713	0	37.34948							20.2959	0.851243129	1.626736241	0	2.21855436	2.28018087	1.63030131	2.411126806	10.00621272	2.67048496	3.356978	0.28531646	0.13819278	6.5944573	4.111314041	11.71553254	0.658689204	0.54390122	0	0	4.32692799	0	0	0	0	0	0	0	0	0	0	0	0.657375616	0	1.379689791	0	0	0	0	0	77.7591	0	NO	7.66896	20.2959	0.851243129	1.626736241	0	2.21855436	2.28018087	1.63030131	2.411126806	10.00621272	2.67048496	3.356978	0.28531646	0.13819278	6.5944573	4.111314041	11.71553254	0.658689204	0.54390122	0	0	4.32692799	0	0	0	0	0	0	0	0	0	0	0	0.657375616	0	1.379689791	0	0	0	0	0	77.7591	YES						20% Coins																										0% Coins									6700	0	0	0	0	0	1.4078	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0	0						1.4078	0	NO	0.070024	20.2959	0.851243129	1.626736241	0	2.21855436	3.68793387	1.63030131	2.411126806	10.00621272	2.67048496	3.356978	0.28531646	0.13819278	6.5944573	4.111314041	11.71553254	0.658689204	0.54390122	0	0	4.32692799	0	0	0	0	0	0	0	0	0	0	0	0.657375616	0	1.379689791	0	0	0	0	0	79.1668
H2944_085_0	2012	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							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	1687.34	70.32	339.37	2343.38	8.8	19.23	9.28	523.3	46.93	8.69	15.16	1.08	0.17	32.84	3297.91	3766.83	81.3	2.87		2068.17	18.03	0							3.47	1.28	3680.51	172.04	382.08	0	0	450.67						"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit: 3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							163.989133	116.360647	49.537808	0	0.2	0.2	0.2	65	0.238527	0.25	0.242717	0.225183	0.2	0.231662	15	34.643692	35	0.25		0	0.2	0							0	0	0	0	19.125791	0	0	15					NO	130.491401	92.59189	40.891479	0	0.180566	0.180566	0.180566	58.68408	0.21535	0.225708	0.219133	0.203302	0.180566	0.209152	13.54248	31.277433	31.59912	0.225708		0	0.180566	0							0	0	0	0	17.267376	0	0	13.54248						18.3486	0.542588475	1.156445102	0	1.5889808	3.47228418	1.67565248	2.559114922	10.1063755	1.96140252	3.32205628	0.21956616	0.03069622	6.86855168	3.721823351	9.818064412	0.214084038	0.64778196	0	0	3.25560498	0	0	0	0	0	0	0	0	0	0	0	0.549793252	0	0	0.508599122	0	0	0	0	70.5681	0	NO	10.531525	18.3486	0.542588475	1.156445102	0	1.5889808	3.47228418	1.67565248	2.559114922	10.1063755	1.96140252	3.32205628	0.21956616	0.03069622	6.86855168	3.721823351	9.818064412	0.214084038	0.64778196	0	0	3.25560498	0	0	0	0	0	0	0	0	0	0	0	0.549793252	0	0	0.508599122	0	0	0	0	70.5681	YES						20% Coins																									20% Coins	$0/Visit									5000						0.8021																							0		0.284	0									1.0861	0	NO	0.10091	18.3486	0.542588475	1.156445102	0	1.5889808	4.27439218	1.67565248	2.559114922	10.1063755	1.96140252	3.32205628	0.21956616	0.03069622	6.86855168	3.721823351	9.818064412	0.214084038	0.64778196	0	0	3.25560498	0	0	0	0	0	0	0	0	0	0.283965	0	0.549793252	0	0	0.508599122	0	0	0	0	71.6542
H2944_106_0	2012	6	r.										OP Facility - Other										Radiology										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		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	NO	298.64	12.06	45.06	1622.1	12.34	9.5	8.56	478.85	68.96	23.95	30.69	2.9	0.27	41.85	33.04	59.99	2.22	8.2		1772.05	17.37	0							3.57	1.09	189											Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"												0.0749	0.0749	0.1467	0	0.2	0.2	0.119078	65	0.2	0.190719	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0										NO	0.062438	0.062438	0.105087	0	0.183785	0.183785	0.109424	59.73019	0.183785	0.175256	0.183785	0.183785	0.183785	0.183785	0.183785	0.183785	0.183785	0.183785		0	0.183785	0							0	0	0											18.6465	0.75300228	4.73522022	0	2.2679069	1.7459575	0.93666944	2.383483457	12.6738136	4.1973812	5.64036165	0.5329765	0.04962195	7.69140225	6.0722564	11.02526215	0.4080027	1.507037	0	0	3.19234545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4592	0	NO	11.069012	18.6465	0.75300228	4.73522022	0	2.2679069	1.7459575	0.93666944	2.383483457	12.6738136	4.1973812	5.64036165	0.5329765	0.04962195	7.69140225	6.0722564	11.02526215	0.4080027	1.507037	0	0	3.19234545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4592	YES						20% Coins				$0/Visit																															6700	0	0	0	0	0	1.0905	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0										1.0905	0	NO	0.059926	18.6465	0.75300228	4.73522022	0	2.2679069	2.8364535	0.93666944	2.383483457	12.6738136	4.1973812	5.64036165	0.5329765	0.04962195	7.69140225	6.0722564	11.02526215	0.4080027	1.507037	0	0	3.19234545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5497
H2944_114_0	2012	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	T	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	1541.28	73.59	345.17	1335.01	241.73	16.65	8.23	437.84	53.41	12.05	16.82	1.69	0.23	31.76	3623.75	4817.5	103.48	2.87		1929.97	26.99	0							4.14	0.81	2085.77	403.14	394.06	0	0	622.96						"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$175/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $175 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$20/Visit: 3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"							182.210148	129.289608	34.03605	0	200	0.2	0.2	65	0.241263	0.25	0.240605	0.211925	0.2	0.232186	20	39.210112	40	0.25		0	0.2	0							0	0	0	0	91.619396	0	0	20					NO	147.807414	104.878695	29.006339	0	179.9402	0.17994	0.17994	58.480565	0.217065	0.224925	0.216472	0.190669	0.17994	0.208898	17.99402	35.277377	35.98804	0.224925		0	0.17994	0							0	0	0	0	82.430062	0	0	17.99402						18.9844	0.643168597	0.834343169	0	3.624745379	2.996001	1.4809062	2.133760882	11.59344165	2.71034625	3.64105904	0.32223061	0.0413862	6.63460048	5.433819165	14.16239697	0.310336865	0.64553475	0	0	4.8565806	0	0	0	0	0	0	0	0	0	0	0	2.706865853	0	0	0.934129558	0	0	0	0	84.69	0	NO	11.873388	18.9844	0.643168597	0.834343169	0	3.624745379	2.996001	1.4809062	2.133760882	11.59344165	2.71034625	3.64105904	0.32223061	0.0413862	6.63460048	5.433819165	14.16239697	0.310336865	0.64553475	0	0	4.8565806	0	0	0	0	0	0	0	0	0	0	0	2.706865853	0	0	0.934129558	0	0	0	0	84.69	YES	0	0	0	$0/Visit	0	20% Coins	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									20% Coins	$0/Visit	0	0	0	0					5900	0	0	0	0	0	0.7529	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0.1704	0	0	0	0	0					0.9233	0	NO	0.007613	18.9844	0.643168597	0.834343169	0	3.624745379	3.748921	1.4809062	2.133760882	11.59344165	2.71034625	3.64105904	0.32223061	0.0413862	6.63460048	5.433819165	14.16239697	0.310336865	0.64553475	0	0	4.8565806	0	0	0	0	0	0	0	0	0	0.17041	0	2.706865853	0	0	0.934129558	0	0	0	0	85.6134
H2944_124_0	2012	9	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	1336.87	62.69	901.46	1050.7	11.34	11.19	6.15	435.23	53.84	16.17	18.39	1.51	0.25	29.74	3250.99	3823.42	106.12	2.59		1518.69	25.35	0							4.32	1.09	1868.86	308.13	349	0	306.84							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.8754	34.03605	0	0.2	0.2	0.2	65	0.24099	0.25	0.246642	0.218774	0.2	0.234266	15	38.218743	40	0.25		0	0.2	0							0	0	0	0	34.776234	0	40						NO	161.314885	114.463099	29.738999	0	0.186798	0.186798	0.186798	60.709285	0.225082	0.233497	0.230361	0.204332	0.186798	0.218801	14.009835	35.695886	37.35956	0.233497		0	0.186798	0							0	0	0	0	32.48062	0	37.35956							17.9714	0.597974306	2.23404317	0	2.11828932	2.09026962	1.1488077	2.201875176	12.11841488	3.77564649	4.23633879	0.30854132	0.0466995	6.50714174	3.795486124	11.3733637	0.330383042	0.60475723	0	0	4.7353293	0	0	0	0	0	0	0	0	0	0	0	0.944644698	0	0.955283949	0	0	0	0	0	78.0947	0	NO	7.196922	17.9714	0.597974306	2.23404317	0	2.11828932	2.09026962	1.1488077	2.201875176	12.11841488	3.77564649	4.23633879	0.30854132	0.0466995	6.50714174	3.795486124	11.3733637	0.330383042	0.60475723	0	0	4.7353293	0	0	0	0	0	0	0	0	0	0	0	0.944644698	0	0.955283949	0	0	0	0	0	78.0947	YES						20% Coins																										0% Coins									6700	0	0	0	0	0	1.2944	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0	0						1.2944	0	NO	0.060641	17.9714	0.597974306	2.23404317	0	2.11828932	3.38471662	1.1488077	2.201875176	12.11841488	3.77564649	4.23633879	0.30854132	0.0466995	6.50714174	3.795486124	11.3733637	0.330383042	0.60475723	0	0	4.7353293	0	0	0	0	0	0	0	0	0	0	0	0.944644698	0	0.955283949	0	0	0	0	0	79.3892
H2944_127_0	2012	11	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	1681.64	64.98	582.83	2057.56	13.94	14.43	8.01	426.98	54.42	12.05	16.07	1.13	0.38	29	3730.78	3818.07	118.28	1.94		1635.52	22.45	0							4.43	1.09	2478.25	492.85	323.89	0	303.59							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210147	129.289608	34.03605	0	0.2	0.2	0.2	65	0.243685	0.25	0.2437	0.20752	0.2	0.237049	20	39.054317	40	0.25		0	0.2	0							0	0	0	0	41.793286	0	40						NO	153.516058	108.929339	29.723785	0	0.18524	0.18524	0.18524	60.202935	0.225701	0.23155	0.225714	0.192205	0.18524	0.219555	18.52398	36.172069	37.04796	0.23155		0	0.18524	0							0	0	0	0	38.7089	0	37.04796							21.5132	0.589852371	1.443659468	0	2.5822456	2.6730132	1.4837724	2.142120766	12.28264842	2.7901775	3.62722398	0.21719165	0.0703912	6.367095	5.759074509	11.50895762	0.365169392	0.449207	0	0	4.158638	0	0	0	0	0	0	0	0	0	0	0	1.044785468	0	0.937282515	0	0	0	0	0	82.0057	0	NO	8.998644	21.5132	0.589852371	1.443659468	0	2.5822456	2.6730132	1.4837724	2.142120766	12.28264842	2.7901775	3.62722398	0.21719165	0.0703912	6.367095	5.759074509	11.50895762	0.365169392	0.449207	0	0	4.158638	0	0	0	0	0	0	0	0	0	0	0	1.044785468	0	0.937282515	0	0	0	0	0	82.0057	YES						20% Coins				0% Coins																						0% Coins									6700	0	0	0	0	0	1.6581	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0	0						1.6581	0	NO	0.088523	21.5132	0.589852371	1.443659468	0	2.5822456	4.3310792	1.4837724	2.142120766	12.28264842	2.7901775	3.62722398	0.21719165	0.0703912	6.367095	5.759074509	11.50895762	0.365169392	0.449207	0	0	4.158638	0	0	0	0	0	0	0	0	0	0	0	1.044785468	0	0.937282515	0	0	0	0	0	83.6638
H2944_128_0	2012	10	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	1810.17	40.96	672.58	1715.9	17.84	14.58	13.15	501.4	59.56	13.97	16.79	1.49	0.37	53.03	3796.23	4175.17	171.63	2.11		1687.12	30.28	0							4.43	1.09	2377.15	502.3	353.7	0	477.9							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.244856	0.25	0.245294	0.214583	0.2	0.226174	20	39.007621	40	0.25		0	0.2	0							0	0	0	0	42.618606	0	40						NO	148.277881	105.212521	28.536165	0	0.181168	0.181168	0.181168	58.87947	0.2218	0.22646	0.222196	0.194378	0.181168	0.204877	18.11676	35.334585	36.23352	0.22646		0	0.181168	0							0	0	0	0	38.605553	0	36.23352							22.3673	0.359125405	1.599404488	0	3.23203712	2.64142944	2.3823592	2.460180522	13.210408	3.1636462	3.73067084	0.28962322	0.06703216	10.86462731	5.731282318	12.2939916	0.51822992	0.4778306	0	0	5.48576704	0	0	0	0	0	0	0	0	0	0	0	1.137898675	0	1.442999934	0	0	0	0	0	93.4559	0	NO	12.69512	22.3673	0.359125405	1.599404488	0	3.23203712	2.64142944	2.3823592	2.460180522	13.210408	3.1636462	3.73067084	0.28962322	0.06703216	10.86462731	5.731282318	12.2939916	0.51822992	0.4778306	0	0	5.48576704	0	0	0	0	0	0	0	0	0	0	0	1.137898675	0	1.442999934	0	0	0	0	0	93.4559	YES						20% Coins				0% Coins																						0% Coins									6700	0	0	0	0	0	1.6538	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0	0						1.6538	0	NO	0.111264	22.3673	0.359125405	1.599404488	0	3.23203712	4.29524344	2.3823592	2.460180522	13.210408	3.1636462	3.73067084	0.28962322	0.06703216	10.86462731	5.731282318	12.2939916	0.51822992	0.4778306	0	0	5.48576704	0	0	0	0	0	0	0	0	0	0	0	1.137898675	0	1.442999934	0	0	0	0	0	95.1097
H2944_133_0	2012	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	T	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	1388.45	87.65	632.67	1354.65	249.98	18.9	7.74	412.12	45.98	9.93	4.54	1.41	0.25	26.51	3796.33	3968.84	123.52	2.92		2280.28	20.78	0							3.99	0.81	2529.86	339.01	642.57	38.78	0	363.84						"$0-$250/Day(Days 1-6): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$20-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"							171.209603	129.289608	38.216144	0	200	0.2	0.2	65	0.24294	0.25	0.246763	0.207444	0.2	0.234632	20	39.129312	40	0.25		0	0.2	0							0	0	0	0	111.23543	150	0	20					NO	143.99498	108.738378	32.564511	0	183.1714	0.183171	0.183171	59.530705	0.222498	0.228964	0.225999	0.189989	0.183171	0.21489	18.31714	35.836854	36.63428	0.228964		0	0.183171	0							0	0	0	0	101.875747	137.37855	0	18.31714						16.6608	0.794243236	1.716882431	0	3.815765548	3.4619319	1.41774354	2.044482845	10.23045804	2.27361252	1.02603546	0.26788449	0.04579275	5.6967339	5.794825675	11.85256164	0.377088855	0.66857488	0	0	3.80629338	0	0	0	0	0	0	0	0	0	0	0	5.455191562	0.443961681	0	0.555375685	0	0	0	0	78.4063	0	NO	9.039414	16.6608	0.794243236	1.716882431	0	3.815765548	3.4619319	1.41774354	2.044482845	10.23045804	2.27361252	1.02603546	0.26788449	0.04579275	5.6967339	5.794825675	11.85256164	0.377088855	0.66857488	0	0	3.80629338	0	0	0	0	0	0	0	0	0	0	0	5.455191562	0.443961681	0	0.555375685	0	0	0	0	78.4063	YES	0	0	0	0	0	20% Coins	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									20% Coins	$0/Visit	0	0	0	0					5900	0	0	0	0	0	0.7946	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0.187	0	0	0	0	0					0.9816	0	NO	0.083	16.6608	0.794243236	1.716882431	0	3.815765548	4.2565439	1.41774354	2.044482845	10.23045804	2.27361252	1.02603546	0.26788449	0.04579275	5.6967339	5.794825675	11.85256164	0.377088855	0.66857488	0	0	3.80629338	0	0	0	0	0	0	0	0	0	0.187018	0	5.455191562	0.443961681	0	0.555375685	0	0	0	0	79.3879
H2944_137_0	2012	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	T	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	1461.76	72.11	602.84	1102.78	271.82	16.03	7.13	457.94	45.19	10.09	5.57	1.51	0.32	23.64	3843.04	4224.95	88.49	2.11		2006.38	18.32	0							3.99	0.81	2734.53	503.09	610.52	40.85	0	467.73						"$0-$250/Day(Days 1-6): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$20-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"							171.209603	129.289608	38.216144	0	200	0.2	0.2	65	0.24482	0.25	0.247279	0.206516	0.2	0.236693	20	39.205185	40	0.25		0	0.2	0							0	0	0	0	110.155704	150	0	20					NO	142.90078	107.912088	32.46213	0	182.695	0.182695	0.182695	59.375875	0.223637	0.228369	0.225883	0.188647	0.182695	0.216213	18.2695	35.812956	36.539	0.228369		0	0.182695	0							0	0	0	0	100.624482	137.02125	0	18.2695						17.4072	0.648461722	1.630789204	0	4.138346242	2.92860085	1.30261535	2.26588235	10.10615603	2.30424321	1.25816831	0.28485697	0.0584624	5.11127532	5.850868273	12.6089957	0.269444676	0.48185859	0	0	3.3469724	0	0	0	0	0	0	0	0	0	0	0	5.119438229	0.466443172	0	0.712099436	0	0	0	0	78.3012	0	NO	9.417807	17.4072	0.648461722	1.630789204	0	4.138346242	2.92860085	1.30261535	2.26588235	10.10615603	2.30424321	1.25816831	0.28485697	0.0584624	5.11127532	5.850868273	12.6089957	0.269444676	0.48185859	0	0	3.3469724	0	0	0	0	0	0	0	0	0	0	0	5.119438229	0.466443172	0	0.712099436	0	0	0	0	78.3012	YES	0	0	0	$0/Visit	0	20% Coins	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									20% Coins	$0/Visit	0	0	0	0					5900	0	0	0	0	0	0.7241	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0.2056	0	0	0	0	0					0.9297	0	NO	0.008682	17.4072	0.648461722	1.630789204	0	4.138346242	3.65267185	1.30261535	2.26588235	10.10615603	2.30424321	1.25816831	0.28485697	0.0584624	5.11127532	5.850868273	12.6089957	0.269444676	0.48185859	0	0	3.3469724	0	0	0	0	0	0	0	0	0	0.205579	0	5.119438229	0.466443172	0	0.712099436	0	0	0	0	79.2308
H2944_166_0	2012	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	1095.55	29.39	424.13	1102	165.6	5.99	2.7	313.95	46.24	6.98	14.28	0.12	0.21	16.65	2188.64	3190.76	36.28	1.37		1094.9	12.17	0							4.67	0.95	708.38	172.72	206.44	51.03	328.7							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	20% Coins: 7h. 20% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office"	$40/Visit: 5. $40 Partial Hospitalization	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.206824	31.003517	0	150	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	15	37.299999	40	0.2		0	0.2	0							0	0	0	0	21.181545	40	40						NO	171.982368	121.413678	29.544491	0	145.39005	0.193853	0.193853	63.002355	0.193853	0.193853	0.193853	0.193853	0.193853	0.193853	14.539005	36.153658	38.77068	0.193853		0	0.193853	0							0	0	0	0	20.530572	38.77068	38.77068							15.7013	0.297362333	1.044225414	0	2.00638269	1.16117947	0.5234031	1.648299113	8.96376272	1.35309394	2.76822084	0.02326236	0.04070913	3.22765245	2.651720659	9.61313715	0.117216689	0.26557861	0	0	2.35919101	0	0	0	0	0	0	0	0	0	0	0	0.353194274	0.164872317	1.061993543	0	0	0	0	0	55.3457	0	NO	2.556498	15.7013	0.297362333	1.044225414	0	2.00638269	1.16117947	0.5234031	1.648299113	8.96376272	1.35309394	2.76822084	0.02326236	0.04070913	3.22765245	2.651720659	9.61313715	0.117216689	0.26557861	0	0	2.35919101	0	0	0	0	0	0	0	0	0	0	0	0.353194274	0.164872317	1.061993543	0	0	0	0	0	55.3457	YES						30% Coins																									30% Coins	$0/Visit									6700						0.3924																									0.0606	0									0.4531	0	NO	0.01987	15.7013	0.297362333	1.044225414	0	2.00638269	1.55359747	0.5234031	1.648299113	8.96376272	1.35309394	2.76822084	0.02326236	0.04070913	3.22765245	2.651720659	9.61313715	0.117216689	0.26557861	0	0	2.35919101	0	0	0	0	0	0	0	0	0	0.060638	0	0.353194274	0.164872317	1.061993543	0	0	0	0	0	55.7988
H2944_178_0	2012	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	1105.08	29.65	427.81	1111.58	7.73	6.32	2.85	316.68	48.76	7.36	15.06	0.13	0.22	17.55	2207.67	3218.51	36.6	1.44		1104.42	12.83	0							5.09	0.95	714.54	205.07	208.23	51.48	331.56							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.206824	22.345311	0	0.2	0.2	0.2	65	0.238226	0.25	0.242099	0.25	0.2	0.236996	15	32.839999	35	0.25		0	0.2	0							0	0	0	0	18.533851	35	35						NO	145.194174	116.169079	20.551876	0	0.188749	0.188749	0.188749	61.343295	0.224824	0.235936	0.228479	0.235936	0.188749	0.223664	14.156145	30.992519	33.031005	0.235936		0	0.188749	0							0	0	0	0	17.491193	33.031005	33.031005							13.3709	0.287034433	0.732691506	0	1.45902977	1.19289368	0.53793465	1.618849555	10.96241824	1.73648896	3.44089374	0.03067168	0.04152478	3.9253032	2.604341386	8.312477694	0.100744565	0.33974784	0	0	2.42164967	0	0	0	0	0	0	0	0	0	0	0	0.303515927	0.141703011	0.912646668	0	0	0	0	0	54.4735	0	NO	4.221229	13.3709	0.287034433	0.732691506	0	1.45902977	1.19289368	0.53793465	1.618849555	10.96241824	1.73648896	3.44089374	0.03067168	0.04152478	3.9253032	2.604341386	8.312477694	0.100744565	0.33974784	0	0	2.42164967	0	0	0	0	0	0	0	0	0	0	0	0.303515927	0.141703011	0.912646668	0	0	0	0	0	54.4735	YES						30% Coins																									30% Coins										5000						0.397																									0.0613										0.4584	0	NO	0.04033	13.3709	0.287034433	0.732691506	0	1.45902977	1.58989868	0.53793465	1.618849555	10.96241824	1.73648896	3.44089374	0.03067168	0.04152478	3.9253032	2.604341386	8.312477694	0.100744565	0.33974784	0	0	2.42164967	0	0	0	0	0	0	0	0	0	0.061347	0	0.303515927	0.141703011	0.912646668	0	0	0	0	0	54.9318
H2944_185_0	2012	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	264.58	4.09	43.6	22.9	9.56	12.23	7.04	26.07	60.61	17.16	26.54	2.07	0.39	29.66	26.45	51.69	0.76	7.11		5.13	24.12	0							4.84	0.93												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											0	YES	0.0864	0.0864	0.1534	0	0.195	0.195	0.195	0.195	0.195	0.180875	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195		0.195	0.195	0							0	0											NO	0.072773	0.072773	0.111223	0	0.18081	0.18081	0.18081	0.18081	0.18081	0.167713	0.18081	0.18081	0.18081	0.18081	0.18081	0.18081	0.18081	0.18081		0.18081	0.18081	0							0	0												19.2543	0.29764157	4.8493228	0	1.7285436	2.2113063	1.2729024	4.7137167	10.9588941	2.87795508	4.7986974	0.3742767	0.0705159	5.3628246	4.7824245	9.3460689	0.1374156	1.2855591	0	0.9275553	4.3611372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.611	0	NO	9.832766	19.2543	0.29764157	4.8493228	0	1.7285436	2.2113063	1.2729024	4.7137167	10.9588941	2.87795508	4.7986974	0.3742767	0.0705159	5.3628246	4.7824245	9.3460689	0.1374156	1.2855591	0	0.9275553	4.3611372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.611	YES						Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing																															6700						0.5238	0.0743			0																															0.5982	0	NO	0.02279	19.2543	0.29764157	4.8493228	0	1.7285436	2.7351233	1.3472414	4.7137167	10.9588941	2.87795508	4.7986974	0.3742767	0.0705159	5.3628246	4.7824245	9.3460689	0.1374156	1.2855591	0	0.9275553	4.3611372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2092
H2944_193_0	2012	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	O							O	O	O	V									0	0	0	0	0	0.513405942	0.253658705	0	2.184127557	0.411082411	0.796858896	0.052225812	0.00711211	0.980745426	1.200202433	2.448875029	0.022566794	0.264342672		0	0.832137914	0							0	0	0	0									9.9673	NO	308.04	5.2	23.59	1335.01	11.36	16.65	8.23	437.84	70.84	13.33	25.84	1.69	0.23	31.81	38.93	79.43	0.73	8.57		1929.97	26.99	0							4.14	0.81	2085.77	187.75										Medicare FFS Costing Sharing	Medicare FFS Costing Sharing	Medicare FFS Costing Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"20% Coins: 8a. 20% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									162	YES	0.0838	0.0838	0.1924	0	0.2	0.2	0.2	65	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	0.068233	0.068233	0.146515	0	0.181892	0.181892	0.181892	59.11503	0.181892	0.181892	0.181892	0.181892	0.181892	0.181892	0.181892	0.181892	0.181892	0.181892		0	0.181892	0							0	0	0	0										21.0185	0.3548116	3.45628885	0	2.06629312	3.0285018	1.49697116	2.156910395	12.88522928	2.42462036	4.70008928	0.30739748	0.04183516	5.78598452	7.08105556	14.44768156	0.13278116	1.55881444	0	0	4.90926508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.853	0	NO	12.232546	21.0185	0.3548116	3.45628885	0	2.06629312	3.541907742	1.750629865	2.156910395	15.06935684	2.835702771	5.496948176	0.359623292	0.04894727	6.766729946	8.281257993	16.89655659	0.155347954	1.823157112	0	0	5.741402994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8204	YES				$0/Visit		20% Coins																									$0/Service										6700				0		1.124																							0		0										1.124	0	NO	0.002642	21.0185	0.3548116	3.45628885	0	2.06629312	4.665868742	1.750629865	2.156910395	15.06935684	2.835702771	5.496948176	0.359623292	0.04894727	6.766729946	8.281257993	16.89655659	0.155347954	1.823157112	0	0	5.741402994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9443
H2944_194_0	2012	4	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	O							O	O	O	V	V								0	0	0	0	0	0.639551459	0.272118755	0	2.214361291	0.36635299	0.856570257	0.053419217	0.010352285	1.01760682	1.418189021	2.389631836	0.031055699	0.220425455		0	0.71570923	0							0	0	0	0	0								10.2053	NO	281.78	5.56	44.41	1415.06	11.65	17.7	7.53	434.98	61.27	10.14	23.7	1.48	0.29	28.16	39.24	66.12	0.86	6.1		2150.86	19.8	0							3.99	0.81	2632.71	419.04	164.42									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0821	0.0821	0.1821	0	0.2	0.2	0.2	65	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	0.067875	0.067875	0.12135	0	0.184003	0.184003	0.184003	59.800975	0.184003	0.184003	0.184003	0.184003	0.184003	0.184003	0.184003	0.184003	0.184003	0.184003		0	0.184003	0							0	0	0	0	0									19.1258	0.377385	5.3891535	0	2.14363495	3.2568531	1.38554259	2.167685675	11.27386381	1.86579042	4.3608711	0.27232444	0.05336087	5.18152448	7.22027772	12.16627836	0.15824258	1.1224183	0	0	3.6432594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1643	0	NO	11.677504	19.1258	0.377385	5.3891535	0	2.14363495	3.896404559	1.657661345	2.167685675	13.4882251	2.23214341	5.217441357	0.325743657	0.063713155	6.1991313	8.638466741	14.5559102	0.189298279	1.342843755	0	0	4.35896863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3696	YES						20% Coins																									$0/Service	$0/Visit									6700						0.907																							0		0	0									0.907	0	NO	0.028035	19.1258	0.377385	5.3891535	0	2.14363495	4.803425559	1.657661345	2.167685675	13.4882251	2.23214341	5.217441357	0.325743657	0.063713155	6.1991313	8.638466741	14.5559102	0.189298279	1.342843755	0	0	4.35896863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2766
H2944_197_0	2012	7	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	V									0	0	0	0	0	0.572622174	0.271038302	0	2.419070265	0.452567731	0.97706461	0.065852534	0.017357715	1.204411822	1.095253858	1.972502393	0.030915723	0.237655229		0	0.853200173	0							0	0	0	0									10.1695	NO	278.22	4.41	32.28	1502.47	10.72	15.47	7.32	374.76	65.37	12.23	28.09	1.78	0.47	32.54	29.6	53.3	0.84	6.42		1657.72	23.05	0							1.34	1.19	1392.38	259.01										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"0%-20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14a. 0% SMAM -- FSR,14a. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL									162	YES	0.0854	0.0854	0.1727	0	0.2	0.2	0.2	65	0.2	0.2	0.187977	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.071539	0.071539	0.130198	0	0.185269	0.185269	0.185269	60.212425	0.185269	0.185269	0.174132	0.185269	0.185269	0.185269	0.185269	0.185269	0.185269	0.185269		0	0.185269	0							0	0	0	0										19.9036	0.31548699	4.20279144	0	1.98608368	2.86611143	1.35616908	1.880434033	12.11103453	2.26583987	4.89136788	0.32977882	0.08707643	6.02865326	5.4839624	9.8748377	0.15562596	1.18942698	0	0	4.27045045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1987	0	NO	9.644767	19.9036	0.31548699	4.20279144	0	1.98608368	3.438733604	1.627207382	1.880434033	14.53010479	2.718407601	5.86843249	0.395631354	0.104434145	7.233065082	6.579216258	11.84734009	0.186541683	1.427082209	0	0	5.123650623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3682	YES				0% Coins		20% Coins																									20% Coins	0% Coins									6700	0	0	0	0	0	0.7598	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0.1251	0									0.8849	0	NO	0.039791	19.9036	0.31548699	4.20279144	0	1.98608368	4.198526604	1.627207382	1.880434033	14.53010479	2.718407601	5.86843249	0.395631354	0.104434145	7.233065082	6.579216258	11.84734009	0.186541683	1.427082209	0	0	5.123650623	0	0	0	0	0	0	0	0	0	0.12512	0	0	0	0	0	0	0	0	0	90.2531
H2944_198_0	2012	3	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	290.69	4.49	47.87	1009.32	10.61	13.58	5.89	387.33	67.18	19.02	27.4	2.28	0.43	32.87	29.36	57.37	0.84	7.89		1345.63	26.73	0							3.56	1.24	1026.38	184.84										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"15% Coins: 4b, 7a, 8a, 8b. 15% Physician Services PCP,4b, 7a, 8a, 8b. 15% PCP Cap"	"15% Coins: 7b. 15% Chiropractic,7f. 15% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Spec Cap"	"15% Coins: 7e, 7h. 15% Psych -- Other Provider"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"											0.0816	0.0816	0.1693	0	0.195	0.195	0.195	65	0.184955	0.180875	0.181828	0.195	0.195	0.195	0.15	0.15	0.15	0.166549		0	0.195	0							0	0	0	0									NO	0.062018	0.062018	0.092536	0	0.17346	0.17346	0.17346	57.81984	0.164524	0.160895	0.161742	0.17346	0.17346	0.17346	0.13343	0.13343	0.13343	0.148151		0	0.17346	0							0	0	0	0										18.028	0.27846082	4.42969832	0	1.8404106	2.3555868	1.0216794	1.866279886	11.05272232	3.0602229	4.4317308	0.3954888	0.0745878	5.7016302	3.9175048	7.6548791	0.1120812	1.16891139	0	0	4.6365858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0265	0	NO	15.57569	18.028	0.27846082	4.42969832	0	1.8404106	2.3555868	1.0216794	1.866279886	11.05272232	3.0602229	4.4317308	0.3954888	0.0745878	5.7016302	3.9175048	7.6548791	0.1120812	1.16891139	0	0	4.6365858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0265	YES						Medicare FFS Cost Sharing				Medicare FFS Cost Sharing																					19% Coins										5000						0.5607				0																			0		0.0796										0.6402	0	NO	0.049019	18.028	0.27846082	4.42969832	0	1.8404106	2.9162388	1.0216794	1.866279886	11.05272232	3.0602229	4.4317308	0.3954888	0.0745878	5.7016302	3.9175048	7.6548791	0.1120812	1.16891139	0	0	4.6365858	0	0	0	0	0	0	0	0	0	0.079566	0	0	0	0	0	0	0	0	0	72.6667
H2944_201_0	2012	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	Inpatient Facility	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Mental Health	Lab	Radiology	Therapy (PT/OT/ST)						D	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	D	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1815.6	10.51	643.79	4184.93	14.41	17.37	8.73	418.03	77.98	11.7	25.47	1.79	0.41	31.64	2963.18	4700.36	104.02	1.73		1593.35	26.74	0							3.7	1.43	1791.63	0	569.41	333.34	444.16							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	$1400/Admit: 1b. $1400 IP Psych - Facility 1	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	1400	31.003517	0	0.2	0.2	0.2	65	0.238879	0.25	0.240538	0.228515	0.2	0.239208	15	34.029499	35	0.25		0	0.2	0							0	0	0	0	0	20.766801	35						NO	123.132388	1051.1998	23.830667	0	0.174414	0.174414	0.174414	56.68455	0.208319	0.218018	0.209766	0.199281	0.174414	0.208606	13.08105	29.676105	30.52245	0.218018		0	0.174414	0							0	0	0	0	0	18.110104	30.52245							18.6299	0.920675825	1.278495426	0	2.51330574	3.02957118	1.52263422	1.974653536	16.24471562	2.5508106	5.34274002	0.35671299	0.07150974	6.60029384	3.230125478	11.62403141	0.264578771	0.37717114	0	0	4.66383036	0	0	0	0	0	0	0	0	0	0	0	0	0.503068506	1.129737616	0	0	0	0	0	82.8286	0	NO	15.966813	18.6299	0.920675825	1.278495426	0	2.51330574	3.02957118	1.52263422	1.974653536	16.24471562	2.5508106	5.34274002	0.35671299	0.07150974	6.60029384	3.230125478	11.62403141	0.264578771	0.37717114	0	0	4.66383036	0	0	0	0	0	0	0	0	0	0	0	0	0.503068506	1.129737616	0	0	0	0	0	82.8286	YES						20% Coins	20% Coins																								20% Coins		$0/Visit								5000	0	0	0	0	0	0.7067	0.3551	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0.128	0	0	0	0						1.1898	0	NO	0.143544	18.6299	0.920675825	1.278495426	0	2.51330574	3.73624218	1.87773522	1.974653536	16.24471562	2.5508106	5.34274002	0.35671299	0.07150974	6.60029384	3.230125478	11.62403141	0.264578771	0.37717114	0	0	4.66383036	0	0	0	0	0	0	0	0	0	0.128003	0	0	0.503068506	1.129737616	0	0	0	0	0	84.0184
H2944_204_0	2012	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	1336.76	58.53	495.38	1507.87	10.92	15.76	7.46	376.1	50.01	12.46	17.95	1.81	0.48	33.16	2940.04	3445.92	95.67	2.91		1663.67	23.49	0							1.34	1.19	1397.38	259.94	350.51	0	424.54							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"							$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210147	128.006658	44.329117	0	0.2	0.2	0.2	65	0.240812	0.25	0.242917	0.214278	0.2	0.237246	20	38.047457	40	0.25		0	0.2	0							0	0	0	0	21.965108	0	40						NO	159.583474	112.110919	39.774654	0	0.187505	0.187505	0.187505	60.93919	0.225768	0.234382	0.227741	0.200891	0.187505	0.222424	18.75052	35.670481	37.50104	0.234382		0	0.187505	0							0	0	0	0	20.59286	0	37.50104							17.7771	0.546821007	1.641964008	0	2.0475546	2.9550788	1.3987873	1.90993578	11.29065768	2.92039972	4.08795095	0.36361271	0.0900024	7.37557984	4.593939902	10.24313532	0.298977041	0.68205162	0	0	4.40449245	0	0	0	0	0	0	0	0	0	0	0	0.60150028	0	1.326724293	0	0	0	0	0	76.5562	0	NO	6.556962	17.7771	0.546821007	1.641964008	0	2.0475546	2.9550788	1.3987873	1.90993578	11.29065768	2.92039972	4.08795095	0.36361271	0.0900024	7.37557984	4.593939902	10.24313532	0.298977041	0.68205162	0	0	4.40449245	0	0	0	0	0	0	0	0	0	0	0	0.60150028	0	1.326724293	0	0	0	0	0	76.5562	YES						20% Coins																									20% Coins	$0/Visit									6700						0.6837																							0	0	0.1126	0									0.7963	0	NO	0.040673	17.7771	0.546821007	1.641964008	0	2.0475546	3.6388288	1.3987873	1.90993578	11.29065768	2.92039972	4.08795095	0.36361271	0.0900024	7.37557984	4.593939902	10.24313532	0.298977041	0.68205162	0	0	4.40449245	0	0	0	0	0	0	0	0	0	0.112597	0	0.60150028	0	1.326724293	0	0	0	0	0	77.3526
H2949_009_0	2012	4	r.	s.	t.								OP Facility - Other	OP Facility - Other	OP Facility - Other								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	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	1548.18	57.2	557.57	2250.14	301.13	15.52	7.75	410.24	335.12	859.48	6.6	135.9	3.12	8.09	4343.01	4259.93	89.58	766.39		1662.88	27.36	0	2.55						4.11	0.24	984.62	0.05	368.25								3400	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $128 (Days 21-100): 2. $0 SNF - Facility 1,2. $128 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b, 9a. 20% Advanced Imaging -- OP"	"$25-$150/Visit: 5. $150 Partial Hospitalization,7h. $25 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$25/Visit: 7b. $0 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Nutritional benefit 13c	"$0-$65/Visit: 8b. $15 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $0 Dialysis -- Dialysis Center	"$25-$30/Visit: 3. $25 Cardiac Rehab,9a, 9c, 9d, 14d. $25 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $25 Observation"										15.729929	12.928961	39.684502	0	100	0.2	0.078455	50	0	0	0.2	130.266621	0.2	0.2	0	23.724858	25	26.28542		0	0.2	0	0						0	0	28.45861	0	25								NO	15.136785	12.441436	38.002236	0	94.0987	0.188197	0.073825	47.04935	0	0	0.188197	122.579197	0.188197	0.188197	0	22.324783	23.524675	24.734239		0	0.188197	0	0						0	0	26.779182	0	23.524675									1.9529	0.059304178	1.765742227	0	2.361328461	2.92081744	0.57214375	1.608460445	0	0	1.2421002	1.388209406	0.58717464	1.52251373	0	7.925167737	0.175611699	1.579672786	0	0	5.14906992	0	0	0	0	0	0	0	0	0	2.197276515	0	0.721913464	0	0	0	0	0	0	0	33.7294	0	NO	2.035315	1.9529	0.059304178	1.765742227	0	2.361328461	2.92081744	0.57214375	1.608460445	0	0	1.2421002	1.388209406	0.58717464	1.52251373	0	7.925167737	0.175611699	1.579672786	0	0	5.14906992	0	0	0	0	0	0	0	0	0	2.197276515	0	0.721913464	0	0	0	0	0	0	0	33.7294	NO																																																																																		0	0	NO	0	1.9529	0.059304178	1.765742227	0	2.361328461	2.92081744	0.57214375	1.608460445	0	0	1.2421002	1.388209406	0.58717464	1.52251373	0	7.925167737	0.175611699	1.579672786	0	0	5.14906992	0	0	0	0	0	0	0	0	0	2.197276515	0	0.721913464	0	0	0	0	0	0	0	33.7294
H2949_012_0	2012	6	r.	s.									OP Facility - Other	OP Facility - Other									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	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	2252.59	61.39	931.05	2438.84	482.49	16.52	11.49	598.65	338.1	993.49	1050.93	183.21	5.67	7.93	4413.43	4880.31	100.5	687.55		1554.6	41.56	0	2.55						4.11	0.24	0	574.22									2500	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $128 (Days 21-100): 2. $0 SNF - Facility 1,2. $128 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$30/Visit: 5. $30 Partial Hospitalization,7h. $30 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$25/Visit: 7b. $0 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Nutritional benefit 13c	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$30-$50/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"											15.729929	12.928961	39.684502	0	100	0.2	0.07325	50	50	40.276144	28.406411	30	0.2	0.2	0	23.322308	25	26.973886		0	0.2	0	0						0	0	0	37.584496									NO	13.698377	11.25916	30.375034	0	86.6341	0.173268	0.063459	43.31705	43.31705	34.892875	24.609638	25.99023	0.173268	0.173268	0	20.205072	21.658525	23.368584		0	0.173268	0	0						0	0	0	32.56099										2.5714	0.057599986	2.35672295	0	3.483340576	2.86238736	0.72914391	2.160979332	1.220457884	2.888810199	2.155250572	0.396805837	0.98242956	1.37401524	0	8.217251244	0.181390147	1.338922494	0	0	7.20101808	0	0	0	0	0	0	0	0	0	0	1.55809764	0	0	0	0	0	0	0	0	41.736	0	NO	6.782132	2.5714	0.057599986	2.35672295	0	3.483340576	2.86238736	0.72914391	2.160979332	1.220457884	2.888810199	2.155250572	0.396805837	0.98242956	1.37401524	0	8.217251244	0.181390147	1.338922494	0	0	7.20101808	0	0	0	0	0	0	0	0	0	0	1.55809764	0	0	0	0	0	0	0	0	41.736	NO																																																																																		0	0	NO	0	2.5714	0.057599986	2.35672295	0	3.483340576	2.86238736	0.72914391	2.160979332	1.220457884	2.888810199	2.155250572	0.396805837	0.98242956	1.37401524	0	8.217251244	0.181390147	1.338922494	0	0	7.20101808	0	0	0	0	0	0	0	0	0	0	1.55809764	0	0	0	0	0	0	0	0	41.736
H2949_013_0	2012	7	r.	s.									OP Facility - Other	OP Facility - Other									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	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	1821.67	73.08	635.04	3022.72	302.68	20.22	7.36	458.44	359	751.67	1562.46	118.43	0.76	6	5276.85	5512.23	109.04	862.13		2365.27	40.85	0	2.55						4.11	0.24	0.12	427.85									2500	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $128 (Days 21-100): 2. $0 SNF - Facility 1,2. $128 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$30/Visit: 5. $30 Partial Hospitalization,7h. $30 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Nutritional benefit 13c	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0-$50/Visit: 3. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"											15.729929	12.928961	39.684502	0	100	0.2	0.076333	50	50	35.394484	26.114219	30	0.2	0.2	0	9.763242	25	10		0	0.2	0	0						0	0	0	28.022213									NO	14.445674	11.873389	34.634927	0	90.2855	0.180571	0.068917	45.14275	45.14275	31.956087	23.577353	27.08565	0.180571	0.180571	0	8.814792	22.571375	9.02855		0	0.180571	0	0						0	0	0	25.299995										2.1929	0.072308939	1.832880337	0	2.277301262	3.65114562	0.50722912	1.724603526	1.350520604	2.00170266	3.069889247	0.267312794	0.13723396	1.083426	0	4.049096742	0.205098561	0.648648651	0	0	7.37632535	0	0	0	0	0	0	0	0	0	0	0.902050238	0	0	0	0	0	0	0	0	33.3497	0	NO	3.615873	2.1929	0.072308939	1.832880337	0	2.277301262	3.65114562	0.50722912	1.724603526	1.350520604	2.00170266	3.069889247	0.267312794	0.13723396	1.083426	0	4.049096742	0.205098561	0.648648651	0	0	7.37632535	0	0	0	0	0	0	0	0	0	0	0.902050238	0	0	0	0	0	0	0	0	33.3497	NO																																																																																		0	0	NO	0	2.1929	0.072308939	1.832880337	0	2.277301262	3.65114562	0.50722912	1.724603526	1.350520604	2.00170266	3.069889247	0.267312794	0.13723396	1.083426	0	4.049096742	0.205098561	0.648648651	0	0	7.37632535	0	0	0	0	0	0	0	0	0	0	0.902050238	0	0	0	0	0	0	0	0	33.3497
H2949_014_0	2012	5	r.	s.									OP Facility - Other	OP Facility - Other									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	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	1845.44	74.04	643.33	3062.16	306.63	20.47	7.45	464.42	363.69	761.48	1582.84	119.98	0.77	6.07	5345.71	5584.16	110.46	873.38		2396.13	41.36	0	2.55						4.11	0.24	0.13	433.44									2500	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $128 (Days 21-100): 2. $0 SNF - Facility 1,2. $128 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit: 4a, 4b. $50 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,14a. $0 SMAM -- FSR,14a. $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"	"$30/Visit: 5. $30 Partial Hospitalization,7h. $30 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0-$10/Visit: 7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $10 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Nutritional benefit 13c	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0-$50/Visit: 3. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"											15.729929	12.928961	39.684502	0	100	0.2	0.076333	50	50	35.394484	26.114219	30	0.2	0.2	0	9.763242	25	10		0	0.2	0	0						0	0	0	28.022213									NO	14.414592	11.847841	34.489761	0	90.127	0.180254	0.068796	45.0635	45.0635	31.899986	23.535962	27.0381	0.180254	0.180254	0	8.799317	22.53175	9.0127		0	0.180254	0	0						0	0	0	25.25558										2.2168	0.073101179	1.849024829	0	2.302970168	3.68979938	0.5125302	1.744032556	1.365762026	2.024266778	3.104471841	0.270335937	0.13879558	1.09414178	0	4.094732835	0.207404759	0.655959327	0	0	7.45530544	0	0	0	0	0	0	0	0	0	0	0.91223155	0	0	0	0	0	0	0	0	33.7116	0	NO	3.727068	2.2168	0.073101179	1.849024829	0	2.302970168	3.68979938	0.5125302	1.744032556	1.365762026	2.024266778	3.104471841	0.270335937	0.13879558	1.09414178	0	4.094732835	0.207404759	0.655959327	0	0	7.45530544	0	0	0	0	0	0	0	0	0	0	0.91223155	0	0	0	0	0	0	0	0	33.7116	NO																																																																																		0	0	NO	0	2.2168	0.073101179	1.849024829	0	2.302970168	3.68979938	0.5125302	1.744032556	1.365762026	2.024266778	3.104471841	0.270335937	0.13879558	1.09414178	0	4.094732835	0.207404759	0.655959327	0	0	7.45530544	0	0	0	0	0	0	0	0	0	0	0.91223155	0	0	0	0	0	0	0	0	33.7116
H2949_805_0	2012	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	280.36	3.26	50.04	27.86	9.57	15.5	4.71	27.01	71.8	9.67	33.33	0.74	0.53	20.99	42.66	107.02	0.73	8.45		17.35	37.01	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																					0.0757	0.0757	0.1515	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062756	0.062756	0.115243	0	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874		0.196874	0.196874	0																				17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	0	NO	16.527621	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	NO																																																																																		0	0	NO	0	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071
H2949_807_0	2012	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	280.36	3.26	50.04	27.86	9.57	15.5	4.71	27.01	71.8	9.67	33.33	0.74	0.53	20.99	42.66	107.02	0.73	8.45		17.35	37.01	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																					0.0757	0.0757	0.1515	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062756	0.062756	0.115243	0	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874		0.196874	0.196874	0																				17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	0	NO	16.527621	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	NO																																																																																		0	0	NO	0	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071
H2949_808_0	2012	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	280.36	3.26	50.04	27.86	9.57	15.5	4.71	27.01	71.8	9.67	33.33	0.74	0.53	20.99	42.66	107.02	0.73	8.45		17.35	37.01	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																					0.0757	0.0757	0.1515	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062756	0.062756	0.115243	0	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874	0.196874		0.196874	0.196874	0																				17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	0	NO	16.527621	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071	NO																																																																																		0	0	NO	0	17.5943	0.20458456	5.76675972	0	1.88408418	3.051547	0.92727654	5.31756674	14.1355532	1.90377158	6.56181042	0.14568676	0.10434322	4.13238526	8.39864484	21.06945548	0.14371802	1.6635853	0	3.4157639	7.28630674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7071
H2960_004_0	2012	4																															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	1588.071851	51.71369677	1346.177159	1007.785676	9.131280909	6.778396424	2.462769185	492.1171601	554.6931869	222.1610591	855.2323989	0	0	244.6904665	4400.453846	10578.70089	256.2961345	641.6095713	2125.976813	2895.073747	28.47328532	119.6291248	1.300454011	6.144838167	157.1313674	181.76	17.53387487	15.61084388	12000	43.02861269											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 1-34	6 Home Health: $0	10A Ambulance: $150	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, $60 Radiation Therapy, $60 CT, $80 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"9D 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: $40	18B Hearing Aids: $400 allowance every 36 months	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													75.28742338	52.23492093	50	0	0.286162977	0.2	0.194828953	36.93501721	150	0	55.69196485	0	0	2.545748645	7.957074788	19.3578769	30.64498006	15	0	0.073536502	0.2	44.81834975	0	0	20	0	40	0	0	20											NO	65.72592061	45.60108597	43.65	0	0.249820279	0.1746	0.170085676	32.24427002	130.95	0	48.61908531	0	0	2.222438567	6.94652629	16.89942653	26.7530676	13.095	0	0.064197366	0.1746	39.12641933	0	0	17.46	0	34.92	0	0	17.46												8.6981	0.196516728	4.896719414	0	2.281179145	1.183508016	0.418881761	1.322329883	6.053089402	0	3.465051413	0	0	0.045317461	2.547322361	14.89783154	0.571392318	0.700156445	0	0.015488009	4.971435617	0.390054942	0	0	0.22862614	0	0.051023576	0	0	0.062606631	0	0	0	0	0	0	0	0	0	0	52.9967			7.709708044	8.6981	0.196516728	4.896719414	0	2.281179145	1.183508016	0.418881761	1.322329883	6.053089402	0	3.465051413	0	0	0.045317461	2.547322361	14.89783154	0.571392318	0.700156445	0	0.015488009	4.971435617	0.390054942	0	0	0.22862614	0	0.051023576	0	0	0.062606631	0	0	0	0	0	0	0	0	0	0	52.9967	NO																																																																																		0				8.6981	0.196516728	4.896719414	0	2.281179145	1.183508016	0.418881761	1.322329883	6.053089402	0	3.465051413	0	0	0.045317461	2.547322361	14.89783154	0.571392318	0.700156445	0	0.015488009	4.971435617	0.390054942	0	0	0.22862614	0	0.051023576	0	0	0.062606631	0	0	0	0	0	0	0	0	0	0	52.9967
H2960_009_0	2012	4																															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	1086.2998	23.47567433	1016.619147	634.5385515	6.096005669	4.360958924	1.747372018	338.2346992	359.017412	136.2213948	510.2967448	0	0	185.9126816	2983.857951	7436.060906	157.9138972	390.3073322	1439.021939	1971.698878	8.776962564	83.76545884	1.847661125	0	95.11335002	221.6	0	0	12000	85.63978251											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 1-34	6 Home Health: $0	10A Ambulance: $150	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, $60 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"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%	"9D 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: $40	18B Hearing Aids: Not Covered	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	"13A Accupuncture: $20, 13B Over the counter drugs: $4"													86.33075591	64.64989317	50	0	0.312151439	0.2	0.192512559	37.34253045	150	0	66.09869257	0	0	4.32900858	8.078841718	19.53539105	33.31659306	20	0	0.071301799	0.2	50.38253755	0	0	20	0	0	0	0	19.76207228											NO	76.31638823	57.15050556	44.2	0	0.275941872	0.1768	0.170181102	33.01079692	132.6	0	58.43124423	0	0	3.826843585	7.141696079	17.26928569	29.45186826	17.68	0	0.06303079	0.1768	44.53816319	0	0	17.68	0	0	0	0	17.46967189												6.9085	0.111803888	3.744547191	0	1.682143217	0.771017538	0.297369696	0.930449747	3.967142402	0	2.48477281	0	0	0.059288229	1.775817219	10.70128835	0.387571608	0.575052803	0	0.010356478	1.551766981	0.31089664	0	0	0.140133669	0	0	0	0	0.124674908	0	0	0	0	0	0	0	0	0	0	36.5346			4.794137381	6.9085	0.111803888	3.744547191	0	1.682143217	0.771017538	0.297369696	0.930449747	3.967142402	0	2.48477281	0	0	0.059288229	1.775817219	10.70128835	0.387571608	0.575052803	0	0.010356478	1.551766981	0.31089664	0	0	0.140133669	0	0	0	0	0.124674908	0	0	0	0	0	0	0	0	0	0	36.5346	NO																																																																																		0				6.9085	0.111803888	3.744547191	0	1.682143217	0.771017538	0.297369696	0.930449747	3.967142402	0	2.48477281	0	0	0.059288229	1.775817219	10.70128835	0.387571608	0.575052803	0	0.010356478	1.551766981	0.31089664	0	0	0.140133669	0	0	0	0	0.124674908	0	0	0	0	0	0	0	0	0	0	36.5346
H2960_010_0	2012	5																															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	1693.251864	30.46510271	1678.202178	1176.932144	9.992697176	9.464583602	5.505265059	577.7760141	659.769948	255.254369	1060.083416	0	0	472.4874517	5234.381995	14296.10655	246.0011615	767.3843439	2370.810431	3178.431347	15.03721588	245.8709806	0.954609338	67.38448924	221.7116322	175.6	24.43624075	29.85382157	12000	109.3727267											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 1-20	6 Home Health: $0	10A Ambulance: $150	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, 3 Cardiac Rehab: $15, 9c Substance Abuse: $30"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"9D Blood: 20%, 17A Medicare Covered Eye Exams: $15, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $30"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Covered"	17A Routine Eye Exams: $15	17B Eye Wear: $200 allowance	18A Routine Hearing Exams: $30	18B Hearing Aids: $800 allowance every 36 months	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													23.8395814	20.05606203	43.89325763	0	0.306725287	0.1	0.097839354	32.24566154	50	0	35.83650686	0	0	4.731146008	8.007931435	15.20174806	26.50518836	10	0	0.185786077	0.2	89.1974945	0	0.340612061	15	0	30	0	0	20											NO	20.14444628	16.94737242	37.0898027	0	0.259182867	0.0845	0.082674254	27.247584	42.25	0	30.2818483	0	0	3.997818376	6.766702062	12.84547711	22.39688416	8.45	0	0.156989235	0.169	75.37188285	0	0.287817191	12.675	0	25.35	0	0	16.9												2.8425	0.043025287	5.18701564	0	2.589935908	0.799757314	0.455143683	1.311916706	2.322940025	0	2.675107099	0	0	0.157409918	2.951625287	15.30335912	0.459138293	0.540366475	0	0.041581625	2.541289484	1.544313229	0	19.39441443	0.234182912	0	0.051621559	0	0	0.154033257	0	0	0	0	0	0	0	0	0	0	61.6006			11.29952672	2.8425	0.043025287	5.18701564	0	2.589935908	0.799757314	0.455143683	1.311916706	2.322940025	0	2.675107099	0	0	0.157409918	2.951625287	15.30335912	0.459138293	0.540366475	0	0.041581625	2.541289484	1.544313229	0	19.39441443	0.234182912	0	0.051621559	0	0	0.154033257	0	0	0	0	0	0	0	0	0	0	61.6006	NO																																																																																		0				2.8425	0.043025287	5.18701564	0	2.589935908	0.799757314	0.455143683	1.311916706	2.322940025	0	2.675107099	0	0	0.157409918	2.951625287	15.30335912	0.459138293	0.540366475	0	0.041581625	2.541289484	1.544313229	0	19.39441443	0.234182912	0	0.051621559	0	0	0.154033257	0	0	0	0	0	0	0	0	0	0	61.6006
H2960_012_0	2012	5																															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	1711.216774	61.38305955	1146.594557	937.8663161	10.11990911	5.973085132	2.149485256	469.3848061	379.0101654	161.9856586	680.9745044	0	0	179.6394844	4108.293945	8929.645299	248.1741042	361.9824475	1894.266282	2925.117978	8.758991978	125.7804655	0.590603633	0	25.362391	221.6	6.111171938	0	12000	31.14461515											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 1-34	6 Home Health: $0	10A Ambulance: $200	11A DME: 20%	11B Prosthetic and Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services including Colonoscopies: $200, 9A OP Hosp - Surgery including Colonoscopies $200"	8A OP Lab: $0	"8B: $50 Routine Imaging, $60 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separate office visit copay applies, 14B Additional Prostate Screening: $0 14A Colorectal Screening: $0, 14A Bone Mass Measurement: $0, separate office visit copay applies, 14A Routine Mammography: $0, 14B Diagnositc Mammography: $0, 14e Diabetes Monitoring: $0, separate office visit copay may apply, 14A Nutrition Therapy: $0, 14A Flu Shots: $0, 14A Colorectal Screening: $0"	"7B Chiropractic: $20, 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"	"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%	"9D 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	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													81.06857749	52.47877386	50	0	0.385325643	0.2	0.194664478	37.62520334	200	0	66.19560717	0	0	2.21249879	8.228043376	17.86547382	28.62794198	20	0	0.103451007	0.2	51.92494309	0	0	20	0	0	0	0	20											NO	71.6646225	46.39123609	44.2	0	0.340627868	0.1768	0.172083399	33.26067975	176.8	0	58.51691674	0	0	1.955848931	7.273590344	15.79307886	25.30710071	17.68	0	0.09145069	0.1768	45.90164969	0	0	17.68	0	0	0	0	17.68												10.2195	0.237303001	4.22328995	0	3.44712307	1.056041451	0.369890728	1.30100481	5.584083103	0	3.320710698	0	0	0.029278974	2.490170598	11.75221603	0.523380587	0.533320806	0	0.022292005	1.548589782	0.481127572	0	0	0.037367256	0	0	0	0	0.0458864	0	0	0	0	0	0	0	0	0	0	47.2226			6.196624493	10.2195	0.237303001	4.22328995	0	3.44712307	1.056041451	0.369890728	1.30100481	5.584083103	0	3.320710698	0	0	0.029278974	2.490170598	11.75221603	0.523380587	0.533320806	0	0.022292005	1.548589782	0.481127572	0	0	0.037367256	0	0	0	0	0.0458864	0	0	0	0	0	0	0	0	0	0	47.2226	NO																																																																																		0				10.2195	0.237303001	4.22328995	0	3.44712307	1.056041451	0.369890728	1.30100481	5.584083103	0	3.320710698	0	0	0.029278974	2.490170598	11.75221603	0.523380587	0.533320806	0	0.022292005	1.548589782	0.481127572	0	0	0.037367256	0	0	0	0	0.0458864	0	0	0	0	0	0	0	0	0	0	47.2226
H2960_018_0	2012	4																															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	1435.711329	41.64010976	1197.629402	882.9321923	7.323914844	5.604495868	2.412709902	439.0422016	462.520343	182.3078187	735.2736113	0	0	243.1996112	3906.905713	9572.072003	217.5258823	505.564115	1839.24952	2581.278066	15.01162184	130.1115974	1.022113913	62.52476761	166.5371183	160.5333333	6.867335626	37	12000	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 1-20	6 Home Health: $0	10A Ambulance: $150	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, 3 Cardiac Rehab: $15, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14A Phsycial Exams: $0, 14B Additional Phsycial Exams: $0, 14A Pap/Pelvic: $0, separate office visit copay applies, 14B Additional Pap/Pelvic: $0, 14A Prostate Screening: $0, separa"	"7B Chiropractic: $20, 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"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"9D 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: $20	17B Eye Wear: $150 allowance	18A Routine Hearing Exams: $35	18B Hearing Aids: $600 allowance every 36 months	"14C Health Education/Wellness Programs: $0, 14C Membership in Health Club $0"	13A Accupuncture: $20													43.06999624	26.73116485	43.89352524	0	0.336309445	0.15	0.145766257	34.95053478	100	0	45.54992098	0	0	3.499021828	8.051591893	16.94259353	27.51099802	15	0	0.096075988	0.2	55.73694432	0	0.37	20	0	35	0	0	20											NO	37.60010672	23.33630692	38.31904753	0	0.293598146	0.13095	0.127253943	30.51181687	87.3	0	39.76508102	0	0	3.054646056	7.029039723	14.79088415	24.01710127	13.095	0	0.083874338	0.1746	48.65835239	0	0.32301	17.46	0	30.555	0	0	17.46												4.4986	0.080977198	3.824334831	0	2.150287818	0.733908734	0.307026848	1.116331271	3.364835495	0	2.436517893	0	0	0.061907394	2.288482954	11.79828401	0.435361762	0.55169684	0	0.018041916	2.621029174	0.527584663	0	20.19612519	0.242311507	0	0.017485953	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	57.4166			8.352702188	4.4986	0.080977198	3.824334831	0	2.150287818	0.733908734	0.307026848	1.116331271	3.364835495	0	2.436517893	0	0	0.061907394	2.288482954	11.79828401	0.435361762	0.55169684	0	0.018041916	2.621029174	0.527584663	0	20.19612519	0.242311507	0	0.017485953	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	57.4166	NO																																																																																		0				4.4986	0.080977198	3.824334831	0	2.150287818	0.733908734	0.307026848	1.116331271	3.364835495	0	2.436517893	0	0	0.061907394	2.288482954	11.79828401	0.435361762	0.55169684	0	0.018041916	2.621029174	0.527584663	0	20.19612519	0.242311507	0	0.017485953	0	0	0.1455	0	0	0	0	0	0	0	0	0	0	57.4166
H2960_803_0	2012	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	158.25	2.68	37.33	9.24	6.28	4.8	2	12.64	35.93	1.52	26.32115665	0	0	2.48	23.54	95.62	1.41	1.87	13.73	27.21	12.88	2.65																			3000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.075942663	0.075942663	0.155132539	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.066297945	0.066297945	0.135430706	0	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552	0	0	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552	0.195552																				10.4916	0.177678493	5.055628265	0	1.22806656	0.9386496	0.391104	2.47177728	7.02618336	0.29723904	5.147154825	0	0	0.48496896	4.60329408	18.69868224	0.27572832	0.36568224	2.68492896	5.32096992	2.51870976	0.5182128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6963			9.993621058	10.4916	0.177678493	5.055628265	0	1.22806656	0.9386496	0.391104	2.47177728	7.02618336	0.29723904	5.147154825	0	0	0.48496896	4.60329408	18.69868224	0.27572832	0.36568224	2.68492896	5.32096992	2.51870976	0.5182128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6963	NO																																																																																		0				10.4916	0.177678493	5.055628265	0	1.22806656	0.9386496	0.391104	2.47177728	7.02618336	0.29723904	5.147154825	0	0	0.48496896	4.60329408	18.69868224	0.27572832	0.36568224	2.68492896	5.32096992	2.51870976	0.5182128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6963
H2997_003_0	2012	11	H.6										OP Facility - Other										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	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	YES	1199.212365	66.68457556	288.726072	152.6809121	136.0352631	10.80543489	5.382698951	236.650942	254.9122333	17301.07232	310.0638058	2.921732417	0.008345316	216.2083022	3743.080007	2968.417158	5.970141984	1230.080644	1240.482616	1277.398875	43.32495256	38.08958853	0	0	0	0	0	0	5872.8	169.1426708	18.03920381	0	0	0	0	0	0	0	0	0	6000	1A: $259/day (days 1-6); no yrly max	1B: $239/day (days 1-6); no yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $45 copay	9A: $0-$268 copay; 9B: $0-$240 copay	8A: $0-$400 copay	8B: $65-$200 copay	5: $40 copay	12: 20% coin	3: $40 copay; 9A: $40-$268 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $65-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	166.8423789	151.6863496	120	0	150	0.2	0.148617023	59.8674234	209.4598251	6.888900191	144.5743469	40	0.2	115.5737142	0	38.1060127	40	40	145.7624779	0.964647095	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	149.979312	136.3551305	107.8713787	0	134.8392234	0.179785631	0.133596026	53.81651252	188.2893343	6.192626346	129.9619511	35.95712624	0.179785631	103.8924658	0	34.25456773	35.95712624	35.95712624	131.0299954	0.867148435	0.179785631	0	0	0	0	0	0	0	0	0	0.179785631	0	0	0	0	0	0	0	0	0		14.9881	0.757732	2.595439955	0	1.528574103	1.942661932	0.71910719	1.061310699	3.999771227	8.928256353	3.35804143	0.008754758	0.001500368	1.871867803	0	8.473487214	0.017889096	3.685847085	13.54503596	0.09230787	7.789203944	0	0	0	0	0	0	0	0	0	3.243189643	0	0	0	0	0	0	0	0	0	78.6081		NO	8.838372793	14.9881	0.757732	2.595439955	0	1.528574103	1.942661932	0.71910719	1.061310699	3.999771227	8.928256353	3.35804143	0.008754758	0.001500368	1.871867803	0	8.473487214	0.017889096	3.685847085	13.54503596	0.09230787	7.789203944	0	0	0	0	0	0	0	0	0	3.243189643	0	0	0	0	0	0	0	0	0	78.6081	YES	1A: 20% coin	1B: 20% coin	2: 35% coin (for days 1-100)	6: 10% coin	10A: $150 copay	11A: 35% coin	11B: 35% coin; 11C: 35% coin	4A: $60 copay; 4B: $45 copay	9A: $0-$368 copay; 9B: $0-$340 copay	8A: $0-$500 copay	8B: $130-$300 copay	5: $55 copay	12: 20% coin	3: $55 copay; 9A: $55-$368 copay; 9C: $80 copay	7A: $30 copay; 7G: $30 copay	7B: $40 copay; 7D: $55 copay; 7F: $55 copay	7E: $80 copay; 7H: $80 copay	7C: $80 copay; 7I: $80 copay	8B: $130-$300 copay	14A: $0-$80 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $55	15: 35% coinsurance	9D: $0 copay; 14A $80 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 35% coinsurance										6000	12.9029	0.2946	2.6985	0.2986	0.5273	1.1728	0.5843	0.3661	1.923	12.8718	1.3906	0.0042	0.0005	0.901	2.902	4.1103	0.0123	2.5432	5.8703	1.1501	4.7026	0.0131	0	0	0	0	0	0	0	0	1.958	0	0	0	0	0	0	0	0	0	59.1983		NO	6.656018131	27.891	1.05231286	5.293900029	0.298634685	2.055916749	3.11550978	1.303358258	1.427452184	5.922782381	21.80009449	4.748667876	0.012907676	0.00201798	2.772893049	2.902020653	12.58378986	0.030232211	6.229007212	19.41534061	1.242374161	12.49179832	0.0131216	0	0	0	0	0	0	0	0	5.201208138	0	0	0	0	0	0	0	0	0	137.8064
H2997_005_0	2012	8	H.6										OP Facility - Other										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	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	YES	982.7925829	51.79827656	357.9242972	237.5614534	151.8017887	10.00684094	6.286680577	304.572566	409.5939624	5690.779275	627.3966819	2.434930236	0	456.9350436	2972.439515	2874.616378	2.904018935	1110.232737	593.5683177	1700.085514	31.43092428	7.937522142	0	0	0	0	0	0	5872.8	144.9957932	12.17992805	0	0	0	0	0	0	0	0	0	6500	1A: $268/day (days 1-6); no yrly max	1B: $239/day (days 1-6); no yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$250 copay; 9B: $230 copay	8A: $0-$200 copay	8B: $35-$200 copay	5: $40 copay	12: 20% coin	3: $40 copay; 9A: $40-$250 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $35-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	190.131181	135.4636342	120	0	200	0.2	0.102973025	49.99580864	238.8189769	9.941174526	163.1974251	40	0.2	135.4457195	0	37.76478948	40	50	118.7462612	0.791720491	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	179.7175453	128.0441834	113.4275047	0	189.0458412	0.189045841	0.097333111	47.2574985	225.7386719	9.396688504	154.2589725	37.80916824	0	128.0272499	0	35.69638198	37.80916824	47.2614603	112.2424342	0.748357331	0.189045841	0	0	0	0	0	0	0	0	0	0.189045841	0	0	0	0	0	0	0	0	0		14.7188	0.552705669	3.383204992	0	2.39145807	1.891751664	0.611902179	1.199444799	7.70509976	4.456206682	8.065130627	0.007671891	0	4.87501142	0	8.551117021	0.009149878	4.372601702	5.551962737	0.106022622	5.94188552	0	0	0	0	0	0	0	0	0	2.302564745	0	0	0	0	0	0	0	0	0	76.6936		NO	4.443971853	14.7188	0.552705669	3.383204992	0	2.39145807	1.891751664	0.611902179	1.199444799	7.70509976	4.456206682	8.065130627	0.007671891	0	4.87501142	0	8.551117021	0.009149878	4.372601702	5.551962737	0.106022622	5.94188552	0	0	0	0	0	0	0	0	0	2.302564745	0	0	0	0	0	0	0	0	0	76.6936	YES	1A: $268/day (days 1-6); no yrly max	1B: $239/day (days 1-6); no yrly max	2: 20% coin (for days 1-100)	6: 10% coin	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$250 copay; 9B: $230 copay	8A: $0-$200 copay	8B: $35-$200 copay	5: $40 copay	12: 20% coin	3: $40 copay; 9A: $40-$250 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $35-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 25% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 25% coinsurance										6500	4.2491	0.1599	1.2474	0.1646	0.6873	0.5437	0.1759	0.3447	2.2146	3.8086	1.4075	0.0022	0	1.4012	0	2.4577	0.0026	1.2568	0.9909	0.0305	2.1347	0	0	0	0	0	0	0	0	0	0.8272	0	0	0	0	0	0	0	0	0	24.1072		NO	1.396875787	18.9678	0.712609731	4.630649056	0.164581527	3.078800219	2.43547044	0.787772358	1.544183841	9.919664962	8.264795748	9.47261049	0.009876911	0	6.276165329	0	11.00884071	0.011779695	5.629355265	6.542887861	0.136495168	8.076623116	0	0	0	0	0	0	0	0	0	3.12980578	0	0	0	0	0	0	0	0	0	100.8008
H2997_006_0	2012	8	H.6										OP Facility - Other										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	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	YES	1003.456855	52.65000767	359.7883986	237.5614534	151.8017887	10.00684094	6.286680577	304.572566	425.8302001	5701.248989	628.5509463	2.439409943	0	470.9748758	2587.721707	2894.144604	2.844176273	1087.354346	581.3367487	1665.827564	31.43092428	7.937522142	0	0	0	0	129.6	0	5872.8	144.9957932	12.2023363	0	0	0	0	0	0	0	0	0	4000	1A: $200/day (days 1-5); no yrly max	1B: $200/day (days 1-5); no yrly max	2: $117/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$150 copay; 9B: $100 copay	8A: $0-$200 copay	8B: $35-$200 copay	5: $40 copay	12: 20% coin	3: $30 copay; 9A: $30-$150 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $35-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $30 copay, 1 Exam per Yr"	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	130.3275443	98.43980439	117	0	200	0.2	0.102973025	49.99580864	124.9756782	9.941174526	163.1974251	40	0.2	84.72605324	10	28.91281069	40	50	118.7462612	0.607478993	0.2	0	0	0	0	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	118.3473714	89.3908663	106.2449425	0	181.6152863	0.181615286	0.093507378	45.4000155	113.4874679	9.027346289	148.1957354	36.32305726	0	76.93773209	9.080764316	26.25504196	36.32305726	45.40382158	107.8306812	0.551637356	0.181615286	0	0	0	0	0	30	0	0	0	0.181615286	0	0	0	0	0	0	0	0	0		9.8964	0.392202483	3.18547481	0	2.297460443	1.817395283	0.587851014	1.152299935	4.027199263	4.288929075	7.762380811	0.007383902	0	3.019644901	1.958207578	6.332157336	0.008609098	4.114170225	5.223828132	0.076577726	5.708336312	0	0	0	0	0	0.324	0	0	0	2.2161308	0	0	0	0	0	0	0	0	0	64.3966		NO	6.485999395	9.8964	0.392202483	3.18547481	0	2.297460443	1.817395283	0.587851014	1.152299935	4.027199263	4.288929075	7.762380811	0.007383902	0	3.019644901	1.958207578	6.332157336	0.008609098	4.114170225	5.223828132	0.076577726	5.708336312	0	0	0	0	0	0.324	0	0	0	2.2161308	0	0	0	0	0	0	0	0	0	64.3966	YES	1A: $200/day (days 1-5); no yrly max	1B: $200/day (days 1-5); no yrly max	2: 25% coin (for days 1-100)	6: 10% coin	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$150 copay; 9B: $100 copay	8A: $0-$200 copay	8B: $35-$200 copay	5: $40 copay	12: 20% coin	3: $30 copay; 9A: $30-$150 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $35-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 25% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $30 copay, 1 Exam per Yr"	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 25% coinsurance										4000	2.8569	0.1135	1.5019	0.1581	0.6603	0.5223	0.169	0.3312	1.1575	3.6656	1.3546	0.0021	0	0.8679	0.5628	1.82	0.0025	1.1825	0.9324	0.022	2.0508	0	0	0	0	0	0.081	0	0	0	0.7962	0	0	0	0	0	0	0	0	0	20.8111		NO	2.098483605	12.7533	0.505671141	4.687352445	0.158112556	2.957786216	2.339742881	0.756808515	1.483488812	5.184678807	7.954550879	9.11702653	0.00950615	0	3.887537691	2.521026815	8.152117588	0.011083486	5.296646572	6.156187152	0.098587352	7.759166826	0	0	0	0	0	0.405	0	0	0	3.012318765	0	0	0	0	0	0	0	0	0	85.2077
H2997_803_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	225.0894764	2.338456449	48.29145602	12.5749279	6.567951074	12.09562998	4.124155293	14.65156359	53.73546725	65.13257367	56.40717718	0.004995585	6.432826422	0.559132784	41.52514214	61.80816399	0.173877453	39.25160355	0	0.097390274	38.29268033	0.432146017																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.0714227	0.0714227	0.126849106	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	0.060562647	0.060562647	0.107561289	0	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436																				13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235		NO	16.19675316	13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235	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	1.5147	0.0157	0.5771	0	0.1298	0.239	0.0815	0.2895	1.0617	1.2868	1.1144	0.0001	0.1271	0.011	0.8204	1.2212	0.0034	0.7755	0	0.0019	0.7566	0.0085																			10.0359		NO	1.79963924	15.1467	0.157359014	5.77143473	0	1.297640572	2.389752912	0.814815941	2.894732793	10.61660199	12.86834649	11.14445599	0.000986986	1.270943779	0.110468756	8.20418858	12.21153757	0.034353246	7.755001934	0	0.019241552	7.565545944	0.085379778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3595
H2997_804_0	2012	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	225.0894764	2.338456449	48.29145602	12.5749279	6.567951074	12.09562998	4.124155293	14.65156359	53.73546725	65.13257367	56.40717718	0.004995585	6.432826422	0.559132784	41.52514214	61.80816399	0.173877453	39.25160355	0	0.097390274	38.29268033	0.432146017																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.0714227	0.0714227	0.126849106	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	0.060562647	0.060562647	0.107561289	0	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436																				13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235		NO	16.19675316	13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235	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	1.5147	0.0157	0.5771	0	0.1298	0.239	0.0815	0.2895	1.0617	1.2868	1.1144	0.0001	0.1271	0.011	0.8204	1.2212	0.0034	0.7755	0	0.0019	0.7566	0.0085																			10.0359		NO	1.79963924	15.1467	0.157359014	5.77143473	0	1.297640572	2.389752912	0.814815941	2.894732793	10.61660199	12.86834649	11.14445599	0.000986986	1.270943779	0.110468756	8.20418858	12.21153757	0.034353246	7.755001934	0	0.019241552	7.565545944	0.085379778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3595
H2997_805_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	225.0894764	2.338456449	48.29145602	12.5749279	6.567951074	12.09562998	4.124155293	14.65156359	53.73546725	65.13257367	56.40717718	0.004995585	6.432826422	0.559132784	41.52514214	61.80816399	0.173877453	39.25160355	0	0.097390274	38.29268033	0.432146017																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.0714227	0.0714227	0.126849106	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	0.060562647	0.060562647	0.107561289	0	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436																				13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235		NO	16.19675316	13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235	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	1.5147	0.0157	0.5771	0	0.1298	0.239	0.0815	0.2895	1.0617	1.2868	1.1144	0.0001	0.1271	0.011	0.8204	1.2212	0.0034	0.7755	0	0.0019	0.7566	0.0085																			10.0359		NO	1.79963924	15.1467	0.157359014	5.77143473	0	1.297640572	2.389752912	0.814815941	2.894732793	10.61660199	12.86834649	11.14445599	0.000986986	1.270943779	0.110468756	8.20418858	12.21153757	0.034353246	7.755001934	0	0.019241552	7.565545944	0.085379778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3595
H2997_806_0	2012	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	225.0894764	2.338456449	48.29145602	12.5749279	6.567951074	12.09562998	4.124155293	14.65156359	53.73546725	65.13257367	56.40717718	0.004995585	6.432826422	0.559132784	41.52514214	61.80816399	0.173877453	39.25160355	0	0.097390274	38.29268033	0.432146017																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.0714227	0.0714227	0.126849106	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	0.060562647	0.060562647	0.107561289	0	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436	0.177814436																				13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235		NO	16.19675316	13.632	0.141623112	5.194291257	0	1.167876515	2.150777621	0.733334347	2.605259513	9.554941793	11.58151184	10.03001039	0.000888287	1.143849401	0.099421881	7.383769722	10.99038381	0.030917921	6.97950174	0	0.017317397	6.808991349	0.0768418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3235	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	1.5147	0.0157	0.5771	0	0.1298	0.239	0.0815	0.2895	1.0617	1.2868	1.1144	0.0001	0.1271	0.011	0.8204	1.2212	0.0034	0.7755	0	0.0019	0.7566	0.0085																			10.0359		NO	1.79963924	15.1467	0.157359014	5.77143473	0	1.297640572	2.389752912	0.814815941	2.894732793	10.61660199	12.86834649	11.14445599	0.000986986	1.270943779	0.110468756	8.20418858	12.21153757	0.034353246	7.755001934	0	0.019241552	7.565545944	0.085379778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3595
H3028_001_0	2012	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	1071.99	54.58	413.05	1122.76	254.74	14.76	2.05	346.66	234.43	1524.83	953.44	336.82	0.28	1760.15	3170.91	2379.67	144.23	451.97		1341.59	15.29	0		2.5	1.52				3.63	1.43	882.7	0.09									2900	"$0-$125/Day(Days 1-5): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-5): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $20 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$50-$150/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											78.649644	64.644804	31.003517	0	50	0.2	0.057982	65	89.721438	0	91.382418	45.125942	0.2	99.863469	0	20	20	56.719385		0	0.2	0		0	0				0	0	0	0									NO	68.26325	56.107876	27.876657	0	44.41025	0.177641	0.0515	57.733325	79.69103	0	81.166321	40.081087	0.177641	88.699233	0	17.7641	17.7641	50.378441		0	0.177641	0		0	0				0	0	0	0										6.0981	0.255197323	0.959537764	0	0.94275559	2.62198116	0.105575	1.667819537	1.55683068	0	6.448934758	1.12500931	0.04973948	13.01032958	0	3.522724654	0.213509679	1.897461998	0	0	2.71613089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1917	0	NO	5.590143	6.0981	0.255197323	0.959537764	0	0.94275559	2.62198116	0.105575	1.667819537	1.55683068	0	6.448934758	1.12500931	0.04973948	13.01032958	0	3.522724654	0.213509679	1.897461998	0	0	2.71613089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1917	NO																																																																																		0	0	NO	0	6.0981	0.255197323	0.959537764	0	0.94275559	2.62198116	0.105575	1.667819537	1.55683068	0	6.448934758	1.12500931	0.04973948	13.01032958	0	3.522724654	0.213509679	1.897461998	0	0	2.71613089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1917
H3028_801_0	2012	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	181.01	2.1	32.31	17.99	6.18	10.01	3.04	17.44	46.36	6.25	21.52	0.48	0.34	13.55	27.54	69.09	0.47	5.45		11.2	23.89	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																					0.0805	0.0805	0.1656	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072822	0.072822	0.14688	0	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255		0.209255	0.209255	0																				13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	0	NO	5.885917	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	NO																																																																																		0	0	NO	0	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744
H3028_803_0	2012	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	181.01	2.1	32.31	17.99	6.18	10.01	3.04	17.44	46.36	6.25	21.52	0.48	0.34	13.55	27.54	69.09	0.47	5.45		11.2	23.89	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																					0.0805	0.0805	0.1656	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072822	0.072822	0.14688	0	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255		0.209255	0.209255	0																				13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	0	NO	5.885917	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	NO																																																																																		0	0	NO	0	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744
H3028_804_0	2012	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	181.01	2.1	32.31	17.99	6.18	10.01	3.04	17.44	46.36	6.25	21.52	0.48	0.34	13.55	27.54	69.09	0.47	5.45		11.2	23.89	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																					0.0805	0.0805	0.1656	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072822	0.072822	0.14688	0	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255	0.209255		0.209255	0.209255	0																				13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	0	NO	5.885917	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744	NO																																																																																		0	0	NO	0	13.1815	0.1529262	4.7456928	0	1.2931959	2.09464255	0.6361352	3.6494072	9.7010618	1.30784375	4.5031676	0.1004424	0.0711467	2.83540525	5.7628827	14.45742795	0.09834985	1.14043975	0	2.343656	4.99910195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0744
H3044_001_0	2012	9																															D	D	D		T	Coin	Coin	V	V	V	P	D	Coin	V	V	V	V	V	P	V	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	1699.839434	0	981.9486608	0	179.0240944	6.910785753	3.041121684	373.0152354	375.0556815	2808.322231	559.9978528	1.087334019	0.052139478	45.28112575	4000.181105	3543.944075	185.4620977	663.5453241	1225.035974	575.5022651	12.07942445	0.724694932	0	0	769.7765281	0	0.216090846	0	0	0											3400	"$160/Days 1-10, $50/Days11-30 for IP Med/Surg; PBP 1a"	"$160/Days 1-9, $50/Days 10-29 for IP MH/SA; PBP 1b"	$85/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 Prosth/Supplies; $8/Service for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$135/Case for OP Surg; $135/Case for ASC services; PBP 9a, 9b"	$15/Case for OP Lab; PBP 8a	$75/Procedure for OP Rad - General; $75/Procedure for OP Rad - Complex Diagnostic; $45/Procedure for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$160/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$135/Visit for Cardiac Rehab-Facility, $35/Visit for Cardiac Rehab-Office; $135/Visit for Pulmonary Rehabilitation Services-Facility, $35/Visit for Pulmonary Rehabilitation Services-Office; $135/Visit for CORF-Facility, $35/Visit for CORF-Office; $60/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$20/Visit for PCP OV; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $35/Visit for Diabetic Footcare; $25/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$50/Visit for OP OT; $35/Visit for PT/ST; PBP 7c, 7i"	"$75/Procedure for Phys Rad - General; $75/Procedure for Phys Rad - Complex Diagnostic; $45/Procedure for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$35/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Blood; PBP 9d, 14a"	PBP 10b	"No Cost Sharing for 1 Prev. Dental Visit/Yr (non-cvd); PBP 16a, 16b"	$25/Exam for 1 Routine Eye Exam/Yr (non-cvd); PBP 17a	"$25/Service for Glasses/Contacts (non-cvd), Max $120/2 Yr; PBP 17b"	$35/Visit for 1 Routine Hearing Test/Yr (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$300/Year Max for Foreign Travel Phys Svc; PBP 13a-e											0	NO	142.5899281	0	85	0	150	0.2	0.171849457	62.49837341	135	15	58.85811253	63.75187349	0.2	52.84551384	20	33.22216015	35	38.12040625	58.06940704	35	0.2	0.2	0	0	25	0	27.04	0	0	0											NO	126.3593476	0	75.32470696	0	125.1360719	0.166848096	0.143363774	52.13867298	112.6224647	12.51360719	49.10182001	53.18439349	0.166848096	44.08586679	16.82281693	27.77550969	29.19841677	31.80158598	48.99779364	29.19841677	0.166848096	0.166856818	0	0	22.15432558	0	22.55786256	0	0	0												17.8992	0	6.163749593	0	1.866864329	1.153051444	0.43598668	1.620709948	3.519974604	2.928520104	2.291409481	0.0048191	0.008699373	0.166354806	5.607859534	8.202904417	0.451266635	1.758482806	5.002004987	1.400312916	2.015428969	0.12092029	0	0	1.421156652	0	0.000406212	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0401	0	NO	10.79	17.8992	0	6.163749593	0	1.866864329	1.153051444	0.43598668	1.620709948	3.519974604	2.928520104	2.291409481	0.0048191	0.008699373	0.166354806	5.607859534	8.202904417	0.451266635	1.758482806	5.002004987	1.400312916	2.015428969	0.12092029	0	0	1.421156652	0	0.000406212	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0401	NO																																										0	0	0	0	0	0	0	0	0	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	17.8992	0	6.163749593	0	1.866864329	1.153051444	0.43598668	1.620709948	3.519974604	2.928520104	2.291409481	0.0048191	0.008699373	0.166354806	5.607859534	8.202904417	0.451266635	1.758482806	5.002004987	1.400312916	2.015428969	0.12092029	0	0	1.421156652	0	0.000406212	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0401
H3044_002_0	2012	7																															D	D	D		T	Coin	Coin	V	V	V	P	D	Coin	V	V	V	V	V	P	V	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	1694.074624	0	1154.61031	0	169.2473577	7.355357534	3.372093383	382.8405789	408.6291157	2909.740917	567.7962216	0.340619174	0.0332305	67.70661612	4045.695059	3855.347062	162.767951	606.7711095	1260.368775	542.9508169	11.0676019	0.752535603	0	0	769.861121	0	0.248316169	0	0	0											3400	"$160/Days 1-10, $50/Days11-30 for IP Med/Surg; PBP 1a"	"$160/Days 1-9, $50/Days 10-29 for IP MH/SA; PBP 1b"	$85/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 Prosth/Supplies; $8/Service for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$135/Case for OP Surg; $135/Case for ASC services; PBP 9a, 9b"	$15/Case for OP Lab; PBP 8a	$75/Procedure for OP Rad - General; $75/Procedure for OP Rad - Complex Diagnostic; $45/Procedure for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$160/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$135/Visit for Cardiac Rehab-Facility, $35/Visit for Cardiac Rehab-Office; $135/Visit for Pulmonary Rehabilitation Services-Facility, $35/Visit for Pulmonary Rehabilitation Services-Office; $135/Visit for CORF-Facility, $35/Visit for CORF-Office; $60/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$20/Visit for PCP OV; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $35/Visit for Diabetic Footcare; $25/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$50/Visit for OP OT; $35/Visit for PT/ST; PBP 7c, 7i"	"$75/Procedure for Phys Rad - General; $75/Procedure for Phys Rad - Complex Diagnostic; $45/Procedure for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$35/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Blood; PBP 9d, 14a"	PBP 10b	"No Cost Sharing for 1 Prev. Dental Visit/Yr (non-cvd); PBP 16a, 16b"	$25/Exam for 1 Routine Eye Exam/Yr (non-cvd); PBP 17a	"$25/Service for Glasses/Contacts (non-cvd), Max $120/2 Yr; PBP 17b"	$35/Visit for 1 Routine Hearing Test/Yr (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$300/Year Max for Foreign Travel Phys Svc; PBP 13a-e											0	NO	142.5899281	0	85	0	150	0.2	0.170463321	61.93184932	135	15	58.03729685	63.75187349	0.2	64.19933413	20	33.38065381	35	37.51794348	58.40031596	35	0.2	0.2	0	0	25	0	27.04	0	0	0											NO	125.6823786	0	74.92115557	0	124.1263981	0.165501864	0.141059987	51.24918256	111.7137583	12.41263981	48.02640409	52.75526952	0.165501864	53.12554738	16.69281392	27.68691296	28.96282622	31.04644792	48.76322491	28.96282622	0.165501864	0.165512571	0	0	22.03563399	0	22.37585203	0	0	0												17.7429	0	7.208728221	0	1.750672074	1.217325383	0.475667447	1.635022227	3.804124522	3.009797162	2.272434231	0.001497455	0.00549971	0.29974592	5.627836231	8.895221546	0.392851657	1.569840637	5.12163717	1.31044918	1.831708745	0.124554102	0	0	1.413698157	0	0.000463024	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7117	0	NO	11.61	17.7429	0	7.208728221	0	1.750672074	1.217325383	0.475667447	1.635022227	3.804124522	3.009797162	2.272434231	0.001497455	0.00549971	0.29974592	5.627836231	8.895221546	0.392851657	1.569840637	5.12163717	1.31044918	1.831708745	0.124554102	0	0	1.413698157	0	0.000463024	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7117	NO																																										0	0	0	0	0	0	0	0	0	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	17.7429	0	7.208728221	0	1.750672074	1.217325383	0.475667447	1.635022227	3.804124522	3.009797162	2.272434231	0.001497455	0.00549971	0.29974592	5.627836231	8.895221546	0.392851657	1.569840637	5.12163717	1.31044918	1.831708745	0.124554102	0	0	1.413698157	0	0.000463024	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7117
H3044_003_0	2012	8																															D	D	D		T	Coin	Coin	V	V		P	D	Coin	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	1689.08705	0	1114.832481	0	211.8500928	8.592696278	3.988631551	465.1239947	487.0448039	0	775.1266422	0.208898147	0.048199677	72.67294876	4645.63379	4499.022096	259.9342653	906.8722329	1331.064904	283.560807	8.86988181	0	0	0	769.7685763	0	0.488050635	0	0	0											3200	"$150/Days 1-5, $130/Days 6-10 for IP Med/Surg; PBP 1a"	"$150/Days 1-5, $130/Days 6-10 for IP MH/SA; PBP 1b"	$75/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 Prosth/Supplies; $5/Other for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $60/Visit for OP ER - Worldwide; $35/Visit for Urgent Care; PBP 4a, 4b"	"$95/Case for OP Surg; $95/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Procedure for OP Rad - General; $30/Procedure for OP Rad - Complex Diagnostic; $20/Procedure for OP Rad - X-Ray; $55/Procedure for OP Rad - Therapeutic; PBP 8b	$50/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$95/Visit for Cardiac Rehab-Facility, $25/Visit for Cardiac Rehab-Office; $95/Visit for Pulmonary Rehabilitation Services-Facility, $25/Visit for Pulmonary Rehabilitation Services-Office; $95/Visit for CORF-Facility, $25/Visit for CORF-Office; $30/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP OT; $25/Visit for PT/ST; PBP 7c, 7i"	"$30/Procedure for Phys Rad - General; $30/Procedure for Phys Rad - Complex Diagnostic; $20/Procedure for Phys Rad - X-Ray; $55/Procedure for Phys Rad - Theraputic; PBP 7d, 14a"	"$25/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"No Cost Sharing for 1 Prev. Dental Visit/Yr (non-cvd); PBP 16a, 16b"	$25/Exam for 1 Routine Eye Exam/Yr (non-cvd); PBP 17a	"$25/Service for Glasses/Contacts (non-cvd), Max $120/2 Yr; PBP 17b"	$25/Visit for 1 Routine Hearing Test/Yr (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$300/Year Max for Foreign Travel Phys Svc; PBP 13a-e											0	NO	145.1404151	0	75	0	125	0.2	0.150096138	55.58919722	95	0	24.32029583	50	0.2	55.89389137	15	24.19812856	30	25	25.6952695	25	0.2	0	0	0	25	0	25	0	0	0											NO	131.2328671	0	67.81340004	0	106.7269442	0.170763111	0.128154417	47.46292119	81.11247758	0	20.76504685	42.69077767	0.170763111	47.72307379	12.88692839	20.69798259	25.6144666	21.34538884	22.10849901	21.34538884	0.170763111	0	0	0	22.60446668	0	21.34538884	0	0	0												18.472	0	6.300048417	0	1.884176085	1.467315546	0.511160752	1.839678625	3.292117561	0	1.341295086	0.000743169	0.008230727	0.289014708	4.988995832	7.76005675	0.554839796	1.61312837	2.452320593	0.504392974	1.514648609	0	0	0	1.450017345	0	0.000868136	0	0	0	0	0	0	0	0	0	0	0	0	0	56.245	0	NO	7.78	18.472	0	6.300048417	0	1.884176085	1.467315546	0.511160752	1.839678625	3.292117561	0	1.341295086	0.000743169	0.008230727	0.289014708	4.988995832	7.76005675	0.554839796	1.61312837	2.452320593	0.504392974	1.514648609	0	0	0	1.450017345	0	0.000868136	0	0	0	0	0	0	0	0	0	0	0	0	0	56.245	NO																																										0	0	0	0	0	0	0	0	0	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	18.472	0	6.300048417	0	1.884176085	1.467315546	0.511160752	1.839678625	3.292117561	0	1.341295086	0.000743169	0.008230727	0.289014708	4.988995832	7.76005675	0.554839796	1.61312837	2.452320593	0.504392974	1.514648609	0	0	0	1.450017345	0	0.000868136	0	0	0	0	0	0	0	0	0	0	0	0	0	56.245
H3044_004_0	2012	9																															D	D	D					V	V		V	D	Coin	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	1762.323899	0	938.2863882	0	0	0	0	433.0888956	440.794533	0	760.0253278	0.441754464	0.085158499	371.5688929	0	4681.73224	341.7244348	829.8730147	1643.363416	715.1203223	10.81293936	0	0	0	769.7866099	0	0	0	0	0											3200	$45/Days 1-10 for IP Med/Surg; $45/Days 1-10 for IP Med/Surg Extra Days; PBP 1a	$45/Days 1-10 for IP MH/SA; $45/Days 1-10 for IP MH/SA Extra Days; 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"	"$60/Visit for OP ER; $60/Visit for OP ER - Worldwide; $25/Visit for Urgent Care; PBP 4a, 4b"	"$10/Case for OP Surg; $10/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for OP Rad - General; $30/Case for OP Rad - Complex Diagnostic; $20/Case for OP Rad - X-Ray; $30/Case for OP Rad - Therapeutic; PBP 8b	$50/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$10/Visit for Cardiac Rehab; $10/Visit for Pulmonary Rehabilitation Services; $10/Visit for CORF; $15/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"$10/Visit for Chiro (cvd); $10/Visit for SCP OV; $10/Visit for SCP - Office Surg; $10/Visit for Podiatry; $10/Visit for Diabetic Footcare; $25/Visit for Vision Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP OT; $10/Visit for PT/ST; PBP 7c, 7i"	"$30/Procedure for Phys Rad - General; $30/Procedure for Phys Rad - Complex Diagnostic; $20/Procedure for Phys Rad - X-Ray; $30/Procedure for Phys Rad - Theraputic; PBP 7d, 14a"	"$10/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a"	PBP 10b	"No Cost Sharing for 1 Prev. Dental Visit/Yr (non-cvd); PBP 16a, 16b"	$25/Exam for 1 Routine Eye Exam/Yr (non-cvd); PBP 17a	"$25/Service for Glasses/Contacts (non-cvd), Max $120/2 Yr; PBP 17b"	No Cost Sharing for 1 Routine Hearing Test/Yr (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$300/Year Max for Foreign Travel Phys Svc; PBP 13a-e											0	NO	45	0	20	0	0	0	0	53.07325515	10	0	24.10209766	50	0.2	10.00540714	0	10.59451006	15	10	24.72021745	10	0.2	0	0	0	25	0	0	0	0	0											NO	44.51385641	0	19.78393618	0	0	0	0	52.19104217	9.833774473	0	23.70145927	49.16887236	0.196675489	9.839091729	0	10.42035074	14.75066171	9.833774473	24.33056522	9.833774473	0.196675489	0	0	0	24.72992023	0	0	0	0	0												6.5373	0	1.546916502	0	0	0	0	1.883613401	0.361222836	0	1.501142446	0.001810047	0.016748589	0.304658368	0	4.065441002	0.420055128	0.680065339	3.331996732	0.586027664	2.126640141	0	0	0	1.586396788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9501	0	NO	0.35	6.5373	0	1.546916502	0	0	0	0	1.883613401	0.361222836	0	1.501142446	0.001810047	0.016748589	0.304658368	0	4.065441002	0.420055128	0.680065339	3.331996732	0.586027664	2.126640141	0	0	0	1.586396788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9501	YES	20% Coinsurance for IP Med/Surg; 20% Coinsurance for IP Med/Surg Extra Days; PBP 1a	20% Coinsurance for IP MH/SA; 20% Coinsurance for IP MH/SA Extra Days; PBP 1b	20% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	15% Coinsurance for DME; PBP 11a	"15% Coinsurance for Prosth/Supplies; 15% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER - Worldwide; $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	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	20% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"20% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a-b"	"15% Coinsurance for Chiro (cvd); 15% Coinsurance for SCP OV; 15% Coinsurance for SCP - Office Surg; 15% Coinsurance for Podiatry; 15% Coinsurance for Diabetic Footcare; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"15% Coinsurance for MH - Non Phys; 15% Coinsurance for Psych Services ; PBP 7e, 7h"	"15% Coinsurance for OP OT; 15% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"15% Coinsurance for SCP - Other; 15% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14a-b, 14d-e"	No Cost Sharing; PBP 15	"20% Coinsurance for Blood; PBP 9d, 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 14c	No Cost Sharing; PBP 13a-e											5100	1.5934	0	0.4628	0	0	0.1456	0.0566	0.1099	0.9023	0.2818	0.2355	0	0	0.0001	0.2975	0.3779	0.0309	0.0779	0.1363	0.0338	0	0.0154	0	0	0	0	0	0	0	0											4.7577	0	NO	0.07	8.1307	0	2.009710757	0	0	0.145649016	0.056643899	1.993506668	1.263493666	0.281820608	1.736622288	0.001854198	0.016748589	0.304713609	0.297506294	4.443384688	0.4509382	0.757958401	3.46826694	0.619796522	2.126640141	0.015392394	0	0	1.586396788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7078
H3044_005_0	2012	8																															D		D	V	T	Coin	Coin	V	V	V	V	D	Coin	V	V	V	V	V	P	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	1583.708724	0	1593.253487	902.2332166	183.2241038	7.599029723	3.407878601	396.8137706	409.3081687	2879.600476	570.8104254	0.462228566	0.045094603	69.59139277	3970.801534	3670.744208	208.6228874	722.0685753	1221.203484	412.5580697	9.993010176	0.890356078	0	0	0	0	0.356592707	0	0	0											3400	$220/Days 1-15 for IP Med/Surg; $220/Days 1-15 for IP Med/Surg Extra Days; PBP 1a	$220/Days 1-8 for IP MH/SA; PBP 1b	"$100/Days 1-20, $146/Days 21-30 for SNF; PBP 2"	$20/Visit for HH; PBP 6	$175/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; $10/Other for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	$35/Case for OP Lab; PBP 8a	$85/Case for OP Rad - General; $130/Case for OP Rad - Complex Diagnostic; $85/Case for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$165/Day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$225/Visit for Cardiac Rehab-Facility, $40/Visit for Cardiac Rehab-Office; $225/Visit for Pulmonary Rehabilitation Services-Facility, $40/Visit for Pulmonary Rehabilitation Services-Office; $225/Visit for CORF-Facility, $40/Visit for CORF-Office; $70/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$25/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Case for SCP - Office Surg; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$60/Visit for OP OT; $40/Visit for PT/ST; PBP 7c, 7i"	"$130/Procedure for Phys Rad - General; $130/Procedure for Phys Rad - Complex Diagnostic; $85/Procedure for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a"	"$40/Visit for SCP - Other; PBP 7d, 7g, 14a-b, 14d-e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Blood; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$300/Year Max for Foreign Travel Phys Svc; PBP 13a-e											0	NO	220	0	108.9530201	20	175	0.2	0.172457249	62.30600827	225	35	97.55926654	63.75187349	0.2	52.91363247	25	38.53751435	40	43.65272353	94.99393117	40	0.2	0.2	0	0	0	0	27.04	0	0	0											NO	188.3799183	0	93.29345922	17.12544712	138.3665386	0.158133187	0.136356072	49.26323829	177.8998354	27.67330773	77.13678871	50.40643466	0.158133187	41.8370067	19.97627377	30.55817111	31.6266374	34.51472147	76.0806849	31.6266374	0.158133187	0.158148129	0	0	0	0	21.37960688	0	0	0												24.8616	0	12.38667744	1.287595603	2.112673753	1.201658788	0.464684939	1.629027612	6.067987986	6.640672508	3.669206931	0.001941608	0.007130953	0.24262463	6.610151546	9.347602467	0.549836701	2.07683298	7.742499786	1.087318706	1.580226547	0.140808148	0	0	0	0	0.000635318	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7094	0	NO	19.77	24.8616	0	12.38667744	1.287595603	2.112673753	1.201658788	0.464684939	1.629027612	6.067987986	6.640672508	3.669206931	0.001941608	0.007130953	0.24262463	6.610151546	9.347602467	0.549836701	2.07683298	7.742499786	1.087318706	1.580226547	0.140808148	0	0	0	0	0.000635318	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7094	NO																																										0	0	0	0	0	0	0	0	0	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	24.8616	0	12.38667744	1.287595603	2.112673753	1.201658788	0.464684939	1.629027612	6.067987986	6.640672508	3.669206931	0.001941608	0.007130953	0.24262463	6.610151546	9.347602467	0.549836701	2.07683298	7.742499786	1.087318706	1.580226547	0.140808148	0	0	0	0	0.000635318	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7094
H3044_801_0	2012	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	233.235115	0	90.30355896	0	9.05787801	8.818544162	4.309314135	18.53377001	57.36272512	14.16837114	20.07644172	0.002320541	0.042618272	22.42468022	37.04902902	53.93725054	1.572360697	18.44792915	24.80518977	59.31338285	26.02723879	0.848596299	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a-b, 14d-e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-b											0	NO	0.083592281	0	0.083592281	0	0.224	0.224	0.224	0.224	0.094990788	0.224	0.224	0.224	0.224	0.202655599	0.204209831	0.179369328	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078228104	0	0.078228104	0	0.209625758	0.209625758	0.209625758	0.209625758	0.08889516	0.209625758	0.209625758	0.209625758	0.209625758	0.189651043	0.191105539	0.167859068	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0	0	0	0	0	0	0	0												18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	0	NO	6.44	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	NO				No Cost Sharing; PBP 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											0	0	NO	0	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984
H3044_802_0	2012	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	233.235115	0	90.30355896	0	9.05787801	8.818544162	4.309314135	18.53377001	57.36272512	14.16837114	20.07644172	0.002320541	0.042618272	22.42468022	37.04902902	53.93725054	1.572360697	18.44792915	24.80518977	59.31338285	26.02723879	0.848596299	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a-b, 14d-e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-b											0	NO	0.083592281	0	0.083592281	0	0.224	0.224	0.224	0.224	0.094990788	0.224	0.224	0.224	0.224	0.202655599	0.204209831	0.179369328	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078228104	0	0.078228104	0	0.209625758	0.209625758	0.209625758	0.209625758	0.08889516	0.209625758	0.209625758	0.209625758	0.209625758	0.189651043	0.191105539	0.167859068	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0	0	0	0	0	0	0	0												18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	0	NO	6.444574705	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	NO				No Cost Sharing; PBP 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											0	0	NO	0	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984
H3044_803_0	2012	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	233.235115	0	90.30355896	0	9.05787801	8.818544162	4.309314135	18.53377001	57.36272512	14.16837114	20.07644172	0.002320541	0.042618272	22.42468022	37.04902902	53.93725054	1.572360697	18.44792915	24.80518977	59.31338285	26.02723879	0.848596299	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a-b, 14d-e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-b											0	NO	0.083592281	0	0.083592281	0	0.224	0.224	0.224	0.224	0.094990788	0.224	0.224	0.224	0.224	0.202655599	0.204209831	0.179369328	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078228104	0	0.078228104	0	0.209625758	0.209625758	0.209625758	0.209625758	0.08889516	0.209625758	0.209625758	0.209625758	0.209625758	0.189651043	0.191105539	0.167859068	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0.209625758	0	0	0	0	0	0	0	0												18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	0	NO	6.444574705	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984	NO				No Cost Sharing; PBP 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											0	0	NO	0	18.2455	0	7.064276237	0	1.898764547	1.848594007	0.903343243	3.885155593	5.099268651	2.970055544	4.208539319	0.000486445	0.008933888	4.252863996	7.080274662	9.053856626	0.329607303	3.867161137	5.199806715	12.43361286	5.455979669	0.177887643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.984
H3044_804_0	2012	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	224.1970036	0	84.75312755	0	9.505923761	8.204411178	4.124776168	18.08925101	56.03147459	13.8367004	19.83780323	0.002140406	0.039305407	23.0954931	37.05123236	53.83499776	1.450950694	19.981958	36.22246618	59.0504422	28.15343075	0.782413429	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a-b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a-b, 14d-e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.083592281	0	0.083592281	0	0.224	0.224	0.224	0.224	0.09533267	0.224	0.224	0.224	0.224	0.202464903	0.205175313	0.181048975	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078075288	0	0.078075288	0	0.20921626	0.20921626	0.20921626	0.20921626	0.089040824	0.20921626	0.20921626	0.20921626	0.20921626	0.189102454	0.19163398	0.169099952	0.20921626	0.20921626	0.20921626	0.20921626	0.20921626	0.20921626	0	0	0	0	0	0	0	0												17.5042	0	6.617124823	0	1.988793814	1.71649622	0.862970242	3.784565438	4.989088694	2.894862705	4.150390993	0.000447808	0.00822333	4.367414428	7.100275134	9.103495549	0.303562477	4.180550513	7.578328892	12.35431265	5.89015548	0.163693611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.559	0	NO	6.752436059	17.5042	0	6.617124823	0	1.988793814	1.71649622	0.862970242	3.784565438	4.989088694	2.894862705	4.150390993	0.000447808	0.00822333	4.367414428	7.100275134	9.103495549	0.303562477	4.180550513	7.578328892	12.35431265	5.89015548	0.163693611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.559	NO				No Cost Sharing; PBP 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											0	0	NO	0	17.5042	0	6.617124823	0	1.988793814	1.71649622	0.862970242	3.784565438	4.989088694	2.894862705	4.150390993	0.000447808	0.00822333	4.367414428	7.100275134	9.103495549	0.303562477	4.180550513	7.578328892	12.35431265	5.89015548	0.163693611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.559
H3107_004_0	2012	4																															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	1335.877669	139.1496872	1305.652567	1450.007875	185.3242281	4.893804462	11.12801094	296.1684632	60.1466245	19.61879645	41.34954206	0	0.079149805	9.570173557	4916.431318	4931.038827	802.8056368	974.7474423	0	0	28.69530931	630.6543438	0	476.5106048	45.7158926	69.11120839	19.31485617	65	438.4477104	0											6700	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	59.76904373	0	200	0.2	0.093410235	64.22400341	0.15	0.262397655	0.137837965	0	0.2	0.140193434	9.815053481	34.9953632	40	35	0	0	0.2	34.17338556	0	0	0	0	15	352.5	0	0											NO	128.3874357	74.1919885	44.57484754	0	149.1569708	0.149156971	0.069663938	47.92597226	0.111867728	0.195692197	0.102797466	0	0.149156971	0.104554139	9.403101197	33.52677952	38.32114095	33.53099833	0	0	0.149156971	25.48599335	0	0	0	0	15	352.5	0	0												14.2925	0.860315999	4.849938676	0	2.303533372	0.729945049	0.775221068	1.182846796	6.728466234	3.83924538	4.250628153	0	0.011805745	1.00060126	3.852475101	13.77682096	2.56370233	2.723687905	0	0	4.280105412	1.339404368	0	0	0	0	0.02414357	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	71.2948	0	NO	16.83446116	14.2925	0.860315999	4.849938676	0	2.303533372	0.729945049	0.775221068	1.182846796	6.728466234	3.83924538	4.250628153	0	0.011805745	1.00060126	3.852475101	13.77682096	2.56370233	2.723687905	0	0	4.280105412	1.339404368	0	0	0	0	0.02414357	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	71.2948	NO	"$320 Days 1-Unlimited (1a); $320 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	"$0 n/c (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9c); 30% (9a)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (9d, 9d1); 30% (14a10, 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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.727	0.0753	0	0.0349	0	0	0	0.016	0.1367	0	0.0864	0	0.0002	0.0198	0.4214	2.2776	0.1976	0	0	0	0.648	0.1728	0	0	0	0	0	0	0	0											4.8134	0	NO	0	15.0195	0.935606575	4.849938676	0.034867766	2.303533372	0.729945049	0.775221068	1.198857843	6.865163108	3.83924538	4.33698477	0	0.011965644	1.020393456	4.2738279	16.0544144	2.76126683	2.723687905	0	0	4.928064009	1.512188895	0	0	0	0	0.02414357	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.1082
H3107_008_0	2012	5																															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	1279.935914	137.4109813	1295.506944	1276.731831	168.9689547	4.468744093	7.540518749	242.3460615	41.92408268	16.62354093	34.77413987	0	0.041642566	6.938903919	4198.508815	4305.50398	737.0403907	762.6129991	0	0	23.1688385	579.6422333	0	412.5801654	42.39732913	35.25085675	18.37610519	65	127.1877016	0											6700	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	51.17720439	0	200	0.2	0.095733816	64.17925251	0.15	0.185096125	0.13776196	0	0.2	0.13938741	9.987240881	29.98479347	40	30	0	0	0.2	29.39682914	0	0	0	0	15	342.5	0	0											NO	137.1907011	79.27918227	40.78423008	0	159.3843609	0.159384361	0.076292366	51.1749579	0.119538271	0.147507138	0.10978551	0	0.159384361	0.111080866	9.66144941	29.00870801	38.69516927	29.02137695	0	0	0.159384361	23.42697413	0	0	0	0	15	342.5	0	0												14.6329	0.907819186	4.403021105	0	2.244250738	0.712247921	0.575284013	1.033504125	5.011532343	2.45209094	3.817696665	0	0.006637174	0.770779458	3.380306709	10.40809232	2.376658556	1.844339943	0	0	3.692750517	1.1316053	0	0	0	0	0.022970131	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	61.2797	0	NO	11.15368818	14.6329	0.907819186	4.403021105	0	2.244250738	0.712247921	0.575284013	1.033504125	5.011532343	2.45209094	3.817696665	0	0.006637174	0.770779458	3.380306709	10.40809232	2.376658556	1.844339943	0	0	3.692750517	1.1316053	0	0	0	0	0.022970131	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	61.2797	NO	"35% (1a, 1a1); $0 n/c (1a2, 1a3)"	"35% (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	"$0 n/c (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9c); 30% (9a)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (9d, 9d1); 30% (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.8837	0.0561	0	0.0298	0	0	0	0.0131	0.0953	0	0.0726	0	0.0001	0.0143	0.3681	2.015	0.1906	0	0	0	0.5232	0.1633	0	0	0	0	0	0	0	0											5.4251	0	NO	0	16.5167	0.963893386	4.403021105	0.029828971	2.244250738	0.712247921	0.575284013	1.046596371	5.106814349	2.45209094	3.890280811	0	0.0067213	0.785047201	3.748369837	12.42311139	2.567258056	1.844339943	0	0	4.215917838	1.294872492	0	0	0	0	0.022970131	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.7048
H3107_012_0	2012	5																															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	1356.108233	121.4371988	1298.916893	1457.098478	184.3681671	4.838948228	11.00327348	297.6333605	60.0731531	19.39888303	41.29903202	0	0.07905312	9.543268002	5237.561228	5293.338142	610.5399522	969.7188606	0	0	30.50930572	673.8790103	0	362.3940007	42.79069767	1.6	17.6381231	65	540.608755	0											6700	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-35 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$10 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $10 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $10 (16b, 18a); $0/$10 (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)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	51.1298482	0	200	0.2	0.093410235	64.22404674	0.15	0.264003282	0.152095489	0	0.2	0.138563793	0.048116915	10	38.5	10	0	0	0.2	9.819079839	0	0	0	0	0	352.5	0	0											NO	153.5786981	80.43830024	40.9204472	0	160.0648101	0.16006481	0.074758457	51.4233023	0.120048608	0.211288176	0.121725678	0	0.16006481	0.110895936	0.046576648	9.68110015	37.26757908	9.67989067	0	0	0.16006481	7.858445747	0	0	0	0	0	352.5	0	0												17.3558	0.814016822	4.429355013	0	2.45923797	0.774545329	0.822587752	1.275440856	7.211698381	4.098754604	5.027152664	0	0.012653623	1.05830964	0.020329004	4.270444724	1.896112163	0.782231046	0	0	4.883466226	0.44130347	0	0	0	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	59.5428	0	NO	12.86962626	17.3558	0.814016822	4.429355013	0	2.45923797	0.774545329	0.822587752	1.275440856	7.211698381	4.098754604	5.027152664	0	0.012653623	1.05830964	0.020329004	4.270444724	1.896112163	0.782231046	0	0	4.883466226	0.44130347	0	0	0	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	59.5428	NO																																										0	0	0	0	0	0	0	0	0	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	17.3558	0.814016822	4.429355013	0	2.45923797	0.774545329	0.822587752	1.275440856	7.211698381	4.098754604	5.027152664	0	0.012653623	1.05830964	0.020329004	4.270444724	1.896112163	0.782231046	0	0	4.883466226	0.44130347	0	0	0	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	59.5428
H3107_801_0	2012	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	268.7524215	7.3635	46.81276779	1921.277603	8.250960408	7.648157776	15.20230199	13.4183636	66.64324873	22.92960552	47.67112344	0	0.079721013	11.40318456	26.51050742	125.8950075	3.4054	7.140066546	0	0	32.20170079	10.13341644	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.062702175	0.062702175	0.137830203	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.043173743	0.043173743	0.094903338	0	0.154235773	0.154235773	0.154235773	0.154235773	0.154235773	0.154235773	0.154235773	0	0.154235773	0.154235773	0.154235773	0.154235773	0.154235773	0.154235773	0	0	0.154235773	0.154235773	0	0	0	0	0	0	0	0												11.603	0.317909858	4.442687946	0	1.272593255	1.179619526	2.344738797	2.06959168	10.27877297	3.536565428	7.352592567	0	0.012295832	1.758778984	4.088868602	19.41751379	0.525234501	1.101253682	0	0	4.966654209	1.562935316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8317	150	YES	35.20496675	11.603	0.317909858	4.442687946	0	1.272593255	1.179619526	2.344738797	2.06959168	10.27877297	3.536565428	7.352592567	0	0.012295832	1.758778984	4.088868602	19.41751379	0.525234501	1.101253682	0	0	4.966654209	1.562935316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8317	NO																																										0	0	0	0	0	0	0	0	0	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	11.603	0.317909858	4.442687946	0	1.272593255	1.179619526	2.344738797	2.06959168	10.27877297	3.536565428	7.352592567	0	0.012295832	1.758778984	4.088868602	19.41751379	0.525234501	1.101253682	0	0	4.966654209	1.562935316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8317
H3107_803_0	2012	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	266.844777	7.3731	46.48048383	1914.220757	8.192393868	7.593870019	15.0943938	13.32311806	66.17020508	22.76684778	47.33274674	0	0.079155142	11.32168645	26.32233192	125.0013861	3.4056	7.089385296	0	0	31.97312835	10.06148795	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.064126195	0.064126195	0.136243413	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.044215214	0.044215214	0.093940263	0	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0	0	0.154448707	0.154448707	0	0	0	0	0	0	0	0												11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106	150	YES	34.94959342	11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106	NO																																										0	0	0	0	0	0	0	0	0	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	11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106
H3107_804_0	2012	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	266.844777	7.3731	46.48048383	1914.220757	8.192393868	7.593870019	15.0943938	13.32311806	66.17020508	22.76684778	47.33274674	0	0.079155142	11.32168645	26.32233192	125.0013861	3.4056	7.089385296	0	0	31.97312835	10.06148795	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.064126195	0.064126195	0.136243413	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.044215214	0.044215214	0.093940263	0	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0.154448707	0	0	0.154448707	0.154448707	0	0	0	0	0	0	0	0												11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106	150	YES	34.94959342	11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106	NO																																										0	0	0	0	0	0	0	0	0	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	11.7986	0.326003195	4.366388896	0	1.265304643	1.172863408	2.331309611	2.057738363	10.21990264	3.51631021	7.310481551	0	0.012225409	1.748619837	4.065450139	19.3063025	0.525990518	1.094946395	0	0	4.938208344	1.553983808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6106
H3107_807_0	2012	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	261.5078814	7.229068	46.48048383	1895.07855	8.11046993	7.517931319	14.94344986	13.18988688	65.50850303	22.5391793	46.85941927	0	0.07836359	11.20846958	24.72696414	116.2512891	3.186738	6.593128326	0	0	29.73500936	9.357183792	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.064126195	0.064126195	0.136243413	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.044288772	0.044288772	0.094096546	0	0.154705653	0.154705653	0.154705653	0.154705653	0.154705653	0.154705653	0.154705653	0	0.154705653	0.154705653	0.154705653	0.154705653	0.154705653	0.154705653	0	0	0.154705653	0.154705653	0	0	0	0	0	0	0	0												11.5819	0.320166544	4.373652966	0	1.25473555	1.163066477	2.311836175	2.040550068	10.13453576	3.486938461	7.249417077	0	0.01212329	1.73401361	3.825401144	17.98473164	0.493006384	1.019994226	0	0	4.600174052	1.447609232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0338	150	YES	33.60846297	11.5819	0.320166544	4.373652966	0	1.25473555	1.163066477	2.311836175	2.040550068	10.13453576	3.486938461	7.249417077	0	0.01212329	1.73401361	3.825401144	17.98473164	0.493006384	1.019994226	0	0	4.600174052	1.447609232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0338	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.3422	0.0095	0	0	0.0184	0.017	0.0338	0.0298	0.1482	0.051	0.106	0	0.0002	0.0254	0.3574	1.96	0.0537	0.1112	0	0	0.5013	0.1578	0	0	0	0	0	0	0	0											3.9229	150	YES	0	11.9241	0.32962721	4.373652966	0	1.273086512	1.180076746	2.345647617	2.070393853	10.28275702	3.5379362	7.355442429	0	0.012300598	1.759374188	4.182763525	19.94475337	0.546735472	1.131155787	0	0	5.101512704	1.605373363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9567
H3113_001_0	2012	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	220.7930665	39.5998	12867.53222	42.97799253	18.81726936	35.08181045	16.47246246	19.12204654	25.17805838	46.60097003	15.3937056	0	0	12.65217358	2.67881913	136.7888593	18.9151	70.03593677	0	38345.82824	29.26487489	9.597912134	1541.345852	0	40.13565015	295.9270401	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.063364488	0.064134097	0	0	0.2	0.2	0.182705079	0.112796067	0.16	0	0.077199081	0	0	0.146479375	0	0.031190124	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.059561856	0.06028528	0	0	0.187997594	0.187997594	0.171740577	0.106026946	0.150398076	0	0.072566208	0	0	0.13768885	0	0.029318341	0.187997594	0	0	0	0.187997594	0.188416546	0	0	0	0	0	0	0	0												13.1508	2.387285023	0	0	3.537601373	6.595295972	2.828990202	2.027452194	3.786731526	0	1.117062836	0	0	1.742063233	0	4.010422488	3.555993298	0	0	0	5.501726081	1.808405453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0499	0	NO	3.318763175	13.1508	2.387285023	0	0	3.537601373	6.595295972	2.828990202	2.027452194	3.786731526	0	1.117062836	0	0	1.742063233	0	4.010422488	3.555993298	0	0	0	5.501726081	1.808405453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0499	NO																																										0	0	0	0	0	0	0	0	0	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	13.1508	2.387285023	0	0	3.537601373	6.595295972	2.828990202	2.027452194	3.786731526	0	1.117062836	0	0	1.742063233	0	4.010422488	3.555993298	0	0	0	5.501726081	1.808405453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0499
H3132_001_0	2012	9																															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	NO	1483.953366	536.2629456	935.0503447	12653.06723	692.2805294	14.52497897	8.866560354	3359.974334	1963.350739	1760.989367	1053.837894	79.44179989	25.3267473	3316.091026	12889.34887	38654.09558	3266.018136	1380.368413	4693.983967	14231.28819	17.88992209	0	791.2866141	1526.686135	33.11204746	51.67586051	0	0	13135.22094	0												1a1: $0	1b1: $0	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $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"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0"	"7b1: $0,7d1: $0,7f1: $0,16b1: $0,17a1: $0,18a1: $0"	"7c: $0,7i: $0"	"7e1: $0,7h1: $0"	7d2:	7g: $0	"152: $0,153: $0"	$0 	10b: $0	"16a1: $0 limited to $850 every year,16a2: $0 limited to $850 every year,16a3: $0 limited to $850 every year,16b2: $0  Covered under 16a"	17a2: $0	17b2: $0 limited to Max cov combined for all supp($100)	18a2: $0	18b1: $0 limited to $400 every year	n/a	n/a												NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	#DIV/0!	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H3144_001_0	2012	7																															D	D	D	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	O	COIN	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	1016.73141	8.406395469	639.173937	0	165.5445848	6.928726883	6.288633289	302.5073347	48.60647451	13.52531325	27.28495358	0.230660689	0	16.22773693	3690.913835	12135.64954	159.4482484	1074.710097	13.78288753	0	15.60414395	0	0	0	0	0	6.333842943	0	0	0											3300	1a $175 days 1-10	1b $175 days 1-10	"2 $0 days 1-20, $100 Days 21 to 53"	6 $0	10a $150	11a 20%	"11b 20%, 11c 0%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	"8a Lab $10, 8a Diagnostic proc/tests  20%"	"8b CAT Scan $150, 8b MRI $150, 8b Diagnostic proc/tests 20%, 8b therepeutic radiology 20%"	5 $40	12 0%	"3 $0, 4a $65 , 9d $0, 14b $0"	"7a PCP $5, $14a 0%, 14c-14e 0%"	"7b $20 7d $25, 7f $25 $17a $0, 14c - 14e 0%"	"7e $40, 7h $40, 9c $40"	"7c $25, 7i $25"	8b $150	7g $25	15 20%			16a $0	17a $0		18a $25		14a $0													NO	159.6676737	156.5789474	11.77892919	0	150	0.2	0.2	62.14520013	0.2	0.207082518	0.279084585	0.2	0	0.104364463	4.857413208	9.856485065	40	25	0.058670578	0	0.187166551	0	0	0	0	0	25	0	0	0											NO	135.6438838	133.0198909	10.00665736	0	127.4308198	0.16990776	0.16990776	52.8027787	0.16990776	0.175924634	0.237093183	0.16990776	0	0.088661661	4.126560983	8.373466484	33.98155196	21.23846997	0.049842932	0	0.159005247	0	0	0	0	0	25	0	0	0												11.4928	0.093184817	0.532999548	0	1.757956847	1.177244463	1.068487594	1.331102321	8.258617194	2.37943578	6.469076488	0.039191041	0	1.438778109	1.269231752	8.468121225	0.451524912	1.902099844	0.686979528	0	2.481140767	0	0	0	0	0	0.013195506	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3112	0	NO	9.085105712	11.4928	0.093184817	0.532999548	0	1.757956847	1.177244463	1.068487594	1.331102321	8.258617194	2.37943578	6.469076488	0.039191041	0	1.438778109	1.269231752	8.468121225	0.451524912	1.902099844	0.686979528	0	2.481140767	0	0	0	0	0	0.013195506	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3112	NO																																										0	0	0	0	0	0	0	0	0	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	11.4928	0.093184817	0.532999548	0	1.757956847	1.177244463	1.068487594	1.331102321	8.258617194	2.37943578	6.469076488	0.039191041	0	1.438778109	1.269231752	8.468121225	0.451524912	1.902099844	0.686979528	0	2.481140767	0	0	0	0	0	0.013195506	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3112
H3144_801_0	2012	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	223.7141752	1.768893205	26.43740441	0	7.588492066	7.789113322	7.069535019	14.76676756	54.64226611	15.20484201	30.67310908	0.259303372	0.290732777	18.24284375	28.7564319	116.9066149	1.225637704	8.210412384	13.38427709	7.70921437	17.54181505	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.8%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.086130118	0.086130118	0.188053861	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.075836641	0.075836641	0.165579398	0	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0	0	0	0	0	0	0	0	0												16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	0	NO	12.29181411	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	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	NO	0	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593
H3144_802_0	2012	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	223.7141752	1.768893205	26.43740441	0	7.588492066	7.789113322	7.069535019	14.76676756	54.64226611	15.20484201	30.67310908	0.259303372	0.290732777	18.24284375	28.7564319	116.9066149	1.225637704	8.210412384	13.38427709	7.70921437	17.54181505	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.8%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.086130118	0.086130118	0.188053861	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.075836641	0.075836641	0.165579398	0	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0	0	0	0	0	0	0	0	0												16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	0	NO	12.29181411	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	NO																																										0	0	0	0	0	0	0	0	0	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	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593
H3144_803_0	2012	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	223.7141752	1.768893205	26.43740441	0	7.588492066	7.789113322	7.069535019	14.76676756	54.64226611	15.20484201	30.67310908	0.259303372	0.290732777	18.24284375	28.7564319	116.9066149	1.225637704	8.210412384	13.38427709	7.70921437	17.54181505	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.8%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.086130118	0.086130118	0.188053861	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.075836641	0.075836641	0.165579398	0	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0.197229586	0	0	0	0	0	0	0	0	0												16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	0	NO	12.29181411	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593	NO																																										0	0	0	0	0	0	0	0	0	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	16.9657	0.134146919	4.377489519	0	1.496675151	1.536243598	1.394321467	2.912443457	10.77707154	2.9988447	6.049644614	0.051142297	0.057341105	3.598028526	5.671619167	23.05744329	0.241732017	1.619336238	2.639775433	1.520485161	3.459764926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5593
H3152_022_0	2012	3																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1732.104995	63.9373337	1295.903581	1682.376964	415.2114803	15.08436394	0	297.6915748	410.6958905	2131.698413	2084.613104	21.30201946	0.021585289	320.1328663	1321.035468	9446.415614	191.5100567	739.8430963	0	0	295.9309054	0	0	0	1214.607066	63.97664602	44.99247806	0.18984168	13.22790205	0											6700	$225/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-10, $50/d 11-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	162.6423925	96.15686456	61.9565603	0	200	0.03	0.03	62.5	300	5	24.48044154	50	0.2	50	20	50	40	25	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	147.3229818	87.09977628	56.12082472	0	181.1618477	0.027174277	0	56.61307742	271.7427716	4.529046193	22.17461012	45.29046193	0.181161848	45.29046193	18.11618477	45.29046193	36.23236955	22.64523097	0	0	45.29046193	0	0	0	0	0	0	0	0	0												21.2649	0.464077288	6.060598144	0	6.268373247	0.409906687	0	1.404436348	9.300303297	0.804546715	3.852123568	0.080398192	0.003910431	1.208247116	1.994343552	35.65271057	0.578238595	1.396159816	0	0	1.11690395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8602	0	NO	9.552100214	21.2649	0.464077288	6.060598144	0	6.268373247	0.409906687	0	1.404436348	9.300303297	0.804546715	3.852123568	0.080398192	0.003910431	1.208247116	1.994343552	35.65271057	0.578238595	1.396159816	0	0	1.11690395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8602	NO																																																																																		0		NO		21.2649	0.464077288	6.060598144	0	6.268373247	0.409906687	0	1.404436348	9.300303297	0.804546715	3.852123568	0.080398192	0.003910431	1.208247116	1.994343552	35.65271057	0.578238595	1.396159816	0	0	1.11690395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8602
H3152_045_0	2012	2																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1477.945941	70.31500139	1041.870165	775.5440044	265.5930239	8.057994567	0	255.08789	387.5304146	2560.275983	2762.709909	52.4162137	0.030081157	395.3127258	1789.787147	7864.211885	134.8746001	588.2808865	0	0	223.0115964	0.002723038	0	0	1249.660882	98.52041098	52.30898358	8.406855376	59.99360102	0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-20, $135/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	54.4473073	0	200	0.03	0.03	62.5	250	4.5	26.4987176	45	0.2	45	20	45	40	22.5	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	164.330524	87.43942416	49.51119423	0	181.8682931	0.027280244	0	56.83384161	227.3353664	4.092036596	24.0963827	40.92036596	0.181868293	40.92036596	18.18682931	40.92036596	36.37365863	20.46018298	0	0	45.46707329	0	0	0	0	0	0	0	0	0												20.2393	0.512358603	4.298686341	0	4.025245828	0.219824058	0	1.208135395	7.341614068	0.873061918	5.547609606	0.178740887	0.005470809	1.348028451	2.712546112	26.81720236	0.408823555	1.003027882	0	0	0.844973716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5847	0	NO	7.734950085	20.2393	0.512358603	4.298686341	0	4.025245828	0.219824058	0	1.208135395	7.341614068	0.873061918	5.547609606	0.178740887	0.005470809	1.348028451	2.712546112	26.81720236	0.408823555	1.003027882	0	0	0.844973716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5847	NO																																																																																		0		NO		20.2393	0.512358603	4.298686341	0	4.025245828	0.219824058	0	1.208135395	7.341614068	0.873061918	5.547609606	0.178740887	0.005470809	1.348028451	2.712546112	26.81720236	0.408823555	1.003027882	0	0	0.844973716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5847
H3152_046_0	2012	3																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1359.530447	42.92755659	1210.359652	872.8337156	242.0788493	9.70464935	0	232.3860489	408.2090923	2963.780335	3111.459183	63.87137468	0.054364389	585.426113	1789.572601	9040.49768	199.8643489	627.1783118	0	0	295.9383316	0	0	0	1631.0163	105.9780405	54.35532905	7.306781938	4.272591327	0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-20, $135/d 21-100; includes non-Medicare covered stays"	$0 per visit	$225 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	54.4473073	0	225	0.03	0.03	62.5	250	4.5	26.4987176	45	0.2	45	20	45	40	22.5	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	164.8063303	87.69259823	49.65455005	0	205.1942385	0.027359232	0	56.99839959	227.9935983	4.10388477	24.16615191	41.0388477	0.182394879	41.0388477	18.23948787	41.0388477	36.47897573	20.51942385	0	0	45.59871967	0	0	0	0	0	0	0	0	0												18.6716	0.313702414	5.008321991	0	4.139432094	0.265511751	0	1.103802739	7.755754986	1.013584415	6.265999606	0.218433968	0.009915786	2.002101091	2.720073979	30.91763395	0.607570561	1.072444801	0	0	1.124534085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2104	0	NO	8.031637479	18.6716	0.313702414	5.008321991	0	4.139432094	0.265511751	0	1.103802739	7.755754986	1.013584415	6.265999606	0.218433968	0.009915786	2.002101091	2.720073979	30.91763395	0.607570561	1.072444801	0	0	1.124534085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2104	NO																																																																																		0		NO		18.6716	0.313702414	5.008321991	0	4.139432094	0.265511751	0	1.103802739	7.755754986	1.013584415	6.265999606	0.218433968	0.009915786	2.002101091	2.720073979	30.91763395	0.607570561	1.072444801	0	0	1.124534085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2104
H3152_048_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1871.676174	96.65425714	1649.973189	1095.391827	327.3166628	13.55417623	0	275.3713568	408.1017173	3728.129573	3551.072739	78.87037074	0	932.253817	2358.999407	11426.24622	313.9753324	849.7246013	0	0	393.7867395	0	0	0	1833.420042	69.9029715	69.9029715	6.867660358	17.65987089	0											6700	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-20, $135/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $35 per visit	$0 to $35 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$35 per visit	20% per visit	$0 to 200 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	144.5710156	96.15686456	54.4473073	0	200	0.03	0.03	62.5	200	3.5	22.37499552	35	0.2	35	15	35	35	17.5	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	133.2788702	88.64624917	50.19453984	0	184.3784104	0.027656762	0	57.61825324	184.3784104	3.226622181	20.62733053	32.26622181	0	32.26622181	13.82838078	32.26622181	32.26622181	16.13311091	0	0	46.09460259	0	0	0	0	0	0	0	0	0												20.7879	0.714003113	6.901637081	0	5.029177165	0.37486462	0	1.322201381	6.270428825	1.002438798	6.104095928	0.21207074	0	2.50669237	2.718428504	30.72348293	0.844233143	1.142391769	0	0	1.512620272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1667	0	NO	7.469983037	20.7879	0.714003113	6.901637081	0	5.029177165	0.37486462	0	1.322201381	6.270428825	1.002438798	6.104095928	0.21207074	0	2.50669237	2.718428504	30.72348293	0.844233143	1.142391769	0	0	1.512620272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1667	NO																																																																																		0		NO		20.7879	0.714003113	6.901637081	0	5.029177165	0.37486462	0	1.322201381	6.270428825	1.002438798	6.104095928	0.21207074	0	2.50669237	2.718428504	30.72348293	0.844233143	1.142391769	0	0	1.512620272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1667
H3152_077_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1611.780549	96.75404067	1196.08388	1100.470087	251.7115704	13.27990466	0	324.2153678	357.5837953	2972.699586	2514.869031	59.67055984	0.081529255	663.630824	2174.713017	6436.317004	270.7878475	752.6116402	0	0	295.4278088	0.007262726	0	0	1271.732438	150	54.61570228	18	0	0											6700	$225/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-10, $50/d 11-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; $50 Therapeutic Radiology; 20% Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	162.6423925	96.15686456	61.9565603	0	200	0.03	0.03	62.5	300	5	23.83758108	50	0.2	50	25	50	40	25	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	146.341315	86.51939868	55.74687118	0	179.9547002	0.026993205	0	56.23584382	269.9320503	4.498867505	21.44842378	44.98867505	0.1799547	44.98867505	22.49433753	44.98867505	35.99094004	22.49433753	0	0	44.98867505	0	0	0	0	0	0	0	0	0												19.6558	0.697591785	5.556494498	0	3.77472335	0.358467189	0	1.519377065	8.043610586	1.114481798	4.494998061	0.223708286	0.014671573	2.487989291	4.07656072	24.13011452	0.812159099	1.410791688	0	0	1.107575474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4792	0	NO	8.853247484	19.6558	0.697591785	5.556494498	0	3.77472335	0.358467189	0	1.519377065	8.043610586	1.114481798	4.494998061	0.223708286	0.014671573	2.487989291	4.07656072	24.13011452	0.812159099	1.410791688	0	0	1.107575474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4792	NO																																																																																		0		NO		19.6558	0.697591785	5.556494498	0	3.77472335	0.358467189	0	1.519377065	8.043610586	1.114481798	4.494998061	0.223708286	0.014671573	2.487989291	4.07656072	24.13011452	0.812159099	1.410791688	0	0	1.107575474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4792
H3152_801_0	2012	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	0	0	0	0	0	0	0											0	YES	296.8119422	1.494531998	50.08327572	11.93550799	12.73841471	13.35061616	0	14.7359782	67.29961117	24.3807756	84.85710075	0.575178336	0.008758672	44.86113036	21.93413882	206.9617294	2.572970723	10.70493398	0	0	82.84401821	3.87E-05	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	NO	0.069716044	0.069716044	0.137500642	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05739252	0.05739252	0.113195011	0	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0.184404102	0	0	0	0	0	0	0	0												17.0348	0.085774958	5.669176945	0	2.349015923	2.461908383	0	2.717374825	12.41032435	4.495915027	15.64799745	0.106065245	0.001615135	8.272576452	4.044745169	38.16459183	0.474466355	1.974033736	0	0	15.27677677	7.13E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1872	0	NO	28.16896709	17.0348	0.085774958	5.669176945	0	2.349015923	2.461908383	0	2.717374825	12.41032435	4.495915027	15.64799745	0.106065245	0.001615135	8.272576452	4.044745169	38.16459183	0.474466355	1.974033736	0	0	15.27677677	7.13E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1872	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		17.0348	0.085774958	5.669176945	0	2.349015923	2.461908383	0	2.717374825	12.41032435	4.495915027	15.64799745	0.106065245	0.001615135	8.272576452	4.044745169	38.16459183	0.474466355	1.974033736	0	0	15.27677677	7.13E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1872
H3152_804_0	2012	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	0	0	0	0	0	0	0											0	YES	311.8916877	3.658088331	46.40354779	8.68322399	12.94128658	12.74601139	0	11.76554406	50.5590012	22.25486911	81.7262061	0.655919308	0.135885551	33.70600094	18.349103	196.0041087	2.753974704	8.885362645	0	0	89.31783932	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	NO	0.066775636	0.066775636	0.137643211	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05461241	0.05461241	0.112571409	0	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0.183198252	0	0	0	0	0	0	0	0												17.0332	0.199777018	5.223712753	0	2.37082108	2.335047007	0	2.155427106	9.262320645	4.07705312	14.9720981	0.120163271	0.024893995	6.174880455	3.361523596	35.9076101	0.504523352	1.627782905	0	0	16.36287204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7137	0	NO	27.10795628	17.0332	0.199777018	5.223712753	0	2.37082108	2.335047007	0	2.155427106	9.262320645	4.07705312	14.9720981	0.120163271	0.024893995	6.174880455	3.361523596	35.9076101	0.504523352	1.627782905	0	0	16.36287204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7137	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		17.0332	0.199777018	5.223712753	0	2.37082108	2.335047007	0	2.155427106	9.262320645	4.07705312	14.9720981	0.120163271	0.024893995	6.174880455	3.361523596	35.9076101	0.504523352	1.627782905	0	0	16.36287204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7137
H3154_004_0	2012	4	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin	coin	V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1859.519831		1365.970711	181.0852179	365.2071694	12.60375783		292.3255636	136.9726671					2127.951096	6210.523981	3879.426032			753.1606691	2501.62084	50.52633746						10.28571429				173.8130402	178.9275388	173.6769606								6700	"(1a.)$175/day for the first 10 days of each IP stay;(1b.)$175/day for days 1-8, $37 for day 9 of each IP stay;"		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31-100	(6.) $0 copay	(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$185 Copay;					(3)$35;(5.)$185; (8a.)$0-$185; (8b.)$35-$185;(9a.)$35-$185;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $500/1 yr for first ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										158.1410738		46.86968638	0	150	0.2		65	185					183.15	15	35			35	35	0.2						35				75	35	20								NO	134.3886147		39.82995733	0	127.4703132	0.169960418		55.2371357	157.2133862					155.6412524	12.61769081	29.74307307			29.74307307	29.74307307	0.169960418						29.74307307				63.73515658	29.74307307	16.99604175									20.8249	0	4.533879594	0	3.879422688	2.142139944	0	1.345602236	1.794494734	0	0	0	0	27.59974779	6.530205947	9.615504329	0	0	1.866776068	6.200490954	8.587477412	0	0	0	0	0	0.025494063	0	0	0	0.923166778	0.443487905	0.245985073	0	0	0	0	0	0	0	96.5587			17.06173553	20.8249	0	4.533879594	0	3.879422688	2.142139944	0	1.345602236	1.794494734	0	0	0	0	27.59974779	6.530205947	9.615504329	0	0	1.866776068	6.200490954	8.587477412	0	0	0	0	0	0.025494063	0	0	0	0.923166778	0.443487905	0.245985073	0	0	0	0	0	0	0	96.5587	NO																																																																																		0				20.8249	0	4.533879594	0	3.879422688	2.142139944	0	1.345602236	1.794494734	0	0	0	0	27.59974779	6.530205947	9.615504329	0	0	1.866776068	6.200490954	8.587477412	0	0	0	0	0	0.025494063	0	0	0	0.923166778	0.443487905	0.245985073	0	0	0	0	0	0	0	96.5587
H3154_005_0	2012	6	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D		T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1929.04281		1179.71995		339.6494013	11.46644634		216.834621	129.7953717					1906.574032	6095.303442	4515.991773			793.4296567	2933.722549	39.8193327						10.28571429				196.9835641	133.7219544	373.3272324								6700	(1a.) $75/day for the first 10 days of each IP stay;(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 23-100		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										66.41367609		54.15414484		150	0.2		65	125					123.75	15	35			35	35	0.2						35				75	35	20								YES	59.39747622		48.43308969		134.1534148	0.17887122		58.13314639	111.7945123					110.6765672	13.19504757	31.30246344			31.30246344	31.30246344	0.17887122						31.30246344				67.07670738	31.30246344	17.88712197								6200	9.5484	0	4.761456845	0	3.797093917	2.051017243	0	1.050439897	1.209200857	0	0	0	0	17.58442241	6.702318238	11.78013895	0	0	2.069691902	7.65272857	7.122532607	0	0	0	0	0	0.026830683	0	0	0	1.101084074	0.348818882	0.556479145	0	0	0	0	0	0	0	77.3626			9.135129837	9.5484	0	4.761456845	0	3.797093917	2.051017243	0	1.050439897	1.209200857	0	0	0	0	17.58442241	6.702318238	11.78013895	0	0	2.069691902	7.65272857	7.122532607	0	0	0	0	0	0.026830683	0	0	0	1.101084074	0.348818882	0.556479145	0	0	0	0	0	0	0	77.3626	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						$900 deductible;35% coins				$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins									0.2228		0.1111	0	0.0886	0.0479		0.0245	0.0282					0.4103	0.1564	0.2749			0.0483	0.1786	0.1662						0.0006				0.0257	0.0081	0.013								1.8053	900	NO	1.461404607	9.7712	0	4.872568811	0	3.885701791	2.098879182	0	1.074952656	1.237418414	0	0	0	0	17.99476735	6.858721578	12.05503683	0	0	2.117989628	7.831310408	7.288741947	0	0	0	0	0	0.027456796	0	0	0	1.12677865	0.356958818	0.56946498	0	0	0	0	0	0	0	79.1679
H3154_006_0	2012	5	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1921.264103		1195.331296	132.5674455	354.7736168	18.55418968		243.5593168	156.9604486					2284.119292	6269.620593	5539.49001			933.5993744	3341.999002	69.39123324						10.28571429				219.2404566	201.6685972	347.2303235								6700	(1a.) $75/day for the first 10 days of each IP stay;(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 23-100	(6.) $0 copay	(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										66.41367609		54.15414484	0	150	0.2		65	125					123.75	15	35			35	35	0.2						35				75	35	20								YES	59.39747622		48.43308969	0	134.1534148	0.17887122		58.13314639	111.7945123					110.6765672	13.2011725	31.30246344			31.30246344	31.30246344	0.17887122						31.30246344				67.07670738	31.30246344	17.88712197								6200	9.5099	0	4.824465654	0	3.966174346	3.318810539	0	1.179905785	1.4622764	0	0	0	0	21.06654019	6.897195247	14.44997363	0	0	2.435330024	8.717733465	12.41209452	0	0	0	0	0	0.026830683	0	0	0	1.225493996	0.526060324	0.517579262	0	0	0	0	0	0	0	92.5363			10.92749775	9.5099	0	4.824465654	0	3.966174346	3.318810539	0	1.179905785	1.4622764	0	0	0	0	21.06654019	6.897195247	14.44997363	0	0	2.435330024	8.717733465	12.41209452	0	0	0	0	0	0.026830683	0	0	0	1.225493996	0.526060324	0.517579262	0	0	0	0	0	0	0	92.5363	NO	$900 deductible;35% coins	0	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	0	$900 deductible;35% coins	$900 deductible;35% coins	0	0	0	0	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	0	0	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	0	0	0	0	0	$900 deductible;35% coins	0	0	0	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins									0.1855	0	0.0941	0	0.0774	0.0647	0	0.023	0.0285	0	0	0	0	0.411	0.1346	0.2819	0	0	0.0475	0.1701	0.2422	0	0	0	0	0	0.0005	0	0	0	0.0239	0.0103	0.0101								1.8053	900	NO	1.461404607	9.6954	0	4.91858721	0	4.04355131	3.38355794	0	1.202924825	1.490804271	0	0	0	0	21.47753193	7.031754139	14.73188133	0	0	2.482841411	8.887809636	12.65424479	0	0	0	0	0	0.027354129	0	0	0	1.249402427	0.53632335	0.527676829	0	0	0	0	0	0	0	94.3416
H3154_012_0	2012	5	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	2640.614161		2118.811423	291.6459919	533.1262398	18.63462566		328.5132053	134.9603348					2781.762921	6355.351492	5216.491575			851.6047829	3190.054787	60.48102241						10.28571429				190.3928236	180.6493458	243.9376055								6700	(1a.) $75/day for the first 10 days of each IP stay;(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 23-100	(6.) $0 copay	(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										66.41367609		54.15414484	0	150	0.2		65	125					123.75	15	35			35	35	0.2						35				75	35	20								YES	59.39747622		48.43308969	0	134.1534148	0.17887122		58.13314639	111.7945123					110.6765672	13.20406155	31.30246344			31.30246344	31.30246344	0.17887122						31.30246344				67.07670738	31.30246344	17.88712197								6200	13.0705	0	8.551715305	0	5.960058797	3.333198221	0	1.591458855	1.257318734	0	0	0	0	25.6563309	6.993037687	13.60741973	0	0	2.221443965	8.321381112	10.81831425	0	0	0	0	0	0.026830683	0	0	0	1.064243643	0.471230795	0.363611809	0	0	0	0	0	0	0	103.3081			12.19988909	13.0705	0	8.551715305	0	5.960058797	3.333198221	0	1.591458855	1.257318734	0	0	0	0	25.6563309	6.993037687	13.60741973	0	0	2.221443965	8.321381112	10.81831425	0	0	0	0	0	0.026830683	0	0	0	1.064243643	0.471230795	0.363611809	0	0	0	0	0	0	0	103.3081	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						$900 deductible;35% coins				$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins									0.2284		0.1494	0	0.1042	0.0582		0.0278	0.022					0.4483	0.1222	0.2378			0.0388	0.1454	0.1891						0.0005				0.0186	0.0082	0.0064								1.8053	900	NO	1.461404607	13.2989	0	8.701156744	0	6.064210974	3.391445943	0	1.619269638	1.279290411	0	0	0	0	26.10467593	7.115241196	13.84520974	0	0	2.260263754	8.466797456	11.00736456	0	0	0	0	0	0.02729955	0	0	0	1.082841327	0.479465565	0.369965934	0	0	0	0	0	0	0	105.1134
H3154_013_0	2012	5	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	892.056548		444.9749049	67.85301183	173.7524236	7.439722028		183.3279424	87.32902174					1101.473041	5425.277184	2753.940254			554.1787636	1774.684562	15.45712652						9.65132464				137.5132806	72.74033379	167.3090067								6700	"(1a.)$175/day for the first 10 days of each IP stay;(1b.)$175/day for days 1-8, $37 for day 9 of each IP stay;"		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31-100	(6.) $0 copay	(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										158.1410738	0	46.86968638	0	150	0.2		65	200					198	15	35			35	35	0.2						35				75	35	20								NO	132.6120303	0	39.30341511	0	125.785187	0.167713583		54.50691438	167.7135827					166.0364469	12.44192546	29.34987697			29.34987697	29.34987697	0.167713583						29.34987697				62.89259351	29.34987697	16.77135827									9.8581	0	1.45741945	0	1.821290092	1.247742436	0	0.832720038	1.220521926	0	0	0	0	15.24038918	5.625074528	6.735650638	0	0	1.355423211	4.340564465	2.592370067	0	0	0	0	0	0.023605433	0	0	0	0.720713905	0.177909987	0.233833274	0	0	0	0	0	0	0	53.4833			11.41911669	9.8581	0	1.45741945	0	1.821290092	1.247742436	0	0.832720038	1.220521926	0	0	0	0	15.24038918	5.625074528	6.735650638	0	0	1.355423211	4.340564465	2.592370067	0	0	0	0	0	0.023605433	0	0	0	0.720713905	0.177909987	0.233833274	0	0	0	0	0	0	0	53.4833	NO																																																																																		0				9.8581	0	1.45741945	0	1.821290092	1.247742436	0	0.832720038	1.220521926	0	0	0	0	15.24038918	5.625074528	6.735650638	0	0	1.355423211	4.340564465	2.592370067	0	0	0	0	0	0.023605433	0	0	0	0.720713905	0.177909987	0.233833274	0	0	0	0	0	0	0	53.4833
H3154_016_0	2012	4	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1303.727993		756.4159432	151.8151555	215.2419725	15.33795357		210.1269066	135.0377394					1876.615372	6470.853637	4656.961495			963.9475678	3041.293528	48.21338602						10.28571429				212.7867409	117.6465154	225.7137967								6700	"(1a.)$150/day for the first 10 days of each IP stay;(1b.)$150/day for days 1-9, $87 for day 10 of each IP stay;"		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31-100	(6.) $0 copay	(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 20% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										135.5494918		46.86968638	0	150	0.2		65	125					123.75	15	35			35	35	0.2						35				75	35	20								NO	119.2507873		41.23399449	0	131.9637414	0.175951655		57.18428794	109.9697845					108.8700867	13.06786122	30.79153966			30.79153966	30.79153966	0.175951655						30.79153966				65.98187071	30.79153966	17.59516552									12.9559	0	2.599170903	0	2.367011333	2.698738318	0	1.001329794	1.237505925	0	0	0	0	17.02560652	7.046684777	11.94958455	0	0	2.47345248	7.803842524	8.483225074	0	0	0	0	0	0.026392748	0	0	0	1.170005602	0.301876445	0.330955968	0	0	0	0	0	0	0	79.4713			10.85820377	12.9559	0	2.599170903	0	2.367011333	2.698738318	0	1.001329794	1.237505925	0	0	0	0	17.02560652	7.046684777	11.94958455	0	0	2.47345248	7.803842524	8.483225074	0	0	0	0	0	0.026392748	0	0	0	1.170005602	0.301876445	0.330955968	0	0	0	0	0	0	0	79.4713	NO																																																																																		0				12.9559	0	2.599170903	0	2.367011333	2.698738318	0	1.001329794	1.237505925	0	0	0	0	17.02560652	7.046684777	11.94958455	0	0	2.47345248	7.803842524	8.483225074	0	0	0	0	0	0.026392748	0	0	0	1.170005602	0.301876445	0.330955968	0	0	0	0	0	0	0	79.4713
H3154_020_0	2012	4	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin	coin	V	V					V	V	V			V	V	coin										P	V	V																																																0	YES	2417.37578		1775.761924	235.4107833	474.7693203	16.38488518	0	380.0232327	178.0644672					2766.336425	8049.886357	5043.253842			979.1088699	3252.107093	65.6842387										225.9569522	232.6058005	225.7800488								6700	(1a.)&(1b.)$0/day		(2.)$0 copay	0	(10a.)$0 /Trip	(11a.)0% Coinsurance;(11b.)0% Coinsurance;(11c.)$0 copay. Prior auth if >$500	0	(4a.)$0 copay per visit; (4b.) $0 copay per visit	(9a.)$0 Copay;					(3)$0;(5.)$0; (8a.)$0; (8b.)$0;(9a.)$0;(9c.)$0;(9d.)$0;	(7a.)$20 ;(7f.)$20; (7g.)$20; (17a.) $0-$20;(18a.) $20; for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$35;	(15.)20% Coinsurance										(9b.)$0 Copay	(8b.)$0 Copay (9a.) $0;	(7b.)$0 Copay										0		0	0	0	0	0	0	0					0	20	35			35	35	0.2										0	0	0								NO	0		0	0	0	0	0	0	0					0	12.89493947	32.35917206			32.35917206	32.35917206	0.184909555										0	0	0	0								0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.650233112	13.59962657	0	0	2.640262699	8.769624415	12.14564333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8054			2.875521403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.650233112	13.59962657	0	0	2.640262699	8.769624415	12.14564333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8054	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.650233112	13.59962657	0	0	2.640262699	8.769624415	12.14564333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8054
H3154_801_0	2012	5	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1486.911585		850.3704432	147.0444009	322.7731063	16.69060959		185.4974314	161.9309467					2291.670302	6207.741866	5904.297732			1021.690849	4335.45878	47.61050616						10.03862031				254.2259136	118.6224245	843.8319391								6700	(1a.) $100/day for the first 10 days of each IP stay;(1b.)$100/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-100	(6.) $0 copay	(10a.)$0 /Trip	(11a.)0% Coinsurance;(11b.)0% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 10% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										92.70690202		0	0	0	0		65	200					198	15	35			35	35	0.1						35				100	35	20								YES	83.44874802		0	0	0	0		58.50878956	180.0270448					178.2267744	13.28970226	31.50473284			31.50473284	31.50473284	0.090013522						31.50473284				90.0135224	31.50473284	18.00270448								6200	10.3401	0	0	0	0	0	0	0.904435848	2.42932915	0	0	0	0	34.03641715	6.874920092	15.50111022	0	0	2.682341438	11.38228922	4.285589363	0	0	0	0	0	0.026355338	0	0	0	1.906980831	0.311430649	1.265938086	0	0	0	0	0	0	0	91.9472			10.48032837	10.3401	0	0	0	0	0	0	0.904435848	2.42932915	0	0	0	0	34.03641715	6.874920092	15.50111022	0	0	2.682341438	11.38228922	4.285589363	0	0	0	0	0	0.026355338	0	0	0	1.906980831	0.311430649	1.265938086	0	0	0	0	0	0	0	91.9472	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	$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	$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									0.1721	0	0	0	0	0	0	0.0151	0.0404	0	0	0	0	0.5664	0.1144	0.258	0	0	0.0446	0.1894	0.0713	0	0	0	0	0	0.0004	0	0	0	0.0317	0.0052	0.0211								1.5302	900	NO	1.238689089	10.5122	0	0	0	0	0	0	0.919487464	2.469758031	0	0	0	0	34.602851	6.989332471	15.75907961	0	0	2.726980949	11.57171321	4.356910115	0	0	0	0	0	0.026793943	0	0	0	1.938716795	0.316613476	1.28700582	0	0	0	0	0	0	0	93.4774
H3154_802_0	2012	5	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin	coin	V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1973.720993		1595.729864	181.9278634	441.6004397	20.79023515	0	257.8402093	176.4307625					2681.538177	6629.803988	6384.549174			993.5367789	4465.145228	72.89695473						10.28571429				251.819575	268.049111	567.3231396								6700	(1a.) $100/day for the first 10 days of each IP stay;(1b.)$100/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-100	(6.) $0 copay	(10a.)$0 /Trip	(11a.)0% Coinsurance;(11b.)0% Coinsurance;(11c.)$0 copay. Prior auth if >$500	0	(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 10% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										92.70690202		0	0	0	0	0	65	200					198	15	35			35	35	0.1						35				100	35	20								YES	83.44874802		0	0	0	0	0	58.50878956	180.0270448					178.2267744	13.29818601	31.50473284			31.50473284	31.50473284	0.090013522						31.50473284				90.0135224	31.50473284	18.00270448								6200	13.7254	0	0	0	0	0	0	1.257159879	2.646859066	0	0	0	0	39.82682496	7.347030555	16.76195967	0	0	2.608425899	11.72276729	6.561711668	0	0	0	0	0	0.027004057	0	0	0	1.888930579	0.703734636	0.851112569	0	0	0	0	0	0	0	105.9289			11.74920034	13.7254	0	0	0	0	0	0	1.257159879	2.646859066	0	0	0	0	39.82682496	7.347030555	16.76195967	0	0	2.608425899	11.72276729	6.561711668	0	0	0	0	0	0.027004057	0	0	0	1.888930579	0.703734636	0.851112569	0	0	0	0	0	0	0	105.9289	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						$900 deductible;35% coins				$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins									0.1983		0	0	0	0		0.0182	0.0382					0.5753	0.1061	0.2421			0.0377	0.1693	0.0948						0.0004				0.0273	0.0102	0.0123								1.5302	900	NO	1.238689089	13.9236	0	0	0	0	0	0	1.275320052	2.685093995	0	0	0	0	40.40213925	7.453161326	17.00409283	0	0	2.646105646	11.89210732	6.656498196	0	0	0	0	0	0.027394141	0	0	0	1.916216931	0.713900362	0.863407228	0	0	0	0	0	0	0	107.4591
H3154_805_0	2012	6	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								ASC	Chemo/Therapeutic XRay	Chiropractic Services								D		D	V	T	coin		V	V					V	V	V			V	V	coin						V				P	V	V																																																0	YES	1973.720993		1595.729864	181.9278634	441.6004397	20.79023515		257.8402093	176.4307625					2681.538177	6629.803988	6384.549174			993.5367789	4465.145228	72.89695473						10.28571429				251.819575	268.049111	567.3231396								6700	(1a.) $100/day for the first 10 days of each IP stay;(1b.)$100/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-100	(6.) $0 copay	(10a.)$0 /Trip	(11a.)0% Coinsurance;(11b.)0% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$65 copay per visit; (4b.) $65 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$0;(12.)$0;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $0-$15; (13d.) $0;(14d.) $15; (14e.) $0-$15;for Selected PCP visit	(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (13d.) $0; (14d.) $35; (14e.) $0-$35; (17a.)$0-$35; (18a.) $0-$35;			(7d.)$35 /visit	(4b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(14a.)$0;(13d.) $0;(14d.) $35; (14e.) $0-$35; (17a.)$0-$35;	(15.) 10% Coinsurance						(18a.)$0-35 /visit; (18b.) Hearing Aids $750/1 yr for first ear and $500/1 yr for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;	(7b.)$20 Copay										92.70690202		0	0	0	0		65	200					198	15	35			35	35	0.1						35				100	35	20								YES	83.44874802		0	0	0	0		58.50878956	180.0270448					178.2267744	13.29818601	31.50473284			31.50473284	31.50473284	0.090013522						31.50473284				90.0135224	31.50473284	18.00270448								6200	13.7254	0	0	0	0	0	0	1.257159879	2.646859066	0	0	0	0	39.82682496	7.347030555	16.76195967	0	0	2.608425899	11.72276729	6.561711668	0	0	0	0	0	0.027004057	0	0	0	1.888930579	0.703734636	0.851112569	0	0	0	0	0	0	0	105.9289			11.74920034	13.7254	0	0	0	0	0	0	1.257159879	2.646859066	0	0	0	0	39.82682496	7.347030555	16.76195967	0	0	2.608425899	11.72276729	6.561711668	0	0	0	0	0	0.027004057	0	0	0	1.888930579	0.703734636	0.851112569	0	0	0	0	0	0	0	105.9289	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						$900 deductible;35% coins				$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins									0.1983		0	0	0	0		0.0182	0.0382					0.5753	0.1061	0.2421			0.0377	0.1693	0.0948						0.0004				0.0273	0.0102	0.0123								1.5302	900	NO	1.238689089	13.9236	0	0	0	0	0	0	1.275320052	2.685093995	0	0	0	0	40.40213925	7.453161326	17.00409283	0	0	2.646105646	11.89210732	6.656498196	0	0	0	0	0	0.027394141	0	0	0	1.916216931	0.713900362	0.863407228	0	0	0	0	0	0	0	107.4591
H3156_027_0	2012	6																															D	D	D	0	T	coin	coin	V	V	v	V		V	V	V	V	V	V	V	V	coin	0		v	v		v														11.92043081	0	1.224884207	0	2.144579614	0	0	0	16.3951461	0	3.210018764		0	0	0	0	0	0	11.19716165	0	0	0		0	0		0														46.0922	YES	0	0	0	0	0	1.721437649	18.10146557	342.0621695	0	0	0		0	710.6926947	2537.887476	4902.103497	143.2771974	207.3322079	0	26.93544565	92.27285916	0		102.6308468	191.4158018		0.0001														6700	$0; PBP 1a	$0; PBP 1b	$0; PBP 2	$0; PBP 6	$0; PBP 10a	20% Coinsurance; PBP 11a	20% Coinsurance; PBP 11b	$50 copay; PBP 4a	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b		$0 copay; PBP 12	"$15-40 copay; PBP 3, 5, 9c"	"$15 Copay per visit; PBP 7a, 4b"	"$15-40 copay; PBP 7b, 7d, 7f"	"$25 copay; PBP 7e, 7h"	"$15 copay; PBP 7c, 7i"	$0; PBP 7d	"$40 copay per visit (PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance; PBP 15	$0; PBP 13		$10 copay per visit	$40 copay per visit		$40 copay per visit																0	0	0	0	0	0.2	0.2	50	0	0	0	0	0	15	15	40	25	15	0	40	0.2	0	0	10	40	0	40	0	0	0											NO	0	0	0	0	0	0.15788	0.15788	39.47	0	0	0	0	0	11.841	11.841	31.576	19.735	11.841	0	31.576	0.15788	0	0	10	40	0	40	0	0	0												0	0	0	0	0	0.271780576	2.857859384	1.125099486	0	0	0	0	0	0.701276016	2.504260467	12.89906834	0.235631291	0.204585056	0	0.070876136	14.568039	0	0	0.085525706	0.638052673	0	3.33E-07	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1621	1500	NO	9.45618321	11.9204	0	1.224884207	0	2.144579614	0.271780576	2.857859384	1.125099486	16.3951461	0	3.210018764	0	0	0.701276016	2.504260467	12.89906834	0.235631291	0.204585056	11.19716165	0.070876136	14.568039	0	0	0.085525706	0.638052673	0	3.33E-07	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2543	NO																																																																																		0				11.9204	0	1.224884207	0	2.144579614	0.271780576	2.857859384	1.125099486	16.3951461	0	3.210018764	0	0	0.701276016	2.504260467	12.89906834	0.235631291	0.204585056	11.19716165	0.070876136	14.568039	0	0	0.085525706	0.638052673	0	3.33E-07	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2543
H3156_028_0	2012	7																															D	D	D	v	T	coin	coin	V	V	v	V		V	V	V	V	V	V	V	V	coin			v	v		v														15.30449931	0	0.453312957	0	2.284012233	0	0	0	13.64946177	0	3.980186899		0	0	0	0	0	0	10.38259147	0.353361976	0.146658474			0	0		0														46.5541	YES	0	0	0	0	0	1.114710599	21.18618206	330.7407965	0	0	0		0	542.4304466	2875.920692	4584.01864	203.5399155	434.5903316	0	20.76215846	122.0328527			102.6308468	191.4158018		0														6700	$0; PBP 1a	$0; PBP 1b	$0; PBP 2	$0; PBP 6	$0; PBP 10a	20% Coinsurance; PBP 11a	20% Coinsurance; PBP 11b	$50 copay; PBP 4a	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b		$0 copay; PBP 12	"$15-40 copay; PBP 3, 5, 9c"	"$15 Copay per visit; PBP 7a, 4b"	"$15-40 copay; PBP 7b, 7d, 7f"	"$25 copay; PBP 7e, 7h"	"$15 copay; PBP 7c, 7i"	$0; PBP 7d	"$40 copay per visit (PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance; PBP 15	$0; PBP 13		$10 copay per visit	$40 copay per visit		$40 copay per visit																0	0	0	0	0	0.2	0.2	50	0	0	0	0	0	15	15	39.91691592	25	15	0	40	0.2	0	0	10	40	0	40	0	0	0											NO	0	0	0	0	0	0.16278	0.16278	40.695	0	0	0	0	0	12.2085	12.2085	32.48837787	20.3475	12.2085	0	32.556	0.16278	0	0	10	40	0	40	0	0	0												0	0	0	0	0	0.181452591	3.448686717	1.121624726	0	0	0	0	0	0.551855176	2.925889814	12.41061081	0.345127369	0.442141339	0	0.056327736	19.86450777	0	0	0.085525706	0.638052673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0718	1500	NO	9.45618321	15.3045	0	0.453312957	0	2.284012233	0.181452591	3.448686717	1.121624726	13.64946177	0	3.980186899	0	0	0.551855176	2.925889814	12.41061081	0.345127369	0.442141339	10.38259147	0.409689712	20.01116624	0	0	0.085525706	0.638052673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6259	NO																																																																																		0				15.3045	0	0.453312957	0	2.284012233	0.181452591	3.448686717	1.121624726	13.64946177	0	3.980186899	0	0	0.551855176	2.925889814	12.41061081	0.345127369	0.442141339	10.38259147	0.409689712	20.01116624	0	0	0.085525706	0.638052673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6259
H3156_801_0	2012	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	424.2247771	5.526597288	47.12428763	19.17472858	13.8147465	1.188260946	20.04577153	26.65793592	74.39850012	8.763847241	6.51818237	0	0.631491499	68.40032519	34.54053712	53.11413268	4.651815799	4.276850129	39.45827663	90.70701411	93.51060926	0.28146525																			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	NO	0.070965929	0.070965929	0.140956957	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.053280233	0.053280233	0.105828524	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																				22.6028	0.294458391	4.987093814	0	2.323310013	0.199837076	3.371219422	4.483227357	12.51204865	1.473869538	1.096202407	0	0.106201769	11.50329906	5.808892384	8.932527012	0.78232418	0.719263921	6.635938573	15.25475072	15.72624838	0.047335724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8608	0	NO	39.4543449	22.6028	0.294458391	4.987093814	0	2.323310013	0.199837076	3.371219422	4.483227357	12.51204865	1.473869538	1.096202407	0	0.106201769	11.50329906	5.808892384	8.932527012	0.78232418	0.719263921	6.635938573	15.25475072	15.72624838	0.047335724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8608	NO																																																																																		0				22.6028	0.294458391	4.987093814	0	2.323310013	0.199837076	3.371219422	4.483227357	12.51204865	1.473869538	1.096202407	0	0.106201769	11.50329906	5.808892384	8.932527012	0.78232418	0.719263921	6.635938573	15.25475072	15.72624838	0.047335724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8608
H3156_803_0	2012	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	333.3025278	6.42922959	41.62814119	12.77618789	9.779447236	0.547273779	17.70428548	17.74452877	54.5227084	9.321902471	4.707070385	0	0	56.65719839	18.67197724	32.70297681	7.426194177	4.770179809	29.71827482	48.64119332	79.25806297	0.610342305																			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	NO	0.071023783	0.071023783	0.139676355	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.05332367	0.05332367	0.104867067	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																				17.7729	0.342830115	4.365421054	0	1.644669172	0.092038363	2.97743746	2.984205419	9.169415764	1.567721083	0.79161668	0	0	9.528385939	3.140180074	5.499858681	1.24890828	0.802230176	4.997903179	8.180285572	13.32931091	0.102644981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.538	0	NO	29.38905508	17.7729	0.342830115	4.365421054	0	1.644669172	0.092038363	2.97743746	2.984205419	9.169415764	1.567721083	0.79161668	0	0	9.528385939	3.140180074	5.499858681	1.24890828	0.802230176	4.997903179	8.180285572	13.32931091	0.102644981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.538	NO																																																																																		0				17.7729	0.342830115	4.365421054	0	1.644669172	0.092038363	2.97743746	2.984205419	9.169415764	1.567721083	0.79161668	0	0	9.528385939	3.140180074	5.499858681	1.24890828	0.802230176	4.997903179	8.180285572	13.32931091	0.102644981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.538
H3164_003_0	2012	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	231.7096459	51.22561868	16.76022337	649.5659028	13.98138073	4.26915661	4.09934068	14.89988924	49.65327739	12.33273285	38.28902653	0	0	58.86438132	28.95702922	91.88068719	35.71283313	1.199042686	0	0.667883697	12.88023709	7.049818139	701.7391304	157.5059231	43.64651163	110.432	0	0	160.3920985	5058.5764											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1, 13e1)"											0	NO	0.062850013	0.062850013	0.138668011	0	0.224	0.224	0.178719258	0.146557989	0.224	0.224	0.224	0	0	0.224	0.218759764	0.223978618	0.224	0.224	0	0.224	0.224	0.044333804	0	0	0	0	0	0	0	0											NO	0.052498393	0.052498393	0.115828899	0	0.187106408	0.187106408	0.149283564	0.122435705	0.187106408	0.187106408	0.187106408	0	0	0.187106408	0.182729257	0.187088547	0.187106408	0.187106408	0	0.187106408	0.187106408	0.042148242	0	0	0	0	0	0	0	0												12.1644	2.68926268	1.94131822	0	2.616005921	0.798786556	0.611964187	1.824278445	9.290446354	2.307533338	7.164122202	0	0	11.01390292	5.29129644	17.18982429	6.682099909	0.224348569	0	0.124965319	2.409974889	0.297137444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6417	150	YES	16.64614569	12.1644	2.68926268	1.94131822	0	2.616005921	0.798786556	0.611964187	1.824278445	9.290446354	2.307533338	7.164122202	0	0	11.01390292	5.29129644	17.18982429	6.682099909	0.224348569	0	0.124965319	2.409974889	0.297137444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6417	NO																																										0	0	0	0	0	0	0	0	0	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	12.1644	2.68926268	1.94131822	0	2.616005921	0.798786556	0.611964187	1.824278445	9.290446354	2.307533338	7.164122202	0	0	11.01390292	5.29129644	17.18982429	6.682099909	0.224348569	0	0.124965319	2.409974889	0.297137444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6417
H3204_001_0	2012	12																															A	A	D		T	Coin	Coin	V	V		V			P	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	166.8948845	0.010257	96.03791179	0	183.4884302	11.98402212	1.6249324	315.7493439	293.4435803	0	84.12233049	0	0	6.919267161	3491.359012	3674.96226	357.238315	838.0961237	0	0	23.71841737	0	0	0	0	0	0.060996168	0	0	417											3000	$600/Admit for IP Med/Surg; PBP 1a	$600/Admit for IP MH/SA; PBP 1b	$40/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$55/Visit for OP ER; PBP 4a, 4b"	"$375/Case for OP Surg; $375/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$25/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$5/Visit for  IN Urgent Care; $5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $25/Exam for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	15% Coinsurance for Part B Drugs - Gen; 15% Coinsurance for Part B Drugs - Chemo; 15% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$25/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$15/Visit for Acupuncture; PBP 13a-e											0	NO	600	600	40	0	100	0.2	0.2	55	375	0	100	0	0	25	5	24.72418076	25	25	0	0	0.15	0	0	0	0	0	25	0	0	15											NO	577.106763	577.106763	38.4737842	0	96.18446049	0.192368921	0.192368921	52.90145327	360.6917269	0	96.18446049	0	0	24.04611512	4.809223025	23.78081988	24.04611512	24.04611512	0	0	0.144276691	0	0	0	0	0	24.04611512	0	0	14.79846017												8.0263	0.000493282	0.307911824	0	1.470727972	2.305353404	0.312586492	1.391966597	8.820222642	0	0.674271748	0	0	0.013865125	1.399227012	7.282801297	0.715849471	1.67941299	0	0	3.422014768	0	0	0	0	0	0.000122227	0	0	0.514246491	0	0	0	0	0	0	0	0	0	0	38.3374	0	NO	1.5	8.0263	0.000493282	0.307911824	0	1.470727972	2.305353404	0.312586492	1.391966597	8.820222642	0	0.674271748	0	0	0.013865125	1.399227012	7.282801297	0.715849471	1.67941299	0	0	3.422014768	0	0	0	0	0	0.000122227	0	0	0.514246491	0	0	0	0	0	0	0	0	0	0	38.3374	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.0263	0.000493282	0.307911824	0	1.470727972	2.305353404	0.312586492	1.391966597	8.820222642	0	0.674271748	0	0	0.013865125	1.399227012	7.282801297	0.715849471	1.67941299	0	0	3.422014768	0	0	0	0	0	0.000122227	0	0	0.514246491	0	0	0	0	0	0	0	0	0	0	38.3374
H3204_007_0	2012	12																															A	A	D		T	Coin	Coin	V	V		V			P	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	241.1504846	0.010455	150.0785714	0	231.37342	23.11597762	2.778408377	381.908651	388.0913929	0	113.0278516	0	0	0.656612244	4555.68903	5480.383173	439.6366701	1153.61954	0	0	36.20612413	0	0	0	0	0	0.136425382	0	0	417											2500	$400/Admit for IP Med/Surg; PBP 1a	$400/Admit for IP MH/SA; PBP 1b	$35/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$55/Visit for OP ER; PBP 4a, 4b"	"$250/Case for OP Surg; $250/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$20/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Visit for CORF; $20/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$5/Visit for  IN Urgent Care; $5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $20/Visit for Podiatry; $20/Visit for Diabetic Footcare; $20/Exam for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	5% Coinsurance for Part B Drugs - Gen; 5% Coinsurance for Part B Drugs - Chemo; 5% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$20/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$15/Visit for Acupuncture; PBP 13a-e											0	NO	400	400	35	0	100	0.1	0.1	55	250	0	100	0	0	20	5	20	20	20	0	0	0.05	0	0	0	0	0	20	0	0	15											NO	378.3072177	378.3072177	33.10188154	0	94.57680441	0.094576804	0.094576804	52.01724243	236.442011	0	94.57680441	0	0	18.91536088	4.728840221	18.91536088	18.91536088	18.91536088	0	0	0.047288402	0	0	0	0	0	18.91536088	0	0	14.83200735												7.6024	0.0003296	0.413990258	0	1.823546557	2.186235294	0.262772986	1.65548624	7.646759116	0	0.890817751	0	0	0.001035005	1.79526046	8.638618791	0.692990523	1.818427493	0	0	1.71212976	0	0	0	0	0	0.000215045	0	0	0.515412255	0	0	0	0	0	0	0	0	0	0	37.6564	0	NO	2.13	7.6024	0.0003296	0.413990258	0	1.823546557	2.186235294	0.262772986	1.65548624	7.646759116	0	0.890817751	0	0	0.001035005	1.79526046	8.638618791	0.692990523	1.818427493	0	0	1.71212976	0	0	0	0	0	0.000215045	0	0	0.515412255	0	0	0	0	0	0	0	0	0	0	37.6564	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.6024	0.0003296	0.413990258	0	1.823546557	2.186235294	0.262772986	1.65548624	7.646759116	0	0.890817751	0	0	0.001035005	1.79526046	8.638618791	0.692990523	1.818427493	0	0	1.71212976	0	0	0	0	0	0.000215045	0	0	0.515412255	0	0	0	0	0	0	0	0	0	0	37.6564
H3204_008_0	2012	8																															A	A	D		T	Coin	Coin	V	V		V			P	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	151.739059	0.010308	111.5182079	0	144.2502129	13.3316099	3.045503881	338.1353785	358.1537109	0	96.24870984	0	0	1.8674321	3664.914803	4601.500796	383.6882355	1196.358357	0	0	18.93289373	0	0	0	0	0	0.581068271	0	0	417											2500	$400/Admit for IP Med/Surg; PBP 1a	$400/Admit for IP MH/SA; PBP 1b	$35/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; PBP 4a, 4b"	"$250/Case for OP Surg; $250/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$20/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Visit for CORF; $20/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$5/Visit for  IN Urgent Care; $5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $20/Visit for Podiatry; $20/Visit for Diabetic Footcare; $20/Exam for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	5% Coinsurance for Part B Drugs - Gen; 5% Coinsurance for Part B Drugs - Chemo; 5% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$20/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$15/Visit for Acupuncture; PBP 13a-e											0	NO	400	400	35	0	100	0.1	0.1	50	250	0	100	0	0	20	5	20	20	20	0	0	0.05	0	0	0	0	0	20	0	0	15											NO	385.1154631	385.1154631	33.69760302	0	96.27886578	0.096278866	0.096278866	48.13943289	240.6971644	0	96.27886578	0	0	19.25577316	4.813943289	19.25577316	19.25577316	19.25577316	0	0	0.048139433	0	0	0	0	0	19.25577316	0	0	14.88663823												4.8698	0.000330814	0.313158025	0	1.157353907	1.28355228	0.293217659	1.356470447	7.183881888	0	0.772226385	0	0	0.002996571	1.470224335	7.383787958	0.615684469	1.919733762	0	0	0.911418767	0	0	0	0	0	0.00093241	0	0	0.517310678	0	0	0	0	0	0	0	0	0	0	30.052	0	NO	1.15	4.8698	0.000330814	0.313158025	0	1.157353907	1.28355228	0.293217659	1.356470447	7.183881888	0	0.772226385	0	0	0.002996571	1.470224335	7.383787958	0.615684469	1.919733762	0	0	0.911418767	0	0	0	0	0	0.00093241	0	0	0.517310678	0	0	0	0	0	0	0	0	0	0	30.052	NO																																										0	0	0	0	0	0	0	0	0	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	4.8698	0.000330814	0.313158025	0	1.157353907	1.28355228	0.293217659	1.356470447	7.183881888	0	0.772226385	0	0	0.002996571	1.470224335	7.383787958	0.615684469	1.919733762	0	0	0.911418767	0	0	0	0	0	0.00093241	0	0	0.517310678	0	0	0	0	0	0	0	0	0	0	30.052
H3204_801_0	2012	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	173.8298953	0.001	12.42713965	0	6.61918781	14.27535595	12.62228904	31.92485403	82.10416786	4.372818386	52.05696717	0	0.002291926	9.125200891	29.57563367	55.50313714	3.054792156	11.64220484	23.24584716	68.17795151	64.55751905	1.122511072	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080915111	0.080915111	0.162728759	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073972445	0.073972445	0.14876633	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0	0	0	0	0	0	0												12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	0	NO	10.41324978	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	NO																																										0	0	0	0	0	0	0	0	0	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	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507
H3204_802_0	2012	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	173.8298953	0.001	12.42713965	0	6.61918781	14.27535595	12.62228904	31.92485403	82.10416786	4.372818386	52.05696717	0	0.002291926	9.125200891	29.57563367	55.50313714	3.054792156	11.64220484	23.24584716	68.17795151	64.55751905	1.122511072	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080915111	0.080915111	0.162728759	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073972445	0.073972445	0.14876633	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0	0	0	0	0	0	0												12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	0	NO	10.41324978	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	NO																																										0	0	0	0	0	0	0	0	0	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	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507
H3204_803_0	2012	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	173.8298953	0.001	12.42713965	0	6.61918781	14.27535595	12.62228904	31.92485403	82.10416786	4.372818386	52.05696717	0	0.002291926	9.125200891	29.57563367	55.50313714	3.054792156	11.64220484	23.24584716	68.17795151	64.55751905	1.122511072	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080915111	0.080915111	0.162728759	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073972445	0.073972445	0.14876633	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0.204780386	0	0	0	0	0	0	0	0												12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	0	NO	10.41324978	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507	NO																																										0	0	0	0	0	0	0	0	0	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	12.8586	7.40E-05	1.848739958	0	1.355479832	2.923312896	2.584797218	6.537583918	16.81332315	0.895467435	10.66024581	0	0.000469341	1.868662157	6.056509666	11.36595382	0.625561516	2.384095196	4.760293545	13.9615072	13.22011364	0.22986825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9507
H3206_001_0	2012	12																															A	A	D		T	Coin	Coin	V	V		V			P	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	147.0112114	0.0010273	29.49823504	0	57.29608423	14.54566127	2.664027032	290.6404722	287.3291587	0	112.3353623	0	0	59.85515926	3937.844472	4302.900436	354.2627986	1071.595138	0	0	22.8387412	0	0	0	71.80983099	0	0.86569522	0	0	0											3400	$650/Admit for IP Med/Surg; PBP 1a	$650/Admit for IP MH/SA; PBP 1b	$40/Days Custom: H3204-001 SNF 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"	"$55/Visit for OP ER; PBP 4a, 4b"	"$375/Case for OP Surg; $375/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$40/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Visit for CORF; $40/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for  IN Urgent Care; $10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$40/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	650	650	40	0	150	0.2	0.2	55	375	0	100	0	0	36.06780754	10	38.57603436	40	20	0	0	0.1	0	0	0	40	0	40	0	0	0											NO	618.5115874	618.5115874	38.06225153	0	142.7334433	0.190311258	0.190311258	52.33559586	356.8336081	0	95.15562884	0	0	34.32054907	9.515562884	36.70726807	38.06225153	19.03112577	0	0	0.095155629	0	0	0	38.06225153	0	38.06225153	0	0	0												7.5773	5.29E-05	0.093564103	0	0.681505616	2.768203089	0.506994335	1.267570191	8.544058367	0	0.890778503	0	0	0.171188494	3.122567225	13.16230998	1.123669979	1.69947182	0	0	2.173234781	0	0	0	0.227770321	0	0.002745859	0	0	0	0	0	0	0	0	0	0	0	0	0	44.013	0	NO	2.23	7.5773	5.29E-05	0.093564103	0	0.681505616	2.768203089	0.506994335	1.267570191	8.544058367	0	0.890778503	0	0	0.171188494	3.122567225	13.16230998	1.123669979	1.69947182	0	0	2.173234781	0	0	0	0.227770321	0	0.002745859	0	0	0	0	0	0	0	0	0	0	0	0	0	44.013	YES	$1000/Admit for IP Med/Surg; PBP 1a	$1000/Admit for IP MH/SA; PBP 1b	$60/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 25% Coinsurance for DMS; PBP 11b, 11c"	"$55/Visit for OP ER; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	15% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	50% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$35/Visit for Cardiac Rehab; $35/Visit for Pulmonary Rehabilitation Services; $35/Visit for CORF; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$35/Visit for Urgent Care; $35/Visit for PCP OV; $35/Visit for Immunizations; $35/Visit for Physical Exams (Initial); $35/Visit for Immunizations (non-cvd); $35/Visit for Routine Exams; PBP 7a, 14a, 14b"	"$55/Visit for Chiro (cvd); $55/Visit for SCP OV; $55/Visit for SCP - Office Surg; $55/Visit for Podiatry; $55/Visit for Diabetic Footcare; $35/Visit for Pap Smears and Pelvic Exams Screening; $35/Visit for Prostate Cancer Screening; $35/Visit for Colorectal Screening; $35/Visit for Pap Smears and Pelvic Exams Screening (non-cvd); $35/Visit for Prostate Cancer Screening (non-cvd); $35/Visit for Colorectal Screening (non-cvd); $55/Visit for Vision Exams; $55/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; 10% Coinsurance for Phys Rad - Complex Diagnostic; 10% Coinsurance for Phys Rad - X-Ray; 10% Coinsurance for Phys Rad - Theraputic; $35/Visit for Bone Mass Measurement; $35/Visit for Mammography Screening; $35/Visit for Mammography Screening (non-cvd); PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - IP/OP Surg; 20% Coinsurance for SCP - Other; $35/Visit for Nutrition Training for Diabetes & Renal Dialysis; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$55/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$55/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											7500	1.7942	0	0.0046	0	0.4591	0.6776	0	0.1404	0	0	0	0	0	0	0.841	1.0595	0.2051	0.1162	0	0	0.2448	0	0	0	0.0048	0	0.0019	0	0	0											5.5493	0	NO	0.17	9.3715	5.29E-05	0.098184762	0	1.140610772	3.445757181	0.506994335	1.407998983	8.544058367	0	0.890778503	0	0	0.171188494	3.963585726	14.22180352	1.328802357	1.815700449	0	0	2.418013918	0	0	0	0.232547851	0	0.004681507	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5623
H3206_002_0	2012	12																															A	A	D		T	Coin	Coin	V	V		V			P	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	167.1060028	0.000746136	39.26300877	0	114.2028768	24.31383222	4.14889457	350.3186044	326.8214731	0	129.112311	0	0	28.49430507	4675.212283	5219.401791	648.8046903	1106.009156	0	0	34.89140981	0	0	0	79.89207953	0	0.248223684	0	0	0											3000	$500/Admit for IP Med/Surg; PBP 1a	$500/Admit for IP MH/SA; PBP 1b	$40/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$55/Visit for OP ER; PBP 4a, 4b"	"$350/Case for OP Surg; $350/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$30/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Visit for CORF; $30/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for  IN Urgent Care; $10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	500	500	40	0	150	0.1	0.1	55	350	0	100	0	0	28.58615086	10	29.36624709	30	20	0	0	0.1	0	0	0	30	0	30	0	0	0											NO	470.7349108	470.7349108	37.65879286	0	141.2204732	0.094146982	0.094146982	51.78084019	329.5144375	0	94.14698216	0	0	26.91299835	9.414698216	27.6474354	28.24409465	18.82939643	0	0	0.094146982	0	0	0	28.24409465	0	28.24409465	0	0	0												6.5552	2.93E-05	0.12321646	0	1.343982026	2.289073928	0.390605903	1.511649306	8.974366156	0	1.012961204	0	0	0.063905599	3.667976062	12.02525616	1.52707509	1.73545707	0	0	3.284920937	0	0	0	0.188039955	0	0.000584238	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6943	0	NO	2.77	6.5552	2.93E-05	0.12321646	0	1.343982026	2.289073928	0.390605903	1.511649306	8.974366156	0	1.012961204	0	0	0.063905599	3.667976062	12.02525616	1.52707509	1.73545707	0	0	3.284920937	0	0	0	0.188039955	0	0.000584238	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6943	YES	$1000/Admit for IP Med/Surg; PBP 1a	$1000/Admit for IP MH/SA; PBP 1b	$60/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 25% Coinsurance for DMS; PBP 11b, 11c"	"$55/Visit for OP ER; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	15% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	50% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$35/Visit for Cardiac Rehab; $35/Visit for Pulmonary Rehabilitation Services; $35/Visit for CORF; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$35/Visit for Urgent Care; $35/Visit for PCP OV; $35/Visit for Immunizations; $35/Visit for Physical Exams (Initial); $35/Visit for Immunizations (non-cvd); $35/Visit for Routine Exams; PBP 7a, 14a, 14b"	"$55/Visit for Chiro (cvd); $55/Visit for SCP OV; $55/Visit for SCP - Office Surg; $55/Visit for Podiatry; $55/Visit for Diabetic Footcare; $35/Visit for Pap Smears and Pelvic Exams Screening; $35/Visit for Prostate Cancer Screening; $35/Visit for Colorectal Screening; $35/Visit for Pap Smears and Pelvic Exams Screening (non-cvd); $35/Visit for Prostate Cancer Screening (non-cvd); $35/Visit for Colorectal Screening (non-cvd); $55/Visit for Vision Exams; $55/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; 10% Coinsurance for Phys Rad - Complex Diagnostic; 10% Coinsurance for Phys Rad - X-Ray; 10% Coinsurance for Phys Rad - Theraputic; $35/Visit for Bone Mass Measurement; $35/Visit for Mammography Screening; $35/Visit for Mammography Screening (non-cvd); PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - IP/OP Surg; 20% Coinsurance for SCP - Other; $35/Visit for Nutrition Training for Diabetes & Renal Dialysis; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$55/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$55/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											7500	1.4615	0	0.0016	0	0.8128	0.7281	0	0.2171	0	0	0	0	0	0	0.957	1.0206	0.4193	0.1736	0.0612	0.0018	0.1513	0	0	0	0.003	0	0.0005	0	0	0											6.0093	0	NO	0.31	8.0167	2.93E-05	0.124773473	0	2.156746474	3.0171637	0.390605903	1.72873234	8.974366156	0	1.012961204	0	0	0.063905599	4.624951619	13.04588835	1.946419379	1.909020952	0.061199317	0.00183406	3.436179589	0	0	0	0.191012859	0	0.001122206	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7036
H3206_003_0	2012	9																															A	A	D		T	Coin	Coin	V	V		V			P	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	131.660794	0.00043893	65.00242998	0	53.03822618	9.444863514	1.486294561	260.680687	220.5640114	0	100.5140848	0	0	29.99101145	2983.900326	3309.318155	279.1739049	966.2139065	0	0	15.12956621	0	0	0	57.1853375	0	0.495713367	0	0	0											3000	$500/Admit for IP Med/Surg; PBP 1a	$500/Admit for IP MH/SA; PBP 1b	$40/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; PBP 4a, 4b"	"$350/Case for OP Surg; $350/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - Complex Diagnostic; PBP 8b	$30/Day for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Visit for CORF; $30/Service for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for  IN Urgent Care; $10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	10% Coinsurance for Part B Drugs - Gen; 10% Coinsurance for Part B Drugs - Chemo; 10% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	500	500	40	0	150	0.1	0.1	50	350	0	100	0	0	28.13794025	10	29.41282616	30	20	0	0	0.1	0	0	0	30	0	30	0	0	0											NO	485.057173	485.057173	38.80457384	0	145.5171519	0.097011435	0.097011435	48.5057173	339.5400211	0	97.01143459	0	0	27.2970195	9.701143459	28.53380461	29.10343038	19.40228692	0	0	0.097011435	0	0	0	29.10343038	0	29.10343038	0	0	0												5.3219	1.77E-05	0.210199299	0	0.643164301	0.916259759	0.144187568	1.053708642	6.240859089	0	0.812584631	0	0	0.068222102	2.412270428	7.868953135	0.677076525	1.562229953	0	0	1.467740923	0	0	0	0.138690791	0	0.001202247	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5393	0	NO	0.91	5.3219	1.77E-05	0.210199299	0	0.643164301	0.916259759	0.144187568	1.053708642	6.240859089	0	0.812584631	0	0	0.068222102	2.412270428	7.868953135	0.677076525	1.562229953	0	0	1.467740923	0	0	0	0.138690791	0	0.001202247	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5393	YES	$1000/Admit for IP Med/Surg; PBP 1a	$1000/Admit for IP MH/SA; PBP 1b	$60/Days Custom: H3204-001 SNF for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 25% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	15% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	50% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$35/Visit for Cardiac Rehab; $35/Visit for Pulmonary Rehabilitation Services; $35/Visit for CORF; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$35/Visit for Urgent Care; $35/Visit for PCP OV; $35/Visit for Immunizations; $35/Visit for Physical Exams (Initial); $35/Visit for Immunizations (non-cvd); $35/Visit for Routine Exams; PBP 7a, 14a, 14b"	"$55/Visit for Chiro (cvd); $55/Visit for SCP OV; $55/Visit for SCP - Office Surg; $55/Visit for Podiatry; $55/Visit for Diabetic Footcare; $35/Visit for Pap Smears and Pelvic Exams Screening; $35/Visit for Prostate Cancer Screening; $35/Visit for Colorectal Screening; $35/Visit for Pap Smears and Pelvic Exams Screening (non-cvd); $35/Visit for Prostate Cancer Screening (non-cvd); $35/Visit for Colorectal Screening (non-cvd); $55/Visit for Vision Exams; $55/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; 10% Coinsurance for Phys Rad - Complex Diagnostic; 10% Coinsurance for Phys Rad - X-Ray; 10% Coinsurance for Phys Rad - Theraputic; $35/Visit for Bone Mass Measurement; $35/Visit for Mammography Screening; $35/Visit for Mammography Screening (non-cvd); PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - IP/OP Surg; 20% Coinsurance for SCP - Other; $35/Visit for Nutrition Training for Diabetes & Renal Dialysis; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$55/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$55/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											7500	1.3977	0	0.0106	0	0.5369	0.4882	0	0.0807	0.0243	0	0.0018	0	0	0	0.6294	0.7722	0.2901	0.1342	0.0158	0.1897	0.1448	0	0	0	0.0052	0	0.0011	0	0	0											4.7227	0	NO	0.1	6.7196	1.77E-05	0.220757038	0	1.180054112	1.404440249	0.144187568	1.134371891	6.265164043	0	0.814414983	0	0	0.068222102	3.041652172	8.641174176	0.967182542	1.696414583	0.015790396	0.189745651	1.612556525	0	0	0	0.143935599	0	0.002308855	0	0	0	0	0	0	0	0	0	0	0	0	0	34.262
H3206_801_0	2012	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	193.2666723	0	29.84937379	0	7.603515971	20.87159608	9.39713349	15.8152829	48.61401626	6.267991537	18.21603778	0	0.015638892	6.685002727	32.83049246	67.1484952	2.909147448	12.53180799	27.13655633	71.95871132	68.57604643	0.774084782	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080827458	0	0.163266074	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073961494	0	0.149397284	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0	0	0	0	0	0	0												14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	0	NO	9.682256725	14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14c"	PBP 13a-e											10000	0.6497	0	0.2631	0	0.4601	0.3777	0.1654	0.1214	0.3187	0.0322	0.1966	0	0.0002	0.0582	0.5127	0.4142	0.0474	0.1717	0.2343	0.5893	0.5161	0.003	0	0	0	0	0	0	0	0											5.1323	0	NO	1.480219534	14.944	0	4.722563647	0	2.018634324	4.65576256	2.091597433	3.363117303	10.28319142	1.316987527	3.930421574	0	0.003375518	1.428484529	7.242017105	14.17780856	0.643717684	2.740413839	5.796565204	15.33879165	14.57231652	0.161715407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4314
H3206_802_0	2012	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	193.2666723	0	29.84937379	0	7.603515971	20.87159608	9.39713349	15.8152829	48.61401626	6.267991537	18.21603778	0	0.015638892	6.685002727	32.83049246	67.1484952	2.909147448	12.53180799	27.13655633	71.95871132	68.57604643	0.774084782	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080827458	0	0.163266074	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073961494	0	0.149397284	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0	0	0	0	0	0	0												14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	0	NO	9.682256725	14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14c"	PBP 13a-e											10000	0.6497	0	0.2631	0	0.4601	0.3777	0.1654	0.1214	0.3187	0.0322	0.1966	0	0.0002	0.0582	0.5127	0.4142	0.0474	0.1717	0.2343	0.5893	0.5161	0.003	0	0	0	0	0	0	0	0											5.1323	0	NO	1.480219534	14.944	0	4.722563647	0	2.018634324	4.65576256	2.091597433	3.363117303	10.28319142	1.316987527	3.930421574	0	0.003375518	1.428484529	7.242017105	14.17780856	0.643717684	2.740413839	5.796565204	15.33879165	14.57231652	0.161715407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4314
H3206_803_0	2012	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	193.2666723	0	29.84937379	0	7.603515971	20.87159608	9.39713349	15.8152829	48.61401626	6.267991537	18.21603778	0	0.015638892	6.685002727	32.83049246	67.1484952	2.909147448	12.53180799	27.13655633	71.95871132	68.57604643	0.774084782	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.080827458	0	0.163266074	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073961494	0	0.149397284	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0.204972109	0	0	0	0	0	0	0	0												14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	0	NO	9.682256725	14.2943	0	4.459415373	0	1.558508705	4.278095069	1.926150271	3.241691891	9.964517444	1.284763445	3.733779683	0	0.003205537	1.370239108	6.729335282	13.76356868	0.596294088	2.568671115	5.562237185	14.74952883	14.05617687	0.15866579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2991	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14c"	PBP 13a-e											10000	0.6497	0	0.2631	0	0.4601	0.3777	0.1654	0.1214	0.3187	0.0322	0.1966	0	0.0002	0.0582	0.5127	0.4142	0.0474	0.1717	0.2343	0.5893	0.5161	0.003	0	0	0	0	0	0	0	0											5.1323	0	NO	1.480219534	14.944	0	4.722563647	0	2.018634324	4.65576256	2.091597433	3.363117303	10.28319142	1.316987527	3.930421574	0	0.003375518	1.428484529	7.242017105	14.17780856	0.643717684	2.740413839	5.796565204	15.33879165	14.57231652	0.161715407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4314
H3209_001_0	2012	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	211.400182	40.1650655	7806.626132	9.871872282	15.07550952	20.77027426	5.6297992	12.65044268	24.94037161	34.68320494	11.76792968	0	0	10.26273552	3.341575876	96.05577014	17.821661	71.26380149	0	11488.4295	26.5234979	6.173838236	2006.839897	156.466641	37.18552906	209.8208	15.59440458	9.570340626	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.079993391	0.08096497	0	0	0.2	0.2	0.186726949	0.124374233	0.16	0	0.073091506	0	0	0.146537725	0.059086879	0.033989464	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.075851601	0.076772875	0	0	0.18964467	0.18964467	0.177058852	0.117934552	0.151715736	0	0.069307072	0	0	0.138950492	0.055553278	0.031956776	0.188039306	0	0	0	0.18964467	0.190152294	0	0	0	0	0	0	0	0												16.035	3.083587559	0	0	2.858990022	3.938971799	0.996805785	1.491924284	3.783846826	0	0.815600753	0	0	1.426012147	0.185635495	3.069632766	3.35117277	0	0	0	5.030039995	1.173969503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2412	0	NO	2.635729813	16.035	3.083587559	0	0	2.858990022	3.938971799	0.996805785	1.491924284	3.783846826	0	0.815600753	0	0	1.426012147	0.185635495	3.069632766	3.35117277	0	0	0	5.030039995	1.173969503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2412	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2986	0.0574	0	0.0011	0.4502	0.6202	0.1681	0.1566	0.5958	0	0.2661	0	0	0.2245	0.0348	1.8842	0.3495	0.006	0	0	0.5245	0.1224	0	0	0.0134	0	0.0014	0	0	0											5.7749	0	NO	0.333829026	16.3336	3.141002815	0	0.001110805	3.309162485	4.559196641	1.164918217	1.648535121	4.379645912	0	1.081698214	0	0	1.650549971	0.220411418	4.953879885	3.700626615	0.006017143	0	0	5.554562882	1.296388783	0	0	0.013437967	0	0.001361283	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0161
H3209_002_0	2012	6																															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	382.2343357	21.9667775	33.90429933	4141.840378	18.87633513	31.37031331	14.63632177	44.20932846	52.2876879	22.69506456	32.48883187	0	0	100.087485	33.75752353	75.38208205	9.866148	5.293222948	0	727.111686	8.269503381	6.267343478	0	915.705	37.97246512	104.9104	0	0	81.19209852	3067.600232											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.079698904	0.080666907	0.164276455	0	0.224	0.224	0.224	0.106846625	0.224	0.224	0.224	0	0	0.224	0.220907706	0.223736307	0.240744535	0.224	0	0	0.224	0.221967283	0	0	0	0	0	0	0	0											NO	0.067908775	0.068733578	0.139974483	0	0.190862922	0.190862922	0.190862922	0.09105245	0.190862922	0.190862922	0.190862922	0	0	0.190862922	0.187436393	0.189836412	0.204267602	0.190060152	0	0	0.190862922	0.190383856	0	0	0	0	0	0	0	0												25.9571	1.509855216	4.745736775	0	3.602792477	5.987429657	2.793531138	4.025367661	9.979780887	4.331646332	6.200913376	0	0	19.10298982	6.327388458	14.310264	2.015334394	1.006030755	0	0	1.578341577	1.19320102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6677	150	YES	20.01571574	25.9571	1.509855216	4.745736775	0	3.602792477	5.987429657	2.793531138	4.025367661	9.979780887	4.331646332	6.200913376	0	0	19.10298982	6.327388458	14.310264	2.015334394	1.006030755	0	0	1.578341577	1.19320102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6677	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	3.5012	0.2037	0.8051	0.9578	0.542	0.9008	0.4028	0.3978	1.237	0	0.7767	0	0	2.1914	1.3186	3.2567	0.4262	0.2287	0	0	0.3588	0.2705	0	0	0.0311	0	0	0	0	0											17.8069	150	YES	3.105538712	29.4583	1.713513409	5.550832294	0.957800519	4.144819882	6.888217305	3.196288236	4.423162551	11.21682565	4.331646332	6.977574618	0	0	21.29442215	7.645982927	17.56700654	2.441564064	1.234704466	0	0	1.937103199	1.46367513	0	0	0.03110796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4746
H3240_010_0	2012	7																																	D		T	Coin	Coin	V					V	V	V	V	V	V	V		Coin																				18.64452562	0.818027209	0	0	0	0	0	0	10.1477081	6.938216853	3.351293325	0	0	4.614067744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											44.5138	YES	0	0	784.0324405	0	295.5975482	5.854752281	2.949485051	360.106498	0	0	0	0	2.194699816	12.32567739	4603.54241	5284.85091	224.7937292	361.2069546	177.5858047	0	17.07456014	0	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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $20/Visit for Speclst Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing;	$30/Visit for Renal Dialysis - Fac; PBP 12	"$20/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"$100/Exam for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits; PBP 7a, 14a-b"	"$100/Exam for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $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"	$25/Visit for Prof Radiology (Office); $50/Visit for Prof Radiology (Office); $50/Visit for Office-Rad Therapeutic; $50/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 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	"No Cost-Sharing; PBP 13a-e, 14c"											0	NO	0	0	91.21903265	0	100	0.2	0.2	64.04546838	0	0	0	0	30	20	6.464717228	20.71162571	20	20	38.49447898	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	83.5031585	0	91.54137692	0.183082754	0.183082754	58.63419462	0	0	0	0	27.46241307	18.30827538	5.917891164	18.96071827	18.30827538	18.30827538	35.2383761	0	0.183082754	0	0	0	0	0	0	0	0	0												0	0	5.455765429	0	2.254950548	1.071904171	0.539999846	1.759546207	0	0	0	0	0.005022646	0.018805158	2.270271912	8.350380765	0.342965458	0.5510897	0.521486281	0	3.126057491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2682	1100	NO	2.426557224	18.6445	0.818027209	5.455765429	0	2.254950548	1.071904171	0.539999846	1.759546207	10.1477081	6.938216853	3.351293325	0	0.005022646	4.632872902	2.270271912	8.350380765	0.342965458	0.5510897	0.521486281	0	3.126057491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7821	NO																																										0	0	0	0	0	0	0	0	0	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	18.6445	0.818027209	5.455765429	0	2.254950548	1.071904171	0.539999846	1.759546207	10.1477081	6.938216853	3.351293325	0	0.005022646	4.632872902	2.270271912	8.350380765	0.342965458	0.5510897	0.521486281	0	3.126057491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7821
H3240_013_0	2012	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	357.9295894	21.77805486	39.69854241	0	21.84641192	10.71869725	6.408835036	30.45396489	31.83368472	12.36766736	10.46711523	0	0.129737209	14.79014677	67.52708558	120.7071038	3.447127712	4.813689618	21.04085562	50.46003175	37.68402738	7.424350155	0	0	0	0	0	0	0	0											6700	6% Coinsurance for IP Medical; 6% Coinsurance for IP Surgical; PBP 1a	6% Coinsurance for IP Psych; 6% Coinsurance for IP Substance Abuse; PBP 1b	14% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; 20% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 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); 20% Coinsurance for Office-Rad Therapeutic; 20% Coinsurance for Office-Rad Diagnostic; 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; 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"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 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	PBP 14a	"No Cost-Sharing; PBP 13a-e, 14c"											0	NO	0.063011171	0.063011171	0.1376636	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.05781975	0.05781975	0.126321648	0	0.183522221	0.183522221	0.183522221	0.183522221	0.183522221	0.183522221	0.187798919	0	0.183522221	0.183522221	0.183522221	0.183553628	0.183522221	0.183522221	0.188560437	0.183522221	0.183522221	0.186285819	0	0	0	0	0	0	0	0												20.6954	1.259201692	5.014785283	0	4.00930203	1.967119123	1.176163638	5.588979266	5.842188514	2.269741778	1.965712921	0	0.023809661	2.714320579	12.3927207	22.15622688	0.632624533	0.883419008	3.967472924	9.260537083	6.915856389	1.383051148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1186	0	NO	9.696341373	20.6954	1.259201692	5.014785283	0	4.00930203	1.967119123	1.176163638	5.588979266	5.842188514	2.269741778	1.965712921	0	0.023809661	2.714320579	12.3927207	22.15622688	0.632624533	0.883419008	3.967472924	9.260537083	6.915856389	1.383051148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1186	NO																																										0	0	0	0	0	0	0	0	0	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	20.6954	1.259201692	5.014785283	0	4.00930203	1.967119123	1.176163638	5.588979266	5.842188514	2.269741778	1.965712921	0	0.023809661	2.714320579	12.3927207	22.15622688	0.632624533	0.883419008	3.967472924	9.260537083	6.915856389	1.383051148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1186
H3251_002_0	2012	7		r.	s									COB/Subrogation	Risk Sharing																		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	1405.01148	76.5555998	1159.159489		219.9462846			347.5751201	276.5608486		187.1169893			77.54136051	3159.522872	4892.784411	440.0402738	696.2632337		174.5085757					122.0504264		0.677348716			197.2750535											2500	"$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) $10/day"	"$10 copay/visit, urgent care $20 copay"	"$25 copay/visit, urgent care $20 copay"	$10 copay/session	$5 copay/visit	(7D) $25/visit	"(7B) $20/visit ,36 visit limits(7D) $25/visit (7F) $30/visit, (7G) $100 daytime study, $100 overnight sleep study, (14E) $0 Copay"	$0 copay	"(9D) $0 copay, 3 pint deductible waived, (14C)  $0 copay"	Not covered	"(16A) Dental Source, (16B) $25 Copay/ Max $150 Copay for Medicare covered benefits"	$30 copay eye exam every year	$150 eyewear benefit every  year	$30 copay rountine hearing tests every year	$300 Maximum Coverage Amount	(14C) No cost sharing	"(13A) $15/treatment, 20 treatment limits, (13B)  and (13C) not covered, (13D) $450 maximum plan benefit coverage amount for safety devices to prevent falls in the bathroom, installation costs is not included"													65.70437928	51.47679325	13.77643115		75			50	150		46.42314315			9.815789598	10.74761215	25.13139099	10	5		20					29.99641253		9.245752319			15											NO	61.07425657	47.68683632	12.78313278		69.41454048			46.34279876	138.3274605		42.787905			9.105949657	9.917958417	23.16483564	9.33230345	4.602623553		18.4027491					29.99641253		9.245752319			15												7.1508	0.30422453	1.234807472	0	1.27228919	0	0	1.34230032	3.187996656	0	0.66719533	0	0	0.058840644	2.611334705	9.445045556	0.34221578	0.26705313	0	0.267619794	0	0	0	0	0.305089578	0	0.000521883	0	0	0.246593817	0	0	0	0	0	0	0	0	0	0	28.704	0		2.291871162	7.1508	0.30422453	1.234807472	0	1.27228919	0	0	1.34230032	3.187996656	0	0.66719533	0	0	0.058840644	2.611334705	9.445045556	0.34221578	0.26705313	0	0.267619794	0	0	0	0	0.305089578	0	0.000521883	0	0	0.246593817	0	0	0	0	0	0	0	0	0	0	28.704	NO																																																																																		0	0		0	7.1508	0.30422453	1.234807472	0	1.27228919	0	0	1.34230032	3.187996656	0	0.66719533	0	0	0.058840644	2.611334705	9.445045556	0.34221578	0.26705313	0	0.267619794	0	0	0	0	0.305089578	0	0.000521883	0	0	0.246593817	0	0	0	0	0	0	0	0	0	0	28.704
H3251_021_0	2012	7		r.	s									COB/Subrogation	Risk Sharing																		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	1992.778134	93.20342324	1802.578877		341.3533509			397.0353952	297.4178897		243.3720414			231.0095174	3715.701227	6649.856938	740.8579816	725.7575486		167.658619					129.9854473		0.219448454			207.5581111											3350	"$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) $10/day"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$10 copay/session	$5 copay/visit	(7D) $30/visit	"(7B) $20/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $100 daytime study, $100 overnight sleep study, (14E) $0 copay"	$0 copay	"(9D) $0 copay, 3 pint deductible waived, (14C)  $0 copay"	Not covered	"(16A) Dental Source, (16B) $30 Copay/ Max $150 Copay for Medicare covered benefits"	$30 copay eye exam every year	$150 eyewear benefit every year	$30 copay rountine hearing tests every year	$300 Maximum Coverage Amount	(14C) No cost sharing	"(13A) $15/treatment, 20 treatment limits, (13B) & (13C) not covered, (13D) $450 maximum plan benefit coverage amount for safety devices to prevent falls in the bathroom, installation costs is not included"													47.31733145	41.93855715	15.09520532		71.51089774			50	150		47.01195219			9.968520462	10.73588472	29.8891184	10	5		20					29.9431882		16.22666791			14.96848739											YES	43.08004043	38.11992852	13.74514286		65.29877543			45.4946054	136.3977177		42.75404861			9.060857437	9.765287984	27.1812983	9.093785976	4.545756545		18.17894134					29.9431882		16.22666791			14.96848739											3400	7.1541	0.296075653	2.064725349	0	1.857496317	0	0	1.505247386	3.380593448	0	0.867095007	0	0	0.174428692	3.023741046	15.06264542	0.56143366	0.274926427	0	0.253988017	0	0	0	0	0.324348226	0	0.000296743	0	0	0.258902581	0	0	0	0	0	0	0	0	0	0	37.06	0		3.612811342	7.1541	0.296075653	2.064725349	0	1.857496317	0	0	1.505247386	3.380593448	0	0.867095007	0	0	0.174428692	3.023741046	15.06264542	0.56143366	0.274926427	0	0.253988017	0	0	0	0	0.324348226	0	0.000296743	0	0	0.258902581	0	0	0	0	0	0	0	0	0	0	37.06	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"												0.8131	0.0185	0.074		0.0259	0.0828	0.0148	0.0244	0.0876	0.0225	0.0735	0.0303		0.0105	0.0899	0.3015	0.0322	0.0257		0.0073																					1.7347	500	NO	0.969103475	7.9672	0.314590439	2.138751641	0	1.883380459	0.082816276	0.014782866	1.529601778	3.46818073	0.02253498	0.940580372	0.030341182	0	0.184965174	3.113643118	15.36418062	0.593679533	0.300661536	0	0.261265803	0	0	0	0	0.324348226	0	0.000296743	0	0	0.258902581	0	0	0	0	0	0	0	0	0	0	38.7947
H3251_023_0	2012	6		r.	s									COB/Subrogation	Risk Sharing																		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					168.1049836			252.1802454	241.1556373		133.202257			46.35990851	2499.08844	3828.023467	286.8631081	495.3453674		196.185792					101.1940819		0.314851914			364.5695096											2800	$0 Copay	$100 Copay/Day for days 1 to 5 /$500 Calendar Year Maximum	"$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) $20/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 benefit every two years	$30 copay rountine hearing tests every year	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			50	50		48.14361179			18.68341954	6.085696324	19.9998355	20	5		20					29.60212185		8.942409814			17.18067058											NO					49.38028976			49.38028976	49.38028976		47.54691001			18.45185341	6.010268958	19.75195344	19.7521159	4.938028976		19.7521159					29.60212185		8.942409814			17.07255987												0	0	0	0	0.691756067	0	0	1.037727799	0.99236127	0	0.527779644	0	0	0.07128552	1.251682806	6.300911775	0.472179447	0.203835815	0	0.322923709	0	0	0	0	0.249629962	0	0.000234628	0	0	0.518677898	0	0	0	0	0	0	0	0	0	0	12.641	0		0.152280679	0	0	0	0	0.691756067	0	0	1.037727799	0.99236127	0	0.527779644	0	0	0.07128552	1.251682806	6.300911775	0.472179447	0.203835815	0	0.322923709	0	0	0	0	0.249629962	0	0.000234628	0	0	0.518677898	0	0	0	0	0	0	0	0	0	0	12.641	NO																																																																																		0	0		0	0	0	0	0	0.691756067	0	0	1.037727799	0.99236127	0	0.527779644	0	0	0.07128552	1.251682806	6.300911775	0.472179447	0.203835815	0	0.322923709	0	0	0	0	0.249629962	0	0.000234628	0	0	0.518677898	0	0	0	0	0	0	0	0	0	0	12.641
H3251_024_0	2012	6		r.	s									COB/Subrogation	Risk Sharing																		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	1688.178296	85.18032694	1605.728167		271.3311338			365.9419563	282.8702041		196.4873019			109.6795745	3724.969393	6034.386603	580.2417207	770.6288285		196.2524386					119.9266282		0.659922095														2800	"$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) $20/day"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$20 copay/session	$10 copay/visit	(7D) $30/visit	"(7B) $20/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $100 daytime study, $100 overnight sleep study, (14E) $0 copay"	$0 copay	"(9D) $0 copay, 3 pint deductible waived, (14C)  $0 copay"	Not covered	"(16A) Not Covered, (16B) $30 Copay/$150 Copay Max"	$30 copay eye exam every year	$150 eyewear benefit every year	$30 copay rountine hearing tests every year	Not covered	(14C) No cost sharing	"(13A) Not Covered, (13B) & (13C) not covered, (13D) $450 cumulative calendar year maximum for safety devices to prevent falls in the bathroom, installation costs is not included"													64.84285834	52.91666667	14.2509286		75			50	150		46.58676757			17.2237412	10.74529187	29.8767201	20	10		20					29.98054355		9.49088516														NO	58.65590458	47.74464859	12.86584221		67.54395461			45.12908107	134.6573741		41.78625201			15.51580712	9.653530654	26.79569641	18.1584434	8.959446872		17.91349379					29.98054355		9.49088516															8.2518	0.338908731	1.721587102	0	1.527231482	0	0	1.376218684	3.174213241	0	0.684205659	0	0	0.141813927	2.996592185	13.47463262	0.87802387	0.575367337	0	0.292963903	0	0	0	0	0.299622125	0	0.000521937	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7337	0		3.943679271	8.2518	0.338908731	1.721587102	0	1.527231482	0	0	1.376218684	3.174213241	0	0.684205659	0	0	0.141813927	2.996592185	13.47463262	0.87802387	0.575367337	0	0.292963903	0	0	0	0	0.299622125	0	0.000521937	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7337	NO																																																																																		0	0		0	8.2518	0.338908731	1.721587102	0	1.527231482	0	0	1.376218684	3.174213241	0	0.684205659	0	0	0.141813927	2.996592185	13.47463262	0.87802387	0.575367337	0	0.292963903	0	0	0	0	0.299622125	0	0.000521937	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7337
H3251_804_0	2012	3		r.	s									COB/Subrogation	Risk Sharing																		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	206.5221559	3.67257949	892.317037		150.7056969	17.79585855	3.291013414	267.9941355	269.4213893	631.9806436	750.8110495	58.88028645		7827.493914	9407.774115	13625.78253	321.2816236	698.5938216	2687.842645	252.9543511	27.75485859	36.18250178																			6700	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	not covered													826.4795022	630.2096116	31.89273902		100.3922621	0.224	0.224	174.9642369	514.6101856	31.15391919	95.5890948	443.8613748		5.400194698	13.4418771	25.25171928	18.34974795	35.66457253	17.50669103	26.98812701	0.224	217.8016544																			NO	715.8448965	545.702866	27.61633889		86.97756452	0.194170297	0.194293382	151.5898997	446.4370789	26.99235448	82.79453905	384.4046837		4.681200456	11.64789855	21.88183912	15.91305444	30.89026465	15.16354787	23.37600722	0.194090217	188.7382618																				12.3198	0.167011429	2.053544141	0	1.092334539	3.455427133	0.639422127	3.385433677	10.02330817	1.421553797	5.180254562	1.886154824	0	3.053505673	9.131733209	24.84643178	0.426047664	1.798312336	3.396435886	0.492755228	5.386946538	0.569085208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7255	0		13.97283814	12.3198	0.167011429	2.053544141	0	1.092334539	3.455427133	0.639422127	3.385433677	10.02330817	1.421553797	5.180254562	1.886154824	0	3.053505673	9.131733209	24.84643178	0.426047664	1.798312336	3.396435886	0.492755228	5.386946538	0.569085208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7255	NO																																																																																		0	0		0	12.3198	0.167011429	2.053544141	0	1.092334539	3.455427133	0.639422127	3.385433677	10.02330817	1.421553797	5.180254562	1.886154824	0	3.053505673	9.131733209	24.84643178	0.426047664	1.798312336	3.396435886	0.492755228	5.386946538	0.569085208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7255
H3283_001_0	2012	7																																																			Coin																				0	0	0	0	0	0	0	0	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	31.2811766	0	0	0	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	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 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	10% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	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	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a											0	NO	0	0	0	0	0	0	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.099980459	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.127506384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1275	0	NO	0.000611275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.127506384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1275	YES	20% Coinsurance; PBP 1a	20% Coinsurance; PBP 1b	$50/Day for Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance; PBP 10a	20% Coinsurance; PBP 11a	"20% Coinsurance; PBP 11b, 11c"	"PBP 4a, 4b"	"20% Coinsurance; PBP 9a, 9b"	20% Coinsurance; PBP 8a	20% Coinsurance; PBP 8b	20% Coinsurance; PBP 5	20% Coinsurance; PBP 12	"20% Coinsurance; PBP 3, 9a, 9c"	"20% Coinsurance; PBP 7a, 14a, 14b"	"20% Coinsurance; PBP 7b, 7d, 7f, 17a, 18a"	"20% Coinsurance; PBP 7e, 7h"	"20% Coinsurance; PBP 7c, 7i"	"20% Coinsurance; PBP 7d, 14a, 14b"	"20% Coinsurance; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance; PBP 15	"20% Coinsurance; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	20% Coinsurance; PBP 17a	PBP 17b	20% Coinsurance; PBP 18a	PBP 18b	PBP 14c	20% Coinsurance; PBP 13a											4000	2.719	0.0584	0.1041	0	0.0974	0.0966	0.0604	0	0.7249	0.1366	0.2318	0	0.0004	0.2358	0.4787	0.6552	0.0215	0.1154	0.2771	0.9094	0.3493	0.0095	0	0	0.0389	0	0.0123	0	0	0.044											7.3765	0	NO	0.001441748	2.719	0.058371305	0.104062874	0	0.097411905	0.096580557	0.060353574	0	0.72486232	0.136642987	0.231752756	9.35E-06	0.000385109	0.235802825	0.478734796	0.655217141	0.021469973	0.115360157	0.277087343	0.909420107	3.476845722	0.009467283	0	0	0.038944945	0	0.012304126	0	0	0.043963281	0	0	0	0	0	0	0	0	0	0	10.504
H3283_002_0	2012	8																																																			Coin																				0	0	0	0	0	0	0	0	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	41.20098873	0	0	0	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	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 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	10% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	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	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a											0	NO	0	0	0	0	0	0	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.099949421	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.118014949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.118	0	NO	0.002083925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.118014949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.118	YES	20% Coinsurance; PBP 1a	20% Coinsurance; PBP 1b	$50/Day for Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance; PBP 10a	20% Coinsurance; PBP 11a	"20% Coinsurance; PBP 11b, 11c"	"PBP 4a, 4b"	"20% Coinsurance; PBP 9a, 9b"	20% Coinsurance; PBP 8a	20% Coinsurance; PBP 8b	20% Coinsurance; PBP 5	20% Coinsurance; PBP 12	"20% Coinsurance; PBP 3, 9a, 9c"	"20% Coinsurance; PBP 7a, 14a, 14b"	"20% Coinsurance; PBP 7b, 7d, 7f, 17a, 18a"	"20% Coinsurance; PBP 7e, 7h"	"20% Coinsurance; PBP 7c, 7i"	"20% Coinsurance; PBP 7d, 14a, 14b"	"20% Coinsurance; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance; PBP 15	"20% Coinsurance; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	20% Coinsurance; PBP 17a	PBP 17b	20% Coinsurance; PBP 18a	PBP 18b	PBP 14c	20% Coinsurance; PBP 13a											4000	3.5801	0.0769	0.137	0	0.1283	0.1272	0.0795	0	0.9544	0.1799	0.3052	0	0.0005	0.3105	0.6304	0.8422	0.0283	0.1519	0.3648	1.1974	0.46	0.0125	0	0	0.0389	0	0.0123	0	0	0.0439											9.662	0	NO	0.004889446	3.5801	0.076858007	0.137020494	0	0.128263105	0.127168462	0.079468077	0	0.954432542	0.179919014	0.305150876	1.23E-05	0.000507077	0.310483637	0.630354283	0.842171537	0.028269701	0.151895726	0.364843323	1.197441391	4.577993103	0.012465654	0	0	0.038932855	0	0.012300306	0	0	0.043949633	0	0	0	0	0	0	0	0	0	0	13.78
H3283_801_0	2012	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	282.0123835	6.08473148	51.13183658	0	9.669879556	10.61000435	6.42020164	42.78891386	77.66942706	13.95322244	23.66530341	0.000954809	0.050463584	24.12838595	46.7643154	58.03134976	2.135610057	11.4748308	28.46392739	87.87437548	35.99377917	1.043973124	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a											0	NO	0.080342287	0.080342287	0.132979808	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080342287	0.080342287	0.132979808	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												22.6575	0.488861241	6.799501826	0	2.166053021	2.376640976	1.438125167	9.584716704	17.39795166	3.125521827	5.301027963	0.000213877	0.011303843	5.404758452	10.47520665	12.99902235	0.478376653	2.570362099	6.375919736	19.68386011	8.062606534	0.23384998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6314	0	NO	2.84E-14	22.6575	0.488861241	6.799501826	0	2.166053021	2.376640976	1.438125167	9.584716704	17.39795166	3.125521827	5.301027963	0.000213877	0.011303843	5.404758452	10.47520665	12.99902235	0.478376653	2.570362099	6.375919736	19.68386011	8.062606534	0.23384998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6314	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 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 14c	Medicare-FFS Cost Sharing; PBP 13a											10000	5.3725	0.1159	1.6526	0	0.5393	0.5347	0.3342	0	4.0134	0.7566	1.2832	0.0001	0.0021	1.3056	2.666	3.2687	0.1189	0.6387	1.698	5.1219	1.9342	0.0524	0	0	0	0	0	0	0	0											31.4091	0	NO	1.07E-14	28.03	0.604779531	8.452099866	0	2.705400223	2.911385195	1.772288954	9.584716704	21.41134678	3.882082462	6.584189402	0.000265648	0.013436105	6.710344188	13.14116286	16.26775055	0.597250933	3.209084625	8.073947011	24.80578936	9.996817698	0.286268138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.0405
H3283_802_0	2012	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	274.8009911	5.929137653	49.82433466	0	9.422609225	10.33869391	6.256029442	41.6947504	75.68332735	13.59642193	23.06015343	0.000930394	0.04917317	23.5113944	45.56849619	56.54741907	2.080999966	11.18140572	27.73607089	85.6273231	35.07337539	1.017277488	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a											0	NO	0.081012578	0.081012578	0.137065414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081012578	0.081012578	0.137065414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												22.2623	0.480334727	6.829193047	0	2.110664466	2.315867437	1.401350595	9.339624089	16.95306533	3.045598513	5.165474368	0.000208408	0.01101479	5.266552345	10.20734315	12.66662187	0.466143992	2.50463488	6.212879879	19.18052037	7.856436088	0.227870157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.5037	0	NO	8.53E-14	22.2623	0.480334727	6.829193047	0	2.110664466	2.315867437	1.401350595	9.339624089	16.95306533	3.045598513	5.165474368	0.000208408	0.01101479	5.266552345	10.20734315	12.66662187	0.466143992	2.50463488	6.212879879	19.18052037	7.856436088	0.227870157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.5037	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 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 14c	Medicare-FFS Cost Sharing; PBP 13a											10000	5.2788	0.1139	1.6598	0	0.5256	0.5211	0.3256	0	3.9108	0.7372	1.2503	0.0001	0.0021	1.2722	2.5978	3.1851	0.1158	0.6224	1.6546	4.991	1.8848	0.0511	0	0	0	0	0	0	0	0											30.7	0	NO	1.78E-14	27.5412	0.594231219	8.489007447	0	2.636219919	2.83693761	1.726969416	9.339624089	20.86383315	3.782812993	6.415823842	0.000258855	0.013092528	6.5387527	12.80512769	15.8517648	0.581978516	3.127024511	7.867486575	24.17147579	9.74118717	0.278947921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	165.2037
H3305_007_0	2012	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	314.8075315	2.674576259	1435.517133		302.0654283	6.981254978	2.296190429	310.5137549	271.4623306	6315.244528	430.6643008	29.66310235		1057.484605	4002.887427	5676.014448	78.80817744	387.2453301	2646.210231		1089.881472	9.414188854			31.23927754		0.303683511			0.158668178											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay ,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25 copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395	298.8636364	29.23796791		75	0.2	0.2	62.00225153	125.8002208	9.682974665	40	25		33.58377408	14.98694634	24.82041385	25	25	24.98198544		22.77297658	29.22357978			25		10.61829068			0.5											NO	247.4467471	263.9543318	25.82277449		66.23949011	0.17663864	0.17663864	54.75996702	111.1058997	8.580873859	35.32772806	22.07983004		29.66096095	13.2447445	21.92122077	22.07983004	22.07983004	22.0639197		20.11293809	25.81006699			25		10.61829068			0.5												6.4915	0.058830499	3.089086267	0	1.667388329	1.233159387	0.405595955	1.416976915	2.513422206	4.515859724	1.267865942	0.054579688	0	2.613834131	4.418101768	10.36876382	0.14500593	0.712525923	4.865480836	0	1.826726547	0.020248404	0	0	0.065081828	0	0.000268717	0	0	0.079334089	0	0	0	0	0	0	0	0	0	0	47.8296	0		6.286173128	6.4915	0.058830499	3.089086267	0	1.667388329	1.233159387	0.405595955	1.416976915	2.513422206	4.515859724	1.267865942	0.054579688	0	2.613834131	4.418101768	10.36876382	0.14500593	0.712525923	4.865480836	0	1.826726547	0.020248404	0	0	0.065081828	0	0.000268717	0	0	0.079334089	0	0	0	0	0	0	0	0	0	0	47.8296	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered POS	(2). Not Covered POS	(6). Not Covered POS	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1).  30%; $5,000 Max. Comb. Annual POS Benefit ,"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a).$0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered POS	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). Not Covered POS, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered POS"	(10b). Not Covered POS	(16a). Not Covered	(17a). Not Covered POS	(17b). Not Covered POS	(18a). Not Covered POS	(18b). Not Covered POS	(14c). Not Covered POS	(13a). Not Covered POS												0.0209													0.0719																											0.0928	0		0	6.5124	0.058830499	3.089086267	0	1.667388329	1.233159387	0.405595955	1.416976915	2.513422206	4.515859724	1.267865942	0.054579688	0	2.685739956	4.418101768	10.36876382	0.14500593	0.712525923	4.865480836	0	1.826726547	0.020248404	0	0	0.065081828	0	0.000268717	0	0	0.079334089	0	0	0	0	0	0	0	0	0	0	47.9225
H3305_011_0	2012	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	294.9155857	3.372830735	1339.559055		299.0340953	9.020842942	3.519358817	309.6392086	271.5756604	6712.488825	443.9355205	83.22672371		1189.098086	3896.525329	5604.53064	230.7149169	507.9605734	2736.467946		1151.28553	10.88431076			39.26031149		0.604683931			0.191106555											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay ,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25 Copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	"(16a). $300 Limit including 2 Oral Exams, x-rays & Prophylaxis"	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395	298.8636364	29.23796791		75	0.2	0.2	61.71676301	125.598638	9.721714307	40	25		33.68722091	14.9802946	24.81746735	25	25	24.98007351		23.54347754	26.31586749			25		12.36644592			0.5											NO	246.2110573	262.6362071	25.69382173		65.90870596	0.175756549	0.175756549	54.23562647	110.373916	8.570995601	35.15130984	21.96956865		29.6037485	13.17843173	21.80916211	21.96956865	21.96956865	21.95205759		20.68960184	23.1259303			25		12.36644592			0.5												6.051	0.073818956	2.868199296	0	1.642412521	1.585472226	0.618550361	1.399456372	2.49790576	4.794392683	1.300409586	0.152371268	0	2.933480057	4.279174419	10.18584311	0.422392267	0.929972891	5.005925163	0	1.984969935	0.020975818	0	0	0.081792316	0	0.000623149	0	0	0.095553277	0	0	0	0	0	0	0	0	0	0	48.9246	0		6.701182972	6.051	0.073818956	2.868199296	0	1.642412521	1.585472226	0.618550361	1.399456372	2.49790576	4.794392683	1.300409586	0.152371268	0	2.933480057	4.279174419	10.18584311	0.422392267	0.929972891	5.005925163	0	1.984969935	0.020975818	0	0	0.081792316	0	0.000623149	0	0	0.095553277	0	0	0	0	0	0	0	0	0	0	48.9246	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered POS	(2). Not Covered POS	(6). Not Covered POS	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered POS	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). Not Covered POS, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered POS"	(10b). Not Covered POS	(16a). Not Covered	(17a). Not Covered POS	(17b). IN-Net combined with OON	(18a). Not Covered POS	(18b). Not Covered POS	(14c). Not Covered POS	(13a). Not Covered POS																									0.0643																											0.0643	0		0	6.051	0.073818956	2.868199296	0	1.642412521	1.585472226	0.618550361	1.399456372	2.49790576	4.794392683	1.300409586	0.152371268	0	2.997810066	4.279174419	10.18584311	0.422392267	0.929972891	5.005925163	0	1.984969935	0.020975818	0	0	0.081792316	0	0.000623149	0	0	0.095553277	0	0	0	0	0	0	0	0	0	0	48.989
H3305_015_0	2012	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	131.3192048	3.319199701	346.9948137		117.0803761	4.511215285	2.607576249	174.0225893	204.1418836	4640.761742	273.9421529	46.85223558		578.4816842	3009.650207	3822.386849	121.8619458	436.9551841	1581.292261		624.9322721	6.299229505			30.10135712		0.969112232			0.063581115											4600	(1a). $500 per stay/$1500 max per yr	(1b). $500 per stay/$1500 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $125 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay, (4b). $40 copay"	"(9a1). $250 copay, (9b). $150 copay"	(8a). $10 copay	(8b). $60 copay	(7e). and (9c). $40 copay	(12a). $0 copay	"(3). ,(5). And(7d). $40 copay ,(8b1). $60 copay"	"(7a). $20 copay ,(14a). $0 copay"	"(7b1). $20 copay,(7d). $40 copay"	(7e). $40 copay	(7i). $40 copay	"(7a). $20 copay, (7d). $40 copay"	(14a). $0 copay	(15) 20% coinsurance	"(7f). $40,20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay and (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $40 copay	(17b). Medicare Covered: 20%	(18a). $40 copay	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													466.9547325	498.1060606	29.23796791		125	0.2	0.2	62.25274725	211.1241218	9.72129957	60	40		52.66115702	19.85470831	39.34205513	40	40	39.93245318		31.49789263	18.92599434			40		10.29145364			0.5											NO	434.9284813	463.9432848	27.23267181		116.4268319	0.186282931	0.186282931	57.98312114	196.6441012	9.07254029	55.88487933	37.25658622		49.04937343	18.5071208	36.64376672	37.25658622	37.25658622	37.19367212		29.33759881	17.6279485			40		10.29145364			0.5												4.7595	0.128326701	0.787466324	0	1.135941439	0.840362406	0.485746947	0.840864406	3.345274767	3.508624824	1.27576868	0.145462863	0	2.364513679	4.641663329	11.672221	0.378346674	1.356621541	4.901172155	0	1.527834357	0.009253541	0	0	0.100337857	0	0.000831131	0	0	0.031790558	0	0	0	0	0	0	0	0	0	0	44.238	0		3.236425048	4.7595	0.128326701	0.787466324	0	1.135941439	0.840362406	0.485746947	0.840864406	3.345274767	3.508624824	1.27576868	0.145462863	0	2.364513679	4.641663329	11.672221	0.378346674	1.356621541	4.901172155	0	1.527834357	0.009253541	0	0	0.100337857	0	0.000831131	0	0	0.031790558	0	0	0	0	0	0	0	0	0	0	44.238	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered POS	(2). Not Covered POS	(6). Not Covered POS	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay, (4b). $40 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered POS	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1).30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). and (7d).30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered POS	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a).  and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). and (9d). 30%; $5,000 Max. Comb. Annual POS Benefit and (14b). Not Covered POS"	(10b). Not Covered POS	(16a). Not Covered	(17a). Not Covered POS	(17b). Not Covered POS	(18a). Not Covered POS	(18b). Not Covered POS	(14c). Not Covered POS	(13a). Not Covered POS												0.0729													0.0197																											0.0926	0		0	4.8324	0.128326701	0.787466324	0	1.135941439	0.840362406	0.485746947	0.840864406	3.345274767	3.508624824	1.27576868	0.145462863	0	2.384219204	4.641663329	11.672221	0.378346674	1.356621541	4.901172155	0	1.527834357	0.009253541	0	0	0.100337857	0	0.000831131	0	0	0.031790558	0	0	0	0	0	0	0	0	0	0	44.3305
H3305_016_0	2012	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	326.3280544	2.772453577	1488.050527		313.1196482	7.236768781	2.380230956	321.8771451	281.3966164	6546.353735	446.4246541	30.74863689		1096.183729	4149.374889	5883.730743	81.69219806	401.4167467	2743.049482		1129.766173	9.758705319			32.38249292		0.314796946			0.16447543											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay ,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395	298.8636364	29.23796791		75	0.2	0.2	62.00225153	132.4094378	9.682975748	40	25		33.58377408	14.98694665	24.82041385	25	25	24.98198544		22.77301021	29.22370757			25		10.61833711			0.5											NO	245.6826149	262.0725114	25.63867513		65.76724622	0.175379323	0.175379323	54.36956456	116.1093879	8.521465116	35.07586465	21.92241541		29.44949785	13.15082971	21.76493692	21.92241541	21.92241541	21.9066185		19.96957559	25.62617028			25		10.61833711			0.5												6.6811	0.060548656	3.17930367	0	1.71608475	1.269179611	0.417443294	1.458360018	2.722732408	4.648710416	1.304894229	0.056173699	0	2.690171697	4.547310213	10.67158571	0.149240858	0.733335389	5.007578209	0	1.88007925	0.020839854	0	0	0.067463527	0	0.000278552	0	0	0.082237715	0	0	0	0	0	0	0	0	0	0	49.3646	0		6.886562137	6.6811	0.060548656	3.17930367	0	1.71608475	1.269179611	0.417443294	1.458360018	2.722732408	4.648710416	1.304894229	0.056173699	0	2.690171697	4.547310213	10.67158571	0.149240858	0.733335389	5.007578209	0	1.88007925	0.020839854	0	0	0.067463527	0	0.000278552	0	0	0.082237715	0	0	0	0	0	0	0	0	0	0	49.3646	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered	(2). Not Covered	(6). Not Covered	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1).  30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered	"(7f). Not Covered, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered"	(10b). Not Covered	(16a). Not Covered	(17a). Not Covered	(17b). Not Covered	(18a). Not Covered	(18b). Not Covered	(14c). Not Covered	(13a). Not Covered												0.0208													0.0714																											0.0922	0		0	6.7019	0.060548656	3.17930367	0	1.71608475	1.269179611	0.417443294	1.458360018	2.722732408	4.648710416	1.304894229	0.056173699	0	2.761604479	4.547310213	10.67158571	0.149240858	0.733335389	5.007578209	0	1.88007925	0.020839854	0	0	0.067463527	0	0.000278552	0	0	0.082237715	0	0	0	0	0	0	0	0	0	0	49.4569
H3305_017_0	2012	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	312.8538627	3.577983583	1421.0379		317.2228812	9.569681663	3.733480757	328.4730519	288.0942836	7120.776789	470.9379535	88.28899949		1261.425125	4133.531965	5945.42691	244.7481803	538.8573382	2902.913948		1221.312615	11.54635031			41.6483248		0.641463906			0.202733703											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay ,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25 copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	"(16a). $300 Limit including 2 Oral Exams, x-rays & Prophylaxis"	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395	298.8636364	29.23796791		75	0.2	0.2	61.71676301	125.598638	9.721717769	40	25		33.68722091	14.98029635	24.81746735	25	25	24.98007351		23.54364008	26.31626577			25		12.36663308			0.5											NO	248.123245	264.67596	25.89337171		66.42058311	0.177121555	0.177121555	54.65684516	111.2311303	9.721717769	35.42431099	22.14019437		29.83366475	13.27988575	21.97854204	22.14019437	22.14019437	22.12254731		20.8504307	23.30588957			25		12.36663308			0.5												6.4689	0.078917187	3.066288546	0	1.755844062	1.694996897	0.661279917	1.496108394	2.670421067	5.76884852	1.390221044	0.162894634	0	3.136077856	4.574402687	10.88931794	0.451564357	0.994200517	5.351654263	0	2.122074504	0.02242483	0	0	0.086767343	0	0.000661062	0	0	0.101366851	0	0	0	0	0	0	0	0	0	0	52.9452	0		6.064148248	6.4689	0.078917187	3.066288546	0	1.755844062	1.694996897	0.661279917	1.496108394	2.670421067	5.76884852	1.390221044	0.162894634	0	3.136077856	4.574402687	10.88931794	0.451564357	0.994200517	5.351654263	0	2.122074504	0.02242483	0	0	0.086767343	0	0.000661062	0	0	0.101366851	0	0	0	0	0	0	0	0	0	0	52.9452	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered	(2). Not Covered	(6). Not Covered	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). Not Covered, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered"	(10b). Not Covered	(16a). Not Covered	(17a). Not Covered	(17b). Not Covered	(18a). Not Covered	(18b). Not Covered	(14c). Not Covered	(13a). Not Covered																									0.0654																											0.0654	0		0	6.4689	0.078917187	3.066288546	0	1.755844062	1.694996897	0.661279917	1.496108394	2.670421067	5.76884852	1.390221044	0.162894634	0	3.201478437	4.574402687	10.88931794	0.451564357	0.994200517	5.351654263	0	2.122074504	0.02242483	0	0	0.086767343	0	0.000661062	0	0	0.101366851	0	0	0	0	0	0	0	0	0	0	53.0106
H3305_018_0	2012	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	135.6247477	3.427340195	358.3000058		120.8948888	4.658338672	2.692616626	179.692296	210.7928856	4791.959112	282.8672681	48.37869507		432.9399548	3107.705487	3946.921326	125.8322435		1632.811223		645.2927476	6.504460238			31.08206811		1.00068619			0.065654674											4600	(1a). $500 per stay/$1500 max per yr	(1b). $500 per stay/$1500 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $125 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay, (4b). $40 copay"	"(9a1). $250 copay, (9b). $150 copay"	(8a). $10 copay	(8b). $60 copay	(7e). and (9c). $40 copay	(12a). $0 copay	"(3). ,(5). And(7d). $40 copay ,(8b1). $60 copay"	"(7a). $20 copay ,(14a). $0 copay"	"(7b1). $20 copay,(7d). $40 copay"	(7e). $40 copay	(7i). $40 copay	"(7a). $20 copay, (7d). $40 copay"	(14a). $0 copay	(15) 20% coinsurance	"(7f). $40,20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay and (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $40 copay	(17b). Medicare Covered: 20%	(18a). $40 copay	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													466.9547325	498.1060606	29.23796791		125	0.2	0.2	62.25274725	211.1241218	9.721307825	60	40		57.4686431	19.85471481	39.34205513	40		39.93245318		31.49820535	18.92659029			40		10.2917777			0.5											NO	435.492842	464.545295	27.26800877		116.5779067	0.186524651	0.186524651	58.0583597	196.8992654	9.083980861	55.95739523	37.30493015		53.59659292	18.53087424	36.69131546	37.30493015		37.24193442		29.37595876	17.65137822			40		10.2917777			0.5												4.922	0.132679563	0.814177309	0	1.174472756	0.868894994	0.502239376	0.869386663	3.458747028	3.627505405	1.31904296	0.150396987	0	1.933675543	4.79904163	12.06814462	0.391180254	0	5.067420707	0	1.579674429	0.009567724	0	0	0.103606894	0	0.000858237	0	0	0.032827337	0	0	0	0	0	0	0	0	0	0	43.8255	0		3.14480169	4.922	0.132679563	0.814177309	0	1.174472756	0.868894994	0.502239376	0.869386663	3.458747028	3.627505405	1.31904296	0.150396987	0	1.933675543	4.79904163	12.06814462	0.391180254	0	5.067420707	0	1.579674429	0.009567724	0	0	0.103606894	0	0.000858237	0	0	0.032827337	0	0	0	0	0	0	0	0	0	0	43.8255	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered POS	(2). Not Covered POS	(6). Not Covered POS	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay, (4b). $40 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered POS	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1).  30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). and (7d).30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered POS	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a).  and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). and (9d). 30%; $5,000 Max. Comb. Annual POS Benefit and (14b). Not Covered POS"	(10b). Not Covered POS	(16a). Not Covered	(17a). Not Covered POS	(17b). Not Covered POS	(18a). Not Covered POS	(18b). Not Covered POS	(14c). Not Covered POS	(13a). Not Covered POS												0.0721													0.0195																											0.0916	0		0	4.9941	0.132679563	0.814177309	0	1.174472756	0.868894994	0.502239376	0.869386663	3.458747028	3.627505405	1.31904296	0.150396987	0	1.953175607	4.79904163	12.06814462	0.391180254	0	5.067420707	0	1.579674429	0.009567724	0	0	0.103606894	0	0.000858237	0	0	0.032827337	0	0	0	0	0	0	0	0	0	0	43.9171
H3305_801_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	252.5170026	2.270836354	1071.940197		231.8797601	644.9869737	250.3504994	30.92674754	70.973912	25.2793658	30.85371131	1.118797677	0.054012094	91.61999259	48.4736861	142.1981403	2.157852532	5.28019833	30.65909444	2.489533663	15.00557852	27.84683368																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													868.1918883	643.2271152	85.72998388		96.52605831	25.34238403	44.89381222	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	168.1200433																			NO	692.5326275	513.0844576	68.38443412		76.99616373	20.21491797	35.81055081	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	0.178678597	134.104703																				14.573	0.097094237	6.108668647	0	1.487820998	1.086529897	0.747099107	5.525947861	12.68151902	4.516881615	5.512897851	0.199905199	0.009650805	16.37053174	8.661210226	25.40776421	0.385562063	0.94345843	5.478123981	0.444826382	2.681175717	0.31119928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2309	0		28.72074688	14.573	0.097094237	6.108668647	0	1.487820998	1.086529897	0.747099107	5.525947861	12.68151902	4.516881615	5.512897851	0.199905199	0.009650805	16.37053174	8.661210226	25.40776421	0.385562063	0.94345843	5.478123981	0.444826382	2.681175717	0.31119928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2309	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.0153													0.0329																											0.0483	0		0	14.5883	0.097094237	6.108668647	0	1.487820998	1.086529897	0.747099107	5.525947861	12.68151902	4.516881615	5.512897851	0.199905199	0.009650805	16.40347162	8.661210226	25.40776421	0.385562063	0.94345843	5.478123981	0.444826382	2.681175717	0.31119928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2791
H3305_803_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	260.1452961	3.235783043	1230.183097		253.4190062	639.7856799	222.6048148	32.130377	62.14993881	22.93062631	27.46887972	0.415850358	0.276498133	73.5546558	47.43811476	125.6790013	1.347074273	3.194849985	24.51832651	2.049539198	16.3077895	30.86205976																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													813.3200278	501.094081	86.0995056		97.3411656	30.25466998	41.15753545	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	242.0760522																			NO	666.9035449	410.8855155	70.59959614		79.81749641	24.80812714	33.74822376	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	0.183674801	198.496744																				14.4577	0.110794699	7.23753582	0	1.685605885	1.322657041	0.626043092	5.901540593	11.41537763	4.211778219	5.045341009	0.076381232	0.05078574	13.51013675	8.713186276	23.08406551	0.247423599	0.586813434	4.503398737	0.376448704	2.995329987	0.510501531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6688	0		23.41878408	14.4577	0.110794699	7.23753582	0	1.685605885	1.322657041	0.626043092	5.901540593	11.41537763	4.211778219	5.045341009	0.076381232	0.05078574	13.51013675	8.713186276	23.08406551	0.247423599	0.586813434	4.503398737	0.376448704	2.995329987	0.510501531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6688	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.0023													0.0617																											0.064	0		0	14.4599	0.110794699	7.23753582	0	1.685605885	1.322657041	0.626043092	5.901540593	11.41537763	4.211778219	5.045341009	0.076381232	0.05078574	13.5718494	8.713186276	23.08406551	0.247423599	0.586813434	4.503398737	0.376448704	2.995329987	0.510501531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7328
H3307_002_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1530.632917	126.584759	1522.834541	2788.202127	204.9951303	5.450982406	10.89540385	204.8499836	433.8761217	21.6328392	52.35320613	0	0.073128575	374.1881401	5921.422988	6689.586677	934.2662834	1672.348445	0	0	49.61617449	1143.630692	0	362.3940007	42.79069767	1.6	23.12287444	65	478.7378578	0											5900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$220 (9b)	20% (8a1a); $15 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $220 (9a); $40 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	63.66485782	0	200	0.2	0.108637125	63.66020512	66	0.23613628	0.141119668	0	0.2	26.03031258	9.817241099	34.97322836	40	35	0	0	0.2	34.63154084	0	0	0	0	15	352.5	0	0											NO	116.4339249	67.28434421	43.0596351	0	135.2697126	0.135269713	0.073476563	43.11011358	44.63900516	0.159710434	0.095446084	0	0.135269713	17.60556451	9.278316354	33.05452982	37.80417028	33.07864899	0	0	0.135269713	23.42299288	0	0	0	0	15	352.5	0	0												14.8515	0.709764375	5.464391638	0	2.310802697	0.737352823	0.800556832	0.735925505	1.613983203	3.454990128	4.99690853	0	0.009892081	0.548982786	4.578402979	18.42676186	2.943263472	4.609918933	0	0	6.711565663	2.232271131	0	0	0	0	0.028903593	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	77.6755	0	NO	23.39223716	14.8515	0.709764375	5.464391638	0	2.310802697	0.737352823	0.800556832	0.735925505	1.613983203	3.454990128	4.99690853	0	0.009892081	0.548982786	4.578402979	18.42676186	2.943263472	4.609918933	0	0	6.711565663	2.232271131	0	0	0	0	0.028903593	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	77.6755	NO																																										0	0	0	0	0	0	0	0	0	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	14.8515	0.709764375	5.464391638	0	2.310802697	0.737352823	0.800556832	0.735925505	1.613983203	3.454990128	4.99690853	0	0.009892081	0.548982786	4.578402979	18.42676186	2.943263472	4.609918933	0	0	6.711565663	2.232271131	0	0	0	0	0.028903593	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	77.6755
H3307_012_0	2012	6																															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	1154.688045	156.5727577	891.4315208	1472.153418	143.3968597	3.580061696	8.354904992	261.1595446	75.89370116	22.00991357	44.8397795	0	0.048018784	8.93758023	5488.038972	5230.066176	946.8773129	1524.376103	0	0	36.36561053	753.1601113	0	0	51.07139462	75.10693811	23.11520937	65	97.76201229	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9c); $60 (5); 20% (9a)"	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $40 (16b, 18a); $0/$40 (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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	64.24493475	0	200	0.2	0.079291057	64.12804955	0.15	0.28037206	0.142516474	0	0.2	0.140314133	8.832135656	39.97841833	40	39.91356508	0	0	0.2	39.35501712	0	0	0	0	15	352.5	0	0											NO	135.3403286	76.67478077	46.51089085	0	144.7923981	0.144792398	0.057403711	46.45990431	0.108594299	0.202978715	0.10317651	0	0.144792398	0.101582099	8.426067032	38.14110737	38.16094933	38.07848837	0	0	0.144792398	28.49153654	0	0	0	0	15	352.5	0	0												13.023	1.000431823	3.455106181	0	1.730231267	0.518365718	0.479602556	1.011120621	8.241623246	4.467543967	4.626411955	0	0.006952755	0.907898163	3.853548688	16.6233763	3.011144764	4.837161476	0	0	5.265463958	1.788224069	0	0	0	0	0.028894012	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.7855	0	NO	19.10196182	13.023	1.000431823	3.455106181	0	1.730231267	0.518365718	0.479602556	1.011120621	8.241623246	4.467543967	4.626411955	0	0.006952755	0.907898163	3.853548688	16.6233763	3.011144764	4.837161476	0	0	5.265463958	1.788224069	0	0	0	0	0.028894012	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.7855	NO																																										0	0	0	0	0	0	0	0	0	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	13.023	1.000431823	3.455106181	0	1.730231267	0.518365718	0.479602556	1.011120621	8.241623246	4.467543967	4.626411955	0	0.006952755	0.907898163	3.853548688	16.6233763	3.011144764	4.837161476	0	0	5.265463958	1.788224069	0	0	0	0	0.028894012	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.7855
H3307_015_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	V	Coin	V	V	V	Coin	O	T	V	P	P	P	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	853.0608657	110.2196793	733.1602815	1255.585283	108.0771425	3.079784132	10.00096618	113.7417714	299.7044244	6989.878106	3550.801606	0	0.040704397	219.8430668	7397.259787	7071.032802	5.142096161	4249.49255	0	0	33.5993238	1298.614743	0	362.3940007	51.9375399	75.12971377	23.1187661	65	917.7288774	756.0835686											3200	"$125 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$75 (10a)	10% (11a)	"10% (11b, 11b1); $0/10% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	$0 (8a1a); $5 (8a2)	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	10% (12)	$15 (3); $0 (5); $75 (9a); $10 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $15 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"45% (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0/$15 (7g)	"10% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (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)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$5 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	88.1811179	56.52372625	24.08905357	0	75	0.1	0.045697068	62.2784272	22.5	2.4	0	0	0.1	8.581533217	0.063989628	15	0.45	15	0	0	0.1	14.8639008	0	0	0	0	0	352.5	0	5											NO	69.63273636	44.63429158	19.02206228	0	59.22418939	0.078965586	0.036084957	49.24164613	17.76725682	1.89517406	0	0	0.078965586	6.77645798	0.061818436	14.49140047	0.43473133	14.49104433	0	0	0.078965586	11.73736635	0	0	0	0	0	352.5	0	5												4.9501	0.409964775	1.162185044	0	0.53339843	0.243196958	0.360884439	0.466736005	0.44374379	1.103919639	0	0	0.003214247	0.124146442	0.038107252	8.539097338	2.235430303	5.131632077	0	0	2.653190288	1.270193082	0	0	0	0	0	1.909375	0	0.31503482	0	0	0	0	0	0	0	0	0	0	31.8935	0	NO	4.214971185	4.9501	0.409964775	1.162185044	0	0.53339843	0.243196958	0.360884439	0.466736005	0.44374379	1.103919639	0	0	0.003214247	0.124146442	0.038107252	8.539097338	2.235430303	5.131632077	0	0	2.653190288	1.270193082	0	0	0	0	0	1.909375	0	0.31503482	0	0	0	0	0	0	0	0	0	0	31.8935	NO																																										0	0	0	0	0	0	0	0	0	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	4.9501	0.409964775	1.162185044	0	0.53339843	0.243196958	0.360884439	0.466736005	0.44374379	1.103919639	0	0	0.003214247	0.124146442	0.038107252	8.539097338	2.235430303	5.131632077	0	0	2.653190288	1.270193082	0	0	0	0	0	1.909375	0	0.31503482	0	0	0	0	0	0	0	0	0	0	31.8935
H3307_018_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1537.646175	109.9401441	1483.40546	3417.744099	197.3390809	5.530663808	10.08267843	200.0373662	520.0711897	23.13584917	56.49681973	0	0.12874806	372.7057479	6029.115422	7207.619091	824.6018011	1813.979212	0	0	44.22850908	1205.564162	0	512.2729747	49.10349422	55.32170389	21.99529228	66.36411836	118.2147795	0											5900	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$220 (9b)	20% (8a1a); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $220 (9a); $40 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	64.52717049	0	200	0.2	0.102881496	63.55184334	66	0.150622609	0.143195236	0	0.2	25.94969875	9.892547509	29.97553516	40	30	0	0	0.2	29.71829686	0	0	0	0	15	342.5	0	0											NO	119.8482985	69.25742799	44.92266667	0	139.2364374	0.139236437	0.071624265	44.29795838	45.94802434	0.104860778	0.099689973	0	0.139236437	18.06571803	9.386384003	28.44402726	37.95335426	28.46501569	0	0	0.139236437	20.6893489	0	0	0	0	15	342.5	0	0												15.357	0.634514301	5.553210751	0	2.289732549	0.770069925	0.72216443	0.738437244	1.99135364	2.426043134	5.632166406	0	0.017926421	0.561099746	4.715966046	17.08447616	2.60803369	4.302912228	0	0	6.158220036	2.07852813	0	0	0	0	0.027494115	1.894142545	0	0	0	0	0	0	0	0	0	0	0	0	75.5635	0	NO	21.15347955	15.357	0.634514301	5.553210751	0	2.289732549	0.770069925	0.72216443	0.738437244	1.99135364	2.426043134	5.632166406	0	0.017926421	0.561099746	4.715966046	17.08447616	2.60803369	4.302912228	0	0	6.158220036	2.07852813	0	0	0	0	0.027494115	1.894142545	0	0	0	0	0	0	0	0	0	0	0	0	75.5635	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	NO	0	15.357	0.634514301	5.553210751	0	2.289732549	0.770069925	0.72216443	0.738437244	1.99135364	2.426043134	5.632166406	0	0.017926421	0.561099746	4.715966046	17.08447616	2.60803369	4.302912228	0	0	6.158220036	2.07852813	0	0	0	0	0.027494115	1.894142545	0	0	0	0	0	0	0	0	0	0	0	0	75.5635
H3307_020_0	2012	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	365.4349427	7.445148821	46.02159511	4707.460694	11.43209054	7.413234626	11.43349154	9.961086387	47.92723874	19.13422553	46.4808389	0	0.036954725	7.752049544	32.02021203	158.3722711	3.654565516	13.13075373	0	0	30.46220054	13.68973522	776.2062225	329.2643113	48.03824363	37.95467775	0	0	176.627158	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.05629196	0.056986274	0.148606453	0	0.224	0.224	0.224	0.151884804	0.224	0.224	0.224	0	0.224	0.224	0.216347579	0.223917589	0.225514305	0.224	0	0	0.224	0.222895932	0	0	0	0	0	0	0	0											NO	0.034182154	0.034603762	0.090238262	0	0.136019468	0.136019468	0.136019468	0.092345426	0.136019468	0.136019468	0.136019468	0	0.136019468	0.136019468	0.131372691	0.135969426	0.136938999	0.136019468	0	0	0.136019468	0.136577364	0	0	0	0	0	0	0	0												12.4914	0.257630156	4.15290877	0	1.554986878	1.008344233	1.555177442	0.919860767	6.519037535	2.602627184	6.322298998	0	0.005026562	1.054429658	4.206581414	21.53378683	0.500452544	1.786038142	0	0	4.143452324	1.869707953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4837	150	YES	46.85452841	12.4914	0.257630156	4.15290877	0	1.554986878	1.008344233	1.555177442	0.919860767	6.519037535	2.602627184	6.322298998	0	0.005026562	1.054429658	4.206581414	21.53378683	0.500452544	1.786038142	0	0	4.143452324	1.869707953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4837	NO																																										0	0	0	0	0	0	0	0	0	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	12.4914	0.257630156	4.15290877	0	1.554986878	1.008344233	1.555177442	0.919860767	6.519037535	2.602627184	6.322298998	0	0.005026562	1.054429658	4.206581414	21.53378683	0.500452544	1.786038142	0	0	4.143452324	1.869707953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4837
H3307_802_0	2012	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	313.2932863	7.322311401	36.75541018	2321.715041	7.14677635	4.427564692	9.838977643	7.354059517	66.58042925	22.90365367	51.26541406	0	0.101341353	11.80264467	31.25879446	149.6005042	3.380883058	12.45988726	0	0	58.69860074	16.98888235	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.057130707	0.057130707	0.148790019	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.03767372	0.03767372	0.098116648	0	0.147712389	0.147712389	0.147712389	0.147712389	0.147712389	0.147712389	0.147712389	0	0.147712389	0.147712389	0.147712389	0.147712389	0.147712389	0.147712389	0	0	0.147712389	0.147712389	0	0	0	0	0	0	0	0												11.8029	0.275858707	3.606317626	0	1.055667405	0.654006156	1.453338888	1.086285697	9.834754235	3.383153389	7.57253676	0	0.014969373	1.743396835	4.617311193	22.0978478	0.499398312	1.840479708	0	0	8.670510519	2.50946839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7182	150	YES	42.72069411	11.8029	0.275858707	3.606317626	0	1.055667405	0.654006156	1.453338888	1.086285697	9.834754235	3.383153389	7.57253676	0	0.014969373	1.743396835	4.617311193	22.0978478	0.499398312	1.840479708	0	0	8.670510519	2.50946839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7182	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	NO	0	11.8029	0.275858707	3.606317626	0	1.055667405	0.654006156	1.453338888	1.086285697	9.834754235	3.383153389	7.57253676	0	0.014969373	1.743396835	4.617311193	22.0978478	0.499398312	1.840479708	0	0	8.670510519	2.50946839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7182
H3307_804_0	2012	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	332.8054642	7.3316	39.04456903	2481.864681	7.591883786	4.703317265	10.45175771	7.812076729	70.72711619	24.3301131	54.45826856	0	0.107652981	12.53576732	33.20561932	158.9177535	3.3657	13.23589986	0	0	62.35440056	18.04696469	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.060344582	0.060344582	0.148922911	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.038732898	0.038732898	0.095587966	0	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0	0	0.1437771	0.1437771	0	0	0	0	0	0	0	0												12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849	150	YES	48.08832121	12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849	NO																																										0	0	0	0	0	0	0	0	0	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	12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849
H3307_805_0	2012	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	332.8054642	7.3316	39.04456903	2481.864681	7.591883786	4.703317265	10.45175771	7.812076729	70.72711619	24.3301131	54.45826856	0	0.107652981	12.53576732	33.20561932	158.9177535	3.3657	13.23589986	0	0	62.35440056	18.04696469	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.060344582	0.060344582	0.148922911	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.038732898	0.038732898	0.095587966	0	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0.1437771	0	0	0.1437771	0.1437771	0	0	0	0	0	0	0	0												12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849	150	YES	48.08832121	12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849	NO																																										0	0	0	0	0	0	0	0	0	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	12.8905	0.283974112	3.732190938	0	1.091539037	0.676229318	1.502723417	1.123197739	10.16893968	3.498113112	7.829851941	0	0.015478033	1.802356275	4.77420766	22.84873378	0.483910587	1.903019302	0	0	8.965134904	2.594740252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1849
H3307_807_0	2012	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	324.4853276	7.15494	36.70189489	2208.859566	6.756776569	4.185952366	9.302064365	6.952748288	62.94713341	21.65380066	48.46785901	0	0.095811153	11.15692191	29.70030984	139.0530343	2.9834	11.58141238	0	0	54.56010049	15.7910941	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.060344582	0.060344582	0.148922911	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.039111037	0.039111037	0.096521166	0	0.145180758	0.145180758	0.145180758	0.145180758	0.145180758	0.145180758	0.145180758	0	0.145180758	0.145180758	0.145180758	0.145180758	0.145180758	0.145180758	0	0	0.145180758	0.145180758	0	0	0	0	0	0	0	0												12.691	0.27983712	3.542509687	0	0.980953944	0.607719737	1.350480755	1.009405266	9.13871254	3.143715192	7.036600508	0	0.013909936	1.61977038	4.311913494	20.18782492	0.433132273	1.681398227	0	0	7.921076743	2.292563011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2425	150	YES	42.47817104	12.691	0.27983712	3.542509687	0	0.980953944	0.607719737	1.350480755	1.009405266	9.13871254	3.143715192	7.036600508	0	0.013909936	1.61977038	4.311913494	20.18782492	0.433132273	1.681398227	0	0	7.921076743	2.292563011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2425	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.5021	0.0111	0.3489	0	0.1871	0.1159	0.2575	0.1925	1.7427	0.5995	1.3419	0	0.0027	0.3089	0.7852	4.4497	0.0955	0.3706	0	0	1.7459	0.5053	0	0	0	0	0	0	0	0											13.5628	150	YES	0	13.193	0.290907937	3.891387541	0	1.16801796	0.723609475	1.608012065	1.201894837	10.88142868	3.743209179	8.378452245	0	0.016562505	1.928654151	5.097102818	24.63752201	0.528601073	2.052003423	0	0	9.666999958	2.797878022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8053
H3312_002_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1841.682832	41.73785455	1562.385048	962.779703	310.7392127	16.10454006	0	195.4379978	301.5775354	3541.960504	2671.923134	58.40612369	1.477292302	255.5441665	2864.589326	10090.66962	413.7250356	749.0501216	0	0	335.7170964	0	0	0	2001.229383	87.47663968	101.4299687	7.513331015	37.38007227	0											6700	$175/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-8, $50/d 9-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$150 per procedure	$0 to $20 per visit	$0 to $20 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$20 per visit	20% per visit	$0 to 150 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	126.4996386	96.15686456	65.01219309	0	200	0.03	0.03	62.5	150	2	16.1894124	20	0.2	20	5	20	20	10	20	20	50	0	0	0	0	0	0	0	0	0											NO	120.8410834	91.85559592	62.10408134	0	191.0536421	0.028658046	0	59.70426315	143.2902316	1.910536421	15.46523101	19.10536421	0.191053642	19.10536421	4.776341052	19.10536421	19.10536421	9.552682103	0	0	47.76341052	0	0	0	0	0	0	0	0	0												18.5459	0.319487958	8.085874009	0	4.947321526	0.461524655	0	0.972373471	3.601092907	0.563920379	3.443492376	0.092989189	0.282242075	0.406855364	1.140187966	16.06549318	0.658697291	0.596286474	0	0	1.336249458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.52	0	NO	2.88076134	18.5459	0.319487958	8.085874009	0	4.947321526	0.461524655	0	0.972373471	3.601092907	0.563920379	3.443492376	0.092989189	0.282242075	0.406855364	1.140187966	16.06549318	0.658697291	0.596286474	0	0	1.336249458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.52	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.5459	0.319487958	8.085874009	0	4.947321526	0.461524655	0	0.972373471	3.601092907	0.563920379	3.443492376	0.092989189	0.282242075	0.406855364	1.140187966	16.06549318	0.658697291	0.596286474	0	0	1.336249458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.52
H3312_018_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1807.920062	104.6143003	1681.50879	1011.027084	306.247166	14.97106864	0	267.1619576	306.4594759	4766.087966	3094.843645	111.2192144	0.467947968	641.5857357	3398.373595	9417.436186	277.3164909	789.3739118	0	0	334.9640702	0	0	0	2042.994534	118.1167564	98.1579693	12.43334278	22.82352344	0											6700	$240/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-8, $50/d 9-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	173.4852187	96.15686456	65.01219309	0	175	0.03	0.03	62.5	200	4	24.43685656	40	0.2	40	15	40	40	20	40	40	50	0	0	0	0	0	0	0	0	0											NO	160.7242948	89.08392519	60.23013928	0	162.1276544	0.027793312	0	57.90273372	185.2887479	3.705774958	22.63937278	37.05774958	0.185288748	37.05774958	13.89665609	37.05774958	37.05774958	18.52887479	0	0	46.32218698	0	0	0	0	0	0	0	0	0												24.2147	0.776621042	8.439792385	0	4.137594558	0.416095584	0	1.289117308	4.731957714	1.471837453	5.838776581	0.34346115	0.086705493	1.981310294	3.935502427	29.08241599	0.856393756	1.218850865	0	0	1.293022358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1142	0	NO	7.154737701	24.2147	0.776621042	8.439792385	0	4.137594558	0.416095584	0	1.289117308	4.731957714	1.471837453	5.838776581	0.34346115	0.086705493	1.981310294	3.935502427	29.08241599	0.856393756	1.218850865	0	0	1.293022358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1142	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		24.2147	0.776621042	8.439792385	0	4.137594558	0.416095584	0	1.289117308	4.731957714	1.471837453	5.838776581	0.34346115	0.086705493	1.981310294	3.935502427	29.08241599	0.856393756	1.218850865	0	0	1.293022358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1142
H3312_025_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1967.066382	186.9469098	1646.768136	1470.164929	296.6122226	11.67363293	0	195.0252795	304.3167115	3423.896812	3068.306695	183.812706	0	300.2456093	3204.250895	11086.22472	413.0200036	887.6662022	0	0	317.6639527	0	0	0	1975.179479	44.87871889	120.7082784	9.285252185	35.98848369	0											6700	$125/day 1-10; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$0 to $25 per visit	$0 to $25 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$25 per visit	20% per visit	$0 to 175 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	102.4559256	96.15686456	71.93854446	0	150	0.03	0.03	62.5	175	2.5	18.25127344	25	0.2	25	5	25	25	12.5	25	25	50	0	0	0	0	0	0	0	0	0											NO	96.94002885	90.98008899	68.06560516	0	141.9244836	0.028384897	0	59.1352015	165.5785642	2.36540806	17.26868372	23.6540806	0	23.6540806	4.73081612	23.6540806	23.6540806	11.8270403	0	0	47.3081612	0	0	0	0	0	0	0	0	0												15.8906	1.417370541	9.340689144	0	3.50804471	0.331354865	0	0.9610716	4.199027012	0.674909426	4.415468158	0.362326714	0	0.591836153	1.263226815	21.85287109	0.814134038	0.874871996	0	0	1.252341457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7502	0	NO	3.854990802	15.8906	1.417370541	9.340689144	0	3.50804471	0.331354865	0	0.9610716	4.199027012	0.674909426	4.415468158	0.362326714	0	0.591836153	1.263226815	21.85287109	0.814134038	0.874871996	0	0	1.252341457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7502	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.8906	1.417370541	9.340689144	0	3.50804471	0.331354865	0	0.9610716	4.199027012	0.674909426	4.415468158	0.362326714	0	0.591836153	1.263226815	21.85287109	0.814134038	0.874871996	0	0	1.252341457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7502
H3312_040_0	2012	2																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1632.205419	58.52111266	1367.919821	1065.634128	266.7405664	13.10565259	0	273.0769598	339.3002621	3571.82227	2574.72514	61.13029979	0.05161963	569.0493286	2529.597651	7993.434062	211.1141122	817.1101485	0	0	302.345859	0.004335779	0	0	1545.482742	33.30827362	65.10434891	3.996992835	93.04991295	0											6700	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-8, $50/d 9-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$30 per visit	20% per visit	$0 to 200 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	144.5710156	96.15686456	65.01219309	0	175	0.03	0.03	62.5	200	3	20.31313448	30	0.2	30	15	30	30	15	30	30	50	0	0	0	0	0	0	0	0	0											NO	134.9848716	89.78094235	60.70139648	0	163.3961858	0.028010775	0	58.35578066	186.7384981	2.801077472	18.96622113	28.01077472	0.186738498	28.01077472	14.00538736	28.01077472	28.01077472	14.00538736	0	0	46.68462453	0	0	0	0	0	0	0	0	0												18.3603	0.437840053	6.919553615	0	3.632032596	0.367099482	0	1.327968264	5.280035113	0.833745908	4.069400529	0.142692255	0.009639372	1.328292712	2.952332914	18.65852339	0.492789153	0.953662012	0	0	1.176241909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9421	0	NO	4.753989287	18.3603	0.437840053	6.919553615	0	3.632032596	0.367099482	0	1.327968264	5.280035113	0.833745908	4.069400529	0.142692255	0.009639372	1.328292712	2.952332914	18.65852339	0.492789153	0.953662012	0	0	1.176241909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9421	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.3603	0.437840053	6.919553615	0	3.632032596	0.367099482	0	1.327968264	5.280035113	0.833745908	4.069400529	0.142692255	0.009639372	1.328292712	2.952332914	18.65852339	0.492789153	0.953662012	0	0	1.176241909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9421
H3312_043_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1220.077984	207.9687798	888.1005629	1202.030206	210.1963537	10.08928472	0	249.4096445	326.2142777	3120.301259	2422.885049	109.1991581	0.032651886	485.8968622	2147.157964	7345.351037	402.3170525	767.3543998	0	0	269.135227	0.002747066	0	0	1570.019425	43.14749126	103.832707	11.21834773	60.31282966	0											6700	$175/day 1-10; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	143.44	96.15686456	71.93854446	0	150	0.03	0.03	62.5	200	4	24.43685656	40	0.2	40	10	40	40	20	40	40	50	0	0	0	0	0	0	0	0	0											NO	132.784603	89.013881	66.59461147	0	138.8572954	0.027771459	0	57.85720643	185.1430606	3.702861211	22.62157207	37.02861211	0.185143061	37.02861211	9.257153029	37.02861211	37.02861211	18.51430606	0	0	46.28576514	0	0	0	0	0	0	0	0	0												13.5006	1.542675685	4.928559328	0	2.432274765	0.280194158	0	1.202512107	5.033025814	0.962836875	4.567455731	0.336957772	0.00604527	1.499340537	1.656380821	22.66567953	1.24143684	1.183919518	0	0	1.038094159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.078	0	NO	5.141987262	13.5006	1.542675685	4.928559328	0	2.432274765	0.280194158	0	1.202512107	5.033025814	0.962836875	4.567455731	0.336957772	0.00604527	1.499340537	1.656380821	22.66567953	1.24143684	1.183919518	0	0	1.038094159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.078	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		13.5006	1.542675685	4.928559328	0	2.432274765	0.280194158	0	1.202512107	5.033025814	0.962836875	4.567455731	0.336957772	0.00604527	1.499340537	1.656380821	22.66567953	1.24143684	1.183919518	0	0	1.038094159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.078
H3312_048_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1134.848675	65.04673337	685.5876015	776.039332	211.5592451	13.70282328	0	294.7320798	295.9819252	5069.406637	2735.634527	67.68564688	0	584.6557257	3146.438898	4863.605636	214.7471251	1278.644859	0	0	292.1770883	0.491475194	0	0	1051.756916	99.27798928	41.77539153	7.863603111	35.31904874	0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-8, $50/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$30 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	54.9293584	0	175	0.03	0.03	62.5	200	3	16.23299738	30	0.2	30	10	30	30	15	30	30	50	0	0	0	0	0	0	0	0	0											NO	169.6918896	90.29217912	51.57917212	0	164.3266076	0.028170276	0	58.68807413	187.8018372	2.817027558	15.24293366	28.17027558	0	28.17027558	9.39009186	28.17027558	28.17027558	14.08513779	0	0	46.9504593	0	0	0	0	0	0	0	0	0												16.0479	0.489434275	2.946836742	0	2.897067753	0.386012308	0	1.441438179	4.632162445	1.19005485	3.474924635	0.15889361	0	1.372492743	2.462112524	11.41742592	0.504123808	1.500824085	0	0	1.143154041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0648	0	NO	3.381731698	16.0479	0.489434275	2.946836742	0	2.897067753	0.386012308	0	1.441438179	4.632162445	1.19005485	3.474924635	0.15889361	0	1.372492743	2.462112524	11.41742592	0.504123808	1.500824085	0	0	1.143154041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0648	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		16.0479	0.489434275	2.946836742	0	2.897067753	0.386012308	0	1.441438179	4.632162445	1.19005485	3.474924635	0.15889361	0	1.372492743	2.462112524	11.41742592	0.504123808	1.500824085	0	0	1.143154041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0648
H3312_801_0	2012	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	0	0	0	0	0	0	0											0	YES	308.627206	2.747143092	40.69337841	6.999050922	8.121891988	10.4227611	0	11.03638045	42.43761164	27.19573363	60.05948632	0.611067889	0.012708417	28.28408448	30.29339069	195.4571639	3.943487312	7.781201017	0	0	56.31031948	5.61E-05	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	NO	0.062904923	0.062904923	0.154840387	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.051161955	0.051161955	0.125935088	0	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0.18218412	0	0	0	0	0	0	0	0												15.79	0.140549212	5.124724192	0	1.479679748	1.898861563	0	2.010653264	7.731458948	4.954630809	10.94188469	0.111326866	0.002315272	5.152911051	5.518974737	35.60919147	0.718440767	1.417611263	0	0	10.25884602	1.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.862	0	NO	24.98660152	15.79	0.140549212	5.124724192	0	1.479679748	1.898861563	0	2.010653264	7.731458948	4.954630809	10.94188469	0.111326866	0.002315272	5.152911051	5.518974737	35.60919147	0.718440767	1.417611263	0	0	10.25884602	1.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.862	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.79	0.140549212	5.124724192	0	1.479679748	1.898861563	0	2.010653264	7.731458948	4.954630809	10.94188469	0.111326866	0.002315272	5.152911051	5.518974737	35.60919147	0.718440767	1.417611263	0	0	10.25884602	1.02E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.862
H3312_804_0	2012	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	0	0	0	0	0	0	0											0	YES	337.032456	3.902354456	44.15008696	9.686489405	8.029525636	10.30891082	0	9.474271998	34.7830376	27.94578491	56.62278815	0.644767394	0	23.18869153	29.7875154	214.2755288	3.119417437	7.286656362	0	0	76.03539007	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	NO	0.058847685	0.058847685	0.149329436	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.047573847	0.047573847	0.120721415	0	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0.181086848	0	0	0	0	0	0	0	0												16.0339	0.185650014	5.329860957	0	1.454041487	1.866808165	0	1.715666052	6.298750638	5.060614101	10.25364222	0.116758895	0	4.199167055	5.39412727	38.80248008	0.564885471	1.319517632	0	0	13.76900912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.3649	0	NO	26.62773425	16.0339	0.185650014	5.329860957	0	1.454041487	1.866808165	0	1.715666052	6.298750638	5.060614101	10.25364222	0.116758895	0	4.199167055	5.39412727	38.80248008	0.564885471	1.319517632	0	0	13.76900912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.3649	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		16.0339	0.185650014	5.329860957	0	1.454041487	1.866808165	0	1.715666052	6.298750638	5.060614101	10.25364222	0.116758895	0	4.199167055	5.39412727	38.80248008	0.564885471	1.319517632	0	0	13.76900912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.3649
H3327_001_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1765.20752	92.50852853	1079.830985	285.5795895	353.983192	6.201208876	4.871070099	234.9195276	1130.491807	1416.881414	253.0443984	0	0	621.1353299	7969.472698	12747.25354	332.2009541	638.5017895	6529.769259	2205.191228	12.62597998	956.7245726	0	678.165289	72.61672539	0	0	1.457191814	2.463850425	5.297953039											3400	1a: $100 per day (days 1-5)	1b: $100 per day (days 1-5)	b: $25 per day (days 1-20); $65 per day (days 21-100)	6: $0 Copay	10a: $75 Copay	11a: 0.2 Coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $150 Copay; 9b: $100 Copay	8a: $0 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $25 Other Radiology			3: $15 Copay; 9c: $25 Copay; 9d: $15 Copay; 12: $0Copay; 9a: $15 Copay;	7a: $5 Copay; 14c: $0 Copay	7b: $15 Copay; 7d: $15 Copay; 9a: $0 Copay; 7f: $15 Copay; 7g: $0 Copay	7e: $15 Copay; 7h: $15 Copay	7c: $15 Copay; 7i: $15 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $25 Other Radiology 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $25 Copay; 18a: $25 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $100 per day (days 1-5)													46.16356646	46.16356646	44.02	0	75	0.2	0.16599585	50	17.89011449	0	16.2250996	0	0	15.48459166	4.950598779	10.6400219	15	15	9.964592843	0	0.2	24.53672228	0	0	0	0	0	0	0	0											NO	44.60896691	44.60896691	42.53758697	0	72.47430766	0.19326482	0.160405791	48.3162051	17.28764882	0	15.6787048	0	0	14.96313413	4.78388292	10.28170961	14.49486153	14.49486153	9.629026232	0	0.19326482	23.71042613	0	0	0	0	0	0	0	0												6.562	0.343892491	3.827783704	0	2.137890564	1.19847552	0.78134785	0.94586834	1.628628779	0	0.330617369	0	0	0.774510938	3.17708536	10.92196326	0.401267236	0.771249586	5.239609957	0	2.440157754	1.890362275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3727			1.511516912	6.562	0.343892491	3.827783704	0	2.137890564	1.19847552	0.78134785	0.94586834	1.628628779	0	0.330617369	0	0	0.774510938	3.17708536	10.92196326	0.401267236	0.771249586	5.239609957	0	2.440157754	1.890362275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3727	NO																																																																																		0			0	6.562	0.343892491	3.827783704	0	2.137890564	1.19847552	0.78134785	0.94586834	1.628628779	0	0.330617369	0	0	0.774510938	3.17708536	10.92196326	0.401267236	0.771249586	5.239609957	0	2.440157754	1.890362275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3727
H3327_002_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1724.001978	126.4098753	972.7871218	291.5249596	472.7969277	5.949789377	5.87142579	309.6146015	1324.823095	1331.087843	370.500676	0	0	675.8902677	13788.95057	7784.631331	573.8186468	1140.214478	6855.274803	2263.337047	11.13894236	1058.58064	1658.292485	665.0018238	0	0	0	0	2.416026083	23332.75266											1700	1a: $50 per day (days 1-5)	1b: $50 per day (days 1-5)	"b: $0 per day (days 1-20), $50 per day (days 21-100)"	6: $0 Copay	10a: $0 Copay	11a: 0.2 Coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $10 Copay	9a: $50 Copay; 9b: $25 Copay	8a: $0 Copay	8b: $10 for X-Ray; $25 for MRI/CT/PET; $10 Other Radiology			3: $10 Copay; 9c: $10 Copay; 9d: $10 Copay; 12: $0Copay; 9a: $10 Copay;	7a: $0 Copay; 14c: $0 Copay	7b: $10 Copay; 7d: $10 Copay; 9a: $0 Copay; 7f: $10 Copay; 7g: $0 Copay	7e: $10 Copay; 7h: $10 Copay	7c: $10 Copay; 7i: $10 Copay	8b: $10 for X-Ray; $25 for MRI/CT/PET; $10 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $10 Copay; 18a: $10 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay					14a: $0 Copay	1a: $50 per day (days 1-5)													23.4293605	23.4293605	27.16621326	0	0	0.2	0.173792601	50	4.575947454	0	11.55112652	0	0	9.907796425	0	5.329744544	10	10	6.084765667	0	0.2	9.880862597	0	0	0	0	0	0	0	0											NO	22.35842391	22.35842391	25.92446824	0	0	0.190858166	0.165848686	47.71454157	4.3667847	0	11.02313413	0	0	9.454919287	0	5.086126352	9.542908313	9.542908313	5.806636087	0	0.190858166	9.429216582	0	0	0	0	0	0	0	0												3.2122	0.235527131	2.101582403	0	0	1.13556589	0.973768251	1.231093231	0.482101435	0	0.340339887	0	0	0.532540661	0	3.299468213	0.456324895	0.906746852	3.317173838	0	2.125958113	0.831798844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1822			1.01459492	3.2122	0.235527131	2.101582403	0	0	1.13556589	0.973768251	1.231093231	0.482101435	0	0.340339887	0	0	0.532540661	0	3.299468213	0.456324895	0.906746852	3.317173838	0	2.125958113	0.831798844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1822	NO																																																																																		0			0	3.2122	0.235527131	2.101582403	0	0	1.13556589	0.973768251	1.231093231	0.482101435	0	0.340339887	0	0	0.532540661	0	3.299468213	0.456324895	0.906746852	3.317173838	0	2.125958113	0.831798844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1822
H3327_021_0	2012	5																															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	V																																																			0	YES	234.2114762	26.31294026	472.6255513	184.3084069	273.6563616	7.262028015	4.238279269	380.5730808	2103.637287	2825.849902	634.2939438	0	0	919.0869026	4051.574197	9648.567624	255.0679835	446.3754962	5318.082458	1504.352729	15.21386626	753.8776591	0	676.2240718	170.7997036	0	0	1.045204879	2.344525769	2.980708418											3400	1a: $300 per admit	1b: $300 per admit	b: $25 per day (days 1-20); $100 per day (days 21-100)	6: $0 Copay	10a: $85 Copay	11a: 0.2 Coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $100 Copay; 9b: $100 Copay	8a: $0 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $30 Other Radiology			3: $30 Copay; 9c: $30 Copay; 9d: $30 Copay; 12: $0Copay; 9a: $30 Copay;	7a: $15 Copay; 14c: $0 Copay	7b: $20 Copay; 7d: $30 Copay; 9a: $0 Copay; 7f: $30 Copay; 7g: $0 Copay	7e: $30 Copay; 7h: $30 Copay	7c: $30 Copay; 7i: $30 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $30 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $30 Copay; 18a: $30 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $300 per admit													300	300	52.73223387	0	85	0.2	0.156903354	50	14.91464009	0	21.74814815	0	0	29.97295275	14.40580023	19.97275513	30	30	10.60105132	0	0.2	28.91063201	0	0	0	0	0	0	0	0											NO	291.1465415	291.1465415	51.17602506	0	82.49152009	0.194097694	0.152272896	48.52442358	14.47448626	0	21.10632706	0	0	29.08840511	13.98066305	19.3833286	29.11465415	29.11465415	10.28819809	0	0.194097694	28.05743507	0	0	0	0	0	0	0	0												5.6825	0.638410129	2.015591421	0	1.881194104	1.409542894	0.645375059	1.538924115	2.537422418	0	1.115634619	0	0	2.22789768	4.720307806	15.58511307	0.618851344	1.083005683	4.559457151	0	2.952976362	1.762656123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9748			1.550091245	5.6825	0.638410129	2.015591421	0	1.881194104	1.409542894	0.645375059	1.538924115	2.537422418	0	1.115634619	0	0	2.22789768	4.720307806	15.58511307	0.618851344	1.083005683	4.559457151	0	2.952976362	1.762656123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9748	NO																																																																																		0			0	5.6825	0.638410129	2.015591421	0	1.881194104	1.409542894	0.645375059	1.538924115	2.537422418	0	1.115634619	0	0	2.22789768	4.720307806	15.58511307	0.618851344	1.083005683	4.559457151	0	2.952976362	1.762656123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9748
H3327_022_0	2012	4																															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	V																																																			0	YES	222.0498915	15.64765554	465.7622184	195.703518	15.26666043	4.191213548	4.320444725	272.0363616	1363.75645	1993.052449	445.4284934	0	0	606.977048	9006.80028	7119.803069	274.5202902	604.7499759	4437.293224	1222.776505	14.1169861	810.2954322	0	715.4650843	97.36196128	0	0	0.352595185	2.500865736	2.946173134											3400	1a: $250 per admit	1b: $250 per admit	b: $25 per day (days 1-20); $100 per day (days 21-100)	6: $0 Copay	10a: $0 Copay	11a: 0.2 coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $100 Copay; 9b: $100 Copay	8a: $0 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $20 Other Radiology			3: $20 Copay; 9c: $20 Copay; 9d: $20 Copay; 12: $0Copay; 9a: $20 Copay;	7a: $5 Copay; 14c: $0 Copay	7b: $20 Copay; 7d: $20 Copay; 9a: $0 Copay; 7f: $20 Copay; 7g: $0 Copay	7e: $20 Copay; 7h: $20 Copay	7c: $20 Copay; 7i: $20 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $20 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $0 Copay; 18a: $20 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $250 per admit													250	250	59.88635028	0	0	0.2	0.16565326	50	14.40747217	0	19.71428571	0	0	19.94788044	4.955411612	13.49399749	20	20	12.89915372	0	0.2	0.782125565	0	0	0	0	0	0	0	0											NO	242.910603	242.910603	58.18811784	0	0	0.194328482	0.160955733	48.5821206	13.99891102	0	19.15523612	0	0	19.38220667	4.814888092	13.11134027	19.43284824	19.43284824	12.53336483	0	0.194328482	0.759946371	0	0	0	0	0	0	0	0												4.4949	0.316748454	2.258485571	0	0	0.814472168	0.695400349	1.101341944	1.590925433	0	0.711023997	0	0	0.980379549	3.613894618	7.779180057	0.444559262	0.979334542	4.634517904	0	2.743332485	0.051315089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2098			0.762078911	4.4949	0.316748454	2.258485571	0	0	0.814472168	0.695400349	1.101341944	1.590925433	0	0.711023997	0	0	0.980379549	3.613894618	7.779180057	0.444559262	0.979334542	4.634517904	0	2.743332485	0.051315089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2098	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance		20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											5100	5.5638	0	0.1469	0.001	1.9674	0.0928	0.0584	0.1198	0.3226	0.0409	0.0407	0	0	0.0011	0.0338	4.1737	0	0.3482	1.1702	0.3055	0.0147	0.0684	0	0	0	0	0	0	0	0											14.47			0.332377071	10.0586	0.316748454	2.4053842	0.001039778	1.967398044	0.907268737	0.753808159	1.221102609	1.913535573	0.040947504	0.751730927	0	0	0.98149477	3.647738894	11.95284853	0.444559262	1.327569662	5.804715153	0.305480984	2.758044376	0.119758334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6798
H3327_023_0	2012	6																															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	V																																																			0	YES	211.7378052	21.26309729	412.2363751	125.8700639	26.16892887	4.862269482	3.055028219	229.8644422	2115.762146	2824.735388	643.1740681	0	0	914.3718227	8630.088831	9024.362854	345.9569556	841.453622	5281.748029	1434.119945	14.45786569	813.891536	0	671.0804834	148.4746846	0	0	2.131583944	2.424345423	2.711920803											3400	1a: $250 per admit	1b: $250 per admit	b: $25 per day (days 1-20); $100 per day (days 21-100)	6: $0 Copay	10a: $0 Copay	11a: 0.2 coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $100 Copay; 9b: $100 Copay	8a: $0 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $20 Other Radiology			3: $20 Copay; 9c: $20 Copay; 9d: $20 Copay; 12: $0Copay; 9a: $20 Copay;	7a: $5 Copay; 14c: $0 Copay	7b: $20 Copay; 7d: $20 Copay; 9a: $0 Copay; 7f: $20 Copay; 7g: $0 Copay	7e: $20 Copay; 7h: $20 Copay	7c: $20 Copay; 7i: $20 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $20 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $20 Copay; 18a: $20 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $250 per admit													250	250	52.76009725	0	0	0.2	0.142877394	50	15.18811093	0	19.17825537	0	0	19.97730076	4.914875143	12.84241088	20	20	10.75839194	0	0.2	19.51706538	0	0	0	0	0	0	0	0											NO	242.9368737	242.9368737	51.26949232	0	0	0.194349499	0.138840749	48.58737473	14.75900875	0	18.63642161	0	0	19.41289197	4.776017607	12.47958059	19.43494989	19.43494989	10.45444041	0	0.194349499	18.96565939	0	0	0	0	0	0	0	0												4.2866	0.430465865	1.761262472	0	0	0.944979637	0.424162407	0.930709149	2.602212668	0	0.998871925	0	0	1.479216784	3.434788017	9.385021962	0.560304675	1.362800748	4.601476669	0	2.809878953	1.286332471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2991			0.888816481	4.2866	0.430465865	1.761262472	0	0	0.944979637	0.424162407	0.930709149	2.602212668	0	0.998871925	0	0	1.479216784	3.434788017	9.385021962	0.560304675	1.362800748	4.601476669	0	2.809878953	1.286332471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2991	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance		20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											5100	3.8087	0	0.6833	0.0387	1.0735	0.2759	0.1667	0.2143	0.3666	0.0518	0.3129	0	0	0	0.0365	3.6566	0	0.4668	1.0964	0.3611	0.1527	0.152	0	0	0.0049	0	0	0.0147	0	0											12.9342			0.308214427	8.0953	0.430465865	2.444523402	0.038666737	1.073516563	1.220887006	0.590868046	1.144987078	2.968858167	0.051758614	1.311770891	0	0	1.479216784	3.471264972	13.04163117	0.560304675	1.829589037	5.697900397	0.361139562	2.962555814	1.43835463	0	0	0.004922628	0	0	0.014740982	0	0	0	0	0	0	0	0	0	0	0	0	50.2332
H3327_026_0	2012	7																															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	V																																																			0	YES	377.3594473	78.62996332	966.8221723	475.3827763	2277.950575	9.410350542	6.825944071	492.4397485	1469.375123	1173.587752	313.5073227	0	0	869.9916213	7135.682784	13536.74923	731.9973237	1026.779962	6028.514922	2492.561526	15.06830382	875.2392237	0	699.0048698	42.23571413	0	0	0.198291783	0	24644.59028											3400	1a: $0 per admit	1b: $0 per admit	b: $0 per day	6: $0 Copay	10a: $0 Copay	11a: 0 Coinsurance	11b: 0 Coinsurance; 11c: 0 Coinsurance	4a: $0 Copay; 4b: $0 Copay	9a: $0 Copay; 9b: $0 Copay	8a: $0 Copay	8b: $0 Copay			3: $0 Copay; 9c: $0 Copay; 9d: $0 Copay; 12: $0Copay; 9a: $0 Copay;	7a: $0 Copay; 14c: $0 Copay	7b: $0 Copay; 7d: $0 Copay; 9a: $0 Copay; 7f: $0 Copay; 7g: $0 Copay	7e: $0 Copay; 7h: $0 Copay	7c: $0 Copay; 7i: $0 Copay	8b: $0 Copay; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $0 Copay; 18a: $0 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $0 per admit													0	0	0	0	0	0	0	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	0
H3327_027_0	2012	6																															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	V																																																			0	YES	430.7263589	52.530732	1293.031876	459.1976954	1924.187794	6.815820319	5.99256653	626.3221038	1856.345969	1754.879312	481.8411402	0	0	1564.09873	8057.137236	13752.82291	685.1674316	957.678214	6761.439267	2667.319998	10.94125959	850.5568384	0	0	94.61267272	0	0	6.23667174	0	15590.15176											3400	1a: $0 per admit	1b: $0 per admit	b: $0 per day	6: $0 Copay	10a: $0 Copay	11a: 0 Coinsurance	11b: 0 Coinsurance; 11c: 0 Coinsurance	4a: $0 Copay; 4b: $0 Copay	9a: $0 Copay; 9b: $0 Copay	8a: $0 Copay	8b: $0 Copay			3: $0 Copay; 9c: $0 Copay; 9d: $0 Copay; 12: $0Copay; 9a: $0 Copay;	7a: $0 Copay; 14c: $0 Copay	7b: $0 Copay; 7d: $0 Copay; 9a: $0 Copay; 7f: $0 Copay; 7g: $0 Copay	7e: $0 Copay; 7h: $0 Copay	7c: $0 Copay; 7i: $0 Copay	8b: $0 Copay; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $0 Copay; 18a: $0 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $0 per admit													0	0	0	0	0	0	0	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	0
H3327_036_0	2012	6																															A	A	A	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	V																																																			0	YES	299.778143	100.744443	906.8462806	257.4959286	378.6304493	4.053378563	3.663123849	248.2603556	1109.972933	1216.75061	300.2478437	0	0	586.1100622	10175.10555	8784.519779	427.3703276	835.9189061	6135.377397	1994.787316	9.766567667	936.7620286	0	683.5188719	63.77609971	0	0	0.972844567	2.16891477	3.516486038											3400	1a: $150 per admit	1b: $150 per admit	b: $25 per day (days 1-20); $65 per day (days 21-100)	6: $0 Copay	10a: $0 Copay	11a: 0.2 coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $35 Copay; 9b: $35 Copay	8a: $0 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $10 Other Radiology			3: $10 Copay; 9c: $10 Copay; 9d: $10 Copay; 12: $0Copay; 9a: $10 Copay;	7a: $0 Copay; 14c: $0 Copay	7b: $10 Copay; 7d: $10 Copay; 9a: $0 Copay; 7f: $10 Copay; 7g: $0 Copay	7e: $10 Copay; 7h: $10 Copay	7c: $10 Copay; 7i: $10 Copay	8b: $10 for X-Ray; $50 for MRI/CT/PET; $10 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $10 Copay; 18a: $10 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $ Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $150 per admit													150	150	37.6	0	0	0.2	0.17114569	50	5.54676657	0	14.21297321	0	0	9.927190979	0	6.284986624	10	10	9.394547269	0	0.2	9.853642673	0	0	0	0	0	0	0	0											NO	145.9655289	145.9655289	36.58869258	0	0	0.194620705	0.166542474	48.65517631	5.397578107	0	13.83069435	0	0	9.660184546	0	6.115942645	9.731035261	9.731035261	9.141867074	0	0.194620705	9.58861443	0	0	0	0	0	0	0	0												3.6464	1.225434659	2.765026648	0	0	0.788871394	0.610065708	1.006595948	0.4992638	0	0.346053013	0	0	0.471827614	0	4.477134927	0.346562977	0.677863029	4.674067051	0	1.900776287	0.748520825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1845			0.668457003	3.6464	1.225434659	2.765026648	0	0	0.788871394	0.610065708	1.006595948	0.4992638	0	0.346053013	0	0	0.471827614	0	4.477134927	0.346562977	0.677863029	4.674067051	0	1.900776287	0.748520825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1845	NO																																																																																		0			0	3.6464	1.225434659	2.765026648	0	0	0.788871394	0.610065708	1.006595948	0.4992638	0	0.346053013	0	0	0.471827614	0	4.477134927	0.346562977	0.677863029	4.674067051	0	1.900776287	0.748520825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1845
H3327_037_0	2012	6																															D	D	A	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	V																																																			0	YES	339.8537757	114.5491851	1029.367005	294.8201566	431.7259693	6.563952249	5.931982335	285.3651536	1268.661962	1393.119523	341.002611	0	0	663.7822097	11649.99472	10063.59331	490.6651887	957.9178022	6942.133702	2283.933233	15.81576525	1116.689931	0	0	73.02049319	0	0	1.113859117	2.483300592	4.026203326											3400	1a: $200 per day (days 1-5)	1a: $200 per day (days 1-5)	b: $25 per day (days 1-20); $65 per day (days 21-100)	6: $0 Copay	10a: $75 Copay	11a: 0.2 coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $150 Copay; 9b: $150 Copay	8a: $0 Copay	8b: $10 for X-Ray; $100 for MRI/CT/PET; $25 Other Radiology			3: $10 Copay; 9c: $25 Copay; 9d: $10 Copay; 12: $0Copay; 9a: $10 Copay;	7a: $0 Copay; 14c: $0 Copay	7b: $10 Copay; 7d: $10 Copay; 9a: $0 Copay; 7f: $10 Copay; 7g: $0 Copay	7e: $10 Copay; 7h: $10 Copay	7c: $10 Copay; 7i: $10 Copay	8b: $10 for X-Ray; $100 for MRI/CT/PET; $25 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $0 Copay; 18a: $0 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $0 Copay	18b: $0 Copay	14a: $0 Copay	1a: $200 per day (days 1-5)													93.37643707	93.37643707	43.97	0	75	0.2	0.17114569	50	23.58699237	0	24.69112564	0	0	11.41134545	0	6.287109553	10	10	16.22552587	0	0.2	0	0	0	0	0	0	0	0	0											NO	87.43514186	87.43514186	41.17230544	0	70.22794878	0.18727453	0.160256143	46.81863252	22.08621456	0	23.12009475	0	0	10.68527178	0	5.887077435	9.363726503	9.363726503	15.19313867	0	0.18727453	0	0	0	0	0	0	0	0	0												2.4763	0.834635354	3.531784395	0	2.526602438	1.229261073	0.950636609	1.113367188	2.334995024	0	0.657001056	0	0	0.591057776	0	4.937096089	0.382871219	0.747473359	8.789399998	0	2.961890004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0643			2.3147017	2.4763	0.834635354	3.531784395	0	2.526602438	1.229261073	0.950636609	1.113367188	2.334995024	0	0.657001056	0	0	0.591057776	0	4.937096089	0.382871219	0.747473359	8.789399998	0	2.961890004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0643	NO																																																																																		0			0	2.4763	0.834635354	3.531784395	0	2.526602438	1.229261073	0.950636609	1.113367188	2.334995024	0	0.657001056	0	0	0.591057776	0	4.937096089	0.382871219	0.747473359	8.789399998	0	2.961890004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0643
H3327_038_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1383.897997	140.1961255	575.1611077	160.7415083	23.1152783	10.76708566	6.807491909	296.8139368	2602.572176	3494.072409	835.6051137	0	0	1128.019198	10218.48572	11154.70153	426.7644138	1079.171091	6604.911088	1830.680315	34.389885	1181.428278	0	828.8343139	192.1918841	0	0	3.507235946	2.994246927	3.346516336											3400	1a: $150 per day (days 1-5)	1a: $150 per day (days 1-5)	b: $25 per day (days 1-20); $100 per day (days 21-100)	6: $0 Copay	10a: $0 Copay	11a: 0.2 coinsurance	11b: 0.2 Coinsurance; 11c: 0 Coinsurance	4a: $50 Copay; 4b: $20 Copay	9a: $150 Copay; 9b: $150 Copay	8a: $0 Copay	8b: $10 for X-Ray; $100 for MRI/CT/PET; $20 Other Radiology			3: $ Copay; 9c: $20 Copay; 9d: $20 Copay; 12: $0Copay; 9a: $20 Copay;	7a: $11 Copay; 14c: $0 Copay	7b: $20 Copay; 7d: $22 Copay; 9a: $0 Copay; 7f: $20 Copay; 7g: $0 Copay	7e: $20 Copay; 7h: $20 Copay	7c: $20 Copay; 7i: $20 Copay	8b: $10 for X-Ray; $100 for MRI/CT/PET; $20 Other Radiology; 8a: $0 Copay	7g: $0 Copay; 14b: $0 Copay; 14d: $0 Copay; 14e: $0 Copay; 14f: $0 Copay; 14g: $0 Copay; 14h: $0 Copay; 14i: $0 Copay; 14j: $0 Copay; Dialysis $0	15: 0.2 Coinsurance	13a: $0 Copay; 13b: $0 Copay; 13c: $0 Copay; 17b: $0 Copay; 17a: $ Copay; 18a: $20 Copay	10b: $0 Copay	16a: $0 Copay; 16b: $0 Copay	17a: $0 Copay	17b: $0 Copay	18a: $ Copay	18b: $ Copay	14a: $0 Copay	1a: $150 per day (days 1-5)													70.0385166	70.0385166	62.5965068	0	0	0.167703798	0.12840174	50	21.93818876	0	23.25825087	0	0	19.93839445	10.80805042	14.32171683	20	20	16.83029829	0	0.194420434	0.900663631	0	0	0	0	0	0	0	0											NO	66.80173436	66.80173436	59.70365197	0	0	0.159953482	0.122467741	47.68928413	20.92433034	0	22.18338669	0	0	19.01695516	10.30856374	13.65984847	19.07571365	19.07571365	16.05249755	0	0.185435427	0.859040076	0	0	0	0	0	0	0	0												7.7039	0.780445361	2.86160155	0	0	1.722232839	0.833698157	1.179570347	4.538089996	0	1.544712613	0	0	1.787624209	8.778159282	12.69762772	0.67840298	1.71549656	8.835443253	0	6.377102994	0.08457452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1187			2.476506225	7.7039	0.780445361	2.86160155	0	0	1.722232839	0.833698157	1.179570347	4.538089996	0	1.544712613	0	0	1.787624209	8.778159282	12.69762772	0.67840298	1.71549656	8.835443253	0	6.377102994	0.08457452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1187	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											5100	6.517	0	0.6903	0.0354	1.9695	0.3428	0.1854	0.2533	0.632	0.0829	0.2989	0	0	0.0011	0.068	6.3956	0	0.7392	1.6834	0.5394	0.1892	0.1931	0	0	0.0042	0	0	0.0124	0	0											20.8334			0.826372781	14.2209	0.780445361	3.551949715	0.035433234	1.969538428	2.065077825	1.019147413	1.432920267	5.170110391	0.082931426	1.8436056	0	0	1.788748305	8.846176018	19.09321018	0.67840298	2.454659028	10.51885865	0.539427684	6.566284776	0.277711337	0	0	0.004193079	0	0	0.012359313	0	0	0	0	0	0	0	0	0	0	0	0	82.9521
H3327_801_0	2012	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	303.3910873	13.94726843	22.14310074	9.35920321	11.87751662	5.878295785	5.33116991	8.675137385	50.55199059	5.237475716	7.662923679	0	0	4.772725154	75.56049464	77.61955806	2.610233283	5.749845094	60.76481057	21.70369163	11.37417975	7.676037546																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223880687								0											NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223225863								0												24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038			0.324744861	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038	NO																																																																																		0			0	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038
H3327_802_0	2012	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	303.3910873	13.94726843	22.14310074	9.35920321	11.87751662	5.878295785	5.33116991	8.675137385	50.55199059	5.237475716	7.662923679	0	0	4.772725154	75.56049464	77.61955806	2.610233283	5.749845094	60.76481057	21.70369163	11.37417975	7.676037546																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223880687								0											NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223225863								0												24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038			0.324744861	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038	NO																																																																																		0			0	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038
H3327_803_0	2012	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	303.3910873	13.94726843	22.14310074	9.35920321	11.87751662	5.878295785	5.33116991	8.675137385	50.55199059	5.237475716	7.662923679	0	0	4.772725154	75.56049464	77.61955806	2.610233283	5.749845094	60.76481057	21.70369163	11.37417975	7.676037546																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223880687								0											NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223225863								0												24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038			0.324744861	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038	NO																																																																																		0			0	24.6309	1.132314429	3.857055574	0	2.652781904	1.31288696	1.190689225	1.937547065	11.29052563	1.169763112	1.711474369	0	0	1.065963477	16.87604566	17.33592683	0.582982103	1.284198162	13.57150615	4.84740727	2.540364217	1.713490109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7038
H3327_805_0	2012	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	273.1651646	14.31568695	15.43126774	7.616690794	0.902746875	4.925688474	4.520217878	8.075687648	49.87117123	5.20427101	7.317914819	0	0	4.874603157	73.06942522	55.4541468	2.529248937	3.707518216	51.92913316	17.60798511	11.04929588	6.858902513																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828																				22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946			0.290911278	22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946	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	3.1015	0	0.5707	0	2.4469	0.2117	0.1801	0.1763	0.4	0.0331	0.1146	0	0	0.0007	0.0327	4.4083	0	0.4159	1.9041	0.7636	0.0708	0.1812																			15.0121			0.046070088	25.2785	1.16222463	3.258669527	0	2.648549137	1.311779179	1.18969623	1.979987098	11.53845309	1.195458043	1.749003165	0	0	1.089407474	16.35242199	16.79371329	0.564894668	1.243944229	13.50216438	4.696258799	2.538555336	1.713050772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8067
H3327_806_0	2012	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	273.1651646	14.31568695	15.43126774	7.616690794	0.902746875	4.925688474	4.520217878	8.075687648	49.87117123	5.20427101	7.317914819	0	0	4.874603157	73.06942522	55.4541468	2.529248937	3.707518216	51.92913316	17.60798511	11.04929588	6.858902513																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828																				22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946			0.290911278	22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946	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	3.1015	0	0.5707	0	2.4469	0.2117	0.1801	0.1763	0.4	0.0331	0.1146	0	0	0.0007	0.0327	4.4083	0	0.4159	1.9041	0.7636	0.0708	0.1812																			15.0121			0.046070088	25.2785	1.16222463	3.258669527	0	2.648549137	1.311779179	1.18969623	1.979987098	11.53845309	1.195458043	1.749003165	0	0	1.089407474	16.35242199	16.79371329	0.564894668	1.243944229	13.50216438	4.696258799	2.538555336	1.713050772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8067
H3327_807_0	2012	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	273.1651646	14.31568695	15.43126774	7.616690794	0.902746875	4.925688474	4.520217878	8.075687648	49.87117123	5.20427101	7.317914819	0	0	4.874603157	73.06942522	55.4541468	2.529248937	3.707518216	51.92913316	17.60798511	11.04929588	6.858902513																			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																					0.081423544	0.081423544	0.174698662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.08118539	0.08118539	0.17418769	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828																				22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946			0.299041135	22.177	1.16222463	2.687936887	0	0.201623845	1.100127044	1.009567284	1.803663067	11.13846815	1.162347012	1.634418425	0	0	1.088717403	16.31967819	12.38539687	0.564894668	0.828055017	11.5981033	3.932652403	2.467803085	1.531900401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7946	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	3.1015	0	0.5707	0	2.4469	0.2117	0.1801	0.1763	0.4	0.0331	0.1146	0	0	0.0007	0.0327	4.4083	0	0.4159	1.9041	0.7636	0.0708	0.1812																			15.0121			0.047392013	25.2785	1.16222463	3.258669527	0	2.648549137	1.311779179	1.18969623	1.979987098	11.53845309	1.195458043	1.749003165	0	0	1.089407474	16.35242199	16.79371329	0.564894668	1.243944229	13.50216438	4.696258799	2.538555336	1.713050772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.8067
H3328_001_0	2012	3																															A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin																																																											0	YES	243.4621123	16.46005683	776.9760487	0	227.7636265	14.18049055	4.552086785	478.3646262	45.3205536	25.00898054	11.38182782	275.4362377	0.039304754	7.322407081	5428.226149	4160.801132	409.4071826	1566.77926	59.67334684	755.3273133	14.62564198																				6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 per day	PBP(6)-0 per visit	PBP(10A)-225 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-65 per visit & PBP(4B)-40 per visit incl. urgent PCP(7B)	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(9C)-40 per visit & PBP(5)-40 per visit	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed cost	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 visitPBP(3)-40 per visit	PBP(8B)-20% of allowed cost excl IPF/SNF svcs$10 copay for x-rays	"PBP(7B)-20 per visit & PBP(7F)-40per visit, PBP(7G) up to 40"	PBP(15)-20% of allowed cost	none for in-net benefits																					1100	1100	50	0	225	0.2	0.2	64.41352858	0.299135356	0.2	0.2	40	0.2	0.2	20	40	40	40	0.203495143	36.68711555	0.2																				YES	1027.293175	1027.293175	41.66773503	0	187.5048076	0.16667094	0.16667094	53.67931682	0.249285855	0.16667094	0.16667094	33.33418802	0.16667094	0.16667094	16.66709401	33.33418802	33.33418802	33.33418802	0.169583634	30.57338019	0.16667094																				5000	20.8422	1.409108671	2.697902677	0	3.558897914	2.363475691	0.758700584	2.139857194	11.29777294	4.168270298	1.897019943	0.765120278	0.00655096	1.220432472	7.539396295	11.55807727	1.137271334	4.352276204	10.119623	1.924409093	2.437669498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1941			16.06511937	20.8422	1.409108671	2.697902677	0	3.558897914	2.363475691	0.758700584	2.139857194	11.29777294	4.168270298	1.897019943	0.765120278	0.00655096	1.220432472	7.539396295	11.55807727	1.137271334	4.352276204	10.119623	1.924409093	2.437669498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1941	NO	POS(1A)-1600 per admit	POS(1B)-1600 per admit	POS(2)-50 per day						POS(9B)-50%	POS(8A)-50% of allowed cost		POS(9C)-50%				POS(7D)-50%	POS(7E)-50% per visit & POS(7H)-50%POS(5)-50%	POS(7C)-50% & POS(7I)-50%POS(3)-50%		POS(7B)-50%POS(7F)-50%POS(7G) 50%		POS(9D)-50% of allowed cost																				0.0916	0	0.3438						0.5946	0.376		0				6.7824	1.3694	0.6599		0.2449		0																			10.4625			0	20.9338	1.409108671	3.041697388	0	3.558897914	2.363475691	0.758700584	2.139857194	11.89236209	4.544246862	1.897019943	0.765120278	0.00655096	1.220432472	7.539396295	18.34046993	2.506679992	5.012186197	10.119623	2.169267739	2.437669498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.6566
H3328_002_0	2012	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	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	365.7584899	10.42454519	15.09037214	18.82007698	12.59584492	13.37590624	16.35655022	15.75903596	43.44033649	32.91079619	9.054627343	2.257012382	0.044553831	6.569747997	7450.980018	136.2602685	5.959803482	27.18732268	93.23884044	6.981323831	25.66352669	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	PBP(7A)-8 per visit	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																					0.059109513	0.059109513	0.151417431	0	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	8	0.2239	0.2239	0.2239	0.2239	0.2239	0.2229	0																			NO	0.059031479	0.059031479	0.151339397	0	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	7.999921966	0.223821966	0.223821966	0.223821966	0.223821966	0.223821966	0.222821966	0																				21.5913	0.615376321	2.283767815	0	2.819226772	2.99382163	3.660955224	3.527218407	9.722901509	7.366159101	2.026624492	0.505168948	0.009972126	1.470453912	4.967271559	30.49804117	1.333934931	6.085120008	20.86890056	1.562573624	5.718397468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6272			0.648364809	21.5913	0.615376321	2.283767815	0	2.819226772	2.99382163	3.660955224	3.527218407	9.722901509	7.366159101	2.026624492	0.505168948	0.009972126	1.470453912	4.967271559	30.49804117	1.333934931	6.085120008	20.86890056	1.562573624	5.718397468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6272	NO																																																																																		0				21.5913	0.615376321	2.283767815	0	2.819226772	2.99382163	3.660955224	3.527218407	9.722901509	7.366159101	2.026624492	0.505168948	0.009972126	1.470453912	4.967271559	30.49804117	1.333934931	6.085120008	20.86890056	1.562573624	5.718397468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6272
H3328_003_0	2012	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin																																																											0	YES	971.9659434	69.93648362	482.4193557	0	272.1216137	11.71662772	5.492586223	455.9579908	52.77792372	27.44783717	10.75980041	347.2271456	0.249344053	7.029927839	5672.469797	4666.006059	857.8876471	1947.351021	69.10519895	925.1673864	20.93750464																				6700	PBP(1A)-320 per day for days 1-5	PBP(1B)-285 per day for days 1-5	PBP(2)-50 per day	PBP(6)-0 per visit	PBP(10A)-225 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-65 per visit & PBP(4B)-30 per visit incl. urgent PCP(7B)	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(9C)-30 per visit & PBP(5)-30 per visit	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(7A)-5 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 visitPBP(3)-30 per visit	PBP(8B)-20% of allowed cost excl IPF/SNF svcs$10 copay for x-rays	"PBP(7B)-20 per visit & PBP(7F)-30per visit, PBP(7G) up to $30"	PBP(15)-20% of allowed cost	none for in-net benefits	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance	$750 Non Medicare Benefit Allowance														320	285	50	0	225	0.2	0.2	64.26193119	0.298894969	0.2	0.2	30	0.2	0.2	5	30	30	30	0.202216874	27.88777232	0.2																				YES	308.6350544	274.8780953	45.00358381	0	202.5161272	0.180014335	0.180014335	57.84034412	0.269026896	0.180014335	0.180014335	27.00215029	0.180014335	0.180014335	4.500358381	27.00215029	27.00215029	27.00215029	0.182009681	25.10099398	0.180014335																				5000	24.9986	1.602000618	1.809216659	0	4.592417943	2.10916095	0.988744258	2.197730591	14.198681	4.941004161	1.936918318	0.781323297	0.044885504	1.265487787	2.127345583	10.49934974	1.930400931	4.381888745	12.5778152	1.935218417	3.76905098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6872			9.090657806	24.9986	1.602000618	1.809216659	0	4.592417943	2.10916095	0.988744258	2.197730591	14.198681	4.941004161	1.936918318	0.781323297	0.044885504	1.265487787	2.127345583	10.49934974	1.930400931	4.381888745	12.5778152	1.935218417	3.76905098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6872	NO	POS(1A)-520 per day	POS(1B)-485 per day	POS(2)-50 per day						POS(9B)-50%	POS(8A)-50% of allowed cost		POS(9C)-50%				POS(7D)-50%	POS(7E)-50% per visit & POS(7H)-50%POS(5)-50%	POS(7C)-50% & POS(7I)-50%POS(3)-50%		POS(7B)-50%POS(7F)-50%POS(7G) 50%		POS(9D)-50% of allowed cost																				0.7218	0.0625	0.2207						2.0595	0.7208		0.1654				11.3371	0.7718	0.431		0.3892		0.0186																			16.8985			0	25.7204	1.664485466	2.029931397	0	4.592417943	2.10916095	0.988744258	2.197730591	16.25817712	5.661800972	1.936918318	0.946685915	0.044885504	1.265487787	2.127345583	21.83649002	2.702237426	4.812853226	12.5778152	2.324456994	3.76905098	0.018619722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5857
H3328_013_0	2012	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	360.5392765	36.94851942	14.26980913	7.019853582	21.46204212	16.90029994	13.41683679	26.45300926	46.15525601	31.56454677	13.30520707	6.422748453	3.981431438	6.725862336	95.70931439	134.5742039	11.66545834	21.05712317	81.76064597	7.254318435	18.8605729	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	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$400 Non Medicare Benefit Allowance	$25/month OTC Benefit													0.064299691	0.064299691	0.157127263	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.062923663	0.062923663	0.155751236	0	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973	0.222623973																				22.6865	2.324936203	2.222540413	0	4.777965081	3.762411914	2.986909508	5.889074014	10.27526646	7.027024803	2.962058056	1.429857777	0.886362084	1.497338194	21.30718781	29.95944392	2.59701068	4.687820416	18.20187983	1.61498519	4.198815668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.2953			1.343066277	22.6865	2.324936203	2.222540413	0	4.777965081	3.762411914	2.986909508	5.889074014	10.27526646	7.027024803	2.962058056	1.429857777	0.886362084	1.497338194	21.30718781	29.95944392	2.59701068	4.687820416	18.20187983	1.61498519	4.198815668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.2953	NO																																																																																		0			0	22.6865	2.324936203	2.222540413	0	4.777965081	3.762411914	2.986909508	5.889074014	10.27526646	7.027024803	2.962058056	1.429857777	0.886362084	1.497338194	21.30718781	29.95944392	2.59701068	4.687820416	18.20187983	1.61498519	4.198815668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.2953
H3328_801_0	2012	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	309.3115529	11.82680157	22.4140896	8.349050806	12.75329524	12.47161125	13.00310909	15.68079096	54.72791386	30.62111273	11.4282001	2.91111185	0.328220859	7.523463429	78.61234172	130.2547052	6.731041646	15.8324768	73.35031347	6.027130309	22.10684012	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																					0.070779814	0.070779814	0.163844933	0	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2229	0.2229																			NO	0.042914612	0.042914612	0.135979731	0	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.195034798	0.195034798																				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198			23.58134982	13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198
H3328_802_0	2012	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	309.3115529	11.82680157	22.4140896	8.349050806	12.75329524	12.47161125	13.00310909	15.68079096	54.72791386	30.62111273	11.4282001	2.91111185	0.328220859	7.523463429	78.61234172	130.2547052	6.731041646	15.8324768	73.35031347	6.027130309	22.10684012	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																					0.070779814	0.070779814	0.163844933	0	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2229	0.2229																			NO	0.042914612	0.042914612	0.135979731	0	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.195034798	0.195034798																				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198			23.58134982	13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198
H3328_803_0	2012	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	309.3115529	11.82680157	22.4140896	8.349050806	12.75329524	12.47161125	13.00310909	15.68079096	54.72791386	30.62111273	11.4282001	2.91111185	0.328220859	7.523463429	78.61234172	130.2547052	6.731041646	15.8324768	73.35031347	6.027130309	22.10684012	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																					0.070779814	0.070779814	0.163844933	0	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2239	0.2229	0.2229																			NO	0.042914612	0.042914612	0.135979731	0	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.196034798	0.195034798	0.195034798																				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198			23.58134982	13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0				13.274	0.507542606	3.047861875	0	2.500089659	2.444869795	2.549061866	3.073980691	10.72857555	6.002803655	2.240324901	0.570679224	0.06434271	1.474860635	15.41075455	25.53445486	1.319518391	3.103716396	14.3792139	1.181527274	4.311603102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7198
H3330_021_1	2012	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	1998.819787	121.4472312	1588.597533	310.6471706	579.0714724	8.888647465	8.888647465	199.5004965	179.0503812	38.03543891	125.6752511	0	10.56757845	836.5452189	14637.68887	20916.22221	235.2992815	15.02071716	526.7871716	1647.828305	19.22563517	0	0	40.48384381	1296.549635	93.07748254	114.0709323	4.134293339	0	0											3400	1A IP Acute: $150 days 1-7	1B IP Psych: $0	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $65; 4B Urgent Care - $25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; High-tech Radiology - $100	5 Partial Hosp - $25	12 Renal Dialysis - $0	"3 CORF - $25; 9C Outpatient Sub Abuse - $25, 9D Blood - $25"	7A Primary Care - $15; 14A Preventive Care - $0;	7D Physician Specialist - $25; 7B Chiropractic - $20; 7F Podiatry - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays; X-Rays - $25; High-tech Radiology - $100	7G Other Health Care - $25; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $25	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													94.97501096	0	30.3123014	0	125	0.2	0.2	61	100	25	52	25	0	25	14.25	24.75	25	25	52	12.5	0.2	0	0	7.5	10	40	27.5	0	0	0											NO	80.82373432	0	25.79576849	0	106.375	0.1702	0.1702	51.911	85.1	21.275	44.252	21.275	0	21.275	12.12675	21.06225	21.275	21.275	44.252	10.6375	0.12765	0	0	7.5	10	40	27.5	0	0	0												13.4627	0	3.414924515	0	5.133227323	1.512847799	1.512847799	0.863022523	1.26976562	0.067433664	0.463448434	0	0	1.483124961	14.79229946	36.71189177	0.417166018	0.02663048	1.942615493	1.460731133	2.454152329	0	0	0.025302402	1.080458029	0.310258275	0.261412553	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6662			16.19198868	13.4627	0	3.414924515	0	5.133227323	1.512847799	1.512847799	0.863022523	1.26976562	0.067433664	0.463448434	0	0	1.483124961	14.79229946	36.71189177	0.417166018	0.02663048	1.942615493	1.460731133	2.454152329	0	0	0.025302402	1.080458029	0.310258275	0.261412553	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6662	NO																																																																																		0				13.4627	0	3.414924515	0	5.133227323	1.512847799	1.512847799	0.863022523	1.26976562	0.067433664	0.463448434	0	0	1.483124961	14.79229946	36.71189177	0.417166018	0.02663048	1.942615493	1.460731133	2.454152329	0	0	0.025302402	1.080458029	0.310258275	0.261412553	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6662
H3330_021_2	2012	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	2291.630003	139.2382248	1633.862215	311.9586713	251.4750551	7.939841938	7.939841938	221.5278612	201.5533976	25.61341595	84.63087515	0	7.116304953	563.3372787	14076.6185	20114.49232	226.2801352	14.44496511	506.5951399	1584.666172	29.15760559	0	0	40.35636966	1377.822714	98.91196312	168.8524653	6.1197503	0	0											3400	1A IP Acute: $200 days 1-7	1B IP Psych: $0	"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 - $65; 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; High-tech Radiology - $100	5 Partial Hosp - $25	12 Renal Dialysis - $0	"3 CORF - $25; 9C Outpatient Sub Abuse - $25, 9D Blood - $30"	7A Primary Care - $15; 14A Preventive Care - $0;	7D Physician Specialist - $25; 7B Chiropractic - $20; 7F Podiatry - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays; X-Rays - $25; High-tech Radiology - $100	7G Other Health Care - $25; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $25	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													126.6333479	0	30.3123014	0	100	0.2	0.2	61	150	25	52	25	0	25	14.25	24.75	25	25	52	12.5	0.2	0	0	7.5	10	40	27.5	0	0	0											NO	107.6383458	0	25.76545619	0	85	0.17	0.17	51.85	127.5	21.25	44.2	21.25	0	21.25	12.1125	21.0375	21.25	21.25	44.2	10.625	0.1275	0	0	7.5	10	40	27.5	0	0	0												20.5556	0	3.508100445	0	1.78128164	1.349773129	1.349773129	0.957184967	2.14150485	0.045357091	0.311723723	0	0	0.997576431	14.20858679	35.26321935	0.400704406	0.025579626	1.865958765	1.40308984	3.717594713	0	0	0.025222731	1.148185595	0.329706544	0.386953566	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7727			18.22200001	20.5556	0	3.508100445	0	1.78128164	1.349773129	1.349773129	0.957184967	2.14150485	0.045357091	0.311723723	0	0	0.997576431	14.20858679	35.26321935	0.400704406	0.025579626	1.865958765	1.40308984	3.717594713	0	0	0.025222731	1.148185595	0.329706544	0.386953566	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7727	NO																																																																																		0				20.5556	0	3.508100445	0	1.78128164	1.349773129	1.349773129	0.957184967	2.14150485	0.045357091	0.311723723	0	0	0.997576431	14.20858679	35.26321935	0.400704406	0.025579626	1.865958765	1.40308984	3.717594713	0	0	0.025222731	1.148185595	0.329706544	0.386953566	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7727
H3330_021_3	2012	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	O	O																																																			0	YES	2487.383407	151.132098	1656.631439	417.2195072	164.4714625	7.663422346	7.663422346	217.3504009	212.407952	50.53908139	166.9893112	0	14.0415287	1111.548285	13461.99428	19236.23777	216.4001167	13.81425785	484.4757905	1515.47525	20.67153818	0	0	40.55166697	1107.21103	79.48512924	132.1937584	4.791122189	0	0											3400	1A IP Acute: $200 days 1-7	1B IP Psych: $0	"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 - $65; 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; High-tech Radiology - $100	5 Partial Hosp - $25	12 Renal Dialysis - $0	"3 CORF - $25; 9C Outpatient Sub Abuse - $25, 9D Blood - $30"	7A Primary Care - $15; 14A Preventive Care - $0;	7D Physician Specialist - $25; 7B Chiropractic - $20; 7F Podiatry - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays; X-Rays - $25; High-tech Radiology - $100	7G Other Health Care - $25; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $25	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													126.6333479	0	30.3123014	0	100	0.2	0.2	61	150	25	52	25	0	25	14.25	24.75	25	25	52	12.5	0.2	0	0	7.5	10	40	27.5	0	0	0											NO	107.6383458	0	25.76545619	0	85	0.17	0.17	51.85	127.5	21.25	44.2	21.25	0	21.25	12.1125	21.0375	21.25	21.25	44.2	10.625	0.1275	0	0	7.5	10	40	27.5	0	0	0												22.3115	0	3.556988732	0	1.165006192	1.302781799	1.302781799	0.939134857	2.25683449	0.08949629	0.615077296	0	0	1.968366755	13.58820047	33.72352935	0.38320854	0.024462748	1.784485828	1.341827044	2.635621119	0	0	0.025344792	0.922675858	0.264950431	0.30294403	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5052			16.73756919	22.3115	0	3.556988732	0	1.165006192	1.302781799	1.302781799	0.939134857	2.25683449	0.08949629	0.615077296	0	0	1.968366755	13.58820047	33.72352935	0.38320854	0.024462748	1.784485828	1.341827044	2.635621119	0	0	0.025344792	0.922675858	0.264950431	0.30294403	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5052	NO																																																																																		0				22.3115	0	3.556988732	0	1.165006192	1.302781799	1.302781799	0.939134857	2.25683449	0.08949629	0.615077296	0	0	1.968366755	13.58820047	33.72352935	0.38320854	0.024462748	1.784485828	1.341827044	2.635621119	0	0	0.025344792	0.922675858	0.264950431	0.30294403	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5052
H3330_029_0	2012	10																															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	2383.43102	141.9392528	1151.303426	369.2426401	849.6338435	9.575368053	9.575368053	368.5649494	208.2521206	136.4524023	273.9260365	0	0	1494.185358	15527.65426	22187.9198	249.6053797	15.9339705	558.815612	1748.015579	26.38474466	0	0	41.37195668	1254.724702	90.03454408	142.0433562	5.148102934	0	995											3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $0 days 21-100"	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; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9C Outpatient Sub Abuse - $0; 9D Blood - $0	7A Primary Care - $0; 14A Preventive Care - $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; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 0%, $3,000 OOP Max"		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		"13A Acupunture - NA; 13B OTC - $660 a year, $55 a month; 13E Private Duty Nursing - 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	7.5	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	0.025857473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0259			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.025857473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0259	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.025857473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0259
H3330_032_1	2012	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	1991.71217	122.5291649	1584.161832	309.7797779	577.2241535	8.313260673	8.313260673	198.864062	178.4791854	37.91410054	49.99426124	0	10.5338664	909.1565911	14596.81735	20857.81969	234.6422761	14.97877614	525.3162703	1643.22722	17.98828459	0	0	40.48384381	1296.549635	93.07748254	114.0709323	4.134293339	0	0											3400	1A IP Acute: $100 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $10	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; High-tech Radiology - $50	5 Partial Hosp - $10	12 Renal Dialysis - $0	3 CORF - $10; 9C Outpatient Sub Abuse - $10; 9D Blood - $10	7A Primary Care - $0; 14A Preventive Care - $0;	7D Physician Specialist - $10; 7B Chiropractic - $10; 7F Podiatry - $10	7E Mental Health - $10; 7H Psychiatric Services - $10	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Specialist Copays; X-Rays - $10; High-tech Radiology - $50	7G Other Health Care - $10; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $10	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													63.31667397	0	5.311879601	0	100	0.2	0.2	59.5	50	10	24.4	10	0	10	0	10	10	10	24.4	5	0.2	0	0	7.5	10	40	20	0	0	0											NO	53.94580622	0	4.52572142	0	85.2	0.1704	0.1704	50.694	42.6	8.52	20.7888	8.52	0	8.52	0	8.52	8.52	8.52	20.7888	4.26	0.1278	0	0	7.5	10	40	20	0	0	0												8.9537	0	0.597456261	0	4.09829149	1.416579619	1.416579619	0.84010123	0.633601108	0.026919011	0.086610058	0	0	0.64550118	0	14.80905198	0.166596016	0.010634931	0.910057907	0.583345663	2.298902771	0	0	0.025302402	1.080458029	0.310258275	0.190118221	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1001			7.412445843	8.9537	0	0.597456261	0	4.09829149	1.416579619	1.416579619	0.84010123	0.633601108	0.026919011	0.086610058	0	0	0.64550118	0	14.80905198	0.166596016	0.010634931	0.910057907	0.583345663	2.298902771	0	0	0.025302402	1.080458029	0.310258275	0.190118221	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1001	NO																																																																																		0				8.9537	0	0.597456261	0	4.09829149	1.416579619	1.416579619	0.84010123	0.633601108	0.026919011	0.086610058	0	0	0.64550118	0	14.80905198	0.166596016	0.010634931	0.910057907	0.583345663	2.298902771	0	0	0.025302402	1.080458029	0.310258275	0.190118221	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1001
H3330_032_2	2012	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	2206.675086	135.753579	1574.264877	300.579556	242.3021617	6.954045492	6.954045492	213.4473323	194.2014643	24.67913189	32.54237735	0	6.856728086	591.79026	13563.15476	19380.78895	218.0262606	13.91806543	488.1163956	1526.863326	25.5399617	0	0	40.35636966	1377.822714	98.91196312	168.8524653	6.1197503	0	0											3400	1A IP Acute: $100 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $10	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; High-tech Radiology - $50	5 Partial Hosp - $10	12 Renal Dialysis - $0	3 CORF - $10; 9C Outpatient Sub Abuse - $10; 9D Blood - $10	7A Primary Care - $0; 14A Preventive Care - $0;	7D Physician Specialist - $10; 7B Chiropractic - $10; 7F Podiatry - $10	7E Mental Health - $10; 7H Psychiatric Services - $10	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Specialist Copays; X-Rays - $10; High-tech Radiology - $50	7G Other Health Care - $10; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $10	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													63.31667397	0	5.311879601	0	100	0.2	0.2	59.5	50	10	24.4	10	0	10	0	10	10	10	24.4	5	0.2	0	0	7.5	10	40	20	0	0	0											NO	54.83223966	0	4.600087735	0	86.6	0.1732	0.1732	51.527	43.3	8.66	21.1304	8.66	0	8.66	0	8.66	8.66	8.66	21.1304	4.33	0.1299	0	0	7.5	10	40	20	0	0	0												10.0831	0	0.603479713	0	1.748613933	1.204440679	1.204440679	0.916525058	0.700743617	0.017810107	0.057302788	0	0	0.427075304	0	13.98646936	0.157342285	0.010044204	0.85950789	0.550943183	3.317641025	0	0	0.025222731	1.148185595	0.329706544	0.281420775	0	0	0	0	0	0	0	0	0	0	0	0	0	37.63			6.823523906	10.0831	0	0.603479713	0	1.748613933	1.204440679	1.204440679	0.916525058	0.700743617	0.017810107	0.057302788	0	0	0.427075304	0	13.98646936	0.157342285	0.010044204	0.85950789	0.550943183	3.317641025	0	0	0.025222731	1.148185595	0.329706544	0.281420775	0	0	0	0	0	0	0	0	0	0	0	0	0	37.63	NO																																																																																		0				10.0831	0	0.603479713	0	1.748613933	1.204440679	1.204440679	0.916525058	0.700743617	0.017810107	0.057302788	0	0	0.427075304	0	13.98646936	0.157342285	0.010044204	0.85950789	0.550943183	3.317641025	0	0	0.025222731	1.148185595	0.329706544	0.281420775	0	0	0	0	0	0	0	0	0	0	0	0	0	37.63
H3330_032_3	2012	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	O	O																																																			0	YES	2492.796679	153.3556404	1661.096156	418.4270908	164.9475021	7.142548465	7.142548465	217.9794913	213.0227371	50.6853597	66.83468887	0	14.08216995	1215.403456	13500.95814	19291.91438	217.0264566	13.85424129	485.878038	1519.861582	19.26651784	0	0	40.55166697	1107.21103	79.48512924	132.1937584	4.791122189	0	0											3400	1A IP Acute: $100 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $10	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; High-tech Radiology - $50	5 Partial Hosp - $10	12 Renal Dialysis - $0	3 CORF - $10; 9C Outpatient Sub Abuse - $10; 9D Blood - $10	7A Primary Care - $0; 14A Preventive Care - $0;	7D Physician Specialist - $10; 7B Chiropractic - $10; 7F Podiatry - $10	7E Mental Health - $10; 7H Psychiatric Services - $10	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Specialist Copays; X-Rays - $10; High-tech Radiology - $50	7G Other Health Care - $10; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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) - $10	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - NA													63.31667397	0	5.311879601	0	100	0.2	0.2	59.5	50	10	24.4	10	0	10	0	10	10	10	24.4	5	0.2	0	0	7.5	10	40	20	0	0	0											NO	55.02218968	0	4.616023373	0	86.9	0.1738	0.1738	51.7055	43.45	8.69	21.2036	8.69	0	8.69	0	8.69	8.69	8.69	21.2036	4.345	0.13035	0	0	7.5	10	40	20	0	0	0												11.4299	0	0.638971557	0	1.194494828	1.241374923	1.241374923	0.939228216	0.771319827	0.036704648	0.118094667	0	0	0.88015467	0	13.97056133	0.157163326	0.01003278	0.858530297	0.550316548	2.5113906	0	0	0.025344792	0.922675858	0.264950431	0.220322931	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9829			6.473110636	11.4299	0	0.638971557	0	1.194494828	1.241374923	1.241374923	0.939228216	0.771319827	0.036704648	0.118094667	0	0	0.88015467	0	13.97056133	0.157163326	0.01003278	0.858530297	0.550316548	2.5113906	0	0	0.025344792	0.922675858	0.264950431	0.220322931	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9829	NO																																																																																		0				11.4299	0	0.638971557	0	1.194494828	1.241374923	1.241374923	0.939228216	0.771319827	0.036704648	0.118094667	0	0	0.88015467	0	13.97056133	0.157163326	0.01003278	0.858530297	0.550316548	2.5113906	0	0	0.025344792	0.922675858	0.264950431	0.220322931	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9829
H3330_033_1	2012	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	2110.851979	129.8585881	1679.087435	328.3422956	612.056618	9.752312707	9.752312707	210.8644701	189.2494726	40.20201859	53.01115392	0	11.16953024	964.0194454	15468.45055	22103.3219	248.6536865	15.8732176	556.6849647	1741.35076	21.0936936	0	0	41.3100447	1323.009831	94.977023	116.3989106	4.218666672	0	0											3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $0 days 21-100"	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; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9C Outpatient Sub Abuse - $0; 9D Blood - $0	7A Primary Care - $0; 14A Preventive Care - $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; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - 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	3.16405404	0	0	0.025818778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1899			1.05468468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.16405404	0	0	0.025818778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1899	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.16405404	0	0	0.025818778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1899
H3330_033_2	2012	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	2453.852094	150.9597884	1749.933685	334.1205777	269.4432318	8.817023593	8.817023593	237.3562771	215.9546155	27.44352344	36.18755715	0	7.62477298	658.0786532	15082.40879	21551.69551	242.4481064	15.47707418	542.7919348	1697.89236	32.38207819	0	0	41.17996904	1405.941545	100.9305746	172.2984339	6.244643163	0	0											3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $0 days 21-100"	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; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9C Outpatient Sub Abuse - $0; 9D Blood - $0	7A Primary Care - $0; 14A Preventive Care - $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; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	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		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - 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	4.857311729	0	0	0.025737481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.883			1.61910391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.857311729	0	0	0.025737481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.883	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.857311729	0	0	0.025737481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.883
H3330_033_3	2012	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	O	O																																																			0	YES	2619.598393	161.1564202	1745.938518	439.7113266	173.3379281	8.201277623	8.201277623	229.0675088	223.8586181	53.26358461	70.23438576	0	14.79849122	1277.227689	14187.71476	20273.24103	228.0659958	14.55896846	510.593318	1597.172762	22.12236464	0	0	41.37925201	1129.807173	81.10727473	134.8915903	4.888900192	0	0											3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0	"2 SNF: $0 days 1-20, $0 days 21-100"	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; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9C Outpatient Sub Abuse - $0; 9D Blood - $0	7A Primary Care - $0; 14A Preventive Care - $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; 13D Additional Pap/Pelvic; 14D Kidney Disease Education Services - $0; 14C Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"		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		13A Acupunture - NA; 13B OTC - NA; 13E Private Duty Nursing - 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	3.318354697	0	0	0.025862033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3442			1.106118232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.318354697	0	0	0.025862033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3442	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.318354697	0	0	0.025862033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3442
H3330_808_0	2012	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	YES	433.7248285	25.82939367	57.04838472	13.07041776	25.94049995	13.77724023	13.77724023	7.380871187	8.136263716	3.042305496	11.12866779	0	0.027543973	67.85626476	170.5485485	243.7018145	2.741549658	0.175011338	6.137771357	19.19939193	31.75457037	0	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1428	0.1904	0	0	0	0	0	0	0	0												0	0	0	0	4.93907119	2.623186539	2.623186539	1.405317874	1.549144612	0.579254966	2.118898346	0	0.005244372	12.91983281	32.47244364	46.40082548	0.521991055	0.033322159	1.168631666	3.655564224	4.534552649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5505			22.5224562	0	0	0	0	4.93907119	2.623186539	2.623186539	1.405317874	1.549144612	0.579254966	2.118898346	0	0.005244372	12.91983281	32.47244364	46.40082548	0.521991055	0.033322159	1.168631666	3.655564224	4.534552649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5505	NO																																																																																		0				0	0	0	0	4.93907119	2.623186539	2.623186539	1.405317874	1.549144612	0.579254966	2.118898346	0	0.005244372	12.91983281	32.47244364	46.40082548	0.521991055	0.033322159	1.168631666	3.655564224	4.534552649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5505
H3330_810_0	2012	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	YES	535.5852591	31.89543598	61.62220511	10.68723168	25.00297525	24.61739411	24.61739411	6.004549384	13.09953165	2.101654465	5.143860944	0	0	65.76907409	148.4390222	212.108865	2.386141389	0.152323265	5.342084623	16.71042638	21.75364828	0	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.057399165	0.148564252	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.04878929	0.126279614	0	0	0.1904	0.1904	0.1904	0.1904	0.1904	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1428	0.1904	0	0	0	0	0	0	0	0												26.1308	4.027743357	0	0	4.760566488	4.687151839	4.687151839	1.143266203	2.494150827	0	0.979391124	0	0	12.52243171	28.26278982	40.38552789	0.45432132	0.02900235	1.017132912	3.181665183	3.106420974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8695			25.54812283	26.1308	4.027743357	0	0	4.760566488	4.687151839	4.687151839	1.143266203	2.494150827	0	0.979391124	0	0	12.52243171	28.26278982	40.38552789	0.45432132	0.02900235	1.017132912	3.181665183	3.106420974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8695	NO																																																																																		0				26.1308	4.027743357	0	0	4.760566488	4.687151839	4.687151839	1.143266203	2.494150827	0	0.979391124	0	0	12.52243171	28.26278982	40.38552789	0.45432132	0.02900235	1.017132912	3.181665183	3.106420974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8695
H3330_814_0	2012	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	YES	373.1326173	22.22097659	51.10845454	12.21575957	19.94463443	11.41401761	11.41401761	7.066723822	28.92917626	3.514500097	12.83642317	0	0.031944708	38.45295096	148.1031838	211.6289756	2.380742822	0.151978639	5.329998331	16.67261959	19.92120798	0	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.058760134	0.148428801	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.049946114	0.126164481	0	0	0.1904	0.1904	0.1904	0.1904	0.1904	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1428	0.1904	0	0	0	0	0	0	0	0												18.6365	2.803497978	0	0	3.797458396	2.173228954	2.173228954	1.345504216	5.50811516	0	2.444054972	0	0.006082272	7.321441863	28.19884619	40.29415695	0.453293433	0.028936733	1.014831682	3.17446677	2.8447485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2184			22.68354364	18.6365	2.803497978	0	0	3.797458396	2.173228954	2.173228954	1.345504216	5.50811516	0	2.444054972	0	0.006082272	7.321441863	28.19884619	40.29415695	0.453293433	0.028936733	1.014831682	3.17446677	2.8447485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2184	NO																																																																																		0				18.6365	2.803497978	0	0	3.797458396	2.173228954	2.173228954	1.345504216	5.50811516	0	2.444054972	0	0.006082272	7.321441863	28.19884619	40.29415695	0.453293433	0.028936733	1.014831682	3.17446677	2.8447485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2184
H3330_815_0	2012	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	YES	303.5995969	26.82571489	51.21929877	18.88296139	14.34825189	7.741363578	7.741363578	4.672848655	7.996705791	0.102224929	5.184986358	0	0	59.38452353	157.2849283	220.4808403	3.284849945	0.904136223	7.013743124	16.89504255	23.1664498	0	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.058977316	0.148407689	0	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.050130718	0.126146536	0	0	0.1904	0.1904	0.1904	0.1904	0.1904	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1428	0.1904	0	0	0	0	0	0	0	0												15.2197	3.383971003	0	0	2.731907159	1.473955625	1.473955625	0.889710384	1.522572783	0	0.987221403	0	0	11.30681328	29.94705035	41.97955199	0.62543543	0.172147537	1.335416691	3.216816102	3.308169031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.5744			22.39867888	15.2197	3.383971003	0	0	2.731907159	1.473955625	1.473955625	0.889710384	1.522572783	0	0.987221403	0	0	11.30681328	29.94705035	41.97955199	0.62543543	0.172147537	1.335416691	3.216816102	3.308169031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.5744	NO																																																																																		0				15.2197	3.383971003	0	0	2.731907159	1.473955625	1.473955625	0.889710384	1.522572783	0	0.987221403	0	0	11.30681328	29.94705035	41.97955199	0.62543543	0.172147537	1.335416691	3.216816102	3.308169031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.5744
H3333_037_0	2012	4																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1245.330714	16.80832933	673.0422437	92.82544314	484.8562459	22.73718413	39.08271412	390.7878236	781.3007335	11.93548371	21.63642097	4.332097487	7.648085198	357.9640868	5388.201518	8377.014526	0.871428614	728.072675	33.59124595	15926.4745	6.759539573	7.117156204	0	0	0	0	0.089901035	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	133.5346232	53.57981011	187.6495665	0.2	0.2	0.241459347	30	11.2672372	18.94533301	20.0026934	0.4	0	0.186111985	3.461430709	0.2	0	0	0	0	0	20	0	0	0											NO	202.0721723	202.0721723	116.0840139	0	128.9822377	0.171976317	114.8239634	46.07229201	161.3564066	0.171976317	0.171976317	0.207626446	25.79644753	9.688489773	16.29074296	17.19994769	0.343952634	0	0.160034268	2.976420522	0.171976317	0	0	0	0	0	20	0	0	0												20.9706	0.283041302	6.510787098	0	5.211486962	3.910257184	0.373969345	1.500374227	10.50565657	2.052620529	3.720951989	0.899458005	0.016441119	0.28901095	7.314817164	12.00701764	0.299730167	0	5.375750473	3.950323795	1.16248072	0	0	0	0	0	0.000149835	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3549	0		14.07157504	20.9706	0.283041302	6.510787098	0	5.211486962	3.910257184	0.373969345	1.500374227	10.50565657	2.052620529	3.720951989	0.899458005	0.016441119	0.28901095	7.314817164	12.00701764	0.299730167	0	5.375750473	3.950323795	1.16248072	0	0	0	0	0	0.000149835	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3549	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	20.9706	0.283041302	6.510787098	0	5.211486962	3.910257184	0.373969345	1.500374227	10.50565657	2.052620529	3.720951989	0.899458005	0.016441119	0.28901095	7.314817164	12.00701764	0.299730167	0	5.375750473	3.950323795	1.16248072	0	0	0	0	0	0.000149835	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3549
H3333_039_0	2012	4																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1223.073619	9.864182417	660.5587485	113.2775685	508.345907	25.09932416	16.57378937	309.7516485	579.5634537	20.08267783	39.41784037	4.694388415	3.907037063	511.9044703	5591.114159	8125.524493	0.51642041	1437.551086	19.33312853	12881.92785	7.221141625	11.68957343	0	0	0	0	0.06314434	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	116.470471	58.92329103	208.601326	0.2	0.2	0.204450589	30	10.28828691	18.92665513	20.5388627	0.4	0	0.180264688	3.573754926	0.2	0	0	0	0	0	20	0	0	0											NO	209.1050938	209.1050938	120.1242028	0	133.4713365	0.177961782	103.6364628	52.43046936	185.6153185	0.177961782	0.177961782	0.181921956	26.69426729	9.154609363	16.84110637	18.27566303	0.355923564	0	0.160401126	3.179958975	0.177961782	0	0	0	0	0	20	0	0	0												21.3126	0.171887566	6.612424423	0	5.654133967	4.466720454	0.143137409	1.353368693	8.964654587	3.573949133	7.014869113	0.854012323	0.008691291	0.390523788	7.846712357	12.37494563	0.183806193	0	3.101055583	3.413666839	1.285087231	0	0	0	0	0	0.000105241	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7263	0		10.98757182	21.3126	0.171887566	6.612424423	0	5.654133967	4.466720454	0.143137409	1.353368693	8.964654587	3.573949133	7.014869113	0.854012323	0.008691291	0.390523788	7.846712357	12.37494563	0.183806193	0	3.101055583	3.413666839	1.285087231	0	0	0	0	0	0.000105241	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7263	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	21.3126	0.171887566	6.612424423	0	5.654133967	4.466720454	0.143137409	1.353368693	8.964654587	3.573949133	7.014869113	0.854012323	0.008691291	0.390523788	7.846712357	12.37494563	0.183806193	0	3.101055583	3.413666839	1.285087231	0	0	0	0	0	0.000105241	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7263
H3333_055_0	2012	6																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1220.955467	13.04011116	537.4478493	84.31702833	447.6127791	24.06550126	19.17484989	370.6671757	968.3036969	8.810868053	32.92476909	5.682194243	4.084213853	338.6316501	5616.81173	8198.295694	0.424961488	687.3065073	18.77008229	16574.51733	7.563562726	20.08325938	0	0	0	0	0.083474654	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	113.0310467	52.57117316	174.4283302	0.2	0.2	0.260347618	30	12.73889034	18.88258096	21.27711842	0.4	0	0.174545538	3.363913869	0.2	0	0	0	0	0	20	0	0	0											NO	199.3869822	199.3869822	114.5414579	0	127.2682865	0.169691049	95.90178428	44.60428753	147.9946314	0.169691049	0.169691049	0.220893301	25.45365731	10.8083783	16.02102483	18.05268269	0.339382097	0	0.148094077	2.854130361	0.169691049	0	0	0	0	0	20	0	0	0												20.2869	0.216669034	5.130005016	0	4.747242619	4.083700146	0.15324186	1.377778774	11.94197906	1.49512544	5.587038595	1.255158645	0.008663182	0.305004915	7.49892335	12.3334359	0.144224321	0	2.779738008	3.942152761	1.283468891	0	0	0	0	0	0.000139124	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5706	0		15.10534142	20.2869	0.216669034	5.130005016	0	4.747242619	4.083700146	0.15324186	1.377778774	11.94197906	1.49512544	5.587038595	1.255158645	0.008663182	0.305004915	7.49892335	12.3334359	0.144224321	0	2.779738008	3.942152761	1.283468891	0	0	0	0	0	0.000139124	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5706	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	20.2869	0.216669034	5.130005016	0	4.747242619	4.083700146	0.15324186	1.377778774	11.94197906	1.49512544	5.587038595	1.255158645	0.008663182	0.305004915	7.49892335	12.3334359	0.144224321	0	2.779738008	3.942152761	1.283468891	0	0	0	0	0	0.000139124	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5706
H3333_057_0	2012	6																															D	D	D	V	T	Coin	P	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	930.4609403	20.33418959	574.0677277	77.19433733	403.5178827	21.89765027	47.13805175	316.1545499	507.2448756	16.85859227	30.82257418	5.002192207	9.340018746	484.7192203	5378.704786	7580.501526	0.885929622	856.1230801	16.1742049	12269.687	10.39948907	4.1490219	0	0	0	0	0.075515669	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	129.2684533	59.91131015	211.033245	0.2	0.2	0.187766323	30	8.686623109	18.91523594	21.46836982	0.4	0	0.17548396	3.285606482	0.2	0	0	0	0	0	20	0	0	0											NO	196.8814991	196.8814991	113.1021378	0	125.669042	0.167558723	108.3002845	50.19331299	176.8023048	0.167558723	0.167558723	0.157309426	25.13380839	7.277597359	15.84706386	17.98606312	0.335117445	0	0.147019341	2.752660126	0.167558723	0	0	0	0	0	20	0	0	0												15.2659	0.333618811	5.410690602	0	4.225808811	3.669142306	0.425422035	1.32240369	7.473505258	2.824804186	5.164591157	0.786891987	0.01956252	0.293965943	7.103056519	11.36194824	0.296890471	0	2.37792095	2.81452318	1.742525104	0	0	0	0	0	0.000125859	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9133	0		14.11681651	15.2659	0.333618811	5.410690602	0	4.225808811	3.669142306	0.425422035	1.32240369	7.473505258	2.824804186	5.164591157	0.786891987	0.01956252	0.293965943	7.103056519	11.36194824	0.296890471	0	2.37792095	2.81452318	1.742525104	0	0	0	0	0	0.000125859	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9133	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	15.2659	0.333618811	5.410690602	0	4.225808811	3.669142306	0.425422035	1.32240369	7.473505258	2.824804186	5.164591157	0.786891987	0.01956252	0.293965943	7.103056519	11.36194824	0.296890471	0	2.37792095	2.81452318	1.742525104	0	0	0	0	0	0.000125859	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9133
H3333_163_0	2012	2																															D	D	D	Coin	T	Coin	P	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1114.137417	26.69712776	816.1541054	20.46084244	508.4924923	27.07457425	35.75319935	338.7180781	560.3472492	1220.530972	23.612972	5.805742617	9.66935493	427.3386342	6096.870519	8659.298293	0.511844386	877.7072073	27.33415988	16394.71941	5.380558424	10.85806182	0	0	0	0	0.197625807	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	132.7825242	59.46825549	101.872976	0	0.2	0.199669022	30	3.55757441	3.921960341	11.99638487	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	153.8376709	153.8376709	76.91883547	0.115378253	115.3782532	0.153837671	102.1347714	45.7422896	78.35950681	0	0.153837671	0.153583086	23.07565064	2.736444807	3.016726222	9.227479541	0.307675342	0	0.141500239	0.918403847	0.153837671	0	0	0	0	0	20	0	0	0												14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658	0		16.64362924	14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658
H3333_164_0	2012	2																															D	D	D	Coin	T	Coin	P	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1096.036778	26.26339754	802.8946003	20.69285148	500.2313578	27.38157754	35.17234124	333.215154	551.2436655	1200.701828	23.88072357	5.871583042	9.512263444	420.3959517	5997.818777	8517.411525	0.517648278	863.4476904	27.64410665	16128.36547	5.438857464	10.68165821	0	0	0	0	0.194415114	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	136.5058873	59.46825549	101.872976	0	0.2	0.19473753	30	3.55757441	3.921960341	12.01156129	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	155.2322637	155.2322637	77.61613185	0.116424198	116.4241978	0.155232264	105.9505895	46.1569596	79.06986338	0	0.155232264	0.151147738	23.28483956	2.761251645	3.04407391	9.32290925	0.310464527	0	0.142782989	0.926729502	0.155232264	0	0	0	0	0	20	0	0	0												14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495	0		16.00423048	14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495
H3333_165_0	2012	4																															D	D	D	Coin	T	Coin	P	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1114.137417	26.69712776	816.1541054	20.46084244	508.4924923	27.07457425	35.75319935	338.7180781	560.3472492	1220.530972	23.612972	5.805742617	9.66935493	427.3386342	6096.870519	8659.298293	0.511844386	877.7072073	27.33415988	16394.71941	5.380558424	10.85806182	0	0	0	0	0.197625807	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	132.7825242	59.46825549	101.872976	0	0.2	0.199669022	30	3.55757441	3.921960341	11.99638487	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	153.8376709	153.8376709	76.91883547	0.115378253	115.3782532	0.153837671	102.1347714	45.7422896	78.35950681	0	0.153837671	0.153583086	23.07565064	2.736444807	3.016726222	9.227479541	0.307675342	0	0.141500239	0.918403847	0.153837671	0	0	0	0	0	20	0	0	0												14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658	0		16.64362924	14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.283	0.342251996	5.231468613	2.36073626	4.889081294	4.165089445	0.304303737	1.291145035	3.659044508	0	3.632564616	0.891663869	0.018593888	0.097449049	1.532715764	6.65862482	0.157481896	0	3.867790159	1.254747782	0.827732576	0	0	0	0	0	0.000329376	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4658
H3333_166_0	2012	4																															D	D	D	Coin	T	Coin	P	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1096.036778	26.26339754	802.8946003	20.69285148	500.2313578	27.38157754	35.17234124	333.215154	551.2436655	1200.701828	23.88072357	5.871583042	9.512263444	420.3959517	5997.818777	8517.411525	0.517648278	863.4476904	27.64410665	16128.36547	5.438857464	10.68165821	0	0	0	0	0.194415114	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65 ,Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	136.5058873	59.46825549	101.872976	0	0.2	0.19473753	30	3.55757441	3.921960341	12.01156129	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	155.2322637	155.2322637	77.61613185	0.116424198	116.4241978	0.155232264	105.9505895	46.1569596	79.06986338	0	0.155232264	0.151147738	23.28483956	2.761251645	3.04407391	9.32290925	0.310464527	0	0.142782989	0.926729502	0.155232264	0	0	0	0	0	20	0	0	0												14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495	0		16.00423048	14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.1784	0.339743888	5.193131097	2.409148633	4.853252878	4.250504265	0.310544191	1.2816832	3.63223011	0	3.70705878	0.887476494	0.018457627	0.096734918	1.521483638	6.617254557	0.160711428	0	3.947108168	1.245552675	0.844286156	0	0	0	0	0	0.000324025	0	0	0	0	0	0	0	0	0	0	0	0	0	55.495
H3335_002_0	2012	9																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	V	Coin	V	Coin	O			V		V		O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1052.173846	91.40571966	1475.233226	0	181.4426232	8.051864385	3.544917804	325.286028	377.4354364	0	14.61114988	0	0	371.4321403	3411.509177	3870.293281	3.335973667	841.6218817	14.74584442	1089.507863	50.28384383	0.013692353	0	0	171.7322252	0	0.186002378	0	152.8482595	0											4000	$150/days 1-7 for IP Medical;  PBP 1a	$150/days 1-7 for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$150/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$150 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	150	150	50	0	150	0.2	0.2	62.65592692	150	0	0.2	0	0	40	20	40	0.412930217	40	0.2	35.60319802	0.2	40	0	0	40	0	40	0	2.083333333	0											NO	140.993055	140.993055	46.99768498	0	140.993055	0.18799074	0.18799074	58.89367031	140.993055	0	0.18799074	0	0	37.59814799	18.79907399	37.59814799	0.388135285	37.59814799	0.18799074	33.4653577	0.18799074	37.59814799	0	0	37.59814799	0	37.59814799	0	2.082597875	0												12.3624	1.073964305	5.777712201	0	2.131845812	1.513675944	0.666411721	1.596440674	4.434647936	0	2.746760878	0	0	1.163763382	5.344434455	12.12632163	1.29480909	2.636952005	2.772082204	3.03839753	9.452897009	4.29E-05	0	0	0.538067801	0	0.000582779	0	0.026526788	0	0	0	0	0	0	0	0	0	0	0	70.6988	0	NO	4.514707049	12.3624	1.073964305	5.777712201	0	2.131845812	1.513675944	0.666411721	1.596440674	4.434647936	0	2.746760878	0	0	1.163763382	5.344434455	12.12632163	1.29480909	2.636952005	2.772082204	3.03839753	9.452897009	4.29E-05	0	0	0.538067801	0	0.000582779	0	0.026526788	0	0	0	0	0	0	0	0	0	0	0	70.6988	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	$150/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	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	0.8518	0.0252	0.1696	0.0861	0.5828	0.1403	0.2251	0.1904	0.2307	0.341	0.0696	0	0	0.058	0.2991	0.6645	0.1404	0.0244	0.255	0.4312	0.2667	0.003	0	0	0.0103	0	0	0	0	0											5.0652	0	NO	1.014641859	13.2142	1.099134605	5.947300182	0.086088227	2.714602685	1.65400673	0.891487304	1.78683602	4.665369422	0.341015974	2.816356097	0	0	1.221758364	5.643552948	12.79082664	1.435187434	2.661364347	3.027101706	3.469630816	9.719563164	0.003077286	0	0	0.548354958	0	0.000589351	0	0.026526788	0	0	0	0	0	0	0	0	0	0	0	75.7639
H3335_005_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	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	731.7913933	79.97333408	635.2016361	0	135.4814164	9.124206059	1.471309113	124.3055337	316.231843	0	21.34106749	0	0	407.0902286	3998.87953	4141.836559	346.5402823	722.3250101	28.58646406	1465.630999	21.46105223	0	0	0	603.2625077	0	0	0	226.1597938	0											3500	$175/days 1-7 for IP Medical;  PBP 1a	$175/days 1-7 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"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$50/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$50 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	20% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$35 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$35/Visit for Vision Exams;  PBP 17a	PBP 17b	$35/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	175	175	25	0	100	0.2	0.2	54.40392645	50	0	0.2	0	0	35	15	35	35	35	0.2	21.8269331	0.2	0	0	0	35	0	0	0	2.083333333	0											NO	171.0913832	171.0913832	24.44162617	0	97.76650468	0.195533009	0.195533009	53.1888173	48.88325234	0	0.195533009	0	0	34.21827664	14.6649757	34.21827664	34.21827664	34.21827664	0.195533009	21.33942957	0.195533009	0	0	0	34.21827664	0	0	0	2.083333333	0												10.4336	1.140229029	1.293780078	0	1.103795378	1.784083469	0.287689499	0.550972027	1.288203415	0	4.17288315	0	0	1.160827172	4.886955929	11.81054243	0.988167604	2.059726418	5.589597343	2.606310789	4.196344126	0	0	0	1.720216948	0	0	0	0.039263853	0	0	0	0	0	0	0	0	0	0	0	57.1132	0	NO	1.303865213	10.4336	1.140229029	1.293780078	0	1.103795378	1.784083469	0.287689499	0.550972027	1.288203415	0	4.17288315	0	0	1.160827172	4.886955929	11.81054243	0.988167604	2.059726418	5.589597343	2.606310789	4.196344126	0	0	0	1.720216948	0	0	0	0.039263853	0	0	0	0	0	0	0	0	0	0	0	57.1132	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.6979	0	0.3358	0.0279	0.308	0.5002	0.4579	0.0388	0.2428	0.0946	0.2452	0	0	0.0639	0.2405	1.4283	0.1221	0.0158	0.244	1.8023	0.1579	0	0	0	0.0401	0	0	0	0	0											8.0642	0	NO	0.184227813	12.1315	1.140229029	1.629619233	0.027906983	1.411768599	2.284266661	0.745634085	0.589791066	1.531050082	0.094576563	4.418084253	0	0	1.224714487	5.127505377	13.23884688	1.110244273	2.075557323	5.833616808	4.40863415	4.354249449	0	0	0	1.760319336	0	0	0	0.039263853	0	0	0	0	0	0	0	0	0	0	0	65.1774
H3335_006_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	V	V	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	1036.898017	69.82425637	1179.450222	0	193.9027129	9.828294581	1.337953428	129.3297274	333.3309422	0	823.5671352	0	0	411.6319321	4480.389664	4865.682624	237.2376593	912.66932	869.4099007	1878.304979	27.81623007	0	0	0	705.33695	0	0	0	192.0798428	0											3500	$100/days 1-7 for IP Medical;  PBP 1a	$100/days 1-7 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"	"$65/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	$25/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$35 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$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-e"	20% Coinsurance for Part B Rx;  PBP 15	$25 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$25/Visit for Vision Exams;  PBP 17a	PBP 17b	$25/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	100	100	25	0	100	0.2	0.2	47.48836396	35	0	25	0	0	25	10	25	25	25	25	15.41590698	0.2	0	0	0	25	0	0	0	2.083333333	0											NO	98.45042766	98.45042766	24.61260692	0	98.45042766	0.196900855	0.196900855	46.75249741	34.45764968	0	24.61260692	0	0	24.61260692	9.845042766	24.61260692	24.61260692	24.61260692	24.61260692	15.17702635	0.196900855	0	0	0	24.61260692	0	0	0	2.083287813	0												8.5069	0.572852325	2.419112057	0	1.590817084	1.935199609	0.263444174	0.503873979	0.957150069	0	1.689177847	0	0	0.844277912	3.675802321	9.97976115	0.486586438	1.871930935	1.783203678	2.375590347	5.477039493	0	0	0	1.446681758	0	0	0	0.033346466	0	0	0	0	0	0	0	0	0	0	0	46.4128	0	NO	0.72999522	8.5069	0.572852325	2.419112057	0	1.590817084	1.935199609	0.263444174	0.503873979	0.957150069	0	1.689177847	0	0	0.844277912	3.675802321	9.97976115	0.486586438	1.871930935	1.783203678	2.375590347	5.477039493	0	0	0	1.446681758	0	0	0	0.033346466	0	0	0	0	0	0	0	0	0	0	0	46.4128	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance;	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	2.8206	0.0454	1.3804	0.0363	0.4086	0.3949	0.3945	0.0277	0.4414	0.1381	0.302	0	0	0.0707	0.2896	1.3634	0.0681	0.0637	0.1824	1.7854	0.095	0.0003	0	0	0.0363	0	0	0	0	0											10.3447	0	NO	0.162821967	11.3275	0.618299436	3.799519097	0.036301998	1.999464156	2.33009977	0.657905241	0.531552457	1.398557236	0.138123144	1.991161514	0	0	0.914941759	3.965444376	11.34316947	0.55466919	1.935614755	1.965585144	4.160995745	5.572003373	0.000263793	0	0	1.482942093	0	0	0	0.033346466	0	0	0	0	0	0	0	0	0	0	0	56.7575
H3335_008_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	V	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	679.6785005	116.1461782	521.4933078	0	92.79052832	12.81827928	0.993320274	129.3727872	304.3509993	0	37.22843797	0	0	646.9265225	3974.463414	4052.770792	436.4720523	685.3153748	20.267074	1246.663929	22.85571465	1.302276647	0	0	540.1889175	0	0	0	222.6735876	0											3500	$175/days 1-7 for IP Medical;  PBP 1a	$175/days 1-7 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"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$50/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$50 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	20% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$35 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$35/Visit for Vision Exams;  PBP 17a	PBP 17b	$35/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	175	175	25	0	100	0.2	0.2	64.0264348	50	0	0.2	0	0	35	15	35	35	35	0.2	25.78799469	0.2	35	0	0	35	0	0	0	2.083333333	0											NO	170.7359347	170.7359347	24.39084781	0	97.56339125	0.195126782	0.195126782	62.46636108	48.78169562	0	0.195126782	0	0	34.14718694	14.63450869	34.14718694	34.14718694	34.14718694	0.195126782	25.15964215	0.195126782	34.14718694	0	0	34.14718694	0	0	0	2.083333333	0												9.6705	1.652527191	1.059971992	0	0.754413218	2.501189592	0.193823389	0.673453936	1.237229818	0	7.264265318	0	0	1.840893408	4.847026613	11.53256015	1.242024397	1.950132685	3.954648941	2.613801529	4.459762062	0.003705757	0	0	1.537160995	0	0	0	0.038658609	0	0	0	0	0	0	0	0	0	0	0	59.0277	0	NO	1.473229262	9.6705	1.652527191	1.059971992	0	0.754413218	2.501189592	0.193823389	0.673453936	1.237229818	0	7.264265318	0	0	1.840893408	4.847026613	11.53256015	1.242024397	1.950132685	3.954648941	2.613801529	4.459762062	0.003705757	0	0	1.537160995	0	0	0	0.038658609	0	0	0	0	0	0	0	0	0	0	0	59.0277	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	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	2.8658	0.6192	0.167	0.007	0.2238	0.49	0.3365	0.0505	0.4444	0.1371	0.1289	0	0	0.0887	0.1119	1.0809	0.2512	0.1114	0.1846	1.7872	0.0417	0	0	0	0.0515	0	0	0	0	0											9.1793	0	NO	0.229249451	12.5362	2.271688801	1.226943363	0.006989975	0.978241678	2.991235405	0.530331895	0.723937353	1.681592529	0.137054248	7.393209242	0	0	1.929563122	4.958943472	12.61347372	1.493273032	2.061565286	4.139253881	4.400983812	4.501445882	0.003705757	0	0	1.588702308	0	0	0	0.038658609	0	0	0	0	0	0	0	0	0	0	0	68.207
H3335_009_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	V	V	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	997.978123	80.24465689	967.1884723	0	156.2355681	12.20353139	1.27097841	131.9740494	303.5417653	0	1120.824118	0	0	750.6788424	4310.037534	4388.798745	356.9000222	797.4276834	477.8546868	1684.675358	30.84766844	0	0	0	611.64246	0	0	0	179.6940195	0											3500	$100/days 1-7 for IP Medical;  PBP 1a	$100/days 1-7 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"	"$65/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	$25/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$35 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$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-e"	20% Coinsurance for Part B Rx;  PBP 15	$25 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$25/Visit for Vision Exams;  PBP 17a	PBP 17b	$25/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	100	100	25	0	100	0.2	0.2	64.12744228	35	0	25	0	0	25	10	25	25	25	25	18.12695715	0.2	0	0	0	25	0	0	0	2.083333333	0											NO	98.53582839	98.53582839	24.6339571	0	98.53582839	0.197071657	0.197071657	63.18850647	34.48753994	0	24.6339571	0	0	24.6339571	9.853582839	24.6339571	24.6339571	24.6339571	24.6339571	17.86154738	0.197071657	0	0	0	24.6339571	0	0	0	2.083254563	0												8.1947	0.658914478	1.985473278	0	1.282900094	2.404970149	0.250473821	0.694936923	0.872367396	0	2.300861103	0	0	1.541015866	3.539109324	9.009456666	0.732654986	1.636983278	0.980954321	2.507575728	6.079201126	0	0	0	1.255597843	0	0	0	0.031195699	0	0	0	0	0	0	0	0	0	0	0	45.9594	0	NO	0.682460684	8.1947	0.658914478	1.985473278	0	1.282900094	2.404970149	0.250473821	0.694936923	0.872367396	0	2.300861103	0	0	1.541015866	3.539109324	9.009456666	0.732654986	1.636983278	0.980954321	2.507575728	6.079201126	0	0	0	1.255597843	0	0	0	0.031195699	0	0	0	0	0	0	0	0	0	0	0	45.9594	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	3.0446	0.0818	0.6491	0.0583	0.2776	0.3873	0.4375	0.0228	0.3924	0.0875	0.0933	0	0	0.0597	0.1147	1.4925	0.2189	0.0292	0.226	1.6695	0.211	0.0026	0	0	0.0493	0	0	0	0	0											9.6058	0	NO	0.142734579	11.2394	0.740732511	2.634593733	0.058335964	1.56046389	2.792307266	0.687994704	0.717689535	1.264799784	0.087546412	2.394115381	0	0	1.600730078	3.653848881	10.50198273	0.951545819	1.666149442	1.206950885	4.177086872	6.290210271	0.002618111	0	0	1.304857649	0	0	0	0.031195699	0	0	0	0	0	0	0	0	0	0	0	55.5651
H3335_014_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	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	749.5510637	89.76792829	639.3074385	0	70.06418154	10.6521417	1.772651736	145.1679453	315.5039541	0	10.99723721	0	0	409.0597718	4164.129687	4979.096856	378.3847401	1097.663962	35.35421301	1298.694619	21.6029383	0	0	0	590.9006173	0	0	0	227.7683305	0											3500	$175/days 1-7 for IP Medical;  PBP 1a	$175/days 1-7 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"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$50/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$50 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	20% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$35 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$35/Visit for Vision Exams;  PBP 17a	PBP 17b	$35/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	175	175	25	0	100	0.2	0.2	51.29042431	50	0	0.2	0	0	35	15	35	35	35	0.2	24.89798258	0.2	0	0	0	35	0	0	0	2.083333333	0											NO	170.6326269	170.6326269	24.37608956	0	97.50435825	0.195008716	0.195008716	50.01039907	48.75217912	0	0.195008716	0	0	34.12652539	14.62565374	34.12652539	34.12652539	34.12652539	0.195008716	24.27661813	0.195008716	0	0	0	34.12652539	0	0	0	2.083267729	0												10.6582	1.276444785	1.298651281	0	0.569296921	2.07726048	0.34568254	0.60499224	1.281792107	0	2.144557113	0	0	1.163315724	5.07525991	14.15993961	1.076079703	3.121621423	6.894379702	2.627326111	4.21276127	0	0	0	1.680448743	0	0	0	0.039541868	0	0	0	0	0	0	0	0	0	0	0	60.3075	0	NO	1.542570757	10.6582	1.276444785	1.298651281	0	0.569296921	2.07726048	0.34568254	0.60499224	1.281792107	0	2.144557113	0	0	1.163315724	5.07525991	14.15993961	1.076079703	3.121621423	6.894379702	2.627326111	4.21276127	0	0	0	1.680448743	0	0	0	0.039541868	0	0	0	0	0	0	0	0	0	0	0	60.3075	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	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.038	0.4025	0.5409	0.0246	0.7503	0.6711	0.4433	0.0349	0.0494	0.0548	0.0742	0	0	0.0425	0.3306	1.4558	0.3698	0.1216	0.2024	2.1454	0.0212	0	0	0	0.0641	0	0.0001	0	0	0											8.8372	0	NO	0.226190914	11.6961	1.678910612	1.839503981	0.024584665	1.319562534	2.748399705	0.788937297	0.639870427	1.331169217	0.054837551	2.218750988	0	0	1.205791253	5.405845123	15.61571176	1.445858251	3.243263823	7.096797843	4.772739149	4.233944166	0	0	0	1.744518917	0	8.70E-05	0	0.039541868	0	0	0	0	0	0	0	0	0	0	0	69.1448
H3335_015_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	V	V	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	958.2004805	108.1618888	851.032563	0	85.11493069	10.72266857	1.025585208	166.1750411	306.0469302	0	460.7042532	0	0	416.8372538	4301.719076	5188.711895	365.9666552	1196.531447	1166.899314	1444.747225	31.83657051	0	0	0	661.1032883	0	0	0	225.7465061	0											3500	$100/days 1-7 for IP Medical;  PBP 1a	$100/days 1-7 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"	"$65/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	$25/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$35 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$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-e"	20% Coinsurance for Part B Rx;  PBP 15	$25 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$25/Visit for Vision Exams;  PBP 17a	PBP 17b	$25/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	100	100	25	0	100	0.2	0.2	46.70176071	35	0	25	0	0	25	10	25	25	25	25	17.2701934	0.2	0	0	0	25	0	0	0	2.083333333	0											NO	98.50908121	98.50908121	24.6272703	0	98.50908121	0.197018162	0.197018162	46.00547539	34.47817842	0	24.6272703	0	0	24.6272703	9.850908121	24.6272703	24.6272703	24.6272703	24.6272703	17.01270885	0.197018162	0	0	0	24.6272703	0	0	0	2.083304695	0												7.866	0.887910691	1.746550747	0	0.698716135	2.112560458	0.202058913	0.637080147	0.879328389	0	0.945490681	0	0	0.855463643	3.531319949	10.64865086	0.751063312	2.455608615	2.394795401	2.048255324	6.27238262	0	0	0	1.356764115	0	0	0	0.039191563	0	0	0	0	0	0	0	0	0	0	0	46.3291	0	NO	0.700591402	7.866	0.887910691	1.746550747	0	0.698716135	2.112560458	0.202058913	0.637080147	0.879328389	0	0.945490681	0	0	0.855463643	3.531319949	10.64865086	0.751063312	2.455608615	2.394795401	2.048255324	6.27238262	0	0	0	1.356764115	0	0	0	0.039191563	0	0	0	0	0	0	0	0	0	0	0	46.3291	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance		$0 Copay;	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.2892	0.0189	0.2928	0.004	0.8421	0.5488	0.3546	0.0448	0.1127	0.0738	0.1244	0	0	0.0408	0.4528	1.9449	0.2684	0.1389	0.2688	2.3791	0.5145	0	0	0	0.0478	0	0	0	0	0											9.7621	0	NO	0.147747853	9.1552	0.906835414	2.039373285	0.004021495	1.540838122	2.66140689	0.556632549	0.68185851	0.991990111	0.073755658	1.06990252	0	0	0.896220805	3.984157844	12.59353749	1.019460533	2.59453767	2.663577996	4.427321665	6.786927419	0	0	0	1.40454382	0	0	0	0.039191563	0	0	0	0	0	0	0	0	0	0	0	56.0913
H3335_018_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	865.0731004	48.91139417	448.3831897	0	44.21909922	9.999383914	1.286653242	140.7145097	294.0280052	0	1102.599938	0	0	517.8649537	4060.701151	3618.815464	322.4674786	396.6908535	369.8699735	1262.492587	29.71252964	0.047085191	0	0	531.5426191	0	0	0	207.782627	0											3500	$100/days 1-7 for IP Medical;  PBP 1a	$100/days 1-7 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"	"$65/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	$25/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$35 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$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-e"	20% Coinsurance for Part B Rx;  PBP 15	$25 Copay;  PBP 7g			$25/Visit for Vision Exams;  PBP 17a	PBP 17b	$25/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	100	100	25	0	100	0.2	0.2	61.52009007	35	0	25	0	0	25	10	25	25	25	25	14.11666246	0.2	25	0	0	25	0	0	0	2.083333333	0											NO	98.58770354	98.58770354	24.64692588	0	98.58770354	0.197175407	0.197175407	60.65124401	34.50569624	0	24.64692588	0	0	24.64692588	9.858770354	24.64692588	24.64692588	24.64692588	24.64692588	13.91729334	0.197175407	24.64692588	0	0	24.64692588	0	0	0	2.083168498	0												7.1071	0.401838502	0.920938937	0	0.363288287	1.971632594	0.253696377	0.711209172	0.845470086	0	2.264641579	0	0	1.063648261	3.336126677	7.432723043	0.662319337	0.814767506	0.759679819	1.464206639	5.858580127	9.67E-05	0	0	1.091740961	0	0	0	0.036070519	0	0	0	0	0	0	0	0	0	0	0	37.3598	0	NO	0.534675818	7.1071	0.401838502	0.920938937	0	0.363288287	1.971632594	0.253696377	0.711209172	0.845470086	0	2.264641579	0	0	1.063648261	3.336126677	7.432723043	0.662319337	0.814767506	0.759679819	1.464206639	5.858580127	9.67E-05	0	0	1.091740961	0	0	0	0.036070519	0	0	0	0	0	0	0	0	0	0	0	37.3598	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	8.3418	0.1747	0.7214	0.2738	0.6978	0.3017	0.3212	0.0521	0.2846	0.2109	0.1807	0	0	0.1011	0.3048	2.2735	0.3839	0.1377	0.3073	1.9309	0.1586	0.0001	0	0	0.0741	0	0	0	0	0											17.2329	0	NO	0.246865433	15.449	0.576575183	1.642343682	0.273803129	1.061121626	2.273303434	0.574891969	0.763299998	1.130088433	0.21094216	2.445340155	0	0	1.164783738	3.640925579	9.706252424	1.046219784	0.952447281	1.066951759	3.395132951	6.017152816	0.000211234	0	0	1.165845167	0	3.40E-06	0	0.036070519	0	0	0	0	0	0	0	0	0	0	0	54.5927
H3335_021_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1001.003244	105.445053	496.1248746	0	81.37426846	10.39434939	1.246015997	123.4748723	392.8813559	0	1059.951155	0	0	967.3749534	4281.332281	3860.181182	352.7724277	469.0849758	472.4799797	1062.294144	30.63135325	0.073372151	0	0	801.1346526	0	0	0	165.2211056	0											3500	$100/days 1-7 for IP Medical;  PBP 1a	$100/days 1-7 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"	"$65/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	$25/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$35 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$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-e"	20% Coinsurance for Part B Rx;  PBP 15	$25 Copay;  PBP 7g			$25/Visit for Vision Exams;  PBP 17a	PBP 17b	$25/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	100	100	25	0	100	0.2	0.2	59.56220887	35	0	25	0	0	25	10	25	25	25	25	17.06388385	0.2	25	0	0	25	0	0	0	2.083333333	0											NO	98.68300229	98.68300229	24.67075057	0	98.68300229	0.197366005	0.197366005	58.77777594	34.5390508	0	24.67075057	0	0	24.67075057	9.868300229	24.67075057	24.67075057	24.67075057	24.67075057	16.83915289	0.197366005	24.67075057	0	0	24.67075057	0	0	0	2.083246007	0												8.2318	0.867136201	1.019981086	0	0.669188093	2.051491208	0.245921199	0.604798198	1.130812426	0	2.179149213	0	0	1.988822182	3.52078936	7.936130591	0.725263381	0.96438987	0.971369644	1.490677792	6.045587806	0.000150846	0	0	1.647049432	0	0	0	0.028683017	0	0	0	0	0	0	0	0	0	0	0	42.3192	0	NO	0.564399794	8.2318	0.867136201	1.019981086	0	0.669188093	2.051491208	0.245921199	0.604798198	1.130812426	0	2.179149213	0	0	1.988822182	3.52078936	7.936130591	0.725263381	0.96438987	0.971369644	1.490677792	6.045587806	0.000150846	0	0	1.647049432	0	0	0	0.028683017	0	0	0	0	0	0	0	0	0	0	0	42.3192	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	2.6109	0.1626	0.3592	0.0159	0.638	0.628	0.4686	0.0387	0.3851	0.1838	0.2375	0	0	0.0877	0.5218	1.5529	0.2752	0.0522	0.4639	1.6604	0.1216	0.0002	0	0	0.0956	0	0	0	0	0											10.5599	0	NO	0.140929971	10.8428	1.029770433	1.379211474	0.015871296	1.307146994	2.679507716	0.714543018	0.643508677	1.515940412	0.183847404	2.416622358	0	0	2.076549153	4.042601052	9.488994062	1.00046452	1.016629054	1.435226158	3.151070192	6.167222843	0.000329481	0	0	1.742632733	0	4.95E-06	0	0.028683017	0	0	0	0	0	0	0	0	0	0	0	52.8791
H3335_032_0	2012	9																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	713.0924236	66.34470765	724.6851189	0	105.7340959	9.632574178	1.658226776	164.4810675	265.8100785	0	18.29514019	0	0	732.2491613	3187.319841	3853.71363	4.225774769	511.3052071	10.76704562	1436.897704	30.06227017	0.042899918	0	0	649.1164921	0	0	0	297.6862808	0											4000	$150/days 1-7 for IP Medical;  PBP 1a	$150/days 1-7 for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$150/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$150 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	150	150	50	0	150	0.2	0.2	59.78940934	150	0	0.2	0	0	40	20	40	0.403819829	40	0.2	30.6786487	0.2	40	0	0	40	0	0	0	2.083333333	0											NO	142.7163759	142.7163759	47.57212529	0	142.7163759	0.190288501	0.190288501	56.88618544	142.7163759	0	0.190288501	0	0	38.05770023	19.02885012	38.05770023	0.38421135	38.05770023	0.190288501	29.1889704	0.190288501	38.05770023	0	0	38.05770023	0	0	0	2.083324572	0												8.4808	0.789039686	2.872900939	0	1.257498915	1.832968103	0.315541488	0.779725042	3.161287589	0	3.481354805	0	0	2.322309923	5.054252628	12.22195651	1.623590628	1.621591691	2.048844973	3.495130377	5.720504332	0.000136056	0	0	2.058656739	0	0	0	0.051681429	0	0	0	0	0	0	0	0	0	0	0	59.1898	0	NO	3.018153125	8.4808	0.789039686	2.872900939	0	1.257498915	1.832968103	0.315541488	0.779725042	3.161287589	0	3.481354805	0	0	2.322309923	5.054252628	12.22195651	1.623590628	1.621591691	2.048844973	3.495130377	5.720504332	0.000136056	0	0	2.058656739	0	0	0	0.051681429	0	0	0	0	0	0	0	0	0	0	0	59.1898	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	$150/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	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	3.1274	0.0648	0.3402	0.2413	0.3846	0.2669	0.1332	0.076	0.5519	0.1252	0.3187	0	0	0.1813	0.2247	0.9707	0.1871	0.1407	0.3971	0.6214	0.4003	0.0002	0	0	0.0954	0	0	0	0	0											8.8491	0	NO	1.178101494	11.6083	0.853861358	3.213059117	0.241261486	1.642106038	2.099849464	0.448755164	0.855721443	3.713155163	0.125197268	3.800050393	0	0	2.503633097	5.278910205	13.19261863	1.810703315	1.762327886	2.445988838	4.116507777	6.120831842	0.000348629	0	0	2.154049135	0	2.09E-06	0	0.051681429	0	0	0	0	0	0	0	0	0	0	0	68.0389
H3335_037_0	2012	7																															D	D	D		T	Coin	Coin	V	Coin		Coin			V	V	V	Coin	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	600.061643	50.48248755	438.0881129	0	73.88154083	7.149064981	0.564609703	97.18643348	20.85232201	0	23.61132034	0	0	472.5467865	3014.47062	2881.78573	1.806728684	522.5888107	14.83354094	811.5229941	14.83278981	0.05651853	0	0	475.8625565	0	0	0	233.9308427	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"20% Coinsurance for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"0% - 20% Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	61.61641015	0.2	0	0.2	0	0	40	15	40	0.402445937	40	0.2	26.4479786	0.2	40	0	0	40	0	0	0	2.083333333	0											NO	197.0613889	197.0613889	49.26534724	0	98.53069447	0.197061389	0.197061389	60.71107683	0.197061389	0	0.197061389	0	0	39.41227779	14.77960417	39.41227779	0.396532777	39.41227779	0.197061389	26.05937699	0.197061389	39.41227779	0	0	39.41227779	0	0	0	2.083313453	0												9.8541	0.829012426	1.798546917	0	0.606633294	1.408804675	0.111262772	0.491691086	4.109187537	0	4.652879581	0	0	1.552012102	3.712723545	9.464811643	0.716427142	1.716367948	2.923118181	1.762315303	2.922970162	0.000185627	0	0	1.562902272	0	0	0	0.040612606	0	0	0	0	0	0	0	0	0	0	0	50.2365	0	NO	0.748530209	9.8541	0.829012426	1.798546917	0	0.606633294	1.408804675	0.111262772	0.491691086	4.109187537	0	4.652879581	0	0	1.552012102	3.712723545	9.464811643	0.716427142	1.716367948	2.923118181	1.762315303	2.922970162	0.000185627	0	0	1.562902272	0	0	0	0.040612606	0	0	0	0	0	0	0	0	0	0	0	50.2365	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	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$20/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"	"$45/Visit for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); $20/Visit for Chiro; $45/Visit for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $45/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance;		30% Coinsurance;														10000	1.6279	0.0579	0.1871	0.0125	0.2958	0.2853	0.3375	0.0308	0.2643	0.0718	0.1183	0	0	0.0225	0.0835	0.4087	0.1958	0.1752	0.1599	0.9521	0.0802	0.0001	0	0	0.0695	0	0	0	0	0											5.4367	0	NO	0.081072485	11.482	0.886958407	1.985649503	0.012475063	0.902430325	1.694137595	0.448779112	0.522447045	4.373460554	0.071778148	4.771208892	0	0	1.574482733	3.796244595	9.873538016	0.912213681	1.891559793	3.082977363	2.714418203	3.003172506	0.000326037	0	0	1.632380279	0	0	0	0.040612606	0	0	0	0	0	0	0	0	0	0	0	55.6732
H3335_038_0	2012	7																															D	D	D		T	Coin	Coin	V	Coin		Coin			V	V	V	Coin	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	529.8819431	64.20619658	180.3202576	0	36.05312581	6.378326852	0.601575813	129.5003474	24.40554186	0	10.17375705	0	0	222.6414975	3086.225391	3201.231852	1.609896447	604.4028566	25.83752131	703.9232016	14.46269159	0.012784036	0	0	484.8381967	0	0	0	316.7019689	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"20% Coinsurance for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"0% - 20% Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	53.05939677	0.2	0	0.2	0	0	40	15	40	0.409877733	40	0.2	28.13858609	0.2	40	0	0	40	0	0	0	2.083333333	0											NO	196.6496336	196.6496336	49.16240841	0	98.32481682	0.196649634	0.196649634	52.17055468	0.196649634	0	0.196649634	0	0	39.32992673	14.74872252	39.32992673	0.40301153	39.32992673	0.196649634	27.66721322	0.196649634	39.32992673	0	0	39.32992673	0	0	0	2.083328346	0												8.6834	1.052177086	0.738748179	0	0.295409749	1.254295639	0.118299663	0.563008746	4.799340866	0	2.000665596	0	0	0.729706149	3.793156828	10.49201785	0.648806831	1.980926672	5.0809391	1.622966109	2.844083002	4.19E-05	0	0	1.589054229	0	0	0	0.054982849	0	0	0	0	0	0	0	0	0	0	0	48.3421	0	NO	0.822678346	8.6834	1.052177086	0.738748179	0	0.295409749	1.254295639	0.118299663	0.563008746	4.799340866	0	2.000665596	0	0	0.729706149	3.793156828	10.49201785	0.648806831	1.980926672	5.0809391	1.622966109	2.844083002	4.19E-05	0	0	1.589054229	0	0	0	0.054982849	0	0	0	0	0	0	0	0	0	0	0	48.3421	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	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$20/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"	"$45/Visit for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); $20/Visit for Chiro; $45/Visit for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $45/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance;		30% Coinsurance;														10000	4.3992	0.0663	0.228	0.0028	0.5036	0.2352	0.386	0.0362	0.1509	0.1842	0.1124	0	0	0.078	0.1466	0.8227	0.4221	0.1179	0.2654	1.4943	0.0828	0	0	0	0.073	0	0	0	0	0											9.8075	0	NO	0.167092276	13.0826	1.118433751	0.966721645	0.002815863	0.799038048	1.489461917	0.504282696	0.599222674	4.950204528	0.184160575	2.113046809	0	0	0.807697824	3.939744707	11.31472144	1.070934146	2.098841128	5.346331992	3.11728824	2.92687402	7.36E-05	0	0	1.662067031	0	0	0	0.054982849	0	0	0	0	0	0	0	0	0	0	0	58.1495
H3335_041_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	622.4391403	54.03515925	468.1372162	0	85.00555088	6.810302767	0.862256288	123.251445	241.4770781	0	635.9570003	0	0	344.5335691	3117.04922	3520.260825	2.032250077	596.9326921	616.8006696	1097.071316	21.01141334	0.113797897	0	0	529.7177684	0	0	0	220.1054683	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/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	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$100 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$30/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$30 Copay;  PBP 7g			$30/Visit for Vision Exams;  PBP 17a	PBP 17b	$30/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	54.68568433	100	0	30	0	0	30	20	30	0.403352489	30	30	24.4196683	0.2	30	0	0	30	0	0	0	2.083333333	0											NO	197.4823412	197.4823412	49.37058531	0	98.74117062	0.197482341	0.197482341	53.99728487	98.74117062	0	29.62235119	0	0	29.62235119	19.74823412	29.62235119	0.398274969	29.62235119	29.62235119	24.11226634	0.197482341	29.62235119	0	0	29.62235119	0	0	0	2.08310577	0												10.2434	0.889249146	1.926017364	0	0.6994623	1.344914535	0.170280391	0.554603616	1.986977448	0	1.569878467	0	0	0.850491198	5.129684814	8.68986687	0.809394336	1.47354582	1.522590504	2.204406314	4.149383099	0.000280913	0	0	1.307623814	0	0	0	0.038208581	0	0	0	0	0	0	0	0	0	0	0	45.5603	0	NO	0.580354685	10.2434	0.889249146	1.926017364	0	0.6994623	1.344914535	0.170280391	0.554603616	1.986977448	0	1.569878467	0	0	0.850491198	5.129684814	8.68986687	0.809394336	1.47354582	1.522590504	2.204406314	4.149383099	0.000280913	0	0	1.307623814	0	0	0	0.038208581	0	0	0	0	0	0	0	0	0	0	0	45.5603	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $30/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	2.4873	0.1152	0.3721	0.0248	0.3797	0.297	0.2594	0.0342	0.1883	0.1189	0.1371	0	0	0.0419	0.1653	0.4582	0.1557	0.0536	0.1694	0.7396	0.102	0.0003	0	0	0.0402	0	0	0	0	0											6.34	0	NO	0.080827369	12.7306	1.004481997	2.29809432	0.024808227	1.07916672	1.641877088	0.42967875	0.588779657	2.175326243	0.118938146	1.706943125	0	0	0.892387252	5.294974907	9.148025563	0.965057172	1.527145539	1.691955634	2.943979443	4.251347251	0.000560137	0	0	1.347869025	0	9.22E-06	0	0.038208581	0	0	0	0	0	0	0	0	0	0	0	51.9003
H3335_042_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	720.2548213	53.2914755	484.2290181	0	111.9574118	9.982880845	0.919162332	131.1878706	275.4756763	0	760.2765955	0	0	480.7260175	3398.572086	3974.835834	2.263558527	885.8848993	565.2611813	1168.565172	17.69055942	0.112231701	0	0	533.6364028	0	0	0	210.4841153	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/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	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$100 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$30/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$30 Copay;  PBP 7g			$30/Visit for Vision Exams;  PBP 17a	PBP 17b	$30/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	58.26691006	100	0	30	0	0	30	20	30	0.403525755	30	30	24.90444458	0.2	30	0	0	30	0	0	0	2.083333333	0											NO	196.9150569	196.9150569	49.22876423	0	98.45752846	0.196915057	0.196915057	57.36815955	98.45752846	0	29.53725854	0	0	29.53725854	19.69150569	29.53725854	0.397301486	29.53725854	29.53725854	24.52030061	0.196915057	29.53725854	0	0	29.53725854	0	0	0	2.083298489	0												11.8191	0.874491161	1.98649968	0	0.918587505	1.96577955	0.180996903	0.627167224	2.260221187	0	1.871373863	0	0	1.183277389	5.576916799	9.783812807	0.899315165	2.180550942	1.391355471	2.387797441	3.483537515	0.000276251	0	0	1.313513033	0	0	0	0.03654177	0	0	0	0	0	0	0	0	0	0	0	50.7411	0	NO	0.794356655	11.8191	0.874491161	1.98649968	0	0.918587505	1.96577955	0.180996903	0.627167224	2.260221187	0	1.871373863	0	0	1.183277389	5.576916799	9.783812807	0.899315165	2.180550942	1.391355471	2.387797441	3.483537515	0.000276251	0	0	1.313513033	0	0	0	0.03654177	0	0	0	0	0	0	0	0	0	0	0	50.7411	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $30/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.7812	0.1133	0.3659	0.0244	0.3293	0.2928	0.375	0.0235	0.2712	0.0843	0.1117	0	0	0.0412	0.1594	0.4127	0.2016	0.0527	0.1675	0.9748	0.1243	0.0003	0	0	0.0371	0	0	0	0	0											5.9441	0	NO	0.093123199	13.6003	0.987811606	2.352401645	0.02439651	1.247880227	2.258563189	0.555973308	0.650661014	2.531395129	0.084309164	1.983066476	0	0	1.224478135	5.736271338	10.19653258	1.100923168	2.23326112	1.558822311	3.362569269	3.607867852	0.000550841	0	0	1.350652418	0	8.51E-06	0	0.03654177	0	0	0	0	0	0	0	0	0	0	0	56.6852
H3335_043_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	846.2666808	57.55916091	773.8138617	0	111.4105228	9.896628061	1.501095923	135.593793	279.094935	0	665.3684564	0	0	508.5995963	3554.074031	4301.143868	1.957707346	790.1989478	800.350749	1329.064292	20.81347654	0.121219435	0	0	577.604082	0	0	0	254.2007128	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/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	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$100 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$30/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$30 Copay;  PBP 7g			$30/Visit for Vision Exams;  PBP 17a	PBP 17b	$30/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	53.9849595	100	0	30	0	0	30	20	30	0.403707103	30	30	24.7348926	0.2	30	0	0	30	0	0	0	2.083333333	0											NO	195.3898922	195.3898922	48.84747304	0	97.69494608	0.195389892	0.195389892	52.74057707	97.69494608	0	29.30848382	0	0	29.30848382	19.53898922	29.30848382	0.394401437	29.30848382	29.30848382	24.16473999	0.195389892	29.30848382	0	0	29.30848382	0	0	0	2.083282835	0												13.7793	0.93720652	3.149904312	0	0.907020418	1.93370109	0.29329897	0.595941241	2.272180386	0	1.625078387	0	0	1.242190253	5.786917847	10.50500046	0.772122591	1.92996109	1.954755582	2.676374419	4.066742937	0.000296063	0	0	1.410724991	0	0	0	0.044130998	0	0	0	0	0	0	0	0	0	0	0	55.8829	0	NO	1.317482969	13.7793	0.93720652	3.149904312	0	0.907020418	1.93370109	0.29329897	0.595941241	2.272180386	0	1.625078387	0	0	1.242190253	5.786917847	10.50500046	0.772122591	1.92996109	1.954755582	2.676374419	4.066742937	0.000296063	0	0	1.410724991	0	0	0	0.044130998	0	0	0	0	0	0	0	0	0	0	0	55.8829	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $30/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	5.4357	0.1214	0.3921	0.0261	0.5562	0.3249	0.3974	0.0366	0.1985	0.0964	0.1443	0	0	0.0454	0.1575	0.6437	0.1883	0.138	0.1809	1.0294	0.1719	0.0003	0	0	0.0493	0	0	0	0	0											10.3343	0	NO	0.243831524	19.215	1.0586539	3.542047449	0.026146139	1.463214506	2.258568006	0.690686638	0.632501118	2.470686867	0.096354722	1.769349949	0	0	1.287574435	5.944378981	11.14870888	0.960391119	2.068005966	2.135664099	3.705762261	4.238675567	0.000590345	0	0	1.460049633	0	8.21E-06	0	0.044130998	0	0	0	0	0	0	0	0	0	0	0	66.2172
H3335_044_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	470.0369528	46.19928959	400.2506354	0	62.2287729	5.779006293	0.7002861	85.63621473	205.3538639	0	511.7391098	0	0	297.0627677	2388.483944	2564.794859	1.327557947	460.2415427	428.2268734	802.0681882	14.14624912	0.097295577	0	0	581.1492212	0	0	0	206.568482	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/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	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$100 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$30/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$30 Copay;  PBP 7g			$30/Visit for Vision Exams;  PBP 17a	PBP 17b	$30/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	54.22887629	100	0	30	0	0	30	20	30	0.40438783	30	30	24.40060035	0.2	30	0	0	30	0	0	0	2.083333333	0											NO	198.5474284	198.5474284	49.6368571	0	99.27371419	0.198547428	0.198547428	53.83501966	99.27371419	0	29.78211426	0	0	29.78211426	19.85474284	29.78211426	0.401450819	29.78211426	29.78211426	24.22338226	0.198547428	29.78211426	0	0	29.78211426	0	0	0	2.08331236	0												7.7771	0.764395845	1.655598633	0	0.514806785	1.147406838	0.139040004	0.384185609	1.698853399	0	1.270056053	0	0	0.737263107	3.951894541	6.365417795	0.532949225	1.142247184	1.062791806	1.619067027	2.808701383	0.000241472	0	0	1.442321042	0	0	0	0.035862223	0	0	0	0	0	0	0	0	0	0	0	35.0502	0	NO	0.256164665	7.7771	0.764395845	1.655598633	0	0.514806785	1.147406838	0.139040004	0.384185609	1.698853399	0	1.270056053	0	0	0.737263107	3.951894541	6.365417795	0.532949225	1.142247184	1.062791806	1.619067027	2.808701383	0.000241472	0	0	1.442321042	0	0	0	0.035862223	0	0	0	0	0	0	0	0	0	0	0	35.0502	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $30/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.557	0.0991	0.3198	0.0213	0.274	0.2553	0.223	0.0513	0.4929	0.1273	2.0209	0	0	0.0975	0.1015	0.3866	0.1338	0.0461	0.5302	0.586	0.0876	0.0002	0	0	0.0479	0	0	0	0	0											7.4593	0	NO	0.054571986	9.334	0.863449651	1.975434846	0.021325076	0.788782274	1.40267494	0.36201804	0.435507378	2.191798382	0.127260626	3.290978294	0	0	0.834750837	4.0533767	6.752054152	0.666756522	1.188321339	1.592954276	2.205056131	2.896349456	0.000481492	0	0	1.490195829	0	1.10E-05	0	0.035862223	0	0	0	0	0	0	0	0	0	0	0	42.5094
H3335_045_0	2012	7																															D	D	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	852.4407787	51.05736849	442.3389268	0	77.14464976	6.386696773	0.773924573	90.84433977	204.3094661	0	498.139148	0	0	315.627307	2523.853074	2775.960548	1.46715709	508.6381683	476.5130631	992.6089899	15.61722004	0.107526678	0	0	639.7567028	0	0	0	210.309827	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/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	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$100 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$30/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$30 Copay;  PBP 7g			$30/Visit for Vision Exams;  PBP 17a	PBP 17b	$30/Visit for Hearing Exam;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	55.68439837	100	0	30	0	0	30	20	30	0.40438783	30	30	23.95159538	0.2	30	0	0	30	0	0	0	2.083333333	0											NO	197.8909765	197.8909765	49.47274412	0	98.94548825	0.197890976	0.197890976	55.09719984	98.94548825	0	29.68364647	0	0	29.68364647	19.78909765	29.68364647	0.400123513	29.68364647	29.68364647	23.69902299	0.197890976	29.68364647	0	0	29.68364647	0	0	0	2.083302498	0												14.0575	0.841982709	1.823643379	0	0.63609292	1.263869661	0.153152689	0.417105729	1.68462499	0	1.23221553	0	0	0.78074745	4.162064577	6.866719295	0.587044049	1.258186298	1.178720442	1.96032194	3.090506923	0.000265982	0	0	1.582525983	0	0	0	0.036511582	0	0	0	0	0	0	0	0	0	0	0	43.6138	0	NO	0.464425908	14.0575	0.841982709	1.823643379	0	0.63609292	1.263869661	0.153152689	0.417105729	1.68462499	0	1.23221553	0	0	0.78074745	4.162064577	6.866719295	0.587044049	1.258186298	1.178720442	1.96032194	3.090506923	0.000265982	0	0	1.582525983	0	0	0	0.036511582	0	0	0	0	0	0	0	0	0	0	0	43.6138	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance;	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $30/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$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-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance;														10000	1.715	0.1091	0.3523	0.0235	0.3715	0.2812	0.2456	0.0226	0.1783	0.0716	0.1075	0	0	0.0397	0.1253	0.3617	0.1474	0.0508	0.1536	0.594	0.0965	0.0003	0	0	0.0483	0	0	0	0	0											5.0958	0	NO	0.054308711	15.7725	0.951090565	2.175943254	0.02348959	1.007580737	1.545047704	0.398763196	0.439726157	1.862962444	0.071599318	1.339756067	0	0	0.820416594	4.287359134	7.228400688	0.734432907	1.308937021	1.332322136	2.554329029	3.187051354	0.000530364	0	0	1.630853858	0	1.11E-05	0	0.036511582	0	0	0	0	0	0	0	0	0	0	0	48.7097
H3335_051_0	2012	7																															D	D	D		T	Coin	Coin	V	Coin		Coin			V	V	V	Coin	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	672.3610765	66.08545115	572.5357261	0	89.0147136	8.266539191	1.001719362	106.7666091	23.31271827	0	18.91247655	0	0	404.4946124	3209.064169	3435.526278	1.898995994	648.2981661	20.83753956	1104.124503	20.21392549	0.13716602	0	0	598.5152919	0	0	0	216.8511658	0											4000	$200/days 1-7 for IP Medical;  PBP 1a	$200/days 1-7 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"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"20% Coinsurance for OP Surgery;  PBP 9a, 9b"	$0 Copay;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"0% - 20% Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	50	0	100	0.2	0.2	58.03227685	0.2	0	0.2	0	0	40	15	40	0.40438783	40	0.2	26.23731659	0.2	40	0	0	40	0	0	0	2.083333333	0											NO	195.6834573	195.6834573	48.92086433	0	97.84172866	0.195683457	0.195683457	56.77978285	0.195683457	0	0.195683457	0	0	39.13669146	14.6762593	39.13669146	0.395660044	39.13669146	0.195683457	25.6710441	0.195683457	39.13669146	0	0	39.13669146	0	0	0	2.083265853	0												10.9642	1.077652463	2.334078548	0	0.725779455	1.617624969	0.196019908	0.505182073	4.561913311	0	3.700858797	0	0	1.31921507	3.924754821	11.20459433	0.751356838	2.114353775	4.077561783	2.3620024	3.955530826	0.000447352	0	0	1.95199236	0	0	0	0.037646552	0	0	0	0	0	0	0	0	0	0	0	57.3827	0	NO	1.264965014	10.9642	1.077652463	2.334078548	0	0.725779455	1.617624969	0.196019908	0.505182073	4.561913311	0	3.700858797	0	0	1.31921507	3.924754821	11.20459433	0.751356838	2.114353775	4.077561783	2.3620024	3.955530826	0.000447352	0	0	1.95199236	0	0	0	0.037646552	0	0	0	0	0	0	0	0	0	0	0	57.3827	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	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care; $65/Visit for OP Observation; 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	50% Coinsurance	$0 Copay	"30% Coinsurance for OP Other; PBP 3, 9a, 9c, 9d"	$20/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"	"$45/Visit for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); $20/Visit for Chiro; $45/Visit for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $45/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-e"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance;		30% Coinsurance;														10000	2.195	0.1396	0.4509	0.0301	0.3863	0.3599	0.3144	0.0314	0.2283	0.0916	0.1376	0	0	0.0508	0.1171	0.5727	0.1886	0.1143	0.1846	0.9567	0.1236	0.0003	0	0	0.0671	0	0	0	0	0											6.741	0	NO	0.1486977	13.1592	1.217299451	2.784986654	0.030064293	1.112032681	1.977504343	0.510376443	0.536583562	4.790167164	0.091639865	3.838499775	0	0	1.369987551	4.041812505	11.77730465	0.939999626	2.228671272	4.262199968	3.31872933	4.079097905	0.000785734	0	0	2.019109901	0	0	0	0.037646552	0	0	0	0	0	0	0	0	0	0	0	64.1237
H3335_801_0	2012	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	250.792758	3.555251205	44.96593888	0	7.356674699	7.858992529	13.47284453	22.46221683	48.38916603	23.33223571	29.87641664	0	0.88313578	6.993017139	42.600992	121.7940086	2.254121848	7.572616008	34.20378788	31.56310176	60.29753311	2.342713084	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090505361	0.090505361	0.180543451	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081279317	0.081279317	0.162138996	0	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0.20116562	0	0	0	0	0	0	0	0												20.3843	0.28896839	7.290732192	0	1.479910023	1.580959101	2.710273117	4.518625764	9.734236562	4.693643651	6.010107861	0	0.177656556	1.406754625	8.569854948	24.50076719	0.453451818	1.523349991	6.880626179	6.349410919	12.1297906	0.471273329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1547	0	NO	13.75230788	20.3843	0.28896839	7.290732192	0	1.479910023	1.580959101	2.710273117	4.518625764	9.734236562	4.693643651	6.010107861	0	0.177656556	1.406754625	8.569854948	24.50076719	0.453451818	1.523349991	6.880626179	6.349410919	12.1297906	0.471273329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1547	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.2934	0.0065	0.1034	0	0.3855	0.0654	0.0396	0.1372	0.1453	0.083	0.0648	0	0.004	0.0329	0.1887	0.7156	0.0069	0.0606	0.1277	0.3688	0.1675	0.0078	0	0	0	0	0	0	0	0											3.0045	0	NO	0.195556201	20.6777	0.29545053	7.394110182	0	1.865409066	1.646352196	2.749836419	4.655848088	9.87954443	4.776676389	6.074931954	0	0.181621823	1.4396508	8.758540923	25.21636928	0.460344747	1.58399319	7.008286398	6.718182927	12.29726122	0.479102426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1592
H3335_811_0	2012	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	0	0	0	0	0	0	0	0	0	0	0											0	YES	210.190089	10.7474688	31.11403966	0	5.793858228	12.58830607	3.50703758	10.78172185	48.51271015	22.06840186	35.86534449	0	0	10.09625011	40.95646553	97.70826362	2.209555385	6.110143602	25.11289807	48.4683591	56.82458998	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.088221812	0.088221812	0.183811164	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.080017318	0.080017318	0.166717006	0	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0	0	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0.203168341	0	0	0	0	0	0	0	0	0												16.8188	0.859983631	5.187239525	0	1.177128566	2.557545264	0.712519008	2.190504544	9.856246853	4.483600602	7.28670255	0	0	2.051238388	8.321057168	19.85122585	0.448911703	1.241387741	5.102145845	9.847236124	11.54495769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	0	NO	11.23141617	16.8188	0.859983631	5.187239525	0	1.177128566	2.557545264	0.712519008	2.190504544	9.856246853	4.483600602	7.28670255	0	0	2.051238388	8.321057168	19.85122585	0.448911703	1.241387741	5.102145845	9.847236124	11.54495769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.3694	0.0029	0.4992	0	0.6424	0.4102	0.212	0.1852	0.3313	0.0945	0.1383	0	0	0.1101	0.177	1.9609	0.1048	0.0655	0.2734	1.5719	0.1685	0	0	0	0	0	0	0	0	0											8.3176	0	NO	0.401132944	18.1882	0.86290337	5.686455488	0	1.819492061	2.967723094	0.924554166	2.375726502	10.18753137	4.578102545	7.425049426	0	0	2.161334427	8.498064123	21.81214639	0.553712818	1.30687226	5.375592678	11.4191338	11.71350037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8561
H3335_813_0	2012	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	258.0277901	5.700076566	45.79940759	0	8.918563839	7.817927772	14.12726316	24.95559023	51.42498818	23.88017274	22.8258025	0	1.415917265	6.549061339	46.69485579	132.1978994	2.46132698	6.829401842	39.98493721	34.44328841	59.76235925	2.795613886	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090864341	0.090864341	0.179508821	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081003382	0.081003382	0.16002781	0	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0	0	0	0	0	0	0	0												20.9011	0.461725478	7.329178917	0	1.780953628	1.561166919	2.821082075	4.983397523	10.26908826	4.768646729	4.558098872	0	0.28274541	1.307786182	9.324525151	26.39868176	0.491503934	1.363767553	7.984617284	6.878001947	11.93398314	0.558257897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9583	0	NO	15.33355753	20.9011	0.461725478	7.329178917	0	1.780953628	1.561166919	2.821082075	4.983397523	10.26908826	4.768646729	4.558098872	0	0.28274541	1.307786182	9.324525151	26.39868176	0.491503934	1.363767553	7.984617284	6.878001947	11.93398314	0.558257897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9583	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.4748	0.0105	0.1657	0	0.0403	0.0353	0.0638	0.1131	0.2321	0.1078	0.103	0	0.0064	0.0296	0.2108	0.5967	0.0111	0.0308	0.1805	0.1555	0.2698	0.0126	0	0	0	0	0	0	0	0											2.8501	0	NO	0.169498587	21.3759	0.472214708	7.494846747	0	1.821210078	1.596455338	2.884849456	5.096546261	10.50120943	4.876436615	4.661129561	0	0.289136551	1.337347215	9.535295534	26.99539421	0.502613827	1.394593982	8.16510056	7.03347143	12.20373738	0.570876688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8084
H3335_819_0	2012	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	0	0	0	0	0	0	0	0	0	0	0											0	YES	210.1902681	10.74747796	31.11406617	0	5.793863166	12.5883168	3.507040568	10.78173103	48.51275149	22.06842067	35.86537505	0	0	10.09625871	40.95650043	97.70834688	2.209557267	6.110148809	25.11291946	48.4684004	56.8246384	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.08822159	0.08822159	0.183811732	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.080017111	0.080017111	0.166717509	0	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0	0	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0	0	0	0	0	0	0	0	0												16.8188	0.859982139	5.187259608	0	1.177129486	2.557547262	0.712519565	2.190506256	9.856254554	4.483604105	7.286708243	0	0	2.051239991	8.32106367	19.85124136	0.448912053	1.241388711	5.102149832	9.847243818	11.54496671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	0	NO	11.23143057	16.8188	0.859982139	5.187259608	0	1.177129486	2.557547262	0.712519565	2.190506256	9.856254554	4.483604105	7.286708243	0	0	2.051239991	8.32106367	19.85124136	0.448912053	1.241388711	5.102149832	9.847243818	11.54496671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.3694	0.0029	0.4992	0	0.6424	0.4102	0.212	0.1852	0.3313	0.0945	0.1383	0	0	0.1101	0.177	1.9609	0.1048	0.0655	0.2734	1.5719	0.1685	0	0	0	0	0	0	0	0	0											8.3176	0	NO	0.401133546	18.1882	0.862901873	5.686477518	0	1.8194935	2.967725424	0.924554894	2.375728363	10.18753934	4.578106125	7.425055232	0	0	2.161336119	8.498070768	21.81216349	0.553713254	1.306873283	5.375596886	11.41914277	11.71350953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8562
H3335_820_0	2012	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	0	0	0	0	0	0	0	0	0	0	0											0	YES	210.1902681	10.74747796	31.11406617	0	5.793863166	12.5883168	3.507040568	10.78173103	48.51275149	22.06842067	35.86537505	0	0	10.09625871	40.95650043	97.70834688	2.209557267	6.110148809	25.11291946	48.4684004	56.8246384	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.08822159	0.08822159	0.183811732	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.080017111	0.080017111	0.166717509	0	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0	0	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0.203168327	0	0	0	0	0	0	0	0	0												16.8188	0.859982139	5.187259608	0	1.177129486	2.557547262	0.712519565	2.190506256	9.856254554	4.483604105	7.286708243	0	0	2.051239991	8.32106367	19.85124136	0.448912053	1.241388711	5.102149832	9.847243818	11.54496671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	0	NO	11.23143057	16.8188	0.859982139	5.187259608	0	1.177129486	2.557547262	0.712519565	2.190506256	9.856254554	4.483604105	7.286708243	0	0	2.051239991	8.32106367	19.85124136	0.448912053	1.241388711	5.102149832	9.847243818	11.54496671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5385	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.3694	0.0029	0.4992	0	0.6424	0.4102	0.212	0.1852	0.3313	0.0945	0.1383	0	0	0.1101	0.177	1.9609	0.1048	0.0655	0.2734	1.5719	0.1685	0	0	0	0	0	0	0	0	0											8.3176	0	NO	0.401133546	18.1882	0.862901873	5.686477518	0	1.8194935	2.967725424	0.924554894	2.375728363	10.18753934	4.578106125	7.425055232	0	0	2.161336119	8.498070768	21.81216349	0.553713254	1.306873283	5.375596886	11.41914277	11.71350953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8562
H3335_822_0	2012	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	258.0277901	5.700076566	45.79940759	0	8.918563839	7.817927772	14.12726316	24.95559023	51.42498818	23.88017274	22.8258025	0	1.415917265	6.549061339	46.69485579	132.1978994	2.46132698	6.829401842	39.98493721	34.44328841	59.76235925	2.795613886	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090864341	0.090864341	0.179508821	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081003382	0.081003382	0.16002781	0	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0.19969063	0	0	0	0	0	0	0	0												20.9011	0.461725478	7.329178917	0	1.780953628	1.561166919	2.821082075	4.983397523	10.26908826	4.768646729	4.558098872	0	0.28274541	1.307786182	9.324525151	26.39868176	0.491503934	1.363767553	7.984617284	6.878001947	11.93398314	0.558257897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9583	0	NO	15.33355753	20.9011	0.461725478	7.329178917	0	1.780953628	1.561166919	2.821082075	4.983397523	10.26908826	4.768646729	4.558098872	0	0.28274541	1.307786182	9.324525151	26.39868176	0.491503934	1.363767553	7.984617284	6.878001947	11.93398314	0.558257897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9583	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.4748	0.0105	0.1657	0	0.0403	0.0353	0.0638	0.1131	0.2321	0.1078	0.103	0	0.0064	0.0296	0.2108	0.5967	0.0111	0.0308	0.1805	0.1555	0.2698	0.0126	0	0	0	0	0	0	0	0											2.8501	0	NO	0.169498587	21.3759	0.472214708	7.494846747	0	1.821210078	1.596455338	2.884849456	5.096546261	10.50120943	4.876436615	4.661129561	0	0.289136551	1.337347215	9.535295534	26.99539421	0.502613827	1.394593982	8.16510056	7.03347143	12.20373738	0.570876688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8084
H3337_001_0	2012	9																															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	77.07623141	0	363.0372171	2.144737588	0.238304176	298.7279517	0	0	0	0	0.013847047	134.5897992	0	0	403.7693975	597.0736162	0	0	8.072131939	0	0	0	0	0	5.327616716	0	0	0											3400	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	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											NO	0	0	25	0	50	0.2	0.2	50	0	0	0	0	0.2	20	0	0	20	20	0	0	0.196677078	0	0	0	0	0	20	0	0	0												0	0	0.160575482	0	1.512655071	0.428947518	0.047660835	1.244699799	0	0	0	0	0.002769409	0.224316332	0	0	0.672948996	0.995122694	0	0	1.587603323	0	0	0	0	0	0.008879361	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8862	0	NO	0.03	0	0	0.160575482	0	1.512655071	0.428947518	0.047660835	1.244699799	0	0	0	0	0.002769409	0.224316332	0	0	0.672948996	0.995122694	0	0	1.587603323	0	0	0	0	0	0.008879361	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8862	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	NO	0	0	0	0.160575482	0	1.512655071	0.428947518	0.047660835	1.244699799	0	0	0	0	0.002769409	0.224316332	0	0	0.672948996	0.995122694	0	0	1.587603323	0	0	0	0	0	0.008879361	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8862
H3337_003_0	2012	9																															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	419.7370151	0	0	0	0	0	134.5897992	0	12311.76675	403.7693975	724.6824989	0	135.322153	11.50955744	0	0	0	0	0	0	0	0	0											3400	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	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											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	1.74890423	0	0	0	0	0	0.224316332	0	10.25980563	0.672948996	0.603902082	0	0.112768461	2.301911489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9246	0	NO	0	0	0	0	0	0	0	0	1.74890423	0	0	0	0	0	0.224316332	0	10.25980563	0.672948996	0.603902082	0	0.112768461	2.301911489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9246	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	NO	0	0	0	0	0	0	0	0	1.74890423	0	0	0	0	0	0.224316332	0	10.25980563	0.672948996	0.603902082	0	0.112768461	2.301911489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9246
H3342_001_0	2012	9	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1521.423513	19.91392032	770.60509	1025.608171	122.8310153	8.209040381	10.14869281	157.2803864	261.239134	17207.65683	257.2138475	6.556179342	0.153536673	247.9968249	3493.35321	5073.229793	9.477470268	1729.302967	1711.06757	3041.906415	45.2625431	10.25869541	0	456.2721669	234.4	234.4	129.6	8.64	5872.8	515.5549278	16.58080793	0	0	0	0	0	0	0	0	0	2800	1A: $125/day (days 1-7); no yrly max	1B: $125/day (days 1-7); no yrly max	2: $50/day (for 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: $0 - $125 copay; 9B: $125 copay	8A: $0 copay	8B: $75 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $20 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $25 copay; 7I: $25 copay	8B: $35 copay	14A: $0 copay; 17A: $0-$20; 17B: $0	15: 20% coinsurance	9D: $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $20 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay; 18A: $20 copay	14A: $0 copay								0	NO	82.49048072	88.63636364	50	0	200	0.2	0.174620747	48.67495116	118.1180716	0	75	40	0.1	24.88298546	10	20	40	25	35	7.564142658	0.2	0	0	0	0	0	0	0	0	13.42770821	0.2	18.87556985	0	0	0	0	0	0	0	0	NO	71.41165707	76.73212167	43.28478658	0	173.1391463	0.173139146	0.151168436	42.13769746	102.2543104	0	64.92717988	34.62782927	0.086569573	21.5410943	8.656957317	17.31391463	34.62782927	21.64239329	30.29935061	6.548246013	0.173139146	0	0	0	0	0	0	0	0	13.42770821	0.173139146	0	0	0	0	0	0	0	0	0		9.0539	0.127336446	2.779623072	0	1.772238094	1.421306244	1.534162016	0.552286111	2.226068958	0	1.391680812	0.018918855	0.013291604	0.445176916	2.520150802	7.319788962	0.027348685	3.118854578	4.320353018	1.659929296	7.836718073	0	0	0	0	0	0	0	0	0.576893428	2.870786931	0	0	0	0	0	0	0	0	0	51.5869		NO	7.91370003	9.0539	0.127336446	2.779623072	0	1.772238094	1.421306244	1.534162016	0.552286111	2.226068958	0	1.391680812	0.018918855	0.013291604	0.445176916	2.520150802	7.319788962	0.027348685	3.118854578	4.320353018	1.659929296	7.836718073	0	0	0	0	0	0	0	0	0.576893428	2.870786931	0	0	0	0	0	0	0	0	0	51.5869	YES	1A: $125/day (days 1-7); no yrly max	1B: $125/day (days1-7); 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-$125 copay; 9B: $125 copay	8A: $0-$50 copay	8B: $150 copay	5: $100 copay	12: 10% coin	3: $50 copay; 9A: $50 copay; 9C: 100 copay	7A: $30 copay; 7G: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14A: $0-$100 copay; 17A: $0-$50; 17B: $0	15: 20% coinsurance	9D: 20% coin	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per 2Yr"	"18A: 50% coins, 1 Exam per Yr"	"18A: 50% coin, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $50 copay; 13A: Not covered; 13D: $50 copay	8B: 20% coinsurance	14D: 20% coin; 14E: 20% coin; 18A: 50% coin	14A: $50 copay								2800	2.1238	0.0299	1.956	0.8678	0.4157	0.3334	0.4122	0.1295	0.5343	12.0182	0.6529	0.0111	0.0031	0.2679	1.7734	4.2925	0.016	1.9452	2.1716	2.3564	1.8382	0.0268	0	0.2019	0	0	0.0705	0.0322	0	0.362	0.6734	0	0	0	0	0	0	0	0	0	35.5158		NO	5.406534212	11.1777	0.157205489	4.735654122	0.867768915	2.187948264	1.754699066	1.946329722	0.681834705	2.760402452	12.01816136	2.044568106	0.030013245	0.016409388	0.713089871	4.293590256	11.6122578	0.043386494	5.064043448	6.491959032	4.016330403	9.674960585	0.026788492	0	0.201862348	0	0	0.070457333	0.032203012	0	0.938859798	3.544181397	0	0	0	0	0	0	0	0	0	87.1027
H3342_002_0	2012	8	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1245.434207	76.42358238	567.3387205	913.3368635	141.1949036	8.13676896	13.11567357	201.0942051	256.2492446	16701.42181	311.5584306	1.918522028	1.623430201	197.9298688	3512.025413	4888.289928	18.35049062	1556.560952	1336.525649	2838.597689	42.86003607	3.836235585	0	456.2721669	234.4	234.4	129.6	8.64	5872.8	459.1399372	14.96410609	0	0	0	0	0	0	0	0	0	2800	1A: $125/day (days 1-7); no yrly max	1B: $125/day (days 1-7); no yrly max	2: $50/day (for 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: $0 - $125 copay; 9B: $125 copay	8A: $0 copay	8B: $75 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $20 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $25 copay; 7I: $25 copay	8B: $35 copay	14A: $0 copay; 17A: $0-$20; 17B: $0	15: 20% coinsurance	9D: $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $20 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay; 18A: $20 copay	14A: $0 copay								0	NO	88.10839999	78.90161929	50	0	200	0.2	0.171556207	49.09572201	116.8241504	0	75	40	0.1	27.44967947	10	20	40	25	35	7.144302078	0.2	0	0	0	0	0	0	0	0	13.57982535	0.2	17.25158169	0	0	0	0	0	0	0	0	NO	76.90535736	68.86922506	43.6424662	0	174.5698648	0.174569865	0.149742719	42.85316777	101.9698807	0	65.4636993	34.91397296	0.087284932	23.95943417	8.72849324	17.45698648	34.91397296	21.8212331	30.54972634	6.235899239	0.174569865	0	0	0	0	0	0	0	0	13.57982535	0.174569865	0	0	0	0	0	0	0	0	0		7.9817	0.438602741	2.063338411	0	2.05403127	1.420434657	1.963976623	0.718126976	2.177475408	0	1.699647285	0.005581936	0.141700995	0.395190638	2.554557506	7.111234265	0.053390711	2.830506613	3.402541069	1.475100764	7.482070702	0	0	0	0	0	0	0	0	0.51958668	2.612281977	0	0	0	0	0	0	0	0	0	49.1011		NO	7.077018817	7.9817	0.438602741	2.063338411	0	2.05403127	1.420434657	1.963976623	0.718126976	2.177475408	0	1.699647285	0.005581936	0.141700995	0.395190638	2.554557506	7.111234265	0.053390711	2.830506613	3.402541069	1.475100764	7.482070702	0	0	0	0	0	0	0	0	0.51958668	2.612281977	0	0	0	0	0	0	0	0	0	49.1011	YES	1A: $125/day (days 1-7); no yrly max	1B: $125/day (days1-7); 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-$125 copay; 9B: $125 copay	8A: $0-$50 copay	8B: $150 copay	5: $100 copay	12: 10% coin	3: $50 copay; 9A: $50 copay; 9C: 100 copay	7A: $30 copay; 7G: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14A: $0-$100 copay; 17A: $0-$50; 17B: $0	15: 20% coinsurance	9D: 20% coin	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per 2Yr"	"18A: 50% coins, 1 Exam per Yr"	"18A: 50% coin, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $50 copay; 13A: Not covered; 13D: $50 copay	8B: 20% coinsurance	14D: 20% coin; 14E: 20% coin; 18A: 50% coin	14A: $50 copay								2800	1.8723	0.1029	1.452	0.7792	0.4818	0.3332	0.5371	0.1684	0.5251	11.8903	0.7974	0.0033	0.0332	0.241	1.7977	4.1702	0.0313	1.8605	1.7103	2.1602	1.7551	0.0086	0	0.2019	0	0	0.0705	0.0322	0	0.3229	0.6128	0	0	0	0	0	0	0	0	0	33.951		NO	4.854339434	9.854	0.541484866	3.515317293	0.779161719	2.535841074	1.753623034	2.501043609	0.886576513	2.702539469	11.89032621	2.497012678	0.008855293	0.1749395	0.636145833	4.352209085	11.28140251	0.084700079	4.690972519	5.112813035	3.635307092	9.237124323	0.008612089	0	0.201862348	0	0	0.070457333	0.032203012	0	0.842514984	3.225039478	0	0	0	0	0	0	0	0	0	83.0521
H3342_012_0	2012	8	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1093.722644	47.39768344	547.8714958	617.1529021	88.06188995	5.838885632	8.999494332	163.4739078	220.7673002	15346.64035	268.4728282	2.502740308	0.065476181	187.8560188	3503.800175	4155.233547	8.316972374	1224.603474	1408.115249	2804.292722	28.30065519	6.920121622	0.050474597	0	0	0	0	0	0	408.6908336	17.02658594	0	0	0	0	0	0	0	0	0	4500	1A: $225/day (days 1-7); no yrly max	1B: $200/day (days 1-7); no yrly max	2: $50/day (for days 1-100)	6: $0 copay	10A: $250 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $65 copay; 4B: $35 copay	9A: $0 - $225 copay; 9B: $225 copay	8A: $0 copay	8B: $125 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $35 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $45 copay	14A: $0 copay; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Not Covered	7B: Not covered; 7F: $35 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay	14A: $0 copay								0	NO	157.2414752	116.6130761	50	0	250	0.2	0.168790937	64.53255008	208.3949919	0	125	40	0.1	33.58084797	15	34.24127189	40	35	45	12.51427937	0.2	0	0	0	0	0	0	0	0	25.44644313	0.2	0	0	0	0	0	0	0	0	0	NO	141.0692838	104.6194912	44.85753002	0	224.2876501	0.17943012	0.15143089	57.89541605	186.9616921	0	112.143825	35.88602401	0.08971506	30.12707792	13.457259	30.71957763	35.88602401	31.40027101	40.37177701	11.22719325	0.17943012	0	0	0	0	0	0	0	0	25.44644313	0.17943012	0	0	0	0	0	0	0	0	0		12.8576	0.413226794	2.048013506	0	1.645932863	1.04767195	1.36280144	0.788699159	3.439585666	0	2.508964156	0.00748445	0.005874199	0.47162941	3.929295538	10.63725163	0.024871923	3.204406748	4.737342904	2.623694692	5.077989959	0	0	0	0	0	0	0	0	0.866644004	3.05508236	0	0	0	0	0	0	0	0	0	60.754		NO	6.865492352	12.8576	0.413226794	2.048013506	0	1.645932863	1.04767195	1.36280144	0.788699159	3.439585666	0	2.508964156	0.00748445	0.005874199	0.47162941	3.929295538	10.63725163	0.024871923	3.204406748	4.737342904	2.623694692	5.077989959	0	0	0	0	0	0	0	0	0.866644004	3.05508236	0	0	0	0	0	0	0	0	0	60.754	YES	1A: 20% coin	1B: 20% coin	2: $195/day (for days 1-100)	6: $65 copay	10A: $250 copay	11A: 30% coin	11B: 30% coin; 11C: 20% coin	4A: $65 copay; 4B: $35 copay	9A: $65-$500 copay; 9B: $500 copay	8A: $0-$75 copay	8B: $175 copay	5: $100 copay	12: 10% coin	3: $65 copay; 9A: $65 copay; 9C: 100 copay	7A: $40 copay; 7G: $40 copay	7B: $65 copay; 7D: $65 copay; 7F: $65 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $150 copay	14A: $0-$100 copay; 17A: $0-$65; 17B: $0; 18A: $65	15: 20% coinsurance	9D: 20% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Not Covered	7B: Not covered; 7F: $65 copay; 13A: Not covered; 13D: $65 copay	8B: 30% coinsurance	14D: 20% coin; 14E: 20% coin	14A: $35 copay								4500	8.2779	0.1457	1.8736	0.7035	0.3861	0.3686	0.5091	0.185	1.8115	12.7421	0.8239	0.0044	0.0014	0.2623	2.4578	4.7365	0.0146	1.4183	3.7041	2.4587	1.1911	0.0255	0	0	0	0	0	0	0	0.4021	1.0749	0	0	0	0	0	0	0	0	0	45.5788		NO	5.179055571	21.1355	0.55895521	3.921566601	0.703491445	2.03201588	1.416297266	1.871858733	0.973702665	5.251082923	12.7420914	3.332895595	0.011873479	0.007252098	0.73392142	6.387126492	15.37379462	0.039457309	4.622743552	8.441438178	5.082348219	6.269123407	0.025516841	0	0	0	0	0	0	0	1.268761374	4.130018746	0	0	0	0	0	0	0	0	0	106.3328
H3342_013_0	2012	7	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1506.267216	19.71553948	761.808276	1031.01232	123.4782381	8.295778674	10.25592584	141.642255	256.5550532	17293.81177	257.2759533	6.589004687	0.155118466	245.6751978	3475.910797	4913.53454	9.430148987	1668.527038	1702.52416	2995.096656	45.7407958	10.3127938	0	456.2721669	234.4	234.4	129.6	8.64	5872.8	498.760575	16.75162963	0	0	0	0	0	0	0	0	0	3400	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days 1-7); no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $65 copay; 4B: $25 copay	9A: $0 - $200 copay; 9B: $200 copay	8A: $0 copay	8B: $125 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $25 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $35 copay	14A: $0 copay; 17A: $0-$25; 17B: $0	15: 20% coinsurance	9D: $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $25 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay; 18A: $25 copay	14A: $0 copay								0	NO	115.486673	124.0909091	60	0	200	0.2	0.174620747	63.19127315	188.8596161	0	125	40	0.1	28.38405083	10	24.81285857	40	35	35	9.291055816	0.2	0	0	0	0	0	0	0	0	16.62938924	0.2	23.55683728	0	0	0	0	0	0	0	0	NO	100.6939568	108.1960742	52.31458532	0	174.3819511	0.174381951	0.152253533	55.09708751	164.6685417	0	108.9887194	34.87639021	0.087190976	24.74833081	8.719097553	21.63457344	34.87639021	30.51684144	30.51684144	8.100962203	0.174381951	0	0	0	0	0	0	0	0	16.62938924	0.174381951	0	0	0	0	0	0	0	0	0		12.6393	0.177761998	3.321140338	0	1.794364673	1.446634071	1.561500945	0.650339643	3.520545539	0	2.33668139	0.019150058	0.01352493	0.506670922	2.52556711	8.858518657	0.027407463	4.243181254	4.32963832	2.021930401	7.976369214	0	0	0	0	0	0	0	0	0.691173645	2.921181859	0	0	0	0	0	0	0	0	0	61.5826		NO	8.945420944	12.6393	0.177761998	3.321140338	0	1.794364673	1.446634071	1.561500945	0.650339643	3.520545539	0	2.33668139	0.019150058	0.01352493	0.506670922	2.52556711	8.858518657	0.027407463	4.243181254	4.32963832	2.021930401	7.976369214	0	0	0	0	0	0	0	0	0.691173645	2.921181859	0	0	0	0	0	0	0	0	0	61.5826	YES	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days1-7); 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: $65 copay; 4B: $25 copay	9A: $50-$200 copay; 9B: $200 copay	8A: $0-$75 copay	8B: $150 copay	5: $100 copay	12: 10% coin	3: $50 copay; 9A: $50 copay; 9C: 100 copay	7A: $30 copay; 7G: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $125 copay	14A: $0-$100 copay; 17A: $0-$50; 17B: $0	15: 20% coinsurance	9D: 20% coin	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: 50% coins, 1 Exam per Yr"	"18A: 50% coin, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $50 copay; 13A: Not covered; 13D: $50 copay	8B: 20% coinsurance	14D: 20% coin; 14E: 20% coin; 18A: 50% coin	14A: $50 copay								3400	2.9648	0.0417	1.9476	0.8786	0.4209	0.3393	0.4195	0.1525	0.838	13.8013	0.6577	0.0112	0.0032	0.2682	1.7773	4.1872	0.0161	1.8903	3.6271	2.3345	1.871	0.0273	0	0.2019	0	0	0.0705	0.0322	0	0.3476	0.6852	0	0	0	0	0	0	0	0	0	39.8126		NO	5.752973562	15.6041	0.219459256	5.268722634	0.878603101	2.215265028	1.785967988	1.981013522	0.802888448	4.358530619	13.8013058	2.99441393	0.030380031	0.016697445	0.774821435	4.30281804	13.0457108	0.043479741	6.133478922	7.956760369	4.356443804	9.847369401	0.027265865	0	0.201862348	0	0	0.070457333	0.032203012	0	1.038754357	3.606397356	0	0	0	0	0	0	0	0	0	101.3952
H3342_014_0	2012	7	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1048.279383	45.31341105	503.4289244	576.6612954	83.60685606	5.097837927	7.857314977	152.9884321	208.0257833	14341.14865	250.8828415	2.338764054	0.057171816	177.0342703	3427.210573	4050.855041	7.880947483	1160.402516	1339.761072	2577.771843	24.70885071	6.465631288	0.047162942	456.2721669	234.4	234.4	129.6	8.64	5872.8	395.2254564	14.8670987	0	0	0	0	0	0	0	0	0	3400	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days 1-7); no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $65 copay; 4B: $25 copay	9A: $0 - $200 copay; 9B: $200 copay	8A: $0 copay	8B: $125 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $25 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $35 copay	14A: $0 copay; 17A: $0-$25; 17B: $0	15: 20% coinsurance	9D: $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $25 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay; 18A: $25 copay	14A: $0 copay								0	NO	122.2989251	102.0364416	60	0	200	0.2	0.168790937	64.34582218	185.3019617	0	125	40	0.1	28.72774268	10	24.75417456	40	35	35	8.443387167	0.2	0	0	0	0	0	0	0	0	18.28949165	0.2	22.59044025	0	0	0	0	0	0	0	0	NO	109.7393479	91.55773488	53.83825629	0	179.4608543	0.179460854	0.151456829	57.73778109	166.2722418	0	112.1630339	35.89217086	0.089730427	25.77752621	8.973042715	22.21202657	35.89217086	31.4056495	31.4056495	7.57628737	0.179460854	0	0	0	0	0	0	0	0	18.28949165	0.179460854	0	0	0	0	0	0	0	0	0		9.5865	0.345732773	2.258644621	0	1.250346484	0.914862349	1.190044009	0.73610105	2.882409444	0	2.344981722	0.006995277	0.005130051	0.380292129	2.562708906	7.498141648	0.023572026	3.036932891	3.506338887	1.627495021	4.434271457	0	0	0	0	0	0	0	0	0.602372724	2.668062233	0	0	0	0	0	0	0	0	0	47.8619		NO	5.40881292	9.5865	0.345732773	2.258644621	0	1.250346484	0.914862349	1.190044009	0.73610105	2.882409444	0	2.344981722	0.006995277	0.005130051	0.380292129	2.562708906	7.498141648	0.023572026	3.036932891	3.506338887	1.627495021	4.434271457	0	0	0	0	0	0	0	0	0.602372724	2.668062233	0	0	0	0	0	0	0	0	0	47.8619	YES	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days1-7); 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: $65 copay; 4B: $25 copay	9A: $50-$200 copay; 9B: $200 copay	8A: $0-$75 copay	8B: $150 copay	5: $100 copay	12: 10% coin	3: $50 copay; 9A: $50 copay; 9C: 100 copay	7A: $30 copay; 7G: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $125 copay	14A: $0-$100 copay; 17A: $0-$50; 17B: $0	15: 20% coinsurance	9D: 20% coin	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: 50% coins, 1 Exam per Yr"	"18A: 50% coin, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $50 copay; 13A: Not covered; 13D: $50 copay	8B: 20% coinsurance	14D: 20% coin; 14E: 20% coin; 18A: 50% coin	14A: $50 copay								3400	2.2487	0.0811	1.3245	0.5057	0.2933	0.2146	0.3308	0.1727	0.6895	11.9093	0.6601	0.0041	0.0012	0.2196	1.8034	3.5526	0.0138	1.3442	2.9374	2.0145	1.0401	0.0223	0	0.2019	0	0	0.0705	0.0322	0	0.3006	0.6258	0	0	0	0	0	0	0	0	0	32.6143		NO	3.663430124	11.8351	0.426830584	3.583158442	0.505729024	1.543637635	1.129459691	1.520803623	0.908766729	3.571937549	11.9092859	3.005050651	0.011097445	0.006333397	0.599847314	4.366096654	11.05072092	0.037395128	4.381142297	6.443748008	3.641984248	5.474409206	0.022282163	0	0.201862348	0	0	0.070457333	0.032203012	0	0.902951427	3.293903991	0	0	0	0	0	0	0	0	0	80.4762
H3342_015_0	2012	7	H.6	I.7	K.								OP Facility - Other	Professional	Other Medicare Part B								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	V	Coin	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1138.809636	49.2267138	546.9054527	626.4622303	90.82721163	6.016365361	9.273044443	166.2006366	225.9910578	15579.66182	272.5492862	2.540741605	0.067473023	192.3230928	3723.187245	4400.690151	8.561552469	1260.615814	1455.46392	2800.390299	29.16088657	7.024621516	0.051235972	456.2721669	234.4	234.4	129.6	8.64	5872.8	429.3574458	17.54584961	0	0	0	0	0	0	0	0	0	3400	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days 1-7); no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $65 copay; 4B: $25 copay	9A: $0 - $200 copay; 9B: $200 copay	8A: $0 copay	8B: $125 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $25 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $35 copay	14A: $0 copay; 17A: $0-$25; 17B: $0	15: 20% coinsurance	9D: $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $25 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance	14D: $0 copay; 14E: $0 copay; 18A: $25 copay	14A: $0 copay								0	NO	122.2989251	102.0364416	60	0	200	0.2	0.168790937	64.34582218	185.3019617	0	125	40	0.1	28.72774268	10	24.75417456	40	35	35	8.443387167	0.2	0	0	0	0	0	0	0	0	18.28949165	0.2	22.59044025	0	0	0	0	0	0	0	0	NO	108.7449953	90.72812657	53.35042569	0	177.8347523	0.177834752	0.150084472	57.21461675	164.7656423	0	111.1467202	35.56695046	0.088917376	25.54395501	8.891737615	22.0107625	35.56695046	31.12108165	31.12108165	7.507638327	0.177834752	0	0	0	0	0	0	0	0	18.28949165	0.177834752	0	0	0	0	0	0	0	0	0		10.32	0.372187293	2.431469893	0	1.346019557	1.069918844	1.391739983	0.792425477	3.102963483	0	2.524413271	0.007530536	0.005999524	0.409391036	2.758800339	8.071878814	0.025375693	3.269310639	3.77463429	1.752026462	5.18581904	0	0	0	0	0	0	0	0	0.654394118	3.12026182	0	0	0	0	0	0	0	0	0	52.3865		NO	6.447873539	10.32	0.372187293	2.431469893	0	1.346019557	1.069918844	1.391739983	0.792425477	3.102963483	0	2.524413271	0.007530536	0.005999524	0.409391036	2.758800339	8.071878814	0.025375693	3.269310639	3.77463429	1.752026462	5.18581904	0	0	0	0	0	0	0	0	0.654394118	3.12026182	0	0	0	0	0	0	0	0	0	52.3865	YES	1A: $175/day (days 1-7); no yrly max	1B: $175/day (days1-7); 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: $65 copay; 4B: $25 copay	9A: $50-$200 copay; 9B: $200 copay	8A: $0-$75 copay	8B: $150 copay	5: $100 copay	12: 10% coin	3: $50 copay; 9A: $50 copay; 9C: 100 copay	7A: $30 copay; 7G: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $125 copay	14A: $0-$100 copay; 17A: $0-$50; 17B: $0	15: 20% coinsurance	9D: 20% coin	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $80 Hardware Per 2Yr"	"18A: 50% coins, 1 Exam per Yr"	"18A: 50% coin, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not covered; 7F: $50 copay; 13A: Not covered; 13D: $50 copay	8B: 20% coinsurance	14D: 20% coin; 14E: 20% coin; 18A: 50% coin	14A: $50 copay								3400	2.4207	0.0873	1.4259	0.5444	0.3157	0.251	0.3868	0.1859	0.7423	12.8206	0.7106	0.0044	0.0014	0.2364	1.9414	3.8244	0.0149	1.4471	3.1622	2.1686	1.2164	0.0261	0	0.2019	0	0	0.0705	0.0322	0	0.3265	0.7319	0	0	0	0	0	0	0	0	0	35.2973		NO	4.320787904	12.7407	0.459490486	3.857331867	0.544426017	1.661752539	1.320887461	1.778558769	0.978303058	3.845252381	12.82055168	3.234988858	0.011946591	0.00740682	0.64574598	4.700178356	11.89629168	0.0402565	4.71637525	6.936805874	3.920658861	6.402245728	0.02605868	0	0.201862348	0	0	0.070457333	0.032203012	0	0.980931041	3.852175086	0	0	0	0	0	0	0	0	0	87.6839
H3342_808_0	2012	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	228.8114105	2.377123654	49.08997233	13.82404024	7.220369031	13.29713195	4.533822316	16.10695555	59.07320246	71.60242403	62.01030285	0.005491814	7.071821966	0.614673434	45.6499823	67.9477889	0.19114932	43.15060503	0	0.107064396	42.09642855	0.475072619																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069353307	0.069353307	0.148505168	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	0.057598818	0.057598818	0.123335462	0	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561																				13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015		NO	19.63234137	13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015	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	1.4644	0.0152	0.6727	0	0.1397	0.2573	0.0877	0.3117	1.1431	1.3856	1.2	0.0001	0.1368	0.0119	0.8834	1.3149	0.0037	0.835	0	0.0021	0.8146	0.0092																			10.6891		NO	2.181371264	14.6436	0.152132792	6.727260476	0	1.39721009	2.573121519	0.877337745	3.116849112	11.4312266	13.85575015	11.99958346	0.001062718	1.36846482	0.118945156	8.833705811	13.14854349	0.036989212	8.350052534	0	0.020717979	8.146059359	0.091931071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8906
H3342_809_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	228.8114105	2.377123654	49.08997233	13.82404024	7.220369031	13.29713195	4.533822316	16.10695555	59.07320246	71.60242403	62.01030285	0.005491814	7.071821966	0.614673434	45.6499823	67.9477889	0.19114932	43.15060503	0	0.107064396	42.09642855	0.475072619																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069353307	0.069353307	0.148505168	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	0.057598818	0.057598818	0.123335462	0	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561																				13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015		NO	19.63234137	13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015	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	1.4644	0.0152	0.6727	0	0.1397	0.2573	0.0877	0.3117	1.1431	1.3856	1.2	0.0001	0.1368	0.0119	0.8834	1.3149	0.0037	0.835	0	0.0021	0.8146	0.0092																			10.6891		NO	2.181371264	14.6436	0.152132792	6.727260476	0	1.39721009	2.573121519	0.877337745	3.116849112	11.4312266	13.85575015	11.99958346	0.001062718	1.36846482	0.118945156	8.833705811	13.14854349	0.036989212	8.350052534	0	0.020717979	8.146059359	0.091931071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8906
H3342_810_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	228.8114105	2.377123654	49.08997233	13.82404024	7.220369031	13.29713195	4.533822316	16.10695555	59.07320246	71.60242403	62.01030285	0.005491814	7.071821966	0.614673434	45.6499823	67.9477889	0.19114932	43.15060503	0	0.107064396	42.09642855	0.475072619																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069353307	0.069353307	0.148505168	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	0.057598818	0.057598818	0.123335462	0	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561																				13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015		NO	19.63234137	13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015	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	1.4644	0.0152	0.6727	0	0.1397	0.2573	0.0877	0.3117	1.1431	1.3856	1.2	0.0001	0.1368	0.0119	0.8834	1.3149	0.0037	0.835	0	0.0021	0.8146	0.0092																			10.6891		NO	2.181371264	14.6436	0.152132792	6.727260476	0	1.39721009	2.573121519	0.877337745	3.116849112	11.4312266	13.85575015	11.99958346	0.001062718	1.36846482	0.118945156	8.833705811	13.14854349	0.036989212	8.350052534	0	0.020717979	8.146059359	0.091931071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8906
H3342_811_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	228.8114105	2.377123654	49.08997233	13.82404024	7.220369031	13.29713195	4.533822316	16.10695555	59.07320246	71.60242403	62.01030285	0.005491814	7.071821966	0.614673434	45.6499823	67.9477889	0.19114932	43.15060503	0	0.107064396	42.09642855	0.475072619																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069353307	0.069353307	0.148505168	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	0.057598818	0.057598818	0.123335462	0	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561	0.174158561																				13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015		NO	19.63234137	13.1793	0.136919513	6.054534428	0	1.257489081	2.315809367	0.789603971	2.805164201	10.28810394	12.47017514	10.79962511	0.000956446	1.231618338	0.107050641	7.95033523	11.83368914	0.03329029	7.515047281	0	0.018646181	7.331453423	0.082737964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2015	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	1.4644	0.0152	0.6727	0	0.1397	0.2573	0.0877	0.3117	1.1431	1.3856	1.2	0.0001	0.1368	0.0119	0.8834	1.3149	0.0037	0.835	0	0.0021	0.8146	0.0092																			10.6891		NO	2.181371264	14.6436	0.152132792	6.727260476	0	1.39721009	2.573121519	0.877337745	3.116849112	11.4312266	13.85575015	11.99958346	0.001062718	1.36846482	0.118945156	8.833705811	13.14854349	0.036989212	8.350052534	0	0.020717979	8.146059359	0.091931071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8906
H3344_003_0	2012	7																															A	A	D		T	Coin	Coin	V	V		V	V		V	V	V	V	V	V	V	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	0											0	YES	230.9486487	3.113220069	746.0694218	0	170.9793634	6.032717009	1.397011157	329.3973674	464.8626116	0	627.68561	1.45889191	0	391.4119263	4512.105637	6897.525521	478.6197733	1671.445828	1340.257372	1221.789581	2108.22618	0	0	4.765541562	0	0	28.34346636	0	0	0											3400	$325/Admit for IP Med/Surg; PBP 1a	$325/Admit for IP MH/SA; PBP 1b	$25/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$75/Case for OP Surg; $75/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$20/Case for OP Rad - General; $30/Case for OP Rad - Complex Diagnostic; $20/Case for OP Rad - X-Ray; $20/Case for OP Rad - Therapeutic; PBP 8b	$40/Case for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$5/Case for OP - Preventive; $20/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-cvd); $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $20/Visit for Podiatry; $20/Visit for Vision Exams; $20/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST; $10/Visit for PT/ST; PBP 7c, 7i"	$20/Case for Phys Rad - General; $30/Case for Phys Rad - Complex Diagnostic; $20/Case for Phys Rad - X-Ray; $20/Case for Phys Rad - Therapeutic; PBP 7d	"$5/Visit for PCP - Facility Visit; $20/Visit for SCP - Facility Visit; $20/Case for SCP - IP/OP Surg; $20/Case for SCP - Other; $5/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $70/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"$20/Procedure for Comprehensive Dental (non-cvd); PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$5/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	325	325	25	0	50	0.2	0.191856757	50	75	0	22.51969402	40	0	26.88865152	5	20	40	10	21.78897699	19.42489777	51.15417776	0	0	20	0	0	5	0	0	0											NO	322.5957928	322.5957928	24.81506098	0	49.63012196	0.198520488	0.190437485	49.63012196	74.44518294	0	22.35310321	39.70409757	0	26.68974109	4.963012196	19.85204878	39.70409757	9.926024392	21.62779171	19.28120091	50.77576162	0	0	19.85204878	0	0	4.963012196	0	0	0												6.2086	0.083692641	1.542813183	0	0.707143888	1.197617924	0.266043292	1.36233596	2.883898514	0	1.169226769	0.004826999	0	0.870556914	1.866136276	11.41083443	1.583597182	1.382567671	2.415567273	1.963130864	8.92056583	0	0	0.007883814	0	0	0.011722414	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8588	0	NO	0.341771165	6.2086	0.083692641	1.542813183	0	0.707143888	1.197617924	0.266043292	1.36233596	2.883898514	0	1.169226769	0.004826999	0	0.870556914	1.866136276	11.41083443	1.583597182	1.382567671	2.415567273	1.963130864	8.92056583	0	0	0.007883814	0	0	0.011722414	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8588	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosth/Supplies; 50% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; PBP 8b	45% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$30/Visit for OP - Preventive; $30/Visit for OP - Other; PBP 3, 9a, 9c"	"$30/Visit for PCP OV; $30/Visit for Immunizations; $30/Visit for Physical Exams (Initial); $30/Visit for Immunizations (non-cvd); PBP 7a, 14a, 14b"	"50% Coinsurance for Chiro (cvd); 50% Coinsurance for Chiro (non-cvd); $30/Visit for SCP OV; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; $30/Visit for Prostate Cancer Screening; $30/Visit for Vision Exams; 30% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"45% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Therapeutic; $30/Procedure for Bone Mass Measurement; $30/Procedure for Mammography Screening; PBP 7d	"30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - IP/OP Surg; $30/Visit for SCP - Other; PBP 7d, 14d, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"50% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	30% Coinsurance for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											5100	18.161	0	1.5003	0.2204	0.1275	0.2063	0.3821	0.1048	0.3963	0.1142	0.1269	0.2474	0	0.0932	0.231	0.4889	0.024	0.0314	0.9007	1.1742	0.0409	0	0	0.0322	0	0	0.0022	0	0	0											24.6063	0	NO	0.183383119	24.3696	0.083692641	3.043138057	0.220401146	0.834685564	1.403911308	0.648167671	1.467185706	3.28020042	0.11422157	1.296141236	0.252232385	0	0.963769228	2.097178599	11.89976142	1.607621072	1.414003578	3.316303273	3.137285179	8.961508306	0	0	0.040083233	0	0	0.013929957	0	0	0	0	0	0	0	0	0	0	0	0	0	70.465
H3344_005_0	2012	10																															A	A	D		T	Coin	Coin	V	V		V	V		V	V	V	V	V	V	V	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	0											0	YES	141.7548961	2.66623629	1006.79218	0	117.0112526	4.112907166	0.88207955	217.196221	298.3492028	0	474.8914429	2.829429732	0	328.0488025	3103.730416	5031.723355	331.1961039	1294.755584	984.7948113	838.3116576	1308.568497	0	0	1.821456245	0	0	21.87529998	0	0	0											3400	$500/Admit for IP Med/Surg; PBP 1a	$500/Admit for IP MH/SA; PBP 1b	$45/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$60/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for OP Rad - General; $75/Case for OP Rad - Complex Diagnostic; $30/Case for OP Rad - X-Ray; $30/Case for OP Rad - Therapeutic; PBP 8b	$40/Case for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$20/Case for OP - Preventive; $30/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$20/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	$30/Case for Phys Rad - General; $75/Case for Phys Rad - Complex Diagnostic; $30/Case for Phys Rad - X-Ray; $30/Case for Phys Rad - Therapeutic; PBP 7d	"$20/Visit for PCP - Facility Visit; $30/Visit for SCP - Facility Visit; $30/Case for SCP - IP/OP Surg; $30/Case for SCP - Other; $20/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $80/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"$30/Procedure for Comprehensive Dental (non-cvd); PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$20/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	500	500	45	0	150	0.3	0.267335952	60	100	0	39.66970485	40	0	36.41481036	20	29.29383534	40	15	37.83662931	29.36459358	51.983162	0	0	30	0	0	20	0	0	0											NO	496.8556498	496.8556498	44.71700849	0	149.056695	0.29811339	0.265654756	59.62141652	99.37112997	0	39.42023397	39.74845199	0	36.18580853	19.87422599	29.10961518	39.74845199	14.9056695	37.59868609	29.17992845	51.65625547	0	0	29.81133899	0	0	19.87422599	0	0	0												5.8693	0.110394547	3.75172787	0	1.453442549	1.226112698	0.234328628	1.079128863	2.470608117	0	1.560027649	0.009372121	0	0.98922593	5.140353309	12.20596088	1.09704437	1.608266567	3.085582581	2.038489515	5.632979048	0	0	0.004525004	0	0	0.036229555	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6031	0	NO	0.31298987	5.8693	0.110394547	3.75172787	0	1.453442549	1.226112698	0.234328628	1.079128863	2.470608117	0	1.560027649	0.009372121	0	0.98922593	5.140353309	12.20596088	1.09704437	1.608266567	3.085582581	2.038489515	5.632979048	0	0	0.004525004	0	0	0.036229555	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6031	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosth/Supplies; 50% Coinsurance for DMS; PBP 11b, 11c"	"$60/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$40/Visit for OP - Preventive; $40/Visit for OP - Other; PBP 3, 9a, 9c"	"$40/Visit for PCP OV; $40/Visit for Immunizations; $40/Visit for Physical Exams (Initial); PBP 7a, 14a, 14b"	"50% Coinsurance for Chiro (cvd); 50% Coinsurance for Chiro (non-cvd); $40/Visit for SCP OV; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; $40/Visit for Prostate Cancer Screening; $40/Visit for Vision Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"45% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Therapeutic; $40/Visit for Bone Mass Measurement; $40/Visit for Mammography Screening; PBP 7d	"30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - IP/OP Surg; $40/Visit for SCP - Other; PBP 7d, 14d, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"50% Coinsurance for Preventive Dental (non-cvd); 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 14c	No Cost Sharing; PBP 13a-e											5100	14.3715	0	0.1086	0.0379	0.1432	0.1749	0.1637	0.0706	0.1988	0.009	0.0231	0	0.0022	0.0218	0.1521	0.3047	0.0126	0.0482	0.1884	1.0778	0.0128	0	0	0.0212	0	0	0	0	0	0											17.1433	500	NO	0.091789664	20.2408	0.110394547	3.860340425	0.037941722	1.59665387	1.40098876	0.398062478	1.149742735	2.669366233	0.008960129	1.583148806	0.009372121	0.002247068	1.010979286	5.292454891	12.51070377	1.109684199	1.656515797	3.274023685	3.116291902	5.64581718	0	0	0.025680563	0	0	0.036229555	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7464
H3344_006_0	2012	5																															A	A	D		T	Coin	Coin	V	V		V	V		V	V	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	104.2522204	1.558911707	402.8736113	0	97.0945109	3.278791083	0.529688628	199.3525462	241.404678	0	330.9006635	1.749313136	0	219.9610272	2612.756305	3615.807228	277.3280019	875.9747883	812.2428799	553.2768938	566.0872118	0	0	0	0	0	17.38373119	0	0	0											3400	$600/Admit for IP Med/Surg; PBP 1a	$600/Admit for IP MH/SA; PBP 1b	$50/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$180/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $35/Case for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $125/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$35/Case for OP Rad - General; $75/Case for OP Rad - Complex Diagnostic; $35/Case for OP Rad - X-Ray; $35/Case for OP Rad - Therapeutic; PBP 8b	$40/Case for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$25/Case for OP - Preventive; $35/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$25/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-cvd); $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	$35/Case for Phys Rad - General; $75/Case for Phys Rad - Complex Diagnostic; $35/Case for Phys Rad - X-Ray; $35/Case for Phys Rad - Therapeutic; PBP 7d	"$25/Visit for PCP - Facility Visit; $35/Visit for SCP - Facility Visit; $35/Case for SCP - IP/OP Surg; $35/Case for SCP - Other; $25/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $85/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$25/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	600	600	50	0	180	0.3	0.294901366	64.9402066	125	0	45.05858432	40	0	35.80061751	25	34.08659898	40	20	42.3508959	34.90056612	52.33278645	0	0	0	0	0	25	0	0	0											NO	598.1497722	598.1497722	49.84581435	0	179.4449316	0.299074886	0.293991975	64.73756163	124.6145359	0	44.91963657	39.87665148	0	35.69021868	24.92290717	33.98148569	39.87665148	19.93832574	42.22029789	34.79294279	52.17140715	0	0	0	0	0	24.92290717	0	0	0												5.1965	0.077705224	1.673463603	0	1.451926489	0.98060407	0.155724206	1.075466479	2.506877659	0	1.238661462	0.005813063	0	0.654204763	5.426456904	10.23920846	0.921576006	1.455455889	2.857761362	1.60417761	2.461130534	0	0	0	0	0	0.036104427	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0189	0	NO	0.123169097	5.1965	0.077705224	1.673463603	0	1.451926489	0.98060407	0.155724206	1.075466479	2.506877659	0	1.238661462	0.005813063	0	0.654204763	5.426456904	10.23920846	0.921576006	1.455455889	2.857761362	1.60417761	2.461130534	0	0	0	0	0	0.036104427	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0189	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosth/Supplies; 50% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $25/Case for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; 30% Coinsurance for OP Rad - Therapeutic; PBP 8b	45% Coinsurance for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"30% Coinsurance for Cardiac Rehab; $40/Visit for Pulmonary Rehabilitation Services; $40/Visit for OP - Preventive; $40/Visit for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$40/Visit for PCP OV; $40/Visit for Immunizations; $40/Visit for Physical Exams (Initial); $40/Visit for Immunizations (non-cvd); $40/Visit for Routine Exams; PBP 7a, 14a, 14b"	"50% Coinsurance for Chiro (cvd); 50% Coinsurance for Chiro (non-cvd); $40/Visit for SCP OV; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; $40/Visit for Pap Smears and Pelvic Exams Screening; $40/Visit for Prostate Cancer Screening; $40/Visit for Colorectal Screening; $40/Visit for Prostate Cancer Screening (non-cvd); $40/Visit for Colorectal Screening (non-cvd); $40/Visit for Vision Exams; 30% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"45% Coinsurance for MH - Non Phys; 45% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Therapeutic; $40/Visit for Bone Mass Measurement; $40/Visit for Mammography Screening; PBP 7d	"30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - IP/OP Surg; $40/Visit for SCP - Other; $40/Visit for Nutrition Training for Diabetes & Renal Dialysis; $40/Visit for Diabetes Monitoring; PBP 7d, 14d, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	30% Coinsurance for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	30% Coinsurance for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											5100	2.2982	0.0342	0.2456	0.1588	0.0797	0.0915	0.0192	0.0709	0.8424	0.0171	0.1798	0.0014	0	0.1074	0.4942	0.7744	0.0447	0.0666	0.3477	0.2895	0.2171	0.0007	0	0	0.0156	0.0037	0.0006	0	0.0091	0											6.4101	250	NO	0.016835428	7.4947	0.111880828	1.919034881	0.158848723	1.531653785	1.072144681	0.174948842	1.146341127	3.349286089	0.017069088	1.418417178	0.007228563	3.84E-05	0.761610728	5.920660774	11.01356326	0.966228575	1.522055346	3.205455408	1.89366598	2.678201071	0.000728109	0	0	0.015620421	0.003680036	0.036693887	0	0.009131107	0	0	0	0	0	0	0	0	0	0	0	46.4289
H3344_801_0	2012	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	258.6696096	0.987511076	32.15003649	0	8.587236961	9.951757151	3.172728788	14.35261759	66.99205243	11.12373285	18.63703918	0	0.139464382	10.45960941	27.83120889	52.07113968	1.834823491	7.022283232	38.06174928	98.06471144	94.53398033	0.816162308	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.09015638	0.09015638	0.181505233	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080693716	0.080693716	0.162454744	0	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0.200489331	0	0	0	0	0	0	0	0												20.873	0.079685938	5.222925947	0	1.721649391	1.99522113	0.636098271	2.877546695	13.43119175	2.230189753	3.736527512	0	0.027961121	2.09704009	5.579860444	10.43970794	0.367862534	1.407892865	7.630974638	19.66092836	18.95305444	0.163631835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.133	0	NO	13.97029796	20.873	0.079685938	5.222925947	0	1.721649391	1.99522113	0.636098271	2.877546695	13.43119175	2.230189753	3.736527512	0	0.027961121	2.09704009	5.579860444	10.43970794	0.367862534	1.407892865	7.630974638	19.66092836	18.95305444	0.163631835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.133	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	1.4589	0.0042	0.1476	0	0.2889	0.0452	0.1046	0.2103	0.8301	0.0919	0.1077	0	0.0208	0.1073	0.3224	0.63	0.0095	0.0517	0.3159	1.6372	0.4257	0.0035	0	0	0	0	0	0	0	0											6.8136	0	NO	0.799003954	22.3319	0.083879935	5.37049862	0	2.010567426	2.040449511	0.740703171	3.087883304	14.26130127	2.322110801	3.844253394	0	0.048747252	2.204353736	5.902292458	11.06971864	0.377322116	1.459571356	7.946903676	21.29810406	19.37878004	0.167175543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9465
H3344_803_0	2012	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	291.3460776	2.465348733	40.04543849	0	8.565271744	8.088004253	4.485466505	16.27494226	73.86740395	8.960989166	14.86932173	0	0.282196133	9.317427339	29.54682544	55.23270851	1.681407929	6.412997569	43.30255788	111.3243246	95.35747148	0.768431905	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090833563	0.090833563	0.179604629	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080430411	0.080430411	0.159034542	0	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0	0	0	0	0	0	0	0												23.4331	0.198289011	6.368607954	0	1.698881553	1.604217781	0.889671283	3.228058608	14.65125378	1.777370252	2.949260357	0	0.055972282	1.848068095	5.860474508	10.95514917	0.333499392	1.271988046	8.588859642	22.08065864	18.91370807	0.152414871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8595	0	NO	16.40845251	23.4331	0.198289011	6.368607954	0	1.698881553	1.604217781	0.889671283	3.228058608	14.65125378	1.777370252	2.949260357	0	0.055972282	1.848068095	5.860474508	10.95514917	0.333499392	1.271988046	8.588859642	22.08065864	18.91370807	0.152414871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8595	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	1.2333	0.0104	0.3352	0	0.0894	0.0844	0.0468	0.1699	0.7711	0.0935	0.1552	0	0.0029	0.0973	0.3084	0.5766	0.0176	0.0669	0.452	1.1621	0.9955	0.008	0	0	0	0	0	0	0	0											6.6768	0	NO	0.863602763	24.6664	0.208725275	6.703797846	0	1.788296372	1.688650296	0.936496088	3.39795643	15.4223724	1.870916054	3.104484586	0	0.058918191	1.945334836	6.168920535	11.53173597	0.351051991	1.338934786	9.040904886	23.24279857	19.90916639	0.160436706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5363
H3344_804_0	2012	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	291.3460776	2.465348733	40.04543849	0	8.565271744	8.088004253	4.485466505	16.27494226	73.86740395	8.960989166	14.86932173	0	0.282196133	9.317427339	29.54682544	55.23270851	1.681407929	6.412997569	43.30255788	111.3243246	95.35747148	0.768431905	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090833563	0.090833563	0.179604629	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080430411	0.080430411	0.159034542	0	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0.198345319	0	0	0	0	0	0	0	0												23.4331	0.198289011	6.368607954	0	1.698881553	1.604217781	0.889671283	3.228058608	14.65125378	1.777370252	2.949260357	0	0.055972282	1.848068095	5.860474508	10.95514917	0.333499392	1.271988046	8.588859642	22.08065864	18.91370807	0.152414871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8595	0	NO	16.40845251	23.4331	0.198289011	6.368607954	0	1.698881553	1.604217781	0.889671283	3.228058608	14.65125378	1.777370252	2.949260357	0	0.055972282	1.848068095	5.860474508	10.95514917	0.333499392	1.271988046	8.588859642	22.08065864	18.91370807	0.152414871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8595	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	1.2333	0.0104	0.3352	0	0.0894	0.0844	0.0468	0.1699	0.7711	0.0935	0.1552	0	0.0029	0.0973	0.3084	0.5766	0.0176	0.0669	0.452	1.1621	0.9955	0.008	0	0	0	0	0	0	0	0											6.6768	0	NO	0.863602763	24.6664	0.208725275	6.703797846	0	1.788296372	1.688650296	0.936496088	3.39795643	15.4223724	1.870916054	3.104484586	0	0.058918191	1.945334836	6.168920535	11.53173597	0.351051991	1.338934786	9.040904886	23.24279857	19.90916639	0.160436706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5363
H3346_002_0	2012	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	270.3356093	2.853752884	878.5287604		179.6825204	8.056965067	3.588825679	262.5809611			494.6074259	52.4519583		1305.049149	3944.306431	6239.414807	310.4580339	743.2386033	2666.176003		1188.843705	8.153599922			48.93236293		2.999865618			0.456288834											2000	(1a). $150 per stay/$450 max	(1b). $150 per stay/$450 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% coinsurance	(11b). 20% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). $0 copay	(8a). $0 copay	(8b1). $15 copay	(7e). And (9c). $15 copay	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). $15 copay"	"(7a). $10 copay ,(14a). $0 copay"	(7b1). And (7d). $15 copay	(7e). $15 copay	(7i). $15 copay	"(7a). $10 copay, (7d). $15 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f). $15, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $15 copay	(17b). Non-Med: $100 allowance	(18a). $15 exam	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% - 10 visit max													140.0864198	149.4318182	29.23796791		75	0.2	0.2	61.09649611			15	15		15	10.00000334	15	15	15	14.98830171		17.65471183	22.45617874			15		15			0.5											NO	121.0206546	129.0941441	25.25867977		64.79249818	0.172779995	0.172779995	52.7812615			12.95849964	12.95849964		12.95849964	8.63900264	12.95849964	12.95849964	12.95849964	12.94839349		15.25190512	19.39989227			15		15			0.5												2.7263	0.030700232	1.849206386	0	0.970173281	1.392082385	0.620077283	1.154946198	0	0	0.534114179	0.056641557	0	1.40928991	2.839572806	6.737787875	0.33525586	0.802604764	2.876891332	0	1.51101095	0.01318158	0	0	0.061165454	0	0.003749832	0	0	0.228144417	0	0	0	0	0	0	0	0	0	0	26.1529	0		4.074003015	2.7263	0.030700232	1.849206386	0	0.970173281	1.392082385	0.620077283	1.154946198	0	0	0.534114179	0.056641557	0	1.40928991	2.839572806	6.737787875	0.33525586	0.802604764	2.876891332	0	1.51101095	0.01318158	0	0	0.061165454	0	0.003749832	0	0	0.228144417	0	0	0	0	0	0	0	0	0	0	26.1529	YES	(1a). 25% coinsurance	(1b). 25% coinsurance	(2). 25% coinsurance	(6). 25% coinsurance	(10a). $75 copay	(11a). 25% coinsurance	(11b). 25% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). 25% coinsurance	(8a). 25% coinsurance	(8b1). 25% coinsurance	(7e). And (9c). $35 copay	(12a). $0 copay	"(3). ,(5). And (7d). $35 copay ,(8b1) 25% coinsurance"	"(7a). $35 copay ,(14a). $0 copay"	"(7b1). $20 copay, (7d). $35 copay"	(7e). $35 copay	(7i). $35 copay	(7a). And (7d). $35 copay	(14a). $0 copay	(15). 25% coinsurance	"(7f). 35, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 copay"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $35 copay	(17b).Non-Med: $100 allowance	(18a). $35 copay	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% coinsurance											5000	1.6941	0.003	0.4649	0.0023	0.3752	0.2179	0.0411	0.0404	0.2909	0.1875	0.0698	0.0016		0.1011	0.2187	0.4425	0.0043	0.1529	0.1878		0.0813	0.0002			0.0034		0.0021			0.0364											4.6194	0		3.770115698	4.4204	0.033681313	2.314080881	0.002347845	1.345354266	1.609981704	0.661193083	1.195379412	0.290858435	0.18746741	0.603951925	0.058200423	0	1.51043018	3.058242196	7.180284373	0.339577233	0.955533043	3.06467648	0	1.592281041	0.013334866	0	0	0.064600499	0	0.005859741	0	0	0.264592067	0	0	0	0	0	0	0	0	0	0	30.7723
H3346_007_0	2012	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	296.1521059	3.386972319	1345.175549		300.2878836	9.058802576	3.534168251	310.937462			445.7968506	83.5756762		1194.083729	3912.862656	5628.029281	231.682257	510.0903473	2747.941392		1156.112633	10.92994643			39.42492188		0.607219246			0.19191073											2000	(1a). $150 per stay/$450 max	(1b). $150 per stay/$450 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% coinsurance	(11b). 20% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). $0 copay	(8a). $0 copay	(8b1). $15 copay	(7e). And (9c). $15 copay	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). $15 copay"	"(7a). $10 copay ,(14a). $0 copay"	(7b1). And (7d). $15 copay	(7e). $15 copay	(7i). $15 copay	"(7a). $10 copay, (7d). $15 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f). $15, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $15 copay	(17b). Non-Med: $100 allowance	(18a). $15 exam	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% - 10 visit max													140.0864198	149.4318182	29.23796791		75	0.2	0.2	60.89595376			15	15		15	10.00001518	15	15	15	14.99003675		18.42213286	26.31626577			15		12.36663308			0.5											NO	119.6400106	127.621395	24.97052033		64.05332375	0.170808863	0.170808863	52.00784321			12.81066475	12.81066475		12.81066475	8.540456127	12.81066475	12.81066475	12.81066475	12.80215569		15.73331787	22.47525722			15		12.36663308			0.5												2.9526	0.036020844	2.79914445	0	1.602869752	1.547323771	0.603667262	1.347598898	0	0	0.475912833	0.089221664	0	1.274750528	2.784802654	6.008233026	0.247333644	0.544549703	2.931631128	0	1.515790629	0.020471113	0	0	0.049281152	0	0.000625771	0	0	0.095955365	0	0	0	0	0	0	0	0	0	0	26.9278	0		4.577021359	2.9526	0.036020844	2.79914445	0	1.602869752	1.547323771	0.603667262	1.347598898	0	0	0.475912833	0.089221664	0	1.274750528	2.784802654	6.008233026	0.247333644	0.544549703	2.931631128	0	1.515790629	0.020471113	0	0	0.049281152	0	0.000625771	0	0	0.095955365	0	0	0	0	0	0	0	0	0	0	26.9278	YES	(1a). 25% coinsurance	(1b). 25% coinsurance	(2). 25% coinsurance	(6). 25% coinsurance	(10a). $75 copay	(11a). 25% coinsurance	(11b). 25% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). 25% coinsurance	(8a). 25% coinsurance	(8b1). 25% coinsurance	(7e). And (9c). $35 copay	(12a). $0 copay	"(3). ,(5). And (7d). $35 copay ,(8b1). 25% copay"	"(7a). $35 copay ,(14a). $0 copay"	"(7b1). $20 copay, (7d). $35 copay"	(7e). $35 copay	(7i). $35 copay	(7a). And (7d). $35 copay	(14a). $0 copay	(15). 25% coinsurance	"(7f). 35, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 copay"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $35 copay	(17b).Non-Med: $100 allowance	(18a). $35 copay	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% coinsurance											5000	1.6582	0.0137	0.3681	0.0053	0.0551	0.0664	0.0259	0.0463	0.4229	0.1661	0.1979	0.0072		0.2366	0.3338	0.472	0.0198	0.0436	0.2351		0.0886	0.0007			0.0061					0.0051											4.4745	0		3.542189163	4.6108	0.049697006	3.167246047	0.005325072	1.657931556	1.613765881	0.629588744	1.393891634	0.422898532	0.166062374	0.673847831	0.0963732	0	1.511319227	3.118584176	6.480266396	0.267158597	0.58819792	3.166771323	0	1.604402244	0.021174337	0	0	0.055333224	0	0.000625771	0	0	0.101005647	0	0	0	0	0	0	0	0	0	0	31.4023
H3346_802_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	269.9505815	5.325094357	772.4716292		224.6016522	711.7976793	208.1756594	26.65498392	58.23066886	22.85570265	19.41709142	0.783375762	0.113333062	78.26520171	44.30138322	117.1791745	1.571314978	2.809712483	23.26637073	2.080510744	14.56919288	25.26824068																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													802.6667612	729.0686024	145.6620477		60.22308378	31.69986068	35.07779344	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	130.1911708																			NO	660.4527322	599.8944689	119.8540939		49.55294295	26.08337682	28.86281784	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	0.184312369	107.1242995																				14.8575	0.266207888	7.715323931	0	0.927472738	1.547173924	0.500711345	4.912843223	10.73263251	4.212588692	3.578810113	0.144385842	0.020888685	14.42524471	8.165292878	21.59757122	0.289612786	0.517864763	4.2882799	0.383463863	2.68528245	0.225570215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9947	0		21.96232197	14.8575	0.266207888	7.715323931	0	0.927472738	1.547173924	0.500711345	4.912843223	10.73263251	4.212588692	3.578810113	0.144385842	0.020888685	14.42524471	8.165292878	21.59757122	0.289612786	0.517864763	4.2882799	0.383463863	2.68528245	0.225570215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9947	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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.6958	0.0017	0.1738		1.0643	0.0639	0.2161	0.1458	0.2703	0.2703	0.0868	0.0012	0.0008	0.3571	0.3244	0.9077	0.0038	0.0488	0.1402	0.0057	0.0636	0.0081																			4.8498	0		0	15.5532	0.267889683	7.889084506	0	1.991760929	1.611040321	0.716840042	5.058593472	11.00293988	4.482841816	3.665563003	0.145544328	0.02165896	14.78230108	8.489654108	22.50527632	0.293365496	0.566661594	4.428476699	0.389173516	2.748850267	0.233677345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8444
H3346_803_0	2012	2																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	258.8362756	3.631857393	1258.548865		257.9600486	626.2501706	220.7553983	32.49543198	58.79258299	22.16821612	27.62097094	0.447038279	0.346823298	70.79305519	46.7539034	120.7361375	1.250349395	2.401679678	23.43009164	1.871798205	16.32137245	27.65444085																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													813.6341332	481.2423313	86.91284235		96.60653257	30.50684268	41.14062111	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	225.0135208																			NO	661.3631852	391.1782312	70.64717654		78.52670073	24.79751257	33.44118826	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	0.182078587	182.9024284																				14.2654	0.118391963	7.409410319	0	1.688062628	1.29412054	0.615193569	5.916722345	10.70487045	4.036357472	5.029187366	0.081396098	0.063149096	12.88989947	8.512884678	21.98346533	0.227661851	0.437294443	4.266117984	0.340814373	2.971772436	0.421505366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2737	0		23.77752643	14.2654	0.118391963	7.409410319	0	1.688062628	1.29412054	0.615193569	5.916722345	10.70487045	4.036357472	5.029187366	0.081396098	0.063149096	12.88989947	8.512884678	21.98346533	0.227661851	0.437294443	4.266117984	0.340814373	2.971772436	0.421505366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2737	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.9271	0.0077	0.4798		0.1093	0.0838	0.0398	0.3831	0.6931	0.2614	0.3256	0.0053	0.0041	0.8951	0.549	1.4162	0.0147	0.0283	0.2762	0.0221	0.1924	0.0273																			6.7414	0		0	15.1925	0.126057767	7.889164964	0	1.797363619	1.377914029	0.655026965	6.299826385	11.39800406	4.297709073	5.354824076	0.086666444	0.06723796	13.78497736	9.061902664	23.39966731	0.242402813	0.465608982	4.542346433	0.362881888	3.164192827	0.448797572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0151
H3346_804_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	308.693203	3.86411843	1572.32781		306.2481035	1024.621543	271.4971723	15.67892884	59.54572437	30.57559396	13.99419526	0.065737029	0.041465085	60.55172949	43.84023786	131.957411	0.970579318	5.651792376	34.9770204	3.338547846	41.63014872	28.15073542																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													787.1690045	481.3848265	93.68185862		102.5482559	38.26584228	45.55149508	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	111.645739																			NO	622.1909917	380.4942787	74.04764185		81.0557843	30.24593476	36.00463145	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	0.177053189	88.24658069																				16.0055	0.122522913	9.702263879	0	2.068598352	2.582553028	0.814596302	2.776004344	10.54276036	5.413506401	2.477716892	0.011638951	0.007341525	10.72087678	7.762053898	23.36348036	0.171844163	1.000667861	6.192792987	0.591100541	7.370750569	0.207017179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9056	0		29.14218851	16.0055	0.122522913	9.702263879	0	2.068598352	2.582553028	0.814596302	2.776004344	10.54276036	5.413506401	2.477716892	0.011638951	0.007341525	10.72087678	7.762053898	23.36348036	0.171844163	1.000667861	6.192792987	0.591100541	7.370750569	0.207017179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9056	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												1.0658	0.0082	0.646		0.1377	0.172	0.0542	0.1848	0.702	0.3605	0.165	0.0008	0.0005	0.7143	0.5169	1.5557	0.0114	0.0666	0.4124	0.0394	0.4908	0.0138																			7.3187	0		0	17.0713	0.130681369	10.34831033	0	2.206340496	2.754517969	0.868837978	2.960850663	11.24477311	5.773976562	2.642701089	0.012413956	0.007830377	11.43516812	8.278907228	24.91918878	0.183286782	1.067299518	6.605153649	0.630460263	7.861548112	0.22080187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.2243
H3346_805_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	294.2555685	3.676006507	1489.11177		291.7695651	974.5531017	258.2317125	15.03617767	56.4378027	29.10567133	13.47965812	0.06154419	0.038820358	58.13709969	41.70903463	125.8710563	0.92779065	5.36683883	33.21834845	3.166658311	39.11502405	26.89186984																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													780.2489949	476.5677234	91.99238643		103.2826453	38.11988806	48.22505033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	110.1933184																			NO	626.5476558	382.6885929	73.87079567		82.93698513	30.61064694	38.72519213	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	0.179874214	88.48632397																				15.3638	0.11723048	9.166822606	0	2.016540674	2.485975076	0.83333939	2.704620644	10.15170542	5.235359761	2.424642914	0.011070213	0.006982781	10.45736513	7.502379834	22.64095735	0.166885614	0.965355918	5.975124328	0.569600176	7.035784218	0.198296892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0298	0		26.01066688	15.3638	0.11723048	9.166822606	0	2.016540674	2.485975076	0.83333939	2.704620644	10.15170542	5.235359761	2.424642914	0.011070213	0.006982781	10.45736513	7.502379834	22.64095735	0.166885614	0.965355918	5.975124328	0.569600176	7.035784218	0.198296892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0298	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												1.007	0.0077	0.6008		0.1322	0.1629	0.0546	0.1773	0.6654	0.3431	0.1589	0.0007	0.0005	0.6854	0.4921	1.484	0.0109	0.0633	0.3916	0.0373	0.4611	0.013																			6.9499	0		0	16.3707	0.124914103	9.767642542	0	2.148710553	2.648913037	0.887958852	2.881889265	10.81707741	5.578500308	2.583560988	0.011795786	0.007440453	11.14277093	7.99447849	24.12491085	0.177823778	1.028628123	6.366751173	0.60693341	7.496929764	0.211293841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9797
H3347_002_0	2012	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	316.6901052	21.27144383	24.82962103		24.04342356	11.04405774	10.354748	13.28272584	24.15515505	36.78049243	11.19629371		12.12531005	41.58195939	50.31558735	246.5980757	8.985166949	42.0641976	117.3669945	53.05916663	10.57094175	14.48845479																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS  11c: FFS	4a: FFS  4a1: 20%  4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	3: FFS  9a: FFS  9c: FFS	7a: FFS  14a: $0  14e: FFS	7b: FFS  7d: FFS  7f: FFS	7e: FFS  7h: FFS	7c: FFS  7i: FFS	7d: FFS	7d: FFS  7g: FFS  16b: FFS	15: FFS	9d: FFS  17a: FFS  17b: FFS  18a: FFS				"17b1: $0, up to $100"		"18b1: $0, up to $1500"	14c: $0	13a1: $0  13b1: $0													0.056986274	0.056986274	0.148606453		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.031483145	0.031483145	0.082100447		0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038		0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038																				9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724	0		83.25146205	9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724	NO																																																																																		0	0		0	9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724
H3347_003_0	2012	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	742.8973164	34.69442919	417.9447235		106.7724892	10.80935277	19.6753876	24.51529981	16.85749807	39.54303704	7.859826399		7.084360786	30.12417409	73.38526877	366.201959	41.25853888	51.27513361	39.22187893	16.69548274	34.56961816	10.94527113																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS  11c: FFS	4a: FFS  4a1: 20%  4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	3: FFS  9a: FFS  9c: FFS	7a: FFS  14a: $0  14e: FFS	7b: FFS  7d: FFS  7f: FFS	7e: FFS  7h: FFS	7c: FFS  7i: FFS	7d: FFS	7d: FFS  7g: FFS  16b: FFS	15: FFS	9d: FFS  17a: FFS  17b: FFS  18a: FFS				"17b1: $0, up to $100"		"18b1: $0, up to $1500"	14c: $0	13a1: $0													0.056986274	0.056986274	0.148606453		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.024468791	0.024468791	0.063808703		0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216		0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216	0.096181216																				18.1778	0.848930722	26.66851055	0	10.26950786	1.039656694	1.892402706	2.357911348	1.621374664	3.803297389	0.755967661	0	0.681382435	2.897379696	7.058284391	35.22174974	3.968296442	4.931704704	3.772408011	1.605791833	3.324947913	1.052729487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.95	0		175.3532911	18.1778	0.848930722	26.66851055	0	10.26950786	1.039656694	1.892402706	2.357911348	1.621374664	3.803297389	0.755967661	0	0.681382435	2.897379696	7.058284391	35.22174974	3.968296442	4.931704704	3.772408011	1.605791833	3.324947913	1.052729487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.95	NO																																																																																		0	0		0	18.1778	0.848930722	26.66851055	0	10.26950786	1.039656694	1.892402706	2.357911348	1.621374664	3.803297389	0.755967661	0	0.681382435	2.897379696	7.058284391	35.22174974	3.968296442	4.931704704	3.772408011	1.605791833	3.324947913	1.052729487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.95
H3347_005_0	2012	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	P																																																			0	YES	1743.884465	59.1834052	1011.069769		389.161426	4.065258025	2.240917168	198.3452225	160.1735862	8468.36285	7.250078427		1.301361111	437.0713721	3854.924789	18265.66349	1.160949697	3569.653065	4191.329286	790.9907305	17.66847304	2792.068762								137.6487749											3400	1a: $120/day days1-7; $0/day days8-90	1b: $120/day days1-7; $0/day days8-90	2: $0/day days1-14; $100/day days15-100	6: $0	10a: $100	11a: 20%	11b: 20%  11c: $0	4a: $50  4a1: $50  4b: $0	9b: $75	8a: $0	"8b: $0 x-rays, $50 diag rad, 20% ther rad"		12: 20%	3: $10  9a: $100  9c: 20%	"7a: $0 PCP, $25 UC  14a: $0  14e: $0"	7b: $15  7d: $15  7f: $15  7f1: $0	7e: 20%  7h: 20%	7c: $15  7i: $15	7d: $15	7d: $15  7g: $15  16b: $0 m/c	15: 20%	9d: $0  17a: $15  17b: $0  18a: $0		16a1: $0  16a2: $0  16a3: $0  16b1:  Comprehensive Dental	17a1: $0	"17b1: $0, up to $100"	18a1: $0	"18b1: $0, up to $1500"	14c: $0	13a1: $15													81.60637922	81.60637922	46.64975507		55.54891002	0.2	0.098375158	50.59111415	71.35815621	0.000845713	0.128871386		0.199224201	13.48327948	0.662637494	3.977558217	0.2	4.426883494	7.810448699	7.831411919	0.193923793	5.368039427								11.33196178											NO	75.07526715	75.07526715	42.9162874		51.10322624	0.183993624	0.090502009	46.54221209	65.6472287	0.000778029	0.118557567		0.183279913	12.40418725	0.609605368	3.659226749	0.183993624	4.072591679	7.185363794	7.204649288	0.178403707	4.938425132								11.33196178												10.9102	0.370267496	3.615946731	0	1.6572837	0.747981555	0.202807506	0.769285451	0.876246004	0.000549053	0.859551656	0	0.238513352	0.451792929	0.195831904	5.569850369	0.213607342	1.211478281	2.509685475	0.4749009	3.152121094	1.149035212	0	0	0	0	0	0	0	0.129985888	0	0	0	0	0	0	0	0	0	0	35.3069	0		3.060190456	10.9102	0.370267496	3.615946731	0	1.6572837	0.747981555	0.202807506	0.769285451	0.876246004	0.000549053	0.859551656	0	0.238513352	0.451792929	0.195831904	5.569850369	0.213607342	1.211478281	2.509685475	0.4749009	3.152121094	1.149035212	0	0	0	0	0	0	0	0.129985888	0	0	0	0	0	0	0	0	0	0	35.3069	NO																																																																																		0	0		0	10.9102	0.370267496	3.615946731	0	1.6572837	0.747981555	0.202807506	0.769285451	0.876246004	0.000549053	0.859551656	0	0.238513352	0.451792929	0.195831904	5.569850369	0.213607342	1.211478281	2.509685475	0.4749009	3.152121094	1.149035212	0	0	0	0	0	0	0	0.129985888	0	0	0	0	0	0	0	0	0	0	35.3069
H3347_007_0	2012	6																															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	1145.359654	21.87557522	25.5348084		79.17740585	11.3577206	16.11685975	13.65996924	24.84118687	38.80620599	11.51428023		12.46968162	42.7629308	71.37081897	332.8138887	9.240355146	43.25886508	121.8382108	67.31441487	10.87116762	14.89994215																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS  11c: FFS	4a: FFS  4a1: 20%  4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	3: FFS  9a: FFS  9c: FFS	7a: FFS  14a: $0  14e: FFS	7b: FFS  7d: FFS  7f: FFS	7e: FFS  7h: FFS	7c: FFS  7i: FFS	7d: FFS	7d: FFS  7g: FFS  16b: FFS	15: FFS	9d: FFS  17a: FFS  17b: FFS  18a: FFS				"17b1: $0, up to $150"		"18b1: $0, up to $1500"	14c: $0	13a1: $0  13b1: $0													0.056986274	0.056986274	0.148606453		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.025867019	0.025867019	0.067454944		0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733		0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733	0.10167733																				29.627	0.56585591	1.722449065	0	8.050547243	1.154822709	1.638719271	1.388909203	2.525785562	3.945711422	1.170741274	0	1.267883936	4.348020638	7.256794331	33.83962768	0.939534642	4.398445911	12.388184	6.844349991	1.105351301	1.514986339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6938	0		151.2155781	29.627	0.56585591	1.722449065	0	8.050547243	1.154822709	1.638719271	1.388909203	2.525785562	3.945711422	1.170741274	0	1.267883936	4.348020638	7.256794331	33.83962768	0.939534642	4.398445911	12.388184	6.844349991	1.105351301	1.514986339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6938	NO																																																																																		0	0		0	29.627	0.56585591	1.722449065	0	8.050547243	1.154822709	1.638719271	1.388909203	2.525785562	3.945711422	1.170741274	0	1.267883936	4.348020638	7.256794331	33.83962768	0.939534642	4.398445911	12.388184	6.844349991	1.105351301	1.514986339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6938
H3347_008_0	2012	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	316.6901052	21.27144383	24.82962103		24.04342356	11.04405774	10.354748	13.28272584	24.15515505	36.78049243	11.19629371		12.12531005	41.58195939	50.31558735	246.5980757	8.985166949	42.0641976	117.3669945	53.05916663	10.57094175	14.48845479																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS  11c: FFS	4a: FFS  4a1: 20%  4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	3: FFS  9a: FFS  9c: FFS	7a: FFS  14a: $0  14e: FFS	7b: FFS  7d: FFS  7f: FFS	7e: FFS  7h: FFS	7c: FFS  7i: FFS	7d: FFS	7d: FFS  7g: FFS  16b: FFS	15: FFS	9d: FFS  17a: FFS  17b: FFS  18a: FFS				"17b1: $0, up to $100"		"18b1: $0, up to $1500"	14c: $0	13a1: $0  13b1: $0													0.056986274	0.056986274	0.148606453		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.031483145	0.031483145	0.082100447		0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038		0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038	0.123753038																				9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724	0		83.25146205	9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724	NO																																																																																		0	0		0	9.9704	0.669691952	2.038522982	0	2.975446718	1.366735701	1.281431527	1.643777681	2.98927383	4.551697692	1.385575365	0	1.50054396	5.145893817	6.226706812	30.51726112	1.11194171	5.205572259	14.52452217	6.566233084	1.30818616	1.792990301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7724
H3347_009_0	2012	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	P																																																			0	YES	2050.583795	87.39667512	806.2907521		549.0619942	6.089515572	1.051275663	255.8877461	166.9222474	723.4351188	9.183227773			626.6335925	3946.204628	11702.35952	1.387259875	3211.643971	4095.774973	772.3032691	20.60331322	2766.266669																			3400	1a: $100/day days1-7; $0/day days8-90	1b: $100/day days1-7; $0/day days8-90	2: $0/day days1-14; $75/day days15-100	6: $0	10a: $55	11a: 20%	11b: 20%  11c: $0	4a: $50  4a1: $50  4b: $0	9b: $50	8a: $0	"8b: $0 x-rays, $50 diag rad, 20% ther rad"		12: 20%	3: $0  9a: $75  9c: 20%	"7a: $0 PCP, $15 UC  14a: $0  14e: $0"	7b: $15  7d: $15  7f: $15  7f1: $0	7e: 20%  7h: 20%	7c: $15  7i: $15	7d: $15	7d: $15  7g: $15  16b: $0 m/c	15: 20%	9d: $0  17a: $15  17b: $0  18a: $0		16a1: $0  16a2: $0  16a3: $0  16b1:  Comprehensive Dental	17a1: $0	"17b1: $0, up to $100"	18a1: $0	"18b1: $0, up to $1500"	14c: $0	13a1: $20  13b1: $0													68.00531602	68.00531602	34.98731631		44.33189655	0.200002905	0.143169598	49.47353982	48.46860465	0.323993234	0.166128076			25.74009142	0.883311962	5.915114431	0.2	5.612562131	3.800079636	9.791585506	0.190182708	5.367943632																			NO	62.78312828	62.78312828	32.30060966		40.92761141	0.184644507	0.132175479	45.6744234	44.74665808	0.29911351	0.153370956			23.76348727	0.815481663	5.460887617	0.184641825	5.181568572	3.508268195	9.039681085	0.175578411	4.955734543																				10.7285	0.457253055	2.170306905	0	1.872649662	1.124395599	0.138952865	0.973960438	0.622434394	0.018032435	1.40844042	0	0	1.240916616	0.268171459	5.325439184	0.256146195	1.386779455	1.197423089	0.581781271	3.617497003	1.14240694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5315	0		2.87226746	10.7285	0.457253055	2.170306905	0	1.872649662	1.124395599	0.138952865	0.973960438	0.622434394	0.018032435	1.40844042	0	0	1.240916616	0.268171459	5.325439184	0.256146195	1.386779455	1.197423089	0.581781271	3.617497003	1.14240694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5315	NO																																																																																		0	0		0	10.7285	0.457253055	2.170306905	0	1.872649662	1.124395599	0.138952865	0.973960438	0.622434394	0.018032435	1.40844042	0	0	1.240916616	0.268171459	5.325439184	0.256146195	1.386779455	1.197423089	0.581781271	3.617497003	1.14240694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5315
H3347_010_0	2012	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	P																																																			0	YES	1656.690242	56.22423494	960.5162801		389.161426	4.065258025	2.240917168	188.4279614	152.1649069	8044.944707	6.887574506		1.301361111	415.2178035	3669.149549	17352.38031	1.102902212	3391.170412	3981.762822	751.441194	17.66847304	2792.068762								137.6487749											3400	1a: $150/day days1-7; $0/day days8-90	1b: $150/day days1-7; $0/day days8-90	2: $0/day days1-14; $100/day days15-100	6: $0	10a: $100	11a: 20%	11b: 20%  11c: $0	4a: $50  4a1: $50  4b: $0	9b: $75	8a: $0	"8b: $0 x-rays, $50 diag rad, 20% ther rad"		12: 20%	3: $10  9a: $100  9c: 20%	"7a: $0 PCP, $25 UC  14a: $0  14e: $0"	7b: $15  7d: $15  7f: $15  7f1: $0	7e: 20%  7h: 20%	7c: $15  7i: $15	7d: $15	7d: $15  7g: $15  16b: $0 m/c	15: 20%	9d: $0  17a: $15  17b: $0  18a: $0		16a1: $0  16a2: $0  16a3: $0  16b1:  Comprehensive Dental	17a1: $0	"17b1: $0, up to $100"	18a1: $0	"18b1: $0, up to $1500"	14c: $0	13a1: $15													102.007974	102.007974	46.64975507		55.54891002	0.2	0.098375158	50.59111415	71.35815621	0.000845713	0.128871386		0.199224201	13.48327948	0.661570335	3.977558217	0.2	4.426883494	7.810448699	7.831411919	0.193923793	5.368039427								9.065569423											NO	92.60809932	92.60809932	42.35105336		50.43016515	0.181570314	0.089310042	45.92922238	64.78261411	0.000767782	0.11699609		0.180866004	12.24081644	0.600607667	3.61103247	0.181570314	4.018953128	7.09072811	7.109759602	0.17605402	4.873383019								9.065569423												12.7852	0.433901628	3.389906353	0	1.635456249	0.738130176	0.200136406	0.721195812	0.821470037	0.000514731	0.805819287	0	0.235371983	0.423550409	0.183643279	5.221667395	0.200254301	1.135746244	2.352799797	0.445213854	3.11060571	1.133901708	0	0	0	0	0	0	0	0.10398871	0	0	0	0	0	0	0	0	0	0	36.0785	0		3.651474074	12.7852	0.433901628	3.389906353	0	1.635456249	0.738130176	0.200136406	0.721195812	0.821470037	0.000514731	0.805819287	0	0.235371983	0.423550409	0.183643279	5.221667395	0.200254301	1.135746244	2.352799797	0.445213854	3.11060571	1.133901708	0	0	0	0	0	0	0	0.10398871	0	0	0	0	0	0	0	0	0	0	36.0785	NO	0.3	0.3	0.3	0.3				0.3	0.3	0.3	0.3			0.3	0.3	0.3	0.3	0.3	0.3	0.3																						5.5955	0.0804	0.5837	0.5787				0.1306	0.4456	0.4223	0.1281			0.2184	0.4214	2.5908	0.0192	0.1503	0.6211	0.4337																					12.4196	0		0	18.3807	0.514259265	3.973581388	0.578657792	1.635456249	0.738130176	0.200136406	0.85177686	1.267061671	0.422768533	0.933906657	0	0.235371983	0.641932646	0.605064886	7.812449002	0.219409971	1.286089359	2.973893113	0.878962963	3.11060571	1.133901708	0	0	0	0	0	0	0	0.10398871	0	0	0	0	0	0	0	0	0	0	48.4981
H3351_001_0	2012	6																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	V	V	Coin	V	Coin				V		V		O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	290.1059434	6.828767364	2094.149394	0	253.3717962	6.938702314	2.205517739	333.5749534	330.4772781	0	18.29159379	0	0	259.6962188	4227.559328	4231.260674	141.7132941	617.9811028	31.94052746	1657.2063	40.53882667	0	0	0	211.9424431	0	0.293130503	0	93.28269642	0											3400	$200/Admit for IP Medical;  PBP 1a	$200/Admit for IP Medical;  PBP 1b	$25/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$125/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$75/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$75 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	10% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$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		$25 Copay per year;   PBP 14c												0	NO	200	200	25	0	125	0.2	0.2	60.50210219	75	0	0.1	0	0	35	15	35	35	35	0.1	30.36619998	0.2	0	0	0	35	0	35	0	2.083333333	0											NO	180.8462696	180.8462696	22.6057837	0	113.0289185	0.18084627	0.18084627	54.70789742	67.81735109	0	0.090423135	0	0	31.64809718	13.56347022	31.64809718	31.64809718	31.64809718	0.090423135	27.45806994	0.18084627	0	0	0	31.64809718	0	31.64809718	0	2.082686592	0												4.372	0.102913092	3.944990687	0	2.386528342	1.254838429	0.398859656	1.520765361	1.867674467	0	1.653983251	0	0	0.684907597	4.778364587	11.15927908	0.373746342	1.629827166	2.88816262	3.791973875	7.331295576	0	0	0	0.558964586	0	0.000773085	0	0.016189885	0	0	0	0	0	0	0	0	0	0	0	50.7161	0	NO	5.369715672	4.372	0.102913092	3.944990687	0	2.386528342	1.254838429	0.398859656	1.520765361	1.867674467	0	1.653983251	0	0	0.684907597	4.778364587	11.15927908	0.373746342	1.629827166	2.88816262	3.791973875	7.331295576	0	0	0	0.558964586	0	0.000773085	0	0.016189885	0	0	0	0	0	0	0	0	0	0	0	50.7161	NO	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"												0	0	0	0.0096	0.0029	0.0098	0.0149	0.0125	0.003	0.0714	0.0009	0	0	0.0071	0.028	0.1372	0	0.0029	0.025	0.028	0.0009	0	0	0	0	0	0	0	0	0											0.3539	0	NO	1.67E-16	4.372	0.102913092	3.944990687	0.009573218	2.3894525	1.264594352	0.413738961	1.533241156	1.870652651	0.071350428	1.654890509	0	0	0.692003384	4.806374554	11.29650693	0.373746342	1.632709758	2.913115828	3.819931925	7.332214459	0	0	0	0.558964586	0	0.000773085	0	0.016189885	0	0	0	0	0	0	0	0	0	0	0	51.07
H3351_002_0	2012	8																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	V	V	Coin	V	Coin	O			V		V		O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	290.04754	7.707121583	2203.420549	0	282.1976919	8.401424717	2.82214951	371.5351072	355.9569644	0	19.77400115	0	0	311.4945553	4226.304615	4472.027794	264.6979994	821.0233397	35.00940319	1465.631938	51.90859565	0.05697613	0	0	198.8669609	0	0.481999553	0	103.8954044	0											3400	$275/Admit for IP Medical;  PBP 1a	$275/Admit for IP Medical;  PBP 1b	$25/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$125/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$75/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH; PBP 5	$0 Copay;  PBP 12	"$0-$75 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	10% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$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		$25 Copay per year;   PBP 14c												0	NO	275	275	25	0	125	0.2	0.2	61.05472179	75	0	0.1	0	0	35	15	35	35	35	0.1	31.0787992	0.2	35	0	0	35	0	35	0	2.083333333	0											NO	243.5293391	243.5293391	22.13903083	0	110.6951541	0.177112247	0.177112247	54.06769471	66.41709248	0	0.088556123	0	0	30.99464316	13.2834185	30.99464316	30.99464316	30.99464316	0.088556123	27.52217974	0.177112247	30.99464316	0	0	30.99464316	0	30.99464316	0	2.082640851	0												5.8863	0.156409185	4.065132955	0	2.60315975	1.487995206	0.49983724	1.674003896	1.970135552	0	1.751108884	0	0	0.804555216	4.678314408	11.55074214	0.683685003	2.120610453	3.100297026	3.361448803	9.193647994	0.000147163	0	0	0.513650874	0	0.00124495	0	0.018031401	0	0	0	0	0	0	0	0	0	0	0	56.1204	0	NO	7.24997064	5.8863	0.156409185	4.065132955	0	2.60315975	1.487995206	0.49983724	1.674003896	1.970135552	0	1.751108884	0	0	0.804555216	4.678314408	11.55074214	0.683685003	2.120610453	3.100297026	3.361448803	9.193647994	0.000147163	0	0	0.513650874	0	0.00124495	0	0.018031401	0	0	0	0	0	0	0	0	0	0	0	56.1204	NO	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"		"30% coinsurance, $1,500 Annual Max"	"30% coinsurance, $1,500 Annual Max"												0	0	0	0.0026	0.0047	0.0159	0.0212	0.0126	0.0116	0.0686	0.0112	0	0	0.0109	0.0223	0.0732	0	0.0055	0.0099	0.0501	0.0017	0	0	0	0	0	0	0	0	0											0.3219	0	NO	1.67E-16	5.8863	0.156409185	4.065132955	0.002646687	2.607864189	1.503872748	0.5210092	1.68655838	1.981686965	0.068605817	1.762290092	0	0	0.815474921	4.700644233	11.62390942	0.683685003	2.126078638	3.110186594	3.411589549	9.195355302	0.000147163	0	0	0.513650874	0	0.00124495	0	0.018031401	0	0	0	0	0	0	0	0	0	0	0	56.4423
H3351_006_0	2012	9																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	V	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	242.2876694	6.663017901	1404.709718	0	214.8629056	13.17313504	1.981193628	232.2975357	336.3878262	0	28.53586873	0	0	829.2980381	4190.84747	4763.619342	856.9931948	621.2724544	28.84440127	1784.077088	61.20598807	0.21426173	0	0	781.3256113	0	0	0	239.2478231	0											3400	$275/Admit for IP Medical;  PBP 1a	$275/Admit for IP Medical;  PBP 1b	$25/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$125/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$75/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH; PBP 5	$0 Copay;  PBP 12	"$0-$75 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	10% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$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		$25 Copay per year;   PBP 14c												0	NO	275	275	25	0	125	0.2	0.2	58.64372241	75	0	0.1	0	0	35	15	35	35	35	0.1	28.17745066	0.2	35	0	0	35	0	0	0	2.083333333	0											NO	240.7239721	240.7239721	21.88399747	0	109.4199873	0.17507198	0.17507198	51.33436291	65.6519924	0	0.08753599	0	0	30.63759645	13.13039848	30.63759645	30.63759645	30.63759645	0.08753599	24.66541035	0.17507198	30.63759645	0	0	30.63759645	0	0	0	2.083255193	0												4.8604	0.133662345	2.561721993	0	1.959191367	2.306246831	0.346851491	0.993737167	1.840377584	0	2.497915516	0	0	2.117308219	4.58562477	12.16215392	2.188017639	1.586191229	2.524923217	3.667082789	10.7154535	0.000547039	0	0	1.994828231	0	0	0	0.041534522	0	0	0	0	0	0	0	0	0	0	0	59.0837	0	NO	8.406859713	4.8604	0.133662345	2.561721993	0	1.959191367	2.306246831	0.346851491	0.993737167	1.840377584	0	2.497915516	0	0	2.117308219	4.58562477	12.16215392	2.188017639	1.586191229	2.524923217	3.667082789	10.7154535	0.000547039	0	0	1.994828231	0	0	0	0.041534522	0	0	0	0	0	0	0	0	0	0	0	59.0837	NO	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"		"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"		"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"												0	0	0	0	0.0719	0.0901	0.0588	0.0161	0.004	0.007	0.0095	0	0	0.0096	0.0102	0.3773	0	0.0229	0.0702	0.1548	0.0019	0	0	0	0.0098	0	0	0	0	0											0.914	0	NO	1.11E-16	4.8604	0.133662345	2.561721993	0	2.031133225	2.396320575	0.405672906	1.009803486	1.84436969	0.007036843	2.507409835	0	0	2.126904782	4.59581873	12.53942655	2.188017639	1.609082933	2.595123334	3.821842381	10.71732853	0.000547039	0	0	2.004634124	0	0	0	0.041534522	0	0	0	0	0	0	0	0	0	0	0	59.9978
H3351_007_0	2012	7																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	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	312.0007461	3.814070539	2078.553149	0	318.0896865	11.53958404	2.31052169	263.4997277	316.855292	0	34.20172498	0	0	759.0501839	4336.201132	4785.56406	339.1858736	380.9065103	28.14311497	1799.125386	50.39899609	0	0	0	741.9485639	0	0	0	177.3884479	0											3400	$200/Admit for IP Medical;  PBP 1a	$200/Admit for IP Medical;  PBP 1b	$25/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$125/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $35/Visit for Urgent Care;  PBP 4a, 4b"	"$75/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	$35/Visit for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$75 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$15/Visit for PCP;  PBP 7a	"$35/Visit for Specialist;  PBP 7d, 17a, 18a"	"$35/Visit for MH; $35/Visit for SA;  PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST;  PBP 7c, 7i"	10% Coinsurance for Radiology;  PBP 8b	"$15/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-e"	20% Coinsurance for Part B Rx;  PBP 15	$35 Copay;  PBP 7g			$35/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$35/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	200	200	25	0	125	0.2	0.2	60.94629587	75	0	0.1	0	0	35	15	35	35	35	0.1	28.52895141	0.2	0	0	0	35	0	0	0	2.083333333	0											NO	176.1603326	176.1603326	22.02004158	0	110.1002079	0.176160333	0.176160333	53.68159876	66.06012473	0	0.088080166	0	0	30.82805821	13.21202495	30.82805821	30.82805821	30.82805821	0.088080166	25.12834785	0.176160333	0	0	0	30.82805821	0	0	0	2.083333333	0												4.5802	0.055990661	3.814152229	0	2.918478384	2.032816962	0.407022269	1.178757221	1.744291676	0	3.012493625	0	0	1.950003604	4.774166461	12.29413728	0.871370155	0.978550673	2.478850247	3.767420711	8.878303914	0	0	0	1.90606946	0	0	0	0.030796606	0	0	0	0	0	0	0	0	0	0	0	57.6739	0	NO	7.800798515	4.5802	0.055990661	3.814152229	0	2.918478384	2.032816962	0.407022269	1.178757221	1.744291676	0	3.012493625	0	0	1.950003604	4.774166461	12.29413728	0.871370155	0.978550673	2.478850247	3.767420711	8.878303914	0	0	0	1.90606946	0	0	0	0.030796606	0	0	0	0	0	0	0	0	0	0	0	57.6739	NO	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"			"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"		"30% coinsurance, $3,000 Annual Max"	"30% coinsurance, $3,000 Annual Max"												0	0	0	0	0.0404	0.0604	0.0578	0.0098	0.0033	0.0007	0.0072	0	0	0.0016	0.0044	0.2269	0	0.016	0.0549	0.1548	0.0002	0	0	0	0.0035	0	0	0	0	0											0.6422	0	NO	0	4.5802	0.055990661	3.814152229	0	2.958885403	2.093177899	0.464808146	1.188600784	1.747612352	0.0007237	3.019711499	0	0	1.951630058	4.778595542	12.52104027	0.871370155	0.994565326	2.53378332	3.922238851	8.878537602	0	0	0	1.909617431	0	0	0	0.030796606	0	0	0	0	0	0	0	0	0	0	0	58.316
H3351_010_0	2012	9																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	V	Coin	V	Coin	O			V		V		O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	899.7202634	72.49487917	1733.988289	0	224.8177049	5.667832382	1.883461148	295.1883873	274.3424617	0	11.00807257	0	0	252.4266169	3047.503864	2941.955198	2.281475504	491.2454704	19.1766098	858.5860173	25.63637615	0.002448045	0	0	150.3884721	0	0.172464887	0	146.1238716	0											3400	$150/days 1-7 for IP Medical;  PBP 1a	$150/days 1-7 for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$150/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$150 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	150	150	50	0	150	0.2	0.2	61.75450696	150	0	0.2	0	0	40	20	40	0.403722458	40	0.2	35.34357831	0.2	40	0	0	40	0	40	0	2.083333333	0											NO	133.6485291	133.6485291	44.54950971	0	133.6485291	0.178198039	0.178198039	55.02266015	133.6485291	0	0.178198039	0	0	35.63960777	17.81980388	35.63960777	0.359712751	35.63960777	0.178198039	31.49078171	0.178198039	35.63960777	0	0	35.63960777	0	35.63960777	0	2.081217321	0												10.0205	0.807402831	6.437360679	0	2.503879632	1.009996615	0.335629083	1.353504193	3.055455541	0	1.961616943	0	0	0.749698801	4.525493432	8.737510777	0.82067583	1.45898299	3.417234258	2.253128737	4.568351954	7.27E-06	0	0	0.446648846	0	0.000512215	0	0.025342961	0	0	0	0	0	0	0	0	0	0	0	54.489	0	NO	6.663475159	10.0205	0.807402831	6.437360679	0	2.503879632	1.009996615	0.335629083	1.353504193	3.055455541	0	1.961616943	0	0	0.749698801	4.525493432	8.737510777	0.82067583	1.45898299	3.417234258	2.253128737	4.568351954	7.27E-06	0	0	0.446648846	0	0.000512215	0	0.025342961	0	0	0	0	0	0	0	0	0	0	0	54.489	NO																																										0	0	0	0	0	0	0	0	0	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	10.0205	0.807402831	6.437360679	0	2.503879632	1.009996615	0.335629083	1.353504193	3.055455541	0	1.961616943	0	0	0.749698801	4.525493432	8.737510777	0.82067583	1.45898299	3.417234258	2.253128737	4.568351954	7.27E-06	0	0	0.446648846	0	0.000512215	0	0.025342961	0	0	0	0	0	0	0	0	0	0	0	54.489
H3351_011_0	2012	9																															D	D	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	639.2265743	60.29715719	709.9926674	0	138.6556943	7.306515514	1.799547041	186.9817314	259.015883	0	22.24387805	0	0	526.9642	3264.681936	3376.354637	4.595751618	324.7564109	15.42367072	1101.724071	20.70956365	0	0	0	561.2280281	0	0	0	305.7533556	0											3400	$150/days 1-7 for IP Medical;  PBP 1a	$150/days 1-7 for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$150/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	20% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$150 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g			$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	150	150	50	0	150	0.2	0.2	59.69958145	150	0	0.2	0	0	40	20	40	0.405615498	40	0.2	31.26974862	0.2	0	0	0	40	0	0	0	2.083333333	0											NO	135.1707554	135.1707554	45.05691846	0	135.1707554	0.180227674	0.180227674	53.79758347	135.1707554	0	0.180227674	0	0	36.04553477	18.02276738	36.04553477	0.365515688	36.04553477	0.180227674	28.17837028	0.180227674	0	0	0	36.04553477	0	0	0	2.083297067	0												7.2004	0.679201024	2.665840143	0	1.561849578	1.316836295	0.324328177	0.838263775	2.917614381	0	4.008962399	0	0	1.5828922	4.903216927	10.1418757	1.679819317	0.975501542	2.779772295	2.587065735	3.732436482	0	0	0	1.6858137	0	0	0	0.053081256	0	0	0	0	0	0	0	0	0	0	0	51.6348	0	NO	5.658898192	7.2004	0.679201024	2.665840143	0	1.561849578	1.316836295	0.324328177	0.838263775	2.917614381	0	4.008962399	0	0	1.5828922	4.903216927	10.1418757	1.679819317	0.975501542	2.779772295	2.587065735	3.732436482	0	0	0	1.6858137	0	0	0	0.053081256	0	0	0	0	0	0	0	0	0	0	0	51.6348	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.2004	0.679201024	2.665840143	0	1.561849578	1.316836295	0.324328177	0.838263775	2.917614381	0	4.008962399	0	0	1.5828922	4.903216927	10.1418757	1.679819317	0.975501542	2.779772295	2.587065735	3.732436482	0	0	0	1.6858137	0	0	0	0.053081256	0	0	0	0	0	0	0	0	0	0	0	51.6348
H3351_012_0	2012	9																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	V	Coin	V	Coin	O			V		V		O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	240.5460961	5.695305465	1603.4749	0	195.4860763	7.279460668	2.316789557	309.351369	330.2949846	0	12.49684574	0	0	269.1352498	3526.294312	3721.395589	1.876029719	556.1103557	13.6108234	1160.179918	46.42076359	0.01844087	0	0	185.1095914	0	0.568346834	0	136.2929478	0											3400	$375/Admit for IP Medical;  PBP 1a	$375/Admit for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$125/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$125 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% Coinsurance for MH; 50% Coinsurance for SA;  PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST;  PBP 7c, 7i"	10% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	375	375	50	0	150	0.2	0.2	61.97032106	125	0	0.1	0	0	40	20	40	0.409781335	40	0.1	35.61500777	0.2	40	0	0	40	0	40	0	2.083333333	0											NO	333.7490747	333.7490747	44.49987663	0	133.4996299	0.177999507	0.177999507	55.15343284	111.2496916	0	0.088999753	0	0	35.5999013	17.79995065	35.5999013	0.364704377	35.5999013	0.088999753	31.69726903	0.177999507	35.5999013	0	0	35.5999013	0	35.5999013	0	2.082869882	0												6.6902	0.158400244	5.946202937	0	2.17477657	1.295740407	0.412387398	1.421815829	3.062101264	0	1.112216188	0	0	0.798432361	5.230655394	11.04010964	0.684196251	1.649789481	1.211359925	3.064544582	8.26287301	5.47E-05	0	0	0.549156932	0	0.001686091	0	0.023656706	0	0	0	0	0	0	0	0	0	0	0	54.7903	0	NO	6.76909001	6.6902	0.158400244	5.946202937	0	2.17477657	1.295740407	0.412387398	1.421815829	3.062101264	0	1.112216188	0	0	0.798432361	5.230655394	11.04010964	0.684196251	1.649789481	1.211359925	3.064544582	8.26287301	5.47E-05	0	0	0.549156932	0	0.001686091	0	0.023656706	0	0	0	0	0	0	0	0	0	0	0	54.7903	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.6902	0.158400244	5.946202937	0	2.17477657	1.295740407	0.412387398	1.421815829	3.062101264	0	1.112216188	0	0	0.798432361	5.230655394	11.04010964	0.684196251	1.649789481	1.211359925	3.064544582	8.26287301	5.47E-05	0	0	0.549156932	0	0.001686091	0	0.023656706	0	0	0	0	0	0	0	0	0	0	0	54.7903
H3351_013_0	2012	9																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	V	Coin	V	Coin	O			V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	204.0314581	7.079370627	1030.70112	0	162.9841123	9.130551192	2.159847682	194.3745955	308.4166386	0	21.60031471	0	0	791.1717377	3846.961135	4223.680698	4.25330882	611.2790153	15.87540712	1618.292288	37.13210817	0.023081803	0	0	651.4828709	0	0	0	263.8001648	0											3400	$375/Admit for IP Medical;  PBP 1a	$375/Admit for IP Medical;  PBP 1b	$50/Day for SNF;  PBP 2	$0 Copay;  PBP 6	$150/Trip for Ambulance;  PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies;  PBP 11a, 11b, 11c"	"$65/Visit for ER; $40/Visit for Urgent Care;  PBP 4a, 4b"	"$125/Visit for OP Surgery;  PBP 9a, 9b"	$0 Copay for Lab;  PBP 8a	10% Coinsurance for OP Radiology;  PBP 8b	40% Coinsurance for MH;  PBP 5	$0 Copay;  PBP 12	"$0-$125 Copay for OP Other;  PBP 3, 9a, 9c, 9d"	$20/Visit for PCP;  PBP 7a	"$40/Visit for Specialist;  PBP 7d, 17a, 18a"	"40% Coinsurance for MH; 50% Coinsurance for SA;  PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST;  PBP 7c, 7i"	10% 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-e"	20% Coinsurance for Part B Rx;  PBP 15	$40 Copay;  PBP 7g		"$0 Copay;  PBP 16a, 16b"	$40/Visit for Vision Exams;  PBP 17a	$0 Copay;  PBP 17b	$40/Visit for Hearing Exams;  PBP 18a		$25 Copay per year;   PBP 14c												0	NO	375	375	50	0	150	0.2	0.2	60.30097341	125	0	0.1	0	0	40	20	40	0.402019057	40	0.1	31.62020538	0.2	40	0	0	40	0	0	0	2.083333333	0											NO	331.7211623	331.7211623	44.2294883	0	132.6884649	0.176917953	0.176917953	53.34162396	110.5737208	0	0.088458977	0	0	35.38359064	17.69179532	35.38359064	0.355621944	35.38359064	0.088458977	27.97091008	0.176917953	35.38359064	0	0	35.38359064	0	0	0	2.083323646	0												5.6401	0.195698088	3.798948593	0	1.802175972	1.615358429	0.382115831	0.864021382	2.841897939	0	1.910741734	0	0	2.332874741	5.671637418	12.4540824	1.51256995	1.802437204	1.404322267	3.772092338	6.569336577	6.81E-05	0	0	1.920983601	0	0	0	0.045798427	0	0	0	0	0	0	0	0	0	0	0	56.5373	0	NO	7.370305123	5.6401	0.195698088	3.798948593	0	1.802175972	1.615358429	0.382115831	0.864021382	2.841897939	0	1.910741734	0	0	2.332874741	5.671637418	12.4540824	1.51256995	1.802437204	1.404322267	3.772092338	6.569336577	6.81E-05	0	0	1.920983601	0	0	0	0.045798427	0	0	0	0	0	0	0	0	0	0	0	56.5373	NO																																										0	0	0	0	0	0	0	0	0	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	5.6401	0.195698088	3.798948593	0	1.802175972	1.615358429	0.382115831	0.864021382	2.841897939	0	1.910741734	0	0	2.332874741	5.671637418	12.4540824	1.51256995	1.802437204	1.404322267	3.772092338	6.569336577	6.81E-05	0	0	1.920983601	0	0	0	0.045798427	0	0	0	0	0	0	0	0	0	0	0	56.5373
H3351_801_0	2012	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	259.3851639	8.309792771	54.79390732	0	9.288658692	7.224928127	15.20608529	27.74932604	54.1341702	25.54644909	22.05558247	0	0.746342687	6.822765506	48.04274012	138.0255463	3.210026745	6.111308248	42.08416826	35.38972416	68.24143001	4.110060099	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090915411	0.090915411	0.179379277	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080625453	0.080625453	0.159076831	0	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0.198647306	0	0	0	0	0	0	0	0												20.913	0.669980803	8.716441116	0	1.845167021	1.435212505	3.02064787	5.512328848	10.75360705	5.074733278	4.381282029	0	0.148258964	1.355323984	9.543560874	27.41840287	0.637663164	1.213994917	8.35990663	7.030073348	13.5559762	0.816452364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4021	0	NO	16.89803427	20.913	0.669980803	8.716441116	0	1.845167021	1.435212505	3.02064787	5.512328848	10.75360705	5.074733278	4.381282029	0	0.148258964	1.355323984	9.543560874	27.41840287	0.637663164	1.213994917	8.35990663	7.030073348	13.5559762	0.816452364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4021	NO																																										0	0	0	0	0	0	0	0	0	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	20.913	0.669980803	8.716441116	0	1.845167021	1.435212505	3.02064787	5.512328848	10.75360705	5.074733278	4.381282029	0	0.148258964	1.355323984	9.543560874	27.41840287	0.637663164	1.213994917	8.35990663	7.030073348	13.5559762	0.816452364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4021
H3351_802_0	2012	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	189.1891665	6.812638987	37.05422471	0	6.761352629	10.59706396	2.690329711	21.72456896	56.63539225	6.157632541	30.55715689	0	0.258800487	9.983982442	35.21744645	102.6245922	2.953315328	6.813498187	25.87644484	68.94806636	49.29066646	0.098989788	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.085876064	0.085876064	0.199806045	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078442581	0.078442581	0.182510714	0	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0.204610426	0	0	0	0	0	0	0	0												14.8405	0.534400985	6.762793024	0	1.383443245	2.168269776	0.550469509	4.445073319	11.58819176	1.25991582	6.252312901	0	0.052953278	2.042826905	7.205856735	20.99806157	0.604279109	1.394112769	5.294590413	14.10749326	10.08538428	0.020254343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5912	0	NO	10.57475531	14.8405	0.534400985	6.762793024	0	1.383443245	2.168269776	0.550469509	4.445073319	11.58819176	1.25991582	6.252312901	0	0.052953278	2.042826905	7.205856735	20.99806157	0.604279109	1.394112769	5.294590413	14.10749326	10.08538428	0.020254343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5912	NO																																										0	0	0	0	0	0	0	0	0	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	14.8405	0.534400985	6.762793024	0	1.383443245	2.168269776	0.550469509	4.445073319	11.58819176	1.25991582	6.252312901	0	0.052953278	2.042826905	7.205856735	20.99806157	0.604279109	1.394112769	5.294590413	14.10749326	10.08538428	0.020254343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5912
H3351_803_0	2012	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	273.9665647	6.248425329	39.78736306	0	9.250687378	8.036879119	12.33245042	26.73889032	51.62795533	23.47467725	18.44249399	0	2.128186681	5.802966665	48.20642799	138.0375258	2.594388322	6.640836567	40.45539098	34.69531643	54.0118536	1.445952428	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090890735	0.090890735	0.179424561	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081324198	0.081324198	0.160539559	0	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0.200423292	0	0	0	0	0	0	0	0												22.2801	0.508148179	6.3874457	0	1.854053218	1.61077777	2.471710311	5.359096423	10.34744477	4.704872093	3.696305359	0	0.426538181	1.163049682	9.661690994	27.66593533	0.519975848	1.330978326	8.108202639	6.953749535	10.82523351	0.289802546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1651	0	NO	14.84137997	22.2801	0.508148179	6.3874457	0	1.854053218	1.61077777	2.471710311	5.359096423	10.34744477	4.704872093	3.696305359	0	0.426538181	1.163049682	9.661690994	27.66593533	0.519975848	1.330978326	8.108202639	6.953749535	10.82523351	0.289802546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1651	NO																																										0	0	0	0	0	0	0	0	0	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	22.2801	0.508148179	6.3874457	0	1.854053218	1.61077777	2.471710311	5.359096423	10.34744477	4.704872093	3.696305359	0	0.426538181	1.163049682	9.661690994	27.66593533	0.519975848	1.330978326	8.108202639	6.953749535	10.82523351	0.289802546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1651
H3351_804_0	2012	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	252.6169086	5.957230983	50.32094545	0	8.058894757	12.21859164	3.341304615	21.91502658	58.37471985	6.084426505	35.73578861	0	0.180273738	10.97801175	40.61061427	113.6349086	2.314142091	6.652732267	29.71206956	78.39492984	45.89118315	0.068953731	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.0858757	0.0858757	0.199807966	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.077061256	0.077061256	0.179299299	0	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0.201008217	0	0	0	0	0	0	0	0												19.467	0.4590717	9.022510269	0	1.619904068	2.456037323	0.671629684	4.405100424	11.73379837	1.223019725	7.183187161	0	0.036236503	2.206670571	8.163067175	22.84155039	0.465161576	1.337253853	5.972370133	15.75802509	9.224504913	0.013860266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2599	0	NO	14.21313754	19.467	0.4590717	9.022510269	0	1.619904068	2.456037323	0.671629684	4.405100424	11.73379837	1.223019725	7.183187161	0	0.036236503	2.206670571	8.163067175	22.84155039	0.465161576	1.337253853	5.972370133	15.75802509	9.224504913	0.013860266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2599	NO																																										0	0	0	0	0	0	0	0	0	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	19.467	0.4590717	9.022510269	0	1.619904068	2.456037323	0.671629684	4.405100424	11.73379837	1.223019725	7.183187161	0	0.036236503	2.206670571	8.163067175	22.84155039	0.465161576	1.337253853	5.972370133	15.75802509	9.224504913	0.013860266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2599
H3351_805_0	2012	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	264.9750124	7.195179313	46.72074629	0	9.202243147	7.588252895	13.62614601	27.03222121	52.46147811	24.3022053	20.04790956	0	1.447971589	6.251787865	47.78001621	137.0362655	2.871889397	6.338164501	40.9473133	34.77921208	60.46881887	2.717346132	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.090900709	0.090900709	0.179406235	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081065189	0.081065189	0.159994356	0	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0.199763045	0	0	0	0	0	0	0	0												21.4802	0.583278574	7.475055717	0	1.838268113	1.515852505	2.72200042	5.400038824	10.47986462	4.854682533	4.004831461	0	0.289251214	1.248876181	9.544681534	27.37478169	0.573697371	1.266131041	8.179759994	6.947601312	12.07943539	0.542825338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4012	0	NO	15.57872331	21.4802	0.583278574	7.475055717	0	1.838268113	1.515852505	2.72200042	5.400038824	10.47986462	4.854682533	4.004831461	0	0.289251214	1.248876181	9.544681534	27.37478169	0.573697371	1.266131041	8.179759994	6.947601312	12.07943539	0.542825338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4012	NO																																										0	0	0	0	0	0	0	0	0	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	21.4802	0.583278574	7.475055717	0	1.838268113	1.515852505	2.72200042	5.400038824	10.47986462	4.854682533	4.004831461	0	0.289251214	1.248876181	9.544681534	27.37478169	0.573697371	1.266131041	8.179759994	6.947601312	12.07943539	0.542825338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4012
H3351_806_0	2012	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	192.1512729	6.746295191	37.68088232	0	6.81379894	10.65655237	2.718620286	21.67382691	56.57159822	6.13624096	30.75640735	0	0.253743492	10.01061862	35.41538307	102.9420714	2.909766651	6.785432552	26.01487852	69.27431461	48.96438454	0.097055515	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"Medicare-FFS Cost Sharing; PBP 7d, 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, 7f, 7g, 8a, 14a-e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	NO	0.085876037	0.085876037	0.199806191	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07839802	0.07839802	0.182407226	0	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0.204494258	0	0	0	0	0	0	0	0												15.0643	0.528896183	6.873265227	0	1.393382759	2.179203769	0.555942238	4.432173153	11.568567	1.254826042	6.2895087	0	0.051889087	2.047114026	7.242242484	21.05106251	0.595030572	1.387581995	5.319893281	14.16619957	10.01293549	0.019847296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0338	0	NO	10.68637921	15.0643	0.528896183	6.873265227	0	1.393382759	2.179203769	0.555942238	4.432173153	11.568567	1.254826042	6.2895087	0	0.051889087	2.047114026	7.242242484	21.05106251	0.595030572	1.387581995	5.319893281	14.16619957	10.01293549	0.019847296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0338	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.0643	0.528896183	6.873265227	0	1.393382759	2.179203769	0.555942238	4.432173153	11.568567	1.254826042	6.2895087	0	0.051889087	2.047114026	7.242242484	21.05106251	0.595030572	1.387581995	5.319893281	14.16619957	10.01293549	0.019847296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0338
H3359_001_0	2012	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	V	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	300.7442424	12.63795502	376.465376	994.976377	210.8989355	8.156206836	2.452296815	378.4570287	69.4629545	307.8611503	16.85843698		0.912394896	3.750556031	4206.549489	5625.648654	3.429036209	1116.596232	29.87790763	428.8134796	6.771875299			7.510771175	275	275	5.862287861				0	514.9945932	4.242309256	836.8828135							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 - $65; 4B Urgent Care - $0	9B ASC Services - $50	8A Outpatient Lab - $0; D/T - $0-$50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 Cardiac Pulmonary Rehab - $0-$50; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0; 9A Outpatient Hospital - 10%	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $20	7E Mental Health - 40%; 7H Psychiatric Services - 40%; 9C Outpatient Sub Abuse - 40%	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%		10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$100	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every 2 years	18A Hearing Exams (Routine) - $20	18B Hearing Aids - $0 ($2000 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	17A Eye Exams (Medicare Covered) - $0-$20							0	NO	527.7768912	754.6077505	50	0	100	0.2	0.2	65	50	50	0.108220158		0.2	0.099390548	0	20	0.4	20	0.149534175	20	0.2			0.05	0	0	20				20	20	20	20							NO	511.281932	731.023497	48.43731704	0	96.87463407	0.193749268	0.193749268	62.96851215	48.43731704	48.43731704	0.104837882		0.193749268	0.096284229	0	19.37492681	0.387498536	19.37492681	0.144860685	19.37492681	0.193749268			0.05	0	0	20				19.37492681	19.37492681	19.37492681	19.37492681								12.8138	0.769886839	1.519581064	0	1.7025631	1.580259105	0.475130713	1.985906334	0.280383262	1.242664012	1.767402827	0	0.176775843	0.361119397	0	9.083044246	1.328746512	1.802830856	4.328134161	0.692352482	1.312045883	0	0	0.375538559	0	0	0.00977048	0	0	0	0	0.831498546	0.006849536	1.351211939	0	0	0	0	0	0	45.7975	0	NO	1.465084966	12.8138	0.769886839	1.519581064	0	1.7025631	1.580259105	0.475130713	1.985906334	0.280383262	1.242664012	1.767402827	0	0.176775843	0.361119397	0	9.083044246	1.328746512	1.802830856	4.328134161	0.692352482	1.312045883	0	0	0.375538559	0	0	0.00977048	0	0	0	0	0.831498546	0.006849536	1.351211939	0	0	0	0	0	0	45.7975	NO																																																																																		0				12.8138	0.769886839	1.519581064	0	1.7025631	1.580259105	0.475130713	1.985906334	0.280383262	1.242664012	1.767402827	0	0.176775843	0.361119397	0	9.083044246	1.328746512	1.802830856	4.328134161	0.692352482	1.312045883	0	0	0.375538559	0	0	0.00977048	0	0	0	0	0.831498546	0.006849536	1.351211939	0	0	0	0	0	0	45.7975
H3359_019_0	2012	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	V	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	356.7676543	17.14447932	415.876667	1251.874603	269.2808244	9.561568358	2.12189192	467.5020161	82.2119994	289.6369064	17.02953632		0.692801046	5.460738352	4090.163604	6553.986291	5.161657182	985.7895129	25.26829539	431.2893068	8.578352835			7.042793717	618.75	618.75	8.491971331				0	600.9379032	4.997169097	867.0411608							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 - $65; 4B Urgent Care - $0	9B ASC Services - $50	8A Outpatient Lab - $0; D/T - $0-$50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 Cardiac & Pulmonary Rehab - $0-$50; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0;  9A Outpatient Hospital - 10%	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $20	7E Mental Health - 40%; 7H Psychiatric Services - 40%; 9C Outpatient Sub Abuse - 40%	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%		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) - $20	18B Hearing Aids - $0 ($2000 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	17A Eye Exams (Medicare Covered) - $0-$20							0	NO	569.9990425	814.9763705	50	0	100	0.2	0.2	65	50	50	0.108220158		0.2	0.083054013	0	20	0.4	20	0.149534175	20	0.2			0	0	0	20				20	20	20	20							NO	552.3282228	789.7108886	48.44992549	0	96.89985099	0.193799702	0.193799702	62.98490314	48.44992549	48.44992549	0.104865172		0.193799702	0.080479215	0	19.3799702	0.387599404	19.3799702	0.144898393	19.3799702	0.193799702			0	0	0	20				19.3799702	19.3799702	19.3799702	19.3799702								16.4211	1.128265166	1.679099461	0	2.174439313	1.853029098	0.411222022	2.453797434	0.331930437	1.169407211	1.785805252	0	0.134264636	0.439475933	0	10.58467158	2.000655247	1.592047615	3.661335389	0.696531159	1.662482223	0	0	0	0	0	0.014153286	0	0	0	0	0.970513221	0.008070416	1.400269321	0	0	0	0	0	0	52.5725	0	NO	1.681517732	16.4211	1.128265166	1.679099461	0	2.174439313	1.853029098	0.411222022	2.453797434	0.331930437	1.169407211	1.785805252	0	0.134264636	0.439475933	0	10.58467158	2.000655247	1.592047615	3.661335389	0.696531159	1.662482223	0	0	0	0	0	0.014153286	0	0	0	0	0.970513221	0.008070416	1.400269321	0	0	0	0	0	0	52.5725	NO																																																																																		0				16.4211	1.128265166	1.679099461	0	2.174439313	1.853029098	0.411222022	2.453797434	0.331930437	1.169407211	1.785805252	0	0.134264636	0.439475933	0	10.58467158	2.000655247	1.592047615	3.661335389	0.696531159	1.662482223	0	0	0	0	0	0.014153286	0	0	0	0	0.970513221	0.008070416	1.400269321	0	0	0	0	0	0	52.5725
H3359_021_0	2012	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	360.2224266	23.84928109	14.59876097	825.5519358	14.52453776	4.116756857	1.531123402	9.812400724	7.862718653	1.469224927	4.326764279		0.091667854	2.870779652	3417.682578	4231.4286	7.247312427	1047.186213	5.031673907	394.2617002	9.506306419				206.25	412.5					0	628.089016	1.644160087	602.883512							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%	8A Outpatient C/D/T - 0-20%; Lab - $0	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 Cardiac & Pulmonary Rehab - 0-20%; 5 Partial Hosp - 20%; 9D Outpatient Blood Svcs - 0%;  9A Outpatient Hospital - 0-20%	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $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%		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	14C Supplemental Education/Wellness Programs  - $0; 13D - Pap/Pelvic Exams - $0	13B OTC Rx Card - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0	NO	0.05713206	0.05713206	0.148591492	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0.2	0.175667518	0	0	0.2	0	0.2	0	0				0	0					0	0	0	0							NO	0.054021598	0.054021598	0.140501669	0	0.189111324	0.189111324	0.189111324	0.189111324	0.189111324	0.189111324	0.189111324		0.189111324	0.166103584	0	0	0.189111324	0	0.189111324	0	0				0	0					0	0	0	0								19.4598	1.288376274	2.051150282	0	2.746754564	0.778525339	0.289552774	1.855636091	1.486929134	0.277847071	0.818240121	0	0.017335429	0.476846789	0	0	1.370548848	0	0.951546514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8691	0	NO	1.950118258	19.4598	1.288376274	2.051150282	0	2.746754564	0.778525339	0.289552774	1.855636091	1.486929134	0.277847071	0.818240121	0	0.017335429	0.476846789	0	0	1.370548848	0	0.951546514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8691	NO																																																																																		0				19.4598	1.288376274	2.051150282	0	2.746754564	0.778525339	0.289552774	1.855636091	1.486929134	0.277847071	0.818240121	0	0.017335429	0.476846789	0	0	1.370548848	0	0.951546514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8691
H3359_027_0	2012	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	V	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	208.2053073	10.61251348	351.6817784	522.7653937	156.9779561	2.970391091	1.490610631	341.1307566	53.22730521	163.4422067	9.960786671		0.885508526	5.444401547	2043.4955	4236.530889	3.1873441	406.2382133	19.62934306	193.716851	2.126155474			6.540485935	275	275	0.864557754				0	225.4490374	4.13553319	564.85414							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 - $65; 4B Urgent Care - $0	9B ASC Services - $50	8A Outpatient Lab - $0; D/T - $0-$50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 Cardiac & Pulmonary Rehab - $0-$50; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0;  9A Outpatient Hospital - 10%	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $20	7E Mental Health - 40%; 7H Psychiatric Services - 40%; 9C Outpatient Sub Abuse - 40%	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%		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)	14C Supplemental Education/Wellness Programs  - $0; 13D - Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	17A Eye Exams (Medicare Covered) - $0-$20							0	NO	527.7768912	754.6077505	50	0	100	0.2	0.2	65	50	50	0.108220158		0.2	0.068586746	0	20	0.4	20	0.149534175	20	0.2			0.1	0	0	20				20	20	20	20							NO	514.3574943	735.4208914	48.72868659	0	97.45737317	0.194914746	0.194914746	63.34729256	48.72868659	48.72868659	0.105468523		0.194914746	0.066842841	0	19.49147463	0.389829493	19.49147463	0.145732079	19.49147463	0.194914746			0.1	0	0	20				19.49147463	19.49147463	19.49147463	19.49147463								8.9243	0.650388677	1.428082596	0	1.274888271	0.578973026	0.290541993	1.800809153	0.216141389	0.663693672	1.05054946	0	0.17259867	0.363919267	0	6.881352863	1.242520734	0.659848486	2.860624972	0.314652257	0.414419055	0	0	0.654048593	0	0	0.00144093	0	0	0	0	0.366194516	0.006717303	0.917486678	0	0	0	0	0	0	31.7342	0	NO	0.810832652	8.9243	0.650388677	1.428082596	0	1.274888271	0.578973026	0.290541993	1.800809153	0.216141389	0.663693672	1.05054946	0	0.17259867	0.363919267	0	6.881352863	1.242520734	0.659848486	2.860624972	0.314652257	0.414419055	0	0	0.654048593	0	0	0.00144093	0	0	0	0	0.366194516	0.006717303	0.917486678	0	0	0	0	0	0	31.7342	NO																																																																																		0				8.9243	0.650388677	1.428082596	0	1.274888271	0.578973026	0.290541993	1.800809153	0.216141389	0.663693672	1.05054946	0	0.17259867	0.363919267	0	6.881352863	1.242520734	0.659848486	2.860624972	0.314652257	0.414419055	0	0	0.654048593	0	0	0.00144093	0	0	0	0	0.366194516	0.006717303	0.917486678	0	0	0	0	0	0	31.7342
H3359_032_0	2012	5	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	V	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	217.8642827	7.189850733	81.4134762	723.8420151	152.0484722	5.872577278	1.526187588	252.7235602	59.67062522	310.2144766	13.32418964		0.46479652	202.8043424	3995.60069	5476.96576	4.350863711	1305.749954	27.63548079	369.0768095	10.54565017			9.000995383	275	275	4.416523521				0	360.4650203	3.352259775	856.1747946	600						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 - $65; 4B Urgent Care - $0	9B ASC Services - $100	8A Outpatient Lab - $0; D/T - $0-$50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 Cardiac & Pulmonary Rehab - $0-$50; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - 0;  9A Outpatient Hospital - $100	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $15	7E Mental Health - 40%; 7H Psychiatric Services - 40%; 9C Outpatient Sub Abuse - 40%	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%		10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$100	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every 2 years	18A Hearing Exams (Routine) - $15	18B Hearing Aids - $0 ($2000 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $15	17A Eye Exams (Medicare Covered) - $0-$15	13A Accupuncture - $5						0	NO	316.9103096	623.6767486	75	0	100	0.2	0.2	65	100	50	0.108220158		0.2	75.17998456	0	15	0.4	20	0.149534175	15	0.2			0.05	0	0	15				20	20	15	15	5						NO	307.0057028	604.184568	72.65597555	0	96.87463407	0.193749268	0.193749268	62.96851215	96.87463407	48.43731704	0.104837882		0.193749268	72.83033494	0	14.53119511	0.387498536	19.37492681	0.144860685	14.53119511	0.193749268			0.05	0	0	15				19.37492681	19.37492681	14.53119511	14.53119511	5							5.5738	0.361999738	0.492931295	0	1.227470009	1.13780755	0.295697728	1.326135547	0.481714165	1.252163079	1.396879821	0	0.090053986	1.230859016	0	6.632238173	1.68595332	2.108234149	4.003294673	0.446927261	2.043212003	0	0	0.450049769	0	0	0.005520654	0	0	0	0	0.581998616	0.004059362	1.036770249	0.25	0	0	0	0	0	34.1158	0	NO	1.077756333	5.5738	0.361999738	0.492931295	0	1.227470009	1.13780755	0.295697728	1.326135547	0.481714165	1.252163079	1.396879821	0	0.090053986	1.230859016	0	6.632238173	1.68595332	2.108234149	4.003294673	0.446927261	2.043212003	0	0	0.450049769	0	0	0.005520654	0	0	0	0	0.581998616	0.004059362	1.036770249	0.25	0	0	0	0	0	34.1158	NO																																																																																		0				5.5738	0.361999738	0.492931295	0	1.227470009	1.13780755	0.295697728	1.326135547	0.481714165	1.252163079	1.396879821	0	0.090053986	1.230859016	0	6.632238173	1.68595332	2.108234149	4.003294673	0.446927261	2.043212003	0	0	0.450049769	0	0	0.005520654	0	0	0	0	0.581998616	0.004059362	1.036770249	0.25	0	0	0	0	0	34.1158
H3359_033_0	2012	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	1770.282253	230.7384231	461.4091362	1057.062974	7.072385778	12.70346353	3.313456118	18.90438828	8.221343611	4.912956313	13.57476865		0.106629317	7.835991032	4382.400237	9898.875298	614.1518096	1591.899344	3920.665138	495.5528057	13.56701806				0	0					0	746.2297205	5.624389736	1043.843484							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	8A Outpatient C/D/T - 0% Coinsurance	8B Outpatient X-Rays - 0%; Diagnostic Radiology - 0%; Therapeutic Radiology - 0%		12 Renal Dialysis - 0%	3 Cardiac & Pulmonary Rehab - 0%; 5 Partial Hosp - 0%; 9D Outpatient Blood Svcs - 0%;  9A Outpatient Hospital - 0% Coinsurance	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $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%		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - $0	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0	13B OTC Rx Card - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0	NO	100	100	48.76348056	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	94.55566195	94.55566195	46.10863184	0	0.189111324	0.094555662	0.094555662	0	0	0	0		0	0	0	0	0	0	0	0	0.189111324				0	0					0	0	0	0								13.9492	1.818135361	1.772911999	0	1.337468238	1.201184403	0.313306037	0	0	0	0	0	0	0	0	0	0	0	0	0	2.565676747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9579	0	NO	1.321871014	13.9492	1.818135361	1.772911999	0	1.337468238	1.201184403	0.313306037	0	0	0	0	0	0	0	0	0	0	0	0	0	2.565676747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9579	NO																																																																																		0				13.9492	1.818135361	1.772911999	0	1.337468238	1.201184403	0.313306037	0	0	0	0	0	0	0	0	0	0	0	0	0	2.565676747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9579
H3359_034_0	2012	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	4039.793035	173.5234702	1332.218272	4674.181536	19.70884906	36.67489471	5.754869385	21.22099755	8.276482613	11.47894482	20.18880528		42.00336385	7.121076853	4892.892182	11350.30307	538.3362722	2331.802028	6215.718784	789.5874088	14.8813459				0	0					0	1189.555952	8.490271277	1344.283635							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	8A Outpatient C/D/T - 0% Coinsurance	8B Outpatient X-Rays - 0%; Diagnostic Radiology - 0%; Therapeutic Radiology - 0%		12 Renal Dialysis - 0%	3 Cardiac & Pulmonary Rehab - 0%; 5 Partial Hosp - 0%; 9D Outpatient Blood Svcs - 0%;  9A Outpatient Hospital - 0% Coinsurance	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $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%		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - $0	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0	13B OTC Rx Card - $0; 13A Accupuncture - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0	NO	100	100	50	0	0.2	0.1	0.1	0	0	0	0		0	0	0	0	0	0	0	0	0.2				0	0					0	0	0	0							NO	100	100	50	0	0.2	0.1	0.1	0	0	0	0		0	0	0	0	0	0	0	0	0.2				0	0					0	0	0	0								33.6649	1.446028918	5.550909468	0	3.941769811	3.667489471	0.575486938	0	0	0	0	0	0	0	0	0	0	0	0	0	2.97626918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8229	0	NO	0	33.6649	1.446028918	5.550909468	0	3.941769811	3.667489471	0.575486938	0	0	0	0	0	0	0	0	0	0	0	0	0	2.97626918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8229	NO																																																																																		0				33.6649	1.446028918	5.550909468	0	3.941769811	3.667489471	0.575486938	0	0	0	0	0	0	0	0	0	0	0	0	0	2.97626918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8229
H3359_804_0	2012	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	YES	360.80855	12.64711594	15.54266511	9.307119228	10.75238935	8.005863974	2.392518033	8.942896934	27.67697491	7.328393084	16.01929071		0.90342247	6.369838831	46.69496349	101.6511523	3.512882049	5.120299825	28.74283444	39.39030363	12.44511796																				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	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 Cardiac & Pulmonary Rehab - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Outpatient Blood Svcs- Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing; 14A Medicare-covered Preventive Services - Medicare FFS Cost-Sharing; 14B Supplemental Preventive Services - Medicare FFS Cost-Sharing; 14D Kidney Disease Education Services - Medicare FFS Cost-Sharing; 14E Diabetes Self-Management Training - 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; 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		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	14C Supplemental Education/Wellness Programs  - NA												0	NO	0.0572455	0.0572455	0.148579896	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.05098733	0.05098733	0.132374945	0	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912		0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912																					18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225	0	NO	9.882580662	18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225	NO																																																																																		0				18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225
H3359_805_0	2012	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	YES	360.80855	12.64711594	15.54266511	9.307119228	10.75238935	8.005863974	2.392518033	8.942896934	27.67697491	7.328393084	16.01929071		0.90342247	6.369838831	46.69496349	101.6511523	3.512882049	5.120299825	28.74283444	39.39030363	12.44511796																				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	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 Cardiac & Pulmonary Rehab - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Outpatient Blood Svcs- Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing; 14A Medicare-covered Preventive Services - Medicare FFS Cost-Sharing; 14B Supplemental Preventive Services - Medicare FFS Cost-Sharing; 14D Kidney Disease Education Services - Medicare FFS Cost-Sharing; 14E Diabetes Self-Management Training - 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; 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		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	14C Supplemental Education/Wellness Programs  - NA												0	NO	0.0572455	0.0572455	0.148579896	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.05098733	0.05098733	0.132374945	0	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912		0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912	0.199489912																					18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225	0	NO	9.882580662	18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225	NO																																																																																		0				18.3967	0.64484267	2.057459447	0	2.144993201	1.597089097	0.477283211	1.784017719	5.521277279	1.461940489	3.195686888	0	0.180223669	1.270718586	9.315174141	20.2783794	0.700784529	1.02144816	5.733905502	7.857968191	2.482675483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1225
H3361_043_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1993.597058	554.1201764	890.2020906	1148.104515	22.68831889	7.683878446	9.829346963	15.84123616	16.30351946	1.973900873	5.685651559	2.719499694	0.400874815	8.777130887	7943.246251	97.91966194	11.29466453	19.07164012	23.23679346	38.05884397	8.594180786	0.000799764	2820	0	1020	204	0	0	2750.606596	4723.775893											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7g) 20% coinsurance; (7b) $0.00 copayment; (7f) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	"(13a) , (13b) , (13c) $0.00 copayment, (13d) $0.00 copayment"											0	NO	119.4361936	42.10374205	46.59978168	0	0.193098411	0.2	0.2	0.194366416	0.180426834	0.009157235	0.179085168	0.2	0.2	0.184946342	0	0.079191032	0.229004727	0.181870006	0.164812916	0.124473171	0.2	0.148310441	0	0	0	0	0	0	0	0											NO	117.2948285	41.34886631	45.76429669	0	0.18963636	0.196414211	0.196414211	0.190881631	0.177191971	0.008993055	0.17587436	0.196414211	0.196414211	0.181630449	0	0.07777122	0.224898914	0.178609269	0.161857994	0.122241498	0.196414211	0.145651391	0	0	0	0	0	0	0	0												19.4866	1.909353424	3.394956049	0	4.302530202	1.50922292	1.930623426	3.023800992	2.888852753	0.0177514	0.999960327	0.534148386	0.07873751	1.594194224	0	7.615331554	2.540157785	3.406371691	3.761060781	4.652370117	1.688019236	0.000116487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3341	0	NO	1.192756654	19.4866	1.909353424	3.394956049	0	4.302530202	1.50922292	1.930623426	3.023800992	2.888852753	0.0177514	0.999960327	0.534148386	0.07873751	1.594194224	0	7.615331554	2.540157785	3.406371691	3.761060781	4.652370117	1.688019236	0.000116487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3341	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	NO	0	19.4866	1.909353424	3.394956049	0	4.302530202	1.50922292	1.930623426	3.023800992	2.888852753	0.0177514	0.999960327	0.534148386	0.07873751	1.594194224	0	7.615331554	2.540157785	3.406371691	3.761060781	4.652370117	1.688019236	0.000116487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3341
H3361_059_0	2012	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	1202.822681	163.30524	498.3812019	647.947856	602.7177842	6.46764806	6.253914859	449.3899915	228.3448002	3910.2828	955.5942107	461.9538845	0.053722186	1299.542162	7130.875514	13276.61047	382.961161	1374.274643	2213.38168	4209.489721	13.92698893	0.004302589	0	630	422.4	253.44	15.6	11.88571429	2750.606596	2045.945047											6700	"(1a) $150 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $150 days 1 - 9, $0 days 10 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $100.00	(8b) Copay between $0.00 and $100.00	(9a) $100.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $100.00 , (5) $150.00 copayment , (9a) $100.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	Not Covered	"(16a) $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"	(14c) $0.00 copayment	"(13a) $10.00 copayment, (13b) $0.00 copayment"											0	NO	121.6478944	65.5896804	55.50228508	0	49.02267342	0.19998836	0.097654562	63.12712152	69.27453936	0.056314274	26.52942369	69.63755975	0.2	22.10031289	3.923940255	8.476854623	16.05902975	9.863211892	5.644297074	5.01560656	0.2	0	0	0	0	0	0	0	0	0.03141114											NO	120.3242279	64.8759906	54.89835753	0	48.48925137	0.197812261	0.09659197	62.44022715	68.52075414	0.055701511	26.2407536	68.87982446	0.197823774	21.85983652	3.881243353	8.384616872	15.88428937	9.755889007	5.582880747	4.961031096	0.197823774	0	0	0	0	0	0	0	0	0.031069351												12.0607	0.882882435	2.280025784	0	2.435444512	1.279380087	0.604077955	2.338334429	1.303863159	0.018150722	2.089626018	2.651608539	0.010627526	2.367314935	2.306388599	9.276607678	0.506922158	1.117272574	1.029753831	1.740284117	2.755089512	0	0	0	0	0	0	0	0	0.005297182	0	0	0	0	0	0	0	0	0	0	49.0597	0	NO	0.539697213	12.0607	0.882882435	2.280025784	0	2.435444512	1.279380087	0.604077955	2.338334429	1.303863159	0.018150722	2.089626018	2.651608539	0.010627526	2.367314935	2.306388599	9.276607678	0.506922158	1.117272574	1.029753831	1.740284117	2.755089512	0	0	0	0	0	0	0	0	0.005297182	0	0	0	0	0	0	0	0	0	0	49.0597	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	NO	0	12.0607	0.882882435	2.280025784	0	2.435444512	1.279380087	0.604077955	2.338334429	1.303863159	0.018150722	2.089626018	2.651608539	0.010627526	2.367314935	2.306388599	9.276607678	0.506922158	1.117272574	1.029753831	1.740284117	2.755089512	0	0	0	0	0	0	0	0	0.005297182	0	0	0	0	0	0	0	0	0	0	49.0597
H3361_065_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2023.114056	547.1627628	415.2599044	895.7453474	26.76158285	11.22911553	10.54124607	61.54100344	36.30439316	9.414123199	21.26035555	10.08229596	0.008724206	24.30928131	9115.256439	99.01498112	8.644701774	2.149626702	20.36830607	25.63868413	22.49368568	0.001261223	2820	0	422.4	253.44	0	0	2750.606596	3151.981786											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7g) 20% coinsurance; (7b) $0.00 copayment; (7f) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	"(13b) $0.00 copayment,(13c) $0.00 copayment, (13d) $0.00 copayment"											0	NO	134.1245513	56.22470734	55.74517887	0	0.19366112	0.189935461	0.2	0.193815935	0.173613828	0.010527422	0.183370089	0.2	0.2	0.176724341	0	0.091946913	0.177572786	0.186745429	0.16342753	0.087083383	0.2	0.148310441	0	0	0	0	0	0	0	0											NO	129.906572	54.45653998	53.99209184	0	0.187570821	0.183962328	0.193710355	0.187720768	0.168153981	0.010196353	0.177603424	0.193710355	0.193710355	0.171166673	0	0.089055346	0.171988436	0.180872616	0.158288024	0.084344765	0.193710355	0.143646341	0	0	0	0	0	0	0	0												21.9013	2.483049239	1.868395908	0	5.019692074	2.065734232	2.041948515	11.55252441	6.104728238	0.095989726	3.77591195	1.953045125	0.001689969	4.160938814	0	8.81781338	1.486788741	0.388808606	3.22405891	2.162488789	4.35725983	0.00018117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4624	0	NO	2.709967062	21.9013	2.483049239	1.868395908	0	5.019692074	2.065734232	2.041948515	11.55252441	6.104728238	0.095989726	3.77591195	1.953045125	0.001689969	4.160938814	0	8.81781338	1.486788741	0.388808606	3.22405891	2.162488789	4.35725983	0.00018117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4624	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	NO	0	21.9013	2.483049239	1.868395908	0	5.019692074	2.065734232	2.041948515	11.55252441	6.104728238	0.095989726	3.77591195	1.953045125	0.001689969	4.160938814	0	8.81781338	1.486788741	0.388808606	3.22405891	2.162488789	4.35725983	0.00018117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4624
H3361_098_0	2012	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	2087.999344	914.0741447	660.9275017	679.2441167	29.25656842	11.94749272	13.17046873	61.05179549	29.58673572	9.384594539	15.51771134	16.38362742	0.025145454	27.24055517	6827.927008	92.09643244	15.90427296	4.266945935	20.35107537	21.68128691	12.00350515	0.005911096	2820	0	422.4	253.44	0	0	2750.606596	3005.758501											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7g) 20% coinsurance; (7b) $0.00 copayment; (7f) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	"(13b) $0.00 copayment,(13c) $0.00 copayment, (13d) $0.00 copayment"											0	NO	121.7611876	45.03616469	46.59978168	0	0.193098411	0.2	0.2	0.194370125	0.180421092	0.009157235	0.179098145	0.2	0.2	0.183369066	0	0.08017409	0.224584545	0.1814758	0.164138455	0.110700386	0.2	0.148310441	0	0	0	0	0	0	0	0											NO	117.9424719	43.62372522	45.13830352	0	0.187042393	0.193727532	0.193727532	0.188274223	0.174762664	0.008870043	0.173481208	0.193727532	0.193727532	0.177618183	0	0.077659643	0.217541049	0.175784294	0.158990689	0.107228563	0.193727532	0.143659079	0	0	0	0	0	0	0	0												20.522	3.322943277	2.486095515	0	5.472218567	2.31455828	2.551482405	11.49447937	5.170656759	0.083241753	2.692031307	3.173959708	0.004871367	4.838417924	0	7.152176096	3.459832218	0.750062081	3.235631492	2.324853231	2.325409429	0.000849183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3758	0	NO	2.699521993	20.522	3.322943277	2.486095515	0	5.472218567	2.31455828	2.551482405	11.49447937	5.170656759	0.083241753	2.692031307	3.173959708	0.004871367	4.838417924	0	7.152176096	3.459832218	0.750062081	3.235631492	2.324853231	2.325409429	0.000849183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3758	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	NO	0	20.522	3.322943277	2.486095515	0	5.472218567	2.31455828	2.551482405	11.49447937	5.170656759	0.083241753	2.692031307	3.173959708	0.004871367	4.838417924	0	7.152176096	3.459832218	0.750062081	3.235631492	2.324853231	2.325409429	0.000849183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3758
H3361_099_0	2012	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	1831.088947	259.3139807	696.2049608	986.4167981	694.715523	7.222206654	8.839064594	614.7078309	330.4694256	5480.726182	1020.137795	356.4264639	0.280671704	1364.208564	9784.378305	17315.81664	589.6958041	210.6819548	2961.550746	5292.389983	15.67354569	0.010154755	0	0	422.4	253.44	15.6	11.88571429	2750.606596	2121.1697											6700	"(1a) $175 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $175 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) Copay between $0.00 and $125.00	(8b) Copay between $0.00 and $125.00	(9a) $125.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $125.00 , (5) $175.00 copayment , (9a) $125.00 copayment"	"(14a) , (14b) $0.00 copayment ; (7a) $10.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $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"	(14c) $0.00 copayment	"(13a) $30.00 copayment, (13b) $0.00 copayment"											0	NO	144.9606676	113.1170249	73.46430524	0	47.93515997	0.179121886	0.072584442	63.63620756	96.59604104	0.070392842	26.63570333	81.83476962	0.2	29.79086246	4.609343865	5.802691327	13.04416909	16.61349478	4.637345758	4.717565378	0.2	0	0	0	0	0	0	0	0	0.272967506											YES	142.2233671	110.9810297	72.07707463	0	47.02999765	0.175739517	0.071213826	62.43456147	94.77201256	0.06906361	26.13273985	80.28947906	0.196223389	29.22831993	4.522305365	5.69311878	12.79785531	16.29978122	4.549778497	4.628483326	0.196223389	0	0	0	0	0	0	0	0	0.267813045											6700	21.702	2.398244383	4.18170141	0	2.722705784	1.269227112	0.629463604	3.198251155	2.609937713	0.031543228	2.221582967	2.384774593	0.055074353	3.322793695	3.687328875	8.215083411	0.628903465	0.286172481	1.122866658	2.041311566	3.075516249	0	0	0	0	0	0	0	0	0.047339743	0	0	0	0	0	0	0	0	0	0	65.8318	0	NO	1.267030851	21.702	2.398244383	4.18170141	0	2.722705784	1.269227112	0.629463604	3.198251155	2.609937713	0.031543228	2.221582967	2.384774593	0.055074353	3.322793695	3.687328875	8.215083411	0.628903465	0.286172481	1.122866658	2.041311566	3.075516249	0	0	0	0	0	0	0	0	0.047339743	0	0	0	0	0	0	0	0	0	0	65.8318	YES	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	Same as in-network	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											6700	0.3655	0	0.0122	0.0046	0.0332	0.0478	0.0585	0	0.0969	0.0021	0.1643	0	0	0.0356	0	0.2244	0	0.0017	0.0397	0.0467	0.037	0	0	0	0	0	0	0	0	0											1.1701	0	NO	0.022520514	22.0675	2.398244383	4.193888253	0.00459934	2.755865256	1.31704469	0.687986252	3.198251155	2.706803649	0.03361972	2.385838033	2.384774593	0.055074353	3.358433514	3.687328875	8.439468313	0.628903465	0.287880546	1.162556349	2.088017696	3.112472803	2.62E-05	0	0	0	0	0	0	0	0.047339743	0	0	0	0	0	0	0	0	0	0	67.0019
H3361_105_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	3495.457934	597.2979034	3037.411024	3387.524008	32.05575669	14.35340877	20.18919636	15.672364	24.30879706	3.480248476	10.7508512	5.522332157	0.886849164	17.26878298	14072.40116	160.6086732	13.69595099	29.92781158	35.27285105	64.71694247	14.25774991	0.005286598	2820	0	1020	204	0	0	504	5002.668413											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7g) 20% coinsurance; (7b) $0.00 copayment; (7f) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment, (13d) $0.00 copayment"											0	NO	119.856968	48.96394644	48.4135762	0	0.19056652	0.199999507	0.2	0.193893403	0.183834949	0.009157235	0.177228961	0.2	0.2	0.185531042	0	0.075464415	0.211410054	0.182007958	0.159876443	0.124341681	0.2	0.148310441	0	0	0	0	0	0	0	0											NO	112.8671382	46.10846244	45.59018875	0	0.179453044	0.188335917	0.188336381	0.182585909	0.173114045	0.008623202	0.166893306	0.188336381	0.188336381	0.174711225	0	0.071063475	0.199081023	0.171393601	0.150552754	0.117090311	0.188336381	0.139661259	0	0	0	0	0	0	0	0												32.8769	2.295040662	11.53967849	0	5.752503102	2.703262403	3.802360184	2.861552834	4.208194189	0.030010887	1.794245098	1.040056055	0.167025962	3.017050231	0	11.41341036	2.726603937	5.129435383	5.310424851	7.57772692	2.685253023	0.000738333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9314	0	NO	6.622233378	32.8769	2.295040662	11.53967849	0	5.752503102	2.703262403	3.802360184	2.861552834	4.208194189	0.030010887	1.794245098	1.040056055	0.167025962	3.017050231	0	11.41341036	2.726603937	5.129435383	5.310424851	7.57772692	2.685253023	0.000738333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9314	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	NO	0	32.8769	2.295040662	11.53967849	0	5.752503102	2.703262403	3.802360184	2.861552834	4.208194189	0.030010887	1.794245098	1.040056055	0.167025962	3.017050231	0	11.41341036	2.726603937	5.129435383	5.310424851	7.57772692	2.685253023	0.000738333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9314
H3361_106_0	2012	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	1495.039192	226.7590868	592.0561368	764.7499431	534.0963739	1.910880622	6.566890784	281.5509859	143.1051709	826.4208232	431.0039522	89.43679535	0.326423586	629.6332422	11015.01618	16684.3687	226.7578052	967.6284253	2583.315078	5941.184545	6.514529411	1.68E-06	2750	630	422.4	253.44	15.6	11.88571429	2750.606596	4578.29165											6700	"(1a) $100 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $100 days 1 - 8, $0 days 9 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $75.00	(8b) Copay between $0.00 and $75.00	(9a) $75.00 copayment	(12) 20% coinsurance	"(3) Copay between $20.00 and $75.00 , (5) $100.00 copayment , (9a) $75.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $20.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $10.00 and $20.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment"											0	NO	73.69232467	48.23875273	56.87652091	0	46.73804775	0.178113538	0.058995778	64.30938474	66.83714993	0.042235705	13.62492416	30.15967025	0.2	11.89545081	0	2.796087775	4.077772657	4.304546907	9.906366032	6.568303358	0.2	0	0	0	0	0	0	0	0	0											YES	73.22933756	47.9356829	56.51918253	0	46.4444064	0.176994503	0.058625125	63.90534788	66.41723186	0.041970351	13.53932279	29.97018595	0.198743459	11.82071521	0	2.778520782	4.052153216	4.277502711	9.844127261	6.527036648	0.198743459	0	0	0	0	0	0	0	0	0											6700	9.1234	0.905820973	2.788544072	0	2.067149087	0.338215366	0.384984794	1.499384475	0.79205411	0.002890431	0.486291803	0.223369782	0.064874553	0.62022627	0	3.863155431	0.076571447	0.344919434	2.119206865	3.231527438	1.294720109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2273	0	NO	0.191109886	9.1234	0.905820973	2.788544072	0	2.067149087	0.338215366	0.384984794	1.499384475	0.79205411	0.002890431	0.486291803	0.223369782	0.064874553	0.62022627	0	3.863155431	0.076571447	0.344919434	2.119206865	3.231527438	1.294720109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2273	YES	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	Same as in-network	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											6700	0.3718	0	0.0097	0.0028	0.0252	0.0128	0.044	0	0.0472	0.0003	0.0762	0	0	0.0133	0	0.1846	0	0.006	0.0529	0.0576	0.0156	0	0	0	0	0	0	0	0	0											0.9202	0	NO	0.005817621	9.4952	0.905820973	2.798205218	0.002828701	2.092343653	0.351029619	0.429021977	1.499384475	0.839288499	0.003228861	0.562538478	0.223369782	0.064874553	0.633573481	0	4.047768106	0.076571447	0.350931312	2.172093702	3.289112933	1.310277951	4.39E-09	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1475
H3361_109_0	2012	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	Coin	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	1573.217321	383.6693179	613.7720979	1178.091043	14.28557296	2.94752174	8.870315964	11.20863945	16.7717941	1.072365076	5.153896635	3.990394378	0.457900929	6.35825591	13105.59526	86.56189944	6.867836187	7.249015272	18.69673841	48.91960976	4.31199422	0.001542491	2820	0	1020	204	0	0	2750.606596	7889.981198											6700	Medicare FFS	Medicare FFS	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) Coin between 0% and 20%	(8b) 20% coinsurance	(9a) 20% coinsurance	(12) 20% coinsurance	"(3) , (9a) 20% coinsurance ; (5) 40% coinsurance"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7g) 20% coinsurance; (7b) $0.00 copayment; (7f) $0.00 copayment"	"(7e) , (7h) 40% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) , (12) 20% coinsurance, (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	(14c) $0.00 copayment	"(13a) , (13b) , (13c) $0.00 copayment, (13d) $0.00 copayment"											0	NO	135.6347887	53.2842779	60.42406549	0	0.19286195	0.192163839	0.2	0.194370079	0.187605046	0.006094917	0.177679411	0.199412128	0.2	0.189374982	0	0.084887654	0.057151262	0.181285723	0.16028706	0.114874962	0.2	0.148310441	0	0	0	0	0	0	0	0											NO	133.9359236	52.61687683	59.6672365	0	0.190446298	0.189756931	0.197494942	0.191935537	0.185255238	0.006018577	0.175453924	0.196914433	0.197494942	0.187003005	0	0.083824412	0.056435425	0.179015066	0.158279418	0.11343612	0.197494942	0.14645281	0	0	0	0	0	0	0	0												17.5592	1.682290104	3.05184041	0	2.720634482	0.559312679	1.751842536	2.151336236	3.10706271	0.006454111	0.90427139	0.785766245	0.090433117	1.189012963	0	7.256000288	0.387589257	1.29768295	2.959308878	5.549250722	0.851597048	0.000225902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8611	0	NO	0.683183064	17.5592	1.682290104	3.05184041	0	2.720634482	0.559312679	1.751842536	2.151336236	3.10706271	0.006454111	0.90427139	0.785766245	0.090433117	1.189012963	0	7.256000288	0.387589257	1.29768295	2.959308878	5.549250722	0.851597048	0.000225902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8611	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	NO	0	17.5592	1.682290104	3.05184041	0	2.720634482	0.559312679	1.751842536	2.151336236	3.10706271	0.006454111	0.90427139	0.785766245	0.090433117	1.189012963	0	7.256000288	0.387589257	1.29768295	2.959308878	5.549250722	0.851597048	0.000225902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8611
H3361_129_0	2012	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	1613.153352	108.7180169	614.1022508	823.0682672	616.1542776	8.212727077	8.424095333	640.8632063	291.3121576	5606.443139	1164.898647	74.36520953	0.209780061	1894.381484	7255.249157	13869.80869	422.1354593	2558.256757	2902.668919	4356.533388	14.92652166	0.009855659	2820	424.2857143	422.4	253.44	15.6	11.88571429	2750.606596	2052.851834											6700	"(1a) $100 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $100 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) Copay between $0.00 and $75.00	(8b) Copay between $0.00 and $75.00	(9a) $75.00 copayment	(12) 20% coinsurance	"(3) Copay between $35.00 and $75.00 , (5) $100.00 copayment , (9a) $75.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $35.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $25.00 and $35.00"	"(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 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $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"	(14c) $0.00 copayment	"(13a) $30.00 copayment, (13b) $0.00 copayment"											0	NO	58.43034996	27.92185559	45.17415402	0	48.90055332	0.2	0.108554027	62.3147134	60.6935092	0.042235705	15.35082237	47.18812116	0.2	19.96551155	0	8.879791122	21.62696261	9.510068831	6.342543091	6.053324208	0.2	0	0	0	0	0	0	0	0	0.194850887											YES	57.84875194	27.64392989	44.72450417	0	48.41381201	0.198009261	0.107473513	61.6944516	60.08938438	0.041815304	15.19802493	46.71842489	0.198009261	19.76678089	0	8.791404369	21.41169437	9.415408484	6.279411337	5.993071252	0.198009261	0	0	0	0	0	0	0	0	0.1929114											6700	7.7766	0.250449436	2.28878489	0	2.485864781	1.626196016	0.905367121	3.294808672	1.458730685	0.01953626	1.475346557	0.289518788	0.041538395	3.12048531	0	10.16125806	0.75321962	2.007252698	1.51892101	2.175751251	2.955589515	0	0	0	0	0	0	0	0	0.033001543	0	0	0	0	0	0	0	0	0	0	44.6382	0	NO	0.448782134	7.7766	0.250449436	2.28878489	0	2.485864781	1.626196016	0.905367121	3.294808672	1.458730685	0.01953626	1.475346557	0.289518788	0.041538395	3.12048531	0	10.16125806	0.75321962	2.007252698	1.51892101	2.175751251	2.955589515	0	0	0	0	0	0	0	0	0.033001543	0	0	0	0	0	0	0	0	0	0	44.6382	YES	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	Same as in-network	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											6700	0.3521	0	0.009	0.0039	0.0328	0.0549	0.0563	0	0.1159	0.0023	0.1422	0	0	0.0366	0	0.2159	0	0.0141	0.0581	0.0467	0.0355	0	0	0	0	0	0	0	0	0											1.1765	0	NO	0.011828108	8.1287	0.250449436	2.297783658	0.003931536	2.518700438	1.681066625	0.961649917	3.294808672	1.574639315	0.021881533	1.617536863	0.289518788	0.041538395	3.15712706	0	10.3771537	0.75321962	2.021362069	1.576986991	2.222471945	2.991104985	2.57E-05	0	0	0	0	0	0	0	0.033001543	0	0	0	0	0	0	0	0	0	0	45.8147
H3361_130_0	2012	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	1916.89538	200.2751936	994.9098717	1070.043709	416.0077848	5.503772467	8.02251414	251.6339659	170.6100588	1334.877691	513.7450421	65.56685884	0.098088112	694.1506318	6928.810273	18183.68617	924.819651	5594.130968	2843.546541	5338.523166	9.56340103	0.000725278	2820	630	1020	204	15.6	11.88571429	2750.606596	4201.535893											6700	"(1a) $100 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $100 days 1 - 5, $0 days 6 - 90"	"(2) $0 days 1 - 20, $146 days 21 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $65.00 copayment , (4b) $35.00 copayment"	"(9a) $50.00 copayment , (9b) $25.00 copayment"	(8a) Copay between $0.00 and $50.00	(8b) Copay between $0.00 and $50.00	(9a) $50.00 copayment	(12) 20% coinsurance	"(3) Copay between $10.00 and $50.00 , (5) $100.00 copayment , (9a) $50.00 copayment"	"(7a) , (14a) , (14b) $0.00 copayment"	"(7d), (7f), (7g) $10.00 copayment; (7b) $0.00 copayment"	"(7e) , (7h) Copay between $5.00 and $10.00"	"(7c) , (7i) $10.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $10.00 copayment , (8a) Copay between $20.00 and $50.00 , (12) 20% coinsurance , (14a) $0.00 copayment"	(15) 20% coinsurance	(9d) $0.00 copayment	(10b) $0.00 copayment	"(16a) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14c) $0.00 copayment	"(13a) $0.00 copayment, (13b) $0.00 copayment"											0	NO	53.54706147	21.66276841	45.17415402	0	48.90055332	0.2	0.115485367	64.24440774	39.221988	0.028157137	10.79932359	31.45874744	0.2	7.663070422	0	2.439728933	6.208582014	2.719190739	6.530664211	6.241573335	0.2	0	0	0	0	0	0	0	0	0											NO	53.21440403	21.52818996	44.8935127	0	48.59676199	0.198757514	0.114767922	63.84529378	38.9783241	0.027982213	10.73223353	31.26331214	0.198757514	7.615464124	0	2.424572285	6.170011626	2.702297953	6.490092909	6.20279799	0.198757514	0	0	0	0	0	0	0	0	0												8.5005	0.359296868	3.722083247	0	1.684719275	1.093916132	0.92072728	1.338803707	0.554174514	0.003112736	0.459469314	0.170819764	0.019495749	0.440523269	0	3.673971793	0.475512333	1.259750722	1.53790677	2.759481731	1.900797812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8751	0	NO	0.193008487	8.5005	0.359296868	3.722083247	0	1.684719275	1.093916132	0.92072728	1.338803707	0.554174514	0.003112736	0.459469314	0.170819764	0.019495749	0.440523269	0	3.673971793	0.475512333	1.259750722	1.53790677	2.759481731	1.900797812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8751	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	NO	0	8.5005	0.359296868	3.722083247	0	1.684719275	1.093916132	0.92072728	1.338803707	0.554174514	0.003112736	0.459469314	0.170819764	0.019495749	0.440523269	0	3.673971793	0.475512333	1.259750722	1.53790677	2.759481731	1.900797812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8751
H3362_003_0	2012	7																															A	A	D		T	Coin	Coin	V	V		V	V		V	V	V	V	V	V	V	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	0											0	YES	176.0616586	1.475377027	1261.644074	0	168.7608291	5.144497197	0.501085701	311.2415846	336.2533119	0	556.0427899	0.198926597	0	325.1010786	4060.432474	4880.423646	237.452621	1207.702889	1096.917907	702.8930524	1106.90726	0	0	1.413422068	0	0	20.070552	0	0	0											3400	$425/Admit for IP Med/Surg; PBP 1a	$425/Admit for IP MH/SA; PBP 1b	$40/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$25/Case for OP Rad - General; $50/Case for OP Rad - Complex Diagnostic; $25/Case for OP Rad - X-Ray; $25/Case for OP Rad - Therapeutic; PBP 8b	$40/Case for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$10/Case for CORF; $10/Case for OP - Preventive; $25/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-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, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST; $10/Visit for PT/ST; PBP 7c, 7i"	$25/Case for Phys Rad - General; $50/Case for Phys Rad - Complex Diagnostic; $25/Case for Phys Rad - X-Ray; $25/Case for Phys Rad - Therapeutic; PBP 7d	"$10/Visit for PCP - Facility Visit; $25/Visit for SCP - Facility Visit; $25/Case for SCP - IP/OP Surg; $25/Case for SCP - Other; $10/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $75/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	No Cost Sharing; PBP 10b	"$25/Procedure for Comprehensive Dental (non-cvd); PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$25/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	425	425	40	0	100	0.25	0.237459057	49.9803737	100	0	32.50171256	40	0	27.63758744	10	24.70973779	40	10	30.71136394	24.89988012	51.89838806	0	0	25	0	0	25	0	0	0											NO	418.3709498	418.3709498	39.37608939	0	98.44022348	0.246100559	0.233755226	49.20079157	98.44022348	0	31.99475848	39.37608939	0	27.20650284	9.844022348	24.3243211	39.37608939	9.844022348	30.2323353	24.51149764	51.08888919	0	0	24.61005587	0	0	24.61005587	0	0	0												6.1383	0.051437907	4.139884153	0	1.384404477	1.266063635	0.117131402	1.276111027	2.758404264	0	1.482537897	0.000652746	0	0.737071952	3.330915668	9.892749323	0.779162969	0.990721186	2.763532498	1.435746783	4.712555196	0	0	0.0028987	0	0	0.041161451	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3014	0	NO	0.686106804	6.1383	0.051437907	4.139884153	0	1.384404477	1.266063635	0.117131402	1.276111027	2.758404264	0	1.482537897	0.000652746	0	0.737071952	3.330915668	9.892749323	0.779162969	0.990721186	2.763532498	1.435746783	4.712555196	0	0	0.0028987	0	0	0.041161451	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.1383	0.051437907	4.139884153	0	1.384404477	1.266063635	0.117131402	1.276111027	2.758404264	0	1.482537897	0.000652746	0	0.737071952	3.330915668	9.892749323	0.779162969	0.990721186	2.763532498	1.435746783	4.712555196	0	0	0.0028987	0	0	0.041161451	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3014
H3362_016_0	2012	2																															A	A	D		T	Coin	Coin	V	V		V			V	V	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	147.7527713	0.257409009	919.4257904	0	124.1165163	3.460508792	0.498574149	229.4253035	286.4546065	0	397.5395566	0	0	209.0080992	3194.313914	4206.727461	60.48092192	921.0584705	777.3315482	702.8846733	752.3471387	0	0	0	0	0	15.8701805	0	0	0											3400	$425/Admit for IP Med/Surg; PBP 1a	$425/Admit for IP MH/SA; PBP 1b	$40/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$25/Case for OP Rad - General; $75/Case for OP Rad - Complex Diagnostic; $25/Case for OP Rad - X-Ray; $25/Case for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$10/Case for OP - Preventive; $30/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-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, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST; $10/Visit for PT/ST; PBP 7c, 7i"	$25/Case for Phys Rad - General; $75/Case for Phys Rad - Complex Diagnostic; $25/Case for Phys Rad - X-Ray; $25/Case for Phys Rad - Therapeutic; PBP 7d	"$10/Visit for PCP - Facility Visit; $25/Visit for SCP - Facility Visit; $25/Case for SCP - IP/OP Surg; $25/Case for SCP - Other; $10/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $75/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$10/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	425	425	40	0	100	0.25	0.244103699	49.97521161	100	0	37.114261	0	0	30.13297248	10	24.74116259	40	10	34.62606943	24.91590706	52.26070719	0	0	0	0	0	10	0	0	0											NO	420.7272936	420.7272936	39.59786293	0	98.99465731	0.247486643	0.241649621	49.47278948	98.99465731	0	36.74113549	0	0	29.83003285	9.899465731	24.49242913	39.59786293	9.899465731	34.27795877	24.66541681	51.73530799	0	0	0	0	0	9.899465731	0	0	0												5.1803	0.009024916	3.033941368	0	1.023905999	0.856429705	0.120480254	0.945859145	2.363122967	0	1.217171226	0	0	0.519559872	2.635166761	8.586081183	0.199576271	0.75983223	2.220444897	1.444745286	3.243575911	0	0	0	0	0	0.013092192	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3723	0	NO	0.349068865	5.1803	0.009024916	3.033941368	0	1.023905999	0.856429705	0.120480254	0.945859145	2.363122967	0	1.217171226	0	0	0.519559872	2.635166761	8.586081183	0.199576271	0.75983223	2.220444897	1.444745286	3.243575911	0	0	0	0	0	0.013092192	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3723	NO																																										0	0	0	0	0	0	0	0	0	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	5.1803	0.009024916	3.033941368	0	1.023905999	0.856429705	0.120480254	0.945859145	2.363122967	0	1.217171226	0	0	0.519559872	2.635166761	8.586081183	0.199576271	0.75983223	2.220444897	1.444745286	3.243575911	0	0	0	0	0	0.013092192	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3723
H3362_017_0	2012	6																															A	A	D		T	Coin	Coin	V	V		V	V		V	V	V	V	V	V	V	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	0											0	YES	99.42825495	1.486777644	394.4632449	0	94.50276533	3.451699619	0.557621998	206.2187533	253.1927175	0	343.6902319	1.809563916	0	227.9870072	2800.305279	3693.453935	281.2547857	888.3780205	827.397853	565.0925828	585.5846907	0	0	0	0	0	18.05635972	0	0	0											3400	$600/Admit for IP Med/Surg; PBP 1a	$600/Admit for IP MH/SA; PBP 1b	$45/Day for SNF (Days 1-100); PBP 2	No Cost Sharing; PBP 6	$180/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 10% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $35/Case for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $125/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for OP Rad - General; $75/Case for OP Rad - Complex Diagnostic; $30/Case for OP Rad - X-Ray; $30/Case for OP Rad - Therapeutic; PBP 8b	$40/Case for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$15/Case for OP - Preventive; $30/Case for OP - Other; 45% Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $20/Visit for Chiro (non-cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	$30/Case for Phys Rad - General; $75/Case for Phys Rad - Complex Diagnostic; $30/Case for Phys Rad - X-Ray; $30/Case for Phys Rad - Therapeutic; PBP 7d	"$15/Visit for PCP - Facility Visit; $30/Visit for SCP - Facility Visit; $30/Case for SCP - IP/OP Surg; $30/Case for SCP - Other; $15/Case for Diabetes Monitoring; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $80/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"$30/Procedure for Comprehensive Dental (non-cvd); PBP 16a, 16b"	No Cost Sharing; 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 14c	PBP 13a-e											0	NO	600	600	45	0	180	0.3	0.294901366	64.9402066	125	0	41.27005933	40	0	32.09820377	15	29.39542663	40	20	38.23323509	29.8503848	51.99953124	0	0	0	0	0	15	0	0	0											NO	593.5688932	593.5688932	44.51766699	0	178.070668	0.296784447	0.291740463	64.2376903	123.6601861	0	40.82770573	39.57125955	0	31.75415881	14.83922233	29.08035142	39.57125955	19.78562977	37.82343173	29.53043311	51.44217368	0	0	0	0	0	14.83922233	0	0	0												4.9181	0.07354208	1.463381948	0	1.402347545	1.024410761	0.1626809	1.103918034	2.60915488	0	1.169340304	0.005967227	0	0.603294636	3.462862719	8.950578199	0.927467177	1.464759884	2.60791885	1.39061906	2.510312447	0	0	0	0	0	0.022328528	0	0	0	0	0	0	0	0	0	0	0	0	0	35.873	0	NO	0.386523834	4.9181	0.07354208	1.463381948	0	1.402347545	1.024410761	0.1626809	1.103918034	2.60915488	0	1.169340304	0.005967227	0	0.603294636	3.462862719	8.950578199	0.927467177	1.464759884	2.60791885	1.39061906	2.510312447	0	0	0	0	0	0.022328528	0	0	0	0	0	0	0	0	0	0	0	0	0	35.873	NO																																										0	0	0	0	0	0	0	0	0	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	4.9181	0.07354208	1.463381948	0	1.402347545	1.024410761	0.1626809	1.103918034	2.60915488	0	1.169340304	0.005967227	0	0.603294636	3.462862719	8.950578199	0.927467177	1.464759884	2.60791885	1.39061906	2.510312447	0	0	0	0	0	0.022328528	0	0	0	0	0	0	0	0	0	0	0	0	0	35.873
H3362_020_0	2012	5																															A				T	Coin	Coin	V	V												O																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	253.3217798	0	0	0	424.2609756	6.27899413	0.027260167	128.3431516	90.45827823	0	0	0	0	0	0	0	0	0	0	0	544.2497976	0	0	0	0	0	0	0	0	0											3400	$100/Admit for IP Med/Surg; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$25/Trip for Ambulance; PBP 10a	15% Coinsurance for DME; PBP 11a	"15% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Case for OP ER; PBP 4a, 4b"	"$50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"No Cost Sharing; PBP 7b, 7d, 7f, 14a, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7d, 14d, 14e"	$50/Visit for Part B Drugs - Gen; $50/Visit for Part B Drugs - Chemo; $50/Visit for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	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	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	100	0	0	0	25	0.15	0.15	50	50	0	0	0	0	0	0	0	0	0	0	0	50	0	0	0	0	0	0	0	0	0											NO	99.99008967	0	0	0	24.99752242	0.149985135	0.149985135	49.99504483	49.99504483	0	0	0	0	0	0	0	0	0	0	0	49.99504483	0	0	0	0	0	0	0	0	0												2.1108	0	0	0	0.883789437	0.941755779	0.00408862	0.534710135	0.37687214	0	0	0	0	0	0	0	0	0	0	0	2.267482753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1195	0	NO	0.000705636	2.1108	0	0	0	0.883789437	0.941755779	0.00408862	0.534710135	0.37687214	0	0	0	0	0	0	0	0	0	0	0	2.267482753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1195	NO																																										0	0	0	0	0	0	0	0	0	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	2.1108	0	0	0	0.883789437	0.941755779	0.00408862	0.534710135	0.37687214	0	0	0	0	0	0	0	0	0	0	0	2.267482753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1195
H3362_801_0	2012	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	253.0732658	2.025179595	27.1619861	0	9.122898832	9.222293516	4.998524604	17.69593933	75.62480979	6.862312715	13.54885396	0.094453696	0.132126168	6.826755457	31.80344914	59.61544234	2.41425553	7.062096475	45.54066582	117.0641573	79.81476736	0.791440201	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090935693	0.090935693	0.179303892	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081701951	0.081701951	0.161097116	0	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0.201254716	0	0	0	0	0	0	0	0												20.6766	0.165461125	4.375717612	0	1.836026414	1.856030062	1.00597665	3.561391245	15.21984962	1.381072797	2.726770757	0.019009252	0.026591014	1.373916731	6.400594124	11.99788892	0.485880311	1.421280221	9.165273767	23.55971372	16.06309834	0.159281073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4774	0	NO	13.95509462	20.6766	0.165461125	4.375717612	0	1.836026414	1.856030062	1.00597665	3.561391245	15.21984962	1.381072797	2.726770757	0.019009252	0.026591014	1.373916731	6.400594124	11.99788892	0.485880311	1.421280221	9.165273767	23.55971372	16.06309834	0.159281073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4774	NO																																										0	0	0	0	0	0	0	0	0	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	20.6766	0.165461125	4.375717612	0	1.836026414	1.856030062	1.00597665	3.561391245	15.21984962	1.381072797	2.726770757	0.019009252	0.026591014	1.373916731	6.400594124	11.99788892	0.485880311	1.421280221	9.165273767	23.55971372	16.06309834	0.159281073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4774
H3362_807_0	2012	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	269.0154547	2.272984606	37.7466665	0	8.059064184	8.088004253	4.485466505	16.27494226	74.89485675	8.960989166	14.86932173	0	0.282196133	9.317427339	28.96747593	54.19183802	1.648439146	6.287252519	42.45348812	109.3107393	95.35747148	0.768251171	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090833563	0.090833563	0.179604629	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080723453	0.080723453	0.159613973	0	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0.199067976	0	0	0	0	0	0	0	0												21.7159	0.183483167	6.024895394	0	1.604301593	1.610062634	0.892912737	3.23981981	14.90916752	1.783845974	2.960005777	0	0.056176213	1.854801399	5.766496794	10.78785949	0.328151444	1.251590632	8.451129942	21.76026759	18.98261881	0.152934205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3164	0	NO	15.56985214	21.7159	0.183483167	6.024895394	0	1.604301593	1.610062634	0.892912737	3.23981981	14.90916752	1.783845974	2.960005777	0	0.056176213	1.854801399	5.766496794	10.78785949	0.328151444	1.251590632	8.451129942	21.76026759	18.98261881	0.152934205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3164	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e												1.2861	0.0109	0.3568	0	0.095	0.0954	0.0529	0.1919	0.883	0.1056	0.1753	0	0.0033	0.1098	0.3415	0.6389	0.0194	0.0741	0.5005	1.2887	1.1242	0.0091	0	0	0	0	0	0	0	0											7.3624	0	NO	0	23.0019	0.194349656	6.381709921	0	1.699313718	1.705415947	0.945794027	3.431692813	15.79213847	1.88949132	3.135307254	0	0.059503157	1.964648964	6.108008089	11.42675274	0.347585674	1.32571403	8.951634223	23.04898368	20.10683322	0.161991482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6788
H3362_817_0	2012	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	269.0169564	2.272984606	37.7466665	0	8.059064184	8.088004253	4.485466505	16.27494226	74.89485675	8.960989166	14.86932173	0	0.282196133	9.317427339	28.96747593	54.19247083	1.648439146	6.287252519	42.45348812	109.3132793	95.35747148	0.768431905	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090833563	0.090833563	0.179604629	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080723375	0.080723375	0.159613817	0	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0.199067781	0	0	0	0	0	0	0	0												21.716	0.183482988	6.024889514	0	1.604300028	1.610061063	0.892911866	3.239816648	14.90915297	1.783844233	2.960002888	0	0.056176158	1.854799589	5.766491166	10.78797494	0.328151124	1.25158941	8.451121695	21.76075199	18.98260029	0.152970035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.317	0	NO	15.57007225	21.716	0.183482988	6.024889514	0	1.604300028	1.610061063	0.892911866	3.239816648	14.90915297	1.783844233	2.960002888	0	0.056176158	1.854799589	5.766491166	10.78797494	0.328151124	1.25158941	8.451121695	21.76075199	18.98260029	0.152970035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.317	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e												1.2861	0.0109	0.3568	0	0.095	0.0954	0.0529	0.1919	0.883	0.1056	0.1753	0	0.0033	0.1098	0.3415	0.6389	0.0194	0.0741	0.5005	1.2887	1.1242	0.0091	0	0	0	0	0	0	0	0											7.3625	0	NO	0	23.002	0.194349477	6.381704042	0	1.699312153	1.705414376	0.945793155	3.431689652	15.79212392	1.889489579	3.135304366	0	0.059503102	1.964647154	6.108002462	11.42687565	0.347585354	1.325712808	8.951625976	23.04949802	20.10681469	0.162029442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6795
H3362_819_0	2012	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	210.2005625	1.390646561	29.43392685	0	6.144271146	8.033586224	4.044401243	14.00798446	73.99427724	7.18709431	11.40967039	0	0.200104339	6.936814169	26.10402394	49.64055397	1.374882395	5.454550404	37.52217788	100.0807191	77.17084398	0.754513702	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090955748	0.090955748	0.179243392	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.08280726	0.08280726	0.163185445	0	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0.203932425	0	0	0	0	0	0	0	0												17.4061	0.115155631	4.803188442	0	1.253016113	1.638308718	0.824784552	2.856682235	15.08983237	1.465681569	2.326801747	0	0.040807763	1.414641333	5.323456897	10.12331853	0.2803831	1.112359689	7.651988715	20.40970371	15.73763733	0.153869809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0278	0	NO	10.82706774	17.4061	0.115155631	4.803188442	0	1.253016113	1.638308718	0.824784552	2.856682235	15.08983237	1.465681569	2.326801747	0	0.040807763	1.414641333	5.323456897	10.12331853	0.2803831	1.112359689	7.651988715	20.40970371	15.73763733	0.153869809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0278	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e												0.7902	0.0067	0.2179	0	0.0581	0.0583	0.0324	0.1174	0.5402	0.0646	0.1073	0	0.002	0.0672	0.2089	0.3933	0.0119	0.0454	0.3062	0.798	0.6878	0.0062	0	0	0	0	0	0	0	0											4.5201	0	NO	0	18.1963	0.121812857	5.021084172	0	1.311147423	1.696648777	0.857138934	2.97407598	15.63006087	1.530318608	2.434056527	0	0.042843289	1.481849417	5.532403903	10.51659016	0.292273554	1.157710641	7.95821247	21.20771779	16.42546592	0.160090294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5478
H3362_820_0	2012	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	253.0741108	2.025179595	27.1619861	0	9.122898832	9.222293516	4.998524604	17.69593933	75.62480979	6.862312715	13.54885396	0.094453696	0.132126168	6.826755457	31.80344914	59.61579837	2.41425553	7.062096475	45.54066582	117.0655863	79.81476736	0.791541887	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.090935693	0.090935693	0.179303892	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081701903	0.081701903	0.16109702	0	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0.201254597	0	0	0	0	0	0	0	0												20.6766	0.165461027	4.37571502	0	1.836025326	1.856028963	1.005976054	3.561389136	15.2198406	1.381071979	2.726769142	0.01900924	0.026590999	1.373915917	6.400590333	11.99795346	0.485880023	1.421279379	9.165268338	23.55998738	16.06308882	0.159301443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4778	0	NO	13.95521849	20.6766	0.165461027	4.37571502	0	1.836025326	1.856028963	1.005976054	3.561389136	15.2198406	1.381071979	2.726769142	0.01900924	0.026590999	1.373915917	6.400590333	11.99795346	0.485880023	1.421279379	9.165268338	23.55998738	16.06308882	0.159301443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4778	NO																																										0	0	0	0	0	0	0	0	0	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	20.6766	0.165461027	4.37571502	0	1.836025326	1.856028963	1.005976054	3.561389136	15.2198406	1.381071979	2.726769142	0.01900924	0.026590999	1.373915917	6.400590333	11.99795346	0.485880023	1.421279379	9.165268338	23.55998738	16.06308882	0.159301443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4778
H3370_001_0	2012	9	H.6										OP Facility - Other										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	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	YES	2143.991969	69.83673299	1410.848293	1910.710026	278.5094671	7.799165526	13.00260878	204.4810674	235.8809257	11442.27283	273.0522423	3.601166287	0.35027044	314.6459008	5878.617796	5645.593019	4.254174643	1702.944271	1852.359972	3670.40334	50.08200194	20.3735268	0	651.8173813	293	293	162	10.8	5872.8	602.510876	22.77484788	0	0	0	0	0	0	0	0	0	2800	1A: $125/day (days1-7) no yrly max	1B: $125/day (days1-7) no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $210 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $65 copay; 4B: $20 copay	9A: $0 - $125 copay; 9B: $125 copay	8A: $0 copay	8B: $105 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $20 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $25 copay; 7I: $25 copay	8B: $35 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not Covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $200 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not Covered: 7F: $20 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	83.88301894	54.67318265	60	0	210	0.2	0.173628377	64.298451	116.8107525	0	105	40	0.1	26.00362771	0	20	40	25	35	8.718436113	0.2	0	0	0	0	0	0	0	0	17.07982151	0.2	0	0	0	0	0	0	0	0	0	NO	75.2219714	49.02809452	53.80490999	0	188.317185	0.1793497	0.155700986	57.65953947	104.749867	0	94.15859249	35.86993999	0.08967485	23.31871414	0	17.93497	35.86993999	22.4187125	31.3861975	7.818244505	0.1793497	0	0	0	0	0	0	0	0	17.07982151	0.1793497	0	0	0	0	0	0	0	0	0		13.4396	0.285330162	6.325880451	0	4.370676569	1.398777997	2.024519013	0.982523681	2.0590413	0	2.142517901	0.010764468	0.031410449	0.611428151	0	8.437795117	0.012716416	3.181484834	4.844877993	2.391342562	8.982192022	0	0	0	0	0	0	0	0	0.857564851	4.084662133	0	0	0	0	0	0	0	0	0	66.4751		NO	7.555195744	13.4396	0.285330162	6.325880451	0	4.370676569	1.398777997	2.024519013	0.982523681	2.0590413	0	2.142517901	0.010764468	0.031410449	0.611428151	0	8.437795117	0.012716416	3.181484834	4.844877993	2.391342562	8.982192022	0	0	0	0	0	0	0	0	0.857564851	4.084662133	0	0	0	0	0	0	0	0	0	66.4751	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	13.4396	0.285330162	6.325880451	0	4.370676569	1.398777997	2.024519013	0.982523681	2.0590413	0	2.142517901	0.010764468	0.031410449	0.611428151	0	8.437795117	0.012716416	3.181484834	4.844877993	2.391342562	8.982192022	0	0	0	0	0	0	0	0	0.857564851	4.084662133	0	0	0	0	0	0	0	0	0	66.4751
H3370_002_0	2012	8	H.6										OP Facility - Other										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	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	YES	2368.173486	42.59729391	2015.645832	1953.057782	321.1028296	7.097132286	6.902640771	285.015651	263.1290745	18905.92965	415.9350797	1.489720608	0.059717601	189.6485667	4940.578431	5802.49307	2.200003118	1899.278882	1641.814752	3635.208909	51.93246697	23.30995235	0	651.8173813	293	293	162	10.8	5872.8	535.3052209	20.31311415	0	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: $50/day (for days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $30 copay	9A: $0 - $300 copay; 9B: $300 copay	8A: $0 copay	8B: $105 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $30 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $35 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not Covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $130 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not Covered: 7F: $30 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	140.0027185	106.2972292	50	0	200	0.2	0.148467313	49.5058204	281.9686411	0	105	40	0.1	27.2023531	15	29.74354733	40	35	35	10.84028011	0.2	0	0	0	0	0	0	0	0	24.31053428	0.2	0	0	0	0	0	0	0	0	0	NO	123.7204151	93.93487114	44.18500455	0	176.7400182	0.176740018	0.131200578	43.74829799	249.1757138	0	92.78850956	35.34800364	0.088370009	24.03872191	13.25550137	26.28437548	35.34800364	30.92950319	30.92950319	9.579556521	0.176740018	0	0	0	0	0	0	0	0	24.31053428	0.176740018	0	0	0	0	0	0	0	0	0		24.416	0.333447609	7.421776689	0	4.729309995	1.254347289	0.905630462	1.039079136	5.463781246	0	3.216166343	0.004388221	0.005277245	0.379909096	5.457487012	12.70957555	0.006480477	4.895312687	4.231709551	2.901974101	9.178545157	0	0	0	0	0	0	0	0	1.084462993	3.590140165	0	0	0	0	0	0	0	0	0	93.2248		NO	12.12618091	24.416	0.333447609	7.421776689	0	4.729309995	1.254347289	0.905630462	1.039079136	5.463781246	0	3.216166343	0.004388221	0.005277245	0.379909096	5.457487012	12.70957555	0.006480477	4.895312687	4.231709551	2.901974101	9.178545157	0	0	0	0	0	0	0	0	1.084462993	3.590140165	0	0	0	0	0	0	0	0	0	93.2248	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	24.416	0.333447609	7.421776689	0	4.729309995	1.254347289	0.905630462	1.039079136	5.463781246	0	3.216166343	0.004388221	0.005277245	0.379909096	5.457487012	12.70957555	0.006480477	4.895312687	4.231709551	2.901974101	9.178545157	0	0	0	0	0	0	0	0	1.084462993	3.590140165	0	0	0	0	0	0	0	0	0	93.2248
H3370_003_0	2012	8	H.6										OP Facility - Other										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	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	YES	2249.238493	38.64372426	1656.426656	1723.579987	202.3846424	7.898337067	14.20681195	239.3584957	274.9529252	12689.31418	209.4026946	3.362991479	0	231.9986471	4575.159465	6116.552744	5.450316142	1751.813528	2199.069749	3549.945122	58.38652523	23.84824901	0	651.8173813	293	293	0	0	5872.8	666.8141986	32.47373425	0	0	0	0	0	0	0	0	0	3400	1A: $225/day (days1-7) no yrly max	1B: $200/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: 10% coin	4A: $50 copay; 4B: $35 copay	9A: $0 - $225 copay; 9B: $225 copay	8A: $0 copay	8B: $105 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $35 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $40 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $130 Hardware Per Yr"	N/A	N/A	14C: Silver Sneakers	7B: Not Covered: 7F: $35 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	159.1669272	96.80365297	50	0	225	0.2	0.175287349	49.98885204	211.4483388	0	105	40	0.1	35.56774972	25	34.59437676	40	35	40	16.13525263	0.2	0	0	0	0	0	0	0	0	28.40840304	0.2	0	0	0	0	0	0	0	0	0	NO	138.5786899	84.28210334	43.53250149	0	195.8962567	0.174130006	0.152613936	43.52279552	184.0975025	0	91.41825313	34.82600119	0	30.96706235	21.76625075	30.11959515	34.82600119	30.47275104	34.82600119	14.04815818	0.174130006	0	0	0	0	0	0	0	0	28.40840304	0.174130006	0	0	0	0	0	0	0	0	0		25.9747	0.27141453	6.009032989	0	3.303866154	1.375337481	2.168157489	0.868129239	4.218178903	0	1.595269045	0.009759962	0	0.598693048	8.298672343	15.35234103	0.015817726	4.448548126	6.382067141	4.155849218	10.16684599	0	0	0	0	0	0	0	0	1.578593875	5.654651538	0	0	0	0	0	0	0	0	0	102.4459		NO	14.98557085	25.9747	0.27141453	6.009032989	0	3.303866154	1.375337481	2.168157489	0.868129239	4.218178903	0	1.595269045	0.009759962	0	0.598693048	8.298672343	15.35234103	0.015817726	4.448548126	6.382067141	4.155849218	10.16684599	0	0	0	0	0	0	0	0	1.578593875	5.654651538	0	0	0	0	0	0	0	0	0	102.4459	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	25.9747	0.27141453	6.009032989	0	3.303866154	1.375337481	2.168157489	0.868129239	4.218178903	0	1.595269045	0.009759962	0	0.598693048	8.298672343	15.35234103	0.015817726	4.448548126	6.382067141	4.155849218	10.16684599	0	0	0	0	0	0	0	0	1.578593875	5.654651538	0	0	0	0	0	0	0	0	0	102.4459
H3370_004_0	2012	8	H.6										OP Facility - Other										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	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	YES	2589.038757	30.52126943	1892.993269	2441.116642	164.7286247	9.573372391	19.68991604	300.5006552	307.3710535	13209.60545	372.8875663	1.902487583	0.573762535	169.7408937	6372.870218	6416.216899	3.91580222	2001.489257	1825.246643	3478.044103	43.61472896	30.77270538	0	651.8173813	293	293	162	10.8	5872.8	806.6792936	22.88888618	0	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 (for 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: $0 - $200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $30 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $30 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$25; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not Covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $130 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not Covered: 7F: $25 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	125.312956	111.7263844	60	0	200	0.2	0.179562728	49.9384453	185.7634113	0	75	40	0.1	30.64135734	15	24.89123067	40	35	30	11.28667536	0.2	0	0	0	0	0	0	0	0	21.30640519	0.2	0	0	0	0	0	0	0	0	0	NO	110.9454228	98.91659531	53.12080716	0	177.0693572	0.177069357	0.158975284	44.21284205	164.4650391	0	66.40100895	35.41387144	0.088534679	27.12822724	13.28020179	22.03737108	35.41387144	30.98713751	26.56040358	9.992621757	0.177069357	0	0	0	0	0	0	0	0	21.30640519	0.177069357	0	0	0	0	0	0	0	0	0		23.9368	0.251588338	8.379777532	0	2.430699307	1.695150896	3.130209993	1.107165667	4.212649363	0	2.063342552	0.005614538	0.050797882	0.383730795	7.052750206	11.78304606	0.011556143	5.16836857	4.039940623	2.896231597	7.722832021	0	0	0	0	0	0	0	0	1.432286324	4.052920364	0	0	0	0	0	0	0	0	0	91.8075		NO	11.70367134	23.9368	0.251588338	8.379777532	0	2.430699307	1.695150896	3.130209993	1.107165667	4.212649363	0	2.063342552	0.005614538	0.050797882	0.383730795	7.052750206	11.78304606	0.011556143	5.16836857	4.039940623	2.896231597	7.722832021	0	0	0	0	0	0	0	0	1.432286324	4.052920364	0	0	0	0	0	0	0	0	0	91.8075	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	23.9368	0.251588338	8.379777532	0	2.430699307	1.695150896	3.130209993	1.107165667	4.212649363	0	2.063342552	0.005614538	0.050797882	0.383730795	7.052750206	11.78304606	0.011556143	5.16836857	4.039940623	2.896231597	7.722832021	0	0	0	0	0	0	0	0	1.432286324	4.052920364	0	0	0	0	0	0	0	0	0	91.8075
H3370_014_0	2012	8	H.6										OP Facility - Other										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	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	YES	1570.722145	69.32556523	934.3234502	1156.896876	222.0736251	8.365649873	10.58319437	310.8890051	321.2903767	10959.80999	569.6648057	0.565327181	0.141457777	134.097439	4660.671787	5374.862077	5.287414684	1661.39768	1476.805651	3198.040172	33.70212296	19.08495056	0	651.8173813	293	293	162	10.8	5872.8	587.4911811	13.92982825	0	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: $35/day (for 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: $0 - $100 copay; 9B: $100 copay	8A: $0 copay	8B: $60 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $20 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $30 copay; 7I: $30 copay	8B: $25 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not Covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $130 Hardware Per 2Yr"	"18A: $0 copay, 1 Exam per Yr"	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not Covered: 7F: $20 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	78.01729412	59.77895357	35	0	50	0.2	0.156806121	47.94980496	89.67067372	0	60	40	0.1	19.84987483	10	20	40	30	25	7.768858935	0.2	0	0	0	0	0	0	0	0	15.37237006	0.2	0	0	0	0	0	0	0	0	0	NO	73.7121902	56.48026691	33.06865082	0	47.24092974	0.188963719	0.148153339	45.30386734	84.72251993	0	56.68911569	37.79274379	0.094481859	18.75453085	9.448185948	18.8963719	37.79274379	28.34455784	23.62046487	7.340162382	0.188963719	0	0	0	0	0	0	0	0	15.37237006	0.188963719	0	0	0	0	0	0	0	0	0		9.6484	0.326293869	2.574734661	0	0.874247043	1.580804312	1.567935581	1.173706187	2.268377529	0	2.691149506	0.001780439	0.013365194	0.20957788	3.669574474	8.463782725	0.016652159	3.924298553	2.906903001	1.956177848	6.368478491	0	0	0	0	0	0	0	0	0.75259432	2.63223215	0	0	0	0	0	0	0	0	0	53.6211		NO	3.087745297	9.6484	0.326293869	2.574734661	0	0.874247043	1.580804312	1.567935581	1.173706187	2.268377529	0	2.691149506	0.001780439	0.013365194	0.20957788	3.669574474	8.463782725	0.016652159	3.924298553	2.906903001	1.956177848	6.368478491	0	0	0	0	0	0	0	0	0.75259432	2.63223215	0	0	0	0	0	0	0	0	0	53.6211	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	9.6484	0.326293869	2.574734661	0	0.874247043	1.580804312	1.567935581	1.173706187	2.268377529	0	2.691149506	0.001780439	0.013365194	0.20957788	3.669574474	8.463782725	0.016652159	3.924298553	2.906903001	1.956177848	6.368478491	0	0	0	0	0	0	0	0	0.75259432	2.63223215	0	0	0	0	0	0	0	0	0	53.6211
H3370_019_0	2012	6	H.6										OP Facility - Other										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	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	YES	1978.92791	51.99515764	1234.432766	1511.080287	235.3844517	5.749678801	5.028673492	257.2744614	225.806704	12151.55394	289.6923066	0.700253993	0.06423091	246.3016982	4010.633077	4553.026873	3.058251688	1490.569331	1446.332329	2805.612387	22.89097348	14.26190462	0	651.8173813	293	293	162	10.8	5872.8	360.2705374	13.76254312	0	0	0	0	0	0	0	0	0	3400	1A: $150/day (days1-7) no yrly max	1B: $150/day (days1-7) no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $30 copay	9A: $0 - $150 copay; 9B: $150 copay	8A: $0 copay	8B: $75 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $30 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $25 copay; 7I: $25 copay	8B: $25 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $200 Hardware Per Yr"	N/A	"18A: $0 copay, $1000 Hardware Limit per Yr"	14C: Silver Sneakers	7B: Not Covered: 7F: $30 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	100.8764294	84.66954346	60	0	200	0.2	0.163886021	49.81729947	139.9334105	0	75	40	0.1	30.74938401	10	29.81786266	40	25	25	12.89288907	0.2	0	0	0	0	0	0	0	0	27.95721551	0.2	0	0	0	0	0	0	0	0	0	NO	93.42584226	78.41597348	55.56848681	0	185.2282894	0.185228289	0.151781637	46.13786581	129.5981312	0	69.46060852	37.04565787	0.092614145	28.478279	9.261414469	27.61555846	37.04565787	23.15353617	23.15353617	11.94063894	0.185228289	0	0	0	0	0	0	0	0	27.95721551	0.185228289	0	0	0	0	0	0	0	0	0		15.4069	0.339770909	5.71629674	0	3.633321612	1.065003169	0.763260293	0.989174548	2.438677238	0	1.676850325	0.002161781	0.005948691	0.584520707	3.095344601	10.47786498	0.009441245	2.87599591	2.790642324	2.79173371	4.24005586	0	0	0	0	0	0	0	0	0.839346755	2.54921232	0	0	0	0	0	0	0	0	0	62.2915		NO	4.900731054	15.4069	0.339770909	5.71629674	0	3.633321612	1.065003169	0.763260293	0.989174548	2.438677238	0	1.676850325	0.002161781	0.005948691	0.584520707	3.095344601	10.47786498	0.009441245	2.87599591	2.790642324	2.79173371	4.24005586	0	0	0	0	0	0	0	0	0.839346755	2.54921232	0	0	0	0	0	0	0	0	0	62.2915	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	15.4069	0.339770909	5.71629674	0	3.633321612	1.065003169	0.763260293	0.989174548	2.438677238	0	1.676850325	0.002161781	0.005948691	0.584520707	3.095344601	10.47786498	0.009441245	2.87599591	2.790642324	2.79173371	4.24005586	0	0	0	0	0	0	0	0	0.839346755	2.54921232	0	0	0	0	0	0	0	0	0	62.2915
H3370_022_0	2012	8	H.6										OP Facility - Other										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	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	YES	2101.629105	40.98282283	1703.573608	1799.004479	265.5541057	6.420823077	7.695006001	243.5045586	245.1450709	16922.58373	306.6210697	0.910477595	0.037387477	191.0634526	5074.735415	6083.353169	1.351500365	1789.720991	1864.058122	3605.387369	49.58836746	16.15939133	0	651.8173813	293	293	0	0	5872.8	555.9136333	13.75025721	0	0	0	0	0	0	0	0	0	3000	1A: $140/day (days1-7) no yrly max	1B: $140/day (days1-7) no yrly max	2: $60/day (for 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: $0 - $200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $25 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $30 copay; 7I: $30 copay	8B: $25 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$25; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not Covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $200 Hardware Per Yr"	N/A	N/A	14C: Silver Sneakers	7B: Not Covered: 7F: $25 copay; 13A: Not covered; 13D: $0 copay	8B: 20% coinsurance										0	NO	103.7488324	91.49311259	60	0	125	0.2	0.153214561	49.59218134	175.0521364	0	75	40	0.1	25.51228467	15	24.87472855	40	30	25	9.441623075	0.2	0	0	0	0	0	0	0	0	21.16777261	0.2	0	0	0	0	0	0	0	0	0	NO	92.61775257	81.67693331	53.56267658	0	111.5889095	0.178542255	0.136776366	44.2714995	156.2710161	0	66.95334572	35.70845105	0.089271128	22.77510421	13.39066914	22.20595067	35.70845105	26.78133829	22.31778191	8.428643386	0.178542255	0	0	0	0	0	0	0	0	21.16777261	0.178542255	0	0	0	0	0	0	0	0	0		16.2207	0.278945941	7.603996848	0	2.469407756	1.146388233	1.052494956	0.898359329	3.192422444	0	1.710775541	0.002709312	0.003337622	0.36262417	5.662841912	11.25722003	0.004021665	3.994260275	3.466803552	2.532377034	8.853618961	0	0	0	0	0	0	0	0	0.980621115	2.455001932	0	0	0	0	0	0	0	0	0	74.1489		NO	8.793584703	16.2207	0.278945941	7.603996848	0	2.469407756	1.146388233	1.052494956	0.898359329	3.192422444	0	1.710775541	0.002709312	0.003337622	0.36262417	5.662841912	11.25722003	0.004021665	3.994260275	3.466803552	2.532377034	8.853618961	0	0	0	0	0	0	0	0	0.980621115	2.455001932	0	0	0	0	0	0	0	0	0	74.1489	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	16.2207	0.278945941	7.603996848	0	2.469407756	1.146388233	1.052494956	0.898359329	3.192422444	0	1.710775541	0.002709312	0.003337622	0.36262417	5.662841912	11.25722003	0.004021665	3.994260275	3.466803552	2.532377034	8.853618961	0	0	0	0	0	0	0	0	0.980621115	2.455001932	0	0	0	0	0	0	0	0	0	74.1489
H3370_801_0	2012	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	351.5081846	3.651821464	45.19797646	20.50415542	8.758833786	17.38845054	5.928808211	8.052094105	36.66377028	44.73413506	38.74138761	0.003431051	4.418172196	0.384021697	88.93084303	132.369255	0.372378461	84.06180002	0	0.208572414	69.91045998	0.663813159																			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																				NO	0.064071325	0.064071325	0.151968273	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.05010795	0.05010795	0.118849089	0	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177	0.182221177																				17.6134	0.182985287	5.371738314	0	1.596045003	3.168543926	1.080354411	1.467262066	6.680915379	8.151506748	7.059501253	0.00062521	0.805084538	0.069976886	16.2050829	24.12048147	0.067855241	15.31784015	0	0.038006311	12.73916631	0.120960815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8573		NO	33.95746683	17.6134	0.182985287	5.371738314	0	1.596045003	3.168543926	1.080354411	1.467262066	6.680915379	8.151506748	7.059501253	0.00062521	0.805084538	0.069976886	16.2050829	24.12048147	0.067855241	15.31784015	0	0.038006311	12.73916631	0.120960815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8573	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		NO	0	17.6134	0.182985287	5.371738314	0	1.596045003	3.168543926	1.080354411	1.467262066	6.680915379	8.151506748	7.059501253	0.00062521	0.805084538	0.069976886	16.2050829	24.12048147	0.067855241	15.31784015	0	0.038006311	12.73916631	0.120960815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8573
H3370_803_0	2012	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	297.2806741	3.088451404	34.05713179	18.14408664	7.439103524	15.52590973	5.293751785	8.910020191	51.44856535	50.17255423	43.45125636	0.00384817	4.955298315	0.430707991	99.52406691	148.136756	0.41673527	94.07503543	0	0.233417049	67.67076605	0.38195633																			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																				NO	0.064071325	0.064071325	0.151968273	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.049225022	0.049225022	0.116754907	0	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347	0.179010347																				14.6336	0.152029089	3.976337262	0	1.331676504	2.77929849	0.947636345	1.594985807	9.209825543	8.98140635	7.778224485	0.000688862	0.887049671	0.077101187	17.81583777	26.51801211	0.074599925	16.84040475	0	0.041784067	12.11376732	0.068374135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8227		NO	37.94821543	14.6336	0.152029089	3.976337262	0	1.331676504	2.77929849	0.947636345	1.594985807	9.209825543	8.98140635	7.778224485	0.000688862	0.887049671	0.077101187	17.81583777	26.51801211	0.074599925	16.84040475	0	0.041784067	12.11376732	0.068374135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8227	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		NO	0	14.6336	0.152029089	3.976337262	0	1.331676504	2.77929849	0.947636345	1.594985807	9.209825543	8.98140635	7.778224485	0.000688862	0.887049671	0.077101187	17.81583777	26.51801211	0.074599925	16.84040475	0	0.041784067	12.11376732	0.068374135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8227
H3370_805_0	2012	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	326.5616984	3.392652211	40.07281167	19.41844408	8.151713296	16.53161887	5.636660809	8.446769078	43.46527532	47.23599154	40.90808629	0.00362294	4.66526835	0.405498969	93.80408376	139.622838	0.392784091	88.66822647	0	0.220001785	68.88012513	0.534149499																			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																				NO	0.064071325	0.064071325	0.151968273	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.04969368	0.04969368	0.117866499	0	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656	0.180714656																				16.2281	0.168593374	4.723242019	0	1.473134065	2.987505819	1.01862722	1.526454969	7.854812283	8.536235969	7.392690748	0.000654718	0.843082366	0.073279607	16.95177274	25.23189315	0.070981842	16.02364806	0	0.039757547	12.44764813	0.096528643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6886		NO	35.78625501	16.2281	0.168593374	4.723242019	0	1.473134065	2.987505819	1.01862722	1.526454969	7.854812283	8.536235969	7.392690748	0.000654718	0.843082366	0.073279607	16.95177274	25.23189315	0.070981842	16.02364806	0	0.039757547	12.44764813	0.096528643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6886	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		NO	0	16.2281	0.168593374	4.723242019	0	1.473134065	2.987505819	1.01862722	1.526454969	7.854812283	8.536235969	7.392690748	0.000654718	0.843082366	0.073279607	16.95177274	25.23189315	0.070981842	16.02364806	0	0.039757547	12.44764813	0.096528643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6886
H3379_001_0	2012	4																															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	1695.451541	141.4085273	1458.63084	1503.903368	179.0208721	4.489145613	7.921192183	308.1481202	39.06471466	22.21100099	45.13368771	0	0.286383115	17.62361974	5500.206488	5169.36522	894.3985104	1990.537843	0	0	18.9674713	1338.005389	0	0	21.93573168	0	7.783292262	65	89.55961067	0											4950	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	73.39250322	0	200	0.2	0.105357675	64.78760536	0.16	0.22453089	0.163693442	0	0.2	0.146874178	10.60778936	32.63787382	38.5	34.98458094	0	0	0.2	34.76956608	0	0	35	0	15	352.5	0	0											NO	147.0916533	77.04064894	56.25674703	0	153.3037969	0.153303797	0.080758658	49.68906311	0.122643037	0.17210719	0.125474131	0	0.153303797	0.112581846	10.18595273	31.34128322	36.96898256	33.59336007	0	0	0.153303797	26.65153247	0	0	35	0	15	352.5	0	0												20.7822	0.907850392	6.838152181	0	2.287048285	0.688203067	0.639704849	1.275965949	4.791015264	3.822672959	5.663110231	0	0.043903619	1.984099638	4.66873694	13.50121162	2.755416911	5.572404541	0	0	2.907785367	2.971657839	0	0	0.063979217	0	0.009729115	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	84.0843	0	NO	18.03258462	20.7822	0.907850392	6.838152181	0	2.287048285	0.688203067	0.639704849	1.275965949	4.791015264	3.822672959	5.663110231	0	0.043903619	1.984099638	4.66873694	13.50121162	2.755416911	5.572404541	0	0	2.907785367	2.971657839	0	0	0.063979217	0	0.009729115	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	84.0843	NO																																										0	0	0	0	0	0	0	0	0	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	20.7822	0.907850392	6.838152181	0	2.287048285	0.688203067	0.639704849	1.275965949	4.791015264	3.822672959	5.663110231	0	0.043903619	1.984099638	4.66873694	13.50121162	2.755416911	5.572404541	0	0	2.907785367	2.971657839	0	0	0.063979217	0	0.009729115	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	84.0843
H3379_002_0	2012	3																															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	432.5988886	39.3721	16729.90042	0	41.70546016	71.55580901	33.94159697	20.96756787	19.24667989	33.24490794	27.88183175	0	0	21.08753556	1.900984685	281.4070022	18.9198	29.62375856	0	27555.86598	30.93134723	6.647419572	945.7691656	0	35.90758613	88.87127567	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.057929104	0.058632696	0	0	0.2	0.2	0.182408789	0.216633012	0.16	0	0.098286886	0	0	0.146289539	0	0.027303233	0.2	0	0	0	0.2	0.196249163	0	0	0	0	0	0	0	0											NO	0.053437	0.054086032	0	0	0.184491029	0.184491029	0.168263925	0.199834236	0.147592823	0	0.090665244	0	0	0.134945538	0	0.025186008	0.184491029	0	0	0	0.184491029	0.18103105	0	0	0	0	0	0	0	0												23.1168	2.129480675	0	0	7.694283246	13.20140481	5.711146338	4.190037916	2.840671816	0	2.527913077	0	0	2.845668832	0	7.08751897	3.490533364	0	0	0	5.706556069	1.203389342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7454	0	NO	6.871808023	23.1168	2.129480675	0	0	7.694283246	13.20140481	5.711146338	4.190037916	2.840671816	0	2.527913077	0	0	2.845668832	0	7.08751897	3.490533364	0	0	0	5.706556069	1.203389342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7454	NO																																										0	0	0	0	0	0	0	0	0	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	23.1168	2.129480675	0	0	7.694283246	13.20140481	5.711146338	4.190037916	2.840671816	0	2.527913077	0	0	2.845668832	0	7.08751897	3.490533364	0	0	0	5.706556069	1.203389342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7454
H3379_022_0	2012	3																															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	278.6152775	40.6708	6854.213128	1.285497844	22.9458338	20.23534454	5.160536046	7.029871562	23.81863142	35.80633869	14.45985758	0	0	20.93693158	2.928703332	108.7953885	18.9166	29.24895126	0	22489.07294	3.426480791	4.958037473	2777.52727	160	16.7269797	22.48812139	17.6381231	11.22	0	2188.537539											3500	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.087751457	0.088817264	0	0	0.2	0.2	0.187117789	1	0.16	0	0.091813352	0	0	0.146294263	0	0.031135223	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.07983065	0.080800253	0	0	0.181947179	0.181947179	0.170227769	0.909735895	0.145557743	0	0.083525902	0	0	0.133089142	0	0.02832483	0.181947179	0	0	0	0.181947179	0.182085086	0	0	0	0	0	0	0	0												22.242	3.286210938	0	0	4.17492973	3.681763855	0.878466538	6.395326497	3.466986235	0	1.207772651	0	0	2.78647827	0	3.081610854	3.441822006	0	0	0	0.623438514	0.902784677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1696	0	NO	5.57240582	22.242	3.286210938	0	0	4.17492973	3.681763855	0.878466538	6.395326497	3.466986235	0	1.207772651	0	0	2.78647827	0	3.081610854	3.441822006	0	0	0	0.623438514	0.902784677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1696	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	22.242	3.286210938	0	0	4.17492973	3.681763855	0.878466538	6.395326497	3.466986235	0	1.207772651	0	0	2.78647827	0	3.081610854	3.441822006	0	0	0	0.623438514	0.902784677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1696
H3384_013_0	2012	10																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	322.6397519	2.261974041	2384.018755	0	99.24513636	14.05231802	1.318352689	281.9599616	360.6514814	0	1697.294269	0	0	54.18099026	4091.784539	4426.086704	41.73848219	1207.816683	630.9669446	801.1361925	973.5139366	0	0	0	714.7044483	0	0	0	0	0											3400	$300 /Admit for IP Acute; PBP 1a	$300 /Admit for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $30 /Visit for Urgent Care; PBP 4a, 4b"	"$150 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $30 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $30 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$10 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$10 /Visit for PCP; PBP 7a	"$30 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$10 /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), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $30 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$30 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	300	300	45	0	125	0.2	0.2	61.8389595	150	0	59.31370019	0	0	0.099985674	10	29.35304549	40	10	30	30	55.5223411	0	0	0	30	0	0	0	0	0											NO	263.8661392	263.8661392	39.57992088	0	109.9442247	0.175910759	0.175910759	54.39069165	131.9330696	0	52.16959024	0	0	0.087942779	8.795537974	25.81758262	35.1821519	8.795537974	26.38661392	26.38661392	48.83488595	0	0	0	26.38661392	0	0	0	0	0												7.0945	0.049738196	7.863272808	0	0.909285798	2.471953936	0.231912423	1.277999777	3.965154751	0	7.378928876	0	0	4.764826866	2.999120525	9.522571598	0.122370802	0.885283125	1.38742343	1.761605951	3.961786839	0	0	0	1.571552529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2193	0	NO	7.97255296	7.0945	0.049738196	7.863272808	0	0.909285798	2.471953936	0.231912423	1.277999777	3.965154751	0	7.378928876	0	0	4.764826866	2.999120525	9.522571598	0.122370802	0.885283125	1.38742343	1.761605951	3.961786839	0	0	0	1.571552529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2193	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.0945	0.049738196	7.863272808	0	0.909285798	2.471953936	0.231912423	1.277999777	3.965154751	0	7.378928876	0	0	4.764826866	2.999120525	9.522571598	0.122370802	0.885283125	1.38742343	1.761605951	3.961786839	0	0	0	1.571552529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2193
H3384_015_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1567.801791	8.802380609	3189.903569	0	98.01875259	11.86802242	0.279567259	284.9130312	307.1778532	0	1468.109053	0	0	43.86145516	3713.547187	4146.682495	5.558788938	938.7622033	529.9359201	859.0855632	960.0973239	0	0	0	760.6328407	0	0	0	0	0											3400	$300 /Day for  1-5 day for IP Acute; PBP 1a	$300 /Day for  1-5 day for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $30 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $30 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $30 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$15 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$15 /Visit for PCP; PBP 7a	"$30 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$15 /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), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $30 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$30 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	300	300	45	0	125	0.2	0.2	61.8389595	200	0	63.37715965	0	0	0.100083912	15	29.35304549	40	15	30	30	57.1207829	0	0	0	30	0	0	0	0	0											NO	233.0803642	233.0803642	34.96205463	0	97.11681842	0.155386909	0.155386909	48.04482401	155.3869095	0	49.23990485	0	0	0.077758649	11.65401821	22.80539511	31.07738189	11.65401821	23.30803642	23.30803642	44.37910961	0	0	0	23.30803642	0	0	0	0	0												30.452	0.17097184	9.29379857	0	0.79327245	1.844135325	0.043441092	1.14071637	3.977618106	0	6.024129172	0	0	3.410607477	3.606478879	7.880561057	0.014396051	0.911695984	1.02931381	1.668633133	3.550688698	0	0	0	1.47740483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2898	0	NO	22.19066562	30.452	0.17097184	9.29379857	0	0.79327245	1.844135325	0.043441092	1.14071637	3.977618106	0	6.024129172	0	0	3.410607477	3.606478879	7.880561057	0.014396051	0.911695984	1.02931381	1.668633133	3.550688698	0	0	0	1.47740483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2898	NO																																										0	0	0	0	0	0	0	0	0	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	30.452	0.17097184	9.29379857	0	0.79327245	1.844135325	0.043441092	1.14071637	3.977618106	0	6.024129172	0	0	3.410607477	3.606478879	7.880561057	0.014396051	0.911695984	1.02931381	1.668633133	3.550688698	0	0	0	1.47740483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2898
H3384_019_0	2012	9																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	154.3904864	0.841037669	1655.013255	0	81.23179171	10.51610313	0.609953324	286.9537215	341.6803876	0	1110.032029	0	0	46.6256439	3444.938594	3152.891392	103.0132415	492.6370291	738.6212011	779.4208793	800.3196229	6.616164031	0	0	553.6513661	0	0	0	0	0											3400	$500 /Admit; Annual OOP Max $500 for IP Acute; PBP 1a	$500 /Admit; Annual OOP Max $500 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $35 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $35 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $35 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$15 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$15 /Visit for PCP; PBP 7a	"$35 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$15 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$35 /Visit for Physician Specialist (Radiology); PBP 7d	"$35 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $35 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$35 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	500	500	45	0	125	0.2	0.2	62.29053671	200	0	65.54520595	0	0	0.100518199	15	34.02956823	40	15	35	35	54.74102169	35	0	0	35	0	0	0	0	0											NO	450.0731225	450.0731225	40.50658103	0	112.5182806	0.180029249	0.180029249	56.07059272	180.029249	0	59.00027102	0	0	0.09048108	13.50219368	30.63158807	36.0058498	13.50219368	31.50511858	31.50511858	49.27492513	31.50511858	0	0	31.50511858	0	0	0	0	0												5.7906	0.031544037	5.586577375	0	0.761671795	1.893206149	0.109809439	1.340805437	5.126038632	0	5.457682545	0	0	4.218738598	3.876185674	8.048172529	0.309089942	0.554306715	1.93919571	2.046312269	3.286307458	0.017370253	0	0	1.453570995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8472	0	NO	5.751437162	5.7906	0.031544037	5.586577375	0	0.761671795	1.893206149	0.109809439	1.340805437	5.126038632	0	5.457682545	0	0	4.218738598	3.876185674	8.048172529	0.309089942	0.554306715	1.93919571	2.046312269	3.286307458	0.017370253	0	0	1.453570995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8472	NO																																										0	0	0	0	0	0	0	0	0	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	5.7906	0.031544037	5.586577375	0	0.761671795	1.893206149	0.109809439	1.340805437	5.126038632	0	5.457682545	0	0	4.218738598	3.876185674	8.048172529	0.309089942	0.554306715	1.93919571	2.046312269	3.286307458	0.017370253	0	0	1.453570995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8472
H3384_022_0	2012	6																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	181.1545586	1.371438503	2300.536034	0	94.87423108	9.708407139	0.476076142	300.313172	364.1713392	0	1328.006602	0	0	49.02117911	3514.165535	3818.986127	42.96224147	561.7260471	876.3265544	944.1822225	1025.256629	21.4226136	0	0	706.2813382	0	0	0	0	0											3400	$400 /Admit; Annual OOP Max $400 for IP Acute; PBP 1a	$400 /Admit; Annual OOP Max $400 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $35 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $35 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $35 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$10 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$10 /Visit for PCP; PBP 7a	"$35 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$10 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$35 /Visit for Physician Specialist (Radiology); PBP 7d	"$35 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $35 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$35 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	400	400	45	0	125	0.2	0.2	62.29053671	200	0	64.09392307	0	0	0.100334146	10	34.02956823	40	10	35	35	56.82233991	35	0	0	35	0	0	0	0	0											NO	353.6828004	353.6828004	39.78931505	0	110.5258751	0.1768414	0.1768414	55.07772866	176.8414002	0	56.6722955	0	0	0.088716154	8.842070011	30.08918247	35.36828004	8.842070011	30.94724504	30.94724504	50.24271077	30.94724504	0	0	30.94724504	0	0	0	0	0												5.3393	0.040421184	7.628062751	0	0.873838118	1.716848312	0.084189972	1.378380617	5.366714129	0	6.271765216	0	0	4.348970478	2.589374807	9.575847538	0.126625049	0.413901753	2.259991051	2.43498655	4.292639354	0.055247573	0	0	1.821455136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6185	0	NO	7.414586675	5.3393	0.040421184	7.628062751	0	0.873838118	1.716848312	0.084189972	1.378380617	5.366714129	0	6.271765216	0	0	4.348970478	2.589374807	9.575847538	0.126625049	0.413901753	2.259991051	2.43498655	4.292639354	0.055247573	0	0	1.821455136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6185	NO																																										0	0	0	0	0	0	0	0	0	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	5.3393	0.040421184	7.628062751	0	0.873838118	1.716848312	0.084189972	1.378380617	5.366714129	0	6.271765216	0	0	4.348970478	2.589374807	9.575847538	0.126625049	0.413901753	2.259991051	2.43498655	4.292639354	0.055247573	0	0	1.821455136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6185
H3384_041_0	2012	9																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	212.7556993	1.555541836	2675.047906	0	107.8778818	15.93792735	1.386216322	339.4925651	430.8935676	0	1630.76127	0	0	54.08680545	4184.972459	4415.635413	101.3670134	784.1954597	941.7269979	912.9471977	1107.110547	18.6094949	0	0	732.3032861	0	0	0	0	0											3400	$400 /Admit; Annual OOP Max $400 for IP Acute; PBP 1a	$400 /Admit; Annual OOP Max $400 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing 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, 11c"	"$65 /Visit for ER, $25 /Visit for Urgent Care; PBP 4a, 4b"	"$125 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $25 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $25 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$10 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$10 /Visit for PCP; PBP 7a	"$25 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$10 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$25 /Visit for Physician Specialist (Radiology); PBP 7d	"$25 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $25 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$25 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	400	400	45	0	50	0.2	0.2	61.38738228	125	0	60.84001096	0	0	0.10043204	10	24.67652274	40	10	25	25	54.94577554	25	0	0	25	0	0	0	0	0											NO	352.77225	352.77225	39.68687813	0	44.09653125	0.176386125	0.176386125	54.13941242	110.2413281	0	53.65666889	0	0	0.088574092	8.81930625	21.76298113	35.277225	8.81930625	22.04826563	22.04826563	48.45836216	22.04826563	0	0	22.04826563	0	0	0	0	0												6.2545	0.045729333	8.84702502	0	0.396420032	2.811229245	0.244509325	1.531660667	3.958523264	0	7.291768126	0	0	4.79068968	3.075712813	8.008115846	0.297995578	0.576338327	1.73028725	1.677408526	4.470730318	0.034192257	0	0	1.345501448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3884	0	NO	7.682926427	6.2545	0.045729333	8.84702502	0	0.396420032	2.811229245	0.244509325	1.531660667	3.958523264	0	7.291768126	0	0	4.79068968	3.075712813	8.008115846	0.297995578	0.576338327	1.73028725	1.677408526	4.470730318	0.034192257	0	0	1.345501448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3884	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.2545	0.045729333	8.84702502	0	0.396420032	2.811229245	0.244509325	1.531660667	3.958523264	0	7.291768126	0	0	4.79068968	3.075712813	8.008115846	0.297995578	0.576338327	1.73028725	1.677408526	4.470730318	0.034192257	0	0	1.345501448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3884
H3384_053_0	2012	18																															D	D	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1711.054264	12.4208509	3682.502878	0	105.9068718	13.79882906	0.723822302	278.6546181	314.135847	0	1593.807467	0	0	39.9330345	4042.215015	3895.747114	20.04052185	851.9011525	576.9410177	896.5396767	889.6983266	0	0	0	816.0963398	0	0	0	0	0											3400	$400 /Day for  1-5 day; Annual OOP Max $2000 for IP Acute; PBP 1a	$350.0 /Day for  1-5 day; Annual OOP Max $1750 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $35 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $35 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $35 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$20 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$20 /Visit for PCP; PBP 7a	"$35 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$35 /Visit for Physician Specialist (Radiology); PBP 7d	"$35 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $35 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$35 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	400	350	45	0	125	0.2	0.2	62.29053671	200	0	62.15022862	0	0	0.100611933	20	34.02956823	40	20	35	35	57.32118758	0	0	0	35	0	0	0	0	0											NO	282.2205997	246.9430247	31.74981746	0	88.1939374	0.1411103	0.1411103	43.94918156	141.1102998	0	43.85018698	0	0	0.0709869	14.11102998	24.00961288	28.22205997	14.11102998	24.69430247	24.69430247	40.44304984	0	0	0	24.69430247	0	0	0	0	0												40.2412	0.255603541	9.743232848	0	0.778362002	1.947156906	0.102138782	1.020553533	3.69398363	0	5.824062951	0	0	2.834722345	4.753318106	7.794615009	0.047132067	1.001766892	1.187263	1.844951829	2.99850948	0	0	0	1.679410822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.748	0	NO	36.61996486	40.2412	0.255603541	9.743232848	0	0.778362002	1.947156906	0.102138782	1.020553533	3.69398363	0	5.824062951	0	0	2.834722345	4.753318106	7.794615009	0.047132067	1.001766892	1.187263	1.844951829	2.99850948	0	0	0	1.679410822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.748	NO																																										0	0	0	0	0	0	0	0	0	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	40.2412	0.255603541	9.743232848	0	0.778362002	1.947156906	0.102138782	1.020553533	3.69398363	0	5.824062951	0	0	2.834722345	4.753318106	7.794615009	0.047132067	1.001766892	1.187263	1.844951829	2.99850948	0	0	0	1.679410822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.748
H3384_805_0	2012	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	281.4655798	1.281759827	44.83171132	0	12.29647364	15.52615785	0.487145224	14.44923107	55.10732665	3.578799358	19.65541817	0	4.081889803	51.62941824	36.34061249	75.80266021	2.147735703	3.509361608	53.1208723	130.9018228	13.29209361	0.316252789	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.090878706	0.090878706	0.179466079	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081043442	0.081043442	0.160043529	0	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0.199757807	0	0	0	0	0	0	0	0												22.8109	0.103878228	7.175025291	0	2.45631661	3.101471247	0.097311062	2.886346715	11.00811873	0.714893112	3.926323234	0	0.815389356	10.31337938	7.259321063	15.14217319	0.429026974	0.70102238	10.61130897	26.14866109	2.655199473	0.063173964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4193	0	NO	15.58469715	22.8109	0.103878228	7.175025291	0	2.45631661	3.101471247	0.097311062	2.886346715	11.00811873	0.714893112	3.926323234	0	0.815389356	10.31337938	7.259321063	15.14217319	0.429026974	0.70102238	10.61130897	26.14866109	2.655199473	0.063173964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4193	NO																																										0	0	0	0	0	0	0	0	0	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	22.8109	0.103878228	7.175025291	0	2.45631661	3.101471247	0.097311062	2.886346715	11.00811873	0.714893112	3.926323234	0	0.815389356	10.31337938	7.259321063	15.14217319	0.429026974	0.70102238	10.61130897	26.14866109	2.655199473	0.063173964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4193
H3384_806_0	2012	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	287.6044562	1.699165691	46.7303293	0	11.17253448	14.35265769	1.923701964	13.09992693	55.4424027	4.731793807	16.36102637	0	0.367912536	56.65806114	34.13281566	72.34816634	1.52041408	4.022770973	46.61897445	136.7789471	13.34804162	0.943373208	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.090631537	0.090631537	0.18294656	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080898973	0.080898973	0.163300648	0	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0.19994552	0	0	0	0	0	0	0	0												23.2669	0.137460759	7.631093051	0	2.233898218	2.869749607	0.38463559	2.619271703	11.08546005	0.946100974	3.271313928	0	0.073562463	11.32852551	6.824703581	14.46569175	0.303999984	0.804335035	9.321255095	27.34833773	2.668881125	0.188623247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7738	0	NO	15.3718493	23.2669	0.137460759	7.631093051	0	2.233898218	2.869749607	0.38463559	2.619271703	11.08546005	0.946100974	3.271313928	0	0.073562463	11.32852551	6.824703581	14.46569175	0.303999984	0.804335035	9.321255095	27.34833773	2.668881125	0.188623247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7738	NO																																										0	0	0	0	0	0	0	0	0	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	23.2669	0.137460759	7.631093051	0	2.233898218	2.869749607	0.38463559	2.619271703	11.08546005	0.946100974	3.271313928	0	0.073562463	11.32852551	6.824703581	14.46569175	0.303999984	0.804335035	9.321255095	27.34833773	2.668881125	0.188623247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7738
H3384_807_0	2012	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	292.3399499	1.349527009	53.78198767	0	9.254022454	13.49434583	1.078550122	14.69936292	49.86256272	4.566590324	30.64668364	0	0.41267633	51.48746839	35.64397782	68.5382451	1.475072186	2.513918177	30.47248972	87.35794485	41.42592919	0.623316322	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.090745088	0.090745088	0.181313851	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081694589	0.081694589	0.163230438	0	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0.201659266	0	0	0	0	0	0	0	0												23.8826	0.110249054	8.778857414	0	1.866159378	2.721259878	0.217499626	2.96426274	10.05524781	0.920895254	6.180187735	0	0.083220006	10.3829251	7.187938414	13.82137222	0.297461975	0.506954895	6.145059918	17.61653906	8.353922483	0.125697512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2183	0	NO	13.53990127	23.8826	0.110249054	8.778857414	0	1.866159378	2.721259878	0.217499626	2.96426274	10.05524781	0.920895254	6.180187735	0	0.083220006	10.3829251	7.187938414	13.82137222	0.297461975	0.506954895	6.145059918	17.61653906	8.353922483	0.125697512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2183	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	NO	0	23.8826	0.110249054	8.778857414	0	1.866159378	2.721259878	0.217499626	2.96426274	10.05524781	0.920895254	6.180187735	0	0.083220006	10.3829251	7.187938414	13.82137222	0.297461975	0.506954895	6.145059918	17.61653906	8.353922483	0.125697512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2183
H3387_010_0	2012	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	141.0803592	19.288	13.47176016	973.6256068	7.02844277	8.157081857	6.024209952	15.26380345	28.30994118	9.353077729	21.03238097	0	0	24.7842622	27.46436085	56.58342633	9.5717	3.669323182	0	1.964999878	13.01087421	4.261401855	701.7391304	632.1852989	43.64651163	110.432	10.34114151	2.719155116	540.608755	3934.326854											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"$0 (7b, 7f, 7f1); $0 n/c (7b1); Medicare FFS (7d)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10); $0 (16b, 17a, 17b, 18a)"	$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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$5 (13a); $0 n/c (13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.057166094	0.057166094	0.148588009	0	0.224	0.224	0.224	0.125309659	0.224	0.224	0.224	0	0	0.224	0.218951039	0.221512676	0.224	0.224	0	0.224	0.224	0.040465056	0	0	0	0	0	0	0	0.573204133											NO	0.049338197	0.049338197	0.128241478	0	0.193327115	0.193327115	0.193327115	0.108166843	0.193327115	0.193327115	0.193327115	0	0	0.193327115	0.188969521	0.191244906	0.193327115	0.193327115	0	0.193327115	0.193327115	0.039955396	0	0	0	0	0	0	0	0.573204133												6.9607	0.951635144	1.72763844	0	1.358788566	1.576985105	1.164643132	1.651037437	5.473079265	1.808203537	4.066129542	0	0	4.791469918	5.189927127	10.82129203	1.85046915	0.709379666	0	0.379887758	2.51535478	0.170266	0	0	0	0	0	0	0	0.187931034	0	0	0	0	0	0	0	0	0	0	53.3548	150	YES	8.40598388	6.9607	0.951635144	1.72763844	0	1.358788566	1.576985105	1.164643132	1.651037437	5.473079265	1.808203537	4.066129542	0	0	4.791469918	5.189927127	10.82129203	1.85046915	0.709379666	0	0.379887758	2.51535478	0.170266	0	0	0	0	0	0	0	0.187931034	0	0	0	0	0	0	0	0	0	0	53.3548	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.9607	0.951635144	1.72763844	0	1.358788566	1.576985105	1.164643132	1.651037437	5.473079265	1.808203537	4.066129542	0	0	4.791469918	5.189927127	10.82129203	1.85046915	0.709379666	0	0.379887758	2.51535478	0.170266	0	0	0	0	0	0	0	0.187931034	0	0	0	0	0	0	0	0	0	0	53.3548
H3388_001_0	2012	6																															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	V	O																																																			0	YES	292.0277197	3.324817362	1380.17953		795.903818		10.52301865	298.1295425	355.2529037		1038.013078		16.59297636	8.160480177	8556.762098	3417.568856	243.9592045	862.1496887							296.9288053																2500	"1a (IP Acute); $275 / admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $275 / admit (190 lifetime limit)	"2a (SNF); $0 - days 1-20 $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0 days 1-20 $0 after 20 days	10a (Ambulance); 50	"11a (DME); Lesser of 20% or $250 max per item,11b (Prosthetics); Lesser of 20% - $200 max  per item"	11c (Diabetic Supplies); 20% / $200 max	"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 - $20	"8b (OP Therap Rad); 20,8b (OP Diag); 20,8b (X-Ray); 20"	5 (Partial Hosp); $275/day pro-rated	12 (Renal Dialysis); 20	"9a (OP Other); 0, 9c (OP SA); 20, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); 20, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; 0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); 20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); 20, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); 20, 17b1 (Non MCR Covered); 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); 20,7e (MH Non-Phys); 20"	7i (PT/ST); 20	7g1 Prof Radiology; n/a	7g (Prof. Other); 20	15 (Part B Rx); 0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$20	17b1 (Non MCR Covered); 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													275	275	21.71160897		50		0.1747	50	50		20		20	20	20	20	20	20							20																NO	245.3642393	245.3642393	19.37182698		44.61167987		0.155873209	44.61167987	44.61167987		17.84467195		17.84467195	17.84467195	17.84467195	17.84467195	17.84467195	17.84467195							17.84467195																	5.9711	0.067982607	2.228049922	0	2.958883861	0	1.64025669	1.108338309	1.320702401	0	1.543583572	0	0.024674685	0.012135091	12.72438438	5.082116258	0.362780998	1.282064864	0	0	0	0	0	0	0.44154976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7686	0		4.441011597	5.9711	0.067982607	2.228049922	0	2.958883861	0	1.64025669	1.108338309	1.320702401	0	1.543583572	0	0.024674685	0.012135091	12.72438438	5.082116258	0.362780998	1.282064864	0	0	0	0	0	0	0.44154976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7686	NO																																																																																		0	0		0	5.9711	0.067982607	2.228049922	0	2.958883861	0	1.64025669	1.108338309	1.320702401	0	1.543583572	0	0.024674685	0.012135091	12.72438438	5.082116258	0.362780998	1.282064864	0	0	0	0	0	0	0.44154976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7686
H3388_002_0	2012	9																															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	V	O																																																			0	YES	232.6798736	6.135396725	870.1032963		599.2275517		10.19077812	272.7237612	384.1748691		1206.592896		25.16972046	78.51295519	8733.91245	4633.36882	681.7432623	1165.777923							327.9931463																2500	"1a (IP Acute); $275 / admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $275 / admit (190 lifetime limit)	"2a (SNF); $0 - days 1-20 $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0 days 1-20 $0 after 20 days	10a (Ambulance); 50	"11a (DME); Lesser of 20% or $250 max per item,11b (Prosthetics); Lesser of 20% - $200 max  per item"	11c (Diabetic Supplies); 0	"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 - $20	"8b (OP Therap Rad); 20,8b (OP Diag); 20,8b (X-Ray); 20"	5 (Partial Hosp); 20	12 (Renal Dialysis); 20	"9a (OP Other); 0, 9c (OP SA); 20, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); 20, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; 0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); 20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); 20, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); 20, 17b1 (Non MCR Covered); 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); 20,7e (MH Non-Phys); 20"	7i (PT/ST); 20	7g1 Prof Radiology; n/a	7g (Prof. Other); 20	15 (Part B Rx); 0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$20	17b1 (Non MCR Covered); 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													275	275	21.71160897		50		0.1747	50	50		20		20	20	20	20	20	20							20																NO	244.5966199	244.5966199	19.31122243		44.47211271		0.155385562	44.47211271	44.47211271		17.78884508		17.78884508	17.78884508	17.78884508	17.78884508	17.78884508	17.78884508							17.78884508																	4.7427	0.125058108	1.400229857	0	2.220742935	0	1.583499784	1.010716821	1.423755673	0	1.788657842	0	0.037311688	0.1163879	12.94718463	6.868523347	1.010618773	1.728153572	0	0	0	0	0	0	0.486218272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4898	0		4.659983389	4.7427	0.125058108	1.400229857	0	2.220742935	0	1.583499784	1.010716821	1.423755673	0	1.788657842	0	0.037311688	0.1163879	12.94718463	6.868523347	1.010618773	1.728153572	0	0	0	0	0	0	0.486218272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4898	NO																																																																																		0	0		0	4.7427	0.125058108	1.400229857	0	2.220742935	0	1.583499784	1.010716821	1.423755673	0	1.788657842	0	0.037311688	0.1163879	12.94718463	6.868523347	1.010618773	1.728153572	0	0	0	0	0	0	0.486218272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4898
H3388_004_0	2012	11																															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	V	O																																																			0	YES	197.4096243	6.452591987	699.2974604		532.1024828		9.167302732	329.8402881	334.4892344		1262.245499		25.99722091	128.8104651	7537.696877	3936.103149	587.7515765	730.3430851							165.511649																3300	"1a (IP Acute); $650 / admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $650 / admit (190 lifetime limit)	"2a (SNF); $0 - days 1-20 $90 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0 days 1-20 $0 after 20 days	10a (Ambulance); 100	"11a (DME); Lesser of 20% or $250 max per item,11b (Prosthetics); Lesser of 20% or $250 max per item"	11c (Diabetic Supplies); 0	"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 - $30	"8b (OP Therap Rad); 30,8b (OP Diag); 30,8b (X-Ray); 30"	5 (Partial Hosp); 30	12 (Renal Dialysis); 30	"9a (OP Other); 0, 9c (OP SA); 30, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); 30, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; 0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); 20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); 30, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); 30, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); 30,7e (MH Non-Phys); 30"	7i (PT/ST); 30	7g1 Prof Radiology; n/a	7g (Prof. Other); 30	15 (Part B Rx); 0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $100 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$30	17b1 (Non MCR Covered); n/a	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													650	650	27.91492582		100		0.17814	50	125		30		30	30	30	29.18257022	30	30							30																NO	572.3634173	572.3634173	24.58074206		88.05591036		0.156862799	44.02795518	110.069888		26.41677311		26.41677311	26.41677311	26.41677311	25.69697787	26.41677311	26.41677311							26.41677311																	9.4158	0.307768967	1.432437541	0	3.904564044	0	1.438008763	1.210182785	3.06809938	0	2.778704413	0	0.057230224	0.283563069	16.59346901	8.428829625	1.293875003	1.607775631	0	0	0	0	0	0	0.364356973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1847	0		7.078443278	9.4158	0.307768967	1.432437541	0	3.904564044	0	1.438008763	1.210182785	3.06809938	0	2.778704413	0	0.057230224	0.283563069	16.59346901	8.428829625	1.293875003	1.607775631	0	0	0	0	0	0	0.364356973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1847	NO																																																																																		0	0		0	9.4158	0.307768967	1.432437541	0	3.904564044	0	1.438008763	1.210182785	3.06809938	0	2.778704413	0	0.057230224	0.283563069	16.59346901	8.428829625	1.293875003	1.607775631	0	0	0	0	0	0	0.364356973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1847
H3388_801_0	2012	1																															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	O																																																			0	YES	193.0130511	1.237434933	21.42067469		8.915174805		8.436670242	10.81700982	60.74408884	4.137232725	16.47254705	1.013960799	0.11370217	14.58832065	76.71618482	177.8825953	2.661413614	7.697695475		12.29075558	61.82191993																				6700	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													0.089804232	0.089804232	0.199360782		0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				NO	0.082134773	0.082134773	0.182334977		0.204869958		0.204869958	0.204869958	0.204869958	0.204869958	0.204869958	0.204869958	0.204869958	0.204869958	0.205591441	0.219503684	0.204869958	0.204869958		0.224	0.204869958																					15.8531	0.101636438	3.905738235	0	1.826451488	0	1.728420278	2.216080347	12.44463893	0.847594695	3.374730023	0.207730106	0.023294159	2.988708639	15.77219095	39.04588505	0.545243695	1.577026549	0	2.75312925	12.66545414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.877	0		7.843198857	15.8531	0.101636438	3.905738235	0	1.826451488	0	1.728420278	2.216080347	12.44463893	0.847594695	3.374730023	0.207730106	0.023294159	2.988708639	15.77219095	39.04588505	0.545243695	1.577026549	0	2.75312925	12.66545414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.877	NO																																																																																		0	0		0	15.8531	0.101636438	3.905738235	0	1.826451488	0	1.728420278	2.216080347	12.44463893	0.847594695	3.374730023	0.207730106	0.023294159	2.988708639	15.77219095	39.04588505	0.545243695	1.577026549	0	2.75312925	12.66545414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.877
H3388_803_0	2012	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	O																																																			0	YES	191.0141575	1.680573683	24.31799818		9.416754942		8.997766722	10.73325816	47.23796804	3.894992114	14.51389679	1.147116345	0.125604695	14.9547076	73.25169124	165.8095987	3.085451788	7.370591782		11.21057496	50.01219627																				6700	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													0.089719362	0.089719362	0.198583368		0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				NO	0.082742199	0.082742199	0.183140229		0.206580298		0.206580298	0.206580298	0.206580298	0.206580298	0.206580298	0.206580298	0.206580298	0.206580298	0.207258051	0.219607829	0.206580298	0.206580298		0.224	0.206580298																					15.8049	0.139054362	4.453603765	0	1.945316044	0	1.858761332	2.217279671	9.758433522	0.804628632	2.998285125	0.236971637	0.025947455	3.089347954	15.18200277	36.41308592	0.63739355	1.522619048	0	2.51116879	10.33153442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9304	0		6.661959028	15.8049	0.139054362	4.453603765	0	1.945316044	0	1.858761332	2.217279671	9.758433522	0.804628632	2.998285125	0.236971637	0.025947455	3.089347954	15.18200277	36.41308592	0.63739355	1.522619048	0	2.51116879	10.33153442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9304	NO																																																																																		0	0		0	15.8049	0.139054362	4.453603765	0	1.945316044	0	1.858761332	2.217279671	9.758433522	0.804628632	2.998285125	0.236971637	0.025947455	3.089347954	15.18200277	36.41308592	0.63739355	1.522619048	0	2.51116879	10.33153442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9304
H3388_804_0	2012	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	O																																																			0	YES	200.3560052	2.401498883	30.22544309		10.35914056		10.62777813	13.56951676	65.50630974	5.114254067	21.79288496	0.736098417	0.075728909	22.20687942	91.11969524	192.429136	2.731662868	8.326376323		18.40331761	61.81161684																				6700	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a													0.08980228	0.08980228	0.199299913		0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				NO	0.080965252	0.080965252	0.179687728		0.201957193		0.201957193	0.201957193	0.201957193	0.201957193	0.201957193	0.201957193	0.201957193	0.201957193	0.202644594	0.219519965	0.201957193	0.201957193		0.224	0.201957193																					16.2219	0.194437962	5.431141189	0	2.092102947	0	2.146356237	2.740461513	13.22947042	1.032860395	4.401229869	0.14866037	0.015293998	4.484839029	18.46491366	42.24203713	0.551678964	1.681571588	0	4.122343145	12.48330062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6846	0		10.10496958	16.2219	0.194437962	5.431141189	0	2.092102947	0	2.146356237	2.740461513	13.22947042	1.032860395	4.401229869	0.14866037	0.015293998	4.484839029	18.46491366	42.24203713	0.551678964	1.681571588	0	4.122343145	12.48330062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6846	NO																																																																																		0	0		0	16.2219	0.194437962	5.431141189	0	2.092102947	0	2.146356237	2.740461513	13.22947042	1.032860395	4.401229869	0.14866037	0.015293998	4.484839029	18.46491366	42.24203713	0.551678964	1.681571588	0	4.122343145	12.48330062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6846
H3404_001_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	V	V	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	946.3640802	0	563.8685835	11.08904632	34.8215664	18.43638848	0	966.5975132	844.8098425	20.47429811	37.21896165	0	0.000258772	1414.280941	4174.182321	5143.185291	472.5793941	302.7759951	0	811.6424923	0.191445894	0.307286854	0	0	71.96193256	0	0	0	6.132772043	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, $50 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, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	(5) $40 copay	(12) 0% coinsurance	"(3) $0 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 copay"	"(7a) $15 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) $20 copay, (7f) $40 copay, (7g) $15-$40 copay, (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) Non Covered, (9d) 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	NO	120.6948412	0	31.71221289	0	100	0.2	0.2	49.6504424	100	0.2	0.2	0	0	99.83689645	15	40	40	40	0	30.39091316	0.2	0	0	40	40	20.1	40	0	0	0											NO	92.79334935	0	24.38117835	0	76.88261439	0.153765229	0.153765229	38.17255818	76.88261439	0.153765229	0.153765229	0	0	76.75721612	11.53239216	30.75304576	30.75304576	30.75304576	0	23.36532858	0.153765229	0	0	30.75304576	30.75304576	15.45340549	30.75304576	0	0	0												7.318	0	1.145648375	0	0.223097755	2.834875492	0	3.074791651	5.412599113	3.148235133	5.722982154	0	0	9.046355654	4.011525623	13.18071772	1.211104644	0.775940336	0	1.580357793	0.029437722	0	0	0	0.184420717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9001	0	NO	17.68661649	7.318	0	1.145648375	0	0.223097755	2.834875492	0	3.074791651	5.412599113	3.148235133	5.722982154	0	0	9.046355654	4.011525623	13.18071772	1.211104644	0.775940336	0	1.580357793	0.029437722	0	0	0	0.184420717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9001	YES	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	"(4a) $50 copay, (4b) $40 copay"	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	20% coinsurance	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	20% coinsurance	Non Covered											5100	2.2254	0	0.2997	0.2206	1.0985	0.7302	0.001	1.2512	0.9435	0.3531	0.5213	0	0.0015	0.0336	0	2.3564	0.0162	0.1078	0	0.3786	0.443	0.009	0	0	0	0	0	0	0	0											10.9905	0	NO	0.391645587	9.5435	0	1.445323151	0.220608174	1.321590754	3.565050305	0.001005474	4.326006643	6.356072046	3.501318932	6.244278407	0	0.001480613	9.07994799	4.011525623	15.53712229	1.227324527	0.883691968	0	1.958989547	0.472415091	0.008986312	0	0	0.184420717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8906
H3404_002_0	2012	10																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	V	V	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1051.689216	0	537.8636571	9.680224117	29.78595949	19.608787	0	923.3776334	991.652107	23.27008279	34.89505532	0	1.350043469	1404.465162	4284.444331	5534.821528	547.6622256	358.8987771	0	911.7772612	10.81550524	0.583132298	0	0	65.28198819	0	0	0	6.132772043	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, $50 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, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	(5) $40 copay	(12) 0% coinsurance	"(3) $0 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 copay"	"(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) $20 copay, (7f) $40 copay, (7g) $20-$40 copay, (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) Non Covered, (9d) 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	NO	122.6787045	0	34.02875156	0	100	0.2	0.2	49.62256354	100	0.2	0.2	0	0	98.94040151	20	40	40	40	0	31.78761911	0.2	0	0	40	40	20.1	40	0	0	0											NO	90.74521687	0	25.17100627	0	73.96981996	0.14793964	0.14793964	36.70572091	73.96981996	0.14793964	0.14793964	0	0	73.18603687	14.79396399	29.58792799	29.58792799	29.58792799	0	23.51324462	0.14793964	0	0	29.58792799	29.58792799	14.86793381	29.58792799	0	0	0												7.953	0	1.128214124	0	0.183605172	2.900916888	0	2.824436809	6.112693985	3.442567669	5.16236192	0	0	8.565603263	5.28199293	13.64699173	1.350349208	0.884922597	0	1.786570149	1.600041951	0	0	0	0.16096323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9852	0	NO	22.13002929	7.953	0	1.128214124	0	0.183605172	2.900916888	0	2.824436809	6.112693985	3.442567669	5.16236192	0	0	8.565603263	5.28199293	13.64699173	1.350349208	0.884922597	0	1.786570149	1.600041951	0	0	0	0.16096323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9852	YES	"195 copay per day, days 1 - 6"	"195 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $50 per day after day 10"	0% coinsurance	$100 copay	20% coinsurance	20% coinsurance	"(4a) $50 copay, (4b) $40 copay"	$100 copay	20% coinsurance	"20% coinsurance, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	$40 copay	0% coinsurance	$40 copay	$40 copay	$40 copay	$40 copay	$40 copay	$40 copay	$40 copay	20% coinsurance	0% coinsurance	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	$40 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	0% coinsurance	Non Covered											5100	0.3747	0	0.3086	0	1.1109	0.3868	0.0005	1.433	1.3173	0.4612	0.7492	0	0	0.4685	0	4.0543	0	0.3052	0	1.0003	0.1178	0	0	0	0	0	0	0	0	0											12.0884	0	NO	0.508426956	8.3277	0	1.436840212	0	1.29449831	3.287693903	0.000541082	4.257455043	7.42997248	3.903717958	5.911566159	0	0	9.034059434	5.28199293	17.70131514	1.350349208	1.190168461	0	2.786911629	1.717871999	0	0	0	0.16096323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0736
H3404_801_0	2012	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	183.5990691	0	33.02797746	9.167384143	0.990422088	11.9908203	0	17.29672991	88.49892566	19.83019157	31.1503157	0	0.008938772	15.41848028	27.4171462	71.62673535	1.796786051	5.037963304	0	8.978678355	0.058189121	0.453311049																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	0	NO	13.89625954	12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	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	0.7836	0	0.313	0	0.7989	0.474	0	0.6413	1.0643	0.2689	0.4224	0	0.0001	0.2091	0.6304	1.6469	0.0413	0.1158	0	0.2064	0.1312	0.0129																			7.7608	0	NO	0.089056114	13.4535	0	5.460378108	0	0.985946697	2.738042486	0	3.907173425	17.77402785	4.013085937	6.30396804	0	0.001808962	3.120276784	5.807104193	15.17094128	0.380569288	1.067068674	0	1.901734059	0.142211061	0.09850631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3264
H3404_803_0	2012	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	189.1117582	0	35.2180985	9.536447013	0.931577482	12.60276623	0	15.34339565	87.84121269	19.45453495	30.56021438	0	0.008769439	15.12639766	27.86644407	72.80051689	1.826230842	5.120522816	0	9.125816247	0.050206318	0.330917065																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				13.0504	0	5.488725191	0	0.175893357	2.379558221	0	2.897022968	16.58550797	3.673256943	5.770146649	0	0.001655779	2.856051064	5.261529481	13.74563847	0.344814982	0.966818073	0	1.723067037	0.009479574	0.062481237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.992	0	NO	13.97573021	13.0504	0	5.488725191	0	0.175893357	2.379558221	0	2.897022968	16.58550797	3.673256943	5.770146649	0	0.001655779	2.856051064	5.261529481	13.74563847	0.344814982	0.966818073	0	1.723067037	0.009479574	0.062481237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.992	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	0.8071	0	0.3337	0	0.7515	0.4982	0	0.5689	1.0564	0.2638	0.4144	0	0.0001	0.2051	0.6407	1.6739	0.042	0.1177	0	0.2098	0.1132	0.0094																			7.7062	0	NO	0.088429551	13.8575	0	5.822461709	0	0.92736799	2.87777721	0	3.465933043	17.64193349	3.937063359	6.184547746	0	0.001774694	3.061167288	5.902267984	15.41955475	0.386805859	1.084555238	0	1.932898683	0.122701523	0.071909606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6982
H3404_807_0	2012	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	183.5990691	0	33.02797746	9.167384143	0.990422088	11.9908203	0	17.29672991	88.49892566	19.83019157	31.1503157	0	0.008938772	15.41848028	27.4171462	71.62673535	1.796786051	5.037963304	0	8.978678355	0.058189121	0.453311049																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	0	NO	13.89625954	12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	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	0.7836	0	0.313	0	0.7989	0.474	0	0.6413	1.0643	0.2689	0.4224	0	0.0001	0.2091	0.6304	1.6469	0.0413	0.1158	0	0.2064	0.1312	0.0129																			7.7608	0	NO	0.089056114	13.4535	0	5.460378108	0	0.985946697	2.738042486	0	3.907173425	17.77402785	4.013085937	6.30396804	0	0.001808962	3.120276784	5.807104193	15.17094128	0.380569288	1.067068674	0	1.901734059	0.142211061	0.09850631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3264
H3404_808_0	2012	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	183.5990691	0	33.02797746	9.167384143	0.990422088	11.9908203	0	17.29672991	88.49892566	19.83019157	31.1503157	0	0.008938772	15.41848028	27.4171462	71.62673535	1.796786051	5.037963304	0	8.978678355	0.058189121	0.453311049																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	0	NO	13.89625954	12.6699	0	5.147395787	0	0.187003946	2.264015256	0	3.265836649	16.70969231	3.744185561	5.881565081	0	0.001687751	2.911199876	5.176696482	13.52401399	0.339255441	0.951229815	0	1.695285582	0.010986826	0.085590736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5656	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	0.7836	0	0.313	0	0.7989	0.474	0	0.6413	1.0643	0.2689	0.4224	0	0.0001	0.2091	0.6304	1.6469	0.0413	0.1158	0	0.2064	0.1312	0.0129																			7.7608	0	NO	0.089056114	13.4535	0	5.460378108	0	0.985946697	2.738042486	0	3.907173425	17.77402785	4.013085937	6.30396804	0	0.001808962	3.120276784	5.807104193	15.17094128	0.380569288	1.067068674	0	1.901734059	0.142211061	0.09850631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3264
H3405_001_0	2012	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	837.76	36.63	406.24	1056.64	30.38	13.21	5.44	212.31	248.76	906.18	593.27	204.22	0.1	5.06	3157.14	3956.68	71.59	791.73		1806.74	28.35	0			0.61				3.99	0.81	2476.52	344.5									4900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$20-$150/Visit: 3. $20 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	195	35.787512	97.91052	46.426375	0.2	0.2	20	38.542693	40	20		0	0.2	0			0				0	0	0	72.371123									NO	116.498973	102.303881	28.083213	0	182.0832	0.182083	0.182083	59.17704	177.53112	32.581523	89.139304	42.267314	0.182083	0.182083	18.20832	35.089884	36.41664	18.20832		0	0.182083	0			0				0	0	0	65.887829										8.1332	0.312282597	0.950710371	0	0.460973968	2.40531643	0.99053152	1.04698978	3.680220118	2.460393709	4.406972907	0.719319239	0.0182083	0.92133998	4.79051795	11.56995352	0.217255605	1.201339433	0	0	5.16205305	0	0	0	0	0	0	0	0	0	0	1.891529758	0	0	0	0	0	0	0	0	51.3391	0	NO	6.186345	8.1332	0.312282597	0.950710371	0	0.460973968	2.40531643	0.99053152	1.04698978	3.680220118	2.460393709	4.406972907	0.719319239	0.0182083	0.92133998	4.79051795	11.56995352	0.217255605	1.201339433	0	0	5.16205305	0	0	0	0	0	0	0	0	0	0	1.891529758	0	0	0	0	0	0	0	0	51.3391	YES	35% Coins	35% Coins	"35% Coins(Days 1-7), 35% (Days 8-100)"	35% Coins	$200/Trip	40% Coins	40% Coins	$65/Visit	35% Coins	35% Coins	35% Coins	35% Coins	20% Coins	35% Coins	35% Coins	35% Coins	35% Coins	35% Coins		35% Coins	20%-35% Coins	$0/Service			"VIS775: Vision 17a,17b"						40% Coins	35% Coins									7300	21.6547	0.2822	0.39	3.1126	4.0297	1.3443	0.553	1.0041	2.1193	1.5434	2.9056	0.3474	0.015	1.3678	1.7261	3.4351	0.0346	0.5893		0.3994	1.2312	0			0				0	0	0.3694	2.6576									51.1115	1000	NO	31.367964	29.7879	0.594470597	1.340681371	3.112584	4.490687968	3.74957543	1.54353952	2.05106978	5.799490118	4.003781709	7.312562907	1.066670239	0.0331903	2.28914298	6.51661595	15.00508252	0.251825605	1.790597433	0	0.399352	6.39328105	0	0	0	0	0	0	0	0	0	0.369363	4.549142758	0	0	0	0	0	0	0	0	102.4506
H3405_002_0	2012	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			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	1110.58	82.23	475.23	1169.73	33.96	13.04	4.25	399.55	317.85	825.23	1012.69	173.5	0.14	10.95	3639.93	3812.99	118.6	640.68		2381.38	18.91	0			1.69				3.99	0.81	2705.47	494.81									4900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	150	0.2	0.2	65	195	57.272011	96.88963	38.711048	0.2	0.2	15	34.285619	35	15		0	0.2	0			0				0	0	0	71.173178									NO	119.642612	105.064476	28.426466	0	137.4864	0.183315	0.183315	59.57744	178.73232	52.494151	88.806709	35.481617	0.183315	0.183315	13.74864	31.425376	32.08016	13.74864		0	0.183315	0			0				0	0	0	65.235627										11.0727	0.719954322	1.12575912	0	0.389086512	2.3904276	0.77908875	1.983680513	4.734172326	3.609979019	7.494472178	0.513005046	0.0256641	2.00729925	4.1703406	9.985387036	0.317058915	0.73403989	0	0	3.46648665	0	0	0	0	0	0	0	0	0	0	2.689936716	0	0	0	0	0	0	0	0	58.2086	0	NO	6.560252	11.0727	0.719954322	1.12575912	0	0.389086512	2.3904276	0.77908875	1.983680513	4.734172326	3.609979019	7.494472178	0.513005046	0.0256641	2.00729925	4.1703406	9.985387036	0.317058915	0.73403989	0	0	3.46648665	0	0	0	0	0	0	0	0	0	0	2.689936716	0	0	0	0	0	0	0	0	58.2086	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$150/Trip	40% Coins	40% Coins	$65/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"						40% Coins	30% Coins									7300	4.4834	0.1028	0.4161	1.849	2.4578	0.965	0.3142	0.1789	1.4139	0.2679	0.726	0.0355	0.0024	0.2741	1.1685	1.8919	0.0289	0.1308		0.321	0.5055	0			0				0	0	0.266	0.3671									18.1668	0	NO	7.613583	15.5562	0.822713322	1.54188112	1.84897	2.846847512	3.3554566	1.09326575	2.162564513	6.148074326	3.877885019	8.220438178	0.548533046	0.0280211	2.28141125	5.3388636	11.87733404	0.345990915	0.86486389	0	0.321011	3.97200565	0	0	0	0	0	0	0	0	0	0.26603	3.057035716	0	0	0	0	0	0	0	0	76.3753
H3405_005_0	2012	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	1197.47	41.51	524.05	984.31	20.58	15.84	5.51	340.09	276.98	1786.75	954.13	137.87	0.12	9.94	3227.56	3560.08	59.3	479.15		1937.2	12.35	0			0.61				3.99	0.81	2579.05	944.03									3900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	150	72.222632	88.32766	44.623672	0.2	0.2	15	38.33016	40	15		0	0.2	0			0				0	0	0	71.65551									NO	108.232051	95.044262	24.748905	0	174.1318	0.174132	0.174132	56.592835	130.59885	62.881285	76.903272	38.852001	0.174132	0.174132	13.059885	33.372499	34.82636	13.059885		0	0.174132	0			0				0	0	0	62.387515										10.8004	0.328773943	1.080805305	0	0.298636037	2.75825088	0.95946732	1.603888105	3.014439123	9.362761331	6.114643243	0.446377115	0.02089584	1.73087208	3.512630203	9.90073052	0.172100262	0.521470325	0	0	2.1505302	0	0	0	0	0	0	0	0	0	0	4.907973815	0	0	0	0	0	0	0	0	59.6856	0	NO	10.943368	10.8004	0.328773943	1.080805305	0	0.298636037	2.75825088	0.95946732	1.603888105	3.014439123	9.362761331	6.114643243	0.446377115	0.02089584	1.73087208	3.512630203	9.90073052	0.172100262	0.521470325	0	0	2.1505302	0	0	0	0	0	0	0	0	0	0	4.907973815	0	0	0	0	0	0	0	0	59.6856	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									5800	3.8452	0.0575	0.2905	2.0997	1.8795	1.1093	0.3861	0.1441	1.3482	0.3612	0.6394	0.0252	0.0019	0.2354	0.9651	1.4947	0.0164	0.0992		0.2228	0.3061	0			0				0	0	0.2807	0.4444									16.2526	0	NO	8.803521	14.6456	0.386321943	1.371298305	2.099718	2.178129037	3.86759088	1.34552032	1.748000105	4.362672123	9.723938331	6.754074243	0.471587115	0.02281484	1.96630008	4.477706203	11.39544652	0.188500262	0.620641325	0	0.222765	2.4566072	0	0	0	0	0	0	0	0	0	0.280689	5.352345815	0	0	0	0	0	0	0	0	75.9383
H3405_007_0	2012	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			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	1306.26	81.65	348.92	1483.52	27.96	12	4.51	384.84	362.15	1093.12	989.95	162.84	0.38	6.8	3184.15	4236.22	90.56	786.8		1925.82	21.12	0			2.86				3.99	0.81	1904.06	498.18									3900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	195	59.616216	92.950903	44.262788	0.2	0.2	15	38.808679	40	15		0	0.2	0			0				0	0	0	73.312723									NO	106.65405	93.658535	25.590106	0	174.168	0.174168	0.174168	56.6046	169.8138	51.916186	80.945365	38.545806	0.174168	0.174168	13.0626	33.79615	34.8336	13.0626		0	0.174168	0			0				0	0	0	63.843652										11.6098	0.637268282	0.744074982	0	0.40581144	2.090016	0.78549768	1.815309522	5.124838973	4.729218437	6.67765534	0.523066587	0.06618384	1.1843424	3.466106483	11.93066055	0.262877568	0.85647114	0	0	3.67842816	0	0	0	0	0	0	0	0	0	0	2.650469213	0	0	0	0	0	0	0	0	59.2381	0	NO	11.177722	11.6098	0.637268282	0.744074982	0	0.40581144	2.090016	0.78549768	1.815309522	5.124838973	4.729218437	6.67765534	0.523066587	0.06618384	1.1843424	3.466106483	11.93066055	0.262877568	0.85647114	0	0	3.67842816	0	0	0	0	0	0	0	0	0	0	2.650469213	0	0	0	0	0	0	0	0	59.2381	YES	$0-$195/Day(Days 1-7)	$0-$195/Day(Days 1-7)	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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"						35% Coins	30% Coins									5800	1.3657	0.075	0.3843	2.293	2.7947	0.8049	0.3023	0.1785	1.6057	0.2101	0.6329	0.0334	0.0065	0.1765	0.9499	1.9066	0.0192	0.1715		0.2321	0.5911	0			0				0	0	0.1715	0.3549									15.2602	0	NO	3.358297	12.9755	0.712228282	1.128401982	2.292964	3.20046944	2.894888	1.08783968	1.993820522	6.730566973	4.939319437	7.31052934	0.556435587	0.07267584	1.3608234	4.416017483	13.83725655	0.282073568	1.02796814	0	0.232092	4.26953316	0	0	0	0	0	0	0	0	0	0.171527	3.005339213	0	0	0	0	0	0	0	0	74.4983
H3410_002_10	2012	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	NO	846.0877135	49.2144207	968.93445		102.7941053	5.547816124	7.222051088	189.0408353	240.2890189		607.0434015	17.74693502	1.074951252	233.9072565	1936.459191	3843.95554	253.9291854	573.7099			13.60139139				175.7236679		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189282265	65	94.17178842		29.84688016	29	412.5164873	79.8315131	10.06517344	29.38203015	29	29.71943235			0.2				30		30														NO	65.48335779	53.7274709	45.18180379		131.1998149	0.174933086	0.165558654	56.85325311	82.36880805		26.10603434	25.36529754	360.8139118	69.82586493	8.803659276	25.69944611	25.36529754	25.99456015			0.174933086				30		30															4.6171	0.220347196	3.648183851	0	1.123880632	0.970496598	1.195673056	0.895632205	1.649360006	0	1.320624657	0.037513024	0.032321447	1.361064708	1.420660576	8.232294021	0.536749112	1.242778042	0	0	2.379333377	0	0	0	0.43930917	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9458	0		4.425496439	4.6171	0.220347196	3.648183851	0	1.123880632	0.970496598	1.195673056	0.895632205	1.649360006	0	1.320624657	0.037513024	0.032321447	1.361064708	1.420660576	8.232294021	0.536749112	1.242778042	0	0	2.379333377	0	0	0	0.43930917	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9458	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.9056	0.1399	2.6703		0.7136	0.5777	0.6912	0.4265	1.9376		0.8385	0.1443	0.0205	0.8328	1.7799	5.533	0.3607	0.8209			1.133				0.0012																21.5272	0		3.084546065	7.5227	0.360250178	6.318449182	0	1.837455636	1.548173144	1.886850473	1.322123731	3.586924994	0	2.159116503	0.181779821	0.052843001	2.19387406	3.200560698	13.76529848	0.897477552	2.063713728	0	0	3.512349271	0	0	0	0.440525418	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4729
H3410_002_11	2012	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	NO	989.6160696	62.62360645	1141.421259		123.5626836	7.360680566	9.505246305	226.7694438	275.5968379		694.6501401	24.53027973	1.522403936	261.9201286	2235.925587	4376.048317	317.2603159	655.767855			18.04592925				175.8438897		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.18965071	65	108.9444994		34.26186216	29	455.7901827	86.66998203	10.08116237	29.41152378	29	29.67375831			0.2				30		30														NO	62.58148619	51.34655723	43.1795883		125.385742	0.167180989	0.158529967	54.33382152	91.06724596		28.63966005	24.24124345	380.9972682	72.44786669	8.42689349	24.58523821	24.24124345	24.80444135			0.167180989				30		30															5.161	0.267958883	4.107175004	0	1.29108323	1.230565859	1.506866381	1.026770874	2.091487085	0	1.657878656	0.049553707	0.048335978	1.581296213	1.570158898	8.965515858	0.640898713	1.355496275	0	0	3.016936305	0	0	0	0.439609724	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6311	0		6.982478689	5.161	0.267958883	4.107175004	0	1.29108323	1.230565859	1.506866381	1.026770874	2.091487085	0	1.657878656	0.049553707	0.048335978	1.581296213	1.570158898	8.965515858	0.640898713	1.355496275	0	0	3.016936305	0	0	0	0.439609724	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6311	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.2479	0.1701	3.0062		0.8197	0.7325	0.872	0.4889	2.4569		1.0526	0.2201	0.0307	0.9697	1.9648	6.0251	0.4684	0.8946			1.4366				0.0014																24.8585	0		4.879646725	8.4089	0.438091507	7.113396036	0	2.110818614	1.963045537	2.378872967	1.515709385	4.548435315	0	2.710500024	0.269694317	0.079025488	2.550994125	3.534921455	14.99065777	1.109291375	2.250090563	0	0	4.453572641	0	0	0	0.441028026	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4895
H3410_002_12	2012	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	NO	843.5308633	51.15073478	957.3088011		101.3273029	5.388807279	6.949373279	188.3928059	245.7836767		615.5364963	17.28627713	1.049146204	225.6766528	1942.748549	3838.09793	245.4039056	566.6375747			15.11808769				175.6959161		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189742816	65	96.38002504		30.8576382	29	395.2341662	76.88634524	10.06348366	29.40773316	29	29.7165146			0.2				30		30														NO	65.43928214	53.69130792	45.15139274		131.1115067	0.174815342	0.165849776	56.81498622	84.24353531		26.97194291	25.34822462	345.4649801	67.20456378	8.796256701	25.70461468	25.34822462	25.97451335			0.174815342				30		30															4.6	0.228862488	3.601985471	0	1.107097946	0.942046189	1.152552004	0.891961223	1.725473821	0	1.383517936	0.036514703	0.030203606	1.263875084	1.424076246	8.221402367	0.518379444	1.226511271	0	0	2.642873673	0	0	0	0.43923979	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0591	0		4.465611193	4.6	0.228862488	3.601985471	0	1.107097946	0.942046189	1.152552004	0.891961223	1.725473821	0	1.383517936	0.036514703	0.030203606	1.263875084	1.424076246	8.221402367	0.518379444	1.226511271	0	0	2.642873673	0	0	0	0.43923979	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0591	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8949	0.1453	2.6365		0.7029	0.5607	0.6671	0.4247	2.027		0.8784	0.135	0.0192	0.7713	1.7842	5.5257	0.3334	0.8101			1.2585				0.0012																21.5763	0		3.108203762	7.4949	0.374172004	6.238436188	0	1.810017277	1.502787968	1.819700951	1.316704662	3.752452558	0	2.261942023	0.171556474	0.049380499	2.035215354	3.208275045	13.74709776	0.851783504	2.036640955	0	0	3.901384945	0	0	0	0.440409397	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6354
H3410_002_13	2012	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	NO	831.4876917	46.9931393	948.5773327		99.47148954	5.358597636	6.941806729	184.3178467	237.5208087		598.7853523	15.85855096	0.951237433	226.1346944	1910.162042	3778.761966	235.5145361	565.7066759			13.25670738				175.6865639		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.18975173	65	92.85323225		29.4578132	29	397.9088918	77.39207206	10.05810161	29.3904421	29	29.73299611			0.2				30		30														NO	65.77640084	53.96790546	45.38399583		131.7869441	0.175715925	0.166712004	57.10767578	81.57895819		25.88103454	25.47880919	349.5946459	67.99509784	8.836843167	25.82184367	25.47880919	26.12280464			0.175715925				30		30															4.5577	0.211343442	3.587519143	0	1.092420303	0.941590943	1.157282512	0.877163652	1.61472501	0	1.291432032	0.033671416	0.027712293	1.281337556	1.406650199	8.131216729	0.500052494	1.231487082	0	0	2.329414606	0	0	0	0.43921641	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3344	0		4.18371132	4.5577	0.211343442	3.587519143	0	1.092420303	0.941590943	1.157282512	0.877163652	1.61472501	0	1.291432032	0.033671416	0.027712293	1.281337556	1.406650199	8.131216729	0.500052494	1.231487082	0	0	2.329414606	0	0	0	0.43921641	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3344	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8683	0.1342	2.6259		0.6936	0.5605	0.6699	0.4177	1.8969		0.82	0.1227	0.0176	0.7824	1.7634	5.4653	0.3259	0.8137			1.1092				0.0012																21.0881	0		2.914235293	7.426	0.345529754	6.213381321	0	1.786020495	1.502061742	1.827186192	1.29486063	3.511602971	0	2.111388878	0.156339968	0.045307399	2.063729623	3.170068732	13.59650193	0.825926632	2.04516068	0	0	3.438659657	0	0	0	0.440370299	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4225
H3410_002_14	2012	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	NO	864.9458518	84.00829175	1037.546628		118.7420604	5.604153544	6.942563395	218.2237549	224.6750833		576.2075972	30.89818404	1.983087435	218.7204891	1860.865861	3556.605183	339.2450631	545.4180685			13.107506				175.7830222		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189682516	65	90.97392639		28.63711175	29	370.4532657	71.96559865	10.12959729	29.44442263	29	29.5559812			0.2				30		30														NO	65.60678959	53.82874363	45.26696851		131.4471179	0.175262824	0.166221467	56.96041774	79.72173616		25.09510535	25.41310945	324.6334272	63.06447018	8.876709123	25.80256328	25.41310945	25.90032362			0.175262824				30		30															4.7289	0.3768384	3.913882543	0	1.3006918	0.982199775	1.154003074	1.03584302	1.492623976	0	1.204999196	0.065434911	0.053648039	1.149457647	1.376530414	7.647460858	0.718439327	1.177208707	0	0	2.297258514	0	0	0	0.439457555	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7373	0		4.329624901	4.7289	0.3768384	3.913882543	0	1.3006918	0.982199775	1.154003074	1.03584302	1.492623976	0	1.204999196	0.065434911	0.053648039	1.149457647	1.376530414	7.647460858	0.718439327	1.177208707	0	0	2.297258514	0	0	0	0.439457555	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7373	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.976	0.2393	2.8647		0.8258	0.5846	0.6679	0.4933	1.7534		0.7651	0.2509	0.0341	0.6989	1.7121	5.1377	0.4135	0.7746			1.0939				0.0013																21.2871	0		3.004352932	7.7048	0.616100876	6.778624369	0	2.126527864	1.566842498	1.821872145	1.529101601	3.246065278	0	1.970078051	0.316341321	0.087710286	1.848325572	3.08861152	12.78516061	1.131976625	1.951837636	0	0	3.39119114	0	0	0	0.440773559	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0245
H3410_002_15	2012	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	NO	890.2670271	51.44075716	1012.369382		106.7824199	6.055454946	7.822239539	198.5426214	253.1855271		637.2690311	17.77225051	1.074136344	239.7174228	2039.186567	4019.948491	256.4566817	602.0996503			15.09159867				175.7347399		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189746885	65	99.1666807		31.39780319	29	420.4687271	81.05987848	10.06175723	29.39693166	29	29.72259139			0.2				30		30														NO	64.54641399	52.95873175	44.53533708		129.3225921	0.172430123	0.163590393	56.03978989	85.49661462		27.06963529	25.0023678	362.5073711	69.88582398	8.674750174	25.34458267	25.0023678	25.62535041			0.172430123				30		30															4.7886	0.227019772	3.757184306	0	1.15078161	1.04414284	1.279643242	0.927190566	1.803875453	0	1.437553354	0.037029029	0.032448529	1.396070801	1.474119502	8.490326405	0.534335357	1.28575121	0	0	2.602246211	0	0	0	0.43933685	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3302	0		5.159390647	4.7886	0.227019772	3.757184306	0	1.15078161	1.04414284	1.279643242	0.927190566	1.803875453	0	1.437553354	0.037029029	0.032448529	1.396070801	1.474119502	8.490326405	0.534335357	1.28575121	0	0	2.602246211	0	0	0	0.43933685	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3302	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.0136	0.1441	2.75		0.7307	0.6215	0.7407	0.4415	2.1191		0.9127	0.1446	0.0206	0.8538	1.8476	5.7065	0.3665	0.8494			1.2392				0.0012																22.5034	0		3.597870546	7.8022	0.371159309	6.507231839	0	1.881436601	1.665656435	2.020366301	1.368709882	3.922955525	0	2.350285643	0.181595349	0.053050769	2.249901154	3.321717868	14.19683903	0.900812994	2.135130483	0	0	3.841411073	0	0	0	0.440571707	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8336
H3410_002_16	2012	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	NO	799.9491712	39.25176659	904.2699551		95.71265973	4.712776159	6.446681261	175.6513361	242.0611157		604.8327163	15.48408619	0.928767277	219.7955697	1904.654753	3748.765863	229.9614731	550.2067594			14.55171298				175.6703897		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189476379	65	94.62794744		30.34614759	29	388.5407249	75.8992141	10.05689282	29.40002786	29	29.73015106			0.2				30		30														NO	65.97010071	54.12683139	45.51764367		132.1750334	0.176233378	0.166960311	57.27584779	83.38301406		26.74002047	25.55383978	342.3692219	66.87987437	8.861800958	25.90633109	25.55383978	26.19722472			0.176233378				30		30															4.3977	0.177047813	3.4300198	0	1.054235333	0.830548461	1.076339908	0.838381599	1.681982118	0	1.347769935	0.032973155	0.026498444	1.224991674	1.406555943	8.093064134	0.489699887	1.20115751	0	0	2.564497531	0	0	0	0.439175974	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9352	0		4.028703143	4.3977	0.177047813	3.4300198	0	1.054235333	0.830548461	1.076339908	0.838381599	1.681982118	0	1.347769935	0.032973155	0.026498444	1.224991674	1.406555943	8.093064134	0.489699887	1.20115751	0	0	2.564497531	0	0	0	0.439175974	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9352	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7676	0.1124	2.5106		0.6694	0.4944	0.6226	0.3992	1.9759		0.8557	0.1173	0.0168	0.748	1.7634	5.4397	0.3116	0.794			1.2212				0.0011																20.8208	0		2.807716835	7.1653	0.289459122	5.94060132	0	1.723591099	1.324922545	1.698890002	1.237610932	3.657869522	0	2.203496877	0.150267649	0.043322853	1.973021229	3.169941122	13.532723	0.801315563	1.995126484	0	0	3.785686832	0	0	0	0.44030268	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	51.756
H3410_002_17	2012	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	NO	926.2344775	53.86821627	1056.059085		111.5617025	6.575553448	8.487662521	206.9156591	263.0730686		662.768154	18.77233771	1.136705724	249.4717283	2119.808078	4179.064617	268.9285949	626.7668864			16.30182391				175.7669998		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.18974584	65	103.0921207		32.63803585	29	437.465246	83.85101771	10.06294414	29.397095	29	29.71992679			0.2				30		30														NO	63.72596791	52.28557609	43.96925075		127.6787794	0.170238373	0.161510115	55.32747106	87.75117423		27.78123053	24.68456401	372.3668575	71.37330394	8.565496162	25.02256805	24.68456401	25.29735984			0.170238373				30		30															4.9188	0.234710893	3.869510558	0	1.187005167	1.119411517	1.370843348	0.954010012	1.923747557	0	1.534376239	0.038615581	0.035272628	1.483801791	1.513100663	8.714244064	0.55319876	1.321295622	0	0	2.775195971	0	0	0	0.439417499	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.609	0		5.864814497	4.9188	0.234710893	3.869510558	0	1.187005167	1.119411517	1.370843348	0.954010012	1.923747557	0	1.534376239	0.038615581	0.035272628	1.483801791	1.513100663	8.714244064	0.55319876	1.321295622	0	0	2.775195971	0	0	0	0.439417499	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.609	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.0955	0.149	2.8323		0.7537	0.6663	0.7935	0.4543	2.2599		0.9742	0.1574	0.0224	0.9087	1.8965	5.857	0.3943	0.8728			1.3215				0.0013																23.4105	0		4.092481289	8.0143	0.383733683	6.701774588	0	1.940659241	1.785727897	2.16435519	1.408300494	4.183645879	0	2.508583375	0.196013365	0.057667948	2.392483797	3.409576558	14.57121362	0.94753749	2.194101487	0	0	4.096717862	0	0	0	0.440706575	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0196
H3410_002_18	2012	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	NO	858.4542501	47.9594936	980.0967023		102.8105847	5.783881667	7.495293018	189.7120575	245.7707713		619.8343522	16.22318283	0.969063598	237.5305411	1975.119488	3925.291536	244.6597862	585.1502172			14.18014522				175.7196453		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189489617	65	95.98652727		30.48309315	29	419.7711999	81.0574959	10.05708921	29.37975042	29	29.73831975			0.2				30		30														NO	65.15914507	53.46146241	44.9581055		130.5502353	0.17406698	0.164919427	56.57176865	83.54042483		26.5304999	25.23971217	365.3415262	70.54716777	8.753035758	25.57022221	25.23971217	25.88229762			0.17406698				30		30															4.6613	0.213665389	3.671940912	0	1.118495503	1.006782817	1.236119429	0.894362219	1.710982887	0	1.370376268	0.034122372	0.029503264	1.396425578	1.440690959	8.364214735	0.514595215	1.262086006	0	0	2.468295062	0	0	0	0.439299113	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4558	0		4.67717265	4.6613	0.213665389	3.671940912	0	1.118495503	1.006782817	1.236119429	0.894362219	1.710982887	0	1.370376268	0.034122372	0.029503264	1.396425578	1.440690959	8.364214735	0.514595215	1.262086006	0	0	2.468295062	0	0	0	0.439299113	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4558	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.9335	0.1357	2.6877		0.7102	0.5993	0.715	0.4259	2.01		0.8701	0.1301	0.0187	0.8547	1.8066	5.6219	0.3545	0.8339			1.1754				0.0012																21.8843	0		3.260203817	7.5948	0.349325953	6.359595075	0	1.828651377	1.606058303	1.951111401	1.32024899	3.720938582	0	2.240456438	0.164250238	0.048235496	2.251095825	3.24727436	13.98616472	0.869107874	2.09603444	0	0	3.643673662	0	0	0	0.440508601	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3401
H3410_002_19	2012	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	NO	816.6365832	48.82671314	937.2810028		100.000895	5.120266794	6.634411918	183.9064663	230.5472832		582.6462679	18.00214362	1.099820653	221.7069938	1861.679317	3676.003257	248.9031405	551.6212629			12.5531833				175.6938389		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189495883	65	90.58868182		28.65389499	29	388.9688663	75.86024808	10.0697375	29.39407162	29	29.70534288			0.2				30		30														NO	66.09706576	54.23100307	45.60524624		132.4294154	0.176572554	0.16729886	57.38608001	79.97737451		25.29745709	25.60302031	343.4061305	66.9741887	8.890196339	25.95093147	25.60302031	26.22574128			0.176572554				30		30															4.4981	0.220660136	3.562077577	0	1.103588339	0.904098584	1.109929551	0.879472599	1.536547201	0	1.22828908	0.038409104	0.031473763	1.23738717	1.379224554	7.949642386	0.531056013	1.205556377	0	0	2.216547634	0	0	0	0.439234597	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6938	0		3.931549018	4.4981	0.220660136	3.562077577	0	1.103588339	0.904098584	1.109929551	0.879472599	1.536547201	0	1.22828908	0.038409104	0.031473763	1.23738717	1.379224554	7.949642386	0.531056013	1.205556377	0	0	2.216547634	0	0	0	0.439234597	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6938	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8308	0.1401	2.6072		0.7007	0.5382	0.642	0.4188	1.805		0.7799	0.1415	0.02	0.7553	1.7268	5.3429	0.3348	0.7962			1.0555				0.0012																20.6368	0		2.737906119	7.3289	0.360761809	6.16931796	0	1.804279348	1.442252504	1.751942951	1.298269075	3.34158676	0	2.008155163	0.179909581	0.051457104	1.992682142	3.106034679	13.2924987	0.865865709	2.001719559	0	0	3.272046507	0	0	0	0.440400713	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3306
H3410_002_7	2012	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	NO	801.5656171	45.30082592	915.9264731		96.88909828	5.025097155	6.63365107	177.6836779	228.9745333		578.8674819	16.31806834	0.978791238	230.0263755	1841.818182	3693.907677	242.3473356	545.5803205			12.31985914				175.7064973		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.188649053	65	89.51206409		28.44386239	29	409.4677608	79.46224139	10.06200263	29.35832291	29	29.7331206			0.2				30		30														NO	66.20539219	54.31988222	45.67998864		132.6464539	0.176861939	0.166824186	57.48013001	79.15638588		25.1531832	25.64498108	362.0963097	70.26923025	8.897926454	25.96184951	25.64498108	26.29328673			0.176861939				30		30															4.4223	0.205061294	3.486625907	0	1.070999609	0.888748424	1.106653442	0.851106742	1.51039971	0	1.213363318	0.034873046	0.029534725	1.346981362	1.365696894	7.991722934	0.51791607	1.195424984	0	0	2.17891417	0	0	0	0.439266243	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4781	0		3.848410763	4.4223	0.205061294	3.486625907	0	1.070999609	0.888748424	1.106653442	0.851106742	1.51039971	0	1.213363318	0.034873046	0.029534725	1.346981362	1.365696894	7.991722934	0.51791607	1.195424984	0	0	2.17891417	0	0	0	0.439266243	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4781	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7831	0.1302	2.552		0.68	0.529	0.6385	0.4053	1.7743		0.7704	0.1307	0.0188	0.825	1.7116	5.3715	0.3473	0.7898			1.0376				0.0012																20.4963	0		2.681285303	7.2054	0.335258941	6.038639913	0	1.75099936	1.417765343	1.745180167	1.256395667	3.284722831	0	1.983752727	0.165607536	0.048286931	2.171973143	3.077299255	13.36319238	0.865237714	1.985258544	0	0	3.216492346	0	0	0	0.440453634	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9744
H3410_002_8	2012	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	NO	778.4950361	45.04144151	891.1555083		94.2097138	4.705010857	6.081691868	173.6791116	221.3385073		558.626503	15.82910185	0.957109423	212.212521	1782.943697	3527.15125	228.0340848	528.2567285			11.53511449				175.6526322		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189606424	65	86.70312071		27.47637149	29	373.1948405	73.30626172	10.06295491	29.39010117	29	29.72205042			0.2				30		30														NO	66.8346622	54.83618265	46.11416848		133.9072339	0.178542979	0.169264478	58.02646802	77.40116709		24.52856602	25.88873189	333.156592	65.44159156	8.983349713	26.23698101	25.88873189	26.53331705			0.178542979				30		30															4.3359	0.205825059	3.424574605	0	1.051280182	0.840046652	1.029414402	0.839832118	1.427654899	0	1.141858922	0.034149614	0.026572276	1.15729376	1.334733896	7.711816698	0.49195944	1.168033605	0	0	2.059513699	0	0	0	0.439131581	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3421	0		3.398698835	4.3359	0.205825059	3.424574605	0	1.051280182	0.840046652	1.029414402	0.839832118	1.427654899	0	1.141858922	0.034149614	0.026572276	1.15729376	1.334733896	7.711816698	0.49195944	1.168033605	0	0	2.059513699	0	0	0	0.439131581	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3421	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7287	0.1307	2.5066		0.6675	0.5	0.5956	0.3999	1.6771		0.725	0.1184	0.0169	0.7053	1.6721	5.1832	0.2994	0.7716			0.9807				0.0011																19.6799	0		2.364966012	7.0645	0.336507637	5.931170548	0	1.718759662	1.340074422	1.625047954	1.239752174	3.104774591	0	1.866848713	0.152579322	0.043443563	1.86259765	3.006834893	12.89505579	0.7913652	1.939628987	0	0	3.040234508	0	0	0	0.440228441	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0219
H3410_002_9	2012	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	NO	850.9743226	60.86014109	993.79565		113.2595737	5.139008845	6.946423858	203.5635717	228.3419809		584.3553307	30.83679091	1.965563395	235.8616376	1878.533888	3702.449526	351.0960616	557.1126216			12.59913254				175.8395413		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.187597217	65	91.8148174		28.67778117	29	411.8640724	79.21627335	10.12673393	29.39633341	29	29.5816205			0.2				30		30														NO	65.58337708	53.80953425	45.25081448		131.4002095	0.175200279	0.164335424	56.94009077	80.42990826		25.12177635	25.4040405	360.7935026	69.39356608	8.871033064	25.75122912	25.4040405	25.91354087			0.175200279				30		30															4.6508	0.272904654	3.747505216	0	1.240194309	0.900355785	1.141543511	0.965910688	1.530460382	0	1.223336994	0.06528159	0.059096875	1.363940011	1.388711352	7.945218837	0.743271547	1.203063391	0	0	2.207371541	0	0	0	0.439598853	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7111	0		4.338384433	4.6508	0.272904654	3.747505216	0	1.240194309	0.900355785	1.141543511	0.965910688	1.530460382	0	1.223336994	0.06528159	0.059096875	1.363940011	1.388711352	7.945218837	0.743271547	1.203063391	0	0	2.207371541	0	0	0	0.439598853	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7111	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.9269	0.1733	2.743		0.7874	0.5359	0.6566	0.46	1.7979		0.7767	0.2749	0.0375	0.8363	1.729	5.338	0.4793	0.7929			1.0511				0.0014																21.398	0		3.028706583	7.5777	0.44617745	6.490468199	0	2.027619267	1.436281848	1.798141355	1.425868158	3.328349526	0	2.000058895	0.340202853	0.096618701	2.200221097	3.11766926	13.28324178	1.222572309	1.995927996	0	0	3.258500846	0	0	0	0.441009847	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1091
H3410_003_10	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	815.5218305	48.14125245	944.9698877		96.50855968	5.16656687	6.406063623	184.4868526	22.08835278		10.17077334	16.98756667	1.030038586	223.0855672	1913.739556	3794.127521	1.479040906	547.1139543			14.20805889				175.6880725		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189098418	65	0.081071812		0.15	29	391.4701348	76.29158738	10.06323412	29.4062309	0.395520425	29.71963234			0.2				30		30														NO	65.82367886	54.0066959	45.41661643		131.8816684	0.175842225	0.166257433	57.14872299	0.071279239		0.131881668	25.49712256	344.1848968	67.07641221	8.847707368	25.85428529	0.347745957	26.12983132			0.175842225				30		30															4.4734	0.216662498	3.576444577	0	1.060642489	0.908500612	1.065055692	0.878599003	1.574440983	0	1.341338557	0.036094506	0.029543644	1.246981622	1.411017297	8.174537945	0.514330495	1.191332945	0	0	2.498376683	0	0	0	0.439220181	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.259	0		4.148601251	4.4734	0.216662498	3.576444577	0	1.060642489	0.908500612	1.065055692	0.878599003	1.574440983	0	1.341338557	0.036094506	0.029543644	1.246981622	1.411017297	8.174537945	0.514330495	1.191332945	0	0	2.498376683	0	0	0	0.439220181	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.259	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8152	0.1376	2.6178		0.6734	0.5408	0.6153	0.4184	1.8496		0.8516	0.132	0.0188	0.761	1.7678	5.4942	0.3278	0.7867			1.1897				0.0012																20.9989	0		2.884736939	7.2886	0.354225989	6.194200796	0	1.734066292	1.449274786	1.680397649	1.296979481	3.423995789	0	2.192982086	0.168079842	0.048301513	2.008005403	3.178855344	13.66875302	0.842159709	1.978067003	0	0	3.688079865	0	0	0	0.440376606	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2579
H3410_003_11	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	905.5449835	60.1919157	1060.288553		112.1116061	6.087314914	7.594636205	212.5244592	26.02737526		11.84311386	24.95677072	1.563125392	241.5501034	2080.636462	4056.713656	1.981022262	596.4210353			16.74011601				175.7976279		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.18881762	65	0.081071812		0.15	29	419.2826289	80.57545063	10.09005257	29.42218645	0.377726039	29.65031985			0.2				30		30														NO	64.05392434	52.55465621	44.19553211		128.3358597	0.17111448	0.161547144	55.61220585	0.069362805		0.12833586	24.81159953	358.7266441	68.93813149	8.632770472	25.17281061	0.323171973	25.36799525			0.17111448				30		30															4.8336	0.263613786	3.9050014	0	1.198994946	1.041627723	1.226891791	0.984912831	1.805331754	0	1.519896199	0.05160145	0.046727894	1.387667733	1.496804751	8.509907046	0.640210873	1.260833832	0	0	2.864476239	0	0	0	0.43949407	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1001	0		5.577108087	4.8336	0.263613786	3.9050014	0	1.198994946	1.041627723	1.226891791	0.984912831	1.805331754	0	1.519896199	0.05160145	0.046727894	1.387667733	1.496804751	8.509907046	0.640210873	1.260833832	0	0	2.864476239	0	0	0	0.43949407	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1001	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.0419	0.1674	2.8582		0.7613	0.62	0.7083	0.469	2.1208		0.965	0.2144	0.0297	0.8489	1.8706	5.7186	0.4273	0.8317			1.364				0.0013																23.0184	0		3.885471907	7.8756	0.430987619	6.763242729	0	1.960261578	1.661644225	1.935149095	1.453918941	3.926122598	0	2.484909658	0.265995817	0.076396398	2.236588275	3.367400017	14.22852554	1.067498596	2.092505444	0	0	4.228512544	0	0	0	0.440834621	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1186
H3410_003_12	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	835.2952948	48.09410608	965.2092744		98.01408015	5.463787596	6.767132162	187.6611706	23.35864859		10.76836516	16.39217956	0.985692424	229.5187065	1966.731094	3905.883857	1.526334463	562.1881174			15.02541589				175.6992065		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189148495	65	0.081071812		0.15	29	403.6148104	78.32400678	10.0585683	29.40256489	0.381869291	29.73154352			0.2				30		30														NO	65.4281307	53.68215844	45.14369854		131.0891641	0.174785552	0.165302121	56.80530444	0.070850908		0.131089164	25.34390506	352.7301874	68.44952385	8.790462068	25.69571769	0.333726175	25.98322125			0.174785552				30		30															4.5543	0.215149619	3.631093043	0	1.07071532	0.954991132	1.1186213	0.888345827	1.654981451	0	1.411615987	0.034620154	0.028973623	1.309203848	1.440706257	8.363707409	0.509377762	1.217288187	0	0	2.626225612	0	0	0	0.439248016	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0917	0		4.476357708	4.5543	0.215149619	3.631093043	0	1.07071532	0.954991132	1.1186213	0.888345827	1.654981451	0	1.411615987	0.034620154	0.028973623	1.309203848	1.440706257	8.363707409	0.509377762	1.217288187	0	0	2.626225612	0	0	0	0.439248016	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0917	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8661	0.1366	2.6578		0.6798	0.5684	0.6464	0.423	1.9442		0.8963	0.1285	0.0184	0.7998	1.8061	5.6215	0.3363	0.804			1.2506				0.0012																21.585	0		3.113668535	7.4205	0.351752551	6.288848865	0	1.75053457	1.523438234	1.765006189	1.31136765	3.599150161	0	2.307880106	0.163145664	0.047369574	2.108998531	3.246787981	13.98523301	0.8456566	2.021323273	0	0	3.876809237	0	0	0	0.440423153	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6767
H3410_003_13	2012	8																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	857.3108899	31.74735291	855.6811032		221.5896049	6.596212822	5.440408859	169.0057777	19.42787221		10.0907292	10.99304796	0.660352416	4429.666215	2138.176014	3707.311333	0.997968633	541.7599558			11.21378119				240.3215925		173.3890955															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.183532268	65	0.081071812		0.15	29	391.7772492	5.423453136	10.03606702	29.02950151	0.393196435	29.81229332			0.2				30		30														NO	67.30681231	55.22357011	46.43993971		134.8532148	0.179804286	0.164999443	58.43639309	0.072885297		0.134853215	26.07162153	352.2161437	4.875800605	9.022639344	26.09814402	0.353492022	26.80189064			0.179804286				26.97064296		26.97064296															4.8086	0.146100181	3.31148157	0	2.490172549	1.18602734	0.897664431	0.823007339	1.416006236	0	1.360767272	0.023883882	0.019382232	1.799847434	1.607665919	8.062828758	0.35277395	1.210015924	0	0	2.016285925	0	0	0	0.540135656	0	0.389701282	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4623	0		3.646185116	4.8086	0.146100181	3.31148157	0	2.490172549	1.18602734	0.897664431	0.823007339	1.416006236	0	1.360767272	0.023883882	0.019382232	1.799847434	1.607665919	8.062828758	0.35277395	1.210015924	0	0	2.016285925	0	0	0	0.540135656	0	0.389701282	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4623	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	1.9906	0.0928	1.8431		0.4707	0.3806	0.4343	0.2928	1.3175		0.6066	0.0859	0.0123	0.5414	1.2565	3.9143	0.2262	0.5594			0.8472				0.0007																14.8729	0		1.670530815	6.7992	0.2388622	5.154591851	0	2.960824978	1.566634638	1.33194511	1.115784047	2.733503642	0	1.967376834	0.109786681	0.031688411	2.341258852	2.864215054	11.97714643	0.578957611	1.76940447	0	0	2.863516544	0	0	0	0.540848549	0	0.389701282	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3352
H3410_003_14	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	933.1826687	82.17465017	1131.661041		133.413852	5.380540159	6.880322499	246.2592453	20.93266378		9.214316204	49.53937362	3.250053068	225.4777875	1928.809644	3540.251679	2.599715553	549.8386204			13.14110052				175.9538088		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.187718404	65	0.081071812		0.15	29	375.6210577	71.69529376	10.20749313	29.49095118	0.445147311	29.34732048			0.2				30		30														NO	64.92670047	53.27074738	44.79772481		130.0845187	0.173446025	0.162795055	56.36995811	0.070307918		0.130084519	25.14967362	325.7498967	62.17631855	8.85224554	25.57544127	0.386045158	25.4508804			0.173446025				30		30															5.049	0.364792086	4.224653324	0	1.446256394	0.933233303	1.120082479	1.156801945	1.47173201	0	1.198639889	0.103824923	0.088225371	1.168281562	1.422858047	7.545291575	1.003607602	1.166156414	0	0	2.27927165	0	0	0	0.439884522	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8051	0		4.85970281	5.049	0.364792086	4.224653324	0	1.446256394	0.933233303	1.120082479	1.156801945	1.47173201	0	1.198639889	0.103824923	0.088225371	1.168281562	1.422858047	7.545291575	1.003607602	1.166156414	0	0	2.27927165	0	0	0	0.439884522	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8051	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.1775	0.2316	3.0922		0.9183	0.5555	0.6445	0.5509	1.7289		0.761	0.4195	0.056	0.712	1.7553	5.0663	0.5684	0.7647			1.0854				0.0016																22.0895	0		3.381575916	8.2265	0.596406109	7.316861878	0	2.364514422	1.488729316	1.764569745	1.707660014	3.200630735	0	1.959681088	0.523350289	0.144241479	1.880263858	3.178117813	12.61155333	1.571981966	1.930901789	0	0	3.364639102	0	0	0	0.441487562	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8946
H3410_003_15	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	899.2238916	56.15841646	1046.846195		108.608058	6.15748737	7.65557715	206.8297688	26.32591628		12.0811615	21.40754808	1.319949779	243.2675577	2092.644429	4119.570837	1.868637723	598.3613951			16.93309027				175.7734451		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.188974577	65	0.081071812		0.15	29	424.7758986	81.66270118	10.07488572	29.41380775	0.36838872	29.68955118			0.2				30		30														NO	64.03308617	52.53755901	44.18115432		128.2941091	0.171058812	0.161628833	55.59411396	0.06934024		0.128294109	24.80352777	363.3083033	69.84562333	8.616989922	25.15745508	0.315080685	25.3932968			0.171058812				30		30															4.7983	0.245868843	3.854239442	0	1.161147838	1.053292476	1.237362002	0.958209811	1.825445346	0	1.549941852	0.044248559	0.039962393	1.415931184	1.502691329	8.636493189	0.588771653	1.266197375	0	0	2.896554308	0	0	0	0.439433613	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1366	0		5.595859253	4.7983	0.245868843	3.854239442	0	1.161147838	1.053292476	1.237362002	0.958209811	1.825445346	0	1.549941852	0.044248559	0.039962393	1.415931184	1.502691329	8.636493189	0.588771653	1.266197375	0	0	2.896554308	0	0	0	0.439433613	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1366	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.0197	0.1561	2.8211		0.7372	0.627	0.7146	0.4563	2.1444		0.9841	0.181	0.0254	0.8665	1.881	5.8043	0.4029	0.8358			1.3793				0.0013																23.038	0		3.897539831	7.8181	0.401976045	6.675325874	0	1.89838456	1.680252283	1.951994366	1.414500198	3.969864379	0	2.534031917	0.225284244	0.065335341	2.282457645	3.383644103	14.44075584	0.991687976	2.101954575	0	0	4.275865883	0	0	0	0.44073352	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1746
H3410_003_16	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	828.6168491	45.8987773	938.6554034		98.43035599	5.247133041	6.79752588	183.1786748	22.63900826		9.746355517	15.69174438	0.941223042	223.9355034	1906.32892	3765.615056	1.440648808	562.7016737			13.23474133				175.6793804		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189751103	65	0.081071812		0.15	29	393.7514724	76.69878461	10.05760518	29.39470216	0.390930319	29.73260451			0.2				30		30														NO	65.85495144	54.03235428	45.43819369		131.9443249	0.175925767	0.166910541	57.17587413	0.071313104		0.131944325	25.50923615	346.3551481	67.46646238	8.846959504	25.85642755	0.34387358	26.1536562			0.175925767				30		30															4.5474	0.20666825	3.554233836	0	1.082277239	0.923105902	1.134578723	0.872783405	1.614457946	0	1.285976299	0.033357034	0.027166454	1.259011351	1.405434563	8.113779407	0.495401064	1.226392176	0	0	2.328332013	0	0	0	0.439198451	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.172	0		4.120392301	4.5474	0.20666825	3.554233836	0	1.082277239	0.923105902	1.134578723	0.872783405	1.614457946	0	1.285976299	0.033357034	0.027166454	1.259011351	1.405434563	8.113779407	0.495401064	1.226392176	0	0	2.328332013	0	0	0	0.439198451	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.172	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8618	0.1312	2.6015		0.6872	0.5495	0.6568	0.4156	1.8966		0.8165	0.1203	0.0172	0.7684	1.7619	5.4536	0.3195	0.8104			1.1087				0.0011																20.9776	0		2.870487662	7.4092	0.337886186	6.155733042	0	1.769437391	1.472573701	1.791339236	1.28839455	3.511022176	0	2.102469187	0.153608451	0.044414996	2.027392744	3.16735954	13.5673522	0.814872382	2.036747903	0	0	3.437061544	0	0	0	0.440340267	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1497
H3410_003_17	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	848.5517293	49.32108147	982.0568169		99.88596578	5.621792669	6.96568231	191.1320302	24.03429913		11.07499572	17.03349107	1.027567405	232.7742442	1995.450084	3960.394539	1.584938666	570.458905			15.45992984				175.7124029		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189129856	65	0.081071812		0.15	29	409.0109584	79.20125437	10.06030265	29.40392649	0.377480821	29.72713932			0.2				30		30														NO	65.11094907	53.42191878	44.92485152		130.4536718	0.173938229	0.164484561	56.52992444	0.070507437		0.130453672	25.22104321	355.7132088	68.88062961	8.749356129	25.5723345	0.328291727	25.85342984			0.173938229				30		30															4.6042	0.219568901	3.676563057	0	1.08587425	0.977844661	1.145747195	0.900389935	1.694596842	0	1.444773857	0.035800201	0.030459942	1.336136375	1.454908618	8.439711158	0.520322252	1.229026606	0	0	2.689072817	0	0	0	0.439281007	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5467	0		4.717501875	4.6042	0.219568901	3.676563057	0	1.08587425	0.977844661	1.145747195	0.900389935	1.694596842	0	1.444773857	0.035800201	0.030459942	1.336136375	1.454908618	8.439711158	0.520322252	1.229026606	0	0	2.689072817	0	0	0	0.439281007	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5467	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8975	0.1394	2.691		0.6894	0.5821	0.662	0.4288	1.9907		0.9173	0.1355	0.0193	0.8166	1.8236	5.6725	0.3475	0.8117			1.2805				0.0012																21.9068	0		3.282194963	7.5017	0.358977727	6.367600371	0	1.775318218	1.559895054	1.80777028	1.329147047	3.685303236	0	2.362090592	0.171291803	0.049799587	2.152754105	3.278537766	14.11225874	0.867819846	2.040753042	0	0	3.969583683	0	0	0	0.440478323	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4536
H3410_003_18	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	822.593196	48.80138252	953.5407926		97.51443331	5.247833967	6.508310232	186.3494583	22.4358691		10.32826496	17.33966966	1.053064665	224.8117184	1928.99349	3823.006852	1.509819539	551.4804532			14.43154341				175.6951672		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189088064	65	0.081071812		0.15	29	394.330502	76.75496552	10.06420135	29.40699205	0.393014236	29.71715002			0.2				30		30														NO	65.69676105	53.90256298	45.32904646		131.627381	0.175503175	0.165927778	57.03853178	0.071141802		0.131627381	25.44796033	346.0312749	67.35370062	8.831496442	25.80510232	0.344876231	26.07727086			0.175503175				30		30															4.5035	0.219209966	3.601924574	0	1.069630789	0.921011522	1.079909455	0.885758291	1.596128165	0	1.359482467	0.036771602	0.030366109	1.261825098	1.419658262	8.221090249	0.520700872	1.198425429	0	0	2.532781684	0	0	0	0.439237918	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5199	0		4.251364608	4.5035	0.219209966	3.601924574	0	1.069630789	0.921011522	1.079909455	0.885758291	1.596128165	0	1.359482467	0.036771602	0.030366109	1.261825098	1.419658262	8.221090249	0.520700872	1.198425429	0	0	2.532781684	0	0	0	0.439237918	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5199	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8341	0.1392	2.6364		0.6791	0.5482	0.6239	0.4218	1.875		0.8632	0.1358	0.0193	0.7703	1.7785	5.5255	0.334	0.7914			1.2061				0.0012																21.183	0		2.956572881	7.3376	0.358390897	6.238330717	0	1.748761449	1.469232665	1.70381427	1.307547954	3.471159714	0	2.222645938	0.172613602	0.049646178	2.032103461	3.198180757	13.7465596	0.854706908	1.989810878	0	0	3.738868201	0	0	0	0.440406266	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7029
H3410_003_19	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	823.0643915	50.46250285	956.6666948		98.72784063	5.193989746	6.451648931	188.2547206	22.20621791		10.20349218	18.75885323	1.150652265	223.5101787	1920.876901	3793.254938	1.545656036	549.2090253			14.2834718				175.703332		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189016832	65	0.081071812		0.15	29	390.9236175	76.13516101	10.07088963	29.41160455	0.39889027	29.69991185			0.2				30		30														NO	65.73547445	53.93432637	45.35575769		131.7049456	0.175606594	0.165963011	57.07214311	0.071183724		0.131704946	25.46295616	343.2438252	66.84918161	8.84257314	25.82435852	0.350238809	26.07750184			0.175606594				30		30															4.5087	0.226805092	3.6158619	0	1.08357874	0.912098849	1.070735082	0.895341696	1.580721295	0	1.343850383	0.039804655	0.032912857	1.245122711	1.415457874	8.163197957	0.54134873	1.193499947	0	0	2.508271836	0	0	0	0.43925833	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4391	0		4.219695194	4.5087	0.226805092	3.6158619	0	1.08357874	0.912098849	1.070735082	0.895341696	1.580721295	0	1.343850383	0.039804655	0.032912857	1.245122711	1.415457874	8.163197957	0.54134873	1.193499947	0	0	2.508271836	0	0	0	0.43925833	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4391	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8374	0.144	2.6466		0.688	0.5429	0.6185	0.4264	1.8569		0.8532	0.1485	0.0209	0.7599	1.772	5.4863	0.3421	0.7879			1.1944				0.0012																21.1271	0		2.934592183	7.3462	0.370808324	6.262469382	0	1.771565242	1.455014831	1.689209879	1.321694885	3.437653817	0	2.197088722	0.188268499	0.053809909	2.005011837	3.187419098	13.64952058	0.883484098	1.981408421	0	0	3.702686996	0	0	0	0.440440401	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5662
H3410_003_7	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	795.6824979	45.48822137	918.2198871		93.14576969	4.96879873	6.152202105	178.4187001	21.24238606		9.795928733	15.35011859	0.920731625	218.8997425	1875.193044	3725.843704	1.378602763	535.8379361			13.66419651				175.6645895		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189162289	65	0.081071812		0.15	29	385.1790884	75.29546037	10.05728671	29.40155958	0.3996307	29.73472261			0.2				30		30														NO	66.17368618	54.29386823	45.65811232		132.582929	0.176777239	0.167197935	57.45260257	0.071658256		0.132582929	25.63269961	340.4544782	66.55261784	8.889496866	25.98763257	0.353228058	26.28211078			0.176777239				30		30															4.3878	0.205810958	3.493682229	0	1.029128247	0.878370519	1.028635489	0.854218222	1.522192332	0	1.298772924	0.032788748	0.026122267	1.214029243	1.389126891	8.068821433	0.486961177	1.173579333	0	0	2.415518927	0	0	0	0.439161474	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5672	0		3.87606385	4.3878	0.205810958	3.493682229	0	1.029128247	0.878370519	1.028635489	0.854218222	1.522192332	0	1.298772924	0.032788748	0.026122267	1.214029243	1.389126891	8.068821433	0.486961177	1.173579333	0	0	2.415518927	0	0	0	0.439161474	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5672	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7613	0.1307	2.5572		0.6534	0.5228	0.5944	0.4068	1.7882		0.8246	0.1156	0.0166	0.7405	1.7414	5.4234	0.3072	0.7752			1.1502				0.0011																20.5107	0		2.694285567	7.1491	0.336484582	6.050861065	0	1.682543008	1.401210114	1.623046996	1.260988804	3.310368689	0	2.123390653	0.148418106	0.042707833	1.954500476	3.130555131	13.49218859	0.794153097	1.948795849	0	0	3.565766035	0	0	0	0.440278431	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0779
H3410_003_8	2012	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	791.5936899	46.80628794	917.3639358		93.73084225	4.865154871	6.032796135	179.1577282	20.7997662		9.576657129	16.55444517	1.004310896	216.4736302	1857.161407	3681.522732	1.395062956	530.9407183			13.3791759				175.6682437		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.189094988	65	0.081071812		0.15	29	379.8135657	74.36994047	10.06355448	29.40648296	0.407784139	29.71881045			0.2				30		30														NO	66.29553907	54.3938455	45.74218763		132.8270685	0.177102758	0.167446219	57.55839636	0.071790208		0.132827069	25.67989991	336.3301501	65.85560786	8.911416273	26.03984618	0.361098478	26.31641648			0.177102758				30		30															4.3733	0.2121645	3.496852773	0	1.037499417	0.861632346	1.010168905	0.859335961	1.49321954	0	1.272039293	0.035426375	0.028148336	1.188000208	1.379161532	7.988857139	0.503755111	1.164371422	0	0	2.369488951	0	0	0	0.439170609	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3351	0		3.784693891	4.3733	0.2121645	3.496852773	0	1.037499417	0.861632346	1.010168905	0.859335961	1.49321954	0	1.272039293	0.035426375	0.028148336	1.188000208	1.379161532	7.988857139	0.503755111	1.164371422	0	0	2.369488951	0	0	0	0.439170609	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3351	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7522	0.1347	2.5595		0.6587	0.5129	0.5836	0.4092	1.7541		0.8076	0.1258	0.0179	0.7243	1.7277	5.3694	0.3114	0.7689			1.1283				0.0011																20.3475	0		2.630540477	7.1255	0.346872118	6.056352269	0	1.696229206	1.374508742	1.593793826	1.268543562	3.247360474	0	2.079683288	0.161234722	0.046020296	1.912274679	3.106873112	13.3582627	0.81518725	1.933290188	0	0	3.497817023	0	0	0	0.440293708	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6826
H3410_003_9	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	821.0221771	53.35986521	959.2589041		100.7167759	5.052438147	6.295245404	191.2493726	21.60211052		9.877715299	21.46650453	1.337338591	220.1723387	1896.996193	3709.411052	1.602261852	542.8410891			13.89420491				175.7167738		249															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	74.86674946	61.42631103	51.65609857		150	0.2	0.188876884	65	0.081071812		0.15	29	383.0199915	74.69237259	10.0842297	29.41898615	0.411688849	29.66527255			0.2				30		30														NO	65.87985828	54.05278972	45.45537876		131.9942273	0.175992303	0.166204389	57.19749848	0.071340075		0.131994227	25.51888394	337.042852	65.72641335	8.873734046	25.88757562	0.362270344	26.10429818			0.175992303				30		30															4.5074	0.240354131	3.633623068	0	1.107836084	0.889190225	1.046297413	0.911582142	1.541096183	0	1.303801398	0.045650103	0.037561701	1.205928178	1.402786642	8.002304927	0.580451952	1.180873804	0	0	2.44527312	0	0	0	0.439291935	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1438	0		4.103587735	4.5074	0.240354131	3.633623068	0	1.107836084	0.889190225	1.046297413	0.911582142	1.541096183	0	1.303801398	0.045650103	0.037561701	1.205928178	1.402786642	8.002304927	0.580451952	1.180873804	0	0	2.44527312	0	0	0	0.439291935	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1438	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	No cost sharing	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$200 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.8366	0.1526	2.6596		0.7034	0.5293	0.6041	0.4341	1.8104		0.8278	0.1716	0.0238	0.7355	1.7535	5.3777	0.3554	0.7791			1.1644				0.0012																20.9202	0		2.853633521	7.344	0.392959929	6.293230725	0	1.811224074	1.418470121	1.650407289	1.345668876	3.351479602	0	2.131611809	0.217248515	0.0614104	1.941425956	3.156274962	13.38002195	0.935896178	1.959997459	0	0	3.609688891	0	0	0	0.440496596	0	0.6225	0	0	0	0	0	0	0	0	0	0	0	0	0	52.064
H3410_004_10	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1046.809549	130.3114901	1306.461487		164.8357904	9.311014639	9.158711393	300.8132799	30.17003815		10.75299975	51.75360008		50.81072647	2322.71812	3956.502267	544.190733	646.8338311			18.90576341				176.1222635		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	74.8338824	60.82		100	0.17	0.2	65	0.2		0.198901797	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	96.57889913	65.55695126	53.28032767		87.60330101	0.148925612	0.175206602	56.94214566	0.175206602		0.17424454	25.40495729		82.77835929	17.60088357	29.94039026	26.2809903	30.66115535			0.175206602				35		35															8.425	0.711902	5.800724678	0	1.203346614	1.386648551	1.604666702	1.4274128	5.285989867	0	1.873651497	0.1095665	0	0.350502381	3.406824266	9.871601828	1.191822615	1.652722715	0	0	3.312414566	0	0	0	0.513689935	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8547	0		6.737942641	8.425	0.711902	5.800724678	0	1.203346614	1.386648551	1.604666702	1.4274128	5.285989867	0	1.873651497	0.1095665	0	0.350502381	3.406824266	9.871601828	1.191822615	1.652722715	0	0	3.312414566	0	0	0	0.513689935	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8547	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	6.1023	0.3051	3.5322	2.8629	0.8374	0.783	0.9438	1.327	2.8177	0.458	1.114	0.2168	0.0726	1.9207	2.8285	8.8007	0.3061	1.1965	1.531		1.59	0.0011			0.0009																39.5482	0		5.596317829	14.5273	1.017002857	9.332893801	2.862884073	2.040725191	2.169697144	2.548478832	2.754404576	8.103662651	0.457972767	2.987672205	0.326336963	0.072596214	2.271172342	6.235300533	18.67227309	1.497943431	2.849227675	1.531035567	0	4.902373557	0.001144985	0	0	0.514598735	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4029
H3410_004_11	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1074.101762	133.7089458	1340.523296		175.8987541	11.02688896	10.84651861	321.0023809	35.72990415		12.73460937	55.22704599		54.22089136	2478.607483	4222.043149	580.714126	690.2461217			22.38979982				176.1975843		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	79.10746472	60.82		100	0.17	0.2	65	0.2		0.180631921	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	93.73010377	67.25658077	51.70871367		85.01925957	0.144532741	0.170038519	55.26251872	0.170038519		0.153571921	24.65558527		80.33663953	17.08170893	29.05723622	25.50577787	29.75674085			0.170038519				35		35															8.3896	0.749400543	5.776394605	0	1.24623182	1.593746489	1.844325962	1.47828334	6.075459991	0	1.955678429	0.113471262	0	0.362993684	3.52823763	10.22340876	1.234297125	1.711622914	0	0	3.807128404	0	0	0	0.513909621	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3305	0		8.826118779	8.3896	0.749400543	5.776394605	0	1.24623182	1.593746489	1.844325962	1.47828334	6.075459991	0	1.955678429	0.113471262	0	0.362993684	3.52823763	10.22340876	1.234297125	1.711622914	0	0	3.807128404	0	0	0	0.513909621	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3305	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	6.4237	0.3212	4.8904	3.2905	0.9624	0.9	1.0848	1.5252	3.2385	0.5264	1.2804	0.2491	0.0834	2.2075	3.2509	10.1151	0.3518	1.3752	1.7597		1.8274	0.0013			0.0011																45.666	0		8.046349119	14.8134	1.070572204	10.66675224	3.290459892	2.208674082	2.493744507	2.92909778	3.00346323	9.313956223	0.526371653	3.236079718	0.362616702	0.083438563	2.570518442	6.779150861	20.33847283	1.586137522	3.086827595	1.759697912	0	5.634550039	0.001315991	0	0	0.514985898	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9965
H3410_004_12	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1110.637147	138.2570323	1386.120963		171.9451362	9.961107592	9.798170567	313.7873167	32.27650344		11.50377178	53.98572598		53.00218635	2422.896644	4127.145685	567.6616071	674.7316884			20.22575957				176.1706666		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	74.95577845	60.82		100	0.17	0.2	65	0.2		0.194294839	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	95.18005714	64.71266728	52.50861915		86.33446095	0.146768584	0.172668922	56.11739962	0.172668922		0.167743402	25.03699368		81.57940335	17.34595361	29.50673575	25.90033829	30.21706133			0.172668922				35		35															8.8092	0.745581778	6.065274812	0	1.237065887	1.461977653	1.691839548	1.467410687	5.573149052	0	1.929681816	0.11263669	0	0.360323895	3.502287732	10.14821643	1.225218971	1.699034068	0	0	3.4923601	0	0	0	0.513831111	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7613	0		7.838524903	8.8092	0.745581778	6.065274812	0	1.237065887	1.461977653	1.691839548	1.467410687	5.573149052	0	1.929681816	0.11263669	0	0.360323895	3.502287732	10.14821643	1.225218971	1.699034068	0	0	3.4923601	0	0	0	0.513831111	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7613	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	6.391	0.3195	3.916	3.0184	0.8829	0.8256	0.9951	1.3991	2.9707	0.4829	1.1745	0.2285	0.0765	2.025	2.9821	9.2788	0.3228	1.2615	1.6142		1.6763	0.0012			0.001																41.8436	0		6.623106273	15.2002	1.065116825	9.981235763	3.018409051	2.119934705	2.287565033	2.686923877	2.866490736	8.54389073	0.482851946	3.104221232	0.341183117	0.076539973	2.385333447	6.484419787	19.42698047	1.547969673	2.960538658	1.614208433	0	5.168692947	0.001207186	0	0	0.514803363	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	92.605
H3410_004_13	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	930.1636811	116.6539465	1185.625179		150.2421769	7.629542294	7.617710773	273.5864695	24.36711429		8.832166043	47.17163379		46.21390386	2109.811558	3532.958753	496.0112133	586.002917			15.03209939				176.0229048		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	71.71929089	60.82		100	0.17	0.2	65	0.2		0.217740807	29		94.4894375	20.09189114	34.16017948	30	35			0.2				35		35														NO	99.76672396	64.90227481	55.03897634		90.49486408	0.153841269	0.180989728	58.82166165	0.180989728		0.197044248	26.24351058		85.50808804	18.18212957	30.91320799	27.14845922	31.67320243			0.180989728				35		35															7.7333	0.630925541	5.437966347	0	1.133012115	1.173738468	1.378727402	1.341067562	4.410197391	0	1.740327514	0.103162439	0	0.329305213	3.196738926	9.101257398	1.122161683	1.546715751	0	0	2.720655582	0	0	0	0.513400139	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3389	0		4.526932554	7.7333	0.630925541	5.437966347	0	1.133012115	1.173738468	1.378727402	1.341067562	4.410197391	0	1.740327514	0.103162439	0	0.329305213	3.196738926	9.101257398	1.122161683	1.546715751	0	0	2.720655582	0	0	0	0.513400139	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3389	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	5.3285	0.2704	2.5526	2.3514	0.7203	0.6628	0.8111	1.1365	2.3508	0.3922	0.9465	0.1865	0.0624	1.6511	2.417	7.2668	0.2633	1.0219	1.2405		1.3059	0.001			0.0008																32.9404	0		3.459813553	13.0617	0.901322202	7.990606178	2.351398752	1.853321501	1.836555485	2.189793158	2.477595127	6.76103299	0.392170909	2.686875472	0.289627442	0.062446946	1.980442272	5.613693212	16.36804041	1.385485469	2.568612355	1.24053103	0	4.026570261	0.000984911	0	0	0.514156905	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2792
H3410_004_14	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	885.6849879	45.50863641	1007.471579		106.9658302	5.939920948	6.553167835	196.5759561	29.02133845		10.3522007	17.1746779		43.9478193	2197.445055	3956.635819	270.073322	622.6572284			17.69786625				175.7873248		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	59.64363346	60.82		100	0.17	0.2	65	0.2		0.205658875	29		95.1220288	20.02925099	34.0542255	30	35			0.2				35		35														NO	99.92939583	54.06243154	55.12871861		90.64241798	0.154092111	0.181284836	58.91757168	0.181284836		0.186414177	26.28630121		86.22090693	18.1549974	30.86757341	27.19272539	31.72484629			0.181284836				35		35															7.3755	0.205025628	4.628384767	0	0.807970124	0.915294955	1.187989956	0.965148165	5.26112858	0	1.929796972	0.037621563	0	0.315768403	3.324550771	10.17764555	0.612002473	1.646142072	0	0	3.20835478	0	0	0	0.512713031	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8373	0		4.3976904	7.3755	0.205025628	4.628384767	0	0.807970124	0.915294955	1.187989956	0.965148165	5.26112858	0	1.929796972	0.037621563	0	0.315768403	3.324550771	10.17764555	0.612002473	1.646142072	0	0	3.20835478	0	0	0	0.512713031	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8373	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	4.6772	0.0879	2.7895	1.8847	0.5467	0.5169	0.6995	0.9211	2.8058	0.4091	1.0947	0.06	0.0215	1.6702	2.3749	8.1554	0.1595	0.8871	1.4097		1.54	0.0011			0.0006																32.7132	0		3.377125829	12.0527	0.292893755	7.417876035	1.884687841	1.354682638	1.432167401	1.887522685	1.886256342	8.066961916	0.409146174	3.024543331	0.097644317	0.021523759	1.985944649	5.699449702	18.33303491	0.771464615	2.533220356	1.409734228	0	4.748365074	0.00107302	0	0	0.513299991	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5505
H3410_004_15	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	887.1520953	110.436623	1107.202401		152.9815501	8.782723871	8.639062046	279.180157	28.45824269		10.14289326	48.03171655		47.15665012	2155.678797	3671.968619	505.0550106	600.316484			17.83308329				176.0415554		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	74.13169105	60.82		100	0.17	0.2	65	0.2		0.195930562	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	98.22262133	66.04708397	54.1871309		89.09426323	0.151460247	0.178188526	57.9112711	0.178188526		0.174562891	25.83733634		84.18720354	17.90044138	30.44995999	26.72827897	31.18299213			0.178188526				35		35															7.2615	0.607834743	4.999676787	0	1.135814874	1.330233531	1.539381736	1.34730648	5.07093233	0	1.77057277	0.103417635	0	0.330832208	3.215633494	9.317608129	1.124937602	1.559972016	0	0	3.177650834	0	0	0	0.513454537	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	45.133	0		5.372839754	7.2615	0.607834743	4.999676787	0	1.135814874	1.330233531	1.539381736	1.34730648	5.07093233	0	1.77057277	0.103417635	0	0.330832208	3.215633494	9.317608129	1.124937602	1.559972016	0	0	3.177650834	0	0	0	0.513454537	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	45.133	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	5.2102	0.2605	3.2275	2.7464	0.8033	0.7512	0.9054	1.273	2.703	0.4393	1.0687	0.208	0.0696	1.8425	2.7134	8.4426	0.2937	1.1478	1.4687		1.5253	0.0011			0.0009																37.1022	0		4.541456638	12.4718	0.868335347	8.227136607	2.746409238	1.939125174	2.081424231	2.444795398	2.620310339	7.773969675	0.439340402	2.839270169	0.311368913	0.069642678	2.173360788	5.929034788	17.76022901	1.418604064	2.707797842	1.468746243	0	4.702923235	0.001098402	0	0	0.514311773	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2353
H3410_004_17	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1105.543029	137.6228939	1379.763293		176.8853348	10.89456698	10.71636106	322.8028185	35.30114754		12.58179485	55.53680336		54.52500541	2492.509492	4245.723738	583.9712345	694.117573			22.12112362				176.2043013		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	75.00661455	60.82		100	0.17	0.2	65	0.2		0.183597464	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	93.89478723	63.8821121	51.7995657		85.16863811	0.144786685	0.170337276	55.35961477	0.170337276		0.15636746	24.69890505		80.47779073	17.11172143	29.10828968	25.55059143	29.80902334			0.170337276				35		35															8.6504	0.732636762	5.95592828	0	1.255423589	1.577388236	1.825395755	1.48918664	6.013101319	0	1.967383297	0.114308186	0	0.365670998	3.554260675	10.29881304	1.243400868	1.724247245	0	0	3.768051944	0	0	0	0.513929212	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7758	0		8.800324296	8.6504	0.732636762	5.95592828	0	1.255423589	1.577388236	1.825395755	1.48918664	6.013101319	0	1.967383297	0.114308186	0	0.365670998	3.554260675	10.29881304	1.243400868	1.724247245	0	0	3.768051944	0	0	0	0.513929212	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7758	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	6.28	0.314	4.4183	3.2567	0.9526	0.8908	1.0736	1.5095	3.2053	0.521	1.2673	0.2466	0.0826	2.1849	3.2175	10.0112	0.3482	1.3611	1.7416		1.8087	0.0013			0.0011																44.6938	0		7.782836217	14.9304	1.046623945	10.37420282	3.25668653	2.20798732	2.468148651	2.899033448	2.998712046	9.218357546	0.520968961	3.234642515	0.360896392	0.082582147	2.550537668	6.771806451	20.31005584	1.591629967	3.085336791	1.741636329	0	5.576716877	0.001302483	0	0	0.514992574	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4695
H3410_004_18	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1046.439917	128.2639784	1330.466371		161.9599652	8.418520974	8.461338508	293.8605634	27.27907309		9.882165014	50.85067538		49.63156724	2277.380468	3815.658183	534.6964514	632.1775043			16.82249039				176.1026838		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	64.33249979	60.82		100	0.17	0.2	65	0.2		0.210821663	29		94.49832745	20.09176932	34.16175419	30	35			0.2				35		35														NO	97.83508084	57.09042237	53.97333385		88.74273898	0.150862656	0.177485478	57.68278034	0.177485478		0.187088918	25.7353943		83.86040407	17.8299864	30.31607635	26.62282169	31.05995864			0.177485478				35		35															8.5315	0.610220392	5.984142133	0	1.19773091	1.270040436	1.501764709	1.412557861	4.841639325	0	1.848843564	0.109055182	0	0.346843607	3.383805231	9.639648733	1.186260691	1.636283928	0	0	2.985747748	0	0	0	0.513632828	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	47.726	0		5.896893574	8.5315	0.610220392	5.984142133	0	1.19773091	1.270040436	1.501764709	1.412557861	4.841639325	0	1.848843564	0.109055182	0	0.346843607	3.383805231	9.639648733	1.186260691	1.636283928	0	0	2.985747748	0	0	0	0.513632828	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	47.726	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	5.3952	0.2615	3.1329	2.547	0.7862	0.7172	0.8838	1.2316	2.5808	0.4288	1.038	0.2035	0.0682	1.8003	2.6367	7.9606	0.2874	1.1095	1.3612		1.4332	0.0011			0.0008																35.8656	0		4.549542866	13.9268	0.871743417	9.117063646	2.547014653	1.983953843	1.987239741	2.385550964	2.644154164	7.42245308	0.428813603	2.886865807	0.312583089	0.068161295	2.147164728	6.020516999	17.60024112	1.473680518	2.745755745	1.361183211	0	4.418906667	0.001075038	0	0	0.514475153	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	83.5916
H3410_004_19	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	967.4308163	115.3508261	1226.097981		153.8512626	7.71673608	7.820790782	277.8803978	25.46751039		9.219359079	48.30478075		46.92436238	2167.017064	3633.326088	507.9262892	601.1294513			15.69813299				176.0474768		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	55.24273186	60.82		100	0.17	0.2	65	0.2		0.215081769	29		94.50937143	20.09161449	34.16376206	30	35			0.2				35		35														NO	99.4776249	49.84697125	54.87948712		90.23263256	0.153395475	0.180465265	58.65121116	0.180465265		0.194073942	26.16746344		85.27829386	18.12919267	30.82686189	27.06978977	31.5814214			0.180465265				35		35															8.0198	0.479157443	5.607302362	0	1.156867037	1.183712399	1.411381082	1.358168491	4.596001015	0	1.789237361	0.105334465	0	0.33346913	3.273855823	9.333670125	1.145788156	1.582043543	0	0	2.832967731	0	0	0	0.513471807	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4485	0		4.785444589	8.0198	0.479157443	5.607302362	0	1.156867037	1.183712399	1.411381082	1.358168491	4.596001015	0	1.789237361	0.105334465	0	0.33346913	3.273855823	9.333670125	1.145788156	1.582043543	0	0	2.832967731	0	0	0	0.513471807	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4485	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	4.4769	0.2054	2.5303	2.377	0.7408	0.6684	0.831	1.15	2.4499	0.405	0.984	0.1918	0.0642	1.6942	2.483	7.5361	0.2708	1.0386	1.2913		1.3598	0.001			0.0008																32.7503	0		3.54501681	12.4967	0.684510633	8.137574457	2.377016632	1.897714615	1.852161754	2.242382736	2.50816882	7.045878388	0.404973037	2.773231818	0.297116148	0.064227496	2.027644154	5.756830758	16.86974889	1.416620096	2.620643481	1.291263013	0	4.192792242	0.001012994	0	0	0.514252413	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1987
H3410_004_7	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	787.5344436	38.64260289	890.2362319		98.1095637	5.155793645	5.735391692	180.0501208	25.75799393		9.179244521	15.87184961		40.24167725	2030.752346	3673.667961	249.5862324	573.8153887			15.91962503				175.7276003		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	56.38862189	60.82		100	0.17	0.2	65	0.2		0.213711189	29		95.14047974	20.02925099	34.05864655	30	35			0.2				35		35														NO	101.7652753	52.05102822	56.14153051		92.30767924	0.156923055	0.184615358	59.99999151	0.184615358		0.197271839	26.76922698		87.82196887	18.48853675	31.43874621	27.69230377	32.30768773			0.184615358				35		35															6.6786	0.167615601	4.164935382	0	0.754688845	0.809062888	1.058841393	0.900250477	4.755321282	0	1.810806444	0.035406429	0	0.294508611	3.128803282	9.624626226	0.575968147	1.544887366	0	0	2.939007282	0	0	0	0.512538834	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4822	0		3.270286681	6.6786	0.167615601	4.164935382	0	0.754688845	0.809062888	1.058841393	0.900250477	4.755321282	0	1.810806444	0.035406429	0	0.294508611	3.128803282	9.624626226	0.575968147	1.544887366	0	0	2.939007282	0	0	0	0.512538834	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4822	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	4.1931	0.0718	1.8562	1.6701	0.4863	0.4569	0.625	0.817	2.5361	0.3695	0.9885	0.0542	0.0194	1.5042	2.1354	7.4357	0.144	0.7892	1.2905		1.4107	0.001			0.0005																28.8554	0		2.404573766	10.8717	0.239450859	6.021167154	1.67007314	1.241031988	1.26594546	1.683846084	1.717283117	7.291400523	0.369452917	2.799346143	0.089606084	0.019435635	1.798696952	5.264153867	17.06037568	0.719960092	2.334060699	1.290518503	0	4.349730778	0.000968921	0	0	0.513059289	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3375
H3410_004_8	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	868.3708359	102.6777697	1099.456183		142.5034309	6.807200206	6.916847695	257.0187947	22.59520643		8.175452072	44.74191868		43.39920633	2008.031616	3367.84234	470.4626825	556.9135379			13.9256237				175.970217		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	59.94724987	60.82		100	0.17	0.2	65	0.2		0.224215703	29		94.51278634	20.09157574	34.16438355	30	35			0.2				35		35														NO	100.9894436	54.91404865	55.71352224		91.60394976	0.155726715	0.1832079	59.54256734	0.1832079		0.20539044	26.56514543		86.57744531	18.40467694	31.29592474	27.48118493	32.06138242			0.1832079				35		35															7.308	0.469871004	5.104548043	0	1.087823094	1.060062924	1.267221137	1.275296574	4.139620309	0	1.679159697	0.099047965	0	0.313116034	3.079764433	8.7833117	1.077405998	1.487951492	0	0	2.551284267	0	0	0	0.513246466	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	42.023	0		3.738052654	7.308	0.469871004	5.104548043	0	1.087823094	1.060062924	1.267221137	1.275296574	4.139620309	0	1.679159697	0.099047965	0	0.313116034	3.079764433	8.7833117	1.077405998	1.487951492	0	0	2.551284267	0	0	0	0.513246466	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	42.023	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	4.4642	0.2014	2.536	2.1296	0.6657	0.5986	0.7462	1.0305	2.2066	0.3641	0.8857	0.1723	0.0577	1.5218	2.2305	6.7818	0.2434	0.9313	1.1628		1.2246	0.0009			0.0007																30.1564	0		2.763947723	11.7722	0.671244291	7.640550713	2.129585205	1.753551747	1.658686692	2.013458894	2.305758096	6.34622603	0.364095678	2.564823985	0.271383951	0.057715152	1.834884367	5.310279325	15.56511026	1.320776946	2.419272963	1.162785343	0	3.775900716	0.000910282	0	0	0.513937422	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1794
H3410_004_9	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	997.8300986	124.2143112	1245.333114		163.0788679	9.459030027	9.304305646	297.6070247	30.64964537		10.92393809	51.20197799		50.26915411	2297.961144	3914.331403	538.3904094	639.9394734			19.20630465				176.1103017		249															Days 1-7: $200/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	$100/trip	20% Coinsurance	20% Coinsurance	ER: $65/visit; UC: $35/visit	20%/visit; ASC: 20%/visit	No Cost Sharing	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/visit	$20/visit	$35/visit	Individual: $30/visit; Group: $20/visit	$35/visit	No Cost Sharing	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Preventive Dental Services: $200 / year	Routine Eye Exam: $35	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $35	Not Covered	Not Covered	Not Covered											0	NO	110.2457305	74.83866824	60.82		100	0.17	0.2	65	0.2		0.194074751	29		94.49228321	20.09157574	34.1772398	30	35			0.2				35		35														NO	96.68064686	65.63021374	53.33645953		87.69559278	0.149082508	0.175391186	57.00213531	0.175391186		0.170195003	25.43172191		82.86556789	17.61942644	29.97193304	26.30867783	30.69345747			0.175391186				35		35															8.0392	0.679350983	5.535138268	0	1.191774833	1.410175917	1.631893198	1.413686324	5.375677639	0	1.859199676	0.108512872	0	0.347131834	3.374063111	9.776673223	1.180361652	1.636829584	0	0	3.368616543	0	0	0	0.513655047	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1682	0		6.584426762	8.0392	0.679350983	5.535138268	0	1.191774833	1.410175917	1.631893198	1.413686324	5.375677639	0	1.859199676	0.108512872	0	0.347131834	3.374063111	9.776673223	1.180361652	1.636829584	0	0	3.368616543	0	0	0	0.513655047	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1682	YES	"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, Blood: Waiver of 3 pint deductible"	Not Covered	Not Covered	Medicare FFS Cost Sharing	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered											6700	5.8233	0.2912	3.5938	2.9115	0.8516	0.7963	0.9598	1.3495	2.8655	0.4657	1.1329	0.2204	0.0738	1.9533	2.8765	8.95	0.3113	1.2168	1.557		1.6169	0.0012			0.0009																39.8193	0		5.586839038	13.8625	0.970501404	9.128974835	2.911458834	2.043361273	2.206510552	2.591719057	2.763193266	8.241158081	0.465743224	2.992122054	0.328961295	0.07382796	2.300389941	6.250530339	18.72666611	1.491676443	2.85363573	1.557012758	0	4.985552484	0.001164412	0	0	0.514578293	0	0.72625	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9875
H3421_001_0	2012	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	1369.988159	93.98105693	490.9019079	23.22452611	488.4663883	24.70713612	5.125735843	425.3551255	353.950258	567.5772615	16.16359112	2.766564469	0.035517971	374.9665167	9883.710084	3748.261989	515.7647884	1126.523491	3327.545944	38.80329207	11.36522194	0.868092939	0	0	241.1043013	6.220766771	23.24567399	0	93.7896866	0												$265 days 1-5;$0 days 6-90	$250 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500,4b: $28"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $265,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	171.8369891	107.511159	70.37195739	20	100	0.2	0.199822798	64.97138527	140.7913454	15	0.2	145	0.2	43.10592045	13.05372937	28.16372292	40	40	0	40	0.199907765	0	0	0	0	0.91439973	0	0	0	0											NO	145.2672522	90.88759491	59.49092184	16.9075649	84.5378245	0.169075649	0.168925846	54.92539565	119.0219405	12.68067368	0.169075649	122.5798455	0.169075649	36.44080738	11.03533883	23.80899866	33.8151298	33.8151298	0	33.8151298	0.168997676	0	0	0	0	0.91439973	0	0	0	0												16.5845	0.711809353	2.433683919	0.032722515	3.441157151	4.177375075	0.865869266	1.94689988	3.51065388	0.599771837	2.732869658	0.02826042	0.006005224	1.138673551	9.089174137	7.436863722	1.453387772	3.174461506	0	0.109344863	1.920696093	0	0	0	0	0.000474022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3947		NO	11.22915244	16.5845	0.711809353	2.433683919	0.032722515	3.441157151	4.177375075	0.865869266	1.94689988	3.51065388	0.599771837	2.732869658	0.02826042	0.006005224	1.138673551	9.089174137	7.436863722	1.453387772	3.174461506	0	0.109344863	1.920696093	0	0	0	0	0.000474022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3947	YES	"$265 days 1-5;$0 days 6-90,1a2: $172"	"$250 days 1-5;$0 days 6-90,1b2: $108"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $28"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0.7284	0.0157	0.1781	0	0	0	0	0.0544	0	0	0	0	0.0004	0	0	0	0	0	0	0	0.0897	0	0	0	0	0	0	0	0	0											1.0666	5000	NO	0.026423407	17.3129	0.727499313	2.611779094	0.032722515	3.441157151	4.177375075	0.865869266	2.001302862	3.51065388	0.599771837	2.732869658	0.02826042	0.006363885	1.138673551	9.089174137	7.436863722	1.453387772	3.174461506	0	0.109344863	2.010401659	0	0	0	0	0.000474022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4613
H3421_002_0	2012	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	NO	1373.807576	47.29937109	820.2374352	17.94849714	380.3668392	20.48169598	5.569006991	321.7744893	405.3120971	673.3285887	16.57747799	3.093985474	0.057764047	310.3654178	11344.88835	3999.062585	304.8653911	1180.710602	3521.011613	31.58846221	14.45942672	0.773496368	0	0	242.3811877	10.79145077	21.01116141	0	95.14705854	0												$295 days 1-5;$0 days 6-90	$295 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $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%"	9c1: $148	12: 20.0%	"31: $148,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	191.2902331	126.8631676	70.37195739	20	100	0.2	0.19985537	64.83173077	142.7958015	15	0.2	147.5	0.2	43.03426791	13.02967685	30.76334815	40	45	0	45	0.199834986	0	0	0	0	2.364082001	0	0	0	0											NO	157.4282703	104.406005	57.91479967	16.45962449	82.29812246	0.164596245	0.164477217	53.35529718	117.5182636	12.34471837	0.164596245	121.3897306	0.164596245	35.41639451	10.72317941	25.31765793	32.91924898	37.03415511	0	37.03415511	0.164460441	0	0	0	0	2.364082001	0	0	0	0												18.023	0.411528198	3.958657228	0.024618794	2.608623059	3.371210247	0.915974771	1.430697792	3.969297822	0.692670983	2.728590627	0.031298172	0.009507745	0.916002007	10.13777276	8.437241548	0.83632831	3.643884964	0	0.097487667	2.378003702	0	0	0	0	0.00212599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6245		NO	13.89992791	18.023	0.411528198	3.958657228	0.024618794	2.608623059	3.371210247	0.915974771	1.430697792	3.969297822	0.692670983	2.728590627	0.031298172	0.009507745	0.916002007	10.13777276	8.437241548	0.83632831	3.643884964	0	0.097487667	2.378003702	0	0	0	0	0.00212599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6245	YES	"$295 days 1-5;$0 days 6-90,1a2: $191"	"$295 days 1-5;$0 days 6-90,1b2: $127"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $30"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	3.8646	0.0882	0.8488	0	0	0	0	0.2525	0	0	0	0	0.0017	0	0	0	0	0	0	0	0.4196	0	0	0	0	0	0	0	0	0											5.4755	5000	NO	0.144931058	21.8877	0.499771552	4.807505961	0.024618794	2.608623059	3.371210247	0.915974771	1.683173873	3.969297822	0.692670983	2.728590627	0.031298172	0.011185583	0.916002007	10.13777276	8.437241548	0.83632831	3.643884964	0	0.097487667	2.797651414	0	0	0	0	0.00212599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1001
H3449_005_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	V	V	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1400.586151	0	1286.175877	16.43349762	252.8319411	19.59667605	0.001845032	1589.409789	990.6918415	21.7691883	34.98736489	0	0.116387117	2089.899816	5390.20644	5872.797368	141.0021527	271.5205164	0	1283.268068	1.051336001	0.919750766	0	0	114.1505141	0	0	0	6.132772043	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, $50 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, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	(5) $35 copay	(12) 0% coinsurance	"(3) $0 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $35 copay"	"(7a) $5 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"	(7d) $35 copay	"(7b) $20 copay, (7f) $35 copay, (7g) $5-$35 copay, (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) Non Covered, (9d) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $35 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered											0	NO	113.0809688	0	34.23999059	0	100	0.2	0.2	49.78939088	100	0.2	0.2	0	0	99.92550117	5	35	35	35	0	29.17412545	0.2	0	0	35	35	17.6	35	0	0	0											NO	85.89512518	0	26.00833994	0	75.95895762	0.151917915	0.151917915	37.81950232	75.95895762	0.151917915	0.151917915	0	0	75.90236909	3.797947881	26.58563517	26.58563517	26.58563517	0	22.16036159	0.151917915	0	0	26.58563517	26.58563517	13.36877654	26.58563517	0	0	0												10.0253	0	2.787608287	0	1.600404225	2.977086172	0.000280293	5.009223934	6.2709933	3.307129703	5.315207533	0	0	13.21902894	1.705976927	13.01100402	0.312385982	0.601545449	0	2.369807033	0.159716773	0	0	0	0.252896994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9256	0	NO	21.74124877	10.0253	0	2.787608287	0	1.600404225	2.977086172	0.000280293	5.009223934	6.2709933	3.307129703	5.315207533	0	0	13.21902894	1.705976927	13.01100402	0.312385982	0.601545449	0	2.369807033	0.159716773	0	0	0	0.252896994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9256	NO																																																																																		0	0	NO		10.0253	0	2.787608287	0	1.600404225	2.977086172	0.000280293	5.009223934	6.2709933	3.307129703	5.315207533	0	0	13.21902894	1.705976927	13.01100402	0.312385982	0.601545449	0	2.369807033	0.159716773	0	0	0	0.252896994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9256
H3449_012_0	2012	4																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1171.177281	0	921.8344277	10.49319388	171.66863	12.65056702	0.002780017	1206.981366	992.0344973	19.28498239	33.81314806	0	0.142560349	15.37222383	4048.154107	5179.307184	81.22765221	360.1866178	0	1108.65095	0.374812618	0.792751683	0	0	90.48617474	0	0	0	6.132772043	0											2500	"(1a) 100 copay per day, days 1 - 6, unlimited days"	"(1b) 100 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $50 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 5% coinsurance	"(11b) 5% coinsurance, (11c) 5% coinsurance"	"(4a) $50 copay, (4b) $20 copay"	"(9a) 0% coinsurance, (9b) $0 copay"	(8a) 5% coinsurance	"(8b) 5% coinsurance, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	(5) $20 copay	(12) 0% coinsurance	"(3) $0 copay for physician services, 5% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $20 copay"	"(7a) $5 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"	(7d) $20 copay	"(7b) $20 copay, (7f) $20 copay, (7g) $5-$20 copay, (14d - j) 0% coinsurance (16b Medicare covered) $20 copay, (17a Medicare Covered) $20 copay, (17b Medicare Covered) 5% coinsurance, (18a Medicare Covered) $20 copay"	(15) 5% coinsurance	"(13a) Non Covered, (9d) 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											0	NO	66.47693727	0	33.80053877	0	100	0.05	0.05	49.29001203	0	0.05	0.05	0	0	0	5	20	20	20	0	16.47656959	0.05	0	0	20	20	10.025	20	0	0	0											NO	58.74660146	0	29.87000999	0	88.37140199	0.044185701	0.044185701	43.55827468	0	0.044185701	0.044185701	0	0	0	4.4185701	17.6742804	17.6742804	17.6742804	0	14.56057555	0.044185701	0	0	17.6742804	17.6742804	8.85923305	17.6742804	0	0	0												5.7336	0	2.294600297	0	1.264216459	0.558974172	0.000122837	4.381168822	0	0.852120466	1.49405765	0	0	0	1.490587725	7.628377287	0.119636692	0.530503273	0	1.345216326	0.016561358	0	0	0	0.133273169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.843	0	NO	3.661761944	5.7336	0	2.294600297	0	1.264216459	0.558974172	0.000122837	4.381168822	0	0.852120466	1.49405765	0	0	0	1.490587725	7.628377287	0.119636692	0.530503273	0	1.345216326	0.016561358	0	0	0	0.133273169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.843	NO																																																																																		0	0	NO		5.7336	0	2.294600297	0	1.264216459	0.558974172	0.000122837	4.381168822	0	0.852120466	1.49405765	0	0	0	1.490587725	7.628377287	0.119636692	0.530503273	0	1.345216326	0.016561358	0	0	0	0.133273169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.843
H3449_013_0	2012	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	976.128078	0	943.4935499	9.278533365	174.6661654	14.0705734	0.001526956	1297.159998	64.20274095	18.31925127	27.38252559	0	0.00041124	10.82761446	4113.335773	4109.069029	169.118242	210.6220307	0	877.6010531	7.072774333	0.287922413	0	0	61.09057072	0	0	0	6.132772043	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, $50 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) 20% coinsurance, (9b) 20% coinsurance"	(8a) 20% coinsurance	"(8b) 20% coinsurance, except other Medicare-covered therapeutic radiological services are 0% member coinsurance"	(5) $35 copay	(12) 0% coinsurance	"(3) $0 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $35 copay"	"(7a) $10 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"	(7d) $35 copay	"(7b) $20 copay, (7f) $35 copay, (7g) $10-$35 copay, (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) Non Covered, (9d) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $35 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered											0	NO	128.9120384	0	32.55753675	0	100	0.2	0.2	49.63716686	0.2	0.2	0.2	0	0	0.172240017	10	35	35	35	0	25.34669393	0.2	0	0	35	35	17.6	35	0	0	0											NO	94.79038419	0	23.93990084	0	73.53105681	0.147062114	0.147062114	36.49873336	0.147062114	0.147062114	0.147062114	0	0	0.126649904	7.353105681	25.73586988	25.73586988	25.73586988	0	18.63769191	0.147062114	0	0	25.73586988	25.73586988	12.941466	25.73586988	0	0	0												7.7106	0	1.882261836	0	1.070282311	2.069248264	0.000224557	3.945391407	9.441790785	2.694067812	4.02693209	0	0	1.371316338	2.52048272	8.812538823	0.362700423	0.451711765	0	1.363038171	1.040137143	0	0	0	0.131018248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8938	0	NO	17.55419638	7.7106	0	1.882261836	0	1.070282311	2.069248264	0.000224557	3.945391407	9.441790785	2.694067812	4.02693209	0	0	1.371316338	2.52048272	8.812538823	0.362700423	0.451711765	0	1.363038171	1.040137143	0	0	0	0.131018248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8938	NO																																																																																		0	0	NO		7.7106	0	1.882261836	0	1.070282311	2.069248264	0.000224557	3.945391407	9.441790785	2.694067812	4.02693209	0	0	1.371316338	2.52048272	8.812538823	0.362700423	0.451711765	0	1.363038171	1.040137143	0	0	0	0.131018248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8938
H3449_801_0	2012	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	217.6392534	0	39.11315195	11.25257446	5.829464522	16.18882804	0	23.10137956	105.0899253	23.72759316	37.27256063	0	0.010695588	18.44880952	34.33482558	89.69903166	2.25013702	6.309102708	0	11.24410809	0.840830783	0.582424022																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061	0	NO	17.22318122	15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061	NO																																																																																		0	0	NO		15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061
H3449_805_0	2012	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	217.6392534	0	39.11315195	11.25257446	5.829464522	16.18882804	0	23.10137956	105.0899253	23.72759316	37.27256063	0	0.010695588	18.44880952	34.33482558	89.69903166	2.25013702	6.309102708	0	11.24410809	0.840830783	0.582424022																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.069008743	0.069008743	0.155849561	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0.188812375	0	0.188812375	0.188812375	0.188812375																				15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061	0	NO	17.22318122	15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061	NO																																																																																		0	0	NO		15.019	0	6.095767561	0	1.10067504	3.056651066	0	4.361826333	19.84227836	4.48006321	7.037520685	0	0.002019459	3.483363537	6.482839953	16.93628718	0.424853714	1.191236665	0	2.123026749	0.158759257	0.109968863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9061
H3449_810_0	2012	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	216.8130043	0	31.73539827	12.15232174	6.501526722	19.57166582	0	24.46118654	128.160486	30.69349934	46.52828545	0	0.421591881	51.67071694	31.39046695	69.46331423	3.437904918	4.642789775	0	13.48050799	4.156719314	0.935840198																			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	NO	0.081869414	0.081869414	0.18489414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224																			NO	0.068821606	0.068821606	0.15542693	0	0.188300355	0.188300355	0.188300355	0.188300355	0.188300355	0.188300355	0.188300355	0	0.188300355	0.188300355	0.188300355	0.188300355	0.188300355	0.188300355	0	0.188300355	0.188300355	0.188300355																				14.9214	0	4.932535518	0	1.224239792	3.685351626	0	4.606050117	24.13266504	5.77959683	8.76129268	0	0.079385901	9.729614357	5.910836079	13.07996675	0.647358717	0.874238964	0	2.538384444	0.782711724	0.176219042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8619	0	NO	19.36913321	14.9214	0	4.932535518	0	1.224239792	3.685351626	0	4.606050117	24.13266504	5.77959683	8.76129268	0	0.079385901	9.729614357	5.910836079	13.07996675	0.647358717	0.874238964	0	2.538384444	0.782711724	0.176219042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8619	NO																																																																																		0	0	NO		14.9214	0	4.932535518	0	1.224239792	3.685351626	0	4.606050117	24.13266504	5.77959683	8.76129268	0	0.079385901	9.729614357	5.910836079	13.07996675	0.647358717	0.874238964	0	2.538384444	0.782711724	0.176219042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8619
H3456_001_0	2012	6																															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	1245.53827	101.3006012	680.4458888	1236.593616	150.5806737	10.51054134	11.76350458	369.0022874	52.75835997	17.46504594	32.15426429	0	0.031505367	32.29539877	6012.297855	3679.328208	557.7849878	370.0655087	0	0	20.32972683	860.2835395	0	0	40.22449939	0	5.55748885	65	686.2913835	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	68.68494543	0	200	0.2	0.103685176	62.99183682	0.16	0.24153194	0.184004185	0	0.2	0.145809041	12.78019922	39.31938257	38.5	40	0	0	0.2	38.54210328	0	0	40	0	20	352.5	0	0											YES	149.9688341	78.5475997	54.60362518	0	158.9973606	0.158997361	0.082428347	50.09601227	0.127197888	0.192014705	0.146280899	0	0.158997361	0.115916263	12.3385761	37.96258955	37.16962246	38.61778957	0	0	0.158997361	30.64046347	0	0	40	0	20	352.5	0	0											7500	15.566	0.663076589	3.096234356	0	1.995160806	1.671148331	0.969646234	1.540461926	6.710751989	3.35354564	4.703554688	0	0.00500927	3.743561948	6.181932884	11.63973555	1.727721451	1.190925995	0	0	3.232372909	2.196623864	0	0	0.134081665	0	0.009262481	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	72.2402	0	NO	13.49258007	15.566	0.663076589	3.096234356	0	1.995160806	1.671148331	0.969646234	1.540461926	6.710751989	3.35354564	4.703554688	0	0.00500927	3.743561948	6.181932884	11.63973555	1.727721451	1.190925995	0	0	3.232372909	2.196623864	0	0	0.134081665	0	0.009262481	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	72.2402	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1329	0.0095	0.2342	0.1776	0.1124	0.2354	0.1581	0.0868	0.5672	0.189	0.3866	0	0.0003	0.316	0.4399	0.6942	0.1022	0.0702	0	0	0.247	0.1258	0	0	0.0079	0	0.0009	0	0	0											4.2941	0	NO	0.943930368	15.6989	0.672555694	3.330405435	0.177568977	2.107578443	1.906551093	1.12772533	1.627264589	7.277929487	3.542501674	5.090105802	0	0.005291518	4.059608631	6.621839792	12.33393378	1.829969741	1.261102397	0	0	3.479422864	2.322390349	0	0	0.142020711	0	0.010199159	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.5343
H3456_010_0	2012	3																															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	534.2472002	40.4377	5178.799269	504.2870033	24.293737	33.90718731	22.31379332	13.56877885	15.89891384	25.42864678	14.85087646	0	0	14.08060452	1.106114307	138.1272566	18.9239	81.04448818	0	22895.07483	6.585404618	8.36879199	215.5714339	160	5.200906081	128.9285464	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.082415651	0.08341665	0	0	0.2	0.2	0.188704071	0.114735184	0.16	0	0.072826145	0	0	0.146431648	0	0.026979136	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.077313553	0.078252584	0	0	0.18761862	0.18761862	0.177021988	0.107632284	0.150094896	0	0.068317704	0	0	0.137366519	0	0.025308941	0.18761862	0	0	0	0.18761862	0.187705365	0	0	0	0	0	0	0	0												41.3045	3.164354526	0	0	4.557957418	6.361619703	3.950032044	1.460438663	2.386345824	0	1.014577786	0	0	1.934203629	0	3.495854618	3.550476009	0	0	0	1.235544529	1.570867156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9868	0	NO	5.01376938	41.3045	3.164354526	0	0	4.557957418	6.361619703	3.950032044	1.460438663	2.386345824	0	1.014577786	0	0	1.934203629	0	3.495854618	3.550476009	0	0	0	1.235544529	1.570867156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9868	NO																																										0	0	0	0	0	0	0	0	0	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	41.3045	3.164354526	0	0	4.557957418	6.361619703	3.950032044	1.460438663	2.386345824	0	1.014577786	0	0	1.934203629	0	3.495854618	3.550476009	0	0	0	1.235544529	1.570867156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9868
H3456_016_0	2012	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	307.5812467	22.5922	39.97340462	3266.515719	17.93746857	25.59089198	17.55781732	42.21006578	62.25062819	22.4574633	43.49173613	0	0	52.49268774	45.69844809	92.18502569	10.9492	5.770613837	0	922.2747403	23.2426571	9.431434803	839.6091958	187.4349449	61.33600549	265.0163687	0	0	547.8386432	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.082290529	0.083290009	0.188766372	0	0.224	0.224	0.224	0.124168157	0.224	0.224	0.224	0	0	0.224	0.220757259	0.223930342	0.232077793	0.224	0	0	0.224	0.223117896	0	0	0	0	0	0	0	0											NO	0.065395472	0.066189749	0.150010775	0	0.178010592	0.178010592	0.178010592	0.098688799	0.178010592	0.178010592	0.178010592	0	0	0.178010592	0.175433618	0.177955235	0.184429935	0.178010592	0	0	0.178010592	0.178064196	0	0	0	0	0	0	0	0												20.1144	1.495372054	5.996441421	0	3.193059404	4.555449838	3.12547746	4.165660688	11.08127119	3.997666343	7.741989708	0	0	9.344254434	8.01704407	16.40480795	2.019360241	1.027230387	0	0	4.137439155	1.679400851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0963	150	YES	27.91723903	20.1144	1.495372054	5.996441421	0	3.193059404	4.555449838	3.12547746	4.165660688	11.08127119	3.997666343	7.741989708	0	0	9.344254434	8.01704407	16.40480795	2.019360241	1.027230387	0	0	4.137439155	1.679400851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0963	NO																																										0	0	0	0	0	0	0	0	0	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	20.1144	1.495372054	5.996441421	0	3.193059404	4.555449838	3.12547746	4.165660688	11.08127119	3.997666343	7.741989708	0	0	9.344254434	8.01704407	16.40480795	2.019360241	1.027230387	0	0	4.137439155	1.679400851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0963
H3456_020_0	2012	6																															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	1127.1818	96.6385526	544.4219873	1245.725625	137.6417726	8.20968636	11.83558048	334.8600852	52.25353532	15.41782081	28.63445077	0	0.014007014	31.92501704	5255.62494	3481.826601	555.2712116	500.133653	0	0	36.67987879	832.9564893	0	0	39.74436589	0	17.81350644	65	117.5306295	0											4200	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	66.13491517	0	200	0.2	0.131560699	62.63006709	0.16	0.144113791	0.184048629	0	0.2	0.145174836	12.64768861	34.24588386	38.5	35	0	0	0.2	33.76167035	0	0	35	0	20	342.5	0	0											YES	150.1213509	78.6274818	52.62985442	0	159.1590593	0.159159059	0.104695386	49.86147951	0.127327247	0.114685077	0.146465034	0	0.159159059	0.115529452	12.21252829	33.07120248	37.17535699	33.79577908	0	0	0.159159059	26.86737847	0	0	35	0	20	342.5	0	0											6600	14.1012	0.633203836	2.387737495	0	1.825577921	1.306645958	1.239130664	1.39138494	6.653298821	1.768193973	4.193945794	0	0.002229343	3.688279721	5.348705689	9.595682712	1.72020046	1.408533871	0	0	5.837935003	1.864946437	0	0	0.115921067	0	0.029689177	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.9676	0	NO	12.67531129	14.1012	0.633203836	2.387737495	0	1.825577921	1.306645958	1.239130664	1.39138494	6.653298821	1.768193973	4.193945794	0	0.002229343	3.688279721	5.348705689	9.595682712	1.72020046	1.408533871	0	0	5.837935003	1.864946437	0	0	0.115921067	0	0.029689177	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	66.9676	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1197	0.0088	0.1784	0.1647	0.1037	0.1855	0.1605	0.079	0.5668	0.1004	0.3471	0	0.0001	0.3138	0.3804	0.5846	0.1019	0.0844	0	0	0.4497	0.1094	0	0	0.007	0	0.0031	0	0	0											4.049	0	NO	0.875584064	14.2209	0.641981505	2.566113934	0.164711662	1.929254745	1.492161052	1.399600533	1.470407409	7.220072404	1.868611892	4.541021087	0	0.00235595	4.002127691	5.729061618	10.18025929	1.822121026	1.492947677	0	0	6.287660327	1.974342323	0	0	0.122893763	0	0.032814354	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	71.0166
H3456_023_0	2012	6																															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	1298.075923	113.3605808	994.667855	1349.473037	220.3328552	9.452485917	11.18111045	366.2631954	63.71039364	20.3438468	31.65632693	0	0.067832248	34.0397738	5778.951418	3657.816706	556.913175	797.7187159	0	0	36.31563217	1045.736731	0	0	47.43792107	0	5.496394222	65	678.7468399	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	66.86912047	0	200	0.2	0.09811695	61.49787234	0.16	0.228503915	0.177498874	0	0.2	0.145591364	13.44417337	39.26272988	38.5	40	0	0	0.2	38.42042896	0	0	40	0	20	352.5	0	0											YES	145.2472483	76.07462436	51.48638841	0	153.9915227	0.153991523	0.075545893	47.36950506	0.123193218	0.175938329	0.13666661	0	0.153991523	0.112099179	12.91800607	37.72745642	36.99321781	38.43451201	0	0	0.153991523	29.58210179	0	0	40	0	20	352.5	0	0											7500	15.7118	0.7186553	4.267654627	0	2.827449323	1.4556027	0.844686974	1.445808857	7.848688423	3.579262409	4.326362872	0	0.010445591	3.815830703	6.221044126	11.50001003	1.716834199	2.554994131	0	0	5.592299496	2.577924201	0	0	0.158126404	0	0.009160657	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	79.092	0	NO	17.33385056	15.7118	0.7186553	4.267654627	0	2.827449323	1.4556027	0.844686974	1.445808857	7.848688423	3.579262409	4.326362872	0	0.010445591	3.815830703	6.221044126	11.50001003	1.716834199	2.554994131	0	0	5.592299496	2.577924201	0	0	0.158126404	0	0.009160657	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	79.092	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1343	0.0103	0.3377	0.1335	0.1595	0.2052	0.1457	0.0815	0.664	0.2019	0.3562	0	0.0006	0.3225	0.4194	0.6851	0.1016	0.1506	0	0	0.4278	0.1477	0	0	0.0094	0	0.0009	0	0	0											4.6952	0	NO	1.193747517	15.8461	0.728938363	4.605387933	0.133490717	2.98690853	1.660831181	0.990342773	1.527352396	8.51265026	3.781121498	4.682562862	0	0.011034689	4.13829739	6.640413322	12.18506349	1.818461781	2.70558448	0	0	6.020110517	2.725602761	0	0	0.167489151	0	0.010087637	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	83.7872
H3456_025_0	2012	6																															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	1194.151031	89.15133014	652.3726963	1185.575407	144.3681588	9.654635023	10.80556554	353.7955353	47.34055172	15.67154307	28.85231104	0	0.028270049	28.9751878	5788.219781	3538.6308	429.5206327	354.7976961	0	0	17.80211528	824.7907754	0	0	41.46418605	0	16.75621695	65	521.5979222	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	64.47581965	0	200	0.2	0.103685176	62.99193443	0.16	0.242887847	0.186788488	0	0.2	0.14563309	9.65175767	34.46054463	38.5	35	0	0	0.2	33.77659458	0	0	35	0	15	352.5	0	0											YES	154.5783228	80.96186316	52.83288993	0	163.884353	0.163884353	0.08496189	51.63367996	0.131107482	0.199027588	0.153058553	0	0.163884353	0.119334924	9.361259745	33.42730967	37.3412297	33.94657246	0	0	0.163884353	27.67727674	0	0	35	0	15	352.5	0	0											7500	15.3825	0.601488149	2.872227905	0	1.971640191	1.582243614	0.918061271	1.522313787	6.20670055	3.119069415	4.416092969	0	0.004633019	3.457751834	4.51541907	9.857242296	1.336569051	1.003680475	0	0	2.917488144	1.902330212	0	0	0.120937209	0	0.020945271	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	65.6387	0	NO	10.84669895	15.3825	0.601488149	2.872227905	0	1.971640191	1.582243614	0.918061271	1.522313787	6.20670055	3.119069415	4.416092969	0	0.004633019	3.457751834	4.51541907	9.857242296	1.336569051	1.003680475	0	0	2.917488144	1.902330212	0	0	0.120937209	0	0.020945271	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	65.6387	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1305	0.0085	0.2394	0.1671	0.1104	0.2215	0.1487	0.0852	0.5213	0.1746	0.3601	0	0.0003	0.2902	0.4215	0.6675	0.079	0.0675	0	0	0.2216	0.1231	0	0	0.0082	0	0.0033	0	0	0											4.0497	0	NO	0.797527496	15.513	0.610032957	3.111663247	0.16706945	2.082036818	1.803727178	1.066793263	1.607557633	6.727991512	3.293713219	4.776208442	0	0.004892432	3.74793655	4.936939358	10.52470708	1.415584428	1.071200351	0	0	3.139075013	2.02546965	0	0	0.12912093	0	0.024252419	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	69.6884
H3456_801_0	2012	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	183.65919	5.5825	23.08949649	1152.388884	5.509778609	9.544239875	11.67293828	13.39650772	60.88307905	20.40411359	34.0012265	0	0.029751228	37.25102918	36.39121831	77.68177638	2.6204	6.129554017	0	0	26.76515395	12.34004284	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082910108	0.082910108	0.191582259	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070599333	0.070599333	0.163135473	0	0.190739717	0.190739717	0.190739717	0.190739717	0.190739717	0.190739717	0.190739717	0	0.190739717	0.190739717	0.190739717	0.190739717	0.190739717	0.190739717	0	0	0.190739717	0.190739717	0	0	0	0	0	0	0	0												12.9662	0.394120777	3.766715925	0	1.050933613	1.820465613	2.226492943	2.555246092	11.61282127	3.891874851	6.485384321	0	0.005674741	7.105250764	6.941250682	14.81700004	0.499814354	1.169149399	0	0	5.10517789	2.353736279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7673	150	YES	14.78132238	12.9662	0.394120777	3.766715925	0	1.050933613	1.820465613	2.226492943	2.555246092	11.61282127	3.891874851	6.485384321	0	0.005674741	7.105250764	6.941250682	14.81700004	0.499814354	1.169149399	0	0	5.10517789	2.353736279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7673	NO																																										0	0	0	0	0	0	0	0	0	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	12.9662	0.394120777	3.766715925	0	1.050933613	1.820465613	2.226492943	2.555246092	11.61282127	3.891874851	6.485384321	0	0.005674741	7.105250764	6.941250682	14.81700004	0.499814354	1.169149399	0	0	5.10517789	2.353736279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7673
H3456_803_0	2012	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	176.2192812	5.6091	29.74556023	1222.936443	5.490816675	9.236905385	11.62847666	15.12057446	58.56298437	19.94662423	32.03332578	0	0.023728719	37.03945043	36.35260062	78.01701719	2.6183	5.563071741	0	0	31.22974156	11.93110102	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.088314705	0.088314705	0.203466419	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075021757	0.075021757	0.172841071	0	0.19028398	0.19028398	0.19028398	0.19028398	0.19028398	0.19028398	0.19028398	0	0.19028398	0.19028398	0.19028398	0.19028398	0.19028398	0.19028398	0	0	0.19028398	0.19028398	0	0	0	0	0	0	0	0												13.2203	0.420804538	5.141254482	0	1.044814448	1.757635116	2.212712817	2.877203083	11.14359773	3.795523039	6.09542871	0	0.004515195	7.048014032	6.917317517	14.84538851	0.498220544	1.05856343	0	0	5.942519507	2.270297383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2941	150	YES	15.29026934	13.2203	0.420804538	5.141254482	0	1.044814448	1.757635116	2.212712817	2.877203083	11.14359773	3.795523039	6.09542871	0	0.004515195	7.048014032	6.917317517	14.84538851	0.498220544	1.05856343	0	0	5.942519507	2.270297383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2941	NO																																										0	0	0	0	0	0	0	0	0	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	13.2203	0.420804538	5.141254482	0	1.044814448	1.757635116	2.212712817	2.877203083	11.14359773	3.795523039	6.09542871	0	0.004515195	7.048014032	6.917317517	14.84538851	0.498220544	1.05856343	0	0	5.942519507	2.270297383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2941
H3456_804_0	2012	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	183.4630673	5.5816	23.06484009	1152.494276	5.503894923	9.53404794	11.66047318	13.38220209	60.81806429	20.3823248	33.96491787	0	0.029719457	37.21046686	36.35235749	77.59882293	2.6195	6.123008496	0	0	26.73657244	12.32686537	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08258406	0.08258406	0.184599362	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070369428	0.070369428	0.15729611	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0	0.190869179	0.190869179	0	0	0	0	0	0	0	0												12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	150	YES	14.67522542	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	NO																																										0	0	0	0	0	0	0	0	0	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	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451
H3456_805_0	2012	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	183.4630673	5.5816	23.06484009	1152.494276	5.503894923	9.53404794	11.66047318	13.38220209	60.81806429	20.3823248	33.96491787	0	0.029719457	37.21046686	36.35235749	77.59882293	2.6195	6.123008496	0	0	26.73657244	12.32686537	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08258406	0.08258406	0.184599362	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070369428	0.070369428	0.15729611	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0	0.190869179	0.190869179	0	0	0	0	0	0	0	0												12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	150	YES	14.67522542	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	NO																																										0	0	0	0	0	0	0	0	0	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	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451
H3456_806_0	2012	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	183.4630673	5.5816	23.06484009	1152.494276	5.503894923	9.53404794	11.66047318	13.38220209	60.81806429	20.3823248	33.96491787	0	0.029719457	37.21046686	36.35235749	77.59882293	2.6195	6.123008496	0	0	26.73657244	12.32686537	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08258406	0.08258406	0.184599362	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070369428	0.070369428	0.15729611	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0.190869179	0	0	0.190869179	0.190869179	0	0	0	0	0	0	0	0												12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	150	YES	14.67522542	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451	NO																																										0	0	0	0	0	0	0	0	0	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	12.9102	0.392773998	3.628009631	0	1.050523908	1.819755907	2.225624949	2.554249933	11.60829403	3.89035761	6.482856004	0	0.005672528	7.102331277	6.938544646	14.81122366	0.499981816	1.168693608	0	0	5.103187644	2.352818679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5451
H3456_808_0	2012	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	182.5457519	5.5547865	22.25757068	1089.107091	5.201180702	9.009675303	11.01914716	12.64618098	57.47307076	19.26129694	32.09684739	0	0.028084887	35.16389118	34.75485115	73.71888178	2.49451	5.816858072	0	0	25.39974382	11.7105221	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08258406	0.08258406	0.184599362	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070490751	0.070490751	0.157567303	0	0.191198256	0.191198256	0.191198256	0.191198256	0.191198256	0.191198256	0.191198256	0	0.191198256	0.191198256	0.191198256	0.191198256	0.191198256	0.191198256	0	0	0.191198256	0.191198256	0	0	0	0	0	0	0	0												12.8678	0.391561074	3.507065395	0	0.994456678	1.722634202	2.106841716	2.417927745	10.98875088	3.682726377	6.136861233	0	0.005369781	6.723274658	6.645066917	14.09492161	0.476945961	1.112173117	0	0	4.856386714	2.239031399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9698	150	YES	13.89107917	12.8678	0.391561074	3.507065395	0	0.994456678	1.722634202	2.106841716	2.417927745	10.98875088	3.682726377	6.136861233	0	0.005369781	6.723274658	6.645066917	14.09492161	0.476945961	1.112173117	0	0	4.856386714	2.239031399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9698	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.0758	0.0023	0.149	0	0.0678	0.1175	0.1437	0.1649	0.7493	0.2511	0.4184	0	0.0004	0.4584	0.3578	0.8691	0.0294	0.0686	0	0	0.2994	0.1381	0	0	0	0	0	0	0	0											4.361	150	YES	0	12.9435	0.393866284	3.656086811	0	1.062264663	1.840093673	2.250498746	2.582796474	11.73802943	3.933836618	6.555309022	0	0.005735925	7.18170761	7.002908337	14.96402843	0.506354921	1.180750812	0	0	5.155836325	2.377092292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3307
H3528_001_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O																																																			0	YES	598.6252424	18.75130782	283.3954837		138.5518076	4.201657908	3.492124282	509.2449599	737.8507376		1280.043079				2656.5799	4599.150758	307.5440528	651.5040165	1201.733281		14.78843194				42.73714296		5.590018654														5400	$250 Days 1-7	$200 Days 1-7	"$50 Days 1-20, $100 days 21-100"		$175 copay	0.2	0.2	$65 ER copay; $30 UC copay	"$175, Colorectal exempt"		"$35 X-ray, 20% ther., $200 diag."				$15 copay	$30 copay; $20 Chiro	$30 copay	$30 copay	$30 copay		20% coinsurance				$30 copay		$30 copay																132.75	106.2	65.76		175	0.2	0.2	63.86979167	157.5		79.60941378				15	29.56068713	30	30	30		0.2				30		12.80915133														NO	125.1222291	100.0977833	61.98145225		164.9445582	0.188508066	0.188508066	60.19985466	148.4501023		77.61004527				14.13810498	27.86213987	28.27620997	28.27620997	28.27620997		0.188508066				28.27620997		12.80915133															6.2418	0.156413696	1.46377197	0	1.904447224	0.792046408	0.658293596	2.554706048	9.127834792	0	8.278683441	0	0	0	3.129917128	10.67851514	0.724681684	1.535172031	2.831705216	0	2.787738711	0	0	0	0.100703702	0	0.00596695	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9724	0		2.937551049	6.2418	0.156413696	1.46377197	0	1.904447224	0.792046408	0.658293596	2.554706048	9.127834792	0	8.278683441	0	0	0	3.129917128	10.67851514	0.724681684	1.535172031	2.831705216	0	2.787738711	0	0	0	0.100703702	0	0.00596695	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9724	NO																																																																																		0	0		0	6.2418	0.156413696	1.46377197	0	1.904447224	0.792046408	0.658293596	2.554706048	9.127834792	0	8.278683441	0	0	0	3.129917128	10.67851514	0.724681684	1.535172031	2.831705216	0	2.787738711	0	0	0	0.100703702	0	0.00596695	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9724
H3528_002_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O																																																			0	YES	1350.478533	8.672337037	958.4071692		295.7502956	8.793703392	5.526784389	693.7572891	1018.023346		1872.411396				3337.343833	6669.885989	414.7226803	974.4044753	1907.866602		37.18715002				56.87845806		3.035929031														3400	$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20, $100 days 21-100"		$175 copay	0.2	0.2	$65 ER copay; $25 UC copay	"$125, Colorectal exempt"		"$35 X-ray, 20% ther., $150 diag."				$10 copay	$25 copay; $20  Chiro	$25 copay	$25 copay	$30 copay		20% coinsurance				$25 copay		$25 copay																106.2	106.2	65.76		175	0.2	0.2	63.85350318	112.5		77.32001027				10	24.74732692	25	25	30		0.2				25		18.10142211														NO	88.6854834	88.6854834	54.914853		146.1389792	0.167015976	0.167015976	53.32277586	93.94648665		71.85438788				8.350798813	20.66640596	20.87699703	20.87699703	25.05239644		0.167015976				20.87699703		18.10142211															9.9807	0.064092534	4.385899067	0	3.601720526	1.468688957	0.92306129	3.082755369	7.969976393	0	11.2117479	0	0	0	2.322457244	11.48688096	0.721513681	1.695219945	3.983052538	0	6.210848164	0	0	0	0.098954283	0	0.004579553	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2121	0		12.30614971	9.9807	0.064092534	4.385899067	0	3.601720526	1.468688957	0.92306129	3.082755369	7.969976393	0	11.2117479	0	0	0	2.322457244	11.48688096	0.721513681	1.695219945	3.983052538	0	6.210848164	0	0	0	0.098954283	0	0.004579553	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2121	NO																																																																																		0	0		0	9.9807	0.064092534	4.385899067	0	3.601720526	1.468688957	0.92306129	3.082755369	7.969976393	0	11.2117479	0	0	0	2.322457244	11.48688096	0.721513681	1.695219945	3.983052538	0	6.210848164	0	0	0	0.098954283	0	0.004579553	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2121
H3528_003_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O																																																			0	YES	930.7305159	41.90294303	780.5242598		180.5092902	3.550222079	3.473698791	400.1796388	521.4330281		993.2295215				2553.968217	3958.027236	274.0808371	609.0748032	1723.549165		12.07011806				7.085750946		3.432541666														5500	$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20,$100 days 21-100"		$100 copay	0.2	0.2	$65 ER; $30 UC	"$125, Colorectal exempt"		"$30 X-ray, $175 advanced rad"				$20 copay	$30 copay; $20 Chiro	$30 copay	$30 copay	$30 copay		20% coinsurance				$30 copay		$30 copay																106.2	106.2	65.76		100	0.2	0.2	62.2685114	112.5		84.00716942				20	29.53174044	30	30	30		0.2				30		13.44231668														NO	100.7838627	100.7838627	62.40627885		94.90005908	0.189800118	0.189800118	59.09285411	106.7625665		81.35621091				18.98001182	28.02563913	28.47001772	28.47001772	28.47001772		0.189800118				28.47001772		13.44231668															7.8169	0.351928372	4.059134551	0	1.427528525	0.67383257	0.659308441	1.970646418	4.63912736	0	6.733782536	0	0	0	4.039528911	9.24385358	0.650257191	1.44503087	4.08912294	0	2.290909834	0	0	0	0.016810955	0	0.003845109	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1115	0		2.550336558	7.8169	0.351928372	4.059134551	0	1.427528525	0.67383257	0.659308441	1.970646418	4.63912736	0	6.733782536	0	0	0	4.039528911	9.24385358	0.650257191	1.44503087	4.08912294	0	2.290909834	0	0	0	0.016810955	0	0.003845109	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1115	NO																																																																																		0	0		0	7.8169	0.351928372	4.059134551	0	1.427528525	0.67383257	0.659308441	1.970646418	4.63912736	0	6.733782536	0	0	0	4.039528911	9.24385358	0.650257191	1.44503087	4.08912294	0	2.290909834	0	0	0	0.016810955	0	0.003845109	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1115
H3528_006_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O																																																			0	NO	908.3283525	33.30281354	767.8621181		162.6260412	8.291385381	5.728743257	378.7051621	691.0192648		1258.158834				2947.406213	5870.029459	599.3387157	894.5397033	1866.270741		46.14363222				39.97319055		3.722470436															$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20,100 days 21-100"		$150 copay	0.2	0.2	$65 ER; $40 UC	"$125, Colorectal exempt"		"$35 X-ray, 20% ther., $150 diag."				$15 copay	$25 copay; $20 copay for Chiro	$25 copay	$25 copay	$30 copay		20% coinsurance				$25 copay		$25 copay														0	NO	106.2	106.2	65.76		150	0.2	0.2	63.29906256	121.5705459		84.41583444				15	24.73467492	25	25	30		0.2				25		13.72678074														NO	96.97440003	96.97440003	60.04742511		136.9694916	0.182625989	0.182625989	57.80026944	111.0097058		80.55413678				13.69694916	22.58597232	22.8282486	22.8282486	27.39389831		0.182625989				22.8282486		13.72678074															7.3404	0.269126697	3.842345252	0	1.856233848	1.514222454	1.046217402	1.824105034	6.392487107	0	8.4458249	0	0	0	3.364206087	11.04836024	1.140154433	1.701731227	4.260369242	0	8.427026459	0	0	0	0.076043161	0	0.004258128	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5531	0		5.551942532	7.3404	0.269126697	3.842345252	0	1.856233848	1.514222454	1.046217402	1.824105034	6.392487107	0	8.4458249	0	0	0	3.364206087	11.04836024	1.140154433	1.701731227	4.260369242	0	8.427026459	0	0	0	0.076043161	0	0.004258128	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5531	YES	$300 Days 1-7				150	0.2	0.2	$65 ER; $40 UC	0.2		0.2			0.2	40	40		40	0.2		0.2				40		40														5500	0.9023				0.444	0.1702	0.1312	0.4402	0.8723		0.2318			0.2767	0.3872	1.9593		0.8763	0.188		0.7039				0.0002																7.5838	0		0.721475538	8.2427	0.269126697	3.842345252	0	2.300188955	1.684383876	1.177434335	2.264342828	7.264818862	0	8.677639472	0	0	0.276727628	3.75142244	13.00769566	1.140154433	2.578064111	4.448379228	0	9.130948198	0	0	0	0.076211158	0	0.004258128	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1368
H3528_008_0	2012	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	NO	812.1648569	207.2146816	838.5454194		145.4311931	4.883530417	6.905762356	313.1413803	307.6541667		734.6253158				2963.216497	3679.680002	753.3805955	725.0992851	2209.726788		15.3021915				171.5740206		2.72568777															$250 Days 1-7	$200 Days 1-7	"$50 Days 1-20, $100 days 21-100"		$175 copay	0.2	0.2	$65 ER; $40 UC	"$225, Colorectal exempt"		"$35 X-ray, 20% ther., $200 diag."				$25 copay	$40 copay; $20 Chiro	$40 copay	$40 copay	$30 copay		20% coinsurance				$40 copay		$40 copay														0	NO	132.75	106.2	65.76		175	0.2	0.2	60	202.5		92.49856414				25	39.15844288	40	40	30		0.2				32.75863967		40														NO	125.0956308	100.0765046	61.96827631		164.9094944	0.188467994	0.188467994	56.54039809	190.8238436		88.37998743				23.55849921	36.90056582	37.69359873	37.69359873	28.27019905		0.188467994				32.75842226		37.69359873															8.4665	1.728110087	4.330267854	0	1.998582045	0.92038918	1.301515176	1.475428192	4.892312548	0	5.410514681	0	0	0	5.817411125	11.31518951	2.366468821	2.277633458	5.205784678	0	2.883973331	0	0	0	0.468374518	0	0.008561748	0	0	0	0	0	0	0	0	0	0	0	0	0	60.867	0		3.616760106	8.4665	1.728110087	4.330267854	0	1.998582045	0.92038918	1.301515176	1.475428192	4.892312548	0	5.410514681	0	0	0	5.817411125	11.31518951	2.366468821	2.277633458	5.205784678	0	2.883973331	0	0	0	0.468374518	0	0.008561748	0	0	0	0	0	0	0	0	0	0	0	0	0	60.867	YES	0.2				0.2	0.2	0.2	$65 ER; $40 UC	0.2		0.2				0.2	0.2		0.2	0.2		0.2				0.2		0.2														6700	2.0012				0.1126	0.0632	0.0893	0.0955	0.3917		0.1866				0.3611	1.3652		0.1269	0.2036		0.198				0.0006																5.1955	0		0.317902887	10.4677	1.728110087	4.330267854	0	2.11121106	0.983573105	1.390864072	1.570903781	5.28399896	0	5.597141165	0	0	0	6.17847548	12.68036675	2.366468821	2.404565646	5.409384878	0	3.081955618	0	0	0	0.468941449	0	0.008561748	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0625
H3528_801_0	2012	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	YES	270.0266996	8.436540849	69.42584567		11.82678649	8.098013142	10.74475275	15.66056567	47.82904072	8.416615922	24.77807076	1.288624135	0.443107057	27.75810193	48.45524261	157.0288426	4.172241741	15.1232491	24.363399	7.164038238	32.27455569	1.276200195																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.065653862	0.065653862	0.136834762		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.057251544	0.057251544	0.119322781		0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697																				15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819	0		16.36124662	15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819	NO																																																																																		0	0		0	15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819
H3528_805_0	2012	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	270.0266996	8.436540849	69.42584567		11.82678649	8.098013142	10.74475275	15.66056567	47.82904072	8.416615922	24.77807076	1.288624135	0.443107057	27.75810193	48.45524261	157.0288426	4.172241741	15.1232491	24.363399	7.164038238	32.27455569	1.276200195																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.065653862	0.065653862	0.136834762		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.057251544	0.057251544	0.119322781		0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697	0.195332697																				15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819	0		16.36124662	15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819	NO																																																																																		0	0		0	15.4594	0.483004989	8.284084999	0	2.310158097	1.581806744	2.098801529	3.059020523	9.342575499	1.644040284	4.839967378	0.251710427	0.086553296	5.422064903	9.464893202	30.67286727	0.81497523	2.954065027	4.758968425	1.399370907	6.304275994	0.249283625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4819
H3528_806_0	2012	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	NO	256.5253646	8.014713806	65.95455339		11.23544717	7.693112485	10.20751512	14.87753739	45.43758869	7.995785126	23.53916722	1.224192928	0.420951704	26.37019684	46.03248048	149.1774005	3.963629654	14.36708664	23.14522905	6.805836326	30.6608279	1.212390185																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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		0.065653862	0.065653862	0.136834762		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.057182941	0.057182941	0.1191798		0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634	0.195098634																				14.6689	0.458304904	7.860450459	0	2.192020395	1.500915738	1.991472256	2.902587223	8.864811488	1.559966756	4.592459372	0.238838368	0.082127103	5.144789383	8.980874064	29.10430707	0.773298731	2.80299898	4.515602573	1.327809371	5.981885643	0.236535669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7809	0		15.67009113	14.6689	0.458304904	7.860450459	0	2.192020395	1.500915738	1.991472256	2.902587223	8.864811488	1.559966756	4.592459372	0.238838368	0.082127103	5.144789383	8.980874064	29.10430707	0.773298731	2.80299898	4.515602573	1.327809371	5.981885643	0.236535669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7809	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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS											6700	0.8675	0.0271	0.4728		0.1317	0.0903	0.1198	0.1697	0.5184	0.0912	0.2686	0.014	0.0048	0.3009	0.4727	1.8012	0.0479	0.1687	0.2785	0.0814	0.3598	0.0138																			6.3008	0		0.933377596	15.5363	0.485407501	8.333259509	0	2.323723153	1.591196383	2.111261078	3.072329166	9.383221516	1.651192882	4.861024248	0.252805524	0.086929857	5.445654259	9.453551646	30.90551692	0.821181006	2.971714529	4.794087981	1.40922873	6.341698314	0.250368164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0817
H3528_807_0	2012	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	NO	256.5253646	8.014713806	65.95455339		11.23544717	7.693112485	10.20751512	14.87753739	45.43758869	7.995785126	23.53916722	1.224192928	0.420951704	26.37019684	46.03248048	149.1558038	3.963629654	14.36708664	23.14522905	6.805836326	30.6608279	1.212390185																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	NO	0.065653862	0.065653862	0.136834762		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.057183357	0.057183357	0.119180666		0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053	0.195100053																				14.669	0.458308237	7.860507622	0	2.192036336	1.500926653	1.991486739	2.902608331	8.864875955	1.559978101	4.59249277	0.238840105	0.0821277	5.144826797	8.980939375	29.10030521	0.773304355	2.803019364	4.515635412	1.327819027	5.981929145	0.236537389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7775	0		15.66869772	14.669	0.458308237	7.860507622	0	2.192036336	1.500926653	1.991486739	2.902608331	8.864875955	1.559978101	4.59249277	0.238840105	0.0821277	5.144826797	8.980939375	29.10030521	0.773304355	2.803019364	4.515635412	1.327819027	5.981929145	0.236537389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7775	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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS											6700	0.8675	0.0271	0.4728		0.1317	0.0903	0.1198	0.1697	0.5184	0.0912	0.2686	0.014	0.0048	0.3009	0.4727	1.801	0.0479	0.1687	0.2785	0.0814	0.3598	0.0138																			6.3005	0		0.933293129	15.5365	0.485411031	8.33332011	0	2.323740052	1.591207955	2.111276431	3.072351509	9.383289753	1.65120489	4.861059598	0.252807363	0.086930489	5.445693861	9.453620395	30.90126726	0.821186978	2.97173614	4.794122844	1.409238978	6.341744432	0.250369985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.078
H3533_001_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1236.9013	26.30649794	725.7713288		194.4236801	7.914881589	4.502130263	213.2268772	179.4708958		4.800962611	8.983753592	0.002397934	14.55251417	4396.484736	4330.540855	154.4169743	1510.918999			12.34234512	0.783344622		1000	159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 300 copay,9b - OP Ambulatory Surgical Center (ASC) 300 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 300 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	63.73145499	300		0.2	300	0.2	0.197121154	5	33.49612036	40	20			0.2			48.93464191	20																NO	172.6013457	135.7067176	57.24301531		238.1297576	0.190503806	0.190503806	60.70542371	285.7557091		0.190503806	285.7557091	0.190503806	0.18776165	4.762595151	31.97009954	38.10076121	19.05038061			0.190503806			46.61117766	20																	17.7909	0.297497374	3.462111607	0	3.858171985	1.507815067	0.85767295	1.078668994	4.273736091	0	0.91460165	0.213929906	0.000456816	2.732404074	1.744889741	11.53731852	0.490283689	2.398631833	0	0	2.351263721	0	0	3.884264805	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6598	0		2.93628879	17.7909	0.297497374	3.462111607	0	3.858171985	1.507815067	0.85767295	1.078668994	4.273736091	0	0.91460165	0.213929906	0.000456816	2.732404074	1.744889741	11.53731852	0.490283689	2.398631833	0	0	2.351263721	0	0	3.884264805	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6598	NO																																																																																		0	0		0	17.7909	0.297497374	3.462111607	0	3.858171985	1.507815067	0.85767295	1.078668994	4.273736091	0	0.91460165	0.213929906	0.000456816	2.732404074	1.744889741	11.53731852	0.490283689	2.398631833	0	0	2.351263721	0	0	3.884264805	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6598
H3533_002_0	2012	8																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	255.0891018	5.860400818	40.42159876		9.145608713	8.992751381	9.293863813	23.11000583	52.01388063	5.688375982	14.36526357	4.007606559	0.453589644	27.1733112		5126.88075	4.110009547	887.7216943		3545.754915	18.41038819	0.083161619			159.1037094		2.022213494														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 100"													0.086706713	0.086706713	0.17771972		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		9.987858523	0.224	10		2.941366473	0.224	1374.431837			5		10														NO	0.073554888	0.073554888	0.150762884		0.190023291	0.190023291	0.190023291	0.190023291	0.190023291	0.190023291	0.190023291	0.190023291	0.190023291	0.190023291		8.473445716	0.190023291	8.483182614		2.495214893	0.190023291	1165.955626			5		10															18.7631	0.431061128	6.094076816	0	1.737878662	1.708832209	1.766050584	4.391439353	9.883848752	1.080923922	2.729734654	0.761538586	0.086192597	5.163562009	0	3.620195477	0.780997538	0.62755877	0	0.737285039	3.498402544	0.00808023	0	0	0.066293212	0	0.001685178	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9387	0		11.41998252	18.7631	0.431061128	6.094076816	0	1.737878662	1.708832209	1.766050584	4.391439353	9.883848752	1.080923922	2.729734654	0.761538586	0.086192597	5.163562009	0	3.620195477	0.780997538	0.62755877	0	0.737285039	3.498402544	0.00808023	0	0	0.066293212	0	0.001685178	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9387	NO																																																																																		0	0		0	18.7631	0.431061128	6.094076816	0	1.737878662	1.708832209	1.766050584	4.391439353	9.883848752	1.080923922	2.729734654	0.761538586	0.086192597	5.163562009	0	3.620195477	0.780997538	0.62755877	0	0.737285039	3.498402544	0.00808023	0	0	0.066293212	0	0.001685178	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9387
H3597_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	849.9014065	20.41407356	417.0092793	473.6128555	176.2211174	8.750647703	0	327.013131	392.5397551	4532.362529	2239.42822	56.01236014	0.005473128	919.9488466	3021.578217	4551.886475	218.7326915	985.5273427	0	0	263.3777742	0.0005961	0	0	1485.519142	91.28807356	40.61904875	16.90519881	40.85308292	0											3400	$200/day 1-10; unlimited additional days	$100/day 1-10	"$0/d 1-8, $75/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$30 per visit	20% per visit	$0 to 175 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	$75.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	163.9294809	58.00564974	62.22836824	0	150	0.03	0.03	62.5	175	3	16.23299738	30	0.2	30	10	30	30	15	30	30	50	0	0	0	0	0	0	0	0	0											NO	143.4612753	50.76307471	54.45854533	0	131.2710269	0.026254205	0	54.6962612	153.1495314	2.625420538	14.20614824	26.25420538	0.175028036	26.25420538	8.751401792	26.25420538	26.25420538	13.12710269	0	0	43.75700896	0	0	0	0	0	0	0	0	0												10.1607	0.086356762	1.892476562	0	1.927727254	0.229741302	0	1.490532969	5.009773295	0.991613139	2.651137439	0.122546667	0.000957951	2.012710496	2.203587085	9.958846863	0.478554417	1.078093219	0	0	0.960385302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2557	0	NO	5.886119418	10.1607	0.086356762	1.892476562	0	1.927727254	0.229741302	0	1.490532969	5.009773295	0.991613139	2.651137439	0.122546667	0.000957951	2.012710496	2.203587085	9.958846863	0.478554417	1.078093219	0	0	0.960385302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2557	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		10.1607	0.086356762	1.892476562	0	1.927727254	0.229741302	0	1.490532969	5.009773295	0.991613139	2.651137439	0.122546667	0.000957951	2.012710496	2.203587085	9.958846863	0.478554417	1.078093219	0	0	0.960385302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2557
H3597_002_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1171.157013	35.51678782	949.0232422	718.5833635	216.5599598	11.05432893	0	323.9171968	378.8830793	4799.561064	2597.56091	56.68781515	0.320484208	822.4914252	3318.004233	6522.156498	278.8794474	1319.616197	0	0	319.308096	0.002609242	0	0	1563.844573	53.50377278	45.49048639	12.77702037	58.52651266	0											3400	$100/day 1-10; unlimited additional days	$100/day 1-10	"$0/d 1-20, $105/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$0 to $20 per visit	$0 to $20 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$20 per visit	20% per visit	$0 to 175 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$50 per script		Not Covered		$0 per visit	$75.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	81.96474044	58.00564974	42.34790568	0	150	0.03	0.03	62.5	175	2	12.1092753	20	0.2	20	5	20	20	10	20	20	50	0	0	0	0	0	0	0	0	0											NO	74.38642764	52.64255147	38.43249432	0	136.1312692	0.027226254	0	56.72136217	158.8198141	1.815083589	10.98967344	18.15083589	0.181508359	18.15083589	4.537708974	18.15083589	18.15083589	9.075417947	0	0	45.37708974	0	0	0	0	0	0	0	0	0												7.2598	0.155807861	3.039444197	0	2.456715182	0.300967966	0	1.531085386	5.014511684	0.725967044	2.378862179	0.085744269	0.058170563	1.244075574	1.254678132	9.865216022	0.42182459	0.99800571	0	0	1.207439344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9984	0	NO	3.871183247	7.2598	0.155807861	3.039444197	0	2.456715182	0.300967966	0	1.531085386	5.014511684	0.725967044	2.378862179	0.085744269	0.058170563	1.244075574	1.254678132	9.865216022	0.42182459	0.99800571	0	0	1.207439344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9984	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		7.2598	0.155807861	3.039444197	0	2.456715182	0.300967966	0	1.531085386	5.014511684	0.725967044	2.378862179	0.085744269	0.058170563	1.244075574	1.254678132	9.865216022	0.42182459	0.99800571	0	0	1.207439344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9984
H3597_801_0	2012	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	0	0	0	0	0	0	0											0	YES	274.8565563	5.056353046	33.56364677	8.748721715	8.191687344	11.35792584	0	14.2286951	35.21007614	17.07433308	47.69928456	0.798422499	0.069729659	23.43137204	23.62965817	117.8093784	2.700126794	7.484717493	0	0	59.14456159	0.000307872	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	NO	0.08168286	0.08168286	0.139052214	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066457897	0.066457897	0.11313411	0	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0.18224838	0	0	0	0	0	0	0	0												18.2664	0.336034591	3.79719331	0	1.492921747	2.069963584	0	2.59315663	6.416979333	3.111769542	8.693117335	0.145511207	0.012708117	4.270329594	4.306466919	21.47056835	0.492093734	1.364077637	0	0	10.77900053	5.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6183	0	NO	20.53083139	18.2664	0.336034591	3.79719331	0	1.492921747	2.069963584	0	2.59315663	6.416979333	3.111769542	8.693117335	0.145511207	0.012708117	4.270329594	4.306466919	21.47056835	0.492093734	1.364077637	0	0	10.77900053	5.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6183	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.2664	0.336034591	3.79719331	0	1.492921747	2.069963584	0	2.59315663	6.416979333	3.111769542	8.693117335	0.145511207	0.012708117	4.270329594	4.306466919	21.47056835	0.492093734	1.364077637	0	0	10.77900053	5.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6183
H3597_802_0	2012	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	0	0	0	0	0	0	0											0	YES	278.5072412	5.123512265	34.00944402	8.864923513	8.300490531	11.50878347	0	14.4176827	35.6777415	17.30111686	48.33283341	0.809027263	0.070655819	23.74259094	23.94351073	119.3741397	2.735990272	7.584130603	0	0	59.93012829	0.000311961	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	NO	0.081661908	0.081661908	0.139385414	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066441585	0.066441585	0.11340646	0	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0.182250396	0	0	0	0	0	0	0	0												18.5045	0.340414276	3.856890639	0	1.512767685	2.097480343	0	2.627628379	6.502282511	3.153135396	8.808678021	0.147445539	0.012877051	4.327096597	4.363714308	21.75598422	0.49863531	1.382210804	0	0	10.9222896	5.69E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8141	0	NO	20.80352489	18.5045	0.340414276	3.856890639	0	1.512767685	2.097480343	0	2.627628379	6.502282511	3.153135396	8.808678021	0.147445539	0.012877051	4.327096597	4.363714308	21.75598422	0.49863531	1.382210804	0	0	10.9222896	5.69E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8141	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.5045	0.340414276	3.856890639	0	1.512767685	2.097480343	0	2.627628379	6.502282511	3.153135396	8.808678021	0.147445539	0.012877051	4.327096597	4.363714308	21.75598422	0.49863531	1.382210804	0	0	10.9222896	5.69E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8141
H3619_001_0	2012	7	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	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	1259.82	60.43	656.97	1679.63	1.66	14.85	4.28	389.43	386.92	1519.45	1009.26	162.25	0.69	7.84	3311.34	3818.32	89.05	501.54		1267.36	23.09	0		3.23	0.61				4.33	1.28	1386.59	407.47									4700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	207.049884	29.8849	85.115071	40.724577	0.198402	0.2	15	38.25978	40	42.87618		0	0.2	0		0	0				0	0	0	91.45873									NO	140.013375	99.348332	25.199815	0	0.178267	0.178267	0.178267	57.936905	184.551222	26.637517	75.866212	36.299323	0.176843	0.178267	13.370055	34.102358	35.65348	38.217126		0	0.178267	0		0	0				0	0	0	81.52055										14.6993	0.500301642	1.379626872	0	0.29592322	2.64726495	0.76298276	1.88019741	5.950546568	3.3728646	6.38072776	0.490797096	0.12202167	1.39761328	3.689399827	10.85114297	0.264578533	1.597284781	0	0	4.11618503	0	0	0	0	0	0	0	0	0	0	2.768098209	0	0	0	0	0	0	0	0	63.1669	0	NO	10.743768	14.6993	0.500301642	1.379626872	0	0.29592322	2.64726495	0.76298276	1.88019741	5.950546568	3.3728646	6.38072776	0.490797096	0.12202167	1.39761328	3.689399827	10.85114297	0.264578533	1.597284781	0	0	4.11618503	0	0	0	0	0	0	0	0	0	0	2.768098209	0	0	0	0	0	0	0	0	63.1669	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						0% Coins	30% Coins									7000	4.9483	0.0779	0.4445	3.7385	2.9324	1.2596	0.3628	0.2665	2.7509	0.4549	1.0188	0.0483	0.0174	0.3	1.4499	2.6555	0.0307	0.1941		0.1938	0.9217	0		0	0				0	0	0	0.6549									24.7216	1000	NO	9.46432	19.6476	0.578233642	1.824117872	3.738506	3.22833422	3.90683895	1.12573276	2.14673941	8.701469568	3.8277886	7.39949776	0.539113096	0.13944867	1.69760528	5.139347827	13.50668997	0.295246533	1.791400781	0	0.193803	5.03789103	0	0	0	0	0	0	0	0	0	0	3.423031209	0	0	0	0	0	0	0	0	87.8884
H3619_004_0	2012	6	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	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	1867.94	99.11	1024.68	1760.72	1.78	15.75	12.47	456.47	349.76	3080.88	1167.97	267.12	0.31	10.45	2843.36	3594.95	147.9	593.97		1288.33	22.63	0		3.23	2.86				4.33	1.28	1634.91	1753.86									6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	212.012379	42.154564	73.347513	38.075734	0.2	0.2	15	33.875879	35	40.385187		0	0.2	0		0	0				0	0	0	68.055949									NO	129.414648	103.701041	25.618935	0	0.18106	0.18106	0.18106	58.8445	191.934807	38.162527	66.401504	34.469962	0.18106	0.18106	13.5795	30.667833	31.6855	36.560709		0	0.18106	0		0	0				0	0	0	61.611051										20.1449	0.856484181	2.18760086	0	0.3222868	2.851695	2.2578182	2.238395743	5.594259841	9.797847182	6.462913719	0.767301354	0.0561286	1.892077	3.21761726	9.187443854	0.390523788	1.809663694	0	0	4.0973878	0	0	0	0	0	0	0	0	0	0	9.004763159	0	0	0	0	0	0	0	0	83.1371	0	NO	12.60038	20.1449	0.856484181	2.18760086	0	0.3222868	2.851695	2.2578182	2.238395743	5.594259841	9.797847182	6.462913719	0.767301354	0.0561286	1.892077	3.21761726	9.187443854	0.390523788	1.809663694	0	0	4.0973878	0	0	0	0	0	0	0	0	0	0	9.004763159	0	0	0	0	0	0	0	0	83.1371	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						0% Coins	30% Coins									10000	6.8288	0.1302	0.7245	3.5523	3.2527	0.9196	0.7285	0.3226	2.8976	1.0034	1.3137	0.078	0.0081	0.413	1.4375	2.8043	0.0529	0.239		0.2208	0.919	0		0	0				0	0	0	1.2359									29.0823	1000	NO	10.029975	26.9737	0.986714181	2.91211286	3.552278	3.5749638	3.771274	2.9863002	2.560990743	8.491831841	10.80127318	7.776629719	0.845307354	0.0642036	2.305037	4.65516226	11.99177285	0.443384788	2.048634694	0	0.220775	5.0163408	0	0	0	0	0	0	0	0	0	0	10.24068616	0	0	0	0	0	0	0	0	112.2194
H3619_012_0	2012	8	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	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	1103.67	65.41	783.92	1373.69	1.51	13.24	3.62	392.91	270.74	1422.84	981.38	127.47	0.55	6.05	3391.01	3657.13	50.33	408.51		1439.14	18.73	0		3.23	0.61		0.24		4.33	1.28	1542.28	559.95									5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	203.299734	29.1117	86.850313	40.740037	0.2	0.2	15	36.686661	40	43.717944		0	0.2	0		0	0		0		0	0	0	72.709497									NO	148.456082	105.338966	26.323243	0	0.183041	0.183041	0.183041	59.488455	186.06134	26.643231	79.486014	37.285567	0.183041	0.183041	13.728105	33.575889	36.60828	40.010969		0	0.183041	0		0	0		0		0	0	0	66.544241										13.6539	0.574185147	1.719609721	0	0.27639191	2.42346284	0.66260842	1.947800738	4.197853933	3.1590879	6.500498702	0.396065935	0.10067255	1.10739805	3.879345111	10.23261591	0.153541228	1.362073412	0	0	3.42835793	0	0	0	0	0	0	0	0	0	0	3.105120646	0	0	0	0	0	0	0	0	58.8806	0	NO	7.716659	13.6539	0.574185147	1.719609721	0	0.27639191	2.42346284	0.66260842	1.947800738	4.197853933	3.1590879	6.500498702	0.396065935	0.10067255	1.10739805	3.879345111	10.23261591	0.153541228	1.362073412	0	0	3.42835793	0	0	0	0	0	0	0	0	0	0	3.105120646	0	0	0	0	0	0	0	0	58.8806	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						0% Coins	30% Coins									7500	5.2848	0.0979	0.5287	2.1562	2.8538	0.8021	0.2196	0.288	2.7657	0.5552	1.1512	0.0417	0.0149	0.2482	1.6539	2.9173	0.0234	0.16		0.3141	0.8104	0		0	0		0		0	0	0	0.894									23.7811	1000	NO	8.785701	18.9387	0.672091147	2.248351721	2.1562	3.13020891	3.22552484	0.88216742	2.235802738	6.963541933	3.7142659	7.651661702	0.437808935	0.11559355	1.35556305	5.533204111	13.14989491	0.176955228	1.522033412	0	0.314127	4.23877893	0	0	0	0	0	0	0	0	0	0	3.999167646	0	0	0	0	0	0	0	0	82.6617
H3619_013_0	2012	5	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	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	1559.61	36.76	584.57	804.67	1.35	12.5	3.41	449.62	432.16	2369.05	976.43	236.97	1.72	14.95	3444.29	4015.93	66.45	821.49		1336.51	22.75	0			0.61				4.33	1.09	1307.47	571.76									6000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289607	34.03605	0	0.2	0.2	0.2	65	208.528549	36.121194	80.324316	40.664041	0.2	0.2	15	36.900436	40	45.426112		0	0.2	0			0				0	0	0	96.618683									NO	144.492283	102.5264	27.05849	0	0.18135	0.18135	0.18135	58.938815	189.083471	32.752929	72.834154	36.87216	0.18135	0.18135	13.601265	33.459507	36.27004	41.190173		0	0.18135	0			0				0	0	0	87.609088										18.7793	0.314072539	1.318131792	0	0.2448225	2.266875	0.6184035	2.208339167	6.809526069	6.466110537	5.926454416	0.72813298	0.311922	2.7111825	3.903891752	11.1975865	0.200845347	2.819776268	0	0	4.1257125	0	0	0	0	0	0	0	0	0	0	4.174281013	0	0	0	0	0	0	0	0	75.1254	0	NO	10.950569	18.7793	0.314072539	1.318131792	0	0.2448225	2.266875	0.6184035	2.208339167	6.809526069	6.466110537	5.926454416	0.72813298	0.311922	2.7111825	3.903891752	11.1975865	0.200845347	2.819776268	0	0	4.1257125	0	0	0	0	0	0	0	0	0	0	4.174281013	0	0	0	0	0	0	0	0	75.1254	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7500	5.7737	0.0513	0.4007	1.9721	2.6299	1.17	0.3189	0.3396	3.6903	0.5813	1.1084	0.0745	0.0485	0.6313	1.5244	2.9899	0.0302	0.2904		0.2644	1.0401	0			0				0	0	0.2075	1.0113									26.1485	1500	NO	10.646372	24.553	0.365373539	1.718812792	1.972104	2.8747325	3.436853	0.9372695	2.547930167	10.49980907	7.047366537	7.034812416	0.80260998	0.360379	3.3425265	5.428316752	14.1874795	0.231039347	3.110212268	0	0.264376	5.1657955	0	0	0	0	0	0	0	0	0	0.207511	5.185581013	0	0	0	0	0	0	0	0	101.2739
H3619_014_0	2012	6	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	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	1091.46	25.7	587.9	883.43	1.45	13.68	3.83	446.46	281.22	1982.75	1025.46	119.83	0.21	3.83	3374.21	3615.82	60.12	407.69		1570.84	16.77	0		3.23	2.86				4.33	1.28	1360.6	563.99									4800	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.071648	44.153975	88.895875	41.813092	0.2	0.2	15	36.571515	40	43.584823		0	0.2	0		0	0				0	0	0	102.034944									NO	134.132943	107.481851	27.063016	0	0.181017	0.181017	0.181017	58.830395	187.417028	39.963012	80.458145	37.844319	0.181017	0.181017	13.576245	33.100257	36.20332	39.447882		0	0.181017	0		0	0				0	0	0	92.350093										12.2001	0.230190298	1.325862259	0	0.26247465	2.47631256	0.69329511	2.188784846	4.392118051	6.60305517	6.875550781	0.377907062	0.03801357	0.69329511	3.817425137	9.973714272	0.181378633	1.340208918	0	0	3.03565509	0	0	0	0	0	0	0	0	0	0	4.340377413	0	0	0	0	0	0	0	0	61.0457	0	NO	8.067694	12.2001	0.230190298	1.325862259	0	0.26247465	2.47631256	0.69329511	2.188784846	4.392118051	6.60305517	6.875550781	0.377907062	0.03801357	0.69329511	3.817425137	9.973714272	0.181378633	1.340208918	0	0	3.03565509	0	0	0	0	0	0	0	0	0	0	4.340377413	0	0	0	0	0	0	0	0	61.0457	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						0% Coins	30% Coins									7200	4.8937	0.0379	0.5027	1.74	2.7781	1.2555	0.3518	0.3306	2.4618	0.6	1.1618	0.0384	0.0059	0.1585	1.4856	2.4855	0.0253	0.1481		0.2887	0.7089	0		0	0				0	0	0	0.8358									22.2947	1000	NO	7.134998	17.0938	0.268126298	1.828610259	1.74004	3.04053065	3.73177556	1.04507311	2.519421846	6.853876051	7.20308717	8.037351781	0.416297062	0.04393457	0.85176011	5.303044137	12.45923127	0.206639633	1.488328918	0	0.288714	3.74457509	0	0	0	0	0	0	0	0	0	0	5.176195413	0	0	0	0	0	0	0	0	83.3404
H3619_015_0	2012	5	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	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	1303.08	57.83	595.57	1192.58	1.2	12.98	3.98	403.7	359.97	1619.55	1126.23	160.53	0.61	8.39	3245.35	4000.49	112.89	600.5		1571.66	20.16	0		3.23	0.61				4.33	1.28	1728.67	544.81									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	41.183744	0.199634	0.2	15	37.959557	40	42.586041		0	0.2	0		0	0				0	0	0	80.952501									NO	130.725577	104.7515	26.580283	0	0.180323	0.180323	0.180323	58.60504	187.057887	32.466396	72.745327	37.131922	0.179994	0.180323	13.52424	34.224944	36.06464	38.396256		0	0.180323	0		0	0				0	0	0	72.98807										14.1955	0.504814937	1.319201596	0	0.2163876	2.34059254	0.71768554	1.971571221	5.611268965	4.38174597	6.827330802	0.496732287	0.10979634	1.51290997	3.657574357	11.40971219	0.339278101	1.921412644	0	0	3.63531168	0	0	0	0	0	0	0	0	0	0	3.313719201	0	0	0	0	0	0	0	0	64.4825	0	NO	9.399094	14.1955	0.504814937	1.319201596	0	0.2163876	2.34059254	0.71768554	1.971571221	5.611268965	4.38174597	6.827330802	0.496732287	0.10979634	1.51290997	3.657574357	11.40971219	0.339278101	1.921412644	0	0	3.63531168	0	0	0	0	0	0	0	0	0	0	3.313719201	0	0	0	0	0	0	0	0	64.4825	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7500	5.1195	0.0738	0.4737	2.7131	2.2553	1.1682	0.3585	0.293	2.4971	0.4468	0.9948	0.0464	0.0164	0.3406	1.3555	2.4941	0.0339	0.2028		0.2617	0.8722	0		0	0				0	0	0.2134	0.666									22.8967	1000	NO	7.162873	19.315	0.578565937	1.792913596	2.713135	2.4717066	3.50874454	1.07614254	2.264602221	8.108395965	4.82856597	7.822173802	0.543086287	0.12619934	1.85352997	5.013058357	13.90377419	0.373166101	2.124166644	0	0.261738	4.50753468	0	0	0	0	0	0	0	0	0	0.213393	3.979678201	0	0	0	0	0	0	0	0	87.3792
H3619_016_0	2012	5	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	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	1225.41	49.97	571.08	1260.66	1.66	18.07	4.57	535.03	383.83	2025.9	1595.04	214.66	0.49	10.6	3816.52	4850.85	275.74	715.44		1536.84	35.47	0		3.23	2.86		0.24		4.33	1.28	2039.29	456.81									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	198.87431	20.247797	81.596994	40.584167	0.199669	0.2	15	37.219727	40	41.306256		0	0.2	0		0	0		0		0	0	0	76.837213									NO	127.903652	102.490268	25.821722	0	0.176072	0.176072	0.176072	57.223335	175.080789	17.82533	71.834648	35.728637	0.175781	0.176072	13.205385	32.766722	35.21436	36.364334		0	0.176072	0		0	0		0		0	0	0	67.644332										13.0612	0.426786558	1.22885575	0	0.29227952	3.18162104	0.80464904	2.551350077	5.600104937	3.009361337	9.548261412	0.639125768	0.08613269	1.8663632	4.199884663	13.24553778	0.809167302	2.168041593	0	0	6.24527384	0	0	0	0	0	0	0	0	0	0	2.575050608	0	0	0	0	0	0	0	0	71.539	0	NO	11.91851	13.0612	0.426786558	1.22885575	0	0.29227952	3.18162104	0.80464904	2.551350077	5.600104937	3.009361337	9.548261412	0.639125768	0.08613269	1.8663632	4.199884663	13.24553778	0.809167302	2.168041593	0	0	6.24527384	0	0	0	0	0	0	0	0	0	0	2.575050608	0	0	0	0	0	0	0	0	71.539	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins	30% Coins									6700	4.6231	0.0683	0.4069	2.8125	2.7369	1.4235	0.3603	0.3401	2.7897	0.4948	1.1349	0.0581	0.0117	0.3766	1.6136	2.9519	0.0648	0.2443		0.2769	1.3947	0		0	0		0		0	0	0.2554	0.5878									25.0268	1000	NO	10.898934	17.6843	0.495075558	1.63577375	2.812514	3.02914752	4.60511304	1.16496704	2.891462077	8.389806937	3.504196337	10.68317341	0.697203768	0.09782469	2.2429982	5.813532663	16.19746378	0.873953302	2.412333593	0	0.276899	7.63996984	0	0	0	0	0	0	0	0	0	0.25537	3.162836608	0	0	0	0	0	0	0	0	96.5659
H3619_017_0	2012	4	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	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	1645.16	35.26	736.92	1093.69	1.73	17.51	3.26	487.45	309.79	2013.15	1156.87	143.25	1.12	6.82	3341.98	3586.24	125.99	552.12		1554.2	15.66	0			0.61				4.33	1.28	1477.21	730.24									6000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	213.323365	45.219888	80.458105	41.724318	0.199924	0.2	15	37.448328	40	42.859283		0	0.2	0			0				0	0	0	75.263085									NO	143.500148	101.822418	26.415481	0	0.18198	0.18198	0.18198	59.14337	194.102503	41.145486	73.208669	37.964873	0.18191	0.18198	13.64847	34.074159	36.39592	38.997576		0	0.18198	0			0				0	0	0	68.481731										19.6734	0.299188205	1.622174688	0	0.3148254	3.1864698	0.5932548	2.402452976	5.010917867	6.902669595	7.057742742	0.453205671	0.2037392	1.2411036	3.801076148	10.183176	0.38212683	1.794278472	0	0	2.8498068	0	0	0	0	0	0	0	0	0	0	4.167341604	0	0	0	0	0	0	0	0	72.1389	0	NO	10.860815	19.6734	0.299188205	1.622174688	0	0.3148254	3.1864698	0.5932548	2.402452976	5.010917867	6.902669595	7.057742742	0.453205671	0.2037392	1.2411036	3.801076148	10.183176	0.38212683	1.794278472	0	0	2.8498068	0	0	0	0	0	0	0	0	0	0	4.167341604	0	0	0	0	0	0	0	0	72.1389	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7500	5.6344	0.0359	0.4496	2.5311	3.2368	1.5662	0.2911	0.3517	2.1657	0.5093	1.1561	0.0435	0.0301	0.2751	1.4372	2.3256	0.0384	0.1767		0.2431	0.6411	0			0				0	0	0.2056	0.8363									24.1805	1000	NO	8.994939	25.3078	0.335100205	2.071735688	2.531055	3.5516514	4.7527108	0.8843958	2.754118976	7.176579867	7.411973595	8.213854742	0.496739671	0.2338132	1.5161716	5.238260148	12.508777	0.42052683	1.971018472	0	0.243064	3.4909328	0	0	0	0	0	0	0	0	0	0.205573	5.003598604	0	0	0	0	0	0	0	0	96.3195
H3620_001_0	2012	9																															D	D	D		T	Coin	Coin	V	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	1134.696297	0	529.7585733	0	128.1710396	7.528351243	4.563174239	472.9870995	30.93729978	2343.535041	789.7426234	0	0	0	4187.61856	5618.332924	126.9392522	566.9916179	667.1968287	1434.474054	17.03210907	0	0	0	0	0	0	0	0	0											3400	$210/Days 1-10 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MH/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 Prosth/Supplies; 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; $100/Visit for OP Rad - Complex Diagnostic; $35/Visit for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$35/Day for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"$0/Visit for Cardiac Rehab; $35/Visit for OP Substance Abuse; PBP 3, 9c"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$20/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; $0/Visit for Colorectal Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 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 - Complex Diagnostic; $35/Visit for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14b"	"$35/Visit for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	$0/Case for Blood; PBP 9d	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, 14b, 14c, 14d, 14e"	No Cost Sharing; PBP 13a-c											0	NO	210	0	84	0	150	0.2	0.2	47.8471286	0.2	35	83.11428141	0	0	0	15	34.14768608	35	10	47.5175564	35	0.2	0	0	0	0	0	0	0	0	0											NO	175.6960726	0	70.27842905	0	125.4971947	0.167329593	0.167329593	40.03120277	0.167329593	29.28267877	69.5373944	0	0	0	12.54971947	28.56959206	29.28267877	8.366479649	39.75546686	29.28267877	0.167329593	0	0	0	0	0	0	0	0	0												16.6135	0	3.102550025	0	1.340425493	1.259715949	0.763554088	1.57785354	5.17672578	5.71874865	4.576387023	0	0	0	4.379453183	13.37612331	0.309760112	0.395310319	2.210393451	3.500436911	2.849975878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1509	0	NO	13.11093143	16.6135	0	3.102550025	0	1.340425493	1.259715949	0.763554088	1.57785354	5.17672578	5.71874865	4.576387023	0	0	0	4.379453183	13.37612331	0.309760112	0.395310319	2.210393451	3.500436911	2.849975878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1509	YES	$400/Days 1-10 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 Prosth/Supplies; 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 - Complex Diagnostic; 40% Coinsurance for OP Rad - X-Ray; 40% Coinsurance for OP Rad - Therapeutic; PBP 8b	$60/Day for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"40% Coinsurance for Cardiac Rehab; $60/Visit for OP Substance Abuse; PBP 3, 9c"	"$30/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$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; $0/Visit for Colorectal Screening; $60/Exam for Vision Exams; $60/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"$60/Visit for MH - Non Phys; $60/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for PT/ST; PBP 7c, 7i"	"40% Coinsurance for Phys Rad - General; 40% Coinsurance for Phys Rad - Complex Diagnostic; 40% Coinsurance for Phys Rad - X-Ray; 40% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"40% Coinsurance for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	40% Coinsurance for Part B Drugs - Gen; 40% Coinsurance for Part B Drugs - Chemo; 40% Coinsurance for Part B Drugs - Pharmacy; PBP 15	40% Coinsurance for Blood; PBP 9d	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 14c	No Cost Sharing; PBP 13a-c											5100	2.6971	0	4.83	0.2943	1.2415	0.4963	0.1462	0.0702	1.2225	0.0797	0.5268	0	0	0.4672	0.2675	0.856	0.3099	0.0336	0.3128	2.6151	2.1205	0	0	0	0	0	0	0	0	0											18.5872	0	NO	9.768248762	19.3106	0	7.932580278	0.294296963	2.581898337	1.756044215	0.909725861	1.648044823	6.399205499	5.798428496	5.103168391	0	0	0.467246095	4.647001393	14.23211821	0.61965275	0.428959336	2.523199012	6.115516761	4.970440478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7381
H3620_801_0	2012	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	240.2081403	0	51.8256079	0	3.743561103	8.657149365	6.842829754	20.48842319	57.10470673	11.46406805	22.90395379	0	0	9.858991771	43.85261179	62.96190862	0.912738417	11.95319385	22.6694217	65.25481043	45.72635645	1.186540909	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-c											0	NO	0.082751818	0	0.176031113	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074096247	0	0.15761883	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0	0	0	0	0	0												17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	0	NO	12.301706	17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-c											10000	3.6139	0	4.5757	0	1.9406	0.2958	0.2588	0.4713	0.7556	0.3832	0.448	0	0.0103	0.5764	1.2447	2.1737	0.0895	0.2007	0.2904	2.4677	0.9182	0.0726	0	0	0	0	0	0	0	0											20.7872	0	NO	1.082997621	21.4124	0	12.74441458	0	2.691443017	2.032173964	1.631284225	4.580675043	12.20913502	2.682520915	5.041842722	0	0.010254283	2.553800955	10.04023695	14.8019976	0.272613686	2.598195349	4.837246483	15.55591597	10.08950868	0.310555983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0962
H3620_802_0	2012	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	256.8631713	0	55.41897967	0	4.003123918	9.257399632	7.317283314	21.90900486	61.0641094	12.2589387	24.49201765	0	0	10.54257342	46.89316936	67.32742537	0.976024518	12.78197866	24.24122418	69.77930657	48.89683203	1.268810808	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-c											0	NO	0.082751818	0	0.176031113	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073326899	0	0.15598226	0	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0	0	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0.198487787	0	0	0	0	0	0	0	0												18.835	0	8.644377671	0	0.794571208	1.837480768	1.452391373	4.348669895	12.12047995	2.433249615	4.861366387	0	0	2.092572069	9.30772142	13.36367168	0.193728947	2.537066659	4.811586945	13.85034015	9.70542399	0.25184345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4415	0	NO	14.32390307	18.835	0	8.644377671	0	0.794571208	1.837480768	1.452391373	4.348669895	12.12047995	2.433249615	4.861366387	0	0	2.092572069	9.30772142	13.36367168	0.193728947	2.537066659	4.811586945	13.85034015	9.70542399	0.25184345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4415	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-c											10000	3.8374	0	4.8587	0	2.0606	0.3141	0.2748	0.5004	0.8024	0.4069	0.4757	0	0.0109	0.612	1.3217	2.3081	0.0951	0.2132	0.3084	2.6203	0.9749	0.0771	0	0	0	0	0	0	0	0											22.0726	0	NO	1.313978027	22.6724	0	13.50304728	0	2.855166613	2.151579068	1.727211278	4.849118907	12.92283062	2.840112497	5.33705768	0	0.010888359	2.704593137	10.62939391	15.67179318	0.288811682	2.750219018	5.119979612	16.4706736	10.68035819	0.328901827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5141
H3620_803_0	2012	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	240.2081403	0	51.8256079	0	3.743561103	8.657149365	6.842829754	20.48842319	57.10470673	11.46406805	22.90395379	0	0	9.858991771	43.85261179	62.96190862	0.912738417	11.95319385	22.6694217	65.25481043	45.72635645	1.186540909	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-c											0	NO	0.082751818	0	0.176031113	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074096247	0	0.15761883	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0	0	0	0	0	0												17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	0	NO	12.301706	17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-c											10000	3.6139	0	4.5757	0	1.9406	0.2958	0.2588	0.4713	0.7556	0.3832	0.448	0	0.0103	0.5764	1.2447	2.1737	0.0895	0.2007	0.2904	2.4677	0.9182	0.0726	0	0	0	0	0	0	0	0											20.7872	0	NO	1.082997621	21.4124	0	12.74441458	0	2.691443017	2.032173964	1.631284225	4.580675043	12.20913502	2.682520915	5.041842722	0	0.010254283	2.553800955	10.04023695	14.8019976	0.272613686	2.598195349	4.837246483	15.55591597	10.08950868	0.310555983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0962
H3620_805_0	2012	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	240.2081403	0	51.8256079	0	3.743561103	8.657149365	6.842829754	20.48842319	57.10470673	11.46406805	22.90395379	0	0	9.858991771	43.85261179	62.96190862	0.912738417	11.95319385	22.6694217	65.25481043	45.72635645	1.186540909	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-c											0	NO	0.082751818	0	0.176031113	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074096247	0	0.15761883	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0	0	0	0	0	0												17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	0	NO	12.301706	17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-c											10000	3.6139	0	4.5757	0	1.9406	0.2958	0.2588	0.4713	0.7556	0.3832	0.448	0	0.0103	0.5764	1.2447	2.1737	0.0895	0.2007	0.2904	2.4677	0.9182	0.0726	0	0	0	0	0	0	0	0											20.7872	0	NO	1.082997621	21.4124	0	12.74441458	0	2.691443017	2.032173964	1.631284225	4.580675043	12.20913502	2.682520915	5.041842722	0	0.010254283	2.553800955	10.04023695	14.8019976	0.272613686	2.598195349	4.837246483	15.55591597	10.08950868	0.310555983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0962
H3620_806_0	2012	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	240.2081403	0	51.8256079	0	3.743561103	8.657149365	6.842829754	20.48842319	57.10470673	11.46406805	22.90395379	0	0	9.858991771	43.85261179	62.96190862	0.912738417	11.95319385	22.6694217	65.25481043	45.72635645	1.186540909	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-c											0	NO	0.082751818	0	0.176031113	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074096247	0	0.15761883	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0.200570327	0	0	0	0	0	0	0	0												17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	0	NO	12.301706	17.7985	0	8.168691704	0	0.750847276	1.736367283	1.372468604	4.109369748	11.45350973	2.299351883	4.593853512	0	0	1.977421208	8.795532707	12.62829063	0.183068243	2.397456004	4.546813334	13.0881787	9.171350287	0.237984899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3091	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	Medicare-FFS Cost Sharing; PBP 13a-c											10000	3.6139	0	4.5757	0	1.9406	0.2958	0.2588	0.4713	0.7556	0.3832	0.448	0	0.0103	0.5764	1.2447	2.1737	0.0895	0.2007	0.2904	2.4677	0.9182	0.0726	0	0	0	0	0	0	0	0											20.7872	0	NO	1.082997621	21.4124	0	12.74441458	0	2.691443017	2.032173964	1.631284225	4.580675043	12.20913502	2.682520915	5.041842722	0	0.010254283	2.553800955	10.04023695	14.8019976	0.272613686	2.598195349	4.837246483	15.55591597	10.08950868	0.310555983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0962
H3623_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1326.018703	84.1726674	1199.163952	902.904444	222.3316603	14.85807858	0	396.2953027	384.808475	3757.408142	2585.143142	20.8445194	0	907.413701	2862.649921	4034.905915	143.33543	639.5622613	0	0	38.74082878	0	0	0	868.7151904	33.11699006	39.57884178	8.48118038	49	0											3400	$225/day 1-8; unlimited additional days	$265/day 1-6	"$0/d 1-10, $75/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$15 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	171.4121744	115.9179994	57.64491905	15	200	0.03	0.03	62.5	200	4	24.71627306	40	0.2	40	10	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	144.5603576	97.75937742	48.61480898	12.65024128	168.6698838	0.025300483	0	52.70933868	168.6698838	3.373397675	20.84445452	33.73397675	0	33.73397675	8.433494188	33.73397675	33.73397675	16.86698838	0	0	0.084334942	0	0	0	0	0	0	0	0	0												15.9741	0.685722297	4.858093871	0.951829923	3.125054608	0.375916558	0	1.740705277	5.408800062	1.056269324	4.490491554	0.058597378	0	2.550889391	2.011845123	11.34278519	0.402939505	0.898957436	0	0	3.267205544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2002	0	NO	11.60321293	15.9741	0.685722297	4.858093871	0.951829923	3.125054608	0.375916558	0	1.740705277	5.408800062	1.056269324	4.490491554	0.058597378	0	2.550889391	2.011845123	11.34278519	0.402939505	0.898957436	0	0	3.267205544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2002	NO																																																																																		0		NO		15.9741	0.685722297	4.858093871	0.951829923	3.125054608	0.375916558	0	1.740705277	5.408800062	1.056269324	4.490491554	0.058597378	0	2.550889391	2.011845123	11.34278519	0.402939505	0.898957436	0	0	3.267205544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2002
H3623_003_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1846.963535	103.0026583	1410.039614	965.7804144	248.3232089	16.50421387	0	368.5224152	366.1860455	4305.99164	2915.94728	19.37267094	0.023353418	1133.886485	3010.808535	5701.999869	253.240372	987.9105655	0	0	52.67938091	0.00215187	0	0	1122.488915	9.723571889	47.55723654	9.723571889	53.28896626	0											3000	$150/day 1-7; unlimited additional days	$150/day 1-7	"$0/d 1-10, $75/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$150 per procedure	$0 to $35 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; $150 Complex Radiology	$35 per visit	20% per visit	$0 to 150 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	108.4282617	72.11764842	57.64491905	0	150	0.03	0.03	62.5	150	3.5	20.00900734	35	0.2	35	10	35	35	17.5	35	35	0.1	0	0	0	0	0	0	0	0	0											NO	90.70409098	60.32897366	48.22202165	0	125.4803262	0.025096065	0	52.28346925	125.4803262	2.927874278	16.73824512	29.27874278	0.167307102	29.27874278	8.365355081	29.27874278	29.27874278	14.63937139	0	0	0.083653551	0	0	0	0	0	0	0	0	0												13.9606	0.517837055	5.666246731	0	2.596639771	0.414190828	0	1.605635864	3.82909537	1.050616847	4.067320028	0.047267287	0.003907193	2.766564227	2.098873539	13.91228229	0.617879976	1.205199139	0	0	4.406817267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.767	0	NO	12.34456971	13.9606	0.517837055	5.666246731	0	2.596639771	0.414190828	0	1.605635864	3.82909537	1.050616847	4.067320028	0.047267287	0.003907193	2.766564227	2.098873539	13.91228229	0.617879976	1.205199139	0	0	4.406817267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.767	NO																																																																																		0		NO		13.9606	0.517837055	5.666246731	0	2.596639771	0.414190828	0	1.605635864	3.82909537	1.050616847	4.067320028	0.047267287	0.003907193	2.766564227	2.098873539	13.91228229	0.617879976	1.205199139	0	0	4.406817267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.767
H3623_004_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1609.952776	141.2839961	1561.529281	1543.654275	294.203197	15.0744273	0	469.0442659	384.2019672	4130.119928	2722.769303	78.30864469	0.012250343	1385.178876	2768.443154	5725.676038	305.1114677	569.2217963	0	0	42.7189135	0.001128158	0	0	1012.373921	30.20918295	38.82910809	6.839815008	44.39631869	0											3000	$225/day 1-8; unlimited additional days	$220/day 1-8	"$0/d 1-10, $75/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$10 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$225 per procedure	$0 to $40 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$40 per visit	20% per visit	$0 to 225 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	171.4121744	114.0191308	57.64491905	10	175	0.03	0.03	62.5	225	4	24.71627306	40	0.2	40	5	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	143.9730698	95.76731839	48.4173075	8.399232455	146.986568	0.025197697	0	52.49520285	188.9827302	3.359692982	20.75977228	33.59692982	0.167984649	33.59692982	4.199616228	33.59692982	33.59692982	16.79846491	0	0	0.083992325	0	0	0	0	0	0	0	0	0												19.3158	1.127532453	6.300420282	1.080459257	3.603659851	0.379840857	0	2.051881157	6.050628061	1.156327911	4.710339226	0.21924417	0.00205787	3.878146457	0.968866566	16.030428	0.854234047	0.796837698	0	0	3.588060847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1148	0	NO	14.42782532	19.3158	1.127532453	6.300420282	1.080459257	3.603659851	0.379840857	0	2.051881157	6.050628061	1.156327911	4.710339226	0.21924417	0.00205787	3.878146457	0.968866566	16.030428	0.854234047	0.796837698	0	0	3.588060847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1148	NO																																																																																		0		NO		19.3158	1.127532453	6.300420282	1.080459257	3.603659851	0.379840857	0	2.051881157	6.050628061	1.156327911	4.710339226	0.21924417	0.00205787	3.878146457	0.968866566	16.030428	0.854234047	0.796837698	0	0	3.588060847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1148
H3623_801_0	2012	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	0	0	0	0	0	0	0											0	YES	326.0901051	5.998862527	39.81994553	10.37949257	9.718626408	13.47505507	0	16.8809387	41.77327105	20.25700657	56.59048094	0.947249286	0.082727341	27.79900422	28.03425109	139.7691694	3.203433245	8.87987664	0	0	70.16916955	0.000365259	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	NO	0.0809119	0.0809119	0.175062423	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067740905	0.067740905	0.146565425	0	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0.187536849	0	0	0	0	0	0	0	0												22.0896	0.406368376	5.836227235	0	1.822600573	2.527069367	0	3.165798052	7.834027624	3.798935182	10.61280048	0.177644146	0.015514425	5.213337657	5.257455113	26.21186961	0.600761777	1.665304084	0	0	13.15930496	6.85E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3947	0	NO	21.46425934	22.0896	0.406368376	5.836227235	0	1.822600573	2.527069367	0	3.165798052	7.834027624	3.798935182	10.61280048	0.177644146	0.015514425	5.213337657	5.257455113	26.21186961	0.600761777	1.665304084	0	0	13.15930496	6.85E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3947	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		22.0896	0.406368376	5.836227235	0	1.822600573	2.527069367	0	3.165798052	7.834027624	3.798935182	10.61280048	0.177644146	0.015514425	5.213337657	5.257455113	26.21186961	0.600761777	1.665304084	0	0	13.15930496	6.85E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3947
H3623_802_0	2012	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	0	0	0	0	0	0	0											0	YES	303.3149964	4.611249747	36.61205899	8.393324586	9.176102195	15.5610241	0	17.36313655	42.05918496	22.0430609	55.42619895	1.244099823	0.06359146	28.00114181	30.95769522	132.590662	2.92618141	8.349112485	0	0	68.55486978	0.00028077	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	NO	0.080223505	0.080223505	0.175196147	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067346769	0.067346769	0.147075279	0	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0.188045588	0	0	0	0	0	0	0	0												20.4273	0.310552769	5.384728786	0	1.725525535	2.92618193	0	3.265061226	7.909044176	4.145100353	10.42265219	0.233947483	0.011958094	5.265491183	5.821458008	24.93308904	0.550255505	1.570013769	0	0	12.89144081	5.28E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7938	0	NO	20.6102365	20.4273	0.310552769	5.384728786	0	1.725525535	2.92618193	0	3.265061226	7.909044176	4.145100353	10.42265219	0.233947483	0.011958094	5.265491183	5.821458008	24.93308904	0.550255505	1.570013769	0	0	12.89144081	5.28E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7938	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		20.4273	0.310552769	5.384728786	0	1.725525535	2.92618193	0	3.265061226	7.909044176	4.145100353	10.42265219	0.233947483	0.011958094	5.265491183	5.821458008	24.93308904	0.550255505	1.570013769	0	0	12.89144081	5.28E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7938
H3653_004_0	2012	6																															D	D	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V	Coin						V																																																						0	YES	992.7892989	39.62841169	1311.800149		318.2190907	0	0.143402235	425.59153	439.8110422				0		3966.32501	5928.186374	178.2551247	46.72237085		4748.927208	2.36526257						31.39033205														3400	"$150 per day first 5 days, Unlimited days (1a)"	"$150 per day first 5 days, Unlimited days (1b)"	$90 per day after 15 days (100 day limit) (2)	Zero cost sharing (06)	$50 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$65 per visit if ER (04A)/$35 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, 14A,B,D,E)"	"$25 per visit (07D, 07F, 07G, 14A,B,D,E)"	"$25 per visit (07E, 07H)"	"$25 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$20 (07B) $25 per visit (14A,B,D,E) $35 if UC (04B)"	20% Coinsurance (15)	"Zero cost sharing (14A, 9D)"	Zero cost sharing (10B)	Zero cost sharing (16A-B)	Zero cost sharing (17A)	Zero cost sharing (17B)	$25 per visit (18A)	Zero cost sharing (18B)															150	150	90		50	0.2	0.2	65	125				0.05		15	25	25	25		25	0.2						25														NO	136.0286352	136.0286352	81.61718109		45.34287838	0.181371514	0.181371514	58.9457419	113.357196				0.045342878		13.60286352	22.67143919	22.67143919	22.67143919		22.67143919	0.181371514						22.67143919															11.254	0.449216563	8.922119195	0	1.202414127	0	0.02600908	2.090567373	4.154645541	0	0	0	0	0	4.496114815	11.20004308	0.336775018	0.088271949	0	8.972084536	0.428991252	0	0	0	0	0	0.059305334	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6805			5.513474382	11.254	0.449216563	8.922119195	0	1.202414127	0	0.02600908	2.090567373	4.154645541	0	0	0	0	0	4.496114815	11.20004308	0.336775018	0.088271949	0	8.972084536	0.428991252	0	0	0	0	0	0.059305334	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6805	NO																																																																																		0				11.254	0.449216563	8.922119195	0	1.202414127	0	0.02600908	2.090567373	4.154645541	0	0	0	0	0	4.496114815	11.20004308	0.336775018	0.088271949	0	8.972084536	0.428991252	0	0	0	0	0	0.059305334	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6805
H3653_015_0	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V	Coin						V																																																						0	YES	993.7384947	67.69631223	1579.905175		299.1403735	0	0.098880757	372.9231147	315.5069788	2757.32576	838.423197		0		2984.126112	4695.349176	217.1626438	24.1812983		3441.481891	1.115234118						20.99609559														3400	"$250 per day first 7 days, Unlimited days (1a)"	"$250 per day first 7 days, Unlimited days (1b)"	$95 per day after 10 days (100 day limit) (2)	Zero cost sharing (06)	$225 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$65 per visit if ER (04A)/$35 if UC (04B)	$225 per visit (09A and 09B)	$5 per visit  (08A)	$15 or $100 per visit routine or advanced respectively.  (08B)	Zero cost sharing (05)	20% Coinsurance (12)	"Covered in Full  (05, 09C and 09D)"	"$30 per visit (07A, 14A,B,D,E)"	"$45 per visit (07D, 07F, 07G, 14A,B,D,E)"	"$40 per visit (07E, 07H)"	"$45 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$20 (07B) $45 per visit (14A,B,D,E) $35 if UC (04B)"	20% Coinsurance (15)	"Zero cost sharing (14A, 9D)"	Zero cost sharing (10B)	Zero cost sharing (16A-B)	Zero cost sharing (17A)	Zero cost sharing (17B)	$45 per visit  (18A)	Zero cost sharing (18B)															250	250	95		225	0.2	0.2	65	225	5	15		0.2		30	45	40	45		44	0.2						45														NO	210.9818036	210.9818036	80.17308535		189.8836232	0.168785443	0.168785443	54.85526893	189.8836232	4.219636071	12.65890821		0.168785443		25.31781643	37.97672464	33.75708857	37.97672464		37.13279743	0.168785443						37.97672464															17.4717	1.190224171	10.55548937	0	4.733488164	0	0.016689632	1.704733145	4.992467356	0.969575936	0.884460191	0	0	0	6.295963092	14.85949856	0.610898217	0.076527209	0	10.64932083	0.188235284	0	0	0	0	0	0.066446912	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2657			12.95345061	17.4717	1.190224171	10.55548937	0	4.733488164	0	0.016689632	1.704733145	4.992467356	0.969575936	0.884460191	0	0	0	6.295963092	14.85949856	0.610898217	0.076527209	0	10.64932083	0.188235284	0	0	0	0	0	0.066446912	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2657	NO																																																																																		0				17.4717	1.190224171	10.55548937	0	4.733488164	0	0.016689632	1.704733145	4.992467356	0.969575936	0.884460191	0	0	0	6.295963092	14.85949856	0.610898217	0.076527209	0	10.64932083	0.188235284	0	0	0	0	0	0.066446912	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2657
H3653_018_0	2012	4																															D	D	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V	Coin						V																																																						0	YES	905.2194292	58.79227941	1140.881484		290.3336097	0	0.11515802	415.6931122	403.8953055				0		3680.765633	5321.248187	146.0695391	32.30227372		4523.716669	1.708907151						25.21451829														3400	"$150 per day first 5 days, Unlimited days (1a)"	"$150 per day first 5 days, Unlimited days (1b)"	$90 per day after 15 days (100 day limit) (2)	Zero cost sharing (06)	$50 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$65 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, 14A,B,D,E)"	"$25 per visit (07D, 07F, 07G, 14A,B,D,E)"	"$25 per visit (07E, 07H)"	"$25 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$20 (07B) $25 per visit (14A,B,D,E) $35 if UC (04B)"	20% Coinsurance (15)	"Zero cost sharing (14A, 9D)"	Zero cost sharing (10B)	Zero cost sharing (16A-B)	Zero cost sharing (17A)	Zero cost sharing (17B)	$25 per visit (18A)	Zero cost sharing (18B)															150	150	90		50	0.2	0.2	65	125				0.05		15	25	25	25		25	0.2						25														NO	136.0286352	136.0286352	81.61718109		45.34287838	0.181371514	0.181371514	58.9457419	113.357196				0.045342878		13.60286352	22.67143919	22.67143919	22.67143919		22.67143919	0.181371514						16.33699379															10.2613	0.666452794	7.759627555	0	1.097046796	0	0.020886384	2.041944908	3.815369941	0	0	0	0	0	4.172412711	10.05336289	0.275967223	0.061028253	0	8.546597282	0.309947076	0	0	0	0	0	0.034327452	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1163			5.044684417	10.2613	0.666452794	7.759627555	0	1.097046796	0	0.020886384	2.041944908	3.815369941	0	0	0	0	0	4.172412711	10.05336289	0.275967223	0.061028253	0	8.546597282	0.309947076	0	0	0	0	0	0.034327452	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1163	NO																																																																																		0				10.2613	0.666452794	7.759627555	0	1.097046796	0	0.020886384	2.041944908	3.815369941	0	0	0	0	0	4.172412711	10.05336289	0.275967223	0.061028253	0	8.546597282	0.309947076	0	0	0	0	0	0.034327452	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1163
H3653_803_0	2012	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	239.9875807	3.476915064	46.60543108		7.174338424	0	0.067422733	22.01673694	55.71767292	17.18694797	25.68343696	9.883596772	0	11.80226454	34.18248053	129.4828128	2.10167758	1.180529647	0	48.63968598	0.65874491	18.18171287																			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																					0.078169291	0.078169291	0.173002233		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.067976773	0.067976773	0.150444417		0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569																				16.3136	0.236349466	7.011526906	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.354			14.74732001	16.3136	0.236349466	7.011526906	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.354	NO																																																																																		0				16.3136	0.236349466	7.011526906	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.354
H3653_806_0	2012	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	241.8692489	3.504176477	46.97084982		7.174338424	0	0.067422733	22.01673694	55.71767292	17.18694797	25.68343696	9.883596772	0	11.80226454	34.18248053	129.4828128	2.10167758	1.180529647	0	48.63968598	0.65874491	18.18171287																			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																					0.078177982	0.078177982	0.173007226		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.06798433	0.06798433	0.150448759		0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569																				16.4433	0.23822909	7.066706055	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5408			14.77532848	16.4433	0.23822909	7.066706055	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5408	NO																																																																																		0				16.4433	0.23822909	7.066706055	0	1.397507815	0	0.013133447	4.288696757	10.85338866	3.347889754	5.002942675	1.925251209	0	2.298993434	6.658493208	25.22228979	0.409391176	0.229958403	0	9.474649403	0.128318614	3.541662565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5408
H3653_809_0	2012	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	311.8676229	2.967716718	69.33586081		12.07097354	0	0.122804519	28.53499409	57.21987731	17.90864774	30.95290265	10.11499064	0	12.65321114	42.75170146	146.0706143	1.954390602	1.71075497	0	54.07975214	2.678190845	25.58975307																			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																					0.078169291	0.078169291	0.173002233		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.067976773	0.067976773	0.150444417		0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569	0.194792569																				21.1998	0.201735805	10.43119316	0	2.35133595	0	0.023921408	5.558404814	11.14600692	3.488471507	6.029395435	1.970325016	0	2.464751508	8.32771377	28.45347026	0.380700767	0.333242356	0	10.53433387	0.521691676	4.984693748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4011			17.75320884	21.1998	0.201735805	10.43119316	0	2.35133595	0	0.023921408	5.558404814	11.14600692	3.488471507	6.029395435	1.970325016	0	2.464751508	8.32771377	28.45347026	0.380700767	0.333242356	0	10.53433387	0.521691676	4.984693748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4011	NO																																																																																		0				21.1998	0.201735805	10.43119316	0	2.35133595	0	0.023921408	5.558404814	11.14600692	3.488471507	6.029395435	1.970325016	0	2.464751508	8.32771377	28.45347026	0.380700767	0.333242356	0	10.53433387	0.521691676	4.984693748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4011
H3655_013_0	2012	9	H.6										OP Facility - Other										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	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	YES	2031.218942	72.9640204	1053.862352	972.9216089	391.6849994	12.13598753	6.816507482	405.6798043	422.9287721	9124.676944	866.5000398	0.207121747	0.025555856	1185.961861	3740.423915	4016.764016	8.420099459	1940.518371	793.4436124	2149.853	41.93324199	14.6848423	0.015924338	0	0	0	0	0	5872.8	416.8832341	13.06414977	0	0	0	0	0	0	0	0	0	3400	1A: $220/day (days1-8) no yrly max	1B: $220/day (days1-8) no yrly max	2: $146/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: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$145 copay	8B: $85-$145 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $40-$200 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $55 copay; 7I: $55 copay	8B: $85-$145 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	178.145492	162.6619185	146	0	150	0.2	0.165681837	49.99128817	174.1239059	22.59536448	106.1462786	40	0.2	58.41684738	25	39.5257296	40	55	97.46965144	0.721627178	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	151.3507104	138.1960141	124.0402071	0	127.4385689	0.169918092	0.140761708	42.47212148	147.9340092	19.19680609	90.18086562	33.98361837	0.169918092	49.63039619	21.23976148	33.58068276	33.98361837	46.72747526	82.80928593	0.613087566	0.169918092	0	0	0	0	0	0	0	0	0	0.169918092	0	0	0	0	0	0	0	0	0		25.6189	0.840278066	10.89344203	0	4.159647982	2.062123844	0.959503234	1.435840161	5.21379574	14.59705449	6.511810304	0.000586562	0.004342402	4.904979751	6.620475983	11.24047318	0.023845454	7.556293682	5.475374914	0.109837345	7.125216465	0	0	0	0	0	0	0	0	0	2.219835401	0	0	0	0	0	0	0	0	0	117.5736		NO	20.81496433	25.6189	0.840278066	10.89344203	0	4.159647982	2.062123844	0.959503234	1.435840161	5.21379574	14.59705449	6.511810304	0.000586562	0.004342402	4.904979751	6.620475983	11.24047318	0.023845454	7.556293682	5.475374914	0.109837345	7.125216465	0	0	0	0	0	0	0	0	0	2.219835401	0	0	0	0	0	0	0	0	0	117.5736	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	25.6189	0.840278066	10.89344203	0	4.159647982	2.062123844	0.959503234	1.435840161	5.21379574	14.59705449	6.511810304	0.000586562	0.004342402	4.904979751	6.620475983	11.24047318	0.023845454	7.556293682	5.475374914	0.109837345	7.125216465	0	0	0	0	0	0	0	0	0	2.219835401	0	0	0	0	0	0	0	0	0	117.5736
H3655_030_0	2012	9	H.6										OP Facility - Other										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	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	YES	1763.249287	67.00642712	668.4662832	865.2818794	259.5800544	12.27290326	7.428199919	349.3856084	490.5505056	9792.966547	1032.4954	0.984723761	0.010534277	992.5335989	4273.427347	4539.455058	6.924232632	1696.075045	858.3850467	2430.998105	45.44677767	12.02650666	0	1004.272118	293	293	324	0	5872.8	419.380229	16.13833702	0	0	0	0	0	0	0	0	0	3000	1A: $135/day (days1-7) no yrly max	1B: $135/day (days1-7) no yrly max	2: $146/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: $0 - $105 copay; 9B: $0-$105 copay	8A: $0-$100 copay	8B: $65-$100 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $20-$105 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $45 copay; 7I: $45 copay	8B: $65-$100 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $20 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	105.1542152	95.23046092	146	0	150	0.2	0.13960648	49.91549296	91.3890774	16.39989618	77.13168739	40	0.2	33.29582822	15	19.42173616	40	45	72.80126794	0.341882108	0.2	0	0	0	0	0	20	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	92.54103076	83.80762479	128.4873884	0	132.0075908	0.176010121	0.122860767	43.9281598	80.42701289	14.43273857	67.87978818	35.20202422	0.176010121	29.30201379	13.20075908	17.09211066	35.20202422	39.60227724	64.06879993	0.300873556	0.176010121	0	0	0	0	0	20	0	0	0	0.176010121	0	0	0	0	0	0	0	0	0		13.5977	0.467970792	7.157457246	0	2.8555448	2.160155189	0.912634343	1.278988903	3.287792653	11.77827716	5.840464088	0.002888689	0.001854139	2.423602767	4.701040405	6.465739017	0.02031225	5.597369514	4.582974985	0.06095192	7.99909284	0	0	0	0	0	0.54	0	0	0	2.840510653	0	0	0	0	0	0	0	0	0	84.5734		NO	11.45360408	13.5977	0.467970792	7.157457246	0	2.8555448	2.160155189	0.912634343	1.278988903	3.287792653	11.77827716	5.840464088	0.002888689	0.001854139	2.423602767	4.701040405	6.465739017	0.02031225	5.597369514	4.582974985	0.06095192	7.99909284	0	0	0	0	0	0.54	0	0	0	2.840510653	0	0	0	0	0	0	0	0	0	84.5734	NO																								N/A	N/A	N/A	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	13.5977	0.467970792	7.157457246	0	2.8555448	2.160155189	0.912634343	1.278988903	3.287792653	11.77827716	5.840464088	0.002888689	0.001854139	2.423602767	4.701040405	6.465739017	0.02031225	5.597369514	4.582974985	0.06095192	7.99909284	0	0	0	0	0	0.54	0	0	0	2.840510653	0	0	0	0	0	0	0	0	0	84.5734
H3655_031_0	2012	9	H.6										OP Facility - Other										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	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	YES	1674.754936	46.8900765	656.9362337	684.3995725	270.8451906	12.96269753	8.115347142	360.3570097	441.710525	9275.694681	732.7162652	0.022785051	0.022184786	462.3140297	4775.401688	3242.223757	2.219999888	1359.649142	917.8224643	2194.963672	21.13141419	11.59119669	0.001752316	0	0	0	162	0	5872.8	296.7692194	5.249438816	0	0	0	0	0	0	0	0	0	3400	1A: $220/day (days1-8) no yrly max	1B: $220/day (days1-8) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0 - $250 copay; 9B: $0-$250 copay	8A: $0-$140 copay	8B: $75-$140 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $45-$250 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $55 copay; 7I: $55 copay	8B: $75-$140 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $45 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	178.8535445	143.4190894	146	0	125	0.2	0.146301164	64.96406704	203.0427631	17.99400241	98.03347252	40	0.2	87.01310765	0	43.2899326	40	55	90.15024811	0.657262353	0.2	0	0	0	0	0	45	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	158.2201694	126.8735975	129.1567623	0	110.5794198	0.176927072	0.129423182	57.46951071	179.6188074	15.91813077	86.72387607	35.38541432	0.176927072	76.97487165	0	38.29580503	35.38541432	48.6549447	79.75009702	0.581437517	0.176927072	0	0	0	0	0	45	0	0	0	0.176927072	0	0	0	0	0	0	0	0	0		22.0817	0.495759391	7.070646414	0	2.495825336	2.293452115	1.050314052	1.725795086	6.611626477	12.30431008	5.295332881	6.72E-05	0.003925089	2.965546924	0	10.34696407	0.006546301	5.512804485	6.099702548	0.106352852	3.738719231	0	0	0	0	0	0.6075	0	0	0	0.928767837	0	0	0	0	0	0	0	0	0	91.7416		NO	11.88473386	22.0817	0.495759391	7.070646414	0	2.495825336	2.293452115	1.050314052	1.725795086	6.611626477	12.30431008	5.295332881	6.72E-05	0.003925089	2.965546924	0	10.34696407	0.006546301	5.512804485	6.099702548	0.106352852	3.738719231	0	0	0	0	0	0.6075	0	0	0	0.928767837	0	0	0	0	0	0	0	0	0	91.7416	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	22.0817	0.495759391	7.070646414	0	2.495825336	2.293452115	1.050314052	1.725795086	6.611626477	12.30431008	5.295332881	6.72E-05	0.003925089	2.965546924	0	10.34696407	0.006546301	5.512804485	6.099702548	0.106352852	3.738719231	0	0	0	0	0	0.6075	0	0	0	0.928767837	0	0	0	0	0	0	0	0	0	91.7416
H3655_801_0	2012	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	312.5007943	3.24657336	65.19601156	10.14747873	13.18196577	11.27539702	3.844486676	17.25106319	51.53417127	62.04738385	53.73529061	0.004758955	6.128117281	0.532647868	57.50295472	85.59036459	0.24078105	54.35461664	0	0.13486356	66.4069738	1.712496242																			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																				NO	0.080990507	0.080990507	0.172508122	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064090269	0.064090269	0.136510959	0	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035	0.184380035																				20.0283	0.208073759	8.899970089	0	2.43049131	2.078958096	0.708846588	3.180751634	9.5018723	11.4402988	9.907714761	0.000877456	1.129902478	0.098209633	10.6023968	15.78115441	0.044395218	10.02190611	0	0.024866148	12.24412015	0.315750117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6488		NO	31.28701693	20.0283	0.208073759	8.899970089	0	2.43049131	2.078958096	0.708846588	3.180751634	9.5018723	11.4402988	9.907714761	0.000877456	1.129902478	0.098209633	10.6023968	15.78115441	0.044395218	10.02190611	0	0.024866148	12.24412015	0.315750117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6488	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		NO	0	20.0283	0.208073759	8.899970089	0	2.43049131	2.078958096	0.708846588	3.180751634	9.5018723	11.4402988	9.907714761	0.000877456	1.129902478	0.098209633	10.6023968	15.78115441	0.044395218	10.02190611	0	0.024866148	12.24412015	0.315750117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6488
H3655_803_0	2012	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	312.0940592	3.242347786	64.75152677	10.11807351	13.16066649	11.25802627	3.838563903	17.23111789	51.3431639	61.86300647	53.57561309	0.004744813	6.109907227	0.531065074	57.40874247	85.45013421	0.240386557	54.26556259	0	0.134642601	65.99021111	1.700763338																			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																				NO	0.080990507	0.080990507	0.172508122	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064147424	0.064147424	0.1366327	0	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465																				20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143		NO	31.09185631	20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143	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		NO	0	20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143
H3655_804_0	2012	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	312.0940592	3.242347786	64.75152677	10.11807351	13.16066649	11.25802627	3.838563903	17.23111789	51.3431639	61.86300647	53.57561309	0.004744813	6.109907227	0.531065074	57.40874247	85.45013421	0.240386557	54.26556259	0	0.134642601	65.99021111	1.700763338																			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																				NO	0.080990507	0.080990507	0.172508122	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064147424	0.064147424	0.1366327	0	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465	0.184544465																				20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143		NO	31.09185631	20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143	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		NO	0	20.02	0.207988259	8.847175922	0	2.428728156	2.077606434	0.708385722	3.179907431	9.475096712	11.41647543	9.887082855	0.000875629	1.12754956	0.09800512	10.59446567	15.7693493	0.044362009	10.01440922	0	0.024847547	12.1781282	0.31386646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.4143
H3659_001_0	2012	5																															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	1584.651189	93.41301855	1738.73016	3226.91369	337.4016256	10.84473187	10.41699929	385.2048666	62.03464269	17.19073308	32.39630883	0	0.040231493	28.47653891	5406.719697	3853.48963	542.1589843	372.2979128	0	0	32.5475354	901.4795099	0	0	42.33711628	0	5.588378969	65	78.2406993	0											5500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$25 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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)"	$25 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	68.42561408	0	200	0.2	0.108257439	63.42669803	0.16	0.224634722	0.190995075	0	0.2	0.145655893	16.80543499	44.2785126	38.5	45	0	0	0.2	43.60894127	0	0	45	0	25	352.5	0	0											YES	159.5214081	83.55085095	52.43781679	0	153.2695541	0.153269554	0.082962847	48.62743681	0.122615643	0.172148318	0.14636865	0	0.153269554	0.111623069	16.13661121	42.51677204	36.96777454	43.20908712	0	0	0.153269554	33.41961491	0	0	45	0	25	352.5	0	0											6700	21.0655	0.650394766	7.597934464	0	4.309449726	1.662167217	0.864223918	1.560960442	7.606417619	2.959355792	4.74180399	0	0.006166263	3.178638673	7.27051114	13.65316168	1.670200925	1.340554412	0	0	4.988546237	2.510591506	0	0	0.158764186	0	0.011642456	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	89.7163	0	NO	20.41319273	21.0655	0.650394766	7.597934464	0	4.309449726	1.662167217	0.864223918	1.560960442	7.606417619	2.959355792	4.74180399	0	0.006166263	3.178638673	7.27051114	13.65316168	1.670200925	1.340554412	0	0	4.988546237	2.510591506	0	0	0.158764186	0	0.011642456	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	89.7163	NO	"$350 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-39 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$32 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$32/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.4497	0.0227	0.7551	0.0918	0.0585	0	0.0325	0.0212	0.155	0.0402	0.0935	0	0.0001	0.0647	0.2904	0.467	0.0574	0.0453	0	0	0.2064	0.0768	0	0	0.0055	0	0.0006	0	0	0											2.9344	0	NO	1.007681135	21.5152	0.673135413	8.353016412	0.09184053	4.367978893	1.662167217	0.896750641	1.582165407	7.761378454	2.999548541	4.835325946	0	0.006250011	3.243313274	7.560881892	14.12012344	1.727632744	1.385885618	0	0	5.194946514	2.58739215	0	0	0.16422	0	0.012193167	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	92.6507
H3659_003_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1469.847952	89.34955648	1345.258628	1107.072155	244.5972456	9.38043729	10.94917767	411.4423191	401.5006488	18.9653735	35.40814816	0	0.284195785	1064.886703	5935.160021	3899.415276	531.7344766	713.0007144	0	0	18.00241449	869.9897137	0	501.6	43.64651163	0	5.7667865	65	533.8838511	0											3350	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-8 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$200 (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $200 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	199.3622966	118.6231222	78.26590389	0	200	0.2	0.095325485	64.12186544	82	0.199066262	0.188588798	0	0.2	71.0434677	7.12171171	34.33482262	38.5	35	0	0	0.2	33.82282342	0	25	35	0	10	122.5	0	0											NO	140.8982794	83.83628247	55.31402569	0	141.348973	0.141348973	0.067370797	45.34295565	57.95307894	0.140689058	0.133284164	0	0.141348973	50.209606	6.759857543	32.59210426	36.54381502	33.22165002	0	0	0.141348973	23.90410678	0	25	35	0	10	122.5	0	0												17.2583	0.624227888	6.200972525	0	2.881130789	1.325915177	0.737654829	1.554667569	1.939016566	2.668220537	4.719345443	0	0.040170782	4.455628484	3.34340302	10.59084577	1.61930053	1.973921683	0	0	2.5446228	1.733027251	0	1.045	0.127302326	0	0.004805655	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	68.051	0	NO	21.13674952	17.2583	0.624227888	6.200972525	0	2.881130789	1.325915177	0.737654829	1.554667569	1.939016566	2.668220537	4.719345443	0	0.040170782	4.455628484	3.34340302	10.59084577	1.61930053	1.973921683	0	0	2.5446228	1.733027251	0	1.045	0.127302326	0	0.004805655	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	68.051	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	NO	0	17.2583	0.624227888	6.200972525	0	2.881130789	1.325915177	0.737654829	1.554667569	1.939016566	2.668220537	4.719345443	0	0.040170782	4.455628484	3.34340302	10.59084577	1.61930053	1.973921683	0	0	2.5446228	1.733027251	0	1.045	0.127302326	0	0.004805655	0.663541667	0	0	0	0	0	0	0	0	0	0	0	0	68.051
H3659_031_0	2012	4																															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	1330.774694	90.76632858	1169.114762	2118.224907	235.4932422	10.12243403	10.10181527	386.9591831	62.37099821	17.15095735	36.20248215	0	0.114034484	29.40764656	5741.907802	3551.801694	553.3690424	441.3496023	0	0	24.79492084	817.3760328	0	0	43.64651163	0	5.801774179	65	537.1229787	0											4300	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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)	$225 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	64.13843611	0	225	0.2	0.090857509	63.26100434	0.16	0.26098875	0.207600371	0	0.2	0.145690781	13.26950601	34.44629496	38.5	35	0	0	0.2	34.32485788	0	0	35	0	20	352.5	0	0											NO	145.6420199	76.28138973	48.67880923	0	170.7670586	0.151792941	0.068957643	48.03471782	0.121434353	0.19808125	0.157561354	0	0.151792941	0.110574161	12.72341012	33.02921063	36.91556335	33.55960305	0	0	0.151792941	26.05135563	0	0	35	0	20	352.5	0	0												16.1514	0.576981807	4.742592872	0	3.351207356	1.536514031	0.696597368	1.548956264	7.573981799	3.397283069	5.70411212	0	0.01730963	3.251725833	6.088053987	9.776100524	1.702327495	1.234293122	0	0	3.763693956	1.774479476	0	0	0.127302326	0	0.009669624	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	74.934	0	NO	17.98297838	16.1514	0.576981807	4.742592872	0	3.351207356	1.536514031	0.696597368	1.548956264	7.573981799	3.397283069	5.70411212	0	0.01730963	3.251725833	6.088053987	9.776100524	1.702327495	1.234293122	0	0	3.763693956	1.774479476	0	0	0.127302326	0	0.009669624	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	74.934	NO																																										0	0	0	0	0	0	0	0	0	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	16.1514	0.576981807	4.742592872	0	3.351207356	1.536514031	0.696597368	1.548956264	7.573981799	3.397283069	5.70411212	0	0.01730963	3.251725833	6.088053987	9.776100524	1.702327495	1.234293122	0	0	3.763693956	1.774479476	0	0	0.127302326	0	0.009669624	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	74.934
H3659_054_0	2012	3																															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	1418.032506	88.6999881	1328.902343	1555.689049	251.2106637	8.692405089	7.321907323	346.9041797	51.83988464	14.92867442	31.19885103	0	0.101632528	28.90676266	4986.23093	3352.141145	545.9831075	494.8920918	0	0	19.06953589	737.3161795	0	0	43.64651163	0	18.58801376	65	119.6015697	0											3650	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-47 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	60.64635266	0	200	0.2	0.099541907	63.32341647	0.16	0.193481713	0.215320805	0	0.2	0.145671443	13.37603745	34.42970565	38.5	35	0	0	0.2	34.25132736	0	0	35	0	20	342.5	0	0											NO	143.490633	75.15458041	45.3485207	0	149.5506942	0.149550694	0.074432806	47.37653574	0.119640555	0.144676622	0.161006879	0	0.149550694	0.108926327	12.79785762	32.94540173	36.83583576	33.48712342	0	0	0.149550694	25.61154892	0	0	35	0	20	342.5	0	0												16.9562	0.555517532	5.021979618	0	3.130727429	1.299955215	0.54499011	1.369593189	6.202152586	2.159830192	5.023229629	0	0.015199215	3.148707487	5.317756126	9.203136389	1.675978673	1.381042713	0	0	2.85186233	1.573650783	0	0	0.127302326	0	0.030980023	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	69.445	0	NO	17.60954298	16.9562	0.555517532	5.021979618	0	3.130727429	1.299955215	0.54499011	1.369593189	6.202152586	2.159830192	5.023229629	0	0.015199215	3.148707487	5.317756126	9.203136389	1.675978673	1.381042713	0	0	2.85186233	1.573650783	0	0	0.127302326	0	0.030980023	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	69.445	NO																																										0	0	0	0	0	0	0	0	0	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	16.9562	0.555517532	5.021979618	0	3.130727429	1.299955215	0.54499011	1.369593189	6.202152586	2.159830192	5.023229629	0	0.015199215	3.148707487	5.317756126	9.203136389	1.675978673	1.381042713	0	0	2.85186233	1.573650783	0	0	0.127302326	0	0.030980023	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	69.445
H3659_056_0	2012	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	286.5395314	22.5512	54.14137116	5119.829475	17.85818115	19.27604614	13.73357596	41.80211317	62.39868817	19.93758387	40.61743283	0	0.059284316	57.37790702	34.88449512	90.04785099	10.9323	5.061403224	0	1049.881085	17.47185797	6.419903572	768.9738811	312.6161799	51.22356889	223.015714	0	0	160.1201595	2999.127076											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.080059891	0.081032279	0.176442897	0	0.224	0.224	0.224	0.12604153	0.224	0.224	0.224	0	0.224	0.224	0.221369024	0.223991199	0.229356201	0.224	0	0	0.224	0.22276606	0	0	0	0	0	0	0	0											NO	0.061974887	0.062727618	0.136585603	0	0.173399868	0.173399868	0.173399868	0.097584207	0.173399868	0.173399868	0.173399868	0	0.173399868	0.173399868	0.171363212	0.173393056	0.177546139	0.173399868	0	0	0.173399868	0.173606079	0	0	0	0	0	0	0	0												17.7583	1.41458306	7.394931817	0	3.096606257	3.342463859	2.38140026	4.079226072	10.8199243	3.457174414	7.043057499	0	0.010279893	9.949321513	5.97791914	15.61367203	1.940987651	0.877646652	0	0	3.029617868	1.114534289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3016	150	YES	28.96695935	17.7583	1.41458306	7.394931817	0	3.096606257	3.342463859	2.38140026	4.079226072	10.8199243	3.457174414	7.043057499	0	0.010279893	9.949321513	5.97791914	15.61367203	1.940987651	0.877646652	0	0	3.029617868	1.114534289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3016	NO																																										0	0	0	0	0	0	0	0	0	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	17.7583	1.41458306	7.394931817	0	3.096606257	3.342463859	2.38140026	4.079226072	10.8199243	3.457174414	7.043057499	0	0.010279893	9.949321513	5.97791914	15.61367203	1.940987651	0.877646652	0	0	3.029617868	1.114534289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3016
H3659_058_0	2012	3																															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	399.9616281	40.246954	11309.48847	10.1802092	34.28653748	36.39930566	3.447915408	14.15812151	36.90477316	38.56668207	16.66769174	0	0	16.09607109	3.212445439	132.5529302	17.8348445	133.0239587	0	22644.04809	30.17566684	6.431941957	2095.782112	160	28.14938642	144.7292533	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.081684681	0.082676803	0	0	0.2	0.2	0.192296332	0.101033642	0.16	0	0.078477795	0	0	0.146347465	0	0.031129405	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.07543189	0.076348067	0	0	0.184690419	0.184690419	0.177576451	0.093299729	0.147752335	0	0.072470484	0	0	0.135144873	0	0.028746514	0.184690419	0	0	0	0.184690419	0.185514237	0	0	0	0	0	0	0	0												30.1699	3.072777134	0	0	6.332394982	6.722603022	0.612268582	1.320948899	5.452766421	0	1.207915686	0	0	2.175301488	0	3.810434711	3.293924908	0	0	0	5.57315656	1.193216803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9376	0	NO	5.874504611	30.1699	3.072777134	0	0	6.332394982	6.722603022	0.612268582	1.320948899	5.452766421	0	1.207915686	0	0	2.175301488	0	3.810434711	3.293924908	0	0	0	5.57315656	1.193216803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9376	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.603	0.0607	0	0.0013	1.0797	1.1463	0.1086	0.1502	0.9298	0	0.3997	0	0	0.3709	0.0531	2.7645	0.372	0.022	0	0	0.6293	0.1341	0	0	0.0107	0	0	0	0	0											8.8358	0	NO	0	30.7728	3.133450934	0	0.00131144	7.41213677	7.868879498	0.720849343	1.471106275	6.382522032	0	1.607600813	0	0	2.546213903	0.05310926	6.574907588	3.665881558	0.022039752	0	0	6.202488649	1.327358908	0	0	0.010728755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7734
H3659_801_0	2012	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	266.0938143	5.1364	44.97937029	2267.107748	9.965035431	9.406118	10.70658403	18.20291373	70.81922248	19.04807367	39.45462264	0	0.109519869	33.47798536	34.5136817	91.28445763	2.3961	5.900561506	0	0	27.73681523	9.818783957	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.08233226	0.08233226	0.174540709	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066915084	0.066915084	0.141856987	0	0.18205475	0.18205475	0.18205475	0.18205475	0.18205475	0.18205475	0.18205475	0	0.18205475	0.18205475	0.18205475	0.18205475	0.18205475	0.18205475	0	0	0.18205475	0.18205475	0	0	0	0	0	0	0	0												17.8057	0.34370264	6.380637957	0	1.814182031	1.712428458	1.949184476	3.313926903	12.89297582	3.467792284	7.182901449	0	0.019938612	6.094826246	6.283379683	16.61876908	0.436221386	1.074225248	0	0	5.049618954	1.787556256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.228	150	YES	21.71003653	17.8057	0.34370264	6.380637957	0	1.814182031	1.712428458	1.949184476	3.313926903	12.89297582	3.467792284	7.182901449	0	0.019938612	6.094826246	6.283379683	16.61876908	0.436221386	1.074225248	0	0	5.049618954	1.787556256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.228	NO																																										0	0	0	0	0	0	0	0	0	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	17.8057	0.34370264	6.380637957	0	1.814182031	1.712428458	1.949184476	3.313926903	12.89297582	3.467792284	7.182901449	0	0.019938612	6.094826246	6.283379683	16.61876908	0.436221386	1.074225248	0	0	5.049618954	1.787556256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.228
H3659_802_0	2012	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	264.2161462	5.1338	44.66197724	2258.997625	9.894718018	9.339744539	10.63103394	18.07446644	70.31949275	18.91366258	39.1762145	0	0.108747051	33.24115175	34.27013888	90.64031673	2.3962	5.858924703	0	0	27.54109279	9.749498555	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081458052	0.081458052	0.174913427	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066363857	0.066363857	0.142501932	0	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0	0	0.182492752	0.182492752	0	0	0	0	0	0	0	0												17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151	150	YES	21.29238642	17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151	NO																																										0	0	0	0	0	0	0	0	0	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	17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151
H3659_803_0	2012	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	264.2161462	5.1338	44.66197724	2258.997625	9.894718018	9.339744539	10.63103394	18.07446644	70.31949275	18.91366258	39.1762145	0	0.108747051	33.24115175	34.27013888	90.64031673	2.3962	5.858924703	0	0	27.54109279	9.749498555	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081458052	0.081458052	0.174913427	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066363857	0.066363857	0.142501932	0	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0.182492752	0	0	0.182492752	0.182492752	0	0	0	0	0	0	0	0												17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151	150	YES	21.29238642	17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151	NO																																										0	0	0	0	0	0	0	0	0	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	17.5344	0.340698771	6.364418035	0	1.805714324	1.704435686	1.940086644	3.298459126	12.83279777	3.451606339	7.149375206	0	0.019845549	6.066269271	6.254051964	16.54120086	0.437289133	1.069211294	0	0	5.026049822	1.779212824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6151
H3659_807_0	2012	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	260.252904	5.0580735	42.42887838	2225.11266	9.746297248	9.199648371	10.47156843	17.80334945	69.26470036	18.62995764	38.58857128	0	0.107115845	32.74253448	33.34013325	87.92110722	2.328	5.683156962	0	0	26.71486	9.457013598	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081458052	0.081458052	0.174913427	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066389484	0.066389484	0.14255696	0	0.182563223	0.182563223	0.182563223	0.182563223	0.182563223	0.182563223	0.182563223	0	0.182563223	0.182563223	0.182563223	0.182563223	0.182563223	0.182563223	0	0	0.182563223	0.182563223	0	0	0	0	0	0	0	0												17.2781	0.335802891	6.048531906	0	1.779315436	1.679517456	1.911723282	3.250236852	12.64518693	3.401145108	7.044853938	0	0.019555414	5.977582618	6.086682175	16.05116069	0.425007183	1.037535451	0	0	4.877150939	1.726502881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5755	150	YES	20.78510384	17.2781	0.335802891	6.048531906	0	1.779315436	1.679517456	1.911723282	3.250236852	12.64518693	3.401145108	7.044853938	0	0.019555414	5.977582618	6.086682175	16.05116069	0.425007183	1.037535451	0	0	4.877150939	1.726502881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5755	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.3228	0.0063	0.3906	0	0.0332	0.0314	0.0357	0.0607	0.2363	0.0635	0.1316	0	0.0004	0.1117	0.2083	0.6091	0.0161	0.0394	0	0	0.1851	0.0655	0	0	0	0	0	0	0	0											2.5478	150	YES	0	17.6009	0.342077319	6.439130881	0	1.812561689	1.710898997	1.947443556	3.310967059	12.88146042	3.464695014	7.176486019	0	0.019920804	6.089272888	6.295003438	16.66026362	0.441135183	1.076907425	0	0	5.062227083	1.792019511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1234
H3660_028_0	2012	5																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V	Coin	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	1264.008973	52.17814947	443.4451685	0	112.8542338	15.72829804	0.70419617	259.3321287	302.915648	1174.811585	1083.118113	0	0.366436405	198.6246123	6.765499561	3360.020907	209.621258	278.6056751	0	1.432647804	0.227900014	0	0	0	679.9530127	0	4.766110283	0	0	0											3000	$195/Days IP 1-10 for 1A IP ACUTE; $195/Days IP 1-10 for 1A IP ACUTE; PBP 1a	$195/Days IP 1-9 for 1B PSYCH; $195/Days IP 1-9 for 1B PSYCH; PBP 1b	$75/Days SNF 11-100 for 2 SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for 10A AMBULANCE; PBP 10a	20% Coinsurance for 11A DME; PBP 11a	"20% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"9A OP HOSPITAL, 9B ASC min $50 / max $150; PBP 9b"	8A OP DIAG PROCS/TESTS/LAB SERVICES min $0 / max $125; PBP 8a	8B OP DIAG /THERAPEUTIC/RAD SERVICES min $0 / max $150; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$25/Case for 3 CORF; PBP 3, 5, 9c, 9d"	"$0/Visit for PBP 7a, 14b-j; 20% Coinsurance for 15 Part B Drugs"	"$25/Visit for 7D PHYSICIAN SPECIALIST; $25/Visit for 7D PHYSICIAN SPECIALIST; $20/Visit for 7B CHIROPRACTOR SERVICES; PBP 7b, 7d, 7f"	"$25/Visit; PBP 7e, 7h"	"$25/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	20% coinsurance; PBP 8b (professional portion)	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"17a min $0 / max $25; PBP 13a, 16b, 17a"	PBP 10b	"PBP 16a, 16b: Not Covered"	$25/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$25/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	PBP 14a	PBP 13b-e: Not Covered											0	NO	195	195	75	0	100	0.2	0.2	63.34896277	135.5095504	10	108.5857297	0	0.2	25	0.2	24.97595561	25	25	0	0.2	0.2	0	0	0	25	0	25	0	0	0											NO	167.3664291	167.3664291	64.37170349	0	85.82893798	0.171657876	0.171657876	54.37174197	116.306408	8.582893798	93.19797864	0	0.171657876	21.4572345	0.171657876	21.43659746	21.4572345	21.4572345	0	0.171657876	0.171657876	0	0	0	21.4572345	0	21.4572345	0	0	0												17.6294	0.727739213	2.378776742	0	0.80717992	2.699886234	0.120880819	1.175028299	2.935919246	0.840273589	8.412034896	0	0.062901695	0.35516124	1.161351285	6.002284635	0.374824374	0.498175608	0	0.245925279	0.039120832	0	0	0	1.215825937	0	0.008522295	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6912	0	NO	7.874208686	17.6294	0.727739213	2.378776742	0	0.80717992	2.699886234	0.120880819	1.175028299	2.935919246	0.840273589	8.412034896	0	0.062901695	0.35516124	1.161351285	6.002284635	0.374824374	0.498175608	0	0.245925279	0.039120832	0	0	0	1.215825937	0	0.008522295	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6912	NO	20% Coinsurance for 1A IP ACUTE; 20% Coinsurance for 1A IP ACUTE; PBP 1a	20% Coinsurance for 1B PSYCH; PBP 1b	$75/Day for 2 SNF; PBP 2	20% Coinsurance for 6 HOME HEALTH; PBP 6	$200/Trip for 10A AMBULANCE; PBP 10a	30% Coinsurance for 11A DME; PBP 11a	"30% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"20% Coinsurance for 9A OP HOSPITAL, 9B ASC; PBP 9b"	20% Coinsurance for 8A OP DIAG PROCS/TESTS/LAB SERVICES; PBP 8a	20% Coinsurance for 8B OP DIAG /THERAPEUTIC/RAD SERVICES; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$40/Case for PBP 3, 5, 9c; $15/Case for PBP 9d"	"$15/Visit for 7A PCP; $15/Exam for 14C PHYSICAL EXAMS; PBP 7a, 14b-j"	"$40/Visit for 7D PHYSICIAN SPECIALIST; $40/Exam for 14C PHYSICAL EXAMS; $40/Visit for 7B CHIROPRACTOR SERVICES; $40/Visit for 7F PODIATRY SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for 7E MENTAL HEALTH, 7H PSYCH; PBP 7e, 7h"	"$40/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"$40/Case for PBP 7g, 18a"	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"$40/Case for PBP 16b, 17a; PBP 13a: Not Covered"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$40/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$40/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	No Cost Sharing; PBP 14a	PBP 13b-e: Not Covered												3.0425	0.0111	1.8565	0.0019	1.895	0.4968	0.0265	0.1454	0.7482	0.0376	0.0623	0	0.0037	0.1019	0.1099	0.6384	0.1743	0.3281	0	0	0.0381	0	0	0	0.0509	0	0.0047	0	0	0											9.7736	0	NO	1.78E-15	20.6719	0.738809836	4.235298342	0.001873644	2.702179201	3.196661255	0.147346041	1.320436671	3.684130727	0.87785419	8.474308429	0	0.066627652	0.457059404	1.271203342	6.640649948	0.54907761	0.826292547	0	0.245925279	0.077264319	0	0	0	1.266730908	0	0.013227697	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4648
H3660_029_0	2012	5																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V	Coin	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	705.1424505	26.76188033	191.1321066	0	45.73477519	10.54989149	0.539527656	243.3720629	254.3903747	1067.187146	902.9223817	0	0.645489468	145.1506473	5.472599147	2629.961019	179.6744506	200.5657138	0	0.046058673	0.009714276	0	0	0	489.3489503	0	0.701254074	0	0	0											3400	$265/Days IP 1-8 for 1A IP ACUTE; $265/Days IP 1-8 for 1A IP ACUTE; PBP 1a	$210/Days IP 1-8 for 1B PSYCH; $210/Days IP 1-8 for 1B PSYCH; PBP 1b	$100/Days SNF 11-100 for 2 SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for 10A AMBULANCE; PBP 10a	20% Coinsurance for 11A DME; PBP 11a	"20% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"9A OP HOSPITAL, 9B ASC min $50 / max $250; PBP 9b"	8A OP DIAG PROCS/TESTS/LAB SERVICES min $0 / max $125; PBP 8a	8B OP DIAG /THERAPEUTIC/RAD SERVICES min $0 / max $250; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$40/Case for 3 CORF; PBP 3, 5, 9c, 9d"	"$0/Visit for PBP 7a, 14b-j; 20% Coinsurance for 15 Part B Drugs"	"$40/Visit for 7D PHYSICIAN SPECIALIST; $40/Visit for 7D PHYSICIAN SPECIALIST; $20/Visit for 7B CHIROPRACTOR SERVICES; PBP 7b, 7d, 7f"	"$40/Visit PBP 7e, 7h"	"$40/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	20% Coinsurance PBP 8B (professional portion)	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"17a min $0 / max $40; PBP 13a, 16b, 17a"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$40/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$40/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	PBP 14a	PBP 13b-e: Not Covered											0	NO	265	210	100	0	200	0.2	0.2	62.76846214	236.7195473	20	165.7641185	0	0.2	40	0.2	39.87727144	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0											NO	243.6747122	193.1007153	91.95272158	0	183.9054432	0.183905443	0.183905443	57.71730923	217.6700663	18.39054432	152.4246183	0	0.183905443	36.78108863	0.183905443	36.66823638	36.78108863	36.78108863	0	0.183905443	0.183905443	0	0	0	36.78108863	0	36.78108863	0	0	0												14.3188	0.430644853	1.464593115	0	0.700906175	1.94018247	0.099222073	1.170565051	4.614430809	1.635512708	11.46896662	0	0.118709027	0.444899902	1.006440771	8.036336026	0.550718491	0.614752108	0	0.008470441	0.001786508	0	0	0	1.499898926	0	0.002149407	0	0	0	0	0	0	0	0	0	0	0	0	0	50.128	0	NO	4.386968694	14.3188	0.430644853	1.464593115	0	0.700906175	1.94018247	0.099222073	1.170565051	4.614430809	1.635512708	11.46896662	0	0.118709027	0.444899902	1.006440771	8.036336026	0.550718491	0.614752108	0	0.008470441	0.001786508	0	0	0	1.499898926	0	0.002149407	0	0	0	0	0	0	0	0	0	0	0	0	0	50.128	NO	25% Coinsurance for 1A IP ACUTE; 25% Coinsurance for 1A IP ACUTE; PBP 1a	25% Coinsurance for 1B PSYCH; PBP 1b	$100/Day for 2 SNF; PBP 2	20% Coinsurance for 6 HOME HEALTH; PBP 6	$250/Trip for 10A AMBULANCE; PBP 10a	30% Coinsurance for 11A DME; PBP 11a	"30% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"20% Coinsurance for 9A OP HOSPITAL, 9B ASC; PBP 9b"	20% Coinsurance for 8A OP DIAG PROCS/TESTS/LAB SERVICES; PBP 8a	20% Coinsurance for 8B OP DIAG /THERAPEUTIC/RAD SERVICES; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$55/Case forPBP 3, 5; $40/Case for PBP 9c; $15/Case for PBP 9d"	"$15/Visit for 7A PCP; $15/Exam for 14C PHYSICAL EXAMS; $15/Service for 7A PCP; PBP 7a, 14b-j"	"$55/Visit for 7D PHYSICIAN SPECIALIST; $55/Exam for 14C PHYSICAL EXAMS; $55/Visit for 7B CHIROPRACTOR SERVICES; $55/Visit for 7F PODIATRY SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for 7E MENTAL HEALTH, 7H PSYCH; PBP 7e, 7h"	"$55/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"$55/Case for PBP 7g, 18a"	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"$55/Case for PBP 16b, 17a; PBP 13a: Not Covered"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$55/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$55/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	No Cost Sharing; PBP 14a	PBP 13b-e: Not Covered												3.5572	0.0868	1.0081	0.0012	2.0055	0.4755	0.0375	0.1923	0.5557	0.0591	0.1377	0	0.0025	0.0619	0.2106	1.0843	0.3257	0.2587	0	0	0.1585	0	0	0	0.097	0	0.0059	0	0	0											10.3218	0	NO	1.78E-15	17.876	0.517459226	2.472675205	0.001235162	2.706455304	2.415663117	0.136751782	1.362872765	5.170162506	1.694642277	11.60666553	0	0.121195708	0.506819325	1.217049061	9.120604705	0.876388591	0.873409845	0	0.008470441	0.160252734	0	0	0	1.596855191	0	0.008087018	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4497
H3660_032_0	2012	5																															D	D	D			Coin	Coin	V	V	V	V		Coin		Coin					Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1286.508838	82.32954807	645.3535114	0	0	24.58867422	0.955918701	300.5967043	319.0524741	1610.651802	1338.467565	0	0.241413784	0	7.584111487	0	0	0	0	0.308113654	0.2284681	0	0	0	0	0	0	0	0	0											3400	$145/Days IP 1-6 for 1A IP ACUTE; $145/Days IP 1-6 for 1A IP ACUTE; PBP 1a	$100/Days IP 1-15 for 1B PSYCH; $100/Days IP 1-15 for 1B PSYCH; PBP 1b	$50/Days SNF 11-100 for 2 SNF; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	10% Coinsurance for 11A DME; PBP 11a	"10% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $35/Visit for 4B URGENT CARE; $35/Visit for 4B URGENT CARE; PBP 4a, 4b"	"9A OP HOSPITAL, 9B ASC min $50 / max $100; PBP 9b"	8A OP DIAG PROCS/TESTS/LAB SERVICES min $0 / max $100; PBP 8a	8B OP DIAG /THERAPEUTIC/RAD SERVICES min $0 / max $100; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"No Cost Sharing; PBP 3, 5, 9c, 9d"	"$0/Visit for PBP 7a, 14b-j; 20% Coinsurance for 15 Part B Drugs"	"No Cost Sharing; PBP 7b, 7d, 7f"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 7d	20% Coinsurance; PBP 8b (professional portion)	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"PBP 13a: Not Covered; PBP 16b, 17a: No Cost Sharing"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	No Cost Sharing; PBP 17a	PBP 17b: Not Covered	No Cost Sharing; PBP 18a	PBP 18b: Not Covered	PBP 14a	PBP 13b-e: Not Covered											0	NO	145	100	50	0	0	0.1	0.1	64.28860833	68.16425269	5	90.40662043	0	0.2	0	0.2	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	135.5980331	93.51588486	46.75794243	0	0	0.093515885	0.093515885	60.12006094	63.74440406	4.675794243	84.54455107	0	0.18703177	0	0.18703177	0	0	0	0	0.18703177	0.18703177	0	0	0	0	0	0	0	0	0												14.5373	0.641593378	2.514616861	0	0	2.299431627	0.089393583	1.505991015	1.694817486	0.627589702	9.430011617	0	0.045152047	0	1.418469793	0	0	0	0	0.057627042	0.042730793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9048	0	NO	2.420193195	14.5373	0.641593378	2.514616861	0	0	2.299431627	0.089393583	1.505991015	1.694817486	0.627589702	9.430011617	0	0.045152047	0	1.418469793	0	0	0	0	0.057627042	0.042730793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9048	NO	20% Coinsurance for 1A IP ACUTE; 20% Coinsurance for 1A IP ACUTE; PBP 1a	20% Coinsurance for 1B PSYCH; PBP 1b	$75/Day for 2 SNF; PBP 2	20% Coinsurance for 6 HOME HEALTH; PBP 6	$200/Trip for 10A AMBULANCE; PBP 10a	30% Coinsurance for 11A DME; PBP 11a	"30% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $35/Visit for 4B URGENT CARE; $35/Visit for 4B URGENT CARE; PBP 4a, 4b"	"20% Coinsurance for 9A OP HOSPITAL, 9B ASC; PBP 9b"	20% Coinsurance for 8A OP DIAG PROCS/TESTS/LAB SERVICES; PBP 8a	20% Coinsurance for 8B OP DIAG /THERAPEUTIC/RAD SERVICES; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$40/Case for PBP 3, 5, 9c; $15/Case for PBP 9d"	"$15/Visit for 7A PCP; $15/Exam for 14C PHYSICAL EXAMS; $15/Service for 7A PCP; PBP 7a, 14b-j"	"$40/Visit for 7B CHIROPRACTOR SERVICES; $40/Visit for 7D PHYSICIAN SPECIALIST; $40/Exam for 14C PHYSICAL EXAMS; $40/Visit for 7B CHIROPRACTOR SERVICES; $40/Visit for 7F PODIATRY SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for 7E MENTAL HEALTH, 7H PSYCH; PBP 7e, 7h"	"$40/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"$40/Case for PBP 7g, 18a"	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"PBP 13a: Not Covered; PBP 16b, 17a: $40/Case"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$40/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$40/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	No Cost Sharing; PBP 14a	PBP 13b-e: Not Covered												6.1129	0.0604	3.5032	0.0084	3.1542	0.9214	0.0367	0.1542	0.85	0.0773	0.2061	0	0.0014	0.1081	0.2479	1.1514	0.3026	0.4192	0	0	0.0527	0	0	0	0.0834	0	0.0039	0	0	0											17.4553	0	NO	1.07E-14	20.6503	0.702008605	6.017854763	0.008439098	3.154150114	3.220805722	0.126057032	1.660231554	2.544811153	0.704870786	9.636159951	0	0.046507491	0.108089167	1.666384139	1.151416521	0.302560743	0.419248988	0	0.057627042	0.09538592	0	0	0	0.08338087	0	0.003852637	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3601
H3660_043_0	2012	2																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V	Coin	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	527.6065142	20.0239574	143.010174	0	34.21998675	7.893712073	0.403689078	182.0975119	190.3549771	798.4980758	675.590769	0	0.477208375	108.6056115	4.094745618	1967.807448	134.4372481	150.0686522	0	0.034462336	0.007181734	0	0	0	490.5098099	0	0.702917627	0	0	0											3400	$265/Days IP 1-8 for 1A IP ACUTE; $265/Days IP 1-8 for 1A IP ACUTE; PBP 1a	$210/Days IP 1-8 for 1B PSYCH; $210/Days IP 1-8 for 1B PSYCH; PBP 1b	$100/Days SNF 11-100 for 2 SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for 10A AMBULANCE; PBP 10a	20% Coinsurance for 11A DME; PBP 11a	"20% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"9A OP HOSPITAL, 9B ASC min $50 / max $250; PBP 9b"	8A OP DIAG PROCS/TESTS/LAB SERVICES min $0 / max $100; PBP 8a	8B OP DIAG /THERAPEUTIC/RAD SERVICES min $0 / max $200; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$40/Case for 3 CORF; PBP 3, 5, 9c, 9d"	"$0/Visit for PBP 7a, 14b-j; 20% Coinsurance for 15 Part B Drugs"	"$40/Visit for 7D PHYSICIAN SPECIALIST; $40/Visit for 7D PHYSICIAN SPECIALIST; $20/Visit for 7B CHIROPRACTOR SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for PBP 7e, 7h"	"$40/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	20% Coinsurance for PBP 8a (professional portion)	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"17a min $0 / max $40; PBP 13a, 16b, 17a"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$40/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$40/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	PBP 14a	PBP 13b-e: Not Covered											0	NO	265	210	100	0	200	0.2	0.2	62.76846214	236.2736386	15	93.70756209	0	0.2	40	0.2	39.87727144	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0											NO	254.0137789	201.293938	95.8542562	0	191.7085124	0.191708512	0.191708512	60.16624251	226.4783389	14.37813843	89.82268664	0	0.191708512	38.34170248	0.191708512	38.22406193	38.34170248	38.34170248	0	0.191708512	0.191708512	0	0	0	38.34170248	0	38.34170248	0	0	0												11.1683	0.33589177	1.142344488	0	0.546688563	1.513291799	0.077390633	0.913010255	3.592606584	0.956742989	5.056948162	0	0.091484908	0.347010337	0.784997591	6.268132812	0.429546081	0.479490634	0	0.006606723	0.0013768	0	0	0	1.567248433	0	0.002245922	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2813	0	NO	1.525935013	11.1683	0.33589177	1.142344488	0	0.546688563	1.513291799	0.077390633	0.913010255	3.592606584	0.956742989	5.056948162	0	0.091484908	0.347010337	0.784997591	6.268132812	0.429546081	0.479490634	0	0.006606723	0.0013768	0	0	0	1.567248433	0	0.002245922	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2813	NO	25% Coinsurance for 1A IP ACUTE; 25% Coinsurance for 1A IP ACUTE; PBP 1a	25% Coinsurance for 1B PSYCH; PBP 1b	$100/Day for 2 SNF; PBP 2	20% Coinsurance for 6 HOME HEALTH; PBP 6	$250/Trip for 10A AMBULANCE; PBP 10a	30% Coinsurance for 11A DME; PBP 11a	"30% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"20% Coinsurance for 9A OP HOSPITAL, 9B ASC; PBP 9b"	20% Coinsurance for 8A OP DIAG PROCS/TESTS/LAB SERVICES; PBP 8a	20% Coinsurance for 8B OP DIAG /THERAPEUTIC/RAD SERVICES; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$55/Case PBP 3, 5; $40/Case for PBP 9c; $15/Case for PBP 9d"	"$15/Visit for 7A PCP; $15/Exam for 14C PHYSICAL EXAMS; $15/Service for 7A PCP; PBP 7a, 14b-j"	"$55/Visit for 7D PHYSICIAN SPECIALIST; $55/Exam for 14C PHYSICAL EXAMS; $55/Visit for 7B CHIROPRACTOR SERVICES; $55/Visit for 7F PODIATRY SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for 7E MENTAL HEALTH, 7H PSYCH; PBP 7e, 7h"	"$55/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"$55/Case for PBP 7g, 18a"	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"$55/Case for PBP 16b, 17a; PBP 13a: Not Covered"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$55/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$55/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	No Cost Sharing; PBP 14a	PBP 13b-e: Not Covered												2.6616	0.065	0.7543	0.0009	1.5006	0.3558	0.0281	0.1439	0.4158	0.0442	0.103	0	0.0019	0.0463	0.1576	0.8113	0.2351	0.1935	0	0	0.1186	0	0	0	0.0972	0	0.006	0	0	0											7.7406	0	NO	5.33E-15	13.8299	0.400848615	1.896618573	0.000924182	2.047294269	1.869059185	0.105471369	1.05690005	4.008419961	1.00098532	5.159978183	0	0.093345509	0.393340112	0.942580368	7.079411749	0.664650675	0.673025298	0	0.006606723	0.119945484	0	0	0	1.664434703	0	0.008197618	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0219
H3660_044_0	2012	4																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V	Coin	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	675.8156534	29.06419718	279.2239233	0	128.2921829	10.96286807	0.600438284	253.635113	259.0209217	1018.547054	843.0247737	0	0.595017021	143.3372205	4.848201974	2594.137916	243.6216367	230.349409	0	0.038731407	0.866421607	0	0	0	509.7130558	0	1.980422309	0	0	0											3400	$295/Days Custom: IP 1-7 for 1A IP ACUTE; $295/Days Custom: IP 1-7 for 1A IP ACUTE; PBP 1a	$210/Days Custom: IP 1-8 for 1B PSYCH; $210/Days Custom: IP 1-8 for 1B PSYCH; PBP 1b	$100/Days Custom: SNF 11-100 for 2 SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for 10A AMBULANCE; PBP 10a	20% Coinsurance for 11A DME; PBP 11a	"20% Coinsurance for 11B PROSTHETICS/MEDICAL SUPPLIES; PBP 11b, 11c"	"$65/Visit for 4A ER, 4B URGENT CARE; $40/Visit for 4B URGENT CARE; $40/Visit for 4B URGENT CARE; PBP 4a, 4b"	"9A OP HOSPITAL, 9B ASC min $50 / max $250; PBP 9b"	8A OP DIAG PROCS/TESTS/LAB SERVICES min $0 / max $125; PBP 8a	8B OP DIAG /THERAPEUTIC/RAD SERVICES min $0 / max $250; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for 12 ESRD; PBP 12	"$40-$45/Case for 3 CORF; PBP 3, 5, 9c, 9d"	"$0/Visit for PBP 7a, 14b-j; 20% Coinsurance for PBP 15 Part B Drugs"	"$40 to $45/Visit for 7D PHYSICIAN SPECIALIST; $45/Visit for 7D PHYSICIAN SPECIALIST; $20/Visit for 7B CHIROPRACTOR SERVICES; $45/Visit for 7F PODIATRY SERVICES; PBP 7b, 7d, 7f"	"$40/Visit for PBP 7e, 7h"	"$45/Service for 7C OCCUPATIONAL THERAPY, 7I PHYSICAL AND SPEECH THERAPY; PBP 7c, 7i"	No Cost Sharing; PBP 7d	20% Copinsurance for PBP 8b (professional portion)	20% Coinsurance for 15 MEDICARE PART B DRUGS; PBP 15	"17a min $0 / max $45; PBP 13a, 16b, 17a"	PBP 10b: Not Covered	"PBP 16a, 16b: Not Covered"	$45/Exam for 17A EYE EXAMS (NON MEDICARE COVERED); PBP 17a	PBP 17b: Not Covered	$45/Exam for 18A HEARING EXAMS (NON MEDICARE COVERED); PBP 18a	PBP 18b: Not Covered	PBP 14a	PBP 13b-e: Not Covered											0	NO	295	210	100	0	200	0.2	0.2	62.63160343	236.7698494	20	165.6661642	0	0.2	45	0.2	39.58930711	40	45	0	0.2	0.2	0	0	0	45	0	45	0	0	0											NO	272.2567965	193.809923	92.2904395	0	184.580879	0.184580879	0.184580879	57.80298207	218.5159346	18.4580879	152.8940311	0	0.184580879	41.53069778	0.184580879	36.53714553	36.9161758	41.53069778	0	0.184580879	0.184580879	0	0	0	41.53069778	0	41.53069778	0	0	0												15.333	0.469410818	2.147474883	0	1.973356991	2.023535824	0.110829426	1.221738824	4.716683233	1.566702588	10.74112133	0	0.109828765	0.496074565	0.894885382	7.898532881	0.749464931	0.797214307	0	0.007149077	0.159924862	0	0	0	1.764061573	0	0.006854027	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1878	0	NO	4.443087747	15.333	0.469410818	2.147474883	0	1.973356991	2.023535824	0.110829426	1.221738824	4.716683233	1.566702588	10.74112133	0	0.109828765	0.496074565	0.894885382	7.898532881	0.749464931	0.797214307	0	0.007149077	0.159924862	0	0	0	1.764061573	0	0.006854027	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1878	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.333	0.469410818	2.147474883	0	1.973356991	2.023535824	0.110829426	1.221738824	4.716683233	1.566702588	10.74112133	0	0.109828765	0.496074565	0.894885382	7.898532881	0.749464931	0.797214307	0	0.007149077	0.159924862	0	0	0	1.764061573	0	0.006854027	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1878
H3660_801_0	2012	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	242.153553	3.341306214	37.11623751	0	7.608682084	15.6790548	0.306596211	11.06327708	60.4448426	7.78976762	31.34834531	0	0.99428541	32.05583033	51.45148214	131.9282777	0.942742197	4.174116975	16.30036874	33.90159874	21.86467669	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	NO	0.080726495	0.080726495	0.177085853	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.073733904	0.073733904	0.16174654	0	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0.204596947	0	0	0	0	0	0	0	0	0												17.8549	0.246367551	6.003422977	0	1.556713126	3.207886746	0.062728649	2.263512716	12.36683027	1.593762674	6.413775749	0	0.20342776	6.558525024	10.52681617	26.99212287	0.192882175	0.85401159	3.335005683	6.936163607	4.473446102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6423	0	NO	10.58765549	17.8549	0.246367551	6.003422977	0	1.556713126	3.207886746	0.062728649	2.263512716	12.36683027	1.593762674	6.413775749	0	0.20342776	6.558525024	10.52681617	26.99212287	0.192882175	0.85401159	3.335005683	6.936163607	4.473446102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6423	NO																																										0	0	0	0	0	0	0	0	0	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	17.8549	0.246367551	6.003422977	0	1.556713126	3.207886746	0.062728649	2.263512716	12.36683027	1.593762674	6.413775749	0	0.20342776	6.558525024	10.52681617	26.99212287	0.192882175	0.85401159	3.335005683	6.936163607	4.473446102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6423
H3660_802_0	2012	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	266.2733741	1.850531669	43.26574452	0	8.204692955	16.35224389	0.618483291	11.09910405	70.91319175	10.2299696	33.41942291	0	2.880028483	36.63148831	60.85411471	133.8688425	1.003340276	4.607530273	20.20282046	48.81806208	20.00766915	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	NO	0.080726495	0.080726495	0.177085853	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072587392	0.072587392	0.15923149	0	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0.201415603	0	0	0	0	0	0	0	0	0												19.3281	0.134325267	6.889268979	0	1.65255318	3.293597065	0.124572185	2.235532737	14.28302329	2.060475498	6.731193223	0	0.580082674	7.378153311	12.25696822	26.96327365	0.202088387	0.928028489	4.069163268	9.832719419	4.029856749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.973	0	NO	13.78875422	19.3281	0.134325267	6.889268979	0	1.65255318	3.293597065	0.124572185	2.235532737	14.28302329	2.060475498	6.731193223	0	0.580082674	7.378153311	12.25696822	26.96327365	0.202088387	0.928028489	4.069163268	9.832719419	4.029856749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.973	NO																																										0	0	0	0	0	0	0	0	0	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	19.3281	0.134325267	6.889268979	0	1.65255318	3.293597065	0.124572185	2.235532737	14.28302329	2.060475498	6.731193223	0	0.580082674	7.378153311	12.25696822	26.96327365	0.202088387	0.928028489	4.069163268	9.832719419	4.029856749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.973
H3660_805_0	2012	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	208.0197846	1.765226105	31.22542332	0	1.260527163	14.0230721	0.553799653	8.456903556	51.25474267	7.971178804	29.08782339	0	0.90018936	25.30368403	49.11632325	105.8840234	0.596441177	3.289081386	14.81510582	36.82383167	15.65926514	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	NO	0.080726495	0.080726495	0.177085853	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.073082613	0.073082613	0.160317833	0	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0.202789743	0	0	0	0	0	0	0	0	0												15.2026	0.129007335	5.005992196	0	0.255621979	2.843735187	0.112304889	1.714973298	10.39393609	1.616473301	5.898712228	0	0.182549169	5.131327581	9.960286569	21.4721939	0.120952153	0.666991969	3.004351502	7.467495359	3.175538354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3551	0	NO	9.868819337	15.2026	0.129007335	5.005992196	0	0.255621979	2.843735187	0.112304889	1.714973298	10.39393609	1.616473301	5.898712228	0	0.182549169	5.131327581	9.960286569	21.4721939	0.120952153	0.666991969	3.004351502	7.467495359	3.175538354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3551	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												3.5747	0	2.1123	0	1.5507	0.5122	0.0141	0.4664	3.5593	0.3888	0.6117	0	0.3998	2.092	2.5938	6.1907	0.0906	0.2927	1.1951	2.6583	0.7454	0	0	0	0	0	0	0	0	0											29.0484	0	NO	1.07E-14	18.7773	0.129007335	7.118250205	0	1.806338627	3.355949953	0.126433965	2.181326882	13.95322075	2.005257116	6.510459304	0	0.582329532	7.223315753	12.55412468	27.66285953	0.211513441	0.959642174	4.199438193	10.12578277	3.920943525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4035
H3660_806_0	2012	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	223.1797497	1.893871399	31.30678821	0	1.263811751	14.05961238	0.555242703	8.611177271	52.20407117	8.118819136	29.62658133	0	0.916862459	25.77235302	49.24430693	106.1599282	0.597995339	3.29765183	14.85370993	36.91978447	15.94930243	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	NO	0.080726495	0.080726495	0.177085853	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072921678	0.072921678	0.159964799	0	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0.202343182	0	0	0	0	0	0	0	0	0												16.2746	0.13810428	5.007984069	0	0.255723691	2.844866703	0.112349575	1.742413007	10.56313786	1.642787695	5.994736729	0	0.185520867	5.214859909	9.964249744	21.48073764	0.12100028	0.667257363	3.005546927	7.470466658	3.2272326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9136	0	NO	10.26564755	16.2746	0.13810428	5.007984069	0	0.255723691	2.844866703	0.112349575	1.742413007	10.56313786	1.642787695	5.994736729	0	0.185520867	5.214859909	9.964249744	21.48073764	0.12100028	0.667257363	3.005546927	7.470466658	3.2272326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9136	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												3.584	0	2.1178	0	1.5548	0.5135	0.0142	0.4676	3.5686	0.3898	0.6133	0	0.4008	2.0974	2.6006	6.2068	0.0908	0.2934	1.1982	2.6652	0.7473	0	0	0	0	0	0	0	0	0											29.1241	0	NO	0	19.8586	0.13810428	7.125746043	0	1.81048108	3.35841616	0.126515467	2.20998178	14.13169704	2.032584575	6.60807785	0	0.586342948	7.312299229	12.56484669	27.68753444	0.211797545	0.960670135	4.203747685	10.13568084	3.974580092	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0377
H3664_012_0	2012	10																															D	D	D		T	Coin	Coin	V	Coin	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	YES	1819.785259	0	961.4718604	0	455.5306301	12.12701633	8.346775819	639.6750089	38.01794216	3169.788646	928.0102044	0	0	4.893518687	5301.464532	6751.723158	295.27788	581.9523832	887.8378697	1858.270639	27.36204857	0	0	0	0	0	0.719931471	0	0	0											3400	$175/Days 1-10 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MH/SA; PBP 1b	$75/Days 11-100 for SNF; PBP 2	$0/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 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; $75/Visit for OP Rad - Complex Diagnostic; $30/Visit for OP Rad - X-Ray; 15% Coinsurance for OP Rad - Therapeutic; PBP 8b	$35/Visit for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"$0/Visit for Cardiac Rehab; $35/Visit for OP Substance Abuse; PBP 3, 9c"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$20/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; $0/Visit for Colorectal Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 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; $75/Visit for Phys Rad - Complex Diagnostic; $30/Visit for Phys Rad - X-Ray; 15% Coinsurance for Phys Rad - Theraputic; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14b"	"$35/Visit for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	15% Coinsurance for Part B Drugs - Gen; 15% Coinsurance for Part B Drugs - Chemo; 15% Coinsurance for Part B Drugs - Pharmacy; PBP 15	$0/Case for Blood; PBP 9d	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	"No Cost Sharing; PBP 14a, 14b, 14c, 14d, 14e"	No Cost Sharing; PBP 13a-c											0	NO	175	0	75	0	125	0.2	0.2	47.92191751	0.2	30	59.19983053	0	0	35	15	34.44334858	35	10	37.31706224	35	0.15	0	0	0	0	0	35	0	0	0											NO	149.2072798	0	63.94597706	0	106.5766284	0.170522605	0.170522605	40.85885117	0.170522605	25.57839082	50.47454673	0	0	29.84145596	12.78919541	29.36684771	29.84145596	8.526130274	31.81701341	29.84145596	0.127891954	0	0	0	0	0	29.84145596	0	0	0												22.6271	0	5.123521461	0	4.045743226	2.067930421	1.42331396	2.178032165	6.482918553	6.756507735	3.903407869	0	0	0.012169144	5.650122155	16.52306881	0.734293488	0.413483486	2.354029117	4.621125119	3.49938586	0	0	0	0	0	0.001790317	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4179	0	NO	15.28437005	22.6271	0	5.123521461	0	4.045743226	2.067930421	1.42331396	2.178032165	6.482918553	6.756507735	3.903407869	0	0	0.012169144	5.650122155	16.52306881	0.734293488	0.413483486	2.354029117	4.621125119	3.49938586	0	0	0	0	0	0.001790317	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4179	NO																																										0	0	0	0	0	0	0	0	0	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	22.6271	0	5.123521461	0	4.045743226	2.067930421	1.42331396	2.178032165	6.482918553	6.756507735	3.903407869	0	0	0.012169144	5.650122155	16.52306881	0.734293488	0.413483486	2.354029117	4.621125119	3.49938586	0	0	0	0	0	0.001790317	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4179
H3664_014_0	2012	8																															D	D	D		T	Coin	Coin	V	Coin	V	V	V		V	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	1239.090395	0	1143.114526	0	235.9836221	5.741038604	3.809880208	442.4573545	31.31123969	1969.640117	619.2320476	0	0	0.870450303	3397.985518	4723.915038	116.2603598	386.0100256	7.039823406	1295.561326	22.00196968	0	0	0	0	0	0	0	0	0											3400	$210/Days 1-10 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MH/SA; PBP 1b	$75/Days 5-100 for SNF; PBP 2	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 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; $100/Visit for OP Rad - Complex Diagnostic; $35/Visit for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$35/Day for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"$0/Visit for Cardiac Rehab; $35/Visit for OP Substance Abuse; PBP 3, 9c"	"$25/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$20/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; $0/Visit for Colorectal Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 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 - Complex Diagnostic; $35/Visit for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14b"	"$35/Visit for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	$0/Case for Blood; PBP 9d	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, 14b, 14c, 14d, 14e"	No Cost Sharing; PBP 13a-c											0	NO	210	0	75	0	150	0.2	0.2	48.16075181	0.2	35	84.21242645	0	0	35	25	34.52165036	35	15	0.393977959	35	0.2	0	0	0	0	0	0	0	0	0											NO	178.10502	0	63.60893571	0	127.2178714	0.169623829	0.169623829	40.84605554	0.169623829	29.68417	71.42217094	0	0	29.68417	21.20297857	29.27847251	29.68417	12.72178714	0.334140249	29.68417	0.169623829	0	0	0	0	0	0	0	0	0												18.3907	0	6.059358198	0	2.501777841	0.973816948	0.646246467	1.50605314	5.311132353	4.872261007	3.685574763	0	0	0.002153216	6.003951177	11.52575138	0.287591024	0.409228115	2.352288348	3.204805221	3.732058334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4647	0	NO	12.79787743	18.3907	0	6.059358198	0	2.501777841	0.973816948	0.646246467	1.50605314	5.311132353	4.872261007	3.685574763	0	0	0.002153216	6.003951177	11.52575138	0.287591024	0.409228115	2.352288348	3.204805221	3.732058334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4647	NO																																										0	0	0	0	0	0	0	0	0	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	18.3907	0	6.059358198	0	2.501777841	0.973816948	0.646246467	1.50605314	5.311132353	4.872261007	3.685574763	0	0	0.002153216	6.003951177	11.52575138	0.287591024	0.409228115	2.352288348	3.204805221	3.732058334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4647
H3664_017_0	2012	10																															D	D	D		T	Coin	Coin	V	Coin	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	YES	1289.404775	0	801.3381786	0	293.1236378	8.261968388	5.359436053	490.518428	30.4821578	2384.097164	741.5374865	0	0	0.383362089	4243.164681	5302.487691	176.7350138	518.1652024	682.9224508	1497.497541	24.88476788	0	0	0	0	0	1.342019305	0	0	0											3400	$200/Days 1-10 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MH/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 Prosth/Supplies; 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; $125/Visit for OP Rad - Complex Diagnostic; $35/Visit for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$35/Day for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"$0/Visit for Cardiac Rehab; $35/Visit for OP Substance Abuse; PBP 3, 9c"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$20/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; $0/Visit for Colorectal Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 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; $125/Visit for Phys Rad - Complex Diagnostic; $35/Visit for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14b"	"$35/Visit for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	$0/Case for Blood; PBP 9d	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 Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	"No Cost Sharing; PBP 14a, 14b, 14c, 14d, 14e"	No Cost Sharing; PBP 13a-c											0	NO	200	0	84	0	150	0.2	0.2	47.80862374	0.2	35	90.31593806	0	0	35	15	34.30337368	35	10	51.7702862	35	0.2	0	0	0	0	0	35	0	0	0											NO	168.2363899	0	70.65928375	0	126.1772924	0.16823639	0.16823639	40.21575132	0.16823639	29.44136823	75.97213684	0	0	29.44136823	12.61772924	28.85537874	29.44136823	8.411819494	43.54823026	29.44136823	0.16823639	0	0	0	0	0	29.44136823	0	0	0												18.0771	0	4.718498479	0	3.082128913	1.389963735	0.901652173	1.643880593	5.128208184	5.849256874	4.694682283	0	0	0.000940559	4.461591922	12.75044088	0.433610052	0.363226013	2.478338678	3.674031377	4.186523511	0	0	0	0	0	0.003292574	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8373	0	NO	13.94074305	18.0771	0	4.718498479	0	3.082128913	1.389963735	0.901652173	1.643880593	5.128208184	5.849256874	4.694682283	0	0	0.000940559	4.461591922	12.75044088	0.433610052	0.363226013	2.478338678	3.674031377	4.186523511	0	0	0	0	0	0.003292574	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8373	NO																																										0	0	0	0	0	0	0	0	0	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	18.0771	0	4.718498479	0	3.082128913	1.389963735	0.901652173	1.643880593	5.128208184	5.849256874	4.694682283	0	0	0.000940559	4.461591922	12.75044088	0.433610052	0.363226013	2.478338678	3.674031377	4.186523511	0	0	0	0	0	0.003292574	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8373
H3664_018_0	2012	10																															D	D	D		T	Coin	Coin	V	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	YES	1082.884647	0	1326.934689	0	246.7939927	6.956123297	4.512350597	395.3993021	25.66430154	1990.915094	620.9932633	0	0	0.320286964	3380.440945	4429.188609	147.6565437	422.6332897	571.622585	1251.112082	20.95160686	0	0	0	0	0	0	0	0	0											3400	$220/Days 1-10 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MH/SA; PBP 1b	$100/Days 5-100 for SNF; PBP 2	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$65/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"	$45/Visit for OP Lab; PBP 8a	$45/Visit for OP Rad - General; $125/Visit for OP Rad - Complex Diagnostic; $45/Visit for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$40/Visit for Partial Hosp; PBP 5	$0/Case for Renal Dialysis; PBP 12	"$0/Visit for Cardiac Rehab; $40/Visit for OP Substance Abuse; PBP 3, 9c"	"$25/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); PBP 7a, 14b"	"$20/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; $0/Visit for Colorectal Screening; $40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14b, 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"	"$45/Visit for Phys Rad - General; $125/Visit for Phys Rad - Complex Diagnostic; $45/Visit for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14b"	"$40/Visit for Other Health Care Professional; $0/Visit for Nutrition Training; $0/Visit for Diabetes Monitoring; PBP 7g, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	$0/Case for Blood; PBP 9d	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, 14b, 14c, 14d, 14e"	No Cost Sharing; PBP 13a-c											0	NO	220	0	100	0	150	0.2	0.2	59.27783823	0.25	45	96.69521307	0	0	40	25	39.54018098	40	15	59.02169517	40	0.2	0	0	0	0	0	0	0	0	0											NO	183.7807452	0	83.53670234	0	125.3050535	0.167073405	0.167073405	49.51875127	0.208841756	37.59151605	80.77599232	0	0	33.41468094	20.88417559	33.03056329	33.41468094	12.53050535	49.30477781	33.41468094	0.167073405	0	0	0	0	0	0	0	0	0												16.5844	0	9.237312345	0	2.577044538	1.162183203	0.753893777	1.631639975	5.359777796	6.23679306	4.180112255	0	0	0.000891857	5.88314352	12.19154955	0.411158025	0.441317391	2.348643712	3.483792587	3.500456292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9842	0	NO	14.97485218	16.5844	0	9.237312345	0	2.577044538	1.162183203	0.753893777	1.631639975	5.359777796	6.23679306	4.180112255	0	0	0.000891857	5.88314352	12.19154955	0.411158025	0.441317391	2.348643712	3.483792587	3.500456292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9842	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	0	NO	0	16.5844	0	9.237312345	0	2.577044538	1.162183203	0.753893777	1.631639975	5.359777796	6.23679306	4.180112255	0	0	0.000891857	5.88314352	12.19154955	0.411158025	0.441317391	2.348643712	3.483792587	3.500456292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9842
H3664_801_0	2012	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	222.136292	0	43.13287906	0	6.866124908	8.488148421	7.313663308	15.67555951	64.02148291	11.29230888	24.27034115	0	0.178644148	10.37415633	44.14784131	69.00222683	1.53105007	15.31907745	21.35398167	77.03748737	60.86360038	0.822824442	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14b"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b, 14c, 14d, 14e"	PBP 13a-c											0	NO	0.082880623	0	0.176123434	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075547213	0	0.160539752	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0	0	0	0	0	0	0												16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	0	NO	10.99336147	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	NO																																										0	0	0	0	0	0	0	0	0	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	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513
H3664_802_0	2012	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	267.0626576	0	58.29590026	0	8.387126211	8.653579678	7.438485661	17.59599416	64.66452371	13.43992798	26.83287447	0	0.154639109	11.70625327	52.19776799	78.82534727	1.46710672	16.60184167	25.41838	83.17924496	65.75399235	0.714565079	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14b"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b, 14c, 14d, 14e"	PBP 13a-c											0	NO	0.082880623	0	0.176123434	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074191319	0	0.157658441	0	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0.200515571	0	0	0	0	0	0	0	0												19.8137	0	9.190840774	0	1.681749398	1.735177467	1.491532197	3.52827081	12.96624387	2.694914828	5.380409136	0	0.031007549	2.347286055	10.46646523	15.80570949	0.294177741	3.328927756	5.096780971	16.67873377	13.1846993	0.143281425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8599	0	NO	14.7407447	19.8137	0	9.190840774	0	1.681749398	1.735177467	1.491532197	3.52827081	12.96624387	2.694914828	5.380409136	0	0.031007549	2.347286055	10.46646523	15.80570949	0.294177741	3.328927756	5.096780971	16.67873377	13.1846993	0.143281425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8599	NO																																										0	0	0	0	0	0	0	0	0	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	19.8137	0	9.190840774	0	1.681749398	1.735177467	1.491532197	3.52827081	12.96624387	2.694914828	5.380409136	0	0.031007549	2.347286055	10.46646523	15.80570949	0.294177741	3.328927756	5.096780971	16.67873377	13.1846993	0.143281425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8599
H3664_803_0	2012	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	222.136292	0	43.13287906	0	6.866124908	8.488148421	7.313663308	15.67555951	64.02148291	11.29230888	24.27034115	0	0.178644148	10.37415633	44.14784131	69.00222683	1.53105007	15.31907745	21.35398167	77.03748737	60.86360038	0.822824442	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14b"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b, 14c, 14d, 14e"	PBP 13a-c											0	NO	0.082880623	0	0.176123434	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075547213	0	0.160539752	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0	0	0	0	0	0	0												16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	0	NO	10.99336147	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	NO																																										0	0	0	0	0	0	0	0	0	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	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513
H3664_805_0	2012	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	222.136292	0	43.13287906	0	6.866124908	8.488148421	7.313663308	15.67555951	64.02148291	11.29230888	24.27034115	0	0.178644148	10.37415633	44.14784131	69.00222683	1.53105007	15.31907745	21.35398167	77.03748737	60.86360038	0.822824442	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14b"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b, 14c, 14d, 14e"	PBP 13a-c											0	NO	0.082880623	0	0.176123434	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075547213	0	0.160539752	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0	0	0	0	0	0	0												16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	0	NO	10.99336147	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	NO																																										0	0	0	0	0	0	0	0	0	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	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513
H3664_806_0	2012	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	222.136292	0	43.13287906	0	6.866124908	8.488148421	7.313663308	15.67555951	64.02148291	11.29230888	24.27034115	0	0.178644148	10.37415633	44.14784131	69.00222683	1.53105007	15.31907745	21.35398167	77.03748737	60.86360038	0.822824442	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14b"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	"PBP 14a, 14b, 14c, 14d, 14e"	PBP 13a-c											0	NO	0.082880623	0	0.176123434	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.075547213	0	0.160539752	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0.204180123	0	0	0	0	0	0	0	0											10000	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	0	NO	10.99336147	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513	NO																																										0	0	0	0	0	0	0	0	0	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	16.7818	0	6.924541697	0	1.401926227	1.733111188	1.493304673	3.200637666	13.07191425	2.305665014	4.955521239	0	0.036475584	2.118196513	9.014111664	14.08888315	0.312609991	3.127851116	4.360058601	15.72952364	12.4271374	0.168004396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2513
H3668_005_0	2012	5																																	D		T	Coin	Coin	V	V		V	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	0	0	1427.174866	0	263.3280285	12.96999437	0.642010314	289.6613143	183.3677481	0	1117.156443	2.468029828	10.24903583	1502.210599	5108.296885	5028.239733	123.0452281	148.4104226	720.1872086	290.8454349	26.12459952	0	0	0	245.4649413	0	48.67090009	0	0	0											3400	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $25/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$21/Case for OP Radiology; $15/Case for Diagnostic Radiology; PBP 8b	$25/Visit for OP Mental Health; PBP 9a	$15/Case for OP Dialysis; PBP 12	"$15/Case for OP Other; $25/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$10/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$13/Visit for Office Surgery; $25/Visit for Specialty Physician, Podiatrist; $25/Visit for Vision Exam; $25/Visit for Hearing Exam; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"$25/Visit for OP Mental Health; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$15/Visit for Radiology; PBP 7d	"$25/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$25/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0	0	50	0	150	0.2	0.2	64.99888073	125	0	19.82509479	25	15	15.00031751	10	22.42397568	25	25	15	20.86313183	0.2	0	0	0	25	0	25	0	0	0											NO	0	0	49.31241593	0	147.9372478	0.197249664	0.197249664	64.10503683	123.2810398	0	19.5524664	24.65620797	14.79372478	14.79403792	9.862483186	22.11560831	24.65620797	24.65620797	14.79372478	20.57622869	0.197249664	0	0	0	24.65620797	0	24.65620797	0	0	0												0	0	5.864786718	0	3.246335317	2.558327027	0.126636319	1.547395769	1.883813888	0	1.820263651	0.005071021	0.012635118	1.851980047	4.198374345	9.266881702	0.252819061	0.30493652	0.887854279	0.498708515	5.15306847	0	0	0	0.504352887	0	0.10000332	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0842	0	NO	0.558911727	0	0	5.864786718	0	3.246335317	2.558327027	0.126636319	1.547395769	1.883813888	0	1.820263651	0.005071021	0.012635118	1.851980047	4.198374345	9.266881702	0.252819061	0.30493652	0.887854279	0.498708515	5.15306847	0	0	0	0.504352887	0	0.10000332	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0842	NO																																										0	0	0	0	0	0	0	0	0	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	5.864786718	0	3.246335317	2.558327027	0.126636319	1.547395769	1.883813888	0	1.820263651	0.005071021	0.012635118	1.851980047	4.198374345	9.266881702	0.252819061	0.30493652	0.887854279	0.498708515	5.15306847	0	0	0	0.504352887	0	0.10000332	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0842
H3668_011_0	2012	5																															D	D	D		T	Coin	Coin	V	V		V	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	588.9512701	20.54702062	768.2514923	0	198.0443217	10.9818167	0.985715415	240.1172532	131.3154805	0	777.6616467	0.981204921	59.29081136	954.2796809	4012.328347	3314.445716	68.02668873	58.79402912	409.8280708	205.3150028	16.51148733	0	0	0	166.6076112	0	25.43464345	0	0	0											3400	$225/Days Custom: IP 1-7 for Inpatient; $225/Days Custom: IP 1-7 for Inpatient; PBP 1a	$225/Days Custom: IP 1-7 for Inpatient Mental Health; $225/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $40/Visit for Urgent Care; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$55/Case for OP Radiology; $55/Case for Diagnostic Radiology; PBP 8b	$40/Visit for OP Mental Health; PBP 9a	$30/Case for OP Dialysis; PBP 12	"$55/Case for OP Other; $45/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$10/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$17/Visit for Office Surgery; $45/Visit for Specialty Physician, Podiatrist; $45/Visit for Vision Exam; $45/Visit for Hearing Exam; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"$40/Visit for OP Mental Health; $45/Visit for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$55/Visit for Radiology; PBP 7d	"$45/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$45/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$45/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											0	NO	225	225	50	0	150	0.2	0.2	64.99948629	250	0	55	40	30	54.41305648	10	39.08329698	40.02366105	45	55	25.25269888	0.2	0	0	0	45	0	45	0	0	0											NO	220.1793753	220.1793753	48.92875007	0	146.7862502	0.195715	0.195715	63.60687238	244.6437503	0	53.82162507	39.14300005	29.35725004	53.24725682	9.785750013	38.2459374	39.16615416	44.03587506	53.82162507	24.71165984	0.195715	0	0	0	44.03587506	0	44.03587506	0	0	0												10.8062	0.377002514	3.132465438	0	2.422515279	2.149306259	0.192919293	1.272758957	2.677125969	0	3.487917799	0.003200609	0.145051265	4.234397937	3.271970181	10.56367361	0.222028648	0.215753877	1.838134398	0.422806209	3.231545747	0	0	0	0.611392662	0	0.093336398	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3715	0	NO	1.124732715	10.8062	0.377002514	3.132465438	0	2.422515279	2.149306259	0.192919293	1.272758957	2.677125969	0	3.487917799	0.003200609	0.145051265	4.234397937	3.271970181	10.56367361	0.222028648	0.215753877	1.838134398	0.422806209	3.231545747	0	0	0	0.611392662	0	0.093336398	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3715	NO																																										0	0	0	0	0	0	0	0	0	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	10.8062	0.377002514	3.132465438	0	2.422515279	2.149306259	0.192919293	1.272758957	2.677125969	0	3.487917799	0.003200609	0.145051265	4.234397937	3.271970181	10.56367361	0.222028648	0.215753877	1.838134398	0.422806209	3.231545747	0	0	0	0.611392662	0	0.093336398	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3715
H3668_013_0	2012	2																															D	D	D		T	Coin	Coin	V	V		V	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	1084.878829	48.41777818	1349.475085	0	335.3249347	13.02830511	2.749687532	287.0888274	217.4468437	0	1076.12398	4.582430617	5.585822093	1703.101623	4812.239558	5221.18769	113.3678505	172.2451149	839.1379183	480.6428988	30.64369155	0	0	0	196.259904	0	32.11434845	0	0	0											3400	$50/Days Custom: IP 1-7 for Inpatient; $50/Days Custom: IP 1-7 for Inpatient; PBP 1a	$50/Days Custom: IP 1-7 for Inpatient Mental Health; $50/Days Custom: IP 1-7 for Inpatient Mental Health; PBP 1b	$50/Days Custom: SNF 8-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for OP Other; 20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for Emergency Room; $25/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$38/Case for OP Radiology; $35/Case for Diagnostic Radiology; PBP 8b	$25/Visit for OP Mental Health; PBP 9a	$30/Case for OP Dialysis; PBP 12	"$35/Case for OP Other; $25/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c"	"$10/Visit for Primary Care Physician; PBP 7a, 14a, 14b"	"$13/Visit for Office Surgery; $25/Visit for Specialty Physician, Podiatrist; $25/Visit for Vision Exam; $25/Visit for Hearing Exam; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"$25/Visit for OP Mental Health; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$35/Visit for Radiology; PBP 7d	"$25/Visit for Other Health Care; $20/Visit for Chiropratic; PBP 7d, 14d, 14e"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Visit for Vision Hardware; PBP 17a-2	No Cost Sharing; PBP 17b-2	$25/Visit for Routine Hearing Exam; PBP 18a-2	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a, 13b, 13c, 13d, 13e"											0	NO	50	50	50	0	50	0.2	0.2	64.99938452	125	0	37.04502377	25	30	34.99984737	10	22.28080634	25	25	35	20.61425167	0.2	0	0	0	25	0	25	0	0	0											NO	48.96750028	48.96750028	48.96750028	0	48.96750028	0.195870001	0.195870001	63.6571476	122.4187507	0	36.28004424	24.48375014	29.38050017	34.27710072	9.793500057	21.82070781	24.48375014	24.48375014	34.2772502	20.18856749	0.195870001	0	0	0	24.48375014	0	24.48375014	0	0	0												4.427	0.197574797	5.5067018	0	1.36833532	2.551854137	0.5385813	1.522937988	2.218297579	0	3.253485465	0.009349591	0.013676187	4.864782156	3.927389032	9.494167585	0.231305844	0.351433863	2.396945031	0.8086243	6.002179898	0	0	0	0.400431538	0	0.065523307	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1506	0	NO	1.057445021	4.427	0.197574797	5.5067018	0	1.36833532	2.551854137	0.5385813	1.522937988	2.218297579	0	3.253485465	0.009349591	0.013676187	4.864782156	3.927389032	9.494167585	0.231305844	0.351433863	2.396945031	0.8086243	6.002179898	0	0	0	0.400431538	0	0.065523307	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1506	NO																																										0	0	0	0	0	0	0	0	0	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	4.427	0.197574797	5.5067018	0	1.36833532	2.551854137	0.5385813	1.522937988	2.218297579	0	3.253485465	0.009349591	0.013676187	4.864782156	3.927389032	9.494167585	0.231305844	0.351433863	2.396945031	0.8086243	6.002179898	0	0	0	0.400431538	0	0.065523307	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1506
H3668_801_0	2012	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	228.5290691	2.365102513	33.17459923	0	10.36754986	17.83682427	1.079390626	15.03626138	48.81227693	9.830632685	24.65387259	0.057991499	0.279604213	60.53272663	56.84916869	138.417589	0.849233963	1.255047987	22.2688413	11.56797127	38.01039328	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078522923	0.078522923	0.169293913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071432703	0.071432703	0.154007534	0	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0	0	0	0	0	0	0	0	0												16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	0	NO	11.40178697	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871
H3668_802_0	2012	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	213.2851965	3.426299283	41.66925669	0	10.01905375	19.1681178	0.612258865	13.33277649	51.38532971	9.248525293	25.05433496	0.072171455	0.133576238	59.26780845	55.09844095	142.3358652	1.049691452	1.134578405	20.4943806	14.76799288	50.94999179	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078210149	0.078210149	0.168519257	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.070887725	0.070887725	0.152741645	0	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0.203028005	0	0	0	0	0	0	0	0	0												15.1193	0.242882562	6.364630811	0	2.03414849	3.891664709	0.124305696	2.706927005	10.43266095	1.877709635	5.086731632	0.014652827	0.027119717	12.03302488	11.18652652	28.89816668	0.213116761	0.23035119	4.160933199	2.998316127	10.34427517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9874	0	NO	12.18763985	15.1193	0.242882562	6.364630811	0	2.03414849	3.891664709	0.124305696	2.706927005	10.43266095	1.877709635	5.086731632	0.014652827	0.027119717	12.03302488	11.18652652	28.89816668	0.213116761	0.23035119	4.160933199	2.998316127	10.34427517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9874	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.1193	0.242882562	6.364630811	0	2.03414849	3.891664709	0.124305696	2.706927005	10.43266095	1.877709635	5.086731632	0.014652827	0.027119717	12.03302488	11.18652652	28.89816668	0.213116761	0.23035119	4.160933199	2.998316127	10.34427517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9874
H3668_803_0	2012	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	228.5290691	2.365102513	33.17459923	0	10.36754986	17.83682427	1.079390626	15.03626138	48.81227693	9.830632685	24.65387259	0.057991499	0.279604213	60.53272663	56.84916869	138.417589	0.849233963	1.255047987	22.2688413	11.56797127	38.01039328	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078522923	0.078522923	0.169293913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071432703	0.071432703	0.154007534	0	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0	0	0	0	0	0	0	0	0												16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	0	NO	11.40178697	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871
H3668_804_0	2012	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	228.5290691	2.365102513	33.17459923	0	10.36754986	17.83682427	1.079390626	15.03626138	48.81227693	9.830632685	24.65387259	0.057991499	0.279604213	60.53272663	56.84916869	138.417589	0.849233963	1.255047987	22.2688413	11.56797127	38.01039328	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"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	PBP 10b	"PBP 16a, 16b"	PBP 17a-2	PBP 17b-2	PBP 18a-2	PBP 18b	PBP 14c	"PBP 13a, 13b, 13c, 13d, 13e"											0	NO	0.078522923	0.078522923	0.169293913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.071432703	0.071432703	0.154007534	0	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0.203773939	0	0	0	0	0	0	0	0	0												16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	0	NO	11.40178697	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	16.3244	0.168945665	5.109138209	0	2.112636474	3.634679942	0.21995168	3.063998211	9.946669945	2.003226746	5.023816731	0.011817156	0.056976052	12.33499215	11.58437904	28.20589734	0.17305175	0.255746072	4.537809511	2.357251074	7.745527563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.871
H3672_013_0	2012	7																															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	1690.03162	37.16529366	1496.727488	613.3	400.6	13.13974806	0	439.6	423.2	9504.5	1150.1	290.4	401.2	5878.5	4092.2	3623.7	185.3	217.7	789	0	14.02265604	0	0	0.3	199.4	123.7	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												20.0867	0.441725001	10.16527419	0	3.400927083	2.141778935	0	1.940650833	7.185583333	6.455139583	4.258849644	0	0.320600437	0	0	8.455096167	0.440473542	0.517491042	0	0	2.171408287	0	0	0	0.473990417	0.126019375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5817	0	NO	15.56763375	20.0867	0.441725001	10.16527419	0	3.400927083	2.141778935	0	1.940650833	7.185583333	6.455139583	4.258849644	0	0.320600437	0	0	8.455096167	0.440473542	0.517491042	0	0	2.171408287	0	0	0	0.473990417	0.126019375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5817	NO																																																																																		0	0	NO	0	20.0867	0.441725001	10.16527419	0	3.400927083	2.141778935	0	1.940650833	7.185583333	6.455139583	4.258849644	0	0.320600437	0	0	8.455096167	0.440473542	0.517491042	0	0	2.171408287	0	0	0	0.473990417	0.126019375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5817
H3672_014_0	2012	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	1404.621532	34.93880141	1042.676138	414.1	319.5	8.863885487	0	382.5	369.3	6970.6	864.2	146.1	118.5	4598.6	3278	3014.5	106.5	150.8	671.8	0	6.096607429	0	0	0	163.3	99.3	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												16.6945	0.415262213	7.081508773	0	2.712421875	1.444813334	0	1.688578125	6.27040625	4.734199167	3.20015465	0	0.094693798	0	0	7.033663768	0.253159375	0.358464167	0	0	0.94405966	0	0	0	0.388177708	0.101161875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4152	0	NO	12.12493108	16.6945	0.415262213	7.081508773	0	2.712421875	1.444813334	0	1.688578125	6.27040625	4.734199167	3.20015465	0	0.094693798	0	0	7.033663768	0.253159375	0.358464167	0	0	0.94405966	0	0	0	0.388177708	0.101161875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4152	NO																																																																																		0	0	NO	0	16.6945	0.415262213	7.081508773	0	2.712421875	1.444813334	0	1.688578125	6.27040625	4.734199167	3.20015465	0	0.094693798	0	0	7.033663768	0.253159375	0.358464167	0	0	0.94405966	0	0	0	0.388177708	0.101161875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4152
H3672_016_0	2012	7																															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	1707.099036	39.13889122	1516.871185	613.3	400.6	13.13974806	0	439.6	427.9	9581.2	1159.4	292.8	404.4	5925.9	4116.4	3645.1	186.4	219	793.6	0	14.02265604	0	0	0	199.4	123.7	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	100	100	75	$0.00 	125	20%	20%	$65.00 	$175.00 	$5.00 	48.02307506	$0.00 	11.76594525	0	0	34.355	$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	85.7	85.7	64.275	0	107.125	0.1714	0.1714	55.705	149.975	4.285	41.15577533	0	10.08341508	0	0	29.442235	29.995	29.995	0	0	0.16283	0	0	0	29.995	12.855	0	0	0	0												12.1915	0.279516915	8.124741285	0	3.576189583	2.252152818	0	2.040659833	5.347858542	3.421286833	3.976333826	0	0.339811088	0	0	8.943324233	0.465922333	0.54740875	0	0	2.283309083	0	0	0	0.498416917	0.132513625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.421	0	NO	9.080746612	12.1915	0.279516915	8.124741285	0	3.576189583	2.252152818	0	2.040659833	5.347858542	3.421286833	3.976333826	0	0.339811088	0	0	8.943324233	0.465922333	0.54740875	0	0	2.283309083	0	0	0	0.498416917	0.132513625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.421	NO																																																																																		0	0	NO	0	12.1915	0.279516915	8.124741285	0	3.576189583	2.252152818	0	2.040659833	5.347858542	3.421286833	3.976333826	0	0.339811088	0	0	8.943324233	0.465922333	0.54740875	0	0	2.283309083	0	0	0	0.498416917	0.132513625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.421
H3672_804_0	2012	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	YES	1424.905843	31.34216009	1261.943386	517.1	337.8	11.07889635	0	370.7	356.8	8013.8	969.7	244.9	338.2	4956.5	3450.4	3055.3	156.2	183.5	665.2	0	11.82332812	0	0	0	168.1	104.3	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												16.9356	0.372514632	8.570698832	0	2.86778125	1.805860105	0	1.636486042	6.058166667	5.442705833	3.590823841	0	0.270256899	0	0	7.128861473	0.371300417	0.436194792	0	0	1.83084236	0	0	0	0.399587708	0.106255625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8239	0	NO	13.12567875	16.9356	0.372514632	8.570698832	0	2.86778125	1.805860105	0	1.636486042	6.058166667	5.442705833	3.590823841	0	0.270256899	0	0	7.128861473	0.371300417	0.436194792	0	0	1.83084236	0	0	0	0.399587708	0.106255625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8239	NO																																																																																		0	0	NO	0	16.9356	0.372514632	8.570698832	0	2.86778125	1.805860105	0	1.636486042	6.058166667	5.442705833	3.590823841	0	0.270256899	0	0	7.128861473	0.371300417	0.436194792	0	0	1.83084236	0	0	0	0.399587708	0.106255625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8239
H3672_805_0	2012	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	YES	1215.360866	30.57145124	815.5094014	461.4	264.3	10.83311208	0	347.7	381.5	7485.4	872.2	330.5	188.9	4687.3	3567.6	3178.5	122.3	282.6	769.1	0	12.49623645	0	0	0	193.8	108.8	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												14.4451	0.363354436	5.538668018	0	2.243796875	1.765797269	0	1.534950625	6.477552083	5.083834167	3.229778854	0	0.150950704	0	0	7.416321209	0.290717292	0.67176375	0	0	1.935042214	0	0	0	0.46067875	0.11084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7191	0	NO	11.73992216	14.4451	0.363354436	5.538668018	0	2.243796875	1.765797269	0	1.534950625	6.477552083	5.083834167	3.229778854	0	0.150950704	0	0	7.416321209	0.290717292	0.67176375	0	0	1.935042214	0	0	0	0.46067875	0.11084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7191	NO																																																																																		0	0	NO	0	14.4451	0.363354436	5.538668018	0	2.243796875	1.765797269	0	1.534950625	6.477552083	5.083834167	3.229778854	0	0.150950704	0	0	7.416321209	0.290717292	0.67176375	0	0	1.935042214	0	0	0	0.46067875	0.11084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7191
H3706_001_0	2012	3																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V		V	V	V	Coin	Coin	Coin									V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1107.722889	0	115.9954007	0	222.7772281	3.728564935	0.671576469	439.4344428	269.7682146	0.993035142	5.721649073	0	0.074942876	1.126154743	0	1384.299892	1.22679686	218.1168761	0.19398149	4.226904445	3.79650846	0	0	0	0	0	0	0	0	0											3000	$285/Days 1 - 6 for IP Med/Surg; PBP 1a	$285/Days 1 - 6 for IP MH/SA; 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 Prosth/Supplies; 0%-20% Coinsurance for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for Worldwide OP ER (non-cvd); $25/Visit for Urgent Care; PBP 4a, 4b"	"$250/Visit for OP Surg; $250/Visit for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for Cardiac & Pulmonary Rehab; $25/Visit for Rehab Services (CORF); $25/Visit for OP SA; PBP 3, 7i, 9a, 9c"	"No Cost Sharing; PBP 7a, 13d, 14a, 14b"	"$20/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, 13d, 14a, 14b, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - Other; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	13(d) $0											0	NO	285	0	105	0	100	0.2	0.187177646	63.82907528	250	0.2	0.2	0	0.2	25	0	24.91537177	25	25	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	258.1021086	0	95.09025052	0	90.56214336	0.181124287	0.169512088	57.80497866	226.4053584	0.181124287	0.181124287	0	0.181124287	22.64053584	0	22.58192431	22.64053584	22.64053584	0.183174233	0.181127647	0.181124287	0	0	0	0	0	0	0	0	0												23.8255	0	0.91916931	0	1.681265272	0.675333664	0.11384033	2.116791549	5.089747442	0.179862782	1.036329607	0	0.013573975	0.002124729	0	2.605012949	0.002314612	0.411523579	0.035532411	0.765609256	0.687639887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1611	0	NO	4.182607521	23.8255	0	0.91916931	0	1.681265272	0.675333664	0.11384033	2.116791549	5.089747442	0.179862782	1.036329607	0	0.013573975	0.002124729	0	2.605012949	0.002314612	0.411523579	0.035532411	0.765609256	0.687639887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1611	NO																																										0	0	0	0	0	0	0	0	0	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	23.8255	0	0.91916931	0	1.681265272	0.675333664	0.11384033	2.116791549	5.089747442	0.179862782	1.036329607	0	0.013573975	0.002124729	0	2.605012949	0.002314612	0.411523579	0.035532411	0.765609256	0.687639887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1611
H3706_009_0	2012	2																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V		V	V	V	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	644.1698662	0	59.97401331	0	175.0156445	2.000225087	0.552157405	273.6122507	166.0680514	0.596544467	3.87692703	0	0.027003222	0.405016952	0	844.9407939	2.900731162	134.468728	0.596852534	2.896622804	2.38559335	0	0	0	0	0	0	0	0	0											3000	$250/Days 1 - 6 for IP Med/Surg; PBP 1a	$250/Days 1 - 6 for IP MH/SA; 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 Prosth/Supplies; 0%-20% Coinsurance for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for Worldwide OP ER (non-cvd); $25/Visit for Urgent Care; PBP 4a, 4b"	"$250/Visit for OP Surg; $250/Visit for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for Cardiac & Pulmonary Rehab; $25/Visit for Rehab Services (CORF); $25/Visit for OP SA; PBP 3, 7i, 9a, 9c"	"No Cost Sharing; PBP 7a, 13d, 14a, 14b"	"$20/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, 13d, 14a, 14b, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - Other; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	No Cost Sharing 13d											0	NO	250	0	105	0	100	0.2	0.193147583	63.54468689	250	0.2	0.2	0	0.2	25	0	24.9195608	25	25	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	242.3539261	0	101.788649	0	96.94157043	0.193883141	0.1872403	61.6012174	242.3539261	0.193883141	0.193883141	0	0.193883141	24.23539261	0	24.16337854	24.23539261	24.23539261	0.194412518	0.193883737	0.193883141	0	0	0	0	0	0	0	0	0												13.0098	0	0.508722816	0	1.413857619	0.387809922	0.103386118	1.404570645	3.353937021	0.115659915	0.75167079	0	0.005235469	0.000817979	0	1.701385354	0.005858363	0.271575201	0.116035604	0.561608055	0.462526332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1744	0	NO	0.761922639	13.0098	0	0.508722816	0	1.413857619	0.387809922	0.103386118	1.404570645	3.353937021	0.115659915	0.75167079	0	0.005235469	0.000817979	0	1.701385354	0.005858363	0.271575201	0.116035604	0.561608055	0.462526332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1744	NO																																										0	0	0	0	0	0	0	0	0	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	13.0098	0	0.508722816	0	1.413857619	0.387809922	0.103386118	1.404570645	3.353937021	0.115659915	0.75167079	0	0.005235469	0.000817979	0	1.701385354	0.005858363	0.271575201	0.116035604	0.561608055	0.462526332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1744
H3706_017_0	2012	3																															A	A			T	Coin	Coin	V	V	Coin	Coin		Coin	V		V	V	V	Coin	Coin	Coin			P	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	568.9801286	0	0	0	230.2894331	4.040563691	2.739687409	507.4869098	298.6588802	1.205967335	5.750871723	0	0.030279937	0.45501997	0	1891.07497	2.998213603	317.3682038	1.26074379	4.428381961	4.692915719	0	0	53.98998887	9.722659851	28.28886077	0	0	0	0											2500	$150/Admit for IP Med/Surg; PBP 1a	$150/Admit for IP MH/SA; 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 Prosth/Supplies; 0%-20% Coinsurance for DMS; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for Worldwide OP ER (non-cvd); $15/Visit for Urgent Care; PBP 4a, 4b"	"$200/Visit for OP Surg; $150/Visit for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Visit for Cardiac & Pulmonary Rehab; $25/Visit for Rehab Services (CORF); $15/Visit for OP SA; $15/Visit for OP PT/OT/ST; PBP 3, 7i, 9a, 9c"	"No Cost Sharing; PBP 7a, 13d, 14a, 14b"	"$20/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $10/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 13d, 14a, 14b, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"20% Coinsurance for SCP - Other; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"$15/Service for Preventive Dental (non-cvd); PBP 16a, 16b"	$10/Visit for Routine Eye Exams (non-cvd); PBP 17a	$20/Service for Glasses/Contacts (non-cvd); PBP 17b	PBP 18a	PBP 18b	PBP 14c	13(d) $0											0	NO	150	0	0	0	50	0.1	0.1	62.65261397	178.227857	0.2	0.2	0	0.2	15	0	14.55497771	15	15	0.2	0.2	0.2	0	0	15	10	20	0	0	0	0											NO	145.8367129	0	0	0	48.61223763	0.097224475	0.097224475	60.91367517	173.2810987	0.194448951	0.194448951	0	0.194448951	14.58367129	0	14.15426423	14.58367129	14.58367129	0.1949123	0.194449505	0.194448951	0	0	14.58367129	9.722447527	19.44489505	0	0	0	0												6.9148	0	0	0	0.932907054	0.392841685	0.266364671	2.576074398	4.312661576	0.234499083	1.118250971	0	0.005887902	0.000552988	0	2.230564567	0.003643747	0.385699464	0.245734472	0.861096682	0.912532536	0	0	0.065614354	0.007877338	0.045839494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5135	0	NO	0.613026068	6.9148	0	0	0	0.932907054	0.392841685	0.266364671	2.576074398	4.312661576	0.234499083	1.118250971	0	0.005887902	0.000552988	0	2.230564567	0.003643747	0.385699464	0.245734472	0.861096682	0.912532536	0	0	0.065614354	0.007877338	0.045839494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.9148	0	0	0	0.932907054	0.392841685	0.266364671	2.576074398	4.312661576	0.234499083	1.118250971	0	0.005887902	0.000552988	0	2.230564567	0.003643747	0.385699464	0.245734472	0.861096682	0.912532536	0	0	0.065614354	0.007877338	0.045839494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5135
H3706_803_0	2012	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	283.1974291	0	7.934666838	0	7.214627477	11.54222639	4.778838546	12.7716713	57.40665695	2.413393665	16.52457435	0	0.107150612	6.253808913	45.07418939	53.80822091	5.340335084	5.790899798	16.77930534	69.35022647	33.75755234	0.152044637	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; PBP6	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	No Cost Sharing; PBP 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.081469853	0	0.186645132	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.076155024	0	0.17446901	0	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0	0.209386968	0.209386968	0.210264575	0.209559072	0.209386968	0.209386968	0.211237639	0.209387619	0.209386968	0.209691553	0	0	0	0	0	0	0	0												21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	0	NO	6.622705365	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	NO																																										0	0	0	0	0	0	0	0	0	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	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121
H3706_804_0	2012	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	283.1974291	0	7.934666838	0	7.214627477	11.54222639	4.778838546	12.7716713	57.40665695	2.413393665	16.52457435	0	0.107150612	6.253808913	45.07418939	53.80822091	5.340335084	5.790899798	16.77930534	69.35022647	33.75755234	0.152044637	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; PBP6	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	No Cost Sharing; PBP 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.081469853	0	0.186645132	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.076155024	0	0.17446901	0	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0	0.209386968	0.209386968	0.210264575	0.209559072	0.209386968	0.209386968	0.211237639	0.209387619	0.209386968	0.209691553	0	0	0	0	0	0	0	0												21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	0	NO	6.622705365	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	NO																																										0	0	0	0	0	0	0	0	0	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	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121
H3706_807_0	2012	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	283.1974291	0	7.934666838	0	7.214627477	11.54222639	4.778838546	12.7716713	57.40665695	2.413393665	16.52457435	0	0.107150612	6.253808913	45.07418939	53.80822091	5.340335084	5.790899798	16.77930534	69.35022647	33.75755234	0.152044637	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; PBP6	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	No Cost Sharing; PBP 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.081469853	0	0.186645132	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.076155024	0	0.17446901	0	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0.209386968	0	0.209386968	0.209386968	0.210264575	0.209559072	0.209386968	0.209386968	0.211237639	0.209387619	0.209386968	0.209691553	0	0	0	0	0	0	0	0												21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	0	NO	6.622705365	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121	NO																																										0	0	0	0	0	0	0	0	0	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	21.5669	0	1.384353466	0	1.510648972	2.416791786	1.000626513	2.674221527	12.02020583	0.505333182	3.460030518	0	0.022435942	1.309466086	9.477505258	11.27600086	1.11819657	1.21253895	3.544420842	14.52107879	7.068391527	0.031882476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.121
H3708_001_0	2012	4																															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	YES	642.3572967	35.3010496	462.5213216		72.72275578	50.01117905	19.27572477	42.56533446	23.65487439	59.33271934	61.70521967	5.04E-05	2.975322639	29.8038901	8.724129114	249.4087387	43.43821269	110.0092053		12.21006986	31.38182977	10.31499222																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.083860953	0.084069317	0.184370544		0.223644812	0.220474048	0.224681503	0.223278567	0.223991881	0.222134879	0.222483769	0.225534333	0.225534333	0.223633606	0.224896489	0.224107621	0.222482144	0.225524022		0.22502739	0.224277089	0.224873691																			NO	0.083984641	0.083984641	0.183569571		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																				53.9481	2.964745992	84.90484047	0	16.28989729	11.20250411	4.317762348	9.53463492	5.298691864	13.29052913	13.82196921	1.13E-05	0.666472271	6.676071382	1.954204922	55.86755748	9.730159642	24.64206199	0	2.735055648	7.029529868	2.310558258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	327.1854	0		0	53.9481	2.964745992	84.90484047	0	16.28989729	11.20250411	4.317762348	9.53463492	5.298691864	13.29052913	13.82196921	1.13E-05	0.666472271	6.676071382	1.954204922	55.86755748	9.730159642	24.64206199	0	2.735055648	7.029529868	2.310558258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	327.1854	NO																																																																																		0	0		0	53.9481	2.964745992	84.90484047	0	16.28989729	11.20250411	4.317762348	9.53463492	5.298691864	13.29052913	13.82196921	1.13E-05	0.666472271	6.676071382	1.954204922	55.86755748	9.730159642	24.64206199	0	2.735055648	7.029529868	2.310558258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	327.1854
H3749_001_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1277.517601	3.172406321	693.3685499	469.4836055	195.3071978	14.28286804	10.22721133	419.9005367	362.9465096	20.31841665	41.91163817	0	0.207684794	1117.693845	6444.613288	4959.101619	0.481241171	1080.843375	0	0	17.57331186	676.9495996	0	0	43.42477268	220.4836534	0	2.376354103	180.1230851	0											4900	"$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 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	146.3610835	89.92354543	71.56091979	0	200	0.2	0.097702467	64.98816153	92.25	0.204494519	0.1782362	0	0.2	78.00984547	6.102117937	33.52768787	38.5	35	0	0	0.2	31.41436931	0	0	35	30	0	0	0	0											NO	121.8471003	74.86227205	59.57519825	0	166.5020473	0.166502047	0.081338304	54.11757731	76.7990693	0.17024378	0.148383461	0	0.166502047	64.94399489	5.932795819	32.59739427	37.43169854	34.02881685	0	0	0.166502047	26.15278402	0	0	35	30	0	0	0	0												12.9718	0.019791129	3.442297402	0	2.70992069	2.378126769	0.831864025	1.893666646	2.322829512	3.459084054	6.218993935	0	0.034579943	6.048958611	3.186214564	13.47114923	0.00150114	3.064985104	0	0	2.925992401	1.475343056	0	0	0.126655587	0.551209133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.135	0	NO	9.964403274	12.9718	0.019791129	3.442297402	0	2.70992069	2.378126769	0.831864025	1.893666646	2.322829512	3.459084054	6.218993935	0	0.034579943	6.048958611	3.186214564	13.47114923	0.00150114	3.064985104	0	0	2.925992401	1.475343056	0	0	0.126655587	0.551209133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.135	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	NO	0	12.9718	0.019791129	3.442297402	0	2.70992069	2.378126769	0.831864025	1.893666646	2.322829512	3.459084054	6.218993935	0	0.034579943	6.048958611	3.186214564	13.47114923	0.00150114	3.064985104	0	0	2.925992401	1.475343056	0	0	0.126655587	0.551209133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.135
H3749_004_0	2012	7																															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	1696.201874	6.717838988	1252.338242	995.1235542	335.2014398	17.18430434	11.10204161	390.5432087	74.47757066	22.60636213	52.76624694	0	0.116532932	36.35927504	6486.551167	5753.714344	0	1238.869118	0	0	22.20568658	763.8163869	0	501.6	48.37560872	192.4392237	7.087411242	2.376354103	114.4548846	0											4900	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-6 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	101.7427073	68.03238782	0	200	0.2	0.082048229	64.9937265	0.16	0.194606024	0.17850799	0	0.2	0.145002284	9.591872427	29.12613964	0	30	0	0	0.2	26.86408151	0	25	30	30	0	0	0	0											NO	129.0668576	77.97564954	52.1400479	0	153.2800761	0.153280076	0.062881794	49.83225034	0.122624061	0.149146131	0.136808591	0	0.153280076	0.111129806	9.210226957	27.97064221	0	28.80634733	0	0	0.153280076	20.58864229	0	25	30	30	0	0	0	0												18.2436	0.043652322	5.441414659	0	4.281641849	2.634011476	0.698116293	1.621803912	9.132742157	3.37165145	7.218875907	0	0.017862177	4.040599177	4.978550701	13.41125711	0	2.973941177	0	0	3.403689327	1.310495197	0	1.045	0.120939022	0.481098059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.471	0	NO	19.61579345	18.2436	0.043652322	5.441414659	0	4.281641849	2.634011476	0.698116293	1.621803912	9.132742157	3.37165145	7.218875907	0	0.017862177	4.040599177	4.978550701	13.41125711	0	2.973941177	0	0	3.403689327	1.310495197	0	1.045	0.120939022	0.481098059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.471	NO																																										0	0	0	0	0	0	0	0	0	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	18.2436	0.043652322	5.441414659	0	4.281641849	2.634011476	0.698116293	1.621803912	9.132742157	3.37165145	7.218875907	0	0.017862177	4.040599177	4.978550701	13.41125711	0	2.973941177	0	0	3.403689327	1.310495197	0	1.045	0.120939022	0.481098059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.471
H3749_017_0	2012	7																															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	1082.592982	0	613.2213117	798.3142968	192.1730751	12.4776016	8.620940094	326.116231	53.61323368	18.2576428	37.74344134	0	0.080219331	29.13707685	5398.489897	4122.029349	0	783.5392138	0	0	14.25490774	540.2092776	0	0	42.05429309	181.9433245	6.764964375	2.376354103	113.7205333	0											6700	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	0	73.35949	0	200	0.2	0.096984004	64.99493948	0.16	0.191579316	0.178959453	0	0.2	0.14487953	12.46922898	33.76601134	0	35	0	0	0.2	31.07485703	0	0	35	30	0	0	0	0											NO	171.6082302	0	65.60384623	0	178.855786	0.178855786	0.086730752	58.13468684	0.143084629	0.171325346	0.160039668	0	0.178855786	0.129562711	12.25970147	33.19944776	0	34.41187518	0	0	0.178855786	27.7895899	0	0	35	30	0	0	0	0												15.4818	0	3.352473053	0	2.8642722	2.231691242	0.747700614	1.579888747	7.671229641	3.127996962	6.040447834	0	0.014347692	3.775078666	5.515322876	11.4040915	0	2.246921135	0	0	2.549572729	1.25101619	0	0	0.122658355	0.454858311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4314	0	NO	6.31918933	15.4818	0	3.352473053	0	2.8642722	2.231691242	0.747700614	1.579888747	7.671229641	3.127996962	6.040447834	0	0.014347692	3.775078666	5.515322876	11.4040915	0	2.246921135	0	0	2.549572729	1.25101619	0	0	0.122658355	0.454858311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4314	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.4818	0	3.352473053	0	2.8642722	2.231691242	0.747700614	1.579888747	7.671229641	3.127996962	6.040447834	0	0.014347692	3.775078666	5.515322876	11.4040915	0	2.246921135	0	0	2.549572729	1.25101619	0	0	0.122658355	0.454858311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4314
H3749_801_0	2012	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	279.7070108	7.0186	31.27589863	1139.851767	12.05874135	18.3850912	10.63788802	18.52541898	83.69715894	26.13001286	60.63711835	0	0.307422659	37.95090768	35.56517847	101.0374814	3.2449	9.272401761	0	0	35.31305741	8.723022471	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.086133064	0.086133064	0.186248062	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067639874	0.067639874	0.146259692	0	0.175906104	0.175906104	0.175906104	0.175906104	0.175906104	0.175906104	0.175906104	0	0.175906104	0.175906104	0.175906104	0.175906104	0.175906104	0.175906104	0	0	0.175906104	0.175906104	0	0	0	0	0	0	0	0												18.9193	0.474737217	4.574403294	0	2.121206205	3.234049757	1.871269432	3.258734271	14.72284111	4.59642875	10.66643922	0	0.054077522	6.675796298	6.256131969	17.77310966	0.570797716	1.631072065	0	0	6.211782335	1.534432895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1467	150	YES	28.74779388	18.9193	0.474737217	4.574403294	0	2.121206205	3.234049757	1.871269432	3.258734271	14.72284111	4.59642875	10.66643922	0	0.054077522	6.675796298	6.256131969	17.77310966	0.570797716	1.631072065	0	0	6.211782335	1.534432895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1467	NO																																										0	0	0	0	0	0	0	0	0	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	18.9193	0.474737217	4.574403294	0	2.121206205	3.234049757	1.871269432	3.258734271	14.72284111	4.59642875	10.66643922	0	0.054077522	6.675796298	6.256131969	17.77310966	0.570797716	1.631072065	0	0	6.211782335	1.534432895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1467
H3749_803_0	2012	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	235.8311221	7.0119	32.86109699	553.7488102	9.987225943	17.22744707	11.20588802	16.39405203	72.92284067	23.43654139	47.85696578	0	0.191345518	34.02266195	33.98677741	87.79482109	3.2737	8.943451342	0	0	20.3550756	7.309840572	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081621496	0.081621496	0.186756373	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066934796	0.066934796	0.153152055	0	0.183694188	0.183694188	0.183694188	0.183694188	0.183694188	0.183694188	0.183694188	0	0.183694188	0.183694188	0.183694188	0.183694188	0.183694188	0.183694188	0	0	0.183694188	0.183694188	0	0	0	0	0	0	0	0												15.7853	0.469340099	5.032744526	0	1.834595357	3.164581895	2.058456498	3.011492071	13.39550198	4.305156433	8.791046454	0	0.035149059	6.24976525	6.243173468	16.12739834	0.601359662	1.64286003	0	0	3.739109077	1.342775226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8298	150	YES	20.58795056	15.7853	0.469340099	5.032744526	0	1.834595357	3.164581895	2.058456498	3.011492071	13.39550198	4.305156433	8.791046454	0	0.035149059	6.24976525	6.243173468	16.12739834	0.601359662	1.64286003	0	0	3.739109077	1.342775226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8298	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.7853	0.469340099	5.032744526	0	1.834595357	3.164581895	2.058456498	3.011492071	13.39550198	4.305156433	8.791046454	0	0.035149059	6.24976525	6.243173468	16.12739834	0.601359662	1.64286003	0	0	3.739109077	1.342775226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8298
H3749_804_0	2012	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	235.4987789	7.0241	32.81478774	551.8701694	9.921488321	17.11405308	11.13212896	16.36188064	72.7797382	23.39054994	47.76305213	0	0.190970025	33.95553378	33.76307065	87.21694063	3.2739	8.884584023	0	0	20.22109502	7.261725956	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.083537049	0.083537049	0.186235194	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06849947	0.06849947	0.15271083	0	0.183677559	0.183677559	0.183677559	0.183677559	0.183677559	0.183677559	0.183677559	0	0.183677559	0.183677559	0.183677559	0.183677559	0.183677559	0.183677559	0	0	0.183677559	0.183677559	0	0	0	0	0	0	0	0												16.1315	0.48114713	5.011173474	0	1.82235476	3.143467501	2.044722278	3.005310303	13.36800469	4.296319127	8.773000845	0	0.035076908	6.236869572	6.201518415	16.01979479	0.601341962	1.63189871	0	0	3.714161382	1.333816101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8515	150	YES	20.60307386	16.1315	0.48114713	5.011173474	0	1.82235476	3.143467501	2.044722278	3.005310303	13.36800469	4.296319127	8.773000845	0	0.035076908	6.236869572	6.201518415	16.01979479	0.601341962	1.63189871	0	0	3.714161382	1.333816101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8515	NO																																										0	0	0	0	0	0	0	0	0	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	16.1315	0.48114713	5.011173474	0	1.82235476	3.143467501	2.044722278	3.005310303	13.36800469	4.296319127	8.773000845	0	0.035076908	6.236869572	6.201518415	16.01979479	0.601341962	1.63189871	0	0	3.714161382	1.333816101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8515
H3755_001_0	2012	9																															D	D	D		T	O		V	V		V	V		V	V	V	V	V	P		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	760.1260552	26.31744998	227.4106439	0	106.5417152	51.15442757	0	308.8987453	380.601937	0	300.1510395	0.053387886	0	23.74075184	3652.443716	3703.038697	120.3731034	513.2897891	40.29790746	0	30.30650652	0	0	0	2.985577972	123.678396	0.071031942	0	0	0											3400	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP Med/Surg; PBP 1b	$100/Days 21-100 for IP Med/Surg; PBP 2	No Cost Sharing; PBP 6	$100/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; $40/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	$0/Case for OP Rad - General; $225/Case for OP Rad - PET/CAT/MRI/Other; PBP 8b	$50/Visit for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$225/Visit for OP Hosp; $30/Case for PT/OT/ST; $0/Case for OP Other; $40/Visit for OP Substance Abuse - Individual; $30/Visit for OP Substance Abuse - Group; PBP 3, 7i, 9a, 9c"	"$30/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $45/Visit for SCP OV; $45/Visit for SCP - Office Surg; $45/Visit for Podiatry; $45/Visit for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$0/Case for OP Rad - General; $225/Case for OP Rad - PET/CAT/MRI/Other; PBP 7d, 8b, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drug; 0% Coinsurance for Chemotherapy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14c, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$45/Exam for Routine Eye Exams (non-cvd); PBP 17a	$45/Service for Glasses/Contacts (non-cvd); PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	300	300	100	0	100	38	0	47.79396374	225	0	225	42.58894324	0	36.27929535	30	44.59434619	30	30	225	0	0.2	0	0	0	45	45	30	0	0	0											NO	272.1188057	272.1188057	90.70626857	0	90.70626857	34.46838206	0	43.35212111	204.0891043	0	204.0891043	38.63084123	0	32.90759508	27.21188057	40.44986742	27.21188057	27.21188057	204.0891043	0	0.181412537	0	0	0	40.81782086	40.81782086	27.21188057	0	0	0												17.237	0.596789421	1.718964245	0	0.805333453	0.146934196	0	1.115951318	6.473059035	0	5.104796399	0.000171868	0	0.065104254	8.282488517	12.48228536	0.272964876	1.163965037	0.685363653	0	5.497980239	0	0	0	0.010155399	0.420690218	0.000161076	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0802	0	NO	6.360715641	17.237	0.596789421	1.718964245	0	0.805333453	0.146934196	0	1.115951318	6.473059035	0	5.104796399	0.000171868	0	0.065104254	8.282488517	12.48228536	0.272964876	1.163965037	0.685363653	0	5.497980239	0	0	0	0.010155399	0.420690218	0.000161076	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0802	NO																																										0	0	0	0	0	0	0	0	0	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	17.237	0.596789421	1.718964245	0	0.805333453	0.146934196	0	1.115951318	6.473059035	0	5.104796399	0.000171868	0	0.065104254	8.282488517	12.48228536	0.272964876	1.163965037	0.685363653	0	5.497980239	0	0	0	0.010155399	0.420690218	0.000161076	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0802
H3755_002_0	2012	6																															D	D	D		T	O		V	V		V			V	V	V	V	V	P		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	683.3163137	17.36090933	258.7673199	0	90.96194968	37.34209828	0	280.9124787	362.9841584	0	274.0032002	0	0	18.36216107	2969.528871	3553.860399	41.13789742	582.920861	38.89125743	0	18.4763629	0	0	0	3.426814754	120.2983964	0	0	0	0											3400	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP Med/Surg; PBP 1b	$50/Days 21-100 for IP Med/Surg; 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"	"$125/Case for OP Surg; $125/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$0/Case for OP Rad - General; $125/Case for OP Rad - PET/CAT/MRI/Other; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$125/Visit for OP Hosp; $25/Case for PT/OT/ST; $0/Case for OP Other; $35/Visit for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$20/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $35/Visit for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$0/Case for OP Rad - General; $125/Case for OP Rad - PET/CAT/MRI/Other; PBP 7d, 8b, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drug; 0% Coinsurance for Chemotherapy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14c, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$35/Service for Glasses/Contacts (non-cvd); PBP 17b	$20/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	200	200	50	0	50	41	0	44.78425501	125	0	125	0	0	35	20	34.43751741	30	25	125	0	0.2	0	0	0	35	35	0	0	0	0											NO	191.4468362	191.4468362	47.86170905	0	47.86170905	39.24660142	0	42.86901967	119.6542726	0	119.6542726	0	0	33.50319634	19.14468362	32.96476878	28.71702543	23.93085453	119.6542726	0	0.191446836	0	0	0	33.50319634	33.50319634	0	0	0	0												10.9016	0.276974264	1.032087181	0	0.362799531	0.122129204	0	1.003536881	3.619383788	0	2.732137801	0	0	0.051265924	4.737557561	9.762682192	0.098446504	1.16248286	0.387792093	0	3.537241221	0	0	0	0.009567437	0.335865066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1335	0	NO	1.793022574	10.9016	0.276974264	1.032087181	0	0.362799531	0.122129204	0	1.003536881	3.619383788	0	2.732137801	0	0	0.051265924	4.737557561	9.762682192	0.098446504	1.16248286	0.387792093	0	3.537241221	0	0	0	0.009567437	0.335865066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1335	NO																																										0	0	0	0	0	0	0	0	0	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	10.9016	0.276974264	1.032087181	0	0.362799531	0.122129204	0	1.003536881	3.619383788	0	2.732137801	0	0	0.051265924	4.737557561	9.762682192	0.098446504	1.16248286	0.387792093	0	3.537241221	0	0	0	0.009567437	0.335865066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1335
H3755_004_0	2012	9																															D	D	D		T	O		V	V		V			V	V	V	V	V	P		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	891.4138187	17.4908412	332.1150035	0	112.0605029	49.57027712	0	342.7636884	499.8632504	0	406.1412773	0	0	27.07738353	4297.439773	4868.415768	150.598505	757.0036311	54.02049877	0	46.7205588	0	0	0	4.607174466	135.8192291	0.281351331	0	0	0											3400	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP Med/Surg; PBP 1b	$50/Days 21-100 for IP Med/Surg; 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"	"$55/Visit for OP ER; $55/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"	No Cost Sharing; PBP 8a	$0/Case for OP Rad - General; $125/Case for OP Rad - PET/CAT/MRI/Other; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$125/Visit for OP Hosp; $25/Case for PT/OT/ST; $0/Case for OP Other; $35/Visit for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$20/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $35/Visit for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$0/Case for OP Rad - General; $125/Case for OP Rad - PET/CAT/MRI/Other; PBP 7d, 8b, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drug; 0% Coinsurance for Chemotherapy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14c, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$35/Service for Glasses/Contacts (non-cvd); PBP 17b	$20/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	200	200	50	0	50	41	0	49.2767836	125	0	125	0	0	35	20	34.5600167	30	25	125	0	0.2	0	0	0	35	35	20	0	0	0											NO	183.8414064	183.8414064	45.9603516	0	45.9603516	37.68748831	0	45.295566	114.900879	0	114.900879	0	0	32.17224612	18.38414064	31.76781038	27.57621096	22.9801758	114.900879	0	0.183841406	0	0	0	32.17224612	32.17224612	18.38414064	0	0	0												13.6566	0.267961737	1.272010195	0	0.429195009	0.155681603	0	1.293806273	4.786227238	0	3.88883248	0	0	0.072595021	6.583728099	12.88824241	0.346078012	1.449673044	0.517250233	0	8.589173239	0	0	0	0.012351929	0.364134139	0.000431034	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5739	0	NO	4.972520909	13.6566	0.267961737	1.272010195	0	0.429195009	0.155681603	0	1.293806273	4.786227238	0	3.88883248	0	0	0.072595021	6.583728099	12.88824241	0.346078012	1.449673044	0.517250233	0	8.589173239	0	0	0	0.012351929	0.364134139	0.000431034	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5739	NO																																										0	0	0	0	0	0	0	0	0	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	13.6566	0.267961737	1.272010195	0	0.429195009	0.155681603	0	1.293806273	4.786227238	0	3.88883248	0	0	0.072595021	6.583728099	12.88824241	0.346078012	1.449673044	0.517250233	0	8.589173239	0	0	0	0.012351929	0.364134139	0.000431034	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5739
H3755_801_0	2012	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	205.6083983	3.140219153	15.43833776	0	7.481091335	12.80862266	4.147036544	11.05983632	86.29193803	1.108121532	30.93147532	0.003915594	0.018375386	9.276472615	39.44998604	53.47237467	0.913238463	7.143905373	15.8493906	73.42485527	65.79360981	0.960871242	0	0	0	0	0	0	0	0											6700	9% Coinsurance for IP Med/Surg; PBP 1a	9% Coinsurance for IP MH/SA; PBP 1b	19% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for Prosth/Supplies; 22% Coinsurance for DMS; PBP 11b, 11c"	"22% Coinsurance for OP ER; 22% Coinsurance for Urgent Care; PBP 4a, 4b"	"22% Coinsurance for OP Surg; 22% Coinsurance for ASC services; PBP 9a, 9b"	22% Coinsurance for OP Lab; PBP 8a	22% Coinsurance for OP Rad - General; 22% Coinsurance for OP Rad - Complex Diagnostic; 22% Coinsurance for OP Rad - X-Ray; 22% Coinsurance for OP Rad - Therapeutic; PBP 8b	22% Coinsurance for Partial Hosp; PBP 5	22% Coinsurance for Renal Dialysis; PBP 12	"22% Coinsurance for Cardiac Rehab; 22% Coinsurance for Pulmonary Rehabilitation Services; 22% Coinsurance for OP - Preventive; 22% Coinsurance for OP - Other; 22% Coinsurance for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"22% Coinsurance for PCP OV; 22% Coinsurance for PCP - Facility Visit; 22% Coinsurance for Immunizations; 22% Coinsurance for Physical Exams (Initial); 22% Coinsurance for Routine Exams; PBP 7a, 14a, 14b"	"22% Coinsurance for Chiro (cvd); 22% Coinsurance for SCP OV; 22% Coinsurance for SCP - Facility Visit; 22% Coinsurance for SCP - Office Surg; 22% Coinsurance for Podiatry; 22% Coinsurance for Pap Smears and Pelvic Exams Screening; 22% Coinsurance for Prostate Cancer Screening; 22% Coinsurance for Colorectal Screening; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"22% Coinsurance for MH - Non Phys; 22% Coinsurance for Psych Services ; PBP 7e, 7h"	"22% Coinsurance for OP PT/OT/ST; 22% Coinsurance for PT/ST; PBP 7c, 7i"	"22% Coinsurance for Phys Rad - General; 22% Coinsurance for Phys Rad - Complex Diagnostic; 22% Coinsurance for Phys Rad - X-Ray; 22% Coinsurance for Phys Rad - Theraputic; 22% Coinsurance for Bone Mass Measurement; 22% Coinsurance for Mammography Screening; PBP 7d, 8b, 14a, 14b"	"22% Coinsurance for SCP - IP/OP Surg; 22% Coinsurance for SCP - Other; 22% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 22% Coinsurance for Diabetes Monitoring; PBP 7d, 14a, 14e"	22% Coinsurance for Part B Drugs - Gen; 22% Coinsurance for Part B Drugs - Chemo; 22% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"22% Coinsurance for Blood; 22% Coinsurance for Health Education/Wellness Programs; PBP 9d, 14a, 14c, 14d"	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 14c	No Cost Sharing; PBP 13a-e											0	NO	0.087309706	0.087309706	0.186192899	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080357335	0.080357335	0.171366574	0	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0.206163139	0	0	0	0	0	0	0	0												16.5221	0.252339642	2.645615043	0	1.542325271	2.64066585	0.85496607	2.28013057	17.79021679	0.228453813	6.376930036	0.000807251	0.003788327	1.912466711	8.133132944	11.0240326	0.188276108	1.472809954	3.267560113	15.13749862	13.56421711	0.198096231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0365	0	NO	9.174083469	16.5221	0.252339642	2.645615043	0	1.542325271	2.64066585	0.85496607	2.28013057	17.79021679	0.228453813	6.376930036	0.000807251	0.003788327	1.912466711	8.133132944	11.0240326	0.188276108	1.472809954	3.267560113	15.13749862	13.56421711	0.198096231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0365	NO																																										0	0	0	0	0	0	0	0	0	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	16.5221	0.252339642	2.645615043	0	1.542325271	2.64066585	0.85496607	2.28013057	17.79021679	0.228453813	6.376930036	0.000807251	0.003788327	1.912466711	8.133132944	11.0240326	0.188276108	1.472809954	3.267560113	15.13749862	13.56421711	0.198096231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0365
H3805_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1321.69058	11.5283053	1578.573289	679.1732364	424.8344821	12.74844986	8.630390802	427.0817589	189.2383804	35.97581418	50.77850479	0	0.571238754	1614.527534	9196.503761	6460.510687	4.392664089	1122.733069	0	0	25.09970189	1046.081753	0	0	83.11945739	427.4219773	0	5.144888831	84.04993415	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $14 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	57.61860678	0	200	0.2	0.094700555	65	92.25	0.16061538	0.17456885	0	0.2	77.68931896	9.141911121	29.77503355	38.5	30	0	0	0.2	28.26409377	0	0	30	30	0	352.5	0	0											NO	144.2228047	77.01021466	44.4099388	0	154.1513802	0.15415138	0.072991106	50.11861772	71.10232412	0.123795413	0.134550146	0	0.15415138	59.87957872	8.968929	29.21320404	37.77150772	29.43234368	0	0	0.15415138	21.78474532	0	0	30	30	0	352.5	0	0												15.8848	0.073983106	5.842028596	0	5.457401814	1.965191141	0.629941773	1.783728951	1.121274055	4.453640761	6.832255213	0	0.088057242	8.056435715	6.873565774	15.72768474	0.013826462	2.75372213	0	0	3.869153688	1.899052047	0	0	0.207798643	1.068554943	0	0.151131109	0	0	0	0	0	0	0	0	0	0	0	0	84.7533	0	NO	17.72543202	15.8848	0.073983106	5.842028596	0	5.457401814	1.965191141	0.629941773	1.783728951	1.121274055	4.453640761	6.832255213	0	0.088057242	8.056435715	6.873565774	15.72768474	0.013826462	2.75372213	0	0	3.869153688	1.899052047	0	0	0.207798643	1.068554943	0	0.151131109	0	0	0	0	0	0	0	0	0	0	0	0	84.7533	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.8848	0.073983106	5.842028596	0	5.457401814	1.965191141	0.629941773	1.783728951	1.121274055	4.453640761	6.832255213	0	0.088057242	8.056435715	6.873565774	15.72768474	0.013826462	2.75372213	0	0	3.869153688	1.899052047	0	0	0.207798643	1.068554943	0	0.151131109	0	0	0	0	0	0	0	0	0	0	0	0	84.7533
H3805_007_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	891.3080445	0	910.6556608	256.3391164	217.219153	10.39469842	8.11052674	354.1176503	153.0461442	27.99518371	39.88536728	0	0.000452341	1388.528658	7204.448233	5136.033135	2.176993021	1045.113123	0	0	14.36152847	627.3293045	0	0	80.67743888	341.8166011	0	5.571471794	84.02532242	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 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $14 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	145.9523587	0	59.07621842	0	200	0.2	0.080876056	64.97396723	71.75	0.148966963	0.172838413	0	0.2	60.1644093	9.226071728	29.65874947	38.5	30	0	0	0.2	27.70788401	0	0	30	30	0	352.5	0	0											NO	133.130732	0	53.88648921	0	182.4303947	0.182430395	0.073771254	59.27490716	65.44690409	0.135880509	0.157654899	0	0.182430395	54.87908467	9.172535151	29.48710558	38.27659417	29.82591754	0	0	0.182430395	25.27380108	0	0	30	30	0	352.5	0	0												9.8884	0	4.08933637	0	3.302281318	1.896308935	0.598323727	1.749190904	0.834699693	3.803999822	6.28812356	0	8.25E-05	6.350098481	5.506921222	12.62056261	0.00694399	2.597621485	0	0	2.619979307	1.321249671	0	0	0.201693597	0.854541503	0	0.163661984	0	0	0	0	0	0	0	0	0	0	0	0	64.694	0	NO	4.23694821	9.8884	0	4.08933637	0	3.302281318	1.896308935	0.598323727	1.749190904	0.834699693	3.803999822	6.28812356	0	8.25E-05	6.350098481	5.506921222	12.62056261	0.00694399	2.597621485	0	0	2.619979307	1.321249671	0	0	0.201693597	0.854541503	0	0.163661984	0	0	0	0	0	0	0	0	0	0	0	0	64.694	NO																																										0	0	0	0	0	0	0	0	0	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	9.8884	0	4.08933637	0	3.302281318	1.896308935	0.598323727	1.749190904	0.834699693	3.803999822	6.28812356	0	8.25E-05	6.350098481	5.506921222	12.62056261	0.00694399	2.597621485	0	0	2.619979307	1.321249671	0	0	0.201693597	0.854541503	0	0.163661984	0	0	0	0	0	0	0	0	0	0	0	0	64.694
H3805_801_0	2012	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	249.944145	4.252810504	39.77324094	560.0523727	14.3722114	12.52717089	7.609319931	22.51259175	75.26004213	32.11719691	45.42959763	0	0.445689671	36.71638471	45.91488177	100.7537147	1.625346507	7.6922822	0	0	22.93174655	13.0426563	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07968486	0.07968486	0.140840004	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063968292	0.063968292	0.113061559	0	0.179819573	0.179819573	0.179819573	0.179819573	0.179819573	0.179819573	0.179819573	0	0.179819573	0.179819573	0.179819573	0.179819573	0.179819573	0.179819573	0	0	0.179819573	0.179819573	0	0	0	0	0	0	0	0												15.9885	0.272045026	4.496824645	0	2.58440491	2.252630515	1.368304657	4.048204625	13.5332286	5.775300619	8.169130824	0	0.080143726	6.602324602	8.256394413	18.11748991	0.292269114	1.383222897	0	0	4.123576861	2.34532488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6893	150	YES	24.49297791	15.9885	0.272045026	4.496824645	0	2.58440491	2.252630515	1.368304657	4.048204625	13.5332286	5.775300619	8.169130824	0	0.080143726	6.602324602	8.256394413	18.11748991	0.292269114	1.383222897	0	0	4.123576861	2.34532488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6893	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.9885	0.272045026	4.496824645	0	2.58440491	2.252630515	1.368304657	4.048204625	13.5332286	5.775300619	8.169130824	0	0.080143726	6.602324602	8.256394413	18.11748991	0.292269114	1.383222897	0	0	4.123576861	2.34532488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6893
H3805_803_0	2012	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	300.6340611	4.763913654	56.69083511	781.9618698	16.95840995	15.14389056	13.05367378	28.15370594	79.51589929	38.35485501	54.49020617	0	0.524719774	39.89805944	55.1408351	120.9277563	1.792641357	8.556072976	0	0	26.6848331	15.9059142	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080192594	0.080192594	0.138823971	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061046367	0.061046367	0.105679324	0	0.170519317	0.170519317	0.170519317	0.170519317	0.170519317	0.170519317	0.170519317	0	0.170519317	0.170519317	0.170519317	0.170519317	0.170519317	0.170519317	0	0	0.170519317	0.170519317	0	0	0	0	0	0	0	0												18.3526	0.290819623	5.99104915	0	2.891736476	2.582325871	2.225903533	4.800750699	13.55899681	6.540243668	9.291632721	0	0.089474857	6.803389833	9.402577521	20.62051838	0.305679979	1.458975717	0	0	4.550279505	2.712265621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4692	150	YES	35.27419522	18.3526	0.290819623	5.99104915	0	2.891736476	2.582325871	2.225903533	4.800750699	13.55899681	6.540243668	9.291632721	0	0.089474857	6.803389833	9.402577521	20.62051838	0.305679979	1.458975717	0	0	4.550279505	2.712265621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4692	NO																																										0	0	0	0	0	0	0	0	0	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	18.3526	0.290819623	5.99104915	0	2.891736476	2.582325871	2.225903533	4.800750699	13.55899681	6.540243668	9.291632721	0	0.089474857	6.803389833	9.402577521	20.62051838	0.305679979	1.458975717	0	0	4.550279505	2.712265621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4692
H3805_804_0	2012	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	296.3424945	4.742624462	56.34982502	787.1514242	16.91606282	14.99798425	13.13026242	28.6713614	79.80952124	38.08359362	54.35293849	0	0.508347968	40.03436681	54.12049683	118.7065927	1.815827229	8.468004915	0	0	26.50284041	15.45125828	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080930613	0.080930613	0.135808388	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061757539	0.061757539	0.103634355	0	0.170932708	0.170932708	0.170932708	0.170932708	0.170932708	0.170932708	0.170932708	0	0.170932708	0.170932708	0.170932708	0.170932708	0.170932708	0.170932708	0	0	0.170932708	0.170932708	0	0	0	0	0	0	0	0												18.3014	0.292892817	5.83977777	0	2.891508427	2.563646063	2.244391312	4.900873447	13.64205759	6.509731788	9.290694965	0	0.086893295	6.843182732	9.250963082	20.29083935	0.310384266	1.447459012	0	0	4.530202282	2.64112542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.878	150	YES	34.73333412	18.3014	0.292892817	5.83977777	0	2.891508427	2.563646063	2.244391312	4.900873447	13.64205759	6.509731788	9.290694965	0	0.086893295	6.843182732	9.250963082	20.29083935	0.310384266	1.447459012	0	0	4.530202282	2.64112542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.878	NO																																										0	0	0	0	0	0	0	0	0	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	18.3014	0.292892817	5.83977777	0	2.891508427	2.563646063	2.244391312	4.900873447	13.64205759	6.509731788	9.290694965	0	0.086893295	6.843182732	9.250963082	20.29083935	0.310384266	1.447459012	0	0	4.530202282	2.64112542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.878
H3810_001_0	2012	7																															D	D	D		T			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	746.7355453	5.305663502	372.0666726	0	150.1028522	0	0	215.1172197	226.813531	0	114.9025989	0	0	207.8275544	2404.604714	2962.22882	117.3111694	705.8320402	0	3.579838198	30.08892838	0	0	0	2.312777668	0	0	0	0	121.3351868											2000	"1a - Acute (200.00/0.00 per day-1-10/11-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (175.00/0.00 per day-1-10/11-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-27/28-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 150.00 per visit), 9b - Ambulatory Surgical Center Services (min 0.00/ max 50.00 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services ($0 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($20 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($20 per service),3 - Intensive Cardiac Rehabilitation Services ($20 per service),3 - Pulmonary Rehabilitation Services ($20 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($20 per visit),9c - Outpatient Substance Abuse Svcs - Group ($20 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($20 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care ($20 per visit),7d - Physician Specialist Services ($20 per visit),7f - Podiatry Services ($20 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($20 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 20.00 per visit),17a - Routine Eye Exams ($20 per visit),18a - Hearing Exams ($20 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($20 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($20 per visit),7h - Psychiatric Services - Individual ($20 per visit),7h - Psychiatric Services - Group ($20 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services ($0 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($20 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($20 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($20 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 20.00 per visit),17a - Routine Eye Exams ($20 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($20 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($20 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($20 per visit),13e - Other 2:  - Not covered"											0	NO	200	175	100	0	150	0	0	65	96.89863843	0	58.2	0	0	20	20	20	20	20	0	20	0.1	0	0	0	20	0	0	0	0	20											NO	175.6498678	153.6936343	87.82493391	0	131.7374009	0	0	57.08620704	85.10116516	0	51.11411153	0	0	17.56498678	17.56498678	17.56498678	17.56498678	17.56498678	0	17.56498678	0.087824934	0	0	0	17.56498678	0	0	0	0	17.56498678												10.9303	0.067953892	2.723060911	0	1.647846634	0	0	1.023352178	1.60850798	0	0.489428688	0	0	0.304207354	3.519737502	4.335959172	0.171714095	1.033160871	0	0.005239984	2.642558146	0	0	0	0.003385326	0	0	0	0	0.177604246	0	0	0	0	0	0	0	0	0	0	30.6841	0	NO	4.253693385	10.9303	0.067953892	2.723060911	0	1.647846634	0	0	1.023352178	1.60850798	0	0.489428688	0	0	0.304207354	3.519737502	4.335959172	0.171714095	1.033160871	0	0.005239984	2.642558146	0	0	0	0.003385326	0	0	0	0	0.177604246	0	0	0	0	0	0	0	0	0	0	30.6841	NO																																										0	0	0	0	0	0	0	0	0	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	10.9303	0.067953892	2.723060911	0	1.647846634	0	0	1.023352178	1.60850798	0	0.489428688	0	0	0.304207354	3.519737502	4.335959172	0.171714095	1.033160871	0	0.005239984	2.642558146	0	0	0	0.003385326	0	0	0	0	0.177604246	0	0	0	0	0	0	0	0	0	0	30.6841
H3810_002_0	2012	10																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	392.5373317	4.298713829	124.078751	0	32.16951009	65.93280548	5.518241742	63.37808036	52.74359727	13.23468251	31.76867206	0	0.229720364	25.26355473	67.55800793	130.6319473	4.131529678	8.632918652	23.52328584	63.84894478	47.06393458	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"	"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 8b	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing;	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, 14b"	No Cost Sharing; PBP 13a-13e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.222576673	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.070551869	0.070551869	0.10825145	0	0.190623121	0.190623121	0.190623121	0.189411876	0.190623121	0.190623121	0.190623121	0	0.190623121	0.190623121	0.190623121	0.190623121	0.190623121	0.190623121	0.190623121	0.190623121	0.190623121	0	0	0	0	0	0	0	0	0												27.6942	0.303282297	13.4317047	0	6.132252411	12.56831715	1.051904463	12.00456107	10.05414912	2.522836484	6.055843415	0	0.043790013	4.815817647	12.87811831	24.90146947	0.787565081	1.645633896	4.48408216	12.17108512	8.97147409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5181	0	NO	28.45587638	27.6942	0.303282297	13.4317047	0	6.132252411	12.56831715	1.051904463	12.00456107	10.05414912	2.522836484	6.055843415	0	0.043790013	4.815817647	12.87811831	24.90146947	0.787565081	1.645633896	4.48408216	12.17108512	8.97147409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5181	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	NO	0	27.6942	0.303282297	13.4317047	0	6.132252411	12.56831715	1.051904463	12.00456107	10.05414912	2.522836484	6.055843415	0	0.043790013	4.815817647	12.87811831	24.90146947	0.787565081	1.645633896	4.48408216	12.17108512	8.97147409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5181
H3810_003_0	2012	11																															D	D	D		T			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	804.0924536	14.62612596	409.313048	0	212.6670645	0	0	283.2675267	278.3799131	0	134.1319709	0	0	268.4540946	3039.849733	3976.907553	242.8183285	933.6815921	0	1.303928365	43.15365338	0	0	0	0.802910944	0	0	0	0	93.31829847											2000	"1a - Acute (200.00/0.00 per day-1-10/11-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (175.00/0.00 per day-1-10/11-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-27/28-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 150.00 per visit), 9b - Ambulatory Surgical Center Services (min 0.00/ max 50.00 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services ($0 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($20 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($20 per service),3 - Intensive Cardiac Rehabilitation Services ($20 per service),3 - Pulmonary Rehabilitation Services ($20 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($20 per visit),9c - Outpatient Substance Abuse Svcs - Group ($20 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($20 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care ($20 per visit),7d - Physician Specialist Services ($20 per visit),7f - Podiatry Services ($20 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($20 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 20.00 per visit),17a - Routine Eye Exams ($20 per visit),18a - Hearing Exams ($20 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($20 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($20 per visit),7h - Psychiatric Services - Individual ($20 per visit),7h - Psychiatric Services - Group ($20 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services ($0 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($20 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($20 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($20 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 20.00 per visit),17a - Routine Eye Exams ($20 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($20 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($20 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($20 per visit),13e - Other 2:  - Not covered"											0	NO	200	175	100	0	150	0	0	65	96.89863843	0	58.2	0	0	20	20	20	20	20	0	20	0.1	0	0	0	20	0	0	0	0	20											NO	167.9641946	146.9686703	83.98209729	0	125.9731459	0	0	54.58836324	81.3775088	0	48.87758062	0	0	16.79641946	16.79641946	16.79641946	16.79641946	16.79641946	0	16.79641946	0.083982097	0	0	0	16.79641946	0	0	0	0	16.79641946												11.2549	0.179131857	2.864580685	0	2.232528262	0	0	1.288592554	1.887821985	0	0.546337185	0	0	0.375755631	4.2548826	5.566483951	0.339873208	1.306875638	0	0.001825111	3.624134317	0	0	0	0.001123836	0	0	0	0	0.130617774	0	0	0	0	0	0	0	0	0	0	35.8555	0	NO	6.838710674	11.2549	0.179131857	2.864580685	0	2.232528262	0	0	1.288592554	1.887821985	0	0.546337185	0	0	0.375755631	4.2548826	5.566483951	0.339873208	1.306875638	0	0.001825111	3.624134317	0	0	0	0.001123836	0	0	0	0	0.130617774	0	0	0	0	0	0	0	0	0	0	35.8555	NO																																										0	0	0	0	0	0	0	0	0	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	11.2549	0.179131857	2.864580685	0	2.232528262	0	0	1.288592554	1.887821985	0	0.546337185	0	0	0.375755631	4.2548826	5.566483951	0.339873208	1.306875638	0	0.001825111	3.624134317	0	0	0	0.001123836	0	0	0	0	0.130617774	0	0	0	0	0	0	0	0	0	0	35.8555
H3810_004_0	2012	7																															D	D	D		T			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	448.0304505	5.376333684	208.3920245	0	176.6081652	0	0	243.0880957	261.7813076	0	131.030478	0	0	274.0346372	2890.506483	3780.418858	173.0036852	790.2116006	0	73.501781	36.03588579	0	0	0	44.86243206	0	0	0	0	209.176422											1000	"1a - Acute (150.00/0.00 per day-1-3/4-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (150.00/0.00 per day-1-3/4-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 150.00 per visit), 9b - Ambulatory Surgical Center Services ($50 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($5 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($5 per service),3 - Intensive Cardiac Rehabilitation Services ($5 per service),3 - Pulmonary Rehabilitation Services ($5 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($5 per visit),9c - Outpatient Substance Abuse Svcs - Group ($5 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($5 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($5 per visit),7b - Routine Care ($5 per visit),7d - Physician Specialist Services ($5 per visit),7f - Podiatry Services ($5 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($5 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 5.00 per visit),17a - Routine Eye Exams ($5 per visit),18a - Hearing Exams ($5 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($5 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($5 per visit),7h - Psychiatric Services - Individual ($5 per visit),7h - Psychiatric Services - Group ($5 per visit)"	"7c - Occupational Therapy Services ($5 per visit),7i - Physical/Speech Therapy ($5 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($5 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($5 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($5 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 5.00 per visit),17a - Routine Eye Exams ($5 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($5 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($5 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($5 per visit),13e - Other 2:  - Not covered"											0	NO	150	150	100	0	150	0	0	65	96.89863843	0	60	0	0	5	5	5	5	5	0	5	0.1	0	0	0	5	0	0	0	0	5											YES	134.2461786	134.2461786	89.49745241	0	134.2461786	0	0	58.17334406	86.72181281	0	53.69847144	0	0	4.47487262	4.47487262	4.47487262	4.47487262	4.47487262	0	4.47487262	0.089497452	0	0	0	4.47487262	0	0	0	0	4.47487262											1000	5.0122	0.060146021	1.554212941	0	1.975747607	0	0	1.178437286	1.891845796	0	0.586344698	0	0	0.102189175	1.07788736	1.40974107	0.064514121	0.294674688	0	0.027409259	3.225119973	0	0	0	0.016729472	0	0	0	0	0.078003154	0	0	0	0	0	0	0	0	0	0	18.5552	0	NO	2.17745726	5.0122	0.060146021	1.554212941	0	1.975747607	0	0	1.178437286	1.891845796	0	0.586344698	0	0	0.102189175	1.07788736	1.40974107	0.064514121	0.294674688	0	0.027409259	3.225119973	0	0	0	0.016729472	0	0	0	0	0.078003154	0	0	0	0	0	0	0	0	0	0	18.5552	YES	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	20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9c, 9d"	"20% Coinsurance for Immunization; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Immunization; 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 8b	No Cost Sharing; PBP 7g	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, 14b"	No Cost Sharing; PBP 13a-13e											2000	0	0	0	0	0	0	0	0	0	0	0.0431	0	0	0	0.0038	0.0202	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0671	0	NO	0.041214812	5.0122	0.060146021	1.554212941	0	1.975747607	0	0	1.178437286	1.891845796	0	0.62940837	0	0	0.102189175	1.081719828	1.429986903	0.064514121	0.294674688	0	0.027409259	3.225119973	0	0	0	0.016729472	0	0	0	0	0.078003154	0	0	0	0	0	0	0	0	0	0	18.6223
H3810_005_0	2012	11																															D	D	D		T			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	593.3992117	7.338591936	254.8170912	0	123.1005112	0	0	173.4983365	173.9099322	0	137.9683388	0	0	228.3933938	2034.381498	2992.735427	136.362522	590.1551614	0	5.066915221	54.41471073	0	0	0	2.889873976	0	0	0	0	95.47787309											1000	"1a - Acute (150.00/0.00 per day-1-3/4-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (150.00/0.00 per day-1-3/4-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 150.00 per visit), 9b - Ambulatory Surgical Center Services ($50 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($5 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($5 per service),3 - Intensive Cardiac Rehabilitation Services ($5 per service),3 - Pulmonary Rehabilitation Services ($5 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($5 per visit),9c - Outpatient Substance Abuse Svcs - Group ($5 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($5 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($5 per visit),7b - Routine Care ($5 per visit),7d - Physician Specialist Services ($5 per visit),7f - Podiatry Services ($5 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($5 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 5.00 per visit),17a - Routine Eye Exams ($5 per visit),18a - Hearing Exams ($5 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($5 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($5 per visit),7h - Psychiatric Services - Individual ($5 per visit),7h - Psychiatric Services - Group ($5 per visit)"	"7c - Occupational Therapy Services ($5 per visit),7i - Physical/Speech Therapy ($5 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($5 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($5 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($5 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 5.00 per visit),17a - Routine Eye Exams ($5 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($5 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($5 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($5 per visit),13e - Other 2:  - Not covered"											0	NO	150	150	100	0	150	0	0	65	96.89863843	0	60	0	0	5	5	5	5	5	0	5	0.1	0	0	0	5	0	0	0	0	5											YES	132.8002963	132.8002963	88.53353088	0	132.8002963	0	0	57.54679507	85.78778597	0	53.12011853	0	0	4.426676544	4.426676544	4.426676544	4.426676544	4.426676544	0	4.426676544	0.088533531	0	0	0	4.426676544	0	0	0	0	4.426676544											1000	6.567	0.081213932	1.879988067	0	1.362315364	0	0	0.832022768	1.243279004	0	0.610741209	0	0	0.084251973	0.750462405	1.10398931	0.050302731	0.217702168	0	0.001869133	4.817526473	0	0	0	0.001066045	0	0	0	0	0.035220805	0	0	0	0	0	0	0	0	0	0	19.6389	0	NO	2.543545216	6.567	0.081213932	1.879988067	0	1.362315364	0	0	0.832022768	1.243279004	0	0.610741209	0	0	0.084251973	0.750462405	1.10398931	0.050302731	0.217702168	0	0.001869133	4.817526473	0	0	0	0.001066045	0	0	0	0	0.035220805	0	0	0	0	0	0	0	0	0	0	19.6389	YES	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	20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9c, 9d"	"20% Coinsurance for Immunization; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Immunization; 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 8b	No Cost Sharing; PBP 7g	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, 14b"	No Cost Sharing; PBP 13a-13e											2000	0	0	0	0	0	0	0	0	0	0	0.0606	0	0	0	0.0053	0.0217	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0876	0	NO	0.059052419	6.567	0.081213932	1.879988067	0	1.362315364	0	0	0.832022768	1.243279004	0	0.671322149	0	0	0.084251973	0.755749628	1.125724116	0.050302731	0.217702168	0	0.001869133	4.817526473	0	0	0	0.001066045	0	0	0	0	0.035220805	0	0	0	0	0	0	0	0	0	0	19.7265
H3810_006_0	2012	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	502.9348247	5.960596749	431.3985253	0	119.6714861	19.15050971	0.459460261	173.4334199	191.1621064	0	92.18717492	0	0	5.698383713	2139.927217	2418.560981	113.2851706	594.4280926	0	4.835345783	26.74429448	0	0	0	3.096989414	0	0	0	0	121.888499											3400	"1a - Acute (300.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (200.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-40/41-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 200.00 per visit), 9b - Ambulatory Surgical Center Services (min 0.00/ max 200.00 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($20 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($20 per service),3 - Intensive Cardiac Rehabilitation Services ($20 per service),3 - Pulmonary Rehabilitation Services ($20 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($20 per visit),9c - Outpatient Substance Abuse Svcs - Group ($20 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($20 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care ($20 per visit),7d - Physician Specialist Services ($30 per visit),7f - Podiatry Services ($30 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($30 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams ($30 per visit),18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($20 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($20 per visit),7h - Psychiatric Services - Individual ($30 per visit),7h - Psychiatric Services - Group ($30 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($30 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($30 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($30 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams ($30 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($20 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($20 per visit),13e - Other 2:  - Not covered"											0	NO	300	200	100	0	150	0.2	0.2	65	200	0	60	0	0	0.085658483	20	27.56706872	30	20	0	20	0.1	0	0	0	30	0	0	0	0	20											NO	282.133972	188.0893146	94.04465732	0	141.066986	0.188089315	0.188089315	61.12902726	188.0893146	0	56.42679439	0	0	0.080557227	18.80893146	25.92535531	28.2133972	18.80893146	0	18.80893146	0.094044657	0	0	0	28.2133972	0	0	0	0	18.80893146												11.8246	0.093427046	3.380893873	0	1.406807988	3.602006246	0.086419566	0.883484688	2.996295799	0	0.433485564	0	0	0.459045988	3.354145364	5.225171065	0.266346626	0.931713105	0	0.007578974	2.51515801	0	0	0	0.007281383	0	0	0	0	0.191049369	0	0	0	0	0	0	0	0	0	0	37.6649	0	NO	2.385115293	11.8246	0.093427046	3.380893873	0	1.406807988	3.602006246	0.086419566	0.883484688	2.996295799	0	0.433485564	0	0	0.459045988	3.354145364	5.225171065	0.266346626	0.931713105	0	0.007578974	2.51515801	0	0	0	0.007281383	0	0	0	0	0.191049369	0	0	0	0	0	0	0	0	0	0	37.6649	NO																																										0	0	0	0	0	0	0	0	0	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	11.8246	0.093427046	3.380893873	0	1.406807988	3.602006246	0.086419566	0.883484688	2.996295799	0	0.433485564	0	0	0.459045988	3.354145364	5.225171065	0.266346626	0.931713105	0	0.007578974	2.51515801	0	0	0	0.007281383	0	0	0	0	0.191049369	0	0	0	0	0	0	0	0	0	0	37.6649
H3810_007_0	2012	12																															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	591.6444268	5.247920938	329.3705636	0	129.0929823	20.32664286	0.329026655	221.1887018	208.5290623	0	115.3622227	0	0	6.05854979	2473.594627	2558.834644	206.1745036	726.9836959	0	3.879734615	37.99755707	0	0	0	2.635011443	0	0	0	0	83.58811828											3400	"1a - Acute (300.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (200.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00/0.00 per day-1-13/14-40/41-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($65 per visit),4a - Worldwide Coverage ($65 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 200.00 per visit), 9b - Ambulatory Surgical Center Services (min 0.00/ max 200.00 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests (min 0.00/ max 60.00 per visit),8a - Outpatient Lab Services ($0 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($20 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($20 per service),3 - Intensive Cardiac Rehabilitation Services ($20 per service),3 - Pulmonary Rehabilitation Services ($20 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($20 per visit),9c - Outpatient Substance Abuse Svcs - Group ($20 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($20 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - no cost sharing,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care ($20 per visit),7d - Physician Specialist Services ($30 per visit),7f - Podiatry Services ($30 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($30 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams ($30 per visit),18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($20 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($20 per visit),7h - Psychiatric Services - Individual ($30 per visit),7h - Psychiatric Services - Group ($30 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient Therapeutic Radiological Services (min 0.00/ max 60.00 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services ($30 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($30 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($30 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams ($30 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture ($20 per visit),13b - Part C OTC Drugs - no cost sharing,13c - Meal Benefit - Not covered,13d - Other 1: Counseling Support Services Benefit ($20 per visit),13e - Other 2:  - Not covered"											0	NO	300	200	100	0	150	0.2	0.2	65	200	0	60	0	0	0.077401528	20	27.79085336	30	20	0	20	0.1	0	0	0	30	0	0	0	0	20											NO	278.4611606	185.6407738	92.82038688	0	139.2305803	0.185640774	0.185640774	60.33325147	185.6407738	0	55.69223213	0	0	0.071844398	18.56407738	25.79557761	27.84611606	18.56407738	0	18.56407738	0.092820387	0	0	0	27.84611606	0	0	0	0	18.56407738												13.7292	0.081185675	2.547691929	0	1.49780757	3.773453708	0.061080763	1.112086131	3.22595804	0	0.535398307	0	0	0.435272861	3.826666837	5.500551471	0.47842993	1.124648465	0	0.006001974	3.526947948	0	0	0	0.00611457	0	0	0	0	0.129311358	0	0	0	0	0	0	0	0	0	0	41.5978	0	NO	3.217568164	13.7292	0.081185675	2.547691929	0	1.49780757	3.773453708	0.061080763	1.112086131	3.22595804	0	0.535398307	0	0	0.435272861	3.826666837	5.500551471	0.47842993	1.124648465	0	0.006001974	3.526947948	0	0	0	0.00611457	0	0	0	0	0.129311358	0	0	0	0	0	0	0	0	0	0	41.5978	NO																																										0	0	0	0	0	0	0	0	0	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	13.7292	0.081185675	2.547691929	0	1.49780757	3.773453708	0.061080763	1.112086131	3.22595804	0	0.535398307	0	0	0.435272861	3.826666837	5.500551471	0.47842993	1.124648465	0	0.006001974	3.526947948	0	0	0	0.00611457	0	0	0	0	0.129311358	0	0	0	0	0	0	0	0	0	0	41.5978
H3810_019_0	2012	13																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	381.7149697	2.964543373	93.32614408	0	11.95202314	14.60418327	9.83116743	36.00127901	93.08467986	15.44743981	46.97485445	0	0.741344798	45.8226067	78.93894	80.50125144	2.033930438	7.22200704	27.0967541	114.2516694	61.47819117	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"	"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 8b	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing;	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, 14b"	No Cost-Sharing; PBP 13a-13e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.22254538	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.22254538	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0												31.6461	0.245775607	11.87160635	0	2.677253183	3.271337052	2.202181504	8.011918323	20.85096829	3.460226517	10.5223674	0	0.166061235	10.2642639	17.68232256	18.03228032	0.455600418	1.617729577	6.069672919	25.59237395	13.77111482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.4112	0	NO	0	31.6461	0.245775607	11.87160635	0	2.677253183	3.271337052	2.202181504	8.011918323	20.85096829	3.460226517	10.5223674	0	0.166061235	10.2642639	17.68232256	18.03228032	0.455600418	1.617729577	6.069672919	25.59237395	13.77111482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.4112	NO																																										0	0	0	0	0	0	0	0	0	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	31.6461	0.245775607	11.87160635	0	2.677253183	3.271337052	2.202181504	8.011918323	20.85096829	3.460226517	10.5223674	0	0.166061235	10.2642639	17.68232256	18.03228032	0.455600418	1.617729577	6.069672919	25.59237395	13.77111482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.4112
H3811_001_0	2012	4																															D	A	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	YES	705.8464265	20.7232253	190.638403	437.4733744	150.2665555	9.683917682	4.289721565	1251.939178	476.469875	3404.197354	1036.455475	0	0	1571.883211	3724.157114	2633.801931	100.3967703	554.5429093	2829.313811	7210.577277	25.43098888	674.1831998	0	0	83.44287767	72.08241692	1.105759418	0	0	109.8676217											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	"$20 Specialist, $20 copay for Medicare covered chiro, $25 copay for Routine Chiro visit (max 5 visits), $15 copay for Podiatry"	$20 copay	$15 copay		20% Coinsurance Immunizations; $0 copay for Hep B vaccine.	20% Coinsurance	$20 Eye Exam copay.		"$15 copay on Comprehensive, Mandatory Exam/Prophylaxis/X-Ray (1 each annually)"	$20 copay (incl. 1 routine exam every 2 yrs).  Glaucoma tests will be provided at a $0 copay	$125 max coverage	$0 copay Medicare covered exams; $10 copay annual routine hearing exam			$20 copay Acupuncture (limit 15 visits)													107.079646	119.4690265	40	0	50	0.2	0.199947686	19.79044455	50	0	0	0	0	4.199290359	10	19.83287837	20	15	0	0.628319439	0.2	15.87273339	0	0	20	0	10	0	0	20											NO	102.2240302	114.051604	38.18616666	0	47.73270833	0.190930833	0.190880892	18.89303035	47.73270833	0	0	0	0	4.008870038	9.546541665	18.93353997	19.09308333	14.3198125	0	0.59982777	0.190930833	15.15297106	0	0	19.09308333	0	9.546541665	0	0	19.09308333												6.0129	0.196959757	0.606645819	0	0.597719139	1.848958473	0.818825879	1.971077074	1.895266464	0	0	0	0	0.525122959	2.962735088	4.155599511	0.159740325	0.661745874	0	0.360425374	4.855559898	0.85132321	0	0	0.132765151	0	0.000879682	0	0	0.174809305	0	0	0	0	0	0	0	0	0	0	28.789			1.367587735	6.0129	0.196959757	0.606645819	0	0.597719139	1.848958473	0.818825879	1.971077074	1.895266464	0	0	0	0	0.525122959	2.962735088	4.155599511	0.159740325	0.661745874	0	0.360425374	4.855559898	0.85132321	0	0	0.132765151	0	0.000879682	0	0	0.174809305	0	0	0	0	0	0	0	0	0	0	28.789	NO																																																																																		0				6.0129	0.196959757	0.606645819	0	0.597719139	1.848958473	0.818825879	1.971077074	1.895266464	0	0	0	0	0.525122959	2.962735088	4.155599511	0.159740325	0.661745874	0	0.360425374	4.855559898	0.85132321	0	0	0.132765151	0	0.000879682	0	0	0.174809305	0	0	0	0	0	0	0	0	0	0	28.789
H3811_002_0	2012	6																															D	A	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	YES	1056.600496	97.40881894	337.348445	644.4930855	192.6860119	10.66514439	5.809477856	1524.48978	530.4059066	4137.259842	1237.304122	0	0.005476324	1806.068261	4190.391632	2819.214874	177.0619156	492.6092564	3240.802664	7946.964204	24.47620522	597.0437867	0	0	159.3701598	113.9669346	5.271870604	0	0	96.35481943											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	"$20 Specialist, $20 copay for Medicare covered chiro, $25 copay for Routine Chiro visit (max 5 visits), $15 copay for Podiatry"	$20 copay	$15 copay		20% Coinsurance Immunizations; $0 copay for Hep B vaccine.	20% Coinsurance	$20 Eye Exam copay.		"$15 copay on Comprehensive, Mandatory Exam/Prophylaxis/X-Ray (1 each annually)"	$20 copay (incl. 1 routine exam every 2 yrs).  Glaucoma tests will be provided at a $0 copay	$125 max coverage	$0 copay Medicare covered exams; $10 copay annual routine hearing exam			$20 copay Acupuncture (limit 15 visits)													107.079646	119.4690265	40	0	50	0.2	0.199925758	19.54598382	50	0	0	0	0.2	4.659436129	10	19.80833754	20	15	0	0.657849179	0.2	17.59231055	0	0	20	0	10	0	0	20											NO	102.2456588	114.0757351	38.19424611	0	47.74280764	0.190971231	0.190900341	18.66360291	47.74280764	0	0	0	0.190971231	4.449091256	9.548561527	18.91411298	19.09712305	14.32284229	0	0.628151336	0.190971231	16.79812597	0	0	19.09712305	0	9.548561527	0	0	19.09712305												9.0027	0.925998552	1.073730794	0	0.766614267	2.036735747	1.109031301	2.371039325	2.110255597	0	0	0	0.00104582	0.669613542	3.334351027	4.443579053	0.281781099	0.587963724	0	0.415991348	4.674251031	0.835768061	0	0	0.253625963	0	0.004194898	0	0	0.153341654	0	0	0	0	0	0	0	0	0	0	35.0516			1.662448873	9.0027	0.925998552	1.073730794	0	0.766614267	2.036735747	1.109031301	2.371039325	2.110255597	0	0	0	0.00104582	0.669613542	3.334351027	4.443579053	0.281781099	0.587963724	0	0.415991348	4.674251031	0.835768061	0	0	0.253625963	0	0.004194898	0	0	0.153341654	0	0	0	0	0	0	0	0	0	0	35.0516	NO																																																																																		0				9.0027	0.925998552	1.073730794	0	0.766614267	2.036735747	1.109031301	2.371039325	2.110255597	0	0	0	0.00104582	0.669613542	3.334351027	4.443579053	0.281781099	0.587963724	0	0.415991348	4.674251031	0.835768061	0	0	0.253625963	0	0.004194898	0	0	0.153341654	0	0	0	0	0	0	0	0	0	0	35.0516
H3811_003_0	2012	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	V																																																			0	YES	339.086472	17.7239196	55.84800223	20.17482612	19.8944651	36.91354622	15.45619129	25.71849261	62.8434725	36.95556547	34.57151204	0	1.080385162	36.57941294	62.48835551	25.55639376	17.05260651	2.511242553	18.93227444	93.3882646	35.98383696	3.228262639	0	0	98.15526791	83.55949795	8.435178812	0	0	53.07922368											3400	FFS Cost Sharing	FFS Cost Sharing	"FFS Cost Sharing, offers additional 20 days at 20%"	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	Covered under Part B at 20%	FFS Cost Sharing	"FFS Cost Sharing, CORF covered under Part B at 20%"	FFS Cost Sharing	"FFS Cost Sharing, 20% for Medicare covered chiro; 20% for Routine Chiro  (max 5 visits)"	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	"FFS Cost Sharing, Eye Exams - $15 copay (incl. 1 routine exam every 2 yrs)."	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													0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	15											NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	15												28.112	1.469402383	7.104177551	0	4.456360182	8.268634354	3.462186848	5.760942344	14.07693784	8.278046665	7.744018696	0	0.242006276	8.193788499	13.99739163	5.724632202	3.819783857	0.562518332	4.240829474	20.91897127	8.060379479	0.723130831	0	0	0	0	0	0	0	0.06634903	0	0	0	0	0	0	0	0	0	0	155.2825			0	28.112	1.469402383	7.104177551	0	4.456360182	8.268634354	3.462186848	5.760942344	14.07693784	8.278046665	7.744018696	0	0.242006276	8.193788499	13.99739163	5.724632202	3.819783857	0.562518332	4.240829474	20.91897127	8.060379479	0.723130831	0	0	0	0	0	0	0	0.06634903	0	0	0	0	0	0	0	0	0	0	155.2825	NO																																																																																		0				28.112	1.469402383	7.104177551	0	4.456360182	8.268634354	3.462186848	5.760942344	14.07693784	8.278046665	7.744018696	0	0.242006276	8.193788499	13.99739163	5.724632202	3.819783857	0.562518332	4.240829474	20.91897127	8.060379479	0.723130831	0	0	0	0	0	0	0	0.06634903	0	0	0	0	0	0	0	0	0	0	155.2825
H3811_009_0	2012	6																															D	A	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	YES	883.7403024	45.5420309	321.8297475	662.2796904	175.587615	13.71637787	6.833086089	1622.278492	600.4446968	4292.542379	1256.599692	0	0	1863.787056	4440.520021	3121.429197	188.3098844	685.844955	3407.727399	8543.664265	27.0996964	591.3186417	0	771.140137	201.0146842	158.5826816	29.56399785	0	0	98.36149824											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, $2,000 maximum out-of-pocket"	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	"$20 Specialist, $20 copay for Medicare covered chiro, $25 copay for Routine Chiro visit (max 5 visits), $15 copay for Podiatry"	$20 copay	$15 copay		20% Coinsurance Immunizations; $0 copay for Hep B vaccine.	20% Coinsurance	$20 Eye Exam copay.		"$15 copay on Comprehensive, Mandatory Exam/Prophylaxis/X-Ray (1 each annually)"	$20 copay (incl. 1 routine exam every 2 yrs).  Glaucoma tests will be provided at a $0 copay	$125 max coverage	$0 copay Medicare covered exams; $10 copay annual routine hearing exam	$500 max on hearing aids		$20 copay Acupuncture (limit 15 visits)													107.079646	119.4690265	40	0	50	0.2	0.199927826	19.03869782	50	0	0	0	0	4.444444444	10	19.80105089	20	15	0	0.609340089	0.2	17.24237495	0	0	20	0	10	0	0	20											NO	102.2830747	114.11748	38.20822294	0	47.76027868	0.191041115	0.190972174	18.18587027	47.76027868	0	0	0	0	4.245358105	9.552055736	18.91407417	19.10411147	14.3280836	0	0.58204505	0.191041115	16.47001265	0	0	19.10411147	0	9.552055736	0	0	19.10411147												7.5326	0.43309515	1.024711895	0	0.698842785	2.620392119	1.304929303	2.458545518	2.389783837	0	0	0	0	0.65937029	3.534674561	4.919911946	0.299791085	0.818903654	0	0.414399791	5.177156209	0.811585459	0	0	0.320017245	0	0.02353308	0	0	0.156592419	0	0	0	0	0	0	0	0	0	0	35.5989			1.669515414	7.5326	0.43309515	1.024711895	0	0.698842785	2.620392119	1.304929303	2.458545518	2.389783837	0	0	0	0	0.65937029	3.534674561	4.919911946	0.299791085	0.818903654	0	0.414399791	5.177156209	0.811585459	0	0	0.320017245	0	0.02353308	0	0	0.156592419	0	0	0	0	0	0	0	0	0	0	35.5989	NO																																																																																		0				7.5326	0.43309515	1.024711895	0	0.698842785	2.620392119	1.304929303	2.458545518	2.389783837	0	0	0	0	0.65937029	3.534674561	4.919911946	0.299791085	0.818903654	0	0.414399791	5.177156209	0.811585459	0	0	0.320017245	0	0.02353308	0	0	0.156592419	0	0	0	0	0	0	0	0	0	0	35.5989
H3812_001_0	2012	5																															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	865.9374209	104.6830882	759.7047052	80.2476398	132.1938469	6.831497329	8.780701644	421.1069197	47.96428694	14.53318865	28.01382305	0	0.079694534	23.21160685	5040.176399	2794.865301	527.9809779	584.9078933	0	0	20.6740766	607.3833278	0	0	47.64793982	0	5.101777035	61.75	79.55104166	0											4500	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	63.90299134	0	200	0.2	0.093388156	64.06533972	0.16	0.183245208	0.179694129	0	0.2	0.14498659	9.902084191	29.37389733	38.5	30	0	0	0.2	29.02276276	0	0	30	0	15	352.5	0	0											NO	159.1622873	83.36275804	53.00248674	0	165.8842118	0.165884212	0.077458103	53.14953172	0.132707369	0.151987434	0.149042095	0	0.165884212	0.120254931	9.621559534	28.541979	37.4093004	29.15010421	0	0	0.165884212	24.07209062	0	0	30	0	15	352.5	0	0												11.4854	0.727222579	3.35551988	0	1.827406008	1.13323755	0.680136493	1.865136299	6.365214346	2.208862054	4.175238862	0	0.013220065	2.791310173	4.04119644	6.647582227	1.645949917	1.420843837	0	0	3.429502901	1.218415542	0	0	0.11911985	0	0.006377221	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	56.9708	0	NO	8.88926574	11.4854	0.727222579	3.35551988	0	1.827406008	1.13323755	0.680136493	1.865136299	6.365214346	2.208862054	4.175238862	0	0.013220065	2.791310173	4.04119644	6.647582227	1.645949917	1.420843837	0	0	3.429502901	1.218415542	0	0	0.11911985	0	0.006377221	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	56.9708	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											8400	0.4509	0.0478	0.1269	0.2565	0.3876	0.601	0.4635	0.3956	2.0253	0.4685	1.296	0	0.0028	0.8868	1.0334	1.4335	0.2657	0.3045	0	0	0.7349	0.2606	0	0	0.0255	0	0.0024	0.0955	0	0											11.5652	0	NO	1.815659325	11.9363	0.775063148	3.482452497	0.256534329	2.215037585	1.734196856	1.143593693	2.260771272	8.39050982	2.67740855	5.471232733	0	0.016024321	3.678149576	5.07455526	8.08105591	1.911622724	1.725310373	0	0	4.16439638	1.478995449	0	0	0.144645532	0	0.008765955	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	68.536
H3812_005_0	2012	3																															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	298.0717769	40.113823	9067.885238	44.14622145	21.85248738	21.61778153	13.68760535	15.36606247	23.56275206	37.32318808	12.27108423	0	0	18.37003848	4.261605702	102.6564076	17.8178275	95.10884143	0	40898.15664	24.52923257	8.325012078	1079.840353	0	98.56237368	371.8601664	0	0	0	1657.113503											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.078879455	0.079837505	0	0	0.2	0.2	0.185713422	0.135023286	0.16	0	0.090410629	0	0	0.146304544	0	0.0324522	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.074383555	0.075286999	0	0	0.188600582	0.188600582	0.175128297	0.127327352	0.150880466	0	0.085257487	0	0	0.137965611	0	0.030316814	0.186839803	0	0	0	0.188600582	0.189610698	0	0	0	0	0	0	0	0												22.1716	3.020049366	0	0	4.121391836	4.077126177	2.397087018	1.95652004	3.555158999	0	1.046201798	0	0	2.534433585	0	3.112215175	3.329079383	0	0	0	4.626227536	1.578511347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5256	0	NO	3.532425686	22.1716	3.020049366	0	0	4.121391836	4.077126177	2.397087018	1.95652004	3.555158999	0	1.046201798	0	0	2.534433585	0	3.112215175	3.329079383	0	0	0	4.626227536	1.578511347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5256	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.4187	0.057	0	0.0282	0.6489	0.642	0.4065	0.2054	0.5598	0	0.2809	0	0	0.3991	0.0728	2.0009	0.3471	0.0123	0	0	0.4824	0.1646	0	0	0.0779	0	0	0	0	0											6.8045	0	NO	0.429047334	22.5903	3.077075675	0	0.028241179	4.770340274	4.719104608	2.803564777	2.161900597	4.114949229	0	1.327091574	0	0	2.933501856	0.072750549	5.113124777	3.676229372	0.01225974	0	0	5.108641638	1.743115472	0	0	0.0779355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3301
H3813_001_0	2012	9	r.	s.	t.	u							Professional	DME/Prosthetics/Supplies	Professional	Professional							Preventitive	Prosthetics/Supplies	Vision - Covered	Hearing Covered							D		D	V	T	COIN		V	P	V	COIN	V	COIN	COIN	V	V	V	V	COIN	V	COIN				V					COIN	P	P	P	P							0.838917783	0	0.02808409	0	0.000459933	0.078589646	0	0.041901838	0.626783606	0	0.192671609	0	3.17E-06	0.070349844	0.286539161	0.101824433	0.02463188	0.102160776	0.146484944	0.178356612	0.335625886	0	0	0	0.000981659	0	0	0	0	5.46E-05	0	0.014095256	0.028713646	0.001934386							3.0992	YES	242.0024129	0	56.58452612	0	1.062583057	8.667213698	0	238.0929471	2016.537382	0	23.45589767	0	0.00038616	8.564410428	5027.149952	924.5082329	286.5703536	1315.73097	16.36208557	19.92208932	37.48876371	0	0	0	9.325880004	0	0	0	0	0.006095857	0	122.7747158	360.7989395	38.23194208							3400	"$200/day, 1-5 days, $0/day, 6-90 days"		"$40/day, 1-100 days"	0	100	0.2		"Emergency Care $50, Urgent Care $35"	200	0	0.2	"$20 Group, $30 Individual"	0.2	0.2	"$20 PCP, Chiropractic Services - $20"	"$35, Cardiac Rehab $35"	"$20 Group, $30 Individual"	35	0.2	0.2	0.2	0	0	Not Covered	Routine Eye Exam $35	Not Covered	Not Covered	Not Covered	Not Covered	0.2	0	Diab. Supplies $10	Medicare Covered Care $30	Medicare Covered Hearing Exam $35							50	NO	200		40	0	100	0.2		50	200	0	0.2	30	0.2	0.2	20	35	30	35	0.2	0.2	0.2	0	0	0	35	0	0	0	0	0.2	0	10	30	35							NO	118.9526038	0	23.79052076	0	59.4763019	0.118952604	0	29.73815095	118.9526038	0	0.118952604	17.84289057	0.118952604	0.118952604	11.89526038	20.81670566	17.84289057	20.81670566	0.118952604	0.118952604	0.118952604	0	0	0	20.81670566	0	0	0	0	0.118952604	0	5.94763019	17.84289057	20.81670566								2.3989	0	0.112181279	0	0.005266543	1.030987637	0	0.590037	19.98936435	0	2.790140102	0	4.59E-05	1.01875892	4.983271471	1.603767981	0.426103622	2.282432028	1.946312682	0.000197482	4.459386057	0	0	0	0.016177842	0	0	0	0	0.000725118	0	0.060851551	0.536474666	0.066321924	0	0	0	0	0	0	44.3177	0	NO	28.97308414	3.2378	0	0.140265369	0	0.005726475	1.109577283	0	0.631938838	20.61614796	0	2.982811711	0	4.91E-05	1.089108764	5.269810632	1.705592414	0.450735501	2.384592804	2.092797627	0.178554094	4.795011943	0	0	0	0.0171595	0	0	0	0	0.000779693	0	0.074946806	0.565188312	0.06825631	0	0	0	0	0	0	47.4169	YES	"$300/day, 1-5 days, $0/day, 6-90 days"		"$40/day, 1-100 days"	0	100	0.2		"Emergency Care $50, Urgent Care $35"	200	0	0.2	"$20 Group, $30 Individual"	0.2	0.2	"$20 PCP, Chiropractic Services - $20"	"$35, Cardiac Rehab $35"	"$20 Group, $30 Individual"	35	0.2	0.2	0.2	0	0	Not Covered	Routine Eye Exam $35	Not Covered	Not Covered	Not Covered	Not Covered	0.2	0	Diab. Supplies $10	Medicare Covered Care $30	Medicare Covered Hearing Exam $35							3400	1.7094	0	0.3122	0	0.4133	1.2351	0	0.5476	7.1867	0	0.8559	0	0	0.3125	2.3806	0.7705	0.2036	1.0772	0.9454	0.0807	1.9926	0	0	0	0.0088	0	0	0	0	0.0076	0	0.0834	0.2553	0.0583							20.4368	0	NO	14.12034746	4.9472	0	0.452468931	0	0.418987094	2.3446786	0	1.179585514	27.80281603	0	3.838670255	0	6.32E-05	1.401606881	7.650454227	2.476095936	0.654355832	3.461835608	3.038221592	0.259216131	6.787595627	0	0	0	0.026003824	0	0	0	0	0.008381695	0	0.15837218	0.820512844	0.126550888	0	0	0	0	0	0	67.8537
H3813_003_0	2012	10	r.	s.	t.	u							Professional	DME/Prosthetics/Supplies	Professional	Professional							Preventitive	Prosthetics/Supplies	Vision - Covered	Hearing Covered							D		D	V	T	COIN		V	P	V	COIN	V	COIN	COIN	V	V	V	V	COIN	V	COIN				V					COIN	P	P	P	P							1.085601177	0	0.034507241	0	0.000844189	0.095383996	0	0.055722148	0.628742351	0	0.207651566	0	1.86E-06	0.076259705	0.293662422	0.124682505	0.024950447	0.07004624	0.151942552	0.175051812	0.386761132	0	0	0	0.000576266	0	0	0	0	3.20E-05	0	0.014665267	0.01685586	0.001135549							3.4451	YES	483.4843002	0	111.9530103	0	2.661543264	16.43939393	0	513.3210291	3023.283589	0	38.39690502	0	0.00038764	14.08894789	8007.56317	1866.840774	454.9913689	1479.317139	26.78915285	31.05495243	67.44721886	0	0	0	9.329982749	0	0	0	0	0.006121084	0	193.1900521	360.9575477	38.24871476							3400	"$200/day, 1-5 days, $0/day, 6-90 days"		"$40/day, 1-100 days"	0	100	0.2		"Emergency Care $50, Urgent Care $35"	200	0	0.2	"$20 Group, $30 Individual"	0.2	0.2	"$20 PCP, Chiropractic Services - $20"	"$35, Cardiac Rehab $35"	"$20 Group, $30 Individual"	35	0.2	0.2	0.2	0	0	Not Covered	Routine Eye Exam $35	Not Covered	Not Covered	Not Covered	Not Covered	0.2	0	Diab. Supplies $10	Medicare Covered Care $30	Medicare Covered Hearing Exam $35							50	NO	200	0	40	0	100	0.2	0	50	200	0	0.2	30	0.2	0.2	20	35	30	35	0.2	0.2	0.2	0	0	0	35	0	0	0	0	0.2	0	10	30	35							NO	121.7808737	0	24.35617475	0	60.89043686	0.121780874	0	30.44521843	121.7808737	0	0.121780874	18.26713106	0.121780874	0.121780874	12.17808737	21.3116529	18.26713106	21.3116529	0.121780874	0.121780874	0.121780874	0	0	0	21.3116529	0	0	0	0	0.121780874	0	6.089043686	18.26713106	21.3116529								4.9066	0	0.227228924	0	0.013505211	2.002003757	0	1.302347571	30.68150975	0	4.676008642	0	4.72E-05	1.715764384	8.126400327	3.315455216	0.692615581	2.627224449	3.262406441	0.000315158	8.213781244	0	0	0	0.016569779	0	0	0	0	0.000745431	0	0.098028556	0.549471569	0.067928611	0	0	0	0	0	0	72.496	0	NO	44.51605282	5.9922	0	0.261736165	0	0.0143494	2.097387752	0	1.35806972	31.3102521	0	4.883660208	0	4.91E-05	1.792024089	8.42006275	3.44013772	0.717566028	2.697270689	3.414348993	0.175366971	8.600542376	0	0	0	0.017146046	0	0	0	0	0.000777468	0	0.112693823	0.56632743	0.06906416	0	0	0	0	0	0	75.941	YES	"$300/day, 1-5 days, $0/day, 6-90 days"		"$40/day, 1-100 days"	0	100	0.2		"Emergency Care $50, Urgent Care $35"	200	0	0.2	"$20 Group, $30 Individual"	0.2	0.2	"$20 PCP, Chiropractic Services - $20"	"$35, Cardiac Rehab $35"	"$20 Group, $30 Individual"	35	0.2	0.2	0.2	0	0	Not Covered	Routine Eye Exam $35	Not Covered	Not Covered	Not Covered	Not Covered	0.2	0	Diab. Supplies $10	Medicare Covered Care $30	Medicare Covered Hearing Exam $35							3400	3.1636	0	0.5826	0	1.0355	2.3347	0	1.1769	10.9146	0	1.4013	0	0	0.5142	3.8038	1.5541	0.3242	1.2185	1.5424	0.0792	3.574	0	0	0	0.0088	0	0	0	0	0.0076	0	0.1254	0.2558	0.059							33.6762	0	NO	22.56531817	9.1558	0	0.84431021	0	1.049897767	4.432048361	0	2.534991162	42.22482205	0	6.284929453	0	6.31E-05	2.306209789	12.22383671	4.994224271	1.041727385	3.915766122	4.956785454	0.25458922	12.1745273	0	0	0	0.025983435	0	0	0	0	0.00835778	0	0.23813645	0.82216656	0.128048686	0	0	0	0	0	0	109.6172
H3813_802_0	2012	8	r.	s.									Professional	DME/Prosthetics/Supplies									Preventitive	Prosthetics/Supplies									D		D		T	COIN		V	P		COIN	V	COIN	COIN	V	V	V	V	COIN	V	COIN				V		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	0									0	NO	195.4992114	0	36.25576339	0	1.062593354	9.206108783	0	238.0948233	2016.544398	0	23.64856927	0	0.000389332	8.634760272	5508.605057	924.5147462	291.7438768	1315.737505	16.50857052	20.10044594	37.8243896	0	0	0	43.13248543	0	39.18491102	0	0	0.006150432	0	129.2398647										"$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		"Emergency Care $50, Urgent Care $20"	125	0	0.1	20	0.1	0.1	15	20	20	20	0.1	0.1	0.1				20		20			0.1	0	$10 Diabetic Supplies									0	NO	100		40	0	50	0.1		50	125		0.1	20	0.1	0.1	15	20	20	20	0.1	0.1	0.1				20		20			0.1	0	10									NO	60.52491893	0	24.20996757	0	30.26245946	0.060524919	0	30.26245946	75.65614866	0	0.060524919	0	0.060524919	0.060524919	9.078737839	12.10498379	12.10498379	12.10498379	0.060524919	0.060524919	0.060524919	0	0	0	12.10498379	0	12.10498379	0	0	0.060524919	0	6.052491893										0.986	0	0.073145905	0	0.002679724	0.557198988	0	0.600444578	12.71366523	0	1.431327738	0	2.36E-05	0.522618165	4.167598431	0.932603001	0.294296242	1.32724843	0.999179892	0.000101381	2.289318114	0	0	0	0.043509836	0	0.039527726	0	0	0.000372254	0	0.065185269	0	0	0	0	0	0	0	0	27.0461	0	NO	16.92487266	0.986	0	0.073145905	0	0.002679724	0.557198988	0	0.600444578	12.71366523	0	1.431327738	0	2.36E-05	0.522618165	4.167598431	0.932603001	0.294296242	1.32724843	0.999179892	0.000101381	2.289318114	0	0	0	0.043509836	0	0.039527726	0	0	0.000372254	0	0.065185269	0	0	0	0	0	0	0	0	27.0461	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		"Emergency Care $50, Urgent Care $20"	125	0	0.1	20	0.1	0.1	15	20	20	20	0.1	0.1	0.1				20		20			0.1	0	$10 Diabetic Supplies									2500	0.5206	0	0.1628	0	0.1934	0.6202	0	0.5204	4.4319	0	0.4107	0	0	0.15	1.8827	0.4213	0.1329	0.5996	0.4514	0	0.9513	0	0	0	0.0224	0	0.0338	0	0	0.0036	0	0.0726									11.5816	0	NO	8.268586414	1.5066	0	0.235954531	0	0.196066475	1.17743267	0	1.120797907	17.14557425	0	1.842018788	0	3.03E-05	0.672573062	6.050316274	1.353907582	0.42724494	1.926834581	1.450560668	0.000147181	3.24065212	0	0	0	0.065935611	0	0.073286541	0	0	0.004001735	0	0.137744805	0	0	0	0	0	0	0	0	38.6277
H3814_007_0	2012	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	395.3732733	10.37019128	43.78731568	42.43623406	32.40173463	33.57737306	18.39500069	42.85059617	36.97123266	16.83777643	14.73970914		0	41.48917272	46.30017809	41.94467718	4.010831776	1.615427954	16.86925379	83.26069379	0	3.266810117	0	0	0	0	0	0	0	0											6700	Medicare IP	Medicare IP	Medicare SNF	Medicare HHC	Medicare Ambul	Medicare DME	Medicare Prosthetics/Medicare Diabetic Supplies	Medicare ER/Medicare Urgent Care	Medicare OP Hosp & Surg/Medicare ASC	Medicare Lab/Medicare Lab	Medicare Rad/Medicare MRI/CT/PET/Medicare Rad		Medicare Dialysis	Medicare CORF/Medicare Partial Hospitalization/Medicare Rad/Medicare OP Hosp & Surg/Medicare OP Substance Abuse/Medicare Cardiac Rehab/Medicare PT & ST	$1 Copay PCP/Medicare Immunizations/No Addl Immunizations/Medicare Physical Exams/Medicare Supp Physical Exams	Medicare Chiro/Medicare Specialists/Medicare Podiatry/Medicare Psychiatric/Medicare Preventive Dental/Medicare Preventive Dental/Medicare Medicare Covered Vision Exams/Medicare Medicare Covered Hearing Exams	Medicare Mental Health	Medicare OT	Medicare Rad	Medicare ER/Medicare Other/Medicare Lab/Medicare Other/Medicare Pap & Pelvic/No Coverage Supp Pap & Pelvic/Medicare Prostate Screen/No Coverage Supp Prostate Screening/Medicare Colorectal Screen/No Coverage Supp Colorectal Screening/Medicare Bone Mass/Medicare Bone Mass/Medicare Mammogram/No Coverage Supp Mammography/Medicare Diab Monitor/Medicare Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	Medicare Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.079590171	0.224	0.224	0.224	0.224	0.224	0	0.224	0	0	0	0	0	0	0	0											NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.079590171	0.224	0.224	0.224	0.224	0.224	0	0.224	0	0	0	0	0	0	0	0												32.7784	0.859741193	5.569990915	0	7.257988557	7.521331566	4.120480155	9.598533542	8.281556116	3.77166192	3.301694848	0	0	9.293574688	3.685039078	9.395607689	0.898426318	0.361855862	3.778712848	18.65039541	0	0.731765466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8568	0	YES	0	32.7784	0.859741193	5.569990915	0	7.257988557	7.521331566	4.120480155	9.598533542	8.281556116	3.77166192	3.301694848	0	0	9.293574688	3.685039078	9.395607689	0.898426318	0.361855862	3.778712848	18.65039541	0	0.731765466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8568	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	Medicare Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	32.7784	0.859741193	5.569990915	0	7.257988557	7.521331566	4.120480155	9.598533542	8.281556116	3.77166192	3.301694848	0	0	9.293574688	3.685039078	9.395607689	0.898426318	0.361855862	3.778712848	18.65039541	0	0.731765466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.8568
H3815_001_0	2012	10																															D	D	D		T	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	3.230163576	45.09814539	158.1581995	0	100.444518	10.63783887	0.873003128	179.5128685	179.9266755	0	18.71734477	0	0	0	0.714751581	3.866814042	87.14917996	0	0	0	16.70070058	0	0	881.5844636	0	0	0	0	0	0											3400	"1a - Acute (0.00/100.00/0.00 per day-1-45/46-60/61-90),1a - Additional Days ($0 per day-91-999),1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych ($250 per admit, $115 -1-10/11-90),1b - Additional Days ($0 per day-91-180),1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/100.00 per day-1-30/31-100),2 - Additional Days - no cost sharing,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($75 per trip)	11a - Durable Medical Equipment (min 0/ max 20 coins per service)	"11b - Prosthetics Devices (min 0/ max 20 coins per service),11b - Medical Supplies (min 0/ max 20 coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care (min 0.00/ max 65.00 per visit),4a - Worldwide Coverage ($0 per visit), 4b - Urgently Needed Care / Urgent Care Centers (min 0.00/ max 25.00 per visit)"	"9a - Outpatient Hospital Services (min 0.00/ max 75.00 per visit), 9b - Ambulatory Surgical Center Services - no cost sharing"	",8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services ($0 per visit),8b - Outpatient Therapeutic Radiological Services ($50 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization ($40 per day)	12 - Renal Dialysis ($30 per service)	"3 - Cardiac Rehabilitation Services ($0 per service),3 - Intensive Cardiac Rehabilitation Services ($0 per service),3 - Pulmonary Rehabilitation Services ($0 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($40 per visit),9c - Outpatient Substance Abuse Svcs - Group ($40 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers (min 0.00/ max 25.00 per visit),7a - Primary Care - no cost sharing,7a - In-Area Network Urgent Care Services ($0 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - no cost sharing,14c - Nutritional Benefit - no cost sharing,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers (min 0.00/ max 25.00 per visit),7b - Chiropractic Services - no cost sharing,7b - Routine Care - Not covered,7d - Physician Specialist Services - no cost sharing,7f - Podiatry Services - no cost sharing,7f - Routine Footcare - no cost sharing,7g - Other Health Care Professional Services - no cost sharing,14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing,18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - no cost sharing,18b - Hearing Aids - no cost sharing"	"7e - Mental Hlth Spec-Non-Physician - Individual ($40 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($40 per visit),7h - Psychiatric Services - Individual ($40 per visit),7h - Psychiatric Services - Group ($40 per visit)"	"7c - Occupational Therapy Services - no cost sharing,7i - Physical/Speech Therapy - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services ($0 per visit),8b - Outpatient Therapeutic Radiological Services ($50 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services - no cost sharing	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services - no cost sharing,14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - no cost sharing	"16a - Preventive Dental - no cost sharing,16a - Oral Exams ($0 per service-),16a - Preventive Dental - Prophylaxis ($0 per service),16a - Preventive Dental - Fluoride Treatment (min 0.00/ max 20.00 per service),16a - Preventive Dental - X-Rays (min 0.00/ max 30.00 per service), 16b - Comprehensive Dental (Medicare Covered: min 0.00/ max 425.00 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs (min 0.00/ max 30.00 per visit),16b - Comprehensive Dental - Restorative Svcs (min 20.00/ max 350.00 per visit),16b - Comprehensive Dental - Endodontics/Periodontics/Extractions (min 15.00/ max 375.00 per visit),16b - Comprehensive Dental - Prosthodontics, Other (min 20.00/ max 425.00 per visit)"	"17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - no cost sharing,17b - Lenses - no cost sharing,17b - Upgrades - no cost sharing"	"18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - no cost sharing,18b - Hearing Aids - no cost sharing"	18b - Hearing Aids - no cost sharing	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - Not covered,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - no cost sharing,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	100	92.23463687	100	0	75	0.1	0.1	65	36.67847938	0	1.5	0	0	0	25	25	40	0	0	0	0.2	0	0	27	0	0	0	0	0	0											NO	99.95271919	92.19102759	99.95271919	0	74.96453939	0.099952719	0.099952719	64.96926747	36.6611375	0	1.499290788	0	0	0	24.9881798	24.9881798	39.98108768	0	0	0	0.199905438	0	0	26.98723418	0	0	0	0	0	0												0.0269	0.346470364	1.317361842	0	0.627481419	1.063280921	0.087259036	0.971901631	0.549693049	0	0.002338562	0	0	0	0.001488362	0.008052054	0.290359917	0	0	0	3.33856087	0	0	1.982627197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6138	0	NO	0.005020655	0.0269	0.346470364	1.317361842	0	0.627481419	1.063280921	0.087259036	0.971901631	0.549693049	0	0.002338562	0	0	0	0.001488362	0.008052054	0.290359917	0	0	0	3.33856087	0	0	1.982627197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6138	NO																																										0	0	0	0	0	0	0	0	0	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	0.0269	0.346470364	1.317361842	0	0.627481419	1.063280921	0.087259036	0.971901631	0.549693049	0	0.002338562	0	0	0	0.001488362	0.008052054	0.290359917	0	0	0	3.33856087	0	0	1.982627197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6138
H3817_001_0	2012	5																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	535.9927383	2.804563734	902.5430034	18.46553652	1.838796699	13.80142904	0.780362494	294.3719264	358.9334269	0	15.5714418	0	0	357.4796023	4452.141676	3171.157605	80.78826094	922.1956501	21.58153933	0	25.1845867	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	18.40289598	0.1	100	0.2	0.2	65	175	0	0.101092721	0	0	35	15	34.06146585	35	35	0.076886042	0	0.209183589	0	0	0	0	0	0	0	0	0											NO	180.510554	180.510554	16.60958475	0.090255277	90.25527702	0.180510554	0.180510554	58.66593006	157.9467348	0	0.091241516	0	0	31.58934696	13.53829155	30.74227037	31.58934696	31.58934696	0.06939371	0	0.188799228	0	0	0	0	0	0	0	0	0												8.0627	0.042187779	1.249238709	1.666612114	0.013830092	2.491303602	0.140863666	1.439133571	4.724363565	0	1.420761951	0	0	0.941045599	5.022866004	8.124048706	0.2126707	2.427629863	1.497623086	0	4.754830531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2317	0	NO	5.040779186	8.0627	0.042187779	1.249238709	1.666612114	0.013830092	2.491303602	0.140863666	1.439133571	4.724363565	0	1.420761951	0	0	0.941045599	5.022866004	8.124048706	0.2126707	2.427629863	1.497623086	0	4.754830531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2317	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												1.7274	0.0082	0.054	0.0415	1.5668	0.3064	0.0054	0.1074	0.6944	0	0.2328	0	0	0.0716	0.3096	0.436	0.0658	0.1182	0.1317	0	0.4064	0	0	1.6295	0	0	0	0	0	0											7.9132	0	NO	0.589220814	9.7901	0.050354978	1.303248092	1.708118369	1.580581957	2.797743498	0.146250703	1.546538272	5.418800714	0	1.653554611	0	0	1.012631102	5.332508731	8.560008836	0.278491536	2.545818204	1.629368662	0	5.161235265	0	0	1.629549531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1449
H3817_002_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	1.219157258	0.0110055	0.224814535	0.145251847	0.00247733	0.109008048	0.004576802	0.132599127	0.303527555	0.039037428	0.09434345	0	8.44E-05	0.10842098	0.375771553	0.676897051	0.009523089	0.045831822	0.128975966	1.80E-06	0.109840505	0.0058699	0	0	0	0	0	0	0	0											3.747	YES	562.7821278	7.126593829	994.8028795	23.60070161	4.149457265	17.71176384	0.743644527	325.7636264	344.4737795	0	15.32904164	0	0	361.9544913	5018.879388	3210.195579	164.5075259	931.0793656	20.95617607	0	26.25169293	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	27.39911328	0.1	100	0.125587765	0.169225387	65	175	0	0.09824759	0	0	35	15	33.90464071	35	35	0.073220278	0	0.193472067	0	0	0	0	0	0	0	0	0											NO	178.6582407	178.6582407	24.47538688	0.08932912	89.32912036	0.112186446	0.15116755	58.06392824	156.3259606	0	0.087763708	0	0	31.26519213	13.39936805	30.28671731	31.26519213	31.26519213	0.06540703	0	0.172826896	0	0	0	0	0	0	0	0	0												8.3788	0.10610206	2.029015446	2.108229915	0.030888947	1.987019832	0.112414921	1.576259652	4.487516208	0	1.34533353	0	0	0.943048059	5.604151012	8.102190501	0.428613284	2.425864604	1.370681243	0	4.536998597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5731	0	NO	5.718021118	9.598	0.117107559	2.253829981	2.253481762	0.033366278	2.09602788	0.116991723	1.70885878	4.791043763	0.039037428	1.43967698	0	8.44E-05	1.05146904	5.979922565	8.779087552	0.438136372	2.471696426	1.499657209	1.80E-06	4.646839102	0.0058699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3201	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												1.5419	0.0467	0.12	0.0358	2.0349	0.2291	0.0091	0.2164	0.7369	0.0146	0.2162	0	0	0.1902	0.4608	0.5484	0.2031	0.0509	0.31	0	0.6396	0.0006	0	1.8366	0	0	0	0	0	0											9.4418	0	NO	0.791978882	11.1398	0.16381449	2.373841103	2.289276231	2.068295359	2.325160852	0.126056831	1.925297056	5.527931428	0.05363575	1.655852751	0	8.44E-05	1.241710442	6.440689712	9.327452786	0.641260234	2.522645063	1.80963219	1.80E-06	5.286446989	0.006442344	0	1.836580565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7619
H3817_003_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	601.1695723	8.484856754	921.666668	26.12341987	2.93559205	21.81313211	1.445642077	303.0515559	439.6603483	0	18.70642248	0	0	575.6705338	5897.094655	3791.16061	310.0736574	1436.850166	27.75510436	0	47.74677815	0	0	0	0	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$0/Days 1-10, $30/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $10/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"	See i.2.; 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	NO	150	150	11.94314344	0	100	0.1	0.1	65	100	0	0.106951102	0	0	25	10	24.17313496	25	25	0.078758039	0	0.121171055	0	0	0	0	0	0	0	0	0											NO	129.0811942	129.0811942	10.27756811	0	86.05412946	0.086054129	0.086054129	55.93518415	86.05412946	0	0.092035839	0	0	21.51353236	8.605412946	20.80198085	21.51353236	21.51353236	0.067774545	0	0.104272696	0	0	0	0	0	0	0	0	0												6.4666	0.09126962	0.78937433	0	0.021051652	1.877110094	0.12440347	1.412603716	3.152882378	0	1.721661297	0	0	1.032058888	4.228911224	6.571970868	0.555898305	2.57597688	1.88108957	0	4.978685294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4816	0	NO	6.663073154	6.4666	0.09126962	0.78937433	0	0.021051652	1.877110094	0.12440347	1.412603716	3.152882378	0	1.721661297	0	0	1.032058888	4.228911224	6.571970868	0.555898305	2.57597688	1.88108957	0	4.978685294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4816	YES	$250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-10, $40/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												1.9345	0.0271	0.0407	0.0258	1.5152	0.2909	0.0047	0.1653	0.9715	0	0.3807	0	0	0.1709	0.5069	0.6455	0.2329	0.1317	0.2185	0	0.7799	0	0	1.9274	0	0	0	0	0	0											9.9702	0	NO	1.026926846	8.4011	0.118370569	0.830114067	0.025805439	1.536261247	2.1680233	0.1291124	1.577933207	4.124417741	0	2.102367498	0	0	1.202996464	4.735810692	7.21743606	0.788831072	2.70769032	2.099553854	0	5.758546051	0	0	1.927400729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4518
H3817_801_0	2012	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	207.5321238	1.596540559	34.95163248	23.89252569	0.331571593	18.85368734	1.045277937	21.02182305	55.27135425	6.938307603	16.79011807	0	0.008288861	19.88503653	64.37671625	129.6716357	2.012070698	9.285031832	24.63972711	0.000777248	35.1581028	1.472194394	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	NO	0.081343403	0.081343403	0.134038114	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075361619	0.075361619	0.124181297	0	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0	0	0	0	0	0	0	0												15.64	0.120317882	4.340339047	0	0.068810263	3.912660832	0.216924041	4.362608873	11.47033252	1.439890453	3.484413217	0	0.001720168	4.126694273	13.35994661	26.91044573	0.41756024	1.926900543	5.113423887	0.0001613	7.296277343	0.305520996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5149	0	NO	8.303086371	15.64	0.120317882	4.340339047	0	0.068810263	3.912660832	0.216924041	4.362608873	11.47033252	1.439890453	3.484413217	0	0.001720168	4.126694273	13.35994661	26.91044573	0.41756024	1.926900543	5.113423887	0.0001613	7.296277343	0.305520996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5149	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												2.3161	0.0191	0.2766	0	1.9598	0.2782	0.0048	0.4234	1.4347	0.5216	0.5414	0	0.0028	1.3011	0.7197	1.3101	0.15	0.0501	0.3245	0	1.4978	0.0234	0	0	0	0	0	0	0	0											13.1553	0	NO	1.036913629	17.9561	0.139416509	4.616938926	0	2.028575005	4.190883351	0.221753584	4.786052574	12.90506344	1.961540328	4.025817284	0	0.004511929	5.427817814	14.07964076	28.22050637	0.567539883	1.976954388	5.437900153	0.0001613	8.794075779	0.32892895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6702
H3817_802_0	2012	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	207.5321238	1.596540559	34.95163248	23.89252569	0.331571593	18.85368734	1.045277937	21.02182305	55.27135425	6.938307603	16.79011807	0	0.008288861	19.88503653	64.37671625	129.6716357	2.012070698	9.285031832	24.63972711	0.000777248	35.1581028	1.472194394	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	NO	0.081343403	0.081343403	0.134038114	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.075361619	0.075361619	0.124181297	0	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0.207527618	0	0	0	0	0	0	0	0												15.64	0.120317882	4.340339047	0	0.068810263	3.912660832	0.216924041	4.362608873	11.47033252	1.439890453	3.484413217	0	0.001720168	4.126694273	13.35994661	26.91044573	0.41756024	1.926900543	5.113423887	0.0001613	7.296277343	0.305520996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5149	0	NO	8.303086371	15.64	0.120317882	4.340339047	0	0.068810263	3.912660832	0.216924041	4.362608873	11.47033252	1.439890453	3.484413217	0	0.001720168	4.126694273	13.35994661	26.91044573	0.41756024	1.926900543	5.113423887	0.0001613	7.296277343	0.305520996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5149	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												2.3161	0.0191	0.2766	0	1.9598	0.2782	0.0048	0.4234	1.4347	0.5216	0.5414	0	0.0028	1.3011	0.7197	1.3101	0.15	0.0501	0.3245	0	1.4978	0.0234	0	0	0	0	0	0	0	0											13.1553	0	NO	1.036913629	17.9561	0.139416509	4.616938926	0	2.028575005	4.190883351	0.221753584	4.786052574	12.90506344	1.961540328	4.025817284	0	0.004511929	5.427817814	14.07964076	28.22050637	0.567539883	1.976954388	5.437900153	0.0001613	8.794075779	0.32892895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6702
H3818_002_0	2012	7																															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	YES	282.5414348	18.44927398	60.25102104	0	26.42208981	29.51043699	15.73050154	40.52693642	43.9361245	33.57603576	53.68621311		0.136886937	93.17957181	0	2.009226781	0	2.154141144	18.2828826	19.99555735	15.50834237	0.504834469	0	0	0	0	0	0	0	0											3400	Medicare IP	Medicare IP	Medicare SNF	$0 Copay HHC	Medicare Ambul	Medicare DME	Medicare Prosthetics/Medicare Diabetic Supplies	$50 ER/Medicare Urgent Care	Medicare OP Hosp & Surg/Medicare ASC	Medicare Lab/Medicare Lab	Medicare Rad/Medicare MRI/CT/PET/Medicare Rad		Medicare Dialysis	Medicare CORF/Medicare Partial Hospitalization/Medicare Rad/Medicare OP Hosp & Surg/Medicare OP Substance Abuse/Medicare Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	Medicare Chiro/$0 Copay Specialists/Medicare Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	Medicare OT	Medicare Rad	$50 ER/$0 Copay Other/Medicare Lab/$0 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	Medicare Part B Rx - Chemo/Medicare Part B Rx/N	Medicare Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$0 Copay Non-Covered Vision Exams (Plan C)	$100 Glasses/$65 Contacts Coverage (Plan C)	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/$0 Copay HE News Letter/No Coverage Fitness/$0 Copay Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													0.080773358	0.080773358	0.136459615	0	0.224	0.224	0.224	0.11565458	0.224	0.224	0.224	0	0.224	0.224	0	0.224	0	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080773358	0.080773358	0.136459615	0	0.224	0.224	0.224	0.11565458	0.224	0.224	0.224	0	0.224	0.224	0	0.224	0	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												22.8218	1.490209805	8.221831128	0	5.918548118	6.610337886	3.523632346	4.687125826	9.841691889	7.52103201	12.02571174	0	0.030662674	20.87222408	0	0.450066799	0	0.482527616	4.095365703	4.479004846	3.473868692	0.113082921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6587	0	YES	0	22.8218	1.490209805	8.221831128	0	5.918548118	6.610337886	3.523632346	4.687125826	9.841691889	7.52103201	12.02571174	0	0.030662674	20.87222408	0	0.450066799	0	0.482527616	4.095365703	4.479004846	3.473868692	0.113082921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6587	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	22.8218	1.490209805	8.221831128	0	5.918548118	6.610337886	3.523632346	4.687125826	9.841691889	7.52103201	12.02571174	0	0.030662674	20.87222408	0	0.450066799	0	0.482527616	4.095365703	4.479004846	3.473868692	0.113082921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.6587
H3818_003_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin			V	V				V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	865.3153149	155.5302284	632.5834811	540.1761842	242.9341225	17.92646061	9.29137321	658.2016964	28.9255761	25.2449915	42.73154937		0.072222078	75.48076477	3481.025894	2986.252318	566.46913	4.56711458	16.44456293	19.67569376	13.63750522	0.331192347	0	0	113.5983778	0	0	0	0	15.1045423											3400	$295/day (Days 1-6)	$295/day (Days 1-6)	$25/day (Days 21-100)	$20 Copay HHC	$100 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$35 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		20% Coin Dialysis	20% Coin CORF/$0 Copay Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$20 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$35 Copay Specialists/$35 Copay Podiatry/$35 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$35 Copay Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/$35 Copay Other/20% Coin Lab/$35 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$20 Copay Non-Covered Vision Exams	$100 Glasses/$65 Contacts Coverage	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/$0 Copay HE News Letter/No Coverage Fitness/$0 Copay Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/$35 Copay Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													295	295	25	20	100	0.2	0.2	49.14003384	0.2	0.2	0.2	0	0.2	0.2	20	33.29928671	35	0.2	0.2	0.190819795	0.2	0.2	0	0	20	0	0	0	0	35											NO	263.3860978	263.3860978	22.32085575	17.8566846	89.28342299	0.178566846	0.178566846	43.87390427	0.178566846	0.178566846	0.178566846	0	0.178566846	0.178566846	17.8566846	29.730743	31.24919805	0.178566846	0.178566846	0.170370445	0.178566846	0.178566846	0	0	17.8566846	0	0	0	0	31.24919805												18.9927	3.41370833	1.176650386	0.803812979	1.807499168	3.201071532	1.659131209	2.406489852	5.165148892	4.507918509	7.630437995	0	0.012896469	13.4783621	5.179965122	7.398625018	1.475142169	0.815535246	2.936453736	3.352156697	2.435206295	0.059139973	0	0	0.169040867	0	0	0	0	0.039333736	0	0	0	0	0	0	0	0	0	0	88.1164	0	NO	10.5765001	18.9927	3.41370833	1.176650386	0.803812979	1.807499168	3.201071532	1.659131209	2.406489852	5.165148892	4.507918509	7.630437995	0	0.012896469	13.4783621	5.179965122	7.398625018	1.475142169	0.815535246	2.936453736	3.352156697	2.435206295	0.059139973	0	0	0.169040867	0	0	0	0	0.039333736	0	0	0	0	0	0	0	0	0	0	88.1164	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	18.9927	3.41370833	1.176650386	0.803812979	1.807499168	3.201071532	1.659131209	2.406489852	5.165148892	4.507918509	7.630437995	0	0.012896469	13.4783621	5.179965122	7.398625018	1.475142169	0.815535246	2.936453736	3.352156697	2.435206295	0.059139973	0	0	0.169040867	0	0	0	0	0.039333736	0	0	0	0	0	0	0	0	0	0	88.1164
H3818_004_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin			V	V				V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	583.011177	63.55178908	469.1863034	325.9517054	149.5409146	12.28425946	6.214968616	467.7306232	20.51390777	17.53811512	28.25137729		0.062688359	48.40959909	2466.69812	2193.982804	282.2515713	3.787588269	13.77405562	14.01759515	12.79611342	0.237666932	0	0	120.5180078	0	0	0	0	16.02460688											3400	$295/day (Days 1-6)	$295/day (Days 1-6)	$25/day (Days 21-100)	$20 Copay HHC	$100 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$35 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		20% Coin Dialysis	20% Coin CORF/$0 Copay Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$20 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$35 Copay Specialists/$35 Copay Podiatry/$35 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$35 Copay Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/$35 Copay Other/20% Coin Lab/$35 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$20 Copay Non-Covered Vision Exams	$100 Glasses/$65 Contacts Coverage	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/$0 Copay HE News Letter/No Coverage Fitness/$0 Copay Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/$35 Copay Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													295	295	25	20	100	0.2	0.2	48.5857692	0.2	0.2	0.2	0	0.2	0.2	20	32.99609493	35	0.2	0.2	0.190372167	0.2	0.2	0	0	20	0	0	0	0	35											NO	263.3860978	263.3860978	22.32085575	17.8566846	89.28342299	0.178566846	0.178566846	43.37903783	0.178566846	0.178566846	0.178566846	0	0.178566846	0.178566846	17.8566846	29.46004301	31.24919805	0.178566846	0.178566846	0.169970787	0.178566846	0.178566846	0	0	17.8566846	0	0	0	0	31.24919805												12.7964	1.394888145	0.872719983	0.485034733	1.112627061	2.193561467	1.109787344	1.6908087	3.663103809	3.131725902	5.044759337	0	0.011194063	8.644349425	3.670587527	5.386235648	0.735011271	0.676337691	2.459589669	2.382581677	2.284961615	0.042439434	0	0	0.179337671	0	0	0	0	0.041729676	0	0	0	0	0	0	0	0	0	0	60.0098	0	NO	7.202899855	12.7964	1.394888145	0.872719983	0.485034733	1.112627061	2.193561467	1.109787344	1.6908087	3.663103809	3.131725902	5.044759337	0	0.011194063	8.644349425	3.670587527	5.386235648	0.735011271	0.676337691	2.459589669	2.382581677	2.284961615	0.042439434	0	0	0.179337671	0	0	0	0	0.041729676	0	0	0	0	0	0	0	0	0	0	60.0098	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	12.7964	1.394888145	0.872719983	0.485034733	1.112627061	2.193561467	1.109787344	1.6908087	3.663103809	3.131725902	5.044759337	0	0.011194063	8.644349425	3.670587527	5.386235648	0.735011271	0.676337691	2.459589669	2.382581677	2.284961615	0.042439434	0	0	0.179337671	0	0	0	0	0.041729676	0	0	0	0	0	0	0	0	0	0	60.0098
H3818_014_0	2012	7																															D	D		V	T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin				V	V				V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	803.1012368	60.61125842	0	465.9071968	178.7678325	15.71725943	7.772570552	534.4552399	34.13926527	0	38.37853501		0.12737636	80.71516572	3752.593866	3400.441491	340.6500889	1356.555245	16.69665249	10.57276335	22.06451468	0	0	0	120.5180078	0	0	0	0	16.02460688											3400	$160/day (Days 1-6)	$160/day (Days 1-6)	$0 Copay	$20 Copay HHC	$100 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$30 Copay Urgent Care	10% Coin OP Hosp & Surg/10% Coin ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		20% Coin Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/10% Coin OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$30 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health	$30 Copay OT	10% Coin Rad	$50 ER Waived/$30 Copay Other/$0 Copay Lab/$30 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$20 Copay Non-Covered Vision Exams	$100 Glasses/$65 Contacts Coverage	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/$0 Copay HE News Letter/No Coverage Fitness/$0 Copay Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/$30 Copay Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													160	160	0	20	100	0.2	0.2	47.65755453	0.1	0	0.1	0	0.2	0.095550392	15	28.92774174	30	30	0.1	0.158527236	0.2	0	0	0	20	0	0	0	0	30											NO	151.0793934	151.0793934	0	18.88492418	94.4246209	0.188849242	0.188849242	45.0004652	0.094424621	0	0.094424621	0	0.188849242	0.090223095	14.16369313	27.31491047	28.32738627	28.32738627	0.094424621	0.149688741	0.188849242	0	0	0	18.88492418	0	0	0	0	28.32738627												10.111	0.76309268	0	0.733218507	1.406673734	2.968192527	1.467844056	2.004227868	3.223587181	0	3.623878619	0	0.024054929	7.282372077	4.429215665	7.740229575	0.804143887	3.202305368	1.576575082	1.582623639	4.166866867	0	0	0	0.189664453	0	0	0	0	0.037827936	0	0	0	0	0	0	0	0	0	0	57.3376	0	NO	3.385545488	10.111	0.76309268	0	0.733218507	1.406673734	2.968192527	1.467844056	2.004227868	3.223587181	0	3.623878619	0	0.024054929	7.282372077	4.429215665	7.740229575	0.804143887	3.202305368	1.576575082	1.582623639	4.166866867	0	0	0	0.189664453	0	0	0	0	0.037827936	0	0	0	0	0	0	0	0	0	0	57.3376	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	10.111	0.76309268	0	0.733218507	1.406673734	2.968192527	1.467844056	2.004227868	3.223587181	0	3.623878619	0	0.024054929	7.282372077	4.429215665	7.740229575	0.804143887	3.202305368	1.576575082	1.582623639	4.166866867	0	0	0	0.189664453	0	0	0	0	0.037827936	0	0	0	0	0	0	0	0	0	0	57.3376
H3832_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	V	V	V	V	V	Coin	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	1544.757531	11.09951279	1219.843241		24.10623083	3.951366711	1.565968378	258.1728307	44.62334899		20.18520391	23.21505778		2321.932313	4771.88271	7076.2756	232.2672974		17.58454665		18.29859208	1.063895249								8.175514918											3400	$195/day days 1-5	$195/day days 1-5	"$50/day days 1-20, $100/day days 21-48, $0/day 49-100"	$0 copay	$100 copay/trip	20% coins	20% coins	"$50 copay ER, $50 copay Urgent Care"	20% coinsurance	"$10 copay, $0 copay certified lab"	20% coinsurance	"$40 copay individual, $30 copay group"	20% coinsurance	$30 Copay for OP PT/OT/ST	$5 copay	$20 copay	$20 copay	$0 copay	20% coins	$20 copay for chiro and podiatry	20% coins	20% coins	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	Woldwide ER coverage $50 copay											0	NO	111.3029979	111.3029979	58.6716089		100	0.2	0.2	50	0.2		0.2	42.65422275		36.82384282	5	10.03790559	10		0.2		0.2	0.2								20											NO	99.24364178	99.24364178	52.31471069		89.1652908	0.178330582	0.178330582	44.5826454	0.178330582		0.178330582	38.03276176		32.83408654	4.45826454	8.950327707	8.91652908		0.178330582		0.178330582	0.178330582								20												12.7756	0.091796339	5.317978853	0	0.179119923	0.704649524	0.279260052	0.95916898	7.957707779	0	3.599639153	0.07357773	0	6.35321054	1.772859623	5.277915464	0.172584843	0	3.135862431	0	3.263198568	0.189725059	0	0	0	0	0	0	0	0.013625858	0	0	0	0	0	0	0	0	0	0	52.1175	0		6.33127821	12.7756	0.091796339	5.317978853	0	0.179119923	0.704649524	0.279260052	0.95916898	7.957707779	0	3.599639153	0.07357773	0	6.35321054	1.772859623	5.277915464	0.172584843	0	3.135862431	0	3.263198568	0.189725059	0	0	0	0	0	0	0	0.013625858	0	0	0	0	0	0	0	0	0	0	52.1175	YES	$375/day days 1-11	$375/day days 1-11	"$175/day days 1-49, $0/day days 50-100"	$0 copay	$150 copay/trip	30% coins	30% coins	"$50 copay ER, $50 copay Urgent Care"	30% coinsurance	$10 copay	30% coinsurance	"$45 copay individual, $35 copay group"	20% coinsurance	$35 Copay for OP PT/OT/ST	$35 copay	$35 copay	$35 copay	$0 copay	30% coins	$35 copay for chiro and podiatry	30% coins	30% coins	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											4500	0.2108		0.0279	0.0006	1.1408	0.0439	0.1509	0.007	0.0587		0.0841	0.0054		0.1023	0.1094	0.0394	0.0084		0.0554		0.0709									0.0005											2.1165	0		0.257120474	12.9864	0.091796339	5.345927301	0.000632658	1.319892006	0.748525716	0.430162167	0.966121879	8.016401349	0	3.683741683	0.078997655	0	6.455517304	1.882273704	5.3173332	0.1810315	0	3.191229128	0	3.334119503	0.189725059	0	0	0	0	0	0	0	0.014161707	0	0	0	0	0	0	0	0	0	0	54.234
H3832_006_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1544.757531	11.09951279	1219.843241		24.10623083	3.951366711	1.565968378	258.1728307	455.2557493		12.71932601	23.21505778		100.6323213	4771.88271	7076.2756	232.2672974				18.29859208									8.175514918											3400	$100/day days 1-5	$195/day days 1-5	"$0/day days 1-20, $95/day days 21-100"	$0 copay	$50 copay/trip	20% coins	20% coins	"$50 copay ER, $50 copay Urgent Care"	$15 copay	"$15 copay, $0 copay certified lab"	$15 copay	"$40 copay individual, $30 copay group"	20% coinsurance	$30 Copay for OP PT/OT/ST	$5 copay	$5 copay	$5 copay	$15 copay	0% coins	$15 copay for chiro and podiatry	20% coins	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	Woldwide ER coverage $50 copay											0	NO	57.07846048	111.3029979	16.49509116		50	0.2	0.2	50	15		0.076859883	15		15	5	5.037905587	5				0.2									15											NO	56.05387311	109.3050526	16.19899589		49.10247459	0.196409898	0.196409898	49.10247459	14.73074238		0.075480209	14.73074238		14.73074238	4.910247459	4.947472621	4.910247459				0.196409898									15												7.2158	0.101102736	1.646686304	0	0.098639632	0.776087534	0.30757169	1.056410405	0.558854597	0	0.960057386	0.02849792	0	0.1235324	1.952593746	2.917473316	0.095040826	0	0	0	3.59402461	0	0	0	0	0	0	0	0	0.010219394	0	0	0	0	0	0	0	0	0	0	21.4426	0		0.391754241	7.2158	0.101102736	1.646686304	0	0.098639632	0.776087534	0.30757169	1.056410405	0.558854597	0	0.960057386	0.02849792	0	0.1235324	1.952593746	2.917473316	0.095040826	0	0	0	3.59402461	0	0	0	0	0	0	0	0	0.010219394	0	0	0	0	0	0	0	0	0	0	21.4426	YES	$375/day days 1-11	$375/day days 1-11	"$0/day days 1-20, $95/day days 21-100"	$0 copay	$100 copay/trip	25% coins	25% coins	"$50 copay ER, $50 copay Urgent Care"	$100 copay	"$30 copay, $0 copay certified lab"	$30 copay	"$45 copay individual, $35 copay group"	20% coinsurance	$30 Copay for OP PT/OT/ST	$30 copay	$30 copay	$30 copay	$30 copay	0% coins	$30 copay for chiro and podiatry	30% coins	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											4500	0.2322		0.0029	0.0007	0.8376	0.0403	0.1385	0.0077	0.023		0.0028	0.0015		0.0012	0.1033	0.0372	0.0062				0.0651									0.0005											1.5006	0		0.02741924	7.448	0.101102736	1.649591167	0.000696798	0.936256029	0.816357868	0.446072281	1.064068195	0.581827967	0	0.962814056	0.029956546	0	0.124772798	2.0558851	2.954685267	0.101242817	0	0	0	3.65911708	0	0	0	0	0	0	0	0	0.010755242	0	0	0	0	0	0	0	0	0	0	22.9432
H3832_801_0	2012	4																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	1601.395067	10.97818859	1258.554957		27.699217	4.095815084	1.63342861	263.672373	44.18338395	3.410651609	20.08052269	0.421529099	0.148439216	39.07624584	54.83553797	97.36622714	2.494542523	7.620353559	17.49772845	53.53551209	18.26138851	1.03779828																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	148.3584289	57.67023229	76.5812014		82.95030196	0.224	0.224	133.643098	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	125.721482	48.87201659	64.8948111		70.28158051	0.189815036	0.189812701	113.2512707	0.189832541	0.189825924	0.189830705	0.18982048	0.189803325	0.189820785	0.189823921	0.189827774	0.189799483	0.18983183	0.189830607	0.189829791	0.189829475	0.18983842																				16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	0		17.22880745	16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	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											6700	0.1776		0.0167		0.8734	0.0314	0.1087	0.089	0.0404	0.0258	0.0579	0.0037		0.083	0.2745	0.0456	0.0057	0.0176	0.0383	0.0937	0.0892																				2.0722	0		0.373128816	16.955	0.044710518	6.822858832	0	1.035599871	0.808821696	0.418784186	2.577432037	8.427848983	0.673268716	3.869796353	0.083745958	0.028174257	7.500482454	10.68360983	18.52843764	0.479139236	1.464185045	3.3599012	10.25629955	3.55576165	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7709
H3832_802_0	2012	4																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	1601.395067	10.97818859	1258.554957		27.699217	4.095815084	1.63342861	263.672373	44.18338395	3.410651609	20.08052269	0.421529099	0.148439216	39.07624584	54.83553797	97.36622714	2.494542523	7.620353559	17.49772845	53.53551209	18.26138851	1.03779828																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	148.3584289	57.67023229	76.5812014		82.95030196	0.224	0.224	133.643098	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	125.721482	48.87201659	64.8948111		70.28158051	0.189815036	0.189812701	113.2512707	0.189832541	0.189825924	0.189830705	0.18982048	0.189803325	0.189820785	0.189823921	0.189827774	0.189799483	0.18983183	0.189830607	0.189829791	0.189829475	0.18983842																				16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	0		17.22880745	16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	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											6700	0.1776		0.0167		0.8734	0.0314	0.1087	0.089	0.0404	0.0258	0.0579	0.0037		0.083	0.2745	0.0456	0.0057	0.0176	0.0383	0.0937	0.0892																				2.0722	0		0.373128816	16.955	0.044710518	6.822858832	0	1.035599871	0.808821696	0.418784186	2.577432037	8.427848983	0.673268716	3.869796353	0.083745958	0.028174257	7.500482454	10.68360983	18.52843764	0.479139236	1.464185045	3.3599012	10.25629955	3.55576165	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7709
H3832_805_0	2012	4																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	1601.395067	10.97818859	1258.554957		27.699217	4.095815084	1.63342861	263.672373	44.18338395	3.410651609	20.08052269	0.421529099	0.148439216	39.07624584	54.83553797	97.36622714	2.494542523	7.620353559	17.49772845	53.53551209	18.26138851	1.03779828																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	148.3584289	57.67023229	76.5812014		82.95030196	0.224	0.224	133.643098	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	125.721482	48.87201659	64.8948111		70.28158051	0.189815036	0.189812701	113.2512707	0.189832541	0.189825924	0.189830705	0.18982048	0.189803325	0.189820785	0.189823921	0.189827774	0.189799483	0.18983183	0.189830607	0.189829791	0.189829475	0.18983842																				16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	0		17.22880745	16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	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											6700	0.1776		0.0167		0.8734	0.0314	0.1087	0.089	0.0404	0.0258	0.0579	0.0037		0.083	0.2745	0.0456	0.0057	0.0176	0.0383	0.0937	0.0892																				2.0722	0		0.373128816	16.955	0.044710518	6.822858832	0	1.035599871	0.808821696	0.418784186	2.577432037	8.427848983	0.673268716	3.869796353	0.083745958	0.028174257	7.500482454	10.68360983	18.52843764	0.479139236	1.464185045	3.3599012	10.25629955	3.55576165	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7709
H3832_806_0	2012	3																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	1601.395067	10.97818859	1258.554957		27.699217	4.095815084	1.63342861	263.672373	44.18338395	3.410651609	20.08052269	0.421529099	0.148439216	39.07624584	54.83553797	97.36622714	2.494542523	7.620353559	17.49772845	53.53551209	18.26138851	1.03779828																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	148.3584289	57.67023229	76.5812014		82.95030196	0.224	0.224	133.643098	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	125.721482	48.87201659	64.8948111		70.28158051	0.189815036	0.189812701	113.2512707	0.189832541	0.189825924	0.189830705	0.18982048	0.189803325	0.189820785	0.189823921	0.189827774	0.189799483	0.18983183	0.189830607	0.189829791	0.189829475	0.18983842																				16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	0		17.22880745	16.7775	0.044710518	6.806140516	0	0.162228729	0.777447286	0.310045496	2.488435941	8.387444048	0.647430092	3.811899769	0.080014856	0.028174257	7.417483677	10.40909683	18.48281412	0.47346288	1.44658566	3.321604416	10.16263508	3.4665498	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6987	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											6700	0.1776		0.0167		0.8734	0.0314	0.1087	0.089	0.0404	0.0258	0.0579	0.0037		0.083	0.2745	0.0456	0.0057	0.0176	0.0383	0.0937	0.0892																				2.0722	0		0.373128816	16.955	0.044710518	6.822858832	0	1.035599871	0.808821696	0.418784186	2.577432037	8.427848983	0.673268716	3.869796353	0.083745958	0.028174257	7.500482454	10.68360983	18.52843764	0.479139236	1.464185045	3.3599012	10.25629955	3.55576165	0.197013986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.7709
H3864_001_0	2012	8																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	191.4428187	1.283333455	43.14771013		196.8657417	0.327787614	1.195552666	252.3459619	194.0861131	7000.774824	94.07467957		0.142521759	837.1704521	2109.436234	9836.619026	333.7845724	1450.586177			49.14050572	968.8989588			167.6433117																3400	"1a (IP Acute); 175 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 175 days 1-5	"2a (SNF); 25 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 20 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 75 copay, 8b (MRI); 75 copay, 8b (CT Scan); 50 copay, 8b (PET Scan); 200 copay"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 175 copay/day, days 1-5, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 25 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 25 copay, 7f (Podiatry); 25 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 25 copay, 7h (Psych); 25 copay"	"7c (OT); 25 copay, 7i (PT/ST); 25 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 25 copay	"; , 7g (Prof. Other); 10-25 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 25 copay, 17a (MCR Eye Exam); 25 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 25 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 25 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 25 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	617.6479418	681.7199891	138.2136985		50	0.2	0.2	64.91112922	175	10	47.81132366		10	125.5941564	10.53944128	24.4288587	25	25			0.2	25			25.06919179																NO	488.4343832	539.1023913	109.2990327		39.53986974	0.158159479	0.158159479	51.33155188	138.3895441	7.907973948	37.80907019		7.907973948	113.323473	8.334562705	19.34083072	19.76993487	19.76993487			0.158159479	19.76993487			19.84635121																	7.7923	0.057654011	0.393000248	0	0.648670482	0.051842718	0.189087987	1.079442486	2.238290725	4.61349541	0.296406347	0	9.39E-05	7.905921924	1.46510238	15.85403195	0.549908271	2.389832853	0	0	7.77203678	1.596255776	0	0	0.277259003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1706	0		13.33599514	7.7923	0.057654011	0.393000248	0	0.648670482	0.051842718	0.189087987	1.079442486	2.238290725	4.61349541	0.296406347	0	9.39E-05	7.905921924	1.46510238	15.85403195	0.549908271	2.389832853	0	0	7.77203678	1.596255776	0	0	0.277259003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1706	YES	1a (IP Acute); 20% coin	1b (IP Psych); 20% coin	2a (SNF); 20% coin	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin	"11b (Prosthetics); 20% coin, 11b (Medical Supplies); 20% coin, 11c (Diabetic Supplies); 20% coin"	"4a (ER); 65 copay, 4b (UC); 20 copay"	"9a (OP Surgery); 20% coin, 9b (OP ASC); 20% coin"	8a (OP Diag Proc/Test/Lab); 20% coin	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 20% coin,8b (OP Diag Rad); 20% coin,8b (X-Ray); 20% coin,8b (Nuclear Medicine); n/a,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 20% coin, 9a2 (OP Clinic); 20% coin, 9a3 (OP Observation); 20% coin, 9a4 (OP Other); 20% coin, 9a5 (OP Other Cardiology); 20% coin, 9c (OP SA); 20% coin"	"7a (PCP); 15 copay, 14a (Education/Wellness); 15-30 copay, 14a1; n/a, 14a2 (Nutritional Training); 15-30 copay, 14a3 (Online Health Programs); 15-30 copay, 14a4 (Immunizations-MC); 15-30 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 15-30 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 15-30 copay, 14h (Mammography); 15-30 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 15-30 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 15-30 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 15-30 copay"	"7d (Specialist); 30 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 15-30 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											5100	1.6451	0.0069	0.1689		0.0341	0.0027	0.0106	0.0568	0.2386	0.2529	0.1067			0.1473	0.198	0.9929	0.027	0.0851			0.4091	0.0821			0.0075																4.4726	0		1.169172107	9.4374	0.064506481	0.561912296	0	0.682811034	0.054571282	0.199712606	1.136263891	2.47689531	4.866363964	0.403139112	0	9.39E-05	8.05326137	1.663120693	16.84697711	0.576955838	2.47495365	0	0	8.181091348	1.678398236	0	0	0.284798334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6432
H3864_002_0	2012	7																															A	A	A	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	140.1802871	6.223352035	16.22203792		181.4672609	0.662226623	1.074840024	276.9247401	17.8782783	5630.022216	126.8226836			1699.599082	2010.881509	6503.971256	335.7053554	1342.946096			33.57017012	835.8059714			100.8483591		0.122507771														3400	"1a (IP Acute); 275 days 1-6, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 275 days 1-6	"2a (SNF); 10 days 1-20, 75 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 100 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 20% coin, 9b (OP ASC); 20% coin"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 175 copay, 8b (MRI); 325 copay, 8b (CT Scan); 125 copay, 8b (PET Scan); 325 copay"		12 (Renal Dialysis); 0 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 275 copay/day, days 1-6, 9a2 (OP Clinic); 20% coin, 9a3 (OP Observation); 20% coin, 9a4 (OP Other); 20% coin, 9a5 (OP Other Cardiology); 20% coin, 9c (OP SA); 35 copay"	"7a (PCP); 15 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 35 copay, 7f (Podiatry); 35 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 35 copay, 7h (Psych); 35 copay"	"7c (OT); 35 copay, 7i (PT/ST); 35 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 35 copay	"; , 7g (Prof. Other); 15-35 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 35 copay, 17a (MCR Eye Exam); 35 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 35 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 35 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 35 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													1062.911298	1193.621821	249.8159523		100	0.2	0.2	64.84756889	0.2	10	130.9495912			21.3768156	16.5746606	33.68468373	35	35			0.2	34.87349549			35		20.54000145														NO	877.100707	984.9613469	206.1449049		82.51871149	0.165037423	0.165037423	53.51137827	0.165037423	8.251871149	108.0579153			17.63987279	13.67719636	27.90853034	28.88154902	28.88154902			0.165037423	28.88154902			28.88154902		20.54000145															10.246	0.510813434	0.278674205	0	1.247870379	0.109292175	0.177388828	1.234885377	2.950584979	3.871518157	1.142016234	0	0	2.498392634	2.291935105	15.12635659	0.807974223	3.232196958	0	0	5.540334365	2.011614261	0	0	0.242721402	0	0.000209692	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5208	0		11.25552838	10.246	0.510813434	0.278674205	0	1.247870379	0.109292175	0.177388828	1.234885377	2.950584979	3.871518157	1.142016234	0	0	2.498392634	2.291935105	15.12635659	0.807974223	3.232196958	0	0	5.540334365	2.011614261	0	0	0.242721402	0	0.000209692	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5208	NO																																																																																		0	0		0	10.246	0.510813434	0.278674205	0	1.247870379	0.109292175	0.177388828	1.234885377	2.950584979	3.871518157	1.142016234	0	0	2.498392634	2.291935105	15.12635659	0.807974223	3.232196958	0	0	5.540334365	2.011614261	0	0	0.242721402	0	0.000209692	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5208
H3864_006_0	2012	8																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	217.2410149	15.6390783	28.51858289		312.9068577	1.02011195	1.94812876	444.9238691	148.7816324	7202.338352	190.8440614			2025.249116	2572.094077	6830.187853	582.9568284	2041.972323			45.651697	771.7999726			104.6717155		0.307857987														3400	"1a (IP Acute); 200 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 200 days 1-5	"2a (SNF); 50 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 20 copay"	"9a (OP Surgery); 200 copay, 9b (OP ASC); 200 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 150 copay, 8b (MRI); 150 copay, 8b (CT Scan); 100 copay, 8b (PET Scan); 300 copay"		12 (Renal Dialysis); 0 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 200 copay/day, days 1-5, 9a2 (OP Clinic); 200 copay, 9a3 (OP Observation); 200 copay, 9a4 (OP Other); 200 copay, 9a5 (OP Other Cardiology); 200 copay, 9c (OP SA); 25 copay"	"7a (PCP); 15 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 25 copay, 7f (Podiatry); 25 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 25 copay, 7h (Psych); 25 copay"	"7c (OT); 25 copay, 7i (PT/ST); 25 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 25 copay	"; , 7g (Prof. Other); 15-25 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 25 copay, 17a (MCR Eye Exam); 25 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 25 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 25 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 25 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													705.883362	779.1085589	276.4273971		50	0.2	0.2	64.97125519	200	10	108.2490922			62.19872577	16.17397292	24.34263218	25	25			0.2	25			25		20.54328193														NO	560.371178	618.5015889	219.44411		39.6929017	0.158771607	0.158771607	51.57795291	158.7716068	7.93858034	86.9815411			55.33986243	12.83983834	19.37049786	19.84645085	19.84645085			0.158771607	19.84645085			19.84645085		19.84645085															10.1446	0.806066231	0.521519587	0	1.035015095	0.161964813	0.309307533	1.912355197	1.968524903	4.764695137	1.383325881	0	0	9.339750622	2.752106013	11.02534493	0.964135337	3.377158613	0	0	7.248193285	1.276457519	0	0	0.173113505	0	0.000509157	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1642	0		14.04153367	10.1446	0.806066231	0.521519587	0	1.035015095	0.161964813	0.309307533	1.912355197	1.968524903	4.764695137	1.383325881	0	0	9.339750622	2.752106013	11.02534493	0.964135337	3.377158613	0	0	7.248193285	1.276457519	0	0	0.173113505	0	0.000509157	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1642	NO																																																																																		0	0		0	10.1446	0.806066231	0.521519587	0	1.035015095	0.161964813	0.309307533	1.912355197	1.968524903	4.764695137	1.383325881	0	0	9.339750622	2.752106013	11.02534493	0.964135337	3.377158613	0	0	7.248193285	1.276457519	0	0	0.173113505	0	0.000509157	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1642
H3864_007_0	2012	9																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	205.862291	4.980539297	31.18445127		200.2660067	0.531310131	1.448224347	249.8711938	202.7178584	8280.457569	107.8580693		0.553118304	964.9148812	2314.184918	11582.98811	510.6889394	2077.797406			55.86339285	1272.595357			195.6225914																3400	"1a (IP Acute); 175 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 175 days 1-5	"2a (SNF); 25 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 20 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 75 copay, 8b (MRI); 75 copay, 8b (CT Scan); 50 copay, 8b (PET Scan); 200 copay"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 175 copay/day, days 1-5, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 25 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 25 copay, 7f (Podiatry); 25 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 25 copay, 7h (Psych); 25 copay"	"7c (OT); 25 copay, 7i (PT/ST); 25 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 25 copay	"; , 7g (Prof. Other); 10-25 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 25 copay, 17a (MCR Eye Exam); 25 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 25 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 25 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 25 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	617.6479418	681.7199891	138.2136985		50	0.2	0.2	64.87548423	175	10	52.5		10	125.684256	10.65346903	24.19798142	25	25			0.2	25			25.22837327																NO	468.7585237	517.3854457	104.8960822		37.94706434	0.151788257	0.151788257	49.23668348	132.8147252	7.589412867	39.84441755		7.589412867	110.8365869	8.085357496	18.41841839	18.97353217	18.97353217			0.151788257	18.97353217			19.22959212																	8.0416	0.214738212	0.272593897	0	0.633292253	0.080646639	0.21982345	1.02523574	2.243659721	5.236984268	0.358128496	0	0.00034982	8.912322674	1.559251031	17.7783601	0.807464418	3.285262993	0	0	8.47940705	2.012135746	0	0	0.313478554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4748	0		17.81913237	8.0416	0.214738212	0.272593897	0	0.633292253	0.080646639	0.21982345	1.02523574	2.243659721	5.236984268	0.358128496	0	0.00034982	8.912322674	1.559251031	17.7783601	0.807464418	3.285262993	0	0	8.47940705	2.012135746	0	0	0.313478554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4748	YES	1a (IP Acute); 20% coin	1b (IP Psych); 20% coin	2a (SNF); 20% coin	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin	"11b (Prosthetics); 20% coin, 11b (Medical Supplies); 20% coin, 11c (Diabetic Supplies); 20% coin"	"4a (ER); 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 20% coin, 9b (OP ASC); 20% coin"	8a (OP Diag Proc/Test/Lab); 20% coin	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 20% coin,8b (OP Diag Rad); 20% coin,8b (X-Ray); 20% coin,8b (Nuclear Medicine); n/a,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 20% coin, 9a2 (OP Clinic); 20% coin, 9a3 (OP Observation); 20% coin, 9a4 (OP Other); 20% coin, 9a5 (OP Other Cardiology); 20% coin, 9c (OP SA); 20% coin"	"7a (PCP); 15 copay, 14a (Education/Wellness); 15-30 copay, 14a1; n/a, 14a2 (Nutritional Training); 15-30 copay, 14a3 (Online Health Programs); 15-30 copay, 14a4 (Immunizations-MC); 15-30 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 15-30 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 15-30 copay, 14h (Mammography); 15-30 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 15-30 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 15-30 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 15-30 copay"	"7d (Specialist); 30 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 15-30 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											5100	1.6819	0.0255	0.1158		0.0333	0.0042	0.0121	0.054	0.2463	0.2768	0.112			0.1853	0.2265	1.1079	0.0369	0.117			0.4463	0.1118			0.0087																4.8024	0		1.493871376	9.7236	0.2402585	0.388402295	0	0.666623425	0.084891199	0.231953716	1.079207023	2.48995039	5.513798067	0.470175893	0	0.00034982	9.097604187	1.785740899	18.88626462	0.844367996	3.402277234	0	0	8.925691631	2.1239045	0	0	0.322148121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2772
H3864_014_0	2012	8																															A	A	A	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	218.2790186	15.7138037	28.65484811		314.4019644	0.886625485	1.693206914	447.0497689	18.54923603	7236.751993	191.7559373			2034.926	2584.383853	6862.823313	585.7422664	2051.729113			39.67795691	775.4877259			105.1718495		0.309328969														3400	"1a (IP Acute); 275 days 1-6, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 275 days 1-6	"2a (SNF); 10 days 1-20, 75 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 100 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 20% coin, 9b (OP ASC); 20% coin"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 175 copay, 8b (MRI); 325 copay, 8b (CT Scan); 125 copay, 8b (PET Scan); 325 copay"		12 (Renal Dialysis); 0 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 275 copay/day, days 1-6, 9a2 (OP Clinic); 225 copay, 9a3 (OP Observation); 225 copay, 9a4 (OP Other); 225 copay, 9a5 (OP Other Cardiology); 225 copay, 9c (OP SA); 35 copay"	"7a (PCP); 15 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 35 copay, 7f (Podiatry); 35 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 35 copay, 7h (Psych); 35 copay"	"7c (OT); 35 copay, 7i (PT/ST); 35 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 35 copay	"; , 7g (Prof. Other); 15-35 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 35 copay, 17a (MCR Eye Exam); 35 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 35 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 35 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 35 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													1062.911298	1193.621821	249.8159523		100	0.2	0.2	64.97444906	0.2	10	121.0486648			63.1409851	17.34794583	33.73757069	35	35			0.2	31.2240477			35		17.77018839														NO	790.6230408	887.8491704	185.8200664		74.38278646	0.148765573	0.148765573	48.3298057	0.148765573	7.438278646	102.6416573			53.37583946	12.90388551	25.21198711	26.03397526	26.03397526			0.148765573	26.03397526			26.03397526		17.77018839															14.3814	1.162623965	0.443720482	0	1.948841182	0.131899348	0.251890897	1.800485706	2.759487725	4.485748151	1.640178934	0	0	9.051323625	2.779049445	14.41878441	1.270766639	4.451222082	0	0	5.902713993	1.682419023	0	0	0.228170111	0	0.00045807	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7912	0		21.62526839	14.3814	1.162623965	0.443720482	0	1.948841182	0.131899348	0.251890897	1.800485706	2.759487725	4.485748151	1.640178934	0	0	9.051323625	2.779049445	14.41878441	1.270766639	4.451222082	0	0	5.902713993	1.682419023	0	0	0.228170111	0	0.00045807	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7912	NO																																																																																		0	0		0	14.3814	1.162623965	0.443720482	0	1.948841182	0.131899348	0.251890897	1.800485706	2.759487725	4.485748151	1.640178934	0	0	9.051323625	2.779049445	14.41878441	1.270766639	4.451222082	0	0	5.902713993	1.682419023	0	0	0.228170111	0	0.00045807	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7912
H3864_015_0	2012	6																															A	A	A	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	163.6712801	2.564040942	35.98347228		185.1877263	15.76104318	15.13361945	196.4193308	32.14974963	6210.192622	308.0649783		5.369696947	796.5011508	2623.821678	9267.983486	1.079910143	702.9943676			46.0552676				167.2939201		2.595851689														2500	"1a (IP Acute); 250 days 1-7, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 250 days 1-7	"2a (SNF);  100 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 150 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 20 copay"	"9a (OP Surgery); 10% coin, 9b (OP ASC); 10% coin"	8a (OP Diag Proc/Test/Lab); 0-15 copay	"8b (OP Therap Rad); 15 copay,8b (OP Diag Rad); 15% coin,8b (X-Ray); 15 copay, 8b (Nuclear Medicine); 15% coin, 8b (MRI); 15% coin, 8b (CT Scan); 15% coin, 8b (PET Scan); 15% coin"		12 (Renal Dialysis); 25 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 250 copay/day, days 1-7, 9a2 (OP Clinic); 10% coin, 9a3 (OP Observation); 10% coin, 9a4 (OP Other); 10% coin, 9a5 (OP Other Cardiology); 10% coin, 9c (OP SA); 25 copay"	"7a (PCP); 15 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 25 copay, 7f (Podiatry); 25 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 25 copay, 7h (Psych); 25 copay"	"7c (OT); 25 copay, 7i (PT/ST); 25 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 25 copay	"; , 7g (Prof. Other); 15-25 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 25 copay, 17a (MCR Eye Exam); 25 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 25 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 25 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 25 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													1033.273292	1175.963905	552.8547941		150	0.2	0.2	65	0.1	15	20.90111481		25	34.58285635	16.61430466	24.3644942	25	25			0.15				25		25														NO	753.8892224	857.9980925	403.3698286		109.4418913	0.145922522	0.145922522	47.42481957	0.072961261	10.94418913	15.24971691		18.24031522	25.23208804	12.12200617	17.77664218	18.24031522	18.24031522			0.109441891				18.24031522		18.24031522															10.2825	0.18332852	1.209553921	0	1.688941252	2.299891167	2.208335913	0.77626261	2.34568627	5.66379355	0.391491976	0	0.00816208	1.674782263	2.650498546	13.72946884	0.001641492	1.068569905	0	0	5.040375592	0	0	0	0.254291153	0	0.003945763	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4815	0		19.07855519	10.2825	0.18332852	1.209553921	0	1.688941252	2.299891167	2.208335913	0.77626261	2.34568627	5.66379355	0.391491976	0	0.00816208	1.674782263	2.650498546	13.72946884	0.001641492	1.068569905	0	0	5.040375592	0	0	0	0.254291153	0	0.003945763	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4815	NO																																																																																		0	0		0	10.2825	0.18332852	1.209553921	0	1.688941252	2.299891167	2.208335913	0.77626261	2.34568627	5.66379355	0.391491976	0	0.00816208	1.674782263	2.650498546	13.72946884	0.001641492	1.068569905	0	0	5.040375592	0	0	0	0.254291153	0	0.003945763	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4815
H3864_016_0	2012	8																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	163.5354949	3.363863027	36.96875541		134.442038	13.24211823	18.4998811	193.3817123	238.1865859	5480.370711	293.8780391		3.542505288	1272.103277	2030.129982	8581.994969	3.051515971	752.5857401			21.24051553				167.2939201		2.595851689														2500	"1a (IP Acute); 175 days 1-7, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 175 days 1-7	"2a (SNF);  125 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 175 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 10 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 175 copay, 8b (MRI); 325 copay, 8b (CT Scan); 125 copay, 8b (PET Scan); 325 copay"		12 (Renal Dialysis); 30 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 175 copay/day, days 1-7, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 30 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 30 copay, 7f (Podiatry); 30 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 30 copay, 7h (Psych); 30 copay"	"7c (OT); 30 copay, 7i (PT/ST); 30 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 30 copay	"; , 7g (Prof. Other); 10-30 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 30 copay, 17a (MCR Eye Exam); 30 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 30 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 30 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 30 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													723.2913046	870.2132896	38.77073031		175	0.2	0.2	65	175	10	51.08546051		30	152.5689811	13.82864505	28.41015271	30	30			0.2				27.97471657		30														NO	518.6746676	624.0329254	27.80262327		125.4930984	0.143420684	0.143420684	46.61172225	125.4930984	7.171034192	36.6335584		21.51310258	125.4930984	9.916568648	20.37301765	21.51310258	21.51310258			0.143420684				21.51310258		21.51310258															7.0685	0.174930107	0.085652365	0	1.405962325	1.899193652	2.653265599	0.751154555	2.490897721	3.274993813	0.897149859	0	0.006350857	13.30334847	1.677660278	14.57009458	0.005470631	1.349204519	0	0	3.046329262	0	0	0	0.299917605	0	0.004653735	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9647	0		19.27740581	7.0685	0.174930107	0.085652365	0	1.405962325	1.899193652	2.653265599	0.751154555	2.490897721	3.274993813	0.897149859	0	0.006350857	13.30334847	1.677660278	14.57009458	0.005470631	1.349204519	0	0	3.046329262	0	0	0	0.299917605	0	0.004653735	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9647	NO																																																																																		0	0		0	7.0685	0.174930107	0.085652365	0	1.405962325	1.899193652	2.653265599	0.751154555	2.490897721	3.274993813	0.897149859	0	0.006350857	13.30334847	1.677660278	14.57009458	0.005470631	1.349204519	0	0	3.046329262	0	0	0	0.299917605	0	0.004653735	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9647
H3864_801_0	2012	5																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	147.3543127	2.315536376			110.1571605			234.7363637	145.131611					939.8770686	1977.586982	9405.926505	508.8046341	2486.537687			29.50309646	1379.319016			229.7496998		0.045581738														3400	"1a (IP Acute); 125 days 1-4, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 125 days 1-4	"2a (SNF); 0 copay, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0% coin"	"4a (ER); 50 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 15 copay"	"9a (OP Surgery); 125 copay, 9b (OP ASC); 125 copay"	8a (OP Diag Proc/Test/Lab); 0 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 0 copay, 8b (Nuclear Medicine); 0 copay, 8b (MRI); 0 copay, 8b (CT Scan); 0 copay, 8b (PET Scan); 0 copay"		12 (Renal Dialysis); 0 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 500 copay/day, days 1-4, 9a2 (OP Clinic); 125 copay, 9a3 (OP Observation); 125 copay, 9a4 (OP Other); 125 copay, 9a5 (OP Other Cardiology); 125 copay, 9c (OP SA); 15 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 15 copay, 7f (Podiatry); 15 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 15 copay, 7h (Psych); 15 copay"	"7c (OT); 15 copay, 7i (PT/ST); 15 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 15 copay	"; , 7g (Prof. Other); 10-15 copay"	15 (Part B Rx); 10% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 0 copay, 17a (MCR Eye Exam); 15 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 15 copay"	10b (Transportation); n/a	"16a (Preventive Dental); 0 copay, 16b1 (Comp. Dental) - Non MCR; 0 copay,"	17a1 (Non MCR Routine Eye Exam); 15 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 15 copay	18b (Hearing Aids); 250 allowance/yr	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"													441.1771013	486.9428493			50			49.94970883	125					92.38300443	10.20760888	14.99209779	15	15			0.1	15			15.7098476		15														NO	406.5289037	448.700402			46.07320989			46.02686838	115.1830247					88.97274728	9.405946126	13.82196297	13.82196297	13.82196297			0.09214642	13.82196297			14.47606212		13.82196297															4.992	0.086581842	0	0	0.422941165	0	0	0.90034831	1.393058161	0	0	0	0	6.968620408	1.550089717	10.83403065	0.586056567	2.864069319	0	0	2.718604711	1.588741364	0	0	0.277155911	0	5.25E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1823	0		2.665544514	4.992	0.086581842	0	0	0.422941165	0	0	0.90034831	1.393058161	0	0	0	0	6.968620408	1.550089717	10.83403065	0.586056567	2.864069319	0	0	2.718604711	1.588741364	0	0	0.277155911	0	5.25E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1823	NO																																																																																		0	0		0	4.992	0.086581842	0	0	0.422941165	0	0	0.90034831	1.393058161	0	0	0	0	6.968620408	1.550089717	10.83403065	0.586056567	2.864069319	0	0	2.718604711	1.588741364	0	0	0.277155911	0	5.25E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1823
H3887_001_0	2012	3																															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	452.2434088	39.895122	12122.15474	8.829439055	30.76292059	27.50372261	4.678325522	12.85154927	22.41102455	46.86791636	22.2217978	0	0	37.9646654	2.448022537	148.4470729	17.8329745	63.73860744	0	30672.45625	28.39451936	10.16546175	1449.267085	160	34.29957736	131.3130454	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.073677443	0.074572311	0	0	0.2	0.2	0.194135048	0.111544091	0.16	0	0.107883788	0	0	0.14614816	0	0.032467986	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.067469049	0.068288511	0	0	0.183147098	0.183147098	0.177776353	0.102144882	0.146517678	0	0.098793013	0	0	0.133833057	0	0.029732087	0.183147098	0	0	0	0.183147098	0.185248282	0	0	0	0	0	0	0	0												30.5124	2.724378491	0	0	5.634139631	5.037226979	0.83169565	1.312719988	3.283611288	0	2.195358363	0	0	5.080927236	0	4.413641283	3.266057528	0	0	0	5.200373821	1.88313433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3757	0	NO	6.544552134	30.5124	2.724378491	0	0	5.634139631	5.037226979	0.83169565	1.312719988	3.283611288	0	2.195358363	0	0	5.080927236	0	4.413641283	3.266057528	0	0	0	5.200373821	1.88313433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3757	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.6818	0.0601	0	0.0012	0.9688	0.8661	0.1473	0.1505	0.5646	0	0.549	0	0	0.8737	0.0375	3.096	0.3719	0.0068	0	0	0.5922	0.212	0	0	0.0116	0	0	0	0	0											9.191	0	NO	0	31.1942	2.784521891	0	0.001241971	6.602916689	5.90336631	0.979024133	1.463199398	3.848220525	0	2.744344518	0	0	5.954580723	0.037450728	7.50959628	3.637975178	0.006767575	0	0	5.792558984	2.095141286	0	0	0.011633015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5667
H3887_003_0	2012	4																															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	1244.337419	91.48057602	844.6019782	502.0111404	129.9775346	4.278319241	8.59259778	201.3491273	33.8224253	13.339761	25.60553627	0	0.060249924	29.54208352	4222.360326	2254.399594	454.7535887	751.4190936	0	0	6.620626031	575.5428245	0	0	39.0615877	0	4.899929955	65	80.06269647	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	61.97680932	0	200	0.2	0.091032258	64.56772334	0.16	0.166706343	0.178671939	0	0.2	0.145632928	3.633319281	39.17085503	38.5	40	0	0	0.2	39.44448877	0	0	40	0	5	352.5	0	0											NO	148.2747585	79.17382414	49.11112969	0	158.4822782	0.158482278	0.072134998	51.19234379	0.126785823	0.132100005	0.14158168	0	0.158482278	0.115401191	3.506042659	37.79938464	37.15132966	38.59878406	0	0	0.158482278	31.25626222	0	0	40	0	5	352.5	0	0												15.3753	0.603572253	3.456613108	0	1.71659465	0.67803778	0.619827027	0.858961145	4.288204014	1.7621825	3.625274841	0	0.009548545	3.409191635	1.233647952	7.101243115	1.407891707	2.416988611	0	0	1.049251897	1.499109787	0	0	0.130205292	0	0.002041637	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.1531	0	NO	10.64489578	15.3753	0.603572253	3.456613108	0	1.71659465	0.67803778	0.619827027	0.858961145	4.288204014	1.7621825	3.625274841	0	0.009548545	3.409191635	1.233647952	7.101243115	1.407891707	2.416988611	0	0	1.049251897	1.499109787	0	0	0.130205292	0	0.002041637	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.1531	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.6878	0.0503	0.1876	0.8481	0.703	0.6942	0.8365	0.3516	2.6341	0.7216	2.1707	0	0.0039	2.0922	1.4356	2.0493	0.3619	0.6873	0	0	0.436	0.5162	0	0	0.0357	0	0.0034	0	0	0											17.5069	0	NO	0	16.0631	0.653843616	3.644183344	0.848100248	2.419563657	1.372202161	1.456324956	1.210524105	6.922321375	2.483820354	5.795979506	0	0.013458805	5.501395736	2.669277429	9.150530507	1.769753557	3.104262172	0	0	1.485244343	2.015350535	0	0	0.165932354	0	0.005468856	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	70.66
H3907_002_0	2012	2																															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	282.1336211	5.349154703	1307.594009		289.1286696	14.00158831	0	1369.795078	1512.782097		9781.546585	107.051673		2208.857998	39377.11413	6816.583047	46.22116697	607.3169606			757.447196	434.9224437	0	0																	3400	1a $325/admit-$975 combined max (1a/1b)	1b $325/admit-$975 combined max (1a/1b)	"2 $30/days 1-10; $70/days 11-54; $0/days 55-100 - $3,400 max"	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $10-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $35 visit"	"9a $200/visit, 9b $200/visit -$400 combined max (9a/9b)"	8a $0/lab	8b $30/x-ray; $90/diag x-ray; $25/therapeutic visit w/ $100 max on therapeutic	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $35/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $35/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $35/visit, 7f $35/visit, 7g $35/visit, 16b $35/visit, 17a $0-$35/visit, 18a $35/visit"	"7e $35/visit, 7h $35/visit"	"7c $35/visit, 7i $35/visit"	0	0	15 15% coins/drug	15 15% coins/drug	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max - 2 yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"													296.4815265	262.5	49.4122063		100	0.155488746	0	13.87413331	29.68162896		6.292919015	33.53106983		7.584813251	0.80303018	19.4311185	8.953488372	35			0.15	16.26924566	0	0																	NO	288.6250524	255.5440035	48.10283056		97.35009659	0.151368444	0	13.50648217	28.89509447		6.12616274	32.64252886		7.383823026	0.781750656	18.91621263	8.716229578	34.07253381			0.146025145	15.83812636	0	0																		6.7859	0.113912034	5.241581089	0	2.345558659	2.119398637	0	1.5417594	3.642665134	0	4.993612186	0.29120311	0	1.359151379	2.565257068	10.74532786	0.033572859	1.724402306	0	0	0.009217195	0.574029718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0866	0	NO	1.200051224	6.7859	0.113912034	5.241581089	0	2.345558659	2.119398637	0	1.5417594	3.642665134	0	4.993612186	0.29120311	0	1.359151379	2.565257068	10.74532786	0.033572859	1.724402306	0	0	0.009217195	0.574029718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0866	NO																																																																																		0	0	NO	0	6.7859	0.113912034	5.241581089	0	2.345558659	2.119398637	0	1.5417594	3.642665134	0	4.993612186	0.29120311	0	1.359151379	2.565257068	10.74532786	0.033572859	1.724402306	0	0	0.009217195	0.574029718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0866
H3907_006_0	2012	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	378.7841781	11.76805214	1938.17367		414.2109184	25.98566605	0	1682.095952	1961.464607		13008.96872	412.0044086		2846.887946	42401.99383	9053.455741	96.06943796	1035.752709			1229.135753	1048.493849	0	0																	3200	1a $100/admit-$200 combined max (1a/1b)	1b $100/admit-$200 combined max (1a/1b)	"2 $0/days 1-10; $60/days 11-60; $0/days 61-100 - $3,000 max"	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $10-$30/item, 11c $15 per pair"	"4a $65/visit, 4b $20 visit"	"9a $60/visit, 9b $60/visit -$120 combined max (9a/9b)"	8a $0/lab	8b $20/x-ray; $50/diag x-ray; $0/therapeutic visit - $250 combined max radiology	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $20/visit, 9d $0/visit"	"7a $5/PCP visit; 7a $20/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $20/visit, 7f $20/visit, 7g $20/visit, 16b $20/visit, 17a $0-$20/visit, 18a $20/visit"	"7e $20/visit, 7h $20/visit"	"7c $20/visit, 7i $20/visit"	0	0	15 $5-$42/drug	15 $5-$42/drug	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max - 2 yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	18a $20/visits	18b $1000 combined max - 3 yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"													81.13268608	59.375	34.50629545		100	0.140563271	0	12.60591381	7.961025061		3.496414538	30.36120202		2.096172709	0.465945074	11.65787452	3.76	20			5	21.1480359	0	0																	NO	77.43425368	56.66839142	32.93332644		95.44150134	0.134155696	0	12.0312734	7.59812184		3.337030528	28.97718704		2.000618704	0.444704974	11.12645047	3.58860045	19.08830027			4.772075067	20.18400297	0	0																		2.4442	0.055573049	5.319208847	0	3.294409327	3.486125109	0	1.686479691	1.241953922	0	3.617610479	0.994894067	0	0.474628106	1.571364797	8.394402239	0.028729569	1.647563226	0	0	0.488794007	1.763566913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5095	0	NO	1.74402852	2.4442	0.055573049	5.319208847	0	3.294409327	3.486125109	0	1.686479691	1.241953922	0	3.617610479	0.994894067	0	0.474628106	1.571364797	8.394402239	0.028729569	1.647563226	0	0	0.488794007	1.763566913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5095	NO																																																																																		0	0	NO	0	2.4442	0.055573049	5.319208847	0	3.294409327	3.486125109	0	1.686479691	1.241953922	0	3.617610479	0.994894067	0	0.474628106	1.571364797	8.394402239	0.028729569	1.647563226	0	0	0.488794007	1.763566913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5095
H3907_029_0	2012	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	0	0	0	0	0	0	0	0	0	0											0	YES	305.0354333	10.84280127	1403.26097	0	316.2048249	19.73430058	0	1524.621963	1725.311763	0	11111.1606	359.1841215	0	2473.661005	40839.42629	7403.373874	77.16042523	695.213266	0	0	893.4860234	846.4587735	0	0	0	0	0	0	0	0											3400	1a $325/admit-$975 combined max (1a/1b)	1b $325/admit-$975 combined max (1a/1b)	"2 $30/days 1-10; $70/days 11-54; $0/days 55-100 - $3,400 max"	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $10-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $40 visit"	"9a $200/visit, 9b $200/visit -$400 combined max (9a/9b)"	8a $0/lab	8b $40/x-ray; $100/diag x-ray; $25/therapeutic visit w/$100 max on therapeutic	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $40/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $40/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $40/visit, 7f $40/visit, 7g $40/visit, 16b $40/visit, 17a $0-$40/vIsit, 18a $40/visit"	"7e $40/visit, 7h $40/visit"	"7c $40/visit, 7i $40/visit"	0	0	"15 15% coins/drug - $2,500 max"	"15 15% coins/drug - $2,500 max"	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max - 2 yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"												NO	287.5240899	240.813253	25.19581936	0	100	0.149049746	0	14.75112947	27.67123993	0	7.757789881	41.20008183	0	7.016495207	0.891200204	21.49325215	9.340999558	40	0	0	53.90032986	29.00972196	0	0	0	0	0	0	0	0											NO	277.7803929	232.6525059	24.34197636	0	96.61117193	0.143998706	0	14.25123905	26.73350918	0	7.49489172	39.80388189	0	6.778718248	0.860998961	20.76488279	9.024449142	38.64446877	0	0	52.07374035	28.02663236	0	0	0	0	0	0	0	0												7.0611	0.210217074	2.846512114	0	2.545743226	2.841713748	0	1.810646005	3.843636489	0	6.939745465	1.191410196	0	1.39735425	2.930225302	12.81084923	0.058027528	2.238845612	0	0	3.877263266	1.976949071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5802	0	NO	1.91450891	7.0611	0.210217074	2.846512114	0	2.545743226	2.841713748	0	1.810646005	3.843636489	0	6.939745465	1.191410196	0	1.39735425	2.930225302	12.81084923	0.058027528	2.238845612	0	0	3.877263266	1.976949071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5802	NO																																																																																		0	0	NO	0	7.0611	0.210217074	2.846512114	0	2.545743226	2.841713748	0	1.810646005	3.843636489	0	6.939745465	1.191410196	0	1.39735425	2.930225302	12.81084923	0.058027528	2.238845612	0	0	3.877263266	1.976949071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5802
H3907_032_0	2012	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																																																							0	YES	382.1483394	37.21022122	460.0507104		68.81146277	9.015271136	25.53009152	21.21012736	23.74330433	14.76876419	12.588386	3.604009406	1.192981337	165.7180361	98.44585878	102.3219535	16.46486681	1.863329349	33.71578263	56.55806821	44.96299181	6.978597323																			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; Non-MC Emergency Response	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	PCP Office Visits - 12%	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	24 One Way Trips	"1 Oral Exam, 1 Cleaning, 1 X-Ray every 6 Months"	One Routine Exam every 2 years	$100/2 yrs																	0.087987324	0.087987324	0.177140801		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.220696454	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.087987324	0.087987324	0.177140801		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.220696454	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				33.6242	3.274027776	81.49375141	0	15.41376766	2.019420734	5.718740499	4.751068528	5.318500171	3.30820318	2.819798465	0.807298107	0.267227819	37.12084009	21.7266519	22.92011758	3.688130165	0.417385774	7.55233531	12.66900728	10.07171017	1.5632058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.5454	0		0	33.6242	3.274027776	81.49375141	0	15.41376766	2.019420734	5.718740499	4.751068528	5.318500171	3.30820318	2.819798465	0.807298107	0.267227819	37.12084009	21.7266519	22.92011758	3.688130165	0.417385774	7.55233531	12.66900728	10.07171017	1.5632058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.5454	NO																																																																																		0	0		0	33.6242	3.274027776	81.49375141	0	15.41376766	2.019420734	5.718740499	4.751068528	5.318500171	3.30820318	2.819798465	0.807298107	0.267227819	37.12084009	21.7266519	22.92011758	3.688130165	0.417385774	7.55233531	12.66900728	10.07171017	1.5632058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.5454
H3907_034_0	2012	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	330.7839636	49.22814407	71.90209382	36.65805881	28.90332096	50.51062527	0	50.53519859	52.94643597	26.84401114	57.646737	18.09472243	1.780914542	24.28472708	101.4380601	94.09895114	3.290221705	10.75341974	0	0	47.85996072	23.36884979																			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	Medicare Cost Sharing																				NO	0.087242787	0.087242787	0.17877683	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.087242787	0.087242787	0.17877683	0	0.224	0.2239	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.22395	0.224																				28.8585	4.294800501	12.85442844	0	6.474343896	11.309329	0	11.31988448	11.86000166	6.013058496	12.91286909	4.053217824	0.398924857	5.439778867	22.72212546	21.07816506	0.737009662	2.408766023	0	0	10.7182382	5.234622354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6881		NO	0	28.8585	4.294800501	12.85442844	0	6.474343896	11.309329	0	11.31988448	11.86000166	6.013058496	12.91286909	4.053217824	0.398924857	5.439778867	22.72212546	21.07816506	0.737009662	2.408766023	0	0	10.7182382	5.234622354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6881	NO																																																																																		0		NO		28.8585	4.294800501	12.85442844	0	6.474343896	11.309329	0	11.31988448	11.86000166	6.013058496	12.91286909	4.053217824	0.398924857	5.439778867	22.72212546	21.07816506	0.737009662	2.408766023	0	0	10.7182382	5.234622354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6881
H3907_801_0	2012	2																															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	0	0	0	0											0	YES	335.3554877	10.39490067	1777.528014	0	363.1818372	28.96612594	0	1562.753374	1973.911676	0	13075.34575	405.4011261	0	2772.399969	41739.3478	10156.66605	111.9624583	1927.997919	0	0	1197.394921	490.7626137	0	0	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max - 2 yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	18a $25/visit	18b $1000 max - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	149.713877	150	36.66378987	0	100	0.132801478	0	13.51577978	0.070890383	0	5.839581218	16.5964497	0	0.956217697	0.955742217	14.02744846	5.410447761	23.76909665	0	0	114.7256539	24.31571212	0	0	0	0	0	0	0	0											NO	142.1877345	142.4594741	34.82069483	0	94.97298275	0.126125525	0	12.8363392	0.067326711	0	5.546024463	15.76214331	0	0.908148469	0.90769689	13.32228621	5.138463619	22.57422006	0	0	108.9583754	23.09335708	0	0	0	0	0	0	0	0												3.9736	0.12340434	5.157896712	0	2.874371863	3.653367841	0	1.671669366	0.011074748	0	6.043015615	0.532499221	0	0.209812566	3.157223018	11.27583434	0.047942918	3.626920774	0	0	10.87218378	0.944446357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1753	0	NO	2.867553229	3.9736	0.12340434	5.157896712	0	2.874371863	3.653367841	0	1.671669366	0.011074748	0	6.043015615	0.532499221	0	0.209812566	3.157223018	11.27583434	0.047942918	3.626920774	0	0	10.87218378	0.944446357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1753	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	3.9736	0.12340434	5.157896712	0	2.874371863	3.653367841	0	1.671669366	0.011074748	0	6.043015615	0.532499221	0	0.209812566	3.157223018	11.27583434	0.047942918	3.626920774	0	0	10.87218378	0.944446357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1753
H3907_802_0	2012	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	0	0	0	0	0	0	0	0	0	0											0	YES	330.0768707	3.766437321	1787.916383	0	364.5454789	21.11447009	0	1469.367093	1790.427341	0	12379.024	263.9930159	0	2372.969647	41787.13172	9705.661175	68.21870475	1221.645497	0	0	1085.462814	917.1655101	0	372.2481017	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max - 2 yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	18a $25/visit	18b $1000 max - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	25.93360996	45.45454545	37.66292989	0	19.72448341	0.141425909	0	11.47950652	3.082045005	0	0.762262585	20.66709901	0	1.289342985	0.265485749	13.56386471	4.851398601	25	0	0	18.66439017	54.30209455	0	0	0	0	0	0	0	0											NO	24.62992291	43.16953761	35.76960791	0	18.73293022	0.134316404	0	10.90242975	2.927110071	0	0.723943514	19.62816037	0	1.224527491	0.252139735	12.88200689	4.607517957	23.74324569	0	0	17.72612806	51.57231889	0	0	0	0	0	0	0	0												0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035	0	NO	1.689176971	0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035
H3907_803_0	2012	2																															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	0	0	0	0											0	YES	330.0768707	3.766437321	1787.916383	0	364.5454789	21.11447009	0	1469.367093	1790.427341	0	12379.024	263.9930159	0	2372.969647	41787.13172	9705.661175	68.21870475	1221.645497	0	0	1085.462814	917.1655101	0	372.2481017	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max - 2 yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	18a $25/visit	18b $1000 max - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	25.93360996	45.45454545	37.66292989	0	19.72448341	0.141425909	0	11.47950652	3.082045005	0	0.762262585	20.66709901	0	1.289342985	0.265485749	13.56386471	4.851398601	25	0	0	18.66439017	54.30209455	0	0	0	0	0	0	0	0											NO	24.62992291	43.16953761	35.76960791	0	18.73293022	0.134316404	0	10.90242975	2.927110071	0	0.723943514	19.62816037	0	1.224527491	0.252139735	12.88200689	4.607517957	23.74324569	0	0	17.72612806	51.57231889	0	0	0	0	0	0	0	0												0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035	0	NO	1.689176971	0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	0.6775	0.013549613	5.329422333	0	0.569083752	2.836019693	0	1.334972626	0.436731492	0	0.746809511	0.431808104	0	0.242147214	0.878016359	10.41903284	0.026193242	2.417152431	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9035
H3909_001_0	2012	7	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	YES	316.6715704	14.82082233	1101.974216	0	276.9784768	0.97389031	22.84795797	324.8360838	364.6834918		798.6787568		46.08671939	381.5548228	4014.192767	6273.042434	211.1606778	771.6399484	123.0798166	8.169235574	142.3074632										262.9368314										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 (PBP 6)	$75 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	$40 copay (PBP 8b)		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	"$10 copay per visit (PBP 7a, 4b)"	"$10 - 40 copay per visit (PBP 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)										$25 copay Therapeutic Radiology (PBP 8b)										0	NO	850	850	25	0	75	0.2	0.2	50	234.1	0	40	0	25	40	10	39.37869295	40	40	40	40	0.2	0	0	0	0	0	0	0	0	0	25										NO	736.355	736.355	21.6575	0	64.9725	0.17326	0.17326	43.315	202.80083	0	34.652	0	21.6575	34.652	8.663	34.1137617	34.652	34.652	34.652	34.652	0.17326	0	0	0	0	0	0	0	0	0	21.6575											19.4319	0.909448885	1.988833881	0	1.49966534	0.168736235	3.958637199	1.172522914	6.163176236	0	2.306318023	0	0.083176927	1.101803143	2.897912662	17.83308956	0.609761651	2.228238958	0.355413484	0.023590029	24.65619107	0	0	0	0	0	0	0	0	0	0.474546202	0	0	0	0	0	0	0	0	0	87.863	0	NO	13.56220419	19.4319	0.909448885	1.988833881	0	1.49966534	0.168736235	3.958637199	1.172522914	6.163176236	0	2.306318023	0	0.083176927	1.101803143	2.897912662	17.83308956	0.609761651	2.228238958	0.355413484	0.023590029	24.65619107	0	0	0	0	0	0	0	0	0	0.474546202	0	0	0	0	0	0	0	0	0	87.863	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	$75 copay per trip	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$50 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	$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	1.289	0.1159	0.134	0	0.7708	0.002	0.2846	0.2031	0.3284	0.0239	0.0098	0	0	0.0191	0.3302	0.4716	0.6694	0.1651	0.4049	1.717	0.0704										0										7.0093	500	NO	0	20.7209	1.02534669	2.122875128	0	2.270483433	0.170757533	4.243235655	1.375664965	6.491547223	0.023876999	2.316108909	0	0.083176927	1.120926138	3.228161583	18.30464001	1.279136409	2.393386404	0.760279231	1.740589665	24.72660338	0	0	0	0	0	0	0	0	0	0.474546202	0	0	0	0	0	0	0	0	0	94.8723
H3909_007_0	2012	5	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	YES	357.6252751	1.967032688	1370.361311	0	261.715428	0.984110161	14.93445227	322.0238141	345.989631	0	757.6875303		20.25974026	357.8698098	3995.47284	6220.93547	66.11122733	639.5034552	111.246499	19.82227866	122.7059136										306.7168615										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 (PBP 6)	$75 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	$40 copay (PBP 8b)		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	"$10 copay per visit (PBP 7a, 4b)"	"$10 - 40 copay per visit (PBP 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)										$25 copay Therapeutic Radiology (PBP 8b)										0	NO	850	850	25	0	75	0.2	0.2	50	245.84	0	40	0	25	40	10	39.37869295	40	40	40	40	0.2	0	0	0	0	0	0	0	0	0	25										NO	795.005	795.005	23.3825	0	70.1475	0.18706	0.18706	46.765	229.934152	0	37.412	0	23.3825	37.412	9.353	36.83089151	37.412	37.412	37.412	37.412	0.18706	0	0	0	0	0	0	0	0	0	23.3825											23.6928	0.130316735	2.670206112	0	1.529890249	0.184087647	2.793638643	1.254953639	6.629569367	0	2.362217157	0	0.039476948	1.115718777	3.114138123	19.09354995	0.20611277	1.993758605	0.346829502	0.061799257	22.9533682	0	0	0	0	0	0	0	0	0	0.597650585	0	0	0	0	0	0	0	0	0	90.7701	0	NO	6.287668809	23.6928	0.130316735	2.670206112	0	1.529890249	0.184087647	2.793638643	1.254953639	6.629569367	0	2.362217157	0	0.039476948	1.115718777	3.114138123	19.09354995	0.20611277	1.993758605	0.346829502	0.061799257	22.9533682	0	0	0	0	0	0	0	0	0	0.597650585	0	0	0	0	0	0	0	0	0	90.7701	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	$75 copay per trip	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$50 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	$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	0.1204	0	0.0673	0	0.3405	0	0.5148	0.0667	0.4467	0	0	0	0	0	0.0382	0.1529	0.6255	0.0323	0.182	1.433	0.0002										0										4.0203	500	NO	0	23.8132	0.130316735	2.737483343	0	1.870353185	0.184087647	3.308452748	1.321666684	7.076258673	0	2.362217157	0	0.039476948	1.115718777	3.152299396	19.24646693	0.83160652	2.026060588	0.52877961	1.494827973	22.95354736	0	0	0	0	0	0	0	0	0	0.597650585	0	0	0	0	0	0	0	0	0	94.7904
H3909_801_0	2012	4	h.5.										OP Facility - Other										Other										coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																												0	YES	292.9782728	1.541437269	16.59442583	10.5039153	6.675848787	1.131771839	18.79733557	20.92179946	93.20534328	13.19003194	40.18395983	0.015904332	0	84.64353183	25.27361262	60.60181489	3.398784698	13.54107135	18.50077357	113.6527798	154.7125803																				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																				0	NO	0.075052451	0.149927746	0.149927746	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.056348337	0.112563668	0.112563668	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																					16.5088	0.173509833	1.86792944	0	1.122718128	0.190336959	3.161262347	3.518546372	15.67490994	2.218247962	6.757981134	0.002674728	0	14.23501799	4.250417282	10.19177611	0.571594312	2.277284398	3.111387711	19.11367981	26.01895641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.9671	0	NO	43.47285261	16.5088	0.173509833	1.86792944	0	1.122718128	0.190336959	3.161262347	3.518546372	15.67490994	2.218247962	6.757981134	0.002674728	0	14.23501799	4.250417282	10.19177611	0.571594312	2.277284398	3.111387711	19.11367981	26.01895641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.9671	YES																																									10000																																									0	500	NO	0	16.5088	0.173509833	1.86792944	0	1.122718128	0.190336959	3.161262347	3.518546372	15.67490994	2.218247962	6.757981134	0.002674728	0	14.23501799	4.250417282	10.19177611	0.571594312	2.277284398	3.111387711	19.11367981	26.01895641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.9671
H3909_802_0	2012	4	h.5.										OP Facility - Other										Other										coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																												0	YES	393.0607424	3.693454083	30.05911888	0	6.343786848	0.848101506	17.68598301	20.27704022	69.438686	14.00629888	36.46575867	0.737039983	0	76.81251093	26.62872113	61.88321573	4.201950168	12.94801541	18.31190346	101.3342307	152.397531																				6700	Medicare FFS	Medicare FFS	Medicare FFS	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0	NO	0.075052451	0.149927746	0.149927746	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.056348337	0.112563668	0.112563668	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																					22.1483	0.415748739	3.383564678	0	1.06687325	0.142630393	2.974359422	3.410113285	11.67792651	2.355524542	6.132668612	0.123952501	0	12.91802754	4.478314127	10.40727709	0.706667538	2.17754657	3.079624275	17.04199442	25.62962047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.2708	0	NO	43.24171932	22.1483	0.415748739	3.383564678	0	1.06687325	0.142630393	2.974359422	3.410113285	11.67792651	2.355524542	6.132668612	0.123952501	0	12.91802754	4.478314127	10.40727709	0.706667538	2.17754657	3.079624275	17.04199442	25.62962047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.2708	YES																																									10000																																									0	500	NO	0	22.1483	0.415748739	3.383564678	0	1.06687325	0.142630393	2.974359422	3.410113285	11.67792651	2.355524542	6.132668612	0.123952501	0	12.91802754	4.478314127	10.40727709	0.706667538	2.17754657	3.079624275	17.04199442	25.62962047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.2708
H3912_001_0	2012	3																															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	379.14296	40.1585	9793.884439	59.71230801	23.54777262	64.70560579	12.99212916	13.10016286	9.877861699	28.97509117	17.26496116	0	0	25.85677084	1.272023673	153.9890354	18.212832	32.74207992	0	21952.89392	10.002656	8.534115932	881.2829594	152	17.1662685	106.0131279	0	0	0	0											3500	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.07686167	0.077795212	0	0	0.2	0.2	0.184674032	0.059612452	0.16	0	0.106700339	0	0	0.146222197	0	0.029884767	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068098488	0.068925595	0	0	0.177197523	0.177197523	0.163618905	0.052815894	0.141758019	0	0.094535179	0	0	0.129551056	0	0.026460343	0.177082475	0	0	0	0.177197523	0.179345345	0	0	0	0	0	0	0	0												25.8191	2.767948498	0	0	4.172606992	11.4656731	2.125757951	0.691896815	1.400266104	0	1.632146192	0	0	3.349771955	0	4.074602663	3.225173372	0	0	0	1.77244587	1.530553966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0279	0	NO	8.224027918	25.8191	2.767948498	0	0	4.172606992	11.4656731	2.125757951	0.691896815	1.400266104	0	1.632146192	0	0	3.349771955	0	4.074602663	3.225173372	0	0	0	1.77244587	1.530553966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0279	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0	0.0156	0.5075	1.3945	0.28	0.0561	0.1703	0	0.2915	0	0	0.4074	0.0123	1.7047	0.2016	0.0025	0	0	0.1108	0.0957	0	0	0.0029	0	0	0	0	0											5.2534	0	NO	0.675273985	25.8191	2.767948498	0	0.01564309	4.680086221	12.86014686	2.405751978	0.747996557	1.570568738	0	1.923691852	0	0	3.757176653	0.01229085	5.779334398	3.426746708	0.002535674	0	0	1.883223737	1.626213588	0	0	0.002905483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2813
H3916_001_0	2012	7																															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	294.9609754	0	586.6406282	0	170.0604894	15.07127217	0	441.3990309	519.9599243	0	1029.140523	0	0	356.4461996	3471.323208	7050.519204	0	0	0	0	69.41872398	0	60.13705952	11.3022	334.4746395	0			0	0											3400	"(1a), (1b) $300 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $20 - $100, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $25, (7g) $10-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	300	0	50	0	100	0.2	0	65	100	0	44.16810048	0	0	25	10	23.09258223	0	0	0	0	0.1	0	40	0.3	25	0		0	0	0											NO	284.157001	0	41.45443382	0	87.50759306	0.1860895	0	62.84090012	97.716575	0	42.51220197	0	0	24.1833351	9.92970964	22.78662624	0	0	0	0	0.069152765	0	32.51365706	0.3	25	0		0	0	0												6.9846	0	2.026571258	0	1.240132008	2.804605502	0	2.311492701	4.234058579	0	3.645919148	0	0	0.718338157	2.87243596	13.38812882	0	0	0	0	4.800496725	0	0.162939644	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2772		NO	4.048868168	6.9846	0	2.026571258	0	1.240132008	2.804605502	0	2.311492701	4.234058579	0	3.645919148	0	0	0.718338157	2.87243596	13.38812882	0	0	0	0	4.800496725	0	0.162939644	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2772	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0% - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b) 20%, (18a) 20% (17a), (17b) 0% - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%	"(16a) 50%, (16b) 20% - 50%"	"(17a) 20%, (17b) 0%"			(18b) $0													5100	0.2661	0	0.0123	0.0465	0.6304	0.0482	0	0	0.2025	0.0261	0.2516	0	0	0.082	0.1439	0.4292	0	0	0	0.517	0.0477	0	0																		2.7037	500	NO	0.918535792	7.2507	0	2.038898388	0.04645586	1.87052806	2.852824245	0	2.311492701	4.436514843	0.026147772	3.897565925	0	0	0.800366309	3.016381015	13.8173613	0	0	0	0.517048451	4.848208052	0	0.162939644	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9809
H3916_002_0	2012	7																															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	246.6915447	0	401.4610983	0	102.9891915	13.36379709	0	476.5847271	579.7654346	0	1106.26555	0	0	602.4863686	3845.549217	6181.58723	0	0	0	0	61.92182645	0	7.318566844	11.3022	334.4746395	0			0	0											3400	"(1a), (1b) $300 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $20 - $100, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $25, (7g) $10-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	300	0	50	0	100	0.2	0	65	100	0	43.73745232	0	0	25	10	23.20194294	0	0	0	0	0.1	0	40	0.3	25	0		0	0	0											NO	287.9653723	0	43.93986742	0	89.98748916	0.188301844	0	63.74940268	95.57358662	0	42.50791202	0	0	23.90913638	9.939003984	22.88378375	0	0	0	0	0.063577077	0	36.91401319	0.3	25	0		0	0	0												5.9199	0	1.470012286	0	0.772311563	2.516427639	0	2.53183264	4.617521832	0	3.918753224	0	0	1.20041073	3.185077415	11.78817545	0	0	0	0	3.936808755	0	0.022513139	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9672		NO	3.605436163	5.9199	0	1.470012286	0	0.772311563	2.516427639	0	2.53183264	4.617521832	0	3.918753224	0	0	1.20041073	3.185077415	11.78817545	0	0	0	0	3.936808755	0	0.022513139	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9672	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0% - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b) 20%, (18a) 20%, (17a), (17b) 0% - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%	"(16a) 50%, (16b) 20% - 50%"	"(17a) 20%, (17b) 0%"			(18b) $0													5100	0.3309	0	0	0.025	0.7732	0.0187	0	0.009	0.1184	0.0939	0.2586	0	0	0.0976	0.1472	0.4153	0	0	0	0.7173	0.0457	0	0																		3.0506	500	NO	1.237851602	6.2508	0	1.470012286	0.024984743	1.545483004	2.535081295	0	2.54087648	4.735897443	0.093904645	4.177317382	0	0	1.29799631	3.332253689	12.20343172	0	0	0	0.717323454	3.982477202	0	0.022513139	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0178
H3916_005_0	2012	7																															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	277.8398908	0	526.5784349	0	64.90671078	14.33967994	0	404.2190182	586.7065973	0	867.9860339	0	0	550.7803098	4327.300028	6615.847745	0	0	0	0	51.10459849	0	13.87593239	11.3022	334.4746395	0			0	0											3400	"(1a), (1b) $150 per admit"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $50"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $25, (7g) $10-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-15%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	150	0	25	0	75	0.2	0	65	50	0	21.69412263	0	0	25	10	23.67770576	0	0	0	0	0.15	0	40	0.3	25	0		0	0	0											NO	144.2578642	0	23.41431058	0	68.06590298	0.186270677	0	62.91239586	49.21810472	0	21.05608652	0	0	24.39097045	9.922016142	23.32316075	0	0	0	0	0.100415292	0	38.08979197	0.3	25	0		0	0	0												3.34	0	1.027455918	0	0.368161157	2.671061893	0	2.119198907	2.406382229	0	1.523032419	0	0	1.119505522	3.577961728	12.85854004	0	0	0	0	5.131683177	0	0.044044282	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2746		NO	3.398880741	3.34	0	1.027455918	0	0.368161157	2.671061893	0	2.119198907	2.406382229	0	1.523032419	0	0	1.119505522	3.577961728	12.85854004	0	0	0	0	5.131683177	0	0.044044282	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2746	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $75 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0% - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b) 20%, (18a) 20%, (17a), (17b) 0% - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%	"(16a) 50%, (16b) 20% - 50%"	"(17a) 20%, (17b) 0%"			(18b) $0													5100	1.078	0	0.2896	0.0872	0.9537	0.0755	0	0.0013	0.9963	0.1451	0.4437	0	0	0.4018	0.4852	1.6573	0	0	0	1.992	0.2088	0	0.0166																		8.8322	500	NO	3.788715822	4.4181	0	1.317041842	0.087167468	1.321833304	2.746601855	0	2.120480484	3.402671858	0.14514291	1.966768101	0	0	1.521272103	4.063154985	14.51580153	0	0	0	1.992037878	5.340517602	0	0.060690873	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1067
H3916_012_0	2012	6																															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	250.0438337	0	532.0843159	0	64.48723319	10.51846077	0	366.8091779	505.0360843	3610.120202	679.7096674	0	0	392.806001	3460.232412	4795.3554	0	0	0	0	46.36991701	0	20.22863313	0	334.4746395	0			0	0											3400	"(1a), (1b) $350 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $30-$125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $25, (7g) $15-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-15%		(10b) $40		"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	350	0	50	0	100	0.2	0	65	100	20	56.89310636	0	0	25	15	24.12829416	0	0	0	0	0.15	0	40		25	0		0	0	0											NO	327.5560434	0	42.58844034	0	85.79315085	0.176723639	0	63.31270664	95.54874288	19.19310789	53.86661798	0	0	24.69862343	14.83420797	23.42871824	0	0	0	0	0.088478779	0	34.71109535		25	0		0	0	0												6.8253	0	1.888386762	0	0.46104691	1.858860666	0	1.935306823	4.021296914	5.774118877	3.051138416	0	0	0.808480625	4.277483936	9.36241921	0	0	0	0	4.102753618	0	0.058513168	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1219		NO	4.974660884	6.8253	0	1.888386762	0	0.46104691	1.858860666	0	1.935306823	4.021296914	5.774118877	3.051138416	0	0	0.808480625	4.277483936	9.36241921	0	0	0	0	4.102753618	0	0.058513168	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1219	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													5100	0.7435	0	0.0385	0.0119	1.1353	0.0446	0	0.0002	1.1557	0.2043	0.4115	0	0	0.4228	0.474	1.2058	0	0	0	1.9856	0.0492	0	0.0109																		7.8938	500	NO	5.501520534	7.5688	0	1.926879614	0.01192662	1.596329334	1.903474362	0	1.935504284	5.176952965	5.978394154	3.462664335	0	0	1.231262588	4.751519096	10.56824728	0	0	0	1.985620696	4.15193148	0	0.069373021	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0157
H3916_015_0	2012	7																															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	243.2847928	0	440.7780521	0	63.46601109	9.117919001	0	361.3031103	478.9993708	0	767.6468928	0	0	390.0314448	3848.118626	5164.28947	0	0	0	0	36.34467085	0	14.78079658	0	334.4746395	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $20 - $75, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $25, (7g) $15-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-15%		(10b) $40		"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	200	0	25	0	100	0.2	0	65	100	0	37.41851356	0	0	25	15	24.11709382	0	0	0	0	0.15	0	40		25	0		0	0	0											NO	193.6025999	0	23.75351552	0	92.57969606	0.185625522	0	63.77520532	97.25088515	0	35.9628182	0	0	24.30766603	14.90969878	23.8236742	0	0	0	0	0.111846274	0	36.75163546		25	0		0	0	0												3.925	0	0.872502358	0	0.489638668	1.692518477	0	1.92018167	3.881926066	0	2.300562137	0	0	0.790062842	4.781190798	10.25269582	0	0	0	0	4.06501603	0	0.045268204	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7134		NO	2.180712123	3.925	0	0.872502358	0	0.489638668	1.692518477	0	1.92018167	3.881926066	0	2.300562137	0	0	0.790062842	4.781190798	10.25269582	0	0	0	0	4.06501603	0	0.045268204	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7134	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0% - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 20%, (17a), (17b) 0% - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%		"(17a) 20%, (17b) 0%"			(18b) $0													5100	0.945	0	0.3296	0.0955	1.2197	0.0598	0	0.005	0.9286	0.0994	0.3195	0	0	0.2349	0.3363	1.277	0	0	0	1.7987	0.1276	0	0.0325																		7.809	500	NO	4.883790963	4.87	0	1.202146794	0.095476263	1.709305486	1.752276024	0	1.925184297	4.810491	0.09936168	2.620037574	0	0	1.024995207	5.117490247	11.52973341	0	0	0	1.798740924	4.192575647	0	0.077808636	0	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5225
H3916_018_0	2012	7																															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	214.252503	0	307.3814917	0	48.78546638	10.68739918	0	370.1139236	418.9201131	3519.149296	734.8737567	0	0	300.8182602	3698.960805	4259.920806	0	0	0	0	26.02820589	0	6.222192733	0	334.4746395	0			0	0											3400	"(1a), (1b) $400 per admit"		(2) $75 per day (days 16-75)	(6) $0	(10a)  $125	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $200"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $30 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $35, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $35, (7g) $15-$35, (7h), (7i) $35, (14a), (14b), (14d), (14e) $0, (16b), (18a) $35, (17a), (17b) $0-$35"					(15) 0%-15%		(10b) $40		"(17a) $35, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	400	0	75	0	125	0.2	0	65	200	20	58.32737258	0	0	35	15	33.70015919	0	0	0	0	0.15	0	40		35	0		0	0	0											NO	366.8682988	0	61.92895032	0	94.45140678	0.182160243	0	63.18624285	191.1871381	19.30087005	52.44684809	0	0	32.64807534	14.83968379	32.86197679	0	0	0	0	0.091740279	0	31.31578947		35	0		0	0	0												6.5502	0	1.586317761	0	0.383987994	1.946819227	0	1.948842355	6.674344791	5.660220271	3.211817691	0	0	0.818428102	4.574284059	11.66578489	0	0	0	0	2.38783486	0	0.01623774	0	0.975551032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4007		NO	4.177126439	6.5502	0	1.586317761	0	0.383987994	1.946819227	0	1.948842355	6.674344791	5.660220271	3.211817691	0	0	0.818428102	4.574284059	11.66578489	0	0	0	0	2.38783486	0	0.01623774	0	0.975551032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4007	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $125 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													5100	1.2905	0	0.183	0.0621	1.1612	0.064	0	0.001	1.1849	0.2173	0.6259	0	0	0.4453	0.71	1.7178	0	0	0	2.1231	0.2098	0	0.0035																		9.9995	500	NO	8.748786771	7.8407	0	1.769361566	0.062063289	1.545191737	2.010840847	0	1.949869894	7.859245031	5.877566362	3.8377124	0	0	1.263678882	5.284305085	13.38359829	0	0	0	2.123093161	2.597624341	0	0.019759768	0	0.975551032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4001
H3916_019_0	2012	8																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													3.19661529	0	0.174916352	0.820101424	0	2.21211798	0	0	7.019884473	4.706310945	13.17343594	0	0	2.626916076	0	4.750960795	0	0	0	22.12561122	2.809596097	0	0	0	0	0	0	0	0	0											63.6165	YES	182.3612752	0	29.66130692	0	105.5304121	0	0	357.4972045	32.10472808	4.817424984	22.46694012	0	0	12.3831301	2698.146378	5943.79548	0	0	0	73.93458924	49.53004053	0	29.39497045	11.3022	334.4746395	0			0	0											3000	"(1a), (1b) 10%"		(2) 10%	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 10%"	(8a) 0% - 10%	"(8b) X-Ray and Diag. X-Ray 10%, Therapeutic Services 0%"			"(3) $0, (5) 10%, (9c) 10%, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c) 10%, (7d) $25, (7e), (7f) 10%, (7g) $10-$25, (7h) $25, (7i) 10%, (14a), (14b), (14d), (14e) $0, (16b) 10%, (18a) $0, (17a), (17b)  $0-$25"				"(7g)10%, (14b), (14e) $0, (18a) $25"	(15) 0%-10%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0											1250	NO	0.1	0	0.1	0	75	0	0	65	0.1	0.1	0.1	0	0	0.1	10	22.85587033	0	0	0	0.1	0.1	0	40	0.3	25	0		0	0	0											NO	0.052096256	0	0.02841144	0	39.72074086	0	0	54.02983395	0.077334578	0.073001813	0.073002342	0	0	0.051916997	9.269171973	19.49463713	0	0	0	0.06441653	0.03510024	0	13.09454053	0.3	25	0		0	0	0												9.5003	0	0.842720455	0	0.349312179	0	0	1.609626216	2.482805596	0.351680757	1.640139257	0	0	0.642894932	2.084131899	9.65601134	0	0	0	4.762609705	1.73851632	0	0.032076136	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7803		NO	21.29641083	12.697	0	1.017636807	0.820101424	0.349312179	2.21211798	0	1.609626216	9.502690069	5.057991702	14.8135752	0	0	3.269811008	2.084131899	14.40697214	0	0	0	26.88822093	4.548112417	0	0.032076136	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3968	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b) 30%, (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%	"(16a) 50%, (16b) 30% - 50%"	"(17a) 30%, (17b) 0%"			(18b) $0													4500	0.547	0	0	0.0159	0.2064	0.0014	0	0.0007	0.0789	0.0088	0.0925	0	0	0.0598	0.08	0.3351	0	0	0	0.3845	0.0094	0	0																		1.8204		NO	0.707635883	13.2439	0	1.017636807	0.835982782	0.555674684	2.213500394	0	1.61033486	9.581620364	5.066813483	14.90605965	0	0	3.329611745	2.164132311	14.7420326	0	0	0	27.27273084	4.557552087	0	0.032076136	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2172
H3916_020_0	2012	8																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													2.906066204	0	0.284124579	0.537025401	0	1.748687326	0	0	5.632765651	4.203795419	10.24706957	0	0	3.485239271	0	3.914211234	0	0	0	15.93926038	1.793503262	0	0	0	0	0	0	0	0	0											50.6917	YES	162.7013563	0	33.34570816	0	77.58977605	0	0	379.3728966	28.73158137	4.181943746	20.17587279	0	0	16.00026252	2763.354492	4939.645029	0	0	0	61.10874279	38.81706415	0	20.15160009	11.3022	334.4746395	0			0	0											2750	"(1a), (1b) 10%"		(2) 10%	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 10%"	(8a) 0% - 10%	"(8b) X-Ray and Diag. X-Ray 10%, Therapeutic Services 0%"			"(3) $0, (5) 10%, (9c) 10%, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c) 10%, (7d) $25, (7e), (7f) 10%, (7g) $10-$25, (7h) $25, (7i) 10%, (14a), (14b), (14d), (14e) $0, (16b) 10%, (18a) $0, (17a), (17b) $0-$25"				"(7g)10%, (14b), (14e) $0, (18a) $25"	(15) 0%-10%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0											1000	NO	0.1	0	0.1	0	75	0	0	65	0.1	0.1	0.1	0	0	0.1	10	23.01694446	0	0	0	0.1	0.1	0	40	0.3	25	0		0	0	0											NO	0.05752278	0	0.029179686	0	42.37961415	0	0	53.98450851	0.085704291	0.073827503	0.076258559	0	0	0.061727143	9.382411016	20.13359717	0	0	0	0.068278489	0.036457443	0	9.691358025	0.3	25	0		0	0	0												9.359	0	0.9730173	0	0.274018731	0	0	1.70668828	2.462419819	0.308742466	1.538582982	0	0	0.987650493	2.160577302	8.287735266	0	0	0	4.172412643	1.41517089	0	0.016274698	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7498		NO	17.22839593	12.2651	0	1.257141879	0.537025401	0.274018731	1.748687326	0	1.70668828	8.095185471	4.512537885	11.78565255	0	0	4.472889764	2.160577302	12.2019465	0	0	0	20.11167302	3.208674151	0	0.016274698	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4416	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b) 30%, (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%	"(16a) 50%, (16b) 30% - 50%"	"(17a) 30%, (17b) 0%"			(18b) $0													4500	1.0356	0	0.0156	0	0.2597	0.0086	0	0.0063	0.2254	0.1146	0.254	0	0	0.1111	0.0911	0.4174	0	0	0	0.6118	0.071	0	0.0394																		3.2617		NO	1.422255905	13.3007	0	1.272727063	0.537025401	0.533767808	1.75726883	0	1.713030878	8.32062471	4.627101363	12.03970247	0	0	4.584004084	2.251688303	12.61932904	0	0	0	20.72345759	3.279696552	0	0.055660638	3.39066	0.696822166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7032
H3916_022_0	2012	7																															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	249.0196496	0	318.895749	0	124.3713787	13.03322889	0	399.7030462	468.3255669	3849.831761	918.1970184	0	0	209.4658591	3228.549542	5563.538454	0	0	0	0	41.46906747	0	29.86346353	0	334.4746395	0			0	0											3400	"(1a), (1b) $400 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $30 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $30, (9d) $0"	"(7a) $20, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $20, (7c), (7d), (7e), (7f) $30, (7g) $20-$30, (7h), (7i) $30, (14a), (14b), (14d), (14e) $0, (16b), (18a) $30, (17a), (17b) $0-$30"					(15) 0%-10%		(10b) $40		"(17a) $30, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	400	0	60	0	100	0.2	0	65	150	20	58.88056153	0	0	30	20	28.81392289	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	372.8437997	0	44.60096638	0	83.17149395	0.182664092	0	62.21498818	147.3995499	19.38186078	56.33531042	0	0	28.25304004	19.79773206	28.33259302	0	0	0	0	0.073803588	0	31.71203753		30	0		0	0	0												7.7371	0	1.185254882	0	0.862012781	2.380702926	0	2.072293358	5.752581481	6.218075269	4.310576171	0	0	0.493170609	5.326496563	13.13578923	0	0	0	0	3.060565966	0	0.078919273	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4497		NO	3.456982963	7.7371	0	1.185254882	0	0.862012781	2.380702926	0	2.072293358	5.752581481	6.218075269	4.310576171	0	0	0.493170609	5.326496563	13.13578923	0	0	0	0	3.060565966	0	0.078919273	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4497	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													5100	0.1585	0	0	0.0397	0.422	0.0741	0	0	0.0683	0.0138	0.1183	0	0	0.0376	0.1258	0.3156	0	0	0	0.4416	0.0272	0	0																		1.8426	500	NO	1.334410934	7.8956	0	1.185254882	0.039749568	1.284014518	2.454833317	0	2.072293358	5.820887004	6.231920479	4.42889988	0	0	0.530778105	5.45228798	13.4513742	0	0	0	0.441633247	3.087745809	0	0.078919273	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2924
H3916_024_0	2012	7																															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	227.5712631	0	459.7723719	0	87.63061653	13.43954141	0	448.436263	479.9084727	3899.432823	890.4286706	0	0	276.434074	3543.789436	5060.270557	0	0	0	0	46.13531459	0	5.603634024	0	334.4746395	0			0	0											3400	"(1a), (1b) $400 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% -20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $30 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $30, (9d) $0"	"(7a) $20, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $20, (7c), (7d), (7e), (7f) $30, (7g) $20-$30, (7h), (7i) $30, (14a), (14b), (14d), (14e) $0, (16b), (18a) $30, (17a), (17b) $0-$30"					(15) 0%-10%		(10b) $40		"(17a) $30, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	400	0	60	0	100	0.2	0	65	150	20	56.12716461	0	0	30	20	28.94537123	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	375.3779648	0	47.7124756	0	83.95061728	0.181345421	0	59.8243653	144.6696027	19.31349859	54.19069069	0	0	27.95392625	19.7912846	28.25972554	0	0	0	0	0.061201905	0	37.44		30	0		0	0	0												7.1188	0	1.828073173	0	0.613053696	2.437199297	0	2.235617901	5.785680673	6.275974195	4.021078722	0	0	0.643951476	5.844678773	11.91682142	0	0	0	0	2.823569123	0	0.017483338	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3981		NO	4.268460988	7.1188	0	1.828073173	0	0.613053696	2.437199297	0	2.235617901	5.785680673	6.275974195	4.021078722	0	0	0.643951476	5.844678773	11.91682142	0	0	0	0	2.823569123	0	0.017483338	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3981	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													5100	0.6125	0	0.0325	0.0287	0.7093	0.0116	0	0.0045	0.1124	0.144	0.2542	0	0	0.2568	0.1279	0.5133	0	0	0	0.7694	0.0596	0	0.0049																		3.6417	500	NO	2.495293314	7.7313	0	1.860577376	0.028720537	1.32237645	2.448761989	0	2.2401362	5.898053368	6.41993555	4.275293177	0	0	0.900772503	5.972594976	12.43013845	0	0	0	0.769350667	2.883184436	0	0.022412469	0	0.836186599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0398
H3916_025_0	2012	8																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													1.713311225	0	0.113369749	0.245509053	0	1.608690089	0	0	5.148473757	4.791722968	9.990463394	0	0	2.65619067	0	3.784723039	0	0	0	15.27369433	1.191308269	0	0	0	0	0	0	0	0	0											46.5175	YES	136.3343373	0	27.91752068	0	38.82550253	0	0	335.2615578	30.57135541	4.179344911	17.39611754	0	0	17.60355155	3052.513293	4888.426688	0	0	0	55.43475776	27.99649373	0	10.44928226	11.3022	334.4746395	0			0	0											2700	"(1a), (1b) 10%"		(2) 10%	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 10%"	(8a) 0% - 10%	"(8b) X-Ray and Diag. X-Ray 10%, Therapeutic Services 0%"			"(3) $0, (5) 10%, (9c) 10%, (9d) $0"	"(7a) $5, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $5, (7c) 10%, (7d) $15, (7e), (7f) 10%, (7g) $5-$15, (7h) $15, (7i) 10%, (14a), (14b), (14d), (14e) $0, (16b) 10%, (18a) $0, (17a), (17b) $0-$15"				"(7g) 10%, (14b), (14e) $0, (18a) $15"	(15) 0%-10%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $15, (17b) $0"			(18b) $0	(14c) $0	(13d) $0											950	NO	0.1	0	0.1	0	75	0	0	65	0.1	0.1	0.1	0	0	0.1	5	14.12670658	0	0	0	0.1	0.1	0	40	0.3	15	0		0	0	0											NO	0.062990415	0	0.040019904	0	46.46127085	0	0	56.33463794	0.083077059	0.077679634	0.077227747	0	0	0.054522339	4.701779637	12.54631892	0	0	0	0.070107982	0.04333419	0	14.8486286	0.3	15	0		0	0	0												8.5878	0	1.117256507	0	0.150323516	0	0	1.573903206	2.539778307	0.324649983	1.343462956	0	0	0.959786805	1.196020404	5.110980022	0	0	0	3.886419016	1.213205374	0	0.012929793	3.39066	0.418093299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8252		NO	12.8470273	10.3011	0	1.230626256	0.245509053	0.150323516	1.608690089	0	1.573903206	7.688252063	5.116372951	11.33392635	0	0	3.615977475	1.196020404	8.895703061	0	0	0	19.16011335	2.404513643	0	0.012929793	3.39066	0.418093299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3427	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b) 30%, (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%	"(16a) 50%, (16b) 30% - 50%"	"(17a) 30%, (17b) 0%"			(18b) $0													4500	1.5913	0	0.1417	0.0519	0.3651	0.0174	0	0.0029	0.8411	0.1724	0.3973	0	0	0.315	0.5476	1.2854	0	0	0	2.4856	0.1607	0	0.0047																		8.3802		NO	5.784786379	11.8924	0	1.372306424	0.297413702	0.515423561	1.626102664	0	1.57683108	8.529347412	5.288802027	11.7312604	0	0	3.931015435	1.743635509	10.18114741	0	0	0	21.64566531	2.565211742	0	0.017616252	3.39066	0.418093299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7229
H3916_801_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	287.1690805	0	67.36904763	30.54426087	4.863972926	21.42347883	0	16.64729974	42.28273782	11.16620512	18.51741229	0	0	33.00127979	25.56145802	32.90402669	0	0	0	172.5439633	46.99317057	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.079847128		0.18098625		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.068429969		0.155107441		0.191970753	0.191970753		0.191970753	0.191970753	0.191970753	0.191970753			0.191970753	0.191970753	0.191970753				0.191970753	0.191970753																					19.651	0	10.44944056	0	0.933740544	4.112681357	0	3.195794661	8.117049005	2.143584801	3.554801576	0	0	6.335280522	4.907052335	6.316610771	0	0	0	33.12339451	9.021314326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8617		NO	18.66350227	19.651	0	10.44944056	0	0.933740544	4.112681357	0	3.195794661	8.117049005	2.143584801	3.554801576	0	0	6.335280522	4.907052335	6.316610771	0	0	0	33.12339451	9.021314326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8617	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b)  FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	4.7061	0	0.0161	0	1.367	0.009	0	0	1.8804	0.3041	1.2461	0	0	0.8987	0.871	1.1212	0	0	0	5.1375	0.6958	0	0	0	0	0	0	0	0	0											18.2529		NO	0.914161522	24.3571	0	10.46552453	0	2.300787706	4.121717697	0	3.195794661	9.997481704	2.447652648	4.800914424	0	0	7.233941078	5.778041215	7.437792564	0	0	0	38.26084622	9.717088698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.1147
H3916_802_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	259.9572317	0	61.93581977	30.40181943	7.69274145	26.20245865	0	20.88308721	46.46876078	14.83641349	24.95935251	0	0	24.61475207	26.64841499	34.43385394	0	0	0	169.0911682	62.20173381	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.084620378		0.179500054		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.072520704		0.153833752		0.191970753	0.191970753		0.191970753	0.191970753	0.191970753	0.191970753			0.191970753	0.191970753	0.191970753				0.191970753	0.191970753																					18.8523	0	9.527819528	0	1.476781366	5.030105709	0	4.00894197	8.920642983	2.848157465	4.791465688	0	0	4.725312483	5.115716284	6.610292859	0	0	0	32.46055883	11.94091366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.309		NO	19.40550506	18.8523	0	9.527819528	0	1.476781366	5.030105709	0	4.00894197	8.920642983	2.848157465	4.791465688	0	0	4.725312483	5.115716284	6.610292859	0	0	0	32.46055883	11.94091366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.309	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	1.8363	0	0.3706	0	0.9687	0.055	0	0.007	0.8692	0.1349	0.6021	0	0	0.5229	0.4558	0.6158	0	0	0	2.5857	0.6416	0	0	0	0	0	0	0	0	0											9.6656		NO	0.484081545	20.6886	0	9.898376037	0	2.445445801	5.085083817	0	4.015961419	9.789849086	2.98307534	5.393520504	0	0	5.248261342	5.571561665	7.226118982	0	0	0	35.04624597	12.58246907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9746
H3916_804_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	259.9572317	0	61.93581977	30.40181943	7.69274145	26.20245865	0	20.88308721	46.46876078	13.89252042	23.36436701	0	0	27.15363064	26.36253086	34.12869045	0	0	0	169.6822158	62.20173381	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.084620378		0.179500054		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.072520704		0.153833752		0.191970753	0.191970753		0.191970753	0.191970753	0.191970753	0.191970753			0.191970753	0.191970753	0.191970753				0.191970753	0.191970753																					18.8523	0	9.527819528	0	1.476781366	5.030105709	0	4.00894197	8.920642983	2.666957601	4.485275122	0	0	5.212702913	5.060834893	6.551710393	0	0	0	32.57402268	11.94091366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.309		NO	19.40550506	18.8523	0	9.527819528	0	1.476781366	5.030105709	0	4.00894197	8.920642983	2.666957601	4.485275122	0	0	5.212702913	5.060834893	6.551710393	0	0	0	32.57402268	11.94091366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.309	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	1.8363	0	0.3706	0	0.9687	0.055	0	0.007	0.8692	0.1939	0.6788	0	0	0.379	0.4602	0.5958	0	0	0	2.6095	0.6416	0	0	0	0	0	0	0	0	0											9.6656		NO	0.484081545	20.6886	0	9.898376037	0	2.445445801	5.085083817	0	4.015961419	9.789849086	2.860859362	5.164097242	0	0	5.591693667	5.521062436	7.147516745	0	0	0	35.18355435	12.58246907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9746
H3920_001_0	2012	8																															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	1541.31988	238.4019989	1088.650653	1030.260675	335.2936256	16.05530408	5.234799899	712.1744096	68.44443333	22.73352042	48.6879278	0	0.400407152	53.21886933	3134.932432	5243.73151	794.8528351	820.2784939	0	0	22.05259985	500.8014608	0	2484.680292	42.79069767	0	19.40647066	0	81.19209852	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $30 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $30 (5); 20% (9a); $35 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$0 n/c (10b)	"$30 (16a1, 16a2); $0 n/c (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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	62.82014169	0	200	0.2	0.1996924	64.99138709	0.16	0.076730462	0.179578611	0	0.2	0.145873015	7.312097342	43.83744874	30	45	0	0	0.2	38.77719703	0	30	45	0	39.10773575	0	0	0											NO	170.4703912	89.28548472	51.44637667	0	163.7894321	0.163789432	0.163537524	53.23285006	0.131031546	0.062838194	0.147065393	0	0.163789432	0.119462292	7.091391686	42.51446913	29.09449104	43.64173655	0	0	0.163789432	31.75647541	0	30	45	0	39.10773575	0	0	0												21.8958	1.773819836	4.667260963	0	4.57646271	2.629689137	0.856086213	3.159256131	8.968379893	1.428533373	7.160309248	0	0.06558246	6.357648082	1.852586148	18.57787178	1.927153224	2.983198161	0	0	3.611982806	1.325307439	0	6.211700729	0.160465116	0	0.063245261	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2523	0	NO	15.9266881	21.8958	1.773819836	4.667260963	0	4.57646271	2.629689137	0.856086213	3.159256131	8.968379893	1.428533373	7.160309248	0	0.06558246	6.357648082	1.852586148	18.57787178	1.927153224	2.983198161	0	0	3.611982806	1.325307439	0	6.211700729	0.160465116	0	0.063245261	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2523	NO																																										0	0	0	0	0	0	0	0	0	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	21.8958	1.773819836	4.667260963	0	4.57646271	2.629689137	0.856086213	3.159256131	8.968379893	1.428533373	7.160309248	0	0.06558246	6.357648082	1.852586148	18.57787178	1.927153224	2.983198161	0	0	3.611982806	1.325307439	0	6.211700729	0.160465116	0	0.063245261	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2523
H3920_009_0	2012	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	341.745623	45.459551	46.01971176	1439.058547	30.10714488	23.18780028	13.2303287	62.62844845	74.32416101	27.68249704	47.99677247	0	0.270285128	75.47511608	13.27445858	132.3240091	11.82343527	8.231110206	0	0	15.53272343	4.387193316	701.7391304	1729.411765	43.21648625	615.9351412	25.06326712	2.613989513	81.19209852	4185.050519											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10); $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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.08303492	0.08303492	0.181023373	0	0.224	0.224	0.224	0.138235084	0.224	0.224	0.224	0	0.224	0.224	0.2125689	0.223996655	0.224	0.224	0	0	0.224	0.085505724	0	0	0	0	0	0	0	0											NO	0.068836332	0.068836332	0.150069213	0	0.185697035	0.185697035	0.185697035	0.114609225	0.185697035	0.185697035	0.185697035	0	0.185697035	0.185697035	0.176220601	0.185694262	0.185697035	0.185697035	0	0	0.185697035	0.074745716	0	0	0	0	0	0	0	0												23.5245	3.129268764	6.906141913	0	5.590807551	4.305905772	2.456832817	7.177797912	13.80177636	5.140557634	8.91285836	0	0.050191147	14.01550531	2.33923307	24.57180927	2.195576879	1.528492764	0	0	2.884380693	0.327923903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8596	150	YES	26.55801792	23.5245	3.129268764	6.906141913	0	5.590807551	4.305905772	2.456832817	7.177797912	13.80177636	5.140557634	8.91285836	0	0.050191147	14.01550531	2.33923307	24.57180927	2.195576879	1.528492764	0	0	2.884380693	0.327923903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8596	NO																																										0	0	0	0	0	0	0	0	0	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	23.5245	3.129268764	6.906141913	0	5.590807551	4.305905772	2.456832817	7.177797912	13.80177636	5.140557634	8.91285836	0	0.050191147	14.01550531	2.33923307	24.57180927	2.195576879	1.528492764	0	0	2.884380693	0.327923903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8596
H3921_001_0	2012	5																															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	1311.924859	145.233243	590.5156172	1019.460827	172.9154231	10.0271614	10.66216689	360.3678176	50.42128882	16.31178613	29.81536839	0	0.124374625	31.33726889	5687.820145	3376.457515	719.4627794	465.1288176	0	0	16.38328719	735.1663604	0	0	41.5782387	0	12.33275429	0	136.3387128	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	68.26283676	0	200	0.2	0.100079597	63.50108172	0.16	0.192558997	0.186527994	0	0.2	0.145824975	6.61909443	29.52873459	38.5	30	0	0	0.2	28.96285929	0	0	30	0	30	0	0	0											NO	152.4652551	81.41141093	55.62098832	0	162.9612567	0.162961257	0.081545484	51.75670599	0.130369005	0.15689828	0.151984182	0	0.162961257	0.118819106	6.41602984	28.62672663	37.31887367	29.07964182	0	0	0.162961257	23.59911973	0	0	30	0	30	0	0	0												16.6686	0.985303602	2.737088521	0	2.348209554	1.634038823	0.869451564	1.554287599	6.573373272	2.559291196	4.531464366	0	0.020268245	3.723466271	3.041101981	8.054743856	2.237461715	1.127148285	0	0	2.66984107	1.445773247	0	0	0.103945597	0	0.030831886	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9157	0	NO	11.43849989	16.6686	0.985303602	2.737088521	0	2.348209554	1.634038823	0.869451564	1.554287599	6.573373272	2.559291196	4.531464366	0	0.020268245	3.723466271	3.041101981	8.054743856	2.237461715	1.127148285	0	0	2.66984107	1.445773247	0	0	0.103945597	0	0.030831886	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9157	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)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9900	0.6138	0.0644	0.4171	0.3493	0.2902	0.5049	0.3221	0.1921	1.2187	0.3163	0.8157	0	0.0025	0.6893	0.9198	1.5457	0.3611	0.2147	0	0	0.5721	0.2751	0	0	0.0198	0	0.0059	0	0	0											9.7106	0	NO	1.604763264	17.2823	1.049689395	3.154150865	0.34934438	2.638437701	2.13893846	1.19157608	1.74639056	7.792032361	2.875608085	5.347208951	0	0.022773309	4.412759036	3.960873547	9.600399648	2.598610452	1.341843196	0	0	3.24194987	1.72086401	0	0	0.123744758	0	0.036704626	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6262
H3921_008_0	2012	5																															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	1464.134747	157.5177827	709.1069126	1082.985734	163.3780743	9.627835312	12.39715839	372.4355567	52.58308074	18.51190978	40.05207244	0	0.023780907	35.36035229	5590.754686	3854.551816	714.6696051	572.1241723	0	0	14.4462145	831.9558899	0	0	39.26825993	0	11.18711682	0	127.3428139	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	67.39693274	0	200	0.2	0.100420972	63.55848757	0.16	0.180532996	0.180938664	0	0.2	0.146150742	6.544946887	29.23159644	38.5	30	0	0	0.2	29.12802616	0	0	30	0	30	0	0	0											NO	148.5685757	79.33071285	53.51192531	0	158.7963224	0.158796322	0.079732405	50.48078041	0.127037058	0.143339879	0.143661972	0	0.158796322	0.116041002	6.319006586	28.22608369	37.17092862	28.96435997	0	0	0.158796322	23.12711717	0	0	30	0	30	0	0	0												18.127	1.041333166	3.162139679	0	2.161986447	1.52886484	0.988455253	1.566736463	6.679999875	2.653494911	5.753959724	0	0.003776321	4.103250697	2.944001307	9.066575181	2.213744407	1.380934206	0	0	2.294005736	1.603395112	0	0	0.09817065	0	0.027967792	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3998	0	NO	13.96280009	18.127	1.041333166	3.162139679	0	2.161986447	1.52886484	0.988455253	1.566736463	6.679999875	2.653494911	5.753959724	0	0.003776321	4.103250697	2.944001307	9.066575181	2.213744407	1.380934206	0	0	2.294005736	1.603395112	0	0	0.09817065	0	0.027967792	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3998	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)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											9900	0.6675	0.068	0.4897	0.3539	0.2672	0.4724	0.365	0.1936	1.2384	0.328	1.0421	0	0.0005	0.7597	0.902	1.7424	0.3573	0.263	0	0	0.4916	0.3054	0	0	0.0187	0	0.0053	0	0	0											10.3318	0	NO	1.942491038	18.7945	1.109380274	3.65186943	0.353916345	2.429198255	2.001266898	1.353424716	1.760378048	7.918426818	2.981454956	6.796099655	0	0.004243057	4.862958182	3.845986787	10.80897003	2.571064933	1.643969293	0	0	2.785578394	1.908813152	0	0	0.116869821	0	0.033294991	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7317
H3923_013_0	2012	10																															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	64.41601375	47.52644965	359.445278	39.8627962	118.7544511	8.232487931	0	213.6180004	443.2529497	2388.968541	953.4879935	0	0.273647276	1426.588179	4194.590409	5001.399473	222.2001969	629.1716526	2643.523226	17314.98396	2.33805872	435.6701386	0	0	634.8922581	11.37187515	10.37623321	10.79174806	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 - $8 copay/visit	10a - $100 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $65 ER copay (WIA) World Wide Coverage; 4b - $35 Urgent Care copay	"9a,9b - $100 copay"	8a - $0 copay	"8b - $100 copay (High Tech Imaging Only), $60 therapeutic radiology copay"	5 - $0 copay	12 - 15% coinsurance	3 - $35 C&P Rehab Svcs copay; 9c - $35 SA Ind/Grp Session copay	7a - $10 OV copay	7d - $35 Specialist OV copay (excluding MH and Radiology); 18a - $35 MC Cov Hearing Exam copay	"7e,7h - $35 MH/Psych Ind/Grp Session copay"	"7c,7i -  $35 OT/PT/ST copay"	7d - $35 OV copay (Radiology only)	"7b - $20 Chiro OV copay, 7f,7g - $35 Pod/Other OV copay; 14a - $0 MC Cov Prev Svcs copay; 14b - $0 Supplemental Prev Health Benefits; 14d - $0 Kidney Disease Ed Svcs copay; 14e - $0 Diabetes Self-Mang Training copay"	15 - 20% coinsurance	9d - $0 OP Blood Svcs copay; 17a - $35 MC Cov Eye Exam copay/$0 for Glaucoma Screening	0	0	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	0	0	14c - $0 Supplemental Education/Wellness Programs copay	0											0	NO	250	250	50	8	100	0.096012585	0	64.4	100	0	21.62583519	0	0.15	13.95709221	10	21.55159215	35	35	0	1.241791866	0.2	33.5224745	0	0	20	0	0	0	0	0											NO	233.7413458	233.7413458	46.74826917	7.479723067	93.49653833	0.09	0	60.21177069	93.49653833	0	20.21940729	0	0.14	13.04939807	9.349653833	20.14999261	32.72378842	32.72378842	0	1.161032408	0.187	31.34235322	0	0	18.69930767	0	0	0	0	0												1.2547	0.925741359	1.40028705	0.02484689	0.925260841	0.740923914	0	1.071859838	3.453551367	0	1.606580174	0	0.038310619	1.551343086	3.268164025	8.398180204	0.605936019	1.715740003	0	1.675271461	0.437216981	1.137910614	0	0	0.989337139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2212	0	NO	2.32	1.2547	0.925741359	1.40028705	0.02484689	0.925260841	0.740923914	0	1.071859838	3.453551367	0	1.606580174	0	0.038310619	1.551343086	3.268164025	8.398180204	0.605936019	1.715740003	0	1.675271461	0.437216981	1.137910614	0	0	0.989337139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2212	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 - $65 ER copay (WIA) World Wide Coverage; 4b - $35 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-$40 Lenses OON allowance"	0	0	"50% coinsurance, no OOP Max"	0											5100	2.0947	0.0628	0.2159	0.002	0.0596	0.1084	0	0.0394	0.5781	0.1425	0.3359	0	0.0036	0.386	0.1001	0.5969	0.0297	0.0517	0.2846	1.6806	0.0308	0.0418	0	0	0.0574	0.0005	0	0	0	0											6.9031	500	NO	53.24	3.3494	0.988570613	1.616189791	0.026810752	0.98485327	0.849333002	0	1.111258938	4.031697631	0.14254163	1.94247624	0	0.041914129	1.937353645	3.368311848	8.995087706	0.63564633	1.767450326	0.284562732	3.355917326	0.468005585	1.179690476	0	0	1.046748827	0.000499166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1243
H3923_017_0	2012	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	236.5838071	49.64987737	557.0570174	93.93764542	260.2675864	17.86640196	0	289.088181	486.5825851	3014.232185	1160.042054	0	0.330774915	2028.412412	4194.590409	6577.257747	220.7112706	1273.587303	3478.61019	21256.15545	4.911752429	449.572471	0	456.5431474	639.308051	15.97579004	12.31817439	11.99339712	0	0											3400	1a - $0 copay/admit	1b - $0 copay/admit	2 - $0 copay Days 1-10/ $25 copay Days 11-100	6 - $8 copay/visit	10a - $75 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $65 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 C&P Rehab Svcs copay; 9c - $25 SA Ind/Grp Session copay	7a - $10 OV copay	7d - $25 Specialist OV copay (excluding MH and Radiology); 18a - $25 MC Cov 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)	"7b - $20 Chiro OV copay, 7f,7g - $25 Pod/Other OV copay; 14a - $0 MC Cov Prev Svcs copay; 14b - $0 Supplemental Prev Health Benefits; 14d - $0 Kidney Disease Ed Svcs copay; 14e - $0 Diabetes Self-Mang Training copay;  18a - $25 MC Cov Dental Exam copay"	15 - 15% coinsurance	9d - $0 OP Blood Svcs copay; 17a - $25 MC Cov Eye Exam copay/$0 for Glaucoma Screening	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	14c - $0 Supplemental Education/Wellness Programs copay	0											0	NO	0	0	25	8	75	0.101152118	0	64.2	50	0	10.81291759	0	0.1	9.048624891	10	16.9003304	25	25	0	1.050818368	0.15	23.63854552	0	10	20	0	20	0	0	0											NO	0	0	23.55980292	7.539136935	70.67940877	0.095	0	60.50157391	47.11960585	0	10.1900083	0	0.094	8.527352766	9.423921169	15.92673814	23.55980292	23.55980292	0	0.990282947	0.141	22.27677895	0	9.423921169	18.84784234	0	18.84784234	0	0	0												0	0	1.093679462	0.059017398	1.532963261	1.697308186	0	1.457524162	1.910631635	0	0.985069847	0	0.031092842	1.441415683	3.294124113	8.729521818	0.43332617	2.500455489	0	1.754134021	0.692557092	0.834585547	0	0.358535553	1.004131446	0	0.019347584	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8294	0	NO	1.93	0	0	1.093679462	0.059017398	1.532963261	1.697308186	0	1.457524162	1.910631635	0	0.985069847	0	0.031092842	1.441415683	3.294124113	8.729521818	0.43332617	2.500455489	0	1.754134021	0.692557092	0.834585547	0	0.358535553	1.004131446	0	0.019347584	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8294	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 - $65 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-$40 Lenses OON allowance"	"20% coinsurance, no OOP Max"	"20% coinsurance, no OOP Max, $400 Hearing Aid OON allowance"	"50% coinsurance, no OOP Max"	0											5100	2.1923	0.0404	0.2353	0.0068	0.0567	0.1664	0	0.0686	0.5362	0.1267	0.2824	0	0.0031	0.5295	0.0531	0.5432	0.021	0.0775	0.2546	1.605	0.0457	0.0382	0	0.0261	0.0431	0.0005	0.0015	0.0037	0	0											6.9577	500	NO	48.14	2.1923	0.040395638	1.329028429	0.065807554	1.589664131	1.863697274	0	1.526166519	2.446797382	0.126671141	1.267483502	0	0.034173336	1.9709392	3.347243851	9.272697871	0.454364035	2.577923596	0.254583487	3.359133546	0.738300047	0.872737019	0	0.384609354	1.047256709	0.00049594	0.020878953	0.003723134	0	0	0	0	0	0	0	0	0	0	0	0	36.7871
H3923_801_0	2012	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	234.5694107	3.963104659	40.70284385	0.754249683	9.782768369	17.79134633	0	25.21886735	51.71524737	15.70618065	25.73970226	0	0.376620152	57.36965904	0	56.2558301	1.625544297	5.446057126	22.64942431	171.4645644	3.143723867	5.01526125	0	0.553715521	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	NO	0.081681031	0.081681031	0.185947677	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065	0.065	0.149	0	0.18	0.18	0	0.18	0.18	0.18	0.18	0	0.18	0.18	0	0.18	0.18	0.18	0.18	0.18	0.18	0.18	0	0	0	0	0	0	0	0												15.247	0.257601803	6.064723733	0	1.760898306	3.20244234	0	4.539396123	9.308744527	2.827112517	4.633146406	0	0.067791627	10.32653863	0	10.12604942	0.292597973	0.980290283	4.076896376	30.8636216	0.565870296	0.902747025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0435	0	NO	27.62	15.247	0.257601803	6.064723733	0	1.760898306	3.20244234	0	4.539396123	9.308744527	2.827112517	4.633146406	0	0.067791627	10.32653863	0	10.12604942	0.292597973	0.980290283	4.076896376	30.8636216	0.565870296	0.902747025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0435	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	0.7683	0.013	0.3567	0	0.1053	0.1915	0	0.2715	0.5568	0.1691	0.2771	0	0.0041	0.6176	0	0.6056	0.0175	0.0586	0.2438	1.846	0.0338	0.054	0	0	0	0	0	0	0	0											6.1904	0	NO	15.35	16.0153	0.270582776	6.421409828	0	1.866218883	3.393982687	0	4.810900624	9.865507137	2.996204121	4.910258177	0	0.071846293	10.94417622	0	10.73169561	0.310098466	1.038922139	4.320738439	32.70959669	0.5997154	0.956740965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.2339
H3923_802_0	2012	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	136.3316503	2.326308343	23.65608783	0.438362411	5.685647633	10.34015346	0	14.65695477	30.05638718	9.12827591	14.95965883	0	0.218887885	33.34267498	0	32.69532868	0.955554059	3.165194211	13.16362004	99.65349869	1.82710103	2.914819934	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	NO	0.077540273	0.077540273	0.190633804	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071	0.071	0.175	0	0.205	0.205	0	0.205	0.205	0.205	0.205	0	0.205	0.205	0	0.205	0.205	0.205	0.205	0.205	0.205	0.205	0	0	0	0	0	0	0	0												9.6795	0.165167892	4.139815371	0	1.165557765	2.119731459	0	3.004675727	6.161559372	1.871296562	3.06673006	0	0.044872016	6.835248371	0	6.702542379	0.195888582	0.648864813	2.698542108	20.42896723	0.374555711	0.597538087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9011	0	NO	6.77	9.6795	0.165167892	4.139815371	0	1.165557765	2.119731459	0	3.004675727	6.161559372	1.871296562	3.06673006	0	0.044872016	6.835248371	0	6.702542379	0.195888582	0.648864813	2.698542108	20.42896723	0.374555711	0.597538087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9011	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	0.5093	0.0087	0.2292	0	0.0651	0.1183	0	0.1677	0.344	0.1045	0.1712	0	0.0025	0.3816	0	0.3742	0.0109	0.0362	0.1506	1.1404	0.0209	0.0334	0	0	0	0	0	0	0	0											3.8686	0	NO	3.01	10.1888	0.173857817	4.368990609	0	1.230623786	2.23806321	0	3.17240855	6.505521864	1.9757597	3.237927	0	0.047376949	7.216818833	0	7.076704671	0.206823854	0.685087001	2.849185347	21.56939257	0.395464885	0.630895014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7697
H3923_803_0	2012	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	234.5700539	3.969697841	40.70284385	0.754249683	9.782768369	17.79134633	0	25.21886735	51.71524737	15.70618065	25.73970226	0	0.376620152	57.36965904	0	56.2558301	1.628642506	5.446057126	22.64942431	171.4645644	3.143723867	5.01526125	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	NO	0.079162367	0.079162367	0.182390065	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064	0.064	0.146	0	0.18	0.18	0	0.18	0.18	0.18	0.18	0	0.18	0.18	0	0.18	0.18	0.18	0.18	0.18	0.18	0.18	0	0	0	0	0	0	0	0												15.0125	0.254060662	5.942615202	0	1.760898306	3.20244234	0	4.539396123	9.308744527	2.827112517	4.633146406	0	0.067791627	10.32653863	0	10.12604942	0.293155651	0.980290283	4.076896376	30.8636216	0.565870296	0.902747025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6839	0	NO	27.26	15.0125	0.254060662	5.942615202	0	1.760898306	3.20244234	0	4.539396123	9.308744527	2.827112517	4.633146406	0	0.067791627	10.32653863	0	10.12604942	0.293155651	0.980290283	4.076896376	30.8636216	0.565870296	0.902747025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6839	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	0.7408	0.0125	0.3497	0	0.1055	0.1918	0	0.2719	0.5576	0.1693	0.2775	0	0.0041	0.6185	0	0.6065	0.0176	0.0587	0.2442	1.8486	0.0339	0.0541	0	0	0	0	0	0	0	0											6.1627	0	NO	15.11	15.7533	0.26659763	6.292301625	0	1.866368292	3.394254409	0	4.811285783	9.866296967	2.996443996	4.910651292	0	0.071852045	10.94505241	0	10.73255479	0.310714372	1.039005315	4.321084356	32.71221541	0.599763413	0.956817561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8466
H3924_001_0	2012	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											8.745133345	0.065805117	1.128120191	0	0.106091308	0	0	0	3.15192154	0.939184731	0.963466284	0	0	0.123852611	0	0.043684857	0	0	0	0.0891021	0	0	0	0	0	0	0	0	0	0											15.3564	YES	1150.697301	23.21339809	800.5838222	655.3342339	46.50064982	7.569071142	2.056267778	945.6426458	591.3360556	861.3085502	277.5643816	0	0	51.13482184	3661.474905	3561.620182	126.5278831	807.468286	421.6216717	92.13570399	13.40310553	0	0	346.8982581	412.0037687	212.9531356	12.55995191	19.94536758	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	49.92470207	125	10	58.6863423	0	0	79.92568563	9.910549594	24.47272223	17.5	25	0	0	0.19993619	0	0	18.51098582	25	0	25	0	0	0											NO	52.12018365	30.37921812	41.78544396	0	99.40759514	0.19881519	0.19881519	49.62894571	124.2594939	9.940759514	58.33868156	0	0	79.45220198	9.851839017	24.32774463	17.39632915	24.85189878	0	0	0.198751758	0	0	18.51098582	24.85189878	0	24.85189878	0	0	0												4.9979	0.058767074	2.787729203	0	0.385209814	1.504846319	0.40881727	3.910937294	6.123259918	0.713505097	1.349395006	0	0	0.338564516	3.006021777	7.220515522	0.183426725	1.67226001	0	0	2.663890788	0	0	0.535119061	0.85325633	0	0.026011554	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7394	195	NO	0.227672839	13.743	0.124572191	3.915849394	0	0.491301122	1.504846319	0.40881727	3.910937294	9.275181457	1.652689828	2.312861289	0	0	0.462417127	3.006021777	7.264200379	0.183426725	1.67226001	0	0.0891021	2.663890788	0	0	0.535119061	0.85325633	0	0.026011554	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0958	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	0.0757	0	0.0609	0.0007	0.0238	0.1993	0.0046	0	0.0074	0.0305	0.012	0	0	0.0012	0.3929	0.6358	0	0.0036	0.0147	0.0004	0.0199	0	0	0	0.0171	0.0024	0.0015	0	0	0											1.5044	195	NO	0.006331685	13.8187	0.124572191	3.976774632	0.000677562	0.515090122	1.704129592	0.413391332	3.910937294	9.282546586	1.683199644	2.324889114	0	2.06E-06	0.463619018	3.398964322	7.899986518	0.183426725	1.675893744	0.014681024	0.089491096	2.683749959	0	0	0.535119061	0.870362784	0.002436587	0.027550183	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6002
H3924_003_0	2012	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											8.775871944	0.085327257	0.918406299	0	0.071297318	0	0	0	3.368259846	0.99653609	1.10913685	0	0	0.125539426	0	0.036540302	0	0	0	0.071416883	0	0	0	0	0	0	0	0	0	0											15.5583	YES	1147.520209	69.85256617	823.3578373	719.019539	39.93053947	7.13836744	1.923830253	924.8394453	916.0606607	1513.562317	582.9788757	0	0	48.22351692	3976.021286	4364.990723	297.6409271	787.3086384	504.8941139	113.2923466	20.94744046	0	0	446.0708122	449.9896419	224.9877622	13.43210521	26.7470882	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	49.76954028	125	10	60.2813026	0	0	99.25141935	9.844133977	24.56382433	17.5	25	0	0	0.199921872	0	0	18.47264306	25	0	25	0	0	0											NO	51.55881144	30.05201189	41.33538439	0	98.33690316	0.196673806	0.196673806	48.94182463	122.921129	9.833690316	59.27876617	0	0	97.60077214	9.680416496	24.15530415	17.20895805	24.58422579	0	0	0.196596978	0	0	18.47264306	24.58422579	0	24.58422579	0	0	0												4.9304	0.174934179	2.836151058	0	0.327220466	1.403929895	0.378367019	3.771944162	9.383600884	1.240325258	2.879855704	0	0	0.392221041	3.207461837	8.786473209	0.426840852	1.612947778	0	0	4.118203485	0	0	0.686675574	0.921887247	0	0.027518159	0	0	0	0	0	0	0	0	0	0	0	0	0	47.507	195	NO	0.791835595	13.7063	0.260261436	3.754557357	0	0.398517784	1.403929895	0.378367019	3.771944162	12.75186073	2.236861348	3.988992555	0	0	0.517760466	3.207461837	8.823013511	0.426840852	1.612947778	0	0.071416883	4.118203485	0	0	0.686675574	0.921887247	0	0.027518159	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0653	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	0.1955	0	0.1803	0.0023	0.0249	0.3617	0.0135	0.0007	0.0144	0.0267	0.0159	0	0	0.0015	0.1522	0.8096	0	0.0108	0.0318	0.001	0.0168	0	0	0	0.0234	0.0073	0.0046	0	0	0											1.8949	195	NO	0.023792225	13.9018	0.260261436	3.934890301	0.002256168	0.423377341	1.765596285	0.391905811	3.772635079	12.76630183	2.263549955	4.004873398	0	5.52E-06	0.519239168	3.359689543	9.632636517	0.426840852	1.623697929	0.031790474	0.072458248	4.135015781	0	0	0.686675574	0.945327448	0.007293452	0.032123746	0	0	0	0	0	0	0	0	0	0	0	0	0	64.9602
H3924_021_0	2012	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											9.799557026	0.099291582	0.900779565	0	0.046885101	0	0	0	2.438927713	0.785468077	1.335687119	0	0	0.05458259	0	0.040403362	0	0	0	0.048260453	0	0	0	0	0	0	0	0	0	0											15.5498	YES	1703.479229	23.91345128	784.6019481	770.6830583	31.71764822	7.798139319	2.479815759	889.2011419	650.8076499	2145.004435	1128.861844	0	0	28.311834	4780.730311	4709.55332	255.9436426	1140.225486	517.1927644	104.9838738	20.27906407	0	0	648.6843919	239.4779119	186.9857233	13.77115757	23.68296422	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	50	125	10	52.51629703	0	0	125	9.827517352	24.54268059	17.5	25	0	0	0.199993168	0	0	18.90111591	25	0	25	0	0	0											NO	52.29090729	30.47872757	41.92231537	0	99.7332123	0.199466425	0.199466425	49.86660615	124.6665154	9.97332123	52.37619001	0	0	124.6665154	9.801298744	24.47720374	17.45331215	24.93330307	0	0	0.199459611	0	0	18.90111591	24.93330307	0	24.93330307	0	0	0												7.423	0.060737631	2.741027526	0	0.263608579	1.555466969	0.494639983	3.695120261	6.761160158	1.782734856	4.927123538	0	0	0.294128141	3.904780499	9.606391344	0.372255357	2.369132302	0	0	4.044854229	0	0	1.02173824	0.49758128	0	0.02861337	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8441	195	NO	0.1359506	17.2226	0.160029212	3.641807091	0	0.310493679	1.555466969	0.494639983	3.695120261	9.20008787	2.568202933	6.262810657	0	0	0.348710731	3.904780499	9.646794707	0.372255357	2.369132302	0	0.048260453	4.044854229	0	0	1.02173824	0.49758128	0	0.02861337	0	0	0	0	0	0	0	0	0	0	0	0	0	67.394	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	2.1417	0	1.4732	0.0075	0.0286	0.4031	0.1598	0.0038	0.0528	0.0298	0.0119	0	0	0.0025	0.2942	1.9354	0	0.0536	0.0201	0.0006	0.4436	0	0	0	0.191	0.0322	0.0094	0	0	0											7.2946	195	NO	0.014715029	19.3642	0.160029212	5.115027501	0.007464114	0.339095382	1.95855301	0.654412139	3.698908766	9.252905595	2.597958858	6.274680187	0	2.11E-05	0.35121839	4.198938974	11.58223003	0.372255357	2.422768078	0.020071574	0.048828918	4.488414745	0	0	1.02173824	0.688626008	0.032177383	0.037999324	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6886
H3924_023_0	2012	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											8.981016413	0.1164162	0.640061802	0	0.045730775	0	0	0	2.931430054	0.847962595	1.520667548	0	0	0.086354397	0	0.021710051	0	0	0	0.078811161	0	0	0	0	0	0	0	0	0	0											15.2702	YES	1176.426293	15.57120927	533.7191121	661.3007033	24.60671547	7.245743803	2.631308206	730.1315	636.6537774	1828.822748	1113.615704	0	0	29.02960554	4515.174407	4048.512087	231.2647955	966.8774761	460.7757489	92.4412318	16.33290317	0	0	649.0829047	261.1814919	183.9858093	11.11792652	22.32484258	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	49.98395875	125	10	45.84580646	0	0	110.8561742	9.835868013	24.76017031	17.5	25	0	0	0.199984566	0	0	18.92849631	25	0	25	0	0	0											NO	52.12172264	30.38011515	41.78667778	0	99.41053041	0.198821061	0.198821061	49.68931852	124.263163	9.941053041	45.57555937	0	0	110.2027108	9.777888563	24.61421664	17.39684282	24.8526326	0	0	0.198805718	0	0	18.92849631	24.8526326	0	24.8526326	0	0	0												5.1098	0.039421261	1.858529047	0	0.20384722	1.440606469	0.523159489	3.023311389	6.592717677	1.515035328	4.229471553	0	0	0.266595102	3.679072683	8.304246131	0.335273108	2.002454224	0	0	3.24707454	0	0	1.023846947	0.540920638	0	0.023025812	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9584	195	NO	0.254586781	14.0908	0.155837461	2.498590849	0	0.249577994	1.440606469	0.523159489	3.023311389	9.524147731	2.362997923	5.750139101	0	0	0.352949499	3.679072683	8.325956182	0.335273108	2.002454224	0	0.078811161	3.24707454	0	0	1.023846947	0.540920638	0	0.023025812	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2286	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	2.2306	0	0.0562	0.0003	0.0296	0.4749	0.1667	0.0005	0.0312	0.0351	0.0247	0	0	0.0026	0.2979	1.7687	0	0.0665	0.0139	0.0009	0.5693	0	0	0	0.184	0.0261	0.0061	0	0	0											5.9859	195	NO	0.025729816	16.3214	0.155837461	2.554831871	0.000322094	0.27920408	1.915529956	0.689820688	3.023783233	9.555356572	2.398075993	5.774849648	0	3.20E-05	0.355588012	3.976995869	10.09461034	0.335273108	2.068966703	0.013927192	0.079730061	3.816373315	0	0	1.023846947	0.724900953	0.026122062	0.029079687	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2145
H3924_045_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	Coin	Coin	V	T	P	V	P	V	P	O	V											2.044188469	0.005534835	0.274507759	0	0.021807058	0.083466471	0.021863529	0	0.593962288	0.172202739	0.212732257	2.28E-08	0.001108476	0.017237694	0.37858867	0.891938918	0.023873344	0.054237332	0.136313102	0.025455765	0	0	0	0.007857389	0.032685184	0	0.00041925	1.94E-05	0	0											5	YES	1510.47702	10.17869361	863.2687224	681.4616428	49.46485989	9.375023776	2.455729897	879.2721557	496.8530984	19.34195563	251.9377171	0	0	49.49916388	3813.083383	3166.050468	71.11355304	645.5629973	433.7213045	2.859212765	16.97809712	0	0	313.4510723	406.9397742	200.3259724	9.352829966	18.40231716	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.98809748	352.1090457	0.2	180.1599744	0	0	154.3430319	19.88096682	33.51508866	17.5	35	0	0.2	0.199959881	0	0	18.54030444	35	0	35	0	0	0											NO	102.9476306	68.27459149	59.28688543	0	79.38081977	0.15876164	0.15876164	39.68096157	279.5070469	0.15876164	143.0124646	0	0	122.518764	15.78167444	26.60455212	13.89164346	27.78328692	0	0.15876164	0.158729793	0	0	18.54030444	27.78328692	0	27.78328692	0	0	0												12.9583	0.057912179	4.26504282	0	0.327213427	1.488394145	0.389875705	2.907530385	11.57282852	3.070760588	3.002519488	0	0	0.505381365	5.014736713	7.019279558	0.082323677	1.494655165	0	0.453933306	2.694929833	0	0	0.484289859	0.942177042	0	0.021654363	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7538	60	NO	15.13550753	15.0025	0.063447014	4.539550579	0	0.349020486	1.571860616	0.411739234	2.907530385	12.16679081	3.242963327	3.215251744	2.28E-08	0.001108476	0.522619059	5.393325383	7.911218476	0.106197021	1.548892497	0.136313102	0.479389071	2.694929833	0	0	0.492147248	0.974862226	0	0.022073613	1.94E-05	0	0	0	0	0	0	0	0	0	0	0	0	63.7538	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.3993	0	0.1222	0.0005	0.0021	0.0795	0.0255	0.0001	0.002	0.0055	0.0017	0	0	0.0001	0.0535	0.3245	0	0.0092	0.0013	0.0001	0.0957	0	0	0	0.0367	0	0.0011	0	0	0											1.1607	60	NO	0.275562922	15.4018	0.063447014	4.66179954	0.000517023	0.3511685	1.651394894	0.437238758	2.907610805	12.16876564	3.248454306	3.216978784	2.28E-08	0.001110105	0.522749515	5.446835944	8.235759166	0.106197021	1.558064625	0.137636183	0.479469622	2.79064703	0	0	0.492147248	1.011583759	0	0.023123936	1.94E-05	0	0	0	0	0	0	0	0	0	0	0	0	64.9145
H3924_046_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	Coin	Coin	V	T	P	V	P	V	P	O	V											2.020268481	0.002627465	0.319460837	0	0.028898235	0.082630132	0.023822281	0	0.563324812	0.170899096	0.218506275	1.09E-08	0.000595671	0.016652738	0.382542764	0.88165678	0.023616248	0.064805826	0.143567255	0.011532573	0	0	0	0.008708487	0.035244508	0	0.000630353	9.17E-06	0	0											5	YES	1547.553515	4.926289819	1001.707674	852.0129619	56.5280392	9.524490639	2.745912298	885.1366873	433.2133929	19.69894999	134.5841766	0	0	52.56350992	3896.84533	3176.207454	33.37384192	798.9438144	441.9697336	1.329319905	17.67998164	0	0	287.5542743	434.9258139	223.9849346	17.12495742	23.19284716	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.99427887	348.5505631	0.2	348.0432498	0	0	147.3415572	19.78067113	33.45840926	17.5	35	0	0.2	0.19999129	0	0	18.35995507	35	0	35	0	0	0											NO	103.1283863	68.39446813	59.39098144	0	79.52019675	0.159040394	0.159040394	39.75554892	277.1680935	0.159040394	276.764677	0	0	117.1662962	15.72962861	26.60619288	13.91603443	27.83206886	0	0.159040394	0.159033468	0	0	18.35995507	27.83206886	0	27.83206886	0	0	0												13.2997	0.028077581	4.957700157	0	0.3745934	1.514778739	0.436710972	2.932424573	10.00607752	3.132928759	3.104012182	0	0	0.513222648	5.107994148	7.042232345	0.038702628	1.853021605	0	0.211415561	2.811708788	0	0	0.439956963	1.008740434	0	0.039718583	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8537	60	NO	15.04401246	15.32	0.030705046	5.277160995	0	0.403491634	1.597408871	0.460533254	2.932424573	10.56940233	3.303827855	3.322518456	1.09E-08	0.000595671	0.529875386	5.490536912	7.923889125	0.062318876	1.917827431	0.143567255	0.222948133	2.811708788	0	0	0.44866545	1.043984942	0	0.040348936	9.17E-06	0	0	0	0	0	0	0	0	0	0	0	0	63.8537	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.1935	0	0.0592	0.0003	0.001	0.0385	0.0124	0	0.0009	0.0027	0.0008	0	0	0.0001	0.0259	0.1572	0	0.0044	0.0006	0	0.0464	0	0	0	0.0178	0	0.0005	0	0	0											0.5623	60	NO	0.132480698	15.5134	0.030705046	5.336391745	0.000250173	0.404505696	1.635943963	0.472888009	2.932462539	10.57033469	3.306488337	3.32334635	1.09E-08	0.00059644	0.529936975	5.516461444	8.08111746	0.062318876	1.922271455	0.144200771	0.222986163	2.858084654	0	0	0.44866545	1.061782272	0	0.040858094	9.17E-06	0	0	0	0	0	0	0	0	0	0	0	0	64.4161
H3924_047_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	Coin	Coin	V	T	P	V	P	V	P	O	V											1.990350459	0.01504508	0.228121757	0	0.018708847	0.075312781	0.021004593	0	0.61134411	0.184156171	0.246725854	3.87E-07	0.002318584	0.019665721	0.369354777	0.91807327	0.02297709	0.062791412	0.157023503	0.016425225	0	0	0	0.010637174	0.029393101	0	0.000530051	4.01E-05	0	0											5	YES	1248.218427	21.92835945	723.0424116	639.0962662	38.02892081	7.487412319	2.088225214	776.8964449	568.2573366	18.30835581	501.534781	0	0	39.79965172	3616.890005	3344.311049	140.8284976	737.4865077	410.3752959	1.632955709	16.10749693	0	0	387.7478563	330.0332412	184.9284064	11.19067688	20.19703691	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.96136736	352.4874237	0.2	109.6971247	0	0	219.6153846	19.74689893	33.68922879	17.5	35	0	0.2	0.199964046	0	0	18.65011573	35	0	35	0	0	0											NO	104.0715337	69.01996099	59.93413406	0	80.24743854	0.160494877	0.160494877	40.09271757	282.8621287	0.160494877	88.02913269	0	0	176.2357208	15.84638058	27.03474317	14.04330174	28.08660349	0	0.160494877	0.160466025	0	0	18.65011573	28.08660349	0	28.08660349	0	0	0												10.8253	0.126124543	3.611243403	0	0.25431029	1.20169132	0.335149449	2.595657479	13.39487332	2.938397314	3.679139316	0	0	0.584510026	4.776217961	7.534382524	0.164808091	1.72612426	0	0.262081026	2.584706002	0	0	0.602628533	0.772459399	0	0.026192342	0	0	0	0	0	0	0	0	0	0	0	0	0	57.996	60	NO	14.12713875	12.8157	0.141169623	3.83936516	0	0.273019138	1.277004101	0.356154042	2.595657479	14.00621743	3.122553486	3.92586517	3.87E-07	0.002318584	0.604175746	5.145572738	8.452455793	0.18778518	1.788915672	0.157023503	0.278506251	2.584706002	0	0	0.613265706	0.8018525	0	0.026722393	4.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	62.996	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.7552	0	0.2199	0.0015	0.0053	0.24	0.0571	0.0002	0.0052	0.0355	0.0085	0	0	0.0004	0.1309	0.7443	0	0.0229	0.0073	0.0002	0.1775	0	0	0	0.0757	0	0.0038	0	0	0											2.4916	60	NO	0.558752824	13.5709	0.141169623	4.059270627	0.001545561	0.278302211	1.517046901	0.413303932	2.595877706	14.01139421	3.158084128	3.934369748	3.87E-07	0.002321884	0.604569658	5.276470851	9.196748456	0.18778518	1.811798048	0.16429952	0.278669541	2.762220093	0	0	0.613265706	0.877587838	0	0.030559166	4.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	65.4876
H3924_048_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	V											2.065429926	0.010363258	0.189417259	0	0.017909107	0.08864257	0.02103841	0	0.600617252	0.171583731	0.226836923	2.53E-07	0.001730798	0.02029852	0.371443473	0.919179326	0.023149372	0.06021033	0.155609538	0.017609358	0	0	0	0.007599789	0.030851234	0	0.000449658	2.99E-05	0	0											5	YES	1412.196942	18.11430061	655.3077323	599.6351752	41.95103579	9.746886274	2.313324078	860.4886846	578.517198	18.86686165	417.8127413	0	0	42.96467569	3990.146343	3587.232653	116.3338163	844.6201956	475.7338107	92.52289773	18.29285212	0	0	395.3534083	358.2170074	212.7538174	10.95691228	25.462433	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.97121455	350.8685966	0.2	128.5291255	0	0	189.5748746	19.81066054	33.88311702	17.5	35	0	50.22605806	0.199965583	0	0	18.57695492	35	0	35	0	0	0											NO	102.1518647	67.74684164	58.82860887	0	78.76722086	0.157534442	0.157534442	39.36093693	276.3694424	0.157534442	101.2388201	0	0	149.3228601	15.60430674	26.68878961	13.78426365	27.5685273	0	39.56167008	0.157507332	0	0	18.57695492	27.5685273	0	27.5685273	0	0	0												12.0215	0.102265555	3.212570189	0	0.275363875	1.535470288	0.364428217	2.82247007	13.32370629	2.972180517	3.524905747	0	0	0.534634022	5.188622288	7.978241463	0.133631333	1.940411243	0	0.30503003	2.881258338	0	0	0.612038537	0.822959612	0	0.025172161	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5769	60	NO	16.16434814	14.087	0.112628813	3.401987448	0	0.293272983	1.624112858	0.385466627	2.82247007	13.92432354	3.143764248	3.75174267	2.53E-07	0.001730798	0.554932542	5.560065761	8.897420789	0.156780705	2.000621573	0.155609538	0.322639388	2.881258338	0	0	0.619638327	0.853810847	0	0.02562182	2.99E-05	0	0	0	0	0	0	0	0	0	0	0	0	65.5769	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.6193	0	0.1804	0.0013	0.004	0.1957	0.0466	0.0002	0.0039	0.0291	0.0069	0	0	0.0003	0.1066	0.6062	0	0.0186	0.0058	0.0001	0.1447	0	0	0	0.0618	0	0.0031	0	0	0											2.0345	60	NO	0.501498558	14.7062	0.112628813	3.582415915	0.001275518	0.29724612	1.819792997	0.432054562	2.82263569	13.92823552	3.172826158	3.758608472	2.53E-07	0.00173328	0.555229527	5.666704431	9.503643004	0.156780705	2.019253041	0.161368296	0.322762083	3.025965789	0	0	0.619638327	0.915615064	0	0.028755852	2.99E-05	0	0	0	0	0	0	0	0	0	0	0	0	67.6114
H3924_051_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	Coin	Coin	V	T	P	V	P	V	P	O	V											1.969014266	0.013215259	0.226622074	0	0.019589266	0.076017879	0.021828976	0	0.604895844	0.181952382	0.243524949	3.53E-07	0.002355727	0.019199344	0.376240156	0.939934174	0.023099593	0.065804777	0.159645819	0.016795326	0	0	0	0.009730443	0.029953934	0	0.000538749	4.07E-05	0	0											5	YES	1399.021824	24.30522189	807.3353884	714.7615191	43.62348057	8.24100433	2.366452279	873.0860969	628.4602408	19.72523304	556.0968329	0	0	44.1136223	4028.411167	3733.544688	156.0932039	824.5411231	460.550247	1.820760507	17.84970303	0	0	430.6157934	366.8229533	205.6247609	12.40365862	22.57313031	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.96192893	352.2708205	0.2	107.2608215	0	0	219.6153846	19.74833078	33.69861544	17.5	35	0	0.2	0.19996402	0	0	18.64681537	35	0	35	0	0	0											NO	100.529429	66.67084667	57.89425849	0	77.51619377	0.155032388	0.155032388	38.72858564	273.0669318	0.155032388	83.14450621	0	0	170.2374871	15.30815436	26.12188404	13.56533391	27.13066782	0	0.155032388	0.155004497	0	0	18.64681537	27.13066782	0	27.13066782	0	0	0												11.7202	0.135037477	3.895006972	0	0.281793848	1.277622577	0.366876747	2.817782473	14.30097581	3.058049973	3.853033048	0	0	0.625816017	5.138961663	8.12726845	0.176454703	1.864195943	0	0.282276849	2.766784245	0	0	0.669134433	0.829345975	0	0.028043295	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2147	60	NO	17.85147705	13.6893	0.148252736	4.121629046	0	0.301383114	1.353640456	0.388705722	2.817782473	14.90587166	3.240002356	4.096557997	3.53E-07	0.002355727	0.645015361	5.515201819	9.067202624	0.199554296	1.93000072	0.159645819	0.299072174	2.766784245	0	0	0.678864876	0.859299909	0	0.028582044	4.07E-05	0	0	0	0	0	0	0	0	0	0	0	0	67.2147	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.7892	0	0.2298	0.0017	0.0054	0.2596	0.0618	0.0002	0.0051	0.0376	0.0089	0	0	0.0004	0.1415	0.8044	0	0.0247	0.0077	0.0002	0.192	0	0	0	0.082	0	0.0042	0	0	0											2.6563	60	NO	0.705478651	14.4785	0.148252736	4.35147367	0.001711672	0.306743963	1.6132432	0.450512484	2.818005941	14.91096657	3.277602091	4.105419825	3.53E-07	0.002359075	0.645408471	5.656693984	9.871593727	0.199554296	1.954723795	0.167332086	0.29923775	2.958763114	0	0	0.678864876	0.941275966	0	0.03273816	4.07E-05	0	0	0	0	0	0	0	0	0	0	0	0	69.871
H3924_052_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	V	V	V	V	V	V	V	Coin	Coin	V	T	P	V	P	V	P	O	V											1.972697372	0.01342418	0.225051103	0	0.019121184	0.075649848	0.021771892	0	0.611845628	0.184147361	0.246507101	3.52E-07	0.002349566	0.01962767	0.37316924	0.931680674	0.02299828	0.064836671	0.158293372	0.016751405	0	0	0	0.009659575	0.029839581	0	0.00053734	4.06E-05	0	0											5	YES	1384.073845	24.36204503	793.9075435	711.8751359	42.43399833	8.241832625	2.371984804	857.7233042	627.5230713	20.06232348	557.3969309	0	0	42.61614893	4022.540835	3724.123948	156.458134	819.7429529	458.1621278	1.825017261	17.8601626	0	0	431.207081	367.2729201	205.4791277	12.43265712	22.62489132	0	0											3000	1a1: $200 days 1-5;$0 days 6-90	1b1: $200 days 1-5;$0 days 6-90	21: $75 days 1-42	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $375,9b: $200"	"8a1: 20.0%,8a2: 20.0%"	"8b1: $45,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: $45,8b6: 20.0%"	"9c1: $25,9c2: $10"	$0 	"31: $35,5: 40.0%,9a2: $375,9a3: $375"	"7a: $20,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20.0%,17a1: $35,18a1: $35"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $35,7i: $35"	7d2: $0	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $35	17b2: $0	18a2: $35	18b1: $0	$0 	$0 											0	NO	129.6882936	86.0089272	74.6866631	0	100	0.2	0.2	49.96115819	352.1836579	0.2	108.5709759	0	0	226.5492958	19.74738568	33.73167738	17.5	35	0	0.2	0.199964071	0	0	18.65470732	35	0	35	0	0	0											NO	100.7273911	66.80213461	58.00826361	0	77.66883833	0.155337677	0.155337677	38.80425118	273.5369559	0.155337677	84.32581573	0	0	175.9582063	15.33756506	26.19900197	13.59204671	27.18409341	0	0.155337677	0.155309771	0	0	18.65470732	27.18409341	0	27.18409341	0	0	0												11.6178	0.135619718	3.837766505	0	0.274649946	1.280267131	0.368458609	2.773609212	14.30422922	3.116434718	3.916912573	0	0	0.624888427	5.141331813	8.130694221	0.177215522	1.856997417	0	0.283493941	2.773857759	0	0	0.670336824	0.831998447	0	0.028164209	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1448	60	NO	17.67498493	13.5905	0.149043898	4.062817608	0	0.29377113	1.35591698	0.390230501	2.773609212	14.91607485	3.30058208	4.163419675	3.52E-07	0.002349566	0.644516097	5.514501052	9.062374895	0.200213802	1.921834088	0.158293372	0.300245346	2.773857759	0	0	0.679996399	0.861838028	0	0.028701549	4.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	67.1448	YES	"1a1: 25.0%,1a2: 25.0%"	"1b1: 25.0%,1b2: 25.0%"	"21: 25.0%,22: $01,23: $01"	6: 25.0%	10a: 25.0%	11a: 25.0%	"11b1: 25.0%,11b2: 25.0%"	"4a1: $50,4b: $35"	"9a1: 25.0%,9b: 25.0%"	"8a1: 25.0%,8a2: 25.0%"	"8b1: 25.0%,8b2: 25.0%,8b3: 25.0%,8b4: 25.0%,8b5: 25.0%,8b6: 25.0%"	9c1: 25.0%	12: 25.0%	"31: 25.0%,5: 25.0%,9a2: 25.0%,9a3: 25.0%"	"7a: $30,13d: $01,14b1: 25.0%"	"7b1: $45,7b2: $01,7d1: $45,7f1: $45,7f2: $45,16b1: $45,17a1: $45,18a1: $45"	"7e1: 25.0%,7h1: 25.0%"	"7c: 25.0%,7i: 25.0%"	7d2: $45	7g: 25.0%	"152: 25.0%,153: 25.0%"	"9d1: 25.0%,9d2: 25.0%"	10b: $01	"16a1: 25.0%,16a2: 25.0%,16a3: 25.0%,16b2: $01"	17a2: $45	$0 	18a2: $45	$0 	$0 	"13a: $01,13b: $01,13c: $01,13e: $01"											5100	0.8052	0	0.2345	0.0017	0.0054	0.2605	0.062	0.0002	0.0052	0.0381	0.009	0	0	0.0004	0.142	0.8072	0	0.0248	0.0077	0.0002	0.1927	0	0	0	0.0823	0	0.0042	0	0	0											2.6832	60	NO	0.706328186	14.3957	0.149043898	4.29735335	0.001715597	0.29912171	1.616441949	0.452256828	2.773832251	14.92123454	3.338706114	4.172416471	3.52E-07	0.002352909	0.644911548	5.656490511	9.869587939	0.200213802	1.946644775	0.165992078	0.300410605	2.966518622	0	0	0.679996399	0.944111069	0	0.032872987	4.06E-05	0	0	0	0	0	0	0	0	0	0	0	0	69.828
H3924_053_0	2012	3																															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											5.763587452	0.0384958	0.664252287	0	0.059140842	0.231431655	0.065739854	0	1.771778963	0.539178671	0.716184775	0	0	0.057630739	0	0.02360682	0	0	0	0.05058058	0	0	0	0	0	0	0	0	0	0											9.9816	YES	1373.851012	23.75758634	791.945202	716.0336999	42.82049177	8.14318882	2.313132322	869.6464115	619.9528646	1073.504227	542.9817463	0	0	43.11967178	4065.235864	3757.223066	156.9124308	829.6862013	463.5805791	91.9586698	17.78690077	0	0	429.5650463	369.1569689	205.6322872	12.46875698	22.48606754	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	49.93654822	125	10	51.42237641	0	0	79.29864253	9.875796515	24.57865146	17.5	25	0	0	0.199964035	0	0	18.63489871	25	0	25	0	0	0											NO	52.00103591	30.30977065	41.68992163	0	99.18034747	0.198360695	0.198360695	49.52724204	123.9754343	9.918034747	51.0008916	0	0	78.6486692	9.794849299	24.37719192	17.35656081	24.79508687	0	0	0.198325025	0	0	18.63489871	24.79508687	0	24.79508687	0	0	0												5.9535	0.060007249	2.751344451	0	0.353912604	1.615288593	0.458834535	3.589265693	6.404910471	0.887254352	2.307712765	0	0	0.282608734	3.318197721	7.632545647	0.226955012	1.71434512	0	0	3.527587542	0	0	0.667075094	0.762773259	0	0.025763659	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5399	120	NO	0.346047694	11.7171	0.098503049	3.415596738	0	0.413053446	1.846720248	0.524574388	3.589265693	8.176689435	1.426433023	3.023897541	0	0	0.340239473	3.318197721	7.656152467	0.226955012	1.71434512	0	0.05058058	3.527587542	0	0	0.667075094	0.762773259	0	0.025763659	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5215	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	0.7083	0	0.2062	0.0015	0.0112	0.2396	0.057	0.0005	0.0104	0.0341	0.0096	0	0	0.0008	0.1577	0.8127	0	0.0229	0.0102	0.0003	0.1772	0	0	0	0.0692	0.0114	0.0036	0	0	0											2.5443	120	NO	0.016763537	12.4254	0.098503049	3.621833798	0.001456799	0.424205812	2.086312717	0.581617062	3.589734075	8.18710947	1.460540484	3.033521117	0	7.02E-06	0.341052684	3.475937283	8.468804815	0.226955012	1.737208911	0.010165705	0.050927623	3.704768608	0	0	0.667075094	0.831930573	0.011364244	0.029340762	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0658
H3924_054_0	2012	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											5.798457162	0.038352538	0.672514817	0	0.056502786	0.220249352	0.063190185	0	1.777710587	0.534717961	0.709851985	0	0	0.057160139	0	0.022679117	0	0	0	0.048613371	0	0	0	0	0	0	0	0	0	0											10	YES	1376.546026	23.99350008	799.8092482	717.0385127	43.24570089	8.137088797	2.334554631	862.3526771	620.9857437	1069.385482	542.6591519	0	0	43.15375357	4064.330163	3745.852984	157.0478731	831.25626	464.2694104	92.26543595	16.48156488	0	0	427.475142	371.5075905	204.7208865	12.57600612	22.2671518	0	0											2550	1a1: $275 per stay	1b1: $275 per stay	21: $0 days 1-6;$75 days 7-100	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $125,9b: $125"	"8a1: $10,8a2: $10"	"8b1: $45,8b2: $125,8b3: $45,8b4: $45,8b5: $0,8b6: $45"	"9c1: $25,9c2: $10"	$0 	"31: $25,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	49.93546116	125	10	51.3937805	0	0	78.88127854	9.878758289	24.57371167	17.5	25	0	0	0.199960853	0	0	18.6234251	25	0	25	0	0	0											NO	52.02085533	30.32132276	41.70581112	0	99.21814857	0.198436297	0.198436297	49.54504004	124.0226857	9.921814857	50.9919575	0	0	78.26454414	9.801521076	24.38158176	17.363176	24.80453714	0	0	0.198397456	0	0	18.6234251	24.80453714	0	24.80453714	0	0	0												5.9674	0.060626222	2.779724453	0	0.357563198	1.61469377	0.463260377	3.560441493	6.418026643	0.884187064	2.305937701	0	0	0.281450738	3.319718146	7.610818398	0.227237488	1.718243898	0	0	3.269900549	0	0	0.663420941	0.767922819	0	0.025995168	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2966	120	NO	0.328074616	11.7659	0.09897876	3.45223927	0	0.414065984	1.834943123	0.526450561	3.560441493	8.195737231	1.418905025	3.015789686	0	0	0.338610877	3.319718146	7.633497515	0.227237488	1.718243898	0	0.048613371	3.269900549	0	0	0.663420941	0.767922819	0	0.025995168	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2966	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	"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%"	9c1: 20.0%	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: 20.0%,13d: 20.0%,14b1: 20.0%"	"7b1: $35,7b2: $01,7d1: $35,7f1: $35,7f2: $35,16b1: $30,17a1: $35,18a1: $35"	"7e1: 20.0%,7h1: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $35	7g: 20.0%	"152: 20.0%,153: 20.0%"	9d1: 20.0%	10b: $01	$0 	17a2: $35	17b2: 20.0%	18a2: $35	$0 	$0 	"13a: 20.0%,13b: 20.0%,13c: 20.0%,13e: 20.0%"											5100	0.7413	0	0.2177	0.0014	0.0108	0.2387	0.0574	0.0005	0.0106	0.0354	0.01	0	0	0.0008	0.1526	0.8033	0	0.023	0.01	0.0003	0.1783	0	0	0	0.0685	0.0115	0.0036	0	0	0											2.5758	120	NO	0.016158914	12.5072	0.09897876	3.669924801	0.001403304	0.424883929	2.073598884	0.58388376	3.560900791	8.206384568	1.454258108	3.025761284	0	6.88E-06	0.339426136	3.472328575	8.436787182	0.227237488	1.741262044	0.010024703	0.048953682	3.448238863	0	0	0.663420941	0.836472361	0.011461993	0.029603038	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8724
H3924_801_0	2012	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	225.8603531	1.529428514	26.29957869	10.60193526	2.137412697	8.364165764	2.375902438	14.25980631	69.8305982	20.92707618	28.02139708	3.85E-05	0.256401265	2.210912421	45.80107652	102.781109	2.516001668	7.180266358	17.44887253	1.828031508	17.76872932	0	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	"11b1: Medicare FFS,11b2: Medicare FFS,17b1: Medicare FFS"	"4a1: Medicare FFS,4a2: 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"	"9c1: Medicare FFS,9c2: Medicare FFS"	12: Medicare FFS	"31: Medicare FFS,5: Medicare FFS,9a2: Medicare FFS,9a3: Medicare FFS"	"7a: Medicare FFS,14a1: Medicare FFS,14a2: Medicare FFS,14a3: Medicare FFS,14a4: Medicare FFS,14a5: Medicare FFS,14a6: Medicare FFS,14a7: Medicare FFS,14a8: Medicare FFS,14a9: Medicare FFS,14a10: Medicare FFS,14a11: Medicare FFS,14a12: Medicare FFS,14a13: Medicare FFS,14a14: Medicare FFS,14a15: Medicare FFS,14a16: Medicare FFS,14b1: Medicare FFS"	"7b1: Medicare FFS,7b2: Medicare FFS,7d1: Medicare FFS,7f1: Medicare FFS,7f2: Medicare FFS,16b1: Medicare FFS,17a1: Medicare FFS,18a1: Medicare FFS"	"7e1: Medicare FFS,7e2: Medicare FFS,7h1: Medicare FFS,7h2: Medicare FFS"	"7c: Medicare FFS,7i: Medicare FFS"	7d2: Medicare FFS	7g: Medicare FFS	"151: Medicare FFS,152: Medicare FFS,153: Medicare FFS"	"9d1: Medicare FFS,9d2: Medicare FFS"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.081349969	0.081349969	0.18092284	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.075339717	0.075339717	0.167556003	0	0.207450561	0.207450561	0.207450561	0.207450561	0.207450561	0.207450561	0.207450561	0.207450561	0.207450561	0.208099542	0.209132681	0.207450561	0.208021479	0.207450561	0.207450561	0.207450561	0.207453536	0	0	0	0	0	0	0	0	0												17.0163	0.115226712	4.406652276	0	0.443407463	1.735150881	0.492882294	2.958204821	14.48639678	4.341333696	5.813054549	7.98E-06	0.053190586	0.460089861	9.578501913	21.32199873	0.523382389	1.489550285	3.619778397	0.379226162	3.686185736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9205	0	NO	7.326416117	17.0163	0.115226712	4.406652276	0	0.443407463	1.735150881	0.492882294	2.958204821	14.48639678	4.341333696	5.813054549	7.98E-06	0.053190586	0.460089861	9.578501913	21.32199873	0.523382389	1.489550285	3.619778397	0.379226162	3.686185736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9205	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: 20.0%,4b: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											10000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1612	0	0	0	0	0	0	0	0	0											0.1612	0	NO	0.012710557	17.0163	0.115226712	4.406652276	0	0.443407463	1.735150881	0.492882294	2.958204821	14.48639678	4.341333696	5.813054549	7.98E-06	0.053190586	0.460089861	9.578501913	21.32199873	0.523382389	1.489550285	3.619778397	0.379226162	3.847392929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0817
H3924_802_0	2012	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	179.5607692	1.632082329	19.71411537	8.226757101	1.698478861	6.506010591	1.889815958	11.40918932	54.98216993	16.58433536	21.70765808	2.33E-05	0.221646328	1.840536076	36.13503244	81.36496671	2.31831482	5.661939885	13.93158023	1.035842655	13.7659985	0	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	"11b1: Medicare FFS,11b2: Medicare FFS,17b1: Medicare FFS"	"4a1: Medicare FFS,4a2: 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"	"9c1: Medicare FFS,9c2: Medicare FFS"	12: Medicare FFS	"31: Medicare FFS,5: Medicare FFS,9a2: Medicare FFS,9a3: Medicare FFS"	"7a: Medicare FFS,14a1: Medicare FFS,14a2: Medicare FFS,14a3: Medicare FFS,14a4: Medicare FFS,14a5: Medicare FFS,14a6: Medicare FFS,14a7: Medicare FFS,14a8: Medicare FFS,14a9: Medicare FFS,14a10: Medicare FFS,14a11: Medicare FFS,14a12: Medicare FFS,14a13: Medicare FFS,14a14: Medicare FFS,14a15: Medicare FFS,14a16: Medicare FFS,14b1: Medicare FFS"	"7b1: Medicare FFS,7b2: Medicare FFS,7d1: Medicare FFS,7f1: Medicare FFS,7f2: Medicare FFS,16b1: Medicare FFS,17a1: Medicare FFS,18a1: Medicare FFS"	"7e1: Medicare FFS,7e2: Medicare FFS,7h1: Medicare FFS,7h2: Medicare FFS"	"7c: Medicare FFS,7i: Medicare FFS"	7d2: Medicare FFS	7g: Medicare FFS	"151: Medicare FFS,152: Medicare FFS,153: Medicare FFS"	"9d1: Medicare FFS,9d2: Medicare FFS"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.080139343	0.080139343	0.184279211	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.076916393	0.076916393	0.176868086	0	0.214991432	0.214991432	0.214991432	0.214991432	0.214991432	0.214991432	0.214991432	0.214991432	0.214991432	0.21535767	0.215900111	0.214991432	0.215286555	0.214991432	0.214991432	0.214991432	0.214993197	0	0	0	0	0	0	0	0	0												13.8112	0.125533886	3.486797861	0	0.365158402	1.398736532	0.406294239	2.452877947	11.82069543	3.565490002	4.666960489	5.00E-06	0.047652061	0.39637356	7.801557505	17.49277068	0.49910201	1.217268562	2.995170379	0.222697295	2.959596031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7319	0	NO	3.137665828	13.8112	0.125533886	3.486797861	0	0.365158402	1.398736532	0.406294239	2.452877947	11.82069543	3.565490002	4.666960489	5.00E-06	0.047652061	0.39637356	7.801557505	17.49277068	0.49910201	1.217268562	2.995170379	0.222697295	2.959596031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7319	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: 20.0%,4b: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											10000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1431	0	0	0	0	0	0	0	0	0											0.1431	0	NO	0.005928215	13.8112	0.125533886	3.486797861	0	0.365158402	1.398736532	0.406294239	2.452877947	11.82069543	3.565490002	4.666960489	5.00E-06	0.047652061	0.39637356	7.801557505	17.49277068	0.49910201	1.217268562	2.995170379	0.222697295	3.102681709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.875
H3931_004_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1811.3887	59.08729327	1333.681554	1705.423595	338.101052	14.6805467	0	261.9808883	461.2545278	2085.44167	1882.352047	23.47546494	0	817.9857549	1663.411941	10302.70576	287.6014092	702.6826848	0	0	351.9247768	0	0	0	1378.350059		72.46408345			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 300 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	300	4	20.35671946	40	0.2	40	20	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	167.8938025	89.33542623	66.83517148	0	162.585372	0.027871778	0	58.06620427	278.7177805	3.716237073	18.91259889	37.16237073	0	37.16237073	18.58118537	37.16237073	37.16237073	18.58118537	0	0	46.45296342	0	0	0	0	0	0	0	0	0												25.3434	0.439882377	7.428069615	0	4.580857108	0.409172939	0	1.267686315	10.71331985	0.645832971	2.96668077	0.072700328	0	2.533190823	2.575680468	31.9060809	0.890662516	1.088056435	0	0	1.362329065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2236	0	NO	7.194688582	25.3434	0.439882377	7.428069615	0	4.580857108	0.409172939	0	1.267686315	10.71331985	0.645832971	2.96668077	0.072700328	0	2.533190823	2.575680468	31.9060809	0.890662516	1.088056435	0	0	1.362329065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2236	NO																																																																																		0		NO		25.3434	0.439882377	7.428069615	0	4.580857108	0.409172939	0	1.267686315	10.71331985	0.645832971	2.96668077	0.072700328	0	2.533190823	2.575680468	31.9060809	0.890662516	1.088056435	0	0	1.362329065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2236
H3931_054_0	2012	2																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1906.851805	100.5962927	1389.406333	1624.03564	327.4118649	11.66657851	0	286.1099011	439.753136	1940.081145	1926.115889	20.87692135	0.016708368	477.4974569	1945.499492	9139.455403	176.4559577	602.8899912	0	0	233.2618162	0.001436114	0	0	1172.928711		53.91612873			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 250 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	250	4	20.35671946	40	0.2	40	15	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	168.0503097	89.41870291	66.89747388	0	162.7369308	0.02789776	0	58.12033241	232.4813297	3.719701274	18.93022883	37.19701274	0.185985064	37.19701274	13.94887978	37.19701274	37.19701274	18.59850637	0	0	46.49626593	0	0	0	0	0	0	0	0	0												26.7039	0.749599168	7.745647824	0	4.440166833	0.325471402	0	1.385733547	8.519532815	0.601376859	3.038484545	0.064713259	0.003107507	1.480123249	2.261461544	28.33003659	0.546969542	0.934404445	0	0	0.903816953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0346	0	NO	6.633859756	26.7039	0.749599168	7.745647824	0	4.440166833	0.325471402	0	1.385733547	8.519532815	0.601376859	3.038484545	0.064713259	0.003107507	1.480123249	2.261461544	28.33003659	0.546969542	0.934404445	0	0	0.903816953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0346	NO																																																																																		0		NO		26.7039	0.749599168	7.745647824	0	4.440166833	0.325471402	0	1.385733547	8.519532815	0.601376859	3.038484545	0.064713259	0.003107507	1.480123249	2.261461544	28.33003659	0.546969542	0.934404445	0	0	0.903816953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0346
H3931_055_0	2012	2																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1339.953725	50.50594809	1019.46514	1172.717805	254.4450621	9.447718887	0	208.4609328	460.7295795	1781.041426	1621.453373	16.65839252	0.043030499	495.9391618	1205.756957	8822.844951	118.2182146	512.1068509	0	0	250.5469002	0	0	0	1207.420387		48.46889438			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 to $45 per visit	$0 to $45 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$45 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	61.85570977	0	175	0.03	0.03	62.5	300	4.5	22.4185805	45	0.2	45	25	45	40	22.5	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	167.8045407	89.28793049	57.43706744	0	162.4989324	0.02785696	0	58.035333	278.5695984	4.178543976	20.81711656	41.78543976	0.185713066	41.78543976	23.2141332	41.78543976	37.14261312	20.89271988	0	0	46.4282664	0	0	0	0	0	0	0	0	0												18.7375	0.375797632	4.879590666	0	3.445587579	0.263184726	0	1.008174971	10.69543783	0.620179993	2.812831988	0.058006521	0.007991326	1.726919664	2.332550218	30.72220469	0.365911117	0.891608749	0	0	0.969371519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9129	0	NO	6.14770969	18.7375	0.375797632	4.879590666	0	3.445587579	0.263184726	0	1.008174971	10.69543783	0.620179993	2.812831988	0.058006521	0.007991326	1.726919664	2.332550218	30.72220469	0.365911117	0.891608749	0	0	0.969371519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9129	NO																																																																																		0		NO		18.7375	0.375797632	4.879590666	0	3.445587579	0.263184726	0	1.008174971	10.69543783	0.620179993	2.812831988	0.058006521	0.007991326	1.726919664	2.332550218	30.72220469	0.365911117	0.891608749	0	0	0.969371519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9129
H3931_058_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	2116.601657	134.7381991	1280.770877	2239.550443	291.7977474	21.0503134	0	299.757783	460.9330119	1845.073037	1928.09298	95.88359364	0	586.8196345	1761.763619	10981.31856	333.2219756	758.0016885	0	0	372.0577158	0	0	0	1232.816902		65.05418179			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$150 per procedure	$0 to $35 per visit	$0 to $35 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$35 per visit	20% per visit	$0 to 150 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	150	3.5	18.29485842	35	0.2	35	15	35	35	17.5	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	167.5654343	89.16070323	66.70445467	0	162.2673861	0.027817266	0	57.95263788	139.0863309	3.245347722	16.96376489	32.45347722	0	32.45347722	13.90863309	32.45347722	32.45347722	16.22673861	0	0	46.36211031	0	0	0	0	0	0	0	0	0												29.5558	1.001112716	7.11942691	0	3.945771477	0.585562171	0	1.447646188	5.342456785	0.498991965	2.725643	0.259313002	0	1.587028137	2.041976981	29.69849765	0.901184316	1.024991272	0	0	1.437448405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1728	0	NO	6.997112404	29.5558	1.001112716	7.11942691	0	3.945771477	0.585562171	0	1.447646188	5.342456785	0.498991965	2.725643	0.259313002	0	1.587028137	2.041976981	29.69849765	0.901184316	1.024991272	0	0	1.437448405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1728	NO																																																																																		0		NO		29.5558	1.001112716	7.11942691	0	3.945771477	0.585562171	0	1.447646188	5.342456785	0.498991965	2.725643	0.259313002	0	1.587028137	2.041976981	29.69849765	0.901184316	1.024991272	0	0	1.437448405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1728
H3931_064_0	2012	3																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1060.484406	73.75396536	703.7455546	1065.650181	168.2884351	9.712123966	0	197.91865	461.4362432	1769.229311	1694.773802	32.51851586	0	528.3499402	1015.376832	8281.236845	215.302062	474.0898914	0	0	275.7944901	0	0	0	1293.260389		62.06865525			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 to $45 per visit	$0 to $45 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$45 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	300	4.5	22.4185805	45	0.2	45	25	45	40	22.5	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	167.3130407	89.02640587	66.6039818	0	162.0229726	0.027775367	0	57.86534734	277.7536672	4.166305009	20.75614316	41.66305009	0	41.66305009	23.14613894	41.66305009	37.0338223	20.83152504	0	0	46.29227787	0	0	0	0	0	0	0	0	0												14.7861	0.547170871	3.906021342	0	2.272216042	0.269757805	0	0.954385952	10.6804674	0.614262412	2.931413972	0.112901713	0	1.834389168	1.958504436	28.75179879	0.664454859	0.823001287	0	0	1.063929598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1707	0	NO	5.780425856	14.7861	0.547170871	3.906021342	0	2.272216042	0.269757805	0	0.954385952	10.6804674	0.614262412	2.931413972	0.112901713	0	1.834389168	1.958504436	28.75179879	0.664454859	0.823001287	0	0	1.063929598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1707	NO																																																																																		0		NO		14.7861	0.547170871	3.906021342	0	2.272216042	0.269757805	0	0.954385952	10.6804674	0.614262412	2.931413972	0.112901713	0	1.834389168	1.958504436	28.75179879	0.664454859	0.823001287	0	0	1.063929598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1707
H3931_065_0	2012	3																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	2036.260054	130.3778557	1468.863251	1573.451895	321.5372778	15.58555571	0	293.9903212	456.1811252	1646.500042	1646.814229	82.62787776	0	438.3446085	1663.79481	9509.457014	258.6420289	587.9068276	0	0	287.2855397	0	0	0	1090.308338		49.60849017			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	250	4.5	22.4185805	45	0.2	45	25	45	40	22.5	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	166.3574003	88.51791459	66.22356046	0	161.0975475	0.027616722	0	57.53483838	230.1393535	4.142508363	20.6375905	41.42508363	0	41.42508363	23.01393535	41.42508363	36.82229656	20.71254182	0	0	46.0278707	0	0	0	0	0	0	0	0	0												28.2289	0.961731325	8.10611286	0	4.31657224	0.430421966	0	1.409557134	8.748769102	0.568386683	2.832189806	0.285238896	0	1.513205172	3.190872183	32.82750434	0.793649458	1.014753729	0	0	1.101928473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3298	0	NO	8.313103153	28.2289	0.961731325	8.10611286	0	4.31657224	0.430421966	0	1.409557134	8.748769102	0.568386683	2.832189806	0.285238896	0	1.513205172	3.190872183	32.82750434	0.793649458	1.014753729	0	0	1.101928473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3298	NO																																																																																		0		NO		28.2289	0.961731325	8.10611286	0	4.31657224	0.430421966	0	1.409557134	8.748769102	0.568386683	2.832189806	0.285238896	0	1.513205172	3.190872183	32.82750434	0.793649458	1.014753729	0	0	1.101928473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3298
H3931_070_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1713.163917	199.2873553	947.2060931	1269.690442	332.1583902	13.86453041	0	486.7629285	456.5595021	3058.347736	2472.563421	140.8413009	0.102027158	925.66814	2750.582137	7282.620265	459.8725335	739.8266535	0	0	327.2015507	0.000989465	0	0	923.0578403		39.38802528			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 250 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	250	4	20.35671946	40	0.2	40	20	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	168.952677	89.89884789	67.25668828	0	163.6107672	0.02804756	0	58.43241685	233.7296674	3.739674679	19.03187708	37.39674679	0.186983734	37.39674679	18.69837339	37.39674679	37.39674679	18.69837339	0	0	46.74593348	0	0	0	0	0	0	0	0	0												24.1203	1.492975303	5.308828745	0	4.528724088	0.38886625	0	2.370227862	8.892625048	0.953102132	3.921460259	0.438917206	0.019077419	2.884748087	4.285950987	22.6955255	1.433144724	1.152796251	0	0	1.274611827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1619	0	NO	5.997880061	24.1203	1.492975303	5.308828745	0	4.528724088	0.38886625	0	2.370227862	8.892625048	0.953102132	3.921460259	0.438917206	0.019077419	2.884748087	4.285950987	22.6955255	1.433144724	1.152796251	0	0	1.274611827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1619	NO																																																																																		0		NO		24.1203	1.492975303	5.308828745	0	4.528724088	0.38886625	0	2.370227862	8.892625048	0.953102132	3.921460259	0.438917206	0.019077419	2.884748087	4.285950987	22.6955255	1.433144724	1.152796251	0	0	1.274611827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1619
H3931_801_0	2012	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	0	0	0	0	0	0	0											0	YES	341.3911684	4.320525662	37.71173864	11.33839607	9.226733041	13.58175276	0	13.46829127	54.87197787	16.86794746	72.74109758	0.502101226	0.017297355	36.57089713	21.79824638	162.2179461	2.824801395	10.36827045	0	0	74.92628219	7.64E-05	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	NO	0.075971009	0.075971009	0.156812969	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063573029	0.063573029	0.131222101	0	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0.187444641	0	0	0	0	0	0	0	0												21.7033	0.274668904	4.948613578	0	1.729501662	2.54582677	0	2.524559022	10.28545819	3.161806356	13.63492892	0.094116184	0.003242296	6.855018682	4.085964467	30.40688467	0.529493883	1.943476732	0	0	14.04453006	1.43E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7714	0	NO	23.16273353	21.7033	0.274668904	4.948613578	0	1.729501662	2.54582677	0	2.524559022	10.28545819	3.161806356	13.63492892	0.094116184	0.003242296	6.855018682	4.085964467	30.40688467	0.529493883	1.943476732	0	0	14.04453006	1.43E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7714	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.7033	0.274668904	4.948613578	0	1.729501662	2.54582677	0	2.524559022	10.28545819	3.161806356	13.63492892	0.094116184	0.003242296	6.855018682	4.085964467	30.40688467	0.529493883	1.943476732	0	0	14.04453006	1.43E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7714
H3931_804_0	2012	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	0	0	0	0	0	0	0											0	YES	347.6020871	3.51998594	52.73308776	11.48662823	10.52238471	14.30590468	0	13.82090978	51.56213868	16.37952096	70.17656945	0.237684058	0	34.37475902	21.17845799	167.4152615	1.741549086	11.46914477	0	0	103.3512242	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	NO	0.076219589	0.076219589	0.154571067	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063873717	0.063873717	0.129534004	0	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0.187717	0	0	0	0	0	0	0	0												22.2026	0.224834586	6.830727994	0	1.975230489	2.685461506	0	2.594419718	9.679089977	3.074714533	13.17333507	0.044617338	0	6.452726633	3.975556594	31.42669061	0.326918369	2.152953446	0	0	19.40078173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2207	0	NO	24.39664782	22.2026	0.224834586	6.830727994	0	1.975230489	2.685461506	0	2.594419718	9.679089977	3.074714533	13.17333507	0.044617338	0	6.452726633	3.975556594	31.42669061	0.326918369	2.152953446	0	0	19.40078173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2207	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		22.2026	0.224834586	6.830727994	0	1.975230489	2.685461506	0	2.594419718	9.679089977	3.074714533	13.17333507	0.044617338	0	6.452726633	3.975556594	31.42669061	0.326918369	2.152953446	0	0	19.40078173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2207
H3949_002_0	2012	7																															D	D	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	1452.242063	68.5421098	1015.671363	29.08625946	335.5622711	11.71176002	2.436169534	450.4648169	296.0402394	6.307808625	21.46244428	0	0.73115705	311.3424079	4046.636622	3348.811848	302.030958	69.19799795	20.43612549	44.29679329	29.47623088	0.352918927	0	0	0	0	0	0	0	0											6700	1a:  Acute - $195/$0/day for 1-7/8-90	1b:  Psych - $195/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													195	195	60	0	125	0.2	0.121381071	48.2531386	209.3561544	0	0.178056942	0	0.2	60.54321456	5	39.88538607	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	184.4219466	184.4219466	56.74521434	0	118.2191965	0.189150714	0.114796582	45.65032948	197.9993309	0	0.168397989	0	0.189150714	57.25896144	4.728767861	37.72174636	18.91507145	37.83014289	0	37.83014289	0.189150714	0	0	0	0	0	0	0	0	0												22.3188	1.053389109	4.802874101	0	3.305825173	2.215287775	0.279663935	1.713655609	4.884647444	0	3.614232451	0	0.138298878	1.485595244	1.594633767	10.52691926	0.476078096	0.218147513	0	0.139646168	5.575450131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3431			3.69	22.3188	1.053389109	4.802874101	0	3.305825173	2.215287775	0.279663935	1.713655609	4.884647444	0	3.614232451	0	0.138298878	1.485595244	1.594633767	10.52691926	0.476078096	0.218147513	0	0.139646168	5.575450131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3431	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	22.3188	1.053389109	4.802874101	0	3.305825173	2.215287775	0.279663935	1.713655609	4.884647444	0	3.614232451	0	0.138298878	1.485595244	1.594633767	10.52691926	0.476078096	0.218147513	0	0.139646168	5.575450131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3431
H3949_009_0	2012	7																															D	D	D	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	2368.173966	279.8083715	1290.204199	56.88452337	20.43233848	30.70034108	7.856276974	719.3248494	41.13478767	6.449337347	22.9929853	0	0.042286098	18.03437804	128.5062173	120.5535229	11.78032699	2.675369251	17.69264439	18.0547796	31.75250118	0.183605685	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - 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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service/13d:  Home Safety Benefit - 0.0%													225	200	60	0	0.2	0.2	0.136094406	81.50222005	0.2	0	0.2	0	0.2	0.2	0	0.195558207	0.2	0.2	0.191344435	0.155953612	0.2	0.2	0	0	0	0	0	0	0	0											NO	189.8687945	168.7722618	50.63167854	0	0.168772262	0.168772262	0.114844803	68.7765701	0.168772262	0	0.168772262	0	0.168772262	0.168772262	0	0.165024005	0.168772262	0.168772262	0.161468165	0.131603219	0.168772262	0.168772262	0	0	0	0	0	0	0	0												37.4702	3.935324311	5.44376702	0	3.44841198	5.181366003	0.902252583	4.122724661	6.942411155	0	3.880578134	0	0.00713672	3.043702772	0	19.89422512	1.988192431	0.45152812	2.856798825	2.376067122	5.358941442	0.030987547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3346			19.86	37.4702	3.935324311	5.44376702	0	3.44841198	5.181366003	0.902252583	4.122724661	6.942411155	0	3.880578134	0	0.00713672	3.043702772	0	19.89422512	1.988192431	0.45152812	2.856798825	2.376067122	5.358941442	0.030987547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3346	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	37.4702	3.935324311	5.44376702	0	3.44841198	5.181366003	0.902252583	4.122724661	6.942411155	0	3.880578134	0	0.00713672	3.043702772	0	19.89422512	1.988192431	0.45152812	2.856798825	2.376067122	5.358941442	0.030987547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3346
H3949_013_0	2012	7																															D	D	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	1386.503934	58.25161037	924.1164207	29.53790019	285.5733615	14.90079864	3.078628565	386.1541158	387.6346291	6.316122834	893.2887073	0	0.253139939	424.740439	4839.884903	3771.562674	231.7090429	131.0073648	26.48287555	57.80005794	31.45338238	0.188927668	0	0	0	0	0	0	0	0											6700	1a:  Acute - $175/$0/day for 1-7/8-90	1b:  Psych - $175/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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 - $5/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													175	175	60	0	100	0.2	0.120847486	44.73581941	186.6163622	0	23.84705964	0	0.2	61.69955898	5	34.72689415	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	166.4789125	166.4789125	57.07848429	0	95.13080715	0.190261614	0.114963188	42.57067148	177.5296516	0	22.68590031	0	0.190261614	58.69528847	4.756540357	33.0359747	19.02616143	33.2957825	0	33.2957825	0.190261614	0	0	0	0	0	0	0	0	0												19.2353	0.808138729	4.39559705	0	2.263902032	2.835050004	0.353928956	1.369903334	5.734720056	0	1.688754881	0	0.048162814	2.077521882	1.918425655	10.38310409	0.367377805	0.363499394	0	0.160374846	5.984371307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9881			3.07	19.2353	0.808138729	4.39559705	0	2.263902032	2.835050004	0.353928956	1.369903334	5.734720056	0	1.688754881	0	0.048162814	2.077521882	1.918425655	10.38310409	0.367377805	0.363499394	0	0.160374846	5.984371307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9881	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	19.2353	0.808138729	4.39559705	0	2.263902032	2.835050004	0.353928956	1.369903334	5.734720056	0	1.688754881	0	0.048162814	2.077521882	1.918425655	10.38310409	0.367377805	0.363499394	0	0.160374846	5.984371307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9881
H3949_016_0	2012	7																															D	D	D	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	2369.548134	143.6719726	12405.54983	4.066943735	48.56579659	8.881215355	5.602272151	93.55799245	29.49755296	11.63553761	9.546288102	0	0.121297749	53.70812618	0	0	6.137392096	0.964577975	24.39136866	13.29384352	4.485958612	0.629586231	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/7f:  Routine Footcare - $0/visit/12 Visits/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													225	200	60	0	0.2	0.2	0.118238476	65	0.2	0	0.2	0	0.2	0.021752042	0	0	0.2	0	0	0.000352048	0.2	0.2	0	0	0	0	0	0	0	0											NO	187.6345665	166.8159967	49.38373943	0	0.167235977	0.16900385	0.096340659	54.29148855	0.170559728	0	0.164285025	0	0.168913017	0.017739221	0	0	0.166815997	0	0	0.000282884	0.162840527	0.165137878	0	0	0	0	0	0	0	0												37.0508	1.997231943	51.05270336	0	8.121948442	1.500959585	0.539726591	0.423283556	5.031094609	0	1.568312175	0	0.020488769	0.952740332	0	0	1.02381518	0	0	0.003760614	0.730495866	0.103968534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1213			22.64515422	37.0508	1.997231943	51.05270336	0	8.121948442	1.500959585	0.539726591	0.423283556	5.031094609	0	1.568312175	0	0.020488769	0.952740332	0	0	1.02381518	0	0	0.003760614	0.730495866	0.103968534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1213	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	37.0508	1.997231943	51.05270336	0	8.121948442	1.500959585	0.539726591	0.423283556	5.031094609	0	1.568312175	0	0.020488769	0.952740332	0	0	1.02381518	0	0	0.003760614	0.730495866	0.103968534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1213
H3949_024_0	2012	7																															D	D	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	1737.075478	60.08953252	1174.101061	34.40258484	340.745271	33.09168532	7.586074365	500.3579074	387.7940683	6.758164773	23.31408537	0	0.0934906	415.5081333	5353.57215	4355.409102	279.9733018	106.3013555	23.65262288	51.33133459	22.78678255	0.346099507	0	0	0	0	0	0	0	0											6700	1a:  Acute - $195/$0/day for 1-7/8-90	1b:  Psych - $195/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $130/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													195	195	60	0	125	0.2	0.052764552	48.25334775	197.2402363	0	0.181398148	0	0.2	65.07841193	5	39.81296437	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	179.6353873	179.6353873	55.27242688	0	115.1508893	0.184241423	0.04860708	44.47281716	181.699109	0	0.167105264	0	0.184241423	59.95069608	4.606035573	36.67598603	18.42414229	36.84828458	0	36.84828458	0.184241423	0	0	0	0	0	0	0	0	0												26.0034	0.899517204	5.407951251	0	3.269760082	6.096859191	0.368736926	1.854360478	5.871819723	0	3.8959064	0	0.017224841	2.075833485	2.054895314	13.31157695	0.429855663	0.32641855	0	0.157622635	4.19826924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.24			6.52	26.0034	0.899517204	5.407951251	0	3.269760082	6.096859191	0.368736926	1.854360478	5.871819723	0	3.8959064	0	0.017224841	2.075833485	2.054895314	13.31157695	0.429855663	0.32641855	0	0.157622635	4.19826924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.24	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	26.0034	0.899517204	5.407951251	0	3.269760082	6.096859191	0.368736926	1.854360478	5.871819723	0	3.8959064	0	0.017224841	2.075833485	2.054895314	13.31157695	0.429855663	0.32641855	0	0.157622635	4.19826924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.24
H3952_008_0	2012	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	2285.455865	42.30208455	1673.307175	0	304.8999629	0.820158226	20.37539178	362.4408568	362.2441471	0	766.4471803		18.11967755	491.9085585	2707.567995	4585.52152	136.2009679	170.9639625	11.24324215	27.2501228	93.18285456			102.6308468	191.4158018		0.000001				206.914821										6700	$190 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	"$30 for days 1-20, $110 for days 21-100 (PBP 2)"	$0 Copay per visit (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$40 copay X-ray (PBP 8b), $100 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c)"	"$10 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $40 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)			$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$40 copay Therapeutic Radiology (PBP 8b)										0	NO	141.3541332	130.1945963	52.21073363	0	100	0.2	0.171977087	50	260.0840336	0	65.46419098	0	25	40	10	39.78034328	40	40	40	40	0.2	0	0	15	40	0	0	0	0	0	40										NO	127.4166156	117.3574091	47.06275529	0	90.14	0.18028	0.155020146	45.07	234.4397479	0	59.00942175	0	22.535	36.056	9.014	35.85800143	36.056	36.056	36.056	36.056	0.18028	0	0	15	40	0	0	0	0	0	36.056											24.2671	0.413705254	6.562537177	0	2.290306888	0.147858125	3.158596206	1.361267451	7.077035543	0	3.768967076	0	0.034027244	1.478021249	2.033834826	13.7023031	0.409238508	0.513689719	0.033782195	0.081877536	16.79900502	0	0	0.128288559	0.638052673	0	0	0	0	0	0.621710066	0	0	0	0	0	0	0	0	0	85.5212	0	NO	9.282314244	24.2671	0.413705254	6.562537177	0	2.290306888	0.147858125	3.158596206	1.361267451	7.077035543	0	3.768967076	0	0.034027244	1.478021249	2.033834826	13.7023031	0.409238508	0.513689719	0.033782195	0.081877536	16.79900502	0	0	0.128288559	0.638052673	0	0	0	0	0	0.621710066	0	0	0	0	0	0	0	0	0	85.5212	NO																																																																																		0	0	NO		24.2671	0.413705254	6.562537177	0	2.290306888	0.147858125	3.158596206	1.361267451	7.077035543	0	3.768967076	0	0.034027244	1.478021249	2.033834826	13.7023031	0.409238508	0.513689719	0.033782195	0.081877536	16.79900502	0	0	0.128288559	0.638052673	0	0	0	0	0	0.621710066	0	0	0	0	0	0	0	0	0	85.5212
H3952_020_0	2012	7	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	2144.970282	62.7071014	1395.181478	0	273.9046005	1.001724812	22.31659618	350.9458355	424.2248705	0	848.8130482		57.41291279	577.502364	2267.688864	4759.541042	195.5670386	247.4446907	13.93431616	28.40911669	109.8964364			102.6308468	191.4158018		0.00001				209.0655796										6700	$190 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	"$30 for days 1-20, $110 for days 21-100 (PBP 2)"	$0 Copay per visit (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$40 copay X-ray (PBP 8b), $100 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c)"	"$10 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $40 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)			$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$40 copay Therapeutic Radiology (PBP 8b)										0	NO	142.4229066	131.1789929	52.5597251	0	100	0.2	0.165565606	50	253.966895	0	64.92492492	0	25	40	10	39.64542721	40	40	40	40	0.2	0	0	15	40	0	0	0	0	0	40										NO	123.8082327	114.0338986	45.69016903	0	86.93	0.17386	0.143926181	43.465	220.7734218	0	56.43923724	0	21.7325	34.772	8.693	34.46376988	34.772	34.772	34.772	34.772	0.17386	0	0	15	40	0	0	0	0	0	34.772											22.1304	0.595894603	5.312173128	0	1.984210577	0.174159876	3.211942471	1.271155062	7.804798023	0	3.99219675	0	0.103977177	1.67340935	1.642751608	13.6693106	0.566688089	0.717012232	0.040377003	0.08232015	19.10659443	0	0	0.128288559	0.638052673	0	0	0	0	0	0.605802361	0	0	0	0	0	0	0	0	0	85.4515	0	NO	12.74487542	22.1304	0.595894603	5.312173128	0	1.984210577	0.174159876	3.211942471	1.271155062	7.804798023	0	3.99219675	0	0.103977177	1.67340935	1.642751608	13.6693106	0.566688089	0.717012232	0.040377003	0.08232015	19.10659443	0	0	0.128288559	0.638052673	0	0	0	0	0	0.605802361	0	0	0	0	0	0	0	0	0	85.4515	NO																																																																																		0	0	NO		22.1304	0.595894603	5.312173128	0	1.984210577	0.174159876	3.211942471	1.271155062	7.804798023	0	3.99219675	0	0.103977177	1.67340935	1.642751608	13.6693106	0.566688089	0.717012232	0.040377003	0.08232015	19.10659443	0	0	0.128288559	0.638052673	0	0	0	0	0	0.605802361	0	0	0	0	0	0	0	0	0	85.4515
H3952_044_0	2012	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	2183.391791	36.72459254	1992.131796	0	343.4820635	0.781986871	18.83931404	342.0621695	399.2653333	0	684.4379889		22.99826355	710.6926947	2619.754813	4902.103497	143.2771974	207.3322079	130.6605011	26.93544565	91.33442846			102.6308468	191.4158018		0				232.4949532										6700	$190 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	"$30 for days 1-20, $110 for days 21-100 (PBP 2)"	$0 Copay per visit (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$40 copay X-ray (PBP 8b), $100 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c)"	"$10 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $40 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)			$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$40 copay Therapeutic Radiology (PBP 8b)										0	NO	145.2877079	133.8176257	54.44740507	0	100	0.2	0.168155471	50	228.7202381	0	64.0381558	0	25	40	10	39.64375733	40	40	40	40	0.2	0	0	15	40	0	0	0	0	0	40										NO	131.4272606	121.0514242	49.25312263	0	90.46	0.18092	0.152113439	45.23	206.9003274	0	57.92891574	0	22.615	36.184	9.046	35.86174288	36.184	36.184	36.184	36.184	0.18092	0	0	15	40	0	0	0	0	0	36.184											23.9131	0.370463686	8.176559306	0	2.589282288	0.141477065	2.865712842	1.289289327	6.88401068	0	3.304062549	0	0.043342144	2.142975372	1.974858504	14.64983127	0.432028509	0.625175718	0.393984964	0.081219347	16.5242248	0	0	0.128288559	0.638052673	0	0	0	0	0	0.701049782	0	0	0	0	0	0	0	0	0	87.869	0	NO	9.184180172	23.9131	0.370463686	8.176559306	0	2.589282288	0.141477065	2.865712842	1.289289327	6.88401068	0	3.304062549	0	0.043342144	2.142975372	1.974858504	14.64983127	0.432028509	0.625175718	0.393984964	0.081219347	16.5242248	0	0	0.128288559	0.638052673	0	0	0	0	0	0.701049782	0	0	0	0	0	0	0	0	0	87.869	NO																																																																																		0	0	NO		23.9131	0.370463686	8.176559306	0	2.589282288	0.141477065	2.865712842	1.289289327	6.88401068	0	3.304062549	0	0.043342144	2.142975372	1.974858504	14.64983127	0.432028509	0.625175718	0.393984964	0.081219347	16.5242248	0	0	0.128288559	0.638052673	0	0	0	0	0	0.701049782	0	0	0	0	0	0	0	0	0	87.869
H3952_045_0	2012	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	v		v				v																																																		0	YES	1902.089801	65.05691964	1443.27408	0	299.3493009	0.902844212	21.31752458	337.6884384	429.1898166	0	751.9721323		20.2147065	808.3858289	2644.918422	5073.651818	266.5333829	266.0643396	161.3919183	25.23124955	132.2225973			102.6308468	191.4158018		0.00001				225.8997413										6700	$190 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	"$30 for days 1-20, $110 for days 21-100 (PBP 2)"	$0 Copay per visit (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$40 copay X-ray (PBP 8b), $100 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c)"	"$10 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $40 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 7d)	"$40 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% coinsurance (PBP 15)			$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$40 copay Therapeutic Radiology (PBP 8b)										0	NO	143.0233938	131.7320732	52.87386465	0	100	0.2	0.162204914	50	236.5230461	0	64.6685879	0	25	40	10	39.66630961	40	40	40	40	0.2	0	0	15	40	0	0	0	0	0	40										NO	121.0693028	111.5112	44.75772643	0	84.65	0.1693	0.13730646	42.325	200.2167585	0	54.74195965	0	21.1625	33.86	8.465	33.57753109	33.86	33.86	33.86	33.86	0.1693	0	0	15	40	0	0	0	0	0	33.86											19.1904	0.604547931	5.38313887	0	2.11165986	0.152851525	2.927033837	1.191055263	7.160916156	0	3.430369011	0	0.035649477	2.280995347	1.865769537	14.19672514	0.752068362	0.750744878	0.455394196	0.071194176	22.38528572	0	0	0.128288559	0.638052673	0	0	0	0	0	0.63741377	0	0	0	0	0	0	0	0	0	86.3495	0	NO	15.69298557	19.1904	0.604547931	5.38313887	0	2.11165986	0.152851525	2.927033837	1.191055263	7.160916156	0	3.430369011	0	0.035649477	2.280995347	1.865769537	14.19672514	0.752068362	0.750744878	0.455394196	0.071194176	22.38528572	0	0	0.128288559	0.638052673	0	0	0	0	0	0.63741377	0	0	0	0	0	0	0	0	0	86.3495	NO																																																																																		0	0	NO		19.1904	0.604547931	5.38313887	0	2.11165986	0.152851525	2.927033837	1.191055263	7.160916156	0	3.430369011	0	0.035649477	2.280995347	1.865769537	14.19672514	0.752068362	0.750744878	0.455394196	0.071194176	22.38528572	0	0	0.128288559	0.638052673	0	0	0	0	0	0.63741377	0	0	0	0	0	0	0	0	0	86.3495
H3952_048_0	2012	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	1740.286612	52.90773629	1085.536315		227.8809726	0.720007981	12.99098622	307.7404315	307.9601125		668.1004228		55.04587156	262.6728043	2256.293955	3423.832708	204.5787145	153.6835838	9.845604296	27.58293148	84.22232929										157.7873498										6700	$215 per day; 8 days max (PBP 1a)	$175 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)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$50 copay X-ray (PBP 8b), $120 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40-$45 copay per visit (PBP 3, 5, 9c)"	"$20 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $45 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 7d)	"$45 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance (PBP 15)										$50 copay Therapeutic Radiology (PBP 8b)										0	NO	157.0044152	127.7942915	66.76258993		100	0.2	0.168225338	50	227.6785714	0	71.85555556	0	25	44.96808511	20	44.83103082	40	45	45	45	0.2										50										NO	140.8643614	114.6570383	59.89939568		89.72	0.17944	0.150931773	44.86	204.2732143	0	64.46880444	0	22.43	40.34536596	17.944	40.22240085	35.888	40.374	40.374	40.374	0.17944										44.86											20.4287	0.505520362	5.418580771	0	1.703790072	0.129198232	1.960752586	1.150436313	5.242333505	0	3.589302959	0	0.102889908	0.883135868	3.373911561	11.47623097	0.611826742	0.517068418	0.033125536	0.092802773	15.11285477	0	0	0	0	0	0	0	0	0	0.589861709	0	0	0	0	0	0	0	0	0	72.9223	0	NO	8.360095464	20.4287	0.505520362	5.418580771	0	1.703790072	0.129198232	1.960752586	1.150436313	5.242333505	0	3.589302959	0	0.102889908	0.883135868	3.373911561	11.47623097	0.611826742	0.517068418	0.033125536	0.092802773	15.11285477	0	0	0	0	0	0	0	0	0	0.589861709	0	0	0	0	0	0	0	0	0	72.9223	NO																																																																																		0				20.4287	0.505520362	5.418580771	0	1.703790072	0.129198232	1.960752586	1.150436313	5.242333505	0	3.589302959	0	0.102889908	0.883135868	3.373911561	11.47623097	0.611826742	0.517068418	0.033125536	0.092802773	15.11285477	0	0	0	0	0	0	0	0	0	0.589861709	0	0	0	0	0	0	0	0	0	72.9223
H3952_049_0	2012	7	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	1725.454102	90.10515496	999.8832826		201.1031825	0.692458112	18.4344406	322.7270583	382.5637402		719.8543352		5.248626336	300.4766173	2320.093202	3777.495428	201.1618053	197.0423448	14.9559503	30.66338497	89.32173673										235.2047529										6700	$215 per day; 8 days max (PBP 1a)	$175 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)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$50 copay X-ray (PBP 8b), $120 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40-$45 copay per visit (PBP 3, 5, 9c)"	"$20 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $45 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 7d)	"$45 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance (PBP 15)										$50 copay Therapeutic Radiology (PBP 8b)										0	NO	157.0044152	127.7942915	66.76258993	0	100	0.2	0.16042221	50	232.2580645	0	71.85555556	0	25	44.96340981	20	44.71536808	40	45	45	45	0.2	0	0	0	0	0	0	0	0	0	50										NO	138.0853832	112.3950794	58.71769784	0	87.95	0.1759	0.141091334	43.975	204.2709677	0	63.19696111	0	21.9875	39.54531893	17.59	39.32716622	35.18	39.5775	39.5775	39.5775	0.1759	0	0	0	0	0	0	0	0	0	43.975											19.855	0.843948003	4.892570372	0	1.473918741	0.121803382	2.60093981	1.182660199	6.51222212	0	3.791050535	0	0.009617014	0.990203639	3.400869952	12.37984922	0.589739359	0.649870283	0.049326594	0.101131677	15.71169349	0	0	0	0	0	0	0	0	0	0.861927417	0	0	0	0	0	0	0	0	0	76.0183	0	NO	10.41122244	19.855	0.843948003	4.892570372	0	1.473918741	0.121803382	2.60093981	1.182660199	6.51222212	0	3.791050535	0	0.009617014	0.990203639	3.400869952	12.37984922	0.589739359	0.649870283	0.049326594	0.101131677	15.71169349	0	0	0	0	0	0	0	0	0	0.861927417	0	0	0	0	0	0	0	0	0	76.0183	NO																																																																																		0				19.855	0.843948003	4.892570372	0	1.473918741	0.121803382	2.60093981	1.182660199	6.51222212	0	3.791050535	0	0.009617014	0.990203639	3.400869952	12.37984922	0.589739359	0.649870283	0.049326594	0.101131677	15.71169349	0	0	0	0	0	0	0	0	0	0.861927417	0	0	0	0	0	0	0	0	0	76.0183
H3952_050_0	2012	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	1633.098367	57.39323335	1341.682683		223.7464467	0.506428142	15.33704657	274.9320573	361.986275		620.8569188		28.40495266	370.5194614	2272.212291	3926.03882	125.554259	128.3442717	101.7798241	18.1190038	77.34542858										173.9544575										6700	$215 per day; 8 days max (PBP 1a)	$175 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)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$50 copay X-ray (PBP 8b), $120 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40-$45 copay per visit (PBP 3, 5, 9c)"	"$20 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $45 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 7d)	"$45 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance (PBP 15)										$50 copay Therapeutic Radiology (PBP 8b)										0	NO	157.0044152	127.7942915	66.76258993	0	100	0.2	0.169982761	50	240.9375	0	71.85555556	0	25	44.99648094	20	44.75413341	40	45	45	45	0.2	0	0	0	0	0	0	0	0	0	50										NO	141.9005905	115.5004806	60.34002878	0	90.38	0.18076	0.15363042	45.19	217.7593125	0	64.94305111	0	22.595	40.66781947	18.076	40.44878578	36.152	40.671	40.671	40.671	0.18076	0	0	0	0	0	0	0	0	0	45.19											19.3115	0.55241217	6.746430973	0	1.685183655	0.091541951	2.356236902	1.035348306	6.568823532	0	3.360028551	0	0.053484159	1.255684881	3.422709114	13.23362527	0.378253131	0.434990823	0.344957269	0.061409834	13.98095967	0	0	0	0	0	0	0	0	0	0.655083495	0	0	0	0	0	0	0	0	0	75.5286	0	NO	8.035562701	19.3115	0.55241217	6.746430973	0	1.685183655	0.091541951	2.356236902	1.035348306	6.568823532	0	3.360028551	0	0.053484159	1.255684881	3.422709114	13.23362527	0.378253131	0.434990823	0.344957269	0.061409834	13.98095967	0	0	0	0	0	0	0	0	0	0.655083495	0	0	0	0	0	0	0	0	0	75.5286	NO																																																																																		0				19.3115	0.55241217	6.746430973	0	1.685183655	0.091541951	2.356236902	1.035348306	6.568823532	0	3.360028551	0	0.053484159	1.255684881	3.422709114	13.23362527	0.378253131	0.434990823	0.344957269	0.061409834	13.98095967	0	0	0	0	0	0	0	0	0	0.655083495	0	0	0	0	0	0	0	0	0	75.5286
H3952_051_0	2012	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	YES	1452.502005	48.83133921	1056.931814		199.3142604	0.691313275	13.89726178	275.8301904	405.6614521		683.5603546		25.44849269	481.3062948	2301.631687	4036.958355	226.4952839	220.9939312	116.9516392	22.08419112	69.28641531										217.391838										6700	$215 per day; 8 days max (PBP 1a)	$175 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)	$100 copay per Ambulatory Service Center visit (PBP 9b); $350 copay per Outpatient Facility visit (PBP 9a)	$0 copay per service (PBP 8a)	"$50 copay X-ray (PBP 8b), $120 copay Dx Rad (PBP 8b)"		$25 copay per visit (PBP 12)	"$40-$45 copay per visit (PBP 3, 5, 9c)"	"$20 Copay per visit (PBP 7a, PBP 4b)"	"$15 copay per visit (PBP 7b), $45 copay per visit (PBP 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 7d)	"$45 copay per visit (PBP 3 - Pulmonary, PBP 4b, PBP 18a - Medicare Covered portion)"	20% Coinsurance (PBP 15)										$50 copay Therapeutic Radiology (PBP 8b)										0	NO	157.0044152	127.7942915	66.76258993	0	100	0.2	0.158616407	50	232.122905	0	71.85555556	0	25	44.98156445	20	44.68762246	40	45	45	45	0.2	0	0	0	0	0	0	0	0	0	50										NO	140.7073569	114.529244	59.83263309	0	89.62	0.17924	0.142152024	44.81	208.0285475	0	64.39694889	0	22.405	40.31247806	17.924	40.04904725	35.848	40.329	40.329	40.329	0.17924	0	0	0	0	0	0	0	0	0	44.81											17.0315	0.466051364	5.269917784	0	1.488545334	0.123910991	1.975523886	1.029995902	7.03243022	0	3.668266768	0	0.047514457	1.616887454	3.437870529	13.47302799	0.676616911	0.742705354	0.393045221	0.074219445	12.41889708	0	0	0	0	0	0	0	0	0	0.811777355	0	0	0	0	0	0	0	0	0	71.7787	0	NO	8.311620821	17.0315	0.466051364	5.269917784	0	1.488545334	0.123910991	1.975523886	1.029995902	7.03243022	0	3.668266768	0	0.047514457	1.616887454	3.437870529	13.47302799	0.676616911	0.742705354	0.393045221	0.074219445	12.41889708	0	0	0	0	0	0	0	0	0	0.811777355	0	0	0	0	0	0	0	0	0	71.7787	NO																																																																																		0				17.0315	0.466051364	5.269917784	0	1.488545334	0.123910991	1.975523886	1.029995902	7.03243022	0	3.668266768	0	0.047514457	1.616887454	3.437870529	13.47302799	0.676616911	0.742705354	0.393045221	0.074219445	12.41889708	0	0	0	0	0	0	0	0	0	0.811777355	0	0	0	0	0	0	0	0	0	71.7787
H3952_802_0	2012	5	h.5.										OP Facility - Other										Other										coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	370.7694752	4.99636634	39.40328524	16.26762178	9.535252847	1.130320965	16.53801582	21.81976409	70.67377666	7.120073663	30.92131125	0.293917401	0.0070742	57.37394714	41.20542412	46.30322097	5.337070706	2.59403904	9.991869135	88.57292605	107.4203976	0.626426378																			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	NO	0.075052451	0.149927746	0.149927746	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.056348337	0.112563668	0.112563668	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																				20.8922	0.562409322	4.435378318	0	1.603601515	0.190092957	2.781298792	3.669562549	11.88563923	1.19742613	5.200225138	0.049429878	0.001189711	9.64892594	6.929767003	7.787094531	0.897567669	0.436255336	1.680393455	14.89584814	18.06554216	0.105349937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9152	0	NO	37.48077787	20.8922	0.562409322	4.435378318	0	1.603601515	0.190092957	2.781298792	3.669562549	11.88563923	1.19742613	5.200225138	0.049429878	0.001189711	9.64892594	6.929767003	7.787094531	0.897567669	0.436255336	1.680393455	14.89584814	18.06554216	0.105349937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9152	NO																																																																																		0				20.8922	0.562409322	4.435378318	0	1.603601515	0.190092957	2.781298792	3.669562549	11.88563923	1.19742613	5.200225138	0.049429878	0.001189711	9.64892594	6.929767003	7.787094531	0.897567669	0.436255336	1.680393455	14.89584814	18.06554216	0.105349937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9152
H3952_804_0	2012	5	h.5.										OP Facility - Other										Other										coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	445.2271429	5.480300826	53.32870447	18.46149929	12.17540224	1.140603984	22.32573758	24.66476892	73.5461996	7.214996978	29.09026346	0.220563003	1.421310861	66.62304726	40.96138232	52.03033142	4.60295893	2.742284589	10.05998333	85.5242061	100.1719645	0.968042162																			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	NO	0.075052451	0.149927746	0.149927746	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.056348337	0.112563668	0.112563668	0	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087	0.168176087																				25.0878	0.616882763	6.002874585	0	2.047611509	0.191822315	3.754655191	4.14802433	12.36871208	1.213389961	4.892286686	0.037093423	0.239030499	11.20440341	6.888725007	8.750257557	0.774107623	0.461186692	1.691848634	14.38312635	16.84652905	0.162801543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7632	0	NO	40.41773808	25.0878	0.616882763	6.002874585	0	2.047611509	0.191822315	3.754655191	4.14802433	12.36871208	1.213389961	4.892286686	0.037093423	0.239030499	11.20440341	6.888725007	8.750257557	0.774107623	0.461186692	1.691848634	14.38312635	16.84652905	0.162801543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7632	NO																																																																																		0				25.0878	0.616882763	6.002874585	0	2.047611509	0.191822315	3.754655191	4.14802433	12.36871208	1.213389961	4.892286686	0.037093423	0.239030499	11.20440341	6.888725007	8.750257557	0.774107623	0.461186692	1.691848634	14.38312635	16.84652905	0.162801543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7632
H3954_003_0	2012	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	1766.167905	19.78876911	1723.875306	1085.901644	81.67658873	8.02592252	3.039855061	902.2700422	1118.477861	3631.41973	1036.721103	0	1.697654791	18.20260516	4766.108181	3973.954103	71.00449963	531.1948712	393.1854357	85.73156695	9.506888757	0	0	269.1005568	459.8962135	196.0003361	5.97822376	27.3290229	4604.940359	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	48.99587345	125	5	45.03192338	0	0	125	9.856773828	20	17.5	10	0	0	0.099968258	0	0	18.65116279	20	0	20	0	0	0											NO	53.73460467	35.63664516	34.59684592	0	82.86731697	0.165734634	0.165734634	40.60156576	103.5841462	4.143365848	37.31674669	0	0	103.5841462	8.168044011	16.57346339	14.50178047	8.286731697	0	0	0.082841013	0	0	18.65116279	16.57346339	0	16.57346339	0	0	0												7.9087	0.058767112	4.970054028	0	0.564026647	1.330173331	0.503809266	3.052798037	9.65471452	1.253858374	3.223921566	0	0	0.15712511	3.244148449	5.488515238	0.085807639	0.366822448	0	0	0.787560296	0	0	0.418253191	0.635172755	0	0.008256656	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7125	0	NO	8.951010821	7.9087	0.058767112	4.970054028	0	0.564026647	1.330173331	0.503809266	3.052798037	9.65471452	1.253858374	3.223921566	0	0	0.15712511	3.244148449	5.488515238	0.085807639	0.366822448	0	0	0.787560296	0	0	0.418253191	0.635172755	0	0.008256656	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7125	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.9087	0.058767112	4.970054028	0	0.564026647	1.330173331	0.503809266	3.052798037	9.65471452	1.253858374	3.223921566	0	0	0.15712511	3.244148449	5.488515238	0.085807639	0.366822448	0	0	0.787560296	0	0	0.418253191	0.635172755	0	0.008256656	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7125
H3954_005_0	2012	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	1819.478492	17.72511132	1374.131251	1457.905032	101.2262941	6.940589682	4.682693129	823.8642192	994.3188853	2753.21341	977.2557036	0	0.633590026	37.67295155	5408.223066	5279.105204	47.32131371	543.7660658	730.8534663	513.8415111	22.4166631	0	0	294.6015058	409.2588678	168.2933662	13.38697231	26.77394462	4527.346541	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.43778111	125	5	30.05615656	0	0	125	9.41235487	20	17.5	10	0	0	0.09996637	0	0	18.56236786	20	0	20	0	0	0											NO	54.47297433	36.12632993	35.07224276	0	84.00600056	0.168012001	0.168012001	41.53070268	105.0075007	4.200300028	25.24897505	0	0	105.0075007	7.906942885	16.80120011	14.7010501	8.400600056	0	0	0.083977749	0	0	18.56236786	16.80120011	0	16.80120011	0	0	0												8.2594	0.053361935	4.016155401	0	0.708634677	1.166102361	0.786748643	2.851304994	8.700911753	0.96369353	2.056225406	0	0	0.329661874	3.563542574	7.391275246	0.05797275	0.380663437	0	0	1.882500918	0	0	0.45570846	0.573003345	0	0.0187431	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2156	0	NO	8.331491993	8.2594	0.053361935	4.016155401	0	0.708634677	1.166102361	0.786748643	2.851304994	8.700911753	0.96369353	2.056225406	0	0	0.329661874	3.563542574	7.391275246	0.05797275	0.380663437	0	0	1.882500918	0	0	0.45570846	0.573003345	0	0.0187431	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2156	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.2594	0.053361935	4.016155401	0	0.708634677	1.166102361	0.786748643	2.851304994	8.700911753	0.96369353	2.056225406	0	0	0.329661874	3.563542574	7.391275246	0.05797275	0.380663437	0	0	1.882500918	0	0	0.45570846	0.573003345	0	0.0187431	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2156
H3954_007_0	2012	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	1489.062657	21.26635367	1704.670369	1211.071681	74.01226729	9.381528684	2.537847271	796.584928	809.8279912	2527.235238	931.0506027	0	0.938948149	29.58862876	4120.037144	5988.344363	71.24233583	840.3031495	629.9429045	60.18031976	15.83586148	0	0	205.5004745	440.3407409	167.8834058	18.80298509	17.95021166	5851.80377	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.9767333	125	5	42.55933903	0	0	118.8879915	9.842502968	20	17.5	10	0	0	0.099775464	0	0	18.36422411	20	0	20	0	0	0											NO	55.08920207	36.53501051	35.46899893	0	84.95632185	0.169912644	0.169912644	42.45839439	106.1954023	4.247816093	36.15684904	0	0	101.0028647	8.3618285	16.99126437	14.86735632	8.495632185	0	0	0.084765565	0	0	18.36422411	16.99126437	0	16.99126437	0	0	0												6.8359	0.064747205	5.038579292	0	0.523984167	1.594040341	0.431212339	2.81847642	7.166667444	0.894602543	2.805321341	0	0	0.249044689	2.870920334	8.479128518	0.088265433	0.594908874	0	0	1.342335741	0	0	0.314488064	0.623495495	0	0.026623874	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7628	0	NO	7.516550289	6.8359	0.064747205	5.038579292	0	0.523984167	1.594040341	0.431212339	2.81847642	7.166667444	0.894602543	2.805321341	0	0	0.249044689	2.870920334	8.479128518	0.088265433	0.594908874	0	0	1.342335741	0	0	0.314488064	0.623495495	0	0.026623874	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7628	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.8359	0.064747205	5.038579292	0	0.523984167	1.594040341	0.431212339	2.81847642	7.166667444	0.894602543	2.805321341	0	0	0.249044689	2.870920334	8.479128518	0.088265433	0.594908874	0	0	1.342335741	0	0	0.314488064	0.623495495	0	0.026623874	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7628
H3954_021_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1712.639555	46.13250909	2136.895705	1450.674701	106.4952107	13.17009717	4.164765852	958.6866402	1263.412691	4017.751342	1226.659452	0	1.767531442	24.23322064	5139.829216	4530.94743	168.0860953	761.4718086	445.5509826	141.9365638	16.5591176	0	0	286.2281587	469.4161008	202.6512326	6.281003116	27.25718333	4762.540985	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	48.96524819	125	5	40.99166061	0	0	125	9.859275713	20	17.5	10	0	0	0.09995845	0	0	18.41019417	20	0	20	0	0	0											NO	51.9569404	34.457703	33.45230271	0	80.12587559	0.160251751	0.160251751	39.23383385	100.1573445	4.006293779	32.84492698	0	0	100.1573445	7.899830991	16.02517512	14.02202823	8.012587559	0	0	0.080092584	0	0	18.41019417	16.02517512	0	16.02517512	0	0	0												7.4153	0.132468358	5.957006831	0	0.711085167	2.110531135	0.667411021	3.134412696	10.54500501	1.341357684	3.357461676	0	0	0.202261252	3.383648511	6.050768834	0.196408998	0.508446628	0	0	1.32626251	0	0	0.439126332	0.626872935	0	0.008387848	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1142	0	NO	11.82515208	7.4153	0.132468358	5.957006831	0	0.711085167	2.110531135	0.667411021	3.134412696	10.54500501	1.341357684	3.357461676	0	0	0.202261252	3.383648511	6.050768834	0.196408998	0.508446628	0	0	1.32626251	0	0	0.439126332	0.626872935	0	0.008387848	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1142	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.4153	0.132468358	5.957006831	0	0.711085167	2.110531135	0.667411021	3.134412696	10.54500501	1.341357684	3.357461676	0	0	0.202261252	3.383648511	6.050768834	0.196408998	0.508446628	0	0	1.32626251	0	0	0.439126332	0.626872935	0	0.008387848	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1142
H3954_027_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1983.057714	37.74019939	2146.5577	1950.596485	144.3284	9.742964308	3.34438482	953.5393158	1214.889114	3461.08848	1199.969133	0	0.579930785	24.93742005	5585.334067	6153.598625	243.3983216	757.6383749	817.2179259	421.9127927	32.69898477	0	0	325.6618436	512.6260053	200.8330534	16.28769152	29.08516342	4679.802795	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.06028369	125	5	39.01533147	0	0	125	9.410715853	20	17.5	10	0	0	0.099979956	0	0	18.53839442	20	0	20	0	0	0											NO	51.34934351	34.05474638	33.06110348	0	79.18886443	0.158377729	0.158377729	38.85028154	98.98608054	3.959443222	30.89579795	0	0	98.98608054	7.452239019	15.83777289	13.85805128	7.918886443	0	0	0.079172992	0	0	18.53839442	15.83777289	0	15.83777289	0	0	0												8.4857	0.107102743	5.913963854	0	0.952433509	1.54306856	0.529676072	3.087105907	10.02142597	1.14199861	3.089500322	0	0	0.205704789	3.468603706	8.121608122	0.281085535	0.499971021	0	0	2.588876454	0	0	0.503103975	0.676571187	0	0.02149673	0	0	0	0	0	0	0	0	0	0	0	0	0	51.239	0	NO	13.33359302	8.4857	0.107102743	5.913963854	0	0.952433509	1.54306856	0.529676072	3.087105907	10.02142597	1.14199861	3.089500322	0	0	0.205704789	3.468603706	8.121608122	0.281085535	0.499971021	0	0	2.588876454	0	0	0.503103975	0.676571187	0	0.02149673	0	0	0	0	0	0	0	0	0	0	0	0	0	51.239	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.4857	0.107102743	5.913963854	0	0.952433509	1.54306856	0.529676072	3.087105907	10.02142597	1.14199861	3.089500322	0	0	0.205704789	3.468603706	8.121608122	0.281085535	0.499971021	0	0	2.588876454	0	0	0.503103975	0.676571187	0	0.02149673	0	0	0	0	0	0	0	0	0	0	0	0	0	51.239
H3954_033_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1775.992727	34.79554549	2474.031277	1659.094346	86.37275707	10.53198806	2.930780793	845.886522	838.6176031	3325.612214	1086.149743	0	1.067729957	41.30870502	4412.766984	6397.523703	138.5459801	1022.974238	716.1723491	133.2619712	29.78769761	0	0	217.4602139	486.1542222	205.409127	33.78792429	27.88844545	4548.766347	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.90786241	125	5	41.42663197	0	0	125	9.862323373	20	17.5	10	0	0	0.099814879	0	0	17.87349398	20	0	20	0	0	0											NO	52.60118617	34.88496506	33.8670982	0	81.11940516	0.16223881	0.16223881	40.48496111	101.3992564	4.055970258	33.60503743	0	0	101.3992564	8.000258054	16.22388103	14.1958959	8.111940516	0	0	0.080969236	0	0	17.87349398	16.22388103	0	16.22388103	0	0	0												7.7849	0.101153449	6.982355016	0	0.583875556	1.708697214	0.475486389	2.853806912	7.086266783	1.124048686	3.04167523	0	0	0.349055998	2.941939551	8.649388621	0.163898693	0.691525514	0	0	2.411887132	0	0	0.323897819	0.657275689	0	0.045680939	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9769	0	NO	11.09125799	7.7849	0.101153449	6.982355016	0	0.583875556	1.708697214	0.475486389	2.853806912	7.086266783	1.124048686	3.04167523	0	0	0.349055998	2.941939551	8.649388621	0.163898693	0.691525514	0	0	2.411887132	0	0	0.323897819	0.657275689	0	0.045680939	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9769	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.7849	0.101153449	6.982355016	0	0.583875556	1.708697214	0.475486389	2.853806912	7.086266783	1.124048686	3.04167523	0	0	0.349055998	2.941939551	8.649388621	0.163898693	0.691525514	0	0	2.411887132	0	0	0.323897819	0.657275689	0	0.045680939	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9769
H3954_097_0	2012	4																															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	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	321.0780563	2.75983035	71.236461	2019.184825	9.643132522	26.08170794	6.770509597	1854.243351	115.3556193	33.74453275	52.60170982	0.00029709	2.866561058	6.115541049	1653.062732	160.4492611	1.607803191	8.572883015	27.87148008	5.207757056	23.7914155	0	0	1110.501592	161.976729	422.1873727	9.716224151	28.70191843	1682.108982	0											6700	1a1: $0	1b1: $0	21: $0	6: $0	10a: 20.0%	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: 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%"	"9c1: 40.0%,9c2: 40.0%"	12: 20.0%	"31: 20.0%,5: 20.0%,9a2: 20.0%,9a3: 20.0%"	"7a: $0,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a13: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,16b1: 20.0%,17a1: $0,18a1: $0"	"7e1: 40.0%,7e2: 40.0%,7h1: 40.0%,7h2: 40.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 20.0%	7g: 20.0%	"151: $0,152: 20.0%,153: 20.0%"	9d1: 20.0%	$0 	"16a1: $0,16a2: $0,16a4: $0,16b2: $0"	17a2: $0	17b2: $0	18a2: $0	18b1: $0	$0 	$0 											0	NO	0.081729609	0.081729609	0.188212022	0	0.2	0.2	0.2	50.09589332	0.2	0.2	0.2	0.4	0.2	0.2	0.095265461	0.177017936	0.4	0.2	0.2	0.2	0.199878225	0	0	0	0	0	0	0	0	0											NO	0.081186427	0.081186427	0.186961149	0	0.198670783	0.198670783	0.198670783	49.76295179	0.198670783	0.198670783	0.198670783	0.397341566	0.198670783	0.198670783	0.094632319	0.17584146	0.397341566	0.198670783	0.198670783	0.198670783	0.198549818	0	0	0	0	0	0	0	0	0												26.0672	0.224060767	13.31845058	0	1.91580869	5.181673343	1.345102444	7.689385208	22.91779123	6.704052748	10.45042288	0.000118046	0.56950193	1.214979329	0.013036097	28.21363235	0.638847038	1.703181382	5.537248774	1.034629173	4.723781208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4629	0	NO	0.933083436	26.0672	0.224060767	13.31845058	0	1.91580869	5.181673343	1.345102444	7.689385208	22.91779123	6.704052748	10.45042288	0.000118046	0.56950193	1.214979329	0.013036097	28.21363235	0.638847038	1.703181382	5.537248774	1.034629173	4.723781208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4629	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	26.0672	0.224060767	13.31845058	0	1.91580869	5.181673343	1.345102444	7.689385208	22.91779123	6.704052748	10.45042288	0.000118046	0.56950193	1.214979329	0.013036097	28.21363235	0.638847038	1.703181382	5.537248774	1.034629173	4.723781208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4629
H3954_098_0	2012	3																															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											20.1101649	0	5.009325022	0	0.784643379	0	0	0	15.89859762	4.08567273	5.771627998	0	0.0017061	0.517566519	0	0	0	0	0	0.146889828	0	0	0	0	0	0	0	0	0	0											52.3262	YES	966.3596079	10.14374799	929.9637889	821.9279362	63.83551105	5.238027595	1.362560416	640.957235	208.0866395	1.724425153	152.1553793	0	0	30.6606655	3050.625228	2533.666365	50.91246466	646.2562297	185.9855599	7.518683418	7.147400749	0	0	235.7833586	346.9389558	167.9972546	12.58611354	21.88889311	5739.267773	0											1500	1a1: $0	1b1: $100 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $0	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	9a1: $0	"8a1: $0,8a2: $0"	"8b1: $0,8b5: $0,8b6: $0"	"9c1: $25,9c2: $10"	$0 	"31: $25,9a2: $0,9a3: $0"	"7a: $10,13d: $0,14a7: $0,14a8: $0,14a13: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	0	43.0044636	0	0	0	0.2	0.2	49.48291967	0	0	0	0	0	15.12958538	9.96626653	24.56911906	17.5	25	0	0	0.099861993	0	0	18.28798186	25	0	25	0	0	0											NO	0	43.0044636	0	0	0	0.180144741	0.180144741	44.57043868	0	0	0	0	0	13.62757618	8.976852501	22.12998792	15.76266481	22.51809259	0	0	0.089948064	0	0	18.28798186	22.51809259	0	22.51809259	0	0	0												0	0.036352203	0	0	0	0.943603123	0.245458093	2.380645428	0	0	0	0	0	0.034819213	2.282084393	4.672500504	0.066876343	1.212704802	0	0	0.642894859	0	0	0.359333482	0.651033628	0	0.023617939	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5519	1300	NO	1.450059112	20.1102	0.036352203	5.009325022	0	0.784643379	0.943603123	0.245458093	2.380645428	15.89859762	4.08567273	5.771627998	0	0.0017061	0.552385732	2.282084393	4.672500504	0.066876343	1.212704802	0	0.146889828	0.642894859	0	0	0.359333482	0.651033628	0	0.023617939	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8781	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	20.1102	0.036352203	5.009325022	0	0.784643379	0.943603123	0.245458093	2.380645428	15.89859762	4.08567273	5.771627998	0	0.0017061	0.552385732	2.282084393	4.672500504	0.066876343	1.212704802	0	0.146889828	0.642894859	0	0	0.359333482	0.651033628	0	0.023617939	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8781
H3954_100_0	2012	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											19.65412366	0	5.268973637	0	0.741234243	0	0	0	19.12163334	4.504446177	7.775654835	0	0.050811385	0.689406141	0	0	0	0	0	0.328533345	0	0	0	0	0	0	0	0	0	0											58.1348	YES	1149.921621	37.00377725	1251.932989	1048.977493	62.13452976	7.836173264	2.797544426	805.035176	337.8526918	9.673860043	199.6976467	0	0	36.85379214	3761.946508	3277.088691	191.0516627	677.8134991	239.705878	10.0704412	16.38919938	0	0	249.6503256	420.2506221	181.3969022	10.76230424	21.35102293	4890.078594	0											1500	1a1: $0	1b1: $100 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $0	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	9a1: $0	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b5: $0,8b6: $0"	"9c1: $25,9c2: $10"	$0 	"31: $25,9a2: $0,9a3: $0"	"7a: $10,13d: $0,14a7: $0,14a8: $0,14a13: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	0	43.0044636	0	0	0	0.2	0.2	49.51431083	0	0	0	0	0	16.31338859	9.938762172	24.67000039	17.5	25	0	0	0.099804129	0	0	18.36277174	25	0	25	0	0	0											NO	0	43.0044636	0	0	0	0.179039143	0.179039143	44.32499898	0	0	0	0	0	14.60367559	8.897137327	22.08447868	15.66592504	22.37989292	0	0	0.089344228	0	0	18.36277174	22.37989292	0	22.37989292	0	0	0												0	0.132610633	0	0	0	1.402981748	0.500869957	2.973598613	0	0	0	0	0	0.044850069	2.789212892	6.031066278	0.249416752	1.264116128	0	0	1.464280374	0	0	0.382022662	0.78376366	0	0.020071601	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0389	1300	NO	2.051634214	19.6541	0.132610633	5.268973637	0	0.741234243	1.402981748	0.500869957	2.973598613	19.12163334	4.504446177	7.775654835	0	0.050811385	0.734256209	2.789212892	6.031066278	0.249416752	1.264116128	0	0.328533345	1.464280374	0	0	0.382022662	0.78376366	0	0.020071601	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1737	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	19.6541	0.132610633	5.268973637	0	0.741234243	1.402981748	0.500869957	2.973598613	19.12163334	4.504446177	7.775654835	0	0.050811385	0.734256209	2.789212892	6.031066278	0.249416752	1.264116128	0	0.328533345	1.464280374	0	0	0.382022662	0.78376366	0	0.020071601	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1737
H3954_134_0	2012	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	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2494.896725	32.60919526	2875.242075	1775.413058	109.0786201	17.26134457	5.319077827	1019.131188	874.705307	2492.531525	707.2811458	0	1.73191114	52.16615245	4492.782159	4088.32663	131.5646745	641.7176316	326.113471	90.41177878	17.15119917	0	0	155.0301408	344.3802918	141.3759314	8.213425107	19.13422332	2833.574043	0											2000	1a1: $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	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $100,9b: $50"	"8a1: $5,8a2: $5"	"8b1: $15,8b2: $75,8b3: $45,8b4: $45,8b5: $45,8b6: $75"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $100,9a3: $100"	"7a: $5,13d: $0,14a2: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $30,7f1: $30,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $20,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 												NO	64.84414681	43.0044636	33.62756651	0	100	0.2	0.2	49.56104109	97.42053339	5	40.77814525	0	0	54.36612345	4.95836911	28.10582061	17.5	10	0	0	0.099936752	0	0	19.9572778	20	0	20	0	0	0											NO	47.253688	31.33851867	24.50531951	0	72.87271146	0.145745423	0.145745423	36.11647447	70.9929842	3.643635573	29.71614013	0	0	39.61806827	3.613298015	20.48147356	12.75272451	7.287271146	0	0	0.072826621	0	0	19.9572778	14.57454229	0	14.57454229	0	0	0												9.8244	0.085160323	5.871560477	0	0.662404567	2.515761965	0.775231247	3.06728546	5.174828337	0.756823044	1.751472136	0	0	0.172226849	1.352813405	6.977912814	0.139817337	0.389697532	0	0	1.249063883	0	0	0.257831632	0.418265427	0	0.009975576	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4526	0	NO	15.33497402	9.8244	0.085160323	5.871560477	0	0.662404567	2.515761965	0.775231247	3.06728546	5.174828337	0.756823044	1.751472136	0	0	0.172226849	1.352813405	6.977912814	0.139817337	0.389697532	0	0	1.249063883	0	0	0.257831632	0.418265427	0	0.009975576	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4526	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	9.8244	0.085160323	5.871560477	0	0.662404567	2.515761965	0.775231247	3.06728546	5.174828337	0.756823044	1.751472136	0	0	0.172226849	1.352813405	6.977912814	0.139817337	0.389697532	0	0	1.249063883	0	0	0.257831632	0.418265427	0	0.009975576	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4526
H3954_135_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	3166.785012	32.3989488	3356.167823	2656.673489	143.5190908	17.60832652	5.490538149	1177.312469	1055.489327	3155.983553	933.7230916	0	1.07256509	41.60060581	5461.469567	6139.566143	178.2846353	773.3118426	632.4143422	348.1182301	32.24778446	0	0	187.5911588	412.5758115	156.0948455	17.70163674	22.27002932	3131.031484	0											2000	1a1: $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	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $100,9b: $50"	"8a1: $5,8a2: $5"	"8b1: $15,8b2: $75,8b3: $45,8b4: $45,8b5: $45,8b6: $75"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $100,9a3: $100"	"7a: $5,13d: $0,14a2: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a10: $0,14a13: $0,14a16: $0"	"7b1: $20,7d1: $30,7f1: $30,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $20,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 												NO	64.84414681	43.0044636	33.62756651	0	100	0.2	0.2	49.6821217	97.00518455	5	44.44674759	0	0	86.43659324	4.807109748	28.46545835	17.5	10	0	0	0.099945126	0	0	20.00875361	20	0	20	0	0	0											NO	44.04725088	29.2120182	22.84249128	0	67.92787482	0.13585575	0.13585575	33.74800944	65.89356033	3.396393741	30.19173107	0	0	58.71454086	3.265367493	19.33598092	11.88737809	6.792787482	0	0	0.0678906	0	0	20.00875361	13.58557496	0	13.58557496	0	0	0												11.624	0.07886989	6.388602853	0	0.812412236	2.392192399	0.745921176	3.310996026	5.795829138	0.893246899	2.349226373	0	0	0.203546706	1.486142099	9.892877816	0.176611406	0.43774525	0	0	2.18932143	0	0	0.312788773	0.467089968	0	0.020040576	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5775	0	NO	23.26030667	11.624	0.07886989	6.388602853	0	0.812412236	2.392192399	0.745921176	3.310996026	5.795829138	0.893246899	2.349226373	0	0	0.203546706	1.486142099	9.892877816	0.176611406	0.43774525	0	0	2.18932143	0	0	0.312788773	0.467089968	0	0.020040576	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5775	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	11.624	0.07886989	6.388602853	0	0.812412236	2.392192399	0.745921176	3.310996026	5.795829138	0.893246899	2.349226373	0	0	0.203546706	1.486142099	9.892877816	0.176611406	0.43774525	0	0	2.18932143	0	0	0.312788773	0.467089968	0	0.020040576	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5775
H3954_136_0	2012	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	1721.546816	35.71846386	1953.990532	1468.877191	103.7839495	10.0770028	3.392793855	901.5492969	970.0781592	2769.809537	947.8251126	0	0.934225165	30.59540858	4836.099216	4913.459529	164.7542943	759.1882662	533.9514014	185.5939589	21.12429143	0	0	279.4860571	470.192864	197.288177	13.79592308	26.5231479	4934.795209	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a13: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.24202717	125	5	39.35385253	0	0	104.0086924	9.733680353	20	17.5	10	0	0	0.099914344	0	0	18.40654364	20	0	20	0	0	0											NO	53.21926163	35.29487104	34.26504402	0	82.07257593	0.164145152	0.164145152	40.41420014	102.5907199	4.103628796	32.2987205	0	0	85.36261306	7.988682198	16.41451519	14.36270079	8.207257593	0	0	0.082002276	0	0	18.40654364	16.41451519	0	16.41451519	0	0	0												7.635	0.105056548	5.579464298	0	0.709818006	1.654091155	0.556910663	3.03628281	8.29341806	0.947189181	2.551128199	0	0	0.217642002	3.219504976	6.721004671	0.197193053	0.519237805	0	0	1.732239966	0	0	0.428697692	0.643165659	0	0.018871116	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7659	0	NO	9.684736738	7.635	0.105056548	5.579464298	0	0.709818006	1.654091155	0.556910663	3.03628281	8.29341806	0.947189181	2.551128199	0	0	0.217642002	3.219504976	6.721004671	0.197193053	0.519237805	0	0	1.732239966	0	0	0.428697692	0.643165659	0	0.018871116	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7659	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.635	0.105056548	5.579464298	0	0.709818006	1.654091155	0.556910663	3.03628281	8.29341806	0.947189181	2.551128199	0	0	0.217642002	3.219504976	6.721004671	0.197193053	0.519237805	0	0	1.732239966	0	0	0.428697692	0.643165659	0	0.018871116	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7659
H3954_137_0	2012	8																															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	1721.615183	35.75524167	1954.085034	1469.02807	103.8615629	10.0723578	3.394748196	900.7816128	968.6571376	2769.960502	947.9216558	0	0.902768957	30.6269114	4835.957074	4914.077428	164.7955894	758.5759906	533.3019152	184.5606751	21.01347443	0	0	279.3937477	470.5149113	197.2968076	13.81012817	26.51803953	4938.385127	0											2800	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $0 days 1-6;$75 days 7-44	6: $0	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $125"	"8a1: $5,8a2: $5"	"8b1: $25,8b2: $100,8b3: $45,8b4: $25,8b5: $0,8b6: $25"	"9c1: $25,9c2: $10"	12: $0	"31: $10,5: $25,9a2: $125,9a3: $125"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a13: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $10,7i: $10"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $20	17b2: $0	18a2: $20	18b1: $0	$0 	$0 											0	NO	64.84414681	43.0044636	41.74968756	0	100	0.2	0.2	49.24060007	125	5	39.34231941	0	0	104.0086924	9.733799696	20	17.5	10	0	0	0.099913869	0	0	18.40947738	20	0	20	0	0	0											NO	53.33492442	35.3715783	34.33951313	0	82.25094638	0.164501893	0.164501893	40.50085956	102.813683	4.112547319	32.35943004	0	0	85.54813383	8.006142368	16.45018928	14.39391562	8.225094638	0	0	0.082180103	0	0	18.40947738	16.45018928	0	16.45018928	0	0	0												7.6519	0.105393278	5.591860721	0	0.711892653	1.656921923	0.558442504	3.040202467	8.299267321	0.94929947	2.556183709	0	0	0.218339593	3.226446735	6.73645865	0.197671151	0.519946609	0	0	1.726889488	0	0	0.428624407	0.645004946	0	0.018931602	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8396	0	NO	9.5835164	7.6519	0.105393278	5.591860721	0	0.711892653	1.656921923	0.558442504	3.040202467	8.299267321	0.94929947	2.556183709	0	0	0.218339593	3.226446735	6.73645865	0.197671151	0.519946609	0	0	1.726889488	0	0	0.428624407	0.645004946	0	0.018931602	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8396	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.6519	0.105393278	5.591860721	0	0.711892653	1.656921923	0.558442504	3.040202467	8.299267321	0.94929947	2.556183709	0	0	0.218339593	3.226446735	6.73645865	0.197671151	0.519946609	0	0	1.726889488	0	0	0.428624407	0.645004946	0	0.018931602	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8396
H3954_138_0	2012	3																															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											19.0534781	0	5.716583592	0	0.907073359	0	0	0	21.9698677	5.080174284	8.314210778	0	0.059271747	0.837092645	0	0	0	0	0	0.561858813	0	0	0	0	0	0	0	0	0	0											62.4996	YES	1021.809672	20.64709834	1214.975523	934.8865777	67.54085422	6.15137012	2.028023762	694.6177322	511.9508753	1321.003265	482.009465	0	0.445513916	16.6461375	3324.102044	3298.308635	117.3900659	610.4879942	340.4122223	88.50617009	12.70072916	0	0	188.9480276	301.6765941	145.7889592	9.839976298	17.19696296	2854.429167	0											1800	1a1: $0	1b1: $100 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $0	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b5: $0,8b6: $0"	"9c1: $25,9c2: $10"	12: $0	"31: $25,9a2: $0,9a3: $0"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a13: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	0	43.0044636	0	0	0	0.2	0.2	49.20091823	0	0	0	0	0	4.848313492	9.775804496	24.78449531	17.5	25	0	0	0.099917636	0	0	18.30044919	25	0	25	0	0	0											NO	0	43.0044636	0	0	0	0.183585413	0.183585413	45.16285453	0	0	0	0	0	4.45039818	8.973475541	22.75035907	16.06372366	22.94817666	0	0	0.091717103	0	0	18.30044919	22.94817666	0	22.94817666	0	0	0												0	0.073993116	0	0	0	1.129301825	0.37231558	2.614243299	0	0	0	0	0	0.006173495	2.485729032	6.253142147	0.157143465	1.167465528	0	0	1.164874079	0	0	0.288152815	0.576910648	0	0.01881746	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3083	1600	NO	1.425760952	19.0535	0.073993116	5.716583592	0	0.907073359	1.129301825	0.37231558	2.614243299	21.9698677	5.080174284	8.314210778	0	0.059271747	0.84326614	2.485729032	6.253142147	0.157143465	1.167465528	0	0.561858813	1.164874079	0	0	0.288152815	0.576910648	0	0.01881746	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8079	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	19.0535	0.073993116	5.716583592	0	0.907073359	1.129301825	0.37231558	2.614243299	21.9698677	5.080174284	8.314210778	0	0.059271747	0.84326614	2.485729032	6.253142147	0.157143465	1.167465528	0	0.561858813	1.164874079	0	0	0.288152815	0.576910648	0	0.01881746	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8079
H3954_139_0	2012	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											19.68156014	0	4.524203081	0	0.782882522	0	0	0	25.65054746	5.246881707	11.85909953	0	0.048912801	0.64303087	0	0	0	0	0	0.667285089	0	0	0	0	0	0	0	0	0	0											69.1044	YES	1273.182909	19.94387375	1200.859762	1330.842284	58.44077072	8.680321624	2.448723915	829.1997808	650.9125836	1331.16063	549.928235	0	0.447891242	37.86568322	4011.323117	3853.382583	212.8073797	550.9849865	356.7519512	88.97845162	16.79061454	0	0	220.6059308	357.2363118	161.2621515	12.68533399	19.79174724	3238.681069	0											1800	1a1: $0	1b1: $100 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $0	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b5: $0,8b6: $0"	"9c1: $25,9c2: $10"	12: $0	"31: $25,9a2: $0,9a3: $0"	"7a: $10,13d: $0,14a3: $0,14a4: $0,14a5: $0,14a6: $0,14a7: $0,14a8: $0,14a13: $0,14a14: $0,14a15: $0,14a16: $0"	"7b1: $20,7d1: $25,7f1: $25,17a1: $25,18a1: $25"	"7e1: $25,7e2: $10,7h1: $25,7h2: $10"	"7c: $25,7i: $25"	7d2: $0	7g: $0	"151: $0,152: 10.0%,153: 10.0%"	$0 	$0 	"16a1: $20,16a2: $0,16a4: $25,16b2: $0"	17a2: $25	17b2: $0	18a2: $25	18b1: $0	$0 	$0 											0	NO	0	43.0044636	0	0	0	0.2	0.2	49.28910853	0	0	0	0	0	16.39928297	9.817436392	24.78303281	17.5	25	0	0	0.09982894	0	0	18.73529363	25	0	25	0	0	0											NO	0	43.0044636	0	0	0	0.179940312	0.179940312	44.34548782	0	0	0	0	0	14.75446047	8.832762834	22.29733327	15.7447773	22.49253899	0	0	0.089816253	0	0	18.73529363	22.49253899	0	22.49253899	0	0	0												0	0.071472966	0	0	0	1.561939781	0.440624145	3.064272398	0	0	0	0	0	0.046557311	2.952588812	7.160012973	0.279217067	1.032754274	0	0	1.50807008	0	0	0.344426408	0.669595973	0	0.023777114	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1553	1600	NO	2.089063387	19.6816	0.071472966	4.524203081	0	0.782882522	1.561939781	0.440624145	3.064272398	25.65054746	5.246881707	11.85909953	0	0.048912801	0.68958818	2.952588812	7.160012973	0.279217067	1.032754274	0	0.667285089	1.50807008	0	0	0.344426408	0.669595973	0	0.023777114	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2597	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	19.6816	0.071472966	4.524203081	0	0.782882522	1.561939781	0.440624145	3.064272398	25.65054746	5.246881707	11.85909953	0	0.048912801	0.68958818	2.952588812	7.160012973	0.279217067	1.032754274	0	0.667285089	1.50807008	0	0	0.344426408	0.669595973	0	0.023777114	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2597
H3954_801_0	2012	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	265.5864041	2.940443989	37.35086898	13.25227624	4.152815174	13.8258349	4.801518155	18.62190593	130.7130112	31.75973541	52.04274395	0.000186779	0.097684346	3.996340685	52.85762486	150.5922152	2.079718162	8.829795942	26.01175067	4.226720842	20.82357855	0	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	"11b1: Medicare FFS,11b2: Medicare FFS,17b1: Medicare FFS"	"4a1: Medicare FFS,4a2: 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"	"9c1: Medicare FFS,9c2: Medicare FFS"	12: Medicare FFS	"31: Medicare FFS,5: Medicare FFS,9a2: Medicare FFS,9a3: Medicare FFS"	"7a: Medicare FFS,13d: $0,14a1: Medicare FFS,14a2: Medicare FFS,14a3: Medicare FFS,14a4: Medicare FFS,14a5: Medicare FFS,14a6: Medicare FFS,14a7: Medicare FFS,14a8: Medicare FFS,14a9: Medicare FFS,14a10: Medicare FFS,14a11: Medicare FFS,14a12: Medicare FFS,14a13: Medicare FFS,14a14: Medicare FFS,14a15: Medicare FFS,14a16: Medicare FFS,14b1: Medicare FFS"	"7b1: Medicare FFS,7b2: Medicare FFS,7d1: Medicare FFS,7f1: Medicare FFS,7f2: Medicare FFS,16b1: Medicare FFS,17a1: Medicare FFS,18a1: Medicare FFS"	"7e1: Medicare FFS,7e2: Medicare FFS,7h1: Medicare FFS,7h2: Medicare FFS"	"7c: Medicare FFS,7i: Medicare FFS"	7d2: Medicare FFS	7g: Medicare FFS	"151: Medicare FFS,152: Medicare FFS,153: Medicare FFS"	"9d1: Medicare FFS,9d2: Medicare FFS"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.081187828	0.081187828	0.187097862	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.068456505	0.068456505	0.157758449	0	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.189641788	0.192482417	0.188873844	0.188873844	0.188873844	0.188873844	0.188873844	0.188909577	0	0	0	0	0	0	0	0	0												18.1811	0.201292519	5.892415151	0	0.784358167	2.61133859	0.906881193	3.517190964	24.68826894	5.998583327	9.829513127	3.53E-05	0.018450018	0.757873194	10.1741634	28.44293063	0.392804365	1.667717505	4.91293935	0.798317015	3.933773418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.71	0	NO	22.77644851	18.1811	0.201292519	5.892415151	0	0.784358167	2.61133859	0.906881193	3.517190964	24.68826894	5.998583327	9.829513127	3.53E-05	0.018450018	0.757873194	10.1741634	28.44293063	0.392804365	1.667717505	4.91293935	0.798317015	3.933773418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.71	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	18.1811	0.201292519	5.892415151	0	0.784358167	2.61133859	0.906881193	3.517190964	24.68826894	5.998583327	9.829513127	3.53E-05	0.018450018	0.757873194	10.1741634	28.44293063	0.392804365	1.667717505	4.91293935	0.798317015	3.933773418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.71
H3954_802_0	2012	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	227.7297508	3.020692715	35.29366773	9.304063614	3.090940826	7.945478299	3.191137418	17.93329928	141.5141126	32.60470419	60.08666699	0.000106696	0.152121398	5.682545405	46.25269976	143.9511432	1.959712858	7.676916679	22.1519873	2.559259553	16.42198692	0	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	"11b1: Medicare FFS,11b2: Medicare FFS,17b1: Medicare FFS"	"4a1: Medicare FFS,4a2: 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"	"9c1: Medicare FFS,9c2: Medicare FFS"	12: Medicare FFS	"31: Medicare FFS,5: Medicare FFS,9a2: Medicare FFS,9a3: Medicare FFS"	"7a: Medicare FFS,13d: $0,14a1: Medicare FFS,14a2: Medicare FFS,14a3: Medicare FFS,14a4: Medicare FFS,14a5: Medicare FFS,14a6: Medicare FFS,14a7: Medicare FFS,14a8: Medicare FFS,14a9: Medicare FFS,14a10: Medicare FFS,14a11: Medicare FFS,14a12: Medicare FFS,14a13: Medicare FFS,14a14: Medicare FFS,14a15: Medicare FFS,14a16: Medicare FFS,14b1: Medicare FFS"	"7b1: Medicare FFS,7b2: Medicare FFS,7d1: Medicare FFS,7f1: Medicare FFS,7f2: Medicare FFS,16b1: Medicare FFS,17a1: Medicare FFS,18a1: Medicare FFS"	"7e1: Medicare FFS,7e2: Medicare FFS,7h1: Medicare FFS,7h2: Medicare FFS"	"7c: Medicare FFS,7i: Medicare FFS"	7d2: Medicare FFS	7g: Medicare FFS	"151: Medicare FFS,152: Medicare FFS,153: Medicare FFS"	"9d1: Medicare FFS,9d2: Medicare FFS"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.082187673	0.082187673	0.188935372	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069870149	0.069870149	0.160619497	0	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190896655	0.194346529	0.190428965	0.190428965	0.190428965	0.190428965	0.190428965	0.190435338	0	0	0	0	0	0	0	0	0												15.9115	0.211056251	5.668851146	0	0.588604662	1.513049208	0.607684995	3.415019619	26.94838598	6.208880068	11.4422418	2.03E-05	0.02896832	1.084778908	8.989051669	27.41246719	0.373186091	1.461907297	4.218380012	0.487357147	3.127326625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6987	0	NO	20.88549472	15.9115	0.211056251	5.668851146	0	0.588604662	1.513049208	0.607684995	3.415019619	26.94838598	6.208880068	11.4422418	2.03E-05	0.02896832	1.084778908	8.989051669	27.41246719	0.373186091	1.461907297	4.218380012	0.487357147	3.127326625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6987	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.9115	0.211056251	5.668851146	0	0.588604662	1.513049208	0.607684995	3.415019619	26.94838598	6.208880068	11.4422418	2.03E-05	0.02896832	1.084778908	8.989051669	27.41246719	0.373186091	1.461907297	4.218380012	0.487357147	3.127326625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6987
H3957_003_0	2012	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	426.5091588	0	1200.935544	0	458.702196	15.68484231	0	569.4472126	457.4553885	0	943.4313707	0	0	548.8344938	3696.932523	5126.686968	0	0	0	0	53.07318948	0	118.6569561	0	295.7806026	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $20 - $75, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $25, (7g) $10-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40		"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	250	0	60	0	100	0.2	0	65	100	0	35.18057717	0	0	25	10	23.90724069	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	238.6074324	0	47.35371559	0	90.5652955	0.185730898	0	63.29883548	98.09565487	0	34.17078159	0	0	22.9875693	9.91279892	23.54101006	0	0	0	0	0.076574332	0	34.81982697		25	0		0	0	0												8.4807	0	4.739063347	0	3.461874994	2.91315985	0	3.003778786	3.739532159	0	2.686482276	0	0	1.051364247	3.053912393	10.05728245	0	0	0	0	4.064044014	0	0.344301223	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2117		NO	4.196250923	8.4807	0	4.739063347	0	3.461874994	2.91315985	0	3.003778786	3.739532159	0	2.686482276	0	0	1.051364247	3.053912393	10.05728245	0	0	0	0	4.064044014	0	0.344301223	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2117	NO																																																																																		0		NO		8.4807	0	4.739063347	0	3.461874994	2.91315985	0	3.003778786	3.739532159	0	2.686482276	0	0	1.051364247	3.053912393	10.05728245	0	0	0	0	4.064044014	0	0.344301223	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2117
H3957_006_0	2012	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	389.1287549	0	1385.068841	0	378.2327665	14.29043269	0	599.4434665	483.2118442	0	983.382097	0	0	880.9846494	4006.592585	5170.016016	0	0	0	0	40.78661697	0	77.66362477	0	295.7806026	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $20 - $75, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $25, (7g) $10-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40		"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	250	0	60	0	100	0.2	0	65	100	0	36.20060595	0	0	25	10	24.08648264	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	243.8842824	0	48.2107143	0	94.82223333	0.190904967	0	63.86211689	98.34678416	0	35.60982157	0	0	23.72135819	9.938887897	23.81740011	0	0	0	0	0.07995742	0	34.47219675		25	0		0	0	0												7.9085	0	5.564596516	0	2.988739637	2.728114578	0	3.190144061	3.960194245	0	2.918171751	0	0	1.741512702	3.318422879	10.26136167	0	0	0	0	3.261192676	0	0.223102979	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6803		NO	3.202333894	7.9085	0	5.564596516	0	2.988739637	2.728114578	0	3.190144061	3.960194245	0	2.918171751	0	0	1.741512702	3.318422879	10.26136167	0	0	0	0	3.261192676	0	0.223102979	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6803	NO																																																																																		0		NO		7.9085	0	5.564596516	0	2.988739637	2.728114578	0	3.190144061	3.960194245	0	2.918171751	0	0	1.741512702	3.318422879	10.26136167	0	0	0	0	3.261192676	0	0.223102979	0	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6803
H3957_020_0	2012	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	459.3703657	0	1272.805874	0	463.3401666	18.00346868	0	566.5905811	534.4014292	0	1041.190933	0	0	521.8675082	4024.153543	6339.204949	0	0	0	0	68.90174402	0	134.12096	10.3311	295.7806026	0			0	0											3400	"(1a), (1b) $150 per admit"		(2) $40 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $75"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $5, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $5, (7c), (7d), (7e), (7f) $25, (7g) $5-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	150	0	40	0	75	0.2	0	65	75	0	21.32337267	0	0	25	5	23.2587128	0	0	0	0	0.1	0	40	0.4	25	0		0	0	0											NO	146.0856735	0	36.32555967	0	69.71200032	0.189679932	0	63.81276171	73.6277049	0	20.79590735	0	0	23.52254186	4.969592857	22.98965959	0	0	0	0	0.075690126	0	36.78784168	0.4	25	0		0	0	0												5.5923	0	3.852948811	0	2.691697487	3.414896714	0	3.012975811	3.278895894	0	1.804375848	0	0	1.022970859	1.666533725	12.14468032	0	0	0	0	5.215181653	0	0.411168387	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8573		NO	3.081051929	5.5923	0	3.852948811	0	2.691697487	3.414896714	0	3.012975811	3.278895894	0	1.804375848	0	0	1.022970859	1.666533725	12.14468032	0	0	0	0	5.215181653	0	0.411168387	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8573	NO																																																																																		0		NO		5.5923	0	3.852948811	0	2.691697487	3.414896714	0	3.012975811	3.278895894	0	1.804375848	0	0	1.022970859	1.666533725	12.14468032	0	0	0	0	5.215181653	0	0.411168387	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8573
H3957_021_0	2012	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	355.8645398	0	1098.783149	0	325.9879537	16.44976595	0	567.0957728	536.5014	0	1035.895888	0	0	824.432296	4328.933204	5923.206645	0	0	0	0	55.94837412	0	51.07890264	10.3311	295.7806026	0			0	0											3400	"(1a), (1b) $150 per admit"		(2) $40 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $75"	(8a) $0	"(8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $5, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $5, (7c), (7d), (7e), (7f) $25, (7g) $5-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0%-10%		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	150	0	40	0	75	0.2	0	65	75	0	21.22092025	0	0	25	5	23.23806313	0	0	0	0	0.1	0	40	0.4	25	0		0	0	0											NO	147.8682565	0	36.84061853	0	71.62158584	0.192900701	0	64.40346886	73.92223044	0	20.9646395	0	0	24.34589389	4.986061299	23.08455058	0	0	0	0	0.076633125	0	37.6109013	0.4	25	0		0	0	0												4.3851	0	3.373320903	0	1.945647851	3.173171384	0	3.043577912	3.304948343	0	1.809765321	0	0	1.672628433	1.79869386	11.39454695	0	0	0	0	4.287498768	0	0.16009363	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0976		NO	2.118865055	4.3851	0	3.373320903	0	1.945647851	3.173171384	0	3.043577912	3.304948343	0	1.809765321	0	0	1.672628433	1.79869386	11.39454695	0	0	0	0	4.287498768	0	0.16009363	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0976	NO																																																																																		0		NO		4.3851	0	3.373320903	0	1.945647851	3.173171384	0	3.043577912	3.304948343	0	1.809765321	0	0	1.672628433	1.79869386	11.39454695	0	0	0	0	4.287498768	0	0.16009363	4.13244	0.616209589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0976
H3957_024_0	2012	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	319.3686496	0	628.0281041	0	290.1848337	8.733857017	0	445.9388399	410.2424236	3541.984158	695.6072157	0	0	188.5725792	3103.208235	4408.498392	0	0	0	0	47.50498419	0	50.69501546	0	295.7806026	0			0	0											3400	"(1a), (1b) $300 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $40 - $100, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $30, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $30, (7g) $10-$30, (7h), (7i) $30, (14a), (14b), (14d), (14e) $0, (16b), (18a) $30, (17a), (17b) $0-$30"					(15) 0%-10%		(10b) $40		"(17a) $30, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	300	0	60	0	100	0.2	0	65	150	20	58.04322479	0	0	30	10	28.26047195	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	288.3037837	0	43.30976395	0	91.62976802	0.186977315	0	63.50421116	144.5073643	19.24829511	56.65306827	0	0	27.1307301	9.913129179	27.67555034	0	0	0	0	0.066504337	0	35.20722464		30	0		0	0	0												7.6729	0	2.266645745	0	2.215797416	1.633033134	0	2.359916188	4.94025428	5.681429697	3.28402359	0	0	0.426342646	2.563542008	10.1673016	0	0	0	0	3.159287471	0	0.1487359	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2587		NO	3.983106382	7.6729	0	2.266645745	0	2.215797416	1.633033134	0	2.359916188	4.94025428	5.681429697	3.28402359	0	0	0.426342646	2.563542008	10.1673016	0	0	0	0	3.159287471	0	0.1487359	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2587	NO																																																																																		0		NO		7.6729	0	2.266645745	0	2.215797416	1.633033134	0	2.359916188	4.94025428	5.681429697	3.28402359	0	0	0.426342646	2.563542008	10.1673016	0	0	0	0	3.159287471	0	0.1487359	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2587
H3957_025_0	2012	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	302.48128	0	470.0166985	0	231.0476598	9.92549889	0	431.5936436	393.4422217	3587.571653	778.547667	0	0	166.1433223	3354.639589	4486.378133	0	0	0	0	44.48542573	0	39.97961495	0	295.7806026	0			0	0											3400	"(1a), (1b) $300 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $40 - $100, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $30, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c), (7d), (7e), (7f) $30, (7g) $10-$30, (7h), (7i) $30, (14a), (14b), (14d), (14e) $0, (16b), (18a) $30, (17a), (17b) $0-$30"					(15) 0%-10%		(10b) $40		"(17a) $30, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	300	0	60	0	100	0.2	0	65	150	20	61.31340161	0	0	30	10	28.68401859	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	292.3397657	0	45.65507986	0	95.63149459	0.193902821	0	64.19494153	148.3165905	19.55478546	57.5908364	0	0	28.95077368	9.954119654	28.31793506	0	0	0	0	0.073231032	0	37.4369715		30	0		0	0	0												7.3689	0	1.788220826	0	1.841286086	1.924582239	0	2.308844059	4.862834072	5.846182833	3.736434277	0	0	0.400831477	2.782706989	10.58708039	0	0	0	0	3.257713632	0	0.124726309	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5698		NO	2.911914917	7.3689	0	1.788220826	0	1.841286086	1.924582239	0	2.308844059	4.862834072	5.846182833	3.736434277	0	0	0.400831477	2.782706989	10.58708039	0	0	0	0	3.257713632	0	0.124726309	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5698	NO																																																																																		0		NO		7.3689	0	1.788220826	0	1.841286086	1.924582239	0	2.308844059	4.862834072	5.846182833	3.736434277	0	0	0.400831477	2.782706989	10.58708039	0	0	0	0	3.257713632	0	0.124726309	0	0.739451506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5698
H3957_030_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	424.7067575	0	140.4049886	56.5902432	33.75264534	70.45355939	0	55.64619896	52.57715587	19.27313182	30.44681926	0	0	39.90258502	33.07689592	43.36483931	0	0	0	234.6810042	67.87062325	0	0	11.29518	295.7806026	0			0	0											3400	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b) $40	(16a) $0	"(17a), (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	0.085983213		0.181444806		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.085983213		0.181444806		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																					36.5177	0	25.47575585	0	7.560592556	15.7815973	0	12.46474857	11.77728291	4.317181527	6.820087515	0	0	8.938179045	7.409224687	9.713724006	0	0	0	52.56854495	15.20301961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	214.5476		NO	0	36.5177	0	25.47575585	0	7.560592556	15.7815973	0	12.46474857	11.77728291	4.317181527	6.820087515	0	0	8.938179045	7.409224687	9.713724006	0	0	0	52.56854495	15.20301961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	214.5476	NO																																																																																		0		NO		36.5177	0	25.47575585	0	7.560592556	15.7815973	0	12.46474857	11.77728291	4.317181527	6.820087515	0	0	8.938179045	7.409224687	9.713724006	0	0	0	52.56854495	15.20301961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	214.5476
H3957_031_0	2012	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	256.8330442	0	488.9767021	0	234.8622894	11.63667654	0	432.4125486	403.8439351	3541.648151	817.6274278	0	0	212.7370757	3284.092475	4210.880731	0	0	0	0	40.69426953	0	55.26525514	0	295.7806026	0			0	0											3400	"(1a), (1b) $450 per admit"		(2) $75 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $200"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $20 - $150, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $40, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $40, (7g) $15-$40, (7h), (7i) $40, (14a), (14b), (14d), (14e) $0, (16b), (18a) $40, (17a), (17b) $0-$40"					(15) 0%-10%		(10b) $40		"(17a) $40, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	450	0	75	0	100	0.2	0	65	200	20	54.87056418	0	0	40	15	38.46034244	0	0	0	0	0.1	0	40		40	0		0	0	0											NO	425.9699518	0	47.14610572	0	90.7356556	0.191009113	0	62.38691912	196.4427625	19.46376225	52.9160102	0	0	34.42313677	14.8662555	37.76401293	0	0	0	0	0.063831914	0	32.61054031		40	0		0	0	0												9.1169	0	1.921112274	0	1.775865317	2.22271126	0	2.248073891	6.611018186	5.744483131	3.605465109	0	0	0.610256454	4.068513151	13.2516462	0	0	0	0	2.597593116	0	0.150185819	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9098		NO	4.547357306	9.1169	0	1.921112274	0	1.775865317	2.22271126	0	2.248073891	6.611018186	5.744483131	3.605465109	0	0	0.610256454	4.068513151	13.2516462	0	0	0	0	2.597593116	0	0.150185819	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9098	NO																																																																																		0		NO		9.1169	0	1.921112274	0	1.775865317	2.22271126	0	2.248073891	6.611018186	5.744483131	3.605465109	0	0	0.610256454	4.068513151	13.2516462	0	0	0	0	2.597593116	0	0.150185819	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9098
H3957_032_0	2012	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	240.3069904	0	691.7158817	0	208.8999695	9.395364528	0	435.4482655	393.6289245	3491.21283	763.8986516	0	0	237.6924181	3408.340666	3894.515775	0	0	0	0	25.35730437	0	29.29039213	0	295.7806026	0			0	0											3400	"(1a), (1b) $450 per admit"		(2) $75 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $200"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $20 - $150, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $40, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $40, (7g) $15-$40, (7h), (7i) $40, (14a), (14b), (14d), (14e) $0, (16b), (18a) $40, (17a), (17b) $0-$40"					(15) 0%-10%		(10b) $40		"(17a) $40, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	450	0	75	0	100	0.2	0	65	200	20	56.81847409	0	0	40	15	38.35638321	0	0	0	0	0.1	0	40		40	0		0	0	0											NO	420.7718191	0	53.59727297	0	92.04728018	0.183945627	0	63.05682838	193.1448836	19.46141292	54.51661652	0	0	37.44707713	14.86309843	37.73057821	0	0	0	0	0.075809685	0	30.2620983		40	0		0	0	0												8.4262	0	3.089507078	0	1.602389502	1.728236222	0	2.288165546	6.335617734	5.66199454	3.470430821	0	0	0.741740526	4.2215419	12.24519434	0	0	0	0	1.922329268	0	0.073865727	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7931		NO	3.804943668	8.4262	0	3.089507078	0	1.602389502	1.728236222	0	2.288165546	6.335617734	5.66199454	3.470430821	0	0	0.741740526	4.2215419	12.24519434	0	0	0	0	1.922329268	0	0.073865727	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7931	NO																																																																																		0		NO		8.4262	0	3.089507078	0	1.602389502	1.728236222	0	2.288165546	6.335617734	5.66199454	3.470430821	0	0	0.741740526	4.2215419	12.24519434	0	0	0	0	1.922329268	0	0.073865727	0	0.985935342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7931
H3957_036_0	2012	11																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													3.711396793	0	0.29539579	1.295043221	0	3.161598975	0	0	7.327502629	4.952256177	12.69943142	0	0	2.356490115	0	5.001513516	0	0	0	22.11433883	2.795236759	0	0	0	0	0	0	0	0	0											65.7102	YES	208.8325324	0	42.05119833	0	225.9353665	0	0	415.9769023	28.78561291	4.109216247	19.573542	0	0	10.53924246	3165.748148	4338.824014	0	0	0	74.78920435	36.17906211	0	53.16466813	10.3311	296.4411426	0			0	0											3000	"(1a), (1b) 10%"		(2) 10%	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 10%"	(8a) 0% - 10%	"(8b) X-Ray and Diag. X-Ray 10%, Therapeutic Services 0%"			"(3) $0, (5) 10%, (9c) 10%, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c) 10%, (7d) $25, (7e), (7f) 10%, (7g) $10-$25, (7h) $25, (7i) 10%, (14a), (14b), (14d), (14e) $0, (16b) 10%, (18a) $0, (17a), (17b) $0-$25"				"(7g) 10%, (14b), (14e) $0, (18a) $25"	(15) 0%-10%		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	0.1	0	0.1	0	75	0	0	65	0.1	0.1	0.1	0	0	0.1	10	24.13740143	0	0	0	0.1	0.1	0	40	0.4	25	0		0	0	0											NO	0.050802301	0	0.030196692	0	48.29602405	0	0	56.55625955	0.084395577	0.07278859	0.075773226	0	0	0.047191494	9.430556204	21.5982182	0	0	0	0.066762969	0.038743459	0	17.43799622	0.4	25	0		0	0	0												10.6092	0	1.269807074	0	0.909314991	0	0	1.960508138	2.429378414	0.299104056	1.483150425	0	0	0.497362597	2.487897153	7.809238983	0	0	0	4.993149335	1.401702018	0	0.077257107	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9771	1250	NO	21.4668889	14.3206	0	1.565202865	1.295043221	0.909314991	3.161598975	0	1.960508138	9.756881043	5.251360233	14.18258184	0	0	2.853852712	2.487897153	12.8107525	0	0	0	27.10748817	4.196938777	0	0.077257107	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6873	NO																																																																																		0		NO		14.3206	0	1.565202865	1.295043221	0.909314991	3.161598975	0	1.960508138	9.756881043	5.251360233	14.18258184	0	0	2.853852712	2.487897153	12.8107525	0	0	0	27.10748817	4.196938777	0	0.077257107	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6873
H3957_037_0	2012	11																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													2.33529307	0	0.188547378	0.940451965	0	2.58036484	0	0	5.22010346	4.286631375	10.30664128	0	0	1.905237318	0	4.24965247	0	0	0	17.55883247	1.997284169	0	0	0	0	0	0	0	0	0											51.569	YES	194.743043	0	39.08238388	0	209.4443323	0	0	385.6147264	28.42536735	4.1380607	19.7239288	0	0	10.07183623	2934.680024	4040.802467	0	0	0	72.48535047	34.16908304	0	49.28417622	10.3311	296.4411426	0			0	0											2750	"(1a), (1b) 10%"		(2) 10%	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 10%"	(8a) 0% - 10%	"(8b) X-Ray and Diag. X-Ray 10%, Therapeutic Services 0%"			"(3) $0, (5) 10%, (9c) 10%, (9d) $0"	"(7a) $10, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $10, (7c) 10%, (7d) $25, (7e), (7f) 10%, (7g) $10-$25, (7h) $25, (7i) 10%, (14a), (14b), (14d), (14e) $0, (16b) 10%, (18a) $0, (17a), (17b) $0-$25"				"(7g) 10%, (14b), (14e) $0, (18a) $25"	(15) 0%-10%		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	0.1	0	0.1	0	75	0	0	65	0.1	0.1	0.1	0	0	0.1	10	24.14138683	0	0	0	0.1	0.1	0	40	0.4	25	0		0	0	0											NO	0.053888771	0	0.034544472	0	48.05729774	0	0	56.47307443	0.086168069	0.074723863	0.077519346	0	0	0.048396056	9.420952195	21.56754869	0	0	0	0.067882467	0.040511245	0	17.34784849	0.4	25	0		0	0	0												10.4945	0	1.350080318	0	0.838777386	0	0	1.814737429	2.449359003	0.309211881	1.528986061	0	0	0.487437155	2.303956685	7.262516997	0	0	0	4.92048438	1.384232078	0	0.071247868	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9655	1000	NO	19.20525033	12.8298	0	1.538627695	0.940451965	0.838777386	2.58036484	0	1.814737429	7.669462463	4.595843256	11.83562734	0	0	2.392674473	2.303956685	11.51216947	0	0	0	22.47931685	3.381516247	0	0.071247868	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5346	NO																																																																																		0		NO		12.8298	0	1.538627695	0.940451965	0.838777386	2.58036484	0	1.814737429	7.669462463	4.595843256	11.83562734	0	0	2.392674473	2.303956685	11.51216947	0	0	0	22.47931685	3.381516247	0	0.071247868	4.13244	0.617585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5346
H3957_805_0	2012	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	276.0474553	0	56.32163618	34.23726864	10.96101209	24.81017811	0	19.50844385	49.09416771	15.99694423	26.04095437	0	0	14.74962229	29.28712116	37.54222024	0	0	0	185.0793177	66.42300421	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.085743808		0.181806749		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.073062751		0.154918489		0.190871581	0.190871581		0.190871581	0.190871581	0.190871581	0.190871581			0.190871581	0.190871581	0.190871581				0.190871581	0.190871581																					20.1688	0	8.725262783	0	2.092145708	4.735557924	0	3.723607521	9.370681413	3.053362037	4.970478133	0	0	2.815283728	5.590079121	7.165742934	0	0	0	35.326382	12.67826383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4156		NO	20.8998088	20.1688	0	8.725262783	0	2.092145708	4.735557924	0	3.723607521	9.370681413	3.053362037	4.970478133	0	0	2.815283728	5.590079121	7.165742934	0	0	0	35.326382	12.67826383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4156	NO																																																																																		0		NO		20.1688	0	8.725262783	0	2.092145708	4.735557924	0	3.723607521	9.370681413	3.053362037	4.970478133	0	0	2.815283728	5.590079121	7.165742934	0	0	0	35.326382	12.67826383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4156
H3957_806_0	2012	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	314.7246209	0	90.48632415	43.43346969	14.71490054	31.52960665	0	22.77301126	51.48066203	16.17618988	28.54589141	0	0	22.88586158	29.21742332	38.47756562	0	0	0	196.7761068	68.47381809	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.086903348		0.179494593		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.074050801		0.152948289		0.190871581	0.190871581		0.190871581	0.190871581	0.190871581	0.190871581			0.190871581	0.190871581	0.190871581				0.190871581	0.190871581																					23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.087574938	5.448599426	0	0	4.368260585	5.576775784	7.344273786	0	0	0	37.55896663	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992		NO	23.70868746	23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.087574938	5.448599426	0	0	4.368260585	5.576775784	7.344273786	0	0	0	37.55896663	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992	NO																																																																																		0		NO		23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.087574938	5.448599426	0	0	4.368260585	5.576775784	7.344273786	0	0	0	37.55896663	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992
H3957_808_0	2012	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	314.7246209	0	90.48632415	43.43346969	14.71490054	31.52960665	0	22.77301126	51.48066203	16.5338634	28.85221342	0	0	22.22186604	29.43021128	38.60784121	0	0	0	196.4330433	68.47381809	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.086903348		0.179494593		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.074050801		0.152948289		0.190871581	0.190871581		0.190871581	0.190871581	0.190871581	0.190871581			0.190871581	0.190871581	0.190871581				0.190871581	0.190871581																					23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.155844649	5.507067594	0	0	4.241522706	5.617390959	7.369139694	0	0	0	37.49348555	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992		NO	23.70868746	23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.155844649	5.507067594	0	0	4.241522706	5.617390959	7.369139694	0	0	0	37.49348555	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992	NO																																																																																		0		NO		23.3056	0	13.83972845	0	2.808656332	6.018105872	0	4.346720665	9.826195358	3.155844649	5.507067594	0	0	4.241522706	5.617390959	7.369139694	0	0	0	37.49348555	13.06970592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5992
H3959_001_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	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	1505.130985	40.96274614	2303.310369	0	443.3968579	14.01601592	11.69687711	417.3861974	423.9873455	0	46.56150803	31.58632053	0	0	3278.98682	162.6504624	165.7699971	909.0429954	14.73661876	0	39.71191533	0	0	478.2794332	0	0	0	0	0	0											4325	1a $200 days 1-1	1b $200 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $100	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $150, 9b $150"	8a $0	"8b $60 (Therapeutic),8b $90 (MRI/CT/PETS),8b 15% (CT Drugs)"	9a $150	12a $0	"3 $0, 9a $0, 9d $0,"	"7a $10, 14a $0,  17a $35"	"7b $20 , 7d  $35 , 7f $35, 8a $0,14a $0, 17a $35,  17b $0,18a $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $20 (x-ray), 15 15% (chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c  20% ,15 20%"			16A $0 ; 16b 50%  with $25 deductible	17a $0 17b $0	"17b $0, $150 Allowance"	18a $0	"18b $0 --$1,000 Allowance"	14c $0													NO	27.90084622	50.63291139	36.08658314	0	100	0.198990835	0.2	62.85628545	150	0	0.180363183	150	0	0	9.430667935	0.08480202	35	35	0.177834684	0	0.190821527	0	0	15	0	0	0	0	0	0											NO	23.8581767	45.79745304	32.64030353	0	90.44996976	0.17998715	0.18089994	56.85664602	135.6749546	0	0.166435415	135.6749546	0	0	8.530036295	0.076703401	31.65748942	31.65748942	0.161895407	0	0.172598014	0	0	13.56749546	0	0	0	0	0	0												2.9925	0.156332454	6.265062465	0	3.342102699	2.522702756	2.115964362	1.977598273	4.793705322	0	7.749483933	0.357122717	0	0	2.330823049	12.47584369	0.437321827	2.39816825	2.385790885	0	6.854197702	0	0	0.540754503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6954	0	NO	6.307113639	2.9925	0.156332454	6.265062465	0	3.342102699	2.522702756	2.115964362	1.977598273	4.793705322	0	7.749483933	0.357122717	0	0	2.330823049	12.47584369	0.437321827	2.39816825	2.385790885	0	6.854197702	0	0	0.540754503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6954	NO																																										0	0	0	0	0	0	0	0	0	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	2.9925	0.156332454	6.265062465	0	3.342102699	2.522702756	2.115964362	1.977598273	4.793705322	0	7.749483933	0.357122717	0	0	2.330823049	12.47584369	0.437321827	2.39816825	2.385790885	0	6.854197702	0	0	0.540754503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6954
H3959_002_0	2012	12																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	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	1418.28313	26.93550841	2177.455313	0	402.4647515	14.93175073	9.424400189	412.2256735	431.7203545	0	35.28736045	46.10414558	0	0	3384.6146	148.3962018	169.0414597	724.6632805	16.82875966	12.34461066	38.25305983	0	0	474.2264255	0	0	0	0	0	0											4300	1a $200 days 1-1	1b $200 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $100	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $150, 9b $150"	"8a $0, 14a $0"	"8b $60 (Therapeutic),8b $90 (MRI/CT/PETS),8b 15% (CT Drugs)"	9a $150	12a 0%	"3 $0, 9a $0 , 9d $0"	"7a $10, 14a $0, 17a $35"	"7b $20 , 7d $35 , 7f$35, 8a $0,14a $0, 17a $35, 17b $0, 18a $35,"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $20 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"			16A $0 ; 16b 50%  with $25 deductible	"17a $0, 17b $0"	"17b $0, $150 Allowance"	18a $0	"18b $0 --$1,000 Allowance"	14c $0													NO	27.01719337	50.63291139	36.08658314	0	100	0.19904486	0.2	62.87503599	150	0	0.217487626	150	0	0	9.708327642	0.087473786	35	35	0.147506527	8.13E-05	0.189757194	0	0	15	0	0	0	0	0	0											NO	23.33304668	46.2262841	32.94593573	0	91.2969111	0.181721809	0.182593822	57.40296571	136.9453666	0	0.200917072	136.9453666	0	0	8.863403256	0.079860864	31.95391888	31.95391888	0.134828165	7.42E-05	0.173242457	0	0	13.69453666	0	0	0	0	0	0												2.7577	0.103760705	5.978191898	0	3.061982387	2.713424758	1.720837252	1.971914683	4.926841853	0	7.089833135	0.52614576	0	0	2.499933672	11.85104896	0.450128091	1.92965264	2.26899078	0.000916064	6.627054057	0	0	0.541192598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0196	0	NO	5.514007093	2.7577	0.103760705	5.978191898	0	3.061982387	2.713424758	1.720837252	1.971914683	4.926841853	0	7.089833135	0.52614576	0	0	2.499933672	11.85104896	0.450128091	1.92965264	2.26899078	0.000916064	6.627054057	0	0	0.541192598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0196	NO																																										0	0	0	0	0	0	0	0	0	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	2.7577	0.103760705	5.978191898	0	3.061982387	2.713424758	1.720837252	1.971914683	4.926841853	0	7.089833135	0.52614576	0	0	2.499933672	11.85104896	0.450128091	1.92965264	2.26899078	0.000916064	6.627054057	0	0	0.541192598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0196
H3959_010_0	2012	12																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	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	1097.581727	31.54331309	1340.22552	0	299.0360799	9.465595616	11.01054976	354.4585456	363.4526811	11.64447611	38.12075292	20.2349187	0	0	2761.344586	123.2940504	165.6805823	589.5616602	10.5532878	18.98195671	22.11581808	0	0	0	0	0	5.487060243	0	0	0											5900	1a $185 days 1-5	1b $185 days 1-5	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $200	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $175, 9b $175"	"8a $0, 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $175	12a 0%	"3 $0, 9a $0 , 9d $0"	"7a $10, 14a $0, 17a $35"	"7b $20 , 7d  $35 $10, 7f $35, 8a $0,14a $0, 17a $0, 17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $35"	"11c 20% , 15 20%"				17a $0		18a $25		14c $0													NO	129.4740417	153.7662338	36.54317219	0	200	0.198510708	0.2	58.04347826	175	0.195702028	0.20228074	175	0	0	9.249390456	0.081901378	35	35	0.215640732	2.11E-05	0.195061415	0	0	0	0	0	25	0	0	0											NO	120.4903746	143.9201472	34.20320959	0	187.1934347	0.185799507	0.187193435	54.32679028	163.7942554	0.183170674	0.191094637	163.7942554	0	0	8.657125841	0.076657002	32.75885107	32.75885107	0.201845356	1.98E-05	0.182571081	0	0	0	0	0	23.39917934	0	0	0												11.0207	0.378309855	3.820001196	0	4.664799241	1.758702995	2.061102627	1.604716256	4.960955104	2.132926534	7.284671425	0.276196953	0	0	1.992108964	9.451352216	0.452292127	1.609446885	2.130132131	0.000375091	4.037708813	0	0	0	0	0	0.010699392	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6472	0	NO	4.076312429	11.0207	0.378309855	3.820001196	0	4.664799241	1.758702995	2.061102627	1.604716256	4.960955104	2.132926534	7.284671425	0.276196953	0	0	1.992108964	9.451352216	0.452292127	1.609446885	2.130132131	0.000375091	4.037708813	0	0	0	0	0	0.010699392	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6472	NO																																										0	0	0	0	0	0	0	0	0	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	11.0207	0.378309855	3.820001196	0	4.664799241	1.758702995	2.061102627	1.604716256	4.960955104	2.132926534	7.284671425	0.276196953	0	0	1.992108964	9.451352216	0.452292127	1.609446885	2.130132131	0.000375091	4.037708813	0	0	0	0	0	0.010699392	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6472
H3959_011_0	2012	12																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	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	1177.950688	54.27653841	1756.645763	0	308.060414	11.4891993	8.140441002	412.3849502	413.4233095	13.28611123	34.8091023	47.63061176	0	12.62948579	3162.806257	131.9543909	184.4804789	652.2582343	17.84143342	15.52478666	23.35789255	0	0	0	0	0	0	0	0	0											6700	1a $185 days 1-5	1b $185 days 1-5	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $200	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $175, 9b $175"	"8a Lab $10, 8a $0 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $175	12a 0%	"3 $15, 9a $0 , 9d $0"	"7a $10, 14a $0,  17a $35"	"7b $20 , 7d $35 , 7f $35, 8a $0,,14a $0, 16b $0, 17a $35, 17b $0, 18a $35,8a $10,"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $40 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"				17a $0		18a $0		14c $0													NO	130.2125252	153.7662338	36.54317219	0	200	0.198790438	0.2	63.5683577	175	0.245032871	0.236343011	175	0	0.013288924	9.6263682	0.088463142	35	35	0.220737048	1.75E-05	0.19146321	0	0	0	0	0	0	0	0	0											NO	120.5147216	143.1374545	34.01719949	0	186.1754054	0.185049451	0.186175405	59.17432382	162.9034797	0.228095471	0.22115372	162.9034797	0	0.012370354	8.960965011	0.082348306	32.58069594	32.58069594	0.205484585	1.63E-05	0.178228704	0	0	0	0	0	0	0	0	0												11.83	0.647417129	4.979680778	0	4.779439372	2.126070029	1.515549904	2.033550048	5.612341309	3.030501795	7.698162462	0.646599366	0	0.156231208	2.36181635	10.86622063	0.500875199	1.770918934	3.666139542	0.000252898	4.163046908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3848	0	NO	5.108468022	11.83	0.647417129	4.979680778	0	4.779439372	2.126070029	1.515549904	2.033550048	5.612341309	3.030501795	7.698162462	0.646599366	0	0.156231208	2.36181635	10.86622063	0.500875199	1.770918934	3.666139542	0.000252898	4.163046908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3848	NO																																										0	0	0	0	0	0	0	0	0	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	11.83	0.647417129	4.979680778	0	4.779439372	2.126070029	1.515549904	2.033550048	5.612341309	3.030501795	7.698162462	0.646599366	0	0.156231208	2.36181635	10.86622063	0.500875199	1.770918934	3.666139542	0.000252898	4.163046908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3848
H3959_031_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	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	1185.631269	46.58639531	1649.588509	0	315.5513105	12.48790746	10.8563941	403.1346718	407.5222036	14.00413457	42.2147473	37.97921745	0	0	3161.742331	151.3396096	185.6233077	659.9769102	17.62555911	20.04731667	26.71884813	0	0	0	0	0	0	0	0	0											6700	1a $195 days 1-6	1b $195 days 1-6	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $200	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $175, 9b $175"	"8a Lab $15, 8a $0 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $195(MRI/CT/PETS),8b 20% (CT Drugs)"	9a $175	12a $0	"3 $0, 9a $0, 9d $0"	"7a $10, 14a $0,  17a $40"	"7b $20 , 7d  $40 , 7f $40, 8a $0,,14a $0, 16b $40, 17a $40, 17b $0, 18a $40, 8a $15"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $20 (x-ray), 15 20%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$40"	"11c 20% , 15 20%"				17a $0		18a $0		14c $0													NO	147.9498624	172.2077922	36.54317219	0	200	0.198695843	0.2	63.13934426	175	0.317415907	0.231322107	175	0	0	9.479257266	0.094936596	40	40	0.121379939	1.70E-05	0.192873881	0	0	0	0	0	0	0	0	0											NO	134.8330754	157.9544394	33.51855455	0	183.4463323	0.182250118	0.183446332	57.91340564	160.5155408	0.29114392	0.213932954	160.5155408	0	0	8.694674892	0.087078852	36.68926646	36.68926646	0.111342966	1.56E-05	0.17691003	0	0	0	0	0	0	0	0	0												13.3219	0.613210663	4.607651867	0	4.823894213	2.275922606	1.991565679	1.945575148	5.45113724	4.077218632	9.031125611	0.508021219	0	0	2.290860139	13.17847941	0.567531916	2.01783906	1.962482034	0.000312745	4.726832236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3915	0	NO	6.635440048	13.3219	0.613210663	4.607651867	0	4.823894213	2.275922606	1.991565679	1.945575148	5.45113724	4.077218632	9.031125611	0.508021219	0	0	2.290860139	13.17847941	0.567531916	2.01783906	1.962482034	0.000312745	4.726832236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3915	NO																																										0	0	0	0	0	0	0	0	0	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	13.3219	0.613210663	4.607651867	0	4.823894213	2.275922606	1.991565679	1.945575148	5.45113724	4.077218632	9.031125611	0.508021219	0	0	2.290860139	13.17847941	0.567531916	2.01783906	1.962482034	0.000312745	4.726832236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3915
H3959_032_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	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	1456.79266	27.56149026	2234.20357	0	412.4785323	14.53744189	9.172018147	422.2105195	442.1773967	0	33.39221746	47.22087077	0	13.08450227	3538.469126	142.3976347	176.1339357	757.453108	16.26947008	11.92316999	36.25486208	0	0	0	0	0	0	0	0	0											4275	1a $225 days 1-1	1b $225 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $100	11a 15%	11b 15%	"4a $65, 4b $50"	"9a $150, 9b $150"	8a $0 14a $0	"8b $60 (Therapeutic),8b $95(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $150	12a $0	"3 $a0, 9a $0 , 9d $0"	"7a $10, 14a $0, 17a $30"	"7b $20 , 7d $30 , 7f $30, 8a $0,14a $0, 17a $30, 17b $0, 18a $30"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b $20 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$30"	"11c 20% , 15 20%"						18a $0		14c $0													NO	41.03310042	56.96202532	36.08658314	0	100	0.149286036	0.15	62.87503599	150	0	0.237205642	150	0	0.006676662	9.699671893	0.071267239	30	30	0.161123583	8.80E-05	0.189787646	0	0	0	0	0	0	0	0	0											NO	37.26306878	52.45267057	33.22981665	0	92.08357723	0.137467922	0.138125366	57.89758233	138.1253658	0	0.220574682	138.1253658	0	0.006148109	8.931804859	0.065625423	27.62507317	27.62507317	0.148513284	8.10E-05	0.174763254	0	0	0	0	0	0	0	0	0												4.5237	0.120472814	6.186847915	0	3.165208232	1.998431931	1.266888362	2.037080692	5.089659557	0	7.365477756	0.543533338	0	0.080444953	2.633742978	9.344905066	0.405476072	1.743724794	2.416232434	0.000965963	6.336017663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2588	0	NO	4.738949818	4.5237	0.120472814	6.186847915	0	3.165208232	1.998431931	1.266888362	2.037080692	5.089659557	0	7.365477756	0.543533338	0	0.080444953	2.633742978	9.344905066	0.405476072	1.743724794	2.416232434	0.000965963	6.336017663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2588	NO																																										0	0	0	0	0	0	0	0	0	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	4.5237	0.120472814	6.186847915	0	3.165208232	1.998431931	1.266888362	2.037080692	5.089659557	0	7.365477756	0.543533338	0	0.080444953	2.633742978	9.344905066	0.405476072	1.743724794	2.416232434	0.000965963	6.336017663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2588
H3959_803_0	2012	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	262.0529729	3.642105825	49.51767027	0	14.21409166	13.88342599	14.0092786	21.08409991	54.40821675	14.41717334	54.03591477	2.829143058	0.046142796	18.69443545	29.68566906	175.5043776	3.13147558	10.86732415	27.47347408	14.24178039	48.74780217	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.1%	Medicare FFS 8.1%	Medicare FFS 19.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.080852741	0.080852741	0.19657803	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.067523601	0.067523601	0.164170766	0	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0.187072033	0	0	0	0	0	0	0	0	0												17.6948	0.245928099	8.129353856	0	2.659059019	2.59720072	2.620744225	3.944245427	10.1782557	2.697049923	10.10860841	0.529253543	0.008632027	3.49720604	5.553358453	32.83196066	0.585811502	2.032972419	5.13951864	2.664238807	9.119350442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8375	0	NO	24.24809002	17.6948	0.245928099	8.129353856	0	2.659059019	2.59720072	2.620744225	3.944245427	10.1782557	2.697049923	10.10860841	0.529253543	0.008632027	3.49720604	5.553358453	32.83196066	0.585811502	2.032972419	5.13951864	2.664238807	9.119350442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8375	YES	Medicare FFS 8.1%	Medicare FFS 8.1%	Medicare FFS 19.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.0187	0	0.0233	0	0.0216	0.0046	0.0134	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1424	0	0.0133	0.0021	0.0082	0.0225	0	0	0	0	0	0	0	0	0											0.3026	0	NO	0	17.7134	0.245928099	8.152677099	0	2.68067075	2.601762109	2.634187536	3.944245427	10.18035726	2.706877845	10.10965099	0.529253543	0.008632027	3.499478005	5.570678517	32.97436471	0.585811502	2.046264853	5.141600983	2.672426328	9.141843091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1401
H3959_804_0	2012	8																															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	264.0204675	3.842944731	49.26224453	0	14.11710712	13.56495159	12.9249678	21.6390295	55.44135581	14.1440715	40.86777967	2.256419282	0.039091836	19.43650128	30.02917226	176.8586306	3.300036071	10.92811131	15.23174547	13.53494138	46.34561548	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.2%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.085324956	0.085324956	0.181584823	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072022119	0.072022119	0.153274308	0	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0.189076623	0	0	0	0	0	0	0	0	0												19.0153	0.276777021	7.550636454	0	2.669214937	2.564815234	2.443809261	4.091434617	10.48266432	2.674313272	7.727141759	0.426636137	0.007391352	3.674988021	5.677814475	33.43983257	0.623959675	2.066250379	2.879966992	2.559141004	8.762872452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.615	0	NO	22.09347079	19.0153	0.276777021	7.550636454	0	2.669214937	2.564815234	2.443809261	4.091434617	10.48266432	2.674313272	7.727141759	0.426636137	0.007391352	3.674988021	5.677814475	33.43983257	0.623959675	2.066250379	2.879966992	2.559141004	8.762872452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.615	YES	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 18.2%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				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	NO	0	19.0153	0.276777021	7.550636454	0	2.669214937	2.564815234	2.443809261	4.091434617	10.48266432	2.674313272	7.727141759	0.426636137	0.007391352	3.674988021	5.677814475	33.43983257	0.623959675	2.066250379	2.879966992	2.559141004	8.762872452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.615
H3959_806_0	2012	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	262.0410674	3.64208295	49.5154206	0	14.52980979	14.20743897	14.31352909	21.08350453	54.40668038	14.41792826	54.03525836	2.829063069	0.046141543	18.69392183	29.68486373	175.5345233	3.131475537	10.86702339	27.47308174	14.24152549	49.66234161	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.8%	Medicare FFS 8.8%	Medicare FFS 17.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.087987324	0.087987324	0.177140801	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.073304046	0.073304046	0.14757964	0	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0	0	0	0	0	0	0	0	0												19.2087	0.266979417	7.307467924	0	2.71153858	2.651378061	2.671176493	3.934582542	10.15332031	2.690659361	10.08400591	0.527956922	0.008610889	3.488641008	5.539759599	32.7580773	0.584392835	2.027993044	5.126999056	2.657739253	9.267936553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6679	0	NO	24.77148178	19.2087	0.266979417	7.307467924	0	2.71153858	2.651378061	2.671176493	3.934582542	10.15332031	2.690659361	10.08400591	0.527956922	0.008610889	3.488641008	5.539759599	32.7580773	0.584392835	2.027993044	5.126999056	2.657739253	9.267936553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6679	YES	Medicare FFS 8.8%	Medicare FFS 8.8%	Medicare FFS 17.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.0203	0	0.021	0	0.0221	0.0047	0.0138	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1428	0	0.0133	0.0021	0.0082	0.023	0	0	0	0	0	0	0	0	0											0.3038	0	NO	0	19.229	0.266979417	7.328484059	0	2.733657109	2.656046416	2.684935052	3.934582542	10.15542181	2.700487005	10.08504845	0.527956922	0.008610889	3.490912908	5.557079193	32.90083069	0.584392835	2.041285108	5.129081342	2.665926552	9.290956658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9717
H3962_001_0	2012	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	375.4800166	51.49142411	1080.54307	174.6077166	464.3877251	18.39705892	0	377.3037583	483.3911397	2255.936538	1057.547117	0	0.421393647	2476.037734	4415.358325	3965.736032	232.6269466	998.3364628	3877.111257	21804.98156	5.026386023	514.1799405	0	127.523927	691.2021992	20.62965713	1.317330596	17.43843352	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), $60 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	3 - $20 C&P Rehab Svcs copay; 9c - $20 SA Ind/Grp Session copay	7a - $10 OV copay	7d - $20 Specialist OV copay (excluding MH and Radiology); 18a - $20 MC Cov 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)	"7b - $20 Chiro OV copay, 7f,7g - $20 Pod/Other OV copay; 14a - $0 MC Cov Prev Svcs copay; 14b - $0 Supplemental Prev Health Benefits; 14d - $0 Kidney Disease Ed Svcs copay; 14e - $0 Diabetes Self-Mang Training copay;  18a - $20 MC Cov Dental Exam copay"	15 - 10% coinsurance	9d - $0 OP Blood Svcs copay; 17a - $20 MC Cov Eye Exam copay/$0 for Glaucoma Screening	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	14c - $0 Supplemental Education/Wellness Programs copay	0											0	NO	0	0	50	0	75	0.059893422	0	49.4	35	0	14.90228013	0	0.1	8.576063878	10	14.7206747	20	20	0	0.50071169	0.1	18.66036798	0	10	20	0	20	0	0	0											NO	0	0	47.95905033	0	71.93857549	0.057	0	47.38354173	33.57133523	0	14.29398406	0	0.096	8.225997583	9.591810066	14.11979158	19.18362013	19.18362013	0	0.480273143	0.096	17.89867055	0	9.591810066	19.18362013	0	19.18362013	0	0	0												0	0	4.318484957	0	2.783949285	1.048632358	0	1.489832365	1.3523405	0	1.259713469	0	0.04045379	1.697323368	3.529273202	4.666280518	0.371885581	1.595975622	0	0.872695585	0.482533058	0.766928113	0	0.101932107	1.104980035	0	0.002105931	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4853	0	NO	1.17	0	0	4.318484957	0	2.783949285	1.048632358	0	1.489832365	1.3523405	0	1.259713469	0	0.04045379	1.697323368	3.529273202	4.666280518	0.371885581	1.595975622	0	0.872695585	0.482533058	0.766928113	0	0.101932107	1.104980035	0	0.002105931	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4853	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	NO	0	0	0	4.318484957	0	2.783949285	1.048632358	0	1.489832365	1.3523405	0	1.259713469	0	0.04045379	1.697323368	3.529273202	4.666280518	0.371885581	1.595975622	0	0.872695585	0.482533058	0.766928113	0	0.101932107	1.104980035	0	0.002105931	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4853
H3962_004_0	2012	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	252.2215436	49.92984332	582.8477269	58.34019573	207.5305926	18.24991633	0	253.8923002	419.6362973	1933.639634	1035.035446	0	0.280736343	1385.406802	4415.358325	2960.705503	232.790468	637.6661555	2980.910286	17124.81272	3.763181698	451.4699858	0	209.2233283	659.7792593	13.73787968	5.201879315	14.73536758	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 - $8 copay	10a - $75 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $65 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), $60 therapeutic radiology copay"	5 - $0 copay	12 - 15% coinsurance	3 - $25 C&P Rehab Svcs copay; 9c - $25 SA Ind/Grp Session copay	7a - $15 OV copay	7d - $25 Specialist OV copay (excluding MH and Radiology); 18a - $25 MC Cov 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)	"7b - $20 Chiro OV copay, 7f,7g - $25 Pod/Other OV copay; 14a - $0 MC Cov Prev Svcs copay; 14b - $0 Supplemental Prev Health Benefits; 14d - $0 Kidney Disease Ed Svcs copay; 14e - $0 Diabetes Self-Mang Training copay;  18a - $25 MC Cov Dental Exam copay"	15 - 15% coinsurance	9d - $0 OP Blood Svcs copay; 17a - $25 MC Cov Eye Exam copay/$0 for Glaucoma Screening	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	14c - $0 Supplemental Education/Wellness Programs copay	0											0	NO	250	250	50	8	75	0.063338558	0	64.2	100	0	19.86970684	0	0.15	7.984601459	15	19.75674849	25	25	0	0.603221555	0.15	23.64841763	0	10	20	0	20	0	0	0											NO	234.6666007	234.6666007	46.93332014	7.509331222	70.3999802	0.059	0	60.26238306	93.86664027	0	18.65102624	0	0.141	7.494877129	14.07999604	18.54499603	23.46666007	23.46666007	0	0.566223807	0.141	22.19797511	0	9.386664027	18.77332805	0	18.77332805	0	0	0												4.9323	0.97640555	2.27958158	0.036507988	1.217512467	1.076745063	0	1.275012921	3.282487447	0	1.608706105	0	0.039583824	0.865287813	5.180685645	4.575522651	0.455234565	1.246991242	0	0.808039721	0.530608619	0.835143292	0	0.163659091	1.032187707	0	0.008138049	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4264	0	NO	2.13	4.9323	0.97640555	2.27958158	0.036507988	1.217512467	1.076745063	0	1.275012921	3.282487447	0	1.608706105	0	0.039583824	0.865287813	5.180685645	4.575522651	0.455234565	1.246991242	0	0.808039721	0.530608619	0.835143292	0	0.163659091	1.032187707	0	0.008138049	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4264	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	NO	0	4.9323	0.97640555	2.27958158	0.036507988	1.217512467	1.076745063	0	1.275012921	3.282487447	0	1.608706105	0	0.039583824	0.865287813	5.180685645	4.575522651	0.455234565	1.246991242	0	0.808039721	0.530608619	0.835143292	0	0.163659091	1.032187707	0	0.008138049	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4264
H3962_007_0	2012	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	32.77916539	39.29327977	425.5240459	26.20967604	166.0049646	10.09259089	0	223.5888093	279.6470081	1323.335428	694.5259204	0	0.14058357	889.5286163	3474.753743	1987.308922	182.8689984	495.0487512	2172.734017	12660.68916	2.066675142	427.0954158	0	0	0	0	3.086015707	6.573379292	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 - $8 copay	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 - $125 copay"	8a - $0 copay	"8b - $125 copay (High Tech Imaging Only), $60 therapeutic radiology copay"	5 - $0 copay	12 - 20% coinsurance	3 - $30 C&P Rehab Svcs copay; 9c - $30 SA Ind/Grp Session copay	7a - $15 OV copay	7d - $30 Specialist OV copay (excluding MH and Radiology); 18a - $30 MC Cov 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)	"7b - $20 Chiro OV copay, 7f,7g - $30 Pod/Other OV copay; 14a - $0 MC Cov Prev Svcs copay; 14b - $0 Supplemental Prev Health Benefits; 14d - $0 Kidney Disease Ed Svcs copay; 14e - $0 Diabetes Self-Mang Training copay"	15 - 20% coinsurance	9d - $0 OP Blood Svcs copay; 17a - $30 MC Cov Eye Exam copay/$0 for Glaucoma Screening	0	0	0	0	0	0	14c - $0 Supplemental Education/Wellness Programs copay	0											0	NO	500	500	60	8	100	0.048727578	0	49.6	125	0	24.83713355	0	0.2	10.82005872	15	22.20956757	30	30	0	0.58556964	0.2	28.82438811	0	0	0	0	0	0	0	0											NO	484.7398734	484.7398734	58.1687848	7.755837974	96.94797467	0.047	0	48.08619544	121.1849683	0	24.07909794	0	0.194	10.48982779	14.5421962	21.53172594	29.0843924	29.0843924	0	0.567697907	0.194	27.94466048	0	0	0	0	0	0	0	0												1.3241	1.587251622	2.062684721	0.016939833	1.341153759	0.474351772	0	0.895961265	2.824084485	0	1.393629805	0	0.027273213	0.7775835	4.210879223	3.565849257	0.443219476	1.199849345	0	0.598953894	0.400934977	0.994586366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1393	0	NO	0.76	1.3241	1.587251622	2.062684721	0.016939833	1.341153759	0.474351772	0	0.895961265	2.824084485	0	1.393629805	0	0.027273213	0.7775835	4.210879223	3.565849257	0.443219476	1.199849345	0	0.598953894	0.400934977	0.994586366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1393	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	NO	0	1.3241	1.587251622	2.062684721	0.016939833	1.341153759	0.474351772	0	0.895961265	2.824084485	0	1.393629805	0	0.027273213	0.7775835	4.210879223	3.565849257	0.443219476	1.199849345	0	0.598953894	0.400934977	0.994586366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1393
H3962_801_0	2012	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	259.5700677	4.15203507	30.63441366	0.412565888	10.76656643	17.6686014	0	19.46167016	55.96731426	9.300372086	26.27488844	0	0.377761408	46.65839971	25.25335785	38.4516797	1.687382865	8.399869847	28.83906241	177.7543112	2.981282183	8.014336034	0	0.763065878	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	NO	0.07863417	0.07863417	0.179632126	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064	0.064	0.146	0	0.182	0.182	0	0.182	0.182	0.182	0.182	0	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0	0	0	0	0	0	0	0												16.6125	0.265730244	4.472624395	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.596111129	6.998205706	0.307103681	1.528776312	5.248709359	32.35128465	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3208	0	NO	24.96	16.6125	0.265730244	4.472624395	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.596111129	6.998205706	0.307103681	1.528776312	5.248709359	32.35128465	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3208	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	NO	0	16.6125	0.265730244	4.472624395	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.596111129	6.998205706	0.307103681	1.528776312	5.248709359	32.35128465	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3208
H3962_802_0	2012	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	215.6317785	4.007587872	24.49287813	0.254646682	8.188686984	16.6895417	0	18.29206493	53.375708	6.936954065	26.18506742	0	0.233151384	45.31282959	22.81247607	34.78524918	1.589146897	6.852838553	25.02568776	152.820205	1.366505632	6.709250235	0	0.110343573	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	NO	0.078250734	0.078250734	0.177548544	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066	0.066	0.15	0	0.189	0.189	0	0.189	0.189	0.189	0.189	0	0.189	0.189	0.189	0.189	0.189	0.189	0.189	0.189	0.189	0.189	0	0	0	0	0	0	0	0												14.2317	0.2645008	3.673931719	0	1.54766184	3.154323381	0	3.457200271	10.08800881	1.311084318	4.948977742	0	0.044065612	8.564124793	4.311557977	6.574412096	0.300348764	1.295186486	4.729854987	28.88301875	0.258269564	1.268048294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9063	0	NO	18.44	14.2317	0.2645008	3.673931719	0	1.54766184	3.154323381	0	3.457200271	10.08800881	1.311084318	4.948977742	0	0.044065612	8.564124793	4.311557977	6.574412096	0.300348764	1.295186486	4.729854987	28.88301875	0.258269564	1.268048294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9063	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	NO	0	14.2317	0.2645008	3.673931719	0	1.54766184	3.154323381	0	3.457200271	10.08800881	1.311084318	4.948977742	0	0.044065612	8.564124793	4.311557977	6.574412096	0.300348764	1.295186486	4.729854987	28.88301875	0.258269564	1.268048294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9063
H3962_803_0	2012	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	259.5700677	4.15203507	30.63441366	0.412565888	10.76656643	17.6686014	0	19.46167016	55.96731426	9.300372086	26.27488844	0	0.377761408	46.65839971	25.10512011	38.4516797	1.687382865	8.399869847	28.83906241	177.6907808	2.981282183	8.014336034	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	NO	0.079162367	0.079162367	0.182390065	0	0.224	0.224	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064	0.064	0.148	0	0.182	0.182	0	0.182	0.182	0.182	0.182	0	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0.182	0	0	0	0	0	0	0	0												16.6125	0.265730244	4.533893222	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.56913186	6.998205706	0.307103681	1.528776312	5.248709359	32.3397221	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3435	0	NO	25.04	16.6125	0.265730244	4.533893222	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.56913186	6.998205706	0.307103681	1.528776312	5.248709359	32.3397221	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3435	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	NO	0	16.6125	0.265730244	4.533893222	0	1.959515091	3.215685454	0	3.54202397	10.1860512	1.69266772	4.782029697	0	0.068752576	8.491828747	4.56913186	6.998205706	0.307103681	1.528776312	5.248709359	32.3397221	0.542593357	1.458609158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3435
H3964_001_0	2012	5																															D	D	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	1297.807911	37.84320724	903.5500235	24.81617189	321.7314081	8.400254048	1.638314448	385.8222858	273.4040674	6.121879187	19.2541231	0	1.876837804	275.2800957	3525.991999	2995.143133	98.64470213	80.03560962	18.05288185	9.368607191	30.40074662	0.408364483	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													225	200	60	0	100	0.2	0.11614912	48.2530293	190.4325033	0	0.172146093	0	0.2	59.30802397	5	39.98710746	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	214.3857799	190.5651376	57.16954129	0	95.28256882	0.190565138	0.110669865	45.98953407	181.448981	0	0.16402522	0	0.190565138	56.51020876	4.764128441	38.10074319	19.05651376	38.11302753	0	38.11302753	0.190565138	0	0	0	0	0	0	0	0	0												23.186	0.600966333	4.304628365	0	2.554616253	1.600795569	0.181312039	1.47864893	4.134074119	0	3.158161775	0	0.357659854	1.29634464	1.399856564	9.509764943	0.15665201	0.254199949	0	0.029755499	5.793322465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9967			2.97	23.186	0.600966333	4.304628365	0	2.554616253	1.600795569	0.181312039	1.47864893	4.134074119	0	3.158161775	0	0.357659854	1.29634464	1.399856564	9.509764943	0.15665201	0.254199949	0	0.029755499	5.793322465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9967	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	23.186	0.600966333	4.304628365	0	2.554616253	1.600795569	0.181312039	1.47864893	4.134074119	0	3.158161775	0	0.357659854	1.29634464	1.399856564	9.509764943	0.15665201	0.254199949	0	0.029755499	5.793322465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9967
H3964_002_0	2012	7																															coin	coin	D	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											18.71452924	0.02547076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											18.74	YES	426.0010974	14.89430466	1318.452255	48.0207963	19.13989071	29.90190494	6.322946549	754.5797095	37.34290878	6.660919145	22.41419357	0	0.276894119	18.09854482	118.5088368	115.4774317	6.163367752	4.582784222	23.74709891	21.61766401	205.8040679	0.293475761	0	0	0	0	0	0	0	0											6700	1a:  Acute - 0/admit	1b:  Psych - 0/admit	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - 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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service/13d:  Home Safety Benefit - 0.0%													0	0	60	0	0.2	0.2	0.122662201	79.47383186	0.2	0	0.2	0	0.2	0.2	0	0.195122394	0.2	0.2	0.186211845	0.156695284	0.2	0.2	0	0	0	0	0	0	0	0											NO	0	0	49.78750966	0	0.165958366	0.165958366	0.101784092	65.94673619	0.165958366	0	0.165958366	0	0.165958366	0.165958366	0	0.161910968	0.165958366	0.165958366	0.154517067	0.130024466	0.165958366	0.165958366	0	0	0	0	0	0	0	0												0	0	5.47020453	0	3.176424978	4.96247127	0.643575371	4.146839087	6.197368105	0	3.71982293	0	0.045952895	3.003604917	0	18.69706272	1.022862438	0.760551379	3.669332071	2.810825221	34.15490673	0.048704758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5305	1100	NO	18.98	18.7145	0.02547076	5.47020453	0	3.176424978	4.96247127	0.643575371	4.146839087	6.197368105	0	3.71982293	0	0.045952895	3.003604917	0	18.69706272	1.022862438	0.760551379	3.669332071	2.810825221	34.15490673	0.048704758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2705	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	18.7145	0.02547076	5.47020453	0	3.176424978	4.96247127	0.643575371	4.146839087	6.197368105	0	3.71982293	0	0.045952895	3.003604917	0	18.69706272	1.022862438	0.760551379	3.669332071	2.810825221	34.15490673	0.048704758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2705
H3964_003_0	2012	7																															D	D	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	1475.870893	37.66950178	1143.490663	30.68164471	372.4822935	14.07195993	2.826483414	452.2973754	284.9525923	6.296213456	24.72025822	0	1.777016488	416.996136	3892.801784	3291.941172	134.4428997	77.7618043	20.49713185	12.78708041	36.80660196	1.728914631	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													225	200	60	0	100	0.2	0.118581966	48.25291087	202.921069	0	0.167083846	0	0.2	61.60469401	5	39.98985439	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	207.7694037	184.6839144	55.40517431	0	92.34195719	0.184683914	0.109500908	44.57843947	187.3812866	0	0.154288494	0	0.184683914	56.88698017	4.617097859	36.92741422	18.46839144	36.93678287	0	36.93678287	0.184683914	0	0	0	0	0	0	0	0	0												25.5534	0.57974592	5.279608293	0	2.866312	2.598864643	0.3095025	1.680225931	4.449565281	0	3.814051402	0	0.328186361	1.976804243	1.497787232	10.13023961	0.206912008	0.239355907	0	0.039359468	6.797587324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3475			5.667303709	25.5534	0.57974592	5.279608293	0	2.866312	2.598864643	0.3095025	1.680225931	4.449565281	0	3.814051402	0	0.328186361	1.976804243	1.497787232	10.13023961	0.206912008	0.239355907	0	0.039359468	6.797587324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3475	NO	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%			4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				7.8933	0.0269	1.3046	0.7645	0.3286	0	0	0.3318	1.0256	0.0216	0.5343	0	0.0464	0.256	0.8174	1.1715	0.0001	0.0666	0.5108	0.3961	0.9083	0.0538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4583			0	33.4467	0.606657058	6.584219506	0.764485914	3.194918815	2.598864643	0.3095025	2.012069562	5.475199803	0.021608266	4.348341457	0	0.374593206	2.23284878	2.315205335	11.30170417	0.207033392	0.305961204	0.510794902	0.435459203	7.705840604	0.053804992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8058
H4003_001_0	2012	6	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	167.2218129	0	0	0	0	10.18587302	4.101540549	405.8285143	72.16709949	0	244.1190228	0.981219335	0	74.44686348	0	4083.846319	237.4126483	156.6884688	1589.374985	8295.380995	0	0	0	3.344761599	256.6716281	0	0	0	0		100	0	0								3250	"$25 per day, Days 1-4 -(1A)"	"$25 per day, Days 1-4 -(1B)"	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $40 Copay - (8B)	$15 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $15 Copay - (7D, 8B, 14B)"	"$0 - $15 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	$0 copay - (10B)	"$5 copay Preventive; 0%-50% coins Comprehensive - (16A, 16B)"	$15 Copay - (17A)	$225 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $1000 max - (13A)"	Not covered - (13D)	Not Covered - (13B)								0	NO	80.91581342	0	0	0	0	0.04	0.056612225	49.83606667	25	0.002	15.05910113	15	0	22.83371608	0	12.83034396	10	4	13.53068592	8.661850154	0	0	0	0.31	15	0	0	0	0		15	0	0								YES	80.91581342	0	0	0	0	0.04	0.056612225	49.83606667	25	0.002	15.05910113	15	0	22.83371608	0	12.83034396	10	4	13.53068592	8.661850154	0	0	0	0.31	15	0	0	0	0		15	0	0								3250	1.1276	0	0	0	0	0.407434921	0.232197335	1.685408075	0.150348124	0	0.306351088	0.001226524	0	0.141658212	0	4.366429415	0.197843874	0.05222949	1.792111144	5.987778929	0	0	0	1.036876096	0.320839535	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	17.9313	0	NO		1.1276	0	0	0	0	0.407434921	0.232197335	1.685408075	0.150348124	0	0.306351088	0.001226524	0	0.141658212	0	4.366429415	0.197843874	0.05222949	1.792111144	5.987778929	0	0	0	1.036876096	0.320839535	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	17.9313	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"								3250																0.02																									0.02	0	NO		1.1276	0	0	0	0	0.407434921	0.232197335	1.685408075	0.150348124	0	0.306351088	0.001226524	0	0.141658212	0	4.386429415	0.197843874	0.05222949	1.792111144	5.987778929	0	0	0	1.036876096	0.320839535	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	17.9513
H4003_009_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	249.282173	0	0	0	0	16.36309662	0	559.3761156	93.41665736	0	310.853448	1.825895345	0	115.3060043	0	5537.58674	262.5541445	228.1820222	2035.29141	11029.58201	0	0	0	3.397324977	263.9184627	0	0	0	0		0	0	0								3250	$50 Copay per admit -(1A)	$50 Copay per admit -(1B)	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $40 Copay - (8B)	$10 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $10 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $12 Copay - (7D, 8B, 14B)"	"$0 - $12 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$5 copay Preventive; 0%-50% coins Comprehensive - (16A, 16B)"	$10 Copay - (17A)	$175 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	Not covered - (13D)	Not Covered - (13B)								0	NO	50	0	0	0	0	0.04	0	49.86126893	25	0.002	14.58485249	10	0	21.01342282	0	5.54573106	10	4	5.567789555	3.340955493	0	0	0	0.31	10	0	0	0	0		0	0	0								NO	50	0	0	0	0	0.04	0	49.86126893	25	0.002	14.58485249	10	0	21.01342282	0	5.54573106	10	4	5.567789555	3.340955493	0	0	0	0.31	10	0	0	0	0		0	0	0									1.0387	0	0	0	0	0.654523865	0	2.324266911	0.194618036	0	0.377812641	0.001521579	0	0.201914485	0	2.559163898	0.21879512	0.076060674	0.944339521	3.070778551	0	0	0	1.053170743	0.219932052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9356	0	NO		1.0387	0	0	0	0	0.654523865	0	2.324266911	0.194618036	0	0.377812641	0.001521579	0	0.201914485	0	2.559163898	0.21879512	0.076060674	0.944339521	3.070778551	0	0	0	1.053170743	0.219932052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9356	NO																																																																																		0	0	NO		1.0387	0	0	0	0	0.654523865	0	2.324266911	0.194618036	0	0.377812641	0.001521579	0	0.201914485	0	2.559163898	0.21879512	0.076060674	0.944339521	3.070778551	0	0	0	1.053170743	0.219932052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9356
H4003_015_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	204.0343869	0	0	0	0	14.68837436	4.979261101	435.2203515	85.11067353	0	334.7502599	3.252919664	0	133.5716173	0	5431.148412	312.6532614	307.338224	2019.653907	10764.95903	0	0	0	3.926038389	270.5986282	0	0	0	0		60	0	1833.251594								3250	$125 Copay per admit -(1A)	$125 Copay per admit -(1B)	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$65 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $40 Copay - (8B)	$3 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$15 Copay - (7E)	$15 Copay - (7I)	"$0 - $15 Copay - (7D, 8B, 14B)"	"$0 - $15 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$15 copay Preventive; 0%-50% coins Comprehensive, $600 limit Comprehensive - (16A, 16B)"	$15 Copay - (17A)	$175 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $750 max- (13A)"	Not covered - (13D)	$45 every 3 months - (13B)								0	NO	125	0	0	0	0	0.04	0.081493585	64.67951591	25	0.002	14.36280852	3	0	21.65578852	0	13.62041604	15	15	13.8329299	8.703019702	0	0	0	0.141	15	0	0	0	0		15	0	0								NO	125	0	0	0	0	0.04	0.081493585	64.67951591	25	0.002	14.36280852	3	0	21.65578852	0	13.62041604	15	15	13.8329299	8.703019702	0	0	0	0.141	15	0	0	0	0		15	0	0									2.1254	0	0	0	0	0.587534975	0.405777837	2.345820137	0.177313903	0	0.400662824	0.00081323	0	0.241049891	0	6.164541745	0.390816577	0.38417278	2.328144243	7.807304207	0	0	0	0.553571413	0.338248285	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	24.3261	0	NO		2.1254	0	0	0	0	0.587534975	0.405777837	2.345820137	0.177313903	0	0.400662824	0.00081323	0	0.241049891	0	6.164541745	0.390816577	0.38417278	2.328144243	7.807304207	0	0	0	0.553571413	0.338248285	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	24.3261	NO																																																																																		0	0	NO		2.1254	0	0	0	0	0.587534975	0.405777837	2.345820137	0.177313903	0	0.400662824	0.00081323	0	0.241049891	0	6.164541745	0.390816577	0.38417278	2.328144243	7.807304207	0	0	0	0.553571413	0.338248285	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	24.3261
H4003_017_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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		V	O	O								0	0	0	0	0	0	0	0	0	0	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	21.49124944	8.023004719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.735657178	0	0	0	0	0		150	0	0								3250	$0 Copay per admit -(1A)	$0 Copay per admit -(1B)	"$0 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$0 copay ER; $0 copay Urgent Care - (4A)	$0 Copay -(9A)	$0 Copay -(8A)	$0 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 Copay - (7B, 7D, 7F, 14B, 14D)"	$0 Copay - (7E)	$0 Copay - (7I)	"$0 Copay - (7D, 8B, 14B)"	"$0 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$0 copay Preventive; 0%-50% coins Comprehensive - (16A, 16B)"	$0 Copay - (17A)	$190 per 2 years - (17B)	$0 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $750 max- (13A)"	Not covered - (13D)	$30 every 6 months - (13B)								0	NO	0	0	0	0	0	0.04	0.126056207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0		15	0	0								NO	0	0	0	0	0	0.04	0.126056207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0		15	0	0									0	0	0	0	0	0.859649978	1.011349547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	3.8366	0	NO		0	0	0	0	0	0.859649978	1.011349547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	3.8366	NO																																																																																		0	0	NO		0	0	0	0	0	0.859649978	1.011349547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	3.8366
H4003_018_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	156.5657034	0	0	0	0	14.92503168	4.968058578	399.0786851	89.22782346	0	366.3970346	0.522261904	0	80.57450991	0	5690.772398	281.2242204	227.1102538	0	9344.413863	0	0	0	3.978939589	279.6066269	0	0	0	0		0	0	441.0129657								3250	$50 Copay per admit -(1A)	$50 Copay per admit -(1B)	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $30 Copay - (8B)	$15 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 Copay - (7D, 8B, 14B)"	"$0 Copay - 10% Coin - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$5 copay Preventive; 0%-50% coins Comprehensive, $500 limit Comprehensive - (16A, 16B)"	$5 Copay - (17A)	$200 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	Not covered - (13D)	$45 every 3 months - (13B)								0	NO	50	0	0	0	0	0.04	0.081377422	49.90834291	25	0.002	10.99890781	15	0	21.06253442	0	0.462049162	10	4	0	0.0423428	0	0	0	0.16	5	0	0	0	0		0	0	0								NO	50	0	0	0	0	0.04	0.081377422	49.90834291	25	0.002	10.99890781	15	0	21.06253442	0	0.462049162	10	4	0	0.0423428	0	0	0	0.16	5	0	0	0	0		0	0	0									0.6524	0	0	0	0	0.597001267	0.404287799	1.659779655	0.185891299	0	0.3358306	0.000652827	0	0.141425282	0	0.219118051	0.234353517	0.075703418	0	0.032972387	0	0	0	0.636630334	0.116502761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2925	0	NO		0.6524	0	0	0	0	0.597001267	0.404287799	1.659779655	0.185891299	0	0.3358306	0.000652827	0	0.141425282	0	0.219118051	0.234353517	0.075703418	0	0.032972387	0	0	0	0.636630334	0.116502761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2925	NO																																																																																		0	0	NO		0.6524	0	0	0	0	0.597001267	0.404287799	1.659779655	0.185891299	0	0.3358306	0.000652827	0	0.141425282	0	0.219118051	0.234353517	0.075703418	0	0.032972387	0	0	0	0.636630334	0.116502761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2925
H4003_019_0	2012	6	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	0	0	0	0	0	17.24254201	0	484.0284593	117.1963933	0	423.8125542	0	0	148.6935288	0	7475.173756	301.7546953	275.101186	2588.821587	13669.95213	0	0	0	5.290303201	380.3830815	0	0	0	0		80.3804753	0	1565.363904								3250	$0 Copay per admit -(1A)	$0 Copay per admit -(1B)	"$0 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $40 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $10 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $5 Copay - (7D, 8B, 14B)"	"$0 - $5 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	$5 copay Preventive; 0%-50% coins Comprehensive	$5 Copay - (17A)	$200 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $1000 max - (13A)"	Not covered - (13D)	$50 every 6 months - (13B)								0	NO	0	0	0	0	0	0.04	0	49.87972808	25	0.002	14.51515021	0	0	21.30931521	0	4.821546589	10	4	4.663661315	1.948497329	0	0	0	0.31	5	0	0	0	0		15	0	0								NO	0	0	0	0	0	0.04	0	49.87972808	25	0.002	14.51515021	0	0	21.30931521	0	4.821546589	10	4	4.663661315	1.948497329	0	0	0	0.31	5	0	0	0	0		15	0	0									0	0	0	0	0	0.68970168	0	2.011933994	0.244159153	0	0.512641907	0	0	0.26404644	0	3.003491544	0.251462246	0.091700395	1.006115591	2.219655433	0	0	0	1.639993992	0.158492951	0	0	0	0	0	0.100475594	0	0	0	0	0	0	0	0	0	12.1939	0	NO		0	0	0	0	0	0.68970168	0	2.011933994	0.244159153	0	0.512641907	0	0	0.26404644	0	3.003491544	0.251462246	0.091700395	1.006115591	2.219655433	0	0	0	1.639993992	0.158492951	0	0	0	0	0	0.100475594	0	0	0	0	0	0	0	0	0	12.1939	NO																																																																																		0	0	NO		0	0	0	0	0	0.68970168	0	2.011933994	0.244159153	0	0.512641907	0	0	0.26404644	0	3.003491544	0.251462246	0.091700395	1.006115591	2.219655433	0	0	0	1.639993992	0.158492951	0	0	0	0	0	0.100475594	0	0	0	0	0	0	0	0	0	12.1939
H4003_021_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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		V	O	O								0	0	0	0	0	0	0	0	0	0	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	19.73686173	7.900024141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.735657178	0	0	0	0	0		150	0	0								3250	$0 Copay -(1A)	$0 Copay -(1B)	$0 Copay -(14B)	$0 Copay -(6)	0% coin -(10A)	20% coins - (11A)	"20% coins (11B, 11C)"	$0 copay ER; $0 copay Urgent Care - (4A)	$0 Copay -(9A)	$0 Copay -(8A)	$0 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 Copay - (7B, 7D, 7F, 14B, 14D)"	$0 Copay - (7E)	$0 Copay - (7I)	"$0 Copay - (7D, 8B, 14B)"	"$0 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$0 copay Preventive; 0%-50% coins Comprehensive - (16A, 16B)"	$0 Copay - (17A)	Not Covered	$0 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $750 max- (13A)"	Not covered - (13D)	$30 every 6 months - (13B)								0	NO	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0		15	0	0								NO	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0		15	0	0									0	0	0	0	0	3.947372346	1.580004828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	7.4929	0	NO		0	0	0	0	0	3.947372346	1.580004828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	7.4929	NO																																																																																		0	0	NO		0	0	0	0	0	3.947372346	1.580004828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.778053725	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	7.4929
H4003_801_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_803_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_804_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_805_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_806_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_807_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_808_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_809_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_810_0	2012	3	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_811_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_812_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_813_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_814_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_815_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_816_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4003_817_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_015_0	2012	6	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	207.2244801	0	0	0	0	12.70823856	5.785801935	462.6385698	82.82648974	0	279.2512413	0.945716826	0	114.8588338	0	4355.208837	190.3656464	239.6579928	1514.272946	9560.810942	0	0	0	3.187686107	272.7568738	0	0	0	0		100	0	0								3250	"$25 per day, Days 1-4 -(1A)"	"$25 per day, Days 1-4 -(1B)"	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $30 Copay - (8B)	$15 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $15 Copay - (7D, 8B, 14B)"	"$0 - $15 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	$0 copay - (10B)	$5 copay Preventive; 0%-50% coins Comprehensive	$15 Copay - (17A)	$225 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		"$15 copay, $1500 max- (13A)"	Not covered - (13D)	Not Covered - (13B)								0	NO	81.70731707	0	0	0	0	0.04	0.096898059	48.81305638	25	0.002	10.44094488	15	0	21.55776892	0	12.98594151	10	4	13.48498635	8.309395904	0	0	0	0.25	15	0	0	0	0		15	0	0								YES	81.70731707	0	0	0	0	0.04	0.096898059	48.81305638	25	0.002	10.44094488	15	0	21.55776892	0	12.98594151	10	4	13.48498635	8.309395904	0	0	0	0.25	15	0	0	0	0		15	0	0								3250	1.411	0	0	0	0	0.508329542	0.560632979	1.881900216	0.172555187	0	0.242970568	0.001182146	0	0.206341683	0	4.713040602	0.158638039	0.079885998	1.701662501	6.620380273	0	0	0	0.796921527	0.340946092	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	19.5214	0	NO		1.411	0	0	0	0	0.508329542	0.560632979	1.881900216	0.172555187	0	0.242970568	0.001182146	0	0.206341683	0	4.713040602	0.158638039	0.079885998	1.701662501	6.620380273	0	0	0	0.796921527	0.340946092	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	19.5214	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"								3250																0.02																									0.02	0	NO		1.411	0	0	0	0	0.508329542	0.560632979	1.881900216	0.172555187	0	0.242970568	0.001182146	0	0.206341683	0	4.733040602	0.158638039	0.079885998	1.701662501	6.620380273	0	0	0	0.796921527	0.340946092	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	19.5414
H4004_025_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	169.942695	0	0	0	0	11.865763	5.911130036	437.4982057	88.33834428	0	333.4511802	0.604038489	0	102.7451192	0	5558.82739	218.2215854	235.9067312	0	9985.066319	0	0	0	3.693680267	279.6089826	0	0	0	0		0	0	568.6249454								3250	$50 Copay per admit -(1A)	$50 Copay per admit -(1B)	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $30 Copay - (8B)	$15 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 Copay - (7D, 8B, 14B)"	"$0 Copay - 10% Coin - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$5 copay Preventive; 0%-50% coins Comprehensive, $500 limit Comprehensive - (16A, 16B)"	$5 Copay - (17A)	$200 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	Not covered - (13D)	$45 every 3 months - (13B)								0	NO	50	0	0	0	0	0.04	0.099052879	49.17002145	25	0.002	10.14680083	15	0	21.45206837	0	0.576300362	10	4	0	0.042341151	0	0	0	0.16	5	0	0	0	0		0	0	0								NO	50	0	0	0	0	0.04	0.099052879	49.17002145	25	0.002	10.14680083	15	0	21.45206837	0	0.576300362	10	4	0	0.042341151	0	0	0	0.16	5	0	0	0	0		0	0	0									0.7081	0	0	0	0	0.47463052	0.58551445	1.79264968	0.184038217	0	0.281955226	0.000755048	0	0.18367461	0	0.266962853	0.181851321	0.078635577	0	0.0352316	0	0	0	0.590988843	0.116503743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.4815	0	NO		0.7081	0	0	0	0	0.47463052	0.58551445	1.79264968	0.184038217	0	0.281955226	0.000755048	0	0.18367461	0	0.266962853	0.181851321	0.078635577	0	0.0352316	0	0	0	0.590988843	0.116503743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.4815	NO																																																																																		0	0	NO		0.7081	0	0	0	0	0.47463052	0.58551445	1.79264968	0.184038217	0	0.281955226	0.000755048	0	0.18367461	0	0.266962853	0.181851321	0.078635577	0	0.0352316	0	0	0	0.590988843	0.116503743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.4815
H4004_035_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	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	0								0	YES	491.5013845	0	0	0	0	108.9624068	5.995975267	741.9815405	19.20987807	0	91.47345242	0	0	103.2530946	0	2487.734057	526.7849519	226.3881832	1004.998032	10820.27792	0	0	0	1.126367071	142.1939662	0	0	0	0		0	0	0								3250	"$25 per day, Days 1-4 -(1A)"	"$25 per day, Days 1-4 -(1B)"	"$25 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $25 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $30 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $10 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $5 Copay - (7D, 8B, 14B)"	"$0 - $5 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	$5 copay Preventive; 0%-50% coins Comprehensive	$5 Copay - (17A)	$50 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	$0 copay - (13D)	$30 every 3 months - (13B)								0	NO	90	0	0	0	0	0.04	0.100483926	50	25	0.002	13.5	0	0	25	0	3.924201092	10	4	4.820143885	2.780447949	0	0	0	0.31	5	0	0	0	0		0	0	0								NO	90	0	0	0	0	0.04	0.100483926	50	25	0.002	13.5	0	0	25	0	3.924201092	10	4	4.820143885	2.780447949	0	0	0	0.31	5	0	0	0	0		0	0	0									3.6863	0	0	0	0	4.358496271	0.602499135	3.091589752	0.040020579	0	0.102907634	0	0	0.215110614	0	0.813530725	0.43898746	0.075462728	0.40368626	2.507101628	0	0	0	0.349173792	0.059247486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7441	0	NO		3.6863	0	0	0	0	4.358496271	0.602499135	3.091589752	0.040020579	0	0.102907634	0	0	0.215110614	0	0.813530725	0.43898746	0.075462728	0.40368626	2.507101628	0	0	0	0.349173792	0.059247486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7441	NO																																																																																		0	0	NO		3.6863	0	0	0	0	4.358496271	0.602499135	3.091589752	0.040020579	0	0.102907634	0	0	0.215110614	0	0.813530725	0.43898746	0.075462728	0.40368626	2.507101628	0	0	0	0.349173792	0.059247486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.7441
H4004_048_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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		V	O	O								0	0	0	0	0	0	0	0	0	0	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	21.1959349	9.498030918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.028434032	0	0	0	0	0		0	0	0								3250	$0 Copay per admit -(1A)	$0 Copay per admit -(1B)	"$0 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$0 copay ER; $0 copay Urgent Care - (4A)	$0 Copay -(9A)	$0 Copay -(8A)	$0 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 Copay - (7B, 7D, 7F, 14B, 14D)"	$0 Copay - (7E)	$0 Copay - (7I)	"$0 Copay - (7D, 8B, 14B)"	"$0 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	Not covered - (10B)	"$0 copay Preventive; 0%-50% coins Comprehensive, $500 limit Comprehensive - (16A, 16B)"	$0 Copay - (17A)	$190 per 2 years - (17B)	$0 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	$0 copay - (13D)	Not Covered - (13B)								0	NO	0	0	0	0	0	0.04	0.136678596	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								NO	0	0	0	0	0	0.04	0.136678596	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	0.847837396	1.29817753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.005686806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1517	0	NO		0	0	0	0	0	0.847837396	1.29817753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.005686806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1517	NO																																																																																		0	0	NO		0	0	0	0	0	0.847837396	1.29817753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.005686806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1517
H4004_050_0	2012	5	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	OTC								A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O		V	O	O								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0								0	YES	0	0	0	0	0	14.2430164	0	493.1772447	109.1580024	0	417.8623643	0	0	147.811686	0	6066.958724	287.1195353	299.0283332	1983.083501	12373.06353	0	0	0	4.493485576	387.3073538	0	0	0	0		0	0	1428.707775								3250	$0 Copay per admit -(1A)	$0 Copay per admit -(1B)	"$0 per day, Days 1-4 - (14B)"	$0 Copay -(6)	0% coin -(10A)	0%-20% coins - (11A)	"0%-20% coins (11B, 11C)"	$50 copay ER; $0 copay Urgent Care - (4A)	$25 Copay -(9A)	0% - 10% coin -(8A)	$0 - $40 Copay - (8B)	$0 Copay - (5)	0% coin - (12)	"$0 - $25 Copay - (3B, 7C, 7I, 9A)"	$0 copay - (7A)	"$0 - $15 Copay - (7B, 7D, 7F, 14B, 14D)"	$10 Copay - (7E)	$4 Copay - (7I)	"$0 - $5 Copay - (7D, 8B, 14B)"	"$0 - $5 Copay - (7D, 7G, 8A, 14B, 14E)"	"$0 copay - (9D, 15)"	$0 copay	$0 copay - (10B)	"$5 copay Preventive; 0%-50% coins Comprehensive, $750 limit Comprehensive - (16A, 16B)"	$5 Copay - (17A)	$175 per 2 years - (17B)	$0 - $10 copay - (18A)	$200 per 3 years - (18B)	$0 copay - (14C)		Not covered - (13A)	Not covered - (13D)	$45 every 6 months - (13B)								0	NO	0	0	0	0	0	0.04	0	49.34045226	25	0.002	13.99718508	0	0	20.88179916	0	4.933168344	10	4	4.505769231	1.906095636	0	0	0	0.13	5	0	0	0	0		0	0	0								NO	0	0	0	0	0	0.04	0	49.34045226	25	0.002	13.99718508	0	0	20.88179916	0	4.933168344	10	4	4.505769231	1.906095636	0	0	0	0.13	5	0	0	0	0		0	0	0									0	0	0	0	0	0.569720656	0	2.027799025	0.227412505	0	0.487408071	0	0	0.257214495	0	2.494110727	0.239266279	0.099676111	0.744609718	1.965353533	0	0	0	0.584153125	0.161378064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8581	0	NO		0	0	0	0	0	0.569720656	0	2.027799025	0.227412505	0	0.487408071	0	0	0.257214495	0	2.494110727	0.239266279	0.099676111	0.744609718	1.965353533	0	0	0	0.584153125	0.161378064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8581	NO																																																																																		0	0	NO		0	0	0	0	0	0.569720656	0	2.027799025	0.227412505	0	0.487408071	0	0	0.257214495	0	2.494110727	0.239266279	0.099676111	0.744609718	1.965353533	0	0	0	0.584153125	0.161378064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8581
H4004_801_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_802_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_803_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_804_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_805_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_806_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_807_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_808_0	2012	4	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_809_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_810_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_811_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_812_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_813_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_814_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_815_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4004_816_0	2012	2	q.	q.	q.	q.							Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							Acupuncture	Respite Care/Diapers	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	YES	137.406293	0	0	0	4.074648878	21.83482916	8.292237309	10.72719703	14.8016663	1.362923761	7.823426261	0.069130909	0.413635705	8.110836949	80.31894853	60.51148342	6.527460494	3.598303233	27.677136	158.8973405	0.007756387	0																			3250	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Not Covered	Not Covered	Not Covered								0	NO	0.152388779	0.152388779	0.122087863	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.13881994	0	0	0	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0.204387983	0																				19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	0	NO	-2.264246724	19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058	NO																																																																																		0	0	NO		19.0747	0	0	0	0.832809265	4.462776688	1.694833657	2.192510162	3.025282718	0.278565238	1.599014312	0.014129527	0.084542167	1.657757603	16.41622787	12.36782003	1.334134483	0.735449939	5.656873998	32.47670691	0.001585312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9058
H4005_001_0	2012	7																															A	A				Coin	Coin	V	P		V			V		V	V	V	P	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	147.8915559	16.09082923	0	0	0	0.194082584	9.737101263	343.9390074	135.9282873	0	26.41821538	0	0	22.16961168	0	5640.537197	584.1563023	66.59498578	392.1651005	0.98794546	0	86.31297467	0	10.26225979	0	0	0	0	0	0											6700	$25/Admit for IP; PBP 1a	$25/Admit for IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$25/Visit for ER - Facility; PBP 4a-b	$25/Procedure for OP Fac - Surgery; $25/Procedure for OP Fac - Surgery; PBP 9a-b	No Cost Sharing; PBP 8a	$10/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP Fac - CORF; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$5/Visit for Speclst Office Visits; $5/Procedure for Speclst Immunizations; $5/Visit for Vision Exams; $5/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 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"	"$5/Visit for Occ Therapy; $5/Visit for PT/ST; PBP 7c, 7i"	$10/Procedure for Prof Radiology (Office); PBP 7d	"$5/Visit for Allergy Testing; PBP 7d, 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	3% Coinsurance for Dental - Comprehensive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	25	25	0	0	0	0.1	0.1	25	25	0	10	0	0	25	0	5	10	5	10	5	0	5	0	0.03055094	0	0	0	0	0	0											NO	25	25	0	0	0	0.1	0.1	25	25	0	10	0	0	25	0	5	10	5	10	5	0	5	0	0.03055094	0	0	0	0	0	0												0.3081	0.033522561	0	0	0	0.019408258	0.973710126	0.716539599	0.283183932	0	0.022015179	0	0	0.046186691	0	2.350223832	0.486796919	0.027747911	0.32680425	0.000411644	0	0.035963739	0	0.313521687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9441	0	NO	0	0.3081	0.033522561	0	0	0	0.019408258	0.973710126	0.716539599	0.283183932	0	0.022015179	0	0	0.046186691	0	2.350223832	0.486796919	0.027747911	0.32680425	0.000411644	0	0.035963739	0	0.313521687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9441	YES	20% Coinsurance for IP; PBP 1a	No Cost Sharing; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	30% Coinsurance for DME / Medical Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; PBP 4a-b	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - Surgery; PBP 9a-b	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;	No Cost Sharing; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; PBP 3, 5"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b, 14d-e"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 25% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; PBP 7b, 7d, 7f, 17a, 18a"	"25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h, 9c"	"25% Coinsurance for Occ Therapy; 25% Coinsurance for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14c"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	20% Coinsurance for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	0.0969	0	0.0023	0.0017	0.0024	0.0004	0.0182	0.1025	0.003	0.0012	0.0012	0	0	0.0178	0.1075	0.0481	0.0015	0.0001	0.0277	0.0618	0.0158	0.0419	0	0.013	0	0	0	0	0	0											0.5648	0	NO	0.004165437	0.405	0.033522561	0.002265812	0.001699159	0.002441001	0.019800649	0.991873774	0.819000092	0.286192118	0.001177499	0.023217999	0	0	0.064026469	0.107499374	2.398283988	0.488273924	0.027829628	0.354534378	0.062173549	0.015789697	0.077910548	0	0.32647616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.509
H4005_004_0	2012	12																															A	A				Coin	Coin	V	P	Coin	Coin			V		V	V	V	Coin	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	245.8660578	8.193014332	0	0	0	0.241564273	14.60765179	414.7796701	183.9291816	2.022028097	3.385294706	0	0	267.9908929	0	8861.591924	865.2380768	165.082605	31.35875691	61.05767849	0	167.3663391	0	8.301936744	0	0	0	0	0	0											6700	$35/Admit for IP; PBP 1a	$35/Admit for IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$50/Visit for ER - Facility; PBP 4a-b	$35/Procedure for OP Fac - Surgery; $35/Procedure for OP Fac - Surgery; PBP 9a-b	10% Coinsurance for OP Fac - Pathology; PBP 8a	10% Coinsurance for OP Fac - Radiology; $20/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for OP Fac - Cardiovascular; $5/Visit for OP Fac - Occ Therapy; $5/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$7/Visit for Speclst Office Visits; $5/Visit for Chiropractor; $7/Procedure for Speclst Immunizations; $5/Visit for Vision Exams; $5/Visit for Hearing/Speech Exams; $15/Visit for Alternative Medicine; PBP 7b, 7d, 7f, 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"	"$5/Visit for Occ Therapy; $5/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for Prof Radiology (Office); $20/Procedure for Prof Radiology (Office); PBP 7d	"$5/Visit for Allergy Testing; $5/Procedure for Prof Path (Office); PBP 7d, 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	2% Coinsurance for Dental - Comprehensive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	35	35	0	0	0	0.1	0.1	50	35	0.1	0.093523148	0	0	12.65865613	0	7.015315365	10	5	0.09205815	5	0	5	0	0.022330555	0	0	0	0	0	0											NO	34.99929509	34.99929509	0	0	0	0.099997986	0.099997986	49.99899299	34.99929509	0.099997986	0.093521264	0	0	12.65840119	0	7.015174074	9.999798598	4.999899299	0.092056296	4.999899299	0	4.999899299	0	0.022330105	0	0	0	0	0	0												0.7171	0.023895811	0	0	0	0.024155941	1.460735759	1.728213818	0.536449309	0.202198737	0.31659704	0	0	0.282694686	0	5.180467493	0.721017209	0.068783033	2.886771017	0.025440187	0	0.06973457	0	0.185383122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4296	0	NO	0.000290622	0.7171	0.023895811	0	0	0	0.024155941	1.460735759	1.728213818	0.536449309	0.202198737	0.31659704	0	0	0.282694686	0	5.180467493	0.721017209	0.068783033	2.886771017	0.025440187	0	0.06973457	0	0.185383122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4296	YES	20% Coinsurance for IP; PBP 1a	No Cost Sharing; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	30% Coinsurance for DME / Medical Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 30% Coinsurance for Prosthetics; PBP 11b-c	20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; PBP 4a-b	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - Surgery; PBP 9a-b	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;	No Cost Sharing; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; PBP 3, 5"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b, 14d-e"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; PBP 7b, 7d, 7f, 17a, 18a"	"25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h, 9c"	"25% Coinsurance for Occ Therapy; 25% Coinsurance for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14c"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	20% Coinsurance for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	0.2795	0	0.0065	0.0049	0.007	0.0007	0.0605	0.0698	0.0087	0.0025	0.0035	0	0	0.0083	0.0722	0.0709	0.0022	0.0002	0.049	0.1327	0.0218	0.0312	0	0.0162	0	0	0	0	0	0											0.8483	0	NO	0.010740103	0.9966	0.023895811	0.006534906	0.004900602	0.007040176	0.024885782	1.521231656	1.798000512	0.545125321	0.204686171	0.320066133	0	0	0.290979354	0.072201417	5.251409548	0.723179112	0.069013692	2.935783189	0.158111035	0.021807254	0.100977852	0	0.201548868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2779
H4005_801_0	2012	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	116.4787495	2.158267184	0.455355529	0	1.68315997	0.700286986	25.89182653	6.048151295	18.70293798	1.779816697	3.646971252	0	0.009808847	15.64013348	35.50156459	83.23127377	5.143972428	13.87420354	30.91887146	74.30365716	12.81413077	17.48595797	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.155888644	0.155888644	0.125946765	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.155383591	0.155383591	0.125538718	0	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0.223274277	0	0	0	0	0	0	0	0												18.0989	0.335359305	0.057164749	0	0.375806325	0.15635607	5.780978847	1.350396607	4.175884954	0.397387286	0.814274869	0	0.002190063	3.492039494	7.926586165	18.58340247	1.148516724	3.097752763	6.903388669	16.59009533	2.861065781	3.904164623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0517	0	NO	0.312203145	18.0989	0.335359305	0.057164749	0	0.375806325	0.15635607	5.780978847	1.350396607	4.175884954	0.397387286	0.814274869	0	0.002190063	3.492039494	7.926586165	18.58340247	1.148516724	3.097752763	6.903388669	16.59009533	2.861065781	3.904164623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0517	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	Medicare-FFS Cost Sharing; PBP 10b	Medicare-FFS Cost Sharing; PBP 16a-b	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	0.1467	0	0.6506	0	0.0247	0.0021	0.0402	0.1377	0.0215	0.0021	0.0055	0	0.0127	0.0433	0.0801	0.1591	0.0287	0.0045	0.0787	0.4009	0.0205	0.0256	0	0	0	0	0	0	0	0											1.8849	0	NO	0.030430174	18.2456	0.335359305	0.707776945	0	0.400492771	0.158442983	5.821156113	1.48806444	4.197349153	0.39949673	0.81979602	0	0.014935024	3.535348464	8.006647679	18.74246829	1.177174213	3.102231207	6.982065959	16.99101154	2.881558699	3.92971709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9366
H4005_802_0	2012	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	112.6063957	2.728349415	0.575282793	0	1.736318757	0.660374032	22.61723225	6.238076659	17.37121265	1.81503267	3.778528942	0	0.012396196	16.29214012	35.86387138	83.14101283	4.726402428	12.0063279	32.71273843	72.73246841	14.84994319	18.33058598	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.154501684	0.154501684	0.127498079	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.154013397	0.154013397	0.127095135	0	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0.223292071	0	0	0	0	0	0	0	0												17.3429	0.420202362	0.073115644	0	0.387706212	0.147456285	5.050248634	1.392913058	3.878854052	0.405282404	0.843715554	0	0.002767972	3.637905713	8.008118123	18.56472896	1.055368188	2.680917826	7.30449512	16.24058351	3.315874571	4.09307451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8462	0	NO	0.300701994	17.3429	0.420202362	0.073115644	0	0.387706212	0.147456285	5.050248634	1.392913058	3.878854052	0.405282404	0.843715554	0	0.002767972	3.637905713	8.008118123	18.56472896	1.055368188	2.680917826	7.30449512	16.24058351	3.315874571	4.09307451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8462	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	Medicare-FFS Cost Sharing; PBP 10b	Medicare-FFS Cost Sharing; PBP 16a-b	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	0.1838	0	0.5379	0	0.0064	0.001	0.0195	0.0552	0.0271	0.0024	0.0073	0	0.0161	0.0385	0.0527	0.1385	0.0336	0.0056	0.0614	0.4497	0.0244	0.0302	0	0	0	0	0	0	0	0											1.6915	0	NO	0.026260815	17.5267	0.420202362	0.611011155	0	0.394093216	0.148448156	5.069753185	1.448153509	3.905996534	0.407703609	0.851037132	0	0.018884571	3.676375609	8.060773995	18.70323333	1.089008768	2.686554054	7.365908742	16.69025476	3.340320763	4.123287399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5377
H4005_804_0	2012	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	83.83020209	1.390437441	0.292336012	0	1.18116985	0.510716895	18.59437432	4.767622812	14.1298137	1.433015117	3.241652935	0	0.006312841	15.40597267	25.85229169	67.49772877	4.177715635	9.883012304	26.62420104	58.00904117	9.945050614	14.56311318	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.150985373	0.150985373	0.13787471	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.150673598	0.150673598	0.137590008	0	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0.223537455	0	0	0	0	0	0	0	0												12.631	0.209502211	0.040222514	0	0.264035702	0.114164355	4.156539107	1.065742268	3.158542589	0.320332552	0.724630846	0	0.001411156	3.443811918	5.778955483	15.08827049	0.933875919	2.209223415	5.951506133	12.96719341	2.223091301	3.255401253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5375	0	NO	0.154233429	12.631	0.209502211	0.040222514	0	0.264035702	0.114164355	4.156539107	1.065742268	3.158542589	0.320332552	0.724630846	0	0.001411156	3.443811918	5.778955483	15.08827049	0.933875919	2.209223415	5.951506133	12.96719341	2.223091301	3.255401253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5375	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	Medicare-FFS Cost Sharing; PBP 10b	Medicare-FFS Cost Sharing; PBP 16a-b	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	0.092	0	0.7172	0	0.0036	0.0007	0.0139	0.0984	0.0139	0.0051	0.0037	0	0.0083	0.0369	0.0315	0.1572	0.0227	0.0033	0.0475	0.424	0.0144	0.0275	0	0	0	0	0	0	0	0											1.7217	0	NO	0.016866046	12.723	0.209502211	0.757469665	0	0.267654905	0.114877435	4.170425901	1.164100309	3.172443495	0.325442211	0.728380561	0	0.009665203	3.480712136	5.810485694	15.24543063	0.956583673	2.212533786	5.9989816	13.39115598	2.237475515	3.282875355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2592
H4005_807_0	2012	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	109.40489	2.591751979	0.544909405	0	1.675589021	0.642825311	22.14208917	6.050921535	16.95968086	1.763925853	3.685566932	0	0.011767029	15.97311922	34.71895018	80.96389691	4.635898463	11.75894109	31.80337273	70.82832918	14.27098684	17.80425485	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.150985373	0.150985373	0.13787471	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.150533586	0.150533586	0.137462154	0	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0.223329735	0	0	0	0	0	0	0	0												16.4691	0.390145718	0.07490442	0	0.374208851	0.143562006	4.944986896	1.3513507	3.787601025	0.393937093	0.823096685	0	0.002627928	3.567272475	7.753773927	18.08164561	1.035333973	2.626121191	7.10263879	15.81807196	3.187135704	3.976219511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9037	0	NO	0.27582491	16.4691	0.390145718	0.07490442	0	0.374208851	0.143562006	4.944986896	1.3513507	3.787601025	0.393937093	0.823096685	0	0.002627928	3.567272475	7.753773927	18.08164561	1.035333973	2.626121191	7.10263879	15.81807196	3.187135704	3.976219511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9037	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	Medicare-FFS Cost Sharing; PBP 10b	Medicare-FFS Cost Sharing; PBP 16a-b	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 14c	Medicare-FFS Cost Sharing; PBP 13a-e											10000	0.1705	0	0.5849	0	0.0067	0.001	0.0195	0.0596	0.0258	0.0025	0.0066	0	0.0153	0.0379	0.0515	0.1381	0.0323	0.0054	0.0602	0.4398	0.0234	0.0294	0	0	0	0	0	0	0	0											1.7106	0	NO	0.026259002	16.6397	0.390145718	0.65984416	0	0.380918075	0.144557212	4.964521674	1.410908914	3.813370313	0.396469629	0.829725216	0	0.017929154	3.605217865	7.805256929	18.21979132	1.067660281	2.631497879	7.162846143	16.25782771	3.210491717	4.005662627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6143
H4006_001_0	2012	6																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	V	coin	coin	V	coin	coin	T	P	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	80.10187686	1.721160832	1.480187772	8.334481055	7.818698101	6.430311008	8.535351581	385.3342714	19.27644944	15.54132766	8.016261401	0	0.034708615	9.022132651	0	0	718.5025537	7.57223557	13.59832226	5.261035869	17.51525141	0.009224149	0	2500.756897	0	0	0	0	0	1200											3400	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-90	2:  Skilled Nursing Services - 0/day for 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 - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $48/visit/4b:  Urgently Needed Care / Urgent Care Centers - $48/visit/4a:  Worldwide Coverage - $48/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 - 5.0%/8b:  Outpatient Therapeutic Radiological Services - 5.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 10.0%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $5 Office Visit Copay/service/16a:  Preventive Dental - Prophylaxis - $5 Office Visit Copay/service/16a:  Preventive Dental - Fluoride Treatment - $5 Office Visit Copay/service/16a:  Preventive Dental - X-Rays - $5 Office Visit Copay/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 - $125 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service/18b:  Hearing Aids - $300/Per Year	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $15/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - $15/visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0.17130385	48	0	0	0.03364422	0	0.1	0	0	0	10	0	0	10	0	0	0	3.485629033	0	0	0	0	0	15											NO	0	0	0	0	0	0.1	0.17130385	48	0	0	0.03364422	0	0.1	0	0	0	10	0	0	10	0	0	0	3.485629033	0	0	0	0	0	15												0	0	0	0	0	0.643031101	1.462138587	1.541337085	0	0	0.269700864	0	0.003470862	0	0	0	0.598752128	0	0	0.004384197	0	0	0	0.72639257	0	0	0	0	0	1.5	0	0	0	0	0	0	0	0	0	0	6.7492	0	NO	0	0	0	0	0	0	0.643031101	1.462138587	1.541337085	0	0	0.269700864	0	0.003470862	0	0	0	0.598752128	0	0	0.004384197	0	0	0	0.72639257	0	0	0	0	0	1.5	0	0	0	0	0	0	0	0	0	0	6.7492	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	0.643031101	1.462138587	1.541337085	0	0	0.269700864	0	0.003470862	0	0	0	0.598752128	0	0	0.004384197	0	0	0	0.72639257	0	0	0	0	0	1.5	0	0	0	0	0	0	0	0	0	0	6.7492
H4006_007_0	2012	7																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	V	coin	coin	V	coin	coin	T	P	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	96.07043774	3.040208529	1.928027219	10.48722187	7.318936145	8.658159359	11.55743485	473.7540258	22.10760499	17.69536497	5.295240921	0	0.035475314	13.49490568	0	0	819.982775	8.961845034	15.70709984	6.004096673	17.96463323	0.135428245	0	2571.035345	0	0	0	0	0	240											3400	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-90	2:  Skilled Nursing Services - 0/day for 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 - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $48/visit/4b:  Urgently Needed Care / Urgent Care Centers - $48/visit/4a:  Worldwide Coverage - $48/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 - 5.0%/8b:  Outpatient Therapeutic Radiological Services - 5.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 10.0%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $5 Office Visit Copay/service/16a:  Preventive Dental - Prophylaxis - $5 Office Visit Copay/service/16a:  Preventive Dental - Fluoride Treatment - $5 Office Visit Copay/service/16a:  Preventive Dental - X-Rays - $5 Office Visit Copay/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 - $125 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service/18b:  Hearing Aids - $300/Per Year	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $15/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - $15/visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0.171465045	48	0	0	0.033746461	0	0.1	0	0	0	10	0	0	10	0	0	0	3.411193808	0	0	0	0	0	15											NO	0	0	0	0	0	0.1	0.171465045	48	0	0	0.033746461	0	0.1	0	0	0	10	0	0	10	0	0	0	3.411193808	0	0	0	0	0	15												0	0	0	0	0	0.865815936	1.981696088	1.895016103	0	0	0.178695643	0	0.003547531	0	0	0	0.683318979	0	0	0.005003414	0	0	0	0.730858321	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	6.644	0	NO	0	0	0	0	0	0	0.865815936	1.981696088	1.895016103	0	0	0.178695643	0	0.003547531	0	0	0	0.683318979	0	0	0.005003414	0	0	0	0.730858321	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	6.644	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	0.865815936	1.981696088	1.895016103	0	0	0.178695643	0	0.003547531	0	0	0	0.683318979	0	0	0.005003414	0	0	0	0.730858321	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	6.644
H4006_008_0	2012	9																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	V	coin	coin	V	coin	coin	T	P	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	126.9775425	1.125952764	1.451146871	13.88163233	8.333447009	12.39240968	14.54781401	457.1383664	18.74815661	15.50478688	4.327653357	0	0.040984044	15.78477542	0	0	547.0628775	8.630163645	17.35657711	4.005716343	28.61796109	0.529739592	0	2856.106916	0	0	0	0	0	240											3400	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-90	2:  Skilled Nursing Services - 0/day for 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 - 10.0%/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 - 5.0%/8b:  Outpatient Therapeutic Radiological Services - 5.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 10.0%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - Min 0%/Max 25%"	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/18b:  Hearing Aids - $550/Per Year	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $15/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - $15/visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0.169175595	45	0	0	0.033718997	0	0.1	0	0	0	10	0	0	10	0	0	0	5.999155359	0	0	0	0	0	15											NO	0	0	0	0	0	0.1	0.169175595	45	0	0	0.033718997	0	0.1	0	0	0	10	0	0	10	0	0	0	5.999155359	0	0	0	0	0	15												0	0	0	0	0	1.239240968	2.461135095	1.714268874	0	0	0.145924132	0	0.004098404	0	0	0	0.455885731	0	0	0.003338097	0	0	0	1.427852426	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	7.7517	0	NO	0	0	0	0	0	0	1.239240968	2.461135095	1.714268874	0	0	0.145924132	0	0.004098404	0	0	0	0.455885731	0	0	0.003338097	0	0	0	1.427852426	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	7.7517	NO	1a:  Acute - 20.0% for 1-90	1b:  Psych - 20.0% for 1-190/1b:  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 - $0/service	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $0/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 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 - $0/service	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $2/visit/14a:  Prostate Cancer Screening - $2/visit/14a:  Colorectal Screening - $2/visit/14a:  Bone Mass Measurement - $2/visit/14a:  Mammography - $2/visit/14a:  Diabetes Monitoring - $2/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $2/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $2/visit/14a:  Prostate Cancer Screening - $2/visit/14a:  Colorectal Screening - $2/visit/14a:  Bone Mass Measurement - $2/visit/14a:  Mammography - $2/visit/14a:  Diabetes Monitoring - $2/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $2/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $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%"	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 - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%		"16a:  Preventive Dental - Oral Exams - 20.0%/16a:  Preventive Dental - Prophylaxis - 20.0%/16a:  Preventive Dental - Fluoride Treatment - 20.0%/16a:  Preventive Dental - X-Rays - 20.0%/16b:  Comprehensive Dental - Emergency Svcs - 20.0%/16b:  Comprehensive Dental - Diagnostic Svcs - 20.0%/16b:  Comprehensive Dental - Restorative Svcs - 20.0%/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - 20.0%/16b:  Comprehensive Dental - Prosthodontics, Other - 20.0%"	17a:  Routine Eye Exams - 20.0%		18a:  Routine Hearing Test - 20.0%		14c:  Supplemental Education/Wellness Programs - 20.0%/													3.9106	0.0358	0.2512	0.3209	0	0	0.0172	0	0.8706	1.1629	0.1892	0	0	0.0175	0.5741	1.2485	0.0507	0.1041	0.2148	0.2772	0	0.033	0	0.002	0.0269	0	0.0047	0	0	0	0	0	0	0	0	0	0	0	0	0	9.3121	0	NO	0	3.9106	0.035804202	0.251219825	0.320924599	0	1.239240968	2.478355189	1.714268874	0.8705589	1.162914708	0.335138622	0	0.004098404	0.017482614	0.574083651	1.248546517	0.506589033	0.10410519	0.214841895	0.280565406	0	0.033039788	0	1.429852426	0.026897236	0	0.004663982	0	0	0.3	0	0	0	0	0	0	0	0	0	0	17.0638
H4006_013_0	2012	7																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	coin	coin	coin	T	P	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	155.471306	8.760648739	3.173241884	18.7004728	10.91599115	16.12495284	17.57820864	16.47327872	25.42057283	19.98466859	6.666853002	0	0.042129582	17.74089474	0	0	11.68866243	8.642759151	16.07702565	23.25017709	29.51707008	0.269016932	0	0	0	0	0	0	0	240											3400	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-90/1b:  Additional Days - $0/day for 91-999	2:  Skilled Nursing Services - 0/day for 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 - $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	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  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 - /16b:  Comprehensive Dental - Diagnostic Svcs - /16b:  Comprehensive Dental - Restorative Svcs - /16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - /16b:  Comprehensive Dental - Prosthodontics, Other -"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $75 Per Year	18a:  Routine Hearing Test - $0/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $0/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - /visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	1.612495284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6125	0	NO	0	0	0	0	0	0	1.612495284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6125	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	1.612495284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6125
H4006_025_0	2012	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	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	96.07043774	3.040208529	1.928027219	10.48722187	7.249442651	8.202466761	11.39253941	8.153147638	21.39762024	16.65446115	5.051029815	0	0.034751328	13.13830183	118.4201004	67.77516695	5.52417521	7.911604057	13.55624633	18.46540156	15.70519293	0.129639375	0	0	0	0	0	0	0	240											6700	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-90	2:  Skilled Nursing Services - 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 - 22.4%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service	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%	9d:  Blood - 20.0%							14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $15/visit/13d:  Other 1: Alternative Medicine Program - $15/visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.188041368	0.199992962	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	15											NO	0	0	0	0	0.193353611	0.193353611	0.193353611	0.193353611	0.193353611	0.193353611	0.193353611	0	0.193353611	0.193353611	0.18613677	0.193346807	0.193353611	0.193353611	0.193353611	0.193353611	0.193353611	0.193353611	0	0	0	0	0	0	0	15												0	0	0	0	1.401705917	1.58597657	2.202788638	1.57644054	4.137307149	3.220200209	0.976634856	0	0.006719295	2.540338105	22.04233497	13.10411213	1.068119227	1.529737216	2.621149185	3.570352076	3.036655769	0.025066241	0	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	64.9456	0	NO	1.69	0	0	0	0	1.401705917	1.58597657	2.202788638	1.57644054	4.137307149	3.220200209	0.976634856	0	0.006719295	2.540338105	22.04233497	13.10411213	1.068119227	1.529737216	2.621149185	3.570352076	3.036655769	0.025066241	0	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	64.9456	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	1.401705917	1.58597657	2.202788638	1.57644054	4.137307149	3.220200209	0.976634856	0	0.006719295	2.540338105	22.04233497	13.10411213	1.068119227	1.529737216	2.621149185	3.570352076	3.036655769	0.025066241	0	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	64.9456
H4006_803_0	2012	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	103.7210757	2.486724505	2.467718632	11.18245332	7.356475217	15.64207891	14.4319731	9.205508625	26.95343482	21.07763279	6.539062968	0	0.047237836	16.77910433	132.3548476	91.26907856	4.604543555	12.66236246	20.27811488	26.56868056	26.67146736	0.118713327	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																					0.153156811	0.153156811	0.122969395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.13524286	0.13524286	0.108586308	0	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0	0.197799892	0.197799892	0.212693353	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0.197799892	0	0	0	0	0	0	0	0												14.0275	0.336311735	0.267960455	0	1.455110002	3.094001516	2.854642718	1.82084861	5.331386492	4.169153486	1.293425948	0	0.009343639	3.318905022	28.15099636	18.05301387	0.910778217	2.504613926	4.011008929	5.255282141	5.275613358	0.023481483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1634			11.3	14.0275	0.336311735	0.267960455	0	1.455110002	3.094001516	2.854642718	1.82084861	5.331386492	4.169153486	1.293425948	0	0.009343639	3.318905022	28.15099636	18.05301387	0.910778217	2.504613926	4.011008929	5.255282141	5.275613358	0.023481483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1634	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.0275	0.336311735	0.267960455	0	1.455110002	3.094001516	2.854642718	1.82084861	5.331386492	4.169153486	1.293425948	0	0.009343639	3.318905022	28.15099636	18.05301387	0.910778217	2.504613926	4.011008929	5.255282141	5.275613358	0.023481483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1634
H4006_807_0	2012	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	106.4297911	2.382290284	2.484900206	12.10035108	10.0739732	16.87512273	15.39610337	9.0024965	26.8247899	20.61992693	6.128419738	0	0.043984258	14.85237072	136.5871922	94.48917247	4.862020833	10.47553994	18.88952493	25.36299263	22.79423856	0.116160038	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																					0.152437564	0.152437564	0.122144468	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.134465454	0.134465454	0.107743858	0	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0	0.197590809	0.197590809	0.212137946	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0.197590809	0	0	0	0	0	0	0	0												14.3111	0.320335744	0.267732736	0	1.990524513	3.334369148	3.042128517	1.778810564	5.300331931	4.07430804	1.210919412	0	0.008690885	2.934691943	28.97532642	18.67019201	0.960690629	2.069870408	3.732396508	5.011494227	4.503932033	0.022952156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5208			11.45	14.3111	0.320335744	0.267732736	0	1.990524513	3.334369148	3.042128517	1.778810564	5.300331931	4.07430804	1.210919412	0	0.008690885	2.934691943	28.97532642	18.67019201	0.960690629	2.069870408	3.732396508	5.011494227	4.503932033	0.022952156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5208	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.3111	0.320335744	0.267732736	0	1.990524513	3.334369148	3.042128517	1.778810564	5.300331931	4.07430804	1.210919412	0	0.008690885	2.934691943	28.97532642	18.67019201	0.960690629	2.069870408	3.732396508	5.011494227	4.503932033	0.022952156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5208
H4006_809_0	2012	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	103.7466792	2.487338351	2.468327787	11.1852137	7.358291159	15.64594015	14.43553562	9.207780999	26.96008826	21.08283579	6.540677132	0	0.047249496	16.78324625	132.3689471	91.29160828	4.605680184	12.66548816	20.28312052	26.57523902	26.67805119	0.118742631	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																					0.153156811	0.153156811	0.122969395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.135231432	0.135231432	0.108577132	0	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0.197783178	0.197783178	0.212684553	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0	0	0	0	0	0	0												14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773			11.31	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773
H4006_811_0	2012	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	103.7466792	2.487338351	2.468327787	11.1852137	7.358291159	15.64594015	14.43553562	9.207780999	26.96008826	21.08283579	6.540677132	0	0.047249496	16.78324625	132.3689471	91.29160828	4.605680184	12.66548816	20.28312052	26.57523902	26.67805119	0.118742631	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																					0.153156811	0.153156811	0.122969395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.135231432	0.135231432	0.108577132	0	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0.197783178	0.197783178	0.212684553	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0	0	0	0	0	0	0												14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773			11.31	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773
H4006_813_0	2012	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	103.7466792	2.487338351	2.468327787	11.1852137	7.358291159	15.64594015	14.43553562	9.207780999	26.96008826	21.08283579	6.540677132	0	0.047249496	16.78324625	132.3689471	91.29160828	4.605680184	12.66548816	20.28312052	26.57523902	26.67805119	0.118742631	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																					0.153156811	0.153156811	0.122969395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.135231432	0.135231432	0.108577132	0	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0.197783178	0.197783178	0.212684553	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0	0	0	0	0	0	0												14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773			11.31	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773
H4006_816_0	2012	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	103.7466792	2.487338351	2.468327787	11.1852137	7.358291159	15.64594015	14.43553562	9.207780999	26.96008826	21.08283579	6.540677132	0	0.047249496	16.78324625	132.3689471	91.29160828	4.605680184	12.66548816	20.28312052	26.57523902	26.67805119	0.118742631	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																					0.153156811	0.153156811	0.122969395	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.135231432	0.135231432	0.108577132	0	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0.197783178	0.197783178	0.212684553	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0.197783178	0	0	0	0	0	0	0	0												14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773			11.31	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	14.0298	0.336366327	0.268003952	0	1.455346207	3.094503757	2.855106105	1.821144184	5.332251922	4.169830254	1.293635906	0	0.009345156	3.319443772	28.15283032	18.05594437	0.910926061	2.505020493	4.011660026	5.256135218	5.276469735	0.023485295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1773
H4007_005_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	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	260.95	0	0.2	279.12	268.27	39975.03	26543.84	897.01	132.58	2987.86	1773.37	0	30.48	199.27	7624.76	3882.5	2.36	795.17		797.05	1360.45	0	1.71	7.46	1.65		0.25		1.71	1.39	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	"$0/Service: 11a. $0: Diabetic Shoes, 11c. $0 DME"	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN885: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER756: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4007_012_0	2012	5																															D	A	D	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	954.75	0.31	0	153.34	150.46	26014	16787.45	569.42	102.89	2581.77	1249.25	0	25.24	119.99	6044.51	2640.57	1.48	877.76		489.18	625.42	0	2.14	4.5	1.65		0.25		1.71	1.39											3500	"$0/Day(Days 1-4): 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $0 (Days 8-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	"$0/Service: 11a. $0: Diabetic Shoes, 11c. $0 DME"	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$35/Visit: 4a, 4b. $35 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN783: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER756: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	35	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.660808333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6608	0	NO	0	0	0	0	0	0	0	0	1.660808333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6608	NO																																																																																		0	0	NO	0	0	0	0	0	0	0	0	1.660808333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6608
H4007_013_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Other	Part B Rx							Radiology	Renal Dialysis	Other								D	D	D	V	T	Coin	O	V	V	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V		V		O	O	V	P	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	0	0	0							0	YES	1005.38	2.27	0	161.47	158.43	8.76	17677.63	599.61	108.34	2718.67	5.49	0	0.65	0.7	6365.03	2780.59	1.56	924.3		515.12	8.83	0		4.5	1.52		0.25		0.43	1.03	307.85	0	93.94	232.76							5000	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	20% Coins: 11a. $0: Diabetic Shoes 11c. 20% DME	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Radiology OP -- Facility"	"$40-$150/Visit: 5. $40 Partial Hospitalization,7h. $150 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$45/Visit: 7b. $20 Chiropractic,7f. $45 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $45 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $45 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$45-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $45 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN783: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER756: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c                       $0: OTC items 13b	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $45 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$45-$150/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $45 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	$0/Script: 15. $0 Part B Rx									185.85435	131.206824	0	0	100	0.2	0	65	138.293608	8.506985	0.2	0	0.2	0.2	10	44.086798	40	46.192003		0	0.2	0		0	0		0		0	0	65.956053	0	148.639684	0							NO	168.350216	118.849503	0	0	95.2552	0.19051	0	61.91588	131.731853	8.103346	0.19051	0	0.19051	0.19051	9.52552	41.994968	38.10208	44.000284		0	0.19051	0		0	0		0		0	0	62.82657	0	141.587028	0								14.1047	0.022482364	0	0	1.257606778	1.6688676	0	3.093781734	1.18931908	1.835860306	1.0458999	0	0.1238315	0.133357	5.05251838	9.730899006	0.00495327	3.389121875	0	0	1.6822033	0	0	0	0	0	0	0	0	0	1.611763298	0	1.108390451	0	0	0	0	0	0	0	47.0555	0	NO	3.108965	14.1047	0.022482364	0	0	1.257606778	1.6688676	0	3.093781734	1.18931908	1.835860306	1.0458999	0	0.1238315	0.133357	5.05251838	9.730899006	0.00495327	3.389121875	0	0	1.6822033	0	0	0	0	0	0	0	0	0	1.611763298	0	1.108390451	0	0	0	0	0	0	0	47.0555	NO																																																																																		0	0	NO	0	14.1047	0.022482364	0	0	1.257606778	1.6688676	0	3.093781734	1.18931908	1.835860306	1.0458999	0	0.1238315	0.133357	5.05251838	9.730899006	0.00495327	3.389121875	0	0	1.6822033	0	0	0	0	0	0	0	0	0	1.611763298	0	1.108390451	0	0	0	0	0	0	0	47.0555
H4007_801_0	2012	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	112.75	1.31	20.12	11.2	3.85	6.23	1.89	10.86	28.88	3.89	13.4	0.3	0.21	8.44	17.16	43.04	0.29	3.4		6.98	14.88	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																					0.1526	0.1526	0.1223	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.141158	0.141158	0.116962	0	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719	0.216719		0.216719	0.216719	0																				15.9156	0.18491698	2.35327544	0	0.83436815	1.35015937	0.40959891	2.35356834	6.25884472	0.84303691	2.9040346	0.0650157	0.04551099	1.82910836	3.71889804	9.32758576	0.06284851	0.7368446	0	1.51269862	3.22477872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9307	0	NO	2.604436	15.9156	0.18491698	2.35327544	0	0.83436815	1.35015937	0.40959891	2.35356834	6.25884472	0.84303691	2.9040346	0.0650157	0.04551099	1.82910836	3.71889804	9.32758576	0.06284851	0.7368446	0	1.51269862	3.22477872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9307	NO																																																																																		0	0	NO	0	15.9156	0.18491698	2.35327544	0	0.83436815	1.35015937	0.40959891	2.35356834	6.25884472	0.84303691	2.9040346	0.0650157	0.04551099	1.82910836	3.71889804	9.32758576	0.06284851	0.7368446	0	1.51269862	3.22477872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9307
H4007_802_0	2012	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	112.4	1.3	20.06	11.17	3.84	6.21	1.89	10.83	28.79	3.88	13.36	0.3	0.21	8.42	17.1	42.9	0.29	3.39		6.95	14.84	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.138794	0.138794	0.113924	0	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854		0.216854	0.216854	0																				15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	0	NO	2.506132	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	NO																																																																																		0	0	NO	0	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568
H4007_803_0	2012	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	112.4	1.3	20.06	11.17	3.84	6.21	1.89	10.83	28.79	3.88	13.36	0.3	0.21	8.42	17.1	42.9	0.29	3.39		6.95	14.84	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.138794	0.138794	0.113924	0	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854		0.216854	0.216854	0																				15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	0	NO	2.506132	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	NO																																																																																		0	0	NO	0	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568
H4007_805_0	2012	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	112.4	1.3	20.06	11.17	3.84	6.21	1.89	10.83	28.79	3.88	13.36	0.3	0.21	8.42	17.1	42.9	0.29	3.39		6.95	14.84	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.138794	0.138794	0.113924	0	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854		0.216854	0.216854	0																				15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	0	NO	2.506132	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	NO																																																																																		0	0	NO	0	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568
H4007_806_0	2012	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	112.4	1.3	20.06	11.17	3.84	6.21	1.89	10.83	28.79	3.88	13.36	0.3	0.21	8.42	17.1	42.9	0.29	3.39		6.95	14.84	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.138794	0.138794	0.113924	0	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854		0.216854	0.216854	0																				15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	0	NO	2.506132	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	NO																																																																																		0	0	NO	0	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568
H4007_807_0	2012	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	112.4	1.3	20.06	11.17	3.84	6.21	1.89	10.83	28.79	3.88	13.36	0.3	0.21	8.42	17.1	42.9	0.29	3.39		6.95	14.84	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																					0.1497	0.1497	0.1189	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.138794	0.138794	0.113924	0	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854	0.216854		0.216854	0.216854	0																				15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	0	NO	2.506132	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568	NO																																																																																		0	0	NO	0	15.6004	0.1804322	2.28531544	0	0.83271936	1.34666334	0.40985406	2.34852882	6.24322666	0.84139352	2.89716944	0.0650562	0.04553934	1.82591068	3.7082034	9.3030366	0.06288766	0.73513506	0	1.5071353	3.21811336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4568
H4011_001_0	2012	3																																				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	5.562320223	0.34418907	206.9950914	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	10% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"10% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$40/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, 14a-b, 14d-e"	$10/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, 14a-e, 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 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	40	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0.1	40	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.556232022	0.034418907	0.689983638	0	0	0	0	0	0	0	3.333333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.614	0	NO	3.55E-15	0	0	0	0	0	0.556232022	0.034418907	0.689983638	0	0	0	0	0	0	0	3.333333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.614	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"	$40/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, 14a-b, 14d-e"	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, 14a-e, 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 for Eyewear; PBP 17b	20% Coinsurance for Hearing Exams; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	0.4353	0.0373	0	0.0443	0.4808	0.5135	0.6172	0.1572	0.0008	0.3191	0.1294	0	0	0	0.5583	0.1953	0.0249	0.0067	0.0054	1.9261	0.0064	0	0	0.0124	0	0	0.0004	0	0	0											5.4706	0	NO	0.105165907	0.4353	0.037254861	0	0.0442716	0.480759654	1.069693866	0.651634556	0.847178432	0.000837509	0.319100643	0.129367399	0	0	3.34E-05	0.558300611	3.528595232	0.024876041	0.006671914	0.005394825	1.926142693	0.006366753	0	0	0.012378767	0	0	0.000424999	0	0	0	0	0	0	0	0	0	0	0	0	0	10.0845
H4011_003_0	2012	5																																				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	7.422024409	1.472857985	288.4554277	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	10% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"10% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$40/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, 14a-b, 14d-e"	$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, 14a-e, 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 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	40	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	0.1	0.1	40	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	0.742202441	0.147285799	0.961518092	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	3.5177	0	NO	0	0	0	0	0	0	0.742202441	0.147285799	0.961518092	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	3.5177	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"	$40/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, 14a-b, 14d-e"	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; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14a-e, 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 for Eyewear; PBP 17b	20% Coinsurance for Hearing Exams; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	0.4209	0.0535	0	0.0109	0.3862	0.6371	0.631	0.1574	0	0.3388	0.2592	0	0	0	0.5802	0.2767	0.0298	0.0084	0.0019	1.6312	0.0029	0	0	0.0228	0	0	0	0	0	0											5.4489	0	NO	0.180193435	0.4209	0.053522366	0	0.010858011	0.386173797	1.379278198	0.77826309	1.118963662	0	0.338798293	0.259184755	0	0	0	0.580197892	1.943354672	0.029829818	0.008406887	0.001918071	1.631215941	0.002912318	0	0	0.022825615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9666
H4011_801_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_802_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_803_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_805_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_806_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_807_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_809_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_810_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_811_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	30.85696952	3.507431965	0.687481416	0	0.415856856	10.3591426	0.495141183	6.518809145	0.919270395	25.47112318	22.99336706	0	0	0	77.86517532	8.783094219	1.153114128	10.02937133	7.664804736	136.5676401	6.426512119	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.146840696	0.146840696	0.115053221	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.14013396	0.14013396	0.109798332	0	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0	0	0	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0.213769125	0	0	0	0	0	0	0	0	0												4.3241	0.49151033	0.075484313	0	0.088897356	2.214464848	0.105845897	1.393520125	0.196511628	5.44493971	4.915271952	0	0	0	16.64517038	1.877554364	0.246500198	2.14396993	1.6384986	29.1939449	1.373789871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.37	0	NO	3.463588457	4.3241	0.49151033	0.075484313	0	0.088897356	2.214464848	0.105845897	1.393520125	0.196511628	5.44493971	4.915271952	0	0	0	16.64517038	1.877554364	0.246500198	2.14396993	1.6384986	29.1939449	1.373789871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.37	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.7087	0.0755	0	0	0.4039	0.7126	0.9501	0.4178	0.0009	0.2524	0.2287	0	0	0	0.7412	0.2722	0.0134	0.007	0.0023	2.1925	0.0074	0	0	0	0	0	0	0	0	0											6.9866	0	NO	0.134420457	5.0328	0.567023793	0.075484313	0	0.492783853	2.927098273	1.05591009	1.811361704	0.197395858	5.697315178	5.143995234	0	0	3.53E-05	17.38638797	2.149710816	0.259859956	2.151014049	1.640837168	31.3864632	1.381164833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3566
H4011_813_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_814_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_815_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_817_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_818_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4011_819_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	34.79446105	3.334083995	0.309015719	0	0.258869839	10.63903656	0.57577441	6.543876392	1.6604438	25.06603252	23.7596039	0	0	0	80.1004478	9.740244952	1.171018469	9.529139281	6.675315918	143.7082734	3.85429805	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142852095	0.142852095	0.113509013	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0.213391461	0	0	0	0	0	0	0	0	0												4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	0	NO	3.702076598	4.9705	0.476280885	0.035076069	0	0.055240613	2.270279559	0.122865343	1.396407346	0.354324529	5.348877309	5.070096597	0	0	0	17.09275161	2.078485104	0.249885342	2.033436956	1.424455418	30.66611847	0.822474293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4675	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				10000	0.5171	0.0433	0	0	0.4006	0.7908	1.0837	0.2379	0.0022	0.3083	0.2371	0	0	0.0001	0.8008	0.2864	0.0135	0.0149	0.0048	1.9317	0.0154	0	0	0	0	0	0	0	0	0											6.6886	0	NO	0.13788452	5.4876	0.519600631	0.035076069	0	0.45583252	3.061036395	1.206602237	1.634276941	0.356502774	5.65722269	5.307165141	0	0	9.92E-05	17.8935156	2.364870307	0.26341218	2.048346298	1.429256877	32.59783761	0.837859697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1561
H4012_003_0	2012	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	0.287588653	16.1980841	0	0	0	0	0	0	0	0	4066.249813	781.0782824	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	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME, 5% Coinsurance for Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 5% Coinsurance for Prosthetics; PBP 11b-c"	No Cost Sharing; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$1/Visit for Speclst Office Visits; $1/Visit for Alternative Medicine; PBP 7b, 7d, 7f, 17a, 18a"	"$1/Visit for OP Psych - Non-Physician; $1/Visit for OP Psych - Psychiatrist; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.078465067	0	0	0	0	0	0	0	0	1	1	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0.078465067	0	0	0	0	0	0	0	0	1	1	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.028758865	1.270983753	0	0	0	0	0	0	0	0	0.338854151	0.065089857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7037	0	NO	0	0	0	0	0	0	0.028758865	1.270983753	0	0	0	0	0	0	0	0	0.338854151	0.065089857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7037	NO																																										0	0	0	0	0	0	0	0	0	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	0.028758865	1.270983753	0	0	0	0	0	0	0	0	0.338854151	0.065089857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7037
H4012_008_0	2012	13																																				Coin	Coin			Coin	Coin					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	0	0	0	0	0	0.189799455	9.392827095	0	0	1.059440264	1.381938182	0	0	0	0	3218.671273	608.6708737	0	14.41736002	0.002232648	0	1122.437334	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	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	No Cost Sharing; PBP 4a-b	No Cost Sharing; PBP 9a-b	10% Coinsurance for OP Fac - Pathology; PBP 8a	10% Coinsurance for OP Fac - Radiology; $10/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$7/Visit for Speclst Office Visits; $15/Visit for Alternative Medicine; PBP 7b, 7d, 7f, 17a, 18a"	"$7/Visit for OP Psych - Non-Physician; $7/Visit for OP Psych - Psychiatrist; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	10% Coinsurance for Prof Radiology (Office); $10/Procedure for Prof Radiology (Office); PBP 7d	"No Cost Sharing; PBP 7d, 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.109831196	0	0	0.1	0.079170313	0	0	0	0	7.497099537	7	0	0.080324802	0.1	0	7	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0.109831196	0	0	0.1	0.079170313	0	0	0	0	7.497099537	7	0	0.080324802	0.1	0	7	0	0	0	0	0	0	0	0												0	0	0	0	0	0.018979945	1.031625433	0	0	0.105944026	0.109408478	0	0	0	0	2.010891576	0.35505801	0	1.15807159	0.000223265	0	0.654755111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.445	0	NO	0	0	0	0	0	0	0.018979945	1.031625433	0	0	0.105944026	0.109408478	0	0	0	0	2.010891576	0.35505801	0	1.15807159	0.000223265	0	0.654755111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.445	NO																																										0	0	0	0	0	0	0	0	0	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	0.018979945	1.031625433	0	0	0.105944026	0.109408478	0	0	0	0	2.010891576	0.35505801	0	1.15807159	0.000223265	0	0.654755111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.445
H4012_009_0	2012	11																															A	A	A			Coin	Coin		P		V			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	278.3006336	12.31749049	44.67307182	0	0	0.286971089	16.16330056	0	226.1677289	0	164.3507476	0	0	265.9660134	0	6054.42642	782.0798922	872.2545772	2418.399015	0	0	0	0	1271.774696	0	0	0	0	0	0											6700	$3/Admit for IP; PBP 1a	$3/Admit for IP MH/SA; PBP 1b	$3/Admit for SNF; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	15% Coinsurance for DME; PBP 11a	"15% Coinsurance for DME, 10% for Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c"	No Cost Sharing; PBP 4a-b	$1/Procedure for OP Fac - Surgery; $1/Procedure for OP Fac - Surgery; PBP 9a-b	No Cost Sharing; PBP 8a	$3/Visit for OP Fac - Radiology; $3/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$3/Visit for OP Fac - Cardiovascular; $1/Visit for OP Fac - Occ Therapy; $1/Visit for OP Fac - Physical/Speech Therapy; $1/Visit for OP Fac - CORF; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$1/Visit for Speclst Office Visits; $1/Visit for Chiropractor; $1/Visit for Vision Exams; $1/Visit for Hearing/Speech Exams; $3/Visit for Alternative Medicine; PBP 7b, 7d, 7f, 17a, 18a"	"$1/Visit for OP Psych - Non-Physician; $1/Visit for OP Psych - Psychiatrist; $1/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$1/Visit for Occ Therapy; $1/Visit for PT/ST; PBP 7c, 7i"	$3/Procedure for Prof Radiology (Office); $3/Procedure for Prof Radiology (Office); PBP 7d	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	$1/Procedure for Dental - Comprehensive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	3	3	3	0	0	0.15	0.124037717	0	1	0	3	0	0	1.588808387	0	1.066067365	1	1	3	0	0	0	0	1	0	0	0	0	0	0											NO	3	3	3	0	0	0.15	0.124037717	0	1	0	3	0	0	1.588808387	0	1.066067365	1	1	3	0	0	0	0	1	0	0	0	0	0	0												0.0696	0.003079373	0.011168268	0	0	0.043045663	2.004858908	0	0.018847311	0	0.041087687	0	0	0.035214086	0	0.537868868	0.065173324	0.072687881	0.604599754	0	0	0	0	0.105981225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.6132	0	NO	8.88E-16	0.0696	0.003079373	0.011168268	0	0	0.043045663	2.004858908	0	0.018847311	0	0.041087687	0	0	0.035214086	0	0.537868868	0.065173324	0.072687881	0.604599754	0	0	0	0	0.105981225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.6132	NO																																										0	0	0	0	0	0	0	0	0	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	0.0696	0.003079373	0.011168268	0	0	0.043045663	2.004858908	0	0.018847311	0	0.041087687	0	0	0.035214086	0	0.537868868	0.065173324	0.072687881	0.604599754	0	0	0	0	0.105981225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.6132
H4036_003_0	2012	11	H.6										OP Facility - Other										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	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	YES	1319.08461	62.69559216	247.7052566	242.4720116	70.94714299	9.1249653	5.332009217	347.1954598	427.5868001	7720.194549	787.0171888	0.836260421	0.002735814	1028.966842	3477.692263	3944.074237	5.224003813	1595.247324	840.4431786	1985.152881	41.42133422	12.54950765	0	0	0	0	0	0	5872.8	401.5776004	13.42946147	0	0	0	0	0	0	0	0	0	3400	1A: $175/day (days1-6) $1050 yrly max	1B: $175/day (days1-6) $1050 yrly max	2: $146/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: $0 - $150 copay; 9B: $0-$150 copay	8A: $0-$120 copay	8B: $60-$120 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $20-$150 copay; 9C: $40 copay	7A: $5 copay; 7G: $5 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $60-$120 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	93.73473847	92.97102679	146	0	100	0.2	0.095164852	49.32226101	137.4025072	16.02308367	85.26252874	40	0.2	39.88349618	5	20	40	40	71.19450122	0.30050424	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	82.97125084	82.29523559	129.2349328	0	88.51707723	0.177034154	0.084237145	43.65862387	121.6246834	14.18316535	75.47189841	35.40683089	0.177034154	35.30370511	4.425853861	17.70341545	35.40683089	35.40683089	63.01929163	0.265997571	0.177034154	0	0	0	0	0	0	0	0	0	0.177034154	0	0	0	0	0	0	0	0	0		9.1205	0.429962377	2.667681015	0	0.523336145	1.615430516	0.449153235	1.263172999	4.333759099	9.124732982	4.949806777	0.002467444	0.000484332	3.027195164	1.282646478	5.818632063	0.015413785	4.706887687	4.413677814	0.04400382	7.33299088	0	0	0	0	0	0	0	0	0	2.377473356	0	0	0	0	0	0	0	0	0	63.4994		NO	8.237494011	9.1205	0.429962377	2.667681015	0	0.523336145	1.615430516	0.449153235	1.263172999	4.333759099	9.124732982	4.949806777	0.002467444	0.000484332	3.027195164	1.282646478	5.818632063	0.015413785	4.706887687	4.413677814	0.04400382	7.33299088	0	0	0	0	0	0	0	0	0	2.377473356	0	0	0	0	0	0	0	0	0	63.4994	YES	1A: 30% coin	1B: 30% coin	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: $20 copay	9A: $225 copay; 9B: $225 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $30-$225 copay; 9C: $50 copay	7A: $15 copay; 7G: $15 copay	7B: $30 copay; 7D: $30 copay; 7F: $30 copay	7E: $50 copay; 7H: $50 copay	7C: $60 copay; 7I: $60 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	13.4496	0.1673	1.1868	0	0.8616	0.744	0.4729	0.1803	0.7771	1.8303	0.6619	0.003	0.0092	0.636	0.4631	1.7119	0.0091	0.7898	1.8093	0.1884	0.9969	0	0	0	0	0	0	0	0	0	0.1145	0	0	0	0	0	0	0	0	0	27.063		NO	3.510764725	22.5701	0.597290666	3.85443263	0	1.384967178	2.359480024	0.922082926	1.443441006	5.110833925	10.95498705	5.611708889	0.005498572	0.009686649	3.663222833	1.745731866	7.530497517	0.024507109	5.496735712	6.223013645	0.232385016	8.329873058	0	0	0	0	0	0	0	0	0	2.492004754	0	0	0	0	0	0	0	0	0	90.5624
H4036_004_0	2012	11	H.6										OP Facility - Other										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	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	YES	1037.573052	11.45471168	154.3936992	25.33957935	41.58268667	4.745397808	5.038407475	212.0977076	395.7025191	6526.391965	644.0737202	0	0	1183.293042	3589.089901	2982.088486	2.39933836	968.6741746	775.4461728	1848.576187	20.8751707	23.26826891	0	0	0	0	0	0	5872.8	216.3005507	9.630192996	0	0	0	0	0	0	0	0	0	4500	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$150 copay	8B: $105-$150 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $45-$200 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $55 copay; 7I: $55 copay	8B: $105-$150 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	157.2344726	198.1666667	146	0	175	0.2	0.14886622	64.35972321	186.097992	28.07284396	122.5595118	40	0.2	54.99425958	0	43.055928	40	55	112.257284	0.770174365	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	141.4555183	178.280043	131.348459	0	157.4382214	0.179929396	0.133927045	57.90103056	167.4224963	25.25564926	110.2602946	0	0	49.4754195	0	38.73513556	35.98587917	49.48058385	100.9919265	0.692885041	0.179929396	0	0	0	0	0	0	0	0	0	0.179929396	0	0	0	0	0	0	0	0	0		12.2309	0.170178874	1.689947872	0	0.545558686	0.85383656	0.674779026	1.023389654	5.520791962	13.73568887	5.917979842	0	0	4.87865997	0	9.625966814	0.007195192	3.994213643	6.526150238	0.106737566	3.756056853	0	0	0	0	0	0	0	0	0	1.732754808	0	0	0	0	0	0	0	0	0	72.9908		NO	8.141907904	12.2309	0.170178874	1.689947872	0	0.545558686	0.85383656	0.674779026	1.023389654	5.520791962	13.73568887	5.917979842	0	0	4.87865997	0	9.625966814	0.007195192	3.994213643	6.526150238	0.106737566	3.756056853	0	0	0	0	0	0	0	0	0	1.732754808	0	0	0	0	0	0	0	0	0	72.9908	YES	1A: 30% coin	1B: 30% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $175 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $45 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $50-$275 copay; 9C: $50 copay	7A: $35 copay; 7G: $35 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay	7E: $50 copay; 7H: $50 copay	7C: $90 copay; 7I: $90 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$50; 17B: $0; 18A: $50	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4500	10.9127	0.1977	2.2075	0	1.2076	0.4522	0.4336	0.1876	1.2405	1.4748	0.9597	0	0	1.2119	0.9501	3.0688	0.0081	1.8387	1.8508	0.3902	0.9443	0	0	0	0	0	0	0	0	0	0.1489	0	0	0	0	0	0	0	0	0	29.6858		NO	3.311365987	23.1436	0.367912367	3.897487731	0	1.75315957	1.306020628	1.108372057	1.211012505	6.761339129	15.21049999	6.877666506	0	0	6.090530193	0.950056018	12.69479982	0.015332611	5.832915596	8.376902936	0.496961386	4.700332756	0	0	0	0	0	0	0	0	0	1.881702319	0	0	0	0	0	0	0	0	0	102.6766
H4036_801_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H4036_802_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H4036_803_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H4036_804_0	2012	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	293.9567698	3.417709527	74.51950805	0	11.13719843	15.22013335	9.482156984	17.28236048	55.51104698	7.805655076	26.11581595	0	0.445781918	27.1202502	34.38818877	69.78193885	1.659410162	6.382064388	30.30835047	104.0665048	47.81118016	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077531623	0.077531623	0.167621029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.060770982	0.060770982	0.131385029	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0.1755761	0	0	0	0	0	0	0	0	0												17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	0	NO	30.17825072	17.864	0.207697563	9.79074775	0	1.955425864	2.672291654	1.664840142	3.03436945	9.746413132	1.370486476	4.585313112	0	0.078268651	4.76166776	6.037744068	12.25204067	0.291352764	1.120537975	5.321421971	18.27159104	8.394500545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4208	YES	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			10000	2.1534	0.025	1.1802	0	0.2428	0.3318	0.2067	0.3767	1.2101	0.1702	0.5693	0	0.0097	0.5912	0.7497	1.5212	0.0362	0.1391	0.659	2.2374	1.0423	0	0	0	0	0	0	0	0	0											13.4521	0	NO	1.90631892	20.0174	0.232734318	10.97096643	0	2.198212738	3.004085023	1.871547714	3.411118621	10.95653376	1.540646916	5.154628398	0	0.087986534	5.352879347	6.787394071	13.77326155	0.327527302	1.259664656	5.980460813	20.50902699	9.436766877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8729
H4102_001_0	2012	5																															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	1635.216419	152.159262	1619.314114	2929.55899	428.4413	8.63462865	8.159408518	448.9485686	56.06242974	25.53241492	45.577415	0	0.024079646	47.55663504	5560.739277	4555.199805	811.7414411	581.8835182	0	0	13.18544162	1235.552451	0	0	46.58178417	0	5.553525942	0	73.95562004	0											4750	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	66.05144226	0	200	0.2	0.101224386	60.05366309	0.16	0.162115205	0.179445173	0	0.2	0.145673092	10.19186165	34.37959693	38.5	35	0	0	0.2	34.12307947	0	0	35	0	35	0	0	0											YES	154.2336486	80.78133677	48.94049543	0	148.1890289	0.148189029	0.075001717	44.51612145	0.118551223	0.120118474	0.132959029	0	0.148189029	0.10793577	9.738454204	32.88471932	36.78724257	33.44294779	0	0	0.148189029	25.28333005	0	0	35	0	35	0	0	0											4750	21.0171	1.024302382	6.604169584	0	5.290858349	1.279557234	0.611969648	1.665454084	6.646269617	3.066914715	6.059928858	0	0.003568339	5.13306204	4.5127504	12.48303892	2.488477442	1.621658343	0	0	1.953937789	2.603240034	0	0	0.135863537	0	0.016197784	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2183	0	NO	22.98060581	21.0171	1.024302382	6.604169584	0	5.290858349	1.279557234	0.611969648	1.665454084	6.646269617	3.066914715	6.059928858	0	0.003568339	5.13306204	4.5127504	12.48303892	2.488477442	1.621658343	0	0	1.953937789	2.603240034	0	0	0.135863537	0	0.016197784	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2183	NO	"$375 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$30/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1342	0.0097	0	0.0261	0.0214	0	0.0073	0.0067	0.0403	0.0124	0.0359	0	0	0.0311	0.1841	0.3537	0.0558	0.0459	0	0	0.0481	0.0608	0	0	0.004	0	0.0004	0	0	0											1.078	0	NO	0.342021654	21.1513	1.034046519	6.604169584	0.026128754	5.312241217	1.279557234	0.619299679	1.672187765	6.686560708	3.079309572	6.095837721	0	0.003582761	5.16414691	4.696835715	12.8367788	2.544235789	1.667600246	0	0	2.002043741	2.664006787	0	0	0.139824573	0	0.016559437	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2963
H4102_025_0	2012	4																															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	1390.904261	149.0159914	1458.879703	2654.022564	356.5017327	9.145966325	6.351737619	394.7327571	44.07919828	19.89844207	35.21992468	0	0.037449557	36.28530002	4695.110343	4015.723138	823.077204	564.6375068	0	0	8.49375292	1032.83853	0	0	43.23187459	0	253.6377062	0	128.069592	0											4250	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	63.90361982	0	200	0.2	0.111516852	60.32840957	0.16	0.11056622	0.182308235	0	0.2	0.145563748	10.2543517	34.55045078	38.5	35	0	0	0.2	34.04791439	0	0	35	0	35	0	0	0											NO	159.7007866	83.64480214	49.02746501	0	153.4419025	0.153441903	0.085556789	46.30538549	0.122753522	0.084827456	0.139868612	0	0.153441903	0.111677892	9.847867442	33.19907409	36.97385341	33.61259401	0	0	0.153441903	26.1218838	0	0	35	0	35	0	0	0												18.5107	1.038701093	5.960431131	0	4.558525343	1.403374473	0.543434278	1.523187707	5.410876835	1.687934217	4.926161971	0	0.005746331	4.052265825	3.85306869	11.1098575	2.53602799	1.581577606	0	0	1.303297608	2.248307339	0	0	0.126092968	0	0.739776643	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1194	0	NO	16.91433503	18.5107	1.038701093	5.960431131	0	4.558525343	1.403374473	0.543434278	1.523187707	5.410876835	1.687934217	4.926161971	0	0.005746331	4.052265825	3.85306869	11.1098575	2.53602799	1.581577606	0	0	1.303297608	2.248307339	0	0	0.126092968	0	0.739776643	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1194	NO																																										0	0	0	0	0	0	0	0	0	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	18.5107	1.038701093	5.960431131	0	4.558525343	1.403374473	0.543434278	1.523187707	5.410876835	1.687934217	4.926161971	0	0.005746331	4.052265825	3.85306869	11.1098575	2.53602799	1.581577606	0	0	1.303297608	2.248307339	0	0	0.126092968	0	0.739776643	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1194
H4102_801_0	2012	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	229.1429065	11.3268	39.09841451	2231.231765	10.88833258	7.490720175	9.850150826	23.72170786	69.42071608	30.33389265	57.56643087	0	0.025473133	55.53979876	33.45293728	91.14563679	5.2944	16.45629338	0	0	20.26568102	14.03692165	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07645736	0.07645736	0.160950149	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061203224	0.061203224	0.128838714	0	0.179309383	0.179309383	0.179309383	0.179309383	0.179309383	0.179309383	0.179309383	0	0.179309383	0.179309383	0.179309383	0.179309383	0.179309383	0.179309383	0	0	0.179309383	0.179309383	0	0	0	0	0	0	0	0												14.0243	0.693236674	5.037389444	0	1.952380197	1.343156413	1.766224467	4.2535248	12.44778577	5.439151574	10.3222012	0	0.004567572	9.958807047	5.998425543	16.34326789	0.949335597	2.950767813	0	0	3.63382676	2.51695176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6353	150	YES	24.83284641	14.0243	0.693236674	5.037389444	0	1.952380197	1.343156413	1.766224467	4.2535248	12.44778577	5.439151574	10.3222012	0	0.004567572	9.958807047	5.998425543	16.34326789	0.949335597	2.950767813	0	0	3.63382676	2.51695176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6353	NO																																										0	0	0	0	0	0	0	0	0	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	14.0243	0.693236674	5.037389444	0	1.952380197	1.343156413	1.766224467	4.2535248	12.44778577	5.439151574	10.3222012	0	0.004567572	9.958807047	5.998425543	16.34326789	0.949335597	2.950767813	0	0	3.63382676	2.51695176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6353
H4102_802_0	2012	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	228.9586089	11.3281	39.06696799	2230.109685	10.87957519	7.484695454	9.842228435	23.7026287	69.36488159	30.30949536	57.52013068	0	0.025452646	55.49525335	33.42603137	91.07232914	5.2953	16.44305773	0	0	20.24938151	14.02563188	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07645736	0.07645736	0.160950149	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061215617	0.061215617	0.128864804	0	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0	0	0.179345693	0.179345693	0	0	0	0	0	0	0	0												14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769	150	YES	24.79310823	14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769	NO																																										0	0	0	0	0	0	0	0	0	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	14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769
H4102_803_0	2012	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	228.9586089	11.3281	39.06696799	2230.109685	10.87957519	7.484695454	9.842228435	23.7026287	69.36488159	30.30949536	57.52013068	0	0.025452646	55.49525335	33.42603137	91.07232914	5.2953	16.44305773	0	0	20.24938151	14.02563188	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07645736	0.07645736	0.160950149	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061215617	0.061215617	0.128864804	0	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0.179345693	0	0	0.179345693	0.179345693	0	0	0	0	0	0	0	0												14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769	150	YES	24.79310823	14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769	NO																																										0	0	0	0	0	0	0	0	0	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	14.0158	0.693456635	5.034357165	0	1.951204953	1.342347894	1.76516128	4.250964372	12.44029277	5.435877453	10.31598771	0	0.004564822	9.952834677	5.994814765	16.33342999	0.949689249	2.948991585	0	0	3.631639362	2.51543667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5769
H4123_001_0	2012	8																															D	D	D		T	Coin	Coin	V	V		V			V		V	V	V	V	V	Coin	V			V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	712.7088863	11.64301233	463.7800692	0	207.4453407	9.48124247	6.200018407	239.4838728	317.8724573	0	135.7945738	0	0	1720.250313	0	4477.588783	111.1651885	409.2216972	923.3305439	80.1322381	35.12194811	492.0871324	0	0	315.2247277	0	135.0963119	0	0	45											3400	$225/Days 1-7 for IP Medical and IP Surgical; PBP 1a	$225/Days 1-7 for IP Psych and IP Substance Abuse; PBP 1b	$130/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 DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9c	No Cost-Sharing; PBP 12	"$35/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; $35/Visit for OP Fac - Other; $30/Visit for Prof - CORF; PBP 3, 5, 9d"	No Cost-Sharing; PBP 7a	"$30/Visit for Prof - Asst Surgeon (OP); $30/Visit for Speclst Office Visits; $30/Visit for Cardio; $10/Visit for Chiropractor; $30/Visit for Speclst Immunizations; $30/Visit for Vision Exams; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f"	"$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"	$30/Case for Prof Radiology (Office); $30/Case for Prof Radiology (Office); PBP 7d	"$30/Visit for Allergy Testing; $30/Visit for Allergy Tx; PBP 7g, 18a, 14a, 14b, 14d, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$35/Visit for Renal Dialysis - Prof; PBP 16b, 17a, 18a"	PBP 10b	"PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$30/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	$30/Visit for Accupuncture; PBP 13a-c											0	NO	225	225	130	0	125	0.2	0.2	65	200	0	100	0	0	33.51183005	0	28.56087448	30	30	30	30	0.2	35	0	0	30	0	30	0	0	30											NO	219.0826264	219.0826264	126.581073	0	121.7125702	0.194740112	0.194740112	63.29053652	194.723774	0	97.37005619	0	0	32.63048775	0	27.81895906	29.21101686	29.21101686	29.21101686	29.21101686	0.194740112	34.07951967	0	0	30	0	30	0	0	30												13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.158110379	0	1.10186044	0	0	4.677717231	0	10.38015492	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	59.0402	0	NO	1.56886449	13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.158110379	0	1.10186044	0	0	4.677717231	0	10.38015492	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	59.0402	NO																$30/Visit for Speclst Office Visits																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5373	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.5373	0	NO	0	13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.158110379	0	1.10186044	0	0	4.677717231	0	10.91746557	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	59.5775
H4123_002_0	2012	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	304.9702277	3.360200612	93.16361419	0	10.90650559	14.49196452	9.203445163	19.94175505	54.59848263	6.968859281	20.92001086	0	0.524235657	36.09263481	34.25647882	58.36357838	1.40920568	5.302060619	22.85623315	79.53091225	46.85514163	10.78384173	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	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	No Cost-Sharing; PBP 9c	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	Medicare-FFS Cost Sharing; PBP 7a	"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, 14a, 14b, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 16b, 17a, 18a"	No coverage; PBP 10b	"No coverage; PBP 16a, 16b"	No coverage; PBP 17a	No coverage; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No coverage; PBP 14c	No Cost Sharing: PBP 13a-c											0	NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												26.1005	0.287578116	15.40712502	0	2.443057253	3.246200053	2.061571717	4.466953131	12.23006011	1.561024479	4.686082433	0	0.117428787	8.084750198	7.673451255	13.07344156	0.315662072	1.187661579	5.119796226	17.81492434	10.49555172	2.415580547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.7884	0	NO	0	26.1005	0.287578116	15.40712502	0	2.443057253	3.246200053	2.061571717	4.466953131	12.23006011	1.561024479	4.686082433	0	0.117428787	8.084750198	7.673451255	13.07344156	0.315662072	1.187661579	5.119796226	17.81492434	10.49555172	2.415580547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.7884	NO																																										0	0	0	0	0	0	0	0	0	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	26.1005	0.287578116	15.40712502	0	2.443057253	3.246200053	2.061571717	4.466953131	12.23006011	1.561024479	4.686082433	0	0.117428787	8.084750198	7.673451255	13.07344156	0.315662072	1.187661579	5.119796226	17.81492434	10.49555172	2.415580547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.7884
H4123_003_0	2012	5																															D	D	D		T	Coin	Coin	V	V		V			V		V	V	V	V	V	Coin	V			V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	712.7088863	11.64301233	463.7800692	0	207.4453407	9.48124247	6.200018407	239.4838728	318.0643944	0	135.7945738	0	0	1720.250313	0	4477.588783	111.1651885	409.2216972	923.3305439	80.1322381	35.12194811	492.0871324	0	0	315.2247277	0	135.0963119	0	0	45											3400	$225/Days 1-7 for IP Medical and IP Surgical; PBP 1a	$225/Days 1-7 for IP Psych and IP Substance Abuse; PBP 1b	$130/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 DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; PBP 4a, 4b"	"$195/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9c	No Cost-Sharing; PBP 12	"$35/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; $35/Visit for OP Fac - Other; $30/Visit for Prof - CORF; PBP 3, 5, 9d"	No Cost-Sharing; PBP 7a	"$30/Visit for Prof - Asst Surgeon (OP); $30/Visit for Speclst Office Visits; $30/Visit for Cardio; $10/Visit for Chiropractor; $30/Visit for Speclst Immunizations; $30/Visit for Vision Exams; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f"	"$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"	$30/Case for Prof Radiology (Office); $30/Case for Prof Radiology (Office); PBP 7d	"$30/Visit for Allergy Testing; $30/Visit for Allergy Tx; PBP 7g, 18a, 14a, 14b, 14d, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$35/Visit for Renal Dialysis - Prof; PBP 16b, 17a, 18a"	PBP 10b	"PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$30/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	$30/Visit for Accupuncture; PBP 13a-c											0	NO	225	225	130	0	125	0.2	0.2	65	195	0	100	0	0	33.51183005	0	28.56087448	30	30	30	30	0.2	35	0	0	30	0	30	0	0	30											NO	219.0826264	219.0826264	126.581073	0	121.7125702	0.194740112	0.194740112	63.29053652	189.8716096	0	97.37005619	0	0	32.63048775	0	27.81895906	29.21101686	29.21101686	29.21101686	29.21101686	0.194740112	34.07951967	0	0	30	0	30	0	0	30												13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.032616543	0	1.10186044	0	0	4.677717231	0	10.38015492	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	58.9147	0	NO	1.56886449	13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.032616543	0	1.10186044	0	0	4.677717231	0	10.38015492	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	58.9147	NO																$30/Visit for Speclst Office Visits																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5485	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.5485	0	NO	0	13.0118	0.212565143	4.892148235	0	2.1040588	1.846378224	1.207392281	1.263088567	5.032616543	0	1.10186044	0	0	4.677717231	0	10.92865955	0.270604016	0.996148491	2.247618673	0.195062013	6.839652121	1.397507759	0	0	0.788061819	0	0.33774078	0	0	0.1125	0	0	0	0	0	0	0	0	0	0	59.4632
H4123_004_0	2012	8																															D	D	D		T	Coin	Coin	V	V		V			V		V	V	V	V	V	Coin	V			V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	668.2408201	10.92449225	465.724189	0	207.4453407	9.48124247	6.200018407	239.4838728	319.5995077	0	136.4743451	0	0	1723.251377	0	4552.647788	113.5637017	418.4498887	938.5966674	81.18773946	35.12194811	500.841919	0	0	321.3186436	0	137.7079901	0	0	45											3400	$175/Days 1-6 for IP Medical and IP Surgical; PBP 1a	$175/Days 1-6 for IP Psych and IP Substance Abuse; PBP 1b	$100/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 DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; PBP 4a, 4b"	"$155/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9c	No Cost-Sharing; PBP 12	"$35/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; $35/Visit for OP Fac - Other; $20/Visit for Prof - CORF; PBP 3, 5, 9d"	No Cost-Sharing; PBP 7a	"$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $20/Visit for Cardio; $10/Visit for Chiropractor; $20/Visit for Speclst Immunizations; $20/Visit for Vision Exams; $20/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f"	"$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"	$20/Case for Prof Radiology (Office); $20/Case for Prof Radiology (Office); PBP 7d	"$20/Visit for Allergy Testing; $20/Visit for Allergy Tx; PBP 7g, 18a, 14a, 14b, 14d, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$20/Visit for Renal Dialysis - Prof; PBP 16b, 17a, 18a"	PBP 10b	"PBP 16a, 16b"	$20/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$20/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	$20/Visit for Accupuncture; PBP 13a-c											0	NO	175	175	100	0	125	0.2	0.2	65	155	0	100	0	0	30.51714248	0	19.29230059	20	20	20	20	0.2	20	0	0	20	0	20	0	0	20											NO	171.7498638	171.7498638	98.14277932	0	122.6784742	0.196285559	0.196285559	63.79280656	152.1071912	0	98.14277932	0	0	29.95037179	0	18.93833254	19.62855586	19.62855586	19.62855586	19.62855586	0.196285559	19.62855586	0	0	20	0	20	0	0	20												9.5642	0.156356671	3.808955526	0	2.120756489	1.861030975	1.216974077	1.273112364	4.051115285	0	1.116164295	0	0	4.301001619	0	7.184963145	0.185757622	0.684463918	1.53527476	0.13279984	6.893931205	0.819233632	0	0	0.535531073	0	0.229513317	0	0	0.075	0	0	0	0	0	0	0	0	0	0	47.7461	0	NO	0.890606351	9.5642	0.156356671	3.808955526	0	2.120756489	1.861030975	1.216974077	1.273112364	4.051115285	0	1.116164295	0	0	4.301001619	0	7.184963145	0.185757622	0.684463918	1.53527476	0.13279984	6.893931205	0.819233632	0	0	0.535531073	0	0.229513317	0	0	0.075	0	0	0	0	0	0	0	0	0	0	47.7461	NO																$20/Visit for Speclst Office Visits																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3794	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.3794	0	NO	0	9.5642	0.156356671	3.808955526	0	2.120756489	1.861030975	1.216974077	1.273112364	4.051115285	0	1.116164295	0	0	4.301001619	0	7.564350461	0.185757622	0.684463918	1.53527476	0.13279984	6.893931205	0.819233632	0	0	0.535531073	0	0.229513317	0	0	0.075	0	0	0	0	0	0	0	0	0	0	48.1255
H4125_001_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1279.931114	37.31484964	274.1315363		111.3601401	8.238076113	6.162721679	340.1117934	218.2419795		11.06022017	32.26650624	0.112049804	17.18281269		2348.240413	56.99217433	291.3729814			13.27173158				159.1037094		0.594140309														4500	"1a - IP Acute 240 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 200 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 275 copay,9b - OP Ambulatory Surgical Center (ASC) 275 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 275 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 25 copay,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 31"													148.5489218	142.4713977	60.09645318		200	0.2	0.2	63.90613675	275		0.2	275	0.2	0.199269477		24.68190449	39.99905516	20			0.2				5		25														NO	140.7869255	135.026965	56.95628604		189.5495758	0.189549576	0.189549576	60.56690556	260.6306667		0.189549576	260.6306667	0.189549576	0.188857225		23.40927522	37.90948927	18.95495758			0.189549576				5		25															15.0165	0.419875908	1.301126183	0	1.759022276	1.561523833	1.16814128	1.716626573	4.740046051	0	2.096460041	0.70080342	0.021238993	3.245098315	0	4.580883842	0.180045352	0.460246875	0	0	2.51565109	0	0	0	0.066293212	0	0.001237792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5508	0		2.283570192	15.0165	0.419875908	1.301126183	0	1.759022276	1.561523833	1.16814128	1.716626573	4.740046051	0	2.096460041	0.70080342	0.021238993	3.245098315	0	4.580883842	0.180045352	0.460246875	0	0	2.51565109	0	0	0	0.066293212	0	0.001237792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5508	NO																																																																																		0	0		0	15.0165	0.419875908	1.301126183	0	1.759022276	1.561523833	1.16814128	1.716626573	4.740046051	0	2.096460041	0.70080342	0.021238993	3.245098315	0	4.580883842	0.180045352	0.460246875	0	0	2.51565109	0	0	0	0.066293212	0	0.001237792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5508
H4141_001_0	2012	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	1271.95	79.27	404.12	1394.48	216.86	10.51	2.42	350.65	286.03	380.29	855.85	96.02	0.44	198.18	4100.8	3929.78	58.45	781.3		2155.43	23.99	0			0.6				4.14	0.81	12107.39										3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$175/Visit: 3. $10 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												163.989133	116.360647	38.216144	0	200	0.2	0.2	65	250	0	65.155704	41.326305	0.2	77.905542	10	34.765485	35	10		0	0.2	0			0				0	0	0										NO	135.868276	96.407123	33.748409	0	180.6768	0.180677	0.180677	58.71996	225.846	0	58.86062	37.333523	0.180677	70.37862	9.03384	31.406583	31.61844	9.03384		0	0.180677	0			0				0	0	0											14.4015	0.636849387	1.13653392	0	3.265130904	1.89891527	0.43723834	1.715846165	5.383227615	0	4.197988469	0.298730407	0.07949788	1.162302909	3.087164256	10.28508015	0.154008152	0.588178266	0	0	4.33444123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0626	0	NO	7.208045	14.4015	0.636849387	1.13653392	0	3.265130904	1.89891527	0.43723834	1.715846165	5.383227615	0	4.197988469	0.298730407	0.07949788	1.162302909	3.087164256	10.28508015	0.154008152	0.588178266	0	0	4.33444123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0626	NO																																																																																		0	0	NO	0	14.4015	0.636849387	1.13653392	0	3.265130904	1.89891527	0.43723834	1.715846165	5.383227615	0	4.197988469	0.298730407	0.07949788	1.162302909	3.087164256	10.28508015	0.154008152	0.588178266	0	0	4.33444123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0626
H4141_003_0	2012	9	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.863979536	0.218963034	0	1.765988154	0.218894744	0.828575255	0.051283092	0.028938495	0.593652361	1.585574656	2.589594913	0.050099382	0.177750106		0	1.025663323	0	0	0	0				0	0	0	0	0								9.999	YES	394.59	8.47	51.11	5050.53	17.84	24.58	6.23	683.28	50.25	6.23	23.57	1.46	0.82	16.89	45.11	73.68	1.43	5.06		1717.7	29.18	0	3.51	2.4	1.52				1.34	0.84	1333.87	364.74	232.36								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0806	0.0806	0.174	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.064447	0.064447	0.125686	0	0.179799	0.179799	0.179799	58.434675	0.179799	0.179799	0.179799	0.179799	0.179799	0.179799	0.179799	0.179799	0.179799	0.179799		0	0.179799	0	0	0	0				0	0	0	0	0									25.4301	0.54586609	6.42381146	0	3.20761416	4.41945942	1.12014777	3.327270395	9.03489975	1.12014777	4.23786243	0.26250654	0.14743518	3.03680511	8.11073289	13.24759032	0.25711257	0.90978294	0	0	5.24653482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0857	162	YES	15.461546	25.4301	0.54586609	6.42381146	0	3.20761416	5.283438956	1.339110804	3.327270395	10.8008879	1.339042514	5.066437685	0.313789632	0.176373675	3.630457471	9.696307546	15.83718523	0.307211952	1.087533046	0	0	6.272198143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0847	NO																																																																																		0	0	NO	0	25.4301	0.54586609	6.42381146	0	3.20761416	5.283438956	1.339110804	3.327270395	10.8008879	1.339042514	5.066437685	0.313789632	0.176373675	3.630457471	9.696307546	15.83718523	0.307211952	1.087533046	0	0	6.272198143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0847
H4141_004_0	2012	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			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	1410.04	56.57	491.55	2339.71	234.29	11.85	1.65	354.85	277.88	581.82	1209.41	91.67	0.45	381.56	4084.5	4266.69	84.4	667.33		1830.81	23.94	0			0.6				4.14	0.81	10713.55										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$175/Visit: 3. $10 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"												163.989133	116.360647	68.0721	0	200	0.2	0.2	65	225	0	70.110629	36.632192	0.2	52.422484	10	34.644863	35	10		0	0.2	0			0				0	0	0										NO	125.076315	88.749545	51.198524	0	173.5352	0.173535	0.173535	56.39894	195.2271	0	60.83331	31.784873	0.173535	45.485731	8.67676	30.060516	30.36866	8.67676		0	0.173535	0			0				0	0	0											14.6969	0.418380147	2.097219539	0	3.388130167	2.05638975	0.28633275	1.667763655	4.520808879	0	6.131034454	0.242809942	0.07809075	1.446294627	2.953352185	10.68824192	0.213592909	0.482521854	0	0	4.1544279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5223	0	NO	11.23582	14.6969	0.418380147	2.097219539	0	3.388130167	2.05638975	0.28633275	1.667763655	4.520808879	0	6.131034454	0.242809942	0.07809075	1.446294627	2.953352185	10.68824192	0.213592909	0.482521854	0	0	4.1544279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5223	NO																																																																																		0	0	NO	0	14.6969	0.418380147	2.097219539	0	3.388130167	2.05638975	0.28633275	1.667763655	4.520808879	0	6.131034454	0.242809942	0.07809075	1.446294627	2.953352185	10.68824192	0.213592909	0.482521854	0	0	4.1544279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5223
H4141_005_0	2012	9	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	0.862600227	0.218613531	0	1.763168859	0.218545314	0.827252506	0.051201167	0.028892216	0.592704624	1.583043369	2.585460852	0.050019336	0.17746642		0	1.005731614	0	0	0	0				0	0	0	0	0								9.9647	YES	341.61	7.34	44.25	4750.49	15.45	21.28	5.39	642.69	43.5	5.39	20.41	1.26	0.71	14.62	39.06	63.79	1.23	4.38		1615.65	25.26	0	3.27	2.33	1.52				1.34	0.84	1254.63	343.07	218.56								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"19%-20% Coins: 15. 20% Part B Rx,15. 19% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0772	0.0772	0.202	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.196427	0	0	0	0				0	0	0	0	0								NO	0.064363	0.064363	0.152115	0	0.183695	0.183695	0.183695	59.700875	0.183695	0.183695	0.183695	0.183695	0.183695	0.183695	0.183695	0.183695	0.183695	0.183695		0	0.180413	0	0	0	0				0	0	0	0	0									21.987	0.47242442	6.73108875	0	2.83808775	3.9090296	0.99011605	3.197429613	7.9907325	0.99011605	3.74921495	0.2314557	0.13042345	2.6856209	7.1751267	11.71790405	0.22594485	0.8045841	0	0	4.55723238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3836	162	YES	11.230788	21.987	0.47242442	6.73108875	0	2.83808775	4.771629827	1.208729581	3.197429613	9.753901359	1.208661364	4.576467456	0.282656867	0.159315666	3.278325524	8.758170069	14.3033649	0.275964186	0.98205052	0	0	5.562963994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3483	NO																																																																																		0	0	NO	0	21.987	0.47242442	6.73108875	0	2.83808775	4.771629827	1.208729581	3.197429613	9.753901359	1.208661364	4.576467456	0.282656867	0.159315666	3.278325524	8.758170069	14.3033649	0.275964186	0.98205052	0	0	5.562963994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3483
H4141_006_0	2012	8	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	289.89	8.44	575.11	2588.29	264.97	20.87	5.16	396.96	510.1	1325.57	1323.73	131.47	0.21	662.47	4463.59	5587.94	106.18	1222.67		3335.92	37.54	0			1.52				4.14	0.81	675.13										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Admit: 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												0	100	68.0721	0	50	0.2	0.2	65	100	0	31.663153	20	0.2	17.341179	10	20	20	10		0	0.2	0			0				0	0	0										NO	0	95.585	60.675113	0	46.00325	0.184013	0.184013	59.804225	92.0065	0	29.132159	18.4013	0.184013	15.955012	9.20065	18.4013	18.4013	9.20065		0	0.184013	0			0				0	0	0											0	0.067228117	2.907905353	0	1.015790096	3.84035131	0.94950708	1.978323763	3.911042971	0	3.213592736	0.201601576	0.03864273	0.880809733	3.422327444	8.568780027	0.162820836	0.937446561	0	0	6.90784802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.004	0	NO	3.487804	0	0.067228117	2.907905353	0	1.015790096	3.84035131	0.94950708	1.978323763	3.911042971	0	3.213592736	0.201601576	0.03864273	0.880809733	3.422327444	8.568780027	0.162820836	0.937446561	0	0	6.90784802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.004	NO																																																																																		0	0	NO	0	0	0.067228117	2.907905353	0	1.015790096	3.84035131	0.94950708	1.978323763	3.911042971	0	3.213592736	0.201601576	0.03864273	0.880809733	3.422327444	8.568780027	0.162820836	0.937446561	0	0	6.90784802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.004
H4141_007_0	2012	6	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	O	T	V	V				O	O	O	V	V								0	0	0	0	0	1.068528352	0.226843489	0	1.767424654	0.219169082	0.693807071	0.070688954	0.041817187	0.800368603	1.510645089	2.333054605	0.081501437	0.262543855		0	0.87123838	0	0	0	0				0	0	0	0	0								9.9476	YES	393.13	14.36	65.56	4217.61	25.04	44.55	9.46	996.5	73.69	9.14	28.93	2.95	1.74	33.37	62.98	97.27	3.4	10.95		2488.01	36.32	0	3.43	2.4	1.52				0.58	0.84	1056.29	235.34	175.49								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"	$0: Other - Transportation 10b	"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0865	0.0865	0.1908	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0	0	0	0				0	0	0	0	0								NO	0.064355	0.064355	0.115801	0	0.170512	0.170512	0.170512	55.41653	0.170512	0.170512	0.170512	0.170512	0.170512	0.170512	0.170512	0.170512	0.170512	0.170512		0	0.170512	0	0	0	0				0	0	0	0	0									25.2999	0.9241378	7.59191356	0	4.26962048	7.5963096	1.61304352	4.601881012	12.56502928	1.55847968	4.93291216	0.5030104	0.29669088	5.68998544	10.73884576	16.58570224	0.5797408	1.8671064	0	0	6.19299584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4073	162	YES	27.704937	25.2999	0.9241378	7.59191356	0	4.26962048	8.664837952	1.839887009	4.601881012	14.33245393	1.777648762	5.626719231	0.573699354	0.338508067	6.490354043	12.24949085	18.91875685	0.661242237	2.129650255	0	0	7.06423422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.3549	NO																																																																																		0	0	NO	0	25.2999	0.9241378	7.59191356	0	4.26962048	8.664837952	1.839887009	4.601881012	14.33245393	1.777648762	5.626719231	0.573699354	0.338508067	6.490354043	12.24949085	18.91875685	0.661242237	2.129650255	0	0	7.06423422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.3549
H4141_008_0	2012	8	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	222.37	7.47	314.04	1702.74	199.95	19.45	4.42	401.01	408.98	1118.97	1112.81	176.6	0.35	608.05	4262.21	4065.32	159.08	835.03		2797.99	22.27	0			0.6				4.14	0.81	1137.31										3400	"$0-$500/Admit: 1a. $500 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$500/Admit: 1b. $500 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$30/Visit: 8a. $0 Lab -- FSL,8a. $30 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $30 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $30 Radiology OP -- Facility"	"$30/Visit: 5. $30 Partial Hospitalization,7h. $30 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,8b. $30 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												500	500	68.0721	0	200	0.2	0.2	65	150	26.333518	71.611513	30	0.2	47.614547	15	29.457424	30	15		0	0.2	0			0				0	0	0										NO	426.0555	426.0555	58.991282	0	176.375	0.176375	0.176375	57.321875	132.28125	23.222871	63.152403	26.45625	0.176375	41.990079	13.228125	25.977766	26.45625	13.228125		0	0.176375	0			0				0	0	0											7.8952	0.265219549	1.54380185	0	2.938848438	3.43049375	0.7795775	1.915553758	4.508365469	2.165474664	5.856385465	0.389347813	0.06173125	2.127672295	4.698420555	8.800660973	0.350721688	0.920490102	0	0	3.92787125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5758	0	NO	7.396473	7.8952	0.265219549	1.54380185	0	2.938848438	3.43049375	0.7795775	1.915553758	4.508365469	2.165474664	5.856385465	0.389347813	0.06173125	2.127672295	4.698420555	8.800660973	0.350721688	0.920490102	0	0	3.92787125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5758	NO																																																																																		0	0	NO	0	7.8952	0.265219549	1.54380185	0	2.938848438	3.43049375	0.7795775	1.915553758	4.508365469	2.165474664	5.856385465	0.389347813	0.06173125	2.127672295	4.698420555	8.800660973	0.350721688	0.920490102	0	0	3.92787125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5758
H4141_801_0	2012	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	241.54	2.8	43.11	24	8.24	13.35	4.06	23.27	61.86	8.33	28.71	0.64	0.46	18.09	36.75	92.2	0.63	7.28		14.95	31.88	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																					0.0816	0.0816	0.1849	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069249	0.069249	0.143305	0	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764		0.200764	0.200764	0																				16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	0	NO	12.960052	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	NO																																																																																		0	0	NO	0	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061
H4141_802_0	2012	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	241.54	2.8	43.11	24	8.24	13.35	4.06	23.27	61.86	8.33	28.71	0.64	0.46	18.09	36.75	92.2	0.63	7.28		14.95	31.88	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																					0.0816	0.0816	0.1849	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069249	0.069249	0.143305	0	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764		0.200764	0.200764	0																				16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	0	NO	12.960052	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	NO																																																																																		0	0	NO	0	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061
H4141_803_0	2012	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	241.54	2.8	43.11	24	8.24	13.35	4.06	23.27	61.86	8.33	28.71	0.64	0.46	18.09	36.75	92.2	0.63	7.28		14.95	31.88	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																					0.0816	0.0816	0.1849	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069249	0.069249	0.143305	0	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764	0.200764		0.200764	0.200764	0																				16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	0	NO	12.960052	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061	NO																																																																																		0	0	NO	0	16.7264	0.1938972	6.17787855	0	1.65429536	2.6801994	0.81510184	4.67177828	12.41926104	1.67236412	5.76393444	0.12848896	0.09235144	3.63182076	7.378077	18.5104408	0.12648132	1.46156192	0	3.0014218	6.40035632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5061
H4152_004_0	2012	9	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Chiropractic Care	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1832.539126	31.83985844	2457.410493		348.0661678	2.245410185		202.6162817	276.4092439		307.7618465		9.567725797	23.8711871	2688.280965	3986.646991	198.0524961	1029.658793							358.6459354		0		862.1353282		121.8948219	316.5398904	21.09868865								3350	"(1a) $335 days 1-6, $0 after day 6"	"(1b) $335 days 1-5, $0 after day 5"	"(2) $100 days 1-30, $0 after day 30"	No Copay	(10a) $150/day	"(11a, 11b, 11c) 20%"	Grouped in Line e.1.	(4a) $50/visit	"(9a, 9b, 16b) $175/visit"	No Copay	"(8b) $150/day, specified services"	No Copay	(12) $25/visit	"(9a, 9b) $40/visit, wound care clinic"	"(7a, 7g, 8a, 8b, 14d) $15/visit"	"(7d, 7f, 7g, 8a, 8b, 17a, 18a) $40/visit"	"(7e, 7h, 9c) $40/visit"	"(3, 7c, 7i) $15/visit"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	(17a) $40/visit	Not Covered	(18a) $40/visit	Not Covered	(14c) $15 Monthly	Not Covered	(4b) $35/visit	(7b) $20/visit	(5) $50/visit								0	NO	335	335	100		150	0.2		50	175		150		25	40	15	40	40	15							40		40		15		35	20	50								NO	136.9728283	156.7250429	60.46269018		136.7231166	0.182297489		45.57437218	159.5103026		136.7231166		22.78718609	36.45949775	13.67231166	36.45949775	36.45949775	13.67231166							40		40		15		31.90206053	18.22974887	45.57437218									20.9173	0.415841932	12.38180411	0	3.965724269	0.409332638	0	0.769509153	3.674176846	0	3.506513234	0	0.018168462	0.072527624	3.062917931	12.11259558	0.601741211	1.173151326	0	0	0	0	0	0	1.195486451	0	0	0	1.07766916	0	0.324057999	0.480870226	0.080129957	0	0	0	0	0	0	0	66.2396	0	YES	6.211637635	20.9173	0.415841932	12.38180411	0	3.965724269	0.409332638	0	0.769509153	3.674176846	0	3.506513234	0	0.018168462	0.072527624	3.062917931	12.11259558	0.601741211	1.173151326	0	0	0	0	0	0	1.195486451	0	0	0	1.07766916	0	0.324057999	0.480870226	0.080129957	0	0	0	0	0	0	0	66.2396	NO																																																																																		0				20.9173	0.415841932	12.38180411	0	3.965724269	0.409332638	0	0.769509153	3.674176846	0	3.506513234	0	0.018168462	0.072527624	3.062917931	12.11259558	0.601741211	1.173151326	0	0	0	0	0	0	1.195486451	0	0	0	1.07766916	0	0.324057999	0.480870226	0.080129957	0	0	0	0	0	0	0	66.2396
H4152_005_0	2012	13	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Chiropractic Care	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1838.688569	74.00930709	3306.850916		319.7468447	3.856395937		235.0172764	305.7741461		325.6750262		3.109363255	32.83487597	3276.341454	4540.046412	345.6861091	1171.518469							431.5326496		0		862.1353282		138.9083794	298.1197559	60.44602167								2400	"(1a) $240 days 1-8, $0 after day 8"	"(1b) $240 days 1-7, $0 after day 7"	"(2) $80 days 1-30, $0 after day 30"	No Copay	(10a) $150/day	"(11a, 11b, 11c) 20%"	Grouped in Line e.1.	(4a) $50/visit	"(9a, 9b, 16b) $150/visit"	No Copay	"(8b) $150/day, specified services"	No Copay	(12) $25/visit	"(9a, 9b) $30/visit, wound care clinic"	"(7a, 7g, 8a, 8b, 14d) $10/visit"	"(7d, 7f, 7g, 8a, 8b, 17a, 18a) $30/visit"	"(7e, 7h, 9c) $30/visit"	"(3, 7c, 7i) $15/visit"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	(17a) $30/visit	No Copay	(18a) $30/visit	Not Covered	(14c) $15 Monthly	Not Covered	(4b) $35/visit	(7b) $20/visit	(5) $40/visit								0	NO	240	240	80		150	0.2		50	150		150		25	30	10	30	30	15							30		30		15		35	20	40								NO	110.0889921	114.9906026	39.43373928		126.349113	0.168465484		42.11637101	126.349113		126.349113		21.0581855	25.2698226	8.423274201	25.2698226	25.2698226	12.6349113							30		30		15		29.4814597	16.8465484	33.6930968									16.8683	0.709197901	10.8667914	0	3.366644184	0.649669608	0	0.824839567	3.219524345	0	3.429062558	0	0.005456462	0.069144291	2.299793537	9.560513953	0.727952221	1.233502662	0	0	0	0	0	0	1.078831624	0	0	0	1.07766916	0	0.341268483	0.418524075	0.169717805	0	0	0	0	0	0	0	56.9164	0	YES	10.25032782	16.8683	0.709197901	10.8667914	0	3.366644184	0.649669608	0	0.824839567	3.219524345	0	3.429062558	0	0.005456462	0.069144291	2.299793537	9.560513953	0.727952221	1.233502662	0	0	0	0	0	0	1.078831624	0	0	0	1.07766916	0	0.341268483	0.418524075	0.169717805	0	0	0	0	0	0	0	56.9164	NO																																																																																		0				16.8683	0.709197901	10.8667914	0	3.366644184	0.649669608	0	0.824839567	3.219524345	0	3.429062558	0	0.005456462	0.069144291	2.299793537	9.560513953	0.727952221	1.233502662	0	0	0	0	0	0	1.078831624	0	0	0	1.07766916	0	0.341268483	0.418524075	0.169717805	0	0	0	0	0	0	0	56.9164
H4152_007_0	2012	11	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Chiropractic Care	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	2656.053643	143.2343873	4321.819147		371.0881619	6.05417582		242.0933055	336.9942835		373.8884803		50.62802721	53.15942857	3373.876578	5141.554056	529.4953727	1368.625156							440.4225648		0.372765607		862.1353282		146.3590935	359.262693	80.03122763								1750	"(1a) $175 days 1-8, $0 after day 8"	"(1b) $175 days 1-8, $0 after day 8"	"(2) $80 days 1-30, $0 after day 30"	No Copay	(10a) $150/day	"(11a, 11b, 11c) 20%"	Grouped in Line e.1.	(4a) $50/visit	"(9a, 9b, 16b) $95/visit"	No Copay	"(8b) $150/day, specified services"	No Copay	(12) $25/visit	"(9a, 9b) $30/visit, wound care clinic"	"(7a, 7g, 8a, 8b, 14d) $10/visit"	"(7d, 7f, 7g, 8a, 8b, 17a, 18a) $30/visit"	"(7e, 7h, 9c) $30/visit"	"(3, 7c, 7i) $15/visit"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	(17a) $30/visit	No Copay	(18a) $30/visit	No Copay	(14c) $15 Monthly	Not Covered	(4b) $35/visit	(7b) $20/visit	(5) $40/visit								0	NO	175	175	80		150	0.2		50	95		150		25	30	10	30	30	15							30		30		15		35	20	40								YES	67.29605199	64.39222897	35.60324303		117.2204092	0.156293879		39.07346973	74.23959248		117.2204092		19.53673486	23.44408184	7.814693945	23.44408184	23.44408184	11.72204092							30		30		15		27.35142881	15.62938789	31.25877578								3000	14.8952	0.768598455	12.82256479	0	3.624925515	0.946230623	0	0.788285453	2.084859856	0	3.652280054	0	0.082425529	0.103856166	2.197151072	10.04491784	1.034461071	1.33692334	0	0	0	0	0	0	1.101056412	0	0.000931914	0	1.07766916	0	0.333594194	0.467921332	0.208473183	0	0	0	0	0	0	0	57.5723	0	YES	15.49003044	14.8952	0.768598455	12.82256479	0	3.624925515	0.946230623	0	0.788285453	2.084859856	0	3.652280054	0	0.082425529	0.103856166	2.197151072	10.04491784	1.034461071	1.33692334	0	0	0	0	0	0	1.101056412	0	0.000931914	0	1.07766916	0	0.333594194	0.467921332	0.208473183	0	0	0	0	0	0	0	57.5723	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	0	0	0.0002	0.0018	0.0461	0.0049	0.0017	0.0479	0.0135	0.0468	0	0	0	0.0178	0.1699	0.0579	0.0088	0	0	0	0	0	0	0.0013	0	0	0	0	0	0.0016	0	0.0397								0.46	0		0.002692017	14.8952	0.768598455	12.82256479	0.00019782	3.626737645	0.992345048	0.004941957	0.79002686	2.132713374	0.013495114	3.699064376	0	0.082425529	0.103856166	2.214918465	10.21480375	1.092409423	1.345770296	0	0	0	0	0	0	1.102373598	0	0.000931914	0	1.07766916	0	0.335226026	0.467921332	0.248160446	0	0	0	0	0	0	0	58.0323
H4152_013_0	2012	9	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Chiropractic Care	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1537.389728	109.0258541	2053.711295		274.4690507	3.981728041		238.5283924	307.0563791		329.7323307		15.22483247	23.03412817	3144.735892	4341.731912	556.5766681	1224.57025							396.4066615		0		862.1353282		156.8930068	331.2860599	74.50602948								3350	"(1a) $335 days 1-6, $0 after day 6"	"(1b) $335 days 1-5, $0 after day 5"	"(2) $100 days 1-30, $0 after day 30"	No Copay	(10a) $150/day	"(11a, 11b, 11c) 20%"	Grouped in Line e.1.	(4a) $50/visit	"(9a, 9b, 16b) $175/visit"	No Copay	"(8b) $150/day, specified services"	No Copay	(12) $25/visit	"(9a, 9b) $40/visit, wound care clinic"	"(7a, 7g, 8a, 8b, 14d) $15/visit"	"(7d, 7f, 7g, 8a, 8b, 17a, 18a) $40/visit"	"(7e, 7h, 9c) $40/visit"	"(3, 7c, 7i) $15/visit"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	(17a) $40/visit	Not Covered	(18a) $40/visit	Not Covered	(14c) $15 Monthly	Not Covered	(4b) $35/visit	(7b) $20/visit	(5) $50/visit								0	NO	335	335	100		150	0.2		50	175		150		25	40	15	40	40	15							40		40		15		35	20	50								NO	141.791267	123.485452	56.94411164		136.2420148	0.18165602		45.41400495	158.9490173		136.2420148		22.70700247	36.33120396	13.62420148	36.33120396	36.33120396	13.62420148							40		40		15		31.78980346	18.16560198	45.41400495									18.1657	1.121925573	9.745563772	0	3.116184706	0.723304868	0	0.902710799	4.067192477	0	3.743616424	0	0.028809192	0.069738134	3.570376284	13.14502897	1.685091704	1.390315985	0	0	0	0	0	0	1.321355538	0	0	0	1.07766916	0	0.415633154	0.501500892	0.281968099	0	0	0	0	0	0	0	65.0737	0	YES	6.329010182	18.1657	1.121925573	9.745563772	0	3.116184706	0.723304868	0	0.902710799	4.067192477	0	3.743616424	0	0.028809192	0.069738134	3.570376284	13.14502897	1.685091704	1.390315985	0	0	0	0	0	0	1.321355538	0	0	0	1.07766916	0	0.415633154	0.501500892	0.281968099	0	0	0	0	0	0	0	65.0737	NO																																																																																		0				18.1657	1.121925573	9.745563772	0	3.116184706	0.723304868	0	0.902710799	4.067192477	0	3.743616424	0	0.028809192	0.069738134	3.570376284	13.14502897	1.685091704	1.390315985	0	0	0	0	0	0	1.321355538	0	0	0	1.07766916	0	0.415633154	0.501500892	0.281968099	0	0	0	0	0	0	0	65.0737
H4152_016_0	2012	10	f.2.	i.7.	h.6.	h.7.							OP Facility - Emergency	Professional	OP Facility - Other	OP Facility - Other							Urgent Care	Chiropractic Care	Partial Hospitalization	Other Radiology							D	D	D		T	Coin		V	V	V	O		V	V	V	V	V	V							V		V		O		V	V	V	O																																															0	YES	1186.461643	107.6171882	1461.28699		429.4143182	3.661552135		239.4854298	287.6410119	2572.883493	314.2373463		0.300191654	22.32176564	2890.040653	4154.137158	774.9027615	1332.379337							334.4442114		0		862.1353282		159.5735964	300.1655936	85.18438371	1055.697082							4800	"(1a) $375 days 1-4, $0 after day 4"	"(1b) $350 days 1-4, $0 after day 4"	"(2) $50 days 1-95, $0 after day 95"	No Copay	(10a) $200/trip	"(11a, 11b, 11c) 20%"	Grouped in Line e.1.	(4a) $50/visit	"(9a, 9b, 16b) $175/visit"	(8a) $5/day	"(8b) $150/day, specified services (MRI, CT Scans, etc.)"	No Copay	(12) $30/visit	"(9a, 9b) $40/visit, wound care clinic"	"(7a, 7g, 8a, 8b, 14d) $20/visit"	"(7d, 7f, 7g, 8a, 8b, 17a, 18a) $40/visit"	"(7e, 7h, 9c) $40/visit"	"(3, 7c, 7i) $35/visit"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	(17a) $40/visit	Not Covered	(18a) $40/visit	Not Covered	(14c) $15 Monthly	Not Covered	(4b) $35/visit	(7b) $20/visit	(5) $50/visit	"(8b) $15/day, specified services (X-Ray, mammogram, therapeutic radiology, etc.)"							0	NO	375	350	50		200	0.2		50	175	5	150		30	40	20	40	40	35							40		40		15		35	20	50	15							YES	153.1739407	113.2163047	48.34002623		194.0324532	0.194032453		48.50811331	169.7783966	4.850811331	145.5243399		29.10486798	38.80649064	19.40324532	38.80649064	38.80649064	33.95567931							38.80649064		38.80649064		14.55243399		33.95567931	19.40324532	48.50811331	14.55243399							4800	15.1446	1.015335031	5.886554286	0	6.943359467	0.710459943	0	0.968082197	4.069602482	1.0400477	3.8107652	0	0.000728087	0.072185782	4.673013982	13.43395706	2.505938064	3.770153791	0	0	0	0	0	0	1.081550513	0	0	0	1.045513955	0	0.451535822	0.485348887	0.344344478	1.280246842	0	0	0	0	0	0	68.7333	0	YES	2.11	15.1446	1.015335031	5.886554286	0	6.943359467	0.710459943	0	0.968082197	4.069602482	1.0400477	3.8107652	0	0.000728087	0.072185782	4.673013982	13.43395706	2.505938064	3.770153791	0	0	0	0	0	0	1.081550513	0	0	0	1.045513955	0	0.451535822	0.485348887	0.344344478	1.280246842	0	0	0	0	0	0	68.7333	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	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)								0	0	0	0	0.0021	0.0281	0	0.0017	0.045	0	0.0392	0	0	0	0.0152	0.1368	0.0846	0.0087	0	0	0	0	0	0	0.001	0	0	0	0	0	0.0018	0	0.0423	0							0.4065	0		0	15.1446	1.015335031	5.886554286	0	6.945456421	0.738510786	0	0.969803195	4.114652001	1.0400477	3.849984552	0	0.000728087	0.072185782	4.688180713	13.57078141	2.590515052	3.778853069	0	0	0	0	0	0	1.082546995	0	0	0	1.045513955	0	0.453307926	0.485348887	0.386670338	1.280246842	0	0	0	0	0	0	69.1398
H4152_815_0	2012	8	f.2.										OP Facility - Emergency										Urgent Care										A	A	A		T			V							V	V									V		V		O		V																																																		0	YES	193.3427611	5.460116233	670.9657473		323.2845501			230.5220252							3249.475395	6081.192133									430.3602795		0		862.1353282		161.1628784										2500	(1a) $100/stay/benefit period	(1b) $100/stay/benefit period	"(2) $0 days 1-29, $50 days 30-100"	No Copay	(10a) $50/day	No Copay	No Copay	(4a) $50/visit	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"(7a, 7g, 8a, 8b, 14d) $10/visit"	"(7b, 7d, 7f, 7g, 8a, 8b, 17a, 18a) $20/visit"	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	No Copay	(17a) $20/visit	No Copay	(18a) $20/visit	No Copay	(14c) $15 Monthly	Not Covered	(4b) $25/visit										0	NO	100	100	50		50			50							10	20									20		20		15		25										YES	100	100	50		50			50							10	20									20		20		15		25										3000	1.6112	0.045500969	2.795690614	0	1.347018959	0	0	0.960508438	0	0	0	0	0	0	2.707896162	10.13532022	0	0	0	0	0	0	0	0	0.717267132	0	0	0	1.07766916	0	0.335755997	0	0	0	0	0	0	0	0	0	21.7338	0	YES	0	1.6112	0.045500969	2.795690614	0	1.347018959	0	0	0.960508438	0	0	0	0	0	0	2.707896162	10.13532022	0	0	0	0	0	0	0	0	0.717267132	0	0	0	1.07766916	0	0.335755997	0	0	0	0	0	0	0	0	0	21.7338	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											0	0	0	0.0034	0	0.0054	0.016	0	0.0205	0.0118	0.0212	0	0	0	0.0172	0.1168	0.0792	0.0156	0	0	0	0	0	0	0.0016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3087	0		0	1.6112	0.045500969	2.795690614	0.003383786	1.347018959	0.005430174	0.015970443	0.960508438	0.020483368	0.011789284	0.021188926	0	0	0	2.725076798	10.25213623	0.079173614	0.015638714	0	0	0	0	0	0	0.718897599	0	0	0	1.07766916	0	0.335755997	0	0	0	0	0	0	0	0	0	22.0425
H4152_817_0	2012	7	f.2.										OP Facility - Emergency										Urgent Care										A	A	A		T			V							V	V									V		V		O		V																																																		0	YES	208.015892	3.364561999	730.4673676		343.172546			249.2003601							3420.506906	6228.626009									516.7043309		0		862.1353282		184.4791764										2500	(1a) $100/stay/benefit period	(1b) $100/stay/benefit period	"(2) $0 days 1-29, $50 days 30-100"	No Copay	(10a) $50/day	No Copay	No Copay	(4a) $50/visit	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"(7a, 7g, 8a, 8b, 14d) $10/visit"	"(7b, 7d, 7f, 7g, 8a, 8b, 17a, 18a) $20/visit"	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	No Copay	(17a) $20/visit	No Copay	(18a) $20/visit	Not Covered	(14c) $15 Monthly	Not Covered	(4b) $25/visit										0	NO	100	100	50		50			50							10	20									20		20		15		25										NO	100	100	50		50			50							10	20									20		20		15		25											1.7335	0.028038017	3.043614032	0	1.429885608	0	0	1.038334834	0	0	0	0	0	0	2.850422421	10.38104335	0	0	0	0	0	0	0	0	0.861173885	0	0	0	1.07766916	0	0.384331618	0	0	0	0	0	0	0	0	0	22.828	0	YES	0	1.7335	0.028038017	3.043614032	0	1.429885608	0	0	1.038334834	0	0	0	0	0	0	2.850422421	10.38104335	0	0	0	0	0	0	0	0	0.861173885	0	0	0	1.07766916	0	0.384331618	0	0	0	0	0	0	0	0	0	22.828	NO																																																																																		0				1.7335	0.028038017	3.043614032	0	1.429885608	0	0	1.038334834	0	0	0	0	0	0	2.850422421	10.38104335	0	0	0	0	0	0	0	0	0.861173885	0	0	0	1.07766916	0	0.384331618	0	0	0	0	0	0	0	0	0	22.828
H4152_821_0	2012	8	f.2.										OP Facility - Emergency										Urgent Care										A	A	A		T			V							V	V									V		V		O		V																																																		0	YES	187.40582	4.728385755	530.415009		289.2910154			211.8712265							3220.3193	6171.854815									489.5186482		0		862.1353282		146.2094434										2500	(1a) $100/stay/benefit period	(1b) $100/stay/benefit period	"(2) $0 days 1-29, $50 days 30-100"	No Copay	(10a) $50/day	No Copay	No Copay	(4a) $50/visit	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"(7a, 7g, 8a, 8b, 14d) $10/visit"	"(7b, 7d, 7f, 7g, 8a, 8b, 17a, 18a) $10/visit"	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	No Copay	(17a) $10/visit	No Copay	(18a) $10/visit	No Copay	(14c) $15 Monthly	Not Covered	(4b) $25/visit										0	NO	100	100	50		50			50							10	10									10		10		15		25										YES	100	100	50		50			50							10	10									10		10		15		25										3000	1.5617	0.039403215	2.210062537	0	1.205379231	0	0	0.882796777	0	0	0	0	0	0	2.683599416	5.143212345	0	0	0	0	0	0	0	0	0.407932207	0	0	0	1.07766916	0	0.304603007	0	0	0	0	0	0	0	0	0	15.5164	0	YES	15.22544795	1.5617	0.039403215	2.210062537	0	1.205379231	0	0	0.882796777	0	0	0	0	0	0	2.683599416	5.143212345	0	0	0	0	0	0	0	0	0.407932207	0	0	0	1.07766916	0	0.304603007	0	0	0	0	0	0	0	0	0	15.5164	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											0	0	0	0.0034	0	0.0054	0.016	0	0.0205	0.0118	0.0212	0	0	0	0.0172	0.1168	0.0792	0.0156	0	0	0	0	0	0	0.0016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3087	0		0	1.5617	0.039403215	2.210062537	0.003383786	1.205379231	0.005430174	0.015970443	0.882796777	0.020483368	0.011789284	0.021188926	0	0	0	2.700780052	5.26002835	0.079173614	0.015638714	0	0	0	0	0	0	0.409562674	0	0	0	1.07766916	0	0.304603007	0	0	0	0	0	0	0	0	0	15.8251
H4155_001_0	2012	11																															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	2498.708866	5.598443934	349.0530582	2268.976045	407.533748	4.672051825	3.589851673	432.5568382	405.3748025	1373.775395	1296.333956	1.217348047	10.52846914	3936.092592	9235.049544	7894.77468	1.579930243	227.0362282	4382.038614	1324.51299	9.944449588	3.025678478	0	0.004482637	0.957719888	0	0	0	1.144457207	0											3400	$0 	$0 	$0 	$0 	10a: $25	11a: 20.0%	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	25	0.2	0	45.73545026	0	0	0	0	0	0	0	0	0	0	0	0	0.028606713	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	25	0.2	0	45.73545026	0	0	0	0	0	0	0	0	0	0	0	0	0.028606713	0	0	0	0	0	0	0	0	0												0	0	0	0	0.849028642	0.934410365	0	1.64859848	0	0	0	0	0	0	0	0	0	0	0	0	0.284478013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7165	0	NO	0	0	0	0	0	0.849028642	0.934410365	0	1.64859848	0	0	0	0	0	0	0	0	0	0	0	0	0.284478013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7165	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0.0012	0	0	0	0	0	0	0	0	0	0	0	0	0.0068	0	0	0	0	0	0	0	0	0											0.008	0	NO	0	0	0	0	0	0.849028642	0.934410365	0	1.649784084	0	0	0	0	0	0	0	0	0	0	0	0	0.291274863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7245
H4155_003_0	2012	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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1739.331729	21.52754048	494.8540135	1350.259639	388.0468105	2.309148725	3.275374378	498.8463809	303.2530014	715.0219671	1014.328885	9.553137856	15.57418537	1881.892785	4154.105483	4441.42018	16.33851335	341.1952608	3810.960016	799.264024	9.50477443	0	0	0	0	0	0	0	0	0											3400	$0 	$0 	$0 	$0 	10a: $25	11a: 20.0%	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	16b1: $25	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	16b2: $25	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	25	0.2	0	47.83283249	0	0	0	0	0	0	0	0	0	0	0	0	0.060090076	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	25	0.2	0	47.83283249	0	0	0	0	0	0	0	0	0	0	0	0	0.060090076	0	0	0	0	0	0	0	0	0												0	0	0	0	0.808430855	0.461829745	0	1.988436281	0	0	0	0	0	0	0	0	0	0	0	0	0.571142622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8298	0	NO	0	0	0	0	0	0.808430855	0.461829745	0	1.988436281	0	0	0	0	0	0	0	0	0	0	0	0	0.571142622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8298	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 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	0	0	0	0	0.0549	0	0	0	0	0	0	0	0	0											0.0549	0	NO	0	0	0	0	0	0.808430855	0.461829745	0	1.988436281	0	0	0	0	0	0	0	0	0	0	0	0	0.626062831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8848
H4199_001_0	2012	17																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	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			1759.979162			39.53250123		245.7483499			1889.037591		16.27391005								51.19578223			443																	3400	NONE	NONE	$100 days 11-100	NONE	NONE	0-20% coinsurance	NONE	$50 waived if admitted	NONE	NONE	$0 to $25	NONE	20% coinsurance	NONE	NONE	NONE	NONE	NONE	NONE	NONE	20% coinsurance	NONE	NONE	copays from $0 to $5926	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	0	NO	0	0	39.69712016	0	0	10	0	15	0	0	12.5	0	20	0	0	0	0	0	0	0	20	0	0	7.64	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	35.72740814	0	0	9.2	0	14.25	0	0	11.5625	0	12	0	0	0	0	0	0	0	18	0	0	7.258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	5.23995782	0	0	3.636990113	0	0.291826165	0	0	1.820166429	0	1.952869205	0	0	0	0	0	0	0	9.215240802	0	0	0.267941167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.425	0	NO	3.401348494	0	0	5.23995782	0	0	3.636990113	0	0.291826165	0	0	1.820166429	0	1.952869205	0	0	0	0	0	0	0	9.215240802	0	0	0.267941167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.425	NO	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE		0	0	0	0	0	0	0	0.2918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2918	0	NO	0	0	0	5.23995782	0	0	3.636990113	0	0.583652331	0	0	1.820166429	0	1.952869205	0	0	0	0	0	0	0	9.215240802	0	0	0.267941167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7168
H4199_002_0	2012	19																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	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	1273.921462	29.21555815	1707.883779		396.0459983	38.3623392		238.4741987	120.4270904		2127.289716		15.79220231								49.68038708			429.8872																	3400	Days 1 - 5:  $200Days 6 +:  $0	Days 1 - 5:  $200Days 6 +:  $0	$100 days 6-100	NONE	$50 copay	0-20% coinsurance	NONE	$50 waived if admitted	$50 outpatient hospital surgery copay	NONE	$0 to $50	NONE	20% coinsurance	NONE	NONE	NONE	NONE	NONE	NONE	NONE	20% coinsurance	NONE	NONE	copays from $0 to $5926	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	0	NO	141.1255594	141.1255594	63.8530288	0	50	10	0	15	50	0	37.5	0	20	0	0	0	0	0	0	0	20	0	0	7.64	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	129.8355147	129.8355147	58.74478649	0	46	9.2	0	13.8	46	0	34.5	0	18.4	0	0	0	0	0	0	0	18.4	0	0	7.0288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		13.7834	0.316101419	8.360772328	0	1.518176327	3.529335206	0	0.274245329	0.46163718	0	6.115957935	0	2.905765225	0	0	0	0	0	0	0	9.141191223	0	0	0.251799263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6583	0	NO	4.057246564	13.7834	0.316101419	8.360772328	0	1.518176327	3.529335206	0	0.274245329	0.46163718	0	6.115957935	0	2.905765225	0	0	0	0	0	0	0	9.141191223	0	0	0.251799263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6583	NO	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE		5.9072	0	0	0	0	0	0	0.2742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1814	0	NO	0	19.6905	0.316101419	8.360772328	0	1.518176327	3.529335206	0	0.548490657	0.46163718	0	6.115957935	0	2.905765225	0	0	0	0	0	0	0	9.141191223	0	0	0.251799263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8397
H4199_004_0	2012	14																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	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								250.6633169					16.59938825								52.21969788			451.86																	3400	NONE	NONE	NONE	NONE	NONE	NONE	NONE	$50 waived if admitted	NONE	NONE	NONE	NONE	10% coinsurance	NONE	NONE	NONE	NONE	NONE	NONE	NONE	10% coinsurance	NONE	NONE	copays from $0 to $5926	NONE	NONE	NONE	NONE	NONE	NONE											0	NO	0	0	0	0	0	0	0	15	0	0	0	0	10	0	0	0	0	0	0	0	10	0	0	7.64	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	13.8	0	0	0	0	9.2	0	0	0	0	0	0	0	9.2	0	0	7.0288	0	0	0	0	0	0												0	0	0	0	0	0	0	0.288262814	0	0	0	0	1.527143719	0	0	0	0	0	0	0	4.804212205	0	0	0.264669464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8843	0	NO	0.598633757	0	0	0	0	0	0	0	0.288262814	0	0	0	0	1.527143719	0	0	0	0	0	0	0	4.804212205	0	0	0.264669464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8843	NO	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE		0	0	0	0	0	0	0	0.2883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2883	0	NO	0	0	0	0	0	0	0	0	0.576525629	0	0	0	0	1.527143719	0	0	0	0	0	0	0	4.804212205	0	0	0.264669464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1726
H4209_001_0	2012	8																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	649.0972822	21.5235052	235.4521652	15.03659572	148.9828093	9.266107937	4.890619351	571.5476291	398.7826325	934.7213972	12.47338291	0	0.014369757	889.8030901	2839.969983	3120.655796	134.9455001	106.3236615	15.18906484	20.56642718	35.88967323	9.637327405	0	0	735	0	0	0	60	0											6700	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 - $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 - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $28/visit/8a:  Outpatient Lab Services - $28/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $40/service/14e:  Diabetes Self-Management Training - $40/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $40/service/14e:  Diabetes Self-Management Training - $40/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $40/service/9d:  3-Pints Deductible Waived - $40/service			17a:  Routine Eye Exams - $25/visit	17b:  Eye Glasses - $10/service			14c:  Written health education materials - $0/service/														275	275	128	0	150	0.2	0.123603532	44.2068251	161.0483281	27.5	0.272054311	0	0.2	40	25	36.67390639	40	40	0	39.82962738	0.2	40	0	0	18.57142857	0	0	0	0	0											NO	265.7808529	265.7808529	123.7089061	0	144.9713743	0.193295166	0.119459826	42.7558512	155.6493164	26.57808529	0.262933915	0	0.193295166	38.65903315	24.16189572	35.44444408	38.65903315	38.65903315	0	38.49437213	0.193295166	38.65903315	0	0	18.57142857	0	0	0	0	0												14.3765	0.476711298	2.427294149	0	1.799853552	1.79109387	0.584232538	2.036417116	5.172520343	2.070258752	3.279675407	0	0.002777605	2.866577263	5.718254881	9.217492485	0.434738547	0.34253083	0	0.065974308	6.937300337	0.03104748	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7687	0	NO	2.066900753	14.3765	0.476711298	2.427294149	0	1.799853552	1.79109387	0.584232538	2.036417116	5.172520343	2.070258752	3.279675407	0	0.002777605	2.866577263	5.718254881	9.217492485	0.434738547	0.34253083	0	0.065974308	6.937300337	0.03104748	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7687	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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 30.0%/7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 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%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%																			10000	3.6336	0.0529	0.7185	0.3285	0.6157	1.0676	0.542	0.2986	0.9301	0.1209	0.2871	0	0.002	0.2513	4.3122	7.8006	0.1317	0.3147	1.9633	2.2177	0.8417	0.0098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4406	2200	NO	2.221561014	18.0101	0.529586519	3.145753324	0.32849224	2.415557143	2.858705681	1.126190308	2.334983144	6.102658029	2.19115163	3.566746575	0	0.004793933	3.117900653	10.03050234	17.01809751	0.566452323	0.657277798	1.963316237	2.283703707	7.778981987	0.040817842	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2093
H4209_003_0	2012	8																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	616.6654851	14.18015742	226.7724489	15.16964323	166.0469806	8.45247966	5.140467663	527.1908737	379.2194216	914.2307607	15.56410128	0	0.026953982	1097.051722	2615.97355	2876.3257	113.8074768	130.7226179	15.38062853	27.45476424	48.47414301	10.34287144	0	0	735	0	0	0	60	0											6700	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 - $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 - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $28/visit/8a:  Outpatient Lab Services - $28/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%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $40/service/14e:  Diabetes Self-Management Training - $40/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $40/service/14e:  Diabetes Self-Management Training - $40/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $40/service/9d:  3-Pints Deductible Waived - $40/service			17a:  Routine Eye Exams - $25/visit	17b:  Eye Glasses - $10/service			14c:  Written health education materials - $0/service/														275	275	128	0	150	0.2	0.133696252	44.20864398	161.5326744	27.5	0.265146976	0	0.2	40	25	36.71529364	40	40	0	39.93768291	0.2	40	0	0	18.57142857	0	0	0	0	0											NO	265.4326111	265.5916059	123.5244782	0	144.7566939	0.193055128	0.129017421	42.70986784	155.9462373	26.54406176	0.255899077	0	0.19291564	38.61253473	24.13044952	35.4384579	38.61509275	38.59655264	0	38.53224227	0.192975329	38.61453761	0	0	18.57142857	0	0	0	0	0												13.6403	0.313844232	2.334329036	0	2.003034329	1.631794543	0.663209882	1.876354379	4.928153493	2.022283148	3.982839159	0	0.005199845	3.529995644	5.260384809	8.494378934	0.366223856	0.420453533	0	0.088157802	9.354313694	0.0332821	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.086	0	NO	2.197798395	13.6403	0.313844232	2.334329036	0	2.003034329	1.631794543	0.663209882	1.876354379	4.928153493	2.022283148	3.982839159	0	0.005199845	3.529995644	5.260384809	8.494378934	0.366223856	0.420453533	0	0.088157802	9.354313694	0.0332821	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.086	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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 30.0%/7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 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%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%																			10000	3.5183	0.0429	0.6249	0.3083	0.6624	0.9661	0.5693	0.2743	0.8176	0.1137	0.3397	0	0.0038	0.2341	4.038	7.3689	0.1078	0.4085	2.0211	2.0019	1.0802	0.0096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5115	2200	NO	2.01724229	17.1586	0.356768961	2.959251151	0.308335211	2.665391297	2.597876506	1.2324681	2.150634266	5.745775716	2.136009228	4.322578417	0	0.008964333	3.764046288	9.298393078	15.8632904	0.473978283	0.829001541	2.021096684	2.090101725	10.43454235	0.042901613	0	0	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5975
H4209_004_0	2012	9																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	811.7704116	43.87719122	170.1789326	23.45354822	186.7014997	14.95009777	5.594289647	531.4747121	381.1776215	1051.656971	15.01472664	0	0.012920375	1034.205572	3226.193326	3507.880244	357.3237632	153.9399444	17.73592322	23.45183162	45.87877493	10.67811474	0	873	735	0	0	0	60	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $25/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $25/service/9d:  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:  Written health education materials - $0/service/														250	250	128	0.1	150	0.2	0.092247089	34.38048608	158.3190933	20	0.205875372	0	0.2	25	15.00100041	24.63987154	25	25	0	25	0.2	25	0	10	18.57142857	0	0	0	0	0											NO	208.4063617	208.116282	106.9904883	0.083288058	125.0305484	0.1665808	0.077020158	28.84842378	132.1254496	16.67438073	0.171677063	0	0.166944783	20.84161937	12.51219696	20.54931517	20.80117728	20.83067466	0	20.84913652	0.166708602	20.85249709	0	10	18.57142857	0	0	0	0	0												14.0982	0.760963158	1.517293924	1.95340048	1.945282575	2.49039925	0.43087307	1.277683977	4.196938717	1.461310727	2.57768417	0	0.002156989	1.796209907	3.363897195	6.007044726	0.619396245	0.267222741	0	0.04074587	7.648386422	0.018555446	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3386	0	NO	10.45339816	14.0982	0.760963158	1.517293924	1.95340048	1.945282575	2.49039925	0.43087307	1.277683977	4.196938717	1.461310727	2.57768417	0	0.002156989	1.796209907	3.363897195	6.007044726	0.619396245	0.267222741	0	0.04074587	7.648386422	0.018555446	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3386	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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - 20.0%/14a:  Pap Smears and Pelvic Exams Screening - $6/visit/14a:  Prostate Cancer Screening - $6/visit/14a:  Colorectal Screening - $6/visit/14a:  Bone Mass Measurement - $6/visit/14a:  Mammography - $6/visit/14a:  Diabetes Monitoring - $6/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 20.0%/14b:  Routine Exams - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - 20.0%/14a:  Pap Smears and Pelvic Exams Screening - $6/visit/14a:  Prostate Cancer Screening - $6/visit/14a:  Colorectal Screening - $6/visit/14a:  Bone Mass Measurement - $6/visit/14a:  Mammography - $6/visit/14a:  Diabetes Monitoring - $6/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 20.0%/14b:  Routine Exams - 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%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																			5100	2.6573	0.0626	0.3082	0.3844	0.6107	1.2668	0.4048	0.1741	0.5344	0.0745	0.2045	0	0.0011	0.185	3.429	5.2698	0.221	0.3084	1.3702	1.4535	0.6355	0.0158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5717	1250	NO	4.822636563	16.7554	0.823577608	1.825537619	2.337770023	2.556009437	3.75724285	0.835642663	1.451805433	4.731342611	1.535810638	2.78216554	0	0.003237142	1.981243562	6.792928112	11.27686783	0.84039253	0.575639288	1.37023797	1.494206944	8.283861735	0.034394873	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9103
H4209_006_0	2012	9																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	848.4236715	29.15858216	291.7906594	18.98539323	200.826406	11.75616612	5.485965094	709.4428637	516.619251	1214.195809	21.51378508	0	0.011347896	1345.595736	3618.99758	3869.358661	344.3746154	208.7984839	17.91912694	31.20125388	49.0807281	19.68572209	0	873	735	0	0	0	60	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $25/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $25/service/9d:  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:  Written health education materials - $0/service/														250	250	128	0.1	150	0.2	0.113592132	33.99250006	163.6060206	20	0.206692492	0	0.2	25	15.00090505	24.60342646	25	25	0	25	0.2	25	0	10	18.57142857	0	0	0	0	0											NO	202.5048386	202.4544281	103.6045094	0.081020708	121.492542	0.162032293	0.092181816	27.73148551	132.6797121	16.20870845	0.167370795	0	0.162768047	20.28429236	12.15503384	19.9351836	20.1813823	20.20358378	0	20.22927244	0.162012954	20.22525823	0	10	18.57142857	0	0	0	0	0												14.3175	0.49194034	2.519235677	1.538210004	2.033242548	1.904878553	0.505706226	1.639492041	5.712074459	1.640045488	3.600779302	0	0.001847075	2.274538108	3.665753172	6.428031276	0.579162981	0.351539805	0	0.052598222	7.951713724	0.033179068	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1065	0	NO	13.39825486	14.3175	0.49194034	2.519235677	1.538210004	2.033242548	1.904878553	0.505706226	1.639492041	5.712074459	1.640045488	3.600779302	0	0.001847075	2.274538108	3.665753172	6.428031276	0.579162981	0.351539805	0	0.052598222	7.951713724	0.033179068	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1065	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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - 20.0%/14a:  Pap Smears and Pelvic Exams Screening - $6/visit/14a:  Prostate Cancer Screening - $6/visit/14a:  Colorectal Screening - $6/visit/14a:  Bone Mass Measurement - $6/visit/14a:  Mammography - $6/visit/14a:  Diabetes Monitoring - $6/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 20.0%/14b:  Routine Exams - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14a:  Immunizations (Hepatitis B) - 20.0%/14a:  Physical Exams (Initial Exam) - 20.0%/14a:  Pap Smears and Pelvic Exams Screening - $6/visit/14a:  Prostate Cancer Screening - $6/visit/14a:  Colorectal Screening - $6/visit/14a:  Bone Mass Measurement - $6/visit/14a:  Mammography - $6/visit/14a:  Diabetes Monitoring - $6/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 20.0%/14b:  Routine Exams - 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%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																			5100	2.4776	0.043	0.5154	0.2922	0.581	0.9462	0.3882	0.2087	0.6761	0.0849	0.2619	0	0.0009	0.1527	3.6606	5.6612	0.2072	0.3696	1.405	1.5976	0.6158	0.0106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1566	1250	NO	5.298203272	16.7951	0.534916992	3.034660101	1.830391637	2.614275265	2.851061236	0.893922089	1.848178798	6.388135639	1.724947501	3.862702545	0	0.002736854	2.427267721	7.326401842	12.08922521	0.786377716	0.721186529	1.405046788	1.650209715	8.567492811	0.043789346	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.263
H4209_007_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	812.2262624	33.11005384	250.3997042	20.77317101	185.7714301	12.49047603	5.651383813	652.2890144	432.6622959	1144.400166	16.52674543	0	0.016193306	1063.720602	3466.018847	3650.117447	274.4421488	157.9713747	18.09360016	26.7223133	46.97020703	12.01904134	0	873	735	0	0	0	60	0											6700	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 - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - 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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $25/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $25/service/9d:  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:  Written health education materials - $0/service/														275	275	128	0	150	0.2	0.110894811	33.88182511	160.6313974	20	0.203910666	0	0.2	25	15.00093124	24.61859151	25	25	0	25	0.2	25	0	10	18.57142857	0	0	0	0	0											NO	257.2155053	257.2155053	119.7221261	0	140.2993665	0.187065822	0.103723145	31.74804223	150.243222	18.7065822	0.190723582	0	0.187065822	23.38322775	14.03080766	23.02648529	23.38322775	23.38322775	0	23.38322775	0.187065822	23.38322775	0	10	18.57142857	0	0	0	0	0												17.4098	0.709701602	2.498198746	0	2.17196783	2.336541166	0.586179301	1.725741598	5.417048115	1.783984648	3.152040089	0	0.003029214	2.072768425	4.052586983	7.004114642	0.534778606	0.307823386	0	0.052071161	8.786520387	0.023420332	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4933	0	NO	4.188649337	17.4098	0.709701602	2.498198746	0	2.17196783	2.336541166	0.586179301	1.725741598	5.417048115	1.783984648	3.152040089	0	0.003029214	2.072768425	4.052586983	7.004114642	0.534778606	0.307823386	0	0.052071161	8.786520387	0.023420332	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4933	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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 30.0%/7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 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%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%																			10000	3.7544	0.0692	0.6182	0.3785	0.6647	1.1976	0.5177	0.2726	0.8747	0.1156	0.3155	0	0.0019	0.2439	4.2611	7.4927	0.2276	0.4054	1.9294	2.1048	0.9137	0.0162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3754	1250	NO	3.185701326	21.1642	0.7789256	3.116381205	0.378506746	2.8366765	3.534108005	1.103884302	1.998390436	6.29170747	1.899558952	3.467588948	0	0.004921506	2.316658449	8.313725381	14.49680048	0.762359037	0.713208121	1.929426532	2.156834281	9.700187944	0.039594102	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8686
H4209_008_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	781.2164057	31.84540504	211.5873584	21.76083633	183.1975191	12.11836911	5.483133012	687.1539927	483.7688564	1157.5012	17.63203408	0	0.015910227	1434.577352	3253.201046	3447.598643	264.3867269	152.1837364	16.85012084	25.127887	47.7928913	14.59587008	0	873	735	0	0	0	60	0											6700	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 - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - 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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $25/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $25/service/14e:  Diabetes Self-Management Training - $25/service/14b:  Routine Exams - $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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $25/service/9d:  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:  Written health education materials - $0/service/														275	275	128	0	150	0.2	0.110893254	33.80299561	160.6313974	20	0.217974111	0	0.2	25	15.00093123	24.61101397	25	25	0	25	0.2	25	0	10	18.57142857	0	0	0	0	0											NO	257.2139215	257.2139215	119.7213889	0	140.2985026	0.18706467	0.10372105	31.66844951	150.2422969	18.70646701	0.203876276	0	0.18706467	23.38308377	14.03072126	23.01925605	23.38308377	23.38308377	0	23.38308377	0.18706467	23.38308377	0	10	18.57142857	0	0	0	0	0												16.745	0.682590126	2.110961035	0	2.141861468	2.26691872	0.568716311	1.813425127	6.056878679	1.804396501	3.594753443	0	0.002976241	2.795403534	3.803729756	6.613429662	0.515181415	0.296543755	0	0.048963957	8.940361446	0.028441371	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6955	0	NO	4.203201007	16.745	0.682590126	2.110961035	0	2.141861468	2.26691872	0.568716311	1.813425127	6.056878679	1.804396501	3.594753443	0	0.002976241	2.795403534	3.803729756	6.613429662	0.515181415	0.296543755	0	0.048963957	8.940361446	0.028441371	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6955	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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - 30.0%/7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - 30.0%/14b:  Routine Exams - 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%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%																			10000	3.5911	0.0662	0.5913	0.3618	0.6351	1.1455	0.4952	0.2606	0.8366	0.1105	0.3018	0	0.0018	0.2333	4.0667	7.1684	0.2177	0.3879	1.8459	2.0136	0.8739	0.0155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2205	1250	NO	2.726910447	20.3361	0.748825304	2.70225072	0.361847609	2.776956581	3.412380739	1.063906156	2.074057396	6.893487754	1.914942979	3.896574986	0	0.004786213	3.02874065	7.87038229	13.78182828	0.732926843	0.684407018	1.845862149	2.062542405	9.814305787	0.043911534	0	0.7275	1.1375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.916
H4209_809_0	2012	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	240.5524917	2.83260023	49.66845207	35.16041903	9.332592057	15.09152921	3.773253176	9.146065894	44.50633547	4.68436481	19.01139439	0	0.024258604	19.76536778	38.97227103	88.72665886	1.090764494	4.675806713	19.4663878	22.53004968	35.72319141	0.713696238	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																					0.07948575	0.07948575	0.181568946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068091225	0.068091225	0.155540483	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0	0	0	0	0	0	0												16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	0	YES	14.895	16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	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	2.222	0.0262	1.3153	0	0.2223	0.3598	0.09	0.2571	1.1295	0.1551	0.5139	0	0.0007	0.5528	1.0275	2.3344	0.0299	0.128	0.5397	0.5861	0.887	0.0217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3989	0	YES	1.543	18.6016	0.219075894	9.040754307	0	2.013124595	3.255671961	0.813997999	2.012133422	9.669766701	1.053937488	4.161969307	0	0.005319894	4.345589485	8.505863449	19.36001246	0.239172485	1.025267476	4.275096187	4.909386181	7.741846852	0.158648639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4082
H4209_810_0	2012	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	240.5524917	2.83260023	49.66845207	35.16041903	9.332592057	15.09152921	3.773253176	9.146065894	44.50633547	4.68436481	19.01139439	0	0.024258604	19.76536778	38.97227103	88.72665886	1.090764494	4.675806713	19.4663878	22.53004968	35.72319141	0.713696238	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																					0.07948575	0.07948575	0.181568946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068091225	0.068091225	0.155540483	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0	0	0	0	0	0	0												16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	0	YES	14.895	16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	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	2.222	0.0262	1.3153	0	0.2223	0.3598	0.09	0.2571	1.1295	0.1551	0.5139	0	0.0007	0.5528	1.0275	2.3344	0.0299	0.128	0.5397	0.5861	0.887	0.0217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3989	0	YES	1.543	18.6016	0.219075894	9.040754307	0	2.013124595	3.255671961	0.813997999	2.012133422	9.669766701	1.053937488	4.161969307	0	0.005319894	4.345589485	8.505863449	19.36001246	0.239172485	1.025267476	4.275096187	4.909386181	7.741846852	0.158648639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4082
H4209_811_0	2012	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	240.5524917	2.83260023	49.66845207	35.16041903	9.332592057	15.09152921	3.773253176	9.146065894	44.50633547	4.68436481	19.01139439	0	0.024258604	19.76536778	38.97227103	88.72665886	1.090764494	4.675806713	19.4663878	22.53004968	35.72319141	0.713696238	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																					0.07948575	0.07948575	0.181568946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068091225	0.068091225	0.155540483	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0	0	0	0	0	0	0												16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	0	YES	14.895	16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	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	2.222	0.0262	1.3153	0	0.2223	0.3598	0.09	0.2571	1.1295	0.1551	0.5139	0	0.0007	0.5528	1.0275	2.3344	0.0299	0.128	0.5397	0.5861	0.887	0.0217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3989	0	YES	1.543	18.6016	0.219075894	9.040754307	0	2.013124595	3.255671961	0.813997999	2.012133422	9.669766701	1.053937488	4.161969307	0	0.005319894	4.345589485	8.505863449	19.36001246	0.239172485	1.025267476	4.275096187	4.909386181	7.741846852	0.158648639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4082
H4209_812_0	2012	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	240.5524917	2.83260023	49.66845207	35.16041903	9.332592057	15.09152921	3.773253176	9.146065894	44.50633547	4.68436481	19.01139439	0	0.024258604	19.76536778	38.97227103	88.72665886	1.090764494	4.675806713	19.4663878	22.53004968	35.72319141	0.713696238	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																					0.07948575	0.07948575	0.181568946	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068091225	0.068091225	0.155540483	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0.191888916	0	0	0	0	0	0	0	0												16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	0	YES	14.895	16.3795	0.192875219	7.725455033	0	1.790820971	2.895897176	0.724045461	1.755028667	8.540272456	0.898877684	3.648075857	0	0.004654957	3.792754992	7.478346831	17.02566236	0.209305616	0.89723548	3.735384047	4.323266805	6.854884465	0.136950397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0093	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	2.222	0.0262	1.3153	0	0.2223	0.3598	0.09	0.2571	1.1295	0.1551	0.5139	0	0.0007	0.5528	1.0275	2.3344	0.0299	0.128	0.5397	0.5861	0.887	0.0217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3989	0	YES	1.543	18.6016	0.219075894	9.040754307	0	2.013124595	3.255671961	0.813997999	2.012133422	9.669766701	1.053937488	4.161969307	0	0.005319894	4.345589485	8.505863449	19.36001246	0.239172485	1.025267476	4.275096187	4.909386181	7.741846852	0.158648639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4082
H4211_001_0	2012	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	223.4915981	2.485040103	28.59462932	0	10.1867863	8.961775399	5.137701606	14.0956418	44.56201819	3.868639685	21.57579266	0	0.189327822	15.54109763	34.31439551	56.15704808	1.442239687	5.518308207	30.00423556	67.06505212	39.05589886	10.72974881	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	18% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; 20% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 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); 20% Coinsurance for Office-Rad Therapeutic; 20% Coinsurance for Office-Rad Diagnostic; 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; 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"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 14a"	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 13a-e, 14c"											0	NO	0.082439043	0.082439043	0.18384785	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.077705556	0.077705556	0.17329167	0	0.188516395	0.188516395	0.188516395	0.188516395	0.188516395	0.188516395	0.191965434	0	0.188516395	0.188516395	0.188516395	0.188516395	0.188516395	0.188516395	0.192629659	0.188516395	0.188516395	0.1922768	0	0	0	0	0	0	0	0												17.3665	0.193101423	4.955211059	0	1.92037623	1.689441592	0.968540986	2.657259578	8.400671027	0.729302007	4.141806393	0	0.035691399	2.929751701	6.468826141	10.58652426	0.271885827	1.04029157	5.77970565	12.64286186	7.362677259	2.063081762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2035	0	NO	5.363953876	17.3665	0.193101423	4.955211059	0	1.92037623	1.689441592	0.968540986	2.657259578	8.400671027	0.729302007	4.141806393	0	0.035691399	2.929751701	6.468826141	10.58652426	0.271885827	1.04029157	5.77970565	12.64286186	7.362677259	2.063081762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2035	NO																																										0	0	0	0	0	0	0	0	0	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	17.3665	0.193101423	4.955211059	0	1.92037623	1.689441592	0.968540986	2.657259578	8.400671027	0.729302007	4.141806393	0	0.035691399	2.929751701	6.468826141	10.58652426	0.271885827	1.04029157	5.77970565	12.64286186	7.362677259	2.063081762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2035
H4211_003_0	2012	9																															D	D	D		T	Coin	Coin	V	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	YES	712.7880653	15.21331957	367.8955353	0	228.6677662	7.665456991	4.468856083	185.6557832	206.858134	76.14947947	564.9000215	0	9.068829483	471.7881978	4031.380101	4031.771938	110.0627483	470.1872044	784.1393952	0	33.77626939	0	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	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$0/$100 per day for SNF days 1-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $35/Visit for Speclst Urgent Care; PBP 4a, 4b"	$200/Visit for OP Fac - Surgery; PBP 9b	$250/Visit for OP Fac - Pathology; PBP 8a	$25/Visit for OP Fac - Radiology; $150/Visit for OP Fac - CT/MRI/PET; $60/Visit for Radiology - Therapeutic; $150/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	$30/Visit for Renal Dialysis - Fac; PBP 12	"$250/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; $250/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP Office Visits; PBP 7a, 14a-b"	"$35/Visit for Speclst Office Visits; $20/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"	$25/Visit for Prof Radiology (Office); $150/Visit for Prof Radiology (Office); $60/Visit for Office-Rad Therapeutic; $150/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											0	NO	250	200	40.00082408	0	200	0.2	0.2	56.86621395	200	250	74.541054	0	30	123.1206153	10	33.55988012	35	35	82.59922489	0	0.2	0	0	0	0	0	0	0	0	0											NO	236.9313189	189.5450551	37.90979202	0	189.5450551	0.189545055	0.189545055	53.89354828	189.5450551	236.9313189	70.64444094	0	28.43175827	116.6845191	9.477252755	31.82119934	33.17038464	33.17038464	78.28137317	0	0.189545055	0	0	0	0	0	0	0	0	0												14.0735	0.240300791	1.162236936	0	3.611903695	1.452949468	0.847049572	0.833804076	3.267411368	1.503516384	3.325587184	0	0.021486897	4.587531581	3.183867347	10.69131821	0.304235308	1.299690869	5.115292384	0	6.402124842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9238	0	NO	3.410049532	14.0735	0.240300791	1.162236936	0	3.611903695	1.452949468	0.847049572	0.833804076	3.267411368	1.503516384	3.325587184	0	0.021486897	4.587531581	3.183867347	10.69131821	0.304235308	1.299690869	5.115292384	0	6.402124842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9238	YES	$350/Days 1-7 for IP Medical; $350/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	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"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a, 4b"	$300/Visit for OP Fac - Surgery; PBP 9b	No Cost-Sharing; PBP 8a	$75/Visit for OP Fac - Radiology; $200/Visit for OP Fac - CT/MRI/PET; $200/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"$45/Visit for Speclst Office Visits; $45/Visit for Chiropractor; $45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$45/Visit for OP Psych - Non-Physician; $45/Visit for OP Psych - Psychiatrist; $45/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	$75/Visit for Prof Radiology (Office); $200/Visit for Prof Radiology (Office); $200/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											6700	2.3987	0	0	0	0	0	0	0.1049	0.7401	0	0.6211	0	0	0	0	1.539	0.0429	0	0.9041	0	0	0	0	0	0	0	0	0	0	0											6.3507	0	NO	0.350293631	16.4722	0.240300791	1.162236936	0	3.611903695	1.452949468	0.847049572	0.938672784	4.007494533	1.503516384	3.946638583	0	0.021486897	4.587531581	3.183867347	12.23027924	0.347173929	1.299690869	6.019408266	0	6.402124842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2745
H4213_001_0	2012	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	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	929.2509101	65.54776431	338.2423941	0	141.831162	21.77795284	1.881295495	324.2058936	289.0569253	0	182.316367	0	0	1372.732553	3014.398834	3588.857009	243.5051774	406.4703844	201.1908562	0	34.16104382	0	0	0	0	0	0	0	0	0	3.992367724	3.238924522										"$200 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 copay, (4b) $10 to $30 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) $30 copay, (9d) $30 copay"	"(7a) $10 to $30 copay, $10 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									0	NO	200	95	146	0	250	0.2	0.2	64.30489499	200	0	200	0	0	107.2079875	10	28.30218559	30	30	200	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	164.5362301	78.15470929	120.111448	0	205.6702876	0.16453623	0.16453623	52.89867063	164.5362301	0	164.5362301	0	0	88.20948652	8.226811504	23.28405425	24.68043451	24.68043451	164.5362301	0	0.16453623	0.16453623	0	0	0	0	0	0	0	0	0.16453623	0.16453623										12.7413	0.426905539	3.385565309	0	2.430871323	3.583262258	0.309541268	1.429171732	3.963361397	0	2.499803976	0	0	10.09066947	2.066574251	6.963595109	0.500817799	0.835988809	2.758598751	0	5.620729366	0	0	0	0	0	0	0	0	0	0.656889134	0.53292043	0	0	0	0	0	0	0	0	60.7966	0	NO	13.10725633	12.7413	0.426905539	3.385565309	0	2.430871323	3.583262258	0.309541268	1.429171732	3.963361397	0	2.499803976	0	0	10.09066947	2.066574251	6.963595109	0.500817799	0.835988809	2.758598751	0	5.620729366	0	0	0	0	0	0	0	0	0	0.656889134	0.53292043	0	0	0	0	0	0	0	0	60.7966	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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									4000	3.193	0.0524	0.4509	0.5136	0.1421	0.3355	0.0297	0.1342	0.593	0.0787	0.1552	0	0	0.2348	0.29	0.3855	0.0278	0.0503	0.2292	1.2853	0.5514	0.1266	0	0	0	0	0	0	0.0647	0	0.0909	0.0692									9.0839	500	NO	6.223316396	15.9343	0.479259687	3.836433018	0.51355586	2.57301171	3.91874721	0.339261178	1.563333718	4.556355248	0.078745921	2.654959358	0	0	10.32551411	2.356621941	7.349055598	0.528646715	0.886288034	2.987763177	1.285295328	6.172107404	0.126619667	0	0	0	0	0	0	0.06470018	0	0.747784707	0.602076504	0	0	0	0	0	0	0	0	69.8804
H4213_002_0	2012	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	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	962.5194876	63.28872509	236.9760439	0	136.9102259	18.09753816	0.523859629	325.8199978	338.3308775	0	196.2648091	0	0	1222.861298	2761.187007	2937.611885	231.0841528	261.3050944	119.7417491	0	34.0379848	0	0	0	0	0	0	0	0	0	2.540878933	4.304408911										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 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									0	NO	265	95	146	0	250	0.2	0.2	63.93080165	250	0	250	0	0	105.8773651	25	38.5513752	40	40	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	240.2410706	86.12415738	132.3592313	0	226.6425194	0.181314016	0.181314016	57.96058945	226.6425194	0	226.6425194	0	0	95.95281263	22.66425194	34.95303675	36.26280311	36.26280311	226.6425194	0	0.181314016	0.181314016	0	0	0	0	0	0	0	0	0.181314016	0.181314016										19.2697	0.45422401	2.613830584	0	2.585806544	3.281337315	0.094983093	1.573726594	6.39001354	0	3.706829233	0	0	9.778081747	5.215019831	8.556538015	0.698313261	0.789637932	2.26154764	0	6.171563705	0	0	0	0	0	0	0	0	0	0.460696962	0.780449664	0	0	0	0	0	0	0	0	74.6823	0	NO	7.711183804	19.2697	0.45422401	2.613830584	0	2.585806544	3.281337315	0.094983093	1.573726594	6.39001354	0	3.706829233	0	0	9.778081747	5.215019831	8.556538015	0.698313261	0.789637932	2.26154764	0	6.171563705	0	0	0	0	0	0	0	0	0	0.460696962	0.780449664	0	0	0	0	0	0	0	0	74.6823	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	4.2122	0.0926	0.322	0.2428	0.1734	0.3405	0.0101	0.1634	0.9532	0.0734	0.231	0	0	0.2731	0.3577	0.4568	0.0308	0.0467	0.2323	1.5403	0.6708	0.2091	0	0	0	0	0	0	0.0627	0	0.0753	0.1027									10.8726	500	NO	3.97646345	23.4819	0.546785808	2.935815401	0.242837118	2.759193261	3.621790285	0.10505279	1.737098087	7.343180838	0.073418981	3.937819361	0	0	10.05116969	5.572757409	9.013351693	0.729130253	0.836300877	2.493841703	1.540257434	6.842321736	0.209057569	0	0	0	0	0	0	0.062737346	0	0.535977319	0.883145247	0	0	0	0	0	0	0	0	85.5549
H4213_003_0	2012	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	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	877.2279297	27.32148774	244.7482948	0	205.8822789	16.2080565	0.890956252	287.1766147	364.6516036	0	203.2937201	0	0	1748.858152	2901.601798	2986.517906	174.6038579	439.5323191	177.3691328	0	31.00024883	0	0	0	0	0	0	0	0	0	3.542272853	4.583126057										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 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									0	NO	265	95	146	0	250	0.2	0.2	63.37134087	250	0	250	0	0	122.0609935	25	37.53537672	40	40	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	235.6228539	84.46857025	129.8148553	0	222.2857112	0.177828569	0.177828569	56.34120899	222.2857112	0	222.2857112	0	0	108.5605147	22.22857112	33.37019485	35.56571379	35.56571379	222.2857112	0	0.177828569	0.177828569	0	0	0	0	0	0	0	0	0.177828569	0.177828569										17.2246	0.192317251	2.647663707	0	3.813724065	2.882255493	0.158437475	1.348323139	6.754736754	0	3.765774097	0	0	15.82141176	5.374871828	8.305057036	0.51749257	1.302690055	3.285551985	0	5.512729887	0	0	0	0	0	0	0	0	0	0.629917312	0.815010748	0	0	0	0	0	0	0	0	80.3525	0	NO	10.00527244	17.2246	0.192317251	2.647663707	0	3.813724065	2.882255493	0.158437475	1.348323139	6.754736754	0	3.765774097	0	0	15.82141176	5.374871828	8.305057036	0.51749257	1.302690055	3.285551985	0	5.512729887	0	0	0	0	0	0	0	0	0	0.629917312	0.815010748	0	0	0	0	0	0	0	0	80.3525	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	4.0929	0.0402	0.3904	0.3709	0.2458	0.3003	0.0169	0.1465	1.0277	0.0719	0.2452	0	0	0.4277	0.3608	0.4695	0.0269	0.0727	0.2494	1.4756	0.602	0.1649	0	0	0	0	0	0	0.0574	0	0.0947	0.1081									11.0585	500	NO	4.232856445	21.3175	0.232561464	3.038070431	0.37091299	4.059546812	3.182602865	0.17533872	1.494805436	7.78242685	0.071876099	4.01095223	0	0	16.24911068	5.735673191	8.774571471	0.544406619	1.375409021	3.534928399	1.475608522	6.114727017	0.164852243	0	0	0	0	0	0	0.057415876	0	0.724623232	0.923112804	0	0	0	0	0	0	0	0	91.4111
H4213_004_0	2012	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	700.0034023	57.70593303	218.7680911	0	61.15789813	15.9252802	1.328873915	290.9072392	363.2055072	0	163.6273724	0	0	1067.839848	3022.828231	3498.96782	175.1527261	332.0085282	141.488382	0	13.64616132	0	0	0	0	0	0	0	0	0	3.860072704	3.161186719										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 copay, (4b) $15 to $35 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) $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 $280 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									0	NO	265	95	146	0	250	0.2	0.2	64.49657517	280	0	280	0	0	118.9031815	15	32.43623349	35	35	280	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	240.9401838	86.37478289	132.7444032	0	227.3020602	0.181841648	0.181841648	58.64081765	254.5783075	0	254.5783075	0	0	108.1077525	13.63812361	29.49129079	31.82228843	31.82228843	254.5783075	0	0.181841648	0.181841648	0	0	0	0	0	0	0	0	0.181841648	0.181841648										14.0549	0.415361453	2.420019974	0	1.15844302	2.895879199	0.241644623	1.421586531	7.705353607	0	3.471331626	0	0	9.620147164	3.435475423	8.599089787	0.464480047	0.880439262	3.001656067	0	2.481440466	0	0	0	0	0	0	0	0	0	0.701921983	0.574835403	0	0	0	0	0	0	0	0	63.544	0	NO	6.345381523	14.0549	0.415361453	2.420019974	0	1.15844302	2.895879199	0.241644623	1.421586531	7.705353607	0	3.471331626	0	0	9.620147164	3.435475423	8.599089787	0.464480047	0.880439262	3.001656067	0	2.481440466	0	0	0	0	0	0	0	0	0	0.701921983	0.574835403	0	0	0	0	0	0	0	0	63.544	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	3.1247	0.0767	0.3613	0.3365	0.0908	0.3132	0.0268	0.1556	0.836	0.0626	0.1816	0	0	0.2505	0.3793	0.4713	0.0257	0.0529	0.2586	1.5651	0.2812	0.1811	0	0	0	0	0	0	0.0926	0	0.1069	0.0824									9.3133	500	NO	3.309812179	17.1796	0.49205333	2.781295155	0.336476174	1.249225661	3.209122703	0.268446584	1.577138186	8.541353371	0.062603791	3.652934151	0	0	9.870618673	3.814774126	9.070347673	0.490198515	0.933349625	3.260210353	1.565063259	2.762683289	0.181090726	0	0	0	0	0	0	0.092600318	0	0.808843352	0.657246343	0	0	0	0	0	0	0	0	72.8573
H4213_005_0	2012	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	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	891.237594	156.7548725	354.5595525	0	147.9168926	21.48743624	1.39094721	313.2776232	349.760883	0	176.4806949	0	0	1432.652276	3263.373018	4206.8569	318.9476364	404.0848384	222.3075861	0	68.89744782	0	0	0	0	0	0	0	0	0	5.6562625	4.326157529										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 copay, (4b) $15 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) $15 to $40 copay, $15 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	n/a	Not covered	"(16a) not covered, (16b) $40 copay Medicare covered only"	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(18a) $40 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									0	NO	265	95	146	0	250	0.2	0.2	63.92741526	250	0	250	0	0	109.7481907	15	37.18666379	40	40	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	231.1094465	82.85055628	127.3282233	0	218.0277797	0.174422224	0.174422224	55.73614252	218.0277797	0	218.0277797	0	0	95.80981452	13.08166678	32.4291979	34.88444475	34.88444475	218.0277797	0	0.174422224	0.174422224	0	0	0	0	0	0	0	0	0.174422224	0.174422224										17.1645	1.082269033	3.762119824	0	2.687499307	3.747886411	0.242612106	1.455073855	6.354799063	0	3.206474506	0	0	11.43851241	3.557529867	11.36874958	0.9271926	1.174689602	4.03910245	0	12.01724606	0	0	0	0	0	0	0	0	0	0.986577883	0.754578016	0	0	0	0	0	0	0	0	85.9674	0	NO	12.70757081	17.1645	1.082269033	3.762119824	0	2.687499307	3.747886411	0.242612106	1.455073855	6.354799063	0	3.206474506	0	0	11.43851241	3.557529867	11.36874958	0.9271926	1.174689602	4.03910245	0	12.01724606	0	0	0	0	0	0	0	0	0	0.986577883	0.754578016	0	0	0	0	0	0	0	0	85.9674	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 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	3.7084	0.1733	0.5256	0.2368	0.1754	0.3764	0.025	0.1424	0.9197	0.0885	0.1946	0	0	0.2951	0.3733	0.5581	0.0428	0.062	0.3294	1.7211	1.2587	0.2431	0	0	0	0	0	0	0.0694	0	0.1306	0.0928									11.7425	500	YES	5.094680024	20.8728	1.255600279	4.287756334	0.236762453	2.862930512	4.124242108	0.267566332	1.597517355	7.274462428	0.08848971	3.401059845	0	0	11.73366143	3.930867494	11.9268118	0.969954746	1.236723029	4.368521003	1.721066374	13.27595997	0.243079611	0	0	0	0	0	0	0.069402397	0	1.117158876	0.847404634	0	0	0	0	0	0	0	0	97.7098
H4213_006_0	2012	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	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	1113.021763	32.00924824	347.1103767	0	204.5130662	24.85036515	2.787506189	303.7017726	439.4833535	0	209.1626734	0	0	1547.411487	3285.108869	3483.796943	133.2105857	476.8367781	222.0283533	0	52.94063647	0	0	0	0	0	0	0	0	0	3.854105641	4.542774576										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 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, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 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) $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									0	NO	265	95	146	0	250	0.2	0.2	63.3045615	250	0	250	0	0	126.8597633	15	33.39865985	35	35	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	229.0038654	82.09572533	126.1681673	0	216.0413824	0.172833106	0.172833106	54.66333861	216.0413824	0	216.0413824	0	0	109.5750035	12.96248295	28.83902035	30.24579354	30.24579354	216.0413824	0	0.172833106	0.172833106	0	0	0	0	0	0	0	0	0.172833106	0.172833106										21.2405	0.218985204	3.649523342	0	3.681940463	4.294965793	0.481773352	1.383446069	7.912215937	0	3.765649427	0	0	14.12980159	3.548597308	8.37244091	0.335754989	1.201858895	3.997276032	0	9.149894632	0	0	0	0	0	0	0	0	0	0.666117049	0.78514184	0	0	0	0	0	0	0	0	88.8159	0	NO	14.40292243	21.2405	0.218985204	3.649523342	0	3.681940463	4.294965793	0.481773352	1.383446069	7.912215937	0	3.765649427	0	0	14.12980159	3.548597308	8.37244091	0.335754989	1.201858895	3.997276032	0	9.149894632	0	0	0	0	0	0	0	0	0	0.666117049	0.78514184	0	0	0	0	0	0	0	0	88.8159	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	4.4143	0.0394	0.5137	0.3506	0.2329	0.4168	0.0466	0.1374	1.0778	0.0936	0.2255	0	0	0.3752	0.354	0.488	0.0206	0.07	0.2657	1.6254	0.9247	0.2173	0	0	0	0	0	0	0.068	0	0.0923	0.099									12.1488	500	NO	5.767753704	25.6548	0.258353301	4.16318455	0.350573859	3.914828281	4.711761788	0.528419196	1.520879179	8.990046389	0.093551853	3.991140132	0	0	14.50501673	3.902622541	8.860427873	0.356324744	1.271853456	4.262956091	1.62544615	10.07455116	0.217268389	0	0	0	0	0	0	0.068045351	0	0.758452849	0.884190844	0	0	0	0	0	0	0	0	100.9647
H4213_007_0	2012	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	791.5851598	57.68443349	324.5294499	0	155.3342676	17.63844442	2.290118765	315.8816936	365.7153471	0	187.7139474	0	0	1347.954898	3167.1527	3496.854834	152.6220638	456.9077277	180.1752262	0	25.22021799	0	0	0	0	0	0	0	0	0	4.763724706	3.971323464										"$175 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 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									0	NO	175	95	146	0	250	0.2	0.2	63.40688465	200	0	200	0	0	111.7469915	15	32.88981377	35	35	200	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	151.7783523	82.39396266	126.626511	0	216.8262175	0.173460974	0.173460974	54.98941765	173.460974	0	173.460974	0	0	96.93169813	13.00957305	28.52529172	30.35567045	30.35567045	173.460974	0	0.173460974	0.173460974	0	0	0	0	0	0	0	0	0.173460974	0.173460974										10.0121	0.396070755	3.424502664	0	2.806711809	3.05958175	0.397246232	1.447512532	5.286445027	0	2.713420346	0	0	10.88829644	3.433608702	8.312400355	0.386078756	1.155811701	2.60444752	0	4.374723578	0	0	0	0	0	0	0	0	0	0.826320328	0.688869636	0	0	0	0	0	0	0	0	62.2142	0	NO	9.523352057	10.0121	0.396070755	3.424502664	0	2.806711809	3.05958175	0.397246232	1.447512532	5.286445027	0	2.713420346	0	0	10.88829644	3.433608702	8.312400355	0.386078756	1.155811701	2.60444752	0	4.374723578	0	0	0	0	0	0	0	0	0	0.826320328	0.688869636	0	0	0	0	0	0	0	0	62.2142	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	3.3177	0.0693	0.4688	0.2978	0.1732	0.2962	0.0393	0.1458	0.7231	0.0641	0.1936	0	0	0.2868	0.3406	0.4608	0.0222	0.0679	0.2556	1.4347	0.4442	0.1607	0	0	0	0	0	0	0.0722	0	0.1093	0.0878									9.5318	500	NO	5.066376829	13.3298	0.46540582	3.893328019	0.297836315	2.979906357	3.355751623	0.436560896	1.593325297	6.009498794	0.064051776	2.907064545	0	0	11.17513672	3.77425033	8.773234376	0.408288905	1.223724974	2.86007997	1.434656856	4.81891186	0.160664696	0	0	0	0	0	0	0.072195619	0	0.935617104	0.776658971	0	0	0	0	0	0	0	0	71.7459
H4268_001_0	2012	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	1156.047868	31.57660774	811.7252789	10.59969604	307.5321938	21.96750913	5.289128086	320.5416237	247.9838754	418.7158783	20.97786199	5.498831202	0.023527018	364.2640377	10119.3425	3554.305424	224.1821082	887.8120989	3152.051391	56.42765564	14.08702814	0.402353503	0	0	370.7620543	19.67341683	16.93272628	0	94.69033499	0												$295 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500,4b: $28"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	221.6078782	131.3683238	70.37195739	20	100	0.2	0.199843235	64.38807531	173.9048134	15	0.2	145	0.2	48.99142431	12.84537736	25.6930906	39.97591092	40	0	40	0.198452381	0	0	0	0	2.358553858	0	0	0	0											NO	185.4425979	109.9296805	58.88761132	16.73610157	83.68050784	0.167361016	0.167229834	53.88026841	145.524431	12.55207618	0.167361016	121.3367364	0.167361016	40.99627266	10.74907701	21.50010869	33.45204527	33.47220314	0	33.47220314	0.16606596	0	0	0	0	2.358553858	0	0	0	0												17.865	0.2892672	3.983380227	0.014783132	2.144537513	3.67650464	0.884500013	1.43923906	3.007309364	0.437979467	3.51087629	0.055600853	0.003937506	1.244455651	9.064465981	6.368162745	0.624945836	2.47641891	0	0.157396496	2.339375853	0	0	0	0	0.003866734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.592		NO	11.62097199	17.865	0.2892672	3.983380227	0.014783132	2.144537513	3.67650464	0.884500013	1.43923906	3.007309364	0.437979467	3.51087629	0.055600853	0.003937506	1.244455651	9.064465981	6.368162745	0.624945836	2.47641891	0	0.157396496	2.339375853	0	0	0	0	0.003866734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.592	YES	"$295 days 1-7;$0 days 8-90,1a2: $222"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $28"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	3.7675	0.061	0.84	0	0	0	0	0.254	0	0	0	0	0.0007	0	0	0	0	0	0	0	0.4128	0	0	0	0	0	0	0	0	0											5.336	5000	NO	0.130178607	21.6325	0.350269642	4.823419885	0.014783132	2.144537513	3.67650464	0.884500013	1.693222424	3.007309364	0.437979467	3.51087629	0.055600853	0.004632359	1.244455651	9.064465981	6.368162745	0.624945836	2.47641891	0	0.157396496	2.752206886	0	0	0	0	0.003866734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.9281
H4268_002_0	2012	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	NO	1268.83748	34.65737403	890.9211158	11.63385356	337.5365193	24.15686675	5.816260807	351.815212	272.1783795	459.5678208	23.06858797	6.03532372	0.025871801	399.8033957	11106.6344	3901.08062	246.0543969	974.4313333	3459.580742	61.93301014	15.49098988	0.441609053	0	0	406.2383013	21.58837889	17.95147722	0	94.10751138	0												$295 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $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%"	9c1: $148	12: 20.0%	"31: $148,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	221.6078782	131.3683238	70.37195739	20	100	0.2	0.199839537	64.42887029	173.9048134	15	0.2	147.5	0.2	49.04797136	12.84537736	28.86073681	39.97638633	45	0	45	0.198452381	0	0	0	0	2.356971134	0	0	0	0											NO	179.8879848	106.6369266	57.12373452	16.23480052	81.1740026	0.162348005	0.162217751	52.29949285	141.1654978	12.17610039	0.162348005	119.7316538	0.162348005	39.81420154	10.42710695	23.42741525	32.45043288	36.52830117	0	36.52830117	0.161091741	0	0	0	0	2.356971134	0	0	0	0												19.0207	0.307979654	4.241061775	0.015739441	2.283265858	3.921819129	0.943500747	1.533313097	3.201849702	0.466311994	3.745139239	0.060218274	0.004200235	1.326487748	9.650838734	7.616019635	0.665380974	2.966193434	0	0.188525637	2.495470526	0	0	0	0	0.004240265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6583		NO	14.99466129	19.0207	0.307979654	4.241061775	0.015739441	2.283265858	3.921819129	0.943500747	1.533313097	3.201849702	0.466311994	3.745139239	0.060218274	0.004200235	1.326487748	9.650838734	7.616019635	0.665380974	2.966193434	0	0.188525637	2.495470526	0	0	0	0	0.004240265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6583	YES	"$295 days 1-7;$0 days 8-90,1a2: $222"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $30"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	4.1351	0.067	0.922	0	0	0	0	0.2706	0	0	0	0	0.0007	0	0	0	0	0	0	0	0.4404	0	0	0	0	0	0	0	0	0											5.8357	5000	NO	0.165059244	23.1558	0.374933789	5.163059757	0.015739441	2.283265858	3.921819129	0.943500747	1.803897761	3.201849702	0.466311994	3.745139239	0.060218274	0.004941453	1.326487748	9.650838734	7.616019635	0.665380974	2.966193434	0	0.188525637	2.935847678	0	0	0	0	0.004240265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.494
H4270_001_0	2012	11																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	243.8234856	7.614972225	208.8804651		144.999125	4.507642782	6.009901372	392.2531272	402.4462672	1616.724705	956.0670024			272.1452077	32.93651689	1148.264748	58.79444034	292.0614797		578.5663848	926.514503																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	"#4a $65, #4b $25"	"#9a $200, #9b $200"	#8a $25	#8b $25			"#3 $25, #9a $25, #9c $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7I $30"		"#7f $30, #17a $30"	#15 $50; $25/$50																						300	300	125		100	0.2	0.038173182	46.12421531	200	25	25			25	25	30	30	30		30	47.66901441																				YES	296.1	296.1	123.375		98.7	0.1974	0.037676931	45.52460052	197.4	24.675	24.675			24.675	24.675	29.61	29.61	29.61		29.61	47.04931722																				20000	6.0163	0.18789944	2.147552282	0	1.192617803	0.889808685	0.226434637	1.488097243	6.620241095	3.324390174	1.965912774	0	0	0.559598583	0.067725713	2.833343266	0.145075282	0.720661701	0	1.427612555	3.63265623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.446			0.44	6.0163	0.18789944	2.147552282	0	1.192617803	0.889808685	0.226434637	1.488097243	6.620241095	3.324390174	1.965912774	0	0	0.559598583	0.067725713	2.833343266	0.145075282	0.720661701	0	1.427612555	3.63265623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.446	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.7448	0.0821		0.1109	0.1091							0.078		0.3847				0.2428																					1.7523			0	6.0163	0.18789944	2.892353862	0.082066573	1.192617803	1.000704572	0.335519974	1.488097243	6.620241095	3.324390174	1.965912774	0	0	0.637623678	0.067725713	3.21803202	0.145075282	0.720661701	0	1.67037159	3.63265623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1983
H4270_002_0	2012	11																															A	A	D		T	Coin	Coin	V	V					V	V	V	V	V		V	O																																																												0	YES	234.8359193	4.412365915	297.4839925		124.975603	7.959562347	12.84956467	415.8670928	565.0836533						25.81676304	1746.102823	210.7441386	592.6226742		833.1502491	1459.411355																				3400	#1a $150	#1b $150	#2 $75/day days 21-100		#10a $100	#11a 20%	#11b 10%/10% #11C 0%	"#4a $65, #4b $20"	"#9a $100, #9b $100"						#7a $0/$20	#7d $15	"#7e $15, #7h $15"	"#7c $15, #7I $15"		"#7f $15, #17a $15"	#15 $50; $25/$50																						150	150	75		100	0.2	0.038903194	49.4320102	100						20	15	15	15		15	47.21893556																				YES	149.25	149.25	74.625		99.5	0.199	0.038708678	49.18485015	99.5						19.9	14.925	14.925	14.925		14.925	46.98284088																				20000	2.9208	0.054878801	1.849978579	0	1.036256042	1.583952907	0.497389657	1.704530053	4.685485292	0	0	0	0	0	0.042812799	2.171715386	0.262113022	0.737074451	0	1.036230622	5.713940954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2971			0.12	2.9208	0.054878801	1.849978579	0	1.036256042	1.583952907	0.497389657	1.704530053	4.685485292	0	0	0	0	0	0.042812799	2.171715386	0.262113022	0.737074451	0	1.036230622	5.713940954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2971	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.5315	0.1173		0.5067	0.2545							0.0246		0.4743				0.3994																					2.3083			0	2.9208	0.054878801	2.38149729	0.117262307	1.036256042	2.090693055	0.751904768	1.704530053	4.685485292	0	0	0	0	0.024573901	0.042812799	2.646065247	0.262113022	0.737074451	0	1.435581296	5.713940954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6054
H4270_003_0	2012	11																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	205.0749421	6.922360914	225.3526931		97.92863941	6.915051604	8.231143822	346.0779102	470.6279273	1990.819901	1181.990122			348.3588186	37.18814689	1203.105679	101.2461109	245.4994193		649.9950754	999.4330539																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	"#4a $65, #4b $25"	"#9a $200, #9b $200"	#8a $25	#8b $25			"#3 $25, #9a $25, #9c $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $50; $25/$50																						300	300	125		100	0.2	0.03753316	49.0497187	200	25	25			25	25	30	30	30		30	46.90799397																				YES	294.3	294.3	122.625		98.1	0.1962	0.03682003	48.11777405	196.2	24.525	24.525			24.525	24.525	29.43	29.43	29.43		29.43	46.01674208																				20000	5.0295	0.169770901	2.302822832	0	0.800566627	1.356733125	0.303070965	1.387708224	7.694766611	4.068738174	2.415692312	0	0	0.711958336	0.076003275	2.950616678	0.248306087	0.602087326	0	1.594112922	3.832554422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.545			0.69	5.0295	0.169770901	2.302822832	0	0.800566627	1.356733125	0.303070965	1.387708224	7.694766611	4.068738174	2.415692312	0	0	0.711958336	0.076003275	2.950616678	0.248306087	0.602087326	0	1.594112922	3.832554422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.545	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.8862	0.0397		0.1772	0.1757							0.083		0.4083				0.3106																					2.0807			0	5.0295	0.169770901	3.188982947	0.039672227	0.800566627	1.53397986	0.478722688	1.387708224	7.694766611	4.068738174	2.415692312	0	0	0.795000036	0.076003275	3.3589226	0.248306087	0.602087326	0	1.904706577	3.832554422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6256
H4270_004_0	2012	14																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	205.0749421	6.922360914	225.3526931	0	97.92863941	6.915051604	8.231143822	346.0779102	470.6279273	1990.819901	1181.990122	0	0	348.3588186	37.18814689	1203.105679	101.2461109	245.4994193	0	649.9950754	999.4330539																				3400	#1a $500	#1b $500	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	"#4a $65, #4b $25"	"#9a $250, #9b $250"	#8a $35	#8b $35			"#3 $35, #9a $35, #9c $35"	#7a $0/$25	#7d $35	"#7e $35, #7h $35"	"#7c $35, #7i $35"		"#7f $35, #17a $35, #18a $35"	#15 $50; $25/$50																						500	500	125		100	0.2	0.2	49.0497187	250	35	35			35	25	35	35	35		35	46.90799397																				YES	485.5	485.5	121.375		97.1	0.1942	0.1942	47.62727686	242.75	33.985	33.985			33.985	24.275	33.985	33.985	33.985		33.985	45.54766214																				20000	8.297	0.280067185	2.279348594	0	0.792405907	1.342903021	1.59848813	1.37356237	9.520410779	5.638167863	3.347494525	0	0	0.986581204	0.075228522	3.407295543	0.286737423	0.695274814	0	1.84084022	3.793486589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5553			1.36	8.297	0.280067185	2.279348594	0	0.792405907	1.342903021	1.59848813	1.37356237	9.520410779	5.638167863	3.347494525	0	0	0.986581204	0.075228522	3.407295543	0.286737423	0.695274814	0	1.84084022	3.793486589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5553	NO			Section C POS	Section C POS		Section C POS	Section C POS							Section C POS		Section C POS				Section C POS																								0.8862	0.0397		0.1772	0.1757							0.083		0.4083				0.3106																					2.0807			0	8.297	0.280067185	3.165508708	0.039672227	0.792405907	1.520149757	1.774139853	1.37356237	9.520410779	5.638167863	3.347494525	0	0	1.069622905	0.075228522	3.815601464	0.286737423	0.695274814	0	2.151433874	3.793486589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.636
H4270_801_0	2012	8																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin																																																												0	YES	215.4308611		57.68994834		7.903660987	21.87561961		15.89706159	45.59259903					50.82106539	231.5851406						60.16212264																				6700	FFS		FFS		FFS	FFS		FFS	FFS					FFS	FFS						FFS																						0.08407968		0.163080606		0.224	0.218786911		0.221487672	0.223956627					0.223692345	0.218247609						0.22399579																				NO	0.081136891		0.157372785		0.21616	0.211129369		0.213735603	0.216118145					0.215863113	0.210608942						0.216155938																					17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851			4.37	17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851	NO																																																																																		0			0	17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851
H4270_803_0	2012	8																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin																																																												0	YES	215.4308611		57.68994834		7.903660987	21.87561961		15.89706159	45.59259903					50.82106539	231.5851406						60.16212264																				6700	FFS		FFS		FFS	FFS		FFS	FFS					FFS	FFS						FFS																						0.08407968		0.163080606		0.224	0.218786911		0.221487672	0.223956627					0.223692345	0.218247609						0.22399579																				NO	0.081136891		0.157372785		0.21616	0.211129369		0.213735603	0.216118145					0.215863113	0.210608942						0.216155938																					17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851			4.311895187	17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851	NO																																																																																		0			0	17.4794	0	9.078827837	0	1.708455359	4.618585757	0	3.397768048	9.853387919	0	0	0	0	10.97039337	48.7739015	0	0	0	0	0	13.00440004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8851
H4279_001_0	2012	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	331.3740323	49.33019762	72.01744705	36.55188263	28.94982637	50.51188731	0	50.50861369	52.86009707	26.83739216	57.56203194	18.1314779	1.787977887	24.30703519	101.8759836	94.12054975	3.298880311	10.75079955	0	0	47.89267256	23.25947263																			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	Medicare Cost Sharing																				NO	0.087256444	0.087256444	0.178748085	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.087256444	0.087256444	0.178748085	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.22399	0.224																				28.9145	4.304377634	12.87298076	0	6.484761108	11.31466276	0	11.31392947	11.84066174	6.011575844	12.89389516	4.061451051	0.400507047	5.444775883	22.82022032	21.08300314	0.73894919	2.408179099	0	0	10.72747973	5.210121869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.8461		NO	0	28.9145	4.304377634	12.87298076	0	6.484761108	11.31466276	0	11.31392947	11.84066174	6.011575844	12.89389516	4.061451051	0.400507047	5.444775883	22.82022032	21.08300314	0.73894919	2.408179099	0	0	10.72747973	5.210121869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.8461	NO																																																																																		0		NO		28.9145	4.304377634	12.87298076	0	6.484761108	11.31466276	0	11.31392947	11.84066174	6.011575844	12.89389516	4.061451051	0.400507047	5.444775883	22.82022032	21.08300314	0.73894919	2.408179099	0	0	10.72747973	5.210121869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.8461
H4346_001_0	2012	6																															D	D	D	V	T	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	732.264987	122.9036996	722.8072987	0	269.9353501	6.376548848	5.073502344	455.2497481	121.9475384	0	1103.911677	23.79933128	0	67.22312879	0	3378.461744	174.4459133	1047.742559	0	0.024827009	16.74660848	0	0	0	193.5174873	294.9444831	0	0	0	0											3400	"1a:$0 days 1-3, $75 days 4-7, $0 days 8-90; Unlimited Add'l Days"	"1b:$0 days 1-3, $75 days 4-7, $0 days 8-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 4 Routine Footcare Visits	7e:$0-$15; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $0 First 3 Pints of Blood	10b:$0 Limited Clinical Transportation	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		16.86202786	25.97420417	10.37461094	0	28.37898518	0.038686464	0.092426535	47.543271	25	0	21.57103816	30	0	23.47098172	0	24.80615876	17.58987585	15	0	25	0.162630833	0	0	0	20	19.01237072	0	0	0	0											NO	16.7251987	25.76343305	10.29042478	0	28.14870015	0.038372537	0.091676528	47.15747483	24.79713419	0	21.39599711	29.75656103	0	23.28052333	0	24.6048659	17.44714047	14.87828051	0	24.79713419	0.155525753	0	0	0	20	19.01237072	0	0	0	0												1.0206	0.263868436	0.619832845	0	0.633194102	0.244684357	0.465121078	1.789035711	0.251995789	0	1.968274255	0.059015521	0	0.130415802	0	6.927216515	0.253631863	1.299050642	0	5.13E-05	2.6045289	0	0	0	0.322529146	0.467299488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3204	0		0.24927684	1.0206	0.263868436	0.619832845	0	0.633194102	0.244684357	0.465121078	1.789035711	0.251995789	0	1.968274255	0.059015521	0	0.130415802	0	6.927216515	0.253631863	1.299050642	0	5.13E-05	2.6045289	0	0	0	0.322529146	0.467299488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3204	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	1.0206	0.263868436	0.619832845	0	0.633194102	0.244684357	0.465121078	1.789035711	0.251995789	0	1.968274255	0.059015521	0	0.130415802	0	6.927216515	0.253631863	1.299050642	0	5.13E-05	2.6045289	0	0	0	0.322529146	0.467299488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3204
H4346_003_0	2012	7																															D	D	D	V	T	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	2475.013716	332.3282908	0	0	1550.167502	45.71474539	16.09967031	187.5865027	70.84212493	0	125.6929713	0	0	5.115896802	0	0	0	0	0	0	6.38458203	0	0	0	188.7802154	300.6991995	0	0	0	0											3400	"1a:$0 days 1-3, $50 days 4-7, $0 days 8-90; Unlimited Add'l Days"	"1b:$0 days 1-3, $50 days 4-7, $0 days 8-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0-$50; Therapeutic $0	5:$0	12:$0	3:Cardiac Rehab $0; Intensive Cardiac Rehab $0; Pulmonary Rehab $0; 9c:$0	7a:$0; 14d:$0; 14e:$0	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Additional Smoking Cessation $0	13d:Comprehensive Health Assessment $0 13b:OTC $24 per month Allowance											0		11.24135191	17.31613611	0	0	14.18949259	0.038686464	0.08726429	65	25	0	50	0	0	25	0	0	0	0	0	0	0.167847089	0	0	0	20	19.01237072	0	0	0	0											NO	11.21837061	17.28073581	0	0	14.16048425	0.038607375	0.087085891	64.86711704	24.94889117	0	49.89778234	0	0	24.94889117	0	0	0	0	0	0	0.167833203	0	0	0	20	19.01237072	0	0	0	0												2.3138	0.478573116	0	0	1.829260209	1.764926306	1.402054129	1.014016302	0.147286039	0	0.522650044	0	0	0.010636329	0	0	0	0	0	0	1.071544853	0	0	0	0.314633692	0.476417055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3458	0		0.019515389	2.3138	0.478573116	0	0	1.829260209	1.764926306	1.402054129	1.014016302	0.147286039	0	0.522650044	0	0	0.010636329	0	0	0	0	0	0	1.071544853	0	0	0	0.314633692	0.476417055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3458	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	2.3138	0.478573116	0	0	1.829260209	1.764926306	1.402054129	1.014016302	0.147286039	0	0.522650044	0	0	0.010636329	0	0	0	0	0	0	1.071544853	0	0	0	0.314633692	0.476417055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3458
H4346_005_0	2012	6																															D	D	D	V	T	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	2139.901917	37.43255353	2894.188406	0	830.497628	44.2625968	4.710212425	783.63367	166.1635942	0	1514.232544	60.09921741	0	88.92012872	0	5340.867076	334.6559974	1600.689127	0	0	27.65895543	0	0	0	201.8568144	302.7489342	0	0	0	0											3400	"1a:$0 days 1-3, $50 days 4-7, $0 days 8-90; 240 Add'l Days"	"1b:$0 days 1-3, $50 days 4-7, $0 days 8-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 9 Routine Footcare Visits	7e:$0-$15; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Health Alert Call $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		11.24135191	17.31613611	3.279235216	0	28.37898518	0.038686464	0.08726429	53.58078319	25	0	22.47502677	30	0	24.25967295	0	24.76555113	17.13014319	15	0	0	0.164025101	0	0	0	20	19.01237072	0	0	0	0											NO	10.94142449	16.85412905	3.191742843	0	27.62181329	0.037654281	0.084936015	52.15120905	24.33298188	0	21.87537676	29.19957825	0	23.61240729	0	24.10478827	16.67309855	14.59978913	0	0	0.148716557	0	0	0	20	19.01237072	0	0	0	0												1.9511	0.052574424	0.769792094	0	1.911654201	1.666676242	0.400066674	3.405620279	0.336937977	0	2.760367284	0.146239317	0	0.174968191	0	10.72837251	0.464979369	1.947476976	0	0	4.11334463	0	0	0	0.336428024	0.479664581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.6463	0		1.155783461	1.9511	0.052574424	0.769792094	0	1.911654201	1.666676242	0.400066674	3.405620279	0.336937977	0	2.760367284	0.146239317	0	0.174968191	0	10.72837251	0.464979369	1.947476976	0	0	4.11334463	0	0	0	0.336428024	0.479664581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.6463	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	1.9511	0.052574424	0.769792094	0	1.911654201	1.666676242	0.400066674	3.405620279	0.336937977	0	2.760367284	0.146239317	0	0.174968191	0	10.72837251	0.464979369	1.947476976	0	0	4.11334463	0	0	0	0.336428024	0.479664581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.6463
H4346_006_0	2012	6																															D	D	D	V	T	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	1070.309249	55.67562068	956.7721467	0	402.2033264	11.89298072	5.101753519	593.3949956	142.8547908	0	1040.478249	33.24866963	0	49.59486173	0	4174.226462	277.8898101	1120.534889	0	0	24.8696096	0	0	0	206.4525244	297.3436841	0	0	0	0											3400	"1a:$0 days 1-3, $50 days 4-7, $0 days 8-90; 240 Add'l Days"	"1b:$0 days 1-3, $50 days 4-7, $0 days 8-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		11.24135191	17.31613611	3.279235216	0	28.37898518	0.038686464	0.08726429	50.41829218	25	0	18.92156427	30	0	23.88968437	0	24.83095179	16.8885913	15	0	0	0.16025644	0	0	0	20	19.01237072	0	0	0	0											NO	11.10943509	17.11293195	3.240753522	0	28.04595893	0.038232479	0.086240247	49.82663555	24.70662601	0	18.69952048	29.64795121	0	23.60933988	0	24.53956157	16.69040436	14.8239756	0	0	0.148365725	0	0	0	20	19.01237072	0	0	0	0												0.9909	0.079397759	0.258388559	0	0.940014831	0.454698141	0.439976483	2.463906349	0.294121657	0	1.62137036	0.082146245	0	0.097575162	0	8.536140605	0.386507775	1.384231821	0	0	3.689797663	0	0	0	0.344087541	0.471100696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5343	0		0.509803466	0.9909	0.079397759	0.258388559	0	0.940014831	0.454698141	0.439976483	2.463906349	0.294121657	0	1.62137036	0.082146245	0	0.097575162	0	8.536140605	0.386507775	1.384231821	0	0	3.689797663	0	0	0	0.344087541	0.471100696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5343	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	0.9909	0.079397759	0.258388559	0	0.940014831	0.454698141	0.439976483	2.463906349	0.294121657	0	1.62137036	0.082146245	0	0.097575162	0	8.536140605	0.386507775	1.384231821	0	0	3.689797663	0	0	0	0.344087541	0.471100696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5343
H4346_007_0	2012	6																															D	D	D	V	T	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	244.099403	50.640922	164.1125743	0	84.8410519	1.492966643	1.639447156	195.6645149	133.600184	0	450.8776327	63.49704899	0	13.30882252	2070.770114	1908.477285	63.59416936	443.6844839	0	0.068892882	4.601837652	0	0	0	192.0926597	296.2561852	0	0	0	0											3400	1a:$125 days 1-5; Unlimited Add'l Days	1b:$125 days 1-5; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $50	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$125; 9b:$75	8a:$0	8b: X-Rays $5; Diagnostic $0-$75; Therapeutic 20%	5:$35	12:20% Coins	3:Cardiac Rehab $35; Intensive Cardiac Rehab $35; Pulmonary Rehab $35; 9c:$35	7a:$10 14d:$0; 14e:$0	7b:$20; 7d:$0-$35; 7f:$0-$35; 16b:$0-$35; 17a:$0-$35  7b:Routine Chiro $20 12 visits per year	7e:$0-$35; 7h:$0-$35	7c:$20; 7i: $0-$20	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $15 per month Allowance											0		99.2397859	72.72228321	17.29101823	0	28.37898518	0.038686464	0.095281199	49.20794105	96.88035404	0	50.88248084	35	0	69.54744765	10	32.39715761	35	20	0	35	0.189615909	0	0	0	20	19.01237072	0	0	0	0											NO	98.70332543	72.32916839	17.19754818	0	28.22557691	0.038477336	0.094766138	48.9419377	96.35664795	0	50.60742544	34.81080051	0	69.17149504	9.945943004	32.22202831	34.81080051	19.89188601	0	34.81080051	0.189602357	0	0	0	20	19.01237072	0	0	0	0												2.0078	0.305234648	0.235194492	0	0.199557303	0.057445379	0.155364075	0.798016708	1.072772158	0	1.901479681	0.184198592	0	0.076715929	1.716313461	5.124584091	0.184480329	0.735476765	0	0.000199851	0.872519265	0	0	0	0.320154433	0.469377702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4169	0		0.080255987	2.0078	0.305234648	0.235194492	0	0.199557303	0.057445379	0.155364075	0.798016708	1.072772158	0	1.901479681	0.184198592	0	0.076715929	1.716313461	5.124584091	0.184480329	0.735476765	0	0.000199851	0.872519265	0	0	0	0.320154433	0.469377702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4169	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	2.0078	0.305234648	0.235194492	0	0.199557303	0.057445379	0.155364075	0.798016708	1.072772158	0	1.901479681	0.184198592	0	0.076715929	1.716313461	5.124584091	0.184480329	0.735476765	0	0.000199851	0.872519265	0	0	0	0.320154433	0.469377702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4169
H4346_008_0	2012	6																															D	D	D	V	T	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	1911.522447	27.18596952	2212.434322	0	678.2476039	12.03447734	5.967241715	659.4118402	181.5498864	0	1146.017987	36.96588135	0	126.5227653	0	5620.114651	197.4890884	1613.183324	0	0	22.34996688	0	0	0	203.783983	296.4564488	0	0	0	0											3400	"1a:$0 days 1-3, $50 days 4-7, $0 days 8-90; 240 Add'l Days"	"1b:$0 days 1-3, $50 days 4-7, $0 days 8-90; 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 20%	11b:$0-$499 0%; >$500 20%; 11c:Diabetic Supplies $0; Therapeutic Shoes $0	4a:$65 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $0-$50; Therapeutic $0	5:$30	12:$0	3:Cardiac Rehab $20; Intensive Cardiac Rehab $20; Pulmonary Rehab $20; 9c:$30	7a:$0; 14d:$0; 14e:$0	7b:$20; 7d:$0-$25; 7f:$0-$25; 16b:$0-$25; 17a:$0-$25; 12 Routine Footcare Visits	7e:$0-$15; 7h:$0-$25	7c:$15; 7i: $0-$15	"7d:Professional Component, Radiology $0"	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; 9d: $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	14c:Newsletters $0 14c:Nutritional Consultation $0 14c:Enhanced Nutritional Training $0 14c:Additional Smoking Cessation $0	13e:Healthy Start $0 13e:Healthy Journey $0 13e:Consult with Exercise Coach $0 13e:Electronic Health Monitoring $0 13d:Exercise/Strength Training 52 Weeks $0 13b:OTC $20 per month Allowance											0		11.24135191	17.31613611	3.279235216	0	28.37898518	0.038686464	0.08726429	53.06984193	25	0	20.85938158	30	0	21.91994308	0	24.83031056	17.56946087	15	0	0	0.160868478	0	0	0	20	19.01237072	0	0	0	0											NO	11.01066863	16.96079247	3.211942178	0	27.79662131	0.03789258	0.085473543	51.9807981	24.48697613	0	20.43132715	29.38437135	0	21.47012491	0	24.32076887	17.20891875	14.69218568	0	0	0.149247965	0	0	0	20	19.01237072	0	0	0	0												1.7539	0.038424632	0.59218426	0	1.57108265	0.4560174	0.510041292	2.856396144	0.370467311	0	1.951222368	0.090518265	0	0.226371631	0	11.39045912	0.283214473	1.975099077	0	0	3.335687066	0	0	0	0.339639972	0.469694992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2104	0		0.763910135	1.7539	0.038424632	0.59218426	0	1.57108265	0.4560174	0.510041292	2.856396144	0.370467311	0	1.951222368	0.090518265	0	0.226371631	0	11.39045912	0.283214473	1.975099077	0	0	3.335687066	0	0	0	0.339639972	0.469694992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2104	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	1.7539	0.038424632	0.59218426	0	1.57108265	0.4560174	0.510041292	2.856396144	0.370467311	0	1.951222368	0.090518265	0	0.226371631	0	11.39045912	0.283214473	1.975099077	0	0	3.335687066	0	0	0	0.339639972	0.469694992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2104
H4346_801_0	2012	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	148.7739978	7.960262023	42.43870465	10.23880138	9.410581755	6.520871683	6.787922124	19.37173091	44.7970898	9.430033883	31.35012275	0.661691419	0.045838586	7.342003452	95.34598713	139.266062	0.987982771	10.34786774	13.56377196	13.07927297	17.11585818	20.38883363	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059522757	0.059522757	0.116547816	0	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.18715418	0.176398368	0	0	0	0	0	0	0	0												8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003	0		24.88961443	8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003
H4346_802_0	2012	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	148.7739978	7.960262023	42.43870465	10.23880138	9.410581755	6.520871683	6.787922124	19.37173091	44.7970898	9.430033883	31.35012275	0.661691419	0.045838586	7.342003452	95.34598713	139.266062	0.987982771	10.34786774	13.56377196	13.07927297	17.11585818	20.38883363	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059522757	0.059522757	0.116547816	0	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.176398368	0.18715418	0.176398368	0	0	0	0	0	0	0	0												8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003	0		24.88961443	8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.8554	0.473816742	4.946138323	0	1.660011262	1.150271122	1.197378384	3.417141714	7.902133524	1.663442586	5.530110484	0.116721286	0.008085852	1.295117426	16.81887651	24.56630603	0.174278548	1.82534698	2.392627235	2.307162405	3.203304396	3.596556974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1003
H4346_803_0	2012	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	148.7764431	7.960262023	42.43884557	10.23881011	9.410581755	6.520871964	6.787931048	19.37174414	44.7970898	9.430033883	31.35012275	0.661691419	0.045838586	7.342003452	95.39026822	139.2770403	0.988253823	10.34838141	13.56378524	13.08326723	17.11595055	20.39068485	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059520726	0.059520726	0.116543838	0	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.18715046	0.176392348	0	0	0	0	0	0	0	0												8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082	0		24.89574129	8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082
H4346_804_0	2012	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	148.7764431	7.960262023	42.43884557	10.23881011	9.410581755	6.520871964	6.787931048	19.37174414	44.7970898	9.430033883	31.35012275	0.661691419	0.045838586	7.342003452	95.39026822	139.2770403	0.988253823	10.34838141	13.56378524	13.08326723	17.11595055	20.39068485	0	0	0	0	0	0	0	0											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	0	0	0	0	0	0	0											0		0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059520726	0.059520726	0.116543838	0	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.176392348	0.18715046	0.176392348	0	0	0	0	0	0	0	0												8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082	0		24.89574129	8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	8.8553	0.473800572	4.945985947	0	1.65995461	1.150231915	1.197339094	3.417027431	7.901863844	1.663385817	5.529921755	0.116717303	0.008085576	1.295073227	16.82611337	24.56740413	0.174320412	1.825375294	2.392547923	2.307788224	3.203258018	3.596760775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1082
H4406_001_0	2012	7																															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	1691.146713	133.534961	810.9042	854.8838926	225.1841089	11.1419923	13.20236559	388.0781616	48.79735015	17.76914569	30.37507973	0	0.019294996	27.78087952	4928.887462	3120.288943	594.0774575	396.0910212	0	0	17.62810737	682.3612314	0	0	43.43888989	184.9504646	6.856301934	2.07930984	93.80841235	0											3950	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)	"$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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	64.75777559	0	200	0.2	0.098260956	63.97917639	0.16	0.212874438	0.184556261	0	0.2	0.145927731	7.037700774	34.12213786	38.5	35	0	0	0.2	34.14388153	0	0	35	15	35	0	0	0											YES	139.7069996	74.59892387	48.34967654	0	149.3246984	0.149324698	0.073363938	47.78727496	0.119459759	0.158937056	0.13779404	0	0.149324698	0.108953072	6.732021492	32.64131047	36.82777028	33.47979117	0	0	0.149324698	25.49262405	0	0	35	15	35	0	0	0											5200	19.6888	0.830130366	3.267246314	0	2.802129095	1.66377464	0.96857753	1.545433151	5.829319674	2.824175704	4.185504961	0	0.002881219	3.026812167	2.765114694	8.487526678	1.823212345	1.105087056	0	0	2.632311815	1.449598195	0	0	0.126696762	0.231188081	0.019997547	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2755	0	NO	17.85411263	19.6888	0.830130366	3.267246314	0	2.802129095	1.66377464	0.96857753	1.545433151	5.829319674	2.824175704	4.185504961	0	0.002881219	3.026812167	2.765114694	8.487526678	1.823212345	1.105087056	0	0	2.632311815	1.449598195	0	0	0.126696762	0.231188081	0.019997547	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2755	NO	"$300 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3968	0.0263	0	0.3457	0.4078	0	0.4304	0.225	1.2727	0.411	0.8875	0	0.0004	0.6599	1.2017	1.8429	0.344	0.2373	0	0	0.5987	0.2812	0	0	0.0276	0	0.0043	0	0	0											9.6013	0	NO	3.181336449	20.0856	0.856457468	3.267246314	0.34567103	3.209969962	1.66377464	1.398982484	1.770407609	7.101977738	3.235225384	5.073054513	0	0.003300572	3.686743556	3.966833599	10.3303938	2.167211434	1.342351399	0	0	3.231003874	1.730799048	0	0	0.154322372	0.231188081	0.024316827	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8768
H4406_801_0	2012	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	274.237006	8.4335	26.259435	1044.698486	11.42254944	11.71529261	16.14148882	22.83276356	59.66066282	21.72492986	37.13720897	0	0.023590466	33.94980737	33.19786147	81.05957092	3.9525	5.542781964	0	0	21.67853143	8.069624202	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080434665	0.080434665	0.198464585	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065989714	0.065989714	0.162823095	0	0.183772704	0.183772704	0.183772704	0.183772704	0.183772704	0.183772704	0.183772704	0	0.183772704	0.183772704	0.183772704	0.183772704	0.183772704	0.183772704	0	0	0.183772704	0.183772704	0	0	0	0	0	0	0	0												18.0968	0.556524249	4.275642491	0	2.099152795	2.152951	2.966365045	4.196038697	10.96400132	3.992449102	6.824805307	0	0.004335284	6.239047897	6.100860767	14.89653652	0.726361612	1.018612029	0	0	3.983922337	1.482976659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5774	150	YES	19.82712338	18.0968	0.556524249	4.275642491	0	2.099152795	2.152951	2.966365045	4.196038697	10.96400132	3.992449102	6.824805307	0	0.004335284	6.239047897	6.100860767	14.89653652	0.726361612	1.018612029	0	0	3.983922337	1.482976659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5774	NO																																										0	0	0	0	0	0	0	0	0	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	18.0968	0.556524249	4.275642491	0	2.099152795	2.152951	2.966365045	4.196038697	10.96400132	3.992449102	6.824805307	0	0.004335284	6.239047897	6.100860767	14.89653652	0.726361612	1.018612029	0	0	3.983922337	1.482976659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5774
H4406_803_0	2012	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	274.237006	8.4343	26.259435	1044.698486	11.42254944	11.71529261	16.14148882	22.83276356	59.66066282	21.72492986	37.13720897	0	0.023590466	33.95020737	33.19786147	81.05957092	3.9524	5.542781964	0	0	21.67853143	8.069624202	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080434665	0.080434665	0.198464585	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065989693	0.065989693	0.162823044	0	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0	0	0.183772646	0.183772646	0	0	0	0	0	0	0	0												18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775	150	YES	19.82717554	18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775	NO																																										0	0	0	0	0	0	0	0	0	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	18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775
H4406_804_0	2012	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	274.237006	8.4343	26.259435	1044.698486	11.42254944	11.71529261	16.14148882	22.83276356	59.66066282	21.72492986	37.13720897	0	0.023590466	33.95020737	33.19786147	81.05957092	3.9524	5.542781964	0	0	21.67853143	8.069624202	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080434665	0.080434665	0.198464585	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065989693	0.065989693	0.162823044	0	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0.183772646	0	0	0.183772646	0.183772646	0	0	0	0	0	0	0	0												18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775	150	YES	19.82717554	18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775	NO																																										0	0	0	0	0	0	0	0	0	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	18.0968	0.556576866	4.275641145	0	2.099152134	2.152950322	2.96636411	4.196037375	10.96399787	3.992447845	6.824803157	0	0.004335282	6.239119441	6.100858845	14.89653183	0.726343006	1.018611708	0	0	3.983921082	1.482976192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5775
H4407_002_0	2012	7																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN																																																												0	YES	1029.681163	20.97313717	257.8660963	188.4512971	179.8485323	19.81390407		432.8451325	508.229193		1308.594823	1.880164975	0.306864978	392.9544798	6664.204389	8345.596657	87.9560432	486.8264716	578.8734936		15.58880203																				3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $30 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $100 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $35 per Urgent Care visit	9a/b. $195 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy visit; $100 per MRI,MRA,PET,CT, and NUC Scan"	"5, 9c. $40 per visit"	12. 20% Coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $15 per visit"	"7b/d/f, 17a, 18a. $40 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $40 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script																						195	195	30	20	100	0.2		64.57716702	195		55.7165657	40	0.2	20	15	39.8	40	20	58.15928211		0.2																				NO	173.2268555	173.2268555	26.65028546	17.76685697	88.83428487	0.17766857		57.36666451	173.2268555		49.49541269	35.53371395	0.17766857	17.76685697	13.32514273	35.35604538	35.53371395	17.76685697	51.66538235		0.17766857																					14.864	0.302759217	0.572683756	0.279015603	1.331392979	3.520307997	0	2.069240125	7.336578748	0	5.3974534	0.005567437	0.054520262	0.58179717	7.400122889	24.58894117	0.260450407	0.720781358	2.492310031	0	2.76964016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5476			9.37	14.864	0.302759217	0.572683756	0.279015603	1.331392979	3.520307997	0	2.069240125	7.336578748	0	5.3974534	0.005567437	0.054520262	0.58179717	7.400122889	24.58894117	0.260450407	0.720781358	2.492310031	0	2.76964016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5476	NO																																																																																		0				14.864	0.302759217	0.572683756	0.279015603	1.331392979	3.520307997	0	2.069240125	7.336578748	0	5.3974534	0.005567437	0.054520262	0.58179717	7.400122889	24.58894117	0.260450407	0.720781358	2.492310031	0	2.76964016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5476
H4407_004_0	2012	7																															D	D	D		COIN	COIN		V	COIN		COIN	V	COIN	COIN	V	V	V	V	COIN		COIN																																																												0	YES	1514.072926	128.8943584	208.0576159		15.21394446	35.40947856		808.7560598	68.94902761		32.59988564	21.21822449	0.656072413	8.936880772	7116.667076	10473.21347	85.8897982	808.8376519	31.1012896		22.57043139																				6700	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $50 per day days 6-35		10a. 20% Coinsurance	11a/b/c. 20% Coinsurance		4a/b. $65 per ER visit; $30 per Urgent Care visit	9a/b. 20% Coinsurance		8a/b. 20% Coinsurance	"5, 9c. $30 per visit"	12. 20% Coinsurance	3. 20% Coinsurance; 9a. $65 per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $35 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	8 a/b. 20% Coinsurance		15. 20% coinsurance per script																						195	195	50		0.2	0.2		64.93396226	0.2		0.2	30	0.2	0.2	10	34.87597436	35	20	0.2		0.2																				NO	183.5121263	183.5121263	47.05439137		0.188217565	0.188217565		61.10856147	0.188217565		0.188217565	28.23263482	0.188217565	0.188217565	9.410878274	32.82135494	32.93807396	18.82175655	0.188217565		0.188217565																					23.1542	1.971139816	0.815835374	0	2.863531588	6.664685849	0	4.118493283	12.97741812	0	6.13587111	0.049920532	0.123484352	1.682077942	5.581173964	28.6454214	0.23575371	1.268645448	5.853809012	0	4.248151649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.3896			6.66	23.1542	1.971139816	0.815835374	0	2.863531588	6.664685849	0	4.118493283	12.97741812	0	6.13587111	0.049920532	0.123484352	1.682077942	5.581173964	28.6454214	0.23575371	1.268645448	5.853809012	0	4.248151649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.3896	NO																																																																																		0				23.1542	1.971139816	0.815835374	0	2.863531588	6.664685849	0	4.118493283	12.97741812	0	6.13587111	0.049920532	0.123484352	1.682077942	5.581173964	28.6454214	0.23575371	1.268645448	5.853809012	0	4.248151649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.3896
H4407_005_0	2012	4																															D	D	D		T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	519.9640959	47.13448885	425.7809489		239.7620489	3.35880646	3.712365034	303.8174561	396.7831891		586.4602909	5.565676577	0	320.6170857	3826.714297	3184.646817	95.5365003	235.7188294			15.72896178																				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/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 CP Per ER Visit, Waived If Admitted; $30 CP Per Visit, Waived if Admitted"	9a/b; $100 CP Per Surg	No Cost Sharing	8a/b; $100 per Radiology Test type;  $30 CP Per Radiation Therapy	"5, 9c; $30 CP Per Visit"	12; 20% Coins.	"3, 9a; OBS $100 CP Per Visit; $15 per Rehab Therapy visit"	7a; $15 CP Per Visit	"7b/d/f/g 16a,17a,18a; $30 CP Per Visit; $20 CP Per Chiro Visit"	7e/h; $30 CP Per Visit	7c/i; $15 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						150	225	50	0	103.2531458	0.2	0.2	65	100	0	70.77	30	0.2	18.07029241	15	29.98692165	30	15	30	0	0.2																				NO	146.19	219.285	48.73	0	100.6305159	0.19492	0.19492	63.349	97.46	0	68.972442	29.238	0.19492	17.61130698	14.619	29.22525384	29.238	14.619	29.238	0	0.19492																					6.3345	0.861323866	1.72902547	0	2.010614889	0.654698555	0.723614192	1.603877669	3.2225408	0	3.370799867	0.013560771	0	0.470540493	4.661894692	7.756009303	0.232774683	0.287164464	0	0	3.065889231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9988			0.96425	6.3345	0.861323866	1.72902547	0	2.010614889	0.654698555	0.723614192	1.603877669	3.2225408	0	3.370799867	0.013560771	0	0.470540493	4.661894692	7.756009303	0.232774683	0.287164464	0	0	3.065889231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9988	NO																																																																																		0				6.3345	0.861323866	1.72902547	0	2.010614889	0.654698555	0.723614192	1.603877669	3.2225408	0	3.370799867	0.013560771	0	0.470540493	4.661894692	7.756009303	0.232774683	0.287164464	0	0	3.065889231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9988
H4407_011_0	2012	4																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN			COIN																																																									0	YES	859.4602186	33.94729548	96.89984858	206.2438099	136.7542721	12.0132452		301.6725397	404.2464147		1295.383892	2.607635322	0.311312558	400.5009569	5265.109913	6855.327139	115.0779391	400.4271302	2657.756818		16.48190337			22.79																	3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $65 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $75 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $25 per Urgent Care visit	9a/b. $50 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy visit; $100 per MRI,MRA,PET,CT, and NUC Scan"	"5, 9c. $25 per visit"	12. 20% Coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $5 per visit"	"7b/d/f, 17a, 18a. $25 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c.$25 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b, 9a. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script			20% coinsurance on basic services; 50% coinsurance on major services																			195	195	65	20	75	0.2		64.48717949	50		51.44206008	25	0.2	20	5	24.98	25	20	62.93797678		0.2			0.21																	NO	181.5024993	181.5024993	60.5008331	18.61564095	69.80865358	0.18615641		60.02350897	46.53910238		47.88134602	23.26955119	0.18615641	18.61564095	4.653910238	23.25093555	23.26955119	18.61564095	58.5815389		0.18615641			0.21																		12.9995	0.513459915	0.488543464	0.319946726	0.795552634	2.236342593	0	1.508953699	1.567772107	0	5.16872703	0.005056542	0.057952828	0.621298501	2.041945744	13.28273079	0.223151	0.621183974	12.9746237	0	3.068211955	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2809			4.35	12.9995	0.513459915	0.488543464	0.319946726	0.795552634	2.236342593	0	1.508953699	1.567772107	0	5.16872703	0.005056542	0.057952828	0.621298501	2.041945744	13.28273079	0.223151	0.621183974	12.9746237	0	3.068211955	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2809	NO																																																																																		0				12.9995	0.513459915	0.488543464	0.319946726	0.795552634	2.236342593	0	1.508953699	1.567772107	0	5.16872703	0.005056542	0.057952828	0.621298501	2.041945744	13.28273079	0.223151	0.621183974	12.9746237	0	3.068211955	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2809
H4407_022_0	2012	8																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN			P																																																									0	YES	575.6660243	35.80575491	412.2977289	971.210019	184.5292421	5.685573587	7.919852576	317.6397336	612.1107582		771.2404965	10.77891209	0.183327676	579.0649671	5901.336546	5050.816516	201.1280475	556.5290097			24.80485967			260.8																	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; $5 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/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $35 Per Urgent Visit, Waived if admitted"	9a/b; $300 CP  Per Surg	8a; No Cost Sharing	"8a/b; $150 Per MRI/MRA, CT, Nuclear Med; $200 Per Pet, Sleep, & Other; $35 CP Per Radiation Therapy"	"5, 9c; $35 CP Per Visit"	12; 20% Coins.	"3,9a; OBS $200 CP Per Visit;  $5 CP Per Rehab Therapy Visit"	7a; $5 CP Per Visit	"7b/d/f/g,16b,17a,18a; $35 CP Per Visit, Chrio $20 Per Visit"	"7e/h, $35 CP Per Visit"	7c/i; $5 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.			"$20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																			300	225	100	5	104.5855258	0.2	0.2	65	300	0	120.9713557	35	0.2	11.70427451	5	34.97517739	35	5	0	0	0.2			31.132																	NO	272.25	204.1875	90.75	4.5375	94.91136466	0.1815	0.1815	58.9875	272.25	0	109.7815053	31.7625	0.1815	10.62162912	4.5375	31.73997348	31.7625	4.5375	0	0	0.1815			31.132																		13.0604	0.609257298	3.118001575	0.367238788	1.459493516	1.031931606	1.437453243	1.561397816	13.88726283	0	7.05566189	0.028530433	0.033273973	0.51255111	2.231442882	13.35939852	0.532360801	0.210437532	0	0	4.502082029	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6748			6.6265	13.0604	0.609257298	3.118001575	0.367238788	1.459493516	1.031931606	1.437453243	1.561397816	13.88726283	0	7.05566189	0.028530433	0.033273973	0.51255111	2.231442882	13.35939852	0.532360801	0.210437532	0	0	4.502082029	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6748	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 Copay; 20% air	30% Coinsurance	Included in Line e1		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																					0.556		0.0655		0.02	0.0594			0.2057	0.2155					0.6161						0.0752																				1.8135				13.6165	0.609257298	3.183493752	0.367238788	1.479493516	1.091323249	1.437453243	1.561397816	14.09295841	0.21549211	7.05566189	0.028530433	0.033273973	0.51255111	2.847570345	13.35939852	0.532360801	0.210437532	0	0	4.577315498	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4883
H4407_023_0	2012	7																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN			COIN																																																									0	YES	945.194428	47.36660567	94.89739329	240.1363327	221.5266617	17.3954998		386.1506752	453.789672		1217.501943	3.638429284	0.434373902	441.5621638	5070.896787	6589.851544	160.5680596	333.3636274	3543.472244		20.05975505			22.79																	3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $30 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $85 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $25 per Urgent Care visit	9a/b. $150 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy visit;  $100 per MRI,MRA, CT, PET, and  Nuc Scan"	"5, 9c. $25 per visit"	12. 20% coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $5 per visit"	"7b/d/f, 17a, 18a. $25 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $25 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b, 9a. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script			20% coinsurance for basic services; 50% coinsurance for major services																			195	195	30	20	85	0.2		59.23481781	150		66.56019256	25	0.2	20	5	24.98	25	20	42.46162551		0.2			0.21																	NO	178.483542	178.483542	27.45900646	18.30600431	77.8005183	0.183060043		54.2176415	137.2950323		60.92255858	22.88250538	0.183060043	18.30600431	4.576501077	22.86419938	22.88250538	18.30600431	38.86513497		0.183060043			0.21																		14.0585	0.704513296	0.217149011	0.366328062	1.436240758	3.184420942	0	1.744681573	5.191922306	0	6.181111123	0.006938031	0.079516505	0.673603239	1.933913717	12.5559733	0.306183291	0.508546333	11.47646059	0	3.672139623	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.084			5.95	14.0585	0.704513296	0.217149011	0.366328062	1.436240758	3.184420942	0	1.744681573	5.191922306	0	6.181111123	0.006938031	0.079516505	0.673603239	1.933913717	12.5559733	0.306183291	0.508546333	11.47646059	0	3.672139623	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.084	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1		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																					0.633		0.0606	0.0551	0.0249	0.0533			0.1708	0.1522					0.6289						0.0619																				1.8407				14.6915	0.704513296	0.277767599	0.42138217	1.461190476	3.237714877	0	1.744681573	5.362741473	0.152186696	6.181111123	0.006938031	0.079516505	0.673603239	2.562803433	12.5559733	0.306183291	0.508546333	11.47646059	0	3.734030886	0	0	4.7859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9247
H4407_802_0	2012	5																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	257.3696818	6.122472125	48.62264569		14.65503036	22.89208447		16.66526017	66.10321764	20.26567877	30.65986878	0.11060872	0.165784231	8.631564206	108.5975613	146.3454597	1.251828781	2.294287587	43.75693725		66.16959945																				6700	1a. FFS	1b. FFS	2. FFS		10a. FFS	11a/b/c. FFS		4a/b. FFS	9a/b. FFS	8a. FFS	8a/b. FFS	"5, 9c. FFS"	12. FFS	"3, 9a. FFS"	"7a, 17a, 18a. FFS"	"7b/d/f, 17a, 18a. FFS"	"5, 7e/h/g, 9c. FFS"	7c/i. FFS	8a/b. FFS		15. FFS																						0.091	0.091	0.185189661		0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224																				NO	0.083976228	0.083976228	0.170895926		0.206710716	0.206710716		0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716		0.206710716																					21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307			12.03	21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307	NO																																																																																		0				21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307
H4407_807_0	2012	5																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	257.3696818	6.122472125	48.62264569		14.65503036	22.89208447		16.66526017	66.10321764	20.26567877	30.65986878	0.11060872	0.165784231	8.631564206	108.5975613	146.3454597	1.251828781	2.294287587	43.75693725		66.16959945																				6700	1a. FFS	1b. FFS	2. FFS		10a. FFS	11a/b/c. FFS		4a/b. FFS	9a/b. FFS	8a. FFS	8a/b. FFS	"5, 9c. FFS"	12. FFS	"3, 9a. FFS"	"7a, 17a, 18a. FFS"	"7b/d/f, 17a, 18a. FFS"	"5, 7e/h/g, 9c. FFS"	7c/i. FFS	8a/b. FFS		15. FFS																						0.091	0.091	0.185189661		0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224																				NO	0.083976228	0.083976228	0.170895926		0.206710716	0.206710716		0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716	0.206710716		0.206710716																					21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307			12.03	21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307	NO																																																																																		0				21.6129	0.514142118	8.309412072	0	3.02935182	4.732039174	0	3.444887864	13.66424345	4.18913297	6.337723431	0.022864008	0.034269377	1.784236818	22.44827967	30.25117477	0.258766424	0.47425383	9.045027832	0	13.67796529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8307
H4408_001_0	2012	9	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	1639.84	54.91	471.49	1331.16	30.15	13.16	3.83	345.02	353.91	727.62	938.76	143.75	0.28	386.15	3112.76	3641.86	79.36	580.14		2001.46	26.38	0			0.61				3.21	1.15	1730.69										4900	"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$90/Visit: 5. $35 Partial Hospitalization,7h. $90 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $90 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												148.989465	124.806492	34.03605	0	200	0.2	0.2	65	225	27.218867	95.279586	41.389	0.2	78.179273	15	34.230754	35	15		0	0.2	0			0				0	0	0										NO	117.688418	98.586021	27.10032	0	182.3898	0.18239	0.18239	59.276685	205.188525	24.822219	86.890123	37.744657	0.18239	71.29551	13.679235	31.216702	31.918215	13.679235		0	0.18239	0			0				0	0	0											16.0825	0.451113201	1.064794156	0	0.458254373	2.4002524	0.6985537	1.704303488	6.051522574	1.505095249	6.797414322	0.452149537	0.0510692	2.294230099	3.548347962	9.473904862	0.211085795	0.661322616	0	0	4.8114482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7174	0	NO	8.639968	16.0825	0.451113201	1.064794156	0	0.458254373	2.4002524	0.6985537	1.704303488	6.051522574	1.505095249	6.797414322	0.452149537	0.0510692	2.294230099	3.548347962	9.473904862	0.211085795	0.661322616	0	0	4.8114482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7174	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										7300	5.0009	0.0727	0.3829	1.8289	2.8462	0.7143	0.208	0.1511	1.684	0.1555	0.6528	0.0317	0.0045	0.488	1.0455	1.8838	0.0168	0.1361		0.2724	0.6931	0			0				0	0	0.1426										18.4119	0	NO	9.432697	21.0834	0.523849201	1.447709156	1.828886	3.304481373	3.1145504	0.9065717	1.855420488	7.735497574	1.660596249	7.450224322	0.483831537	0.0555882	2.782258099	4.593853962	11.35768186	0.227854795	0.797460616	0	0.272362	5.5045402	0	0	0	0	0	0	0	0	0	0.142624	0	0	0	0	0	0	0	0	0	77.1293
H4408_002_0	2012	9	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	1316.81	100.97	564.35	2224.89	36.68	15.07	4.74	402.34	400.19	1345.71	1185.77	237.49	0.15	727.61	3463.22	4139.58	188.69	898.78		1563.03	23.75	0			0.61				3.21	1.15	1083.15										4900	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$90/Visit: 5. $40 Partial Hospitalization,7h. $90 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $90 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												141.569359	116.360647	34.03605	0	200	0.2	0.2	65	225	38.757355	85.744199	44.266492	0.2	77.708453	15	38.385032	40	15		0	0.2	0			0				0	0	0										NO	113.558587	93.337646	26.695189	0	179.2182	0.179218	0.179218	58.245915	201.620475	34.730117	76.834605	39.666805	0.179218	69.633845	13.441365	34.396482	35.84364	13.441365		0	0.179218	0			0				0	0	0											12.4613	0.78535851	1.255452493	0	0.547810298	2.70081526	0.84949332	1.952888453	6.723874824	3.894722146	7.592347464	0.785039127	0.0268827	4.222190163	3.879200341	11.86558241	0.563611369	1.006735836	0	0	4.2564275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3697	0	NO	9.511173	12.4613	0.78535851	1.255452493	0	0.547810298	2.70081526	0.84949332	1.952888453	6.723874824	3.894722146	7.592347464	0.785039127	0.0268827	4.222190163	3.879200341	11.86558241	0.563611369	1.006735836	0	0	4.2564275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3697	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins										7300	4.5236	0.1066	0.4305	3.1529	3.417	0.6729	0.2115	0.1739	1.9033	0.2407	0.8192	0.0428	0.0025	0.7393	1.104	1.8352	0.0362	0.2029		0.1806	0.6017	0			0						0.0712										20.4686	0	NO	9.864753	16.9848	0.89200851	1.685982493	3.152873	3.964785298	3.37373426	1.06100332	2.126802453	8.627170824	4.135382146	8.411561464	0.827857127	0.0293777	4.961458163	4.983246341	13.70083141	0.599831369	1.209654836	0	0.180622	4.8581105	0	0	0	0	0	0	0	0	0	0.071182	0	0	0	0	0	0	0	0	0	85.8383
H4408_006_0	2012	9	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	1413.61	76.74	385.48	1493.05	26	13.98	3.94	359.75	364.24	1147.77	1058.65	148.66	0.36	10.04	3491.7	4568	110.62	782		2165.13	20.69	0			0.61				3.21	1.15	1666.69	516.79									5300	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$20-$150/Visit: 3. $20 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	225	60.486959	94.052348	42.873843	0.2	0.2	20	38.986845	40	20		0	0.2	0			0				0	0	0	69.87485									NO	130.188349	92.376856	27.483838	0	179.775	0.179775	0.179775	58.426875	202.246875	54.370215	84.541304	38.538225	0.179775	0.179775	17.9775	35.0443	35.955	17.9775		0	0.179775	0			0				0	0	0	62.808756										15.3363	0.590749994	0.882872489	0	0.3895125	2.5132545	0.7083135	1.751589023	6.138866813	5.200375139	7.45830429	0.477424377	0.064719	1.804941	5.231003063	13.34019687	0.331445175	1.17153375	0	0	3.71954475	0	0	0	0	0	0	0	0	0	0	2.704911418	0	0	0	0	0	0	0	0	69.8159	0	NO	10.308895	15.3363	0.590749994	0.882872489	0	0.3895125	2.5132545	0.7083135	1.751589023	6.138866813	5.200375139	7.45830429	0.477424377	0.064719	1.804941	5.231003063	13.34019687	0.331445175	1.17153375	0	0	3.71954475	0	0	0	0	0	0	0	0	0	0	2.704911418	0	0	0	0	0	0	0	0	69.8159	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7300	5.0991	0.0775	0.3282	2.76	3.0104	0.9309	0.2623	0.1933	2.2452	0.3281	0.9428	0.035	0.0071	0.3017	1.3587	2.7641	0.0247	0.2216		0.3386	0.6695	0			0				0	0	0.1804	0.4725									22.5516	500	NO	10.138723	20.4354	0.668246994	1.211037489	2.759967	3.3998975	3.4441645	0.9705935	1.944847023	8.384036813	5.528518139	8.40110229	0.512474377	0.07184	2.106594	6.589727063	16.10426887	0.356100175	1.39317675	0	0.338601	4.38904975	0	0	0	0	0	0	0	0	0	0.180359	3.177439418	0	0	0	0	0	0	0	0	92.3674
H4408_007_0	2012	9	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	1291.78	96.03	395.05	1699.83	29.06	14.49	4.16	416.93	368.45	1069.42	929.37	192.7	0.77	10.08	3648.8	3986.49	115.15	744.07		2166.07	25.44	0			0.61				3.21	1.15	1635.69	569.84									5300	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$20-$150/Visit: 3. $20 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	225	62.079504	97.043497	42.712825	0.2	0.2	20	38.000046	40	20		0	0.2	0			0				0	0	0	68.943773									NO	132.415321	93.957033	27.831312	0	180.5758	0.180576	0.180576	58.687135	203.147775	56.05028	87.618536	38.564513	0.180576	0.180576	18.05758	34.309444	36.11516	18.05758		0	0.180576	0			0				0	0	0	62.247885										14.2543	0.751891157	0.916229984	0	0.437294396	2.61654624	0.75119616	2.0390356	6.237483142	4.995107536	6.785836567	0.619281805	0.13904352	1.82020608	5.490708159	11.39785462	0.346555056	1.119675296	0	0	4.59385344	0	0	0	0	0	0	0	0	0	0	2.955944566	0	0	0	0	0	0	0	0	68.268	0	NO	9.413359	14.2543	0.751891157	0.916229984	0	0.437294396	2.61654624	0.75119616	2.0390356	6.237483142	4.995107536	6.785836567	0.619281805	0.13904352	1.82020608	5.490708159	11.39785462	0.346555056	1.119675296	0	0	4.59385344	0	0	0	0	0	0	0	0	0	0	2.955944566	0	0	0	0	0	0	0	0	68.268	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7300	4.9226	0.1116	0.3619	2.8863	3.4285	0.9836	0.2826	0.2283	2.0464	0.2767	0.8402	0.0495	0.0157	0.3086	1.4837	2.3054	0.0364	0.2054		0.3723	0.8355	0			0						0.1718	0.5223									22.6753	500	NO	9.397644	19.1769	0.863470157	1.278107984	2.886334	3.865841396	3.60011424	1.03374916	2.2672976	8.283894142	5.271829536	7.626044567	0.668762805	0.15478152	2.12882208	6.974361159	13.70326762	0.382921056	1.325058296	0	0.372339	5.42938144	0	0	0	0	0	0	0	0	0	0.171767	3.478271566	0	0	0	0	0	0	0	0	90.9433
H4408_008_0	2012	9	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	1378.71	86.18	368.28	1565.8	29.51	12.65	4.75	406.18	382.24	1153.75	1044.86	171.87	0.4	7.21	3360.76	4471.18	95.58	830.44		2032.64	22.39	0			0.61				3.55	1.15	2009.67	525.81									4900	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											141.569359	116.360647	34.03605	0	100	0.2	0.2	65	125	59.616216	70.355082	39.871758	0.2	0.2	15	34.106509	35	15		0	0.2	0			0				0	0	0	69.084139									NO	115.527109	94.95564	28.169018	0	91.0931	0.182186	0.182186	59.210515	113.866375	54.306259	64.088625	36.32042	0.182186	0.182186	13.663965	31.068676	31.882585	13.663965		0	0.182186	0			0				0	0	0	62.930884										13.2732	0.681939755	0.864507162	0	0.224013115	2.3046529	0.8653835	2.004177249	3.627023598	5.221320527	5.580303393	0.520199215	0.0728744	1.31356106	3.826775584	11.5761369	0.25394479	0.945591925	0	0	4.07914454	0	0	0	0	0	0	0	0	0	0	2.75747401	0	0	0	0	0	0	0	0	59.9922	0	NO	7.742918	13.2732	0.681939755	0.864507162	0	0.224013115	2.3046529	0.8653835	2.004177249	3.627023598	5.221320527	5.580303393	0.520199215	0.0728744	1.31356106	3.826775584	11.5761369	0.25394479	0.945591925	0	0	4.07914454	0	0	0	0	0	0	0	0	0	0	2.75747401	0	0	0	0	0	0	0	0	59.9922	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	30% Coins									7300	4.7066	0.0983	0.3409	2.3657	1.4428	0.5932	0.2228	0.1843	1.6628	0.2179	0.6551	0.0344	0.0067	0.183	0.9801	1.9672	0.0198	0.1772		0.2395	0.613	0			0				0	0	0.1264	0.368									17.2058	0	NO	6.995988	17.9798	0.780226755	1.205435162	2.365741	1.666794115	2.8978079	1.0881965	2.188495249	5.289839598	5.439205527	6.235435393	0.554614215	0.0796074	1.49658106	4.806838584	13.5433569	0.27375079	1.122762925	0	0.239459	4.69215154	0	0	0	0	0	0	0	0	0	0.126408	3.12549301	0	0	0	0	0	0	0	0	77.198
H4454_002_0	2012	7																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	819.5851536	52.12494889	758.2822136	1285.598727	303.9317507	5.707693795	8.6769269	443.3486486	562.4778756		873.9057967	14.56377542	0.338865683	608.44	5639.533342	4741.860005	234.3130085	454.7318717			34.58681988																				3400	1a; $325/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-30 Days); $0 (31-100)	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/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $40 CP Per Urgent Care Visit, Waived if Admitted"	9a/b; $300 CP Per Surg	8a; No Cost Sharing	"8a/b; $200 Per MRI/MRA, CT & Nuclear Med; $225 Per PET, Sleep, & Other; $40 CP Per Radiation Therapy"	"5, 9c; $40 CP Per Visit"	12; 20% Coins.	"9a, 3; $200 Per Obs Visit; $15 CP Per Rehab Therapy"	7a; $15 CP Per Visit	"7b/d/f/g,16b,17a,18a; $40 CP Per Visit, Chrio $20 Per Visit"	7e/h; $40 CP Per Visit	7c/i; $15 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						325	225	100	15	103.2227356	0.2	0.2	65	300	0	144.58894	40	0.2	21.93061584	15	39.97483418	40	15	0	0	0.2																				NO	281.6775	195.0075	86.67	13.0005	89.46314493	0.17334	0.17334	56.3355	260.01	0	125.3152343	34.668	0.17334	19.00726475	13.0005	34.64618879	34.668	13.0005	0	0	0.17334																					19.2382	0.847062998	5.476693288	1.392785521	2.265890855	0.989371642	1.504058509	2.081355649	12.18748937	0	9.126142474	0.042074747	0.058738978	0.96373168	6.109729434	13.69061474	0.676930282	0.492645142	0	0	5.995279359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1388			12.789	19.2382	0.847062998	5.476693288	1.392785521	2.265890855	0.989371642	1.504058509	2.081355649	12.18748937	0	9.126142474	0.042074747	0.058738978	0.96373168	6.109729434	13.69061474	0.676930282	0.492645142	0	0	5.995279359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1388	NO																																																																																		0				19.2382	0.847062998	5.476693288	1.392785521	2.265890855	0.989371642	1.504058509	2.081355649	12.18748937	0	9.126142474	0.042074747	0.058738978	0.96373168	6.109729434	13.69061474	0.676930282	0.492645142	0	0	5.995279359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1388
H4454_012_0	2012	4																															D	D	D		T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	525.4604712	47.63273256	430.2817441		242.2310319	3.391508918	3.748509857	306.2322245	396.4030981		592.6595763	5.624509576	0	324.006227	3867.165278	3218.310707	96.54638629	238.2105382			15.8952896																				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/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 CP Per ER Visit, Waived If Admitted; $30 CP Per Visit, Waived if Admitted"	9a/b; $100 CP Per Surg	No Cost Sharing	8a/b; $100 per Radiology Test type;  $30 CP Per Radiation Therapy	"5, 9c; $30 CP Per Visit"	12; 20% Coins.	"3, 9a; OBS $100 CP Per Visit; $15 per Rehab Therapy visit"	7a; $15 CP Per Visit	"7b/d/f/g 16a,17a,18a; $30 CP Per Visit; $20 CP Per Chiro Visit"	7e/h; $30 CP Per Visit	7c/i; $15 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						150	225	50	0	103.2531458	0.2	0.2	65	100	0	70.77376456	30	0.2	18.07029241	15	29.98692165	30	15	0	0	0.2																				NO	146.115	219.1725	48.705	0	100.5788893	0.19482	0.19482	63.3165	97.41	0	68.94072405	29.223	0.19482	17.60227183	14.6115	29.21026038	29.223	14.6115	0	0	0.19482																					6.3981	0.86998209	1.746406029	0	2.030277345	0.660733767	0.73028469	1.615796054	3.217802149	0	3.404865026	0.013697087	0	0.475270474	4.708757122	7.833974478	0.235114587	0.290051107	0	0	3.096720321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3279			0.99325	6.3981	0.86998209	1.746406029	0	2.030277345	0.660733767	0.73028469	1.615796054	3.217802149	0	3.404865026	0.013697087	0	0.475270474	4.708757122	7.833974478	0.235114587	0.290051107	0	0	3.096720321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3279	NO																																																																																		0				6.3981	0.86998209	1.746406029	0	2.030277345	0.660733767	0.73028469	1.615796054	3.217802149	0	3.404865026	0.013697087	0	0.475270474	4.708757122	7.833974478	0.235114587	0.290051107	0	0	3.096720321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3279
H4454_020_0	2012	8																															COIN	D			COIN	COIN	COIN	V	COIN		COIN	COIN	COIN	COIN							COIN																																																												0	YES	558.6407512	34.93344512			30.63300167	11.50115939	18.57440987	717.7950096	58.58970324		43.2333872	1.337269574	0.785821346	3.374733109							18.9985131																				6700	1a; Medicare FFS Cost Sharing	1b; $200/days 1-7	2a; No Cost Sharing	6a; No Cost Sharing	10a; 20% Coins for air and land ambulance	11a; 20% Coins.	11b/c; 0% - 20% Coins.	"4a/b; $65 Per ER Visit, Waived if Admitted; $0 CP Per Urgent Visit"	9a/b; 20% Coins	8a; No Cost Sharing	8a/b; 20% Coins Per Radiology Test Type; 20% Coins Per Radiation Therapy Visit	"5, 9c; 20% Coins"	12; 20% Coins.	"3,9a; OBS 20% Coins.; Rehab Therapy 0% Coins"	7a; No Cost Sharing	"7b/d/f/g,16b,17a, 18a; No Cost Sharing"	"7e/h, No Cost Sharing"	7c/i; No Cost Sharing	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						0.081860767	200	0	0	0.2	0.2	0.2	65	0.2	0	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.2																				NO	0.078905593	192.78	0	0	0.19278	0.19278	0.19278	62.6535	0.19278	0	0.19278	0.19278	0.19278	0.19278	0	0	0	0	0	0	0.19278																					44.0799	0.561205796	0	0	5.905430063	2.217193508	3.580774734	3.747697469	11.29492299	0	8.334532385	0.257798828	0.151490639	0.650581049	0	0	0	0	0	0	3.662533356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.444			3.161	44.0799	0.561205796	0	0	5.905430063	2.217193508	3.580774734	3.747697469	11.29492299	0	8.334532385	0.257798828	0.151490639	0.650581049	0	0	0	0	0	0	3.662533356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.444	NO																																																																																		0				44.0799	0.561205796	0	0	5.905430063	2.217193508	3.580774734	3.747697469	11.29492299	0	8.334532385	0.257798828	0.151490639	0.650581049	0	0	0	0	0	0	3.662533356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.444
H4454_028_0	2012	6																															A	D			COIN	COIN	COIN	V			COIN	COIN	COIN	COIN							COIN																																																												0	YES	542.9725694	38.77731309			22.90704325	10.46835681	25.046238	727.2786901			33.96869434	0.28666594	6.1712537	1.211438167							26.01344121																				3400	1a; $500 CP Per Admission	1b; $200/days 1-7	2a; No Cost Sharing	6a; No Cost Sharing	10a; 10% Coins for air and land ambulance	11a; 20% Coins.	11b/c; 0% - 20% Coins.	"4a/b; $65 Per ER Visit, Waived if Admitted; $0 Per Urgent Visit"	9a/b;No Cost Sharing	8a; No Cost Sharing	8a/b; 10% Coins Per Radiology Test Type; 10% Coins Per Radiation Therapy Visit	"5, 9c; 10% Coins"	12; 10% Coins.	"3,9a; OBS 10% Coins.; Rehab Therapy 0% Coins"	7a; No Cost Sharing	"7b/d/f/g,16b,17a, 18a; No Cost Sharing"	7e/h; No Cost Sharing	7c/i; No Cost Sharing	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						500	200	0	0	0.1	0.2	0.2	65	0	0	0.1	0.1	0.1	0.1	0	0	0	0	0	0	0.2																				NO	480.7	192.28	0	0	0.09614	0.19228	0.19228	62.491	0	0	0.09614	0.09614	0.09614	0.09614	0	0	0	0	0	0	0.19228																					21.7506	0.621341813	0	0	2.202283138	2.012855647	4.815890643	3.787364386	0	0	3.265750274	0.027560063	0.593304331	0.116467665	0	0	0	0	0	0	5.001864476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1953			1.77625	21.7506	0.621341813	0	0	2.202283138	2.012855647	4.815890643	3.787364386	0	0	3.265750274	0.027560063	0.593304331	0.116467665	0	0	0	0	0	0	5.001864476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1953	NO																																																																																		0				21.7506	0.621341813	0	0	2.202283138	2.012855647	4.815890643	3.787364386	0	0	3.265750274	0.027560063	0.593304331	0.116467665	0	0	0	0	0	0	5.001864476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1953
H4454_030_0	2012	7																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN			P																																																									0	YES	599.2756995	36.15602168	416.3309966	980.7107988	184.5292421	5.74119218	8.056022234	317.6397336	612.1107582		778.7850914	11.01044906	0.185121063	584.7296212	5959.065872	5100.225701	203.0955656	561.9732077			25.04782293			260.8																	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; $5 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/c; 0%-20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $35 Per Urgent Visit, Waived if admitted"	9a/b; $300 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 Per MRI/MRA, CT, Nuclear Med; $200 Per Pet, Sleep, & Other; $35 CP Per Radiation Therapy"	"5, 9c; $35 CP Per Visit"	12; 20% Coins.	"3, 9a; OBS $200 CP Per Visit;  $5 CP Per Rehab Therapy Visit"	7a; $5 CP Per Visit	"7b/d/f/g,16b,17a,18a; $35 CP Per Visit, Chrio $20 Per Visit"	"7e/h, $35 CP Per Visit"	7c/i; $5 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.			"$20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																			300	225	100	5	104.5855258	0.2	0.2	65	300	0	120.9713557	35	0.2	11.70427451	5	34.97517739	35	5	0	0	0.2			31.132																	NO	271.68	203.76	90.56	4.528	94.71265216	0.18112	0.18112	58.864	271.68	0	109.5516598	31.696	0.18112	10.59939099	4.528	31.67352064	31.696	4.528	0	0	0.18112			31.132																		13.5676	0.613929248	3.141911254	0.370054875	1.456437827	1.039844728	1.459106747	1.558128773	13.85818756	0	7.109766614	0.029082266	0.033529127	0.51648149	2.248554189	13.461842	0.536443087	0.212051224	0	0	4.536661688	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4262			6.85125	13.5676	0.613929248	3.141911254	0.370054875	1.456437827	1.039844728	1.459106747	1.558128773	13.85818756	0	7.109766614	0.029082266	0.033529127	0.51648149	2.248554189	13.461842	0.536443087	0.212051224	0	0	4.536661688	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4262	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																					0.556		0.0655		0.02	0.0594		0.041	0.2057	0.2155					0.6161						0.0752																				1.8545				14.1236	0.613929248	3.207403431	0.370054875	1.476437827	1.099236371	1.459106747	1.599176875	14.06388315	0.21549211	7.109766614	0.029082266	0.033529127	0.51648149	2.864681653	13.461842	0.536443087	0.212051224	0	0	4.611895157	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2807
H4454_031_0	2012	7																															D	D	D		T	COIN	COIN	V	V		V	V	COIN	V	V	V	V	V			COIN																																																												0	YES	834.535528	42.83712326	425.0191027		256.105531	5.398446816	7.881720384	345.2896356	597.1507922		863.7044593	8.251429922	0.227222581	551.4802459	5701.771623	5021.964583	198.4754632	508.0489275			34.91250407																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-7 Days); $100 (8-20 Days); $0 (21-100)	6a; No Cost Share	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit, Waived if Admitted; $25 Per Urgent Visit, Waived if Admitted"	9a/b; $100 CP Per Surg	8a; No Cost Sharing	8a/b; $130 Per Radiology Test type; $25 CP Per Radiation Therapy	"5, 9c; $25 CP Per Visit"	12; 20% Coins.	"3, 9a; $200 Per Obs Visit; $10 CP Per Rehab Therapy Visit"	7a; $10 CP Per Visit	"7b/d/f/g,16b,17a,18a; $25 CP Per Visit, Chrio $20 Per Visit"	7e/h; $25 CP Per Visit	7c/i; $10 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.																						300	225	100	0	103.5057619	0.2	0.2	65	100	0	94.9413485	25	0.2	17.49583735	10	24.99280268	25	10	0	0	0.2																				NO	276.21	207.1575	92.07	0	95.29775495	0.18414	0.18414	59.8455	92.07	0	87.41249956	23.0175	0.18414	16.10841745	9.207	23.01087343	23.0175	9.207	0	0	0.18414																					19.2089	0.739502613	3.260959066	0	2.033856845	0.994069997	1.451339992	1.722002574	4.581639453	0	6.291547139	0.015827274	0.041840766	0.740289501	4.374684277	9.629982615	0.380700748	0.38980054	0	0	6.4287885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2858			5.365	19.2089	0.739502613	3.260959066	0	2.033856845	0.994069997	1.451339992	1.722002574	4.581639453	0	6.291547139	0.015827274	0.041840766	0.740289501	4.374684277	9.629982615	0.380700748	0.38980054	0	0	6.4287885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2858	NO																																																																																		0				19.2089	0.739502613	3.260959066	0	2.033856845	0.994069997	1.451339992	1.722002574	4.581639453	0	6.291547139	0.015827274	0.041840766	0.740289501	4.374684277	9.629982615	0.380700748	0.38980054	0	0	6.4287885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2858
H4454_032_0	2012	7																															D	D	D		T	COIN	COIN	V	V		V	V	COIN	V		V	V	V			COIN			P																																																									0	YES	834.535528	42.84	425.0191027		256.105531	5.398446816	7.881720384	345.2896356	597.1507922		863.7044593	8.251429922	0.227222581	21.75687487		5021.964583	198.4754632				34.91250407			260.8																	3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-7 Days); $100 (8-20 Days); $0 (21-100)	6a; No Cost Share	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b/c; 0% - 20% Coins. On DME/Prosthetics/Supplies	"4a/b; $65 Per ER Visit,Waived if Admitted; $20 Per Urgent Visit, Waived if Admitted"	9a/b; $100 CP Per Surg	8a; No Cost Sharing	8a/b; $130 Per Radiology Test Type; $20 CP Per Rehab Therapy Visit	"5, 9c; $20 CP Per Visit"	12; 20% Coins.	"3, 9a; $200 Per Obs Visit; $0 CP Per Rehab Therapy"	7a; No Cost Sharing	"7b/d/f/g,16b,17a,18a; $20 CP Per Visit, Chrio $20 Per Visit"	7e/h; $20 CP Per Visit	7c/I; $0 CP Per Visit Per PT/OT/ST	No Cost Sharing	No Cost Sharing	15; 20% Coins.			"$20 amaigam/fillings, $35 CP simple extractions, $25 adjustments/repairs, $75 oral surgery"																			300	225	100	0	103.5057619	0.2	0.2	65	100	0	93.2718889	20	0.2	7.890355106	0	20	20	0	0	0	0.2			31.132																	NO	279.66	209.745	93.22	0	96.48807121	0.18644	0.18644	60.593	93.22	0	86.94805483	18.644	0.18644	7.35538903	0	18.644	18.644	0	0	0	0.18644			31.132																		19.4489	0.74878965	3.301690063	0	2.059260726	1.006486424	1.469467948	1.743511241	4.638866404	0	6.258118557	0.012819972	0.042363378	0.013335857	0	7.802458973	0.308364711	0	0	0	6.50908726	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0401			4.02375	19.4489	0.74878965	3.301690063	0	2.059260726	1.006486424	1.469467948	1.743511241	4.638866404	0	6.258118557	0.012819972	0.042363378	0.013335857	0	7.802458973	0.308364711	0	0	0	6.50908726	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0401	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																					0.7001		0.0943		0.02	0.0579		0.0483	0.201	0.2424					0.6425						0.1049																				2.1115				20.1489	0.74878965	3.396011567	0	2.079260726	1.064395247	1.469467948	1.791809557	4.839875629	0.2424423	6.258118557	0.012819972	0.042363378	0.013335857	0.642491199	7.802458973	0.308364711	0	0	0	6.61400598	0	0	0.676602133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1516
H4454_803_0	2012	1																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	252.0622371	18.48614122	39.39497409	24.31891302	11.88784864	9.131364637	9.504073397	15.87308618	64.00766554	14.35065154	52.76098723	0	0	14.79257637	47.325848	149.3913632	2.155146441	3.576351797	19.85151331	0	32.11088438																				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																						0.08368829	0.08368829	0.184858508	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.077319611	0.077319611	0.170790775	0	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536	0.2069536																					19.4894	1.429341249	6.728298173	0	2.460233072	1.889768785	1.966902204	3.284992329	13.24661681	2.969918999	10.91907625	0	0	3.061376933	9.794254616	30.91708042	0.446015314	0.740138879	4.108342146	0	6.645463121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0972			9.86	19.4894	1.429341249	6.728298173	0	2.460233072	1.889768785	1.966902204	3.284992329	13.24661681	2.969918999	10.91907625	0	0	3.061376933	9.794254616	30.91708042	0.446015314	0.740138879	4.108342146	0	6.645463121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0972	NO																																																																																		0				19.4894	1.429341249	6.728298173	0	2.460233072	1.889768785	1.966902204	3.284992329	13.24661681	2.969918999	10.91907625	0	0	3.061376933	9.794254616	30.91708042	0.446015314	0.740138879	4.108342146	0	6.645463121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0972
H4454_805_0	2012	1																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	215.2785999	4.558683437	33.99723115	24.1832055	8.602974291	4.775384808	12.27956093	14.62940826	63.16240479	17.11683205	51.50256135	1.374344488	0	7.108225652	48.49767452	139.8931921	1.80053798	4.693462446	23.25896928	0	38.47355563																				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																						0.083894	0.083894	0.185697398	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.078180818	0.078180818	0.173051405	0	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456	0.2087456																					16.8307	0.356401602	5.88326863	0	1.79583303	0.996840567	2.563304315	3.053824605	13.18487409	3.573063376	10.75093307	0.286888365	0	1.483810829	10.12367617	29.20208832	0.375854381	0.979739634	4.855207498	0	8.031185454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3275			8.3375	16.8307	0.356401602	5.88326863	0	1.79583303	0.996840567	2.563304315	3.053824605	13.18487409	3.573063376	10.75093307	0.286888365	0	1.483810829	10.12367617	29.20208832	0.375854381	0.979739634	4.855207498	0	8.031185454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3275	NO																																																																																		0				16.8307	0.356401602	5.88326863	0	1.79583303	0.996840567	2.563304315	3.053824605	13.18487409	3.573063376	10.75093307	0.286888365	0	1.483810829	10.12367617	29.20208832	0.375854381	0.979739634	4.855207498	0	8.031185454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3275
H4456_010_0	2012	4																															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	922.977391	92.46833901	827.3420696	459.6557808	122.6706599	8.524149335	7.744748109	322.0043803	48.96738098	16.3927408	26.90167766	0	0.016332836	30.4808484	4550.394364	2565.843131	517.719023	408.4784985	0	0	14.90383174	624.6113758	0	0	37.44186047	0	8.243805497	0	104.1501036	0											3600	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-41 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	101.7427073	68.20125807	0	200	0.2	0.089492042	62.93272567	0.16	0.186568496	0.182060415	0	0.2	0.144110191	6.53541109	34.93607466	38.5	35	0	0	0.2	34.1803221	0	0	35	0	35	0	0	0											YES	132.7115645	80.17759663	53.74550281	0	157.6085378	0.157608538	0.070523549	49.6132361	0.12608683	0.147023939	0.143471379	0	0.157608538	0.113564983	6.301190392	33.68640092	37.12020969	33.74564517	0	0	0.157608538	26.93555294	0	0	35	0	35	0	0	0											5600	10.2075	0.617824099	3.705492961	0	1.611161945	1.343478713	0.546187127	1.331306612	6.174141854	2.410125327	3.859620803	0	0.002574194	3.461557022	2.389408437	7.202835034	1.601486558	1.148697539	0	0	2.348971129	1.402021065	0	0	0.109205426	0	0.024044433	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4976	0	NO	10.9531895	10.2075	0.617824099	3.705492961	0	1.611161945	1.343478713	0.546187127	1.331306612	6.174141854	2.410125327	3.859620803	0	0.002574194	3.461557022	2.389408437	7.202835034	1.601486558	1.148697539	0	0	2.348971129	1.402021065	0	0	0.109205426	0	0.024044433	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4976	NO	"$325 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-32 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.4436	0.0373	0.4073	0.1975	0.1896	0.3952	0.2154	0.1567	1.0897	0.2836	0.6625	0	0.0003	0.6103	0.6876	1.3141	0.2566	0.2095	0	0	0.4792	0.2445	0	0	0.0201	0	0.0044	0	0	0											7.905	0	NO	1.910749911	10.6511	0.655121381	4.112743628	0.197461947	1.80073964	1.738680448	0.761627127	1.48796976	7.263864327	2.693713211	4.522109853	0	0.002877087	4.071853762	3.077051085	8.516980807	1.858125246	1.358166878	0	0	2.828170528	1.646553281	0	0	0.129263566	0	0.028460757	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4027
H4456_013_0	2012	4																															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	1033.172772	98.58043898	405.0795465	714.3022887	168.4124749	17.31420335	11.80983387	471.2629888	55.50199265	20.60136402	35.44999593	0	0.096320202	28.57840244	5775.40856	3028.060903	554.2026852	355.0557989	0	0	23.95155007	509.8797499	0	0	40.65116279	0	5.379535433	65	78.56429134	0											3400	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-8 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	199.8100905	118.6231222	72.76747765	0	200	0.2	0.086886427	63.83405998	0.16	0.188185874	0.183882051	0	0.2	0.145639818	7.107567035	24.99971383	38.5	25	0	0	0.2	23.51546434	0	0	25	0	10	352.5	0	0											YES	150.6301247	89.42599266	54.85696046	0	150.7732911	0.150773291	0.065500763	48.13907866	0.120618633	0.141867018	0.13862251	0	0.150773291	0.109792974	6.808379837	23.94738573	36.87937412	23.94764553	0	0	0.150773291	17.72751975	0	0	25	0	10	352.5	0	0											4400	12.9689	0.734637801	1.851786055	0	2.116008592	2.610519422	0.773553129	1.890513841	6.694574476	2.92265408	4.914167419	0	0.014522514	3.137707788	3.276764599	6.042845207	1.70322068	0.708562535	0	0	3.611254031	0.753241945	0	0	0.084689922	0	0.004482946	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	58.724	0	NO	15.20497735	12.9689	0.734637801	1.851786055	0	2.116008592	2.610519422	0.773553129	1.890513841	6.694574476	2.92265408	4.914167419	0	0.014522514	3.137707788	3.276764599	6.042845207	1.70322068	0.708562535	0	0	3.611254031	0.753241945	0	0	0.084689922	0	0.004482946	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	58.724	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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.0879	0.0067	0.0857	0.1146	0.115	0	0.1451	0.1027	0.5456	0.1588	0.3903	0	0.0008	0.2554	0.3526	0.441	0.1003	0.0517	0	0	0.2662	0.0521	0	0	0.0062	0	0.0008	0	0	0											3.2795	0	NO	1.029939401	13.0568	0.741294821	1.937501866	0.114604877	2.230982832	2.610519422	0.918678246	1.99324604	7.240203367	3.081457751	5.304424657	0	0.015311601	3.39311826	3.629319539	6.483800372	1.803526492	0.760267574	0	0	3.877417188	0.805390917	0	0	0.090930233	0	0.005308752	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	62.0035
H4456_015_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1257.607074	90.50492775	1095.330834	396.2610895	113.0135555	11.07658182	10.39096443	427.858819	460.6046184	24.7820561	42.87016472	0	0.033906174	865.8917643	6232.956362	4067.603475	589.9861752	784.7531814	0	0	29.96405713	1019.641831	0	0	62.77865932	230.0226473	9.011138673	0	101.6048971	0											3500	"$125 Days 1-28 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-45 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$100 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $100 (9a); $40/$30 (9c)	"$20 (7a); $25 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$20/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	120.7113585	79.93079843	59.95242763	0	200	0.2	0.083019608	63.93274517	41	0.148329319	0.178333719	0	0.2	34.66226198	12.41128602	24.99773219	38.5	25	0	0	0.2	24.34636806	0	0	25	15	25	0	0	0											NO	95.27744617	63.08935993	47.32043668	0	157.8599518	0.157859952	0.065527356	50.47990629	32.36129012	0.117076296	0.140758761	0	0.157859952	27.35891503	11.96937198	24.10892275	37.12917585	24.10985445	0	0	0.157859952	19.21658244	0	0	25	15	25	0	0	0												9.9851	0.47582483	4.319294448	0	1.486692869	1.748548672	0.680892428	1.799856091	1.24214664	2.901391335	6.034351283	0	0.005352427	1.974154934	6.217047771	8.172128162	1.825475037	1.576690415	0	0	4.730124614	1.632835941	0	0	0.130788874	0.287528309	0.018773206	0	0	0	0	0	0	0	0	0	0	0	0	0	57.245	0	NO	11.07093444	9.9851	0.47582483	4.319294448	0	1.486692869	1.748548672	0.680892428	1.799856091	1.24214664	2.901391335	6.034351283	0	0.005352427	1.974154934	6.217047771	8.172128162	1.825475037	1.576690415	0	0	4.730124614	1.632835941	0	0	0.130788874	0.287528309	0.018773206	0	0	0	0	0	0	0	0	0	0	0	0	0	57.245	NO																																										0	0	0	0	0	0	0	0	0	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	9.9851	0.47582483	4.319294448	0	1.486692869	1.748548672	0.680892428	1.799856091	1.24214664	2.901391335	6.034351283	0	0.005352427	1.974154934	6.217047771	8.172128162	1.825475037	1.576690415	0	0	4.730124614	1.632835941	0	0	0.130788874	0.287528309	0.018773206	0	0	0	0	0	0	0	0	0	0	0	0	0	57.245
H4456_020_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1349.917877	100.3752437	976.5840543	1431.194064	249.1104031	14.31826903	10.23184253	393.6321251	371.4735336	21.38853549	42.32616901	0	0.052226766	596.6539367	5773.168876	3789.271115	581.0724106	417.4870251	0	0	33.39372866	733.2485012	0	0	46.03606603	179.7027469	18.31230339	65	134.0785367	0											3400	"$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 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$160 (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $160 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	130.982886	87.20789285	61.69082275	0	200	0.2	0.101047115	62.52583513	65.6	0.122548441	0.182055329	0	0.2	56.57096125	6.905686453	29.94837326	38.5	30	0	0	0.2	29.18638565	0	0	30	15	10	342.5	0	0											NO	102.3631551	68.15298803	48.21139196	0	156.3000453	0.156300045	0.078968343	48.88374119	51.26641487	0.095771635	0.142276281	0	0.156300045	44.21021904	6.649942997	28.84405775	37.07420068	28.88898754	0	0	0.156300045	22.809167	0	0	30	15	10	342.5	0	0												11.5152	0.570072732	3.923539718	0	3.244663941	2.237946099	0.80799165	1.603517577	1.587009691	2.048415003	6.022009923	0	0.008163046	2.198183436	3.199270328	9.108162905	1.79523293	1.005064789	0	0	5.219441303	1.393732293	0	0	0.115090165	0.224628434	0.015260253	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	59.6978	0	NO	12.42759986	11.5152	0.570072732	3.923539718	0	3.244663941	2.237946099	0.80799165	1.603517577	1.587009691	2.048415003	6.022009923	0	0.008163046	2.198183436	3.199270328	9.108162905	1.79523293	1.005064789	0	0	5.219441303	1.393732293	0	0	0.115090165	0.224628434	0.015260253	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	59.6978	NO																																										0	0	0	0	0	0	0	0	0	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	11.5152	0.570072732	3.923539718	0	3.244663941	2.237946099	0.80799165	1.603517577	1.587009691	2.048415003	6.022009923	0	0.008163046	2.198183436	3.199270328	9.108162905	1.79523293	1.005064789	0	0	5.219441303	1.393732293	0	0	0.115090165	0.224628434	0.015260253	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	59.6978
H4456_021_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1407.387108	99.72259359	1166.454155	1604.256314	264.8216503	18.13780032	13.07187531	429.5678396	429.3539758	25.22255492	49.55793578	0	0.087283139	683.1518997	6920.405505	4249.69816	580.9791124	453.809188	0	0	32.88737646	883.8803831	0	0	42.79069767	0	5.677027295	65	78.76350109	0											3400	"$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 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$160 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $160 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	130.982886	87.20789285	61.4980618	0	200	0.2	0.093515674	62.48840635	65.6	0.182288321	0.179627441	0	0.2	56.75089427	6.805123191	29.96683121	38.5	30	0	0	0.2	29.03826769	0	0	30	0	10	352.5	0	0											NO	97.39364381	64.84430685	45.72750309	0	148.7120139	0.148712014	0.069534521	46.48574257	48.77754054	0.135542317	0.133563793	0	0.148712014	42.19769887	6.505676035	28.6483233	36.80587703	28.67990418	0	0	0.148712014	21.59169634	0	0	30	0	10	352.5	0	0												11.4225	0.538870205	4.444919664	0	3.281846743	2.697308812	0.90894659	1.664065001	1.745235913	3.418723529	6.619145857	0	0.012980051	2.402286512	3.751826354	10.14556057	1.781953814	1.084600336	0	0	4.890747983	1.590373069	0	0	0.106976744	0	0.004730856	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	64.423	0	NO	16.51021038	11.4225	0.538870205	4.444919664	0	3.281846743	2.697308812	0.90894659	1.664065001	1.745235913	3.418723529	6.619145857	0	0.012980051	2.402286512	3.751826354	10.14556057	1.781953814	1.084600336	0	0	4.890747983	1.590373069	0	0	0.106976744	0	0.004730856	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	64.423	NO																																										0	0	0	0	0	0	0	0	0	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	11.4225	0.538870205	4.444919664	0	3.281846743	2.697308812	0.90894659	1.664065001	1.745235913	3.418723529	6.619145857	0	0.012980051	2.402286512	3.751826354	10.14556057	1.781953814	1.084600336	0	0	4.890747983	1.590373069	0	0	0.106976744	0	0.004730856	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	64.423
H4456_025_0	2012	5																															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	1083.122928	93.31652257	461.4029846	102.2656738	82.13501423	6.847951891	9.657442733	325.8010041	57.27315362	17.95524421	29.36772603	0	0.063152995	34.48029419	4941.301544	2847.753369	516.8942497	539.4211254	0	0	15.90640944	656.4574752	0	0	37.44186047	0	4.976122033	0	78.90181611	0											3400	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	199.8100905	118.6231222	59.32293975	0	200	0.2	0.086750208	63.64885342	0.16	0.163550639	0.178373647	0	0.2	0.143371181	6.469803591	34.99395178	38.5	35	0	0	0.2	34.02104817	0	0	35	0	35	0	0	0											YES	151.3849074	89.87409152	44.94566674	0	151.5287912	0.151528791	0.065725771	48.24567262	0.121223033	0.123913153	0.135143716	0	0.151528791	0.108624309	6.201970331	33.545592	36.90619883	33.55108985	0	0	0.151528791	25.77584152	0	0	35	0	35	0	0	0											5940	13.664	0.698894808	1.728172065	0	1.037151618	1.037661872	0.634742869	1.309874049	6.942825387	2.224890928	3.968863621	0	0.009569497	3.745398121	2.553817131	7.96079772	1.58971683	1.508180554	0	0	2.410278994	1.410061987	0	0	0.109205426	0	0.014513689	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5587	0	NO	13.64530364	13.664	0.698894808	1.728172065	0	1.037151618	1.037661872	0.634742869	1.309874049	6.942825387	2.224890928	3.968863621	0	0.009569497	3.745398121	2.553817131	7.96079772	1.58971683	1.508180554	0	0	2.410278994	1.410061987	0	0	0.109205426	0	0.014513689	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5587	NO	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.123	0.0332	0.2681	0.1169	0.1251	0.3129	0.2648	0.158	1.2563	0.2684	0.6986	0	0.0012	0.6771	0.7714	1.4572	0.2557	0.276	0	0	0.5041	0.2524	0	0	0.0201	0	0.0023	0	0	0											8.8427	0	NO	2.262785162	14.787	0.73213517	1.996261738	0.116850985	1.162262906	1.350593972	0.899533616	1.467891238	8.199091797	2.493278852	4.667481248	0	0.010723862	4.422466914	3.325266376	9.418020001	1.845413099	1.784221749	0	0	2.914373661	1.6624198	0	0	0.129263566	0	0.016801386	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4014
H4456_026_0	2012	5																															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	1263.77347	100.259772	476.4328788	611.5420594	167.9764185	17.27080369	12.72044753	468.1468783	52.40518325	18.85035299	32.92375717	0	0.06027401	30.65355148	5351.198339	3219.438952	514.2021333	338.6408315	0	0	17.01066596	498.283102	0	0	38.04378482	0	10.44811124	65	121.5530313	0											3900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	66.80994409	0	200	0.2	0.087497223	64.03519521	0.16	0.206384415	0.187768263	0	0.2	0.145782276	7.265748268	34.36183817	38.5	35	0	0	0.2	32.17382854	0	0	35	0	10	352.5	0	0											YES	142.9670567	76.33968668	51.04586521	0	152.809184	0.152809184	0.066851896	48.94116685	0.122247347	0.15768717	0.143463575	0	0.152809184	0.111384353	6.973518245	32.98362259	36.95152137	33.59229216	0	0	0.152809184	24.58228243	0	0	35	0	10	352.5	0	0											4700	15.0565	0.637816632	2.026660709	0	2.139028288	2.639137419	0.850386036	1.90930454	6.406394633	2.972458817	4.72335991	0	0.009210422	3.414326006	3.109723271	8.849063278	1.58337926	0.947976812	0	0	2.599385985	1.020744662	0	0	0.110961039	0	0.008706759	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	62.9239	0	NO	14.93615616	15.0565	0.637816632	2.026660709	0	2.139028288	2.639137419	0.850386036	1.90930454	6.406394633	2.972458817	4.72335991	0	0.009210422	3.414326006	3.109723271	8.849063278	1.58337926	0.947976812	0	0	2.599385985	1.020744662	0	0	0.110961039	0	0.008706759	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	62.9239	NO	"$325 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-27 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.548	0.0351	0.1799	0.3311	0.2405	0	0.3278	0.2147	1.0803	0.3342	0.7749	0	0.001	0.5751	0.9093	1.4409	0.2522	0.1527	0	0	0.5066	0.1525	0	0	0.0181	0	0.005	0	0	0											8.0798	0	NO	2.479188746	15.6045	0.672886682	2.206526355	0.331121647	2.379490189	2.639137419	1.178158793	2.123970068	7.48667055	3.306611993	5.498282607	0	0.010245825	3.989424466	4.01899986	10.28992422	1.83554901	1.100687408	0	0	3.10601617	1.173274615	0	0	0.129077127	0	0.01368205	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	71.0037
H4456_801_0	2012	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	239.9643828	5.6463	40.28911725	1291.294121	9.627221795	18.93189729	12.53832156	20.60897519	78.08338854	28.37754101	50.85574144	0	0.044165569	34.80980673	38.99018458	93.03590044	2.6061	6.884017566	0	0	45.6752133	11.0371161	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.089616211	0.089616211	0.207285747	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070764989	0.070764989	0.163682145	0	0.17688047	0.17688047	0.17688047	0.17688047	0.17688047	0.17688047	0.17688047	0	0.17688047	0.17688047	0.17688047	0.17688047	0.17688047	0.17688047	0	0	0.17688047	0.17688047	0	0	0	0	0	0	0	0												16.9811	0.399560357	6.59460912	0	1.702867519	3.348682896	2.217784214	3.645325224	13.81142649	5.019432801	8.995387466	0	0.007812027	6.157174986	6.896602187	16.45623383	0.460968194	1.217648265	0	0	8.079053212	1.952250287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9439	150	YES	27.68981494	16.9811	0.399560357	6.59460912	0	1.702867519	3.348682896	2.217784214	3.645325224	13.81142649	5.019432801	8.995387466	0	0.007812027	6.157174986	6.896602187	16.45623383	0.460968194	1.217648265	0	0	8.079053212	1.952250287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9439	NO																																										0	0	0	0	0	0	0	0	0	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	16.9811	0.399560357	6.59460912	0	1.702867519	3.348682896	2.217784214	3.645325224	13.81142649	5.019432801	8.995387466	0	0.007812027	6.157174986	6.896602187	16.45623383	0.460968194	1.217648265	0	0	8.079053212	1.952250287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9439
H4456_805_0	2012	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	231.0401253	5.6537	38.79076799	1266.954043	9.269186135	18.22782144	12.07202231	19.84252894	75.17947315	27.32218237	48.96442021	0	0.042523055	33.51511278	37.54014252	89.57590224	2.6115	6.628001466	0	0	43.97655553	10.62664658	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.09009562	0.09009562	0.174397844	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071994502	0.071994502	0.13935956	0	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0	0	0.178996143	0.178996143	0	0	0	0	0	0	0	0												16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804	150	YES	25.23799485	16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804	NO																																										0	0	0	0	0	0	0	0	0	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	16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804
H4456_810_0	2012	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	231.0401253	5.6537	38.79076799	1266.954043	9.269186135	18.22782144	12.07202231	19.84252894	75.17947315	27.32218237	48.96442021	0	0.042523055	33.51511278	37.54014252	89.57590224	2.6115	6.628001466	0	0	43.97655553	10.62664658	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.09009562	0.09009562	0.174397844	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071994502	0.071994502	0.13935956	0	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0.178996143	0	0	0.178996143	0.178996143	0	0	0	0	0	0	0	0												16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804	150	YES	25.23799485	16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804	NO																																										0	0	0	0	0	0	0	0	0	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	16.6336	0.407035315	5.405864355	0	1.659148568	3.262709735	2.160845434	3.551736149	13.45683573	4.890565266	8.764442368	0	0.007611463	5.999075923	6.719540724	16.03374102	0.467448428	1.186386699	0	0	7.871633826	1.902128751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3804
H4461_001_0	2012	7	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	284.67	8.29	564.76	2541.73	260.21	20.43	5.05	389.82	500.92	1301.72	1299.92	129.1	0.21	650.55	4383.28	5487.4	104.27	1200.67		3275.9	36.55	0			1.52				3.21	1.15	662.98										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Admit: 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												0	100	68.0721	0	50	0.2	0.2	65	100	0	31.663153	20	0.2	24.27014	10	20	20	10		0	0.2	0			0				0	0	0										NO	0	95.6929	60.950805	0	46.0655	0.184262	0.184262	59.88515	92.131	0	29.17158	18.4262	0.184262	22.360323	9.2131	18.4262	18.4262	9.2131		0	0.184262	0			0				0	0	0											0	0.066107845	2.868548053	0	0.99889198	3.76447266	0.9305231	1.945369098	3.845855043	0	3.160060023	0.198235202	0.03869502	1.212209011	3.365299747	8.425994157	0.160108323	0.921824398	0	0	6.7347761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.637	0	NO	3.38743	0	0.066107845	2.868548053	0	0.99889198	3.76447266	0.9305231	1.945369098	3.845855043	0	3.160060023	0.198235202	0.03869502	1.212209011	3.365299747	8.425994157	0.160108323	0.921824398	0	0	6.7347761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.637	NO																																																																																		0	0	NO	0	0	0.066107845	2.868548053	0	0.99889198	3.76447266	0.9305231	1.945369098	3.845855043	0	3.160060023	0.198235202	0.03869502	1.212209011	3.365299747	8.425994157	0.160108323	0.921824398	0	0	6.7347761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.637
H4461_004_0	2012	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	210.61	3.9	424.3	1760.94	193.19	12.24	2.78	297.75	404.5	1022.62	976.73	50.39	0.33	507.36	3379.51	4496.57	41.51	921.79		2826.99	24.8	0			1.52				3.21	1.15	140.3										3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$100/Admit: 1b. $100 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20/Visit: 5. $20 Partial Hospitalization,7h. $20 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $20 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												0	100	68.0721	0	50	0.2	0.2	65	100	0	35.484485	20	0.2	23.201714	10	20	20	10		0	0.2	0			0				0	0	0										NO	0	97.792	65.121447	0	47.59965	0.190399	0.190399	61.879545	95.1993	0	33.780982	19.03986	0.190399	22.087869	9.51993	19.03986	19.03986	9.51993		0	0.190399	0			0				0	0	0											0	0.0317824	2.30258583	0	0.766314699	2.33048376	0.52930922	1.53538621	3.209009738	0	2.749574879	0.079951545	0.06283167	0.933875101	2.68105822	7.134505273	0.065862049	0.731281356	0	0	4.7218952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8657	0	NO	1.493402	0	0.0317824	2.30258583	0	0.766314699	2.33048376	0.52930922	1.53538621	3.209009738	0	2.749574879	0.079951545	0.06283167	0.933875101	2.68105822	7.134505273	0.065862049	0.731281356	0	0	4.7218952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8657	NO																																																																																		0	0	NO	0	0	0.0317824	2.30258583	0	0.766314699	2.33048376	0.52930922	1.53538621	3.209009738	0	2.749574879	0.079951545	0.06283167	0.933875101	2.68105822	7.134505273	0.065862049	0.731281356	0	0	4.7218952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8657
H4461_011_0	2012	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O			V				O	O	O	V	V								0	0	0	0	0	1.050456738	0.248727349	0	1.760631208	0.226157917	0.697986771	0.069324354	0.065746607	0.785370408	1.510759267	2.324694848	0.079002043	0.258967631		0	0.854580751	0			0				0	0	0	0	0								9.9324	YES	393.64	13.89	62.75	55.16	24.4	43.79	10.37	995.03	73.4	9.43	29.1	2.89	2.74	32.74	62.98	96.91	3.29	10.8		2482.92	35.63	0			1.52				2.36	1.15	1434.69	230.76	174.03								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins: 6. 0% Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0947	0.0947	0.2048	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.069025	0.069025	0.121277	0	0.169738	0.169738	0.169738	55.164785	0.169738	0.169738	0.169738	0.169738	0.169738	0.169738	0.169738	0.169738	0.169738	0.169738		0	0.169738	0			0				0	0	0	0	0									27.171	0.95875725	7.61013175	0	4.1416072	7.43282702	1.76018306	4.574218002	12.4587692	1.60062934	4.9393758	0.49054282	0.46508212	5.55722212	10.69009924	16.44930958	0.55843802	1.8331704	0	0	6.04776494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7391	162	YES	29.789206	27.171	0.95875725	7.61013175	0	4.1416072	8.483283758	2.008910409	4.574218002	14.21940041	1.826787257	5.637362571	0.559867174	0.530828727	6.342592528	12.20085851	18.77400443	0.637440063	2.092138031	0	0	6.902345691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.6715	NO																																																																																		0	0	NO	0	27.171	0.95875725	7.61013175	0	4.1416072	8.483283758	2.008910409	4.574218002	14.21940041	1.826787257	5.637362571	0.559867174	0.530828727	6.342592528	12.20085851	18.77400443	0.637440063	2.092138031	0	0	6.902345691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.6715
H4461_015_0	2012	7	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	218.37	7.34	308.39	1672.12	196.35	19.03	4.33	393.8	401.62	1098.85	1092.8	173.43	0.34	597.12	4185.57	3992.22	156.22	820.02		2747.68	21.69	0			0.6				3.21	1.15	1116.86										3400	"$0-$500/Admit: 1a. $500 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$500/Admit: 1b. $500 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$30/Visit: 8a. $0 Lab -- FSL,8a. $30 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $30 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $30 Radiology OP -- Facility"	"$30/Visit: 5. $30 Partial Hospitalization,7h. $30 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $30 OP Other,8b. $30 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												500	500	68.0721	0	200	0.2	0.2	65	150	26.333518	71.611513	30	0.2	47.614547	15	29.457424	30	15		0	0.2	0			0				0	0	0										NO	427.9305	427.9305	59.352745	0	176.898	0.176898	0.176898	57.49185	132.6735	23.291733	63.339667	26.5347	0.176898	42.114591	13.26735	26.054797	26.5347	13.26735		0	0.176898	0			0				0	0	0											7.7873	0.261750823	1.525316086	0	2.894493525	3.36636894	0.76596834	1.886690878	4.440360923	2.132843401	5.768132341	0.383492752	0.06014532	2.095622048	4.627618512	8.66804014	0.34543757	0.906624362	0	0	3.83691762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7531	0	NO	7.087972	7.7873	0.261750823	1.525316086	0	2.894493525	3.36636894	0.76596834	1.886690878	4.440360923	2.132843401	5.768132341	0.383492752	0.06014532	2.095622048	4.627618512	8.66804014	0.34543757	0.906624362	0	0	3.83691762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7531	NO																																																																																		0	0	NO	0	7.7873	0.261750823	1.525316086	0	2.894493525	3.36636894	0.76596834	1.886690878	4.440360923	2.132843401	5.768132341	0.383492752	0.06014532	2.095622048	4.627618512	8.66804014	0.34543757	0.906624362	0	0	3.83691762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7531
H4461_018_0	2012	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			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	1407.88	56.48	490.79	2098.11	154.36	12.1	3.44	359.36	281.42	589.23	1227.24	91.67	0.53	386.41	4194.38	4381.48	86.67	683.32		1880.07	29.11	0			1.52				3.21	1.15	648.29										3400	"$0-$150/Day(Days 1-4): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-4): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35/Visit: 5. $35 Partial Hospitalization,7h. $35 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$150/Visit: 3. $5 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $35 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$5/Visit: 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												83.702847	65.811029	34.03605	0	200	0.2	0.2	65	150	0	60.273773	35	0.2	40.875348	5	34.644863	35	5		0	0.2	0			0				0	0	0										NO	70.575311	55.489556	29.860031	0	177.0764	0.177076	0.177076	57.54983	132.8073	0	53.365313	30.98837	0.177076	36.190297	4.42691	30.673938	30.98837	4.42691		0	0.177076	0			0				0	0	0											8.2801	0.261170844	1.221250385	0	2.277792759	2.1426196	0.60914144	1.723425576	3.114552531	0	5.457670561	0.236725323	0.09385028	1.165357722	1.54734523	11.19977049	0.223813502	0.252083012	0	0	5.15468236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9614	0	NO	6.316442	8.2801	0.261170844	1.221250385	0	2.277792759	2.1426196	0.60914144	1.723425576	3.114552531	0	5.457670561	0.236725323	0.09385028	1.165357722	1.54734523	11.19977049	0.223813502	0.252083012	0	0	5.15468236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9614	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	30% Coins	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	30% Coins	$0/Service			"VIS734: Vision 17a,17b"						30% Coins										5100	1.9714	0.0284	0.1758	1.3645	1.0259	0.7417	0.211	0.0773	0.5921	0.0879	0.2835	0.0118	0.0043	0.194	0.3942	0.6827	0.0053	0.0564		0.0756	0.2456	0			0				0		0.0591										8.2887	500	NO	5.496598	10.2515	0.289590844	1.397076385	1.364519	3.303732759	2.8843256	0.82012044	1.800751576	3.706698531	0.087877	5.741199561	0.248505323	0.09814028	1.359340722	1.94156423	11.88251249	0.229136502	0.308478012	0	0.075577	5.40031336	0	0	0	0	0	0	0	0	0	0.059085	0	0	0	0	0	0	0	0	0	53.2501
H4461_022_0	2012	6	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	O		V	V				O	O	O	V	V								0	0	0	0	0	1.065692655	0.226241484	0	1.755892385	0.217423289	0.689602509	0.070017459	0.041484091	0.793993261	1.513553563	2.356989315	0.081285169	0.261364443		0	0.864298404	0		0	0				0	0	0	0	0								9.9378	YES	398.67	14.55	66.47	4138.33	25.55	45.45	9.65	977.77	74.89	9.27	29.41	2.99	1.77	33.86	64.55	100.53	3.47	11.15		2441.24	36.86	0		2.48	1.52				3.21	1.18	1036.43	230.91	172.19								6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0946	0.0946	0.2048	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0		0	0				0	0	0	0	0								NO	0.068344	0.068344	0.117954	0	0.168953	0.168953	0.168953	54.909595	0.168953	0.168953	0.168953	0.168953	0.168953	0.168953	0.168953	0.168953	0.168953	0.168953		0	0.168953	0		0	0				0	0	0	0	0									27.2467	0.9944052	7.84040238	0	4.31674915	7.67891385	1.63039645	4.474079559	12.65289017	1.56619431	4.96890773	0.50516947	0.29904681	5.72074858	10.90591615	16.98484509	0.58626691	1.88382595	0	0	6.22760758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4831	162	YES	31.397112	27.2467	0.9944052	7.84040238	0	4.31674915	8.744606505	1.856637934	4.474079559	14.40878255	1.783617599	5.658510239	0.575186929	0.340530901	6.514741841	12.41946971	19.34183441	0.667552079	2.145190393	0	0	7.091905984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.4209	NO																																																																																		0	0	NO	0	27.2467	0.9944052	7.84040238	0	4.31674915	8.744606505	1.856637934	4.474079559	14.40878255	1.783617599	5.658510239	0.575186929	0.340530901	6.514741841	12.41946971	19.34183441	0.667552079	2.145190393	0	0	7.091905984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.4209
H4461_025_0	2012	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	1477.44	59.27	515.04	2451.55	245.49	14.48	4.12	371.81	291.17	609.64	1267.21	96.05	0.54	399.8	4279.74	4470.64	88.44	699.23		1918.33	29.26	0			0.6				3.21	1.15	756.5										3400	"$0-$275/Day(Days 1-4): 1a. $275 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$275/Day(Days 1-4): 1b. $275 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$40/Visit: 8a. $0 Lab -- FSL,8a. $40 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $40 DMAM -- OP,8b. $40 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $40 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $40 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												153.45522	120.653552	68.0721	0	200	0.2	0.2	65	225	28.315587	76.315119	36.632192	0.2	50.459103	15	34.644863	35	15		0	0.2	0			0				0	0	0										NO	114.63197	90.128927	49.539267	0	169.7696	0.16977	0.16977	55.17512	190.9908	24.035629	64.779937	31.095163	0.16977	42.832109	12.73272	29.408222	29.70968	12.73272		0	0.16977	0			0				0	0	0											14.1135	0.445161792	2.12622534	0	3.473061592	2.4582696	0.6994524	1.709555114	4.634232603	1.221090072	6.84081533	0.248890867	0.0916758	1.427023098	4.541060924	10.95613113	0.218960342	0.741924984	0	0	4.9674702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9145	0	NO	13.601856	14.1135	0.445161792	2.12622534	0	3.473061592	2.4582696	0.6994524	1.709555114	4.634232603	1.221090072	6.84081533	0.248890867	0.0916758	1.427023098	4.541060924	10.95613113	0.218960342	0.741924984	0	0	4.9674702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9145	NO																																																																																		0	0	NO	0	14.1135	0.445161792	2.12622534	0	3.473061592	2.4582696	0.6994524	1.709555114	4.634232603	1.221090072	6.84081533	0.248890867	0.0916758	1.427023098	4.541060924	10.95613113	0.218960342	0.741924984	0	0	4.9674702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9145
H4461_026_0	2012	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		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	270.9	8.52	515.04	2451.55	245.49	14.48	4.12	371.81	291.17	609.64	1267.21	96.05	0.54	399.8	4279.74	4470.64	88.44	699.23		1918.33	29.26	0		2.48	0.6				3.21	1.15	756.5										3400	"$0-$500/Admit: 1a. $500 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$500/Admit: 1b. $500 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	"20% Coins: 11a, 11c. 20% DME"	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $50 DMAM -- OP,8b. $40 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$40/Visit: 5. $35 Partial Hospitalization,7h. $40 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $40 OP Other,8b. $40 Rad therapy,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												500	500	68.0721	0	200	0.2	0.2	65	150	35.394484	77.703197	35.544064	0.2	49.838992	10	34.644863	35	10		0	0.2	0		0	0				0	0	0										NO	412.0495	412.0495	53.965519	0	174.8136	0.174814	0.174814	56.81442	131.1102	30.937186	67.917878	31.067929	0.174814	43.562668	8.74068	30.281966	30.59238	8.74068		0	0.174814	0		0	0				0	0	0											9.302	0.292555145	2.316200075	0	3.576249222	2.53130672	0.72023368	1.760347458	3.181279745	1.571712173	7.172184515	0.248672882	0.09439956	1.451362889	3.117319819	11.28164737	0.225465841	0.50931214	0	0	5.11505764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4673	0	NO	8.784633	9.302	0.292555145	2.316200075	0	3.576249222	2.53130672	0.72023368	1.760347458	3.181279745	1.571712173	7.172184515	0.248672882	0.09439956	1.451362889	3.117319819	11.28164737	0.225465841	0.50931214	0	0	5.11505764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4673	NO																																																																																		0	0	NO	0	9.302	0.292555145	2.316200075	0	3.576249222	2.53130672	0.72023368	1.760347458	3.181279745	1.571712173	7.172184515	0.248672882	0.09439956	1.451362889	3.117319819	11.28164737	0.225465841	0.50931214	0	0	5.11505764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4673
H4461_806_0	2012	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	241.88	2.81	43.17	24.04	8.26	13.37	4.06	23.31	61.95	8.35	28.75	0.64	0.46	18.11	36.8	92.33	0.63	7.29		14.97	31.93	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																					0.1012	0.1012	0.2029	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.083303	0.083303	0.149967	0	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277	0.199277		0.199277	0.199277	0																				20.1493	0.23408143	6.47407539	0	1.64602802	2.66433349	0.80906462	4.64514687	12.34521015	1.66396295	5.72921375	0.12753728	0.09166742	3.60890647	7.3333936	18.39924541	0.12554451	1.45272933	0	2.98317669	6.36291461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8456	0	NO	15.346781	20.1493	0.23408143	6.47407539	0	1.64602802	2.66433349	0.80906462	4.64514687	12.34521015	1.66396295	5.72921375	0.12753728	0.09166742	3.60890647	7.3333936	18.39924541	0.12554451	1.45272933	0	2.98317669	6.36291461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8456	NO																																																																																		0	0	NO	0	20.1493	0.23408143	6.47407539	0	1.64602802	2.66433349	0.80906462	4.64514687	12.34521015	1.66396295	5.72921375	0.12753728	0.09166742	3.60890647	7.3333936	18.39924541	0.12554451	1.45272933	0	2.98317669	6.36291461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8456
H4461_807_0	2012	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	241.88	2.81	43.17	24.04	8.26	13.37	4.06	23.31	61.95	8.35	28.75	0.64	0.46	18.11	36.8	92.33	0.63	7.29		14.97	31.93	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																					0.0892	0.0892	0.2046	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.074614	0.074614	0.153132	0	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995		0.199995	0.199995	0																				18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083	0	NO	14.221368	18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083	NO																																																																																		0	0	NO	0	18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083
H4461_808_0	2012	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	241.88	2.81	43.17	24.04	8.26	13.37	4.06	23.31	61.95	8.35	28.75	0.64	0.46	18.11	36.8	92.33	0.63	7.29		14.97	31.93	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																					0.0892	0.0892	0.2046	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.074614	0.074614	0.153132	0	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995	0.199995		0.199995	0.199995	0																				18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083	0	NO	14.221368	18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083	NO																																																																																		0	0	NO	0	18.0476	0.20966534	6.61070844	0	1.6519587	2.67393315	0.8119797	4.66188345	12.38969025	1.66995825	5.74985625	0.1279968	0.0919977	3.62190945	7.359816	18.46553835	0.12599685	1.45796355	0	2.99392515	6.38584035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1083
H4506_003_0	2012	8																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P																																																			0	YES	234.6983776	11.66853427	486.739821		217.0721107	16.752448	9.728913496	345.3247374	272.8013504		324.362818		8.244636085	36.88706297		3035.600434	240.0473937	233.5646143		199.3025716	25.01193076	932.8597943		693.7372667	122.8142424																3000	(1a/1a1) $305/Admit	(1b) $305/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $50	(11a) 10%	(11b) 20% (11c) 0-20%	(4a) $65 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $50	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50/20%	Included in h.5.	(12) $30	(3) $25 (5) $25 (9a) $150 (9c) 35 Ind/20 Grp (3) $25	(7a) $0 (14b) $0 (14a) $0 (14a) $0 (13d) $0 (14b2) $0 (14a) $0 (14a) $0 (14a) $0 (14a) $0 (14e) $0 (14b) $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%	(9d) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) $0	(16a) $5	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14c) $0  (14c) $0	(13d) $0													305	305	31.19338124		50	0.1	0.2	64.68973583	50		68.02909535		30	135.2482416		20.00485705	31.25	10		25	0.1	24.99740017		5	25																NO	286.8606658	286.8606658	29.33821019		47.02633865	0.094052677	0.188105355	60.84242849	47.02633865		63.98318552		28.21580319	127.2045923		18.81510365	29.39146166	9.40526773		23.51316933	0.094052677	23.51083234		4.702633865	23.51316933																	5.6105	0.278936959	1.190006265	0	0.850675549	1.575612586	1.830060723	1.750866304	1.069070724	0	1.72948053	0	0.019385752	0.391016984	0	4.759594732	0.587945314	0.183061477	0	0.390519593	2.352439052	1.827692519	0	0.27186603	0.240646006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9094	0		1.701575969	5.6105	0.278936959	1.190006265	0	0.850675549	1.575612586	1.830060723	1.750866304	1.069070724	0	1.72948053	0	0.019385752	0.391016984	0	4.759594732	0.587945314	0.183061477	0	0.390519593	2.352439052	1.827692519	0	0.27186603	0.240646006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9094	NO																																																																																		0	0		0	5.6105	0.278936959	1.190006265	0	0.850675549	1.575612586	1.830060723	1.750866304	1.069070724	0	1.72948053	0	0.019385752	0.391016984	0	4.759594732	0.587945314	0.183061477	0	0.390519593	2.352439052	1.827692519	0	0.27186603	0.240646006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9094
H4506_010_0	2012	7																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P																																																			0	YES	151.7658064	11.0446925	381.0088237		139.0996534	9.202948912	6.068457098	244.4953079	153.9945484		108.4294917		9.95663244	22.39360125		1680.989827	240.7525903	103.5545058		154.5771463	14.09043371	601.4840859		833.0837632	121.5450078																3000	(1a/1a1) $300/Admit	(1b) $300/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $50	(11a) 10%	(11b) 20% (11c) 0-20%	(4a) $65 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $50	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50	Included in h.5.	(12) $30	(3) $25 (5) $25 (9a) $150 (9c) 35 Ind/20 Grp (3) $25	(7a) $0 (14b) $0 (14a) $0 (14a) $0 (13d) $0 (14b2) $0 (14a) $0 (14a) $0 (14a) $0 (14a) $0 (14e) $0 (14b) $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%	(9d) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14c) $0  (14c) $0	(13d) $0													300	300	31.19338124		50	0.1	0.2	64.79903019	50		69.06445585		30	112.2909947		20.00003575	31.25	10		25	0.1	24.99939221		15	25																NO	292.3948897	292.3948897	30.40261755		48.73248162	0.097464963	0.194929926	63.15635095	48.73248162		67.31364651		29.23948897	109.4443767		19.49302749	30.45780101	9.746496324		24.36624081	0.097464963	24.36566547		14.61974449	24.36624081																	3.698	0.269117637	0.965305463	0	0.564889275	0.896965077	1.182923896	1.286785956	0.625378042	0	0.60823204	0	0.02426057	0.204237811	0	2.730631742	0.611066207	0.084107801	0	0.313871998	1.373323603	1.221296669	0	1.014955979	0.246799577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9221	0		0.466148292	3.698	0.269117637	0.965305463	0	0.564889275	0.896965077	1.182923896	1.286785956	0.625378042	0	0.60823204	0	0.02426057	0.204237811	0	2.730631742	0.611066207	0.084107801	0	0.313871998	1.373323603	1.221296669	0	1.014955979	0.246799577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9221	NO																																																																																		0	0		0	3.698	0.269117637	0.965305463	0	0.564889275	0.896965077	1.182923896	1.286785956	0.625378042	0	0.60823204	0	0.02426057	0.204237811	0	2.730631742	0.611066207	0.084107801	0	0.313871998	1.373323603	1.221296669	0	1.014955979	0.246799577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9221
H4506_027_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P																																																			0	YES	1339.652152	79.84245469	487.2301436	772.6825096	217.2907806	16.78621652	9.748524419	345.672604	273.0761597		4568.183481		8.252941407	36.92422154	4059.454177	3038.658378	240.289208	233.7998981		199.5033412	25.06234821	933.7995206			115.7419604																3400	(1a/1a1) $300/Day Days 1-5	(1b) $300/Day Days 1-5	(2a/2a2) $100/Day Days 21-100	(6a) 20%	(10a) $150	(11a) 20%	(11b) 20% (11c) 0-20%	(4a) $65 (4a1) n/c (4b) $35 (4b1) n/c	(9b) $145	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	Included in h.5.	(12) $30	(3) $35 (5) $300 (9a) $245 (9c) 40% (3) $35	(7a) $20 (14b) $0 (14a) $0 (14a) $0 (13d) $0 (14b2) $0 (14a) $0 (14a) $0 (14a) $0 (14a) $0 (14e) $0 (14b) $0	(7b) 50% (7d) $45 (7f) $45	(7e) 40% (7h) 40%	(7c) $35 (7i) $35		(7d) $45 (7g) $45	(15) 20%	(9d) $0 (16b) $0 (17a) $20 (17b) $0 (18a) $20	(10b) $0	(16a) $0	(17a1) $20	(17b1) $0	(18a1) n/c	(18b) n/c	(14c) $0  (14c) $0	(13d) $0													162.8189065	125.0543007	31.19338124	29.08247646	150	0.2	0.2	64.76730187	145		23.41864968		30	219.3169029	20	44.98945582	38.79007141	35		32.29519897	0.2	19.99828592			20																NO	129.9879959	99.83826988	24.90352748	23.21826692	119.7539021	0.159671869	0.159671869	51.70758085	115.7621054		18.69649788		23.95078042	175.0936994	15.96718695	35.91775258	30.9684161	27.94257716		25.78317397	0.159671869	15.9661858			15.96718695																	14.5116	0.664277712	1.011145773	1.495029063	2.168451572	2.680286573	1.556565119	1.489491177	2.634322598	0	7.117419395	0	0.016472032	0.538766546	5.401505313	9.095148317	0.620114681	0.544414308	0	0.428652446	4.001751992	1.24243472	0	0	0.154006127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3718	0		14.49029364	14.5116	0.664277712	1.011145773	1.495029063	2.168451572	2.680286573	1.556565119	1.489491177	2.634322598	0	7.117419395	0	0.016472032	0.538766546	5.401505313	9.095148317	0.620114681	0.544414308	0	0.428652446	4.001751992	1.24243472	0	0	0.154006127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3718	NO																																																																																		0	0		0	14.5116	0.664277712	1.011145773	1.495029063	2.168451572	2.680286573	1.556565119	1.489491177	2.634322598	0	7.117419395	0	0.016472032	0.538766546	5.401505313	9.095148317	0.620114681	0.544414308	0	0.428652446	4.001751992	1.24243472	0	0	0.154006127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3718
H4506_801_0	2012	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	262.0431951	6.686972429	44.2590193		12.56323801	19.73205728	13.57129914	27.27503075	39.43392856	31.91705035	52.76207549		0.253168447	9.533074203	62.08882699	178.01875	2.038728863	2.102264054		12.66090231	30.39357986	10.31849554																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.070689636	0.070689636	0.184729644		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.057185986	0.057187045	0.149407445		0.181194601	0.181203844	0.18118765	0.181223137	0.181218573	0.181201352	0.181203125		0.181288954	0.181288868	0.181190328	0.181194419	0.181216292	0.18128278		0.181173667	0.181200649	0.181197572																				14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256	0		27.93156147	14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256	NO																																																																																		0	0		0	14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256
H4506_806_0	2012	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	262.0431951	6.686972429	44.2590193		12.56323801	19.73205728	13.57129914	27.27503075	39.43392856	31.91705035	52.76207549		0.253168447	9.533074203	62.18195786	178.01875	2.038728863	2.102264054		12.66090231	30.39357986	10.31849554																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.070689636	0.070689636	0.184729644		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.057183238	0.057184297	0.149400317		0.181185918	0.181195148	0.181178978	0.181214413	0.181209855	0.18119266	0.181194431		0.181280131	0.181280046	0.181181652	0.181185737	0.181207578	0.181273967		0.181165016	0.181191958	0.181188886																				14.9845	0.382389814	6.612311492	0	2.276281815	3.575353035	2.458834106	4.94262868	7.145816464	5.783135258	9.560194225	0	0.045894409	1.728156131	11.26622985	32.25445838	0.369433119	0.381085744	0	2.293712565	5.507072252	1.869596708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4371	0		27.94088425	14.9845	0.382389814	6.612311492	0	2.276281815	3.575353035	2.458834106	4.94262868	7.145816464	5.783135258	9.560194225	0	0.045894409	1.728156131	11.26622985	32.25445838	0.369433119	0.381085744	0	2.293712565	5.507072252	1.869596708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4371	NO																																																																																		0	0		0	14.9845	0.382389814	6.612311492	0	2.276281815	3.575353035	2.458834106	4.94262868	7.145816464	5.783135258	9.560194225	0	0.045894409	1.728156131	11.26622985	32.25445838	0.369433119	0.381085744	0	2.293712565	5.507072252	1.869596708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4371
H4506_808_0	2012	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	262.0431951	6.686972429	44.2590193		12.56323801	19.73205728	13.57129914	27.27503075	39.43392856	31.91705035	52.76207549		0.253168447	9.533074203	62.08882699	178.01875	2.038728863	2.102264054		12.66090231	30.39357986	10.31849554																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.070689636	0.070689636	0.184729644		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.057185986	0.057187045	0.149407445		0.181194601	0.181203844	0.18118765	0.181223137	0.181218573	0.181201352	0.181203125		0.181288954	0.181288868	0.181190328	0.181194419	0.181216292	0.18128278		0.181173667	0.181200649	0.181197572																				14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256	0		27.93156147	14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256	NO																																																																																		0	0		0	14.9852	0.382408195	6.612626999	0	2.276390892	3.575524624	2.458951795	4.942866644	7.146160242	5.783412689	9.560652986	0	0.045896643	1.728240234	11.24989491	32.25600394	0.369450885	0.381104272	0	2.293822096	5.50733641	1.869686341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4256
H4510_012_0	2012	5	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	270.09	7.97	532.99	4061.23	334.34	13.96	2.61	380.59	265.72	217.25	1861.51	62.87	0.42	159.34	4623.4	5593.3	167.95	1106.82		1704.1	45.63	0			2.45				2.94	1.43	14064.23	0									3400	"$0-$65/Admit: 1a. $65 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$65/Admit: 1b. $65 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins: 11b. 20% Prosthetics	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$100/Visit: 3. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"10% Coins: 15. 10% Part B Rx,15. 10% Part B Rx at Pharmacy,15. 10% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS122: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11c. $0 Diabetic Monitoring Supplies"	$0/Proc: 12. $0 Dialysis -- Dialysis Center											65	65	44.690621	0	100	0.2	0.2	65	41.378739	17.877684	47.730179	36.213073	0.2	51.315014	0	19.587756	20	21.139293		0	0.1	0			0				0	0	0	0									NO	62.570755	62.570755	42.57747	0	93.6213	0.187243	0.187243	60.853845	38.739313	16.73732	44.685614	33.90315	0.187243	48.041783	0	18.338312	18.72426	19.790881		0	0.093621	0			0				0	0	0	0										1.4083	0.04155741	1.891113811	0	2.608445454	2.61391228	0.48870423	1.930030406	0.857817521	0.303015231	6.93189311	0.177624253	0.07864206	0.637914809	0	8.547640042	0.262061622	1.825411909	0	0	4.27192623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.876	0	NO	2.298722	1.4083	0.04155741	1.891113811	0	2.608445454	2.61391228	0.48870423	1.930030406	0.857817521	0.303015231	6.93189311	0.177624253	0.07864206	0.637914809	0	8.547640042	0.262061622	1.825411909	0	0	4.27192623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.876	NO																																																																																		0	0	NO	0	1.4083	0.04155741	1.891113811	0	2.608445454	2.61391228	0.48870423	1.930030406	0.857817521	0.303015231	6.93189311	0.177624253	0.07864206	0.637914809	0	8.547640042	0.262061622	1.825411909	0	0	4.27192623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.876
H4510_015_0	2012	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			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	1614.96	50.29	461.08	2890.97	273.83	15.42	5.13	354.59	293.02	195.36	1888.06	95.51	0.76	126.82	5017.43	5461.46	68.56	721		1963.7	40.89	0			2.45				3.7	1.43	628.78	0.05									4000	"$0-$75/Day(Days 1-5): 1a. $75 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$75/Day(Days 1-5): 1b. $75 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS122: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											47.189786	38.786882	45.597948	0	200	0.2	0.095257	65	34.307324	26.976327	38.606607	31.230296	0.2	49.925237	0	29.925767	30	31.044572		0	0.2	0			0				0	0	0	0									NO	43.499498	35.753709	42.767866	0	184.7722	0.184772	0.088004	60.050965	31.695198	24.922377	35.667138	28.852452	0.184772	46.123979	0	27.647249	27.71583	28.680869		0	0.184772	0			0				0	0	0	0										5.8542	0.149837835	1.643283971	0	4.216347627	2.84918424	0.45146052	1.774455973	0.77394391	0.405736298	5.611808048	0.229641474	0.14042672	0.487453585	0	12.58286204	0.158349775	1.723242212	0	0	7.55532708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6075	0	NO	3.828996	5.8542	0.149837835	1.643283971	0	4.216347627	2.84918424	0.45146052	1.774455973	0.77394391	0.405736298	5.611808048	0.229641474	0.14042672	0.487453585	0	12.58286204	0.158349775	1.723242212	0	0	7.55532708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6075	NO																																																																																		0	0	NO	0	5.8542	0.149837835	1.643283971	0	4.216347627	2.84918424	0.45146052	1.774455973	0.77394391	0.405736298	5.611808048	0.229641474	0.14042672	0.487453585	0	12.58286204	0.158349775	1.723242212	0	0	7.55532708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6075
H4510_018_0	2012	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	1607.11	103.86	232.57	1918.58	225.46	9.9	2	493.53	206.25	339.07	1027.43	117.06	0.18	284.2	4667.98	3236.49	131.98	351.85		1941.05	16.04	0			0.6				5.7	1.43	412.49	0									3400	"$0-$125/Day(Days 1-5): 1a. $125 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$125/Day(Days 1-5): 1b. $125 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20/Visit: 7b. $20 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											78.649644	64.644804	44.690621	0	100	0.2	0.094598	65	100	17.403562	46.443717	24.130659	0.2	46.474567	5	20	20	23.157937		0	0.2	0			0				0	0	0	0									NO	70.199369	57.699237	41.958773	0	94.3708	0.188742	0.089273	61.34102	94.3708	16.423881	43.829307	22.772296	0.188742	43.858421	4.71854	18.87416	18.87416	21.85433		0	0.188742	0			0				0	0	0	0										9.4015	0.499386896	0.813195986	0	1.773070047	1.8685458	0.178546	2.5228028	1.621998125	0.464070444	3.752628741	0.222143747	0.03397356	1.038713604	1.835504196	5.090502508	0.207584303	0.640787168	0	0	3.02742168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9924	0	NO	2.692974	9.4015	0.499386896	0.813195986	0	1.773070047	1.8685458	0.178546	2.5228028	1.621998125	0.464070444	3.752628741	0.222143747	0.03397356	1.038713604	1.835504196	5.090502508	0.207584303	0.640787168	0	0	3.02742168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9924	NO																																																																																		0	0	NO	0	9.4015	0.499386896	0.813195986	0	1.773070047	1.8685458	0.178546	2.5228028	1.621998125	0.464070444	3.752628741	0.222143747	0.03397356	1.038713604	1.835504196	5.090502508	0.207584303	0.640787168	0	0	3.02742168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9924
H4510_020_0	2012	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	1379.14	44.39	778.1	1725.61	234.98	15.44	3.7	351.73	235.79	323.09	786.07	87.89	0.58	653.94	3467.68	3593.63	95.13	525.16		2293.76	25.64	0		3.86	0.6				5.7	1.43	414.21	0.33									3400	"$0-$175/Day(Days 1-5): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-5): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN749: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											110.109501	90.502725	44.690621	0	100	0.2	0.096913	65	100	44.259299	63.022286	22.15412	0.2	42.225618	10	29.111043	30	37.616258		0	0.2	0		0	0				0	0	0	0									NO	92.481521	76.013691	36.647158	0	90.4335	0.180867	0.087642	58.781775	90.4335	40.025233	56.993259	20.034746	0.180867	38.186104	9.04335	26.326135	27.13005	34.017698		0	0.180867	0		0	0				0	0	0	0										10.6287	0.281187312	2.376262803	0	1.770838653	2.79258648	0.3242754	1.72294281	1.776942914	1.077646044	3.733390925	0.146737819	0.10490286	2.080951737	2.613286994	7.88386571	0.215073471	1.488727857	0	0	4.63742988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6558	0	NO	6.025338	10.6287	0.281187312	2.376262803	0	1.770838653	2.79258648	0.3242754	1.72294281	1.776942914	1.077646044	3.733390925	0.146737819	0.10490286	2.080951737	2.613286994	7.88386571	0.215073471	1.488727857	0	0	4.63742988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6558	NO																																																																																		0	0	NO	0	10.6287	0.281187312	2.376262803	0	1.770838653	2.79258648	0.3242754	1.72294281	1.776942914	1.077646044	3.733390925	0.146737819	0.10490286	2.080951737	2.613286994	7.88386571	0.215073471	1.488727857	0	0	4.63742988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6558
H4510_021_0	2012	3																															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	438.76	14.72	1213.48	4026.02	506.2	7136.38	11021.72	711.18	252.36	736.57	949.35	168.93	354.6	800.19	4344.4	3025.05	219.34	426.87		2292.32	2618	0	5.36	2.63	0.6				1.34	2.42											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 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											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																																																																		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
H4510_022_0	2012	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Surgery								Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	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	1165.6	76.19	306.66	2141	140.39	9.13	3.11	332.43	22.66	558.72	1005.99	46.79	0.38	304.38	4831.68	3240.73	36.53	459.54		3025.08	11.69	0			1.52				3.7	1.43	638.87	0.09	121.65								3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% 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,14a. $0 SMAM -- FSR,14a. $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"	"$20-$200/Visit: 5. $20 Partial Hospitalization,7h. $200 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$15-$200/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $200 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS734: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0-$150/Visit: 9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician"										94.379573	77.573765	44.690621	0	100	0.2	0.130904	65	0.2	79.737636	99.348063	43.463941	0.2	127.715429	0	29.843404	30	31.757332		0	0.2	0			0				0	0	0	0	150								NO	82.792026	68.049568	40.898354	0	90.8581	0.181716	0.118936	59.057765	0.181716	72.448101	90.265762	39.490511	0.181716	116.039812	0	27.11515	27.25743	28.854108		0	0.181716	0			0				0	0	0	0	136.28715									8.0419	0.432058049	1.045157436	0	1.062964055	1.65906708	0.36989096	1.636047735	4.11768456	3.373183583	7.567204493	0.153980084	0.06905208	2.943349831	0	7.322740005	0.08297616	1.104968066	0	0	2.12426004	0	0	0	0	0	0	0	0	0	0	0	1.381610983	0	0	0	0	0	0	0	44.4881	0	NO	4.801271	8.0419	0.432058049	1.045157436	0	1.062964055	1.65906708	0.36989096	1.636047735	4.11768456	3.373183583	7.567204493	0.153980084	0.06905208	2.943349831	0	7.322740005	0.08297616	1.104968066	0	0	2.12426004	0	0	0	0	0	0	0	0	0	0	0	1.381610983	0	0	0	0	0	0	0	44.4881	NO																																																																																		0	0	NO	0	8.0419	0.432058049	1.045157436	0	1.062964055	1.65906708	0.36989096	1.636047735	4.11768456	3.373183583	7.567204493	0.153980084	0.06905208	2.943349831	0	7.322740005	0.08297616	1.104968066	0	0	2.12426004	0	0	0	0	0	0	0	0	0	0	0	1.381610983	0	0	0	0	0	0	0	44.4881
H4510_023_0	2012	3																															A	A	D	V	T	O	O	V	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											0	YES	458.1	29.92	1255.94	4532.13	543.19	9604.58	14080.28	891.37	288.83	766.89	1156.1	326.86	57.47	990.72	4672.8	4029.52	320.96	709.17		2106.55	3128.77	0	7.98		0.6				0.58	1.43											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 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											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0		0				0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																																																																		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
H4510_024_0	2012	3																															A	A	D	V	T	O	O	V	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											0	YES	403.15	42.42	992.31	4738.04	512.47	5016.58	15253.63	845.48	389.95	362.44	2181.86	230.77	43.9	416.73	5635.85	5904.51	351.3	1444.86		2071.34	4319.66	0	5.36		2.45				1.34	1.43											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS122: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 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											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0		0				0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																																																																		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
H4510_027_0	2012	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	1177.04	37.89	664.07	1472.74	200.54	13.13	3.14	300.18	201.23	275.74	670.88	75.01	0.49	558.11	2959.52	3067.01	81.19	448.2		1957.62	21.8	0			0.6				3.7	1.43	353.51	0.28									4000	"$0-$200/Day(Days 1-6): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-6): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$175/Trip: 10a. $175 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 0% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$50/Visit: 5. $20 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											136.967682	116.805214	45.597948	0	175	0.2	0.096913	65	150	44.259299	63.022286	22.15412	0.2	42.225618	0	29.555522	30	37.616258		0	0.2	0			0				0	0	0	0									NO	120.367336	102.648539	40.773958	0	164.42475	0.187914	0.091057	61.07205	140.9355	41.58471	59.213849	20.815346	0.187914	39.673924	0	27.769481	28.1871	35.343107		0	0.187914	0			0				0	0	0	0										11.8064	0.324112762	2.256396857	0	2.747811614	2.46731082	0.28591898	1.527717331	2.363370889	0.955547328	3.310448918	0.130113259	0.09207786	1.845201144	0	7.09743966	0.190709221	1.320065046	0	0	4.0965252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8172	0	NO	3.768569	11.8064	0.324112762	2.256396857	0	2.747811614	2.46731082	0.28591898	1.527717331	2.363370889	0.955547328	3.310448918	0.130113259	0.09207786	1.845201144	0	7.09743966	0.190709221	1.320065046	0	0	4.0965252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8172	NO																																																																																		0	0	NO	0	11.8064	0.324112762	2.256396857	0	2.747811614	2.46731082	0.28591898	1.527717331	2.363370889	0.955547328	3.310448918	0.130113259	0.09207786	1.845201144	0	7.09743966	0.190709221	1.320065046	0	0	4.0965252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8172
H4510_801_0	2012	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	277.31	3.22	49.5	27.56	9.47	15.33	4.66	26.72	71.02	9.57	32.96	0.73	0.52	20.76	42.19	105.85	0.72	8.35		17.16	36.61	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																					0.0787	0.0787	0.1938	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064529	0.064529	0.138833	0	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396	0.196396		0.196396	0.196396	0																				17.8945	0.20778338	6.8722335	0	1.85987012	3.01075068	0.91520536	5.24770112	13.94804392	1.87950972	6.47321216	0.14336908	0.10212592	4.07718096	8.28594724	20.7885166	0.14140512	1.6399066	0	3.37015536	7.19005756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0475	0	NO	17.810115	17.8945	0.20778338	6.8722335	0	1.85987012	3.01075068	0.91520536	5.24770112	13.94804392	1.87950972	6.47321216	0.14336908	0.10212592	4.07718096	8.28594724	20.7885166	0.14140512	1.6399066	0	3.37015536	7.19005756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0475	NO																																																																																		0	0	NO	0	17.8945	0.20778338	6.8722335	0	1.85987012	3.01075068	0.91520536	5.24770112	13.94804392	1.87950972	6.47321216	0.14336908	0.10212592	4.07718096	8.28594724	20.7885166	0.14140512	1.6399066	0	3.37015536	7.19005756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0475
H4510_802_0	2012	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	277.31	3.22	49.5	27.56	9.47	15.33	4.66	26.72	71.02	9.57	32.96	0.73	0.52	20.76	42.19	105.85	0.72	8.35		17.16	36.61	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																					0.0824	0.0824	0.1929	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067204	0.067204	0.13769	0	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173		0.196173	0.196173	0																				18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516	0	NO	18.199525	18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516	NO																																																																																		0	0	NO	0	18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516
H4510_803_0	2012	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	277.31	3.22	49.5	27.56	9.47	15.33	4.66	26.72	71.02	9.57	32.96	0.73	0.52	20.76	42.19	105.85	0.72	8.35		17.16	36.61	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																					0.0824	0.0824	0.1929	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067204	0.067204	0.13769	0	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173	0.196173		0.196173	0.196173	0																				18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516	0	NO	18.199525	18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516	NO																																																																																		0	0	NO	0	18.6363	0.21639688	6.815655	0	1.85775831	3.00733209	0.91416618	5.24174256	13.93220646	1.87737561	6.46586208	0.14320629	0.10200996	4.07255148	8.27653887	20.76491205	0.14124456	1.63804455	0	3.36632868	7.18189353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.6516
H4513_001_0	2012	7																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	V	V	Coin																																																												0	YES	230.2222313	37.35365452	308.8257641	0	280.064264	5.439915812	3.696288275	402.6597222	204.4279801	0	613.3778396	6.384078005	10.70098138	425.9587922	0	3347.280433	1.168179992	238.8651201	0	0	38.66344529																				3400	1a. $300 per admit	"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, 10% Coinsurance on DME"	"11b, c. 10% Coinsurance on Prosthetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	4a-b. $50 per ER visit; $25 per urgent care visit	9a-b. $250 Amb. Surg and 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"	"5, 9c. $30 copay for OP Behavioral Health visits"	12. $30 copay	"3, 9a, $30 for OP Rehab & $0 for Observation"	7a. $0 copay	"7b, 7d, 7f, 7g. $30 copay; $20 copay for chiropractic services"	"7e, 7h. 20% Coinsurance"	"7c, 7i.  $30 copay"	$0 copay for Radiology professional component	0	15. 15% Coinsurance; $0 for certain Immunizations																						300	150	25	0	50	0.1	0.1	48.84119427	250	0	76.72320596	30	30	29.94280264	0	29.97770763	0.2	30	0	0	0.15																				NO	293.8255919	146.912796	24.48546599	0	48.97093198	0.097941864	0.097941864	47.83597605	244.8546599	0	75.14413801	29.38255919	29.38255919	29.32653903	0	29.36072563	0.195883728	29.38255919	0	0	0.146912796																					5.6371	0.457310819	0.630145229	0	1.142917335	0.532795494	0.362021363	1.605135069	4.171261961	0	3.840979086	0.015631712	0.026201852	1.040991428	0	8.189881866	0.228827452	0.584872378	0	0	5.680154849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1462			0.717543819	5.6371	0.457310819	0.630145229	0	1.142917335	0.532795494	0.362021363	1.605135069	4.171261961	0	3.840979086	0.015631712	0.026201852	1.040991428	0	8.189881866	0.228827452	0.584872378	0	0	5.680154849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1462	NO																																																																																		0				5.6371	0.457310819	0.630145229	0	1.142917335	0.532795494	0.362021363	1.605135069	4.171261961	0	3.840979086	0.015631712	0.026201852	1.040991428	0	8.189881866	0.228827452	0.584872378	0	0	5.680154849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1462
H4513_009_0	2012	5																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	V	V	Coin																																																												0	YES	203.6864255	7.114058188	225.1695931	0	190.3506644	2.824831728	4.607619848	257.8047935	206.5332398	0	292.4873825	0	0	321.5241247	3137.825265	2302.132249	0.495786437	85.18277536	0	0	25.40911152																				3400	1a. $500 per admit	"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, 10% Coinsurance on DME"	"11b, c. 10% Coinsurance on Prosthetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	4a-b. $50 per ER visit; $25 per urgent care visit	9a-b. $250 Amb. Surg and 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"	"5, 9c. $35 copay for OP Behavioral Health visits"	12. $30 copay	"3, 9a, $35 for OP Rehab & $0 for Observation"	7a. $15 copay	"7b, 7d, 7f, 7g. $35 copay; $20 copay for chiropractic services"	"7e, 7h. 20% Coinsurance"	"7c, 7i.  $35 copay"	$0 copay for Radiology professional component		15. 15% Coinsurance; $0 cost share for certain immunizations																						500	150	25	0	50	0.1	0.1	48.83542515	250	0	87.34736692	35	30	28.70221106	15	35	0.2	35	0		0.15																				NO	490.7292571	147.2187771	24.53646286	0	49.07292571	0.098145851	0.098145851	47.92994381	245.3646286	0	85.72781696	34.351048	29.44375543	28.17002942	14.72187771	34.351048	0.196291703	34.351048	0	0	0.147218777																					8.3296	0.087276912	0.460405447	0	0.778422001	0.277245515	0.452218773	1.029714105	4.222995972	0	2.089525399	0	0	0.754778671	3.849556653	6.590054614	0.097318764	0.243843134	0	0	3.740698326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0036			0.623496863	8.3296	0.087276912	0.460405447	0	0.778422001	0.277245515	0.452218773	1.029714105	4.222995972	0	2.089525399	0	0	0.754778671	3.849556653	6.590054614	0.097318764	0.243843134	0	0	3.740698326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0036	NO																																																																																		0				8.3296	0.087276912	0.460405447	0	0.778422001	0.277245515	0.452218773	1.029714105	4.222995972	0	2.089525399	0	0	0.754778671	3.849556653	6.590054614	0.097318764	0.243843134	0	0	3.740698326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0036
H4513_010_0	2012	6																																																						P																																																									0	YES																								1192.749853																	0																								16 a-b. $0-195 copay for select dental services																																										9.96017729																	NO																								9.96017729																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.99
H4513_802_0	2012	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	YES	249.8234594	0.794689346	15.03434187	0	8.470830704	8.151171171	5.619455696	17.1416376	43.83398516	0	48.36030098	0	1.072109294	2.437409386	77.57744684	187.9701731	0.974866159	6.599942755	45.73580195	0	49.01319241	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																						0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											NO	0.064182411	0.064182411	0.165040486	0	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0	0	0	0	0	0	0	0	0												16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633			11.29691551	16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633	NO																																																																																		0				16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633
H4513_804_0	2012	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	YES	249.8234594	0.794689346	15.03434187	0	8.470830704	8.151171171	5.619455696	17.1416376	43.83398516	0	48.36030098	0	1.072109294	2.437409386	77.57744684	187.9701731	0.974866159	6.599942755	45.73580195	0	49.01319241	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	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing													0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											NO	0.064182411	0.064182411	0.165040486	0	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0.210885065	0	0	0	0	0	0	0	0	0												16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633			11.29691551	16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633	NO																																																																																		0				16.0343	0.051005078	2.481275082	0	1.786371683	1.718960262	1.185059279	3.614915358	9.243932807	0	10.19846521	0	0.226091838	0.514013237	16.35992491	39.64010217	0.205584713	1.391829356	9.644997565	0	10.33615026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.633
H4514_001_0	2012	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	3426.935059	355.7229632	937.9790507	1969.418107	804.5472743	23.77531519	20.54819256	1587.724995	648.5824055	16740.05391	7771.153421	0	0.529131209	1999.059276	7110.737328	6683.918818	1205.256688	668.1472452	0	2284.907717	27.28256791	1624.640971	701.7391304	963.9	51.74320096	250.1481984	7.633262604	1.98	187.2772043	8808.217485											2500	"$125 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-14 (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); $0/20% (11c)"	"$65 (4a, 4a1); $0 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9a, 9c); $30 (5)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	116.889516	83.47969434	0	0	50	0.2	0.105270147	64.63660082	0	0	0	0	0.2	0.020494741	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	91.16755218	65.10968347	0	0	38.99731784	0.155989271	0.082105067	50.42218684	0	0	0	0	0.155989271	0.015984798	0	0	0	0	0	0	0.155989271	0	0	0	0	0	0	0	0	0												26.0354	1.930084128	0	0	2.614598815	3.708694093	1.687110736	6.671380527	0	0	0	0	0.082538792	0.00266288	0	0	0	0	0	0	4.255787889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9883	0	NO	13.25570829	26.0354	1.930084128	0	0	2.614598815	3.708694093	1.687110736	6.671380527	0	0	0	0	0.082538792	0.00266288	0	0	0	0	0	0	4.255787889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9883	NO																																										0	0	0	0	0	0	0	0	0	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	26.0354	1.930084128	0	0	2.614598815	3.708694093	1.687110736	6.671380527	0	0	0	0	0.082538792	0.00266288	0	0	0	0	0	0	4.255787889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9883
H4514_007_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1594.010437	81.62719373	557.7361758	905.7640867	136.6543432	9.278675247	12.6832774	393.7712123	274.9163845	18.59089697	40.16323799	0	0.049118736	460.2487211	5253.884252	3880.534323	444.8556406	397.5678766	0	0	20.71289438	682.5396682	0	0	33.66536518	0	5.487080835	0	90.64910042	0											3400	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-38 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$150 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $150 (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$5/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	163.8672982	106.6104145	71.83713649	0	200	0.2	0.11625498	64.54068241	61.5	0.198971534	0.181231187	0	0.2	53.29876352	3.594089542	29.93417907	38.5	30	0	0	0.2	29.51147406	0	0	30	0	30	0	0	0											NO	124.8215678	81.20765545	54.72003327	0	152.3446951	0.152344695	0.088554148	49.18347885	46.84599373	0.151561288	0.13804805	0	0.152344695	40.59891938	3.448001461	28.71771461	36.93509989	28.78059732	0	0	0.152344695	22.47958258	0	0	30	0	30	0	0	0												16.5806	0.552396085	2.543278508	0	1.734880353	1.413556951	1.12315682	1.613919841	1.073227602	2.817660295	5.544456678	0	0.007482979	1.557133394	1.509616715	9.286673102	1.369232294	0.95352008	0	0	3.155499579	1.27860057	0	0	0.084163413	0	0.013717702	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2127	0	NO	13.37883284	16.5806	0.552396085	2.543278508	0	1.734880353	1.413556951	1.12315682	1.613919841	1.073227602	2.817660295	5.544456678	0	0.007482979	1.557133394	1.509616715	9.286673102	1.369232294	0.95352008	0	0	3.155499579	1.27860057	0	0	0.084163413	0	0.013717702	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2127	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)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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)"	"$0 (9d, 9d1); 30% (14a10, 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)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												2.0459	0.0337	0.2819	0.3777	0.2815	0	0.4703	0.2618	1.5099	0.4572	1.2141	0	0.0012	0.9398	1.2251	3.7344	0.1156	0.1746	0	0	0.8877	0.2779	0	0	0	0	0.0007	0	0	0											14.2909	0	NO	0	18.6264	0.586099585	2.825138204	0.377665445	2.016378064	1.413556951	1.593435645	1.875677229	2.583139021	3.274847397	6.758534878	0	0.00869715	2.496916253	2.734720482	13.02109707	1.484784794	1.128152905	0	0	4.043195053	1.556548105	0	0	0.084163413	0	0.014466281	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5036
H4514_801_0	2012	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	273.7768149	4.1484	20.51423572	1051.545752	6.583910234	9.425678675	14.47665218	23.87478271	58.09974126	21.21959023	45.84219116	0	0.056063968	39.72550228	36.48273892	101.159946	1.9538	4.730654883	0	0	24.04691639	7.586108	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.072867755	0.072867755	0.187572781	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059727019	0.059727019	0.153746511	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0	0.183604563	0.183604563	0	0	0	0	0	0	0	0												16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	150	YES	20.31293506	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	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	NO	0	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326
H4514_803_0	2012	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	273.7768149	4.1484	20.51423572	1051.545752	6.583910234	9.425678675	14.47665218	23.87478271	58.09974126	21.21959023	45.84219116	0	0.056063968	39.72550228	36.48273892	101.159946	1.9538	4.730654883	0	0	24.04691639	7.586108	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.072867755	0.072867755	0.187572781	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059727019	0.059727019	0.153746511	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0	0.183604563	0.183604563	0	0	0	0	0	0	0	0												16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	150	YES	20.31293506	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	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	NO	0	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326
H4514_806_0	2012	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	273.7768149	4.1484	20.51423572	1051.545752	6.583910234	9.425678675	14.47665218	23.87478271	58.09974126	21.21959023	45.84219116	0	0.056063968	39.72550228	36.48273892	101.159946	1.9538	4.730654883	0	0	24.04691639	7.586108	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.072867755	0.072867755	0.187572781	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059727019	0.059727019	0.153746511	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0.183604563	0	0	0.183604563	0.183604563	0	0	0	0	0	0	0	0												16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	150	YES	20.31293506	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326	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	NO	0	16.3519	0.247771566	3.153992173	0	1.208835961	1.730597614	2.657979398	4.383519046	10.6673776	3.896013591	8.416835474	0	0.0102936	7.293783487	6.698397337	18.57342767	0.358726595	0.868569822	0	0	4.415123575	1.392844044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.326
H4520_006_0	2012	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			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	1554.94	59.13	363.71	2003.46	28	13.97	5.65	361.63	347.38	855.56	1312.73	200.38	0.23	394.05	3274.85	4937.99	133.4	587.69		1537.85	31.52	0			0.61				3.7	1.43	1177.85	1.02									3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$40-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											163.989133	144.00749	44.690621	0	100	0.2	0.2	65	126.013321	40.382309	82.961662	43.435685	0.2	93.131883	15	38.597542	40	53.368246		0	0.2	0			0				0	0	0	0									NO	104.571442	91.829688	27.538182	0	82.6955	0.165391	0.165391	53.752075	104.207346	33.394352	68.605562	35.919357	0.165391	77.015876	12.404325	31.91843	33.0782	44.133138		0	0.165391	0			0				0	0	0	0										13.5502	0.452490788	0.834659348	0	0.192956167	2.31051227	0.93445915	1.619863574	3.016628988	2.380905983	7.505048284	0.599793396	0.03803993	2.529008828	3.385191977	13.13440735	0.367719323	2.161383656	0	0	5.21312432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2264	0	NO	17.974396	13.5502	0.452490788	0.834659348	0	0.192956167	2.31051227	0.93445915	1.619863574	3.016628988	2.380905983	7.505048284	0.599793396	0.03803993	2.529008828	3.385191977	13.13440735	0.367719323	2.161383656	0	0	5.21312432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2264	YES	$0-$240/Day(Days 1-7)	$0-$240/Day(Days 1-7)	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									5000	2.022	0.0675	0.3127	2.9632	1.6721	0.9598	0.3885	0.2004	2.1755	0.2361	0.9763	0.0559	0.0048	0.5806	1.3116	3.1132	0.0377	0.1871		0.2796	1.0567	0							0	0	0.1192	0									18.7206	500	NO	5.164738	15.5722	0.520007788	1.147319348	2.963156	1.865049167	3.27036027	1.32294115	1.820301574	5.192177988	2.617014983	8.481304284	0.655739396	0.04283693	3.109642828	4.696774977	16.24757935	0.405447323	2.348497656	0	0.2796	6.26983932	0	0	0	0	0	0	0	0	0	0.11921	0	0	0	0	0	0	0	0	0	78.947
H4522_001_0	2012	4																															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	1327.615198	81.48011788	280.7774353	1286.669323	110.803068	10.00815583	10.97325978	338.0182677	49.15841178	15.33203326	29.2856791	0	0.015888523	20.01659612	4940.310041	3337.232677	440.7955593	611.0155762	0	0	11.39135136	657.8648785	0	0	39.15348837	0	11.13458051	10.659	548.1943989	0											4200	"$220 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	172.1507685	99.48175821	64.23774152	0	200	0.2	0.099747139	64.82602501	0.16	0.201149198	0.1854227	0	0.2	0.145996157	10.77220588	34.28371805	38.5	35	0	0	0.2	34.61574071	0	0	35	0	35	0	0	0											NO	138.5210949	80.04798459	51.68889087	0	160.9299756	0.160929976	0.080261523	52.18258439	0.12874398	0.161854678	0.149200353	0	0.160929976	0.11747579	10.41325487	33.14150369	37.21710455	33.83373141	0	0	0.160929976	27.85355153	0	0	35	0	35	0	0	0												15.3252	0.543526602	1.209422851	0	1.485961252	1.610612274	0.880730545	1.469888899	6.328849606	2.4815613	4.36943365	0	0.00255694	2.351465448	4.287058967	9.216742423	1.367094535	1.722744741	0	0	1.833209896	1.526989441	0	0	0.114197674	0	0.03247586	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1597	0	NO	10.62689468	15.3252	0.543526602	1.209422851	0	1.485961252	1.610612274	0.880730545	1.469888899	6.328849606	2.4815613	4.36943365	0	0.00255694	2.351465448	4.287058967	9.216742423	1.367094535	1.722744741	0	0	1.833209896	1.526989441	0	0	0.114197674	0	0.03247586	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1597	YES	"$375 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-36 (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $15 (8a2)	"$21 (8b1); 40% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 40% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 40% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 40% (14a10); $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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											6200	0.3093	0.0158	0.1532	0.4361	0.1033	0.2799	0.1841	0.1022	0.8799	0.1725	0.564	0	0.0002	0.326	0.7164	1.1099	0.1435	0.2058	0	0	0.2554	0.182	0	0	0.0136	0	0.0034	0	0	0											6.1567	0	NO	1.03687046	15.6345	0.559313622	1.362582324	0.436128599	1.589263371	1.890531519	1.064877953	1.572073688	7.20879661	2.654076256	4.93342726	0	0.002734695	2.677492466	5.003470911	10.32667578	1.510585615	1.928505823	0	0	2.088657177	1.709026643	0	0	0.127837209	0	0.035872524	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3165
H4522_007_0	2012	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	269.9194106	4.15545	14.62786864	2397.951512	9.64024297	20.79418906	18.81661549	27.72850669	54.65359956	22.51758607	35.80501882	0	0	30.60375051	33.97108285	78.88801626	1.8777045	4.669987132	0	111.2961956	16.92089156	10.28542474	0	915.705	38.62716279	199.4848	0	0	173.7284054	3073.979688											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.079784256	0.080753296	0.212931996	0	0.224	0.224	0.224	0.130652899	0.224	0.224	0.224	0	0	0.224	0.221983028	0.223914514	0.240447237	0.224	0	0	0.224	0.219627568	0	0	0	0	0	0	0	0											NO	0.068585884	0.06941891	0.183045249	0	0.192559769	0.192559769	0.192559769	0.112329866	0.192559769	0.192559769	0.192559769	0	0	0.192559769	0.189653055	0.191303236	0.205428106	0.191376272	0	0	0.192559769	0.191358154	0	0	0	0	0	0	0	0												18.5127	0.288466811	2.677561861	0	1.856322957	4.004124236	3.623323127	3.114739448	10.52408449	4.335981165	6.894606144	0	0	5.893051121	6.442719648	15.09153282	0.38573328	0.893724729	0	0	3.258282965	1.968199891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7651	150	YES	14.78944945	18.5127	0.288466811	2.677561861	0	1.856322957	4.004124236	3.623323127	3.114739448	10.52408449	4.335981165	6.894606144	0	0	5.893051121	6.442719648	15.09153282	0.38573328	0.893724729	0	0	3.258282965	1.968199891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7651	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.7635	0.0275	0.077	0.6141	0.1485	0.3203	0.2827	0.1638	0.6935	0	0.4607	0	0	0.3594	1.1302	2.9817	0.071	0.1765	0	0	0.6435	0.3873	0	0	0.0275	0	0	0	0	0											10.3286	150	YES	1.705050513	20.2761	0.315945262	2.75454999	0.61408544	2.004814503	4.32442335	3.905993224	3.278577336	11.21756438	4.335981165	7.355279583	0	0	6.252434716	7.572962301	18.07321052	0.456702772	1.070231	0	0	3.901777944	2.355548907	0	0	0.02751858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0937
H4522_010_0	2012	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	260.724317	4.1485275	48.11809346	1617.496158	17.5695578	19.31224877	21.77913364	32.67843419	50.12938735	18.95387636	25.50414721	0	0	31.82852223	31.05813917	63.46732081	1.8706245	7.835060332	0	0	10.49145998	5.158218514	0	915.705	38.62716279	104.9104	0	0	81.19209852	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.078244402	0.079194739	0.17546729	0	0.224	0.224	0.224	0.125371438	0.224	0.224	0.224	0	0	0.224	0.220528305	0.223860596	0.237602731	0.224	0	0	0.224	0.223498028	0	0	0	0	0	0	0	0											NO	0.065820699	0.066620141	0.147606465	0	0.188433116	0.188433116	0.188433116	0.105478816	0.188433116	0.188433116	0.188433116	0	0	0.188433116	0.184267159	0.187051526	0.198534062	0.187168008	0	0	0.188433116	0.188342946	0	0	0	0	0	0	0	0												17.1611	0.276375485	7.102541688	0	3.310686528	3.639067218	4.103910021	3.446882556	9.446036675	3.571537988	4.805825937	0	0	5.997547631	5.72299506	11.87165918	0.37138268	1.466472633	0	0	1.976938499	0.971514069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2424	150	YES	16.24313139	17.1611	0.276375485	7.102541688	0	3.310686528	3.639067218	4.103910021	3.446882556	9.446036675	3.571537988	4.805825937	0	0	5.997547631	5.72299506	11.87165918	0.37138268	1.466472633	0	0	1.976938499	0.971514069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2424	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.6669	0.0268	0.2478	0.2389	0.2626	0.2887	0.3126	0.1813	0.6161	0	0.3163	0	0	0.3618	1.0197	2.3265	0.0686	0.2872	0	0	0.3872	0.1898	0	0	0.0275	0	0	0	0	0											8.8263	150	YES	1.686106097	18.8279	0.303220264	7.350365366	0.238939994	3.57330326	3.927732404	4.416559086	3.628213254	10.0621658	3.571537988	5.122076654	0	0	6.359320582	6.74264765	14.19820411	0.439952141	1.753673975	0	0	2.364112032	1.161280318	0	0	0.02751858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0688
H4523_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1421.377987	97.13663462	806.1379042	1384.151422	167.2563491	14.68399055	0	354.4586522	369.6875337	2919.69564	2610.847385	49.14577819	0.007359545	371.5244402	3779.586723	4685.276738	268.209762	847.6539955	0	0	42.67199229	0.000637603	0	0	923.3054618	112.794615	69.81836873	3.048503109	41.10900665	0											3400	$100/day 1-5; unlimited additional days	$100/day 1-5	"$0/d 1-20, $130/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$0 to $20 per visit	$0 to $20 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$20 per visit	20% per visit	$0 to 100 per visit	$0 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	61.28387407	38.74210874	52.43074037	0	150	0.03	0.03	61	100	2	8.264969718	20	0.2	20	0	20	20	10	20	20	0.1	0	0	0	0	0	0	0	0	0											NO	52.28022885	33.0502329	44.72777132	0	127.9624444	0.025592489	0	52.03806071	85.30829625	1.706165925	7.050704853	17.06165925	0.170616593	17.06165925	0	17.06165925	17.06165925	8.530829625	0	0	0.085308296	0	0	0	0	0	0	0	0	0												6.1925	0.267532366	3.004729319	0	1.783544272	0.375799865	0	1.537111739	2.628117804	0.415123768	1.534026194	0.06987571	0.001255661	0.528235283	0	6.661549601	0.381341964	0.602599318	0	0	3.64027496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6236	0	NO	5.728671637	6.1925	0.267532366	3.004729319	0	1.783544272	0.375799865	0	1.537111739	2.628117804	0.415123768	1.534026194	0.06987571	0.001255661	0.528235283	0	6.661549601	0.381341964	0.602599318	0	0	3.64027496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6236	NO																																																																																		0		NO		6.1925	0.267532366	3.004729319	0	1.783544272	0.375799865	0	1.537111739	2.628117804	0.415123768	1.534026194	0.06987571	0.001255661	0.528235283	0	6.661549601	0.381341964	0.602599318	0	0	3.64027496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6236
H4523_005_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1439.362702	82.40718219	734.2281634	1102.619141	183.3680598	14.6168529	0	440.9638632	419.0608198	3044.902478	2429.743996	95.56656658	0.018286937	363.3652816	3680.374445	5239.547586	289.0304178	782.6924467	0	0	49.84388745	0.001417472	0	0	965.7205639	82.06767093	44.3882668	6.618360559	46.59373839	0											3400	$100/day 1-5; unlimited additional days	$100/day 1-5	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $25 Urgent Care Ctr	$75 per procedure	$0 to $20 per visit	$0 to $20 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$20 per visit	20% per visit	$0 to 75 per visit	$0 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	20% per script		Not Covered		$0 per visit	$200.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	61.28387407	38.74210874	40.33133874	0	100	0.03	0.03	61	75	2	8.264969718	20	0.2	20	0	20	20	10	20	20	0.1	0	0	0	0	0	0	0	0	0											NO	53.38659669	33.74965056	35.13408622	0	87.11361268	0.026134084	0	53.13930373	65.33520951	1.742272254	7.199913709	17.42272254	0.174227225	17.42272254	0	17.42272254	17.42272254	8.711361268	0	0	0.087113613	0	0	0	0	0	0	0	0	0												6.4036	0.2317678	2.149702966	0	1.331154512	0.381998059	0	1.952709389	2.281618872	0.442087425	1.457828925	0.138752481	0.003186082	0.527567707	0	7.607265317	0.419641398	0.568193055	0	0	4.342081106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2391	0	NO	5.11546505	6.4036	0.2317678	2.149702966	0	1.331154512	0.381998059	0	1.952709389	2.281618872	0.442087425	1.457828925	0.138752481	0.003186082	0.527567707	0	7.607265317	0.419641398	0.568193055	0	0	4.342081106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2391	NO																																																																																		0		NO		6.4036	0.2317678	2.149702966	0	1.331154512	0.381998059	0	1.952709389	2.281618872	0.442087425	1.457828925	0.138752481	0.003186082	0.527567707	0	7.607265317	0.419641398	0.568193055	0	0	4.342081106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2391
H4523_015_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1810.08501	112.3479044	727.9160655	823.8787021	197.2014467	16.90682474	0	313.5434844	374.5636845	4039.477448	3036.846234	23.46599743	0.019162521	431.4613257	3769.15693	6022.368498	219.5030811	740.4401807	0	0	49.71053435	0.001563491	0	0	998.5619315	96.19890055	37.14116862	6.655269849	47.78750583	0											3400	$175/day 1-5; unlimited additional days	$175/day 1-5	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $25 Urgent Care Ctr	$175 per procedure	$0 to $25 per visit	$0 to $25 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$25 per visit	20% per visit	$0 to 175 per visit	$5 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	107.2467796	67.7986903	58.48044118	0	150	0.03	0.03	61	175	2.5	10.32683076	25	0.2	25	5	25	25	12.5	25	25	0.1	0	0	0	0	0	0	0	0	0											NO	90.95240651	57.49780145	49.59530606	0	127.2099827	0.025441997	0	51.73205962	148.4116464	2.120166378	8.757839745	21.20166378	0.16961331	21.20166378	4.240332756	21.20166378	21.20166378	10.60083189	0	0	0.084806655	0	0	0	0	0	0	0	0	0												13.7193	0.538313125	3.008435004	0	2.090499385	0.430143376	0	1.351687519	4.63246776	0.713697022	2.216351054	0.041459849	0.003250219	0.762308163	1.331873299	10.64035267	0.38781921	0.654106823	0	0	4.215784142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7378	0	NO	9.128482892	13.7193	0.538313125	3.008435004	0	2.090499385	0.430143376	0	1.351687519	4.63246776	0.713697022	2.216351054	0.041459849	0.003250219	0.762308163	1.331873299	10.64035267	0.38781921	0.654106823	0	0	4.215784142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7378	NO																																																																																		0		NO		13.7193	0.538313125	3.008435004	0	2.090499385	0.430143376	0	1.351687519	4.63246776	0.713697022	2.216351054	0.041459849	0.003250219	0.762308163	1.331873299	10.64035267	0.38781921	0.654106823	0	0	4.215784142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7378
H4523_801_0	2012	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	0	0	0	0	0	0	0											0	YES	302.6912329	5.183375236	36.45258696	8.993524836	8.98217035	13.70454665	0	16.92135819	40.56964306	20.78314911	54.60196758	0.818479915	0.071481359	27.0033611	32.12317966	141.5792607	2.979394945	8.847433363	0	0	63.15331827	0.000315606	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	NO	0.076088767	0.076088767	0.189364201	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062121943	0.062121943	0.154604583	0	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0.182882648	0	0	0	0	0	0	0	0												18.8038	0.322001342	5.635737001	0	1.6426831	2.506323783	0	3.094622796	7.419483759	3.800877347	9.985752426	0.149685774	0.0130727	4.938446188	5.874772163	25.89239013	0.544879638	1.618042043	0	0	11.54964609	5.77E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7922	0	NO	23.33552231	18.8038	0.322001342	5.635737001	0	1.6426831	2.506323783	0	3.094622796	7.419483759	3.800877347	9.985752426	0.149685774	0.0130727	4.938446188	5.874772163	25.89239013	0.544879638	1.618042043	0	0	11.54964609	5.77E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7922	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.8038	0.322001342	5.635737001	0	1.6426831	2.506323783	0	3.094622796	7.419483759	3.800877347	9.985752426	0.149685774	0.0130727	4.938446188	5.874772163	25.89239013	0.544879638	1.618042043	0	0	11.54964609	5.77E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7922
H4523_802_0	2012	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	0	0	0	0	0	0	0											0	YES	242.3528861	1.568491331	27.08734923	7.004245573	6.181594602	15.12826291	0	17.49463617	32.8224023	18.72327936	48.82796923	0.344689333	0.020335837	21.86934964	40.5106446	115.1343371	1.549062975	9.90140169	0	0	45.98762835	8.98E-05	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	NO	0.077309678	0.077309678	0.190311994	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063419941	0.063419941	0.156119851	0	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0.183755348	0	0	0	0	0	0	0	0												15.37	0.099473627	4.22887293	0	1.135901065	2.77989921	0	3.21473295	6.031291943	3.440502706	8.972400456	0.063338508	0.003736819	4.018609943	7.444047579	21.15655013	0.284648605	1.819435509	0	0	8.450472631	1.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5139	0	NO	19.38562698	15.37	0.099473627	4.22887293	0	1.135901065	2.77989921	0	3.21473295	6.031291943	3.440502706	8.972400456	0.063338508	0.003736819	4.018609943	7.444047579	21.15655013	0.284648605	1.819435509	0	0	8.450472631	1.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5139	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.37	0.099473627	4.22887293	0	1.135901065	2.77989921	0	3.21473295	6.031291943	3.440502706	8.972400456	0.063338508	0.003736819	4.018609943	7.444047579	21.15655013	0.284648605	1.819435509	0	0	8.450472631	1.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5139
H4524_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1064.659765	109.6808894	645.4058347	1013.294252	171.427173	14.93401678	0	296.9834024	317.3081282	3245.842873	2198.072292	43.07355757	0.019650484	403.4068816	2263.102132	4626.051705	344.641982	966.7664685	0	0	46.33048232	0.001771062	0	0	1011.71809	42.1159275	57.92462837	8.537012332	43.76512953	0											5000	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 175 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	144.5710156	96.15686456	80.00481221	0	150	0.03	0.03	62	175	4	16.51241388	40	0.2	40	15	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	119.872672	79.72953806	66.33688348	0	124.3741751	0.024874835	0	51.40799237	145.1032043	3.316644669	13.69145237	33.16644669	0.165832233	33.16644669	12.43741751	33.16644669	33.16644669	16.58322335	0	0	0.082916117	0	0	0	0	0	0	0	0	0												10.6353	0.728733887	3.567850971	0	1.776759436	0.371481204	0	1.272276707	3.836868845	0.897108955	2.507900173	0.119049738	0.003258684	1.114964403	2.345595506	12.78580811	0.952545827	1.336008689	0	0	3.84154368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0931	0	NO	10.70050876	10.6353	0.728733887	3.567850971	0	1.776759436	0.371481204	0	1.272276707	3.836868845	0.897108955	2.507900173	0.119049738	0.003258684	1.114964403	2.345595506	12.78580811	0.952545827	1.336008689	0	0	3.84154368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0931	YES	$250/d 1-7 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$150 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$65 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 20% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP		Not Covered	0	$500 ded; 25% coinsurance; $7500 max OOP	$100.00 Every 2 Years	$500 ded; 25% coinsurance; $7500 max OOP	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											7500	1.5393	0.2631	0.9114	0.5699	0.3259	0.6024	0	0.4099	1.1283	0.8435	2.3331	0.0379	0.0007	0.7458	1.1729	4.0643	0.1636	0.4399	0	0	1.8687	0	0	0	0.2738	0.0028	0.0145	0	0	0											17.7116	500	NO	4.844957908	12.1746	0.991853958	4.479228977	0.569927179	2.102621043	0.973847968	0	1.6821677	4.965189419	1.740591104	4.840956369	0.156970278	0.003922312	1.860801407	3.51852748	16.8501195	1.116180107	1.775876889	0	0	5.710293606	0	0	0	0.273755233	0.002767071	0.014453252	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8046
H4524_007_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1322.718156	217.5215859	726.3423212	949.5366907	163.8979325	14.96344044	0	341.275888	306.7978162	3437.861264	2364.400341	38.82202975	0.022158704	486.7412427	2428.589586	5047.26498	492.5839803	822.1888152	0	0	57.27074182	0.001804393	0	0	938.8061855	46.36129764	36.1296295	3.909988958	44.11654221	0											5000	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 175 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$75.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	144.5710156	96.15686456	80.00481221	0	100	0.03	0.03	62	175	4	16.51241388	40	0.2	40	15	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	120.2072115	79.95204646	66.52201579	0	83.14751819	0.024944255	0	51.55146128	145.5081568	3.325900728	13.72966233	33.25900728	0.166295036	33.25900728	12.47212773	33.25900728	33.25900728	16.62950364	0	0	0.083147518	0	0	0	0	0	0	0	0	0												13.25	1.449274662	4.026479613	0	1.135642194	0.373251881	0	1.466105894	3.720132063	0.952832107	2.705201525	0.107598514	0.003684882	1.349044211	2.52413996	13.98891856	1.365237849	1.139382658	0	0	4.761920048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3189	0	NO	11.97459568	13.25	1.449274662	4.026479613	0	1.135642194	0.373251881	0	1.466105894	3.720132063	0.952832107	2.705201525	0.107598514	0.003684882	1.349044211	2.52413996	13.98891856	1.365237849	1.139382658	0	0	4.761920048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3189	YES	$250/d 1-7 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$100 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$65 copay	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 20% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP	$500 ded; 25% coinsurance; $7500 max OOP		Not Covered	0	$500 ded; 25% coinsurance; $7500 max OOP	$75.00 Every 2 Years	$500 ded; 25% coinsurance; $7500 max OOP	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											7500	1.7304	0.4706	1.0693	0.4438	0.22	0.5914	0	0.3614	1.1114	0.9206	1.9388	0.0461	0.0007	0.7418	1.3251	4.5887	0.2424	0.3292	0	0	2.2635	0	0	0	0.2499	0.0039	0.0077	0	0	0											18.6568	500	NO	5.194383865	14.9804	1.919885308	5.095779071	0.443845082	1.355644275	0.964658537	0	1.827547392	4.831490794	1.873391833	4.643996587	0.153664526	0.00441523	2.090879853	3.849288932	18.57756873	1.607674505	1.468533259	0	0	7.025456837	0	0	0	0.249924172	0.003865743	0.00771416	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9757
H4524_013_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1520.110665	146.3836044	547.3568213	841.8156345	146.1177233	14.91434768	0	323.4670801	320.4356597	4050.013004	2533.557136	35.54688177	0.016058889	694.1166349	2645.920003	5517.910789	295.2560462	936.4648701	0	0	85.27041464	0.001245995	0	0	980.1764575	84.2029637	41.05416878	4.158171047	38.8856471	0											3400	$225/day 1-7; unlimited additional days	$225/day 1-7	"$0/d 1-4, $50/d 5-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$100.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	162.6423925	108.1764726	80.00481221	0	150	0.03	0.03	62	200	4	16.51241388	40	0.2	40	10	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	129.0002104	85.80043314	63.45601196	0	118.9728659	0.023794573	0	49.17545123	158.6304879	3.172609757	13.09686135	31.72609757	0.158630488	31.72609757	7.931524393	31.72609757	31.72609757	15.86304879	0	0	0.079315244	0	0	0	0	0	0	0	0	0												16.3412	1.046648055	2.894423416	0	1.448670358	0.354880537	0	1.325553302	4.235905419	1.070759231	2.76513721	0.09398032	0.002547429	1.83513434	1.748848254	14.58848134	0.780610177	1.237932327	0	0	6.763243737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.534	0	NO	17.02897082	16.3412	1.046648055	2.894423416	0	1.448670358	0.354880537	0	1.325553302	4.235905419	1.070759231	2.76513721	0.09398032	0.002547429	1.83513434	1.748848254	14.58848134	0.780610177	1.237932327	0	0	6.763243737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.534	YES	$250/day 1-7 copay	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$150 copay	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$65 copay	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP	$500 ded; 25% coinsurance; $5000 max OOP		Not Covered	0	$500 ded; 25% coinsurance; $5000 max OOP	$100.00 Every 2 Years	$500 ded; 25% coinsurance; $5000 max OOP	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												5000	1.555	0.2893	0.7362	0.2877	0.2356	0.5022	0	0.2892	1.1689	0.9545	1.8897	0.027	0.0005	0.7814	1.1693	4.2859	0.1325	0.329	0	0	2.8714	0	0	0	0.225	0.0063	0.0078	0	0												17.7444	500	NO	8.16189838	17.8962	1.335966811	3.630670387	0.287659491	1.684243001	0.857102675	0	1.614753773	5.404850467	2.025258831	4.65481119	0.12098371	0.002998342	2.616555294	2.91816292	18.87439043	0.913066746	1.566894175	0	0	9.63461906	0	0	0	0.22503993	0.006255718	0.007830921	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2784
H4524_801_0	2012	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	323.1187055	3.320446657	38.46005575	40.95959381	11.08273025	15.74271451	0	15.72780435	38.53540539	22.47848634	42.2605425	0.426346185	0.035549124	25.66885159	39.35704279	127.1874619	2.208095524	12.41200466	0	0	47.50740609	0.000156957																			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	NO	0.076885159	0.076885159	0.192941327	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061817355	0.061817355	0.155129062	0	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0.180100916	0	0	0	0	0	0	0	0												19.9743	0.205261231	5.966272359	0	1.996009869	2.835277303	0	2.83259197	6.940261808	4.04839598	7.611162414	0.076785338	0.00640243	4.622983683	7.088239456	22.90657838	0.397680026	2.235413408	0	0	8.556127353	2.83E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2998	0	NO	29.21987715	19.9743	0.205261231	5.966272359	0	1.996009869	2.835277303	0	2.83259197	6.940261808	4.04839598	7.611162414	0.076785338	0.00640243	4.622983683	7.088239456	22.90657838	0.397680026	2.235413408	0	0	8.556127353	2.83E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2998	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	4.7333	0.0486	1.4138	0	0.473	0.6719	0	0.6712	1.6446	0.9593	1.8036	0.0182	0.0015	1.0955	1.6797	5.4281	0.0942	0.5297	0	0	2.0275	0	0	0	0	0	0	0	0	0											23.2938	0	NO	3.543742433	24.7076	0.253901434	7.380083925	0	2.468998976	3.507145364	0	3.503823695	8.584877042	5.007733522	9.414759166	0.094980954	0.007919597	5.718479732	8.767920557	28.33468885	0.491917196	2.765133331	0	0	10.58364991	3.50E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5937
H4524_802_0	2012	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	243.1411231	3.245335446	19.41570152	13.71211443	11.00262692	15.73907	0	13.16439039	49.75010866	33.17115307	60.94192445	0.469087396	0.0245854	33.15192691	39.14462031	145.8476292	2.570567191	10.21668322	0	0	80.11705182	0.00010855																			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	NO	0.076493465	0.076493465	0.193065731	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063308058	0.063308058	0.159786413	0	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0.185388449	0	0	0	0	0	0	0	0												15.3928	0.205455883	3.102365297	0	2.039759943	2.917841781	0	2.44052592	9.223095495	6.149548628	11.29792887	0.086963385	0.004557849	6.145984321	7.256960457	27.0384658	0.476553465	1.894055059	0	0	14.852776	2.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5257	0	NO	28.07267513	15.3928	0.205455883	3.102365297	0	2.039759943	2.917841781	0	2.44052592	9.223095495	6.149548628	11.29792887	0.086963385	0.004557849	6.145984321	7.256960457	27.0384658	0.476553465	1.894055059	0	0	14.852776	2.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5257	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	3.6085	0.0482	0.7273	0	0.4782	0.684	0	0.5721	2.1621	1.4416	2.6485	0.0204	0.0011	1.4408	1.7012	6.3385	0.1117	0.444	0	0	3.4819	0	0	0	0	0	0	0	0	0											25.9102	0	NO	3.40461151	19.0013	0.253620292	3.829643528	0	2.517934775	3.601862715	0	3.012651123	11.38523823	7.591168947	13.94646859	0.107349952	0.005626332	7.586769071	8.958188024	33.37701259	0.588270471	2.338072731	0	0	18.33466792	2.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4358
H4524_805_0	2012	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	316.1686607	5.81634432	38.60840501	10.06369164	9.422932641	13.06507019	0	16.36732822	40.50229968	19.64067764	54.86868902	0.918428782	0.080210322	26.95320648	27.18129585	135.5166268	3.105967285	8.609702227	0	0	68.03423966	0.000354146																			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	NO	0.080283923	0.080283923	0.198943417	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06041341	0.06041341	0.149704323	0	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0.168559326	0	0	0	0	0	0	0	0												19.1008	0.351385194	5.779845119	0	1.588323173	2.202239423	0	2.75886581	6.827040326	3.310619381	9.248629226	0.154809736	0.013520198	4.543214311	4.581660902	22.84259125	0.523539751	1.451245602	0	0	11.46780557	5.97E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7462	0	NO	28.80085645	19.1008	0.351385194	5.779845119	0	1.588323173	2.202239423	0	2.75886581	6.827040326	3.310619381	9.248629226	0.154809736	0.013520198	4.543214311	4.581660902	22.84259125	0.523539751	1.451245602	0	0	11.46780557	5.97E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7462	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	4.6428	0.0854	1.4049	0	0.3861	0.5353	0	0.6706	1.6594	0.8047	2.248	0.0376	0.0033	1.1043	1.1136	5.5523	0.1273	0.3527	0	0	2.7874	0	0	0	0	0	0	0	0	0											23.5157	0	NO	3.492924237	23.7436	0.436794951	7.18472834	0	1.974390364	2.737528717	0	3.429451994	8.486460986	4.11531804	11.49665556	0.192438703	0.016806497	5.647514759	5.695306405	28.39484611	0.650794409	1.803993912	0	0	14.25523798	7.42E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2619
H4524_806_0	2012	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	309.2124073	5.688374758	37.7589538	9.84227314	9.215611943	12.77761622	0	16.0072189	39.61117954	19.20854901	53.66148365	0.898221772	0.078445558	26.36018966	26.58326067	132.5350283	3.037630672	8.420273995	0	0	66.53736956	0.000346354																			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	NO	0.076624092	0.076624092	0.193409662	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.057657275	0.057657275	0.145534829	0	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0.168553118	0	0	0	0	0	0	0	0												17.8283	0.327976189	5.49524288	0	1.553320131	2.153707058	0	2.698066661	6.676587834	3.237660835	9.044810404	0.151398081	0.013222243	4.443092167	4.480691482	22.33919232	0.512002122	1.419263439	0	0	11.21508113	5.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5897	0	NO	28.16718815	17.8283	0.327976189	5.49524288	0	1.553320131	2.153707058	0	2.698066661	6.676587834	3.237660835	9.044810404	0.151398081	0.013222243	4.443092167	4.480691482	22.33919232	0.512002122	1.419263439	0	0	11.21508113	5.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5897	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	4.3335	0.0797	1.3357	0	0.3776	0.5235	0	0.6558	1.6229	0.787	2.1985	0.0368	0.0032	1.08	1.0891	5.43	0.1245	0.345	0	0	2.726	0	0	0	0	0	0	0	0	0											22.7488	0	NO	3.416073906	22.1619	0.407697164	6.830968262	0	1.930884721	2.677207338	0	3.353884102	8.299462023	4.024637107	11.24332703	0.188198321	0.016436166	5.523071908	5.569810466	27.76916636	0.63645417	1.76424295	0	0	13.94112415	7.26E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3385
H4525_001_0	2012	8																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	O	V																																																			0	YES	1178.082203	97.65878107	1600.103698	2219.073432	192.793137	21.41525437	0.116269863	182.0838493	215.6953701	921.9942116	407.2049573	0	0	452.3889098	2660.613371	1858.893397	298.0016598	1321.984177	2099.137337	17456.11579	16.02693373	41.35159554	0	0	82.60284849	112.3398739	0	0	198.8006665	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 Surgical 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	"$20 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $30 Copay for Opthamology; $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; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	$25 eye exam copay; limit one annually	$50 limit	Non-Covered	Non-Covered	Gym Membership	Non-Covered													85.37524054	85.37524054	60.35873926	0	100	0.2	0.2	49.74588702	100	0	49.85176662	0	0	13.19097499	10	35	25	20	0	1.69949336	0.2	10	0	0	25	0	0	0	0	0											NO	83.16253752	83.16253752	58.79439854	0	97.40826145	0.194816523	0.194816523	48.45660369	97.40826145	0	48.55973916	0	0	12.84909941	9.740826145	34.09289151	24.35206536	19.48165229	0	1.655446936	0.194816523	9.740826145	0	0	24.35206536	0	0	0	0	0												8.1644	0.676796004	7.839761211	0	1.564970358	4.172045394	0.02265129	0.735263744	1.750875917	0	1.647813876	0	0	0.484399173	2.159714357	5.281254243	0.604746325	2.146203006	0	2.408139449	3.122311503	0.033566559	0	0	0.167629164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9825			1.143634035	8.1644	0.676796004	7.839761211	0	1.564970358	4.172045394	0.02265129	0.735263744	1.750875917	0	1.647813876	0	0	0.484399173	2.159714357	5.281254243	0.604746325	2.146203006	0	2.408139449	3.122311503	0.033566559	0	0	0.167629164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9825	NO																																																																																		0				8.1644	0.676796004	7.839761211	0	1.564970358	4.172045394	0.02265129	0.735263744	1.750875917	0	1.647813876	0	0	0.484399173	2.159714357	5.281254243	0.604746325	2.146203006	0	2.408139449	3.122311503	0.033566559	0	0	0.167629164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9825
H4525_002_0	2012	7																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	O	V																																																			0	YES	1716.658494	81.27736501	1838.813061	3061.129697	208.1637161	24.17483108	0.324096909	338.6354043	387.0216026	1503.124336	912.6430598	0	0	658.2862632	3458.999433	2357.094803	257.2283622	1088.439279	2411.383522	17140.97486	16.80613816	43.59317982	0	0	82.72203152	112.5019629	0	0	199.0875049	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 Surgical 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	"$20 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $30 Copay for Opthamology; $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; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	$25 eye exam copay; limit one annually	$50 limit	Non-Covered	Non-Covered	Gym Membership	Non-Covered													85.37524054	85.37524054	60.35873926	0	100	0.2	0.2	49.83171468	100	0	49.85176662	0	0	11.54992959	10	35	25	20	0	1.964180396	0.2	10	0	0	25	0	0	0	0	0											NO	83.16253752	83.16253752	58.79439854	0	97.40826145	0.194816523	0.194816523	48.54020692	97.40826145	0	48.55973916	0	0	11.25058561	9.740826145	34.09289151	24.35206536	19.48165229	0	1.913273976	0.194816523	9.740826145	0	0	24.35206536	0	0	0	0	0												11.8968	0.563269326	9.009325664	0	1.689738807	4.709656532	0.063139433	1.36978605	3.141591787	0	3.693142411	0	0	0.617175497	2.807792676	6.696681448	0.522003491	1.767049631	0	2.732948427	3.2741134	0.035386132	0	0	0.167871027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7575			1.456930498	11.8968	0.563269326	9.009325664	0	1.689738807	4.709656532	0.063139433	1.36978605	3.141591787	0	3.693142411	0	0	0.617175497	2.807792676	6.696681448	0.522003491	1.767049631	0	2.732948427	3.2741134	0.035386132	0	0	0.167871027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7575	NO																																																																																		0				11.8968	0.563269326	9.009325664	0	1.689738807	4.709656532	0.063139433	1.36978605	3.141591787	0	3.693142411	0	0	0.617175497	2.807792676	6.696681448	0.522003491	1.767049631	0	2.732948427	3.2741134	0.035386132	0	0	0.167871027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7575
H4525_003_0	2012	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	420.1029982	3.998644186	22.22856793	83.07294275	17.67002228	35.15883472	5.899740581	33.81491947	61.26546765	18.72344906	65.82499827	0	0	28.38421922	67.16578188	5.056609802	2.601552289	2.949181859	29.68179185	146.7449746	33.84382429	15.24391687	0	0.41901707	0.43951198	2.769017718	0.00371509	0	0	0											0	No Cost Sharing For This Service	No Cost Sharing For This Service	No prior hosp stay required	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	"Yearly maximum benefit of $1,860"	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	No Cost Sharing For This Service	$200 limit	limit one eye exam annually	$225 limit	No Cost Sharing For This Service	Not Covered	No Cost Sharing For This Service	No Cost Sharing For This 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											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	5																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	V	V																																																			0	YES	972.1704789	72.16056572	1171.090907	1635.491909	138.084106	15.8702363	0.086339338	126.3762565	127.7040287	589.4918063	311.1481391	0	0	383.5342985	1891.638275	1347.194764	220.1132737	976.4585376	1594.776657	12831.64582	12.63736267	38.13941473	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 Surgical 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	"$20 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $30 Copay for Opthamology; $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; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	$25 eye exam copay; limit one annually	$50 limit	Non-Covered	Non-Covered	Non-Covered	Non-Covered													85.37524054	85.37524054	60.35873926	0	100	0.2	0.2	49.72948675	100	0	49.85176662	0	0	12.5118599	10	35	25	20	0	1.841936671	0.2	10	0	0	0	0	0	0	0	0											NO	83.16253752	83.16253752	58.79439854	0	97.40826145	0.194816523	0.194816523	48.44062847	97.40826145	0	48.55973916	0	0	12.1875852	9.740826145	34.09289151	24.35206536	19.48165229	0	1.794198489	0.194816523	9.740826145	0	0	0	0	0	0	0	0												6.7373	0.50008798	5.737798793	0	1.120877725	3.091784253	0.01682033	0.510145441	1.036618951	0	1.25910604	0	0	0.389529745	1.535509964	3.827480411	0.446684402	1.585252142	0	1.918543295	2.461967053	0.030959117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2065			0.856917669	6.7373	0.50008798	5.737798793	0	1.120877725	3.091784253	0.01682033	0.510145441	1.036618951	0	1.25910604	0	0	0.389529745	1.535509964	3.827480411	0.446684402	1.585252142	0	1.918543295	2.461967053	0.030959117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2065	NO																																																																																		0				6.7373	0.50008798	5.737798793	0	1.120877725	3.091784253	0.01682033	0.510145441	1.036618951	0	1.25910604	0	0	0.389529745	1.535509964	3.827480411	0.446684402	1.585252142	0	1.918543295	2.461967053	0.030959117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2065
H4525_005_0	2012	6																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	V	V																																																			0	YES	1290.367124	82.45280135	1397.121249	2749.022078	164.3753189	20.15626946	0.144771668	253.0536404	248.8960066	1001.211335	567.0320466	0	0	553.5832076	2307.92456	1669.192631	234.4339627	1074.107747	1909.860276	14564.13284	16.73051244	39.65900961	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 Surgical 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	"$20 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $30 Copay for Opthamology; $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; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	$25 eye exam copay; limit one annually	$50 limit	Non-Covered	Non-Covered	Non-Covered	Non-Covered													85.37524054	85.37524054	60.35873926	0	100	0.2	0.2	49.7715444	100	0	49.85176662	0	0	13.59652406	10	35	25	20	0	1.768029405	0.2	10	0	0	0	0	0	0	0	0											NO	83.16253752	83.16253752	58.79439854	0	97.40826145	0.194816523	0.194816523	48.48159609	97.40826145	0	48.55973916	0	0	13.2441377	9.740826145	34.09289151	24.35206536	19.48165229	0	1.722206705	0.194816523	9.740826145	0	0	0	0	0	0	0	0												8.9425	0.571415349	6.845241958	0	1.334292837	3.92677433	0.028203913	1.022370366	2.020377274	0	2.294577357	0	0	0.610977686	1.873424325	4.742300272	0.475745932	1.743782804	0	2.090203937	3.25938026	0.032192626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8138			1.112537883	8.9425	0.571415349	6.845241958	0	1.334292837	3.92677433	0.028203913	1.022370366	2.020377274	0	2.294577357	0	0	0.610977686	1.873424325	4.742300272	0.475745932	1.743782804	0	2.090203937	3.25938026	0.032192626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8138	NO																																																																																		0				8.9425	0.571415349	6.845241958	0	1.334292837	3.92677433	0.028203913	1.022370366	2.020377274	0	2.294577357	0	0	0.610977686	1.873424325	4.742300272	0.475745932	1.743782804	0	2.090203937	3.25938026	0.032192626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8138
H4525_008_0	2012	8																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	V	V																																																			0	YES	1551.563295	98.92369338	1692.398043	2199.278952	223.1283519	23.37092407	0.317893852	267.3093902	194.184939	1146.900844	749.643353	0	0	539.0188511	3338.229976	2318.535052	409.1300532	1337.883868	2662.29185	19482.47776	29.33686715	43.07496487	0	81.89287664	13.64881277	40.94643832	0.629291539	0	200.4791485	0											3400	No Cost Sharing for Inpatient	No Cost Sharing for Inpatient	No prior hosp stay required; days 1-100 $0/day	No Cost Sharing for Home Health	$50 Copay for Ambulance	10% coinsurance for DME	10% coinsurance for Prosthetics; 0% 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	$75 Copay for Outpatient Surgical Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$0 Copay per X-rays; $25 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; $25 Copay for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$0 Copay for Outpatient Rehabilitation Service; $0 Copay for CORF Visits; $0 Copay for Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	No Cost Sharing for Primary Care Physician Services	No Cost Sharing 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	"No Cost Sharing for Chiropractic Services; No Cost Sharing for Podiatry Services; No Cost Sharing for Opthamology; $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	$00 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	$200 limit	$25 eye exam copay; limit one per year	$100 limit	$25 hearing exam copay ; limit one per year	Non-Covered	Gym Membership	Non-Covered													0	0	0	0	50	0.097299824	0.1	49.83090044	75	0	15.32760255	0	0	6.622771444	0	0	25	20	0	0	0.2	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	49.7026835	0.096721247	0.099405367	49.53458946	74.55402525	0	15.23645956	0	0	6.583390259	0	0	24.85134175	19.8810734	0	0	0.198810734	0	0	0	24.85134175	0	24.85134175	0	0	0												0	0	0	0	0.924173154	2.260464916	0.031600355	1.103421742	1.20643907	0	0.951825886	0	0	0.295714288	0	0	0.847285898	2.216547282	0	0	5.832484092	0	0	0	0.028265943	0	0.001303228	0	0	0	0	0	0	0	0	0	0	0	0	0	15.6995			0.093913	0	0	0	0	0.924173154	2.260464916	0.031600355	1.103421742	1.20643907	0	0.951825886	0	0	0.295714288	0	0	0.847285898	2.216547282	0	0	5.832484092	0	0	0	0.028265943	0	0.001303228	0	0	0	0	0	0	0	0	0	0	0	0	0	15.6995	NO																																																																																		0				0	0	0	0	0.924173154	2.260464916	0.031600355	1.103421742	1.20643907	0	0.951825886	0	0	0.295714288	0	0	0.847285898	2.216547282	0	0	5.832484092	0	0	0	0.028265943	0	0.001303228	0	0	0	0	0	0	0	0	0	0	0	0	0	15.6995
H4525_009_0	2012	7																															D	D	D	V	T	coin	coin	V	V	V	V	V	V	V	V	V	V	V	V	V	coin	V	V	V	V	P	V	V	V	V																																																			0	YES	2507.995697	99.36488287	1650.046798	2865.688752	202.0768723	28.96514187	3.130394009	387.3880194	452.1025046	1880.510633	1006.433765	0	0	617.6829171	4330.115712	3096.006966	249.7435161	993.9483749	3026.555862	17367.38614	20.27686452	47.65898113	0	114.0562441	82.64945228	112.4032551	0.331762426	0	198.9128281	0											3400	No Cost Sharing for Inpatient	No Cost Sharing for Inpatient	No prior hosp stay required; days 1-100 $0/day	No Cost Sharing for Home Health	$50 Copay for Ambulance	10% coinsurance for DME	10% coinsurance for Prosthetics; 0% 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	$75 Copay for Outpatient Surgical Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$0 Copay per X-rays; $25 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; $25 Copay for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$0 Copay for Outpatient Rehabilitation Service; $0 Copay for CORF Visits; $0 Copay for Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	No Cost Sharing for Primary Care Physician Services	No Cost Sharing 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	"No Cost Sharing for Chiropractic Services; No Cost Sharing for Podiatry Services; No Cost Sharing for Opthamology; $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	$00 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	$200 limit	$25 eye exam copay; limit one per year	$100 limit	$25 hearing exam copay ; limit one per year	Non-Covered	Gym Membership	Non-Covered													0	0	0	0	50	0.089119358	0.1	49.89855932	75	0	15.32760255	0	0	5.235813598	0	0	25	20	0	0	0.2	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	49.7026835	0.088589425	0.099405367	49.60184602	74.55402525	0	15.23645956	0	0	5.204679722	0	0	24.85134175	19.8810734	0	0	0.198810734	0	0	0	24.85134175	0	24.85134175	0	0	0												0	0	0	0	0.836980236	2.56600526	0.311177965	1.601263407	2.808838462	0	1.277873947	0	0	0.267903479	0	0	0.517205122	1.64673005	0	0	4.031258318	0	0	0	0.171162482	0	0.000687062	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0371			0.09593225	0	0	0	0	0.836980236	2.56600526	0.311177965	1.601263407	2.808838462	0	1.277873947	0	0	0.267903479	0	0	0.517205122	1.64673005	0	0	4.031258318	0	0	0	0.171162482	0	0.000687062	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0371	NO																																																																																		0				0	0	0	0	0.836980236	2.56600526	0.311177965	1.601263407	2.808838462	0	1.277873947	0	0	0.267903479	0	0	0.517205122	1.64673005	0	0	4.031258318	0	0	0	0.171162482	0	0.000687062	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0371
H4525_802_0	2012	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	YES	240.90037	9.362675042	84.765444	83.67282674	10.87510962	33.81995128	0.183991728	13.83136561	53.4454327	9.853951713	26.66817298	0	0	35.63663307	31.02469743	20.28212583	3.95123119	5.925949805	23.35132728	128.435169	22.97815017	0	0	0	0	0	0	0	0	0											3400	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing													0.080283923	0.080283923	0.198943417	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072558582	0.072558582	0.179800038	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0	0	0	0	0	0	0												17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48			12.61460989	17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48	NO																																																																																		0				17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48
H4525_803_0	2012	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	YES	240.90037	9.362675042	84.765444	83.67282674	10.87510962	33.81995128	0.183991728	13.83136561	53.4454327	9.853951713	26.66817298	0	0	35.63663307	31.02469743	20.28212583	3.95123119	5.925949805	23.35132728	128.435169	22.97815017	0	0	0	0	0	0	0	0	0											3400	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing													0.080283923	0.080283923	0.198943417	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072558582	0.072558582	0.179800038	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0	0	0	0	0	0	0												17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48			12.61460989	17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48	NO																																																																																		0				17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48
H4525_804_0	2012	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	YES	240.90037	9.362675042	84.765444	83.67282674	10.87510962	33.81995128	0.183991728	13.83136561	53.4454327	9.853951713	26.66817298	0	0	35.63663307	31.02469743	20.28212583	3.95123119	5.925949805	23.35132728	128.435169	22.97815017	0	0	0	0	0	0	0	0	0											3400	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing													0.080283923	0.080283923	0.198943417	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072558582	0.072558582	0.179800038	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0	0	0	0	0	0	0												17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48			12.61460989	17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48	NO																																																																																		0				17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48
H4525_805_0	2012	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	YES	240.90037	9.362675042	84.765444	83.67282674	10.87510962	33.81995128	0.183991728	13.83136561	53.4454327	9.853951713	26.66817298	0	0	35.63663307	31.02469743	20.28212583	3.95123119	5.925949805	23.35132728	128.435169	22.97815017	0	0	0	0	0	0	0	0	0											3400	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing	Traditional FFS Cost Sharing													0.080283923	0.080283923	0.198943417	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072558582	0.072558582	0.179800038	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0.202445545	0	0	0	0	0	0	0	0	0												17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48			12.61460989	17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48	NO																																																																																		0				17.4794	0.679342427	15.24083003	0	2.20161749	6.846698458	0.037248305	2.800098345	10.81978973	1.994888622	5.398852803	0	0	7.214477593	6.280811769	4.106026011	0.79990915	1.199682136	4.727372171	26.00112775	4.651824127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.48
H4527_001_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1794.604299	32.98294846	611.652132	1820.277291	248.4970565	17.90761797	12.37313814	525.8695813	653.7336092	17.74233248	47.51495935	0	0.355608849	1157.820245	4416.562351	6766.120606	229.1386905	2297.657061	0	0	26.60602944	1238.815239	759.9128285	1062.767321	60.19649554	1066.542339	0.777968749	1.98	380.2166565	1846.037452											3600	"$25 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-92 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$65 (4a, 4a1); $40 (4b)"	$25 (9b)	10% (8a1a); $0 (8a2)	"$0 (8b1); 10% (8b2, 8b3)"	Included in h.5.	20% (12)	"$10 (3, 9c); $0 (5); $25 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $10 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$10 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $10 (16b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a3, 16a4, 16b3, 16b4); $0 n/c (16a5, 16b1, 16b2, 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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	16.26234262	9.991505047	27.74973436	0	50	0.2	0.191053111	64.99808061	6.5	0	0.008676273	0	0.2	0.735987929	0.000282683	10	10	10	0	0	0.2	1.041096123	0	0	0	0	0	0	0	0											NO	15.43168563	9.481153392	26.33231799	0	47.44607217	0.189784289	0.181294394	61.68127837	6.167989383	0	0.008233101	0	0.189784289	0.698394728	0.000281013	9.940893975	9.940893975	9.940893975	0	0	0.189784289	0.987918435	0	0	0	0	0	0	0	0												2.3078	0.026059699	1.34218487	0	0.98251744	3.398584539	2.243180578	2.703025669	0.336018497	0	0.391195472	0	0.067488972	0.06738463	0.000103426	5.605107298	0.189820286	1.903397103	0	0	5.049406373	0.101987368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.7153	0	NO	1.069264008	2.3078	0.026059699	1.34218487	0	0.98251744	3.398584539	2.243180578	2.703025669	0.336018497	0	0.391195472	0	0.067488972	0.06738463	0.000103426	5.605107298	0.189820286	1.903397103	0	0	5.049406373	0.101987368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.7153	NO																																										0	0	0	0	0	0	0	0	0	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	2.3078	0.026059699	1.34218487	0	0.98251744	3.398584539	2.243180578	2.703025669	0.336018497	0	0.391195472	0	0.067488972	0.06738463	0.000103426	5.605107298	0.189820286	1.903397103	0	0	5.049406373	0.101987368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.7153
H4527_002_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1545.137438	58.15898123	540.8224672	1093.880304	194.575692	14.69989916	10.64095839	450.3714843	425.5507391	23.5492656	48.99268361	0	0.057158852	679.4775734	6102.066306	5357.643949	346.0993482	1891.205006	0	0	25.11010882	963.7755087	1429.041864	0	58.14114996	330.5742023	6.676898069	0	380.2166565	0											4200	"$300 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-62 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$160 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $0 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9c); $0 (5); $175 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $30 (7d, 7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$0/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $30 (16b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$5 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	195.1481114	102.2106748	46.28999394	0	160	0.2	0.197198229	64.92493569	45.5	0	0.048019378	0	0.2	5.023495982	0.020558575	29.2742951	30	30	0	0	0.2	2.823717565	0	0	0	5	0	0	0	0											NO	163.1485976	85.45062586	38.69956792	0	133.7639161	0.167204895	0.164862546	54.29057376	38.03911365	0	0.040145375	0	0.167204895	4.199765595	0.020000992	28.48032819	29.18635079	29.18635079	0	0	0.167204895	2.360696997	0	0	0	5	0	0	0	0												21.0073	0.414143445	1.744132984	0	2.16893388	2.457895098	1.754295488	2.037577191	1.348964411	0	1.966829656	0	0.00955724	0.237803878	0.010170615	12.7156215	0.841781415	4.59978106	0	0	4.198533113	0.189598496	0	0	0	0.137739251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8406	0	NO	8.260324079	21.0073	0.414143445	1.744132984	0	2.16893388	2.457895098	1.754295488	2.037577191	1.348964411	0	1.966829656	0	0.00955724	0.237803878	0.010170615	12.7156215	0.841781415	4.59978106	0	0	4.198533113	0.189598496	0	0	0	0.137739251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8406	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	21.0073	0.414143445	1.744132984	0	2.16893388	2.457895098	1.754295488	2.037577191	1.348964411	0	1.966829656	0	0.00955724	0.237803878	0.010170615	12.7156215	0.841781415	4.59978106	0	0	4.198533113	0.189598496	0	0	0	0.137739251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8406
H4527_003_0	2012	4																															D	A	D	V	T	Coin	Coin	V	V	O	O	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	2280.385381	6.936804124	630.7961548	2165.00172	365.8473985	33.33891602	26.6485745	734.1380655	748.7812181	12063.35199	7822.85454	0	12.42240187	1427.81281	4914.984446	10639.29204	725.7117112	2860.918238	0	0	35.71416851	1566.786975	5320.097948	426.0647158	54.00518646	311.3181714	11.91977616	2.07930984	380.2166565	997.5971328											3350	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$900 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	5% (11a)	"$0 (11b, 11b1); $0/5% (11c)"	"$65 (4a, 4a1); $30 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"5% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$10 (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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	900	24.98563586	0	50	0.05	8.61E-05	64.99885225	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	881.3199052	24.46704247	0	48.96221695	0.048962217	8.44E-05	63.65063709	0	0	0	0	0	0	0	0	0	0	0	0	0.048962217	0	0	0	0	10	0	0	0	0												0	0.509461963	1.286143026	0	1.492724975	1.632347239	0.002248088	3.894029632	0	0	0	0	0	0	0	0	0	0	0	0	1.748644867	0	0	0	0	0.25943181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.825	0	NO	0.223889201	0	0.509461963	1.286143026	0	1.492724975	1.632347239	0.002248088	3.894029632	0	0	0	0	0	0	0	0	0	0	0	0	1.748644867	0	0	0	0	0.25943181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.825	NO																																										0	0	0	0	0	0	0	0	0	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	0.509461963	1.286143026	0	1.492724975	1.632347239	0.002248088	3.894029632	0	0	0	0	0	0	0	0	0	0	0	0	1.748644867	0	0	0	0	0.25943181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.825
H4527_004_0	2012	4																															D	A	D	V	T	Coin	Coin	V	V	O	O	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	2291.97801	9.265500132	707.5133612	2024.093527	379.4772761	22.15512434	15.4225872	807.7758703	776.5449428	8325.301765	6925.255652	0	45.31616667	1460.05916	4080.930237	9681.702798	368.7693597	2656.79341	0	0	35.3791792	1255.651972	3360.963328	291.6	55.0214476	906.2313525	3.95408636	1.98	380.2166565	2131.332581											3350	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$900 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	5% (11a)	"$0 (11b, 11b1); $0/5% (11c)"	"$65 (4a, 4a1); $20 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"5% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	900	27.21992949	0	50	0.05	0.00012089	64.99949591	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	884.7254193	26.75795948	0	49.15141218	0.049151412	0.000118838	63.89701228	0	0	0	0	0	0	0	0	0	0	0	0	0.049151412	0	0	0	0	0	0	0	0	0												0	0.683118624	1.577634488	0	1.554320334	1.088955648	0.001832796	4.301205392	0	0	0	0	0	0	0	0	0	0	0	0	1.73893662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.946	0	NO	0.188934224	0	0.683118624	1.577634488	0	1.554320334	1.088955648	0.001832796	4.301205392	0	0	0	0	0	0	0	0	0	0	0	0	1.73893662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.946	NO																																										0	0	0	0	0	0	0	0	0	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	0.683118624	1.577634488	0	1.554320334	1.088955648	0.001832796	4.301205392	0	0	0	0	0	0	0	0	0	0	0	0	1.73893662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.946
H4527_005_0	2012	4																															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	1242.494308	27.98540073	230.3246014	1530.308677	144.6746049	12.21408273	10.13908422	332.3466873	78.34678988	24.64250616	49.33697603	0	0.105544601	35.24842382	6495.179587	4120.966894	120.8042615	1534.952902	0	0	7.576741692	890.1103245	673.27038	0	28.75085115	0	7.705531781	0	380.2166565	0											3600	"$175 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-68 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$210 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $0 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9c); $0 (5); 20% (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $25 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1, 7f1); $25 (7d, 7f)"	"$25 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$0/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $25 (16b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	113.8363983	69.94053533	41.72469494	0	210	0.2	0.195494521	64.99970639	0.018	0	0.046162956	0	0.2	0.005986489	4.65E-05	24.67688257	25	25	0	0	0.2	1.581616298	0	0	0	0	0	0	0	0											NO	103.1702774	63.387322	37.81521918	0	190.323645	0.181260614	0.177177285	58.918905	0.016313455	0	0.041837629	0	0.181260614	0.005425574	4.58E-05	24.31422533	24.63259416	24.63259416	0	0	0.181260614	1.433423709	0	0	0	0	0	0	0	0												10.6824	0.147826634	0.725814607	0	2.29458318	2.213932139	1.79641541	1.631791908	1.278106854	0	2.064142083	0	0.019131079	0.191242914	2.48E-05	8.349843137	0.247976862	3.150822658	0	0	1.373364854	0.106325437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2737	0	NO	2.710436534	10.6824	0.147826634	0.725814607	0	2.29458318	2.213932139	1.79641541	1.631791908	1.278106854	0	2.064142083	0	0.019131079	0.191242914	2.48E-05	8.349843137	0.247976862	3.150822658	0	0	1.373364854	0.106325437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2737	NO																																										0	0	0	0	0	0	0	0	0	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	10.6824	0.147826634	0.725814607	0	2.29458318	2.213932139	1.79641541	1.631791908	1.278106854	0	2.064142083	0	0.019131079	0.191242914	2.48E-05	8.349843137	0.247976862	3.150822658	0	0	1.373364854	0.106325437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2737
H4527_006_0	2012	4																															D	A	D	V	T	Coin	Coin	V	V	O	O	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	1619.667138	4.891964731	341.7145168	2086.535052	179.119764	14.37889549	12.75432955	437.8908122	628.524953	9807.803238	6978.785416	0	7.949864448	1115.042825	5850.083114	5352.420075	143.429334	2634.775999	0	0	11.26851372	1192.293995	1654.138945	417.034655	45.93311207	460.5989484	8.588318181	2.07930984	380.2166565	0											3350	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$900 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$100 (10a)	5% (11a)	"10% (11b, 11b1); $0/5% (11c)"	"$65 (4a, 4a1); $30 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"10% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$10 (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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	900	24.83606726	0	100	0.05	0.098518382	64.99876856	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	888.9048428	24.5298894	0	98.76720476	0.049383602	0.097303852	64.1983539	0	0	0	0	0	0	0	0	0	0	0	0	0.098767205	0	0	0	0	10	0	0	0	0												0	0.362374262	0.698518275	0	1.4742632	0.710081658	1.241045401	2.342655777	0	0	0	0	0	0	0	0	0	0	0	0	1.112959602	0	0	0	0	0.383832457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3257	0	NO	0.099096632	0	0.362374262	0.698518275	0	1.4742632	0.710081658	1.241045401	2.342655777	0	0	0	0	0	0	0	0	0	0	0	0	1.112959602	0	0	0	0	0.383832457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3257	NO																																										0	0	0	0	0	0	0	0	0	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	0.362374262	0.698518275	0	1.4742632	0.710081658	1.241045401	2.342655777	0	0	0	0	0	0	0	0	0	0	0	0	1.112959602	0	0	0	0	0.383832457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3257
H4527_013_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1150.700838	22.87166836	377.2986926	2103.056948	122.6390178	7.03338182	10.1606251	259.818604	548.3233902	25.4792342	42.53446743	0	0.067008742	895.7867151	9571.612735	4604.267786	99.64819996	1431.517733	0	0	15.59342483	1151.344921	292.8311677	0	44.67700084	701.2389795	4.699410857	2.07930984	380.2166565	442.9742347											3600	"$150 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-68 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$100 (9b)	20% (8a1a); $0 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9c); $0 (5); $150 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $20 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$20 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$0/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $20 (16b, 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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	97.5740557	59.94903028	46.26091864	0	150	0.2	0.198057254	64.9858159	26	0	0.049619166	0	0.2	4.364253418	0.000952492	20	20	20	0	0	0.2	2.233638733	0	0	0	0	0	0	0	0											NO	90.21486433	55.42757852	42.77184616	0	138.68676	0.18491568	0.183119459	60.09432976	24.03903841	0	0.045876809	0	0.18491568	4.035094444	0.000941822	19.77596464	19.77596464	19.77596464	0	0	0.18491568	2.065174126	0	0	0	0	0	0	0	0												8.6509	0.105643433	1.344813469	0	1.417367337	1.300582582	1.860608174	1.301135405	1.098430586	0	1.951345657	0	0.012390967	0.301215333	0.00075123	7.587819744	0.16421994	2.359137006	0	0	2.883468757	0.198143978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5379	0	NO	1.943704055	8.6509	0.105643433	1.344813469	0	1.417367337	1.300582582	1.860608174	1.301135405	1.098430586	0	1.951345657	0	0.012390967	0.301215333	0.00075123	7.587819744	0.16421994	2.359137006	0	0	2.883468757	0.198143978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5379	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.6509	0.105643433	1.344813469	0	1.417367337	1.300582582	1.860608174	1.301135405	1.098430586	0	1.951345657	0	0.012390967	0.301215333	0.00075123	7.587819744	0.16421994	2.359137006	0	0	2.883468757	0.198143978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5379
H4527_015_0	2012	4																															D	A	D	V	T	Coin	Coin	V	V	O	O	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	1598.287916	3.64946961	423.3054956	2538.160509	216.0046624	16.22399271	15.65175321	472.4004077	734.5312422	12428.20423	6904.488105	0	16.25094662	1221.889109	8144.632124	6901.327613	193.0074966	2346.757129	0	0	33.10384806	1368.281395	1313.210222	415.5719226	55.31610715	620.6657713	11.58182814	2.07930984	380.2166565	377.9372559											3350	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$900 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-65 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$100 (10a)	5% (11a)	"$0 (11b, 11b1); $0/5% (11c)"	"$65 (4a, 4a1); $30 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	900	39.92544691	0	100	0.05	9.45E-05	64.99838093	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	872.4670201	38.70403966	0	96.94078001	0.04847039	9.17E-05	63.0120716	0	0	0	0	0	0	0	0	0	0	0	0	0.19388156	0	0	0	0	0	0	0	0	0												0	0.265336823	1.365302724	0	1.744971705	0.786383254	0.001434543	2.480577359	0	0	0	0	0	0	0	0	0	0	0	0	6.418225704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0622	0	NO	0.412126251	0	0.265336823	1.365302724	0	1.744971705	0.786383254	0.001434543	2.480577359	0	0	0	0	0	0	0	0	0	0	0	0	6.418225704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0622	NO																																										0	0	0	0	0	0	0	0	0	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	0.265336823	1.365302724	0	1.744971705	0.786383254	0.001434543	2.480577359	0	0	0	0	0	0	0	0	0	0	0	0	6.418225704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0622
H4527_024_0	2012	3																															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	1380.161918	22.67775876	585.8845453	1086.74794	173.1080461	11.408265	7.504328742	353.6652563	432.8845723	6804.847378	37.09622562	0	0.160521626	702.8521327	3689.268142	4586.347926	138.7028398	1492.194178	0	0	14.50145523	902.7916406	568.1846758	374.5039395	40.91967314	280.8400328	12.17722998	2.07930984	380.2166565	0											3350	"$50 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-65 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$100 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$50 (9b)	"$0 (8a1a, 8a2)"	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$10 (3, 9c); $0 (5); $50 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $10 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$10 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $10 (16b, 18a)"	$0 (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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	32.52468523	19.98301009	38.69004752	0	100	0.2	0.191237413	64.9986998	13	0	0.048628608	0	0.2	1.476161386	0.000154172	10	10	10	0	0	0.2	0.985697361	0	0	0	0	0	0	0	0											NO	31.1820574	19.15810601	37.09291185	0	95.87197285	0.191743946	0.183343081	62.31955498	12.46335647	0	0.046621206	0	0.191743946	1.415225043	0.000153562	9.960417436	9.960417436	9.960417436	0	0	0.191743946	0.945007506	0	0	0	0	0	0	0	0												3.5864	0.036205242	1.81101365	0	1.383017491	2.187465745	1.375866753	1.836688448	0.449599561	0	1.729470775	0	0.03077905	0.082891162	4.72E-05	3.806828321	0.115128182	1.238573075	0	0	2.780566245	0.071095406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5216	0	NO	0.767910056	3.5864	0.036205242	1.81101365	0	1.383017491	2.187465745	1.375866753	1.836688448	0.449599561	0	1.729470775	0	0.03077905	0.082891162	4.72E-05	3.806828321	0.115128182	1.238573075	0	0	2.780566245	0.071095406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5216	NO																																										0	0	0	0	0	0	0	0	0	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	3.5864	0.036205242	1.81101365	0	1.383017491	2.187465745	1.375866753	1.836688448	0.449599561	0	1.729470775	0	0.03077905	0.082891162	4.72E-05	3.806828321	0.115128182	1.238573075	0	0	2.780566245	0.071095406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.5216
H4528_001_0	2012	6																															D	D	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	807.0988809	21.15782662	350.9727759	21.93492243	157.632454	12.23663246	3.601621608	306.7870707	287.8921605	2.598044112	9.792703183	0	0.560625358	407.1565013	0	2903.445947	112.3419828	96.87910609	24.42551726	37.20350291	23.63111891	0.280193279	0	0	0	0	0	0	0	0											3400	1a:  Acute - $150/$0/day for 1-5/6-90	1b:  Psych - $150/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													150	150	60	0	50	0.2	0.144438201	44.72849951	201.6076678	0	0.17936815	0	0.2	67.25229242	0	34.85264187	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	142.7494371	142.7494371	57.09977485	0	47.58314571	0.190332583	0.13745648	42.57835371	191.8625407	0	0.170698016	0	0.190332583	64.00151259	0	33.16796673	19.03325828	33.308202	0	33.308202	0.190332583	0	0	0	0	0	0	0	0	0												9.6011	0.251688987	1.670038873	0	0.625054002	2.329029861	0.495066227	1.088540701	4.602976779	0	1.671595003	0	0.106705272	2.171552662	0	8.025116547	0.178186165	0.268905736	0	0.103265149	4.497771898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6866			1.913865414	9.6011	0.251688987	1.670038873	0	0.625054002	2.329029861	0.495066227	1.088540701	4.602976779	0	1.671595003	0	0.106705272	2.171552662	0	8.025116547	0.178186165	0.268905736	0	0.103265149	4.497771898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6866	NO	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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/		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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				5.3099	0	0.5058	0.2987	0.1416	0	0	0.1981	1.138	0.1478	0.2785	0	0.0177	0.2137	1.0167	1.4882	0	0.091	0.5699	0.8367	0.8097	0.0092	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0714			0	14.911	0.251688987	2.175828547	0.298673274	0.766619143	2.329029861	0.495066227	1.286662095	5.740927697	0.147820613	1.950133945	0	0.124416784	2.385251137	1.016732836	9.513361916	0.178186165	0.359954779	0.569948731	0.940001597	5.307479352	0.009223345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.758
H4528_002_0	2012	6																															A	A	D	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	305.0536313	138.9409649	705.2274412	42.02775074	8.604450481	22.18704063	3.893259014	162.008243	52.40633345	2.801323466	10.18673294	0	0.059482359	8.210171878	0	0	4.203651923	4.802082359	35.88575101	0	13.18789441	0	0	0	0	0	0	0	0	0											6700	1a:  Acute - $400/admit for 1-90	1b:  Psych - $400/$0/admit for 1-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service/13d:  Home Safety Benefit - 0.0%													400	400	60	0	0.2	0.2	0.106803727	65	0.2	0	0.152893679	0	0.2	0.124728336	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	392.5765038	392.5765038	58.88647558	0	0.196288252	0.196288252	0.104821584	63.79368187	0.196288252	0	0.150056165	0	0.196288252	0.122413535	0	0	0	0	0	0	0.196288252	0	0	0	0	0	0	0	0	0												9.9797	4.545413187	3.460696541	0	1.688952544	4.35505542	0.408097578	0.861258526	10.28674758	0	1.528582083	0	0.011675688	1.005036166	0	0	0	0	0	0	2.588628739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7199			0.77	9.9797	4.545413187	3.460696541	0	1.688952544	4.35505542	0.408097578	0.861258526	10.28674758	0	1.528582083	0	0.011675688	1.005036166	0	0	0	0	0	0	2.588628739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7199	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	9.9797	4.545413187	3.460696541	0	1.688952544	4.35505542	0.408097578	0.861258526	10.28674758	0	1.528582083	0	0.011675688	1.005036166	0	0	0	0	0	0	2.588628739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7199
H4528_013_0	2012	7																															A	A	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	468.0348709	108.9777453	492.7582343	7.761727366	54.99754803	7.180344997	10.58935617	86.41476586	14.37025288	6.012724525	9.618088511	0	0.076879622	82.2449279	0	0	3.626123598	1.015620391	16.95844067	4.381359342	6.439348486	0.628833334	0	0	0	0	0	0	0	0											6700	1a:  Acute - $800/admit for 1-90	1b:  Psych - $800/$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 - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/7f:  Routine Footcare - $0/visit/12 Visits/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													800	800	0	0	0.2	0.2	0.120014537	65	0.2	0	0.136726142	0	0.2	0.0247067	0	0	0	0	0	22.99156703	0.2	0.2	0	0	0	0	0	0	0	0											NO	774.2622559	774.2622559	0	0	0.193565564	0.193565564	0.116153408	62.9088083	0.193565564	0	0.132327364	0	0.193565564	0.023911831	0	0	0	0	0	22.2518782	0.193565564	0.193565564	0	0	0	0	0	0	0	0												30.1985	7.031446242	0	0	10.6456314	1.389867529	1.229989808	0.453020828	2.781586104	0	1.272736296	0	0.014881247	1.966626826	0	0	0	0	0	0.008124456	1.246436121	0.121720479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3605			1.94	30.1985	7.031446242	0	0	10.6456314	1.389867529	1.229989808	0.453020828	2.781586104	0	1.272736296	0	0.014881247	1.966626826	0	0	0	0	0	0.008124456	1.246436121	0.121720479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3605	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	30.1985	7.031446242	0	0	10.6456314	1.389867529	1.229989808	0.453020828	2.781586104	0	1.272736296	0	0.014881247	1.966626826	0	0	0	0	0	0.008124456	1.246436121	0.121720479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3605
H4528_014_0	2012	6																															D	D	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	1276.006203	19.82134912	381.3051088	31.55717046	199.4251258	30.51062701	10.51409792	419.4743369	407.3069616	3.320221908	10.09285678	0	0.140246002	760.0131685	0	4643.954353	103.3063991	92.72720461	33.23433532	58.43095071	15.76780971	0.144507272	0	0	0	0	0	0	0	0											6700	1a:  Acute - $195/$0/day for 1-5/6-90	1b:  Psych - $195/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0/service			14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													195	195	60	0	50	0.2	0.102053322	44.7287188	202.6401144	0	0.200096022	0	0.2	70.07404423	0	34.97351277	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	190.1859231	190.1859231	58.51874558	0	48.76562132	0.195062485	0.099533874	43.63057008	197.6374217	0	0.195156137	0	0.195062485	68.34408611	0	34.1101016	19.50624853	34.13593492	0	34.13593492	0.195062485	0	0	0	0	0	0	0	0	0												20.2232	0.314145132	1.859458054	0	0.81042418	5.951478732	1.046508892	1.525158705	6.708258144	0	1.96968294	0	0.027356734	4.328533786	0	13.20047957	0.167926691	0.263777485	0	0.166216261	3.075708149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6383			1.56	20.2232	0.314145132	1.859458054	0	0.81042418	5.951478732	1.046508892	1.525158705	6.708258144	0	1.96968294	0	0.027356734	4.328533786	0	13.20047957	0.167926691	0.263777485	0	0.166216261	3.075708149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6383	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	20.2232	0.314145132	1.859458054	0	0.81042418	5.951478732	1.046508892	1.525158705	6.708258144	0	1.96968294	0	0.027356734	4.328533786	0	13.20047957	0.167926691	0.263777485	0	0.166216261	3.075708149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6383
H4528_801_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	297.4425958	3.509537025	65.32878173	48.34472607	8.727012606	14.12937566	3.532691146	9.182392447	44.52475319	5.467430604	21.88925313	0	0.028162383	19.36800145	49.11174465	101.635924	1.261527386	5.408056143	22.02011712	25.29997925	36.12158393	0.746463523	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067761552	0.067761552	0.146526866	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0	0	0	0	0	0	0												20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739			9.67	20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739
H4528_802_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	297.4425958	3.509537025	65.32878173	48.34472607	8.727012606	14.12937566	3.532691146	9.182392447	44.52475319	5.467430604	21.88925313	0	0.028162383	19.36800145	49.11174465	101.635924	1.261527386	5.408056143	22.02011712	25.29997925	36.12158393	0.746463523	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067761552	0.067761552	0.146526866	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0	0	0	0	0	0	0												20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739			9.67	20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	20.1552	0.237811676	9.572421652	0	1.790821219	2.899409786	0.7249237	1.884267158	9.136674414	1.121940712	4.491770637	0	0.005779044	3.974398749	10.07794516	20.85613687	0.258870946	1.109756813	4.518624502	5.191666579	7.412307269	0.153177585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5739
H4528_803_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	267.6983362	3.158583323	58.79590356	43.51025346	7.854311345	12.7164381	3.179422032	8.264153203	40.07227787	4.920687544	19.70032781	0	0.025346145	17.43120131	44.20057019	91.47233162	1.135374647	4.867250529	19.81810541	22.76998132	32.50942554	0.67181717	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067761552	0.067761552	0.146526866	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0	0	0	0	0	0	0												18.1397	0.214030508	8.615179487	0	1.611739097	2.609468808	0.65243133	1.695840442	8.223006973	1.009746641	4.042593573	0	0.00520114	3.576958874	9.070150643	18.77052318	0.232983852	0.998781132	4.066762052	4.672499921	6.671076542	0.137859827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0165			8.703	18.1397	0.214030508	8.615179487	0	1.611739097	2.609468808	0.65243133	1.695840442	8.223006973	1.009746641	4.042593573	0	0.00520114	3.576958874	9.070150643	18.77052318	0.232983852	0.998781132	4.066762052	4.672499921	6.671076542	0.137859827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0165	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				2.433	0.0287	1.2759	0	0.254	0	0	0.2835	1.2468	0.1713	0.5679	0	0.0008	0.5202	1.1937	2.3314	0.0338	0.1448	0.6106	0.6589	1.0051	0.024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.7844			0	20.5727	0.242733268	9.891109632	0	1.865752586	2.609468808	0.65243133	1.979387492	9.469791878	1.181087441	4.610444895	0	0.005954136	4.097157099	10.26383961	21.10194576	0.26676303	1.143584953	4.677346364	5.33139344	7.676226491	0.16181129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8009
H4528_804_0	2012	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	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	267.6983362	3.158583323	58.79590356	43.51025346	7.854311345	12.7164381	3.179422032	8.264153203	40.07227787	4.920687544	19.70032781	0	0.025346145	17.43120131	44.20057019	91.47233162	1.135374647	4.867250529	19.81810541	22.76998132	32.50942554	0.67181717	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																					0.073968146	0.073968146	0.15994794	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.067761552	0.067761552	0.146526866	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0.205204381	0	0	0	0	0	0	0	0												18.1397	0.214030508	8.615179487	0	1.611739097	2.609468808	0.65243133	1.695840442	8.223006973	1.009746641	4.042593573	0	0.00520114	3.576958874	9.070150643	18.77052318	0.232983852	0.998781132	4.066762052	4.672499921	6.671076542	0.137859827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0165			8.703	18.1397	0.214030508	8.615179487	0	1.611739097	2.609468808	0.65243133	1.695840442	8.223006973	1.009746641	4.042593573	0	0.00520114	3.576958874	9.070150643	18.77052318	0.232983852	0.998781132	4.066762052	4.672499921	6.671076542	0.137859827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0165	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				2.433	0.0287	1.2759	0	0.254	0	0	0.2835	1.2468	0.1713	0.5679	0	0.0008	0.5202	1.1937	2.3314	0.0338	0.1448	0.6106	0.6589	1.0051	0.024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.7844			0	20.5727	0.242733268	9.891109632	0	1.865752586	2.609468808	0.65243133	1.979387492	9.469791878	1.181087441	4.610444895	0	0.005954136	4.097157099	10.26383961	21.10194576	0.26676303	1.143584953	4.677346364	5.33139344	7.676226491	0.16181129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8009
H4529_002_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	852.6906055	46.50639092	88.49022256		85.60148338	5.061703245	5.228881994	269.5691495	105.0155529		5.995126719	14.97166742	0.009581951	6.761053913		2782.15552	67.16614649	672.0229114			9.780393112				159.1037094																3200	"1a - IP Acute 100 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 100 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 150 copay,9b - OP Ambulatory Surgical Center (ASC) 150 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 150 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 15 copay,7f - Podiatry 15 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 15 copay,18a - Hearing Exam (M/C) 15 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 15 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 15 copay,18a - Hearing Exam (M/C) 15 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 25"											0	NO	61.89538407	142.4713977	60.09645318		100	0.2	0.2	64.74273428	150		0.2	150	0.2	0.199341962		15.00532801	40	20			0.2				5																YES	59.6739557	137.3580923	57.93958853		96.41099509	0.19282199	0.19282199	62.41911437	144.6164926		0.19282199	144.6164926	0.19282199	0.192187569		14.46678605	38.56439804	19.28219902			0.19282199				5																	4.2403	0.532335761	0.427257257	0	0.687743683	0.976007693	1.008243432	1.402188965	1.265581745	0	1.155992265	0.180429169	0.001847611	1.299390515	0	3.354070723	0.215851834	1.07983996	0	0	1.885874865	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.7792	0		0.733835809	4.2403	0.532335761	0.427257257	0	0.687743683	0.976007693	1.008243432	1.402188965	1.265581745	0	1.155992265	0.180429169	0.001847611	1.299390515	0	3.354070723	0.215851834	1.07983996	0	0	1.885874865	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.7792	YES	"1a - IP Acute 20% coin, 1a1 - Add'l Days Unlimited"	1b - IP Psych 20% coin	"2a - Skilled Nursing Facility (SNF) 20% coin, 2a2 (Waiver 3 Day) 0 copay"	6a - Home Health 0 copay	10a - Ambulance n/a	11a - Durable Medical Equipment (DME) n/a	11b - Prosthetics & Medical Supplies 20% coin	"4a - ER n/a, 4a1 - ER - Worldwide Coverage n/a, 4b - UC n/a"	"9a4 - OP Surgical (Hospital) 20% coin,9b - OP Ambulatory Surgical Center (ASC) 20% coin"	8a - OP Diag Proc/Test/Lab  (M/C) 20% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 20% coin	12 - End Stage Renal Disease (ESRD) n/a	"3 - Cardiac and Pulmonary Rehab Services n/a, 5 - Partial Hosp n/a, 9a2 - OP Other 20% coin, 9a3 - OP Chemo n/a, 9c - OP Substance Abuse (SA) n/a, 9d - OP Blood Services 20% coin, 9d1 (3 Pint Blood) 20% coin"	"7a - PCP w/Copay 40 copay,14a - Zero Cost-sharing Preventive Services (M/C) n/a,14a2 (Routine Physical) n/a,14a3 (Pap & Pelvic Exam) n/a,14a4 (Prostate Screening) n/a,14a5 (Colorectal Screening) n/a,14a6 (Mammography) n/a,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) n/a,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) n/a,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 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"	7h - Psych n/a	7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay	"7e - MH Professional n/a, 7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 20% coin"	"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 20% coin"	15 - Part B Rx n/a	"14a1 (Smoking Cessation - Mdcr Covered) n/a, , ,16b - Comprehensive Dental (M/C) 40 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) n/a,16b1 - Routine Comprehensive Dental n/a"	17a - Eye Exam (M/C) 40 copay 17b - Eyewear (M/C) n/a	17b1 - Routine Eyewear Allowance (1 per 2yrs.) n/a	18a1 - Routine Hearing Exam n/a	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters n/a, 14c2 - Nutritional Benefit n/a, 14c2 - Nutritional Benefit n/a"	"13a - Acupuncture n/a,13b - OTC Rx n/a"											3200	1.6691	0.0314	0.0328				0.0584		0.2913	0.0217	0.0542	0.0116		0.0704	0.7875	0.509		0.0625		0.0585		0.0011																			3.6596	0		0.13575981	5.9094	0.563783959	0.46005736	0	0.687743683	0.976007693	1.066615421	1.402188965	1.556907551	0.021748135	1.210157134	0.192073731	0.001847611	1.369745362	0.787513853	3.863024601	0.215851834	1.142357011	0	0.05851228	1.885874865	0.001105978	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4388
H4529_004_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1242.919679	81.93648341	495.8662275		163.5880142	8.43258353	5.096444694	424.4151695	158.3467919		3.788612627	23.10275495	0.085797619	6.246677694	4048.609595	3182.552766	104.2392958	490.106172			15.71407511				159.1037094																4950	"1a - IP Acute 255 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 200 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 450 copay,9b - OP Ambulatory Surgical Center (ASC) 450 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 450 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 7 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 10 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													172.8461944	142.4713977	60.09645318		200	0.2	0.2	63.86995523	450		0.2	450	0.2	0.199033048	7	34.37805402	40	20			0.2				10																NO	162.2108013	133.7049952	56.39866044		187.6938071	0.187693807	0.187693807	59.93997527	422.3110659		0.187693807	422.3110659	0.187693807	0.186786353	6.569283247	32.28584382	37.53876141	18.76938071			0.187693807				10																	16.8012	0.912943093	2.330515915	0	2.558704764	1.582743706	0.956571107	2.119952897	5.572633541	0	0.711099128	0.813045756	0.016103682	1.166794144	2.216371932	8.562616796	0.326084504	0.766582444	0	0	2.949434582	0	0	0	0.132586424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.496	0		3.29556306	16.8012	0.912943093	2.330515915	0	2.558704764	1.582743706	0.956571107	2.119952897	5.572633541	0	0.711099128	0.813045756	0.016103682	1.166794144	2.216371932	8.562616796	0.326084504	0.766582444	0	0	2.949434582	0	0	0	0.132586424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.496	NO																																																																																		0	0		0	16.8012	0.912943093	2.330515915	0	2.558704764	1.582743706	0.956571107	2.119952897	5.572633541	0	0.711099128	0.813045756	0.016103682	1.166794144	2.216371932	8.562616796	0.326084504	0.766582444	0	0	2.949434582	0	0	0	0.132586424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.496
H4529_007_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	230.1982881	0.922034948	8.867509701		5.242497011	5.715372577	5.666960091	17.23804085	22.26785041	4.530878095	6.729782435	1.461056148	0.137798261	8.442330974		3418.147158	1.547488024	649.418423		2736.492743	8.380297464	0.026140635			159.1037094		0.657707507														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 100"													0.080753296	0.080753296	0.212931996		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.730017091	0.224	1421.771594			5		10														NO	0.074349682	0.074349682	0.196046811		0.20623714	0.20623714	0.20623714	0.20623714	0.20623714	0.20623714	0.20623714	0.20623714	0.20623714	0.20623714		9.207015162	0.20623714	9.207015162		2.513530874	0.20623714	1309.027262			5		10															17.1152	0.068553005	1.738446999	0	1.081197588	1.178722092	1.168737639	3.555124238	4.592457775	0.934435338	1.38793108	0.301324041	0.028419119	1.741122192	0	2.622577726	0.319149504	0.498267106	0	0.57318825	1.728328578	0.002851567	0	0	0.066293212	0	0.00054809	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7028	0		3.499911094	17.1152	0.068553005	1.738446999	0	1.081197588	1.178722092	1.168737639	3.555124238	4.592457775	0.934435338	1.38793108	0.301324041	0.028419119	1.741122192	0	2.622577726	0.319149504	0.498267106	0	0.57318825	1.728328578	0.002851567	0	0	0.066293212	0	0.00054809	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7028	NO																																																																																		0	0		0	17.1152	0.068553005	1.738446999	0	1.081197588	1.178722092	1.168737639	3.555124238	4.592457775	0.934435338	1.38793108	0.301324041	0.028419119	1.741122192	0	2.622577726	0.319149504	0.498267106	0	0.57318825	1.728328578	0.002851567	0	0	0.066293212	0	0.00054809	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7028
H4529_014_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1208.560211	39.96424982	635.8960675		216.2527532	11.75384916	5.765000921	497.5015788	288.373354		18.03127943	45.37687897	0.039044163	27.66807082		3298.650925	99.39140511	797.6667512			19.40712395	0.350603869			159.1037094																4950	"1a - IP Acute 150 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 125 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 175 copay,9b - OP Ambulatory Surgical Center (ASC) 175 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 175 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 15 copay,7f - Podiatry 15 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 15 copay,18a - Hearing Exam (M/C) 15 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 15 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 15 copay,18a - Hearing Exam (M/C) 15 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													108.723085	142.4713977	60.09645318		125	0.2	0.2	64.75	175		0.2	175	0.2	0.199851792		15.19786786	40	20			0.2	15			5																NO	103.2935085	135.3564474	57.09526639		118.7575626	0.1900121	0.1900121	61.51641741	166.2605876		0.1900121	166.2605876	0.1900121	0.189871294		14.4464855	38.00242002	19.00121001			0.1900121	14.25090751			5																	10.403	0.450784907	3.025554614	0	2.140137489	2.233373563	1.095419932	2.550376232	3.995426941	0	3.426161272	0.62869888	0.007418863	5.253372396	0	3.971159398	0.314759494	1.263052788	0	0	3.687588379	0.000416369	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.513	0		2.334126057	10.403	0.450784907	3.025554614	0	2.140137489	2.233373563	1.095419932	2.550376232	3.995426941	0	3.426161272	0.62869888	0.007418863	5.253372396	0	3.971159398	0.314759494	1.263052788	0	0	3.687588379	0.000416369	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.513	NO																																																																																		0	0		0	10.403	0.450784907	3.025554614	0	2.140137489	2.233373563	1.095419932	2.550376232	3.995426941	0	3.426161272	0.62869888	0.007418863	5.253372396	0	3.971159398	0.314759494	1.263052788	0	0	3.687588379	0.000416369	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.513
H4529_027_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1072.147767	58.44653688	507.4990185		166.3554024	8.498385473	5.392917286	325.7872347	234.0597897		8.147145931	27.04845727	0.149473413	9.193483619		3745.867533	120.5164191	359.3360957			17.02829321				159.1037094		0.981598543														4900	"1a - IP Acute 225 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 300 copay,9b - OP Ambulatory Surgical Center (ASC) 300 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 300 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 20 copay,7f (Podiatry) 20 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 20 copay,18a - Hearing Exam (M/C) 20 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 20 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 20 copay,18a - Hearing Exam (M/C) 20 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													163.0846274	142.4713977	60.09645318		150	0.2	0.2	63.30855351	300		0.2	300	0.2	0.199169968		19.99751903	40	20			0.2				5		20														NO	155.2762499	135.6499672	57.21907719		142.8181053	0.19042414	0.19042414	60.27738441	285.6362106		0.19042414	285.6362106	0.19042414	0.18963385		19.04017189	38.08482808	19.04241404			0.19042414				5		20															13.8733	0.660689234	2.419885459	0	1.979880282	1.618297748	1.026941638	1.636466865	5.571329282	0	1.551413261	0.643834903	0.028463346	1.743395694	0	5.94349681	0.382487258	0.570218893	0	0	3.242598098	0	0	0	0.066293212	0	0.001635998	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9606	0		2.156903825	13.8733	0.660689234	2.419885459	0	1.979880282	1.618297748	1.026941638	1.636466865	5.571329282	0	1.551413261	0.643834903	0.028463346	1.743395694	0	5.94349681	0.382487258	0.570218893	0	0	3.242598098	0	0	0	0.066293212	0	0.001635998	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9606	NO																																																																																		0	0		0	13.8733	0.660689234	2.419885459	0	1.979880282	1.618297748	1.026941638	1.636466865	5.571329282	0	1.551413261	0.643834903	0.028463346	1.743395694	0	5.94349681	0.382487258	0.570218893	0	0	3.242598098	0	0	0	0.066293212	0	0.001635998	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9606
H4529_028_0	2012	10																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1452.795418	57.9453148	604.0687123		124.875319	8.927185882	11.11242638	317.1982484	436.1240151		12.717287	41.80591277	0.581837335	19.01103723		5316.969763	239.7394806	525.0026038			23.35000424				159.1037094																4400	"1a - IP Acute 150 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 200 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 275 copay,9b - OP Ambulatory Surgical Center (ASC) 275 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 275 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													108.723085	142.4713977	60.09645318		200	0.2	0.2	60	275		0.2	275	0.2	0.197490616		24.78310786	40	20			0.2				5																NO	99.65359068	130.5866768	55.08330958		183.3163412	0.183316341	0.183316341	54.99490236	252.0599691		0.183316341	252.0599691	0.183316341	0.181016286		22.71574328	36.66326824	18.33163412			0.183316341				5																	12.0647	0.630573841	2.77284199	0	1.907640548	1.636499053	2.037089347	1.453690558	9.160783815	0	2.331286524	0.87813309	0.106660292	3.441307347	0	10.06491001	0.732469407	0.80201297	0	0	4.280437345	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3673	0		4.941947823	12.0647	0.630573841	2.77284199	0	1.907640548	1.636499053	2.037089347	1.453690558	9.160783815	0	2.331286524	0.87813309	0.106660292	3.441307347	0	10.06491001	0.732469407	0.80201297	0	0	4.280437345	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3673	NO																																																																																		0	0		0	12.0647	0.630573841	2.77284199	0	1.907640548	1.636499053	2.037089347	1.453690558	9.160783815	0	2.331286524	0.87813309	0.106660292	3.441307347	0	10.06491001	0.732469407	0.80201297	0	0	4.280437345	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3673
H4529_030_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1388.375136	96.06854903	747.4627715		283.1946216	11.48758291	4.432376142	503.8221007	161.3467095		11.28366379	26.58202494	0.0120716	10.65964513		2698.755958	82.89244517	427.5139353			15.3862652				159.1037094																3400	"1a - IP Acute 150 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 125 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 175 copay,9b - OP Ambulatory Surgical Center (ASC) 175 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 175 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 15 copay,7f - Podiatry 15 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 15 copay,18a - Hearing Exam (M/C) 15 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 15 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 15 copay,18a - Hearing Exam (M/C) 15 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													108.723085	142.4713977	60.09645318		125	0.2	0.2	64.75	175		0.2	175	0.2	0.200274456		15.14655154	40	20			0.2				5																NO	100.9539636	132.2906934	55.80208792		116.0677647	0.185708424	0.185708424	60.12310214	162.4948706		0.185708424	162.4948706	0.185708424	0.185963267		14.0643861	37.14168472	18.57084236			0.185708424				5																	11.6802	1.059081247	3.475831941	0	2.739147227	2.133340913	0.823129586	2.524278968	2.184834391	0	2.095471414	0.359953559	0.002241798	1.982302437	0	3.163028817	0.256563755	0.661607825	0	0	2.857359055	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0646	0		2.924198359	11.6802	1.059081247	3.475831941	0	2.739147227	2.133340913	0.823129586	2.524278968	2.184834391	0	2.095471414	0.359953559	0.002241798	1.982302437	0	3.163028817	0.256563755	0.661607825	0	0	2.857359055	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0646	NO																																																																																		0	0		0	11.6802	1.059081247	3.475831941	0	2.739147227	2.133340913	0.823129586	2.524278968	2.184834391	0	2.095471414	0.359953559	0.002241798	1.982302437	0	3.163028817	0.256563755	0.661607825	0	0	2.857359055	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0646
H4529_031_0	2012	8																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	255.8707977	6.906727818	35.25748758		9.91716473	8.27077681	10.48952197	29.38963968	110.7627658	7.140964313	19.26802754	4.840780306	0.547890064	31.82304571		5684.779287	4.008219418	875.9387666		3085.681564	23.88497274	0.086707883			159.1037094		1.819985823														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 100"													0.079594027	0.079594027	0.196120807		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		3.260337901	0.224	1187.761078			5		10														NO	0.064548264	0.064548264	0.159047834		0.181656987	0.181656987	0.181656987	0.181656987	0.181656987	0.181656987	0.181656987	0.181656987	0.181656987	0.181656987		8.109686924	0.181656987	8.109686924		2.644031964	0.181656987	963.2370479			5		10															16.516	0.445817292	5.607627039	0	1.801522265	1.502444396	1.905494956	5.338833397	20.12083031	1.297206062	3.50017183	0.879361566	0.099528058	5.780878603	0	3.841815021	0.728121063	0.591965763	0	0.679886724	4.338872184	0.00696002	0	0	0.066293212	0	0.001516655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0512	0		17.47811141	16.516	0.445817292	5.607627039	0	1.801522265	1.502444396	1.905494956	5.338833397	20.12083031	1.297206062	3.50017183	0.879361566	0.099528058	5.780878603	0	3.841815021	0.728121063	0.591965763	0	0.679886724	4.338872184	0.00696002	0	0	0.066293212	0	0.001516655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0512	NO																																																																																		0	0		0	16.516	0.445817292	5.607627039	0	1.801522265	1.502444396	1.905494956	5.338833397	20.12083031	1.297206062	3.50017183	0.879361566	0.099528058	5.780878603	0	3.841815021	0.728121063	0.591965763	0	0.679886724	4.338872184	0.00696002	0	0	0.066293212	0	0.001516655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0512
H4590_010_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1268.75984	35.69317902	1113.533892	674.786547	544.4893947	10.31126853	11.06680451	206.5221923	257.4955728	46.01510148	83.18300065	0	0.385690005	1426.842223	10180.65048	6653.953779	214.6591428	1289.40916	0	0	29.89212734	1217.244874	701.7391304	0	83.84957851	0.491999545	0	4.733429502	144.1993907	0											3900	"$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 21-53 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $75 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b); $0 n/c (7b1); $32 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0/$32 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $32 (16b, 18a); $0/$32 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$32 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $20 (17b2)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	48.78702785	29.97451514	33.94938952	0	200	0.2	0.098741911	64.99117558	30.75	0	0.144970889	0	0.2	26.57900083	0.000609266	31.69052955	38.5	15	0	0	0.2	28.15286527	0	0	32	20	0	122.5	0	0											NO	39.50394393	24.27103305	27.48957744	0	161.9444581	0.161944458	0.079953526	52.65691877	24.89896043	0	0.11738616	0	0.161944458	21.52160942	0.000600078	31.21271893	37.91939409	14.77378991	0	0	0.161944458	22.79600255	0	0	32	20	0	122.5	0	0												4.1768	0.072192527	2.550881346	0	7.348086662	1.669852793	0.884830044	0.906235192	0.534281007	0	9.764533022	0	0.062460359	2.558995085	0.000509098	17.30733242	0.678312053	1.587455003	0	0	4.840864362	2.31235977	0	0	0.223598876	0.000819999	0	0.048320426	0	0	0	0	0	0	0	0	0	0	0	0	57.5287	0	NO	9.153980801	4.1768	0.072192527	2.550881346	0	7.348086662	1.669852793	0.884830044	0.906235192	0.534281007	0	9.764533022	0	0.062460359	2.558995085	0.000509098	17.30733242	0.678312053	1.587455003	0	0	4.840864362	2.31235977	0	0	0.223598876	0.000819999	0	0.048320426	0	0	0	0	0	0	0	0	0	0	0	0	57.5287	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	4.1768	0.072192527	2.550881346	0	7.348086662	1.669852793	0.884830044	0.906235192	0.534281007	0	9.764533022	0	0.062460359	2.558995085	0.000509098	17.30733242	0.678312053	1.587455003	0	0	4.840864362	2.31235977	0	0	0.223598876	0.000819999	0	0.048320426	0	0	0	0	0	0	0	0	0	0	0	0	57.5287
H4590_012_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1472.865454	2.501600544	1057.132339	728.9127391	264.702314	14.30817117	11.6885567	348.2537639	378.041137	27.96648704	53.32629093	0	0.234203095	997.2952666	6979.068765	5975.699361	1.62716943	1256.21899	0	0	29.73698686	982.0369655	0	0	73.12955007	285.2249353	0	5.904060406	144.9670872	0											4900	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-3/$50 Days 4-20/$146 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $14 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $160 (18b2); $110 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	130.982886	87.20789285	79.47645335	0	200	0.2	0.102702456	64.99533958	71.75	0.173825865	0.173123913	0	0.2	60.00171054	3.12449619	33.82415032	38.5	35	0	0	0.2	30.52291856	0	0	35	30	0	122.5	0	0											NO	105.9145922	70.51752096	64.26577092	0	161.7227951	0.161722795	0.083046641	52.57640834	58.01805276	0.140558023	0.139990415	0	0.161722795	48.51822171	3.077039537	33.31057877	37.91523976	34.46839978	0	0	0.161722795	24.68125853	0	0	35	30	0	122.5	0	0												12.9998	0.014700556	5.661452063	0	3.567366509	2.313957435	0.970695373	1.525827675	1.827767553	3.930914141	7.465169614	0	0.037875979	4.032249405	1.789572543	16.58783369	0.00514121	3.608321531	0	0	4.809148634	2.019825686	0	0	0.213294521	0.713062338	0	0.060270617	0	0	0	0	0	0	0	0	0	0	0	0	74.1543	0	NO	12.45107541	12.9998	0.014700556	5.661452063	0	3.567366509	2.313957435	0.970695373	1.525827675	1.827767553	3.930914141	7.465169614	0	0.037875979	4.032249405	1.789572543	16.58783369	0.00514121	3.608321531	0	0	4.809148634	2.019825686	0	0	0.213294521	0.713062338	0	0.060270617	0	0	0	0	0	0	0	0	0	0	0	0	74.1543	NO																																										0	0	0	0	0	0	0	0	0	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	12.9998	0.014700556	5.661452063	0	3.567366509	2.313957435	0.970695373	1.525827675	1.827767553	3.930914141	7.465169614	0	0.037875979	4.032249405	1.789572543	16.58783369	0.00514121	3.608321531	0	0	4.809148634	2.019825686	0	0	0.213294521	0.713062338	0	0.060270617	0	0	0	0	0	0	0	0	0	0	0	0	74.1543
H4590_020_0	2012	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	414.9552579	8.195153013	70.80731164	1504.641591	16.7152093	42.89246948	31.15685226	40.20420819	118.0297329	41.59684481	91.44774112	0	0.332498767	43.61152903	59.15674057	183.4479548	3.136596559	10.77991444	0	462.5397322	48.71032671	17.57538239	930.222859	178.7967905	151.0601593	1150.513141	0	6.425047694	123.1792705	3364.337421											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.078218869	0.079168896	0.190605851	0	0.224	0.224	0.140386449	0.118084978	0.224	0.224	0.224	0	0.224	0.224	0.218345634	0.223988422	0.223733662	0.224	0	0	0.224	0.223273524	0	0	0	0	0	0	0	0											NO	0.058904882	0.059620325	0.143541005	0	0.168689393	0.168689393	0.105721897	0.088947155	0.168689393	0.168689393	0.168689393	0	0.168689393	0.168689393	0.164431216	0.168680673	0.168488819	0.168689393	0	0	0.168689393	0.168889648	0	0	0	0	0	0	0	0												24.4429	0.48859769	10.1637527	0	2.819678502	7.23550462	3.293961512	3.576049955	19.91036394	7.01694648	15.4262639	0	0.056089015	7.356802337	9.727214786	30.94412451	0.52848145	1.818457219	0	0	8.216915421	2.968300139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.9904	150	YES	51.1282958	24.4429	0.48859769	10.1637527	0	2.819678502	7.23550462	3.293961512	3.576049955	19.91036394	7.01694648	15.4262639	0	0.056089015	7.356802337	9.727214786	30.94412451	0.52848145	1.818457219	0	0	8.216915421	2.968300139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.9904	NO																																										0	0	0	0	0	0	0	0	0	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	24.4429	0.48859769	10.1637527	0	2.819678502	7.23550462	3.293961512	3.576049955	19.91036394	7.01694648	15.4262639	0	0.056089015	7.356802337	9.727214786	30.94412451	0.52848145	1.818457219	0	0	8.216915421	2.968300139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.9904
H4590_022_0	2012	5																															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	1084.000479	15.78749007	404.1931229	590.836152	422.9579744	24.05260991	25.720455	283.6047718	190.4436884	17409.01886	127.1102746	0	1.816111673	1035.342774	10776.70277	8729.967326	162.3553695	1363.845079	0	0.229097001	46.74070861	1265.812711	897.6619549	170.76497	130.7935256	1373.824928	0	3.360799269	218.0331701	3313.03507											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); $0/20% (11c)"	"$65 (4a, 4a1); $50 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	$0 (8b1); 20% (8b2); $20 (8b3)	Included in h.5.	20% (12)	"$0 (3, 9a); $10 (5, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $50 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	0	0	0	50	0.2	0.101044287	64.98239346	0	0	0.112559483	0	0.2	0	0.003861773	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	47.2140435	0.188856174	0.095414187	61.36708999	0	0	0.106287766	0	0.188856174	0	0.003646598	0	9.442808699	0	0	0	0.188856174	0	0	0	0	0	0	0	0	0												0	0	0	0	1.664129683	4.542483883	2.454096305	1.450333296	0	0	13.51026713	0	0.342983902	0	0.003274859	0	0.127757558	0	0	0	8.827271397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9226	0	NO	1.942525326	0	0	0	0	1.664129683	4.542483883	2.454096305	1.450333296	0	0	13.51026713	0	0.342983902	0	0.003274859	0	0.127757558	0	0	0	8.827271397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9226	NO																																										0	0	0	0	0	0	0	0	0	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	1.664129683	4.542483883	2.454096305	1.450333296	0	0	13.51026713	0	0.342983902	0	0.003274859	0	0.127757558	0	0	0	8.827271397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9226
H4590_025_0	2012	5																															A	A	D	V	T	Coin	Coin	V	V	Coin	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	267.7284863	0.250521279	708.5331553	678.7853942	367.9814655	11.30194606	14.55648608	372.7836623	340.1699823	23.11606997	44.42633467	0	0.220644373	1409.34634	6438.083095	5646.835909	0.945641801	961.8886924	0	0	25.76179089	1098.645977	0	0	46.48265161	206.564427	8.29864469	4.09138853	97.87334068	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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $13 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); $75 (9a); $40/$30 (9c)	"$10 (7a); $20 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	148.2	150	36.45441691	0	200	0.2	0.108016812	64.97841063	30.75	0.186274463	0.178445728	0	0.2	26.52624232	6.707797466	20	38.5	20	0	0	0.2	15.19372813	0	0	20	30	0	0	0	0											NO	132.5851605	134.1955066	32.61345963	0	178.9273421	0.178927342	0.096635805	58.14196272	27.51007885	0.166647973	0.159644099	0	0.178927342	23.73135017	6.656592311	19.84758093	38.20610346	19.84732647	0	0	0.178927342	13.59286695	0	0	20	30	0	0	0	0												2.9581	0.002801569	1.925643121	0	5.486828797	2.022227168	1.406677752	1.806197816	0.77984192	3.852246204	7.092402185	0	0.039479311	2.78714096	3.571307869	9.339669391	0.003010774	1.590909909	0	0	4.609488772	1.24447905	0	0	0.077471086	0.516411067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1123	0	NO	4.35250342	2.9581	0.002801569	1.925643121	0	5.486828797	2.022227168	1.406677752	1.806197816	0.77984192	3.852246204	7.092402185	0	0.039479311	2.78714096	3.571307869	9.339669391	0.003010774	1.590909909	0	0	4.609488772	1.24447905	0	0	0.077471086	0.516411067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1123	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	2.9581	0.002801569	1.925643121	0	5.486828797	2.022227168	1.406677752	1.806197816	0.77984192	3.852246204	7.092402185	0	0.039479311	2.78714096	3.571307869	9.339669391	0.003010774	1.590909909	0	0	4.609488772	1.24447905	0	0	0.077471086	0.516411067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1123
H4590_027_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1152.546855	1.205197551	733.3019245	533.8425787	189.159529	10.56529401	7.477260277	274.9503408	328.6038158	24.39273586	46.04671993	0	0.118273463	807.8720652	5646.371112	4897.313958	0.564540675	1195.066573	0	0	27.59068761	792.8082165	0	0	55.69208409	239.900891	17.6381231	65	302.3026782	0											4500	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-3/$50 Days 4-20/$146 Days 21-45 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$5 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $150 (18b2); $100 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	130.982886	87.20789285	77.03066353	0	200	0.2	0.123694549	64.97664348	71.75	0.11723013	0.172157453	0	0.2	56.07552809	3.081175104	33.54198385	38.5	35	0	0	0.2	30.26442353	0	0	35	30	5	112.5	0	0											NO	111.4264429	74.18728958	65.52957484	0	170.1389339	0.170138934	0.105226293	55.29526375	61.03734253	0.099727046	0.146453427	0	0.170138934	47.70315283	3.046471743	33.16466484	38.06637342	34.60579402	0	0	0.170138934	25.74578377	0	0	35	30	5	112.5	0	0												10.702	0.007450862	4.004413612	0	2.68195005	1.797567858	0.786804384	1.266954301	1.671425305	2.4326155	6.743699958	0	0.020122921	3.211503716	1.43345917	13.53481467	0.001790835	3.446352304	0	0	4.694250175	1.700955743	0	0	0.162435245	0.599752227	0.007349218	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	61.5171	0	NO	7.531633793	10.702	0.007450862	4.004413612	0	2.68195005	1.797567858	0.786804384	1.266954301	1.671425305	2.4326155	6.743699958	0	0.020122921	3.211503716	1.43345917	13.53481467	0.001790835	3.446352304	0	0	4.694250175	1.700955743	0	0	0.162435245	0.599752227	0.007349218	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	61.5171	NO																																										0	0	0	0	0	0	0	0	0	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	10.702	0.007450862	4.004413612	0	2.68195005	1.797567858	0.786804384	1.266954301	1.671425305	2.4326155	6.743699958	0	0.020122921	3.211503716	1.43345917	13.53481467	0.001790835	3.446352304	0	0	4.694250175	1.700955743	0	0	0.162435245	0.599752227	0.007349218	0.609375	0	0	0	0	0	0	0	0	0	0	0	0	61.5171
H4590_029_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1161.544798	34.60071042	1033.957932	619.834822	503.1208842	9.957823288	9.210827233	182.9678399	240.4871886	43.36794925	77.52835127	0	0.322307562	1346.441644	9508.023941	6208.934377	205.5102988	1229.196414	0	0	29.43350437	1135.7291	701.7391304	520.6657388	66.44228917	209.984	6.481151126	27.49097545	290.1173362	0											3900	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-53 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$65 (4a, 4a1); $40 (4b)"	$0 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $0 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $20 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b); $0 n/c (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 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0	0	39.33906999	0	200	0.2	0.115535088	64.99045518	0	0	0.144770191	0	0.2	0.029158178	0.000416764	0.640651806	38.5	15	0	0	0.2	17.57575205	0	20	20	20	0	342.5	0	0											NO	0	0	34.85161242	0	177.1857465	0.177185747	0.102355854	57.59978686	0	0	0.128256072	0	0.177185747	0.025832067	0.000369224	0.57058898	34.10825621	13.28893099	0	0	0.177185747	15.57086374	0	20	20	20	0	342.5	0	0												0	0	3.002925092	0	7.428820789	1.764384353	0.942782091	0.878242382	0	0	9.943481802	0	0.057108306	0.002898448	0.000292549	0.295229128	0.58413316	1.361225527	0	0	5.215197444	1.473690255	0	0.867776231	0.110737149	0.349973333	0	0.784638257	0	0	0	0	0	0	0	0	0	0	0	0	35.0635	0	NO	4.240505081	0	0	3.002925092	0	7.428820789	1.764384353	0.942782091	0.878242382	0	0	9.943481802	0	0.057108306	0.002898448	0.000292549	0.295229128	0.58413316	1.361225527	0	0	5.215197444	1.473690255	0	0.867776231	0.110737149	0.349973333	0	0.784638257	0	0	0	0	0	0	0	0	0	0	0	0	35.0635	NO																																										0	0	0	0	0	0	0	0	0	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	3.002925092	0	7.428820789	1.764384353	0.942782091	0.878242382	0	0	9.943481802	0	0.057108306	0.002898448	0.000292549	0.295229128	0.58413316	1.361225527	0	0	5.215197444	1.473690255	0	0.867776231	0.110737149	0.349973333	0	0.784638257	0	0	0	0	0	0	0	0	0	0	0	0	35.0635
H4590_033_0	2012	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	356.8819068	7.498495711	51.44803282	1196.215596	14.11939262	26.65358439	25.07843694	33.92935658	95.90622805	34.54352981	86.80085532	0	0.188370903	33.56151792	52.37489943	172.4304627	3.133969243	11.46449493	0	450.6822376	50.73226361	14.51942124	814.2142533	651.4906822	49.30367172	236.8324666	10.37206319	2.806046019	160.3920985	3423.711943											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.079320617	0.080283923	0.198943417	0	0.224	0.224	0.128503253	0.13998188	0.224	0.224	0.224	0	0.224	0.224	0.221546071	0.223920651	0.227178653	0.224	0	0	0.224	0.222760401	0	0	0	0	0	0	0	0											NO	0.062430192	0.063188373	0.156580675	0	0.176301743	0.176301743	0.101139944	0.110193996	0.176301743	0.176301743	0.176301743	0	0.176301743	0.176301743	0.17437035	0.17623929	0.178803538	0.176301743	0	0	0.176301743	0.176424511	0	0	0	0	0	0	0	0												22.2802	0.473817741	8.055767694	0	2.489273524	4.699073376	2.536431709	3.738811392	16.90843514	6.090084504	15.30314206	0	0.033210118	5.916954096	9.13262956	30.38902228	0.560364787	2.021210435	0	0	8.944186484	2.561581797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.1342	150	YES	38.43315316	22.2802	0.473817741	8.055767694	0	2.489273524	4.699073376	2.536431709	3.738811392	16.90843514	6.090084504	15.30314206	0	0.033210118	5.916954096	9.13262956	30.38902228	0.560364787	2.021210435	0	0	8.944186484	2.561581797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.1342	NO																																										0	0	0	0	0	0	0	0	0	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	22.2802	0.473817741	8.055767694	0	2.489273524	4.699073376	2.536431709	3.738811392	16.90843514	6.090084504	15.30314206	0	0.033210118	5.916954096	9.13262956	30.38902228	0.560364787	2.021210435	0	0	8.944186484	2.561581797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.1342
H4590_037_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1118.742052	34.53009583	744.9359303	681.4221302	444.9030844	16.64111247	25.1895447	237.4136874	225.436269	62.21042614	115.512847	0	0.208179589	1219.470216	9104.626393	6414.299948	123.8103437	1191.722426	0	0	33.3001823	1026.738139	811.2909581	0	55.62895288	43.656	4.622212128	3.440034823	316.2963971	0											3900	"$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 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $75 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$9 (7b); $0 n/c (7b1); $32 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0/$32 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $32 (16b, 18a); $0/$32 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$32 (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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	48.78702785	29.97451514	46.71351397	0	200	0.2	0.078452966	64.98845309	30.75	0	0.14371939	0	0.2	26.82536486	0.0010248	31.85902305	38.5	15	0	0	0.2	30.33535368	0	0	32	20	0	0	0	0											NO	39.00874483	23.96678511	37.35082105	0	159.9144139	0.159914414	0.0627288	51.99388403	24.58684114	0	0.11491401	0	0.159914414	21.4488125	0.001008324	31.34799406	37.88101346	14.75883641	0	0	0.159914414	24.25530152	0	0	32	20	0	0	0	0												3.6367	0.068964616	2.318664052	0	5.928867999	2.661153749	1.580109916	1.028671644	0.461897144	0	13.27404449	0	0.033290917	2.179682334	0.000765034	16.75628639	0.390838441	1.465703028	0	0	5.325179136	2.075320263	0	0	0.148343874	0.07276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4073	0	NO	10.47302761	3.6367	0.068964616	2.318664052	0	5.928867999	2.661153749	1.580109916	1.028671644	0.461897144	0	13.27404449	0	0.033290917	2.179682334	0.000765034	16.75628639	0.390838441	1.465703028	0	0	5.325179136	2.075320263	0	0	0.148343874	0.07276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4073	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	3.6367	0.068964616	2.318664052	0	5.928867999	2.661153749	1.580109916	1.028671644	0.461897144	0	13.27404449	0	0.033290917	2.179682334	0.000765034	16.75628639	0.390838441	1.465703028	0	0	5.325179136	2.075320263	0	0	0.148343874	0.07276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4073
H4590_038_0	2012	3																															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	251.8974811	48.29423718	9224.285042	16.52030238	23.16307545	33.94847113	6.199951631	17.97538285	52.37472967	59.24640678	21.33388256	0	0	26.1745951	5.320892665	182.4122807	22.0163825	115.431521	0	0	55.7490519	16.8921963	1507.893137	160	43.64651163	220.864	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.07720274	0.078140302	0	0	0.2	0.2	0.192275425	0.099563911	0.16	0	0.085911248	0	0	0.146279515	0	0.032692534	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.069620889	0.070466376	0	0	0.180358596	0.180358596	0.173392628	0.089786036	0.144286877	0	0.077474161	0	0	0.13191384	0	0.029481897	0.180358596	0	0	0	0.180358596	0.181031238	0	0	0	0	0	0	0	0												17.5373	3.403119876	0	0	4.177659768	6.12289859	1.07502591	1.613938378	7.556986168	0	1.652824647	0	0	3.452791354	0	5.377860113	3.970843837	0	0	0	10.05482073	3.05801521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0541	0	NO	7.507528016	17.5373	3.403119876	0	0	4.177659768	6.12289859	1.07502591	1.613938378	7.556986168	0	1.652824647	0	0	3.452791354	0	5.377860113	3.970843837	0	0	0	10.05482073	3.05801521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0541	NO																																										0	0	0	0	0	0	0	0	0	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	17.5373	3.403119876	0	0	4.177659768	6.12289859	1.07502591	1.613938378	7.556986168	0	1.652824647	0	0	3.452791354	0	5.377860113	3.970843837	0	0	0	10.05482073	3.05801521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0541
H4590_039_0	2012	3																															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	239.7664756	45.96904328	8802.528943	15.76495514	21.09322989	30.92610005	5.640803356	21.82922584	62.29681133	71.1288552	25.60505764	0	0	30.84936939	4.766338891	162.3185917	20.12734614	110.1537192	0	0	50.45765413	14.83734449	1507.893137	160	43.64651163	220.864	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.073675755	0.074570498	0	0	0.2	0.2	0.192277596	0.078237779	0.16	0	0.086131985	0	0	0.146287629	0	0.032791861	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.066978088	0.067791491	0	0	0.18181853	0.18181853	0.174798149	0.07112539	0.145454824	0	0.078301955	0	0	0.132989008	0	0.02981084	0.18181853	0	0	0	0.18181853	0.182466587	0	0	0	0	0	0	0	0												16.0591	3.116309998	0	0	3.835140053	5.622938052	0.986001988	1.552612192	9.06137173	0	2.004926067	0	0	4.102627044	0	4.838853591	3.659524488	0	0	0	9.174136503	2.707319611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7209	0	NO	6.661368597	16.0591	3.116309998	0	0	3.835140053	5.622938052	0.986001988	1.552612192	9.06137173	0	2.004926067	0	0	4.102627044	0	4.838853591	3.659524488	0	0	0	9.174136503	2.707319611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7209	NO																																										0	0	0	0	0	0	0	0	0	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	16.0591	3.116309998	0	0	3.835140053	5.622938052	0.986001988	1.552612192	9.06137173	0	2.004926067	0	0	4.102627044	0	4.838853591	3.659524488	0	0	0	9.174136503	2.707319611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7209
H4590_801_0	2012	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	240.4997612	7.107851511	36.9451628	813.8271309	9.765029699	18.94932042	12.28744303	14.06847743	98.38337641	31.35366691	70.54390348	0	0.115441407	30.57764349	41.04087377	135.8421853	2.961078097	8.836298872	0	0	44.13203448	19.07763656	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.078341355	0.078341355	0.190519187	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059944253	0.059944253	0.145779076	0	0.171397504	0.171397504	0.171397504	0.171397504	0.171397504	0.171397504	0.171397504	0	0.171397504	0.171397504	0.171397504	0.171397504	0.171397504	0.171397504	0	0	0.171397504	0.171397504	0	0	0	0	0	0	0	0												14.4166	0.42607485	5.385831704	0	1.673701715	3.24786622	2.106037063	2.411301914	16.86266514	5.373940244	12.09104897	0	0.019786369	5.240931768	7.03430332	23.28301148	0.507521395	1.51451957	0	0	7.564120549	3.269859286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4291	150	YES	34.50488585	14.4166	0.42607485	5.385831704	0	1.673701715	3.24786622	2.106037063	2.411301914	16.86266514	5.373940244	12.09104897	0	0.019786369	5.240931768	7.03430332	23.28301148	0.507521395	1.51451957	0	0	7.564120549	3.269859286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4291	NO																																										0	0	0	0	0	0	0	0	0	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	14.4166	0.42607485	5.385831704	0	1.673701715	3.24786622	2.106037063	2.411301914	16.86266514	5.373940244	12.09104897	0	0.019786369	5.240931768	7.03430332	23.28301148	0.507521395	1.51451957	0	0	7.564120549	3.269859286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4291
H4590_803_0	2012	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	268.9692485	7.519035187	46.7358868	746.7852173	10.75500908	20.38813805	13.07379608	14.2997565	108.9635384	32.60983217	74.07857629	0	0.144551724	34.21590676	43.19914391	145.068318	3.108483696	8.584635385	0	0	50.9323501	20.9304482	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.080601511	0.080601511	0.19207554	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059893439	0.059893439	0.142727655	0	0.166450109	0.166450109	0.166450109	0.166450109	0.166450109	0.166450109	0.166450109	0	0.166450109	0.166450109	0.166450109	0.166450109	0.166450109	0.166450109	0	0	0.166450109	0.166450109	0	0	0	0	0	0	0	0												16.1095	0.450340876	6.670503517	0	1.790172435	3.393607804	2.176134783	2.38019603	18.13699285	5.427910122	12.3303871	0	0.02406065	5.695241413	7.190502217	24.14663736	0.51740745	1.428913496	0	0	8.477695231	3.483875386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8301	150	YES	41.43107871	16.1095	0.450340876	6.670503517	0	1.790172435	3.393607804	2.176134783	2.38019603	18.13699285	5.427910122	12.3303871	0	0.02406065	5.695241413	7.190502217	24.14663736	0.51740745	1.428913496	0	0	8.477695231	3.483875386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8301	NO																																										0	0	0	0	0	0	0	0	0	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	16.1095	0.450340876	6.670503517	0	1.790172435	3.393607804	2.176134783	2.38019603	18.13699285	5.427910122	12.3303871	0	0.02406065	5.695241413	7.190502217	24.14663736	0.51740745	1.428913496	0	0	8.477695231	3.483875386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8301
H4590_804_0	2012	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	265.9331191	7.452803708	46.31610718	743.7105963	10.63249747	20.21787021	12.95377574	14.26297017	107.8709798	32.36962296	73.67773669	0	0.142365204	33.66601012	42.33829314	141.8624447	3.083585477	8.481980095	0	0	50.39155241	20.3507131	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.077426862	0.077426862	0.191821473	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.057861149	0.057861149	0.143348324	0	0.167395361	0.167395361	0.167395361	0.167395361	0.167395361	0.167395361	0.167395361	0	0.167395361	0.167395361	0.167395361	0.167395361	0.167395361	0.167395361	0	0	0.167395361	0.167395361	0	0	0	0	0	0	0	0												15.3872	0.431227787	6.639336341	0	1.779830747	3.384377675	2.168401962	2.387555034	18.05710156	5.418524708	12.3333113	0	0.023831275	5.635533904	7.087233847	23.74711509	0.516177903	1.419844117	0	0	8.435312087	3.406614957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2585	150	YES	39.98904872	15.3872	0.431227787	6.639336341	0	1.779830747	3.384377675	2.168401962	2.387555034	18.05710156	5.418524708	12.3333113	0	0.023831275	5.635533904	7.087233847	23.74711509	0.516177903	1.419844117	0	0	8.435312087	3.406614957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2585	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.3872	0.431227787	6.639336341	0	1.779830747	3.384377675	2.168401962	2.387555034	18.05710156	5.418524708	12.3333113	0	0.023831275	5.635533904	7.087233847	23.74711509	0.516177903	1.419844117	0	0	8.435312087	3.406614957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2585
H4604_003_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	719.3460068	83.50795164	824.1675118	1399.498482	85.42208769	16.83339236	10.12107753	314.8982017	320.2061374	14.28417179	27.40963161	0	0.022468286	774.1093869	4984.981384	3386.817237	476.8858676	710.6346955	0	0	19.20312512	682.5120744	0	0	77.20357856	184.8369174	11.16623475	2.673398366	678.7239572	0											3900	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-6 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$220 (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); $220 (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	101.7427073	63.14206397	0	200	0.2	0.1025671	63.0490698	90.2	0.211930398	0.183696997	0	0.2	77.81945218	3.476828485	38.29225223	38.5	40	0	0	0.2	39.44680517	0	0	40	0	38.88979452	0	0	0											YES	138.7092694	83.80110576	52.00741088	0	164.731425	0.164731425	0.084480123	51.94945668	74.29387269	0.174557982	0.15130334	0	0.164731425	64.09654626	3.374836921	37.16902253	37.37061578	38.8266138	0	0	0.164731425	32.49064214	0	0	40	0	38.88979452	0	0	0											7800	8.315	0.583171557	3.571901535	0	1.172641853	2.772988712	0.855029871	1.36323254	1.982446167	2.493416206	4.147168819	0	0.003701233	4.134811511	1.401958269	10.49039051	1.485126544	2.299294906	0	0	3.163358166	1.847937964	0	0	0.257345262	0	0.036187715	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3771	0	NO	8.267762056	8.315	0.583171557	3.571901535	0	1.172641853	2.772988712	0.855029871	1.36323254	1.982446167	2.493416206	4.147168819	0	0.003701233	4.134811511	1.401958269	10.49039051	1.485126544	2.299294906	0	0	3.163358166	1.847937964	0	0	0.257345262	0	0.036187715	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3771	NO	"$450 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$450 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-45 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.7414	0.0723	0.0868	0.5148	0.1016	0	0.2167	0.1181	1.0097	0.2161	0.524	0	0.0003	0.4339	0.6149	1.2478	0.1558	0.2669	0	0	0.4392	0.2117	0	0	0.0299	0	0.0034	0	0	0											7.0051	0	NO	1.093231278	9.0564	0.655491249	3.658667712	0.514777976	1.274252557	2.772988712	1.071734674	1.481358985	2.992140416	2.709473459	4.671189841	0	0.004021949	4.568684017	2.016817531	11.73814422	1.640922659	2.566146208	0	0	3.602605739	2.059616515	0	0	0.28722825	0	0.039549415	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3822
H4604_005_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	737.7161816	82.67457964	1263.473239	5116.728959	101.2859164	17.9616236	8.495950826	299.7142514	302.9398021	13.36913687	26.39342001	0	0.01192498	732.3800853	4462.043403	3249.447985	472.4013816	699.5203038	0	0	20.0417538	660.0232407	0	0	53.3555252	180.9320161	13.62783802	6.874767188	119.4530572	0											3100	"$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 21-41 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$220 (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); $220 (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	112.1244337	57.31412786	0	200	0.2	0.101665641	63.24188369	90.2	0.113915845	0.184102998	0	0.2	78.05496162	3.425159049	38.28780006	38.5	40	0	0	0.2	39.39017013	0	0	40	0	40	0	0	0											YES	131.4993873	87.55177739	44.75343687	0	156.1689536	0.156168954	0.079385084	49.40647104	70.43219807	0.088950592	0.143755863	0	0.156168954	60.94880839	3.2979048	36.87042314	37.06961721	38.51388801	0	0	0.156168954	30.75760825	0	0	40	0	40	0	0	0											7800	8.0841	0.603192199	4.712064153	0	1.318142965	2.805047962	0.674451772	1.23398529	1.778059679	1.189192634	3.794208864	0	0.001862312	3.719807791	1.226282863	9.984043517	1.459311532	2.245103887	0	0	3.129899719	1.691728023	0	0	0.177851751	0	0.045426127	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8738	0	NO	10.32236874	8.0841	0.603192199	4.712064153	0	1.318142965	2.805047962	0.674451772	1.23398529	1.778059679	1.189192634	3.794208864	0	0.001862312	3.719807791	1.226282863	9.984043517	1.459311532	2.245103887	0	0	3.129899719	1.691728023	0	0	0.177851751	0	0.045426127	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8738	NO	"$450 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$450 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-45 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.7392	0.0696	0.1303	1.6512	0.1171	0	0.1769	0.1097	0.9837	0.1057	0.492	0	0.0002	0.3894	0.5525	1.1903	0.1537	0.2616	0	0	0.4457	0.1989	0	0	0.0207	0	0.005	0	0	0											7.7932	0	NO	1.495186165	8.8233	0.6728016	4.84241408	1.651168874	1.435277649	2.805047962	0.851308238	1.343636138	2.76176047	1.294868351	4.286213184	0	0.002027803	4.109190998	1.778761533	11.17430721	1.612982278	2.506657735	0	0	3.575597371	1.890670525	0	0	0.198503935	0	0.050408515	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6669
H4604_801_0	2012	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	170.7380847	5.6544	30.89833521	1600.395794	4.209040689	17.7218473	11.58180552	17.9061302	67.41568072	16.3364572	31.34772392	0	0.025696428	31.86419947	30.44633067	68.7208899	2.6583	7.592854681	0	0	22.09470266	8.046698671	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082784394	0.082784394	0.162929975	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070917827	0.070917827	0.139575098	0	0.19189116	0.19189116	0.19189116	0.19189116	0.19189116	0.19189116	0.19189116	0	0.19189116	0.19189116	0.19189116	0.19189116	0.19189116	0.19189116	0	0	0.19189116	0.19189116	0	0	0	0	0	0	0	0												12.1084	0.400997764	4.312638158	0	0.8076777	3.400665835	2.222446096	3.436028094	12.93647317	3.134821723	6.015351106	0	0.004930917	6.114458198	5.84238171	13.18693128	0.510104271	1.457001692	0	0	4.239778122	1.544090342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6752	150	YES	13.66657189	12.1084	0.400997764	4.312638158	0	0.8076777	3.400665835	2.222446096	3.436028094	12.93647317	3.134821723	6.015351106	0	0.004930917	6.114458198	5.84238171	13.18693128	0.510104271	1.457001692	0	0	4.239778122	1.544090342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6752	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	NO	0	12.1084	0.400997764	4.312638158	0	0.8076777	3.400665835	2.222446096	3.436028094	12.93647317	3.134821723	6.015351106	0	0.004930917	6.114458198	5.84238171	13.18693128	0.510104271	1.457001692	0	0	4.239778122	1.544090342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6752
H4604_803_0	2012	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	170.7380847	5.6547	30.89833521	1600.395794	4.209040689	17.7218473	11.58180552	17.9061302	67.41568072	16.3364572	31.34772392	0	0.025696428	31.86319947	30.44633067	68.7208899	2.6569	7.592854681	0	0	22.09470266	8.046698671	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082784394	0.082784394	0.162929975	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070917903	0.070917903	0.139575247	0	0.191891365	0.191891365	0.191891365	0.191891365	0.191891365	0.191891365	0.191891365	0	0.191891365	0.191891365	0.191891365	0.191891365	0.191891365	0.191891365	0	0	0.191891365	0.191891365	0	0	0	0	0	0	0	0												12.1084	0.401019467	4.312642757	0	0.807678561	3.400669462	2.222448466	3.436031759	12.93648697	3.134825066	6.01535752	0	0.004930923	6.114272827	5.84238794	13.18694534	0.509836167	1.457003246	0	0	4.239782644	1.544091989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748	150	YES	13.6664113	12.1084	0.401019467	4.312642757	0	0.807678561	3.400669462	2.222448466	3.436031759	12.93648697	3.134825066	6.01535752	0	0.004930923	6.114272827	5.84238794	13.18694534	0.509836167	1.457003246	0	0	4.239782644	1.544091989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748	NO																																										0	0	0	0	0	0	0	0	0	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	12.1084	0.401019467	4.312642757	0	0.807678561	3.400669462	2.222448466	3.436031759	12.93648697	3.134825066	6.01535752	0	0.004930923	6.114272827	5.84238794	13.18694534	0.509836167	1.457003246	0	0	4.239782644	1.544091989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748
H4604_805_0	2012	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	170.7380847	5.6548	30.89833521	1600.395794	4.209040689	17.7218473	11.58180552	17.9061302	67.41568072	16.3364572	31.34772392	0	0.025696428	31.86319947	30.44633067	68.7208899	2.6568	7.592854681	0	0	22.09470266	8.046698671	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.082784394	0.082784394	0.162929975	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.070917905	0.070917905	0.139575251	0	0.19189137	0.19189137	0.19189137	0.19189137	0.19189137	0.19189137	0.19189137	0	0.19189137	0.19189137	0.19189137	0.19189137	0.19189137	0.19189137	0	0	0.19189137	0.19189137	0	0	0	0	0	0	0	0												12.1084	0.40102657	4.312642883	0	0.807678585	3.400669562	2.222448531	3.43603186	12.93648735	3.134825158	6.015357697	0	0.004930923	6.114273007	5.842388111	13.18694573	0.509816992	1.457003289	0	0	4.239782768	1.544092034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748	150	YES	13.66640687	12.1084	0.40102657	4.312642883	0	0.807678585	3.400669562	2.222448531	3.43603186	12.93648735	3.134825158	6.015357697	0	0.004930923	6.114273007	5.842388111	13.18694573	0.509816992	1.457003289	0	0	4.239782768	1.544092034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748	NO																																										0	0	0	0	0	0	0	0	0	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	12.1084	0.40102657	4.312642883	0	0.807678585	3.400669562	2.222448531	3.43603186	12.93648735	3.134825158	6.015357697	0	0.004930923	6.114273007	5.842388111	13.18694573	0.509816992	1.457003289	0	0	4.239782768	1.544092034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6748
H4605_001_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	425.1399016	6.433568103	591.8688751	19.85679491	0	17.03879416	0.487476709	249.984572	447.3560445	0	23.24368578	0	0	358.2548134	3289.116573	4227.921582	141.0063634	983.2905202	18.94926056	0	26.71539623	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	19.17189833	0.095512341	0	0.19283058	0.187168259	65	175	0	0.11746981	0	0	35	15	34.01959739	35	35	0.084359761	0	0.173838242	0	0	0	0	0	0	0	0	0											NO	183.2744786	183.2744786	17.56859835	0.087524872	0	0.17670462	0.171515825	59.56420553	160.3651687	0	0.107646091	0	0	32.07303375	13.74558589	31.17461987	32.07303375	32.07303375	0.077304956	0	0.159300566	0	0	0	0	0	0	0	0	0												6.4931	0.09825907	0.866525545	1.737963438	0	3.010833647	0.08360997	1.240844369	5.978360631	0	2.50209191	0	0	0.95752656	3.76756953	10.98365401	0.376875154	2.628092503	1.464871754	0	4.25577773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.446	0	NO	4.436166731	6.4931	0.09825907	0.866525545	1.737963438	0	3.010833647	0.08360997	1.240844369	5.978360631	0	2.50209191	0	0	0.95752656	3.76756953	10.98365401	0.376875154	2.628092503	1.464871754	0	4.25577773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.446	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.299	0.0005	0.1121	0.8869	0.5253	0.3925	0.0113	0.032	0.6752	0	0.0583	0	0.0003	0.0296	0.1039	0.4684	0.0181	0.126	0.0621	0	0.082	0	0	1.2816	0	0	0	0	0	0											5.165	0	NO	0.273833269	6.7921	0.098805889	0.978583636	2.624882375	0.525251446	3.403323509	0.094926939	1.272840674	6.653545466	0	2.560419728	0	0.00025603	0.987082063	3.871424917	11.45201659	0.394963952	2.754105448	1.526986523	0	4.337822876	0	0	1.281619073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6109
H4605_002_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	1.06929247	0.009503473	0.191950952	0.178137321	0.001398383	0.147609918	0.006291614	0.122031254	0.424713402	0.051195017	0.155437261	0	0	0.151446134	0.31256187	0.861982695	0.010262999	0.063279212	0.120109659	0	0.155038351	0.006558912	0	0	0	0	0	0	0	0											4.0388	YES	472.6347756	9.666745303	718.9572698	26.29419826	0.257324017	21.78815996	0.928682088	233.8082921	471.8136292	0	22.94352555	0	0	363.5685825	4178.229796	4014.853224	157.5502059	952.8834626	17.72894733	0	31.42099526	0	0	0	0	0	0	0	0	0												$175/Days 1-5 for IP Med/Surg; PBP 1a	$175/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-10, $35/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	175	175	17.85245589	0.1	100	0.13242478	0.105758571	65	175	0	0.122203332	0	0	35	15	33.84540751	35	35	0.08008942	0	0.161847689	0	0	0	0	0	0	0	0	0											NO	158.120883	158.120883	16.13054908	0.09035479	90.35479029	0.119652132	0.095557935	58.73061369	158.120883	0	0.110416564	0	0	31.6241766	13.55321854	30.58094698	31.6241766	31.6241766	0.072364627	0	0.14623714	0	0	0	0	0	0	0	0	0												6.2278	0.127376192	0.966431294	2.37580677	0.001937538	2.606999799	0.088742942	1.144308707	6.216965638	0	2.533345259	0	0	0.958129755	4.719038462	10.23150113	0.415199628	2.511179575	1.282948667	0	4.594916484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0026	0	NO	5.194372247	7.2971	0.136879665	1.158382246	2.553944091	0.003335921	2.754609717	0.095034556	1.266339961	6.64167904	0.051195017	2.688782521	0	0	1.109575889	5.031600332	11.09348382	0.425462627	2.574458787	1.403058326	0	4.749954835	0.006558912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0414	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.2409	0.0115	0.0891	0.999	0.5985	0.4137	0.0235	0.0712	0.6745	0.0159	0.0852	0	0.0134	0.0712	0.1509	0.2706	0.05	0.0129	0.0871	0	0.0406	0	0	1.2443	0	0	0	0	0	0											5.164	0	NO	0.345627753	7.538	0.148354448	1.247523181	3.55296061	0.601881794	3.168264397	0.118492605	1.337503127	7.316220703	0.067080714	2.773980203	0	0.013363767	1.180794556	5.182479925	11.36405838	0.475445494	2.587360053	1.490134206	1.91E-05	4.790582722	0.006558912	0	1.244307895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2054
H4605_004_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	636.43136	12.67514132	1092.24724	35.47786606	0.713168413	32.99460207	1.560664463	286.7155669	568.1255623	0	29.8507319	0	0	645.4837058	5290.815781	5113.269539	311.3426839	1421.868964	24.38238127	0	62.70324538	0	0	0	0	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$0/Days 1-10, $30/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $10/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"	See i.2.; 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	NO	150	150	10.78238355	0	100	0.1	0.1	65	100	0	0.133139234	0	0	25	10	24.02903823	25	25	0.081505285	0	0.10572649	0	0	0	0	0	0	0	0	0											NO	129.7708224	129.7708224	9.328258541	0	86.51388159	0.086513882	0.086513882	56.23402304	86.51388159	0	0.11518392	0	0	21.6284704	8.651388159	20.78845369	21.6284704	21.6284704	0.070513386	0	0.091468091	0	0	0	0	0	0	0	0	0												6.8825	0.137071959	0.849063721	0	0.005141581	2.854491097	0.135019141	1.343597483	4.095895636	0	3.4383243	0	0	1.163402102	3.814408416	8.858080583	0.561155502	2.562737567	1.719284264	0	5.735346133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1555	0	NO	7.246922136	6.8825	0.137071959	0.849063721	0	0.005141581	2.854491097	0.135019141	1.343597483	4.095895636	0	3.4383243	0	0	1.163402102	3.814408416	8.858080583	0.561155502	2.562737567	1.719284264	0	5.735346133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1555	YES	$250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-10, $40/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.311	0.0105	0.0758	0.5753	0.7385	0.4422	0.1055	0.0791	0.6577	0	0.1132	0	0	0.0761	0.1473	0.2925	0.1123	0.068	0.1013	0	0.0963	0	0	1.2375	0	0	0	0	0	0											5.2402	0	NO	0.453077864	7.1935	0.147567623	0.924852331	0.575256623	0.743645228	3.296718646	0.240551123	1.422679047	4.7536053	0	3.551572616	0	0	1.239525906	3.96171483	9.150596258	0.67349002	2.630699963	1.820621715	0	5.831658629	0	0	1.237454174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3957
H4605_801_0	2012	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	193.1912365	1.730674709	34.88938021	29.99131734	0.409687412	26.5900459	1.18327009	19.99877425	68.13814592	9.599802657	26.20503227	0	0.025584653	26.65932805	51.35560764	147.2552821	2.076715681	11.03112549	20.95770399	0	45.62496616	1.018593268	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	NO	0.082820775	0.082820775	0.162590302	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.076943955	0.076943955	0.151053173	0	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0	0	0	0	0	0	0	0												14.8649	0.133164957	5.270151572	0	0.085258139	5.533530627	0.246244828	4.161851779	14.17991224	1.997770226	5.453407233	0	0.005324303	5.547948613	10.68737635	30.64461101	0.43217563	2.295636155	4.361410182	0	9.49479924	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.6074	0	NO	8.813709159	14.8649	0.133164957	5.270151572	0	0.085258139	5.533530627	0.246244828	4.161851779	14.17991224	1.997770226	5.453407233	0	0.005324303	5.547948613	10.68737635	30.64461101	0.43217563	2.295636155	4.361410182	0	9.49479924	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.6074	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												0.3547	0.0135	0.4156	0	0.8246	0.4193	0.0684	0.209	0.5418	0.4211	0.2293	0	0.045	1.0378	0.3066	0.6419	0.0609	0.0253	0.1121	0.0011	0.1657	0	0	0	0	0	0	0	0	0											5.8936	0	NO	0.466290841	15.2196	0.146709231	5.685713284	0	0.909876652	5.952813019	0.314655666	4.370819056	14.72171516	2.418846871	5.682734436	0	0.050323021	6.585709482	10.99397737	31.28646462	0.493069095	2.320950055	4.473489835	0.00110671	9.660508078	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5011
H4605_802_0	2012	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	193.1912365	1.730674709	34.88938021	29.99131734	0.409687412	26.5900459	1.18327009	19.99877425	68.13814592	9.599802657	26.20503227	0	0.025584653	26.65932805	51.35560764	147.2552821	2.076715681	11.03112549	20.95770399	0	45.62496616	1.018593268	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	NO	0.082820775	0.082820775	0.162590302	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.076943955	0.076943955	0.151053173	0	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0.208105343	0	0	0	0	0	0	0	0												14.8649	0.133164957	5.270151572	0	0.085258139	5.533530627	0.246244828	4.161851779	14.17991224	1.997770226	5.453407233	0	0.005324303	5.547948613	10.68737635	30.64461101	0.43217563	2.295636155	4.361410182	0	9.49479924	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.6074	0	NO	8.813709159	14.8649	0.133164957	5.270151572	0	0.085258139	5.533530627	0.246244828	4.161851779	14.17991224	1.997770226	5.453407233	0	0.005324303	5.547948613	10.68737635	30.64461101	0.43217563	2.295636155	4.361410182	0	9.49479924	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.6074	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												0.3547	0.0135	0.4156	0	0.8246	0.4193	0.0684	0.209	0.5418	0.4211	0.2293	0	0.045	1.0378	0.3066	0.6419	0.0609	0.0253	0.1121	0.0011	0.1657	0	0	0	0	0	0	0	0	0											5.8936	0	NO	0.466290841	15.2196	0.146709231	5.685713284	0	0.909876652	5.952813019	0.314655666	4.370819056	14.72171516	2.418846871	5.682734436	0	0.050323021	6.585709482	10.99397737	31.28646462	0.493069095	2.320950055	4.473489835	0.00110671	9.660508078	0.211974702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5011
H4606_001_0	2012	8	r.	s.	t.								OP Facility - Other	OP Facility - Other	OP Facility - Surgery								Radiology	Other									D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V				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	764.27	37.78	453.23	1620.16	13.5	20.48	5.14	324.33	45.01	1423.5	12.65	162.91	0.22	9.68	2775.78	3216.17	60.19	738.22		1436.34	24.24	0		3.27	0.61				4.86	0.93	662.08	533.15	140.18								6700	"$0-$220/Day(Days 1-8): 1a. $220 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-8): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% Surgery OP -- Facility	"$0-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"20% Coins: 8b, 9a. 20% Advanced Imaging -- OP"	"$50-$100/Visit: 5. $100 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$15-$195/Visit: 3. $15 Cardiac Rehab,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $195 Observation"	"$0-$100/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician"										168.090679	120.013094	49.537808	0	200	0.2	0.147445	65	0.2	66.110092	0.2	94.791667	0.2	0.2	20	37.609761	40	42.66689		0	0.2	0		0	0				0	0	83.553984	96.059307	100								NO	152.051634	108.561565	44.223342	0	187.334	0.187334	0.138107	60.88355	0.187334	61.923339	0.187334	88.78851	0.187334	0.187334	18.7334	35.227935	37.4668	39.964796		0	0.187334	0		0	0				0	0	78.26251	89.975871	93.667									9.684	0.341787994	1.670278775	0	0.21075075	3.83660032	0.70986998	1.645530148	8.43190334	7.345656089	2.3697751	1.205378014	0.04121348	1.81339312	4.333316421	9.441585642	0.187927224	2.458567642	0	0	4.54097616	0	0	0	0	0	0	0	0	0	4.318003552	3.997552969	1.094186672	0	0	0	0	0	0	0	69.6783	0	NO	5.178529	9.684	0.341787994	1.670278775	0	0.21075075	3.83660032	0.70986998	1.645530148	8.43190334	7.345656089	2.3697751	1.205378014	0.04121348	1.81339312	4.333316421	9.441585642	0.187927224	2.458567642	0	0	4.54097616	0	0	0	0	0	0	0	0	0	4.318003552	3.997552969	1.094186672	0	0	0	0	0	0	0	69.6783	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	25% Coins	$200/Trip	30% Coins	30% Coins	$65/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% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins								10000	4.8995	0.0619	0.5614	2.0679	1.4255	1.244	0.3121	0.159	1.2336	0.4235	0.3466	0.0365	0.0039	0.2096	0.912	1.6947	0.0165	0.1806		0.1672	0.6092	0		0	0				0	0	0.4359	0.2868	0.8041								18.0921	0	NO	4.02743	14.5835	0.403703994	2.231654775	2.067863	1.63625275	5.08062132	1.02194898	1.804491148	9.66554434	7.769206089	2.7163831	1.241847014	0.04516248	2.02304112	5.245309421	11.13627164	0.204445224	2.639150642	0	0.167181	5.15014516	0	0	0	0	0	0	0	0	0	4.753912552	4.284386969	1.898328672	0	0	0	0	0	0	0	87.7703
H4606_006_0	2012	3	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery							Prosthetics/Supplies	Radiology	Other								D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O		V	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							0	YES	807.49	11.76	274.3	1107.97	13.11	7.6	1.41	243.2	30.86	823.14	7.93	72.22	0.18	4.61	1613.72	2584.11	21.52	415.63		855.28	15.42	0		3.27	0.61				4.86	0.93	436.01	441.03	329.1	99.21							3400	"$0-$220/Day(Days 1-8): 1a. $220 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$220/Day(Days 1-8): 1b. $220 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% Surgery OP -- Facility	"$0-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"20% Coins: 8b, 9a. 20% Advanced Imaging -- OP"	"$50-$100/Visit: 5. $100 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$15-$195/Visit: 3. $15 Cardiac Rehab,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $195 Observation"	"$0-$100/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician"									168.090679	150.873604	49.537808	0	200	0.2	0.2	65	0.2	64.198814	0.2	95.763153	0.2	0.2	20	36.488757	40	42.856826		0	0.2	0		0	0				0	0	0	93.853453	97.377957	100							NO	135.083553	121.247309	38.868404	0	179.5346	0.179535	0.179535	58.348745	0.179535	57.629542	0.179535	85.963997	0.179535	0.179535	17.95346	32.754972	35.90692	38.471416		0	0.179535	0		0	0				0	0	0	84.249711	87.413563	89.7673								9.0899	0.118822363	0.888466935	0	0.196141551	1.364466	0.25314435	1.182534565	5.5404501	3.953098433	1.42371255	0.517359989	0.0323163	0.82765635	2.414321456	7.053537558	0.064393077	1.332489553	0	0	2.7684297	0	0	0	0	0	0	0	0	0	0	3.096387504	2.397316965	0.742151153	0	0	0	0	0	0	45.2571	0	NO	6.501705	9.0899	0.118822363	0.888466935	0	0.196141551	1.364466	0.25314435	1.182534565	5.5404501	3.953098433	1.42371255	0.517359989	0.0323163	0.82765635	2.414321456	7.053537558	0.064393077	1.332489553	0	0	2.7684297	0	0	0	0	0	0	0	0	0	0	3.096387504	2.397316965	0.742151153	0	0	0	0	0	0	45.2571	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	25% Coins	$200/Trip	30% Coins	30% Coins	$65/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% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins							4000	2.9379	0.0132	0.1865	1.1037	1.2137	0.4048	0.0749	0.1045	0.7414	0.1723	0.1905	0.0131	0.0029	0.0906	0.4886	1.111	0.007	0.0853		0.092	0.3212	0		0	0				0	0	0.0379	0.2537	0.1828	0.4511							10.2807	0	NO	6.057502	12.0278	0.132028363	1.074965935	1.103714	1.409849551	1.76926	0.32802535	1.287037565	6.2818611	4.125368433	1.61420055	0.530493989	0.0352173	0.91825235	2.902961456	8.164499558	0.071364077	1.417812553	0	0.092048	3.0896387	0	0	0	0	0	0	0	0	0	0.037913	3.350134504	2.580152965	1.193217153	0	0	0	0	0	0	55.5378
H4606_007_0	2012	8	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery							Prosthetics/Supplies	Radiology	Other								D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	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	987.41	46.91	391.95	936.22	20.33	10.27	3.26	302.8	31.59	1199.27	7.38	140.41	0.37	8.89	2484.37	3192.73	76	585.47		1291.21	18.49	0			0.61				4.86	0.93	1101.28	691.39	460.57	106.39							6700	"$0-$220/Day(Days 1-8): 1a. $220 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-8): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% Surgery OP -- Facility	"$0-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"20% Coins: 8b, 9a. 20% Advanced Imaging -- OP"	"$100/Visit: 5. $100 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0-$150/Visit: 8b, 9a. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$15-$195/Visit: 3. $15 Cardiac Rehab,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $195 Observation"	"$0-$100/Visit: 9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician"									168.090679	120.013094	49.537808	0	200	0.2	0.2	65	0.2	55.522505	0.2	100	0.2	0.2	20	38.203606	40	42.995797		0	0.2	0			0				0	0	0	81.705454	106.724086	100							NO	151.146298	107.915174	44.683103	0	189.6036	0.189604	0.189604	61.62117	0.189604	52.636334	0.189604	94.8018	0.189604	0.189604	18.96036	36.217706	37.92072	40.76079		0	0.189604	0			0				0	0	0	77.458241	101.176354	94.8018								12.4369	0.421858401	1.459461852	0	0.321220099	1.94723308	0.61810904	1.554907523	5.98959036	5.260431356	1.39927752	1.109260062	0.07015348	1.68557956	3.925379131	9.63611304	0.24016456	1.988684977	0	0	3.50577796	0	0	0	0	0	0	0	0	0	0	4.462821104	3.88323278	0.840496959	0	0	0	0	0	0	62.7567	0	NO	4.256264	12.4369	0.421858401	1.459461852	0	0.321220099	1.94723308	0.61810904	1.554907523	5.98959036	5.260431356	1.39927752	1.109260062	0.07015348	1.68557956	3.925379131	9.63611304	0.24016456	1.988684977	0	0	3.50577796	0	0	0	0	0	0	0	0	0	0	4.462821104	3.88323278	0.840496959	0	0	0	0	0	0	62.7567	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	25% Coins	$200/Trip	30% Coins	30% Coins	$65/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% Coins			"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins							10000	5.1052	0.0782	0.5221	1.2583	2.1875	0.6358	0.202	0.1512	0.882	0.2669	0.2061	0.0318	0.0069	0.193	0.8007	1.5495	0.0187	0.1469		0.172	0.4537	0			0				0	0	0.1002	0.4007	0.3027	0.5937							16.2657	0	NO	3.423032	17.5421	0.500030401	1.981559852	1.258299	2.508762099	2.58299508	0.82009304	1.706091523	6.87154736	5.527336356	1.60534752	1.141072062	0.07707748	1.87861856	4.726115131	11.18565104	0.25883756	2.135578977	0	0.172017	3.95948896	0	0	0	0	0	0	0	0	0	0.100152	4.863534104	4.18591178	1.434171959	0	0	0	0	0	0	79.0224
H4738_001_0	2012	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	1318.756387	45.40399167	787.3688976	17.22926533	365.124787	16.35243145	5.72455092	308.8803486	389.0704391	646.3469794	17.0404916	2.970003352	0.059377413	297.9284612	10890.27622	3838.812232	292.6488314	1133.397191	3379.917709	30.32265001	14.86328257	0.742500838	0	0	232.979338	10.36100988	20.45159669	0	95.71380499	0											3400	$265 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500,4b: $23"	"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%"	9c1: $143	12: 20.0%	"31: $143,5: $265,9a2: $250"	7a: $10	"7b1: $20,7d1: $35,7f1: $35"	"7e1: $35,7h1: $35"	"7c: $35,7i: $35"	$0 	7g: $35	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	199.0714838	131.3683238	70.37195739	20	100	0.2	0.199722372	64.79567308	142.7958015	15	0.2	142.5	0.2	42.49844237	8.686451236	24.01148106	35	35	0	35	0.199834986	0	0	0	0	2.365542661	0	0	0	0											NO	182.5789574	120.4848185	64.54183372	18.34305485	91.71527426	0.183430549	0.183175921	59.42752927	130.965561	13.75729114	0.183430549	130.6942658	0.183430549	38.97756297	7.966802574	22.02219571	32.10034599	32.10034599	0	32.10034599	0.183279205	0	0	0	0	2.365542661	0	0	0	0												20.0648	0.455874308	4.234852706	0.026336447	2.790626665	2.999535471	1.048599889	1.52966633	4.246235694	0.740998631	3.125746722	0.032346867	0.010891631	0.967710447	7.230056716	7.044922854	0.782844062	3.031870165	0	0.081113963	2.72413062	0	0	0	0	0.002042451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1712		NO	5.706125528	20.0648	0.455874308	4.234852706	0.026336447	2.790626665	2.999535471	1.048599889	1.52966633	4.246235694	0.740998631	3.125746722	0.032346867	0.010891631	0.967710447	7.230056716	7.044922854	0.782844062	3.031870165	0	0.081113963	2.72413062	0	0	0	0	0.002042451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1712	YES	"$265 days 1-7;$0 days 8-90,1a2: $199"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $23"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											5100	2.4308	0.0552	0.513	0	0	0	0	0.17	0	0	0	0	0.0012	0	0	0	0	0	0	0	0.3027	0	0	0	0	0	0	0	0	0											3.4729	5000	NO	0.042803697	22.4956	0.511102514	4.747896136	0.026336447	2.790626665	2.999535471	1.048599889	1.699629255	4.246235694	0.740998631	3.125746722	0.032346867	0.012101813	0.967710447	7.230056716	7.044922854	0.782844062	3.031870165	0	0.081113963	3.0268118	0	0	0	0	0.002042451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6441
H4738_002_0	2012	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	1456.400081	50.14298151	869.5496282	19.02755024	403.2342702	18.06001324	6.322329844	341.1193826	429.6792224	713.8087081	18.81992319	3.279994064	0.065577824	329.0244045	12026.93637	4239.48388	323.1937194	1251.69423	3732.692764	33.48754201	16.41536188	0.819998516	0	0	256.5872958	11.43788063	21.942105	0	95.71481282	0												$265 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $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%"	9c1: $145	12: 20.0%	"31: $145,5: $265,9a2: $250"	7a: $10	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	199.0714838	131.3683238	70.37195739	20	100	0.2	0.199722287	64.80769231	142.7958015	15	0.2	145	0.2	42.57943925	8.686451236	27.38920781	40	40	0	40	0.199834986	0	0	0	0	2.362510464	0	0	0	0											NO	178.7148312	117.9348612	63.17586148	17.95483992	89.77419959	0.179548399	0.179299085	58.18058704	128.1937879	13.46612994	0.179548399	130.1725894	0.179548399	38.22535078	7.798192069	24.58844208	35.90967984	35.90967984	0	35.90967984	0.179400259	0	0	0	0	2.362510464	0	0	0	0												21.69	0.492800464	4.577878905	0.028469718	3.016669488	3.242646466	1.133587956	1.653877161	4.590183923	0.801020068	3.379087082	0.035580443	0.011774393	1.04808944	7.815696654	8.686858653	0.967148582	3.745661588	0	0.100210576	2.944920176	0	0	0	0	0.002251843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9644		NO	7.969097543	21.69	0.492800464	4.577878905	0.028469718	3.016669488	3.242646466	1.133587956	1.653877161	4.590183923	0.801020068	3.379087082	0.035580443	0.011774393	1.04808944	7.815696654	8.686858653	0.967148582	3.745661588	0	0.100210576	2.944920176	0	0	0	0	0.002251843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9644	YES	"$265 days 1-7;$0 days 8-90,1a2: $199"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $25"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											5100	2.6845	0.061	0.5666	0	0	0	0	0.1838	0	0	0	0	0.0013	0	0	0	0	0	0	0	0.3272	0	0	0	0	0	0	0	0	0											3.8244	5000	NO	0.058352309	24.3745	0.553793051	5.144470659	0.028469718	3.016669488	3.242646466	1.133587956	1.83764129	4.590183923	0.801020068	3.379087082	0.035580443	0.013082659	1.04808944	7.815696654	8.686858653	0.967148582	3.745661588	0	0.100210576	3.272133529	0	0	0	0	0.002251843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7888
H4754_001_0	2012	9																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	178.3864364	12.57613706	22.02563638		223.0532404	0.945299412	1.537931194	296.344906	108.7672418	6458.056703	130.3097529		1.596393092	1250.704666	1904.244763	6124.504844	494.822143	1633.400819			41.0875704	779.9316834			107.3532365		0.167322326														3400	"1a (IP Acute); 175 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 175 days 1-5	"2a (SNF); 50 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 150 copay, 8b (MRI); 150 copay, 8b (CT Scan); 100 copay, 8b (PET Scan); 300 copay"		12 (Renal Dialysis); 15 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 175 copay/day, days 1-5, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 30 copay"	"7a (PCP); 15 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 15 copay, 7b1 (Routine Chiro); 15 copay, 7d (Specialist); 30 copay, 7f (Podiatry); 30 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 30 copay, 7h (Psych); 30 copay"	"7c (OT); 30 copay, 7i (PT/ST); 30 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 30 copay	"; , 7g (Prof. Other); 15-30 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 30 copay, 17a (MCR Eye Exam); 30 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 30 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 30 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 30 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); 15 copay  ($500 benefit limit per calendar year) , 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; 15 copay ($500 benefit limit per calendar year)"											0	NO	617.6479418	681.7199891	276.4273971		50	0.2	0.2	64.75274111	175	10	108.4769016		15	62.20753658	16.36081477	28.99199023	30	30			0.2	30			29.84496103		20.46302688														NO	506.5523951	559.0998851	226.7067541		41.00656384	0.164026255	0.164026255	53.10574825	143.5229734	8.201312768	88.9652998		12.30196915	56.12607498	13.41801591	23.81748108	24.6039383	24.6039383			0.164026255	24.6039383			24.53948977		20.46302688															7.5302	0.585943065	0.416113378	0	0.762220579	0.155053923	0.252261095	1.311468164	1.300883163	4.413711908	0.966087186	0	0.001636565	5.849761988	2.129265544	12.15585652	1.01454779	3.349007747	0	0	6.739440315	1.599115918	0	0	0.219532804	0	0.000285327	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7524	0		10.45595644	7.5302	0.585943065	0.416113378	0	0.762220579	0.155053923	0.252261095	1.311468164	1.300883163	4.413711908	0.966087186	0	0.001636565	5.849761988	2.129265544	12.15585652	1.01454779	3.349007747	0	0	6.739440315	1.599115918	0	0	0.219532804	0	0.000285327	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7524	YES	1a (IP Acute); 20% coin	1b (IP Psych); 20% coin	2a (SNF); 20% coin	6a (Home Health); 0 copay	10a (Ambulance); 50 copay	11a (DME); 20% coin	"11b (Prosthetics); 20% coin, 11b (Medical Supplies); 20% coin, 11c (Diabetic Supplies); 20% coin"	"4a (ER); 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 20% coin, 9b (OP ASC); 20% coin"	8a (OP Diag Proc/Test/Lab); 20% coin	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 20% coin,8b (OP Diag Rad); 20% coin,8b (X-Ray); 20% coin,8b (Nuclear Medicine); 20% coin,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 15 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 20% coin, 9a2 (OP Clinic); 20% coin, 9a3 (OP Observation); 20% coin, 9a4 (OP Other); 20% coin, 9a5 (OP Other Cardiology); 20% coin, 9c (OP SA); 20% coin"	"7a (PCP); 25 copay, 14a (Education/Wellness); 25-40 copay, 14a1; n/a, 14a2 (Nutritional Training); 25-40 copay, 14a3 (Online Health Programs); 25-40 copay, 14a4 (Immunizations-MC); 25-40 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 25-40 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 25-40 copay, 14h (Mammography); 25-40 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 25-40 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 25-40 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 25-40 copay"	"7d (Specialist); 40 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 25-40 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); 15 copay  ($500 benefit limit per calendar year) , 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; 15 copay ($500 benefit limit per calendar year)"											5100	1.4072	0.087	0.083		0.0401	0.0082	0.0142	0.069	0.1412	0.2128	0.1361		0.0001	0.1057	0.2496	0.8309	0.0349	0.0905			0.3547	0.0875			0.0054																3.9579	0		0.836562563	8.9373	0.672989672	0.49906844	0	0.802337451	0.163214656	0.266460007	1.380492804	1.442039467	4.626488973	1.102165495	0	0.0017227	5.955490199	2.378862819	12.98672015	1.049476195	3.43946259	0	0	7.0941477	1.686574181	0	0	0.224938736	0	0.000285327	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7103
H4754_002_0	2012	7																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	156.2516649	3.214037412	35.32217631		128.4540234	12.72503848	17.77749562	184.7685393	227.5778151	5236.276374	93.35773741		3.384722991	1215.444116	1939.708502	8199.755065	2.915602215	719.0657599			20.41111343				167.2939201		2.595851689														2500	"1a (IP Acute); 125 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 125 days 1-5	"2a (SNF); 85 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 150 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 150 copay, 9b (OP ASC); 150 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 150 copay, 8b (MRI); 150 copay, 8b (CT Scan); 100 copay, 8b (PET Scan); 300 copay"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 125 copay/day, days 1-5, 9a2 (OP Clinic); 150 copay, 9a3 (OP Observation); 150 copay, 9a4 (OP Other); 150 copay, 9a5 (OP Other Cardiology); 150 copay, 9c (OP SA); 20 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 20 copay, 7f (Podiatry); 20 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 20 copay, 7h (Psych); 20 copay"	"7c (OT); 20 copay, 7i (PT/ST); 20 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 20 copay	"; , 7g (Prof. Other); 10-20 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20 copay, 17a (MCR Eye Exam); 20 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	441.1771013	486.9428493	469.926575		150	0.2	0.2	65	150	10	88.04896713		10	142.9243327	11.91432253	19.20507636	20	20			0.2				20		20														NO	335.2972441	370.0794872	357.1470166		114.0009	0.1520012	0.1520012	49.40039001	114.0009	7.600060002	66.91774333		7.600060002	114.0009	9.054956607	14.59597326	15.20012	15.20012			0.1520012				15.20012		15.20012															4.3659	0.099120776	1.051267491	0	1.220322856	1.934221119	2.702200668	0.760636492	2.162006312	3.316334552	0.520607426	0	0.002143675	11.54681027	1.463664693	9.973617142	0.003693125	0.91082382	0	0	3.102513736	0	0	0	0.211907305	0	0.003288105	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3511	0		13.604248	4.3659	0.099120776	1.051267491	0	1.220322856	1.934221119	2.702200668	0.760636492	2.162006312	3.316334552	0.520607426	0	0.002143675	11.54681027	1.463664693	9.973617142	0.003693125	0.91082382	0	0	3.102513736	0	0	0	0.211907305	0	0.003288105	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3511	YES	1a (IP Acute); 175 days 1-6	1b (IP Psych); 175 days 1-6	2a (SNF); 20% coin	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); 65 copay, 4b (UC); 30% coin"	"9a (OP Surgery); 150 copay, 9b (OP ASC); 15% coin"	8a (OP Diag Proc/Test/Lab); 20% coin	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 150 copay,8b (OP Diag Rad); 20% coin,8b (X-Ray); 20% coin,8b (Nuclear Medicine); 20% coin,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 175 copay/day, days 1-6, 9a2 (OP Clinic); 150 copay, 9a3 (OP Observation); 150 copay, 9a4 (OP Other); 150 copay, 9a5 (OP Other Cardiology); 150 copay, 9c (OP SA); 20% coin"	"7a (PCP); 20 copay, 14a (Education/Wellness); 20-30 copay, 14a1; n/a, 14a2 (Nutritional Training); 20-30 copay, 14a3 (Online Health Programs); 20-30 copay, 14a4 (Immunizations-MC); 20-30 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 20-30 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 20-30 copay, 14h (Mammography); 20-30 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 20-30 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 20-30 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 20-30 copay"	"7d (Specialist); 30 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 20-30 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											2500	0.3523	0.0081	0.1791		0.0642	0.1018	0.1703	0.04	0.115	0.1126	0.0985		0.0001	0.6077	0.1726	0.7817	0.0001	0.0744			0.1633	0.005																			3.0469	0		0.91574041	4.7182	0.107258543	1.230333071	0	1.284550375	2.03602223	2.872478566	0.800669992	2.277024651	3.428952965	0.619074133	0	0.0022565	12.15453712	1.636246555	10.75531118	0.003820338	0.985259717	0	0	3.265803933	0.004991862	0	0	0.211907305	0	0.003288105	0	0	0	0	0	0	0	0	0	0	0	0	0	48.398
H4754_004_0	2012	7																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	155.4877161	2.435838895	34.18429867		175.92834	14.97299102	14.37693847	186.5983643	204.6763959		175.8000938		5.1012121	756.6760932	2492.630594	8804.584312	1.025914636	667.8446492			43.75250422				167.2939201		2.595851689														2500	"1a (IP Acute); 200 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 200 days 1-5	"2a (SNF); 50 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 100 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 15% coin,8b (X-Ray); 0 copay, 8b (Nuclear Medicine); 15% coin, 8b (MRI); 15% coin, 8b (CT Scan); 15% coin, 8b (PET Scan); 15% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 200 copay/day, days 1-5, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 20 coapy"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 20 copay, 7f (Podiatry); 20 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 20 copay, 7h (Psych); 20 copay"	"7c (OT); 20 copay, 7i (PT/ST); 20 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 20 copay	"; , 7g (Prof. Other); 10-20 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20 copay, 17a (MCR Eye Exam); 20 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	705.883362	779.1085589	276.4273971		100	0.2	0.2	65	175		21.56535322		10	164.8031105	11.61430466	19.3644942	20	20			0.2				20		20														NO	536.4975447	592.1514111	210.0950777		76.00371018	0.15200742	0.15200742	49.40241162	133.0064928		16.39046856		7.600371018	133.0064928	8.827302453	14.71773405	15.20074204	15.20074204			0.15200742				15.20074204		15.20074204															6.9516	0.120198787	0.598496074	0	1.114267214	2.276005741	2.18540133	0.768200767	2.268607465	0	0.240120493	0	0.003230925	8.38690278	1.833600346	10.79862753	0.001299555	0.845977853	0	0	6.650705301	0	0	0	0.211915977	0	0.003288239	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2584	0		13.6462443	6.9516	0.120198787	0.598496074	0	1.114267214	2.276005741	2.18540133	0.768200767	2.268607465	0	0.240120493	0	0.003230925	8.38690278	1.833600346	10.79862753	0.001299555	0.845977853	0	0	6.650705301	0	0	0	0.211915977	0	0.003288239	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2584	YES	1a (IP Acute); 300 days 1-5	1b (IP Psych); 300 days 1-5	2a (SNF);  100 days 21-100	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); 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 225 copay, 9b (OP ASC); 225 copay"	8a (OP Diag Proc/Test/Lab); 0 copay	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 225 copay,8b (OP Diag Rad); 20% coin,8b (X-Ray); 10% coin,8b (Nuclear Medicine); 20% coin,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 300 copay/day, days 1-5, 9a2 (OP Clinic); 225 copay, 9a3 (OP Observation); 225 copay, 9a4 (OP Other); 225 copay, 9a5 (OP Other Cardiology); 225 copay, 9c (OP SA); 20% coin"	"7a (PCP); 20 copay, 14a (Education/Wellness); 20-25 copay, 14a1; n/a, 14a2 (Nutritional Training); 20-25 copay, 14a3 (Online Health Programs); 20-25 copay, 14a4 (Immunizations-MC); 20-25 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 20-25 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 20-25 copay, 14h (Mammography); 20-25 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 20-25 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 20-25 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 20-25 copay"	"7d (Specialist); 25 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 20-25 copay	15 (Part B Rx); 20% coin	"9d (Blood); 10% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											2500	0.5488	0.0095	0.063		0.0586	0.1198	0.1524	0.0404	0.1556		0.0948		0.0002	0.5406	0.1815	0.7164	0.0001	0.0752			0.35	0.001																			3.108	0		0.895925423	7.5004	0.129688164	0.661495661	0	1.172912857	2.395795516	2.337840169	0.808632386	2.424204783	0	0.334896707	0	0.003400974	8.927533853	2.01505438	11.51501519	0.001357468	0.921188671	0	0	7.000742422	0.001049076	0	0	0.211915977	0	0.003288239	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3664
H4754_005_0	2012	6																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	155.4877161	2.435838895	34.18429867		175.92834	14.97299102	14.37693847	186.5983643	204.6763959		175.8000938			756.6760932	2492.630594	8804.584312	1.025914636	667.8446492			43.75250422				167.2939201		2.595851689														2500	"1a (IP Acute); 200 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 200 days 1-5	"2a (SNF); 50 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 100 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 175 copay, 9b (OP ASC); 175 copay"	8a (OP Diag Proc/Test/Lab); 0 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 15% coin,8b (X-Ray); 0 copay, 8b (Nuclear Medicine); 15% coin, 8b (MRI); 15% coin, 8b (CT Scan); 15% coin, 8b (PET Scan); 15% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 200 copay/day, days 1-5, 9a2 (OP Clinic); 175 copay, 9a3 (OP Observation); 175 copay, 9a4 (OP Other); 175 copay, 9a5 (OP Other Cardiology); 175 copay, 9c (OP SA); 20 coapy"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 20 copay, 7f (Podiatry); 20 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 20 copay, 7h (Psych); 20 copay"	"7c (OT); 20 copay, 7i (PT/ST); 20 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 20 copay	"; , 7g (Prof. Other); 10-20 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20 copay, 17a (MCR Eye Exam); 20 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	705.883362	779.1085589	276.4273971		100	0.2	0.2	65	175		21.56535322			164.8031105	11.61430466	19.3644942	20	20			0.2				20		20														NO	536.5066776	592.1614914	210.0986542		76.00500401	0.152010008	0.152010008	49.40325261	133.008757		16.39074758			133.008757	8.827452722	14.71798459	15.2010008	15.2010008			0.152010008				15.2010008		15.2010008															6.9517	0.120200833	0.598506262	0	1.114286182	2.276044486	2.185438533	0.768213844	2.268646084	0	0.24012458	0	0	8.387045552	1.83363156	10.79881135	0.001299577	0.845992254	0	0	6.650818518	0	0	0	0.211919585	0	0.003288295	0	0	0	0	0	0	0	0	0	0	0	0	0	45.256	0		13.64445383	6.9517	0.120200833	0.598506262	0	1.114286182	2.276044486	2.185438533	0.768213844	2.268646084	0	0.24012458	0	0	8.387045552	1.83363156	10.79881135	0.001299577	0.845992254	0	0	6.650818518	0	0	0	0.211919585	0	0.003288295	0	0	0	0	0	0	0	0	0	0	0	0	0	45.256	YES	1a (IP Acute); 300 days 1-5	1b (IP Psych); 300 days 1-5	2a (SNF);  100 days 21-100	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); 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 225 copay, 9b (OP ASC); 225 copay"	8a (OP Diag Proc/Test/Lab); 0 copay	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 225 copay,8b (OP Diag Rad); 20% coin,8b (X-Ray); 10% coin,8b (Nuclear Medicine); 20% coin,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 300 copay/day, days 1-5, 9a2 (OP Clinic); 225 copay, 9a3 (OP Observation); 225 copay, 9a4 (OP Other); 225 copay, 9a5 (OP Other Cardiology); 225 copay, 9c (OP SA); 20% coin"	"7a (PCP); 20 copay, 14a (Education/Wellness); 20-25 copay, 14a1; n/a, 14a2 (Nutritional Training); 20-25 copay, 14a3 (Online Health Programs); 20-25 copay, 14a4 (Immunizations-MC); 20-25 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 20-25 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 20-25 copay, 14h (Mammography); 20-25 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 20-25 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 20-25 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 20-25 copay"	"7d (Specialist); 25 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 20-25 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											2500	0.5488	0.0095	0.063		0.0586	0.1198	0.1524	0.0404	0.1556		0.0948		0.0004	0.5406	0.1815	0.7164	0.0001	0.0752			0.35	0.001																			3.1083	0		0.895957645	7.5005	0.129690372	0.661506921	0	1.172932824	2.395836301	2.337879967	0.808646151	2.424246051	0	0.334902408	0	0.000425129	8.927681227	2.015088683	11.51521121	0.001357491	0.921204353	0	0	7.000861598	0.001049094	0	0	0.211919585	0	0.003288295	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3642
H4754_006_0	2012	6																															A	A	A	P	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	YES	156.2516649	3.214037412	35.32217631		128.4540234	12.72503848	17.77749562	184.7685393	227.5778151	5236.276374	93.35773741			1215.444116	1939.708502	8199.755065	2.915602215	719.0657599			20.41111343				167.2939201		2.595851689														2500	"1a (IP Acute); 125 days 1-5, 1a1 (Add'l Days); Unlimited"	1b (IP Psych); 125 days 1-5	"2a (SNF); 85 days 21-100, 2a2 (Waiver 3 Day); 0 copay"	6a (Home Health); 0 copay	10a (Ambulance); 150 copay	11a (DME); 20% coin ($500 MOOP)	"11c (Diabetic Supplies); 0 copay, 11b (Prosthetics); 20% coin ($500 MOOP), 11b (Medical Supplies); 0 copay"	"4a (ER); 65 copay, 4a1 (ER) - Worldwide Coverage; 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 150 copay, 9b (OP ASC); 150 copay"	8a (OP Diag Proc/Test/Lab); 0-10 copay	"8b (OP Therap Rad); 0 copay,8b (OP Diag Rad); 0 copay,8b (X-Ray); 10 copay, 8b (Nuclear Medicine); 150 copay, 8b (MRI); 150 copay, 8b (CT Scan); 100 copay, 8b (PET Scan); 300 copay"		12 (Renal Dialysis); 0 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 0 copay, 5 (Partial Hosp); 125 copay/day, days 1-5, 9a2 (OP Clinic); 150 copay, 9a3 (OP Observation); 150 copay, 9a4 (OP Other); 150 copay, 9a5 (OP Other Cardiology); 150 copay, 9c (OP SA); 20 copay"	"7a (PCP); 10 copay, 14a (Education/Wellness); 0 copay, 14a1; n/a, 14a2 (Nutritional Training); 0 copay, 14a3 (Online Health Programs); 0 copay, 14a4 (Immunizations-MC); 0 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 0 copay14e (Diabetes Self-Management Training); 0 copay, 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 (Prostate Screening); 0 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 0 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 0 copay, 14k1 (Additional Physical Exams); 1/ yr"	"7b (Chiro); 10 copay, 7b1 (Routine Chiro); 10 copay, 7d (Specialist); 20 copay, 7f (Podiatry); 20 copay, 7f1 (Routine Podiatry); n/a"	"7e (MH Non-Phys); 20 copay, 7h (Psych); 20 copay"	"7c (OT); 20 copay, 7i (PT/ST); 20 copay"	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only); 20 copay	"; , 7g (Prof. Other); 10-20 copay"	15 (Part B Rx); 20% coin	"9d (Blood); 0 copay, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20 copay, 17a (MCR Eye Exam); 20 copay, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20 copay"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20 copay	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20 copay	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											0	NO	441.1771013	486.9428493	469.926575		150	0.2	0.2	65	150	10	88.04896713			142.9243327	11.91432253	19.20507636	20	20			0.2				20		20														NO	335.3009221	370.0835468	357.1509343		114.0021505	0.152002867	0.152002867	49.4009319	114.0021505	7.600143369	66.91847737			114.0021505	9.055055934	14.59613337	15.20028674	15.20028674			0.152002867				15.20028674		15.20028674															4.3659	0.099121864	1.051279023	0	1.220336242	1.934242336	2.702230309	0.760644836	2.162030028	3.31637093	0.520613137	0	0	11.54693693	1.463680748	9.973726545	0.003693166	0.910833811	0	0	3.102547769	0	0	0	0.21190963	0	0.003288141	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3494	0		13.60307363	4.3659	0.099121864	1.051279023	0	1.220336242	1.934242336	2.702230309	0.760644836	2.162030028	3.31637093	0.520613137	0	0	11.54693693	1.463680748	9.973726545	0.003693166	0.910833811	0	0	3.102547769	0	0	0	0.21190963	0	0.003288141	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3494	YES	1a (IP Acute); 175 days 1-6	1b (IP Psych); 175 days 1-6	2a (SNF); 20% coin	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); 65 copay, 4b (UC); 25 copay"	"9a (OP Surgery); 150 copay, 9b (OP ASC); 150 copay"	8a (OP Diag Proc/Test/Lab); 20% coin	"8b (OP Therap Rad); 20% coin,9a2 (OP Clinic); 150 copay,8b (OP Diag Rad); 20% coin,8b (X-Ray); 20% coin,8b (Nuclear Medicine); 20% coin,8b (MRI); 20% coin,8b (CT Scan); 20% coin,8b (PET Scan); 20% coin"		12 (Renal Dialysis); 10 copay	"; , 3a (OP Cardiac and Pulmonary Rehab); 20% coin, 5 (Partial Hosp); 175 copay/day, days 1-6, 9a2 (OP Clinic); 150 copay, 9a3 (OP Observation); 150 copay, 9a4 (OP Other); 150 copay, 9a5 (OP Other Cardiology); 150 copay, 9c (OP SA); 20% coin"	"7a (PCP); 20 copay, 14a (Education/Wellness); 20-30 copay, 14a1; n/a, 14a2 (Nutritional Training); 20-30 copay, 14a3 (Online Health Programs); 20-30 copay, 14a4 (Immunizations-MC); 20-30 copay, 14b (Immunizations-NMC); n/a, 14d (Kidney Disease Education); 20% coin, 14e (Diabetes Self-Management Training); 20% coin, 14f (Colorectal Screening); 20-30 copay, 14f1 (Add'l Colorectal); n/a, 14g (Bone Mass); 20-30 copay, 14h (Mammography); 20-30 copay, 14h1 (Add'l Mammography); n/a, 14i (Prostate Screening); 20-30 copay, 14i1 (Add'l Prostate); n/a, 14j (Pap & Pelvic Exam); 20-30 copay, 14j1 (Add'l Pap); n/a, 14j2 (Add'l Pelvic); n/a, 14k (Routine Physical); 20-30 copay"	"7d (Specialist); 30 copay, 7f (Podiatry); 20% coin"	"7e (MH Non-Phys); 20% coin, 7h (Psych); 20% coin"	"7c (OT); 20% coin, 7i (PT/ST); 20% coin"		7g (Prof. Other); 20-30 copay	15 (Part B Rx); 20% coin	"9d (Blood); 20% coin, 9d1 (Add'l Blood); n/a, 16b (MCR Comp. Dental); 20% coin, 17a (MCR Eye Exam); 20% coin, 17b (MCR Eyewear); 0 copay, 18a (MCR Hearing Exam); 20% coin"	10b (Transportation); n/a	"16a (Preventive Dental); n/a, 16b1 (Comp. Dental) - Non MCR; n/a,"	17a1 (Non MCR Routine Eye Exam); 20% coin	17b1 (Non MCR Covered); 100 allowance/ 2 yrs	18a1 (Non MCR Routine Hearing Exam); 20% coin	18b (Hearing Aids); n/a	"14c (Written health education materials, incl. newsletters); 0 copay"	"13a (Acupuncture); n/a, 13b (Other) OTC Rx; n/a, , 13c (Other) Meal Benefit; n/a, 13d (Other) Alternative Care; n/a"											2500	0.3523	0.0081	0.1791		0.0642	0.1018	0.1703	0.04	0.115	0.1126	0.0985		0.0003	0.6077	0.1726	0.7817	0.0001	0.0744			0.1633	0.005																			3.0472	0		0.915778521	4.7182	0.107259719	1.230346566	0	1.284564466	2.036044564	2.872510076	0.800678774	2.277049628	3.428990579	0.619080924	0	0.000338479	12.15467045	1.636264223	10.75542915	0.00382038	0.985270525	0	0	3.265839756	0.004991916	0	0	0.21190963	0	0.003288141	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3966
H4785_001_0	2012	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	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	1695.27	118.64	384.8	2909.88	1.46	20.2	6.37	458.78	55.81	12.34	5.81	1.36	0.28	39.89	3448.76	4654.79	75.45	1.91		1793.98	19.01	0			0.61				4.84	1.28	2763.12	437.55	675.55	44.35	0	593.94						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	49.537808	0	0.2	0.2	0.2	65	0.241755	0.25	0.247049	0.206552	0.2	0.238676	15	38.855037	40	0.25		0	0.2	0			0				0	0	0	0	106.974241	150	0	15					NO	111.108149	93.073817	37.400946	0	0.172525	0.172525	0.172525	56.070625	0.208544	0.215656	0.213111	0.178177	0.172525	0.205888	12.939375	33.517327	34.505	0.215656		0	0.172525	0			0				0	0	0	0	92.278654	129.39375	0	12.939375						15.6965	0.920189804	1.199323668	0	0.2518865	3.485005	1.09898425	2.143673445	11.63884064	2.66119504	1.23817491	0.24232072	0.048307	8.21287232	3.718733244	13.00134321	0.216950188	0.41190296	0	0	3.27970025	0	0	0	0	0	0	0	0	0	0	0	5.194903726	0.478217734	0	0.640434366	0	0	0	0	75.7795	0	NO	15.285289	15.6965	0.920189804	1.199323668	0	0.2518865	3.485005	1.09898425	2.143673445	11.63884064	2.66119504	1.23817491	0.24232072	0.048307	8.21287232	3.718733244	13.00134321	0.216950188	0.41190296	0	0	3.27970025	0	0	0	0	0	0	0	0	0	0	0	5.194903726	0.478217734	0	0.640434366	0	0	0	0	75.7795	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$150/Visit	$15-$150/Visit	$0/Visit	$15/Visit					5000	1.8932	0.111	0.1452	0	1.8233	0.8059	0.2543	0.2215	1.2144	0.2777	0.1291	0.0287	0.005	0.857	0.4381	1.5317	0.0256	0.043		0	0.4055								0	0	0.2488	0	0.5664	0.0494	0	0.0755					11.1503	0	NO	1.960867	17.5898	1.031180804	1.344501668	0	2.0751695	4.290934	1.35330025	2.365214445	12.85319464	2.93889604	1.36728991	0.27105372	0.053298	9.06986532	4.156852244	14.53308321	0.242508188	0.45488396	0	0	3.68515425	0	0	0	0	0	0	0	0	0	0.248832	0	5.761310726	0.527639734	0	0.715886366	0	0	0	0	86.9298
H4785_003_0	2012	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	O			V				O	O	O	V	V								0	0	0	0	0	0.581044505	0.226984004	0	1.998491793	0.316826527	0.74582309	0.042354676	0.009597834	0.884276917	1.147614164	2.060518305	0.025100448	0.205516617		0	0.698625172	0			0				0	0	0	0	0								8.9428	NO	329.99	6.47	39.77	1623.04	1.83	21.71	8.48	449.46	74.69	11.84	27.87	1.58	0.36	33.05	42.89	77	0.94	7.68		2071.2	26.11	0			0.61				4.84	1.28	2800.07	441.62	188.22									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0794	0.0794	0.2126	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.060524	0.060524	0.121968	0	0.176757	0.176757	0.176757	57.445895	0.176757	0.176757	0.176757	0.176757	0.176757	0.176757	0.176757	0.176757	0.176757	0.176757		0	0.176757	0			0				0	0	0	0	0									19.9723	0.39159028	4.85066736	0	0.32346531	3.83739447	1.49889936	2.151635997	13.20198033	2.09280288	4.92621759	0.27927606	0.06363252	5.84181885	7.58110773	13.610289	0.16615158	1.35749376	0	0	4.61512527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7619	0	NO	18.049161	19.9723	0.39159028	4.85066736	0	0.32346531	4.418438975	1.725883364	2.151635997	15.20047212	2.409629407	5.67204068	0.321630736	0.073230354	6.726095767	8.728721894	15.6708073	0.191252028	1.563010377	0	0	5.313750442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7046	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.3953	0.0469	0.5798	0	2.3185	1.0508	0.4105	0.2198	1.7032	0.2585	0.6511	0.039	0.0078	0.7214	1.1094	1.9919	0.0243	0.1874		0	0.6754	0							0	0	0	0	0								14.3909	0	NO	2.456801	22.3676	0.43845828	5.43047436	0	2.64199631	5.469211975	2.136365364	2.371467997	16.90369912	2.668090407	6.32313268	0.360634736	0.081060354	7.447472767	9.838124894	17.6627183	0.215517028	1.750377377	0	0	5.989113442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0955
H4837_001_0	2012	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	218.2985293	28.9879	22.01333792	2226.282539	15.05871319	16.22124793	10.3392365	32.41629407	42.36688435	13.96877544	28.49357028	0	0	34.67024988	29.11003865	65.55677146	14.0807	4.056680936	0	4.261912285	15.40365842	5.651104491	0	0	32.08044008	0	0	0	81.19209852	3033.235218											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.076757433	0.076757433	0.161423737	0	0.224	0.224	0.224	0.12828631	0.224	0.224	0.224	0	0	0.224	0.218787308	0.223651478	0.224	0.224	0	0.224	0.224	0.043342202	0	0	0	0	0	0	0	0											NO	0.063715768	0.063715768	0.133996632	0	0.185940718	0.185940718	0.185940718	0.106501928	0.185940718	0.185940718	0.185940718	0	0	0.185940718	0.181613701	0.185651412	0.185940718	0.185940718	0	0.185940718	0.185940718	0.042147541	0	0	0	0	0	0	0	0												13.9091	1.846986321	2.949713139	0	2.800027936	3.01619048	1.922485054	3.452397821	7.877728879	2.59736413	5.298114905	0	0	6.446611142	5.286781866	12.17070718	2.618175463	0.754302164	0	0.792463029	2.864167301	0.23818016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8415	150	YES	15.68581005	13.9091	1.846986321	2.949713139	0	2.800027936	3.01619048	1.922485054	3.452397821	7.877728879	2.59736413	5.298114905	0	0	6.446611142	5.286781866	12.17070718	2.618175463	0.754302164	0	0.792463029	2.864167301	0.23818016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8415	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	13.9091	1.846986321	2.949713139	0	2.800027936	3.01619048	1.922485054	3.452397821	7.877728879	2.59736413	5.298114905	0	0	6.446611142	5.286781866	12.17070718	2.618175463	0.754302164	0	0.792463029	2.864167301	0.23818016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8415
H4866_002_0	2012	6																															D	D	D		T	Coin	Coin	V	Coin	Coin	Coin			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	YES	1042.96619	30.8672189	573.6877342	0	144.5119264	5.572001111	3.197670679	137.7462686	34.2283915	3.094863143	26.63410257	0	0	16.54627133	0	0	0	0	2113.746055	14.02803517	49.5636733	0	0	0	0	0	0	0	0	0											3400	$185/Days 1-5 for IP Medical; $185/Days 1-5 for IP Surgical; PBP 1a	$185/Days 1-5 for IP Psych; $185/Days 1-5 for IP Substance Abuse; PBP 1b	$138/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 DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a-b	15% Coinsurance for OP Fac - Surgery; PBP 9a-b	15% Coinsurance for OP Fac - Pathology; PBP 8a	15% Coinsurance for OP Fac - Radiology; 15% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"15% Coinsurance for OP Fac - Cardiovascular; 15% Coinsurance for OP Fac - Occ Therapy; 15% Coinsurance for OP Fac - Physical/Speech Therapy; 15% Coinsurance for OP Fac - CORF; 15% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost-Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost-Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	15% Coinsurance for Prof Radiology (OP); 15% Coinsurance for Prof Radiology (OP); $20/Procedure for Prof Radiology (Office); $50/Procedure for Prof Radiology (Office); PBP 7d	15% Coinsurance for Prof - Primary Surgeon (OP); 15% Coinsurance for Prof Path (OP); PBP 7g	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 16b"	No Cost-Sharing; PBP 10b	No Cost-Sharing; PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	No Cost-Sharing; PBP 13a-e											0	NO	185	185	137.5	0	100	0.2	0.2	65	0.15	0.15	0.15	0	0	0.15	0	0	0	0	17.51340232	0.15	0.2	0	0	0	0	0	0	0	0	0											NO	173.1809481	173.1809481	128.7155695	0	93.61132328	0.187222647	0.187222647	60.84736013	0.140416985	0.140416985	0.140416985	0	0	0.140416985	0	0	0	0	16.39452766	0.140416985	0.187222647	0	0	0	0	0	0	0	0	0												15.0518	0.445467853	6.153545286	0	1.127329388	1.043204795	0.598676367	0.698458068	4.806247534	0.434571351	3.739880379	0	0	2.323377531	0	0	0	0	2.887822347	1.969774402	9.279442088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5596	0	NO	3.450534158	15.0518	0.445467853	6.153545286	0	1.127329388	1.043204795	0.598676367	0.698458068	4.806247534	0.434571351	3.739880379	0	0	2.323377531	0	0	0	0	2.887822347	1.969774402	9.279442088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5596	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.0518	0.445467853	6.153545286	0	1.127329388	1.043204795	0.598676367	0.698458068	4.806247534	0.434571351	3.739880379	0	0	2.323377531	0	0	0	0	2.887822347	1.969774402	9.279442088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5596
H4866_003_0	2012	8																															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	967.1101796	28.62221412	604.1296487	0	140.2046223	5.405922756	3.102361314	150.1513058	182.7485468	0	371.6875414	0	0	234.6219728	0	5165.679276	140.5678596	553.4038512	805.2517139	0	48.44541166	595.2087773	0	0	412.809514	0	0	0	0	0											3400	$270/Days 1-5 for IP Medical; $270/Days 1-5 for IP Surgical; PBP 1a	$270/Days 1-5 for IP Psych; $270/Days 1-5 for IP Substance Abuse; PBP 1b	$138/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 DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$35/Visit for ER - Facility; $35/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a-b	$100/Case for OP Fac - Surgery; PBP 9a-b	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	"$15/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; PBP 3, 5, 9c"	"No Cost-Sharing; PBP 7a, 14a-b, 14d-e"	"$15/Visit for Speclst Office Visits; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; $15/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 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/Procedure for Prof Radiology (Office); $50/Procedure for Prof Radiology (Office); PBP 7d	No Cost-Sharing; PBP 7g	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$15/Other for Renal Dialysis - Prof; PBP 9d, 16b"	No Cost-Sharing; PBP 10b	No Cost-Sharing; PBP 16a-b	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	No Cost-Sharing; PBP 13a-e											0	NO	270	270	137.5	0	100	0.2	0.2	33.55873988	100	0	27.63794378	0	0	15	0	15	15	15	24.20400168	0	0.2	15	0	0	15	0	0	0	0	0											NO	252.8366374	252.8366374	128.7593987	0	93.64319902	0.187286398	0.187286398	31.42547757	93.64319902	0	25.8810547	0	0	14.04647985	0	14.12704872	14.04647985	14.04647985	22.66540146	0	0.187286398	14.04647985	0	0	15	0	0	0	0	0												20.3767	0.603062031	6.482280857	0	1.094100779	1.012455801	0.581030076	0.393214708	1.426096545	0	0.801638799	0	0	0.274634401	0	6.081316902	0.164540301	0.647781337	1.520946114	0	9.073166651	0.696715675	0	0	0.516011893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7457	0	NO	3.440600837	20.3767	0.603062031	6.482280857	0	1.094100779	1.012455801	0.581030076	0.393214708	1.426096545	0	0.801638799	0	0	0.274634401	0	6.081316902	0.164540301	0.647781337	1.520946114	0	9.073166651	0.696715675	0	0	0.516011893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7457	NO																																										0	0	0	0	0	0	0	0	0	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	20.3767	0.603062031	6.482280857	0	1.094100779	1.012455801	0.581030076	0.393214708	1.426096545	0	0.801638799	0	0	0.274634401	0	6.081316902	0.164540301	0.647781337	1.520946114	0	9.073166651	0.696715675	0	0	0.516011893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7457
H4866_004_0	2012	6																															D	D	D		T	Coin	Coin	V	Coin	Coin	Coin			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	YES	1096.853058	32.46203354	402.6366397	0	154.5928274	5.960694232	3.420734633	166.656148	35.48284648	3.20828847	27.61023032	0	0	17.15268464	0	0	0	0	2261.197308	15.00660654	49.81858709	0	0	0	0	0	0	0	0	0											3400	$170/Days 1-5 for IP Medical; $170/Days 1-5 for IP Surgical; PBP 1a	$170/Days 1-5 for IP Psych; $170/Days 1-5 for IP Substance Abuse; PBP 1b	$138/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 DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a-b	15% Coinsurance for OP Fac - Surgery; PBP 9a-b	15% Coinsurance for OP Fac - Pathology; PBP 8a	15% Coinsurance for OP Fac - Radiology; 15% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"15% Coinsurance for OP Fac - Cardiovascular; 15% Coinsurance for OP Fac - Occ Therapy; 15% Coinsurance for OP Fac - Physical/Speech Therapy; 15% Coinsurance for OP Fac - CORF; 15% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost-Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost-Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	15% Coinsurance for Prof Radiology (OP); 15% Coinsurance for Prof Radiology (OP); $20/Procedure for Prof Radiology (Office); $50/Procedure for Prof Radiology (Office); PBP 7d	15% Coinsurance for Prof - Primary Surgeon (OP); 15% Coinsurance for Prof Path (OP); PBP 7g	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 16b"	No Cost-Sharing; PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	No Cost-Sharing; PBP 13a-e											0	NO	170	170	137.5	0	100	0.2	0.2	59.27286864	0.15	0.15	0.15	0	0	0.15	0	0	0	0	17.51340232	0.15	0.2	0	0	0	0	0	0	0	0	0											NO	159.5210562	159.5210562	129.0243837	0	93.83591542	0.187671831	0.187671831	55.61923888	0.140753873	0.140753873	0.140753873	0	0	0.140753873	0	0	0	0	16.43386139	0.140753873	0.187671831	0	0	0	0	0	0	0	0	0												14.5809	0.43153149	4.329162024	0	1.20886329	1.1186544	0.641975531	0.772440675	4.994348072	0.451579028	3.886246855	0	0	2.414306798	0	0	0	0	3.096683595	2.112237993	9.349545448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3885	0	NO	3.244332633	14.5809	0.43153149	4.329162024	0	1.20886329	1.1186544	0.641975531	0.772440675	4.994348072	0.451579028	3.886246855	0	0	2.414306798	0	0	0	0	3.096683595	2.112237993	9.349545448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3885	NO																																										0	0	0	0	0	0	0	0	0	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	14.5809	0.43153149	4.329162024	0	1.20886329	1.1186544	0.641975531	0.772440675	4.994348072	0.451579028	3.886246855	0	0	2.414306798	0	0	0	0	3.096683595	2.112237993	9.349545448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3885
H4875_011_0	2012	6																															D	D	D		P	Coin		P	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	667.7821828	20.41414268	233.9982401	0	140.0692176	11.9375881	0	320.9589475	389.4214473	3633.119513	1056.517739	6.521593963	2.895240744	627.2077532	3346.138696	5633.52206	99.82198678	7.966249654	636.1807803	1347.923955	19.5730677	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$90 copay OP Hospital, $50 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $100 copay;  PBP 8b	"$30 copay individual visit, $15 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $50 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$30 copay individual visit, $15 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $100 copay;  PBP 8b	"$0 - $30 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	100	100	120	0	75	0.2	0	63.14138429	78.75101101	10	40.92008453	29.475	10	30.14225346	15	28.80473208	29.475	30	25.06059703	10.00113735	0.2	0	0	0.2238	0	0	0	0	0	0											NO	90.57158047	90.57158047	108.6858966	0	67.92868535	0.181143161	0	57.18814968	71.3260353	9.057158047	37.06196729	26.69597334	9.057158047	27.30031535	13.58573707	26.08890109	26.69597334	27.17147414	22.6977788	9.05818816	0.181143161	0	0	0.2238	0	0	0	0	0	0												5.0402	0.154078431	2.119359043	0	0.792893151	2.162412443	0	1.529587361	2.314657325	2.742144803	3.263052157	0.014508358	0.002185221	1.426914121	3.788313377	12.24769999	0.222070425	0.018037896	1.203324219	1.017479067	3.545527352	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.193	0	NO	4.539180512	5.0402	0.154078431	2.119359043	0	0.792893151	2.162412443	0	1.529587361	2.314657325	2.742144803	3.263052157	0.014508358	0.002185221	1.426914121	3.788313377	12.24769999	0.222070425	0.018037896	1.203324219	1.017479067	3.545527352	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.193	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $150 copay;  PBP 8b	"$40 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$40 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay;  PBP 7e, 7h, 9c"	"$40 copay;  PBP 3, 7c, 7i"	$10 - $150 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											5100	0.6772	0.0155	0.4409	0	0.2144	0.5951	0.0336	0.3513	0.0877	0.0581	0.0989	0	0	0.162	0.0921	3.5711	0.091	0.0033	0.288	0.3052	0.0828	0	0	0.1034	0	0	0	0	0	0											7.2715	750	NO	0.746195553	5.7174	0.169535992	2.560223201	0	1.007277069	2.757524144	0.033570742	1.880908212	2.402382987	2.800242835	3.361926826	0.014508358	0.002185221	1.588866935	3.880462734	15.81879606	0.313046857	0.021347836	1.491346254	1.322635678	3.62834863	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4645
H4875_012_0	2012	5																															D	D	D		P	Coin		P	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	697.0554922	21.30902956	244.2559305	0	146.2093778	12.46272097	0	335.0287008	406.4923648	3792.383169	1102.831899	6.807478556	3.022158293	654.7024169	3492.822085	5880.476589	104.1978446	8.315463059	664.0687912	1407.012376	20.43408428	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$90 copay OP Hospital, $50 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $100 copay;  PBP 8b	"$30 copay individual visit, $15 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $50 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$30 copay individual visit, $15 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $100 copay;  PBP 8b	"$0 - $30 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	100	100	120	0	75	0.2	0	63.14138429	78.75101101	10	40.92008453	29.475	10	30.14232784	15	28.80473208	29.475	30	25.06059703	10.00113735	0.2	0	0	0.2238	0	0	0	0	0	0											NO	90.57158047	90.57158047	108.6858966	0	67.92868535	0.181143161	0	57.18814968	71.3260353	9.057158047	37.06196729	26.69597334	9.057158047	27.30038272	13.58573707	26.08890109	26.69597334	27.17147414	22.6977788	9.05818816	0.181143161	0	0	0.2238	0	0	0	0	0	0												5.2611	0.160832707	2.212264566	0	0.827650902	2.257536671	0	1.596639291	2.416124063	2.862351144	3.406093313	0.015144356	0.002281014	1.489468879	3.954380206	12.78459767	0.23180524	0.018828616	1.256073878	1.062081904	3.701494617	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1053	0	NO	4.738254256	5.2611	0.160832707	2.212264566	0	0.827650902	2.257536671	0	1.596639291	2.416124063	2.862351144	3.406093313	0.015144356	0.002281014	1.489468879	3.954380206	12.78459767	0.23180524	0.018828616	1.256073878	1.062081904	3.701494617	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1053	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $150 copay;  PBP 8b	"$40 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$40 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay;  PBP 7e, 7h, 9c"	"$40 copay;  PBP 3, 7c, 7i"	$10 - $150 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											5100	0.7069	0.0161	0.4602	0	0.2238	0.6212	0.035	0.3667	0.0916	0.0606	0.1032	0	0	0.1691	0.0962	3.7276	0.095	0.0035	0.3006	0.3185	0.0865	0	0	0.1034	0	0	0	0	0	0											7.5857	750	NO	0.778906239	5.968	0.176967876	2.672454715	0	1.051432684	2.878736054	0.035042369	1.963360858	2.507695321	2.922995997	3.509302312	0.015144356	0.002281014	1.658521156	4.050569078	16.5122385	0.326769771	0.022283653	1.556721824	1.380615546	3.787946499	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.691
H4875_013_0	2012	5																															D	D	D		P	Coin		P	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	659.4099962	20.15820442	231.0645336	0	138.3131276	11.78835392	0	316.9349884	384.5391532	3587.569998	1043.271857	6.439830773	2.858942237	619.3442604	3304.187146	5562.892895	98.57048843	7.866374379	628.20479	1331.024625	19.32838085	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$90 copay OP Hospital, $50 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $100 copay;  PBP 8b	"$30 copay individual visit, $15 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $50 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$30 copay individual visit, $15 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $100 copay;  PBP 8b	"$0 - $30 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	100	100	120	0	75	0.2	0	63.14138429	78.75101101	10	40.92008453	29.475	10	30.14227161	15	28.80473208	29.475	30	25.06059703	10.00113735	0.2	0	0	0.2238	0	0	0	0	0	0											NO	90.57158047	90.57158047	108.6858966	0	67.92868535	0.181143161	0	57.18814968	71.3260353	9.057158047	37.06196729	26.69597334	9.057158047	27.30033179	13.58573707	26.08890109	26.69597334	27.17147414	22.6977788	9.05818816	0.181143161	0	0	0.2238	0	0	0	0	0	0												4.977	0.152146703	2.092788	0	0.78295241	2.135379691	0	1.510410463	2.285637768	2.707765706	3.222142288	0.014326463	0.002157824	1.409025317	3.74081815	12.09414688	0.219286261	0.017811749	1.188237781	1.004722625	3.501204003	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6465	0	NO	4.482292976	4.977	0.152146703	2.092788	0	0.78295241	2.135379691	0	1.510410463	2.285637768	2.707765706	3.222142288	0.014326463	0.002157824	1.409025317	3.74081815	12.09414688	0.219286261	0.017811749	1.188237781	1.004722625	3.501204003	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6465	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $150 copay;  PBP 8b	"$40 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$40 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay;  PBP 7e, 7h, 9c"	"$40 copay;  PBP 3, 7c, 7i"	$10 - $150 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											5100	0.6687	0.0153	0.4353	0	0.2117	0.5877	0.0331	0.3469	0.0866	0.0574	0.0976	0	0	0.1599	0.091	3.5263	0.0898	0.0033	0.2844	0.3013	0.0818	0	0	0.1034	0	0	0	0	0	0											7.1816	750	NO	0.736840275	5.6457	0.167410468	2.52812491	0	0.994648532	2.723030297	0.033149855	1.857326699	2.372263587	2.765135346	3.319777335	0.014326463	0.002157824	1.568947679	3.831812202	15.62047104	0.309122094	0.021080192	1.472648797	1.306053395	3.582986926	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8281
H4875_014_0	2012	5																															D	D	D		P	Coin		P	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	713.0595	21.79827307	249.8639112	0	149.5662641	12.75188392	0	342.7207741	415.8252042	3879.454184	1128.152308	6.963774491	3.091545372	669.7340216	3573.015344	6015.489072	106.5901694	8.506381482	679.3154426	1439.3166	20.90820065	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$90 copay OP Hospital, $50 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $100 copay;  PBP 8b	"$30 copay individual visit, $15 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $50 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$30 copay individual visit, $15 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $100 copay;  PBP 8b	"$0 - $30 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	100	100	120	0	75	0.2	0	63.14138429	78.75101101	10	40.92008453	29.475	10	30.1423855	15	28.80473208	29.475	30	25.06059703	10.00113735	0.2	0	0	0.2238	0	0	0	0	0	0											NO	90.57158047	90.57158047	108.6858966	0	67.92868535	0.181143161	0	57.18814968	71.3260353	9.057158047	37.06196729	26.69597334	9.057158047	27.30043494	13.58573707	26.08890109	26.69597334	27.17147414	22.6977788	9.05818816	0.181143161	0	0	0.2238	0	0	0	0	0	0												5.3819	0.164525337	2.263056934	0	0.846653308	2.309916561	0	1.633297244	2.471596933	2.92806914	3.484295327	0.015492062	0.002333385	1.523669174	4.045170584	13.07812495	0.23712736	0.01926091	1.284912638	1.086466716	3.787377554	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1518	0	NO	4.847192859	5.3819	0.164525337	2.263056934	0	0.846653308	2.309916561	0	1.633297244	2.471596933	2.92806914	3.484295327	0.015492062	0.002333385	1.523669174	4.045170584	13.07812495	0.23712736	0.01926091	1.284912638	1.086466716	3.787377554	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1518	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $150 copay;  PBP 8b	"$40 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$40 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay;  PBP 7e, 7h, 9c"	"$40 copay;  PBP 3, 7c, 7i"	$10 - $150 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											5100	0.7232	0.0165	0.4708	0	0.2289	0.6355	0.0358	0.3751	0.0937	0.062	0.1056	0	0	0.1729	0.0984	3.8132	0.0971	0.0035	0.3076	0.3258	0.0884	0	0	0.1034	0	0	0	0	0	0											7.7575	750	NO	0.796789495	6.1051	0.18103096	2.733812794	0	1.075572996	2.945378337	0.035846923	2.008438535	2.565270616	2.990106365	3.589873949	0.015492062	0.002333385	1.696602797	4.143567899	16.89135035	0.334272223	0.022795273	1.592463294	1.412313714	3.875814324	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9093
H4875_015_0	2012	5																															D	D	D		P	Coin		P	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	922.1498404	28.19017772	323.131472	0	193.4235594	16.48492448	0	443.2167402	537.7575724	5017.026008	1458.960256	9.00576114	3.998078802	866.1200378	4620.730148	7779.410116	137.8455903	11.00070657	878.5110177	1861.367212	27.02895594	0	0	7.098084	0	0	0	0	0	0											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	$75 copay;  PBP 10a	"20% coinsurance;  PBP 11a, 11b"	"20% coinsurance, 0% Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$90 copay OP Hospital, $50 copay Amb Surg;  PBP 9a, 9b"	$10 copay;  PBP 8a	$0 - $100 copay;  PBP 8b	"$30 copay individual visit, $15 copay group visit;  PBP 9a, 9c"	$10 copay;  PBP 12	"40% for Partial Hosp, $0 - $50 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$15 PCP, $0 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$30 Specialist, $20 Chiro, $0 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$30 copay individual visit, $15 copay group visit;  PBP 7e, 7h, 9c"	"$30 copay;  PBP 3, 7c, 7i"	$0 - $100 copay;  PBP 8b	"$0 - $30 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											0	NO	100	100	120	0	75	0.2	0	63.14138429	78.75101101	10	40.92008453	29.475	10	30.14225736	15	28.80473208	29.475	30	25.06059703	10.00113735	0.2	0	0	0.2238	0	0	0	0	0	0											NO	90.57158047	90.57158047	108.6858966	0	67.92868535	0.181143161	0	57.18814968	71.3260353	9.057158047	37.06196729	26.69597334	9.057158047	27.30031888	13.58573707	26.08890109	26.69597334	27.17147414	22.6977788	9.05818816	0.181143161	0	0	0.2238	0	0	0	0	0	0												6.96	0.212769079	2.926652812	0	1.094917342	2.986131327	0	2.112228773	3.196342966	3.786666457	4.505994773	0.020034797	0.003017603	1.970446102	5.231335406	16.91302176	0.306660184	0.024908785	1.661687396	1.405051203	4.896110515	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8026	0	NO	6.268225454	6.96	0.212769079	2.926652812	0	1.094917342	2.986131327	0	2.112228773	3.196342966	3.786666457	4.505994773	0.020034797	0.003017603	1.970446102	5.231335406	16.91302176	0.306660184	0.024908785	1.661687396	1.405051203	4.896110515	0	0	1.588551199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8026	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	$75 copay;  PBP 10a	"30% coinsurance;  PBP 11a, 11b"	"30% coinsurance, $10 copay Diab Mon Supp;  PBP 11a, 11b, 11c"	"$65 ER, $40 Urgent Care;  PBP 4a, 4b"	"$175 copay OP Hospital, $75 copay Amb Surg;  PBP 9a, 9b"	$20 copay;  PBP 8a	$10 - $150 copay;  PBP 8b	"$40 copay;  PBP 9a, 9c"		"40% for Partial Hosp, $0 - $75 copay for other;  PBP 3, 5, 9a, 9c, 9d"	"$40 PCP, $10 Preventive/Physical Exams/Immun/Screenings;  PBP 7a, 14a-e"	"$40 Specialist, $10 Screenings/Exams;  PBP 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"$40 copay;  PBP 7e, 7h, 9c"	"$40 copay;  PBP 3, 7c, 7i"	$10 - $150 copay;  PBP 8b	"$0 - $40 copay;  PBP 7g, 8a"	0% - 20% coinsurance;  PBP 15			"$0 copay Exam/Prophylaxis, 50% coinsurance X-rays PBP 16a"						"$0 copay; PBP 13d, 13e, 14c"											5100	0.9352	0.0213	0.6088	0	0.296	0.8218	0.0464	0.4851	0.1211	0.0802	0.1365	0	0	0.2236	0.1273	4.9314	0.1256	0.0046	0.3977	0.4214	0.1144	0	0	0.1034	0	0	0	0	0	0											10.0019	750	NO	1.03043197	7.8953	0.234114644	3.535448349	0	1.390963119	3.807929474	0.046358311	2.597372694	3.317484571	3.866894849	4.642532199	0.020034797	0.003017603	2.194089028	5.358585752	21.84439872	0.432290822	0.029479528	2.059421089	1.826446273	5.010479587	0	0	1.691928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8045
H4909_001_0	2012	11	H.6										OP Facility - Other										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	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	YES	749.4333406	114.0959323	170.7871054	235.2610698	29.94925417	7.932030355	3.424839095	244.6000111	216.306807	5781.627408	425.7563606	0.776147121	0	238.3175092	2790.798298	2460.77488	0.83881708	778.8605187	606.4762491	1606.736222	14.93412844	4.989880293	0	0	0	0	0	0	5872.8	86.69108955	5.671818898	0	0	0	0	0	0	0	0	0	4500	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0 - $250 copay; 9B: $0-$250 copay	8A: $0-$160 copay	8B: $100-$160 copay	5: $45 copay	12: 20% coin	3: $0 copay; 9A: $45-$250 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $65 copay; 7I: $65 copay	8B: $100-$160 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	153.8682133	137.4386786	146	0	175	0.2	0.122472094	64.99420135	205.0561082	20.52385489	125.6156289	45	0.2	55.73155406	0	43.37196867	40	65	110.1391253	0.831951843	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	142.8361924	127.5846201	135.5321132	0	162.4528754	0.185660429	0.113691108	60.33425652	190.354025	19.05233852	116.6092578	41.77359652	0	51.73572118	0	40.26229155	37.1320858	60.33963942	102.2423862	0.77230268	0.185660429	0	0	0	0	0	0	0	0	0	0.185660429	0	0	0	0	0	0	0	0	0		8.9205	1.213073849	1.928928108	0	0.405445205	1.472664158	0.38937375	1.229813318	3.431239279	9.179460215	4.137261099	0.002701871	0	1.027460684	0	8.256369638	0.002595586	3.916346905	5.167298242	0.103407224	2.772676693	0	0	0	0	0	0	0	0	0	1.05303233	0	0	0	0	0	0	0	0	0	54.6097		NO	4.217803314	8.9205	1.213073849	1.928928108	0	0.405445205	1.472664158	0.38937375	1.229813318	3.431239279	9.179460215	4.137261099	0.002701871	0	1.027460684	0	8.256369638	0.002595586	3.916346905	5.167298242	0.103407224	2.772676693	0	0	0	0	0	0	0	0	0	1.05303233	0	0	0	0	0	0	0	0	0	54.6097	YES	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0-$250 copay; 9B: $0-$250 copay	8A: $0-$160 copay	8B: $100-$160 copay	5: $45 copay	12: 20% coin	3: $0 copay; 9A: $45-$250 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $65 copay; 7I: $65 copay	8B: $100-$160 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4500	4.3207	0.7791	0.0334	0	0.6172	0.1778	0.1183	0.5201	2.6653	7.1797	1.5175	0	0	0.8659	0	0.632	0.0002	0.9857	3.0967	0.0186	1.2756	0	0	0	0	0	0	0	0	0	0.4162	0	0	0	0	0	0	0	0	0	25.22		NO	1.94787614	13.2412	1.992148333	1.962309793	0	1.022612892	1.65048725	0.507656631	1.749916969	6.096538051	16.35914499	5.654790576	0.002701871	0	1.89334308	0	8.888331155	0.002842869	4.902094907	8.263976324	0.122036543	4.048240244	0	0	0	0	0	0	0	0	0	1.469242056	0	0	0	0	0	0	0	0	0	79.8296
H4909_004_0	2012	11	H.6										OP Facility - Other										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	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	YES	878.4932724	52.42435587	200.2355455	252.2280386	69.53498872	8.584438383	4.270376406	231.4871607	277.8796068	6759.159947	587.3899668	0	0.042401885	284.6702577	2682.650803	3158.61771	2.156843316	942.2391624	705.2422586	1592.688717	30.15049343	5.698418762	0	0	0	0	0	0	5872.8	146.6440461	8.428610006	0	0	0	0	0	0	0	0	0	3350	1A: $195/day (days1-7) $1365 yrly max	1B: $195/day (days1-7) $1365 yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $25 copay	9A: $0 - $150 copay; 9B: $0-$150 copay	8A: $0-$130 copay	8B: $70-$130 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $25-$150 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $60 copay; 7I: $60 copay	8B: $70-$130 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	123.2475291	135.0469348	146	0	125	0.2	0.116740966	64.97873021	121.9065887	13.82724603	91.51336282	40	0.2	72.51248974	15	24.87470977	40	60	79.40441531	0.47631759	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	111.1566315	121.7984853	131.6770268	0	112.7371805	0.180379489	0.105288379	58.60415069	109.9472407	12.47075785	82.53566801	0	0.180379489	65.39882915	13.52846166	22.43443716	36.07589776	54.11384664	71.61463921	0.429589617	0.180379489	0	0	0	0	0	0	0	0	0	0.180379489	0	0	0	0	0	0	0	0	0		8.1375	0.532100595	2.197201774	0	0.653264881	1.548456607	0.44962101	1.130509037	2.546008002	7.024320582	4.040051941	0	0.00764843	1.551425129	3.024344877	5.905150878	0.006484172	4.249015461	4.208805825	0.057016878	5.438530593	0	0	0	0	0	0	0	0	0	1.520348364	0	0	0	0	0	0	0	0	0	54.2278		NO	5.898552218	8.1375	0.532100595	2.197201774	0	0.653264881	1.548456607	0.44962101	1.130509037	2.546008002	7.024320582	4.040051941	0	0.00764843	1.551425129	3.024344877	5.905150878	0.006484172	4.249015461	4.208805825	0.057016878	5.438530593	0	0	0	0	0	0	0	0	0	1.520348364	0	0	0	0	0	0	0	0	0	54.2278	YES	1A: $195/day (days1-7) no yrly max	1B: $195/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $25 copay	9A: $0-$150 copay; 9B: $0-$150 copay	8A: $0-$130 copay	8B: $70-$130 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $25-$150 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $60 copay; 7I: $60 copay	8B: $70-$130 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3350	3.4583	0.189	0.4005	0	0.2659	0.1609	0.0945	0.4363	1.5259	5.6906	1.6607	0	0	0.5035	0.7105	0.1539	0.0075	0.7611	2.3225	0.0294	1.8331	0	0	0	0	0	0	0	0	0	0.4633	0	0	0	0	0	0	0	0	0	20.6674		NO	2.248060753	11.5958	0.721149606	2.597669765	0	0.919183738	1.709335313	0.544091346	1.566806496	4.071873415	12.7149011	5.700726555	0	0.00764843	2.054925001	3.734876559	6.059080774	0.014006464	5.010097393	6.531349963	0.086366924	7.271657947	0	0	0	0	0	0	0	0	0	1.983648289	0	0	0	0	0	0	0	0	0	74.8952
H4909_804_0	2012	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	233.7217159	2.428136857	50.14344581	13.18698588	6.887632182	12.68435915	4.324889817	15.36469741	56.3509273	68.30276374	59.15267706	0.005238734	6.745930624	0.586347388	43.54629048	64.81654546	0.18234057	41.16209221	0	0.102130539	40.15649544	0.453179809																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071760037	0.071760037	0.16045679	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	0.059925529	0.059925529	0.133994607	0	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735																				14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638		NO	18.67510899	14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638	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	1.5562	0.0162	0.7466	0	0.134	0.2468	0.0842	0.299	1.0964	1.329	1.151	0.0001	0.1313	0.0114	0.8473	1.2612	0.0035	0.8009	0	0.002	0.7813	0.0088																			10.5071		NO	2.07501211	15.5621	0.161674873	7.465501489	0	1.340155176	2.468048398	0.841511759	2.989572937	10.96443377	13.28995219	11.50958185	0.001019322	1.312583716	0.114088045	8.472982449	12.61162423	0.035478761	8.009079099	0	0.019871963	7.813415961	0.088177076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0709
H4909_805_0	2012	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	233.7217159	2.428136857	50.14344581	13.18698588	6.887632182	12.68435915	4.324889817	15.36469741	56.3509273	68.30276374	59.15267706	0.005238734	6.745930624	0.586347388	43.54629048	64.81654546	0.18234057	41.16209221	0	0.102130539	40.15649544	0.453179809																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071760037	0.071760037	0.16045679	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	0.059925529	0.059925529	0.133994607	0	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735																				14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638		NO	18.67510899	14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638	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	1.5562	0.0162	0.7466	0	0.134	0.2468	0.0842	0.299	1.0964	1.329	1.151	0.0001	0.1313	0.0114	0.8473	1.2612	0.0035	0.8009	0	0.002	0.7813	0.0088																			10.5071		NO	2.07501211	15.5621	0.161674873	7.465501489	0	1.340155176	2.468048398	0.841511759	2.989572937	10.96443377	13.28995219	11.50958185	0.001019322	1.312583716	0.114088045	8.472982449	12.61162423	0.035478761	8.009079099	0	0.019871963	7.813415961	0.088177076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0709
H4909_806_0	2012	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	233.7217159	2.428136857	50.14344581	13.18698588	6.887632182	12.68435915	4.324889817	15.36469741	56.3509273	68.30276374	59.15267706	0.005238734	6.745930624	0.586347388	43.54629048	64.81654546	0.18234057	41.16209221	0	0.102130539	40.15649544	0.453179809																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071760037	0.071760037	0.16045679	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	0.059925529	0.059925529	0.133994607	0	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735																				14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638		NO	18.67510899	14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638	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	1.5562	0.0162	0.7466	0	0.134	0.2468	0.0842	0.299	1.0964	1.329	1.151	0.0001	0.1313	0.0114	0.8473	1.2612	0.0035	0.8009	0	0.002	0.7813	0.0088																			10.5071		NO	2.07501211	15.5621	0.161674873	7.465501489	0	1.340155176	2.468048398	0.841511759	2.989572937	10.96443377	13.28995219	11.50958185	0.001019322	1.312583716	0.114088045	8.472982449	12.61162423	0.035478761	8.009079099	0	0.019871963	7.813415961	0.088177076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0709
H4909_807_0	2012	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	233.7217159	2.428136857	50.14344581	13.18698588	6.887632182	12.68435915	4.324889817	15.36469741	56.3509273	68.30276374	59.15267706	0.005238734	6.745930624	0.586347388	43.54629048	64.81654546	0.18234057	41.16209221	0	0.102130539	40.15649544	0.453179809																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071760037	0.071760037	0.16045679	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	0.059925529	0.059925529	0.133994607	0	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735	0.175116735																				14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638		NO	18.67510899	14.0059	0.145507386	6.71895134	0	1.206139659	2.221243558	0.757360583	2.690615643	9.867990396	11.96095697	10.35862366	0.00091739	1.181325344	0.10267924	7.625684204	11.35046181	0.031930885	7.208171189	0	0.017884767	7.032074365	0.079359368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5638	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	1.5562	0.0162	0.7466	0	0.134	0.2468	0.0842	0.299	1.0964	1.329	1.151	0.0001	0.1313	0.0114	0.8473	1.2612	0.0035	0.8009	0	0.002	0.7813	0.0088																			10.5071		NO	2.07501211	15.5621	0.161674873	7.465501489	0	1.340155176	2.468048398	0.841511759	2.989572937	10.96443377	13.28995219	11.50958185	0.001019322	1.312583716	0.114088045	8.472982449	12.61162423	0.035478761	8.009079099	0	0.019871963	7.813415961	0.088177076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0709
H4910_005_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1496.033094	60.23536129	1337.434886	965.6362046	209.8616406	10.08105345	0	293.2168309	378.6589114	3079.51472	2410.197948	33.45029951	0.04183515	530.5541093	2593.955634	5479.642547	221.0393973	737.8901419	0	0	52.93362226	0.004060051	0	0	1066.650769		45.69708783			0											6700	$220/day 1-8; unlimited additional days	$205/day 1-7	"$0/d 1-8, $50/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 250 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	167.6030149	98.56078618	54.9293584	0	175	0.03	0.03	63.5	250	4	16.51241388	40	0.2	40	25	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	152.5225042	89.69252691	49.98694864	0	159.2539266	0.027300673	0	57.7864248	227.5056095	3.640089751	15.02666713	36.40089751	0.182004488	36.40089751	22.75056095	36.40089751	36.40089751	18.20044876	0	0	0.091002244	0	0	0	0	0	0	0	0	0												19.0149	0.450221814	5.571190746	0	2.785107526	0.275219545	0	1.411996029	7.178918868	0.934142498	3.018103524	0.10146841	0.007614185	1.609387147	4.917828811	16.62199223	0.670502704	1.119160976	0	0	4.817078397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5048	0	NO	7.4473783	19.0149	0.450221814	5.571190746	0	2.785107526	0.275219545	0	1.411996029	7.178918868	0.934142498	3.018103524	0.10146841	0.007614185	1.609387147	4.917828811	16.62199223	0.670502704	1.119160976	0	0	4.817078397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5048	NO																																																																																		0		NO		19.0149	0.450221814	5.571190746	0	2.785107526	0.275219545	0	1.411996029	7.178918868	0.934142498	3.018103524	0.10146841	0.007614185	1.609387147	4.917828811	16.62199223	0.670502704	1.119160976	0	0	4.817078397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5048
H4910_801_0	2012	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	0	0	0	0	0	0	0											0	YES	308.3553266	5.672607616	37.65429284	9.814992145	9.190067939	12.74219898	0	15.96284979	39.50138454	19.1553064	53.51274375	0.895732064	0.078228121	26.287124	26.5095767	132.1676653	3.029210911	8.396934524	0	0	66.35294005	0.000345394	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	NO	0.073769001	0.073769001	0.158406238	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061477804	0.061477804	0.132013007	0	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0.186677709	0	0	0	0	0	0	0	0												18.957	0.348739458	4.970856418	0	1.715580828	2.378684514	0	2.979908228	7.374027968	3.575868713	9.989636405	0.16721321	0.014603446	4.907220083	4.948747043	24.67275696	0.565486153	1.567520499	0	0	12.38661483	6.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5205	0	NO	20.29690136	18.957	0.348739458	4.970856418	0	1.715580828	2.378684514	0	2.979908228	7.374027968	3.575868713	9.989636405	0.16721321	0.014603446	4.907220083	4.948747043	24.67275696	0.565486153	1.567520499	0	0	12.38661483	6.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5205	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.957	0.348739458	4.970856418	0	1.715580828	2.378684514	0	2.979908228	7.374027968	3.575868713	9.989636405	0.16721321	0.014603446	4.907220083	4.948747043	24.67275696	0.565486153	1.567520499	0	0	12.38661483	6.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5205
H4910_802_0	2012	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	0	0	0	0	0	0	0											0	YES	317.0221737	5.832045831	38.71263031	10.09085907	9.448370315	13.10034	0	16.41151264	40.61163765	19.69369863	55.01680977	0.920908126	0.080426854	27.025968	27.25467311	135.8824607	3.114351998	8.632944546	0	0	68.21790146	0.000355102	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	NO	0.070754255	0.070754255	0.150855138	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058845016	0.058845016	0.125463452	0	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0.186296692	0	0	0	0	0	0	0	0												18.6552	0.343186831	4.857020231	0	1.760200136	2.440550008	0	3.057410517	7.565813755	3.668870909	10.24944967	0.171562138	0.014983257	5.034848439	5.077455444	25.31445294	0.580193475	1.608289012	0	0	12.70876939	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1083	0	NO	20.86738005	18.6552	0.343186831	4.857020231	0	1.760200136	2.440550008	0	3.057410517	7.565813755	3.668870909	10.24944967	0.171562138	0.014983257	5.034848439	5.077455444	25.31445294	0.580193475	1.608289012	0	0	12.70876939	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1083	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.6552	0.343186831	4.857020231	0	1.760200136	2.440550008	0	3.057410517	7.565813755	3.668870909	10.24944967	0.171562138	0.014983257	5.034848439	5.077455444	25.31445294	0.580193475	1.608289012	0	0	12.70876939	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1083
H4956_001_0	2012	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	1401.68	61.47	239.87	2026.19	26.95	15.18	4.89	477.75	481.48	1441.08	1496.44	109.22	0.19	10.83	3207.23	4686.22	83.5	854.21		1352.69	17.47	0			0.61				3.47	1.28	2123.22	491.08									3900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	49.537808	0	200	0.2	0.2	65	175	62.60066	81.614212	39.192829	0.2	0.2	10	34.301289	35	10		0	0.2	0			0				0	0	0	73.171499									NO	103.598528	90.975321	36.128518	0	171.472	0.171472	0.171472	55.7284	150.038	53.671302	69.972761	33.602364	0.171472	0.171472	8.5736	29.408553	30.0076	8.5736		0	0.171472	0			0				0	0	0	62.734316										12.101	0.466021082	0.722178968	0	0.385097533	2.60294496	0.83849808	2.218686925	6.020024687	6.445386657	8.725836539	0.305837516	0.03257968	1.85704176	2.291458927	11.4845791	0.208802883	0.610304571	0	0	2.99561584	0	0	0	0	0	0	0	0	0	0	2.567297325	0	0	0	0	0	0	0	0	62.8792	0	NO	13.191731	12.101	0.466021082	0.722178968	0	0.385097533	2.60294496	0.83849808	2.218686925	6.020024687	6.445386657	8.725836539	0.305837516	0.03257968	1.85704176	2.291458927	11.4845791	0.208802883	0.610304571	0	0	2.99561584	0	0	0	0	0	0	0	0	0	0	2.567297325	0	0	0	0	0	0	0	0	62.8792	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	30% Coins	$200/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									5800	4.1494	0.0763	0.1948	3.8853	3.4009	1.4694	0.4728	0.2797	2.8574	0.3026	1.1607	0.0284	0.0041	0.3546	1.1713	2.6999	0.0209	0.2425		0.2105	0.5873	0			0				0	0	0.3565	0.5602									24.4856	1000	NO	12.017051	16.2504	0.542329082	0.917002968	3.885319	3.786018533	4.07232796	1.31130208	2.498431925	8.877413687	6.747987657	9.886525539	0.334250516	0.03671268	2.21168076	3.462773927	14.1844351	0.229725883	0.852760571	0	0.210545	3.58292384	0	0	0	0	0	0	0	0	0	0.356483	3.127485325	0	0	0	0	0	0	0	0	87.3648
H4956_002_0	2012	10	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	1564.83	97.3	308.74	2987.03	21.9	15.11	6.32	385.74	377.67	1606.79	874.38	145.6	1.62	10.75	2928.41	3414.11	87.9	1081.38		2150.78	20.93	0			0.61				3.47	1.28	2482.8	627.87									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	49.537808	0	200	0.2	0.2	65	250	73.093489	110.514249	53.284714	0.2	0.2	15	34.086964	35	15		0	0.2	0			0				0	0	0	74.764751									NO	110.525232	78.424632	32.98366	0	168.4592	0.168459	0.168459	54.74924	210.574	61.566354	93.08571	44.881501	0.168459	0.168459	12.63444	28.711313	29.48036	12.63444		0	0.168459	0			0				0	0	0	62.97405										14.4128	0.635893058	0.848614599	0	0.30743804	2.54541549	1.06466088	1.75991432	6.627290215	8.243683495	6.782690259	0.544562212	0.27290358	1.81093425	3.083235037	8.168631736	0.215943637	1.138552561	0	0	3.52584687	0	0	0	0	0	0	0	0	0	0	3.294959731	0	0	0	0	0	0	0	0	65.2839	0	NO	16.952318	14.4128	0.635893058	0.848614599	0	0.30743804	2.54541549	1.06466088	1.75991432	6.627290215	8.243683495	6.782690259	0.544562212	0.27290358	1.81093425	3.083235037	8.168631736	0.215943637	1.138552561	0	0	3.52584687	0	0	0	0	0	0	0	0	0	0	3.294959731	0	0	0	0	0	0	0	0	65.2839	YES	35% Coins	35% Coins	"35% Coins(Days 1-7), 35% (Days 8-20), 0% (Days 21-100)"	35% Coins	$200/Trip	40% Coins	40% Coins	$65/Visit	35% Coins	35% Coins	35% Coins	35% Coins	20% Coins	35% Coins	35% Coins	35% Coins	35% Coins	35% Coins		35% Coins	20%-35% Coins	$0/Service			"VIS775: Vision 17a,17b"						40% Coins	35% Coins									5800	4.1743	0.0909	0.2184	5.9642	2.579	1.3648	0.5711	0.2108	2.6668	0.3686	0.8819	0.0615	0.033	0.3832	1.1943	2.1643	0.027	0.3533		0.4259	0.7593	0			0				0	0	0.409	0.5183									25.4201	1000	NO	14.703763	18.5871	0.726788058	1.067011599	5.964212	2.88639604	3.91024649	1.63575588	1.97067732	9.294134215	8.612283495	7.664564259	0.606060212	0.30593358	2.19412025	4.277567037	10.33296874	0.242963637	1.491895561	0	0.425855	4.28512987	0	0	0	0	0	0	0	0	0	0.409047	3.813283731	0	0	0	0	0	0	0	0	90.704
H4956_003_0	2012	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	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	1201.43	87.93	326.02	1543.96	23.93	14.84	4.05	425.31	374.56	982.35	1058.25	173.3	0.3	5.69	3264.59	3971.8	61.48	707.13		2062.12	25.7	0			0.61				3.47	1.28	2239.85	423.65									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	49.537808	0	200	0.2	0.2	65	225	61.143674	106.258217	51.518799	0.2	0.2	15	34.309896	35	15		0	0.2	0			0				0	0	0	76.559935									NO	131.790522	93.513699	39.625094	0	180.2496	0.18025	0.18025	58.58112	202.7808	55.105614	95.765005	46.431215	0.18025	0.18025	13.51872	30.921725	31.54368	13.51872		0	0.18025	0			0				0	0	0	68.999488										13.1948	0.685221629	1.076547762	0	0.359447744	2.67491	0.7300125	2.076261346	6.329464704	4.511083326	8.445276378	0.67054413	0.054075	1.0256225	3.67775651	10.23457561	0.161608787	0.796624373	0	0	4.632425	0	0	0	0	0	0	0	0	0	0	2.435969424	0	0	0	0	0	0	0	0	63.7722	0	NO	9.009532	13.1948	0.685221629	1.076547762	0	0.359447744	2.67491	0.7300125	2.076261346	6.329464704	4.511083326	8.445276378	0.67054413	0.054075	1.0256225	3.67775651	10.23457561	0.161608787	0.796624373	0	0	4.632425	0	0	0	0	0	0	0	0	0	0	2.435969424	0	0	0	0	0	0	0	0	63.7722	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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			"VIS775: Vision 17a,17b"						35% Coins	30% Coins									7300	4.8858	0.0813	0.3167	3.4291	3.3212	1.3823	0.3775	0.2739	2.5691	0.2778	1.0116	0.0634	0.0073	0.205	1.392	2.6041	0.0202	0.2491		0.3864	0.9305	0			0				0	0	0.3329	0.6032									24.7205	1000	NO	8.264452	18.0805	0.766559629	1.393244762	3.42906	3.680670744	4.057195	1.1075235	2.350129346	8.898568704	4.788869326	9.456925378	0.73398813	0.06139	1.2306695	5.06972551	12.83871861	0.181801787	1.045691373	0	0.386432	5.562905	0	0	0	0	0	0	0	0	0	0.332866	3.039177424	0	0	0	0	0	0	0	0	88.4926
H4971_001_0	2012	5																															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	1039.316845	78.72061675	496.0116196	544.2547343	127.7881243	11.48020731	9.146275099	364.9873412	44.56083347	13.78126516	23.51511354	0	0.01323136	23.7004669	4750.2109	3143.145118	428.7325889	433.4233793	0	0	12.08220376	632.2028809	0	0	29.67939744	0	8.329909136	0	109.5330185	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-63 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	89.35610296	0	200	0.2	0.089953217	62.88265061	0.16	0.16650482	0.184326399	0	0.2	0.145595478	12.52481762	42.77306682	38.5	45	0	0	0.2	42.78600817	0	0	45	0	45	0	0	0											YES	180.1740213	94.36785305	77.34340989	0	173.1127642	0.173112764	0.07786025	54.43721717	0.138490211	0.144120549	0.159546262	0	0.173112764	0.126022178	12.25122695	41.83977186	37.65901044	44.01702519	0	0	0.173112764	37.03402071	0	0	45	0	45	0	0	0											10000	15.6048	0.619057966	3.196935834	0	1.843479618	1.98737042	0.712131266	1.655741263	6.171239245	1.986163494	3.751748467	0	0.002290517	2.98678446	4.849659315	10.95903956	1.34547042	1.589833984	0	0	2.09158369	1.951084549	0	0	0.11129774	0	0.031237159	0	0	0	0	0	0	0	0	0	0	0	0	0	63.447	0	NO	7.338980052	15.6048	0.619057966	3.196935834	0	1.843479618	1.98737042	0.712131266	1.655741263	6.171239245	1.986163494	3.751748467	0	0.002290517	2.98678446	4.849659315	10.95903956	1.34547042	1.589833984	0	0	2.09158369	1.951084549	0	0	0.11129774	0	0.031237159	0	0	0	0	0	0	0	0	0	0	0	0	0	63.447	NO	"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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$60 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$60 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$60 (7c, 7i)"	Included in h.2.	$40/$60 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $60 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$60 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$60 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.7828	0.0429	1.1997	1.0357	0.6603	0	0.8507	0.5931	3.3158	0.7115	1.9577	0	0.0008	1.6031	2.2829	3.4398	0.3534	0.4929	0	0	0.695	0.5719	0	0	0.0348	0	0.0077	0	0	0											21.6327	0	NO	3.559450849	17.3876	0.661994666	4.396629322	1.035747562	2.503821481	1.98737042	1.562867832	2.248873977	9.487083567	2.697615299	5.70942778	0	0.00311099	4.589894314	7.132585604	14.39883489	1.698919947	2.082684522	0	0	2.786561423	2.522958785	0	0	0.14610691	0	0.038964475	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0797
H4971_801_0	2012	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	210.9317786	4.4796265	19.85006463	572.2871261	5.54408313	8.758369849	9.624536048	17.11690896	46.89093029	14.50189086	24.74472455	0	0.013923231	24.92881779	27.09479681	61.48487677	1.787427	4.576335773	0	0	12.71398513	6.857579358	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.0778513	0.0778513	0.185582062	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065695643	0.065695643	0.156605385	0	0.189024769	0.189024769	0.189024769	0.189024769	0.189024769	0.189024769	0.189024769	0	0.189024769	0.189024769	0.189024769	0.189024769	0.189024769	0.189024769	0	0	0.189024769	0.189024769	0	0	0	0	0	0	0	0												13.8573	0.294291944	3.108627019	0	1.047969031	1.655548834	1.819275699	3.235519756	8.863547247	2.741216565	4.677365831	0	0.002631835	4.712164013	5.121587697	11.6221646	0.337867975	0.86504081	0	0	2.403258097	1.296252351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6616	150	YES	12.51942335	13.8573	0.294291944	3.108627019	0	1.047969031	1.655548834	1.819275699	3.235519756	8.863547247	2.741216565	4.677365831	0	0.002631835	4.712164013	5.121587697	11.6221646	0.337867975	0.86504081	0	0	2.403258097	1.296252351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6616	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.5956	0.0126	0.8086	0	0.4711	0.7442	0.8178	1.4543	3.9841	1.2322	2.1024	0	0.0012	2.1181	1.242	3.2306	0.0939	0.2405	0	0	0.668	0.3603	0	0	0	0	0	0	0	0											20.1775	150	YES	0	14.4529	0.306940717	3.917269539	0	1.519024922	2.399708258	2.637029383	4.68986678	12.84765939	3.973377223	6.779814152	0	0.00381483	6.830253911	6.363606466	14.85277739	0.431785127	1.105496181	0	0	3.071291686	1.656571583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8392
H5005_001_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1271.57213	5.847034457	1723.085688	375.1372772	401.7383114	8.942848956	9.238569843	333.1660978	196.9100199	22.92846673	42.70387667	0	0.067829341	1536.482495	7114.42736	5372.458037	33.71666497	1163.363542	0	0	27.46688385	1036.820108	0	0	88.78384867	340.9740136	0	10.06400015	87.94828884	0											4200	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$195 (9b)	20% (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $195 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	157.9430369	97.17450918	61.70179201	0	200	0.2	0.094544906	64.9881051	79.95	0.133502592	0.176154321	0	0.2	68.49829714	9.440428367	29.23505823	38.5	30	0	0	0.2	26.24205524	0	0	30	30	0	0	0	0											NO	120.448489	74.10597538	47.05422768	0	152.5214298	0.15252143	0.072100621	49.58588652	60.97044154	0.101810031	0.134336545	0	0.15252143	52.23729108	9.254200918	28.66014797	37.74052633	29.40820234	0	0	0.15252143	20.01237893	0	0	30	30	0	0	0	0												12.7632	0.036108349	6.756538855	0	5.106141804	1.363976109	0.666106625	1.376694693	1.000474238	2.334347908	5.73669123	0	0.010345428	6.688473613	5.486528351	12.83128686	0.10604039	2.85103587	0	0	4.189288396	1.729103073	0	0	0.221959622	0.852435034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1068	0	NO	15.91545746	12.7632	0.036108349	6.756538855	0	5.106141804	1.363976109	0.666106625	1.376694693	1.000474238	2.334347908	5.73669123	0	0.010345428	6.688473613	5.486528351	12.83128686	0.10604039	2.85103587	0	0	4.189288396	1.729103073	0	0	0.221959622	0.852435034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1068	NO																																										0	0	0	0	0	0	0	0	0	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	12.7632	0.036108349	6.756538855	0	5.106141804	1.363976109	0.666106625	1.376694693	1.000474238	2.334347908	5.73669123	0	0.010345428	6.688473613	5.486528351	12.83128686	0.10604039	2.85103587	0	0	4.189288396	1.729103073	0	0	0.221959622	0.852435034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1068
H5005_010_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1322.823993	6.396189342	1638.304426	358.2486409	363.7646579	12.4448726	10.89337407	357.5878733	175.9980958	26.08658315	50.38010634	0	0.052586653	880.49866	6136.727514	5504.396681	21.69736292	1147.803958	0	0	40.7965694	777.0996018	0	0	54.30286199	318.0502221	4.583873726	11.52276356	106.8551046	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	62.2542626	0	200	0.2	0.10426247	64.98940913	92.25	0.161687734	0.171791356	0	0.2	78.49736879	9.818388034	34.24407128	38.5	35	0	0	0.2	30.21364947	0	0	35	30	0	0	0	0											NO	138.0808973	73.73063894	45.93949096	0	147.586652	0.147586652	0.076938744	47.98284446	68.07434325	0.119314757	0.126770555	0	0.147586652	57.92581927	9.600355497	33.48420693	37.64504778	34.22277071	0	0	0.147586652	22.29565686	0	0	35	30	0	0	0	0												15.2214	0.039299594	6.271905947	0	4.473900666	1.836697083	0.838122519	1.429840276	0.998412899	3.112514328	6.386714064	0	0.007761088	4.25030052	4.90956381	15.35919646	0.068066522	3.273419305	0	0	6.021029093	1.443828839	0	0	0.158383347	0.795125555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8955	0	NO	19.11981185	15.2214	0.039299594	6.271905947	0	4.473900666	1.836697083	0.838122519	1.429840276	0.998412899	3.112514328	6.386714064	0	0.007761088	4.25030052	4.90956381	15.35919646	0.068066522	3.273419305	0	0	6.021029093	1.443828839	0	0	0.158383347	0.795125555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8955	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.2214	0.039299594	6.271905947	0	4.473900666	1.836697083	0.838122519	1.429840276	0.998412899	3.112514328	6.386714064	0	0.007761088	4.25030052	4.90956381	15.35919646	0.068066522	3.273419305	0	0	6.021029093	1.443828839	0	0	0.158383347	0.795125555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8955
H5005_011_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1178.444162	1.858781532	1761.434101	431.5926809	446.9694112	12.30527241	9.564693277	341.5914543	168.1645756	27.29987762	41.95468106	0	0.056532703	830.5507891	7023.699116	5480.176381	2.590585163	974.2820476	0	0	28.09956739	1104.988663	0	0	99.18138599	306.5081576	0	15.59937067	87.90065772	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	62.41034831	0	200	0.2	0.089825219	64.96834445	92.25	0.161757144	0.16949383	0	0.2	78.59190665	9.4116912	34.0895015	38.5	35	0	0	0.2	32.557883	0	0	35	30	0	0	0	0											NO	140.8969475	75.23431672	46.99392022	0	150.5965645	0.150596565	0.067636847	48.94531098	69.46266538	0.121800351	0.127625943	0	0.150596565	59.1783557	9.216976728	33.38424005	37.70348989	34.2758999	0	0	0.150596565	24.51552664	0	0	35	30	0	0	0	0												13.8366	0.01165368	6.898057802	0	5.609338148	1.85313175	0.646925697	1.393274997	0.97342997	3.325134678	5.35450572	0	0.008513631	4.095885835	5.394772608	15.24596032	0.008139508	2.782866161	0	0	4.231698313	2.25744825	0	0	0.289279042	0.766270394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9829	0	NO	17.05921307	13.8366	0.01165368	6.898057802	0	5.609338148	1.85313175	0.646925697	1.393274997	0.97342997	3.325134678	5.35450572	0	0.008513631	4.095885835	5.394772608	15.24596032	0.008139508	2.782866161	0	0	4.231698313	2.25744825	0	0	0.289279042	0.766270394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9829	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	13.8366	0.01165368	6.898057802	0	5.609338148	1.85313175	0.646925697	1.393274997	0.97342997	3.325134678	5.35450572	0	0.008513631	4.095885835	5.394772608	15.24596032	0.008139508	2.782866161	0	0	4.231698313	2.25744825	0	0	0.289279042	0.766270394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9829
H5005_018_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1002.461005	3.84172185	1508.14788	269.2921619	324.3503126	7.368310035	6.712166102	290.1230718	170.3104004	19.80403201	37.55198821	0	0.046923379	1098.918992	5760.122256	4400.714066	24.7072151	966.7466654	0	0	17.71263721	795.3265408	0	0	49.01749984	191.7580841	0	0	140.6034465	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$225 (9b)	20% (8a1a); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); $225 (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	61.36892469	0	200	0.2	0.098238337	64.99168262	92.25	0.122425302	0.173798073	0	0.2	79.32267148	9.345046921	33.80294231	38.5	35	0	0	0.2	31.30852951	0	0	35	30	0	0	0	0											NO	151.2833009	80.78028644	49.61614183	0	161.6979345	0.161697935	0.079424681	52.56848825	74.5831723	0.098979592	0.140513947	0	0.161697935	64.13156069	9.202995721	33.29032962	37.91477327	34.4679757	0	0	0.161697935	25.31262277	0	0	35	30	0	0	0	0												12.638	0.025861283	6.235706594	0	4.370564634	1.191440514	0.533111651	1.270944274	1.058524161	1.960195012	5.276578071	0	0.007587414	5.872949171	4.417531706	12.20843515	0.078064038	2.776816714	0	0	2.864096852	1.677650059	0	0	0.142967708	0.47939521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0864	0	NO	10.95489441	12.638	0.025861283	6.235706594	0	4.370564634	1.191440514	0.533111651	1.270944274	1.058524161	1.960195012	5.276578071	0	0.007587414	5.872949171	4.417531706	12.20843515	0.078064038	2.776816714	0	0	2.864096852	1.677650059	0	0	0.142967708	0.47939521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0864	NO																																										0	0	0	0	0	0	0	0	0	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	12.638	0.025861283	6.235706594	0	4.370564634	1.191440514	0.533111651	1.270944274	1.058524161	1.960195012	5.276578071	0	0.007587414	5.872949171	4.417531706	12.20843515	0.078064038	2.776816714	0	0	2.864096852	1.677650059	0	0	0.142967708	0.47939521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0864
H5005_019_0	2012	4																															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	801.2878723	1.831739895	750.8189664	179.4209601	211.6051436	7.246492335	8.978551982	279.2703422	64.4109821	21.55527838	38.48591715	0	0.045970072	27.16671477	6403.729296	4369.771981	10.64081193	978.7495991	0	0	17.94796117	729.2552588	0	0	68.45808641	0	0	8.547017679	88.84026295	0											5700	"$380 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$380 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	220.0027809	103.6459741	74.06911606	0	200	0.2	0.089334532	64.97867029	0.16	0.179270875	0.172162391	0	0.2	0.145261405	8.849100498	38.28283009	38.5	40	0	0	0.2	35.28273375	0	0	40	0	0	0	0	0											NO	187.6679915	88.41266325	63.18284789	0	170.6051085	0.170605108	0.076204637	55.44663102	0.136484087	0.152922636	0.146858917	0	0.170605108	0.123911689	8.751119264	37.85895714	38.07371063	39.55710195	0	0	0.170605108	30.09707309	0	0	40	0	0	0	0	0												12.5313	0.01349575	3.953240046	0	3.008409873	1.236288611	0.684207299	1.290383302	8.79107407	3.296289981	5.652000124	0	0.007842729	3.366273504	4.669983234	13.78625084	0.033761266	3.226374806	0	0	3.062013862	1.829037402	0	0	0.228193621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6665	0	NO	8.637323294	12.5313	0.01349575	3.953240046	0	3.008409873	1.236288611	0.684207299	1.290383302	8.79107407	3.296289981	5.652000124	0	0.007842729	3.366273504	4.669983234	13.78625084	0.033761266	3.226374806	0	0	3.062013862	1.829037402	0	0	0.228193621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6665	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	NO	0	12.5313	0.01349575	3.953240046	0	3.008409873	1.236288611	0.684207299	1.290383302	8.79107407	3.296289981	5.652000124	0	0.007842729	3.366273504	4.669983234	13.78625084	0.033761266	3.226374806	0	0	3.062013862	1.829037402	0	0	0.228193621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6665
H5005_801_0	2012	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	253.2727335	5.386933134	55.78532432	360.3867613	13.03087698	12.0825587	6.556960051	25.79770241	82.72003287	29.34330481	50.66613503	0	0.04292129	42.10081095	50.62082899	110.0187965	2.224894051	13.42828104	0	0	33.98840477	14.01534135	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07447297	0.07447297	0.141456979	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058213188	0.058213188	0.110572489	0	0.175093783	0.175093783	0.175093783	0.175093783	0.175093783	0.175093783	0.175093783	0	0.175093783	0.175093783	0.175093783	0.175093783	0.175093783	0.175093783	0	0	0.175093783	0.175093783	0	0	0	0	0	0	0	0												14.7438	0.31359055	6.168322138	0	2.281625541	2.115580907	1.148082938	4.517017299	14.48376346	5.137830234	8.871325234	0	0.007515251	7.371590241	8.863392429	19.26360724	0.389565115	2.351208522	0	0	5.951158357	2.453999131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.433	150	YES	29.72826766	14.7438	0.31359055	6.168322138	0	2.281625541	2.115580907	1.148082938	4.517017299	14.48376346	5.137830234	8.871325234	0	0.007515251	7.371590241	8.863392429	19.26360724	0.389565115	2.351208522	0	0	5.951158357	2.453999131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.433	NO																																										0	0	0	0	0	0	0	0	0	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	14.7438	0.31359055	6.168322138	0	2.281625541	2.115580907	1.148082938	4.517017299	14.48376346	5.137830234	8.871325234	0	0.007515251	7.371590241	8.863392429	19.26360724	0.389565115	2.351208522	0	0	5.951158357	2.453999131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.433
H5005_803_0	2012	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	299.1315931	5.78768855	54.03703501	383.0938531	13.77105993	12.98549661	9.057286694	26.48500734	92.78396149	31.50247962	57.1300058	0	0.041148063	41.27143508	53.06083398	121.7584527	2.313598661	13.23346195	0	0	38.27983341	14.00720628	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.074524652	0.074524652	0.140799651	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056704879	0.056704879	0.1071327	0	0.170438809	0.170438809	0.170438809	0.170438809	0.170438809	0.170438809	0.170438809	0	0.170438809	0.170438809	0.170438809	0.170438809	0.170438809	0.170438809	0	0	0.170438809	0.170438809	0	0	0	0	0	0	0	0												16.9622	0.328190179	5.789133459	0	2.347123056	2.213232579	1.543713159	4.514073112	15.81398791	5.369245113	9.737170158	0	0.007013227	7.034254248	9.043625357	20.75236569	0.394327001	2.255495497	0	0	6.524369222	2.387371559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0169	150	YES	35.51609156	16.9622	0.328190179	5.789133459	0	2.347123056	2.213232579	1.543713159	4.514073112	15.81398791	5.369245113	9.737170158	0	0.007013227	7.034254248	9.043625357	20.75236569	0.394327001	2.255495497	0	0	6.524369222	2.387371559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0169	NO																																										0	0	0	0	0	0	0	0	0	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	16.9622	0.328190179	5.789133459	0	2.347123056	2.213232579	1.543713159	4.514073112	15.81398791	5.369245113	9.737170158	0	0.007013227	7.034254248	9.043625357	20.75236569	0.394327001	2.255495497	0	0	6.524369222	2.387371559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0169
H5005_804_0	2012	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	301.375639	5.831038203	54.44177814	384.6262152	13.88113659	13.08916349	9.129582185	26.79525626	93.87106578	31.87210404	57.80005406	0	0.041637272	41.75534552	53.48462251	122.7313767	2.33205138	13.339229	0	0	38.5853266	14.11943121	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.07380334	0.07380334	0.141421621	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056015326	0.056015326	0.107336311	0	0.170011724	0.170011724	0.170011724	0.170011724	0.170011724	0.170011724	0.170011724	0	0.170011724	0.170011724	0.170011724	0.170011724	0.170011724	0.170011724	0	0	0.170011724	0.170011724	0	0	0	0	0	0	0	0												16.8817	0.326627509	5.843579604	0	2.35995596	2.225311247	1.552136004	4.555507705	15.9591817	5.418631348	9.826686824	0	0.007078824	7.098898268	9.093012868	20.8657729	0.396476075	2.267825316	0	0	6.559957888	2.400468838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6388	150	YES	36.0866935	16.8817	0.326627509	5.843579604	0	2.35995596	2.225311247	1.552136004	4.555507705	15.9591817	5.418631348	9.826686824	0	0.007078824	7.098898268	9.093012868	20.8657729	0.396476075	2.267825316	0	0	6.559957888	2.400468838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6388	NO																																										0	0	0	0	0	0	0	0	0	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	16.8817	0.326627509	5.843579604	0	2.35995596	2.225311247	1.552136004	4.555507705	15.9591817	5.418631348	9.826686824	0	0.007078824	7.098898268	9.093012868	20.8657729	0.396476075	2.267825316	0	0	6.559957888	2.400468838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6388
H5006_017_10	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1513.975954	75.46667397	1202.622964		2989.166407	12.59395825	9.917684637	353.1599169	30.89214711		15.04658205	10.49357628		8103.841897	3268.561269	4566.181833	0.047206042	770.0391747			14.21579202	0.006020424			262.2367751		0.587535717														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.36427797	0.2	0.170782954	65	0.081071812		0.15	29		5.143967239	10.0139916	28.45766193	0.227687842	30			0.2	0.441640054			30		30														NO	62.31981227	69.00603243	45.67290593		37.36427797	0.176834516	0.151001605	57.47121768	0.071681474		0.132625887	25.64100481		4.548154784	8.854096785	25.16148436	0.201315347	26.52517739			0.176834516	0.390486026			30		30															7.8626	0.433971313	4.577273792	0	9.307337045	2.227046512	1.4975863	1.691377538	2.214394627	0	1.99556629	0.022422153	0	3.071460608	2.411679819	9.574326065	0.009503301	1.702118809	0	0	2.513842701	0.002350891	0	0	0.655591938	0	0.001468839	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7719	0		5.464790516	7.8626	0.433971313	4.577273792	0	9.307337045	2.227046512	1.4975863	1.691377538	2.214394627	0	1.99556629	0.022422153	0	3.071460608	2.411679819	9.574326065	0.009503301	1.702118809	0	0	2.513842701	0.002350891	0	0	0.655591938	0	0.001468839	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7719	NO																																																																																		0	0		0	7.8626	0.433971313	4.577273792	0	9.307337045	2.227046512	1.4975863	1.691377538	2.214394627	0	1.99556629	0.022422153	0	3.071460608	2.411679819	9.574326065	0.009503301	1.702118809	0	0	2.513842701	0.002350891	0	0	0.655591938	0	0.001468839	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7719
H5006_017_11	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1179.620184	64.8867932	693.9739396		3103.837051	10.27000737	8.27763329	299.9791216	26.39418455		13.3980996	11.10690816		6616.782402	3028.368034	3995.076396	0.04023456	678.6744282			11.58506933	0.005131316			222.139771		0.621876191														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.68566648	0.2	0.170163898	65	0.081071812		0.15	29		5.527158888	10.0139916	28.15003125	0.225546605	30			0.2	0.437486753			30		30														NO	64.12958263	71.03364797	47.01492039		37.68566648	0.182030473	0.154875075	59.15990387	0.073787702		0.136522855	26.39441865		5.030556746	9.114258159	25.62081758	0.205281776	27.30457102			0.182030473	0.398179604			30		30															6.304	0.384095469	2.71892746	0	9.747513994	1.869454304	1.281999075	1.478894667	1.947566225	0	1.82914681	0.024430032	0	2.773841613	2.300110672	8.529760296	0.008259422	1.544242843	0	0	2.108835655	0.002043185	0	0	0.555349427	0	0.00155469	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4101	0		3.458467596	6.304	0.384095469	2.71892746	0	9.747513994	1.869454304	1.281999075	1.478894667	1.947566225	0	1.82914681	0.024430032	0	2.773841613	2.300110672	8.529760296	0.008259422	1.544242843	0	0	2.108835655	0.002043185	0	0	0.555349427	0	0.00155469	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4101	NO																																																																																		0	0		0	6.304	0.384095469	2.71892746	0	9.747513994	1.869454304	1.281999075	1.478894667	1.947566225	0	1.82914681	0.024430032	0	2.773841613	2.300110672	8.529760296	0.008259422	1.544242843	0	0	2.108835655	0.002043185	0	0	0.555349427	0	0.00155469	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4101
H5006_017_12	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1270.821132	72.02699093	1143.461442		2837.93053	11.43348192	9.157302565	328.6745919	29.23052131		14.51836695	10.01529131		7146.123951	3119.584056	4221.632626	0.044494893	728.4019722			12.80428447	0.005674658			241.4301049		0.560756524														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		38.29368373	0.2	0.170174233	65	0.081071812		0.15	29		5.37716066	10.0139916	28.40781912	0.222108134	30			0.2	0.430817243			30		30														NO	63.2660113	70.06612706	46.37454897		38.29368373	0.179551109	0.152774862	58.35411049	0.072782669		0.134663332	26.03491083		4.827375804	8.990116495	25.50327716	0.199398809	26.93266638			0.179551109	0.386768569			30		30															6.7	0.420554358	4.418959053	0	9.056234514	2.052894361	1.399005633	1.598292788	2.127475365	0	1.955091667	0.021728935	0	2.874752155	2.337118673	8.972122244	0.008872229	1.634817276	0	0	2.299023479	0.002194779	0	0	0.603575262	0	0.001401891	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4841	0		4.412721239	6.7	0.420554358	4.418959053	0	9.056234514	2.052894361	1.399005633	1.598292788	2.127475365	0	1.955091667	0.021728935	0	2.874752155	2.337118673	8.972122244	0.008872229	1.634817276	0	0	2.299023479	0.002194779	0	0	0.603575262	0	0.001401891	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4841	NO																																																																																		0	0		0	6.7	0.420554358	4.418959053	0	9.056234514	2.052894361	1.399005633	1.598292788	2.127475365	0	1.955091667	0.021728935	0	2.874752155	2.337118673	8.972122244	0.008872229	1.634817276	0	0	2.299023479	0.002194779	0	0	0.603575262	0	0.001401891	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4841
H5006_017_13	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1309.743554	70.99044244	1126.596901		3110.853981	11.59894514	9.289825343	323.8270772	29.65353997		14.95754763	11.07782256		7073.244016	3248.149433	4235.82009	0.045138815	727.2778207			12.98958569	0.00575678			238.3452684		0.620247687														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.41300217	0.2	0.170174233	65	0.081071812		0.15	29		5.649086441	10.0139916	28.24480184	0.21571061	30			0.2	0.418408135			30		30														NO	62.87500639	69.62805622	46.08460376		39.41300217	0.178428511	0.151819675	57.98926608	0.072327614		0.133821383	25.8721341		5.039790411	8.933908052	25.19838968	0.192444615	26.76427665			0.178428511	0.373279702			30		30															6.8625	0.411910543	4.326564315	0	10.21734123	2.069582512	1.410378268	1.564874545	2.144769791	0	2.001639714	0.023883909	0	2.970638947	2.418222364	8.894653772	0.008686722	1.622088733	0	0	2.317712433	0.002148889	0	0	0.595863171	0	0.001550619	0	0	0	0	0	0	0	0	0	0	0	0	0	49.865	0		4.711461273	6.8625	0.411910543	4.326564315	0	10.21734123	2.069582512	1.410378268	1.564874545	2.144769791	0	2.001639714	0.023883909	0	2.970638947	2.418222364	8.894653772	0.008686722	1.622088733	0	0	2.317712433	0.002148889	0	0	0.595863171	0	0.001550619	0	0	0	0	0	0	0	0	0	0	0	0	0	49.865	NO																																																																																		0	0		0	6.8625	0.411910543	4.326564315	0	10.21734123	2.069582512	1.410378268	1.564874545	2.144769791	0	2.001639714	0.023883909	0	2.970638947	2.418222364	8.894653772	0.008686722	1.622088733	0	0	2.317712433	0.002148889	0	0	0.595863171	0	0.001550619	0	0	0	0	0	0	0	0	0	0	0	0	0	49.865
H5006_017_14	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1598.908097	79.70025926	1270.088597		3156.854875	13.20093133	10.47003322	372.9717431	32.38101194		15.77176074	11.08225269		8618.243822	3451.923436	4822.338878	0.049481164	813.2374018			15.01017082	0.006310582			276.9479277		0.62049573														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.08466776	0.2	0.170990459	65	0.081071812		0.15	29		5.098961904	10.0139916	28.45766193	0.229404558	30			0.2	0.444969922			30		30														NO	61.73082672	68.34614966	45.23615044		37.08466776	0.175143504	0.14973934	56.92163869	0.070996006		0.131357628	25.39580803		4.465250264	8.769427871	24.92087308	0.20089359	26.27152555			0.175143504	0.389667956			30		30															8.2252	0.453933821	4.787826569	0	9.755909516	2.312057364	1.567775867	1.769180233	2.298922531	0	2.071741076	0.023453563	0	3.206884625	2.522616132	10.01474126	0.009940449	1.780415598	0	0	2.628933907	0.002459032	0	0	0.692369819	0	0.001551239	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1259	0		6.184775181	8.2252	0.453933821	4.787826569	0	9.755909516	2.312057364	1.567775867	1.769180233	2.298922531	0	2.071741076	0.023453563	0	3.206884625	2.522616132	10.01474126	0.009940449	1.780415598	0	0	2.628933907	0.002459032	0	0	0.692369819	0	0.001551239	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1259	NO																																																																																		0	0		0	8.2252	0.453933821	4.787826569	0	9.755909516	2.312057364	1.567775867	1.769180233	2.298922531	0	2.071741076	0.023453563	0	3.206884625	2.522616132	10.01474126	0.009940449	1.780415598	0	0	2.628933907	0.002459032	0	0	0.692369819	0	0.001551239	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1259
H5006_017_15	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1673.953132	80.47546546	1298.28383		3303.878657	13.88271281	11.22661292	374.6324771	35.77709165		17.94328158	11.66440327		8231.641899	3633.252926	4864.820207	0.054578408	847.1832097			15.72006071	0.006960659			277.8676595		0.653090363														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.82934737	0.2	0.170158467	65	0.081071812		0.15	29		5.688789938	10.0139916	28.39604442	0.20831045	30			0.2	0.404054242			30		30														NO	60.8809683	67.39399232	44.60594767		40.82934737	0.17270351	0.146934823	56.12864074	0.070006933		0.129527632	25.04200895		4.912369949	8.64725749	24.52048271	0.17987973	25.9055265			0.17270351	0.348907929			30		30															8.4927	0.451963575	4.825931713	0	11.24126745	2.39759323	1.649580378	1.752300976	2.504644454	0	2.324150782	0.024341674	0	3.369739192	2.618139465	9.94064498	0.009817549	1.828893924	0	0	2.714909661	0.002428629	0	0	0.694669149	0	0.001632726	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8453	0		7.081805159	8.4927	0.451963575	4.825931713	0	11.24126745	2.39759323	1.649580378	1.752300976	2.504644454	0	2.324150782	0.024341674	0	3.369739192	2.618139465	9.94064498	0.009817549	1.828893924	0	0	2.714909661	0.002428629	0	0	0.694669149	0	0.001632726	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8453	NO																																																																																		0	0		0	8.4927	0.451963575	4.825931713	0	11.24126745	2.39759323	1.649580378	1.752300976	2.504644454	0	2.324150782	0.024341674	0	3.369739192	2.618139465	9.94064498	0.009817549	1.828893924	0	0	2.714909661	0.002428629	0	0	0.694669149	0	0.001632726	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8453
H5006_017_16	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1430.721777	68.27471802	1106.233982		2942.78765	11.05431875	8.962560769	319.5466002	28.54930751		14.39109408	10.42477064		7052.443624	3245.373117	4185.967147	0.043577887	727.9194078			12.55465236	0.005557707			237.9789519		0.583683287														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		38.11885177	0.2	0.170154211	65	0.081071812		0.15	29		5.415969185	10.0139916	28.35061856	0.22308792	30			0.2	0.432717707			30		30														NO	63.09273647	69.87199485	46.24605901		38.11885177	0.179053627	0.152333643	58.19242875	0.07258101		0.13429022	25.96277591		4.848744629	8.96520758	25.38140539	0.199723506	26.85804404			0.179053627	0.387398374			30		30															7.5223	0.397540895	4.263246833	0	9.347973854	1.979315866	1.365299532	1.549599397	2.072137583	0	1.932583194	0.022554665	0	2.849624846	2.424620306	8.85381076	0.008703528	1.629207626	0	0	2.24795604	0.002153047	0	0	0.59494738	0	0.001459208	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0651	0		4.566337993	7.5223	0.397540895	4.263246833	0	9.347973854	1.979315866	1.365299532	1.549599397	2.072137583	0	1.932583194	0.022554665	0	2.849624846	2.424620306	8.85381076	0.008703528	1.629207626	0	0	2.24795604	0.002153047	0	0	0.59494738	0	0.001459208	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0651	NO																																																																																		0	0		0	7.5223	0.397540895	4.263246833	0	9.347973854	1.979315866	1.365299532	1.549599397	2.072137583	0	1.932583194	0.022554665	0	2.849624846	2.424620306	8.85381076	0.008703528	1.629207626	0	0	2.24795604	0.002153047	0	0	0.59494738	0	0.001459208	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0651
H5006_017_17	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1244.054842	61.49967136	975.9812276		3014.593559	9.658938218	7.736035298	280.5343669	24.69377232		12.55693338	10.82572155		6160.633394	2813.901643	3747.159414	0.037589024	630.0474461			10.81698414	0.004793917			206.480692		0.606132543														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.87105047	0.2	0.170174233	65	0.081071812		0.15	29		5.615578595	10.0139916	28.06106193	0.224405514	30			0.2	0.43527341			30		30														NO	64.22476427	71.14028679	47.08550125		37.87105047	0.182303746	0.155117001	59.24871731	0.073898475		0.136727809	26.43404311		5.118705057	9.127940883	25.57818347	0.204549829	27.34556184			0.182303746	0.396759865			30		30															6.6583	0.364592021	3.829547109	0	9.513818734	1.760860615	1.199990593	1.38510845	1.824832126	0	1.716881991	0.023847299	0	2.627872109	2.140427321	7.987127582	0.007688828	1.435750116	0	0	1.971976724	0.001902034	0	0	0.51620173	0	0.001515331	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9682	0		3.383984473	6.6583	0.364592021	3.829547109	0	9.513818734	1.760860615	1.199990593	1.38510845	1.824832126	0	1.716881991	0.023847299	0	2.627872109	2.140427321	7.987127582	0.007688828	1.435750116	0	0	1.971976724	0.001902034	0	0	0.51620173	0	0.001515331	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9682	NO																																																																																		0	0		0	6.6583	0.364592021	3.829547109	0	9.513818734	1.760860615	1.199990593	1.38510845	1.824832126	0	1.716881991	0.023847299	0	2.627872109	2.140427321	7.987127582	0.007688828	1.435750116	0	0	1.971976724	0.001902034	0	0	0.51620173	0	0.001515331	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9682
H5006_017_18	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1257.26201	66.17724028	991.655754		3140.233592	10.13089265	8.169249349	306.23936	26.04655398		13.21403917	11.22892772		6755.019308	3093.009661	4072.894587	0.039708744	693.2061238			11.43415373	0.005064256			226.8756167		0.628708071														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		36.41806206	0.2	0.170163148	65	0.081071812		0.15	29		5.356394331	10.0139916	28.16634195	0.233405172	30			0.2	0.452729806			30		30														NO	63.81318622	70.67916637	46.78030026		36.41806206	0.181122081	0.154101517	58.86467622	0.073419477		0.135841561	26.2627017		4.850806431	9.068774971	25.5077323	0.211374152	27.1683121			0.181122081	0.409996822			30		30															6.6858	0.389779348	3.865829494	0	9.53010182	1.834928357	1.258893716	1.502223397	1.912324365	0	1.795015701	0.024575165	0	2.730607592	2.33748405	8.6575254	0.008393402	1.569436693	0	0	2.070977714	0.002076329	0	0	0.567189042	0	0.00157177	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7448	0		3.811566776	6.6858	0.389779348	3.865829494	0	9.53010182	1.834928357	1.258893716	1.502223397	1.912324365	0	1.795015701	0.024575165	0	2.730607592	2.33748405	8.6575254	0.008393402	1.569436693	0	0	2.070977714	0.002076329	0	0	0.567189042	0	0.00157177	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7448	NO																																																																																		0	0		0	6.6858	0.389779348	3.865829494	0	9.53010182	1.834928357	1.258893716	1.502223397	1.912324365	0	1.795015701	0.024575165	0	2.730607592	2.33748405	8.6575254	0.008393402	1.569436693	0	0	2.070977714	0.002076329	0	0	0.567189042	0	0.00157177	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7448
H5006_017_19	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1676.250561	83.55552429	1331.525387		3309.558421	13.07037821	10.36648783	391.0131513	32.06077376		15.61578291	11.61832398		9035.125954	3618.900054	5055.605302	0.048991811	852.5753631			14.86172488	0.006248172			290.3444671		0.650510382														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		35.02374166	0.2	0.170990459	65	0.081071812		0.15	29		4.859825332	10.0139916	28.45766193	0.242903568	30			0.2	0.471153593			30		30														NO	61.42983918	68.00893174	45.01295658		35.02374166	0.174279351	0.149000531	56.64078897	0.070645714		0.130709513	25.27050585		4.234836016	8.726159767	24.79791421	0.211665381	26.1419026			0.174279351	0.410561711			30		30															8.581	0.473543496	4.99465787	0	9.659426594	2.277897027	1.544612189	1.845607782	2.26495626	0	2.04113138	0.024466744	0	3.188523067	2.631591671	10.44737221	0.01036987	1.857328508	0	0	2.590091762	0.00256526	0	0	0.725861168	0	0.001626276	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1626	0		6.593124351	8.581	0.473543496	4.99465787	0	9.659426594	2.277897027	1.544612189	1.845607782	2.26495626	0	2.04113138	0.024466744	0	3.188523067	2.631591671	10.44737221	0.01036987	1.857328508	0	0	2.590091762	0.00256526	0	0	0.725861168	0	0.001626276	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1626	NO																																																																																		0	0		0	8.581	0.473543496	4.99465787	0	9.659426594	2.277897027	1.544612189	1.845607782	2.26495626	0	2.04113138	0.024466744	0	3.188523067	2.631591671	10.44737221	0.01036987	1.857328508	0	0	2.590091762	0.00256526	0	0	0.725861168	0	0.001626276	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1626
H5006_017_20	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1304.27036	70.48802313	1145.625301		3044.057696	11.81105569	9.593936952	331.1714849	30.55073266		15.40325278	10.77879019		7322.05886	3357.400297	4342.333249	0.046652555	755.9658449			13.4427969	0.005949835			247.0449639		0.603504854														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.30634082	0.2	0.170151152	65	0.081071812		0.15	29		5.553096674	10.0139916	28.36208495	0.216352555	30			0.2	0.4196533			30		30														NO	62.72431927	69.45923063	45.97286346		39.30634082	0.177995879	0.151431019	57.84866081	0.072152243		0.13349691	25.80940251		4.94214163	8.912246205	25.24167126	0.192549317	26.69938191			0.177995879	0.373482791			30		30															6.8175	0.408003655	4.388972963	0	9.970897441	2.102319244	1.452819652	1.596485575	2.20430388	0	2.056286643	0.023182845	0	3.015554325	2.493498171	9.133979032	0.008982918	1.681985067	0	0	2.392762456	0.002222161	0	0	0.61761241	0	0.001508762	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3688	0		4.907739421	6.8175	0.408003655	4.388972963	0	9.970897441	2.102319244	1.452819652	1.596485575	2.20430388	0	2.056286643	0.023182845	0	3.015554325	2.493498171	9.133979032	0.008982918	1.681985067	0	0	2.392762456	0.002222161	0	0	0.61761241	0	0.001508762	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3688	NO																																																																																		0	0		0	6.8175	0.408003655	4.388972963	0	9.970897441	2.102319244	1.452819652	1.596485575	2.20430388	0	2.056286643	0.023182845	0	3.015554325	2.493498171	9.133979032	0.008982918	1.681985067	0	0	2.392762456	0.002222161	0	0	0.61761241	0	0.001508762	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3688
H5006_017_21	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1510.940797	75.31538146	1200.211995		2978.956031	12.00131828	9.56823928	352.4519163	30.30064305		14.72992051	10.47253919		7809.370795	3262.008591	4557.027738	0.046302169	766.0391632			13.44020083	0.005905149			261.7110536		0.58635785														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		36.72009403	0.2	0.170295769	65	0.081071812		0.15	29		5.133249679	10.0139916	28.45766193	0.231667206	30			0.2	0.449358719			30		30														NO	62.49190219	69.1988371	45.80051723		36.72009403	0.177328596	0.150991548	57.63179378	0.071881754		0.132996447	25.71264646		4.551359799	8.878835366	25.23178621	0.205406102	26.59928944			0.177328596	0.398420755			30		30															7.8685	0.434311401	4.580860845	0	9.115628796	2.128176923	1.444723261	1.692703013	2.178063355	0	1.959027095	0.022439725	0	2.961938025	2.41356977	9.581829137	0.009510748	1.698008118	0	0	2.383331946	0.002352734	0	0	0.654277634	0	0.001465895	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1307	0		5.276059635	7.8685	0.434311401	4.580860845	0	9.115628796	2.128176923	1.444723261	1.692703013	2.178063355	0	1.959027095	0.022439725	0	2.961938025	2.41356977	9.581829137	0.009510748	1.698008118	0	0	2.383331946	0.002352734	0	0	0.654277634	0	0.001465895	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1307	NO																																																																																		0	0		0	7.8685	0.434311401	4.580860845	0	9.115628796	2.128176923	1.444723261	1.692703013	2.178063355	0	1.959027095	0.022439725	0	2.961938025	2.41356977	9.581829137	0.009510748	1.698008118	0	0	2.383331946	0.002352734	0	0	0.654277634	0	0.001465895	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1307
H5006_017_22	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1525.135689	74.16270413	1188.44973		3025.606392	12.47313532	10.04677751	342.3913038	32.03887912		16.0884077	10.6903367		7493.95621	3329.848617	4434.453616	0.048831971	773.3519442			14.05973826	0.006227787			253.0479838		0.59855234														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.12155927	0.2	0.17016497	65	0.081071812		0.15	29		5.613895941	10.0139916	28.38206704	0.211977633	30			0.2	0.411167379			30		30														NO	62.17699922	68.84602871	45.56700454		40.12155927	0.176424491	0.150106341	57.33795965	0.071515266		0.132318368	25.58155123		4.952143676	8.833566865	25.03645868	0.18699023	26.46367368			0.176424491	0.362699978			30		30															7.9024	0.425483971	4.512841186	0	10.11600385	2.200566552	1.508085012	1.636001564	2.291268974	0	2.128791858	0.022789616	0	3.092595655	2.451203368	9.251917896	0.009131102	1.705477791	0	0	2.480482169	0.002258818	0	0	0.632619959	0	0.001496381	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3714	0		5.54946679	7.9024	0.425483971	4.512841186	0	10.11600385	2.200566552	1.508085012	1.636001564	2.291268974	0	2.128791858	0.022789616	0	3.092595655	2.451203368	9.251917896	0.009131102	1.705477791	0	0	2.480482169	0.002258818	0	0	0.632619959	0	0.001496381	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3714	NO																																																																																		0	0		0	7.9024	0.425483971	4.512841186	0	10.11600385	2.200566552	1.508085012	1.636001564	2.291268974	0	2.128791858	0.022789616	0	3.092595655	2.451203368	9.251917896	0.009131102	1.705477791	0	0	2.480482169	0.002258818	0	0	0.632619959	0	0.001496381	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3714
H5006_017_23	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1415.804904	70.57317312	1124.641039		2795.339283	11.02992559	8.748146964	330.2598967	27.05567838		13.17796018	9.813139187		7631.30282	3056.617287	4270.095978	0.041343565	720.1073682			12.54162022	0.005272753			245.2325027		0.54943802														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		34.99310604	0.2	0.170990459	65	0.081071812		0.15	29		4.856270573	10.0139916	28.45766193	0.243116224	30			0.2	0.471566077			30		30														NO	63.45398822	70.27673109	46.5139411		34.99310604	0.180090802	0.153969044	58.52951066	0.073001439		0.135068102	26.11316629		4.372848312	9.017138892	25.6248158	0.218914979	27.0136203			0.180090802	0.424623565			30		30															7.4865	0.413304326	4.359290588	0	8.151466997	1.986388146	1.346943829	1.610829179	1.975103445	0	1.779922064	0.021354345	0	2.780877471	2.296828552	9.118368574	0.009050726	1.621058918	0	0	2.258630444	0.002238935	0	0	0.613081257	0	0.001373595	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8327	0		4.309369629	7.4865	0.413304326	4.359290588	0	8.151466997	1.986388146	1.346943829	1.610829179	1.975103445	0	1.779922064	0.021354345	0	2.780877471	2.296828552	9.118368574	0.009050726	1.621058918	0	0	2.258630444	0.002238935	0	0	0.613081257	0	0.001373595	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8327	NO																																																																																		0	0		0	7.4865	0.413304326	4.359290588	0	8.151466997	1.986388146	1.346943829	1.610829179	1.975103445	0	1.779922064	0.021354345	0	2.780877471	2.296828552	9.118368574	0.009050726	1.621058918	0	0	2.258630444	0.002238935	0	0	0.613081257	0	0.001373595	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8327
H5006_017_24	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1218.398505	68.80281631	873.5175883		3213.458452	11.85396021	9.654173317	324.9993429	30.72862732		15.57628789	11.44316644		7227.965263	3315.911201	4322.342183	0.046952285	744.2209731			13.53250925	0.005988061			243.0898199		0.640703305														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.19773813	0.2	0.170146816	65	0.081071812		0.15	29		5.755288221	10.0139916	28.27051221	0.211499559	30			0.2	0.410240071			30		30														NO	62.92679608	69.68607992	46.12300781		40.19773813	0.178577202	0.151921712	58.03759074	0.072387887		0.133932902	25.89369433		5.138816343	8.941353017	25.24234489	0.188844997	26.78658034			0.178577202	0.36629762			30		30															6.3892	0.39954988	3.357438212	0	10.76448011	2.11684705	1.46667854	1.571848238	2.224380411	0	2.086177435	0.024692155	0	3.095265502	2.470727719	9.092171008	0.008866704	1.661261241	0	0	2.416597642	0.002193413	0	0	0.60772455	0	0.001601758	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7577	0		4.595808701	6.3892	0.39954988	3.357438212	0	10.76448011	2.11684705	1.46667854	1.571848238	2.224380411	0	2.086177435	0.024692155	0	3.095265502	2.470727719	9.092171008	0.008866704	1.661261241	0	0	2.416597642	0.002193413	0	0	0.60772455	0	0.001601758	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7577	NO																																																																																		0	0		0	6.3892	0.39954988	3.357438212	0	10.76448011	2.11684705	1.46667854	1.571848238	2.224380411	0	2.086177435	0.024692155	0	3.095265502	2.470727719	9.092171008	0.008866704	1.661261241	0	0	2.416597642	0.002193413	0	0	0.60772455	0	0.001601758	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7577
H5006_017_9	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1523.996725	75.96617615	1210.582938		3008.951234	12.82188026	10.11555405	355.4974274	31.49289079		15.33918518	10.56303163		8172.765064	3290.195367	4596.40468	0.048124033	775.1359442			14.5207369	0.0061375			263.9724796		0.591424525														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.84042198	0.2	0.170797411	65	0.081071812		0.15	29		5.19589464	10.0139916	28.45766193	0.224822858	30			0.2	0.43608292			30		30														NO	62.18026723	68.84969011	45.5694279		37.84042198	0.176433874	0.150672245	57.34100902	0.07151907		0.132325405	25.58291171		4.583659098	8.834036655	25.10447768	0.198331839	26.46508108			0.176433874	0.384698995			30		30															7.8969	0.435853974	4.597130994	0	9.488332036	2.262214004	1.524133233	1.698715099	2.252342251	0	2.029763898	0.022519425	0	3.121764079	2.422142206	9.615861559	0.009544528	1.709502968	0	0	2.561949863	0.00236109	0	0	0.659931199	0	0.001478561	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3124	0		5.619289068	7.8969	0.435853974	4.597130994	0	9.488332036	2.262214004	1.524133233	1.698715099	2.252342251	0	2.029763898	0.022519425	0	3.121764079	2.422142206	9.615861559	0.009544528	1.709502968	0	0	2.561949863	0.00236109	0	0	0.659931199	0	0.001478561	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3124	NO																																																																																		0	0		0	7.8969	0.435853974	4.597130994	0	9.488332036	2.262214004	1.524133233	1.698715099	2.252342251	0	2.029763898	0.022519425	0	3.121764079	2.422142206	9.615861559	0.009544528	1.709502968	0	0	2.561949863	0.00236109	0	0	0.659931199	0	0.001478561	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3124
H5006_018_10	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1471.633189	61.45189444	1329.010312		2993.206732	12.60826045	9.389414275	355.3541552	32.90303751		15.0813031	14.16116075		9008.079472	2922.594857	4495.862591	0.070250973	725.9535626			14.7877312	0.009752042			313.845711		0.415442069														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.97653074	0.2	0.171834419	65	0.081071812		0.15	29		4.38267245	9.988071332	28.22934834	0.276269287	30			0.2	0.369526904			29.15811768		30														NO	62.2653439	68.94538453	45.63276501		39.97653074	0.1766791	0.151797752	57.42070748	0.071618474		0.132509325	25.61846949		3.87163312	8.823417266	24.93787004	0.244055045	26.50186499			0.1766791	0.326438404			29.15811768		30															7.636	0.353068708	5.05386794	0	9.971501744	2.227616108	1.425291981	1.700390583	2.356465346	0	1.998413293	0.030232272	0	2.906331569	2.148939494	9.343103084	0.017145104	1.603260275	0	0	2.612683038	0.003183441	0	0	0.762595848	0	0.001038605	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1511	0		5.454920236	7.636	0.353068708	5.05386794	0	9.971501744	2.227616108	1.425291981	1.700390583	2.356465346	0	1.998413293	0.030232272	0	2.906331569	2.148939494	9.343103084	0.017145104	1.603260275	0	0	2.612683038	0.003183441	0	0	0.762595848	0	0.001038605	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1511	NO																																																																																		0	0		0	7.636	0.353068708	5.05386794	0	9.971501744	2.227616108	1.425291981	1.700390583	2.356465346	0	1.998413293	0.030232272	0	2.906331569	2.148939494	9.343103084	0.017145104	1.603260275	0	0	2.612683038	0.003183441	0	0	0.762595848	0	0.001038605	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1511
H5006_018_11	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1096.905358	52.61139325	855.5002903		3011.362159	10.80005175	8.08696257	307.121615	28.20099352		13.23105438	14.43396765		7666.003454	2497.528295	3950.563112	0.060307494	659.3312046			12.60746113	0.008371716			266.9359809		0.42344533														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.33269562	0.2	0.171926877	65	0.081071812		0.15	29		4.639430973	9.988071332	27.95610314	0.273661842	30			0.2	0.366039289			29.15413263		30														NO	64.0846218	70.98356764	46.98177381		40.33269562	0.181902138	0.156369333	59.1181948	0.07373568		0.136426603	26.37580999		4.219612062	9.084257642	25.42653474	0.24889837	27.28532068			0.181902138	0.332916646			29.15413263		30															5.8579	0.311212033	3.349410095	0	10.12136278	1.964552503	1.264552941	1.513039622	2.079419435	0	1.805067808	0.031725632	0	2.695630054	1.890682542	8.370760852	0.015010437	1.499171946	0	0	2.293324132	0.002787084	0	0	0.648523916	0	0.001058613	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7152	0		3.470033249	5.8579	0.311212033	3.349410095	0	10.12136278	1.964552503	1.264552941	1.513039622	2.079419435	0	1.805067808	0.031725632	0	2.695630054	1.890682542	8.370760852	0.015010437	1.499171946	0	0	2.293324132	0.002787084	0	0	0.648523916	0	0.001058613	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7152	NO																																																																																		0	0		0	5.8579	0.311212033	3.349410095	0	10.12136278	1.964552503	1.264552941	1.513039622	2.079419435	0	1.805067808	0.031725632	0	2.695630054	1.890682542	8.370760852	0.015010437	1.499171946	0	0	2.293324132	0.002787084	0	0	0.648523916	0	0.001058613	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7152
H5006_018_12	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1514.806796	63.25472139	1367.999763		3081.019057	12.84112442	9.628455358	365.7792536	33.51072897		15.49321112	14.57660965		9272.351363	3008.335627	4627.758642	0.07154845	777.5747334			15.06084817	0.009932154			323.0530676		0.427629979														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.55444668	0.2	0.172026392	65	0.081071812		0.15	29		4.344213255	9.988071332	28.22933107	0.279217346	30			0.2	0.373470112			29.15811768		30														NO	61.96800798	68.61227157	45.41228809		39.55444668	0.175825466	0.151233103	57.14327655	0.071272446		0.1318691	25.49469262		3.819116607	8.780786498	24.81737214	0.2454676	26.37381995			0.175825466	0.328327783			29.15811768		30															7.8225	0.361670843	5.176999946	0	10.155667	2.25779669	1.456141182	1.741818754	2.388391627	0	2.043075802	0.030968849	0	2.951015923	2.201296071	9.570734034	0.017562826	1.708968001	0	0	2.648080652	0.003261002	0	0	0.78496828	0	0.001069075	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3219	0		5.814263698	7.8225	0.361670843	5.176999946	0	10.155667	2.25779669	1.456141182	1.741818754	2.388391627	0	2.043075802	0.030968849	0	2.951015923	2.201296071	9.570734034	0.017562826	1.708968001	0	0	2.648080652	0.003261002	0	0	0.78496828	0	0.001069075	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3219	NO																																																																																		0	0		0	7.8225	0.361670843	5.176999946	0	10.155667	2.25779669	1.456141182	1.741818754	2.388391627	0	2.043075802	0.030968849	0	2.951015923	2.201296071	9.570734034	0.017562826	1.708968001	0	0	2.648080652	0.003261002	0	0	0.78496828	0	0.001069075	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3219
H5006_018_13	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1310.848825	57.44096676	1182.998341		3159.422008	11.42336492	8.417863989	319.1034201	29.16342048		13.77022952	15.17601517		7928.446329	2549.015214	4058.146731	0.062565239	675.8292042			13.23331245	0.00868513			272.6917727		0.445214573														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.9536313	0.2	0.172020749	65	0.081071812		0.15	29		4.711860551	9.988071332	27.91453512	0.269485323	30			0.2	0.360452942			29.154917		30														NO	63.12303532	69.90627795	46.26874991		40.9536313	0.179141481	0.154080259	58.22098121	0.072616623		0.13435611	25.97551469		4.220448379	8.946389436	25.00343743	0.241379999	26.8712221			0.179141481	0.322860369			29.154917		30															6.8954	0.334623682	4.561321198	0	10.78248367	2.046398505	1.29702666	1.548209519	2.1177491	0	1.850114479	0.0328504	0	2.788466538	1.900373566	8.455634823	0.015101997	1.513363054	0	0	2.370635187	0.002804084	0	0	0.6625255	0	0.001113036	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1762	0		4.383850785	6.8954	0.334623682	4.561321198	0	10.78248367	2.046398505	1.29702666	1.548209519	2.1177491	0	1.850114479	0.0328504	0	2.788466538	1.900373566	8.455634823	0.015101997	1.513363054	0	0	2.370635187	0.002804084	0	0	0.6625255	0	0.001113036	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1762	NO																																																																																		0	0		0	6.8954	0.334623682	4.561321198	0	10.78248367	2.046398505	1.29702666	1.548209519	2.1177491	0	1.850114479	0.0328504	0	2.788466538	1.900373566	8.455634823	0.015101997	1.513363054	0	0	2.370635187	0.002804084	0	0	0.6625255	0	0.001113036	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1762
H5006_018_14	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1461.495362	61.02856296	1319.85499		2972.587048	12.56319447	9.420059578	352.9061818	32.78543148		15.20927703	14.06360695		8946.024368	2902.461606	4464.89137	0.069999874	750.2091154			14.73487509	0.009717185			311.6836821		0.41258016														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.1099523	0.2	0.172026392	65	0.081071812		0.15	29		4.394829474	9.988071332	28.2293538	0.275350306	30			0.2	0.368297712			29.15811768		30														NO	62.30517307	68.99000616	45.66229865		40.1099523	0.176793447	0.152065694	57.45787031	0.071664826		0.132595085	25.63504983		3.884885261	8.829127805	24.95401429	0.243400649	26.51901707			0.176793447	0.32556311			29.15811768		30															7.5882	0.350863411	5.022301061	0	9.935860391	2.221090457	1.4324679	1.689769802	2.349562241	0	2.016675386	0.030043439	0	2.896189851	2.135517039	9.284746923	0.017038015	1.657900695	0	0	2.60502936	0.003163557	0	0	0.757342457	0	0.00103145	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9948	0		5.40959757	7.5882	0.350863411	5.022301061	0	9.935860391	2.221090457	1.4324679	1.689769802	2.349562241	0	2.016675386	0.030043439	0	2.896189851	2.135517039	9.284746923	0.017038015	1.657900695	0	0	2.60502936	0.003163557	0	0	0.757342457	0	0.00103145	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9948	NO																																																																																		0	0		0	7.5882	0.350863411	5.022301061	0	9.935860391	2.221090457	1.4324679	1.689769802	2.349562241	0	2.016675386	0.030043439	0	2.896189851	2.135517039	9.284746923	0.017038015	1.657900695	0	0	2.60502936	0.003163557	0	0	0.757342457	0	0.00103145	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9948
H5006_018_15	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1767.875727	73.82227678	1596.542597		3595.744897	16.72077813	12.53747417	426.8876173	43.63523363		20.16211964	17.01182913		10821.42287	3510.918718	5400.888216	0.093165187	907.479093			19.61114092	0.012932929			377.023445		0.499071342														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		44.13206567	0.2	0.172026392	65	0.081071812		0.15	29		4.761313929	9.988071332	28.22951839	0.250255397	30			0.2	0.334731752			29.15811768		30														NO	59.12267636	65.4245745	43.30245243		44.13206567	0.16765669	0.144206877	54.48842413	0.067961159		0.125742517	24.31022		3.991330659	8.372834877	23.66463007	0.209784957	25.14850345			0.16765669	0.280600087			29.15811768		30															8.7101	0.402482587	5.761184154	0	13.22397083	2.80335031	1.807989998	1.938369463	2.965501029	0	2.535235677	0.034463442	0	3.599323073	2.449695224	10.65083514	0.019544655	1.901811758	0	0	3.287938967	0.003628981	0	0	0.916107832	0	0.001247678	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0128	0		9.407232486	8.7101	0.402482587	5.761184154	0	13.22397083	2.80335031	1.807989998	1.938369463	2.965501029	0	2.535235677	0.034463442	0	3.599323073	2.449695224	10.65083514	0.019544655	1.901811758	0	0	3.287938967	0.003628981	0	0	0.916107832	0	0.001247678	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0128	NO																																																																																		0	0		0	8.7101	0.402482587	5.761184154	0	13.22397083	2.80335031	1.807989998	1.938369463	2.965501029	0	2.535235677	0.034463442	0	3.599323073	2.449695224	10.65083514	0.019544655	1.901811758	0	0	3.287938967	0.003628981	0	0	0.916107832	0	0.001247678	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0128
H5006_018_16	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1247.662124	59.81782574	1006.188221		2913.614304	12.13683174	9.100366816	345.9049249	31.67277768		14.69311302	13.784601		8768.545428	2844.880071	4376.313008	0.067624257	735.3258205			14.23481106	0.009387409			305.5002327		0.40439504														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.53301294	0.2	0.172026392	65	0.081071812		0.15	29		4.342260268	9.988071332	28.22933019	0.27936873	30			0.2	0.373672598			29.15811768		30														NO	63.13241348	69.91678455	46.27570389		39.53301294	0.179168405	0.154108471	58.22973156	0.072627537		0.134376304	25.9794187		3.889979227	8.947734038	25.2891888	0.250270249	26.87526072			0.179168405	0.334751616			29.15811768		30															6.564	0.348522503	3.880172346	0	9.598662667	2.174536782	1.402443618	1.67849591	2.300315819	0	1.974406216	0.029842993	0	2.842454964	2.121269188	9.222783824	0.01692434	1.646839428	0	0	2.550428391	0.00314245	0	0	0.742317645	0	0.001010988	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0986	0		4.497327543	6.564	0.348522503	3.880172346	0	9.598662667	2.174536782	1.402443618	1.67849591	2.300315819	0	1.974406216	0.029842993	0	2.842454964	2.121269188	9.222783824	0.01692434	1.646839428	0	0	2.550428391	0.00314245	0	0	0.742317645	0	0.001010988	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0986	NO																																																																																		0	0		0	6.564	0.348522503	3.880172346	0	9.598662667	2.174536782	1.402443618	1.67849591	2.300315819	0	1.974406216	0.029842993	0	2.842454964	2.121269188	9.222783824	0.01692434	1.646839428	0	0	2.550428391	0.00314245	0	0	0.742317645	0	0.001010988	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0986
H5006_018_17	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1246.622608	59.26670735	1233.256014		2878.43605	11.37538137	8.382504973	332.6599862	29.0409203		13.60672258	13.65759961		8214.505499	2657.305791	4116.450141	0.062302436	704.5406587			13.17772627	0.008648649			284.2766189		0.400669235														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.14232884	0.2	0.172020749	65	0.081071812		0.15	29		4.362121141	9.988071332	28.13487843	0.282118982	30			0.2	0.377351226			29.154917		30														NO	63.43082465	70.25110213	46.4969781		39.14232884	0.180025125	0.154840285	58.50816575	0.072974816		0.135018844	26.10364318		3.926457026	8.990518969	25.32509362	0.253942526	27.00376881			0.180025125	0.339663509			29.154917		30															6.5895	0.346962626	4.778556489	0	9.389057534	2.047854458	1.297949457	1.621943801	2.119255816	0	1.837163954	0.029709426	0	2.687825236	1.990879843	8.687457099	0.015821238	1.585437755	0	0	2.372321824	0.00293763	0	0	0.690671769	0	0.001001673	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0923	0		4.209197473	6.5895	0.346962626	4.778556489	0	9.389057534	2.047854458	1.297949457	1.621943801	2.119255816	0	1.837163954	0.029709426	0	2.687825236	1.990879843	8.687457099	0.015821238	1.585437755	0	0	2.372321824	0.00293763	0	0	0.690671769	0	0.001001673	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0923	NO																																																																																		0	0		0	6.5895	0.346962626	4.778556489	0	9.389057534	2.047854458	1.297949457	1.621943801	2.119255816	0	1.837163954	0.029709426	0	2.687825236	1.990879843	8.687457099	0.015821238	1.585437755	0	0	2.372321824	0.00293763	0	0	0.690671769	0	0.001001673	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0923
H5006_018_18	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1224.891009	49.81921198	1045.251639		3058.052032	10.03975325	7.547877066	294.317872	26.36475991		12.39527467	14.72492412		7376.795169	2404.182983	3845.975175	0.056334905	633.996302			11.74230957	0.007820253			256.8986629		0.43198104														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		39.13984423	0.2	0.171903151	65	0.081071812		0.15	29		4.60467347	9.988071332	27.86450768	0.281940953	30			0.2	0.377113101			29.15393321		30														NO	64.06800272	70.96494887	46.96945064		39.13984423	0.181854425	0.156306743	59.10268828	0.073716339		0.136390819	26.36889169		4.186901242	9.081874869	25.33657522	0.25636105	27.27816382			0.181854425	0.342898432			29.15393321		30															6.5397	0.294618153	4.091241273	0	9.97430668	1.825773558	1.179784084	1.449581454	1.943513589	0	1.690601666	0.032356661	0	2.573826071	1.819540751	8.120319944	0.014442075	1.441187916	0	0	2.135390961	0.002681552	0	0	0.624133872	0	0.001079953	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7541	0		3.500311176	6.5397	0.294618153	4.091241273	0	9.97430668	1.825773558	1.179784084	1.449581454	1.943513589	0	1.690601666	0.032356661	0	2.573826071	1.819540751	8.120319944	0.014442075	1.441187916	0	0	2.135390961	0.002681552	0	0	0.624133872	0	0.001079953	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7541	NO																																																																																		0	0		0	6.5397	0.294618153	4.091241273	0	9.97430668	1.825773558	1.179784084	1.449581454	1.943513589	0	1.690601666	0.032356661	0	2.573826071	1.819540751	8.120319944	0.014442075	1.441187916	0	0	2.135390961	0.002681552	0	0	0.624133872	0	0.001079953	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7541
H5006_018_19	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1563.890421	65.30433655	1412.326463		3180.851975	12.71689741	9.535308196	377.6314393	33.18654101		15.28517269	15.04892918		9572.799323	3105.813415	4777.709888	0.070856279	802.7701487			14.9151472	0.009836069			333.5208154		0.441486287														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		37.94236108	0.2	0.172026392	65	0.081071812		0.15	29		4.197324229	9.988071332	28.2292651	0.291080663	30			0.2	0.389338018			29.15811768		29.74543632														NO	61.8127936	68.43838097	45.29719542		37.94236108	0.175379855	0.150849819	56.99845292	0.071091814		0.131534891	25.43007899		3.680630576	8.758532517	24.75441325	0.255248423	26.30697827			0.175379855	0.341410226			29.15811768		29.74543632															8.0557	0.372443589	5.331202316	0	10.05741951	2.230287625	1.438399512	1.793700651	2.359291389	0	2.010533529	0.031891288	0	2.936161491	2.266863982	9.855783749	0.018085953	1.759871405	0	0	2.615816355	0.003358135	0	0	0.810403265	0	0.00109435	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9483	0		6.034216276	8.0557	0.372443589	5.331202316	0	10.05741951	2.230287625	1.438399512	1.793700651	2.359291389	0	2.010533529	0.031891288	0	2.936161491	2.266863982	9.855783749	0.018085953	1.759871405	0	0	2.615816355	0.003358135	0	0	0.810403265	0	0.00109435	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9483	NO																																																																																		0	0		0	8.0557	0.372443589	5.331202316	0	10.05741951	2.230287625	1.438399512	1.793700651	2.359291389	0	2.010533529	0.031891288	0	2.936161491	2.266863982	9.855783749	0.018085953	1.759871405	0	0	2.615816355	0.003358135	0	0	0.810403265	0	0.00109435	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9483
H5006_018_20	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1465.249276	61.18531748	1301.118682		2980.222267	13.3084232	9.951167736	353.8126367	34.73021117		15.8960726	14.09972994		8969.002621	2909.916705	4476.359638	0.074152155	752.1360601			15.60892446	0.010293593			312.4842552		0.41363989														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		42.38035513	0.2	0.171948596	65	0.081071812		0.15	29		4.601702645	9.988071332	28.22944671	0.260599223	30			0.2	0.348567245			29.15811768		30														NO	62.0237279	68.67469601	45.45360486		42.38035513	0.175985435	0.151302242	57.19526634	0.071337291		0.131989076	25.51788806		4.049163206	8.788775386	24.84006552	0.229308338	26.39781523			0.175985435	0.306713791			29.15811768		30															7.5734	0.350156923	4.92837787	0	10.52523984	2.342088644	1.50563399	1.686367332	2.477559176	0	2.098107937	0.029982944	0	3.026412951	2.131217026	9.266088891	0.017003707	1.654562395	0	0	2.74694336	0.003157187	0	0	0.759287724	0	0.0010341	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1226	0		5.696816247	7.5734	0.350156923	4.92837787	0	10.52523984	2.342088644	1.50563399	1.686367332	2.477559176	0	2.098107937	0.029982944	0	3.026412951	2.131217026	9.266088891	0.017003707	1.654562395	0	0	2.74694336	0.003157187	0	0	0.759287724	0	0.0010341	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1226	NO																																																																																		0	0		0	7.5734	0.350156923	4.92837787	0	10.52523984	2.342088644	1.50563399	1.686367332	2.477559176	0	2.098107937	0.029982944	0	3.026412951	2.131217026	9.266088891	0.017003707	1.654562395	0	0	2.74694336	0.003157187	0	0	0.759287724	0	0.0010341	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1226
H5006_018_21	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1515.145917	63.26888228	1368.306018		3081.708808	12.59996809	9.447632952	365.8611409	32.88139743		15.227975	14.57987293		9274.427173	3009.009106	4628.794663	0.07020477	777.7488098			14.77800541	0.009745628			323.1253898		0.427725713														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		38.80292727	0.2	0.172026392	65	0.081071812		0.15	29		4.27573677	9.988071332	28.22930032	0.284625115	30			0.2	0.38070333			29.15811768		30														NO	62.05769393	68.71274901	45.47879093		38.80292727	0.176082949	0.151454572	57.22695853	0.071376819		0.132062212	25.53202765		3.764421705	8.793645291	24.85368217	0.250588148	26.4124424			0.176082949	0.335176826			29.15811768		30															7.8355	0.362281569	5.185741945	0	9.964943561	2.218639542	1.430887209	1.744760028	2.34696956	0	2.011040063	0.031021143	0	2.909404579	2.20501323	9.586882615	0.017592483	1.711853803	0	0	2.602154778	0.003266509	0	0	0.785144012	0	0.001069314	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9542	0		5.719854734	7.8355	0.362281569	5.185741945	0	9.964943561	2.218639542	1.430887209	1.744760028	2.34696956	0	2.011040063	0.031021143	0	2.909404579	2.20501323	9.586882615	0.017592483	1.711853803	0	0	2.602154778	0.003266509	0	0	0.785144012	0	0.001069314	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9542	NO																																																																																		0	0		0	7.8355	0.362281569	5.185741945	0	9.964943561	2.218639542	1.430887209	1.744760028	2.34696956	0	2.011040063	0.031021143	0	2.909404579	2.20501323	9.586882615	0.017592483	1.711853803	0	0	2.602154778	0.003266509	0	0	0.785144012	0	0.001069314	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9542
H5006_018_22	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1537.410908	64.1986152	1379.772694		3126.994358	14.13602977	10.56844111	371.2374513	36.88996747		16.8707124	14.7941234		9410.714397	3053.226338	4696.814559	0.078763431	789.177788			16.57959155	0.010933718			327.8737005		0.43401112														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		42.90293442	0.2	0.171944464	65	0.081071812		0.15	29		4.649318703	9.988071332	28.2294681	0.257424994	30			0.2	0.344321521			29.15811768		30														NO	61.35313948	67.92341882	44.95635829		42.90293442	0.174060216	0.149643453	56.5695701	0.070556886		0.130545162	25.23873128		4.046307081	8.692629252	24.56836424	0.22403725	26.10903235			0.174060216	0.299663391			29.15811768		30															7.8604	0.363382452	5.169129631	0	11.17976949	2.46052039	1.581498015	1.750061919	2.602841223	0	2.20238988	0.031115409	0	3.173220025	2.211713715	9.616087569	0.017645942	1.7170557	0	0	2.885847281	0.003276435	0	0	0.796681662	0	0.001085028	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6237	0		6.490548799	7.8604	0.363382452	5.169129631	0	11.17976949	2.46052039	1.581498015	1.750061919	2.602841223	0	2.20238988	0.031115409	0	3.173220025	2.211713715	9.616087569	0.017645942	1.7170557	0	0	2.885847281	0.003276435	0	0	0.796681662	0	0.001085028	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6237	NO																																																																																		0	0		0	7.8604	0.363382452	5.169129631	0	11.17976949	2.46052039	1.581498015	1.750061919	2.602841223	0	2.20238988	0.031115409	0	3.173220025	2.211713715	9.616087569	0.017645942	1.7170557	0	0	2.885847281	0.003276435	0	0	0.796681662	0	0.001085028	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6237
H5006_018_23	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1327.215645	55.421362	1198.58895		2699.470787	10.28824599	7.714271274	320.4817598	26.84863192		12.45517483	12.77146658		8124.078808	2635.788352	4054.664716	0.057324267	681.281173			12.06667778	0.007957593			283.0467136		0.374672994														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		36.17007023	0.2	0.172026392	65	0.081071812		0.15	29		4.03583772	9.988071332	28.22919257	0.305343273	30			0.2	0.408415122			29.15811768		28.35602451														NO	63.95254032	70.83559341	46.88383436		36.17007023	0.18152294	0.156133682	58.99495545	0.073581969		0.136142205	26.32082628		3.662985638	9.065320358	25.62136687	0.277134043	27.22844098			0.18152294	0.370683568			29.15811768		28.35602451															7.0732	0.327150422	4.682870483	0	8.136670661	1.867552659	1.204457579	1.575567262	1.975575193	0	1.695674963	0.028012963	0	2.479865333	1.991188817	8.65717102	0.015886506	1.545852017	0	0	2.190378825	0.002949749	0	0	0.687759115	0	0.000885353	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1387	0		3.789885746	7.0732	0.327150422	4.682870483	0	8.136670661	1.867552659	1.204457579	1.575567262	1.975575193	0	1.695674963	0.028012963	0	2.479865333	1.991188817	8.65717102	0.015886506	1.545852017	0	0	2.190378825	0.002949749	0	0	0.687759115	0	0.000885353	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1387	NO																																																																																		0	0		0	7.0732	0.327150422	4.682870483	0	8.136670661	1.867552659	1.204457579	1.575567262	1.975575193	0	1.695674963	0.028012963	0	2.479865333	1.991188817	8.65717102	0.015886506	1.545852017	0	0	2.190378825	0.002949749	0	0	0.687759115	0	0.000885353	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1387
H5006_018_24	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1387.747804	54.3309959	1150.334632		3259.157763	11.6598986	8.860645737	331.128914	31.08918452		14.51039453	15.60774992		8305.350332	2737.716996	4316.456115	0.066283589	719.8258235			13.70679143	0.009201301			292.3517591		0.457880257														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.47888284	0.2	0.171839165	65	0.081071812		0.15	29		4.660661277	9.988071332	27.97270673	0.272685052	30			0.2	0.364732773			29.15339308		30														NO	62.66104406	69.38869745	45.92617978		40.47888284	0.177815131	0.152778019	57.78991771	0.072078975		0.133361349	25.78319406		4.143680487	8.880151083	24.87005497	0.242437642	26.67226971			0.177815131	0.32427503			29.15339308		30															7.2465	0.314163086	4.402539595	0	10.9939221	2.073306402	1.353711902	1.594659391	2.240876552	0	1.935125783	0.033534804	0	2.867893176	2.025945046	8.94587507	0.016069637	1.599949042	0	0	2.437274919	0.002983752	0	0	0.710253813	0	0.001144701	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7957	0		4.866519847	7.2465	0.314163086	4.402539595	0	10.9939221	2.073306402	1.353711902	1.594659391	2.240876552	0	1.935125783	0.033534804	0	2.867893176	2.025945046	8.94587507	0.016069637	1.599949042	0	0	2.437274919	0.002983752	0	0	0.710253813	0	0.001144701	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7957	NO																																																																																		0	0		0	7.2465	0.314163086	4.402539595	0	10.9939221	2.073306402	1.353711902	1.594659391	2.240876552	0	1.935125783	0.033534804	0	2.867893176	2.025945046	8.94587507	0.016069637	1.599949042	0	0	2.437274919	0.002983752	0	0	0.710253813	0	0.001144701	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7957
H5006_018_9	2012	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	YES	1459.260688	61.01904999	1276.296425		2972.123689	12.33251383	9.189230356	352.6729954	31.98019896		14.80140883	14.06141476		8730.180119	2852.254454	4383.806419	0.068456904	749.6695438			14.36271206	0.009502995			304.936551		0.412515848														4000	Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	No Cost Sharing	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$200 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance													70.3884322	78.04588608	51.65609857		40.10158836	0.2	0.171955804	65	0.081071812		0.15	29		4.4215243	9.988071332	28.19688385	0.275407735	30			0.2	0.368374527			29.15437511		30														NO	62.47059223	69.17532943	45.78495825		40.10158836	0.177268356	0.152411613	57.61221557	0.071857334		0.132951267	25.70391156		3.918981709	8.852844904	24.99226611	0.244105382	26.59025334			0.177268356	0.326505733			29.15437511		30															7.5967	0.351751074	4.869598211	0	9.932240061	2.186164447	1.400545422	1.693189387	2.298011852	0	1.967866053	0.030119447	0	2.851118017	2.104213859	9.130104715	0.016710699	1.661158591	0	0	2.546054349	0.003102782	0	0	0.740852883	0	0.00103129	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3806	0		5.208526785	7.5967	0.351751074	4.869598211	0	9.932240061	2.186164447	1.400545422	1.693189387	2.298011852	0	1.967866053	0.030119447	0	2.851118017	2.104213859	9.130104715	0.016710699	1.661158591	0	0	2.546054349	0.003102782	0	0	0.740852883	0	0.00103129	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3806	NO																																																																																		0	0		0	7.5967	0.351751074	4.869598211	0	9.932240061	2.186164447	1.400545422	1.693189387	2.298011852	0	1.967866053	0.030119447	0	2.851118017	2.104213859	9.130104715	0.016710699	1.661158591	0	0	2.546054349	0.003102782	0	0	0.740852883	0	0.00103129	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3806
H5008_001_0	2012	3																															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	199.5378606	40.0043	13692.15059	6.804624876	17.06210948	24.44106771	3.42705857	8.584555946	19.31052746	32.74086491	9.864132191	0	0	11.81001914	2.24470665	92.75133335	18.9117	60.90401615	0	25024.81503	19.64128064	6.122108535	702.9291809	0	45.19750642	119.4643192	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.072769233	0.07365307	0	0	0.2	0.2	0.188014835	0.112410563	0.16	0	0.080195518	0	0	0.146515743	0	0.033000968	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.069982417	0.070832406	0	0	0.192340676	0.192340676	0.180814503	0.108105619	0.153872541	0	0.077124301	0	0	0.140904685	0	0.031737142	0.192340676	0	0	0	0.192340676	0.192617701	0	0	0	0	0	0	0	0												13.9641	2.833600823	0	0	3.281737676	4.701011493	0.619661891	0.928038732	2.971359929	0	0.760764303	0	0	1.664087031	0	2.943662278	3.637489167	0	0	0	3.7778172	1.179226473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2626	0	NO	1.721024702	13.9641	2.833600823	0	0	3.281737676	4.701011493	0.619661891	0.928038732	2.971359929	0	0.760764303	0	0	1.664087031	0	2.943662278	3.637489167	0	0	0	3.7778172	1.179226473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2626	NO																																										0	0	0	0	0	0	0	0	0	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	13.9641	2.833600823	0	0	3.281737676	4.701011493	0.619661891	0.928038732	2.971359929	0	0.760764303	0	0	1.664087031	0	2.943662278	3.637489167	0	0	0	3.7778172	1.179226473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2626
H5008_002_0	2012	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	238.1095968	22.3882	35.58554244	1628.956018	11.86037983	16.43360082	9.589346282	27.11461447	67.22940665	17.87723908	31.67791711	0	0	28.7460568	35.52560645	71.94150089	11.0311	7.534448072	0	989.7867456	14.46274105	6.119451179	610.6910226	143.1999369	44.46898572	181.7716823	0	0	146.7209716	4252.145923											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.072373537	0.073252568	0.145036608	0	0.224	0.224	0.224	0.129824254	0.224	0.224	0.224	0	0	0.224	0.221259823	0.223682409	0.233560059	0.224	0	0	0.224	0.223533892	0	0	0	0	0	0	0	0											NO	0.058604324	0.059316118	0.117443099	0	0.181383545	0.181383545	0.181383545	0.105140315	0.181383545	0.181383545	0.181383545	0	0	0.181383545	0.179164692	0.181126376	0.189124784	0.181383545	0	0	0.181383545	0.181375607	0	0	0	0	0	0	0	0												13.9543	1.32798111	4.179276376	0	2.151277741	2.980784777	1.739349624	2.8508391	12.19430812	3.242637002	5.745852909	0	0	5.214061692	6.364934344	13.03050335	2.086254402	1.366624902	0	0	2.623303245	1.109919171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1622	150	YES	19.3008689	13.9543	1.32798111	4.179276376	0	2.151277741	2.980784777	1.739349624	2.8508391	12.19430812	3.242637002	5.745852909	0	0	5.214061692	6.364934344	13.03050335	2.086254402	1.366624902	0	0	2.623303245	1.109919171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1622	NO																																										0	0	0	0	0	0	0	0	0	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	13.9543	1.32798111	4.179276376	0	2.151277741	2.980784777	1.739349624	2.8508391	12.19430812	3.242637002	5.745852909	0	0	5.214061692	6.364934344	13.03050335	2.086254402	1.366624902	0	0	2.623303245	1.109919171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1622
H5009_001_0	2012	5																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	1.396507357	0.003194208	0.231773317	0.164307033	0	0.066656536	0.004107877	0.080140937	0.352623032	0.033530062	0.10022543	0	0	0.115544486	0.323346063	0.779303739	0.023079259	0.074859937	0.160840055	0	0.143331876	0.004690584	0	0	0	0	0	0	0	0											4.0581	YES	429.292899	2.375218546	649.0949864	21.11242912	0	10.24740889	0.707371385	193.4153866	394.4860697	0	16.31350609	0	0	285.5482025	3787.85923	3457.328947	357.4398645	1192.314334	23.61625227	0	43.56766987	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	23.61814844	0.083809418	0	0.166732244	0.152294394	65	200	0	0.081155547	0	0	40	15	38.81859325	40	40	0.103026484	0	0.178336775	0	0	0	0	0	0	0	0	0											NO	178.3909256	178.3909256	21.0663168	0.074754198	0	0.148717597	0.135839689	57.97705081	178.3909256	0	0.072387066	0	0	35.67818511	13.37931942	34.6244239	35.67818511	35.67818511	0.091894949	0	0.159068312	0	0	0	0	0	0	0	0	0												6.3818	0.035309786	1.139503385	1.578242711	0	1.523970026	0.096089109	0.934471141	5.864394591	0	1.180886834	0	0	0.848986802	4.223248213	9.975668586	1.062733804	3.544967628	2.170214294	0	6.930235686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4908	0	NO	6.070307919	7.7783	0.038503994	1.371276702	1.742549744	0	1.590626562	0.100196987	1.014612079	6.217017623	0.033530062	1.281112264	0	0	0.964531288	4.546594275	10.75497232	1.085813064	3.619827565	2.33105435	0	7.073567562	0.004690584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5488	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-10, $100/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.2299	0.0188	0.397	0.1227	1.0466	0.1351	0.0106	0.1099	0.765	0.0045	0.0699	0	0	0.4488	0.226	0.5026	0.1719	0.1074	0.1098	0	0.0595	0	0	2.2552	0	0	0	0	0	0											6.7912	0	NO	0.469692081	8.0082	0.057300461	1.768317529	1.865205238	1.046574387	1.725720716	0.110760012	1.124552282	6.981992134	0.038000906	1.35103809	0	0	1.41337899	4.772575757	11.25759684	1.257715347	3.727255547	2.440805128	0	7.133112606	0.004690584	0	2.255210487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.34
H5009_002_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	2.530777493	0.024118959	0.282438429	0.220676841	0.000247819	0.162073551	0.007073317	0.189892735	0.745879917	0.078458733	0.273375865	0	0	0.327183004	0.734749271	1.601602266	0.041359223	0.14440369	0.350417634	6.76E-05	0.242828301	0.00886411	0	0	0	0	0	0	0	0											7.9665	YES	444.5832403	7.591901148	461.241591	15.74261983	0.294262194	11.56198486	0.504595505	227.8061088	429.7948522	0	19.50205692	0	0	304.1213855	4671.95318	4041.765078	323.6371425	1247.554203	24.99805404	0	39.71067223	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	36.11848286	0.1	100	0.130953217	0.059381663	65	200	0	0.082004335	0	0	40	15	38.80987097	40	40	0.098545904	0	0.188822476	0	0	0	0	0	0	0	0	0											NO	176.9984909	176.9984909	31.9645848	0.088499245	88.49924544	0.115892609	0.052552324	57.52450954	176.9984909	0	0.072573218	0	0	35.39969818	13.27488682	34.34644297	35.39969818	35.39969818	0.087212382	0	0.167106467	0	0	0	0	0	0	0	0	0												6.5575	0.111979587	1.228616329	1.393209976	0.002170165	1.339948593	0.026517666	1.092036223	6.33942002	0	1.415327025	0	0	0.897150438	5.16830414	11.56835448	0.95472143	3.680253519	2.180139827	0	6.635910127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5916	0	NO	6.866042216	9.0883	0.136098546	1.511054758	1.613886817	0.002417984	1.502022143	0.033590984	1.281928958	7.085299937	0.078458733	1.688702889	0	0	1.224333442	5.90305341	13.16995674	0.996080654	3.824657209	2.53055746	6.76E-05	6.878738428	0.00886411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5581	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-10, $100/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.4423	0.1245	0.3807	0.1261	1.1943	0.2065	0.015	0.178	0.669	0.0215	0.122	0	0	0.3459	0.4236	0.5398	0.2555	0.092	0.184	0	0.1434	0.0001	0	2.3929	0	0	0	0	0	0											7.8571	0	NO	0.633957784	9.5306	0.260648245	1.891766395	1.739979808	1.196760144	1.708504812	0.048585699	1.45995415	7.754270646	0.099986518	1.810700972	0	0	1.570210031	6.326658465	13.70970811	1.251551667	3.916695101	2.714514323	6.76E-05	7.022101009	0.008992717	0	2.392892848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4152
H5009_004_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	576.1012481	6.973928183	502.7445727	23.54434187	0.812314945	16.82447205	1.732684174	237.7616454	542.3510809	0	29.76815735	0	0	451.7530389	5870.874199	5108.772497	489.2764823	1822.87094	35.36725532	0	82.59689166	0	0	0	0	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-10, $40/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $25/Visit for SCP OV; $10/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/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"	See i.2.; 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	NO	150	150	28.55484614	0	100	0.1	0.1	65	100	0	0.096582132	0	0	30	10	29.02443981	30	30	0.096650004	0	0.103611149	0	0	0	0	0	0	0	0	0											NO	129.2252957	129.2252957	24.60005624	0	86.15019712	0.086150197	0.086150197	55.99762813	86.15019712	0	0.083205697	0	0	25.84505914	8.615019712	25.00461211	25.84505914	25.84505914	0.083264169	0	0.089261209	0	0	0	0	0	0	0	0	0												6.2039	0.075100661	1.03062873	0	0.005831758	1.449431583	0.149271083	1.10950735	3.893637711	0	2.476880294	0	0	0.972965334	4.214808079	10.64523955	1.053781635	3.92601727	2.94482512	0	7.372698399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5245	0	NO	8.151069313	6.2039	0.075100661	1.03062873	0	0.005831758	1.449431583	0.149271083	1.10950735	3.893637711	0	2.476880294	0	0	0.972965334	4.214808079	10.64523955	1.053781635	3.92601727	2.94482512	0	7.372698399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5245	YES	$250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$40/Days 1-10, $80/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.7097	0.0597	0.2917	0.057	1.1155	0.2432	0.0589	0.136	0.6881	0	0.1472	0	0	0.262	0.296	0.5379	0.2945	0.1234	0.0941	0	0.1363	0	0	2.2742	0	0	0	0	0	0											7.5253	0	NO	0.698930687	6.9136	0.134805071	1.322307929	0.057039768	1.121363698	1.692642646	0.208123738	1.245529823	4.581702587	0	2.624045484	0	0	1.234973243	4.510796955	11.18316098	1.348281908	4.049389006	3.038899344	0	7.509046438	0	0	2.274160216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0498
H5009_801_0	2012	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	220.2118181	2.023550698	20.65908477	20.55168286	0.036958214	14.31893997	1.138633972	14.29654761	63.02778251	7.139744376	24.16220573	0	0.020853727	28.53147084	58.63430022	133.8543049	3.634392475	12.56215182	30.71305646	0.002596189	61.93321888	1.532059339	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	NO	0.073894732	0.073894732	0.142389009	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068489801	0.068489801	0.131974156	0	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0	0	0	0	0	0	0	0												15.0823	0.138592584	2.726465281	0	0.00767311	2.972838471	0.236398426	2.968189463	13.08556479	1.482323887	5.016456169	0	0.004329564	5.92358473	12.17340835	27.79027135	0.754557376	2.608101458	6.376516419	0.00053901	12.85831606	0.318079757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5245	0	NO	8.896382625	15.0823	0.138592584	2.726465281	0	0.00767311	2.972838471	0.236398426	2.968189463	13.08556479	1.482323887	5.016456169	0	0.004329564	5.92358473	12.17340835	27.79027135	0.754557376	2.608101458	6.376516419	0.00053901	12.85831606	0.318079757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5245	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												0.7508	0.0945	0.8698	0	1.2304	0.2987	0.0432	0.3143	0.493	0.2656	0.2427	0	0	1.0544	0.6754	1.0148	0.1958	0.0703	0.1798	0.0002	0.3139	0.0028	0	0	0	0	0	0	0	0											8.1104	0	NO	0.623617375	15.8331	0.233098084	3.596232865	0	1.238066525	3.271570389	0.27963149	3.28246519	13.5785441	1.747921961	5.259186321	0	0.004329564	6.977993171	12.84877111	28.80508956	0.950357662	2.678421714	6.556301196	0.000694251	13.17216631	0.32091094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6348
H5009_802_0	2012	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	220.2118181	2.023550698	20.65908477	20.55168286	0.036958214	14.31893997	1.138633972	14.29654761	63.02778251	7.139744376	24.16220573	0	0.020853727	28.53147084	58.63430022	133.8543049	3.634392475	12.56215182	30.71305646	0.002596189	61.93321888	1.532059339	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	NO	0.073894732	0.073894732	0.142389009	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068489801	0.068489801	0.131974156	0	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0.207615821	0	0	0	0	0	0	0	0												15.0823	0.138592584	2.726465281	0	0.00767311	2.972838471	0.236398426	2.968189463	13.08556479	1.482323887	5.016456169	0	0.004329564	5.92358473	12.17340835	27.79027135	0.754557376	2.608101458	6.376516419	0.00053901	12.85831606	0.318079757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5245	0	NO	8.896382625	15.0823	0.138592584	2.726465281	0	0.00767311	2.972838471	0.236398426	2.968189463	13.08556479	1.482323887	5.016456169	0	0.004329564	5.92358473	12.17340835	27.79027135	0.754557376	2.608101458	6.376516419	0.00053901	12.85831606	0.318079757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5245	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												0.7508	0.0945	0.8698	0	1.2304	0.2987	0.0432	0.3143	0.493	0.2656	0.2427	0	0	1.0544	0.6754	1.0148	0.1958	0.0703	0.1798	0.0002	0.3139	0.0028	0	0	0	0	0	0	0	0											8.1104	0	NO	0.623617375	15.8331	0.233098084	3.596232865	0	1.238066525	3.271570389	0.27963149	3.28246519	13.5785441	1.747921961	5.259186321	0	0.004329564	6.977993171	12.84877111	28.80508956	0.950357662	2.678421714	6.556301196	0.000694251	13.17216631	0.32091094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6348
H5010_001_0	2012	5																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	1.491858288	0	0.298716595	0.112480782	0	0.072802413	0	0.096345029	0.248938925	0.014496017	0.035642209	0	0	0.235644771	0.308751662	0.680943726	0.002811261	0.1126359	0.156293003	0	0.044796313	0	0	0	0	0	0	0	0	0											3.9132	YES	393.2226756	3.935844862	530.6389652	17.02317257	0	11.92911117	0.718538794	214.9236107	307.9586593	0	16.87573897	0	0	244.2263101	3498.830037	2974.00492	230.6249435	1386.159825	25.40787772	0	53.48423329	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	19.92987541	0.054373175	0	0.135991814	0.093931635	65	200	0	0.099256927	0	0	40	15	39.33064598	40	40	0.104214372	0	0.156720994	0	0	0	0	0	0	0	0	0											NO	181.9072037	181.9072037	18.12693954	0.049454361	0	0.123689453	0.085434205	59.11984122	181.9072037	0	0.09027775	0	0	36.38144075	13.64304028	35.77263916	36.38144075	36.38144075	0.094786725	0	0.142543389	0	0	0	0	0	0	0	0	0												5.9608	0.059663211	0.801571703	0.841870127	0	1.475505234	0.061387791	1.058854145	4.668324882	0	1.523503741	0	0	0.740442086	3.977889928	8.865667072	0.699205643	4.202540963	2.408329527	0	7.623823856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9694	0	NO	4.765614786	7.4527	0.059663211	1.100288299	0.954350909	0	1.548307647	0.061387791	1.155199174	4.917263806	0.014496017	1.55914595	0	0	0.976086857	4.28664159	9.546610798	0.702016904	4.315176864	2.564622529	0	7.668620169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8826	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-10, $100/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.5331	0.0449	0.8144	0.2649	1.1818	0.5337	0.0253	0.0936	0.4315	0	0.0829	0	0	0.1782	0.4501	0.6836	0.1989	0.3767	0.1399	0	0.1365	0	0	1.912	0	0	0	0	0	0											8.0819	0	NO	0.464385214	7.9858	0.104607973	1.914675454	1.219286989	1.181776658	2.081985215	0.08664534	1.248760693	5.34875624	0.014496017	1.642081342	0	0	1.154323235	4.73672465	10.23025774	0.900884208	4.691865636	2.70447945	0	7.805101451	0	0	1.911952582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9644
H5010_002_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V		Coin																	2.497816327	0.020208609	0.119228676	0.257528008	0	0.158809393	0.007339188	0.303027383	0.788026255	0.068374772	0.163953185	0	0	0.195829337	0.657603693	1.654444729	0.031444901	0.130389714	0.46238539	0	0.308895428	0.001190977	0	0	0	0	0	0	0	0											7.8265	YES	402.9905708	6.380717161	274.6655711	17.36226971	0	11.40784022	0.696556329	310.2542086	326.3596855	0	15.18266789	0	0	199.7981187	3829.42264	3379.947898	265.2013142	1157.989656	29.42046268	0	41.2518241	0	0	0	0	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-10, $50/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $15/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"	See i.2.; 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	NO	200	200	42.5064548	0.075594712	0	0.12621351	0.140307613	65	200	0	0.105039985	0	0	40	15	38.60283855	40	40	0.087544834	0	0.158126313	0	0	0	0	0	0	0	0	0											NO	180.3479962	180.3479962	38.32976975	0.068166774	0	0.113811769	0.126520984	58.61309877	180.3479962	0	0.094718754	0	0	36.06959924	13.52609972	34.8097229	36.06959924	36.06959924	0.078942677	0	0.142588818	0	0	0	0	0	0	0	0	0												6.0565	0.095895796	0.877322342	1.183529922	0	1.29834647	0.088128992	1.515413381	4.90485961	0	1.438083385	0	0	0.600553172	4.316429373	9.804587481	0.797142094	3.480685233	2.322530085	0	5.88204885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6621	0	NO	5.177213066	8.5544	0.116104405	0.996551017	1.44105793	0	1.457155863	0.09546818	1.818440764	5.692885865	0.068374772	1.60203657	0	0	0.796382509	4.974033066	11.45903221	0.828586995	3.611074948	2.784915476	0	6.190944278	0.001190977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4886	YES	$300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-10, $100/Days 11-25, $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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.5361	0.0243	0.7068	0.0356	1.1834	0.5544	0.0334	0.1447	0.4573	0.0037	0.0636	0	0	0.4074	0.7864	1.1367	0.3484	0.137	0.2862	0	0.2118	0.0001	0	1.8055	0	0	0	0	0	0											8.8628	0	NO	0.552786934	9.0905	0.140413579	1.703359238	1.476685988	1.183392014	2.011544805	0.128889884	1.963098696	6.150198348	0.072068111	1.665676426	0	0	1.203794593	5.760433439	12.59570839	1.177012771	3.748122829	3.071067739	0	6.402704983	0.00125629	0	1.805502938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3514
H5010_004_0	2012	6																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	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	648.570762	18.34122638	298.759521	30.11861458	0	16.97227884	0.842068942	292.7671461	576.0560409	0	18.78374969	0	0	490.1733429	5660.149099	4715.187424	460.849097	1898.885264	36.78419	0	60.01456473	0	0	0	0	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-10, $40/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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; $25/Visit for SCP OV; $10/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/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"	See i.2.; 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	NO	150	150	18.51141116	0.007999391	0	0.103796282	0.0972084	65	100	0	0.102719414	0	0	30	10	29.23593522	30	30	0.08453897	0	0.118795645	0	0	0	0	0	0	0	0	0											NO	129.6180462	129.6180462	15.99608632	0.006912436	0	0.089692476	0.083999753	56.16782003	86.41203081	0	0.088761932	0	0	25.92360924	8.641203081	25.26336535	25.92360924	25.92360924	0.07305184	0	0.102653729	0	0	0	0	0	0	0	0	0												7.0055	0.198112827	0.398248591	0.208192996	0	1.522285704	0.070733583	1.370341031	4.148181029	0	1.667281912	0	0	1.05892185	4.07587482	9.926791882	0.995572659	4.102163299	2.687152779	0	6.160718888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5961	0	NO	7.736749855	7.0055	0.198112827	0.398248591	0.208192996	0	1.522285704	0.070733583	1.370341031	4.148181029	0	1.667281912	0	0	1.05892185	4.07587482	9.926791882	0.995572659	4.102163299	2.687152779	0	6.160718888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5961	YES	$250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$40/Days 1-10, $80/Days 11-25, $0 Days 26-100 for SNF; PBP 3"	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"	"$65/Visit for OP ER; $65/Visit for OP Worldwide ER; 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"	See i.2.; 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												0.789	0.0504	0.9278	0.0988	1.0311	0.8713	0.0528	0.136	0.3828	0	0.243	0	0	0.1879	0.6457	0.7416	0.6616	0.4598	0.2255	0	0.3739	0	0	1.9144	0	0	0	0	0	0											9.7933	0	NO	0.973250145	7.7945	0.248542838	1.326060172	0.307039424	1.031083755	2.393611239	0.123545316	1.5063143	4.530941315	0	1.910236278	0	0	1.246787228	4.721552151	10.66840467	1.657196727	4.562012504	2.91260371	0	6.534603383	0	0	1.914379847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3894
H5016_001_0	2012	9																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	644.0163696	28.63669069	222.9537462	0	191.7874352	11.26072543	3.307648722	369.2230328	246.7521709	0	17.36586125		0.064431502	33.59933144	8658.247472	315.7989805	510.1813169	328.9035482	16.32570931	784.0150453	24.86797331	0	0	0	321.9131782	0	0	0	0	0											2500	$150/day (Days 1-6)	$150/day (Days 1-6)	$50/day (Days 21-100)	$0 Copay HHC	$100 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$115 Copay OP Hosp & Surg/$115Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$10 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$115 Copay OP Hosp & Surg/$10 Copay OP Substance Abuse/$10 Copay Cardiac Rehab/$10 Copay PT & ST	$10 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$10 Copay Chiro/$10 Copay Specialists/$10 Copay Podiatry/$10 Copay Psychiatric/$10 Copay Preventive Dental/$10 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$10 Copay Medicare Covered Hearing Exams	$10 Copay Mental Health	$10 Copay OT	10% Coin Rad	$50 ER Waived/$10 Copay Other/$0 Copay Lab/$10 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$10 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													150	150	50	0	100	0.1	0.1	46.56330723	115	0	0.1	0	0.1	0.106475789	10	10	10	10	0.1	10	0.1	0	0	0	10	0	0	0	0	0											NO	143.6553664	143.6553664	47.88512214	0	95.77024428	0.095770244	0.095770244	44.59379308	110.1357809	0	0.095770244	0	0.095770244	0.101972124	9.577024428	9.577024428	9.577024428	9.577024428	0.095770244	9.577024428	0.095770244	0	0	0	9.577024428	0	0	0	0	0												7.7097	0.342817858	0.889680614	0	1.53062746	1.078442425	0.316774326	1.372087961	2.264686919	0	1.663132774	0	0.006170621	3.426195177	6.910020629	0.252034546	0.407168245	0.26249311	1.563517168	0.625710937	2.381611879	0	0	0	0.256914198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2598	0	NO	1.468940352	7.7097	0.342817858	0.889680614	0	1.53062746	1.078442425	0.316774326	1.372087961	2.264686919	0	1.663132774	0	0.006170621	3.426195177	6.910020629	0.252034546	0.407168245	0.26249311	1.563517168	0.625710937	2.381611879	0	0	0	0.256914198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2598	YES	$200/day (Days 1-6)	$200/day (Days 1-6)	$50/day (Days 21-100)	10% Coin HHC	$100 Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$215 Copay OP Hosp & Surg/$215 Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$25 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$215 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay PT & ST	$25 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Psychiatric/$25 Copay Preventive Dental/$25 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health	$25 Copay OT	10% Coin Rad	$50 ER Waived/$25 Copay Other/$0 Copay Lab/$25 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$25 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											2500	0.465	0.0207	0.0288	0.0061	0	0.235	0.069	0	0.0622	0	0.0127	0	0	0.054	0.8983	0.0359	0.0579	0.0374	0.089	0.089	0.01	0	0	0	0.0114	0	0	0	0	0											2.1824	0	NO	0.096393412	8.1747	0.363517858	0.918480614	0.0061	1.53062746	1.313442425	0.385774326	1.372087961	2.326886919	0	1.675832774	0	0.006170621	3.480195177	7.808320629	0.287934546	0.465068245	0.29989311	1.652517168	0.714710937	2.391611879	0	0	0	0.268314198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4422
H5016_002_0	2012	8																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	572.5111414	25.45715489	198.1991604	0	170.4932493	10.0104455	2.940400019	328.2281475	219.3552426	0	15.43772723		0.057277663	29.86879294	7696.921036	280.7357752	453.5358134	292.3853409	14.5130635	696.9657445	22.10687873	0	0	0	321.9131782	0	0	0	0	0											2500	$150/day (Days 1-6)	$150/day (Days 1-6)	$50/day (Days 21-100)	$0 Copay HHC	$100 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$115 Copay OP Hosp & Surg/$115Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$10 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$115 Copay OP Hosp & Surg/$10 Copay OP Substance Abuse/$10 Copay Cardiac Rehab/$10 Copay PT & ST	$10 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$10 Copay Chiro/$10 Copay Specialists/$10 Copay Podiatry/$10 Copay Psychiatric/$10 Copay Preventive Dental/$10 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$10 Copay Medicare Covered Hearing Exams	$10 Copay Mental Health	$10 Copay OT	10% Coin Rad	$50 ER Waived/$10 Copay Other/$0 Copay Lab/$10 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$10 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													150	150	50	0	100	0.1	0.1	46.56330723	115	0	0.1	0	0.1	0.106475789	10	10	10	10	0.1	10	0.1	0	0	0	10	0	0	0	0	0											NO	143.6553664	143.6553664	47.88512214	0	95.77024428	0.095770244	0.095770244	44.59379308	110.1357809	0	0.095770244	0	0.095770244	0.101972124	9.577024428	9.577024428	9.577024428	9.577024428	0.095770244	9.577024428	0.095770244	0	0	0	9.577024428	0	0	0	0	0												6.8537	0.304754743	0.79089925	0	1.360681678	0.958702811	0.281602828	1.219744841	2.013238412	0	1.478474908	0	0.005485496	3.045784244	6.142800065	0.224051115	0.361960297	0.233348463	1.389919637	0.556238163	2.117181176	0	0	0	0.256914198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5955	0	NO	1.307103533	6.8537	0.304754743	0.79089925	0	1.360681678	0.958702811	0.281602828	1.219744841	2.013238412	0	1.478474908	0	0.005485496	3.045784244	6.142800065	0.224051115	0.361960297	0.233348463	1.389919637	0.556238163	2.117181176	0	0	0	0.256914198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5955	YES	$200/day (Days 1-6)	$200/day (Days 1-6)	$50/day (Days 21-100)	10% Coin HHC	$100 Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$215 Copay OP Hosp & Surg/$215 Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$25 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$215 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay PT & ST	$25 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Psychiatric/$25 Copay Preventive Dental/$25 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health	$25 Copay OT	10% Coin Rad	$50 ER Waived/$25 Copay Other/$0 Copay Lab/$25 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$25 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											2500	0.4134	0.0184	0.0256	0.0055	0	0.2089	0.0614	0	0.0553	0	0.0113	0	0	0.048	0.7986	0.0319	0.0515	0.0332	0.0791	0.0791	0.0089	0	0	0	0.0114	0	0	0	0	0											1.9415	0	NO	0.085746756	7.2671	0.323154743	0.81649925	0.0055	1.360681678	1.167602811	0.343002828	1.219744841	2.068538412	0	1.489774908	0	0.005485496	3.093784244	6.941400065	0.255951115	0.413460297	0.266548463	1.469019637	0.635338163	2.126081176	0	0	0	0.268314198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.537
H5041_001_0	2012	12	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	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	1342.77	35.21	323.38	859.56	1.52	17.57	5.59	449.43	344.39	1752.68	966.28	104.98	0.16	10.61	3002.86	3368.16	139.85	556.37		1246.44	18.13	0		2.89	0.79				3.43	1.09	2440.99	1408.88									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	219.349822	44.625278	79.380004	41.619926	0.2	0.2	10	32.947907	35	38.764849		0	0.2	0		0	0				0	0	0	60.157114									NO	120.156805	96.282655	25.294878	0	0.173546	0.173546	0.173546	56.402385	190.336202	38.722647	68.880331	36.114817	0.173546	0.173546	8.67729	28.589854	30.370515	33.637383		0	0.173546	0		0	0				0	0	0	52.200072										13.4452	0.282509357	0.681654804	0	0.26378992	3.04920322	0.97012214	2.112410324	5.462490384	5.655700745	5.546473853	0.315944457	0.02776736	1.84132306	2.171390587	8.024600221	0.353943044	1.559569232	0	0	3.14638898	0	0	0	0	0	0	0	0	0	0	6.128636453	0	0	0	0	0	0	0	0	61.0392	0	NO	12.350987	13.4452	0.282509357	0.681654804	0	0.26378992	3.04920322	0.97012214	2.112410324	5.462490384	5.655700745	5.546473853	0.315944457	0.02776736	1.84132306	2.171390587	8.024600221	0.353943044	1.559569232	0	0	3.14638898	0	0	0	0	0	0	0	0	0	0	6.128636453	0	0	0	0	0	0	0	0	61.0392	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	40% Coins	40% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						40% Coins	30% Coins									6000	4.2563	0.0384	0.2655	2.0536	2.2169	1.6359	0.5202	0.2533	2.2121	0.3783	0.7028	0.0286	0.0033	0.3344	1.1211	1.7806	0.0324	0.1535		0.1655	0.5899	0		0	0				0	0	0.3547	0.7647									19.8622	500	NO	8.607679	17.7015	0.320948357	0.947129804	2.053623	2.48073592	4.68514922	1.49034114	2.365665324	7.674627384	6.034018745	6.249260853	0.344563457	0.03105336	2.17570106	3.292531587	9.805167221	0.386366044	1.713116232	0	0.165483	3.73631898	0	0	0	0	0	0	0	0	0	0.354749	6.893309453	0	0	0	0	0	0	0	0	80.9014
H5041_002_0	2012	8	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	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	1019.72	103.25	636.27	865.59	1.47	11.31	2.94	439.88	299.95	1583.51	984.56	243.45	0.35	10.76	2939.73	3570.92	128.63	498.86		1350.53	14.58	0		2.89	2.86				3.43	1.09	1603.03	797.23									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	208.445526	37.526104	75.175018	39.478526	0.199686	0.2	10	33.45162	35	38.66964		0	0.2	0		0	0				0	0	0	65.544533									NO	127.921527	102.504591	24.95918	0	0.178094	0.178094	0.178094	57.88055	185.614488	33.41587	66.941098	35.154443	0.177815	0.178094	8.9047	29.787664	31.16645	34.434155		0	0.178094	0		0	0				0	0	0	58.36544										10.8703	0.881966585	1.323398122	0	0.26179818	2.01424314	0.52359636	2.121708028	4.639588806	4.409530359	5.492293954	0.713195762	0.06223525	1.91629144	2.181451144	8.864113761	0.334078372	1.431485214	0	0	2.59661052	0	0	0	0	0	0	0	0	0	0	3.877556644	0	0	0	0	0	0	0	0	54.5155	0	NO	8.892121	10.8703	0.881966585	1.323398122	0	0.26179818	2.01424314	0.52359636	2.121708028	4.639588806	4.409530359	5.492293954	0.713195762	0.06223525	1.91629144	2.181451144	8.864113761	0.334078372	1.431485214	0	0	2.59661052	0	0	0	0	0	0	0	0	0	0	3.877556644	0	0	0	0	0	0	0	0	54.5155	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins	30% Coins									6000	3.9029	0.1327	0.4267	1.84	2.2932	0.847	0.2198	0.2657	1.8727	0.4201	0.8364	0.0709	0.0079	0.3635	1.0434	2.0355	0.0348	0.1443		0.1914	0.5124	0			0				0	0	0.189	0.6562									18.3066	500	NO	7.413311	14.7733	1.014693585	1.750128122	1.840045	2.55504718	2.86127114	0.74336436	2.387377028	6.512300806	4.829596359	6.328698954	0.784054762	0.07014925	2.27975544	3.224888144	10.89959576	0.368870372	1.575797214	0	0.191414	3.10903652	0	0	0	0	0	0	0	0	0	0.188997	4.533742644	0	0	0	0	0	0	0	0	72.8221
H5041_003_0	2012	9																															A	A	A	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	268.69	9.05	50.51	1255.21	33.02	14.28	16119.33	424.9	378.87	1704.61	1185.38	168.96	0.67	708.46	3415.8	4210.59	118.82	632.03		1654.2	22.17	0		2.89	0.61				3.43	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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											NO	0	0	0	0	0	0.199891	0	0	0	0	0	0	0.199891	0	0	0	0	0		0	0.199891	0		0	0				0	0												0	0	0	0	0	2.85444348	0	0	0	0	0	0	0.13392697	0	0	0	0	0	0	0	4.43158347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.42	0	NO	0.00403	0	0	0	0	0	2.85444348	0	0	0	0	0	0	0.13392697	0	0	0	0	0	0	0	4.43158347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.42	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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"																7500	5.4482	0.0785	0.4895	2.2356	0	0.9625	0.4712	0	3.0864	0.5523	1.2296	0.0573	0.0203	1.2441	1.6753	3.0826	0.0419	0.2506		0.3235	1.078	0		0	0				0	0											22.3275	1000	NO	7.341909	5.4482	0.078487	0.489476	2.235585	0	3.81698548	0.471197	0	3.086396	0.552259	1.229606	0.057293	0.15423797	1.244111	1.67535	3.082609	0.041886	0.2506	0	0.323502	5.50963247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7474
H5042_001_0	2012	8																															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	V	O																																																			0	YES	195.9475776	2.529299383	589.2457126		306.9775384		9.608933589	220.6760951	346.4500354				2.667932065	6.86039674	7571.380912	3650.998971	680.9084423	1275.07939							379.6242235																2500	"1a (IP Acute); $300 / $750 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $300 (190 lifetime limit) / $750 admit	"2a (SNF); $0 / $0 days 1-20 $70 / $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $75/ $75	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); 20%, $200 max / 20%"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $75 / $125,9b (OP ASC); $75 / $125"	8a (OP Diag Proc/Test/Lab); $0 / $20	"8b (OP Therap Rad); $0 / $20,8b (OP Diag); $0 / $20,8b (X-Ray); $0 / $20"	5 (Partial Hosp); $300 per day pro-rated	12 (Renal Dialysis); $20 / $20	"9a (OP Other); 0, 9c (OP SA); $15 / $25, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $20 / $25, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $20 / $25, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $20 / $25, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); $20 / $25,7e (MH Non-Phys); $20/ $25"	7i (PT/ST); $20 / $25	7g1 Prof Radiology; n/a	7g (Prof. Other); $20 / $25	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250/$250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$15 / $0-$25	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	300	300	21.71160897		75		0.1747	50	75				20	20	20	20	20	20							20																YES	269.6631818	269.6631818	19.51607186		67.41579546		0.15703386	44.94386364	67.41579546				17.97754546	17.97754546	17.97754546	17.97754546	17.97754546	17.97754546							17.97754546																	4.4033	0.056838243	0.958313473	0	1.724594578	0	1.508927928	0.826503027	1.946350393	0	0	0	0.003996906	0.010277758	11.34290371	5.469666664	1.020088539	1.91023314	0	0	0	0	0	0	0.568725978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7507	0		3.571924234	4.4033	0.056838243	0.958313473	0	1.724594578	0	1.508927928	0.826503027	1.946350393	0	0	0	0.003996906	0.010277758	11.34290371	5.469666664	1.020088539	1.91023314	0	0	0	0	0	0	0.568725978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7507	YES	"1a (IP Acute); $300 / $750 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $300 (190 lifetime limit) / $750 admit	"2a (SNF); $0 / $0 days 1-20 $70 / $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $75 / $75	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); $0 / 20%,                      test strips $0 / $0"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $75 / $125,9b (OP ASC); $75 / $125"	8a (OP Diag Proc/Test/Lab); $0 / $20	"8b (OP Therap Rad); $0 / $20,8b (OP Diag); $0 / $20,8b (X-Ray); $0 / $20"	5 (Partial Hosp);$750 per day pro-rated	12 (Renal Dialysis); $20 / $20	"9a (OP Other); 0, 9c (OP SA); $15 / $25, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $20 / $25, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $20 / $25, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $20 / $25, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); $20 / $25,7e (MH Non-Phys); $20/ $25"	7i (PT/ST); $20 / $25	7g1 Prof Radiology; n/a	7g (Prof. Other); $20 / $25	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250/$250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$15 / $0-$25	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											2500	0.7502	0.0097	0.0653		0.1175		0.1028	0.0563	0.2211	0.2774	0.1386		0.0003	0.0009	0.9662	0.4475	0.0869	0.1627							0.0484																3.4518	0		0.357663958	5.1535	0.066521751	1.023620458	0	1.842121959	0	1.611758094	0.882827417	2.167416325	0.277414655	0.138563834	0	0.004269286	0.011153266	12.30914657	5.917117814	1.106984567	2.072955949	0	0	0	0	0	0	0.617172781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2026
H5042_004_0	2012	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	V	O																																																			0	YES	221.7575695	5.049563982	468.6431038		166.0035545	9.70714234	9.810554355	234.9850232	284.8474598				1.286329653	17.87566776	5911.052123	5002.590581	446.8746786	982.4034552							191.6473562																2500	"1a (IP Acute); $300 / $750 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $300 (190 lifetime limit) / $750 admit	"2a (SNF); $0 / $0 days 1-20 $70 / $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $75 / $75	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); 20%, $200 max / 20%"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $75 / $125,9b (OP ASC); $75 / $125"	8a (OP Diag Proc/Test/Lab); $0 / $20	"8b (OP Therap Rad); $0 / $20,8b (OP Diag); $0 / $20,8b (X-Ray); $0 / $20"	5 (Partial Hosp); $300 per day pro-rated	12 (Renal Dialysis); $20 / $20	"9a (OP Other); 0, 9c (OP SA); $15 / $25, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $20 / $25, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $20 / $25, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $20 / $25, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); $20 / $25,7e (MH Non-Phys); $20/ $25"	7i (PT/ST); $20 / $25	7g1 Prof Radiology; n/a	7g (Prof. Other); $20 / $25	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250/$250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$15 / $0-$25	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	300	300	21.71160897		75	0.1747	0.1747	47.50250023	75				20	17.58215039	20	20	20	20							20																YES	270.7013744	270.7013744	19.59120797		67.67534361	0.157638434	0.157638434	42.863307	67.67534361				18.04675829	15.86504092	18.04675829	18.04675829	18.04675829	18.04675829							18.04675829																	5.0025	0.113910326	0.765107042	0	0.936195632	1.530218714	1.546520422	0.839352933	1.606429143	0	0	0	0.001934507	0.023633183	8.889610744	7.523378589	0.672053276	1.477433142	0	0	0	0	0	0	0.288217793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2165	0		3.378633028	5.0025	0.113910326	0.765107042	0	0.936195632	1.530218714	1.546520422	0.839352933	1.606429143	0	0	0	0.001934507	0.023633183	8.889610744	7.523378589	0.672053276	1.477433142	0	0	0	0	0	0	0.288217793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2165	YES	"1a (IP Acute); $300 / $750 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $300 (190 lifetime limit) / $750 admit	"2a (SNF); $0 / $0 days 1-20 $70 / $70 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $75 / $75	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); $0 / 20%,                      test strips $0 / $0"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $75 / $125,9b (OP ASC); $75 / $125"	8a (OP Diag Proc/Test/Lab); $0 / $20	"8b (OP Therap Rad); $0 / $20,8b (OP Diag); $0 / $20,8b (X-Ray); $0 / $20"	5 (Partial Hosp);$750 per day pro-rated	12 (Renal Dialysis); $20 / $20	"9a (OP Other); 0, 9c (OP SA); $15 / $25, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $20 / $25, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $20 / $25, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $20 / $25, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear ,"	"7h (Psych); $20 / $25,7e (MH Non-Phys); $20/ $25"	7i (PT/ST); $20 / $25	7g1 Prof Radiology; n/a	7g (Prof. Other); $20 / $25	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $250/$250 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$15 / $0-$25	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $100 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											2500	0.8523	0.0194	0.0521		0.0638	0.1043	0.1054	0.0572	0.1825	0.2234	0.077		0.0001	0.002	0.7573	0.6262	0.0572	0.1259							0.0246																3.3306	0		0.351396314	5.8548	0.13331718	0.817247428	0	0.999995335	1.634499802	1.651912436	0.896553015	1.788886914	0.223394287	0.076990321	0	0.002066339	0.025627915	9.646870364	8.1496102	0.729301993	1.603287973	0	0	0	0	0	0	0.312769565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5471
H5042_005_0	2012	8																															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	V	O																																																			0	YES	207.265295	6.322420658	429.3290923		222.2720601	7.118214362	9.252521363	247.0303719	285.796328				0.955716454	4.852405219	5538.001565	4415.398731	574.3667097	944.7611999							140.212476																3300	"1a (IP Acute); $750 / $1,250 admit, 1a1 (Add'l Days); 0"	"1b (IP Psych); $750 (190 lifetime limit) / $1,250 admit"	"2a (SNF); $0 / $0 days 1-20 $90 / $90 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $100 / $125	"11a (DME); Lesser of 20% or $300 max per item / 20%,11b (Prosthetics); Lesser of 20% or $300 max per item / 20%"	"11c (Diabetic Supplies); 20%, $200 max / 20%"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $125 / $275,9b (OP ASC); $125 / $275"	8a (OP Diag Proc/Test/Lab); $0 / $35	"8b (OP Therap Rad); $0 / $35,8b (OP Diag); $0 / $35,8b (X-Ray); $0 / $35"	5 (Partial Hosp); $750 per day pro-rated	12 (Renal Dialysis); $30 / $30	"9a (OP Other); 0, 9c (OP SA); $30 / $35, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $30 / $35, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $30 / $35, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $30 / $35, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); $30 / $35,7e (MH Non-Phys); $30 / $35"	7i (PT/ST); $30 / $35	7g1 Prof Radiology; n/a	7g (Prof. Other); $30 / $35	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $100/$100 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$30 / $0-$35	17b1 (Non MCR Covered); n/a	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	750	750	27.91492582		100	0.1804	0.1804	48.2348888	125				30	18.97039323	30	29.06611876	30	30							30																YES	665.0094471	665.0094471	24.75158585		88.66792628	0.159956939	0.159956939	42.76887565	110.8349078				26.60037788	16.82065429	26.60037788	25.77232475	26.60037788	26.60037788							26.60037788																	11.4861	0.350372456	0.885547991	0	1.642366887	1.138607781	1.480004995	0.880434271	2.63968414	0	0	0	0.002118535	0.006801719	12.27607786	9.482924167	1.273197627	2.094250411	0	0	0	0	0	0	0.310808737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9493	0		5.872484208	11.4861	0.350372456	0.885547991	0	1.642366887	1.138607781	1.480004995	0.880434271	2.63968414	0	0	0	0.002118535	0.006801719	12.27607786	9.482924167	1.273197627	2.094250411	0	0	0	0	0	0	0.310808737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9493	YES	"1a (IP Acute); $750 / $1,250 admit, 1a1 (Add'l Days); 0"	"1b (IP Psych); $750 (190 lifetime limit) / $1,250 admit"	"2a (SNF); $0 / $0 days 1-20 $90 / $90 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $100 / $125	"11a (DME); Lesser of 20% or $300 max per item / 20%,11b (Prosthetics); Lesser of 20% or $300 max per item / 20%"	"11c (Diabetic Supplies); $0 / 20%,                      test strips $0 / $0"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $125 / $275,9b (OP ASC); $125 / $275"	8a (OP Diag Proc/Test/Lab); $0 / $35	"8b (OP Therap Rad); $0 / $35,8b (OP Diag); $0 / $35,8b (X-Ray); $0 / $35"	5 (Partial Hosp); $1250 per day pro-rated	12 (Renal Dialysis); $30 / $30	"9a (OP Other); 0, 9c (OP SA); $30 / $35, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $30 / $35, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $20 / $20, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $30 / $35, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); $30 / $35, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); $30 / $35,7e (MH Non-Phys); $30 / $35"	7i (PT/ST); $30 / $35	"7e (MH Non-Phys); $30 / $35, 7g1 Prof Radiology; n/a"	7g (Prof. Other); $30 / $35	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $100/$100 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$30 / $0-$35	17b1 (Non MCR Covered); n/a	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); n/a	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											3300	1.3046	0.0398	0.0603		0.1399	0.0776	0.1009	0.06	0.3958	0.2946	0.1191		0.0001	0.0005	0.976	0.747	0.1012	0.1665							0.0247																4.6086	0		0.574808807	12.7907	0.390167661	0.945896166	0	1.782271564	1.216201432	1.580864127	0.940433958	3.035439391	0.294578858	0.119054272	0	0.002262908	0.007333512	13.2520973	10.22995053	1.374424227	2.260755473	0	0	0	0	0	0	0.335519836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.558
H5042_007_0	2012	8																															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	V	O																																																			0	YES	263.4440594	11.41385059	705.5139394		295.4892755	11.26441281	13.50906129	316.3801631	325.8981558				1.476341642	6.27017064	7368.96491	6319.856315	997.4822533	1279.725862							243.5737486																2000	"1a (IP Acute); $150 / $300 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $150 (190 lifetime limit) / $300 admit	"2a (SNF); $0 / $0 days 1-20 $30 / $30 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $50 / $50	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); 20% , $200 max / 20%"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $50 / $50,9b (OP ASC); $50 / $50"	8a (OP Diag Proc/Test/Lab); $0 / $0	"8b (OP Therap Rad); $0 / $0,8b (OP Diag); $0 / $0,8b (X-Ray); $0 / $0"	5 (Partial Hosp); $150 per day pro-rated	12 (Renal Dialysis); $10 / $10	"9a (OP Other); 0, 9c (OP SA); $10 / $10, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $10 / $10, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $10 / $10, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $10 / $10, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); 10, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $150 annual eyewear ,"	"7h (Psych); $10 / $10,7e (MH Non-Phys); $10 / $10"	7i (PT/ST); $10 / $10	7g1 Prof Radiology; n/a	7g (Prof. Other); 10	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $400/$400 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$10 / $0-$10	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $150 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); $200 annual max	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; Silver Sneakers,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	150	150	9.304975274		50	0.1747	0.1747	47.87102294	50				10	7.362906476	10	10	10	10							10																YES	137.1019186	137.1019186	8.504866419		45.70063955	0.159678035	0.159678035	43.75472728	45.70063955				9.140127909	6.729790698	9.140127909	9.140127909	9.140127909	9.140127909							9.140127909																	3.0099	0.130405068	0.500025151	0	1.125337406	1.798679297	2.157100356	1.153593979	1.241146179	0	0	0	0.001124496	0.003516411	5.612773486	4.813691257	0.759759615	0.974738172	0	0	0	0	0	0	0.185524601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4673	0		2.207724187	3.0099	0.130405068	0.500025151	0	1.125337406	1.798679297	2.157100356	1.153593979	1.241146179	0	0	0	0.001124496	0.003516411	5.612773486	4.813691257	0.759759615	0.974738172	0	0	0	0	0	0	0.185524601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4673	YES	"1a (IP Acute); $150 / $300 admit, 1a1 (Add'l Days); 0"	1b (IP Psych); $150 (190 lifetime limit) / $300 admit	"2a (SNF); $0 / $0 days 1-20 $30 / $30 days 21-100, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); $0/$0 days 1-20 $0/$0 after 20 days	10a (Ambulance); $50 / $50	"11a (DME); Lesser of 20% - $200 max  per item / 20%,11b (Prosthetics); Lesser of 20% - $200 max  per item / 20%"	"11c (Diabetic Supplies); $0 / 20%,                      test strips $0 / $0"	"4a (ER); $50 (waived if admit), 4a (ER) - Worldwide Coverage; $50 (waived if admit), 4b (UC); 35"	"9b (OP Surg); $50 / $50,9b (OP ASC); $50 / $50"	8a (OP Diag Proc/Test/Lab); $0 / $0	"8b (OP Therap Rad); $0 / $0,8b (OP Diag); $0 / $0,8b (X-Ray); $0 / $0"	5 (Partial Hosp); $300 per day pro-rated	12 (Renal Dialysis); $10 / $10	"9a (OP Other); 0, 9c (OP SA); $10 / $10, 9d (OP Blood Services); 0"	"7a (PCP w/Copay); $10 / $10, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); n/a, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); n/a, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); n/a, 14a6 (Mammography); n/a, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; $0 / $0, 14a7 (Nutrition Therapy Diabetes); n/a"	"7b (Chiro); $10 / $10, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); $10 / $10, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); 10, 17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $150 annual eyewear ,"	"7h (Psych); $10 / $10,7e (MH Non-Phys); $10 / $10"	7i (PT/ST); $10 / $10	"7e (MH Non-Phys); $10 / $10, 7g1 Prof Radiology; n/a"	7g (Prof. Other); 10	15 (Part B Rx); $0 / $0	"14a1 (Smoking Cessation - Mdcr Covered); n/a,14a1 (Smoking Cessation - Mdcr Covered); n/a,16b (Comp. Dental); n/a"	10b (Transportation); 0	"16a (Preventive Dental); Prev Dental - $400/$400 annual max to include up to 2 preventative office visits per year,16b1 (Comp. Dental) - Non MCR; n/a"	17a1 (Routine Eye Exam); $0-$10 / $0-$10	17b1 (Non MCR Covered); 20% / 20% coins. after cataract surgery. $150 annual eyewear	18a1 (Routine Hearing Exam); n/a	18b (Hearing Aids); $200 annual max	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											2000	0.4102	0.0178	0.0341		0.0767	0.1226	0.147	0.0786	0.0846				0.0001	0.0002	0.3825	0.328	0.0518	0.0664							0.0126																1.8133	0		0.170584415	3.4201	0.148178713	0.534100781	0	1.20202671	1.921255391	2.304102068	1.232208908	1.3257276	0	0	0	0.001201128	0.003756047	5.995271829	5.141733878	0.811535586	1.041164465	0	0	0	0	0	0	0.198167701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2806
H5042_801_0	2012	1																															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	O																																																			0	YES	209.9930158	2.779279428	14.90905045		8.774107087	8.526489815	10.2973854	12.09184518	45.64169603	9.834476991	20.52755941	3.464033442	0.320713132	28.32504576	47.61631132	149.2796059	3.209617292	6.706892542		15.78798847	30.44515039																					"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	0.089547363	0.089547363	0.191747352		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				YES	0.082245466	0.082245466	0.176111835		0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205734528	0.205933859	0.219382881	0.205734528	0.205734528		0.224	0.205734528																					17.271	0.228583132	2.625660228	0	1.805136783	1.754193361	2.118527729	2.487710065	9.390072808	2.023291486	4.223227754	0.712671286	0.065981765	5.827439931	9.805810761	32.74938995	0.6603291	1.379839374	0	3.536509418	6.263618657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.929	0		6.77315942	17.271	0.228583132	2.625660228	0	1.805136783	1.754193361	2.118527729	2.487710065	9.390072808	2.023291486	4.223227754	0.712671286	0.065981765	5.827439931	9.805810761	32.74938995	0.6603291	1.379839374	0	3.536509418	6.263618657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.929	YES	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	"7e (MH Non-Phys); Medicare Cost Share, 7g1 Prof Radiology; Medicare Cost Share"	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											6700	1.177	0.0156	0.1789		0.123	0.1195	0.1444	0.1695	0.6399	0.1379	0.2878	0.0486	0.0045	0.3971	0.6682	2.2318	0.045	0.094		0.241	0.4269																				7.1507	0		0.461576128	18.448	0.244160577	2.804593279	0	1.928152941	1.873737835	2.2629008	2.657242111	10.02998591	2.161174413	4.511031568	0.761238289	0.070478279	6.224567327	10.4740555	34.98118987	0.705329096	1.473872435	0	3.777514867	6.690470687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0796
H5042_802_0	2012	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	O																																																			0	YES	186.557926	2.813644986	15.65644409		7.2353422	2.427657423	8.535660198	8.311060474	44.71133563	5.041175806	10.48983887	1.438995733	0.188129032	20.08273615	56.38460651	144.4276513	2.461259759	6.835015194		10.58208968	40.36485456																					"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	0.089553203	0.089553203	0.195418957		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				YES	0.083076028	0.083076028	0.181284758		0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.2077986	0.208168107	0.219806179	0.2077986	0.2077986		0.224	0.2077986																					15.4985	0.23374645	2.838274674	0	1.50349398	0.504463814	1.773698239	1.727026731	9.290952946	1.047549275	2.179773831	0.299021299	0.03909295	4.173164455	11.73747678	31.74609019	0.511446332	1.420306588	0	2.370388089	8.387760265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2822	0		5.508077917	15.4985	0.23374645	2.838274674	0	1.50349398	0.504463814	1.773698239	1.727026731	9.290952946	1.047549275	2.179773831	0.299021299	0.03909295	4.173164455	11.73747678	31.74609019	0.511446332	1.420306588	0	2.370388089	8.387760265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2822	YES	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	"7e (MH Non-Phys); Medicare Cost Share, 7g1 Prof Radiology; Medicare Cost Share"	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											6700	1.0562	0.0159	0.1934		0.1025	0.0344	0.1209	0.1177	0.6332	0.0714	0.1485	0.0204	0.0027	0.2844	0.7999	2.1634	0.0349	0.0968		0.1615	0.5716																				6.6296	0		0.375363567	16.5547	0.249675763	3.031696939	0	1.605953834	0.538841929	1.894571928	1.844719858	9.924111244	1.118937486	2.328320691	0.319398952	0.041757049	4.457556564	12.53736038	33.9095174	0.546300291	1.517097402	0	2.531924897	8.95936794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9118
H5042_803_0	2012	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	O																																																			0	YES	163.5019115	3.576123587	14.21402817		8.536020225	10.97111037	9.503768396	10.28615523	33.81658001	7.311137384	14.60922805	3.603384271	0.412664443	24.49425037	34.61623782	134.4367353	3.686793611	6.559118124		15.88073286	27.17751074																					"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	7g1 Prof Radiology; Medicare Cost Share	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											0	NO	0.089800846	0.089800846	0.199255216		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																				YES	0.084193318	0.084193318	0.186812915		0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.210012535	0.220734978	0.210012535	0.210012535		0.224	0.210012535																					13.7658	0.301085711	2.655364039	0	1.792671249	2.304070703	1.995910496	2.160221538	7.101905701	1.535430498	3.068121021	0.756755866	0.086664706	5.14409962	7.269843867	29.67488976	0.774272873	1.377497026	0	3.557284162	5.707617934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.0295	0		4.288412575	13.7658	0.301085711	2.655364039	0	1.792671249	2.304070703	1.995910496	2.160221538	7.101905701	1.535430498	3.068121021	0.756755866	0.086664706	5.14409962	7.269843867	29.67488976	0.774272873	1.377497026	0	3.557284162	5.707617934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.0295	YES	"1a (IP Acute); Medicare Cost Share, 1a1 (Add'l Days); n/a"	1b (IP Psych); Medicare Cost Share	"2a (SNF); Medicare Cost Share, 2a2 (Waiver 3 Day); n/a"	6a (Home Health); Medicare Cost Share	10a (Ambulance); Medicare Cost Share	"11a (DME); Medicare Cost Share,11b (Prosthetics); Medicare Cost Share"	11c (Diabetic Supplies); Medicare Cost Share	"4a (ER); Medicare Cost Share, 4a (ER) - Worldwide Coverage; n/a, 4b (UC); Medicare Cost Share"	"9b (OP Surg); Medicare Cost Share,9b (OP ASC); Medicare Cost Share"	8a (OP Diag Proc/Test/Lab); Medicare Cost Share	"8b (OP Therap Rad); Medicare Cost Share,8b (OP Diag); Medicare Cost Share,8b (X-Ray); Medicare Cost Share"	5 (Partial Hosp); Medicare Cost Share	12 (Renal Dialysis); Medicare Cost Share	"9a (OP Other); Medicare Cost Share, 9c (OP SA); Medicare Cost Share, 9d (OP Blood Services); Medicare Cost Share"	"7a (PCP w/Copay); Medicare Cost Share, 14b2 - Additional Pap Exams; n/a, 14b3 - Additional Pelvic Exams; n/a, 14a4 (Prostate Screening); Medicare Cost Share, 14b4 - Additional Prostate Exams; n/a, 14a5 (Colorectal Screening); Medicare Cost Share, 14b5 - Additional Colorectal Exams; n/a, 14a8 (Bone Mass); Medicare Cost Share, 14a6 (Mammography); Medicare Cost Share, 14b6 - Additional Mammorgraphy Exams; n/a, 14e - Diabetes Self Management Training; Medicare Cost Share, 14a7 (Nutrition Therapy Diabetes); Medicare Cost Share"	"7b (Chiro); Medicare Cost Share, 7b1 (Routine Chiro); n/a, 7d (SPC w/Copay); Medicare Cost Share, 7f1 (Routine Podiatry); n/a, 7g (Prof. Other); Medicare Cost Share, 17b1 (Non MCR Covered); n/a,"	"7h (Psych); Medicare Cost Share,7e (MH Non-Phys); Medicare Cost Share"	7i (PT/ST); Medicare Cost Share	"7e (MH Non-Phys); Medicare Cost Share, 7g1 Prof Radiology; Medicare Cost Share"	7g (Prof. Other); Medicare Cost Share	15 (Part B Rx); Medicare Cost Share	"14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,14a1 (Smoking Cessation - Mdcr Covered); Medicare Cost Share,16b (Comp. Dental); Medicare Cost Share"	10b (Transportation); n/a	"16a (Preventive Dental); n/a,16b1 (Comp. Dental) - Non MCR; 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	"14c1 - Written Health Edu. Materials / incl. Newsletters; n/a,14c2 - Nutritional Benefit; n/a,14c2 - Nutritional Benefit; n/a,14c3 - Additional Smoking Cessation; n/a,14c4 - Membership in Health Club/Fitness Classes; n/a,14c5 - Nursing Hotline; n/a"	13b (OTC); n/a											6700	0.9381	0.0205	0.181		0.1222	0.157	0.136	0.1472	0.484	0.1046	0.2091	0.0516	0.0059	0.3506	0.4954	2.0223	0.0528	0.0939		0.2424	0.389																				6.2035	0		0.292246018	14.7039	0.321604049	2.83632134	0	1.914837907	2.461088125	2.131927468	2.307435951	7.585885176	1.640066757	3.277206816	0.808327138	0.092570718	5.494658855	7.765267963	31.69716915	0.827037891	1.471370462	0	3.799705364	6.09657972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2329
H5050_001_0	2012	7																															D	D	D		T	Coin	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	501.1870914	7.632290732	221.9495551	0	217.4989194	3.735599564	1.867799822	245.0451352	546.7710146	0	442.7152928	0	0	0	3464.161603	2383.790829	147.6045745	213.6772105	0	522.1331483	0	519.8002473	0	0	0	0	48.82424037	0	0	0.105901939											2500	$200/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$200/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$60/Days Custom: SNF 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$35/Visit for Phys - Specialist; PBP 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"	$75/Procedure for Phys Rad - Diag; PBP 8b	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	200	200	60	0	150	0.2	0.2	65	200	0	75	0	0	0	10	35	10	10	0	10	0	10	0	0	0	0	10	0	0	10											NO	187.8859954	187.8859954	56.36579863	0	140.9144966	0.187885995	0.187885995	61.06294852	187.8859954	0	70.45724829	0	0	0	9.394299772	32.8800492	9.394299772	9.394299772	0	9.394299772	0	9.394299772	0	0	0	0	9.394299772	0	0	9.394299772												7.8472	0.119500045	1.042530328	0	2.554062561	0.701866843	0.350933429	1.24693154	8.560884696	0	2.599375109	0	0	0	2.711947713	6.531596644	0.115553468	0.167278981	0	0.408756276	0	0.406929945	0	0	0	0	0.038222463	0	0	8.29E-05	0	0	0	0	0	0	0	0	0	0	35.4036	0	NO	2.221512105	7.8472	0.119500045	1.042530328	0	2.554062561	0.701866843	0.350933429	1.24693154	8.560884696	0	2.599375109	0	0	0	2.711947713	6.531596644	0.115553468	0.167278981	0	0.408756276	0	0.406929945	0	0	0	0	0.038222463	0	0	8.29E-05	0	0	0	0	0	0	0	0	0	0	35.4036	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.8472	0.119500045	1.042530328	0	2.554062561	0.701866843	0.350933429	1.24693154	8.560884696	0	2.599375109	0	0	0	2.711947713	6.531596644	0.115553468	0.167278981	0	0.408756276	0	0.406929945	0	0	0	0	0.038222463	0	0	8.29E-05	0	0	0	0	0	0	0	0	0	0	35.4036
H5050_004_0	2012	9																															D	D	D		T	Coin	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	640.8356335	9.758918277	405.0137204	0	459.5035158	10.1731595	5.086579749	397.2776991	670.376111	0	621.4720659	0	0	0	4771.494768	3463.76481	361.5252364	296.702857	0	916.9520177	0	664.2759721	0	0	0	0	87.53449977	0	0	0.137061479											1000	$100/Days Custom: IP 1-3 for IP Med/Surg; PBP 1a	$100/Days Custom: IP 1-3 for IP MH/SA; PBP 1b	$25/Days Custom: SNF 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$25/Visit for Phys - Specialist; PBP 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"	$40/Procedure for Phys Rad - Diag; PBP 8b	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	100	100	25	0	75	0.2	0.2	65	100	0	40	0	0	0	10	25	10	10	0	10	0	10	0	0	0	0	10	0	0	10											NO	78.11457451	78.11457451	19.52864363	0	58.58593088	0.156229149	0.156229149	50.77447343	78.11457451	0	31.2458298	0	0	0	7.811457451	19.52864363	7.811457451	7.811457451	0	7.811457451	0	7.811457451	0	0	0	0	7.811457451	0	0	7.811457451												4.1716	0.063526146	0.659114051	0	2.243370102	1.589344051	0.794672026	1.680963831	4.363845389	0	1.618200867	0	0	0	3.106027363	5.636885715	0.235336583	0.193140145	0	0.596894306	0	0.432413624	0	0	0	0	0.056981002	0	0	8.92E-05	0	0	0	0	0	0	0	0	0	0	27.4424	0	NO	7.207502974	4.1716	0.063526146	0.659114051	0	2.243370102	1.589344051	0.794672026	1.680963831	4.363845389	0	1.618200867	0	0	0	3.106027363	5.636885715	0.235336583	0.193140145	0	0.596894306	0	0.432413624	0	0	0	0	0.056981002	0	0	8.92E-05	0	0	0	0	0	0	0	0	0	0	27.4424	NO																																										0	0	0	0	0	0	0	0	0	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	4.1716	0.063526146	0.659114051	0	2.243370102	1.589344051	0.794672026	1.680963831	4.363845389	0	1.618200867	0	0	0	3.106027363	5.636885715	0.235336583	0.193140145	0	0.596894306	0	0.432413624	0	0	0	0	0.056981002	0	0	8.92E-05	0	0	0	0	0	0	0	0	0	0	27.4424
H5050_009_0	2012	9																															D	D	D		T	Coin	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	628.9072818	9.57726825	271.5132055	0	260.2082171	6.560702651	3.280351285	295.5009917	636.0023132	0	583.2144269	0	0	0	4282.516638	3019.360937	376.9257833	272.4315067	0	711.8656684	0	549.8514744	0	0	0	0	70.24377203	0	0	0.207273046											2500	$200/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$200/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$50/Days Custom: SNF 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$35/Visit for Phys - Specialist; PBP 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"	$50/Procedure for Phys Rad - Diag; PBP 8b	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	200	200	50	0	150	0.2	0.2	65	200	0	50	0	0	0	10	35	10	10	0	10	0	10	0	0	0	0	10	0	0	10											NO	183.9991054	183.9991054	45.99977636	0	137.9993291	0.183999105	0.183999105	59.79970927	183.9991054	0	45.99977636	0	0	0	9.199955272	32.19984345	9.199955272	9.199955272	0	9.199955272	0	9.199955272	0	0	0	0	9.199955272	0	0	9.199955272												9.6432	0.146850733	1.040795561	0	2.992379948	1.207163419	0.603581702	1.472572783	9.751988058	0	2.235644434	0	0	0	3.283246794	8.101912457	0.288975029	0.20886314	0	0.545761026	0	0.421550748	0	0	0	0	0.053853297	0	0	0.000158909	0	0	0	0	0	0	0	0	0	0	41.9985	0	NO	3.505003555	9.6432	0.146850733	1.040795561	0	2.992379948	1.207163419	0.603581702	1.472572783	9.751988058	0	2.235644434	0	0	0	3.283246794	8.101912457	0.288975029	0.20886314	0	0.545761026	0	0.421550748	0	0	0	0	0.053853297	0	0	0.000158909	0	0	0	0	0	0	0	0	0	0	41.9985	NO																																										0	0	0	0	0	0	0	0	0	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	9.6432	0.146850733	1.040795561	0	2.992379948	1.207163419	0.603581702	1.472572783	9.751988058	0	2.235644434	0	0	0	3.283246794	8.101912457	0.288975029	0.20886314	0	0.545761026	0	0.421550748	0	0	0	0	0.053853297	0	0	0.000158909	0	0	0	0	0	0	0	0	0	0	41.9985
H5050_012_0	2012	9																															D	D	D		T			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	810.1523592	12.33734557	249.8370733	0	323.6809687	0	0	356.9295955	713.9294912	0	716.9717018	0	0	0	5505.488334	3986.506953	444.2861637	330.5861144	0	871.5484375	0	816.2768171	0	0	0	0	96.37882013	0	0	0.054696291											2500	$100/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$100/Days Custom: IP 1-5 for IP MH/SA; PBP 1b	$25/Days Custom: SNF 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$25/Visit for Phys - Specialist; PBP 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"	$40/Procedure for Phys Rad - Diag; PBP 8b	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; $10/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$10/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	100	100	25	0	150	0	0	65	200	0	40	0	0	0	10	25	10	10	0	10	0	10	0	0	0	0	10	0	0	10											NO	94.15886375	94.15886375	23.53971594	0	141.2382956	0	0	61.20326144	188.3177275	0	37.6635455	0	0	0	9.415886375	23.53971594	9.415886375	9.415886375	0	9.415886375	0	9.415886375	0	0	0	0	9.415886375	0	0	9.415886375												6.3569	0.09680587	0.490091145	0	3.809679029	0	0	1.820437946	11.20379828	0	2.250308026	0	0	0	4.319921049	7.820103438	0.348612336	0.259396774	0	0.683866755	0	0.64049748	0	0	0	0	0.075624335	0	0	4.29E-05	0	0	0	0	0	0	0	0	0	0	40.1761	0	NO	2.339849286	6.3569	0.09680587	0.490091145	0	3.809679029	0	0	1.820437946	11.20379828	0	2.250308026	0	0	0	4.319921049	7.820103438	0.348612336	0.259396774	0	0.683866755	0	0.64049748	0	0	0	0	0.075624335	0	0	4.29E-05	0	0	0	0	0	0	0	0	0	0	40.1761	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.3569	0.09680587	0.490091145	0	3.809679029	0	0	1.820437946	11.20379828	0	2.250308026	0	0	0	4.319921049	7.820103438	0.348612336	0.259396774	0	0.683866755	0	0.64049748	0	0	0	0	0.075624335	0	0	4.29E-05	0	0	0	0	0	0	0	0	0	0	40.1761
H5050_013_0	2012	9																															D	D	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	235.1676848	3.581233778	113.5317762	0	89.79226879	2.915662519	1.457831407	139.6384084	362.6229908	0	398.9955097	0	0	0	3041.799819	1979.501518	407.0750526	205.962813	0	340.0495643	0	344.3907182	0	0	0	0	23.6570631	0	0	0											3200	$350/Days Custom: IP 1-3 for IP Med/Surg; PBP 1a	$350/Days Custom: IP 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$45/Visit for Phys - Specialist; PBP 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"	$150/Procedure for Phys Rad - Diag; PBP 8b	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; $20/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"Optional Supplemental; PBP 16a, 16b"	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 14c	"$20/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	350	350	75	0	200	0.2	0.2	65	300	0	150	0	0	0	20	45	20	20	0	20	0	20	0	0	0	0	20	0	0	0											NO	330.0342202	330.0342202	70.72161861	0	188.590983	0.188590983	0.188590983	61.29206946	282.8864744	0	141.4432372	0	0	0	18.8590983	42.43297117	18.8590983	18.8590983	0	18.8590983	0	18.8590983	0	0	0	0	18.8590983	0	0	0												6.4678	0.098494141	0.669095915	0	1.411167686	0.54986766	0.274933858	0.713227252	8.548428286	0	4.70293471	0	0	0	4.780466815	6.999677568	0.639755703	0.323689411	0	0.534419013	0	0.541241534	0	0	0	0	0.03717924	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2924	0	NO	2.256042004	6.4678	0.098494141	0.669095915	0	1.411167686	0.54986766	0.274933858	0.713227252	8.548428286	0	4.70293471	0	0	0	4.780466815	6.999677568	0.639755703	0.323689411	0	0.534419013	0	0.541241534	0	0	0	0	0.03717924	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2924	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.4678	0.098494141	0.669095915	0	1.411167686	0.54986766	0.274933858	0.713227252	8.548428286	0	4.70293471	0	0	0	4.780466815	6.999677568	0.639755703	0.323689411	0	0.534419013	0	0.541241534	0	0	0	0	0.03717924	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2924
H5050_801_0	2012	6																															D	D			T	Coin	Coin	V	V						V	V	V	V		V		V								V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	591.7414029	9.011290399	0	0	244.304137	7.015927419	3.507963686	258.0312027	683.646954	0	0	0	0	0	3758.923094	2998.697521	282.2313348	274.9948171	0	266.6967574	0	526.2018832	0	0	0	0	0	0	0	0.377208061											2500	$200/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$200/Days Custom: IP 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 7d, 7f"	"$20/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$20/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	$0/Procedure for Phys Rad - Diag; PBP 8b	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; $20/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"$20/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	200	200	0	0	150	0.2	0.2	65	200	0	0	0	0	0	20	20	20	20	0	20	0	20	0	0	0	0	0	0	0	20											NO	187.7281559	187.7281559	0	0	140.7961169	0.187728156	0.187728156	61.01165067	187.7281559	0	0	0	0	0	18.77281559	18.77281559	18.77281559	18.77281559	0	18.77281559	0	18.77281559	0	0	0	0	0	0	0	18.77281559												9.2572	0.140972744	0	0	2.86642282	1.317087116	0.658543554	1.311909133	10.69498183	0	0	0	0	0	5.880464172	4.691166299	0.441523067	0.430202249	0	0.417220754	0	0.82319091	0	0	0	0	0	0	0	0.000590105	0	0	0	0	0	0	0	0	0	0	38.9315	0	NO	2.446537601	9.2572	0.140972744	0	0	2.86642282	1.317087116	0.658543554	1.311909133	10.69498183	0	0	0	0	0	5.880464172	4.691166299	0.441523067	0.430202249	0	0.417220754	0	0.82319091	0	0	0	0	0	0	0	0.000590105	0	0	0	0	0	0	0	0	0	0	38.9315	NO																																										0	0	0	0	0	0	0	0	0	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	9.2572	0.140972744	0	0	2.86642282	1.317087116	0.658543554	1.311909133	10.69498183	0	0	0	0	0	5.880464172	4.691166299	0.441523067	0.430202249	0	0.417220754	0	0.82319091	0	0	0	0	0	0	0	0.000590105	0	0	0	0	0	0	0	0	0	0	38.9315
H5050_802_0	2012	6																															D	D			T	Coin	Coin	V	V						V	V	V	V		V		V								V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	400.1236674	6.093253818	0	0	234.211336	6.237242917	3.118621458	241.6351357	604.2810121	0	0	0	0	0	3522.679088	3033.210028	239.9870154	269.0853077	0	228.024332	0	525.3972444	0	0	0	0	0	0	0	0.193860265											2500	$200/Days Custom: IP 1-5 for IP Med/Surg; PBP 1a	$200/Days Custom: IP 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"	$65/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;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 5, 9a, 9d"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 7d, 7f"	"$20/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$20/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	$0/Procedure for Phys Rad - Diag; PBP 8b	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; $20/Visit for Phys - Urgent Care; PBP 3, 7b, 7g, 13d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 14a, 17a, 18a"	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	No Cost Sharing; PBP 14c	"$20/Visit for World Wide Urgent Care; PBP 4a, 4b, 13b, 14b"											0	NO	200	200	0	0	150	0.2	0.2	65	200	0	0	0	0	0	20	20	20	20	0	20	0	20	0	0	0	0	0	0	0	20											NO	190.3314338	190.3314338	0	0	142.7485753	0.190331434	0.190331434	61.85771597	190.3314338	0	0	0	0	0	19.03314338	19.03314338	19.03314338	19.03314338	0	19.03314338	0	19.03314338	0	0	0	0	0	0	0	19.03314338												6.3463	0.096644811	0	0	2.786111212	1.187143387	0.593571694	1.245583133	9.584472618	0	0	0	0	0	5.587304679	4.810960113	0.380642273	0.426794937	0	0.361668317	0	0.83333009	0	0	0	0	0	0	0	0.000307481	0	0	0	0	0	0	0	0	0	0	34.2409	0	NO	1.662549935	6.3463	0.096644811	0	0	2.786111212	1.187143387	0.593571694	1.245583133	9.584472618	0	0	0	0	0	5.587304679	4.810960113	0.380642273	0.426794937	0	0.361668317	0	0.83333009	0	0	0	0	0	0	0	0.000307481	0	0	0	0	0	0	0	0	0	0	34.2409	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.3463	0.096644811	0	0	2.786111212	1.187143387	0.593571694	1.245583133	9.584472618	0	0	0	0	0	5.587304679	4.810960113	0.380642273	0.426794937	0	0.361668317	0	0.83333009	0	0	0	0	0	0	0	0.000307481	0	0	0	0	0	0	0	0	0	0	34.2409
H5087_001_0	2012	13																															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	1607.789085	109.7800787	330.9944256	180.9877749	352.7730485	3.639323307	3.126769676	231.2716349	125.926809	32.19759368	43.2026893	0	1.716921415	107.2094404	4197.247174	16736.09426	116.5175712	423.9632855	2385.808637	388.044588	13.64857491	0	1489.245372	480.3838049	395.1290882	475.6094509	0	6.954828419	0	871.760993											6700	$0 	$0 	$0 	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,11c1: $0,11c2: $0,17b1: $0"	"4a1: $0,4a2: $0,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: $0,9c2: $0"	12: $0	"31: $0,32: $0,33: $0,37: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0,14d: $0,14e: $0"	"7b1: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7c: $0,7i: $0"	"7e1: $0,7e2: $0,7h1: $0,7h2: $0"	7d2:	7g: $0	"152: $0,153: $0"	9d1: $0	10b: $0	"16a1: $0,16a2: $0,16a4: $0,16b3: $0,16b4: $0,16b5: $0,16b6: $0"	17a2: $0	17b3: $0	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c4: $0"	"13a: $0,13b: $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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
H5087_002_0	2012	10																															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	980.0357381	37.01564703	372.1903924	71.30559401	273.247835	2.366269223	1.541264646	190.188708	278.5496498	13.86304636	14.25072657	0	1.337066213	50.79599247	4676.908968	17840.02766	51.5510118	391.1903681	1697.184599	75.23380047	15.15136132	0	2036.565395	694.6178951	460.7375668	844.8049573	3.789491608	24.24945863	0	286.3830771											3400	$0 	$0 	$0 	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,11c1: $0,11c2: $0,17b1: $0"	"4a1: $0,4a2: $0,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: $0,9c2: $0"	12: $0	"31: $0,32: $0,33: $0,37: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0,14d: $0,14e: $0"	"7b1: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7c: $0,7i: $0"	"7e1: $0,7e2: $0,7h1: $0,7h2: $0"	7d2:	7g: $0	"152: $0,153: $0"	9d1: $0	10b: $0	"16a1: $0,16a2: $0,16a4: $0,16b3: $0,16b4: $0,16b5: $0,16b6: $0"	17a2: $0	17b3: $0	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c4: $0"	"13a: $0,13b: $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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
H5087_005_0	2012	16																															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	866.3914541	11.90350872	267.0480043	192.7236587	199.3570137	1.640175298	2.092793224	127.6292074	240.8991241	28.80456346	62.85236006	0	0.401228128	28.58870508	4667.329947	19129.30527	39.22674904	697.7835166	1968.633887	163.453068	14.29040834	1.191429867	1071.281005	360.3171776	263.774742	329.0365825	0	5.617193785	0	718.5995764											3400	$0 	$0 	$0 	6: $0	10a: $50	11a: $0	"11b1: $0,11b2: $0,11c1: $0,11c2: $0,17b1: $10"	"4a1: $50,4a2: $100,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: $0,9c2: $0"	12: 20%	"31: $0,32: $0,33: $0,37: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0,14d: $0,14e: $0"	"7b1: $10,7d1: $0,7f1: $0,7f2: $0,16b1: $20,17a1: $10,18a1: $10"	"7c: $0,7i: $0"	"7e1: $0,7e2: $0,7h1: $10,7h2: $5"	7d2:	7g: $0	"152: 20%,153: 0%"	9d1: $0	10b: $0	"16a1: $10,16a2: $10,16a4: $10,16b3: $20,16b4: $20-$100,16b5: $20-$100,16b6: $20-$100"	17a2: $10	17b3: $10	18a2: $10	"18a3: $10,18b1: 20%"	"14c1: $0,14c4: $0"	"13a: $10,13b: $0"											0	NO	0	0	0	0	50	0.096861609	0.0884783	49.23617012	0	0	0	0	13.57065325	0	0	0.666770529	10	0	0	0	0.020949536	0	0	10	10	2.009204488	0	80.75357796	0	10											NO	0	0	0	0	50	0.096861609	0.0884783	49.23617012	0	0	0	0	13.57065325	0	0	0.666770529	10	0	0	0	0.020949536	0	0	10	10	2.009204488	0	80.75357796	0	10												0	0	0	0	0.830654224	0.158870019	0.185166787	0.523664447	0	0	0	0	0.000453744	0	0	1.06290475	0.032688958	0	0	0	0.299377421	0	0	0.300264315	0.219812285	0.055091815	0	0.037800708	0	0.59883298	0	0	0	0	0	0	0	0	0	0	4.3056	0	NO	0	0	0	0	0	0.830654224	0.158870019	0.185166787	0.523664447	0	0	0	0	0.000453744	0	0	1.06290475	0.032688958	0	0	0	0.299377421	0	0	0.300264315	0.219812285	0.055091815	0	0.037800708	0	0.59883298	0	0	0	0	0	0	0	0	0	0	4.3056	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 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	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	0	0	0	0	0.830654224	0.158870019	0.185166787	0.523664447	0	0	0	0	0.000453744	0	0	1.06290475	0.032688958	0	0	0	0.299377421	0	0	0.300264315	0.219812285	0.055091815	0	0.037800708	0	0.59883298	0	0	0	0	0	0	0	0	0	0	4.3056
H5096_001_0	2012	8																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V		P	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	665.2228575	12.4192724	1212.61629	0	177.3665412	8.385488171	5.738806413	225.7336794	40.39777051	0	125.7661508	0	0.356527232	21.2365464	3834.343419	4072.055897	104.9965677	0	100.4106947	12.97961267	38.66274671	9.166642196	0	2378.577756	0	0	145.4256208	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$239/Days 1-6 for IP Psych; $239/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $146 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; $5 (mail order) or 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$60/Visit for ER - Facility; $60/Visit for ER - Worldwide; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC;PBP 9a, 9b"	$0-$15/Procedure for Lab Services; PBP 8a	$0-$100/Procedure or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for CORF; 30% Coinsurance for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP Office Visits; $15/Visit PCP Consults; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $25-$40/Visit for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 30% in Outpatient Hospital, CMS Cap/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$15-$40/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Copay for Oral Exams, $20 for Routine Cleanings,$0 for Fluoride;  $10 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$40/Exam for Routine Hearing/Speech Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	268	239	88.40038641	0	125	0.2	0.2	55.11973769	0.3	0	100	0	0.2	0.26643485	15	38.96399647	40	0	100	0.310684911	0.081793896	0.2	0	17	0	0	40	0	0	0											NO	250.0463349	222.9890823	82.4783307	0	116.626089	0.186601742	0.186601742	51.42719549	0.279902614	0	93.30087124	0	0.186601742	0.248586036	13.99513069	36.35374818	37.32034849	0	93.30087124	0.289871729	0.076314417	0.186601742	0	17	0	0	40	0	0	0												13.8614	0.23078018	8.334547282	0	1.723797169	1.564746704	1.070871276	0.967404172	11.30744155	0	0.977840954	0	0.066528603	5.279108891	4.471844771	12.33620789	0.326542375	0	0.780700442	3.762422761	2.950524994	1.710511406	0	3.369651821	0	0	0.484752069	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5776	0	NO	5.149822748	13.8614	0.23078018	8.334547282	0	1.723797169	1.564746704	1.070871276	0.967404172	11.30744155	0	0.977840954	0	0.066528603	5.279108891	4.471844771	12.33620789	0.326542375	0	0.780700442	3.762422761	2.950524994	1.710511406	0	3.369651821	0	0	0.484752069	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5776	YES	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$239/Days 1-6 for IP Psych; $239/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $146 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"	"$60/Visit for ER - Facility; $60/Visit for ER - Worldwide; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC;PBP 9a, 9b"	$0-$15/Procedure for Lab Services; PBP 8a	$0-$100/Procedure or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for CORF; 30% Coinsurance for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP Office Visits; $15/Visit PCP Consults; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $40/Visit or 50% Coinsurance for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 30% in Outpatient Hospital, CMS Cap/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$15-$40/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"50% Coinsurance with $2000 deductible and plan coverage limit of $500; PBP 16a, 16b"	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Routine Eye Exam; PBP 17a	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Glasses/Contacts (non-cvd); PBP 17b	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Routine Hearing Services (non-cvd); PBP 17b	30% Coinsurance for Hearing Aids (non-cvd); PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											6700	2.4784	0.0656	1.3589	0	0.275	0.2737	0.1718	0.1393	1.821	0	0.1746	0	0.0065	0.6548	0.5319	1.5223	0.0498	0	0.1362	0.6283	0.4029	0.2439	0	0.2297	0	0	0.0572	0	0	0											11.2221	0	NO	0.785160273	16.3398	0.296391736	9.693473478	0	1.998781171	1.838496315	1.24270622	1.106704742	13.12840725	0	1.152421474	0	0.073063986	5.933955841	5.003734058	13.85848639	0.376329701	0	0.916903687	4.390766733	3.353471682	1.954455211	0	3.5993547	0	0	0.541967899	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7997
H5096_002_0	2012	5																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V		P	Coin	Coin	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	656.3382931	12.23468815	1188.791868	0	175.4523748	8.212850636	5.620454523	225.9288702	42.04271326	0	124.2233974	0	0.366016444	21.73039431	3798.712146	4034.447582	103.9877402	0	99.0430301	12.84434908	38.53816647	9.132213466	0	2378.577756	600	0	144.0607469	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$239/Days 1-6 for IP Psych; $239/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $146 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; $5 (mail order) or 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$60/Visit for ER - Facility; $60/Visit for ER - Worldwide; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC;PBP 9a, 9b"	$0-$15/Procedure for Lab Services; PBP 8a	$0-$100/Procedure or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for CORF; 30% Coinsurance for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP Office Visits; $15/Visit PCP Consults; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $25-$40/Visit for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 30% in Outpatient Hospital, CMS Cap/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$15-$40/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Copay for Oral Exams, $20 for Routine Cleanings,$0 for Fluoride;  $10 Copay for Dental X-Rays; PBP 16a, 16b"	$20/Visit for Routine Eye Exam; PBP 17a	"$25/Other, $100 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$40/Exam for Routine Hearing/Speech Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	268	239	88.40038641	0	125	0.2	0.2	55.16790745	0.3	0	100	0	0.2	0.264275156	15	38.96282104	40	0	100	0.310653629	0.081608649	0.2	0	17	20	0	40	0	0	0											NO	250.1291669	223.0629511	82.50565301	0	116.6647234	0.186663557	0.186663557	51.48918929	0.279995336	0	93.3317787	0	0.186663557	0.246652704	13.9997668	36.36469391	37.33271148	0	93.3317787	0.289938558	0.076166804	0.186663557	0	17	20	0	40	0	0	0												13.6808	0.22742547	8.173504111	0	1.705758564	1.533039916	1.049134035	0.969407864	11.77176363	0	0.966165886	0	0.068321931	5.359860515	4.431757017	12.22595428	0.323512025	0	0.770321847	3.724072049	2.935328974	1.704651452	0	3.369651821	1	0	0.48020249	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4706	0	NO	5.117046692	13.6808	0.22742547	8.173504111	0	1.705758564	1.533039916	1.049134035	0.969407864	11.77176363	0	0.966165886	0	0.068321931	5.359860515	4.431757017	12.22595428	0.323512025	0	0.770321847	3.724072049	2.935328974	1.704651452	0	3.369651821	1	0	0.48020249	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4706	YES	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$239/Days 1-6 for IP Psych; $239/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $146 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"	"$60/Visit for ER - Facility; $60/Visit for ER - Worldwide; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC;PBP 9a, 9b"	$0-$15/Procedure for Lab Services; PBP 8a	$0-$100/Procedure or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $40 in facility, 30% in Outpatient Hospital, CMS Cap/Visit for CORF; 30% Coinsurance for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP Office Visits; $15/Visit PCP Consults; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare; $40/Visit or 50% Coinsurance for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 30% in Outpatient Hospital, CMS Cap/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$15-$40/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"50% Coinsurance with $2000 deductible and plan coverage limit of $500; PBP 16a, 16b"	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Routine Eye Exam; PBP 17a	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Glasses/Contacts (non-cvd); PBP 17b	50% Coinsurance with $2000 deductible and plan coverage limit of $500 for Routine Hearing Services (non-cvd); PBP 17b	30% Coinsurance for Hearing Aids (non-cvd); PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											6700	2.4328	0.0644	1.2913	0	0.2724	0.2702	0.1696	0.1374	1.9306	0	0.1651	0	0.0067	0.6528	0.5308	1.519	0.0495	0	0.1337	0.6318	0.3893	0.2457	0	0.2297	0	0	0.0581	0	0	0											11.1807	0	NO	0.778260124	16.1135	0.291827531	9.464799728	0	1.978137147	1.803277971	1.218764745	1.10679844	13.70238366	0	1.13122773	0	0.074992479	6.012619383	4.962595229	13.7449221	0.373046271	0	0.903987803	4.35584791	3.324588905	1.950325144	0	3.5993547	1	0	0.538270027	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6513
H5106_013_0	2012	9																															D	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	810.2012356	0	299.1574288	0	253.0018947	14.44924129	0	622.8813305	486.1142909	3581.692642	854.6640991	0	0	429.9930223	3761.952254	3933.678604	0	0	0	0	33.01194887	0	0.985904282	0	211.6682116	0			0	0											4000	"(1a), (1b) $150 per day, days 1-4"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$25	"(8b) X-Ray and Diag. X-Ray $25 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $35, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $35, (7g) $15-$35, (7h), (7i) $35, (14a), (14b), (14d), (14e) $0, (16b), (18a) $35, (17a), (17b) $0-$35"					(15) 0% - 20%		(10b) $40		"(17a) $35, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	150	0	50	0	100	0.2	0	65	150	25	61.11037742	0	0	35	15	33.85986476	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	141.7978729	0	40.7089759	0	91.84549356	0.184717397	0	62.04957438	146.2066903	24.35236668	59.0936652	0	0	30.79019223	14.83486964	33.04596525	0	0	0	0	0.13137965	0	40		35	0		0	0	0												9.5737	0	1.014866047	0	1.936423658	2.669026243	0	3.220793454	5.922763464	7.268557713	4.208769511	0	0	1.103297318	4.650672608	10.83268387	0	0	0	0	4.337098298	0	0.003286348	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3593		NO	4.556610133	9.5737	0	1.014866047	0	1.936423658	2.669026243	0	3.220793454	5.922763464	7.268557713	4.208769511	0	0	1.103297318	4.650672608	10.83268387	0	0	0	0	4.337098298	0	0.003286348	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3593	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b)  0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													6000	2.406	0	0.6693	0.4408	0.2191	1.585	0	0.0035	1.2705	0.1897	1.072	0	0	0.9137	0.362	1.0873	0	0	0	2.813	0.13	0	0.0054																		13.1673	500	NO	9.635872825	11.9797	0	1.684154015	0.440844923	2.155548574	4.254070267	0	3.224250886	7.193287962	7.458215465	5.280755664	0	0	2.017001275	5.012678267	11.91997745	0	0	0	2.812972509	4.467131825	0	0.008688722	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5267
H5106_014_0	2012	9																															D	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	994.7940527	0	353.9363878	0	269.3966983	16.19090352	0	624.6536829	625.7586482	4651.99277	1042.453619	0	0	402.6252134	4165.716963	5667.49938	0	0	0	0	35.75730353	0	0.863239273	11.3022	211.6682116	0			0	0											3400	"(1a), (1b) $100 per day, days 1-4"		(2) $35 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $25, (7g) $15-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0% - 20%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	100	0	35	0	100	0.2	0	65	100	20	30.32459444	0	0	25	15	24.37805426	0	0	0	0	0.2	0	40	0.3	25	0		0	0	0											NO	95.25242416	0	32.98788797	0	91.13101244	0.185195918	0	63.06793236	94.65036231	19.48176789	29.74562687	0	0	23.40345444	14.86320356	23.95560955	0	0	0	0	0.12090365	0	40	0.3	25	0		0	0	0												7.8964	0	0.972967826	0	2.045866155	2.998489234	0	3.282968018	4.935690231	7.552420282	2.584036366	0	0	0.78523507	5.159658265	11.31403352	0	0	0	0	4.323188505	0	0.002877464	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6854		NO	4.651295325	7.8964	0	0.972967826	0	2.045866155	2.998489234	0	3.282968018	4.935690231	7.552420282	2.584036366	0	0	0.78523507	5.159658265	11.31403352	0	0	0	0	4.323188505	0	0.002877464	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6854	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0 % - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b) 20%, (18a) 20%, (17a), (17b) 0% - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%	"(16a) 50%, (16b) 20% - 50%"	"(17a) 20%, (17b) 0%"			(18b) $0													5100	1.3319	0	0.6428	0.5641	0.1492	0.776	0	0.0064	1.1359	0.1301	1.1174	0	0	0.5971	0.5587	1.4619	0	0	0	2.5597	0.3286	0	0.0015																		11.3614	500	NO	4.287611463	9.2283	0	1.615742038	0.564107247	2.195090169	3.774494281	0	3.289397198	6.071634989	7.682521528	3.701421536	0	0	1.382380096	5.718401258	12.77589551	0	0	0	2.559670536	4.651746871	0	0.004388939	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0468
H5106_015_0	2012	9																															D	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	929.7587444	0	345.9450491	0	246.5978486	14.43990174	0	565.4723996	451.4189055	3850.451318	872.322708	0	0	312.6374182	3587.609244	4304.571855	0	0	0	0	50.3835179	0	3.054410591	0	211.6682116	0			0	0											4000	"(1a), (1b) $150 per day, days 1-4"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $150"	(8a) $0-$25	"(8b) X-Ray and Diag. X-Ray $25 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $35, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $35, (7g) $15-$35, (7h), (7i) $30, (14a), (14b), (14d), (14e) $0, (16b), (18a) $35, (17a), (17b) $0-$35"					(15) 0% - 20%		(10b) $40		"(17a) $35, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	150	0	50	0	100	0.2	0	65	150	25	58.26733977	0	0	35	15	33.93694116	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	135.6784828	0	36.2028013	0	87.98542531	0.183230643	0	63.29215757	145.9517542	23.84588809	55.8262575	0	0	33.63658294	14.73949906	33.12090389	0	0	0	0	0.087732932	0	33.33333333		35	0		0	0	0												10.5124	0	1.043681656	0	1.808084716	2.645832478	0	2.982497351	5.490448426	7.651452601	4.058209343	0	0	0.876337871	4.406630256	11.88094256	0	0	0	0	4.420293751	0	0.008484474	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4026		NO	8.841202443	10.5124	0	1.043681656	0	1.808084716	2.645832478	0	2.982497351	5.490448426	7.651452601	4.058209343	0	0	0.876337871	4.406630256	11.88094256	0	0	0	0	4.420293751	0	0.008484474	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4026	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													6000	1.7535	0	0.4963	0.572	0.1264	1.5866	0	0.0032	1.3208	0.2927	1.8516	0	0	0.357	0.5858	1.495	0	0	0	2.8032	0.0812	0	0																		13.3251	500	NO	14.82169211	12.2658	0	1.539951179	0.572008679	1.934533856	4.232421363	0	2.985670403	6.811252238	7.944103119	5.909798175	0	0	1.233292937	4.992395561	13.37593832	0	0	0	2.803171385	4.501483858	0	0.008484474	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7277
H5106_016_0	2012	9																															D	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	1219.70114	0	830.3459154	0	358.2756212	18.91366762	0	608.6894096	546.2106878	4687.039666	1011.33232	0	0	517.2369757	3871.343816	5806.711703	0	0	0	0	52.45052277	0	2.440745531	11.3022	211.6682116	0			0	0											3400	"(1a), (1b) $100 per day, days 1-4"		(2) $35 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $100"	(8a) $0-$20	"(8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $25, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $25, (7g) $15-$25, (7h), (7i) $25, (14a), (14b), (14d), (14e) $0, (16b), (18a) $25, (17a), (17b) $0-$25"					(15) 0% - 20%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	100	0	35	0	100	0.2	0	65	100	20	29.90442634	0	0	25	15	24.39268182	0	0	0	0	0.2	0	40	0.3	25	0		0	0	0											NO	92.20898037	0	30.86750612	0	85.81867079	0.181650083	0	61.76258025	95.20528109	19.1891106	29.10746897	0	0	21.58398688	14.78356492	23.66758099	0	0	0	0	0.096883037	0	39.25269891	0.3	25	0		0	0	0												9.3723	0	2.135892302	0	2.562228133	3.435669301	0	3.132852376	4.333511839	7.495010211	2.453110344	0	0	0.930336342	4.769355221	11.45256829	0	0	0	0	5.081565913	0	0.007983821	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.994		NO	8.59128342	9.3723	0	2.135892302	0	2.562228133	3.435669301	0	3.132852376	4.333511839	7.495010211	2.453110344	0	0	0.930336342	4.769355221	11.45256829	0	0	0	0	5.081565913	0	0.007983821	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.994	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 20%"	( 8a) 0 % - 20%	( 8b) 20%			"(3), (5), (9c), (9d) 20%"	"(7a) 20%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 20%, (14a), (14b), (14d), (14e) $0, (16b) 20%, (18a) 20%, (17a), (17b) 0%  - 20%"				"(7e), (7g) 20%, (14b) $0, (14d) $0, (14e) $0, (18a) 20%"	(15) 0% - 20%		(10b) 50%	"(16a) 50%, (16b) 20% - 50%"	"(17a) 20%, (17b) 0%"			(18b) $0													5100	1.2805	0	0.6585	0.5706	0.2905	1.2144	0	0.0004	0.5473	0.2569	1.8011	0	0	0.5448	0.6862	1.7102	0	0	0	2.7452	0.1761	0	0.0047																		12.4874	500	NO	6.681031856	10.6527	0	2.794424976	0.57057066	2.852683149	4.650090704	0	3.13324837	4.880828221	7.751888919	4.254242559	0	0	1.475174238	5.455531964	13.16278207	0	0	0	2.745150417	5.257711202	0	0.012684188	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4814
H5106_017_0	2012	8																															D	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	733.5496851	0	290.7228956	0	185.4707345	12.24932019	0	450.7401735	364.3679937	2719.168955	657.5457336	0	0	223.661965	2650.556096	3355.745428	0	0	0	0	21.18844855	0	0.460695639	0	211.6682116	0			0	0											4000	"(1a), (1b) $200 per day, days 1-4"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $250"	(8a) $0-$25	"(8b) X-Ray and Diag. X-Ray $25 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $35, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $35, (7g) $15-$35, (7h), (7i) $35, (14a), (14b), (14d), (14e) $0, (16b), (18a) $35, (17a), (17b) $0-$35"					(15) 0% - 20%		(10b) $40		"(17a) $35, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	200	0	50	0	100	0.2	0	65	250	25	59.68606083	0	0	35	15	33.88884841	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	184.7186262	0	43.06575893	0	86.38350824	0.184449977	0	62.22350939	240.1432614	24.18727324	58.42019188	0	0	32.97965082	14.834875	33.23769621	0	0	0	0	0.144227389	0	33.84903324		35	0		0	0	0												11.2917	0	1.043350178	0	1.335134394	2.259386823	0	2.337219618	7.291709861	5.48077354	3.201162327	0	0	0.614691126	3.276722363	9.294770591	0	0	0	0	3.055954601	0	0.001299508	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1012		NO	3.598364525	11.2917	0	1.043350178	0	1.335134394	2.259386823	0	2.337219618	7.291709861	5.48077354	3.201162327	0	0	0.614691126	3.276722363	9.294770591	0	0	0	0	3.055954601	0	0.001299508	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1012	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													6000	1.3078	0	0.3661	0.2778	0.1096	0.7286	0	0.0027	0.9245	0.1013	0.7491	0	0	0.6105	0.41	0.974	0	0	0	1.9259	0.147	0	0.0015																		8.6362	500	NO	4.670504672	12.5995	0	1.409437152	0.27778505	1.444757602	2.987960524	0	2.339905769	8.216254304	5.582087977	3.950220367	0	0	1.22514188	3.686713448	10.26875617	0	0	0	1.92585817	3.202909624	0	0.002820445	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7374
H5106_018_0	2012	8																															D	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	931.5475269	0	595.7783828	0	270.4219156	12.16494569	0	541.6213714	423.428746	3228.100641	746.0875114	0	0	279.4122619	3030.955352	4100.014166	0	0	0	0	34.84869728	0	1.816099025	0	211.6682116	0			0	0											4000	"(1a), (1b) $200 per day, days 1-4"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0% - 20%"		(4a) $65	"(9a), (9b) $250"	(8a) $0-$25	"(8b) X-Ray and Diag. X-Ray $25 - $125, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $35, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c), (7d), (7e), (7f) $35, (7g) $15-$35, (7h), (7i) $35, (14a), (14b), (14d), (14e) $0, (16b), (18a) $35, (17a), (17b) $0-$35"					(15) 0% - 20%		(10b) $40		"(17a) $35, (17b) $0"			(18b) $0	(14c) $0	(13d) $0												NO	200	0	50	0	100	0.2	0	65	250	25	57.29072518	0	0	35	15	33.83911163	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	181.7297048	0	34.24018747	0	81.96892449	0.180483863	0	61.68514199	226.6163735	23.94432553	54.76295625	0	0	31.86682254	14.73827226	32.75230918	0	0	0	0	0.118335936	0	30.66202221		35	0		0	0	0												14.1075	0	1.699963627	0	1.847182799	2.195576397	0	2.784165933	7.996323906	6.441224382	3.404829812	0	0	0.741998414	3.7225871	11.19041097	0	0	0	0	4.123853215	0	0.004640439	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8776		NO	7.618042057	14.1075	0	1.699963627	0	1.847182799	2.195576397	0	2.784165933	7.996323906	6.441224382	3.404829812	0	0	0.741998414	3.7225871	11.19041097	0	0	0	0	4.123853215	0	0.004640439	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8776	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b), (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%		"(17a) 30%, (17b) 0%"			(18b) $0													6000	1.3477	0	0.5048	0.782	0.1609	0.9368	0	0.0012	0.9142	0.231	1.4141	0	0	0.3764	0.6014	1.261	0	0	0	2.6456	0.3022	0	0.0015																		11.4807	500	NO	9.412932255	15.4552	0	2.204753043	0.781987802	2.008109516	3.132374618	0	2.785352011	8.910486149	6.672194996	4.818939717	0	0	1.118385246	4.324029332	12.45144991	0	0	0	2.645569943	4.426015614	0	0.006104458	0	0.617365617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3583
H5106_025_0	2012	10																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													4.208498193	0	0.301252211	0.517331914	0	3.026133517	0	0	7.536695663	3.724669551	11.89765088	0	0	5.568803863	0	3.179957269	0	0	0	17.77427099	1.726567323	0	0	0	0	0	0	0	0	0											59.4618	YES	231.3790248	0	23.871548	0	237.6927207	0	0	564.9685714	51.57881416	4.23379246	19.62656812	0	0	16.97348772	3602.652971	4628.426545	0	0	0	77.90128649	29.90155067	0	0.799113328	11.3022	211.6682116	0			0	0											2850	"(1a), (1b) 5%"		(2) 5%	(6) $0	(10a)  $100	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 5%"	(8a) 0% - 5%	"(8b) X-Ray and Diag. X-Ray 5%, Therapeutic Services 0%"			"(3) $0, (5) 5%, (9c) 5%, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c) 5%, (7d) $25, (7e), (7f) 5%, (7g) $15-$25, (7h) $25, (7i) 5%, (14a), (14b), (14d), (14e) $0, (16b) 5%, (18a) $0, (17a), (17b) $0-$25"				"(7g) 5%, (14b), (14e) $0, (18a) $25"	(15) 0% - 5%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0											1100	NO	0.05	0	0.05	0	100	0	0	65	0.05	0.05	0.05	0	0	0.05	15	24.41471829	0	0	0	0.05	0.05	0	40	0.3	25	0		0	0	0											NO	0.037415265	0	0.02951945	0	73.79369632	0	0	58.7661358	0.044637834	0.044338899	0.044383931	0	0	0.043092677	14.51525596	23.30293448	0	0	0	0.04087886	0.034005079	0	30.73001159	0.3	25	0		0	0	0												8.6571	0	0.704674968	0	1.461685371	0	0	2.766751649	2.302366525	0.187721698	0.871104236	0	0	0.731433023	4.357785835	8.987993377	0	0	0	3.18451575	1.016804585	0	0.002046397	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0636		NO	6.505122528	12.8656	0	1.00592718	0.517331914	1.461685371	3.026133517	0	2.766751649	9.839062187	3.912391249	12.76875511	0	0	6.300236887	4.357785835	12.16795065	0	0	0	20.95878674	2.743371908	0	0.002046397	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5255	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b) 30%-50%, (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%	"(16a) 50%, (16b) 30% - 50%"	"(17a) 30%, (17b) 0%"			(18b) $0													5100	1.5121	0	0.5202	0.3339	0.0929	0.8255	0	0.0047	1.0223	0.1112	0.8382	0	0	0.6204	0.4371	1.0882	0	0	0	1.9819	0.2132	0	0.0015																		9.6032		NO	7.85680616	14.3777	0	1.526158724	0.851182886	1.554564938	3.851671322	0	2.771410992	10.86137413	4.023542834	13.60692263	0	0	6.920657884	4.794852977	13.25618624	0	0	0	22.94069713	2.956554345	0	0.003520677	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1287
H5106_026_0	2012	11																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	V	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													4.69975634	0	0.432312876	0.583958101	0	3.43277288	0	0	5.704042084	4.233378628	12.06945025	0	0	5.048788077	0	3.292675135	0	0	0	17.96491911	1.929157433	0	0	0	0	0	0	0	0	0											59.3912	YES	254.2838375	0	43.25898423	0	274.6748047	0	0	535.7044926	45.21700132	5.864584033	21.32025968	0	0	18.05202057	3356.935905	4663.042375	0	0	0	73.82721326	45.02847894	0	2.430344426	11.3022	211.6682116	0			0	0											2850	"(1a), (1b) 5%"		(2) 5%	(6) $0	(10a)  $100	"(11a), (11b), (11c) $0"		(4a) $65	"(9a), (9b) 5%"	(8a) 0% - 5%	"(8b) X-Ray and Diag. X-Ray 5%, Therapeutic Services 0%"			"(3) $0, (5) 5%, (9c) 5%, (9d) $0"	"(7a) $15, (14a), (14d), (14e) $0"	"(4b) $50, (7b) $15, (7c) 5%, (7d) $25, (7e), (7f) 5%, (7g) $15-$25, (7h) $25, (7i) 5%, (14a), (14b), (14d), (14e) $0, (16b) 5%, (18a) $0, (17a), (17b) $0-$25"				"(7g) 5%, (14b), (14e) $0, (18a) $25"	(15) 0% - 5%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			(18b) $0	(14c) $0	(13d) $0											1100	NO	0.05	0	0.05	0	100	0	0	65	0.05	0.05	0.05	0	0	0.05	15	24.4392217	0	0	0	0.05	0.05	0	40	0.3	25	0		0	0	0											NO	0.034399417	0	0.026986758	0	68.81475116	0	0	58.82277924	0.04498691	0.041926329	0.04197322	0	0	0.034377316	14.41966601	22.96371707	0	0	0	0.039044768	0.022920879	0	10.72660742	0.3	25	0		0	0	0												8.7472	0	1.167419754	0	1.575139861	0	0	2.625968925	2.034173182	0.245880478	0.894879947	0	0	0.620580016	4.033824546	8.923398816	0	0	0	2.882566389	1.032092338	0	0.002172446	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6169		NO	9.44902751	13.447	0	1.59973263	0.583958101	1.575139861	3.43277288	0	2.625968925	7.738215266	4.479259105	12.96433019	0	0	5.669368092	4.033824546	12.21607395	0	0	0	20.8474855	2.961249771	0	0.002172446	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0082	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0% - 50%"		(4a) $65	"(9a), (9b) 30%"	( 8a) 0% - 30%	( 8b) 30%			"(3), (5), (9c), (9d) 30%"	"(7a) 30%, (14a), (14d), (14e) $0"	"(4b) $50, (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14a), (14b), (14d), (14e) $0, (16b) 30%-50%, (18a) 30%, (17a), (17b) 0% - 30%"				"(7e), (7g) 30%, (14b) $0, (14d) $0, (14e) $0, (18a) 30%"	(15) 0% - 30%		(10b) 50%	"(16a) 50%, (16b) 30% - 50%"	"(17a) 30%, (17b) 0%"			(18b) $0													5100	1.0858	0	0.3894	0.4572	0.1183	1.0789	0	0.0016	0.9041	0.2104	1.2033	0	0	0.3947	0.5369	1.2138	0	0	0	1.9942	0.1356	0	0																		9.7242		NO	12.20876654	14.5328	0	1.989088049	1.041165825	1.693469949	4.511686539	0	2.627556161	8.642356075	4.689622267	14.1676074	0	0	6.06405573	4.570692009	13.42991175	0	0	0	22.84167675	3.096897285	0	0.002172446	3.39066	0.440975441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7324
H5106_806_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	353.4872456	0	89.74194585	40.10352492	11.67586176	27.60558345	0	32.59629756	74.36473794	15.75166286	28.75123017	0	0	31.95712933	26.45024151	36.16857329	0	0	0	175.2843335	59.53906487	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.084582524		0.18003437		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.071495465		0.152178493		0.189341527	0.189341527		0.189341527	0.189341527	0.189341527	0.189341527			0.189341527	0.189341527	0.189341527				0.189341527	0.189341527																					25.2727	0	13.65679412	0	2.21072549	5.226883314	0	6.171832741	14.08033301	2.982443893	5.443801813	0	0	6.050811655	5.008129107	6.848212882	0	0	0	33.1886033	11.27321744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4145		NO	25.15337072	25.2727	0	13.65679412	0	2.21072549	5.226883314	0	6.171832741	14.08033301	2.982443893	5.443801813	0	0	6.050811655	5.008129107	6.848212882	0	0	0	33.1886033	11.27321744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4145	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	2.1059	0	0.7392	0	0.9508	0.8955	0	0.0072	0.3877	0.1409	0.4194	0	0	0.2858	0.213	0.2912	0	0	0	1.2491	0.1003	0	0	0	0	0	0	0	0	0											7.786		NO	0.570046512	27.3786	0	14.39598792	0	3.161486314	6.122419291	0	6.179052648	14.46803928	3.12332486	5.863217533	0	0	6.336632353	5.221097289	7.139429705	0	0	0	34.43766384	11.37354638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.2005
H5106_807_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	221.4563306	0	56.22245859	25.12446937	7.314814136	17.29463026	0	20.42126424	46.58878699	9.868263994	18.01236682	0	0	20.02083155	16.57081974	22.65926034	0	0	0	109.8139347	37.30064662	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.083619497		0.188156525		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.070681443		0.159043945		0.189341527	0.189341527		0.189341527	0.189341527	0.189341527	0.189341527			0.189341527	0.189341527	0.189341527				0.189341527	0.189341527																					15.6529	0	8.941841618	0	1.384998076	3.274591696	0	3.866593347	8.821192053	1.86847217	3.410489032	0	0	3.79077481	3.137544307	4.290338944	0	0	0	20.79233805	7.062561375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2946		NO	15.79599968	15.6529	0	8.941841618	0	1.384998076	3.274591696	0	3.866593347	8.821192053	1.86847217	3.410489032	0	0	3.79077481	3.137544307	4.290338944	0	0	0	20.79233805	7.062561375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2946	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	1.3043	0	0.484	0	0.5956	0.561	0	0.0045	0.2429	0.0883	0.2628	0	0	0.1791	0.1334	0.1824	0	0	0	0.7825	0.0629	0	0	0	0	0	0	0	0	0											4.8837		NO	0.357558479	16.9571	0	9.425831771	0	1.98064051	3.835636299	0	3.871116549	9.064086269	1.956732729	3.673248912	0	0	3.969838705	3.270966808	4.472783459	0	0	0	21.57486236	7.125416483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1783
H5106_808_0	2012	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	353.4872456	0	89.74194585	40.10352492	11.67586176	27.60558345	0	32.59629756	74.36473794	15.8728369	28.95482465	0	0	31.63236082	26.59981046	36.42435888	0	0	0	174.878979	59.53906487	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e), (16b), (18a), (17a), (17b) FFS"				"(7g), (14b), (14e), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14c)	(13d)												NO	0.084582524		0.18003437		0.224	0.224		0.224	0.224	0.224	0.224			0.224	0.224	0.224				0.224	0.224																				NO	0.071495465		0.152178493		0.189341527	0.189341527		0.189341527	0.189341527	0.189341527	0.189341527			0.189341527	0.189341527	0.189341527				0.189341527	0.189341527																					25.2727	0	13.65679412	0	2.21072549	5.226883314	0	6.171832741	14.08033301	3.00538717	5.482350703	0	0	5.989319488	5.036448721	6.896643717	0	0	0	33.11185285	11.27321744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4145		NO	25.15337072	25.2727	0	13.65679412	0	2.21072549	5.226883314	0	6.171832741	14.08033301	3.00538717	5.482350703	0	0	5.989319488	5.036448721	6.896643717	0	0	0	33.11185285	11.27321744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4145	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		(4a) FFS	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d)"	"(7a), (14a), (14d), (14e) FFS"	"(4b), (7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14a), (14b), (14d), (14e) , (16b), (18a), (17a), (17b) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)													10000	2.1059	0	0.7392	0	0.9508	0.8955	0	0.0072	0.3877	0.1141	0.4187	0	0	0.3546	0.181	0.2364	0	0	0	1.2946	0.1003	0	0	0	0	0	0	0	0	0											7.786		NO	0.570046512	27.3786	0	14.39598792	0	3.161486314	6.122419291	0	6.179052648	14.46803928	3.119449036	5.901055649	0	0	6.343940832	5.217462983	7.133030116	0	0	0	34.40642696	11.37354638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.2005
H5151_002_0	2012	7																															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	1994.028213	70.30577441	1710.352243	2376.4	403.2	15.47036864	0	431.8	336.6	15425.8	1213	198.5	30.8	6217	3675.7	3247.6	214.2	39.3	828.6	0	17.07970229	0	0	0.4	203.1	155.1	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												23.6999	0.835613423	11.61614232	0	3.423	2.521670088	0	1.906217083	5.7151875	10.47668917	4.491769949	0	0.024612396	0	0	7.577550656	0.50917125	0.093419375	0	0	2.6447919	0	0	0	0.482785625	0.158008125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1765	0	NO	17.29159476	23.6999	0.835613423	11.61614232	0	3.423	2.521670088	0	1.906217083	5.7151875	10.47668917	4.491769949	0	0.024612396	0	0	7.577550656	0.50917125	0.093419375	0	0	2.6447919	0	0	0	0.482785625	0.158008125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1765	NO																																																																																		0	0	NO	0	23.6999	0.835613423	11.61614232	0	3.423	2.521670088	0	1.906217083	5.7151875	10.47668917	4.491769949	0	0.024612396	0	0	7.577550656	0.50917125	0.093419375	0	0	2.6447919	0	0	0	0.482785625	0.158008125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1765
H5151_004_0	2012	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	1642.671775	56.7755523	1256.639444	1799.1	350.1	11.11863173	0	376.4	287.6	12285.3	1032.6	169.9	22.5	4501.8	3171.5	2961.9	116.3	33	623.3	0	8.784974794	0	0	0	163.9	129	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												19.5238	0.674801096	8.534676221	0	2.972203125	1.812336972	0	1.661649167	4.883208333	8.34376625	3.823744146	0	0.017979835	0	0	6.910933393	0.276454792	0.07844375	0	0	1.360353347	0	0	0	0.389603958	0.13141875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3954	0	NO	13.93638178	19.5238	0.674801096	8.534676221	0	2.972203125	1.812336972	0	1.661649167	4.883208333	8.34376625	3.823744146	0	0.017979835	0	0	6.910933393	0.276454792	0.07844375	0	0	1.360353347	0	0	0	0.389603958	0.13141875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3954	NO																																																																																		0	0	NO	0	19.5238	0.674801096	8.534676221	0	2.972203125	1.812336972	0	1.661649167	4.883208333	8.34376625	3.823744146	0	0.017979835	0	0	6.910933393	0.276454792	0.07844375	0	0	1.360353347	0	0	0	0.389603958	0.13141875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3954
H5151_006_0	2012	7																															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	2014.223166	74.07794708	1733.373612	2376.4	403.2	15.47036864	0	431.8	340.3	15550.3	1222.8	200.1	31.1	6267.2	3697.5	3266.8	215.4	39.5	833.5	0	17.07970229	0	0	0	203.1	155.1	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	100	100	75	$0.00 	125	20%	20%	$65.00 	$175.00 	$5.00 	48.02307506	$0.00 	11.76594525	0	0	34.355	$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	85.7	85.7	64.275	0	107.125	0.1714	0.1714	55.705	149.975	4.285	41.15577533	0	10.08341508	0	0	29.442235	29.995	29.995	0	0	0.16283	0	0	0	29.995	12.855	0	0	0	0												14.3849	0.529040005	9.284382408	0	3.5994	2.651621185	0	2.004451583	4.253041042	5.552752958	4.193773506	0	0.026132851	0	0	8.015157775	0.53841025	0.098733542	0	0	2.781087924	0	0	0	0.507665375	0.166150875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5867	0	NO	9.775845714	14.3849	0.529040005	9.284382408	0	3.5994	2.651621185	0	2.004451583	4.253041042	5.552752958	4.193773506	0	0.026132851	0	0	8.015157775	0.53841025	0.098733542	0	0	2.781087924	0	0	0	0.507665375	0.166150875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5867	NO																																																																																		0	0	NO	0	14.3849	0.529040005	9.284382408	0	3.5994	2.651621185	0	2.004451583	4.253041042	5.552752958	4.193773506	0	0.026132851	0	0	8.015157775	0.53841025	0.098733542	0	0	2.781087924	0	0	0	0.507665375	0.166150875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5867
H5151_802_0	2012	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	YES	1616.668539	56.94682093	1386.642464	1926.6	326.9	12.5427063	0	350.1	272.9	12506.6	983.5	160.9	25	5040.5	2980.1	2633	173.6	31.9	671.8	0	13.84748448	0	0	0	164.7	125.8	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												19.2148	0.676836695	9.417613404	0	2.775244792	2.044461127	0	1.545545625	4.633614583	8.494065833	3.641925594	0	0.019977595	0	0	6.14351856	0.412661667	0.075828958	0	0	2.144282971	0	0	0	0.391505625	0.12815875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.76	0	NO	14.01914586	19.2148	0.676836695	9.417613404	0	2.775244792	2.044461127	0	1.545545625	4.633614583	8.494065833	3.641925594	0	0.019977595	0	0	6.14351856	0.412661667	0.075828958	0	0	2.144282971	0	0	0	0.391505625	0.12815875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.76	NO																																																																																		0	0	NO	0	19.2148	0.676836695	9.417613404	0	2.775244792	2.044461127	0	1.545545625	4.633614583	8.494065833	3.641925594	0	0.019977595	0	0	6.14351856	0.412661667	0.075828958	0	0	2.144282971	0	0	0	0.391505625	0.12815875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.76
H5151_803_0	2012	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	YES	1301.234096	52.49383644	691.9388216	1194.8	212.2	11.02995404	0	351	367.7	14975.6	1195.4	319.4	4.7	5538.8	3408.6	3448.3	121.2	45.1	809.8	0	14.05086832	0	0	0	257.4	207.6	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												15.4657	0.623911118	4.69941783	0	1.801489583	1.797882508	0	1.54951875	6.243239583	10.17092833	4.4265967	0	0.003755788	0	0	8.045839366	0.2881025	0.107206458	0	0	2.175776959	0	0	0	0.61186125	0.2114925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2227	0	NO	13.21620221	15.4657	0.623911118	4.69941783	0	1.801489583	1.797882508	0	1.54951875	6.243239583	10.17092833	4.4265967	0	0.003755788	0	0	8.045839366	0.2881025	0.107206458	0	0	2.175776959	0	0	0	0.61186125	0.2114925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2227	NO																																																																																		0	0	NO	0	15.4657	0.623911118	4.69941783	0	1.801489583	1.797882508	0	1.54951875	6.243239583	10.17092833	4.4265967	0	0.003755788	0	0	8.045839366	0.2881025	0.107206458	0	0	2.175776959	0	0	0	0.61186125	0.2114925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2227
H5162_004_0	2012	9																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	931.6392902	52.40223413	1229.494483		114.3459922	5.650199862	7.008849459	190.4036163	25.60140866		10.69195101	12.43614746		272.3533648	1865.089237	3700.550916	1.790303245	437.8424912			17.44186938	0.018719006			123.0824009		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.188460339	65	0.081071812		0.15	29		76.05032479	10.65713203	29.07348226	0.37963325	30			0.2	0.366902975			30		30														NO	60.38478366	66.95395534	44.31470114		128.6819051	0.171575873	0.161676237	55.76215886	0.069549835		0.128681905	24.87850164		65.2420045	9.142533682	24.94154056	0.325679533	25.73638101			0.171575873	0.314758492			30		30															4.6881	0.29237807	4.540390046	0	1.226188342	0.969437976	1.133164404	0.884776392	1.780573753	0	1.375860625	0.025782726	0	1.480739954	1.420970097	7.691453395	0.583065124	0.939040098	0	0	2.992603973	0.005891966	0	0	0.307706002	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7738	0		5.30631579	4.6881	0.29237807	4.540390046	0	1.226188342	0.969437976	1.133164404	0.884776392	1.780573753	0	1.375860625	0.025782726	0	1.480739954	1.420970097	7.691453395	0.583065124	0.939040098	0	0	2.992603973	0.005891966	0	0	0.307706002	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7738	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.3881	0.1768	3.3233		0.7785	0.577	0.6535	0.4213	2.0917		0.8736	0.0884		0.9165	1.6705	5.1724	0.3872	0.6184			1.425	0.003			0.176		0.249														23.9902	0		3.903933595	9.0762	0.469175089	7.863700116	0	2.004720623	1.546484391	1.786621026	1.306098483	3.872280444	0	2.249422926	0.114165503	0	2.39726436	3.091479698	12.86385712	0.970257783	1.557409677	0	0	4.417653484	0.008862705	0	0	0.483684827	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	56.764
H5162_006_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	909.4559747	55.58842019	1155.594437		105.5581445	7.536589617	10.16564888	231.8524772	26.18896549		10.55871732	19.67687147		331.943305	1832.921761	3743.204009	1.581272202	378.7024593			18.40199753	0.008532588			123.8340755		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.190674648	65	0.081071812		0.15	29		81.59186169	10.02327333	28.92142657	0.376164138	30			0.2	0.365079675			30		30														NO	59.97795738	66.50287103	44.01614273		127.8149452	0.170419927	0.162473798	55.38647627	0.069081262		0.127814945	24.71088941		69.52439556	8.540827542	24.64393702	0.320529325	25.56298905			0.170419927	0.311084258			30		30															4.5456	0.308065795	4.23873414	0	1.124325705	1.284385052	1.651651584	1.070124311	1.809166781	0	1.349561876	0.040519416	0	1.923179803	1.304555722	7.687273654	0.506844111	0.806730568	0	0	3.136067076	0.002654354	0	0	0.309585189	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5348	0		5.691319792	4.5456	0.308065795	4.23873414	0	1.124325705	1.284385052	1.651651584	1.070124311	1.809166781	0	1.349561876	0.040519416	0	1.923179803	1.304555722	7.687273654	0.506844111	0.806730568	0	0	3.136067076	0.002654354	0	0	0.309585189	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5348	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.2547	0.1863	3.1025		0.7139	0.7645	0.9586	0.5096	2.1253		0.8569	0.1605		1.1653	1.6417	5.174	0.3397	0.5288			1.4934	0.0013			0.1772		0.249														24.4033	0		4.16173279	8.8003	0.494348966	7.341249059	0	1.838183295	2.048899964	2.610291744	1.579707316	3.934462774	0	2.20642656	0.20100079	0	3.088503392	2.946261477	12.86127903	0.846525153	1.335551602	0	0	4.62943235	0.00400341	0	0	0.486827333	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9381
H5162_016_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1013.136348	62.04961357	798.0606667		101.0357697	7.665722921	11.52755442	237.4718322	26.11548311		11.49618738	8.196646331		235.1873378	2088.18712	3375.298938	1.338497173	342.9356144			18.68519962	0.01018577			122.6008844		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.19273714	65	0.081071812		0.15	29		64.79208142	10.04484639	29.32415561	0.377637845	30			0.2	0.459901396			30		30														NO	60.76433159	67.37479373	44.59324073		129.4907338	0.172654312	0.166384491	56.11265132	0.06998699		0.129490734	25.0348752		55.93316112	8.671430199	25.31470952	0.326004011	25.89814676			0.172654312	0.397019795			30		30															5.1302	0.34838166	2.965675952	0	1.09026633	1.323520115	1.918006273	1.110431177	1.827744054	0	1.48864974	0.017100168	0	1.096230938	1.508964071	7.120392679	0.436355447	0.740116406	0	0	3.22608028	0.004043952	0	0	0.306502211	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0944	0		4.965683813	5.1302	0.34838166	2.965675952	0	1.09026633	1.323520115	1.918006273	1.110431177	1.827744054	0	1.48864974	0.017100168	0	1.096230938	1.508964071	7.120392679	0.436355447	0.740116406	0	0	3.22608028	0.004043952	0	0	0.306502211	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0944	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.8019	0.2107	2.1707		0.6922	0.7878	1.1198	0.5288	2.1471		0.9452	0.138		0.6558	1.8957	4.7943	0.2913	0.4898			1.5362	0.002			0.1752		0.249														23.6315	0		3.675494615	9.9321	0.559043283	5.1363839	0	1.78249892	2.111329707	3.037764926	1.639207927	3.974863465	0	2.433824178	0.155087633	0	1.752037757	3.404622565	11.91469053	0.727654575	1.229897328	0	0	4.762308985	0.00608919	0	0	0.481671765	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7259
H5162_017_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1004.014775	41.62507339	932.931217		107.158488	6.913576039	8.511243231	195.4902702	27.07421914		7.374224402	13.05359725		173.0167691	1832.186143	3497.178013	1.526375941	338.2064096			16.85184159	0.008453311			122.5094162		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.191042669	65	0.081071812		0.15	29		72.26863091	10.03912397	29.50391227	0.379865429	30			0.2	0.404454922			30		30														NO	61.29166614	67.95949623	44.98023679		130.6145006	0.174152667	0.166352952	56.59961693	0.070594362		0.130614501	25.25213678		62.92887424	8.741701089	25.69092512	0.330772888	26.12290012			0.174152667	0.352184518			30		30															5.1281	0.235734918	3.496955587	0	1.166371034	1.204017709	1.415870433	0.9220562	1.911287227	0	0.963180638	0.027469269	0	0.907312542	1.334701967	7.48714487	0.504883779	0.736244355	0	0	2.934793166	0.002977125	0	0	0.30627354	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1212	0		4.508801912	5.1281	0.235734918	3.496955587	0	1.166371034	1.204017709	1.415870433	0.9220562	1.911287227	0	0.963180638	0.027469269	0	0.907312542	1.334701967	7.48714487	0.504883779	0.736244355	0	0	2.934793166	0.002977125	0	0	0.30627354	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1212	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.8	0.1425	2.5596		0.7406	0.7167	0.8226	0.4391	2.2453		0.6115	0.2606		0.5514	1.6773	5.0359	0.3351	0.4856			1.3975	0.0015			0.175		0.249														23.2467	0		3.387296399	9.9281	0.378280598	6.056530337	0	1.906924071	1.920694917	2.238515886	1.361130582	4.156547934	0	1.5747239	0.288051985	0	1.458709476	3.012000125	12.52303332	0.839954084	1.221835954	0	0	4.332313721	0.004485111	0	0	0.481289366	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3679
H5162_018_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	1002.463634	48.27129584	1079.753433		131.6028582	7.750885994	11.15501293	241.313948	26.18382856		10.54291218	3.218646658		233.0733756	2082.796505	3580.734423	0.982287712	380.766934			16.26833884	0.005250909			125.4113727		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.190413705	65	0.081071812		0.15	29		88.43055571	10.0052651	29.41706237	0.413653765	30			0.2	0.350305899			30		30														NO	60.0986068	66.63664572	44.10468395		128.072053	0.170762737	0.162577827	55.49788963	0.069220223		0.128072053	24.76059691		75.50321878	8.542632278	25.11669047	0.353183246	25.6144106			0.170762737	0.299095971			30		30															5.0206	0.268053103	3.968515326	0	1.404554019	1.323562509	1.813557765	1.116034571	1.812450454	0	1.350252408	0.006641301	0	1.466482506	1.482713721	7.49468318	0.346927563	0.812760049	0	0	2.778026072	0.001570526	0	0	0.313528432	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2166	0		5.558918672	5.0206	0.268053103	3.968515326	0	1.404554019	1.323562509	1.813557765	1.116034571	1.812450454	0	1.350252408	0.006641301	0	1.466482506	1.482713721	7.49468318	0.346927563	0.812760049	0	0	2.778026072	0.001570526	0	0	0.313528432	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2166	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.6993	0.1621	2.9047		0.8918	0.7878	1.0518	0.5314	2.1292		0.8573	0.0452		0.9095	1.8682	5.0381	0.2114	0.5339			1.3229	0.0008			0.1799		0.249														24.3743	0		4.09951786	9.7199	0.430141148	6.873245275	0	2.296334349	2.111397336	2.86535113	1.647479605	3.941603901	0	2.207555524	0.051847733	0	2.375970965	3.350921276	12.5327478	0.558362191	1.346656831	0	0	4.10089563	0.002362388	0	0	0.493421495	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5909
H5206_002_0	2012	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	533.7375624		275.6057335		29.03817417	55.44462254		72.50108285	33.08693244					151.5751668						282.1949464	77.44085541	0.293437826																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.085583615		0.165377064		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.085583615		0.165377064		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																				45.6792	0	45.57886712	0	6.504551015	12.41959545	0	16.24024256	7.411472866	0	0	0	0	33.95283736	0	0	0	0	0	63.211668	17.34675161	0.065730073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	248.4109	0		0	45.6792	0	45.57886712	0	6.504551015	12.41959545	0	16.24024256	7.411472866	0	0	0	0	33.95283736	0	0	0	0	0	63.211668	17.34675161	0.065730073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	248.4109	NO																																																																																		0	0		0	45.6792	0	45.57886712	0	6.504551015	12.41959545	0	16.24024256	7.411472866	0	0	0	0	33.95283736	0	0	0	0	0	63.211668	17.34675161	0.065730073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	248.4109
H5206_003_0	2012	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	569.0951757		172.3616204		45.24320354	100.7581935		90.22934689	70.78582499					199.7307626						402.9988863	84.54701714	0.137529346																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.080342287		0.132979808		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.080342287		0.132979808		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																				45.7224	0	22.92061524	0	10.13447759	22.56983534	0	20.2113737	15.8560248	0	0	0	0	44.73969083	0	0	0	0	0	90.27175052	18.93853184	0.030806573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	291.3955	0		0	45.7224	0	22.92061524	0	10.13447759	22.56983534	0	20.2113737	15.8560248	0	0	0	0	44.73969083	0	0	0	0	0	90.27175052	18.93853184	0.030806573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	291.3955	NO																																																																																		0	0		0	45.7224	0	22.92061524	0	10.13447759	22.56983534	0	20.2113737	15.8560248	0	0	0	0	44.73969083	0	0	0	0	0	90.27175052	18.93853184	0.030806573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	291.3955
H5207_001_0	2012	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	786.9646137	29.46670224	482.7041391	0	44.70078657	43.82014096	32.38147924	29.97662403	66.17790137	19.42041891	46.93858052	0	20.92816327	149.1360587	58.72598547	90.75361075	5.808884478	10.61641703	31.95406298	165.5414201	137.9880798	15.15164592	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 13e:  Home Modification											0	NO	0.080244667	0.080244667	0.16299472	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080244667	0.080244667	0.16299472	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												63.1497	2.364545719	78.67822604	0	10.01297619	9.815711574	7.253451349	6.714763783	14.82384991	4.350173836	10.51424204	0	4.687908572	33.40647714	13.15462075	20.32880881	1.301190123	2.378077416	7.157710107	37.08127811	30.90932988	3.393968686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	361.477	0	NO	0	63.1497	2.364545719	78.67822604	0	10.01297619	9.815711574	7.253451349	6.714763783	14.82384991	4.350173836	10.51424204	0	4.687908572	33.40647714	13.15462075	20.32880881	1.301190123	2.378077416	7.157710107	37.08127811	30.90932988	3.393968686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	361.477	NO																																										0	0	0	0	0	0	0	0	0	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	63.1497	2.364545719	78.67822604	0	10.01297619	9.815711574	7.253451349	6.714763783	14.82384991	4.350173836	10.51424204	0	4.687908572	33.40647714	13.15462075	20.32880881	1.301190123	2.378077416	7.157710107	37.08127811	30.90932988	3.393968686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	361.477
H5209_002_0	2012	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	YES	756.2219164		184.3033832		51.36775086	123.8211036		61.05958809	82.94156003					168.4237326						485.4655224	161.9108495	3.30764595																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.079434778		0.151826237		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.079434778		0.151826237		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																				60.0703	0	27.98208919	0	11.50637619	27.7359272	0	13.67734773	18.57890945	0	0	0	0	37.72691611	0	0	0	0	0	108.744277	36.2680303	0.740912693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	343.0311	0		0	60.0703	0	27.98208919	0	11.50637619	27.7359272	0	13.67734773	18.57890945	0	0	0	0	37.72691611	0	0	0	0	0	108.744277	36.2680303	0.740912693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	343.0311	NO																																																																																		0	0		0	60.0703	0	27.98208919	0	11.50637619	27.7359272	0	13.67734773	18.57890945	0	0	0	0	37.72691611	0	0	0	0	0	108.744277	36.2680303	0.740912693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	343.0311
H5211_001_0	2012	12																															D		D			Coin	Coin	V			V					V	V		V								V																																																						0	Yes	1379.523637		2749.140162			4.876419275	6.306810309	306.7043414			134.0385164					4221.084295	68.25420856		360.0170942						0		13.17733798														900	$50 per days 1-5 per admit for IP Acute & IP Mental (see PBP notes for additional information); PBP 1a & 1b	in line a1	$100 per days 15-25 per admit; PBP 2	No Cost Sharing	No Cost Sharing	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 0%-20% Coinsurance for Supplies (0% for wound, urinary, & ostomy supplies); PBP 11b"	$50/Visit for OP ER; PBP 4a	No Cost Sharing	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 4b (if spec), 7b, 7d, 7f, 7g (if spec), 13D"	"$20/Visit for Mental Health (MH); PBP 7e, 7h"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	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 Hearing Exams; PBP 18a	No Cost Sharing	No Cost Sharing	No Cost Sharing													35.2024886		21.76065911			0.201005025	0.201005025	50.06577117			81.53179726					20.02857734	20.03209645		93.25185061						0		20.03209645														Yes	28.39875328		12.48556776			0.156175282	0.16930493	45.01919282			72.60536551					19.09014617	18.44718334		81.25136142						0		19.70749754														5000	3.2647	0	2.860381316	0	0	0.761576154	1.067774079	1.150631824	0	0	0.810992956	0	0	0	0	6.715093014	0.104924825	0	2.437656586	0	0	0	0	0	0	0	0.02164103	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1954	0	NO	3.972765894	3.2647	0	2.860381316	0	0	0.761576154	1.067774079	1.150631824	0	0	0.810992956	0	0	0	0	6.715093014	0.104924825	0	2.437656586	0	0	0	0	0	0	0	0.02164103	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1954	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												1.0122		0.4243	0.0547		0.0447			0.1775					0.2788						0.9885	0.018	0					0.0048														3.0033	5000	NO	0	4.2769	0	3.284675205	0.054701732	0	0.806231701	1.067774079	1.150631824	0.177472153	0	0.810992956	0	0	0.278773586	0	6.715093014	0.104924825	0	2.437656586	0.988496444	0.017973917	0	0	0	0	0	0.026403228	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1987
H5211_002_0	2012	13																															D		D		T	Coin	Coin	V	V		V					V	V		V								V																																																						0	YES	796.0338438		798.5835649		74.63560552	3.292216263	3.866092216	219.83485	290.1820516		134.0975112					3560.852423	57.36428481		265.7246416						0		15.71992733														3400	$300 per days 1-5 per admit for IP Acute & IP Mental (see PBP notes for additional information); PBP 1a & 1b	in line 1a	$100 per days 15-45 per admit; PBP 2	No Cost Sharing	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 0%-20% Coinsurance for Supplies (0% for wound, urinary, & ostomy supplies); PBP 11b"	$50/Visit for OP ER; PBP 4a	"$250/Case for OP Surgery (excluding colonscopies and other minor surgeries; see PBP for more information); PBP 9a, 9b"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"$20/Visit for Specialist excl. MH; PBP 4b (if spec), 7b, 7d, 7f, 7g (if spec), 13D"	"$20/Visit for Mental Health (MH); PBP 7e, 7h"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	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 Hearing Exams; PBP 18a	No Cost Sharing	No Cost Sharing	No Cost Sharing													201.0128492		34.39884857		150.105666	0.201005025	0.201005025	50.042225	187.190826		82.29519117					20.02878468	20.03209645		95.39171656						0		20.03209645														YES	184.9226809		27.94153761		141.3802806	0.191928568	0.197451024	48.90986763	184.3485864		80.53426001					19.85334936	19.8383268		91.89544261						0		20.03209645														5000	12.2671	0	1.85947106	0	0.879333571	0.631870353	0.763363867	0.896007785	4.457887585	0	0.899953653	0	0	0	0	5.891237266	0.094834286	0	2.034906963	0	0	0	0	0	0	0	0.026241925	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7022	0	NO	1.857991189	12.2671	0	1.85947106	0	0.879333571	0.631870353	0.763363867	0.896007785	4.457887585	0	0.899953653	0	0	0	0	5.891237266	0.094834286	0	2.034906963	0	0	0	0	0	0	0	0.026241925	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7022	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												0.648		0.1204	0.017		0.0301			0.1733					0.3109						0.7272	0.0153	0.004					0.0056														2.0518	5000	NO	0	12.9151	0	1.979846471	0.016975787	0.879333571	0.661934283	0.763363867	0.896007785	4.631210088	0	0.899953653	0	0	0.310921205	0	5.891237266	0.094834286	0	2.034906963	0.727223991	0.015304419	0.003977535	0	0	0	0	0.031861694	0	0	0	0	0	0	0	0	0	0	0	0	0	32.754
H5211_003_0	2012	12																															D		D		T	Coin	Coin	V	V		V					V	V		V								V																																																						0	YES	683.2327426		814.1760314		96.21082741	2.525770043	2.966044489	213.4678328	240.1900013		106.8713647					2990.176935	48.1708706		223.1386196						0		11.31640928														3400	$300 per days 1-5 per admit for IP Acute & IP Mental (see PBP notes for additional information); PBP 1a & 1b	in line 1a	$100 per days 15-45 per admit; PBP 2	No Cost Sharing	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 0%-20% Coinsurance for Supplies (0% for wound, urinary, & ostomy supplies); PBP 11b"	$50/Visit for OP ER; PBP 4a	"$250/Case for OP Surgery (excluding colonscopies and other minor surgeries; see PBP for more information); PBP 9a, 9b"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"$20/Visit for Specialist excl. MH; PBP 4b (if spec), 7b, 7d, 7f, 7g (if spec), 13D"	"$20/Visit for Mental Health (MH); PBP 7e, 7h"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	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 Hearing Exams; PBP 18a	No Cost Sharing	No Cost Sharing	No Cost Sharing													201.0128492		34.39884857		150.105666	0.201005025	0.201005025	50.042225	187.190826		82.29519117					20.02878468	20.03209645		95.39171656						0		20.03209645														YES	184.9226809		27.94153761		141.3802806	0.191928568	0.197451024	48.90986763	184.3485864		80.53426001					19.85334936	19.8383268		91.89544261						0		20.03209645														5000	10.5288	0	1.895777517	0	1.133526148	0.484767428	0.585648521	0.870056954	3.689890601	0	0.717233856	0	0	0	0	4.947085611	0.079635789	0	1.708785184	0	0	0	0	0	0	0	0.01889095	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6601	0	NO	1.613376994	10.5288	0	1.895777517	0	1.133526148	0.484767428	0.585648521	0.870056954	3.689890601	0	0.717233856	0	0	0	0	4.947085611	0.079635789	0	1.708785184	0	0	0	0	0	0	0	0.01889095	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6601	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												0.6303		0.1574	0.0231		0.0246			0.1748					0.2741						0.7541	0.0089	0					0.0046														2.0518	5000	NO	0	11.1591	0	2.053216967	0.023088785	1.133526148	0.509354451	0.585648521	0.870056954	3.864665065	0	0.717233856	0	0	0.274084396	0	4.947085611	0.079635789	0	1.708785184	0.754109913	0.00885756	0	0	0	0	0	0.023459941	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7119
H5211_004_0	2012	13																															D		D			Coin	Coin	V			V					V	V		V								V																																																						0	Yes	1210.180102		1997.53561			5.527691563	7.149119091	275.5284562			144.8295145					4460.065852	72.11849932		380.3998773						0		16.29123474														900	$50 per days 1-5 per admit for IP Acute & IP Mental (see PBP notes for additional information); PBP 1a & 1b	in line a1	$100 per days 15-25 per admit; PBP 2	No Cost Sharing	No Cost Sharing	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 0%-20% Coinsurance for Supplies (0% for wound, urinary, & ostomy supplies); PBP 11b"	$50/Visit for OP ER; PBP 4a	No Cost Sharing	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 4b (if spec), 7b, 7d, 7f, 7g (if spec), 13D"	"$20/Visit for Mental Health (MH); PBP 7e, 7h"	No Cost Sharing	"$100/Day for each of outpatient MRI, CT, PET Scans; PBP 8b (taken on facility or professional bill whichever is first; any remaining copay taken on the second bill)"	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 Hearing Exams; PBP 18a	No Cost Sharing	No Cost Sharing	No Cost Sharing													35.2024886		21.76065911			0.201005025	0.201005025	50.06577117			81.53179726					20.02857734	20.03209645		93.25185061						0		20.03209645														Yes	28.39875328		12.48556776			0.156175282	0.16930493	45.01919282			72.60536551					19.09014617	18.44718334		81.25136142						0		19.70749754														5000	2.864	0	2.078363851	0	0	0.863288787	1.210381108	1.033672392	0	0	0.876283319	0	0	0	0	7.095275751	0.110865265	0	2.575667326	0	0	0	0	0	0	0	0.026754956	0	0	0	0	0	0	0	0	0	0	0	0	0	18.7345	0	NO	3.877379878	2.864	0	2.078363851	0	0	0.863288787	1.210381108	1.033672392	0	0	0.876283319	0	0	0	0	7.095275751	0.110865265	0	2.575667326	0	0	0	0	0	0	0	0.026754956	0	0	0	0	0	0	0	0	0	0	0	0	0	18.7345	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												0.9467		0.3172	0.0385		0.0534			0.2179					0.3059						1.0908	0.0226	0.0042					0.0062														3.0033	5000	NO	0	3.8107	0	2.395565608	0.038514202	0	0.916676218	1.210381108	1.033672392	0.217869257	0	0.876283319	0	0	0.305915926	0	7.095275751	0.110865265	0	2.575667326	1.090781843	0.02256838	0.004197324	0	0	0	0	0.032919209	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7378
H5211_005_0	2012	12																																																																																																															0	NO																																										no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing																																																					YES																																									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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												1.3415		0.494	0.0565		0.1105			0.2708					0.4883						1.5257	0.0327	0.0041							0.006												4.3301	5000	NO	0	1.3415	0	0.493952327	0.056520711	0	0.110505576	0	0	0.270778243	0	0	0	0	0.488279988	0	0	0	0	0	1.525692997	0.032727791	0.004072258	0	0	0	0	0	0	0.005997509	0	0	0	0	0	0	0	0	0	0	0	4.3301
H5211_006_0	2012	11																																																																																																															0	NO																																										no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing																																																					YES																																									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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	5000 deductible (lines a1 & a2)	5000 deductible in line a1	5000 deductible	5000 deductible	no out-of-network benefit	5000 deductible (lines e1 & e2)	5000 deductible in line e1	no out-of-network benefit	5000 deductible	5000 deductible in line h5; coumadin plan paid at 100%	5000 deductible in line h5	5000 deductible in line h5	5000 deductible in line h5	"5000 deductible (lines h1, h2, h3, h4, & h5)"	5000 deductible in line i6; $0 preventive services plan paid at 100%	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	5000 deductible in line i6	"5000 deductible (lines i1, i2, i3, i4, i5, & i6)"	5000 deductible	5000 deductible	no out-of-network benefit	no out-of-network benefit	plan paid at 100%	no out-of-network benefit	5000 deductible	no out-of-network benefit	no out-of-network benefit	no out-of-network benefit												1.5147		0.6709	0.0578		0.072			0.2304					0.4216						1.3342	0.0242	0							0.0042												4.3301	5000	NO	0	1.5147	0	0.670923191	0.057834444	0	0.072000919	0	0	0.230371247	0	0	0	0	0.421557459	0	0	0	0	0	1.334221529	0.024221121	0	0	0	0	0	0	0	0.004216895	0	0	0	0	0	0	0	0	0	0	0	4.3301
H5214_003_0	2012	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	1284.92	82.79	319.62	1195.71	28.06	11.75	5.07	352.66	396.51	760.01	964.9	186.22	0.21	7.32	2943.86	5034.24	83.7	961.45		1961.5	28.11	0			0.61				4.14	0.81	1296.33	415.93									4900	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											182.210147	129.289607	38.216144	0	200	0.2	0.2	65	250	48.113297	103.870769	44.040089	0.2	0.2	15	39.008525	40	15		0	0.2	0			0				0	0	0	94.964364									NO	140.483113	99.681641	30.017405	0	177.6876	0.177688	0.177688	57.74847	222.1095	42.745681	92.282738	39.126889	0.177688	0.177688	13.32657	34.656656	35.53752	13.32657		0	0.177688	0			0				0	0	0	84.36995										15.0425	0.687720255	0.799513582	0	0.415492838	2.087834	0.90087816	1.697131286	7.339053154	2.707262085	7.420301158	0.607184106	0.03731448	1.30067616	3.269296363	14.53916033	0.247874202	1.067735894	0	0	4.99480968	0	0	0	0	0	0	0	0	0	0	2.924332775	0	0	0	0	0	0	0	0	68.086	0	NO	11.364405	15.0425	0.687720255	0.799513582	0	0.415492838	2.087834	0.90087816	1.697131286	7.339053154	2.707262085	7.420301158	0.607184106	0.03731448	1.30067616	3.269296363	14.53916033	0.247874202	1.067735894	0	0	4.99480968	0	0	0	0	0	0	0	0	0	0	2.924332775	0	0	0	0	0	0	0	0	68.086	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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									25% Coins	30% Coins									7300	4.9394	0.1108	0.3203	3.4694	3.7859	0.7596	0.3281	0.2208	2.6634	0.2687	0.9671	0.0575	0.0048	0.2561	1.3389	3.5269	0.0265	0.3329		0.3482	1.0779	0			0				0	0	0.1052	0.5472									25.4554	1000	NO	9.416968	19.9819	0.798525255	1.119835582	3.469358	4.201368838	2.84739	1.22894416	1.917927286	10.00247015	2.975966085	8.387398158	0.664634106	0.04216148	1.55680616	4.608193363	18.06604533	0.274334202	1.400623894	0	0.348187	6.07274868	0	0	0	0	0	0	0	0	0	0.105173	3.471511775	0	0	0	0	0	0	0	0	93.5415
H5214_004_0	2012	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	1241.73	44.45	253.46	802.05	22.4	13.46	4.3	349.29	365.57	1213.48	1051.86	88.1	0.21	531.78	2948.39	4177.24	71.69	452.46		2331	35.1	0			0.61				4.14	0.81	1532.45										4900	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	129.289608	38.216144	0	200	0.2	0.2	65	250	61.913193	96.943984	43.848652	0.2	68.070846	15	38.923368	40	15		0	0.2	0			0				0	0	0										NO	143.003626	101.470104	30.886097	0	178.8548	0.178855	0.178855	58.12781	223.5685	55.367359	86.694484	39.21271	0.178855	60.873988	13.41411	34.808156	35.77096	13.41411		0	0.178855	0			0				0	0	0											14.7977	0.375862177	0.652365845	0	0.333862293	2.4073883	0.7690765	1.69195523	6.810828045	5.5989319	7.599204995	0.287886646	0.03755955	2.697630778	3.295835649	12.11683513	0.213701677	0.505779018	0	0	6.2778105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4702	0	NO	10.302226	14.7977	0.375862177	0.652365845	0	0.333862293	2.4073883	0.7690765	1.69195523	6.810828045	5.5989319	7.599204995	0.287886646	0.03755955	2.697630778	3.295835649	12.11683513	0.213701677	0.505779018	0	0	6.2778105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4702	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	25% Coins	$65/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									25% Coins										7300	5.0627	0.0514	0.2614	1.6927	2.7428	0.79	0.2521	0.1985	2.1566	0.3259	0.8403	0.0232	0.0045	0.4026	1.1916	2.5338	0.0206	0.1163		0.4223	1.2443	0			0				0	0	0.1371										20.4708	500	NO	7.732095	19.8604	0.427288177	0.913781845	1.692659	3.076701293	3.1973953	1.0211535	1.89041023	8.967448045	5.9247909	8.439482995	0.311084646	0.04209155	3.100250778	4.487457649	14.65067713	0.234303677	0.622068018	0	0.422279	7.5221425	0	0	0	0	0	0	0	0	0	0.137131	0	0	0	0	0	0	0	0	0	86.9409
H5214_008_0	2012	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	1176.36	66.55	253.66	1385.04	24.61	12.21	4.72	353.69	309.85	1033.21	895.18	132.15	0.27	4.05	3213.19	3967.36	78.89	758.59		1766.2	15.9	0			0.61				4.14	0.81	1615.02	623.4									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	34.03605	0	200	0.2	0.2	65	225	63.962812	104.332208	39.220723	0.2	0.2	15	34.298715	35	15		0	0.2	0			0				0	0	0	72.34553									NO	134.759218	95.620176	28.807636	0	182.4828	0.182483	0.182483	59.30691	205.29315	58.360565	95.194167	35.785537	0.182483	0.182483	13.68621	31.294628	31.93449	13.68621		0	0.182483	0			0				0	0	0	66.009075										13.2104	0.530293559	0.608945412	0	0.374241809	2.22811743	0.86131976	1.74802175	5.300840211	5.02489328	7.101326201	0.394088226	0.04927041	0.73905615	3.664699426	10.34642128	0.20994266	0.86518517	0	0	2.9014797	0	0	0	0	0	0	0	0	0	0	3.429171446	0	0	0	0	0	0	0	0	59.5878	0	NO	7.433545	13.2104	0.530293559	0.608945412	0	0.374241809	2.22811743	0.86131976	1.74802175	5.300840211	5.02489328	7.101326201	0.394088226	0.04927041	0.73905615	3.664699426	10.34642128	0.20994266	0.86518517	0	0	2.9014797	0	0	0	0	0	0	0	0	0	0	3.429171446	0	0	0	0	0	0	0	0	59.5878	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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									30% Coins	30% Coins									7300	4.7914	0.0907	0.2797	2.6316	3.0984	0.8842	0.3417	0.2066	1.7778	0.2709	0.7605	0.034	0.0058	0.1324	1.2596	2.3921	0.0269	0.2121		0.2674	0.5468	0			0				0	0	0.1705	0.432									20.6132	500	NO	6.634408	18.0019	0.621042559	0.888668412	2.631637	3.472599809	3.11231243	1.20299576	1.95465175	7.078671211	5.29579528	7.861793201	0.428129226	0.05510041	0.87143415	4.924257426	12.73847628	0.23686166	1.07731117	0	0.267418	3.4483207	0	0	0	0	0	0	0	0	0	0.170479	3.861154446	0	0	0	0	0	0	0	0	80.201
H5214_009_0	2012	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	1338.53	94.59	223.52	1378.15	25.51	11	10.94	405.84	350.65	949.69	881.04	112.76	0.26	8.99	3465.46	4228.46	70.25	663.89		1959.17	16.62	0		4.92	0.61				4.14	0.81	2549.37	359.55									3900	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$75/Visit: 8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $75 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN750: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											145.768118	128.006658	34.03605	0	200	0.2	0.2	65	200	60.875308	72.059654	39.973784	0.2	0.2	15	33.8904	35	15		0	0.2	0		0	0				0	0	0	69.961954									NO	110.284951	96.847021	26.623985	0	176.3792	0.176379	0.176379	57.32324	176.3792	53.685691	63.54912	35.25272	0.176379	0.176379	13.22844	29.887808	30.86636	13.22844		0	0.176379	0		0	0				0	0	0	61.699167										12.3016	0.763396643	0.495916094	0	0.374952783	1.940169	1.92958626	1.938671977	5.153947207	4.248730324	4.66577639	0.331258059	0.04585854	1.58564721	3.82021914	10.53161672	0.180696816	0.731852419	0	0	2.93141898	0	0	0	0	0	0	0	0	0	0	1.848661291	0	0	0	0	0	0	0	0	55.82	0	NO	10.00101	12.3016	0.763396643	0.495916094	0	0.374952783	1.940169	1.92958626	1.938671977	5.153947207	4.248730324	4.66577639	0.331258059	0.04585854	1.58564721	3.82021914	10.53161672	0.180696816	0.731852419	0	0	2.93141898	0	0	0	0	0	0	0	0	0	0	1.848661291	0	0	0	0	0	0	0	0	55.82	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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		"DEN750: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						35% Coins	30% Coins									5800	3.9063	0.0816	0.1821	2.0655	2.3424	0.6775	0.6741	0.1729	1.4652	0.1818	0.5251	0.0217	0.0041	0.2142	1.0016	1.6623	0.0135	0.1215		0.2298	0.418	0		0	0				0	0	0.2312	0.2847									16.4774	0	NO	8.398033	16.208	0.845014643	0.678052094	2.065508	2.717322783	2.617701	2.60368926	2.111560977	6.619107207	4.430483324	5.19089139	0.353006059	0.04998754	1.79987821	4.82186814	12.19394572	0.194241816	0.853352419	0	0.229794	3.34941698	0	0	0	0	0	0	0	0	0	0.231204	2.133385291	0	0	0	0	0	0	0	0	72.2974
H5214_010_0	2012	7																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0											0	YES	290.37	16.18	297.26	1606.38	45.17	15.11	17680.05	606.04	470.51	1157.74	1104.69	206.01	0.31	784.52	4122.09	5899.67	105.57	881.87		2286.75	34.57	0			0.61				4.14	0.81											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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											NO	0	0	0	0	0	0.199318	0	0	0	0	0	0	0.199318	0	0	0	0	0		0	0.199318	0			0				0	0												0	0	0	0	0	3.01169498	0	0	0	0	0	0	0.06178858	0	0	0	0	0	0	0	6.89042326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.9639	0	NO	0.034095	0	0	0	0	0	3.01169498	0	0	0	0	0	0	0.06178858	0	0	0	0	0	0	0	6.89042326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.9639	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			"VIS775: Vision 17a,17b"																5100	3.6981	0.0971	0.1835	2.9398	0	0.9919	0.4409	0	2.4878	0.3066	0.9051	0.0555	0.0062	1.0371	1.5115	3.1117	0.0326	0.2043		0.3405	1.1303	0			0				0	0											19.4804	500	NO	11.400125	3.6981	0.097129	0.183471	2.939827	0	4.00358098	0.440907	0	2.487758	0.306551	0.905118	0.055515	0.06798658	1.037059	1.511497	3.111693	0.032622	0.20429	0	0.340514	8.02070626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4443
H5214_011_0	2012	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	1280.69	80.05	342.09	1454.48	27.41	11.31	4.25	377.31	355.06	1071.72	970.57	159.65	0.36	6.45	3121.82	4153.29	88.78	771.4		1888.12	20.01	0			1.69				4.14	0.81	1866.79	488.42									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	38.216144	0	200	0.2	0.2	65	225	59.616216	94.538304	39.871758	0.2	0.2	15	34.106509	35	15		0	0.2	0			0				0	0	0	73.312723									NO	131.642932	93.408975	31.079929	0	181.157	0.181157	0.181157	58.876025	203.801625	53.999474	85.631378	36.11524	0.181157	0.181157	13.586775	30.893164	31.702475	13.586775		0	0.181157	0			0				0	0	0	66.405565										14.0495	0.623115704	0.886011076	0	0.413792781	2.04888567	0.76991725	1.851209416	6.030150414	4.822693023	6.925937212	0.480483172	0.06521652	1.16846265	3.534622161	10.69235576	0.234545478	0.873403186	0	0	3.62495157	0	0	0	0	0	0	0	0	0	0	2.702817171	0	0	0	0	0	0	0	0	61.7981	0	NO	8.617934	14.0495	0.623115704	0.886011076	0	0.413792781	2.04888567	0.76991725	1.851209416	6.030150414	4.822693023	6.925937212	0.480483172	0.06521652	1.16846265	3.534622161	10.69235576	0.234545478	0.873403186	0	0	3.62495157	0	0	0	0	0	0	0	0	0	0	2.702817171	0	0	0	0	0	0	0	0	61.7981	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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									35% Coins	30% Coins									7300	4.5855	0.0958	0.3326	2.6803	3.3987	0.9408	0.3534	0.2171	1.8839	0.2469	0.7422	0.039	0.0076	0.2074	1.1104	2.2288	0.0224	0.2007		0.2713	0.6945	0			0				0	0	0.2005	0.417									20.8768	500	NO	6.620926	18.635	0.718873704	1.218610076	2.680302	3.812473781	2.98971967	1.12333225	2.068303416	7.914062414	5.069550023	7.668178212	0.519474172	0.07284452	1.37581865	4.645000161	12.92114776	0.256985478	1.074133186	0	0.271299	4.31946657	0	0	0	0	0	0	0	0	0	0.200502	3.119770171	0	0	0	0	0	0	0	0	82.6749
H5214_012_0	2012	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	1268.43	79.28	338.82	1440.56	27.15	12.32	4.63	373.69	351.66	1061.46	961.28	158.13	0.39	7.02	3091.94	4113.54	87.93	764.02		1870.05	21.81	0			1.69				4.14	0.81	1848.92	483.75									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	38.216144	0	200	0.2	0.2	65	225	59.616216	94.538304	39.871758	0.2	0.2	15	34.106509	35	15		0	0.2	0			0				0	0	0	73.312723									NO	131.80069	93.520914	31.116349	0	181.0924	0.181092	0.181092	58.85503	203.72895	53.980218	85.600842	36.102361	0.181092	0.181092	13.58193	30.882148	31.69117	13.58193		0	0.181092	0			0				0	0	0	66.381885										13.9317	0.617861505	0.878570114	0	0.409721555	2.23105344	0.83845596	1.83279468	5.97027688	4.774820183	6.857198116	0.475738862	0.07062588	1.27126584	3.49954272	10.58624592	0.232217048	0.864738847	0	0	3.94961652	0	0	0	0	0	0	0	0	0	0	2.676019739	0	0	0	0	0	0	0	0	61.9684	0	NO	8.613066	13.9317	0.617861505	0.878570114	0	0.409721555	2.23105344	0.83845596	1.83279468	5.97027688	4.774820183	6.857198116	0.475738862	0.07062588	1.27126584	3.49954272	10.58624592	0.232217048	0.864738847	0	0	3.94961652	0	0	0	0	0	0	0	0	0	0	2.676019739	0	0	0	0	0	0	0	0	61.9684	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	35% Coins	35% Coins	$65/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"						35% Coins	30% Coins									7300	4.7216	0.0986	0.3348	2.8528	3.287	1.0014	0.3762	0.21	2.0051	0.2627	0.79	0.0415	0.0081	0.2207	1.1818	2.3722	0.0239	0.2136		0.2888	0.7392	0			0				0	0	0.2134	0.4438									21.6872	500	NO	7.667591	18.6533	0.716460505	1.213363114	2.852763	3.696763555	3.23242444	1.21461096	2.04275768	7.97540788	5.037560183	7.647198116	0.517238862	0.07874488	1.49196384	4.68136672	12.95844692	0.256100048	1.078383847	0	0.288755	4.68881952	0	0	0	0	0	0	0	0	0	0.213402	3.119800739	0	0	0	0	0	0	0	0	83.6556
H5215_001_0	2012	9																															D	D	D		T	Coin	V	V	V	P	P		V	V	V	V	V	V	V	V	Coin	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	92.34685418	0.862051982	678.9152399	0	8.882575924	9.157523174	404.6316967	298.6462334	335.9953127	1316.918288	1067.570629	0	5.502295592	1220.344903	3217.913525	4048.634655	55.26762338	230.4225985	137.8167396	49.16263962	11.87764185	24.27398406	0	0	0	0	0	0	0	0											2700	IP Acute $50 per day for days 11-20; PBP 1a	IP Mental Health $50 per day for days 11-20; PBP 1b	SNF $50 per day for days 1-100; PBP 2	Home Health $0; PBP 6	Ambulance $75; PBP 10a	DME 20%; PBP 11a	"Prosthetics/Medical Supplies 20%; Diabetes Monitoring Supplies $10; PBP 11b, 11c"	"ER $65; Urgent Care $10; PBP 4a, 4b"	"OP Hospital (Surgery) $40; ASC Services $40; PBP 9a, 9b"	OP Diagnostic Procedures/Tests min $0 / max $3; PBP 8a	"OP Radiology X-rays: $20, Therapeutic Radiological services: $20, CAT, PET, MRI, MRA, and NUC: $50; PBP 8b"		Renal Dialysis $10; PBP 12	"Cardiac Rehab $10; Partial Hosp $10; OP Substance Abuse $10; PBP 3, 5, 9c"	"PCP $10; Preventative Services (Medicare Covered) $0; Supp Preventative Health Benefits $0; PBP 7a, 14a, 14b"	"Chiropractic $20; Physician Specialist (excl. Radiology) $25; Podiatry $25; Comprehensive Dental (Medicare Covered) $25; Vision Exams (Medicare Covered) min $0 / max $25; Hearing Exams (Medicare Covered) $25; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $25; Psychiatric $25; PBP 7e, 7h"	"Occupational Therapy $25; Physical and Speech Therapy $25; PBP 7c, 7i"	Physician Specialist (Radiology) $25; PBP 7d	"Other Health Care $25; Kidney Disease Education Services $0; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 15%; PBP 15	"OP Blood Services $0; Eye Wear (Medicare Covered) $15; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: $0; ; Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $0; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not coveredOther Non-Covered 2 (Courage Program): $0; PBP 13a, 13b, 13c, 13e"											0	NO	50	50	50	0	75	0.2	13.19606098	57.00171877	40	3	25.13597991	0	10	10	10	23.82769302	25	25	25	25	0.15	15	0	0	0	0	0	0	0	0											NO	48.85243615	48.85243615	48.85243615	0	73.27865422	0.195409745	12.89319453	55.69345653	39.08194892	2.931146169	24.55907707	0	9.77048723	9.77048723	9.77048723	23.28081703	24.42621807	24.42621807	24.42621807	24.42621807	0.146557308	14.65573084	0	0	0	0	0	0	0	0												0.3759	0.003509445	2.763888617	0	0.054241934	1.789469265	0.434749598	1.386053418	1.094279304	0.321673333	2.184879114	0	0.004480009	0.993613691	2.620048584	7.854626886	0.112498252	0.469029387	0.280528478	0.100071446	1.74075522	0.029646081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.614	0	NO	0.578192753	0.3759	0.003509445	2.763888617	0	0.054241934	1.789469265	0.434749598	1.386053418	1.094279304	0.321673333	2.184879114	0	0.004480009	0.993613691	2.620048584	7.854626886	0.112498252	0.469029387	0.280528478	0.100071446	1.74075522	0.029646081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.614	YES	IP Acute $100 per day for days 1-7; PBP 1a	IP Mental Health $150 per day for days 1-7; PBP 1b	SNF $100 per day for days 1-100; PBP 2	Home Health $40; PBP 6	Ambulance $75; PBP 10a	DME 30%; PBP 11a	"Prosthetics/Medical Supplies 30%; Diabetes Monitoring Supplies 20%; PBP 11b, 11c"	"ER $65; Urgent Care $40; PBP 4a, 4b"	"OP Hospital (Surgery) $100; ASC Services $100; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $3; PBP 8a	"OP Radiology X-rays: $35, Therapeutic Radiological services: 10%, CAT, PET, MRI, MRA, and NUC: $125; PBP 8b"		Renal Dialysis $40; PBP 12	"Cardiac Rehab $40; Partial Hosp $40; OP Substance Abuse $40; PBP 3, 5, 9c"	"PCP $20; Preventative Services (Medicare Covered) $35; Supp Preventative Health Benefits $35; PBP 7a, 14a, 14b"	"Chiropractic $45; Physician Specialist (excl. Radiology) $35; Podiatry $35; Comprehensive Dental (Medicare Covered): $45; Vision Exams (Medicare Covered) $45; Hearing Exams (Medicare Covered) $45; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $45; Psychiatric $45; PBP 7e, 7h"	"Occupational Therapy $35; Physical and Speech Therapy $35; PBP 7c, 7i"	Physician Specialist (Radiology) $35; PBP 7d	"Other Health Care $35; Kidney Disease Education Services $40; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 25%; PBP 15	"OP Blood Services $35; Eye Wear (Medicare Covered) $45; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: 50% for Health & Wellness benefit ($35 for HIV Screenings); Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $35; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): 50%; PBP 13a, 13b, 13c, 13e"											2700	0.4808	0.0229	0.7327	0.0373	0.822	1.1101	0.04	0.2111	0.5511	0.0352	0.4849	0	0	0.3789	1.4278	3.1354	0.1263	0.2761	0.3159	0.0597	0.2215	0.0323	0	0	0	0	0	0	0	0											10.5022	0	NO	0.246701448	0.8568	0.026428634	3.496566157	0.037317215	0.876289068	2.899598179	0.47478929	1.597103823	1.645385092	0.356864947	2.669771778	0	0.004480009	1.372558546	4.047891677	10.99005139	0.238804172	0.745164074	0.596444008	0.159748609	1.962269283	0.061904758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1162
H5215_002_0	2012	11																															D	D	D		T	Coin	V	V	V	P	P		V	V	V	V	V	V	V	V	Coin	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	96.31460987	1.084119149	597.9369577	0	4.656882514	9.1586229	560.406836	279.0042886	359.7372993	1422.301484	1281.559987	0	1.952923982	1817.660186	3468.612551	4389.089948	129.0586741	280.1799266	153.8416737	65.2373347	16.61745285	20.4394747	0	0	0	0	0	0	0	0											2700	IP Acute $50 per day for days 11-20; PBP 1a	IP Mental Health $50 per day for days 11-20; PBP 1b	SNF $50 per day for days 1-100; PBP 2	Home Health $0; PBP 6	Ambulance $75; PBP 10a	DME 20%; PBP 11a	"Prosthetics/Medical Supplies 20%; Diabetes Monitoring Supplies $10; PBP 11b, 11c"	"ER $65; Urgent Care $10; PBP 4a, 4b"	"OP Hospital (Surgery) $40; ASC Services $40; PBP 9a, 9b"	OP Diagnostic Procedures/Tests min $0 / max $3; PBP 8a	"OP Radiology X-rays: $20, Therapeutic Radiological services: $20, CAT, PET, MRI, MRA, and NUC: $50; PBP 8b"		Renal Dialysis $10; PBP 12	"Cardiac Rehab $10; Partial Hosp $10; OP Substance Abuse $10; PBP 3, 5, 9c"	"PCP $10; Preventative Services (Medicare Covered) $0; Supp Preventative Health Benefits $0; PBP 7a, 14a, 14b"	"Chiropractic $20; Physician Specialist (excl. Radiology) $25; Podiatry $25; Comprehensive Dental (Medicare Covered) $25; Vision Exams (Medicare Covered) min $0 / max $25; Hearing Exams (Medicare Covered) $25; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $25; Psychiatric $25; PBP 7e, 7h"	"Occupational Therapy $25; Physical and Speech Therapy $25; PBP 7c, 7i"	Physician Specialist (Radiology) $25; PBP 7d	"Other Health Care $25; Kidney Disease Education Services $0; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 15%; PBP 15	"OP Blood Services $0; Eye Wear (Medicare Covered) $15; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: $0; Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $0; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): $0; PBP 13a, 13b, 13c, 13e"											0	NO	50	50	50	0	75	0.2	11.98210307	57.55841485	40	3	24.97573026	0	10	10	10	23.82565256	25	25	25	25	0.15	15	0	0	0	0	0	0	0	0											NO	48.65693274	48.65693274	48.65693274	0	72.98539912	0.194627731	11.66024766	56.0123184	38.92554619	2.919415965	24.30484855	0	9.731386549	9.731386549	9.731386549	23.18566348	24.32846637	24.32846637	24.32846637	24.32846637	0.145970798	14.59707982	0	0	0	0	0	0	0	0												0.3905	0.004395826	2.424481528	0	0.028323702	1.782521994	0.544540208	1.302306421	1.166914239	0.346024138	2.595676783	0	0.001583722	1.47402949	2.81286746	8.480330211	0.261649968	0.568028993	0.311894332	0.132260359	2.425662857	0.024863054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0789	0	NO	0.747452904	0.3905	0.004395826	2.424481528	0	0.028323702	1.782521994	0.544540208	1.302306421	1.166914239	0.346024138	2.595676783	0	0.001583722	1.47402949	2.81286746	8.480330211	0.261649968	0.568028993	0.311894332	0.132260359	2.425662857	0.024863054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0789	YES	IP Acute $100 per day for days 1-7; PBP 1a	IP Mental Health $150 per day for days 1-7; PBP 1b	SNF $100 per day for days 1-100; PBP 2	Home Health $40; PBP 6	Ambulance $75; PBP 10a	DME 30%; PBP 11a	"Prosthetics/Medical Supplies 30%; Diabetes Monitoring Supplies 20%; PBP 11b, 11c"	"ER $65; Urgent Care $40; PBP 4a, 4b"	"OP Hospital (Surgery) $100; ASC Services $100; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $3; PBP 8a	"OP Radiology X-rays: $35, Therapeutic Radiological services: 10%, CAT, PET, MRI, MRA, and NUC: $125; PBP 8b"		Renal Dialysis $40; PBP 12	"Cardiac Rehab $40; Partial Hosp $40; OP Substance Abuse $40; PBP 3, 5, 9c"	"PCP $20; Preventative Services (Medicare Covered) $35; Supp Preventative Health Benefits $35; PBP 7a, 14a, 14b"	"Chiropractic $45; Physician Specialist (excl. Radiology) $35; Podiatry $35; Comprehensive Dental (Medicare Covered) $45; Vision Exams (Medicare Covered) $45; Hearing Exams (Medicare Covered) $45; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $45; Psychiatric $45; PBP 7e, 7h"	"Occupational Therapy $35; Physical and Speech Therapy $35; PBP 7c, 7i"	Physician Specialist (Radiology) $35; PBP 7d	"Other Health Care $35; Kidney Disease Education Services $40; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 25%; PBP 15	"OP Blood Services $35; Eye Wear (Medicare Covered) $45; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: 50% for Health & Wellness benefit ($35 for HIV Screenings); Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $35; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): 50%; PBP 13a, 13b, 13c, 13e"											2700	0.5678	0.0276	0.447	0.0374	0.7312	0.7492	0.0308	0.2457	0.4799	0.0354	0.5867	0	0.0022	0.7019	1.2045	3.466	0.2346	0.3502	0.3111	0.0481	0.5994	0.0263	0	0	0	0	0	0	0	0											10.8831	0	NO	0.300402688	0.9583	0.032027081	2.87150231	0.03739118	0.75947992	2.53175875	0.575372992	1.547976113	1.646780663	0.381428567	3.182419918	0	0.003773223	2.175903678	4.017407785	11.94635366	0.496216949	0.918274181	0.622990369	0.180312069	3.025094026	0.051139254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9619
H5215_005_0	2012	11																																	D		T	Coin		V								V			V		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	913.6583295	0	12.26303007	15.60659083	0	276.5206481	0	0	0	0	0	0	0	4577.707341	0	0	173.4787477	0	42.04900704	0	0	0	0	0	0	0	0	0											2000	IP Acute $0 per day ; PBP 1a	IP Mental Health $0 per day ; PBP 1b	SNF $35 per day for days 1-100; PBP 2	Home Health $0; PBP 6	Ambulance $65; PBP 10a	"DME $20 for services under $300, 10% for services over $300 ; PBP 11a"	"Prosthetics/Medical Supplies 0%; Diabetes Monitoring Supplies $0; PBP 11b, 11c"	"ER $65; Urgent Care $0; PBP 4a, 4b"	"OP Hospital (Surgery) $0; ASC Services $0; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $0; PBP 8a	OP Radiology $0; PBP 8b		Renal Dialysis $0; PBP 12	"Cardiac Rehab $0; Partial Hosp $0; OP Substance Abuse $0; PBP 3, 5, 9c"	"PCP $0; Preventative Services (Medicare Covered) $0; Supp Preventative Health Benefits $0; PBP 7a, 14a, 14b"	"Chiropractic $15; Physician Specialist (excl. Radiology) $15; Podiatry $15; Comprehensive Dental (Medicare Covered) $0; Vision Exams (Medicare Covered) $0; Hearing Exams (Medicare Covered) $0; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $0; Psychiatric $0; PBP 7e, 7h"	"Occupational Therapy $0; Physical and Speech Therapy $0; PBP 7c, 7i"	Physician Specialist (Radiology) $15; PBP 7d	"Other Health Care $0; Kidney Disease Education Services $0; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 12%; PBP 15	"OP Blood Services $0; Eye Wear (Medicare Covered) $0; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 18a-2	Hearing Aids (Non Medicare Covered): Covered (up to $100 per year); PBP 18b	"Supp Education/Wellness Programs: $0; Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $0; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): $0; PBP 13a, 13b, 13c, 13e"											0	NO	0	0	35	0	65	0.189809153	0	65	0	0	0	0	0	0	0	15	0	0	15	0	0.12	0	0	0	0	0	0	0	0	0											NO	0	0	33.72886217	0	62.63931546	0.182915622	0	62.63931546	0	0	0	0	0	0	0	14.45522664	0	0	14.45522664	0	0.115641813	0	0	0	0	0	0	0	0	0												0	0	2.568054655	0	0.064012317	2.854689265	0	1.443422009	0	0	0	0	0	0	0	5.514316426	0	0	0.208972885	0	4.862623415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5161	0	NO	0.660127987	0	0	2.568054655	0	0.064012317	2.854689265	0	1.443422009	0	0	0	0	0	0	0	5.514316426	0	0	0.208972885	0	4.862623415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5161	YES	IP Acute $100 per day for days 1-7; PBP 1a	IP Mental Health $150 per day for days 1-7; PBP 1b	SNF $100 per day for days 1-100; PBP 2	Home Health $40; PBP 6	Ambulance $65; PBP 10a	"DME $30 for services under $300, 20% for services over $300 ; PBP 11a"	"Prosthetics/Medical Supplies 20%; Diabetes Monitoring Supplies 10%; PBP 11b, 11c"	"ER $65; Urgent Care $40; PBP 4a, 4b"	"OP Hospital (Surgery) $100; ASC Services $100; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $25; PBP 8a	"OP Radiology X-rays: $30, Therapeutic Radiological services: $35, CAT, PET, MRI, MRA, and NUC: $50; PBP 8b"		Renal Dialysis $35; PBP 12	"Cardiac Rehab $35; Partial Hosp $35; OP Substance Abuse $35; PBP 3, 5, 9c"	"PCP $20; Preventative Services (Medicare Covered) $35; Supp Preventative Health Benefits $35; PBP 7a, 14a, 14b"	"Chiropractic $35; Physician Specialist (excl. Radiology) $25; Podiatry $25; Comprehensive Dental (Medicare Covered) $30; Vision Exams (Medicare Covered) $35; Hearing Exams (Medicare Covered) $35; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $35; Psychiatric $35; PBP 7e, 7h"	"Occupational Therapy $25; Physical and Speech Therapy $25; PBP 7c, 7i"	Physician Specialist (Radiology) $25; PBP 7d	"Other Health Care $25; Kidney Disease Education Services $35; Diabetes Self-Management Training $35; PBP 7g, 14d, 14e"	Part B Drugs 30%; PBP 15	"OP Blood Services $35; Eye Wear (Medicare Covered) $35; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 18a-2	Hearing Aids (Non Medicare Covered): Covered (up to $100 per year); PBP 18b	"Supp Education/Wellness Programs: 50% for Health & Wellness benefit ($35 for HIV Screenings); Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $35; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): 50%; PBP 13a, 13b, 13c, 13e"											2000	0.3388	0.0154	0.8196	0.0264	0.9647	1.1451	0.1036	0.1509	0.4585	0.321	0.3799	0	0	0.3643	1.2375	2.7838	0.2336	0.2901	0.2278	0.0478	0.7071	0.0271	0	0	0	0	0	0	0	0											10.6432	0	NO	0.401110655	0.3388	0.015417914	3.38765096	0.026435332	1.02867154	3.999752002	0.103637327	1.594348076	0.458544694	0.321032002	0.379877681	0	0	0.364274547	1.237543365	8.298150561	0.23362174	0.290128848	0.436749194	0.04780269	5.569695408	0.02714147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1593
H5215_006_0	2012	9																																	D		T	Coin		V								V			V		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	1626.709432	0	14.48525711	21.61448823	0	342.6922116	0	0	0	0	0	0	0	4300.847936	0	0	144.2897453	0	34.99230492	0	0	0	0	0	0	0	0	0											2000	IP Acute $0 per day ; PBP 1a	IP Mental Health $0 per day ; PBP 1b	SNF $35 per day for days 1-100; PBP 2	Home Health $0; PBP 6	Ambulance $65; PBP 10a	"DME $20 for services under $300, 10% for services over $300 ; PBP 11a"	"Prosthetics/Medical Supplies 0%; Diabetes Monitoring Supplies $0; PBP 11b, 11c"	"ER $65; Urgent Care $0; PBP 4a, 4b"	"OP Hospital (Surgery) $0; ASC Services $0; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $0; PBP 8a	OP Radiology $0; PBP 8b		Renal Dialysis $0; PBP 12	"Cardiac Rehab $0; Partial Hosp $0; OP Substance Abuse $0; PBP 3, 5, 9c"	"PCP $0; Preventative Services (Medicare Covered) $0; Supp Preventative Health Benefits $0; PBP 7a, 14a, 14b"	"Chiropractic $15; Physician Specialist (excl. Radiology) $15; Podiatry $15; Comprehensive Dental (Medicare Covered) $0; Vision Exams (Medicare Covered) $0; Hearing Exams (Medicare Covered) $0; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $0; Psychiatric $0; PBP 7e, 7h"	"Occupational Therapy $0; Physical and Speech Therapy $0; PBP 7c, 7i"	Physician Specialist (Radiology) $15; PBP 7d	"Other Health Care $0; Kidney Disease Education Services $0; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 12%; PBP 15	"OP Blood Services $0; Eye Wear (Medicare Covered) $0; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 17a-2	Eye Wear (Non Medicare Covered): $125 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 18a-2	Hearing Aids (Non Medicare Covered): Covered (up to $100 per year); PBP 18b	"Supp Education/Wellness Programs: $0; Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $0; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): $0; PBP 13a, 13b, 13c, 13e"											0	NO	0	0	35	0	65	0.177746616	0	65	0	0	0	0	0	0	0	15	0	0	15	0	0.12	0	0	0	0	0	0	0	0	0											NO	0	0	33.55940895	0	62.32461663	0.170430611	0	62.32461663	0	0	0	0	0	0	0	14.38260384	0	0	14.38260384	0	0.115060831	0	0	0	0	0	0	0	0	0												0	0	4.549283924	0	0.075232341	3.683770437	0	1.779846725	0	0	0	0	0	0	0	5.154782669	0	0	0.17293852	0	4.026243672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4421	0	NO	0.834583016	0	0	4.549283924	0	0.075232341	3.683770437	0	1.779846725	0	0	0	0	0	0	0	5.154782669	0	0	0.17293852	0	4.026243672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4421	YES	IP Acute $100 per day for days 1-7; PBP 1a	IP Mental Health $150 per day for days 1-7; PBP 1b	SNF $100 per day for days 1-100; PBP 2	Home Health $40; PBP 6	Ambulance $65; PBP 10a	"DME $30 for services under $300, 20% for services over $300 ; PBP 11a"	"Prosthetics/Medical Supplies 20%; Diabetes Monitoring Supplies 10%; PBP 11b, 11c"	"ER $65; Urgent Care $40; PBP 4a, 4b"	"OP Hospital (Surgery) $100; ASC Services $100; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $25; PBP 8a	"OP Radiology X-rays: $30, Therapeutic Radiological services: $35, CAT, PET, MRI, MRA, and NUC: $50; PBP 8b"		Renal Dialysis $35; PBP 12	"Cardiac Rehab $35; Partial Hosp $35; OP Substance Abuse $35; PBP 3, 5, 9c"	"PCP $20; Preventative Services (Medicare Covered) $35; Supp Preventative Health Benefits $35; PBP 7a, 14a, 14b"	"Chiropractic $35; Physician Specialist (excl. Radiology) $25; Podiatry $25; Comprehensive Dental (Medicare Covered) $30; Vision Exams (Medicare Covered) $35; Hearing Exams (Medicare Covered) $35; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $35; Psychiatric $35; PBP 7e, 7h"	"Occupational Therapy $25; Physical and Speech Therapy $25; PBP 7c, 7i"	Physician Specialist (Radiology) $25; PBP 7d	"Other Health Care $25; Kidney Disease Education Services $35; Diabetes Self-Management Training $35; PBP 7g, 14d, 14e"	Part B Drugs 30%; PBP 15	"OP Blood Services $35; Eye Wear (Medicare Covered) $35; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 17a-2	Eye Wear (Non Medicare Covered): $125 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Covered (One exam per year) at $0; PBP 18a-2	Hearing Aids (Non Medicare Covered): Covered (up to $100 per year); PBP 18b	"Supp Education/Wellness Programs: 50% for Health & Wellness benefit ($35 for HIV Screenings); Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $35; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): 50%; PBP 13a, 13b, 13c, 13e"											2000	0.3484	0.0557	1.248	0.05	1.2995	1.3114	0.0251	0.1738	0.4543	0.3671	0.3447	0	0	0.475	1.2869	2.5921	0.1397	0.1559	0.2009	0.0331	0.4369	0.0325	0	0	0	0	0	0	0	0											11.0308	0	NO	0.473516583	0.3484	0.055662275	5.797323361	0.050030426	1.374717303	4.99513577	0.025147587	1.953627856	0.454256365	0.36706669	0.344654545	0	0	0.474987537	1.286939318	7.746905462	0.139693212	0.155874319	0.373848839	0.033057834	4.463132729	0.032489607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4729
H5215_007_0	2012	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin																	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	261.193148	12.26311991	155.2392978	0	3.934243612	25.62337889	6.323071628	43.53110915	62.31495232	17.79841467	31.34620672	0	0.253520233	63.78020026	37.08020613	73.44854607	3.696542825	6.90349654	14.3195809	30.01527029	72.2159783	5.512007334	0	46.144	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	Non Covered: PBP 10b	"16A & 16B: Preventive 0%, Basic 20%, Major 50%"	17a: No Cost Sharing (Covered at one exam per year)	17b-2 Eye Wear (non Medicare Covered): $400 allowance	Non Covered	Non Covered	"14c, 13d: 0% minimum, 0% maximum"	"13a-c: Not covered, 13e: No Cost Sharing"											0	NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.25	0	0	0	0	0	0											NO	0.071991879	0.071991879	0.139113143	0	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0.188426032	0	0.210296911	0	0	0	0	0	0												18.8038	0.88284505	21.59582663	0	0.741313913	4.828111613	1.191431298	8.202394169	11.74175921	3.353684653	5.906441354	0	0.047769811	12.01785006	6.98687611	13.8396181	0.696524897	1.300798461	2.698181811	5.655658283	13.60737025	1.038605671	0	9.703940653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.8408	0	NO	27.34527428	18.8038	0.88284505	21.59582663	0	0.741313913	4.828111613	1.191431298	8.202394169	11.74175921	3.353684653	5.906441354	0	0.047769811	12.01785006	6.98687611	13.8396181	0.696524897	1.300798461	2.698181811	5.655658283	13.60737025	1.038605671	0	9.703940653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.8408	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	Non Covered: PBP 10b	"16A & 16B: Preventive 0%, Basic 20%, Major 50%"	17a: No Cost Sharing (Covered at one exam per year)	17b-2 Eye Wear (non Medicare Covered): $400 allowance	Non Covered	Non Covered	"14c: 0% minimum, 20% maximum, 13d: 0% minimum, 0% maximum"	"13a-c: Not Covered, 13e: No Cost Sharing"											10000	2.947	0.6098	4.4052	0	2.9165	2.5137	0.2296	1.1662	1.5964	0.5898	0.3936	0	0	2.0261	1.767	4.4636	0.6524	0.5662	1.0986	0.4457	0.7579	0.1958	0	0	0	0	0	0	0	0											29.3411	0	NO	3.144569817	21.7508	1.492651206	26.00101826	0	3.6577725	7.341848449	1.421040274	9.368545632	13.33813333	3.9434879	6.300026102	0	0.047769811	14.04395581	8.75389286	18.30323373	1.348966415	1.866976049	3.796796772	6.101341845	14.36530513	1.234422797	0	9.703940653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.1819
H5215_008_0	2012	10																															D	D	D		T	Coin	V	V	V		P			V	V	V	V	V	V	V	Coin	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	412.892994	11.17800455	331.6471419	0	3.811651399	5.31728362	350.7995925	197.9009972	310.682473	0	921.9400148	0	0	552.4813435	2244.288918	3025.149417	75.87592285	212.0449563	89.08388256	40.35751734	8.930495257	18.05690153	0	0	0	0	0	0	0	0											2900	IP Acute $175 per day for days 1-10; PBP 1a	IP Mental Health $175 per day for days 1-10; PBP 1b	SNF $75 per day for days 1-100; PBP 2	Home Health $0; PBP 6	Ambulance $95; PBP 10a	DME 20%; PBP 11a	"Prosthetics/Medical Supplies 20%; Diabetes Monitoring Supplies $15; PBP 11b, 11c"	"ER $65; Urgent Care $25; PBP 4a, 4b"	"OP Hospital (Surgery) $115; ASC Services $115; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $0; PBP 8a	"OP Radiology X-rays: $20, Therapeutic Radiological services: 20%, CAT, PET, MRI, MRA, and NUC:  $60; PBP 8b"		Renal Dialysis $20; PBP 12	"Cardiac Rehab $30; Partial Hosp $25; OP Substance Abuse $30; PBP 3, 5, 9c"	"PCP $15; Preventative Services (Medicare Covered) $0; Supp Preventative Health Benefits $0; PBP 7a, 14a, 14b"	"Chiropractic $20; Physician Specialist (excl. Radiology) $30; Podiatry $30; Comprehensive Dental (Medicare Covered) $30; Vision Exams (Medicare Covered) min $0 / max $30; Hearing Exams (Medicare Covered) $30; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $30; Psychiatric $30; PBP 7e, 7h"	"Occupational Therapy $30; Physical and Speech Therapy $30; PBP 7c, 7i"	Physician Specialist (Radiology) $30; PBP 7d	"Other Health Care $30; Kidney Disease Education Services $0; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 20%; PBP 15	"OP Blood Services $0; Eye Wear (Medicare Covered) $30; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: $0; Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $0; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): $0; PBP 13a, 13b, 13c, 13e"											0	NO	175	175	75	0	95	0.2	15.63801795	60.74821102	115	0	35.46180016	0	0	29.29405286	15	27.95023629	30	30	30	30	0.2	30	0	0	0	0	0	0	0	0											NO	157.7089618	157.7089618	67.58955504	0	85.61343639	0.180238813	14.092889	54.74592736	103.6373177	0	31.95796392	0	0	26.39962664	13.51791101	25.18858712	27.03582202	27.03582202	27.03582202	27.03582202	0.180238813	27.03582202	0	0	0	0	0	0	0	0												5.4264	0.146905958	1.86799023	0	0.027194048	0.95838089	0.411981643	0.902856135	2.683191514	0	2.455277144	0	0	1.215441766	2.528174823	6.349936636	0.170947329	0.477734141	0.200704666	0.090924888	1.609621869	0.040681931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5644	0	NO	3.022125877	5.4264	0.146905958	1.86799023	0	0.027194048	0.95838089	0.411981643	0.902856135	2.683191514	0	2.455277144	0	0	1.215441766	2.528174823	6.349936636	0.170947329	0.477734141	0.200704666	0.090924888	1.609621869	0.040681931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5644	YES	IP Acute $215 per day for days 1-10; PBP 1a	IP Mental Health $300 per day for days 1-10; PBP 1b	SNF $100 per day for days 1-100; PBP 2	Home Health 30%; PBP 6	Ambulance $95; PBP 10a	DME 30%; PBP 11a	"Prosthetics/Medical Supplies 30%; Diabetes Monitoring Supplies $40; PBP 11b, 11c"	"ER $65; Urgent Care $50; PBP 4a, 4b"	"OP Hospital (Surgery) $215; ASC Services $215; PBP 9a, 9b"	OP Diagnostic Procedures/Tests $20; PBP 8a	"OP Radiology X-rays: 30%, Therapeutic Radiological services: 30%, CAT, PET, MRI, MRA, and NUC: $125; PBP 8b"		Renal Dialysis $40; PBP 12	"Cardiac Rehab $40; Partial Hosp $50; OP Substance Abuse $45; PBP 3, 5, 9c"	"PCP $20; Preventative Services (Medicare Covered) $20; Supp Preventative Health Benefits $35; PBP 7a, 14a, 14b"	"Chiropractic $45; Physician Specialist (excl. Radiology) $35; Podiatry $35; Comprehensive Dental (Medicare Covered) $45; Vision Exams (Medicare Covered) $45; Hearing Exams (Medicare Covered) $45; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"Mental Health $45; Psychiatric $45; PBP 7e, 7h"	"Occupational Therapy $35; Physical and Speech Therapy $35; PBP 7c, 7i"	Physician Specialist (Radiology) $35; PBP 7d	"Other Health Care $35; Kidney Disease Education Services $20; Diabetes Self-Management Training $0; PBP 7g, 14d, 14e"	Part B Drugs 30%; PBP 15	"OP Blood Services $40; Eye Wear (Medicare Covered) $45; PBP 9d, 17b-1"	Transportation: Not Covered; PBP 10b	"Preventative Dental Services (Non Medicare Covered): Not covered; Comprehensive Dental (Non Medicare Covered): Not covered; PBP 16a, 16b"	Routine Eye Exams (Non Medicare Covered): Not covered; PBP 17a-2	Eye Wear (Non Medicare Covered): $100 allowance; PBP 17b-2	Routine Hearing Exams (Non Medicare Covered): Not covered; PBP 18a-2	Hearing Aids (Non Medicare Covered): Not covered; PBP 18b	"Supp Education/Wellness Programs: 50% for Health & Wellness benefit ($20 for HIV Screenings); Other Non-Covered 1 (Comprehensive Anti-Coagulation Benefit): $50; PBP 14c, 13d"	"Acupuncture: Not covered; OTC Rx: Not covered; Meal Benefit: Not covered; Other Non-Covered 2 (Courage Program): 50%; PBP 13a, 13b, 13c, 13e"											2900	1.4783	0.1312	0.4734	0.1418	0.4767	0.5192	0.1224	0.2204	1.1745	0.1803	0.6665	0	0	0.5757	1.2493	2.9462	0.1988	0.2187	0.2176	0.043	0.4683	0.0204	0	0	0	0	0	0	0.478	0											12.0007	0	NO	1.315747792	6.9048	0.278078764	2.341420563	0.1418456	0.503909764	1.477551913	0.534347746	1.1232515	3.857676022	0.180309743	3.121789274	0	0	1.791146533	3.777473411	9.296148884	0.369753208	0.696392195	0.418316469	0.133897843	2.077879322	0.061111056	0	0	0	0	0	0	0.478038393	0	0	0	0	0	0	0	0	0	0	0	39.5651
H5215_806_0	2012	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	171.1574717	1.643568177	54.89611713	0	0.753172686	12.47678014	5.15332415	23.36236238	57.71663657	11.80376055	28.13529207	0	0.024468085	26.61118568	28.45429231	79.98440035	1.138829736	2.340334087	11.39745042	7.052331745	44.8271756	0.894981291	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											0	NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07819334	0.07819334	0.151096505	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0	0	0	0	0	0	0												13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	0	NO	8.678663355	13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											10000	2.8024	0.0727	1.9821	0	1.1938	0.7222	0.0815	0.7711	2.5334	0.5019	0.6628	0	0.0008	0.586	1.7813	4.5542	0.1086	0.231	0.759	0.3432	1.2677	0.0571	0	0	0	0	0	0	0	0											21.0131	0	NO	0.947534068	16.1858	0.201249491	10.27674833	0	1.347990365	3.275695168	1.136206955	5.552422364	14.34549191	2.917624713	6.420894151	0	0.005766211	6.032127527	7.604665447	20.92361453	0.341703994	0.710014968	3.091614004	1.78647915	10.44195078	0.240277579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8383
H5215_807_0	2012	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	171.1574717	1.643568177	54.89611713	0	0.753172686	12.47678014	5.15332415	23.36236238	57.71663657	11.80376055	28.13529207	0	0.024468085	26.61118568	28.45429231	79.98440035	1.138829736	2.340334087	11.39745042	7.052331745	44.8271756	0.894981291	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											0	NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07819334	0.07819334	0.151096505	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0	0	0	0	0	0	0												13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	0	NO	8.678663355	13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											10000	2.8024	0.0727	1.9821	0	1.1938	0.7222	0.0815	0.7711	2.5334	0.5019	0.6628	0	0.0008	0.586	1.7813	4.5542	0.1086	0.231	0.759	0.3432	1.2677	0.0571	0	0	0	0	0	0	0	0											21.0131	0	NO	0.947534068	16.1858	0.201249491	10.27674833	0	1.347990365	3.275695168	1.136206955	5.552422364	14.34549191	2.917624713	6.420894151	0	0.005766211	6.032127527	7.604665447	20.92361453	0.341703994	0.710014968	3.091614004	1.78647915	10.44195078	0.240277579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8383
H5215_808_0	2012	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	171.1574717	1.643568177	54.89611713	0	0.753172686	12.47678014	5.15332415	23.36236238	57.71663657	11.80376055	28.13529207	0	0.024468085	26.61118568	28.45429231	79.98440035	1.138829736	2.340334087	11.39745042	7.052331745	44.8271756	0.894981291	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											0	NO	0.085583615	0.085583615	0.165377064	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07819334	0.07819334	0.151096505	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0.204657261	0	0	0	0	0	0	0	0												13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	0	NO	8.678663355	13.3834	0.128516086	8.294611415	0	0.154142259	2.55346365	1.054665206	4.781277097	11.81212876	2.415725305	5.758091816	0	0.005007571	5.446172375	5.823377532	16.36938831	0.233069775	0.478966364	2.332570987	1.443310899	9.17420698	0.18316442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8252	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 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b-1, 17a-1, 18a-1"	"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, 14d, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 17b-1"	Not Covered; PBP 10b	"Not Covered; PBP 16a, 16b"	Not Covered; PBP 17a-2	Not Covered; PBP 17b-2	Not Covered; PBP 18a-2	Not Covered; PBP 18b	"Not Covered; PBP 14c, 13d"	"Not Covered; PBP 13a, 13b, 13c, 13e"											10000	2.8024	0.0727	1.9821	0	1.1938	0.7222	0.0815	0.7711	2.5334	0.5019	0.6628	0	0.0008	0.586	1.7813	4.5542	0.1086	0.231	0.759	0.3432	1.2677	0.0571	0	0	0	0	0	0	0	0											21.0131	0	NO	0.947534068	16.1858	0.201249491	10.27674833	0	1.347990365	3.275695168	1.136206955	5.552422364	14.34549191	2.917624713	6.420894151	0	0.005766211	6.032127527	7.604665447	20.92361453	0.341703994	0.710014968	3.091614004	1.78647915	10.44195078	0.240277579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8383
H5216_001_0	2012	5	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		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	1327.6	55.29	578.78	830.01	26.03	12.36	5.78	380.44	464.95	1869.78	926.98	293.98	0.28	6.51	2810.99	3178.83	134.5	949.76		1401.81	34.29	0		3.75	0.61				5.23	1.24	1113.08										4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.135823	65	137.340755	33.598769	39.598475	32.169151	0.199875	0.2	10	33.573855	35	42.996916		0	0.2	0		0	0				0	0	50										NO	127.132903	101.718353	31.148738	0	89.822	0.179644	0.121999	58.3843	123.362213	30.179086	35.568142	28.894975	0.179532	0.179644	8.9822	30.156708	31.4377	38.62069		0	0.179644	0		0	0				0	0	44.911											14.0651	0.468667311	1.502355548	0	0.194838888	2.22039984	0.70515422	1.850976924	4.779771745	4.702354285	2.747579689	0.707878729	0.05026896	1.16948244	2.104072865	7.988587341	0.352364221	3.056698878	0	0	6.15999276	0	0	0	0	0	0	0	0	0	4.165794657	0	0	0	0	0	0	0	0	0	58.9924	0	NO	9.627186	14.0651	0.468667311	1.502355548	0	0.194838888	2.22039984	0.70515422	1.850976924	4.779771745	4.702354285	2.747579689	0.707878729	0.05026896	1.16948244	2.104072865	7.988587341	0.352364221	3.056698878	0	0	6.15999276	0	0	0	0	0	0	0	0	0	4.165794657	0	0	0	0	0	0	0	0	0	58.9924	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6000	4.369	0.0489	0.3417	0.875	1.1872	0.6486	0.3033	0.161	1.7808	0.5286	0.6033	0.0591	0.0044	0.1027	0.8347	0.9439	0.0399	0.2237		0.4163	0.7753	0		0	0				0	0	0.6497										14.897	0	NO	10.123292	18.4341	0.517532311	1.844051548	0.875026	1.382058888	2.86898584	1.00843322	2.012008924	6.560547745	5.230910285	3.350862689	0.766963729	0.05470996	1.27221844	2.938769865	8.932511341	0.392303221	3.280397878	0	0.416254	6.93531576	0	0	0	0	0	0	0	0	0	4.815464657	0	0	0	0	0	0	0	0	0	73.8894
H5216_003_0	2012	4	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		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	770.68	36.43	477	396.39	14.26	8.2	3.17	273.57	327.82	1681.19	778.51	117.11	0.21	5.38	2127.18	3371.03	79.02	683.68		1883.73	18.44	0		4.95	2.86				5.23	1.24	930.57										4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN749: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.145033	65	91.572472	48.096561	38.265967	34.473503	0.2	0.2	10	26.753916	30	40.926653		0	0.2	0		0	0				0	0	50										NO	143.9554	115.177943	36.225158	0	94.0708	0.188142	0.136433	61.14602	86.142957	45.24482	35.997101	32.4295	0.188142	0.188142	9.40708	25.167623	28.22124	38.50003		0	0.188142	0		0	0				0	0	47.0354											9.2453	0.349661039	1.439950031	0	0.111787467	1.5427644	0.43249261	1.393976391	2.353282014	6.338761578	2.335341925	0.316484895	0.03950982	1.01220396	1.667546036	7.07006768	0.185836865	2.193475043	0	0	3.46933848	0	0	0	0	0	0	0	0	0	3.647477682	0	0	0	0	0	0	0	0	0	45.1453	0	NO	3.73361	9.2453	0.349661039	1.439950031	0	0.111787467	1.5427644	0.43249261	1.393976391	2.353282014	6.338761578	2.335341925	0.316484895	0.03950982	1.01220396	1.667546036	7.07006768	0.185836865	2.193475043	0	0	3.46933848	0	0	0	0	0	0	0	0	0	3.647477682	0	0	0	0	0	0	0	0	0	45.1453	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN749: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins										6000	3.8735	0.0435	0.3887	0.6263	0.7001	0.386	0.1491	0.1247	1.7792	0.4537	0.675	0.0284	0.0036	0.0914	0.5951	0.9431	0.0221	0.1579		0.527	0.4087	0		0	0				0	0	0.5675										12.5447	0	NO	5.709533	13.1188	0.393136039	1.828682031	0.626288	0.811927467	1.9287574	0.58163161	1.518659391	4.132440014	6.792452578	3.010377925	0.344911895	0.04306782	1.10363496	2.262661036	8.01317168	0.207942865	2.351388043	0	0.527007	3.87803348	0	0	0	0	0	0	0	0	0	4.214937682	0	0	0	0	0	0	0	0	0	57.6899
H5216_006_0	2012	4	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		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	866.5	47.35	368.51	423.5	15.71	7.3	4.02	302.44	331	1573.38	791.93	308.17	0.21	6.16	2124.18	2687.06	89.37	780.44		1763.55	13.48	0		3.75	0.61				5.23	1.24	1516.23										4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.139267	65	140.683309	46.251882	39.105519	33.02635	0.19972	0.2	10	29.888158	35	44.324019		0	0.2	0		0	0				0	0	50										NO	141.229409	112.996892	36.301103	0	93.2451	0.18649	0.12986	60.609315	131.180292	43.127613	36.46398	30.795453	0.186229	0.18649	9.32451	27.869243	32.635785	41.329976		0	0.18649	0		0	0				0	0	46.62255											10.1979	0.445866903	1.114776622	0	0.122073377	1.361377	0.5220372	1.527556769	3.618389721	5.654676978	2.406409973	0.790852896	0.03910809	1.1487784	1.650578138	6.240527341	0.243055009	2.687963872	0	0	2.5138852	0	0	0	0	0	0	0	0	0	5.890875749	0	0	0	0	0	0	0	0	0	48.1767	0	NO	4.543108	10.1979	0.445866903	1.114776622	0	0.122073377	1.361377	0.5220372	1.527556769	3.618389721	5.654676978	2.406409973	0.790852896	0.03910809	1.1487784	1.650578138	6.240527341	0.243055009	2.687963872	0	0	2.5138852	0	0	0	0	0	0	0	0	0	5.890875749	0	0	0	0	0	0	0	0	0	48.1767	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6000	3.9337	0.0556	0.3265	0.705	0.7786	0.416	0.229	0.1391	1.5667	0.4206	0.5557	0.0654	0.0037	0.1056	0.6854	0.867	0.0288	0.1755		0.569	0.3063	0		0	0				0	0	0.5842										12.5175	0	NO	5.265072	14.1316	0.501445903	1.441278622	0.705049	0.900630377	1.777409	0.7510632	1.666657769	5.185100721	6.075303978	2.962113973	0.856202896	0.04277009	1.2544234	2.335960138	7.107525341	0.271890009	2.863471872	0	0.569023	2.8201772	0	0	0	0	0	0	0	0	0	6.475074749	0	0	0	0	0	0	0	0	0	60.6942
H5216_007_0	2012	4	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		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	953.29	37.51	302.02	426.13	14.91	7.52	5.42	331.81	293.55	1668.29	864.92	121.03	0.17	14.11	2113.74	2749.88	68.68	636.48		1615.26	13.88	0		3.75	0.61				5.23	1.24	1066.9										4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.158204	65	138.110807	42.173777	39.192057	39.183542	0.199493	0.2	10	31.108549	35	40.421502		0	0.2	0		0	0				0	0	50										NO	140.174139	112.152576	36.585642	0	93.289	0.186578	0.147587	60.63785	128.842191	39.343494	36.561878	36.553934	0.186105	0.186578	9.3289	29.020854	32.65115	37.708815		0	0.186578	0		0	0				0	0	46.6445											11.1356	0.35057026	0.920799633	0	0.115911583	1.40306656	0.79992154	1.676687084	3.151802097	5.469696467	2.635258293	0.368676886	0.03163785	2.63261558	1.643239091	6.650322166	0.186873415	2.000075548	0	0	2.58970264	0	0	0	0	0	0	0	0	0	4.147084754	0	0	0	0	0	0	0	0	0	47.9095	0	NO	4.653597	11.1356	0.35057026	0.920799633	0	0.115911583	1.40306656	0.79992154	1.676687084	3.151802097	5.469696467	2.635258293	0.368676886	0.03163785	2.63261558	1.643239091	6.650322166	0.186873415	2.000075548	0	0	2.58970264	0	0	0	0	0	0	0	0	0	4.147084754	0	0	0	0	0	0	0	0	0	47.9095	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6000	4.0426	0.037	0.3136	0.9313	0.7292	0.423	0.3047	0.1506	1.6155	0.401	0.7702	0.0246	0.0029	0.2387	0.6729	0.8753	0.0219	0.1946		0.5142	0.2975	0		0	0				0	0	0.575										13.1363	0	NO	5.896176	15.1782	0.38759526	1.234370633	0.931347	0.845149583	1.82602156	1.10457954	1.827248084	4.767270097	5.870676467	3.405467293	0.393323886	0.03455785	2.87127358	2.316092091	7.525671166	0.208734415	2.194721548	0	0.514176	2.88723864	0	0	0	0	0	0	0	0	0	4.722057754	0	0	0	0	0	0	0	0	0	61.0457
H5253_004_0	2012	4																															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	1040.772134	97.3730396	818.5321058	455.9551611	152.5255542	6.754734048	8.409116717	260.096324	69.93059336	15.54019511	33.44552453	0	0.063228088	46.52231092	5241.500594	2969.915268	573.7785796	695.6418955	0	0	16.05627236	704.7200241	0	0	41.07906977	137.9310345	11.69735275	65	905.0609677	0											4450	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	66.55480777	0	200	0.2	0.079101707	63.48392004	0.16	0.239159785	0.18150868	0	0.2	0.145466026	11.93802306	38.07524805	38.5	40	0	0	0.2	39.16409062	0	0	40	15	20	352.5	0	0											NO	148.908394	84.3615394	53.01358231	0	159.3080473	0.159308047	0.063007692	50.5943189	0.127446438	0.190500392	0.144578967	0	0.159308047	0.115869543	11.52891703	36.77403305	37.18063733	38.62923359	0	0	0.159308047	31.195774	0	0	40	15	20	352.5	0	0												12.915	0.68454496	3.616109931	0	2.024879017	1.076083491	0.529839039	1.096616363	8.912405019	2.960413255	4.835519386	0	0.010072743	5.390518899	5.035735455	9.101313519	1.777787773	2.239342773	0	0	2.557893396	1.832023884	0	0	0.136930233	0.172413793	0.019495588	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	68.8343	0	NO	13.01603678	12.915	0.68454496	3.616109931	0	2.024879017	1.076083491	0.529839039	1.096616363	8.912405019	2.960413255	4.835519386	0	0.010072743	5.390518899	5.035735455	9.101313519	1.777787773	2.239342773	0	0	2.557893396	1.832023884	0	0	0.136930233	0.172413793	0.019495588	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	68.8343	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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1482	0.0138	0.3692	0.0132	0.0128	0	0.0127	0.0069	0.0843	0.0187	0.0445	0	0.0001	0.051	0.2959	0.5039	0.0867	0.1208	0	0	0.2007	0.1189	0	0	0.0071	0	0.0015	0	0	0											2.1108	0	NO	0	13.0632	0.698328763	3.985293226	0.013224329	2.037653352	1.076083491	0.5425161	1.103530909	8.996743423	2.979089585	4.880054573	0	0.010136289	5.441486984	5.33159921	9.60524672	1.864452246	2.360113935	0	0	2.758596801	1.950940689	0	0	0.144062016	0.172413793	0.021035932	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	70.9451
H5253_007_0	2012	4																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	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	414.7990076	40.262	9682.018275	5.650153742	23.41351246	22.9117469	9.236497945	12.53343668	15.1406651	29.71833786	17.66033676	0	0	20.80032725	3.371119384	99.21871998	2436.775134	76.7819955	0	28940.39075	14.20877474	4.597107417	1070.483218	160	31.87818174	141.1158645	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	14% (8a1a); $0 (8a2)	"$0 (8b1); 14% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a); $0 (9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $0 (7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.078627314	0.079582301	0	0	0.2	0.2	0.185384963	0.116971983	0.16	0	0.070186066	0	0	0.145237344	0	0.03409245	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.074734472	0.075642178	0	0	0.190097991	0.190097991	0.176206545	0.111180695	0.152078393	0	0.066711151	0	0	0.138046636	0	0.032404531	0	0	0	0	0.190097991	0.19044816	0	0	0	0	0	0	0	0												30.9998	3.045505371	0	0	4.450861678	4.355477054	1.627531393	1.393476199	2.302568014	0	1.178141384	0	0	2.871415214	0	3.215136084	0	0	0	0	2.701059531	0.875510648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0165	0	NO	3.072413551	30.9998	3.045505371	0	0	4.450861678	4.355477054	1.627531393	1.393476199	2.302568014	0	1.178141384	0	0	2.871415214	0	3.215136084	0	0	0	0	2.701059531	0.875510648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0165	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0	0.0001	0.1433	0.1403	0.0565	0.0299	0.0742	0	0.0842	0	0	0.0931	0.1089	3.6789	0.6329	0.021	0	0	0.5268	0.1705	0	0	0.0177	0	0	0	0	0											5.7784	0	NO	0	30.9998	3.045505371	0	0.000138817	4.594209713	4.495753056	1.68408138	1.42339581	2.376726374	0	1.262318631	0	0	2.964563324	0.108876169	6.894032443	0.6329136	0.020994809	0	0	3.227901741	1.045965192	0	0	0.017722173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.7949
H5253_011_0	2012	4																															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	689.687521	93.44860396	756.8139628	116.3236685	82.82484011	6.493284804	7.397912318	278.6899745	68.9609346	16.96093274	34.24378608	0	0.018245476	32.14811735	5292.826311	3385.967056	559.7964556	582.1402832	0	0	17.83705264	829.3454798	0	0	40.22325581	137.9310345	11.42103905	2.613989513	837.1538781	0											3400	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-8 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	199.8100905	118.6231222	59.5809959	0	200	0.2	0.091826302	63.50538694	0.16	0.196198907	0.179254937	0	0.2	0.144301982	5.498594157	27.01714644	38.5	30	0	0	0.2	28.7131431	0	0	30	15	30	0	0	0											YES	156.7436378	93.05545905	46.73909119	0	156.8926148	0.156892615	0.072034343	49.84476325	0.125514092	0.153910798	0.140618879	0	0.156892615	0.113199577	5.29791637	26.03446308	37.09489634	28.90511403	0	0	0.156892615	22.52440049	0	0	30	15	30	0	0	0											4800	9.0087	0.724658562	2.947733068	0	1.082883811	1.018748431	0.532903754	1.157602983	8.655569078	2.610470691	4.815322796	0	0.00286258	3.639153274	2.33674593	7.345986193	1.730465957	1.402235939	0	0	2.798501828	1.556709145	0	0	0.10055814	0.172413793	0.028552598	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6688	0	NO	11.62555056	9.0087	0.724658562	2.947733068	0	1.082883811	1.018748431	0.532903754	1.157602983	8.655569078	2.610470691	4.815322796	0	0.00286258	3.639153274	2.33674593	7.345986193	1.730465957	1.402235939	0	0	2.798501828	1.556709145	0	0	0.10055814	0.172413793	0.028552598	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6688	NO	"$355 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$355 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.2048	0.022	0	0.023	0.0427	0.1004	0.0686	0.0456	0.5118	0.1029	0.278	0	0.0001	0.2149	0.3451	0.5952	0.1238	0.1036	0	0	0.2535	0.1102	0	0	0.0075	0	0.0021	0	0	0											3.1559	0	NO	0.73992905	9.2135	0.746674467	2.947733068	0.023007032	1.12557215	1.11914858	0.601536335	1.20324339	9.167385572	2.713377998	5.093333149	0	0.002975426	3.85409614	2.681804885	7.941190828	1.854260562	1.505816442	0	0	3.052002366	1.666859567	0	0	0.108046512	0.172413793	0.030678855	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8246
H5253_021_0	2012	3																															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	1332.603426	100.7510308	1049.349425	498.8269321	178.9155137	6.711877322	7.829228282	295.1653493	64.70182027	15.5789703	32.35251258	0	0.064959732	42.39109867	5225.853153	3245.639325	567.0849562	682.1549901	0	0	12.1721245	721.5496964	0	0	41.07906977	137.9310345	14.03065545	65	113.4546991	0											3950	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	63.41845409	0	200	0.2	0.085303083	63.62860095	0.16	0.142406336	0.185311301	0	0.2	0.144490186	12.51548294	37.86946299	38.5	40	0	0	0.2	39.10660162	0	0	40	15	20	342.5	0	0											NO	144.1123693	81.64443246	48.88835771	0	154.1770717	0.154177072	0.065758898	49.07839143	0.123341657	0.109778959	0.142853769	0	0.154177072	0.111385369	12.02778476	36.40026075	36.99974786	38.44129648	0	0	0.154177072	30.14670661	0	0	40	15	20	342.5	0	0												16.0037	0.685480061	4.275080837	0	2.298722498	1.034817591	0.51484142	1.207186712	7.980429745	1.710243146	4.621678349	0	0.010015301	4.721748168	5.237953076	9.845176478	1.748500033	2.185243518	0	0	1.876662511	1.812695583	0	0	0.136930233	0.172413793	0.023384426	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	69.9581	0	NO	15.25833346	16.0037	0.685480061	4.275080837	0	2.298722498	1.034817591	0.51484142	1.207186712	7.980429745	1.710243146	4.621678349	0	0.010015301	4.721748168	5.237953076	9.845176478	1.748500033	2.185243518	0	0	1.876662511	1.812695583	0	0	0.136930233	0.172413793	0.023384426	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	69.9581	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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.1897	0.0143	0.4733	0.0124	0.015	0	0.0118	0.0079	0.078	0.0111	0.0439	0	0.0001	0.0461	0.3057	0.5482	0.0857	0.1184	0	0	0.1522	0.1216	0	0	0.0071	0	0.0023	0	0	0											2.2447	0	NO	0	16.1935	0.699742041	4.748369882	0.012408138	2.313707047	1.034817591	0.526644277	1.215051435	8.058462091	1.721391609	4.665543733	0	0.010080587	4.767875371	5.543696526	10.39336211	1.83415349	2.303673204	0	0	2.028814067	1.934296266	0	0	0.144062016	0.172413793	0.025635921	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	72.2029
H5253_024_0	2012	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	267.2087323	22.5474	36.64642054	1659.134193	12.58278419	14.68300349	13.36200143	27.79714736	53.32097193	17.16595101	34.3216756	0	0	51.64378727	33.89130805	68.47863418	10.9839	6.43954097	0	847.7075756	16.84497413	6.517270994	0	148.0337348	42.79069767	197.6190476	0	0	148.3536387	2963.350567											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.079127569	0.080088633	0.162857823	0	0.224	0.224	0.224	0.126679988	0.224	0.224	0.224	0	0	0.224	0.220672907	0.224118037	0.230821072	0.224	0	0	0.224	0.222507323	0	0	0	0	0	0	0	0											NO	0.062549627	0.063309339	0.128737634	0	0.177069972	0.177069972	0.177069972	0.100154682	0.177069972	0.177069972	0.177069972	0	0	0.177069972	0.174439935	0.177163279	0.182461968	0.177069972	0	0	0.177069972	0.177193063	0	0	0	0	0	0	0	0												16.7138	1.427460991	4.717773476	0	2.22803324	2.599919012	2.366009215	2.784014461	9.441542988	3.039574459	6.077338126	0	0	9.144563948	5.911997572	12.13189937	2.004144006	1.140249337	0	0	2.982739091	1.154815209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8659	150	YES	22.74632266	16.7138	1.427460991	4.717773476	0	2.22803324	2.599919012	2.366009215	2.784014461	9.441542988	3.039574459	6.077338126	0	0	9.144563948	5.911997572	12.13189937	2.004144006	1.140249337	0	0	2.982739091	1.154815209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8659	NO																																										0	0	0	0	0	0	0	0	0	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	16.7138	1.427460991	4.717773476	0	2.22803324	2.599919012	2.366009215	2.784014461	9.441542988	3.039574459	6.077338126	0	0	9.144563948	5.911997572	12.13189937	2.004144006	1.140249337	0	0	2.982739091	1.154815209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8659
H5253_028_0	2012	4																															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	578.8501328	91.88434524	551.0690037	67.41394065	82.17795693	6.033110884	6.271527747	252.7084555	55.23176931	12.81456024	25.84973781	0	0.008886034	35.06689439	5240.675741	3149.711158	561.6750062	670.3625064	0	0	19.18954373	669.14017	0	0	40.22325581	137.9310345	14.25567322	2.613989513	479.1436935	0											3400	"$195 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	180.1800198	112.2768957	59.10295153	0	200	0.2	0.087115584	63.46021854	0.16	0.243927472	0.184751096	0	0.2	0.14349677	5.394862919	26.94766375	38.5	30	0	0	0.2	29.05385569	0	0	30	15	30	0	0	0											NO	144.8612779	90.26846933	47.51763872	0	160.7961616	0.160796162	0.070039258	51.04701239	0.128636929	0.196113006	0.148536335	0	0.160796162	0.115368649	5.217350638	26.06513418	37.23319806	29.01288161	0	0	0.160796162	23.35874238	0	0	30	15	30	0	0	0												6.9877	0.691188267	2.182124819	0	1.101158337	0.970101073	0.439253148	1.075000972	7.104845202	2.513101929	3.839625317	0	0.00142884	4.045620231	2.27853691	6.84147033	1.742746396	1.620762336	0	0	3.085604975	1.302522737	0	0	0.10055814	0.172413793	0.035639183	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1315	0	NO	9.039026158	6.9877	0.691188267	2.182124819	0	1.101158337	0.970101073	0.439253148	1.075000972	7.104845202	2.513101929	3.839625317	0	0.00142884	4.045620231	2.27853691	6.84147033	1.742746396	1.620762336	0	0	3.085604975	1.302522737	0	0	0.10055814	0.172413793	0.035639183	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1315	NO	"$250 Days 1-Unlimited/$395 Days 1-Unlimited (1a); $250 (1a1); $0 n/c (1a2, 1a3)"	"$395 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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.324	0.0458	0	0.0177	0.0571	0.1257	0.0784	0.0557	0.5523	0.1302	0.2897	0	0.0001	0.3142	0.3502	0.5792	0.13	0.1248	0	0	0.3675	0.1208	0	0	0.0075	0	0.0027	0	0	0											3.6733	0	NO	0	7.3118	0.736981165	2.182124819	0.017663099	1.158226362	1.095790883	0.517647245	1.13068477	7.657162895	2.643344566	4.129283106	0	0.001502891	4.359781903	2.628752309	7.420679521	1.872708432	1.745563867	0	0	3.453064323	1.423307131	0	0	0.108046512	0.172413793	0.038293165	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8048
H5253_030_0	2012	4																															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	698.8400132	76.27919366	766.8572559	117.8673407	83.92396643	6.939877038	7.590453713	282.3533522	70.84278359	17.42377324	35.17825187	0	0.01874337	33.01712224	5344.491829	3439.077596	365.7836186	589.8655707	0	0	17.99214159	840.3513017	0	0	40.22325581	137.9310345	16.57983572	2.613989513	517.7957556	0											3900	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $18 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$5 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$5/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	168.4065678	101.7427073	68.64589438	0	200	0.2	0.091826302	63.50520181	0.16	0.217711828	0.178792641	0	0.2	0.144046793	2.893492506	26.99543659	38.5	30	0	0	0.2	28.7131431	0	0	30	15	30	0	0	0											YES	137.8301119	83.26996334	56.18231775	0	163.6873356	0.163687336	0.075154013	51.9963829	0.130949868	0.178183345	0.146330455	0	0.163687336	0.117893179	2.805889556	26.18217833	37.3343797	29.09172444	0	0	0.163687336	23.49988945	0	0	30	15	30	0	0	0											5900	8.0268	0.529313805	3.590318168	0	1.144774205	1.135969982	0.570453061	1.223446085	9.276853193	3.104626197	5.147649604	0	0.003068052	3.892493495	1.24967115	7.503545242	1.138025376	1.43001722	0	0	2.945085718	1.645680224	0	0	0.10055814	0.172413793	0.041449589	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8722	0	NO	9.721462972	8.0268	0.529313805	3.590318168	0	1.144774205	1.135969982	0.570453061	1.223446085	9.276853193	3.104626197	5.147649604	0	0.003068052	3.892493495	1.24967115	7.503545242	1.138025376	1.43001722	0	0	2.945085718	1.645680224	0	0	0.10055814	0.172413793	0.041449589	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8722	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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.2116	0.0196	0	0.0251	0.0461	0	0.075	0.0492	0.56	0.125	0.3035	0	0.0001	0.2348	0.3476	0.6702	0.0816	0.1211	0	0	0.2724	0.1354	0	0	0.0086	0	0.0035	0	0	0											3.2905	0	NO	0.588965015	8.2384	0.548917592	3.590318168	0.025144121	1.190847784	1.135969982	0.64546082	1.272689898	9.836899656	3.229577685	5.451154598	0	0.003191532	4.127333048	1.59726364	8.173724455	1.219667498	1.551080886	0	0	3.217453638	1.781033562	0	0	0.109116279	0.172413793	0.044977214	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1626
H5253_801_0	2012	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	232.8527373	4.7956	41.33539917	573.4105844	5.842261999	6.203245835	8.120603356	13.15657861	69.91311184	17.72233017	35.65738794	0	0.779610838	45.07829599	27.73482886	65.14845203	2.2529	8.838567217	0	0	22.45548234	7.948066734	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081219135	0.081219135	0.163635743	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068848673	0.068848673	0.138712434	0	0.189882629	0.189882629	0.189882629	0.189882629	0.189882629	0.189882629	0.189882629	0	0.189882629	0.189882629	0.189882629	0.189882629	0.189882629	0.189882629	0	0	0.189882629	0.189882629	0	0	0	0	0	0	0	0												16.0316	0.330170697	5.733733812	0	1.109344067	1.177888627	1.541961513	2.498205734	13.27528547	3.365162643	6.770718562	0	0.148034555	8.559585348	5.266362216	12.37055934	0.427786575	1.678290379	0	0	4.263906019	1.509199806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0578	150	YES	15.46252981	16.0316	0.330170697	5.733733812	0	1.109344067	1.177888627	1.541961513	2.498205734	13.27528547	3.365162643	6.770718562	0	0.148034555	8.559585348	5.266362216	12.37055934	0.427786575	1.678290379	0	0	4.263906019	1.509199806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0578	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	NO	0	16.0316	0.330170697	5.733733812	0	1.109344067	1.177888627	1.541961513	2.498205734	13.27528547	3.365162643	6.770718562	0	0.148034555	8.559585348	5.266362216	12.37055934	0.427786575	1.678290379	0	0	4.263906019	1.509199806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0578
H5253_802_0	2012	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	232.6706421	4.7963	41.30307411	572.9621666	5.83769324	6.19839478	8.114252891	13.14628992	69.85843847	17.70847097	35.6295032	0	0.779001168	45.04215455	27.7131397	65.09750471	2.2521	8.831655292	0	0	22.43792173	7.941851196	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081219135	0.081219135	0.163635743	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068864654	0.068864654	0.138744631	0	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0	0	0.189926703	0.189926703	0	0	0	0	0	0	0	0												16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108	150	YES	15.43053565	16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108	NO																																										0	0	0	0	0	0	0	0	0	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	16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108
H5253_805_0	2012	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	232.6706421	4.7963	41.30307411	572.9621666	5.83769324	6.19839478	8.114252891	13.14628992	69.85843847	17.70847097	35.6295032	0	0.779001168	45.04215455	27.7131397	65.09750471	2.2521	8.831655292	0	0	22.43792173	7.941851196	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081219135	0.081219135	0.163635743	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068864654	0.068864654	0.138744631	0	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0.189926703	0	0	0.189926703	0.189926703	0	0	0	0	0	0	0	0												16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108	150	YES	15.43053565	16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108	NO																																										0	0	0	0	0	0	0	0	0	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	16.0228	0.330295539	5.730579764	0	1.108733832	1.177240687	1.541113302	2.496831506	13.26798292	3.363311514	6.766994084	0	0.147953124	8.554707925	5.263465263	12.36375447	0.427733929	1.677367175	0	0	4.261560504	1.508369616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0108
H5253_807_0	2012	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	229.1805824	4.725833	41.30307411	550.0436799	5.604185511	5.950458989	7.789682776	12.62043832	67.06410093	17.00013214	34.20432307	0	0.747841121	43.24056437	26.23129747	61.19165443	2.123084	8.301755974	0	0	21.09164642	7.465340124	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.081219135	0.081219135	0.163635743	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068999977	0.068999977	0.139017272	0	0.190299921	0.190299921	0.190299921	0.190299921	0.190299921	0.190299921	0.190299921	0	0.190299921	0.190299921	0.190299921	0.190299921	0.190299921	0.190299921	0	0	0.190299921	0.190299921	0	0	0	0	0	0	0	0												15.8135	0.326082369	5.741840708	0	1.06647606	1.132371876	1.482376017	2.401668417	12.76229311	3.235123804	6.50907998	0	0.142314106	8.228675986	4.991813839	11.64476701	0.404022718	1.579823507	0	0	4.01373865	1.420653636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8966	150	YES	14.68009637	15.8135	0.326082369	5.741840708	0	1.06647606	1.132371876	1.482376017	2.401668417	12.76229311	3.235123804	6.50907998	0	0.142314106	8.228675986	4.991813839	11.64476701	0.404022718	1.579823507	0	0	4.01373865	1.420653636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8966	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.2835	0.0058	0	0	0.0523	0.0555	0.0727	0.1178	0.6259	0.1587	0.3192	0	0.007	0.4036	0.3319	0.8749	0.0304	0.1187	0	0	0.3016	0.1067	0	0	0	0	0	0	0	0											3.8662	150	YES	0	16.0969	0.331927467	5.741840708	0	1.118781792	1.187909493	1.555079723	2.519459175	13.38822472	3.393791704	6.828320329	0	0.149293957	8.632254587	5.323746498	12.51967747	0.434378302	1.698520954	0	0	4.315304318	1.527392117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7628
H5262_001_0	2012	7	f.	e.2.	e.2.								OP Facility - Emergency	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	Coin	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	194.6448957	2.474299522	38.15905971	0	0	10.83134274	0.892329162	292.2248294	0	0	0	0	1.274116637	60.81348875	2703.84164	4123.988026	157.0949882	547.9963298	0	0	0	2.224353815	0	0	141.9384603	0	0	0	0	0	3.605706322	0.035526796	3.950052739								3400	1A IP Acute: $500 per admit	1B IP Psych: $500 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Supplies and Services: 10%"	4A ER: $50	9B ASC Services: $0	"8A OP Procs/Tests/Labs: $0, 8A AAA Screenings: $0, 8A Cardiac Screenings: $0, 8A EKGs: $0"	8B OP Radiology: $0	9A OP Hospital: $0	12 End Stage Renal: 20%	"5 Partial Hosp: $0, 9C OP substance Abuse: $20, 3 Cardiac and Pulmonary Rehab: $10, 9D Outpatient Blood Services: $0"	"14A Medicare-Covered Preventative Services: $0, 14B Supplemental Preventative Services: $0, 14D Kidney Disease Education: $0, 14E Diabetes Self-Management: $0, 7A PCP: $20"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $20, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"16B Medicare Covered Comp Dental Services: $20, 17A medicare Covered Eye Exams: $20, 17A Glaucoma Screenings: $0,17B Eye Wear: Medicare Covered: $0"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $20	17B Supplemental Eye Wear: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $20	11C Diabetes Monitoring Supplies: 5%	11C Diabetes Non Preferred Monitoring Supplies: 25%								0	NO	500	500	0.1			0.1	0.1	50					0.2	10	20	19.73533005	20	20		20		20			20						20	0.05	0.25								NO	495.7955986	495.7955986	0.09915912			0.09915912	0.09915912	49.57955986					0.198318239	9.915911972	19.83182394	19.56937955	19.83182394	19.83182394		19.83182394		19.83182394			19.83182394						19.83182394	0.04957956	0.247897799									8.042	0.102228901	3.78381877	0	0	1.074026412	0.088482574	1.207364869	0	0	0	0	0.252680568	0.050251767	4.468509282	6.725323913	0.259623346	0.905647228	0	0	0	0.003676083	0	0	0.23457488	0	0	0	0	0	0.005958978	0.001761403	0.979209381	0	0	0	0	0	0	0	28.1851	0	NO	0.24104	8.042	0.102228901	3.78381877	0	0	1.074026412	0.088482574	1.207364869	0	0	0	0	0.252680568	0.050251767	4.468509282	6.725323913	0.259623346	0.905647228	0	0	0	0.003676083	0	0	0.23457488	0	0	0	0	0	0.005958978	0.001761403	0.979209381	0	0	0	0	0	0	0	28.1851	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	NO	0	8.042	0.102228901	3.78381877	0	0	1.074026412	0.088482574	1.207364869	0	0	0	0	0.252680568	0.050251767	4.468509282	6.725323913	0.259623346	0.905647228	0	0	0	0.003676083	0	0	0.23457488	0	0	0	0	0	0.005958978	0.001761403	0.979209381	0	0	0	0	0	0	0	28.1851
H5262_003_0	2012	7	f.	e.2.	e.2.								OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies								Urgently Needed Services	Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								D	A	Coin	V	P	Coin	Coin	V	V	Coin	Coin	V	Coin	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	478.1450856	9.917635293	16.57420406	0	0	5.825934314	1.593993421	945.9775478	525.8101363	17.8618663	24.96703338	0	0.212387914	170.2792971	1999.22768	2825.372066	103.6843611	544.7736412	0	0	0	2.720650891	0	0	76.64108317	0	0	0	0	0	6.562453527	0.038067688	2.252551748								3400	1A IP Acute: $200 per day (1-17 only)	1B IP Psych: $500 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 20%	"11B Prosthetic Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	4A ER: $50	9B ASC Services: $75	"8A OP C/D/T: 10%, 8A EKG, AAA Screenings, Cardiac Screenings: $0"	8B OP X-Ray: 10%	9A OP Hospital: $0	12 Renal Dialysis: 20%	"5 Partial Hosp: $0, 9C OP substance Abuse: $35, 3 Cardiac and Pulmonary Rehab: $15, 9D Outpatient Blood Services: $0"	"14A Medicare-Covered Preventative Services: $0, 14B Supplemental Preventative Services: $0, 14D Kidney Disease Education: $0, 14E Diabetes Self-Management: $0, 7A PCP: $35"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $35, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $35, 17A medicare Covered Eye Exams: $35, 17A Glaucoma Screenings: $0, 17B Eye Wear: Medicare Covered: $0"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $35	17B Eye Wear Supplemental: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $35	11C Diabetes Monitoring Supplies: 15%	11C Diabetes Non Preferred Monitoring Supplies: 35%								0	NO	186.89	500	0.1			0.2	0.2	50	75	0.1	0.1		0.2	15	35	33.90552995	35	35		35		35			35						35	0.15	0.35								NO	184.3878118	493.3057193	0.098661144			0.197322288	0.197322288	49.33057193	73.99585789	0.098661144	0.098661144		0.197322288	14.79917158	34.53140035	33.45158368	34.53140035	34.53140035		34.53140035		34.53140035			34.53140035						34.53140035	0.147991716	0.345314003									7.347	0.407702184	1.635229931	0	0	1.149586687	0.314530428	3.888801122	3.242314344	1.762272161	2.463276072	0	0.041908869	0.209999378	5.753010949	7.876097509	0.298363849	1.567649725	0	0	0	0.00782899	0	0	0.220543661	0	0	0	0	0	0.018884226	0.005633703	0.777837662	0	0	0	0	0	0	0	38.9885	0	NO	0.536263143	7.347	0.407702184	1.635229931	0	0	1.149586687	0.314530428	3.888801122	3.242314344	1.762272161	2.463276072	0	0.041908869	0.209999378	5.753010949	7.876097509	0.298363849	1.567649725	0	0	0	0.00782899	0	0	0.220543661	0	0	0	0	0	0.018884226	0.005633703	0.777837662	0	0	0	0	0	0	0	38.9885	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	NO	0	7.347	0.407702184	1.635229931	0	0	1.149586687	0.314530428	3.888801122	3.242314344	1.762272161	2.463276072	0	0.041908869	0.209999378	5.753010949	7.876097509	0.298363849	1.567649725	0	0	0	0.00782899	0	0	0.220543661	0	0	0	0	0	0.018884226	0.005633703	0.777837662	0	0	0	0	0	0	0	38.9885
H5262_004_0	2012	6	f.	e.2.	e.2.								OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies								Urgently Needed Services	Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								D	A	Coin	V	P	Coin	Coin	V	V	Coin	Coin	V	Coin	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	317.6282447	8.14085125	16.923901	0	0	4.758091042	0.296394098	851.0965536	575.9073464	14.37800038	24.67357429	0	0.293487403	147.8140971	1850.112627	2331.325405	94.27829349	593.5460714	0	0	0	0	0	0	32.2638985	0	0	0	0	0	0	0.072051398	1.27751592								3400	1A IP Acute: $200 per day (1-17 only)	1B IP Psych: $500 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 20%	"11B Prosthetic Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	4A ER: $50	9B ASC Services: $75	"8A OP C/D/T: 10%, 8A EKG, AAA Screenings, Cardiac Screenings: $0"	8B OP X-Ray: 10%	9A OP Hospital: $0	12 Renal Dialysis: 20%	"5 Partial Hosp: $0, 9C OP substance Abuse: $35, 3 Cardiac and Pulmonary Rehab: $15, 9D Outpatient Blood Services: $0"	"14A Medicare-Covered Preventative Services: $0, 14B Supplemental Preventative Services: $0, 14D Kidney Disease Education: $0, 14E Diabetes Self-Management: $0, 7A PCP: $35"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $35, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $35, 17A medicare Covered Eye Exams: $35, 17A Glaucoma Screenings: $0, 17B Eye Wear: Medicare Covered: $0"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $35	17B Eye Wear Supplemental: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $35	11C Diabetes Monitoring Supplies: 15%	11C Diabetes Non Preferred Monitoring Supplies: 35%								0	NO	186.89	500	0.1			0.2	0.2	50	75	0.1	0.1		0.2	15	35	33.93814997	35	35		35		35			35						35	0.15	0.35								NO	183.9738159	492.1981271	0.098439625			0.196879251	0.196879251	49.21981271	73.82971906	0.098439625	0.098439625		0.196879251	14.76594381	34.4538689	33.40858771	34.4538689	34.4538689		34.4538689		34.4538689			34.4538689						34.4538689	0.147659438	0.344538689									4.8696	0.333909312	1.665982475	0	0	0.9367694	0.058353848	3.49090108	3.543256466	1.415364971	2.428857411	0	0.05778158	0.181884554	5.311961492	6.490524106	0.270687664	1.704163211	0	0	0	0	0	0	0.092634677	0	0	0	0	0	0	0.010639069	0.44015366	0	0	0	0	0	0	0	33.3034	0	NO	0.536263143	4.8696	0.333909312	1.665982475	0	0	0.9367694	0.058353848	3.49090108	3.543256466	1.415364971	2.428857411	0	0.05778158	0.181884554	5.311961492	6.490524106	0.270687664	1.704163211	0	0	0	0	0	0	0.092634677	0	0	0	0	0	0	0.010639069	0.44015366	0	0	0	0	0	0	0	33.3034	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									0	0	0	0	0	0	0	0	0	0	0	0	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	4.8696	0.333909312	1.665982475	0	0	0.9367694	0.058353848	3.49090108	3.543256466	1.415364971	2.428857411	0	0.05778158	0.181884554	5.311961492	6.490524106	0.270687664	1.704163211	0	0	0	0	0	0	0.092634677	0	0	0	0	0	0	0.010639069	0.44015366	0	0	0	0	0	0	0	33.3034
H5262_005_0	2012	6	f.	e.2.	e.2.								OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies								Urgent Care	Preferred Diabetic Supplies	Non Preferred Diabetic Supplies								A	A	Coin	V	P	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	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	250.2881386	2.467243425	41.89063854	0	0	10.38741642	0.21636195	319.3084429	0	0	0	0	0.460170982	63.07909761	2978.997706	4016.361034	59.05452962	404.7720014	0	0	0	2.495261815	0	0	159.2970238	0	0	0	0	0	4.793898307	0.479972437	1.976571318								3400	1A IP Acute: $500 per admit	1B IP Psych: $500 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Supplies and Services: 10%"	4A ER: $50	9B ASC Services: $0	"8A OP Procs/Tests/Labs: $0, 8A AAA Screenings: $0, 8A Cardiac Screenings: $0, 8A EKGs: $0"	8B OP Radiology: $0	9A OP Hospital: $0	12 End Stage Renal: 20%	"5 Partial Hosp: $0, 9C OP substance Abuse: $20, 3 Cardiac and Pulmonary Rehab: $10, 9D Outpatient Blood Services: $0"	"14A Medicare-Covered Preventative Services: $0, 14B Supplemental Preventative Services: $0, 14D Kidney Disease Education: $0, 14E Diabetes Self-Management: $0, 7A PCP: $20"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $20, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"16B Medicare Covered Comp Dental Services: $20, 17A medicare Covered Eye Exams: $20, 17A Glaucoma Screenings: $0,17B Eye Wear: Medicare Covered: $0"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $20	17B Supplemental Eye Wear: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $20	11C Diabetes Monitoring Supplies: 5%	11C Diabetes Non Preferred Monitoring Supplies: 25%								0	NO	500	500	0.1			0.1	0.1	50					0.2	10	20	19.74090185	20	20		20		20			20						20	0.05	0.25								NO	496.0663292	496.0663292	0.099213266			0.099213266	0.099213266	49.60663292					0.198426532	9.921326584	19.84265317	19.58559343	19.84265317	19.84265317		19.84265317		19.84265317			19.84265317						19.84265317	0.049606633	0.248033165									10.3466	0.101993032	4.156107058	0	0	1.030569506	0.021465976	1.319984726	0	0	0	0	0.091310132	0.052152361	4.925934856	6.555234523	0.097649879	0.669312536	0	0	0	0.004126051	0	0	0.263406299	0	0	0	0	0	0.007926972	0.023809816	0.490255239	0	0	0	0	0	0	0	30.1579	0	NO	0.24104	10.3466	0.101993032	4.156107058	0	0	1.030569506	0.021465976	1.319984726	0	0	0	0	0.091310132	0.052152361	4.925934856	6.555234523	0.097649879	0.669312536	0	0	0	0.004126051	0	0	0.263406299	0	0	0	0	0	0.007926972	0.023809816	0.490255239	0	0	0	0	0	0	0	30.1579	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	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	10.3466	0.101993032	4.156107058	0	0	1.030569506	0.021465976	1.319984726	0	0	0	0	0.091310132	0.052152361	4.925934856	6.555234523	0.097649879	0.669312536	0	0	0	0.004126051	0	0	0.263406299	0	0	0	0	0	0.007926972	0.023809816	0.490255239	0	0	0	0	0	0	0	30.1579
H5291_001_0	2012	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		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	1114.7	76.4	445.67	907.88	207.85	20.26	3.05	375.01	332.02	689.08	1147.62	129.57	0.2	378.2	4201.06	3636.1	84.8	1005.47		1749.56	24.67	0		2.75	0.6				6.13	1.19	759.23										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$40-$100/Visit: 3. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329116	0	100	0.2	0.2	65	225	29.652591	50.954242	36.244196	0.2	58.271241	10	34.618932	35	36.475846		0	0.2	0		0	0				0	0	0										NO	131.28232	102.47637	36.85638	0	87.5216	0.175043	0.175043	56.88904	196.9236	25.952422	44.595968	31.7215	0.175043	50.999923	8.75216	30.299043	30.63256	31.924244		0	0.175043	0		0	0				0	0	0											12.195	0.652432889	1.36881524	0	1.515947047	3.54637118	0.53388115	1.777829908	5.448547806	1.490274579	4.2649354	0.342512896	0.0350086	1.607347573	3.064029107	9.180862521	0.216470091	2.674905801	0	0	4.31831081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2335	0	NO	9.183708	12.195	0.652432889	1.36881524	0	1.515947047	3.54637118	0.53388115	1.777829908	5.448547806	1.490274579	4.2649354	0.342512896	0.0350086	1.607347573	3.064029107	9.180862521	0.216470091	2.674905801	0	0	4.31831081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2335	NO																																																																																		0	0	NO	0	12.195	0.652432889	1.36881524	0	1.515947047	3.54637118	0.53388115	1.777829908	5.448547806	1.490274579	4.2649354	0.342512896	0.0350086	1.607347573	3.064029107	9.180862521	0.216470091	2.674905801	0	0	4.31831081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2335
H5291_002_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1326.89	42.71	748.62	1660.24	226.08	13.38	3.2	338.4	226.85	310.85	756.29	84.56	0.51	629.17	3336.32	3457.5	91.52	505.26		2206.87	22.37	0			0.6				6.13	1.19	398.52										3400	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$255/Visit: 9b. $0 Surgery ASC -- Physician,9b. $255 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $255 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$40-$100/Visit: 3. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												185.85435	128.006658	44.329117	0	100	0.2	0.2	65	255	44.259299	65.460297	40.71804	0.2	57.195626	15	38.888804	40	43.808129		0	0.2	0			0				0	0	0										NO	140.585992	96.828204	33.229194	0	86.9232	0.173846	0.173846	56.50008	221.65416	38.471599	56.900185	35.393423	0.173846	49.716269	13.03848	33.803393	34.76928	38.079427		0	0.173846	0			0				0	0	0											15.5452	0.344627716	2.073003268	0	1.637633088	2.32605948	0.5563072	1.593302256	4.190187183	0.996574712	3.586086743	0.249405654	0.08866146	2.606665414	3.625045133	9.739602608	0.265173709	1.603334274	0	0	3.88893502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9158	0	NO	11.368169	15.5452	0.344627716	2.073003268	0	1.637633088	2.32605948	0.5563072	1.593302256	4.190187183	0.996574712	3.586086743	0.249405654	0.08866146	2.606665414	3.625045133	9.739602608	0.265173709	1.603334274	0	0	3.88893502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9158	NO																																																																																		0	0	NO	0	15.5452	0.344627716	2.073003268	0	1.637633088	2.32605948	0.5563072	1.593302256	4.190187183	0.996574712	3.586086743	0.249405654	0.08866146	2.606665414	3.625045133	9.739602608	0.265173709	1.603334274	0	0	3.88893502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9158
H5291_801_0	2012	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	YES	250.5	2.91	44.71	24.89	8.55	13.85	4.21	24.14	64.16	8.64	29.78	0.66	0.47	18.76	38.11	95.62	0.65	7.55		15.5	33.07	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																					0.0816	0.0816	0.1476	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069122	0.069122	0.118234	0	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136	0.200136		0.200136	0.200136	0																				17.3151	0.20114502	5.28624214	0	1.7111628	2.7718836	0.84257256	4.83128304	12.84072576	1.72917504	5.96005008	0.13208976	0.09406392	3.75455136	7.62718296	19.13700432	0.1300884	1.5110268	0	3.102108	6.61849752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5959	0	NO	13.154623	17.3151	0.20114502	5.28624214	0	1.7111628	2.7718836	0.84257256	4.83128304	12.84072576	1.72917504	5.96005008	0.13208976	0.09406392	3.75455136	7.62718296	19.13700432	0.1300884	1.5110268	0	3.102108	6.61849752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5959	NO																																																																																		0	0	NO	0	17.3151	0.20114502	5.28624214	0	1.7111628	2.7718836	0.84257256	4.83128304	12.84072576	1.72917504	5.96005008	0.13208976	0.09406392	3.75455136	7.62718296	19.13700432	0.1300884	1.5110268	0	3.102108	6.61849752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5959
H5291_802_0	2012	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	YES	250.5	2.91	44.71	24.89	8.55	13.85	4.21	24.14	64.16	8.64	29.78	0.66	0.47	18.76	38.11	95.62	0.65	7.55		15.5	33.07	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																					0.082	0.082	0.1476	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069423	0.069423	0.118176	0	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111	0.200111		0.200111	0.200111	0																				17.3905	0.20202093	5.28364896	0	1.71094905	2.77153735	0.84246731	4.83067954	12.83912176	1.72895904	5.95930558	0.13207326	0.09405217	3.75408236	7.62623021	19.13461382	0.13007215	1.51083805	0	3.1017205	6.61767077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6605	0	NO	13.191568	17.3905	0.20202093	5.28364896	0	1.71094905	2.77153735	0.84246731	4.83067954	12.83912176	1.72895904	5.95930558	0.13207326	0.09405217	3.75408236	7.62623021	19.13461382	0.13007215	1.51083805	0	3.1017205	6.61767077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6605	NO																																																																																		0	0	NO	0	17.3905	0.20202093	5.28364896	0	1.71094905	2.77153735	0.84246731	4.83067954	12.83912176	1.72895904	5.95930558	0.13207326	0.09405217	3.75408236	7.62623021	19.13461382	0.13007215	1.51083805	0	3.1017205	6.61767077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6605
H5291_803_0	2012	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	YES	250.5	2.91	44.71	24.89	8.55	13.85	4.21	24.14	64.16	8.64	29.78	0.66	0.47	18.76	38.11	95.62	0.65	7.55		15.5	33.07	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																					0.078	0.078	0.148	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.066405	0.066405	0.119018	0	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362	0.200362		0.200362	0.200362	0																				16.6345	0.19323855	5.32129478	0	1.7130951	2.7750137	0.84352402	4.83673868	12.85522592	1.73112768	5.96678036	0.13223892	0.09417014	3.75879112	7.63579582	19.15861444	0.1302353	1.5127331	0	3.105611	6.62597134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0247	0	NO	12.831836	16.6345	0.19323855	5.32129478	0	1.7130951	2.7750137	0.84352402	4.83673868	12.85522592	1.73112768	5.96678036	0.13223892	0.09417014	3.75879112	7.63579582	19.15861444	0.1302353	1.5127331	0	3.105611	6.62597134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0247	NO																																																																																		0	0	NO	0	16.6345	0.19323855	5.32129478	0	1.7130951	2.7750137	0.84352402	4.83673868	12.85522592	1.73112768	5.96678036	0.13223892	0.09417014	3.75879112	7.63579582	19.15861444	0.1302353	1.5127331	0	3.105611	6.62597134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0247
H5294_001_0	2012	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	309.8437822	16.11498305	41.45840957	0	16.52883525	23.04724314	17.04179129	29.82495274	38.87462225	5.582846463	13.50444856	0	1.416546701	20.11590687	44.66824497	47.13020172	7.261546722	4.592260444	18.20397444	59.25477998	22.89721817	22.47363566	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost Sharing; PBP 13a-e											0	YES	0.075179901	0.075179901	0.195736323	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074831084	0.074831084	0.194828151	0	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0.222960691	0	0	0	0	0	0	0	0												23.1859	1.205901643	8.077265294	0	3.685280535	5.138629266	3.799649569	6.649792084	8.667512656	1.244755307	3.010961187	0	0.315834232	4.485056505	9.959262783	10.50818236	1.619039478	1.023893564	4.058770728	13.21148671	5.105179594	5.010737345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9631	0	NO	0.559195963	23.1859	1.205901643	8.077265294	0	3.685280535	5.138629266	3.799649569	6.649792084	8.667512656	1.244755307	3.010961187	0	0.315834232	4.485056505	9.959262783	10.50818236	1.619039478	1.023893564	4.058770728	13.21148671	5.105179594	5.010737345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9631	NO																																										0	0	0	0	0	0	0	0	0	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	23.1859	1.205901643	8.077265294	0	3.685280535	5.138629266	3.799649569	6.649792084	8.667512656	1.244755307	3.010961187	0	0.315834232	4.485056505	9.959262783	10.50818236	1.619039478	1.023893564	4.058770728	13.21148671	5.105179594	5.010737345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9631
H5302_003_0	2012	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	COIN	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	898.1772756	32.41737039	232.9019687	0	151.5054545	4.494876486	5.524541718	329.2517243	326.9376206	2218.440062	938.4102028	119.2072045	0.026132855	351.6150489	3250.479591	10753.12418	164.5928845	369.6443552	1605.010503	1736.500908	15.98804743	0	0	0	0	0	0	0	0	0											4375	1a $250 days 1-7	1b $200 days 1-7	"2 $50 days 1-20, $125 Days 21 to 100"	6 $0	10a $200	11a 20%	11b 20%	"4a $65, 4b $25"	"9a $350, 9b $350"	"8a $40, 14a $0"	"8a X-Ray $40, Ther. $40 , CT  $71, Other (CAT Scan and MRI) $375, 9a $40"	9a $250 (observation)	12a 20%	"3 $40, 9a (Other Cardiology) $71, 9a $0, 13a $0"	"7a $25, 14a $0, 14b $0"	"7b $20, 7d $40, 7f $40, 8a $0, 9a $40, 14a 0%, 17a $0, 17b $40"	"7e $40, 7h $40"	"7c $40, 7i $40"	"8b $40, 14a $0"	"7g (other medicine) $25, 7g (Other Physician Services) $40"	"11c 20%, 15 20%"				17a $0				"13c OTC $0, 13d Meals on Wheels $0/discharage, 14c Fitness $0"													NO	204.4491525	175	61.14864865	0	200	0.2	0.2	63.37725916	301.7832168	33.59563733	84.17641556	82.5	0.2	58.15016669	24.45898161	17.79179043	40	40	32.67878974	19.47312682	0.22315304	0	0	0	0	0	0	0	0	0											NO	175.5079655	150.2275435	52.49263586	0	171.6886212	0.171688621	0.171688621	54.41186331	259.0637219	28.83994325	72.26066361	70.82155623	0.171688621	49.9186097	20.99664414	15.27323984	34.33772423	34.33772423	28.05288176	16.71657147	0.191564189	0	0	0	0	0	0	0	0	0												13.1364	0.405831827	1.018803186	0	2.167646882	0.771719146	0.94850095	1.492933318	7.058139735	5.331640456	5.650845332	0.703536645	0.004486714	1.462677866	5.687430272	13.68625372	0.470978757	1.057728828	3.752097488	2.41902846	3.062737339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2895	0	NO	11.59050592	13.1364	0.405831827	1.018803186	0	2.167646882	0.771719146	0.94850095	1.492933318	7.058139735	5.331640456	5.650845332	0.703536645	0.004486714	1.462677866	5.687430272	13.68625372	0.470978757	1.057728828	3.752097488	2.41902846	3.062737339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2895	NO	1a 20%	1b 20%	2 20%	6 $0	10a $200	11a 20%	11b 20%	"4a $65, 4b $25"	9a 20% 9b 20%	8a 20% 14a 0%	8a 20% 9a 20%	9a 20%	12a 20%	"3 20%, 9a 20%"	"7a 20%, 14a 0, 14b 0"	0.2	0.2	0.2	0.2	0.2	0.2			0	0				0													0.7568	0	0.2987	0	0.1744	0.4992	0.5614	0.031	1.14	0.1452	0.2492	0	0.003	0.2889	0.8653	5.6478	0	0.4294	0.2967	0.4453	0.1427	0	0	0	0	0.0009	0.0005	0	0	0											11.9766	0	NO	0	13.8933	0.405831827	1.317470276	0	2.342052561	1.270951006	1.509897713	1.52391473	8.198179804	5.476854033	5.900036864	0.703536645	0.007498456	1.75161456	6.552761359	19.33400756	0.470978757	1.487155446	4.048815371	2.864368963	3.205484327	0	0	0	0	0.000861521	0.000539524	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2661
H5302_006_0	2012	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	0	0	0	0	0	0											0	YES	808.0555182	34.67343923	168.7407494	0	148.7499407	9.783139605	10.17231678	309.4720159	440.6576132	2542.830275	1054.891616	90.57919644	7.157519478	579.600979	3823.959626	14303.36976	154.5367176	589.1506126	1535.053734	4151.51947	25.40784492	0	0	317.6097899	0	0	1.973675484	0	0	0											4200	1a $250 days 1-7	1b $200 days 1-7	"2 $50 days 1-20, $125 Days 21 to 100"	6 $0	10a $100	"11a (inpatient) $0, 11a (other services) 20%"	11b 20%	"4a $65, 4b $15"	"9a $250, 9b $250"	"8a $35, 14a $0"	"8a X-Ray $35, Ther. $35 , Other (CAT Scan and MRI) $300, 9a $35"	9a $35	12a 20%	"3 $35, 9a $35, 9a $0, 9d $0"	"7a $15, 14a $0, 14b $0"	"7b $20, 7d $35, 7f $35, 8a $0, 9a $35, 14a 0%"	"7e $35, 7h $35"	"7c $35, 7i $35"	"8b $35, 14a $0, 15 $35"	"7g (other medicine) $25, 7g (Other Physician Services) $35, 14a $0"	"11c 20%, 15 20%"			16a $25	17a $0	17b $0	18a $35		"13c OTC $0, 13d Meals on Wheels $0/discharage, 14c Fitness $0"													NO	204.4491525	175	61.14864865	0	100	0.155135454	0.2	61.68475868	213.6111921	29.5394509	69.14228506	82.5	0.189253096	44.24624879	14.47661902	17.18222479	35	35	30.99639637	17.77068559	0.215983168	0	0	25	0	0	35	0	0	0											NO	169.6364963	145.2018092	50.73653952	0	82.97246243	0.128719706	0.165944925	51.18979652	177.2384661	24.5096098	57.36905649	68.4522815	0.157027954	36.71220216	12.01160728	14.256515	29.04036185	29.04036185	25.71847333	14.74477543	0.179206553	0	0	20.74311561	0	0	29.04036185	0	0	0												11.423	0.419553842	0.713443475	0	1.028512406	1.259282857	1.688044344	1.320150794	6.508456621	5.193648152	5.043178061	0.516696054	1.12393064	1.773202359	3.827658439	16.99301713	0.373983517	1.425762248	3.289936543	5.101101855	4.553252302	0	0	0.549018049	0	0	0.004776354	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1296	0	NO	15.21254704	11.423	0.419553842	0.713443475	0	1.028512406	1.259282857	1.688044344	1.320150794	6.508456621	5.193648152	5.043178061	0.516696054	1.12393064	1.773202359	3.827658439	16.99301713	0.373983517	1.425762248	3.289936543	5.101101855	4.553252302	0	0	0.549018049	0	0	0.004776354	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1296	NO																																										1.8773	0.0695	0.2158	0	0.169	0.207	0.2774	0.2168	1.0697	0.2792	0.8288	0.0849	0.1847	0.2914	0.6291	2.6032	0.0615	0.2343	0.5407	0.8384	0.7483	0	0	0	0	0	0.0008	0	0	0											11.4278	0	NO	0	13.3003	0.489068182	0.929215949	0	1.197546429	1.466243557	1.965471166	1.536905104	7.578108872	5.472889194	5.872014616	0.601614051	1.308646465	2.064624736	4.456726696	19.59621894	0.435446984	1.660083514	3.830631247	5.939458074	5.301570507	0	0	0.549018049	0	0	0.005561339	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5574
H5302_007_0	2012	7																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	COIN	V	V	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	226.5474447	3.051690687	14.47642423	0	8.267782473	10.35047176	11.71835173	447.6526564	66.99883878	16.39674297	28.74422687	3.717176113	3.006425437	20.46687544	43.11924853	180.9856475	1.952621856	7.494003364	20.38012736	15.55582664	25.67315818	0	0	100.4830014	0	0	0	0	0	0											6500	1a FFS Medicare 8.2%	1b FFS Medicare 8.2%	2 FFS Medicare 18%	6 $0	10a 20%	11a 20%	11b 20%	"4a $65, 4b $25"	"9a 20%, 9b 20%"	"8a 20%, 14a $0"	"8b 20%, 9a 20%, 14a $0"	9a 20%	12a 20%	"3 20%, 9a 20%, 9c 20%, 9d $0"	"7a 20%, 14a $0, 14b $0"	"7a 20%, 7b 20%, 7d 20%, 7f 20%, 8a 20%, 9a 20%, 14a $0, 17a 20%, 17b 20%"	"7e 20%, 7h 20%"	"7c 20%, 7i 20%"	"8b 20%, 14a $0, 15 20%"	"7g 20%, 14a $0"	"11c 20%, 15 20%"			16a $25	17a $0	17b $0			"13c OTC $0, 13d Meals on Wheels $0/discharage, 14c Fitness $0"													NO	0.081800854	0.081800854	0.180207584	0	0.2	0.2	0.2	62.72756628	0.2	0.199044435	0.2	0.2	0.2	0.189947206	0.195168199	0.189048862	0.2	0.2	0.199609265	0.194296588	0.218751374	0	0	25	0	0	0	0	0	0											NO	0.06971205	0.06971205	0.153575906	0	0.170443332	0.170443332	0.170443332	53.46317272	0.170443332	0.169628984	0.170443332	0.170443332	0.170443332	0.161876174	0.166325591	0.16111059	0.170443332	0.170443332	0.170110341	0.16558279	0.186423566	0	0	21.30541654	0	0	0	0	0	0												15.7931	0.212739615	2.223229961	0	1.409188396	1.764168898	1.997314919	1.994410941	11.41950534	2.781362856	4.899261813	0.633567884	0.51242517	3.313099482	7.171834514	29.15870454	0.332811376	1.277302906	3.466870418	2.575777175	4.786081692	0	0	0.178402683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9011	0	NO	16.97684002	15.7931	0.212739615	2.223229961	0	1.409188396	1.764168898	1.997314919	1.994410941	11.41950534	2.781362856	4.899261813	0.633567884	0.51242517	3.313099482	7.171834514	29.15870454	0.332811376	1.277302906	3.466870418	2.575777175	4.786081692	0	0	0.178402683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9011	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.7931	0.212739615	2.223229961	0	1.409188396	1.764168898	1.997314919	1.994410941	11.41950534	2.781362856	4.899261813	0.633567884	0.51242517	3.313099482	7.171834514	29.15870454	0.332811376	1.277302906	3.466870418	2.575777175	4.786081692	0	0	0.178402683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9011
H5302_008_0	2012	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											13.3863589	0.180135982	0.971511787	0	1.589716964	0.034875668	0	0	16.39724236	0	2.484255822	1.073359964	0	0	0	27.38504727	0	0	0.778700525	0	0	0	0	0	0	0	0	0	0	0											64.2812	YES	0	0	0	0	0	7.951776927	9.476483102	377.9385704	0	2665.357024	1118.873315	0	0.046852303	452.7141675	4457.240055	16032.45583	195.8865627	655.5086651	2033.827803	2466.638616	18.99702015	0	0	5.311093713	0	0	0	0	0	0											3300	1a $0	1b $0	2 $0	6 $0	10a $0	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $10"	"9a $35, 9b $0"	"8a $35, 14a $0"	"8b $35, 9a $35, 14a $0"	9a $0	12a 20%	"3 $35, 9a $35, 9a (clinical trials) , 9d $35"	"7a $10, 14a $0, 14b $0"	"7b $20, 7d $35, 7f $35, 8a $0, 9a $35, 14a 0%, 17a $0, 17b $0"	"7e $35, 7h $35"	"7c $35, 7i $35"	"8b $35, 14h $0"	"7g (other medicine) $10, 7g (Other Physician Services) $35"	"11c 20%, 15 20%"			16a $25	17a $0	17b $0			"13c OTC $0, 13d Meals on Wheels $0/discharage, 14c Fitness $0"													NO	0	0	0	0	0	0.2	0.2	62.09949886	0	29.52447615	18.25621762	0	0.2	32.44958598	9.792536214	15.23160058	35	35	23.72021803	16.40195209	0.222163617	0	0	25	0	0	0	0	0	0											NO	0	0	0	0	0	0.159389129	0.159389129	49.49844512	0	23.52940273	14.54921315	0	0.159389129	25.86055628	7.804119104	12.13875777	27.89309763	27.89309763	18.9037245	13.07146431	0.177052327	0	0	19.92364116	0	0	0	0	0	0												0	0	0	0	0	1.267426801	1.51044839	1.558947632	0	5.226188237	1.356560529	0	0.007467748	0.975620017	2.898736022	16.21784149	0.455323585	1.523680599	3.203910039	2.686881553	3.363466629	0	0	0.008818027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2613	1500	NO	10.76745468	13.3864	0.180135982	0.971511787	0	1.589716964	1.302302468	1.51044839	1.558947632	16.39724236	5.226188237	3.840816351	1.073359964	0.007467748	0.975620017	2.898736022	43.60288875	0.455323585	1.523680599	3.982610563	2.686881553	3.363466629	0	0	0.008818027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5425	NO																																										0	0	0	0	0	0	0	0	0	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	13.3864	0.180135982	0.971511787	0	1.589716964	1.302302468	1.51044839	1.558947632	16.39724236	5.226188237	3.840816351	1.073359964	0.007467748	0.975620017	2.898736022	43.60288875	0.455323585	1.523680599	3.982610563	2.686881553	3.363466629	0	0	0.008818027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5425
H5302_009_0	2012	7																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	P	COIN	P	P	P	P	COIN	V	T	V	COIN	V	V	V	P	O											12.56639425	0.177157319	0.875291993	0	1.450286136	0.02722422	0	0	16.30912738	0	3.311792792	0.899920431	0	0	0	27.38367002	0	0	1.023010979	0	4.785943197	0	0	0	0	0	0	0	0	0											68.8098	YES	0	0	0	0	0	9.030547471	9.564097222	398.0955328	0	2822.974291	1136.015138	0	0.042081771	462.4486403	4713.275523	167.367483	203.7797073	745.5355146	2230.145236	2641.183816	0	0	0	58.9669983	0	0	0	0	0	0											3300	1a $0	1b $0	"2 $0 days 1-1, $0 Days 2 to 50"	6 $0	10a $0	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $10"	"9a $0, 9b $0"	"8a $35, 14a $0"	"8b $35, 9a $35, 14a $0"	9a $0	12a 20%	"3 $35, 9a $35, 9d $0"	"7a $10, 14a $0, 14b $0"	"7a $10, 7b $20, 7d $35, 7f $35, 8a $0, 9a $35, 14a $0, 17a $0, 17b $0"	"7e $35, 7h $35"	"7c $35, 7i $35"	"8b $35, 14h $0, 15 $0"	"7g (other medicine) $10, 7g (Other Physician Services) $35"	"11c 20%, 15 15%"			16a $25	17a $0	17b $0			"13c OTC $0, 13d Meals on Wheels $0/discharage, 14c Fitness $0"													NO	0	0	0	0	0	0.189709245	0.2	61.27000475	0	29.49740789	16.0379056	0	0.2	32.2659082	9.783823684	0.117792996	35	35	23.12339066	16.43347761	0	0	0	25	0	0	0	0	0	0											NO	0	0	0	0	0	0.152568112	0.160844151	49.27460933	0	23.72242757	12.89801651	0	0.160844151	25.94891298	7.868354046	0.094731572	28.14772634	28.14772634	18.59631064	13.21614373	0	0	0	20.10551881	0	0	0	0	0	0												0	0	0	0	0	1.377773574	1.538329093	1.634666821	0	5.580650262	1.221028501	0	0.006768607	1.000003294	3.090476711	15.85498472	0.47799462	1.748760803	3.456039465	2.908855411	0	0	0	0.098796841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9951	1500	NO	9.736401579	12.5664	0.177157319	0.875291993	0	1.450286136	1.404997794	1.538329093	1.634666821	16.30912738	5.580650262	4.532821293	0.899920431	0.006768607	1.000003294	3.090476711	43.23865475	0.47799462	1.748760803	4.479050444	2.908855411	4.785943197	0	0	0.098796841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8049	NO																																										0	0	0	0	0	0	0	0	0	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	12.5664	0.177157319	0.875291993	0	1.450286136	1.404997794	1.538329093	1.634666821	16.30912738	5.580650262	4.532821293	0.899920431	0.006768607	1.000003294	3.090476711	43.23865475	0.47799462	1.748760803	4.479050444	2.908855411	4.785943197	0	0	0.098796841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8049
H5302_809_0	2012	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	169.582052	3.566745498	10.64081475	0	5.897451956	7.884475948	8.165213173	12.9850595	50.53571649	11.53702683	19.81255432	2.429305861	1.905470338	13.55403422	31.32195674	133.2812768	1.381516921	5.76267512	16.22331853	11.12487827	20.18530565	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.081705535	0.081705535	0.182750906	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.073500609	0.073500609	0.164398935	0	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0	0	0	0	0	0	0	0	0											10000	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	0	NO	9.578624476	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	NO	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				1.8894	0.0397	0.2652	0	0.1801	0.2408	0.2494	0.3966	1.5436	0.3002	0.6052	0.0742	0.0582	0.414	0.9567	4.0255	0.0422	0.176	0.4955	0.3398	0.6763	0	0	0	0	0	0	0	0	0											12.9689	0	NO	0	14.3538	0.301897445	2.014513865	0	1.368510928	1.829602272	1.894747688	3.013198913	11.72687472	2.624968937	4.597527424	0.563723392	0.442166719	3.145230191	7.26829831	30.88246119	0.320582688	1.337235799	3.764640876	2.581541589	4.743708545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7752
H5302_810_0	2012	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	169.582052	3.566745498	10.64081475	0	5.897451956	7.884475948	8.165213173	12.9850595	50.53571649	11.53702683	19.81255432	2.429305861	1.905470338	13.55403422	31.32195674	133.2812768	1.381516921	5.76267512	16.22331853	11.12487827	20.18530565	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.081705535	0.081705535	0.182750906	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.073500609	0.073500609	0.164398935	0	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0	0	0	0	0	0	0	0	0											10000	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	0	NO	9.578624476	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	NO	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				1.8894	0.0397	0.2652	0	0.1801	0.2408	0.2494	0.3966	1.5436	0.3002	0.6052	0.0742	0.0582	0.414	0.9567	4.0255	0.0422	0.176	0.4955	0.3398	0.6763	0	0	0	0	0	0	0	0	0											12.9689	0	NO	0	14.3538	0.301897445	2.014513865	0	1.368510928	1.829602272	1.894747688	3.013198913	11.72687472	2.624968937	4.597527424	0.563723392	0.442166719	3.145230191	7.26829831	30.88246119	0.320582688	1.337235799	3.764640876	2.581541589	4.743708545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7752
H5302_811_0	2012	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	169.582052	3.566745498	10.64081475	0	5.897451956	7.884475948	8.165213173	12.9850595	50.53571649	11.53702683	19.81255432	2.429305861	1.905470338	13.55403422	31.32195674	133.2812768	1.381516921	5.76267512	16.22331853	11.12487827	20.18530565	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.081705535	0.081705535	0.182750906	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.073500609	0.073500609	0.164398935	0	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0.201505767	0	0	0	0	0	0	0	0	0											10000	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	0	NO	9.578624476	12.4644	0.262157966	1.74933861	0	1.188370577	1.58876737	1.64533754	2.616564369	10.18323829	2.324777436	3.992343947	0.48951914	0.383963261	2.731216055	6.311554904	26.85694584	0.278383626	1.161212268	3.269092237	2.241727125	4.06745549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8064	NO	FFS Medicare 8.2%	FFS Medicare 8.2%	FFS Medicare 18.3%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				1.8894	0.0397	0.2652	0	0.1801	0.2408	0.2494	0.3966	1.5436	0.3002	0.6052	0.0742	0.0582	0.414	0.9567	4.0255	0.0422	0.176	0.4955	0.3398	0.6763	0	0	0	0	0	0	0	0	0											12.9689	0	NO	0	14.3538	0.301897445	2.014513865	0	1.368510928	1.829602272	1.894747688	3.013198913	11.72687472	2.624968937	4.597527424	0.563723392	0.442166719	3.145230191	7.26829831	30.88246119	0.320582688	1.337235799	3.764640876	2.581541589	4.743708545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7752
H5378_010_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1661.118601	12.60371798	554.969129	41.54562673	642.6469655	36.95970227	1.923095321	334.9849982	716.3299507	879.741903	21.17668659	9.582793782	10.86966161	466.9314973	5799.257377	12191.89052	0.276923196	874.4437459	38.54725358	23748.54428	7.37852258	12.33152998	0	0	0	0	0.093299173	0	0	0											3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	60.7062626	97.57989667	0	0.2	0.098437404	30	4.302050544	3.838821033	10.69241111	0.4	0	0.18369807	0.910850977	0.2	0	0	0	0	0	20	0	0	0											NO	173.5577605	173.5577605	86.77888024	0.13016832	130.1683204	0.17355776	0.17355776	52.68021492	84.67874167	0	0.17355776	0.085422877	26.03366407	3.733271289	3.331285907	9.278754633	0.347115521	0	0.159411128	0.790426278	0.17355776	0	0	0	0	0	20	0	0	0												24.025	0.182289422	4.013299965	5.407924449	6.971023007	6.414643153	0.333768117	1.470590142	5.05482657	0	3.675378299	0.818589815	0.023581427	0.145265163	1.609915364	9.427130051	0.096124339	0	6.144861178	1.564289455	1.280599855	0	0	0	0	0	0.000155499	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6593	0		11.98403808	24.025	0.182289422	4.013299965	5.407924449	6.971023007	6.414643153	0.333768117	1.470590142	5.05482657	0	3.675378299	0.818589815	0.023581427	0.145265163	1.609915364	9.427130051	0.096124339	0	6.144861178	1.564289455	1.280599855	0	0	0	0	0	0.000155499	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6593	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	6.048	0.046	1.01	1.362	1.756	1.616	0.084	0.37	1.272	0	0.9	0.206	0.006	0.036	0.778	3.04	0.024	0	1.5	0.394	0.322	0	0	0	0	0	0	0	0	0											20.77	0		2.996	30.073	0.228289422	5.023299965	6.769924449	8.727023007	8.030643153	0.417768117	1.840590142	6.32682657	0	4.575378299	1.024589815	0.029581427	0.181265163	2.387915364	12.46713005	0.120124339	0	7.644861178	1.958289455	1.602599855	0	0	0	0	0	0.000155499	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4293
H5378_016_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1138.353084	2.596811834	519.7079448	138.2595388	426.6670553	22.41166004	3.201605226	332.1961202	525.4216212	7.103232033	20.03431405	3.477224039	32.7614777	310.2963552	4582.270483	7771.153859	0.011319722	433.7591504	30.13511588	16859.39867	4.525151874	7.211149629	0	0	0	0	0	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	56.15292166	203.6587251	0.2	0.2	0.329187301	30	11.1775159	19.84419909	16.11661228	0.4	0	0.185677538	2.932348958	0.2	0	0	0	0	0	0	0	0	0											NO	210.159373	210.159373	120.7298526	0	134.1442807	0.178859041	0.178859041	50.21728855	182.1310212	0.178859041	0.178859041	0.294390625	26.82885613	9.995998867	17.74657208	14.41300907	0.357718082	0	0.166050532	2.622385611	0.178859041	0	0	0	0	0	0	0	0	0												19.9363	0.045478696	5.22868863	0	4.769578768	4.00852802	0.57263604	1.390165702	7.974631371	1.270477269	3.583318195	1.023662157	0.073246081	0.258476835	6.776632786	9.333809253	0.004049269	0	5.003952023	3.684320374	0.809364324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7473	0		8.953256412	19.9363	0.045478696	5.22868863	0	4.769578768	4.00852802	0.57263604	1.390165702	7.974631371	1.270477269	3.583318195	1.023662157	0.073246081	0.258476835	6.776632786	9.333809253	0.004049269	0	5.003952023	3.684320374	0.809364324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7473	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.006	0.012	1.312	0	1.198	1.006	0.144	0.35	2.002	0.318	0.896	0.258	0.018	0.064	2.01	2.772	0.002	0	1.252	0.922	0.204	0	0	0	0	0	0	0	0	0											19.746	0		2.238	24.9423	0.057478696	6.54068863	0	5.967578768	5.01452802	0.71663604	1.740165702	9.976631371	1.588477269	4.479318195	1.281662157	0.091246081	0.322476835	8.786632786	12.10580925	0.006049269	0	6.255952023	4.606320374	1.013364324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4933
H5378_182_0	2012	8																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	793.4519221	14.20516816	561.6342122	14.80743614	367.1982021	23.47920875	1.271342652	261.8057388	488.8918623	962.9958749	17.57356503	5.135457739	5.144928472	452.8675956	4523.111173	6881.490568	0.269097965	658.9753734	18.57867795	15703.16743	4.643590606	8.208185733	0	0	0	0	0.105153927	0	0	0											3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.37562637	100.9986769	0	0.2	0.246193535	30	2.463336433	3.696703096	12.50324123	0.4	0	0.182547153	1.058613431	0.2	0	0	0	0	0	20	0	0	0											NO	155.1148828	155.1148828	77.55744142	0.116336162	116.3361621	0.155114883	0.155114883	46.05021664	78.33198967	0	0.155114883	0.190941407	23.26723243	1.910500711	2.867068338	9.697193991	0.310229766	0	0.141578901	0.821033491	0.155114883	0	0	0	0	0	20	0	0	0												10.2564	0.183619416	3.629909376	1.722640291	3.559869131	3.641974714	0.197204167	1.004684249	3.191322692	0	2.725921481	0.980571524	0.009975687	0.072100322	1.080672403	5.560929082	0.083482199	0	2.630348811	1.074402198	0.720290013	0	0	0	0	0	0.000175257	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3264	0		12.24782213	10.2564	0.183619416	3.629909376	1.722640291	3.559869131	3.641974714	0.197204167	1.004684249	3.191322692	0	2.725921481	0.980571524	0.009975687	0.072100322	1.080672403	5.560929082	0.083482199	0	2.630348811	1.074402198	0.720290013	0	0	0	0	0	0.000175257	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3264	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	2.602	0.046	0.922	0.438	0.904	0.924	0.05	0.254	0.81	0	0.672	0.248	0.002	0.018	0.526	1.792	0.022	0	0.648	0.272	0.182	0	0	0	0	0	0	0	0	0											11.332	0		3.066	12.8584	0.229619416	4.551909376	2.160640291	4.463869131	4.565974714	0.247204167	1.258684249	4.001322692	0	3.397921481	1.228571524	0.011975687	0.090100322	1.606672403	7.352929082	0.105482199	0	3.278348811	1.346402198	0.902290013	0	0	0	0	0	0.000175257	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6584
H5378_183_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	624.5507173	3.366607931	624.3193046	59.59426101	308.2344029	18.55269601	0.431061801	239.5651798	425.1168109	6.486744554	25.17115838	5.847443409	8.95135662	436.4205132	4834.838334	5866.062893	0.006530618	506.3841841	23.76553615	16755.81844	3.826101525	9.853755178	0	0	0	0	0	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	62.42920303	224.7784417	0.2	0.2	0.144596404	30	8.35952617	16.37615827	20.79158215	0.4	0	0.189168321	2.733736998	0.2	0	0	0	0	0	0	0	0	0											NO	199.19235	199.19235	114.4296479	0	127.1440532	0.169525404	0.169525404	52.9166794	190.528281	0.169525404	0.169525404	0.12256382	25.42881063	7.085760266	13.88087425	17.62350684	0.339050808	0	0.160344181	2.317189348	0.169525404	0	0	0	0	0	0	0	0	0												10.3671	0.055883545	5.953386515	0	3.26584761	3.145153291	0.073075926	1.056416151	6.749731267	1.099667993	4.267150799	0.716684999	0.018968529	0.257697594	5.592648578	8.615049962	0.002214211	0	3.81066542	3.235533666	0.648621408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9315	0		10.59378035	10.3671	0.055883545	5.953386515	0	3.26584761	3.145153291	0.073075926	1.056416151	6.749731267	1.099667993	4.267150799	0.716684999	0.018968529	0.257697594	5.592648578	8.615049962	0.002214211	0	3.81066542	3.235533666	0.648621408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9315	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	2.61	0.014	1.5	0	0.822	0.792	0.018	0.266	1.7	0.276	1.07	0.18	0.004	0.064	1.664	2.558	0	0	0.956	0.814	0.164	0	0	0	0	0	0	0	0	0											15.472	0		2.656	12.9771	0.069883545	7.453386515	0	4.08784761	3.937153291	0.091075926	1.322416151	8.449731267	1.375667993	5.337150799	0.896684999	0.022968529	0.321697594	7.256648578	11.17304996	0.002214211	0	4.76666542	4.049533666	0.812621408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4035
H5378_184_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1245.662614	2.907499584	696.118517	95.94859386	375.0700765	26.30749924	3.394343754	327.5022926	580.3494253	5.85981835	17.79952175	2.852994591	11.60857	361.7932003	4265.991714	6932.813618	0.024512768	520.4983068	25.19371381	12880.41608	2.991025911	9.19943427	0	0	0	0	0	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		234.7722952	235	135	0	150	0.2	0.2	56.3479165	191.8552421	0.2	0.2	0.430256757	30	9.512122492	19.47806668	15.51001872	0.4	0	0.183681443	3.013005674	0.2	0	0	0	0	0	0	0	0	0											NO	205.0891684	205.2880837	117.9314523	0	131.034947	0.174713263	0.174713263	49.22364169	167.5982765	0.174713263	0.174713263	0.375857809	26.2069894	8.309469779	17.0153829	13.54902988	0.349426525	0	0.160457921	2.63206026	0.174713263	0	0	0	0	0	0	0	0	0												21.2893	0.049739585	6.841188975	0	4.095607301	4.596269026	0.593036872	1.343404625	8.105463623	1.023787983	3.109812519	1.072320297	0.025352139	0.250525805	6.048956874	7.827741569	0.008565411	0	4.042530945	2.825169275	0.522571896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6714	0		10.66266272	21.2893	0.049739585	6.841188975	0	4.095607301	4.596269026	0.593036872	1.343404625	8.105463623	1.023787983	3.109812519	1.072320297	0.025352139	0.250525805	6.048956874	7.827741569	0.008565411	0	4.042530945	2.825169275	0.522571896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6714	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.348	0.012	1.718	0	1.028	1.154	0.148	0.338	2.036	0.256	0.778	0.27	0.006	0.062	1.796	2.314	0.002	0	1.012	0.708	0.132	0	0	0	0	0	0	0	0	0											19.118	0		2.664	26.6373	0.061739585	8.559188975	0	5.123607301	5.750269026	0.741036872	1.681404625	10.14146362	1.279787983	3.887812519	1.342320297	0.031352139	0.312525805	7.844956874	10.14174157	0.010565411	0	5.054530945	3.533169275	0.654571896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7894
H5378_188_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1077.504845	25.81933258	789.3191534	21.16529753	491.7733805	28.00673633	2.046187635	327.5811086	541.9231655	1180.400205	24.42595309	6.005651581	9.351428849	413.2878419	5896.406872	8371.64243	0.529466895	848.848404	28.27525935	15855.66495	5.558923029	10.50105134	0	0	0	0	0.191127918	0	0	0											3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.187904726	30	3.55757441	3.921960341	12.03381955	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	165.1689919	165.1689919	82.58449597	0.123876744	123.876744	0.165168992	0.165168992	49.11155906	84.13128377	0	0.165168992	0.155180171	24.77534879	2.938004896	3.23893118	9.938069223	0.330337984	0	0.151922814	0.986051314	0.165168992	0	0	0	0	0	20	0	0	0												14.8309	0.355379428	5.432127037	2.621888143	5.076607095	4.625844408	0.337966749	1.340668247	3.799390968	0	4.03441005	0.931958037	0.019307076	0.101186809	1.591504672	6.933163498	0.174903026	0	4.295656963	1.302874939	0.918161713	0	0	0	0	0	0.000318547	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7242	0		12.38374938	14.8309	0.355379428	5.432127037	2.621888143	5.076607095	4.625844408	0.337966749	1.340668247	3.799390968	0	4.03441005	0.931958037	0.019307076	0.101186809	1.591504672	6.933163498	0.174903026	0	4.295656963	1.302874939	0.918161713	0	0	0	0	0	0.000318547	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7242	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.746	0.09	1.372	0.662	1.282	1.168	0.086	0.338	0.96	0	0.992	0.236	0.004	0.026	0.772	2.222	0.044	0	1.052	0.33	0.232	0	0	0	0	0	0	0	0	0											15.614	0		3.098	18.5769	0.445379428	6.804127037	3.283888143	6.358607095	5.793844408	0.423966749	1.678668247	4.759390968	0	5.02641005	1.167958037	0.023307076	0.127186809	2.363504672	9.155163498	0.218903026	0	5.347656963	1.632874939	1.150161713	0	0	0	0	0	0.000318547	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3382
H5378_190_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	993.2772957	0	463.4829429	97.72400412	86.07736604	22.67431202	1.802533661	333.4116493	470.7910536	6.977305344	17.6259413	5.377492436	5.580531893	321.9413611	4210.449153	5765.926665	0	174.516947	31.65875717	12364.0912	5.024485326	5.187921063	0	0	0	0	0	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $350; 9b: $200	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		234.7651963	0	135	0	150	0.2	0.2	54.34262358	246.9557728	0.2	0.2	0.255462122	30	11.17744771	18.07717392	14.14404313	0	0	0.187052839	2.545194239	0.2	0	0	0	0	0	0	0	0	0											NO	207.5087675	0	119.326391	0	132.5848789	0.176779839	0.176779839	48.03340112	218.2840083	0.176779839	0.176779839	0.225802764	26.51697579	9.87973701	15.97839944	12.50190831	0	0	0.165335853	2.249695133	0.176779839	0	0	0	0	0	0	0	0	0												17.1761	0	4.60881224	0	0.95104643	4.008361218	0.31865161	1.334574624	8.563846519	1.233446912	3.115911058	1.214252653	0.012331569	0.265057998	5.6063532	6.007090538	0	0	5.234327631	2.317952983	0.888227705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8564	0		8.256232984	17.1761	0	4.60881224	0	0.95104643	4.008361218	0.31865161	1.334574624	8.563846519	1.233446912	3.115911058	1.214252653	0.012331569	0.265057998	5.6063532	6.007090538	0	0	5.234327631	2.317952983	0.888227705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8564	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $350; 9b: $200	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.312	0	1.158	0	0.238	1.006	0.08	0.336	2.15	0.31	0.78	0.304	0.004	0.066	1.664	1.782	0	0	1.31	0.58	0.222	0	0	0	0	0	0	0	0	0											16.302	0		2.064	21.4881	0	5.76681224	0	1.18904643	5.014361218	0.39865161	1.670574624	10.71384652	1.543446912	3.895911058	1.518252653	0.016331569	0.331057998	7.2703532	7.789090538	0	0	6.544327631	2.897952983	1.110227705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1584
H5378_194_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1266.649432	32.40752305	846.791035	100.0162145	533.7772527	30.39887755	2.220958794	355.5608154	581.7951031	11.30696587	25.20120337	6.518612695	10.15016306	437.3280095	5797.620464	9018.997843	0.574690285	842.1741281	28.71198136	16516.23083	6.033727688	11.39797833	0	0	0	0	0.207452739	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.46825549	203.9195381	0.2	0.2	0.242843726	30	10.06908316	19.04971935	19.26867217	0.4	0	0.182948305	3.305120873	0.2	0	0	0	0	0	20	0	0	0											NO	212.4569667	212.4569667	122.0497468	0	135.6108298	0.18081444	0.18081444	53.7635965	184.3579852	0.18081444	0.18081444	0.219548261	27.12216596	9.103178152	17.22232166	17.42027082	0.36162888	0	0.165398476	2.988067895	0.18081444	0	0	0	0	0	20	0	0	0												22.4257	0.573767004	8.61255262	0	6.032164681	5.496556013	0.40158142	1.593019018	8.938214417	2.044462699	4.556741469	1.431150082	0.022941201	0.331756232	8.320707043	13.09278208	0.207824604	0	4.748917966	4.112634924	1.090985092	0	0	0	0	0	0.000345755	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0348	0		9.97765403	22.4257	0.573767004	8.61255262	0	6.032164681	5.496556013	0.40158142	1.593019018	8.938214417	2.044462699	4.556741469	1.431150082	0.022941201	0.331756232	8.320707043	13.09278208	0.207824604	0	4.748917966	4.112634924	1.090985092	0	0	0	0	0	0.000345755	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0348	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.63	0.144	2.162	0	1.514	1.38	0.1	0.4	2.244	0.512	1.14	0.36	0.006	0.084	2.468	3.868	0.052	0	1.188	1.03	0.274	0	0	0	0	0	0	0	0	0											24.556	0		2.494	28.0557	0.717767004	10.77455262	0	7.546164681	6.876556013	0.50158142	1.993019018	11.18221442	2.556462699	5.696741469	1.791150082	0.028941201	0.415756232	10.78870704	16.96078208	0.259824604	0	5.936917966	5.142634924	1.364985092	0	0	0	0	0	0.000345755	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5908
H5378_199_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	815.3174155	19.5367581	597.2554603	14.46701428	372.1109965	19.14331013	1.398620818	247.8713521	410.0579192	893.1754216	16.69575454	4.104993324	7.075961501	312.7232112	4461.644172	6337.89005	0.361903966	642.2995591	19.32685237	11997.53285	3.806655437	7.945848295	0	0	0	0	0.144621085	0	0	0											3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.205993646	30	3.55757441	3.921960341	11.97792379	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	145.0741701	145.0741701	72.53708507	0.108805628	108.8056276	0.14507417	0.14507417	43.13653908	73.89568727	0	0.14507417	0.149421786	21.76112552	2.580560776	2.844875709	8.688436768	0.29014834	0	0.133439551	0.866086149	0.14507417	0	0	0	0	0	20	0	0	0												9.8568	0.236189914	3.610264178	1.574092568	3.373980876	2.77719983	0.202903754	0.891026022	2.52512598	0	2.422122734	0.613375435	0.012831741	0.067250104	1.057735261	4.588863079	0.105005835	0	2.578966506	0.865908085	0.552247379	0	0	0	0	0	0.000241035	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9121	0		14.35363379	9.8568	0.236189914	3.610264178	1.574092568	3.373980876	2.77719983	0.202903754	0.891026022	2.52512598	0	2.422122734	0.613375435	0.012831741	0.067250104	1.057735261	4.588863079	0.105005835	0	2.578966506	0.865908085	0.552247379	0	0	0	0	0	0.000241035	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9121	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	2.512	0.06	0.92	0.402	0.86	0.708	0.052	0.228	0.644	0	0.6	0.156	0.004	0.018	0.518	1.486	0.026	0	0.638	0.22	0.14	0	0	0	0	0	0	0	0	0											10.192	0		3.588	12.3688	0.296189914	4.530264178	1.976092568	4.233980876	3.48519983	0.254903754	1.119026022	3.16912598	0	3.022122734	0.769375435	0.016831741	0.085250104	1.575735261	6.074863079	0.131005835	0	3.216966506	1.085908085	0.692247379	0	0	0	0	0	0.000241035	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1041
H5378_200_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1012.69613	24.26637644	741.8439516	19.57078739	462.1946729	25.89681915	1.892035919	307.8780783	509.3280973	1109.40264	22.58579801	5.553204726	8.78896819	388.4298063	5541.755519	7868.799344	0.489578945	797.7926947	26.1451127	14901.99382	5.141716845	9.869444301	0	0	0	0	0.179632141	0	0	0											3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.190681341	30	3.55757441	3.921960341	12.02459481	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	161.880785	161.880785	80.94039251	0.121410589	121.4105888	0.161880785	0.161880785	48.13383942	82.45638665	0	0.161880785	0.154338226	24.28211775	2.879514692	3.174450095	9.732754234	0.32376157	0	0.148898314	0.96642087	0.161880785	0	0	0	0	0	20	0	0	0												13.6613	0.327355006	5.003761719	2.37610082	4.67627728	4.192197414	0.30628426	1.234946165	3.499779544	0	3.656206713	0.857071765	0.017784563	0.093207444	1.466002194	6.382090845	0.158506848	0	3.892963192	1.200133152	0.832345159	0	0	0	0	0	0.000299387	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8347	0		12.67675594	13.6613	0.327355006	5.003761719	2.37610082	4.67627728	4.192197414	0.30628426	1.234946165	3.499779544	0	3.656206713	0.857071765	0.017784563	0.093207444	1.466002194	6.382090845	0.158506848	0	3.892963192	1.200133152	0.832345159	0	0	0	0	0	0.000299387	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8347	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.456	0.082	1.266	0.602	1.182	1.06	0.078	0.312	0.886	0	0.9	0.216	0.004	0.024	0.712	2.05	0.04	0	0.956	0.304	0.21	0	0	0	0	0	0	0	0	0											14.34	0		3.166	17.1173	0.409355006	6.269761719	2.97810082	5.85827728	5.252197414	0.38428426	1.546946165	4.385779544	0	4.556206713	1.073071765	0.021784563	0.117207444	2.178002194	8.432090845	0.198506848	0	4.848963192	1.504133152	1.042345159	0	0	0	0	0	0.000299387	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1747
H5378_801_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	292.9448262	4.363832949	59.02660661	24.08466973	11.94851987	29.00148342	2.118864407	14.01306303	50.36891021	11.1966352	24.16212894	6.219151694	0.277552702	16.96936939	33.27932545	85.24102303	0.548272572	3.188291979	27.8786513	60.10075267	5.762624444	1.435084957																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071430704	0.071430704	0.157233094	0	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.179032033	0.171091506	0.171091506	0.1581969	0.168479189	0.342183011	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506																				20.9253	0.311711658	9.280935972	0	2.044290256	4.961907468	0.362519702	2.397516054	8.617692691	1.915649175	4.133935022	1.113427371	0.04748691	2.90331496	5.26468611	14.36133847	0.18760956	0.545489675	4.769800429	10.28272827	0.985936093	0.245530846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6588	0		16.16299274	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944
H5378_802_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	292.9448262	4.363832949	59.02660661	24.08466973	11.94851987	29.00148342	2.118864407	14.01306303	50.36891021	11.1966352	24.16212894	6.219151694	0.277552702	16.96936939	33.27932545	85.24102303	0.548272572	3.188291979	27.8786513	60.10075267	5.762624444	1.435084957																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071430704	0.071430704	0.157233094	0	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.179032033	0.171091506	0.171091506	0.1581969	0.168479189	0.342183011	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506																				20.9253	0.311711658	9.280935972	0	2.044290256	4.961907468	0.362519702	2.397516054	8.617692691	1.915649175	4.133935022	1.113427371	0.04748691	2.90331496	5.26468611	14.36133847	0.18760956	0.545489675	4.769800429	10.28272827	0.985936093	0.245530846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6588	0		16.16299274	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944
H5378_803_0	2012	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	0.338116011	0.820676201	0.059959057	0	1.425325915	0.31683938	0.683733445	0.18415566	0.007854112	0.480194664	0.870754367	2.233455204	0.03102974	0.090221431	0.788902599	1.700714983	0.163069201	0.040609649																			10.2356	YES	292.9448262	4.363832949	59.02660661	24.08466973	11.94851987	29.00148342	2.118864407	14.01306303	50.36891021	11.1966352	24.16212894	6.219151694	0.277552702	16.96936939	33.27932545	85.24102303	0.548272572	3.188291979	27.8786513	60.10075267	5.762624444	1.435084957																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282199	0.2	0.2	0.184926655	0.196946293	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071430704	0.071430704	0.157233094	0	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506	0.179032033	0.171091506	0.171091506	0.1581969	0.168479189	0.342183011	0.171091506	0.171091506	0.171091506	0.171091506	0.171091506																				20.9253	0.311711658	9.280935972	0	2.044290256	4.961907468	0.362519702	2.397516054	8.617692691	1.915649175	4.133935022	1.113427371	0.04748691	2.90331496	5.26468611	14.36133847	0.18760956	0.545489675	4.769800429	10.28272827	0.985936093	0.245530846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6588	0		16.16299274	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	20.9253	0.311711658	9.280935972	0	2.382406267	5.782583669	0.422478759	2.397516054	10.04301861	2.232488555	4.817668467	1.297583031	0.055341022	3.383509624	6.135440477	16.59479367	0.2186393	0.635711107	5.558703028	11.98344325	1.149005294	0.286140495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8944
H5402_007_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	P	V	V	V	P	O	O																																																			0	YES	1654.819051	5.531043411	684.6787627		165.5206942	1.393167704	1.570343509	255.0193576	379.9257046	23.15216391	8.398854832	1.727773426	0.133563841	153.4262802		5638.196415	289.4261194	568.285364	3355.358511	7.805674442	36.24364753	187.3495733			59.10435189	788.45701															3400	1a: $150/d (1-5) then $0	1b: $150/d (1-5) then $0	"2: $0 (1-8), $100/d (9-100)"	6: $0/visit	10a: $100/trip	11a: : 0%-20%	11b: 20%;11c: 20%	4a: $65/visit;4b: $25/visit	9a: $175/visit;9b: $125/visit	8a: $0 - $175/visit	8b: $100/visit;8b: 20%;8b: $5/visit;8b: $150/visit	9c: $30/visit	12a: 20%	3: $25/visit;5: $125/visit;9a: $175/visit	7a: $0/visit;14a: $0/visit	7b: $20/visit;7d: $30/visit;7f: $20/visit;16b: $0/visit;17a: $25/visit;18a: $20/visit	7e: $30/visit;7h: $30/visit	7c: $25/visit;7i: $25/visit	8b: $5/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $20/visit	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $25/visit	17b1: $20/visit	18a1: $0/visit	"18b: $1,000 Allowance /yr"	14c: $0	13b: $20/Qtr													110.0704754	141.1646943	38.16762597		100	0.2	0.2	65	153.5163713	17.5	0.104361906	30	0.2	168.5220313		28.15729222	30	22.05852817	5		0.2	24.41300753			25	20															NO	95.45821557	122.4245628	33.10073347		86.72463279	0.173449266	0.173449266	56.37101132	133.1365093	15.17681074	0.09050748	26.01738984	0.173449266	146.9342213		24.52143886	26.01738984	19.13017756	4.33623164		0.173449266	21.17209113			25	20																13.1638	0.056427964	1.888614103	0	1.196226785	0.241643915	0.272374928	1.197974925	4.215165174	0.029281334	0.760159187	0.003746013	0.02316655	1.878630917	0	11.52139072	0.627509348	0.905949993	1.212467645	0	6.286434046	0.33054852	0	0	0.123134066	1.314095017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2488	0		6.945708776	13.1638	0.056427964	1.888614103	0	1.196226785	0.241643915	0.272374928	1.197974925	4.215165174	0.029281334	0.760159187	0.003746013	0.02316655	1.878630917	0	11.52139072	0.627509348	0.905949993	1.212467645	0	6.286434046	0.33054852	0	0	0.123134066	1.314095017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2488	NO																																																																																		0	0		0	13.1638	0.056427964	1.888614103	0	1.196226785	0.241643915	0.272374928	1.197974925	4.215165174	0.029281334	0.760159187	0.003746013	0.02316655	1.878630917	0	11.52139072	0.627509348	0.905949993	1.212467645	0	6.286434046	0.33054852	0	0	0.123134066	1.314095017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2488
H5402_032_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	1515.68489	48.56438998	1243.49474		112.275302	4.059650054	5.384044207	211.4478063	292.3573091	800.6672323	5.60363518		0.149593306	528.2536934		4446.427621	351.85462	946.4713473	3495.175088		17.71863114	0.268139664			163.9245294																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: $65/visit;4b: $25/visit	9a: $175/visit;9b: $50/visit	8a: $0 - $200/visit	8b: 20%;8b: $5/visit	9c: $20/visit	12a: 20%	3: $10/visit;5: $0/visit;9a: $175/visit	7a: $0/visit;14a: $0/visit	7b: $20/visit;7d: $19/visit;7f: $10/visit;16b: $0/visit;17a: $0/visit;18a: $0/visit	7e: $20/visit;7h: $20/visit	7c: $10/visit;7i: $10/visit	8b: $5/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $0/visit	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $10/visit	17b1: $0/visit	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14c: $0														54.48592787	53.63424047	21.42733798		100	0.2	0.2	59.77457172	89.91630496	10.18010847	0.188169271		0.2	141.3342002		18.30198712	20	9.614190711	5		0.2	0.2			10																NO	53.38736219	52.55284683	20.99531197		97.98376256	0.195967525	0.195967525	58.56937443	88.10337876	10.18010847	0.184375332		0.195967525	141.1420731		17.93486037	19.59675251	9.421073183	4.899188128		0.195967525	0.195967525			10																	6.7432	0.212683079	2.17563	0	0.916763044	0.795559574	1.055097818	1.032030478	2.146472228	0.67923994	1.033172097	0	0.02931543	6.213235116	0	6.645504875	0.574600659	0.743064652	1.426960025	0	3.472276294	0.052546666	0	0	0.136603775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.084	0		0.605556173	6.7432	0.212683079	2.17563	0	0.916763044	0.795559574	1.055097818	1.032030478	2.146472228	0.67923994	1.033172097	0	0.02931543	6.213235116	0	6.645504875	0.574600659	0.743064652	1.426960025	0	3.472276294	0.052546666	0	0	0.136603775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.084	NO																																																																																		0	0		0	6.7432	0.212683079	2.17563	0	0.916763044	0.795559574	1.055097818	1.032030478	2.146472228	0.67923994	1.033172097	0	0.02931543	6.213235116	0	6.645504875	0.574600659	0.743064652	1.426960025	0	3.472276294	0.052546666	0	0	0.136603775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.084
H5402_035_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	2434.010406	28.15414742	1347.229897		229.2389193	1.738292901	3.573091079	350.908388	442.6595144	1261.695451	384.0922418	0.901880267	0.143364946	591.5165367		7091.918124	115.9684447	758.4483367	4570.433528	14.54116822	50.36414449	0.872272604			132.5551942	788.45701															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: $65/visit;4b: $20/visit	9a: $150/visit;9b: $75/visit	8a: $0 - $175/visit	8b: $100/visit;8b: 20%;8b: $5/visit;8b: $150/visit	9c: $25/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $150/visit	7a: $0/visit;14a: $0/visit	7b: $5/visit;7d: $10/visit;7f: $5/visit;16b: $0/visit;17a: $5/visit;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $15/visit;7i: $15/visit	8b: $5/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $15/visit		"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $15/visit	17b1: $15/visit	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14c: $0	13b: $35/Qtr													74.32203998	78.50689571	32.0892567		100	0.2	0.2	63.24005695	122.5175042	5.922120113	64.70531738	25	0.2	125.4461956		9.077058022	25	12.76419449	5		0.2	0.257003732			15	15															NO	63.57803385	67.15792617	27.45042856		85.54398382	0.171087968	0.171087968	54.09806408	104.806354	5.907653362	56.21779498	21.38599596	0.171087968	109.8598818		7.764877046	21.38599596	11.00055795	4.277199191		0.171087968	0.219851231			15	15																12.8958	0.157564513	3.081836503	0	1.634167534	0.297401	0.611312891	1.581955372	3.866127479	0.621138281	1.799401575	0.001607301	0.024528017	5.415328067	0	4.588989354	0.206675057	0.695279573	1.629054549	0	8.616699122	0.191770206	0	0	0.165693993	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0679	0		7.80867814	12.8958	0.157564513	3.081836503	0	1.634167534	0.297401	0.611312891	1.581955372	3.866127479	0.621138281	1.799401575	0.001607301	0.024528017	5.415328067	0	4.588989354	0.206675057	0.695279573	1.629054549	0	8.616699122	0.191770206	0	0	0.165693993	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0679	NO																																																																																		0	0		0	12.8958	0.157564513	3.081836503	0	1.634167534	0.297401	0.611312891	1.581955372	3.866127479	0.621138281	1.799401575	0.001607301	0.024528017	5.415328067	0	4.588989354	0.206675057	0.695279573	1.629054549	0	8.616699122	0.191770206	0	0	0.165693993	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0679
H5402_036_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	O																																																			0	YES	1718.553347	6.217256606	1117.984539		300.3816354	0.601342001	0.562317721	336.1166921	317.3738022	39.36035223	5.01929126		0.01179164	124.8137485		6232.711917	230.0169099	727.4260878	3500.725849	5.572943413	32.27620565	156.7050337			186.2972963	788.45701	16.40419387														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: $65/visit;4b: $15/visit	9a: $150/visit;9b: $75/visit	8a: $0 - $175/visit	8b: $100/visit;8b: 20%;8b: $5/visit;8b: $150/visit	9c: $25/visit	12a: 20%	3: $25/visit;5: $125/visit;9a: $150/visit	7a: $0/visit;14a: $0/visit	7b: $5/visit;7d: $15/visit;7f: $5/visit;16b: $0/visit;17a: $10/visit;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $20/visit;7i: $20/visit	8b: $5/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $15/visit	10b: $10 allowance/trip 18 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $10/visit	17b1: $15/visit	18a1: $15/visit	"18b: $1,000 Allowance /2 yr"	14c: $0	13b: $30/Qtr													77.3	87.22771215	34.84721403		100	0.2	0.2	64.9229584	134.320818	17.5	0.128071667		0.2	141.9225825		13.0565918	25	17.58539949	5		0.2	15.83572112			10	15	15														NO	70.32633806	79.35841621	31.70345348		90.97844509	0.18195689	0.18195689	59.06589806	122.2029917	15.92122789	0.116517611		0.18195689	129.3060775		11.87871674	22.74461127	15.99892302	4.548922255		0.18195689	14.40709285			10	15	13.64676676															10.0716	0.04111597	2.953664234	0	2.27735451	0.10941832	0.102317584	1.654419522	3.232002342	0.052222095	0.584835829	0	0.00214557	1.344931353	0	6.169718282	0.435970434	0.969836165	1.327044143	0	5.872878008	0.188138664	0	0	0.155247747	0.985571263	0.018655351	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5491	0		3.707303474	10.0716	0.04111597	2.953664234	0	2.27735451	0.10941832	0.102317584	1.654419522	3.232002342	0.052222095	0.584835829	0	0.00214557	1.344931353	0	6.169718282	0.435970434	0.969836165	1.327044143	0	5.872878008	0.188138664	0	0	0.155247747	0.985571263	0.018655351	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5491	NO																																																																																		0	0		0	10.0716	0.04111597	2.953664234	0	2.27735451	0.10941832	0.102317584	1.654419522	3.232002342	0.052222095	0.584835829	0	0.00214557	1.344931353	0	6.169718282	0.435970434	0.969836165	1.327044143	0	5.872878008	0.188138664	0	0	0.155247747	0.985571263	0.018655351	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5491
H5402_038_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	O																																																			0	YES	2005.195947	36.67751305	1175.99983		249.8032116	2.288521279	3.146820872	317.1075472	282.9083048	890.5013984	341.2890171	1.090965986	0.239901854	462.7690604	4771.203219	4894.0834	532.7837259	484.8892582	3757.699875	5.854011747	26.83045245	54.13394473			87.91276046	788.45701	11.20011749														3400	1a: $200/d (1-8) then $0	1b: $200/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: $65/visit;4b: $30/visit	9a: $190/visit;9b: $150/visit	8a: $0 - $175/visit	8b: $100/visit;8b: 20%;8b: $10/visit;8b: $150/visit	9c: $30/visit	12a: 20%	3: $25/visit;5: $125/visit;9a: $190/visit	7a: $5/visit;14a: $0/visit	7b: $20/visit;7d: $30/visit;7f: $30/visit;16b: $0/visit;17a: $30/visit;18a: $20/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	8b: $10/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $25/visit	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $30/visit	17b1: $25/visit	18a1: $20/visit	"18b: $1,000 Allowance /2yr"	14c: $0														157.3543421	169.7235749	44.91996362		150	0.2	0.2	63.51490651	165.3862111	7.687015725	52.60258325	30	0.2	143.0199671	5	29.35286279	30	26.91480782	10		0.2	30.92902256			30	25	20														NO	124.6882945	134.4897307	35.59478294		118.8606804	0.158480907	0.158480907	50.32950004	131.0527839	7.651409781	43.68486922	23.77213609	0.158480907	119.099286	3.962022681	23.3228521	23.77213609	21.32741581	7.924045362		0.158480907	24.50829778			30	25	20															20.8354	0.411062404	3.488288222	0	2.474314975	0.362686929	0.498711027	1.329988692	3.089660078	0.567799259	1.242430507	0.002161216	0.038019863	4.592955391	1.575301281	9.511998609	1.055450603	0.861786236	2.481348689	0	4.252114446	0.110560903	0	0	0.219781901	1.642618771	0.018666862	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6631	0		14.86835232	20.8354	0.411062404	3.488288222	0	2.474314975	0.362686929	0.498711027	1.329988692	3.089660078	0.567799259	1.242430507	0.002161216	0.038019863	4.592955391	1.575301281	9.511998609	1.055450603	0.861786236	2.481348689	0	4.252114446	0.110560903	0	0	0.219781901	1.642618771	0.018666862	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6631	NO																																																																																		0	0		0	20.8354	0.411062404	3.488288222	0	2.474314975	0.362686929	0.498711027	1.329988692	3.089660078	0.567799259	1.242430507	0.002161216	0.038019863	4.592955391	1.575301281	9.511998609	1.055450603	0.861786236	2.481348689	0	4.252114446	0.110560903	0	0	0.219781901	1.642618771	0.018666862	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6631
H5402_039_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	P	V	P	V	P	O	O																																																			0	YES	907.7194194	32.00196964	419.0897721		106.4324151	6.299112158	1.195862403	185.957759	206.212233	0.268592783	3.226221828	0.298967458	0.091880523	67.86561301	3467.096794	2491.182857	121.9882933	220.621161	22.60592215	3130.941912	17.70659665	108.6290247			89.31389765	0.636732205	5.01693716														3400	1a: $190/d (1-5) then $0	1b: $190/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: $65/visit;4b: $35/visit	9a: $200/visit;9b: $140/visit	8a: 20%	8b: 20%	9c: $35/visit	12a: 20%	3: $35/visit;5: $200/visit;9a: $200/visit	7a: $20/visit;14a: $0/visit	7b: $20/visit;7d: $30/visit;7f: $35/visit;16b: $0/visit;17a: $35/visit;18a: $20/visit	7e: $35/visit;7h: $35/visit	7c: $35/visit;7i: $35/visit	8b: 20%	7g: $0/visit	15: 20%	9d: 20%;17b: $25/visit	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $20/visit	17b1: $25/visit	18a1: $20/visit	"18b: $1,000 Allowance /2 yr"	14c: $0														135.5060189	112.8081294	45.63809576		150	0.2	0.2	64.95176849	186.619742	0.2	0.2	35	0.2	177.881681	19.96862279	30.26343628	35	29.66287693	0.2	9.304331106	0.2	32.35850491			20	25	20														NO	121.5019979	101.1498471	40.92157573		134.4980823	0.179330776	0.179330776	58.23925536	167.3333161	0.179330776	0.179330776	31.38288587	0.179330776	160.5814498	17.91004191	27.13582763	31.38288587	27.01435471	0.179330776	8.342764606	0.179330776	29.01437905			20	25	17.93307764															9.1908	0.269749528	1.429151154	0	1.192912977	1.129624674	0.214454933	0.902503451	2.87551473	0.048166952	0.578560865	0.000781872	0.016477005	0.908163211	5.174654074	5.633359049	0.319028724	0.496661525	4.053937571	2.176725948	3.175337726	0.262650308	0	0	0.148856496	0.001326525	0.007497427	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2069	0		4.599813989	9.1908	0.269749528	1.429151154	0	1.192912977	1.129624674	0.214454933	0.902503451	2.87551473	0.048166952	0.578560865	0.000781872	0.016477005	0.908163211	5.174654074	5.633359049	0.319028724	0.496661525	4.053937571	2.176725948	3.175337726	0.262650308	0	0	0.148856496	0.001326525	0.007497427	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2069	NO																																																																																		0	0		0	9.1908	0.269749528	1.429151154	0	1.192912977	1.129624674	0.214454933	0.902503451	2.87551473	0.048166952	0.578560865	0.000781872	0.016477005	0.908163211	5.174654074	5.633359049	0.319028724	0.496661525	4.053937571	2.176725948	3.175337726	0.262650308	0	0	0.148856496	0.001326525	0.007497427	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2069
H5402_040_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	1475.825087	44.51560536	1189.336712		112.7430665	2.713640801	4.091228053	178.8486554	262.8247615	1523.368968	8.379080763	2.051080286	0.153511757	534.3007504		4736.656695	205.1486881	593.8672146	2977.163632	4.336047549	22.18447196	0.635064442			146.30618	788.45701															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: $65/visit;4b: $20/visit	9a: $150/visit;9b: $50/visit	8a: $0 - $175/visit	8b: $100/visit;8b: 20%;8b: $20/visit;8b: $5/visit;8b: $150/visit	9c: $25/visit	12a: 20%	3: $25/visit;5: $125/visit;9a: $150/visit	7a: $0/visit;14a: $0/visit	7b: $5/visit;7d: $5/visit;7f: $5/visit;16b: $0/visit;17a: $5/visit;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $15/visit;7i: $15/visit	8b: $5/visit	7g: $0/visit	15: 20%	9d: 20%;17b: $15/visit	10b: $10 allowance/trip	"16a: X - rays, 1 exam/year, 1 cleaning/ 6 months"	17a1: $15/visit	17b1: $15/visit	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14c: $0	13b: $30/Qtr													78.80350752	62.1083297	31.55672346		100	0.2	0.2	59.95767349	85.30837137	7.828524892	0.205793762	25	0.2	124.5543969		5	25	14.84111364	5		0.2	0.221473532			15	15															NO	73.30706869	57.7763571	29.35568437		93.02513428	0.186050269	0.186050269	55.77570627	79.35822702	7.828524892	0.193843576	23.25628357	0.186050269	117.2790582		4.651256714	23.25628357	13.80596589	4.651256714		0.186050269	0.20602605			15	15																9.0157	0.214329126	2.90948276	0	0.873994908	0.5048736	0.761174078	0.831284173	1.738108924	0.993810991	1.624230982	0.003975042	0.028560904	5.2218574	0	1.835950521	0.397583005	0.683242542	1.153962694	0	4.127426965	0.130839819	0	0	0.182882725	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2188	0		2.314305969	9.0157	0.214329126	2.90948276	0	0.873994908	0.5048736	0.761174078	0.831284173	1.738108924	0.993810991	1.624230982	0.003975042	0.028560904	5.2218574	0	1.835950521	0.397583005	0.683242542	1.153962694	0	4.127426965	0.130839819	0	0	0.182882725	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2188	NO																																																																																		0	0		0	9.0157	0.214329126	2.90948276	0	0.873994908	0.5048736	0.761174078	0.831284173	1.738108924	0.993810991	1.624230982	0.003975042	0.028560904	5.2218574	0	1.835950521	0.397583005	0.683242542	1.153962694	0	4.127426965	0.130839819	0	0	0.182882725	0.985571263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2188
H5402_041_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	2784.140353	25.22642465	1624.780164		420.5460755	4.044231457	3.573445238	548.15785	434.808551	690.7370773	175.3794913		0.119081635	374.7746484						22.47551429	60.80264648	0.204721539																			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: $65/visit;4b: $0/visit	9a: $150/visit;9b: $25/visit	8a: $0 - $175/visit	8b: $0/visit;8b: $30/visit;8b: $0/visit;8b: $0/visit	9c: $0/visit	12a: 20%	3: $0/visit;5: $25/visit;9a: $150/visit	7a: $0/visit;14a: $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	7g: $0/visit	15: 20%	9d: 20%;17b: $0/visit		"16a: X - rays, 1 exam/year, 1 cleaning/ 6 months"	17a1: $0/visit	17b1: $0/visit	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14c: $0	13b: $30/Qtr													53.34392044	40.09865662	4.012466562		100	0.2	0.2	65	131.9671404	17.5	30		0.2	126.4013609							0.2	0.2																			NO	48.10627065	36.16151217	3.618496743		90.18135572	0.180362711	0.180362711	58.61788122	119.0097563	15.78173725	27.05440672		0.180362711	116.5142824							0.180362711	0.180362711																				11.1612	0.076018805	0.489938478	0	3.160451269	0.729428551	0.644516272	2.677654312	4.312204974	0.908419255	0.395399007	0	0.021477887	3.63888327	0	0	0	0	0	0	10.96653018	0.036924132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2191	0		4.182636545	11.1612	0.076018805	0.489938478	0	3.160451269	0.729428551	0.644516272	2.677654312	4.312204974	0.908419255	0.395399007	0	0.021477887	3.63888327	0	0	0	0	0	0	10.96653018	0.036924132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2191	NO																																																																																		0	0		0	11.1612	0.076018805	0.489938478	0	3.160451269	0.729428551	0.644516272	2.677654312	4.312204974	0.908419255	0.395399007	0	0.021477887	3.63888327	0	0	0	0	0	0	10.96653018	0.036924132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2191
H5404_001_0	2012	6																															D	D	D	V	T	Coin	Coin	V	P		P	V	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	1429.656737	3.749196225	474.539911	607.9426169	1.482981477	0.487558674	0.42111937	294.3488685	256.8174669	0	53.69299854	0.107387141	0.094262905	135.8868707	0	4549.290324	64.12610923	403.7776478	396.5916179	0	20.29144597	0	0	2925	0	0	0.199516555	0	0	0											3400	$175/Day for Days 1-10 for IP Med/Surg; PBP 1a	$175/Day for Days 1-10 for IP MH/SA; PBP 1b	$100/Day for Days 11-25 for SNF; PBP 2	$20/Visit for HH; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care; PBP 4a, 4b"	"$200/Procedure for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Procedure or 0-25% for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$175/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for CORF; $200/Visit for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $30/Visit for SPC OV; $30/Visit for SPC - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare;  $10-$30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services; PBP 7e, 7h"	"$30 in facility; 25% in Outpatient Hospital; CMS Cap/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	175	175	100	20	125	0.2	0.2	48.53197674	105.8557295	0	118.5226624	175	0.2	178.5479932	0	29.79622761	30	30	47.17530053	0	0.2	0	0	4	0	0	10	0	0	0											NO	161.0918707	161.0918707	92.05249756	18.41049951	115.065622	0.184104995	0.184104995	44.67489671	97.44284283	0	109.1030709	161.0918707	0.184104995	164.3578871	0	27.4281717	27.61574927	27.61574927	43.42604237	0	0.184104995	0	0	4	0	0	10	0	0	0												19.1922	0.050330419	3.640215334	0.932710604	0.014220016	0.089761987	0.07753018	1.095833775	2.085418672	0	0.488172586	0.0014416	0.017354272	1.861173246	0	10.39822634	0.147574213	0.929218524	1.435200367	0	3.735756562	0	0	0.975	0	0	0.000166264	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1675	0	NO	3.988088548	19.1922	0.050330419	3.640215334	0.932710604	0.014220016	0.089761987	0.07753018	1.095833775	2.085418672	0	0.488172586	0.0014416	0.017354272	1.861173246	0	10.39822634	0.147574213	0.929218524	1.435200367	0	3.735756562	0	0	0.975	0	0	0.000166264	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1675	NO																																										0	0	0	0	0	0	0	0	0	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	19.1922	0.050330419	3.640215334	0.932710604	0.014220016	0.089761987	0.07753018	1.095833775	2.085418672	0	0.488172586	0.0014416	0.017354272	1.861173246	0	10.39822634	0.147574213	0.929218524	1.435200367	0	3.735756562	0	0	0.975	0	0	0.000166264	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1675
H5404_034_0	2012	5																															D	D	D		T	Coin	Coin	V	P		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	477.0010398	5.042285994	623.2163853	0	119.2905399	3.79416144	2.135940014	183.9460139	192.2598248	0	76.95403047	0	0.165409911	548.6585756	0	4255.289377	148.1927531	285.3430824	253.0958075	43.57526692	21.98791138	4.555929386	0	2925	0	0	92.09962477	0	0	0											3400	$100/Day for Days 1-5 for IP Med/Surg; PBP 1a	$100/Day for Days 1-5 for IP MH/SA; PBP 1b	$50/Day for 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 Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $5/Visit for Urgent Care; PBP 4a, 4b"	"$100/Procedure for OP Surg; $25/Visit for ASC services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Procedure or 0-25% for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$100/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $15 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $15 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for CORF; $100/Visit for OP - Other; $15/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $15/Visit for SPC OV; $15/Visit for SPC - Other; $15/Visit for Podiatry; $15/Visit for Diabetic Footcare;  $10-$15/Exam for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services; PBP 7e, 7h"	"$15 in facility; 25% in Outpatient Hospital; CMS Cap/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	100	100	50	0	100	0.2	0.2	41.84883472	81.12805134	0	165.324155	0	0.2	87.99217517	0	14.80285196	15	15	63.03855649	11.88782658	0.073061124	0.2	0	4	0	0	10	0	0	0											NO	98.13064874	98.13064874	49.06532437	0	98.13064874	0.196261297	0.196261297	41.066533	79.61148309	0	162.2336659	0	0.196261297	86.34729234	0	14.52613466	14.71959731	14.71959731	61.86014444	11.66560134	0.071695355	0.196261297	0	4	0	0	10	0	0	0												3.9007	0.041233566	2.548192841	0	0.975504839	0.744647047	0.419202358	0.629502088	1.275507483	0	1.040377872	0	0.032463564	3.947931868	0	5.151075541	0.181778137	0.350011272	1.304711934	0.042360974	1.576431109	0.894152613	0	0.975	0	0	0.076749687	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1075	0	NO	0.47730314	3.9007	0.041233566	2.548192841	0	0.975504839	0.744647047	0.419202358	0.629502088	1.275507483	0	1.040377872	0	0.032463564	3.947931868	0	5.151075541	0.181778137	0.350011272	1.304711934	0.042360974	1.576431109	0.894152613	0	0.975	0	0	0.076749687	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1075	NO																																										0	0	0	0	0	0	0	0	0	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	3.9007	0.041233566	2.548192841	0	0.975504839	0.744647047	0.419202358	0.629502088	1.275507483	0	1.040377872	0	0.032463564	3.947931868	0	5.151075541	0.181778137	0.350011272	1.304711934	0.042360974	1.576431109	0.894152613	0	0.975	0	0	0.076749687	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1075
H5404_086_0	2012	11																															D	D	D	V	T	Coin	Coin	V	Coin	P	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	1381.033553	0	534.3911465	611.3928134	2.558391778	3.090490363	2.393845797	336.9558997	47.02298898	124.1583467	81.9272232	0	0.018813127	11.55019449	3553.820624	6139.895299	60.20373796	652.4489433	321.626395	0	26.06158187	0	0	2925	0	0	1.034811275	0	0	0											3400	$300/Day for Days 1-7 for IP Med/Surg; PBP 1a	$299/Day for Days 1-6 for IP MH/SA; PBP 1b	$100/Day for Days 7-20 for SNF; PBP 2	$20/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Surg; 10% Coinsurance for ASC services; PBP 9a, 9b"	$0-$15/Procedure for OP Lab; PBP 8a	$0-$100/Procedure or 0-25% for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$300/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40, 25% in Outpatient Hospital/Visit for Cardiac Rehab; $40, 25% in Outpatient Hospital/Visit for Pulmonary Rehabilitation Services; $40, 25% in Outpatient Hospital/Visit for CORF; 25% Coinsurance for OP - Other; $40/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $10-$40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$40, 25% in Outpatient Hospital/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	300	0	100	20	150	0.2	0.2	46.39454131	0.168578664	7.5	115.7332548	0	0.2	0.24534213	15	38.94052652	40	40	68.8677822	0	0.2	0	0	4	0	0	10	0	0	0											NO	256.2158821	0	85.40529404	17.08105881	128.1079411	0.170810588	0.170810588	39.62339443	0.143975104	6.405397053	98.84232658	0	0.170810588	0.209535168	12.81079411	33.25727117	34.16211762	34.16211762	58.81673189	0	0.170810588	0	0	4	0	0	10	0	0	0												29.4869	0	3.803319417	0.870269717	0.027312525	0.527888476	0.408894208	1.112611377	6.770139706	0.066273626	0.674823113	0	0.003213481	2.420171941	3.793938692	17.01634691	0.171390598	1.857419795	1.576417787	0	4.451594126	0	0	0.975	0	0	0.000862343	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0148	0	NO	12.82322109	29.4869	0	3.803319417	0.870269717	0.027312525	0.527888476	0.408894208	1.112611377	6.770139706	0.066273626	0.674823113	0	0.003213481	2.420171941	3.793938692	17.01634691	0.171390598	1.857419795	1.576417787	0	4.451594126	0	0	0.975	0	0	0.000862343	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0148	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	NO	0	29.4869	0	3.803319417	0.870269717	0.027312525	0.527888476	0.408894208	1.112611377	6.770139706	0.066273626	0.674823113	0	0.003213481	2.420171941	3.793938692	17.01634691	0.171390598	1.857419795	1.576417787	0	4.451594126	0	0	0.975	0	0	0.000862343	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0148
H5404_111_0	2012	5																																																						V			V														0	0	0	0	0	0	0	0	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	2925	0	0	64.96109477	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; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"No Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	10	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	10	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975	0	0	0.054134246	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0291	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	0.975	0	0	0.054134246	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0291	NO																																										0	0	0	0	0	0	0	0	0	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	0.975	0	0	0.054134246	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0291
H5404_116_0	2012	3																															D	D	D	V	T	Coin	Coin	V	P		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	860.3549383	6.115554729	284.7127738	1272.838507	91.00847309	4.374412324	2.987178933	220.9771435	147.0092006	0	74.88855172	0	0.16331517	519.9071501	0	2892.048101	73.88846647	272.9002109	119.5024173	38.51951255	22.75364474	5.353914785	0	2925	0	0	81.99992875	0	0	0											3400	$175/Day for Days 1-10 for IP Med/Surg; PBP 1a	$175/Day for Days 1-10 for IP MH/SA; PBP 1b	$100/Day for Days 11-25 for SNF; PBP 2	$20/Visit for HH; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care; PBP 4a, 4b"	"$200/Procedure for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$0-$100/Procedure or 0-25% for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$175/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Cardiac Rehab; $30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for Pulmonary Rehabilitation Services; $30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for CORF; $200/Visit for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $30/Visit for SPC OV; $30/Visit for SPC - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare;  $10-$30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services; PBP 7e, 7h"	"$30 in facility; 25% in Outpatient Hospital; CMS Cap/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	175	175	100	20	125	0.2	0.2	46.44271832	190.0397571	0	100	0	0.2	129.9469812	0	28.49053887	30	30	73.59813821	23.77570644	0.06772711	0.2	0	4	0	0	10	0	0	0											NO	165.6353467	165.6353467	94.64876953	18.92975391	118.3109619	0.189297539	0.189297539	43.95746142	179.8702917	0	94.64876953	0	0.189297539	122.9932187	0	26.96594447	28.39463086	28.39463086	69.65973222	22.50341359	0.064102876	0.189297539	0	4	0	0	10	0	0	0												11.8754	0.084412669	2.245642809	2.007876642	0.897274999	0.828065488	0.565465621	0.809466188	2.203548983	0	0.590675773	0	0.03091516	5.328754485	0	6.498900708	0.174836311	0.645741729	0.693708865	0.072235044	1.458574066	1.013482893	0	0.975	0	0	0.068333274	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0683	0	NO	2.149849358	11.8754	0.084412669	2.245642809	2.007876642	0.897274999	0.828065488	0.565465621	0.809466188	2.203548983	0	0.590675773	0	0.03091516	5.328754485	0	6.498900708	0.174836311	0.645741729	0.693708865	0.072235044	1.458574066	1.013482893	0	0.975	0	0	0.068333274	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0683	NO																																										0	0	0	0	0	0	0	0	0	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	11.8754	0.084412669	2.245642809	2.007876642	0.897274999	0.828065488	0.565465621	0.809466188	2.203548983	0	0.590675773	0	0.03091516	5.328754485	0	6.498900708	0.174836311	0.645741729	0.693708865	0.072235044	1.458574066	1.013482893	0	0.975	0	0	0.068333274	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0683
H5404_135_0	2012	7																															D	D	D		T	Coin	Coin	V	P		P	V	Coin	V		V	V	V	P	V	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	2354.840221	2.687115994	1629.889399	0	3.979617333	0.999989166	0.908593929	410.2849048	306.3435671	0	69.30802196	0.603472912	0.035740024	370.5683498	0	6069.923871	67.24768707	503.8084012	381.3407315	0	20.70354977	0	0	2925.329951	0	16.08140321	0	0	0	0											3400	$75/Days 1-5 for IP Medical; $75/Days 1-5 for IP Surgical; PBP 1a	$75/Days 1-5 for IP Psych; $75/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 Urgent Care; PBP 4a, 4b"	"$100/Procedure for OP Fac - Surgery; 25$/Procedure of ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; 20% Coinsurance for OP Fac - Radiation Therapy; PBP 8b	$75/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $100/Visit for OP - Other; $15/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Other; $15/Visit for Podiatry; $15/Visit for Diabetic Footcare; $10-$15/Visit for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 OP - PT/ST/OT; PBP 7c, 7i"	"$0-$200/Service for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride;$0-$75 Dental X-Ray; PBP 16a, 16b"	$0/Visit for routine (non-covered) eye care; PBP 17a	"$10/Other, $225 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Exam (non-cvd); PBP 18a	"$0 copay, $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b"	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	75	75	50	0	100	0.2	0.2	48.21762926	58.79227793	0	223.2446559	75	0.2	93.89871715	0	14.97266608	15	15	37.6515304	0	0.2	0	0	4	0	20	0	0	0	0											NO	70.92301519	70.92301519	47.28201013	0	94.56402026	0.189128041	0.189128041	45.5965287	55.59634161	0	211.1091216	70.92301519	0.189128041	88.79440191	0	14.15875498	14.18460304	14.18460304	35.60480083	0	0.189128041	0	0	4	0	20	0	0	0	0												13.9177	0.015881531	6.422037254	0	0.031360718	0.189125992	0.171840589	1.558963953	1.419298467	0	1.219296303	0.003566677	0.006759441	2.742032916	0	7.161880404	0.079490146	0.595526848	1.131463399	0	3.9156218	0	0	0.975109984	0	0.026802339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5838	0	NO	2.332833148	13.9177	0.015881531	6.422037254	0	0.031360718	0.189125992	0.171840589	1.558963953	1.419298467	0	1.219296303	0.003566677	0.006759441	2.742032916	0	7.161880404	0.079490146	0.595526848	1.131463399	0	3.9156218	0	0	0.975109984	0	0.026802339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5838	NO																																										0	0	0	0	0	0	0	0	0	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	13.9177	0.015881531	6.422037254	0	0.031360718	0.189125992	0.171840589	1.558963953	1.419298467	0	1.219296303	0.003566677	0.006759441	2.742032916	0	7.161880404	0.079490146	0.595526848	1.131463399	0	3.9156218	0	0	0.975109984	0	0.026802339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5838
H5404_136_0	2012	8																															D	D	D		T	Coin	Coin	V	P		P	V	Coin	V		V	V	V	P	V	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	3379.04472	0	5214.649738	0	4.729078694	0.318417531	0.091991024	640.150591	204.6128625	0	68.90610358	0.971554432	0	396.8958246	0	5149.378438	113.9115624	590.9770801	205.398847	0	7.004936569	0	0	2925	0	9.836140709	0	0	0	0											3400	$75/Days 1-5 for IP Medical; $75/Days 1-5 for IP Surgical; PBP 1a	$75/Days 1-5 for IP Psych; $75/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 Urgent Care; PBP 4a, 4b"	"$100/Procedure for OP Fac - Surgery; 25$/Procedure of ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; 20% Coinsurance for OP Fac - Radiation Therapy; PBP 8b	$75/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $100/Visit for OP - Other; $15/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Other; $15/Visit for Podiatry; $15/Visit for Diabetic Footcare; $10-$15/Visit for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 OP - PT/ST/OT; PBP 7c, 7i"	"$0-$200/Service for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride;$0-$75 Dental X-Ray; PBP 16a, 16b"	$0/Visit for routine (non-covered) eye care; PBP 17a	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Exam (non-cvd); PBP 18a	"$0 copay, $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b"	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	75	0	50	0	100	0.2	0.2	48.53706112	58.6432899	0	199.9999	75	0	93.64270802	0	14.9725762	15	15	16.72381696	0	0.2	0	0	4	0	20	0	0	0	0											NO	67.86751933	0	45.24501288	0	90.49002577	0.180980052	0.180980052	43.92119911	53.06632814	0	180.979961	67.86751933	0	84.73731062	0	13.54868806	13.57350387	13.57350387	15.13338628	0	0.180980052	0	0	4	0	20	0	0	0	0												19.1106	0	19.66140788	0	0.035661204	0.057627221	0.01664854	2.343015131	0.904837775	0	1.039218662	0.005494749	0	2.802657065	0	5.813943516	0.128848253	0.66846914	0.259031674	0	1.267753781	0	0	0.975	0	0.016393568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1066	0	NO	5.68719521	19.1106	0	19.66140788	0	0.035661204	0.057627221	0.01664854	2.343015131	0.904837775	0	1.039218662	0.005494749	0	2.802657065	0	5.813943516	0.128848253	0.66846914	0.259031674	0	1.267753781	0	0	0.975	0	0.016393568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1066	NO																																										0	0	0	0	0	0	0	0	0	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	19.1106	0	19.66140788	0	0.035661204	0.057627221	0.01664854	2.343015131	0.904837775	0	1.039218662	0.005494749	0	2.802657065	0	5.813943516	0.128848253	0.66846914	0.259031674	0	1.267753781	0	0	0.975	0	0.016393568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1066
H5404_137_0	2012	11																															D	D	D		T	Coin	Coin	V	P		P		Coin	V		V	V	V	P	V	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	2286.078785	7.527778372	1499.227757	0	2.988614068	0.840720759	0.957193035	414.3932119	309.9131271	0	85.40198959	0	0.439056789	366.6440336	0	6107.129814	90.89405876	471.5106371	581.9024092	0	20.02122951	0	0	2925	0	17.68215315	0	0	0	0											3400	$75/Days 1-5 for IP Medical; $75/Days 1-5 for IP Surgical; PBP 1a	$75/Days 1-5 for IP Psych; $75/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 Urgent Care; PBP 4a, 4b"	"$100/Procedure for OP Fac - Surgery; 25$/Procedure of ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; 20% Coinsurance for OP Fac - Radiation Therapy; PBP 8b	$75/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for Pulmonary Rehabilitation Services; $15/Visit for CORF; $100/Visit for OP - Other; $15/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Other; $15/Visit for Podiatry; $15/Visit for Diabetic Footcare; $10-$15/Visit for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 OP - PT/ST/OT; PBP 7c, 7i"	"$0-$200/Service for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride;$0-$75 Dental X-Ray; PBP 16a, 16b"	$0/Visit for routine (non-covered) eye care; PBP 17a	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Exam (non-cvd); PBP 18a	"$0 copay, $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b"	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	75	75	50	0	100	0.2	0.199162829	48.26885024	59.25375422	0	207.9076805	0	0.2	91.97534079	0	14.98468904	15	15	41.25918978	0	0.2	0	0	4	0	20	0	0	0	0											NO	70.92887143	70.92887143	47.28591429	0	94.57182858	0.189143657	0.188351929	45.6487343	56.03735887	0	196.6220952	0	0.189143657	86.98276162	0	14.17129443	14.18577429	14.18577429	39.01957023	0	0.189143657	0	0	4	0	20	0	0	0	0												13.5124	0.044494735	5.90769627	0	0.023553225	0.159016999	0.180289154	1.576377135	1.447226093	0	1.399326511	0	0.083044807	2.657642548	0	7.212161228	0.107450217	0.557395289	1.892131827	0	3.786888569	0	0	0.975	0	0.029470255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5516	0	NO	2.327296286	13.5124	0.044494735	5.90769627	0	0.023553225	0.159016999	0.180289154	1.576377135	1.447226093	0	1.399326511	0	0.083044807	2.657642548	0	7.212161228	0.107450217	0.557395289	1.892131827	0	3.786888569	0	0	0.975	0	0.029470255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5516	NO																																										0	0	0	0	0	0	0	0	0	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	13.5124	0.044494735	5.90769627	0	0.023553225	0.159016999	0.180289154	1.576377135	1.447226093	0	1.399326511	0	0.083044807	2.657642548	0	7.212161228	0.107450217	0.557395289	1.892131827	0	3.786888569	0	0	0.975	0	0.029470255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5516
H5404_138_0	2012	9																															A	A	D		T	Coin	Coin	V	P		P	V	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	269.2241022	0.595444098	817.5441092	0	5.481721043	0.861075187	1.065788847	349.4496728	253.2946076	0	104.1567477	1.746222912	0.072690837	187.9175724	0	3367.337576	135.4553323	482.1688395	226.5311694	0.426917271	11.89821351	0.309947198	0	2925	0	0	4.968651994	0	0	0											3400	$100/Day for Days 1-5 for IP Med/Surg; PBP 1a	$100/Day for Days 1-5 for IP MH/SA; PBP 1b	$75/Day for 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 Prosth/Supplies; PBP 11b, 11c"	"$50/Visit for OP ER; $5/Visit for Urgent Care; PBP 4a, 4b"	"$150/Procedure for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$0-200/Procedure for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$100/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$20/Visit for Cardiac Rehab; $20/Visit for Pulmonary Rehabilitation Services; $20/Visit for CORF; $150/Visit for OP - Other;  $20/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $20/Visit for SPC OV; $20/Visit for SPC - Other; $20/Visit for Podiatry; $20/Visit for Diabetic Footcare;  $10-$20/Exam for Vision Exams; $20/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$20/Visit for MH - Non Phys; $20/Visit for Psych Services; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Other Glasses/Contacts (non-cvd); PBP 17b	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	181.0341968	199.9501728	75	0	100	0.2	0.2	48.22204579	91.28713583	0	260.5579055	50	0.2	139.0808286	0	19.97296681	20	20	48.14373031	0.202312114	0.184495481	0.2	0	4	0	0	10	0	0	0											NO	177.0613107	195.5621661	73.35408742	0	97.8054499	0.1956109	0.1956109	47.16378883	89.2837939	0	254.8398317	48.90272495	0.1956109	136.0286301	0	19.53465005	19.56108998	19.56108998	47.08719203	0.197872274	0.180446635	0.1956109	0	4	0	0	10	0	0	0												3.9724	0.009703861	4.997516838	0	0.044678516	0.168435692	0.208479915	1.373447548	1.884591962	0	2.211940671	0.007116255	0.01421912	2.13018083	0	5.481646761	0.220804495	0.785979005	0.888893056	0.084475091	2.146992588	0.06062905	0	0.975	0	0	0.004140543	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6713	0	NO	0.598916395	3.9724	0.009703861	4.997516838	0	0.044678516	0.168435692	0.208479915	1.373447548	1.884591962	0	2.211940671	0.007116255	0.01421912	2.13018083	0	5.481646761	0.220804495	0.785979005	0.888893056	0.084475091	2.146992588	0.06062905	0	0.975	0	0	0.004140543	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6713	NO																																										0	0	0	0	0	0	0	0	0	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	3.9724	0.009703861	4.997516838	0	0.044678516	0.168435692	0.208479915	1.373447548	1.884591962	0	2.211940671	0.007116255	0.01421912	2.13018083	0	5.481646761	0.220804495	0.785979005	0.888893056	0.084475091	2.146992588	0.06062905	0	0.975	0	0	0.004140543	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6713
H5404_143_0	2012	5																															D	D	D		T	Coin	Coin	V					Coin			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	435.7112776	7.958151313	747.2480419	0	308.9986538	16.47366424	10.35866131	335.9939589	0	0	0	0	1.283320864	0	0	944.4100837	0	0	0	0	27.00209297	18.29208353	0	2925	0	0	247.4050359	0	0	0											3400	$50/Days 6-15 for IP Medical; $50/Days 6-15 for IP Surgical; PBP 1a	$50/Days 6-15 for IP Psych; $50/Days 6-15 for IP Substance Abuse; PBP 1b	$10/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 Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"No Cost-Sharing; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$0-$10/Exam for Vision Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 17b, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 8b, 14a"	"No Cost-Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	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/Other, $225 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Visit for Routine Hearing/Speech Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	50	50	10	0	50	0.2	0.2	50	0	0	0	0	0.2	0	0	5	0	0	0	0	0.2	0.2	0	4	0	0	10	0	0	0											NO	49.85079731	49.85079731	9.970159461	0	49.85079731	0.199403189	0.199403189	49.85079731	0	0	0	0	0.199403189	0	0	4.985079731	0	0	0	0	0.199403189	0.199403189	0	4	0	0	10	0	0	0												1.81	0.033060016	0.620848511	0	1.283652438	3.284901188	2.065550101	1.395797228	0	0	0	0	0.255898273	0	0	0.392329964	0	0	0	0	5.384303453	3.647499794	0	0.975	0	0	0.206170863	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3551	0	NO	0.060380144	1.81	0.033060016	0.620848511	0	1.283652438	3.284901188	2.065550101	1.395797228	0	0	0	0	0.255898273	0	0	0.392329964	0	0	0	0	5.384303453	3.647499794	0	0.975	0	0	0.206170863	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3551	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	1.81	0.033060016	0.620848511	0	1.283652438	3.284901188	2.065550101	1.395797228	0	0	0	0	0.255898273	0	0	0.392329964	0	0	0	0	5.384303453	3.647499794	0	0.975	0	0	0.206170863	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3551
H5404_801_0	2012	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	265.1543195	2.472859353	77.68723299	0	10.43065675	13.19592271	8.669597975	16.32870683	57.1500683	5.573645002	24.55730644	0	0.373195803	26.86778059	48.40080286	112.5847955	1.964872808	7.376273011	42.35781848	73.81954413	60.65509373	15.85415713	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; PBP 5	20% Coinsurance: PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance: PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.085881737	0.085881737	0.163742359	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.067734639	0.067734639	0.129143052	0	0.176668052	0.157739333	0.176668052	0.176668052	0.176668052	0.176668052	0.176668052	0	0.157739333	0.176668052	0.176668052	0.176668052	0.176668052	0.176668052	0.176668052	0.176668052	0.157739333	0.176668052	0	0	0	0	0	0	0	0												17.9601	0.167498237	10.03276638	0	1.842763815	2.081516041	1.53164099	2.884760835	10.09659126	0.984685008	4.338491502	0	0.058867657	4.746678471	8.55087558	19.89013656	0.347130252	1.303151787	7.483273297	13.04155509	9.567694001	2.800923064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7111	0	NO	32.07235798	17.9601	0.167498237	10.03276638	0	1.842763815	2.081516041	1.53164099	2.884760835	10.09659126	0.984685008	4.338491502	0	0.058867657	4.746678471	8.55087558	19.89013656	0.347130252	1.303151787	7.483273297	13.04155509	9.567694001	2.800923064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7111	NO																																										0	0	0	0	0	0	0	0	0	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	17.9601	0.167498237	10.03276638	0	1.842763815	2.081516041	1.53164099	2.884760835	10.09659126	0.984685008	4.338491502	0	0.058867657	4.746678471	8.55087558	19.89013656	0.347130252	1.303151787	7.483273297	13.04155509	9.567694001	2.800923064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7111
H5407_001_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1620.214195	54.01577744	910.467178	1708.909619	221.9424151	13.41376543	8.266107069	443.4916697	390.9651479	21.11718809	65.82298556	0	0.086096688	246.1284648	5286.770731	6092.977381	294.4056617	571.899949	0	0	37.91313085	1363.96889	673.27038	0	54.17158068	178.282105	19.2274124	2.673398366	804.7919229	0											3800	"$125 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-51 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $0/$75 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $0 (5); $125 (9a); $25 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $20 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$10 (7b, 7b1); $20 (7d, 7f, 7f1)"	"$20 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$0/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $20 (16b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2, 17b5); $0 n/c (17b3, 17b4)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	104.0763412	76.15029608	44.22647202	0	200	0.2	0.142294069	64.43769876	19.5	0.009116822	0.056854713	0	0.2	14.94169752	0.102953476	19.08787059	20	35	0	0	0.2	0.848989979	0	0	0	0	0	0	0	0											NO	89.22734765	65.2856246	37.91650195	0	171.4651891	0.171465189	0.121992397	55.25411713	16.71785594	0.007816088	0.048743021	0	0.171465189	12.80990495	0.100552563	18.66321368	19.53359271	34.18378724	0	0	0.171465189	0.727861137	0	0	0	0	0	0	0	0												12.0473	0.293871147	2.876810877	0	3.171283182	2.299993826	1.008402219	2.042061722	0.544674918	0.165053805	3.208411159	0	0.014762585	0.262740187	0.044299862	9.476211567	0.479233357	1.629142182	0	0	6.500782152	0.082731662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1478	0	NO	6.011130852	12.0473	0.293871147	2.876810877	0	3.171283182	2.299993826	1.008402219	2.042061722	0.544674918	0.165053805	3.208411159	0	0.014762585	0.262740187	0.044299862	9.476211567	0.479233357	1.629142182	0	0	6.500782152	0.082731662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1478	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	NO	0	12.0473	0.293871147	2.876810877	0	3.171283182	2.299993826	1.008402219	2.042061722	0.544674918	0.165053805	3.208411159	0	0.014762585	0.262740187	0.044299862	9.476211567	0.479233357	1.629142182	0	0	6.500782152	0.082731662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1478
H5407_004_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1785.693634	77.85837339	1076.771228	2536.59903	253.5746785	13.14963572	9.30755201	515.7691394	436.9498799	19.27471544	50.99552453	0	0.102642172	323.4121608	7177.596015	6435.391229	423.9175188	606.5939316	0	0	34.28713792	1467.335582	673.27038	0	48.57149053	190.313683	18.16903387	2.673398366	804.7919229	0											3950	"$125 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$75 (9b)	20% (8a1a); $0/$25 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9c); $0 (5); $125 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $25 (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$10 (7b, 7b1); $25 (7d, 7f, 7f1)"	"$15 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$0/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17a, 17b); $25 (16b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2, 17b5); $0 n/c (17b3, 17b4)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	104.0763412	76.15029608	48.42379925	0	200	0.2	0.132134929	64.17084921	19.5	0.004258301	0.059017333	0	0.2	14.92997307	0.162553698	23.61925813	15	25	0	0	0.2	0.598836104	0	0	0	0	0	0	0	0											NO	88.02788856	64.40800761	40.95690485	0	169.160229	0.169160229	0.111759874	54.28576548	16.49312233	0.003601676	0.049916928	0	0.169160229	12.62778832	0.158426651	23.04105317	14.61916763	24.36527938	0	0	0.169160229	0.506496263	0	0	0	0	0	0	0	0												13.0992	0.417891892	3.675101393	0	3.574562557	2.22439539	1.04021084	2.333243545	0.600555652	0.069421275	2.545539921	0	0.017362973	0.340331692	0.094760208	12.35651595	0.516443439	1.231652551	0	0	5.800020102	0.061933332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9992	0	NO	6.884279276	13.0992	0.417891892	3.675101393	0	3.574562557	2.22439539	1.04021084	2.333243545	0.600555652	0.069421275	2.545539921	0	0.017362973	0.340331692	0.094760208	12.35651595	0.516443439	1.231652551	0	0	5.800020102	0.061933332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9992	NO																																										0	0	0	0	0	0	0	0	0	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	13.0992	0.417891892	3.675101393	0	3.574562557	2.22439539	1.04021084	2.333243545	0.600555652	0.069421275	2.545539921	0	0.017362973	0.340331692	0.094760208	12.35651595	0.516443439	1.231652551	0	0	5.800020102	0.061933332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9992
H5407_011_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	O	O	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	2582.627173	34.90069983	747.2563571	1104.79662	324.2038956	22.46421658	16.38861389	747.617371	360.0692028	7105.834541	12301.98857	0	22.26743754	326.099138	5030.740508	6772.850304	84.98081412	855.6932449	0	0	48.22766191	1227.315653	831.3356418	0	62.11510539	159.6699789	22.31539749	2.613989513	474.4630194	0											3400	"$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); $0/20% (11c)"	"$65 (4a, 4a1); $0 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$0 (7b, 7b1, 7d, 7f, 7f1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2, 17b5); $0 n/c (17b3, 17b4)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0	0	0	0	50	0.2	0.178104519	65	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	47.01534261	0.18806137	0.1674729	61.12223921	0	0	0	0	0	0	0	0	0	0	0	0	0.18806137	0	0	0	0	0	0	0	0	0												0	0	0	0	1.270213102	4.224651357	2.744648688	3.808003982	0	0	0	0	0	0	0	0	0	0	0	0	9.069760193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1173	0	NO	1.340428227	0	0	0	0	1.270213102	4.224651357	2.744648688	3.808003982	0	0	0	0	0	0	0	0	0	0	0	0	9.069760193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1173	NO																																										0	0	0	0	0	0	0	0	0	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	1.270213102	4.224651357	2.744648688	3.808003982	0	0	0	0	0	0	0	0	0	0	0	0	9.069760193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1173
H5410_001_0	2012	6		r.	s									COB/Subrogation	Risk Sharing																		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	0.029468941															0.211512117																									3400	"$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"	$0 copay for exams	"$1,800 limit for hearing aids every 3 years"	No cost sharing; Activity Center; $25 limit for vitamins every 3 months	$0 copay													0.3															0.3																									NO	0.3															0.3																										0.0088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.063453635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0723	0		0	0.0088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.063453635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0723	NO																																																																																		0	0		0	0.0088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.063453635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0723
H5410_004_0	2012	4																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN																																																												0	YES	973.6213281	48.79116524	97.75145023	247.3584781	228.1891176	17.91867273		397.7642293	467.4374817		1254.118543	3.747855729	0	454.8422288	5223.404961	6788.042567	165.3971741	343.3896011	3650.042838		20.66305595																				3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $75 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $100 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $35 per Urgent Care Visit	9a/b. $175 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy visist; $100 per MRI,MRA,PET,CT, and NUC Scan"	"5, 9c. $35 per visit"	12. 20%  coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 copay per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $35 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script																						195	195	75	20	100	0.2		60.67611336	175		58.61536486	35	0.2	6.79025886	10	34.93	35	20	43.42752038		0.2																				NO	174.3793296	174.3793296	67.06897294	17.88505945	89.42529725	0.178850595		54.25979474	156.4942702		52.41696426	31.29885404	0.178850595	6.07220917	8.942529725	31.23625633	31.29885404	17.88505945	38.83518919		0.178850595																					14.1483	0.709014224	0.546340781	0.368668424	1.700489973	3.20476527	0	1.798550453	6.09594063	0	5.478090571	0.009775299	0	0.230158096	3.892537844	17.6694198	0.431395168	0.511795286	11.81250868	0	3.695599842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3033			8.55	14.1483	0.709014224	0.546340781	0.368668424	1.700489973	3.20476527	0	1.798550453	6.09594063	0	5.478090571	0.009775299	0	0.230158096	3.892537844	17.6694198	0.431395168	0.511795286	11.81250868	0	3.695599842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3033	NO																																																																																		0				14.1483	0.709014224	0.546340781	0.368668424	1.700489973	3.20476527	0	1.798550453	6.09594063	0	5.478090571	0.009775299	0	0.230158096	3.892537844	17.6694198	0.431395168	0.511795286	11.81250868	0	3.695599842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3033
H5410_005_0	2012	8																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN																																																												0	YES	748.6451552	19.95098413	57.62366613	106.7778571	162.94325	13.58824794		368.8043748	377.007911		1250.605747	4.40324116	0.250606653	555.6317218	1239.527341	5712.645589	102.5284368	110.6418383	953.5318328		12.04750874																				3400	1a. $220 per day days 1-6	1b. $220 per day days 1-6	2. $0 per day days 1-5; $60 per day days 6-35	6. $20 per PT/OT/ST	10a. $85 per trip	11a/b/c. 20% coinsurance		4a/b. $65 per ER visit; $40 per Urgent Care visit	9a/b. $175 per visit		"8a/b, 9a. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"	"5, 9c. $40 per visit"	12. 20% coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 copay per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $40 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $40 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b, 9a. $25 per Xray; $35 per Radiation Therapy; $100 per MRI,MRA, CT, PET, and  Nuc Scan"		15. 20% coinsurance per script																						220	220	60	20	85	0.2		65	175		58.61536486	40	0.2	6.79025886	10	39.86305572	40	20	43.42752038		0.2																				NO	206.4578215	206.4578215	56.30667859	18.76889286	79.76779467	0.187688929		60.99890181	164.2278126		55.00727516	37.53778573	0.187688929	6.372282053	9.384446432	37.4092711	37.53778573	18.76889286	40.75432387		0.187688929																					12.8803	0.34325306	0.270383104	0.167008513	1.083135309	2.550363698	0	1.87472182	5.159598712	0	5.732701202	0.013773994	0.047036094	0.295053504	0.969356495	17.80882563	0.320724208	0.173052068	3.238378761	0	2.261184008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1889			3.62	12.8803	0.34325306	0.270383104	0.167008513	1.083135309	2.550363698	0	1.87472182	5.159598712	0	5.732701202	0.013773994	0.047036094	0.295053504	0.969356495	17.80882563	0.320724208	0.173052068	3.238378761	0	2.261184008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1889	NO																																																																																		0				12.8803	0.34325306	0.270383104	0.167008513	1.083135309	2.550363698	0	1.87472182	5.159598712	0	5.732701202	0.013773994	0.047036094	0.295053504	0.969356495	17.80882563	0.320724208	0.173052068	3.238378761	0	2.261184008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1889
H5410_012_0	2012	7																															D	D	D	V	T	COIN		V	V		P	V	COIN	V	V	V	V	V	P		COIN			COIN																																																									0	YES	904.5845708	45.33152057	90.82016909	229.8189823	212.0088674	16.6481099		369.5598835	448.1641405		1165.192515	3.482105792	0.41571122	422.5906422	4853.027967	6306.721509	153.6693244	319.0408077	3391.228539		19.19789662			23.87																	3400	1a. $195 per day days 1-6	1b. $195 per day days 1-6	2. $0 per day days 1-5; $50 per day days 6-35	6. $20 per PT/OT/ST visit	10a. $75 per trip	11a/b/c; 17b. 20% coinsurance		4a/b. $65 per ER visit; $40 per Urgent Care visit	9a/b. $150 per visit		"8a/b. $25 per Xray; $35 per Radiation Therapy visit; $100 per MRI,MRA,PET,CT, and NUC Scan"	5; 9c. $35 per visit	12. 20%  coinsurance	3. $20 per PT/OT/ST visit; 9a. $65 per Observation Stay	"7a, 17a, 18a. $10 per visit"	"7b/d/f, 17a, 18a. $40 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $35 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b, 9a. $25 per Xray; $35 per Radiation Therapy visit; $100 per MRI,MRA,PET,CT, and NUC Scan"		15. 20% coinsurance per script			20% coinsurance for basic services; 50% coinsurance for major services																			195	195	50	20	75	0.2		61.39676113	150		58.61536486	35	0.2	6.79025886	10	35	35	20	43.42752038		0.2			0.21																	NO	177.1887926	177.1887926	45.43302374	18.1732095	68.14953561	0.181732095		55.78881012	136.2990712		53.26146526	31.80311662	0.181732095	6.170039839	9.086604748	31.80311662	31.80311662	18.1732095	39.46087129		0.181732095			0.21																		13.3569	0.669353116	0.343852908	0.348045709	1.204025488	3.02549589	0	1.718108848	5.090363009	0	5.171655055	0.009228485	0.075548071	0.217283425	3.674795581	16.71444997	0.40726362	0.483166286	11.15173607	0	3.488873971	0	0	5.0127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1628			6.75	13.3569	0.669353116	0.343852908	0.348045709	1.204025488	3.02549589	0	1.718108848	5.090363009	0	5.171655055	0.009228485	0.075548071	0.217283425	3.674795581	16.71444997	0.40726362	0.483166286	11.15173607	0	3.488873971	0	0	5.0127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1628	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1		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																					0.5807		0.058	0.0527	0.0239	0.051			0.1635	0.1456					0.6507						0.0592																				1.7853				13.9375	0.669353116	0.401867045	0.400734442	1.227903252	3.076500075	0	1.718108848	5.253843006	0.145648062	5.171655055	0.009228485	0.075548071	0.217283425	4.325451804	16.71444997	0.40726362	0.483166286	11.15173607	0	3.548106103	0	0	5.0127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9481
H5410_013_0	2012	6																															D	D	D		COIN	COIN		V	V		COIN	V	COIN	COIN	V	V	V	V	COIN		COIN																																																												0	YES	1237.478704	60.28412518	171.7933679		13.24938371	26.46537967		549.8505734	414.0182901		25.33968847	6.148786487	1.595786958	7.836780155	5390.123889	7137.85024	205.0983023	348.5305117	28.93947961		12.0910535																				6700	1a. $235 per day days 1-6	1b. $235 per day days 1-6	2. $0 per day days 1-5; $50 per day days 6-35		10a. 20% coinsurance	11a/b/c. 20% coinsurance		4a/b. $65 copay per ER visit; $40 per Urgent Care visit	9a/b. $220 copay per visit		8a/b. 20% coinsurance	"5, 9c. $40 per visit"	12. 20% coinsurance	3. 20% coinsurance; 9a. $65 per Observation Stay	"7a, 17a, 18a. $15 per visit"	"7b/d/f, 17a, 18a. $40 per visit; $20 per chiro visit"	"5, 7e/h/g, 9c. $40 per visit"	7c/i. $20 per PT/OT/ST visit	"8a/b, 9a. 20% coinsurance"		15. 20% coinsurance per script																						235	235	50		0.2	0.2		61.39676113	220		0.2	40	0.2	6.79025886	15	39.91	40	20	0.2		0.2																				NO	226.0539798	226.0539798	48.09659146		0.192386366	0.192386366		59.05949874	211.6250024		0.192386366	38.47727317	0.192386366	6.531766125	14.42897744	38.3906993	38.47727317	19.23863658	0.192386366		0.192386366																					23.3114	1.135622202	0.688556286	0	2.549000781	5.091578215	0	2.706158271	7.301385137	0	4.875010576	0.019715711	0.307007654	0.511880151	6.481164664	22.83558852	0.657635283	0.558770988	5.56756131	0	2.326153842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9242			3.44	23.3114	1.135622202	0.688556286	0	2.549000781	5.091578215	0	2.706158271	7.301385137	0	4.875010576	0.019715711	0.307007654	0.511880151	6.481164664	22.83558852	0.657635283	0.558770988	5.56756131	0	2.326153842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9242	NO																																																																																		0				23.3114	1.135622202	0.688556286	0	2.549000781	5.091578215	0	2.706158271	7.301385137	0	4.875010576	0.019715711	0.307007654	0.511880151	6.481164664	22.83558852	0.657635283	0.558770988	5.56756131	0	2.326153842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9242
H5414_009_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1153.902613	188.5240047	915.2649944	882.3026136	156.5021952	7.985493067	0	265.7127869	392.6136958	3542.473068	2786.44407	29.85097695	0.01841891	475.1750656	2408.378025	5158.593954	216.2642879	671.9465359	0	0	61.15059565	0.001726237	0	0	1189.070711	110.9329853	39.79736767	7.523161369	49.19222746	0											6700	$265/day 1-6; unlimited additional days	$205/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$275 per procedure	$0 to $45 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 275 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	178.5937298	98.56078618	51.87372562	0	200	0.03	0.03	63.5	275	4.5	24.71627306	45	0.2	45	25	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	158.7891345	87.63119481	46.1213504	0	177.821623	0.026673243	0	56.4583653	244.5047316	4.000986518	21.97543895	40.00986518	0.177821623	40.00986518	22.22770288	40.00986518	35.5643246	20.00493259	0	0	0.088910812	0	0	0	0	0	0	0	0	0												15.2689	1.376715315	3.51777146	0	2.319122862	0.212999001	0	1.250142465	7.99965886	1.181115582	5.102777629	0.099527797	0.003275281	1.584307526	4.461059263	17.19955405	0.640941111	1.120187096	0	0	5.436949083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.775	0	NO	9.255912683	15.2689	1.376715315	3.51777146	0	2.319122862	0.212999001	0	1.250142465	7.99965886	1.181115582	5.102777629	0.099527797	0.003275281	1.584307526	4.461059263	17.19955405	0.640941111	1.120187096	0	0	5.436949083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.775	NO																																																																																		0		NO		15.2689	1.376715315	3.51777146	0	2.319122862	0.212999001	0	1.250142465	7.99965886	1.181115582	5.102777629	0.099527797	0.003275281	1.584307526	4.461059263	17.19955405	0.640941111	1.120187096	0	0	5.436949083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.775
H5414_019_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1551.932523	61.76730769	716.4437195	1133.494912	183.0243389	11.42200831	0	336.930761	384.2993121	3424.36536	2726.427162	40.19912682	0.016680733	468.1316076	2653.630118	5376.05068	199.4068845	670.1792073	0	0	56.31081723	0.001524483	0	0	1043.659631	118.3236097	52.33439105	10.45812581	47.46265104	0											6700	$265/day 1-6; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $140/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$275 per procedure	$0 to $50 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $200 Complex Radiology	$50 per visit	20% per visit	$0 to 275 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	178.5937298	98.56078618	77.98824527	0	200	0.03	0.03	63.5	275	5	25.29981669	50	0.2	50	20	50	40	25	50	50	0.1	0	0	0	0	0	0	0	0	0											NO	161.6611155	89.21615925	70.59411739	0	181.0378401	0.027155676	0	57.47951424	248.9270302	4.525946003	22.90112085	45.25946003	0.18103784	45.25946003	18.10378401	45.25946003	36.20756802	22.62973001	0	0	0.09051892	0	0	0	0	0	0	0	0	0												20.9073	0.459220163	4.214726003	0	2.761194251	0.310172357	0	1.613884706	7.97187387	1.29154106	5.203186493	0.151615898	0.003019844	1.765615315	4.003395542	20.27642924	0.601669861	1.26383121	0	0	5.097194363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8958	0	NO	8.692807182	20.9073	0.459220163	4.214726003	0	2.761194251	0.310172357	0	1.613884706	7.97187387	1.29154106	5.203186493	0.151615898	0.003019844	1.765615315	4.003395542	20.27642924	0.601669861	1.26383121	0	0	5.097194363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8958	NO																																																																																		0		NO		20.9073	0.459220163	4.214726003	0	2.761194251	0.310172357	0	1.613884706	7.97187387	1.29154106	5.203186493	0.151615898	0.003019844	1.765615315	4.003395542	20.27642924	0.601669861	1.26383121	0	0	5.097194363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8958
H5414_801_0	2012	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	0	0	0	0	0	0	0											0	YES	290.7144708	4.910257381	33.15307221	8.160962852	8.351938354	13.69854319	0	18.70553711	45.83129489	22.48455105	58.1163222	0.705207371	0.061588783	30.51708959	32.37457242	139.9360824	2.680148392	8.147852565	0	0	58.13126059	0.000271928	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	NO	0.089126373	0.089126373	0.161583432	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073331815	0.073331815	0.132948375	0	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0.184303772	0	0	0	0	0	0	0	0												21.3186	0.360078088	4.407647086	0	1.539293741	2.524693178	0	3.447501043	8.446880516	4.143987567	10.71105739	0.129972378	0.011351045	5.624414717	5.966755808	25.7907478	0.493961458	1.50167996	0	0	10.71381059	5.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1325	0	NO	23.07471093	21.3186	0.360078088	4.407647086	0	1.539293741	2.524693178	0	3.447501043	8.446880516	4.143987567	10.71105739	0.129972378	0.011351045	5.624414717	5.966755808	25.7907478	0.493961458	1.50167996	0	0	10.71381059	5.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1325	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.3186	0.360078088	4.407647086	0	1.539293741	2.524693178	0	3.447501043	8.446880516	4.143987567	10.71105739	0.129972378	0.011351045	5.624414717	5.966755808	25.7907478	0.493961458	1.50167996	0	0	10.71381059	5.01E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1325
H5414_803_0	2012	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	0	0	0	0	0	0	0											0	YES	248.2982361	3.512136911	25.56629539	6.739611059	6.003151506	13.29645582	0	12.87976407	40.160186	19.8524685	56.54177865	0.483569853	0.039319193	26.74976717	33.96547612	127.118033	2.068737449	8.711704762	0	0	73.99663414	0.000173603	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	NO	0.087710241	0.087710241	0.164597579	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072480324	0.072480324	0.136017023	0	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0.185104868	0	0	0	0	0	0	0	0												17.9967	0.254560821	3.477451384	0	1.111212566	2.461238697	0	2.384107025	7.433845917	3.674788556	10.46615846	0.089511134	0.007278174	4.951512114	6.287174964	23.53016669	0.382933372	1.612578958	0	0	13.69713718	3.21E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8184	0	NO	20.97433135	17.9967	0.254560821	3.477451384	0	1.111212566	2.461238697	0	2.384107025	7.433845917	3.674788556	10.46615846	0.089511134	0.007278174	4.951512114	6.287174964	23.53016669	0.382933372	1.612578958	0	0	13.69713718	3.21E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8184	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		17.9967	0.254560821	3.477451384	0	1.111212566	2.461238697	0	2.384107025	7.433845917	3.674788556	10.46615846	0.089511134	0.007278174	4.951512114	6.287174964	23.53016669	0.382933372	1.612578958	0	0	13.69713718	3.21E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8184
H5415_039_0	2012	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	1269.7	56.58	523.69	719.42	22.69	12.27	3.87	413.68	442.08	913.91	1832.26	167.08	0.4	11.67	3822.21	6431.93	79.63	1068.78		1630.74	28.43	0			1.69				5.79	1.24	1199.97	373.13									6000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$150/Visit: 5. $35 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$200/Visit: 3. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											163.989133	131.206824	34.03605	0	150	0.2	0.2	65	121.931988	79.453127	79.470778	39.464191	0.199881	0.2	15	34.186252	35	47.106826		0	0.2	0			0				0	0	0	161.585875									NO	135.11491	108.104714	27.968818	0	135.4569	0.180609	0.180609	58.69799	110.110194	71.749829	71.765768	35.63798	0.180502	0.180609	13.54569	30.871758	31.60661	42.539631		0	0.180609	0			0				0	0	0	145.919478										14.2963	0.509713727	1.220582525	0	0.256126422	2.21607243	0.69895683	2.023515375	4.056459547	5.464407185	10.95779551	0.496199475	0.0722008	2.10770703	4.314539315	16.5470822	0.209736196	3.788792235	0	0	5.13471387	0	0	0	0	0	0	0	0	0	0	4.537244569	0	0	0	0	0	0	0	0	78.9081	0	NO	10.180054	14.2963	0.509713727	1.220582525	0	0.256126422	2.21607243	0.69895683	2.023515375	4.056459547	5.464407185	10.95779551	0.496199475	0.0722008	2.10770703	4.314539315	16.5470822	0.209736196	3.788792235	0	0	5.13471387	0	0	0	0	0	0	0	0	0	0	4.537244569	0	0	0	0	0	0	0	0	78.9081	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$150/Trip	40% Coins	40% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins			"VIS742: Vision 17a,17b"						40% Coins	30% Coins									7500	1.5997	0.057	0.5528	1.0104	1.7393	0.9619	0.3036	0.1961	2.3854	0.2079	1.2688	0.0343	0.007	0.3095	1.2714	2.1395	0.0265	0.3497		0.5424	0.8124	0			0				0	0	0.1187	0.397									16.2914	0	NO	3.222984	15.896	0.566746727	1.773414525	1.010402	1.995386422	3.17796243	1.00259083	2.219663375	6.441838547	5.672296185	12.22656951	0.530540475	0.0791948	2.41717203	5.585947315	18.6865802	0.236224196	4.138479235	0	0.542443	5.94716187	0	0	0	0	0	0	0	0	0	0.118661	4.934247569	0	0	0	0	0	0	0	0	95.1995
H5415_056_0	2012	9	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	1146.38	50.87	523.95	1049.16	27.6	17.18	5.27	355.15	316.68	1424.79	990.79	141.23	0.8	11.11	2855.07	3519.39	99.31	528.28		1382.65	26.69	0			1.69				4.18	1.98	1520.78	479.29									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$150/Visit: 5. $35 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$200/Visit: 3. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											163.989133	131.405866	34.03605	0	150	0.2	0.2	65	132.469574	108.02735	110.095981	48.61305	0.199634	0.2	15	33.775734	35	64.739471		0	0.2	0			0				0	0	0	159.302267									NO	130.914329	104.902748	26.688518	0	133.17615	0.177568	0.177568	57.709665	117.611919	95.91111	97.747725	43.160659	0.177243	0.177568	13.317615	29.987482	31.074435	57.478357		0	0.177568	0			0				0	0	0	141.435084										12.5065	0.444700233	1.165287417	0	0.306305145	3.05061824	0.93578336	1.707965627	3.103778542	11.38776587	8.070622371	0.507964989	0.1417944	1.97278048	3.168560255	8.79480369	0.257166845	2.53038887	0	0	4.73928992	0	0	0	0	0	0	0	0	0	0	5.649035118	0	0	0	0	0	0	0	0	70.4411	0	NO	10.708374	12.5065	0.444700233	1.165287417	0	0.306305145	3.05061824	0.93578336	1.707965627	3.103778542	11.38776587	8.070622371	0.507964989	0.1417944	1.97278048	3.168560255	8.79480369	0.257166845	2.53038887	0	0	4.73928992	0	0	0	0	0	0	0	0	0	0	5.649035118	0	0	0	0	0	0	0	0	70.4411	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"30% Coins(Days 1-7), 0% (Days 8-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins			"VIS742: Vision 17a,17b"						40% Coins	30% Coins									7500	1.4646	0.0521	0.7127	2.3801	2.1459	1.0248	0.3145	0.1709	2.1907	0.392	0.8727	0.0407	0.0144	0.2988	0.9636	1.1879	0.0335	0.1749		0.4667	0.7652	0			0				0	0	0.2496	0.5842									16.5003	0	NO	3.33012	13.971	0.496778233	1.878003417	2.380147	2.452179145	4.07540124	1.25024636	1.878832627	5.294428542	11.77974687	8.943366371	0.548629989	0.1561844	2.27159548	4.132195255	9.98265969	0.290686845	2.70529787	0	0.466668	5.50446392	0	0	0	0	0	0	0	0	0	0.249604	6.233260118	0	0	0	0	0	0	0	0	86.9414
H5415_066_0	2012	9	r.	s.									OP Facility - Other	Skilled Nursing Facility									Other										D	D	A	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				O	O	V	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	1583.25	70.26	58.31	1448.99	38.11	18.72	18607.81	490.49	437.36	1967.77	1368.38	195.05	0.88	12.1	3943.12	4860.62	137.16	729.61		1909.57	29.08	0			1.69				3.95	1.24	661.95	0									3400	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	0% Coins: 8b. 0% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	$0/Day(Days 1-100) : 2. $0 SNF - Physician											15.729929	12.928961	0	0	0	0.2	0	25	0	0	0	0	0.199634	0	0	0	0	0		0	0.2	0			0				0	0	0	0									NO	15.641558	12.856326	0	0	0	0.198976	0	24.872	0	0	0	0	0.198612	0	0	0	0	0		0	0.198976	0			0				0	0	0	0										2.0637	0.075273789	0	0	0	3.72483072	0	1.016622273	0	0	0	0	0.17477856	0	0	0	0	0	0	0	5.78622208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8414	0	NO	0.067158	2.0637	0.075273789	0	0	0	3.72483072	0	1.016622273	0	0	0	0	0.17477856	0	0	0	0	0	0	0	5.78622208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8414	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 0% (Days 21-100)"	30% Coins	$0/Trip	30% Coins	20%-30% Coins	$25/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			"VIS742: Vision 17a,17b"						30% Coins	30% Coins(Days 1-100)									5100	3.8544	0.0555	0.239	2.7871	0	1.2	0.5144	0.0976	2.5652	0.459	1.022	0.0476	0.0169	0.3499	1.3924	2.5621	0.0348	0.2083		0.2689	0.896	0			0				0	0	0.6841	0.0217									19.2769	500	NO	15.24408	5.9182	0.130800789	0.239024	2.787119	0	4.92483772	0.514374	1.114175273	2.565219	0.459004	1.021972	0.047619	0.19162856	0.349908	1.392446	2.562072	0.034812	0.208283	0	0.268875	6.68222908	0	0	0	0	0	0	0	0	0	0.684118	0.021699	0	0	0	0	0	0	0	0	32.1184
H5415_067_0	2012	7	r.	s.									OP Facility - Other	Skilled Nursing Facility									Other										D	D	A	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				O	O	V	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	1355.57	60.15	49.92	1240.61	32.63	19.02	15931.86	419.96	374.47	1684.79	1171.6	167	0.89	12.29	3376.07	4161.62	117.44	624.68		1634.96	29.54	0			1.69				3.95	1.78	566.75	0									3400	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	0% Coins: 8b. 0% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	$0/Day(Days 1-100) : 2. $0 SNF - Physician											15.729929	12.928961	0	0	0	0.2	0	25	0	0	0	0	0.199634	0	0	0	0	0		0	0.2	0			0				0	0	0	0									NO	15.666223	12.876598	0	0	0	0.19901	0	24.876275	0	0	0	0	0.198646	0	0	0	0	0		0	0.19901	0			0				0	0	0	0										1.7697	0.064543947	0	0	0	3.7851702	0	0.870586704	0	0	0	0	0.17679494	0	0	0	0	0	0	0	5.8787554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5456	0	NO	0.060726	1.7697	0.064543947	0	0	0	3.7851702	0	0.870586704	0	0	0	0	0.17679494	0	0	0	0	0	0	0	5.8787554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5456	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 0% (Days 21-100)"	30% Coins	$0/Trip	30% Coins	20%-30% Coins	$25/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			"VIS742: Vision 17a,17b"						30% Coins	30% Coins(Days 1-100)									5100	3.8503	0.0555	0.2368	2.8116	0	1.2106	0.5189	0.0829	2.5878	0.463	1.031	0.048	0.017	0.353	1.4047	2.5846	0.0351	0.2101		0.2712	0.9039	0			0				0	0	0.6901	0.0215									19.3877	500	NO	15.599124	5.62	0.120010947	0.236799	2.811641	0	4.9957352	0.518899	0.953536704	2.587789	0.463042	1.030962	0.048038	0.19379294	0.352987	1.404698	2.584614	0.035119	0.210116	0	0.271241	6.7826464	0	0	0	0	0	0	0	0	0	0.690138	0.021497	0	0	0	0	0	0	0	0	31.9333
H5415_068_0	2012	8	r.	s.									OP Facility - Other	Skilled Nursing Facility									Radiology										D	D	A	V	T	Coin	O	V	V	V	Coin	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O	V	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	1161.82	51.56	42.79	1063.29	27.97	17.96	13654.72	359.93	320.94	1443.98	4.78	143.13	0.84	600.14	2893.53	3566.8	100.65	535.4		1401.28	27.89	0			1.69				3.95	1.66	701.89	0									3400	"$0-$25/Day(Days 1-5): 1a. $25 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$25/Day(Days 1-5): 1b. $25 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	0% Coins: 8b. 0% Radiology OP -- Facility	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	$0/Day(Days 1-100) : 2. $0 SNF - Physician											15.729929	12.928961	0	0	0	0.2	0	25	0	0	0	0	0.199634	0	0	0	0	0		0	0.2	0			0				0	0	0	0									NO	15.688811	12.895164	0	0	0	0.199228	0	24.9035	0	0	0	0	0.198863	0	0	0	0	0		0	0.199228	0			0				0	0	0	0										1.519	0.055406221	0	0	0	3.57813488	0	0.74695973	0	0	0	0	0.16704492	0	0	0	0	0	0	0	5.55646892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.623	0	NO	0.04306	1.519	0.055406221	0	0	0	3.57813488	0	0.74695973	0	0	0	0	0.16704492	0	0	0	0	0	0	0	5.55646892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.623	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 0% (Days 21-100)"	30% Coins	$0/Trip	30% Coins	20%-30% Coins	$25/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			"VIS742: Vision 17a,17b"						30% Coins	30% Coins(Days 1-100)									5100	3.8668	0.0557	0.245	2.728	0	1.1745	0.5035	0.0731	2.5108	0.4493	0.141	0.0466	0.0165	1.0121	1.3629	2.5077	0.0341	0.2039		0.2632	0.877	0			0				0	0	0.8593	0.0222									18.953	500	NO	14.299121	5.3857	0.111111221	0.245014	2.727967	0	4.75267288	0.503457	0.82001273	2.510777	0.449262	0.141003	0.046608	0.18353792	1.012081	1.362893	2.507696	0.034073	0.203863	0	0.263169	6.43346092	0	0	0	0	0	0	0	0	0	0.859279	0.022243	0	0	0	0	0	0	0	0	30.5759
H5415_801_0	2012	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	294.53	1.94	38.79	24.95	1.19	15.68	5.52	28.99	96.64	10.68	50.62	1.4	0.09	50.2	53.94	175.92	0.87	13.78		11.17	66.83	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																					0.0861	0.0861	0.1632	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.059641	0.059641	0.085079	0	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436		0.183436	0.183436	0																				17.5661	0.11570354	3.30021441	0	0.21828884	2.87627648	1.01256672	5.31780964	17.72725504	1.95909648	9.28553032	0.2568104	0.01650924	9.2084872	9.89453784	32.27006112	0.15958932	2.52774808	0	2.04898012	12.25902788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0206	0	NO	34.544864	17.5661	0.11570354	3.30021441	0	0.21828884	2.87627648	1.01256672	5.31780964	17.72725504	1.95909648	9.28553032	0.2568104	0.01650924	9.2084872	9.89453784	32.27006112	0.15958932	2.52774808	0	2.04898012	12.25902788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0206	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	2.4798	0.0163	0.5355	0	1.6914	0.7134	0.2513	0.5951	2.0886	0.2193	1.1021	0.0332	0.0019	1.0306	1.3121	4.2794	0.0212	0.3234		0.2718	1.6256	0																			18.592	0	NO	2.684389	20.0459	0.13201354	3.83572641	0	1.90966784	3.58971348	1.26386572	5.91289164	19.81585204	2.17837948	10.38763732	0.2900054	0.01840224	10.2390802	11.20660884	36.54946712	0.18078332	2.85117708	0	2.32076112	13.88462488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.6125
H5415_803_0	2012	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	280.46	1.58	71.33	31.21	1.49	14.3	7.01	25.04	79.2	9.45	33.95	0.42	0.23	19.72	41.73	130.12	0.46	12.56		7.34	28.93	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																					0.0888	0.0888	0.1649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064545	0.064545	0.070205	0	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544	0.192544		0.192544	0.192544	0																				18.1023	0.1019811	5.00772265	0	0.28689056	2.7533792	1.34973344	4.82130176	15.2494848	1.8195408	6.5368688	0.08086848	0.04428512	3.79696768	8.03486112	25.05382528	0.08857024	2.41835264	0	1.41327296	5.57029792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5305	0	NO	26.552851	18.1023	0.1019811	5.00772265	0	0.28689056	2.7533792	1.34973344	4.82130176	15.2494848	1.8195408	6.5368688	0.08086848	0.04428512	3.79696768	8.03486112	25.05382528	0.08857024	2.41835264	0	1.41327296	5.57029792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5305	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	2.4935	0.014	0.8551	0	2.1919	0.6731	0.3299	0.5315	1.759	0.2005	0.7722	0.0101	0.0049	0.4187	1.0496	3.2733	0.0116	0.2994		0.1847	0.7277	0																			15.8006	0	NO	2.102816	20.5958	0.1159511	5.86277565	0	2.47882456	3.4264692	1.67958944	5.35284876	17.0084608	2.0200478	7.3090438	0.09101248	0.04918312	4.21567268	9.08449912	28.32713428	0.10012724	2.71772164	0	1.59799296	6.29795992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3311
H5415_804_0	2012	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	180.46	1.19	23.77	15.28	0.73	9.61	3.38	17.76	59.21	6.55	31.01	0.86	0.06	30.76	33.05	107.79	0.53	8.45		6.85	40.94	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																					0.0865	0.0865	0.1657	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072388	0.072388	0.123082	0	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003		0.202003	0.202003	0																				13.0631	0.08614172	2.92565914	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2991	0	NO	11.441031	13.0631	0.08614172	2.92565914	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2991	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	1.7133	0.0113	0.4158	0	1.1045	0.4659	0.1641	0.3886	1.3639	0.1432	0.7197	0.0217	0.0012	0.673	0.8568	2.7946	0.0138	0.2112		0.1775	1.0616	0																			12.3017	0	NO	0.750121	14.7765	0.09741072	3.34147014	0	1.25197819	2.40714283	0.84687514	3.97617828	13.32450763	1.46631765	6.98381803	0.19539958	0.01335618	6.88661628	7.53301715	24.56847037	0.12090159	1.91813335	0	1.56120055	9.33156182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6008
H5415_806_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				15.28	0.73	9.61	3.38	17.76	59.21	6.55	31.01	0.86	0.06	30.76	33.05	107.79	0.53	8.45		6.85	40.94	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003		0.202003	0.202003	0																				0	0	0	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2242	0	NO	7.8648	0	0	0	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2242	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	1.1045	0.4659	0.1641	0.3886	1.3639	0.1432	0.7197	0.0217	0.0012	0.673	0.8568	2.7946	0.0138	0.2112		0.1775	1.0616	0																			10.1613	0	NO	0.515648602	0	0	0	0	1.25197819	2.40714283	0.84687514	3.97617828	13.32450763	1.46631765	6.98381803	0.19539958	0.01335618	6.88661628	7.53301715	24.56847037	0.12090159	1.91813335	0	1.56120055	9.33156182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3855
H5415_807_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				33.16	1.58	15.2	7.45	26.6	84.14	10.04	36.07	0.44	0.25	20.96	44.33	138.25	0.49	13.35		7.8	30.73	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309	0.190309		0.190309	0.190309	0																				0	0	0	0	0.30068822	2.8926968	1.41780205	5.0622194	16.01259926	1.91070236	6.86444563	0.08373596	0.04757725	3.98887664	8.43639797	26.31021925	0.09325141	2.54062515	0	1.4844102	5.84819557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2944	0	NO	14.7459	0	0	0	0	0.30068822	2.8926968	1.41780205	5.0622194	16.01259926	1.91070236	6.86444563	0.08373596	0.04757725	3.98887664	8.43639797	26.31021925	0.09325141	2.54062515	0	1.4844102	5.84819557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2944	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	2.3114	0.7098	0.3478	0.5605	1.8548	0.2114	0.8142	0.0107	0.0052	0.4415	1.1068	3.4516	0.0122	0.3157		0.1948	0.7673	0																			13.1157	0	NO	1.184493683	0	0	0	0	2.61203822	3.6024568	1.76562905	5.6227254	17.86740426	2.12213336	7.67868863	0.09443296	0.05274225	4.43039364	9.54321997	29.76185725	0.10543841	2.85630415	0	1.6791932	6.61550057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4102
H5415_808_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				15.28	0.73	9.61	3.38	17.76	59.21	6.55	31.01	0.86	0.06	30.76	33.05	107.79	0.53	8.45		6.85	40.94	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003	0.202003		0.202003	0.202003	0																				0	0	0	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2242	0	NO	7.8648	0	0	0	0	0.14746219	1.94124883	0.68277014	3.58757328	11.96059763	1.32311965	6.26411303	0.17372258	0.01212018	6.21361228	6.67619915	21.77390337	0.10706159	1.70692535	0	1.38372055	8.27000282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2242	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	1.1045	0.4659	0.1641	0.3886	1.3639	0.1432	0.7197	0.0217	0.0012	0.673	0.8568	2.7946	0.0138	0.2112		0.1775	1.0616	0																			10.1613	0	NO	0.515648602	0	0	0	0	1.25197819	2.40714283	0.84687514	3.97617828	13.32450763	1.46631765	6.98381803	0.19539958	0.01335618	6.88661628	7.53301715	24.56847037	0.12090159	1.91813335	0	1.56120055	9.33156182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3855
H5415_809_0	2012	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	243.44	1.61	32.06	20.62	0.98	12.96	4.56	23.96	79.87	8.83	41.84	1.15	0.08	41.5	44.58	145.41	0.72	11.39		9.23	55.23	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																					0.0873	0.0873	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065704	0.065704	0.099958	0	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363		0.191363	0.191363	0																				15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	0	NO	23.105819	15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	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	2.1892	0.0144	0.4946	0	1.4385	0.6068	0.2137	0.5061	1.7763	0.1865	0.9373	0.0282	0.0016	0.8765	1.1159	3.6395	0.018	0.2751		0.2311	1.3825	0																			15.9317	0	NO	1.694617	18.1841	0.12018244	3.69921148	0	1.62600274	3.08682148	1.08633728	5.09115648	17.06045281	1.87622829	8.94393592	0.24829845	0.01691904	8.8180525	9.64683954	31.46560183	0.15580736	2.45469057	0	1.99742249	11.95150049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5296
H5415_810_0	2012	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	381.06	2.14	96.91	42.41	2.02	19.43	9.52	34.02	107.6	12.83	46.12	0.57	0.31	26.8	56.69	176.79	0.62	17.07		9.98	39.3	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																					0.0873	0.0873	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.054885	0.054885	0.049772	0	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097		0.180097	0.180097	0																				20.9145	0.1174539	4.82340452	0	0.36379594	3.49928471	1.71452344	6.12689994	19.3784372	2.31064451	8.30607364	0.10265529	0.05583007	4.8265996	10.20969893	31.83934863	0.11166014	3.07425579	0	1.79736806	7.0778121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6502	0	NO	48.121006	20.9145	0.1174539	4.82340452	0	0.36379594	3.49928471	1.71452344	6.12689994	19.3784372	2.31064451	8.30607364	0.10265529	0.05583007	4.8265996	10.20969893	31.83934863	0.11166014	3.07425579	0	1.79736806	7.0778121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6502	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	3.03	0.017	0.8963	0	2.8438	0.8732	0.4279	0.6896	2.282	0.2601	1.0018	0.0132	0.0064	0.5432	1.3618	4.2467	0.015	0.3884		0.2397	0.944	0																			20.0801	0	NO	4.172415	23.9445	0.1344289	5.71971952	0	3.20755194	4.37253371	2.14247044	6.81651494	21.6604852	2.57077751	9.30787264	0.11581629	0.06218507	5.3698176	11.57147093	36.08605163	0.12665414	3.46264879	0	2.03701906	8.0218611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.7303
H5415_811_0	2012	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	243.44	1.61	32.06	20.62	0.98	12.96	4.56	23.96	79.87	8.83	41.84	1.15	0.08	41.5	44.58	145.41	0.72	11.39		9.23	55.23	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																					0.0873	0.0873	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065704	0.065704	0.099958	0	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363		0.191363	0.191363	0																				15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	0	NO	23.105819	15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	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	2.1892	0.0144	0.4946	0	1.4385	0.6068	0.2137	0.5061	1.7763	0.1865	0.9373	0.0282	0.0016	0.8765	1.1159	3.6395	0.018	0.2751		0.2311	1.3825	0																			15.9317	0	NO	1.694617	18.1841	0.12018244	3.69921148	0	1.62600274	3.08682148	1.08633728	5.09115648	17.06045281	1.87622829	8.94393592	0.24829845	0.01691904	8.8180525	9.64683954	31.46560183	0.15580736	2.45469057	0	1.99742249	11.95150049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5296
H5415_812_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				20.62	0.98	12.96	4.56	23.96	79.87	8.83	41.84	1.15	0.08	41.5	44.58	145.41	0.72	11.39		9.23	55.23	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363		0.191363	0.191363	0																				0	0	0	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2925	0	NO	15.7405	0	0	0	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2925	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	1.4385	0.6068	0.2137	0.5061	1.7763	0.1865	0.9373	0.0282	0.0016	0.8765	1.1159	3.6395	0.018	0.2751		0.2311	1.3825	0																			13.2336	0	NO	1.154432954	0	0	0	0	1.62600274	3.08682148	1.08633728	5.09115648	17.06045281	1.87622829	8.94393592	0.24829845	0.01691904	8.8180525	9.64683954	31.46560183	0.15580736	2.45469057	0	1.99742249	11.95150049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5261
H5415_813_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				42.41	2.02	19.43	9.52	34.02	107.6	12.83	46.12	0.57	0.31	26.8	56.69	176.79	0.62	17.07		9.98	39.3	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097	0.180097		0.180097	0.180097	0																				0	0	0	0	0.36379594	3.49928471	1.71452344	6.12689994	19.3784372	2.31064451	8.30607364	0.10265529	0.05583007	4.8265996	10.20969893	31.83934863	0.11166014	3.07425579	0	1.79736806	7.0778121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7949	0	NO	24.5712	0	0	0	0	0.36379594	3.49928471	1.71452344	6.12689994	19.3784372	2.31064451	8.30607364	0.10265529	0.05583007	4.8265996	10.20969893	31.83934863	0.11166014	3.07425579	0	1.79736806	7.0778121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7949	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	2.8438	0.8732	0.4279	0.6896	2.282	0.2601	1.0018	0.0132	0.0064	0.5432	1.3618	4.2467	0.015	0.3884		0.2397	0.944	0																			16.1368	0	NO	2.130488366	0	0	0	0	3.20755194	4.37253371	2.14247044	6.81651494	21.6604852	2.57077751	9.30787264	0.11581629	0.06218507	5.3698176	11.57147093	36.08605163	0.12665414	3.46264879	0	2.03701906	8.0218611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9317
H5415_814_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				20.62	0.98	12.96	4.56	23.96	79.87	8.83	41.84	1.15	0.08	41.5	44.58	145.41	0.72	11.39		9.23	55.23	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363		0.191363	0.191363	0																				0	0	0	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2925	0	NO	15.7405	0	0	0	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2925	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	1.4385	0.6068	0.2137	0.5061	1.7763	0.1865	0.9373	0.0282	0.0016	0.8765	1.1159	3.6395	0.018	0.2751		0.2311	1.3825	0																			13.2336	0	NO	1.154432954	0	0	0	0	1.62600274	3.08682148	1.08633728	5.09115648	17.06045281	1.87622829	8.94393592	0.24829845	0.01691904	8.8180525	9.64683954	31.46560183	0.15580736	2.45469057	0	1.99742249	11.95150049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5261
H5415_815_0	2012	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	294.53	1.94	38.79	24.95	1.19	15.68	5.52	28.99	96.64	10.68	50.62	1.4	0.09	50.2	53.94	175.92	0.87	13.78		11.17	66.83	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																					0.0861	0.0861	0.1632	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.059641	0.059641	0.085079	0	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436	0.183436		0.183436	0.183436	0																				17.5661	0.11570354	3.30021441	0	0.21828884	2.87627648	1.01256672	5.31780964	17.72725504	1.95909648	9.28553032	0.2568104	0.01650924	9.2084872	9.89453784	32.27006112	0.15958932	2.52774808	0	2.04898012	12.25902788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0206	0	NO	34.544864	17.5661	0.11570354	3.30021441	0	0.21828884	2.87627648	1.01256672	5.31780964	17.72725504	1.95909648	9.28553032	0.2568104	0.01650924	9.2084872	9.89453784	32.27006112	0.15958932	2.52774808	0	2.04898012	12.25902788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0206	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	2.4798	0.0163	0.5355	0	1.6914	0.7134	0.2513	0.5951	2.0886	0.2193	1.1021	0.0332	0.0019	1.0306	1.3121	4.2794	0.0212	0.3234		0.2718	1.6256	0																			18.592	0	NO	2.684389	20.0459	0.13201354	3.83572641	0	1.90966784	3.58971348	1.26386572	5.91289164	19.81585204	2.17837948	10.38763732	0.2900054	0.01840224	10.2390802	11.20660884	36.54946712	0.18078332	2.85117708	0	2.32076112	13.88462488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.6125
H5415_816_0	2012	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	243.44	1.61	32.06	20.62	0.98	12.96	4.56	23.96	79.87	8.83	41.84	1.15	0.08	41.5	44.58	145.41	0.72	11.39		9.23	55.23	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																					0.0873	0.0873	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065704	0.065704	0.099958	0	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363	0.191363		0.191363	0.191363	0																				15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	0	NO	23.105819	15.995	0.10578344	3.20465348	0	0.18753574	2.48006448	0.87261528	4.58505748	15.28416281	1.68973529	8.00662792	0.22006745	0.01530904	7.9415645	8.53096254	27.82609383	0.13778136	2.17962457	0	1.76628049	10.56897849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5979	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	2.1892	0.0144	0.4946	0	1.4385	0.6068	0.2137	0.5061	1.7763	0.1865	0.9373	0.0282	0.0016	0.8765	1.1159	3.6395	0.018	0.2751		0.2311	1.3825	0																			15.9317	0	NO	1.694617	18.1841	0.12018244	3.69921148	0	1.62600274	3.08682148	1.08633728	5.09115648	17.06045281	1.87622829	8.94393592	0.24829845	0.01691904	8.8180525	9.64683954	31.46560183	0.15580736	2.45469057	0	1.99742249	11.95150049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5296
H5416_002_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	903.0463242	56.00599485	1161.62381		184.2471505	8.507572189	4.682191274	349.5752876	155.6626824		3.043239941	205.9248753	0.015955214	6.2090427		3003.296379	94.56988931	891.0621928			15.94737301				159.1037094		0.387597005														3400	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 20 copay,7f (Podiatry) 20 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 20 copay,18a - Hearing Exam (M/C) 20 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 20 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 20 copay,18a - Hearing Exam (M/C) 20 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1500 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 25"													181.2051416	142.4713977	60.09645318		150	0.2	0.2	64.09096479	200		0.2	200	0.2	0.197939558		19.98454518	40	20			0.2				5		20														NO	166.5390086	130.9402433	55.23244894		137.8595059	0.183812675	0.183812675	58.90365825	183.8126745		0.183812675	183.8126745	0.183812675	0.181918998		18.36745997	36.76253491	18.38126745			0.183812675				5		20															12.5327	0.611119883	5.34661065	0	2.116685095	1.563799598	0.860646101	1.715938606	2.384397832	0	0.559386073	3.154300174	0.002932771	1.129542825	0	4.596910501	0.289719071	1.364904374	0	0	2.931329284	0	0	0	0.066293212	0	0.000645995	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2279	0		3.624698158	12.5327	0.611119883	5.34661065	0	2.116685095	1.563799598	0.860646101	1.715938606	2.384397832	0	0.559386073	3.154300174	0.002932771	1.129542825	0	4.596910501	0.289719071	1.364904374	0	0	2.931329284	0	0	0	0.066293212	0	0.000645995	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2279	NO																																																																																		0	0		0	12.5327	0.611119883	5.34661065	0	2.116685095	1.563799598	0.860646101	1.715938606	2.384397832	0	0.559386073	3.154300174	0.002932771	1.129542825	0	4.596910501	0.289719071	1.364904374	0	0	2.931329284	0	0	0	0.066293212	0	0.000645995	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2279
H5416_004_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1044.107073	11.61383666	237.4443438		160.8218125	6.228978468	4.872460708	383.7510005	215.6515672		14.64035571	105.5608278	0.146546448	33.22300678		3715.329692	120.8915962	1034.165301			23.66733535				159.1037094																6700	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 425 copay,9b - OP Ambulatory Surgical Center (ASC) 425 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 425 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 39 copay,7f (Podiatry) 39 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 39 copay,18a - Hearing Exam (M/C) 39 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 39 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 39 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	63.44078416	425		0.2	425	0.2	0.199969313		37.96400459	40	20			0.2				20																NO	170.4648417	135.2063189	57.03194003		237.2516888	0.189801351	0.189801351	60.20573273	403.327871		0.189801351	403.327871	0.189801351	0.189772228		36.04169395	37.96027021	18.9801351			0.189801351				20																	14.832	0.130855342	1.128492631	0	3.179603884	1.182268529	0.924799625	1.925334181	7.248190622	0	2.778759294	3.547968661	0.027814714	6.304804032	0	11.15889797	0.382423138	1.635716427	0	0	4.492092225	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452	0		3.266845111	14.832	0.130855342	1.128492631	0	3.179603884	1.182268529	0.924799625	1.925334181	7.248190622	0	2.778759294	3.547968661	0.027814714	6.304804032	0	11.15889797	0.382423138	1.635716427	0	0	4.492092225	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452	NO																																																																																		0	0		0	14.832	0.130855342	1.128492631	0	3.179603884	1.182268529	0.924799625	1.925334181	7.248190622	0	2.778759294	3.547968661	0.027814714	6.304804032	0	11.15889797	0.382423138	1.635716427	0	0	4.492092225	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452
H5416_009_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	881.2309274	16.07258955	519.5402813		71.0818656	4.840917622	6.000980228	393.1377635	228.2012801		9.35498169	84.82789718	0.009241178	24.61331082		3318.983934	86.57925751	907.2129863			12.88271438				159.1037094																4950	"1a - IP Acute 225 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 20 copay,7f (Podiatry) 20 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 20 copay,18a - Hearing Exam (M/C) 20 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 20 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 20 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													163.0846274	142.4713977	60.09645318		150	0.2	0.2	62.98141414	200		0.2	200	0.2	0.199786343		20	40	20			0.2				5																NO	156.2625791	136.5116283	57.58253806		143.7252991	0.191633732	0.191633732	60.34681724	191.6337322		0.191633732	191.6337322	0.191633732	0.191429013		19.16337322	38.32674643	19.16337322			0.191633732				5																	11.4753	0.182841281	2.493037335	0	0.8513552	0.927683111	1.149990238	1.977051064	3.644255249	0	1.792730056	1.354657211	0.001770921	4.711701795	0	5.300243986	0.276525104	1.448771754	0	0	2.468762637	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.123	0		1.748777509	11.4753	0.182841281	2.493037335	0	0.8513552	0.927683111	1.149990238	1.977051064	3.644255249	0	1.792730056	1.354657211	0.001770921	4.711701795	0	5.300243986	0.276525104	1.448771754	0	0	2.468762637	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.123	NO																																																																																		0	0		0	11.4753	0.182841281	2.493037335	0	0.8513552	0.927683111	1.149990238	1.977051064	3.644255249	0	1.792730056	1.354657211	0.001770921	4.711701795	0	5.300243986	0.276525104	1.448771754	0	0	2.468762637	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.123
H5416_013_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	902.9594085	66.6079641	817.5839117		128.7095603	5.614768241	5.122451016	296.9668352	174.9657379		10.73914893	1.476057939	0.031997093	11.22241016		3217.975111	239.9294635	682.576767			17.79357007				159.1037094		1.241917393														3000	"1a - IP Acute 165 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 175 copay,9b - OP Ambulatory Surgical Center (ASC) 175 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 175 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 15 copay,7f - Podiatry 15 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 15 copay,18a - Hearing Exam (M/C) 15 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 15 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 15 copay,18a - Hearing Exam (M/C) 15 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1000 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 25"													102.1273837	142.4713977	60.09645318		150	0.2	0.2	62.97172315	175		0.2	175	0.2	0.19819844		15.19622904	39.95724769	20			0.2				5		15														NO	95.30763809	132.9576056	56.08340096		139.9834715	0.186644629	0.186644629	58.76666943	163.3140501		0.186644629	163.3140501	0.186644629	0.184963371		14.18147264	37.31815445	18.66446287			0.186644629				5		15															7.1716	0.738002952	3.821073861	0	1.501434255	1.047966334	0.956077968	1.454312653	2.38119694	0	2.004404465	0.020088417	0.005972086	2.075734813	0	3.802968832	0.746143731	1.061660727	0	0	3.321074279	0	0	0	0.066293212	0	0.001552397	0	0	0	0	0	0	0	0	0	0	0	0	0	32.1775	0		2.296987382	7.1716	0.738002952	3.821073861	0	1.501434255	1.047966334	0.956077968	1.454312653	2.38119694	0	2.004404465	0.020088417	0.005972086	2.075734813	0	3.802968832	0.746143731	1.061660727	0	0	3.321074279	0	0	0	0.066293212	0	0.001552397	0	0	0	0	0	0	0	0	0	0	0	0	0	32.1775	NO																																																																																		0	0		0	7.1716	0.738002952	3.821073861	0	1.501434255	1.047966334	0.956077968	1.454312653	2.38119694	0	2.004404465	0.020088417	0.005972086	2.075734813	0	3.802968832	0.746143731	1.061660727	0	0	3.321074279	0	0	0	0.066293212	0	0.001552397	0	0	0	0	0	0	0	0	0	0	0	0	0	32.1775
H5416_014_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	277.1320142	23.54417351	50.72516385		13.27038176	13.48133148	16.52205022	37.71872634	54.87814124	8.607535576	16.61074762	5.939002478	2.227516356	40.12125911		4807.983338	18.96041679	648.741479		2389.069917	16.39553245	0.014468114			159.1037094		2.595851689														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													0.07543944	0.07543944	0.150632695		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.964603965	0.224	10077.36281			5		10														NO	0.061510955	0.061510955	0.122821179		0.18264258	0.18264258	0.18264258	0.18264258	0.18264258	0.18264258	0.18264258	0.18264258	0.18264258	0.18264258		8.15368661	0.18264258	8.15368661		2.417245165	0.18264258	8216.76582			5		10															17.0467	1.448224595	6.230124406	0	2.423736763	2.462265164	3.01762988	6.889045496	10.0230853	1.572102506	3.033829801	1.084714736	0.406839334	7.327850279	0	3.266899114	3.462979442	0.440802893	0	0.481247309	2.994522349	0.009906759	0	0	0.066293212	0	0.00216321	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6909	0		16.67100319	17.0467	1.448224595	6.230124406	0	2.423736763	2.462265164	3.01762988	6.889045496	10.0230853	1.572102506	3.033829801	1.084714736	0.406839334	7.327850279	0	3.266899114	3.462979442	0.440802893	0	0.481247309	2.994522349	0.009906759	0	0	0.066293212	0	0.00216321	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6909	NO																																																																																		0	0		0	17.0467	1.448224595	6.230124406	0	2.423736763	2.462265164	3.01762988	6.889045496	10.0230853	1.572102506	3.033829801	1.084714736	0.406839334	7.327850279	0	3.266899114	3.462979442	0.440802893	0	0.481247309	2.994522349	0.009906759	0	0	0.066293212	0	0.00216321	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6909
H5416_016_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	938.8525882	67.30138322	772.7799572		133.1493642	5.082612779	6.065327685	334.8944661	298.37473		20.34046917	59.40651435	0.004225501	59.00926924	3759.779041	4226.146666	473.3000948	923.3109374			13.41181742				159.1037094																4950	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 45 copay,7f - Podiatry 45 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 45 copay,18a - Hearing Exam (M/C) 45 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 45 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 45 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	61.58161399	400		0.2	400	0.2	0.200394577	10	43.11573775	39.99960769	20			0.2				5																NO	161.4910593	128.0886512	54.02960703		224.7620457	0.179809637	0.179809637	55.36483816	359.6192732		0.179809637	359.6192732	0.179809637	0.180164381	8.990481829	38.83987668	35.96192732	17.98096366			0.179809637				5																	12.6347	0.718378617	3.479416451	0	2.49391029	0.913902757	1.090604367	1.545114827	8.941775294	0	3.657412369	1.780310626	0.000759786	10.63136844	2.816852096	13.67858461	1.418398634	1.383501701	0	0	2.411574016	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6628	0		7.784738321	12.6347	0.718378617	3.479416451	0	2.49391029	0.913902757	1.090604367	1.545114827	8.941775294	0	3.657412369	1.780310626	0.000759786	10.63136844	2.816852096	13.67858461	1.418398634	1.383501701	0	0	2.411574016	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6628	NO																																																																																		0	0		0	12.6347	0.718378617	3.479416451	0	2.49391029	0.913902757	1.090604367	1.545114827	8.941775294	0	3.657412369	1.780310626	0.000759786	10.63136844	2.816852096	13.67858461	1.418398634	1.383501701	0	0	2.411574016	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6628
H5416_017_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1080.636724	18.04781387	308.00502		123.4767372	4.991907096	3.680379942	321.0430991	195.0817305		13.47855377	8.362939541	0.028929315	28.29950342		2363.580344	122.2124041	580.3841289			14.14311506	0.251571016			159.1037094																5950	"1a - IP Acute 245 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 200 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 375 copay,9b - OP Ambulatory Surgical Center (ASC) 375 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 375 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 40 copay,7f (Podiatry) 40 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 40 copay,18a - Hearing Exam (M/C) 40 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 40 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 40 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													177.5810388	142.4713977	60.09645318		200	0.2	0.2	63.0393397	375		0.2	375	0.2	0.199487775		38.82771426	40	20			0.2	40			20																NO	170.2388097	136.5808047	57.61171762		191.7308412	0.191730841	0.191730841	60.43292816	359.4953273		0.191730841	359.4953273	0.191730841	0.191239795		37.22807911	38.34616825	19.17308412			0.191730841	38.34616825			20																	15.3305	0.205415412	1.478724853	0	1.972858225	0.957102547	0.705642342	1.616797879	5.844247546	0	2.584254453	0.250536474	0.005546642	5.411991232	0	7.332629668	0.390531451	0.927312811	0	0	2.711671347	0.000803899	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9918	0		2.057223264	15.3305	0.205415412	1.478724853	0	1.972858225	0.957102547	0.705642342	1.616797879	5.844247546	0	2.584254453	0.250536474	0.005546642	5.411991232	0	7.332629668	0.390531451	0.927312811	0	0	2.711671347	0.000803899	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9918	NO																																																																																		0	0		0	15.3305	0.205415412	1.478724853	0	1.972858225	0.957102547	0.705642342	1.616797879	5.844247546	0	2.584254453	0.250536474	0.005546642	5.411991232	0	7.332629668	0.390531451	0.927312811	0	0	2.711671347	0.000803899	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9918
H5416_018_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	981.912626	13.88596973	366.7473711		154.4301013	8.050612173	3.139933785	307.4816525	283.5807677		14.29239291	17.44118617	1.022846469	17.4167718		2495.918148	66.3582128	720.5255367			21.8562863				159.1037094																5950	"1a - IP Acute 245 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 200 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 375 copay,9b - OP Ambulatory Surgical Center (ASC) 375 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 375 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry)35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													177.5810388	142.4713977	60.09645318		200	0.2	0.2	64.59401261	375		0.2	375	0.2	0.199926389		34.29092258	40	20			0.2				5																NO	169.7624629	136.1986366	57.45051373		191.1943574	0.191194357	0.191194357	61.75005365	358.4894201		0.191194357	358.4894201	0.191194357	0.191123988		32.80654426	38.23887147	19.11943574			0.191194357				5																	13.891	0.157604179	1.75581874	0	2.460513665	1.539231621	0.600337622	1.582250711	8.471725414	0	2.732624877	0.52104006	0.195562473	3.328762877	0	6.823537433	0.211455264	1.148003475	0	0	4.178798613	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6646	0		2.278772099	13.891	0.157604179	1.75581874	0	2.460513665	1.539231621	0.600337622	1.582250711	8.471725414	0	2.732624877	0.52104006	0.195562473	3.328762877	0	6.823537433	0.211455264	1.148003475	0	0	4.178798613	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6646	NO																																																																																		0	0		0	13.891	0.157604179	1.75581874	0	2.460513665	1.539231621	0.600337622	1.582250711	8.471725414	0	2.732624877	0.52104006	0.195562473	3.328762877	0	6.823537433	0.211455264	1.148003475	0	0	4.178798613	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6646
H5416_019_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	268.2084871	2.966394778	44.6367137		9.612725771	13.66894464	8.908727702	23.37420901	60.1670961	6.674179168	19.64899764	3.916942976	0.465570256	32.84717249		5044.551176	4.875874476	848.7113275		3385.327719	24.53092351	0.079779788			159.1037094		1.904165586														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 80"													0.08404134	0.08404134	0.199535011		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.991117204	0.224	1349.243703			5		10														NO	0.069662026	0.069662026	0.165394949		0.185674024	0.185674024	0.185674024	0.185674024	0.185674024	0.185674024	0.185674024	0.185674024	0.185674024	0.185674024		8.289018943	0.185674024	8.289018943		2.479342716	0.185674024	1118.390662			5		10															18.6839	0.206645071	7.382686966	0	1.784833479	2.53796796	1.654119324	4.339983452	11.17146687	1.239221705	3.648308466	0.727274565	0.086444303	6.098866704	0	3.484531688	0.905323236	0.586248689	0	0.699448968	4.554755288	0.007435414	0	0	0.066293212	0	0.001586805	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8674	0		14.40769265	18.6839	0.206645071	7.382686966	0	1.784833479	2.53796796	1.654119324	4.339983452	11.17146687	1.239221705	3.648308466	0.727274565	0.086444303	6.098866704	0	3.484531688	0.905323236	0.586248689	0	0.699448968	4.554755288	0.007435414	0	0	0.066293212	0	0.001586805	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8674	NO																																																																																		0	0		0	18.6839	0.206645071	7.382686966	0	1.784833479	2.53796796	1.654119324	4.339983452	11.17146687	1.239221705	3.648308466	0.727274565	0.086444303	6.098866704	0	3.484531688	0.905323236	0.586248689	0	0.699448968	4.554755288	0.007435414	0	0	0.066293212	0	0.001586805	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8674
H5416_020_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	907.7570141	30.79615763	516.8698616		107.7740863	7.236688398	4.481743374	260.956516	255.3297264		11.37320028	33.6217498	0.716928467	11.36782283	4859.863495	4190.239899	62.44015254	1146.263717			21.27851794				159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 450 copay,9b - OP Ambulatory Surgical Center (ASC) 450 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 450 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f (Podiatry) 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	62.88606891	450		0.2	450	0.2	0.197664787	10	29.62572397	40	20			0.2				20																NO	173.1261484	136.1193403	57.41706542		238.8538024	0.191083042	0.191083042	60.08230672	429.9368444		0.191083042	429.9368444	0.191083042	0.188851944	9.554152098	28.30858944	38.21660839	19.1083042			0.191083042				20																	13.0964	0.349329388	2.473095888	0	2.145187527	1.382808433	0.856385157	1.306572453	9.147971406	0	2.173225706	1.204602418	0.136992872	2.146835438	3.869322917	9.884981746	0.198854238	1.825262983	0	0	4.065963936	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5289	0		2.624208226	13.0964	0.349329388	2.473095888	0	2.145187527	1.382808433	0.856385157	1.306572453	9.147971406	0	2.173225706	1.204602418	0.136992872	2.146835438	3.869322917	9.884981746	0.198854238	1.825262983	0	0	4.065963936	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5289	NO																																																																																		0	0		0	13.0964	0.349329388	2.473095888	0	2.145187527	1.382808433	0.856385157	1.306572453	9.147971406	0	2.173225706	1.204602418	0.136992872	2.146835438	3.869322917	9.884981746	0.198854238	1.825262983	0	0	4.065963936	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5289
H5416_021_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	842.9007878	7.386823441	520.3796071		74.9774269	6.644683097	7.664724703	247.2143191	409.5026381		9.36832586	29.44170532	1.944622299	14.31740815	4731.792306	5052.433726	128.665988	1337.417942			21.57534746				159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 450 copay,9b - OP Ambulatory Surgical Center (ASC) 450 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 450 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f (Podiatry) 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	60	450		0.2	450	0.2	0.195183062	10	29.45573667	40	20			0.2				20																NO	171.5723168	134.89765	56.90173916		236.7100559	0.189368045	0.189368045	56.81041341	426.0781006		0.189368045	426.0781006	0.189368045	0.184807174	9.468402235	27.88987629	37.87360894	18.93680447			0.189368045				20																	12.0515	0.08303876	2.467542056	0	1.478992576	1.258290646	1.45145393	1.170362306	14.54000885	0	1.77406155	1.045372157	0.368249322	2.645959736	3.733542737	11.74264596	0.40608711	2.110535171	0	0	4.085681361	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6785	0		3.504160723	12.0515	0.08303876	2.467542056	0	1.478992576	1.258290646	1.45145393	1.170362306	14.54000885	0	1.77406155	1.045372157	0.368249322	2.645959736	3.733542737	11.74264596	0.40608711	2.110535171	0	0	4.085681361	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6785	NO																																																																																		0	0		0	12.0515	0.08303876	2.467542056	0	1.478992576	1.258290646	1.45145393	1.170362306	14.54000885	0	1.77406155	1.045372157	0.368249322	2.645959736	3.733542737	11.74264596	0.40608711	2.110535171	0	0	4.085681361	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6785
H5416_023_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1094.580831	109.3696244	681.0980356		108.0384701	4.677522443	5.937184825	353.7777249	227.1166158		12.65193391	2.381975777	0.00769639	10.68731903		4037.929548	303.8788944	643.6341885			12.35324219				159.1037094		1.821253431														3600	"1a - IP Acute 150 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 20 copay,7f (Podiatry) 20 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 20 copay,18a - Hearing Exam (M/C) 20 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 20 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam 20 copay,18a - Hearing Exam (M/C) 20 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 700 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 25"													92.84307611	142.4713977	60.09645318		150	0.2	0.2	62.34114434	200		0.2	200	0.2	0.19651998		19.97588347	40	20			0.2				20		20														NO	87.30941068	133.9797677	56.5145634		141.0596476	0.18807953	0.18807953	58.6254657	188.0795302		0.18807953	188.0795302	0.18807953	0.184806928		18.78606706	37.61590604	18.80795302			0.18807953				20		20															7.9639	1.22110974	3.207663176	0	1.269989044	0.879746224	1.116662933	1.728365323	3.559665534	0	2.379569786	0.037333407	0.001447533	1.975090595	0	6.321401272	0.952556662	1.008786798	0	0	2.323391988	0	0	0	0.265172849	0	0.003035422	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2149	0		2.278016853	7.9639	1.22110974	3.207663176	0	1.269989044	0.879746224	1.116662933	1.728365323	3.559665534	0	2.379569786	0.037333407	0.001447533	1.975090595	0	6.321401272	0.952556662	1.008786798	0	0	2.323391988	0	0	0	0.265172849	0	0.003035422	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2149	NO																																																																																		0	0		0	7.9639	1.22110974	3.207663176	0	1.269989044	0.879746224	1.116662933	1.728365323	3.559665534	0	2.379569786	0.037333407	0.001447533	1.975090595	0	6.321401272	0.952556662	1.008786798	0	0	2.323391988	0	0	0	0.265172849	0	0.003035422	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2149
H5417_001_0	2012	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	251.7306449	40.817	12504.97411	491.1871964	11.81973024	54.74852703	7.295118244	5.096969913	22.23020356	39.55714238	10.65355357	0	0	15.85704413	3.149444318	146.2090641	18.407981	49.93273569	0	25887.28003	26.59486573	8.408013838	944.9966917	152	69.81541218	136.3560278	0	0	0	0											5000	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare 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)	"$0/20% (11b); 20% (11b1, 11c)"	$65 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); 20% (7a1); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.091127334	0.092234144	0	0	0.2	0.2	0.191340952	0.14338927	0.16	0	0.080384437	0	0	0.14636671	0	0.028035371	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.083366175	0.08437872	0	0	0.182966342	0.182966342	0.175044771	0.131177051	0.146373074	0	0.073538232	0	0	0.133900908	0	0.0253891	0.181121907	0	0	0	0.182966342	0.183171308	0	0	0	0	0	0	0	0												20.9858	3.444086198	0	0	2.162612806	10.01713772	1.276972301	0.668605483	3.253903222	0	0.783443495	0	0	2.123272602	0	3.712116481	3.334088622	0	0	0	4.865965298	1.540106895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1681	0	NO	5.49184204	20.9858	3.444086198	0	0	2.162612806	10.01713772	1.276972301	0.668605483	3.253903222	0	0.783443495	0	0	2.123272602	0	3.712116481	3.334088622	0	0	0	4.865965298	1.540106895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1681	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)"	$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0	0	0	0.0477	0.1352	0.6261	0.0834	0.0279	0.2034	0	0.0929	0	0	0.1327	0.0181	1.2287	0.1547	0.0031	0	0	0.2257	0.0714	0	0	0.0071	0	0	0	0	0											3.0582	0	NO	0.299369861	20.9858	3.444086198	0	0.047669947	2.297776106	10.64320883	1.360394869	0.696464045	3.457272173	0	0.876392072	0	0	2.25597714	0.018106893	4.940842183	3.488762836	0.003117399	0	0	5.091705956	1.611555153	0	0	0.007149587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2263
H5420_001_0	2012	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	YES	1721.957468	5.445041134	507.3826949	0.073812864	475.9762414	8.960329394	4.575852385	389.7125756	531.7986322	154.6962944	802.0753875	0	0.039674041	90.1993451	7716.010808	8687.385241	23.74091384	1015.199906	5899.618514	647.6391108	29.8874713	0	527.9000975	421.6	217.4904867	1.041681886	47.28982328	0	0	0											500	$0 	$0 	$0 	$0 	$0 	$0 	11c: $0-$25	"4a1: $25,4a2: $25"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"16a:$0,16b: $$0-$175"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	0	0	0	16.82811212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	16.81139561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29	0	0	0	0	0	0												0	0	0	0	0	0	0	0.54596769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.018866667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5648	0	NO	0.000542886	0	0	0	0	0	0	0	0.54596769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.018866667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5648	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	0	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	0.54596769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.018866667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5648
H5420_003_0	2012	4																															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	YES	1880.032006	10.70989038	836.4243186	0	660.03545	8.17523902	4.57346529	447.1679285	541.9110245	353.1554991	1646.678848	0.73066655	0.119140065	278.3839555	6580.699012	9819.254443	60.0483077	709.847736	6907.001079	705.0415033	32.39603443	0	552.6580802	0	197.2382829	3.158707815	7.633323362	0	0	0											3400	$0 	$175 days 1-5;$0 days 6-90	$0 days 1-6;$50 days 7-20;$100 days 21-100	$0 	10a: $100	11a: 0-20.0%	"11b1: 20.0%,11b2: 20.0%,11c:$0-$25"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $75,9b: $75"	$0 	8b: $0-$25	9c1: $25	12: 20.0%	"3: $25,5: $25"	$0 	"7b1: $20,7d1: $20,7f1: $20,7f2: $20,17a1: $20,18a1: $20"	"7e1: $25,7h:$25"	"7c: $25,7i: $25"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 											0	NO	0	75.2578113	33.28454157	0	100	0.1	0.19990152	49.78213508	75	0	77.31104866	25	0.2	2.734033246	0	20	10.49081713	25	0	20	0.195338249	0	0	0	20	0	20	0	0	0											NO	0	69.46295983	30.70212024	0	92.3	0.0923	0.184509103	45.94891068	69.225	0	71.35809791	23.075	0.1846	2.523512686	0	18.53692031	9.683024216	23.075	0	18.46	0.180297204	0	0	0	20	0	20	0	0	0												0	0.061995057	2.14	0	5.07677267	0.754574562	0.843845976	1.712239934	3.126149222	0	9.791989205	0.001405011	0.021993256	0.05854212	0	15.16822809	0.048454101	1.364978042	0	1.084588846	5.840914419	0	0	0	0.328730471	0	0.012722206	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4381	0	NO	3.86225564	0	0.061995057	2.14	0	5.07677267	0.754574562	0.843845976	1.712239934	3.126149222	0	9.791989205	0.001405011	0.021993256	0.05854212	0	15.16822809	0.048454101	1.364978042	0	1.084588846	5.840914419	0	0	0	0.328730471	0	0.012722206	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4381	YES	$0 	$0 	$0 days 1-6;$50 days 7-20;$100 days 21-100	$0 	10a: $100	$0 	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $25"	$0 	$0 	"8b2: $25,8b3: $25,8b4: $25,8b6: $25"	$0 	12: 20.0%	3: $25	$0 	"7b1: $20,7d1: $20"	$0 	"7c: $25,7i: $25"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0.0703	0	0	0	0.016	0	0	0	0	0.3829	0	0.334	0.1927	0.0075	0.0679	0	0	0	0	0	0	0	0	0											1.0714	0	NO	0	0	0.061995057	2.14	0	5.07677267	0.754574562	0.914121553	1.712239934	3.126149222	0	9.807991596	0.001405011	0.021993256	0.05854212	0	15.55116597	0.048454101	1.698984548	0.192746489	1.092098449	5.908830542	0	0	0	0.328730471	0	0.012722206	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5095
H5420_006_0	2012	4																															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	YES	2157.868089	25.45416753	979.5341889	0	797.1604823	9.712644234	5.064651013	691.1072222	515.3953633	500.5244265	1336.036272	0	0.200817154	176.8858802	8721.411916	8093.945976	69.19072416	834.0255098	6946.49589	804.6636491	35.60378271	0	3251.796015	0	273.0103306	4.71282738	29.60383278	0	0	0											500	$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 	"16a:$0,16b$0-$175"	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	0	0	0	22.76330691	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	22.76330691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.310990484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.311	0	NO	0	0	0	0	0	0	0	0	1.310990484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.311	YES	$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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	0	0	0	0	0	0	0	1.310990484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.311
H5420_007_0	2012	3																															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	YES	885.5088346	2.240421366	208.7681254	0.030371105	247.4928316	7.824970503	2.121238972	236.8658948	304.8930497	78.95435582	553.8273131	0	3.241047814	42.8520825	2178.817668	4573.658202	7.669100942	546.1963649	3715.50789	439.0653786	10.69293506	0	142.6083403	0	46.16693071	0.428611336	16.72942936	0	0	0											2500	$0 	$0 	$0 	$0 	10a: $25	11a: 0-20.0%	"11b1: 20.0%,11b2: 20.0%,11c:$0-25"	"4a1: $25,4a2: $25,4b: $10"	$0 	$0 	8b: $0-$25	$0 	12: 20.0%	"3: $25, 9c:$0, 9d:$0"	$0 	$0 	$0 	"7c: $25,7i: $25"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	0	0	0	25	0.1	0.2	20.83276892	0	0	19.66737672	0	0.2	1.311079895	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	25	0.1	0.2	20.83276892	0	0	19.66737672	0	0.2	1.311079895	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0.515610066	0.78249705	0.424247794	0.411214371	0	0	0.9076942	0	0.648209563	0.004681875	0	0	0	1.137909094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8321	0	NO	0	0	0	0	0	0.515610066	0.78249705	0.424247794	0.411214371	0	0	0.9076942	0	0.648209563	0.004681875	0	0	0	1.137909094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8321	YES	$0 	$0 	$0 	$0 	10a: $25	$0 	"11b1: 20.0%,11b2: 20.0%"	"4a1: $25,4b: $10"	$0 	$0 	8b: $0-$25	$0 	12: 20.0%	3: $25	$0 	$0 	$0 	"7c: $25,7i: $25"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											2500	0	0	0	0	0	0	0.006	0	0	0	0.0006	0	0	0	0	0	0	0.067	0	0	0	0	0	0	0	0	0	0	0	0											0.0736	0	NO	0	0	0	0	0	0.515610066	0.78249705	0.430207255	0.411214371	0	0	0.908279435	0	0.648209563	0.004681875	0	0	0	1.20492755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.9056
H5420_008_0	2012	3																															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	YES	1230.452567	3.552048728	581.9714719	0	426.0703405	7.376588027	2.272743264	299.7364733	346.9328267	214.9253314	1041.435848	0.24233331	0.039514066	205.9003568	3573.288036	6283.064653	31.14555193	314.1818791	4307.210208	469.5340914	19.58974385	0	169.11563	0	130.7160418	3.970087153	12.47247528	0	0	0											3400	$75 days 1-5;$0 days 6-90	$175 days 1-5;$0 days 6-90	$0 days 1-7;$50 days 8-30;$0 days 31-100	$0 	10a: $100	11a: 0-20.0%	"11b1: 20.0%,11b2: 20.0%,11c:$0-25"	"4a1: $50,4a2: $50,4b: $15"	"9a1: $100,9b: $100"	$0 	8b:$0-$50	9c1: $10	12: 20.0%	"3: $25,5: $10,9a2: $100"	$0 	"7b1: $20,7d1: $20,7f1: $20,7f2: $20,17a1: $20,18a1: $20"	7e1: $10	"7c:$25,7i: $25"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 											0	NO	48.63311011	75.2578113	24.7434809	0	100	0.1	0.199934274	49.84908226	100	0	26.60842249	10	0.2	36.38593882	0	20	3.719705794	24.70672094	0	20	0.189255031	0	0	0	20	0	20	0	0	0											NO	47.40257629	73.35360896	23.81560037	0	97.4697612	0.097469761	0.194875459	48.58778144	97.4697612	0	25.93516586	9.74697612	0.194939522	35.46528767	0	19.51519927	3.625588355	24.0815819	0	19.49395224	0.184466427	0	0	0	20	0	20	0	0	0												4.8606	0.021712966	1.155	0	3.460747861	0.718994273	0.442901887	1.213627521	2.817954981	0	2.250817621	0.000196835	0.007702853	0.608526282	0	10.21793823	0.009410079	0.630499721	0	0.762756263	3.613650048	0	0	0	0.21786007	0	0.020787459	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0316	0	NO	0.854883973	4.8606	0.021712966	1.155	0	3.460747861	0.718994273	0.442901887	1.213627521	2.817954981	0	2.250817621	0.000196835	0.007702853	0.608526282	0	10.21793823	0.009410079	0.630499721	0	0.762756263	3.613650048	0	0	0	0.21786007	0	0.020787459	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0316	YES	$75 days 1-5;$0 days 6-90	$0 	$0 days 1-7;$50 days 8-30;$0 days 31-100	$0 	10a: $100	$0 	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4b: $15"	"9a1: $100,9b: $100"	$0 	8b:$0-$50	$0 	12: 20.0%	"31: $25,9a2: $100,9a3: $100"	$0 	"7b1: $20,7d1: $20"	$0 	"7c: $25,7i: $25"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0.0122	0	0.0945	0	0.0089	0	0	0.0142	0	0.371	0	0.3663	0.1483	0.0091	0.0265	0	0	0	0	0	0	0	0	0											1.051	0	NO	0	4.8606	0.021712966	1.155	0	3.460747861	0.718994273	0.455147738	1.213627521	2.912471619	0	2.259671335	0.000196835	0.007702853	0.622750485	0	10.5889342	0.009410079	0.996848298	0.148295383	0.771863143	3.640103153	0	0	0	0.21786007	0	0.020787459	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0827
H5420_009_0	2012	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	YES	831.3064863	2.897379563	257.5590844	0	265.1406459	7.224435754	1.607816598	259.0787822	358.1770754	220.3355666	1168.885452	1.317796451	0.003213155	159.4533706	6597.613703	6290.611454	26.55035758	413.5139086	4348.65444	627.2795733	17.78994734	0	266.8191234	421.6	225.4178216	0.732458515	7.98666182	0	0	0											3400	$100 days 1-5;$0 days 6-90	$175 days 1-10;$0 days 11-90	$50 days 1-7;$100 days 8-100	$0 	10a: $100	$0 	"11b1: 20.0%,11b2: 20.0%, 11c: $0-$25"	"4a1: $50,4a2: $50, 4b:$25"	"9a1: $50,9b: $50"	$0 	"8b2: $25,8b3: $55,8b4: $55,8b6: $25"	9c1: $25	12: 20.0%	"3: $20,5: $25,9a2: $50"	$0 	"7b1: $20,7d1: $20,7f1: $20,7f2: $20,17a1: $10,18a1: $20"	"7e1: $25,7h1: $25"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $0,16b1: $10-$150 restorative, $0-$175 endo/perio/extractions/prostho/surgery/other"	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 											0	NO	64.84414681	109.6813914	61.50045158	0	100	0	0.199822371	48.2706002	50	0	21.38105975	25	0.2	14.09917355	0	17.29777848	25	20	0	20	0.196951464	0	0	29	20	0	20	0	0	0											NO	61.71481841	104.3882522	58.70497651	0	95.1740773	0	0.190179098	45.94109835	47.58703865	0	20.34922634	23.79351933	0.190348155	13.41875834	0	16.51944653	23.79351933	19.03481546	0	19.03481546	0.187446739	0	0	29	20	0	20	0	0	0												4.2753	0.025204366	1.26	0	2.102876361	0	0.30577311	0.991863651	1.420382194	0	1.982159552	0.002612918	0.000611618	0.17830552	0	8.659784961	0.052643871	0.655930078	0	0.995012577	3.334667611	0	0	1.018866667	0.375696369	0	0.013311103	0	0	0	0	0	0	0	0	0	0	0	0	0	27.651	0	NO	1.295712615	4.2753	0.025204366	1.26	0	2.102876361	0	0.30577311	0.991863651	1.420382194	0	1.982159552	0.002612918	0.000611618	0.17830552	0	8.659784961	0.052643871	0.655930078	0	0.995012577	3.334667611	0	0	1.018866667	0.375696369	0	0.013311103	0	0	0	0	0	0	0	0	0	0	0	0	0	27.651	YES	$100 days 1-5;$0 days 6-90	$175 days 1-10;$0 days 11-90	$0 	$0 	10a: $100	$0 	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50, 4b:$25"	"9a1: $50,9b: $50"	$0 	"8b1: $55,8b3: $25,8b4: $25"	$0 	12: 20.0%	"31: $20,9a2: $50,9a3: $50"	$0 	7d1: $20	$0 	"7c: $20,7i: $20"	7d2: $20	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0.0061	0.0011	0.056	0	0.0197	0	0	0.0125	0	0.2455	0	0.1841	0.1488	0	0.0316	0	0	0	0	0	0	0	0	0											0.7053	0	NO	0	4.2753	0.025204366	1.26	0	2.102876361	0	0.311846999	0.992919532	1.476343892	0	2.001904528	0.002612918	0.000611618	0.190764917	0	8.905271778	0.052643871	0.840045191	0.148816355	0.995012577	3.366270012	0	0	1.018866667	0.375696369	0	0.013311103	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3563
H5420_010_0	2012	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	YES	2372.794074	10.1124157	888.4332549	0	723.48008	8.854081143	6.523586983	478.7938737	564.3420586	316.160335	1229.410206	0	0.239154877	171.6482936	1861.861781	9089.72648	13.1045122	913.0350468	7153.316394	673.2224735	23.4673888	0	659.4716736	0	0	2.471207977	32.49919026	0	0	0											3400	$0 	$175 days 1-5;$0 days 6-90	$0 days 1-7;$75 days 8-30;$0 days 31-100	$0 	10a: $100	$0 	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50"	"9a1: $50,9b: $50"	$0 	"8b2: $25,8b3: $55,8b4: $55,8b6: $25"	9c1: $25	12: 20.0%	"31: $20,5: $25,9a2: $50"	$0 	$0 	"7e1: $25,7h1: $25"	"7c: $20,7i: $20"	$0 	$0 	15: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0	75.2578113	37.07552223	0	100	0	0.199972853	41.1815562	50	0	24.29105874	0	0.2	11.23258307	0	0	25	20	0	0	0.198999434	0	0	0	0	0	0	0	0	0											NO	0	74.69610676	36.79880027	0	99.25362626	0	0.198480309	40.87418787	49.62681313	0	24.10975665	0	0.198507253	11.14874602	0	0	24.81340656	19.85072525	0	0	0.197514154	0	0	0	0	0	0	0	0	0												0	0.062946507	2.724439825	0	5.984001789	0	1.294803558	1.630859229	2.333874824	0	2.470065074	0	0.047473978	0.159471936	0	0	0.027097299	1.510367322	0	0	4.635141451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8805	0	NO	0.172058563	0	0.062946507	2.724439825	0	5.984001789	0	1.294803558	1.630859229	2.333874824	0	2.470065074	0	0.047473978	0.159471936	0	0	0.027097299	1.510367322	0	0	4.635141451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8805	YES	$0 	$0 	$0 	$0 	$0 	$0 	"11b1: 20.0%,11b2: 20.0%"	4a1: $50	"9a1: $50,9b: $50"	$0 	"8b1: $55,8b3: $25,8b4: $25"	$0 	12: 20.0%	"31: $20,9a2: $50,9a3: $50"	$0 	7d1: $20	$0 	"7c: $20,7i: $20"	7d2: $20	7g: $20	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	0	0.062946507	2.724439825	0	5.984001789	0	1.294803558	1.630859229	2.333874824	0	2.470065074	0	0.047473978	0.159471936	0	0	0.027097299	1.510367322	0	0	4.635141451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8805
H5421_046_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1124.629994	42.22275862	1133.064282	125.7672929	502.2419308	28.52412337	2.262169415	310.1837134	580.6701872	11.2881644	22.9812127	5.526827444	10.89480808	390.5856491	6164.47263	8672.498955	0.430143497	566.0549037	23.58110566	14597.447	3.916472798	14.53179986	0	0	0	0	0.250487128	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	63.15471726	201.9603725	0.2	0.2	0.292142416	30	10.56440711	19.54932152	19.94302686	0.4	0	0.181078327	3.238791429	0.2	0	0	0	0	0	1.071408	0	0	0											NO	203.7523962	203.7523962	117.0492489	0	130.054721	0.173406295	0.173406295	54.75712756	175.1059993	0.173406295	0.173406295	0.253296669	26.0109442	9.159673458	16.94987704	17.29123196	0.346812589	0	0.157000609	2.808134105	0.173406295	0	0	0	0	0	1.071408	0	0	0												19.0955	0.716915687	11.05202693	0	5.443244516	4.946262542	0.392274416	1.41539743	8.473236117	1.957438762	3.985086942	1.399926983	0.023615354	0.298136417	8.707254427	12.49651593	0.14917918	0	3.702247948	3.415965731	0.679141036	0	0	0	0	0	2.24E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3494	0		13.54931863	19.0955	0.716915687	11.05202693	0	5.443244516	4.946262542	0.392274416	1.41539743	8.473236117	1.957438762	3.985086942	1.399926983	0.023615354	0.298136417	8.707254427	12.49651593	0.14917918	0	3.702247948	3.415965731	0.679141036	0	0	0	0	0	2.24E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3494	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	19.0955	0.716915687	11.05202693	0	5.443244516	4.946262542	0.392274416	1.41539743	8.473236117	1.957438762	3.985086942	1.399926983	0.023615354	0.298136417	8.707254427	12.49651593	0.14917918	0	3.702247948	3.415965731	0.679141036	0	0	0	0	0	2.24E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3494
H5421_047_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1114.019763	20.12264326	959.5974711	64.61543467	540.3046991	27.1156573	1.720560016	363.363395	437.985952	9.986245713	29.73523382	7.325192096	10.89818664	416.8585409	6093.981705	7992.948073	0.369004648	618.8695034	19.62524164	16401.60461	4.503491629	13.80932104	0	0	0	0	0.205108809	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.720455	226.5003428	0.2	0.2	0.217302489	30	9.634348999	19.22673664	18.96547094	0.4	0	0.176582619	3.204985861	0.2	0	0	0	0	0	20	0	0	0											NO	203.378917	203.378917	116.834697	0	129.81633	0.17308844	0.17308844	50.81915976	196.022955	0.17308844	0.17308844	0.188062744	25.963266	8.337972195	16.63962926	16.41351889	0.34617688	0	0.15282205	2.773730014	0.17308844	0	0	0	0	0	20	0	0	0												18.8807	0.34104345	9.342856649	0	5.845031094	4.693406822	0.297809049	1.538818535	7.154608379	1.728503692	5.146825236	1.377595728	0.023579377	0.289646244	8.450133023	10.93270035	0.127740878	0	2.999169666	3.791135249	0.779502341	0	0	0	0	0	0.000341848	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7411	0		13.01990542	18.8807	0.34104345	9.342856649	0	5.845031094	4.693406822	0.297809049	1.538818535	7.154608379	1.728503692	5.146825236	1.377595728	0.023579377	0.289646244	8.450133023	10.93270035	0.127740878	0	2.999169666	3.791135249	0.779502341	0	0	0	0	0	0.000341848	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7411	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	18.8807	0.34104345	9.342856649	0	5.845031094	4.693406822	0.297809049	1.538818535	7.154608379	1.728503692	5.146825236	1.377595728	0.023579377	0.289646244	8.450133023	10.93270035	0.127740878	0	2.999169666	3.791135249	0.779502341	0	0	0	0	0	0.000341848	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7411
H5421_048_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1422.371098	16.02007423	841.3668255	72.09728524	615.5990683	28.24525065	2.495114901	349.2803596	626.0596581	10.37475071	23.2594179	9.71282201	34.29828613	369.4726807	5873.586873	8710.859505	0.501279508	531.6658073	24.04238343	17716.55434	3.950468777	5.741791626	0	0	0	0	0.086328739	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	62.09591122	195.3266596	0.2	0.2	0.213858109	30	11.42914649	19.31930604	18.8746328	0.4	0	0.18119495	3.247793004	0.2	0	0	0	0	0	20	0	0	0											NO	200.19486	200.19486	115.0055579	0	127.7839532	0.170378604	0.170378604	52.89907343	166.3974183	0.170378604	0.170378604	0.182184231	25.55679064	9.736410132	16.457982	16.07916796	0.340757209	0	0.154358714	2.766772195	0.170378604	0	0	0	0	0	20	0	0	0												23.7293	0.267261376	8.06348843	0	6.555306879	4.812386384	0.425114194	1.539717282	8.681225899	1.767635546	3.962907158	1.769523005	0.073046177	0.299778129	8.055615585	11.67194776	0.170814606	0	3.71115138	4.084805828	0.673075357	0	0	0	0	0	0.000143881	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3142	0		15.70167333	23.7293	0.267261376	8.06348843	0	6.555306879	4.812386384	0.425114194	1.539717282	8.681225899	1.767635546	3.962907158	1.769523005	0.073046177	0.299778129	8.055615585	11.67194776	0.170814606	0	3.71115138	4.084805828	0.673075357	0	0	0	0	0	0.000143881	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3142	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	23.7293	0.267261376	8.06348843	0	6.555306879	4.812386384	0.425114194	1.539717282	8.681225899	1.767635546	3.962907158	1.769523005	0.073046177	0.299778129	8.055615585	11.67194776	0.170814606	0	3.71115138	4.084805828	0.673075357	0	0	0	0	0	0.000143881	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3142
H5421_049_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1320.369428	53.21420277	921.1208318	107.7574034	546.8549192	32.74807323	1.230204949	345.5813469	607.9578247	10.80754412	27.89496991	8.53324235	8.596624881	406.5250303	6205.484095	9486.132172	0.40825545	593.3696246	25.3823493	17401.13461	5.689409549	9.191100436	0	0	0	0	0.36787225	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	61.40126449	204.7022546	0.2	0.2	0.205972004	30	11.58726863	19.94687383	19.3267693	0.4	0	0.180952749	3.200990199	0.2	0	0	0	0	0	20	0	0	0											NO	206.9070368	206.9070368	118.8614892	0	132.0683213	0.176091095	0.176091095	54.06107952	180.231221	0.176091095	0.176091095	0.181349179	26.41366427	10.20207411	17.56233429	17.01635986	0.35218219	0	0.159320839	2.818329347	0.176091095	0	0	0	0	0	20	0	0	0												22.7661	0.917532751	9.12381615	0	6.0185176	5.766644078	0.216628137	1.556875057	9.131081753	1.90311228	4.9120558	1.547496491	0.018922364	0.345616541	9.081898839	13.45161989	0.143780299	0	4.043937178	4.08684403	1.001854358	0	0	0	0	0	0.00061312	0	0	0	0	0	0	0	0	0	0	0	0	0	96.035	0		13.03914201	22.7661	0.917532751	9.12381615	0	6.0185176	5.766644078	0.216628137	1.556875057	9.131081753	1.90311228	4.9120558	1.547496491	0.018922364	0.345616541	9.081898839	13.45161989	0.143780299	0	4.043937178	4.08684403	1.001854358	0	0	0	0	0	0.00061312	0	0	0	0	0	0	0	0	0	0	0	0	0	96.035	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	22.7661	0.917532751	9.12381615	0	6.0185176	5.766644078	0.216628137	1.556875057	9.131081753	1.90311228	4.9120558	1.547496491	0.018922364	0.345616541	9.081898839	13.45161989	0.143780299	0	4.043937178	4.08684403	1.001854358	0	0	0	0	0	0.00061312	0	0	0	0	0	0	0	0	0	0	0	0	0	96.035
H5421_056_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1542.502695	54.18581178	964.3073371	114.570485	556.9047327	33.08748941	2.811203748	353.9135854	613.1476828	11.91569628	29.46157089	7.58931258	16.85772803	410.8392096	6155.820186	10358.5159	0.497154911	849.2872533	45.14649288	18233.91791	3.659754922	15.05748374	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	61.52248291	205.1235821	0.2	0.2	0.289159625	30	13.39512774	20.14264574	17.57386533	0.4	0	0.187754317	3.117419764	0.2	0	0	0	0	0	0	0	0	0											NO	213.1912505	213.1912505	122.4715695	0	136.0795216	0.181439362	0.181439362	55.81300029	186.0874595	0.181439362	0.181439362	0.262324689	27.21590432	12.15201717	18.27334397	15.94295458	0.362878724	0	0.170330117	2.828113268	0.181439362	0	0	0	0	0	0	0	0	0												27.404	0.962661748	9.841686084	0	6.315277468	6.003372974	0.510063015	1.646081587	9.508257881	2.161976332	5.34548863	1.990864065	0.038233193	0.416043761	9.373951641	13.76211238	0.18040694	0	7.689807431	4.297298765	0.664023599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1116	0		11.0594553	27.404	0.962661748	9.841686084	0	6.315277468	6.003372974	0.510063015	1.646081587	9.508257881	2.161976332	5.34548863	1.990864065	0.038233193	0.416043761	9.373951641	13.76211238	0.18040694	0	7.689807431	4.297298765	0.664023599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1116	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	27.404	0.962661748	9.841686084	0	6.315277468	6.003372974	0.510063015	1.646081587	9.508257881	2.161976332	5.34548863	1.990864065	0.038233193	0.416043761	9.373951641	13.76211238	0.18040694	0	7.689807431	4.297298765	0.664023599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1116
H5421_057_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1526.170271	44.10019402	739.6952557	203.2161291	533.5062361	39.78246396	2.729352073	349.7539353	601.212002	12.72612105	31.8584246	11.32547241	38.30337172	434.3846979	6285.278926	10782.10845	0.500007532	607.8540163	33.86294305	19924.48965	4.335476118	8.741584864	0	0	0	0	0.071061542	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	63.00859773	206.3674232	0.2	0.2	0.194394376	30	11.37245867	20.18820214	19.80835297	0.4	0	0.183242737	3.148834566	0.2	0	0	0	0	0	20	0	0	0											NO	211.215794	211.215794	121.3367327	0	134.8185919	0.179758123	0.179758123	56.63153616	185.4811027	0.179758123	0.179758123	0.17471984	26.96371838	10.2214591	18.14496657	17.8035617	0.359516245	0	0.164696852	2.830142948	0.179758123	0	0	0	0	0	20	0	0	0												26.8626	0.776221458	7.47935046	0	5.993879959	7.151221031	0.490623204	1.650591886	9.292788757	2.287623628	5.726810593	1.978784726	0.086066777	0.370003785	9.503847998	15.99666108	0.179760831	0	5.577120125	4.699096157	0.779337047	0	0	0	0	0	0.000118436	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8825	0		12.03561938	26.8626	0.776221458	7.47935046	0	5.993879959	7.151221031	0.490623204	1.650591886	9.292788757	2.287623628	5.726810593	1.978784726	0.086066777	0.370003785	9.503847998	15.99666108	0.179760831	0	5.577120125	4.699096157	0.779337047	0	0	0	0	0	0.000118436	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8825	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	26.8626	0.776221458	7.47935046	0	5.993879959	7.151221031	0.490623204	1.650591886	9.292788757	2.287623628	5.726810593	1.978784726	0.086066777	0.370003785	9.503847998	15.99666108	0.179760831	0	5.577120125	4.699096157	0.779337047	0	0	0	0	0	0.000118436	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8825
H5421_065_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	928.0244207	33.04926786	547.6479352	59.73335976	382.4354989	27.98219486	1.238762166	314.6311874	542.6971032	10.99070299	23.5725275	7.024788455	4.570135414	462.820706	6432.765335	7211.167859	0.333328376	576.7662514	18.71958136	15776.3752	6.044285302	9.608169604	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.84713317	221.1568821	0.2	0.2	0.239175419	30	9.296670561	18.553535	19.75141849	0.4	0	0.180521747	3.345301043	0.2	0	0	0	0	0	0	0	0	0											NO	198.9316874	198.9316874	114.2799055	0	126.9776728	0.169303564	0.169303564	49.8151468	187.2132414	0.169303564	0.169303564	0.202466254	25.39553456	7.869797284	15.70589798	16.7199277	0.338607127	0	0.152814876	2.831856942	0.169303564	0	0	0	0	0	0	0	0	0												15.3845	0.547878885	5.215429524	0	4.046730803	4.737485311	0.209726849	1.306116566	8.46667365	1.860765183	3.990912911	1.422282603	0.009671753	0.303525428	8.419363005	10.0475171	0.112867364	0	2.860630494	3.723036468	1.023319042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6884	0		13.36044479	15.3845	0.547878885	5.215429524	0	4.046730803	4.737485311	0.209726849	1.306116566	8.46667365	1.860765183	3.990912911	1.422282603	0.009671753	0.303525428	8.419363005	10.0475171	0.112867364	0	2.860630494	3.723036468	1.023319042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6884	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	15.3845	0.547878885	5.215429524	0	4.046730803	4.737485311	0.209726849	1.306116566	8.46667365	1.860765183	3.990912911	1.422282603	0.009671753	0.303525428	8.419363005	10.0475171	0.112867364	0	2.860630494	3.723036468	1.023319042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6884
H5421_067_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1209.104516	43.73049238	621.6294508	25.17297482	480.3957218	39.78670472	1.808214242	381.1467602	873.1956324	1325.393216	27.5255044	11.55720014	11.76195218	465.9384896	8180.584296	11393.05214	0.543181769	1085.478186	32.687076	22865.42508	7.017711616	14.4583728	0	0	0	0	0	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	58.88109847	98.29923873	0	0.2	0.135832422	30	4.280480782	4.034446003	13.85213395	0.4	0	0.185250512	1.117556986	0.2	0	0	0	0	0	0	0	0	0											NO	162.618006	162.618006	81.30900302	0.121963505	121.9635045	0.162618006	0.162618006	47.87563413	79.92613099	0	0.162618006	0.110443988	24.3927009	3.480416248	3.280367822	11.26303201	0.325236012	0	0.150625344	0.908674444	0.162618006	0	0	0	0	0	0	0	0	0												16.3852	0.592613789	4.212005907	3.070184228	4.882562149	6.470034589	0.294048195	1.520636903	5.815929041	0	4.476142641	1.276423275	0.023908815	0.135138324	2.236277124	10.69335925	0.176662272	0	4.923502072	1.731435618	1.14120627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0573	0		16.10448803	16.3852	0.592613789	4.212005907	3.070184228	4.882562149	6.470034589	0.294048195	1.520636903	5.815929041	0	4.476142641	1.276423275	0.023908815	0.135138324	2.236277124	10.69335925	0.176662272	0	4.923502072	1.731435618	1.14120627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0573	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	16.3852	0.592613789	4.212005907	3.070184228	4.882562149	6.470034589	0.294048195	1.520636903	5.815929041	0	4.476142641	1.276423275	0.023908815	0.135138324	2.236277124	10.69335925	0.176662272	0	4.923502072	1.731435618	1.14120627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0573
H5421_068_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1553.941782	17.94098989	795.2322393	26.28143177	581.1593865	37.96858287	1.354284236	398.7099088	743.5363117	1471.718615	31.06370798	9.549229366	5.413071816	499.7059316	7908.972904	11103.99953	0.589709577	1215.373764	27.66146867	20980.33957	5.561505804	8.017515508	0	0	0	0	0.110634338	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.78260788	103.4168271	0	0.2	0.149400873	30	3.884599635	3.990715232	11.86170152	0.4	0	0.17715008	1.021530151	0.2	0	0	0	0	0	20	0	0	0											NO	167.386618	167.386618	83.69330899	0.125539963	125.5399635	0.167386618	0.167386618	50.03404273	86.55296467	0	0.167386618	0.125038534	25.1079927	3.251149976	3.33996163	9.927450507	0.334773236	0	0.148262764	0.854952386	0.167386618	0	0	0	0	0	20	0	0	0												21.6758	0.250256802	5.546301461	3.299369985	6.079894014	6.355432676	0.226689058	1.662422385	5.362939343	0	5.199649022	1.194021643	0.011325947	0.135384911	2.201305503	9.186200479	0.197418983	0	4.101165805	1.494765947	0.930921648	0	0	0	0	0	0.000184391	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1114	0		14.63456852	21.6758	0.250256802	5.546301461	3.299369985	6.079894014	6.355432676	0.226689058	1.662422385	5.362939343	0	5.199649022	1.194021643	0.011325947	0.135384911	2.201305503	9.186200479	0.197418983	0	4.101165805	1.494765947	0.930921648	0	0	0	0	0	0.000184391	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1114	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	21.6758	0.250256802	5.546301461	3.299369985	6.079894014	6.355432676	0.226689058	1.662422385	5.362939343	0	5.199649022	1.194021643	0.011325947	0.135384911	2.201305503	9.186200479	0.197418983	0	4.101165805	1.494765947	0.930921648	0	0	0	0	0	0.000184391	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1114
H5421_070_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1245.937524	15.03989313	710.6597495	103.4379265	348.4742319	28.31895078	1.425783186	264.2492408	628.9340044	14.72931083	29.93837454	6.386965185	7.246684274	413.7220202	6331.236405	8194.685611	0.344018609	628.3672331	22.74002637	14749.24172	7.413919785	7.849027531	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	62.4397446	210.0158099	0.2	0.2	0.268478827	30	9.273938499	19.07895526	21.07502584	0.4	0	0.184172541	3.38260043	0.2	0	0	0	0	0	0	0	0	0											NO	202.4377671	202.4377671	116.2940364	0	129.215596	0.172287461	0.172287461	53.78792543	180.9154537	0.172287461	0.172287461	0.231277678	25.8431192	7.988916604	16.43532384	18.1548135	0.344574923	0	0.158653097	2.913898205	0.172287461	0	0	0	0	0	0	0	0	0												21.0187	0.253720199	6.887124232	0	3.752358798	4.879000139	0.245644566	1.184451538	9.481990062	2.537675571	5.158006546	1.477162478	0.01560641	0.27543256	8.671326718	12.39774908	0.118540186	0	3.60777562	3.581482415	1.277325419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8211	0		13.96522565	21.0187	0.253720199	6.887124232	0	3.752358798	4.879000139	0.245644566	1.184451538	9.481990062	2.537675571	5.158006546	1.477162478	0.01560641	0.27543256	8.671326718	12.39774908	0.118540186	0	3.60777562	3.581482415	1.277325419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8211	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	21.0187	0.253720199	6.887124232	0	3.752358798	4.879000139	0.245644566	1.184451538	9.481990062	2.537675571	5.158006546	1.477162478	0.01560641	0.27543256	8.671326718	12.39774908	0.118540186	0	3.60777562	3.581482415	1.277325419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8211
H5421_072_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1237.196578	17.11069525	745.8684027	93.26364988	497.6296146	27.45450724	1.645170442	337.3195669	663.42066	12.6389349	19.92207338	6.49825109	6.750638115	379.6981797	6066.089444	8282.030772	0.404422359	613.4823623	27.16054342	18110.22574	4.346717222	7.996360296	0	0	0	0	0.067663543	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.97150585	196.1356976	0.2	0.2	0.273915607	30	9.530006755	18.89946517	19.38382905	0.4	0	0.183213711	3.140094724	0.2	0	0	0	0	0	20	0	0	0											NO	201.498058	201.498058	115.7542035	0	128.6157817	0.171487709	0.171487709	50.56444214	168.1743071	0.171487709	0.171487709	0.234865799	25.72315634	8.171395121	16.20512991	16.62044217	0.342975418	0	0.157094497	2.69243825	0.171487709	0	0	0	0	0	20	0	0	0												20.7744	0.287314322	7.194783573	0	5.333585156	4.708110545	0.28212651	1.421364644	9.297525816	2.167421988	3.416390721	1.526216936	0.014470643	0.258555321	8.191813955	11.47091779	0.138706927	0	4.26677192	4.063388708	0.745408578	0	0	0	0	0	0.000112773	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5594	0		14.22545513	20.7744	0.287314322	7.194783573	0	5.333585156	4.708110545	0.28212651	1.421364644	9.297525816	2.167421988	3.416390721	1.526216936	0.014470643	0.258555321	8.191813955	11.47091779	0.138706927	0	4.26677192	4.063388708	0.745408578	0	0	0	0	0	0.000112773	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5594	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	20.7744	0.287314322	7.194783573	0	5.333585156	4.708110545	0.28212651	1.421364644	9.297525816	2.167421988	3.416390721	1.526216936	0.014470643	0.258555321	8.191813955	11.47091779	0.138706927	0	4.26677192	4.063388708	0.745408578	0	0	0	0	0	0.000112773	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5594
H5421_073_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1082.407637	22.94765261	458.2258544	87.09236925	329.5969332	28.03416516	3.155481201	333.6728163	647.619095	9.980295359	31.22237142	8.068244819	14.82393579	397.8654167	6408.128518	8110.217258	0.430937526	633.004557	19.6586013	17485.80745	5.462233237	12.08859729	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	61.35308055	198.6266	0.2	0.2	0.235470921	30	9.725732512	19.49892796	20.2397907	0.4	0	0.181445679	3.298971708	0.2	0	0	0	0	0	0	0	0	0											NO	203.7388943	203.7388943	117.0414925	0	130.0461028	0.173394804	0.173394804	53.19152679	172.2041016	0.173394804	0.173394804	0.204147171	26.00922055	8.431957399	16.90506393	17.54737267	0.346789607	0	0.15730869	2.860122758	0.173394804	0	0	0	0	0	0	0	0	0												18.3774	0.389610781	4.469286492	0	3.571899721	4.860978564	0.547144043	1.479047212	9.293555367	1.730531355	5.413796963	1.647109355	0.032129918	0.279565354	9.027485189	11.85941706	0.149444655	0	3.092468812	4.167629652	0.94712286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3356	0		12.47989901	18.3774	0.389610781	4.469286492	0	3.571899721	4.860978564	0.547144043	1.479047212	9.293555367	1.730531355	5.413796963	1.647109355	0.032129918	0.279565354	9.027485189	11.85941706	0.149444655	0	3.092468812	4.167629652	0.94712286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3356	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	18.3774	0.389610781	4.469286492	0	3.571899721	4.860978564	0.547144043	1.479047212	9.293555367	1.730531355	5.413796963	1.647109355	0.032129918	0.279565354	9.027485189	11.85941706	0.149444655	0	3.092468812	4.167629652	0.94712286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3356
H5421_074_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1372.77278	34.38886861	395.7933124	98.88056499	408.2741784	29.27378736	1.235124122	349.3008007	598.9055854	12.48517659	29.32293559	7.003080991	8.640928068	418.7567495	6135.542245	8989.406027	0.360783742	836.7337957	18.33351872	16438.05113	4.841304122	7.484400653	0	0	0	0	0.699079468	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.95523848	203.1170366	0.2	0.2	0.272688525	30	9.115041727	19.62619072	18.13883373	0.4	0	0.172801549	3.270355497	0.2	0	0	0	0	0	3.77524167	0	0	0											NO	208.7655979	208.7655979	119.9291732	0	133.2546369	0.177672849	0.177672849	53.26209024	180.4419131	0.177672849	0.177672849	0.242246736	26.65092739	8.097477174	17.43520613	16.11389136	0.355345698	0	0.153510718	2.905266896	0.177672849	0	0	0	0	0	3.77524167	0	0	0												23.8823	0.598267726	3.955597061	0	4.533702285	5.201157208	0.219448022	1.550374231	9.005639135	2.218276898	5.209889515	1.696473511	0.019190729	0.282572768	8.914536979	12.07119267	0.128202951	0	2.814391627	3.979743815	0.860168297	0	0	0	0	0	0.000219933	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1414	0		10.95053799	23.8823	0.598267726	3.955597061	0	4.533702285	5.201157208	0.219448022	1.550374231	9.005639135	2.218276898	5.209889515	1.696473511	0.019190729	0.282572768	8.914536979	12.07119267	0.128202951	0	2.814391627	3.979743815	0.860168297	0	0	0	0	0	0.000219933	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1414	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	23.8823	0.598267726	3.955597061	0	4.533702285	5.201157208	0.219448022	1.550374231	9.005639135	2.218276898	5.209889515	1.696473511	0.019190729	0.282572768	8.914536979	12.07119267	0.128202951	0	2.814391627	3.979743815	0.860168297	0	0	0	0	0	0.000219933	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1414
H5421_075_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1575.393451	25.94077432	670.9702386	106.7747263	549.0855363	37.13817618	2.213282541	372.0248897	712.0655008	14.75711174	29.78748677	15.59633937	15.06166323	549.8890546	6321.099703	10163.17331	0.721093405	777.6682843	29.60335349	17764.31978	5.28066828	17.49070277	0	0	0	0	0.053367764	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		234.7007588	235	135	0	150	0.2	0.2	62.10004451	195.808654	0.2	0.2	0.16498528	30	15.8126504	20.07187861	18.30752433	0.4	0	0.182648902	3.407156197	0.2	0	0	0	0	0	20	0	0	0											NO	210.7887817	211.0575354	121.2458182	0	134.7175758	0.179623434	0.179623434	55.77311636	175.8591146	0.179623434	0.179623434	0.148176113	26.94351516	14.20161286	18.02689885	16.44230198	0.359246869	0	0.164040115	3.060025488	0.179623434	0	0	0	0	0	20	0	0	0												27.6729	0.456249658	6.779361299	0	6.164289364	6.670886754	0.397557411	1.729082288	10.43526738	2.650723092	5.350530676	2.311004946	0.033817846	0.650775956	9.495818749	13.92549705	0.259050548	0	4.856137513	4.529939275	0.948531772	0	0	0	0	0	8.89E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3175	0		11.94726149	27.6729	0.456249658	6.779361299	0	6.164289364	6.670886754	0.397557411	1.729082288	10.43526738	2.650723092	5.350530676	2.311004946	0.033817846	0.650775956	9.495818749	13.92549705	0.259050548	0	4.856137513	4.529939275	0.948531772	0	0	0	0	0	8.89E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3175	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	27.6729	0.456249658	6.779361299	0	6.164289364	6.670886754	0.397557411	1.729082288	10.43526738	2.650723092	5.350530676	2.311004946	0.033817846	0.650775956	9.495818749	13.92549705	0.259050548	0	4.856137513	4.529939275	0.948531772	0	0	0	0	0	8.89E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3175
H5421_206_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1200.587927	28.76866783	879.482863	23.02152033	547.9485185	30.46296179	2.225640824	365.0006085	603.8268996	1315.236995	26.56813942	6.532346474	10.41963999	460.4975984	6569.951807	9329.131557	0.575901797	945.8121235	30.7550346	17666.8532	6.049187609	11.70058354	0	0	0	0	0.212960407	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.192027341	30	3.55757441	3.921960341	12.02021269	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	160.2074139	160.2074139	80.10370693	0.12015556	120.1555604	0.160207414	0.160207414	47.6362771	81.60403015	0	0.160207414	0.153821018	24.03111208	2.84974898	3.141635618	9.628635943	0.320414828	0	0.147359143	0.95643092	0.160207414	0	0	0	0	0	20	0	0	0												16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196	0		15.6528134	16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196
H5421_207_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1077.198593	25.81199411	789.0948103	19.64384941	491.633607	25.99349763	1.899099302	327.4880023	541.7691382	1180.064707	22.67011573	5.573919778	9.348770953	413.1703758	5894.730975	8372.498323	0.49140665	848.6071412	26.24271811	15851.1584	5.166358302	10.49806669	0	0	0	0	0.191073594	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.200944869	30	3.55757441	3.921960341	11.99257261	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	151.6846252	151.6846252	75.84231261	0.113763469	113.7634689	0.151684625	0.151684625	45.10210023	77.26282093	0	0.151684625	0.152401236	22.75269378	2.698146706	2.974505422	9.095444407	0.30336925	0	0.139519863	0.905550263	0.151684625	0	0	0	0	0	20	0	0	0												13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718	0		16.80904211	13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718
H5421_208_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1146.81917	27.48025282	840.0949105	21.1496893	523.4084494	27.98608293	2.044678686	348.6539266	576.7842973	1256.333639	24.40794032	6.001203435	9.952992714	439.8740498	6275.714181	8913.118126	0.529076442	903.4535915	28.25440792	16875.6369	5.561287384	11.17656875	0	0	0	0	0.203422899	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.198911152	30	3.55757441	3.921960341	11.99867118	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	155.4708539	155.4708539	77.73542695	0.11660314	116.6031404	0.155470854	0.155470854	46.22790231	79.19139285	0	0.155470854	0.154624433	23.32062809	2.765495657	3.048752616	9.327218273	0.310941708	0	0.143002445	0.928153875	0.155470854	0	0	0	0	0	20	0	0	0												14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675	0		16.54537021	14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675
H5421_209_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1220.54863	29.24696919	894.1049461	23.11356322	557.0585865	30.58475649	2.234539212	371.069026	613.865989	1337.103828	26.67436214	6.558459419	10.59287457	468.1537273	6679.182339	9484.856222	0.578204324	961.5369819	30.87799705	17960.5783	6.0747741	11.8951148	0	0	0	0	0.216501038	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.194205183	30	3.55757441	3.921960341	12.01324278	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	160.0074843	160.0074843	80.00374215	0.120005613	120.0056132	0.160007484	0.160007484	47.57682979	81.50219305	0	0.160007484	0.155371414	24.00112264	2.846192658	3.137715039	9.611043781	0.320014969	0	0.147175247	0.95523735	0.160007484	0	0	0	0	0	20	0	0	0												16.2747	0.38997783	5.960978464	2.773757328	5.57084644	4.893789944	0.357542998	1.471190657	4.169285361	0	4.268097582	1.018997114	0.02118674	0.111037975	1.746447573	7.596614034	0.185034038	0	4.544476856	1.429717935	0.972009321	0	0	0	0	0	0.000360835	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7561	0		15.9352051	16.2747	0.38997783	5.960978464	2.773757328	5.57084644	4.893789944	0.357542998	1.471190657	4.169285361	0	4.268097582	1.018997114	0.02118674	0.111037975	1.746447573	7.596614034	0.185034038	0	4.544476856	1.429717935	0.972009321	0	0	0	0	0	0.000360835	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7561	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	16.2747	0.38997783	5.960978464	2.773757328	5.57084644	4.893789944	0.357542998	1.471190657	4.169285361	0	4.268097582	1.018997114	0.02118674	0.111037975	1.746447573	7.596614034	0.185034038	0	4.544476856	1.429717935	0.972009321	0	0	0	0	0	0.000360835	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7561
H5421_210_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1300.772652	31.16930924	952.8725309	24.8872456	593.6728429	32.93176128	2.406012679	395.4585907	654.214073	1424.988771	28.72129214	7.06174441	11.28912131	498.9244595	7118.190552	10107.73203	0.622574411	1024.736729	33.24750445	19141.08828	6.539699329	12.67695497	0	0	0	0	0.230731184	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.192412357	30	3.55757441	3.921960341	12.01896975	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	163.1312737	163.1312737	81.56563686	0.122348455	122.3484553	0.163131274	0.163131274	48.50566132	83.09334167	0	0.163131274	0.156942364	24.46969106	2.901758225	3.19897193	9.803349221	0.326262547	0	0.150048516	0.97388623	0.163131274	0	0	0	0	0	20	0	0	0												17.6831	0.423724093	6.476804569	3.044916055	6.05291294	5.372200163	0.392495913	1.598498372	4.530069458	0	4.685340971	1.108286862	0.023020109	0.120646513	1.897574314	8.257468906	0.203122713	0	4.988738705	1.553436858	1.066829481	0	0	0	0	0	0.000384552	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4795	0		15.70273763	17.6831	0.423724093	6.476804569	3.044916055	6.05291294	5.372200163	0.392495913	1.598498372	4.530069458	0	4.685340971	1.108286862	0.023020109	0.120646513	1.897574314	8.257468906	0.203122713	0	4.988738705	1.553436858	1.066829481	0	0	0	0	0	0.000384552	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4795	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	17.6831	0.423724093	6.476804569	3.044916055	6.05291294	5.372200163	0.392495913	1.598498372	4.530069458	0	4.685340971	1.108286862	0.023020109	0.120646513	1.897574314	8.257468906	0.203122713	0	4.988738705	1.553436858	1.066829481	0	0	0	0	0	0.000384552	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4795
H5421_211_0	2012	2																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1307.64377	31.33395598	957.9059231	25.23401809	596.8088219	33.39062399	2.439537442	397.5475356	657.6698512	1432.51604	29.12148726	7.160144104	11.34875423	501.5599458	7155.791221	10160.66479	0.631249203	1030.149732	33.71076665	19242.19793	6.629764377	12.7439189	0	0	0	0	0.231949983	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.19093162	30	3.55757441	3.921960341	12.02377561	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	163.8637862	163.8637862	81.93189311	0.12289784	122.8978397	0.163863786	0.163863786	48.72346752	83.46645781	0	0.163863786	0.156433891	24.57956793	2.914788063	3.213336355	9.851306983	0.327727572	0	0.150722283	0.978259296	0.163863786	0	0	0	0	0	20	0	0	0												17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356	0		15.51073146	17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356
H5421_212_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1200.587927	28.76866783	879.482863	23.02152033	547.9485185	30.46296179	2.225640824	365.0006085	603.8268996	1315.236995	26.56813942	6.532346474	10.41963999	460.4975984	6569.951807	9329.131557	0.575901797	945.8121235	30.7550346	17666.8532	6.049187609	11.70058354	0	0	0	0	0.212960407	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.192027341	30	3.55757441	3.921960341	12.02021269	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	160.2074139	160.2074139	80.10370693	0.12015556	120.1555604	0.160207414	0.160207414	47.6362771	81.60403015	0	0.160207414	0.153821018	24.03111208	2.84974898	3.141635618	9.628635943	0.320414828	0	0.147359143	0.95643092	0.160207414	0	0	0	0	0	20	0	0	0												16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196	0		15.6528134	16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	16.0286	0.384079489	5.870819793	2.766163676	5.486588442	4.880392327	0.356564161	1.448939177	4.10622571	0	4.256412908	1.004812186	0.020866295	0.109358547	1.720032884	7.485567619	0.184527475	0	4.532035545	1.408093722	0.969124703	0	0	0	0	0	0.000354934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0196
H5421_213_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1077.198593	25.81199411	789.0948103	19.64384941	491.633607	25.99349763	1.899099302	327.4880023	541.7691382	1180.064707	22.67011573	5.573919778	9.348770953	413.1703758	5894.730975	8372.498323	0.49140665	848.6071412	26.24271811	15851.1584	5.166358302	10.49806669	0	0	0	0	0.191073594	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.200944869	30	3.55757441	3.921960341	11.99257261	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	151.6846252	151.6846252	75.84231261	0.113763469	113.7634689	0.151684625	0.151684625	45.10210023	77.26282093	0	0.151684625	0.152401236	22.75269378	2.698146706	2.974505422	9.095444407	0.30336925	0	0.139519863	0.905550263	0.151684625	0	0	0	0	0	20	0	0	0												13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718	0		16.80904211	13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	13.6162	0.326273554	4.987231273	2.234752452	4.660828713	3.942813946	0.288064166	1.230866392	3.488217659	0	3.438708008	0.849472264	0.01772581	0.092899524	1.461159104	6.345966087	0.149077667	0	3.661380429	1.196168388	0.783657123	0	0	0	0	0	0.000318456	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7718
H5421_214_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1146.81917	27.48025282	840.0949105	21.1496893	523.4084494	27.98608293	2.044678686	348.6539266	576.7842973	1256.333639	24.40794032	6.001203435	9.952992714	439.8740498	6275.714181	8913.118126	0.529076442	903.4535915	28.25440792	16875.6369	5.561287384	11.17656875	0	0	0	0	0.203422899	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.198911152	30	3.55757441	3.921960341	11.99867118	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	155.4708539	155.4708539	77.73542695	0.11660314	116.6031404	0.155470854	0.155470854	46.22790231	79.19139285	0	0.155470854	0.154624433	23.32062809	2.765495657	3.048752616	9.327218273	0.310941708	0	0.143002445	0.928153875	0.155470854	0	0	0	0	0	20	0	0	0												14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675	0		16.54537021	14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	14.8581	0.356031531	5.442094712	2.466120192	5.08592241	4.35102021	0.317887941	1.343128305	3.806362657	0	3.794723323	0.927932678	0.019342503	0.101372481	1.594425002	6.927883188	0.164511933	0	4.040449401	1.305265648	0.864618098	0	0	0	0	0	0.000339038	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7675
H5421_215_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1307.64377	31.33395598	957.9059231	25.23401809	596.8088219	33.39062399	2.439537442	397.5475356	657.6698512	1432.51604	29.12148726	7.160144104	11.34875423	501.5599458	7155.791221	10160.66479	0.631249203	1030.149732	33.71076665	19242.19793	6.629764377	12.7439189	0	0	0	0	0.231949983	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.19093162	30	3.55757441	3.921960341	12.02377561	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	163.8637862	163.8637862	81.93189311	0.12289784	122.8978397	0.163863786	0.163863786	48.72346752	83.46645781	0	0.163863786	0.156433891	24.57956793	2.914788063	3.213336355	9.851306983	0.327727572	0	0.150722283	0.978259296	0.163863786	0	0	0	0	0	20	0	0	0												17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356	0		15.51073146	17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356	YES																																									3250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	17.8563	0.427875055	6.540253809	3.10120631	6.112209576	5.471514071	0.399751842	1.61415787	4.574447741	0	4.771957163	1.1200892	0.023245623	0.121828412	1.916163673	8.341318999	0.206877769	0	5.080963701	1.568654916	1.086378293	0	0	0	0	0	0.000386583	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3356
H5422_002_0	2012	9	H.6										OP Facility - Other										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	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	YES	1374.92255	67.11433864	293.3743711	483.0594858	189.2768071	5.754802576	4.960920388	203.7601975	304.3455826	15931.84107	575.5301496	19.07997081	0.001751755	256.0025078	3125.202139	2367.351749	3.622329607	999.3415391	756.7119522	1747.114663	85.636889	27.55566823	0	0	0	0	0	0	5872.8	183.7150629	14.40964113	0	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: $146/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: $0 - $215 copay; 9B: $190 copay	8A: $0-$165 copay	8B: $50-$165 copay	5: $25 copay	12: 20% coin	3: $25 copay; 9A: $25-$215 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $50-$165 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	147.9223351	132.2679605	146	0	125	0.2	0.108496249	49.99500036	194.661917	12.22080429	94.07599845	25	0.2	62.41756861	10	24.94495362	40	50	77.79561689	0.454003375	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	132.1392501	118.1551731	130.4220251	0	111.6626928	0.178660308	0.096919866	44.66061091	173.8917906	10.91686332	84.03823448	22.33253855	0.178660308	55.75771029	8.93301542	22.28336553	35.73206168	44.6650771	69.49494453	0.405561915	0.178660308	0	0	0	0	0	0	0	0	0	0.178660308	0	0	0	0	0	0	0	0	0		15.1401	0.660825525	3.188539966	0	1.761263163	1.028154803	0.48081174	0.758337908	4.410266527	14.49381095	4.030544805	0.035508682	0.000312969	1.189509472	2.326456575	4.39604703	0.010786109	3.719638908	4.382304595	0.059046931	15.299913	0	0	0	0	0	0	0	0	0	2.574430929	0	0	0	0	0	0	0	0	0	79.9466		NO	9.549049204	15.1401	0.660825525	3.188539966	0	1.761263163	1.028154803	0.48081174	0.758337908	4.410266527	14.49381095	4.030544805	0.035508682	0.000312969	1.189509472	2.326456575	4.39604703	0.010786109	3.719638908	4.382304595	0.059046931	15.299913	0	0	0	0	0	0	0	0	0	2.574430929	0	0	0	0	0	0	0	0	0	79.9466	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	15.1401	0.660825525	3.188539966	0	1.761263163	1.028154803	0.48081174	0.758337908	4.410266527	14.49381095	4.030544805	0.035508682	0.000312969	1.189509472	2.326456575	4.39604703	0.010786109	3.719638908	4.382304595	0.059046931	15.299913	0	0	0	0	0	0	0	0	0	2.574430929	0	0	0	0	0	0	0	0	0	79.9466
H5422_006_0	2012	9	H.6										OP Facility - Other										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	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	YES	1344.124972	188.0506756	464.787242	517.5768376	220.3191353	7.550245284	4.428135045	241.7755683	278.5017153	12051.90513	530.2924362	0.074687849	0.008977319	473.8543133	2699.094869	2386.639125	3.94963277	1128.608368	647.9081799	1651.649759	29.67365821	24.87380991	0.005840372	0	0	0	0	0	5872.8	172.2334943	13.55139179	0	0	0	0	0	0	0	0	0	4500	1A: $265/day (days1-6) no yrly max	1B: $239/day (days1-6) no yrly max	2: $146/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: $0 - $265 copay; 9B: $240 copay	8A: $0-$170 copay	8B: $50-$170 copay	5: $35 copay	12: 20% coin	3: $35 copay; 9A: $35-$265 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $50-$170 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	187.2540015	99.63593437	146	0	150	0.2	0.11976591	49.9957513	246.2047082	14.14150109	92.63655431	35	0.2	77.54054137	25	34.82914629	40	50	73.80930284	0.741935636	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	172.7521739	91.91966059	134.6930757	0	138.3832969	0.184511063	0.110490677	46.12384598	227.1374615	13.04631696	85.46234533	32.28943595	0.184511063	71.5354384	23.06388282	32.13181395	36.90221251	46.12776564	68.09316446	0.684476663	0.184511063	0	0	0	0	0	0	0	0	0	0.184511063	0	0	0	0	0	0	0	0	0		19.35	1.440462856	5.216968596	0	2.54070736	1.39310378	0.489267637	0.92930159	5.271514388	13.10274786	3.776669609	0.000200969	0.001656415	2.824781336	5.187633981	6.390587027	0.012145849	4.338348526	3.676509854	0.094209643	5.475118205	0	0	0	0	0	0	0	0	0	2.500381699	0	0	0	0	0	0	0	0	0	84.0124		NO	7.052488711	19.35	1.440462856	5.216968596	0	2.54070736	1.39310378	0.489267637	0.92930159	5.271514388	13.10274786	3.776669609	0.000200969	0.001656415	2.824781336	5.187633981	6.390587027	0.012145849	4.338348526	3.676509854	0.094209643	5.475118205	0	0	0	0	0	0	0	0	0	2.500381699	0	0	0	0	0	0	0	0	0	84.0124	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	19.35	1.440462856	5.216968596	0	2.54070736	1.39310378	0.489267637	0.92930159	5.271514388	13.10274786	3.776669609	0.000200969	0.001656415	2.824781336	5.187633981	6.390587027	0.012145849	4.338348526	3.676509854	0.094209643	5.475118205	0	0	0	0	0	0	0	0	0	2.500381699	0	0	0	0	0	0	0	0	0	84.0124
H5422_803_0	2012	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	279.082238	3.244769712	56.6777358	0	12.56587878	17.17257279	10.69852854	19.57989467	66.20198506	4.610892158	28.01075715	0	0.234838529	19.48454372	42.12582317	82.81392122	1.804285285	6.939251747	36.5871727	117.00775	48.38415081	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.081290867	0.081290867	0.177462713	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.064591854	0.064591854	0.141007792	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0	0	0	0	0	0	0	0												18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	0	NO	30.44257213	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	NO																																										0	0	0	0	0	0	0	0	0	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	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752
H5422_804_0	2012	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	279.082238	3.244769712	56.6777358	0	12.56587878	17.17257279	10.69852854	19.57989467	66.20198506	4.610892158	28.01075715	0	0.234838529	19.48454372	42.12582317	82.81392122	1.804285285	6.939251747	36.5871727	117.00775	48.38415081	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.081290867	0.081290867	0.177462713	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.064591854	0.064591854	0.141007792	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0	0	0	0	0	0	0	0												18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	0	NO	30.44257213	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	NO																																										0	0	0	0	0	0	0	0	0	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	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752
H5422_805_0	2012	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	279.082238	3.244769712	56.6777358	0	12.56587878	17.17257279	10.69852854	19.57989467	66.20198506	4.610892158	28.01075715	0	0.234838529	19.48454372	42.12582317	82.81392122	1.804285285	6.939251747	36.5871727	117.00775	48.38415081	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.081290867	0.081290867	0.177462713	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.064591854	0.064591854	0.141007792	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0.177985251	0	0	0	0	0	0	0	0	0												18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	0	NO	30.44257213	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752	NO																																										0	0	0	0	0	0	0	0	0	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	18.0264	0.209585692	7.992002407	0	2.236541091	3.056464681	1.904180289	3.484932469	11.78297693	0.820670799	4.985501646	0	0.041797795	3.467961406	7.497775215	14.73965656	0.32113617	1.235084465	6.51197712	20.82565377	8.611665231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.752
H5424_001_0	2012	3																															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	1166.729088	82.13016139	556.3944059	26.76583037	97.26987856	4.576461034	6.832474858	370.9922252	45.37825636	20.84009796	25.59661079	0	0.064838101	29.29474404	6264.983232	2761.505869	429.711572	673.5343157	0	0	12.76304613	1117.738853	0	0	61.9116543	106.2944613	5.004909545	0	79.18614814	0											3750	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $14 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	63.27613752	0	200	0.2	0.09306968	64.96589596	0.16	0.179118834	0.180907178	0	0.2	0.146520413	6.897705721	29.75815756	38.5	30	0	0	0.2	29.77821237	0	0	30	0	30	0	0	0											NO	148.5434868	84.15480736	50.27847702	0	158.9176552	0.158917655	0.073952076	51.64063458	0.127134124	0.142325726	0.143746722	0	0.158917655	0.116423402	6.662928062	28.75055747	37.18957299	28.97888805	0	0	0.158917655	23.66141843	0	0	30	0	30	0	0	0												14.4425	0.575970659	2.331221946	0	1.288158419	0.727280457	0.505275702	1.596522828	5.769124879	2.966082066	3.679428903	0	0.010303919	3.410593767	3.478594382	6.616236101	1.331732489	1.626522961	0	0	2.028273364	2.203940559	0	0	0.154779136	0	0.012512274	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7551	0	NO	11.19519862	14.4425	0.575970659	2.331221946	0	1.288158419	0.727280457	0.505275702	1.596522828	5.769124879	2.966082066	3.679428903	0	0.010303919	3.410593767	3.478594382	6.616236101	1.331732489	1.626522961	0	0	2.028273364	2.203940559	0	0	0.154779136	0	0.012512274	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7551	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $14 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											8500	0	0	0.2076	0.0118	0.0607	0.0857	0.0767	0.0752	0.4078	0.1398	0.2519	0	0.0005	0.2408	1.2971	1.4239	0.215	0.3485	0	0	0.4346	0.4707	0	0	0.0332	0	0.0023	0	0	0											5.7838	0	NO	0.752254105	14.4425	0.575970659	2.538839237	0.011808151	1.348856983	0.812954856	0.582020791	1.671751652	6.17689025	3.105845095	3.931366991	0	0.010789444	3.651385342	4.77565491	8.040138001	1.546687455	1.975063595	0	0	2.46290337	2.67467949	0	0	0.187946093	0	0.014838273	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5389
H5424_003_0	2012	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	1128.080728	134.8518996	450.2758881	38.24017278	116.6203357	4.359105855	6.644320487	414.2532932	50.04757907	21.44073802	30.49406851	0	0.052447358	34.96546824	6570.47642	3385.473562	422.8322833	899.698499	0	0	12.56345978	1279.209969	0	0	53.77842808	141.6419083	13.50910857	10.659	127.5437625	355.9648738											3750	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$10 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	63.58618154	0	200	0.2	0.100345551	64.98053963	0.16	0.13243029	0.179569519	0	0.2	0.146435323	6.714433876	27.30236054	38.5	30	0	0	0.2	29.76815703	0	0	30	0	30	0	0	10											NO	148.8339829	84.31938306	50.62364227	0	159.2284394	0.159228439	0.079889328	51.75096711	0.127382752	0.105433342	0.142962871	0	0.159228439	0.11658334	6.487541202	26.42204598	37.19901646	28.98624659	0	0	0.159228439	23.69968594	0	0	30	0	30	0	0	10												13.9914	0.947552415	1.899550457	0	1.547439505	0.694093622	0.530810296	1.786500712	6.375198328	2.260568666	4.359519583	0	0.008351111	4.076391076	3.552186375	7.454261508	1.310745422	2.173240213	0	0	2.000460094	2.526406209	0	0	0.13444607	0	0.033772771	0	0	0.296637395	0	0	0	0	0	0	0	0	0	0	57.9595	0	NO	11.50522772	13.9914	0.947552415	1.899550457	0	1.547439505	0.694093622	0.530810296	1.786500712	6.375198328	2.260568666	4.359519583	0	0.008351111	4.076391076	3.552186375	7.454261508	1.310745422	2.173240213	0	0	2.000460094	2.526406209	0	0	0.13444607	0	0.033772771	0	0	0.296637395	0	0	0	0	0	0	0	0	0	0	57.9595	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"50% (7b); $50 (7b1); $45 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$50 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											8500	0	0	0.1679	0.0185	0.0729	0.0818	0.0748	0.0842	0.4506	0.1065	0.2994	0	0.0004	0.2879	1.3574	1.6863	0.2116	0.4657	0	0	0.4287	0.5392	0	0	0.0288	0	0.0072	0	0	0.1458											6.5154	0	NO	0.792234732	13.9914	0.947552415	2.067401852	0.018488965	1.620355502	0.775858578	0.605587912	1.870681374	6.825801351	2.367087609	4.658900232	0	0.008744619	4.364241753	4.909581175	9.140568262	1.522312865	2.638934544	0	0	2.429130114	3.065606857	0	0	0.163255942	0	0.041009794	0	0	0.442391268	0	0	0	0	0	0	0	0	0	0	64.4749
H5424_005_0	2012	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	264.1534476	22.259543	33.11568427	81.67464915	10.24107697	9.4300345	18.19617471	30.54061618	61.85829238	25.2552373	45.31310424	0	0	40.5716515	41.95888989	64.51445417	10.0444955	8.681124499	0	1.547675603	7.619289728	9.765756353	0	208.5449622	0	0	0	0	181.2867436	4044.965066											6400	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.069955177	0.070804835	0.147168803	0	0.224	0.224	0.224	0.160741616	0.224	0.224	0.224	0	0	0.224	0.223713361	0.223683033	0.234498379	0.224	0	0	0.224	0.221999119	0	0	0	0	0	0	0	0											NO	0.05751918	0.058217793	0.121006468	0	0.184179311	0.184179311	0.184179311	0.132189598	0.184179311	0.184179311	0.184179311	0	0	0.184179311	0.1829249	0.182900101	0.191743544	0.183159277	0	0	0.184179311	0.184016205	0	0	0	0	0	0	0	0												15.1939	1.295901474	4.007211978	0	1.886194496	1.736817253	3.351358914	4.037151785	11.39301765	4.651492195	8.345736302	0	0	7.472458804	7.675325734	11.7997002	1.92596716	1.590028491	0	0	1.40331553	1.797057425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5626	150	YES	19.50124414	15.1939	1.295901474	4.007211978	0	1.886194496	1.736817253	3.351358914	4.037151785	11.39301765	4.651492195	8.345736302	0	0	7.472458804	7.675325734	11.7997002	1.92596716	1.590028491	0	0	1.40331553	1.797057425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5626	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.3235	0.0276	2.44	0.0043	0.0142	0.013	0.0248	0.0203	0.0702	0	0.0522	0	0	0.0425	1.2359	2.0704	0.3223	0.2786	0	0	0.2458	0.3147	0	0.0573	0	0	0	0	0	0											7.5576	150	YES	1.643841566	15.5174	1.323493097	6.447184433	0.00429794	1.900348503	1.749850333	3.376184257	4.05743898	11.46317569	4.651492195	8.397948279	0	0	7.514975945	8.911229772	13.87011673	2.248273845	1.868587475	0	0	1.649164048	2.111805214	0	0.057302481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1203
H5425_001_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	429.7881992	6.378845665	851.8813621	0	210.3044972	16.04171291	0.914232636	239.457043	490.1303256	3.975802276	10.25598152	9.731964648	0	329.8742205	10360.64968	1355.876787	192.1845044	869.9313962	4.139708399	1716.752376	63.67957583	0	0	0	0	259.898625	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% - 20% coinsurance for specialized diagnostics	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$200/day	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													200	125	50	0	100	0.06	0.05570521	48.35628395	116.5	0.02	0.098	200	0	10	10	10	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	0											NO	196	122.5	49	0	98	0.0588	0.054591105	47.38915827	114.17	0.0196	0.09604	196	0	9.8	9.8	9.8	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	0												7.0199	0.065117383	3.478515562	0	1.717486727	0.943252719	0.04990897	0.945638976	4.663181606	0.077925725	0.984984465	0.158955423	0	0.26939728	8.461197241	1.107299376	0.392376696	0.710443974	0.405691423	1.40201444	12.48119686	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8759			0.939218705	7.0199	0.065117383	3.478515562	0	1.717486727	0.943252719	0.04990897	0.945638976	4.663181606	0.077925725	0.984984465	0.158955423	0	0.26939728	8.461197241	1.107299376	0.392376696	0.710443974	0.405691423	1.40201444	12.48119686	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8759	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.0199	0.065117383	3.478515562	0	1.717486727	0.943252719	0.04990897	0.945638976	4.663181606	0.077925725	0.984984465	0.158955423	0	0.26939728	8.461197241	1.107299376	0.392376696	0.710443974	0.405691423	1.40201444	12.48119686	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8759
H5425_003_0	2012	12																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	376.3788	5.565466986	746.779411	0	186.5702126	13.25765537	0.755566521	210.0365768	430.2507051	3.290614276	8.488470211	8.5086464	0	288.4086821	10080.71072	1282.150239	179.512115	846.4263361	4.021156327	1640.748042	60.18806069	0	0	0	0	259.898625	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% - 20% coinsurance for specialized diagnostics	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$100/day	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													100	100	50	0	100	0.06	0.055684211	48.35628395	116.5	0.02	0.088	100	0	10	5	10	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	0											NO	98	98	49	0	98	0.0588	0.054570526	47.38915827	114.17	0.0196	0.08624	98	0	9.8	4.9	9.8	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	0												3.0738	0.045451314	3.049349261	0	1.523656736	0.779550136	0.041231663	0.829454715	4.093476917	0.06449604	0.732045671	0.069487279	0	0.235533757	4.116290211	1.047089362	0.366503902	0.691248174	0.39407332	1.339944234	11.79685989	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.831			0.709889298	3.0738	0.045451314	3.049349261	0	1.523656736	0.779550136	0.041231663	0.829454715	4.093476917	0.06449604	0.732045671	0.069487279	0	0.235533757	4.116290211	1.047089362	0.366503902	0.691248174	0.39407332	1.339944234	11.79685989	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.831	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				3.0738	0.045451314	3.049349261	0	1.523656736	0.779550136	0.041231663	0.829454715	4.093476917	0.06449604	0.732045671	0.069487279	0	0.235533757	4.116290211	1.047089362	0.366503902	0.691248174	0.39407332	1.339944234	11.79685989	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.831
H5425_004_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	401.9267591	5.942252858	804.4087517	0	181.5435325	11.8917952	0.715376217	206.9994163	381.0644836	3.913975604	9.594694012	7.623958123	0	324.560265	12126.46553	1583.189642	220.0472368	996.0532488	3.9084399	1925.085592	86.1318046	0	0	0	0	259.898625	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% Coinsurance	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$100/day	$0 Copay	$25/visit cardiac rehab	$10/visit	$25/visit	$25/visit	$25/visit PT/OT/ST	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	"$10/visit for hearing/vision/dental, $20/visit for chiropractic, $25/visit for podiatry"	20% coinsurance	$0 Copay	$0 Copay (up to 12 one-way trips)	Not Covered	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													100	0	50	0	100	0.2	0.2	48.38430899	66.5	0	0.088	100	0	25	10	25	25	25	0.1	14.1892852	0.2	0	0	0	0	25	0	0	0	0											NO	95	0	47.5	0	95	0.19	0.19	45.96509354	63.175	0	0.0836	95	0	23.75	9.5	23.75	23.75	23.75	0.095	13.47982094	0.19	0	0	0	0	25	0	0	0	0												3.1819	0	3.184117976	0	1.437219632	2.259441087	0.135921481	0.792895628	2.006145729	0	0.802116419	0.060356335	0	0.642358858	9.600118546	3.133396167	0.435510156	1.971355388	0.37130179	2.162484088	16.36504287	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0832			2.485303727	3.1819	0	3.184117976	0	1.437219632	2.259441087	0.135921481	0.792895628	2.006145729	0	0.802116419	0.060356335	0	0.642358858	9.600118546	3.133396167	0.435510156	1.971355388	0.37130179	2.162484088	16.36504287	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0832	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				3.1819	0	3.184117976	0	1.437219632	2.259441087	0.135921481	0.792895628	2.006145729	0	0.802116419	0.060356335	0	0.642358858	9.600118546	3.133396167	0.435510156	1.971355388	0.37130179	2.162484088	16.36504287	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0832
H5425_005_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	518.7374182	7.680873901	779.6059234	0	175.3901363	11.8427379	0.712425071	200.6165837	369.5040289	3.894942151	9.54803553	7.394071973	0	314.7737593	10757.11889	1404.412453	195.1990282	883.5767677	3.253894414	1707.700775	71.59265181	0	0	0	0	259.898625	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% Coinsurance	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$150/day	$0 Copay	$25/visit cardiac rehab	$10/visit	$35/visit	$25/visit	$25/visit PT/OT/ST	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	"$10/visit for hearing/vision/dental, $20/visit for chiropractic, $25/visit for podiatry"	20% coinsurance	$0 Copay	$0 Copay (up to 12 one-way trips)	Not Covered	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													150	0	50	0	100	0.2	0.2	48.38430899	66.5	0	0.088	150	0	25	10	35	25	25	0.1	14.1892852	0.2	0	0	0	0	25	0	0	0	0											NO	147	0	49	0	98	0.196	0.196	47.41662281	65.17	0	0.08624	147	0	24.5	9.8	34.3	24.5	24.5	0.098	13.90549949	0.196	0	0	0	0	25	0	0	0	0												6.3545	0	3.183390854	0	1.43235278	2.321176628	0.139635314	0.792713407	2.006714797	0	0.823422584	0.090577382	0	0.642663092	8.784980427	4.014278929	0.398531349	1.803969234	0.318881653	1.978869354	14.03215976	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6603			0.999940222	6.3545	0	3.183390854	0	1.43235278	2.321176628	0.139635314	0.792713407	2.006714797	0	0.823422584	0.090577382	0	0.642663092	8.784980427	4.014278929	0.398531349	1.803969234	0.318881653	1.978869354	14.03215976	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6603	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				6.3545	0	3.183390854	0	1.43235278	2.321176628	0.139635314	0.792713407	2.006714797	0	0.823422584	0.090577382	0	0.642663092	8.784980427	4.014278929	0.398531349	1.803969234	0.318881653	1.978869354	14.03215976	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6603
H5425_006_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	624.8185368	9.384994468	674.0371085	0	236.7389237	17.51796759	0.998365809	215.2291456	470.6707877	6.494570555	11.88701366	9.362392856	0	380.1649404	0	0	236.1383076	1202.501441	3.801837812	2217.008166	80.02981357	0	0	0	0	259.898625	0	0	0	276											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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0 Copay	$0 Copay	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$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	47.95934453	66.5	0.02	0.045	0	0	10	0	0	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	0	147	49	0	98	0.0588	0.054588481	47.00015764	65.17	0.0196	0.0441	0	0	9.8	0	0	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	10												0	0.114966182	2.752318193	0	1.933367877	1.030056494	0.054499273	0.842983648	2.556134603	0.127293583	0.524217302	0	0	0.310468035	0	0	0.482115711	0.982042844	0.372580106	1.810556669	15.68584346	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	30.3509			0.608316484	0	0.114966182	2.752318193	0	1.933367877	1.030056494	0.054499273	0.842983648	2.556134603	0.127293583	0.524217302	0	0	0.310468035	0	0	0.482115711	0.982042844	0.372580106	1.810556669	15.68584346	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	30.3509	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.114966182	2.752318193	0	1.933367877	1.030056494	0.054499273	0.842983648	2.556134603	0.127293583	0.524217302	0	0	0.310468035	0	0	0.482115711	0.982042844	0.372580106	1.810556669	15.68584346	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	30.3509
H5425_007_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	418.7305464	8.242054212	615.3521496	0	204.4721695	15.25315595	0.869292017	220.1474703	462.1870172	4.584288635	10.38635056	9.197792738	0	433.242433	10917.24606	1414.172398	226.6135877	1068.516789	3.30330843	1904.431143	70.12832363	0	0	0	0	259.898625	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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													50	50	50	0	50	0.06	0.055702532	48.17525337	66.5	0.02	0.045	50	0	10	5	10	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	0											NO	49	49	49	0	49	0.0588	0.054588481	47.2117483	65.17	0.0196	0.0441	49	0	9.8	4.9	9.8	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	0												1.7098	0.033655055	2.512687944	0	0.834928025	0.89688557	0.047453331	0.866128913	2.510060659	0.089852057	0.45803806	0.037557654	0	0.353814654	4.457875475	1.154907458	0.462669408	0.872622044	0.323724226	1.555285434	13.74515143	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4646			0.702727515	1.7098	0.033655055	2.512687944	0	0.834928025	0.89688557	0.047453331	0.866128913	2.510060659	0.089852057	0.45803806	0.037557654	0	0.353814654	4.457875475	1.154907458	0.462669408	0.872622044	0.323724226	1.555285434	13.74515143	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4646	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				1.7098	0.033655055	2.512687944	0	0.834928025	0.89688557	0.047453331	0.866128913	2.510060659	0.089852057	0.45803806	0.037557654	0	0.353814654	4.457875475	1.154907458	0.462669408	0.872622044	0.323724226	1.555285434	13.74515143	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4646
H5425_008_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	600.769207	8.983950477	798.6576766	0	233.5881715	16.83556386	0.959474964	220.0708938	415.1634341	6.077527348	9.369105572	8.278048643	0	312.174383	10015.80287	1324.986685	204.2372028	924.4884523	3.812394909	1732.669104	65.25519352	0	0	0	0	259.898625	0	0	0	0											5000	$150/day (1-10); $0/day (11-90)	$143/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$200/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $50/ASC visits	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$150/day	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													150	143	50	0	200	0.06	0.055692475	48.46986048	66.5	0.02	0.075	150	0	10	10	10	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	49	0	196	0.0588	0.054578626	47.50046327	65.17	0.0196	0.0735	147	0	9.8	9.8	9.8	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	0												7.3594	0.104917568	3.261185513	0	3.815273468	0.989931155	0.052366825	0.871122451	2.254683417	0.119119536	0.68862926	0.101406096	0	0.254942413	8.179572341	1.082072459	0.416984289	0.754998903	0.373614701	1.415013102	12.79001793	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4267			0.901683283	7.3594	0.104917568	3.261185513	0	3.815273468	0.989931155	0.052366825	0.871122451	2.254683417	0.119119536	0.68862926	0.101406096	0	0.254942413	8.179572341	1.082072459	0.416984289	0.754998903	0.373614701	1.415013102	12.79001793	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4267	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.3594	0.104917568	3.261185513	0	3.815273468	0.989931155	0.052366825	0.871122451	2.254683417	0.119119536	0.68862926	0.101406096	0	0.254942413	8.179572341	1.082072459	0.416984289	0.754998903	0.373614701	1.415013102	12.79001793	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4267
H5425_009_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	641.0961749	9.587003161	852.4973941	0	250.5589503	17.834661	1.01641447	234.9189909	443.0804664	6.439842207	9.927649528	8.833607265	0	333.1251139	10774.18422	1425.312661	219.7017331	994.4893115	4.105095052	1863.864173	70.2773	0	0	0	0	259.898625	0	0	0	0											5000	$150/day (1-10); $0/day (11-90)	$143/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$200/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $50/ASC visits	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$150/day	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	Not Covered													150	143	50	0	200	0.06	0.055692475	48.46986048	66.5	0.02	0.075	150	0	10	10	10	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	49	0	196	0.0588	0.054578626	47.50046327	65.17	0.0196	0.0735	147	0	9.8	9.8	9.8	24.5	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	0												7.8534	0.111960219	3.481031026	0	4.092462855	1.048678067	0.055474505	0.929896741	2.406296166	0.126220907	0.72968224	0.108211689	0	0.272052176	8.798917115	1.164005339	0.448557705	0.812166271	0.402299315	1.522155741	13.7743508	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6793			0.966572473	7.8534	0.111960219	3.481031026	0	4.092462855	1.048678067	0.055474505	0.929896741	2.406296166	0.126220907	0.72968224	0.108211689	0	0.272052176	8.798917115	1.164005339	0.448557705	0.812166271	0.402299315	1.522155741	13.7743508	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6793	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.8534	0.111960219	3.481031026	0	4.092462855	1.048678067	0.055474505	0.929896741	2.406296166	0.126220907	0.72968224	0.108211689	0	0.272052176	8.798917115	1.164005339	0.448557705	0.812166271	0.402299315	1.522155741	13.7743508	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6793
H5425_010_0	2012	7																															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	263.4170918	1.566183928	66.12243814	0	9.755186664	19.37274667	1.165408754	11.72295931	60.11374007	7.434140349	30.70336991	0	0	20.57759539	152.8557621	270.4107347	5.047048176	19.92081504	75.05892209	75.78176442	120.8126839	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.059843193	0.059843193	0.158469945	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.059244761	0.059244761	0.156885246	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												15.6061	0.092788193	10.37363497	0	2.163310195	4.296100302	0.258441045	2.599683456	13.330823	1.648594964	6.808779312	0	0	4.563287554	33.8972938	59.96628453	1.119233404	4.417639943	16.64506656	16.80536408	26.79142078	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	221.7092			2.191653661	15.6061	0.092788193	10.37363497	0	2.163310195	4.296100302	0.258441045	2.599683456	13.330823	1.648594964	6.808779312	0	0	4.563287554	33.8972938	59.96628453	1.119233404	4.417639943	16.64506656	16.80536408	26.79142078	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	221.7092	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				15.6061	0.092788193	10.37363497	0	2.163310195	4.296100302	0.258441045	2.599683456	13.330823	1.648594964	6.808779312	0	0	4.563287554	33.8972938	59.96628453	1.119233404	4.417639943	16.64506656	16.80536408	26.79142078	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	221.7092
H5425_011_0	2012	7																															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	249.182634	1.481304042	56.04845029	0	9.376617959	18.62095013	1.120182835	12.39782183	53.20989307	6.940848927	24.14441955	0	0	13.55996552	112.8955276	219.4371238	3.976313084	15.69459904	76.06369936	62.69802379	92.66509883	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.067342774	0.067342774	0.138410396	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.066669346	0.066669346	0.137026292	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												16.6128	0.098757572	7.680111311	0	2.079358799	4.1293819	0.248411745	2.749340969	11.79982589	1.539202658	5.354266479	0	0	3.007057954	25.03571221	48.66237658	0.881787189	3.480434284	16.86788597	13.90391376	20.54941232	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	185.0054			1.829343973	16.6128	0.098757572	7.680111311	0	2.079358799	4.1293819	0.248411745	2.749340969	11.79982589	1.539202658	5.354266479	0	0	3.007057954	25.03571221	48.66237658	0.881787189	3.480434284	16.86788597	13.90391376	20.54941232	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	185.0054	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				16.6128	0.098757572	7.680111311	0	2.079358799	4.1293819	0.248411745	2.749340969	11.79982589	1.539202658	5.354266479	0	0	3.007057954	25.03571221	48.66237658	0.881787189	3.480434284	16.86788597	13.90391376	20.54941232	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	185.0054
H5425_012_0	2012	7																															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	293.3898185	1.744100369	65.99193689	0	11.04011221	21.92446998	1.318913093	14.59730415	62.64979473	8.172216395	28.42785131	0	0	15.96562232	127.2837167	247.4037129	4.483082002	17.6948276	85.75778478	70.68869481	104.4749817	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.067342774	0.067342774	0.138410396	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.066669346	0.066669346	0.137026292	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												19.5601	0.116278032	9.042630409	0	2.448255285	4.861970462	0.292482168	3.237098168	13.89321848	1.812270708	6.304160308	0	0	3.540536406	28.22643702	54.86424737	0.994168265	3.924004969	19.01764635	15.67592496	23.16837195	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	211.3051			2.079142019	19.5601	0.116278032	9.042630409	0	2.448255285	4.861970462	0.292482168	3.237098168	13.89321848	1.812270708	6.304160308	0	0	3.540536406	28.22643702	54.86424737	0.994168265	3.924004969	19.01764635	15.67592496	23.16837195	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	211.3051	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				19.5601	0.116278032	9.042630409	0	2.448255285	4.861970462	0.292482168	3.237098168	13.89321848	1.812270708	6.304160308	0	0	3.540536406	28.22643702	54.86424737	0.994168265	3.924004969	19.01764635	15.67592496	23.16837195	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	211.3051
H5425_014_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	544.8188001	8.204499382	802.7533886	0	207.4861872	13.82668552	0.831773657	202.1421769	381.2742382	5.22310257	8.051925823	7.653280221	0	288.6136738	0	0	177.575056	918.1881818	3.411870424	1631.611806	54.08545582	0	0	0	0	259.898625	0	0	0	276											5000	$50/day (1-10); $0/day (11-90)	$143/day (1-10); $0/day (11-90)	$0/day (1-7); $50/day (8-100)	$0 Copay	$200/run	20% coinsurance	20% coinsurance	$65 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$200/OP hospital and $200/ASC visits	0% - 20% coinsurance for specialized diagnostics	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST	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	$0 Copay	$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	143	50	0	200	0.2	0.2	61.94	66.5	0.02	0.2	50	0	10	0	0	35	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	49	140.14	49	0	196	0.198	0.198	60.7012	65.17	0.0196	0.198	49	0	9.8	0	0	34.3	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	10												2.2247	0.095814879	3.27790967	0	3.388941058	2.737683733	0.164691184	1.022522726	2.070636842	0.10237281	1.594281313	0.031250894	0	0.235701167	0	0	0.507568702	0.749853682	0.334363302	1.332482975	10.60074934	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	31.243			0.609930693	2.2247	0.095814879	3.27790967	0	3.388941058	2.737683733	0.164691184	1.022522726	2.070636842	0.10237281	1.594281313	0.031250894	0	0.235701167	0	0	0.507568702	0.749853682	0.334363302	1.332482975	10.60074934	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	31.243	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				2.2247	0.095814879	3.27790967	0	3.388941058	2.737683733	0.164691184	1.022522726	2.070636842	0.10237281	1.594281313	0.031250894	0	0.235701167	0	0	0.507568702	0.749853682	0.334363302	1.332482975	10.60074934	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	31.243
H5425_015_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	551.1792138	8.119047675	734.5189652	0	201.8333321	13.83863686	0.832492615	202.4069389	381.7689015	5.226771514	8.057581861	7.66180036	0	288.9349777	0	0	179.3303725	927.2644052	3.474360172	1647.740171	55.01098476	0	0	0	0	259.898625	0	0	0	276											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% - 20% coinsurance for specialized diagnostics	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST	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	$0 Copay	$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	48.46986048	66.5	0.02	0.2	0	0	10	0	0	35	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	0	49	49	0	98	0.196	0.196	47.50046327	65.17	0.0196	0.196	0	0	9.8	0	0	34.3	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	10												0	0.033152778	2.999285775	0	1.648305546	2.712372825	0.163168553	0.801201947	2.073323276	0.102444722	1.579286045	0	0	0.235963565	0	0	0.512585981	0.757265931	0.340487297	1.345654473	10.78215301	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	26.8581			0.548596394	0	0.033152778	2.999285775	0	1.648305546	2.712372825	0.163168553	0.801201947	2.073323276	0.102444722	1.579286045	0	0	0.235963565	0	0	0.512585981	0.757265931	0.340487297	1.345654473	10.78215301	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	26.8581	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.033152778	2.999285775	0	1.648305546	2.712372825	0.163168553	0.801201947	2.073323276	0.102444722	1.579286045	0	0	0.235963565	0	0	0.512585981	0.757265931	0.340487297	1.345654473	10.78215301	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	26.8581
H5425_016_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	577.0277531	8.499805001	768.9754697	0	211.3086377	14.48517461	0.871386468	211.9021805	399.6762697	5.47103266	8.434134418	8.021213198	0	302.4888339	0	0	187.44117	969.2029439	3.625053705	1722.264561	57.3924613	0	0	0	0	259.898625	0	0	0	276											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% - 20% coinsurance for specialized diagnostics	20% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST	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	$0 Copay	$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	48.46986048	66.5	0.02	0.2	0	0	10	0	0	35	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	0	49	49	0	98	0.196	0.196	47.50046327	65.17	0.0196	0.196	0	0	9.8	0	0	34.3	9.8	0.098	9.8	0.196	0	0	0	0	25	0	0	0	10												0	0.034707537	3.139983168	0	1.725687208	2.839094223	0.170791748	0.838787645	2.170575208	0.10723224	1.653090346	0	0	0.247032548	0	0	0.535769344	0.791515738	0.355255263	1.406516058	11.24892241	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	28.0364			0.573860201	0	0.034707537	3.139983168	0	1.725687208	2.839094223	0.170791748	0.838787645	2.170575208	0.10723224	1.653090346	0	0	0.247032548	0	0	0.535769344	0.791515738	0.355255263	1.406516058	11.24892241	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	28.0364	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.034707537	3.139983168	0	1.725687208	2.839094223	0.170791748	0.838787645	2.170575208	0.10723224	1.653090346	0	0	0.247032548	0	0	0.535769344	0.791515738	0.355255263	1.406516058	11.24892241	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	28.0364
H5425_018_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	606.8383817	10.0452155	667.3500371	0	197.2259368	17.85612769	1.071197766	254.8855249	385.7182529	13.20121275	14.78624203	7.69556331	0	407.9706366	9957.544773	1285.911117	162.4058332	735.1369647	3.176392742	1541.122871	68.64278902	0	0	0	0	259.898625	0	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$143/Days 1-10 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	$150 per day.	No cost-sharing	$15/Case for Cardio/PT/OT/ST	$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 Part B Rx	No cost-sharing	No cost-sharing	Not Covered	$0 Copay	$25/Service for Vision Hardware	$0/visit for routine hearing	Not covered	N/A	No cost-sharing													150	143	75	0	100	0.1	0.1	48.61906984	162.5	0.02	0.2	150	0	15	10	15	25	15	0.2	12.01990318	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	73.5	0	98	0.098	0.098	47.64668844	159.25	0.0196	0.196	147	0	14.7	9.8	14.7	24.5	14.7	0.196	11.77950512	0.196	0	0	0	0	25	0	0	0	0												7.4338	0.117311375	4.087518977	0	1.610678484	1.749900514	0.104977381	1.0120376	5.118802648	0.25874377	2.898103438	0.094270651	0	0.49976403	8.131994898	1.575241118	0.331578576	0.900542782	0.622572977	1.512805396	13.45398665	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0561			1.018233422	7.4338	0.117311375	4.087518977	0	1.610678484	1.749900514	0.104977381	1.0120376	5.118802648	0.25874377	2.898103438	0.094270651	0	0.49976403	8.131994898	1.575241118	0.331578576	0.900542782	0.622572977	1.512805396	13.45398665	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0561	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.4338	0.117311375	4.087518977	0	1.610678484	1.749900514	0.104977381	1.0120376	5.118802648	0.25874377	2.898103438	0.094270651	0	0.49976403	8.131994898	1.575241118	0.331578576	0.900542782	0.622572977	1.512805396	13.45398665	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0561
H5425_019_0	2012	8																															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	567.5990434	9.321430853	613.7255991	0	144.1332093	13.48497964	0.808970473	212.6366987	371.5649574	12.67904145	16.65858034	7.418688803	0	506.5126906	8352.309577	1072.321693	128.0745019	579.7347222	2.07315305	1261.43771	56.45982578	0	0	0	0	259.898625	0	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$143/Days 1-10 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	$150 per day.	No cost-sharing	$15/Case for Cardio/PT/OT/ST	$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 Part B Rx	No cost-sharing	No cost-sharing	Not Covered	$0 Copay	$25/Service for Vision Hardware	$0/visit for routine hearing	Not covered	N/A	No cost-sharing													150	143	75	0	100	0.1	0.1	48.53319779	162.5	0.02	0.2	150	0	15	10	15	25	15	0.2	11.94609063	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	73.5	0	98	0.098	0.098	47.56253383	159.25	0.0196	0.196	147	0	14.7	9.8	14.7	24.5	14.7	0.196	11.70716881	0.196	0	0	0	0	25	0	0	0	0												6.9531	0.108858777	3.759069294	0	1.177087876	1.321528005	0.079279106	0.842795015	4.930976622	0.248509212	3.265081747	0.090878938	0	0.620478046	6.821052821	1.313594074	0.261485441	0.710175035	0.406337998	1.230655351	11.06612585	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7485			0.902290788	6.9531	0.108858777	3.759069294	0	1.177087876	1.321528005	0.079279106	0.842795015	4.930976622	0.248509212	3.265081747	0.090878938	0	0.620478046	6.821052821	1.313594074	0.261485441	0.710175035	0.406337998	1.230655351	11.06612585	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7485	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				6.9531	0.108858777	3.759069294	0	1.177087876	1.321528005	0.079279106	0.842795015	4.930976622	0.248509212	3.265081747	0.090878938	0	0.620478046	6.821052821	1.313594074	0.261485441	0.710175035	0.406337998	1.230655351	11.06612585	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7485
H5425_020_0	2012	8																															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	627.9014697	10.20788167	693.2189915	0	191.0306922	16.48020386	0.988655428	212.2376145	384.9503178	8.736390282	12.55268045	7.691948984	0	344.4331474	9504.396676	1228.045432	155.8618875	705.5155143	2.703198718	1474.235724	59.83680294	0	0	0	0	259.898625	0	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$143/Days 1-10 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	$150 per day.	No cost-sharing	$15/Case for Cardio/PT/OT/ST	$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 Part B Rx	No cost-sharing	No cost-sharing	Not Covered	$0 Copay	$25/Service for Vision Hardware	$0/visit for routine hearing	Not covered	N/A	No cost-sharing													150	143	75	0	100	0.1	0.1	48.34560653	162.5	0.02	0.2	150	0	15	10	15	25	15	0.2	12.02646541	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	73.5	0	98	0.098	0.098	47.3786944	159.25	0.0196	0.196	147	0	14.7	9.8	14.7	24.5	14.7	0.196	11.7859361	0.196	0	0	0	0	25	0	0	0	0												7.6918	0.119211045	4.245966323	0	1.560083987	1.615059979	0.096888232	0.837961757	5.108611509	0.171233249	2.460325368	0.094226375	0	0.421930606	7.761923952	1.504355654	0.31821802	0.864256505	0.529826949	1.447937337	11.72801338	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1193			0.963194592	7.6918	0.119211045	4.245966323	0	1.560083987	1.615059979	0.096888232	0.837961757	5.108611509	0.171233249	2.460325368	0.094226375	0	0.421930606	7.761923952	1.504355654	0.31821802	0.864256505	0.529826949	1.447937337	11.72801338	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1193	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.6918	0.119211045	4.245966323	0	1.560083987	1.615059979	0.096888232	0.837961757	5.108611509	0.171233249	2.460325368	0.094226375	0	0.421930606	7.761923952	1.504355654	0.31821802	0.864256505	0.529826949	1.447937337	11.72801338	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1193
H5425_022_0	2012	8																															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	420.5617076	6.956363455	463.540525	0	138.3420489	11.36480857	0.683674216	176.7757293	267.2592896	8.307602718	9.305071193	5.315941093	0	282.9130969	7368.863429	924.6283416	115.3774926	544.0220474	2.307136276	1122.045125	48.38912646	0	0	0	0	259.898625	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$143/Days 1-10 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	$125 per day.	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 Part B Rx	No cost-sharing	Not covered	Not Covered	$0 Copay	$25/Service for Vision Hardware	Not Covered	Not covered	$0 Health Club Membership	$10 routine chiropractic (20 visits/yr)													125	143	100	0	150	0.2	0.2	48.61906984	187.5	0.02	0.2	125	0	15	5	10	25	15	0.2	11.97095618	0.2	0	0	0	0	25	0	0	0	10											NO	122.5	140.14	98	0	147	0.196	0.196	47.64668844	183.75	0.0196	0.196	122.5	0	14.7	4.9	9.8	24.5	14.7	0.196	11.73153706	0.196	0	0	0	0	25	0	0	0	10												4.2932	0.081238731	3.785580954	0	1.694690098	2.22750248	0.134000146	0.701898175	4.092407873	0.162829013	1.823793954	0.054266899	0	0.346568544	3.008952567	0.755113146	0.235562381	0.666427008	0.45219871	1.09694283	9.484268786	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8796			0.69735262	4.2932	0.081238731	3.785580954	0	1.694690098	2.22750248	0.134000146	0.701898175	4.092407873	0.162829013	1.823793954	0.054266899	0	0.346568544	3.008952567	0.755113146	0.235562381	0.666427008	0.45219871	1.09694283	9.484268786	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8796	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				4.2932	0.081238731	3.785580954	0	1.694690098	2.22750248	0.134000146	0.701898175	4.092407873	0.162829013	1.823793954	0.054266899	0	0.346568544	3.008952567	0.755113146	0.235562381	0.666427008	0.45219871	1.09694283	9.484268786	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8796
H5425_023_0	2012	8																															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	427.1439562	7.00950578	460.9995369	0	107.1265818	9.93166066	0.597460157	159.7092059	277.6224727	9.19875445	12.0859444	5.551434501	0	380.498369	6280.857163	783.4262533	92.45837207	435.9549833	1.527575474	933.8208065	40.40067223	0	0	0	0	259.898625	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$143/Days 1-10 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	$125 per day.	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 Part B Rx	No cost-sharing	Not covered	Not Covered	$0 Copay	$25/Service for Vision Hardware	Not Covered	Not covered	$0 Health Club Membership	$10 routine chiropractic (20 visits/yr)													125	143	100	0	150	0.2	0.2	48.53319779	187.5	0.02	0.2	125	0	15	5	10	25	15	0.2	11.89779322	0.2	0	0	0	0	25	0	0	0	10											NO	122.5	140.14	98	0	147	0.196	0.196	47.56253383	183.75	0.0196	0.196	122.5	0	14.7	4.9	9.8	24.5	14.7	0.196	11.65983736	0.196	0	0	0	0	25	0	0	0	10												4.3604	0.081859345	3.764829551	0	1.312300627	1.946605489	0.117102191	0.633014543	4.251094113	0.180295587	2.368845102	0.056670894	0	0.466110502	2.564683341	0.639798107	0.188769176	0.534044855	0.299404793	0.907349894	7.918531756	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	33.3739			0.649935318	4.3604	0.081859345	3.764829551	0	1.312300627	1.946605489	0.117102191	0.633014543	4.251094113	0.180295587	2.368845102	0.056670894	0	0.466110502	2.564683341	0.639798107	0.188769176	0.534044855	0.299404793	0.907349894	7.918531756	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	33.3739	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				4.3604	0.081859345	3.764829551	0	1.312300627	1.946605489	0.117102191	0.633014543	4.251094113	0.180295587	2.368845102	0.056670894	0	0.466110502	2.564683341	0.639798107	0.188769176	0.534044855	0.299404793	0.907349894	7.918531756	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	33.3739
H5425_024_0	2012	8																															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	466.2200263	7.573815106	514.8000056	0	141.7364585	11.52248072	0.693159319	157.5194989	284.7992561	6.03022244	8.664385735	5.686594853	0	255.6261239	7330.577764	920.3232393	115.4050506	544.1519875	2.042372568	1118.619087	43.87570241	0	0	0	0	259.898625	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$143/Days 1-10 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	$125 per day.	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 Part B Rx	No cost-sharing	Not covered	Not Covered	$0 Copay	$25/Service for Vision Hardware	Not Covered	Not covered	$0 Health Club Membership	$10 routine chiropractic (20 visits/yr)													125	143	100	0	150	0.2	0.2	48.34560653	187.5	0.02	0.2	125	0	15	5	10	25	15	0.2	11.97746491	0.2	0	0	0	0	25	0	0	0	10											NO	122.5	140.14	98	0	147	0.196	0.196	47.3786944	183.75	0.0196	0.196	122.5	0	14.7	4.9	9.8	24.5	14.7	0.196	11.73791561	0.196	0	0	0	0	25	0	0	0	10												4.7593	0.088449537	4.204200045	0	1.736271616	2.25840622	0.135859227	0.62192235	4.360988608	0.11819236	1.698219604	0.058050656	0	0.313142002	2.993319254	0.751597312	0.235618645	0.666586185	0.400305023	1.094188037	8.599637673	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8764			0.697830349	4.7593	0.088449537	4.204200045	0	1.736271616	2.25840622	0.135859227	0.62192235	4.360988608	0.11819236	1.698219604	0.058050656	0	0.313142002	2.993319254	0.751597312	0.235618645	0.666586185	0.400305023	1.094188037	8.599637673	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8764	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				4.7593	0.088449537	4.204200045	0	1.736271616	2.25840622	0.135859227	0.62192235	4.360988608	0.11819236	1.698219604	0.058050656	0	0.313142002	2.993319254	0.751597312	0.235618645	0.666586185	0.400305023	1.094188037	8.599637673	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.8764
H5425_025_0	2012	7																															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	534.684447	8.072342847	905.6477462	2672.664466	170.122677	14.47705801	0.825061449	155.8645532	340.7535727	4.837448403	8.853982686	6.792191754	0	275.8005579	9585.634378	1258.644741	203.6006861	829.446509	3.034138493	1555.808973	68.1341788	0	0	0	0	259.898625	213.0490344	0	0	276											3000	$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% - 20% coinsurance for specialized diagnostics	10% diagnostic radiology; 10% coinsurance for therapeutic radiology; 0% for routine X-rays	$100/day.	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$0 Copay	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr)													100	100	68.28810407	10	100	0.05	0.045702532	46.55379588	66.5	0.02	0.045	100	0	20	10	20	25	20	0.1	22.84171133	0.2	0	0	0	0	25	25	0	0	10											NO	96	96	65.5565799	9.6	96	0.048	0.04387443	44.69164405	63.84	0.0192	0.0432	96	0	19.2	9.6	19.2	24	19.2	0.096	21.92804288	0.192	0	0	0	0	25	25	0	0	10												4.2775	0.064578743	4.947597403	2.138131573	1.360981416	0.694898785	0.036199101	0.580486928	1.812809007	0.092879009	0.382492052	0.054337534	0	0.441280893	7.668507503	2.013831585	0.407201372	1.327114414	0.291277295	2.842987157	13.08176233	0	0	0	0	0.541455469	0.443852155	0	0	0.23	0	0	0	0	0	0	0	0	0	0	45.7321			1.814170285	4.2775	0.064578743	4.947597403	2.138131573	1.360981416	0.694898785	0.036199101	0.580486928	1.812809007	0.092879009	0.382492052	0.054337534	0	0.441280893	7.668507503	2.013831585	0.407201372	1.327114414	0.291277295	2.842987157	13.08176233	0	0	0	0	0.541455469	0.443852155	0	0	0.23	0	0	0	0	0	0	0	0	0	0	45.7321	NO	20%Copay	Not covered.	20%Copay	20%Copay	20%Copay	Not covered.	Not covered.	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%Copay	20%Copay	20%Copay	20%Copay	20%Copay	$40/visit	$40/visit	Not covered.	20%Copay	20%Copay	"$20% hearing/dental, $40 chiro/pod"	30% coinsurance									0												1.5825	0	1.4123	1.1357	0.1614	0	0	0.0855	0.4264	0	0.1672	0	0	0.143	3.1804	0.442	0	0	0.0648	0	2.0997	0	0	0	0	0	0	0	0	0											10.9012				5.86	0.064578743	6.359917455	3.273879021	1.522385811	0.694898785	0.036199101	0.666029291	2.239248017	0.092887251	0.549733947	0.054337534	0	0.584278985	10.84892632	2.455858089	0.407201372	1.327129491	0.356036058	2.843007712	15.18148449	0	0	0	0	0.541455469	0.443852155	0	0	0.23	0	0	0	0	0	0	0	0	0	0	56.6333
H5425_026_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	651.9203828	9.691865505	1125.348807	2779.061743	204.2101388	16.69420066	0.95141854	216.5314727	454.2961295	4.527711682	10.25816752	9.05792992	0	426.6544929	11349.30059	1512.175573	272.6642524	1110.803782	3.836512986	1946.305522	83.52317479	0	0	0	0	259.898625	213.5567553	0	0	276											3000	$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% - 20% coinsurance for specialized diagnostics	10% diagnostic radiology; 10% coinsurance for therapeutic radiology; 0% for routine X-rays	$100/day.	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$0 Copay	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr)													100	100	68.28810407	10	100	0.05	0.045702532	46.9177358	66.5	0.02	0.045	100	0	20	10	20	25	20	0.1	22.68951181	0.2	0	0	0	0	25	25	0	0	10											NO	96	96	65.5565799	9.6	96	0.048	0.04387443	45.04102637	63.84	0.0192	0.0432	96	0	19.2	9.6	19.2	24	19.2	0.096	21.78193133	0.192	0	0	0	0	25	25	0	0	10												5.2154	0.077534924	6.147834913	2.223249395	1.63368111	0.801321632	0.041742946	0.812733314	2.416855409	0.086932064	0.443152837	0.072463439	0	0.682647189	9.079440468	2.419480917	0.545328505	1.777286052	0.368305247	3.53285777	16.03644956	0	0	0	0	0.541455469	0.444909907	0	0	0.23	0	0	0	0	0	0	0	0	0	0	55.631			2.270702899	5.2154	0.077534924	6.147834913	2.223249395	1.63368111	0.801321632	0.041742946	0.812733314	2.416855409	0.086932064	0.443152837	0.072463439	0	0.682647189	9.079440468	2.419480917	0.545328505	1.777286052	0.368305247	3.53285777	16.03644956	0	0	0	0	0.541455469	0.444909907	0	0	0.23	0	0	0	0	0	0	0	0	0	0	55.631	NO	20%Copay	Not covered.	20%Copay	20%Copay	20%Copay	Not covered.	Not covered.	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%Copay	20%Copay	20%Copay	20%Copay	20%Copay	$40/visit	$40/visit	Not covered.	20%Copay	20%Copay	"$20% hearing/dental, $40 chiro/pod"	30% coinsurance									0												1.7064	0	1.7935	1.1719	0.1929	0	0	0.1195	0.5798	0	0.1938	0	0	0.2272	3.7656	0.531	0	0	0.0819	0	2.5667	0	0	0	0	0	0	0	0	0											12.93				6.9218	0.077534924	7.941331889	3.395115336	1.826548283	0.801321632	0.041742946	0.932254437	2.996662366	0.086939778	0.636918223	0.072463439	0	0.909813756	12.84502631	2.950463614	0.545328505	1.777306814	0.450189391	3.532885203	18.60310743	0	0	0	0	0.541455469	0.444909907	0	0	0.23	0	0	0	0	0	0	0	0	0	0	68.5611
H5425_027_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	428.3860197	6.402068239	737.5041749	1733.881162	148.5854314	12.40433052	0.706934718	148.9502324	280.7322952	4.034729259	6.219931596	5.593076661	0	210.9211157	7439.952686	984.2284611	168.5686272	686.7298044	3.059204942	1242.326146	52.15349414	0	0	0	0	259.898625	188.2319213	0	0	276											3000	$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% - 20% coinsurance for specialized diagnostics	10% diagnostic radiology; 10% coinsurance for therapeutic radiology; 0% for routine X-rays	$100/day.	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$0 Copay	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr)													100	100	68.28810407	10	100	0.05	0.045702532	47.4145906	66.5	0.02	0.045	100	0	20	10	20	25	20	0.1	22.76216692	0.2	0	0	0	0	25	25	0	0	10											NO	96	96	65.5565799	9.6	96	0.048	0.04387443	45.51800697	63.84	0.0192	0.0432	96	0	19.2	9.6	19.2	24	19.2	0.096	21.85168024	0.192	0	0	0	0	25	25	0	0	10												3.4271	0.051216546	4.029020948	1.387104929	1.188683451	0.595407865	0.031016358	0.564993143	1.493495811	0.077466802	0.268701045	0.044744613	0	0.337473785	5.951962149	1.574765538	0.337137254	1.098767687	0.293683674	2.262242808	10.01347088	0	0	0	0	0.541455469	0.392149836	0	0	0.23	0	0	0	0	0	0	0	0	0	0	36.192			1.41503867	3.4271	0.051216546	4.029020948	1.387104929	1.188683451	0.595407865	0.031016358	0.564993143	1.493495811	0.077466802	0.268701045	0.044744613	0	0.337473785	5.951962149	1.574765538	0.337137254	1.098767687	0.293683674	2.262242808	10.01347088	0	0	0	0	0.541455469	0.392149836	0	0	0.23	0	0	0	0	0	0	0	0	0	0	36.192	NO	20%Copay	Not covered.	20%Copay	20%Copay	20%Copay	Not covered.	Not covered.	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%Copay	20%Copay	20%Copay	20%Copay	20%Copay	$40/visit	$40/visit	Not covered.	20%Copay	20%Copay	"$20% hearing/dental, $40 chiro/pod"	30% coinsurance									0												1.2687	0	1.1146	0.6811	0.1464	0	0	0.0829	0.3527	0	0.1175	0	0	0.1099	2.4685	0.3456	0	0	0.0653	0	1.6037	0	0	0	0	0	0	0	0	0											8.357				4.6958	0.051216546	5.143587164	2.068241103	1.335044468	0.595407865	0.031016358	0.647852387	1.846240735	0.077473676	0.386188642	0.044744613	0	0.447396434	8.420464969	1.920391795	0.337137254	1.0987791	0.35897744	2.262259734	11.61714483	0	0	0	0	0.541455469	0.392149836	0	0	0.23	0	0	0	0	0	0	0	0	0	0	44.549
H5425_028_0	2012	7																															D	D	D	V	T	O	O	V	V	Coin	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	0	994.2651161	0	497.5036663	3982.029065	56.53996644	393.4146033	0	0	0	19.93734865	0	0	0	0	510.0427778	0	0	4788.587736	148.1054455	0	0	0	0	259.898625	0	0	0	276											3400	$0 Copay	$0 Copay	$0/day (1-31); $25/day (32-100)	$0 Copay	$50/run	"$0 ($0-$499)$100 ($500-$1,000)$250 (= $1,001)"	"$0 ($0-$499)$100 ($500-$1,000)$250 (= $1,001)"	$50 ER ($0 if admitted immed.) Worldwide coverage; $0 Urgent care	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0/visit	$0/visit	$25/visit	$0 Copay	$0 Copay	$10/visit for hearing/vision/chiropractic/podiatry/dental	20% coinsurance	$0 Copay	$0 Copay to approved location	Not Covered	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay for routine podiatry (up to 12 visits)													0	0	25	0	50	20	5	50	0	0	0	0	0	0	0	0	25	0	0	10	0.2	0	0	0	0	25	0	0	0	0											NO	0	0	22.5	0	49	19.6	4.9	49	0	0	0	0	0	0	0	0	22.5	0	0	9	0.18	0	0	0	0	25	0	0	0	0												0	0	1.864247093	0	2.031473304	6.503980806	0.023087153	1.606442964	0	0	0	0	0	0	0	0	0.956330208	0	0	3.591440802	26.65898018	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7774			7.047790607	0	0	1.864247093	0	2.031473304	6.503980806	0.023087153	1.606442964	0	0	0	0	0	0	0	0	0.956330208	0	0	3.591440802	26.65898018	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7774	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0	1.864247093	0	2.031473304	6.503980806	0.023087153	1.606442964	0	0	0	0	0	0	0	0	0.956330208	0	0	3.591440802	26.65898018	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7774
H5425_029_0	2012	7																															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	349.1043557	2.07564979	87.40063219	0	12.8671797	25.55282859	1.537184718	15.46413262	79.29056846	9.838718712	18.00780864	0	0	11.85782081	188.8258801	334.0439658	6.234722856	24.60859427	92.72183676	93.61477882	149.2424037	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.059843193	0.059843193	0.158469945	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.059244761	0.059244761	0.156885246	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												20.6826	0.122971376	13.71186967	0	2.85342577	5.666595269	0.340886083	3.429326049	17.58347646	2.181834262	3.993411644	0	0	2.629590344	41.87402716	74.07758985	1.382612141	5.457201865	20.56199452	20.76001335	33.09599546	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	270.7308			2.221875891	20.6826	0.122971376	13.71186967	0	2.85342577	5.666595269	0.340886083	3.429326049	17.58347646	2.181834262	3.993411644	0	0	2.629590344	41.87402716	74.07758985	1.382612141	5.457201865	20.56199452	20.76001335	33.09599546	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	270.7308	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				20.6826	0.122971376	13.71186967	0	2.85342577	5.666595269	0.340886083	3.429326049	17.58347646	2.181834262	3.993411644	0	0	2.629590344	41.87402716	74.07758985	1.382612141	5.457201865	20.56199452	20.76001335	33.09599546	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	270.7308
H5425_030_0	2012	6																															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	370.7088718	2.203735233	82.94237525	0	13.77067068	27.34706405	1.645120765	18.21159242	78.14501106	10.28185966	15.85049694	0	0	10.9088374	153.255927	297.8863781	5.397853755	21.30545271	103.2566392	85.11270517	125.7930754	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.067342774	0.067342774	0.138410396	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.066669346	0.066669346	0.137026292	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												24.7149	0.146921588	11.36528612	0	3.053783929	6.064484923	0.364821981	4.038602736	17.32943765	2.280105198	3.515006201	0	0	2.419143783	33.98603438	66.05928322	1.197028049	4.724697194	22.8981923	18.8745935	27.89587241	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	251.2535			1.974593224	24.7149	0.146921588	11.36528612	0	3.053783929	6.064484923	0.364821981	4.038602736	17.32943765	2.280105198	3.515006201	0	0	2.419143783	33.98603438	66.05928322	1.197028049	4.724697194	22.8981923	18.8745935	27.89587241	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	251.2535	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				24.7149	0.146921588	11.36528612	0	3.053783929	6.064484923	0.364821981	4.038602736	17.32943765	2.280105198	3.515006201	0	0	2.419143783	33.98603438	66.05928322	1.197028049	4.724697194	22.8981923	18.8745935	27.89587241	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	251.2535
H5425_031_0	2012	7																															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	329.7960352	1.960522658	74.1432698	0	12.39474119	24.61461676	1.480744591	16.38874301	70.33696544	9.182550972	14.15580458	0	0	9.742493949	135.2315216	262.8520082	4.763013026	18.79972178	91.11264209	75.10261333	110.9985717	0	0	0	0	0	0	0	0	390.4											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10/visit for Acupuncture/Chiro; $0/visit for Routine Podiatry													0.067342774	0.067342774	0.138410396	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	10											NO	0.066669346	0.066669346	0.137026292	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	0	0	0	0	0	10												21.9873	0.130706764	10.15957733	0	2.748657806	5.458537412	0.32836992	3.63436765	15.59792546	2.036322504	3.139191224	0	0	2.160495458	29.98894223	58.29006133	1.056245769	4.169026301	20.20513951	16.65475553	24.61504325	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	222.686			1.858427712	21.9873	0.130706764	10.15957733	0	2.748657806	5.458537412	0.32836992	3.63436765	15.59792546	2.036322504	3.139191224	0	0	2.160495458	29.98894223	58.29006133	1.056245769	4.169026301	20.20513951	16.65475553	24.61504325	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	222.686	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				21.9873	0.130706764	10.15957733	0	2.748657806	5.458537412	0.32836992	3.63436765	15.59792546	2.036322504	3.139191224	0	0	2.160495458	29.98894223	58.29006133	1.056245769	4.169026301	20.20513951	16.65475553	24.61504325	0	0	0	0	0	0	0	0	0.325333333	0	0	0	0	0	0	0	0	0	0	222.686
H5425_801_0	2012	6																															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	312.0908064	1.855580448	78.34041786	0	11.5577317	22.95240635	1.380750791	13.88910567	71.22144387	8.807806817	36.37668084	0	0	24.37988475	162.6950148	287.8169451	5.371924267	21.20310843	79.89042921	92.27540199	128.5893389	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.06388771	0.151049809	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062609956	0.148028812	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0												19.54	0.27467937	0	0	2.537153263	5.038512243	0.303102414	3.048936477	15.63453136	1.933489752	7.985408978	0	0	5.351872301	35.71480965	63.18157579	1.179244815	4.654506362	17.53754702	20.25629625	28.22793168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.3996			4.962510842	19.54	0.27467937	0	0	2.537153263	5.038512243	0.303102414	3.048936477	15.63453136	1.933489752	7.985408978	0	0	5.351872301	35.71480965	63.18157579	1.179244815	4.654506362	17.53754702	20.25629625	28.22793168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.3996	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				19.54	0.27467937	0	0	2.537153263	5.038512243	0.303102414	3.048936477	15.63453136	1.933489752	7.985408978	0	0	5.351872301	35.71480965	63.18157579	1.179244815	4.654506362	17.53754702	20.25629625	28.22793168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.3996
H5425_803_0	2012	6																															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	260.6798596	1.549909324	65.43534353	0	9.653818106	19.17143967	1.153298703	11.60114314	59.48908333	7.356890358	30.3843236	0	0	20.36376851	136.0078529	240.6058033	4.49075767	17.72512364	66.78585547	77.13929844	107.4965936	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.065501574	0.147968028	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064191543	0.145008667	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0												16.7334	0.224750285	0	0	2.119206151	4.208514436	0.253172131	2.546682941	13.05904357	1.614984571	6.669966716	0	0	4.470254463	29.85644387	52.81778595	0.985811124	3.891019141	14.66083099	16.93361879	23.59765224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	194.6432			4.147468267	16.7334	0.224750285	0	0	2.119206151	4.208514436	0.253172131	2.546682941	13.05904357	1.614984571	6.669966716	0	0	4.470254463	29.85644387	52.81778595	0.985811124	3.891019141	14.66083099	16.93361879	23.59765224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	194.6432	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				16.7334	0.224750285	0	0	2.119206151	4.208514436	0.253172131	2.546682941	13.05904357	1.614984571	6.669966716	0	0	4.470254463	29.85644387	52.81778595	0.985811124	3.891019141	14.66083099	16.93361879	23.59765224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	194.6432
H5425_804_0	2012	6																															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	250.6399425	1.490215563	62.91514336	0	9.282007511	18.433064	1.108880145	11.15433257	57.19789955	7.073544458	29.21409092	0	0	19.57947106	130.7972646	231.3879694	4.318712533	17.04605753	64.22722674	74.1840196	103.3782984	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.063743204	0.151319019	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06246834	0.148292639	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0												15.6571	0.220987998	0	0	2.037586289	4.046426209	0.24342137	2.448599086	12.55608291	1.552784479	6.413077239	0	0	4.298085487	28.71261552	50.79428705	0.948043775	3.741950549	14.09916081	16.28487598	22.69360405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7487			3.98832378	15.6571	0.220987998	0	0	2.037586289	4.046426209	0.24342137	2.448599086	12.55608291	1.552784479	6.413077239	0	0	4.298085487	28.71261552	50.79428705	0.948043775	3.741950549	14.09916081	16.28487598	22.69360405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7487	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				15.6571	0.220987998	0	0	2.037586289	4.046426209	0.24342137	2.448599086	12.55608291	1.552784479	6.413077239	0	0	4.298085487	28.71261552	50.79428705	0.948043775	3.741950549	14.09916081	16.28487598	22.69360405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7487
H5426_001_0	2012	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	1427.41	5.13	647.86	36.83	309.68	9.43	3.41	402.89	403.89	150.21	1233.57	0	0.71	1.71	6589.11	6417.99	19.76	1229.72		1725.3	35.63	0			2.3		0.4		4.63	1.24	248.54	210.53									5000	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS883: Vision 17a,17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$150/Visit: 3. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											142.969536	112.005826	34.03605	0	150	0.2	0.2	65	146.594563	45.738831	86.060758	0	0.2	0.2	0	34.739594	35	45.967143		0	0.2	0			0		0		0	0	0	108.98125									NO	122.923492	96.301265	30.662193	0	135.8472	0.18113	0.18113	58.86712	132.763072	41.423281	77.940754	0	0.18113	0.18113	0	31.461844	31.69768	41.630051		0	0.18113	0			0		0		0	0	0	98.698651										14.6219	0.041168791	1.655400696	0	3.505763408	1.7080559	0.6176533	1.976414498	4.468473096	0.51851592	8.012114659	0	0.1286023	0.3097323	0	16.82681668	0.052195513	4.26610886	0	0	6.4536619	0	0	0	0	0	0	0	0	0	0	1.731585583	0	0	0	0	0	0	0	0	66.8941	0	NO	7.842667	14.6219	0.041168791	1.655400696	0	3.505763408	1.7080559	0.6176533	1.976414498	4.468473096	0.51851592	8.012114659	0	0.1286023	0.3097323	0	16.82681668	0.052195513	4.26610886	0	0	6.4536619	0	0	0	0	0	0	0	0	0	0	1.731585583	0	0	0	0	0	0	0	0	66.8941	NO																																																																																		0	0	NO	0	14.6219	0.041168791	1.655400696	0	3.505763408	1.7080559	0.6176533	1.976414498	4.468473096	0.51851592	8.012114659	0	0.1286023	0.3097323	0	16.82681668	0.052195513	4.26610886	0	0	6.4536619	0	0	0	0	0	0	0	0	0	0	1.731585583	0	0	0	0	0	0	0	0	66.8941
H5426_002_0	2012	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	1688.99	13.36	469.49	130.16	260.78	8.86	3.06	359.85	309.46	255.33	1266.91	2.68	1.4	3.85	5423.68	5504.79	48.28	521.5		1295.19	41.26	0			1.21				0.58	1.43	321.93	323.09									6700	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$160/Day(Days 1-8): 1b. $160 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$35/Service: 9d, 7g. $35 Other Part B"			"VIS878: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $175 Observation"											142.969537	109.726258	34.03605	0	150	0.2	0.2	65	106.684361	66.760321	87.309603	51.668948	0.199964	0.2	0	34.647494	35	42.066527		0	0.2	0			0				0	0	0	131.237055									NO	128.626261	98.718081	32.190547	0	141.61425	0.188819	0.188819	61.366175	100.720172	63.028085	82.428559	48.780395	0.188785	0.188819	0	32.710526	33.043325	39.714798		0	0.188819	0			0				0	0	0	123.900247										18.104	0.10990613	1.259428326	0	3.077513676	1.67293634	0.57778614	1.840218173	2.597405369	1.341080079	8.702463807	0.010894288	0.264299	0.72695315	0	15.00538137	0.132944311	1.72593893	0	0	7.79067194	0	0	0	0	0	0	0	0	0	0	3.3359109	0	0	0	0	0	0	0	0	68.2758	0	NO	4.993224	18.104	0.10990613	1.259428326	0	3.077513676	1.67293634	0.57778614	1.840218173	2.597405369	1.341080079	8.702463807	0.010894288	0.264299	0.72695315	0	15.00538137	0.132944311	1.72593893	0	0	7.79067194	0	0	0	0	0	0	0	0	0	0	3.3359109	0	0	0	0	0	0	0	0	68.2758	NO																																																																																		0	0	NO	0	18.104	0.10990613	1.259428326	0	3.077513676	1.67293634	0.57778614	1.840218173	2.597405369	1.341080079	8.702463807	0.010894288	0.264299	0.72695315	0	15.00538137	0.132944311	1.72593893	0	0	7.79067194	0	0	0	0	0	0	0	0	0	0	3.3359109	0	0	0	0	0	0	0	0	68.2758
H5426_008_0	2012	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	1196.2	17.02	453.19	106.65	197.79	5.31	2.53	316.77	231.89	203.3	882.14	2.3	0.88	2.31	4328.85	4639.79	39.32	334.17		1196.38	32.4	0			1.21				0.58	1.43	354.75	259.98									6700	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS878: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$150/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											185.85435	131.8754	34.03605	0	150	0.2	0.2	65	121.52728	83.404364	89.642357	100	0.2	0.2	5	39.696946	40	45.339486		0	0.2	0			0				0	0	0	125.78925									NO	169.919013	120.568271	32.535809	0	143.48595	0.191315	0.191315	62.177245	116.249715	79.782363	85.749458	95.6573	0.191315	0.191315	4.782865	37.973026	38.26292	43.370528		0	0.191315	0			0				0	0	0	120.3266										16.9381	0.171005998	1.22874194	0	2.365007171	1.01588265	0.48402695	1.641323825	2.246428868	1.3516462	6.303585573	0.018334316	0.1683572	0.44193765	1.725358763	14.68223886	0.125374835	1.207760778	0	0	6.198606	0	0	0	0	0	0	0	0	0	0	2.606875789	0	0	0	0	0	0	0	0	60.9206	0	NO	3.594394	16.9381	0.171005998	1.22874194	0	2.365007171	1.01588265	0.48402695	1.641323825	2.246428868	1.3516462	6.303585573	0.018334316	0.1683572	0.44193765	1.725358763	14.68223886	0.125374835	1.207760778	0	0	6.198606	0	0	0	0	0	0	0	0	0	0	2.606875789	0	0	0	0	0	0	0	0	60.9206	NO																																																																																		0	0	NO	0	16.9381	0.171005998	1.22874194	0	2.365007171	1.01588265	0.48402695	1.641323825	2.246428868	1.3516462	6.303585573	0.018334316	0.1683572	0.44193765	1.725358763	14.68223886	0.125374835	1.207760778	0	0	6.198606	0	0	0	0	0	0	0	0	0	0	2.606875789	0	0	0	0	0	0	0	0	60.9206
H5426_013_0	2012	4	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T		V				O	O	D	D	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	YES	285.05	0.72	47.59	28.28	291.93	765.09	6605.73	416.5	341.37	136.01	1152.17	0	0.25	242.4	5633.65	5669.17	21.24	1125.22		1406.17	2732.86	0	1.92		2.3				4.63	2.5	0	0	602.3								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b		"VIS883: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$0/Day(Days 1-30), $0 (Days 31-100): 2. $0 SNF - Facility 2,2. $0 SNF - Physician"										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0		0				0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0		0				0	0	0	0	0									0	0	0	0	0.6081875	0	0	0.867708333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4759	0	NO	0	0	0	0	0	0.6081875	0	0	0.867708333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4759	NO																																																																																		0	0	NO	0	0	0	0	0	0.6081875	0	0	0.867708333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.4759
H5426_019_0	2012	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	1796.88	13.66	481.78	98.3	273.58	8.82	0.85	384.42	328.93	278.64	1291.32	1.21	1	3.79	5550.04	5829.01	51.41	549.02		1412.96	40.83	0			1.21				0.58	1.05	5740.39	352.27									6700	"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-8): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c0%-20% Coins: DME 11a	0% Coins: 11c. 0% Diabetic Monitoring Supplies	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$25/Service: 9d, 7g. $25 Other Part B"			"VIS856: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics"	"$40-$195/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $195 Observation"											148.989465	120.013094	34.03605	0	150	0.045	0	65	146.297593	89.206626	93.507083	100.000001	0.2	0.2	5	39.510595	40	51.034505		0	0.2	0			0				0	0	0	151.424261									NO	131.341812	105.797663	31.731163	0	139.44105	0.041832	0	60.424455	135.999267	82.927104	86.924839	92.960701	0.185921	0.185921	4.648035	36.729326	37.18428	47.442033		0	0.185921	0			0				0	0	0	140.765053										19.6671	0.120433006	1.273953309	0	3.179023538	0.36895824	0	1.935697416	3.727853241	1.925567355	9.353981925	0.009373537	0.185921	0.70464059	2.149731681	17.84130071	0.159303653	2.17055208	0	0	7.59115443	0	0	0	0	0	0	0	0	0	0	4.132275435	0	0	0	0	0	0	0	0	76.4968	0	NO	6.949087	19.6671	0.120433006	1.273953309	0	3.179023538	0.36895824	0	1.935697416	3.727853241	1.925567355	9.353981925	0.009373537	0.185921	0.70464059	2.149731681	17.84130071	0.159303653	2.17055208	0	0	7.59115443	0	0	0	0	0	0	0	0	0	0	4.132275435	0	0	0	0	0	0	0	0	76.4968	NO																																																																																		0	0	NO	0	19.6671	0.120433006	1.273953309	0	3.179023538	0.36895824	0	1.935697416	3.727853241	1.925567355	9.353981925	0.009373537	0.185921	0.70464059	2.149731681	17.84130071	0.159303653	2.17055208	0	0	7.59115443	0	0	0	0	0	0	0	0	0	0	4.132275435	0	0	0	0	0	0	0	0	76.4968
H5426_025_0	2012	4	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V				O	O	D	D	D								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0								0	YES	441.48	1.13	104.41	77.01	545.15	2008.22	3073.69	645.87	433.17	211.31	1422.1	0	0.4	279.8	7043.82	7868.92	73.89	1077.54		1520.48	4600	0	1.99	3.36	2.3				0.58	1.75	0	0	0								3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	$0/Admit(Days 1-100) : 2. $0 SNF - Facility 1	$0/Visit: 6. $0 Home Health	$25/Trip: 10a. $25 Ambulance Emergency	$0: Diabetic Shoes 11c0% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$25/Visit: 4a, 4b. $25 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"$0/Proc: 12. $0 Dialysis -- Dialysis Center,9a, 12. $0 Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"$0/Script: 15. $0 Part B Rx,15. $0 Part B Rx at Pharmacy,15. $0 Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"	$0: Other - Transportation 10b	"DEN849: Dental 16a, 16b"	"VIS883: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0									0	0	0	0	1.135729167	0	0	1.3455625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4813	0	NO	0	0	0	0	0	1.135729167	0	0	1.3455625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4813	NO																																																																																		0	0	NO	0	0	0	0	0	1.135729167	0	0	1.3455625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4813
H5426_801_0	2012	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	337.7	1.92	31.22	13.27	11.79	7.72	4.13	32.65	62.01	5.92	29.83	0.44	5.54	22.7	41.01	97.12	0.4	6.97		5.04	33.58	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																					0.0919	0.0919	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073888	0.073888	0.131118	0	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808		0.197808	0.197808	0																				24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	0	NO	16.771807	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	NO																																																																																		0	0	NO	0	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532
H5426_802_0	2012	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	337.7	1.92	31.22	13.27	11.79	7.72	4.13	32.65	62.01	5.92	29.83	0.44	5.54	22.7	41.01	97.12	0.4	6.97		5.04	33.58	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																					0.0919	0.0919	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073888	0.073888	0.131118	0	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808		0.197808	0.197808	0																				24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	0	NO	16.771806	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	NO																																																																																		0	0	NO	0	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532
H5426_803_0	2012	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	337.7	1.92	31.22	13.27	11.79	7.72	4.13	32.65	62.01	5.92	29.83	0.44	5.54	22.7	41.01	97.12	0.4	6.97		5.04	33.58	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																					0.0919	0.0919	0.1646	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.073888	0.073888	0.131118	0	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808	0.197808		0.197808	0.197808	0																				24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	0	NO	16.771806	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532	NO																																																																																		0	0	NO	0	24.952	0.14186496	4.09350396	0	2.33215632	1.52707776	0.81694704	6.4584312	12.26607408	1.17102336	5.90061264	0.08703552	1.09585632	4.4902416	8.11210608	19.21111296	0.0791232	1.37872176	0	0.99695232	6.64239264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7532
H5427_052_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	745.6973656	2.943542233	439.1002433	75.2962007	221.7040082	1.692316646	0.803678071	129.5950966	214.7422881	3059.079335	1.858875071	0	0.051528741	23.56274483	5332.411418	5041.005682	73.06982479	214.1199085	2111.191782	46.28245052	12.22221209	0.031265035	11.24489892	264.4390618	599.6597966	298.0745202	3.944208485	3.169095451	0	0											3400	$295 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $250,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $35-$250	12: 20%	"31-33: $35-$250, 5: $295, 9a2: $250"	$0 	"7b1: $20,7d1: $35,7f1: $35"	"7e1: $35,7h1: $35"	"7c: $35,7i: $35"	$0 	7g: $35	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	221.6078782	131.3683238	43.13699935	15	100	0.182305782	0.124425881	48.84297521	65.96009975	0	0.065215727	0	0.182305782	9.227272727	0	34.08980667	35	35	0	35	0.180522012	0	0	0	0	10	0	0	0	0											NO	204.6095501	121.2917783	39.82819608	13.84943205	92.329547	0.168322102	0.114881852	45.09649775	60.9006613	0	0.060213385	0	0.168322102	8.519499109	0	31.47496407	32.31534145	32.31534145	0	32.31534145	0.166675156	0	0	0	0	10	0	0	0	0												12.7147	0.029752289	1.457380883	0.086900801	1.70581922	0.284854296	0.092328026	0.487023748	1.089828946	0	0.11192916	0	0.008673426	0.016728565	0	13.22212273	0.196773028	0.576613163	0	0.124636099	2.037139106	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4916	0	NO	2.844822148	12.7147	0.029752289	1.457380883	0.086900801	1.70581922	0.284854296	0.092328026	0.487023748	1.089828946	0	0.11192916	0	0.008673426	0.016728565	0	13.22212273	0.196773028	0.576613163	0	0.124636099	2.037139106	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4916	NO																																										0	0	0	0	0	0	0	0	0	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	12.7147	0.029752289	1.457380883	0.086900801	1.70581922	0.284854296	0.092328026	0.487023748	1.089828946	0	0.11192916	0	0.008673426	0.016728565	0	13.22212273	0.196773028	0.576613163	0	0.124636099	2.037139106	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4916
H5427_053_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	957.1965786	5.172437896	461.4865372	120.6741523	239.5564546	3.960552727	2.600234956	160.5108905	338.928021	3073.562447	2.742207442	0	0.023868625	55.00925995	8539.410381	3144.604487	147.3854874	517.3854765	3147.824104	41.67274196	23.89917009	0.042551278	23.71165218	264.4390618	600.7322569	298.0745202	6.910435635	3.169095451	0	4662.999722											3400	$225 days 1-8;$0 days 9-90	$220 days 1-8;$0 days 9-90	$0 days 1-8;$95 days 9-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$200	12: 20%	"31-33: $30-$200, 5: $225, 9a2: $200"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	"17b2: $15, 17b3: $15"	18a3: $5	18b1: $10	$0 	$0 												NO	177.0402741	123.6632292	43.13699935	15	100	0.177044417	0.117159207	49.75879397	65.49262256	0	0.077231527	0	0.177044417	21.09090909	0	28.53422171	30	30	0	30	0.173549641	0	0	10.04182106	0	15	0.62101489	10	0	0											NO	162.5990418	113.5759796	39.61830037	13.77644515	91.8429677	0.162602847	0.107602492	45.69995307	60.15036818	0	0.070931726	0	0.162602847	19.37051682	0	26.20667603	27.55289031	27.55289031	0	27.55289031	0.15939314	0	0	10.04182106	0	15	0.62101489	10	0	0												12.9699	0.048955392	1.523609354	0.138538403	1.833464644	0.643997147	0.279791762	0.611278347	1.698887104	0	0.194509508	0	0.003881106	0.088796483	0	6.867469251	0.338408014	1.18795544	0	0.095683707	3.809363775	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.9314	0	NO	2.871790677	12.9699	0.048955392	1.523609354	0.138538403	1.833464644	0.643997147	0.279791762	0.611278347	1.698887104	0	0.194509508	0	0.003881106	0.088796483	0	6.867469251	0.338408014	1.18795544	0	0.095683707	3.809363775	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.9314	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	NO	0	12.9699	0.048955392	1.523609354	0.138538403	1.833464644	0.643997147	0.279791762	0.611278347	1.698887104	0	0.194509508	0	0.003881106	0.088796483	0	6.867469251	0.338408014	1.18795544	0	0.095683707	3.809363775	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.9314
H5427_054_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	907.7076547	0.486315379	451.310342	120.8632528	269.141176	3.603980872	3.164032858	143.9931834	328.7291386	3074.208009	3.149514569	0	0.192250574	40.74277172	5982.231595	3163.595563	172.6411073	397.9133652	3119.781949	70.70934363	29.42397053	0.005231377	21.69334772	264.4390618	599.7858382	298.0745202	2.92701177	3.169095451	0	4398.788541											3400	$195 days 1-10;$0 days 11-90	$175 days 1-10;$0 days 11-90	$0 days 1-8;$95 days 9-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$200	12: 20%	"31-33: $30-$200, 5: $195, 9a2: $200"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	"17b2: $15, 17b3: $15"	18a3: $5	18b1: $10	$0 	$0 												NO	163.6288514	109.6813914	43.13699935	15	100	0.174384749	0.135224745	51.32718894	63.08033912	0	0.09848623	0	0.174384749	44.82084691	0	28.99782703	30	30	0	30	0.168915679	0	0	10.04182106	0	15	1.466165414	10	0	0											NO	151.5696902	101.598064	39.95787768	13.89452614	92.63017429	0.161532897	0.125258917	47.6803139	58.43142807	0	0.091227967	0	0.161532897	41.51762861	0	26.86073772	27.78905229	27.78905229	0	27.78905229	0.156466888	0	0	10.04182106	0	15	1.466165414	10	0	0												11.4651	0.004117392	1.50278362	0.139944802	2.077549504	0.582161469	0.396323329	0.572136682	1.600676085	0	0.287323811	0	0.031054792	0.140961939	0	7.081375889	0.399794396	0.921469609	0	0.163745471	4.603877096	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.5673	0	NO	2.541861692	11.4651	0.004117392	1.50278362	0.139944802	2.077549504	0.582161469	0.396323329	0.572136682	1.600676085	0	0.287323811	0	0.031054792	0.140961939	0	7.081375889	0.399794396	0.921469609	0	0.163745471	4.603877096	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.5673	NO																																										0	0	0	0	0	0	0	0	0	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	11.4651	0.004117392	1.50278362	0.139944802	2.077549504	0.582161469	0.396323329	0.572136682	1.600676085	0	0.287323811	0	0.031054792	0.140961939	0	7.081375889	0.399794396	0.921469609	0	0.163745471	4.603877096	0	0	0.221287478	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	32.5673
H5427_059_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	1522.878444	5.162080666	666.8416874	281.0258456	437.6992632	7.203216867	4.154491589	264.408651	306.6281179	3092.189178	3.810050052	0	0.056009791	55.88441662	8586.945686	3718.973201	407.5004896	613.4173939	4130.650918	122.628536	42.86936279	0	39.75494563	264.4390618	601.0304482	298.0745202	3.889479238	3.169095451	0	3457.101054											3400	$125 days 1-7;$0 days 8-90	$125 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $125, 9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	93.90164332	65.68416192	43.13699935	0	100	0.195855998	0.142711899	49.7228115	67.78394105	0	0.099711805	0	0.195855998	23.55312906	0	19.22348837	20	20	0	20	0.19115248	0	0	0	0	10	0	0	0	0											NO	86.65214379	60.6131399	39.80668855	0	92.27968833	0.180735305	0.131694096	45.88405548	62.55080954	0	0.092013743	0	0.180735305	21.73475409	0	17.73937515	18.45593767	18.45593767	0	18.45593767	0.176394913	0	0	0	0	10	0	0	0	0												10.9967	0.02607416	2.21206328	0	3.365895966	1.301875597	0.547122014	1.011011768	1.59831975	0	0.350576966	0	0.010122947	0.101219504	0	5.497688399	0.626733636	0.943432765	0	0.188602051	7.561937511	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5878	0	NO	3.040230168	10.9967	0.02607416	2.21206328	0	3.365895966	1.301875597	0.547122014	1.011011768	1.59831975	0	0.350576966	0	0.010122947	0.101219504	0	5.497688399	0.626733636	0.943432765	0	0.188602051	7.561937511	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5878	NO																																										0	0	0	0	0	0	0	0	0	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	10.9967	0.02607416	2.21206328	0	3.365895966	1.301875597	0.547122014	1.011011768	1.59831975	0	0.350576966	0	0.010122947	0.101219504	0	5.497688399	0.626733636	0.943432765	0	0.188602051	7.561937511	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5878
H5427_060_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	1558.955903	2.407653905	615.8221707	324.84707	489.2717758	7.12104822	6.641132772	225.5818841	337.7157916	3103.89484	3.37591752	0	0.020174392	53.43881527	6986.495047	3658.922903	362.3372668	475.4939226	4056.050521	113.9854198	38.90299036	0	39.59010938	264.4390618	599.6597966	298.0745202	4.175027315	3.169095451	0	3096.184727											3400	$100 days 1-7;$0 days 8-90	$100 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $100, 9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	75.12131465	52.54732954	43.13699935	0	100	0.174395192	0.140183477	49.68932039	64.98054475	0	0.079803026	0	0.174395192	24.32786885	0	19.54976353	20	20	0	20	0.166873932	0	0	0	0	10	0	0	0	0											NO	70.95787194	49.63500302	40.74622082	0	94.45770786	0.164729701	0.132414099	46.93539309	61.37913313	0	0.075380109	0	0.164729701	22.97954729	0	18.46625853	18.89154157	18.89154157	0	18.89154157	0.157625291	0	0	0	0	10	0	0	0	0												9.2183	0.009958659	2.091035513	0	3.851290872	1.173048147	0.879379613	0.882314534	1.727391877	0	0.254477032	0	0.003323322	0.102333315	0	5.630551355	0.570425795	0.748567767	0	0.179446691	6.132095185	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7024	0	NO	1.962907899	9.2183	0.009958659	2.091035513	0	3.851290872	1.173048147	0.879379613	0.882314534	1.727391877	0	0.254477032	0	0.003323322	0.102333315	0	5.630551355	0.570425795	0.748567767	0	0.179446691	6.132095185	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7024	NO																																										0	0	0	0	0	0	0	0	0	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	9.2183	0.009958659	2.091035513	0	3.851290872	1.173048147	0.879379613	0.882314534	1.727391877	0	0.254477032	0	0.003323322	0.102333315	0	5.630551355	0.570425795	0.748567767	0	0.179446691	6.132095185	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7024
H5427_070_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	2336.606055	13.80896926	1336.634415	545.7969729	681.8998953	12.04710301	10.54517855	268.1330512	392.9078373	3114.743615	6.042052838	0	0.085107841	81.63405434	9116.812326	4934.190251	302.4400727	829.2962592	5375.162563	158.9908472	64.38316066	0	71.32678896	264.414928	599.6597966	298.0745202	5.448347777	3.169095451	0	4046.370832											3400	$95 days 1-7;$0 days 8-90	$95 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20.0%	"11b1: 20%,11b2: 20%,17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$200	12: 20%	"31-33: $15-$200 ,5: $95, 9a2: $200"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	71.36524892	49.91996306	43.13699935	0	100	0.179163414	0.121011777	49.90062112	69.09780776	0	0.095583874	0	0.179163414	19.77682403	0	14.83856639	15	15	0	15	0.173443146	0	0	0	0	10	0	0	0	0											NO	62.74785572	43.89209996	37.92818286	0	87.9249448	0.157529333	0.106399538	43.87509357	60.75420933	0	0.084042069	0	0.157529333	17.38876162	0	13.04680131	13.18874172	13.18874172	0	13.18874172	0.15249979	0	0	0	0	10	0	0	0	0												12.2181	0.050508722	4.224676211	0	4.996334221	1.897772106	1.122002125	0.980363559	1.98923375	0	0.507786619	0	0.013406981	0.118292926	0	5.364616652	0.332400334	0.911447848	0	0.174740768	9.818418481	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9685	0	NO	6.141573491	12.2181	0.050508722	4.224676211	0	4.996334221	1.897772106	1.122002125	0.980363559	1.98923375	0	0.507786619	0	0.013406981	0.118292926	0	5.364616652	0.332400334	0.911447848	0	0.174740768	9.818418481	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9685	NO																																										0	0	0	0	0	0	0	0	0	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	12.2181	0.050508722	4.224676211	0	4.996334221	1.897772106	1.122002125	0.980363559	1.98923375	0	0.507786619	0	0.013406981	0.118292926	0	5.364616652	0.332400334	0.911447848	0	0.174740768	9.818418481	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9685
H5427_072_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	1449.868221	4.196738464	683.6143603	221.8605456	419.8112497	5.964744812	6.271542433	220.5329802	339.461072	3089.346562	2.959810274	0	0.135004976	44.41201352	8585.167537	3975.239393	105.0114107	490.52001	4090.799449	52.34638755	45.38012183	0.136694228	61.57947106	264.414928	600.0098482	298.0745202	3.860482769	3.169095451	0	4727.629001											3400	$150 days 1-10;$0 days 11-90	$150 days 1-10;$0 days 11-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%,17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$200	12: 20%	"31-33: $25-$200 ,5: $150, 9a2: $200"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	125.8683472	94.01262121	43.13699935	0	100	0.183592414	0.096135333	50.44921875	64.50879321	0	0.058093094	0	0.183592414	12.22772277	0	24.59980767	25	25	0	25	0.176173057	0	0	0	0	10	0	0	0	0											NO	113.6410921	84.8799335	38.9465328	0	90.2856791	0.165757657	0.086796438	45.64328616	58.24220203	0	0.052449744	0	0.165757657	11.03988254	0	22.21010341	22.57141977	22.57141977	0	22.57141977	0.159059041	0	0	0	0	10	0	0	0	0												13.7304	0.029684907	2.218700759	0	3.158578648	0.988702127	0.544347545	0.838820827	1.647580028	0	0.155241291	0	0.022378109	0.040858618	0	7.357539832	0.197521386	0.922644421	0	0.098461024	7.21811866	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.418	0	NO	4.212532456	13.7304	0.029684907	2.218700759	0	3.158578648	0.988702127	0.544347545	0.838820827	1.647580028	0	0.155241291	0	0.022378109	0.040858618	0	7.357539832	0.197521386	0.922644421	0	0.098461024	7.21811866	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.418	NO																																										0	0	0	0	0	0	0	0	0	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	13.7304	0.029684907	2.218700759	0	3.158578648	0.988702127	0.544347545	0.838820827	1.647580028	0	0.155241291	0	0.022378109	0.040858618	0	7.357539832	0.197521386	0.922644421	0	0.098461024	7.21811866	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.418
H5427_076_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	3100.54144	7.484842277	1100.778295	557.5365753	851.3929062	36.66484313	8.452980437	367.4972256	421.8622097	3114.36677	4.448135112	0	0.255362825	78.62134586	11493.73131	5613.536852	377.3578256	657.0968976	6288.120841	122.0421348	70.97893295	0	78.57413798	264.414928	599.8240979	298.0745202	5.227230398	3.169095451	0	4305.488828											3400	$95 days 1-7;$0 days 8-90	$95 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 0%-20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$200	12: 20%	"31-33: $15-$200 ,5: $95, 9a2: $200"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	71.36524892	49.91996306	43.13699935	0	100	0.170190188	0.114277083	49.95844565	69.50768833	0	0.081093368	0	0.170190188	18.17501765	0	14.78255981	15	15	0	15	0.163090085	0	0	0	0	10	0	0	0	0											NO	59.54130125	41.6491164	35.98996868	0	83.43178529	0.141992712	0.095343411	41.7101698	57.99150529	0	0.067657645	0	0.141992712	15.1637417	0	12.33335357	12.51476779	12.51476779	0	12.51476779	0.13606897	0	0	0	0	10	0	0	0	0												15.3842	0.025978089	3.301414696	0	5.919435846	5.206140518	0.805935985	1.277364307	2.038702047	0	0.300950344	0	0.03625966	0.099349482	0	5.769477896	0.393545464	0.685284591	0	0.127277415	9.658030264	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2777	0	NO	10.13254532	15.3842	0.025978089	3.301414696	0	5.919435846	5.206140518	0.805935985	1.277364307	2.038702047	0	0.300950344	0	0.03625966	0.099349482	0	5.769477896	0.393545464	0.685284591	0	0.127277415	9.658030264	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2777	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.3842	0.025978089	3.301414696	0	5.919435846	5.206140518	0.805935985	1.277364307	2.038702047	0	0.300950344	0	0.03625966	0.099349482	0	5.769477896	0.393545464	0.685284591	0	0.127277415	9.658030264	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2777
H5427_077_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	2056.207475	5.404435278	766.7710466	298.2037735	564.8227358	24.44551284	5.64285327	292.2303062	374.0547919	3111.371315	3.887365334	0	0.497222112	60.06857969	9727.000069	4629.02677	243.8369088	481.7555689	5339.705883	57.94310966	48.97653821	0	65.73860334	264.414928	600.103862	298.0745202	9.143928079	3.169095451	0	4651.479668											3400	$150 days 1-10;$0 days 11-90	$150 days 1-10;$0 days 11-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 0%-20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$200	12: 20%	"31-33: $25-$200 ,5: $150, 9a2: $200"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	125.8683472	94.01262121	43.13699935	0	100	0.178382219	0.126231607	50.29691211	65.05190311	0	0.041383582	0	0.178382219	33.13609467	0	24.56090012	25	25	0	25	0.171996439	0	0	0	0	10	0	0	0	0											NO	105.4666335	78.77432953	36.14502136	0	83.79122773	0.149468651	0.105771013	42.24065179	54.50778828	0	0.034675811	0	0.149468651	27.76514055	0	20.57987975	20.94780693	20.94780693	0	20.94780693	0.144117928	0	0	0	0	10	0	0	0	0												18.0718	0.035477564	2.309579654	0	3.94393254	3.653837829	0.596850308	1.02866655	1.69907495	0	0.134797547	0	0.074319118	0.13898438	0	7.938734524	0.425654041	0.840976887	0	0.101148423	7.058397206	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3006	0	NO	9.292534196	18.0718	0.035477564	2.309579654	0	3.94393254	3.653837829	0.596850308	1.02866655	1.69907495	0	0.134797547	0	0.074319118	0.13898438	0	7.938734524	0.425654041	0.840976887	0	0.101148423	7.058397206	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3006	NO																																										0	0	0	0	0	0	0	0	0	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	18.0718	0.035477564	2.309579654	0	3.94393254	3.653837829	0.596850308	1.02866655	1.69907495	0	0.134797547	0	0.074319118	0.13898438	0	7.938734524	0.425654041	0.840976887	0	0.101148423	7.058397206	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3006
H5427_078_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	2307.227693	3.374990225	1003.389152	354.2179798	874.0432501	17.98813649	9.509424132	654.3811688	380.8397091	3111.906729	7.328580099	0	0.998106868	96.70657668	9156.6817	4166.387969	897.3066554	728.2034004	5323.975972	125.9595071	55.39430568	0	369.5558714	517.9310061	599.6597966	298.0745202	5.988527568	3.169095451	0	4323.919308											6700	$0 	$0 	$0 days 1-8;$40 days 9-100	$0 	10a: $100	11a: $0 or 20%	"11b1: 20%,11b2: 20%"	"4a1: $50,4a2: $500"	$0 	$0 	"8b3: 20%,8b4: 20%"	$0 	12: 20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	0	0	18.16294709	0	100	0.162009308	0.123775271	49.89444053	0	0	0.085387815	0	0.162009308	0	0	0	0	0	0	0	0.153044741	0	0	0	0	10	0	0	0	0											NO	0	0	18.16294709	0	100	0.162009308	0.123775271	49.89444053	0	0	0.085387815	0	0.162009308	0	0	0	0	0	0	0	0.153044741	0	0	0	0	10	0	0	0	0												0	0	1.518708674	0	7.283693751	2.914245536	1.177031546	2.72083186	0	0	0.62577144	0	0.161702603	0	0	0	0	0	0	0	8.477807193	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1282	0	NO	0	0	0	1.518708674	0	7.283693751	2.914245536	1.177031546	2.72083186	0	0	0.62577144	0	0.161702603	0	0	0	0	0	0	0	8.477807193	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1282	NO																																										0	0	0	0	0	0	0	0	0	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	1.518708674	0	7.283693751	2.914245536	1.177031546	2.72083186	0	0	0.62577144	0	0.161702603	0	0	0	0	0	0	0	8.477807193	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1282
H5427_082_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	1569.706936	3.093574427	569.5450913	162.8301816	436.8347794	6.600227978	8.131553169	227.7950121	392.7760665	3100.200471	5.891313617	0	0.060054929	93.6509666	11994.98829	4493.678846	179.1605271	685.5182406	4659.05502	134.9203903	38.00130732	0.081787969	106.491889	264.414928	600.4784667	298.0745202	5.351095035	3.169095451	0	5059.885105											3400	$195 days 1-10;$0 days 11-90	$175 days 1-10;$0 days 11-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%,17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$200	12: 20%	"31-33: $30-$200, 5: $195, 9a2: $200"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	163.6288514	109.6813914	43.13699935	0	100	0.196175068	0.103034168	50.00138	67.44948313	0	0.10788138	0	0.196175068	24.81750314	0	27.06571012	30	30	0	30	0.19003508	0	0	0	0	10	0	0	0	0											NO	138.378972	92.75624718	36.48044689	0	84.5688097	0.16590292	0.087134769	42.32549056	57.04122504	0	0.091233999	0	0.16590292	20.987867	0	22.88914888	25.37064291	25.37064291	0	25.37064291	0.160710405	0	0	0	0	10	0	0	0	0												18.1012	0.023912363	1.731438288	0	3.078549777	1.094997094	0.708541008	0.803461303	1.867035667	0	0.537488102	0	0.009963288	0.163794503	0	8.571373678	0.378784813	1.449336541	0	0.28525142	6.107205502	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1607	0	NO	8.194215208	18.1012	0.023912363	1.731438288	0	3.078549777	1.094997094	0.708541008	0.803461303	1.867035667	0	0.537488102	0	0.009963288	0.163794503	0	8.571373678	0.378784813	1.449336541	0	0.28525142	6.107205502	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1607	NO																																										0	0	0	0	0	0	0	0	0	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	18.1012	0.023912363	1.731438288	0	3.078549777	1.094997094	0.708541008	0.803461303	1.867035667	0	0.537488102	0	0.009963288	0.163794503	0	8.571373678	0.378784813	1.449336541	0	0.28525142	6.107205502	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1607
H5427_083_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	2392.422376	5.02949546	948.4376011	296.6529469	709.6473431	30.34790009	4.906627409	320.8115967	401.168392	3103.710167	4.007444262	0	0.335692656	67.11771981	11688.20584	4914.426472	313.8977181	528.3973043	5553.651138	86.34216037	53.17625118	0	61.47997834	264.414928	599.9550842	298.0745202	7.061038451	3.169095451	0	4915.131815											3400	$195 days 1-10;$0 days 11-90	$175 days 1-10;$0 days 11-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$200	12: 20%	"31-33: $30-$200, 5: $195, 9a2: $200"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	163.6288514	109.6813914	43.13699935	0	100	0.18330081	0.120727256	50.01026437	64.76076785	0	0.050698263	0	0.18330081	21.1284527	0	28.61364866	30	30	0	30	0.178531847	0	0	0	0	10	0	0	0	0											NO	124.4801193	83.43976365	32.81633268	0	76.07467646	0.139445498	0.09184287	38.1312044	49.26654462	0	0.038568539	0	0.139445498	16.07340203	0	21.76774064	22.82240294	22.82240294	0	22.82240294	0.135817525	0	0	0	0	10	0	0	0	0												24.8174	0.034971659	2.593686987	0	4.498849335	4.231878041	0.450638742	1.019411047	1.64701504	0	0.154561271	0	0.04681083	0.089900841	0	8.914663403	0.596991684	1.004941349	0	0.164211298	7.222266817	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7366	0	NO	18.07689739	24.8174	0.034971659	2.593686987	0	4.498849335	4.231878041	0.450638742	1.019411047	1.64701504	0	0.154561271	0	0.04681083	0.089900841	0	8.914663403	0.596991684	1.004941349	0	0.164211298	7.222266817	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7366	NO																																										0	0	0	0	0	0	0	0	0	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	24.8174	0.034971659	2.593686987	0	4.498849335	4.231878041	0.450638742	1.019411047	1.64701504	0	0.154561271	0	0.04681083	0.089900841	0	8.914663403	0.596991684	1.004941349	0	0.164211298	7.222266817	0	0	0	0	0.248395434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7366
H5427_084_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	907.7076547	0.486315379	451.310342	120.8632528	269.141176	3.995730363	3.507960394	143.9931834	328.7291386	3074.208009	3.49186398	0	0.213148039	40.74277172	5982.231595	3163.595563	172.6411073	397.9133652	3119.781949	70.70934363	32.62232976	0.005800023	21.69334772	264.4390618	599.7858382	298.0745202	2.92701177	3.169095451	0	4398.788541											3400	$225 days 1-8;$0 days 9-90	$220 days 1-8;$0 days 9-90	$0 days 1-8;$95 days 9-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0%-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$200	12: 20%	"31-33: $30-$200, 5: $225, 9a2: $200"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	"17b2: $15, 17b3: $15"	18a3: $5	18b1: $10	$0 	$0 												NO	177.0402741	123.6632292	43.13699935	15	100	0.157287715	0.121967037	51.32718894	63.08033912	0	0.088830441	0	0.157287715	44.82084691	0	28.99782703	30	30	0	30	0.152354844	0	0	0	0	15	1.466165414	10	0	0											NO	163.4747459	114.1876619	39.83167131	13.85064049	92.33760326	0.145235706	0.112621439	47.53553842	58.24687327	0	0.0820239	0	0.145235706	41.38649579	0	26.77589848	27.70128098	27.70128098	0	27.70128098	0.140680811	0	0	0	0	15	1.466165414	10	0	0												12.3656	0.004627601	1.4980371	0.139502789	2.070987595	0.580322721	0.395071548	0.570399459	1.595620373	0	0.286416303	0	0.030956706	0.140516713	0	7.059009468	0.398531652	0.918559161	0	0.163228283	4.589335819	0	0	0	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	33.1823	0	NO	2.720545995	12.3656	0.004627601	1.4980371	0.139502789	2.070987595	0.580322721	0.395071548	0.570399459	1.595620373	0	0.286416303	0	0.030956706	0.140516713	0	7.059009468	0.398531652	0.918559161	0	0.163228283	4.589335819	0	0	0	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	33.1823	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	12.3656	0.004627601	1.4980371	0.139502789	2.070987595	0.580322721	0.395071548	0.570399459	1.595620373	0	0.286416303	0	0.030956706	0.140516713	0	7.059009468	0.398531652	0.918559161	0	0.163228283	4.589335819	0	0	0	0	0.37259315	0.000357624	0.002640913	0	0	0	0	0	0	0	0	0	0	0	0	33.1823
H5427_087_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	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	2057.238126	3.009307919	894.6713086	315.8382396	779.3401161	16.49559495	8.720392397	583.478559	339.5754879	3249.562514	6.720500978	0	0.915290287	86.22835847	8302.905535	3798.501053	800.0829168	649.3021054	4747.119837	112.3117155	50.79803734	0	329.5142611	528.0766445	597.1013463	289.5007344	5.644322308	3.077939904	0	4199.546523											6700	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a2: $500	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.241250612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2413	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	0.241250612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2413	NO																																										0	0	0	0	0	0	0	0	0	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	0.241250612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2413
H5428_001_0	2012	6																															A	A	D		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	261.2672639	29.94222291	1528.501251	0	20.67090341	23.63396807	8.619588764	17.0802008	58.56068847	26.86511952	37.90277689	0	2.350211679	65.83586603	78.96450544	132.793871	11.09194416	2.432491241	25.36124004	4.311908264	25.69400349	1.015907881	0	2496.2977	0	0	0	0	0	0											3400	1A Inpatient Hospital - Acute: $756 per Admit	1B Inpatient Psychiatric Hospital: $756 per Admit	2 Skilled Nursing Facility: $69 per Day	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	Standard FFS	10B Transportation: 50 one-way rides at $0	16A Preventative Dental Services (Non Medicare Covered): $0; 16B Comprehensive Dental (Non Medicare Covered): $0 - $20	"17A Routine Eye Exams (Non Medicare Covered): $0 cost sharing, 1 exam annually"	"17B Eye Wear (Non Medicare Covered): $0 cost sharing, $150 annual limit"	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14C Health Education/Wellness Program: Covered at $0 cost sharing	"13A Acupuncture, 13B Other-the-counter Rx, 13C Meal Benefit, 13D Other 1, 13E Other 2: Not Covered"											0	NO	756	756	69	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	3.730790917	0	0	0	0	0	0											NO	565.9197584	565.9197584	51.65140652	0	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0.167679928	0	2.792762294	0	0	0	0	0	0												12.3214	1.41207463	6.57910329	0	3.466095605	3.962942074	1.445332027	2.864006848	9.819452051	4.504741318	6.355534917	0	0.394083326	11.0393533	13.24076262	22.26686678	1.859896403	0.407879957	4.252570915	0.723020469	4.308368666	0.170347361	0	0.580963841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.9748	0	NO	37.60990533	12.3214	1.41207463	6.57910329	0	3.466095605	3.962942074	1.445332027	2.864006848	9.819452051	4.504741318	6.355534917	0	0.394083326	11.0393533	13.24076262	22.26686678	1.859896403	0.407879957	4.252570915	0.723020469	4.308368666	0.170347361	0	0.580963841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.9748	NO																																										0	0	0	0	0	0	0	0	0	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	12.3214	1.41207463	6.57910329	0	3.466095605	3.962942074	1.445332027	2.864006848	9.819452051	4.504741318	6.355534917	0	0.394083326	11.0393533	13.24076262	22.26686678	1.859896403	0.407879957	4.252570915	0.723020469	4.308368666	0.170347361	0	0.580963841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.9748
H5429_001_0	2012	8																															D	D	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	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	147.3307549	1.790558406	188.327339	0	61.57782146	1.460662965	0.942707516	62.68094735	7.956794212	0	1.132050875	0	0.02392729	3.949674225	740.7098637	2274.46617	52.36997279	77.47193368	2.025309851	3.481235608	5.76279339	1.089801245	0	994.5	0	0	15.35567745	0	0	0											6700	$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-25, $146/Day for Days 26-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	No Cost Sharing; PBP 8a	$0-$100 or 0%-25% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit or 25% Coinsurance for Cardiac Rehab; $25/Visit or 25% Coinsurance for Pulmonary Rehabilitation Services; $25/Visit or 25% Coinsurance for CORF; 25% Coinsurance for OP - Other; $25/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$5/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $25/Visit for SPC OV; $25/Visit for SPC - Other; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare;  $10-$25/Exam for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services; PBP 7e, 7h"	"$25/Visit or 25% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"25% Coinsurance for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$5-$25(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 1/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	$0/Visit Advantica Eye Care - Optometry; PBP 17a	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Exam (non-cvd); PBP 18a	"$0 copay, $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b"	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	268	239	80.70410204	0	125	0.2	0.2	44.41885867	0.2245689	0	0.247775715	0	0.2	0.201388517	5	24.83538596	25	25	0.24377419	0.252179405	0.2	0.2	0	4	0	0	10	0	0	0											NO	240.7849819	214.7298905	72.50871547	0	112.3064281	0.179690285	0.179690285	39.90818687	0.201764248	0	0.222614444	0	0.179690285	0.1809378	4.492257124	22.3133879	22.46128562	22.46128562	0.219019269	0.226570946	0.179690285	0.179690285	0	4	0	0	10	0	0	0												2.9563	0.032040534	1.137947786	0	0.576298765	0.262466944	0.169395382	0.208456913	1.605396604	0	0.252010877	0	0.004299502	0.714645366	0.277288264	4.229253828	0.098024743	0.145009936	0.443581882	0.788746845	1.035517987	0.195826696	0	0.3315	0	0	0.012796398	0	0	0	0	0	0	0	0	0	0	0	0	0	15.4768	0	NO	1.710365049	2.9563	0.032040534	1.137947786	0	0.576298765	0.262466944	0.169395382	0.208456913	1.605396604	0	0.252010877	0	0.004299502	0.714645366	0.277288264	4.229253828	0.098024743	0.145009936	0.443581882	0.788746845	1.035517987	0.195826696	0	0.3315	0	0	0.012796398	0	0	0	0	0	0	0	0	0	0	0	0	0	15.4768	YES	$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-25, $146/Day for Days 26-100 for SNF; PBP 2"	30% Coinsurance for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosth/Supplies; 25% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	30% Coinsurance for Lab Services; 30% Coinsurance for Pathology; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	30% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit or 25% Coinsurance for Cardiac Rehab; $25/Visit or 25% Coinsurance for Pulmonary Rehabilitation Services; $25/Visit or 25% Coinsurance for CORF; 25% Coinsurance for OP - Other; $40/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$25/Visit for PCP OV; PBP 7a, 14a-b"	"$40/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $25/Exam or 30% Coinsurance for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$25/Visit or 25% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Phys Rad; 30% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$25-$40(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"30% Coinsurance for Preventative Dental; PBP 16a, 16b"	30% Coinsurance for Routine Eye Exams (non-cvd); 30% Coinsurance for Advantica Eye Care - Optometry; PBP 17a	"30% Coinsurance, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	30% Coinsurance for Routine Hearing Exam (non-cvd); PBP 18a	30% Coinsurance for Hearing Aids (non-cvd); PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											6700	16.9348	0.068	4.6582	2.435	0.3684	0.5742	0.3501	1.1113	8.8469	0.2518	2.6845	0	0.0103	1.6176	6.664	13.975	0.1086	0.8322	9.28	2.3305	7.5584	0.5451	0	1.0997	0.1745	0.4346	0.0612	0.0224	0	0											82.9973	0	NO	9.178281613	19.891	0.099995411	5.796150066	2.434984123	0.94470721	0.836658424	0.519496576	1.319799522	10.45228499	0.251790632	2.936536906	0	0.01455811	2.332248174	6.941303674	18.20425135	0.206648794	0.977195748	9.723589862	3.119246665	8.593908834	0.740975636	0	1.431237958	0.174462961	0.434555331	0.074039952	0.022448148	0	0	0	0	0	0	0	0	0	0	0	0	98.4741
H5430_001_0	2012	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	YES	308.1962992	13.59202749	40.81955565	6.935132219	15.06488519	8.617134081	6.775152532	32.89041531	0	0.951951672	2.576307719	0	0	95.36796367	24.54916331	46.46677112	2.219687688	0	0	201.6810836	18.0688188	0	1.826666667	19.89867187	7.282566622	0.995727269	0	3.895333946	0	9.315833333											3000	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 - $75 per quarter.													0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0	0												25.6187	1.129833498	5.522700547	0	3.374534282	1.930238034	1.517634167	7.367453029	0	0.213237175	0.577092929	0	0	21.36242386	5.499012582	10.40855673	0.497210042	0	0	45.17656272	4.047415411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.2426			0	25.6187	1.129833498	5.522700547	0	3.374534282	1.930238034	1.517634167	7.367453029	0	0.213237175	0.577092929	0	0	21.36242386	5.499012582	10.40855673	0.497210042	0	0	45.17656272	4.047415411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.2426	NO																																																																																		0				25.6187	1.129833498	5.522700547	0	3.374534282	1.930238034	1.517634167	7.367453029	0	0.213237175	0.577092929	0	0	21.36242386	5.499012582	10.40855673	0.497210042	0	0	45.17656272	4.047415411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.2426
H5431_001_0	2012	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	YES	1763.292719	55.90202887	430.0021425	3.095217337	591.4782684	9.246076975	2.976110222	1508.886384	477.8573058	8805.624605	8804.975343	0	6.006464502	153.8752466	10146.6316	11781.16458	370.97601	611.3093056	2549.99789	908.3366093	4.296867659	0	294.3167606	763.5203928	203.9751816	149.1104813	21.72243248	7.05759579	0	15237.12814											3400	"1a1: $0,1a2: $0"	1b1: $200 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $25	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0,14b2: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b4: $0 limited to $2400 every year,16b5: $0 limited to $2400 every year,16b6: $0 limited to $2400 every year"	17a2: $0	"17b2: $0 limited to Max cov combined for all supp($100),17b3: $0 limited to Max cov combined for all supp($100)"	"18a2: $0,18a3: $0"	18b3: $0 limited to $700 every two years	n/a	13b: $0											0	NO	0	86.0089272	0	0	25	0	0	49.16092943	0	0	0	0	0	0	0	0	0	0	0	0	0.199978231	0	0	0	0	0	0	0	0	0											NO	0	86.0089272	0	0	25	0	0	49.16092943	0	0	0	0	0	0	0	0	0	0	0	0	0.199978231	0	0	0	0	0	0	0	0	0												0	0.400672794	0	0	1.232246393	0	0	6.18152142	0	0	0	0	0	0	0	0	0	0	0	0	0.859279993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6737	0	NO	0	0	0.400672794	0	0	1.232246393	0	0	6.18152142	0	0	0	0	0	0	0	0	0	0	0	0	0.859279993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6737	NO																																										0	0	0	0	0	0	0	0	0	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	0.400672794	0	0	1.232246393	0	0	6.18152142	0	0	0	0	0	0	0	0	0	0	0	0	0.859279993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6737
H5431_002_0	2012	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	YES	1391.887743	27.05700206	371.3963718	3.135526105	616.2929108	9.387286776	3.463766155	1678.065265	410.755195	11343.14625	11343.89737	0	3.011315442	113.7499702	10908.58194	10503.43957	261.3684999	637.5616473	2968.595647	782.3875624	7.048386108	0	304.9238526	918.7010796	192.7371194	140.895203	16.64501178	5.407947067	0	12392.38917											3400	"1a1: $0,1a2: $0"	1b1: $200 days 1-5;$0 days 6-90	21: $0 days 1-6;$25 days 7-25;$0 days 26-100	6: $0	10a: $25	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $25,4a2: $25,4b: $25"	"9a1: $50,9b: $50"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0,14b2: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $10,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b4: $0 limited to $2400 every year,16b5: $0 limited to $2400 every year,16b6: $0 limited to $2400 every year"	17a2: $10	"17b2: $0 limited to Max cov combined for all supp($100),17b3: $0 limited to Max cov combined for all supp($100)"	"18a2: $0,18a3: $0"	18b3: $0 limited to $700 every two years	n/a	13b: $0											0	NO	0	86.0089272	13.65946557	0	25	0	0	25	50	0	0	0	0	0	0	0.065853582	0	0	0	0	0.199263462	0	0	0	10	0	0	0	0	0											NO	0	86.00485193	13.65881836	0	24.99881545	0	0	24.99881591	49.99763091	0	0	0	0	0	0	0.065850462	0	0	0	0	0.19925402	0	0	0	10	0	0	0	0	0												0	0.193919455	0.422736298	0	1.283882728	0	0	3.495803721	1.711398886	0	0	0	0	0	0	0.057638029	0	0	0	0	1.404419268	0	0	0	0.160614266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7304	0	NO	0.000406009	0	0.193919455	0.422736298	0	1.283882728	0	0	3.495803721	1.711398886	0	0	0	0	0	0	0.057638029	0	0	0	0	1.404419268	0	0	0	0.160614266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7304	NO																																										0	0	0	0	0	0	0	0	0	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	0.193919455	0.422736298	0	1.283882728	0	0	3.495803721	1.711398886	0	0	0	0	0	0	0.057638029	0	0	0	0	1.404419268	0	0	0	0.160614266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7304
H5431_005_0	2012	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	YES	1125.669687	26.07660797	207.7683445	3.153482727	337.6037978	9.441051598	2.002302797	1209.201401	484.776911	7360.763624	7363.904144	0	15.6845246	107.164596	8178.508031	8849.708247	225.5674923	519.9521401	1914.043303	661.8304611	2.121656174	0	185.3482482	665.7215993	135.3103492	108.5016741	18.73902034	6.088288279	0	9841.515902											3400	1a1: $0	1b1: $100 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $25	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $25"	"9a1: $100,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0,14b2: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b4: $0 limited to $2400 every year,16b5: $0 limited to $2400 every year,16b6: $0 limited to $2400 every year"	17a2: $0	"17b2: $0 limited to Max cov combined for all supp($100),17b3: $0 limited to Max cov combined for all supp($100)"	"18a2: $0,18a3: $0"	18b3: $0 limited to $700 every two years	n/a	13b: $0											0	NO	0	43.0044636	0	0	25	0	0	49.71134197	23.99318249	0	0	0	0	0	0	0	0	0	0	0	0.199978392	0	0	0	0	0	0	0	0	0											NO	0	43.0044636	0	0	25	0	0	49.71134197	23.99318249	0	0	0	0	0	0	0	0	0	0	0	0.199978392	0	0	0	0	0	0	0	0	0												0	0.093450878	0	0	0.703341245	0	0	5.009252029	0.969278408	0	0	0	0	0	0	0	0	0	0	0	0.424285389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1996	0	NO	0	0	0.093450878	0	0	0.703341245	0	0	5.009252029	0.969278408	0	0	0	0	0	0	0	0	0	0	0	0.424285389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1996	NO																																										0	0	0	0	0	0	0	0	0	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	0.093450878	0	0	0.703341245	0	0	5.009252029	0.969278408	0	0	0	0	0	0	0	0	0	0	0	0.424285389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1996
H5431_006_0	2012	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	YES	1790.007189	47.85139477	416.9324593	3.333315827	665.6265209	10.03208045	5.288571628	1854.662852	497.4666331	10030.0475	10037.76534	0	1.607358038	199.8573042	11771.04791	12515.0728	384.255338	1054.241643	2794.626681	832.1388184	3.928705012	16.97027077	206.6731238	1133.317075	133.50736	97.14438542	19.75478478	6.418309092	12885.68996	24663.71516											3400	"1a1: $0,1a2: $0"	1b1: $200 days 1-5;$0 days 6-90	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0,14b2: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b4: $0 limited to $2400 every year,16b5: $0 limited to $2400 every year,16b6: $0 limited to $2400 every year"	17a2: $0	"17b2: $0 limited to Max cov combined for all supp($200),17b3: $0 limited to Max cov combined for all supp($200)"	"18a2: $0,18a3: $0"	18b3: $0 limited to $700 every two years	n/a	13b: $0											0	NO	0	86.0089272	0	0	0	0	0	49.3584163	0	0	0	0	0	0	0	0	0	0	0	0	0.199422623	0	0	0	0	0	0	0	0	0											NO	0	86.0089272	0	0	0	0	0	49.3584163	0	0	0	0	0	0	0	0	0	0	0	0	0.199422623	0	0	0	0	0	0	0	0	0												0	0.342970594	0	0	0	0	0	7.628601762	0	0	0	0	0	0	0	0	0	0	0	0	0.783472657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.755	0	NO	0	0	0.342970594	0	0	0	0	0	7.628601762	0	0	0	0	0	0	0	0	0	0	0	0	0.783472657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.755	NO																																										0	0	0	0	0	0	0	0	0	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	0.342970594	0	0	0	0	0	7.628601762	0	0	0	0	0	0	0	0	0	0	0	0	0.783472657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.755
H5433_001_0	2012	5																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin		Coin																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	292.1157354	0	37.2696259	0	14.90975764	7.569807491	0	23.54185545	15.35023545	0	0	0	0	34.33731843	412.5845138	0	5.235877441	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	33.5% of Medicare-FFS Cost Sharing; PBP 1a	33.5% of Medicare-FFS Cost Sharing; PBP 1b	33.5% of Medicare-FFS Cost Sharing; PBP 2	33.5% of Medicare-FFS Cost Sharing; PBP 6	33.5% of Medicare-FFS Cost Sharing; PBP 10a	33.5% of Medicare-FFS Cost Sharing; PBP 11a	33.5% of Medicare-FFS Cost Sharing; PBP 11b-c	33.5% of Medicare-FFS Cost Sharing; PBP 4a-b	33.5% of Medicare-FFS Cost Sharing; PBP 9a-b	33.5% of Medicare-FFS Cost Sharing; PBP 8a	33.5% of Medicare-FFS Cost Sharing; PBP 8b	33.5% of Medicare-FFS Cost Sharing;	33.5% of Medicare-FFS Cost Sharing; PBP 12	"33.5% of Medicare-FFS Cost Sharing; PBP 3, 5, 9c"	"33.5% of Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"33.5% of Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"33.5% of Medicare-FFS Cost Sharing; PBP 7e, 7h"	"33.5% of Medicare-FFS Cost Sharing; PBP 7c, 7i"	33.5% of Medicare-FFS Cost Sharing; PBP 7d	"33.5% of Medicare-FFS Cost Sharing; PBP 7g, 18a"	33.5% of Medicare-FFS Cost Sharing; PBP 15	"33.5% of Medicare-FFS Cost Sharing; PBP 9d, 16b, 17a"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0.023412933	0	0.047497828	0	0.074827139	0.074827139	0	0.074827139	0.074827139	0	0	0	0	0.074827139	0.074827139	0	0.074827139	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0.023167911	0	0.047000751	0	0.074044054	0.074044054	0	0.074044054	0.074044054	0	0	0	0	0.074044054	0.074044054	0	0.074044054	0	0	0	0	0	0	0	0	0	0	0	0	0												6.7677	0	1.75170041	0	1.103978902	0.560499236	0	1.74313442	1.136593665	0	0	0	0	2.542474265	30.54943008	0	0.387685593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5432	0	NO	0.49223768	6.7677	0	1.75170041	0	1.103978902	0.560499236	0	1.74313442	1.136593665	0	0	0	0	2.542474265	30.54943008	0	0.387685593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5432	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.7677	0	1.75170041	0	1.103978902	0.560499236	0	1.74313442	1.136593665	0	0	0	0	2.542474265	30.54943008	0	0.387685593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5432
H5434_002_0	2012	6	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	Dialysis	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	Coin	V	V	V	V	V	V	V			Coin			V						O	V	V	V	Coin	V	V	V	O	O	Coin																																									0	YES	1563.603712	52.07722022	815.703984	1320.23339	34.72196514	1219.751503	68.50269357	219.7182744	220.9470538	307.3625085	1.940715796	0	14.60205384	712.1562479	5362.965631	14640.83202	339.0920531	1892.57093	0	0	52.21207138	0	0	0	0	0	0	0	0	374.5200731	201.9773007	176.2824313	460.7384205	0.016835283	212.5109496	74.88693078	542.4118154	118.5707969	0	0.180652206	6700	225 Copay for 7 days(#1A)	225 Copay for 6 days(#1B)	50 Copay for days 6 to 25(#2)	0(#6)	150 Copay(#10A)	0 Copay(#11A)	0(#11B)	65 Copay(#4A)	150 Copay(#9A)	30 Copay(#8A)	0.2 Coins(#9A)	40 Copay(#7E/7H)	25 Copay(#9A)	150 Copay(#9A)	15 Copay(#14B)	"50 Copay(#14C), 20 Copay(#7B)"	40 Copay(#7H)	50 Copay(#7I)			0.2 Coins(#15)			0(#16A)						(many)	50 Copay(#9B)	100 Copay(#8B)	75 Copay(#8B/#8A)	0.2 Coins(#9A/#12)	50 Copay(#9A)	25 Copay(#4B)	100 Copay(#8B)	5 Copay(#7G)	5 Copay(#7G)	0.2 Coins(#11A)	0	NO	135.1650896	132.2977519	26.18970013	0	141.1111111	0	0	63.82798842	145.640546	7.371611864	0.2	39.64075099	8.189655172	87.70418102	10.91885389	30.62778117	39.64075099	26.89934272	0	0	0.185972777	0	0	0	0	0	0	0	0	47.16507595	48.81669643	91.40991006	37.68061955	0.2	48.23244814	22.43690098	26.84099929	4.96868476	5	0.137100678	YES	125.0453064	124.881572	23.49860716	0	122.5512816	0	0	61.9638353	138.2565712	6.553430046	0.14807491	38.89768435	2.586206897	82.0845199	10.60587556	29.04025046	38.89768435	26.48874257	0	0	0.13703714	0	0	0	0	0	0	0	0	44.93572596	48.43981201	88.80498966	37.19646139	0.188957002	47.87430224	22.3561927	22.33579227	4.96868476	5	0.137100678	10000	16.2934	0.541957094	1.597325623	0	0.354601777	0	0	1.134548914	2.545615173	0.167856558	0.287371318	0	0.003146994	4.871416975	4.739912175	35.43111907	1.09915797	4.177652013	0	0	7.15499294	0	0	0	0	0	0	0	0	1.402444281	0.815311873	1.30456329	1.428153239	0.003181145	0.847817786	0.139515555	1.009599803	0.049095076	0	0.02476754	87.4246	0	NO	7.280574467	16.2934	0.541957094	1.597325623	0	0.354601777	0	0	1.134548914	2.545615173	0.167856558	0.287371318	0	0.003146994	4.871416975	4.739912175	35.43111907	1.09915797	4.177652013	0	0	7.15499294	0	0	0	0	0	0	0	0	1.402444281	0.815311873	1.30456329	1.428153239	0.003181145	0.847817786	0.139515555	1.009599803	0.049095076	0	0.02476754	87.4246	YES	0.3 Coins 1000 Ded(#1A)	0.3 Coins 1000 Ded(#1B)	0.3 Coins 1000 Ded(#2)	0(#6)	150 Copay (#10A)	0.3 Coins 1000 Ded(#11A)	0(#11B)	65 Copay (#4A)	0.3 Coins 1000 Ded(#9A)	0.3 Coins 1000 Ded(#8A)	0(#9A)	0(#7E/7H)	25 Copay (#9A)	0.3 Coins 1000 Ded 0.3 Coins 1000 Ded(#9A)	0.3 Coins 1000 Ded(#14B)	0.3 Coins 1000 Ded(#14C)	0.3 Coins 1000 Ded(#7H)	0.3 Coins 1000 Ded(#7I)			0.3 Coins 1000 Ded(#15)			0(#16A)						(many)	0.3 Coins 1000 Ded(#9B)	0.3 Coins 1000 Ded(#8B)	0.3 Coins 1000 Ded(#8B/#8A)	0.3 Coins (#9A/#12)	0.3 Coins 1000 Ded(#9A)	25 Copay 1000 Ded(#4B)	0.3 Coins 1000 Ded(#8B)	0.3 Coins 1000 Ded(#7G)	0.3 Coins 1000 Ded(#7G)	0.3 Coins 1000 Ded(#11A)	10000	9.9401	0.5759	1.011	0	2.3279	3.1342	0.3491	0.2919	2.2301	2.3866	0.103	0.02	0.0435	1.6603	3.2004	10.0695	0.7231	1.9556	0	0	0.736	0	0	0	0	0	0	0	0	0.0054	5.6481	1.5694	1.3675	0	0.1907	0.0276	0.217	0.015	0	0	49.799	1000	NO	4.391608767	26.2336	1.117844377	2.608307312	0	2.682464033	3.134229982	0.349092467	1.426464191	4.775752406	2.554413324	0.390377428	0.019955253	0.046675526	6.53172356	7.940325681	45.50063673	1.822226572	6.133235836	0	0	7.891006665	0	0	0	0	0	0	0	0	1.407882662	6.463362771	2.874013182	2.795687934	0.003181145	1.038488668	0.167151302	1.226642747	0.064073892	0	0.02476754	137.2236
H5434_801_0	2012	4																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	192.5618791		15.24803972		1.354158359	18.61370949		18.98178992	50.52759463					36.60504915						294.0743634	43.29780126	0								6.892656929											3400	9.2% coinsurance		16.8% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											0	NO	0.091613876		0.168429226		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224								0.224											YES	0.07031151		0.124551283		0.186192655	0.186192655		0.186192655	0.186192655					0.186192655						0.186192655	0.186192655	0.186192655								0.186192655											3400	13.5393	0	1.899162903	0	0.252134341	3.465735997	0	3.534269869	9.407867014	0	0	0	0	6.815591302	0	0	0	0	0	54.7544866	8.061732589	0	0	0	0	0	0	0	0	1.283362096	0	0	0	0	0	0	0	0	0	0	103.0137	0	NO	22.37391	13.5393	0	1.899162903	0	0.252134341	3.465735997	0	3.534269869	9.407867014	0	0	0	0	6.815591302	0	0	0	0	0	54.7544866	8.061732589	0	0	0	0	0	0	0	0	1.283362096	0	0	0	0	0	0	0	0	0	0	103.0137	YES	9.2% coinsurance		16.8% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											3400	4.2525		1.0334		0.939	1.4079		0.5459	4.9087					1.975						5.738	1.1272	0								0											21.9277	1000	NO	4.981139	17.7918	0	2.932565481	0	1.191153742	4.873628064	0	4.080189238	14.31652839	0	0	0	0	8.790640642	0	0	0	0	0	60.4924985	9.188980015	0	0	0	0	0	0	0	0	1.283362096	0	0	0	0	0	0	0	0	0	0	124.9413
H5434_802_0	2012	4																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	202.7334754		20.51795596		1.313115856	22.17344769		16.08505254	59.1636224					32.62984997						265.5443489	40.60273667	0								6.955859705											3400	9% coinsurance		16.7% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											0	NO	0.089877246		0.167170168		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224								0.224											YES	0.068978686		0.123620225		0.186192655	0.186192655		0.186192655	0.186192655					0.186192655						0.186192655	0.186192655	0.186192655								0.186192655											3400	13.9843	0	2.53643433	0	0.244492528	4.128533105	0	2.994918645	11.01583196	0	0	0	0	6.075438412	0	0	0	0	0	49.44240744	7.559931357	0	0	0	0	0	0	0	0	1.295129989	0	0	0	0	0	0	0	0	0	0	99.2774	0	NO	23.86599	13.9843	0	2.53643433	0	0.244492528	4.128533105	0	2.994918645	11.01583196	0	0	0	0	6.075438412	0	0	0	0	0	49.44240744	7.559931357	0	0	0	0	0	0	0	0	1.295129989	0	0	0	0	0	0	0	0	0	0	99.2774	YES	9% coinsurance		16.7% coinsurance		22.4% coinsurance	22.4% coinsurance		22.4% coinsurance	22.4% coinsurance					22.4% coinsurance						22.4% coinsurance	22.4% coinsurance	22.4% coinsurance								22.4% coinsurance											3400	5.072		1.4997		1.2562	0.8288		0.9827	4.6219					3.1896						11.5414	2.61	0								0											31.6023	1000	NO	5.00206	19.0563	0	4.036128521	0	1.500691648	4.957374828	0	3.977581101	15.63772149	0	0	0	0	9.264998307	0	0	0	0	0	60.98384849	10.16989072	0	0	0	0	0	0	0	0	1.295129989	0	0	0	0	0	0	0	0	0	0	130.8797
H5435_001_0	2012	3																															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	NO	1197.48708	71.81734325	720.4074216	206.656228	151.27737	17.13272377	14.33045523	498.4813852	56.0543156	19.58500281	31.6751248	0	0.036663794	33.51066957	4992.402288	3631.754279	201.1110096	577.9242885	0	0	14.71293555	673.4775576	0	0	30.78169829	0	19.07922797	0	0	0												"$395 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $0 n/c (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	228.6871012	107.7372625	86.74642473	0	200	0.2	0.106435126	65	0.16	0.080393246	0.178442576	0	0.2	0.145554013	14.38127869	42.93195633	38.5	45	0	0	0.2	43.36386062	0	0	45	0	38.94669465	0	0	0											NO	193.2621666	91.04814687	73.30890941	0	169.0188607	0.169018861	0.089947719	54.94043415	0.135215089	0.067939874	0.150800804	0	0.169018861	0.123006868	14.01436031	41.83685712	37.5177259	43.85188741	0	0	0.169018861	36.6465516	0	0	45	0	38.94669465	0	0	0												19.2857	0.544903001	4.401023534	0	2.130727394	2.895753453	1.288991757	2.282231977	7.579389249	1.330602629	4.776634301	0	0.006196873	4.122042495	5.830443706	12.66176541	0.628768978	2.111922569	0	0	2.486763605	2.056719172	0	0	0.115431369	0	0.061922739	0	0	0	0	0	0	0	0	0	0	0	0	0	76.598	0	NO	10.67128044	19.2857	0.544903001	4.401023534	0	2.130727394	2.895753453	1.288991757	2.282231977	7.579389249	1.330602629	4.776634301	0	0.006196873	4.122042495	5.830443706	12.66176541	0.628768978	2.111922569	0	0	2.486763605	2.056719172	0	0	0.115431369	0	0.061922739	0	0	0	0	0	0	0	0	0	0	0	0	0	76.598	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)"	"$0 n/c (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7, 14d, 14e)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											6200	0	0	0	0	0	0	0	0	0	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	19.2857	0.544903001	4.401023534	0	2.130727394	2.895753453	1.288991757	2.282231977	7.579389249	1.330602629	4.776634301	0	0.006196873	4.122042495	5.830443706	12.66176541	0.628768978	2.111922569	0	0	2.486763605	2.056719172	0	0	0.115431369	0	0.061922739	0	0	0	0	0	0	0	0	0	0	0	0	0	76.598
H5435_014_0	2012	5																															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	NO	1207.624143	49.77588026	509.8061674	188.2290158	146.5090754	15.02134335	15.52853236	509.0206178	64.85956712	23.98498346	35.276921	0	0.086349217	40.46667974	5313.488441	4055.909096	209.2673278	660.3983957	0	0	16.40508463	771.9932305	0	0	36.53010521	0	19.69940217	0	0	0												"$395 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $0 n/c (4b)"	20% (9b)	20% (8a1a); $19 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	228.6871012	107.7372625	87.53520356	0	200	0.2	0.106103293	65	0.16	0.144844211	0.176661362	0	0.2	0.14525512	13.66089197	42.46842158	38.5	45	0	0	0.2	43.56240755	0	0	45	0	39.0943007	0	0	0											NO	196.0724698	92.37211475	75.05120956	0	171.4766323	0.171476632	0.090971177	55.7389647	0.137181306	0.124186987	0.151466477	0	0.171476632	0.124539294	13.34245583	41.47874662	37.60256289	43.95104753	0	0	0.171476632	37.3496747	0	0	45	0	39.0943007	0	0	0												19.7318	0.38315861	3.188464125	0	2.09357357	2.57580937	1.41264886	2.364356854	8.897520112	2.978622833	5.343270944	0	0.014806873	5.039691733	5.907915401	14.01950214	0.655748988	2.418766773	0	0	2.813088665	2.402808003	0	0	0.136987895	0	0.064177863	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4427	0	NO	10.4023354	19.7318	0.38315861	3.188464125	0	2.09357357	2.57580937	1.41264886	2.364356854	8.897520112	2.978622833	5.343270944	0	0.014806873	5.039691733	5.907915401	14.01950214	0.655748988	2.418766773	0	0	2.813088665	2.402808003	0	0	0.136987895	0	0.064177863	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4427	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)"	"$0 n/c (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7, 14d, 14e)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											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	NO	0	19.7318	0.38315861	3.188464125	0	2.09357357	2.57580937	1.41264886	2.364356854	8.897520112	2.978622833	5.343270944	0	0.014806873	5.039691733	5.907915401	14.01950214	0.655748988	2.418766773	0	0	2.813088665	2.402808003	0	0	0.136987895	0	0.064177863	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4427
H5435_024_0	2012	5																															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	NO	1021.39836	30.03183045	681.2084277	97.65114151	84.72180762	15.37290683	12.05345659	418.3651754	61.92037143	20.48476682	34.56714065	0	0.115442099	40.7912405	5021.255403	3675.45598	222.1379111	649.0320502	0	0	14.96329448	710.7907507	0	0	43.00123077	0	19.89602081	0	0	0												"$395 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$135 Days 21-63 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $0 n/c (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$17 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	228.6871012	107.7372625	89.97947093	0	200	0.2	0.106445934	65	0.16	0.144439429	0.17622579	0	0.2	0.144649992	13.24859285	40.78393619	38.5	45	0	0	0.2	43.59899581	0	0	45	0	39.46973217	0	0	0											NO	199.7030845	94.08254128	78.57538876	0	174.6518132	0.174651813	0.092954877	56.77162475	0.139721451	0.126133041	0.153890769	0	0.174651813	0.126316917	12.97727424	39.94901617	37.71155653	44.0784427	0	0	0.174651813	38.07321837	0	0	45	0	39.46973217	0	0	0												16.998	0.235455911	4.460518086	0	1.23306811	2.684906052	1.120427579	1.979272562	8.651604117	2.583805934	5.31956386	0	0.020162172	5.152623724	5.430184033	12.2359042	0.6980972	2.384026837	0	0	2.613366513	2.255174289	0	0	0.161254615	0	0.065440884	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2829	0	NO	8.460458321	16.998	0.235455911	4.460518086	0	1.23306811	2.684906052	1.120427579	1.979272562	8.651604117	2.583805934	5.31956386	0	0.020162172	5.152623724	5.430184033	12.2359042	0.6980972	2.384026837	0	0	2.613366513	2.255174289	0	0	0.161254615	0	0.065440884	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2829	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)"	"$0 n/c (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7, 14d, 14e)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											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	NO	0	16.998	0.235455911	4.460518086	0	1.23306811	2.684906052	1.120427579	1.979272562	8.651604117	2.583805934	5.31956386	0	0.020162172	5.152623724	5.430184033	12.2359042	0.6980972	2.384026837	0	0	2.613366513	2.255174289	0	0	0.161254615	0	0.065440884	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2829
H5439_001_0	2012	6																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											14.48741721	0	0	0	0	1.875798772	0.383063888	0.021105622	6.060919252	0	4.524547371	0	0.001585108	2.632560215	2.06579273	12.88521801	0	0.934432693	1.824395513	0.247067746	5.373831697	0.037431803	0	0	0	0	0.114029225	0	0	0											53.4692	YES	153.4732831	4.850295722	669.8848932	22.51657383	178.0291481	11.84355325	2.427990358	243.7248141	253.3035022	6.522948075	295.8764595	0	0.86349436	413.4678204	3011.43661	3945.752949	580.1428943	430.0341794	11.36937596	25.23751429	33.97535601	0	0	0	419.9378044	0	71.54264625	0	1000	0											3400	1a:  Acute - $300/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $300/admit	2:  Skilled Nursing Services - $0/$100/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/day	11a:  Durable Medical Equipment - 10.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 ($50,000 Max)"	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 - $15/visit/8b:  Outpatient Therapeutic Radiological Services - $15/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $15/service	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit/9a:  Outpatient Hospital Services - $200/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $20/visit		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/												1000	NO	300	300	100	0	200	0.1	0.1	39.02022023	167.6636168	0	15	0	15	74.86376071	20	26.55172319	25	25	0	20.84159152	0.1	0	0	0	10	0	20	0	0	0											NO	262.0324169	262.543469	87.32896118	0	174.8595839	0.087374302	0.0874441	34.12958132	146.4994414	0	13.1149388	0	13.02690763	65.18202247	17.46392624	23.18859794	21.90778508	21.89814444	0	18.19116847	0.087398604	0	0	0	10	0	17.42353203	0	0	0												3.3512	0.106117789	4.87502932	0	2.594175229	1.034822196	0.212313431	0.693185489	3.092401797	0	0.323366805	0	0.000937388	2.245889063	4.382625569	7.624706559	1.059137154	0.784745881	0	0.038258323	2.969398673	0	0	0	0.34994817	0	0.103877132	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8422			5.139351481	17.8387	0.106117789	4.87502932	0	2.594175229	2.910620968	0.595377319	0.71429111	9.15332105	0	4.847914176	0	0.002522496	4.878449279	6.448418299	20.50992457	1.059137154	1.719178574	1.824395513	0.285326069	8.34323037	0.037431803	0	0	0.34994817	0	0.217906357	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3114	YES	1a:  Acute - $600/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $600/admit	2:  Skilled Nursing Services - 30.0% for 1-100	6:  Home Health Services - 5.0%	10a:  Ambulance - $200/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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 ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	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	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $50/day/9a:  Outpatient Hospital Services - 30.0%	7a:  Primary Care - $30/visit/17a:  Vision Exams - 10.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 10.0%/14d:  Kidney Disease Education Services - 10.0%/14e:  Diabetes Self-Management Training - 10.0%/13d:  Additional Pap Smears - 10.0%/13d:  Additional Pelvic Exams - 10.0%	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $50/visit/7f:  Podiatry Services - $35/visit/7-12 Additional Visits/17a:  Vision Exams - 10.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 10.0%/14d:  Kidney Disease Education Services - 10.0%/14e:  Diabetes Self-Management Training - 10.0%/13d:  Additional Pap Smears - 10.0%/13d:  Additional Pelvic Exams - 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%	9d:  Blood - 10.0%/9d:  3-Pints Deductible Waived - 10.0%			17a:  Routine Eye Exams - 10.0%		18a:  Routine Hearing Test - 10.0%		14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												5100	5.4943	0.0709	4.1559	0.3122	1.0439	0.9217	0.2039	0.4099	3.7615	0.4215	1.5008	0	0.0005	1.4464	2.7253	5.6703	0.5633	0.4735	0.5759	1.1291	2.6598	0.0154	0	0	0	0	0.0382	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5944			3.554017543	23.333	0.177017407	9.030933239	0.312237239	3.638124657	3.832308504	0.799293164	1.124197171	12.91486644	0.421523691	6.348677856	0	0.003069404	6.32486094	9.173700749	26.18025276	1.622413867	2.192715872	2.400339461	1.414390374	11.00299028	0.052869966	0	0	0.34994817	0	0.256116218	0	0	0	0	0	0	0	0	0	0	0	0	0	122.9058
H5439_002_0	2012	6																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											12.91172463	0	0	0	0	1.392096631	0.231507802	0.012701377	4.276612432	0	1.244913909	0	0.002564989	1.77083674	1.050519252	7.459365295	0	0.483130645	3.026095879	0.152190287	3.353500664	0.072239463	0	0	0	0	0	0	0	0											37.44	YES	105.6943337	1.724246884	357.7626107	23.1981303	118.7657087	8.240255382	1.370367092	183.5986304	190.0741089	5.654601253	112.9720706	0	1.568267097	673.851562	2461.877183	2873.475238	85.03906429	98.99422062	17.91240802	23.06594596	19.85041935	3.773206009	0	0	0	0	0	0	1000	0											3400	1a:  Acute - $200/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $200/admit	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 10.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 - $35/visit/4a:  Worldwide Coverage - $0/visit ($50,000 Max)"	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	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit/9a:  Outpatient Hospital Services - $200/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/												700	NO	200	200	125	0	250	0.1	0.037399001	40.01111436	167.6634358	0	25	0	20	115.2723026	20.00052158	27.88650895	25	25	0	25	0.1	271.9859831	0	0	0	0	0	0	0	0											NO	184.3626957	184.3626957	115.2266848	0	230.4533696	0.092181348	0.034474903	36.8827845	154.5544149	0	23.04533696	0	18.43626957	106.2595622	18.43675037	25.70615982	23.04533696	23.04533696	0	23.04533696	0.092181348	250.7203452	0	0	0	0	0	0	0	0												1.6238	0.026490567	3.435316631	0	2.280829814	0.759597848	0.047243273	0.564302393	2.448066058	0	0.216956619	0	0.002409416	5.966930997	3.782417921	6.15550114	0.163312824	0.190112931	0	0.044296875	1.829838411	0.078834959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6163			2.512	14.5356	0.026490567	3.435316631	0	2.280829814	2.151694478	0.278751075	0.577003771	6.72467849	0	1.461870529	0	0.004974405	7.737767737	4.832937173	13.61486644	0.163312824	0.673243576	3.026095879	0.196487162	5.183339075	0.151074423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0563	YES	1a:  Acute - $300/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $300/admit	2:  Skilled Nursing Services - 30.0% for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 10.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/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 ($50,000 Max)"	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	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/9a:  Outpatient Hospital Services - 30.0%	7a:  Primary Care - $30/visit/17a:  Vision Exams - 30.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 30.0%/14d:  Kidney Disease Education Services - 30.0%/14e:  Diabetes Self-Management Training - 30.0%/13d:  Additional Pap Smears - 30.0%/13d:  Additional Pelvic Exams - 30.0%	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - 30.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 30.0%/14d:  Kidney Disease Education Services - 30.0%/14e:  Diabetes Self-Management Training - 30.0%/13d:  Additional Pap Smears - 30.0%/13d:  Additional Pelvic Exams - 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 - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												5100	3.7231	0.0187	4.3366	0	0.9424	0.5933	0.1197	0.2976	3.1397	0.4357	1.4441	0	0.0013	1.2734	2.6345	4.2358	0.0836	0.1958	0.418	0.469	1.3112	0.0603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7339			1.044	18.2586	0.045236089	7.771876727	0	3.223200645	2.745027966	0.398460374	0.874649254	9.864396533	0.435730264	2.905951607	0	0.006315	9.011179082	7.467481612	17.85061698	0.24693138	0.86902216	3.44405977	0.665471306	6.494538067	0.211390233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7902
H5439_003_0	2012	6																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											15.04335016	0	0	0	0	1.389648689	0.231100706	0.011098322	4.298717052	0	2.387231341	0	0.002770907	1.540179497	1.613904831	8.352677533	0	0.519682965	2.219471148	0.145355015	3.46659694	0.066214893	0	0	0	0	0	0	0	0											41.288	YES	153.7633371	2.48651586	452.3138458	32.86864065	123.5396074	9.800035486	1.629760912	186.4289968	195.5176392	8.817574131	221.7606568	0	1.640379434	561.8048057	2760.692051	3184.534994	86.69458789	103.103048	15.65208256	26.33997776	24.44702268	3.53928638	0	0	0	0	0	0	1000	0											3400	1a:  Acute - $200/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $200/admit	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 10.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 - $35/visit/4a:  Worldwide Coverage - $0/visit ($50,000 Max)"	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	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit/9a:  Outpatient Hospital Services - $200/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/												750	NO	200	200	125	0	250	0.1	0.037399001	40.01111436	167.6634358	0	25	0	20	118.5067209	20.00053273	27.96230797	25	25	0	25	0.1	316.6458821	0	0	0	0	0	0	0	0											NO	181.9638846	181.9638846	113.7274279	0	227.4548558	0.090981942	0.034026338	36.40288899	152.5434504	0	22.74548558	0	18.19638846	107.8197164	18.19687315	25.44065091	22.74548558	22.74548558	0	22.74548558	0.090981942	288.0905738	0	0	0	0	0	0	0	0												2.3316	0.037704674	4.286707524	0	2.341640298	0.891626263	0.055454795	0.565546173	2.485411275	0	0.420337818	0	0.002487415	5.047802904	4.186330254	6.751386924	0.164325875	0.195427408	0	0.049926299	2.224237607	0.084969587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.1229			3.184	17.375	0.037704674	4.286707524	0	2.341640298	2.281274953	0.286555501	0.576644495	6.784128327	0	2.807569159	0	0.005258322	6.5879824	5.800235085	15.10406446	0.164325875	0.715110373	2.219471148	0.195281314	5.690834546	0.15118448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4109	YES	1a:  Acute - $200/admit/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $200/admit	2:  Skilled Nursing Services - 30.0% for 1-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 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 - $0/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	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	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/9a:  Outpatient Hospital Services - $200/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - 30.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 30.0%/14d:  Kidney Disease Education Services - 30.0%/14e:  Diabetes Self-Management Training - 30.0%/13d:  Additional Pap Smears - 30.0%/13d:  Additional Pelvic Exams - 30.0%	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - 30.0%/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - 30.0%/14d:  Kidney Disease Education Services - 30.0%/14e:  Diabetes Self-Management Training - 30.0%/13d:  Additional Pap Smears - 30.0%/13d:  Additional Pelvic Exams - 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 - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 30.0%/9d:  3-Pints Deductible Waived - 30.0%							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												5100	3.453	0.012	4.4951	0.8088	0.934	0.8717	0.1423	0.3066	1.7541	0.4516	1.4967	0	0.0014	2.6614	2.6819	4.3535	0.0829	0.2017	0.4498	0.5039	1.9857	0.0625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7104			2.256	20.8279	0.049717096	8.781791155	0.808760353	3.275686444	3.152930537	0.428807843	0.883272168	8.53818547	0.451605734	4.304264131	0	0.006629913	9.24935378	8.482142063	19.45756061	0.247205764	0.916853628	2.669230783	0.699137899	7.676524331	0.213705143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1213
H5439_801_0	2012	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	229.6703741	2.716883026	60.44277548	29.59005043	6.547580881	11.42578852	1.864664444	8.942685142	38.07127001	5.978897895	15.86794026	0	0.023495119	13.27154707	36.33886036	82.81766017	1.049484472	4.499321974	20.28685898	20.52205456	29.81334813	0.592025517	0	0	0	0	0	0	1000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.061184835	0.061184835	0.128513722	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056329713	0.056329713	0.118315936	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0	0	0	0	0	0	0												12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789			7.04	12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												10000	3.7428	0.044	1.9246	0	0.4701	0.8174	0.1334	0.525	2.307	0.317	1.0507	0	0.0014	1.1291	2.1479	4.8926	0.0625	0.2681	1.1304	1.2345	1.8601	0.0443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1029			1.172	16.68	0.197035365	9.075948223	0	1.82037802	3.173669673	0.517936157	2.369236735	10.15823043	1.550038045	4.323086773	0	0.006238583	3.865996699	9.64189519	21.97173025	0.278963854	1.195938828	5.314025376	5.466710777	8.008368454	0.166408914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7819
H5439_802_0	2012	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	229.6703741	2.716883026	60.44277548	29.59005043	6.547580881	11.42578852	1.864664444	8.942685142	38.07127001	5.978897895	15.86794026	0	0.023495119	13.27154707	36.33886036	82.81766017	1.049484472	4.499321974	20.28685898	20.52205456	29.81334813	0.592025517	0	0	0	0	0	0	1000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.061184835	0.061184835	0.128513722	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056329713	0.056329713	0.118315936	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0	0	0	0	0	0	0												12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789			7.04	12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												10000	3.7428	0.044	1.9246	0	0.4701	0.8174	0.1334	0.525	2.307	0.317	1.0507	0	0.0014	1.1291	2.1479	4.8926	0.0625	0.2681	1.1304	1.2345	1.8601	0.0443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1029			1.172	16.68	0.197035365	9.075948223	0	1.82037802	3.173669673	0.517936157	2.369236735	10.15823043	1.550038045	4.323086773	0	0.006238583	3.865996699	9.64189519	21.97173025	0.278963854	1.195938828	5.314025376	5.466710777	8.008368454	0.166408914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7819
H5439_803_0	2012	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	229.6703741	2.716883026	60.44277548	29.59005043	6.547580881	11.42578852	1.864664444	8.942685142	38.07127001	5.978897895	15.86794026	0	0.023495119	13.27154707	36.33886036	82.81766017	1.049484472	4.499321974	20.28685898	20.52205456	29.81334813	0.592025517	0	0	0	0	0	0	1000	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.061184835	0.061184835	0.128513722	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056329713	0.056329713	0.118315936	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0.206225212	0	0	0	0	0	0	0	0												12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789			7.04	12.9373	0.15304124	7.151343528	0	1.350276258	2.356285664	0.384540821	1.844207143	7.851255745	1.232999488	3.27236935	0	0.004845286	2.736927614	7.493989196	17.07908956	0.216430158	0.92787363	4.183661802	4.23216506	6.14826405	0.122090588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6789	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												10000	3.7428	0.044	1.9246	0	0.4701	0.8174	0.1334	0.525	2.307	0.317	1.0507	0	0.0014	1.1291	2.1479	4.8926	0.0625	0.2681	1.1304	1.2345	1.8601	0.0443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1029			1.172	16.68	0.197035365	9.075948223	0	1.82037802	3.173669673	0.517936157	2.369236735	10.15823043	1.550038045	4.323086773	0	0.006238583	3.865996699	9.64189519	21.97173025	0.278963854	1.195938828	5.314025376	5.466710777	8.008368454	0.166408914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7819
H5440_001_0	2012	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	439.0578702	22.8339	52.56714653	4091.790825	26.03141595	32.92085394	23.3382132	70.63041931	91.48123765	31.34806168	56.78887116	0	0	65.01165095	50.00656576	132.4236183	10.8166	6.290133235	0	944.3886745	34.41388332	10.54086376	527	221.2203123	50.39247754	206.4654851	0	0	161.1869294	0											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.093200864	0.094332859	0.170019735	0	0.224	0.224	0.224	0.089201352	0.224	0.224	0.224	0	0	0.224	0.221005719	0.223884246	0.224731494	0.224	0	0	0.224	0.223397134	0	0	0	0	0	0	0	0											NO	0.067981876	0.068807566	0.12401452	0	0.1633884	0.1633884	0.1633884	0.065077178	0.1633884	0.1633884	0.1633884	0	0	0.1633884	0.161204335	0.163303968	0.163921961	0.1633884	0	0	0.1633884	0.163628362	0	0	0	0	0	0	0	0												29.848	1.571145091	6.519089438	0	4.253231408	5.378885661	3.81319332	4.596428344	14.94697307	5.12190965	9.278642811	0	0	10.62214965	8.061275161	21.6253023	1.773078285	1.027734807	0	0	5.622829342	1.724784277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7846	150	YES	50.36048749	29.848	1.571145091	6.519089438	0	4.253231408	5.378885661	3.81319332	4.596428344	14.94697307	5.12190965	9.278642811	0	0	10.62214965	8.061275161	21.6253023	1.773078285	1.027734807	0	0	5.622829342	1.724784277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7846	NO																																										0	0	0	0	0	0	0	0	0	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	29.848	1.571145091	6.519089438	0	4.253231408	5.378885661	3.81319332	4.596428344	14.94697307	5.12190965	9.278642811	0	0	10.62214965	8.061275161	21.6253023	1.773078285	1.027734807	0	0	5.622829342	1.724784277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7846
H5470_002_0	2012	4	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			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	1193.67	59.4	311	930.31	24.15	12.21	7.22	370.55	317.59	2327.53	1024.91	168.13	0.25	6.89	2513.69	3515.03	95.1	629.31		1290.99	20.78	0			0.61				3.56	1.24	1153.74										4500	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $20 Lab -- FSL,8a. $20 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												141.569359	116.360647	42.474818	0	100	0.2	0.118038	65	96.558984	20	36.254286	33.259167	0.2	0.2	10	28.148459	30	39.537755		0	0.2	0			0				0	0	50										NO	119.038454	97.841733	35.999617	0	92.851	0.185702	0.109599	60.35315	89.655982	18.5702	33.662467	30.881469	0.185702	0.185702	9.2851	26.136126	27.8553	36.711201		0	0.185702	0			0				0	0	46.4255											11.8411	0.484316578	0.932990074	0	0.186862638	2.26742142	0.79130478	1.863654978	2.372820277	3.601891467	2.875083254	0.432675115	0.0464255	1.27948678	1.944988585	7.655772248	0.220753253	1.925227158	0	0	3.85888756	0	0	0	0	0	0	0	0	0	4.463579698	0	0	0	0	0	0	0	0	0	49.0452	0	NO	5.255909	11.8411	0.484316578	0.932990074	0	0.186862638	2.26742142	0.79130478	1.863654978	2.372820277	3.601891467	2.875083254	0.432675115	0.0464255	1.27948678	1.944988585	7.655772248	0.220753253	1.925227158	0	0	3.85888756	0	0	0	0	0	0	0	0	0	4.463579698	0	0	0	0	0	0	0	0	0	49.0452	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins										6000	4.3928	0.065	0.2653	1.5772	1.1429	0.5539	0.3276	0.1628	1.6544	0.4075	0.5956	0.032	0.004	0.1127	0.6777	0.9477	0.0256	0.1479		0.3481	0.4561	0			0				0	0	0.5221										14.4189	0	NO	7.935976	16.2339	0.549327578	1.198276074	1.577181	1.329714638	2.82133042	1.11892778	2.026410978	4.027225277	4.009420467	3.470662254	0.464664115	0.0504515	1.39222778	2.622711585	8.603469248	0.246393253	2.073092158	0	0.348067	4.31503556	0	0	0	0	0	0	0	0	0	4.985643698	0	0	0	0	0	0	0	0	0	63.4641
H5470_005_0	2012	4	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			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	1056.1	23.17	390.77	884.77	17.82	12.58	8.53	405.77	312	2721.88	1029.32	238.55	0.28	1.49	1982.43	3742.53	102.87	771.67		1369.62	21.2	0			0.61				3.56	1.24	2018.45										4500	"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												141.569359	116.360647	42.474818	0	100	0.2	0.117702	65	96.691408	46.876654	38.21828	38.695181	0.125004	0.2	10	28.011369	30	38.933428		0	0.2	0			0				0	0	50										NO	118.244391	97.189067	34.822598	0	90.9682	0.181936	0.107071	59.12933	87.958434	42.642849	34.766482	35.20031	0.113714	0.181936	9.09682	25.481438	27.29046	35.417039		0	0.181936	0			0				0	0	45.4841											10.4065	0.18765589	1.133968885	0	0.135087777	2.28875488	0.91331563	1.99940902	2.286919284	9.672393153	2.982152938	0.699752829	0.03183992	0.27108464	1.502817406	7.94708718	0.233947468	2.277522207	0	0	3.8570432	0	0	0	0	0	0	0	0	0	7.650615137	0	0	0	0	0	0	0	0	0	56.4779	0	NO	6.782038	10.4065	0.18765589	1.133968885	0	0.135087777	2.28875488	0.91331563	1.99940902	2.286919284	9.672393153	2.982152938	0.699752829	0.03183992	0.27108464	1.502817406	7.94708718	0.233947468	2.277522207	0	0	3.8570432	0	0	0	0	0	0	0	0	0	7.650615137	0	0	0	0	0	0	0	0	0	56.4779	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins										6000	4.2087	0.0284	0.2918	1.5109	0.8425	0.6841	0.4637	0.178	1.7344	0.454	0.5471	0.0419	0.0029	0.0243	0.5338	1.0077	0.0277	0.1834		0.3688	0.4553	0			0				0	0	0.7408										14.3301	0	NO	7.527659	14.6152	0.21602989	1.425813885	1.510946	0.977550777	2.97283688	1.37702263	2.17740502	4.021366284	10.12639615	3.529208938	0.741617829	0.03474492	0.29539264	2.036618406	8.95482618	0.261647468	2.460873207	0	0.368794	4.3123392	0	0	0	0	0	0	0	0	0	8.391388137	0	0	0	0	0	0	0	0	0	70.808
H5470_007_0	2012	4	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			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	1017.79	72.54	524.65	928.29	17.58	10.44	4.24	334.98	355.1	2353.71	881.73	150.52	0.22	2.97	2667.14	3418.25	100.49	819.24		1470.57	21.91	0			0.61				3.56	1.24	762.4										4500	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.113881	65	96.516305	47.256345	37.987899	34.605054	0.199458	0.2	10	27.239748	30	37.687723		0	0.2	0			0				0	0	50										NO	136.05096	108.853643	33.823377	0	92.1797	0.184359	0.104975	59.916805	88.968441	43.560757	35.017132	31.898835	0.183859	0.184359	9.21797	25.109518	27.65391	34.74043		0	0.184359	0			0				0	0	46.08985											11.5393	0.658020272	1.478786229	0	0.135043261	1.92470796	0.445094	1.672577612	2.63272445	8.54411578	2.572971317	0.40011772	0.04044898	0.54754623	2.048801375	7.152550825	0.231578451	2.371729156	0	0	4.03930569	0	0	0	0	0	0	0	0	0	2.928241803	0	0	0	0	0	0	0	0	0	51.3636	0	NO	6.080468	11.5393	0.658020272	1.478786229	0	0.135043261	1.92470796	0.445094	1.672577612	2.63272445	8.54411578	2.572971317	0.40011772	0.04044898	0.54754623	2.048801375	7.152550825	0.231578451	2.371729156	0	0	4.03930569	0	0	0	0	0	0	0	0	0	2.928241803	0	0	0	0	0	0	0	0	0	51.3636	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins										6000	4.0024	0.0836	0.3674	1.2955	0.8507	0.5814	0.2362	0.1505	1.6792	0.3675	0.5474	0.0286	0.0037	0.0498	0.7354	0.9424	0.0277	0.1982		0.4054	0.4675	0			0				0	0	0.4452										13.4659	0	NO	6.587815	15.5417	0.741614272	1.846216229	1.295505	0.985775261	2.50613996	0.681279	1.823033612	4.31193645	8.91165478	3.120402317	0.42875172	0.04416098	0.59733723	2.784153375	8.094990825	0.259284451	2.569947156	0	0.405448	4.50677069	0	0	0	0	0	0	0	0	0	3.373468803	0	0	0	0	0	0	0	0	0	64.8296
H5471_001_0	2012	10																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	1601.153651	634.9600695	2579.125471	321.8153674	907.884346	4900.909011	298.2790838	320.5667414	121.3626036	587.0712164	340.3230291	17.63298137	11.24163394	5453.496142	17456.49562	22234.05196	4335.22825	4164.186684	7807.989361	22559.07164	942.7981103	0.238065302	2100.600179	621.6	0	0	0	0	0	0											500	1a1: $0	1b1: $0	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $0,4a2: $0,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: ,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: $0,153: $0"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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
H5471_002_0	2012	8																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	1407.492546	281.9281074	1598.282907	223.3699085	638.0344027	2928.246235	253.7110307	306.1915497	246.8112615	791.3527901	564.6673273	13.21408721	14.4829898	3035.707166	14797.14809	31059.22525	2387.453234	5604.711569	7820.940054	20929.20639	1297.546915	0.961135778	2067.069295	611.3786414	0	0	0	0	0	0											3400	1a1: $0	1b1: $0	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $25,4a2: $25,4b: $0"	"9a1: $25,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0-$25,8b4: $0-$25,8b5: $0,8b6: $0"	9c1: $0	12: 0-20%	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 0-20%,153: $0-$50"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $0"											0	NO	0	0	0	0	0	0	0	21.49917643	7.03030936	0	0.236598434	0	2.203059507	0	0	0	0	0	0	0	14.65957603	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	21.49917643	7.03030936	0	0.236598434	0	2.203059507	0	0	0	0	0	0	0	14.65957603	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.548572179	0.144596627	0	0.011133284	0	0.002658907	0	0	0	0	0	0	0	1.58512397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2921	0	NO	0	0	0	0	0	0	0	0	0.548572179	0.144596627	0	0.011133284	0	0.002658907	0	0	0	0	0	0	0	1.58512397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2921	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	0.548572179	0.144596627	0	0.011133284	0	0.002658907	0	0	0	0	0	0	0	1.58512397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2921
H5471_003_0	2012	8																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	1222.299864	123.6259453	1094.485144	167.8624935	483.8607038	1937.480831	216.602979	276.6256639	275.8227487	808.0221714	606.8710698	10.4722882	14.5962438	1864.814035	11383.10699	29390.06258	1303.867984	5191.22161	6490.759055	16791.75207	1332.515021	1.164580681	1261.675107	485.76	0	0	0	0	0	0											3400	1a1: $50 days 1-5; $0 days 6-90	1b1: $0	21: $0 days 1-7; $15 days 8-100	6: $0	10a: $50	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $25,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0-$25,8b4: $0-$25,8b5: $0,8b6: $0"	9c1: $0	12: 0-20%	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 0-20%,153: $0-$50"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $0"											0	NO	32.42207341	0	7.576325656	0	50	0	0	42.02471463	6.816657151	0	0.241894938	0	1.782989213	0	0	0	0	0	0	0	15.56914806	0	0	0	0	0	0	0	0	0											NO	32.42207341	0	7.576325656	0	50	0	0	42.02471463	6.816657151	0	0.241894938	0	1.782989213	0	0	0	0	0	0	0	15.56914806	0	0	0	0	0	0	0	0	0												3.3025	0	0.691014656	0	2.016086266	0	0	0.968759549	0.156682426	0	0.012233253	0	0.002168745	0	0	0	0	0	0	0	1.728843638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8782	0	NO	0	3.3025	0	0.691014656	0	2.016086266	0	0	0.968759549	0.156682426	0	0.012233253	0	0.002168745	0	0	0	0	0	0	0	1.728843638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8782	NO	$0 	$0 	$0 	6: $0	10a: 25	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: 50,4a2: 50,4b: $0"	"9a1: 25,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: 0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: 20%	"31: $0,5: $0,9a2: $0,9a3: 25"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 0,153: $0"	"9d1: $0,9d2: $0"	10b: 0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $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	0	0	0	0	0											0	0	NO	0	3.3025	0	0.691014656	0	2.016086266	0	0	0.968759549	0.156682426	0	0.012233253	0	0.002168745	0	0	0	0	0	0	0	1.728843638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8782
H5471_004_0	2012	10																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	1252.008541	126.6307426	1121.087213	171.9424846	495.621207	1984.572379	221.8676347	283.3452386	282.5267738	827.6615992	621.6214083	10.72682299	14.95101362	1910.139376	12916.24065	32803.0818	1483.954688	5859.382399	7387.245066	19110.98326	1364.902539	1.192886462	631.9064683	485.76	0	0	0	0	0	0											3400	1a1: $75 days 1-5; $0 days 6-90	1b1: $0	21: $0 days 1-30; $50 days 31-100	6: $0	10a: $50	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $50,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0-$25,8b4: $0-$25,8b5: $0,8b6: $0"	9c1: $0	12: 0-20%	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: 0-20%,153: $0-$50"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $0"											0	NO	48.63311011	0	0.537404035	0	50	0	0	42.02460301	13.6333143	0	0.241894938	0	1.782607612	0	0	0	0	0	0	0	15.56806859	0	0	0	0	0	0	0	0	0											NO	48.63311011	0	0.537404035	0	50	0	0	42.02460301	13.6333143	0	0.241894938	0	1.782607612	0	0	0	0	0	0	0	15.56806859	0	0	0	0	0	0	0	0	0												5.0741	0	0.050206399	0	2.065088362	0	0	0.992289264	0.320981359	0	0.012530589	0	0.002220983	0	0	0	0	0	0	0	1.770741362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2881	0	NO	0	5.0741	0	0.050206399	0	2.065088362	0	0	0.992289264	0.320981359	0	0.012530589	0	0.002220983	0	0	0	0	0	0	0	1.770741362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2881	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	5.0741	0	0.050206399	0	2.065088362	0	0	0.992289264	0.320981359	0	0.012530589	0	0.002220983	0	0	0	0	0	0	0	1.770741362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2881
H5471_005_0	2012	8																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	988.3197204	181.9273858	1643.506628	126.3507624	590.0729124	1839.183255	248.4520694	270.4207368	157.7605662	712.6068322	246.0720252	0.343049308	8.331963213	850.7278043	13665.91967	19961.16346	1211.304401	1881.971075	4464.205962	9945.59502	1309.634928	0	606.3096842	466.4617401	0	0	0	0	0.224754515	0											3400	1a1: $50 days 1-7; $0 days 8-90	1b1: $0	21: $0 days 1-7; $50 days 8-100	6: $0	10a: $100	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $100,9b: $25"	"8a1: $0-$25,8a2: $0-$25"	"8b1: $0-$25,8b2: $0-$25,8b3: $0-$25,8b4: $0-$25,8b5: $0-$25,8b6: $0-$25"	9c1: $0	12: 0-20%	"31: $0-$50,5: $0,9a2: $0,9a3: 0"	"7a: $0,14a1-16: $0"	"7b1: $10,7b2: $0,7d1: $10,7f1: $10,7f2: $0,16b1: $0,17a1: 10,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $50,7i: $50"	7d2: $0	7g: $0	"152: 0-20%,153: $0-$50"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	"13b: $0,13c: $0"											0	NO	37.56065733	0	25.25441885	0	100	0	0	49.93657119	41.50491445	1.300823754	2.5	0	3.263055727	0.299123766	0	2.744732567	0	19.67255379	0	0	9.553866224	0	0	0	0	0	0	0	0	0											NO	37.53914838	0	25.23995702	0	99.94273543	0	0	49.90797523	41.48114684	1.300078843	2.498568386	0	3.261187153	0.298952474	0	2.743499085	0	19.67255379	0	0	9.548395244	0	0	0	0	0	0	0	0	0												3.0917	0	3.456836388	0	4.914458414	0	0	1.124679286	0.545340768	0.077203755	0.051235649	0	0.002264341	0.021193932	0	4.563619474	0	3.085264766	0	0	1.042075993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9759	0	NO	0.010260812	3.0917	0	3.456836388	0	4.914458414	0	0	1.124679286	0.545340768	0.077203755	0.051235649	0	0.002264341	0.021193932	0	4.563619474	0	3.085264766	0	0	1.042075993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9759	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	3.0917	0	3.456836388	0	4.914458414	0	0	1.124679286	0.545340768	0.077203755	0.051235649	0	0.002264341	0.021193932	0	4.563619474	0	3.085264766	0	0	1.042075993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9759
H5471_006_0	2012	8																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	764.6859464	48.28850784	1282.399685	105.3603045	382.5135966	1449.54748	212.8613498	173.3591401	167.4403482	551.0777153	239.0282558	0.459310886	0.925798505	607.6465063	13171.63448	19520.32964	591.8172231	2090.862735	4040.850005	9106.979611	1277.299753	0	211.2427468	226.56	0	0	0	0	0.300925241	0											3400	1a1: $150 day 1-10; $0 days 11-90	1b1: $0	21: $0 days 1-7; $50 days 8-100	6: $0	10a: $100	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $100,9b: $75"	"8a1: $0-$75,8a2: $0-$65"	"8b1: $0-$65,8b2: $0-$65,8b3: $0-$65,8b4: $0-$65,8b5: $0-$65,8b6: $0-$65"	9c1: $0	12: 0-20%	"31: $35-$50,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $20,7d1: $20,7f1: $20,7f2: $0,16b1: $0,17a1: $20,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $50,7i: $35"	7d2: $0	7g: $0	"152: 0-20%,153: $0-$50"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0"	17a2: $0	17b2: $0	18a2: $0	18b1: $0	$0 	13c: $0											0	NO	125.8683472	0	25.25441885	0	100	0	0	49.8675262	57.69893683	3.952720616	7.5	0	1.285192572	0.953212336	0	5.626664897	0	24.35922672	0	0	9.850276087	0	0	0	0	0	0	0	0	0											NO	123.595111	0	24.79831324	0	98.19395718	0	0	48.96689732	56.65686932	3.881332789	7.364546789	0	1.261981444	0.935996913	0	5.549345064	0	24.35922672	0	0	9.672375883	0	0	0	0	0	0	0	0	0												7.876	0	2.650112423	0	3.130043644	0	0	0.707404934	0.790553827	0.178243	0.146694564	0	9.74E-05	0.047396271	0	9.027087077	0	4.244316618	0	0	1.029543611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8274	0	NO	0.43028451	7.876	0	2.650112423	0	3.130043644	0	0	0.707404934	0.790553827	0.178243	0.146694564	0	9.74E-05	0.047396271	0	9.027087077	0	4.244316618	0	0	1.029543611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8274	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.876	0	2.650112423	0	3.130043644	0	0	0.707404934	0.790553827	0.178243	0.146694564	0	9.74E-05	0.047396271	0	9.027087077	0	4.244316618	0	0	1.029543611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8274
H5471_007_0	2012	10																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	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	1448.174447	506.3209372	2380.263732	165.4372992	1056.581956	2626.157857	310.5736562	489.2871244	113.5199614	1044.908343	234.471828	0	26.52201401	1377.699365	13288.98596	16947.29056	2670.385649	1112.015408	5020.046286	10912.8455	1234.537441	0	631.4236462	748.32	0	0	0	0	0	0											500	1a1: $0	1b1: $0	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $0"	"4a1: $0,4a2: $0,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3: $0"	"7a: $0,14a1-16: $0"	"7b1: $0,7b2: $0,7d1: $0,7f1: $0,7f2: $0,16b1: $0,17a1: $0,18a1: $0"	"7e1: $0,7h1: $0"	"7c: $0,7i: $0"	7d2: $0	7g: $0	"152: $0,153: $0"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0"	17a2: $0	17b2: $0	18a2: $0	18b2: $0	$0 	13b: $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $0,4a2: ,4b: $0"	$0 	$0 	$0 	$0 	12: $0	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: $0,153: $0"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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
H5471_008_0	2012	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											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; PBP 5	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"No Cost-Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 8b, 14a"	"No Cost-Sharing; PBP 7d, 7g, 14a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost-Sharing; PBP 13a-c, 14b"											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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H5471_009_0	2012	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											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; PBP 5	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"No Cost-Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 8b, 14a"	"No Cost-Sharing; PBP 7d, 7g, 14a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost-Sharing; PBP 13a-c, 14b"											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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H5471_010_0	2012	7																															Coin	Coin			Coin	Coin	Coin	V	Coin		Coin		Coin	Coin		Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	293.5556594	5.787643774	0	0	53.92890458	14.23285649	13.00626308	1007.06059	42.39095618	0	13.27592344	0	1.272016184	41.08169343	0	21.30881264	4.284240575	0	2.407011474	6.969777354	10.61410601	0	0	0	0	0	0	0	0	0											3400	"$1,132/Admit, 283/Days 61-90, $566/Days 91-150 for IP Med/Surg; PBP 1a"	"$1,132/Admit, 283/Days 61-90, $566/Days 91-150 for IP MH/SA; PBP 1b"	No 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; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; 20% Coinsurance for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Other; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); PBP 8b, 14a"	"20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	0.093163667	0.093163667	0	0	0.2	0.2	0.2	49.81132368	0.2	0	0.2	0	0.2	0.2	0	0.2	0.2	0	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	0.073478394	0.073478394	0	0	0.157740451	0.157740451	0.157740451	39.2863033	0.157740451	0	0.157740451	0	0.157740451	0.157740451	0	0.15821164	0.157740451	0	0.157740451	0.157740451	0.157740451	0	0	0	0	0	0	0	0	0												21.57	0.425266771	0	0	8.506769727	2.245097201	2.051613804	3.296973981	6.686768543	0	2.09415015	0	0.200648406	6.480244846	0	3.371302194	0.67579804	0	0.379683075	1.099415823	1.674273868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.758	0	NO	16.26467895	21.57	0.425266771	0	0	8.506769727	2.245097201	2.051613804	3.296973981	6.686768543	0	2.09415015	0	0.200648406	6.480244846	0	3.371302194	0.67579804	0	0.379683075	1.099415823	1.674273868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.758	NO																																										0	0	0	0	0	0	0	0	0	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	21.57	0.425266771	0	0	8.506769727	2.245097201	2.051613804	3.296973981	6.686768543	0	2.09415015	0	0.200648406	6.480244846	0	3.371302194	0.67579804	0	0.379683075	1.099415823	1.674273868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.758
H5471_011_0	2012	7																															Coin	Coin			Coin	Coin	Coin	V	Coin		Coin		Coin	Coin		Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	399.3281681	7.613362513	0	0	58.61891303	15.4706383	12.05554539	1282.270431	60.35250749	0	1.350077842	0	0.129356039	4.177749612	0	16.44594187	2.476782839	0	1.43898747	4.166752999	4.31755106	0	0	0	0	0	0	0	0	0											3400	"$1,132/Admit, 283/Days 61-90, $566/Days 91-150 for IP Med/Surg; PBP 1a"	"$1,132/Admit, 283/Days 61-90, $566/Days 91-150 for IP MH/SA; PBP 1b"	No 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; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; 20% Coinsurance for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Other; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); PBP 8b, 14a"	"20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 9d, 14a, 14d-e"	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 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	0.093163667	0.093163667	0	0	0.2	0.2	0.2	49.5006889	0.2	0	0.2	0	0.2	0.2	0	0.2	0.2	0	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	0.07279492	0.07279492	0	0	0.156273197	0.156273197	0.156273197	38.67815443	0.156273197	0	0.156273197	0	0.156273197	0.156273197	0	0.157058698	0.156273197	0	0.156273197	0.156273197	0.156273197	0	0	0	0	0	0	0	0	0												29.0691	0.554214116	0	0	9.160564919	2.417646101	1.883958614	4.132987811	9.431479267	0	0.21098098	0	0.020214882	0.652870286	0	2.58297821	0.387054771	0	0.224875172	0.65115181	0.674717506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0548	0	NO	17.34700858	29.0691	0.554214116	0	0	9.160564919	2.417646101	1.883958614	4.132987811	9.431479267	0	0.21098098	0	0.020214882	0.652870286	0	2.58297821	0.387054771	0	0.224875172	0.65115181	0.674717506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0548	NO																																										0	0	0	0	0	0	0	0	0	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	29.0691	0.554214116	0	0	9.160564919	2.417646101	1.883958614	4.132987811	9.431479267	0	0.21098098	0	0.020214882	0.652870286	0	2.58297821	0.387054771	0	0.224875172	0.65115181	0.674717506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0548
H5475_001_0	2012	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	417.776734	11.76079531	85.97764579	0	27.27394803	34.96831013	24.71673586	19.85101647	34.9190801	10.93639159	23.03569536	0	7.800363446	47.13142775	54.33392905	75.90733858	4.073425824	9.716256387	25.49689267	139.5214178	53.23000864	0.257245332	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"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 14a	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$10 Allowance for Covered Items; PBP 13b											0	NO	0.06854925	0.06854925	0.178212061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.06854925	0.06854925	0.178212061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												28.6383	0.806193694	15.32225347	0	6.109364358	7.83290147	5.536548833	4.446627689	7.821873942	2.449751715	5.159995761	0	1.747281412	10.55743982	12.17080011	17.00324384	0.912447384	2.176441431	5.711303957	31.2527976	11.92352194	0.057622954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.6367	0	NO	0	28.6383	0.806193694	15.32225347	0	6.109364358	7.83290147	5.536548833	4.446627689	7.821873942	2.449751715	5.159995761	0	1.747281412	10.55743982	12.17080011	17.00324384	0.912447384	2.176441431	5.711303957	31.2527976	11.92352194	0.057622954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.6367	NO																																										0	0	0	0	0	0	0	0	0	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	28.6383	0.806193694	15.32225347	0	6.109364358	7.83290147	5.536548833	4.446627689	7.821873942	2.449751715	5.159995761	0	1.747281412	10.55743982	12.17080011	17.00324384	0.912447384	2.176441431	5.711303957	31.2527976	11.92352194	0.057622954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.6367
H5507_001_0	2012	4																															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	1518.867019	84.0398158	1219.934732	1406.252873	185.8379464	9.903400955	10.06514955	325.7877577	63.10649287	19.86320497	44.36635427	0	0.112715265	44.23617637	5028.729885	4306.160493	430.8134321	733.9121594	0	0	22.35036617	1526.168056	0	0	3.941411908	0	18.10083332	0	78.77374383	0											4500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	66.25283906	0	200	0.2	0.097888326	62.72432432	0.16	0.183026066	0.176693317	0	0.2	0.145245946	12.08575989	33.55577308	38.5	35	0	0	0.2	34.60833098	0	0	35	0	35	0	0	0											NO	156.4922882	81.96432066	49.80860262	0	150.3591494	0.150359149	0.073592027	47.1845897	0.120287319	0.137598218	0.132837284	0	0.150359149	0.109195285	11.30390347	31.38582734	36.00934385	32.73576714	0	0	0.150359149	26.01839604	0	0	35	0	35	0	0	0												19.8076	0.574022201	5.06360369	0	2.328536295	1.489066943	0.740714761	1.281013473	7.59091087	2.733141601	5.893506013	0	0.016947771	4.830381877	4.737023098	11.26270081	1.292775751	2.002098129	0	0	3.360582045	3.309037076	0	0	0.011495785	0	0.052794097	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3779	0	NO	20.81823352	19.8076	0.574022201	5.06360369	0	2.328536295	1.489066943	0.740714761	1.281013473	7.59091087	2.733141601	5.893506013	0	0.016947771	4.830381877	4.737023098	11.26270081	1.292775751	2.002098129	0	0	3.360582045	3.309037076	0	0	0.011495785	0	0.052794097	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3779	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a); $75 (5); $45/$35 (9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2816	0.0059	0	0.0122	0.0117	0.0187	0.0114	0.0064	0.0572	0.0137	0.0433	0	0.0001	0.0364	0.4743	1.8632	0.1099	0.161	0	0	0.3794	0.2557	0	0	0.0015	0	0.0013	0	0	0											3.7451	0	NO	0.553186993	20.0892	0.579910115	5.06360369	0.012185684	2.340237482	1.507773815	0.752122204	1.287450727	7.648128792	2.74687598	5.936778785	0	0.017032936	4.866764208	5.211368242	13.12590409	1.402718557	2.163094334	0	0	3.740002598	3.564734487	0	0	0.012947536	0	0.054135526	0	0	0	0	0	0	0	0	0	0	0	0	0	82.123
H5508_001_0	2012	6																															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	229.1120521	1.958570858	64.15647982	58.38730904	54.35696392	8.36443818	3.255730811	273.001617	2.129497792	2158.033063	1531.807293	0	0	810.4868598	3883.628653	3141.179621	122.1919886	785.2337629	7323.506727	5451.76584	29.06309273	442.4617646	0	436.5411986	138.6313266	30.77699725	0	0	0	5074.664347											3400	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay		$50 copay/trip	20% coinsurance	20% coinsurance for prosthetics/medical supplies; 0% for diabetes monitoring supplies	$50 copay/visit	$150 copay/visit		$0 copay/visit for x-rays; $50 copay/visit for all other			$150 copay/visit for outpatient hospital surgeries; $25 copay/visit for outpatient substance abuse services; $0 copay for all other	"$0 copay for immunizations and routine exams, $5 copay for all other"	$25 copay/visit for podiatry; $20 copay/visit for all other	$25 copay/visit	$25 copay/visit		20% for nutritional training; $0 copay/visit for all other	20% coinsurance			$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years				$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-5: $125 copay for IP-Acute non-Medicare covered stays													443.6120972	443.6120972	2024.738676	0	50	0.2	0.120660415	50	150	0	5.6	0	0	41.27693116	4.198973919	20	25	25	0	0.020923997	0.2	0	0	10	20	0	0	0	0	4.166666667											NO	423.0948298	423.0948298	1931.093564	0	47.68747657	0.190749906	0.115079814	47.68747657	143.0624297	0	5.340997376	0	0	39.36785375	4.004769408	19.07499063	23.84373829	23.84373829	0	0.019956252	0.190749906	0	0	9.537495315	19.07499063	0	0	0	0	3.973956381												8.078	0.0690551	10.3243471	0	0.216012204	1.595515799	0.374668896	1.084896518	0.025387594	0	0.681781561	0	0	2.658927347	1.296086435	4.993164319	0.242792816	1.560242361	0	0.009066401	5.543782214	0	0	0.346959136	0.220365938	0	0	0	0	1.68054123	0	0	0	0	0	0	0	0	0	0	41.0016			1.988303327	8.078	0.0690551	10.3243471	0	0.216012204	1.595515799	0.374668896	1.084896518	0.025387594	0	0.681781561	0	0	2.658927347	1.296086435	4.993164319	0.242792816	1.560242361	0	0.009066401	5.543782214	0	0	0.346959136	0.220365938	0	0	0	0	1.68054123	0	0	0	0	0	0	0	0	0	0	41.0016	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		50% coinsurance	20% coinsurance	20% coinsurance				Fee For Service Cost Sharing											5100	2.0521	0.0154	1.7147	0	0.8988	0.46	0.3128	0.1033	0	0.1417	0.571	0	0	0.3948	0	1.3352	0.1206	0.3597	0.7891	3.0819	0.5153	0.0102	0	0	0.1058	0.0126	0	0	0	0											12.9951			0.179183621	10.1301	0.084437066	12.03902913	0	1.114787446	2.05555817	0.687489928	1.188172793	0.025387594	0.141710316	1.25277115	0	0	3.053721843	1.296086435	6.328383943	0.363402089	1.9199693	0.789125214	3.090962547	6.059107207	0.01018981	0	0.346959136	0.326142824	0.012645327	0	0	0	1.68054123	0	0	0	0	0	0	0	0	0	0	53.9967
H5508_002_0	2012	4																															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	234.4687047	1.274910941	58.18614959	64.20328348	55.67872913	6.503908578	3.035353506	296.1940061	1.353503874	2084.668212	1435.24387	0	0	755.536832	3489.917682	2929.193134	94.31285231	698.1235425	6980.888584	5441.920619	23.28546788	505.6278459	0	465.7194079	147.8973795	32.83411733	0	0	0	5151.126359											3400	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay		$50 copay/trip	20% coinsurance	20% coinsurance for prosthetics/medical supplies; 0% for diabetes monitoring supplies	$50 copay/visit	$150 copay/visit		$0 copay/visit for x-rays; $50 copay/visit for all other			$150 copay/visit for outpatient hospital/ASC surgeries; $25 copay/visit for outpatient substance abuse services; $0 copay for all other	$0 copay/visit for immunizations and routine exams; $10 copay/visit for all other	$25 copay/visit for podiatry; $20 copay/visit for chiro; $30 copay/visit for all other	$25 copay/visit	$25 copay/visit		20% for nutritional training; $0 copay/visit for all other	20% coinsurance			$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years				$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-5: $125 copay for IP-acute non-Medicare covered stays													443.6120972	443.6120972	2024.738676	0	50	0.2	0.114330045	50	150	0	5.6	0	0	41.81763001	8.255084166	29.57802439	25	25	0	0.016927334	0.2	0	0	10	20	0	0	0	0	4.409613887											NO	423.0948298	423.0948298	1931.093564	0	47.68747657	0.190749906	0.109042226	47.68747657	143.0624297	0	5.340997376	0	0	39.88354503	7.873282655	28.21002691	23.84373829	23.84373829	0	0.016144437	0.190749906	0	0	9.537495315	19.07499063	0	0	0	0	4.205667179												8.2669	0.044950686	9.363574913	0	0.221264841	1.240619952	0.330981704	1.17706206	0.016136296	0	0.638802812	0	0	2.511123938	2.289759029	6.886051428	0.187397581	1.387156253	0	0.007321395	4.441700816	0	0	0.370149723	0.235095094	0	0	0	0	1.805326922	0	0	0	0	0	0	0	0	0	0	41.4214			2.041910261	8.2669	0.044950686	9.363574913	0	0.221264841	1.240619952	0.330981704	1.17706206	0.016136296	0	0.638802812	0	0	2.511123938	2.289759029	6.886051428	0.187397581	1.387156253	0	0.007321395	4.441700816	0	0	0.370149723	0.235095094	0	0	0	0	1.805326922	0	0	0	0	0	0	0	0	0	0	41.4214	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		50% coinsurance	20% coinsurance	20% coinsurance				Fee For Service Cost Sharing											5100	1.6829	0.0101	2.1695	0	0.8648	0.5986	0.2969	0.0923	0	0.1561	0.4423	0	0	0.4106	0.0012	1.3421	0.0911	0.2628	0.6969	2.9811	0.4273	0.0123	0	0	0.1069	0.0142	0	0	0	0.0204											12.6806			0.17952729	9.9498	0.055043287	11.53311884	0	1.086017012	1.839196013	0.627926904	1.269382011	0.016136296	0.156132003	1.081070594	0	0	2.921747049	2.290987712	8.228193768	0.278449773	1.649981716	0.696947426	2.988455779	4.868955501	0.012289484	0	0.370149723	0.341961215	0.014213003	0	0	0	1.825767459	0	0	0	0	0	0	0	0	0	0	54.1019
H5508_005_0	2012	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	226.4568035	1.938299355	65.23533567	59.36915115	54.06960674	8.505094734	3.310479243	277.5924174	2.102053178	2194.322588	1451.473257	0	0	710.6211007	3999.445004	2850.739064	115.1231698	741.9909828	7446.658958	5053.906819	29.55181825	441.1839992	0	0	0	0	0	0	0	5160											3900	Days 1-7: $240 copay	Days 1-7: $205 copay	Days 21-100: $100 copay		$125 copay/trip	20% coinsurance	20% coinsurance for prosthetics/medical supplies; 0% for diabetes monitoring supplies	$50 copay/visit	$225 copay/visit		$75 copay/visit		20% coinsurance	$225 copay/visit for outpatient hospital surgeries; $40 copay/visit for outpatient substance abuse services; 20% coinsurance for renal dialysis; $225 copay for all other		$40 copay/visit for podiatry; $20 copay/visit for chiro; $45 copay/visit for all other	$40 copay/visit	$40 copay/visit		20% for nutritional training and dialysis; $0 copay/visit for preventative; $40 copay/visit for all other	20% coinsurance	$40 copay/visit for Medicare covered hearing exams; $0 copay/visit for all other								$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-7: $240 copay for IP-Acute non-Medicare covered stays													991.0544999	846.5257187	2699.651568	0	125	0.2	0.120660415	50	225	0	75	0	0	138.0056266	0	44.04238119	40	40	0	24.01542342	0.2	2.472639836	0	0	0	0	0	0	0	4.166666667											NO	959.6178496	819.6735799	2614.017526	0	121.0349494	0.193655919	0.116833018	48.41397974	217.8629088	0	72.62096961	0	0	133.6280322	0	42.64533901	38.73118379	38.73118379	0	23.25364446	0.193655919	2.394206698	0	0	0	0	0	0	0	4.034498312												18.1093	0.132397731	14.2105259	0	0.545359343	1.647061937	0.38677328	1.11994614	0.038163285	0	8.783949606	0	0	7.91324161	0	10.13089448	0.371571387	2.394849094	0	9.793479359	5.722884521	0.088023807	0	0	0	0	0	0	0	1.734834274	0	0	0	0	0	0	0	0	0	0	83.1233			2.723081638	18.1093	0.132397731	14.2105259	0	0.545359343	1.647061937	0.38677328	1.11994614	0.038163285	0	8.783949606	0	0	7.91324161	0	10.13089448	0.371571387	2.394849094	0	9.793479359	5.722884521	0.088023807	0	0	0	0	0	0	0	1.734834274	0	0	0	0	0	0	0	0	0	0	83.1233	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											5100	2.0733	0.0155	1.7397	0	0.9122	0.4669	0.3175	0.1048	0	0.1438	0.5795	0	0	0.4007	0	1.3552	0.1224	0.3651	0.8009	3.1289	0.523	0.0103	0	0	0	0	0	0	0	0											13.06			0.204094885	20.1826	0.147942999	15.95018028	0	1.457593727	2.113993433	0.7042788	1.224768975	0.038163285	0.143832425	9.363489753	0	0	8.313948147	0	11.486109	0.493986782	2.759962937	0.80094235	12.92239885	6.245926496	0.098366326	0	0	0	0	0	0	0	1.734834274	0	0	0	0	0	0	0	0	0	0	96.1833
H5508_006_0	2012	6																															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	227.4802736	1.944621553	65.23533567	59.36915115	55.0346894	8.505094734	3.310479243	277.5924174	2.140115979	2194.322588	1472.808709	0	0	822.1034662	3650.931142	2961.515929	120.3513046	777.2965051	7446.658958	5543.442839	29.55181825	449.0452949	0	443.8820838	140.9625536	31.29454382	0	0	0	5160											3600	Days 1-5: $200 copay	Days 1-5: $200 copay	Days 21-100: $100 copay		$75 copay/trip	20% coinsurance	20% coinsurance for prosthetics/medical supplies; 0% for diabetes monitoring supplies	$50 copay/visit	$175 copay/visit		$60 copay/visit			$175 copay/visit for outpatient hospital surgeries; $30 copay/visit for outpatient substance abuse services; $0 copay for all other	"$0 copay for immunizations and routine exams, $15 copay for all other"	$30 copay/visit for podiatry; $20 copay/visit for chiro; $35 copay/visit for all other	$30 copay/visit	$30 copay/visit		20% for nutritional training; $0 copay/visit for all other	20% coinsurance			$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years				$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-5: $200 copay for IP-Acute non-Medicare covered stays													709.7793555	709.7793555	2699.651568	0	75	0.2	0.120660415	50	175	0	60	0	0	48.2652953	12.40077219	34.44692082	30	30	0	0.020923997	0.2	0	0	10	20	0	0	0	0	4.166666667											NO	681.4142745	681.4142745	2591.764751	0	72.00275718	0.192007352	0.115838434	48.00183812	168.0064334	0	57.60220575	0	0	46.33645784	11.90519718	33.07031034	28.80110287	28.80110287	0	0.020087806	0.192007352	0	0	9.600367625	19.20073525	0	0	0	0	4.000153177												12.9174	0.110424407	14.08955363	0	0.330220781	1.633040723	0.383480731	1.110412191	0.029962771	0	7.069752525	0	0	3.174446883	3.622087928	8.161520905	0.288854192	1.865583051	0	0.009279634	5.674166384	0	0	0.355119266	0.225548723	0	0	0	0	1.720065866	0	0	0	0	0	0	0	0	0	0	62.7709			2.612949484	12.9174	0.110424407	14.08955363	0	0.330220781	1.633040723	0.383480731	1.110412191	0.029962771	0	7.069752525	0	0	3.174446883	3.622087928	8.161520905	0.288854192	1.865583051	0	0.009279634	5.674166384	0	0	0.355119266	0.225548723	0	0	0	0	1.720065866	0	0	0	0	0	0	0	0	0	0	62.7709	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		50% coinsurance	20% coinsurance	20% coinsurance				Fee For Service Cost Sharing											5100	2.0756	0.0156	1.7416	0	0.9133	0.4675	0.3179	0.1049	0	0.144	0.5802	0	0	0.4012	0	1.3568	0.1226	0.3655	0.8019	3.1325	0.5236	0.0104	0	0	0.1075	0.0128	0	0	0	0											13.1952			0.190936499	14.993	0.12598741	15.83119271	0	1.243495895	2.100504921	0.70134848	1.215354614	0.029962771	0.143996517	7.649953845	0	0	3.575610568	3.622087928	9.518281523	0.411409245	2.231113436	0.801856111	3.141768776	6.197805075	0.010354318	0	0.355119266	0.333032099	0.012849333	0	0	0	1.720065866	0	0	0	0	0	0	0	0	0	0	75.9661
H5508_007_0	2012	6																															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	266.7679622	3.258880368	72.09548567	71.07105248	56.18043226	11.20970794	8.985487659	310.0434333	2.03001009	2625.197891	1816.764304	0	0	1093.547222	4246.148842	3490.329634	143.7548398	967.273827	8278.243996	6333.338862	37.03889335	487.2650751	0	488.9434977	140.9625536	32.4780999	0	0	0	5163.240097											3400	Days 1-5: $75 copay	Days 1-5: $75 copay	Days 21-100: $75 copay			20% coinsurance		$50 copay/visit								$20 copay/visit for podiatry and chiro; $15 copay/visit for all other	$20 copay/visit	$20 copay/visit		$0 copay for outpatient surgery and preventative; 20% for nutritional training; $20 copay/visit for all other	20% coinsurance			$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years				$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-5: $75 copay for IP-Acute non-Medicare covered stays													266.1672583	266.1672583	2024.738676	0	0	0.2	0	50	0	0	0	0	0	0	0	15.26013509	20	20	0	12.85810982	0.2	0	0	10	20	0	0	0	0	4.331080337											NO	253.8568979	253.8568979	1931.093564	0	0	0.190749906	0	47.68747657	0	0	0	0	0	0	0	14.55434669	19.07499063	19.07499063	0	12.26341622	0.190749906	0	0	9.537495315	19.07499063	0	0	0	0	4.130765842												5.6434	0.068940772	11.60192736	0	0	2.138250738	0	1.23209908	0	0	0	0	0	0	0	4.233288963	0.228510185	1.537561599	0	6.472364211	7.065165436	0	0	0.388608027	0.224071616	0	0	0	0	1.777344652	0	0	0	0	0	0	0	0	0	0	42.6115			2.066374474	5.6434	0.068940772	11.60192736	0	0	2.138250738	0	1.23209908	0	0	0	0	0	0	0	4.233288963	0.228510185	1.537561599	0	6.472364211	7.065165436	0	0	0.388608027	0.224071616	0	0	0	0	1.777344652	0	0	0	0	0	0	0	0	0	0	42.6115	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		50% coinsurance	20% coinsurance	20% coinsurance				Fee For Service Cost Sharing											5100	2.0822	0.0111	2.8135	0	1.0228	0.4829	0.3937	0.1107	0	0.1592	0.6652	0	0	0.4446	0	1.7324	0.1414	0.3059	0.8341	3.1409	0.4473	0.0903	0	0	0.1076	0.0129	0	0	0	0.0228											15.0213			0.207122437	7.7256	0.08004758	14.41545664	0	1.022816051	2.621161068	0.393721429	1.342750854	0	0.159231597	0.665172225	0	0	0.444557455	0	5.965694482	0.369881797	1.843458586	0.834077901	9.613271915	7.512494816	0.09027891	0	0.388608027	0.331627248	0.012857971	0	0	0	1.800110651	0	0	0	0	0	0	0	0	0	0	57.6328
H5508_801_0	2012	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	YES	175.3493027	1.700052211	38.64668299	11.24677724	1.804449736	8.267909914	3.211428311	6.008258753	0.074587748	16.23118653	29.85975338	0	0	29.65191613	21.72979961	21.75181485	0.905436037	5.944632791	31.98340938	65.96016879	28.72700042	3.928116625	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079538672	0.079538672	0.192127982	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0	0	0	0	0	0												13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595			0.243944607	13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595	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																			10000	2.1467	0.0174	1.9154	0	1.0003	0.5119	0.3522	0.1105	0	0.1556	0.6451	0	0	0.4463	0.0503	1.4777	0.1199	0.4134	0.8837	3.4448	0.5773	0.0117	0	0	0	0	0	0	0	0											14.2803			0.056036635	16.0937	0.152657428	9.340534074	0	1.403283254	2.358490332	1.069436311	1.452463262	0.016658788	3.780795736	7.314162807	0	0	7.068909734	4.903534888	6.335875208	0.322131328	1.741056054	8.027001859	18.17668346	6.993335009	0.889022541	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4398
H5508_802_0	2012	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	YES	179.2083443	0.933063587	26.70294727	7.911345013	1.973923478	11.69866812	5.518312467	6.382116516	0.090379968	20.51806531	35.41543893	0	0	44.77020872	36.32923131	12.40898931	1.322819797	6.386459832	36.42042057	79.48514656	39.68161603	2.549197212	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079538672	0.079538672	0.192127982	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0	0	0	0	0	0												14.254	0.074214639	5.130383381	0	0.440865599	2.612837016	1.232486548	1.425412714	0.020185898	4.582603762	7.909855109	0	0	9.999194557	8.11394591	2.771483581	0.29544496	1.426382771	8.134312561	17.75259637	8.862683699	0.569350012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6082			0.280462544	14.254	0.074214639	5.130383381	0	0.440865599	2.612837016	1.232486548	1.425412714	0.020185898	4.582603762	7.909855109	0	0	9.999194557	8.11394591	2.771483581	0.29544496	1.426382771	8.134312561	17.75259637	8.862683699	0.569350012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6082	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																			10000	2.1467	0.0174	1.9154	0	0.7824	0.4097	0.341	0.1105	0	0.1556	0.6451	0	0	0.4463	0.053	1.2177	0.0947	0.2727	0.7475	3.3305	0.4669	0.0102	0	0	0	0	0	0	0	0											13.1633			0.051653462	16.4007	0.091652171	7.045808229	0	1.223241969	3.022501943	1.573494087	1.53596246	0.020185898	4.738247936	8.55499644	0	0	10.44550219	8.166942695	3.989145009	0.390135884	1.699132312	8.881768363	21.08305707	9.32957696	0.579510053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7715
H5508_803_0	2012	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	YES	175.3493027	1.700052211	38.64668299	11.24677724	1.804449736	8.267909914	3.211428311	6.008258753	0.074587748	16.23118653	29.85975338	0	0	29.65191613	21.72979961	21.75181485	0.905436037	5.944632791	31.98340938	65.96016879	28.72700042	3.928116625	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079538672	0.079538672	0.192127982	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0	0	0	0	0	0												13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595			0.243944607	13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595	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																			10000	2.1467	0.0174	1.9154	0	1.0003	0.5119	0.3522	0.1105	0	0.1556	0.6451	0	0	0.4463	0.0503	1.4777	0.1199	0.4134	0.8837	3.4448	0.5773	0.0117	0	0	0	0	0	0	0	0											14.2803			0.056036635	16.0937	0.152657428	9.340534074	0	1.403283254	2.358490332	1.069436311	1.452463262	0.016658788	3.780795736	7.314162807	0	0	7.068909734	4.903534888	6.335875208	0.322131328	1.741056054	8.027001859	18.17668346	6.993335009	0.889022541	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4398
H5508_804_0	2012	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	175.3493027	1.700052211	38.64668299	11.24677724	1.804449736	8.267909914	3.211428311	6.008258753	0.074587748	16.23118653	29.85975338	0	0	29.65191613	21.72979961	21.75181485	0.905436037	5.944632791	31.98340938	65.96016879	28.72700042	3.928116625	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079538672	0.079538672	0.192127982	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0.223344828	0	0	0	0	0	0	0	0												13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595			0.243944607	13.9471	0.135219896	7.425109226	0	0.403014515	1.846594916	0.717255903	1.341913516	0.016658788	3.625151561	6.669021475	0	0	6.6226021	4.853238353	4.858155343	0.202224456	1.327702987	7.14332906	14.73186254	6.416026961	0.877324531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595	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																			10000	2.1467	0.0174	1.9154	0	1.0003	0.5119	0.3522	0.1105	0	0.1556	0.6451	0	0	0.4463	0.0503	1.4777	0.1199	0.4134	0.8837	3.4448	0.5773	0.0117	0	0	0	0	0	0	0	0											14.2803			0.056036635	16.0937	0.152657428	9.340534074	0	1.403283254	2.358490332	1.069436311	1.452463262	0.016658788	3.780795736	7.314162807	0	0	7.068909734	4.903534888	6.335875208	0.322131328	1.741056054	8.027001859	18.17668346	6.993335009	0.889022541	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4398
H5509_001_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	COIN	COIN	COIN	V	T	V	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	1044.166906	77.89722432	1227.052183	0	163.2807977	8.645369879	6.529689649	329.8310038	420.7920491	0	19.4768025	22.73110119	0	18.59174781	3296.014561	128.8650845	177.4158217	6.815815239	18.21267682	9.998048779	14.48652621	0	0	0	32.12	0	0	-8.71E-06	0	0											3950	1a $250 days 1-7	1b $200 days 1-7	"2 $0 days 1-3, $50 Days 4 to 22, $100 Days 23 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $20"	"9a $375, 9b $375"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $20, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $20"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7g $40, 14a $0"	15 20%				17a $40	17b $0			14c $0													NO	209.8423178	153.0261969	49.37864707	0	150	0.2	0.2	62.30061877	375	0	0.308079881	40	0	0.006428902	18.2712107	0.117303468	40	0.327510692	0.189270294	0.415644243	0.167483462	0	0	0	40	0	0	1	0	0											YES	177.8122886	129.6684986	41.8415615	0	127.104216	0.169472288	0.169472288	52.79114204	317.7605401	0	0.261055012	33.89445761	0	0.005447604	15.48231942	0.099398436	33.89445761	0.277519932	0.160380349	0.352200905	0.141919027	0	0	0	33.89445761	0	0	0.84736144	0	0											10000	15.4721	0.841734677	4.278481613	0	1.729473149	1.465150614	1.106601445	1.451012948	11.1425924	0	5.084516904	0.064204862	0	0.101280476	4.252495852	12.80898785	0.501117754	1.891524581	2.920955464	3.521321823	2.055913708	0	0	0	0.090724165	0	0	-7.38E-06	0	0	0	0	0	0	0	0	0	0	0	0	70.7802	0	NO	12.74992125	15.4721	0.841734677	4.278481613	0	1.729473149	1.465150614	1.106601445	1.451012948	11.1425924	0	5.084516904	0.064204862	0	0.101280476	4.252495852	12.80898785	0.501117754	1.891524581	2.920955464	3.521321823	2.055913708	0	0	0	0.090724165	0	0	-7.38E-06	0	0	0	0	0	0	0	0	0	0	0	0	70.7802	YES	0.3	0.3	0.3	0	10a $150	0.3	0.3	"4a $65, 4b $20"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3								$50/visit												10000	8.4235	0.2308	1.3821	0.5697	0.2889	0.3671	0.2773	0.2424	2.0277	0.3418	0.7676	0.022	0.0019	0.5719	1.0389	3.9789	0.0525	0.2894	0.7728	0.3369	0.7591	0	0	0	0	0	0.0003	0.0001	0	0											22.7436	0	NO	0	23.8956	1.072499781	5.66057199	0.569733608	2.018383237	1.83228276	1.383889636	1.693406001	13.17026097	0.341783095	5.852072879	0.08619448	0.001921274	0.67313053	5.291433036	16.78792324	0.553581286	2.18096331	3.693736627	3.858236141	2.815044085	0	0	0	0.090724165	0	0.000302299	9.70E-05	0	0	0	0	0	0	0	0	0	0	0	0	93.5238
H5509_003_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	V	COIN	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	966.0751503	41.25794627	790.4135168	0	109.3687188	11.35168388	7.297779388	272.5799586	364.8173035	0	10.44488844	0.581261543	0	8.000763499	3909.781651	124.6078069	228.84454	724.766838	14.05006319	10.25205547	28.49829057	0	0	0	0	0	0	0	0	0											3400	1a $200 days 1-7	1b $200 days 1-5	"2 $0 days 1-5, $50 Days 6 to 21, $100 Days 22 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a $225, 9b $225"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $225 14a $0"	"7e $35, 7h $35, 9c $35"	12 0%	"3 $35, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $35 , 7f $10, 17a $35, 18a $10"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $225 14a $0"	"7g $35, 14a $0"	15 20%				17a $35	17b $0			14c $0													NO	168.0730451	127.6150628	45.36956029	0	149.7863436	0.2	0.2	64.54637097	225	0	0.296881831	35	0	0.016104252	9.791181494	0.105021363	35	34.14314089	0.162934066	0.447426062	0.187266495	0	0	0	0	0	0	0	0	0											YES	147.9497451	112.3357763	39.93748594	0	131.8525009	0.176054102	0.176054102	56.81826685	198.0608646	0	0.26133632	30.80946783	0	0.014176098	8.618888321	0.092447209	30.80946783	30.05520002	0.143426053	0.393855967	0.164845173	0	0	0	0	0	0	0	0	0											10000	11.9109	0.386228619	2.63059406	0	1.201711592	1.998510511	1.284803996	1.290626735	6.021335879	0	2.729628712	0.001492363	0	0.113419606	2.808164284	11.51964391	0.587548208	1.815251024	2.015145111	4.037833223	4.697805634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0506	0	NO	7.759708107	11.9109	0.386228619	2.63059406	0	1.201711592	1.998510511	1.284803996	1.290626735	6.021335879	0	2.729628712	0.001492363	0	0.113419606	2.808164284	11.51964391	0.587548208	1.815251024	2.015145111	4.037833223	4.697805634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0506	YES	0.3	0.3	0.3	0	10a $150	0.3	0.3	"4a $65, 4b $35"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3								$50/visit												10000	4.6263	0.0832	0.53	0.3691	0.1187	0.2961	0.1904	0.1275	1.1415	0.1059	0.2655	0.0002	0.0047	0.1441	0.8712	2.397	0.0386	0.1782	0.3597	0.2302	0.8261	0	0	0	0.0006	0.0084	0.0007	0	0	0											12.9139	0	NO	0	16.5372	0.469442882	3.160623012	0.369072689	1.320421299	2.29463232	1.475174527	1.418119831	7.162814499	0.105915342	2.995113933	0.001651927	0.004720989	0.257545452	3.679349964	13.91659974	0.626113447	1.993426642	2.374855845	4.268053916	5.523863452	0	0	0	0.000611085	0.008449655	0.000715097	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9645
H5509_010_0	2012	7																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	COIN	COIN	COIN	V	T	V	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	1452.037282	66.98483906	1137.3378	0	170.8929044	11.68360505	5.938032382	385.7608302	357.8933489	0	27.40355697	58.08352057	0	21.06193798	3870.714073	121.5548606	151.3188727	6.508436994	12.77509442	8.902927142	12.95195033	0	0	0	0	0	0	0	0	0											3400	1a $200 days 1-5	1b $200 days 1-5	"2 $0 days 1-3, $50 Days 4 to 20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $10"	"9a $200, 9b $200"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $5"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	149.2924834	127.6150628	51.63960986	0	150	0.2	0.2	63.64883037	200	0	0.267464087	40	0	0.002190681	4.747415981	0.115882288	40	0.341341842	0.155281847	0.4660445	0.165235497	0	0	0	0	0	0	0	0	0											YES	126.6260517	108.23982	43.79939136	0	127.2261491	0.169634865	0.169634865	53.98530389	169.6348655	0	0.226856172	33.9269731	0	0.00185808	4.026636356	0.098288381	33.9269731	0.289517388	0.131706076	0.39528698	0.140148506	0	0	0	0	0	0	0	0	0											10000	15.3221	0.604202244	4.151225286	0	1.811837178	1.981946771	1.007297324	1.735451304	5.059265841	0	6.216666037	0.164216503	0	0.039134758	1.298829834	11.94743048	0.427815943	1.884305676	1.68255756	3.519211187	1.815196492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6687	0	NO	10.85988029	15.3221	0.604202244	4.151225286	0	1.811837178	1.981946771	1.007297324	1.735451304	5.059265841	0	6.216666037	0.164216503	0	0.039134758	1.298829834	11.94743048	0.427815943	1.884305676	1.68255756	3.519211187	1.815196492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6687	YES	0.2	0.2	0.2	0	10a $150	0.2	0.2	"4a $65, 4b $10"	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2								$50/visit												10000	6.217	0.127	0.7795	0.2939	0.2845	0.3178	0.159	0.2137	1.0356	0.289	0.7163	0.0199	0.0058	0.4118	0.7646	2.2521	0.0283	0.1734	0.3344	0.1772	0.4358	0	0	0	0	0	0.0001	0	0	0											15.0365	0	NO	0	21.5392	0.731184379	4.930685787	0.293870969	2.096324433	2.299776947	1.166279092	1.949149754	6.09486013	0.288971884	6.932935063	0.184076323	0.005824991	0.450888231	2.063408194	14.19957144	0.45607427	2.057751068	2.016945606	3.696449418	2.251028083	0	0	0	0	0	5.64E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7053
H5509_011_0	2012	8																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	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	1166.948144	37.17550419	870.7137303	0	157.6305425	11.90267929	7.631392654	487.1223219	476.4539887	0	33.5112445	5.510433506	0	31.6342825	3718.784836	121.1236641	140.1239656	7.015046608	9.109069818	0	6.751286825	0	0	0	0	0	0	0	0	0											6700	1a $200 days 1-7	1b $200 days 1-7	"2 $0 days 1-3, $50 Days 4 to 22, $100 Days 23 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $10"	"9a $300, 9b $300"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $40 , 7f $10, 17a $40, 18a $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7g $40, 14a $0"	15 20%				17a $40	17b $0			14c $0													NO	168.0730451	154.6722455	49.768316	0	150	0.2	0.2	53.33333333	300	0	0.261481071	40	0	0.167272542	9.727366255	0.065004274	40	0.412496742	0.208292696	0	0.157125139	0	0	0	0	0	0	0	0	0											YES	159.1289397	146.4412715	47.11986595	0	142.0176623	0.189356883	0.189356883	50.49516881	284.0353245	0	0.247566202	37.87137661	0	0.158371036	9.209718771	0.061545034	37.87137661	0.390545487	0.197208278	0	0.148763633	0	0	0	0	0	0	0	0	0											10000	15.4746	0.453669008	3.418992855	0	1.865526762	2.253854249	1.445056726	2.049776989	11.27748028	0	8.29625154	0.017390642	0	5.009954081	2.854080209	7.454560023	0.442223956	2.739694794	1.796383973	0	1.004345955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8538	0	NO	3.813837579	15.4746	0.453669008	3.418992855	0	1.865526762	2.253854249	1.445056726	2.049776989	11.27748028	0	8.29625154	0.017390642	0	5.009954081	2.854080209	7.454560023	0.442223956	2.739694794	1.796383973	0	1.004345955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8538	YES	0.2	0.2	0.2	0	10a $150	0.25	0.25	"4a $65, 4b $10"	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25								$50/visit												10000	6.5283	0.0611	0.7731	0.6698	0.2789	0.4212	0.2701	0.2386	1.9979	0.6171	1.1258	0.0017	0.0179	1.1017	0.9478	3.1899	0.0307	0.2482	0.3223	0.0107	0.376	0	0	0	0.0005	0	0.0003	0	0	0											19.2296	0	NO	0	22.0029	0.514757539	4.192095204	0.669818623	2.144439251	2.675045397	1.715108768	2.288327852	13.2753872	0.61705825	9.42207194	0.019098862	0.017923626	6.111641551	3.801840562	10.64441475	0.472963363	2.987933713	2.118732594	0.010693596	1.380363331	0	0	0	0.000525012	0	0.000337182	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0834
H5509_012_0	2012	7																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	COIN	COIN	COIN	V	T	V	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	890.3183763	80.34295316	1147.824196	0	130.8755362	6.617397856	5.815325996	342.4324105	346.7274047	0	17.70739988	20.44325313	0	16.27277184	3061.051259	98.93197991	335.9664192	6.660268435	10.49524377	7.555341538	9.521164739	0	0	0.105482383	0	0	0	0	0	0											6700	1a $175 days 1-9	1b $175 days 1-8	"2 $0 days 1-6, $50 Days 7 to 20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $20"	"9a $300, 9b $300"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $20, 14a $0"	"7b $20 , 7d $40 , 7f $20, 17a $40, 18a $20"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	155.9392445	143.1485356	43.84984284	0	150	0.2	0.2	63.88780547	300	0	0.322183652	40	0	0.010443383	18.72884316	0.118386509	39.92878936	0.348548632	0.163800853	0.420401719	0.158396153	0	0	40	0	0	0	0	0	0											YES	150.601893	138.2489733	42.34898896	0	144.8659318	0.193154576	0.193154576	61.70110981	289.7318637	0	0.311156233	38.63091515	0	0.010085936	18.08780877	0.11433448	38.56214185	0.336618816	0.158194422	0.406012578	0.152974708	0	0	38.63091515	0	0	0	0	0	0											10000	11.1736	0.925610899	4.050766184	0	1.579950542	1.278180676	1.123256826	1.76070498	8.371498095	0	5.509767839	0.065811798	0	0.164126131	4.613975818	11.31133647	1.07963206	2.241971674	1.66028902	3.067563697	1.4564974	0	0	0.000339573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4349	0	NO	2.177261703	11.1736	0.925610899	4.050766184	0	1.579950542	1.278180676	1.123256826	1.76070498	8.371498095	0	5.509767839	0.065811798	0	0.164126131	4.613975818	11.31133647	1.07963206	2.241971674	1.66028902	3.067563697	1.4564974	0	0	0.000339573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4349	YES	0.2	0.2	0.2	0	10a $150	0.2	0.2	"4a $65, 4b $20"	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2								$50/visit												10000	5.49	0.2133	1.0585	0.2968	0.2887	0.2326	0.2046	0.2481	1.2205	0.2158	0.5842	0.0182	0.0029	0.4467	0.7993	2.4885	0.0692	0.2344	0.3531	0.1976	0.4405	0	0	0	0	0	0	0	0	0											15.1033	0	NO	0	16.6636	1.138885389	5.109291441	0.296797067	1.868646578	1.510830046	1.327880018	2.00875968	9.591993823	0.215763651	6.093947584	0.084016962	0.002903655	0.610784481	5.413285234	13.79981402	1.148794367	2.47633688	2.013391461	3.26518802	1.896953623	0	0	0.000339573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5382
H5509_014_0	2012	8																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	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	976.635791	61.09036137	1330.736832	0	161.5817538	6.356030273	4.484567486	292.0863555	348.6671185	0	14.9118882	16.74550562	0	13.05538117	2810.299958	94.54830165	135.6856542	5.038749678	12.57114682	7.278433384	11.3208558	0	0	0	0	0	0	0	0	0											5500	1a $200 days 1-6	1b $200 days 1-7	"2 $0 days 1-8, $50 Days 9 to 20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $20"	"9a $300, 9b $300"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $20, 14a $0"	"7b $20 , 7d $40 , 7f $20, 17a $40, 18a $20"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	160.0761608	154.6722455	39.20320145	0	150	0.2	0.2	62.84084624	300	0	0.322004559	40	0	0.005872426	18.16780822	0.126728605	39.97394431	0.336237139	0.183731843	0.456884214	0.171107183	0	0	0	0	0	0	0	0	0											YES	151.9176312	146.7891348	37.20514954	0	142.3550176	0.18980669	0.18980669	59.63806513	284.7100351	0	0.305593098	37.96133802	0	0.005573129	17.24185772	0.120269686	37.93661029	0.319100292	0.174367665	0.433598402	0.16238644	0	0	0	0	0	0	0	0	0											10000	12.364	0.747283441	4.125855235	0	1.916831116	1.206417068	0.851200911	1.451622091	8.272418962	0	4.556970113	0.052973483	0	0.072759319	4.037899336	11.37129452	0.428954482	1.607866495	2.192001514	3.155917082	1.838353476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2506	0	NO	3.235678337	12.364	0.747283441	4.125855235	0	1.916831116	1.206417068	0.851200911	1.451622091	8.272418962	0	4.556970113	0.052973483	0	0.072759319	4.037899336	11.37129452	0.428954482	1.607866495	2.192001514	3.155917082	1.838353476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2506	YES	0.2	0.2	0.2	0	10a $150	0.2	0.2	"4a $65, 4b $20"	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2								$50/visit												10000	4.0059	0.0953	0.7695	0.2418	0.2536	0.1586	0.1121	0.1484	0.8605	0.1261	0.3474	0.0077	0.0031	0.2407	0.4557	1.6583	0.0215	0.1263	0.3146	0.1429	0.3463	0	0	0	0	0	0	0	0	0											10.4364	0	NO	0	16.3699	0.842629117	4.89536036	0.241790091	2.170455444	1.365031634	0.963274632	1.600045474	9.132968574	0.126129046	4.904334373	0.060627165	0.003121513	0.313416562	4.493627566	13.02958527	0.450481848	1.734188898	2.506600057	3.298813598	2.18466685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.687
H5509_015_0	2012	6																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	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	966.4251793	51.74188545	1432.33387	0	166.4194037	8.854564949	5.659839883	326.0091258	371.0426431	0	24.36970561	14.29229348	0	17.13477505	3184.874533	113.30114	128.2096782	6.157073376	13.45815309	8.515888742	11.15629959	0	0	0	0	0	0	0	0	0											5500	1a $250 days 1-7	1b $200 days 1-7	"2 $0 days 1-3, $50 Days 4 to 20, $100 Days 21 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $20"	"9a $300, 9b $300"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $20, 14a $0"	"7b $20 , 7d $40 , 7f $20, 17a $40, 18a $20"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $400 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	210.0913064	154.6722455	51.63960986	0	150	0.2	0.2	62.38628408	300	0	0.247306843	40	0	0.00409495	18.4176517	0.121637237	40	0.3427726	0.187961713	0.521638413	0.167583852	0	0	0	0	0	0	0	0	0											YES	193.7122745	142.6137663	47.61370877	0	138.305776	0.184407701	0.184407701	57.52255622	276.611552	0	0.228026432	36.88154027	0	0.003775702	16.98178407	0.112154216	36.88154027	0.316049537	0.173307937	0.480970703	0.154518765	0	0	0	0	0	0	0	0	0											10000	15.6007	0.61492543	5.683227312	0	1.918063731	1.632849969	1.043718063	1.562739855	8.552890115	0	5.556937015	0.043926816	0	0.064695796	4.507070967	12.70720052	0.394047534	1.945940188	2.332404751	4.095892999	1.723857632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9811	0	NO	5.917139315	15.6007	0.61492543	5.683227312	0	1.918063731	1.632849969	1.043718063	1.562739855	8.552890115	0	5.556937015	0.043926816	0	0.064695796	4.507070967	12.70720052	0.394047534	1.945940188	2.332404751	4.095892999	1.723857632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9811	YES	0.2	0.2	0.2	0	10a $150	0.2	0.2	"4a $65, 4b $20"	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2								$50/visit												10000	5.374	0.0992	1.0277	0.3631	0.2945	0.2498	0.1596	0.1856	1.1996	0.2026	0.6533	0.008	0.0033	0.3656	0.6557	2.3159	0.0239	0.1736	0.3792	0.1952	0.3856	0	0	0	0	0	0	0	0	0											14.3151	0	NO	0	20.9747	0.714123858	6.710930248	0.363108882	2.212527288	1.882667372	1.203359082	1.748319831	9.752494419	0.202576668	6.210278443	0.051951138	0.003272676	0.430310804	5.162798767	15.02314801	0.41791348	2.119582695	2.711574835	4.291117963	2.109425903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2962
H5509_016_0	2012	8																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	COIN	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	849.1364716	53.11504491	1155.105144	0	140.2560676	5.637202168	3.982372592	253.5365699	302.6497596	0	13.25737513	14.53542069	0	11.60081413	2518.12668	86.53852592	121.5790737	4.632518193	11.5421533	6.668897592	10.04085365	0	0	0	0	0	0	0	0	0											5900	1a $200 days 1-5	1b $200 days 1-7	"2 $0 days 1-3, $50 Days 4 to 21, $100 Days 22 to 100"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $15"	"9a $300, 9b $300"	8a 0% 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $300 14a $0"	"7e $40, 7h $40, 9c $40"	12 0%	"3 $40, 14b $0"	"7a $10, 14a $0"	"7b $20 , 7d $40 , 7f $10, 17a $40, 18a $15"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $300 14a $0"	"7g $40, 14a $0"	15 20%								14c $0													NO	149.2924834	154.6722455	50.66426882	0	150	0.2	0.2	62.60094027	300	0	0.293579432	40	0	0.195554804	9.08390411	0.063821535	39.98299854	0.32769984	0.174096764	0.000384859	0.170331518	0	0	0	0	0	0	0	0	0											YES	146.0089467	151.2703863	49.54995963	0	146.7009022	0.195601203	0.195601203	61.22409609	293.4018044	0	0.28712245	39.12024058	0	0.191253775	8.884112855	0.062417845	39.10361305	0.320492414	0.170267682	0.000376394	0.166585249	0	0	0	0	0	0	0	0	0											10000	10.3318	0.669561114	4.769617772	0	1.714640971	1.102643525	0.778956869	1.29354561	7.399832129	0	3.806490028	0.047385763	0	2.21869949	1.864276801	5.401548323	0.396181755	1.48468694	1.965255693	0.002510134	1.672658102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9203	0	NO	1.055171482	10.3318	0.669561114	4.769617772	0	1.714640971	1.102643525	0.778956869	1.29354561	7.399832129	0	3.806490028	0.047385763	0	2.21869949	1.864276801	5.401548323	0.396181755	1.48468694	1.965255693	0.002510134	1.672658102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9203	YES	0.2	0.2	0.2	0	10a $150	0.25	0.25	"4a $65, 4b $15"	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25								$50/visit												10000	4.0074	0.0954	0.7685	0.3019	0.2482	0.198	0.1399	0.1445	1.0743	0.1575	0.4337	0.0096	0.0039	0.3896	0.5873	2.137	0.0277	0.1628	0.4054	0.0062	0.4323	0	0	0	0	0	0	0	0	0											11.7311	0	NO	0	14.3392	0.764942664	5.538145199	0.301853605	1.962810953	1.300659823	0.918871027	1.438059564	8.474152427	0.15746099	4.240143672	0.05694071	0.003896933	2.608290165	2.45157593	7.538595459	0.423924173	1.64747922	2.370680326	0.008744521	2.104999808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6514
H5509_801_0	2012	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	136.7252686	3.301192065	13.6694036	0	5.016131219	6.477819167	4.645184108	10.96077616	38.00778271	7.047902881	36.60115353	0.960558027	0.159054618	15.91402813	23.57390047	103.8887524	0.732016858	6.687813731	11.41410502	7.808401455	20.77595537	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.7%	Medicare FFS 8.7%	Medicare FFS 17.3%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.087393994	0.087393994	0.173363898	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.08241573	0.08241573	0.163488491	0	0.211240185	0.211240185	0.211240185	0.211240185	0.211240185	0.211242795	0.211240185	0.211240185	0.211240185	0.211240185	0.211240185	0.211240551	0.211240185	0.211240185	0.211240185	0.211241279	0.211240185	0	0	0	0	0	0	0	0	0											10000	11.2683	0.272070154	2.234790172	0	1.059608489	1.368375722	0.981249553	2.31535639	8.028771069	1.488818703	7.731634462	0.202908456	0.033598727	3.361682253	4.979755108	21.9455173	0.154631377	1.412735013	2.411117661	1.64945671	4.388716667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2891	0	NO	4.668525204	11.2683	0.272070154	2.234790172	0	1.059608489	1.368375722	0.981249553	2.31535639	8.028771069	1.488818703	7.731634462	0.202908456	0.033598727	3.361682253	4.979755108	21.9455173	0.154631377	1.412735013	2.411117661	1.64945671	4.388716667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2891	NO	Medicare FFS 8.7%	Medicare FFS 8.7%	Medicare FFS 17.3%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					1.6914	0.0408	0.3354	0	0.1591	0.2054	0.1473	0.3475	1.2051	0.2212	1.1605	0.0305	0.005	0.5046	0.7475	3.2921	0.0232	0.2121	0.3619	0.2476	0.7168	0	0	0	0	0	0	0	0	0											11.6552	0	NO	0	12.9597	0.312908671	2.570238638	0	1.218658787	1.573772875	1.128537947	2.662898078	9.233912818	1.710031054	8.892175147	0.233365602	0.038641993	3.866280478	5.727230747	25.2376217	0.177841994	1.624790623	2.773033392	1.897043649	5.105563792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9443
H5509_802_0	2012	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	188.725598	5.517263449	35.74880401	0	6.778923129	7.513684474	5.308967374	14.46196071	40.9034299	6.308127564	17.67242583	0.36259528	0.147887301	15.46594686	24.40872391	110.9253944	1.01186853	5.937212304	14.79826308	8.550236744	13.70215637	0	0	0	0	0	0	0	0	0											6700	Medicare FSS 8.8%	Medicare FSS 8.8%	Medicare FSS 16.1%	Medicare FSS 0%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%																					NO	0.087689128	0.071393057	0.160850642	0	0.224	0.224	0.224	0.224	0.224	0.221854419	0.208587712	0.224	0.224	0.165128544	0.196581244	0.157881979	0.224	0.224	0.223834583	0.175896161	0.224	0	0	0	0	0	0	0	0	0											YES	0.082681198	0.067315797	0.151664455	0	0.211207351	0.211207351	0.211207351	0.211207351	0.211207351	0.209184304	0.196675259	0.211207351	0.211207351	0.155698047	0.185354482	0.148865332	0.211207351	0.211207351	0.21105138	0.165850724	0.211207351	0	0	0	0	0	0	0	0	0											10000	15.6041	0.371398986	5.421822887	0	1.431758396	1.586945393	1.121292935	3.054472411	8.639105072	1.319561274	3.475728929	0.076582789	0.031234885	2.408017714	4.524266366	16.51294571	0.213714072	1.253982883	3.123193852	1.418062955	2.893996149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4821	0	NO	4.511319826	15.6041	0.371398986	5.421822887	0	1.431758396	1.586945393	1.121292935	3.054472411	8.639105072	1.319561274	3.475728929	0.076582789	0.031234885	2.408017714	4.524266366	16.51294571	0.213714072	1.253982883	3.123193852	1.418062955	2.893996149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4821	NO	Medicare FSS 8.8%	Medicare FSS 8.8%	Medicare FSS 16.1%	Medicare FSS 0%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%																					2.3426	0.0558	0.814	0	0.2149	0.2382	0.1683	0.4586	1.297	0.1895	0.5218	0.0115	0.0047	0.3615	0.6792	2.4715	0.0321	0.1883	0.4689	0.2129	0.5202	0	0	0	0	0	0	0	0	0											11.2512	0	NO	0	17.9466	0.427155715	6.235780697	0	1.646702881	1.825187516	1.289628412	3.513028828	9.936061315	1.509027779	3.997526997	0.088079874	0.035924061	2.769524326	5.203477402	18.98442752	0.245798159	1.442238601	3.592067159	1.630951396	3.414161147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7334
H5509_803_0	2012	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	176.0949308	7.293005307	21.50338084	0	5.136501974	6.933770955	6.072462407	11.04830192	46.04052137	5.617293542	14.91482951	0.218105881	0.088956178	13.48235574	24.92779876	107.8604978	1.560556408	5.307019057	11.68157694	7.98602471	13.99357609	0	0	0	0	0	0	0	0	0											6700	Medicare FSS 8.7%	Medicare FSS 8.7%	Medicare FSS 17.8%	Medicare FSS 0%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%																					NO	0.087337337	0.075832222	0.17805666	0	0.224	0.224	0.224	0.224	0.224	0.221349104	0.209843516	0.224	0.224	0.141773398	0.189907284	0.16450122	0.224	0.224	0.223367622	0.172703398	0.238596358	0	0	0	0	0	0	0	0	0											YES	0.083068318	0.072125569	0.169353311	0	0.213050956	0.213050956	0.213050956	0.213050956	0.213050956	0.210529635	0.199586436	0.213050956	0.213050956	0.134843563	0.180624681	0.156460456	0.213050956	0.213050956	0.212449489	0.164261715	0.226933849	0	0	0	0	0	0	0	0	0											10000	14.6279	0.526012159	3.64166875	0	1.094336659	1.477246534	1.293743924	2.353851291	9.808977115	1.182606762	2.976797674	0.046467667	0.018952199	1.818008887	4.50257569	16.87590269	0.332478035	1.130665486	2.481745054	1.311798112	3.175616089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6774	0	NO	3.632227275	14.6279	0.526012159	3.64166875	0	1.094336659	1.477246534	1.293743924	2.353851291	9.808977115	1.182606762	2.976797674	0.046467667	0.018952199	1.818008887	4.50257569	16.87590269	0.332478035	1.130665486	2.481745054	1.311798112	3.175616089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6774	NO	Medicare FSS 8.7%	Medicare FSS 8.7%	Medicare FSS 17.8%	Medicare FSS 0%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%	Medicare FSS 22.4%																					2.177	0.0783	0.542	0	0.1629	0.2199	0.1925	0.3503	1.4598	0.1708	0.443	0.0069	0.0028	0.2706	0.6701	2.5071	0.0495	0.1683	0.3694	0.1952	0.4726	0	0	0	0	0	0	0	0	0											10.509	0	NO	0	16.8049	0.60429704	4.183647861	0	1.257203643	1.697100897	1.48628812	2.704168225	11.26881903	1.353412935	3.41982593	0.053383316	0.0217728	2.088577933	5.172681111	19.38295316	0.381959787	1.298939186	2.85109605	1.507029261	3.64823392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1863
H5516_001_0	2012	6																															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	1387.3015	101.4472678	975.4062018	1395.393586	192.0231985	11.3545411	10.92954848	345.7591093	54.35988397	18.83193217	33.25176432	0	0.015805772	31.48495659	6373.565194	4181.20374	545.3978509	445.6636403	0	0	23.07877613	937.3040135	0	0	44.94214226	0	10.35753805	61.75	115.2290495	0											4200	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	66.32870464	0	200	0.2	0.107639979	62.21320493	0.16	0.220403887	0.186458919	0	0.2	0.145840601	12.68978742	34.40031265	38.5	35	0	0	0.2	33.91191508	0	0	35	0	20	352.5	0	0											NO	143.620836	75.22277545	50.49842933	0	152.2671959	0.152267196	0.081950189	47.38873914	0.121813757	0.16780141	0.141957884	0	0.152267196	0.111033697	12.17692487	33.01298094	36.94400795	33.58546177	0	0	0.152267196	25.81836109	0	0	35	0	20	352.5	0	0												16.6038	0.635928754	4.104706763	0	2.436569499	1.728924134	0.895678564	1.36542402	6.621781683	3.160024764	4.720350103	0	0.002406701	3.49589113	6.467535376	11.50283328	1.679098545	1.247318263	0	0	3.514140526	2.016637789	0	0	0.131081248	0	0.017262563	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	74.1613	0	NO	16.96040762	16.6038	0.635928754	4.104706763	0	2.436569499	1.728924134	0.895678564	1.36542402	6.621781683	3.160024764	4.720350103	0	0.002406701	3.49589113	6.467535376	11.50283328	1.679098545	1.247318263	0	0	3.514140526	2.016637789	0	0	0.131081248	0	0.017262563	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	74.1613	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.1597	0.0106	0	0.1541	0.1148	0.2037	0.1176	0.0643	0.468	0.1489	0.3238	0	0.0001	0.2468	0.6033	0.8687	0.1104	0.0933	0	0	0.3068	0.1506	0	0	0.0098	0	0.0023	0.0955	0	0											4.253	0	NO	0.843597427	16.7635	0.646561355	4.104706763	0.154052509	2.551381674	1.932593207	1.013306092	1.429763371	7.089813373	3.308926455	5.044106363	0	0.002520105	3.742681178	7.070820933	12.37148473	1.789515456	1.340655003	0	0	3.820930572	2.167203067	0	0	0.140890049	0	0.019523137	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	78.4143
H5520_001_0	2012	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											2.168698028	0.031081136	0.364780117	0	0.079142291	0.112246327	0.011494601	0.005257836	0.621006818	0.146087236	0.394076078	0	0	0.201079321	0.080748663	0.627297395	0	0.046386526	0.016668338	0.017168049	0.124151391	0.00082985	0	0	0	0	0	0	0	0											5.0482	YES	478.3148001	20.51616346	289.9524964	11.02381792	162.6258453	9.02977069	3.326633104	382.0736884	523.012499	11.75213724	31.70185342	0	0.249016059	453.0960418	1949.298659	2955.152358	125.9350498	325.7481648	4.941399178	50.43026089	18.66454685	0	0	2182.074602	420	270	0	0	12650	250											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 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $12/visit (including 16b Medicare Covered Dental @ $12 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											75	NO	175	175	100	0	100	0.15	0.041695083	52.10042982	165.7852654	0	0.085661972	0	0.15	25	12	12.23801797	25	25	0	12.23770685	0.15	0	0	18.7941948	10	0	0	0	0.770750988	0											NO	155.9408762	155.9408762	89.10907209	0	89.10907209	0.133663608	0.037154102	46.42620957	147.7297117	0	0.076332589	0	0.133663608	22.27726802	10.69308865	10.90518425	22.27726802	22.27726802	0	10.90490702	0.133663608	0	0	18.7941948	10	0	0	0	0.770750988	0												6.2157	0.266609042	2.153116492	0	1.207619848	1.206951731	0.123598064	1.478186094	6.438707139	0	2.41988454	0	0.033284385	0.841145164	1.737001948	2.68554008	0.233790738	0.604731598	0	0.045828109	2.494770676	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	34.7665			3.6894	8.3844	0.297690178	2.517896609	0	1.286762139	1.319198058	0.135092665	1.48344393	7.059713956	0.146087236	2.813960618	0	0.033284385	1.042224485	1.81775061	3.312837475	0.233790738	0.651118124	0.016668338	0.062996158	2.618922066	0.00082985	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	39.8147	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/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/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 - $20/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												5100	2.2402	0.0857	0.7995	0	0.2238	0.263	0.0274	0.2445	1.3729	0.0174	0.8528	0	0.0093	0.2512	0.5229	0.8786	0.0988	0.1888	0.0029	0.0164	0.704	0.0001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8004			0.6678	10.6247	0.38344005	3.317422297	0	1.510600728	1.58220206	0.162485421	1.727936028	8.432600863	0.163482742	3.666744748	0	0.042627134	1.293466142	2.340665058	4.191445421	0.332596839	0.839896033	0.019605411	0.079362889	3.322912935	0.000971424	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	48.6151
H5520_002_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											4.806148331	0.066173451	0.691539697	0	0.195319838	0.356972193	0.026850927	0.011968081	1.474711376	0.35529742	1.052848185	0	0	0.427223797	0.189798672	1.356842608	0	0.11025389	0.041815328	0.031956663	0.355788701	0.006890841	0	0	0	0	0	0	0	0											11.5584	YES	533.2553415	16.63395476	299.5595993	16.16172961	194.3531099	13.8549259	6.79292548	471.010091	563.8362441	1903.431679	40.86350102	0	0.032678949	571.5226369	2536.619345	3563.405668	303.6532394	366.5335338	6.139062726	66.39393189	25.79348054	0	0	2182.074602	420	270	0	0	12650	250											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 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $12/visit (including 16b Medicare Covered Dental @ $12 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											175	NO	200	200	100	0	175	0.15	0.023012485	55.28627557	166.732504	12	0.079020648	0	0.15	25	12	12.25511175	25	25	0	12.43534727	0.15	0	0	18.7941948	10	0	0	0	0.770750988	0											NO	166.1958997	166.1958997	83.09794984	0	145.4214122	0.124646925	0.019122903	45.94176154	138.5512926	9.971753981	0.065664538	0	0.124646925	20.77448746	9.971753981	10.18374661	20.77448746	20.77448746	0	10.33351864	0.124646925	0	0	18.7941948	10	0	0	0	0.770750988	0												7.3854	0.23037459	2.074399047	0	2.355258643	1.726973906	0.129900457	1.803252774	6.510020034	1.581712702	2.683282919	0	0.00407333	0.989424154	2.107878671	3.024068368	0.525686701	0.634545525	0	0.057173578	3.215078028	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	41.6185			7.5336	12.1916	0.296548041	2.765938744	0	2.550578481	2.083946099	0.156751385	1.815220855	7.98473141	1.937010122	3.736131104	0	0.00407333	1.416647952	2.297677343	4.380910976	0.525686701	0.744799415	0.041815328	0.089130241	3.570866729	0.006890841	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.1769	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/day	11a:  Durable Medical Equipment - 18.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 18.0%	11b:  Prosthetics Devices - 18.0%/11b:  Medical Supplies - 18.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												4000	2.9569	0.0781	0.8037	0	0.4473	0.3723	0.0283	0.2917	1.4919	0.3993	0.9653	0	0.001	0.3156	0.6473	1.0881	0.2199	0.2077	0.0076	0.0224	0.8509	0.0012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.1966			1.8914	15.1485	0.374691293	3.569659371	0	2.997849405	2.456257638	0.185039817	2.106891898	9.476588392	2.336336661	4.701405573	0	0.005097476	1.732199001	2.94493812	5.469003422	0.745630836	0.952542917	0.049423618	0.111570335	4.421816646	0.008086069	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	64.3736
H5520_003_0	2012	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											2.725260079	0.020933656	0.303388376	0	0.121793281	0.179237854	0.014910752	0.004150399	0.969739732	0.24150556	0.405287748	0	0	0.271004635	0.119785901	1.012527118	0	0.077055099	0.026395107	0.023107843	0.157940012	0.00138498	0	0	0	0	0	0	0	0											6.6754	YES	424.0530812	4.707508555	209.3179377	10.16723592	154.0057565	9.708910462	3.728463914	370.1144066	481.5753066	12.99038597	21.81261237	0	0	437.5041196	2207.370397	4096.677068	39.47863724	335.6886745	5.247204277	48.54317759	17.53364921	0	0	2182.074602	420	270	0	0	12650	250											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 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $12/visit (including 16b Medicare Covered Dental @ $12 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											100	NO	175	175	100	0	100	0.15	0.032426954	49.69451389	166.0717313	0	0.100365643	0	0	25	12	12.21040117	25	25	0	12.07741413	0.15	0	0	18.7941948	10	0	0	0	0.770750988	0											NO	157.0125933	158.3420438	89.38728474	0	89.77177742	0.134213696	0.029039532	44.56301684	149.2404241	0	0.08996783	0	0	22.41883629	10.76849238	10.96253384	22.07075605	22.41452272	0	10.80080772	0.13388219	0	0	18.7941948	10	0	0	0	0.770750988	0												5.5485	0.062116377	1.559196842	0	1.152114208	1.303068755	0.108272846	1.374451211	5.989208584	0	1.962433394	0	0	0.817361103	1.980837608	3.74249675	0.072610281	0.627025118	0	0.043692127	2.347443359	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	33.2708			3.30136799	8.2737	0.083050033	1.862585218	0	1.273907489	1.48230661	0.123183598	1.378601611	6.958948316	0.24150556	2.367721142	0	0	1.088365738	2.100623509	4.755023867	0.072610281	0.704080217	0.026395107	0.06679997	2.505383371	0.00138498	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	39.9462	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/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/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 - $20/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												5100	2.0015	0.0207	0.5847	0	0.2054	0.2772	0.0234	0.232	1.3056	0.0261	0.4765	0	0	0.2631	0.6052	1.2299	0.0287	0.1875	0.0064	0.0167	0.6025	0.0002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.0935			0.459096329	10.2752	0.103747118	2.447311398	0	1.479290268	1.759504313	0.1466104	1.610590438	8.26452809	0.267630789	2.844186386	0	0	1.351511874	2.705869786	5.984920257	0.101356896	0.891609465	0.032795623	0.08354662	3.107905256	0.001595568	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	48.0398
H5520_004_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											4.630274031	0.004230933	0.7437348	0	0.191427777	0.421320122	0.032499913	0.007750879	1.349017303	0.408132929	0.735478649	0	0	0.425090588	0.207394846	1.637048474	0	0.150764217	0.050227303	0.033231482	0.493852322	0.011123432	0	0	0	0	0	0	0	0											11.5326	YES	511.0013939	0.626112892	352.5363995	14.49310742	171.8052483	14.94534975	7.300910689	462.6929378	481.7012565	2179.198695	26.08939159	0	0	555.1419905	2680.827141	4719.248657	131.442904	438.1052535	6.700990953	80.07984755	32.68285373	0	0	2182.074602	420	270	0	0	12650	250											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 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $12/visit (including 16b Medicare Covered Dental @ $12 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $12/visit/17a:  Vision Exams - $12/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											175	NO	200	200	100	0	175	0.15	0.023685923	54.10164069	166.711606	12	0.109984667	0	0	25	12	12.2197071	25	25	0	12.15624287	0.15	0	0	18.7941948	10	0	0	0	0.770750988	0											NO	165.6573444	165.6573444	82.82867222	0	144.9501764	0.124243008	0.019618735	44.81167064	138.0850097	9.939440666	0.091098839	0	0	20.70716806	9.939440666	10.12142114	20.70716806	20.70716806	0	10.06885456	0.124243008	0	0	18.7941948	10	0	0	0	0.770750988	0												7.0543	0.00864335	2.43334349	0	2.075266754	1.856855214	0.143234634	1.727836961	5.542976888	1.805001344	2.376713293	0	0	0.957951541	2.220493526	3.980458594	0.226817525	0.755993259	0	0.067192695	4.060616069	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	41.8737			7.7314	11.6845	0.012874283	3.17707829	0	2.266694531	2.278175336	0.175734548	1.73558784	6.891994191	2.213134273	3.112191943	0	0	1.383042129	2.427888372	5.617507068	0.226817525	0.906757476	0.050227303	0.100424177	4.55446839	0.011123432	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.4063	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/day	11a:  Durable Medical Equipment - 18.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 18.0%	11b:  Prosthetics Devices - 18.0%/11b:  Medical Supplies - 18.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network			7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												4000	2.665	0.003	0.9309	0	0.3598	0.3788	0.0295	0.2755	1.244	0.4227	0.5783	0	0	0.3192	0.6773	1.3654	0.0872	0.2322	0.0122	0.0248	0.9572	0.0017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.5647			1.5316	14.3495	0.015888597	4.107977425	0	2.62648499	2.657010825	0.20525331	2.011058358	8.136009211	2.635868303	3.690455355	0	0	1.702205396	3.105230816	6.982915886	0.313990403	1.138950299	0.062383153	0.1252717	5.511649816	0.012857229	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	63.971
H5520_005_0	2012	6																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											7.559050991	0.172381119	0	0	0.258698136	0.625729201	0.051150622	0.019700137	2.498064295	0.567507687	1.60570623	0	0	0.689524313	0.304065848	2.296423302	0	0.199869561	0.07024016	0.057007439	0.456719964	0.008960993	0	0	0	0	0	0	0	0											17.4408	YES	374.2241639	21.78140833	221.435044	11.281474	124.0730123	11.58540929	5.881974375	405.5802506	46.2517927	1563.492418	29.72973588	0	0.027613548	443.3458294	2186.914797	3075.668124	317.4642209	315.797596	5.021217943	59.32022242	15.52806154	0	0	0	0	0	0	0	12650	250											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $15/visit (including 16b Medicare Covered Dental @ $15 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											275	NO	250	250	100	0	250	0.15	0.024151495	55.16108125	0.144215675	15	0.103104034	0	0.15	25	14.99940864	14.99958584	25	25	0	15.39186363	0.15	0	0	0	0	0	0	0	0.770750988	0											NO	223.2238579	223.2238579	89.28954314	0	223.2238579	0.133934315	0.021564759	49.25307744	0.128769518	13.39343147	0.092061121	0	0.133934315	22.32238579	13.39290345	13.39306167	22.32238579	22.32238579	0	13.74332472	0.133934315	0	0	0	0	0	0	0	0.770750988	0												6.9613	0.4051775	1.647652826	0	2.308004705	1.551683854	0.126843361	1.664672958	5.955821036	1.745044047	2.736952812	0	0.003698402	0.824711387	2.440761561	3.43271774	0.590546568	0.587446314	0	0.06793809	2.079740282	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	35.9432			4.214	14.5204	0.577558619	1.647652826	0	2.566702841	2.177413056	0.177993983	1.684373094	8.453885331	2.312551734	4.342659043	0	0.003698402	1.514235699	2.744827408	5.729141042	0.590546568	0.787315875	0.07024016	0.124945529	2.536460246	0.008960993	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.384	YES	1a:  Acute - $275/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$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/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												4500	3.2448	0.1434	0.5251	0	0.4656	0.4163	0.0346	0.2902	1.4861	0.3459	0.949	0	0.001	0.315	0.6397	1.2027	0.2486	0.2123	0.0133	0.0275	0.6565	0.0016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2193			1.2166	17.7652	0.720951816	2.172797189	0	3.032314735	2.593730781	0.212607123	1.974526241	9.939948957	2.658492571	5.291632322	0	0.004730877	1.829261521	3.384563055	6.931880806	0.839135419	0.999635789	0.0835052	0.152428626	3.192973986	0.010575171	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	64.6034
H5520_006_0	2012	5																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											7.541401744	0.061540211	0	0	0.347971097	0.756499194	0.072664729	0.011952692	2.165790977	0.614809479	1.268028681	0	0	0.621113535	0.323037338	2.476555873	0	0.208638051	0.076830565	0.05508296	0.670310855	0.030972022	0	0	0	0	0	0	0	0											17.3032	YES	356.9975281	3.883094262	168.7571753	6.279226778	122.0261998	12.74407697	5.925949909	404.6309332	36.4851769	1579.672402	21.36136462	0	0.019263884	340.0756091	2165.718689	3421.328191	210.2976934	296.9501117	5.013463258	55.54625155	21.70252212	0	0	0	0	0	0	0	12650	250											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/day	11a:  Durable Medical Equipment - 15.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $15/visit (including 16b Medicare Covered Dental @ $15 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											275	NO	250	250	100	0	250	0.15	0.030985382	53.92454537	0.14483033	15	0.127891259	0	0.15	25	15	15	25	25	0	15.27721881	0.15	0	0	0	0	0	0	0	0.770750988	0											NO	224.9112964	224.9112964	89.96451854	0	224.9112964	0.134946778	0.02787585	48.51295762	0.130295909	13.49467778	0.115056756	0	0.134946778	22.49112964	13.49467778	13.49467778	22.49112964	22.49112964	0	13.74407635	0.134946778	0	0	0	0	0	0	0	0.770750988	0												6.6911	0.072779314	1.265179836	0	2.287089232	1.719772123	0.165190889	1.635820276	4.753869287	1.776430839	2.457769309	0	0.002599599	0.637390384	2.435472989	3.847476794	0.394152724	0.556561955	0	0.063619327	2.92868543	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	34.5034			3.7582	14.2325	0.134319524	1.265179836	0	2.635060329	2.476271317	0.237855618	1.647772968	6.919660264	2.391240318	3.725797991	0	0.002599599	1.258503919	2.758510327	6.324032667	0.394152724	0.765200005	0.076830565	0.118702287	3.598996285	0.030972022	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	51.8066	YES	1a:  Acute - $275/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$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/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												4500	3.0703	0.0298	0.4173	0	0.4049	0.4148	0.0405	0.2687	1.1386	0.3642	0.5856	0	0.0007	0.2526	0.6536	1.3176	0.1553	0.1952	0.0196	0.0253	0.7793	0.0044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.1381			0.8106	17.3028	0.164102264	1.682489625	0	3.039956128	2.891032635	0.278375207	1.916454609	8.05826169	2.755423336	4.3113934	0	0.003304201	1.511063191	3.412074426	7.641608557	0.549462614	0.960366831	0.096383959	0.144008771	4.378270708	0.035388094	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	61.9447
H5520_009_0	2012	5																															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											2.078041296	0.043275272	0.297762186	0	0.058411065	0.185598144	0.00853091	0.0046383	0.703360903	0.173196182	0.415246179	0	0	0.17615348	0.082311736	0.625979401	0	0.062605162	0.016860065	0.014222303	0.112390466	0.004975135	0	0	0	0	0	0.001841813	0	0											5.0654	YES	550.0814006	20.69684391	371.3152406	18.01127156	171.562032	19.80996992	9.068438903	508.5578052	815.7616591	18.48623635	44.32164102	0	0.033368374	726.348755	3049.891994	4199.025132	391.3815088	548.1846328	6.657113027	79.23953118	26.17878099	0	0	2182.074602	420	270	0	0	24650	250											1750	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/day	11a:  Durable Medical Equipment - 12.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $10 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year		"18b:  Hearing Aids - $0/service, $250 Per Three Years"	7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											75	NO	175	175	75	0	75	0.12	0.01204909	50.29528386	84.6767383	0	0.027607716	0	0.12	25	10	10.42370533	25	25	0	10.54249109	0.12	0	0	18.7941948	10	0	0	0	0.395537525	0											NO	142.7703581	142.7703581	61.18729632	0	61.18729632	0.097899674	0.009830017	41.03243249	69.0818757	0	0.02252322	0	0.097899674	20.39576544	8.158306176	8.503977957	20.39576544	20.39576544	0	8.600887019	0.097899674	0	0	18.7941948	10	0	0	0	0.395537525	0												6.5446	0.246241318	1.893314638	0	0.874784741	1.939389599	0.089142906	1.738946984	4.696195461	0	0.998266054	0	0.003266753	1.23453657	2.073496058	2.97570143	0.665210454	0.931720432	0	0.056794188	2.562894128	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	34.1045			6.665	8.6227	0.28951659	2.191076824	0	0.933195806	2.124987743	0.097673815	1.743585284	5.399556365	0.173196182	1.413512233	0	0.003266753	1.41069005	2.155807794	3.601680831	0.665210454	0.994325594	0.016860065	0.071016491	2.675284594	0.004975135	0	3.417527928	0.35	0	0	0.001841813	0.8125	0	0	0	0	0	0	0	0	0	0	0	39.1699	YES	1a:  Acute - $200/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/day	11a:  Durable Medical Equipment - 12.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $20/visit (including 16b Medicare Covered Dental @ $20 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 - $15 to $20/visit/18a:  Hearing Exams - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network		"18b:  Hearing Aids - $0/service, $250/Per Three Years"	7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												3500	2.4851	0.0876	0.508	0	0.1939	0.3875	0.0178	0.3269	1.9083	0.017	0.2692	0	0.0008	0.3844	0.8044	1.2092	0.3155	0.3235	0.0032	0.0247	0.6295	0.0009	0	0	0	0	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	9.8977			1.12	11.1077	0.377147866	2.699103763	0	1.127093603	2.512468615	0.115484146	2.070507194	7.307902735	0.190160231	1.682692542	0	0.004043213	1.795080495	2.96019301	4.810921756	0.980707467	1.31781161	0.020015702	0.095744665	3.304783492	0.005886934	0	3.417527928	0.35	0	0	0.002093942	0.8125	0	0	0	0	0	0	0	0	0	0	0	49.0676
H5520_010_0	2012	5																															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											1.393681143	0.007215744	0.180545104	0	0.056684832	0.130962715	0.007187754	0.001863313	0.409925857	0.118844641	0.222027553	0	0	0.126587611	0.055768028	0.492747047	0	0.04789446	0.013403627	0.010612973	0.107541183	0.001094418	0	0	0	0	0	0.001909284	0	0											3.3865	YES	492.6888285	6.125540325	294.8236523	10.61846049	175.5693892	18.40879485	7.679014646	478.4362431	549.5229238	16.67055942	31.16531378	0	0	530.4102979	3113.934768	5237.882624	132.4984515	555.5610312	6.903624607	85.22701798	28.92428551	0	0	2182.074602	420	270	0	0	24650	250											1750	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/day	11a:  Durable Medical Equipment - 12.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $10 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year		"18b:  Hearing Aids - $0/service, $250 Per Three Years"	7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year											50	NO	175	175	100	0	100	0.12	0.015634037	48.26050548	116.1271824	0	0.030922711	0	0	25	10	10.38176649	25	25	0	10.17075275	0.12	0	0	18.7941948	10	0	0	0	0.395537525	0											NO	143.3558327	143.1474281	81.95555727	0	81.93354961	0.098292897	0.012813895	39.54431944	95.12406487	0	0.02533265	0	0	20.48468457	8.190426811	8.503616979	20.47977366	20.47386742	0	8.331387772	0.09834802	0	0	18.7941948	10	0	0	0	0.395537525	0												5.8858	0.073071279	2.013536393	0	1.198751939	1.809453784	0.09839809	1.576619636	4.356071188	0	0.789499979	0	0	0.905440637	2.125371234	3.711745634	0.226128191	0.947873575	0	0.059171611	2.84464621	0	0	3.417527928	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	33.2016			6.315669795	7.2795	0.080287022	2.194081497	0	1.255436771	1.940416499	0.105585844	1.578482948	4.765997045	0.118844641	1.011527532	0	0	1.032028248	2.181139262	4.204492682	0.226128191	0.995768035	0.013403627	0.069784584	2.952187393	0.001094418	0	3.417527928	0.35	0	0	0.001909284	0.8125	0	0	0	0	0	0	0	0	0	0	0	36.5881	YES	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 - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/day	11a:  Durable Medical Equipment - 12.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $10/visit (including 16b Medicare Covered Dental @ $10 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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 to $15/visit/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		16a: Dental - Preventive/Diagnostic 100% IN / 80% OON; Deductible $35; Annual Max $500 - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $100 Every Other Year - priced as In-Network		"18b:  Hearing Aids - $0/service, $250/Per Three Years"	7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/ - priced as In-Network												3500	1.7772	0.0201	0.5357	0	0.2208	0.3114	0.0169	0.2808	0.8569	0.0128	0.1413	0	0	0.2862	0.4204	0.8127	0.0975	0.2964	0.0033	0.0136	0.5865	0.0002	0	0	0	0	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	6.691			0.45514872	9.0567	0.100431835	2.729794696	0	1.476189625	2.251773117	0.122489241	1.859270996	5.622932256	0.131677728	1.152847818	0	0	1.318221492	2.601548945	5.017223887	0.323610358	1.292153168	0.016689168	0.083370506	3.538687543	0.001249797	0	3.417527928	0.35	0	0	0.002203043	0.8125	0	0	0	0	0	0	0	0	0	0	0	43.2791
H5520_807_0	2012	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	185.5948563	2.063419864	26.92899812	15.34721211	7.512226029	14.49765213	6.730558155	33.67906598	55.83965073	14.81924239	39.40387968	0	0.024616034	16.47364141	33.0980161	84.92511673	2.212083228	4.573221266	6.145604883	17.37476745	27.51011161	0.302763925	0	0	0	0	0	0	800	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.081184969	0.081184969	0.13474487	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074227406	0.074227406	0.123197217	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0	0	0	0	0	0	0												13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252			8.6258	13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252	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	2.7931	0.0315	0.7373	0	0.2569	0.4708	0.2085	0.7407	1.922	0.3819	1.4083	0	0.0011	0.5901	1.3672	3.2716	0.1004	0.225	0.275	0.7397	1.1626	0.0122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6959			0.7966	16.5693	0.184709066	4.054876351	0	1.79544222	3.439931175	1.586955012	7.638326631	13.35808792	3.416899438	9.478353243	0	0.006125942	3.963968528	8.145741028	20.66455522	0.553478822	1.161618173	1.533637456	4.29811091	6.796715874	0.074218101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7211
H5520_808_0	2012	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	185.5948563	2.063419864	26.92899812	15.34721211	7.512226029	14.49765213	6.730558155	33.67906598	55.83965073	14.81924239	39.40387968	0	0.024616034	16.47364141	33.0980161	84.92511673	2.212083228	4.573221266	6.145604883	17.37476745	27.51011161	0.302763925	0	0	0	0	0	0	800	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.081184969	0.081184969	0.13474487	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074227406	0.074227406	0.123197217	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0	0	0	0	0	0	0												13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252			8.6258	13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252	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	2.7931	0.0315	0.7373	0	0.2569	0.4708	0.2085	0.7407	1.922	0.3819	1.4083	0	0.0011	0.5901	1.3672	3.2716	0.1004	0.225	0.275	0.7397	1.1626	0.0122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6959			0.7966	16.5693	0.184709066	4.054876351	0	1.79544222	3.439931175	1.586955012	7.638326631	13.35808792	3.416899438	9.478353243	0	0.006125942	3.963968528	8.145741028	20.66455522	0.553478822	1.161618173	1.533637456	4.29811091	6.796715874	0.074218101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7211
H5520_809_0	2012	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	185.5948563	2.063419864	26.92899812	15.34721211	7.512226029	14.49765213	6.730558155	33.67906598	55.83965073	14.81924239	39.40387968	0	0.024616034	16.47364141	33.0980161	84.92511673	2.212083228	4.573221266	6.145604883	17.37476745	27.51011161	0.302763925	0	0	0	0	0	0	800	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							14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/														0.081184969	0.081184969	0.13474487	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.074227406	0.074227406	0.123197217	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0.20480317	0	0	0	0	0	0	0	0												13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252			8.6258	13.7762	0.153162305	3.317577627	0	1.538527706	2.969165116	1.378439648	6.897579483	11.4361375	3.035027821	8.070039478	0	0.005041442	3.373853986	6.778578626	17.39293314	0.453041658	0.936610214	1.258639363	3.558407456	5.63415807	0.062007012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0252	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	2.7931	0.0315	0.7373	0	0.2569	0.4708	0.2085	0.7407	1.922	0.3819	1.4083	0	0.0011	0.5901	1.3672	3.2716	0.1004	0.225	0.275	0.7397	1.1626	0.0122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6959			0.7966	16.5693	0.184709066	4.054876351	0	1.79544222	3.439931175	1.586955012	7.638326631	13.35808792	3.416899438	9.478353243	0	0.006125942	3.963968528	8.145741028	20.66455522	0.553478822	1.161618173	1.533637456	4.29811091	6.796715874	0.074218101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7211
H5521_012_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1441.871036	37.74474701	1241.746435	980.1348844	263.4818255	15.98823378	0	298.0051653	369.2537659	4142.636599	2368.762736	87.36736554	0.023649862	1098.047862	2190.034807	6817.686909	224.5836912	881.7957588	0	0	323.0855388	0.002252283	0	0	1171.08767		50.05164769			0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 to $35 per visit	$0 to $35 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$35 per visit	20% per visit	$0 to 250 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	175	0.03	0.03	62.5	250	3.5	18.29485842	35	0.2	35	10	35	35	17.5	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	166.6775873	88.68828444	66.35102052	0	161.4076109	0.027669876	0	57.64557531	230.5823012	3.228152217	16.87388222	32.28152217	0.184465841	32.28152217	9.223292049	32.28152217	32.28152217	16.14076109	0	0	46.11646025	0	0	0	0	0	0	0	0	0												20.0273	0.278959738	6.8659286	0	3.543997663	0.442392448	0	1.4315566	7.095281923	1.114421794	3.330851953	0.235029296	0.004362592	2.953888034	1.683277552	18.34044259	0.604158617	1.186071223	0	0	1.241630117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3795	0	NO	5.926772717	20.0273	0.278959738	6.8659286	0	3.543997663	0.442392448	0	1.4315566	7.095281923	1.114421794	3.330851953	0.235029296	0.004362592	2.953888034	1.683277552	18.34044259	0.604158617	1.186071223	0	0	1.241630117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3795	YES	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$175 copay	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$65 copay	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP	$250 ded; 25% coinsurance; $10000 max OOP		Not Covered	0	$250 ded; 25% coinsurance; $10000 max OOP	Not Covered	$250 ded; 25% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	8.5948	0.0664	1.29	0.296	0.45	0.4845	0	0.2169	1.396	0.7314	1.8145	0.0244	0.0006	0.9262	0.7666	3.7978	0.0856	0.3156	0	0	2.3729	0	0	0	0.2088	0.0004	0.0078	0	0	0											23.8473	250	NO	5.641848779	28.6221	0.345391301	8.15593325	0.295976409	3.994034764	0.926917294	0	1.648469475	8.491323922	1.84581115	5.145367063	0.259432828	0.004947675	3.880070314	2.449885588	22.13820053	0.689732524	1.501672237	0	0	3.614553493	0	0	0	0.208805424	0.000422168	0.007780587	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2269
H5521_013_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1094.333447	161.8845256	860.5364059	1113.387679	213.2559287	12.31528409	0	289.8543919	334.9378187	3568.646487	2305.027212	99.65785398	0.031107048	726.2617106	2268.133922	5368.888044	389.4731213	971.6970624	0	0	264.8821523	0.002903003	0	0	1295.005486	131.4500688	53.90477246	16.08267211	60.25581828	0											6700	$195/day 1-7; unlimited additional days	$195/day 1-7	"$0/d 1-8, $50/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$30 per visit	20% per visit	$0 to 175 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	140.9567402	93.75294295	54.9293584	0	150	0.03	0.03	62.5	175	3	16.23299738	30	0.2	30	10	30	30	15	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	127.6063033	84.87331966	49.72683361	0	135.7930487	0.02715861	0	56.58043697	158.4252235	2.715860974	14.69552136	27.15860974	0.181057398	27.15860974	9.052869914	27.15860974	27.15860974	13.57930487	0	0	45.26434957	0	0	0	0	0	0	0	0	0												11.637	1.144973091	3.565979223	0	2.413222726	0.334465994	0	1.366674012	4.421883232	0.80766231	2.822798053	0.225547397	0.005632161	1.643688197	1.711093446	12.15096126	0.881462376	1.099580888	0	0	0.999143195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2318	0	NO	4.941484447	11.637	1.144973091	3.565979223	0	2.413222726	0.334465994	0	1.366674012	4.421883232	0.80766231	2.822798053	0.225547397	0.005632161	1.643688197	1.711093446	12.15096126	0.881462376	1.099580888	0	0	0.999143195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2318	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	$150 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$1000 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 30% coinsurance; $10000 max OOP	$500.00 Every 3 Yrs	Nursing Hotline	0											10000	9.0616	0.2996	1.1062	0.3479	0.3718	0.512	0	0.3038	1.4824	0.9298	2.2347	0.0588	0.001	0.9832	1.242	4.8238	0.2018	0.4179	0	0	2.3756	0	0	0	0.3935	0.0048	0.0118	0	0	0											27.1642	1000	NO	6.522467044	20.6986	1.444612405	4.672133133	0.347902881	2.785061504	0.846444081	0	1.670501913	5.904314721	1.737478578	5.057522881	0.284351411	0.006593725	2.626916635	2.953113179	16.97475552	1.083287142	1.517471311	0	0	3.374760106	0	0	0	0.393521457	0.004836585	0.011785503	0	0	0	0	0	0	0	0	0	0	0	0	0	74.396
H5521_015_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1366.53141	69.32241637	945.8025092	1128.459986	191.8215805	11.45952654	0	268.7854499	319.6795483	2860.240253	2180.049976	42.37299852	0.06008595	572.1115043	1850.601766	5626.319644	305.8295082	644.4701545	0	0	75.05253605	0.005077435	0	0	1072.737632		45.6622509			0											6700	$225/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $35 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; $150 Complex Radiology	$35 per visit	20% per visit	$0 to 250 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	162.6423925	98.56078618	71.93854446	0	150	0.03	0.03	63.5	250	3.5	20.00900734	35	0.2	35	15	35	35	17.5	35	35	0.1	0	0	0	0	0	0	0	0	0											NO	147.1298153	89.16021243	65.07715852	0	135.6932344	0.027138647	0	57.44346925	226.1553907	3.16617547	18.10057949	31.6617547	0.180924313	31.6617547	13.56932344	31.6617547	31.6617547	15.83087735	0	0	0.090462156	0	0	0	0	0	0	0	0	0												16.7548	0.515066781	5.129178319	0	2.169074225	0.310996044	0	1.28666406	6.024771096	0.754668544	3.288347325	0.11180029	0.010871009	1.509504509	2.092617828	14.84492937	0.806924906	0.850210664	0	0	6.789414246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2498	0	NO	7.384561809	16.7548	0.515066781	5.129178319	0	2.169074225	0.310996044	0	1.28666406	6.024771096	0.754668544	3.288347325	0.11180029	0.010871009	1.509504509	2.092617828	14.84492937	0.806924906	0.850210664	0	0	6.789414246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2498	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	$150 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$1000 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 30% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	11.8155	0.2174	1.4428	0.3761	0.3704	0.4883	0	0.2851	1.5136	0.734	2.0505	0.0343	0.0022	1.0073	1.0158	5.0644	0.1161	0.3218	0	0	2.5425	0	0	0	0.2949	0	0.0135	0	0	0											29.7062	1000	NO	7.316766902	28.5703	0.7324284	6.57200649	0.376088517	2.539426385	0.799248572	0	1.571737419	7.538375684	1.488656985	5.338835819	0.146122737	0.013080529	2.516768229	3.108405436	19.9092983	0.922997484	1.17196239	0	0	9.331910306	0	0	0	0.294908308	0	0.013505537	0	0	0	0	0	0	0	0	0	0	0	0	0	92.956
H5521_016_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1569.297801	96.02638193	943.8079854	721.8618893	192.3303231	12.37788602	0	261.9507584	316.7144645	3108.034589	2191.760038	32.26211901	0.029428726	645.7441523	2763.844742	5411.317175	290.2091385	851.9114412	0	0	70.01916629	0.00232942	0	0	900.8705019	1.334520294	34.47991301	1.334520294	50.50436857	0											6700	$200/day 1-8; unlimited additional days	$205/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $50 X-ray; $60 Therapeutic Radiology; $250 Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	152.3663772	98.56078618	51.87372562	0	175	0.03	0.03	62.5	200	4	30.31120955	40	0.2	40	10	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	137.5865402	89.00019686	46.84187263	0	158.0246572	0.027089941	0	56.43737758	180.5996083	3.611992165	27.37096285	36.11992165	0.180599608	36.11992165	9.029980413	36.11992165	36.11992165	18.05996083	0	0	0.090299804	0	0	0	0	0	0	0	0	0												17.9929	0.712197241	3.684144453	0	2.532744449	0.335316205	0	1.231984488	4.766542352	0.935516382	4.999215214	0.097108768	0.005314816	1.943685682	2.079788657	16.28802936	0.873527612	1.282123938	0	0	6.322717001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0828	0	NO	7.777937793	17.9929	0.712197241	3.684144453	0	2.532744449	0.335316205	0	1.231984488	4.766542352	0.935516382	4.999215214	0.097108768	0.005314816	1.943685682	2.079788657	16.28802936	0.873527612	1.282123938	0	0	6.322717001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0828	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	$175 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$1000 ded; 30% coinsurance; $10000 max OOP		Not Covered		$1000 ded; 30% coinsurance; $10000 max OOP	Not Covered	$1000 ded; 30% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												10000	15.9381	0.2912	1.4027	0.5799	0.4639	0.6437	0	0.3419	1.6412	1.0086	2.2844	0.0225	0.0011	1.0865	2.0249	6.2168	0.1951	0.4571	0	0	3.6414	0	0	0	0.3619	0.0001	0.0151	0	0	0											38.6181	1000	NO	9.544901968	33.931	1.003408313	5.086810974	0.579909695	2.996660389	0.979041381	0	1.573922165	6.407710619	1.944159903	7.283579359	0.119584363	0.006441904	3.030194924	4.104686633	22.50478394	1.068601358	1.73924	0	0	9.964138494	0	0	0	0.36185014	7.68E-05	0.015129059	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7009
H5521_020_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1315.524721	77.45625837	1025.856896	650.2039184	216.6275742	10.83280849	0	326.9063021	292.6706101	3110.268436	2305.907994	28.04242351	0.032440736	1035.743928	2157.15345	5115.823583	291.3323385	718.6706877	0	0	55.99347378	0.003090526	0	0	928.6959781	1.488589715	45.19835304	3.721474288	63.92162445	0											5000	$220/day 1-8; unlimited additional days	$205/day 1-7	"$0/d 1-8, $50/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$180 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$220 per procedure	$0 to $45 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 220 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												0	NO	167.6030149	98.56078618	54.9293584	0	180	0.03	0.03	62.5	220	4.5	24.71627306	45	0.2	45	15	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	143.6501989	84.47507071	47.07918448	0	154.2754813	0.02571258	0	53.56787546	188.5589216	3.856887033	21.18397179	38.56887033	0.171417201	38.56887033	12.85629011	38.56887033	34.28344029	19.28443517	0	0	0.085708601	0	0	0	0	0	0	0	0	0												15.7479	0.545260242	4.024708839	0	2.78502694	0.278539457	0	1.45930634	4.598804553	0.999662833	4.070690824	0.090130383	0.0055609	3.328956104	2.311082547	16.44262803	0.832322903	1.154929857	0	0	4.799122288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4747	0	NO	11.38425069	15.7479	0.545260242	4.024708839	0	2.78502694	0.278539457	0	1.45930634	4.598804553	0.999662833	4.070690824	0.090130383	0.0055609	3.328956104	2.311082547	16.44262803	0.832322903	1.154929857	0	0	4.799122288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4747	YES	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$180 copay	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$65 copay	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 20% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP	$1000 ded; 25% coinsurance; $7500 max OOP		Not Covered		$1000 ded; 25% coinsurance; $7500 max OOP	$50.00 Every 2 Years	$1000 ded; 25% coinsurance; $7500 max OOP	$300.00 Every 3 Yrs	Fitness/Nursing Hotline												7500	11.6736	0.1605	1.1899	0.4902	0.54	0.5018	0	0.4316	1.8231	0.9324	2.1729	0.0187	0.0013	1.2105	1.2084	4.7879	0.1614	0.3324	0	0	2.5939	0	0	0	0.255	0.0004	0.0122	0	0	0											30.4979	1000	NO	7.672523723	27.4216	0.705718725	5.214615228	0.490158916	3.325007931	0.780368002	0	1.890879149	6.421877934	1.932059643	6.24357083	0.108812273	0.006847465	4.539493184	3.519502612	21.23051939	0.993689827	1.487293558	0	0	7.393013199	0	0	0	0.255035317	0.000384413	0.012209888	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9726
H5521_022_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1378.161654	56.03919936	898.1738757	1080.905207	170.8739912	16.04546952	0	233.1496273	318.3106659	3194.512722	2453.3953	20.4286684	0.026652593	394.8173977	2881.974583	6101.404785	189.8936351	983.3439609	0	0	62.22945887	0.002244557	0	0	847.4402523	0	45.86584136	0	50.3404652	0											6700	$200/day 1-5; unlimited additional days	$200/day 1-5	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	122.5677481	77.48421749	58.48044118	0	200	0.03	0.03	62	200	4	16.51241388	40	0.2	40	20	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	106.8500354	67.54787868	50.98108846	0	174.3526124	0.026152892	0	54.04930983	174.3526124	3.487052247	14.39491248	34.87052247	0.174352612	34.87052247	17.43526124	34.87052247	34.87052247	17.43526124	0	0	0.087176306	0	0	0	0	0	0	0	0	0												12.2714	0.315444087	3.815823484	0	2.482693896	0.419635429	0	1.05013137	4.624858012	0.928286064	2.943034219	0.059363195	0.004646949	1.147290745	4.187331645	17.72993106	0.551807522	1.428738237	0	0	5.42493436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3853	0	NO	9.533634675	12.2714	0.315444087	3.815823484	0	2.482693896	0.419635429	0	1.05013137	4.624858012	0.928286064	2.943034219	0.059363195	0.004646949	1.147290745	4.187331645	17.72993106	0.551807522	1.428738237	0	0	5.42493436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3853	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	$200 copay	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$750 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$750 ded; 30% coinsurance; $10000 max OOP	Not Covered	$750 ded; 30% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	10.9484	0.1424	1.1389	0.4814	0.3573	0.6144	0	0.2176	1.3704	0.944	1.7976	0.017	0.0007	0.9163	1.4736	5.2487	0.0927	0.457	0	0	2.383	0	0	0	0.2131	0.0003	0.0109	0	0	0											28.8257	750	NO	7.660423347	23.2198	0.457839257	4.954676473	0.481410747	2.839984894	1.034069498	0	1.267710502	5.995299209	1.872251318	4.740676377	0.076410871	0.005384997	2.063613486	5.660886559	22.9786402	0.644536825	1.885734903	0	0	7.807906052	0	0	0	0.213059483	0.000266503	0.010873971	0	0	0	0	0	0	0	0	0	0	0	0	0	88.211
H5521_027_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1512.851212	141.8036261	1086.902809	833.3962733	235.7431862	10.28141498	0	302.5749716	327.6352964	3399.411046	2402.789519	33.52807387	0.04043135	642.1926252	2183.356515	5479.380797	487.0741655	842.0391644	0	0	63.48106689	0.003893329	0	0	1037.457988		50.36572104			0											6700	$225/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$175 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	162.6423925	98.56078618	51.87372562	0	175	0.03	0.03	63.5	250	4.5	18.57427492	45	0.2	45	25	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	145.5434683	88.19889104	46.42013575	0	156.6018955	0.026846039	0	56.82411635	223.7169935	4.026905883	16.62152377	40.26905883	0.178973595	40.26905883	22.37169935	40.26905883	35.79471896	20.13452942	0	0	0.089486797	0	0	0	0	0	0	0	0	0												18.3488	1.042243547	4.204514662	0	3.076485817	0.27601527	0	1.432796283	6.108131957	1.140759028	3.328168591	0.112511998	0.007236144	2.155041051	4.070449628	18.38745897	1.452890239	1.412838527	0	0	5.680717372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2371	0	NO	9.154036176	18.3488	1.042243547	4.204514662	0	3.076485817	0.27601527	0	1.432796283	6.108131957	1.140759028	3.328168591	0.112511998	0.007236144	2.155041051	4.070449628	18.38745897	1.452890239	1.412838527	0	0	5.680717372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2371	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	$175 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$1000 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 30% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	11.2002	0.3423	1.1913	0.356	0.4405	0.4187	0	0.329	1.3686	0.9728	1.9915	0.0193	0.0012	0.9089	1.1815	4.9887	0.2421	0.4398	0	0	2.5851	0	0	0	0.2762	0	0.0132	0	0	0											29.2669	1000	NO	7.179188594	29.549	1.384558808	5.395827638	0.356041891	3.516959503	0.694692338	0	1.761821733	7.476685358	2.113533343	5.319652261	0.131789115	0.008451535	3.06393435	5.25197036	23.37617528	1.694987579	1.85266467	0	0	8.265776631	0	0	0	0.27618726	4.19E-05	0.013185722	0	0	0	0	0	0	0	0	0	0	0	0	0	101.504
H5521_028_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1085.312497	47.34779498	687.0608324	900.3647477	164.018845	12.97345115	0	265.1415733	325.5438279	3293.52054	2271.148686	29.71678876	0.032890688	645.3382663	2114.508068	4862.522994	245.3894932	846.3629866	0	0	65.11890465	0.003100929	0	0	1007.520711	0	66.6633818	0	64.04792269	0											6700	$265/day 1-6; unlimited additional days	$235/day 1-6	"$0/d 1-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$100 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 to $45 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$45 per visit	20% per visit	$0 to 250 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	178.5937298	102.795207	40.33133874	0	100	0.03	0.03	62	250	4.5	18.57427492	45	0.2	45	20	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	154.7676649	89.08137018	34.95076298	0	86.65906978	0.025997721	0	53.72862326	216.6476745	3.89965814	16.09629386	38.9965814	0.17331814	38.9965814	17.33181396	38.9965814	34.66362791	19.4982907	0	0	0.08665907	0	0	0	0	0	0	0	0	0												13.9976	0.351483871	2.001108359	0	1.184476711	0.337280163	0	1.187140975	5.877359437	1.070300349	3.046423055	0.096571098	0.005700553	2.09716552	3.054021703	15.80181448	0.70884084	1.375219296	0	0	5.643143702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8357	0	NO	9.77239025	13.9976	0.351483871	2.001108359	0	1.184476711	0.337280163	0	1.187140975	5.877359437	1.070300349	3.046423055	0.096571098	0.005700553	2.09716552	3.054021703	15.80181448	0.70884084	1.375219296	0	0	5.643143702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8357	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	$65 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; 20% 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	$750 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$750 ded; 30% coinsurance; $10000 max OOP	Not Covered	$750 ded; 30% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	8.7388	0.1094	0.7945	0.2999	0.1893	0.5144	0	0.2573	1.3704	0.8412	1.918	0.0166	0.001	0.9165	1.0887	4.2021	0.1151	0.3545	0	0	2.582	0	0	0	0.2558	0	0.0157	0	0	0											24.5812	750	NO	6.300304713	22.7364	0.460872786	2.795653033	0.299928461	1.373803205	0.851685855	0	1.44440853	7.247756149	1.911499497	4.964437431	0.11316472	0.006655986	3.013635811	4.142725801	20.00386625	0.823943887	1.729722377	0	0	8.225150203	0	0	0	0.255805236	2.75E-05	0.015713126	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4169
H5521_033_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1225.149497	74.10066051	793.6415891	1102.943807	164.1165937	12.75370455	0	248.0524519	331.9148973	4068.131345	2490.889571	16.49818893	0.02257774	712.3849247	2381.016241	5826.678695	351.0527179	865.874035	0	0	82.1176798	0.002003412	0	0	1177.136352	102.3691157	43.37093226	8.268102507	47.47912316	0											6700	$265/day 1-6; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$275 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; $150 Complex Radiology	$40 per visit	20% per visit	$0 to 275 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness/Nursing Hotline	0											0	NO	178.5937298	98.56078618	71.93854446	0	200	0.03	0.03	63.5	275	4	20.00900734	40	0.2	40	25	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	160.5614783	88.60930086	64.67505361	0	179.8064003	0.02697096	0	57.08853209	247.2338004	3.596128006	17.98873792	35.96128006	0.1798064	35.96128006	22.47580004	35.96128006	35.96128006	17.98064003	0	0	0.0899032	0	0	0	0	0	0	0	0	0												16.3927	0.54716731	4.277401026	0	2.459101161	0.343979656	0	1.180079197	6.838381789	1.219126755	3.733996639	0.049441333	0.004059622	2.134856149	4.459603742	17.46123536	1.052025425	1.297414111	0	0	7.382642202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8332	0	NO	8.784218208	16.3927	0.54716731	4.277401026	0	2.459101161	0.343979656	0	1.180079197	6.838381789	1.219126755	3.733996639	0.049441333	0.004059622	2.134856149	4.459603742	17.46123536	1.052025425	1.297414111	0	0	7.382642202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8332	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	$200 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$65 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; 20% 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	$500 ded; 30% coinsurance; $10000 max OOP		Not Covered	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	Fitness/Nursing Hotline	0											10000	8.2747	0.1343	1.0377	0.356	0.3164	0.4651	0	0.2108	1.2197	0.9656	1.9127	0.0094	0.0006	0.8104	1.0582	4.6377	0.1431	0.3347	0	0	2.9944	0	0	0	0.2825	0.0022	0.011	0	0	0											25.1771	500	NO	7.181497683	24.6674	0.681436003	5.315091877	0.356047854	2.775493231	0.809032804	0	1.390841905	8.058032188	2.184754368	5.646692356	0.058868081	0.004645194	2.945231362	5.517818301	22.09889297	1.195082608	1.632110593	0	0	10.37699458	0	0	0	0.28254956	0.002212697	0.011043314	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0102
H5521_036_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1307.655195	62.41656702	955.4620572	1149.69098	154.3270832	13.24347223	0	318.6533529	364.2784896	4336.466723	2521.686104	48.69061406	1.437938768	659.5345865	2892.748496	5221.793646	420.9155827	1002.484715	0	0	88.04754887	0	0	0	1036.78179	74.15731631	53.7001256	0.284127649	21.28069066	0											6700	$250/day 1-7; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $105/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	20% per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	98.56078618	63.87227671	0	150	0.03	0.03	63.5	300	5	20.63613596	50	0.2	50	20	50	40	25	50	50	0.1	0	0	0	0	0	0	0	0	0											NO	160.2574412	87.40396175	56.64210126	0	133.0203905	0.026604078	0	56.3119653	266.0407809	4.434013016	18.30017909	44.34013016	0.177360521	44.34013016	17.73605206	44.34013016	35.47210413	22.17006508	0	0	0.08868026	0	0	0	0	0	0	0	0	0												17.4635	0.45462127	4.509948216	0	1.710720738	0.352330369	0	1.495333046	8.07607782	1.602329158	3.845608942	0.179912347	0.255033568	2.436987451	4.275494827	19.29458416	1.244230115	1.852095948	0	0	7.808079554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8568	0	NO	10.80719531	17.4635	0.45462127	4.509948216	0	1.710720738	0.352330369	0	1.495333046	8.07607782	1.602329158	3.845608942	0.179912347	0.255033568	2.436987451	4.275494827	19.29458416	1.244230115	1.852095948	0	0	7.808079554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8568	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	$65 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; 20% 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	$1000 ded; 35% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 35% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 35% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	14.3501	0.1984	1.477	0.4748	0.2281	0.5538	0	0.3145	1.7592	1.2594	2.0437	0.082	0.0385	1.1742	1.522	5.0576	0.2027	0.5673	0	0	3.6821	0	0	0	0.3466	0.0042	0.0167	0	0	0											35.3528	1000	NO	11.66545158	31.8135	0.653035291	5.986996902	0.474829665	1.93878343	0.906165031	0	1.809867898	9.835266369	2.861682595	5.889344246	0.261901618	0.293502138	3.611144135	5.79750826	24.35213872	1.446918246	2.419399316	0	0	11.4901792	0	0	0	0.34655644	0.004234288	0.016690611	0	0	0	0	0	0	0	0	0	0	0	0	0	112.2097
H5521_037_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1506.091357	71.85208521	1258.364846	958.5631238	271.1447463	9.189925679	0	254.2550523	377.2728823	3879.890457	2863.112783	39.35626969	0.014626118	623.0735233	1915.911682	8670.186682	275.5725005	709.4511086	0	0	271.4005712	0.001317929	0	0	1383.9837	81.20202745	59.25632667	10.83727483	42.97696206	0											6700	$225/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-7, $35/d 8-21, $100/d 22-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $35 per visit	$0 to $35 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$35 per visit	20% per visit	$0 to 200 per visit	$20 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	162.6423925	96.15686456	50.56636726	0	200	0.03	0.03	62.5	200	3.5	22.37499552	35	0.2	35	20	35	35	17.5	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	148.1850758	87.60946048	46.07151215	0	182.2219576	0.027333294	0	56.94436174	182.2219576	3.188884258	20.38607742	31.88884258	0.182221958	31.88884258	18.22219576	31.88884258	31.88884258	15.94442129	0	0	45.55548939	0	0	0	0	0	0	0	0	0												18.5984	0.524576868	4.831230943	0	4.117377205	0.251190937	0	1.206532639	5.728950263	1.031043467	4.863969906	0.104585491	0.0026652	1.655757792	2.909343143	23.04018485	0.732307341	0.942648947	0	0	1.030315487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.571	0	NO	6.982654146	18.5984	0.524576868	4.831230943	0	4.117377205	0.251190937	0	1.206532639	5.728950263	1.031043467	4.863969906	0.104585491	0.0026652	1.655757792	2.909343143	23.04018485	0.732307341	0.942648947	0	0	1.030315487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.571	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	$65 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; 20% 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	$1000 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 30% coinsurance; $10000 max OOP	$500.00 Every 3 Yrs	Nursing Hotline	0											10000	6.0378	0.1099	0.9107	0.2021	0.3249	0.2121	0	0.1519	0.843	0.6049	1.3158	0.0134	0.0002	0.5655	0.5479	3.5988	0.0869	0.1528	0	0	1.4013	0	0	0	0.2074	0.0015	0.0104	0	0	0											17.2994	1000	NO	4.283559351	24.6362	0.634466472	5.741938536	0.202052653	4.442265274	0.463320251	0	1.358470236	6.571908692	1.635971078	6.179788981	0.118031792	0.002913708	2.221237138	3.457252829	26.63899369	0.819244515	1.095485351	0	0	2.431652981	0	0	0	0.207354865	0.001535378	0.01036312	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8704
H5521_038_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1620.183786	64.38236031	1281.022396	988.515009	250.6223333	24.49173407	0	244.4687177	381.8511507	4408.299044	3093.58028	63.70034561	0.007156326	968.4566588	1879.42547	9984.73031	683.6581465	1070.689442	0	0	318.9172363	0.000631779	0	0	1641.150542	68.1833034	52.88748277	7.101990892	38.10274892	0											6700	$175/day 1-7; unlimited additional days	$175/day 1-7	"$0/d 1-7, $35/d 8-21, $100/d 22-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$30 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	126.4996386	84.13725649	50.56636726	0	200	0.03	0.03	62.5	200	3	20.31313448	30	0.2	30	10	30	30	15	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	115.8161854	77.03149353	46.29581418	0	183.1091166	0.027466367	0	57.22159892	183.1091166	2.746636748	18.59760055	27.46636748	0.183109117	27.46636748	9.155455828	27.46636748	27.46636748	13.73318374	0	0	45.77727914	0	0	0	0	0	0	0	0	0												15.637	0.413289114	4.942164567	0	3.824269503	0.672698968	0	1.165740909	5.826702239	1.008999679	4.794430859	0.145801425	0.001310389	2.21666554	1.433916406	22.85368933	1.56480049	1.225331236	0	0	1.216596946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9434	0	NO	6.359674427	15.637	0.413289114	4.942164567	0	3.824269503	0.672698968	0	1.165740909	5.826702239	1.008999679	4.794430859	0.145801425	0.001310389	2.21666554	1.433916406	22.85368933	1.56480049	1.225331236	0	0	1.216596946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9434	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	$65 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; 20% 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	$500 ded; 35% coinsurance; $10000 max OOP		Not Covered	0	$500 ded; 35% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 35% coinsurance; $10000 max OOP	$500.00 Every 3 Yrs	Nursing Hotline	0											10000	6.8187	0.0822	0.9225	0.1667	0.2562	0.5334	0	0.0979	1.0394	0.7135	1.3763	0.0247	0.0001	0.6982	0.5142	4.174	0.1955	0.2326	0	0	1.5505	0	0	0	0.2375	0.0007	0.0084	0	0	0											19.6432	500	NO	7.353116329	22.4557	0.495485418	5.864614669	0.166677428	4.080424856	1.20614266	0	1.26359184	6.866140425	1.72246457	6.170688824	0.170488546	0.001405403	2.914838512	1.948148434	27.02773449	1.760342402	1.457955617	0	0	2.767091301	0	0	0	0.23749846	0.000657249	0.00842599	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5865
H5521_040_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1199.539047	193.4957983	881.8432721	974.2630217	184.4770545	12.32191369	0	237.7643457	283.4113418	3677.548627	2442.638316	126.7823227	0.028085926	605.4002401	2186.237065	6144.805902	638.8079799	1030.754259	0	0	228.7614582	0.002609101	0	0	1265.74867	54.52177512	68.76083978	5.696304863	55.38640561	0											6700	$175/day 1-10; unlimited additional days	$200/day 1-7	"$0/d 1-8, $50/d 9-20, $100/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$0 to $25 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; $175 Complex Radiology	$25 per visit	20% per visit	$0 to 175 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	143.44	96.15686456	54.9293584	0	150	0.03	0.03	62.5	175	2.5	20.31313448	25	0.2	25	10	25	25	12.5	25	25	50	0	0	0	0	0	0	0	0	0											NO	130.4382366	87.44096382	49.95042281	0	136.4036217	0.027280724	0	56.83484236	159.1375586	2.273393694	18.47190074	22.73393694	0.181871496	22.73393694	9.093574777	22.73393694	22.73393694	11.36696847	0	0	45.46787388	0	0	0	0	0	0	0	0	0												13.0388	1.409954925	3.670703691	0	2.096944862	0.336150731	0	1.126108259	3.758449085	0.696709655	3.760014375	0.240188444	0.005108029	1.146927574	1.656725853	11.64130249	1.210218361	0.976379263	0	0	0.866774761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6375	0	NO	4.748386485	13.0388	1.409954925	3.670703691	0	2.096944862	0.336150731	0	1.126108259	3.758449085	0.696709655	3.760014375	0.240188444	0.005108029	1.146927574	1.656725853	11.64130249	1.210218361	0.976379263	0	0	0.866774761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6375	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	$65 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; 20% 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	$1000 ded; 40% coinsurance; $10000 max OOP		Not Covered	0	$1000 ded; 40% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$1000 ded; 40% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	11.1309	0.5717	1.1893	0.3611	0.2654	0.555	0	0.2345	1.5545	1.1709	2.6731	0.1138	0.0007	1.0286	1.1768	6.1552	0.3883	0.4557	0	0	3.4856	0	0	0	0.3845	0.0027	0.0241	0	0	0											32.9225	1000	NO	13.11586315	24.1697	1.981637783	4.859969334	0.361112929	2.362393022	0.891189877	0	1.360603621	5.312915148	1.867586013	6.433154408	0.353951634	0.005839508	2.175528365	2.833516782	17.79650245	1.598556904	1.43209397	0	0	4.352332223	0	0	0	0.38451927	0.002740141	0.024120045	0	0	0	0	0	0	0	0	0	0	0	0	0	80.56
H5521_801_0	2012	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	285.2508162	3.140025771	25.55723911	26.27026298	11.39127281	17.30621592	0	17.42780391	42.37895484	26.73304516	49.33295356	0.241268603	0.042985767	28.25263656	41.73319987	116.8328554	2.396294344	11.99832196	0	0	53.58650375	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	NO	0.079468727	0.079468727	0.172448405	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.066438628	0.066438628	0.144172881	0	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0.187271813	0	0	0	0	0	0	0	0												18.9517	0.208619004	3.684660793	0	2.133264309	3.240966429	0	3.263736432	7.936383698	5.00634583	9.238671646	0.045182809	0.008050023	5.290922466	7.815451996	21.87950064	0.448758386	2.246947505	0	0	10.0352417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4344	0	NO	23.73326706	18.9517	0.208619004	3.684660793	0	2.133264309	3.240966429	0	3.263736432	7.936383698	5.00634583	9.238671646	0.045182809	0.008050023	5.290922466	7.815451996	21.87950064	0.448758386	2.246947505	0	0	10.0352417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.4344	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	3.8981	0.0429	0.7579	0	0.4388	0.6666	0	0.6713	1.6324	1.0297	1.9003	0.0093	0.0017	1.0883	1.6075	4.5003	0.0923	0.4622	0	0	2.0641	0	0	0	0	0	0	0	0	0											20.8638	0	NO	2.554096297	22.8498	0.251529372	4.442550295	0	2.572050595	3.907593446	0	3.935046959	9.568800419	6.036089722	11.13895301	0.054476358	0.009705813	6.37920028	9.42299455	26.37984539	0.541062478	2.709117029	0	0	12.09936775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2982
H5521_802_0	2012	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	281.9552851	1.767035458	34.06872543	9.769798996	7.411829042	10.48587883	0	11.14799123	51.10423128	31.33786396	66.46946728	0.256618688	0.100573024	34.06948754	28.99172143	141.9160789	3.199988479	13.51672001	0	0	71.43866411	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	NO	0.075493156	0.075493156	0.162627783	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063580592	0.063580592	0.136965669	0	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0.188653558	0	0	0	0	0	0	0	0												17.9269	0.11234916	4.66624576	0	1.398267918	1.978198347	0	2.103108207	9.640995043	5.911999525	12.53970148	0.048412028	0.018973459	6.427330033	5.469391391	26.77297317	0.603689211	2.549977317	0	0	13.47715814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6457	0	NO	24.46364042	17.9269	0.11234916	4.66624576	0	1.398267918	1.978198347	0	2.103108207	9.640995043	5.911999525	12.53970148	0.048412028	0.018973459	6.427330033	5.469391391	26.77297317	0.603689211	2.549977317	0	0	13.47715814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6457	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	3.2291	0.0202	0.8405	0	0.2519	0.3563	0	0.3788	1.7366	1.0649	2.2588	0.0087	0.0034	1.1577	0.9852	4.8226	0.1087	0.4593	0	0	2.4276	0	0	0	0	0	0	0	0	0											20.1106	0	NO	2.358405584	21.156	0.132586437	5.50676928	0	1.650135721	2.334528108	0	2.481937785	11.37761234	6.976918714	14.79845821	0.057132411	0.022391118	7.585074896	6.454584272	31.59554677	0.7124308	3.009300726	0	0	15.90477747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7562
H5521_805_0	2012	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	295.6947208	2.060118301	29.09937642	34.02540417	10.82340085	17.73757278	0	17.31088346	38.70762561	22.56072625	43.5650383	0.325302602	0.028410071	25.78796639	35.42405741	111.0407055	2.579957257	7.017990171	0	0	39.25805239	0.000125437																			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	NO	0.08128475	0.08128475	0.174577125	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.062629352	0.062629352	0.134510498	0	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0.17259049	0	0	0	0	0	0	0	0												18.5192	0.129023874	3.914171625	0	1.868016057	3.061336381	0	2.987693861	6.680568076	3.893766801	7.518911314	0.056144136	0.004903308	4.450757758	6.113855432	19.16456978	0.445276087	1.211238363	0	0	6.775566505	2.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.795	0	NO	23.35423529	18.5192	0.129023874	3.914171625	0	1.868016057	3.061336381	0	2.987693861	6.680568076	3.893766801	7.518911314	0.056144136	0.004903308	4.450757758	6.113855432	19.16456978	0.445276087	1.211238363	0	0	6.775566505	2.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.795	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	4.4178	0.0308	0.9337	0	0.4456	0.7303	0	0.7127	1.5937	0.9289	1.7937	0.0134	0.0012	1.0617	1.4585	4.5718	0.1062	0.2889	0	0	1.6163	0	0	0	0	0	0	0	0	0											20.7053	0	NO	2.769118659	22.937	0.159803105	4.847915049	0	2.313639774	3.791632082	0	3.700421805	8.274247941	4.822642561	9.312581767	0.069537574	0.006073014	5.512506242	7.572343421	23.73636497	0.551498721	1.500184778	0	0	8.391908677	2.68E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5003
H5521_806_0	2012	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	273.8322391	5.037509364	33.43856399	8.716117558	8.161159106	11.31559788	0	14.17566854	35.07885756	17.01070158	47.52152202	0.795446991	0.069469795	23.34404955	23.54159672	117.3703342	2.690064141	7.456823944	0	0	58.92414556	0.000306724																			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	NO	0.08128475	0.08128475	0.174577125	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063547693	0.063547693	0.136482842	0	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0.175121205	0	0	0	0	0	0	0	0												17.4014	0.3201221	4.563790235	0	1.429192016	1.981601134	0	2.482460154	6.143051799	2.978934556	8.322026192	0.139299635	0.012165634	4.088038084	4.122632781	20.55403433	0.471087273	1.305847993	0	0	10.31886736	5.37E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6346	0	NO	21.93436227	17.4014	0.3201221	4.563790235	0	1.429192016	1.981601134	0	2.482460154	6.143051799	2.978934556	8.322026192	0.139299635	0.012165634	4.088038084	4.122632781	20.55403433	0.471087273	1.305847993	0	0	10.31886736	5.37E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6346	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	4.1275	0.0759	1.0825	0	0.339	0.47	0	0.5888	1.4571	0.7066	1.9739	0.033	0.0029	0.9697	0.9779	4.8753	0.1117	0.3097	0	0	2.4476	0	0	0	0	0	0	0	0	0											20.5491	0	NO	2.600763891	21.5289	0.396052602	5.646286204	0	1.768185377	2.451621693	0	3.071280623	7.600136473	3.685514938	10.29594685	0.172340438	0.015051229	5.057689298	5.100489592	25.42929331	0.582825554	1.615585101	0	0	12.7664234	6.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1837
H5522_001_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	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	1062.545945	37.50324531	1433.8704	0	280.8857664	11.74890492	10.53642779	324.5414627	384.7471795	0	30.62991357	21.70607727	0	12.4315068	2877.730281	136.6396281	160.6264001	947.7879901	12.08902664	0	27.70254364	0	0	925.3571859	0	0	0	0	0	0											4700	1a $250 days 1-1	1b $250 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $75	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $175, 9b $175"	8a $0 14a $0	"8b $60 (Therapeutic),8b $75(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $175	12a 0%	"3 $10, 9a $0 , 9d $0"	"7a $10, 14a $0,  17a $30"	"7b $20 , 7d $30, 7f $30, 8a $0,14a $0, 17a $30, 17b $0, 18a $30"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	"8b $20 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0, Other $0"	"11c 20% , 15 20%"			16A $0 ; 16b 50%  with $25 deductible	"17a $0, 17b $0"	"17b $0, $150 Allowance"	18a $0	"18b $0 --$1,000 Allowance"	14c $0													NO	37.893828	63.29113924	36.08658314	0	75	0.19888818	0.2	62.54072501	175	0	0.199628149	175	0	0.008351865	9.353736961	0.084400585	30	30	0.165580207	0	0.191039898	0	0	15	0	0	0	0	0	0											NO	34.95882479	59.78056641	34.0849668	0	70.8399712	0.187856439	0.18890659	59.07177545	165.2932661	0	0.188555364	165.2932661	0	0.007888611	8.834912759	0.079719134	28.33598848	28.33598848	0.156395961	0	0.180443478	0	0	14.16799424	0	0	0	0	0	0												3.0954	0.186830437	4.072785414	0	1.658161633	2.207107443	1.990400644	1.597603367	5.299676494	0	5.775434501	0.298989034	0	0.098067326	2.118707998	10.89279276	0.379292318	2.238042464	1.890674944	0	4.998743332	0	0	1.09253794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8913	0	NO	3.007935449	3.0954	0.186830437	4.072785414	0	1.658161633	2.207107443	1.990400644	1.597603367	5.299676494	0	5.775434501	0.298989034	0	0.098067326	2.118707998	10.89279276	0.379292318	2.238042464	1.890674944	0	4.998743332	0	0	1.09253794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8913	YES	0.2	0.2	0.2		75	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2			0	0.2	1 pair of glasses after cataract surgery - Medicare Covered Only	0	"18b 50% --$1,000 Allowance"	0												10000	0.6833	0.0014	0.1346	0	0.0249	0.0534	0.0459	0.024	0.2427	0.0345	0.1273	0.0137	0.0002	0.0025	0.0599	0.1848	0.0001	0.0503	0.0445	0	0.1373	0	0	0.012	0	0	0	0	0	0											1.8774	750	NO	0	3.7788	0.188272846	4.20741332	0	1.683088109	2.260487995	2.036280372	1.621619495	5.542381154	0.034522524	5.902746585	0.312653987	0.000223704	0.100552908	2.178637188	11.07762208	0.379342843	2.288359404	1.935136686	0	5.136029484	0	0	1.104550609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7687
H5522_002_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	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	1147.179156	32.30419017	1301.82346	0	250.6841859	11.65461737	8.835908509	333.1472597	610.3959677	25.10862451	37.88679226	11.77233176	0	0	5095.190014	158.8834535	233.0087166	1311.138882	15.67013009	0	38.55686983	0	0	0	0	0	0	0	0	0											4300	1a $250 days 1-1	1b $250 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $125	"11a 15%,"	"11b 15%,"	"4a $65, 4b $50"	"9a $150, 9b $150"	"8a Lab $10, 8a $0 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $90(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $150	12a 0%	"3 $35, 4a $50 , 9d 0%, 13a $0, 14b $0"	"7a $5, 14a $0, 17a $35"	"7b $20 , 7d $35, 7f $35, 8a $0, 14a $0, 17a $35, 17b $0, 18a $35,"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $20 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"			16A $0 ; 16b 50%  with $25 deductible	17a $0 17b $0	"17b $0, $150 Allowance"	18a $0	"18b $0 --$1,000 Allowance"	14c $0													NO	52.91435495	63.29113924	36.08658314	0	125	0.149999964	0.15	64.61275626	150	0.140132919	0.261528704	150	0	0	4.857261484	0.12641701	35	35	0.163845946	0	0.187690543	0	0	0	0	0	0	0	0	0											NO	47.14980116	56.39612603	32.15526715	0	111.3823489	0.133658787	0.133658819	57.5737645	133.6588187	0.124866669	0.2355701	133.6588187	0	0	4.328105547	0.112644988	31.18705769	31.18705769	0.147975782	0	0.167243309	0	0	0	0	0	0	0	0	0												4.5074	0.151819265	3.488373429	0	2.326816122	1.557742019	1.180997093	1.598378489	6.798733665	3.135230312	8.924995423	0.131122996	0	0	1.837710013	17.89742471	0.605571357	3.407546997	2.318799754	0	6.448378485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3171	0	NO	7.965457815	4.5074	0.151819265	3.488373429	0	2.326816122	1.557742019	1.180997093	1.598378489	6.798733665	3.135230312	8.924995423	0.131122996	0	0	1.837710013	17.89742471	0.605571357	3.407546997	2.318799754	0	6.448378485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3171	YES	0.2	0.2	0.2		125	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2			0	0.2	1 pair of glasses after cataract surgery - Medicare Covered Only	0	"18b 50% --$1,000 Allowance"	0												10000	3.6968	0.009	0.623	0	0.1667	0.2344	0.1729	0.1145	1.5647	0.4593	0.075	0.0078	0.0019	0.0178	0.4893	0.9812	0	0.298	0.227	0	0.8342	0	0	0.0517	0	0.0002	0	0	0	0											10.0255	750	NO	0	8.2042	0.16085755	4.111394531	0	2.493494437	1.792160887	1.353880216	1.712876163	8.363444045	3.594569205	8.999955958	0.13893193	0.001928346	0.017819366	2.326968721	18.87866211	0.605571357	3.705595171	2.545776448	0	7.282602543	0	0	0.051682896	0	0.000155381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3425
H5522_004_0	2012	11																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	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	754.7979772	38.77974337	903.2755759	0	196.5813733	6.697256484	6.180294868	274.166602	453.9689692	18.16595422	27.59527953	12.63788765	0	0	3692.85661	107.5214119	134.8070649	889.0721222	9.290652823	11.95177146	20.78571546	0	0	0	0	0	0	0	0	0											6700	1a $150 days 1-7	1b $150 days 1-7	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $150	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $200, 9b $200"	"8a $25, 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $200	12a $0	"3 $0, 9a $0 , 9d 0%"	"7a $10, 14a $0, 14b $0"	"7b $20 , 7d $40, 7f $40, 8a $25, 14a $0, 17a $40, 17b $0, 18a  $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$40"	"11c 20% , 15 20%"				17a $0				14c $0													NO	127.8187005	138.3116883	36.54317219	0	150	0.2	0.2	64.78030717	200	0.325926874	0.272448671	200	0	0	9.681360289	0.137368938	40	40	0.211065879	0.027689419	0.199056245	0	0	0	0	0	0	0	0	0											NO	121.2208065	131.1721551	34.65684432	0	142.2571259	0.189676168	0.189676168	61.43923447	189.6761679	0.309102802	0.259275432	189.6761679	0	0	9.181616599	0.130278069	37.93523358	37.93523358	0.200371398	0.026260114	0.188781128	0	0	0	0	0	0	0	0	0												7.6248	0.423901876	2.608723418	0	2.330425098	1.270309945	1.172254647	1.403715512	7.175591202	5.615147358	7.154778034	0.199758842	0	0	2.825532796	14.00768188	0.426161458	2.810596552	1.861581096	0.313854884	3.92395082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1487	0	NO	3.409165839	7.6248	0.423901876	2.608723418	0	2.330425098	1.270309945	1.172254647	1.403715512	7.175591202	5.615147358	7.154778034	0.199758842	0	0	2.825532796	14.00768188	0.426161458	2.810596552	1.861581096	0.313854884	3.92395082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1487	YES	0.2	0.2	0.2		150	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2								0												10000	4.0674	0.0145	0.7178	0	0.243	0.2326	0.2075	0.1463	2.1643	0.5895	0.8456	0.0213	0.0019	0.0187	0.5573	1.0778	0.0002	0.3683	0.1476	0.0217	0.8163	0	0	0	0	0.0001	0	0	0	0											12.2597	1000	NO	0	11.6921	0.438352087	3.326547341	0	2.573451521	1.502922685	1.379783464	1.54997007	9.339879972	6.204689519	8.000405943	0.221026668	0.001876245	0.018709154	3.382812654	15.08551944	0.426371971	3.178933994	2.009151785	0.335545549	4.740234588	0	0	5.19E-06	0	0.000129113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4085
H5522_005_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	V	P	O											0	0	0	0	-1.55E-21	0	0	0	-4.43E-20	-8.01E-21	0	-3.23E-21	-4.28E-23	-3.64E-22	-3.17E-20	-5.93E-20	-2.39E-21	-5.56E-21	0	-1.67E-23	0	0	0	0	0	0	0	0	0	0											0	YES	977.4821592	69.75424047	626.7301421	0	231.9212284	9.328514581	9.820504895	380.2141273	417.0653175	13.09052923	32.00526857	57.317868	0	0	3229.420363	124.3174445	163.3644178	698.1126117	12.29354731	9.840302145	29.09766736	0	0	0	0	0	0	0	0	0											5900	1a $250 days 1-1	1b $250 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $100	11a 20%	11b 20%	"4a $65, 4b $40"	"9a $175, 9b $175"	"8a Lab $10, 8a $0 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $125(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $175	12a $0	"3 $0, 9a $0 , 9d 0%,"	"7a $10, 14a $0,  17a $35"	"7b $20 , 7d $35, 7f $35, 8a $0, 14a $0, 17a $35, 17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $40 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"				17a $0				14c $0													NO	55.90564592	61.68831169	36.54317219	0	100	0.198527814	0.2	62.01149425	175	0.107639976	0.283768755	175	0	0	9.570163412	0.099864403	35	35	0.25529171	0.000136247	0.194615249	0	0	0	0	0	0	0	0	0											NO	53.01761428	58.50155312	34.65538723	0	94.83409664	0.188272059	0.189668193	58.80804039	165.9596691	0.102079399	0.270363282	165.9596691	0	0	9.075778019	0.094705504	33.19193383	33.19193383	0.242106195	0.000129209	0.184561614	0	0	0	0	0	0	0	0	0												4.3186	0.34006095	1.809964647	0	1.832836682	1.756298644	1.862637421	1.86330398	5.768001841	1.336273357	8.653049453	0.792704534	0	0	2.442458529	11.77354628	0.451865079	1.930975634	2.976343962	0.001271452	5.370312438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2806	0	NO	2.968954705	4.3186	0.34006095	1.809964647	0	1.832836682	1.756298644	1.862637421	1.86330398	5.768001841	1.336273357	8.653049453	0.792704534	-4.28E-23	-3.64E-22	2.442458529	11.77354628	0.451865079	1.930975634	2.976343962	0.001271452	5.370312438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2806	YES	0.2	0.2	0.2		100	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2								0												10000	1.6958	0.0072	0.1818	0	0.0701	0.1321	0.1354	0.0713	0.8688	0.1573	0.4185	0.0634	0.0007	0.0071	0.1715	0.5009	0	0.0958	0.159	0.0001	0.4512	0	0	0.0001	0	0.0018	0	0	0	0											5.19	1500	NO	0	6.0145	0.347282856	1.991769706	0	1.902933772	1.888440217	1.998039491	1.934566296	6.636804606	1.493529143	9.071570488	0.85613958	0.000682238	0.007149801	2.613986441	12.2744104	0.451865079	2.026728196	3.135318828	0.001362092	5.821533448	0	0	0.000140767	0	0.00182605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4705
H5522_008_0	2012	10																															D	D	D	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	O											14.57904788	0.107727623	2.732448721	0	2.266889207	0	0	0	21.00198893	0	0	0.303333577	0.01623152	0.264268162	0	1.179907582	0	4.650232343	1.334466605	0	0.437180947	0	0	1.00E-04	0	0	0	0	0	0											48.8738	YES	1015.360898	33.86676029	1333.31129	0	0	7.276608491	7.493070792	295.3580786	0	0	40.32440062	0	0	0	3760.25518	132.8433923	0	0	11.5189669	13.86386243	36.9374625	0	0	0	0	0	0	0	0	0											6400	1a $100 days 1-5	1b $100 days 1-5	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $0	"11a 20%,"	"11b 20%,"	"4a $65, 4b $50"	"9a $0, 9b $0"	"8a $0, 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $0	12a $0	"3 $0, 9a $0 , 9d $0"	"7a $15, 14a $0,  17a $40"	"7b $0 , 7d $40, 7f $0, 8a $0, 9a $0,14a $0, 17a $40, 17b $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$40"	"11c 20% , 15 20%"				"17a $0, 17b $0"	17b $0 -- $150 Allowance every two years			14c $0													NO	75.83666865	83.11688312	36.54317219	0	0	0.2	0.2	64.62298025	0	0	0.26230553	0	0	0	14.5052558	0.139808404	0	0	0.282956589	0.241251248	0.203455166	0	0	0	0	0	0	0	0	0											NO	70.56377878	77.33780317	34.00234167	0	0	0.186094089	0.186094089	60.12977315	0	0	0.247668333	0	0	0	13.49671181	0.130087588	0	0	0.263290904	0.224477156	0.189309018	0	0	0	0	0	0	0	0	0												5.9706	0.21826507	3.777975504	0	0	1.354133827	1.394416182	1.479984522	0	0	9.987077082	0	0	0	4.229256709	17.28127642	0	0	3.032839212	3.112120408	6.992594769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8306	1500	NO	4.23997398	20.5497	0.325992693	6.510424225	0	2.266889207	1.354133827	1.394416182	1.479984522	21.00198893	0	9.987077082	0.303333577	0.01623152	0.264268162	4.229256709	18.461184	0	4.650232343	4.367305817	3.112120408	7.429775716	0	0	1.00E-04	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7044	YES	0.2	0.2	0.3		0	0.2	0.2	"4a $65, 4b $50"	0.3	0	"8b Therapeutic 30% Diagnostic 30% CT Drugs 30%, 14a $0"	0.3	0.3	0.3	0.3	0.3	0.45	0.3	"8b $25 Other PhySvcsNuclearMed 20% PhySvcsRadTher 20% Other 0%, 15 30%"	0.3	0.3				0				0												10000	3.3935	0.0148	0.8908	0	0.1006	0.1393	0.1344	0.1015	1.9318	0	0.9206	0.0279	0.0015	0.0243	1.1535	1.9329	0	0.422	0.3323	0.3364	0.7742	0	0	0	0	0.0011	0	0	0	0											12.6334	1500	NO	0	23.9432	0.340770078	7.401265015	0	2.367479344	1.493473139	1.528775554	1.581510688	22.93374694	0	10.90770459	0.331257777	0.017697363	0.288596089	5.382770879	20.39405057	0	5.072277657	4.699586132	3.448497913	8.203934979	0	0	0.000104427	0	0.001140496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3378
H5522_009_0	2012	10																															D	D	D	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	O											22.77287045	0.076669075	2.467479137	0	3.175078161	0	0	0	24.18800409	0	0	2.168746934	0.045611736	0.238413401	0	1.2474138	0	4.010232502	0	0	0.642815733	0	0	0.003177916	0	0	0	0	0	0											61.0365	YES	1361.977908	17.92988986	1131.397186	0	0	11.91381672	10.56060872	420.4653517	0	16.33343132	37.3991088	0	0	0	3476.666322	162.5133511	0	0	23.16067417	15.51098905	54.51367764	0	0	0	0	0	0	0	0	0											6550	1a $100 days 1-5	1b $100 days 1-5	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $0	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $0, 9b $0"	"8a Lab $25, 8a $0 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $0	12a $0	"3 $0, 9a $0 , 9d $0"	"7a $15, 14a $0,  17a $30"	"7b $0 , 7d $40, 7f $40, 8a $0,14a $0, 17a $30, 17b $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$40"	"11c 20% , 15 20%"								14c $0													NO	75.83666865	83.11688312	36.54317219	0	0	0.198845876	0.2	62.31399748	0	0.26709885	0.298529412	0	0	0	14.44961639	0.133939762	0	0	0.13217148	0.000113563	0.200618585	0	0	0	0	0	0	0	0	0											NO	67.90598597	74.42486595	32.72163957	0	0	0.178051404	0.179084834	55.79745937	0	0.239166765	0.268896162	0	0	0	12.93853574	0.1199329	0	0	0.118686575	0.000101687	0.17963873	0	0	0	0	0	0	0	0	0												7.7072	0.111202471	3.085097578	0	0	2.121271789	1.891244856	1.955074865	0	3.906413937	10.05647681	0	0	0	3.748580954	19.49069744	0	0	2.748861091	0.001577264	9.792767793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6165	2000	NO	7.705133402	30.4801	0.187871546	5.552576715	0	3.175078161	2.121271789	1.891244856	1.955074865	24.18800409	3.906413937	10.05647681	2.168746934	0.045611736	0.238413401	3.748580954	20.73811124	0	4.010232502	2.748861091	0.001577264	10.43558353	0	0	0.003177916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.653	YES	0.3	0.3	0.2		0	0.3	0.3	"4a $65, 4b $50"	0.3	0.3	"8b 30%, 14a $0"	0.3	0.3	0.3	0.3	0.3	0.45	0.3	"8b $25 Other PhySvceNuclearMed 20% Other 0%, 15 30%"	0.3	0.2								14c $50/visit												10000	0.4475	0.0006	0.2917	0	0.0237	0.0277	0.0469	0.0029	0.1915	0.0604	0.106	0.0158	0.0004	0.0017	0.1441	0.6535	0	0.0317	0.0335	0	0.0085	0	0	0	0	0.0025	0	0	0	0											2.0904	2000	NO	0	30.9276	0.188435077	5.844233038	0	3.198736294	2.149009757	1.938160814	1.957946896	24.37951717	3.966799805	10.16248538	2.184520488	0.045973901	0.24014741	3.892654862	21.39158568	0	4.041947516	2.782312914	0.001621974	10.44403869	0	0	0.003201614	0	0.002456787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.7434
H5522_013_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	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	845.6498221	39.85650132	1007.630335	0	188.6209135	7.052584823	6.041574596	308.8965068	497.9073502	0	28.96108974	14.16439002	0	0	4127.923667	116.4270053	144.0991572	944.3081964	10.23543351	12.8462193	22.91068028	0	0	0	0	0	0	0	0	0											4700	1a $250 days 1-1	1b $250 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $125	11a 20%	11b 20%	"4a $65, 4b $50"	"9a $150, 9b $150"	"8a $0, 14a $0"	"8b $60 (Therapeutic),8b $115(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $150	12a $0	"3 $0, 9a $0 , 9d $0"	"7a $5, 14a $0, 17a $35"	"7b $20 , 7d $35, 7f $35, 8a $0, 14a $0, 17a $35, 17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"								14c $0													NO	55.90564592	61.68831169	36.54317219	0	125	0.2	0.2	64.77964887	150	0	0.259463237	150	0	0	4.83815401	0.097309161	35	35	0.22187278	1.01E-05	0.196729938	0	0	0	0	0	0	0	0	0											NO	52.5068003	57.9379025	34.32148959	0	117.4004866	0.187840779	0.187840779	60.84129842	140.880584	0	0.244784116	140.880584	0	0	4.544013082	0.091393142	32.87213626	32.87213626	0.208627215	9.46E-06	0.184769524	0	0	0	0	0	0	0	0	0												3.7002	0.192433507	2.881947838	0	1.84534892	1.324763025	1.134854076	1.566138713	5.845456522	0	7.08921476	0.166290628	0	0	1.563111595	10.64062988	0.394737261	2.586785642	2.135389989	0.000121511	4.233195485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3006	0	NO	3.025416005	3.7002	0.192433507	2.881947838	0	1.84534892	1.324763025	1.134854076	1.566138713	5.845456522	0	7.08921476	0.166290628	0	0	1.563111595	10.64062988	0.394737261	2.586785642	2.135389989	0.000121511	4.233195485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3006	YES	0.2	0.2	0.2		125	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2								0												10000	0.7005	0.0182	0.0793	0	0.3556	0.0776	0.1581	0.0036	0.5657	0.1058	0.1673	0.0026	0.0002	0.0023	0.2781	0.5737	0	0.2727	0.0348	0	0.1	0	0	0	0	0.0004	0	0	0	0											3.4964	750	NO	0	4.4007	0.210612143	2.961284405	0	2.200931142	1.402353982	1.292951381	1.56973568	6.411129034	0.105812081	7.256497582	0.168912887	0.000242314	0.002259417	1.841206471	11.21428348	0.394737261	2.85944761	2.170219242	0.000121511	4.33315404	0	0	1.10E-06	0	0.000414432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.797
H5522_014_0	2012	10																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	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	1536.294011	42.68760239	2328.995914	0	443.9378862	16.08881705	13.54625736	429.287659	443.6662431	0	52.48687364	32.16117196	0	0	3485.620764	191.8595148	177.4030534	986.2124524	17.30669078	0	45.0564461	0	0	0	0	0	0	0	0	0											4800	1a $350 days 1-1	1b $350 days 1-1	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $75	11a 15%	"11b 15%,"	"4a $65, 4b $50"	"9a $150, 9b $150"	"8a $0, 14a $0"	"8b $60 (Therapeutic),8b $90(MRI/CT/PETS),8b 20% (CT Drugs)"	9a $150	12a $0	"3 $0, 9a $0 , 9d $0"	"7a $5, 14a $0,  17a $35"	"7b $20 , 7d $35, 7f $35, 8a $0, 14a $0, 17a $35, 17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $20 (x-ray), 15 20%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"			"16A $0 , 16b 50%  with $25 deductible"	"17a $0, 17b $0"	17b $0 --$150 Allowance	18a $0	18b $0 --$1000 Allowance	14c $0													NO	74.08009693	88.60759494	36.08658314	0	75	0.149232861	0.15	62.82403433	150	0	0.179065511	150	0	0	4.714146703	0.078057858	35	35	0.163287302	0	0.19084236	0	0	0	0	0	0	0	0	0											NO	67.16798695	80.3399837	32.71949208	0	68.00205763	0.135308555	0.136004115	56.96218138	136.0041153	0	0.166540318	136.0041153	0	0	4.27428901	0.070774599	31.73429356	31.73429356	0.149330786	0	0.173035642	0	0	0	0	0	0	0	0	0												8.5991	0.28579344	6.350296948	0	2.515724144	2.176954586	1.842346747	2.037763458	5.028369572	0	8.741180618	0.364504311	0	0	1.241545877	13.5787803	0.469146715	2.608062957	2.58442174	0	7.796371092	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2204	0	NO	6.548053458	8.5991	0.28579344	6.350296948	0	2.515724144	2.176954586	1.842346747	2.037763458	5.028369572	0	8.741180618	0.364504311	0	0	1.241545877	13.5787803	0.469146715	2.608062957	2.58442174	0	7.796371092	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2204	YES	0.2	0.2	0.2		75	0.2	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0	0.2			0	0.2		0	18b 50% -$1000 Allowance	0												10000	0.0015	0	0.0003	0	0.0192	0.0195	0.0118	0.0013	0.002	0.0013	0.0015	0.0001	0	0	0.0044	0.0195	0.0005	0.0005	0.0014	0	0.0016	0	0	0.0001	0	0	0	0	0	0											0.0864	350	NO	0	8.6006	0.285810403	6.350620372	0	2.534940411	2.196458139	1.854107656	2.039094107	5.030326301	0.001306057	8.742654429	0.36464175	4.16E-06	1.58E-05	1.245930739	13.59824518	0.469659315	2.608516217	2.585786182	0	7.797988116	0	0	0.000124915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3068
H5522_802_0	2012	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	262.0410674	3.64208295	49.5154206	0	14.52980979	14.20743897	14.31352909	21.08350453	54.40668038	14.41792826	54.03525836	2.829063069	0.046141543	18.69392183	29.68486373	175.5345233	3.131475537	10.86702339	27.47308174	14.24152549	49.66234161	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.1%	Medicare FFS 8.1%	Medicare FFS 19.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.080834871	0.080834871	0.196654341	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.06744989	0.06744989	0.164091481	0	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0.18690913	0	0	0	0	0	0	0	0	0												17.6746	0.245658094	8.125058696	0	2.715754103	2.655500055	2.675329266	3.940699483	10.16910528	2.694842424	10.09968312	0.528777716	0.008624276	3.494064662	5.548372047	32.809005	0.585301367	2.031145885	5.134969801	2.661871136	9.282345051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0807	0	NO	24.4245537	17.6746	0.245658094	8.125058696	0	2.715754103	2.655500055	2.675329266	3.940699483	10.16910528	2.694842424	10.09968312	0.528777716	0.008624276	3.494064662	5.548372047	32.809005	0.585301367	2.031145885	5.134969801	2.661871136	9.282345051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0807	YES	Medicare FFS 8.1%	Medicare FFS 8.1%	Medicare FFS 19.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.0187	0	0.0233	0	0.0221	0.0047	0.0138	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1428	0	0.0133	0.0021	0.0082	0.023	0	0	0	0	0	0	0	0	0											0.3044	0	NO	0	17.6933	0.245658094	8.148389933	0	2.737872632	2.660168409	2.689087825	3.940699483	10.17120678	2.704670068	10.10072566	0.528777716	0.008624276	3.496336562	5.565691641	32.95175839	0.585301367	2.044437949	5.137052087	2.670058436	9.305365157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.3852
H5522_803_0	2012	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	267.6117053	2.522768055	62.15008114	0	15.11940011	16.70938886	19.87050881	21.32087665	57.73343594	18.19118986	41.32716009	6.682866296	0.107519223	16.87962733	29.93597663	185.3099029	2.933591298	12.38962233	28.27182493	19.46452343	62.63801721	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 17.9%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.084678896	0.084678896	0.179184729	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069158546	0.069158546	0.146342902	0	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0.182944218	0	0	0	0	0	0	0	0	0												18.5076	0.174470971	9.09522323	0	2.766006827	3.056886076	3.635194692	3.900531103	10.56199828	3.327973	7.560564979	1.222591747	0.01967002	3.088030219	5.476613829	33.90137525	0.536683565	2.266609767	5.172166898	3.560922015	11.45926307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.2904	0	NO	29.01495907	18.5076	0.174470971	9.09522323	0	2.766006827	3.056886076	3.635194692	3.900531103	10.56199828	3.327973	7.560564979	1.222591747	0.01967002	3.088030219	5.476613829	33.90137525	0.536683565	2.266609767	5.172166898	3.560922015	11.45926307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.2904	YES	Medicare FFS 8.5%	Medicare FFS 8.5%	Medicare FFS 17.9%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.1561	0	0.1698	0	0.1302	0.0372	0.0747	0	0.0167	0.0724	0.0083	0	0	0.0099	0.11	0.9055	0	0.106	0.0147	0.0535	0.1824	0	0	0	0	0	0	0	0	0											2.0475	0	NO	0	18.6638	0.174470971	9.265031728	0	2.896159469	3.094090506	3.709939549	3.900531103	10.57874618	3.400346751	7.568873526	1.222591747	0.01967002	3.097959864	5.58664144	34.80687048	0.536683565	2.372568371	5.186823665	3.614432898	11.64167707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.3379
H5522_805_0	2012	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	262.0410674	3.64208295	49.5154206	0	14.52980979	14.20743897	14.31352909	21.08350453	54.40668038	14.41792826	54.03525836	2.829063069	0.046141543	18.69392183	29.68486373	175.5345233	3.131475537	10.86702339	27.47308174	14.24152549	49.66234161	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.8%	Medicare FFS 8.8%	Medicare FFS 17.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.087987324	0.087987324	0.177140801	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.073304046	0.073304046	0.14757964	0	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0.186619	0	0	0	0	0	0	0	0	0												19.2087	0.266979417	7.307467924	0	2.71153858	2.651378061	2.671176493	3.934582542	10.15332031	2.690659361	10.08400591	0.527956922	0.008610889	3.488641008	5.539759599	32.7580773	0.584392835	2.027993044	5.126999056	2.657739253	9.267936553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6679	0	NO	24.77148178	19.2087	0.266979417	7.307467924	0	2.71153858	2.651378061	2.671176493	3.934582542	10.15332031	2.690659361	10.08400591	0.527956922	0.008610889	3.488641008	5.539759599	32.7580773	0.584392835	2.027993044	5.126999056	2.657739253	9.267936553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6679	YES	Medicare FFS 8.8%	Medicare FFS 8.8%	Medicare FFS 17.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.0203	0	0.021	0	0.0221	0.0047	0.0138	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1428	0	0.0133	0.0021	0.0082	0.023	0	0	0	0	0	0	0	0	0											0.3038	0	NO	0	19.229	0.266979417	7.328484059	0	2.733657109	2.656046416	2.684935052	3.934582542	10.15542181	2.700487005	10.08504845	0.527956922	0.008610889	3.490912908	5.557079193	32.90083069	0.584392835	2.041285108	5.129081342	2.665926552	9.290956658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9717
H5525_004_0	2012	5	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		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	1326.13	35.85	993	1075.76	31.29	12.12	5.61	374.33	332.32	2299.2	1053	184.29	0.38	9.63	2923.8	4168.58	57.1	855.58		1431.67	31.94	0		3.21	0.61		0.24		5.16	1.24	784.46										4000	"$0-$175/Day(Days 1-10): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$143/Day(Days 1-10): 1b. $143 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$50/Visit: 3. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"												142.969537	108.261289	42.474818	0	100	0.2	0.151385	65	100	0	38.941384	31.758189	0.2	0.2	10	27.528689	30	30		0	0.2	0		0	0		0		0	0	47.774155										NO	111.0676	84.104081	26.737643	0	90.4395	0.180879	0.136911	58.785675	90.4395	0	35.218393	28.721947	0.180879	0.180879	9.04395	24.896809	27.13185	27.13185		0	0.180879	0		0	0		0		0	0	43.206706											12.2742	0.251260942	2.212539958	0	0.235820996	2.19225348	0.76807071	1.833770144	2.50457122	0	3.090413986	0.441097301	0.06873402	1.74186477	2.203558418	8.648695005	0.129102386	1.934455685	0	0	5.77727526	0	0	0	0	0	0	0	0	0	2.824494382	0	0	0	0	0	0	0	0	0	49.1322	0	NO	8.536103	12.2742	0.251260942	2.212539958	0	0.235820996	2.19225348	0.76807071	1.833770144	2.50457122	0	3.090413986	0.441097301	0.06873402	1.74186477	2.203558418	8.648695005	0.129102386	1.934455685	0	0	5.77727526	0	0	0	0	0	0	0	0	0	2.824494382	0	0	0	0	0	0	0	0	0	49.1322	YES	$0-$200/Day(Days 1-10)	$0-$200/Day(Days 1-10)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										6000	1.5364	0.0385	0.6225	1.6473	1.5743	0.7017	0.3245	0.1748	1.8213	0.4769	0.8028	0.0428	0.0067	0.1677	0.838	1.1948	0.0164	0.2207		0.4103	0.729	0		0	0		0		0	0	0.5817										13.929	0	NO	4.25182	13.8105	0.289745942	2.835051958	1.647307	1.810128996	2.89399148	1.09260371	2.008556144	4.32583622	0.476874	3.893218986	0.483887301	0.07543002	1.90956377	3.041574418	9.843489005	0.145469386	2.155130685	0	0.410344	6.50624626	0	0	0	0	0	0	0	0	0	3.406158382	0	0	0	0	0	0	0	0	0	63.0611
H5526_002_0	2012	6																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	283.1631037	1.307176386	3169.273376	0	108.4689288	13.76601891	0.322387883	344.9701421	427.4230147	0	1615.210281	0	0	60.26635571	3887.032701	5434.653637	82.71320228	991.1736796	1166.208688	2135.511933	1158.455742	63.94469098	0	0	844.8345582	0	0	0	0	0											3400	$450 /Admit; Annual OOP Max $450 for IP Acute; PBP 1a	$450 /Admit; Annual OOP Max $450 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $25 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $25 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $25 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$15 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$15 /Visit for PCP; PBP 7a	"$25 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$15 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$25 /Visit for Physician Specialist (Radiology); PBP 7d	"$25 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $25 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$25 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	450	450	45	0	125	0.2	0.2	61.38738228	200	0	56.23633674	0	0	0.100574928	15	24.67652274	40	15	25	25	55.32906794	25	0	0	25	0	0	0	0	0											NO	370.3989239	370.3989239	37.03989239	0	102.88859	0.164621744	0.164621744	50.52848964	164.621744	0	46.28861914	0	0	0.0827841	12.3466308	20.31146104	32.92434879	12.3466308	20.57771799	20.57771799	45.54183828	20.57771799	0	0	20.57771799	0	0	0	0	0												8.7403	0.040348061	9.782462067	0	0.930017928	2.26618604	0.053072055	1.452568354	5.863593507	0	6.230487795	0	0	4.989096047	3.999313138	9.19881297	0.22693986	1.019804623	1.999826125	3.66199686	4.396517005	0.109652985	0	0	1.448730608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4097	0	NO	14.27186577	8.7403	0.040348061	9.782462067	0	0.930017928	2.26618604	0.053072055	1.452568354	5.863593507	0	6.230487795	0	0	4.989096047	3.999313138	9.19881297	0.22693986	1.019804623	1.999826125	3.66199686	4.396517005	0.109652985	0	0	1.448730608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4097	YES	20% Coinsurance for IP Acute; PBP 1a	20% Coinsurance for IP Psych; PBP 1b	20% Coinsurance for SNF; PBP 2	$30 /Visit for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	35% Coinsurance for DME; PBP 11a	"35% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $30 /Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	$30 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $30 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	$30 /Visit for Renal Dialysis; PBP 12	"$30 /Visit for Cardiac Rehab, 50% Coinsurance for Partial Hosp, $30 /Visit for Blood Services; PBP 3, 5, 9d"	$30 /Visit for PCP; PBP 7a	"$30 /Visit for Physician Specialist (excl. Radiology), Podiatry; $30 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"50% Coinsurance 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), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"$30 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	$30 /Visit for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$30 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	$30 /Visit; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											5100	8.3074	0	0.2206	0.0038	0.2242	0.2447	0.0205	0.0783	0.2233	0.1646	0.5838	0	0.0015	0.3362	0.1166	1.4459	0.0054	0.3346	0.1799	0.9541	0.2715	0.0073	0.1007	0	0.0877	0	0	0	0	0											13.9126	0	NO	5.031527796	17.0476	0.040348061	10.00304103	0.003772871	1.154206583	2.510930583	0.073616419	1.530832826	6.086896733	0.16463829	6.814264354	0	0.001486307	5.325268939	4.11594543	10.64475146	0.232326581	1.354402916	2.179701095	4.616128733	4.66803235	0.116953021	0.100698334	0	1.536435401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3223
H5526_003_0	2012	8																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	188.0842841	2.547078728	1687.028083	0	37.69203947	11.00868103	0.333032762	226.0951207	330.3488963	0	1483.927956	0	0	51.61104642	3510.606212	5342.629031	39.00483643	1678.809389	419.3089826	957.1656	934.287802	16.53328316	0	0	732.8260888	0	0	0	0	0											3400	$250 /Admit for IP Acute; PBP 1a	$250 /Admit for IP Psych; PBP 1b	$45 /Day for 1-75 day 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, 11c"	"$65 /Visit for ER, $30 /Visit for Urgent Care; PBP 4a, 4b"	"$150 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $30 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $30 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$20 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$20 /Visit for PCP; PBP 7a	"$30 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20 /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), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $30 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$30 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	250	250	45	0	100	0.2	0.2	61.8389595	150	0	58.89629194	0	0	0.100817674	20	29.35304549	40	20	30	30	56.03928856	30	0	0	30	0	0	0	0	0											NO	213.5656546	213.5656546	38.44181783	0	85.42626185	0.170852524	0.170852524	52.82671146	128.1393928	0	50.31290057	0	0	0.08612477	17.08525237	25.0752095	34.17050474	17.08525237	25.62787856	25.62787856	47.87226938	25.62787856	0	0	25.62787856	0	0	0	0	0												3.3474	0.045330711	5.404368853	0	0.268324169	1.880860937	0.056899488	0.995321809	3.527558915	0	6.22172664	0	0	4.444989497	4.998299426	11.16396185	0.111067912	2.390240175	0.895499974	2.044176979	3.727206445	0.035309414	0	0	1.565064834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1236	0	NO	9.062892155	3.3474	0.045330711	5.404368853	0	0.268324169	1.880860937	0.056899488	0.995321809	3.527558915	0	6.22172664	0	0	4.444989497	4.998299426	11.16396185	0.111067912	2.390240175	0.895499974	2.044176979	3.727206445	0.035309414	0	0	1.565064834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1236	YES	$1000 /Admit for IP Acute; PBP 1a	$1000 /Admit for IP Psych; PBP 1b	20% Coinsurance for SNF; PBP 2	$25 /Visit for Home Health; PBP 6	$100 /Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, 20% Coinsurance for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	20% Coinsurance for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, 20% Coinsurance for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	$25 /Visit for Renal Dialysis; PBP 12	"20% Coinsurance for Cardiac Rehab, 50% Coinsurance for Partial Hosp, 20% Coinsurance for Blood Services; PBP 3, 5, 9d"	$25 /Visit for PCP; PBP 7a	"20% Coinsurance for Physician Specialist (excl. Radiology), Podiatry; 20% Coinsurance for Chiropractor; PBP 7b, 7d, 7f"	"50% Coinsurance for Mental Health, Psychiatric; PBP 7e, 7h"	"20% Coinsurance for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	20% Coinsurance for Physician Specialist (Radiology); PBP 7d	"20% Coinsurance for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"20% Coinsurance for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	20% Coinsurance for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non-Medicare Covered); PBP 17a	20% Coinsurance; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											5100	3.924	0	0.5829	0	0.2951	0.37	0.02	0.2129	0.0907	0.0428	1.0686	0	0	0.48	0.0216	1.4291	0.0136	0.112	0.0307	0.4495	0.7078	0	0.388	0	0.1433	0	0	0	0	0											10.3825	0	NO	0.66889876	7.2714	0.045330711	5.987237112	0	0.563413278	2.250856637	0.076930959	1.208198634	3.618266395	0.042823678	7.290294251	0	0	4.925024312	5.019870707	12.59305825	0.12467978	2.502273375	0.926165899	2.493703984	4.43496664	0.035309414	0.387990033	0	1.708350019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5061
H5526_004_0	2012	9																															A	A	D		T	Coin	Coin	V	V		V			Coin	V	V	V	V	V	V	S	V			V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	193.2539892	1.688241427	2165.892476	0	70.53950988	15.50599366	1.36685043	323.8268874	438.1927456	0	1772.071593	0	0	58.60458554	3405.949094	5788.361382	118.4176721	1548.54558	910.4299977	1003.552739	1356.204744	18.73104077	0	0	723.8034079	0	0	0	0	0											5100	$700 /Admit; Annual OOP Max $700 for IP Acute; PBP 1a	$700 /Admit; Annual OOP Max $700 for IP Psych; PBP 1b	$45 /Day for 1-75 day for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $35 /Visit for Urgent Care; PBP 4a, 4b"	"$200 /Visit for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	min $0 - max $35 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $35 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	No Cost Sharing for Renal Dialysis; PBP 12	"$25 /Visit for Cardiac Rehab, 45% Coinsurance for Partial Hosp, No Cost Sharing for Blood Services; PBP 3, 5, 9d"	$25 /Visit for PCP; PBP 7a	"$35 /Visit for Physician Specialist (excl. Radiology), Podiatry; $20 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"$40 /Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$25 /Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$35 /Visit for Physician Specialist (Radiology); PBP 7d	"$35 /Visit for Other Health Care, Hearing Exams (Medicare Covered), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"min $0 - max $35 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	No Cost Sharing for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$35 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											0	NO	700	700	45	0	125	0.2	0.2	62.29053671	200	0	62.31796691	0	0	0.10247502	25	34.02956823	40	25	35	35	55.44583382	35	0	0	35	0	0	0	0	0											NO	599.7409583	599.7409583	38.55477589	0	107.0965997	0.17135456	0.17135456	53.3688374	171.3545595	0	53.39233884	0	0	0.08779781	21.41931994	29.15560837	34.2709119	21.41931994	29.98704791	29.98704791	47.50448215	29.98704791	0	0	29.98704791	0	0	0	0	0												9.6585	0.084375628	6.958791586	0	0.629545138	2.657022714	0.234216053	1.440188708	6.257193742	0	7.884587246	0	0	5.145354242	6.079426112	14.0635998	0.338190134	2.764066101	2.27509233	2.507798673	5.368817006	0.046807385	0	0	1.808727289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2023	0	NO	12.73878703	9.6585	0.084375628	6.958791586	0	0.629545138	2.657022714	0.234216053	1.440188708	6.257193742	0	7.884587246	0	0	5.145354242	6.079426112	14.0635998	0.338190134	2.764066101	2.27509233	2.507798673	5.368817006	0.046807385	0	0	1.808727289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2023	YES	20% Coinsurance for IP Acute; PBP 1a	20% Coinsurance for IP Psych; PBP 1b	20% Coinsurance for SNF; PBP 2	$30 /Visit for Home Health; PBP 6	$125 /Trip for Ambulance; PBP 10a	35% Coinsurance for DME; PBP 11a	"35% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b, 11c"	"$65 /Visit for ER, $40 /Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for Outpatient Hospital Services and ASC Services; PBP 9a, 9b"	$40 /Visit for Outpatient Diagnostic Procedures/Tess/Lab Services; PBP 8a	"$75 /Visit for High End Radiology, $40 /Visit for OP Radiology; PBP 8b"	50% Coinsurance for Outpatient Substance Abuse Services; PBP 9c	$30 /Visit for Renal Dialysis; PBP 12	"$40 /Visit for Cardiac Rehab, 50% Coinsurance for Partial Hosp, $40 /Visit for Blood Services; PBP 3, 5, 9d"	$30 /Visit for PCP; PBP 7a	"$40 /Visit for Physician Specialist (excl. Radiology), Podiatry; $40 /Visit for Chiropractor; PBP 7b, 7d, 7f"	"50% Coinsurance 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), Immunizations, Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7g, 18a, 14a, 13d, 14d, 14e"	"$75 /Case for Chemo Drugs, $50 /Case for Part B Drugs; PBP 15"	"$40 /Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); Hearing Exams (Medicare Covered); PBP 16b, 17a, 18a"	$40 /Visit for Wheel Chair; PBP 10b	"No Coverage for Preventive Dental, Comprehensive Dental (non-Medicare covered); PBP 16a, 16b"	$40 /Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	$40 /Visit; PBP 17b	No coverage; PBP 18a	No coverage; PBP 18b	No cost sharing; PBP 14c	No coverage; PBP 13a-c											7000	5.3511	0	0.2382	0	0.1328	0.4232	0.0321	0.084	0.1473	0.1161	1.4204	0	0	0.3637	0.1944	2.1725	0.0022	0.4953	0.2739	0.8667	0.6462	0.0013	0.1188	0	0.1207	0	0	0	0	0											13.2007	0	NO	2.853607134	15.0096	0.084375628	7.196958741	0	0.762360615	3.080197282	0.266282178	1.524213877	6.404502275	0.116074599	9.304946667	0	0	5.509057846	6.273811876	16.23606697	0.340404643	3.259404951	2.548993914	3.374536794	6.01498395	0.048069815	0.11876748	0	1.929421986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.403
H5526_806_0	2012	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	226.4589944	1.106638242	31.76838177	0	9.09244467	11.07117159	0.569369198	11.06838573	49.5297072	5.942061891	14.92395537	0	0.091898715	41.2047826	28.44801064	66.58027066	2.187361387	4.089788584	42.59894515	129.131709	23.53703419	7.381303462	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.090634609	0.090634609	0.180223915	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081205001	0.081205001	0.161473451	0	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0.20069508	0	0	0	0	0	0	0	0												18.3896	0.089864559	5.12975024	0	1.824808911	2.221929668	0.114269597	2.221370561	9.940368552	1.192542587	2.995164418	0	0.01844362	8.269597143	5.709375773	13.36233275	0.438992669	0.820800447	8.549398707	25.91609867	4.723766961	1.481391289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4099	0	NO	13.1692712	18.3896	0.089864559	5.12975024	0	1.824808911	2.221929668	0.114269597	2.221370561	9.940368552	1.192542587	2.995164418	0	0.01844362	8.269597143	5.709375773	13.36233275	0.438992669	0.820800447	8.549398707	25.91609867	4.723766961	1.481391289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4099	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											10000	2.8331	0	0.1036	0	0.2739	0.4812	0.0074	0.1012	0.6942	0.1919	0.3165	0	0.0021	0.7347	0.1727	2.0153	0.026	0.161	0.506	2.8142	0.1842	0.0045	0	0	0	0	0	0	0	0											11.6239	0	NO	0.548641376	21.2227	0.089864559	5.233317673	0	2.098734547	2.703123923	0.121631947	2.322593235	10.63459109	1.384431987	3.311661766	0	0.020533091	9.004314021	5.882125716	15.37765183	0.465005738	0.9818496	9.055428617	28.73031245	4.907949724	1.485939484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0338
H5526_808_0	2012	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	241.7882197	2.02172421	33.28398871	0	9.84184127	12.93648764	1.60153414	11.92981911	51.19905617	11.01514218	21.32895494	0	1.238279002	46.61548397	29.59037411	68.73000006	1.315694573	5.892963729	37.72640218	115.3808618	11.23269727	0.766676003	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.090412403	0.090412403	0.183819096	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079780032	0.079780032	0.16220223	0	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0.197657916	0	0	0	0	0	0	0	0												19.2899	0.161293223	5.398737196	0	1.94531784	2.556999194	0.316555901	2.358023189	10.11989877	2.177230054	4.215836795	0	0.244755648	9.213919438	5.848771696	13.58502861	0.260057448	1.164790933	7.456922053	22.80594074	2.220231538	0.151539581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4917	0	NO	14.8586219	19.2899	0.161293223	5.398737196	0	1.94531784	2.556999194	0.316555901	2.358023189	10.11989877	2.177230054	4.215836795	0	0.244755648	9.213919438	5.848771696	13.58502861	0.260057448	1.164790933	7.456922053	22.80594074	2.220231538	0.151539581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4917	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											10000	5.2584	0	0.8013	0	0.8681	0.6196	0.0604	0.2541	1.5923	0.4707	1.1687	0	0.0393	1.6355	0.2554	4.61	0.0348	0.2925	1.3771	5.7126	0.4427	0.0213	0	0	0	0	0	0	0	0											25.5148	0	NO	1.615683531	24.5483	0.161293223	6.200005593	0	2.813385798	3.176612666	0.376975306	2.612123253	11.71215869	2.647938587	5.384497133	0	0.284090725	10.84940829	6.104171532	18.19507847	0.294809893	1.457332753	8.83400577	28.51854815	2.662952989	0.172829927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0065
H5526_810_0	2012	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	262.7160703	1.658897993	40.55554056	0	8.495214469	13.20847611	1.180552872	12.79093596	51.10951174	9.328132994	27.70779015	0	0.816269975	48.8279455	30.64677284	71.09507156	1.639865199	4.910415594	31.793812	101.0979425	39.95363154	1.727767551	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											0	NO	0.089726463	0.089726463	0.196972534	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079080028	0.079080028	0.173600886	0	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0.197421426	0	0	0	0	0	0	0	0												20.7756	0.1311857	7.040477789	0	1.677137352	2.607636184	0.233066431	2.525204813	10.09011267	1.841573315	5.470111434	0	0.161149182	9.639682614	6.050329587	14.03569039	0.323744525	0.969421247	6.276779692	19.95889995	7.8877029	0.341098333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0366	0	NO	15.89110446	20.7756	0.1311857	7.040477789	0	1.677137352	2.607636184	0.233066431	2.525204813	10.09011267	1.841573315	5.470111434	0	0.161149182	9.639682614	6.050329587	14.03569039	0.323744525	0.969421247	6.276779692	19.95889995	7.8877029	0.341098333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0366	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	No coverage PBP 10b	"No coverage PBP 16a, 16b"	No coverage PBP 17a	No coverage PBP 17b	No coverage PBP 18a	No coverage PBP 18b	No coverage PBP 14c	No coverage PBP 13a-c											10000	4.225	0	0.5322	0	0.5519	0.4186	0.0346	0.1902	1.1482	0.3552	0.9858	0	0.0183	1.1524	0.2268	3.4536	0.0367	0.2105	0.8303	4.0848	1.128	0.031	0	0	0	0	0	0	0	0											19.614	0	NO	1.243679601	25.0006	0.1311857	7.572685849	0	2.229063449	3.026203834	0.267630259	2.715440199	11.23832154	2.19678213	6.455899689	0	0.17942557	10.79212408	6.277121105	17.48925724	0.360458637	1.179912431	7.10706155	24.04366869	9.01566071	0.372126021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6506
H5528_001_0	2012	9	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	256.0535899	0.16736799	747.3705717	454.9543622	46.44520127	6.638750529	2.992372677	211.6083613	210.8831	270.1660909	416.5429473	0	0	238.3065711	8591.886558	21992.62421	2151.5	1106.544601	2313.580737	520.3420249	11.82542021	0	0	70.4	478.2	359.8273653	0	0	0	0	167.4295784	1270.537604	1341.138398								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	269.9878115	354.1666667	2.38669331	0	63.75	0.17	0.17	53.125	42.5	12.75	27.625	0	0	12.75	4.25	12.75	12.75	12.75	12.75	12.1125	0.17	0	0	0	20	0.4	0	0	0	0	12.75	12.75	42.5									5.7609	0.00493968	0.148645362	0	0.246740132	1.12858759	0.508703355	0.93680785	0.746877646	0.287051472	0.958916576	0	0	0.253200732	3.042959823	23.36716322	2.28596875	1.175703639	2.458179533	0.525220231	2.010321436	0	0	0	0.797	0.011994246	0	0	0	0	0.177893927	1.349946204	4.749865161	0	0	0	0	0	0	0	52.9336		NO	9.198465532	5.7609	0.00493968	0.148645362	0	0.246740132	1.12858759	0.508703355	0.93680785	0.746877646	0.287051472	0.958916576	0	0	0.253200732	3.042959823	23.36716322	2.28596875	1.175703639	2.458179533	0.525220231	2.010321436	0	0	0	0.797	0.011994246	0	0	0	0	0.177893927	1.349946204	4.749865161	0	0	0	0	0	0	0	52.9336	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.044	0	0.2288	0	1.1176	0.1936	0.2024	0	0.1672	0	0.0176	0	0	0.0088	1.584	7.1368	0.0528	0.572	0.176	0.1936	0.2728	0	0	0	0	0	0	0	0	0	0.0088	0.4048	0.308								12.6896		NO	3.3104	5.8049	0.00493968	0.377445362	0	1.364340132	1.32218759	0.711103355	0.93680785	0.914077646	0.287051472	0.976516576	0	0	0.262000732	4.626959823	30.50396322	2.33876875	1.747703639	2.634179533	0.718820231	2.283121436	0	0	0	0.797	0.011994246	0	0	0	0	0.186693927	1.754746204	5.057865161	0	0	0	0	0	0	0	65.6232
H5528_002_0	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	283.6	0.3	729.6	567.3	32.6	6.2945225	3.956342	228.8	227.5	337.6	478.9	0	0	158.9	5804.7	15290.2	1391.1	847.3	1558.8	352.5	13.4586185	0	0	70.4	478.2	360.8	0	0	0	0	134.5	1030.6	1502.2								3400	1A IP Acute: $150 days 1-7	1B IP Psych: $150 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $65; 4B Urgent Care - $25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $25; 9D Outpatient Blood Services - $25; 9C Outpatient Sub Abuse - $25; 5 Partial Hosp - $25	7A Primary Care - $15	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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0;  14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicar	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $20	7F Podiatry - $25	7D High Tech Radiology: $50									NO	635.2654388	833.3333333	27.88780343	0	125	0.2	0.2	63	100	25	37.5	0	0	25	15	25	25	25	25	23.75	0.2	0	0	0	20	0.4	0	0	0	0	20	25	50								NO	544.422481	714.1666667	23.89984754	0	107.125	0.1714	0.1714	53.991	85.7	21.425	32.1375	0	0	21.425	12.855	21.425	21.425	21.425	21.425	20.35375	0.118393784	0	0	0	20	0.4	0	0	0	0	17.14	21.425	42.85									12.8665	0.017854167	1.453110731	0	0.291022917	1.078881157	0.678117019	1.0294284	1.624729167	0.602756667	1.282554063	0	0	0.283702708	6.218284875	27.29937792	2.483693125	1.512783542	2.7831075	0.597891406	1.593416767	0	0	0	0.797	0.012026667	0	0	0	0	0.192110833	1.840050417	5.364105833	0	0	0	0	0	0	0	71.9025		NO	12.69516983	12.8665	0.017854167	1.453110731	0	0.291022917	1.078881157	0.678117019	1.0294284	1.624729167	0.602756667	1.282554063	0	0	0.283702708	6.218284875	27.29937792	2.483693125	1.512783542	2.7831075	0.597891406	1.593416767	0	0	0	0.797	0.012026667	0	0	0	0	0.192110833	1.840050417	5.364105833	0	0	0	0	0	0	0	71.9025	YES	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $65; 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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.088	0	0.4048	0	2.3232	0.3344	0.22	0	0.1936	0	0.0176	0	0	0.0264	1.6104	7.7	0.0616	0.6072	0.2464	0.22	0.352	0	0	0	0	0	0	0	0	0	0.0176	0.4488	0.3608								15.2328		NO	4.8872	12.9545	0.017854167	1.857910731	0	2.614222917	1.413281157	0.898117019	1.0294284	1.818329167	0.602756667	1.300154063	0	0	0.310102708	7.828684875	34.99937792	2.545293125	2.119983542	3.0295075	0.817891406	1.945416767	0	0	0	0.797	0.012026667	0	0	0	0	0.209710833	2.288850417	5.724905833	0	0	0	0	0	0	0	87.1353
H5528_003_0	2012	12	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	282.4	2.1	647.1	640	64	8.648398417	4.577711333	218.2	266.1	436.1	651.8	0	0.4	297.1	9912.4	30254.7	2088.7	1904.9	2680.9	388.3	20.287893	0	0	70.4	478.2	358.6	0	0	0	0	265.7	1377	1742.5								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	269.9878115	354.1666667	2.38669331	0	63.75	0.17	0.17	53.125	42.5	12.75	27.625	0	0	12.75	4.25	12.75	12.75	12.75	12.75	12.1125	0.130029355	0	0	0	20	0.4	0	0	0	0	12.75	12.75	42.5									6.3537	0.061979167	0.128702437	0	0.34	1.470227731	0.778210927	0.965989583	0.9424375	0.46335625	1.500497917	0	0	0.31566875	3.510641667	32.14561875	2.21924375	2.02395625	2.84845625	0.391940313	2.638021639	0	0	0	0.797	0.011953333	0	0	0	0	0.28230625	1.4630625	6.171354167	0	0	0	0	0	0	0	67.8243		NO	12.78026814	6.3537	0.061979167	0.128702437	0	0.34	1.470227731	0.778210927	0.965989583	0.9424375	0.46335625	1.500497917	0	0	0.31566875	3.510641667	32.14561875	2.21924375	2.02395625	2.84845625	0.391940313	2.638021639	0	0	0	0.797	0.011953333	0	0	0	0	0.28230625	1.4630625	6.171354167	0	0	0	0	0	0	0	67.8243	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.1056	0	0.3432	0	1.1264	0.44	0.2288	0	0.2376	0	0.0088	0	0	0	1.7336	9.108	0.1408	0.5016	0.5808	0.2288	0.924	0	0	0	0	0	0	0	0	0	0.0968	0.4664	0.616								16.8872		NO	2.3028	6.4593	0.061979167	0.471902437	0	1.4664	1.910227731	1.007010927	0.965989583	1.1800375	0.46335625	1.509297917	0	0	0.31566875	5.244241667	41.25361875	2.36004375	2.52555625	3.42925625	0.620740313	3.562021639	0	0	0	0.797	0.011953333	0	0	0	0	0.37910625	1.9294625	6.787354167	0	0	0	0	0	0	0	84.7115
H5528_004_0	2012	8	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	331.9503544	0.550779719	643.4465267	524.2885169	84.15959636	8.747998133	4.25113621	317.5077972	264.581685	365.5251804	484.0716466	0	19.80637952	114.7828191	9491.066353	24439.00524	2190.536832	1555.4556	2609.921386	263.3853709	15.21983122	0	0	70.4	478.2	358.7502127	0	0	0	0	149.6227974	1243.250861	1537.456822								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	269.9878115	354.1666667	2.38669331	0	63.75	0.17	0.17	53.125	42.5	12.75	27.625	0	0	12.75	4.25	12.75	12.75	12.75	12.75	12.1125	0.17	0	0	0	20	0.4	0	0	0	0	12.75	12.75	42.5									7.4685	0.016255651	0.127975793	0	0.447097856	1.487159683	0.722693156	1.405633477	0.937060134	0.388370504	1.11437327	0	0	0.121956745	3.361419333	25.96644306	2.327445384	1.652671575	2.773041473	0.265854609	2.587371307	0	0	0	0.797	0.01195834	0	0	0	0	0.158974222	1.32095404	5.445159576	0	0	0	0	0	0	0	60.9054		NO	10.60525706	7.4685	0.016255651	0.127975793	0	0.447097856	1.487159683	0.722693156	1.405633477	0.937060134	0.388370504	1.11437327	0	0	0.121956745	3.361419333	25.96644306	2.327445384	1.652671575	2.773041473	0.265854609	2.587371307	0	0	0	0.797	0.01195834	0	0	0	0	0.158974222	1.32095404	5.445159576	0	0	0	0	0	0	0	60.9054	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.0616	0	0.8448	0	1.8216	0.3168	0.4048	0.0088	0.1848	0	0	0	0	0.0616	2.3056	7.6648	0.1408	0.66	0.924	0.1232	0.2464	0	0	0	0	0	0	0	0	0	0.0176	0.3696	0.4048								16.5616		NO	2.2584	7.5301	0.016255651	0.972775793	0	2.268697856	1.803959683	1.127493156	1.414433477	1.121860134	0.388370504	1.11437327	0	0	0.183556745	5.667019333	33.63124306	2.468245384	2.312671575	3.697041473	0.389054609	2.833771307	0	0	0	0.797	0.01195834	0	0	0	0	0.176574222	1.69055404	5.849959576	0	0	0	0	0	0	0	77.467
H5528_005_0	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	312.5	1	603	485.7	26.2	8.75876125	4.521370667	303.8	269.9	426.8	436.6	0	22.9	129.7	6853.5	18164.5	1588.7	1100.2	2001.1	203.4	19.3228865	0	0	70.4	478.2	358.9	0	0	0	0	189	1070.7	1517								3400	1A IP Acute: $150 days 1-7	1B IP Psych: $150 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $65; 4B Urgent Care - $25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $25; 9D Outpatient Blood Services - $25; 9C Outpatient Sub Abuse - $25; 5 Partial Hosp - $25	7A Primary Care - $15	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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0;  14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicar	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $20	7F Podiatry - $25	7D High Tech Radiology: $50									NO	635.2654388	833.3333333	27.88780343	0	125	0.2	0.2	63	100	25	37.5	0	0	25	15	25	25	25	25	23.75	0.2	0	0	0	20	0.4	0	0	0	0	20	25	50								NO	543.7872156	713.3333333	23.87195974	0	107	0.1712	0.1712	53.928	85.6	21.4	32.1	0	0	21.4	12.84	21.4	21.4	21.4	21.4	20.33	0.116831246	0	0	0	20	0.4	0	0	0	0	17.12	21.4	42.8									14.1611	0.059444444	1.199565977	0	0.233616667	1.499499926	0.774058658	1.3652772	1.925286667	0.761126667	1.167905	0	0	0.231298333	7.333245	32.39335833	2.833181667	1.962023333	3.568628333	0.3445935	2.257516908	0	0	0	0.797	0.011963333	0	0	0	0	0.26964	1.909415	5.410633333	0	0	0	0	0	0	0	82.4694		NO	14.96456153	14.1611	0.059444444	1.199565977	0	0.233616667	1.499499926	0.774058658	1.3652772	1.925286667	0.761126667	1.167905	0	0	0.231298333	7.333245	32.39335833	2.833181667	1.962023333	3.568628333	0.3445935	2.257516908	0	0	0	0.797	0.011963333	0	0	0	0	0.26964	1.909415	5.410633333	0	0	0	0	0	0	0	82.4694	YES	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $65; 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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.132	0	0.9064	0	2.4464	0.484	0.3432	0	0.2024	0	0	0	0	0.1056	2.1648	7.6912	0.132	0.7392	0.2728	0.132	0.132	0	0	0	0	0	0	0	0	0	0.0352	0.2552	0.3784								16.5528		NO	2.2572	14.2931	0.059444444	2.105965977	0	2.680016667	1.983499926	1.117258658	1.3652772	2.127686667	0.761126667	1.167905	0	0	0.336898333	9.498045	40.08455833	2.965181667	2.701223333	3.841428333	0.4765935	2.389516908	0	0	0	0.797	0.011963333	0	0	0	0	0.30484	2.164615	5.789033333	0	0	0	0	0	0	0	99.0222
H5528_008_0	2012	12	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	301.550331	2.533875866	500.1828479	632.9581107	38.41698271	8.937215597	4.585659566	256.9826688	337.668145	335.9478273	508.0758002	0	12.57707928	141.3382311	9828.616963	32050.93433	2107.830272	1684.097352	2815.085083	263.3415758	16.87968608	0	0	70.4	478.2	358.6311483	0	0	0	0	346.9219901	1271.312663	1721.827445								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	279.5167931	366.6666667	2.470929544	0	66	0.176	0.176	55	44	13.2	28.6	0	0	13.2	4.4	13.2	13.2	13.2	13.2	12.54	0.157752288	0	0	0	20	0.4	0	0	0	0	13.2	13.2	44									7.024	0.077423985	0.102993048	0	0.211293405	1.572949945	0.807076084	1.177837232	1.238116532	0.36954261	1.21091399	0	0	0.155472054	3.60382622	35.25602776	2.318613299	1.852507087	3.096593591	0.275191947	2.662809101	0	0	0	0.797	0.011954372	0	0	0	0	0.381614189	1.398443929	6.313367299	0	0	0	0	0	0	0	71.9156		NO	10.04637848	7.024	0.077423985	0.102993048	0	0.211293405	1.572949945	0.807076084	1.177837232	1.238116532	0.36954261	1.21091399	0	0	0.155472054	3.60382622	35.25602776	2.318613299	1.852507087	3.096593591	0.275191947	2.662809101	0	0	0	0.797	0.011954372	0	0	0	0	0.381614189	1.398443929	6.313367299	0	0	0	0	0	0	0	71.9156	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0.3872	0	0.4576	0	1.672	0.2816	0.3168	0	0.1848	0	0.0088	0	0	0.0176	1.936	8.712	0.0704	0.4488	0.3696	0.1408	0.2376	0	0	0	0	0	0	0	0	0	0.0088	0.308	0.4048								15.9632		NO	2.1768	7.4112	0.077423985	0.560593048	0	1.883293405	1.854549945	1.123876084	1.177837232	1.422916532	0.36954261	1.21971399	0	0	0.173072054	5.53982622	43.96802776	2.389013299	2.301307087	3.466193591	0.415991947	2.900409101	0	0	0	0.797	0.011954372	0	0	0	0	0.390414189	1.706443929	6.718167299	0	0	0	0	0	0	0	87.8788
H5528_009_0	2012	8	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	305.2610649	0.1740059	682.1204306	466.6158495	46.66314454	7.365321139	3.846805087	363.9220177	313.3440915	260.9883097	383.9446107	0	0	202.3708024	11238.21017	24671.93192	2413.900982	1084.058478	2762.240915	289.2615988	8.972948962	0	0	70.4	478.2	359.6440354	0	0	0	0	307.9791209	1255.226599	1823.819389								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	279.5167931	366.6666667	2.470929544	0	66	0.176	0.176	55	44	13.2	28.6	0	0	13.2	4.4	13.2	13.2	13.2	13.2	12.54	0.176	0	0	0	20	0.4	0	0	0	0	13.2	13.2	44									7.1105	0.005316847	0.14045596	0	0.256647295	1.296296521	0.677037695	1.667975914	1.148928335	0.287087141	0.915067989	0	0	0.222607883	4.120677064	27.13912511	2.655291081	1.192464326	3.038465006	0.302278371	1.579239017	0	0	0	0.797	0.011988135	0	0	0	0	0.338777033	1.380749259	6.687337761	0	0	0	0	0	0	0	62.9713		NO	8.47667615	7.1105	0.005316847	0.14045596	0	0.256647295	1.296296521	0.677037695	1.667975914	1.148928335	0.287087141	0.915067989	0	0	0.222607883	4.120677064	27.13912511	2.655291081	1.192464326	3.038465006	0.302278371	1.579239017	0	0	0	0.797	0.011988135	0	0	0	0	0.338777033	1.380749259	6.687337761	0	0	0	0	0	0	0	62.9713	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0	0	0.5368	0	0.6336	0.3344	0.3256	0	0.2288	0	0	0	0	0.0528	2.6664	8.7208	0.0968	0.5984	0.2112	0.088	0.1936	0	0	0	0	0	0	0	0	0	0.0264	0.3872	0.308								15.4088		NO	2.1012	7.1105	0.005316847	0.67725596	0	0.890247295	1.630696521	1.002637695	1.667975914	1.377728335	0.287087141	0.915067989	0	0	0.275407883	6.787077064	35.85992511	2.752091081	1.790864326	3.249665006	0.390278371	1.772839017	0	0	0	0.797	0.011988135	0	0	0	0	0.365177033	1.767949259	6.995337761	0	0	0	0	0	0	0	78.3801
H5528_010_0	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	290.5	0.4	518.7	392.5	46.4	6.494573	4.086817333	324	298.6	225.5	447.1	0	0	173.2	8656.5	18280.3	1723.3	888	1992.1	208.1	10.933983	0	0	70.4	478.2	361	0	0	0	0	209.7	1050.8	1719.2								3400	1A IP Acute: $150 days 1-7	1B IP Psych: $150 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $65; 4B Urgent Care - $25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $25; 9D Outpatient Blood Services - $25; 9C Outpatient Sub Abuse - $25; 5 Partial Hosp - $25	7A Primary Care - $15	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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $20	7F Podiatry - $25	7D High Tech Radiology: $50									NO	635.2654388	833.3333333	27.88780343	0	125	0.2	0.2	63	100	25	37.5	0	0	25	15	25	25	25	25	23.75	0.2	0	0	0	20	0.4	0	0	0	0	20	25	50								NO	564.1157096	740	24.76436945	0	111	0.1776	0.1776	55.944	88.8	22.2	33.3	0	0	22.2	13.32	22.2	22.2	22.2	22.2	21.09	0.149957871	0	0	0	20	0.4	0	0	0	0	17.76	22.2	44.4									13.6563	0.024666667	1.070439869	0	0.4292	1.153436165	0.725818758	1.510488	2.20964	0.417175	1.2407025	0	0	0.32042	9.608715	33.818555	3.188105	1.6428	3.685385	0.36573575	1.639636808	0	0	0	0.797	0.012033333	0	0	0	0	0.310356	1.94398	6.36104	0	0	0	0	0	0	0	86.1316		NO	11.10176734	13.6563	0.024666667	1.070439869	0	0.4292	1.153436165	0.725818758	1.510488	2.20964	0.417175	1.2407025	0	0	0.32042	9.608715	33.818555	3.188105	1.6428	3.685385	0.36573575	1.639636808	0	0	0	0.797	0.012033333	0	0	0	0	0.310356	1.94398	6.36104	0	0	0	0	0	0	0	86.1316	YES	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $125 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $65; 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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0	0	0.6571	0	0.7104	0.4529	0.444	0	0.3108	0	0	0	0	0.0977	2.5042	9.2974	0.1154	0.5328	0.2575	0.0888	0.1865	0	0	0	0	0	0	0	0	0	0.0533	0.2486	0.3463								16.3037		NO	2.05632	13.6563	0.024666667	1.727559869	0	1.1396	1.606316165	1.169818758	1.510488	2.52044	0.417175	1.2407025	0	0	0.4181	12.112875	43.115915	3.303545	2.1756	3.942905	0.45453575	1.826116808	0	0	0	0.797	0.012033333	0	0	0	0	0.363636	2.19262	6.70736	0	0	0	0	0	0	0	102.4353
H5528_011_0	2012	13	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	363.4	0.4	597.9	617.2	50	9.630269167	5.00573	286.3	365.9	283.8	421.8	0	44.4	214.4	11316.7	31182.8	2115.3	1438.3	3118.8	308.2	13.37822267	0	0	70.4	478.2	360.2	0	0	0	0	278.9	1285.9	1948.7								3400	1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $0 days 1-20, $25 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 - $65; 4B Urgent Care - $15	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $15	8B Outpatient X-Rays - $15; Outpatient Radiology Therapy - $50; $50 High-tech Radiology		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $15; 9D Outpatient Blood Services - $15; 9C Outpatient Sub Abuse - $15;	7A Primary Care - $5	7D Physician Specialist - $15	7E Mental Health - $15; 7H Psychiatric Services - $15	7C Occupational Therapy - $15; 7I PT and ST Services - $15	7D Specialist Copays - $15	7G Other Health Care - $15; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $15	7F Podiatry - $15	7D High Tech Radiology: $50									NO	317.6327194	416.6666667	2.807874482	0	75	0.2	0.2	62.5	50	15	32.5	0	0	15	5	15	15	15	15	14.25	0.2	0	0	0	20	0.4	0	0	0	0	15	15	50								NO	279.5167931	366.6666667	2.470929544	0	66	0.176	0.176	55	44	13.2	28.6	0	0	13.2	4.4	13.2	13.2	13.2	13.2	12.54	0.1329526	0	0	0	20	0.4	0	0	0	0	13.2	13.2	44									8.4647	0.012222222	0.123114065	0	0.275	1.694927373	0.88100848	1.312208333	1.341633333	0.31218	1.00529	0	0	0.23584	4.149456667	34.30108	2.32683	1.58213	3.43068	0.322069	1.778669487	0	0	0	0.797	0.012006667	0	0	0	0	0.30679	1.41449	7.145233333	0	0	0	0	0	0	0	73.2246		NO	10.52927728	8.4647	0.012222222	0.123114065	0	0.275	1.694927373	0.88100848	1.312208333	1.341633333	0.31218	1.00529	0	0	0.23584	4.149456667	34.30108	2.32683	1.58213	3.43068	0.322069	1.778669487	0	0	0	0.797	0.012006667	0	0	0	0	0.30679	1.41449	7.145233333	0	0	0	0	0	0	0	73.2246	YES	1A IP Acute: 25%	1B IP Psych: 25%	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 - $65; 4B Urgent Care - $15	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 50%; 9D Outpatient Blood Services - 50%; 9C Outpatient Sub Abuse - 25%; 5 Partial Hosp - 25%	7A Primary Care - 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%; 14A Preventive Care - 25%; 13D Pap/Pelvic - 25%; 14E Diabetes Self Management Training - 25%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 25%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $40	7F Podiatry - $40	7D High Tech Radiology: 25%								5100	0	0	0.3432	0	0.7656	0.6072	0.1584	0	0.308	0	0	0	0	0	3.6168	9.7416	0.1496	0.3256	0.308	0.0968	0.5368	0	0	0	0	0	0	0	0	0	0.0176	0.3432	0.4224								17.7408		NO	2.4192	8.4647	0.012222222	0.466314065	0	1.0406	2.302127373	1.03940848	1.312208333	1.649633333	0.31218	1.00529	0	0	0.23584	7.766256667	44.04268	2.47643	1.90773	3.73868	0.418869	2.315469487	0	0	0	0.797	0.012006667	0	0	0	0	0.32439	1.75769	7.567633333	0	0	0	0	0	0	0	90.9654
H5528_018_0	2012	12	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	409.1	0.6	525.4	778	119.6	14.27524233	4.97897625	511.7	326.1	884.1	670.6	0	17.8	201.6	10200.5	27524.8	2179.8	2514.7	2486.2	1384.5	15.02301333	0	0	70.4	478.2	359.7	0	0	0	517.9	150	1535.1	1727.9								3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	"2 SNF: $0 days 1-20, $0 days 21-100"	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $0; 9D Outpatient Blood Services - $0; 9C Outpatient Sub Abuse - $0 ; 5 Partial Hosp - $0	7A Primary Care - $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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	15 Medicare Part B Rx Drugs - 0%		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - $600 a year with up to $55 a Month; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $0	7F Podiatry - $0	7D High Tech Radiology: $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								NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	YES	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	"2 SNF: $0 days 1-20, $0 days 21-100"	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $0; 9D Outpatient Blood Services - $0; 9C Outpatient Sub Abuse - $0 ; 5 Partial Hosp - $0	7A Primary Care - $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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - 0%		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - $600 a year with up to $55 a Month; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $0	7F Podiatry - $0	7D High Tech Radiology: $0								5100	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0		NO	4.569366171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	298.4	0.8	754.7	611.9	68.1	7.3757715	4.29691	238.7	250.5	378.8	549.2	0	0.1	212.7	9622.6	26392.6	2261	1527.2	2615.4	530.6	16.04588558	0	0	70.4	478.2	360.2	0.1	2.1	0	0	180.7	1208.6	1645.4								3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	"2 SNF: $0 days 1-20, $0 days 21-100"	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $0; 9D Outpatient Blood Services - $0; 9C Outpatient Sub Abuse - $0 ; 5 Partial Hosp - $0	7A Primary Care - $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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $0	7F Podiatry - $0	7D High Tech Radiology: $0									NO	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								NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.121571213	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.950717776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9507		NO	1.258459341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.950717776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9507	YES	1A IP Acute: 35%	1B IP Psych: 35%	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0 per trip one way	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 35%; 9D Outpatient Blood Services - 35%; 9C Outpatient Sub Abuse - 35%; 5 Partial Hosp - 35%	7A Primary Care - 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%; 14A Preventive Care - 35%; 13D Pap/Pelvic - 35%;  14E Diabetes Self Management Training - 35%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 35%; 18A Hearing Exams (Med	15 Medicare Part B Rx Drugs - 35%		10B Transportation - NA	16A Preventative Dental - 35%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%	17B Eye Wear - 35%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - 35%	7F Podiatry - 35%	7D High Tech Radiology: 35%								5100	0.1144	0	0.5632	0	0	0.44	0.2728	0	0.2992	0	0.0264	0	0	0.0088	2.4464	11.9504	0.1232	0.528	0.484	0.2552	0.5192	0	0	0	0	0	0	0	0	0	0	0	0.6336								18.6648		NO	2.5452	0.1144	0	0.5632	0	0	0.44	0.2728	0	0.2992	0	0.0264	0	0	0.0088	2.4464	11.9504	0.1232	0.528	0.484	0.2552	2.469917776	0	0	0	0	0	0	0	0	0	0	0	0.6336	0	0	0	0	0	0	0	20.6155
H5528_020_0	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	333.7	1.5	619.2	570.3	57	9.515185167	4.858112	312.4	308.1	417.6	496.2	0	20.8	139.6	10029.9	28304.5	2271	1648.1	2884.6	283.4	19.41135	0	0	70.4	478.2	358.8	0.1	2.1	0	0	243.7	1234	1686.3								3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	"2 SNF: $0 days 1-20, $0 days 21-100"	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $0; 9D Outpatient Blood Services - $0; 9C Outpatient Sub Abuse - $0 ; 5 Partial Hosp - $0	7A Primary Care - $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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $0	7F Podiatry - $0	7D High Tech Radiology: $0									NO	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								NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.157752288	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.062184876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0622		NO	1.013740224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.062184876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0622	YES	1A IP Acute: 35%	1B IP Psych: 35%	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0 per trip one way	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 35%; 9D Outpatient Blood Services - 35%; 9C Outpatient Sub Abuse - 35%; 5 Partial Hosp - 35%	7A Primary Care - 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%; 14A Preventive Care - 35%; 13D Pap/Pelvic - 35%; 14E Diabetes Self Management Training - 35%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 35%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 35%		10B Transportation - NA	16A Preventative Dental - 35%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%	17B Eye Wear - 35%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - 35%	7F Podiatry - 35%	7D High Tech Radiology: 35%								5100	0.308	0	1.1616	0	0	0.5016	0.4312	0	0.2992	0	0.0088	0	0	0.0528	3.2032	12.0736	0.176	0.5808	0.6072	0.1232	0.132	0	0	0	0	0	0	0	0	0	0	0	0.5984								20.2576		NO	2.7624	0.308	0	1.1616	0	0	0.5016	0.4312	0	0.2992	0	0.0088	0	0	0.0528	3.2032	12.0736	0.176	0.5808	0.6072	0.1232	3.194184876	0	0	0	0	0	0	0	0	0	0	0	0.5984	0	0	0	0	0	0	0	23.3198
H5528_021_0	2012	10	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	350.7	0.4	627.8	543.9	51.8	8.69817875	4.80689575	338.9	356.7	277.5	458.1	0	21.1	211.8	12284.9	29580.8	2413.7	1378.9	3104.8	313.5	12.6140145	0	0	70.4	478.2	360.4	0.1	2.1	0	0	277.6	1283.7	1983.2								3400	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	"2 SNF: $0 days 1-20, $0 days 21-100"	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - $0; 9D Outpatient Blood Services - $0; 9C Outpatient Sub Abuse - $0 ; 5 Partial Hosp - $0	7A Primary Care - $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; 14A Preventive Care - $0; 13D Pap/Pelvic - $0; 14E Diabetes Self Management Training - $0; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - $0; 18A Hearing Exams (Medicare	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"		10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - $0	7F Podiatry - $0	7D High Tech Radiology: $0									NO	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								NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1329526	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.677066025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6771		NO	0.845736875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.677066025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6771	YES	1A IP Acute: 35%	1B IP Psych: 35%	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0 per trip one way	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		12 Renal Dialysis - $0	3 Cardiac and Pulmonary Rehabilitation Services - 35%; 9D Outpatient Blood Services - 35%; 9C Outpatient Sub Abuse - 35%; 5 Partial Hosp - 35%	7A Primary Care - 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%; 14A Preventive Care - 35%; 13D Pap/Pelvic - 35%; 14E Diabetes Self Management Training - 35%; 14D Kidney Disease Education Services - $0; 14C Health/Wellness - $0; 17A Eye Exams (Medicare Covered) - 35%; 18A Hearing Exams (Medi	15 Medicare Part B Rx Drugs - 35%		10B Transportation - NA	16A Preventative Dental - 35%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%	17B Eye Wear - 35%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA		13A Acupunture - NA; 13B OTC - NA; 13C Meal Benefit - NA; 13D Other - NA; 13E Private Duty Nursing - NA	7B Chiropractic - 35%	7F Podiatry - 35%	7D High Tech Radiology: 35%								5100	0	0	0.7392	0	0	0.6248	0.3608	0	0.44	0	0	0	0	0.0352	4.5672	14.1152	0.1936	0.4488	0.4136	0.0616	0.3784	0	0	0	0	0	0	0	0	0	0	0	0.5632								22.9416		NO	3.1284	0	0	0.7392	0	0	0.6248	0.3608	0	0.44	0	0	0	0	0.0352	4.5672	14.1152	0.1936	0.4488	0.4136	0.0616	2.055466025	0	0	0	0	0	0	0	0	0	0	0	0.5632	0	0	0	0	0	0	0	24.6187
H5528_804_0	2012	6	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	288.7222433	0	25.85608817	12.22094942	1.7743275	7.29157975	2.897071333	11.68825667	41.83013067	3.016981333	21.18445933	0	0.268185667	6.568640833	35.74202125	140.7738298	17.97218625	3.742674	17.62522708	1.059741333	8.14149125	0	0	0	0	0	0	0	0	0	0.590492667	5.602171	18.83762483								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	Medicare Cost Sharing	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing									NO	0.056986274	0.056986274	0.148606453	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0.224	0.224	0.224								NO	0.048438333	0.048438333	0.126315485	0	0.1904	0.1904	0.1904	0.1904	0.1904	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0	0	0	0	0	0	0	0	0.1904	0.1904	0.1904									13.9852	0	3.266024321	0	0.337831956	1.388316784	0.551602382	2.225444069	7.964456879	0	4.033521057	0	0.051062551	1.250669215	6.805280846	26.8033372	3.421904262	0.71260513	3.355843237	0.20177475	1.550139934	0	0	0	0	0	0	0	0	0	0.112429804	1.066653358	3.586683768	0	0	0	0	0	0	0	82.6708		NO	50.3691445	13.9852	0	3.266024321	0	0.337831956	1.388316784	0.551602382	2.225444069	7.964456879	0	4.033521057	0	0.051062551	1.250669215	6.805280846	26.8033372	3.421904262	0.71260513	3.355843237	0.20177475	1.550139934	0	0	0	0	0	0	0	0	0	0.112429804	1.066653358	3.586683768	0	0	0	0	0	0	0	82.6708	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	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing								5100	0	0	0.2288	0	0.924	0.088	0.1936	0.044	0.1232	0	0	0	0.0968	0	1.9008	6.0896	0.0792	0.2376	0.5368	0.0968	0.1056	0	0	0	0	0	0	0	0	0	0	0.22	0.2552								11.22		NO	1.53	13.9852	0	3.494824321	0	1.261831956	1.476316784	0.745202382	2.269444069	8.087656879	0	4.033521057	0	0.147862551	1.250669215	8.706080846	32.8929372	3.501104262	0.95020513	3.892643237	0.29857475	1.655739934	0	0	0	0	0	0	0	0	0	0.112429804	1.286653358	3.841883768	0	0	0	0	0	0	0	93.8908
H5528_807_0	2012	6	i.2	i.2	i.5								Professional	Professional	Professional								Chiropractic	Podiatry	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																																																0	YES	375.491662	2.542288938	31.5479591	25.39034189	1.734668465	7.95965151	5.021844947	10.25703607	50.59361188	4.745183412	85.46644287	0	0.204445498	8.314677892	37.56710206	168.1425425	18.50155859	5.577611798	26.16654788	1.430450522	15.58280031	0	0	0	0	0	0	0	0	0	0.586613407	4.502141275	25.29664568								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	Medicare Cost Sharing	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing									NO	0.059328071	0.059328071	0.148373877	0	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0.224	0.224	0.224								NO	0.05042886	0.05042886	0.126117795	0	0.1904	0.1904	0.1904	0.1904	0.1904	0	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0.1904	0	0	0	0	0	0	0	0	0.1904	0.1904	0.1904									18.9356	0.128204733	3.978759048	0	0.330280876	1.515517647	0.956159278	1.952939667	9.633023701	0	16.27281072	0	0.038926423	1.583114671	7.152776232	32.01434009	3.522696755	1.061977286	4.982110716	0.272357779	2.96696518	0	0	0	0	0	0	0	0	0	0.111691193	0.857207699	4.816481337	0	0	0	0	0	0	0	113.084		NO	19.9559925	18.9356	0.128204733	3.978759048	0	0.330280876	1.515517647	0.956159278	1.952939667	9.633023701	0	16.27281072	0	0.038926423	1.583114671	7.152776232	32.01434009	3.522696755	1.061977286	4.982110716	0.272357779	2.96696518	0	0	0	0	0	0	0	0	0	0.111691193	0.857207699	4.816481337	0	0	0	0	0	0	0	113.084	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	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing								5100	0.0086	0	0.2062	0	1.4412	0.4602	0.172	0.01	0.2761	0	0.0058	0	0.0412	0.0163	2.1197	9.7266	0.0978	0.269	0.5192	0.1657	1.669	0	0	0	0	0	0	0	0	0	0.0534	0.2664	0.6807								18.2051		NO	2.482514097	18.9443	0.128204733	4.184964102	0	1.771502527	1.975690043	1.128109357	1.962940571	9.909102052	0	16.27859804	0	0.080161668	1.599411316	9.272478846	41.74096433	3.620491749	1.330937931	5.501294663	0.438071566	4.635989324	0	0	0	0	0	0	0	0	0	0.165104639	1.123630449	5.497147238	0	0	0	0	0	0	0	131.2891
H5529_001_0	2012	9	H.6										OP Facility - Other										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	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	YES	1316.081614	78.21675183	528.0614384	600.2614727	127.0714474	10.43420992	5.962458808	327.9030814	446.5264273	7812.69127	860.7017219	0	0.242736028	969.7172519	3198.201384	3680.762293	10.82112857	1488.203072	767.5204391	1963.644196	39.65791715	9.926796971	0	456.2721669	234.4	234.4	129.6	0	5872.8	325.3280344	11.76762193	0	0	0	0	0	0	0	0	0	4500	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $35 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$155 copay	8B: $95-$155 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $35-$200 copay; 9C: $40 copay	7A: $20 copay; 7G: $20 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $95-$155 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $35 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	163.3412298	111.8502582	146	0	150	0.2	0.164595808	59.94567579	176.4413433	24.05071517	117.0508768	40	0.2	59.52649297	20	33.90380689	40	50	112.0383722	0.586980774	0.2	0	0	0	0	0	35	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	145.9234142	99.92315823	130.4313583	0	134.0048202	0.178673094	0.147044211	53.5533967	157.6266032	21.48607841	104.5692113	0	0.178673094	53.17891325	17.86730936	30.2884903	35.73461871	44.66827339	100.0912128	0.524388354	0.178673094	0	0	0	0	0	35	0	0	0	0.178673094	0	0	0	0	0	0	0	0	0		16.0039	0.651305406	5.739647556	0	1.419015538	1.864312565	0.87674505	1.463360316	5.865370333	13.98867477	7.500241687	0	0.043370397	4.297375801	4.761937793	9.290394419	0.032224075	5.539621806	6.401837632	0.085809346	7.085802743	0	0	0	0	0	0.378	0	0	0	2.102557413	0	0	0	0	0	0	0	0	0	95.3915		NO	11.34107355	16.0039	0.651305406	5.739647556	0	1.419015538	1.864312565	0.87674505	1.463360316	5.865370333	13.98867477	7.500241687	0	0.043370397	4.297375801	4.761937793	9.290394419	0.032224075	5.539621806	6.401837632	0.085809346	7.085802743	0	0	0	0	0	0.378	0	0	0	2.102557413	0	0	0	0	0	0	0	0	0	95.3915	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: $150 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $60 copay; 4B: $35 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $45-$275 copay; 9C: $50 copay	7A: $30 copay; 7G: $30 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $90 copay; 7I: $90 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $45 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4500	3.4983	0.0709	1.2795	0	1.4791	0.4284	0.3664	0.1731	0.5818	0.8197	0.3463	0	0	0.2543	0.8935	1.3511	0.0089	0.7838	0.7956	0.0252	0.6276	0	0	0.1807	0	0	0.1215	0	0	0	0.1424	0	0	0	0	0	0	0	0	0	14.2279		NO	1.662210779	19.5022	0.722178509	7.01919214	0	2.898155207	2.292668832	1.243139523	1.636435471	6.447123682	14.80840487	7.846520518	0	0.043370397	4.551648399	5.655389111	10.64149789	0.041096018	6.323463567	7.197412781	0.111029093	7.713371758	0	0	0.180728745	0	0	0.4995	0	0	0	2.244921804	0	0	0	0	0	0	0	0	0	109.6195
H5529_004_0	2012	9	H.6										OP Facility - Other										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	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	YES	1494.286565	51.88386423	534.4703493	660.7537608	136.3462976	10.82678429	5.831712056	379.596421	459.7320332	8425.480001	979.1676008	2.457863997	0.008186096	1079.701515	3539.113599	4180.302472	7.727751603	1575.383003	773.4713033	2043.862974	41.10933032	18.23492806	0	702.9904829	234.4	234.4	259.2	0	5872.8	371.0568083	12.1851939	0	0	0	0	0	0	0	0	0	3400	1A: $200/day (days1-5) $1000 yrly max	1B: $200/day (days1-5) $1000 yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $20 copay	9A: $0 - $175 copay; 9B: $0-$175 copay	8A: $0-$155 copay	8B: $95-$155 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $20-$175 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $95-$155 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $20 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	91.91146881	80.15564202	146	0	150	0.2	0.128528226	59.90996061	154.8274598	24.24153161	117.0120416	40	0.2	43.70366719	10	19.30642177	40	50	110.137524	0.311580435	0.2	0	0	0	0	0	20	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	80.47474398	70.18171784	127.8329328	0	131.335205	0.175113607	0.112535206	52.45524638	135.5619744	21.22511015	102.4520032	35.02272133	0.175113607	38.26553393	8.755680332	16.90408573	35.02272133	43.77840166	96.43289531	0.272809868	0.175113607	0	0	0	0	0	20	0	0	0	0.175113607	0	0	0	0	0	0	0	0	0		10.021	0.30344156	5.693576023	0	1.492255746	1.895917246	0.65627292	1.659318649	5.193515178	14.90264509	8.359806844	0.007173424	0.001433497	3.442946245	2.582278945	5.888682614	0.022553908	5.747312489	6.215673102	0.046465499	7.198803098	0	0	0	0	0	0.432	0	0	0	2.133793251	0	0	0	0	0	0	0	0	0	83.8969		NO	11.86167193	10.021	0.30344156	5.693576023	0	1.492255746	1.895917246	0.65627292	1.659318649	5.193515178	14.90264509	8.359806844	0.007173424	0.001433497	3.442946245	2.582278945	5.888682614	0.022553908	5.747312489	6.215673102	0.046465499	7.198803098	0	0	0	0	0	0.432	0	0	0	2.133793251	0	0	0	0	0	0	0	0	0	83.8969	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: $150 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $60 copay; 4B: $20 copay	9A: $225 copay; 9B: $225 copay	8A: 0% - 25% coin	8B: 25% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $25-$225 copay; 9C: $50 copay	7A: $15 copay; 7G: $15 copay	7B: $25 copay; 7D: $25 copay; 7F: $25 copay	7E: $50 copay; 7H: $50 copay	7C: $60 copay; 7I: $60 copay	8B: 25% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $25 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	2.6184	0.1776	1.126	0	1.4933	0.4146	0.5928	0.2398	0.7115	0.8687	0.5676	0.0088	0.0272	0.6172	0.5291	1.089	0.0177	0.7466	0.7949	0.0116	1.4209	0	0	0.247	0	0	0.135	0	0	0	0.2534	0	0	0	0	0	0	0	0	0	14.709		NO	2.036083049	12.6395	0.48102744	6.819581475	0	2.985549559	2.31052949	1.249104842	1.899133426	5.904967976	15.77134464	8.927441928	0.015985604	0.028669937	4.060166028	3.111391895	6.977712102	0.040272785	6.493961337	7.010549375	0.058052846	8.619713386	0	0	0.247044534	0	0	0.567	0	0	0	2.387201397	0	0	0	0	0	0	0	0	0	98.6059
H5529_804_0	2012	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	249.6503719	2.593619797	53.56083343	13.38886519	6.993074812	12.87854376	4.391099473	15.59991527	57.21360258	69.34840946	60.05824427	0.005318934	6.849203948	0.59532377	44.21293982	65.80882072	0.185132019	41.7922419	0	0.103694054	40.77125047	0.46011753																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071473614	0.071473614	0.157460651	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	0.059331944	0.059331944	0.130711826	0	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695																				14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445		NO	19.71590414	14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445	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	1.6458	0.0171	0.7779	0	0.1353	0.2491	0.0849	0.3017	1.1066	1.3413	1.1616	0.0001	0.1325	0.0115	0.8552	1.2729	0.0036	0.8083	0	0.002	0.7886	0.0089																			10.7049		NO	2.190656016	16.458	0.170982784	7.77892702	0	1.352592368	2.490952904	0.849321335	3.017317405	11.06618824	13.41328842	11.61639551	0.001028782	1.324765034	0.115146829	8.551615216	12.7286653	0.035808019	8.083406652	0	0.020056383	7.88592768	0.088995396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0494
H5529_805_0	2012	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	249.6503719	2.593619797	53.56083343	13.38886519	6.993074812	12.87854376	4.391099473	15.59991527	57.21360258	69.34840946	60.05824427	0.005318934	6.849203948	0.59532377	44.21293982	65.80882072	0.185132019	41.7922419	0	0.103694054	40.77125047	0.46011753																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071473614	0.071473614	0.157460651	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	0.059331944	0.059331944	0.130711826	0	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695																				14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445		NO	19.71590414	14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445	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	1.6458	0.0171	0.7779	0	0.1353	0.2491	0.0849	0.3017	1.1066	1.3413	1.1616	0.0001	0.1325	0.0115	0.8552	1.2729	0.0036	0.8083	0	0.002	0.7886	0.0089																			10.7049		NO	2.190656016	16.458	0.170982784	7.77892702	0	1.352592368	2.490952904	0.849321335	3.017317405	11.06618824	13.41328842	11.61639551	0.001028782	1.324765034	0.115146829	8.551615216	12.7286653	0.035808019	8.083406652	0	0.020056383	7.88592768	0.088995396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0494
H5529_806_0	2012	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	249.6503719	2.593619797	53.56083343	13.38886519	6.993074812	12.87854376	4.391099473	15.59991527	57.21360258	69.34840946	60.05824427	0.005318934	6.849203948	0.59532377	44.21293982	65.80882072	0.185132019	41.7922419	0	0.103694054	40.77125047	0.46011753																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071473614	0.071473614	0.157460651	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	0.059331944	0.059331944	0.130711826	0	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695																				14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445		NO	19.71590414	14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445	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	1.6458	0.0171	0.7779	0	0.1353	0.2491	0.0849	0.3017	1.1066	1.3413	1.1616	0.0001	0.1325	0.0115	0.8552	1.2729	0.0036	0.8083	0	0.002	0.7886	0.0089																			10.7049		NO	2.190656016	16.458	0.170982784	7.77892702	0	1.352592368	2.490952904	0.849321335	3.017317405	11.06618824	13.41328842	11.61639551	0.001028782	1.324765034	0.115146829	8.551615216	12.7286653	0.035808019	8.083406652	0	0.020056383	7.88592768	0.088995396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0494
H5529_807_0	2012	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	249.6503719	2.593619797	53.56083343	13.38886519	6.993074812	12.87854376	4.391099473	15.59991527	57.21360258	69.34840946	60.05824427	0.005318934	6.849203948	0.59532377	44.21293982	65.80882072	0.185132019	41.7922419	0	0.103694054	40.77125047	0.46011753																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071473614	0.071473614	0.157460651	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	0.059331944	0.059331944	0.130711826	0	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695	0.17407695																				14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445		NO	19.71590414	14.8122	0.153884505	7.001034318	0	1.217333131	2.241857613	0.764389202	2.715585665	9.959569412	12.07195958	10.45475596	0.000925904	1.19228853	0.103632146	7.696453695	11.45579877	0.032227217	7.275065987	0	0.018050745	7.097334912	0.080095856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3445	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	1.6458	0.0171	0.7779	0	0.1353	0.2491	0.0849	0.3017	1.1066	1.3413	1.1616	0.0001	0.1325	0.0115	0.8552	1.2729	0.0036	0.8083	0	0.002	0.7886	0.0089																			10.7049		NO	2.190656016	16.458	0.170982784	7.77892702	0	1.352592368	2.490952904	0.849321335	3.017317405	11.06618824	13.41328842	11.61639551	0.001028782	1.324765034	0.115146829	8.551615216	12.7286653	0.035808019	8.083406652	0	0.020056383	7.88592768	0.088995396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0494
H5530_001_0	2012	9	H.6										OP Facility - Other										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	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	YES	1403.389874	155.6033569	308.7355776	695.7865168	159.5829002	10.03138501	6.018078368	357.0294669	429.6099949	8407.879181	788.3327839	19.19375504	0	537.6036876	3117.814514	3691.503442	1.228549119	1298.479755	845.617078	1858.666281	26.36093943	8.394517029	0	0	0	0	129.6	0	5872.8	207.3327366	9.0552953	0	0	0	0	0	0	0	0	0	4500	1A: $205/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $30 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$125 copay	8B: $85-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $30-$200 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $85-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $30 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	157.9528387	149.5945946	146	0	100	0.2	0.112655661	60	186.4929542	19.15486737	102.3268048	40	0.2	38.40266223	15	29.4596405	40	50	93.33152271	0.504156992	0.2	0	0	0	0	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	144.286173	136.6511152	133.3675382	0	91.34762893	0.182695258	0.102908275	54.80857736	170.3568918	17.49751717	93.47310998	36.53905157	0	35.07992139	13.70214434	26.91068309	36.53905157	45.67381446	85.25613303	0.460535458	0.182695258	0	0	0	0	0	30	0	0	0	0.182695258	0	0	0	0	0	0	0	0	0		16.8741	1.771947687	3.431275329	0	1.214793296	1.832686472	0.619310064	1.630689763	6.098918616	12.25975086	6.140659751	0.058443467	0	1.571591258	3.560062041	8.278406605	0.003740835	4.942210286	6.007836842	0.071331811	4.816018626	0	0	0	0	0	0.324	0	0	0	1.65435951	0	0	0	0	0	0	0	0	0	83.1622		NO	7.846363116	16.8741	1.771947687	3.431275329	0	1.214793296	1.832686472	0.619310064	1.630689763	6.098918616	12.25975086	6.140659751	0.058443467	0	1.571591258	3.560062041	8.278406605	0.003740835	4.942210286	6.007836842	0.071331811	4.816018626	0	0	0	0	0	0.324	0	0	0	1.65435951	0	0	0	0	0	0	0	0	0	83.1622	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: $60 copay; 4B: $30 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $40-$275 copay; 9C: $50 copay	7A: $20 copay; 7G: $20 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $80 copay; 7I: $80 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $40 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4500	1.2462	0	0.3357	0	0.7303	0.257	0.4085	0.1046	0.3907	0.6981	0.1432	0	0	0.1083	0.459	1.3575	0	0.5869	0.9976	0.0083	0.3854	0	0	0	0	0	0.108	0	0	0	0.216	0	0	0	0	0	0	0	0	0	8.5414		NO	0.798801451	18.1204	1.771947687	3.766984878	0	1.945075626	2.089721959	1.027807528	1.735296972	6.489595453	12.95783261	6.283873818	0.058443467	0	1.679890061	4.019093666	9.635955615	0.003740835	5.529116715	7.005430619	0.079623995	5.201410604	0	0	0	0	0	0.432	0	0	0	1.870336801	0	0	0	0	0	0	0	0	0	91.7035
H5530_004_0	2012	9	H.6										OP Facility - Other										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	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	YES	1325.110145	163.3526794	215.5527182	976.2422297	114.6071117	12.41390247	5.607011116	338.2446907	551.7115238	9124.448816	904.4607553	8.841278435	0	659.3872518	3510.9006	3809.212069	1.208202327	1641.72121	965.9318354	2016.133208	30.62108946	21.9271175	0	702.9904829	234.4	234.4	259.2	0	5872.8	304.0590033	9.332261032	0	0	0	0	0	0	0	0	0	3400	1A: $175/day (days1-7) $1225 yrly max	1B: $175/day (days1-7) $1225 yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $60 copay; 4B: $15 copay	9A: $0 - $150 copay; 9B: $0-$150 copay	8A: $0-$125 copay	8B: $75-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $15-$150 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $10 copay; 7D: $15 copay; 7F: $15 copay	7E: $40 copay; 7H: $40 copay	7C: $30 copay; 7I: $30 copay	8B: $75-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $15	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $15 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	112.4446808	85.93100159	146	0	100	0.2	0.117986196	60	140.7138961	17.10283156	96.3914406	40	0.2	29.11030727	10	14.66821908	40	30	84.78770923	0.31395198	0.2	0	0	0	0	0	15	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	101.2164741	77.3503285	131.4211141	0	90.01446168	0.180028923	0.10620464	54.00867701	126.662856	15.39502176	86.76623636	36.00578467	0	26.20348638	9.001446168	13.20351844	36.00578467	27.0043385	76.32120003	0.282602184	0.180028923	0	0	0	0	0	15	0	0	0	0.180028923	0	0	0	0	0	0	0	0	0		11.1769	1.052948618	2.36068153	0	0.859691455	2.234861497	0.595490595	1.522345687	5.823446443	11.705924	6.539721306	0.026528097	0	1.439853739	2.633598563	4.19125015	0.003625189	3.694466273	6.143423069	0.047480304	5.512681768	0	0	0	0	0	0.324	0	0	0	1.680076906	0	0	0	0	0	0	0	0	0	69.569		NO	7.681529024	11.1769	1.052948618	2.36068153	0	0.859691455	2.234861497	0.595490595	1.522345687	5.823446443	11.705924	6.539721306	0.026528097	0	1.439853739	2.633598563	4.19125015	0.003625189	3.694466273	6.143423069	0.047480304	5.512681768	0	0	0	0	0	0.324	0	0	0	1.680076906	0	0	0	0	0	0	0	0	0	69.569	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: $60 copay; 4B: $15 copay	9A: $225 copay; 9B: $225 copay	8A: 0% - 25% coin	8B: 25% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $25-$225 copay; 9C: $50 copay	7A: $15 copay; 7G: $15 copay	7B: $25 copay; 7D: $25 copay; 7F: $25 copay	7E: $50 copay; 7H: $50 copay	7C: $50 copay; 7I: $50 copay	8B: 25% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $25 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	1.1106	0.0688	0.2533	0	0.6278	0.3986	0.4556	0.0971	0.2443	0.7041	0.0969	0	0	0.0348	0.3887	1.1199	0	0.589	0.8431	0.0074	0.6811	0	0	0.2259	0	0	0.135	0	0	0	0.2605	0	0	0	0	0	0	0	0	0	8.3425		NO	0.885414416	12.2876	1.121723706	2.614029837	0	1.487497057	2.633497057	1.051058498	1.619471824	6.06774076	12.41003449	6.636588924	0.026528097	0	1.474661417	3.022273764	5.311114086	0.003625189	4.283494194	6.986480571	0.054854655	6.193756322	0	0	0.225910931	0	0	0.459	0	0	0	1.940575581	0	0	0	0	0	0	0	0	0	77.9115
H5530_804_0	2012	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	280.5839347	2.91498884	60.19742441	14.63181547	7.642274288	14.07411854	4.798745544	17.04812755	62.5250059	75.78634302	65.63372883	0.005812715	7.485047225	0.650590428	48.31743149	71.91815789	0.20231868	45.67200899	0	0.113320452	44.5562342	0.502832368																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074005813	0.074005813	0.177709942	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	0.059313097	0.059313097	0.142428367	0	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291																				16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865		NO	25.7288775	16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865	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	1.8491	0.0192	0.9526	0	0.1427	0.2628	0.0896	0.3184	1.1676	1.4152	1.2257	0.0001	0.1398	0.0121	0.9023	1.343	0.0038	0.8529	0	0.0021	0.832	0.0094																			11.5406		NO	2.858764167	18.4914	0.192107796	9.526467592	0	1.427129259	2.628221077	0.896124624	3.183591784	11.67600926	14.15245036	12.25653663	0.001085475	1.397768452	0.121492189	9.022866438	13.43009993	0.03778128	8.528856448	0	0.021161624	8.320495063	0.093899637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4056
H5530_805_0	2012	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	280.5839347	2.91498884	60.19742441	14.63181547	7.642274288	14.07411854	4.798745544	17.04812755	62.5250059	75.78634302	65.63372883	0.005812715	7.485047225	0.650590428	48.31743149	71.91815789	0.20231868	45.67200899	0	0.113320452	44.5562342	0.502832368																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074005813	0.074005813	0.177709942	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	0.059313097	0.059313097	0.142428367	0	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291																				16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865		NO	25.7288775	16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865	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	1.8491	0.0192	0.9526	0	0.1427	0.2628	0.0896	0.3184	1.1676	1.4152	1.2257	0.0001	0.1398	0.0121	0.9023	1.343	0.0038	0.8529	0	0.0021	0.832	0.0094																			11.5406		NO	2.858764167	18.4914	0.192107796	9.526467592	0	1.427129259	2.628221077	0.896124624	3.183591784	11.67600926	14.15245036	12.25653663	0.001085475	1.397768452	0.121492189	9.022866438	13.43009993	0.03778128	8.528856448	0	0.021161624	8.320495063	0.093899637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4056
H5530_806_0	2012	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	280.5839347	2.91498884	60.19742441	14.63181547	7.642274288	14.07411854	4.798745544	17.04812755	62.5250059	75.78634302	65.63372883	0.005812715	7.485047225	0.650590428	48.31743149	71.91815789	0.20231868	45.67200899	0	0.113320452	44.5562342	0.502832368																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074005813	0.074005813	0.177709942	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	0.059313097	0.059313097	0.142428367	0	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291																				16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865		NO	25.7288775	16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865	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	1.8491	0.0192	0.9526	0	0.1427	0.2628	0.0896	0.3184	1.1676	1.4152	1.2257	0.0001	0.1398	0.0121	0.9023	1.343	0.0038	0.8529	0	0.0021	0.832	0.0094																			11.5406		NO	2.858764167	18.4914	0.192107796	9.526467592	0	1.427129259	2.628221077	0.896124624	3.183591784	11.67600926	14.15245036	12.25653663	0.001085475	1.397768452	0.121492189	9.022866438	13.43009993	0.03778128	8.528856448	0	0.021161624	8.320495063	0.093899637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4056
H5530_807_0	2012	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	280.5839347	2.91498884	60.19742441	14.63181547	7.642274288	14.07411854	4.798745544	17.04812755	62.5250059	75.78634302	65.63372883	0.005812715	7.485047225	0.650590428	48.31743149	71.91815789	0.20231868	45.67200899	0	0.113320452	44.5562342	0.502832368																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074005813	0.074005813	0.177709942	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	0.059313097	0.059313097	0.142428367	0	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291	0.168067291																				16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865		NO	25.7288775	16.6423	0.172897016	8.573820833	0	1.284416333	2.365398969	0.806512161	2.865232606	10.50840833	12.73720533	11.03088297	0.000976927	1.257991606	0.10934297	8.120579794	12.08708993	0.034003152	7.675970803	0	0.019045461	7.488445557	0.084509674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.865	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	1.8491	0.0192	0.9526	0	0.1427	0.2628	0.0896	0.3184	1.1676	1.4152	1.2257	0.0001	0.1398	0.0121	0.9023	1.343	0.0038	0.8529	0	0.0021	0.832	0.0094																			11.5406		NO	2.858764167	18.4914	0.192107796	9.526467592	0	1.427129259	2.628221077	0.896124624	3.183591784	11.67600926	14.15245036	12.25653663	0.001085475	1.397768452	0.121492189	9.022866438	13.43009993	0.03778128	8.528856448	0	0.021161624	8.320495063	0.093899637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4056
H5532_001_0	2012	5																															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	1601.004034	84.80091606	1500.787602	2926.403348	224.0533794	11.70026597	12.68237593	395.8247846	69.29011685	22.46327087	51.75694943	0	0.126199569	26.33945593	6001.577635	5785.9536	464.4319627	1078.396229	0	0	31.17117934	1346.602826	0	0	43.39661082	0	11.2754649	61.75	120.8490829	0											5900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$130 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	77.89230624	0	200	0.2	0.140607535	63.54925949	0.16	0.209323623	0.180272151	0	0.2	0.146052065	10.3029562	39.54432566	38.5	40	0	0	0.2	39.3408025	0	0	40	0	15	352.5	0	0											NO	161.4795987	84.57647187	60.42534628	0	155.1510006	0.155151001	0.109076999	49.31849876	0.124120801	0.162383848	0.139847023	0	0.155151001	0.11330062	9.908772886	38.03407634	37.0270191	38.46963024	0	0	0.155151001	30.51882437	0	0	40	0	15	352.5	0	0												21.5441	0.597680191	7.557134214	0	2.896842167	1.815307973	1.383355504	1.626790346	8.60034477	3.647672353	7.238055295	0	0.019579989	2.984276696	4.955689145	18.33861675	1.433044263	3.457125348	0	0	4.836239666	3.424727927	0	0	0.144655369	0	0.014094331	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	98.3293	0	NO	20.82532092	21.5441	0.597680191	7.557134214	0	2.896842167	1.815307973	1.383355504	1.626790346	8.60034477	3.647672353	7.238055295	0	0.019579989	2.984276696	4.955689145	18.33861675	1.433044263	3.457125348	0	0	4.836239666	3.424727927	0	0	0.144655369	0	0.014094331	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	98.3293	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)"	50% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$40/$50 (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2109	0.01	0	0.4649	0.1365	0.2138	0.1391	0.0767	0.6079	0.1719	0.5015	0	0.0009	0.2107	0.792	1.3448	0.0942	0.2515	0	0	0.7037	0.248	0	0	0.0105	0	0.0027	0.0955	0	0											6.2876	0	NO	1.16633976	21.755	0.607638275	7.557134214	0.464913862	3.033342584	2.029153153	1.522432597	1.703445388	9.208222542	3.819552202	7.739522851	0	0.020502607	3.194939787	5.747695113	19.68345911	1.527280734	3.70863579	0	0	5.539925332	3.672762506	0	0	0.155179239	0	0.016815123	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	104.6169
H5533_003_0	2012	5																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	6.172118555	0.113040836	0	0	3.285103795	3.427145943	0	0	8.887327049		24.9851107	1.979241327	0.00746456	0	2.191592254	8.580079975	0.042923691	1.39854992			1.50984806	2.495834542	0	0	0	0	0.006095514	0	0.198691663	0.046705268											65.3269	YES	282.1336211	5.349154703	1307.594009	0	289.1286696	14.00158831	0	1369.795078	1512.782097		9781.546585	2208.857998	0	107.051673	39377.11413	6816.583047	46.22116697	803.1658685			757.447196	434.9224437	0	0	0	0	0	0	0	0											3400	1a $0/admit	1b $0/admit	2 $30/days 1 - 10; $70/days 11-54; $0/day 55-100	6 $0/visit	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $65/visit, 4b $35/visit"	"9a $0/visit, 9b $0/visit"	8a $0/lab	8b $0/all x-rays/diag	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $35/visit, 9d $0/visit"	"7a $20/PCP; $35/IN Urgt, 14a $0/visit, 14d $0/visit, 14e $0/visit"	"7b $20/visit, 7d $35/visit, 7f $35/visit, 7g $35/visit, 16b $35/visit, 17a $0-$35/visit, 18a $35/visit"	"7e $35/visit, 7h $35/visit"	"7c $0/visit, 7i $0/visit"	0	0	"15 15% coinss - $2,500 max/drug"	"15 15% coinss - $2,500 max/drug"	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	14c $0/visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											1250	NO	0	0	46.94159598		0	0	0	28.31712476	0		0	0		33.25	1.525757343	18.66837936	0	0			0	0	0	0																	NO	0	0	46.05979237		0	0	0	27.78518412	0		0	0		32.62539469	1.497095805	18.31769158	0	0			0	0	0	0																		0	0	5.018959048	0	0	0	0	3.171667369	0	0	0	0	0	0.291050257	4.912609364	10.40533882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7996	1250	NO	0.455638076	6.1721	0.113040836	5.018959048	0	3.285103795	3.427145943	0	3.171667369	8.887327049	0	24.9851107	1.979241327	0.00746456	0.291050257	7.104201618	18.9854188	0.042923691	1.39854992	0	0	1.50984806	2.495834542	0	0	0	0	0.006095514	0	0.198691663	0.046705268	0	0	0	0	0	0	0	0	0	0	89.1265	YES	1a 30% coins/admit	1b 30% coins/admit	2 30% coins/admit	6 30% coins/visit	10a 30% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 30% coins/item"	refer to In Network	"9a 30% coins/visit, 9b 30% coins/visit"	8a 30% coins/lab	8b 30% coins/all x-rays/diag	5 30% coins/visit	12 30% coins/visit	"3 30% coins/visit, 9c $50/visit, 9d 30% coins/visit"	"7a $30/visit, 14a 30% coins/visit, 14d 30% coins/visit, 14e 30% coins/visit"	"7b $30/visit, 7d $50/visit, 7f $50/visit, 7g $50/visit, 16b $50/visit, 17a $0-$50/visit, 18a $50/visit"	"7e $50/visit, 7h $50/visit"	"7c 30% coins/visit, 7i 30% coins/visit"			15 50% coins/drug	15 50% coins/drug	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	14c 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	3.7542	0.059	0.0284	0	0.2914	0.4463	0	0.1566	1.0116	0	1.9607	0.243	0.0005	0.0298	0.9866	1.7964	0.0082	0.1489	0	0	0.4856	0.2392	0	0	0	0	0.0005	0	0.013												11.66		NO	0.17	9.9264	0.172035374	5.04739728	0	3.576465651	3.873427841	0	3.328311956	9.898911146	0	26.94581089	2.222245365	0.007990325	0.320885041	8.090849301	20.78183733	0.051074505	1.547452622	0	0	1.995462776	2.735029796	0	0	0	0	0.006557085	0	0.211705361	0.046705268	0	0	0	0	0	0	0	0	0	0	100.7865
H5533_004_0	2012	8																															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	289.7836616	10.30066121	1333.097922		300.3945837	19.76207159	0	1448.390865	1639.046175		10555.60257	341.2249155		2349.977955	38966.52657	7033.20518	72.91335981	965.4608323			806.3711361	846.4587735	0	0																	3400	1a $250/admit-$750 combined max (1a/1b)	1b $250/admit-$750 combined max (1a/1b)	"2 $30/days 1-10; $70/days 11-54; $0/days 55-100 - $3,400 max"	6 $0/visit	10a $100/trip	11a 20% coinss/item	"11b 20% coinss/item, 11c $10-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $30 visit"	"9a $150/visit, 9b $150/visit -$300 combined max (9a/9b)"	8a $0/lab	8b $30/x-ray; $90/diag x-ray; $25/therapeutic visit w/ $100 max on therapeutic	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $30/visit, 9d $0/visit"	"7a $10/PCP visit; 7a $30/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $30/visit, 7f $30/visit, 7g $30/visit, 16b $30/visit, 17a $0-$30/visit, 18a $30/visit"	"7e $30/visit, 7h $30/visit"	"7c $30/visit, 7i $30/visit"	0	0	"15 15% coins - $2,500 max/drug"	"15 15% coins - $2,500 max/drug"	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $30/visit	18b $500 combined max (IN/OON) - 3 yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	232.8130283	194.9904883	26.52191512		100	0.149049746	0	14.75112947	60.53083734		7.178328754	41.15370977		14.84258602	0.934035139	17.40026468	7.04313028	20.52240486			56.73718933	29.00972196	0	0																	NO	224.923395	188.3825959	25.62313301		96.61117193	0.143998706	0	14.25123905	58.47955133		6.935067534	39.7590813		14.33959629	0.902382294	16.81059963	6.804450704	19.82693585			54.81446353	28.02663236	0	0																		5.4316	0.161705441	2.846512114	0	2.418456064	2.845712737	0	1.720113704	7.987557078	0	6.100318057	1.130565763	0	2.808144598	2.930225302	9.852699699	0.041344614	1.595177499	0	0	3.683400102	1.976949071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5305	0	NO	1.877687382	5.4316	0.161705441	2.846512114	0	2.418456064	2.845712737	0	1.720113704	7.987557078	0	6.100318057	1.130565763	0	2.808144598	2.930225302	9.852699699	0.041344614	1.595177499	0	0	3.683400102	1.976949071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5305	YES	1a 30% coins/admit	1b 30% coins/admit	2 30% coins/stay	6 30% coins/visit	10a 30% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	Refer to In Network column	"9a 30% coins/visit, 9b 30% coins/visit"	8a 30% coins/lab	8b 30% coins/x-ray; 30% coins/diag x-ray; 30% coins/therapeutic visit	5 30% coins/visit	12 30% coins/visit	"3 30% coins/visit, 9c $50/visit, 9d 30% coins/visit"	"7a $30/PCP visit; 14a 30% coins/visit, 14d 30% coins/visit, 14e 30% coins/visit"	"7b $30/visit, 7d $50/visit, 7f $50/visit, 7g $50/visit, 16b $50/visit, 17a $0-$50/visit, 18a $50/visit"	"7e $50/visit, 7h $50/visit"	"7c $50/visit, 7i $50/visit"			15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON) -2yr (17a/17b)	18a $50/visit	18b $500 combined max (IN/OON) - 3 yr	14c 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	7.3383	0.1831	0.9785	0.6066	0.4484	0.9021	0	0.201	2.2913	0	3.4174	0.0831	0.0102	0.5254	1.4362	3.0313	0.0198	0.2458			1.2289	0	0	0	0	0	0.0045	0.0005	0.0221	0.006											22.9805	500	NO	0.5	12.7699	0.344842695	3.825050094	0.606564283	2.866898568	3.747785093	0	1.921161536	10.27882119	0	9.517743229	1.213699359	0.010152337	3.333561067	4.36641893	12.88396749	0.061159731	1.840953504	0	0	4.912306809	1.976949071	0	0	0	0	0.004459329	0.000488977	0.022122474	0.005983951	0	0	0	0	0	0	0	0	0	0	76.511
H5533_801_0	2012	2																															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	0	0	0	0											0	YES	313.5730272	3.578115455	1698.520564	0	346.318205	20.05874658	0	1395.898739	1700.905974	0	11760.0728	250.7933651	0	2254.321165	41255.75333	9220.378117	64.80776951	1593.074626	0	0	979.6301893	917.1655101	0	0	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	27.2985368	47.84688995	0	0	15.57196058	0.141425909	0	7.216886629	3.082045005	0	0.802381669	20.66709901	0	1.289342985	0.40335785	14.04683854	0	18.21263115	0	0	20.68076473	54.30209455	0	0	0	0	0	0	0	0											NO	25.92623464	45.44161854	0	0	14.78915544	0.134316404	0	6.854092493	2.927110071	0	0.762045804	19.62816037	0	1.224527491	0.383080981	13.34070154	0	17.29707904	0	0	19.64113912	51.57231889	0	0	0	0	0	0	0	0												0.6775	0.013549613	0	0	0.426812814	2.694218708	0	0.797301589	0.414894917	0	0.746809511	0.410217699	0	0.230039853	1.317024538	10.25052604	0	2.29629481	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8203	0	NO	1.650577721	0.6775	0.013549613	0	0	0.426812814	2.694218708	0	0.797301589	0.414894917	0	0.746809511	0.410217699	0	0.230039853	1.317024538	10.25052604	0	2.29629481	0	0	1.60342107	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8203	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	6.369	0.0542	0.88	0	0.3757	0.8792	0	0.1414	2.1282	0	3.2085	0	0	0.4671	2.3444	3.6416	0.0157	0.3293	0	0	0.8787	0	0	0	0	0	0	0	0	0											21.7129	500	NO	0.18	7.0465	0.067764481	0.879958474	0	0.80252811	3.573403608	0	0.93874141	2.54310001	0	3.955294153	0.41022948	0	0.697140632	3.661387865	13.89209521	0.015709018	2.625551328	0	0	2.482112774	3.941696014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5332
H5533_802_0	2012	2																															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	0	0	0	0											0	YES	328.6841853	2.468899664	1702.189979	0	354.581852	23.56864367	0	1485.122184	1804.592479	0	11721.86569	329.9633876	0	2455.683723	41393.20276	9406.678443	53.34722928	1934.177768	0	0	957.0192207	882.4400772	0	14.66550415	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	59.18157863	33.01435407	40.75828738	0	41.7446528	0.141882935	0	8.364145445	5.345003462	0	1.089472106	22.01029831	0	2.096735467	0.652699513	14.32946343	0	19.08899272	0	0	14.33099825	41.0068861	0	0	0	0	0	0	0	0											NO	56.20651046	31.35471679	38.70936124	0	39.6461419	0.134750456	0	7.94367841	5.076309216	0	1.034704155	20.90383682	0	1.991332213	0.619888196	13.60911883	0	18.12938576	0	0	13.6105765	38.94546286	0	0	0	0	0	0	0	0												1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	0	NO	1.650577721	1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	4.3946	0.0374	0.6072	0	0.2598	0.6634	0	0.1886	1.4685	0	2.2143	0.0007	0	0.3236	1.6183	2.5144	0.0108	0.2308	0	0	0.6068	0	0	0	0	0	0	0	0	0											15.1393	500	NO	0.18	5.9342	0.04385923	6.098061912	0	1.43133273	3.839252645	0	1.171723649	2.231850633	0	3.2250043	0.575488091	0	0.731072718	3.756584565	13.18243875	0.010839222	3.152963565	0	0	1.692282716	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9408
H5533_803_0	2012	2																															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	0	0	0	0											0	YES	328.6841853	2.468899664	1702.189979	0	354.581852	23.56864367	0	1485.122184	1804.592479	0	11721.86569	329.9633876	0	2455.683723	41393.20276	9406.678443	53.34722928	1934.177768	0	0	957.0192207	882.4400772	0	14.66550415	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	59.18157863	33.01435407	40.75828738	0	41.7446528	0.141882935	0	8.364145445	5.345003462	0	1.089472106	22.01029831	0	2.096735467	0.652699513	14.32946343	0	19.08899272	0	0	14.33099825	41.0068861	0	0	0	0	0	0	0	0											NO	56.20651046	31.35471679	38.70936124	0	39.6461419	0.134750456	0	7.94367841	5.076309216	0	1.034704155	20.90383682	0	1.991332213	0.619888196	13.60911883	0	18.12938576	0	0	13.6105765	38.94546286	0	0	0	0	0	0	0	0												1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	0	NO	1.650577721	1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	4.3946	0.0374	0.6072	0	0.2598	0.6634	0	0.1886	1.4685	0	2.2143	0.0007	0	0.3236	1.6183	2.5144	0.0108	0.2308	0	0	0.6068	0	0	0	0	0	0	0	0	0											15.1393	500	NO	0.18	5.9342	0.04385923	6.098061912	0	1.43133273	3.839252645	0	1.171723649	2.231850633	0	3.2250043	0.575488091	0	0.731072718	3.756584565	13.18243875	0.010839222	3.152963565	0	0	1.692282716	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9408
H5549_002_0	2012	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	641.1704528	14.70512843	50.07204297		45.8604013	11.48904589	10.42338396	7.07518288	23.47863392	5.739449323	10.58323317	0.663419822	0.18838534	20.52490115	125.6631187	92.58336959	3.947228914	7.64381754	34.65229665	92.68693928	14.35195014	15.60278241																			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																					0.056986274	0.056986274	0.148606453		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.043736179	0.043736179	0.114053404		0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912	0.171916912																				28.0423	0.643146135	5.710886959	0	7.884178585	1.975161294	1.791955985	1.216343594	4.036374247	0.986708406	1.819436768	0.114053087	0.032386626	3.52857763	21.60361536	15.91664703	0.678595407	1.314101509	5.957315841	15.93445241	2.467342953	2.682382175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.336	0		37.66821501	28.0423	0.643146135	5.710886959	0	7.884178585	1.975161294	1.791955985	1.216343594	4.036374247	0.986708406	1.819436768	0.114053087	0.032386626	3.52857763	21.60361536	15.91664703	0.678595407	1.314101509	5.957315841	15.93445241	2.467342953	2.682382175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.336	NO																																																																																		0	0		0	28.0423	0.643146135	5.710886959	0	7.884178585	1.975161294	1.791955985	1.216343594	4.036374247	0.986708406	1.819436768	0.114053087	0.032386626	3.52857763	21.60361536	15.91664703	0.678595407	1.314101509	5.957315841	15.93445241	2.467342953	2.682382175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.336
H5549_003_0	2012	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	P	P	Coin	P	P	Coin	Coin	Coin	Coin																																																											0	YES								667.2986472				0.918373453		680.1292074		40.45984314	574.1500815	3675.246074																							6700								"$50 - ER, $10 UC"						"$10 - OP PT, OT, ST"	$10 - Specialist Office Visit		$20 - MH/SA	"$10 - PT, OT, ST, CORF"																																49.39273196				0.091961842		10		0.098169408	10	10																							NO								49.34471609				0.091872444		9.990278757		0.098073975	9.990278757	9.990278757																								0	0	0	0	0	0	0	2.743971858	0	0	0	0.084373214	0	0.566223364	0	3.968057649	0.47799328	3.059727732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9003	0		0.010606803	0	0	0	0	0	0	0	2.743971858	0	0	0	0.084373214	0	0.566223364	0	3.968057649	0.47799328	3.059727732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9003	NO																																																																																		0	0		0	0	0	0	0	0	0	0	2.743971858	0	0	0	0.084373214	0	0.566223364	0	3.968057649	0.47799328	3.059727732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9003
H5549_004_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	Coin	Coin																																																											0	YES	2320.996269	180.416797	612.8126943		2319.697637	3.21064087	4.614705536	364.5471402	131.9418071		8.163286135	1.088534559	0.348105015	1235.269677		2221.95631	173.1740424	1456.363081	27.14213082		3.011804671	0.189233218																			3400	$225 per day 1-6	$225 per day 1-6	"$0 Days 1-20, $125 Days 21-100"		50	0.2	0.2	"ER - $60, UC $25"	200		0.2	0.2	0.2	0.2		20	20	20	0.2	20	0.2	0.2																					178.94	178.94	38.875		50	0.2	0.2	59.72964209	200		0.2	0.2	0.2	20.06765435		20	20	20	0.2		0.2	0.2																			NO	143.3893888	143.3893888	31.1515731		40.06633197	0.160265328	0.160265328	47.86295337	160.2653279		0.160265328	0.160265328	0.160265328	16.08074602		16.02653279	16.02653279	16.02653279	0.160265328		0.160265328	0.160265328																				27.7339	2.155821188	1.590839954	0	7.745147964	0.514554412	0.739577296	1.454025231	1.762141415	0	1.308291729	0.174454348	0.055789164	1.655338162	0	2.967521304	0.231281622	1.945037556	4.349942494	0	0.482687863	0.030327524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8966	0		14.10641378	27.7339	2.155821188	1.590839954	0	7.745147964	0.514554412	0.739577296	1.454025231	1.762141415	0	1.308291729	0.174454348	0.055789164	1.655338162	0	2.967521304	0.231281622	1.945037556	4.349942494	0	0.482687863	0.030327524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8966	NO																																																																																		0	0		0	27.7339	2.155821188	1.590839954	0	7.745147964	0.514554412	0.739577296	1.454025231	1.762141415	0	1.308291729	0.174454348	0.055789164	1.655338162	0	2.967521304	0.231281622	1.945037556	4.349942494	0	0.482687863	0.030327524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8966
H5549_006_0	2012	9																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	P	P	Coin	P	P	Coin	Coin	Coin	Coin																																																											0	YES								441.8005698				0.785909297		411.0220724		20.64415891	379.8020399	2422.68763																							6700								"$50 - ER, $10 UC"						"$10 - OP PT, OT, ST"	$10 - Specialist Office Visit		$20 - MH/SA	"$10 - PT, OT, ST, CORF"																																49.35799875				0.082549211		10		0.099126773	10	10																							NO								49.34567152				0.082528595		9.997502486		0.099102016	9.997502486	9.997502486																								0	0	0	0	0	0	0	1.816745483	0	0	0	0.06485999	0	0.342432849	0	2.045877765	0.316422653	2.018402134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6047	0		0.001649955	0	0	0	0	0	0	0	1.816745483	0	0	0	0.06485999	0	0.342432849	0	2.045877765	0.316422653	2.018402134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6047	NO																																																																																		0	0		0	0	0	0	0	0	0	0	1.816745483	0	0	0	0.06485999	0	0.342432849	0	2.045877765	0.316422653	2.018402134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6047
H5575_005_0	2012	7																															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	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	413.5214296	10.56806023	0	0	35.09286667	44.30823683	10.14587053	57.16832038	111.9763711	27.05979579	56.68690671	27.39732948	0.888562037	6.685915355	0	88.79470293	6.883753274	4132.60091	29.40404789	68.8167534	66.61119239	39.69823636	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 Copay for Visits 1-4; 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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	Not Covered; PBP 13b											0	NO	0.081485558	0.081485558	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	5	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069655649	0.069655649	0	0	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0.191480134	0	0.191480134	0.191480134	4.237839963	0.191480134	0.191480134	0.191480134	0.191480134	0	0	0	0	0	0	0	0												28.8041	0.736125099	0	0	6.719586813	8.484147126	1.942732649	10.94659765	21.44125054	5.181413325	10.8544165	5.24604432	0.170141978	1.280219968	0	17.00242162	1.318102	1.459441774	5.630291031	13.17704116	12.75472005	7.601423619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.7502	0	NO	27.05301422	28.8041	0.736125099	0	0	6.719586813	8.484147126	1.942732649	10.94659765	21.44125054	5.181413325	10.8544165	5.24604432	0.170141978	1.280219968	0	17.00242162	1.318102	1.459441774	5.630291031	13.17704116	12.75472005	7.601423619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.7502	NO																																										0	0	0	0	0	0	0	0	0	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	28.8041	0.736125099	0	0	6.719586813	8.484147126	1.942732649	10.94659765	21.44125054	5.181413325	10.8544165	5.24604432	0.170141978	1.280219968	0	17.00242162	1.318102	1.459441774	5.630291031	13.17704116	12.75472005	7.601423619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.7502
H5575_006_0	2012	7																															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	1762.720226	42.90116219	0	0	437.1957954	29.71536257	0	774.1642421	2164.818664	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"	"$65/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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	75	75	0	0	50	0.2	0	62.32627576	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	58.89887805	58.89887805	0	0	39.2659187	0.157063675	0	48.94596954	39.2659187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												8.6519	0.210569193	0	0	1.430574547	4.667204044	0	3.157684951	7.083632805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2015	0	NO	6.889311765	8.6519	0.210569193	0	0	1.430574547	4.667204044	0	3.157684951	7.083632805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2015	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.6519	0.210569193	0	0	1.430574547	4.667204044	0	3.157684951	7.083632805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2015
H5575_007_0	2012	10																															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	1774.436351	42.42336703	0	0	436.0773197	0	0	1993.694336	2169.51014	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"	"$65/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	NO	65	65	0	0	50	0	0	62.44796865	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	47.43359756	47.43359756	0	0	36.48738274	0	0	45.57125866	36.48738274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.014	0.167691077	0	0	1.325943339	0	0	7.571263357	6.59664557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6755	0	NO	8.397583016	7.014	0.167691077	0	0	1.325943339	0	0	7.571263357	6.59664557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6755	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.014	0.167691077	0	0	1.325943339	0	0	7.571263357	6.59664557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6755
H5575_011_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	433.7349143	4.720921277	368.2539543	0	18.24245415	32.69972363	3.522249389	122.6565536	175.8778061	22.6991375	70.65731955	42.127173	1.366286692	40.40969625	0	96.36586775	2.180905186	8.176841304	41.69086893	101.5057123	90.83957492	17.06472457	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	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"	"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 Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	0.082305696	0.082305696	0.181601525	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064323388	0.064323388	0.141924873	0	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0.175060047	0	0	0	0	0	0	0	0												27.8993	0.303665652	52.26439577	0	3.193524889	5.72441517	0.616605145	21.47226209	30.78917708	3.973712087	12.36927371	7.374784903	0.239182213	7.074123342	0	16.86981338	0.381789365	1.431438226	7.298405491	17.76959481	15.90238029	2.987351492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.9352	0	NO	65.95826631	27.8993	0.303665652	52.26439577	0	3.193524889	5.72441517	0.616605145	21.47226209	30.78917708	3.973712087	12.36927371	7.374784903	0.239182213	7.074123342	0	16.86981338	0.381789365	1.431438226	7.298405491	17.76959481	15.90238029	2.987351492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.9352	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	NO	0	27.8993	0.303665652	52.26439577	0	3.193524889	5.72441517	0.616605145	21.47226209	30.78917708	3.973712087	12.36927371	7.374784903	0.239182213	7.074123342	0	16.86981338	0.381789365	1.431438226	7.298405491	17.76959481	15.90238029	2.987351492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	235.9352
H5576_006_0	2012	10																															BP	BP	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	O	V	V	V	Coin	P	V	Coin	Coin	T	Coin	V	Coin	Coin	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	264.1488239	12.0251448	722.821094	19277.59042	187.6999779	18.36229997	5.805719823	350.4999907	951.5668042	2065.416526	29.60043215	1.095243343	0.145164994	477.6438532	21188.56973	5512.469502	118.5122139	2.243581941	3540.509109	11.08680827	27.59287766	0.132450498	0	5.092982082	165.3680734	0.318984998	0	0	10136.2715	0											3800	1a1: $200	1b1: $200	21: $50 days 1-20;$125 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: 20%"	"4a1: $65,4a2: $65,4b: $65"	"9a1: $200,9b: $200"	"8a1: $0,8a2: $0-$200"	"8b1: 0%,8b2: $100-$200,8b3: 5%,8b4: 5%,8b5: $0,8b6: 0%"	"9c1: 40%,9c2: 40%"	12: 20%	"31: 20%,32: 20%,33: 20%,37: 20%,5: 40%,9a2: $65,9a3: 0%"	"7a: $5,14a1-16: $0,14d: 20%,14e: $0"	"7b1: $20,7d1: $25,7f1: $25,16b1: 20%,17a1: $0-$25,18a1: 20%"	"7e1: $15,7e2: $15,7h1: $25,7h2: $25"	"7c: 20%,7i: 20%"	7d2: $0	"7g: $5-$25,7d3: 20%"	"152: 5%,153: 0%-20%"	"9d1: $0,9d2: $0"	n/a	"16a1: 20% limited to $100 every 6 months,16a2: 20% limited to $100 every 6 months,16a4: 20% limited to $50 every year"	17a2: $25	"17b2: 20% limited to Max cov combined for all supp($100),17b3: 20% limited to Max cov combined for all supp($100),17b4: 20%,17b5: 20%"	n/a	n/a	14c1: $0	n/a											0	NO	200	200	57.79771469	0	150	0.2	0.2	65	200	12.36170337	0.166720323	134.0878897	0.2	67.45633491	4.476057769	23.23860364	17.91141943	0.2	0	80.24720456	0.088680135	0	0	0.2	25	0.2	0	0	0	0											NO	179.021529	179.021529	51.7351763	0	134.2661468	0.179021529	0.179021529	58.18684051	179.021529	11.06505519	0.149232636	120.0230952	0.179021529	62.64027273	4.00655353	20.80105178	16.03264847	0.179021529	0	71.82988631	0.079378267	0	0	0.2	25	0.2	0	0	0	0												3.9407	0.179396651	3.116273061	0	2.100146065	3.287247017	1.03934884	1.699540588	14.19591202	1.904495655	4.417350503	0.010954541	0.025987659	2.493311769	7.074428238	9.555430296	0.158338722	0.40164947	0	0.066363681	2.190274799	0	0	1.018596416	0.344516819	0.063797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2841	0	NO	6.679297814	3.9407	0.179396651	3.116273061	0	2.100146065	3.287247017	1.03934884	1.699540588	14.19591202	1.904495655	4.417350503	0.010954541	0.025987659	2.493311769	7.074428238	9.555430296	0.158338722	0.40164947	0	0.066363681	2.190274799	0	0	1.018596416	0.344516819	0.063797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2841	NO	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	n/a	INN CS	n/a												1.4509	0.0585	0.4437	0.3692	0.0398	0	0	0.025	0.8497	0.0083	0.0091	0.0021	0.0255	0.0861	0.0987	1.3067	0.0366	0.0247	0	0	0.038	0	0	0	0.0043	0.1458	0	0	0	0											5.0226	0	NO	0	5.3916	0.237929984	3.560016571	0.36918015	2.13994053	3.287247017	1.03934884	1.724490783	15.04564296	1.912817535	4.426420096	0.013040437	0.051455117	2.579418173	7.173094932	10.86210158	0.194953132	0.426327371	0	0.066363681	2.228249201	0	0	1.018596416	0.348842165	0.20960275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3067
H5576_007_0	2012	8																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	Coin	T	Coin	V	Coin	Coin	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1379.585087	12.33096101	418.1123188	17070.35489	184.1249007	15.19318874	6.372401446	414.20409	52.41549211	17.19391305	26.62453842	0.054751359	0.048617318	25.6688923	18814.78725	4156.868516	99.32480408	1.394108997	17.38706888	15.31142738	13.63682689	0.126524846	0	3.565087458	167.6394006	0.118791082	0	0	7893.288288	0											5200	1a1: $100 days 1-5;$0 days 6-90	1b1: $100 days 1-5;$0 days 6-90	21: $50 days 1-20;$146 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: 20%"	"4a1: $65,4a2: $65,4b: $65"	"9a1: $300,9b: $300"	"8a1: 0%,8a2: 0%-20%"	"8b1: 20%,8b2: 20%,8b3: 20%,8b4: 20%,8b5: 20%,8b6: 20%"	"9c1: 40%,9c2: 40%"	12: 20%	"31: 20%,32: 20%,33: 20%,37: 20%,5: 40%,9a2: $65,9a3: 20%"	"7a: $5,14a1-16: $0,14d: 20%,14e: $0"	"7b1: $20,7d1: $35,7f1: $35,16b1: 20%,17a1: $0-$35,18a1: 20%"	"7e1: $15,7e2: $15,7h1: $35,7h2: $35"	"7c: 20%,7i: 20%"	7d2: $0	"7g: $5-$35,7d3: 20%"	"152: 20%,153: 0%-20%"	"9d1: 20%,9d2: 20%"	n/a	"16a1: 20% limited to $70 every 6 months,16a2: 20% limited to $70 every 6 months,16a4: 20% limited to $50 every year"	17a2: $35	"17b2: 20% limited to Max cov combined for all supp($100),17b3: 20% limited to Max cov combined for all supp($100),17b4: 20%,17b5: 20%"	n/a	n/a	14c1: $0	n/a											0	NO	64.84414681	43.0044636	59.98107481	0	150	0.2	0.2	65	0.351041101	0.026410539	0.2	0.4	0.2	0.188735463	4.545293663	32.5287252	19.70732523	0.2	0	381.1863993	0.111467282	0.2	0	0.2	35	0.2	0	0	0	0											NO	61.11402074	40.53065403	56.53069445	0	141.3713274	0.188495103	0.188495103	61.26335847	0.330847643	0.024891286	0.188495103	0.376990207	0.188495103	0.18169868	4.283827991	30.65752707	18.57367152	0.188495103	0	359.2588484	0.105055184	0.199728489	0	0.2	35	0.2	0	0	0	0												7.026	0.041648493	1.969681645	0	2.169165136	2.863841681	1.201166469	2.114627804	17.34154204	0.42797861	5.018595119	0.020640726	0.009164126	4.66400386	6.716609357	10.61994242	0.153735524	0.262782719	0	0.458397147	1.432619357	0.025270616	0	0.713017492	0.488948252	0.023758216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7631	0	NO	3.833433288	7.026	0.041648493	1.969681645	0	2.169165136	2.863841681	1.201166469	2.114627804	17.34154204	0.42797861	5.018595119	0.020640726	0.009164126	4.66400386	6.716609357	10.61994242	0.153735524	0.262782719	0	0.458397147	1.432619357	0.025270616	0	0.713017492	0.488948252	0.023758216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7631	NO	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	n/a	INN CS	n/a												1.9853	0.1723	0.5959	0.3073	0.0326	0	0	0.0659	2.0807	0.0325	0.1211	0.0037	0	0.4016	0.2109	1.2038	0.0064	0.0567	0.0856	0	0.1003	0	0	0	0.0094	0.0337	0	0	0	0											7.5058	0	NO	0	9.0113	0.213937583	2.565590115	0.30734758	2.201731973	2.863841681	1.201166469	2.180508069	19.42226942	0.460491648	5.139709803	0.024373473	0.009164126	5.06563528	6.927538182	11.82378676	0.160106523	0.319446974	0.085553201	0.458397147	1.532885247	0.025270616	0	0.713017492	0.498370804	0.057437082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.2689
H5576_008_0	2012	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	345.9909955	12.14774509	31.61586969	81.29536783	17.33191377	19.33588481	7.043620108	28.86963855	71.41498734	22.41399938	35.71502836	0.191508921	0.018212911	33.04569616	22618.69427	164.4002553	171.581497	3.114993457	27.87295826	69.67035288	29.22454226	0.161954768	0	4.18653665	2.151154575	0.437503264	0.086997692	0.423768046	0.512426526	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 except PCP @$0	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	n/a	"16a1: 20% limited to $100 every 6 months,16a2: 20% limited to $100 every 6 months,16a4: 20% limited to $50 every year,16b5: 20% limited to $275 every year"	17a2: 20%	"17b2: 20% limited to Max cov combined for all supp($100),17b3: 20% limited to Max cov combined for all supp($100),17b4: 20%,17b5: 20%"	18a2: 20%	18b1: 20% limited to $500 every year	14c1: $0	n/a											0	NO	0.082170883	0.082170883	0.223137227	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.620063648	0.224	32.61541265	0.224	0.224	72.1814098	0.224	0.224	0	0.185068694	0.2	0.013003832	0.2	0.2	0	0											NO	0.06840508	0.06840508	0.185755821	0	0.186474057	0.186474057	0.186474057	0.186474057	0.186474057	0.186474057	0.186474057	0.186474057	0.186474057	0.198968923	0.619938042	0.186474057	27.15146571	0.186474057	0.186474057	60.08910862	0.186477627	0.221826938	0	0.185068694	0.2	0.013003832	0.2	0.2	0	0												23.6675	0.830967479	5.872831844	0	3.231952277	3.605640888	1.313452418	5.383438626	13.31704242	4.1796294	6.659926236	0.035711445	0.003396235	6.575066568	1.168515754	30.65638259	0.388224094	0.580865468	5.197583608	0.348869117	5.449723279	0.03592593	0	0.774796872	0.430230915	0.005689219	0.017399538	0.084753609	0	0	0	0	0	0	0	0	0	0	0	0	119.8156	0	NO	23.10950817	23.6675	0.830967479	5.872831844	0	3.231952277	3.605640888	1.313452418	5.383438626	13.31704242	4.1796294	6.659926236	0.035711445	0.003396235	6.575066568	1.168515754	30.65638259	0.388224094	0.580865468	5.197583608	0.348869117	5.449723279	0.03592593	0	0.774796872	0.430230915	0.005689219	0.017399538	0.084753609	0	0	0	0	0	0	0	0	0	0	0	0	119.8156	NO																																										0	0	0	0	0	0	0	0	0	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	23.6675	0.830967479	5.872831844	0	3.231952277	3.605640888	1.313452418	5.383438626	13.31704242	4.1796294	6.659926236	0.035711445	0.003396235	6.575066568	1.168515754	30.65638259	0.388224094	0.580865468	5.197583608	0.348869117	5.449723279	0.03592593	0	0.774796872	0.430230915	0.005689219	0.017399538	0.084753609	0	0	0	0	0	0	0	0	0	0	0	0	119.8156
H5576_009_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	O	V	V	V	Coin	P	V	Coin	Coin	T	Coin	V	Coin	Coin	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1250.114838	18.8654272	357.0389071	15630.59257	187.7948996	13.15743392	5.41313369	353.130788	595.571283	1537.001921	29.56686092	3.542239024	0.010479882	399.6355535	17580.25822	3998.339462	90.68793437	1.669012632	2308.915554	11.50186451	19.20281645	0.115803321	0	5.092982082	142.8086233	0.121539678	0	0	12000.01367	0											3800	1a1: $100 days 1-3;$0 days 4-90	1b1: $100 days 1-3;$0 days 4-90	21: $50 days 1-20;$125 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: 20%"	"4a1: $65,4a2: $65,4b: $65"	"9a1: $250,9b: $250"	"8a1: $0,8a2: $0-$300"	"8b1: 0%,8b2: $150-$300,8b3: 20%,8b4: 20%,8b5: $0,8b6: 0%"	"9c1: 40%,9c2: 40%"	12: 20%	"31: 20%,32: 20%,33: 20%,37: 20%,5: 40%,9a2: $65,9a3: 0%"	"7a: $5,14a1-16: $0,14d: 20%,14e: $0"	"7b1: $20,7d1: $30,7f1: $30,16b1: 20%,17a1: $0-$30,18a1: 20%"	"7e1: $15,7e2: $15,7h1: $30,7h2: $30"	"7c: 20%,7i: 20%"	7d2: $0	"7g: $5-$30,7d3: 20%"	"152: 20%,153: 0%-20%"	"9d1: $0,9d2: $0"	n/a	"16a1: 20% limited to $100 every 6 months,16a2: 20% limited to $100 every 6 months,16a4: 20% limited to $50 every year"	17a2: $30	"17b2: 20% limited to Max cov combined for all supp($100),17b3: 20% limited to Max cov combined for all supp($100),17b4: 20%,17b5: 20%"	n/a	n/a	14c1: $0	n/a											0	NO	47.86400256	29.64445129	57.79771469	0	150	0.2	0.2	65	250	12.10376018	0.219699283	134.0878897	0.2	86.48227706	4.513915486	27.68413438	19.72930874	0.2	0	286.0208633	0.115789554	0	0	0.2	30	0.2	0	0	0	0											NO	44.25722689	27.41060372	53.44238752	0	138.6968009	0.184929068	0.184929068	60.1051132	231.1613348	11.19168544	0.203143918	123.9837423	0.184929068	83.30272473	4.173770916	25.59800582	18.24261337	0.184929068	0	264.4678582	0.107064271	0	0	0.2	30	0.2	0	0	0	0												4.6106	0.043092729	1.590084303	0	2.170545984	2.433191991	1.001045768	1.768747165	11.4727544	1.433470168	6.006327964	0.036598338	0.001938035	2.774227542	6.114664204	8.529126403	0.13786541	0.30864895	0	0.253489456	2.05593555	0	0	1.018596416	0.357021558	0.024307936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1422	0	NO	4.177973495	4.6106	0.043092729	1.590084303	0	2.170545984	2.433191991	1.001045768	1.768747165	11.4727544	1.433470168	6.006327964	0.036598338	0.001938035	2.774227542	6.114664204	8.529126403	0.13786541	0.30864895	0	0.253489456	2.05593555	0	0	1.018596416	0.357021558	0.024307936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1422	NO	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	n/a	INN CS	n/a												1.3794	0.4858	0.229	0.4195	0.0369	0	0	0.0144	1.2846	0.0049	0.0311	0.0067	0	0.0472	0.1003	1.3506	0.0226	0.0099	0.1147	0	0.1149	0	0	0	0.0155	0.0423	0	0	0	0											5.7104	0	NO	0	5.9899	0.528929792	1.819047095	0.419501651	2.207444307	2.433191991	1.001045768	1.783137512	12.75740426	1.438394843	6.037460641	0.043344547	0.001938035	2.821431443	6.214962372	9.87977322	0.16045157	0.318521282	0.114669818	0.253489456	2.17084826	0	0	1.018596416	0.37253079	0.066638073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8527
H5576_012_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	O	V	V	V	V	P	V	Coin	Coin	T	Coin	V	Coin	Coin	P	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1557.664847	6.806488296	489.2074837	12478.14448	161.9719388	15.95357647	5.389327062	359.3604822	732.8876063	1698.580361	504.3324507	0	0.106132636	480.6364373	19795.31074	4319.057148	111.311608	121.3171458	2874.924527	12.13615534	17.05168797	0	0	0	149.6661695	0.219790993	0	0	0	0											6700	1a1: $25 days 1-10;$0 days 11-90	1b1: $25 days 1-10;$0 days 11-90	21: $0 days 1-8;$50 days 9-20;$100 days 21-100	6: $0	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%,11c1: 20%,11c2: 20%,17b1: 20%"	"4a1: $65,4a2: $65,4b: $65"	"9a1: $100,9b: $100"	"8a1: $0,8a2: $0-$100"	"8b1: $0,8b2: $100,8b3: $15,8b4: $15,8b5: $0,8b6: $100"	"9c1: 40%,9c2: 40%"	12: 0%-20%	"31: $5,32: $5,33: $5,37: $10,5: 40%,9a2: $65,9a3: 0%"	"7a: $5,14a1-16: $0,14d: 20%,14e: $0"	"7b1: $20,7d1: $15,7f1: $20,16b1: 20%,17a1: $0-$15,18a1: 20%"	"7e1: $15,7e2: $15,7h1: $15,7h2: $15"	"7c: $10,7i: $10"	7d2: $0	"7g: $5-$15,7d3: 20%"	"152: 20%,153: 0%-20%"	"9d1: $0,9d2: $0"	n/a	"16a1: 20% limited to $100 every 6 months,16a2: 20% limited to $100 every 6 months,16a4: 20% limited to $50 every year"	17a2: $0	"17b2: 20% limited to Max cov combined for all supp($100),17b3: 20% limited to Max cov combined for all supp($100),17b4: 20%,17b5: 20%"	n/a	n/a	14c1: $0	n/a											0	NO	20.97805787	15.6687702	27.90216033	0	100	0.2	0.2	65	100	4.531554073	73.94662921	0	0.100737735	37.18367031	4.538879653	14.28029633	15	10	0	73.06509677	0.120715351	0	0	0	0	0.019707945	0	0	0	0											NO	20.96653882	15.66016648	27.88683926	0	99.94509002	0.19989018	0.19989018	64.96430851	99.94509002	4.529065797	73.90602513	0	0.10068242	37.1639433	4.536387355	14.27245502	14.9917635	9.994509002	0	73.02497674	0.120649067	0	0	0	0	0.019707945	0	0	0	0												2.7216	0.008882562	1.136870872	0	1.349025	3.188963274	1.077273557	1.945467103	6.104043149	0.641081851	3.106100565	0	0.010685691	1.488528776	7.483266446	5.136962408	0.139063108	0.101042109	0	0.073853538	2.057270237	0	0	0	0	0.004331629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7743	0	NO	0.020723193	2.7216	0.008882562	1.136870872	0	1.349025	3.188963274	1.077273557	1.945467103	6.104043149	0.641081851	3.106100565	0	0.010685691	1.488528776	7.483266446	5.136962408	0.139063108	0.101042109	0	0.073853538	2.057270237	0	0	0	0	0.004331629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7743	NO	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	INN CS + 20%	INN CS + 20%	n/a	n/a	INN CS + 20%	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	INN CS + 20%	INN CS + 20%	INN CS + 20%	n/a	n/a	INN CS	n/a												1.0267	0.1047	0.2822	0.2576	0	0	0	0.0409	0.369	0.0177	0.0253	0	0.0154	0.3368	0.1186	0.6939	0.0214	0.0381	0.0522	0	0.0071	0	0	0	0	0.0941	0	0	0	0											3.5018	0	NO	0	3.7483	0.113547917	1.419068316	0.257649701	1.349025	3.188963274	1.077273557	1.986392957	6.473054735	0.658771344	3.131415016	0	0.026107351	1.825374151	7.601882068	5.830900164	0.160452655	0.139101785	0.052197779	0.073853538	2.064354914	0	0	0	0	0.098386311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2761
H5576_801_0	2012	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	245.6524643	3.630651074	22.68158916	53.93024749	12.16975103	14.68072809	6.880830258	18.20521781	62.10728712	19.26878398	30.58718086	0.184467392	0.019536637	30.6790455	59.97875231	133.3790085	85.98978125	2.448356587	22.82138768	21.44182136	29.08267332	0.010060156	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a											0	NO	0.082741102	0.082741102	0.221852719	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	23.8523056	0.224	0.224	100.5321297	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072888584	0.072888584	0.195435284	0	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.206554693	0.199394352	0.197326874	21.0120576	0.197326874	0.197326874	100.5321297	0.19732923	0.197326874	0	0	0	0	0	0	0	0												17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	0	NO	14.47137432	17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a												0.9388	0.1351	0.2376	0	0.0408	0	0	0.0379	0.6384	0.0103	0.0303	0.0047	0	0.0496	0.1175	1.4554	0.008	0.0103	0.2144	0	0.1391	0	0	0	0	0	0	0	0	0											4.0683	0	NO	0	18.8441	0.399695825	4.670417971	0	2.442241536	2.896902182	1.357772726	3.630318619	12.89383297	3.81253118	6.066006819	0.04109553	0.003855103	6.386451533	12.07693465	27.77465478	0.158582146	0.493432815	4.717681369	0.179632664	5.87796326	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7261
H5576_802_0	2012	3																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	245.6524643	3.630651074	22.68158916	53.93024749	12.16975103	14.68072809	6.880830258	18.20521781	62.10728712	19.26878398	30.58718086	0.184467392	0.019536637	30.6790455	59.97875231	133.3790085	85.98978125	2.448356587	22.82138768	21.44182136	29.08267332	0.010060156	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a											0	NO	0.082741102	0.082741102	0.221852719	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	23.8523056	0.224	0.224	100.5321297	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072888584	0.072888584	0.195435284	0	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.206554693	0.199394352	0.197326874	21.0120576	0.197326874	0.197326874	100.5321297	0.19732923	0.197326874	0	0	0	0	0	0	0	0												17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	0	NO	14.47137432	17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a												0.9388	0.1351	0.2376	0	0.0408	0	0	0.0379	0.6384	0.0103	0.0303	0.0047	0	0.0496	0.1175	1.4554	0.008	0.0103	0.2144	0	0.1391	0	0	0	0	0	0	0	0	0											4.0683	0	NO	0	18.8441	0.399695825	4.670417971	0	2.442241536	2.896902182	1.357772726	3.630318619	12.89383297	3.81253118	6.066006819	0.04109553	0.003855103	6.386451533	12.07693465	27.77465478	0.158582146	0.493432815	4.717681369	0.179632664	5.87796326	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7261
H5576_803_0	2012	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	245.6524643	3.630651074	22.68158916	53.93024749	12.16975103	14.68072809	6.880830258	18.20521781	62.10728712	19.26878398	30.58718086	0.184467392	0.019536637	30.6790455	59.97875231	133.3790085	85.98978125	2.448356587	22.82138768	21.44182136	29.08267332	0.010060156	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a											0	NO	0.082741102	0.082741102	0.221852719	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	23.8523056	0.224	0.224	100.5321297	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072888584	0.072888584	0.195435284	0	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.197326874	0.206554693	0.199394352	0.197326874	21.0120576	0.197326874	0.197326874	100.5321297	0.19732923	0.197326874	0	0	0	0	0	0	0	0												17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	0	NO	14.47137432	17.9053	0.264633018	4.432782809	0	2.401418928	2.896902182	1.357772726	3.592378721	12.25543682	3.80224891	6.035672784	0.036400374	0.003855103	6.336900827	11.95942448	26.31926282	0.15056852	0.483126552	4.503273093	0.179632664	5.738861547	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6578	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	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a												0.9388	0.1351	0.2376	0	0.0408	0	0	0.0379	0.6384	0.0103	0.0303	0.0047	0	0.0496	0.1175	1.4554	0.008	0.0103	0.2144	0	0.1391	0	0	0	0	0	0	0	0	0											4.0683	0	NO	0	18.8441	0.399695825	4.670417971	0	2.442241536	2.896902182	1.357772726	3.630318619	12.89383297	3.81253118	6.066006819	0.04109553	0.003855103	6.386451533	12.07693465	27.77465478	0.158582146	0.493432815	4.717681369	0.179632664	5.87796326	0.001985139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7261
H5577_002_0	2012	6																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	coin	coin	coin	T	P	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	156.4112525	8.813613761	3.19242663	18.81353189	10.98198691	16.22244088	17.68448275	16.57287267	25.57426022	20.10549165	6.70715938	0	0.042384288	17.84815243	0	0	11.7593296	8.695011438	16.17422393	23.39074272	29.69552402	0.270643351	0	2795.123683	0	0	0	0	0	240											3400	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-90/1b:  Additional Days - $0/day for 91-999	2:  Skilled Nursing Services - 0/day for 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 - $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	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - Min 0%/Max 25%"	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/18b:  Hearing Aids - $300/Per Year	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $0/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - /visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.285422452	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.285422452	0	0	0	0	0	0												0	0	0	0	0	1.622244088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.231117456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8534	0	NO	0	0	0	0	0	0	1.622244088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.231117456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8534	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	1.622244088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.231117456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8534
H5577_005_0	2012	7																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	V	coin	coin	V	coin	coin	T	P	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	65.05856308	4.685574408	1.010658739	6.267918487	3.257146875	6.354142744	7.785027863	451.2971195	13.50476153	14.62672964	4.199446876	0	0.020561601	5.355163095	0	0	880.9870983	5.017716813	10.37401002	6.450783927	12.33884143	0.012782647	0	2453.070061	0	0	0	0	0	240											3400	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-90	2:  Skilled Nursing Services - 0/day for 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 - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $48/visit/4b:  Urgently Needed Care / Urgent Care Centers - $48/visit/4a:  Worldwide Coverage - $48/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 - 5.0%/8b:  Outpatient Therapeutic Radiological Services - 5.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 10.0%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14b:  Routine Exams - $0/visit/14b:  Additional Pap - $0/visit/14b:  Addition Pelvic - $0/visit/14b:   Additional Prostate Screening - $0/visit/14b:   Additional Colorectal Screening - $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	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	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	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $5 Office Visit Copay/service/16a:  Preventive Dental - Prophylaxis - $5 Office Visit Copay/service/16a:  Preventive Dental - Fluoride Treatment - $5 Office Visit Copay/service/16a:  Preventive Dental - X-Rays - $5 Office Visit Copay/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 - Min 5%/Max 50%"	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/18b:  Hearing Aids - $300/Per Year	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/	13a:  Acupuncture - $15/visit/13b:  Over-the-counter Rx - $0/visit/13d:  Other 1: Alternative Medicine Program - $15/visit/13e:  Other 2: Blood Pressure Monitor - $0/visit													0	0	0	0	0	0.1	0.168910777	48	0	0	0.034314342	0	0.1	0	0	0	10	0	0	10	0	0	0	2.982270995	0	0	0	0	0	15											NO	0	0	0	0	0	0.1	0.168910777	48	0	0	0.034314342	0	0.1	0	0	0	10	0	0	10	0	0	0	2.982270995	0	0	0	0	0	15												0	0	0	0	0	0.635414274	1.314975106	1.805188478	0	0	0.144101256	0	0.00205616	0	0	0	0.734155915	0	0	0.005375653	0	0	0	0.609643308	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	5.5509	0	NO	0	0	0	0	0	0	0.635414274	1.314975106	1.805188478	0	0	0.144101256	0	0.00205616	0	0	0	0.734155915	0	0	0.005375653	0	0	0	0.609643308	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	5.5509	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	0.635414274	1.314975106	1.805188478	0	0	0.144101256	0	0.00205616	0	0	0	0.734155915	0	0	0.005375653	0	0	0	0.609643308	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0	5.5509
H5578_002_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1605.199076	132.4240184	1170.429488		273.516931	6.364599299	8.309965203	603.4434449	196.6038264		13.7904626	56.29784673	0.13047496	18.89411165	4454.352075	3641.520981	94.09186736	811.1299898			14.88459436				159.1037094		0.656621326														4950	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 35 copay,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 700 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	64.19041519	350		0.2	350	0.2	0.199654682	10	34.55436412	40	20			0.2				5		35														NO	163.2487462	128.3532953	54.14123765		225.2264268	0.180181141	0.180181141	57.82951139	315.3169975		0.180181141	315.3169975	0.180181141	0.179870042	9.009057072	31.14675237	36.03622829	18.01811414			0.180181141				5		35															21.8372	1.416421595	5.280708424	0	5.13360342	1.146780767	1.497299016	2.908069964	5.166044019	0	2.484781293	1.479305667	0.023509127	3.398484663	3.344126005	9.451796019	0.282559668	1.217919395	0	0	2.681923202	0	0	0	0.066293212	0	0.001915146	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8188	0		7.556587054	21.8372	1.416421595	5.280708424	0	5.13360342	1.146780767	1.497299016	2.908069964	5.166044019	0	2.484781293	1.479305667	0.023509127	3.398484663	3.344126005	9.451796019	0.282559668	1.217919395	0	0	2.681923202	0	0	0	0.066293212	0	0.001915146	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8188	NO																																																																																		0	0		0	21.8372	1.416421595	5.280708424	0	5.13360342	1.146780767	1.497299016	2.908069964	5.166044019	0	2.484781293	1.479305667	0.023509127	3.398484663	3.344126005	9.451796019	0.282559668	1.217919395	0	0	2.681923202	0	0	0	0.066293212	0	0.001915146	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8188
H5578_006_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1578.788753	70.81752077	287.795863		273.3078548	8.761301776	8.129038991	611.3125445	198.2044016		9.293126568	151.8381276	0.18101877	20.17405134	4138.929951	3352.569822	62.83060672	622.540091			16.71751535	4.307231616			159.1037094																6700	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 20 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 50 copay,7f (Podiatry) 50 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 50 copay,18a - Hearing Exam (M/C) 50 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) n/a,16b1 - Routine Comprehensive Dental n/a"	"17a - Eye Exam (M/C) 50 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 50 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	64.38912621	350		0.2	350	0.2	0.199786895	20	49.01704646	40	20			0.2	43.89179269			20																NO	167.0112592	132.4670668	55.87648472		232.4450186	0.185956015	0.185956015	59.86772657	325.4230261		0.185956015	325.4230261	0.185956015	0.185757874	18.59560149	45.616401	37.19120298	18.59560149			0.185956015	43.89179269			20																	21.973	0.781749104	1.340085095	0	5.294087451	1.629216764	1.511643696	3.049824355	5.375023013	0	1.728112783	4.117635247	0.033661529	3.747488887	6.41382433	12.74434745	0.194728821	0.964708954	0	0	3.108722534	0.015754343	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2887	0		5.576885757	21.973	0.781749104	1.340085095	0	5.294087451	1.629216764	1.511643696	3.049824355	5.375023013	0	1.728112783	4.117635247	0.033661529	3.747488887	6.41382433	12.74434745	0.194728821	0.964708954	0	0	3.108722534	0.015754343	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2887	NO																																																																																		0	0		0	21.973	0.781749104	1.340085095	0	5.294087451	1.629216764	1.511643696	3.049824355	5.375023013	0	1.728112783	4.117635247	0.033661529	3.747488887	6.41382433	12.74434745	0.194728821	0.964708954	0	0	3.108722534	0.015754343	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2887
H5578_007_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	264.755379	6.063668951	29.57919488		10.94553726	9.48697735	13.77001962	25.10127054	55.53972002	6.076980305	14.67379018	3.892978219	0.403434666	23.12502813		4646.299786	4.150847441	812.4989213		2981.760947	16.71249895	0.064033585			159.1037094		1.477700313														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													0.08420385	0.08420385	0.195301613		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.829709913	0.224	1304.870473			5		10														NO	0.071482015	0.071482015	0.165794709		0.190157236	0.190157236	0.190157236	0.190157236	0.190157236	0.190157236	0.190157236	0.190157236	0.190157236	0.190157236		8.489162317	0.190157236	8.489162317		2.402186676	0.190157236	1107.725725			5		10															18.9252	0.433443276	4.904074007	0	2.081373112	1.80401739	2.618468869	4.773188223	10.56127964	1.155581777	2.790327381	0.740277977	0.076716021	4.39739143	0	3.286932755	0.789313676	0.574786269	0	0.596895535	3.178002605	0.005910971	0	0	0.066293212	0	0.001231417	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7608	0		11.335645	18.9252	0.433443276	4.904074007	0	2.081373112	1.80401739	2.618468869	4.773188223	10.56127964	1.155581777	2.790327381	0.740277977	0.076716021	4.39739143	0	3.286932755	0.789313676	0.574786269	0	0.596895535	3.178002605	0.005910971	0	0	0.066293212	0	0.001231417	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7608	NO																																																																																		0	0		0	18.9252	0.433443276	4.904074007	0	2.081373112	1.80401739	2.618468869	4.773188223	10.56127964	1.155581777	2.790327381	0.740277977	0.076716021	4.39739143	0	3.286932755	0.789313676	0.574786269	0	0.596895535	3.178002605	0.005910971	0	0	0.066293212	0	0.001231417	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7608
H5578_009_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1596.138027	45.92280857	587.4005972		198.6594518	8.809054016	8.728257471	421.9112377	391.368229		16.57571867	245.9871904	0.129659832	23.97146069	4228.946571	4604.8652	128.2980683	827.7721351			25.83334087				159.1037094																4950	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 325 copay,9b - OP Ambulatory Surgical Center (ASC) 325 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 325 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 15 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 40 copay,7f (Podiatry) 40 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 40 copay,18a - Hearing Exam (M/C) 40 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) n/a,16b1 - Routine Comprehensive Dental n/a"	"17a - Eye Exam (M/C) 40 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 20 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 70	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 40 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		250	0.2	0.2	62.68725873	325		0.2	325	0.2	0.199336114	15	39.48935882	40	20			0.2				20																NO	157.8589999	125.207838	52.81443921		219.7069728	0.175765578	0.175765578	55.09131139	285.6190646		0.175765578	285.6190646	0.175765578	0.175182137	13.18241837	34.70753757	35.15311564	17.57655782			0.175765578				20																	20.9971	0.479157965	2.585269428	0	3.637238898	1.548328473	1.534127221	1.936970281	9.315185623	0	2.913440777	5.854885937	0.022789735	4.19937171	4.645645245	13.31862766	0.375839736	1.212448733	0	0	4.540612096	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3822	0		10.90719911	20.9971	0.479157965	2.585269428	0	3.637238898	1.548328473	1.534127221	1.936970281	9.315185623	0	2.913440777	5.854885937	0.022789735	4.19937171	4.645645245	13.31862766	0.375839736	1.212448733	0	0	4.540612096	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3822	NO																																																																																		0	0		0	20.9971	0.479157965	2.585269428	0	3.637238898	1.548328473	1.534127221	1.936970281	9.315185623	0	2.913440777	5.854885937	0.022789735	4.19937171	4.645645245	13.31862766	0.375839736	1.212448733	0	0	4.540612096	0	0	0	0.265172849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3822
H5578_013_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1144.746633	34.47186315	345.495114		159.0766758	5.858208054	6.200485214	364.1307402	294.0750155		12.71074361	61.41548832	0.108624503	11.83506385	4046.258747	4442.3359	114.5221172	575.1252286			11.21746309				159.1037094		2.595851689														3400	"1a - IP Acute 200 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 35 copay,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													123.7907681	142.4713977	60.09645318		150	0.2	0.2	62.41213395	200		0.2	200	0.2	0.198944919	10	34.62783395	40	20			0.2				5		35														NO	111.9571311	128.8520072	54.35160138		135.6609213	0.180881228	0.180881228	56.44591729	180.8812284		0.180881228	180.8812284	0.180881228	0.179927006	9.044061422	31.32566564	36.17624569	18.08812284			0.180881228				5		35															10.6802	0.370147396	1.56485106	0	1.798374033	1.059639869	1.121551382	1.712807804	4.432720838	0	2.299134919	0.925742414	0.019648134	2.12944761	3.049551053	11.59659409	0.345248354	0.866911315	0	0	2.029028504	0	0	0	0.066293212	0	0.007571234	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0755	0		4.858984184	10.6802	0.370147396	1.56485106	0	1.798374033	1.059639869	1.121551382	1.712807804	4.432720838	0	2.299134919	0.925742414	0.019648134	2.12944761	3.049551053	11.59659409	0.345248354	0.866911315	0	0	2.029028504	0	0	0	0.066293212	0	0.007571234	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0755	NO																																																																																		0	0		0	10.6802	0.370147396	1.56485106	0	1.798374033	1.059639869	1.121551382	1.712807804	4.432720838	0	2.299134919	0.925742414	0.019648134	2.12944761	3.049551053	11.59659409	0.345248354	0.866911315	0	0	2.029028504	0	0	0	0.066293212	0	0.007571234	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0755
H5580_001_0	2012	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	486.564868	1.550837178	126.156771		23.35849042	33.29870571	12.72748142	24.00323668	35.81848092	7.635362899	19.85535116	1.561918416	0.979064764	32.96870147	0.166691672	193.5115778	7.264437051	8.768958433	34.27282829	52.25432255	41.64658053	4.297864508																			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)"	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; Van-Gogh Wellness Benefit - 16 visit max"														0.082815877	0.082815877	0.139818841		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.08266526	0.08266526	0.139564553		0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612	0.223592612																				40.222	0.128200359	17.60701335	0	5.222785876	7.445344571	2.845770811	5.366946377	8.008747692	1.707210731	4.43950982	0.349233418	0.218911647	7.371558062	0.037271026	43.26775904	1.624274452	1.960674317	7.663151184	11.68368045	9.311867705	0.96097075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.4429	0		0.323303071	40.222	0.128200359	17.60701335	0	5.222785876	7.445344571	2.845770811	5.366946377	8.008747692	1.707210731	4.43950982	0.349233418	0.218911647	7.371558062	0.037271026	43.26775904	1.624274452	1.960674317	7.663151184	11.68368045	9.311867705	0.96097075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.4429	NO																																																																																		0	0		0	40.222	0.128200359	17.60701335	0	5.222785876	7.445344571	2.845770811	5.366946377	8.008747692	1.707210731	4.43950982	0.349233418	0.218911647	7.371558062	0.037271026	43.26775904	1.624274452	1.960674317	7.663151184	11.68368045	9.311867705	0.96097075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.4429
H5587_001_0	2012	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	0.81433021	0.614199287	0.34402534	0	1.802379266	0	0.214716474	0	0.071135808	0.318997026	2.666110818	2.7566834	0.067711415	0.285846342	1.007573924	1.679669542	1.386340971	0.044844167	0	0	0	0	0	0	0	0											14.0746	YES	341.3484708	29.47150473	38.60136272	0	19.29628928	14.55400645	8.151990934	47.2272729	42.70900342	1.218495843	5.08790064	0	1.685627172	7.558922441	63.17590207	65.32210115	1.604483096	6.773387058	23.87537349	79.58528634	32.85060053	1.062623007	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 7h	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	N/C	No Cost Sharing; PBP 16a	N/C	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	N/C	No Cost Sharing; PBP 13b											0	NO	0.079052238	0.117571242	0.157388747	0	0.191559722	0.181790176	0.181790176	0.199990465	0.167808115	0.003586157	0.191553674	0	0.191388451	0.186373136	0.191500919	0.190998745	0.383119444	0.188810959	0.191559722	0.152812227	0.181502837	0.188535687	0	0	0	0	0	0	0	0											NO	0.079052238	0.117571242	0.157388747	0	0.191559722	0.181790176	0.181790176	0.199990465	0.167808115	0.003586157	0.191553674	0	0.191388451	0.186373136	0.191500919	0.190998745	0.383119444	0.188810959	0.191559722	0.152812227	0.181502837	0.188535687	0	0	0	0	0	0	0	0												26.9844	3.46500142	6.075420122	0	3.696391814	2.645775399	1.48195187	9.44500426	7.166917345	0.004369718	0.974606061	0	0.322609573	1.408780081	12.09824328	12.47643933	0.614708672	1.278889704	4.573559912	12.16160481	5.962477187	0.200342359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0375	0	NO	2.84E-14	26.9844	3.46500142	6.075420122	0	4.510722024	3.259974687	1.82597721	9.44500426	8.969296612	0.004369718	1.189322535	0	0.393745381	1.727777108	14.7643541	15.23312273	0.682420088	1.564736046	5.581133836	13.84127435	7.348818159	0.245186526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.112	NO																																										0	0	0	0	0	0	0	0	0	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	26.9844	3.46500142	6.075420122	0	4.510722024	3.259974687	1.82597721	9.44500426	8.969296612	0.004369718	1.189322535	0	0.393745381	1.727777108	14.7643541	15.23312273	0.682420088	1.564736046	5.581133836	13.84127435	7.348818159	0.245186526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.112
H5587_002_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0.846269729	0.57135066	0.367057601	0	1.751867419	0	0.304378721	0	0.023602652	0.341619472	2.418319019	2.643420414	0.049334483	0.29420132	0.823218458	1.744590797	1.306505966	0.038160625	0	0	0	0	0	0	0	0											13.5239	YES	311.7497584	21.94616679	26.39650738	0	21.15291187	14.2811798	9.174778218	53.47967127	43.78875415	3.009412447	7.60809	0	0	8.536447932	60.44702688	66.07354266	1.233138729	7.353701038	20.57673445	83.93995342	32.65673414	0.953842852	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, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 7h	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a"	N/C	No Cost Sharing; PBP 16a	N/C	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	N/C	No Cost Sharing; PBP 13b											0	NO	0.081668297	0.133703228	0.162379697	0	0.191998551	0.183838613	0.183838613	0.199956602	0.173581306	0.0070178	0.190651623	0	0	0.191605245	0.191945121	0.190925879	0.383997102	0.190547887	0.191844973	0.158816859	0.183934612	0.191245047	0	0	0	0	0	0	0	0											NO	0.081668297	0.133703228	0.162379697	0	0.191998551	0.183838613	0.183838613	0.199956602	0.173581306	0.0070178	0.190651623	0	0	0.191605245	0.191945121	0.190925879	0.383997102	0.190547887	0.191844973	0.158816859	0.183934612	0.191245047	0	0	0	0	0	0	0	0												25.4601	2.934273338	4.286256858	0	4.061328429	2.625432281	1.686678498	10.69361335	7.600909153	0.021119454	1.450494705	0	0	1.635628197	11.60251189	12.61514919	0.473521698	1.401232194	3.947543057	13.33107976	6.006703717	0.182417721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.016	0	NO	9.95E-14	25.4601	2.934273338	4.286256858	0	4.907598158	3.196782941	2.053736099	10.69361335	9.352776572	0.021119454	1.754873426	0	0.023602652	1.977247669	14.02083091	15.2585696	0.522856182	1.695433513	4.770761515	15.07567055	7.313209683	0.220578346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.5399	NO																																										0	0	0	0	0	0	0	0	0	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	25.4601	2.934273338	4.286256858	0	4.907598158	3.196782941	2.053736099	10.69361335	9.352776572	0.021119454	1.754873426	0	0.023602652	1.977247669	14.02083091	15.2585696	0.522856182	1.695433513	4.770761515	15.07567055	7.313209683	0.220578346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.5399
H5590_002_0	2012	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	765.3720107	9.884031955	234.6511252	0.117619291	52.58881082	102.3710229	34.1795458	52.84274964	51.23558031	5.594974425	16.20617837	0	2.943851077	25.21246972	141.4334516	103.694506	7.732781806	16.34049589	32.76844508	121.5191174	41.62850957	10.5195832	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost Sharing; PBP 13a-e											0	YES	0.081589504	0.081589504	0.153149037	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081303099	0.081303099	0.152611436	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0.223213689	0	0	0	0	0	0	0	0												62.2271	0.803602429	35.8104451	0.026254236	11.73854249	22.85061372	7.629342522	11.79522511	11.43648291	1.248874884	3.617440867	0	0.65710786	5.627768387	31.56988254	23.14603327	1.726062757	3.647422375	7.314365525	27.12473054	9.292053207	2.348114977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	281.6375	0	NO	0.992118904	62.2271	0.803602429	35.8104451	0.026254236	11.73854249	22.85061372	7.629342522	11.79522511	11.43648291	1.248874884	3.617440867	0	0.65710786	5.627768387	31.56988254	23.14603327	1.726062757	3.647422375	7.314365525	27.12473054	9.292053207	2.348114977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	281.6375	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	YES	0	62.2271	0.803602429	35.8104451	0.026254236	11.73854249	22.85061372	7.629342522	11.79522511	11.43648291	1.248874884	3.617440867	0	0.65710786	5.627768387	31.56988254	23.14603327	1.726062757	3.647422375	7.314365525	27.12473054	9.292053207	2.348114977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	281.6375
H5591_001_0	2012	7																															D	D	D			Coin	Coin	V	V		Coin			V	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	520.8269682	16.15895219	16.10138676	0	0	8.180949914	0.800762127	228.522364	289.8067576	0	9.771090636	0	0	377.8860653	2858.16723	2220.941936	186.6461367	663.5197182	1.924287432	4.16807959	4.41864352	0	0	0	0	0	0	0	0	0											2800	"1a - Acute (250.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (250.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/135.00 per day-1-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay (0.00/135.00 per day-1-20/21-100)"	6 - Home Health Services - no cost sharing	10a - Ambulance ($125 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($35 per visit)"	"9a - Outpatient Hospital Services ($300 per visit), 9b - Ambulatory Surgical Center Services ($300 per visit)"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($50 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($20 per service),3 - Intensive Cardiac Rehabilitation Services ($20 per service),3 - Pulmonary Rehabilitation Services ($20 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($30 per visit),9c - Outpatient Substance Abuse Svcs - Group ($20 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7a - Primary Care (min 0.00/ max 5.00 per visit),7a - In-Area Network Urgent Care Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($30 per visit),7f - Podiatry Services ($30 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($30 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams - Not covered,18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($30 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($20 per visit),7h - Psychiatric Services - Individual ($30 per visit),7h - Psychiatric Services - Group ($20 per visit)"	"7c - Occupational Therapy Services ($20 per visit),7i - Physical/Speech Therapy ($20 per visit)"	"8b - Outpatient Diagnostic/Therapeutic Radiological Services - no cost sharing,8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($30 per visit)	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($30 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($30 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 30.00 per visit),17a - Routine Eye Exams - Not covered"	"17b - Eye Wear (20% coins per service),17b - Contact Lenses - Not covered,17b - Eye Glasses - Not covered,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($30 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	250	250	135	0	0	0.2	0.2	50	300	0	0.2	0	0	20.03307449	5	27.92468232	29	20	0.2	20	0.2	0	0	0	0	0	0	0	0	0											NO	234.7218603	234.7218603	126.7498046	0	0	0.187777488	0.187777488	46.94437206	281.6662324	0	0.187777488	0	0	18.80880205	4.694437206	26.21813353	27.22773579	18.77774882	0.187777488	18.77774882	0.187777488	0	0	0	0	0	0	0	0	0												10.1875	0.31607161	0.170070635	0	0	1.536198226	0.150365101	0.893986573	6.802398127	0	1.834790857	0	0	0.592298683	1.118123882	4.852412687	0.423495975	1.038283884	0.361337861	0.006522263	0.829721782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1135	0	NO	2.025192389	10.1875	0.31607161	0.170070635	0	0	1.536198226	0.150365101	0.893986573	6.802398127	0	1.834790857	0	0	0.592298683	1.118123882	4.852412687	0.423495975	1.038283884	0.361337861	0.006522263	0.829721782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1135	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"	"$325/Visit 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	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; PBP 3, 9c, 9d"	"$35/Visit for OV; PBP 4b, 7a, 14b-c"	"$35/Visit for OV; $35/Visit for OV; $35/Visit for Vision Exams; $35/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$34/Visit for OP Psych; $34/Visit for OP Substance Abuse; PBP 7e, 7h"	"$35/Visit for PT/OT/ST; $35/Visit for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; PBP 8b	No Cost Sharing; PBP 7g	20% Coinsurance for Part B Rx; 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, 14b"	No Cost Sharing; PBP 13a-13e											2800	0	0	0	0	0.76	0.2751	0.0491	0.0707	0.2724	0	0.6516	0	0	0.0216	0.1206	1.3995	0.3068	0.1545	0.2072	0.0029	0.0348	0	0	0	0	0	0	0	0	0											4.3269	0	NO	0.281637691	10.1875	0.31607161	0.170070635	0	0.760031796	1.811332018	0.199500872	0.964704965	7.074826346	0	2.486437702	0	0	0.613900996	1.238762607	6.251884225	0.730267522	1.192754535	0.568496758	0.009427479	0.864477981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4404
H5591_003_0	2012	5																															D	D	D		T	Coin	Coin	V	V		Coin			V	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	452.2609723	12.33681368	12.50148251	0	54.25451908	5.984403243	0.431103912	203.7215913	235.1922024	0	9.029240591	0	0	284.3171994	2078.523015	2051.800009	193.9179117	409.7300978	2.429890214	6.878878652	3.110476819	0	0	0	0	0	0	0	0	0											3400	"1a - Acute (250.00/0.00 per day-1-7/8-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (250.00/0.00 per day-1-7/8-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/135.00 per day-1-20/21-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay (0.00/135.00 per day-1-20/21-100)"	6 - Home Health Services - no cost sharing	10a - Ambulance ($150 per trip)	11a - Durable Medical Equipment (20% coins per service)	"11b - Prosthetics Devices (20% coins per service),11b - Medical Supplies (20% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($35 per visit)"	"9a - Outpatient Hospital Services ($325 per visit), 9b - Ambulatory Surgical Center Services ($325 per visit)"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($50 per day)	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services ($25 per service),3 - Intensive Cardiac Rehabilitation Services ($25 per service),3 - Pulmonary Rehabilitation Services ($25 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($25 per visit),9c - Outpatient Substance Abuse Svcs - Group ($15 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7a - Primary Care (min 0.00/ max 5.00 per visit),7a - In-Area Network Urgent Care Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($35 per visit),7b - Chiropractic Services ($20 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($25 per visit),7f - Podiatry Services ($25 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($25 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 25.00 per visit),17a - Routine Eye Exams - Not covered,18a - Hearing Exams ($25 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($25 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($15 per visit),7h - Psychiatric Services - Individual ($25 per visit),7h - Psychiatric Services - Group ($15 per visit)"	"7c - Occupational Therapy Services ($25 per visit),7i - Physical/Speech Therapy ($25 per visit)"	"8b - Outpatient Diagnostic/Therapeutic Radiological Services - no cost sharing,8b - Outpatient Diagnostic Radiological Services (20% coins per visit),8b - Outpatient Therapeutic Radiological Services (20% coins per visit),8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($25 per visit)	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($25 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - Not covered,16a - Preventive Dental - Prophylaxis - Not covered,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - Not covered, 16b - Comprehensive Dental ($25 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 25.00 per visit),17a - Routine Eye Exams - Not covered"	"17b - Eye Wear (20% coins per service),17b - Contact Lenses - Not covered,17b - Eye Glasses - Not covered,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($25 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	250	250	135	0	150	0.165278617	0.2	50	325	0	0.2	0	0	24.99513032	5	23.89973358	24	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	242.2806634	242.2806634	130.8315583	0	145.3683981	0.160175252	0.193824531	48.45613269	314.9648625	0	0.193824531	0	0	24.22334702	4.845613269	23.16177323	23.25894369	24.22806634	0.193824531	24.22806634	0.193824531	0	0	0	0	0	0	0	0	0												9.1312	0.24908095	0.136299036	0	0.657241044	0.958553298	0.083558513	0.822630038	6.17310664	0	1.750088321	0	0	0.573926182	0.839309892	3.960277209	0.375860482	0.827247333	0.470972331	0.013888494	0.60288671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6261	0	NO	0.880198875	9.1312	0.24908095	0.136299036	0	0.657241044	0.958553298	0.083558513	0.822630038	6.17310664	0	1.750088321	0	0	0.573926182	0.839309892	3.960277209	0.375860482	0.827247333	0.470972331	0.013888494	0.60288671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6261	NO																																										0	0	0	0	0	0	0	0	0	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	9.1312	0.24908095	0.136299036	0	0.657241044	0.958553298	0.083558513	0.822630038	6.17310664	0	1.750088321	0	0	0.573926182	0.839309892	3.960277209	0.375860482	0.827247333	0.470972331	0.013888494	0.60288671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6261
H5594_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	807.8651455	4.398305036	426.9813849	93.95234109	260.9531709	3.357126263	2.998988928	155.8941021	174.9572396	2825.758473	2.954580687	0	0.058549451	19.91038804	3335.201774	2990.737072	143.3839228	410.2436221	2509.695976	26.82207402	27.63898682	0	20.37164744	331.4094099	670.1625361	346.6328089	1.682131268	4.386059212	0	4777.209411											3400	$95 days 1-5;$0 days 6-90	$95 days 1-5;$0 days 6-90	$0 days 1-7;$75 days 8-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $95, 9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	17b2: $15	$0 	$0 	$0 	$0 												NO	61.60193947	40.85424042	37.88162828	15	100	0.146017183	0.092123037	48.74094203	54.0960452	0	0.036627662	0	0.146017183	28.53900709	0	19.91480037	20	20	0	20	0.143985465	0	0	8.443409091	0	15	0	0	0	0											NO	61.42445198	40.7365312	37.77248375	14.95678201	99.71188003	0.145596478	0.091857613	48.60181453	53.94018369	0	0.036522131	0	0.145596478	28.45678051	0	19.85742185	19.94237601	19.94237601	0	19.94237601	0.143570614	0	0	8.443409091	0	15	0	0	0	0												4.1352	0.014930974	1.344012285	0.117102057	2.168344272	0.488785761	0.275479963	0.631394686	0.78643547	0	0.107907582	0	0.008524594	0.047215462	0	4.949027306	0.238284675	0.681769381	0	0.044574657	3.968146317	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6736	0	NO	0.057794182	4.1352	0.014930974	1.344012285	0.117102057	2.168344272	0.488785761	0.275479963	0.631394686	0.78643547	0	0.107907582	0	0.008524594	0.047215462	0	4.949027306	0.238284675	0.681769381	0	0.044574657	3.968146317	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6736	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8209	0	0	0.1727	0	0	0	0	0	0	0	0	0	0	0											0.9936	0	NO	0	4.1352	0.014930974	1.344012285	0.117102057	2.168344272	0.488785761	0.275479963	0.631394686	0.78643547	0	0.107907582	0	0.008524594	0.047215462	0	5.769901655	0.238284675	0.681769381	0.172746803	0.044574657	3.968146317	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6673
H5594_002_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1513.116269	3.117072949	973.7913407	272.0375346	555.5835001	13.31504555	10.90351624	209.4982402	290.6727323	2824.310564	7.34262796	0	0.753967176	50.55177954	3929.314593	4995.970599	519.4174691	1281.97849	4386.367098	49.39564221	43.09799776	0	27.00439566	260.6679738	670.1625361	346.3711871	3.856228478	4.386059212	0	4932.078821											3400	$0 days 1-5;$50 days 6-10;$0 days 11-90	$0 days 1-5;$50 days 6-10;$0 days 11-90	$0 days 1-7;$75 days 8-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	9a1: $200	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $0-$200	12: 20%	"31-33: $0-$200, 5: $50, 9a2: $200"	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	9.534042337	9.835308604	37.88162828	0	100	0.135025493	0.10073268	49.09512761	32.44147157	0	0.029665186	0	0.135025493	23.76923077	0	0	0	0	0	0	0.130066165	0	0	0	0	10	0	0	0	0											NO	9.519423734	9.820228067	37.82354416	0	99.84666941	0.134818458	0.100578226	49.02162854	32.39172887	0	0.029619701	0	0.134818458	23.73278527	0	0	0	0	0	0	0.129866734	0	0	0	0	10	0	0	0	0												1.2003	0.002550864	3.069353314	0	4.622763505	1.795113904	1.096656326	0.855828743	0.784616028	0	0.217486442	0	0.101648692	0.099977877	0	0	0	0	0	0	5.596996195	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.732	0	NO	0.029827245	1.2003	0.002550864	3.069353314	0	4.622763505	1.795113904	1.096656326	0.855828743	0.784616028	0	0.217486442	0	0.101648692	0.099977877	0	0	0	0	0	0	5.596996195	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.732	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4586	0	0	0.0946	0	0	0	0	0	0	0	0	0	0	0											0.5532	0	NO	0	1.2003	0.002550864	3.069353314	0	4.622763505	1.795113904	1.096656326	0.855828743	0.784616028	0	0.217486442	0	0.101648692	0.099977877	0	0.45857755	0	0	0.094581733	0	5.596996195	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2851
H5594_006_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1300.337399	1.862113451	960.5253558	190.256684	492.9117775	9.325621488	9.690731768	276.1001461	236.5403224	2339.907828	4.425662291	0	0.431079973	55.3571526	4100.191306	3915.010884	460.9129118	918.7606492	3623.586649	29.50854577	37.03821234	0	38.67535862	230.1894082	553.3260678	284.7497439	2.65152301	3.605753839	0	3924.908392											3400	$175 days 1-5;$0 days 6-90	$175 days 1-5;$0 days 6-90	$0 days 1-7;$95 days 8-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$200	12: 20%	"31-33: $25-$200, 5: $175, 9a2: $200"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	113.4772569	75.2578113	47.98339582	0	100	0.145894779	0.111160771	49.81069236	77.43380294	0	0.033302611	0	0.145894779	22.30802874	0	24.30835557	25	25	0	25	0.140704042	0	0	0	0	10	0	0	0	0											NO	103.8559539	68.87698905	43.91506704	0	91.52138212	0.133524919	0.101735874	45.63201929	70.86848668	0	0.03047901	0	0.133524919	20.41661623	0	22.24734299	22.88034553	22.88034553	0	22.88034553	0.128774284	0	0	0	0	10	0	0	0	0												11.254	0.010688064	3.51512795	0	3.759330595	1.24520285	0.985895062	1.049917266	1.396937891	0	0.134889804	0	0.057559918	0.094183812	0	7.25821583	0.878820557	1.751796759	0	0.05626381	4.769569288	0	0	0	0	0.237291453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4557	0	NO	3.539462142	11.254	0.010688064	3.51512795	0	3.759330595	1.24520285	0.985895062	1.049917266	1.396937891	0	0.134889804	0	0.057559918	0.094183812	0	7.25821583	0.878820557	1.751796759	0	0.05626381	4.769569288	0	0	0	0	0.237291453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4557	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3205	0	0	0.2612	0	0	0	0	0	0	0	0	0	0	0											1.5817	0	NO	0	11.254	0.010688064	3.51512795	0	3.759330595	1.24520285	0.985895062	1.049917266	1.396937891	0	0.134889804	0	0.057559918	0.094183812	0	8.578680124	0.878820557	1.751796759	0.261214576	0.05626381	4.769569288	0	0	0	0	0.237291453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0374
H5594_016_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	2403.152642	2.588574815	992.186824	306.8657095	1007.78258	16.22134653	11.16435765	722.0512043	335.1718947	3304.384818	6.194069438	0	0.845470163	100.4948991	8414.248812	4149.934217	930.1846146	619.8841112	5344.738124	107.972555	57.07914815	0	384.2228931	582.0842344	669.7138466	336.3948751	5.162199228	3.762229294	0	4865.094465											6700	$0 	$0 	$0 days 1-8;$40 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%"	"4a1: $50,4a2: $500"	$0 	$0 	"8b3: 20%, 8b4: 20%"	$0 	12: 20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	0	0	18.16294709	0	100	0.168194483	0.128891423	49.92662499	0	0	0.078924353	0	0.168194483	0	0	0	0	0	0	0	0.159520569	0	0	0	0	10	0	0	0	0											NO	0	0	18.16294709	0	100	0.168194483	0.128891423	49.92662499	0	0	0.078924353	0	0.168194483	0	0	0	0	0	0	0	0.159520569	0	0	0	0	10	0	0	0	0												0	0	1.501753066	0	8.39818817	2.728340987	1.438989941	3.004131641	0	0	0.488862921	0	0.142203417	0	0	0	0	0	0	0	9.10529821	0	0	0	0	0.280329063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0881	0	NO	0	0	0	1.501753066	0	8.39818817	2.728340987	1.438989941	3.004131641	0	0	0.488862921	0	0.142203417	0	0	0	0	0	0	0	9.10529821	0	0	0	0	0.280329063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0881	NO																																										0	0	0	0	0	0	0	0	0	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	1.501753066	0	8.39818817	2.728340987	1.438989941	3.004131641	0	0	0.488862921	0	0.142203417	0	0	0	0	0	0	0	9.10529821	0	0	0	0	0.280329063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0881
H5594_017_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	2296.558039	10.49869423	1021.977129	285.8651037	1066.155126	13.29505622	8.13741125	722.1652194	225.5510555	2878.97546	3.405905802	0	0.53590796	64.17002461	6452.176061	3148.760661	1141.956358	436.7356472	4294.691902	107.8061766	30.76366285	0	304.7669911	559.2428454	618.7120436	314.3821266	3.431502323	3.705438754	0	3714.637146											6700	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a2: $500	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.261985105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.262	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	0.261985105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.262	NO																																										0	0	0	0	0	0	0	0	0	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	0.261985105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.262
H5594_018_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	785.4021846	2.178258772	304.9379189	63.70844132	241.3949248	4.013916802	2.204624553	181.3531801	142.7264882	2601.971706	3.084734017	0	0.470879171	33.89446301	3505.720734	2461.311863	165.5017871	272.9183441	2099.979436	81.76088161	18.66034947	1.335213971	17.26768358	304.9306289	616.6182297	318.8265658	1.490756016	4.035624077	0	2029.611347											3400	$195 days 1-7;$0 days 8-90	$195 days 1-7;$0 days 8-90	$0 days 1-7;$95 days 8-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $250,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $30-$250	12: 20%	"31-33: $30-$250, 5: $195, 9a2: $250"	$0 	"7b1: $20,7d1: $30,7f1: $30"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	$0 	7g: $30	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	17b2: $15	$0 	$0 	$0 	$0 												NO	146.4865636	102.4672926	47.98339582	15	100	0.163624305	0.083778872	49.64137339	83.49374799	0	0.08134916	0	0.163624305	10.41125841	0	28.59915129	30	30	0	30	0.162056028	0	0	8.443409091	0	15	0	0	0	0											NO	141.6594383	99.09072042	46.40221421	14.50570976	96.70473174	0.158232445	0.081018133	48.01191058	80.74240501	0	0.078668487	0	0.158232445	10.06817951	0	27.65673254	29.01141952	29.01141952	0	29.01141952	0.156715847	0	0	8.443409091	0	15	0	0	0	0												9.2716	0.017987103	1.179149553	0.077011347	1.945335954	0.635131871	0.178614565	0.725592722	0.960339993	0	0.242671357	0	0.074508363	0.028437962	0	5.672653657	0.400120148	0.659812381	0	0.197666603	2.924372481	0	0	0.214554504	0	0.398533207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8041	0	NO	0.858299671	9.2716	0.017987103	1.179149553	0.077011347	1.945335954	0.635131871	0.178614565	0.725592722	0.960339993	0	0.242671357	0	0.074508363	0.028437962	0	5.672653657	0.400120148	0.659812381	0	0.197666603	2.924372481	0	0	0.214554504	0	0.398533207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8041	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8201	0	0	0.1894	0	0	0	0	0	0	0	0	0	0	0											1.0096	0	NO	0	9.2716	0.017987103	1.179149553	0.077011347	1.945335954	0.635131871	0.178614565	0.725592722	0.960339993	0	0.242671357	0	0.074508363	0.028437962	0	6.492796451	0.400120148	0.659812381	0.189435553	0.197666603	2.924372481	0	0	0.214554504	0	0.398533207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8137
H5594_019_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1184.606448	1.723134821	677.3848466	182.5508142	437.1397357	8.437227798	6.5084468	253.3225147	195.6881988	2241.155962	4.326733726	0	0.377087587	65.44823008	3540.766782	3503.215017	402.0567799	739.5534095	3156.772099	93.79272117	31.43206042	2.500195491	41.81223762	219.1401101	522.2152117	269.9051246	2.482264285	3.417778101	0	3597.651446											3400	$100 days 1-5;$0 days 6-90	$100 days 1-5;$0 days 6-90	$0 days 1-7;$95 days 8-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $100, 9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	64.84414681	43.0044636	47.98339582	0	100	0.155606104	0.114438854	49.80907002	85.31070992	0	0.037606567	0	0.155606104	17.78928669	0	19.84974284	20	20	0	20	0.151686811	0	0	0	0	10	0	0	0	0											NO	63.16754955	41.89254881	46.74274676	0	97.41442005	0.151582784	0.111479946	48.53492961	83.10493331	0	0.036634219	0	0.151582784	17.32933047	0	19.33651187	19.48288401	19.48288401	0	19.48288401	0.147764827	0	0	0	0	10	0	0	0	0												6.2357	0.006015542	2.638569029	0	3.548642819	1.278938477	0.7255613	1.024582535	1.355221226	0	0.15850651	0	0.057159986	0.094514501	0	5.644996563	0.652768801	1.200719441	0	0.152279392	4.644552977	0	0	0	0	0.224920937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6437	0	NO	0.780537312	6.2357	0.006015542	2.638569029	0	3.548642819	1.278938477	0.7255613	1.024582535	1.355221226	0	0.15850651	0	0.057159986	0.094514501	0	5.644996563	0.652768801	1.200719441	0	0.152279392	4.644552977	0	0	0	0	0.224920937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6437	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4179	0	0	0.0844	0	0	0	0	0	0	0	0	0	0	0											0.5023	0	NO	0	6.2357	0.006015542	2.638569029	0	3.548642819	1.278938477	0.7255613	1.024582535	1.355221226	0	0.15850651	0	0.057159986	0.094514501	0	6.062915901	0.652768801	1.200719441	0.08438448	0.152279392	4.644552977	0	0	0	0	0.224920937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.146
H5594_022_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	807.8651455	4.398305036	426.9813849	93.95234109	260.9531709	3.738742035	3.339894031	155.8941021	174.9572396	2825.758473	3.290437758	0	0.065204962	19.91038804	3335.201774	2990.737072	143.3839228	410.2436221	2509.695976	26.82207402	30.78080291	0	20.37164744	331.4094099	670.1625361	346.6328089	1.682131268	4.386059212	0	4777.209411											3400	$175 days 1-7;$0 days 8-90	$175 days 1-7;$0 days 8-90	$0 days 1-7;$95 days 8-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $250,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$250	12: 20%	"31-33: $25-$250, 5: $175, 9a2: $250"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	17b2: $15	$0 	$0 	$0 	$0 												NO	131.4623006	91.95782669	47.98339582	15	100	0.131113116	0.08271998	49.1576087	62.40920097	0	0.032889054	0	0.131113116	35.67375887	0	24.36258222	25	25	0	25	0.129288777	0	0	8.443409091	0	15	0	0	0	0											NO	127.5588445	89.22736065	46.55864453	14.55461115	97.03074101	0.127220028	0.08026381	47.71143971	60.55611016	0	0.031912492	0	0.127220028	34.61451257	0	23.63919405	24.25768525	24.25768525	0	24.25768525	0.125449859	0	0	8.443409091	0	15	0	0	0	0												8.5875	0.032704096	1.656639543	0.113953316	2.110039961	0.475642868	0.26807262	0.619827671	0.882894156	0	0.10500607	0	0.008295377	0.057432365	0	5.891551167	0.289846839	0.829296722	0	0.054220119	3.861447376	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5109	0	NO	0.790690075	8.5875	0.032704096	1.656639543	0.113953316	2.110039961	0.475642868	0.26807262	0.619827671	0.882894156	0	0.10500607	0	0.008295377	0.057432365	0	5.891551167	0.289846839	0.829296722	0	0.054220119	3.861447376	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5109	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8209	0	0	0.1727	0	0	0	0	0	0	0	0	0	0	0											0.9936	0	NO	0	8.5875	0.032704096	1.656639543	0.113953316	2.110039961	0.475642868	0.26807262	0.619827671	0.882894156	0	0.10500607	0	0.008295377	0.057432365	0	6.712425515	0.289846839	0.829296722	0.172746803	0.054220119	3.861447376	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5045
H5594_023_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1513.116269	3.117072949	973.7913407	272.0375346	555.5835001	14.60202397	11.957406	209.4982402	290.6727323	2824.310564	8.052336665	0	0.826842592	50.55177954	3929.314593	4995.970599	519.4174691	1281.97849	4386.367098	49.39564221	47.26367581	0	27.00439566	260.6679738	670.1625361	346.3711871	3.856228478	4.386059212	0	4932.078821											3400	$50 days 1-7;$0 days 8-90	$50 days 1-7;$0 days 8-90	$0 days 1-7;$95 days 8-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$200	12: 20%	"31-33: $15-$200, 5: $50, 9a2: $200"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	37.56065733	26.27366477	47.98339582	0	100	0.123124753	0.091854405	49.58236659	74.33110368	0	0.027050586	0	0.123124753	23.30769231	0	14.94733042	15	15	0	15	0.118602525	0	0	0	0	10	0	0	0	0											NO	36.49238532	25.52640893	46.61868812	0	97.15587511	0.119622931	0.089241951	48.20517665	72.21703426	0	0.026281234	0	0.119622931	22.64479243	0	14.52220968	14.57338127	14.57338127	0	14.57338127	0.115229321	0	0	0	0	10	0	0	0	0												4.6014	0.00663064	3.7830729	0	4.498183429	1.746736905	1.067102244	0.841574973	1.749293556	0	0.211625342	0	0.098909334	0.095394546	0	6.046044381	0.630805734	1.556896776	0	0.059988461	5.446161264	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7285	0	NO	0.949046039	4.6014	0.00663064	3.7830729	0	4.498183429	1.746736905	1.067102244	0.841574973	1.749293556	0	0.211625342	0	0.098909334	0.095394546	0	6.046044381	0.630805734	1.556896776	0	0.059988461	5.446161264	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7285	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4586	0	0	0.0946	0	0	0	0	0	0	0	0	0	0	0											0.5532	0	NO	0	4.6014	0.00663064	3.7830729	0	4.498183429	1.746736905	1.067102244	0.841574973	1.749293556	0	0.211625342	0	0.098909334	0.095394546	0	6.504621931	0.630805734	1.556896776	0.094581733	0.059988461	5.446161264	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2817
H5594_026_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	807.8651455	4.398305036	426.9813849	93.95234109	260.9531709	3.472695601	3.102229359	155.8941021	174.9572396	2825.758473	3.056292362	0	0.06056502	19.91038804	3335.201774	2990.737072	143.3839228	410.2436221	2509.695976	26.82207402	28.59046113	0	20.37164744	331.4094099	670.1625361	346.6328089	1.682131268	4.386059212	0	4777.209411											3400	$175 days 1-7;$0 days 8-90	$175 days 1-7;$0 days 8-90	$0 days 1-7;$95 days 8-100	6: $15	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $15"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $250,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$250	12: 20%	"31-33: $25-$250, 5: $175, 9a2: $250"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $5-$75	$0 	17b2: $15	$0 	$0 	$0 	$0 												NO	131.4623006	91.95782669	47.98339582	15	100	0.141157814	0.089057235	49.1576087	62.40920097	0	0.035408714	0	0.141157814	35.67375887	0	24.36258222	25	25	0	25	0.139193711	0	0	8.443409091	0	15	0	0	0	0											NO	127.558832	89.22735195	46.55863999	14.55460973	97.03073155	0.136966459	0.086412887	47.7114351	60.55610425	0	0.034357335	0	0.136966459	34.6145092	0	23.63919175	24.25768289	24.25768289	0	24.25768289	0.135060676	0	0	8.443409091	0	15	0	0	0	0												8.5875	0.032704093	1.656639382	0.113953305	2.110039756	0.475642821	0.268072594	0.619827611	0.88289407	0	0.105006059	0	0.008295376	0.057432359	0	5.891550592	0.289846811	0.829296641	0	0.054220114	3.861447	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5109	0	NO	0.790692594	8.5875	0.032704093	1.656639382	0.113953305	2.110039756	0.475642821	0.268072594	0.619827611	0.88289407	0	0.105006059	0	0.008295376	0.057432359	0	5.891550592	0.289846811	0.829296641	0	0.054220114	3.861447	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5109	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8209	0	0	0.1727	0	0	0	0	0	0	0	0	0	0	0											0.9936	0	NO	0	8.5875	0.032704093	1.656639382	0.113953305	2.110039756	0.475642821	0.268072594	0.619827611	0.88289407	0	0.105006059	0	0.008295376	0.057432359	0	6.712424941	0.289846811	0.829296641	0.172746803	0.054220114	3.861447	0	0	0.233185435	0	0.433291011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5045
H5594_027_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1513.116269	3.117072949	973.7913407	272.0375346	555.5835001	13.66401344	11.18928147	209.4982402	290.6727323	2824.310564	7.53506751	0	0.773727554	50.55177954	3929.314593	4995.970599	519.4174691	1281.97849	4386.367098	49.39564221	44.2275333	0	27.00439566	260.6679738	670.1625361	346.3711871	3.856228478	4.386059212	0	4932.078821											3400	$0 days 1-5;$50 days 6-10;$0 days 11-90	$0 days 1-5;$50 days 6-10;$0 days 11-90	$0 days 1-7;$95 days 8-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $20"	9a1: $200	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $50, 9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	9.534042337	9.835308604	47.98339582	0	100	0.131577051	0.098160049	49.58236659	32.44147157	0	0.028907561	0	0.131577051	23.76923077	0	19.9297739	20	20	0	20	0.12674438	0	0	0	0	10	0	0	0	0											NO	9.385378386	9.68194702	47.2351926	0	98.4407039	0.129525375	0.096629443	48.82731996	31.93561297	0	0.028456807	0	0.129525375	23.39859808	0	19.61900971	19.68814078	19.68814078	0	19.68814078	0.12476806	0	0	0	0	10	0	0	0	0												1.1834	0.002514945	3.833101794	0	4.557669235	1.769836464	1.081214038	0.852436467	0.773567657	0	0.214423962	0	0.100217352	0.098570064	0	8.16799964	0.852197021	2.103314415	0	0.081042363	5.518183514	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4784	0	NO	0.493722879	1.1834	0.002514945	3.833101794	0	4.557669235	1.769836464	1.081214038	0.852436467	0.773567657	0	0.214423962	0	0.100217352	0.098570064	0	8.16799964	0.852197021	2.103314415	0	0.081042363	5.518183514	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4784	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4586	0	0	0.0946	0	0	0	0	0	0	0	0	0	0	0											0.5532	0	NO	0	1.1834	0.002514945	3.833101794	0	4.557669235	1.769836464	1.081214038	0.852436467	0.773567657	0	0.214423962	0	0.100217352	0.098570064	0	8.62657719	0.852197021	2.103314415	0.094581733	0.081042363	5.518183514	0	0	0	0	0.288642656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0315
H5594_028_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	999.0249818	7.511466028	443.4201143	133.9932098	300.1671389	4.842620159	7.313776766	169.6906866	192.5062411	2828.721499	4.580265894	0	0.098263925	23.88503362	3464.945332	3540.752942	938.3401408	467.569832	3061.655555	33.18019083	37.38484379	0	388.085514	332.5284349	827.9038261	427.8992268	1.886594274	4.386059212	0	5135.359413											3400	$50 days 1-5;$0 days 6-90	$50 days 1-5;$0 days 6-90	$0 days 1-8;$50 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $100,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$100	12: 20%	"31-33: $15-$100, 5: $50, 9a2: $100"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	32.42207341	21.5022318	22.70368387	0	100	0.130158856	0.058015767	48.23529412	38.75	0	0.025181283	0	0.130158856	22.80597015	0	14.94549554	15	15	0	15	0.127989288	0	0	0	0	10	0	0	0	0											NO	32.39610129	21.48500716	22.68549679	0	99.91989372	0.130054591	0.057969293	48.19665462	38.71895882	0	0.025161111	0	0.130054591	22.78770114	0	14.93352326	14.98798406	14.98798406	0	14.98798406	0.127886761	0	0	0	0	10	0	0	0	0												2.697	0.013448658	0.838267132	0	2.499389052	0.629804984	0.42397447	0.681543618	0.621136769	0	0.115244578	0	0.012779675	0.045357084	0	4.406326368	1.171985589	0.583994099	0	0.041442014	4.781026581	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9193	0	NO	0.015683565	2.697	0.013448658	0.838267132	0	2.499389052	0.629804984	0.42397447	0.681543618	0.621136769	0	0.115244578	0	0.012779675	0.045357084	0	4.406326368	1.171985589	0.583994099	0	0.041442014	4.781026581	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9193	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0442	0	0	0.2151	0	0	0	0	0	0	0	0	0	0	0											1.2594	0	NO	0	2.697	0.013448658	0.838267132	0	2.499389052	0.629804984	0.42397447	0.681543618	0.621136769	0	0.115244578	0	0.012779675	0.045357084	0	5.450557077	1.171985589	0.583994099	0.215142908	0.041442014	4.781026581	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1787
H5594_029_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1544.431851	9.255022326	653.9729508	243.7077779	447.6699118	19.2862429	11.90141782	219.7307888	253.8269457	2838.177244	6.122202031	0	0.040546214	49.88141471	3816.262311	4573.996582	938.5237637	842.5384796	4218.033945	28.78423275	42.40980752	0	388.085514	332.5284349	827.9038261	427.8992268	1.548020898	4.386059212	0	5135.359413											3400	$50 days 1-5;$0 days 6-90	$50 days 1-5;$0 days 6-90	$0 days 1-8;$50 days 9-100	$0 	10a: $100	11a: 0%-20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $100,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$100	12: 20%	"31-33: $15-$100, 5: $50, 9a2: $100"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	32.42207341	21.5022318	22.70368387	0	100	0.12863181	0.084297726	48.27586207	41.60447761	0	0.039403687	0	0.12863181	10.83544304	0	14.95673552	15	15	0	15	0.125799771	0	0	0	0	10	0	0	0	0											NO	32.11893403	21.30119058	22.49140933	0	99.06502163	0.12742913	0.083509561	47.8244932	41.21548475	0	0.039035271	0	0.12742913	10.73413399	0	14.81689327	14.85975324	14.85975324	0	14.85975324	0.12462357	0	0	0	0	10	0	0	0	0												4.1338	0.016428583	1.225731111	0	3.695702458	2.457629156	0.993882177	0.875709468	0.871800051	0	0.238981815	0	0.005166769	0.044619482	0	5.6477016	1.162185962	1.043326159	0	0.035643883	5.285261623	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.0901	0	NO	0.261750116	4.1338	0.016428583	1.225731111	0	3.695702458	2.457629156	0.993882177	0.875709468	0.871800051	0	0.238981815	0	0.005166769	0.044619482	0	5.6477016	1.162185962	1.043326159	0	0.035643883	5.285261623	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.0901	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0431	0	0	0.2182	0	0	0	0	0	0	0	0	0	0	0											1.2613	0	NO	0	4.1338	0.016428583	1.225731111	0	3.695702458	2.457629156	0.993882177	0.875709468	0.871800051	0	0.238981815	0	0.005166769	0.044619482	0	6.690802771	1.162185962	1.043326159	0.218197885	0.035643883	5.285261623	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3514
H5594_030_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	999.0249818	7.511466028	443.4201143	133.9932098	300.1671389	5.00487478	7.558828833	169.6906866	192.5062411	2828.721499	4.733730193	0	0.101556312	23.88503362	3464.945332	3540.752942	938.3401408	467.569832	3061.655555	33.18019083	38.63744331	0	388.085514	332.5284349	827.9038261	427.8992268	1.886594274	4.386059212	0	5135.359413											3400	$50 days 1-5;$0 days 6-90	$50 days 1-5;$0 days 6-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%,11b2: 20% 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $100,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$100	12: 20%	"31-33: $15-$100, 5: $50, 9a2: $100"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	32.42207341	21.5022318	43.13699935	0	100	0.125939195	0.056134936	48.23529412	38.75	0	0.024364923	0	0.125939195	22.80597015	0	14.94549554	15	15	0	15	0.123839963	0	0	0	0	10	0	0	0	0											NO	32.35561103	21.45815413	43.04857231	0	99.79500885	0.125681031	0.056019864	48.13641603	38.67056593	0	0.024314977	0	0.125681031	22.75921993	0	14.9148586	14.96925133	14.96925133	0	14.96925133	0.123586102	0	0	0	0	10	0	0	0	0												2.6937	0.01343185	1.590716905	0	2.496265191	0.629017822	0.423444565	0.680691791	0.620360441	0	0.11510054	0	0.012763702	0.045300394	0	4.400819121	1.170520783	0.583264194	0	0.041390218	4.775051015	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6484	0	NO	0.04168186	2.6937	0.01343185	1.590716905	0	2.496265191	0.629017822	0.423444565	0.680691791	0.620360441	0	0.11510054	0	0.012763702	0.045300394	0	4.400819121	1.170520783	0.583264194	0	0.041390218	4.775051015	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6484	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0442	0	0	0.2151	0	0	0	0	0	0	0	0	0	0	0											1.2594	0	NO	0	2.6937	0.01343185	1.590716905	0	2.496265191	0.629017822	0.423444565	0.680691791	0.620360441	0	0.11510054	0	0.012763702	0.045300394	0	5.445049831	1.170520783	0.583264194	0.215142908	0.041390218	4.775051015	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9078
H5594_031_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	V	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	1544.431851	9.255022326	653.9729508	243.7077779	447.6699118	19.85691682	12.25357706	219.7307888	253.8269457	2838.177244	6.303356079	0	0.041745964	49.88141471	3816.262311	4573.996582	938.5237637	842.5384796	4218.033945	28.78423275	43.66470049	0	388.085514	332.5284349	827.9038261	427.8992268	1.548020898	4.386059212	0	5135.359413											3400	$50 days 1-5;$0 days 6-90	$50 days 1-5;$0 days 6-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 0%-20%	"11b1: 20%,11b2: 20%, 11c1: 0-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $100,9b: $25"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $15-$100	12: 20%	"31-33: $15-$100, 5: $50, 9a2: $100"	$0 	"7b1: $15,7d1: $15,7f1: $15"	"7e1: $15,7h1: $15"	"7c: $15,7i: $15"	$0 	7g: $15	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	32.42207341	21.5022318	43.13699935	0	100	0.124935021	0.081875069	48.27586207	41.60447761	0	0.038271252	0	0.124935021	10.83544304	0	14.95673552	15	15	0	15	0.122184373	0	0	0	0	10	0	0	0	0											NO	31.87159036	21.13715293	42.40459132	0	98.30213498	0.122813793	0.080484941	47.45620309	40.89808974	0	0.037621458	0	0.122813793	10.65147184	0	14.70279034	14.74532025	14.74532025	0	14.74532025	0.120109848	0	0	0	0	10	0	0	0	0												4.102	0.016302069	2.310954643	0	3.667242341	2.438703278	0.986228422	0.868965745	0.865086434	0	0.237141447	0	0.00512698	0.044275874	0	5.604209395	1.153236121	1.035291642	0	0.035369394	5.244560521	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9712	0	NO	0.494229526	4.102	0.016302069	2.310954643	0	3.667242341	2.438703278	0.986228422	0.868965745	0.865086434	0	0.237141447	0	0.00512698	0.044275874	0	5.604209395	1.153236121	1.035291642	0	0.035369394	5.244560521	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9712	NO																7d1: 30%			7d2: 30%																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0431	0	0	0.2182	0	0	0	0	0	0	0	0	0	0	0											1.2613	0	NO	0	4.102	0.016302069	2.310954643	0	3.667242341	2.438703278	0.986228422	0.868965745	0.865086434	0	0.237141447	0	0.00512698	0.044275874	0	6.647310567	1.153236121	1.035291642	0.218197885	0.035369394	5.244560521	0	0	0	0	0.356582689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2325
H5608_001_0	2012	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	513.3621321	6.709134041	41.10687137	0	11.10094891	21.46150535	6.169454409	20.91986351	38.16255801	12.83601112	15.08060597	0	0.136635403	34.37341307	23.9676038	38.92764679	1.728135347	2.11332411	11.0206777	46.91252898	14.87826016	2.529368042	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; Non-covered immunizations are provided at 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	10 round trips / year	"$1050 Max, all services except implants"	No Cost-Sharing; PBP 17a	$200 Allowance	1 exam	$1500 Allowance	No Cost-Sharing; PBP 14c	PBP 13a-e											0	NO	0.077953808	0.077953808	0.148036649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071818178	0.071818178	0.136384902	0	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0	0.20636929	0.20636929	0.206501401	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0.20636929	0	0	0	0	0	0	0	0												36.8687	0.481837786	5.60635664	0	2.29089494	4.428995613	1.273185924	4.317217373	7.875579987	2.648958497	3.112173942	0	0.028197351	7.093616837	4.949343769	8.033470816	0.356634064	0.436125195	2.274329428	9.681305282	3.070415981	0.521983886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3494	0	NO	8.996855689	36.8687	0.481837786	5.60635664	0	2.29089494	4.428995613	1.273185924	4.317217373	7.875579987	2.648958497	3.112173942	0	0.028197351	7.093616837	4.949343769	8.033470816	0.356634064	0.436125195	2.274329428	9.681305282	3.070415981	0.521983886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3494	NO																																										0	0	0	0	0	0	0	0	0	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	36.8687	0.481837786	5.60635664	0	2.29089494	4.428995613	1.273185924	4.317217373	7.875579987	2.648958497	3.112173942	0	0.028197351	7.093616837	4.949343769	8.033470816	0.356634064	0.436125195	2.274329428	9.681305282	3.070415981	0.521983886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3494
H5608_002_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin		V	V	V	Coin	Coin	Coin	Coin																			0	0	0	0	0.567907952	0	0	1.246404182	1.949747205	0.801628056	1.583975265	0	0.004784259	1.836719714	0	0.031214617	0	0	0.016133298	1.08145986	0.948510214	0.047717362	0	0	0	0	0	0	0	0											10.1162	YES	424.8707145	6.325194977	30.07939	0	12.95217062	22.60813287	5.304072816	28.42650745	44.46752044	18.28258139	36.12542809	0	0.109113703	41.9272686	0	5248.897116	396.1704363	325.2319978	0.367949115	37.06722491	21.63249533	1.088280957	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; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	20% coinsurance	20% coinsurance	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"$0 / PCP visit, including non-covered immunizations"	$15 / specialist visit; FFS Cost-sharing for services provided in a facility setting	$15 / specialist visit; FFS Cost-sharing for services provided in a facility setting	$15 / specialist visit; FFS Cost-sharing for services provided in a facility setting	$15 / specialist visit; FFS Cost-sharing for services provided in a facility setting	$15 / specialist visit; FFS Cost-sharing for services provided in a facility setting	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	"Medicare-FFS Cost Sharing; some Part B services are removed from the deductible, so the effective cost-sharing for the rest of the Part B services is not equal to the CMS cost-sharing equivalent"	10 round trips / year	"$1850 Max, all services except implants"	1 exam	$200 Allowance	1 exam	$1500 Allowance	No Cost-Sharing; PBP 14c	PBP 13a-e											0	NO	0.077953808	0.077953808	0.148036649	0	0.191230691	0.2	0.2	0.191230691	0.191230691	0.191230691	0.191230691	0	0.191230691	0.191164051	0	15.11531228	15	15	0.191230691	0.254566866	0.191230691	0.191230691	0	0	0	0	0	0	0	0											NO	0.076888723	0.076888723	0.146014021	0	0.188617901	0.197267395	0.197267395	0.188617901	0.188617901	0.188617901	0.188617901	0	0.188617901	0.188552172	0	14.90879136	14.7950546	14.7950546	0.188617901	0.251088712	0.188617901	0.188617901	0	0	0	0	0	0	0	0												32.6678	0.486336165	4.392012669	0	2.443011231	4.459847471	1.046320626	5.361748159	8.387370354	3.448422121	6.813902408	0	0.020580798	7.905477544	0	6.521225999	0.488446936	0.40098543	0.06940179	9.30716175	4.080275855	0.205269269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5056	Medicare FFS	YES	1.364527706	32.6678	0.486336165	4.392012669	0	3.010919184	4.459847471	1.046320626	6.608152341	10.33711756	4.250050177	8.397877672	0	0.025365057	9.742197258	0	6.552440616	0.488446936	0.40098543	0.085535088	10.38862161	5.028786068	0.252986631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6218	NO																																										0	0	0	0	0	0	0	0	0	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	32.6678	0.486336165	4.392012669	0	3.010919184	4.459847471	1.046320626	6.608152341	10.33711756	4.250050177	8.397877672	0	0.025365057	9.742197258	0	6.552440616	0.488446936	0.40098543	0.085535088	10.38862161	5.028786068	0.252986631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6218
H5609_001_0	2012	8																															D	A	D	V	T	Coin	Coin	V	V	P	Coin	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	1315.088847	6.655162567	1022.429485	490.7730105	291.8217736	14.218373	3.957461109	889.3233329	877.8772704	4478.363253	6.156937339	0	542.8942373	1386.562931	4472.580569	12129.10855	543.498844	1159.019829	2010.519717	1680.524652	57.52517317	0.708743332	0	0.166715442	318.7629596	340.0965247	12.00351184	0	0	0											3350	$200 days 1-5;$0 days 6-90	$948.48 	$0 days 1-14;$50 days 15-20;$100 days 21-100	$0 	10a: $175	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $100,9b: $100"	$0 	"8b3: 20.0%,8b4: 20.0%"	9c1: $100	$0 	"31: $10,5: $100,9a2: $100"	7a: $0 to $5	"7b1: $10,7b2: $10,7d1: $10,7f1: $10,7f2: $10,17a1: $05,18a1: $10"	"7e1: $30,7h1: $30"	"7c: $10,7i: $10"	$0 	7g: $10	"152: 20.0%,153: 20.0%"	9d2: $0	$0 	$0 	17a2: $20	$0 	18a2: $10	$0 	$0 	$0 											0	NO	129.6882936	105.4028875	16.75415104	0	175	0.2	0.154648112	49.90518108	100	0	0.127139641	0	0	3.28623602	3.043113994	9.444579824	29.82944983	10	0	10	0.157449248	0	0	0	20	0	10	0	0	0											NO	115.1931378	93.62209192	14.88155312	0	155.4403914	0.177646162	0.137363217	44.32731932	88.8230808	0	0.112929346	0	0	2.918936076	2.702987602	8.441369264	26.49543632	8.88230808	0	8.88230808	0.139851273	0	0	0	20	0	10	0	0	0												12.6241	0.05192252	1.267944891	0	3.780074226	2.525839387	0.54360959	3.285109946	6.497980311	0	0.695298905	0	0	0.337274047	1.007444152	8.532190343	1.200019918	0.8578976	0	1.243911475	8.04496867	0	0	0	0.531271599	0	0.010002927	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0369	0	NO	6.546072237	12.6241	0.05192252	1.267944891	0	3.780074226	2.525839387	0.54360959	3.285109946	6.497980311	0	0.695298905	0	0	0.337274047	1.007444152	8.532190343	1.200019918	0.8578976	0	1.243911475	8.04496867	0	0	0	0.531271599	0	0.010002927	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0369	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	12.6241	0.05192252	1.267944891	0	3.780074226	2.525839387	0.54360959	3.285109946	6.497980311	0	0.695298905	0	0	0.337274047	1.007444152	8.532190343	1.200019918	0.8578976	0	1.243911475	8.04496867	0	0	0	0.531271599	0	0.010002927	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0369
H5609_004_0	2012	7																															D	A	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	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	868.657628	44.58951436	1372.643108	68.48594542	475.6195379	13.05727681	3.569654014	1212.814941	34.94862078	6403.620612	6.262076436	0.037503437	0.537420925	255.8677179	6111.934129	15922.67097	3.42994424	54.58894891	42.95855633	2343.67005	54.27600102	0.312371812	0	0	0	0	27.09267266	0	0	0											6700	$320 days 1-5;$0 days 6-90	$948.48 	$50 days 1-20;$75 days 21-96;$0 days 97-100	$0 	10a: $200	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: 20.0%,9b: 20.0%"	$0 	"8b2: $125,8b3: 20.0%,8b4: 20.0%"	9c1: 20.0%	$0 	"31: $20,5: 20.0%,9a2: 20.0%"	7a: $10	"7b1: $20,7b2: $20,7d1: $20,7f1: $20,7f2: $20,17a1: $05,18a1: $10"	"7e1: $30,7h1: $30"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	9d2: $0	$0 	$0 	0	$0 	0	$0 	$0 	$0 											0	NO	207.5012698	105.4028875	52.59923823	0	200	0.2	0.186566978	49.97731622	0.2	0	0.105062784	0.2	0	2.247310545	9.956838565	19.95722463	30	20	0	20	0.199998289	0	0	0	0	0	10	0	0	0											NO	195.0317243	99.06882455	49.43834869	0	187.9812345	0.187981235	0.175355454	46.97398801	0.187981235	0	0.098749159	0.187981235	0	2.112261053	9.358494027	18.75857575	28.19718518	18.79812345	0	18.79812345	0.187979626	0	0	0	0	0	10	0	0	0												14.118	0.368119231	5.655100717	0	7.45062899	2.454523014	0.6259583	4.747562876	6.569684878	0	0.618374783	0.007049942	0	0.045038285	4.766541587	24.89055245	0.008059564	0.08551415	0	3.671383245	10.2027824	0	0	0	0	0	0.022577227	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3074	0	NO	5.515779706	14.118	0.368119231	5.655100717	0	7.45062899	2.454523014	0.6259583	4.747562876	6.569684878	0	0.618374783	0.007049942	0	0.045038285	4.766541587	24.89055245	0.008059564	0.08551415	0	3.671383245	10.2027824	0	0	0	0	0	0.022577227	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3074	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	14.118	0.368119231	5.655100717	0	7.45062899	2.454523014	0.6259583	4.747562876	6.569684878	0	0.618374783	0.007049942	0	0.045038285	4.766541587	24.89055245	0.008059564	0.08551415	0	3.671383245	10.2027824	0	0	0	0	0	0.022577227	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3074
H5609_005_0	2012	7																															D	A	D	V	T	Coin	Coin	V	V	P	Coin	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	1059.465325	46.95690573	858.3303774	74.54339871	384.6709091	11.95872414	3.117290469	1076.18517	753.0989934	5653.020387	6.269925418	3.264600346	2.62259707	152.869159	5509.102964	14373.25009	5.807628864	46.58075661	49.9290866	2120.685295	52.1775554	0.414466962	0	2.486801775	0	0	25.03369204	0	0	0											5900	$295 days 1-5;$0 days 6-90	$948.48 	$50 days 1-20;$100 days 21-69;$0 days 70-100	$0 	10a: $200	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $260,9b: $260"	$0 	"8b2: $125,8b3: 20.0%,8b4: 20.0%"	9c1: $260	$0 	"31: $20,5: $260,9a2: $260"	7a: $10	"7b1: $20,7b2: $20,7d1: $20,7f1: $20,7f2: $20,17a1: $05,18a1: $10"	"7e1: $30,7h1: $30"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20.0%,153: 20.0%"	9d2: $0	$0 	$0 	0	$0 	0	$0 	$0 	$0 											0	NO	191.2902331	105.4028875	55.12468012	0	200	0.2	0.181140078	49.9958747	251.7164065	0	0.12013672	122.664822	0	12.19132773	9.947752584	19.9607296	30	20	0	20	0.199959909	0	0	0	0	0	10	0	0	0											NO	175.6905296	96.80729029	50.62926678	0	183.6900157	0.183690016	0.166368118	45.91871505	231.1889534	0	0.11033958	112.6615154	0	11.19712591	9.136514143	18.33384647	27.55350236	18.36900157	0	18.36900157	0.183653194	0	0	0	0	0	10	0	0	0												15.5115	0.378814234	3.621386472	0	5.888350445	2.196698225	0.51861775	4.11808668	14.50901401	0	0.691820937	0.030649569	0	0.142641268	4.194499762	21.95974671	0.013335043	0.071303499	0	3.246239293	9.582574692	0	0	0	0	0	0.02086141	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6961	0	NO	7.694777493	15.5115	0.378814234	3.621386472	0	5.888350445	2.196698225	0.51861775	4.11808668	14.50901401	0	0.691820937	0.030649569	0	0.142641268	4.194499762	21.95974671	0.013335043	0.071303499	0	3.246239293	9.582574692	0	0	0	0	0	0.02086141	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6961	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.5115	0.378814234	3.621386472	0	5.888350445	2.196698225	0.51861775	4.11808668	14.50901401	0	0.691820937	0.030649569	0	0.142641268	4.194499762	21.95974671	0.013335043	0.071303499	0	3.246239293	9.582574692	0	0	0	0	0	0.02086141	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6961
H5609_801_0	2012	4																															D	A	D	V	T	Coin	Coin	V	V	P	Coin	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	887.2093606	5.848228365	576.4323998	144.2704644	270.8948793	12.68113696	3.656526568	846.3827242	1102.765776	5087.14413	3.439657164	0.188311077	7.157052797	768.115927	4907.588845	13520.93838	267.0830977	1033.941695	975.0414981	1902.735977	40.51458331	0	0	0	140.294029	154.3494275	13.34405412	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 	$0 	$0 	$0 	$0 	$0 	$0 												NO	183.832477	75.47194673	72.15932861	0	89.56633594	0.224	0.224	25.86532903	101.0987068	20.73191894	0.224	24.86003869	77.80200742	31.20455544	22.44383315	31.74957539	7.021982929	9.974232347	29.60152252	16.92360847	0.224	0	0	0	0	0	0	0	0	0											NO	168.5069181	69.18007829	66.14362314	0	82.09946081	0.205325796	0.205325796	23.7090146	92.6704127	19.00356142	0.205325796	22.78753229	71.31588885	28.60312582	20.57275852	29.12825664	6.436581403	9.142710696	27.13373292	15.51273831	0.205325796	0	0	0	0	0	0	0	0	0												12.4584	0.033715075	3.177277285	0	1.853360294	2.603764541	0.750779228	1.672241697	8.516146629	8.056154661	0.706250345	0.000357595	0.042534298	1.830876376	8.41355335	32.8201136	0.143258508	0.787752483	2.204709633	2.45972044	8.318689066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8497	0	NO	8.77698988	12.4584	0.033715075	3.177277285	0	1.853360294	2.603764541	0.750779228	1.672241697	8.516146629	8.056154661	0.706250345	0.000357595	0.042534298	1.830876376	8.41355335	32.8201136	0.143258508	0.787752483	2.204709633	2.45972044	8.318689066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8497	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	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	12.4584	0.033715075	3.177277285	0	1.853360294	2.603764541	0.750779228	1.672241697	8.516146629	8.056154661	0.706250345	0.000357595	0.042534298	1.830876376	8.41355335	32.8201136	0.143258508	0.787752483	2.204709633	2.45972044	8.318689066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8497
H5619_001_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	946.0817422	64.80594299	707.6950088		226.5486552	4.966268792	5.120323368	336.9232277	242.584724		19.21512329	1246.615943	0.015334462	22.68582628	3751.281336	3848.279942	234.7577925	1175.982963			17.53438035	1.65805915			159.1037094																4950	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 29 copay,7f - Podiatry 29 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 29 copay,18a - Hearing Exam (M/C) 29 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 29 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 29 copay,18a - Hearing Exam (M/C) 29 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1000 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		150	0.2	0.2	63.83615385	350		0.2	121.4206251	0.2	0.199416484	4.994302806	27.93454092	40	20			0.2	29			5																NO	165.0880727	129.7994541	54.75124793		136.6584341	0.182211246	0.182211246	58.15832551	318.8696797		0.182211246	121.4206251	0.182211246	0.18167963	4.550090674	25.57795302	36.4422491	18.22112455			0.182211246	26.4206306			5																	13.0156	0.700981335	3.228932074	0	2.57998204	0.904910022	0.932980498	1.632907563	6.446076102	0	3.501211547	12.61374059	0.002794111	4.121552515	1.422389185	8.202593629	0.712925163	1.785644336	0	0	3.194961283	0.003650581	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0701	0		5.069628077	13.0156	0.700981335	3.228932074	0	2.57998204	0.904910022	0.932980498	1.632907563	6.446076102	0	3.501211547	12.61374059	0.002794111	4.121552515	1.422389185	8.202593629	0.712925163	1.785644336	0	0	3.194961283	0.003650581	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0701	NO																																																																																		0	0		0	13.0156	0.700981335	3.228932074	0	2.57998204	0.904910022	0.932980498	1.632907563	6.446076102	0	3.501211547	12.61374059	0.002794111	4.121552515	1.422389185	8.202593629	0.712925163	1.785644336	0	0	3.194961283	0.003650581	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0701
H5619_003_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	410.6562567	10.58712948	90.34368093		20.15252409	10.29178771	7.434444875	25.59019868	75.74085642	14.24110847	30.52044117	25.78711968		43.52640205		4962.804243	7.766480085	1175.038493		1670.414361	20.95485015	6.260560758			159.1037094																3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 75"													0.081779221	0.081779221	0.137559498		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224		9.951219305	0.224	10		2.880968468	0.224	108.8194441			5																NO	0.062462695	0.062462695	0.105067483		0.171090449	0.171090449	0.171090449	0.171090449	0.171090449	0.171090449	0.171090449	0.171090449		0.171090449		7.600707923	0.171090449	7.637966453		2.200474051	0.171090449	83.11592636			5																	25.6507	0.661300637	9.492183199	0	3.447904386	1.760826575	1.271962508	4.378238571	12.9585371	2.436517635	5.22175597	4.411929872	0	7.446951652	0	3.143402127	1.328770561	0.747908716	0	0.306308621	3.585174711	0.043362692	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.36	0		27.30474899	25.6507	0.661300637	9.492183199	0	3.447904386	1.760826575	1.271962508	4.378238571	12.9585371	2.436517635	5.22175597	4.411929872	0	7.446951652	0	3.143402127	1.328770561	0.747908716	0	0.306308621	3.585174711	0.043362692	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.36	NO																																																																																		0	0		0	25.6507	0.661300637	9.492183199	0	3.447904386	1.760826575	1.271962508	4.378238571	12.9585371	2.436517635	5.22175597	4.411929872	0	7.446951652	0	3.143402127	1.328770561	0.747908716	0	0.306308621	3.585174711	0.043362692	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.36
H5619_004_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1069.165059	24.01799554	638.6662509		143.2266748	6.410762764	4.785272415	378.7787952	301.1128043		20.83035472	321.3677956	0.116045998	49.39047472	2526.206917	3027.014785	232.508642	931.6258459			19.80334898				159.1037094		1.195634915														4950	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation 24 trips	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 35 copay,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1000 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 20"													181.2051416	142.4713977	60.09645318		150	0.2	0.2	62.88890993	350		0.2	198.7872737	0.2	0.200309819	5	33.92095456	40	20			0.2				5		35														NO	165.1931674	129.8820842	54.78610245		136.7454306	0.182327241	0.182327241	57.33180712	319.0726714		0.182327241	198.7872737	0.182327241	0.182609683	4.55818102	30.94783388	36.46544816	18.23272408			0.182327241				5		35															14.7182	0.259958943	2.915836221	0	1.632132777	1.168856686	0.872485516	1.809672736	8.006405572	0	3.797941102	5.323652329	0.021158347	9.019178948	0.959575702	7.806629226	0.706544319	1.415506416	0	0	3.610689978	0	0	0	0.066293212	0	0.003487269	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1142	0		5.685022682	14.7182	0.259958943	2.915836221	0	1.632132777	1.168856686	0.872485516	1.809672736	8.006405572	0	3.797941102	5.323652329	0.021158347	9.019178948	0.959575702	7.806629226	0.706544319	1.415506416	0	0	3.610689978	0	0	0	0.066293212	0	0.003487269	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1142	NO																																																																																		0	0		0	14.7182	0.259958943	2.915836221	0	1.632132777	1.168856686	0.872485516	1.809672736	8.006405572	0	3.797941102	5.323652329	0.021158347	9.019178948	0.959575702	7.806629226	0.706544319	1.415506416	0	0	3.610689978	0	0	0	0.066293212	0	0.003487269	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1142
H5619_007_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	882.1943897	35.92677572	711.9959674		150.1104498	4.350844329	5.682503682	344.3047026	263.9801368		20.38747554	463.3301947	0.002615079	30.77978353	3200.935249	3043.634549	188.0565931	783.5294829			14.40658033	1.323462143			159.1037094		1.079072942														4950	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 35 copay,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1000 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		150	0.2	0.2	63.01379478	350		0.2	158.6358797	0.2	0.197449634	5	33.95087461	39.99298189	20			0.2	35			5		35														NO	167.5770359	131.7563857	55.57670939		138.7187757	0.184958368	0.184958368	58.27464309	323.6771433		0.184958368	158.6358797	0.184958368	0.18259981	4.623959189	31.41686031	36.99167352	18.49583676			0.184958368	32.36771433			5		35															12.3196	0.394465177	3.297532747	0	1.735261484	0.804725065	1.051026605	1.672019471	7.120361379	0	3.770834194	6.125066087	0.000483681	5.620382613	1.233416163	7.968453456	0.579710675	1.207669451	0	0	2.66461758	0.003569787	0	0	0.066293212	0	0.003147296	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6387	0		4.178244229	12.3196	0.394465177	3.297532747	0	1.735261484	0.804725065	1.051026605	1.672019471	7.120361379	0	3.770834194	6.125066087	0.000483681	5.620382613	1.233416163	7.968453456	0.579710675	1.207669451	0	0	2.66461758	0.003569787	0	0	0.066293212	0	0.003147296	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6387	NO																																																																																		0	0		0	12.3196	0.394465177	3.297532747	0	1.735261484	0.804725065	1.051026605	1.672019471	7.120361379	0	3.770834194	6.125066087	0.000483681	5.620382613	1.233416163	7.968453456	0.579710675	1.207669451	0	0	2.66461758	0.003569787	0	0	0.066293212	0	0.003147296	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6387
H5619_009_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	199.6003493	2.020995921	79.55125838		13.88886314	11.64910171	8.848214381	42.61075248	50.91336189	17.41004998	24.23056157	5.725110166	0.302038142	52.95549794		4429.884315	2.102239283	781.496579		2546.668911	16.07305716	0.054803508			159.1037094		1.318861505														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													0.081976045	0.081976045	0.134699647		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.952568424	0.224	1360.325935			5		10														NO	0.067333173	0.067333173	0.110639084		0.183988269	0.183988269	0.183988269	0.183988269	0.183988269	0.183988269	0.183988269	0.183988269	0.183988269	0.183988269		8.213761994	0.183988269	8.213761994		2.42516943	0.183988269	1117.339346			5		10															13.4397	0.136080067	8.801478344	0	2.555387882	2.143298055	1.627967645	7.839878575	9.367461306	3.203244954	4.458139072	1.053353107	0.055571475	9.743190382	0	3.032167952	0.386787366	0.534918908	0	0.514675299	2.957253959	0.005102843	0	0	0.066293212	0	0.001099051	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9231	0		15.62637805	13.4397	0.136080067	8.801478344	0	2.555387882	2.143298055	1.627967645	7.839878575	9.367461306	3.203244954	4.458139072	1.053353107	0.055571475	9.743190382	0	3.032167952	0.386787366	0.534918908	0	0.514675299	2.957253959	0.005102843	0	0	0.066293212	0	0.001099051	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9231	NO																																																																																		0	0		0	13.4397	0.136080067	8.801478344	0	2.555387882	2.143298055	1.627967645	7.839878575	9.367461306	3.203244954	4.458139072	1.053353107	0.055571475	9.743190382	0	3.032167952	0.386787366	0.534918908	0	0.514675299	2.957253959	0.005102843	0	0	0.066293212	0	0.001099051	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9231
H5628_001_0	2012	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	231.4853079	4.89375995	101.7519519	0	13.30397618	35.43183035	5.042360141	46.50305803	27.34652969	4.39804381	6.557413016	0	0.463350196	6.588220205	43.15843261	60.72770412	3.463182268	4.571502217	10.44790286	40.54795479	30.7470346	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, 7c, 7i, 9a, 9c, 9d, 14a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8a, 14a, 14f-h"	"Medicare-FFS Cost Sharing; PBP 7a, 7d, 8a, 14a, 14b, 14d-e, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 13a, 14a, 14c"	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 13a-d, 14c"											0	NO	0.08284667	0.08284667	0.162533744	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.081689439	0.081689439	0.160263415	0	0.220871088	0.220871088	0.220871088	0.220871088	0.220871088	0.220871088	0.220871088	0	0.220871088	0.220871088	0.220871088	0.220955495	0.220871088	0.220871088	0.220871088	0.220871088	0.220871088	0	0	0	0	0	0	0	0	0												18.9099	0.399768503	16.30711529	0	2.9384637	7.825866936	1.113711573	10.27118105	6.040057778	0.971400723	1.44834295	0	0.102340662	1.455147368	9.532449988	13.41811993	0.764916837	1.009712671	2.307639676	8.955870909	6.791130999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5631	0	NO	1.561064922	18.9099	0.399768503	16.30711529	0	2.9384637	7.825866936	1.113711573	10.27118105	6.040057778	0.971400723	1.44834295	0	0.102340662	1.455147368	9.532449988	13.41811993	0.764916837	1.009712671	2.307639676	8.955870909	6.791130999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5631	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	18.9099	0.399768503	16.30711529	0	2.9384637	7.825866936	1.113711573	10.27118105	6.040057778	0.971400723	1.44834295	0	0.102340662	1.455147368	9.532449988	13.41811993	0.764916837	1.009712671	2.307639676	8.955870909	6.791130999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5631
H5628_002_0	2012	4																															D	D	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	668.003204	16.18338898	643.1910944	0	113.1079848	15.33131912	5.504836946	471.463971	35.2194186	0	11.30180848	0	0.020439306	1.016066026	3288.286588	3597.542965	200.1479475	472.7016015	1.819216908	318.5293019	17.06753292	0	0	0	36.90729273	0	0	0	0	0											3400	$175/Days Custom for IP Medical; $175/Days Custom for IP Surgical;	$275/Days Custom for IP Psych; $275/Days Custom for IP Substance Abuse;	$100/Days Custom for SNF;	No Cost-Sharing;	$175/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $35/Visit for PCP Urgent Care;	20% Coinsurance for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; 20% Coinsurance for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	20% Coinsurance for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; $35/Visit for OP Substance Abuse;	$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for PCP Office Visits;	$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $28/Proceedure for Cardio; $20/Visit for Chiropractor; $25/Exam for Vision Exams; $50/Exam for Hearing/Speech Exams;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist;	$35/Visit for Occ Therapy; $35/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; 20% Coinsurance for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$15/Visit for PCP Office Visits; $35/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$25/Exam for Vision Exams (Refractions);	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	175	275	100	0	175	0.2	0.2	52.84898588	0.2	0	0.2	0	0.2	0.188491916	15	32.32471932	35	35	0.2	35	0.2	0	0	0	25	0	0	0	0	0											NO	163.1159323	256.3250365	93.20910419	0	163.1159323	0.186418208	0.186418208	49.26006631	0.186418208	0	0.186418208	0	0.186418208	0.175691627	13.98136563	30.12958131	32.62318647	32.62318647	0.186418208	32.62318647	0.186418208	0	0	0	25	0	0	0	0	0												9.0802	0.345683981	4.995938811	0	1.5374762	2.858037042	1.026201841	1.935362207	6.565540916	0	2.106862889	0	0.003810259	0.178514293	3.83122809	9.032705272	0.544121984	1.285086041	0.339135157	0.865953401	3.181698909	0	0	0	0.076890193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7904	0	NO	3.621956727	9.0802	0.345683981	4.995938811	0	1.5374762	2.858037042	1.026201841	1.935362207	6.565540916	0	2.106862889	0	0.003810259	0.178514293	3.83122809	9.032705272	0.544121984	1.285086041	0.339135157	0.865953401	3.181698909	0	0	0	0.076890193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7904	NO																																										0	0	0	0	0	0	0	0	0	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	9.0802	0.345683981	4.995938811	0	1.5374762	2.858037042	1.026201841	1.935362207	6.565540916	0	2.106862889	0	0.003810259	0.178514293	3.83122809	9.032705272	0.544121984	1.285086041	0.339135157	0.865953401	3.181698909	0	0	0	0.076890193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7904
H5628_006_0	2012	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	213.592568	0	69.52338989	0	15.9255218	54.22577722	11.53058377	48.43501747	48.2448918	16.60257711	17.97590718	0	0.211749235	39.10842486	1.63712494	90.66678115	14.61417449	10.95163962	12.61814336	56.79674403	18.40254739	0.396395212	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, 7c, 7i, 9a, 9c, 9d, 14a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8a, 14a, 14f-h"	"Medicare-FFS Cost Sharing; PBP 7a, 7d, 8a, 14a, 14b, 14d-e, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 13a, 14a, 14c"	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 13a-d, 14c"											0	NO	0.081951496	0	0.1680187	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.081879951	0	0.167872017	0	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223804444	0.223872167	0	0	0	0	0	0	0	0												17.4889	0	11.67103168	0	3.564202551	12.13596992	2.580595888	10.83997215	10.79742118	3.715730537	4.023087909	0	0.04739042	8.752639278	0.366395837	20.29162854	3.270717194	2.451025614	2.823996558	12.71136371	4.118571885	0.088741855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7394	0	NO	0.115084556	17.4889	0	11.67103168	0	3.564202551	12.13596992	2.580595888	10.83997215	10.79742118	3.715730537	4.023087909	0	0.04739042	8.752639278	0.366395837	20.29162854	3.270717194	2.451025614	2.823996558	12.71136371	4.118571885	0.088741855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7394	NO																																										0	0	0	0	0	0	0	0	0	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	17.4889	0	11.67103168	0	3.564202551	12.13596992	2.580595888	10.83997215	10.79742118	3.715730537	4.023087909	0	0.04739042	8.752639278	0.366395837	20.29162854	3.270717194	2.451025614	2.823996558	12.71136371	4.118571885	0.088741855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7394
H5640_001_0	2012	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; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9c, 9d"	"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 8b	No Cost Sharing; PBP 7g	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, 14b"	No Cost Sharing; PBP 13a-13e											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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H5649_001_0	2012	5																															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			330.8281784		463.7858761	1.150716202	1.237289385	191.0965189			0.212629719	0.231431596	0.087822268	23.66241008			192.3586261		170.5958649		8.645051088									690.2572426											3400	"(1a) $0.00, (1a1) $0.00"	(1b) $0.00	"(2) $0.00 days 1 - 14, $75 days 15-60"	(6) $0.00	(10a) $50/trip	(11a) 0-20%	"(11b) 0-20%, (11c) $0.00"	"(4a) $65/visit (waived if admitted), (4a1) $0, (4b) $0/visit"	"(9a) $0.00, (9b) $0.00"	(8a) $0.00	(8b) 0-20%	(9c) $5/visit	(12a) 20%	"(3) $0.00, (5) $10/visit, (7g) $0.00, (9a) $0.00, (9b) $0.00"	"(7a) $0.00, (7g) $0.00, (14a) $0.00"	"(7b) $0.00 (7d) $0.00, (7f) $0.00, (14a) $0.00, (14d) $0.00, (14e) $0.00, (16b) $0.00, (18a) $0.00"	"(7e) $5/visit, (7h) $5/visit"	(7c) $0.00 (7i) $0.00	"(7g) $0.00, (8b) 20%"	(7g) $0.00	(15) 20%	"(9d) $0.00, (17a) $0.00, (17b) $0.00"	(10b) not covered	"(16a1) $0.00 (Oral Exams, Cleaning and Fluoride), (16a2) $0.00 (Dental X-Rays), (16b1) $0.00 (Diagnostic, Restorative, Endodontics, Periodontics, Extractions, Surgery and Other)"	"(17a1) $0.00, 1 per year"	"(17b1) $0.00, Limited to $300 every year (1 pair)"	"(18a1) $0.00, 1 routine every year, 1 fitting every year"	(18b) Limited to $500 every year	(14c) $0.00	"(13a) $10/visit, 6 treatments per year; (13b) Limited to $8 per month"															21.2705262		50	0.037934623	0.037934623	13			0.2	5	0.2	10			5		11.02441175		0.2									10											NO			21.25643991		49.96688777	0.037909501	0.037909501	12.99139082			0.199867551	4.996688777	0.199867551	9.993377554			4.996688777		11.01711089		0.199867551									9.993377554												0	0	0.586019108	0	1.931161402	0.043623077	0.046905023	0.20688413	0	0	0.042497781	9.64E-05	0.017552822	0.019705616	0	0	0.080096349	0	0.156622797	0	1.72786519	0	0	0	0	0	0	0	0	0.574833436	0	0	0	0	0	0	0	0	0	0	5.4339	0		0.003600931	0	0	0.586019108	0	1.931161402	0.043623077	0.046905023	0.20688413	0	0	0.042497781	9.64E-05	0.017552822	0.019705616	0	0	0.080096349	0	0.156622797	0	1.72786519	0	0	0	0	0	0	0	0	0.574833436	0	0	0	0	0	0	0	0	0	0	5.4339	NO																																																																																		0	0		0	0	0	0.586019108	0	1.931161402	0.043623077	0.046905023	0.20688413	0	0	0.042497781	9.64E-05	0.017552822	0.019705616	0	0	0.080096349	0	0.156622797	0	1.72786519	0	0	0	0	0	0	0	0	0.574833436	0	0	0	0	0	0	0	0	0	0	5.4339
H5649_002_0	2012	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																																									0	"(1a) $0.00, (1a1) $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, (4a1) $0.00, (4b) $0.00"	"(9a) $0.00, (9b) $0.00"	(8a) $0.00	"(8b) $0.00, (14h) $0.00"	(9c) $0.00	(12a) $0.00	"(3) $0.00, (5) $0.00, (7g) $0.00, (9b) $0.00"	"(7a) $0.00, (7g) $0.00, (14a) $0.00"	"(7b) $0.00, (7d) $0.00, (7f) $0.00, (14a) $0.00, (14d) $0.00, (14e) $0.00,  (16b) $0.00, (18a) $0.00"	"(7e) $0.00, (7h) $0.00"	(7c) $0.00 (7i) $0.00	"(7g) $0.00, (8b) $0.00"	"(7g) $0.00,"	(15) $0.00	"(9d) $0.00, (17a) $0.00, (17b) $0.00"	"(10b) $0/Trip, 40 single trips on bus/subway/taxi/van"	"(16a1) $0.00 (Oral Exams, Cleaning and Fluoride), (16a2) $0.00 (Dental X-Rays), (16b1) $0.00 (Diagnostic, Restorative, Endodontics, Periodontics, Extractions, Surgery and Other)"	"(17a1) $0.00, 1 per year"	"(17b1) $0.00, Limited to $300 every year (1 pair)"	"(18a1) $0.00, 1 routine every year, 1 fitting every year"	(18b) Limited to $1000 every year	(14c) $0.00	"(13a) 24 treatments per year, (13b) $0.00, Limited to $25/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	2012	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	1569.180667	88.09310787	2476.482761	1954.376245	496.7113118	12.89899434	7.988094594	463.0938848	444.5827263	19092.98831	5698.404353	0	0.103440405	813.4740837	9658.467653	7692.879809	964.1280434	3864.378033	0	9016.528228	27.88968324	1754.680123	1115.103785	1005.117848	55.68846052	180.3037425	18.28865201	0	78.4	223.7525919											5000	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$75 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	"$0 (8a1a, 8a2)"	$20 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	20% (12)	"$0 (3); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	20% (15); $0 (15a1); $0 n/c (15a2)	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13e4, 13e5); $0 (13d5)"											0	NO	0	0	33.30934061	0	75	0.2	0.2	47.73277932	20.5	0	12.81879174	0	0.2	17.94147189	0.444798322	22.33245096	24.57379261	0	0	0	0.103470461	29.59266884	0	30	30	0	30	0	0	0											NO	0	0	31.58104205	0	71.10852723	0.189622739	0.189622739	45.25925615	19.43633078	0	12.15367202	0	0.189622739	17.01055523	0.440904288	22.13693917	24.35865876	0	0	0	0.098101761	28.05721464	0	30	30	0	30	0	0	0												0	0	6.517492186	0	2.943367487	2.445942641	1.514724379	1.746607063	0.720088077	0	5.771378131	0	0.019614653	1.153137153	0.35487165	14.19140103	1.957072168	0	0	0	2.736027045	4.102619737	0	2.512794619	0.139221151	0	0.04572163	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8721	0	NO	1.769397768	0	0	6.517492186	0	2.943367487	2.445942641	1.514724379	1.746607063	0.720088077	0	5.771378131	0	0.019614653	1.153137153	0.35487165	14.19140103	1.957072168	0	0	0	2.736027045	4.102619737	0	2.512794619	0.139221151	0	0.04572163	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8721	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.	20% (12)	"30% (3, 5, 9a, 9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5273	1.4131	0.0919	0.2518	0	0	0.3035	0.2081	0	0	0.009	0	0.0007	0	0	0											2.8055	0	NO	0	0	0	6.517492186	0	2.943367487	2.445942641	1.514724379	1.746607063	0.720088077	0	5.771378131	0	0.019614653	1.153137153	0.882201454	15.60452808	2.048970523	0.251759745	0	0	3.039489919	4.310749791	0	2.512794619	0.148240299	0	0.046446247	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6775
H5652_002_0	2012	3																															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	2649.232205	211.6760896	2789.133674	4451.195067	702.5582076	17.45831162	13.23661191	694.7682538	538.6706038	22970.52711	7817.864966	0	0.027482645	1256.544753	10123.59569	8480.658644	1133.532467	2077.929042	0	9157.250151	27.93748859	2065.938797	1425.934614	1207.288	43.04300301	160.6476696	17.54670261	0	78.4	388.155425											5000	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$75 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	"$0 (8a1a, 8a2)"	$20 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	20% (12)	"$0 (3); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	20% (15); $0 (15a1); $0 n/c (15a2)	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13e4, 13e5); $0 (13d5)"											0	NO	0	0	31.25739926	0	75	0.2	0.2	46.53988177	20.5	0	13.20004701	0	0.2	17.88415716	0.971631526	25.54469789	19.26511435	0	0	0	0.142633729	29.36223977	0	30	30	0	30	0	0	0											NO	0	0	28.72357596	0	68.92026361	0.18378737	0.18378737	42.77039503	18.83820539	0	12.1300096	0	0.18378737	16.43441101	0.958076628	25.18833258	18.99635336	0	0	0	0.131071389	26.98204407	0	30	30	0	30	0	0	0												0	0	6.676157745	0	4.035041406	3.208617172	2.432722085	2.476292723	0.845632289	0	7.902564756	0	0.005050963	1.720881076	0.808265035	17.80113753	1.794415274	0	0	0	3.661805434	4.645270972	0	3.01822	0.107607508	0	0.043866757	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1835	0	NO	3.606207409	0	0	6.676157745	0	4.035041406	3.208617172	2.432722085	2.476292723	0.845632289	0	7.902564756	0	0.005050963	1.720881076	0.808265035	17.80113753	1.794415274	0	0	0	3.661805434	4.645270972	0	3.01822	0.107607508	0	0.043866757	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1835	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.	20% (12)	"30% (3, 5, 9a, 9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5332	1.7231	0.1181	0.1806	0	0	0.304	0.2362	0	0	0.0077	0	0.0008	0	0	0											3.1036	0	NO	0	0	0	6.676157745	0	4.035041406	3.208617172	2.432722085	2.476292723	0.845632289	0	7.902564756	0	0.005050963	1.720881076	1.34142885	19.5241927	1.91252668	0.180638618	0	0	3.96578847	4.881438815	0	3.01822	0.115309991	0	0.044646123	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2872
H5652_003_0	2012	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	673.5687983	465.3342954	6473.589093	9.364309364	614.2590265	4047.702003	621.6858768	253.6262576	101.7356584	35990.48999	4301.010325	0	0	331.2857932	877.0299685	10991.40504	1975.929383	69.16713115	0	37338.97392	502.2952302	676.8444336	941.2458881	0	32.00205332	118.4129042	18.55445605	21.30122729	0	4091.662966											500	"$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)	$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)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $20 (7a1); $0 n/c (14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	0	0	0	50	0	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	47.14697451	0	0	47.14697451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	2.413371222	0	0	0.996475892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.4098	0	NO	0.20634157	0	0	0	0	2.413371222	0	0	0.996475892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.4098	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.	$0 (12)	"30% (3, 5, 9a, 9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0104	0.6728	0.0665	0.0018	0	0	0.1342	0.0377	0	0	0.0026	0	0.0003	0	0	0											0.9265	0	NO	0	0	0	0	0	2.413371222	0	0	0.996475892	0	0	0	0	0	0	0.010445789	0.67283746	0.066501467	0.001761651	0	0	0.134243811	0.037729565	0	0	0.002637815	0	0.000341801	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3363
H5652_004_0	2012	4																															D	D	D	V	T	O	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	2367.660624	148.4625051	4202.639129	2228.600755	906.0053401	3691.243277	15.47884311	631.2417001	588.9667793	29346.49234	8253.040164	0	0.032372628	1193.843151	13742.78262	11656.62059	1417.097495	6045.607757	0	10461.22592	48.81391321	2245.192698	1294.817064	1001.440534	61.2798635	204.5005383	20.64790269	0	78.4	146.5145277											5000	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$75 (10a)	$0 (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	"$0 (8a1a, 8a2)"	$20 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	20% (12)	"$0 (3); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $30 (7a1); $0 n/c (14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	20% (15); $0 (15a1); $0 n/c (15a2)	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13e4, 13e5); $0 (13d5)"											0	NO	0	0	32.80368898	0	75	0	0.10664118	48.38936882	20.5	0	12.780085	0	0.2	17.87088596	0.302711791	22.41312472	26.49408511	0	0	0	0.133562275	29.63141815	0	30	0	0	30	0	0	0											NO	0	0	29.52820899	0	67.51117764	0	0.095992956	43.56264449	18.45305522	0	11.50398118	0	0.180029807	16.08646075	0.297465699	22.02469814	26.03493418	0	0	0	0.120225953	26.67269246	0	30	0	0	30	0	0	0												0	0	10.34136721	0	5.097123955	0	1.485859899	2.291546481	0.905686375	0	7.911901563	0	0.005828038	1.600392583	0.340667204	21.39446249	3.074503333	0	0	0	5.868699213	4.990444529	0	2.503601335	0	0	0.051619757	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8637	0	NO	4.929671223	0	0	10.34136721	0	5.097123955	0	1.485859899	2.291546481	0.905686375	0	7.911901563	0	0.005828038	1.600392583	0.340667204	21.39446249	3.074503333	0	0	0	5.868699213	4.990444529	0	2.503601335	0	0	0.051619757	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8637	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.	20% (12)	"30% (3, 5, 9a, 9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7536	2.2133	0.1301	0.4124	0	0	0.5311	0.2668	0	0	0.0091	0	0.0008	0	0	0											4.3172	0	NO	0	0	0	10.34136721	0	5.097123955	0	1.485859899	2.291546481	0.905686375	0	7.911901563	0	0.005828038	1.600392583	1.094230946	23.60775394	3.204644564	0.412399622	0	0	6.399835056	5.257220332	0	2.503601335	0.009109367	0	0.052395932	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1809
H5656_001_0	2012	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	P																																																			0	YES	1617.663469	148.8838202	807.1361094		99.20757603	11.00082569	6.435805862	384.5944434	228.9244883		5172.422096		6.159341224	52.07547181		4685.039384	459.5801057	428.7774817		125.3937641	25.71421329	941.8118134		712.1074873	129.1965004																3000	(1a/1a1) $250/Day Days 1 - 7	(1b) $250/Day Days 1 - 7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 15%	(11b) 15% (11c) 0-20%	(4a) $65 (4a1) $65 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	Included in h.5.	(12) $30	(3) $20 (5) $20 (9a) $150 (9c) 35 Ind/20 Grp (3) $20	(7a) $0 (14b) $0 (14a) $0 (14a) $0 (13d) $0 (14b2) $0 (14a) $0 (14a) $0 (14a) $0 (14a) $0 (14e) $0 (14b) $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%	(9d) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $20	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14c) $0  (14c) $0	(13d) $0													222.4456251	176.1697852	38.99172655		100	0.15	0.181169138	64.96030038	75		24.34220835		30	131.6825642		19.96358377	31.25	20		20	0.2	24.98703914		15	25																NO	171.6155782	135.9140219	30.08190292		77.14945087	0.115724176	0.139770995	50.11651503	57.86208815		18.77988007		23.14483526	101.5923752		15.40179525	24.1092034	15.42989017		15.42989017	0.154298902	19.27951533		11.57241763	19.28736272																	23.1347	1.686283234	2.023349173	0	0.637817501	1.273061492	0.899538992	1.6062111	1.10383741	0	8.094788886	0	0.011879745	0.440872572	0	6.013168111	0.92334252	0.551332454	0	0.161234334	3.96767487	1.513139608	0	0.68673377	0.20765498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9366	0		16.27120823	23.1347	1.686283234	2.023349173	0	0.637817501	1.273061492	0.899538992	1.6062111	1.10383741	0	8.094788886	0	0.011879745	0.440872572	0	6.013168111	0.92334252	0.551332454	0	0.161234334	3.96767487	1.513139608	0	0.68673377	0.20765498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9366	NO																																																																																		0	0		0	23.1347	1.686283234	2.023349173	0	0.637817501	1.273061492	0.899538992	1.6062111	1.10383741	0	8.094788886	0	0.011879745	0.440872572	0	6.013168111	0.92334252	0.551332454	0	0.161234334	3.96767487	1.513139608	0	0.68673377	0.20765498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9366
H5656_003_0	2012	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	P																																																			0	YES	1276.875539	127.4554381	678.2375694		85.90561557	7.158682875	3.340853058	285.2910289	135.9788419		3432.192092		2.526458343	36.02691221		2947.697878	410.6657628	256.5134416		80.59890284	14.33184021	623.0623394		694.0892105	125.8286339																3000	(1a/1a1) $75/Day Days 1 - 7	(1b) $75/Day Days 1 - 7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 15%	(11b) 15% (11c) 0-20%	(4a) $65 (4a1) $65 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	Included in h.5.	(12) $30	(3) $20 (5) $20 (9a) $150 (9c) 35 Ind/20 Grp (3) $20	(7a) $0 (14b) $0 (14a) $0 (14a) $0 (13d) $0 (14b2) $0 (14a) $0 (14a) $0 (14a) $0 (14a) $0 (14e) $0 (14b) $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%	(9d) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $20	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14c) $0  (14c) $0	(13d) $0													66.73368752	52.85093557	38.99172655		100	0.15	0.182927581	64.97804774	75		21.98533406		30	132.3918538		19.97619929	31.25	20		20	0.2	24.96418256		15	25																NO	61.55509982	48.74966057	35.96593728		92.23991976	0.13835988	0.168732254	59.9356991	69.17993982		20.27925449		27.67197593	122.1181397		18.42603019	28.82497493	18.44798395		18.44798395	0.18447984	23.02883174		13.83598796	23.05997994																	6.5499	0.517784112	2.03278749	0	0.660327257	0.990474501	0.563709667	1.424926439	0.783917341	0	5.800191408	0	0.005826008	0.366628292	0	4.526197508	0.986452526	0.394346321	0	0.123907272	2.643935582	1.195699815	0	0.800284164	0.241800481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.609	0		2.57501138	6.5499	0.517784112	2.03278749	0	0.660327257	0.990474501	0.563709667	1.424926439	0.783917341	0	5.800191408	0	0.005826008	0.366628292	0	4.526197508	0.986452526	0.394346321	0	0.123907272	2.643935582	1.195699815	0	0.800284164	0.241800481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.609	NO																																																																																		0	0		0	6.5499	0.517784112	2.03278749	0	0.660327257	0.990474501	0.563709667	1.424926439	0.783917341	0	5.800191408	0	0.005826008	0.366628292	0	4.526197508	0.986452526	0.394346321	0	0.123907272	2.643935582	1.195699815	0	0.800284164	0.241800481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.609
H5656_014_0	2012	5																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	809.7444652	11.02659535	676.532397	2201.160307	202.7094048	12.87259042	1.182935799	243.7514105	296.2535303	5.025633757	17.41352706	0	19.05112467	1316.005323	4662.042195	11433.77342	1.087738793	2061.128488	18.40882978	11714.68386	10.53530549	0	0	0	383.1293659	0	164.1982997	0	0	0											6700	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	2:$135 Per Day (Days 21-100)	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $350; 9b: $175	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14a: $0; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	63.3762365	309.75	0.2	0.2	0	0	14.07738426	24.69981876	15.75582648	0.4	0	0.182963388	3.847730598	0.2	0	0	0	20	0	20	0	0	0											NO	195.5560723	195.5560723	112.3407224	0	124.8230249	0.1664307	0.1664307	52.97331633	257.7595464	0.1664307	0.1664307	0	0	11.71454457	20.55404061	13.11126614	0.3328614	0	0.152253624	3.201902482	0.1664307	0	0	0	20	0	20	0	0	0												13.1959	0.17969314	6.333511518	0	2.108566757	2.142394233	0.196876833	1.076026714	6.363514632	0.836419743	2.898145495	0	0	1.284700251	7.98531705	12.49260386	0.362066257	0	2.802811045	3.125772943	1.753398265	0	0	0	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0499	0		13.0772022	13.1959	0.17969314	6.333511518	0	2.108566757	2.142394233	0.196876833	1.076026714	6.363514632	0.836419743	2.898145495	0	0	1.284700251	7.98531705	12.49260386	0.362066257	0	2.802811045	3.125772943	1.753398265	0	0	0	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0499	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	13.1959	0.17969314	6.333511518	0	2.108566757	2.142394233	0.196876833	1.076026714	6.363514632	0.836419743	2.898145495	0	0	1.284700251	7.98531705	12.49260386	0.362066257	0	2.802811045	3.125772943	1.753398265	0	0	0	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0499
H5656_015_0	2012	5																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	809.0767394	11.01843315	680.9238734	34.29016659	202.7094048	12.87259042	1.182935799	243.7514105	296.2535303	1108.762928	17.52403239	0	19.06171329	1321.504557	4728.285499	11497.89822	1.087738793	2083.106124	18.60014976	11825.19711	10.53530549	0	0	46.05630506	383.1293659	0	164.1982997	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: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $245; 9b: $123	8a: $0	8b: 20%	5: $250; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $30; 7c: $30; 7i: $30	7a : $15; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $40; 7g: $40; 14a: $0; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $30; 7i: $30; 3: $30	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0		16a: $15; 16b: $0	17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		250	250	100	0.15	150	0.2	0.2	63.3762365	216.94	0	0.2	0	0	9.459444503	12.37614527	12.82252838	0.4	0	0.183152393	1.095486513	0.2	0	0	15	20	0	20	0	0	0											NO	159.5657066	159.5657066	63.82628264	0.095739424	95.73942396	0.127652565	0.127652565	40.95621034	138.4647376	0	0.127652565	0	0	6.037611785	7.89923346	8.184143205	0.255305131	0	0.116899364	0.699208318	0.127652565	0	0	15	20	0	20	0	0	0												10.7584	0.146513673	3.621736634	3.282920797	1.617273471	1.64321919	0.151004789	0.831927836	3.418388943	0	2.236987689	0	0	0.66489429	3.112485918	7.841703798	0.277705295	0	2.174345678	0.689023015	1.344858771	0	0	0.057570381	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7832	0		24.66349434	10.7584	0.146513673	3.621736634	3.282920797	1.617273471	1.64321919	0.151004789	0.831927836	3.418388943	0	2.236987689	0	0	0.66489429	3.112485918	7.841703798	0.277705295	0	2.174345678	0.689023015	1.344858771	0	0	0.057570381	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7832	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		0	10.7584	0.146513673	3.621736634	3.282920797	1.617273471	1.64321919	0.151004789	0.831927836	3.418388943	0	2.236987689	0	0	0.66489429	3.112485918	7.841703798	0.277705295	0	2.174345678	0.689023015	1.344858771	0	0	0.057570381	0.638548943	0	0.273663833	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7832
H5656_801_0	2012	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	280.0019946	11.58720629	30.08893171		7.091029436	12.03794528	7.042551257	25.46614215	48.79510572	27.11469228	57.40765055		0.061645009	13.1278281	43.33288748	159.4270059	3.804264447	6.518470592		6.949979762	28.13845989	6.918579178																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.078001865	0.078001865	0.18973726		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.066294577	0.066294577	0.161259625		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876																				18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	0		23.35590387	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	NO																																																																																		0	0		0	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696
H5656_802_0	2012	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	280.0019946	11.58720629	30.08893171		7.091029436	12.03794528	7.042551257	25.46614215	48.79510572	27.11469228	57.40765055		0.061645009	13.1278281	43.33288748	159.4270059	3.804264447	6.518470592		6.949979762	28.13845989	6.918579178																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.078001865	0.078001865	0.18973726		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.066294577	0.066294577	0.161259625		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876																				18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	0		23.35590387	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	NO																																																																																		0	0		0	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696
H5656_803_0	2012	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	280.0019946	11.58720629	30.08893171		7.091029436	12.03794528	7.042551257	25.46614215	48.79510572	27.11469228	57.40765055		0.061645009	13.1278281	43.33288748	159.4270059	3.804264447	6.518470592		6.949979762	28.13845989	6.918579178																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Included in h.5.	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.078001865	0.078001865	0.18973726		0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224																			NO	0.066294577	0.066294577	0.161259625		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876	0.190379876	0.190379876	0.190379876		0.190379876	0.190379876	0.190379876																				18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	0		23.35590387	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696	NO																																																																																		0	0		0	18.5626	0.768168944	4.852129849	0	1.349989304	2.291782529	1.340760034	4.848240983	9.289606172	5.162091752	10.92926139	0	0.011735969	2.499274284	8.249709741	30.35169361	0.724255393	1.240985622	0	1.323136285	5.356996503	1.317158246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4696
H5665_002_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2768.959923	9.414631314	288.1802827	0	330.948558	31.06532978	5.522929439	644.4071569	294.2183666	7.373234307	20.00408664	0	1.095587199	1839.695969	4483.452352	5923.31692	123.174704	284.8579189	16.28753844	58.39472227	26.22012388	500.7069539	0	40.85777071	73.26220956	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$185/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$25/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	185	0.2	0.2	63.00332298	150	0.2	0.2	0	0.2	37.22299495	35	49.42819865	39.75574652	50	0.2	0.175359289	0.2	49.77295816	0	10	25	0	0	0	0	0											NO	169.0850235	966.2001345	125.6060175	0	178.7470249	0.193240027	0.193240027	60.87381914	144.9300202	0.193240027	0.193240027	0	0.193240027	35.96486273	33.81700471	47.75753219	38.41200764	48.31000673	0.193240027	0.169432168	0.193240027	48.09063887	0	10	25	0	0	0	0	0												39.0158	0.758034837	3.016431469	0	4.929672512	6.003065163	1.067251033	3.268960394	3.553422818	1.424803996	3.865590241	0	0.2117113	5.513701082	12.63474411	23.5735832	0.394282306	1.146790665	3.147404366	9.893944407	5.066777443	2.006609775	0	0.034048142	0.152629603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6793	0	NO	4.564925715	39.0158	0.758034837	3.016431469	0	4.929672512	6.003065163	1.067251033	3.268960394	3.553422818	1.424803996	3.865590241	0	0.2117113	5.513701082	12.63474411	23.5735832	0.394282306	1.146790665	3.147404366	9.893944407	5.066777443	2.006609775	0	0.034048142	0.152629603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6793	NO																																										0	0	0	0	0	0	0	0	0	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	39.0158	0.758034837	3.016431469	0	4.929672512	6.003065163	1.067251033	3.268960394	3.553422818	1.424803996	3.865590241	0	0.2117113	5.513701082	12.63474411	23.5735832	0.394282306	1.146790665	3.147404366	9.893944407	5.066777443	2.006609775	0	0.034048142	0.152629603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6793
H5679_001_0	2012	9	H.6										OP Facility - Other										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	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	YES	1267.861299	40.63861808	468.2279423	515.2131983	224.5467209	14.12274112	5.098485831	276.8906426	326.4351447	10445.72001	658.1379552	0.070393217	0.008613633	849.1660829	3232.085683	2622.22509	5.356542336	1407.311021	705.4736103	1761.681508	64.5473578	27.90499596	0.005689049	0	0	0	0	0	5872.8	259.3499666	13.04507696	0	0	0	0	0	0	0	0	0	4300	1A: $230/day (days1-7) no yrly max	1B: $205/day (days1-7) no yrly max	2: $146/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: $0 - $100 copay; 9B: $100 copay	8A: $0-$200 copay	8B: $35-$200 copay	5: $35 copay	12: 20% coin	3: $35 copay; 9A: $35-$100 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35 copay; 7I: $35 copay	8B: $35-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	171.7471818	161.8301105	146	0	100	0.2	0.108720044	49.94662557	93.38886283	26.00283275	88.3973952	35	0.2	42.8056926	10	34.62783508	40	35	75.60550288	0.83886278	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	156.3702648	147.3410916	132.928287	0	91.04677191	0.182093544	0.09898609	45.47479026	85.02754494	23.67473982	80.48297479	31.86637017	0.182093544	38.9732013	9.104677191	31.52752602	36.41870877	31.86637017	68.83636977	0.763757482	0.182093544	0	0	0	0	0	0	0	0	0	0.182093544	0	0	0	0	0	0	0	0	0		16.5213	0.498978196	5.186728191	0	1.70368784	2.571659979	0.504679178	1.049295325	2.312998245	20.60830863	4.414075038	0.000186931	0.001568487	2.757893391	2.452258066	6.889355814	0.01625653	3.737157828	4.046853525	0.112124786	11.75365713	0	0	0	0	0	0	0	0	0	2.375424292	0	0	0	0	0	0	0	0	0	89.5145		NO	8.802546231	16.5213	0.498978196	5.186728191	0	1.70368784	2.571659979	0.504679178	1.049295325	2.312998245	20.60830863	4.414075038	0.000186931	0.001568487	2.757893391	2.452258066	6.889355814	0.01625653	3.737157828	4.046853525	0.112124786	11.75365713	0	0	0	0	0	0	0	0	0	2.375424292	0	0	0	0	0	0	0	0	0	89.5145	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	16.5213	0.498978196	5.186728191	0	1.70368784	2.571659979	0.504679178	1.049295325	2.312998245	20.60830863	4.414075038	0.000186931	0.001568487	2.757893391	2.452258066	6.889355814	0.01625653	3.737157828	4.046853525	0.112124786	11.75365713	0	0	0	0	0	0	0	0	0	2.375424292	0	0	0	0	0	0	0	0	0	89.5145
H5679_801_0	2012	6																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	261.4653969	3.039946243	101.015347	0	15.0657569	20.58891475	12.8269127	17.63485884	54.46860686	3.371388863	26.53293557	0	0.602150844	34.11011399	38.19538113	75.96136583	1.770366135	6.808799249	28.86916536	113.1435243	52.04705573	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077953808	0.077953808	0.148036649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.061963094	0.061963094	0.117669798	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0	0	0	0	0	0	0	0												16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	0	NO	30.36355207	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	NO																																										0	0	0	0	0	0	0	0	0	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	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657
H5679_802_0	2012	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	261.4653969	3.039946243	101.015347	0	15.0657569	20.58891475	12.8269127	17.63485884	54.46860686	3.371388863	26.53293557	0	0.602150844	34.11011399	38.19538113	75.96136583	1.770366135	6.808799249	28.86916536	113.1435243	52.04705573	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077953808	0.077953808	0.148036649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.061963094	0.061963094	0.117669798	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0	0	0	0	0	0	0	0												16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	0	NO	30.36355207	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	NO																																										0	0	0	0	0	0	0	0	0	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	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657
H5679_803_0	2012	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	261.4653969	3.039946243	101.015347	0	15.0657569	20.58891475	12.8269127	17.63485884	54.46860686	3.371388863	26.53293557	0	0.602150844	34.11011399	38.19538113	75.96136583	1.770366135	6.808799249	28.86916536	113.1435243	52.04705573	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.077953808	0.077953808	0.148036649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.061963094	0.061963094	0.117669798	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0.178050739	0	0	0	0	0	0	0	0	0												16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	0	NO	30.36355207	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657	NO																																										0	0	0	0	0	0	0	0	0	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	16.2012	0.188364476	11.88645549	0	2.682469148	3.665871485	2.283841285	3.139899647	9.698175701	0.600278278	4.724208785	0	0.107213403	6.073331001	6.800715833	13.52497732	0.315214999	1.212311738	5.140176224	20.1452881	9.267016733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.657
H5685_001_0	2012	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	257.3412537	29.08012442	63.8673708	0	14.99913145	15.62576245	10.50617091	27.39146973	42.17603572	6.549195431	15.14747278	0	2.643628936	25.29313876	51.78380862	57.97166992	9.628178386	4.711754169	17.26925336	67.84356456	31.04710322	25.57940486	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	10B Transportation: Not Covered	16A Preventative Dental Services (Non Medicare Covered): $0; 16B Comprehensive Dental (Non Medicare Covered): $0	17A Routine Eye Exams (Non Medicare Covered): Biennial vision exams at $0	17B Eye Wear (Non Medicare Covered): Vision hardware at $0 limited to $125 biennially	18A Routine Hearing Exams (Non Medicare Covered): Annual exams at $0	18B Hearing Aids (Non Medicare Covered): Not Covered	14C Health Education/Wellness Program: Written materials at $0	"7F Podiatry Services: 6 Routine podiatry visits at $0, 13A Acupuncture: Not Covered, 13B Other-the-counter Rx: $25 / month OTC card expiring monthly at $0, 13C Meal Benefit: Not covered, 13D Other 1: Emergency response service at $0 for high-risk beneficiaries, 13E Other 2: Not Covered"											0	NO	0.067915493	0.067915493	0.179172433	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061778035	0.061778035	0.162980791	0	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0.203757333	0	0	0	0	0	0	0	0												15.898	1.796512932	10.40915459	0	3.056183027	3.183863688	2.140709369	5.581212829	8.59367657	1.334446597	3.08640866	0	0.538658782	5.153662506	10.55133076	11.81215287	1.961811953	0.960054465	3.518737014	13.8236238	6.32607496	5.211991323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9383	0	NO	11.41876823	15.898	1.796512932	10.40915459	0	3.056183027	3.183863688	2.140709369	5.581212829	8.59367657	1.334446597	3.08640866	0	0.538658782	5.153662506	10.55133076	11.81215287	1.961811953	0.960054465	3.518737014	13.8236238	6.32607496	5.211991323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9383	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.898	1.796512932	10.40915459	0	3.056183027	3.183863688	2.140709369	5.581212829	8.59367657	1.334446597	3.08640866	0	0.538658782	5.153662506	10.55133076	11.81215287	1.961811953	0.960054465	3.518737014	13.8236238	6.32607496	5.211991323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9383
H5696_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	2010.985623	15.76069958	693.0875068	2434.774661	220.9668816	5.06	6.751471236	855.8787629	1136.515947	3354.000035	361.6492956	3.805542734	0.093272056	442.3328682	6482.17162	2765.148853	162.6303099	547.4020133	425.0039658	580.8155396	13.33396715	0.040207984	0	2965.863017	1054.629254	0.034580472	1053.588102	0	2043.975361	0											3400	1a1: $100 days 1-6;$0 days 7-90	1b1: $100 days 1-10;$0 days 11-90	21: $0 days 1-5;$60 days 6-60;$0 days 61-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $5"	"9a1: $5-$125,9b: $50"	"8a1: $0-$5,8a2: $40-$60"	"8b1: $0-$10,8b2: $125,8b3: $55,8b4: $55,8b5: $40,8b6: $40"	"9c1: $15,9c2: $15"	12: 20%	"31: $15,32: $15,33: $15,37: $15,5: $100,9a2: $5-$125,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $15,7d1: $15,7f1: $15,16b1: 0%,17a1: $10,18a1: $10"	"7c: $15,7i: $15"	"7e1: $15,7e2: $15,7h1: $15,7h2: $15"	7d2:	7g: $15	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													70.60082986	62.67508081	37.19478665	0	150	0.2	0.199997319	45.82318933	54.45096376	3.843972997	49.323118	14.76658674	0.2	26.43770869	0	11.21875483	15	15	0	15	0.199917674	0	0	0	0	0	0	0	0	0											NO	64.06713406	56.87486694	33.75262567	0	136.1183732	0.181491164	0.181488732	41.58251992	49.41184404	3.488235673	44.75855056	13.4000251	0.181491164	23.99105265	0	10.18052438	13.61183732	13.61183732	0	13.61183732	0.181416457	0	0	0	0	0	0	0	0	0												10.7365	0.074698974	1.949460264	0	2.506471038	0.918345291	1.225315952	2.965799642	4.679779062	0.974961881	1.34890819	0.004249531	0.016928054	0.884335928	0	2.345888775	0.184474777	0.62092893	0	0.658830553	2.419001085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5149	0	NO	3.51989773	10.7365	0.074698974	1.949460264	0	2.506471038	0.918345291	1.225315952	2.965799642	4.679779062	0.974961881	1.34890819	0.004249531	0.016928054	0.884335928	0	2.345888775	0.184474777	0.62092893	0	0.658830553	2.419001085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5149	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				10.7365	0.074698974	1.949460264	0	2.506471038	0.918345291	1.225315952	2.965799642	4.679779062	0.974961881	1.34890819	0.004249531	0.016928054	0.884335928	0	2.345888775	0.184474777	0.62092893	0	0.658830553	2.419001085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5149
H5696_002_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1197.545593	2.779172877	578.7106764	1232.237432	125.0268522	4.636613603	2.649847425	536.6095013	921.1748535	2464.897206	329.9559226	0	0.013600952	330.8181767	5343.160281	2390.249704	82.07483924	376.6803148	338.4747172	519.2313514	16.45013444	0	0	1046.344083	1046.344083	0.26032342	1046.344083	0	1000	0											4200	1a1: $130 days 1-4;$0 days 5-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $10-$175,9b: $100"	"8a1: $0-$10,8a2: $60-$85"	"8b1: $0-$15,8b2: $175,8b3: $55,8b4: $55,8b5: $60,8b6: $60"	"9c1: $20,9c2: $20"	12: 20%	"31: $20,32: $20,33: $20,37: $20,5: $130,9a2: $10-$175,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $20,7f1: $20,16b1: 0%,17a1: $40,18a1: $40"	"7c: $20,7i: $20"	"7e1: $20,7e2: $20,7h1: $20,7h2: $20"	7d2:	7g: $20	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													74.77999265	87.74511313	43.07564125	0	150	0.2	0.20008856	45.6293519	97.86583463	6.534806437	61.08013937	0	0.2	33.66854909	0	17.36510759	20	20	0	20	0.199954896	0	0	0	20	10	1.83496044	0	0	0											NO	72.54028673	85.11709402	41.78549979	0	145.5074094	0.194009879	0.194095787	44.26272527	94.93469381	6.339085039	59.25075233	0	0.194009879	32.66015572	0	16.84501213	19.40098793	19.40098793	0	19.40098793	0.193966126	0	0	0	20	10	1.83496044	0	0	0												7.2392	0.019712927	2.015142904	0	1.516027781	0.899548845	0.514324221	1.979316577	7.287621055	1.302099417	1.629178054	0	0.002638719	0.900381097	0	3.355315439	0.132694414	0.60899752	0	0.839466765	3.190768855	0	0	0	1.743906806	0.000216936	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3366	0	NO	1.032237487	7.2392	0.019712927	2.015142904	0	1.516027781	0.899548845	0.514324221	1.979316577	7.287621055	1.302099417	1.629178054	0	0.002638719	0.900381097	0	3.355315439	0.132694414	0.60899752	0	0.839466765	3.190768855	0	0	0	1.743906806	0.000216936	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3366	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.2392	0.019712927	2.015142904	0	1.516027781	0.899548845	0.514324221	1.979316577	7.287621055	1.302099417	1.629178054	0	0.002638719	0.900381097	0	3.355315439	0.132694414	0.60899752	0	0.839466765	3.190768855	0	0	0	1.743906806	0.000216936	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3366
H5696_003_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1857.80572	14.78640141	384.0450048	1369.412514	266.0685613	5.06	1.835215104	769.5094032	922.4282342	4278.996575	472.9560988	0	0.03229478	233.747356	5024.481972	1467.07019	232.5642786	394.5384585	399.8281558	649.5383499	3.12609667	0	0	1047.513878	1047.513878	0	1047.513878	0	0	0											3400	1a1: $60 days 1-10;$0 days 11-90	1b1: $75 days 1-10;$0 days 11-90	21: $0 days 1-5;$75 days 6-50;$0 days 51-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $20"	"9a1: $10-$125,9b: $50"	"8a1: $5-$10,8a2: $40-$75"	"8b1: $0-$10,8b2: $125,8b3: $55,8b4: $55,8b5: $40,8b6: $40"	"9c1: $15,9c2: $15"	12: 20%	"31: $15,32: $15,33: $15,37: $15,5: $60,9a2: $10-$125,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $15,7d1: $15,7f1: $15,16b1: 0%,17a1: $10,18a1: $10"	"7c: $15,7i: $15"	"7e1: $15,7e2: $15,7h1: $15,7h2: $15"	7d2:	7g: $15	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													50.34733889	47.0063106	46.39350116	0	139.4757925	0.2	0.2	48.10503903	54.15482534	8.3232291	53.46997691	0	0.2	27.14369159	0	10.35837525	14.15857485	15	0	15	0.199916228	0	0	0	0	0	0	0	0	0											NO	48.75119288	45.51608417	44.92270243	0	135.0540349	0.193659462	0.193659462	46.57997995	52.43797177	8.059360359	51.77483487	0	0.193659462	26.28316358	0	10.02998691	13.70970996	14.52445967	0	14.52445967	0.193578346	0	0	0	0	0	0	0	0	0												7.5475	0.056084924	1.437694956	0	2.994469397	0.979916879	0.35540677	2.986977715	4.030855475	2.873831281	2.040601993	0	0.00625419	0.511968333	0	1.226224567	0.265699067	0.477538161	0	0.786182797	0.605144624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1824	0	NO	0.955449975	7.5475	0.056084924	1.437694956	0	2.994469397	0.979916879	0.35540677	2.986977715	4.030855475	2.873831281	2.040601993	0	0.00625419	0.511968333	0	1.226224567	0.265699067	0.477538161	0	0.786182797	0.605144624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1824	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.5475	0.056084924	1.437694956	0	2.994469397	0.979916879	0.35540677	2.986977715	4.030855475	2.873831281	2.040601993	0	0.00625419	0.511968333	0	1.226224567	0.265699067	0.477538161	0	0.786182797	0.605144624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1824
H5696_004_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1099.890921	27.74129367	288.6689624	713.447039	168.4188469	5.06	2.23448314	498.881064	776.7455969	3236.617084	355.9641245	0	0.003510401	198.702362	3961.839693	1046.209811	152.2469501	233.161413	278.5870765	459.4025102	2.991383804	0.015568462	0	1051.781672	1051.781672	0	1051.781672	0	0	0											4300	1a1: $150 days 1-7;$0 days 8-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $10-$200,9b: $100"	"8a1: $0-$10,8a2: $30-$60"	"8b1: $0-$20,8b2: $150,8b3: $55,8b4: $55,8b5: $30,8b6: $30"	"9c1: $20,9c2: $20"	12: 20%	"31: $20,32: $20,33: $20,37: $20,5: $150,9a2: $10-$200,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $20,7f1: $20,16b1: 0%,17a1: $40,18a1: $40"	"7c: $20,7i: $20"	"7e1: $20,7e2: $20,7h1: $20,7h2: $20"	7d2:	7g: $20	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													112.681972	87.74511313	43.07564125	0	150	0.2	0.2	45.82534611	101.1080711	5.426789232	56.24626866	0	0.2	26.39037433	0	17.35186117	20	20	0	20	0.199946833	0	0	0	20	0	1.825473909	0	0	0											NO	109.4610142	85.236963	41.84434562	0	145.7123251	0.1942831	0.1942831	44.51545154	98.21794755	5.271667179	54.63849723	0	0.1942831	25.63601869	0	16.8558669	19.42831001	19.42831001	0	19.42831001	0.194231453	0	0	0	20	0	1.825473909	0	0	0												10.0329	0.197048635	1.006596986	0	2.045058482	0.983072487	0.434122312	1.850659652	6.357529858	1.421864004	1.620778736	0	0.000682012	0.424494789	0	1.469564444	0.246491745	0.377494351	0	0.743784532	0.581020824	0	0	0	1.752969453	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7062	0	NO	0.876683114	10.0329	0.197048635	1.006596986	0	2.045058482	0.983072487	0.434122312	1.850659652	6.357529858	1.421864004	1.620778736	0	0.000682012	0.424494789	0	1.469564444	0.246491745	0.377494351	0	0.743784532	0.581020824	0	0	0	1.752969453	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7062	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				10.0329	0.197048635	1.006596986	0	2.045058482	0.983072487	0.434122312	1.850659652	6.357529858	1.421864004	1.620778736	0	0.000682012	0.424494789	0	1.469564444	0.246491745	0.377494351	0	0.743784532	0.581020824	0	0	0	1.752969453	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7062
H5696_021_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	2524.612454	12.56353696	1189.962601	2598.364774	403.509094	5.357533173	8.956375892	1341.742615	1375.153641	4185.311773	493.9269759	0	0.087520132	483.0035161	6615.443668	2072.858508	378.5279805	774.4443506	249.9214906	978.5978093	11.43456503	0	209.8513551	1062.652559	1075.681208	0.079310848	1063.120343	0	235.5971816	102.8980574											700	1a1: $0	1b1: $0	21: $0	6: $0	10a: $150	11a: $0	"11b1: $0,11b2: $0,11c1: $0,11c2: $0,17b1: $0"	"4a1: $25,4a2: $25,4b: $0"	"9a1: $0,9b: $0"	"8a1: $0,8a2: $0"	"8b1: $0,8b2: $0,8b3: $0,8b4: $0,8b5: $0,8b6: $0"	"9c1: $0,9c2: $0"	12: 20%	"31: $0,32: $0,33: $0,37: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $0,7d1: $0,7f1: $0,16b1: 0%,17a1: $0,18a1: $0"	"7c: $0,7i: $0"	"7e1: $0,7e2: $0,7h1: $0,7h2: $0"	7d2:	7g: $0	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	13b: $0													0	0	0	0	150	0	0	23.52585398	0	0	0	0	0.2	0	0	0	0	0	0	0	0.199831187	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	143.8997744	0	0	22.56910053	0	0	0	0	0.191866366	0	0	0	0	0	0	0	0.191704418	0	0	0	0	0	0	0	0	0												0	0	0	0	4.838738965	0	0	2.523493663	0	0	0	0	0.01679217	0	0	0	0	0	0	0	2.192056639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5711	0	NO	0.405739041	0	0	0	0	4.838738965	0	0	2.523493663	0	0	0	0	0.01679217	0	0	0	0	0	0	0	2.192056639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5711	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0	0	0	4.838738965	0	0	2.523493663	0	0	0	0	0.01679217	0	0	0	0	0	0	0	2.192056639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5711
H5696_023_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1330.751885	9.02179104	875.8483589	1808.817766	220.9194829	5.06	4.366109881	685.6482383	1075.237986	3219.711013	221.4924653	0	0.172375124	398.9299467	6058.834284	2957.069139	187.2171913	723.0211789	648.8844171	801.0122118	30.54916272	0.381216181	0	1019.820104	1030.839655	0.067080626	1020.215753	0	218.4150718	0											3400	1a1: $175 days 1-5;$0 days 6-90	1b1: $175 days 1-10;$0 days 11-90	21: $0 days 1-5;$50 days 6-75;$0 days 76-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $15-$225,9b: $50"	"8a1: $0-$15,8a2: $100-$140"	"8b1: $0-$25,8b2: $225,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $20,9c2: $20"	12: 20%	"31: $20,32: $20,33: $20,37: $20,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $20,7f1: $20,16b1: 0%,17a1: $10,18a1: $10"	"7c: $20,7i: $20"	"7e1: $20,7e2: $20,7h1: $20,7h2: $20"	7d2:	7g: $20	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	109.6813914	31.03195858	0	150	0.2	0.199992171	46.21799785	69.94639245	9.220173285	73.13239789	0	0.2	36.6298049	0	15.95683034	20	20	0	20	0.199945919	0	0	0	0	0	0	0	0	0											NO	101.9599259	98.5493203	27.88238174	0	134.775807	0.179701076	0.179694042	41.52711974	62.84720995	8.284375304	65.70985298	0	0.179701076	32.91207679	0	14.33729791	17.97010761	17.97010761	0	17.97010761	0.179652484	0	0	0	0	0	0	0	0	0												11.3069	0.074090948	2.035061524	0	2.4812168	0.909287445	0.784563931	2.372749708	5.631308956	2.222774534	1.212853111	0	0.030975995	1.09413442	0	3.533031766	0.280359423	1.082730699	0	1.19952297	5.488232977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7398	0	NO	4.714907111	11.3069	0.074090948	2.035061524	0	2.4812168	0.909287445	0.784563931	2.372749708	5.631308956	2.222774534	1.212853111	0	0.030975995	1.09413442	0	3.533031766	0.280359423	1.082730699	0	1.19952297	5.488232977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7398	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				11.3069	0.074090948	2.035061524	0	2.4812168	0.909287445	0.784563931	2.372749708	5.631308956	2.222774534	1.212853111	0	0.030975995	1.09413442	0	3.533031766	0.280359423	1.082730699	0	1.19952297	5.488232977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7398
H5696_024_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1137.687397	10.40580098	400.1162332	1295.260053	141.3328361	5.06	1.897604575	461.4596116	723.5532784	2382.711838	198.5004817	0	0.005241871	407.7718821	4911.319802	2073.781574	3298.570762	374.292798	429.6884163	522.0253612	15.92523713	0	0	1010.870252	1025.975598	0.091952577	1011.412598	0	427.8694788	0											6700	1a1: $175 days 1-5;$0 days 6-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $65,4a2: $65,4b: $0"	"9a1: $15-$225,9b: $125"	"8a1: $0-$15,8a2: $90-$125"	"8b1: $0-$25,8b2: $200,8b3: $55,8b4: $55,8b5: $90,8b6: $90"	"9c1: $25,9c2: $25"	12: 20%	"31: $25,32: $25,33: $25,37: $25,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $25,7f1: $25,16b1: 0%,17a1: $40,18a1: $40"	"7c: $25,7i: $25"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	7d2:	7g: $25	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	87.74511313	43.07564125	0	150	0.2	0.200038343	55.94508964	123.5290414	9.10770987	71.74023486	0	0.2	21.00062677	0	21.3054759	3.675515216	25	0	25	0.199975037	0	0	0	20	10	1.898335065	0	0	0											NO	112.3392504	86.86516137	42.64365724	0	148.4957252	0.1979943	0.198032259	55.38404438	122.2902306	9.016373213	71.02078801	0	0.1979943	20.79002201	0	21.09181396	3.638655317	24.74928753	0	24.74928753	0.197969588	0	0	0	20	10	1.898335065	0	0	0												10.6506	0.075325132	1.421868292	0	1.748943499	1.001851159	0.375786921	2.129791634	7.373624771	1.790284932	1.174805052	0	0.001037861	0.706465534	0	3.644984596	1.000196837	0.771956673	0	1.076646314	3.152712631	0	0	0	1.70995933	7.66E-05	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9669	0	NO	0.385924565	10.6506	0.075325132	1.421868292	0	1.748943499	1.001851159	0.375786921	2.129791634	7.373624771	1.790284932	1.174805052	0	0.001037861	0.706465534	0	3.644984596	1.000196837	0.771956673	0	1.076646314	3.152712631	0	0	0	1.70995933	7.66E-05	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9669	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				10.6506	0.075325132	1.421868292	0	1.748943499	1.001851159	0.375786921	2.129791634	7.373624771	1.790284932	1.174805052	0	0.001037861	0.706465534	0	3.644984596	1.000196837	0.771956673	0	1.076646314	3.152712631	0	0	0	1.70995933	7.66E-05	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9669
H5696_025_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1686.325176	3.91349542	814.9120915	1735.176529	176.0567029	5.06	5.474494786	755.6272743	1297.153409	3470.947779	464.6278044	0	0.028105652	465.8419886	7523.977175	3365.832816	115.5737774	530.4228101	476.6235546	731.156213	33.99333855	0	25	1000	1051.89175	0.315886841	1001.863135	0	1000	100											3400	1a1: $0	1b1: $0	21: $0 days 1-7;$50 days 8-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: 0-$75,9b: $50"	"8a1: $0-$15,8a2: $25"	"8b1: $0-$5,8b2: $75,8b3: $55,8b4: $55,8b5: $25,8b6: $25"	"9c1: $0,9c2: $0"	12: 20%	"31: $0,32: $0,33: $0,37: $0,5: $0,9a2: $5-$75,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $0,7d1: $0,7f1: $0,16b1: 0%,17a1: $10,18a1: $10"	"7c: $0,7i: $0"	"7e1: $0,7e2: $0,7h1: $0,7h2: $0"	7d2:	7g: $0	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $2500 every year,16b3: 0% limited to $2500 every year,16b4: 30% limited to $2500 every year,16b5: 20%-50% limited to $2500 every year,16b6: 50% limited to $2500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	13b: $0													0	0	25.25441885	0	150	0.2	0.199971413	44.53668988	46.44305772	7.89791278	41.46341463	0	0.2	13.93570808	0	0.309638554	0	0	0	0	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	0	24.99297523	0	148.4471413	0.197929522	0.197901231	44.07562864	45.96226102	7.816150497	41.03416914	0	0.197929522	13.79144018	0	0.306433055	0	0	0	0	0.197884885	0	0	0	0	0	0	0	0	0												0	0	1.697256476	0	2.177926188	1.00152338	1.083409255	2.775395594	4.968341963	2.260787518	1.588801326	0	0.005562938	0.535385993	0	0.085950203	0	0	0	0	6.726767885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9071	0	NO	0.260545401	0	0	1.697256476	0	2.177926188	1.00152338	1.083409255	2.775395594	4.968341963	2.260787518	1.588801326	0	0.005562938	0.535385993	0	0.085950203	0	0	0	0	6.726767885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9071	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0	1.697256476	0	2.177926188	1.00152338	1.083409255	2.775395594	4.968341963	2.260787518	1.588801326	0	0.005562938	0.535385993	0	0.085950203	0	0	0	0	6.726767885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9071
H5696_027_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1826.958694	4.239867009	882.8728594	1879.884076	190.7392053	5.06	4.388152243	818.6438995	1405.331386	3760.41247	503.3761096	0	0.022527652	504.6915524	8151.450092	3646.531293	125.2122191	574.6581845	516.3722627	792.1320388	27.24683674	0	25	1000	1056.219337	0.342230679	1002.018514	0	1000	40											5000	1a1: $65 days 1-5;$0 days 6-90	1b1: $50 days 1-10;$0 days 11-90	21: $0 days 1-7;$50 days 8-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $15-$150,9b: $50"	"8a1: $0-$15,8a2: $100-$125"	"8b1: $0-$25,8b2: $150,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $10,9c2: $10"	12: 20%	"31: $10,32: $10,33: $10,37: $10,5: $65,9a2: $15-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $10,7d1: $10,7f1: $10,16b1: 0%,17a1: $10,18a1: $10"	"7c: $10,7i: $10"	"7e1: $10,7e2: $10,7h1: $10,7h2: $10"	7d2:	7g: $10	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $2500 every year,16b3: 0% limited to $2500 every year,16b4: 30% limited to $2500 every year,16b5: 20%-50% limited to $2500 every year,16b6: 50% limited to $2500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	13b: $0													42.14869543	31.3375404	25.25441885	0	150	0.2	0.199964336	44.53668988	59.24804992	9.887476679	64.40766551	0	0.2	29.46350999	0	8.490005329	10	10	0	10	0.199954896	0	0	0	0	0	0	0	0	0											NO	41.59096754	30.92286991	24.92024259	0	148.0151418	0.197353522	0.19731833	43.94736312	58.46405675	9.756641753	63.55539829	0	0.197353522	29.0736374	0	8.377662286	9.867676121	9.867676121	0	9.867676121	0.197309015	0	0	0	0	0	0	0	0	0												6.3321	0.010925738	1.833450486	0	2.352690877	0.998608823	0.865862873	2.998103393	6.846781158	3.057416443	2.666022428	0	0.004445912	1.222768266	0	2.545783974	0.102962802	0.47254507	0	0.6513752	5.37604653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3379	0	NO	0.514104416	6.3321	0.010925738	1.833450486	0	2.352690877	0.998608823	0.865862873	2.998103393	6.846781158	3.057416443	2.666022428	0	0.004445912	1.222768266	0	2.545783974	0.102962802	0.47254507	0	0.6513752	5.37604653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3379	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				6.3321	0.010925738	1.833450486	0	2.352690877	0.998608823	0.865862873	2.998103393	6.846781158	3.057416443	2.666022428	0	0.004445912	1.222768266	0	2.545783974	0.102962802	0.47254507	0	0.6513752	5.37604653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3379
H5696_028_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1383.269856	3.210187643	668.4614254	1423.341963	144.4169448	5.06	3.597016246	619.8308874	1064.03749	2847.171768	381.1279372	0	0.018465438	382.1239161	6171.817254	2760.947377	94.80361477	435.0986952	390.9678897	599.757605	22.33365308	0	0	1000	1042.566104	0.259117726	1001.528304	0	1000	0											4600	1a1: $175 days 1-5;$0 days 6-90	1b1: $125 days 1-5;$0 days 6-90	21: $35 days 1-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $15-$225,9b: $100"	"8a1: $0-$15,8a2: $100-$140"	"8b1: $0-$15,8b2: $225,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $15,9c2: $15"	12: 20%	"31: $15,32: $15,33: $15,37: $15,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $15,7d1: $15,7f1: $15,16b1: 0%,17a1: $40,18a1: $40"	"7c: $15,7i: $15"	"7e1: $15,7e2: $15,7h1: $15,7h2: $15"	7d2:	7g: $15	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	53.7555795	35	0	150	0.2	0.200065952	44.53668988	105.6911076	10.05801073	73.44947735	0	0.2	42.88879235	0	13.50963855	15	15	0	15	0.199954896	0	0	0	20	10	1.917070133	0	0	0											NO	108.0513389	51.18525503	33.32647407	0	142.827746	0.190436995	0.190499793	42.40716686	100.6374845	9.577086676	69.93748863	0	0.190436995	40.8380636	0	12.86367483	14.2827746	14.2827746	0	14.2827746	0.190394047	0	0	0	20	10	1.917070133	0	0	0												12.4553	0.013692856	1.856455196	0	1.718895559	0.963611193	0.685230851	2.190439322	8.923504702	2.2723009	2.221260898	0	0.003516503	1.300433399	0	2.959660773	0.112838222	0.517868049	0	0.713850224	4.252194604	0	0	0	1.737610174	0.000215931	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0589	0	NO	2.167382602	12.4553	0.013692856	1.856455196	0	1.718895559	0.963611193	0.685230851	2.190439322	8.923504702	2.2723009	2.221260898	0	0.003516503	1.300433399	0	2.959660773	0.112838222	0.517868049	0	0.713850224	4.252194604	0	0	0	1.737610174	0.000215931	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0589	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				12.4553	0.013692856	1.856455196	0	1.718895559	0.963611193	0.685230851	2.190439322	8.923504702	2.2723009	2.221260898	0	0.003516503	1.300433399	0	2.959660773	0.112838222	0.517868049	0	0.713850224	4.252194604	0	0	0	1.737610174	0.000215931	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0589
H5696_030_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1549.800179	3.596658573	748.9367549	1594.696523	161.8031406	5.6	3.529126883	694.4516404	1192.135783	3189.939618	427.0115068	0	0.018116849	428.1273905	6914.835487	3093.33477	106.2169168	487.4797444	438.0360802	671.9617578	21.91204047	0	0	1000	1047.69059	0.290312622	1001.712295	0	1000	0											6700	1a1: $175 days 1-6;$0 days 7-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $65,4a2: $65,4b: $0"	"9a1: $15-$225,9b: $125"	"8a1: $5-$15,8a2: $100-$140"	"8b1: $0-$25,8b2: $225,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $25,9c2: $25"	12: 20%	"31: $25,32: $25,33: $25,37: $25,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $25,7f1: $25,16b1: 0%,17a1: $40,18a1: $40"	"7c: $25,7i: $25"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	7d2:	7g: $25	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													123.5514523	87.74511313	43.07564125	0	150	0.2	0.200080652	57.89769684	123.5772231	12.50116604	74.59930314	0	0.2	43.60990443	0	21.03731797	25	25	0	25	0.199954896	0	0	0	20	10	1.916718013	0	0	0											NO	119.4910099	84.86142406	41.65998685	0	145.0703424	0.193427123	0.193505125	55.99492471	119.5159338	12.09032293	72.14764301	0	0.193427123	42.17669179	0	20.34593948	24.17839041	24.17839041	0	24.17839041	0.193383502	0	0	0	20	10	1.916718013	0	0	0												15.4323	0.025434797	2.600057947	0	1.956069751	1.08319189	0.682904137	3.24048061	11.87326845	3.213950009	2.567322812	0	0.00350429	1.50474975	0	5.244733501	0.21401284	0.982206298	0	1.35391281	4.237427115	0	0	0	1.746150984	0.000241927	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1219	0	NO	1.910267285	15.4323	0.025434797	2.600057947	0	1.956069751	1.08319189	0.682904137	3.24048061	11.87326845	3.213950009	2.567322812	0	0.00350429	1.50474975	0	5.244733501	0.21401284	0.982206298	0	1.35391281	4.237427115	0	0	0	1.746150984	0.000241927	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1219	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				15.4323	0.025434797	2.600057947	0	1.956069751	1.08319189	0.682904137	3.24048061	11.87326845	3.213950009	2.567322812	0	0.00350429	1.50474975	0	5.244733501	0.21401284	0.982206298	0	1.35391281	4.237427115	0	0	0	1.746150984	0.000241927	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1219
H5696_033_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1460.985996	3.39054536	706.0175403	1503.309471	152.5307105	5.06	3.320303872	654.6547967	1123.818224	3007.134192	402.5408177	0	0.017044614	403.5927536	6518.56797	2842.988161	100.1299587	459.5438104	412.9336074	633.4537387	20.61518909	0	0	1000	1044.957592	0.273675717	1001.614169	0	1000	0											4200	1a1: $0	1b1: $100 days 1-10;$0 days 11-90	21: $0 days 1-3;$45 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$150,9b: $25"	"8a1: $0-$5,8a2: $50-$75"	"8b1: $0,8b2: $150,8b3: $55,8b4: $55,8b5: $50,8b6: $50"	"9c1: $5,9c2: $5"	12: 20%	"31: $5,32: $5,33: $5,37: $5,5: $0,9a2: $0-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $5,7d1: $5,7f1: $5,16b1: 0%,17a1: $10,18a1: $10"	"7c: $5,7i: $5"	"7e1: $5,7e2: $5,7h1: $5,7h2: $5"	7d2:	7g: $5	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													0	62.67508081	39.80777242	0	150	0.2	0.199952866	44.53668988	39.22776911	3.864272388	54.56445993	0	0.2	26.49000869	0	4.256055363	5	5	0	5	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	62.56356745	39.73694526	0	149.7331156	0.199644154	0.199597104	44.45744888	39.1579739	3.85739696	54.46737723	0	0.199644154	26.44287688	0	4.248482864	4.991103852	4.991103852	0	4.991103852	0.19959913	0	0	0	0	0	0	0	0	0												0	0.017677051	2.337915029	0	1.903241542	1.01019942	0.662723036	2.425356847	3.667203723	0.966642524	1.827111881	0	0.003402858	0.889346124	0	1.006532207	0.041646585	0.191135907	0	0.26346945	4.114773818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3284	0	NO	0.038015719	0	0.017677051	2.337915029	0	1.903241542	1.01019942	0.662723036	2.425356847	3.667203723	0.966642524	1.827111881	0	0.003402858	0.889346124	0	1.006532207	0.041646585	0.191135907	0	0.26346945	4.114773818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3284	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.017677051	2.337915029	0	1.903241542	1.01019942	0.662723036	2.425356847	3.667203723	0.966642524	1.827111881	0	0.003402858	0.889346124	0	1.006532207	0.041646585	0.191135907	0	0.26346945	4.114773818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3284
H5696_034_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1029.468132	2.389111469	497.4876971	1059.290915	107.4791313	5.06	2.139039301	461.2954899	791.8864731	2118.944897	283.6460752	0	0.010979222	284.3873106	4593.239095	2054.774293	70.55550282	323.8126235	290.9692432	446.3563915	13.279194	0	0	1000	1031.678886	0.192842662	1001.137407	0	1000	0											6700	1a1: $175 days 1-5;$0 days 6-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $65,4a2: $65,4b: $0"	"9a1: $15-$225,9b: $125"	"8a1: $0-$15,8a2: $90-$125"	"8b1: $0-$25,8b2: $200,8b3: $55,8b4: $55,8b5: $90,8b6: $90"	"9c1: $28,9c2: $28"	12: 20%	"31: $28,32: $28,33: $28,37: $28,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $28,7f1: $28,16b1: 0%,17a1: $40,18a1: $40"	"7c: $28,7i: $28"	"7e1: $28,7e2: $28,7h1: $28,7h2: $28"	7d2:	7g: $28	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	87.74511313	43.07564125	0	150	0.2	0.200063825	57.89769684	123.5772231	9.773787313	69.80836237	0	0.2	43.82623805	0	23.63745441	28	28	0	28	0.199954896	0	0	0	20	10	1.91781866	0	0	0											NO	112.2274545	86.77871639	42.60121986	0	148.3479478	0.197797264	0.197860386	57.26003004	122.2161829	9.666141932	69.03951529	0	0.197797264	43.34354982	0	23.37711901	27.69161692	27.69161692	0	27.69161692	0.197752657	0	0	0	20	10	1.91781866	0	0	0												9.6279	0.017277002	1.766131897	0	1.32869238	1.000854154	0.423231142	2.201149468	8.065111836	1.706835176	1.631898962	0	0.00217166	1.027196297	0	4.002891932	0.16281633	0.74724126	0	1.030027517	2.62599589	0	0	0	1.71946481	0.000160702	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.247	0	NO	0.416135892	9.6279	0.017277002	1.766131897	0	1.32869238	1.000854154	0.423231142	2.201149468	8.065111836	1.706835176	1.631898962	0	0.00217166	1.027196297	0	4.002891932	0.16281633	0.74724126	0	1.030027517	2.62599589	0	0	0	1.71946481	0.000160702	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.247	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				9.6279	0.017277002	1.766131897	0	1.32869238	1.000854154	0.423231142	2.201149468	8.065111836	1.706835176	1.631898962	0	0.00217166	1.027196297	0	4.002891932	0.16281633	0.74724126	0	1.030027517	2.62599589	0	0	0	1.71946481	0.000160702	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	39.247
H5696_035_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1612.681852	3.742589584	779.3241535	1659.399822	168.3681496	5.06	3.612801926	722.6283571	1240.505562	3319.368393	444.3370937	0	0.018546492	445.4982534	7195.39838	3218.843895	110.5265675	507.2587728	455.8089788	699.2259689	22.43168672	0	0	1000	1000	0.302091781	1000	0	1000	0											4200	1a1: $0	1b1: $100 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$150,9b: $25"	"8a1: $0-$5,8a2: $50-$75"	"8b1: $0,8b2: $150,8b3: $55,8b4: $55,8b5: $50,8b6: $50"	"9c1: $5,9c2: $5"	12: 20%	"31: $5,32: $5,33: $5,37: $5,5: $0,9a2: $0-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $5,7d1: $5,7f1: $5,16b1: 0%,17a1: $10,18a1: $10"	"7c: $5,7i: $5"	"7e1: $5,7e2: $5,7h1: $5,7h2: $5"	7d2:	7g: $5	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													0	62.67508081	43.07564125	0	150	0.2	0.199956682	44.53668988	39.22776911	3.864272388	54.56445993	0	0.2	26.49000869	0	4.4	5	5	0	5	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	62.47340013	42.93702915	0	149.5173185	0.199356425	0.199313246	44.3933763	39.10153899	3.851837636	54.38887823	0	0.199356425	26.40476711	0	4.385841343	4.983910617	4.983910617	0	4.983910617	0.199311466	0	0	0	0	0	0	0	0	0												0	0.019484358	2.788488658	0	2.097829521	1.008743509	0.720079278	2.673326049	4.042139717	1.065472342	2.01391634	0	0.003697362	0.980273136	0	1.176444886	0.045904544	0.210677699	0	0.290406644	4.470892364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6078	0	NO	0.076212153	0	0.019484358	2.788488658	0	2.097829521	1.008743509	0.720079278	2.673326049	4.042139717	1.065472342	2.01391634	0	0.003697362	0.980273136	0	1.176444886	0.045904544	0.210677699	0	0.290406644	4.470892364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6078	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	0.019484358	2.788488658	0	2.097829521	1.008743509	0.720079278	2.673326049	4.042139717	1.065472342	2.01391634	0	0.003697362	0.980273136	0	1.176444886	0.045904544	0.210677699	0	0.290406644	4.470892364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6078
H5696_037_0	2012	3																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1438.348762	3.338010587	695.0781583	1480.016457	150.1673249	5.06	3.232618685	644.5112542	1106.405233	2960.54018	396.3036528	0	0.01659438	397.3392896	6417.566082	2870.882516	98.57849602	452.4234133	406.5354116	623.6386959	20.07063869	0	0	1000	1044.260997	0.269435251	1001.589158	0	1000	0											4200	1a1: $0	1b1: $100 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$150,9b: $25"	"8a1: $0-$5,8a2: $50-$75"	"8b1: $0,8b2: $150,8b3: $55,8b4: $55,8b5: $50,8b6: $50"	"9c1: $5,9c2: $5"	12: 20%	"31: $5,32: $5,33: $5,37: $5,5: $0,9a2: $0-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $5,7d1: $5,7f1: $5,16b1: 0%,17a1: $10,18a1: $10"	"7c: $5,7i: $5"	"7e1: $5,7e2: $5,7h1: $5,7h2: $5"	7d2:	7g: $5	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													0	62.67508081	43.07564125	0	150	0.2	0.199951587	44.53668988	39.22776911	3.864272388	54.56445993	0	0.2	26.49000869	0	4.4	5	5	0	5	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	62.22426515	42.76580243	0	148.9210648	0.19856142	0.198513355	44.21634187	38.94560765	3.836477059	54.17198317	0	0.19856142	26.29946868	0	4.368351235	4.964035495	4.964035495	0	4.964035495	0.19851664	0	0	0	0	0	0	0	0	0												0	0.017308771	2.477131266	0	1.863589827	1.004720784	0.641717981	2.374827497	3.590802008	0.946503707	1.789046234	0	0.003295004	0.870817683	0	1.045085265	0.040778929	0.187153824	0	0.257980385	3.984355762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0951	0	NO	0.152834397	0	0.017308771	2.477131266	0	1.863589827	1.004720784	0.641717981	2.374827497	3.590802008	0.946503707	1.789046234	0	0.003295004	0.870817683	0	1.045085265	0.040778929	0.187153824	0	0.257980385	3.984355762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0951	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.017308771	2.477131266	0	1.863589827	1.004720784	0.641717981	2.374827497	3.590802008	0.946503707	1.789046234	0	0.003295004	0.870817683	0	1.045085265	0.040778929	0.187153824	0	0.257980385	3.984355762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0951
H5696_038_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	926.31809	2.149728684	447.6407176	953.1527077	96.71000056	5.06	1.893281144	415.074876	712.5414984	1906.632103	255.2254727	0	0.009717337	255.8924383	4133.008427	1848.891228	63.48602408	291.3674368	261.8148783	401.6326365	11.75296467	0	0	1000	1028.504743	0.173520327	1001.023442	0	1000	0											6700	1a1: $175 days 1-5;$0 days 6-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $65,4a2: $65,4b: $0"	"9a1: $15-$225,9b: $125"	"8a1: $0-$15,8a2: $100-$140"	"8b1: $0-$25,8b2: $225,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $25,9c2: $25"	12: 20%	"31: $25,32: $25,33: $25,37: $25,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $25,7f1: $25,16b1: 0%,17a1: $40,18a1: $40"	"7c: $25,7i: $25"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	7d2:	7g: $25	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	87.74511313	43.07564125	0	150	0.2	0.200056603	57.89769684	123.5772231	10.05801073	74.59930314	0	0.2	43.60990443	0	21.42897815	25	25	0	25	0.199954896	0	0	0	20	10	1.918037001	0	0	0											NO	111.5738716	86.27334013	42.35312164	0	147.4840086	0.196645345	0.196700998	56.92656279	121.5044282	9.889304938	73.34802844	0	0.196645345	42.87842347	0	21.06954398	24.5806681	24.5806681	0	24.5806681	0.196600997	0	0	0	20	10	1.918037001	0	0	0												8.6127	0.015455356	1.579915147	0	1.188598213	0.995025445	0.372410291	1.969065499	7.214745612	1.571272189	1.560023769	0	0.001910869	0.914355361	0	3.246274587	0.130044074	0.596833855	0	0.822699878	2.310644577	0	0	0	1.714174572	0.0001446	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9763	0	NO	0.564701138	8.6127	0.015455356	1.579915147	0	1.188598213	0.995025445	0.372410291	1.969065499	7.214745612	1.571272189	1.560023769	0	0.001910869	0.914355361	0	3.246274587	0.130044074	0.596833855	0	0.822699878	2.310644577	0	0	0	1.714174572	0.0001446	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9763	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				8.6127	0.015455356	1.579915147	0	1.188598213	0.995025445	0.372410291	1.969065499	7.214745612	1.571272189	1.560023769	0	0.001910869	0.914355361	0	3.246274587	0.130044074	0.596833855	0	0.822699878	2.310644577	0	0	0	1.714174572	0.0001446	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9763
H5696_039_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1510.533067	3.505530441	729.9610289	1554.291877	157.7035527	5.06	3.373603513	676.8563976	1161.930774	3109.116479	416.1923644	0	0.01731829	417.2799752	6739.635081	3014.959296	103.5257108	475.1285252	426.9376096	654.9363386	20.9461953	0	0	1000	1046.482259	0.282957004	1001.668911	0	1000	0											4200	1a1: $0	1b1: $100 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$150,9b: $25"	"8a1: $0-$5,8a2: $50-$75"	"8b1: $0,8b2: $150,8b3: $55,8b4: $55,8b5: $50,8b6: $50"	"9c1: $5,9c2: $5"	12: 20%	"31: $5,32: $5,33: $5,37: $5,5: $0,9a2: $0-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $5,7d1: $5,7f1: $5,16b1: 0%,17a1: $10,18a1: $10"	"7c: $5,7i: $5"	"7e1: $5,7e2: $5,7h1: $5,7h2: $5"	7d2:	7g: $5	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													0	62.67508081	43.07564125	0	150	0.2	0.19995361	44.53668988	39.22776911	3.864272388	54.56445993	0	0.2	26.49000869	0	4.4	5	5	0	5	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	62.56974125	43.00324296	0	149.7478913	0.199663855	0.199617543	44.46183596	39.16183803	3.85777761	54.4727521	0	0.199663855	26.44548628	0	4.392604811	4.991596377	4.991596377	0	4.991596377	0.199618827	0	0	0	0	0	0	0	0	0												0	0.018278344	2.615890957	0	1.967981206	1.010299107	0.673430446	2.50785651	3.791945397	0.999523328	1.889261958	0	0.003457836	0.919597655	0	1.103627059	0.043063214	0.197637485	0	0.272431488	4.181254936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1955	0	NO	0.037367391	0	0.018278344	2.615890957	0	1.967981206	1.010299107	0.673430446	2.50785651	3.791945397	0.999523328	1.889261958	0	0.003457836	0.919597655	0	1.103627059	0.043063214	0.197637485	0	0.272431488	4.181254936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1955	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0.018278344	2.615890957	0	1.967981206	1.010299107	0.673430446	2.50785651	3.791945397	0.999523328	1.889261958	0	0.003457836	0.919597655	0	1.103627059	0.043063214	0.197637485	0	0.272431488	4.181254936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1955
H5696_040_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	992.9098197	2.304269714	479.8209913	1021.673541	103.6623491	5.06	2.023176914	444.9140362	763.7651238	2043.697255	273.5732799	0	0.010388326	274.2881926	4430.124702	1981.805467	68.04994677	312.3134399	280.6363887	430.5054528	12.56451458	0	0	1000	1030.55391	0.185994463	1001.097016	0	1000	0											6700	1a1: $175 days 1-5;$0 days 6-90	1b1: $140 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $10"	"4a1: $65,4a2: $65,4b: $0"	"9a1: $15-$225,9b: $125"	"8a1: $0-$15,8a2: $100-$140"	"8b1: $0-$25,8b2: $225,8b3: $55,8b4: $55,8b5: $100,8b6: $100"	"9c1: $25,9c2: $25"	12: 20%	"31: $25,32: $25,33: $25,37: $25,5: $175,9a2: $15-$225,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $20,7d1: $25,7f1: $25,16b1: 0%,17a1: $40,18a1: $40"	"7c: $25,7i: $25"	"7e1: $25,7e2: $25,7h1: $25,7h2: $25"	7d2:	7g: $25	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $20	"17b2: $10,17b3: $10"	18a2: $10	"18a3: $10,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													113.4772569	87.74511313	43.07564125	0	150	0.2	0.2	57.89769684	123.5772231	10.05801073	74.59930314	0	0.2	43.60990443	0	19.54715898	25	25	0	25	0.199954896	0	0	0	20	0	1.917896038	0	0	0											NO	112.2238973	86.77596582	42.59986955	0	148.3432457	0.197790994	0.197790994	57.25821511	122.2123091	9.946919709	73.77535168	0	0.197790994	43.12823178	0	19.33126004	24.72387428	24.72387428	0	24.72387428	0.197746389	0	0	0	20	0	1.917896038	0	0	0												9.2857	0.016662936	1.703359303	0	1.281467443	1.000822431	0.400166173	2.122915299	7.778458281	1.694041042	1.681913745	0	0.002054717	0.985797062	0	3.192566404	0.140204861	0.643466519	0	0.886980224	2.484587382	0	0	0	1.71758985	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1787	0	NO	0.394256776	9.2857	0.016662936	1.703359303	0	1.281467443	1.000822431	0.400166173	2.122915299	7.778458281	1.694041042	1.681913745	0	0.002054717	0.985797062	0	3.192566404	0.140204861	0.643466519	0	0.886980224	2.484587382	0	0	0	1.71758985	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1787	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				9.2857	0.016662936	1.703359303	0	1.281467443	1.000822431	0.400166173	2.122915299	7.778458281	1.694041042	1.681913745	0	0.002054717	0.985797062	0	3.192566404	0.140204861	0.643466519	0	0.886980224	2.484587382	0	0	0	1.71758985	0	0.16	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1787
H5696_041_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1785.455045	4.143548492	862.8163331	1837.178103	186.4061172	5.06	4.577743816	800.0464845	1373.40599	3674.985887	491.9407414	0	0.023501141	493.2263009	7966.270797	3563.691788	122.3677301	561.603477	504.6416564	774.1369029	28.42425531	0	25	1000	1054.942183	0.334456107	1001.972658	0	1000	0											5000	1a1: $25 days 1-5;$0 days 6-90	1b1: $25 days 1-10;$0 days 11-90	21: $0 days 1-7;$50 days 8-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$100,9b: $50"	"8a1: $0,8a2: $25"	"8b1: $0-$5,8b2: $75,8b3: $55,8b4: $55,8b5: $25,8b6: $25"	"9c1: $10,9c2: $10"	12: 20%	"31: $10,32: $10,33: $10,37: $10,5: $25,9a2: $0-$100,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $10,7d1: $10,7f1: $10,16b1: 0%,17a1: $10,18a1: $10"	"7c: $10,7i: $10"	"7e1: $10,7e2: $10,7h1: $10,7h2: $10"	7d2:	7g: $10	"152: 20%,153: 20%"	"9d1: $0,9d2: $0"	10b: $0	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $2500 every year,16b3: 0% limited to $2500 every year,16b4: 30% limited to $2500 every year,16b5: 20%-50% limited to $2500 every year,16b6: 50% limited to $2500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	13b: $0													16.2110367	15.6687702	25.25441885	0	150	0.2	0.199965813	44.53668988	50	0.568446828	41.46341463	0	0.2	18.14074718	0	8.490361446	10	10	0	10	0.199954896	0	0	0	0	0	0	0	0	0											NO	16.16569126	15.62494159	25.18377731	0	149.5804207	0.199440561	0.199406469	44.41211204	49.86014022	0.566856771	41.34743335	0	0.199440561	18.09000396	0	8.466612244	9.972028044	9.972028044	0	9.972028044	0.199395583	0	0	0	0	0	0	0	0	0												2.4053	0.005395225	1.810747866	0	2.323558785	1.009169238	0.912831732	2.960979509	5.706517936	0.17359922	1.695040585	0	0.004687081	0.743538811	0	2.514366377	0.10168787	0.466693802	0	0.643309575	5.667670965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1451	0	NO	0.081753096	2.4053	0.005395225	1.810747866	0	2.323558785	1.009169238	0.912831732	2.960979509	5.706517936	0.17359922	1.695040585	0	0.004687081	0.743538811	0	2.514366377	0.10168787	0.466693802	0	0.643309575	5.667670965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1451	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				2.4053	0.005395225	1.810747866	0	2.323558785	1.009169238	0.912831732	2.960979509	5.706517936	0.17359922	1.695040585	0	0.004687081	0.743538811	0	2.514366377	0.10168787	0.466693802	0	0.643309575	5.667670965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1451
H5696_043_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	Coin	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	1596.294184	3.70455833	771.4048575	1642.537419	166.6572348	5.06	3.597976862	715.2851896	1227.899857	3285.637807	439.821852	0	0.01847037	440.9712122	7122.280552	3186.134813	109.4034243	502.1041368	451.1771627	692.1206106	22.33961878	0	0	1000	1049.121308	0.299022	1001.763664	0	1000	0											4200	1a1: $0	1b1: $50 days 1-10;$0 days 11-90	21: $0 days 1-3;$50 days 4-20;$100 days 21-100	6: $0	10a: $150	11a: 20%	"11b1: 20%,11b2: 20%,11c1: $0,11c2: $0,17b1: $0"	"4a1: $50,4a2: $50,4b: $0"	"9a1: $0-$150,9b: $25"	"8a1: $0-$5,8a2: $50-$75"	"8b1: $0,8b2: $150,8b3: $55,8b4: $55,8b5: $50,8b6: $50"	"9c1: $5,9c2: $5"	12: 20%	"31: $5,32: $5,33: $5,37: $5,5: $0,9a2: $0-$150,9a3:"	"7a: $0,14a1-16: $0,14b1: $0,14b2: $0,14d: $0,14e: $0"	"7b1: $5,7d1: $5,7f1: $5,16b1: 0%,17a1: $10,18a1: $10"	"7c: $5,7i: $5"	"7e1: $5,7e2: $5,7h1: $5,7h2: $5"	7d2:	7g: $5	"151: 0,152: 20%,153: 20%"	"9d1: $0,9d2: $0"	N/A	"16a1: $0,16a2: $0,16a3: $0,16a4: $0,16b2: 0% limited to $500 every year,16b3: 0% limited to $500 every year,16b5: 0%-20% limited to $500 every year"	17a2: $0	"17b2: $0,17b3: $0"	18a2: $0	"18a3: $0,18b1: $0"	"14c1: $0,14c3: $0,14c4: $0,14c5: $0"	N/A													0	31.3375404	43.07564125	0	150	0.2	0.199956503	44.53668988	39.22776911	3.864272388	54.56445993	0	0.2	26.49000869	0	4.4	5	5	0	5	0.199954896	0	0	0	0	0	0	0	0	0											NO	0	31.23532038	42.93513268	0	149.5107145	0.199347619	0.199304264	44.3914155	39.09981192	3.851667505	54.38647594	0	0.199347619	26.40360084	0	4.385647625	4.983690483	4.983690483	0	4.983690483	0.199302663	0	0	0	0	0	0	0	0	0												0	0.009642756	2.760030825	0	2.076420188	1.008698954	0.717092132	2.646043504	4.000887788	1.054598698	1.993363381	0	0.003682024	0.970268989	0	1.164438715	0.045436067	0.208527634	0	0.287442908	4.452345504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3989	0	NO	0.076574795	0	0.009642756	2.760030825	0	2.076420188	1.008698954	0.717092132	2.646043504	4.000887788	1.054598698	1.993363381	0	0.003682024	0.970268989	0	1.164438715	0.045436067	0.208527634	0	0.287442908	4.452345504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3989	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	0.009642756	2.760030825	0	2.076420188	1.008698954	0.717092132	2.646043504	4.000887788	1.054598698	1.993363381	0	0.003682024	0.970268989	0	1.164438715	0.045436067	0.208527634	0	0.287442908	4.452345504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3989
H5698_020_0	2012	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	1507.673983	62.80919899	329.7953455		434.7562996	13.30873608	3.027185157	465.823869	361.0674414	222.4030073		0.361832436		43.13538164	3255.753736	4384.845547	181.0509555	392.4863717			30.83879166		4.429510617		289.3521638		222.9615796														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: $65/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	$25/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$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	$475 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;													56.05171607	91.13704819	33.95471492		50	0.168	0.2	65	130.0122729	78.88399788		25		29.57750595	15.00019285	24.67031809	25	25			0.179986176		3		29.98777633		30														NO	51.1174594	83.06376766	31.32599005		45.71147181	0.153337345	0.18230593	59.39945665	118.5465402	71.80366394		22.69771914		26.98304339	13.67038525	22.47487925	22.7776058	22.72358308			0.164441087		2.73848707		27.31633994		27.34482058															6.4224	0.434764059	0.860930476	0	1.656112528	2.040726251	0.551873806	2.30580706	3.566941329	1.330779233	0	0.000684398	0	0.096993656	3.708950654	8.212406183	0.343658941	0.743224723	0	0	5.071164434	0	0.001010846	0	0.658670172	0	0.508070366	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5151	0		3.705771284	6.4224	0.434764059	0.860930476	0	1.656112528	2.040726251	0.551873806	2.30580706	3.566941329	1.330779233	0	0.000684398	0	0.096993656	3.708950654	8.212406183	0.343658941	0.743224723	0	0	5.071164434	0	0.001010846	0	0.658670172	0	0.508070366	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5151	NO																																																																																		0	0		0	6.4224	0.434764059	0.860930476	0	1.656112528	2.040726251	0.551873806	2.30580706	3.566941329	1.330779233	0	0.000684398	0	0.096993656	3.708950654	8.212406183	0.343658941	0.743224723	0	0	5.071164434	0	0.001010846	0	0.658670172	0	0.508070366	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5151
H5698_028_0	2012	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	1468.666367	91.91181157	256.6878517		550.0802636	8.194996856	3.227547243	461.8867683	251.6288308	193.5216767				44.90637599	2825.858616	3639.809386	83.61828554	250.2098861			22.9988375		0.362279044		256.2373158		14.7985624														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: $65/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	$25/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$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	$475 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;													56.04581856	91.13704819	33.95471492		50	0.168	0.2	65	137.4244768	81.79690348				31.62458352	15.00127002	24.88365035	25	25			0.178098164		3		30		29.5188111														NO	52.51530405	85.16194641	31.86098793		46.95777205	0.157356642	0.186571712	60.9662324	128.4017356	76.54556803				29.46631598	14.01493974	23.24778399	23.49301219	23.33077297			0.166534933		3		28.02569846		29.5188111															6.4273	0.652282398	0.681527379	0	2.152545302	1.289537184	0.602169014	2.346624671	2.692464884	1.234435556	0	0	0	0.110268789	3.300353186	7.051458532	0.163703783	0.486465837	0	0	3.830109863	0	9.06E-05	0	0.598435812	0	0.036402997	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6562	0		2.31175003	6.4273	0.652282398	0.681527379	0	2.152545302	1.289537184	0.602169014	2.346624671	2.692464884	1.234435556	0	0	0	0.110268789	3.300353186	7.051458532	0.163703783	0.486465837	0	0	3.830109863	0	9.06E-05	0	0.598435812	0	0.036402997	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6562	NO																																																																																		0	0		0	6.4273	0.652282398	0.681527379	0	2.152545302	1.289537184	0.602169014	2.346624671	2.692464884	1.234435556	0	0	0	0.110268789	3.300353186	7.051458532	0.163703783	0.486465837	0	0	3.830109863	0	9.06E-05	0	0.598435812	0	0.036402997	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6562
H5698_035_0	2012	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	1013.736029	76.1166338	203.2913396		474.9974364	5.305555655	2.285929633	233.5758799	208.499375	164.794176		0.384713987		27.8525403	1988.469113	2486.866033	89.1891192	265.8962199			9.805362689				155.1512007		3.187142907														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	ER:$65/visit; UC: $25/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: $30/visit; Partial Hospitalization: $50/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: $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													82.38614619	83.05556331	33.95471492		50	0.168	0.2	65	137.1262967	83.42509118		30		29.4577476	20.00050359	29.518146	30	30			0.173526861				29.97562222		24.84084369														NO	78.50743932	79.13213166	32.3577274		47.67665475	0.160097763	0.190559752	61.95754336	130.6715082	79.507576		28.58054534		28.06707993	19.06348173	28.13029795	28.61491974	28.58293969			0.165383376				28.56741854		24.84084369															6.6322	0.501939291	0.548170479	0	1.887190732	0.849407589	0.435606185	1.205982309	2.270410648	1.091865456	0	0.000916278	0	0.065144956	3.158928717	5.829690206	0.212678291	0.633341301	0	0	1.621643981	0	0	0	0.369355774	0	0.00659761	0	0	0	0	0	0	0	0	0	0	0	0	0	27.321	0		1.346157669	6.6322	0.501939291	0.548170479	0	1.887190732	0.849407589	0.435606185	1.205982309	2.270410648	1.091865456	0	0.000916278	0	0.065144956	3.158928717	5.829690206	0.212678291	0.633341301	0	0	1.621643981	0	0	0	0.369355774	0	0.00659761	0	0	0	0	0	0	0	0	0	0	0	0	0	27.321	NO																																																																																		0	0		0	6.6322	0.501939291	0.548170479	0	1.887190732	0.849407589	0.435606185	1.205982309	2.270410648	1.091865456	0	0.000916278	0	0.065144956	3.158928717	5.829690206	0.212678291	0.633341301	0	0	1.621643981	0	0	0	0.369355774	0	0.00659761	0	0	0	0	0	0	0	0	0	0	0	0	0	27.321
H5698_036_0	2012	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	1772.735319	117.3254206	340.668245		693.0532089	15.69059424	5.639870453	489.0968954	354.5979951	228.4620729		3.818342018		17.60110257	3426.787503	4534.066891	294.1847064	520.1381121			31.30221375		46.25660018		293.0827974		7.920767556														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: $65/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	$25/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$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	$475 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;													56.03708116	91.13704819	33.95471492		50	0.168	0.2	65	152.4128619	79.60223856		25		34.01268502	15.00193354	24.7037128	25	25			0.174924434		3		29.87405492		30														NO	50.06313098	80.91902249	30.51659734		44.68277127	0.149619528	0.177828325	58.01500999	135.7247124	70.91701991		22.19707136		30.30057963	13.36114643	21.99057836	22.26017378	22.23762111			0.155519547		2.678266508		26.60999371		29.57231104															7.3957	0.791154862	0.866336305	0	2.580628168	2.347619302	1.002928714	2.364580106	4.010642574	1.350154114	0	0.007063001	0	0.044443634	3.815484136	8.308896106	0.545716891	0.963886189	0	0	4.86810611	0	0.010323959	0	0.64991095	0	0.019519617	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9431	0		5.119324831	7.3957	0.791154862	0.866336305	0	2.580628168	2.347619302	1.002928714	2.364580106	4.010642574	1.350154114	0	0.007063001	0	0.044443634	3.815484136	8.308896106	0.545716891	0.963886189	0	0	4.86810611	0	0.010323959	0	0.64991095	0	0.019519617	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9431	NO																																																																																		0	0		0	7.3957	0.791154862	0.866336305	0	2.580628168	2.347619302	1.002928714	2.364580106	4.010642574	1.350154114	0	0.007063001	0	0.044443634	3.815484136	8.308896106	0.545716891	0.963886189	0	0	4.86810611	0	0.010323959	0	0.64991095	0	0.019519617	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9431
H5698_061_0	2012	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	1328.84082	91.8324464	342.5555007		791.723564	8.894950465	2.765178302	414.1172315	200.7721422	168.3449855		0.949309562		45.29562367	2567.429206	3114.184247	160.4346074	285.733427			16.29908285				237.292679		133.7603861			3.687931609											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: $65/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $125 Annual Allowance; Lens & Frames, Lens, Frames: $125 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													96.41763709	77.40141084	60.82204238		50	0.168	0.2	65	300	104.1944526		30		33.71217746	20.00231518	28.73180183	30	30			0.180848219				29.9701946		30			20											NO	94.38725306	75.8964195	59.4473095		49.19981868	0.164006528	0.195140791	63.46422918	292.505253	101.7170212		29.80270917		33.32005762	19.50412215	28.05099142	29.49594279	29.38597596			0.176388902				29.29152342		29.32039475			20												10.4521	0.580812823	1.697000239	0	3.24605465	1.458829947	0.539599081	2.190135907	4.893908853	1.426962539	0	0.002357666	0	0.125771066	4.172954405	7.279662968	0.3943475	0.699712968	0	0	2.87497732	0	0	0	0.579222005	0	0.32682561	0	0	0.006146553	0	0	0	0	0	0	0	0	0	0	42.9474	0		0.990303924	10.4521	0.580812823	1.697000239	0	3.24605465	1.458829947	0.539599081	2.190135907	4.893908853	1.426962539	0	0.002357666	0	0.125771066	4.172954405	7.279662968	0.3943475	0.699712968	0	0	2.87497732	0	0	0	0.579222005	0	0.32682561	0	0	0.006146553	0	0	0	0	0	0	0	0	0	0	42.9474	NO																																																																																		0	0		0	10.4521	0.580812823	1.697000239	0	3.24605465	1.458829947	0.539599081	2.190135907	4.893908853	1.426962539	0	0.002357666	0	0.125771066	4.172954405	7.279662968	0.3943475	0.699712968	0	0	2.87497732	0	0	0	0.579222005	0	0.32682561	0	0	0.006146553	0	0	0	0	0	0	0	0	0	0	42.9474
H5698_062_0	2012	9																															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	1232.746523	86.85937937	391.9119237		606.822303	9.269200689	4.982830213	422.3596055	268.1732836	187.8342021		0.538213914		16.85486429	3168.813023	3273.260953	206.2100086	330.8182035			19.26458177				247.7575789		10.5400677														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: $65/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $125 Annual Allowance; Lens & Frames, Lens, Frames: $125 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													96.41763709	83.01064104	60.82204238		50	0.168	0.2	65	300	103.4554389		30		36.14806964	20	29.63022243	30	30			0.174189858				29.93735595		27.82358065														NO	93.26017767	80.35891087	58.83936211		48.4281415	0.162622127	0.193520841	62.95204999	290.2717867	100.0294747		28.98691054		34.95363452	19.34842706	28.66920396	29.02542784	28.99534963			0.168402054				28.96217817		27.82358065															9.5805	0.581660427	1.921653966	0	2.448939696	1.507377132	0.964281493	2.21570025	6.48692818	1.56574638	0	0.001300097	0	0.049094897	5.109295637	7.820148823	0.49877781	0.799349123	0	0	3.244195131	0	0	0	0.597966595	0	0.024438535	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4174	0		1.525038294	9.5805	0.581660427	1.921653966	0	2.448939696	1.507377132	0.964281493	2.21570025	6.48692818	1.56574638	0	0.001300097	0	0.049094897	5.109295637	7.820148823	0.49877781	0.799349123	0	0	3.244195131	0	0	0	0.597966595	0	0.024438535	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4174	NO																																																																																		0	0		0	9.5805	0.581660427	1.921653966	0	2.448939696	1.507377132	0.964281493	2.21570025	6.48692818	1.56574638	0	0.001300097	0	0.049094897	5.109295637	7.820148823	0.49877781	0.799349123	0	0	3.244195131	0	0	0	0.597966595	0	0.024438535	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4174
H5698_063_0	2012	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	1119.370957	64.69663456	236.6478711		431.0909925	9.629464386	3.598525733	306.7901883	278.3844288	160.5195017		0.34775112		39.92491976	3058.907824	3101.482597	142.2149809	308.2825791			16.16804465				230.8707546		196.3506569			1.160056261											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: $65/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $125 Annual Allowance; Lens & Frames, Lens, Frames: $125 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													96.41763709	77.36763302	60.82204238		50	0.168	0.2	65	300	100.7150617		30		38.55676429	20.0006531	29.32937193	30	30			0.168638241				29.9860596		30			20											NO	94.14995004	75.89009203	59.46937043		49.0033305	0.163957608	0.195085463	63.40731351	292.7106479	98.28248256		29.75442575		37.78225704	19.5033536	28.61406909	29.36514846	29.31534588			0.164503627				29.26028699		29.27246658			20												8.7824	0.409152796	1.172774992	0	1.760407865	1.578823948	0.702020058	1.621061804	6.79050721	1.314687927	0	0.000862261	0	0.125704465	4.971580077	7.395503111	0.348013669	0.753117536	0	0	2.659701987	0	0	0	0.562945378	0	0.478972337	0	0	0.001933427	0	0	0	0	0	0	0	0	0	0	41.4302	0		1.013004785	8.7824	0.409152796	1.172774992	0	1.760407865	1.578823948	0.702020058	1.621061804	6.79050721	1.314687927	0	0.000862261	0	0.125704465	4.971580077	7.395503111	0.348013669	0.753117536	0	0	2.659701987	0	0	0	0.562945378	0	0.478972337	0	0	0.001933427	0	0	0	0	0	0	0	0	0	0	41.4302	NO																																																																																		0	0		0	8.7824	0.409152796	1.172774992	0	1.760407865	1.578823948	0.702020058	1.621061804	6.79050721	1.314687927	0	0.000862261	0	0.125704465	4.971580077	7.395503111	0.348013669	0.753117536	0	0	2.659701987	0	0	0	0.562945378	0	0.478972337	0	0	0.001933427	0	0	0	0	0	0	0	0	0	0	41.4302
H5698_067_0	2012	10																															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	1905.785952	100.1342136	535.8680063		637.5568621	14.55184264	7.414399948	386.2683807	374.0765576	326.6913711				13.99318028		4562.16838	110.1581058	594.2120432			35.42236965				256.2883919		4.783037871														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: $65/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	$15/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	"Chiro, $15/visit"	15% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$475 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;													36.64848833	91.13704819	30.26279895		50	0.084	0.1	65	102.2757815	50				31.954142		15	15	15			0.152455603				10		9.921378125														NO	34.62256257	86.14881017	28.58742019		47.2560911	0.079412032	0.095450803	61.4501337	96.60456425	47.25439189				30.16637861		14.16744624	14.20874896	14.16287553			0.143965314				9.448173348		9.824427492															5.4986	0.71887028	1.276590322	0	2.510703763	1.155591387	0.707710427	1.978020303	3.01145857	1.28646684	0	0	0	0.035176965	0	5.386189607	0.130434073	0.7013126	0	0	5.099592562	0	0	0	0.201788096	0	0.003915884	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7024	0		1.730159163	5.4986	0.71887028	1.276590322	0	2.510703763	1.155591387	0.707710427	1.978020303	3.01145857	1.28646684	0	0	0	0.035176965	0	5.386189607	0.130434073	0.7013126	0	0	5.099592562	0	0	0	0.201788096	0	0.003915884	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7024	NO																																																																																		0	0		0	5.4986	0.71887028	1.276590322	0	2.510703763	1.155591387	0.707710427	1.978020303	3.01145857	1.28646684	0	0	0	0.035176965	0	5.386189607	0.130434073	0.7013126	0	0	5.099592562	0	0	0	0.201788096	0	0.003915884	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7024
H5698_068_0	2012	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	2264.934507	55.13675023	765.7443512		901.4968641	20.7729028	8.782816251	488.5854269	494.8686776	320.8690919		3.873863552		23.35075193	0.048152172	5739.877731	270.8087278	713.4202839			48.37750914				310.3529019		5.50335			0.491895593											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: $65/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	$15/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	"Chiro, $15/visit"	15% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$475 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;													36.64848833	91.13704819	30.26279895		50	0.084	0.1	65	110.6605039	50		15		27.55867796	15	15	15	15			0.150556803				9.942210947		10			20											NO	33.52523911	83.78018307	27.65015666		45.92458746	0.076965789	0.091375023	59.48893439	101.0920092	45.72531918		13.74216245		25.52148351	15	13.72249701	13.74531661	13.75423147			0.137620769				9.096494067		9.672397743			20												6.3277	0.384947252	1.764412606	0	3.450072631	1.598802855	0.802530037	2.422118867	4.168939074	1.22265347	0	0.004436272	0	0.049662153	6.02E-05	6.563787917	0.310195975	0.81771231	0	0	6.65775001	0	0	0	0.235260278	0	0.004435883	0	0	0.000819826	0	0	0	0	0	0	0	0	0	0	36.7863	0		3.416979589	6.3277	0.384947252	1.764412606	0	3.450072631	1.598802855	0.802530037	2.422118867	4.168939074	1.22265347	0	0.004436272	0	0.049662153	6.02E-05	6.563787917	0.310195975	0.81771231	0	0	6.65775001	0	0	0	0.235260278	0	0.004435883	0	0	0.000819826	0	0	0	0	0	0	0	0	0	0	36.7863	NO																																																																																		0	0		0	6.3277	0.384947252	1.764412606	0	3.450072631	1.598802855	0.802530037	2.422118867	4.168939074	1.22265347	0	0.004436272	0	0.049662153	6.02E-05	6.563787917	0.310195975	0.81771231	0	0	6.65775001	0	0	0	0.235260278	0	0.004435883	0	0	0.000819826	0	0	0	0	0	0	0	0	0	0	36.7863
H5698_069_0	2012	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	2061.348997	87.84952063	582.0647445		676.4739166	15.20650699	4.390690422	399.1320238	389.3459049	305.4452401		0.319102993		64.62252486	0.269155088	4744.398451	168.6098555	544.283158			34.80786826				259.0904773		120.6529306			1.181695855											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: $65/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	$15/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	"Chiro, $15/visit"	15% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$475 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;													36.64848833	91.13704819	30.26279895		50	0.084	0.1	65	99.46112912	50		15		22.03307225	15	15	15	15			0.154924588				10		10			20											NO	34.73087176	86.6359354	28.65666699		47.70553917	0.079501528	0.094555874	61.46150355	94.06312868	47.29597318		15		21.03062679	15	14.19955434	14.28485964	14.21040482			0.1464283				9.464656509		9.465317171			20												5.966	0.634243783	1.390002963	0	2.689296077	1.208940537	0.415165572	2.044271191	3.051924496	1.203860824	0	0.000398879	0	0.11325435	0.000336444	5.614028634	0.20071401	0.644540334	0	0	5.096856992	0	0	0	0.204350198	0	0.095168188	0	0	0.001969493	0	0	0	0	0	0	0	0	0	0	30.5754	0		1.703983182	5.966	0.634243783	1.390002963	0	2.689296077	1.208940537	0.415165572	2.044271191	3.051924496	1.203860824	0	0.000398879	0	0.11325435	0.000336444	5.614028634	0.20071401	0.644540334	0	0	5.096856992	0	0	0	0.204350198	0	0.095168188	0	0	0.001969493	0	0	0	0	0	0	0	0	0	0	30.5754	NO																																																																																		0	0		0	5.966	0.634243783	1.390002963	0	2.689296077	1.208940537	0.415165572	2.044271191	3.051924496	1.203860824	0	0.000398879	0	0.11325435	0.000336444	5.614028634	0.20071401	0.644540334	0	0	5.096856992	0	0	0	0.204350198	0	0.095168188	0	0	0.001969493	0	0	0	0	0	0	0	0	0	0	30.5754
H5698_122_0	2012	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																																									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	"Medicare FFS Cost Sharing, Blood: Waiver of 3 pint deductible"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	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	2012	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	3391.270521	228.2744614	979.011974	24.69784078	16.49284254	27.3092701	10.42184453	34.50144363	39.26464654	14.8958941			0.432501362	26.42515216	55.19547129	144.402939	3.200996897	6.291797859	21.29660903		25.77548677	0.005399236			198.8077387		249														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, Blood: Waiver of 3 pint deductible"	"No Cost Sharing, 24 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $300 Annual Allowance; Lens & Frames, Lens, Frames: $300 Annual Allowance"	Routine Hearing Tests: $10	Hearing Aids: $2000 annual allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;													124.7736289	76.26033498	79.1170981	0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224	0.223167685	0.224	0.224	0.224	0.224	0.224		0.165848651	0.224			10		10														NO	77.70263291	47.49103529	49.27008122	0.139495741	0.139495741	0.139495741	0.139495741	0.139495741	0.139495741	0.139495741			0.139495741	0.138977418	0.139495741	0.139495741	0.139495741	0.139495741	0.139495741		0.103282055	0.139495741			6.227488419		6.227488419															21.9592	0.903415875	4.019666623	3.445243591	2.300681284	3.809526858	1.453802921	4.81280443	5.477250948	2.07791378	0	0	0.060332098	3.672499408	7.699533145	20.14359492	0.446525433	0.877679002	2.970786249	0	2.662145255	0.00075317	0	0	0.103172741	0	0.129220385	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0258	0		53.93036827	21.9592	0.903415875	4.019666623	3.445243591	2.300681284	3.809526858	1.453802921	4.81280443	5.477250948	2.07791378	0	0	0.060332098	3.672499408	7.699533145	20.14359492	0.446525433	0.877679002	2.970786249	0	2.662145255	0.00075317	0	0	0.103172741	0	0.129220385	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0258	NO																																																																																		0	0		0	21.9592	0.903415875	4.019666623	3.445243591	2.300681284	3.809526858	1.453802921	4.81280443	5.477250948	2.07791378	0	0	0.060332098	3.672499408	7.699533145	20.14359492	0.446525433	0.877679002	2.970786249	0	2.662145255	0.00075317	0	0	0.103172741	0	0.129220385	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0258
H5698_129_0	2012	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	1388.552257	881.6686635	1390.704726		427.9445186	15.74667473	8.700094565	699.5797645	375.537364	380.7802894				81.40714128	3419.188753	5695.697854		734.2019566			19.29926682				222.6702731		249.8394278														4500	"(1a) Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	(1b) Days 1 - 5 : $150/day Days 6-90 $0/day	(2) Days 21 - 100 : $100/day	(6) No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER ; $65/visit UC; $35/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;	(5) Partial Hospitalization $20/observation	$0/visit	$0/visit	(7a) $10/visit	(7d) $25/visit	"(7e)non-physician (7h) Psychiatric, Individual: $0/visit; Group: $0/visit"	(7c) OT (7i)PT/ST $25/visit	No Cost Sharing	(7b) Chiro (7f) pod. (7g) other $20 visit	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"No Cost Sharing, 70 annual trip limit"	$225 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;													95.51623749	60.94879518	33.95471492		50	0.164	0.19259606	65	76.62162162	68.20018298				44.10752066	10.00124678	24.1471023		25			0.179789005				30		30														NO	87.00754778	55.51941061	30.9299922		45.54594594	0.149390703	0.175439395	59.20972972	69.79608472	62.12483694				40.17837503	9.110324902	21.99605232		22.77297297			0.163773206				27.32756756		27.32756756															10.0679	4.079143712	3.584540528	0	1.624261492	2.352406803	1.526339326	3.451827398	2.184253139	1.971326116	0	0	0	0.272567221	2.595826703	10.440239	0	1.393330109	0	0	3.160702801	0	0	0	0.507086411	0	0.568958654	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7807	0		4.868180141	10.0679	4.079143712	3.584540528	0	1.624261492	2.352406803	1.526339326	3.451827398	2.184253139	1.971326116	0	0	0	0.272567221	2.595826703	10.440239	0	1.393330109	0	0	3.160702801	0	0	0	0.507086411	0	0.568958654	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7807	NO																																																																																		0	0		0	10.0679	4.079143712	3.584540528	0	1.624261492	2.352406803	1.526339326	3.451827398	2.184253139	1.971326116	0	0	0	0.272567221	2.595826703	10.440239	0	1.393330109	0	0	3.160702801	0	0	0	0.507086411	0	0.568958654	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7807
H5698_134_0	2012	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	2769.984648	430.4801438	935.8262211	18.86699144	17.8940972	19.45481871	12.07246259	40.69799806	32.88390509	17.20785363		0.019292673	1.904465272	49.4456716	49.15020003	136.8540975	1.118068683	4.004791538	18.46571413		24.08485954	0.007777125			262.0815835		0.997565187														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, Blood: Waiver of 3 pint deductible"	"No Cost Sharing, 24 annual trip limit"	Preventive Dental: $500 annual allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	Hearing Aids: $500 annual allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;													132.9695086	77.66970153	94.19460014	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.223993704	0.224	0.224	0.224	0.224	0.224		0.180324081	0.224			9.98552627		9.3008321														NO	83.66137665	48.86800155	59.26509019	0.140935682	0.140935682	0.140935682	0.140935682	0.140935682	0.140935682	0.140935682		0.140935682	0.140935682	0.14093172	0.140935682	0.140935682	0.140935682	0.140935682	0.140935682		0.113455792	0.140935682			6.284355127		6.291771513															19.3117	1.753058695	4.621818783	2.659032304	2.52191679	2.741878141	1.701440747	5.735800108	4.634515587	2.425200586	0	0.002719026	0.268407112	6.968463565	6.927016956	19.28762555	0.157575772	0.564418026	2.602478013	0	2.732566812	0.001096074	0	0	0.137251145	0	0.000523038	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7565	0		51.72160653	19.3117	1.753058695	4.621818783	2.659032304	2.52191679	2.741878141	1.701440747	5.735800108	4.634515587	2.425200586	0	0.002719026	0.268407112	6.968463565	6.927016956	19.28762555	0.157575772	0.564418026	2.602478013	0	2.732566812	0.001096074	0	0	0.137251145	0	0.000523038	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7565	NO																																																																																		0	0		0	19.3117	1.753058695	4.621818783	2.659032304	2.52191679	2.741878141	1.701440747	5.735800108	4.634515587	2.425200586	0	0.002719026	0.268407112	6.968463565	6.927016956	19.28762555	0.157575772	0.564418026	2.602478013	0	2.732566812	0.001096074	0	0	0.137251145	0	0.000523038	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7565
H5698_140_0	2012	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	2400.54742	391.4586633	1060.802736	21.991355	20.72017008	15.79948041	6.621586791	30.71243073	39.21057698	17.68048136		0.060592189	0.502842052	41.17343197	47.62927638	139.8916599	3.410656687	5.841920606	17.38743229		25.31757055	0.015887121			228.4729098		0.816766889														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, Blood: Waiver of 3 pint deductible"	"No Cost Sharing, 24 annual trip limit"	Preventive Dental: $500 annual allowance	Routine Eye Exam: $10	"Contact Lens: $300 Annual Allowance; Lens & Frames, Lens, Frames: $300 Annual Allowance"	Routine Hearing Tests: $10	Hearing Aids: $1000 annual allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;													141.6974594	78.32136363	87.24180155	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.223894403	0.224	0.224	0.224	0.224	0.224		0.175913465	0.224			9.961135257		9.833083455														NO	124.0372461	69.53559953	75.32195297	0.19463271	0.196489044	0.196181595	0.187352121	0.196419948	0.195403791	0.197056209		0.199028988	0.142565804	0.198946962	0.196887602	0.197910892	0.200006349	0.201337092	0.19729889		0.156823072	0.206377544			8.699822614		8.216231784															24.8131	2.268359404	6.658477816	4.280237021	4.071286401	3.099567259	1.24056833	6.032534056	7.661895384	3.484048636	0	0.012059602	0.071688081	8.191329196	9.37761402	27.68608325	0.682152992	1.176195304	3.430521089	0	3.970379182	0.003278745	0	0	0.165639482	0	0.000559229	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3776	0		16.41276168	24.8131	2.268359404	6.658477816	4.280237021	4.071286401	3.099567259	1.24056833	6.032534056	7.661895384	3.484048636	0	0.012059602	0.071688081	8.191329196	9.37761402	27.68608325	0.682152992	1.176195304	3.430521089	0	3.970379182	0.003278745	0	0	0.165639482	0	0.000559229	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3776	NO																																																																																		0	0		0	24.8131	2.268359404	6.658477816	4.280237021	4.071286401	3.099567259	1.24056833	6.032534056	7.661895384	3.484048636	0	0.012059602	0.071688081	8.191329196	9.37761402	27.68608325	0.682152992	1.176195304	3.430521089	0	3.970379182	0.003278745	0	0	0.165639482	0	0.000559229	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3776
H5698_141_0	2012	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	1326.431162	1539.253532	1480.857199		568.4499649	16.47033906	11.71234444	727.4842327	464.4078356	367.6152155				31.18024176	3474.393706	5361.524064		781.5294381			16.68619957				185.3937268		164.9003966														4500	"(1a) Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	(1b) Days 1 - 5 : $150/day Days 6-90 $0/day	(2) Days 21 - 100 : $100/day	(6) No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER ; $65/visit UC; $35/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;	(5) Partial Hospitalization $20/observation	$0/visit	$0/visit	(7a) $10/visit	(7d) $25/visit	"(7e)non-physician (7h) Psychiatric, Individual: $0/visit; Group: $0/visit"	(7c) OT (7i)PT/ST $25/visit	No Cost Sharing	(7b) Chiro (7f) pod. (7g) other $20 visit	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"No Cost Sharing, 70 annual trip limit"	$225 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;													95.51623749	60.94879518	33.95471492		50	0.164	0.19048732	65	71.80163914	69.82759315				44.42203445	10.00136307	24.48566353		25			0.175939498				29.4806626		30														NO	86.15859312	54.97769367	30.62820044		45.10154262	0.14793306	0.171825439	58.6320054	64.76729376	62.98664336				40.07004559	9.021538051	22.08682394		22.55077131			0.158702855				26.59476106		27.06092557															9.5236	7.052050763	3.779665927	0	2.136497527	2.436507652	2.012478731	3.554488288	2.506536559	1.929570706	0	0	0	0.104116142	2.612031252	9.868253173	0	1.468674302	0	0	2.648147514	0	0	0	0.410875156	0	0.371863113	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4154	0		5.692770221	9.5236	7.052050763	3.779665927	0	2.136497527	2.436507652	2.012478731	3.554488288	2.506536559	1.929570706	0	0	0	0.104116142	2.612031252	9.868253173	0	1.468674302	0	0	2.648147514	0	0	0	0.410875156	0	0.371863113	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4154	NO																																																																																		0	0		0	9.5236	7.052050763	3.779665927	0	2.136497527	2.436507652	2.012478731	3.554488288	2.506536559	1.929570706	0	0	0	0.104116142	2.612031252	9.868253173	0	1.468674302	0	0	2.648147514	0	0	0	0.410875156	0	0.371863113	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4154
H5698_150_0	2012	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	1310.289816	86.30043742	389.418384		609.0018632	8.899543963	4.128376836	412.0265993	228.7650109	207.4109518		0.655017471		20.01259781	2975.138482	3200.75714	190.5847466	302.1737464			19.86702818				240.8181536		80.20227179			1.04147163											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: $65/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $125 Annual Allowance; Lens & Frames, Lens, Frames: $125 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													96.41763709	79.54203041	60.82204238		50	0.168	0.201041482	65	300	102.5657862		30		37.4923702	20.00077011	29.22769195	30	30			0.172071331				29.95411897		30			20											NO	93.61883774	77.34442314	58.94098764		48.68817382	0.162964306	0.194938748	62.99500719	290.7278048	99.47268857		29.4559197		36.83479064	19.38232697	28.34635856	29.17027605	29.14372843			0.16679685				29.05320155		29.10673507			20												10.2223	0.556238129	1.912725346	0	2.470932381	1.450308004	0.80478061	2.162968216	5.542362452	1.719310417	0	0.001607845	0	0.061429988	4.805425571	7.560817464	0.463284139	0.733872467	0	0	3.313757719	0	0	0	0.583044863	0	0.194535523	0	0	0.001735786	0	0	0	0	0	0	0	0	0	0	44.5615	0		1.37121472	10.2223	0.556238129	1.912725346	0	2.470932381	1.450308004	0.80478061	2.162968216	5.542362452	1.719310417	0	0.001607845	0	0.061429988	4.805425571	7.560817464	0.463284139	0.733872467	0	0	3.313757719	0	0	0	0.583044863	0	0.194535523	0	0	0.001735786	0	0	0	0	0	0	0	0	0	0	44.5615	NO																																																																																		0	0		0	10.2223	0.556238129	1.912725346	0	2.470932381	1.450308004	0.80478061	2.162968216	5.542362452	1.719310417	0	0.001607845	0	0.061429988	4.805425571	7.560817464	0.463284139	0.733872467	0	0	3.313757719	0	0	0	0.583044863	0	0.194535523	0	0	0.001735786	0	0	0	0	0	0	0	0	0	0	44.5615
H5698_151_0	2012	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	1759.140974	99.11172765	298.7283627		740.9094915	11.94719475	4.121567308	430.4085987	302.6440886	199.7496113		3.22467701		25.46337532	3054.851506	3993.841246	272.1118546	450.5050226			26.11257598		32.21190506		272.7614356		59.45449222			2.146008588											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: $65/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	$25/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$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	$475 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;													56.04582733	91.13704819	33.95471492		50	0.168	0.2	65	152.2837136	76.98656942		25		32.21797597	15.00216075	24.53269412	25	25			0.17602774		3		29.90084081		30			20											NO	51.78890039	90.98010145	31.20252873		46.77043078	0.154889891	0.184166187	59.7126198	139.9073083	70.92305372		23.2461025		30.88718798	13.78288621	22.60788037	23.21610121	23.12884646			0.167539305		2.755849772		27.56465558		27.79231935			20												7.592	0.75143292	0.776756693	0	2.887721341	1.850499698	0.759053335	2.141735418	3.528509985	1.180571034	0	0.006246764	0	0.065541005	3.508722557	7.524357091	0.52644803	0.868305125	0	0	4.374882835	0	0.007397598	0	0.626547919	0	0.137698186	0	0	0.003576681	0	0	0	0	0	0	0	0	0	0	39.118	0		3.069210788	7.592	0.75143292	0.776756693	0	2.887721341	1.850499698	0.759053335	2.141735418	3.528509985	1.180571034	0	0.006246764	0	0.065541005	3.508722557	7.524357091	0.52644803	0.868305125	0	0	4.374882835	0	0.007397598	0	0.626547919	0	0.137698186	0	0	0.003576681	0	0	0	0	0	0	0	0	0	0	39.118	NO																																																																																		0	0		0	7.592	0.75143292	0.776756693	0	2.887721341	1.850499698	0.759053335	2.141735418	3.528509985	1.180571034	0	0.006246764	0	0.065541005	3.508722557	7.524357091	0.52644803	0.868305125	0	0	4.374882835	0	0.007397598	0	0.626547919	0	0.137698186	0	0	0.003576681	0	0	0	0	0	0	0	0	0	0	39.118
H5698_152_0	2012	9																															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	2575.920144	176.5053666	568.8169514		1628.759521	19.26764239	8.027886119	398.8732606	393.6096951	405.218619		12.88349943		113.8802449	3.619836841	6066.522939	398.3954293	919.2905358			45.23082947				369.0971115		26.69528721			12.10084034											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: $65/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	$15/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	"Chiro, $15/visit"	15% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$475 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;													36.64848833	91.13704819	30.26279895		50	0.084	0.1	65	118.4514071	50		15		31.57514851	15	15	15	15			0.168366644				10		10			20											NO	34.30315772	86.7090181	27.79313921		48.31937638	0.077712368	0.092375931	59.62095657	108.6711956	46.53641668		15		31.15640619	15	14.02032377	14.65766191	14.15332348			0.155145742				9.400443963		9.9507774			20												7.3635	1.275383919	1.31743406	0	6.558387025	1.497334123	0.741583452	1.981767112	3.564503014	1.571451875	0	0.016104374	0	0.295674931	0.004524796	7.087884648	0.486628792	1.08425136	0	0	7.017370609	0	0	0	0.289139726	0	0.022136572	0	0	0.020168067	0	0	0	0	0	0	0	0	0	0	42.1952	0		2.904676469	7.3635	1.275383919	1.31743406	0	6.558387025	1.497334123	0.741583452	1.981767112	3.564503014	1.571451875	0	0.016104374	0	0.295674931	0.004524796	7.087884648	0.486628792	1.08425136	0	0	7.017370609	0	0	0	0.289139726	0	0.022136572	0	0	0.020168067	0	0	0	0	0	0	0	0	0	0	42.1952	NO																																																																																		0	0		0	7.3635	1.275383919	1.31743406	0	6.558387025	1.497334123	0.741583452	1.981767112	3.564503014	1.571451875	0	0.016104374	0	0.295674931	0.004524796	7.087884648	0.486628792	1.08425136	0	0	7.017370609	0	0	0	0.289139726	0	0.022136572	0	0	0.020168067	0	0	0	0	0	0	0	0	0	0	42.1952
H5698_153_0	2012	10																															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	1735.629617	71.88988482	1353.638922		235.3889691	18.47866096	28.92854894	351.1893997	473.5742397	570.0059726		8.881566987		51.72320961	1.52509123	5191.915894	219.5852777	674.1362893			33.30494287						249														3400	"Days 1 - 7: $125/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $125/day	Days 11 - 20 : $50/day; Days 21-100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER; $65/visit UC;$35 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	$0/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$20/visit	No Cost Sharing	"Chiro, $20/visit"	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$0/trip, 20 annual trip limit"	Not Covered	Routine Eye Exam: $0	"Contact Lens: $375 Annual Allowance; Lens & Frames, Lens, Frames: $375 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;													69.25605489	65.09789157	47.24015641		50	0.15	0.189246222	65	86.40107891	54.5643469		15		46.88892976	20	19.14452356	20	20			0.2						30														NO	60.91252796	57.25531358	41.54896424		43.97631951	0.131928959	0.166447047	57.16921536	75.99202905	47.99078307		13.19289585		41.24005114	17.5905278	16.8381137	17.5905278	17.5905278			0.175905278						26.38579171															8.8101	0.343006492	4.686857929	0	0.862628376	2.437870496	4.815071539	1.673101869	2.998988948	2.279586082	0	0.009764466	0	0.177755651	0.002235597	7.285172512	0.321885078	0.988201095	0	0	5.858515236	0	0	0	0	0	0.547505178	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0983	0		6.040385934	8.8101	0.343006492	4.686857929	0	0.862628376	2.437870496	4.815071539	1.673101869	2.998988948	2.279586082	0	0.009764466	0	0.177755651	0.002235597	7.285172512	0.321885078	0.988201095	0	0	5.858515236	0	0	0	0	0	0.547505178	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0983	NO																																																																																		0	0		0	8.8101	0.343006492	4.686857929	0	0.862628376	2.437870496	4.815071539	1.673101869	2.998988948	2.279586082	0	0.009764466	0	0.177755651	0.002235597	7.285172512	0.321885078	0.988201095	0	0	5.858515236	0	0	0	0	0	0.547505178	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0983
H5698_154_0	2012	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	1718.008967	73.22570192	1354.810771		235.60504	18.02042128	25.29010424	350.1221846	465.7634715	561.1331115		9.176189976		51.0136654	1.618850513	5107.551185	221.9463577	663.0015734			32.23042971						249														3400	"Days 1 - 7: $125/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $125/day	Days 11 - 20 : $50/day; Days 21-100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER; $65/visit UC;$35 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	$0/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$20/visit	No Cost Sharing	"Chiro, $20/visit"	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$0/trip, 20 annual trip limit"	Not Covered	Routine Eye Exam: $0	"Contact Lens: $375 Annual Allowance; Lens & Frames, Lens, Frames: $375 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;													69.25605489	65.09789157	47.24015641		50	0.15	0.182581374	65	85.04284148	54.5278696		15		46.90014229	20	19.14435238	20	20			0.2						30														NO	61.27129164	57.59253694	41.79368006		44.23533201	0.132705996	0.161530954	57.50593162	75.23796657	48.24116832		13.2705996		41.49286731	17.69413281	16.93713568	17.69413281	17.69413281			0.176941328						26.54119921															8.7721	0.351437829	4.718543992	0	0.868505597	2.391417955	4.085134659	1.677841867	2.920258041	2.25580974	0	0.010147795	0	0.176391937	0.002387013	7.208940617	0.327262361	0.977603158	0	0	5.702895036	0	0	0	0	0	0.550729884	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9974	0		5.603337706	8.7721	0.351437829	4.718543992	0	0.868505597	2.391417955	4.085134659	1.677841867	2.920258041	2.25580974	0	0.010147795	0	0.176391937	0.002387013	7.208940617	0.327262361	0.977603158	0	0	5.702895036	0	0	0	0	0	0.550729884	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9974	NO																																																																																		0	0		0	8.7721	0.351437829	4.718543992	0	0.868505597	2.391417955	4.085134659	1.677841867	2.920258041	2.25580974	0	0.010147795	0	0.176391937	0.002387013	7.208940617	0.327262361	0.977603158	0	0	5.702895036	0	0	0	0	0	0.550729884	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9974
H5698_155_0	2012	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	1596.960947	64.41581003	1039.891221		477.5997761	18.96960197	25.25174385	514.3715244	467.0914304	477.2081941		6.535775757		52.50004098	1.12228555	5029.649625	183.0631781	572.4585947			35.11980773						249														3400	"Days 1 - 7: $125/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $125/day	Days 11 - 20 : $50/day; Days 21-100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER; $65/visit UC;$35 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	$0/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$20/visit	No Cost Sharing	"Chiro, $20/visit"	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$0/trip, 20 annual trip limit"	Not Covered	Routine Eye Exam: $0	"Contact Lens: $375 Annual Allowance; Lens & Frames, Lens, Frames: $375 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;													69.21164194	65.09789157	47.24015641		50	0.15	0.18215191	65	91.06232418	57.37423931		15		40.90726149	20	19.13420533	19.76538635	20			0.189612253						30														NO	61.22666954	57.58245541	41.78636411		44.22758866	0.132682766	0.161122795	57.49586525	80.54934032	50.75048511		13.2682766		36.18459068	17.69103546	16.92519526	17.48350754	17.69103546			0.167721855						26.53655319															8.1481	0.309101709	3.621106099	0	1.760257203	2.516939259	4.068631539	2.464519654	3.135325549	2.018212279	0	0.00722654	0	0.158307708	0.001654533	7.093983497	0.266715538	0.843948775	0	0	5.890359291	0	0	0	0	0	0.550633479	0	0	0	0	0	0	0	0	0	0	0	0	0	42.855	0		5.59245213	8.1481	0.309101709	3.621106099	0	1.760257203	2.516939259	4.068631539	2.464519654	3.135325549	2.018212279	0	0.00722654	0	0.158307708	0.001654533	7.093983497	0.266715538	0.843948775	0	0	5.890359291	0	0	0	0	0	0.550633479	0	0	0	0	0	0	0	0	0	0	0	0	0	42.855	NO																																																																																		0	0		0	8.1481	0.309101709	3.621106099	0	1.760257203	2.516939259	4.068631539	2.464519654	3.135325549	2.018212279	0	0.00722654	0	0.158307708	0.001654533	7.093983497	0.266715538	0.843948775	0	0	5.890359291	0	0	0	0	0	0.550633479	0	0	0	0	0	0	0	0	0	0	0	0	0	42.855
H5698_156_0	2012	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	1820.105898	71.29800609	1355.614458		500.016208	20.8825634	28.14915233	416.9084358	496.0820573	519.181055		7.358566246		45.32319722	1.263570366	5466.689558	253.9209095	701.7027577			36.32905755						249														3400	"Days 1 - 7: $125/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $125/day	Days 11 - 20 : $50/day; Days 21-100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER; $65/visit UC;$35 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	$0/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$20/visit	No Cost Sharing	"Chiro, $20/visit"	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$0/trip, 20 annual trip limit"	Not Covered	Routine Eye Exam: $0	"Contact Lens: $375 Annual Allowance; Lens & Frames, Lens, Frames: $375 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;													69.25605489	65.09789157	47.24015641		50	0.15	0.17642433	65	87.41629809	56.62195012		15		47.90052881	20	19.15154262	20	20			0.188521222						30														NO	60.24763576	56.6303418	41.0954355		43.49629492	0.130488885	0.153476093	56.54518339	76.04570164	49.25690083		13.04888847		41.66991056	17.39851797	16.66042292	17.39851797	17.39851797			0.163999493						26.09777695															9.1381	0.336469205	4.642463877	0	1.81240437	2.724942409	4.320221931	1.964513663	3.143742343	2.131104145	0	0.008001759	0	0.157384465	0.001832021	7.589780001	0.368153959	1.017382336	0	0	5.957947036	0	0	0	0	0	0.541528872	0	0	0	0	0	0	0	0	0	0	0	0	0	45.856	0		6.856530075	9.1381	0.336469205	4.642463877	0	1.81240437	2.724942409	4.320221931	1.964513663	3.143742343	2.131104145	0	0.008001759	0	0.157384465	0.001832021	7.589780001	0.368153959	1.017382336	0	0	5.957947036	0	0	0	0	0	0.541528872	0	0	0	0	0	0	0	0	0	0	0	0	0	45.856	NO																																																																																		0	0		0	9.1381	0.336469205	4.642463877	0	1.81240437	2.724942409	4.320221931	1.964513663	3.143742343	2.131104145	0	0.008001759	0	0.157384465	0.001832021	7.589780001	0.368153959	1.017382336	0	0	5.957947036	0	0	0	0	0	0.541528872	0	0	0	0	0	0	0	0	0	0	0	0	0	45.856
H5698_157_0	2012	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	1713.553584	129.2757436	392.3619985		654.4891413	13.45364004	5.156966103	477.5290661	344.8337863	230.528362		8.236424369		18.61492565	3365.018591	4463.255598	326.2011592	522.9453573			26.61163588		43.26952051		283.6667252		7.889849415			3.326606512											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: $65/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	$25/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$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	$475 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;													56.03902232	91.13704819	33.95471492		50	0.168	0.2	65	131.50702	76.75725263		25		34.52929259	15.00783661	24.70292688	25	25			0.175792811		3		29.87111872		30			20											NO	50.61185639	82.99361831	31.33333037		45.05558663	0.151810206	0.181687045	58.71759139	118.546581	69.32370464		23.85892695		31.56635813	13.54054228	22.28260697	22.83018401	22.58725787			0.158554303		2.697967835		26.9096611		29.62295613			20												7.2272	0.894088477	1.024500677	0	2.457366017	2.04239987	0.936953933	2.336613048	3.406572198	1.331756673	0	0.016376021	0	0.048967117	3.797014709	8.287747523	0.620602708	0.984325136	0	0	4.219389381	0	0.009728315	0	0.63611462	0	0.019476722	0	0	0.005544344	0	0	0	0	0	0	0	0	0	0	40.3027	0		4.306839941	7.2272	0.894088477	1.024500677	0	2.457366017	2.04239987	0.936953933	2.336613048	3.406572198	1.331756673	0	0.016376021	0	0.048967117	3.797014709	8.287747523	0.620602708	0.984325136	0	0	4.219389381	0	0.009728315	0	0.63611462	0	0.019476722	0	0	0.005544344	0	0	0	0	0	0	0	0	0	0	40.3027	NO																																																																																		0	0		0	7.2272	0.894088477	1.024500677	0	2.457366017	2.04239987	0.936953933	2.336613048	3.406572198	1.331756673	0	0.016376021	0	0.048967117	3.797014709	8.287747523	0.620602708	0.984325136	0	0	4.219389381	0	0.009728315	0	0.63611462	0	0.019476722	0	0	0.005544344	0	0	0	0	0	0	0	0	0	0	40.3027
H5698_158_0	2012	5																															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	2261.493832	343.1983398	644.0219607	19.13758887	22.66031889	20.25850084	11.10773346	48.34195998	44.84446614	18.25408393		0.101580151	0.006221229	30.61104746	47.99061063	167.2566711	3.204582717	6.707164938	19.65513747		33.26883427	0.0161257			124.833968		1.64520735														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, Blood: Waiver of 3 pint deductible"	"No Cost Sharing, 24 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $300 Annual Allowance; Lens & Frames, Lens, Frames: $300 Annual Allowance"	Routine Hearing Tests: $10	Hearing Aids: $1000 annual allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;													138.0148715	78.12268097	85.08507964	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.223911	0.224	0.224	0.224	0.224	0.224		0.190984194	0.224			9.898471559		9.71														NO	121.4282225	69.57699049	73.78510089	0.194886456	0.200841716	0.202141247	0.187797433	0.196585818	0.199531071	0.203553198		0.187771303	0.142506147	0.204482856	0.197400481	0.198017648	0.194858903	0.199074004	0.199872285		0.176936644	0.224			8.766991029		7.361257583															22.8841	1.989892302	3.959935445	3.729656875	4.551137327	4.09507863	2.086003829	9.503343759	8.947864363	3.715677158	0	0.019073837	0.000886563	6.259434411	9.473369627	33.11977268	0.624441473	1.335222179	3.92851724	0	5.886475888	0.003612157	0	0	0.091201523	0	0.001009233	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2057	0		16.13481362	22.8841	1.989892302	3.959935445	3.729656875	4.551137327	4.09507863	2.086003829	9.503343759	8.947864363	3.715677158	0	0.019073837	0.000886563	6.259434411	9.473369627	33.11977268	0.624441473	1.335222179	3.92851724	0	5.886475888	0.003612157	0	0	0.091201523	0	0.001009233	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2057	NO																																																																																		0	0		0	22.8841	1.989892302	3.959935445	3.729656875	4.551137327	4.09507863	2.086003829	9.503343759	8.947864363	3.715677158	0	0.019073837	0.000886563	6.259434411	9.473369627	33.11977268	0.624441473	1.335222179	3.92851724	0	5.886475888	0.003612157	0	0	0.091201523	0	0.001009233	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2057
H5698_159_0	2012	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	1328.833583	105.9192446	522.746959		600.791451	9.050149957	5.125328367	442.0699408	277.0463591	207.2483135		7.033217847		20.33848167	3298.71837	3422.650328	269.8104605	370.3256736			18.58808227				252.9108485		10.59040964			4.537284765											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: $65/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $100/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	Chiro; $20	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $150 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													96.41763709	69.5326034	60.82204238		50	0.168	0.2	65	300	100.1845089		30		43.91933226	20.00867405	29.62273247	30	30			0.176248021				29.9360218		27.66626545			20											NO	93.2787664	67.49573178	59.22916589		48.29868906	0.162611833	0.193838066	62.86627254	289.9091302	96.89159233		29.91692294		42.86091755	19.33794538	28.63785481	29.2018263	29.0382704			0.170380118				28.91231464		27.66626545			20												10.3293	0.595758077	2.580155529	0	2.418119957	1.471661472	0.993483737	2.315940782	6.693189083	1.673384925	0	0.017534353	0	0.072643832	5.315869639	8.168113597	0.65657985	0.896134754	0	0	3.167039657	0	0	0	0.609353169	0	0.024416424	0	0	0.007562141	0	0	0	0	0	0	0	0	0	0	48.0063	0		1.614326634	10.3293	0.595758077	2.580155529	0	2.418119957	1.471661472	0.993483737	2.315940782	6.693189083	1.673384925	0	0.017534353	0	0.072643832	5.315869639	8.168113597	0.65657985	0.896134754	0	0	3.167039657	0	0	0	0.609353169	0	0.024416424	0	0	0.007562141	0	0	0	0	0	0	0	0	0	0	48.0063	NO																																																																																		0	0		0	10.3293	0.595758077	2.580155529	0	2.418119957	1.471661472	0.993483737	2.315940782	6.693189083	1.673384925	0	0.017534353	0	0.072643832	5.315869639	8.168113597	0.65657985	0.896134754	0	0	3.167039657	0	0	0	0.609353169	0	0.024416424	0	0	0.007562141	0	0	0	0	0	0	0	0	0	0	48.0063
H5698_160_0	2012	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	2260.340467	123.9516198	678.2257709		744.969125	17.73734568	7.651012797	456.0575048	439.633654	385.2827304		2.568672709		17.67586318	1.134797555	5411.492195	148.2894782	712.1510862			43.57132066				300.8769183		5.186134724			1.644699313											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: $65/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	$15/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	"Chiro, $15/visit"	15% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$475 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;													36.64848833	91.13704819	30.26279895		50	0.084	0.1	65	106.5923843	50		15		33.397521	15	15	15	15			0.152420254				10		10			20											NO	33.86744787	84.57618513	28.10763623		46.17673977	0.077636239	0.092546575	60.10486054	98.43389212	46.20964236		15		31.05092577	15	13.85725303	14.04301763	13.86278425			0.140750454				9.234709616		9.736366826			20												6.3793	0.873612929	1.588610271	0	2.866687118	1.377060815	0.708075027	2.284272727	3.606237639	1.483648098	0	0.003210841	0	0.04573766	0.001418497	6.249034718	0.17353598	0.822699738	0	0	6.132683168	0	0	0	0.231542581	0	0.004207843	0	0	0.002741166	0	0	0	0	0	0	0	0	0	0	34.8343	0		2.853175037	6.3793	0.873612929	1.588610271	0	2.866687118	1.377060815	0.708075027	2.284272727	3.606237639	1.483648098	0	0.003210841	0	0.04573766	0.001418497	6.249034718	0.17353598	0.822699738	0	0	6.132683168	0	0	0	0.231542581	0	0.004207843	0	0	0.002741166	0	0	0	0	0	0	0	0	0	0	34.8343	NO																																																																																		0	0		0	6.3793	0.873612929	1.588610271	0	2.866687118	1.377060815	0.708075027	2.284272727	3.606237639	1.483648098	0	0.003210841	0	0.04573766	0.001418497	6.249034718	0.17353598	0.822699738	0	0	6.132683168	0	0	0	0.231542581	0	0.004207843	0	0	0.002741166	0	0	0	0	0	0	0	0	0	0	34.8343
H5698_163_0	2012	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	1621.9884	85.37633013	1547.793947		194.6832337	13.12842653	18.66318409	335.5627416	450.8199357	643.0074173		25.59555298		72.02072283	5.841728888	5870.559374	437.2823038	1016.782503			38.09007518						249.0641445														3400	"Days 1 - 7: $125/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $125/day	Days 11 - 20 : $50/day; Days 21-100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER; $65/visit UC;$35 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	$0/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$20/visit	No Cost Sharing	"Chiro, $20/visit"	20% Coinsurance	"No Cost Sharing, Waiver of 3 pint deductible"	"$0/trip, 20 annual trip limit"	Not Covered	Routine Eye Exam: $0	"Contact Lens: $375 Annual Allowance; Lens & Frames, Lens, Frames: $375 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;													69.25605489	65.09789157	47.24015641		50	0.15	0.188775284	65	100.6550268	53.99031307		15		47.56379996	20	19.16793817	20	20			0.2						30														NO	60.70155311	57.05700575	41.40505646		43.82400442	0.131472013	0.165457778	56.97120574	88.22212676	47.32143437		13.14720133		41.68872359	17.52960177	16.80031614	17.52960177	17.52960177			0.175296018						26.29440265															8.2048	0.405943147	5.340541314	0	0.710983241	1.726020667	3.087968967	1.593117833	3.314357792	2.535669441	0	0.028042491	0	0.250204334	0.008533598	8.218937784	0.638782054	1.485316029	0	0	6.677038492	0	0	0	0	0	0.545749409	0	0	0	0	0	0	0	0	0	0	0	0	0	44.772	0		6.309590383	8.2048	0.405943147	5.340541314	0	0.710983241	1.726020667	3.087968967	1.593117833	3.314357792	2.535669441	0	0.028042491	0	0.250204334	0.008533598	8.218937784	0.638782054	1.485316029	0	0	6.677038492	0	0	0	0	0	0.545749409	0	0	0	0	0	0	0	0	0	0	0	0	0	44.772	NO																																																																																		0	0		0	8.2048	0.405943147	5.340541314	0	0.710983241	1.726020667	3.087968967	1.593117833	3.314357792	2.535669441	0	0.028042491	0	0.250204334	0.008533598	8.218937784	0.638782054	1.485316029	0	0	6.677038492	0	0	0	0	0	0.545749409	0	0	0	0	0	0	0	0	0	0	0	0	0	44.772
H5698_801_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1427.997977	90.47569519	721.6110713		157.0459115	11.62345785	15.48020904	15.49130312	51.39611451	4.767822053	16.07121241	0.99782247	0.577181926	20.31132391	36.3115279	112.3267401	1.361544791	9.913846931	22.46916783	19.18448437	33.37799276	0.808993588																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													173.3945466	68.62255524	89.17130557		148.3215094	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	147.6532858	58.43520432	75.93339307		126.3024625	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114																				17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	0		16.61033304	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	NO																																																																																		0	0		0	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778
H5698_802_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1427.997977	90.47569519	721.6110713		157.0459115	11.62345785	15.48020904	15.49130312	51.39611451	4.767822053	16.07121241	0.99782247	0.577181926	20.31132391	36.3115279	112.3267401	1.361544791	9.913846931	22.46916783	19.18448437	33.37799276	0.808993588																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													173.3945466	68.62255524	89.17130557		148.3215094	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	147.6532858	58.43520432	75.93339307		126.3024625	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114																				17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	0		16.61033304	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	NO																																																																																		0	0		0	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778
H5698_803_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1427.997977	90.47569519	721.6110713		157.0459115	11.62345785	15.48020904	15.49130312	51.39611451	4.767822053	16.07121241	0.99782247	0.577181926	20.31132391	36.3115279	112.3267401	1.361544791	9.913846931	22.46916783	19.18448437	33.37799276	0.808993588																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													173.3945466	68.62255524	89.17130557		148.3215094	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	147.6532858	58.43520432	75.93339307		126.3024625	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114																				17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	0		16.61033304	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	NO																																																																																		0	0		0	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778
H5698_804_0	2012	2																															D	D	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	Coin																																																			0	YES	1427.997977	90.47569519	721.6110713		157.0459115	11.62345785	15.48020904	15.49130312	51.39611451	4.767822053	16.07121241	0.99782247	0.577181926	20.31132391	36.3115279	112.3267401	1.361544791	9.913846931	22.46916783	19.18448437	33.37799276	0.808993588																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													173.3945466	68.62255524	89.17130557		148.3215094	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	147.6532858	58.43520432	75.93339307		126.3024625	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114	0.190746114																				17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	0		16.61033304	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778	NO																																																																																		0	0		0	17.5707	0.440580478	4.566198093	0	1.652940446	2.21712942	2.952789724	2.954905876	9.803609136	0.90944353	3.06552132	0.190330759	0.11009521	3.874306113	6.926282853	21.4258892	0.259709378	1.89102778	4.285906457	3.65936585	6.366722423	0.154312383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2778
H5700_002_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	998.9287661	28.71475124	492.5876071		157.5010611	9.909295785	2.996570434	306.4523842	224.1595693		8.20221243	11.61186958		12.13869409		2649.906864	95.67750058	589.1717239			10.04621912				159.1037094																4950	"1a - IP Acute 200 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 225 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													135.5656427	142.4713977	60.09645318		225	0.2	0.2	64.5461285	400		0.2	395.252415		0.199811884		33.59293884	40	20			0.2				5																NO	129.432705	136.0260464	57.3777127		214.8210864	0.190952077	0.190952077	61.62608642	381.9041535		0.190952077	381.9041535		0.190772471		32.09306966	38.19041535	19.09520768			0.190952077				5																	10.7745	0.325496174	2.35529585	0	2.819545754	1.892200609	0.572201348	1.573788426	7.133955881	0	1.566229498	0.369551769	0	2.315728664	0	7.086970465	0.304496957	0.937529702	0	0	1.918346405	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0121	0		1.978340827	10.7745	0.325496174	2.35529585	0	2.819545754	1.892200609	0.572201348	1.573788426	7.133955881	0	1.566229498	0.369551769	0	2.315728664	0	7.086970465	0.304496957	0.937529702	0	0	1.918346405	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0121	NO																																																																																		0	0		0	10.7745	0.325496174	2.35529585	0	2.819545754	1.892200609	0.572201348	1.573788426	7.133955881	0	1.566229498	0.369551769	0	2.315728664	0	7.086970465	0.304496957	0.937529702	0	0	1.918346405	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0121
H5700_005_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1329.270226	65.17582324	384.5786539		171.9089656	12.81365337	5.491150168	322.8873048	208.3788173		11.22367963	68.57194307	0.007573525	12.08250684		2580.994953	50.28764167	587.0555354			13.24208567				159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f - Podiatry 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	64.75	350		0.2	350	0.2	0.200203321		29.5813771	40	19.76071093			0.2				5																NO	173.9579527	136.7733412	57.69293226		240.0014028	0.192001122	0.192001122	62.16036332	336.0019639		0.192001122	336.0019639	0.192001122	0.192196311		28.40632889	38.40022444	19.00196416			0.192001122				5																	19.2698	0.742859593	1.848955852	0	3.438199408	2.460235826	1.054306994	1.672566014	5.834640987	0	2.154959084	1.920025628	0.001454125	2.322213244	0	6.109715958	0.160921394	0.929600687	0	0	2.542495309	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5292	0		2.182224861	19.2698	0.742859593	1.848955852	0	3.438199408	2.460235826	1.054306994	1.672566014	5.834640987	0	2.154959084	1.920025628	0.001454125	2.322213244	0	6.109715958	0.160921394	0.929600687	0	0	2.542495309	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5292	NO																																																																																		0	0		0	19.2698	0.742859593	1.848955852	0	3.438199408	2.460235826	1.054306994	1.672566014	5.834640987	0	2.154959084	1.920025628	0.001454125	2.322213244	0	6.109715958	0.160921394	0.929600687	0	0	2.542495309	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5292
H5700_009_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1110.272847	28.95350575	288.7102256		175.6490869	14.84679192	7.864256553	486.7195685	201.088854		14.06401964	37.43996681	0.08722363	30.25793236		2553.705482	70.06409026	439.5778497			17.47892041				159.1037094																4950	"1a - IP Acute 200 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 225 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 400 copay,9b - OP Ambulatory Surgical Center (ASC) 400 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 400 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 35 copay,7f (Podiatry) 35 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 35 copay,18a - Hearing Exam (M/C) 35 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 35 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 35 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													135.5656427	142.4713977	60.09645318		225	0.2	0.2	64.75	400		0.2	314.7102113	0.2	0.199942694		33.35203158	40	20			0.2				5																NO	127.3988642	133.888601	56.47610798		211.4454951	0.187951551	0.187951551	60.8493147	375.9031024		0.187951551	314.7102113	0.187951551	0.187897698		31.39386906	37.59031024	18.79515512			0.187951551				5																	11.7873	0.323045365	1.358769157	0	3.095017345	2.790477571	1.478099218	2.468046016	6.299160339	0	2.643354307	0.981894989	0.016393817	5.685395825	0	6.680891294	0.219477574	0.688494489	0	0	3.285190204	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8673	0		3.11794277	11.7873	0.323045365	1.358769157	0	3.095017345	2.790477571	1.478099218	2.468046016	6.299160339	0	2.643354307	0.981894989	0.016393817	5.685395825	0	6.680891294	0.219477574	0.688494489	0	0	3.285190204	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8673	NO																																																																																		0	0		0	11.7873	0.323045365	1.358769157	0	3.095017345	2.790477571	1.478099218	2.468046016	6.299160339	0	2.643354307	0.981894989	0.016393817	5.685395825	0	6.680891294	0.219477574	0.688494489	0	0	3.285190204	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8673
H5700_018_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	300.5625839	1.99771553	34.20438934		11.08494614	17.66273751	11.25750584	35.77343258	67.1156143	9.67239929	20.21982088	3.07982905	0.389783505	32.49967464		4742.000951	3.50830247	1210.496628		2872.105084	22.62033824	0.053494775			159.1037094		1.271267651														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 25"													0.084323713	0.084323713	0.186331061		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.741975586	0.224	1343.439778			5		10														NO	0.068783684	0.068783684	0.151992084		0.182719009	0.182719009	0.182719009	0.182719009	0.182719009	0.182719009	0.182719009	0.182719009	0.182719009	0.182719009		8.157098616	0.182719009	8.157098616		2.236656526	0.182719009	1095.857075			5		10															20.6738	0.137410233	5.198796418	0	2.025430373	3.227317895	2.056960311	6.53648615	12.26329853	1.767331213	3.694545634	0.562743312	0.071220856	5.938308344	0	3.223414116	0.641033551	0.822845031	0	0.535326048	4.133165786	0.004885219	0	0	0.066293212	0	0.00105939	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5817	0		16.60880294	20.6738	0.137410233	5.198796418	0	2.025430373	3.227317895	2.056960311	6.53648615	12.26329853	1.767331213	3.694545634	0.562743312	0.071220856	5.938308344	0	3.223414116	0.641033551	0.822845031	0	0.535326048	4.133165786	0.004885219	0	0	0.066293212	0	0.00105939	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5817	NO																																																																																		0	0		0	20.6738	0.137410233	5.198796418	0	2.025430373	3.227317895	2.056960311	6.53648615	12.26329853	1.767331213	3.694545634	0.562743312	0.071220856	5.938308344	0	3.223414116	0.641033551	0.822845031	0	0.535326048	4.133165786	0.004885219	0	0	0.066293212	0	0.00105939	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5817
H5700_020_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1362.050672	75.49688466	460.4808809		216.4948661	14.32785939	8.901328361	485.162772	139.426417		13.12632	31.89829466	0.171314967	16.55743781		3206.920557	58.86563349	496.7056414			19.18521891				159.1037094																4400	"1a - IP Acute 165 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 175 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation 12 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 25 copay,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													102.1273837	142.4713977	60.09645318		175	0.2	0.2	64.75	200		0.2	200	0.2	0.200067565		24.79499878	40	20			0.2				5																NO	96.26411753	134.2919291	56.64623748		164.9530219	0.188517739	0.188517739	61.03261811	188.5177394		0.188517739	188.5177394	0.188517739	0.188581425		23.39029138	37.70354787	18.85177394			0.188517739				5																	10.9264	0.84488519	2.173709112	0	2.975956867	2.701055661	1.6780583	2.467562849	2.190362744	0	2.474544172	0.5011162	0.03229591	3.122425217	0	6.250900521	0.184953603	0.780315205	0	0	3.616754098	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9876	0		2.60892251	10.9264	0.84488519	2.173709112	0	2.975956867	2.701055661	1.6780583	2.467562849	2.190362744	0	2.474544172	0.5011162	0.03229591	3.122425217	0	6.250900521	0.184953603	0.780315205	0	0	3.616754098	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9876	NO																																																																																		0	0		0	10.9264	0.84488519	2.173709112	0	2.975956867	2.701055661	1.6780583	2.467562849	2.190362744	0	2.474544172	0.5011162	0.03229591	3.122425217	0	6.250900521	0.184953603	0.780315205	0	0	3.616754098	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9876
H5700_027_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1338.789224	17.77562834	271.7558543		142.2620059	9.235591861	4.062321994	339.192276	161.0306765		8.339386088	22.6128184	0.022619206	11.02653513		2671.142624	51.95801321	432.6918919			39.47165041				159.1037094																6700	"1a - IP Acute 250 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 250 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 30 copay,7f - Podiatry 30 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 30 copay,18a - Hearing Exam (M/C) 30 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 30 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam n/a,18a - Hearing Exam (M/C) 30 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) n/a	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													181.2051416	142.4713977	60.09645318		250	0.2	0.2	64.75	350		0.2	350	0.2	0.200098187		29.64218511	40	20			0.2				5																NO	174.0987792	136.8840652	57.73963721		240.1956944	0.192156556	0.192156556	62.21068485	336.2739721		0.192156556	336.2739721	0.192156556	0.192250892		28.50065106	38.4313111	19.21565555			0.192156556				5																	19.4235	0.202766689	1.30759037	0	2.847560108	1.77467952	0.780601802	1.758448649	4.512535435	0	1.602467706	0.633675189	0.004346429	2.119861215	0	6.344108657	0.166401214	0.69287153	0	0	7.584736383	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8224	0		2.107726874	19.4235	0.202766689	1.30759037	0	2.847560108	1.77467952	0.780601802	1.758448649	4.512535435	0	1.602467706	0.633675189	0.004346429	2.119861215	0	6.344108657	0.166401214	0.69287153	0	0	7.584736383	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8224	NO																																																																																		0	0		0	19.4235	0.202766689	1.30759037	0	2.847560108	1.77467952	0.780601802	1.758448649	4.512535435	0	1.602467706	0.633675189	0.004346429	2.119861215	0	6.344108657	0.166401214	0.69287153	0	0	7.584736383	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8224
H5700_028_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	388.3798847	5.127904823	49.31672692		10.27753767	15.93646013	66.41594448	32.86151912	88.70318878	9.058351494	28.9701662	6.771084862	0.76636614	41.76938176		6240.503817	5.334044886	1047.376907		4675.690924	31.06832176	0.108858016			159.1037094		2.050825854														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 20"											0	NO	0.082876379	0.082876379	0.186947292		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		3.43387376	0.224	1067.100176			5		10														NO	0.061605311	0.061605311	0.138965363		0.166508115	0.166508115	0.166508115	0.166508115	0.166508115	0.166508115	0.166508115	0.166508115	0.166508115	0.166508115		7.433398004	0.166508115	7.433398004		2.552535035	0.166508115	793.218032			5		10															23.9263	0.31590617	6.853316842	0	1.711293427	2.653549941	11.05879374	5.471709615	14.76980078	1.508289035	4.823767774	1.127440579	0.127606182	6.954941034	0	3.865679051	0.888161761	0.648797451	0	0.994572075	5.173127701	0.007195678	0	0	0.066293212	0	0.001709022	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9482	0		32.06965887	23.9263	0.31590617	6.853316842	0	1.711293427	2.653549941	11.05879374	5.471709615	14.76980078	1.508289035	4.823767774	1.127440579	0.127606182	6.954941034	0	3.865679051	0.888161761	0.648797451	0	0.994572075	5.173127701	0.007195678	0	0	0.066293212	0	0.001709022	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9482	YES																																																																																		0	0		0	23.9263	0.31590617	6.853316842	0	1.711293427	2.653549941	11.05879374	5.471709615	14.76980078	1.508289035	4.823767774	1.127440579	0.127606182	6.954941034	0	3.865679051	0.888161761	0.648797451	0	0.994572075	5.173127701	0.007195678	0	0	0.066293212	0	0.001709022	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9482
H5703_001_0	2012	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	259.796013	47.64700018	47.40726819		15.58457316	34.28721774	18.36955859	38.83801662	38.27607291	26.67652629	37.42303651			66.95265693		145.3185406	30.16684941	6.794705546	22.50242923		28.14711976																				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																						0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.081833114	0.081833114	0.151455864		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					21.2599	3.899102413	7.180108751	0	3.490944387	7.680336774	4.114781123	8.699715723	8.573840331	5.975541889	8.382760177	0	0	14.99739515	0	32.5513531	6.757374267	1.522014042	5.040544148	0	6.304954826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4307	Medicare FFS	YES	0	21.2599	3.899102413	7.180108751	0	3.490944387	7.680336774	4.114781123	8.699715723	8.573840331	5.975541889	8.382760177	0	0	14.99739515	0	32.5513531	6.757374267	1.522014042	5.040544148	0	6.304954826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4307	NO																																																																																		0				21.2599	3.899102413	7.180108751	0	3.490944387	7.680336774	4.114781123	8.699715723	8.573840331	5.975541889	8.382760177	0	0	14.99739515	0	32.5513531	6.757374267	1.522014042	5.040544148	0	6.304954826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4307
H5732_001_0	2012	19																																						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	0	0	0	0	0	0	0	543.7843033	0	0	139.242881	0	0	1555.458161	0	0	0	523.7424154	443.9777703	0	0	0	0	5.383975321	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-c	$45/Visit for ER - Facility; $45/Visit for PCP Urgent Care; $45/Visit for Urgent Care - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$10/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for OP Fac - Cardiovascular; $5/Visit for OP Fac - Occ Therapy; $5/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h, 9c"	"$5/Visit for Occ Therapy; $5/Visit for PT/ST; PBP 7c, 7i"	$10/Procedure for Prof Radiology (Office); PBP 7d	"No Cost Sharing; PBP 7d, 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	7% Coinsurance for Dental - Comprehensive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0	0	0	0	0	0	0	45	0	0	10	0	0	8.223293786	0	0	0	5	10	0	0	0	0	0.068600826	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	45	0	0	10	0	0	8.223293786	0	0	0	5	10	0	0	0	0	0.068600826	0	0	0	0	0	0												0	0	0	0	0	0	0	2.039191137	0	0	0.116035734	0	0	1.065915786	0	0	0	0.218226006	0.369981475	0	0	0	0	0.369345153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1787	0	NO	8.88E-16	0	0	0	0	0	0	0	2.039191137	0	0	0.116035734	0	0	1.065915786	0	0	0	0.218226006	0.369981475	0	0	0	0	0.369345153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1787	NO																																										0	0	0	0	0	0	0	0	0	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	2.039191137	0	0	0.116035734	0	0	1.065915786	0	0	0	0.218226006	0.369981475	0	0	0	0	0.369345153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1787
H5732_005_0	2012	19																															A	A	A			Coin	Coin	V	P	Coin	Coin			Coin		V	V	V	Coin	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	191.1212231	8.002328963	46.29412812	0	0	0.520346356	17.84537188	357.087411	154.3762023	1.677832627	2.86253874	0	0	2.626001169	0	7023.325932	831.7925199	137.5516004	27.79105951	44.44268234	0	157.9870624	0	9.593502367	0	0	0	0	0	0											6700	$50/Admit for IP; PBP 1a	$50/Admit for IP MH/SA; PBP 1b	$35/Admit for SNF; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$50/Visit for ER - Facility; PBP 4a-b	$50/Procedure for OP Fac - Surgery; $50/Procedure for OP Fac - Surgery; PBP 9a-b	10% Coinsurance for OP Fac - Pathology; PBP 8a	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"10% Coinsurance for OP Fac - Cardiovascular; $5/Visit for OP Fac - Occ Therapy; $5/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$5/Visit for Speclst Office Visits; $5/Visit for Chiropractor; $5/Visit for Vision Exams; $5/Visit for Hearing/Speech Exams; $15/Visit for Alternative Medicine; PBP 7b, 7d, 7f, 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"	"$5/Visit for Occ Therapy; $5/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for Prof Radiology (Office); 10% Coinsurance for Prof Radiology (Office); PBP 7d	"$5/Visit for Allergy Testing; $5/Procedure for Prof Path (Office); PBP 7d, 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	11% Coinsurance for Dental - Comprehensive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	50	50	35	0	0	0.1	0.1	50	50	0.1	0.1	0	0	0.114528863	0	5.427148053	10	5	0.1	5	0	5	0	0.113552221	0	0	0	0	0	0											NO	49.99924989	49.99924989	34.99947493	0	0	0.0999985	0.0999985	49.99924989	49.99924989	0.0999985	0.0999985	0	0	0.114527145	0	5.427066635	9.999849979	4.999924989	0.0999985	4.999924989	0	4.999924989	0	0.113550517	0	0	0	0	0	0												0.7963	0.033342537	0.135022515	0	0	0.052033855	1.784510416	1.487841891	0.643224526	0.167780746	0.28624958	0	0	0.300748416	0	3.176338152	0.693150034	0.057312307	2.779064258	0.018517507	0	0.065826955	0	1.089347158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5666	0	NO	0.000203531	0.7963	0.033342537	0.135022515	0	0	0.052033855	1.784510416	1.487841891	0.643224526	0.167780746	0.28624958	0	0	0.300748416	0	3.176338152	0.693150034	0.057312307	2.779064258	0.018517507	0	0.065826955	0	1.089347158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5666	NO	$250/Admit for IP; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	50% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 50% Coinsurance for Prosthetics; PBP 11b-c	20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; PBP 4a-b	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - Surgery; PBP 9a-b	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;	No Cost Sharing; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; PBP 3, 5"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b, 14d-e"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; PBP 7b, 7d, 7f, 17a, 18a"	"25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h, 9c"	"25% Coinsurance for Occ Therapy; 25% Coinsurance for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14c"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	20% Coinsurance for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	20% Coinsurance for Vision Hardware; PBP 17b	No Cost Sharing; PBP 18a	20% Coinsurance for Hearing Aids; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.0219	0	0	0.0023	0.0043	0.0011	0.1054	0.065	0.0086	0.0011	0.0011	0	0	0.0065	0.0561	0.0588	0.0023	0.0003	0.0368	0.0906	0.0132	0.0387	0	0.0178	0	0.1578	0	0.0176	0	0											0.7072	0	NO	4.44E-16	0.8182	0.033342537	0.135022515	0.002259787	0.004272446	0.05310115	1.889949743	1.552843437	0.651816342	0.168857687	0.287332863	0	0	0.307242222	0.056065717	3.235091716	0.695447698	0.05757555	2.81587734	0.109138598	0.013216429	0.104556048	0	1.10713095	0	0.157799115	0	0.017639674	0	0	0	0	0	0	0	0	0	0	0	0	14.2738
H5746_006_0	2012	7																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin							Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	196.3347051	6.301955676	27.69797835	0	11.61513775	14.65964735	5.899925482	19.47075852	29.50846768	8.965438843	11.06541697	0	0.514127568	23.87619319	0	0	0	0	0	0	8.020545326	0	0	0	0	0	0	0	0	0												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	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 0% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"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	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											0	NO	0.080870432	0.080870432	0.163001406	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0.079785896	0.079785896	0.160815428	0	0.197317842	0.197317842	0.197317842	0.197327423	0.197317842	0.197317842	0.198033803	0	0.197317842	0.197317842	0	0	0	0	0	0	0.197317842	0	0	0	0	0	0	0	0	0												15.6647	0.502807179	4.454262254	0	2.291873914	2.892609977	1.164160563	3.842114606	5.82254716	1.769041044	2.191326599	0	0.101446542	4.711198912	0	0	0	0	0	0	1.582596694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9907	0	NO	0.630529735	15.6647	0.502807179	4.454262254	0	2.291873914	2.892609977	1.164160563	3.842114606	5.82254716	1.769041044	2.191326599	0	0.101446542	4.711198912	0	0	0	0	0	0	1.582596694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9907	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	NO	0	15.6647	0.502807179	4.454262254	0	2.291873914	2.892609977	1.164160563	3.842114606	5.82254716	1.769041044	2.191326599	0	0.101446542	4.711198912	0	0	0	0	0	0	1.582596694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9907
H5746_012_0	2012	9																															D	D	D		T	Coin	Coin	V	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	YES	763.245965	72.68699222	322.83339	0	275.2600599	13.42455329	8.050226433	284.6441582	225.4870607	109.4589422	289.964602	0	37.33941258	485.6776426	3882.192542	3656.82487	284.7971171	524.7590062	237.8429451	0	43.84796401	0	0	0	0	0	0	0	0	0											6700	$125/Days 1-10 for IP Medical; $125/Days 1-10 for IP Surgical; PBP 1a	$125/Days 1-10 for IP Psych; $125/Days 1-10 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Speclst Urgent Care; PBP 4a, 4b"	$150/Visit for OP Fac - Surgery; PBP 9b	$250/Visit for OP Fac - Pathology; PBP 8a	$50/Visit for OP Fac - Radiology; $100/Visit for OP Fac - CT/MRI/PET; $60/Visit for Radiology - Therapeutic; $100/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	$30/Visit for Renal Dialysis - Fac; PBP 12	"$250/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; $250/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d"	"$5/Visit for PCP Office Visits; PBP 7a, 14a-b"	"$25/Visit for Speclst Office Visits; $20/Visit for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; 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); $60/Visit for Office-Rad Therapeutic; $100/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 14a"	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 13a-e, 14c"											0	NO	125	125	97.32949737	0	100	0.2	0.2	63.39051856	150	250	70.91751467	0	30	181.1675876	5	24.85252793	25	25	74.53906845	0	0.2	0	0	0	0	0	0	0	0	0											NO	120.7507184	120.7507184	94.0208538	0	96.60057469	0.193201149	0.193201149	61.23965246	144.900862	241.5014367	68.50672673	0	28.98017241	175.0089308	4.830028735	24.0076848	24.15014367	24.15014367	72.00516849	0	0.193201149	0	0	0	0	0	0	0	0	0												7.6802	0.731417211	2.52942258	0	2.215856665	2.593639126	1.555313	1.452625777	2.722772456	2.202874317	1.655377146	0	0.090175218	7.083160413	1.562591794	7.315991572	0.573157608	1.056083783	1.427160111	0	8.471477044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9193	0	NO	1.862158914	7.6802	0.731417211	2.52942258	0	2.215856665	2.593639126	1.555313	1.452625777	2.722772456	2.202874317	1.655377146	0	0.090175218	7.083160413	1.562591794	7.315991572	0.573157608	1.056083783	1.427160111	0	8.471477044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9193	YES	$225/Days 1-10 for IP Medical; $225/Days 1-10 for IP Surgical; PBP 1a	$225/Days 1-10 for IP Psych; $225/Days 1-10 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"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a, 4b"	$250/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; $150/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"$35/Visit for Speclst Office Visits; $35/Visit for Chiropractor; $35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; 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"	"No Cost-Sharing; PBP 7c, 7i"	$100/Visit for Prof Radiology (Office); $150/Visit for Prof Radiology (Office); $150/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											6700	1.6038	0.1406	0	0	0	0	0	0.1611	0.4977	0	0.1995	0	0	0	0	1.1391	0.089	0	0.2286	0	0	0	0	0	0	0	0	0	0	0											4.0595	0	NO	0.123743884	9.2841	0.872044908	2.52942258	0	2.215856665	2.593639126	1.555313	1.613676496	3.220522197	2.202874317	1.854909028	0	0.090175218	7.083160413	1.562591794	8.455044705	0.662181599	1.056083783	1.655770019	0	8.471477044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9788
H5749_001_0	2012	6																															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	1239.307247	78.19804864	929.6871933	451.7376187	127.8537378	10.68933968	11.92378909	358.1431379	60.94304349	16.27058185	32.38673895	0	0.038348735	26.94019907	5160.247764	3877.315309	429.4975163	533.0103685	0	0	15.33853998	738.3581188	0	0	66.09466899	0	6.991103346	0	90.50115549	0											3400	"$275 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	215.1884607	124.3521978	56.10283748	0	200	0.2	0.086436498	64.16504539	0.16	0.224853669	0.183453309	0	0.2	0.144916393	6.351685215	38.4368567	38.5	40	0	0	0.2	39.04957083	0	0	40	0	40	0	0	0											NO	155.5872367	89.91009449	40.56391049	0	144.6055576	0.144605558	0.06249599	46.41700392	0.115684446	0.162575451	0.13264184	0	0.144605558	0.104778579	6.048114068	36.6052148	36.65993886	38.08824817	0	0	0.144605558	28.23392483	0	0	40	0	40	0	0	0												16.0684	0.585899495	3.142645674	0	1.540696754	1.545737925	0.745189001	1.38532762	7.050162229	2.645197184	4.29583666	0	0.00554544	2.822755781	2.600813925	11.82749665	1.312112724	1.691785932	0	0	2.218038127	1.737228968	0	0	0.220315563	0	0.023303678	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4645	0	NO	18.41252364	16.0684	0.585899495	3.142645674	0	1.540696754	1.545737925	0.745189001	1.38532762	7.050162229	2.645197184	4.29583666	0	0.00554544	2.822755781	2.600813925	11.82749665	1.312112724	1.691785932	0	0	2.218038127	1.737228968	0	0	0.220315563	0	0.023303678	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4645	NO	"$380 Days 1-Unlimited (1a); $380 (1a1); $0 n/c (1a2, 1a3)"	"$380 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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$30 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$30/$50 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3964	0.0249	0.1369	0.2525	0.2107	0.5286	0.3538	0.1894	1.4466	0.3618	0.8573	0	0.0008	0.5786	1.0195	1.872	0.1827	0.2605	0	0	0.5398	0.3499	0	0	0.0323	0	0.003	0	0	0											9.5979	0	NO	0	16.4648	0.61076795	3.279594545	0.252474346	1.751444673	2.074331645	1.098971754	1.574725455	8.496722383	3.007026857	5.153095834	0	0.006303987	3.40132513	3.620311251	13.69947546	1.49476914	1.952335694	0	0	2.757886182	2.087128059	0	0	0.25262441	0	0.026281781	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0624
H5750_004_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	347.7952788	34.40778427	69.92379191		16.17322998	28.6100685	14.26052369	38.53536699	39.64984791	19.51614805	28.6883409			69.60945273		196.2915195	19.52444269	6.565088164	29.44613961		29.33596922																				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																						0.080342287	0.080342287	0.132979808		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																				NO	0.080342287	0.080342287	0.132979808		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224		0.224	0.224	0.224	0.224		0.224																					27.9427	2.764400067	9.298452443	0	3.622803514	6.408655345	3.194357306	8.631922207	8.881565933	4.371617164	6.426188362	0	0	15.59251741	0	43.96930036	4.373475163	1.470579749	6.595935274	0	6.571257105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.1157	Medicare FFS	YES	0	27.9427	2.764400067	9.298452443	0	3.622803514	6.408655345	3.194357306	8.631922207	8.881565933	4.371617164	6.426188362	0	0	15.59251741	0	43.96930036	4.373475163	1.470579749	6.595935274	0	6.571257105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.1157	NO																																																																																		0				27.9427	2.764400067	9.298452443	0	3.622803514	6.408655345	3.194357306	8.631922207	8.881565933	4.371617164	6.426188362	0	0	15.59251741	0	43.96930036	4.373475163	1.470579749	6.595935274	0	6.571257105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.1157
H5774_003_0	2012	4																																				Coin	Coin	V			V			Coin					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	0	0	0	0	0	14.71114161	6.797879012	350.8295158	0	0	261.2440961	0	0	2.743378505	0	0	0	0	82.2238293	0	10.33654962	6.53068397	0	1872.924367	0	0	0	0	0	0.267276793											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; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"5% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$25/Procedure for Prof Radiology (OP); $25/Procedure for Prof Radiology (Office); PBP 7d	No Cost Sharing; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	$5/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$5/Visit for Acupuncture; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	49.90318239	0	0	25	0	0	0.05	0	0	0	0	25	0	0.05	0.05	0	5	0	0	0	0	0	5											NO	0	0	0	0	0	0.099970783	0.099970783	49.88860215	0	0	24.99269573	0	0	0.049985391	0	0	0	0	24.99269573	0	0.049985391	0.049985391	0	4.998539147	0	0	0	0	0	4.998539147												0	0	0	0	0	1.470684345	0.679589287	1.458532845	0	0	0.544099517	0	0	0.137128849	0	0	0	0	0.171249596	0	0.516676479	0.326438795	0	0.780157147	0	0	0	0	0	0.000111333	0	0	0	0	0	0	0	0	0	0	6.0847	0	NO	0.001778281	0	0	0	0	0	1.470684345	0.679589287	1.458532845	0	0	0.544099517	0	0	0.137128849	0	0	0	0	0.171249596	0	0.516676479	0.326438795	0	0.780157147	0	0	0	0	0	0.000111333	0	0	0	0	0	0	0	0	0	0	6.0847	NO																																										0	0	0	0	0	0	0	0	0	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	1.470684345	0.679589287	1.458532845	0	0	0.544099517	0	0	0.137128849	0	0	0	0	0.171249596	0	0.516676479	0.326438795	0	0.780157147	0	0	0	0	0	0.000111333	0	0	0	0	0	0	0	0	0	0	6.0847
H5774_005_0	2012	7																																			T	Coin	Coin	V	P		V			Coin		V	V		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	YES	0	0	0	0	99.92138941	14.76282356	8.040214455	535.4542887	205.1973446	0	332.9874591	0	0	5.36870879	0	2957.343854	172.7788725	0	54.4389326	40.49661382	12.39862414	10.03933322	0	0	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	$25/Trip for Ambulance; PBP 10a	15% Coinsurance for DME; PBP 11a	15% Coinsurance for DME / Medical Supplies; 5% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$35/Case for ER - Facility; $60/Case for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a-b	$10/Procedure for OP Fac - Surgery; $10/Procedure for OP Fac - Surgery; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"5% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$5/Visit for Speclst Office Visits; $5/Procedure for Cardio; $10/Visit for Chiropractor; $5/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$25/Procedure for Prof Radiology (Office); PBP 7d	$5/Visit for Prof - IP Visits; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	25	0.15	0.138776553	35.05609706	10	0	25	0	0	0.05	0	5.415399006	10	0	25	5	0.05	0.05	0	0	0	0	0	0	0	0											NO	0	0	0	0	24.97196659	0.1498318	0.138620938	35.01678738	9.988786635	0	24.97196659	0	0	0.049943933	0	5.409326522	9.988786635	0	24.97196659	4.994393318	0.049943933	0.049943933	0	0	0	0	0	0	0	0												0	0	0	0	0.207936133	2.21194042	1.114542071	1.562490748	0.170806041	0	0.692945975	0	0	0.268134433	0	1.333103212	0.143820941	0	0.113287267	0.016854668	0.619236055	0.501403788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9565	0	NO	0.010054527	0	0	0	0	0.207936133	2.21194042	1.114542071	1.562490748	0.170806041	0	0.692945975	0	0	0.268134433	0	1.333103212	0.143820941	0	0.113287267	0.016854668	0.619236055	0.501403788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9565	NO																																										0	0	0	0	0	0	0	0	0	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	0.207936133	2.21194042	1.114542071	1.562490748	0.170806041	0	0.692945975	0	0	0.268134433	0	1.333103212	0.143820941	0	0.113287267	0.016854668	0.619236055	0.501403788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9565
H5774_008_0	2012	8																																				Coin	Coin	V			V			Coin		V	V		P	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	0	0	0	14.75786261	16.88778947	457.5992333	0	0	265.3635143	0	0	0.785936481	0	1597.516079	172.7788725	0	81.23415056	31.41295198	40.82090978	1.33224567	0	1223.435314	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; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"5% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$10/Visit for Speclst Office Visits; $10/Procedure for Cardio; $10/Visit for Chiropractor; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$25/Procedure for Prof Radiology (OP); $25/Procedure for Prof Radiology (Office); PBP 7d	$10/Visit for Prof - IP Visits; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	$10/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	49.95515407	0	0	25	0	0	0.05	0	10	10	0	25	10	0.05	0.05	0	10	0	0	0	0	0	0											NO	0	0	0	0	0	0.099820392	0.099820392	49.8654308	0	0	24.95509809	0	0	0.049910196	0	9.982039236	9.982039236	0	24.95509809	9.982039236	0.049910196	0.049910196	0	9.982039236	0	0	0	0	0	0												0	0	0	0	0	1.473135636	1.685745771	1.901531908	0	0	0.551847711	0	0	0.039226244	0	1.328872348	0.14372379	0	0.16893385	0.026130443	2.037379615	0.066492643	0	1.017698275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.4407	0	NO	0.018786068	0	0	0	0	0	1.473135636	1.685745771	1.901531908	0	0	0.551847711	0	0	0.039226244	0	1.328872348	0.14372379	0	0.16893385	0.026130443	2.037379615	0.066492643	0	1.017698275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.4407	NO																																										0	0	0	0	0	0	0	0	0	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	1.473135636	1.685745771	1.901531908	0	0	0.551847711	0	0	0.039226244	0	1.328872348	0.14372379	0	0.16893385	0.026130443	2.037379615	0.066492643	0	1.017698275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.4407
H5774_009_0	2012	8																																			T	Coin	Coin	V			V			Coin		V	V	V	P	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	0	0	213.5630774	14.78175919	14.06922036	554.9617	0	0	254.3799603	0	0	5.351604672	0	113.6028252	172.7788725	911.2981917	93.76385735	1.115108295	11.8295087	7.953085076	0	1304.78497	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	$25/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$5/Visit for OP Fac - Occ Therapy; $5/Visit for OP Fac - Physical/Speech Therapy; $5/Visit for OP Fac - CORF; 5% Coinsurance for OP Fac - Other; $5/Visit for Prof - CORF; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$5/Visit for Speclst Office Visits; $5/Procedure for Cardio; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h"	"$5/Visit for Occ Therapy; $5/Visit for PT/ST; PBP 7c, 7i"	$25/Procedure for Prof Radiology (OP); $25/Procedure for Prof Radiology (Office); PBP 7d	$5/Visit for Prof - IP Visits; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	$5/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	25	0.2	0.2	49.95944016	0	0	25	0	0	0.053739852	0	5	10	5	25	5	0.05	0.05	0	5	0	0	0	0	0	0											NO	0	0	0	0	24.9838045	0.199870436	0.199870436	49.92707543	0	0	24.9838045	0	0	0.053705038	0	4.9967609	9.993521799	4.9967609	24.9838045	4.9967609	0.049967609	0.049967609	0	4.9967609	0	0	0	0	0	0												0	0	0	0	0.444634848	2.954436653	2.812021207	2.308967888	0	0	0.529614933	0	0	0.287408131	0	0.047303846	0.143889119	0.379461598	0.195214823	0.000464327	0.591092265	0.397396645	0	0.54330821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6352	0	NO	0.007542412	0	0	0	0	0.444634848	2.954436653	2.812021207	2.308967888	0	0	0.529614933	0	0	0.287408131	0	0.047303846	0.143889119	0.379461598	0.195214823	0.000464327	0.591092265	0.397396645	0	0.54330821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6352	NO																																										0	0	0	0	0	0	0	0	0	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	0.444634848	2.954436653	2.812021207	2.308967888	0	0	0.529614933	0	0	0.287408131	0	0.047303846	0.143889119	0.379461598	0.195214823	0.000464327	0.591092265	0.397396645	0	0.54330821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6352
H5774_014_0	2012	9																																				Coin	Coin	V			V			Coin			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	0	0	0	0	0	14.84519379	7.57595958	403.7028806	0	0	328.1112675	0	0	4.24886639	0	0	172.7788725	0	88.65989567	0	18.18698964	6.293218384	0	2008.673697	0	0	0	0	0	0.12688934											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; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $5/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"5% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$25/Procedure for Prof Radiology (OP); $25/Procedure for Prof Radiology (Office); PBP 7d	No Cost Sharing; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	No Cost Sharing; PBP 10b	$5/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$5/Visit for Acupuncture; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	49.95323203	0	0	25	0	0	0.05	0	0	10	0	25	0	0.05	0.05	0	5	0	0	0	0	0	5											NO	0	0	0	0	0	0.099945847	0.099945847	49.92618071	0	0	24.98646167	0	0	0.049972923	0	0	9.994584669	0	24.98646167	0	0.049972923	0.049972923	0	4.997292335	0	0	0	0	0	4.997292335												0	0	0	0	0	1.483715462	0.757185695	1.679611914	0	0	0.683194967	0	0	0.212328274	0	0	0.143904423	0	0.18460809	0	0.908857039	0.31449052	0	0.836494139	0	0	0	0	0	5.28E-05	0	0	0	0	0	0	0	0	0	0	7.2044	0	NO	0.003903558	0	0	0	0	0	1.483715462	0.757185695	1.679611914	0	0	0.683194967	0	0	0.212328274	0	0	0.143904423	0	0.18460809	0	0.908857039	0.31449052	0	0.836494139	0	0	0	0	0	5.28E-05	0	0	0	0	0	0	0	0	0	0	7.2044	NO																																										0	0	0	0	0	0	0	0	0	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	1.483715462	0.757185695	1.679611914	0	0	0.683194967	0	0	0.212328274	0	0	0.143904423	0	0.18460809	0	0.908857039	0.31449052	0	0.836494139	0	0	0	0	0	5.28E-05	0	0	0	0	0	0	0	0	0	0	7.2044
H5774_019_0	2012	6																															A	A				Coin	Coin	V	P					V	V	V	V	V	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	YES	122.2639627	0.532438897	0	0	0	25.27692525	8.464774656	0.175679934	182.18084	0	0	0	0	152.7303034	12691.37394	8429.19485	172.8703469	1374.572731	769.9416948	14915.05687	0	3114.293142	0	1647.948765	0	0	0	0	0	0											2500	$3/Admit for IP Medical; $3/Admit for IP Surgical; PBP 1a	$3/Admit for IP Psych; $3/Admit for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	$5/Visit for Urgent Care - Worldwide; PBP 4a-b	$1/Procedure for OP Fac - Surgery; $1/Procedure for OP Fac - Surgery; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$1/Visit for Prof - CORF; PBP 3, 5, 9c"	"$1/Visit for PCP Office Visits; $1/Visit for Physical Exams; PBP 7a, 14a-b, 14d-e"	"$1/Visit for Speclst Office Visits; $1/Procedure for Cardio; $1/Visit for Chiropractor; $1/Visit for Vision Exams; $1/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 17a, 18a"	"$1/Visit for OP Psych - Non-Physician; $1/Visit for OP Psych - Psychiatrist; $1/Visit for OP Substance Abuse; PBP 7e, 7h"	"$1/Visit for Occ Therapy; $1/Visit for PT/ST; PBP 7c, 7i"	$1/Procedure for Prof Radiology (Office); PBP 7d	$1/Procedure for Prof Path (Office); PBP 7g	No Cost Sharing; PBP 15	"$1/Procedure for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	$5/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	3	3	0	0	0	0.1	0.1	5	1	0	0	0	0	1	1	1	1	1	1	1	0	1	0	5	0	0	0	0	0	0											NO	2.998039455	2.998039455	0	0	0	0.099934648	0.099934648	4.996732424	0.999346485	0	0	0	0	0.999346485	0.999346485	0.999346485	0.999346485	0.999346485	0.999346485	0.999346485	0	0.999346485	0	4.996732424	0	0	0	0	0	0												0.0305	0.000133023	0	0	0	2.526040639	0.84592428	7.32E-05	0.015171815	0	0	0	0	0.012719208	1.056923328	0.701973854	0.014396448	0.114472869	0.064119877	1.242109138	0	0.259354825	0	0.686196586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5702	0	NO	0.004950446	0.0305	0.000133023	0	0	0	2.526040639	0.84592428	7.32E-05	0.015171815	0	0	0	0	0.012719208	1.056923328	0.701973854	0.014396448	0.114472869	0.064119877	1.242109138	0	0.259354825	0	0.686196586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5702	NO																																										0	0	0	0	0	0	0	0	0	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	0.0305	0.000133023	0	0	0	2.526040639	0.84592428	7.32E-05	0.015171815	0	0	0	0	0.012719208	1.056923328	0.701973854	0.014396448	0.114472869	0.064119877	1.242109138	0	0.259354825	0	0.686196586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5702
H5774_802_0	2012	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	118.8129483	0.652441435	6.068171327	0	2.518765727	14.99300118	9.944360688	8.36906504	20.66561764	1.082439559	12.9522795	0	0.092912744	13.08799711	69.61659549	40.05541599	0.964374264	5.548170753	7.31876309	55.66728553	15.27577942	15.79236878	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-c	Medicare-FFS Cost Sharing; PBP 4a-b	Medicare-FFS Cost Sharing; PBP 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0.149699739	0.149699739	0.118832583	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.143546547	0.143546547	0.113948141	0	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0	0	0	0	0	0	0	0												17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776	0	NO	3.471144433	17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776	NO																																										0	0	0	0	0	0	0	0	0	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	17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776
H5774_806_0	2012	2																															A	A				Coin	Coin	V			V			Coin					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	274.5838198	1.582993233	0	0	0	14.99460242	7.461773726	458.5806931	0	0	380.6354188	0	0	4.458438457	0	0	0	0	149.2878831	0	18.68495976	8.832124824	0	1934.495134	0	0	0	0	0	0.364219791											3400	$400/Admit for IP Medical; $400/Admit for IP Surgical; PBP 1a	$400/Admit for IP Psych; $400/Admit for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	20% Coinsurance for DME; PBP 11a	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b-c	$50/Case for ER - Facility; $50/Case for ER - Worldwide; PBP 4a-b	No Cost Sharing; PBP 9a-b	No Cost Sharing; PBP 8a	$25/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"5% Coinsurance for OP Fac - Other; PBP 3, 5, 9c"	"No Cost Sharing; PBP 7a, 14a-b, 14d-e"	"No Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$25/Procedure for Prof Radiology (OP); $25/Procedure for Prof Radiology (Office); PBP 7d	No Cost Sharing; PBP 7g	5% Coinsurance for Part B Rx; 5% Coinsurance for Tx Injections; PBP 15	"5% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b"	PBP 10b	$5/Visit for Dental - Preventive; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	$5/Visit for Acupuncture; PBP 13a-e											0	NO	400	400	0	0	0	0.2	0.2	50	0	0	25	0	0	0.05	0	0	0	0	25	0	0.05	0.05	0	5	0	0	0	0	0	5											NO	398.9830484	398.9830484	0	0	0	0.199491524	0.199491524	49.87288105	0	0	24.93644052	0	0	0.049872881	0	0	0	0	24.93644052	0	0.049872881	0.049872881	0	4.987288105	0	0	0	0	0	4.987288105												9.1295	0.052632289	0	0	0	2.991296091	1.488560614	1.90589503	0	0	0.790974374	0	0	0.222355171	0	0	0	0	0.310225701	0	0.931872775	0.440483511	0	0.803990381	0	0	0	0	0	0.000151372	0	0	0	0	0	0	0	0	0	0	19.068	0	NO	0.048601549	9.1295	0.052632289	0	0	0	2.991296091	1.488560614	1.90589503	0	0	0.790974374	0	0	0.222355171	0	0	0	0	0.310225701	0	0.931872775	0.440483511	0	0.803990381	0	0	0	0	0	0.000151372	0	0	0	0	0	0	0	0	0	0	19.068	NO																																										0	0	0	0	0	0	0	0	0	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	9.1295	0.052632289	0	0	0	2.991296091	1.488560614	1.90589503	0	0	0.790974374	0	0	0.222355171	0	0	0	0	0.310225701	0	0.931872775	0.440483511	0	0.803990381	0	0	0	0	0	0.000151372	0	0	0	0	0	0	0	0	0	0	19.068
H5774_808_0	2012	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	118.8129483	0.652441435	6.068171327	0	2.518765727	14.99300118	9.944360688	8.36906504	20.66561764	1.082439559	12.9522795	0	0.092912744	13.08799711	69.61659549	40.05541599	0.964374264	5.548170753	7.31876309	55.66728553	15.27577942	15.79236878	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-c	Medicare-FFS Cost Sharing; PBP 4a-b	Medicare-FFS Cost Sharing; PBP 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 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 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0.149699739	0.149699739	0.118832583	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.143546547	0.143546547	0.113948141	0	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0.214792803	0	0	0	0	0	0	0	0												17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776	0	NO	3.471144433	17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776	NO																																										0	0	0	0	0	0	0	0	0	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	17.0552	0.093655715	0.691456843	0	0.54101275	3.220388746	2.135977105	1.797614938	4.438825937	0.232500227	2.782056418	0	0.019956989	2.811207584	14.95314367	8.603615072	0.207140651	1.191707147	1.572017638	11.95693229	3.281127478	3.392087155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9776
H5782_001_0	2012	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											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	NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1210.766865	43.35064049	772.1843955		230.9086323	10.13008847	9.626257977	478.1962151	235.2143488		12.57247851	19.72677513	0.096302421	14.78912421	4433.23542	3413.046056	129.0607867	758.6420834			12.94048695				159.1037094																3900	"1a - IP Acute 265 days 1-6, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 350 copay,9b - OP Ambulatory Surgical Center (ASC) 350 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 350 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 10 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 29 copay,7f - Podiatry 29 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 29 copay,18a - Hearing Exam (M/C) 29 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Silver,16b1 - Routine Comprehensive Dental Silver"	"17a - Eye Exam (M/C) 29 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 29 copay,18a - Hearing Exam (M/C) 29 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 750 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													179.6244766	142.4713977	60.09645318		150	0.2	0.2	64.72312492	350		0.2	350	0.2	0.202074652	10	28.43348035	40	19.99533375			0.2				5																NO	161.4999841	128.0957301	54.032593		134.8646804	0.179819574	0.179819574	58.1924237	314.6842542		0.179819574	314.6842542	0.179819574	0.18194656	8.990978692	25.68922629	35.96391477	17.98195738			0.179819574				5																	16.2949	0.462752662	3.476927097	0	2.595118241	1.821588191	1.730989607	2.31894973	6.16818766	0	2.260777728	0.517308793	0.01731706	2.690830269	3.321593766	7.306542707	0.386794261	1.136822468	0	0	2.326952849	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9006	0		6.109777848	16.2949	0.462752662	3.476927097	0	2.595118241	1.821588191	1.730989607	2.31894973	6.16818766	0	2.260777728	0.517308793	0.01731706	2.690830269	3.321593766	7.306542707	0.386794261	1.136822468	0	0	2.326952849	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9006	NO																																																																																		0	0		0	16.2949	0.462752662	3.476927097	0	2.595118241	1.821588191	1.730989607	2.31894973	6.16818766	0	2.260777728	0.517308793	0.01731706	2.690830269	3.321593766	7.306542707	0.386794261	1.136822468	0	0	2.326952849	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9006
H5783_006_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1362.397243	162.7107778	721.9894691		295.4572871	11.57541553	9.39466324	505.8743862	121.8061598		11.54163572	85.67227507	0.61462592	12.64763128	4876.801507	3596.169064	216.0903997	688.5692341			20.56679961				159.1037094																3900	"1a - IP Acute 195 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 200 copay,9b - OP Ambulatory Surgical Center (ASC) 200 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 200 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 25 copay,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1000 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													141.3400104	142.4713977	60.09645318		150	0.2	0.2	64.75	200		0.2	200	0.2	0.199935017	4.996920424	24.9236454	40	20			0.2				5																NO	128.4874769	129.5159833	54.63167589		136.3599838	0.181813312	0.181813312	58.86205969	181.8133118		0.181813312	181.8133118	0.181813312	0.181754238	4.542533255	22.69339236	36.36266236	18.18133118			0.181813312				5																	14.5876	1.756137198	3.28695789	0	3.357379241	2.104564632	1.708074837	2.481400693	1.845498442	0	2.098423014	1.298030005	0.111747174	2.298760582	1.846086085	6.800772964	0.654801854	1.043258774	0	0	3.73931795	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0851	0		5.091468818	14.5876	1.756137198	3.28695789	0	3.357379241	2.104564632	1.708074837	2.481400693	1.845498442	0	2.098423014	1.298030005	0.111747174	2.298760582	1.846086085	6.800772964	0.654801854	1.043258774	0	0	3.73931795	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0851	NO																																																																																		0	0		0	14.5876	1.756137198	3.28695789	0	3.357379241	2.104564632	1.708074837	2.481400693	1.845498442	0	2.098423014	1.298030005	0.111747174	2.298760582	1.846086085	6.800772964	0.654801854	1.043258774	0	0	3.73931795	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0851
H5783_008_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	323.1759706	23.353418	124.919791		26.75517265	17.87224949	10.3274097	33.46700997	125.9076793	3.985533829	16.5682202	2.337600786	0.195607656	18.65642574		4546.961543	3.274935112	778.3579586		3235.626806	10.20937024	0.034474344			159.1037094		0.805843011														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 50"													0.080152557	0.080152557	0.185647915		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.737585127	0.224	1321.602406			5		10														NO	0.061046247	0.061046247	0.141394222		0.170604155	0.170604155	0.170604155	0.170604155	0.170604155	0.170604155	0.170604155	0.170604155	0.170604155	0.170604155		7.61625692	0.170604155	7.61625692		2.085015166	0.170604155	1006.566347			5		10															19.7287	1.425638517	17.66293661	0	4.564543622	3.049080023	1.761899005	5.709610956	21.48037323	0.679948631	2.826607207	0.398804407	0.033371479	3.182863748	0	2.885902276	0.558717538	0.494014516	0	0.562194247	1.741760983	0.002891726	0	0	0.066293212	0	0.000671536	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8168	0		27.77700598	19.7287	1.425638517	17.66293661	0	4.564543622	3.049080023	1.761899005	5.709610956	21.48037323	0.679948631	2.826607207	0.398804407	0.033371479	3.182863748	0	2.885902276	0.558717538	0.494014516	0	0.562194247	1.741760983	0.002891726	0	0	0.066293212	0	0.000671536	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8168	NO																																																																																		0	0		0	19.7287	1.425638517	17.66293661	0	4.564543622	3.049080023	1.761899005	5.709610956	21.48037323	0.679948631	2.826607207	0.398804407	0.033371479	3.182863748	0	2.885902276	0.558717538	0.494014516	0	0.562194247	1.741760983	0.002891726	0	0	0.066293212	0	0.000671536	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8168
H5783_011_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	336.3854271	2.944385285	82.20458021		14.107669	14.41704204	12.18543005	27.14809507	70.16070823	7.934274362	15.02606771	4.729974616	0.44003882	28.59338897		5216.777708	6.033199614	1115.892536		3038.474001	24.76888607	0.071064394			159.1037094		1.522149774														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 20"													0.078306852	0.078306852	0.184267905		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		2.967388063	0.224	1211.857854			5		10														NO	0.062545471	0.062545471	0.147178984		0.178913916	0.178913916	0.178913916	0.178913916	0.178913916	0.178913916	0.178913916	0.178913916	0.178913916	0.178913916		7.987228382	0.178913916	7.987228382		2.370120616	0.178913916	967.9385444			5		10															21.0394	0.184157964	12.0987866	0	2.524058303	2.579409445	2.180143006	4.857171995	12.55272704	1.419552095	2.688372613	0.84625828	0.078729068	5.115755185	0	3.472299581	1.079423368	0.742740711	0	0.600129156	4.431498397	0.005732164	0	0	0.066293212	0	0.001268458	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5639	0		19.78097751	21.0394	0.184157964	12.0987866	0	2.524058303	2.579409445	2.180143006	4.857171995	12.55272704	1.419552095	2.688372613	0.84625828	0.078729068	5.115755185	0	3.472299581	1.079423368	0.742740711	0	0.600129156	4.431498397	0.005732164	0	0	0.066293212	0	0.001268458	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5639	NO																																																																																		0	0		0	21.0394	0.184157964	12.0987866	0	2.524058303	2.579409445	2.180143006	4.857171995	12.55272704	1.419552095	2.688372613	0.84625828	0.078729068	5.115755185	0	3.472299581	1.079423368	0.742740711	0	0.600129156	4.431498397	0.005732164	0	0	0.066293212	0	0.001268458	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5639
H5783_012_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1306.674018	36.47132968	711.3320285		194.0074867	12.62252558	7.911353081	489.3523061	328.9031285		12.72268018	23.02937475	0.53829759	10.79144546	4641.91564	4584.510066	213.9075515	577.8581073			18.43124561	2.153587735			159.1037094		1.010822579														3900	"1a - IP Acute 195 days 1-7, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 150 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 250 copay,9b - OP Ambulatory Surgical Center (ASC) 250 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 250 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 5 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 25 copay,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 750 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													141.3400104	142.4713977	60.09645318		150	0.2	0.2	63.78819434	250		0.2	250	0.2	0.199175548	5	24.88037836	40	20			0.2	25			5		25														NO	128.0829998	129.1082685	54.45969602		135.9307242	0.181240966	0.181240966	57.80516968	226.551207		0.181240966	226.551207	0.181240966	0.180493843	4.53102414	22.54671899	36.24819312	18.12409656			0.181240966	22.6551207			5		25															13.9469	0.392395852	3.228243837	0	2.197631514	2.287718724	1.433861272	2.357257757	6.209450062	0	2.30587084	0.43477772	0.097561575	1.947789462	1.752719318	8.613805014	0.646146853	0.872763011	0	0	3.340496752	0.004065816	0	0	0.066293212	0	0.00210588	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1378	0		5.389358796	13.9469	0.392395852	3.228243837	0	2.197631514	2.287718724	1.433861272	2.357257757	6.209450062	0	2.30587084	0.43477772	0.097561575	1.947789462	1.752719318	8.613805014	0.646146853	0.872763011	0	0	3.340496752	0.004065816	0	0	0.066293212	0	0.00210588	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1378	NO																																																																																		0	0		0	13.9469	0.392395852	3.228243837	0	2.197631514	2.287718724	1.433861272	2.357257757	6.209450062	0	2.30587084	0.43477772	0.097561575	1.947789462	1.752719318	8.613805014	0.646146853	0.872763011	0	0	3.340496752	0.004065816	0	0	0.066293212	0	0.00210588	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1378
H5793_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1061.328833	129.8054951	861.0205678	950.7545891	200.2572879	8.638003781	0	308.9544108	399.0518563	3960.824699	2374.626743	119.5424345	0.013645899	589.6906177	2496.242328	5111.691995	254.4969499	881.8544083	0	0	258.162858	0.001305925	0	0	1480.233357	127.3560254	65.88078298	14.05647265	45.72122564	0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-10, $50/d 11-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	61.9565603	0	150	0.03	0.03	62.5	200	4	20.35671946	40	0.2	40	15	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	165.5707107	88.0993211	56.76485943	0	137.4306268	0.027486125	0	57.26276115	183.2408357	3.664816714	18.65091143	36.64816714	0.183240836	36.64816714	13.74306268	36.64816714	36.64816714	18.32408357	0	0	45.81020892	0	0	0	0	0	0	0	0	0												14.6437	0.952981333	4.072975958	0	2.29345705	0.237425255	0	1.474298553	6.093549637	1.20964138	3.69074609	0.36508426	0.002500486	1.80092336	2.858834564	15.61117855	0.77723723	1.346597823	0	0	0.985541205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4167	0	NO	5.342779668	14.6437	0.952981333	4.072975958	0	2.29345705	0.237425255	0	1.474298553	6.093549637	1.20964138	3.69074609	0.36508426	0.002500486	1.80092336	2.858834564	15.61117855	0.77723723	1.346597823	0	0	0.985541205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4167	NO																																																																																		0		NO		14.6437	0.952981333	4.072975958	0	2.29345705	0.237425255	0	1.474298553	6.093549637	1.20964138	3.69074609	0.36508426	0.002500486	1.80092336	2.858834564	15.61117855	0.77723723	1.346597823	0	0	0.985541205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4167
H5793_008_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1271.014289	44.92887721	1015.682631	1068.026458	242.0749624	10.30473135	0	324.3355675	408.6501567	5434.625914	2985.569367	60.6965268	0	835.9897459	3117.821787	5820.647161	217.4130354	1216.819654	0	0	304.1537417	0	0	0	1788.044295	113.7959225	65.79473338	13.24170735	31.37856495	0											3400	$195/day 1-7; unlimited additional days	$195/day 1-7	"$0/d 1-10, $50/d 11-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$0 to $25 per visit	$0 to $25 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$25 per visit	20% per visit	$0 to 175 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$50 per script		Not Covered		$0 per visit	$50.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Nursing Hotline	0											0	NO	140.9567402	93.75294295	61.9565603	0	150	0.03	0.03	62	175	2.5	14.17113634	25	0.2	25	10	25	25	12.5	25	25	$50 	0	0	0	0	0	0	0	0	0											NO	125.3571892	83.3773922	55.09988556	0	133.3996399	0.026679928	0	55.13851783	155.6329132	2.223327332	12.6028299	22.23327332	0	22.23327332	8.893309327	22.23327332	22.23327332	11.11663666	0	0	44.46654664	0	0	0	0	0	0	0	0	0												13.2776	0.312171051	4.663666393	0	2.691059401	0.27492949	0	1.490281873	5.299951198	1.006912694	3.135551908	0.112456872	0	1.548899043	2.310646131	10.7843366	0.402816953	1.127245164	0	0	1.127055545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5655	0	NO	6.16797691	13.2776	0.312171051	4.663666393	0	2.691059401	0.27492949	0	1.490281873	5.299951198	1.006912694	3.135551908	0.112456872	0	1.548899043	2.310646131	10.7843366	0.402816953	1.127245164	0	0	1.127055545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5655	NO																																																																																		0		NO		13.2776	0.312171051	4.663666393	0	2.691059401	0.27492949	0	1.490281873	5.299951198	1.006912694	3.135551908	0.112456872	0	1.548899043	2.310646131	10.7843366	0.402816953	1.127245164	0	0	1.127055545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5655
H5793_801_0	2012	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	0	0	0	0	0	0	0											0	YES	291.4249359	4.960266342	43.46774231	9.053662644	10.15188159	11.70678958	0	14.917231	41.26701648	21.78490076	53.06613969	2.133649028	0.068404575	27.4701307	30.56781643	134.2749378	3.319303512	11.58545812	0	0	59.41963466	0.000302021	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	NO	0.067309818	0.067309818	0.148259469	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.054559171	0.054559171	0.120174353	0	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0.181567188	0	0	0	0	0	0	0	0												15.8999	0.27062802	5.223707789	0	1.843248595	2.125568866	0	2.708479688	7.492736146	3.955423175	9.63506977	0.387400655	0.012420026	4.987674389	5.550112478	24.37992289	0.602676605	2.103539054	0	0	10.78865599	5.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9672	0	NO	22.89524183	15.8999	0.27062802	5.223707789	0	1.843248595	2.125568866	0	2.708479688	7.492736146	3.955423175	9.63506977	0.387400655	0.012420026	4.987674389	5.550112478	24.37992289	0.602676605	2.103539054	0	0	10.78865599	5.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9672	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		15.8999	0.27062802	5.223707789	0	1.843248595	2.125568866	0	2.708479688	7.492736146	3.955423175	9.63506977	0.387400655	0.012420026	4.987674389	5.550112478	24.37992289	0.602676605	2.103539054	0	0	10.78865599	5.48E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9672
H5793_802_0	2012	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	0	0	0	0	0	0	0											0	YES	326.6696014	6.009523134	39.89070974	10.39793801	9.735897426	13.49900165	0	16.9109379	41.84750653	20.29300539	56.69104816	0.948932647	0.082874356	27.84840597	28.08407089	140.0175538	3.209126081	8.895657111	0	0	70.29386752	0.000365908	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	NO	0.067607782	0.067607782	0.149108278	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.054580241	0.054580241	0.120376169	0	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0.180836786	0	0	0	0	0	0	0	0												17.8297	0.328001223	4.8018908	0	1.7606084	2.441116074	0	3.058119659	7.567568585	3.669721875	10.25182695	0.17160193	0.014986732	5.036016232	5.07863312	25.32032443	0.580328047	1.608662042	0	0	12.71171708	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2309	0	NO	24.40108614	17.8297	0.328001223	4.8018908	0	1.7606084	2.441116074	0	3.058119659	7.567568585	3.669721875	10.25182695	0.17160193	0.014986732	5.036016232	5.07863312	25.32032443	0.580328047	1.608662042	0	0	12.71171708	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2309	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		17.8297	0.328001223	4.8018908	0	1.7606084	2.441116074	0	3.058119659	7.567568585	3.669721875	10.25182695	0.17160193	0.014986732	5.036016232	5.07863312	25.32032443	0.580328047	1.608662042	0	0	12.71171708	6.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2309
H5810_001_0	2012	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;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	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	NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	3																															D	D	D		T	Coin	Coin	V	V		V		Coin	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	614.1205274	84.29896569	214.4971021	0	256.0866815	3.138613107	1.334998049	293.0468809	175.4689633	0	426.5335033	0	10.00384887	533.4146931	4041.693261	3894.744188	142.4752363	303.115952	1689.317004	130.5162906	20.83354345	0	0	0	43.57122179	0	17.11694525	0	0	0											3350	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse;	$50/Days Custom for SNF;	No Cost-Sharing;	$50/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $25/Visit for PCP Urgent Care;	$50/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $50/Case for OP Fac - Other; $30/Visit for Prof - CORF; $15/Visit for OP Substance Abuse;	$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits;	$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for Speclst Office Visits; $8/Proceedure for Cardio; $10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist;	$10/Visit for Occ Therapy; $10/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$5/Visit for PCP Office Visits; $10/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$10/Exam for Vision Exams (Refractions);	No Cost-Sharing;	$10/Exam for Hearing Exam;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	200	100	50	0	50	0.2	0.2	61.3479075	50	0	46.32780023	0	0.2	36.77507022	5	9.924664986	15	10	12.84825011	9.757974309	0.2	0	0	0	10	0	10	0	0	0											NO	192.7756763	96.38783816	48.19391908	0	48.19391908	0.192775676	0.192775676	59.13192179	48.19391908	0	44.65436511	0	0.192775676	35.44669517	4.819391908	9.566170024	14.45817572	9.638783816	12.38415052	9.405500485	0.192775676	0	0	0	10	0	10	0	0	0												9.8656	0.677116255	0.861454665	0	1.028485067	0.605048264	0.257355152	1.444035437	0.704711418	0	1.587215232	0	1.928498732	1.575649002	1.62320865	3.104815425	0.171661	0.243472428	1.743396338	0.102297586	4.016200428	0	0	0	0.036309351	0	0.014264121	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5908	0	NO	1.181979755	9.8656	0.677116255	0.861454665	0	1.028485067	0.605048264	0.257355152	1.444035437	0.704711418	0	1.587215232	0	1.928498732	1.575649002	1.62320865	3.104815425	0.171661	0.243472428	1.743396338	0.102297586	4.016200428	0	0	0	0.036309351	0	0.014264121	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5908	NO																																										0	0	0	0	0	0	0	0	0	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	9.8656	0.677116255	0.861454665	0	1.028485067	0.605048264	0.257355152	1.444035437	0.704711418	0	1.587215232	0	1.928498732	1.575649002	1.62320865	3.104815425	0.171661	0.243472428	1.743396338	0.102297586	4.016200428	0	0	0	0.036309351	0	0.014264121	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5908
H5810_007_0	2012	2																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	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	NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	3																															A	A	D		T	Coin	Coin	V	V		V		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	193.6663481	2.300090946	291.9417426	0	158.3393813	2.863233569	1.822763499	203.0276234	229.5624429	0	476.3475653	0	0.301670137	752.4739601	4104.34652	4440.349976	92.02920518	350.4318069	19.88210049	68.97601034	30.10078966	0	0	0	53.86174988	0	23.29597012	0	0	0											3350	$300/Admit for IP Medical; $300/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$50/Days Custom for SNF;	No Cost-Sharing;	$100/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $25/Visit for PCP Urgent Care;	$50/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	$30/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $50/Case for OP Fac - Other; $30/Visit for Prof - CORF; $15/Visit for OP Substance Abuse;	$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits;	$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for Speclst Office Visits; $13/Proceedure for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist;	$15/Visit for Occ Therapy; $15/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$10/Visit for PCP Office Visits; $15/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$15/Exam for Vision Exams (Refractions);	No Cost-Sharing;	$15/Exam for Hearing Exam;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	300	500	50	0	100	0.2	0.2	60.69499625	50	0	35.80447265	0	0.2	36.19041796	10	14.89788554	15	15	0.093283091	14.29495416	0.2	0	0	0	15	0	15	0	0	0											NO	290.7085666	484.5142777	48.45142777	0	96.90285554	0.193805711	0.193805711	58.81518454	48.45142777	0	34.69555641	0	0.193805711	35.06954843	9.690285554	14.4364765	14.53542833	14.53542833	0.090393979	13.85221878	0.193805711	0	0	0	15	0	15	0	0	0												4.6917	0.092868909	1.178749521	0	1.278628183	0.554911018	0.353261976	0.995092261	0.926885677	0	1.377261985	0	0.058465395	2.199076832	3.314357483	5.34191734	0.11147366	0.424473035	1.797222173	0.079622565	5.833704945	0	0	0	0.067327187	0	0.029119963	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7061	0	NO	0.978326135	4.6917	0.092868909	1.178749521	0	1.278628183	0.554911018	0.353261976	0.995092261	0.926885677	0	1.377261985	0	0.058465395	2.199076832	3.314357483	5.34191734	0.11147366	0.424473035	1.797222173	0.079622565	5.833704945	0	0	0	0.067327187	0	0.029119963	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7061	NO																																										0	0	0	0	0	0	0	0	0	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	4.6917	0.092868909	1.178749521	0	1.278628183	0.554911018	0.353261976	0.995092261	0.926885677	0	1.377261985	0	0.058465395	2.199076832	3.314357483	5.34191734	0.11147366	0.424473035	1.797222173	0.079622565	5.833704945	0	0	0	0.067327187	0	0.029119963	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7061
H5811_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	535.1713727	8.834466015	602.241537	0	226.9803147	19.36389158	1.126799776	210.5147314	360.0771871	11.83201024	5.465384441	7.150660522	0	256.8617423	7871.677529	1039.155912	157.683902	713.7629406	3.012026599	1330.609372	46.16602859	0	0	0	0	259.898625	0	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$143/Days 1-10 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	$150 per day.	No cost-sharing	$15/Case for Cardio/PT/OT/ST	$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 Part B Rx	No cost-sharing	No cost-sharing	Not Covered	$0 Copay	$25/Service for Vision Hardware	$0/Exam for Routine Hearing	Not covered	N/A	No cost-sharing													150	143	75	0	100	0.1	0.1	48.59793643	162.5	0.02	0.2	150	0	15	10	15	25	15	0.2	12.27144892	0.2	0	0	0	0	25	0	0	0	0											NO	147	140.14	73.5	0	98	0.098	0.098	47.6259777	159.25	0.0196	0.196	147	0	14.7	9.8	14.7	24.5	14.7	0.196	12.02601994	0.196	0	0	0	0	25	0	0	0	0												6.5558	0.103171839	3.688729414	0	1.85367257	1.897661375	0.110426378	0.835497492	4.778524337	0.231907401	1.07121535	0.087595591	0	0.314655634	6.428536649	1.272965993	0.321937966	0.874359602	0.590357213	1.33349457	9.048541604	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9406			0.842178242	6.5558	0.103171839	3.688729414	0	1.85367257	1.897661375	0.110426378	0.835497492	4.778524337	0.231907401	1.07121535	0.087595591	0	0.314655634	6.428536649	1.272965993	0.321937966	0.874359602	0.590357213	1.33349457	9.048541604	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9406	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				6.5558	0.103171839	3.688729414	0	1.85367257	1.897661375	0.110426378	0.835497492	4.778524337	0.231907401	1.07121535	0.087595591	0	0.314655634	6.428536649	1.272965993	0.321937966	0.874359602	0.590357213	1.33349457	9.048541604	0	0	0	0	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9406
H5811_002_0	2012	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	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	270.2628199	259.898625	0	0	0	0											6700	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No cost sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$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	0	0	0	0	15	25	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	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	0	0	0	0.337828525	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8793			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.337828525	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8793	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.337828525	0.541455469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8793
H5811_005_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	463.6508266	7.647981735	519.5343783	0	191.8754171	17.45232733	1.049881847	181.4697155	307.676002	10.47405543	4.838124583	6.153520039	0	221.902035	6373.225356	817.8170798	122.5605136	577.8910601	2.371826311	1057.738112	35.05931016	0	0	0	0	259.898625	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$143/Days 1-10 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	$125 per day.	No cost-sharing	$15/Case for PT/OT/ST	$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 Part B Rx	No cost-sharing	Not covered	Not Covered	$0 Copay	$25/Service for Vision Hardware	Not covered	Not covered	$0 Health Club Membership	$10 routine chiropractic (20 visits/yr)													125	143	100	0	150	0.2	0.2	48.59793643	187.5	0.02	0.2	125	0	15	5	10	25	15	0.2	12.22094915	0.2	0	0	0	0	25	0	0	0	10											NO	122.5	140.14	98	0	147	0.196	0.196	47.6259777	183.75	0.0196	0.196	122.5	0	14.7	4.9	9.8	24.5	14.7	0.196	11.97653016	0.196	0	0	0	0	25	0	0	0	10												4.7331	0.08931568	4.242864089	0	2.35047386	3.420656157	0.205776842	0.720222719	4.71128878	0.205291486	0.948272418	0.062817184	0	0.271829993	2.602400354	0.667883949	0.250227715	0.707916549	0.464877957	1.055669367	6.871624791	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.3647			0.702554262	4.7331	0.08931568	4.242864089	0	2.35047386	3.420656157	0.205776842	0.720222719	4.71128878	0.205291486	0.948272418	0.062817184	0	0.271829993	2.602400354	0.667883949	0.250227715	0.707916549	0.464877957	1.055669367	6.871624791	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.3647	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				4.7331	0.08931568	4.242864089	0	2.35047386	3.420656157	0.205776842	0.720222719	4.71128878	0.205291486	0.948272418	0.062817184	0	0.271829993	2.602400354	0.667883949	0.250227715	0.707916549	0.464877957	1.055669367	6.871624791	0	0	0	0	0.541455469	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	35.3647
H5813_003_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1447.218216	128.0987104	892.9640105	1233.081149	302.4859872	16.54402274	0	406.8853837	380.1520504	3008.334453	2452.559078	22.60657279	0.024051809	585.8798371	1735.565099	8465.419449	263.4178629	1011.380285	0	0	275.4361687	0.000951393	0	0	1023.637655		37.07295082		0	0											6700	$250/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 to $40 per visit	$0 to $40 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 300 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	180.7137695	96.15686456	71.93854446	0	200	0.03	0.03	62	300	4	20.35671946	40	0.2	40	10	40	40	20	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	163.1599281	86.81655609	64.95071058	0	180.5727682	0.027085915	0	55.97755815	270.8591524	3.611455365	18.37934593	36.11455365	0.180572768	36.11455365	9.028638412	36.11455365	36.11455365	18.05727682	0	0	45.14319206	0	0	0	0	0	0	0	0	0												19.6773	0.926757406	4.833220584	0	4.551727672	0.448109997	0	1.898037519	8.580638511	0.905372133	3.756369309	0.068035524	0.004343102	1.763232401	1.30581581	25.4770704	0.792768212	1.521897815	0	0	1.036172322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5469	0	NO	8.343016978	19.6773	0.926757406	4.833220584	0	4.551727672	0.448109997	0	1.898037519	8.580638511	0.905372133	3.756369309	0.068035524	0.004343102	1.763232401	1.30581581	25.4770704	0.792768212	1.521897815	0	0	1.036172322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5469	NO																																																																																		0		NO		19.6773	0.926757406	4.833220584	0	4.551727672	0.448109997	0	1.898037519	8.580638511	0.905372133	3.756369309	0.068035524	0.004343102	1.763232401	1.30581581	25.4770704	0.792768212	1.521897815	0	0	1.036172322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5469
H5813_006_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1635.228334	133.4559219	1382.81579	1698.146231	267.6829771	15.09336328	0	306.2485349	368.6273338	3003.377541	2531.045695	62.81097048	0.046164705	689.8761021	1986.373681	7712.203992	276.5612661	1063.847825	0	0	315.561101	0.00380752	0	0	1108.662059		55.77830801		0	0											6700	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$30 per visit	20% per visit	$0 to 300 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	144.5710156	96.15686456	71.93854446	0	200	0.03	0.03	62	300	3	16.23299738	30	0.2	30	10	30	30	15	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	131.7217759	87.61059686	65.54476216	0	182.2243212	0.027333648	0	56.48953957	273.3364818	2.733364818	14.79023465	27.33364818	0.182224321	27.33364818	9.111216059	27.33364818	27.33364818	13.66682409	0	0	45.5560803	0	0	0	0	0	0	0	0	0												17.9496	0.974346081	7.553027672	0	4.0648624	0.412556682	0	1.441653227	8.396608208	0.684110542	3.119563311	0.143071081	0.008412332	1.571402555	1.508189982	17.56688922	0.629952362	1.211618424	0	0	1.197977238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4338	0	NO	6.675606999	17.9496	0.974346081	7.553027672	0	4.0648624	0.412556682	0	1.441653227	8.396608208	0.684110542	3.119563311	0.143071081	0.008412332	1.571402555	1.508189982	17.56688922	0.629952362	1.211618424	0	0	1.197977238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4338	NO																																																																																		0		NO		17.9496	0.974346081	7.553027672	0	4.0648624	0.412556682	0	1.441653227	8.396608208	0.684110542	3.119563311	0.143071081	0.008412332	1.571402555	1.508189982	17.56688922	0.629952362	1.211618424	0	0	1.197977238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4338
H5813_801_0	2012	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	0	0	0	0	0	0	0											0	YES	376.789214	6.931540273	46.01098206	11.99325212	11.22963729	15.57009957	0	19.50551558	48.26800236	23.40648018	65.38892932	1.094523594	0.095589437	32.1210757	32.39289775	161.499888	3.701489482	10.26048226	0	0	81.07877494	0.000422048	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	NO	0.073217095	0.073217095	0.154342055	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060985086	0.060985086	0.12855691	0	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0	0	0	0	0	0	0	0												22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524	0	NO	24.8014315	22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524
H5813_802_0	2012	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	0	0	0	0	0	0	0											0	YES	376.789214	6.931540273	46.01098206	11.99325212	11.22963729	15.57009957	0	19.50551558	48.26800236	23.40648018	65.38892932	1.094523594	0.095589437	32.1210757	32.39289775	161.499888	3.701489482	10.26048226	0	0	81.07877494	0.000422048	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	NO	0.073217095	0.073217095	0.154342055	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060985086	0.060985086	0.12855691	0	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0.186577454	0	0	0	0	0	0	0	0												22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524	0	NO	24.8014315	22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		22.9785	0.422720577	5.915029669	0	2.095197139	2.905029542	0	3.639289442	9.005721006	4.367121487	12.20009997	0.204213426	0.017834834	5.993068534	6.043784401	30.13223798	0.690614485	1.914374661	0	0	15.12747143	7.87E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6524
H5817_009_0	2012	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	270.7251391	6.923364443	16.89424727	0	11.08587715	9.504774327	10.2905256	22.48452106	31.08836877	11.41716151	7.355681558	0	0.060438895	7.277142174	70.84034533	114.1533784	4.546035305	4.967948762	10.62527782	17.10331905	14.48378298	1.87809861	0	0	0	0	0	0	0	0											6700	1% Coinsurance for IP Medical; 1% Coinsurance for IP Surgical; PBP 1a	1% Coinsurance for IP Psych; 1% Coinsurance for IP Substance Abuse; PBP 1b	3% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	4% Coinsurance for Ambulance; PBP 10a	4% Coinsurance for DME; PBP 11a	"4% Coinsurance for DME / Medical Supplies; 4% Coinsurance for Diabetes Monitoring Supplies; 4% Coinsurance for Prosthetics; PBP 11b, 11c"	"4% Coinsurance for ER - Facility; 4% Coinsurance for PCP Urgent Care; 4% Coinsurance for Speclst Urgent Care; PBP 4a, 4b"	4% Coinsurance for OP Fac - Surgery; PBP 9b	4% Coinsurance for OP Fac - Pathology; PBP 8a	4% Coinsurance for OP Fac - Radiology; 4% Coinsurance for OP Fac - CT/MRI/PET; 4% Coinsurance for Radiology - Therapeutic; 4% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	4% Coinsurance for Renal Dialysis - Fac; PBP 12	"4% Coinsurance for OP Fac - Cardiovascular; 4% Coinsurance for OP Fac - Occ Therapy; 4% Coinsurance for OP Fac - Physical/Speech Therapy; 4% Coinsurance for OP Fac - CORF; 4% Coinsurance for OP Fac - Other; 4% Coinsurance for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"4% Coinsurance for Prof - Asst Surgeon (OP); 4% Coinsurance for PCP Office Visits; 4% Coinsurance for PCP Immunizations; 4% Coinsurance for Physical Exams; 4% Coinsurance for Medical Nutrition Therapy; 4% Coinsurance for Pelvic Tests; 4% Coinsurance for Colorectal Cancer Screening; PBP 7a, 14a-b"	"4% Coinsurance for Prof - Asst Surgeon (OP); 4% Coinsurance for Speclst Office Visits; 4% Coinsurance for Cardio; 4% Coinsurance for Chiropractor; 4% Coinsurance for Speclst Immunizations; 4% Coinsurance for Vision Exams; 4% Coinsurance for Hearing/Speech Exams; 4% Coinsurance for Prostate Cancer Screening; 4% Coinsurance for Influenza Virus Vaccine; 4% Coinsurance for Pneumococcal Vaccine; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"4% Coinsurance for OP Psych - Non-Physician; 4% Coinsurance for OP Psych - Psychiatrist; 4% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"4% Coinsurance for Occ Therapy; 4% Coinsurance for PT/ST; PBP 7c, 7i"	4% Coinsurance for Prof Radiology (IP); 4% Coinsurance for Prof Radiology (OP); 4% Coinsurance for Prof Radiology (OP); 4% Coinsurance for Prof Radiology (Office); 4% Coinsurance for Prof Radiology (Office); 4% Coinsurance for Initial Preventive Physical Examination (IPPE); 4% Coinsurance for Glaucoma Screening; 4% Coinsurance for Other Vaccines - Rabies/Tetanus/etc.; 4% Coinsurance for Office-Rad Therapeutic; 4% Coinsurance for Office-Rad Diagnostic; PBP 7d	"4% Coinsurance for Prof - Primary Surgeon (IP); 4% Coinsurance for Prof - Asst Surgeon (IP); 4% Coinsurance for Prof - Anesthesia (IP); 4% Coinsurance for Prof - Primary Surgeon (OP); 4% Coinsurance for Prof - Anesthesia (OP); 4% Coinsurance for Prof - IP Visits; 4% Coinsurance for Allergy Testing; 4% Coinsurance for Allergy Tx; 4% Coinsurance for Prof - ER Visits; 4% Coinsurance for Prof Path (IP); 4% Coinsurance for Prof Path (OP); 4% Coinsurance for Prof Path (Office); 4% Coinsurance for Ultrasound Screening for Abdominal Aortic Aneurysm; 4% Coinsurance for Cardio Screenings; 4% Coinsurance for Diabetes Screening Tests; 4% Coinsurance for Diabetes Self-Management Training; PBP 7d, 7g"	4% Coinsurance for Part B Rx; 4% Coinsurance for Rx Injections; PBP 15	"4% Coinsurance for Renal Dialysis - Prof; 4% Coinsurance for Pap Tests; 4% Coinsurance for Bone Mass Measurements; 4% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 7g, 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 13a-e, 14c"											0	NO	0.012978601	0.012978601	0.033555889	0	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0.040096	0	0	0	0	0	0	0	0											NO	0.012970229	0.012969368	0.033541217	0	0.04006539	0.04006539	0.04006539	0.04006539	0.04006539	0.04006539	0.04006539	0	0.04006539	0.04006539	0.04006539	0.040065412	0.04006539	0.04006539	0.04006539	0.04006539	0.04006539	0.040069167	0	0	0	0	0	0	0	0												3.5114	0.089791662	0.566653611	0	0.444159994	0.380812492	0.412293923	0.900851109	1.245567625	0.457433031	0.294708252	0	0.002421508	0.291561541	2.838246077	4.573602124	0.182138678	0.199042806	0.425705902	0.685251151	0.580298417	0.075253847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1572	0	NO	0.013256662	3.5114	0.089791662	0.566653611	0	0.444159994	0.380812492	0.412293923	0.900851109	1.245567625	0.457433031	0.294708252	0	0.002421508	0.291561541	2.838246077	4.573602124	0.182138678	0.199042806	0.425705902	0.685251151	0.580298417	0.075253847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1572	NO																																										0	0	0	0	0	0	0	0	0	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	3.5114	0.089791662	0.566653611	0	0.444159994	0.380812492	0.412293923	0.900851109	1.245567625	0.457433031	0.294708252	0	0.002421508	0.291561541	2.838246077	4.573602124	0.182138678	0.199042806	0.425705902	0.685251151	0.580298417	0.075253847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1572
H5817_010_0	2012	7																															A	A	D		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	YES	203.6552976	15.57470386	217.3023338	0	175.9287486	7.053812643	4.960945433	231.3411132	227.8335555	305.8369453	178.3551774	0	4.91676233	429.8324068	0	4295.990441	534.5361633	463.5989239	165.2934811	0	18.49304677	0	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 11-20/21-100; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $15/Visit for Speclst Urgent Care; PBP 4a, 4b"	$50/Visit for OP Fac - Surgery; PBP 9b	$150/Visit for OP Fac - Pathology; PBP 8a	$50/Visit for OP Fac - CT/MRI/PET; $50/Visit for Radiology - Therapeutic; $50/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	$30/Visit 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; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"$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, 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"	$50/Visit for Prof Radiology (Office); $50/Visit for Office-Rad Therapeutic; $50/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 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	PBP 14a	"No Cost-Sharing; PBP 13a-e, 14c"											0	NO	200	200	40.77649912	0	50	0.2	0.2	65	50	150	37.17417578	0	30	117.5247041	0	15	15	15	47.96437547	0	0.2	0	0	0	0	0	0	0	0	0											NO	198.4644002	198.4644002	40.46341721	0	49.61610006	0.1984644	0.1984644	64.50213024	49.61610006	148.8483002	36.8887525	0	29.76966004	116.6223496	0	14.88499649	14.88483002	14.88483002	47.59610505	0	0.1984644	0	0	0	0	0	0	0	0	0												3.3682	0.257585355	0.732732916	0	0.7274082	1.399930696	0.98457106	1.243499551	0.942017707	3.79360912	0.548275	0	0.012197529	4.177338767	0	5.328816888	0.663039994	0.575049265	0.655610491	0	3.670211436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0801	0	NO	0.224921089	3.3682	0.257585355	0.732732916	0	0.7274082	1.399930696	0.98457106	1.243499551	0.942017707	3.79360912	0.548275	0	0.012197529	4.177338767	0	5.328816888	0.663039994	0.575049265	0.655610491	0	3.670211436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0801	YES	$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	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"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a, 4b"	$150/Visit for OP Fac - Surgery; PBP 9b	No Cost-Sharing; PBP 8a	$50/Visit for OP Fac - Radiology; $100/Visit for OP Fac - CT/MRI/PET; $100/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"$25/Visit for Speclst Office Visits; $25/Visit for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; 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"	"No Cost-Sharing; PBP 7c, 7i"	$50/Visit for Prof Radiology (Office); $100/Visit for Prof Radiology (Office); $100/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											6700	0.6197	0.0485	0	0	0	0	0	0.1146	0.3174	0	0.1901	0	0	0	0	0.8465	0.1021	0	0.1881	0	0	0	0	0	0	0	0	0	0	0											2.4271	0	NO	0.018779438	3.9879	0.306065071	0.732732916	0	0.7274082	1.399930696	0.98457106	1.358088446	1.259464169	3.79360912	0.738400318	0	0.012197529	4.177338767	0	6.175355187	0.765125025	0.575049265	0.84371619	0	3.670211436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5072
H5820_002_0	2012	6																															A	A	D		T	Coin	Coin	V	Coin		Coin	V	Coin	Coin	V	V	V	V	Coin	Coin	Coin	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	NO	216.5448467	0	1057.211948	0	4.213070786	3.329611317	3.172678046	378.3865563	36.0019951	0	7.481368166	0.047016901	0.054657805	22.77643188	2555.343175	10901.44345	95.14132379	477.435329	5.972121991	0.15410118	18.47332301	0	0	2642.864173	0	0	0.227953251	0	0	0												$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-20, $146/Day for 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 Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $15-$40(PCP or SPC co-pay)/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	$0-$15/Visit for OP Lab; PBP 8a	$0-$100 or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit or 30% Coinsurance for Cardiac Rehab; $40/Visit or 30% Coinsurance for Pulmonary Rehabilitation Services; $40/Visit or 30% Coinsurance for CORF; 30% Coinsurance for OP - Other; $40/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $25-$40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$40/Visit or 30% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$15-$40(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Oral Exam; $20 Routine Cleaning 1/year; $0 Fluoride; $10 Dental X-Ray; PBP 16a, 16b"	$0/Visit Advantica Eye Care - Optometry; PBP 17a	$10/Other for Glasses/Contacts (non-cvd); PBP 17b	$40/Exam for Routine Hearing Exam (non-cvd); PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	1035.655048	0	88.40038641	0	125	0.2	0.2	58.01974635	0.244964129	0	0.265958428	51.05980106	0.2	0.299736646	15	39.84134557	40	53.2	0.241158905	0.3	0.2	0	0	17	0	0	40	0	0	0											NO	950.0338546	0	81.09201997	0	114.6658166	0.183465307	0.183465307	53.22305276	0.224712095	0	0.243970722	46.83851028	0.183465307	0.274956378	13.75989799	36.54752339	36.69306131	48.80177155	0.221221462	0.27519796	0.183465307	0	0	17	0	0	40	0	0	0												17.1437	0	7.144287699	0	0.040257934	0.610868161	0.58207635	1.678240637	8.090083737	0	1.825234795	0.000183517	0.010027811	6.262525215	2.930105119	33.20172996	0.290918869	1.941640821	1.321161558	0.04240833	3.389213869	0	0	3.744057579	0	0	0.000759844	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2495	0	NO	7.796181578	17.1437	0	7.144287699	0	0.040257934	0.610868161	0.58207635	1.678240637	8.090083737	0	1.825234795	0.000183517	0.010027811	6.262525215	2.930105119	33.20172996	0.290918869	1.941640821	1.321161558	0.04240833	3.389213869	0	0	3.744057579	0	0	0.000759844	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2495	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	NO	0	17.1437	0	7.144287699	0	0.040257934	0.610868161	0.58207635	1.678240637	8.090083737	0	1.825234795	0.000183517	0.010027811	6.262525215	2.930105119	33.20172996	0.290918869	1.941640821	1.321161558	0.04240833	3.389213869	0	0	3.744057579	0	0	0.000759844	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2495
H5820_026_0	2012	2																															A	A	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	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	NO	206.7100675	0.707771744	1000.04822	0	50.27576929	5.67291015	4.2387248	325.5828233	34.15795845	0	7.753534113	0	0.180976625	22.35856	2399.167893	7338.719228	119.0586739	298.5738287	5.21811656	3.057922972	23.02861145	1.836063626	0	2642.864173	666.6666667	0	30.12260753	0	0	0												$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-20, $146/Day for 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 Prosth/Supplies; 20% Coinsurance for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $15-$40(PCP or SPC co-pay)/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	$0-$15/Visit for OP Lab; PBP 8a	$0-$100 or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit or 30% Coinsurance for Cardiac Rehab; $40/Visit or 30% Coinsurance for Pulmonary Rehabilitation Services; $40/Visit or 30% Coinsurance for CORF; 30% Coinsurance for OP - Other; $40/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $25-$40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$40/Visit or 30% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$15-$40(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Oral Exam; $20 Routine Cleaning 1/year; $0 Fluoride; $10 Dental X-Ray; PBP 16a, 16b"	$20/Visit for Routine Eye Exams;$20/Visit Advantica Eye Care - Optometry; PBP 17a	$25/Other for Glasses/Contacts (non-cvd); PBP 17b	$40/Exam for Routine Hearing Exam (non-cvd); PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	1035.655048	923.5878974	88.40038641	0	125	0.2	0.2	58.19290658	0.258947502	0	0.280181299	0	0.2	0.293941127	15	39.59514406	40	53.2	0.254709022	0.311073921	0.2	0.2	0	17	20	0	40	0	0	0											NO	967.629858	862.923642	82.59396167	0	116.7895937	0.18686335	0.18686335	54.37060731	0.241938988	0	0.26177808	0	0.18686335	0.274634118	14.01475124	36.99440629	37.37266997	49.70565107	0.237978905	0.290641575	0.18686335	0.18686335	0	17	20	0	40	0	0	0												16.6682	0.050896081	6.883162028	0	0.489307222	1.060058994	0.792062315	1.475177986	8.264141899	0	2.029705276	0	0.033817898	6.140423404	2.801978433	22.62429673	0.370795044	1.236733879	1.241801666	0.888759549	4.303203478	0.343093	0	3.744057579	1.111111111	0	0.100408692	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6532	0	NO	5.462209992	16.6682	0.050896081	6.883162028	0	0.489307222	1.060058994	0.792062315	1.475177986	8.264141899	0	2.029705276	0	0.033817898	6.140423404	2.801978433	22.62429673	0.370795044	1.236733879	1.241801666	0.888759549	4.303203478	0.343093	0	3.744057579	1.111111111	0	0.100408692	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6532	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	NO	0	16.6682	0.050896081	6.883162028	0	0.489307222	1.060058994	0.792062315	1.475177986	8.264141899	0	2.029705276	0	0.033817898	6.140423404	2.801978433	22.62429673	0.370795044	1.236733879	1.241801666	0.888759549	4.303203478	0.343093	0	3.744057579	1.111111111	0	0.100408692	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6532
H5821_001_0	2012	9																															A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	Coin	P	P	P	S	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P																																																			0	YES	215.8432603		51.97558998			3.308679946	4.446819249	50.62617933		627.6858845	671.3468643	0.092410487		0.046831587	3355.946513	4302.720731	0.000860111	3384.517728	2188.747583	10875.26399	1032.609921																				6700	1a (IP Acute) - $85 per Admit	1b (IP Psych) - Medicare Cost Share	2 (SNF) - $146/day days 21-100	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) -$45 (UC) - $45	"9a,9b - $0"	8a (OP Diag Proc/Test/Lab) - $5 with max of $15/visit	"8b (OP Radiation Therapy,OP nuclear med,CT Scan,MRI,Diagnostic Radiology,Other Imaging) - $5 with max of $15/visit"	7e - 42%	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	"9d,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%	13c (OTC)  - $0													85		59.19208386			0.2	0.2	45		5	5	0.42		0.229997532	2	2	0.2	5	5	5	16																				NO	84.70889776		58.98936682			0.199315054	0.199315054	44.84588705		4.982876339	4.982876339	0.418561612		0.229338269	1.993150536	1.993150536	0.199315054	4.982876339	4.982876339	4.982876339	15.94520428																					1.5237	0	0.255500595	0	0	0.659469721	0.886318017	0.189197993	0	0.260640095	0.278769867	0.038679482	0	0.010740275	0.557408882	0.714664177	0.000171433	1.405386109	0.908854878	4.515841299	1.372098011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5774	0		0.046652699	1.5237	0	0.255500595	0	0	0.659469721	0.886318017	0.189197993	0	0.260640095	0.278769867	0.038679482	0	0.010740275	0.557408882	0.714664177	0.000171433	1.405386109	0.908854878	4.515841299	1.372098011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5774	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%	7h (OP Mental Health) - 20%	12 (Renal Dialysis) - 0%	"3,9c,9d (OP Other) - 20%; 5 (OP Observation) -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%	"9d (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%	13c (OTC)  - 20%												0.294		0.007						0.0403	0.006	0.0239			0.0374	0.7142	0.8624		0.0426	0.2149	1.1986		0.0793	0.0011	0.0413	0.034			0.0013													3.5983	0		0	1.8176	0	0.262477452	0	0	0.659469721	0.886318017	0.189197993	0.040306322	0.266619314	0.302692036	0.038679482	0	0.048124963	1.271656299	1.577024026	0.000171433	1.448009738	1.123782028	5.714432056	1.372098011	0.079303939	0.001122026	0.0413141	0.033987725	0	0	0.001324932	0	0	0	0	0	0	0	0	0	0	0	0	17.1757
H5821_013_0	2012	10																															A	A	Coin	V	Coin	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	S	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P																																																			0	YES	314.6531005							52.12339287		812.2503752	983.8350365								21.79483096	20.48170897	1349.053996	4.112553268		5.67003998																	6700	"1a (IP Acute) $50 per Admit, (Add'l Days) - 0%"	1b (IP Psych) - $50 per Admit	"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) -$45"	9b (OP Surg/ASC) - 0%	8a (OP Diag Proc/Test/Lab) - $5 with $15 max/visit	"8b (OP Diag & Therap Rad) - $5 with $15 max/visit; (CT Scan), (MRI) - $20"	7h (OP Mental Health) - 0%	12 (Renal Dialysis) - 0%	(OP - Other) - 0%; 9a (OP Observation) - 0%	7 (PCP) - 0%	7d (Specialist) - 0%	"7e (MH),(Psychiatric) -0%"	"7c(OT), 7i (PT/ST) - 0%"	Professional Radiology - 0%	7g (Prof Others) - 0%	15 (Part B Rx) - $19	"9d (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%	"13b (OTC) - $0, $25 max/quarter"													50							45		5	6.508282592								0.061726117	0.318483	19	0.5		0.5																	NO	49.71892284							44.74703055		4.971892284	6.471696								0.061379121	0.316692634	18.89319068	0.497189228		0.497189228																		1.3037	0	0	0	0	0	0	0.194363921	0	0.336535114	0.530590106	0	0	0	0	0	0	0	1.337747565	6.486406369	2.123994532	2.044717186	0	2.819082802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1771	0		0.09710783	1.3037	0	0	0	0	0	0	0.194363921	0	0.336535114	0.530590106	0	0	0	0	0	0	0	1.337747565	6.486406369	2.123994532	2.044717186	0	2.819082802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1771	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%	7h (OP Mental Health) - 20%	12 (Renal Dialysis) - 0%	(OP Other) - 20%; 9a (OP Observation) -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%	9d (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%	13b (OTC) - 20%												0.8766		0.0166				1.6429		0.039	0.0101	0.0185	0.0004		0.0558	0.8958	1.1346		0.1271	0.1403	1.7475		0.155		0.1025	0.0596			0.004													7.0262	0		0	2.1803	0	0.016583197	0	0	0	1.642888756	0.194363921	0.039000797	0.346677504	0.549129015	0.000428971	0	0.055779927	0.895778937	1.134585468	0	0.127105414	1.477998775	8.233884204	2.123994532	2.199724572	0	2.921545419	0.059556254	0	0	0.003951	0	0	0	0	0	0	0	0	0	0	0	0	24.2033
H5821_020_0	2012	8																															Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	S	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P																																																			0	YES						4.731860031	2.460783501	53.64471241		811.238263	883.8056377								21.65300473	20.00446306	1388.428681	4.016726341																			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 (DME) - 20%	"11b (Med Supp) - 20%, (Diab Supp) - 0%"	"4 (ER), (UC) -$45"	9b (OP Surg/ASC) - 0%	8a (OP Diag Proc/Test/Lab) - $5 with max $15/visit	8b (OP Diag & Therap Rad) - $5 with max $15/visit	7e (OP Mental Health) - 0%	12 (Renal Dialysis) - 0%	(OP - Other) - 0%; 9a (OP Observation) - 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	"9d (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%	"13b (OTC) - 0%, $25 maximum/quarter"																		0.2	0.2	45		5	5								0.074463603	0.384203522	15	0.5																			NO						0.199237334	0.199237334	44.82840007		4.980933341	4.980933341								0.074179648	0.382738427	14.94280002	0.498093334																				0	0	0	0	0	0.942763176	0.490279943	0.200400552	0	0.336726976	0.366848081	0	0	0	0	0	0	0	1.606212272	7.656476717	1.728917678	2.000704615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.3293	0		0.058679585	0	0	0	0	0	0.942763176	0.490279943	0.200400552	0	0.336726976	0.366848081	0	0	0	0	0	0	0	1.606212272	7.656476717	1.728917678	2.000704615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.3293	NO																																																																																		0	0		0	0	0	0	0	0	0.942763176	0.490279943	0.200400552	0	0.336726976	0.366848081	0	0	0	0	0	0	0	1.606212272	7.656476717	1.728917678	2.000704615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.3293
H5821_804_0	2012	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	110.4462441		1.912144377		1.317330289	5.530629058	6.806538049	0.697500211	16.14070291	4.553249722	3.538085563	0.183422721	0.317863542	8.901448628	42.40805263	64.59246009	0.002953653	8.412389885	27.3609976	90.5232748	15.04768574	7.095071646																			6700	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share																					0.15058934		0.11993975		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.134636866		0.107234099		0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087	0.20027087																				14.8701	0	0.205047079	0	0.263822883	1.107623892	1.363151295	0.139688974	3.23251261	0.911883282	0.708575473	0.036734228	0.063658808	1.782700858	8.493097582	12.93598816	0.000591531	1.684756638	5.479610785	18.12917497	3.01361311	1.420936169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8433	0		8.986307683	14.8701	0	0.205047079	0	0.263822883	1.107623892	1.363151295	0.139688974	3.23251261	0.911883282	0.708575473	0.036734228	0.063658808	1.782700858	8.493097582	12.93598816	0.000591531	1.684756638	5.479610785	18.12917497	3.01361311	1.420936169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8433	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%	7e (OP Mental Health) -20%	12 (Renal Dialysis) - 0%	(OP Other) - 20%; 9a (OP Observation) -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%	9d (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%	13c (OTC) - 20%												1.0234	0.0001	0.0192	0.001	0.6384	0.0579	1.8898	0.0003	0.0448	0.0117	0.0101	0.0009	0.0087	0.0655	1.0395	1.3163	0.0003	0.1475	0.1808	2.0278	0.0237	0.1784	0.004	0.1179	0.0691			0.0045													8.8816	0		0	15.8935	0.000123234	0.224243808	0.000980626	0.902197725	1.165510928	3.252995879	0.140038364	3.277344594	0.923542107	0.718670887	0.037585419	0.072383901	1.848227396	9.532554777	14.25229286	0.000928235	1.832249097	5.660410629	20.15693912	3.037346216	1.599370577	0.003973954	0.117864596	0.069108766	0	0	0.004544907	0	0	0	0	0	0	0	0	0	0	0	0	84.7249
H5823_002_0	2012	5																															D	D	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	776.991079	3.254594747	686.7888459	0	223.3750976	9.905054603	4.794879983	370.9549643	33.07191678	0	12.47700046	0	0.301000588	14.15530208	4208.84329	4124.325338	172.5106903	406.7078912	14.74277171	186.4505245	24.16782179	0	0	0	58.25110753	0	0	0	0	0											3400	$290/Days Custom for IP Medical; $290/Days Custom for IP Surgical;	$290/Days Custom for IP Psych; $290/Days Custom for IP Substance Abuse;	$100/Days Custom for SNF;	No Cost-Sharing;	$150/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $50/Visit for PCP Urgent Care;	20% Coinsurance for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; 20% Coinsurance for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	$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;	$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits;	$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $27/Proceedure for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist;	$30/Visit for Occ Therapy; $30/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; 20% Coinsurance for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$10/Visit for PCP Office Visits; $35/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$30/Exam for Vision Exams (Refractions);	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	290	290	100	0	150	0.2	0.2	63.71582028	0.2	0	0.145812618	0	0.2	0.11178095	10	33.345434	30	30	0.130778754	34.30646854	0.2	0	0	0	30	0	0	0	0	0											NO	258.1281589	258.1281589	89.00970997	0	133.5145649	0.17801942	0.17801942	56.71326683	0.17801942	0	0.129787388	0	0.17801942	0.0994959	8.900970997	29.68067409	26.70291299	26.70291299	0.11640579	30.53608814	0.17801942	0	0	0	30	0	0	0	0	0												16.7136	0.070008546	5.094239665	0	2.485319081	1.763292075	0.853581753	1.753172323	5.887443442	0	1.619357299	0	0.05358395	1.408394515	3.121899337	10.20106301	0.383878163	0.905023786	1.716143982	0.474455804	4.302341615	0	0	0	0.145627769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9524	0	NO	7.261048714	16.7136	0.070008546	5.094239665	0	2.485319081	1.763292075	0.853581753	1.753172323	5.887443442	0	1.619357299	0	0.05358395	1.408394515	3.121899337	10.20106301	0.383878163	0.905023786	1.716143982	0.474455804	4.302341615	0	0	0	0.145627769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9524	NO																																										0	0	0	0	0	0	0	0	0	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	16.7136	0.070008546	5.094239665	0	2.485319081	1.763292075	0.853581753	1.753172323	5.887443442	0	1.619357299	0	0.05358395	1.408394515	3.121899337	10.20106301	0.383878163	0.905023786	1.716143982	0.474455804	4.302341615	0	0	0	0.145627769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9524
H5823_006_0	2012	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	302.1279698	15.44711715	60.88649897	0	21.14579085	21.95489714	8.854017756	51.69385978	32.92295754	6.828783365	13.7676559	0	2.593737959	17.98325415	45.40572909	74.14115496	4.142883534	8.626639179	19.66381452	66.48307059	31.73256326	1.115071259	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, 7c, 7i, 9a, 9c, 9d, 14a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8a, 14a, 14f-h"	"Medicare-FFS Cost Sharing; PBP 7a, 7d, 8a, 14a, 14b, 14d-e, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 13a, 14a, 14c"	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 13a-d, 14c"											0	NO	0.07323063	0.07323063	0.143075014	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.196690504	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073169319	0.073169319	0.142955227	0	0.223812461	0.223812461	0.223812461	0.223812461	0.223812461	0.223812461	0.223812461	0	0.223812461	0.196525829	0.223812461	0.223815258	0.223812461	0.223812461	0.223812461	0.223812461	0.223812461	0.223842183	0	0	0	0	0	0	0	0												22.1065	1.130255043	8.704043307	0	4.732691496	4.913779568	1.981639507	11.56972999	7.368568161	1.528366813	3.081372955	0	0.580510877	3.534173936	10.16236799	16.59392174	0.927228961	1.930749348	4.401006728	14.87973967	7.102143088	0.249599985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4784	0	NO	0.106576971	22.1065	1.130255043	8.704043307	0	4.732691496	4.913779568	1.981639507	11.56972999	7.368568161	1.528366813	3.081372955	0	0.580510877	3.534173936	10.16236799	16.59392174	0.927228961	1.930749348	4.401006728	14.87973967	7.102143088	0.249599985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4784	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	NO	0	22.1065	1.130255043	8.704043307	0	4.732691496	4.913779568	1.981639507	11.56972999	7.368568161	1.528366813	3.081372955	0	0.580510877	3.534173936	10.16236799	16.59392174	0.927228961	1.930749348	4.401006728	14.87973967	7.102143088	0.249599985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4784
H5826_005_0	2012	8																															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	296.9950954	12.05325104	50.37875075	70.09238295	437.9301635	11.91707335	16.76893008	1334.945586	89.09679706	20.43756362	51.76500152	0	0	0.716553333	13445.43692	3309.265248	927.4033652	1615.793344	12882.85555	1571.366658	41.63763201	8.277961049	0	26.89773592	418.6324829	3.385635785	14.74496571	22.74170857	93.75052105	3.607808045											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		"0% coinsurance, $1,200 limit per year"	"$0 copay/visit, 1 visit per year"	"0% coinsurance, $270 limit per year"	"$0 copay/visit, 1 visit per year"	"$0 copay/visit, $2,000 limit every 2 years"	$0 copay/visit	$0 copay/visit													822.7552088	405.5295901	744.1776091	0	101.6878075	0.224	0.224	85.86194139	0.224	0.224	0.224	0	0	0.224	21.07083466	54.59419705	18.58464096	22.58226849	13.36763368	13.77150905	0.224	0.210705693	0	0	0	0	0	0	0	0											NO	822.7552088	405.5295901	744.1776091	0	101.6878075	0.224	0.224	85.86194139	0.224	0.224	0.224	0	0	0.224	21.07083466	54.59419705	18.58464096	22.58226849	13.36763368	13.77150905	0.224	0.210705693	0	0	0	0	0	0	0	0												20.3629	0.407329163	3.12422819	0	3.711013179	2.669424431	3.756240339	9.551751639	19.95768254	4.578014251	11.59536034	0	0	0.160507946	23.60888153	15.05555659	1.436288214	3.040689926	14.3511078	1.803340846	9.326829569	1.744213519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2413			0	20.3629	0.407329163	3.12422819	0	3.711013179	2.669424431	3.756240339	9.551751639	19.95768254	4.578014251	11.59536034	0	0	0.160507946	23.60888153	15.05555659	1.436288214	3.040689926	14.3511078	1.803340846	9.326829569	1.744213519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2413	NO																																																																																		0				20.3629	0.407329163	3.12422819	0	3.711013179	2.669424431	3.756240339	9.551751639	19.95768254	4.578014251	11.59536034	0	0	0.160507946	23.60888153	15.05555659	1.436288214	3.040689926	14.3511078	1.803340846	9.326829569	1.744213519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2413
H5826_006_0	2012	3																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	144.3610851	11.29618225	28.95331647	18.24275277	163.7929903	2.789908108	5.617632371	462.0367904	972.9949278	6.94213926	22.69844483	0	0	0.194794021	5210.719689	3475.384018	311.5882864	664.712118	36.51764428	869.5712012	8.422516527	368.8536351	0	9.136895912	166.7496507	1.238070281	0	0	33.95346065	1.744485593											2800	Days 1-5: $175/day	Days 1-5: $175/day	Days 21-55: $100/day; 3 day requirement waived	$0 copay/visit	$150 copay/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$150 copay/visit	0% coinsurance	15% coinsurance			20% coinsurance	$0 copay/visit	"$0 copay/visit for OP surgery, add'l podiatry services, and anesthesia; $20 copay/visit for all other"	$20 copay/visit	$20 copay/visit	15% coinsurance for radiology; 0% coinsurance for lab	$0 copay/visit for preventative;  $20 copay/visit for all other	20% coinsurance	"0% coinsurance for Medicare covered eye wear, blood, and accupuncture; $20 copay/visit for all other"		0% coinsurance; $500 limit per year	$0 copay/visit; 1 exam per year	0% coinsurance; $270 limit per year			$0 copay/visit	$0 copay/visit; includes IP add'l days													687.6106195	714.5833333	222.2222222	0	150	0.2	0.138150335	49.09081302	150	0	0.15	0	0	0.2	0	15.98717345	20	20	0.085467175	0.822089519	0.2	19.27700561	0	0	0	0	0	0	0	0											NO	585.1566372	608.1104167	189.1111111	0	127.65	0.1702	0.117565935	41.77628188	127.65	0	0.12765	0	0	0.1702	0	13.6050846	17.02	17.02	0.072732566	0.69959818	0.1702	16.40473178	0	0	0	0	0	0	0	0												7.0395	0.572443841	0.456282821	0	1.742347934	0.47484236	0.660442202	1.608514933	10.35023354	0	2.897456483	0	0	0.033153942	0	3.940241133	0.441936053	0.942783354	2.656021984	0.050695869	1.433512313	0.504245412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8046			6.268967772	7.0395	0.572443841	0.456282821	0	1.742347934	0.47484236	0.660442202	1.608514933	10.35023354	0	2.897456483	0	0	0.033153942	0	3.940241133	0.441936053	0.942783354	2.656021984	0.050695869	1.433512313	0.504245412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8046	NO																																																																																		0				7.0395	0.572443841	0.456282821	0	1.742347934	0.47484236	0.660442202	1.608514933	10.35023354	0	2.897456483	0	0	0.033153942	0	3.940241133	0.441936053	0.942783354	2.656021984	0.050695869	1.433512313	0.504245412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8046
H5826_008_0	2012	5																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	195.1481398	7.77398514	48.50481051	57.55986748	194.0591317	8.64124094	15.14648816	728.8519823	1877.704953	13.39270197	26.94826631	0	0	0.331291096	7228.324989	4526.699789	462.9631044	1094.54254	41.36826407	1031.125704	25.9161529	461.8965676	0	11.1539933	286.6646164	3.136137262	0	0	83.1800813	2.362700226											2800	Days 1-5: $175/day	Days 1-5: $175/day	Days 21-55: $100/day; 3 day requirement waived	$0 copay/visit	$150 copay/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$150 copay/visit	0% coinsurance	15% coinsurance			20% coinsurance	$0 copay/visit	"$0 copay/visit for OP surgery, add'l podiatry services, and anesthesia; $20 copay/visit for all other"	$20 copay/visit	$20 copay/visit	15% coinsurance for radiology; 0% coinsurance for lab	$0 copay/visit for preventative;  $20 copay/visit for all other	20% coinsurance	"0% coinsurance for Medicare covered eye wear, blood, and accupuncture; $20 copay/visit for all other"		0% coinsurance; $500 limit per year	$0 copay/visit; 1 exam per year	0% coinsurance; $270 limit per year			$0 copay/visit	$0 copay/visit; includes IP add'l days													687.6106195	714.5833333	222.2222222	0	150	0.2	0.120798942	49.07837967	150	0	0.15	0	0	0.2	0	15.24631983	20	20	0.09116312	2.048215224	0.2	15.45808385	0	0	0	0	0	0	0	0											NO	585.1566372	608.1104167	189.1111111	0	127.65	0.1702	0.1027999	41.7657011	127.65	0	0.12765	0	0	0.1702	0	12.97461818	17.02	17.02	0.077579815	1.743031156	0.1702	13.15482936	0	0	0	0	0	0	0	0												9.516	0.393953445	0.764399884	0	2.064304014	1.470739208	1.557057469	2.53675117	19.97408644	0	3.439946194	0	0	0.056385745	0	4.894350115	0.656636003	1.552426169	3.209342274	0.149773686	4.410929224	0.506347544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1534			10.00689037	9.516	0.393953445	0.764399884	0	2.064304014	1.470739208	1.557057469	2.53675117	19.97408644	0	3.439946194	0	0	0.056385745	0	4.894350115	0.656636003	1.552426169	3.209342274	0.149773686	4.410929224	0.506347544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1534	NO																																																																																		0				9.516	0.393953445	0.764399884	0	2.064304014	1.470739208	1.557057469	2.53675117	19.97408644	0	3.439946194	0	0	0.056385745	0	4.894350115	0.656636003	1.552426169	3.209342274	0.149773686	4.410929224	0.506347544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1534
H5826_009_0	2012	5																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	186.9683073	3.437872698	36.60029192	22.00667948	213.8553667	7.314151916	11.66192075	553.3293668	2831.754289	17.15053943	37.14110285	0	0	0.212955643	5843.851556	2476.756957	228.293664	812.6674915	36.40890307	775.769871	18.83683809	282.0791318	0	9.576472767	287.4480483	2.804664791	0	0	60.33339138	0											2800	Days 1-10: $175/day	Days 1-10: $175/day	Days 21-55: $100/day; 3 day requirement waived	$0 copay/visit	$150/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$150 copay/visit	0% coinsurance	15% coinsurance			20% coinsurance	$0 copay/visit	"$20 copay/visit for chiro; $0 copay/visit for podiatry routine visits, OP surgery, and anesthesia; $25 copay/visit for all other"	$25 copay/visit	$25 copay/visit	"15% coinsurance for radiology, 0% coinsurance for lab"	$0 copay/visit for preventative; $25 copay/visit for all other	20% coinsurance	$25 copay/visit for Medicare covered eye exams and hearing; 20% coinsurance for Medicare covered eye wear; $0 copay/visit for all other		0% coinsurance; $500 limit per year	$0 copay/visit; 1 exam per year	0% coinsurance; $270 limit per year			$0 copay/visit	$0 copay/visit; includes IP add'l days													865.7079646	1137.5	222.2222222	0	150	0.2	0.127028548	49.35451367	150	0	0.15	0	0	0.2	0	16.43841566	25	25	0.097079488	2.621403205	0.2	24.06570124	0	0	0	0	0	0	0	0											NO	736.7174779	968.0125	189.1111111	0	127.65	0.1702	0.108101294	42.00069113	127.65	0	0.12765	0	0	0.1702	0	13.98909173	21.275	21.275	0.082614644	2.230814128	0.1702	20.47991175	0	0	0	0	0	0	0	0												11.4786	0.277325312	0.576793489	0	2.274886463	1.244868656	1.260668728	1.936684653	30.12278624	0	4.741061779	0	0	0.03624505	0	2.887298356	0.404745642	1.44079174	3.007908573	0.144216532	3.206029844	0.481412977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5223			11.47217575	11.4786	0.277325312	0.576793489	0	2.274886463	1.244868656	1.260668728	1.936684653	30.12278624	0	4.741061779	0	0	0.03624505	0	2.887298356	0.404745642	1.44079174	3.007908573	0.144216532	3.206029844	0.481412977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5223	NO																																																																																		0				11.4786	0.277325312	0.576793489	0	2.274886463	1.244868656	1.260668728	1.936684653	30.12278624	0	4.741061779	0	0	0.03624505	0	2.887298356	0.404745642	1.44079174	3.007908573	0.144216532	3.206029844	0.481412977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5223
H5826_010_0	2012	6																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	150.5961334	5.54957886	22.33329131	22.73919371	112.9972802	5.424825327	11.44718225	487.9779664	1442.243191	12.87956333	26.04474021	0	0	0.75983638	2173.865	6917.471904	2.063075198	6.604292046	42.19110108	6.102068136	15.41662123	5.79135668	0	0	169.6477788	1.629757723	0	0	58.01849358	0											3400	Days 1-7: $250/day	Days 1-7: $250/day	Days 21-60: $100/day	$0 copay/visit	$150 copay/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$150 copay/visit	0% coinsurance	20% coinsurance			20% coinsurance	$0 copay/visit for routine physicals and immunizations; $10 copay/visit for all other	20% coinsurance for chiro; $0 copay/visit for OP surgery and anesthesia; $40 copay/visit for all other	20% coinsurance	20% coinsurance	"20% coinsurance for radiology, 0% coinsurance for lab"	$0 copay/visit for preventative; 20% coinsurance for all other	20% coinsurance	"20% coinsurance for Medicare covered eye exams, eye wear, and hearing; 0% coinsurance for all other"			$0 copay/visit; 1 exam per year	0% coinsurance; $145 limit every 2 years			$0 copay/visit	$0 copay/visit; includes IP add'l days													1125.368732	1302.083333	229.6296296	0	150	0.2	0.087830215	49.19613867	150	0	0.2	0	0	0.2	9.229757761	33.89157729	0.2	0.2	0.106824556	0.027975041	0.2	0.188290036	0	0	0	0	0	0	0	0											NO	1007.205015	1165.364583	205.5185185	0	134.25	0.179	0.078608042	44.03054411	134.25	0	0.179	0	0	0.179	8.260633196	30.33296168	0.179	0.179	0.095607977	0.025037661	0.179	0.168519582	0	0	0	0	0	0	0	0												12.6401	0.538940221	0.382492079	0	1.264157072	0.971043734	0.899840584	1.790494615	16.1350957	0	4.662008498	0	0	0.136010712	1.496458449	17.48561751	0.369290461	1.182168276	4.033805832	0.152781515	2.759575199	0.975957007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8758			7.96308689	12.6401	0.538940221	0.382492079	0	1.264157072	0.971043734	0.899840584	1.790494615	16.1350957	0	4.662008498	0	0	0.136010712	1.496458449	17.48561751	0.369290461	1.182168276	4.033805832	0.152781515	2.759575199	0.975957007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8758	NO																																																																																		0				12.6401	0.538940221	0.382492079	0	1.264157072	0.971043734	0.899840584	1.790494615	16.1350957	0	4.662008498	0	0	0.136010712	1.496458449	17.48561751	0.369290461	1.182168276	4.033805832	0.152781515	2.759575199	0.975957007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8758
H5826_011_0	2012	7																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	169.9314805	6.667634524	39.64750569	47.33715776	166.5110711	7.305455314	12.54137262	608.355977	1423.300621	10.60611382	21.96035522	0	0	0.256319964	6138.365221	3319.832877	357.5379572	816.7836384	38.09045399	855.8585456	22.56314652	2.902736015	0	9.852868117	216.4077952	2.5367486	0	0	36.25170114	0											1500	$500 copay/admit	$500 copay/admit	Days 21-55: $100/day; 3 day requirement waived	$0 copay/visit	$150 copay/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$50 copay/visit	0% coinsurance	15% coinsurance			20% coinsurance	$0 copay/visit	"$0 copay/visit for podiatry routine visits, OP surgery, and anesthesia; $20 copay/visit for all other"	$20 copay/visit	$20 copay/visit	"15% coinsurance for radiology, 0% coinsurance for lab"	$0 copay/visit for preventative; $20 copay/visit for all other	20% coinsurance	$20 copay/visit for Medicare covered eye exams and hearing exams; 20% coinsurance for Medicare covered eye wear; $0 copay/visit for all other		$0 copay/visit; $500 limit per year	$0 copay/visit; 1 visit per year	$0 copay/visit; $200 limit every 2 years			$0 copay/visit	$0 copay/visit; includes IP add'l days													500	500	222.2222222	0	150	0.2	0.114563891	49.32460933	50	0	0.15	0	0	0.2	0	15.22421026	20	20	0.088745833	1.931736253	0.2	0.1786732	0	0	0	0	0	0	0	0											YES	342.5	342.5	152.2222222	0	102.75	0.137	0.078476265	33.78735739	34.25	0	0.10275	0	0	0.137	0	10.42858403	13.7	13.7	0.060790896	1.323239334	0.137	0.122391142	0	0	0	0	0	0	0	0											2500	4.8501	0.190305402	0.502935952	0	1.425751046	1.000847378	0.984200084	1.712895068	4.062337191	0	2.256426499	0	0	0.035115835	0	2.885096343	0.408189168	0.932494654	2.315552816	0.094375474	3.091151074	0.355269175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1031			12.46345593	4.8501	0.190305402	0.502935952	0	1.425751046	1.000847378	0.984200084	1.712895068	4.062337191	0	2.256426499	0	0	0.035115835	0	2.885096343	0.408189168	0.932494654	2.315552816	0.094375474	3.091151074	0.355269175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1031	NO							25% coinsurance		25% coinsurance					25% coinsurance		25% coinsurance	25% coinsurance	25% coinsurance		25% coinsurance		25% coinsurance																				0	0	0	0	0	0	0	0	1.1728	0	0	0	0	0.0059	0	0.6564	0.0547	0.1416	0	0.0193	0	0.0641	0	0	0	0	0	0	0	0											2.1148			0.453763764	4.8501	0.190305402	0.502935952	0	1.425751046	1.000847378	0.984200084	1.712895068	5.235144214	0	2.256426499	0	0	0.040982714	0	3.541461331	0.46287727	1.074099804	2.315552816	0.113673461	3.091151074	0.419413877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2178
H5826_012_0	2012	4																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	195.05715	7.627795081	46.27703243	55.25248428	194.35367	8.71513619	14.96139059	715.4088968	1771.700432	12.6526989	26.19788614	0	0	0.339755748	7164.771692	4225.136141	446.3550059	1031.406361	45.44049341	1013.552996	26.91699372	367.3902567	0	12.25565386	280.6596779	3.362496257	0	0	47.0148996	0											2300	Days 1-10: $150/day	Days 1-10: $150/day	Days 21-55: $100/day; 3 day requirement waived	$0 copay/visit	$150 copay/trip	20% coinsurance	20% coinsurance for DME and prosthetics; 0% coinsurance for diabetes monitoring	"$50 copay/visit for emergency care, 20% coinsurance for emegency care (worldwide), $40 copay/visit for urgent care"	$150 copay/visit	0% coinsurance	15% coinsurance			20% coinsurance	$0 copay/visit	"$20 copay/visit for chiro; $0 copay/visit for podiatry routine visits, anesthesia, and OP surgery; $25 copay/visit for all other"	$25 copay/visit	$25 copay/visit	"15% coinsurance for radiology, 0% coinsurance for lab"	$0 copay/visit for preventative; $20 copay/visit for all other	20% coinsurance	$25 copay/visit for Medicare covered eye exams and hearing; 20% coinsurance for eye wear; $0 copay/visit for all other		0% coinsurance; $500 limit per year	$0 copay/visit; 1 exam per year	0% coinsurance; $270 limit per year			$0 copay/visit	$0 copay/visit; includes IP add'l days													742.0353982	975	222.2222222	0	150	0.2	0.114563891	49.25515548	150	0	0.15	0	0	0.2	0	18.6512831	25	25	0.088745833	2.574756414	0.2	25.87345941	0	0	0	0	0	0	0	0											NO	595.8544248	782.925	178.4444444	0	120.45	0.1606	0.091994804	39.55188985	120.45	0	0.12045	0	0	0.1606	0	14.97698033	20.075	20.075	0.071262904	2.067529401	0.1606	20.77638791	0	0	0	0	0	0	0	0												9.6855	0.497665955	0.688156612	0	1.950824963	1.399650872	1.376370199	2.357981157	17.78344309	0	3.155535385	0	0	0.054564773	0	5.273315072	0.746714729	1.725456891	3.23822152	0.174629218	4.322869192	0.636086874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.067			13.50957765	9.6855	0.497665955	0.688156612	0	1.950824963	1.399650872	1.376370199	2.357981157	17.78344309	0	3.155535385	0	0	0.054564773	0	5.273315072	0.746714729	1.725456891	3.23822152	0.174629218	4.322869192	0.636086874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.067	NO																																																																																		0				9.6855	0.497665955	0.688156612	0	1.950824963	1.399650872	1.376370199	2.357981157	17.78344309	0	3.155535385	0	0	0.054564773	0	5.273315072	0.746714729	1.725456891	3.23822152	0.174629218	4.322869192	0.636086874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.067
H5832_001_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1573.592028	100.507438	1032.202556	1094.198877	282.8491224	11.8001747	0	397.8994201	372.4471903	3121.960299	2517.858191	43.73834185	0.058515294	667.5227477	2419.330554	5917.653547	322.3281849	613.0042019	0	0	57.09390412	0.005428978	0	0	1099.408163	0	48.89219854	4.080565663	148.5221314	0											5000	$250/day 1-5; unlimited additional days	$250/day 1-5	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 to $40 per visit	$0 to $40 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$40 per visit	20% per visit	$0 to 200 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	153.2096852	96.85527186	58.48044118	0	200	0.03	0.03	62	200	4	16.51241388	40	0.2	40	10	40	40	20	40	40	0.1	0	0	0	0	0	0	0	0	0											NO	133.3427122	84.29587614	50.89717814	0	174.0656436	0.026109847	0	53.9603495	174.0656436	3.481312871	14.37121974	34.81312871	0.174065644	34.81312871	8.703282178	34.81312871	34.81312871	17.40656436	0	0	0.087032822	0	0	0	0	0	0	0	0	0												17.4856	0.706030212	4.378016447	0	4.102859543	0.30810075	0	1.789232648	5.402521656	0.905710048	3.015391111	0.126889044	0.010185502	1.936546278	1.754676374	17.16766955	0.935104382	0.889191424	0	0	4.969043582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8828	0	NO	10.55633808	17.4856	0.706030212	4.378016447	0	4.102859543	0.30810075	0	1.789232648	5.402521656	0.905710048	3.015391111	0.126889044	0.010185502	1.936546278	1.754676374	17.16766955	0.935104382	0.889191424	0	0	4.969043582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8828	NO																																																																																		0		NO		17.4856	0.706030212	4.378016447	0	4.102859543	0.30810075	0	1.789232648	5.402521656	0.905710048	3.015391111	0.126889044	0.010185502	1.936546278	1.754676374	17.16766955	0.935104382	0.889191424	0	0	4.969043582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8828
H5832_801_0	2012	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	0	0	0	0	0	0	0											0	YES	359.2052919	6.608060568	43.86375095	11.43355348	10.70557487	14.84347735	0	18.59523616	46.01544109	22.31415135	62.33737212	1.043444591	0.091128489	30.6220559	30.88119262	153.9630442	3.528749127	9.781648172	0	0	77.29500723	0.000402352	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	NO	0.087328359	0.087328359	0.186206897	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073385128	0.073385128	0.156476284	0	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0.188235174	0	0	0	0	0	0	0	0												26.3603	0.484933374	6.863636733	0	2.015165747	2.794064538	0	3.500277509	8.661724548	4.200308156	11.73408607	0.196412974	0.017153587	5.764148013	5.812926658	28.98126038	0.664234705	1.841250243	0	0	14.54963912	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4416	0	NO	23.64400336	26.3603	0.484933374	6.863636733	0	2.015165747	2.794064538	0	3.500277509	8.661724548	4.200308156	11.73408607	0.196412974	0.017153587	5.764148013	5.812926658	28.98126038	0.664234705	1.841250243	0	0	14.54963912	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4416	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		26.3603	0.484933374	6.863636733	0	2.015165747	2.794064538	0	3.500277509	8.661724548	4.200308156	11.73408607	0.196412974	0.017153587	5.764148013	5.812926658	28.98126038	0.664234705	1.841250243	0	0	14.54963912	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4416
H5832_802_0	2012	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	0	0	0	0	0	0	0											0	YES	358.96753	6.60368662	43.83471705	11.42598549	10.69848874	14.83365229	0	18.58292777	45.98498296	22.29938137	62.29611033	1.042753923	0.09106817	30.60178683	30.86075202	153.8611344	3.526413409	9.775173592	0	0	77.24384482	0.000402086	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	NO	0.08709373	0.08709373	0.186230632	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073179995	0.073179995	0.156479195	0	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0.188214684	0	0	0	0	0	0	0	0												26.2692	0.483257756	6.859221236	0	2.01361268	2.791911182	0	3.497579882	8.655049048	4.197071022	11.72504274	0.1962616	0.017140367	5.759705645	5.808446697	28.95892483	0.663722786	1.839831211	0	0	14.53842586	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2745	0	NO	23.62835314	26.2692	0.483257756	6.859221236	0	2.01361268	2.791911182	0	3.497579882	8.655049048	4.197071022	11.72504274	0.1962616	0.017140367	5.759705645	5.808446697	28.95892483	0.663722786	1.839831211	0	0	14.53842586	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2745	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		26.2692	0.483257756	6.859221236	0	2.01361268	2.791911182	0	3.497579882	8.655049048	4.197071022	11.72504274	0.1962616	0.017140367	5.759705645	5.808446697	28.95892483	0.663722786	1.839831211	0	0	14.53842586	7.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2745
H5850_002_0	2012	8																															D	D	D	V	T	O	O	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	0	0	0	0	0	0	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	(12) 0%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	$0 	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H5850_003_0	2012	8																															D	D	D	V	T	O	O	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	1643.231336	0	964.3472908	0	657.1214616	0	0	266.468792	259.175334	1999.408795	85.06882448	0	0.269532266	432.6543112	0	17106.23997	0	843.0776357	2436.801983	0	45.6105222	0	9.716656408	0	58.10924	0	0	0	0	0											3400	$50 copay (days 1-10) PBP L.1a	$0 	"(2) $35 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $100 @ Hospital; $50 ASC"	$0 	$50 (L.8a Diag @ Hosp); $75 (L.8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)	(9a) $100 copay	(12) 20%	"(7c,7i) $15 @ Hospital, (8b) $55 @ Hospital"	$0 	(7d) $0   (9a) $55	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	45.17612692	0	20.23452565	0	100	0	0	53.99470899	55.92635213	3.836495724	59.59697493	0	0.2	0.276876411	0	3.301157577	0	15	21.68346264	0	0.132014361	0	100	0	16.65470008	0	0	0	0	0											NO	39.55923175	0	17.71870109	0	87.56667392	0	0	47.28137076	48.9728464	3.359491701	52.1870887	0	0.175133348	0.242451464	0	2.890713891	0	13.13500109	18.98748702	0	0.115600585	0	87.56667392	0	14.58396691	0	0	0	0	0												5.4171	0	1.423915116	0	4.79516173	0	0	1.049917479	1.057712819	0.559749771	0.369957857	0	0.047204088	0.008741473	0	4.120770459	0	0.922818805	3.855728836	0	5.272603055	0	0.070904607	0	0.070621936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0429	0	NO	4.123711574	5.4171	0	1.423915116	0	4.79516173	0	0	1.049917479	1.057712819	0.559749771	0.369957857	0	0.047204088	0.008741473	0	4.120770459	0	0.922818805	3.855728836	0	5.272603055	0	0.070904607	0	0.070621936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0429	NO																																										0	0	0	0	0	0	0	0	0	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	5.4171	0	1.423915116	0	4.79516173	0	0	1.049917479	1.057712819	0.559749771	0.369957857	0	0.047204088	0.008741473	0	4.120770459	0	0.922818805	3.855728836	0	5.272603055	0	0.070904607	0	0.070621936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0429
H5850_004_0	2012	7																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	P	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	1201.383661	0	812.9124182	0	229.4621461	0	0	255.3024686	313.5226667	1946.564495	188.630605	0	0.002684712	350.9689202	0	19561.50078	0	778.0254386	2261.14472	2518.452567	37.12455202	0	9.716656408	0	0	0	0	0.000445411	0	0											6700	$95 copay (days 1-10) PBP L.1a	$0 	"(2) $50 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $150 @ Hospital; $100 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)"	(9a) $150 copay	(12) 20%	"(7c,7i) $15 @ Hospital, (8b) $55 @ Hospital"	$0 	"(7b,7g) $20; (7c,7i) $15; (7d) $10"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	85.4821175	0	26.03979114	0	97.62260785	0	0	33.50931677	113.556338	10.44557907	67.94108516	0	0.2	0.477881067	0	3.3924901	0	15	23.56557865	10.25175907	0.123484596	0	100	0	0	0	0	0.95981942	0	0											NO	83.30951979	0	25.37796862	0	95.14144968	0	0	32.65765016	110.6702111	10.18009616	66.21430709	0	0.194916837	0.46573533	0	3.306267199	0	14.61876277	22.96664025	9.991202251	0.120346134	0	97.45841847	0	0	0	0	0.935424827	0	0												8.3406	0	1.719172153	0	1.819280102	0	0	0.694798225	2.89146831	1.651351146	1.040837067	0	0.000523296	0.013621552	0	5.389629032	0	0.94781411	4.327574779	2.096864079	4.467796318	0	0.078914164	0	0	0	0	0.000416649	0	0	0	0	0	0	0	0	0	0	0	0	35.4806	0	NO	0.92528575	8.3406	0	1.719172153	0	1.819280102	0	0	0.694798225	2.89146831	1.651351146	1.040837067	0	0.000523296	0.013621552	0	5.389629032	0	0.94781411	4.327574779	2.096864079	4.467796318	0	0.078914164	0	0	0	0	0.000416649	0	0	0	0	0	0	0	0	0	0	0	0	35.4806	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.3406	0	1.719172153	0	1.819280102	0	0	0.694798225	2.89146831	1.651351146	1.040837067	0	0.000523296	0.013621552	0	5.389629032	0	0.94781411	4.327574779	2.096864079	4.467796318	0	0.078914164	0	0	0	0	0.000416649	0	0	0	0	0	0	0	0	0	0	0	0	35.4806
H5850_005_0	2012	7																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	COIN	V	V	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	1346.691149	0	1083.25902	0	297.871176	0	0	277.1272261	345.8042683	1794.342001	71.04778178	0	0.257334502	394.8659241	0	18324.999	0	795.1096003	2542.334595	1966.863706	45.36927391	0	0	2.06347947	0	0	0.008133308	2.86E-05	0	0											5000	$145 copay (days 1-10) PBP L.1a	$0 	"(2) $50 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $150 @ Hospital; $100 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)"	(9a) $150 copay	(12) 20%	"(7c,7i) $25 @ Hospital, (8b) $55 @ Hospital"	$0 	"(7b) $20; (7c,7d,7g,7i) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	129.9402108	0	26.06777863	0	100	0	0	49.63883048	112.5051711	5.639159003	31.00518293	0	0.2	1.346995698	0	6.36178717	0	25	22.46130848	23.7863883	0.117482568	0	0	0.187000047	0	0	0.000393998	0.95981942	0	0											NO	120.058606	0	24.08539393	0	92.395268	0	0	45.86393045	103.9494543	5.210316074	28.64732186	0	0.184790536	1.244560285	0	5.877990305	0	23.098817	20.75318617	21.97749721	0.108548334	0	0	0.172779195	0	0	0.000364036	0.886827725	0	0												13.4735	0	2.174226685	0	2.293490595	0	0	1.059178652	2.99551375	0.779090748	0.169610723	0	0.047552981	0.040952871	0	8.97618054	0	1.530507596	4.396795262	3.602228469	4.924759078	0	0	0.356526321	0	0	2.96E-06	2.54E-05	0	0	0	0	0	0	0	0	0	0	0	0	46.8201	0	NO	3.858389746	13.4735	0	2.174226685	0	2.293490595	0	0	1.059178652	2.99551375	0.779090748	0.169610723	0	0.047552981	0.040952871	0	8.97618054	0	1.530507596	4.396795262	3.602228469	4.924759078	0	0	0.356526321	0	0	2.96E-06	2.54E-05	0	0	0	0	0	0	0	0	0	0	0	0	46.8201	NO																																										0	0	0	0	0	0	0	0	0	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	13.4735	0	2.174226685	0	2.293490595	0	0	1.059178652	2.99551375	0.779090748	0.169610723	0	0.047552981	0.040952871	0	8.97618054	0	1.530507596	4.396795262	3.602228469	4.924759078	0	0	0.356526321	0	0	2.96E-06	2.54E-05	0	0	0	0	0	0	0	0	0	0	0	0	46.8201
H5850_006_0	2012	7																															D	D	D	V	T	O	O	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	0	0	181.7639162	0	357.6719597	0	0	241.6663425	0	0	0	0	0.019926403	0	0	0	0	0	0	0	17.02389183	0	9.716656408	0	0	0	0	0	0	0											3400	$0 	$0 	(2) $50 days 6-100	$0 	(10a) $50	$0 	$0 	(4a) $65	$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%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0	0	29.31209024	0	50	0	0	49.96327003	0	0	0	0	0.2	0	0	0	0	0	0	0	0.170269484	0	50	0	0	0	0	0	0	0											NO	0	0	29.31209024	0	50	0	0	49.96327003	0	0	0	0	0.2	0	0	0	0	0	0	0	0.170269484	0	50	0	0	0	0	0	0	0												0	0	0.443990026	0	1.490299832	0	0	1.006203394	0	0	0	0	0.003985281	0	0	0	0	0	0	0	2.898649272	0	0.040486068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8836	0	NO	-1.18E-15	0	0	0.443990026	0	1.490299832	0	0	1.006203394	0	0	0	0	0.003985281	0	0	0	0	0	0	0	2.898649272	0	0.040486068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8836	NO																																										0	0	0	0	0	0	0	0	0	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	0.443990026	0	1.490299832	0	0	1.006203394	0	0	0	0	0.003985281	0	0	0	0	0	0	0	2.898649272	0	0.040486068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8836
H5850_007_0	2012	8																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	COIN	V	V	COIN	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	1488.736906	0	1068.931666	0	352.7848713	0	0	153.8340419	388.700007	1942.583357	106.6311636	0	0.388800283	564.3074402	0	22025.48791	0	837.8256914	3190.025706	2388.548858	46.15271672	0	0	2.065672729	0	0	0.002247317	0	0	0											3400	$95 copay (days 1-10) PBP L.1a	$0 	"(2) $10 days 1-7, $25 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $100 @ Hospital; $50 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $10 (L.8b MRI/CT @ freest.); $25 (L.8b Therapy @ freest.)"	(9a) $100 copay	(12) 20%	"(7c,7i) $20 @ Hospital, (8b) $55 @ Hospital"	$0 	"(7b,7d) $15; (7c,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	85.38715922	0	21.79449479	0	100	0	0	53.23045267	53.90879479	4.812894442	11.85266028	0	0.027798077	0.168275799	0	4.415188565	0	20	25.81032517	14.81272267	0.152963962	0	0	0.187000047	0	0	0.004111277	0	0	0											NO	75.89200417	0	19.3709207	0	88.87987943	0	0	47.31116216	47.91407181	4.277694777	10.53463017	0	0.024706897	0.149563327	0	3.924214273	0	17.77597589	22.94018589	13.16553005	0.135954185	0	0	0.166205416	0	0	0.003654098	0	0	0												9.4153	0	1.725515877	0	2.612956402	0	0	0.606505608	1.552016671	0.692481557	0.093609989	0	0.009606049	0.007033308	0	7.202727835	0	1.241097441	6.098315225	2.620542647	6.274655004	0	0	0.343325996	0	0	8.21E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4957	0	NO	5.066576371	9.4153	0	1.725515877	0	2.612956402	0	0	0.606505608	1.552016671	0.692481557	0.093609989	0	0.009606049	0.007033308	0	7.202727835	0	1.241097441	6.098315225	2.620542647	6.274655004	0	0	0.343325996	0	0	8.21E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4957	NO																																										0	0	0	0	0	0	0	0	0	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	9.4153	0	1.725515877	0	2.612956402	0	0	0.606505608	1.552016671	0.692481557	0.093609989	0	0.009606049	0.007033308	0	7.202727835	0	1.241097441	6.098315225	2.620542647	6.274655004	0	0	0.343325996	0	0	8.21E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4957
H5850_012_0	2012	7																															D	D	D	V	T	O	O	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	1795.413429	0	0	0	0	0	0	310.4341413	0	0	0	0	1.264668635	0	0	0	0	0	0	0	33.01516858	0	0	0	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%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	0.266335227	0	0	0	0	0	0	38.13654546	0	0	0	0	0.057066746	0	0	0	0	0	0	0	0.162825721	0	0	0	0	0	0	0	0	0											NO	0.266335227	0	0	0	0	0	0	38.13654546	0	0	0	0	0.057066746	0	0	0	0	0	0	0	0.162825721	0	0	0	0	0	0	0	0	0												0.0398	0	0	0	0	0	0	0.986573812	0	0	0	0	0.072170523	0	0	0	0	0	0	0	5.375718638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4743	0	NO	-2.37E-15	0.0398	0	0	0	0	0	0	0.986573812	0	0	0	0	0.072170523	0	0	0	0	0	0	0	5.375718638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4743	NO																																										0	0	0	0	0	0	0	0	0	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	0.0398	0	0	0	0	0	0	0.986573812	0	0	0	0	0.072170523	0	0	0	0	0	0	0	5.375718638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4743
H5850_020_0	2012	7																															D	D	D	V	T	O	O	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	1592.565831	0	728.9400921	0	201.9293262	0	0	363.5593179	444.4677367	2372.087612	352.1099426	0	0.042126351	344.8538833	0	0	0	1384.262723	3079.372107	0	29.96180595	0	9.716656408	0	0	0	0	0	0	0											3400	$50 copay (days 1-5) PBP L.1a	$0 	"(2) $25 days 8-20, $100 days 21-100"	$0 	(10a) $50	$0 	$0 	(4a) $65	"(9a,9b) $50 @ Hospital; $25 ASC"	$0 	"$25 (L.8a Diag @ Hosp); $50 (L.8b MRI/CT, 8b Therapy @ Hosp); $10 (L.8b Therapy @ freest.)"	(9a) $50 copay	(12) 20%	"(7c,7i) $15 @ Hospital, (8b) $50 @ Hospital"	$0 	"(7c,7i) $15"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	35.52650546	0	16.54093495	0	50	0	0	49.45420159	16.74530856	2.366247251	46.33423587	0	0.2	1.34122695	0	0	0	13.75299985	26.14691592	0	0.160913246	0	50	0	0	0	0	0	0	0											NO	34.42496923	0	16.02806607	0	48.44969803	0	0	47.92082266	16.22610286	2.292879295	44.89759472	0	0.193798792	1.299640814	0	0	0	13.32657379	25.33620362	0	0.155923964	0	48.44969803	0	0	0	0	0	0	0												4.5687	0	0.973624996	0	0.815284573	0	0	1.451838467	0.600998268	0.453242548	1.317407459	0	0.008164036	0.037348848	0	0	0	1.537289943	6.501633227	0	4.67176354	0	0.039230756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9765	0	NO	0.735205961	4.5687	0	0.973624996	0	0.815284573	0	0	1.451838467	0.600998268	0.453242548	1.317407459	0	0.008164036	0.037348848	0	0	0	1.537289943	6.501633227	0	4.67176354	0	0.039230756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9765	NO																																										0	0	0	0	0	0	0	0	0	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	4.5687	0	0.973624996	0	0.815284573	0	0	1.451838467	0.600998268	0.453242548	1.317407459	0	0.008164036	0.037348848	0	0	0	1.537289943	6.501633227	0	4.67176354	0	0.039230756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9765
H5850_021_0	2012	7																															D	D	D	V	T	O	O	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	1918.962397	0	0	0	0	0	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	(12) 0%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	$0 	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	Not covered	(14c) $0	$0 												NO	0.009119045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0.009119045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.0015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0015	0	NO	0	0.0015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0015	NO																																										0	0	0	0	0	0	0	0	0	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	0.0015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0015
H5850_022_0	2012	7																															D	D	D	V	T	O	O	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	COIN	V	V	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	1066.41421	0	612.1065605	0	426.6266177	0	0	176.1586159	176.6195785	1381.026122	57.18374054	0	0.174632119	288.0431755	0	11404.73115	136.9948534	568.9343444	1620.102202	1210.086006	33.0111039	0	0	2.033149582	0	0	0.044722144	0.393050672	0	0											6700	$145 copay (days 1-10) PBP L.1a	$0 	"(2) $10 days 1-7, $50 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $150 @ Hospital; $50 ASC"	$0 	"$150 (L.8a Diag, 8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $25 (L.8a Diag, 8b MRI/CT, 8b Therapy @ freest.)"	(9a) $200 copay	(12) 20%	"(7c,7i) $25 @ Hospital, (8b) $55 @ Hospital"	$0 	"(7b,7d,7g) $20; (7c,7i) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	130.4922352	0	31.4885668	0	100	0	0	63.34181078	62.67305644	11.13895795	97.69355349	0	0.2	0.559333786	0	6.297090352	1.854874283	16.72956059	22.76433436	19.92420935	0.120012223	0	0	0.181405896	0	0	0.976525122	0.962962963	0	0											NO	122.337128	0	29.52069004	0	93.75050387	0	0	59.38326677	58.75630621	10.4428292	91.58819864	0	0.187501008	0.524378242	0	5.903553935	1.738953987	15.68404735	21.34167816	18.67904666	0.112512064	0	0	0.170068941	0	0	0.915497222	0.90278263	0	0												10.8718	0	1.505817337	0	3.333038365	0	0	0.871739507	0.864792836	1.201818327	0.436446316	0	0.032743698	0.012586965	0	5.610703789	0.019852312	0.743599433	2.881308316	1.883604414	3.71414742	0	0	0.345775597	0	0	0.040942998	0.35483932	0	0	0	0	0	0	0	0	0	0	0	0	34.7256	0	NO	2.318734395	10.8718	0	1.505817337	0	3.333038365	0	0	0.871739507	0.864792836	1.201818327	0.436446316	0	0.032743698	0.012586965	0	5.610703789	0.019852312	0.743599433	2.881308316	1.883604414	3.71414742	0	0	0.345775597	0	0	0.040942998	0.35483932	0	0	0	0	0	0	0	0	0	0	0	0	34.7256	NO																																										0	0	0	0	0	0	0	0	0	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	10.8718	0	1.505817337	0	3.333038365	0	0	0.871739507	0.864792836	1.201818327	0.436446316	0	0.032743698	0.012586965	0	5.610703789	0.019852312	0.743599433	2.881308316	1.883604414	3.71414742	0	0	0.345775597	0	0	0.040942998	0.35483932	0	0	0	0	0	0	0	0	0	0	0	0	34.7256
H5850_023_0	2012	6																															D	D	D	V	T	O	O	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	0	0	0	0	0	0	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	(12) 0%	$0 	$0 	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	$0 	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H5850_024_0	2012	7																															D	D	D	V	T	O	O	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	1483.092844	0	794.236366	0	398.4905185	0	0	136.6623802	203.1586982	0	147.5487084	0	1.173446407	430.712993	0	19025.27111	191.235382	786.2778799	1957.036255	2033.51813	0	0	0	0	0	0	0	0	0	0											3400	$95 copay (days 1-10) PBP L.1a	$0 	"(2) $15 days 1-7, $35 days 8-20, $75 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $100 @ Hospital; $50 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $15 (L.8a Diag, 8b MRI/CT @ freest.); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)"	(9a) $150 copay	(12) 20%	"(7c,7i) $20; (8b) $25 @ freest.; (8b) $55 @ Hospital"	$0 	"(7c,7i) $20; (7d) $15"	$0 	(7c) Included in i.2.	(7d) Included in i.2.	(7g) Included in i.2.	(15) 20%	$0 	(10b) Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	85.45005942	0	26.72938423	0	100	0	0	37.60089686	59.45072698	0	69.24996283	0	0.2	1.805912634	0	2.715333553	3.565560212	13.04408118	22.01031208	13.8749172	0	0	0	0	0	0	0	0	0	0											NO	76.99517583	0	24.08463672	0	90.10546787	0	0	33.88046404	53.56835569	0	62.39800301	0	0.180210936	1.627226028	0	2.446664002	3.212764711	11.75343037	19.83249467	12.50205906	0	0	0	0	0	0	0	0	0	0												9.5159	0	1.594074529	0	2.992181217	0	0	0.385848738	0.906906451	0	0.767228729	0	0.211467875	0.058405616	0	3.879037162	0.051199524	0.77012186	3.234409258	2.11859698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4854	0	NO	2.908376034	9.5159	0	1.594074529	0	2.992181217	0	0	0.385848738	0.906906451	0	0.767228729	0	0.211467875	0.058405616	0	3.879037162	0.051199524	0.77012186	3.234409258	2.11859698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4854	NO	Not covered	$0 	"(2) $35 days 1-20, $100 days 21-100"	"20% coinsurance, $20k"	Not covered	"20% coinsurance, $20k"	"20% coinsurance, $20k"	(4a) $65	"(9a,9b) $250 @ Hospital"	"20% coinsurance, $20k"	"$150 (L.8a Diag, 8b MRI/CT @ Hosp); $25 (L.8a Diag, 8b MRI/CT @ freest.); (8a,8b) Therapy not covered."	(9a) $250 copay	"20% coinsurance, $20k"	(9d) 20%	$0 	"(7b,7d) $30; (7g) 20%, $20k; (7c,7i) Not covered"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	Not covered	$0 	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												0.9183	0	0.226	0.0144	0.2818	0.024	0.3312	0.0372	0.2818	0.0601	0.0424	0	0.0204	0.0056	0	0.967	0	0.0129	0.2607	0.3537	0	0	0	0	0	0	0	0	0	0											3.8378	0	NO	0	10.4343	0	1.820079495	0.014434786	3.274012854	0.024038549	0.331217681	0.423085174	1.188734384	0.060139754	0.809596042	0	0.231875639	0.064042066	0	4.846079496	0.051199524	0.783050471	3.495105283	2.472249413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3232
H5850_025_0	2012	7																															D	D	D	V	T	O	O	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	1612.956672	0	859.5996633	0	439.2630657	0	0	157.1160308	218.0601414	0	0	0	1.459758945	468.1384149	0	19642.98991	190.79072	789.8507739	0	2170.019853	0	0	0	0	0	0	0	0	0	0											3400	$95 copay (days 1-10) PBP L.1a	$0 	"(2) $50 days 8-20, $100 days 21-100"	$0 	(10a) $100	$0 	$0 	(4a) $65	"(9a,9b) $150 @ Hospital; $50 ASC"	$0 	"$100 (L.8a Diag, 8b MRI/CT @ Hosp); $55 (L.8b Therapy @ Hosp); $25 (L.8b Therapy @ freest.)"	(9a) $150 copay	(12) 20%	"(7c,7i) $15 @ Hospital, (8b) $55 @ Hospital"	$0 	"(7c,7d,7i) $15; (7g) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	$0 	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	85.45005942	0	26.03979114	0	100	0	0	37.60089686	38.28756058	0	0	0	0.2	0.361204039	0	3.890771699	3.565560212	9.790762939	0	15.29143599	0	0	0	0	0	0	0	0	0	0											NO	77.42422574	0	23.594023	0	90.60757391	0	0	34.06926041	34.69142975	0	0	0	0.181215148	0.327278216	0	3.525333843	3.230667604	8.871172766	0	13.85519916	0	0	0	0	0	0	0	0	0	0												10.4068	0	1.690117853	0	3.316713391	0	0	0.446068914	0.630401506	0	0	0	0.264530433	0.012767625	0	5.77067476	0.051365117	0.583908556	0	2.50550477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6789	0	NO	2.669490667	10.4068	0	1.690117853	0	3.316713391	0	0	0.446068914	0.630401506	0	0	0	0.264530433	0.012767625	0	5.77067476	0.051365117	0.583908556	0	2.50550477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6789	NO																																										0	0	0	0	0	0	0	0	0	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	10.4068	0	1.690117853	0	3.316713391	0	0	0.446068914	0.630401506	0	0	0	0.264530433	0.012767625	0	5.77067476	0.051365117	0.583908556	0	2.50550477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6789
H5850_026_0	2012	8																															D	D	D	V	T	O	O	V	V	O	COIN	O	COIN	O	P	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	983.1134086	0	176.1943974	0	340.9586077	0	0	221.6040982	268.3146927	1783.109678	3.461828318	0	0.018237135	0	0	85.88585275	0	743.8723362	12.84944883	1141.888207	16.00963708	0	0	0	0	0	0	0	0	0											3400	$175 copay (days 1-10) PBP L.1a	$0 	"(2) $50 days 8-20, $100 days 21-100"	$0 	(10a) $150	$0 	$0 	(4a) $65	"(9a,9b) $200 @ Hospital; $100 ASC"	$0 	"$200 (L.8a Diag, 8b MRI/CT @ Hosp); $25 (L.8a Diag, 8b MRI/CT @ freest.); 20% L.8b Therapy"	(9a) $200 copay	(12) 20%	"(7c,7i) $25 @ Hospital, (8b) 20% @ Hospital"	$0 	"(7c,7d,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20%	$0 	Not covered	$0 	(17a) $0	(17b) $0	(18a) $0	(18b) $0	(14c) $0	$0 												NO	156.787156	0	26.06777863	0	150	0	0	49.96289891	120.696325	11.59163814	0.243248522	0	0.2	0	0	0.066417318	0	24.94729459	0.161679095	20.4193175	0.15158903	0	0	0	0	0	0	0	0	0											NO	132.6916541	0	22.0616073	0	126.9475678	0	0	42.28445664	102.147366	9.810201791	0.205865388	0	0.169263424	0	0	0.056210113	0	21.11332248	0.136831786	17.28121795	0.128292391	0	0	0	0	0	0	0	0	0												10.8709	0	0.323927634	0	3.60698883	0	0	0.780867407	2.283969926	1.457722146	0.71267063	0	0.00308688	0	0	4.82765353	0	1.308801376	1.758213033	1.644434914	2.053914621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.6332	0	NO	5.744271885	10.8709	0	0.323927634	0	3.60698883	0	0	0.780867407	2.283969926	1.457722146	0.71267063	0	0.00308688	0	0	4.82765353	0	1.308801376	1.758213033	1.644434914	2.053914621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.6332	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	"(7d) 30%, $5k"	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	0.0814	0	0	0	0.1513	0	0	0	0	0	0	0	0	0	0											0.2328	0	NO	0	10.8709	0	0.323927634	0	3.60698883	0	0	0.780867407	2.283969926	1.457722146	0.71267063	0	0.00308688	0	0	4.909098228	0	1.308801376	1.758213033	1.795781119	2.053914621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.866
H5850_802_0	2012	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	283.4947986	2.470491908	22.32285548	0	10.65974998	6.171602761	14.6323356	11.30246196	23.64801922	4.48793737	3.856735409	2.047628647	0.470991612	31.94367215	117.1277333	160.9006601	0.872659299	3.217867334	24.21035101	18.1876257	37.49105762	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												NO	0.081711212	0.081711212	0.167301435	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.063261371	0.063261371	0.129525898	0	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0	0	0	0	0	0	0	0	0											10000	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	0	NO	29.95295078	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	NO																																										0	0	0	0	0	0	0	0	0	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	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036
H5850_803_0	2012	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	283.4947986	2.470491908	22.32285548	0	10.65974998	6.171602761	14.6323356	11.30246196	23.64801922	4.48793737	3.856735409	2.047628647	0.470991612	31.94367215	117.1277333	160.9006601	0.872659299	3.217867334	24.21035101	18.1876257	37.49105762	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												NO	0.081711212	0.081711212	0.167301435	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.063261371	0.063261371	0.129525898	0	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0	0	0	0	0	0	0	0	0											10000	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	0	NO	29.95295078	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	NO																																										0	0	0	0	0	0	0	0	0	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	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036
H5850_805_0	2012	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	283.4947986	2.470491908	22.32285548	0	10.65974998	6.171602761	14.6323356	11.30246196	23.64801922	4.48793737	3.856735409	2.047628647	0.470991612	31.94367215	117.1277333	160.9006601	0.872659299	3.217867334	24.21035101	18.1876257	37.49105762	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												NO	0.081711212	0.081711212	0.167301435	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.063261371	0.063261371	0.129525898	0	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0.17342231	0	0	0	0	0	0	0	0	0											10000	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	0	NO	29.95295078	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036	NO																																										0	0	0	0	0	0	0	0	0	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	17.9343	0.156286705	2.891387909	0	1.848638464	1.070293606	2.537573438	1.96009906	4.101094116	0.778308465	0.668843963	0.35510449	0.081680453	5.539745409	20.31256205	27.90376412	0.151338591	0.558049986	4.198614995	3.15414006	6.501785812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7036
H5852_001_0	2012	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	NO	2584.473513	415.7452139	1219.789605	9819.493705	869.5051363	12.76740647	7.843991176	898.7097057	1638.138947	1637.577077	1083.231974	141.3544051	15.69665333	3375.840792	10589.89717	11513.52021	2010.627491	1070.149571	4595.562518	11248.96527	19.13672183	0	103.2427133	1028.843437	0	745.5116454	0	7.508560967	6320.177969	0												1a1: $0	1b1: $0	21: $0	6: $0	10a: $0	11a: $0	"11b1: $0,11b2: $0,17b1: $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"	9c1: $0	12: $0	"31: $0,5: $0,9a2: $0,9a3:"	"7a: $0,14a1-16: $0"	"7b1: $0,7d1: $0,7f1: $0,16b1: $0,17a1: $0,18a1: $0"	"7c: $0,7i: $0"	"7e1: $0,7h1: $0"	7d2:	7g: $0	"152: $0,153: $0"	$0 	10b: $0	"16a1: $0 limited to $1250 every year,16a2: $0 limited to $1250 every year,16a3: $0 limited to $1250 every year,16b2: $0  Covered under 16a"	17a2: $0	17b2: $0 limited to Max cov combined for all supp($100)	18a2: $0	18b1: $0 limited to $400 every year	n/a	n/a												NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	#DIV/0!	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_005_0	2012	10	H.6										OP Facility - Other										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	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	YES	1056.381681	60.31590094	740.6091382	1561.436259	173.7493647	5.298023417	6.029644305	205.8021729	255.8316656	12411.07014	343.1605547	0.815062473	0.072371765	309.9987278	3316.10505	3380.972631	2.675657319	1327.788344	1084.425102	3108.273835	20.02631363	8.126069392	0.041317322	0	0	0	0	0	5872.8	417.8175374	19.24165123	0	0	0	0	0	0	0	0	0	5400	1A: $250/day (days1-7) no yrly max	1B: $205/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: $65 copay; 4B: $25-$45 copay	9A: $0 - $300 copay; 9B: $0-$300 copay	8A: $0 copay	8B: $200 copay	5: $40 copay	12: 10% coin	3: $0 copay; 9A: $45 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $45 copay; 7I: $45 copay	8B: $50 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: Not Covered: 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	185.7105336	138.6500657	50	0	225	0.2	0.2	59.87369534	239.9036669	0	200	40	0.1	41.10075819	25	42.61826562	40	45	50	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	177.7303184	132.692098	47.85143712	0	215.331467	0.191405748	0.191405748	57.30084736	229.5947046	0	191.4057485	38.2811497	0.095702874	39.33460692	23.92571856	40.78690515	38.2811497	43.06629341	47.85143712	0	0.191405748	0	0	0	0	0	0	0	0	0	0.191405748	0	0	0	0	0	0	0	0	0		15.6459	0.66695362	2.953267634	0	3.1178088	1.014072138	1.154108581	0.982719908	4.894799643	0	5.473575235	0.002600127	0.006926186	1.016139842	6.611683011	11.4916175	0.008535603	4.765243534	4.324274966	0	3.83315155	0	0	0	0	0	0	0	0	0	3.682962656	0	0	0	0	0	0	0	0	0	71.6464		NO	3.216971575	15.6459	0.66695362	2.953267634	0	3.1178088	1.014072138	1.154108581	0.982719908	4.894799643	0	5.473575235	0.002600127	0.006926186	1.016139842	6.611683011	11.4916175	0.008535603	4.765243534	4.324274966	0	3.83315155	0	0	0	0	0	0	0	0	0	3.682962656	0	0	0	0	0	0	0	0	0	71.6464	NO																								16A: OSB	17A: OSB	17B: OSB	N/A	N/A														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	0	15.6459	0.66695362	2.953267634	0	3.1178088	1.014072138	1.154108581	0.982719908	4.894799643	0	5.473575235	0.002600127	0.006926186	1.016139842	6.611683011	11.4916175	0.008535603	4.765243534	4.324274966	0	3.83315155	0	0	0	0	0	0	0	0	0	3.682962656	0	0	0	0	0	0	0	0	0	71.6464
H5854_801_0	2012	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	313.5525966	3.645541816	141.0406834	0	11.89248686	16.25231309	10.12520591	20.55820598	58.2673593	10.40410906	27.48340322	0	0.300102127	25.86052753	43.5954949	85.09766137	2.040544756	7.847901815	33.55719593	114.4424045	59.40225358	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.068594244	0.068594244	0.152783925	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.053002927	0.053002927	0.118056483	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0	0	0	0	0	0	0	0												16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	0	NO	36.6820384	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	NO																																										0	0	0	0	0	0	0	0	0	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	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012
H5854_803_0	2012	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	313.5525966	3.645541816	141.0406834	0	11.89248686	16.25231309	10.12520591	20.55820598	58.2673593	10.40410906	27.48340322	0	0.300102127	25.86052753	43.5954949	85.09766137	2.040544756	7.847901815	33.55719593	114.4424045	59.40225358	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.068594244	0.068594244	0.152783925	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.053002927	0.053002927	0.118056483	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0	0	0	0	0	0	0	0												16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	0	NO	36.6820384	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	NO																																										0	0	0	0	0	0	0	0	0	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	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012
H5854_805_0	2012	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	313.5525966	3.645541816	141.0406834	0	11.89248686	16.25231309	10.12520591	20.55820598	58.2673593	10.40410906	27.48340322	0	0.300102127	25.86052753	43.5954949	85.09766137	2.040544756	7.847901815	33.55719593	114.4424045	59.40225358	0	0	0	0	0	0	0	0	0											6700	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing	Similar to Medicare-FFS Cost Sharing																			0	NO	0.068594244	0.068594244	0.152783925	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.053002927	0.053002927	0.118056483	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0.173085304	0	0	0	0	0	0	0	0	0												16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	0	NO	36.6820384	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012	NO																																										0	0	0	0	0	0	0	0	0	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	16.6192	0.193224387	16.65076707	0	2.058414708	2.813036559	1.752524347	3.55832334	10.08522362	1.800798384	4.756973213	0	0.051943268	4.47607728	7.545739505	14.72915462	0.35318831	1.358356475	5.808257472	19.80829843	10.28165714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7012
H5859_001_0	2012	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	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	329.6962618	47.41782074	42.06607226	40.74972703	26.62662555	51.01328912	8.918052087	80.98560069	45.93915482	18.21344846	34.84979441	0	0.099176814	27.7224821	37.14023494	114.057823	4.198779304	1.049225509	16.22975895	2.396023517	15.02117718	0.299221184	0	0	414.5324598	1.647709269	0	0	1.269880814	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 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	0.079432289	0.079432289	0.14182569	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.079432289	0.079432289	0.14182569	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												26.1885	3.766506018	5.966049742	0	5.964364124	11.42697676	1.997643668	18.14077456	10.29037068	4.079812454	7.806353947	0	0.022215606	6.209835989	8.319412627	25.54895235	0.940526564	0.235026514	3.635466005	0.536709268	3.364743689	0.067025545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.5073	0	NO	-0.000332374	26.1885	3.766506018	5.966049742	0	5.964364124	11.42697676	1.997643668	18.14077456	10.29037068	4.079812454	7.806353947	0	0.022215606	6.209835989	8.319412627	25.54895235	0.940526564	0.235026514	3.635466005	0.536709268	3.364743689	0.067025545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.5073	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.	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	0.4082	1.2327	0	0	0	0.0299	0	0	0	0	0	0	0	0	0	0											1.6708	0	NO	-3.84E-06	26.1885	3.766506018	5.966049742	0	5.964364124	11.42697676	1.997643668	18.14077456	10.29037068	4.079812454	7.806353947	0	0.022215606	6.209835989	8.727644402	26.78169354	0.940526564	0.235026514	3.635466005	0.566571678	3.364743689	0.067025545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1781
H5859_003_0	2012	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	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	986.0475408	140.9347281	1078.597091	22.31541119	242.1011016	21.78966028	7.318663352	555.7453747	38.52347028	4795.487176	41.52985697	0.06887834	0.282589797	26.57038926	8768.365974	11067.88404	624.6642205	1011.099948	1891.779143	2404.347832	22.02040383	0.06300087	0	0.070126132	346.7054666	426.5225525	0	0.072980384	89.76679126	0											6700	1a1: $300 days 1-5;$0 days 6-90	1b1: $275 days 1-5;$0 days 6-90	2: $0 days 1-20;$100 days 21-100	6: $0	10a: $200	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%, 11c1: 0%,11c2: 0%"	"4a1: $50,4b: $25"	"9a1: 20.0%,9b: 20.0%"	"8a1: $0, 8a2: 0"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	9c1: 20.0%	12: 20.0%	"5: 20.0%,9a2: 20.0%, 3: $30"	"7a: $10 per visit, Ip visit and ER visit no copay, 14a: $0"	"7b1: 20.0%,7d1: $30, IP visit and ER visit no copay,7f1: $30,7f2: $30,16b1: 20.0%,18a1: $20, copay per visit"	"7e1: $30,7h1: $30"	"7c: $30,7i: $30"	7d2: $0	7g: $30	15: 20.0%	$0 	$0 	$0 	17a2: $20	$0 	$0 	$0 	$0 	$0 											0	NO	233.6240224	181.9702239	10.11302098	0	200	0.2	0.152679783	48.7031179	0.2	0	0.2	0.2	0.2	0.179231333	6.906755506	19.03930015	30	30	0	30	0.2	0	0	0	20	0	0	0	0	0											NO	223.9089953	174.4031696	9.692480871	0	191.6831951	0.191683195	0.146330743	46.67784625	0.191683195	0	0.191683195	0.191683195	0.191683195	0.171778173	6.619544815	18.25566387	28.75247926	28.75247926	0	28.75247926	0.191683195	0	0	0	20	0	0	0	0	0												18.3987	2.048288608	0.871190139	0	3.867226056	4.176711702	1.070945449	2.161749763	7.384301868	0	7.960575675	0.01320282	0.054167715	4.564212916	4.836882626	16.83763089	1.49672042	2.422635856	0	5.760913431	4.220941363	0	0	0	0.577842444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7249	0	NO	3.8167592	18.3987	2.048288608	0.871190139	0	3.867226056	4.176711702	1.070945449	2.161749763	7.384301868	0	7.960575675	0.01320282	0.054167715	4.564212916	4.836882626	16.83763089	1.49672042	2.422635856	0	5.760913431	4.220941363	0	0	0	0.577842444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7249	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: $10 per visit, Ip visit and ER visit no copay, 14a: $0"	"7b1: 20.0%,7d1: $30, IP visit and ER visit no copay,7f1: $30,7f2: $30,16b1: 20.0%,18a1: $20, copay per visit"	No OON Coverage	No OON Coverage	No OON Coverage	7g: $30	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	0.2703	0.9332	0	0	0	0.3411	0	0	0	0	0	0	0	0	0	0											1.5446	0	NO	0.066445334	18.3987	2.048288608	0.871190139	0	3.867226056	4.176711702	1.070945449	2.161749763	7.384301868	0	7.960575675	0.01320282	0.054167715	4.564212916	5.107180841	17.77085013	1.49672042	2.422635856	0	6.1019929	4.220941363	0	0	0	0.577842444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2695
H5868_001_0	2012	8	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	904.82	55.94	389.45	573.1	16.89	11	3.67	278.2	276.29	1456.32	679.57	127.72	1.38	590.31	2930.66	3743.97	130.12	801.54		1870.09	20.04	0			0.61				5.09	0.95	726.53	0									4000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	250	28.36732	34.001416	32.319588	0.2	50	10	26.657531	30	36.322634		0	0.2	0			0				0	0	0	0									NO	149.38335	104.945107	31.481204	0	92.0103	0.184021	0.184021	59.806695	230.02575	26.100856	31.284805	29.737349	0.184021	46.00515	9.20103	24.527674	27.60309	33.420565		0	0.184021	0			0				0	0	0	0										11.2638	0.489219107	1.021696241	0	0.129504497	2.024231	0.67535707	1.386518546	5.296151206	3.167599884	1.771684578	0.316504518	0.25394898	2.263108341	2.247090882	7.652572969	0.299309506	2.232326639	0	0	3.68778084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1784	0	NO	5.719219	11.2638	0.489219107	1.021696241	0	0.129504497	2.024231	0.67535707	1.386518546	5.296151206	3.167599884	1.771684578	0.316504518	0.25394898	2.263108341	2.247090882	7.652572969	0.299309506	2.232326639	0	0	3.68778084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1784	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	3.9189	0.0679	0.3243	1.0511	0.8298	0.6214	0.2071	0.1268	1.5514	0.2573	0.3724	0.0319	0.0235	0.4637	0.8202	1.0478	0.0364	0.1996		0.5234	0.5455	0			0				0	0	0.0646	0									13.0849	0	NO	5.615217	15.1826	0.557136107	1.345995241	1.051104	0.959289497	2.645602	0.88248107	1.513360546	6.847561206	3.424860884	2.144042578	0.348369518	0.27748598	2.726767341	3.067288882	8.700390969	0.335725506	2.431887639	0	0.52338	4.23330484	0	0	0	0	0	0	0	0	0	0.06458	0	0	0	0	0	0	0	0	0	59.2632
H5868_004_0	2012	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			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	902.11	18.91	462.9	807.58	18.9	5.46	1.89	279.21	230.62	814.99	577.44	51.61	0.18	478.67	1885.72	2908.16	35.73	481.97		949.03	9.46	0			0.61				5.09	0.95	557.68	0									4000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	250	37.614806	39.142343	33.825208	0.2	50	10	27.484219	30	35.023088		0	0.2	0			0				0	0	0	0									NO	154.216291	108.340355	32.184829	0	94.4189	0.188838	0.188838	61.372285	236.04725	35.515486	36.95777	31.937389	0.188838	47.20945	9.44189	25.950297	28.32567	33.068415		0	0.188838	0			0				0	0	0	0										11.5933	0.170726343	1.241529779	0	0.148709768	1.03105548	0.35690382	1.427979641	4.536434733	2.412063828	1.778407892	0.137357387	0.03399084	1.883145619	1.483730068	6.288967977	0.084339682	1.328165331	0	0	1.78640748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7233	0	NO	3.849873	11.5933	0.170726343	1.241529779	0	0.148709768	1.03105548	0.35690382	1.427979641	4.536434733	2.412063828	1.778407892	0.137357387	0.03399084	1.883145619	1.483730068	6.288967977	0.084339682	1.328165331	0	0	1.78640748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7233	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	3.9188	0.0273	0.3925	1.645	1.4624	0.4861	0.1684	0.2005	1.6895	0.2577	0.5554	0.0182	0.0047	0.5514	0.8312	1.2819	0.0158	0.1997		0.4183	0.4278	0			0				0	0	0.0683	0									14.6208	500	NO	3.957692	15.5121	0.197988343	1.634051779	1.645016	1.611093768	1.51714348	0.52527082	1.628483641	6.225895733	2.669767828	2.333759892	0.155558387	0.03871384	2.434510619	2.314968068	7.570906977	0.100090682	1.527841331	0	0.41834	2.21421748	0	0	0	0	0	0	0	0	0	0.068314	0	0	0	0	0	0	0	0	0	52.3441
H5883_001_1	2012	5																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					4.631966799	0.081959138	0.630523333	0.225733835	0.004182014	0.194358809	0.019713755	0.273721488	1.121844549	0.003944898	0.279938783	0	0	0.442305607	0.928594784	0.094719568	0.013071251	0.030593727	0.461479015	2.325381913	0.199676412	0	0	0	0	0	0	0	0	0											11.9637	YES	476.7732961	16.95924497	115.3104561	0	0.026309668	5.712384879	0.76231868	227.9566262	261.1126664	0	0	0	0	562.2131056	8267.325794	315.1367167	79.61337324	150.7948292	216.1690371	1045.339486	0	0	0	0	0	0	0	0	0	0											4600	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	175.4017497	175.4017497	126.6790414	0	48.72270825	0.194890833	0.194890833	63.33952072	121.8067706	0	0	0	0	37.4123194	19.4890833	34.90777876	38.9781666	38.9781666	19.4890833	47.55925429	0	0	0	0	0	0	0	0	0	0											NO	171.6700777	171.6700777	123.983945	0	47.6861327	0.194890833	0.194890833	61.99197251	119.2153318	0	0	0	0	36.61637236	19.07445308	34.16511582	38.14890616	38.14890616	19.07445308	46.62725525	0	0	0	0	0	0	0	0	0	0												6.8206	0.242616242	1.191387104	0	0.000104551	1.113291447	0.148568922	1.177623409	2.594052762	0	0	0	0	1.715517035	13.1412265	0.897223536	0.253096925	0.479388149	0.343608846	4.06177592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1801	160	NO	0.708454778	11.4526	0.32457538	1.821910437	0.225733835	0.004286564	1.307650257	0.168282678	1.451344897	3.715897311	0.003944898	0.279938783	0	0	2.157822642	14.06982128	0.991943104	0.266168176	0.509981876	0.805087861	6.387157833	0.199676412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1438	NO	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.2305	0.02	0.0449	0	0.004	0.0013	0.0075	0.055	0.0587	0	0	0	0	0.0366	0.2965	0.0326	0.0999	0.0412	0.0216	0.2477	0	0	0	0	0	0	0	0	0	0											1.1981	0	NO	0	11.6831	0.344592596	1.866807385	0.225733835	0.008272288	1.308948701	0.175748651	1.506311527	3.774641845	0.003944898	0.279938783	0	0	2.194462563	14.36630619	1.024562622	0.366112733	0.551176397	0.826705494	6.63488288	0.199676412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3419
H5883_001_2	2012	5																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					4.054746091	0.03305063	0.545060835	0.254277872	0.002441274	0.183941166	0.006705387	0.312665625	1.109738893	0.0029692	0.319070064	0	0	0.484653764	1.031507868	0.105916447	0.028716011	0.024128565	0.447201346	2.49023597	0.241754694	0	0	0	0	0	0	0	0	0											11.6788	YES	405.2226839	8.514715652	101.2482665	0	0.026588563	4.989793037	0.245449835	227.256786	263.1018938	0	0	0	0	535.9175393	8891.259225	346.8584514	170.9439523	120.7914569	204.2867522	988.6453979	0	0	0	0	0	0	0	0	0	0											4600	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	175.1588188	175.1588188	126.5035913	0	48.65522743	0.19462091	0.19462091	63.25179566	121.6380686	0	0	0	0	37.69195516	19.46209097	34.27216169	38.92418194	38.92418194	19.46209097	47.16877551	0	0	0	0	0	0	0	0	0	0											NO	171.3227251	171.3227251	123.7330792	0	47.58964585	0.19462091	0.19462091	61.86653961	118.9741146	0	0	0	0	36.86647647	19.03585834	33.52157873	38.07171668	38.07171668	19.03585834	46.21597725	0	0	0	0	0	0	0	0	0	0												5.7853	0.121563691	1.043979982	0	0.000105445	0.97111806	0.04776967	1.171632579	2.60852624	0	0	0	0	1.64644928	14.10439592	0.968936907	0.542344143	0.383228177	0.324064473	3.807601102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.527	160	NO	0.72113337	9.8401	0.15461432	1.589040817	0.254277872	0.002546719	1.155059226	0.054475057	1.484298204	3.718265133	0.0029692	0.319070064	0	0	2.131103044	15.13590379	1.074853355	0.571060154	0.407356741	0.771265819	6.297837072	0.241754694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2058	NO	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.5054	0.0045	0.0513	0	0.0078	0.0024	0.0084	0.0371	0.1262	0	0	0	0	0.0529	0.4138	0.0276	0.1404	0.0242	0.0363	0.2654	0	0	0	0	0	0	0	0	0	0											1.7038	0	NO	1.55E-15	10.3455	0.159108344	1.640325641	0.254277872	0.010339767	1.157506466	0.06289737	1.521372531	3.844463991	0.0029692	0.319070064	0	0	2.184018351	15.54969727	1.102458339	0.711447857	0.431574694	0.80759427	6.563232576	0.241754694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9096
H5883_001_3	2012	5																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					4.238929577	0.032499782	0.964137682	0.241740616	0.005467388	0.161565118	0.007627004	0.279868758	1.073491759	0.003778213	0.3615592	0	0	0.479467746	0.947725944	0.110925936	0.015260292	0.025589074	0.407327614	2.203226716	0.219491346	0	0	0	0	0	0	0	0	0											11.7797	YES	483.1458629	9.165525682	242.1863563	0	0.029842961	4.57315916	0.306870556	220.0338282	264.7175921	0	0	0	0	500.8459602	8809.917219	385.567424	96.75017311	148.8842241	230.2009038	1028.901293	0	0	0	0	0	0	0	0	0	0											4600	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	175.5775307	175.5775307	126.8059944	0	48.77153631	0.195086145	0.195086145	63.40299721	121.9288408	0	0	0	0	37.961879	19.50861453	35.03135118	39.01722905	39.01722905	19.50861453	47.03562692	0	0	0	0	0	0	0	0	0	0											NO	171.1299034	171.1299034	123.5938191	0	47.53608428	0.195086145	0.195086145	61.79690956	118.8402107	0	0	0	0	37.00025088	19.01443371	34.14395748	38.02886742	38.02886742	19.01443371	45.93945076	0	0	0	0	0	0	0	0	0	0												6.8901	0.13070796	2.494394726	0	0.000118218	0.892159992	0.059866194	1.133117548	2.621591202	0	0	0	0	1.544285515	13.95963225	1.097066477	0.306608292	0.471824868	0.364761652	3.938930022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9051	160	NO	0.900039257	11.129	0.163207742	3.458532408	0.241740616	0.005585606	1.05372511	0.067493198	1.412986306	3.695082961	0.003778213	0.3615592	0	0	2.023753261	14.90735819	1.207992413	0.321868584	0.497413942	0.772089267	6.142156738	0.219491346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6848	NO	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.3706	0.0048	0.1206	0	0.0043	0.0023	0.0091	0.0336	0.0407	0	0	0	0	0.0811	0.3707	0.0437	0.0676	0.0194	0.0301	0.225	0	0	0	0	0	0	0	0	0	0											1.4236	0	NO	1.55E-15	11.4996	0.168045261	3.579178795	0.241740616	0.009900105	1.056005338	0.076559259	1.446603914	3.735766884	0.003778213	0.3615592	0	0	2.1048938	15.27810818	1.251690395	0.389422035	0.516766052	0.802178186	6.367125088	0.219491346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1084
H5883_001_4	2012	5																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					4.584364437	0.035604911	0.691985302	0.240037467	0.002629945	0.162789182	0.008646748	0.294118889	1.01850931	0.002637591	0.28275154	0	0	0.438193206	1.000267921	0.104552084	0.022323826	0.020771977	0.437094072	2.284513636	0.228789959	0	0	0	0	0	0	0	0	0											11.8606	YES	469.2660789	9.572989044	127.6648813	0	0.029893191	4.420003227	0.331728199	208.3465237	270.0998099	0	0	0	0	600.4983996	9013.124961	361.6428662	133.033676	112.9355771	249.2674726	1025.763775	0	0	0	0	0	0	0	0	0	0											4600	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	175.3612165	175.3612165	126.6497675	0	48.71144903	0.194845796	0.194845796	63.32488373	121.7786226	0	0	0	0	38.32029257	19.48457961	35.2796609	38.96915922	38.96915922	19.48457961	47.03936982	0	0	0	0	0	0	0	0	0	0											NO	171.1833938	171.1833938	123.6324511	0	47.55094273	0.194845796	0.194845796	61.81622554	118.8773568	0	0	0	0	37.4073462	19.02037709	34.43915483	38.04075418	38.04075418	19.02037709	46.00929334	0	0	0	0	0	0	0	0	0	0												6.6942	0.136561396	1.315293516	0	0.000118454	0.861219048	0.064635845	1.073266309	2.67572929	0	0	0	0	1.87192096	14.28608629	1.037889555	0.421725114	0.358012877	0.395096777	3.932888868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1247	160	NO	0.826707147	11.2786	0.172166308	2.007278818	0.240037467	0.002748399	1.02400823	0.073282593	1.367385198	3.694238599	0.002637591	0.28275154	0	0	2.310114166	15.28635421	1.142441639	0.44404894	0.378784854	0.832190849	6.217402504	0.228789959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9852	NO	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.2769	0.0051	0.0556	0	0.0095	0.0024	0.0095	0.0283	0.0959	0	0	0	0	0.0463	0.4154	0.037	0.0646	0.0224	0.0473	0.2742	0	0	0	0	0	0	0	0	0	0											1.3902	0	NO	0	11.5555	0.177218883	2.062830606	0.240037467	0.012219878	1.026389828	0.082751696	1.395693611	3.790120147	0.002637591	0.28275154	0	0	2.356429895	15.70175989	1.179397639	0.508606613	0.401220509	0.879477007	6.491592039	0.228789959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3754
H5883_001_5	2012	5																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					4.464224599	0.0267906	0.701731805	0.202234432	0.003362269	0.152523385	0.005760631	0.26487281	1.05657423	0.002521203	0.294902975	0	0	0.397695265	1.001003048	0.109698865	0.02013763	0.02577343	0.487582079	2.479456392	0.241115463	0	0	0	0	0	0	0	0	0											11.938	YES	553.1839764	7.650003167	186.4249596	0	0.024114792	4.552807641	0.233597571	207.7281432	265.6339752	0	0	0	0	480.4417868	9447.18572	329.0046078	132.3711246	141.348779	283.6574012	1120.126321	0	0	0	0	0	0	0	0	0	0											4600	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	PBP 17a	PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	175.6322016	175.6322016	126.845479	0	48.78672268	0.195146891	0.195146891	63.42273948	121.9668067	0	0	0	0	38.18038994	19.51468907	35.69898772	39.02937814	39.02937814	19.51468907	47.05135449	0	0	0	0	0	0	0	0	0	0											NO	170.8929242	170.8929242	123.4226675	0	47.47025672	0.195146891	0.195146891	61.71133374	118.6756418	0	0	0	0	37.15012636	18.98810269	34.73568256	37.97620538	37.97620538	18.98810269	45.87172213	0	0	0	0	0	0	0	0	0	0												7.8779	0.108944284	1.917422149	0	9.54E-05	0.888466255	0.04558584	1.068265064	2.627023541	0	0	0	0	1.487372757	14.94867771	0.952349968	0.418912751	0.447324188	0.448842989	4.281843613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5191	160	NO	1.005957002	12.3422	0.135734884	2.619153954	0.202234432	0.003457663	1.040989641	0.051346471	1.333137874	3.683597771	0.002521203	0.294902975	0	0	1.885068023	15.94968076	1.062048833	0.439050381	0.473097618	0.936425068	6.761300005	0.241115463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.457	NO	$180/Day: 1-5 for IP; PBP 1a	$180/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$40/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$20/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $40/Visit for Consult; $40/Visit for Hearing/Speech Exam; $40/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$40/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $40/Visit for Allergy Test; $40/Visit for Cardio; $125/Visit for OP Surg; $40/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.3656	0.004	0.0645	0	0.0062	0.0013	0.0076	0.0449	0.0443	0	0	0	0	0.0706	0.3708	0.0322	0.0931	0.0506	0.0411	0.3201	0	0	0	0	0	0	0	0	0	0											1.517	0	NO	0	12.7078	0.139772517	2.683697603	0.202234432	0.009632124	1.04231542	0.058913456	1.378001811	3.727918152	0.002521203	0.294902975	0	0	1.955664204	16.32049451	1.094230637	0.532157894	0.523701773	0.97754545	7.081416912	0.241115463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.974
H5883_002_1	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					3.071041174	0.054394417	0.590194754	0.189946572	0.002312905	0.227287686	0.014865412	0.267298605	1.020905423	0.00773075	0.290804872	0	0	0.42758416	0.744389247	0.07949429	0.020117563	0.015740638	0.298504349	1.986161174	0.18915756	0	0	0	0	0	0	0	0	0											9.4979	YES	550.5560575	22.1068769	192.0154634	0	0.019506224	11.56477312	0.956437882	337.0752145	341.821652	0	0	0	0	916.4999945	11992.25658	454.0571783	198.4638458	167.2007599	176.3084571	1261.117169	0	0	0	0	0	0	0	0	0	0											4400	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	127.9915597	127.9915597	127.9915597	0	49.22752296	0.196910092	0.196910092	63.99577985	98.45504593	0	0	0	0	33.54570613	14.76825689	28.09657595	34.45926607	34.45926607	19.69100919	38.95091312	0	0	0	0	0	0	0	0	0	0											NO	125.3541991	125.3541991	125.3541991	0	48.21315351	0.196910092	0.196910092	62.67709957	96.42630702	0	0	0	0	32.85447209	14.46394605	27.51762526	33.74920746	33.74920746	19.2852614	38.19419199	0	0	0	0	0	0	0	0	0	0												5.7512	0.230932487	2.005828719	0	7.84E-05	2.277220538	0.188332271	1.760574732	2.74671663	0	0	0	0	2.509260291	14.45461268	1.041214607	0.558166459	0.470241094	0.283346224	4.01394594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2917	125	NO	0.748831181	8.8223	0.285326904	2.596023474	0.189946572	0.002391276	2.504508224	0.203197683	2.027873337	3.767622053	0.00773075	0.290804872	0	0	2.936844451	15.19900193	1.120708896	0.578284022	0.485981733	0.581850573	6.000107114	0.18915756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7896	NO	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.3123	0.0008	0.0795	0	0.0061	0.0037	0.0058	0.0374	0.0342	0	0	0	0	0.096	0.2468	0.0455	0.0714	0.0206	0.0161	0.1532	0	0	0	0	0	0	0	0	0	0											1.1295	0	NO	0	9.1346	0.286157017	2.675532865	0.189946572	0.008502376	2.508252395	0.209013131	2.065252666	3.801823888	0.00773075	0.290804872	0	0	3.032797366	15.44583287	1.166213613	0.64970752	0.50662292	0.59794989	6.153259828	0.18915756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9191
H5883_002_2	2012	6																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					3.207705821	0.038332249	0.540082565	0.201919989	0.00114054	0.174063186	0.011954822	0.248592806	0.9636458	0.00155072	0.273614209	0	0	0.458320352	0.852680919	0.081301647	0.0116999	0.015897722	0.361446635	1.822822181	0.187781235	0	0	0	0	0	0	0	0	0											9.4546	YES	578.5759596	26.08314179	201.8260054	0	0.018769168	7.921909436	0.738035532	277.542271	387.7676154	0	0	0	0	758.2107419	13637.63843	359.5288009	114.633342	149.2679767	246.0035984	1182.941951	0	0	0	0	0	0	0	0	0	0											4400	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	127.981443	127.981443	127.981443	0	49.22363192	0.196894528	0.196894528	63.99072149	98.44726384	0	0	0	0	33.16728821	14.76708958	29.35373384	34.45654234	34.45654234	19.68945277	38.78766409	0	0	0	0	0	0	0	0	0	0											NO	125.1517053	125.1517053	125.1517053	0	48.13527125	0.196894528	0.196894528	62.57585263	96.27054251	0	0	0	0	32.43394183	14.44058138	28.70470718	33.69468988	33.69468988	19.2541085	37.9834571	0	0	0	0	0	0	0	0	0	0												6.0341	0.272029139	2.104905728	0	7.53E-05	1.559780617	0.145315157	1.447287021	3.110883225	0	0	0	0	2.049313592	16.41128562	0.860014079	0.321877909	0.419128182	0.394714998	3.74435207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8751	125	NO	0.835047139	9.2419	0.310361388	2.644988293	0.201919989	0.001215828	1.733843802	0.157269979	1.695879826	4.074529025	0.00155072	0.273614209	0	0	2.507633944	17.26396654	0.941315727	0.333577809	0.435025904	0.756161633	5.567174251	0.187781235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3297	NO	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.0731	0.0009	0.1659	0	0.0081	0.0098	0.006	0.0201	0.0253	0	0	0	0	0.0166	0.4442	0.0258	0.1524	0.0173	0.0699	0.2258	0	0	0	0	0	0	0	0	0	0											1.261	0	NO	8.88E-16	9.3149	0.311217353	2.81088348	0.201919989	0.009287349	1.743635844	0.163266533	1.715970464	4.099839196	0.00155072	0.273614209	0	0	2.524222429	17.70817382	0.967096455	0.486011345	0.452282248	0.826040953	5.79296115	0.187781235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5907
H5883_002_3	2012	6																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					2.829897026	0.021358683	0.563581376	0.131728198	0.007470205	0.176428979	0.009856156	0.199212	0.981157328	0.010725901	0.37377847	0	0	0.410244362	0.885507851	0.118063247	0.015591512	0.05319804	0.327841571	2.067091466	0.220095202	0	0	0	0	0	0	0	0	0											9.4028	YES	449.5843893	10.91877579	131.0770451	0	0.006141596	6.469690314	0.569195185	241.2890747	343.0995853	0	0	0	0	672.5763492	12168.31853	435.6745086	141.1659628	520.9533398	198.9596397	1175.90212	0	0	0	0	0	0	0	0	0	0											4400	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	127.7591168	127.7591168	127.7591168	0	49.13812186	0.196552487	0.196552487	63.87955841	98.27624371	0	0	0	0	33.64489103	14.74143656	29.96888635	34.3966853	34.3966853	19.65524874	38.66433028	0	0	0	0	0	0	0	0	0	0											NO	125.3737769	125.3737769	125.3737769	0	48.22068343	0.196552487	0.196552487	62.68688846	96.44136687	0	0	0	0	33.01672058	14.46620503	29.40934913	33.7544784	33.7544784	19.28827337	37.98651173	0	0	0	0	0	0	0	0	0	0												4.6972	0.114077347	1.369468684	0	2.47E-05	1.271633724	0.111876729	1.260471776	2.757416081	0	0	0	0	1.850522116	14.6691159	1.067741978	0.397081953	1.465375688	0.319798993	3.722368305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0741	125	NO	0.636591827	7.5271	0.13543603	1.93305006	0.131728198	0.007494884	1.448062703	0.121732886	1.459683776	3.738573409	0.010725901	0.37377847	0	0	2.260766478	15.55462375	1.185805225	0.412673465	1.518573729	0.647640564	5.789459771	0.220095202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.477	NO	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.5475	0.0003	0.1293	0	0.0006	0.003	0.0632	0.0373	0.0685	0	0	0	0	0.0123	0.3019	0.0257	0.0107	0.0316	0.0141	0.1262	0	0	0	0	0	0	0	0	0	0											1.3722	0	NO	8.88E-16	8.0746	0.135689332	2.062373855	0.131728198	0.008106268	1.451057268	0.184895192	1.496994102	3.807054313	0.010725901	0.37377847	0	0	2.273067762	15.8565305	1.211541106	0.42334306	1.550189999	0.661720323	5.915631986	0.220095202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8491
H5883_002_4	2012	6																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					3.223544505	0.055438701	0.551040437	0.183480733	0.002927712	0.174578832	0.003497601	0.234805473	0.948626268	0.001339768	0.195750614	0	0	0.235181987	0.81447815	0.084397704	0.015161781	0.009694762	0.47592132	1.920639119	0.22127127	0	0	0	0	0	0	0	0	0											9.3518	YES	553.0235035	24.35172726	209.2883204	0	0.010553164	7.356240687	0.217047374	258.3051319	441.4771822	0	0	0	0	651.8059021	12585.64005	339.5828775	153.1989169	91.06371906	406.4483974	1319.997846	0	0	0	0	0	0	0	0	0	0											4400	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	127.9841866	127.9841866	127.9841866	0	49.22468714	0.196898749	0.196898749	63.99209328	98.44937427	0	0	0	0	34.13686996	14.76740614	32.30833207	34.45728099	34.45728099	19.68987485	38.85436072	0	0	0	0	0	0	0	0	0	0											NO	125.1901456	125.1901456	125.1901456	0	48.15005601	0.196898749	0.196898749	62.59507282	96.30011203	0	0	0	0	33.39162311	14.4450168	31.60300429	33.70503921	33.70503921	19.26002241	38.05635524	0	0	0	0	0	0	0	0	0	0												5.7694	0.25404969	2.183402943	0	4.23E-05	1.448434585	0.042736356	1.347385712	3.542858508	0	0	0	0	1.813738085	15.14998183	0.894319928	0.430297958	0.255775518	0.652350437	4.186192245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.971	125	NO	0.808521824	8.993	0.309488391	2.73444338	0.183480733	0.002970056	1.623013417	0.046233957	1.582191185	4.491484776	0.001339768	0.195750614	0	0	2.048920072	15.96445998	0.978717632	0.445459739	0.26547028	1.128271756	6.106831364	0.22127127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3228	NO	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.3818	0.0068	0.0313	0	0.0018	0.0058	0.0665	0.0138	0.0236	0	0	0	0	0.0146	0.4243	0.0511	0.0253	0.0139	0.1118	0.1997	0	0	0	0	0	0	0	0	0	0											1.3721	0	NO	6.66E-16	9.3747	0.316307076	2.765747688	0.183480733	0.00477085	1.6288515	0.112750944	1.595952896	4.515105901	0.001339768	0.195750614	0	0	2.063481274	16.38875797	1.029787601	0.470787234	0.279356852	1.240087781	6.306549755	0.22127127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6949
H5883_002_7	2012	6																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					3.119465093	0.047318907	0.532426511	0.133416147	0.00125296	0.135799908	0.003502658	0.208776633	0.898287133	0.00113198	0.271186773	0	0	0.323310899	0.867339021	0.095623261	0.016580165	0.023539412	0.392054284	2.093126165	0.241381583	0	0	0	0	0	0	0	0	0											9.4055	YES	600.8445857	24.30227294	172.4594814	0	0.173093379	5.602100831	0.225121393	237.3739695	351.229386	0	0	0	0	718.1124985	13378.82389	394.4066484	177.7608494	222.7750774	315.7211682	1355.483942	0	0	0	0	0	0	0	0	0	0											4400	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	128.0405805	128.0405805	128.0405805	0	49.24637711	0.196985508	0.196985508	64.02029025	98.49275423	0	0	0	0	34.17878896	14.77391313	30.72641997	34.47246398	34.47246398	19.69855085	38.74212782	0	0	0	0	0	0	0	0	0	0											NO	125.1616247	125.1616247	125.1616247	0	48.13908642	0.196985508	0.196985508	62.58081235	96.27817285	0	0	0	0	33.41028867	14.44172593	30.03554521	33.6973605	33.6973605	19.25563457	37.91732738	0	0	0	0	0	0	0	0	0	0												6.2669	0.253475997	1.79877574	0	0.00069438	1.103532681	0.044345652	1.23792132	2.817976962	0	0	0	0	1.999362156	16.10110898	0.987184893	0.499172619	0.625577675	0.50661762	4.283027365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5257	125	NO	0.854409473	9.3864	0.300794904	2.331202252	0.133416147	0.00194734	1.239332589	0.04784831	1.446697953	3.716264095	0.00113198	0.271186773	0	0	2.322673056	16.96844801	1.082808155	0.515752784	0.649117087	0.898671904	6.37615353	0.241381583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9312	NO	$130/Day: 1-5 for IP; PBP 1a	$130/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for OP PT/OT/ST; $30/Visit for OP Other; PBP 3, 5, 9c"	"$15/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $35/Visit for Consult; $35/Visit for Hearing/Speech Exam; $35/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"$35/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$40/Visit for Primary Surgery - Office; $35/Visit for Allergy Test; $35/Visit for Cardio; $100/Visit for OP Surg; $35/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.3542	0.006	0.1755	0	0.0656	0.0044	0.0184	0.0456	0.0296	0	0	0	0	0.0743	0.4195	0.0492	0.0331	0.0286	0.0421	0.2761	0	0	0	0	0	0	0	0	0	0											1.6222	0	NO	0	9.7405	0.3068418	2.506676574	0.133416147	0.067576777	1.243756731	0.066289274	1.49229336	3.745842391	0.00113198	0.271186773	0	0	2.396932771	17.3879962	1.132042723	0.548829326	0.677691267	0.940782648	6.652205546	0.241381583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5534
H5883_003_1	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					1.310633412	0.017066859	0.327881687	0.113242978	0.00128086	0.084479483	0.001598864	0.091014876	0.347490479	0.002141753	0.107774621	0	0	0.156123618	0.275159541	0.024223517	0.005095035	0.008754491	0.106126464	0.747947063	0.077655068	0	0	0	0	0	0	0	0	0											3.8057	YES	662.4233114	27.97796264	392.4393011	0	0.071662244	12.68135765	0.325516748	394.535591	435.1350416	0	0	0	0	1007.780932	11802.97347	158.4530785	144.8802082	264.1409344	187.6517375	1077.6896	0	0	0	0	0	0	0	0	0	0											4200	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Consult; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	89.5690613	89.5690613	129.377533	0	49.76058961	0.199042358	0.199042358	64.68876649	74.64088442	0	0	0	0	24.88029481	9.952117922	21.2578166	24.88029481	24.88029481	9.952117922	29.77984654	0	0	0	0	0	0	0	0	0	0											NO	87.57604454	87.57604454	126.498731	0	48.65335808	0.199042358	0.199042358	63.2493655	72.98003712	0	0	0	0	24.32667904	9.730671616	20.78480523	24.32667904	24.32667904	9.730671616	29.14871049	0	0	0	0	0	0	0	0	0	0												4.8344	0.204183275	4.136922799	0	0.000290551	2.524127336	0.064791621	2.079510483	2.646347624	0	0	0	0	2.042996939	9.570904909	0.274451365	0.293704527	0.535472644	0.152164786	2.617771846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.978	50	NO	0.665930496	6.145	0.221250134	4.464804486	0.113242978	0.001571411	2.608606819	0.066390486	2.170525359	2.993838103	0.002141753	0.107774621	0	0	2.199120557	9.846064449	0.298674882	0.298799562	0.544227136	0.25829125	3.365718909	0.077655068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7837	NO	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 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-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.369	0.0036	2.1628	0	0.0265	0.0009	0	0.0228	0.0308	0	0	0	0	0.0129	0.1843	0.0222	0.0143	0.0326	0.0101	0.0985	0	0	0	0	0	0	0	0	0	0											2.9912	0	NO	3.55E-15	6.514	0.224828165	6.627635674	0.113242978	0.028038557	2.609536215	0.066390486	2.193326485	3.024613678	0.002141753	0.107774621	0	0	2.212000274	10.03031732	0.320848014	0.313114262	0.576823583	0.268362846	3.464218804	0.077655068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7749
H5883_003_2	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					1.330968633	0.017265513	0.275155046	0.094281229	0.001010368	0.076492307	0.001918444	0.089446458	0.36128899	0.000501665	0.087414324	0	0	0.155592157	0.263423639	0.02485024	0.004967016	0.00453534	0.098539251	0.738939484	0.074206503	0	0	0	0	0	0	0	0	0											3.7008	YES	880.1941324	23.08646055	380.6094413	0	0.082195662	13.33669807	0.408771601	339.1232794	477.2573713	0	0	0	0	954.3573853	12744.82875	110.4758381	173.0300051	135.1545951	221.445048	992.4118494	0	0	0	0	0	0	0	0	0	0											4200	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Consult; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	89.61227132	89.61227132	129.4399475	0	49.78459518	0.199138381	0.199138381	64.71997373	74.67689277	0	0	0	0	24.89229759	9.956919036	21.80975792	24.89229759	24.89229759	9.956919036	29.13118869	0	0	0	0	0	0	0	0	0	0											NO	87.26304337	87.26304337	126.0466182	0	48.47946854	0.199138381	0.199138381	63.0233091	72.71920281	0	0	0	0	24.23973427	9.695893707	21.23800483	24.23973427	24.23973427	9.695893707	28.40070405	0	0	0	0	0	0	0	0	0	0												6.4007	0.167882901	3.997877744	0	0.000332067	2.655848458	0.081402115	1.781055938	2.892147964	0	0	0	0	1.927780785	10.29770874	0.195523865	0.349516779	0.273009289	0.178925637	2.348766269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5485	50	NO	0.826656156	7.7317	0.185148413	4.27303279	0.094281229	0.001342435	2.732340765	0.083320559	1.870502396	3.253436954	0.000501665	0.087414324	0	0	2.083372942	10.56113238	0.220374105	0.354483794	0.277544629	0.277464888	3.087705753	0.074206503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2493	NO	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 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-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.7894	0.0046	0.5954	0	0.0399	0.0014	0	0.0303	0.0504	0	0	0	0	0.0488	0.2848	0.0185	0.0693	0.0138	0.0337	0.1076	0	0	0	0	0	0	0	0	0	0											2.0878	0	NO	0	8.521	0.189707647	4.868394138	0.094281229	0.041231705	2.733723493	0.083320559	1.900834321	3.303828906	0.000501665	0.087414324	0	0	2.132132991	10.84595432	0.238874154	0.42376532	0.291350625	0.311122414	3.195354105	0.074206503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.337
H5883_003_3	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					1.238110928	0.023281606	0.337067237	0.096591424	0.001498843	0.070208916	0.001360366	0.095093394	0.334156245	0.001028365	0.104861189	0	0	0.139133589	0.270992119	0.032341906	0.009099378	0.013774836	0.09886306	0.711128825	0.074786702	0	0	0	0	0	0	0	0	0											3.6534	YES	800.3748472	35.58365587	488.6581432	0	0.753137484	11.46323323	0.317683455	399.5937592	479.5375357	0	0	0	0	965.042721	12892.36937	145.50915	327.7416327	510.2618561	209.5183578	1074.771953	0	0	0	0	0	0	0	0	0	0											4200	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Consult; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	89.62400933	89.62400933	129.4569024	0	49.79111629	0.199164465	0.199164465	64.72845118	74.68667444	0	0	0	0	24.89555815	9.958223259	21.45439868	24.89555815	24.89555815	9.958223259	29.58963061	0	0	0	0	0	0	0	0	0	0											NO	86.83631133	86.83631133	125.4302275	0	48.24239518	0.199164465	0.199164465	62.71511374	72.36359278	0	0	0	0	24.12119759	9.648479037	20.78707321	24.12119759	24.12119759	9.648479037	28.70957182	0	0	0	0	0	0	0	0	0	0												5.7918	0.257496118	5.107708505	0	0.003027763	2.283068716	0.063271255	2.088380671	2.891754913	0	0	0	0	1.93983218	10.36597963	0.252059113	0.65879339	1.025677255	0.168461124	2.571353547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4687	50	NO	1.059596833	7.0299	0.280777725	5.444775742	0.096591424	0.004526606	2.353277633	0.064631621	2.183474065	3.225911158	0.001028365	0.104861189	0	0	2.078965769	10.63697175	0.284401019	0.667892768	1.039452091	0.267324184	3.282482372	0.074786702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.122	NO	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 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-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.8792	0.0034	0.4375	0	0.1937	0.0006	0	0.0392	0.0589	0	0	0	0	0.0481	0.245	0.0387	0.0431	0.0261	0.0116	0.0866	0	0	0	0	0	0	0	0	0	0											2.1117	0	NO	0	7.9091	0.284219819	5.88229328	0.096591424	0.198226799	2.35388189	0.064631621	2.222664187	3.28484993	0.001028365	0.104861189	0	0	2.127045126	10.88196773	0.323067937	0.710948552	1.065523209	0.278964374	3.369089284	0.074786702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2338
H5883_003_4	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					1.393061954	0.020224369	0.310557339	0.089965819	0.000647702	0.073546363	0.004308197	0.089983147	0.271138955	0.000890695	0.074746971	0	0	0.119370402	0.240734954	0.022031065	0.007859771	0.00552185	0.105761365	0.714900007	0.071034535	0	0	0	0	0	0	0	0	0											3.6163	YES	1043.305007	32.97799141	527.4341678	0	0.100169821	15.70455412	1.204858265	412.2098721	507.0352877	0	0	0	0	827.709331	14088.22549	122.7392513	354.9988701	216.5145825	318.9361317	1252.329517	0	0	0	0	0	0	0	0	0	0											4200	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Consult; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	89.68638079	89.68638079	129.5469945	0	49.8257671	0.199303068	0.199303068	64.77349723	74.73865066	0	0	0	0	24.91288355	9.965153421	21.90702728	24.91288355	24.91288355	9.965153421	29.38565579	0	0	0	0	0	0	0	0	0	0											NO	86.38979933	86.38979933	124.7852657	0	47.99433296	0.199303068	0.199303068	62.39263285	71.99149944	0	0	0	0	23.99716648	9.598866592	21.10179577	23.99716648	23.99716648	9.598866592	28.34507817	0	0	0	0	0	0	0	0	0	0												7.5109	0.237413505	5.48466773	0	0.000400632	3.129965824	0.240131949	2.143238267	3.041852553	0	0	0	0	1.655223218	11.26924975	0.215834884	0.709913916	0.43297804	0.255118782	2.958114839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.285	50	NO	1.366206683	8.904	0.257637874	5.795225069	0.089965819	0.001048334	3.203512187	0.244440146	2.233221414	3.312991508	0.000890695	0.074746971	0	0	1.77459362	11.5099847	0.237865949	0.717773686	0.43849989	0.360880147	3.673014846	0.071034535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9013	NO	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 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-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												1.1375	0.0588	0.8656	0	0.0716	0.0004	0	0.0535	0.1654	0	0	0	0	0.0329	0.3762	0.0387	0.0236	0.0236	0.0351	0.1024	0	0	0	0	0	0	0	0	0	0											2.9852	0	NO	1.33E-15	10.0415	0.316432598	6.660844299	0.089965819	0.072676143	3.203904281	0.244440146	2.286707411	3.478350633	0.000890695	0.074746971	0	0	1.807464668	11.8861605	0.276550153	0.741338038	0.462114744	0.396017169	3.775403234	0.071034535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8865
H5883_003_5	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					1.330112093	0.016522638	0.302163473	0.075207257	0.000835103	0.061749993	0.002622154	0.077999011	0.293246175	0.000702326	0.106531098	0	0	0.121523103	0.275128662	0.026345899	0.008213137	0.007707598	0.121530221	0.845723377	0.08613205	0	0	0	0	0	0	0	0	0											3.76	YES	1041.576844	24.00614013	413.8703852	0	0.211468438	11.03886533	0.641029791	334.4055491	470.2602189	0	0	0	0	982.9925072	14615.97236	140.5457635	341.7163031	260.0243965	269.91141	1283.766149	0	0	0	0	0	0	0	0	0	0											4200	$90/Day: 1-5 for IP; PBP 1a	$90/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Consult; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	89.66532162	89.66532162	129.5165757	0	49.81406757	0.19925627	0.19925627	64.75828784	74.72110135	0	0	0	0	24.90703378	9.962813514	21.72887083	24.90703378	24.90703378	9.962813514	29.67397083	0	0	0	0	0	0	0	0	0	0											NO	86.74402343	86.74402343	125.2969227	0	48.19112413	0.19925627	0.19925627	62.64846136	72.28668619	0	0	0	0	24.09556206	9.638224825	21.02094373	24.09556206	24.09556206	9.638224825	28.73923554	0	0	0	0	0	0	0	0	0	0												7.5292	0.173532432	4.321390473	0	0.000849242	2.199563135	0.127729205	1.74583276	2.832796072	0	0	0	0	1.97381308	11.73933564	0.246200382	0.686153866	0.522119499	0.216788904	3.074538145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3899	50	NO	1.17726649	8.8593	0.190055069	4.623553946	0.075207257	0.001684344	2.261313127	0.130351359	1.823831771	3.126042247	0.000702326	0.106531098	0	0	2.095336183	12.0144643	0.272546281	0.694367003	0.529827097	0.338319125	3.920261522	0.08613205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1499	NO	$90/Day: 1-5 for IP; PBP 1a	No Cost Sharing; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	20% Coinsurance for DME; PBP 11a	No Cost Sharing; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$75/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP PT/OT/ST; $25/Visit for OP Other; PBP 3, 5, 9c"	"$10/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $25/Visit for Hearing/Speech Exam; $25/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$25/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT; PBP 7c, 7i"	$10/Procedure for Phys Rad - Office; PBP 7d	"$30/Visit for Primary Surgery - Office; $25/Visit for Allergy Test; $25/Visit for Cardio; $75/Visit for OP Surg; $25/Visit for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.7183	0	0.1094	0	0	0.0067	0	0.0953	0.0432	0	0	0	0	0.0408	0.3193	0.0447	0.0135	0.0462	0.0165	0.1575	0	0	0	0	0	0	0	0	0	0											1.6113	0	NO	0	9.5776	0.190055069	4.732945846	0.075207257	0.001684344	2.267964646	0.130351359	1.919118695	3.169250023	0.000702326	0.106531098	0	0	2.136144875	12.33378954	0.317214374	0.70784285	0.576027321	0.354804942	4.077722606	0.08613205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7611
H5883_004_1	2012	8																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					6.477219415	0.070875867	1.070264986	0.334953618	0.005257515	0.27744225	0.014196251	0.432199471	1.700160344	0.0052728	0.48953133	0	0	0.678483591	1.532584413	0.166352686	0.030434662	0.041034529	0.706984541	3.71188546	0.373995234	0	0	0	0	0	0	0	0	0											18.1191	YES	450.8261634	12.24893645	144.9053036	0	0.038412138	4.875773037	0.347516133	205.6430664	262.2128589	0	0	0	0	523.6441964	8760.965606	321.7835031	120.0789088	144.1130855	226.6058209	1001.885672	0	0	0	0	0	0	0	0	0	0											5200	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	PBP 10b	PBP 16a-b	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	215.9790605	215.9790605	124.7879016	0	47.99534677	0.191981387	0.191981387	62.3939508	119.9883669	0	0	0	0	41.38501927	23.99767338	37.79781979	38.39627741	43.19581209	19.19813871	47.96881873	0	0	0	0	0	0	0	0	0	0											NO	211.4291077	211.4291077	122.15904	0	46.98424615	0.191981387	0.191981387	61.07952	117.4606154	0	0	0	0	40.51317603	23.49212308	37.00154679	37.58739692	42.28582154	18.79369846	47.03676575	0	0	0	0	0	0	0	0	0	0												7.9431	0.215815142	1.475124398	0	0.000150397	0.936057671	0.066716629	1.046714982	2.566640314	0	0	0	0	1.767874126	17.15114019	0.992207279	0.376121134	0.507828351	0.354896789	3.927121804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3276	250	NO	0.818054942	14.4204	0.286691009	2.545389384	0.334953618	0.005407912	1.213499921	0.08091288	1.478914453	4.266800658	0.0052728	0.48953133	0	0	2.446357717	18.6837246	1.158559965	0.406555795	0.54886288	1.06188133	7.639007264	0.373995234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4467	NO	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.4288	0.0081	0.0801	0	0.0085	0.0031	0.0122	0.0358	0.0564	0	0	0	0	0.059	0.4438	0.0369	0.0764	0.0326	0.0348	0.2531	0	0	0	0	0	0	0	0	0	0											1.5693	0	NO	0	14.8491	0.294772168	2.625448648	0.334953618	0.013898628	1.216560226	0.093080483	1.514681966	4.323179063	0.0052728	0.48953133	0	0	2.50537168	19.12755047	1.195445295	0.482912319	0.58148706	1.096638016	7.89207649	0.373995234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.016
H5883_004_2	2012	7																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					6.482384141	0.070932381	1.07111838	0.335220699	0.005261707	0.277663474	0.014207571	0.432544093	1.701515997	0.005277004	0.489921666	0	0	0.679024592	1.53160216	0.16648533	0.030458929	0.041067249	0.707548268	3.714845198	0.374293446	0	0	0	0	0	0	0	0	0											18.1314	YES	456.1761078	12.39429432	146.6248918	0	0.038867974	4.933633731	0.3516401	208.0834282	265.3245333	0	0	0	0	529.8582709	8864.931797	325.6021011	121.5038826	145.8232724	229.2949473	1013.775028	0	0	0	0	0	0	0	0	0	0											5200	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	PBP 10b	PBP 16a-b	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	216.0777476	216.0777476	124.8449209	0	48.01727725	0.192069109	0.192069109	62.42246043	120.0431931	0	0	0	0	41.4039293	24.00863863	37.81509072	38.4138218	43.21554953	19.2069109	47.99073709	0	0	0	0	0	0	0	0	0	0											NO	211.4073401	211.4073401	122.1464632	0	46.97940891	0.192069109	0.192069109	61.07323158	117.4485223	0	0	0	0	40.50900501	23.48970445	36.99773731	37.58352713	42.28146802	18.79176356	47.03313681	0	0	0	0	0	0	0	0	0	0												8.0366	0.218353733	1.492475995	0	0.000152166	0.947598635	0.067539201	1.059027283	2.596831197	0	0	0	0	1.788669279	17.35288566	1.003878417	0.380545372	0.513801836	0.35907137	3.973418297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7908	250	NO	0.849750542	14.519	0.289286114	2.563594375	0.335220699	0.005413873	1.225262109	0.081746771	1.491571376	4.298347194	0.005277004	0.489921666	0	0	2.467693872	18.88448782	1.170363747	0.411004302	0.554869084	1.066619638	7.688263495	0.374293446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9222	NO	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.4338	0.0082	0.081	0	0.0086	0.0031	0.0123	0.0362	0.057	0	0	0	0	0.0597	0.4491	0.0373	0.0773	0.033	0.0352	0.2561	0	0	0	0	0	0	0	0	0	0											1.5879	0	NO	6.66E-16	14.9528	0.297463172	2.644603701	0.335220699	0.014005348	1.22835873	0.094058766	1.527763341	4.35539464	0.005277004	0.489921666	0	0	2.527408152	19.33358056	1.207686794	0.488266946	0.587880415	1.10178878	7.944335888	0.374293446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5101
H5883_004_3	2012	8																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					6.487974417	0.070993552	1.072042091	0.335509787	0.005266245	0.277902925	0.014219823	0.43291711	1.70298335	0.005281555	0.490344165	0	0	0.679610169	1.530586283	0.166628904	0.030485196	0.041102664	0.708158443	3.718048805	0.374616229	0	0	0	0	0	0	0	0	0											18.1447	YES	461.9827668	12.55206111	148.4912779	0	0.039362724	4.996433883	0.356116121	210.7321191	268.7018455	0	0	0	0	536.6028291	8977.773385	329.7466854	123.0505038	147.6794547	232.2136394	1026.679355	0	0	0	0	0	0	0	0	0	0											5200	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	PBP 10b	PBP 16a-b	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	216.1822937	216.1822937	124.9053253	0	48.04050971	0.192162039	0.192162039	62.45266263	120.1012743	0	0	0	0	41.42396199	24.02025486	37.83338701	38.43240777	43.23645874	19.21620389	48.01395671	0	0	0	0	0	0	0	0	0	0											NO	211.3843119	211.3843119	122.133158	0	46.97429153	0.192162039	0.192162039	61.06657898	117.4357288	0	0	0	0	40.50459244	23.48714576	36.99370721	37.57943322	42.27686237	18.78971661	47.02924824	0	0	0	0	0	0	0	0	0	0												8.138	0.221109067	1.511309058	0	0.000154086	0.960124922	0.068432	1.0723908	2.629599755	0	0	0	0	1.811239908	17.57185601	1.016546028	0.385347349	0.520285332	0.363602373	4.023663188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2937	250	NO	0.884155138	14.626	0.292102618	2.583351149	0.335509787	0.005420331	1.238027847	0.082651823	1.50530791	4.332583104	0.005281555	0.490344165	0	0	2.490850077	19.10244229	1.183174932	0.415832545	0.561387996	1.071760816	7.741711993	0.374616229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4383	NO	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.4394	0.0083	0.082	0	0.0087	0.0031	0.0125	0.0367	0.0578	0	0	0	0	0.0605	0.4548	0.0378	0.0782	0.0334	0.0356	0.2593	0	0	0	0	0	0	0	0	0	0											1.6081	0	NO	2.22E-16	15.0653	0.300383762	2.665391641	0.335509787	0.014121167	1.241163886	0.095120537	1.541960562	4.390356706	0.005281555	0.490344165	0	0	2.55132446	19.55725153	1.220973064	0.494078665	0.594819527	1.107377627	8.001043928	0.374616229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0464
H5883_004_4	2012	8																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					6.49950378	0.07111971	1.073947148	0.336106	0.005275603	0.278396769	0.014245092	0.433686419	1.706009612	0.00529094	0.491215524	0	0	0.680817861	1.52864057	0.166925009	0.03053937	0.041175705	0.709416866	3.724655911	0.375281935	0	0	0	0	0	0	0	0	0											18.1722	YES	474.0086124	12.87880306	152.3566454	0	0.040387373	5.126495752	0.365386159	216.2176742	275.696407	0	0	0	0	550.571105	9211.473263	338.3303016	126.253624	151.5236897	238.2583786	1053.404783	0	0	0	0	0	0	0	0	0	0											5200	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	PBP 10b	PBP 16a-b	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	216.3907317	216.3907317	125.0257561	0	48.08682926	0.192347317	0.192347317	62.51287804	120.2170732	0	0	0	0	41.46390201	24.04341463	37.86986508	38.46946341	43.27814634	19.2347317	48.06025065	0	0	0	0	0	0	0	0	0	0											NO	211.3384968	211.3384968	122.106687	0	46.9641104	0.192347317	0.192347317	61.05334352	117.410276	0	0	0	0	40.49581355	23.4820552	36.98568926	37.57128832	42.26769936	18.78564416	47.02135937	0	0	0	0	0	0	0	0	0	0												8.348	0.226815573	1.550313768	0	0.000158063	0.986067704	0.070281047	1.100067662	2.697465937	0	0	0	0	1.857985401	18.0253603	1.042781617	0.395292609	0.533713147	0.372986427	4.127710408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.335	250	NO	0.955418695	14.8475	0.297935283	2.624260916	0.336106	0.005433666	1.264464473	0.084526139	1.533754081	4.403475549	0.00529094	0.491215524	0	0	2.538803262	19.55400087	1.209706626	0.425831979	0.574888852	1.082403293	7.852366319	0.375281935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5073	NO	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.4508	0.0085	0.0842	0	0.0089	0.0032	0.0128	0.0376	0.0593	0	0	0	0	0.062	0.4666	0.0388	0.0803	0.0343	0.0365	0.2661	0	0	0	0	0	0	0	0	0	0											1.65	0	NO	6.66E-16	15.2983	0.306431993	2.708437	0.336106	0.014360993	1.267682145	0.097319426	1.571360836	4.462753052	0.00529094	0.491215524	0	0	2.60085185	20.02064922	1.248488679	0.506114919	0.609190637	1.118947242	8.118448908	0.375281935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1573
H5883_004_5	2012	8																															D	D	D		T	Coin	Coin	V	V					V	V	V	V	V	P	V																					6.525735514	0.071406746	1.078281556	0.33746251	0.005296895	0.279520367	0.014302585	0.43543676	1.712894998	0.005312294	0.49319805	0	0	0.683565614	1.524909955	0.167598712	0.030662625	0.041341888	0.712280044	3.739688471	0.376796558	0	0	0	0	0	0	0	0	0											18.2357	YES	501.6038143	13.62856406	161.2263416	0	0.042738591	5.424943253	0.386657723	228.8051468	291.7465332	0	0	0	0	582.6235202	9747.734543	358.0267644	133.6036893	160.344894	252.1289875	1114.7305	0	0	0	0	0	0	0	0	0	0											5200	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	PBP 10b	PBP 16a-b	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	216.8315263	216.8315263	125.2804374	0	48.18478363	0.192739135	0.192739135	62.64021872	120.4619591	0	0	0	0	41.54836527	24.09239182	37.94700718	38.5478269	43.36630527	19.27391345	48.15815088	0	0	0	0	0	0	0	0	0	0											NO	211.2420358	211.2420358	122.050954	0	46.94267461	0.192739135	0.192739135	61.02547699	117.3566865	0	0	0	0	40.47733008	23.47133731	36.96880791	37.55413969	42.24840715	18.77706984	47.00407569	0	0	0	0	0	0	0	0	0	0												8.83	0.239910468	1.639819067	0	0.000167189	1.045598867	0.074524075	1.163578602	2.853200537	0	0	0	0	1.965253711	19.06603045	1.102985223	0.418114301	0.564526364	0.394520301	4.366406399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7246	250	NO	1.11899154	15.3557	0.311317214	2.718100622	0.33746251	0.005464084	1.325119234	0.08882666	1.599015362	4.566095534	0.005312294	0.49319805	0	0	2.648819326	20.59094041	1.270583935	0.448776926	0.605868252	1.106800345	8.10609487	0.376796558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9603	NO	$225/Day: 1-5 for IP; PBP 1a	$225/Day: 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 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 Prosthetics; PBP 11b-c	$65/Visit for ER; PBP 4a-b	$125/Case for OP Surg; PBP 9a-b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$45/Visit for OP PT/OT/ST; $35/Visit for OP Other; PBP 3, 5, 9c"	"$25/Visit for OV; PBP 7a, 14a-b, 14d-e"	"$20/Visit for Chiro; $45/Visit for Consult; $45/Visit for Hearing/Speech Exam; $45/Visit for Vision Exam; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"$45/Visit for PT; PBP 7c, 7i"	$20/Procedure for Phys Rad - Office; PBP 7d	"$50/Visit for Primary Surgery - Office; $45/Visit for Allergy Test; $45/Visit for Cardio; $125/Visit for OP Surg; $45/Other for Other Prof; PBP 7g, 14c"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e												0.477	0.009	0.0891	0	0.0094	0.0034	0.0135	0.0398	0.0627	0	0	0	0	0.0657	0.4938	0.041	0.085	0.0363	0.0387	0.2816	0	0	0	0	0	0	0	0	0	0											1.746	0	NO	2.22E-16	15.8328	0.320308574	2.807177157	0.33746251	0.01491113	1.328524229	0.102364729	1.638811457	4.628823976	0.005312294	0.49319805	0	0	2.714480175	21.08475547	1.31162375	0.533733671	0.642166973	1.145471761	8.387667901	0.376796558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7064
H5883_801_0	2012	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	274.0952239	2.053262574	47.76059055	11.5299765	7.956616427	18.16152093	1.274778382	19.26050649	74.83671199	0.15818351	18.62541141	0	0	32.48432172	32.17544569	42.94178564	0	2.555057534	36.23531425	159.8456838	13.91084877	1.486169597	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing																			0	NO	0.073755111	0.073755111	0.176331184	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.233	0.23	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069595323	0.069595323	0.166386105	0	0.2113664	0.2113664	0.2113664	0.2113664	0.2113664	0.2113664	0.224	0.2198588	0.217028	0.2113664	0.2113664	0.2113664	0	0.2113664	0.2113664	0.2113664	0.2113664	0.2113664	0	0	0	0	0	0	0	0												19.0757	0.142897472	7.946698634	0	1.68176137	3.838735299	0.269445317	4.071023918	15.8179664	0.033434679	4.172092155	0	0	6.866094138	6.800808125	9.076450639	0	0.540053313	7.658927927	33.78600673	2.940286025	0.314126318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0326	0	NO	7.413286176	19.0757	0.142897472	7.946698634	0	1.68176137	3.838735299	0.269445317	4.071023918	15.8179664	0.033434679	4.172092155	0	0	6.866094138	6.800808125	9.076450639	0	0.540053313	7.658927927	33.78600673	2.940286025	0.314126318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.0326	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				1.6816	0.0126	0.7005	0	0.1483	0.3384	0.0238	0.3589	1.3944	0.0029	0.3678	0	0	0.6053	0.5995	0.8001	0	0.0476	0.6752	2.9783	0.2592	0.0277	0	0	0	0	0	0	0	0											11.022	0	NO	0.653502015	20.7573	0.155494285	8.647222456	0	1.830013363	4.177130606	0.293197679	4.42989612	17.2123646	0.03638204	4.539873806	0	0	7.471359637	7.400318478	9.876565277	0	0.58766053	8.334083953	36.76433819	3.199480504	0.341817435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0545
H5883_805_0	2012	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	223.0416062	2.54586441	38.92842398	10.55721523	6.011802636	13.280141	0.547172683	16.65257452	67.03691282	0.061446284	15.94707542	0	0	38.62426032	30.56782014	43.85751293	0	3.817379008	25.8578041	146.6220185	20.33861664	1.390847121	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing																			0	NO	0.076399366	0.076399366	0.178570696	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.233	0.23	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072365479	0.072365479	0.169142163	0	0.2121728	0.2121728	0.2121728	0.2121728	0.2121728	0.2121728	0.224	0.2206976	0.217856	0.2121728	0.2121728	0.2121728	0	0.2121728	0.2121728	0.2121728	0.2121728	0.2121728	0	0	0	0	0	0	0	0												16.1405	0.184232698	6.584437834	0	1.275540998	2.817684701	0.11609516	3.533223363	14.2234095	0.01303723	3.572144895	0	0	8.19501746	6.48565999	9.305371319	0	0.809943993	5.486322698	31.10920421	4.315301242	0.295099928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.4622	0	NO	6.245256926	16.1405	0.184232698	6.584437834	0	1.275540998	2.817684701	0.11609516	3.533223363	14.2234095	0.01303723	3.572144895	0	0	8.19501746	6.48565999	9.305371319	0	0.809943993	5.486322698	31.10920421	4.315301242	0.295099928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.4622	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				1.198	0.0137	0.4887	0	0.0947	0.2091	0.0086	0.2623	1.0557	0.001	0.2651	0	0	0.6083	0.4814	0.6907	0	0.0601	0.4072	2.3091	0.3203	0.0219	0	0	0	0	0	0	0	0											8.496	0	NO	0.46355843	17.3386	0.197907495	7.073172198	0	1.370218894	3.026829258	0.124712402	3.795479263	15.27915171	0.014004927	3.837289772	0	0	8.803298188	6.967062501	9.996068815	0	0.870062635	5.893548721	33.41830599	4.635607403	0.31700392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.9583
H5883_807_0	2012	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	235.9420578	0.772284725	48.36340575	15.34635121	6.859598793	14.99149803	1.57123178	17.07882514	63.18575339	0.11524465	19.16475355	0	0	26.79667165	27.88855012	41.63173788	0	3.013878674	33.20361393	144.583552	16.03268589	1.300113951	0	0	0	0	0	0	0	0											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	Medicare Cost Sharing																			0	NO	0.075950383	0.075950383	0.179187901	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.233	0.23	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.071742732	0.071742732	0.169260891	0	0.2115904	0.2115904	0.2115904	0.2115904	0.2115904	0.2115904	0.224	0.2200918	0.217258	0.2115904	0.2115904	0.2115904	0	0.2115904	0.2115904	0.2115904	0.2115904	0.2115904	0	0	0	0	0	0	0	0												16.9271	0.055405816	8.186033157	0	1.451425253	3.172057065	0.332457561	3.613715443	13.36949883	0.024384662	4.292904795	0	0	5.669918473	5.900949476	8.80887607	0	0.637707794	7.025565953	30.59249159	3.39236242	0.275091631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.728	0	NO	6.631502307	16.9271	0.055405816	8.186033157	0	1.451425253	3.172057065	0.332457561	3.613715443	13.36949883	0.024384662	4.292904795	0	0	5.669918473	5.900949476	8.80887607	0	0.637707794	7.025565953	30.59249159	3.39236242	0.275091631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.728	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				1.447	0.0047	0.6998	0	0.1241	0.2712	0.0284	0.3089	1.1429	0.0021	0.367	0	0	0.4847	0.5044	0.753	0	0.0545	0.6006	2.6151	0.29	0.0235	0	0	0	0	0	0	0	0											9.7218	0	NO	0.56688083	18.3741	0.060142072	8.885799975	0	1.575497463	3.443214076	0.360877037	3.922626745	14.51236394	0.026469136	4.659875252	0	0	6.154600215	6.405380446	9.56188538	0	0.692220981	7.626132533	33.2076301	3.682351797	0.298607294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4498
H5884_007_0	2012	9																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	652.4637965	68.82978604	244.9173105	21.72818878	173.3452257	25.49591274	6.378721212	322.0140333	404.6942039	2966.021761	19.99415417	0	0.038543302	440.1841901	4381.535859	4839.561142	279.1121348	204.7011935	18.89154834	23.64113258	53.64210085	0	0	0	244.2823177	0	69.32514028	0	450.00001	0												1a:  Acute - $275/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	275	275	71.78814225	0	175	0.2	0.2	64.75113035	250	37.13900009	0.195614971	0	0.2	40	20.00121372	35.11293872	40	40	0	17.15259896	0.2	0	0	0	35	0	15	0	0	0											NO	240.4444167	240.4444167	62.76748359	0	153.0100833	0.174868667	0.174868667	56.61471915	218.5858333	32.47223714	0.171034646	0	0.174868667	34.97373334	17.48792788	30.70076388	34.97373334	34.97373334	0	14.99726055	0.174868667	0	0	0	35	0	15	0	0	0												13.0734	1.379144813	1.281070273	0	2.210297286	4.458436267	1.115438473	1.519227838	7.371701651	8.026113498	3.419693076	0	0.006740016	1.28290704	6.385331926	12.38151866	0.813466115	0.59659708	0	0.029546019	9.380322654	0	0	0	0.712490093	0	0.086656425	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5301	0	NO	10.74	13.0734	1.379144813	1.281070273	0	2.210297286	4.458436267	1.115438473	1.519227838	7.371701651	8.026113498	3.419693076	0	0.006740016	1.28290704	6.385331926	12.38151866	0.813466115	0.59659708	0	0.029546019	9.380322654	0	0	0	0.712490093	0	0.086656425	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5301	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												4800	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	13.0734	1.379144813	1.281070273	0	2.210297286	4.458436267	1.115438473	1.519227838	7.371701651	8.026113498	3.419693076	0	0.006740016	1.28290704	6.385331926	12.38151866	0.813466115	0.59659708	0	0.029546019	9.380322654	0	0	0	0.712490093	0	0.086656425	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5301
H5887_001_0	2012	6																																				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	7.869329533	6.008058356	332.0134159	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	10% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"10% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$40/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, 14a-b, 14d-e"	$2/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, 14a-e, 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 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	40	0	0	0	0	0	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0.1	40	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	0	0	0.786932953	0.600805836	1.106711386	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1611	0	NO	0	0	0	0	0	0	0.786932953	0.600805836	1.106711386	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1611	NO																																										0	0	0	0	0	0	0	0	0	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	0.786932953	0.600805836	1.106711386	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1611
H5887_007_0	2012	4																																				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	14.98736075	3.348793436	409.9300324	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	10% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"10% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$40/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, 14a-b, 14d-e"	$2/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, 14a-e, 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 14c	No Cost Sharing; PBP 13a-e											0	NO	0	0	0	0	0	0.1	0.1	40	0	0	0	0	0	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.1	0.1	40	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	0	0	1.498736075	0.334879344	1.366433441	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8667	0	NO	0	0	0	0	0	0	1.498736075	0.334879344	1.366433441	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8667	NO																																										0	0	0	0	0	0	0	0	0	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	1.498736075	0.334879344	1.366433441	0	0	0	0	0	0	0	0.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8667
H5887_010_0	2012	3																																						V																																	0	0	0	0	0	0	0	0	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	435.5143383	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"	$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, 14a-b, 14d-e"	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, 14a-e, 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 14c	No Cost Sharing; PBP 13a-e											0	NO	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	0	0	0											NO	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	0	0	0												0	0	0	0	0	0	0	1.270250153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2703	0	NO	0	0	0	0	0	0	0	0	1.270250153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2703	NO																																										0	0	0	0	0	0	0	0	0	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	1.270250153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2703
H5887_806_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_807_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_808_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_809_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_810_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_811_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_812_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_813_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_814_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_815_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_816_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_817_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_818_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_819_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5887_820_0	2012	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	38.24515103	3.623145346	0.309015719	0	2.04830464	13.99471447	5.174750713	7.606434383	1.670173969	26.44340422	24.81858361	0	0	0.000442923	83.67759596	11.01952104	1.231442538	9.595738964	6.69676392	152.4984146	3.924398817	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, 14a-b, 14d-e"	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, 14a-e, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15																				0	NO	0.149953842	0.149953842	0.119151998	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.142864828	0.142864828	0.11351913	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0.213410481	0	0	0	0	0	0	0	0	0												5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	0	NO	4.009120423	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958	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	NO	0	5.4639	0.517620035	0.035079196	0	0.437129678	2.986618741	1.104346037	1.623292817	0.356432629	5.643299603	5.296545857	0	0	9.45E-05	17.85767597	2.351681282	0.262802744	2.047831264	1.429159607	32.54475994	0.837507838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7958
H5896_007_0	2012	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	544.7086404	14.50603759	47.47721689	0	5.772116193	9.574230309	5.553538537	54.85449326	72.38145793	22.67647922	15.19919094	0	0.744005406	35.5566422	66.47464602	141.4341572	4.146134853	10.05560816	17.45590334	39.96190599	30.40683661	4.53479954	0	0	0	0	0	0	0	0											6700	6% Coinsurance for IP Medical; 6% Coinsurance for IP Surgical; PBP 1a	6% Coinsurance for IP Psych; 6% Coinsurance for IP Substance Abuse; PBP 1b	15% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; 20% Coinsurance for Speclst Urgent Care; 20% Coinsurance for Urgent Care - Worldwide; 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 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); 20% Coinsurance for Office-Rad Therapeutic; 20% Coinsurance for Office-Rad Diagnostic; 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; 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"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 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	PBP 14a	"No Cost-Sharing; PBP 13a-e, 14c"											0	NO	0.062390777	0.062390777	0.148758003	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.055408495	0.055408495	0.132110184	0	0.177617582	0.177617582	0.177617582	0.177630716	0.177617582	0.177617582	0.180719197	0	0.177617582	0.177617582	0.177617582	0.177617582	0.177617582	0.177617582	0.183631304	0.177617582	0.177617582	0.180691579	0	0	0	0	0	0	0	0												30.1815	0.803757705	6.272223874	0	1.02522932	1.700551636	0.986406086	9.743842936	12.85621953	4.027741405	2.746785575	0	0.132148441	6.315484807	11.80706588	25.12119299	0.736426447	1.786052805	3.205450285	7.097937109	5.400788791	0.81940009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7662	0	NO	16.54269185	30.1815	0.803757705	6.272223874	0	1.02522932	1.700551636	0.986406086	9.743842936	12.85621953	4.027741405	2.746785575	0	0.132148441	6.315484807	11.80706588	25.12119299	0.736426447	1.786052805	3.205450285	7.097937109	5.400788791	0.81940009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7662	NO																																										0	0	0	0	0	0	0	0	0	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	30.1815	0.803757705	6.272223874	0	1.02522932	1.700551636	0.986406086	9.743842936	12.85621953	4.027741405	2.746785575	0	0.132148441	6.315484807	11.80706588	25.12119299	0.736426447	1.786052805	3.205450285	7.097937109	5.400788791	0.81940009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7662
H5926_001_0	2012	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	333.7177591	30.87066623	25.33246324	0	25.45096425	16.40472296	9.936851601	57.99929257	55.35528791	8.714846457	23.99287196	0	0.079545468	21.34206619	75.39775926	92.04308832	6.403426825	8.841724746	24.99629801	93.57601115	22.8526667	1.211272927	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, 7c, 7i, 9a, 9c, 9d, 14a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8a, 14a, 14f-h"	"Medicare-FFS Cost Sharing; PBP 7a, 7d, 8a, 14a, 14b, 14d-e, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 13a, 14a, 14c"	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		"No Cost-Sharing; PBP 13a-d, 14c"											0	NO	0.069708159	0.069708159	0.178450652	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069634432	0.069634432	0.178261913	0	0.223763086	0.223763086	0.223763086	0.223763086	0.223763086	0.223763086	0.223763086	0	0.223763086	0.223763086	0.223763086	0.223767342	0.223763086	0.223763086	0.223763086	0.223763086	0.223763086	0.223798091	0	0	0	0	0	0	0	0												23.2382	2.149661311	4.515813363	0	5.694986304	3.670771435	2.22350058	12.9781007	12.38647005	1.950060938	5.368719073	0	0.017799339	4.775566593	16.87123529	20.59623721	1.432850548	1.978451615	5.593248784	20.93885704	5.113583226	0.271080569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.7652	0	NO	0.160250103	23.2382	2.149661311	4.515813363	0	5.694986304	3.670771435	2.22350058	12.9781007	12.38647005	1.950060938	5.368719073	0	0.017799339	4.775566593	16.87123529	20.59623721	1.432850548	1.978451615	5.593248784	20.93885704	5.113583226	0.271080569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.7652	NO																																										0	0	0	0	0	0	0	0	0	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	23.2382	2.149661311	4.515813363	0	5.694986304	3.670771435	2.22350058	12.9781007	12.38647005	1.950060938	5.368719073	0	0.017799339	4.775566593	16.87123529	20.59623721	1.432850548	1.978451615	5.593248784	20.93885704	5.113583226	0.271080569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.7652
H5926_002_0	2012	4																															A	A	D		T	Coin	Coin	V	V		V		Coin	V	V	V	V	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	317.8687225	1.990993451	580.6000933	0	291.54364	9.146743749	4.364319422	546.9303226	286.5688468	0	501.2207418	0	0.403471291	575.7669508	4938.234208	3990.161319	62.38419095	419.6319109	1844.518978	415.2682946	41.04202921	0	0	0	40.71929825	0	0	0	0	0											3000	$500/Admit for IP Medical; $500/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$100/Days Custom for SNF;	No Cost-Sharing;	$75/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $30/Visit for PCP Urgent Care;	$50/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	20% Coinsurance for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; $50/Case for OP Fac - Other; 20% Coinsurance for Prof - CORF; $30/Visit for OP Substance Abuse;	$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for PCP Office Visits;	$30/Visit for Prof - Asst Surgeon (OP); $30/Visit for Speclst Office Visits; $25/Proceedure for Cardio; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist;	$30/Visit for Occ Therapy; $30/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$15/Visit for PCP Office Visits; $30/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$20/Exam for Vision Exams (Refractions);	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	500	500	100	0	75	0.2	0.2	61.43205641	50	0	60.44337206	0	0.2	43.80879108	15	27.67674484	30	30	11.72163099	29.74995554	0.2	0	0	0	20	0	0	0	0	0											NO	441.0611907	441.0611907	88.21223815	0	66.15917861	0.176424476	0.176424476	54.1905919	44.10611907	0	53.3184513	0	0.176424476	38.64471512	13.23183572	24.41427607	26.46367144	26.46367144	10.33991304	26.24310163	0.176424476	0	0	0	20	0	0	0	0	0												11.6833	0.073179162	4.268002808	0	1.607357313	1.613709476	0.769972768	2.469873159	1.05328664	0	2.227026143	0	0.071182211	1.854195816	5.44515865	8.118074999	0.137576228	0.925416751	1.589347153	0.908160672	7.24081851	0	0	0	0.067865497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1235	0	NO	6.956171164	11.6833	0.073179162	4.268002808	0	1.607357313	1.613709476	0.769972768	2.469873159	1.05328664	0	2.227026143	0	0.071182211	1.854195816	5.44515865	8.118074999	0.137576228	0.925416751	1.589347153	0.908160672	7.24081851	0	0	0	0.067865497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1235	NO																																										0	0	0	0	0	0	0	0	0	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	11.6833	0.073179162	4.268002808	0	1.607357313	1.613709476	0.769972768	2.469873159	1.05328664	0	2.227026143	0	0.071182211	1.854195816	5.44515865	8.118074999	0.137576228	0.925416751	1.589347153	0.908160672	7.24081851	0	0	0	0.067865497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1235
H5928_001_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1386.830034	117.6494665	974.1459916	36.04461146	762.9308818	29.03920194	0.250861076	638.6044886	41.81657776	0	0	0	0	3838.658593	6630.060496	5152.043447	972.1928096	0	6700.889883	57796.93136	447.2589976	66.62905036	1027.208226	469.9475402	2121.068164	0	141.7958614	10.73668888	0	3521.459834											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	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Transportation: $0 copay for 24 round trips annually (all SNP Plans)	No Cost Sharing; Dental Reimbursement: Up to $500 for non-covered dental benefit costs incurred during benefit year	"Vision: $0 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every year, $200 limit for eyewear every year"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Acupuncture and non-Medicare Covered Chiropractic $0, 15 visits each; Member Incentive Program, Gym Membership; $0 copay for refraction test once every year; OTC Benefit"													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5928_004_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1420.00326	120.4636631	1307.47232	81.09405631	638.357658	32.26502585	0.652344374	467.3947766	30.16809801	0	0	0	0	3165.615095	5463.392359	4243.967662	799.8202914	0	5512.90834	47505.6481	409.1856284	54.81553242	897.671908	364.3314561	1742.713725	0	116.6550566	5.323782002	0	1742.713725											3400	"Inpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 0 to 20% Coinsurance	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; $10 Dialysis Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $1000 towards cost of hearing aid annually		Member Incentive Program; $0 copay for refraction test once every two years													19.27569936	19.27569936	28.47426425	0	100	0.2	0.2	47.43790069	20	0	0	0	0	18.42983058	0	5	10	0	0.003119909	0.861429227	144.5414659	0	0	0	4.990544418	0	10	0	0	0											NO	18.19857564	18.19857564	26.88312585	0	94.42	0.188824024	0.188824024	44.7870766	18.88240244	0	0	0	0	17.3999739	0	4.720600611	9.441201222	0	0.002945569	0.813292668	136.4645064	0	0	0	4.711673406	0	9.441201222	0	0	0												2.1535	0.182688924	2.929078577	0	5.022810839	6.09241203	0.12317829	1.744437139	0.047470514	0	0	0	0	4.590135002	0	1.669506361	0.629272026	0	0.001353221	3.219666273	4.653276235	0	0	0	0.68425816	0	0.091780322	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8348			1.853934742	2.1535	0.182688924	2.929078577	0	5.022810839	6.09241203	0.12317829	1.744437139	0.047470514	0	0	0	0	4.590135002	0	1.669506361	0.629272026	0	0.001353221	3.219666273	4.653276235	0	0	0	0.68425816	0	0.091780322	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8348	NO																																																																																		0			0	2.1535	0.182688924	2.929078577	0	5.022810839	6.09241203	0.12317829	1.744437139	0.047470514	0	0	0	0	4.590135002	0	1.669506361	0.629272026	0	0.001353221	3.219666273	4.653276235	0	0	0	0.68425816	0	0.091780322	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8348
H5928_005_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1149.567097	97.52165176	703.8377819	55.35522326	868.4898536	15.27131793	0.186130566	646.0122739	75.77537048	0	0	0	0	3276.10837	6807.075964	5289.178906	998.7791269	0	6896.441508	59398.51889	497.1528381	56.36471491	1397.807729	285.424036	2179.313694	0	145.6735179	13.0862272	0	3417.372481											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	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Transportation: $0 copay for 24 round trips annually (all SNP Plans)	No Cost Sharing; Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"Vision: $0 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Acupuncture and non-Medicare Covered Chiropractic $0, 15 visits each; Member Incentive Program, Gym Membership; $0 copay for refraction test once every two years; OTC Benefit"													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5928_006_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1204.289588	102.1639451	1298.475581	179.5592743	1037.718938	23.67695934	0.659968389	707.2822898	93.10899005	0	0	0	0	3398.639419	6977.143438	5419.734145	1023.806363	0	7063.889568	60815.43756	538.0051527	57.77709226	1715.671934	299.6224074	2229.237342	0	149.3237799	17.74602074	0	616.32											3400	"IInpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $75 Copay	DME: 0 to 20% Coinsurance	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; $10 Dialysis Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years,"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		"Acupuncture: $5 copay/visit, 15 visits; Routine Chiropractic: $10 copay/visit, 15 visits; Member Incentive Program; $0 copay for gym membership; $0 copay for refraction test once every two years."													19.65973033	19.65973033	27.11584566	0	75	0.196003673	0.11310336	46.88172017	21.891836	0	0	0	0	20.88174258	0	4.981406274	10	0	0.002703344	0.860239923	122.7666845	0	0	0	4.99393717	0	10	0	0	7.5											NO	18.57406147	18.57406147	25.61842791	0	72	0.185179767	0.106857455	44.29277196	20.68290362	0	0	0	0	19.72859057	0	4.706318184	9.447770218	0	0.002554057	0.812734912	115.9871425	0	0	0	4.718157086	0	9.447770218	0	0	7.085827663												1.864	0.158133283	2.772075255	0	6.226313628	4.384493802	0.070522543	2.610624431	0.160480356	0	0	0	0	5.587530466	0	2.12558278	0.806057272	0	0.001503465	4.118902441	5.200140028	0	0	0	0.876490997	0	0.11756473	0	0	0.363928109	0	0	0	0	0	0	0	0	0	0	37.4444			2.06911533	1.864	0.158133283	2.772075255	0	6.226313628	4.384493802	0.070522543	2.610624431	0.160480356	0	0	0	0	5.587530466	0	2.12558278	0.806057272	0	0.001503465	4.118902441	5.200140028	0	0	0	0.876490997	0	0.11756473	0	0	0.363928109	0	0	0	0	0	0	0	0	0	0	37.4444	NO																																																																																		0			0	1.864	0.158133283	2.772075255	0	6.226313628	4.384493802	0.070522543	2.610624431	0.160480356	0	0	0	0	5.587530466	0	2.12558278	0.806057272	0	0.001503465	4.118902441	5.200140028	0	0	0	0.876490997	0	0.11756473	0	0	0.363928109	0	0	0	0	0	0	0	0	0	0	37.4444
H5928_007_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	955.7285452	81.07767404	347.403725	38.91463463	698.4661658	30.0305194	0.291561718	712.8381542	48.11174762	0	0	0	0	3430.610391	5495.9066	4271.824651	804.1215696	0	5547.219283	47843.63119	495.3058053	58.94305888	1286.121805	282.0722771	1754.750413	0	117.2824048	10.84687059	0	3155.142083											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	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Transportation: $0 copay for 24 round trips annually (all SNP Plans)	No Cost Sharing; Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"Vision: $0 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every year, $200 limit for eyewear every year"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Acupuncture and non-Medicare Covered Chiropractic $0, 15 visits each; Member Incentive Program, Gym Membership; $0 copay for refraction test once every year; OTC Benefit"													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5928_008_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1399.232789	118.701634	1069.205771	110.9624773	740.8982465	39.96603482	0.815384061	632.2492786	48.09026865	0	0	0	0	3132.215159	4973.801274	3863.13232	724.5914832	0	5019.907974	43159.58416	552.3825811	53.11340981	1776.00979	259.0222762	1579.730196	0	105.6828157	14.68303668	0	1632.979009											3400	"Inpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 0 to 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; Dialysis $10 Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years, $0 copay for refraction test once every two years."		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		Member Incentive Program; $0 copay for refraction test once every two years.													21.78047663	21.78047663	26.67864361	0	100	0.203428712	0.096591162	51.20074624	12.40158987	0	0	0	0	22.14371369	0	4.984065636	10	0	0.000322441	0.872709753	126.8636329	0	0	0	4.987602851	0	10	0	0	0											NO	20.66482373	20.66482373	25.3120938	0	93.25396825	0.193008562	0.09164351	48.57811029	11.76634805	0	0	0	0	21.00945483	0	4.728768777	9.487773881	0	0.000305925	0.82800728	120.3653463	0	0	0	4.732124806	0	9.487773881	0	0	0												2.4096	0.204412362	2.255319731	0	5.757641796	7.713786925	0.074724657	2.559456266	0.047153903	0	0	0	0	5.48384441	0	1.522321625	0.572896679	0	0.000127976	2.978037491	5.540643386	0	0	0	0.622956704	0	0.083557888	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8265			1.890267801	2.4096	0.204412362	2.255319731	0	5.757641796	7.713786925	0.074724657	2.559456266	0.047153903	0	0	0	0	5.48384441	0	1.522321625	0.572896679	0	0.000127976	2.978037491	5.540643386	0	0	0	0.622956704	0	0.083557888	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8265	NO																																																																																		0			0	2.4096	0.204412362	2.255319731	0	5.757641796	7.713786925	0.074724657	2.559456266	0.047153903	0	0	0	0	5.48384441	0	1.522321625	0.572896679	0	0.000127976	2.978037491	5.540643386	0	0	0	0.622956704	0	0.083557888	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8265
H5928_009_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1354.788799	114.9313005	754.2900178	88.1002321	870.0593885	17.68126865	0.290785811	917.0032818	87.36803606	0	0	0	0	4245.805772	5889.213941	4579.830167	839.6770841	0	5923.755949	50246.54797	530.49328	72.72290802	1614.985602	320.8270997	1870.67938	8.061748691	122.3453381	16.77293518	0	3271.07105											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	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Transportation: $0 copay for 24 round trips annually (all SNP Plans)	No Cost Sharing; Dental Reimbursement: Up to $500 for non-covered dental benefit costs incurred during benefit year	"Vision: $0 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every year, $200 limit for eyewear every year"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Acupuncture and non-Medicare Covered Chiropractic $0, 15 visits each; Member Incentive Program, Gym Membership; $0 copay for refraction test once every year; OTC Benefit"													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5928_010_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1013.173077	85.95088728	601.0265467	66.7663535	657.9345445	18.67177675	0.645667897	711.2359839	124.3228066	0	0	0	0	3340.746629	4582.368881	3560.858236	648.842901	0	4569.157855	38760.86653	443.3428112	56.16489794	1417.551619	210.8569688	1442.907352	5.312940453	94.48898034	21.78305586	0	1496.156166											3400	"Inpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 0 to 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; Dialysis $10 Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		Member Incentive Program; $0 copay for refraction test once every two years.													21.50339839	21.50339839	27.10371332	0	100	0.2	0.2	45.00820211	20	0	0	0	0	19.2562529	0	5	10	0	0.002899434	0.850769997	144.7601677	0	0	0	4.88217255	0	10	0	0	0											NO	20.33307907	20.33307907	25.62859767	0	94	0.189115029	0.189115029	42.55863727	18.91150291	0	0	0	0	18.20823414	0	4.727875729	9.455751457	0	0.002741633	0.804466964	136.8816167	0	0	0	4.61646102	0	9.455751457	0	0	0												1.7167	0.145637182	1.283622296	0	5.153820599	3.531113604	0.122105503	2.522436188	0.195927593	0	0	0	0	5.069091403	0	1.402941269	0.511274767	0	0.001043913	2.598486384	5.057123395	0	0	0	0.555093796	0	0.074455359	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9409			1.575880997	1.7167	0.145637182	1.283622296	0	5.153820599	3.531113604	0.122105503	2.522436188	0.195927593	0	0	0	0	5.069091403	0	1.402941269	0.511274767	0	0.001043913	2.598486384	5.057123395	0	0	0	0.555093796	0	0.074455359	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9409	NO																																																																																		0			0	1.7167	0.145637182	1.283622296	0	5.153820599	3.531113604	0.122105503	2.522436188	0.195927593	0	0	0	0	5.069091403	0	1.402941269	0.511274767	0	0.001043913	2.598486384	5.057123395	0	0	0	0.555093796	0	0.074455359	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9409
H5928_012_0	2012	5																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1052.626515	89.29785542	617.4471038	96.82701857	606.6313313	22.57724025	0.627765012	501.5620278	52.92450124	0	0	0	0	2458.195826	4280.068394	3324.993365	625.2927164	0	4355.241664	37258.27024	409.0990689	42.19984321	1382.794566	197.6898175	1363.437362	0	91.19993326	18.80065931	0	1415.722582											3400	"Inpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 0 to 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; Dialysis $10 Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		Member Incentive Program; $0 copay for refraction test once every two years.													22.9218918	22.9218918	25.90213809	0	100	0.193859565	0.061910691	56.63989625	25.71807178	0	0	0	0	19.86185564	0	4.961695057	10	0	0.002350045	0.854823765	114.7114222	0	0	0	4.986889421	0	10	0	0	0											NO	21.6218212	21.6218212	24.43303561	0	94	0.182864351	0.058399277	53.4274274	24.25940907	0	0	0	0	18.7353424	0	4.680280508	9.432825787	0	0.002216757	0.806340365	108.2052862	0	0	0	4.704045913	0	9.432825787	0	0	0												1.8966	0.160898522	1.25717559	0	4.751945429	4.128572379	0.036661023	2.233097402	0.106993094	0	0	0	0	3.837928375	0	1.296825136	0.491523105	0	0.000804543	2.503570602	3.688890151	0	0	0	0.534472662	0	0.071689424	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9977			1.50857541	1.8966	0.160898522	1.25717559	0	4.751945429	4.128572379	0.036661023	2.233097402	0.106993094	0	0	0	0	3.837928375	0	1.296825136	0.491523105	0	0.000804543	2.503570602	3.688890151	0	0	0	0.534472662	0	0.071689424	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9977	NO																																																																																		0			0	1.8966	0.160898522	1.25717559	0	4.751945429	4.128572379	0.036661023	2.233097402	0.106993094	0	0	0	0	3.837928375	0	1.296825136	0.491523105	0	0.000804543	2.503570602	3.688890151	0	0	0	0.534472662	0	0.071689424	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9977
H5928_016_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1131.781359	95.93483784	848.0869138	140.160856	712.4809549	24.50547181	0.882870108	522.5669263	51.70358928	0	0	0	0	3069.104506	5195.96529	4036.610137	757.3477683	0	5258.154341	45075.97593	496.594879	51.90468609	1551.512758	384.2987164	1652.746618	0	110.4603718	9.201486228	0	616.32											3400	"Inpatient Hospital Care: $50 copay (days 1-3), $0 copay (days 4-90), $0 copay additional days"	"Inpatient Mental Health: $50 Copay (days 1-8), $400 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 0 to 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; Dialysis $10 Copay	PCP Visit: $0 Copay/visit	"Specialist: $5 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		"Acupuncture: $5 copay/visit, 15 visits; Routine Chiropractic: $10 copay/visit, 15 visits ; Member Incentive Program; $0 copay for refraction test once every two years."													22.0510174	36.93600708	23.78303199	0	100	0.2	0.2	39.90145081	20	0	0	0	0	2.362161995	0	5	10	0	0	0.759826303	96.37518122	0	0	0	5	0	10	0	0	7.5											NO	20.70677693	34.68437058	22.33320709	0	93	0.187807905	0.187807905	37.46903946	18.78079052	0	0	0	0	2.21816348	0	4.69519763	9.390395261	0	0	0.713506932	90.5001045	0	0	0	4.69519763	0	9.390395261	0	0	7.042796445												1.953	0.277286622	1.578375056	0	5.5217274	4.602321327	0.165809986	1.631673398	0.080919523	0	0	0	0	0.567314628	0	1.579390196	0.592649575	0	0	2.68016844	3.74515737	0	0	0	0.646664334	0	0.086438879	0	0	0.361718025	0	0	0	0	0	0	0	0	0	0	26.0706			1.514959716	1.953	0.277286622	1.578375056	0	5.5217274	4.602321327	0.165809986	1.631673398	0.080919523	0	0	0	0	0.567314628	0	1.579390196	0.592649575	0	0	2.68016844	3.74515737	0	0	0	0.646664334	0	0.086438879	0	0	0.361718025	0	0	0	0	0	0	0	0	0	0	26.0706	NO																																																																																		0			0	1.953	0.277286622	1.578375056	0	5.5217274	4.602321327	0.165809986	1.631673398	0.080919523	0	0	0	0	0.567314628	0	1.579390196	0.592649575	0	0	2.68016844	3.74515737	0	0	0	0.646664334	0	0.086438879	0	0	0.361718025	0	0	0	0	0	0	0	0	0	0	26.0706
H5928_018_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V		V	V	P	V	V		V																																																			0	YES	1529.345927	129.7432622	1631.293848	0	525.772183	29.28924788	0.165176678	383.4071022	0.526341419	0	0	0	0	3236.536153	5721.448497	4443.900203	842.1591986	0	5752.940636	49894.23564	283.7970852	57.71722142	0	336.9179827	1831.495059	0	122.8302533	0	0	642											3400	"Inpatient: $100 Copay (days 1-5), $50 Copay (days 6-30)"	"Inpatient Mental Health: $75 Copay (days 1-8), $600 out of pocket limit with every benefit period"	"Skilled Nursing Facility: $50 Copay (days 1-20), $75 Copay (days 21-100)"	No Cost Sharing	Ambulance: $100 Copay	"DME: 20% Coinsurance, 20% coinsurance for inserts"	Prosthetic Devices: 20% Coinsurance: Diabetes Programs & Supplies: $0 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 (contracted) to $75 (noncontracted) Copay for each ASC or outpatient visit; Rehab: $15 Copay/visit; Lab/Rad: 10% Copay for therapeutic radiology services; Dialysis: $10 copay; Urgently Need Care $25/visit copay; Cardiac and Pulmonay Rehab Services $10 copay/visit	PCP Visit: $0 Copay/visit	Specialist: $15 Copay/visit; Urgent Care Visit: $15 Copay/visit	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $15 Copays for Medicare-covered visits; Podiatry: $15 Copay; PTOTST $15 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	$10 Dental Copayment; Dental Reimbursement: Up to $275 for non-covered dental benefit costs incurred during benefit year	"Eye Exam: $20 copay for eye exams.  1 pair of glasses/year, $150 limit for eyewear every year."		Hearing Exam: $10 copay	Hearing Aid:  $1000 towards cost of hearing aid annually		"Acupuncture: $5 copay/visit, 15 visits; non-Medicare Covered Chiro $15; $0 copay for gym membership;  Member Incentive Program;$0 copay for refraction test once per year."													75.03528748	51.9845004	58.55068077	0	100	0.2	0.2	39.85064022	20	0	0	0	0	1.690634729	0	15	10	0	0	1.117150059	179.8146853	0	0	10	20	0	10	0	0	10											NO	72.54816843	50.26142255	56.60996036	0	96	0.193370802	0.193370802	38.52975121	19.33708016	0	0	0	0	1.634596964	0	14.50281012	9.668540079	0	0	1.080121012	173.8545491	0	0	9.668540079	19.33708016	0	9.668540079	0	0	9.668540079												9.2459	0.54342341	7.69562334	0	4.206177464	5.66368534	0.031940347	1.231048355	0.000848159	0	0	0	0	0.440869347	0	5.370753402	0.678537497	0	0	4.490984357	4.111617857	0	0	0.271458752	2.951313897	0	0.098965769	0	0	0.517266894	0	0	0	0	0	0	0	0	0	0	47.5505			1.558555485	9.2459	0.54342341	7.69562334	0	4.206177464	5.66368534	0.031940347	1.231048355	0.000848159	0	0	0	0	0.440869347	0	5.370753402	0.678537497	0	0	4.490984357	4.111617857	0	0	0.271458752	2.951313897	0	0.098965769	0	0	0.517266894	0	0	0	0	0	0	0	0	0	0	47.5505	NO																																																																																		0			0	9.2459	0.54342341	7.69562334	0	4.206177464	5.66368534	0.031940347	1.231048355	0.000848159	0	0	0	0	0.440869347	0	5.370753402	0.678537497	0	0	4.490984357	4.111617857	0	0	0.271458752	2.951313897	0	0.098965769	0	0	0.517266894	0	0	0	0	0	0	0	0	0	0	47.5505
H5928_020_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1213.922242	102.9332938	911.7249173	150.6766758	730.8512822	22.28528807	0.891485887	536.4319542	55.58274389	0	0	0	0	3081.103586	5200.08883	4039.796088	757.3477683	0	5264.83385	45091.93254	514.7047105	51.90468609	1667.917789	387.853541	1653.173983	0	110.4603718	9.891844252	0	1706.422796											3400	"Inpatient Hospital Care: $100 copay (days 1-5), $0 copay (days 6-90), $0 copay additional days"	"Inpatient Mental Health: $100 Copay (days 1-8), $800 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $5 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: $0 Copay 10% copay/therapeutic radiology services; $10 Dialysis Copay	PCP Visit: $0 Copay/visit	"Specialist: $10 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered visits and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $100 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		Member Incentive Program; $0 copay for refraction test once every two years.													65.95283275	79.07291949	23.62455257	0	100	0.2	0.2	39.90399799	20	0	0	0	0	2.421486005	0	10	10	0	0	0.760942723	88.65351651	0	0	0	5	0	10	0	0	0											NO	63.13186556	75.69077347	22.61407152	0	95.72275054	0.191445501	0.191445501	38.19720445	19.14455011	0	0	0	0	2.317913008	0	9.572275054	9.572275054	0	0	0.728395305	84.86158446	0	0	0	4.786137527	0	9.572275054	0	0	0												6.3864	0.649258385	1.71815104	0	5.82992458	4.266418142	0.170670962	1.707516752	0.088675552	0	0	0	0	0.595144173	0	3.222503276	0.604128429	0	0	2.737062662	3.639888105	0	0	0	0.659359837	0	0.088113088	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3632			1.446110533	6.3864	0.649258385	1.71815104	0	5.82992458	4.266418142	0.170670962	1.707516752	0.088675552	0	0	0	0	0.595144173	0	3.222503276	0.604128429	0	0	2.737062662	3.639888105	0	0	0	0.659359837	0	0.088113088	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3632	NO																																																																																		0			0	6.3864	0.649258385	1.71815104	0	5.82992458	4.266418142	0.170670962	1.707516752	0.088675552	0	0	0	0	0.595144173	0	3.222503276	0.604128429	0	0	2.737062662	3.639888105	0	0	0	0.659359837	0	0.088113088	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3632
H5928_022_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1523.433239	129.2365728	1631.293848	0	524.8537889	25.61950709	0.144481179	382.35981	0.455820075	0	0	0	0	3236.3246	5720.814778	4443.412694	842.1591986	0	5752.277265	49893.30692	283.7970852	57.71722142	0	336.9179827	1831.495059	0	122.8302533	0	0	1884.743872											3400	"Inpatient Hospital Care: $100 copay (days 1-5), $0 copay (days 6-90), $0 copay additional days"	"Inpatient Mental Health: $100 Copay (days 1-8), $800 out of pocket limit every benefit period"	"Skilled Nursing Facility: $0 copay (days 1-20), $50 copay (days 21-100), covers 100 days per benefit period"	No Cost Sharing	Ambulance: $100 Copay	DME: 20% Coinsurance; 20% coinsurance for inserts	Prosthetic Devices: 20% Coinsurance; Diabetes Program & Supplies: $5 copay for diabetic monitoring supplies	"ER: $50 Copay, $25000 limit for emergency services outside the U.S. every year"	Surgery: $20 ASC					Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit; Surgery: $20 to $50 Copay for each ASC or outpatient visit; Rehab: $10 Copay/visit; Lab/Rad: $0 Copay 10% copay/therapeutic radiology services; $10 Dialysis Copay	PCP Visit: $0 Copay/visit	"Specialist: $10 Copay/visit; Urgent Care Visit: $15 copay/visit (in network), $25 copay/visit (out-of-network)"	Mental Health: $10 Copay/visit; Substance Abuse: $10 Copay/visit			Chiropractic: $5 Copays for Medicare-covered visits; Podiatry: $5 Copay for Medicare-covered visits and routine visits; PTOTST $10 copay	Part B Drugs: 20% Coinsurance	Blood: $0 Copay	Transportation: $0 copay for 24 round trips annually	Dental Reimbursement: Up to $100 for non-covered dental benefit costs incurred during benefit year	"$5 copay for up to 1 routine eye exam/year, $0 copay for 1 pair of glasses every two years, $150 limit for eyewear every two years"		Hearing Exam: $10 copay	Hearing Aid: $500 towards cost of hearing aid annually		Member Incentive Program;  $0 copay for refraction test once every two years.													70.29102668	84.07437348	22.25385528	0	100	0.2	0.2	39.85023112	20	0	0	0	0	1.530756885	0	10	10	0	0	0.744780569	157.2851451	0	0	0	5	0	10	0	0	0											NO	67.63178237	80.89367874	21.41194927	0	96.21680827	0.192433617	0.192433617	38.34262047	19.24336165	0	0	0	0	1.472845417	0	9.621680827	9.621680827	0	0	0.716604092	151.3347465	0	0	0	4.810840414	0	9.621680827	0	0	0												8.586	0.871201817	2.910765093	0	4.208313031	4.930054403	0.027803036	1.22172309	0.000730959	0	0	0	0	0.397217155	0	3.562758227	0.675248918	0	0	2.979478993	3.579029995	0	0	0	0.734252537	0	0.098486124	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7831			1.367652484	8.586	0.871201817	2.910765093	0	4.208313031	4.930054403	0.027803036	1.22172309	0.000730959	0	0	0	0	0.397217155	0	3.562758227	0.675248918	0	0	2.979478993	3.579029995	0	0	0	0.734252537	0	0.098486124	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7831	NO																																																																																		0			0	8.586	0.871201817	2.910765093	0	4.208313031	4.930054403	0.027803036	1.22172309	0.000730959	0	0	0	0	0.397217155	0	3.562758227	0.675248918	0	0	2.979478993	3.579029995	0	0	0	0.734252537	0	0.098486124	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7831
H5932_001_0	2012	5																															D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	3067.356869	268.9071938	56.11925166	28.65914801	24.76921632	26.60985287	15.69298745	47.31558838	39.13473012	20.05140244	24.4971383	1.1123374	0.224964484	58.66127527	23.62153108	161.0253582	42.10253763	0.488112668	1.01218512	14.59546975	27.6446492	0.030579426	2.998895509	6.150766565	3.81323151	0	0.515209281	1.145826666	1.690099245	0.852191689											3400	$175/day: PBP 1a	"$115/day for days 1-15, $0 per day after day 15: PBP 1b"	FFS Medicare: PBP 2	FFS Medicare: PBP 6	FFS Medicare: PBP 10a	FFS Medicare: PBP 11a	"FFS Medicare: PBP 11b, 11c"	"FFS Medicare: PBP 4a, 4b"	"FFS Medicare: PBP 9a, 9b"	FFS Medicare: PBP 8a	FFS Medicare: PBP 8b	FFS Medicare: PBP 5	FFS Medicare: PBP 12	"FFS Medicare: PBP 3, 5, 9a, 9c, 9d"	"FFS Medicare: PBP 7a, 14a, 14b, 14d, 14e"	"FFS Medicare: PBP 7b, 7d, 7f, 7g, 14a, 14b, 14d, 14e"	"FFS Medicare: PBP 7e, 7h"	"FFS Medicare: PBP 7c, 7i"	FFS Medicare: PBP 7d	"FFS Medicare: PBP 7b, 7f, 7g, 14a, 14b, 14d, 14e"	FFS Medicare: PBP 15	"FFS Medicare: PBP 9d, 14a"																					170.5993114	61.64945755	0.114547123	0	0.199377943	0.214787746	0.212242966	0.2	0.170575011	4.43E-05	0.21627151	0.204285216	0.194105258	0.205725218	0.2763531	0.226727212	0.289389609	0.203010388	0.208475694	2.63E-05	0.223431449	0.121994207	0	0.014295593	0	0	0	0	0	0.008369951											NO	170.5993114	61.64945755	0.114547123	0	0.199377943	0.214787746	0.212242966	0.2	0.170575011	4.43E-05	0.21627151	0.204285216	0.194105258	0.205725218	0.2763531	0.226727212	0.289389609	0.203010388	0.208475694	2.63E-05	0.223431449	0.121994207	0	0.014295593	0	0	0	0	0	0.008369951												43.6074	1.381498552	6.428298846	0	4.938435407	5.71547033	3.330726199	9.463117676	6.675407013	0.000888424	5.298033082	0.227234086	0.043666789	12.06810365	6.52788335	36.50883054	12.18403691	0.099091942	0.211015995	0.000383231	6.176684018	0.003730513	0	0.087928854	0	0	0	0	0	0.007132803	0	0	0	0	0	0	0	0	0	0	160.985				43.6074	1.381498552	6.428298846	0	4.938435407	5.71547033	3.330726199	9.463117676	6.675407013	0.000888424	5.298033082	0.227234086	0.043666789	12.06810365	6.52788335	36.50883054	12.18403691	0.099091942	0.211015995	0.000383231	6.176684018	0.003730513	0	0.087928854	0	0	0	0	0	0.007132803	0	0	0	0	0	0	0	0	0	0	160.985	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				43.6074	1.381498552	6.428298846	0	4.938435407	5.71547033	3.330726199	9.463117676	6.675407013	0.000888424	5.298033082	0.227234086	0.043666789	12.06810365	6.52788335	36.50883054	12.18403691	0.099091942	0.211015995	0.000383231	6.176684018	0.003730513	0	0.087928854	0	0	0	0	0	0.007132803	0	0	0	0	0	0	0	0	0	0	160.985
H5938_001_0	2012	10																															D	D	D		T	Coin	Coin	V	V		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	686.3310163	0	887.2759972	0	145.5410934	8.444888254	1.053340329	474.6685466	530.0876089	0	341.3005343	0	0	84.21228687	3465.788953	5604.297944	273.3340745	408.9880437	2405.447423	0	0	0	0	0	0.613118942	0	0.600237797	0	0	0											3400	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical; PBP 1a	$150/Days 1-5 for IP Psych; $150/Days 1-5 for IP Substance Abuse; PBP 1b	$100/Days 7-100 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; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Service for OP Fac - CT/MRI/PET; PBP 8b	$30/Visit for Partial Hospitalization; 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; $40/Visit for OP Fac - Other; PBP 3, 7c, 7i"	"$10/Visit for PCP Office Visits; $10/Visit for Physical Exams; PBP 4b, 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Cardio; $20/Visit for Chiropractor; $10/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"	"$40/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 7d, 8b"	"$10 Primary/$30 Specialist Visit for Allergy Testing; $10 Primary/$30 Specialist Visit for Allergy Tx; $10/Service for Prof Path (OP); $10/Service for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"$20/Visit Misc Medical; PBP 7g, 9d"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$10/Exam for Vision (Refractions); 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	No Cost-Sharing; PBP 13b											0	NO	150	0	100	0	100	0.2	0.2	37.47326333	100	0	44.32299104	0	0	32.08935839	10	26.44509238	30	30	49.59236451	0	0	0	0	0	10	0	30	0	0	0											NO	142.6172461	0	95.0781641	0	95.0781641	0.190156328	0.190156328	35.6288908	95.0781641	0	42.14148615	0	0	30.50997283	9.542734043	25.14350833	28.52344923	28.52344923	47.15150971	0	0	0	0	0	10	0	30	0	0	0												8.1569	0	7.030047739	0	1.15314833	1.605848943	0.200299329	1.409326151	4.199979722	0	1.198575978	0	0	0.214109549	2.756091852	11.74264267	0.64970255	0.972145808	9.451706459	0	0	0	0	0	0.000510932	0	0.001500594	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7425	0	NO	2.616037008	8.1569	0	7.030047739	0	1.15314833	1.605848943	0.200299329	1.409326151	4.199979722	0	1.198575978	0	0	0.214109549	2.756091852	11.74264267	0.64970255	0.972145808	9.451706459	0	0	0	0	0	0.000510932	0	0.001500594	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7425	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	NO	0	8.1569	0	7.030047739	0	1.15314833	1.605848943	0.200299329	1.409326151	4.199979722	0	1.198575978	0	0	0.214109549	2.756091852	11.74264267	0.64970255	0.972145808	9.451706459	0	0	0	0	0	0.000510932	0	0.001500594	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7425
H5938_006_0	2012	9																															A	A	D		T	Coin	Coin	V	V		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	242.7612328	0.388468038	917.2019914	0	192.9380003	14.04818614	3.565526763	465.3029017	554.2943334	0	360.124674	0	0	260.1741591	4054.827647	6271.028024	416.2140581	477.4607502	987.3878645	1147.152233	75.85223095	70.70162695	0	0	60.34248121	0	23.4653818	0	0	0											3400	"$250 per admit, $100 per day (days 6-10), $750 max; PBP 1a"	"$250 per admit, $100 per day (days 6-10), $750 max; PBP 1b"	$75/Days 7-100 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; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Service for OP Fac - CT/MRI/PET; PBP 8b	$25/Visit for Partial Hospitalization; PBP 5	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, 7c, 7i"	"$10/Visit for PCP Office Visits; $10/Visit for Physical Exams; PBP 4b, 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Cardio; $20/Visit for Chiropractor; $10/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, 8b"	"$10 Primary/$25 Specialist Visit for Allergy Testing; $10 Primary/$25 Specialist Visit for Allergy Tx; $10/Service for Prof Path (OP); $10/Service for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"$20/Visit for Renal Dialysis - Prof; PBP 7g, 9d"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$10/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; PBP 14a	No Cost-Sharing; PBP 13b											0	NO	363.651164	363.651164	75	0	100	0.2	0.2	38.23666103	100	0	55.40890557	0	0	36.48566478	10	22.72246782	25	25	63.33513658	10.14155585	20.95	20	0	0	10	0	25	0	0	0											NO	348.1384003	348.1384003	71.8006227	0	95.7341636	0.191468327	0.191468327	36.60554763	95.7341636	0	53.04525231	0	0	34.92924602	9.601716754	21.75316452	23.9335409	23.9335409	60.63336327	9.70893367	20.05630727	19.14683272	0	0	10	0	25	0	0	0												7.0429	0.011270053	5.487972844	0	1.539229841	2.6897827	0.682685445	1.419388961	4.422075367	0	1.591908683	0	0	0.757307268	3.244442213	11.36789203	0.830123015	0.952277199	4.989053923	0.928135412	0.126776304	0.112809352	0	0	0.050285401	0	0.048886212	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2952	0	NO	2.137585925	7.0429	0.011270053	5.487972844	0	1.539229841	2.6897827	0.682685445	1.419388961	4.422075367	0	1.591908683	0	0	0.757307268	3.244442213	11.36789203	0.830123015	0.952277199	4.989053923	0.928135412	0.126776304	0.112809352	0	0	0.050285401	0	0.048886212	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2952	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.0429	0.011270053	5.487972844	0	1.539229841	2.6897827	0.682685445	1.419388961	4.422075367	0	1.591908683	0	0	0.757307268	3.244442213	11.36789203	0.830123015	0.952277199	4.989053923	0.928135412	0.126776304	0.112809352	0	0	0.050285401	0	0.048886212	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2952
H5938_802_0	2012	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	191.9980755	0	62.51375503	0	7.49578121	13.23176898	6.944567664	16.40394227	65.8329999	0.90294273	10.37235787	0	0.330109833	5.91431252	50.56872882	151.4464658	1.860263374	4.895171735	39.68566249	45.0855805	38.05603467	0.718433038	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 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"																			0	NO	0.085611318	0	0.167918089	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.077703253	0	0.152407206	0	0.203308734	0.181525655	0.203308734	0.203308734	0.203308734	0.203308734	0.203308734	0	0.181525655	0.203308734	0.203308734	0.203308734	0.203308734	0.203308734	0.203308734	0.203308734	0.181525655	0.203308734	0	0	0	0	0	0	0	0												14.9189	0	9.527546718	0	1.523957789	2.401905537	1.411891261	3.335064738	13.38442388	0.183576143	2.108790949	0	0.059923404	1.202431392	10.28106424	30.79038925	0.378207792	0.995231169	8.068441804	9.1662923	6.908146638	0.146063711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7922	0	NO	11.88625251	14.9189	0	9.527546718	0	1.523957789	2.401905537	1.411891261	3.335064738	13.38442388	0.183576143	2.108790949	0	0.059923404	1.202431392	10.28106424	30.79038925	0.378207792	0.995231169	8.068441804	9.1662923	6.908146638	0.146063711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7922	NO																																										0	0	0	0	0	0	0	0	0	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	14.9189	0	9.527546718	0	1.523957789	2.401905537	1.411891261	3.335064738	13.38442388	0.183576143	2.108790949	0	0.059923404	1.202431392	10.28106424	30.79038925	0.378207792	0.995231169	8.068441804	9.1662923	6.908146638	0.146063711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7922
H5938_803_0	2012	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	196.6503905	0	64.02852895	0	7.677411858	13.55105867	7.109671824	16.75655625	67.42817774	0.92482198	10.62369099	0	0.338108741	6.057622522	50.99554848	154.4419068	1.90524881	4.976067259	40.45984432	46.17766512	38.88639741	0.735841424	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 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"																			0	NO	0.085611318	0	0.167918089	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.077495114	0	0.151998962	0	0.202764143	0.181039414	0.202764143	0.202764143	0.202764143	0.202764143	0.202764143	0	0.181039414	0.202764143	0.202764143	0.202764143	0.202764143	0.202764143	0.202764143	0.202764143	0.181039414	0.202764143	0	0	0	0	0	0	0	0												15.2394	0	9.732269912	0	1.556703838	2.453275715	1.441586516	3.397628771	13.67201669	0.187520736	2.154103602	0	0.061211008	1.228268641	10.3400687	31.3152809	0.386316143	1.008968015	8.203805669	9.363174704	7.039970584	0.149202256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9308	0	NO	12.45584032	15.2394	0	9.732269912	0	1.556703838	2.453275715	1.441586516	3.397628771	13.67201669	0.187520736	2.154103602	0	0.061211008	1.228268641	10.3400687	31.3152809	0.386316143	1.008968015	8.203805669	9.363174704	7.039970584	0.149202256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9308	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.2394	0	9.732269912	0	1.556703838	2.453275715	1.441586516	3.397628771	13.67201669	0.187520736	2.154103602	0	0.061211008	1.228268641	10.3400687	31.3152809	0.386316143	1.008968015	8.203805669	9.363174704	7.039970584	0.149202256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9308
H5938_804_0	2012	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	195.4565197	0	53.03116041	0	7.750474451	13.49764768	5.123973976	15.17482742	71.81233419	0.77102979	8.962265984	0	0.415986309	5.397187673	50.74470529	147.7245415	1.18213947	5.250068234	40.66658236	44.83246431	35.44638005	0.492831668	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 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"																			0	NO	0.085611318	0	0.167918089	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.077869334	0	0.152732957	0	0.203743281	0.181913644	0.203743281	0.203743281	0.203743281	0.203743281	0.203743281	0	0.181913644	0.203743281	0.203743281	0.203743281	0.203743281	0.203743281	0.203743281	0.203743281	0.181913644	0.203743281	0	0	0	0	0	0	0	0												15.2201	0	8.099605925	0	1.579107092	2.455406269	1.043975268	3.091769123	14.63128056	0.157092139	1.826001474	0	0.075673585	1.099640723	10.33889273	30.09788272	0.240852974	1.069666126	8.285542906	9.134313361	6.448180145	0.100411141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9954	0	NO	11.43315638	15.2201	0	8.099605925	0	1.579107092	2.455406269	1.043975268	3.091769123	14.63128056	0.157092139	1.826001474	0	0.075673585	1.099640723	10.33889273	30.09788272	0.240852974	1.069666126	8.285542906	9.134313361	6.448180145	0.100411141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9954	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.2201	0	8.099605925	0	1.579107092	2.455406269	1.043975268	3.091769123	14.63128056	0.157092139	1.826001474	0	0.075673585	1.099640723	10.33889273	30.09788272	0.240852974	1.069666126	8.285542906	9.134313361	6.448180145	0.100411141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9954
H5950_001_0	2012	4																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1627.513031	97.69845038	1182.712464	1115.486524	254.5646513	13.00761298	0	309.2883709	354.6852819	2909.155269	2461.111283	58.39504414	0.079857576	649.4450759	2266.945974	7394.258642	282.2723807	784.5310687	0	0	67.73504051	0.007262726	0	0	1292.145317	150	55.49235187	18	0	0											6700	$220/day 1-8; unlimited additional days	$205/day 1-7	"$0/d 1-4, $50/d 5-20, $140/d 21-100; includes non-Medicare covered stays"	$0 per visit	$150 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $50 Urgent Care Ctr	$300 per procedure	$0 to $45 per visit	$0 to $45 X-ray; 20% Therapeutic Radiology; $175 Complex Radiology	$45 per visit	20% per visit	$0 to 300 per visit	$25 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$45 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	167.6030149	98.56078618	77.98824527	0	150	0.03	0.03	63.5	300	4.5	22.65441202	45	0.2	45	25	45	40	22.5	45	45	0.1	0	0	0	0	0	0	0	0	0											NO	153.3698432	90.19081386	71.36533286	0	137.2617103	0.027452342	0	58.10745736	274.5234206	4.117851309	20.73055559	41.17851309	0.183015614	41.17851309	22.87695172	41.17851309	36.60312275	20.58925654	0	0	0.091507807	0	0	0	0	0	0	0	0	0												20.801	0.734291896	7.033722389	0	2.911831618	0.357089441	0	1.497663402	8.114118069	0.998289069	4.25168369	0.200385091	0.014615183	2.228598547	4.321734466	25.37371469	0.861004217	1.346075953	0	0	6.198285005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2441	0	NO	8.671723422	20.801	0.734291896	7.033722389	0	2.911831618	0.357089441	0	1.497663402	8.114118069	0.998289069	4.25168369	0.200385091	0.014615183	2.228598547	4.321734466	25.37371469	0.861004217	1.346075953	0	0	6.198285005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2441	NO																																																																																		0		NO		20.801	0.734291896	7.033722389	0	2.911831618	0.357089441	0	1.497663402	8.114118069	0.998289069	4.25168369	0.200385091	0.014615183	2.228598547	4.321734466	25.37371469	0.861004217	1.346075953	0	0	6.198285005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2441
H5950_801_0	2012	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	0	0	0	0	0	0	0											0	YES	324.7754887	5.974678405	39.65941336	10.33764815	9.67944624	13.42073104	0	16.81288402	41.60486414	20.17534144	56.36233918	0.943430496	0.082393829	27.68693389	27.92123237	139.2056968	3.19051876	8.84407785	0	0	69.88628597	0.000363787	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	NO	0.080779349	0.080779349	0.196197061	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065947007	0.065947007	0.160172237	0	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0.182870125	0	0	0	0	0	0	0	0												21.418	0.394012161	6.352336975	0	1.770081547	2.454250767	0	3.074574207	7.608286719	3.689467216	10.30698803	0.172525253	0.01506737	5.06311307	5.105959263	25.45656321	0.583450565	1.617317625	0	0	12.78011387	6.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8621	0	NO	24.25960249	21.418	0.394012161	6.352336975	0	1.770081547	2.454250767	0	3.074574207	7.608286719	3.689467216	10.30698803	0.172525253	0.01506737	5.06311307	5.105959263	25.45656321	0.583450565	1.617317625	0	0	12.78011387	6.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8621	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		21.418	0.394012161	6.352336975	0	1.770081547	2.454250767	0	3.074574207	7.608286719	3.689467216	10.30698803	0.172525253	0.01506737	5.06311307	5.105959263	25.45656321	0.583450565	1.617317625	0	0	12.78011387	6.65E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8621
H5950_802_0	2012	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	0	0	0	0	0	0	0											0	YES	331.4604435	6.097657066	40.47573538	10.55043117	9.878681288	13.69697411	0	17.15894883	42.46122998	20.59061675	57.52246271	0.962849419	0.084089767	28.25682265	28.49594377	142.0710109	3.256190198	9.026118251	0	0	71.3247771	0.000371275	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	NO	0.08368829	0.08368829	0.184858508	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068381192	0.068381192	0.151046762	0	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0.183029037	0	0	0	0	0	0	0	0												22.6657	0.416965061	6.113728762	0	1.808085521	2.506943979	0	3.140585878	7.771638025	3.768680752	10.52828095	0.176229402	0.015390869	5.171819034	5.215585141	26.00312028	0.595977356	1.65204173	0	0	13.05450525	6.80E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6053	0	NO	24.75894542	22.6657	0.416965061	6.113728762	0	1.808085521	2.506943979	0	3.140585878	7.771638025	3.768680752	10.52828095	0.176229402	0.015390869	5.171819034	5.215585141	26.00312028	0.595977356	1.65204173	0	0	13.05450525	6.80E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6053	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		22.6657	0.416965061	6.113728762	0	1.808085521	2.506943979	0	3.140585878	7.771638025	3.768680752	10.52828095	0.176229402	0.015390869	5.171819034	5.215585141	26.00312028	0.595977356	1.65204173	0	0	13.05450525	6.80E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6053
H5969_001_0	2012	7																															D	D	D		Coin	Coin	Coin	V	Coin		Coin		Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin			V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	764.7100471	4.210653457	12.39468768	0	8.262702641	4.173094326	3.045964031	388.2115835	28.24431262	0	11.30166063	0	0.104164632	9.526772165	38.64481544	3615.242224	276.9134546	241.8429209	13.6867244	25.08645277	12.78626819	1.583263763	0	0	98.65298709	0	30.8528195	0	0	49.13701137											3400	$220/Days 1-10 for IP Medical; $220/Days 1-10 for IP Surgical; PBP 1a	$118/Days 1-15 for IP Psych; $118/Days 1-15 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; $30/Visit for PCP Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; 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"	"$35/Visit for OP Subatance Abuse; $35/Visit for OP Psych - Non-Physician; PBP 7h, 9c"	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; PBP 3, 5, 9a"	"25% Coinsurance for Prof - Outpatient Surgery; $2/Visit for PCP Office Visits; $2/Consult for PCP Consults; PBP 7a, 14a"	"25% Coinsurance for Prof - Outpatient Surgery; $20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $30/Visit for Podiatrist; 25% Coinsurance for Cardio; $20/Visit for Chiropractor; 25% Coinsurance for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 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 (Office); PBP 7d	"25% Coinsurance for Prof - Outpatient Surgery; 25% Coinsurance for Prof - Anesthesia (OP); 25% for Other Health Care Professional; 25% Coinsurance for Allergy Testing; 25% Coinsurance for Allergy Tx; 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14a, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"25% Coinsurance for Renal Dialysis - Prof; Blood Services; PBP 9d, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$100 plan maximum per year; 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$500 plan maximum per year; 18b	No Cost-Sharing; PBP 14c	"$50/Visit for ER - Worldwide; $30/Visit for Urgent Care - Worldwide; $25/Visit for Acupuncture; PBP 13b-c, 14b, 4a, 13a"											0	NO	220	118	90	0	0.25	0.2	0.25	49.49615012	0.25	0	0.238019707	0	0.2	0.232254486	0.027563825	24.56679771	35	30	0.234647952	0.25	0.2	0.25	0	0	25	0	30	0	0	26.98962886											NO	200.7738976	107.6878178	82.1347763	0	0.228152156	0.182521725	0.228152156	45.17061353	0.228152156	0	0.217218838	0	0.182521725	0.211957447	0.025154985	22.4198715	31.94130189	27.37825877	0.214141745	0.228152156	0.182521725	0.228152156	0	0	24.54489166	0	30	0	0	25.62896798												12.7945	0.03778634	0.084836242	0	1.885153425	0.761680375	0.694943262	1.461312951	6.44400083	0	2.454933589	0	0.019012308	2.019270306	0.972109738	6.75443884	0.737081354	0.551769839	2.930899045	5.723528295	2.333771727	0.361225042	0	0	0.201785573	0	0.077132049	0	0	0.104944241	0	0	0	0	0	0	0	0	0	0	49.4061	0	NO	4.703681105	12.7945	0.03778634	0.084836242	0	1.885153425	0.761680375	0.694943262	1.461312951	6.44400083	0	2.454933589	0	0.019012308	2.019270306	0.972109738	6.75443884	0.737081354	0.551769839	2.930899045	5.723528295	2.333771727	0.361225042	0	0	0.201785573	0	0.077132049	0	0	0.104944241	0	0	0	0	0	0	0	0	0	0	49.4061	NO																																										0	0	0	0	0	0	0	0	0	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	12.7945	0.03778634	0.084836242	0	1.885153425	0.761680375	0.694943262	1.461312951	6.44400083	0	2.454933589	0	0.019012308	2.019270306	0.972109738	6.75443884	0.737081354	0.551769839	2.930899045	5.723528295	2.333771727	0.361225042	0	0	0.201785573	0	0.077132049	0	0	0.104944241	0	0	0	0	0	0	0	0	0	0	49.4061
H5969_002_0	2012	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	279.7927492	1.904647189	13.91792134	0	15.18335532	8.531050284	9.034389017	29.79083499	42.84859094	2.397426923	24.36683775	0	0.459425665	22.60672566	66.02486973	76.75929811	5.551415246	6.13288561	21.75617772	61.45750455	50.06978148	5.729962027	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 7h, 9c"	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a"	"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, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14d"	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 14c	"No Cost-Sharing; PBP 13b-c, 14b, 4a, 13a"											0	NO	0.080460577	0.080460577	0.180194296	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.07323738	0.07323738	0.164017692	0	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0.203890821	0	0	0	0	0	0	0	0												20.4913	0.13949137	2.282785341	0	3.095746785	1.739402849	1.842028996	6.074077812	8.736434397	0.488813344	4.968174561	0	0.093672676	4.609303861	13.46186491	15.65051633	1.131882614	1.250439084	4.435884944	12.53062108	10.20876887	1.168286664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3995	0	NO	11.28289966	20.4913	0.13949137	2.282785341	0	3.095746785	1.739402849	1.842028996	6.074077812	8.736434397	0.488813344	4.968174561	0	0.093672676	4.609303861	13.46186491	15.65051633	1.131882614	1.250439084	4.435884944	12.53062108	10.20876887	1.168286664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3995	NO																																										0	0	0	0	0	0	0	0	0	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	20.4913	0.13949137	2.282785341	0	3.095746785	1.739402849	1.842028996	6.074077812	8.736434397	0.488813344	4.968174561	0	0.093672676	4.609303861	13.46186491	15.65051633	1.131882614	1.250439084	4.435884944	12.53062108	10.20876887	1.168286664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3995
H5969_801_0	2012	4																															D	D	D		Coin	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	809.3396831	21.39409413	390.5800686	0	7.379785437	8.673507666	5.767170071	236.5616201	35.26099038	0	22.35815305	0	0.481421034	23.17539431	5269.899876	7121.284929	97.71027224	357.802264	16.05573307	33.1343283	34.65297161	7.791420424	0	0	380.3435638	0	162.1493445	0	0	330.9257477											3400	$220/Days 1-10 for IP Medical; $220/Days 1-10 for IP Surgical; PBP 1a	$118/Days 1-15 for IP Psych; $118/Days 1-15 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; $30/Visit for PCP Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; 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"	"$35/Visit for OP Subatance Abuse; $35/Visit for OP Psych - Non-Physician; PBP 7h, 9c"	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; PBP 3, 5, 9a"	"25% Coinsurance for Prof - Outpatient Surgery; $4/Visit for PCP Office Visits; $4/Consult for PCP Consults; PBP 7a, 14a"	"25% Coinsurance for Prof - Outpatient Surgery; $20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $30/Visit for Podiatrist; 25% Coinsurance for Cardio; $20/Visit for Chiropractor; 25% Coinsurance for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 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 (Office); PBP 7d	"25% Coinsurance for Prof - Outpatient Surgery; 25% Coinsurance for Prof - Anesthesia (OP); 25% for Other Health Care Professional; 25% Coinsurance for Allergy Testing; 25% Coinsurance for Allergy Tx; 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14a, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"25% Coinsurance for Renal Dialysis - Prof; Blood Services; PBP 9d, 14d"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$100 plan maximum per year; 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$500 plan maximum per year; 18b	No Cost-Sharing; PBP 14c	"$50/Visit for ER - Worldwide; $30/Visit for Urgent Care - Worldwide; $25/Visit for Acupuncture; PBP 13b-c, 14b, 4a, 13a"											0	NO	220	118	90	0	0.25	0.2	0.25	47.7076524	0.25	0	0.221758863	0	0.2	0.22000272	5.644799977	20.48103934	35	30	0.24500003	0.25	0.2	0.25	0	0	25	0	30	0	0	25.17685601											NO	186.6938319	100.1357826	76.37474942	0	0.212152082	0.169721665	0.212152082	40.48511108	0.212152082	0	0.188186418	0	0.169721665	0.18669614	4.790224264	17.38038053	29.70129144	25.45824981	0.207909065	0.212152082	0.169721665	0.212152082	0	0	25	0	30	0	0	24.85181963												12.5916	0.178526196	2.485871239	0	1.565636843	1.472082166	1.223517136	0.798101955	7.480692513	0	4.207500725	0	0.08170758	4.326756665	2.103666854	10.31422016	0.241843439	0.759084952	3.338132459	7.029516726	5.881360052	1.652966062	0	0	0.792382425	0	0.405373361	0	0	0.685342249	0	0	0	0	0	0	0	0	0	0	69.6158	0	NO	12.09248098	12.5916	0.178526196	2.485871239	0	1.565636843	1.472082166	1.223517136	0.798101955	7.480692513	0	4.207500725	0	0.08170758	4.326756665	2.103666854	10.31422016	0.241843439	0.759084952	3.338132459	7.029516726	5.881360052	1.652966062	0	0	0.792382425	0	0.405373361	0	0	0.685342249	0	0	0	0	0	0	0	0	0	0	69.6158	NO																																										0	0	0	0	0	0	0	0	0	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	12.5916	0.178526196	2.485871239	0	1.565636843	1.472082166	1.223517136	0.798101955	7.480692513	0	4.207500725	0	0.08170758	4.326756665	2.103666854	10.31422016	0.241843439	0.759084952	3.338132459	7.029516726	5.881360052	1.652966062	0	0	0.792382425	0	0.405373361	0	0	0.685342249	0	0	0	0	0	0	0	0	0	0	69.6158
H5970_001_0	2012	10	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	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	1158.2	63.66	466.32	1091.94	1.05	13.85	3.31	419.98	312.38	1836.94	1026.77	194.82	0.42	5.53	3467.19	3798.09	111.01	538.42		1485.35	17.38	0		3.57	2.86		0.24		3.23	1.28	1638.16	668.27									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	209.635329	41.031527	78.336552	38.455975	0.199656	0.2	10	32.854396	35	40.705765		0	0.2	0		0	0		0		0	0	0	78.052211									NO	125.141091	100.276605	25.462811	0	0.176501	0.176501	0.176501	57.362825	185.004226	36.210528	69.132399	33.93759	0.176198	0.176501	8.82505	28.994169	30.887675	35.923041		0	0.176501	0		0	0		0		0	0	0	68.881467										12.0782	0.53196739	0.989484835	0	0.18532605	2.44453885	0.58421831	2.00760327	4.815968343	5.543047275	5.91525611	0.550976774	0.07400316	0.97605053	2.549843759	9.176871945	0.285736733	1.611806978	0	0	3.06758738	0	0	0	0	0	0	0	0	0	0	3.835951496	0	0	0	0	0	0	0	0	57.2244	0	NO	10.055789	12.0782	0.53196739	0.989484835	0	0.18532605	2.44453885	0.58421831	2.00760327	4.815968343	5.543047275	5.91525611	0.550976774	0.07400316	0.97605053	2.549843759	9.176871945	0.285736733	1.611806978	0	0	3.06758738	0	0	0	0	0	0	0	0	0	0	3.835951496	0	0	0	0	0	0	0	0	57.2244	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	$0-$225/Visit	$0-$50/Visit	$0-$175/Visit	$35-$50/Visit	0%-20% Coins	20% Coins	$10/Visit	$10-$35/Visit	$35/Visit	$35-$50/Visit		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$0/Service	$35-$175/Visit									6000	1.632	0.0719	0.1379	0	1.4091	0.5938	0.1418	0.2179	0.5228	0.6017	0.659	0.0666	0.0082	0.1069	0.3155	1.1356	0.0354	0.188		0	0.3984	0		0	0		0		0	0	0	0.4164									8.659	0	NO	0.703287	13.7102	0.60384239	1.127408835	0	1.59447405	3.03833085	0.72605131	2.22553327	5.338749343	6.144755275	6.57423811	0.617620774	0.08218316	1.08294553	2.865380759	10.31249094	0.321095733	1.799822978	0	0	3.46597738	0	0	0	0	0	0	0	0	0	0	4.252353496	0	0	0	0	0	0	0	0	65.8835
H5970_002_0	2012	10	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	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	1308.36	55.46	471.69	934.64	1.31	13.38	2.88	378.29	316.7	1994.06	1070.82	222.02	0.38	5.53	3400.94	4022.87	122.25	660.77		1821.82	15.51	0		3.57	2.86		0.24		3.23	1.28	3486.77	557.13									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	210.683597	32.657203	88.821968	37.123622	0.199723	0.2	10	32.657385	35	37.549387		0	0.2	0		0	0		0		0	0	0	80.824171									NO	121.778166	97.581865	24.870891	0	0.175539	0.175539	0.175539	57.05011	184.915729	28.663031	77.958509	32.58318	0.175296	0.175539	8.77694	28.663191	30.71929	32.956872		0	0.175539	0		0	0		0		0	0	0	70.93889										13.2775	0.450990853	0.977612548	0	0.22995609	2.34871182	0.50555232	1.798457176	4.880234281	4.762983633	6.956627551	0.602843135	0.06661248	0.97073067	2.487487194	9.609024265	0.312952767	1.814742693	0	0	2.72260989	0	0	0	0	0	0	0	0	0	0	3.293515315	0	0	0	0	0	0	0	0	58.0691	0	NO	11.161307	13.2775	0.450990853	0.977612548	0	0.22995609	2.34871182	0.50555232	1.798457176	4.880234281	4.762983633	6.956627551	0.602843135	0.06661248	0.97073067	2.487487194	9.609024265	0.312952767	1.814742693	0	0	2.72260989	0	0	0	0	0	0	0	0	0	0	3.293515315	0	0	0	0	0	0	0	0	58.0691	YES	20% Coins	20% Coins	"20% Coins(Days 1-8), 20% (Days 9-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						20% Coins	20% Coins									6000	3.3643	0.0527	0.2958	1.1035	1.6145	0.5276	0.1134	0.1805	1.257	0.2373	0.4894	0.0276	0.0067	0.0983	0.6481	1.1443	0.0183	0.0992		0.1621	0.3268	0		0	0		0		0	0	0.1311	0.3128									12.2112	0	NO	3.457839	16.6418	0.503645853	1.273363548	1.103487	1.84443909	2.87634382	0.61895232	1.978922176	6.137206281	5.000262633	7.446044551	0.630456135	0.07333248	1.06898367	3.135634194	10.75331926	0.331235767	1.913935693	0	0.162053	3.04945889	0	0	0	0	0	0	0	0	0	0.131075	3.606317315	0	0	0	0	0	0	0	0	70.2803
H5970_004_0	2012	7	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	D								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0	0	0								0	YES	270.74	9.12	50.9	1264.78	33.27	12.96	16242.22	428.14	381.76	1717.61	1194.42	170.25	0.61	713.87	3441.84	4242.69	119.72	636.85		1666.81	20.13	0		3.57	1.69		0.24		5.23	1.09	0	0	0								5000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										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	0	0	0								NO	0	0	0	0	0	0.199905	0	0	0	0	0	0	0.199905	0	0	0	0	0		0	0.199905	0		0	0		0		0	0	0	0	0									0	0	0	0	0	2.5907688	0	0	0	0	0	0	0.12194205	0	0	0	0	0	0	0	4.02408765	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7368	0	NO	0.003188	0	0	0	0	0	2.5907688	0	0	0	0	0	0	0.12194205	0	0	0	0	0	0	0	4.02408765	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7368	YES	$0/Admit	$0/Admit	"$0/Admit(Days 1-20), $0 (Days 21-100)"	$0/Visit	$0/Trip	20% Coins	$0/Service	$0/Visit	$0/Visit	$0/Visit	$0/Visit	$0/Visit	20% Coins	$0/Visit	$0/Visit	$0/Visit	$0/Visit	$0/Visit		$0/Visit	20% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						$0/Day(Days 1-1)	$0/Day(Days 1-1)	$0/Day(Days 1-100)								7500	0	0	0	0	0	0.5907	0	0	0	0	0	0	0.0125	0	0	0	0	0		0	0.4904	0		0	0		0		0	0	0	0	0								1.0937	0	NO	0.000295	0	0	0	0	0	3.1815098	0	0	0	0	0	0	0.13440705	0	0	0	0	0	0	0	4.51453565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.8305
H5970_005_0	2012	12	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	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	1201.08	53.3	548.95	1099.22	1.1	11.87	3.64	372.09	331.79	1492.77	1038.07	147.96	0.56	7.67	2991.3	3687.32	104.05	553.49		1448.62	18.43	0		3.57	2.86		0.24		3.23	1.28	1593.34	502.16									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	207.469574	36.009117	80.68327	36.775615	0.199634	0.2	10	32.959557	35	38.879061		0	0.2	0		0	0		0		0	0	0	80.952501									NO	125.151094	100.28462	25.071125	0	0.177482	0.177482	0.177482	57.68165	184.110575	31.95485	71.59914	32.635049	0.177157	0.177482	8.8741	29.248641	31.05935	34.501668		0	0.177482	0		0	0		0		0	0	0	71.838058										12.5264	0.445430854	1.146899506	0	0.1952302	2.10671134	0.64603448	1.788563762	5.090503973	3.975103453	6.193743272	0.402390154	0.09920792	1.36128694	2.212091278	8.987424911	0.269310447	1.591360685	0	0	3.27099326	0	0	0	0	0	0	0	0	0	0	3.006183267	0	0	0	0	0	0	0	0	55.3148	0	NO	9.662218	12.5264	0.445430854	1.146899506	0	0.1952302	2.10671134	0.64603448	1.788563762	5.090503973	3.975103453	6.193743272	0.402390154	0.09920792	1.36128694	2.212091278	8.987424911	0.269310447	1.591360685	0	0	3.27099326	0	0	0	0	0	0	0	0	0	0	3.006183267	0	0	0	0	0	0	0	0	55.3148	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	$0-$225/Visit	$0-$50/Visit	$0-$175/Visit	$35-$50/Visit	0%-20% Coins	20% Coins	$10/Visit	$10-$35/Visit	$35/Visit	$35-$50/Visit		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$0/Service	$35-$175/Visit									6000	1.6907	0.0601	0.1611	0	1.478	0.5104	0.1566	0.1937	0.5511	0.4304	0.6894	0.0495	0.0107	0.1488	0.273	1.1093	0.0332	0.1884		0	0.4237	0			0				0	0	0	0.3255									8.4838	0	NO	0.680812	14.2171	0.505550854	1.307993506	0	1.6732232	2.61706634	0.80264148	1.982214762	5.641651973	4.405491453	6.883179272	0.451921154	0.10995692	1.51010094	2.485124278	10.09671891	0.302551447	1.779755685	0	0	3.69470326	0	0	0	0	0	0	0	0	0	0	3.331666267	0	0	0	0	0	0	0	0	63.7986
H5970_006_0	2012	10	r.	s.	t.								Inpatient Facility	Inpatient Facility	Skilled Nursing Facility								Acute	Mental Health									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	D	D	D								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0	0	0								0	YES	207.89	7	39.08	971.19	25.54	10.02	12471.96	328.76	293.14	1318.9	917.16	130.73	0.49	548.16	2642.9	3257.85	91.93	489.02		1279.9	16.14	0		3.57	1.69		0.24		5.23	1.09	0	0	0								5000	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician										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	0	0	0								NO	0	0	0	0	0	0.199907	0	0	0	0	0	0	0.199907	0	0	0	0	0		0	0.199907	0		0	0		0		0	0	0	0	0									0	0	0	0	0	2.00306814	0	0	0	0	0	0	0.09795443	0	0	0	0	0	0	0	3.22649898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3275	0	NO	0.002474	0	0	0	0	0	2.00306814	0	0	0	0	0	0	0.09795443	0	0	0	0	0	0	0	3.22649898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3275	YES	$0/Admit	$0/Admit	"$0/Admit(Days 1-20), $0 (Days 21-100)"	$0/Visit	$0/Trip	20% Coins	$0/Service	$0/Visit	$0/Visit	$0/Visit	$0/Visit	$0/Visit	20% Coins	$0/Visit	$0/Visit	$0/Visit	$0/Visit	$0/Visit		$0/Visit	20% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						$0/Day(Days 1-1)	$0/Day(Days 1-1)	$0/Day(Days 1-100)								7500	0	0	0	0	0	1.2134	0	0	0	0	0	0	0.0373	0	0	0	0	0		0	1.3383	0		0			0		0	0	0	0	0								2.589	0	NO	0.000756	0	0	0	0	0	3.21647814	0	0	0	0	0	0	0.13524443	0	0	0	0	0	0	0	4.56482498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9165
H5970_801_0	2012	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	224.03	2.22	27.62	24.45	1.1	11.42	4.52	18.2	62.61	11.82	26.56	0.56	0.11	23.62	30.19	78.62	0.39	8.74		7.38	32.11	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																					0.0891	0.0891	0.1837	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072407	0.072407	0.125428	0	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611	0.202611		0.202611	0.202611	0																				16.2213	0.16074354	3.46432136	0	0.2228721	2.31381762	0.91580172	3.6875202	12.68547471	2.39486202	5.38134816	0.11346216	0.02228721	4.78567182	6.11682609	15.92927682	0.07901829	1.77082014	0	1.49526918	6.50583921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2666	0	NO	12.187332	16.2213	0.16074354	3.46432136	0	0.2228721	2.31381762	0.91580172	3.6875202	12.68547471	2.39486202	5.38134816	0.11346216	0.02228721	4.78567182	6.11682609	15.92927682	0.07901829	1.77082014	0	1.49526918	6.50583921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2666	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	2.152	0.0213	0.5123	0	1.6788	0.5562	0.22	0.3999	1.4418	0.2596	0.6189	0.0139	0.0025	0.5188	0.786	2.0465	0.0103	0.2193		0.1921	0.8359	0																			12.4861	0	NO	0.811314	18.3734	0.18203154	3.97664736	0	1.9016341	2.86997562	1.13579072	4.0873782	14.12727471	2.65442202	6.00021316	0.12735416	0.02480321	5.30450682	6.90283709	17.97578482	0.08928829	1.99015914	0	1.68741718	7.34176121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7526
H5970_802_0	2012	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	268.17	2.74	60.2	38.22	1.6	13.56	5.07	20.76	56.85	8.25	22.74	0.73	0.71	16.89	29.15	72.07	0.64	8.94		6.55	24.92	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																					0.0887	0.0887	0.1846	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.068344	0.068344	0.087781	0	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056	0.201056		0.201056	0.201056	0																				18.3278	0.18726256	5.2844162	0	0.3216896	2.72631936	1.01935392	4.17392256	11.4300336	1.658712	4.57201344	0.14677088	0.14274976	3.39583584	5.8607824	14.49010592	0.12867584	1.79744064	0	1.3169168	5.01031552	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9911	0	NO	17.983862	18.3278	0.18726256	5.2844162	0	0.3216896	2.72631936	1.01935392	4.17392256	11.4300336	1.658712	4.57201344	0.14677088	0.14274976	3.39583584	5.8607824	14.49010592	0.12867584	1.79744064	0	1.3169168	5.01031552	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9911	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	2.4687	0.0252	0.875	0	2.4213	0.6569	0.2458	0.4537	1.2974	0.1802	0.5263	0.018	0.0155	0.3691	0.7549	1.8665	0.0167	0.2191		0.1697	0.6454	0																			13.2252	0	NO	1.37041	20.7965	0.21242956	6.1593762	0	2.7429586	3.38323236	1.26516192	4.62766256	12.7273836	1.838937	5.09829944	0.16481088	0.15821676	3.76489484	6.6156974	16.35659692	0.14536784	2.01652164	0	1.4866098	5.65570952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2163
H5970_803_0	2012	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	224.24	2.22	27.65	24.48	1.1	11.43	4.52	18.22	62.67	11.83	26.59	0.56	0.11	23.64	30.22	78.69	0.39	8.75		7.39	32.14	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																					0.0888	0.0888	0.1839	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072177	0.072177	0.125505	0	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026		0.2026	0.2026	0																				16.185	0.16023294	3.47021325	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2929	0	NO	12.189881	16.185	0.16023294	3.47021325	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2929	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	2.1471	0.0212	0.5132	0	1.6803	0.5567	0.2202	0.4002	1.4431	0.2598	0.6194	0.0139	0.0025	0.5193	0.7867	2.0484	0.0103	0.2195		0.1923	0.8367	0																			12.4911	0	NO	0.811511	18.3321	0.18147294	3.98345325	0	1.903171	2.872389	1.135944	4.091599	14.140072	2.656558	6.006569	0.127361	0.024804	5.308778	6.909309	17.99099	0.089293	1.992291	0	1.689539	7.348258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7839
H5970_805_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				24.48	1.1	11.43	4.52	18.22	62.67	11.83	26.59	0.56	0.11	23.64	30.22	78.69	0.39	8.75		7.39	32.14	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026		0.2026	0.2026	0																				0	0	0	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4775	0	NO	6.8105	0	0	0	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4775	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	1.6803	0.5567	0.2202	0.4002	1.4431	0.2598	0.6194	0.0139	0.0025	0.5193	0.7867	2.0484	0.0103	0.2195		0.1923	0.8367	0																			9.8095	0	NO	0.453392093	0	0	0	0	1.903171	2.872389	1.135944	4.091599	14.140072	2.656558	6.006569	0.127361	0.024804	5.308778	6.909309	17.99099	0.089293	1.992291	0	1.689539	7.348258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2869
H5970_806_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				41.24	1.72	14.63	5.47	22.4	61.35	8.9	24.54	0.78	0.76	18.22	31.45	77.77	0.7	9.64		7.07	26.89	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607	0.198607		0.198607	0.198607	0																				0	0	0	0	0.34160404	2.90562041	1.08638029	4.4487968	12.18453945	1.7676023	4.87381578	0.15491346	0.15094132	3.61861954	6.24619015	15.44566639	0.1390249	1.91457148	0	1.40415149	5.34054223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.023	0	NO	7.93	0	0	0	0	0.34160404	2.90562041	1.08638029	4.4487968	12.18453945	1.7676023	4.87381578	0.15491346	0.15094132	3.61861954	6.24619015	15.44566639	0.1390249	1.91457148	0	1.40415149	5.34054223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.023	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	2.5934	0.7036	0.2633	0.486	1.3896	0.193	0.5637	0.0193	0.0166	0.3953	0.8086	1.9991	0.0179	0.2347		0.1818	0.6913	0																			10.5569	0	NO	0.620057552	0	0	0	0	2.93495404	3.60922041	1.34965929	4.9347848	13.57409345	1.9606363	5.43750478	0.17423646	0.16750632	4.01390854	7.05475815	17.44480939	0.1569029	2.14922248	0	1.58590449	6.03180523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5799
H5970_807_0	2012	3																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				24.48	1.1	11.43	4.52	18.22	62.67	11.83	26.59	0.56	0.11	23.64	30.22	78.69	0.39	8.75		7.39	32.14	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026	0.2026		0.2026	0.2026	0																				0	0	0	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4775	0	NO	6.8105	0	0	0	0	0.22286	2.315718	0.915752	3.691372	12.696942	2.396758	5.387134	0.113456	0.022286	4.789464	6.122572	15.942594	0.079014	1.77275	0	1.497214	6.511564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4775	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	1.6803	0.5567	0.2202	0.4002	1.4431	0.2598	0.6194	0.0139	0.0025	0.5193	0.7867	2.0484	0.0103	0.2195		0.1923	0.8367	0																			9.8095	0	NO	0.453392093	0	0	0	0	1.903171	2.872389	1.135944	4.091599	14.140072	2.656558	6.006569	0.127361	0.024804	5.308778	6.909309	17.99099	0.089293	1.992291	0	1.689539	7.348258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2869
H5970_808_0	2012	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	186.88	1.85	23.04	20.4	0.92	9.53	3.77	15.18	52.23	9.86	22.16	0.47	0.1	19.7	25.19	65.58	0.33	7.29		6.16	26.79	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																					0.0888	0.0888	0.183	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.076021	0.076021	0.139231	0	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847		0.207847	0.207847	0																				14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	0	NO	7.704943	14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	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	1.8445	0.0182	0.4528	0	1.4209	0.4707	0.1862	0.3384	1.2203	0.2197	0.5238	0.0118	0.0021	0.4391	0.6653	1.7321	0.0087	0.1856		0.1626	0.7075	0																			10.6105	0	NO	0.473577	16.0513	0.15888485	3.66067924	0	1.61210024	2.45150591	0.96977919	3.49355146	12.07616781	2.26905942	5.12968852	0.10944609	0.0229137	4.5337209	5.90093493	15.36274226	0.07728151	1.70084963	0	1.44296852	6.27573413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2993
H5970_809_0	2012	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	242.29	2.48	54.39	34.53	1.44	12.25	4.58	18.76	51.37	7.45	20.54	0.66	0.64	15.26	26.34	65.12	0.58	8.07		5.92	22.52	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																					0.0888	0.0888	0.183	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070789	0.070789	0.095828	0	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413		0.20413	0.20413	0																				17.1515	0.17555672	5.21208492	0	0.2939472	2.5005925	0.9349154	3.8294788	10.4861581	1.5207685	4.1928302	0.1347258	0.1306432	3.1150238	5.3767842	13.2929456	0.1183954	1.6473291	0	1.2084496	4.5970076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9191	0	NO	14.34557	17.1515	0.17555672	5.21208492	0	0.2939472	2.5005925	0.9349154	3.8294788	10.4861581	1.5207685	4.1928302	0.1347258	0.1306432	3.1150238	5.3767842	13.2929456	0.1183954	1.6473291	0	1.2084496	4.5970076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9191	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	2.2807	0.0233	0.8384	0	2.2069	0.5988	0.224	0.4136	1.1825	0.1643	0.4797	0.0164	0.0141	0.3364	0.6881	1.7012	0.0152	0.1997		0.1547	0.5883	0																			12.1261	0	NO	1.053444	19.4322	0.19880772	6.05046592	0	2.5008362	3.0993425	1.1589604	4.2430448	11.6686411	1.6850365	4.6725182	0.1511688	0.1447402	3.4514068	6.0648592	14.9941766	0.1336094	1.8470121	0	1.3631176	5.1852586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0452
H5970_810_0	2012	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	186.88	1.85	23.04	20.4	0.92	9.53	3.77	15.18	52.23	9.86	22.16	0.47	0.1	19.7	25.19	65.58	0.33	7.29		6.16	26.79	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																					0.0888	0.0888	0.183	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.076021	0.076021	0.139231	0	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847		0.207847	0.207847	0																				14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	0	NO	7.704943	14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	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	1.8445	0.0182	0.4528	0	1.4209	0.4707	0.1862	0.3384	1.2203	0.2197	0.5238	0.0118	0.0021	0.4391	0.6653	1.7321	0.0087	0.1856		0.1626	0.7075	0																			10.6105	0	NO	0.473577	16.0513	0.15888485	3.66067924	0	1.61210024	2.45150591	0.96977919	3.49355146	12.07616781	2.26905942	5.12968852	0.10944609	0.0229137	4.5337209	5.90093493	15.36274226	0.07728151	1.70084963	0	1.44296852	6.27573413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2993
H5970_811_0	2012	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	YES				20.4	0.92	9.53	3.77	15.18	52.23	9.86	22.16	0.47	0.1	19.7	25.19	65.58	0.33	7.29		6.16	26.79	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847		0.207847	0.207847	0																				0	0	0	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1335	0	NO	4.2847	0	0	0	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1335	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	1.4209	0.4707	0.1862	0.3384	1.2203	0.2197	0.5238	0.0118	0.0021	0.4391	0.6653	1.7321	0.0087	0.1856		0.1626	0.7075	0																			8.2949	0	NO	0.263355014	0	0	0	0	1.61210024	2.45150591	0.96977919	3.49355146	12.07616781	2.26905942	5.12968852	0.10944609	0.0229137	4.5337209	5.90093493	15.36274226	0.07728151	1.70084963	0	1.44296852	6.27573413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4284
H5970_812_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				34.53	1.44	12.25	4.58	18.76	51.37	7.45	20.54	0.66	0.64	15.26	26.34	65.12	0.58	8.07		5.92	22.52	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413	0.20413		0.20413	0.20413	0																				0	0	0	0	0.2939472	2.5005925	0.9349154	3.8294788	10.4861581	1.5207685	4.1928302	0.1347258	0.1306432	3.1150238	5.3767842	13.2929456	0.1183954	1.6473291	0	1.2084496	4.5970076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.38	0	NO	5.196	0	0	0	0	0.2939472	2.5005925	0.9349154	3.8294788	10.4861581	1.5207685	4.1928302	0.1347258	0.1306432	3.1150238	5.3767842	13.2929456	0.1183954	1.6473291	0	1.2084496	4.5970076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.38	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	2.2069	0.5988	0.224	0.4136	1.1825	0.1643	0.4797	0.0164	0.0141	0.3364	0.6881	1.7012	0.0152	0.1997		0.1547	0.5883	0																			8.9837	0	NO	0.381559954	0	0	0	0	2.5008362	3.0993425	1.1589604	4.2430448	11.6686411	1.6850365	4.6725182	0.1511688	0.1447402	3.4514068	6.0648592	14.9941766	0.1336094	1.8470121	0	1.3631176	5.1852586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3637
H5970_813_0	2012	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	YES				20.4	0.92	9.53	3.77	15.18	52.23	9.86	22.16	0.47	0.1	19.7	25.19	65.58	0.33	7.29		6.16	26.79	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847		0.207847	0.207847	0																				0	0	0	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1335	0	NO	4.2847	0	0	0	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1335	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	1.4209	0.4707	0.1862	0.3384	1.2203	0.2197	0.5238	0.0118	0.0021	0.4391	0.6653	1.7321	0.0087	0.1856		0.1626	0.7075	0																			8.2949	0	NO	0.263355014	0	0	0	0	1.61210024	2.45150591	0.96977919	3.49355146	12.07616781	2.26905942	5.12968852	0.10944609	0.0229137	4.5337209	5.90093493	15.36274226	0.07728151	1.70084963	0	1.44296852	6.27573413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4284
H5970_814_0	2012	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	224.24	2.22	27.65	24.48	1.1	11.43	4.52	18.22	62.67	11.83	26.59	0.56	0.11	23.64	30.22	78.69	0.39	8.75		7.39	32.14	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																					0.0891	0.0891	0.1837	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.072385	0.072385	0.12535	0	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581	0.202581		0.202581	0.202581	0																				16.2316	0.1606947	3.4659275	0	0.2228391	2.31550083	0.91566612	3.69102582	12.69575127	2.39653323	5.38662879	0.11344536	0.02228391	4.78901484	6.12199782	15.94109889	0.07900659	1.77258375	0	1.49707359	6.51095334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3296	0	NO	12.215351	16.2316	0.1606947	3.4659275	0	0.2228391	2.31550083	0.91566612	3.69102582	12.69575127	2.39653323	5.38662879	0.11344536	0.02228391	4.78901484	6.12199782	15.94109889	0.07900659	1.77258375	0	1.49707359	6.51095334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3296	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	2.1537	0.0213	0.5126	0	1.6802	0.5566	0.2202	0.4002	1.443	0.2598	0.6194	0.0139	0.0025	0.5193	0.7867	2.0483	0.0103	0.2195		0.1923	0.8366	0																			12.4965	0	NO	0.813518	18.3853	0.1819997	3.9785505	0	1.9030551	2.87214083	1.13584612	4.09123082	14.13879927	2.65631823	6.00602879	0.12734936	0.02480191	5.30829984	6.90868982	17.98937889	0.08928459	1.99211275	0	1.68938759	7.34759934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8262
H5970_815_0	2012	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	186.88	1.85	23.04	20.4	0.92	9.53	3.77	15.18	52.23	9.86	22.16	0.47	0.1	19.7	25.19	65.58	0.33	7.29		6.16	26.79	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																					0.0888	0.0888	0.183	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.076021	0.076021	0.139231	0	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847	0.207847		0.207847	0.207847	0																				14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	0	NO	7.704943	14.2068	0.14063885	3.20788224	0	0.19121924	1.98078191	0.78358319	3.15511746	10.85584881	2.04937142	4.60588952	0.09768809	0.0207847	4.0945859	5.23566593	13.63060626	0.06858951	1.51520463	0	1.28033752	5.56822113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6888	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	1.8445	0.0182	0.4528	0	1.4209	0.4707	0.1862	0.3384	1.2203	0.2197	0.5238	0.0118	0.0021	0.4391	0.6653	1.7321	0.0087	0.1856		0.1626	0.7075	0																			10.6105	0	NO	0.473577	16.0513	0.15888485	3.66067924	0	1.61210024	2.45150591	0.96977919	3.49355146	12.07616781	2.26905942	5.12968852	0.10944609	0.0229137	4.5337209	5.90093493	15.36274226	0.07728151	1.70084963	0	1.44296852	6.27573413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2993
H5980_005_0	2012	6																															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	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	752.4171328	5.894900529	0	0	32.68723138	37.58308919	13.44839173	43.19253323	147.2147374	27.18138614	70.00069539	27.23810826	0.883398106	8.153993244	0	104.2221739	6.780766322	4346.502765	49.04902578	129.6038252	81.48615346	33.42375702	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 Copay for Visits 1-4; 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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	Not Covered; PBP 13b											0	NO	0.072493378	0.072493378	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	5	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059311043	0.059311043	0	0	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0.183267409	0	0.183267409	0.183267409	4.082012457	0.183267409	0.183267409	0.183267409	0.183267409	0	0	0	0	0	0	0	0												44.6266	0.349632698	0	0	5.990504197	6.887755372	2.464651905	7.915783646	26.97966346	4.981462207	12.82884606	4.991857523	0.161898082	1.494361213	0	19.10052775	1.242693474	1.478539869	8.989087861	23.75215722	14.9337562	6.125485343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.2953	0	NO	43.0772676	44.6266	0.349632698	0	0	5.990504197	6.887755372	2.464651905	7.915783646	26.97966346	4.981462207	12.82884606	4.991857523	0.161898082	1.494361213	0	19.10052775	1.242693474	1.478539869	8.989087861	23.75215722	14.9337562	6.125485343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.2953	NO																																										0	0	0	0	0	0	0	0	0	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	44.6266	0.349632698	0	0	5.990504197	6.887755372	2.464651905	7.915783646	26.97966346	4.981462207	12.82884606	4.991857523	0.161898082	1.494361213	0	19.10052775	1.242693474	1.478539869	8.989087861	23.75215722	14.9337562	6.125485343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.2953
H5980_006_0	2012	7																															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	2568.72175	65.36603323	0	0	496.6202986	36.7396421	0	757.1220389	2370.40938	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"	"$65/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	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	75	75	0	0	50	0.2	0	61.86729765	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	56.51528601	56.51528601	0	0	37.67685734	0.150707429	0	46.61930695	37.67685734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												12.0977	0.307848339	0	0	1.559257678	5.536937015	0	2.941375394	7.44246467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8856	0	NO	9.774805143	12.0977	0.307848339	0	0	1.559257678	5.536937015	0	2.941375394	7.44246467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8856	NO																																										0	0	0	0	0	0	0	0	0	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	12.0977	0.307848339	0	0	1.559257678	5.536937015	0	2.941375394	7.44246467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8856
H5980_007_0	2012	10																															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	2401.496269	61.7913371	0	0	517.1748968	0	0	2082.582699	2524.604968	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"	"$65/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	NO	65	65	0	0	50	0	0	62.0171503	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	45.88588123	45.88588123	0	0	35.29683172	0	0	43.78017836	35.29683172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												9.1829	0.236279163	0	0	1.521219608	0	0	7.597986832	7.425879725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9643	0	NO	10.81561461	9.1829	0.236279163	0	0	1.521219608	0	0	7.597986832	7.425879725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9643	NO																																										0	0	0	0	0	0	0	0	0	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	9.1829	0.236279163	0	0	1.521219608	0	0	7.597986832	7.425879725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9643
H5980_011_0	2012	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	473.4488511	4.96928681	423.8533236	0	18.56586442	32.97415338	3.706192908	115.2521833	170.595425	10.69312429	68.15348862	31.05180367	1.007085525	36.00607055	0	102.9239228	2.612188937	9.799141052	56.98196803	132.4333058	89.41207495	20.6947808	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	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"	"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 Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	NO	0.075167164	0.075167164	0.18870893	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058127613	0.058127613	0.145930738	0	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0.173221719	0	0	0	0	0	0	0	0												27.5205	0.288852782	61.85322842	0	3.216010958	5.711839545	0.641993108	19.96418137	29.55083285	1.852281375	11.80566448	5.378846823	0.174449086	6.237033451	0	17.82865888	0.452487859	1.697424062	9.870514479	22.94032493	15.48811336	3.584785513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.058	0	NO	72.1295282	27.5205	0.288852782	61.85322842	0	3.216010958	5.711839545	0.641993108	19.96418137	29.55083285	1.852281375	11.80566448	5.378846823	0.174449086	6.237033451	0	17.82865888	0.452487859	1.697424062	9.870514479	22.94032493	15.48811336	3.584785513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.058	NO																																										0	0	0	0	0	0	0	0	0	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	27.5205	0.288852782	61.85322842	0	3.216010958	5.711839545	0.641993108	19.96418137	29.55083285	1.852281375	11.80566448	5.378846823	0.174449086	6.237033451	0	17.82865888	0.452487859	1.697424062	9.870514479	22.94032493	15.48811336	3.584785513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.058
H5985_001_0	2012	5																															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	982.3344062	64.25960617	585.6003413		167.1207451	8.887709219	10.39113408	326.5980633	504.2197809	1.152436125	231.3725123	40.71860801		404.4482809	4626.173871	5073.11625	186.153528	866.199087	1.187175694		18.2878458				108.2260713																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;2a: $0, 1-20 days then $75 , 21+ days"	6: $0/visit	10a: $200/trip	11a: 20%	11b: 20%;11c: 20%	4a: $65/visit;4b: $35/visit	9a: $250/visit;9b: $200/visit	8a: $0/visit; 8a: 20%	8b: $0/visit;8b: $150/visit;8b: 20%	9c: $40/visit	12: $0/visit	3: $20/visit;5: $35/visit;9a: $250/visit;9d: 20%	7a: $10/visit;14a: $0/visit	7b: $20/visit;7d: $40/visit;7f: $40/visit;16b: $35/visit;17a: $30/visit;18a: $30/visit	7e: $40/visit;7h: $40/visit	7c: $35/visit;7i: $35/visit	;8b: $0/visit;8b: 20%	7g: $30/visit	15: 20%	17b: $0/visit			17a1: $10/visit				14c: Newsletters and Nurseline														159.4013789	98.98533354	10.25010018		200	0.2	0.2	61.60688208	185.7828306	0.055541463	98.49262606	40		102.2853061	10	37.46039751	40	35	0.2		0.2				10																NO	154.6631577	96.04298502	9.945414973		194.0549808	0.194054981	0.194054981	59.7756116	180.2604181	0.053890488	95.56492331	38.81099617		99.24486552	9.702749041	36.3468836	38.81099617	33.95962164	0.194054981		0.194054981				9.702749041																	12.6609	0.514307033	0.485336534	0	2.702551083	1.724704242	2.016451325	1.626883248	7.574239045	0.062105345	1.842591366	0.131694145	0	3.344951271	3.740550341	15.36599716	0.602066988	2.451316105	0.230377356	0	3.548847566	0	0	0	0.087507534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7134	0		1.86	12.6609	0.514307033	0.485336534	0	2.702551083	1.724704242	2.016451325	1.626883248	7.574239045	0.062105345	1.842591366	0.131694145	0	3.344951271	3.740550341	15.36599716	0.602066988	2.451316105	0.230377356	0	3.548847566	0	0	0	0.087507534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7134	NO																																																																																		0	0		0	12.6609	0.514307033	0.485336534	0	2.702551083	1.724704242	2.016451325	1.626883248	7.574239045	0.062105345	1.842591366	0.131694145	0	3.344951271	3.740550341	15.36599716	0.602066988	2.451316105	0.230377356	0	3.548847566	0	0	0	0.087507534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7134
H5985_002_0	2012	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	O	O																																																			0	YES	175.1375671	30.0125416	13.92477249		12.99386041	15.91524414	0.952384533	46.11788482	69.17718244	0.227386972	9.109834482			2.47080614	43.630725	86.46366123	0.462531516	3.642027378	39.76013806	8.867233923	7.509428177																				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 $175 allowance	18a1 $0 copay	18b1 $700 allowance/2 yrs	14c $0 copay	7f1 $0 copay; 13b $52.50/quarter													0.083124721	0.083124721	0.13529546		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.083124721	0.083124721	0.13529546		0.224	0.224	0.224	0.224	0.224	0.224	0.224			0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																					14.5583	2.494784158	1.883958495	0	2.910624731	3.565014687	0.213334135	10.3304062	15.49568887	0.050934682	2.040602924	0	0	0.553460575	9.773282401	19.36786012	0.10360706	0.815814133	8.906270925	1.986260399	1.682111912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7323	0		-2.84E-14	14.5583	2.494784158	1.883958495	0	2.910624731	3.565014687	0.213334135	10.3304062	15.49568887	0.050934682	2.040602924	0	0	0.553460575	9.773282401	19.36786012	0.10360706	0.815814133	8.906270925	1.986260399	1.682111912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7323	NO																																																																																		0	0		0	14.5583	2.494784158	1.883958495	0	2.910624731	3.565014687	0.213334135	10.3304062	15.49568887	0.050934682	2.040602924	0	0	0.553460575	9.773282401	19.36786012	0.10360706	0.815814133	8.906270925	1.986260399	1.682111912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7323
H5989_002_0	2012	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	707.4665844	31.74793876	508.7279761	0	50.64340833	5.831218009	14.9307917	18.63505934	12.89157515	8.922202122	9.664736752	3.77699915	1.722664954	65.09366758	0.668460519	82.26357994	10.22570925	1.098363124	23.94328023	226.5510052	5.535586404	5.880189799	0	0	0	0	0	0	0	0.106847039											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 9a-b	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, 9c"	"$0 Primary Care PBP 7a; Medicare-FFS Cost Sharing PBP 4b, 14b-c"	"$0 Chiropractic Care PBP 7b; Medicare-FFS Cost Sharing PBP PBP 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 9d, 16b, 17a"	PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	20% Coinsurance for Foreign Travel; PBP 13a-e											0	NO	0.058588258	0.058848841	0.148423913	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0.2											NO	0.058508936	0.058769167	0.148222964	0	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0.22369673	0	0	0	0	0	0	0	0.199729223												41.3931	1.865799916	75.40516849	0	11.32876485	1.304424402	3.339969283	4.168601841	2.883803209	1.995867441	2.16197001	0.84490236	0.385354518	14.5612406	0.149532432	18.40209385	2.287457723	0.245700239	5.356033498	50.67871908	1.238292578	1.315379231	0	0	0	0	0	0	0	0.021340476	0	0	0	0	0	0	0	0	0	0	241.3335	0	NO	0.327180334	41.3931	1.865799916	75.40516849	0	11.32876485	1.304424402	3.339969283	4.168601841	2.883803209	1.995867441	2.16197001	0.84490236	0.385354518	14.5612406	0.149532432	18.40209385	2.287457723	0.245700239	5.356033498	50.67871908	1.238292578	1.315379231	0	0	0	0	0	0	0	0.021340476	0	0	0	0	0	0	0	0	0	0	241.3335	NO																																										0	0	0	0	0	0	0	0	0	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	41.3931	1.865799916	75.40516849	0	11.32876485	1.304424402	3.339969283	4.168601841	2.883803209	1.995867441	2.16197001	0.84490236	0.385354518	14.5612406	0.149532432	18.40209385	2.287457723	0.245700239	5.356033498	50.67871908	1.238292578	1.315379231	0	0	0	0	0	0	0	0.021340476	0	0	0	0	0	0	0	0	0	0	241.3335
H5989_008_0	2012	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	534.8211775	31.47232026	516.3967496	0	43.18802705	4.468637695	10.06326731	19.02186591	11.45332083	9.231791891	7.975607027	3.916121425	1.934804522	71.28309769	5.864169082	15.89065799	4.587298679	0.984469461	21.00508091	216.044374	5.955661167	6.176625736	0	0	0	0	0	0	0	0.073784125											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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"$0 Chiropractic Care PBP 7b; Medicare-FFS Cost Sharing PBP PBP 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 9d, 16b, 17a"	No Cost-Sharing; PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14c	20% Coinsurance for Foreign Travel; PBP 13a-e											0	NO	0.058848841	0.058848841	0.148420162	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0.2											NO	0.058843513	0.058843513	0.148406724	0	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0.223979719	0	0	0	0	0	0	0	0.199981892												31.4708	1.851941898	76.63674978	0	9.673242174	1.000884216	2.253967786	4.260512186	2.565311585	2.067734156	1.786374223	0.877131777	0.433356974	15.96596821	1.313454945	3.559185115	1.02746187	0.220501194	4.704712126	48.38955824	1.333947316	1.383438898	0	0	0	0	0	0	0	0.014755489	0	0	0	0	0	0	0	0	0	0	212.7909	0	NO	0.019267628	31.4708	1.851941898	76.63674978	0	9.673242174	1.000884216	2.253967786	4.260512186	2.565311585	2.067734156	1.786374223	0.877131777	0.433356974	15.96596821	1.313454945	3.559185115	1.02746187	0.220501194	4.704712126	48.38955824	1.333947316	1.383438898	0	0	0	0	0	0	0	0.014755489	0	0	0	0	0	0	0	0	0	0	212.7909	NO																																										0	0	0	0	0	0	0	0	0	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	31.4708	1.851941898	76.63674978	0	9.673242174	1.000884216	2.253967786	4.260512186	2.565311585	2.067734156	1.786374223	0.877131777	0.433356974	15.96596821	1.313454945	3.559185115	1.02746187	0.220501194	4.704712126	48.38955824	1.333947316	1.383438898	0	0	0	0	0	0	0	0.014755489	0	0	0	0	0	0	0	0	0	0	212.7909
H5991_001_0	2012	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								537.2587715						5133.682574		3257.897747	1353.600981	1921.776185		1066.68385																					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 $20 copay	7c OT $10 copay; 7i PT/ST $10 copay		7g Prof Other $10 copay																														28.13857291						10		10	20	10		10																					NO								28.12425104						9.994910238		9.994910238	19.98982048	9.994910238		9.994910238																						0	0	0	0	0	0	0	1.259166714	0	0	0	0	0	4.275891376	0	2.713532962	2.254853385	1.600665039	0	0.888450778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9926	0		0.006616271	0	0	0	0	0	0	0	1.259166714	0	0	0	0	0	4.275891376	0	2.713532962	2.254853385	1.600665039	0	0.888450778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9926	NO																																																																																		0	0		0	0	0	0	0	0	0	0	1.259166714	0	0	0	0	0	4.275891376	0	2.713532962	2.254853385	1.600665039	0	0.888450778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9926
H5991_002_0	2012	5																															A	A	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	V	V																																																			0	YES	395.4336517	11.4545631	392.466109			5.906818247	5.212718728	382.1596137	814.7314805		153.2279383					8759.723902	1197.901271	2521.452103	3353.02164	501.0313779					32.02422076																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 0%				$10 copay																		146.9660097	150	6.1			0.2	0.2	50	75		25					10	10	10	10	10					7.04460089																NO	141.2297593	144.0910361	5.859702135			0.192121381	0.192121381	48.03034537	72.04551806		24.01517269					9.632497184	9.606069074	9.606069074	9.606069074	9.606069074					7.04460089																	4.6539	0.137541655	0.191644541	0	0	1.134826082	1.001474723	1.529604853	4.891479299	0	0.306649617	0	0	0	0	7.031501318	0.958926863	2.018436922	2.684113124	0.401078502	0	0	0	0	0.018799821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.96	0		1.082911337	4.6539	0.137541655	0.191644541	0	0	1.134826082	1.001474723	1.529604853	4.891479299	0	0.306649617	0	0	0	0	7.031501318	0.958926863	2.018436922	2.684113124	0.401078502	0	0	0	0	0.018799821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.96	NO																																																																																		0	0		0	4.6539	0.137541655	0.191644541	0	0	1.134826082	1.001474723	1.529604853	4.891479299	0	0.306649617	0	0	0	0	7.031501318	0.958926863	2.018436922	2.684113124	0.401078502	0	0	0	0	0.018799821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.96
H5992_005_0	2012	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	353.509544	16.85240323	63.74136943	0	30.10769477	40.3025663	6.901788059	48.60939836	85.68170712	28.25476911	26.16776819	18.42570946	0.528524543	143.558097	63.50283534	157.2840705	9.067787428	9.250553206	26.49163536	55.27349772	63.99552245	8.545946125	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 16b, 17a"	PBP 10b	PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											0	NO	0.087033865	0.087034007	0.189935051	0	0.224000897	0.224000898	0.224000279	0.224000926	0.224000781	0.224000918	0.224000574	0.224001127	0.224000603	0.224001021	0.224000708	0.224000838	0.224001006	0.224000676	0.224000301	0.224000122	0.224000655	0.224000161	0	0	0	0	0	0	0	0											NO	0.071694301	0.071694418	0.156459335	0	0.184521137	0.184521137	0.184520628	0.18452116	0.184521041	0.184521154	0.184520871	0.184521326	0.184520894	0.184521238	0.184520981	0.184521088	0.184521226	0.184520954	0.184520646	0.184520498	0.184520938	0.184520531	0	0	0	0	0	0	0	0												25.3446	1.208223237	9.972932291	0	5.555506058	7.436675375	1.273522266	8.969462589	15.81007782	5.213602601	4.82849937	3.399936344	0.097523821	26.48951784	11.71760549	29.02222785	1.673199255	1.706920906	4.888253667	10.19909334	11.8085138	1.576902515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.1928	0	NO	40.2653453	25.3446	1.208223237	9.972932291	0	5.555506058	7.436675375	1.273522266	8.969462589	15.81007782	5.213602601	4.82849937	3.399936344	0.097523821	26.48951784	11.71760549	29.02222785	1.673199255	1.706920906	4.888253667	10.19909334	11.8085138	1.576902515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.1928	NO																																										0	0	0	0	0	0	0	0	0	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	25.3446	1.208223237	9.972932291	0	5.555506058	7.436675375	1.273522266	8.969462589	15.81007782	5.213602601	4.82849937	3.399936344	0.097523821	26.48951784	11.71760549	29.02222785	1.673199255	1.706920906	4.888253667	10.19909334	11.8085138	1.576902515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.1928
H5992_006_0	2012	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	808.6783463	6.567619582	340.2342779	0	25.52369951	33.89369223	21.53400643	17.42553508	53.75436662	6.437548272	25.21051898	0	0.455012316	28.86681206	77.9059125	136.0547804	3.701689072	14.15589432	73.10385515	165.4297949	17.77947009	47.42293337	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 9a-b	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, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b, 14d-e"	"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 9d, 16b, 17a"	PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14c	No Cost-Sharing; PBP 13a-e											0	NO	0.056986274	0.056986274	0.148606453	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056986274	0.056986274	0.148606453	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												46.0836	0.374264166	50.56100926	0	5.717308689	7.59218706	4.823617441	3.903319858	12.04097812	1.442010813	5.647156252	0	0.101922759	6.466165901	17.4509244	30.47627081	0.829178352	3.170920328	16.37526355	37.05627406	3.9826013	10.62273708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	264.7177	0	NO	5.68E-14	46.0836	0.374264166	50.56100926	0	5.717308689	7.59218706	4.823617441	3.903319858	12.04097812	1.442010813	5.647156252	0	0.101922759	6.466165901	17.4509244	30.47627081	0.829178352	3.170920328	16.37526355	37.05627406	3.9826013	10.62273708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	264.7177	NO																																										0	0	0	0	0	0	0	0	0	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	46.0836	0.374264166	50.56100926	0	5.717308689	7.59218706	4.823617441	3.903319858	12.04097812	1.442010813	5.647156252	0	0.101922759	6.466165901	17.4509244	30.47627081	0.829178352	3.170920328	16.37526355	37.05627406	3.9826013	10.62273708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	264.7177
H5995_001_0	2012	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	YES	284.4552272	25.43606927	41.43705091	0	36.07253483	26.85876986	0.762849924	45.69689489	44.9491247	14.44604752	10.67314467	0	0	6.714204875	41.83184065	98.68547417	14.24795009	3.885711615	18.1782586	42.3494874	32.20112749	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"	"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 8b	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS 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, 14b"	No Cost Sharing; PBP 13a-13e											0	NO	0.082905047	0.082905047	0.127205581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.075226219	0.075226219	0.115423551	0	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0	0	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0.203252682	0	0	0	0	0	0	0	0	0												21.3985	1.913459322	4.782811559	0	7.331839448	5.459117008	0.155051293	9.288016443	9.136030145	2.936197902	2.169345278	0	0	1.364680148	8.502433803	20.05808729	2.895934069	0.789781307	3.694779814	8.607646892	6.544965523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0287	0	NO	11.9458744	21.3985	1.913459322	4.782811559	0	7.331839448	5.459117008	0.155051293	9.288016443	9.136030145	2.936197902	2.169345278	0	0	1.364680148	8.502433803	20.05808729	2.895934069	0.789781307	3.694779814	8.607646892	6.544965523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0287	NO																																										0	0	0	0	0	0	0	0	0	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	21.3985	1.913459322	4.782811559	0	7.331839448	5.459117008	0.155051293	9.288016443	9.136030145	2.936197902	2.169345278	0	0	1.364680148	8.502433803	20.05808729	2.895934069	0.789781307	3.694779814	8.607646892	6.544965523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0287
H6169_001_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	926.524335	22.20151497	678.7193645	17.73618797	422.865852	23.46920658	1.714673203	281.6802822	465.9886244	1015.001946	20.14268508	4.952500975	8.041102029	355.3777458	5070.199435	7201.008927	0.427095256	729.9073472	22.80827992	13633.96137	4.587701176	9.029638847	0	0	0	0	0.16434698	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.195127226	30	3.55757441	3.921960341	11.99822504	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	155.7987201	155.7987201	77.89936007	0.11684904	116.8490401	0.15579872	0.15579872	46.32539048	79.3583964	0	0.15579872	0.152002861	23.36980802	2.7713277	3.055182008	9.346540527	0.31159744	0	0.143304017	0.930111221	0.15579872	0	0	0	0	0	20	0	0	0												12.0293	0.288247301	4.40598368	2.07245654	4.117622409	3.656472348	0.267143891	1.087412422	3.081675831	0	3.138204555	0.752794316	0.015659918	0.082072349	1.290865174	5.608710148	0.133081789	0	3.268518124	1.056758371	0.714757972	0	0	0	0	0	0.000273912	0	0	0	0	0	0	0	0	0	0	0	0	0	47.068	0		13.35346744	12.0293	0.288247301	4.40598368	2.07245654	4.117622409	3.656472348	0.267143891	1.087412422	3.081675831	0	3.138204555	0.752794316	0.015659918	0.082072349	1.290865174	5.608710148	0.133081789	0	3.268518124	1.056758371	0.714757972	0	0	0	0	0	0.000273912	0	0	0	0	0	0	0	0	0	0	0	0	0	47.068	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.0445	0.073	1.1151	0.5024	1.0421	0.8864	0.0648	0.2752	0.7799	0	0.7518	0.19	0.004	0.0208	0.6273	1.8022	0.0335	0	0.7985	0.2675	0.1762	0	0	0	0	0	0.0001	0	0	0											12.4551	0		3.338366861	15.0738	0.361199909	5.521095592	2.574860434	5.159752868	4.542872576	0.331904781	1.362626002	3.861618218	0	3.890036463	0.942828123	0.019623291	0.102844068	1.918139748	7.410879621	0.166596552	0	4.066993797	1.324213707	0.89091818	0	0	0	0	0	0.00034239	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5231
H6169_011_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	930.4387832	19.86368632	737.0506769	79.65450957	395.6917935	21.35730807	1.800159833	277.0590588	491.8603244	6.871704815	15.11246138	3.340892137	7.396750316	335.3494031	5032.800655	7512.123528	0.543702133	758.2983259	24.43309575	15018.19578	4.691081488	9.263760972	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.48723118	200.2580519	0.2	0.2	0.273538664	30	9.356058737	18.85470089	19.85963123	0.4	0	0.185718915	3.257303242	0.2	0	0	0	0	0	0	0	0	0											NO	202.2149284	202.2149284	116.1660227	0	129.0733586	0.172097811	0.172097811	50.32762241	172.3198623	0.172097811	0.172097811	0.235377027	25.81467171	8.05078616	16.22426379	17.08899535	0.344195623	0	0.159809094	2.802873795	0.172097811	0	0	0	0	0	0	0	0	0												15.6791	0.334727826	7.135020472	0	4.256105728	3.675545976	0.309803567	1.161976975	7.063108614	1.182605359	2.600821529	0.786369259	0.015912057	0.224985528	6.804457118	10.697887	0.187139894	0	3.904630905	3.507842284	0.807324857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3353	0		11.40345269	15.6791	0.334727826	7.135020472	0	4.256105728	3.675545976	0.309803567	1.161976975	7.063108614	1.182605359	2.600821529	0.786369259	0.015912057	0.224985528	6.804457118	10.697887	0.187139894	0	3.904630905	3.507842284	0.807324857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3353	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.9442	0.0842	1.7949	0	1.0707	0.8856	0.0746	0.2923	1.7768	0.2956	0.6344	0.1976	0.004	0.0566	2.0229	3.1691	0.0468	0	0.9739	0.8785	0.1978	0	0	0	0	0	0	0	0	0											18.4003	0		2.850863172	19.6232	0.418931068	8.929887254	0	5.32676037	4.561172981	0.384451091	1.454280813	8.839885439	1.478164	3.235177145	0.983949416	0.019914851	0.281582289	8.827388468	13.8670165	0.233938033	0	4.878493873	4.386302632	1.005133031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7357
H6169_012_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1057.477198	42.63558009	920.2519609	70.50904163	462.3317357	22.48486835	1.242628344	322.8746104	438.2623325	9.056837085	21.39752451	5.047841362	6.797154102	341.8446176	4943.073444	6875.220232	0.35842519	452.1149418	21.31168635	14696.95409	4.646587505	7.741761231	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	57.8839114	208.4872423	0.2	0.2	0.258763728	30	11.20303816	19.34658657	17.87774702	0.4	0	0.18053407	3.067062647	0.2	0	0	0	0	0	0	0	0	0											NO	206.9415821	206.9415821	118.8813344	0	132.0903715	0.176120495	0.176120495	50.97271576	183.594382	0.176120495	0.176120495	0.22786798	26.41807431	9.865423152	17.03665206	15.74318831	0.352240991	0	0.15897875	2.700862964	0.176120495	0	0	0	0	0	0	0	0	0												18.2363	0.7352562	9.116731757	0	5.089130896	3.960046154	0.21885232	1.371482978	6.705208508	1.595094634	3.768542616	1.150241414	0.014963977	0.281036817	7.017785197	9.019823901	0.126252044	0	3.388105246	3.307871582	0.818359293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9211	0		10.29385428	18.2363	0.7352562	9.116731757	0	5.089130896	3.960046154	0.21885232	1.371482978	6.705208508	1.595094634	3.768542616	1.150241414	0.014963977	0.281036817	7.017785197	9.019823901	0.126252044	0	3.388105246	3.307871582	0.818359293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9211	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.5786	0.1846	2.289	0	1.2777	0.9529	0.0527	0.3443	1.6835	0.3926	0.9258	0.2887	0.0038	0.0706	2.0823	2.6721	0.0311	0	0.8326	0.8192	0.202	0	0	0	0	0	0	0	0	0											19.6841	0		2.573463571	22.815	0.919858302	11.40568607	0	6.366868184	4.912959286	0.271515153	1.715823688	8.388697322	1.98773374	4.694353678	1.438975509	0.01872101	0.351597238	9.100111024	11.69189502	0.15734395	0	4.220713647	4.127050542	1.020314262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6052
H6169_013_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1197.195104	37.7016548	975.5312941	95.87060869	473.4192226	24.84912196	1.079764958	301.3684793	552.4248127	9.796315343	21.34231927	4.395799404	2.409167095	351.9379487	4972.873048	7830.239412	0.427190781	637.5064924	21.71930181	13925.78747	7.570373641	9.007197535	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.71072483	196.6297581	0.2	0.2	0.318622395	30	12.00489974	19.53485888	17.22993206	0.4	0	0.181053654	3.207419763	0.2	0	0	0	0	0	0	0	0	0											NO	208.436437	208.436437	119.7400808	0	133.0445342	0.177392712	0.177392712	52.07427359	174.4034306	0.177392712	0.177392712	0.282606454	26.60890685	10.64790863	17.32670801	15.2823219	0.354785425	0	0.160587994	2.844864456	0.177392712	0	0	0	0	0	0	0	0	0												20.7949	0.654866549	9.734182998	0	5.248819997	4.408053143	0.191542434	1.307795387	8.028731872	1.737794949	3.785971902	1.242281284	0.005342109	0.312283593	7.180293271	9.97201994	0.151561063	0	3.487859103	3.301414816	1.342929113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8887	0		10.56350014	20.7949	0.654866549	9.734182998	0	5.248819997	4.408053143	0.191542434	1.307795387	8.028731872	1.737794949	3.785971902	1.242281284	0.005342109	0.312283593	7.180293271	9.97201994	0.151561063	0	3.487859103	3.301414816	1.342929113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8887	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.2165	0.1643	2.4418	0	1.3167	1.0662	0.0463	0.3281	2.014	0.403	0.8763	0.3103	0.0013	0.0783	2.1287	2.9398	0.0376	0	0.862	0.8206	0.3128	0	0	0	0	0	0	0	0	0											21.3646	0		2.640875036	26.0114	0.81914159	12.17602907	0	6.565500656	5.474261735	0.237872227	1.635859388	10.04276093	2.14081148	4.66225322	1.552579995	0.006682191	0.390620775	9.308979383	12.91186321	0.189151787	0	4.349825271	4.122010064	1.65571582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2533
H6169_015_0	2012	4																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1467.744772	20.37055215	786.2077486	90.12620062	659.0993677	27.27000341	2.797103384	303.637271	529.2466812	8.251875641	25.9021938	10.17846658	43.85329637	346.4324791	5483.852829	8850.601789	0.415330096	803.9817042	24.3979913	16411.14777	22.59540665	14.23250575	0	0	0	0	0.098567199	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	61.10960869	199.0665286	0.2	0.2	0.19305285	30	10.73529926	19.90254615	17.78825643	0.4	0	0.179136695	3.34939555	0.2	0	0	0	0	0	20	0	0	0											NO	212.001684	212.001684	121.7882014	0	135.3202238	0.180426965	0.180426965	55.12910616	179.584848	0.180426965	0.180426965	0.174159699	27.06404476	9.684687326	17.95478	16.04740561	0.36085393	0	0.161605451	3.02160637	0.180426965	0	0	0	0	0	20	0	0	0												25.9304	0.359882613	7.979235638	0	7.432456163	4.920243954	0.504672875	1.394937612	7.920390401	1.488860878	4.673454217	1.772678674	0.098903965	0.279590853	8.205114257	11.8357664	0.149873497	0	3.942848384	4.132335721	4.076820647	0	0	0	0	0	0.000164279	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0986	0		10.53340873	25.9304	0.359882613	7.979235638	0	7.432456163	4.920243954	0.504672875	1.394937612	7.920390401	1.488860878	4.673454217	1.772678674	0.098903965	0.279590853	8.205114257	11.8357664	0.149873497	0	3.942848384	4.132335721	4.076820647	0	0	0	0	0	0.000164279	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0986	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	6.5012	0.0902	2.0005	0	1.8635	1.2336	0.1265	0.3497	1.9858	0.3415	1.0698	0.4433	0.0248	0.0701	2.4312	3.5087	0.0368	0	0.9661	1.0269	0.9371	0	0	0	0	0	0	0	0	0											25.0074	0		2.633352181	32.4316	0.450112004	9.979781211	0	9.295913761	6.153842347	0.631203927	1.744674904	9.906182358	1.830355188	5.743257044	2.21593775	0.123701063	0.349689578	10.63632418	15.34449319	0.186711817	0	4.908921012	5.159204465	5.013875903	0	0	0	0	0	0.000205348	0	0	0	0	0	0	0	0	0	0	0	0	0	122.106
H6169_016_0	2012	5																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1262.731325	57.24152834	801.4287404	167.314735	451.5720793	22.07897502	1.873391272	279.43595	515.326101	6.350948326	19.85825045	5.432583891	31.42223721	363.8846152	4981.774113	8588.233301	0.960669062	829.4777135	31.20479506	16687.9408	3.549692866	4.702361122	0	0	0	0	0.07241304	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	59.52335107	204.8618985	0.2	0.2	0.218464718	30	8.944196162	19.2447755	17.5530982	0.4	0	0.185740011	3.244432591	0.2	0	0	0	0	0	20	0	0	0											NO	210.8853168	210.8853168	121.1468841	0	134.607649	0.179476865	0.179476865	53.41532232	183.8398568	0.179476865	0.179476865	0.196046813	26.9215298	8.02638145	17.2699599	15.75187521	0.358953731	0	0.166680175	2.911502956	0.179476865	0	0	0	0	0	20	0	0	0												22.191	1.00594982	8.090882893	0	5.065421329	3.962665227	0.336230393	1.243846778	7.894789718	1.139848297	3.564096541	1.065040761	0.070494558	0.243389727	7.169586598	11.27339827	0.344835744	0	5.201220688	4.048915748	0.637087748	0	0	0	0	0	0.000120688	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5488	0		9.668117994	22.191	1.00594982	8.090882893	0	5.065421329	3.962665227	0.336230393	1.243846778	7.894789718	1.139848297	3.564096541	1.065040761	0.070494558	0.243389727	7.169586598	11.27339827	0.344835744	0	5.201220688	4.048915748	0.637087748	0	0	0	0	0	0.000120688	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5488	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.5718	0.2526	2.0315	0	1.2719	1.0132	0.086	0.3123	1.9823	0.2854	0.8907	0.2674	0.0177	0.0611	2.1275	3.333	0.0866	0	1.3013	1.0146	0.1598	0	0	0	0	0	0	0	0	0											22.0666	0		2.417029499	27.7628	1.258528929	10.12238383	0	6.337273646	4.975875876	0.422200869	1.556158292	9.877054557	1.425265054	4.454767261	1.332448109	0.088194698	0.304501285	9.297068589	14.60644423	0.431418788	0	6.502482563	5.063477015	0.796914666	0	0	0	0	0	0.000150861	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6154
H6169_021_0	2012	5																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1168.133526	23.92997215	1097.232536	22.86393796	492.3761414	28.32381639	2.163419899	300.1425289	544.2568701	919.6349317	22.00903915	5.044575136	6.970488203	416.642935	6455.722073	9644.54216	0.738613791	1110.228412	48.79769291	19748.06626	6.647177768	13.9499085	0	0	0	0	0	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.22583401	101.8892436	0	0.2	0.199247731	30	3.746678695	3.886026475	12.62695055	0.4	0	0.191154924	1.052128751	0.2	0	0	0	0	0	0	0	0	0											NO	164.3561397	164.3561397	82.17806983	0.123267105	123.2671048	0.16435614	0.16435614	48.67064723	83.73061375	0	0.16435614	0.163737939	24.65342095	3.078948234	3.193461551	10.37658424	0.328712279	0	0.157087427	0.8646191	0.16435614	0	0	0	0	0	0	0	0	0												15.9992	0.327753154	7.514037663	2.818371435	5.057815117	4.655193122	0.355571343	1.217344262	3.797580148	0	3.617320712	0.825988338	0.014320532	0.106901836	1.718008352	8.339783683	0.242791423	0	7.665504006	1.422879606	1.092504478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7888	0		14.48447071	15.9992	0.327753154	7.514037663	2.818371435	5.057815117	4.655193122	0.355571343	1.217344262	3.797580148	0	3.617320712	0.825988338	0.014320532	0.106901836	1.718008352	8.339783683	0.242791423	0	7.665504006	1.422879606	1.092504478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7888	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	4.0373	0.0827	1.8961	0.6812	1.2763	1.1252	0.0859	0.3072	0.9583	0	0.8641	0.207	0.0036	0.027	0.8324	2.6765	0.061	0	1.8671	0.3591	0.2685	0	0	0	0	0	0	0	0	0											17.6165	0		3.621117677	20.0365	0.410460604	9.410180799	3.499592351	6.334138426	5.780387227	0.441515528	1.524537155	4.755887233	0	4.481390261	1.033005692	0.017934272	0.133878169	2.550393361	11.01623744	0.303755367	0	9.532601968	1.781938679	1.360962384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4053
H6169_024_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1116.049698	29.5740516	607.042836	31.08067629	528.7898727	33.4499173	1.638710153	335.5194391	635.8731978	1102.048844	20.96568608	4.446264768	3.913235853	426.9461065	6438.965632	8573.651527	0.745402461	1058.610517	28.74396671	16965.47537	6.890131441	13.89819553	0	0	0	0	0.638908973	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	58.20921377	98.38023276	0	0.2	0.272935833	30	3.861971957	4.032828704	11.91960098	0.4	0	0.18346268	1.145528171	0.2	0	0	0	0	0	20	0	0	0											NO	164.6266756	164.6266756	82.31333781	0.123470007	123.4700067	0.164626676	0.164626676	47.91394677	80.98005333	0	0.164626676	0.224662594	24.69400134	3.178918023	3.319555915	9.81142142	0.329253351	0	0.151014255	0.942922473	0.164626676	0	0	0	0	0	20	0	0	0												15.311	0.40572315	4.163976835	3.83753131	5.440807428	5.506748685	0.269775405	1.339671712	4.291087122	0	3.451511201	0.998909378	0.008052788	0.113102223	1.781208871	7.009975687	0.245426258	0	4.340748727	1.333094	1.134299434	0	0	0	0	0	0.001064848	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9837	0		13.10333053	15.311	0.40572315	4.163976835	3.83753131	5.440807428	5.506748685	0.269775405	1.339671712	4.291087122	0	3.451511201	0.998909378	0.008052788	0.113102223	1.781208871	7.009975687	0.245426258	0	4.340748727	1.333094	1.134299434	0	0	0	0	0	0.001064848	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9837	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.8611	0.1023	1.0501	0.9331	1.3721	1.339	0.0656	0.3378	1.0821	0	0.7841	0.2514	0.002	0.0285	0.8624	2.2454	0.0612	0	1.0499	0.3362	0.2653	0	0	0	0	0	0.0003	0	0	0											16.03	0		3.275832634	19.1721	0.508039059	5.214055137	4.77066075	6.812878899	6.845762988	0.335373664	1.677512255	5.373220299	0	4.235570211	1.250283973	0.010083552	0.141624521	2.643649996	9.255359405	0.306579639	0	5.390636353	1.669275765	1.399635935	0	0	0	0	0	0.00133106	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0136
H6169_031_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	769.3097826	13.39665442	694.8589115	73.8486846	347.5628179	20.06538324	1.710155341	271.5258929	455.1406002	7.769547547	13.16233632	1.127925967	11.45527693	288.1101727	4864.793651	6344.542781	0.402682107	581.5515627	10.68940387	13684.61575	3.692471866	1.141140898	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	60.06568137	204.2392993	0.2	0.2	0.302883289	30	6.342357963	18.51794455	19.07440622	0.4	0	0.17225071	3.340817137	0.2	0	0	0	0	0	0	0	0	0											NO	194.4609674	194.4609674	111.7116196	0	124.1240217	0.165498696	0.165498696	49.70395959	169.0066882	0.165498696	0.165498696	0.250633946	24.82480435	5.248259851	15.32347834	15.78394675	0.330997391	0	0.142536339	2.764504393	0.165498696	0	0	0	0	0	0	0	0	0												12.4667	0.217093865	6.468651197	0	3.595074563	3.320794753	0.283028478	1.124659334	6.410150458	1.285849985	2.178349493	0.282696536	0.023697917	0.126006421	6.212130012	8.345160449	0.133286727	0	1.523628496	3.152598362	0.611099277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7607	0		12.04129682	12.4667	0.217093865	6.468651197	0	3.595074563	3.320794753	0.283028478	1.124659334	6.410150458	1.285849985	2.178349493	0.282696536	0.023697917	0.126006421	6.212130012	8.345160449	0.133286727	0	1.523628496	3.152598362	0.611099277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7607	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.1417	0.0547	1.6301	0	0.906	0.8016	0.0683	0.2834	1.6154	0.3148	0.5323	0.0712	0.006	0.0318	1.8501	2.4776	0.0334	0	0.3807	0.7903	0.1499	0	0	0	0	0	0	0	0	0											15.1393	0		3.010324205	15.6084	0.271803149	8.098799869	0	4.501060347	4.122375929	0.351346552	1.408081931	8.025556504	1.60065902	2.710612497	0.353858647	0.029669971	0.157760985	8.062270402	10.82273726	0.166691454	0	1.904322287	3.94287122	0.761047175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9
H6169_032_0	2012	6																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	940.1856861	27.00401294	559.8017501	63.52459929	406.8334957	25.70565371	1.437677683	292.4895434	536.7782524	6.552753765	22.24569364	6.519644714	8.270408352	377.3525736	5532.076683	6991.896254	0.482954663	379.8136884	29.41075214	16707.94668	4.341945767	6.606743005	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	56.2507934	198.4561759	0.2	0.2	0.151472106	30	12.63563824	18.77608645	19.50171005	0.4	0	0.186853954	3.318370004	0.2	0	0	0	0	0	0	0	0	0											NO	204.4076641	204.4076641	117.4256794	0	130.4729771	0.173963969	0.173963969	48.92805652	172.6211206	0.173963969	0.173963969	0.131753444	26.09459541	10.99072892	16.33181265	16.96297445	0.347927939	0	0.162529278	2.88638409	0.173963969	0	0	0	0	0	0	0	0	0												16.0151	0.459985601	5.477925068	0	4.423398113	4.471857557	0.250104116	1.192578743	7.721605286	1.139943056	3.869949168	0.858985644	0.017984413	0.345614987	7.529069994	9.883613129	0.16803342	0	4.780108311	4.018795957	0.755342121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.38	0		10.98229538	16.0151	0.459985601	5.477925068	0	4.423398113	4.471857557	0.250104116	1.192578743	7.721605286	1.139943056	3.869949168	0.858985644	0.017984413	0.345614987	7.529069994	9.883613129	0.16803342	0	4.780108311	4.018795957	0.755342121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.38	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	4.0251	0.1156	1.3768	0	1.1117	1.0772	0.0602	0.2997	1.9407	0.2809	0.9517	0.2158	0.0045	0.0869	2.2363	2.9389	0.0414	0	1.1759	0.996	0.1865	0	0	0	0	0	0	0	0	0											19.1218	0		2.745573845	20.0402	0.575593399	6.85468742	0	5.535127083	5.549031832	0.310348817	1.492308566	9.662269921	1.42083236	4.821647135	1.074740603	0.022504421	0.432478114	9.765394876	12.82254267	0.209458154	0	5.95599602	5.014830361	0.941861942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5018
H6169_033_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	922.0634332	33.21332775	545.2170121	79.62347339	353.515603	25.05137606	1.702470764	298.16927	604.7701343	7.532906614	24.69393553	5.744294387	9.512247145	382.7156888	5302.123099	7063.903777	0.406969442	640.2847934	21.07396264	14417.8704	8.464484603	7.59299674	0	0	0	0	0	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	57.49357171	192.1012275	0.2	0.2	0.248816715	30	11.97754686	19.13959126	19.05224393	0.4	0	0.18406237	3.222199031	0.2	0	0	0	0	0	0	0	0	0											NO	204.6415885	204.6415885	117.5600615	0	130.6222905	0.174163054	0.174163054	50.06628019	167.2846824	0.174163054	0.174163054	0.216673395	26.12445811	10.4302307	16.66704834	16.59098495	0.348326108	0	0.160284323	2.80594012	0.174163054	0	0	0	0	0	0	0	0	0												15.7244	0.566402346	5.341312123	0	3.848084817	4.363024163	0.296507508	1.244018851	8.430731651	1.311954022	4.300771228	1.244635767	0.020708525	0.332651077	7.364228499	9.76642677	0.141758082	0	3.377825829	3.37130675	1.474200489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5209	0		10.75841972	15.7244	0.566402346	5.341312123	0	3.848084817	4.363024163	0.296507508	1.244018851	8.430731651	1.311954022	4.300771228	1.244635767	0.020708525	0.332651077	7.364228499	9.76642677	0.141758082	0	3.377825829	3.37130675	1.474200489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5209	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	3.9492	0.1423	1.3415	0	0.9665	1.0566	0.0718	0.3124	2.1174	0.3046	0.9966	0.3108	0.0052	0.0835	2.1858	2.8918	0.0352	0	0.8358	0.8468	0.3436	0	0	0	0	0	0	0	0	0											18.7974	0		2.689604931	19.6736	0.70865515	6.682790721	0	4.814537124	5.419598333	0.368311413	1.556456063	10.54812262	1.616587808	5.297391054	1.555440194	0.025909503	0.416196897	9.55004507	12.65823489	0.176959317	0	4.213593928	4.218075921	1.817813525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3183
H6169_035_0	2012	8																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1217.026767	20.9950268	597.1141578	96.69027977	557.2253384	31.63695721	3.672613588	379.2295875	569.25713	8.897986177	25.95722932	9.931917554	3.721361035	341.1899531	5696.804248	8147.830778	0.335934723	575.2443067	35.24958545	16687.40022	4.585283059	9.629062819	0	0	0	0	0.076058536	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.6235595	192.9187572	0.2	0.2	0.171382098	30	11.22774566	19.91998968	19.84031752	0.4	0	0.187717249	3.162691802	0.2	0	0	0	0	0	20	0	0	0											NO	212.5018002	212.5018002	122.0755023	0	135.6394469	0.180852596	0.180852596	53.01111459	174.4492902	0.180852596	0.180852596	0.154974486	27.12788939	10.15283474	18.01290922	17.94086463	0.361705192	0	0.169745759	2.859905113	0.180852596	0	0	0	0	0	20	0	0	0												21.5517	0.371790083	6.074417559	0	6.29847806	5.721625839	0.664201701	1.675281926	8.275541856	1.609223899	4.694432306	1.53919382	0.008412723	0.288670434	8.551334813	12.18159409	0.121509334	0	5.983467643	3.977031768	0.829260344	0	0	0	0	0	0.000126764	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4173	0		9.572735252	21.5517	0.371790083	6.074417559	0	6.29847806	5.721625839	0.664201701	1.675281926	8.275541856	1.609223899	4.694432306	1.53919382	0.008412723	0.288670434	8.551334813	12.18159409	0.121509334	0	5.983467643	3.977031768	0.829260344	0	0	0	0	0	0.000126764	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4173	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	5.4062	0.0933	1.5238	0	1.58	1.4353	0.1666	0.4202	2.0759	0.3693	1.0752	0.3852	0.0021	0.0724	2.5351	3.6226	0.0299	0	1.4668	0.9831	0.1909	0	0	0	0	0	0	0	0	0											23.434	0		2.393183813	26.9579	0.465053714	7.598186663	0	7.878452794	7.156897055	0.830816858	2.0955268	10.35146352	1.97852176	5.769599965	1.924383882	0.010523056	0.361083482	11.08645818	15.80418352	0.151391021	0	7.450297863	4.960134983	1.020181238	0	0	0	0	0	0.000158455	0	0	0	0	0	0	0	0	0	0	0	0	0	113.8513
H6169_036_0	2012	9																															D	D	D	V	T	Coin	Coin	P	P	Coin	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1469.977814	24.0475336	627.5587112	178.2093088	512.7794537	25.30054149	2.008285065	298.2263226	568.9657223	8.077237595	21.87643724	7.637272893	21.16833985	333.0302216	5213.568875	9735.409849	0.750389768	1106.169687	22.18206227	19196.38556	4.269256859	9.330621853	0	0	0	0	0.032941039	0	0	0												1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $25; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		235	235	135	0	150	0.2	0.2	58.38975426	204.6037817	0.2	0.2	0.176270384	30	10.04671239	19.4230886	17.54993399	0.4	0	0.176260651	2.983818925	0.2	0	0	0	0	0	20	0	0	0											NO	213.6165284	213.6165284	122.715878	0	136.3509756	0.181801301	0.181801301	53.07666639	185.9861683	0.181801301	0.181801301	0.160230925	27.27019512	9.132526905	17.65571387	15.95300414	0.363602602	0	0.160222078	2.712310809	0.181801301	0	0	0	0	0	20	0	0	0												26.1676	0.42807922	6.417618189	0	5.826498232	4.599671353	0.365108837	1.319071586	8.818312883	1.468452302	3.977164748	1.223727303	0.048105397	0.253450622	7.670773358	12.94241947	0.272843672	0	3.554056118	4.338880339	0.77615645	0	0	0	0	0	5.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4681	0		9.056042356	26.1676	0.42807922	6.417618189	0	5.826498232	4.599671353	0.365108837	1.319071586	8.818312883	1.468452302	3.977164748	1.223727303	0.048105397	0.253450622	7.670773358	12.94241947	0.272843672	0	3.554056118	4.338880339	0.77615645	0	0	0	0	0	5.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4681	YES	1a: $235 Per Day (Days 1-6)	1b: $235 Per Day (Days 1-6)	"2: $0 Per Day (Days 1-20), $135 Per Day (Days 21-100)"	6: $0	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $300; 9b: $150	8a: 20%	8b: 20%	5: $265; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $45; 7c: $45; 7i: $45	7a : $30; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $60; 7f: $50; 7g: $50; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $45; 7i: $45; 3: $45	8b: 20%	8a: 20%; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												6700	6.568	0.1074	1.6108	0	1.4624	1.1757	0.0933	0.3311	2.2134	0.3676	0.9936	0.3071	0.0121	0.0636	2.2754	3.8305	0.0685	0	0.8889	1.0866	0.1946	0	0	0	0	0	0	0	0	0											23.6506	0		2.264010589	32.7357	0.535526292	8.028428172	0	7.288938227	5.775349622	0.458430836	1.65015605	11.03169268	1.836018063	4.970716797	1.530866156	0.06017976	0.317066246	9.946186464	16.77289474	0.341326916	0	4.442913602	5.425434889	0.970803686	0	0	0	0	0	6.86E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1187
H6169_050_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	952.6173631	22.82676002	697.8336422	18.42800293	434.7747142	24.38464277	1.781555477	289.6130382	479.1119217	1043.586705	20.75069892	5.101999933	8.267557712	365.3859897	5212.987758	7402.896173	0.449780397	750.4631946	24.01974044	14017.92466	4.726012883	9.28393397	0	0	0	0	0.168975363	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.194781317	30	3.55757441	3.921960341	12.0113985	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	157.7836788	157.7836788	78.89183939	0.118337759	118.3377591	0.157783679	0.157783679	46.91560061	80.36946462	0	0.157783679	0.153666564	23.66755182	2.80663589	3.094106653	9.476013209	0.315567358	0	0.145129786	0.941961333	0.157783679	0	0	0	0	0	20	0	0	0												12.5256	0.300140848	4.587781635	2.180728571	4.287522115	3.847498641	0.281100377	1.132280803	3.20883072	0	3.274121613	0.784006797	0.016306071	0.085458786	1.344128342	5.845828494	0.141936011	0	3.485979791	1.100361917	0.745687699	0	0	0	0	0	0.000281626	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1756	0		13.1572619	12.5256	0.300140848	4.587781635	2.180728571	4.287522115	3.847498641	0.281100377	1.132280803	3.20883072	0	3.274121613	0.784006797	0.016306071	0.085458786	1.344128342	5.845828494	0.141936011	0	3.485979791	1.100361917	0.745687699	0	0	0	0	0	0.000281626	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1756	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.1676	0.0759	1.1602	0.5285	1.0843	0.9325	0.0681	0.2863	0.8115	0	0.791	0.1979	0.0041	0.0216	0.6526	1.8757	0.0353	0	0.84	0.2783	0.1853	0	0	0	0	0	0.0001	0	0	0											12.9968	0		3.289315475	15.6932	0.376042493	5.747970853	2.709274604	5.371779677	4.780021914	0.349231043	1.418619623	4.020301513	0	4.065074423	0.981930857	0.02042966	0.107070181	1.996759876	7.721510345	0.177194686	0	4.326003432	1.378628873	0.930977549	0	0	0	0	0	0.000352032	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1724
H6169_051_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	999.8816761	23.95931457	732.4568068	19.98981518	456.3461541	26.45129284	1.932546074	303.9822507	502.8831615	1095.364481	24.0153154	5.904685414	8.677754346	383.5146933	5471.631254	7768.863398	0.487669409	787.6975856	26.04313727	14713.42697	5.459277529	9.744558328	0	0	0	0	0.177359112	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.178409071	30	3.55757441	3.921960341	12.0295795	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	162.6944691	162.6944691	81.34723454	0.122020852	122.0208518	0.162694469	0.162694469	48.37578127	82.87084873	0	0.162694469	0.145130845	24.40417036	2.893988399	3.190406277	9.785730254	0.325388938	0	0.149646742	0.971278526	0.162694469	0	0	0	0	0	20	0	0	0												13.5563	0.32483733	4.965277971	2.439174275	4.640312203	4.303479045	0.314414557	1.225448239	3.472862867	0	3.907158988	0.856951984	0.017647783	0.092490589	1.454727225	6.335333466	0.158682231	0	3.897270647	1.190902972	0.888194259	0	0	0	0	0	0.000295599	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0417	0		12.39159776	13.5563	0.32483733	4.965277971	2.439174275	4.640312203	4.303479045	0.314414557	1.225448239	3.472862867	0	3.907158988	0.856951984	0.017647783	0.092490589	1.454727225	6.335333466	0.158682231	0	3.897270647	1.190902972	0.888194259	0	0	0	0	0	0.000295599	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0417	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.419	0.0819	1.2523	0.5932	1.1703	1.0466	0.0765	0.3091	0.8759	0	0.8877	0.2144	0.0045	0.0233	0.7044	2.0271	0.0396	0	0.9427	0.3004	0.2078	0	0	0	0	0	0.0001	0	0	0											14.1768	0		3.09789944	16.9753	0.406764967	6.217577044	3.032350729	5.810651247	5.350030932	0.390876217	1.534520099	4.348758029	0	4.794829227	1.071399281	0.022098753	0.115817759	2.159172545	8.362477391	0.198252324	0	4.84001208	1.491262126	1.095993005	0	0	0	0	0	0.000369498	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2185
H6169_052_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1113.399892	26.67945507	815.6138361	21.53765295	508.1558856	28.49945135	2.082185667	338.493857	559.9763163	1219.723017	27.11877766	6.66774289	9.66295411	427.0557489	6092.834575	8650.337438	0.549337402	877.1261917	29.33640927	16383.86661	6.163017033	10.85087411	0	0	0	0	0.197494985	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.17619142	30	3.55757441	3.921960341	12.03614093	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	166.421595	166.421595	83.21079748	0.124816196	124.8161962	0.166421595	0.166421595	49.48400964	84.76931576	0	0.166421595	0.146610286	24.96323924	2.960286038	3.263494477	10.01536886	0.33284319	0	0.153074961	0.993529297	0.166421595	0	0	0	0	0	20	0	0	0												15.4411	0.370003122	5.655656478	2.688247916	5.285507061	4.74292415	0.34652066	1.395836107	3.955734098	0	4.513150232	0.977559691	0.020101553	0.105350598	1.656994332	7.219693348	0.182843213	0	4.490669705	1.356487622	1.025659124	0	0	0	0	0	0.000329158	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4304	0		12.39457158	15.4411	0.370003122	5.655656478	2.688247916	5.285507061	4.74292415	0.34652066	1.395836107	3.955734098	0	4.513150232	0.977559691	0.020101553	0.105350598	1.656994332	7.219693348	0.182843213	0	4.490669705	1.356487622	1.025659124	0	0	0	0	0	0.000329158	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4304	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.8926	0.0933	1.4257	0.6777	1.3324	1.1956	0.0874	0.3519	0.9972	0	1.0141	0.2442	0.0051	0.0266	0.802	2.3082	0.0452	0	1.077	0.342	0.2374	0	0	0	0	0	0.0001	0	0	0											16.1556	0		3.098642894	19.3337	0.463277428	7.081394267	3.365929924	6.617933664	5.938570706	0.433875258	1.747713257	4.952937448	0	5.527280421	1.221791173	0.025168965	0.131908492	2.459002681	9.527851518	0.228050571	0	5.567716684	1.69844539	1.263046008	0	0	0	0	0	0.000411448	0	0	0	0	0	0	0	0	0	0	0	0	0	77.586
H6169_053_0	2012	3																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1109.316553	26.58160948	812.6226124	21.9927951	506.2922489	29.10171297	2.126187233	337.2524474	557.9226307	1215.249743	25.8687474	6.360403241	9.6275157	425.489543	6070.489404	8617.509038	0.560255479	873.9093745	29.91947017	16323.77958	5.88406215	10.81107906	0	0	0	0	0.196770681	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.183189285	30	3.55757441	3.921960341	12.04957834	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	167.8651867	167.8651867	83.93259336	0.12589889	125.89889	0.167865187	0.167865187	49.91324906	85.5046307	0	0.167865187	0.153755518	25.17977801	2.985964463	3.291803025	10.11352359	0.335730373	0	0.15440278	1.002147474	0.167865187	0	0	0	0	0	20	0	0	0												15.518	0.371843903	5.683793607	2.768868492	5.311802681	4.885164482	0.356912817	1.40278045	3.975414041	0	4.342462112	0.977947094	0.020201559	0.105874721	1.665237949	7.262781746	0.188094781	0	4.61964937	1.363236205	0.987729192	0	0	0	0	0	0.000327951	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8081	0		11.83200047	15.518	0.371843903	5.683793607	2.768868492	5.311802681	4.885164482	0.356912817	1.40278045	3.975414041	0	4.342462112	0.977947094	0.020201559	0.105874721	1.665237949	7.262781746	0.188094781	0	4.61964937	1.363236205	0.987729192	0	0	0	0	0	0.000327951	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8081	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.9179	0.0939	1.435	0.7119	1.3411	1.256	0.0918	0.3542	1.0037	0	1.0653	0.2469	0.0051	0.0267	0.8072	2.3265	0.0475	0	1.1314	0.3442	0.2492	0	0	0	0	0	0.0001	0	0	0											16.4554	0		2.958000117	19.4358	0.465724626	7.118800728	3.480752665	6.65289196	6.141154532	0.448676144	1.756945305	4.979100637	0	5.407774785	1.224830759	0.025301917	0.13260528	2.472460498	9.589240668	0.235583724	0	5.751054201	1.707417187	1.236892702	0	0	0	0	0	0.000409939	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2635
H6169_054_0	2012	5																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	952.6173631	22.82676002	697.8336422	18.42800293	434.7747142	24.38464277	1.781555477	289.6130382	479.1119217	1043.586705	20.75069892	5.101999933	8.267557712	365.3859897	5212.987758	7402.896173	0.449780397	750.4631946	24.01974044	14017.92466	4.726012883	9.28393397	0	0	0	0	0.168975363	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.194781317	30	3.55757441	3.921960341	12.0113985	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	157.7836788	157.7836788	78.89183939	0.118337759	118.3377591	0.157783679	0.157783679	46.91560061	80.36946462	0	0.157783679	0.153666564	23.66755182	2.80663589	3.094106653	9.476013209	0.315567358	0	0.145129786	0.941961333	0.157783679	0	0	0	0	0	20	0	0	0												12.5256	0.300140848	4.587781635	2.180728571	4.287522115	3.847498641	0.281100377	1.132280803	3.20883072	0	3.274121613	0.784006797	0.016306071	0.085458786	1.344128342	5.845828494	0.141936011	0	3.485979791	1.100361917	0.745687699	0	0	0	0	0	0.000281626	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1756	0		13.1572619	12.5256	0.300140848	4.587781635	2.180728571	4.287522115	3.847498641	0.281100377	1.132280803	3.20883072	0	3.274121613	0.784006797	0.016306071	0.085458786	1.344128342	5.845828494	0.141936011	0	3.485979791	1.100361917	0.745687699	0	0	0	0	0	0.000281626	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1756	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.1676	0.0759	1.1602	0.5285	1.0843	0.9325	0.0681	0.2863	0.8115	0	0.791	0.1979	0.0041	0.0216	0.6526	1.8757	0.0353	0	0.84	0.2783	0.1853	0	0	0	0	0	0.0001	0	0	0											12.9968	0		3.289315475	15.6932	0.376042493	5.747970853	2.709274604	5.371779677	4.780021914	0.349231043	1.418619623	4.020301513	0	4.065074423	0.981930857	0.02042966	0.107070181	1.996759876	7.721510345	0.177194686	0	4.326003432	1.378628873	0.930977549	0	0	0	0	0	0.000352032	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1724
H6169_056_0	2012	5																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1113.399892	26.67945507	815.6138361	21.53765295	508.1558856	28.49945135	2.082185667	338.493857	559.9763163	1219.723017	27.11877766	6.66774289	9.66295411	427.0557489	6092.834575	8650.337438	0.549337402	877.1261917	29.33640927	16383.86661	6.163017033	10.85087411	0	0	0	0	0.197494985	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.17619142	30	3.55757441	3.921960341	12.03614093	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	166.421595	166.421595	83.21079748	0.124816196	124.8161962	0.166421595	0.166421595	49.48400964	84.76931576	0	0.166421595	0.146610286	24.96323924	2.960286038	3.263494477	10.01536886	0.33284319	0	0.153074961	0.993529297	0.166421595	0	0	0	0	0	20	0	0	0												15.4411	0.370003122	5.655656478	2.688247916	5.285507061	4.74292415	0.34652066	1.395836107	3.955734098	0	4.513150232	0.977559691	0.020101553	0.105350598	1.656994332	7.219693348	0.182843213	0	4.490669705	1.356487622	1.025659124	0	0	0	0	0	0.000329158	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4304	0		12.39457158	15.4411	0.370003122	5.655656478	2.688247916	5.285507061	4.74292415	0.34652066	1.395836107	3.955734098	0	4.513150232	0.977559691	0.020101553	0.105350598	1.656994332	7.219693348	0.182843213	0	4.490669705	1.356487622	1.025659124	0	0	0	0	0	0.000329158	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4304	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.8926	0.0933	1.4257	0.6777	1.3324	1.1956	0.0874	0.3519	0.9972	0	1.0141	0.2442	0.0051	0.0266	0.802	2.3082	0.0452	0	1.077	0.342	0.2374	0	0	0	0	0	0.0001	0	0	0											16.1556	0		3.098642894	19.3337	0.463277428	7.081394267	3.365929924	6.617933664	5.938570706	0.433875258	1.747713257	4.952937448	0	5.527280421	1.221791173	0.025168965	0.131908492	2.459002681	9.527851518	0.228050571	0	5.567716684	1.69844539	1.263046008	0	0	0	0	0	0.000411448	0	0	0	0	0	0	0	0	0	0	0	0	0	77.586
H6169_057_0	2012	4																															D	D	D	Coin	T	Coin	Coin	P	P	P	Coin	Coin	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1109.316553	26.58160948	812.6226124	21.9927951	506.2922489	29.10171297	2.126187233	337.2524474	557.9226307	1215.249743	25.8687474	6.360403241	9.6275157	425.489543	6070.489404	8617.509038	0.560255479	873.9093745	29.91947017	16323.77958	5.88406215	10.81107906	0	0	0	0	0.196770681	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $5; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												0		200	200	100	0.15	150	0.2	0.2	59.46825549	101.872976	0	0.2	0.183189285	30	3.55757441	3.921960341	12.04957834	0.4	0	0.183960454	1.193990837	0.2	0	0	0	0	0	20	0	0	0											NO	167.8651867	167.8651867	83.93259336	0.12589889	125.89889	0.167865187	0.167865187	49.91324906	85.5046307	0	0.167865187	0.153755518	25.17977801	2.985964463	3.291803025	10.11352359	0.335730373	0	0.15440278	1.002147474	0.167865187	0	0	0	0	0	20	0	0	0												15.518	0.371843903	5.683793607	2.768868492	5.311802681	4.885164482	0.356912817	1.40278045	3.975414041	0	4.342462112	0.977947094	0.020201559	0.105874721	1.665237949	7.262781746	0.188094781	0	4.61964937	1.363236205	0.987729192	0	0	0	0	0	0.000327951	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8081	0		11.83200047	15.518	0.371843903	5.683793607	2.768868492	5.311802681	4.885164482	0.356912817	1.40278045	3.975414041	0	4.342462112	0.977947094	0.020201559	0.105874721	1.665237949	7.262781746	0.188094781	0	4.61964937	1.363236205	0.987729192	0	0	0	0	0	0.000327951	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8081	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	"2: $0 Per Day (Days 1-20), $100 Per Day (Days 21-100)"	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	"4a: $65, Worldwide ER: $250 deductible, 20% coinsurance; 4b: $35"	9a: $150; 9b: $75	8a: $0	8b: 20%	5: $200; 9c: 40%; 7e: 40%; 7h: 40%	12: $30	3: $15; 7c: $15; 7i: $15	7a : $10; 14a: $0; 14d: $0; 14e: $0	7b: 50%; 7d: $40; 7f: $35; 7g: $35; 14d: $0; 14e: $0	7e: 40%; 7h: 40%	7c: $15; 7i: $15; 3: $15	8b: 20%	8a: $0; 17a: $20; 18a: $20	15: 20%	9d: $0			17a: $20		18a: $20		14c: $0  Writen Health Materials;   Nursing Hotline												3250	3.9179	0.0939	1.435	0.7119	1.3411	1.256	0.0918	0.3542	1.0037	0	1.0653	0.2469	0.0051	0.0267	0.8072	2.3265	0.0475	0	1.1314	0.3442	0.2492	0	0	0	0	0	0.0001	0	0	0											16.4554	0		2.958000117	19.4358	0.465724626	7.118800728	3.480752665	6.65289196	6.141154532	0.448676144	1.756945305	4.979100637	0	5.407774785	1.224830759	0.025301917	0.13260528	2.472460498	9.589240668	0.235583724	0	5.751054201	1.707417187	1.236892702	0	0	0	0	0	0.000409939	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2635
H6169_801_0	2012	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	0.343106015	0.833164186	0.060871436	0	1.453743614	0.314533195	0.697187009	0.187870998	0.008012576	0.489495022	0.86829056	2.200785687	0.030589285	0.088717067	0.777034242	1.674565293	0.166216448	0.041428987																			10.2356	YES	302.0635148	4.501546015	62.00124128	25.37841229	12.5846663	30.55933968	2.232682246	14.82969471	53.32135685	11.53665375	25.57188004	6.585227772	0.293890493	17.95401781	34.42967777	87.18229268	0.560986876	3.254022477	28.50056895	61.42079849	6.096595321	1.519559427																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282208	0.2	0.2	0.185001602	0.196945052	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071846432	0.071846432	0.158148194	0	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.180074012	0.172087262	0.172087262	0.159182096	0.169458674	0.344174525	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262																				21.7022	0.32342002	9.805384347	0	2.165660774	5.258873108	0.384216176	2.552001567	9.175926332	1.985311162	4.400594832	1.185828382	0.05057481	3.089657776	5.480588283	14.77379572	0.193077391	0.55997582	4.90458489	10.56973707	1.049146399	0.261496822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.872	0		16.199351	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076
H6169_802_0	2012	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	0.343106015	0.833164186	0.060871436	0	1.453743614	0.314533195	0.697187009	0.187870998	0.008012576	0.489495022	0.86829056	2.200785687	0.030589285	0.088717067	0.777034242	1.674565293	0.166216448	0.041428987																			10.2356	YES	302.0635148	4.501546015	62.00124128	25.37841229	12.5846663	30.55933968	2.232682246	14.82969471	53.32135685	11.53665375	25.57188004	6.585227772	0.293890493	17.95401781	34.42967777	87.18229268	0.560986876	3.254022477	28.50056895	61.42079849	6.096595321	1.519559427																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282208	0.2	0.2	0.185001602	0.196945052	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071846432	0.071846432	0.158148194	0	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.180074012	0.172087262	0.172087262	0.159182096	0.169458674	0.344174525	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262																				21.7022	0.32342002	9.805384347	0	2.165660774	5.258873108	0.384216176	2.552001567	9.175926332	1.985311162	4.400594832	1.185828382	0.05057481	3.089657776	5.480588283	14.77379572	0.193077391	0.55997582	4.90458489	10.56973707	1.049146399	0.261496822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.872	0		16.199351	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076
H6169_803_0	2012	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	0.343106015	0.833164186	0.060871436	0	1.453743614	0.314533195	0.697187009	0.187870998	0.008012576	0.489495022	0.86829056	2.200785687	0.030589285	0.088717067	0.777034242	1.674565293	0.166216448	0.041428987																			10.2356	YES	302.0635148	4.501546015	62.00124128	25.37841229	12.5846663	30.55933968	2.232682246	14.82969471	53.32135685	11.53665375	25.57188004	6.585227772	0.293890493	17.95401781	34.42967777	87.18229268	0.560986876	3.254022477	28.50056895	61.42079849	6.096595321	1.519559427																			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																			162	YES	0.0835	0.0835	0.1838	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.209282208	0.2	0.2	0.185001602	0.196945052	0.4	0.2	0.2	0.2	0.2	0.2																			NO	0.071846432	0.071846432	0.158148194	0	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262	0.180074012	0.172087262	0.172087262	0.159182096	0.169458674	0.344174525	0.172087262	0.172087262	0.172087262	0.172087262	0.172087262																				21.7022	0.32342002	9.805384347	0	2.165660774	5.258873108	0.384216176	2.552001567	9.175926332	1.985311162	4.400594832	1.185828382	0.05057481	3.089657776	5.480588283	14.77379572	0.193077391	0.55997582	4.90458489	10.56973707	1.049146399	0.261496822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.872	0		16.199351	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0		0	21.7022	0.32342002	9.805384347	0	2.508766789	6.092037295	0.445087612	2.552001567	10.62966995	2.299844357	5.097781841	1.37369938	0.058587386	3.579152798	6.348878843	16.97458141	0.223666676	0.648692887	5.681619132	12.24430236	1.215362847	0.302925809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1076
H6178_001_0	2012	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	332.1210173	1.051095718	74.01909323	0	18.79658929	18.45791185	13.61778892	48.44537251	45.05779164	10.13624611	19.04504685	0.027284166	0.198269869	32.79843296	11.52691692	68.8480376	3.09019323	5.615268657	21.51601351	62.75224923	22.5901268	3.737319457	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost-Sharing; PBP 13a-e											0	NO	0.08077759	0.08077759	0.173584964	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.08077759	0.08077759	0.173584964	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0												26.8279	0.084904979	12.84860161	0	4.210436002	4.134572255	3.050384717	10.85176344	10.09294533	2.270519128	4.266090494	0.006111653	0.044412451	7.346848983	2.582029391	15.42196042	0.692203284	1.257820179	4.819587027	14.05650383	5.060188403	0.837159558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.763	0	NO	0	26.8279	0.084904979	12.84860161	0	4.210436002	4.134572255	3.050384717	10.85176344	10.09294533	2.270519128	4.266090494	0.006111653	0.044412451	7.346848983	2.582029391	15.42196042	0.692203284	1.257820179	4.819587027	14.05650383	5.060188403	0.837159558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.763	NO																																										0	0	0	0	0	0	0	0	0	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	26.8279	0.084904979	12.84860161	0	4.210436002	4.134572255	3.050384717	10.85176344	10.09294533	2.270519128	4.266090494	0.006111653	0.044412451	7.346848983	2.582029391	15.42196042	0.692203284	1.257820179	4.819587027	14.05650383	5.060188403	0.837159558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.763
H6181_007_0	2012	7																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin							Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	318.253523	6.029088877	39.97935887	0	9.648791819	5.363508014	4.261119663	10.68389131	24.73370845	9.456950818	10.67740721	0	0.176140842	12.37693285	0	0	0	0	0	0	4.330423146	0	0	0	0	0	0	0	0	0											6700	6% Coinsurance for IP Medical; 6% Coinsurance for IP Surgical; PBP 1a	6% Coinsurance for IP Psych; 6% Coinsurance for IP Substance Abuse; PBP 1b	15% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 0% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"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	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											0	NO	0.056986274	0.056986274	0.148606453	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0.056371159	0.056371159	0.147002383	0	0.197841184	0.197841184	0.197841184	0.197841184	0.197841184	0.197841184	0.198446544	0	0.197841184	0.197841184	0	0	0	0	0	0	0.197841184	0	0	0	0	0	0	0	0	0												17.9403	0.339866729	5.877061028	0	1.908928397	1.061122775	0.843024959	2.113713705	4.893346162	1.870974346	2.118894562	0	0.034847913	2.448667049	0	0	0	0	0	0	0.856736042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3075	0	NO	0.455119518	17.9403	0.339866729	5.877061028	0	1.908928397	1.061122775	0.843024959	2.113713705	4.893346162	1.870974346	2.118894562	0	0.034847913	2.448667049	0	0	0	0	0	0	0.856736042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3075	NO																																										0	0	0	0	0	0	0	0	0	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	17.9403	0.339866729	5.877061028	0	1.908928397	1.061122775	0.843024959	2.113713705	4.893346162	1.870974346	2.118894562	0	0.034847913	2.448667049	0	0	0	0	0	0	0.856736042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3075
H6181_009_0	2012	7																																	D		T	Coin	Coin	V					V	V	V	V	V	V	V		Coin																				12.06121236	0.248487602	0	0	0	0	0	0	10.69050464	4.462218671	4.288449364	0	0	5.254300519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											37.0052	YES	0	0	345.0690634	0	187.9726147	3.111136912	3.558684696	144.9126189	0	0	0	0	5.928952772	31.65406702	183.2822855	4461.391542	129.8900376	396.3585788	394.4446434	0	23.46261573	0	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	$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"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $15/Visit for Speclst Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing;	$30/Visit for Renal Dialysis - Fac; PBP 12	"$15/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"$50/Exam for Prof - Asst Surgeon (OP); PBP 7a, 14a-b"	"$50/Exam for Prof - Asst Surgeon (OP); $15/Visit for Speclst Office Visits; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; 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"	$15/Visit for Prof Radiology (Office); $50/Visit for Prof Radiology (Office); $50/Visit for Office-Rad Therapeutic; $50/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											0	NO	0	0	77.4793551	0	100	0.2	0.2	65	0	0	0	0	30	15	50	15.71593275	15	15	33.63027222	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	73.31977703	0	94.63137237	0.189262745	0.189262745	61.53573453	0	0	0	0	28.38941171	14.19470585	47.31568618	14.87220284	14.19470585	14.19470585	31.82478813	0	0.189262745	0	0	0	0	0	0	0	0	0												0	0	2.108365566	0	1.482342208	0.588822311	0.673526433	0.743108704	0	0	0	0	0.014026623	0.037443348	0.722677259	5.529226662	0.153645906	0.468849453	1.046093101	0	4.440599052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0087	1000	NO	1.021347797	12.0612	0.248487602	2.108365566	0	1.482342208	0.588822311	0.673526433	0.743108704	10.69050464	4.462218671	4.288449364	0	0.014026623	5.291743866	0.722677259	5.529226662	0.153645906	0.468849453	1.046093101	0	4.440599052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0139	NO																																										0	0	0	0	0	0	0	0	0	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	12.0612	0.248487602	2.108365566	0	1.482342208	0.588822311	0.673526433	0.743108704	10.69050464	4.462218671	4.288449364	0	0.014026623	5.291743866	0.722677259	5.529226662	0.153645906	0.468849453	1.046093101	0	4.440599052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0139
H6264_001_0	2012	5																															D	D	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin																																																			0	YES	1327.116523	269.5777349	23.98445798		7.208925165	3.430035739	5.530013274	194.8580415	27.83528931		14.59858744		0.230009628	34.8044388		3812.900713	462.5592617	1354.651581	2482.510968	99.12781409	16.12758974	0.566141588																			5900	"$100 Copay per day, Max $700"	"$100 Copay per day, Max $700"	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS; Diabetic Supplies $0 copay	"4A ER: $50 copay, 4B UC: $50 copay"	Medicare FFS	$0 copay	Medicare FFS; $0 copay X-Rays	$0 copay	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: $0"	"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													63.08281425	63.08281425	0.14		0.224	0.224	0.224	50	0.224		0.215211552		0.224	0.224		15	15	15	15	15	0.224	0.224																			NO	60.61021231	60.61021231	0.134512542		0.215220068	0.215220068	0.215220068	48.0401937	0.215220068		0.206776093		0.215220068	0.215220068		14.41205811	14.41205811	14.41205811	14.41205811	14.41205811	0.215220068	0.215220068																				6.7031	1.361596979	3.22621042	0	1.551505363	0.738212524	1.190169832	0.780084838	5.990712853	0	3.018638875	0	0.049502688	7.490613677	0	4.57931222	0.555535913	1.626943109	2.981507694	0.119052985	3.470980957	0.121845031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5555	0		1.858442628	6.7031	1.361596979	3.22621042	0	1.551505363	0.738212524	1.190169832	0.780084838	5.990712853	0	3.018638875	0	0.049502688	7.490613677	0	4.57931222	0.555535913	1.626943109	2.981507694	0.119052985	3.470980957	0.121845031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5555	NO																																																																																		0	0		0	6.7031	1.361596979	3.22621042	0	1.551505363	0.738212524	1.190169832	0.780084838	5.990712853	0	3.018638875	0	0.049502688	7.490613677	0	4.57931222	0.555535913	1.626943109	2.981507694	0.119052985	3.470980957	0.121845031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5555
H6264_002_0	2012	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	306.9001542	43.98428935	27.30275013		14.7543269	6.43494411	4.459998647	13.57622478	27.62817904	5.813110384	13.98101708	9.623631686	3.426059666	49.83374029		140.8959931	9.416708877	22.64232086	26.37636816	2.27116327	10.12585506	0.149145165																			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	$0 copay	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.057091179	0.057091179	0.148595681		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.057091179	0.057091179	0.148595681		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224																				17.5213	2.511114955	4.057070743	0	3.304969225	1.441427481	0.999039697	3.041074351	6.188712105	1.302136726	3.131747826	2.155693498	0.767437365	11.16275782	0	31.56070246	2.109342788	5.071879873	5.908306467	0.508740573	2.268191534	0.033408517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.045	0		0	17.5213	2.511114955	4.057070743	0	3.304969225	1.441427481	0.999039697	3.041074351	6.188712105	1.302136726	3.131747826	2.155693498	0.767437365	11.16275782	0	31.56070246	2.109342788	5.071879873	5.908306467	0.508740573	2.268191534	0.033408517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.045	NO																																																																																		0	0		0	17.5213	2.511114955	4.057070743	0	3.304969225	1.441427481	0.999039697	3.041074351	6.188712105	1.302136726	3.131747826	2.155693498	0.767437365	11.16275782	0	31.56070246	2.109342788	5.071879873	5.908306467	0.508740573	2.268191534	0.033408517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.045
H6328_001_0	2012	8																															D	A	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	1224.669621	19.23045974	632.7133165	111.1224094	147.1483055	9.508877624	3.418961662	237.7651694	907.0160252	2383.322205	1336.935338	0.601481219	2.413976566	623.4788278	11607.00401	15858.09528	340.2831679	1483.236193	5132.519905	9604.010284	14.44538288	0	0	701.308793	121.770286	257.1718168	64.71270059	7.913484374	0	2551.107844											2500	$75 days 1-5;$0 days 6-90	$975 	$0 days 1-20;$100 days 21-100	$5 	10a: $100	11a: 20% to 30%	"11b1: 21.5%,11b2: 21.5%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $100,9b: $75"	"8a1: $03,8a2: $03"	"8b3: 20.0%,8b4: 20.0%"	9c1: $35	12: $25	"31: $10,5: $50,9a2: $100"	7a: $05	"7b1: $10,7d1: $15,7f1: $20,16b1: $20,17a1: $10,18a1: $20"	"7e1: $35,7h1: $35"	"7c: $10,7i: $10"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $10,16a2: $10"	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 											0	NO	48.63311011	108.3500077	10.39695293	5	100	0.215	0.210264094	49.93987934	88.45885785	2.5	1.547386267	35	25	3.128556678	3.713531628	14.32159045	35	10	0	0	0.198962305	0	0	5.551086987	20	0	20	0	0	0											NO	46.66884674	103.9738132	9.977025971	4.798052873	95.96105747	0.206316274	0.201771648	47.92283631	84.88605541	2.399026437	1.484888225	33.58637011	23.99026437	3.002196072	3.563544219	13.74314964	33.58637011	9.596105747	0	0	0.190926332	0	0	5.326881774	19.19221149	0	19.19221149	0	0	0												4.7628	0.166622019	0.526049766	0.044430933	1.176708917	1.961836197	0.689849528	0.949531774	6.416084381	0.476471081	0.165433295	0.001683464	0.004825995	0.155983807	3.446839338	18.16168138	0.952406368	1.186107613	0	0	2.758003962	0	0	0.311315752	0.194753424	0	0.10349832	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6129	0	NO	1.877731668	4.7628	0.166622019	0.526049766	0.044430933	1.176708917	1.961836197	0.689849528	0.949531774	6.416084381	0.476471081	0.165433295	0.001683464	0.004825995	0.155983807	3.446839338	18.16168138	0.952406368	1.186107613	0	0	2.758003962	0	0	0.311315752	0.194753424	0	0.10349832	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6129	YES	1a1.$300 days 1-5	Medicare FFS Cost Sharing	"21. $0 days 1-10, $125 days 11-100"	6: $40	10a: $100	11a: 30.0%	"11b1: 30.0%,11b2: 30.0%"	"4a1: $50,4b: $30"	"9a1: $200,9b: $150"	"8a1: $18,8a2: $18"	"8b1: $10,8b2: $200,8b3: 30.0%,8b4: 30.0%,8b5: $200,8b6: $200"	9c1: $50	12: $50	"31: $20,5: $100,9a2: $200"	"7a: $20,14b2: $30"	"7b1: $20,7d1: $30,7f1: $30,16b1: $30,18a1: $30"	"7e1: $50,7h1: $50"	"7c: $20,7i: $20"	7d2: $30	7g: $30	"152: 30.0%,153: 30.0%"	9d1: 30.0%	$0 	"16a1: 50.0%,16a2: 50.0%"	17a2: $30	17b2: 50.0%	18a2: $30	$0 	$0 	$0 											5100	3.6207	0.0158	0.5335	0.005	1.3353	0.8706	0.1621	0.1413	2.3976	0.2539	1.1784	0.0003	0.0014	0.0119	1.3651	4.3266	0.4104	0.2419	1.66	1.7862	0.2321	0	0	0	0.2713	0.2206	0.0083	0	0	0											21.0503	0	NO	0.697889162	8.3835	0.182469921	1.059509362	0.049445167	2.512051081	2.832392203	0.851995117	1.09087816	8.813636058	0.730357547	1.343839176	0.002023526	0.006190793	0.167841069	4.811933965	22.48832102	1.362808295	1.427970133	1.659988248	1.78624348	2.990083775	0	0	0.311315752	0.466069714	0.220573136	0.111780304	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6632
H6328_002_0	2012	6																															D	A	D	V	T	Coin	Coin	V	V	P	Coin	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	1443.422307	16.19598419	678.142027	200.18065	160.3445985	9.182961918	2.005361504	247.7467827	786.6962925	1819.632474	8.574234178	0.507063511	2.034311711	398.8110057	10665.17546	14948.94616	282.8257502	1362.867588	4708.444024	8888.357962	9.221419362	0	0	0	146.4883813	211.1346309	0	2.692347778	0	2554.303427											3100	$125 days 1-6;$0 days 7-90	$975 	$0 days 1-15;$100 days 16-100	$10 	10a: $100	11a: 20% to 30%	"11b1: 21.5%,11b2: 21.5%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $125,9b: $100"	"8a1: $03,8a2: $03"	"8b2,8b5,8b6: $50-$100, 8b3,8b4: 20%"	9c1: $35	12: $25	"31: $10,5: $50,9a2: $125"	7a: $10	"7b1: $10,7d1: $25,7f1: $25,16b1: $25,17a1: $13,18a1: $25"	"7e1: $35,7h1: $35"	"7c: $10,7i: $10"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $25	$0 	$0 	$0 	$0 	$0 											0	NO	88.25103733	108.3500077	20.51181337	10	100	0.215	0.208188199	49.95135457	113.04959	2.5	0.018885152	35	25	3.171837777	7.397519198	23.01775395	35	10	0	0	0.198562747	0	0	0	25	0	0	0	0	0											NO	80.78203452	99.17995671	18.7758248	9.153664021	91.53664021	0.196803776	0.190568483	45.72379171	103.4817965	2.288416005	0.017286834	32.03782407	22.88416005	2.903393734	6.771440533	21.06967862	32.03782407	9.153664021	0	0	0.181757667	0	0	0	22.88416005	0	0	0	0	0												9.7169	0.133859751	1.061056324	0.152698868	1.223117152	1.807241585	0.382158699	0.943993524	6.784062137	0.34700634	0.148221362	0.001353768	0.00387946	0.096492115	6.018216785	26.24745761	0.755093469	1.039602667	0	0	1.676063674	0	0	0	0.279355297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8178	0	NO	5.438219204	9.7169	0.133859751	1.061056324	0.152698868	1.223117152	1.807241585	0.382158699	0.943993524	6.784062137	0.34700634	0.148221362	0.001353768	0.00387946	0.096492115	6.018216785	26.24745761	0.755093469	1.039602667	0	0	1.676063674	0	0	0	0.279355297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8178	YES	1a1.$300 days 1-6	Medicare FFS Cost Sharing	"21. $0 days 1-10, $125 days 11-100"	6: $40	10a: $100	11a: 30.0%	"11b1: 30.0%,11b2: 30.0%"	"4a1: $50,4b: $30"	"9a1: $225,9b: $175"	"8a1: $18,8a2: $18"	"8b1: $10,8b2: $200,8b3: 30.0%,8b4: 30.0%,8b5: $200,8b6: $200"	9c1: $55	12: $55	"31: $20,5: $125,9a2: $225"	"7a: $25,14b2: $30"	"7b1: $20,7d1: $35,7f1: $35,16b1: $35,18a1: $35"	"7e1: $55,7h1: $55"	"7c: $20,7i: $20"	7d2: $35	7g: $35	"152: 30.0%,153: 30.0%"	9d1: 30.0%	$0 	"16a1: 50.0%,16a2: 50.0%"	17a2: $35	17b2: 50.0%	$0 	$0 	$0 	$0 											5100	4.1576	0.0139	0.6419	0.0015	1.2772	0.9645	0.1638	0.1283	1.6188	0.2933	0.7997	0.009	0.0013	0.012	1.5013	4.3375	0.407	0.2215	1.9352	1.6046	0.2352	0	0	0	0.4618	0.2613	0	0	0	0											21.0485	0	NO	1.519228745	13.8745	0.147798685	1.703000251	0.154206186	2.500343112	2.771738175	0.545951287	1.072277967	8.40286416	0.640290873	0.947943583	0.010372058	0.005200543	0.108486083	7.51955416	30.58497427	1.16212222	1.261079213	1.935216754	1.604614894	1.91125959	0	0	0	0.741155555	0.261335275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.8663
H6328_003_0	2012	5																															D	A	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	900.6681557	16.83843786	313.3962391	92.76561858	116.9102931	6.214956387	1.834457584	204.5344332	777.7723962	2878.249327	2436.998807	0.495489349	1.987179035	468.444876	10086.30775	12741.71454	270.6160409	1299.379573	4043.582201	8466.293484	9.200353543	0	0	0	0	27.0066267	0	0	0	2539.789423											3400	$175 days 1-6;$0 days 7-90	$975 	$0 days 1-10;$100 days 11-100	$25 	10a: $200	11a: 20% to 30%	"11b1: 21.5%,11b2: 21.5%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $150,9b: $125"	"8a1: $03,8a2: $03"	"8b3: 20.0%,8b4: 20.0%"	9c1: $45	12: $30	"31: $15,5: $75,9a2: $150"	7a: $15	"7b1: $15,7d1: $35,7f1: $35,16b1: $35,17a1: $18,18a1: $35"	"7e1: $40,7h1: $40"	"7c: $20,7i: $20"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	123.5514523	108.3500077	36.46848777	25	200	0.215	0.207727283	49.94241723	139.8368576	2.5	0.88827952	45	30	6.691087954	11.20558024	32.0583016	40	20	0	0	0.197308374	0	0	0	0	0	0	0	0	0											NO	112.2964096	98.4797558	33.14635455	22.72260009	181.7808008	0.195414361	0.188804159	45.39286298	127.0982797	2.272260009	0.807360812	40.90068017	27.26712011	6.081556631	10.18479675	29.13791868	36.35616015	18.17808008	0	0	0.179334371	0	0	0	0	0	0	0	0	0												8.4285	0.138187104	0.865661904	0.175656338	1.771003892	1.21449173	0.346353222	0.773700292	8.237794464	0.545010904	0.163961445	0.001688821	0.004515387	0.23740617	8.560582864	30.93892017	0.81988001	1.968352161	0	0	1.649939616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8416	0	NO	6.699278682	8.4285	0.138187104	0.865661904	0.175656338	1.771003892	1.21449173	0.346353222	0.773700292	8.237794464	0.545010904	0.163961445	0.001688821	0.004515387	0.23740617	8.560582864	30.93892017	0.81988001	1.968352161	0	0	1.649939616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8416	YES	1a1: $212	Medicare FFS Cost Sharing	21: $55	6: $45	10a: $200	11a: 30.0%	"11b1: 30.0%,11b2: 30.0%"	"4a1: $50,4b: $30"	"9a1: $250,9b: $175"	"8a1: $18,8a2: $18"	"8b1: $10,8b2: $250,8b3: 30.0%,8b4: 30.0%,8b5: $250,8b6: $250"	9c1: $60	12: $60	"31: $25,5: $150,9a2: $250"	"7a: $35,14b2: $30"	"7b1: $20,7d1: $45,7f1: $45,16b1: $45"	"7e1: $60,7h1: $60"	"7c: $25,7i: $25"	7d2: $45	7g: $45	"152: 30.0%,153: 30.0%"	9d1: 30.0%	$0 	"16a1: 50.0%,16a2: 50.0%"	$0 	$0 	$0 	$0 	$0 	$0 											5100	2.0385	0.013	0.3226	0.0472	1.3423	0.6021	0.1256	0.1717	1.384	0.3075	1.5788	0.0207	0.0013	0.0128	1.9569	4.6608	0.3644	0.2688	2.2544	1.5355	0.1832	0	0	0	0	0	0	0	0	0											19.1919	0	NO	1.434104651	10.467	0.151172822	1.188300549	0.222897321	3.113266738	1.816564019	0.471935358	0.945424861	9.621792773	0.852554587	1.742763445	0.022407027	0.005778564	0.250180893	10.51744816	35.59969087	1.184295614	2.237137144	2.254356336	1.535471648	1.833115894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0335
H6328_005_0	2012	5																															D	A	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	1365.770694	47.93583269	892.8630523	8.222187001	294.1037096	11.32475802	2.644162785	296.6440171	343.0317543	278.0385476	249.1324771	1.770352006	7.369627308	327.0628433	16092.5692	23511.95552	803.7288011	2107.198715	6461.181403	13478.03492	12.61894061	0	0	697.1956031	50.73124458	376.3321506	94.92233994	15.14195494	0	2500.405855											3000	$75 days 1-5;$0 days 6-90	$975 	$0 days 1-20;$100 days 21-100	$5 	10a: $100	11a: 20% to 30%	"11b1: 21.5%,11b2: 21.5%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $100,9b: $75"	"8a1: $03,8a2: $03"	"8b2,8b5,8b6: $50-$150, 8b3,8b4: 20%"	9c1: $35	12: $25	"31: $10,5: $50,9a2: $100"	7a: $05	"7b1: $10,7d1: $15,7f1: $20,16b1: $20,17a1: $10,18a1: $20"	"7e1: $35,7h1: $35"	"7c: $10,7i: $10"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $10,16a2: $10"	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 											0	NO	48.63311011	108.3500077	10.39695293	5	100	0.215	0.202322046	49.89197997	95.28259001	2.5	15.72722207	35	25	4.98679595	3.961652072	14.32529383	35	10	0	0	0.199968516	0	0	0	20	0	20	0	0	0											NO	46.81526825	104.3000265	10.00832846	4.813106559	96.26213117	0.206963582	0.194759513	48.02708321	91.72105178	2.406553279	15.13935914	33.69174591	24.06553279	4.800396059	3.813570714	13.78983313	33.69174591	9.626213117	0	0	0.192493955	0	0	0	19.25242623	0	19.25242623	0	0	0												5.3282	0.416642385	0.744672225	0.003297855	2.359254156	2.343812485	0.514975857	1.187245574	2.621936108	0.055759548	0.314308837	0.004970521	0.014779501	0.130835932	5.114179219	27.01882861	2.256585546	1.690361993	0	0	2.429069787	0	0	0	0.081391629	0	0.152290446	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7834	0	NO	2.127246886	5.3282	0.416642385	0.744672225	0.003297855	2.359254156	2.343812485	0.514975857	1.187245574	2.621936108	0.055759548	0.314308837	0.004970521	0.014779501	0.130835932	5.114179219	27.01882861	2.256585546	1.690361993	0	0	2.429069787	0	0	0	0.081391629	0	0.152290446	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7834	YES	1a1.$300 days 1-5	Medicare FFS Cost Sharing	"21. $0 days 1-10, $125 days 11-100"	6: $40	10a: $100	11a: 30.0%	"11b1: 30.0%,11b2: 30.0%"	"4a1: $50,4b: $30"	"9a1: $200,9b: $150"	"8a1: $18,8a2: $18"	"8b1: $10,8b2: $200,8b3: 30.0%,8b4: 30.0%,8b5: $100,8b6: $200"	9c1: $50	12: $50	"31: $20,5: $100,9a2: $200"	"7a: $20,14b2: $30"	"7b1: $20,7d1: $30,7f1: $30,16b1: $30"	"7e1: $50,7h1: $50"	"7c: $20,7i: $20"	7d2: $30	7g: $35	"152: 30.0%,153: 30.0%"	9d1: 30.0%	$0 	"16a1: 50.0%,16a2: 50.0%"	17a2: $30	17b2: 50.0%	18a2: $30	$0 	$0 	$0 											5100	1.8001	0.0236	0.2758	0.0022	0.1993	0.2762	0.0607	0.1003	0.4217	0.033	0.2407	0.0006	0.0025	0.0221	1.7278	4.0736	0.2789	0.2966	1.3643	2.516	0.3077	0	0	0	0.0103	0.0479	0.0193	0	0	0											14.1014	0	NO	0.3609578	7.1284	0.440278953	1.020466485	0.005526178	2.558519274	2.620036994	0.575667126	1.2875216	3.043683573	0.088726124	0.554969921	0.005570257	0.017276085	0.152937016	6.842013934	31.09244549	2.535512411	1.986989071	1.364295653	2.516018077	2.736812518	0	0	0	0.091703264	0.047944705	0.171584365	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8849
H6328_006_0	2012	4																															D	A	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	1067.952436	34.98357282	696.3998542	6.388453487	223.1568477	8.703654294	1.994562571	224.6343428	273.9565266	216.7900465	199.2062983	1.434602738	5.739557862	248.2459697	12818.4105	18843.18623	547.7737162	1698.812747	5105.734317	10587.01475	10.38595534	0	0	0	52.28975967	325.6389495	0	0	0	2163.592812											3400	$150 days 1-6;$0 days 7-90	$975 	$0 days 1-15;$100 days 16-100	$10 	10a: $150	11a: 20% to 30%	"11b1: 21.5%,11b2: 21.5%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $125,9b: $100"	"8a1: $03,8a2: $03"	"8b2,8b5,8b6: $50-$175, 8b3,8b4: 20%"	9c1: $35	12: $25	"31: $10,5: $50,9a2: $125"	7a: $10	"7b1: $10,7d1: $25,7f1: $25,16b1: $25,17a1: $13,18a1: $25"	"7e1: $35,7h1: $35"	"7c: $10,7i: $10"	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $25	$0 	$0 	$0 	$0 	$0 											0	NO	105.9012448	108.3500077	20.51181337	10	150	0.215	0.201356228	49.88326464	120.2652604	2.5	15.35185617	35	25	5.896733627	7.901915541	22.63895999	35	10	0	0	0.199968659	0	0	0	25	0	0	0	0	0											NO	94.53533332	96.72128135	18.3103713	8.926744299	133.9011645	0.191925002	0.179745556	44.52951482	107.3577228	2.231686075	13.70420945	31.24360505	22.31686075	5.263863328	7.05383795	20.2092207	31.24360505	8.926744299	0	0	0.178506908	0	0	0	22.31686075	0	0	0	0	0												8.4133	0.281971332	1.062611659	0.004752341	2.490080148	1.670448871	0.358513759	0.833571525	2.450945736	0.040317277	0.22749707	0.00373518	0.010674076	0.108894405	7.534915869	31.73384243	1.426202137	1.263738917	0	0	1.853964779	0	0	0	0.097245274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8672	0	NO	7.438245694	8.4133	0.281971332	1.062611659	0.004752341	2.490080148	1.670448871	0.358513759	0.833571525	2.450945736	0.040317277	0.22749707	0.00373518	0.010674076	0.108894405	7.534915869	31.73384243	1.426202137	1.263738917	0	0	1.853964779	0	0	0	0.097245274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8672	YES	days 1-6: $300 per day days 7-90 $0	Medicare FFS Cost Sharing	"days 1-10: $0, days 11-90: $125"	6: $40	10a: $150	11a: 30.0%	"11b1: 30.0%,11b2: 30.0%"	"4a1: $50,4b: $30"	"9a1: $225,9b: $175"	"8a1: $18,8a2: $18"	"8b1: $10,8b2: $200,8b3: 30.0%,8b4: 30.0%,8b5: $100,8b6: $200"	9c1: $55	12: $55	"31: $20,5: $125,9a2: $225"	"7a: $25,14b2: $30"	"7b1: $20,7d1: $35,7f1: $35,16b1: $35,18a1: $35"	"7e1: $55,7h1: $55"	"7c: $20,7i: $20"	7d2: $35	7g: $40	"152: 30.0%,153: 30.0%"	9d1: 30.0%	$0 	"16a1: 50.0%,16a2: 50.0%"	17a2: $35	17b2: 50.0%	$0 	$0 	$0 	$0 											5100	4.2619	0.048	0.5982	0.0048	0.6307	0.5904	0.1267	0.2111	1.0398	0.0715	0.5333	0.0015	0.0059	0.0539	4.7712	10.6364	0.6289	0.7171	3.7718	5.8533	0.7044	0	0	0	0.0345	0.0769	0	0	0	0											35.3724	0	NO	2.824324855	12.6751	0.330017201	1.660809895	0.009567078	3.120773628	2.26081441	0.485218725	1.044700523	3.490777163	0.111798875	0.760747146	0.005221839	0.016621899	0.162799342	12.30616434	42.37027925	2.055113898	1.980871205	3.7718119	5.853343172	2.558329758	0	0	0	0.131727997	0.076913148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2396
H6328_801_0	2012	5																															D	A	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	1019.856097	33.41185216	450.5327451	6.613741521	231.0353307	9.123846434	2.107537322	214.7296099	323.608853	159.258109	146.3349395	1.053822948	4.216396614	182.3741715	13263.81129	19497.74498	566.9557215	1757.808639	5283.208739	10955.12046	11.14319991	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	159.0716086	73.28990337	89.89916329	0	47.48201024	0.224	0.224	124.0058311	453.0758521	44.77322193	73.90195264	31.94606062	12.6339936	93.62027248	10.14173654	20.66181698	17.60933144	12.46280475	13.86696373	6.167424361	0.224	0	0	0	0	0	0	0	0	0											NO	152.6133233	70.31434343	86.2492697	0	45.5542472	0.214905631	0.214905631	118.9712115	434.6810352	42.95543532	70.90154359	30.64905498	12.12105521	89.81930237	9.729983442	19.82295007	16.89439502	11.9568166	13.30396692	5.917027785	0.214905631	0	0	0	0	0	0	0	0	0												12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	0	NO	4.042196616	12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											10000	3.2249	0.0487	0.8098	0	0.2193	0.4902	0.1061	0.5322	2.9306	0.1425	0.2162	0.0007	0.0011	0.0354	2.3864	7.1177	0.2057	0.4564	1.5263	1.4076	0.5986	0	0	0	0	0	0	0	0	0											22.4563	0	NO	0.786066293	16.1952	0.24445573	4.04802469	0	1.096316726	2.450957469	0.559032335	2.661108525	14.65277409	0.712604312	1.08076803	0.003364446	0.005323664	1.400488895	13.14110446	39.32623323	1.003928706	2.207883498	7.383595858	6.809414283	2.99332691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9759
H6328_802_0	2012	2																															D	A	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	1019.856097	33.41185216	450.5327451	6.613741521	231.0353307	9.123846434	2.107537322	214.7296099	323.608853	159.258109	146.3349395	1.053822948	4.216396614	182.3741715	13263.81129	19497.74498	566.9557215	1757.808639	5283.208739	10955.12046	11.14319991	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	159.0716086	73.28990337	89.89916329	0	47.48201024	0.224	0.224	124.0058311	453.0758521	44.77322193	73.90195264	31.94606062	12.6339936	93.62027248	10.14173654	20.66181698	17.60933144	12.46280475	13.86696373	6.167424361	0.224	0	0	0	0	0	0	0	0	0											NO	152.6133233	70.31434343	86.2492697	0	45.5542472	0.214905631	0.214905631	118.9712115	434.6810352	42.95543532	70.90154359	30.64905498	12.12105521	89.81930237	9.729983442	19.82295007	16.89439502	11.9568166	13.30396692	5.917027785	0.214905631	0	0	0	0	0	0	0	0	0												12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	0	NO	4.042196616	12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	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 												3.2249	0.0487	0.8098	0	0.2193	0.4902	0.1061	0.5322	2.9306	0.1425	0.2162	0.0007	0.0011	0.0354	2.3864	7.1177	0.2057	0.4564	1.5263	1.4076	0.5986	0	0	0	0	0	0	0	0	0											22.4563	0	NO	0.786066293	16.1952	0.24445573	4.04802469	0	1.096316726	2.450957469	0.559032335	2.661108525	14.65277409	0.712604312	1.08076803	0.003364446	0.005323664	1.400488895	13.14110446	39.32623323	1.003928706	2.207883498	7.383595858	6.809414283	2.99332691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9759
H6328_803_0	2012	2																															D	A	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	1019.856097	33.41185216	450.5327451	6.613741521	231.0353307	9.123846434	2.107537322	214.7296099	323.608853	159.258109	146.3349395	1.053822948	4.216396614	182.3741715	13263.81129	19497.74498	566.9557215	1757.808639	5283.208739	10955.12046	11.14319991	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	159.0716086	73.28990337	89.89916329	0	47.48201024	0.224	0.224	124.0058311	453.0758521	44.77322193	73.90195264	31.94606062	12.6339936	93.62027248	10.14173654	20.66181698	17.60933144	12.46280475	13.86696373	6.167424361	0.224	0	0	0	0	0	0	0	0	0											NO	152.6133233	70.31434343	86.2492697	0	45.5542472	0.214905631	0.214905631	118.9712115	434.6810352	42.95543532	70.90154359	30.64905498	12.12105521	89.81930237	9.729983442	19.82295007	16.89439502	11.9568166	13.30396692	5.917027785	0.214905631	0	0	0	0	0	0	0	0	0												12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	0	NO	4.042196616	12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	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 												3.2249	0.0487	0.8098	0	0.2193	0.4902	0.1061	0.5322	2.9306	0.1425	0.2162	0.0007	0.0011	0.0354	2.3864	7.1177	0.2057	0.4564	1.5263	1.4076	0.5986	0	0	0	0	0	0	0	0	0											22.4563	0	NO	0.786066293	16.1952	0.24445573	4.04802469	0	1.096316726	2.450957469	0.559032335	2.661108525	14.65277409	0.712604312	1.08076803	0.003364446	0.005323664	1.400488895	13.14110446	39.32623323	1.003928706	2.207883498	7.383595858	6.809414283	2.99332691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9759
H6328_804_0	2012	2																															D	A	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	1019.856097	33.41185216	450.5327451	6.613741521	231.0353307	9.123846434	2.107537322	214.7296099	323.608853	159.258109	146.3349395	1.053822948	4.216396614	182.3741715	13263.81129	19497.74498	566.9557215	1757.808639	5283.208739	10955.12046	11.14319991	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	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											0	NO	159.0716086	73.28990337	89.89916329	0	47.48201024	0.224	0.224	124.0058311	453.0758521	44.77322193	73.90195264	31.94606062	12.6339936	93.62027248	10.14173654	20.66181698	17.60933144	12.46280475	13.86696373	6.167424361	0.224	0	0	0	0	0	0	0	0	0											NO	152.6133233	70.31434343	86.2492697	0	45.5542472	0.214905631	0.214905631	118.9712115	434.6810352	42.95543532	70.90154359	30.64905498	12.12105521	89.81930237	9.729983442	19.82295007	16.89439502	11.9568166	13.30396692	5.917027785	0.214905631	0	0	0	0	0	0	0	0	0												12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	0	NO	4.042196616	12.9703	0.195777704	3.238176687	0	0.877053381	1.960765975	0.452921638	2.12888682	11.72221927	0.57008345	0.864614424	0.002691556	0.004258931	1.365060072	10.75472202	32.20856878	0.798197827	1.751482959	5.857302859	5.401812682	2.394736408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5196	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 												3.2249	0.0487	0.8098	0	0.2193	0.4902	0.1061	0.5322	2.9306	0.1425	0.2162	0.0007	0.0011	0.0354	2.3864	7.1177	0.2057	0.4564	1.5263	1.4076	0.5986	0	0	0	0	0	0	0	0	0											22.4563	0	NO	0.786066293	16.1952	0.24445573	4.04802469	0	1.096316726	2.450957469	0.559032335	2.661108525	14.65277409	0.712604312	1.08076803	0.003364446	0.005323664	1.400488895	13.14110446	39.32623323	1.003928706	2.207883498	7.383595858	6.809414283	2.99332691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9759
H6411_002_0	2012	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			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	1116.01	94.53	175.59	2451.54	19.75	11.23	4.69	323.47	337.9	1179.53	1007.9	130.75	0.92	538.2	3272.56	4472.48	74.84	622.95		1634.05	18.56	0			1.69				3.63	1.43	1832.39	0.05									5000	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$75/Visit: 5. $30 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$100/Visit: 3. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$30/Visit: 7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS742: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											127.547103	112.005826	31.003517	0	100	0.2	0.2	65	63.157026	0	60.9275	34.187923	0.2	72.997503	15	29.272083	30	40.012024		0	0.2	0			0				0	0	0	0									NO	113.34907	99.537785	28.382263	0	94.8353	0.189671	0.189671	61.642945	59.895155	0	57.780777	32.422219	0.189671	69.227401	14.225295	27.760268	28.45059	37.945523		0	0.189671	0			0				0	0	0	0										10.5416	0.784108901	0.415303463	0	0.156083098	2.13000533	0.88955699	1.661636952	1.68654774	0	4.853103762	0.353267095	0.17449732	3.104848935	3.879427617	10.34643695	0.177436846	1.969846963	0	0	3.52029376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.644	0	NO	3.357868	10.5416	0.784108901	0.415303463	0	0.156083098	2.13000533	0.88955699	1.661636952	1.68654774	0	4.853103762	0.353267095	0.17449732	3.104848935	3.879427617	10.34643695	0.177436846	1.969846963	0	0	3.52029376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.644	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-7)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS742: Vision 17a,17b"						30% Coins	$0/Proc									7500	1.8941	0.1409	0.305	3.3331	1.3609	0.8899	0.3719	0.2068	2.0543	0.3742	0.8552	0.0456	0.022	0.7779	1.3093	2.8465	0.0267	0.2048		0.2908	0.6778	0							0	0	0.1895	0									18.1773	500	NO	1.814865	12.4357	0.925002901	0.720345463	3.333123	1.516962098	3.01989133	1.26147299	1.868456952	3.74086674	0.374228	5.708295762	0.398890095	0.19647332	3.882740935	5.188688617	13.19298095	0.204157846	2.174613963	0	0.290801	4.19806576	0	0	0	0	0	0	0	0	0	0.189503	0	0	0	0	0	0	0	0	0	64.8212
H6411_007_0	2012	6	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	815.97	7.32	163.66	450.55	15.52	14.36	1.64	356.08	228.53	1534.44	968.73	135.05	0.17	434.89	3056.19	2607.97	51.45	539.4		1141.44	20.12	0			0.61				3.63	1.43	1205.46	0.02									4000	"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c15% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$75/Visit: 5. $30 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$100/Visit: 3. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$30/Visit: 7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											127.547103	112.005826	45.597948	0	100	0.15	0.2	65	65.186678	0	51.272748	35.200352	0.2	71.905485	15	28.914524	30	46.889616		0	0.2	0			0				0	0	0	0									NO	115.043278	101.025559	41.843595	0	95.0444	0.142567	0.190089	61.77886	61.956287	0	48.731875	33.455963	0.190089	68.342137	14.25666	27.481636	28.51332	44.565954		0	0.190089	0			0				0	0	0	0										7.8227	0.061625591	0.570676896	0	0.122924091	2.04726212	0.31174596	1.833184706	1.179905856	0	3.934002439	0.376518984	0.03231513	2.476775997	3.63092181	5.972606853	0.12225086	2.003239632	0	0	3.82459068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3232	0	NO	2.361187	7.8227	0.061625591	0.570676896	0	0.122924091	2.04726212	0.31174596	1.833184706	1.179905856	0	3.934002439	0.376518984	0.03231513	2.476775997	3.63092181	5.972606853	0.12225086	2.003239632	0	0	3.82459068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3232	YES	$0-$200/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"30% Coins(Days 1-14), 30% (Days 15-20), 0% (Days 21-100)"	20% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	$0/Proc									5000	1.4017	0.011	0.2514	1.1443	1.208	1.2861	0.147	0.2572	1.7097	0.4356	1.0155	0.0412	0.0045	0.69	1.3854	1.8813	0.0183	0.222		0.2103	0.8707	0			0				0	0	0.1302	0									14.3216	500	NO	1.313789	9.2243	0.072663591	0.822121896	1.144314	1.330892091	3.33339212	0.45877596	2.090414706	2.889583856	0.435639	4.949489439	0.417733984	0.03679413	3.166779997	5.01628681	7.853948853	0.14054486	2.225251632	0	0.210314	4.69533068	0	0	0	0	0	0	0	0	0	0.13021	0	0	0	0	0	0	0	0	0	50.6448
H6411_008_0	2012	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	830.69	20.46	312.16	661.59	18.61	5.51	1.83	279.48	248.78	915.39	624.3	50.31	0.18	440.3	1856.55	2730.08	27.34	376.72		935.51	10.55	0		3.26	0.61				3.63	1.43	632.08	0									3400	"$0-$150/Day(Days 1-5): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-5): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c15% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$75/Visit: 5. $30 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$100/Visit: 3. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$30/Visit: 7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											94.379573	77.573765	44.690621	0	100	0.15	0.2	65	64.896445	0	60.802828	39.853414	0.2	73.209371	15	28.152642	30	44.219314		0	0.2	0		0	0				0	0	0	0									NO	86.061618	70.736956	40.081767	0	95.7661	0.143649	0.191532	62.247965	62.148794	0	58.228497	38.166061	0.191532	70.10976	14.364915	26.960687	28.72983	42.347112		0	0.191532	0		0	0				0	0	0	0										5.9575	0.12060651	1.042660366	0	0.14851726	0.79150599	0.35050356	1.449755105	1.288448081	0	3.029337556	0.160011211	0.03447576	2.572443944	2.222431912	6.13373603	0.065456129	1.329417003	0	0	2.0206626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7175	0	NO	1.662198	5.9575	0.12060651	1.042660366	0	0.14851726	0.79150599	0.35050356	1.449755105	1.288448081	0	3.029337556	0.160011211	0.03447576	2.572443944	2.222431912	6.13373603	0.065456129	1.329417003	0	0	2.0206626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7175	YES	$0-$200/Day(Days 1-5)	$0-$200/Day(Days 1-5)	"30% Coins(Days 1-14), 30% (Days 15-100)"	20% Coins	$100/Trip	30% Coins	30% Coins	$65/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"	"VIS775: Vision 17a,17b"						25% Coins	$0/Proc									5000	1.2873	0.0261	0.3835	0.9703	1.4818	0.5048	0.1673	0.2066	2.1615	0.2683	0.6653	0.0168	0.0051	0.5283	0.8476	1.8747	0.0107	0.1321		0.1641	0.4992	0		0					0	0	0.0636	0									12.2649	500	NO	1.112943	7.2449	0.14666851	1.426129366	0.970256	1.63029726	1.29631699	0.51777656	1.656308105	3.449981081	0.268266	3.694603556	0.176803211	0.03955076	3.100747944	3.070057912	8.00840903	0.076204129	1.461562003	0	0.16412	2.5198546	0	0	0	0	0	0	0	0	0	0.063639	0	0	0	0	0	0	0	0	0	40.9824
H6528_001_0	2012	8																															D	A	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1270.11906	7.389907454	49.15709278	0	132.5947906	9.398677855	5.893890977	415.2506757	232.9170878	4.089096727	15.92982932	0	0	1451.036014	3237.629282	4096.115506	191.0818789	195.384934	12.33254076	41.06344488	45.31347199	288.9584386	0	178.5375	216.1243421	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $40/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$45/Visit for CORF; $45/Visit for OP PT/OT/ST; $30/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $30/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$30/Visit for Office Surgery - PCP; $30/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$45/Visit for Office Surgery - SCP; $45/Visit for Office/Home Visits - SCP; $45/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $30/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$45/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$45/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $45/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$30/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	63.58802512	150	0.2	0.2	0	0	33.102146	30	43.64133265	39.50094133	45	0.2	0.173153625	0.2	44.70659346	0	10	30	0	0	0	0	0											YES	172.0929621	983.3883546	127.8404861	0	157.3421367	0.196677671	0.196677671	62.5317234	147.5082532	0.196677671	0.196677671	0	0	32.55226488	29.50165064	42.91637831	38.8447657	44.25247596	0.196677671	0.170277258	0.196677671	43.96394338	0	10	30	0	0	0	0	0											6700	18.2149	0.605595744	0.523688886	0	1.738562306	1.84851007	1.15919675	2.163861699	2.863099397	0.80423402	3.133041728	0	0	3.936209058	7.959617331	14.64920355	0.618544234	0.720522258	2.425535394	6.992170797	8.912148133	1.058646036	0	0.14878125	0.540310855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0164	0	NO	1.356908555	18.2149	0.605595744	0.523688886	0	1.738562306	1.84851007	1.15919675	2.163861699	2.863099397	0.80423402	3.133041728	0	0	3.936209058	7.959617331	14.64920355	0.618544234	0.720522258	2.425535394	6.992170797	8.912148133	1.058646036	0	0.14878125	0.540310855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0164	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	2.3648	0	1.493	0.8047	0.0221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.6846	0	NO	0.079134132	18.2149	0.605595744	0.523688886	2.364844781	1.738562306	3.341537435	1.963891038	2.185935567	2.863099397	0.80423402	3.133041728	0	0	3.936209058	7.959617331	14.64920355	0.618544234	0.720522258	2.425535394	6.992170797	8.912148133	1.058646036	0	0.14878125	0.540310855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.701
H6528_005_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1290.492584	9.384129138	73.32947845	0	127.4610126	7.45699188	5.071720746	490.5895342	235.9357483	5.446450515	18.1904687	0	0	1587.641209	3523.501679	4254.559799	215.3815062	258.2132113	14.1960831	40.49012898	34.30600129	355.9576489	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.60590885	150	0.2	0.2	0	0	37.0902212	35	48.05447343	39.7534037	50	0.2	0.179430008	0.2	49.4739057	0	10	10	0	0	0	0	0											YES	171.6504569	980.8597538	127.511768	0	156.9375606	0.196171951	0.196171951	63.36933585	147.1289631	0.196171951	0.196171951	0	0	36.38030524	34.33009138	47.13469898	38.99251376	49.04298769	0.196171951	0.175995673	0.196171951	48.52696296	0	10	10	0	0	0	0	0											6700	18.4595	0.767042883	0.77919762	0	1.666951699	1.462852644	0.994929352	2.590694413	2.892748499	1.068440822	3.568459729	0	0	4.813239317	10.08017789	16.71144962	0.699855529	1.055295612	2.784873314	7.126087519	6.729875196	1.43946197	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9118	0	NO	1.672154268	18.4595	0.767042883	0.77919762	0	1.666951699	1.462852644	0.994929352	2.590694413	2.892748499	1.068440822	3.568459729	0	0	4.813239317	10.08017789	16.71144962	0.699855529	1.055295612	2.784873314	7.126087519	6.729875196	1.43946197	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9118	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.5209	0	1.1815	0.6368	0.0257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.3649	0	NO	0.104689888	18.4595	0.767042883	0.77919762	3.520863735	1.666951699	2.644387472	1.631739065	2.616416988	2.892748499	1.068440822	3.568459729	0	0	4.813239317	10.08017789	16.71144962	0.699855529	1.055295612	2.784873314	7.126087519	6.729875196	1.43946197	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2767
H6528_006_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1105.831048	8.041318091	59.98565219	0	121.0705907	7.457254673	5.071899479	421.8492549	227.8819856	4.30701616	14.38489938	0	0	1296.43465	3804.961179	4594.416676	232.5863146	278.8394429	15.4679753	44.11782536	36.563447	339.808533	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$110/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	110	0.2	0.2	64.60590885	150	0.2	0.2	0	0	36.68116807	35	48.05447343	39.7534037	50	0.2	0.178885044	0.2	49.44131564	0	10	10	0	0	0	0	0											YES	171.7936894	981.6782254	127.6181693	0	107.9846048	0.196335645	0.196335645	63.42221395	147.2517338	0.196335645	0.196335645	0	0	36.00910397	34.35873789	47.1740302	39.0250508	49.08391127	0.196335645	0.175607553	0.196335645	48.535463	0	10	10	0	0	0	0	0											6700	15.8312	0.657832239	0.63793826	0	1.08947999	1.464124907	0.995794656	2.229551142	2.79633479	0.845620796	2.824268499	0	0	3.89028751	10.89447199	18.06142925	0.756391062	1.140544206	3.036914908	7.747423351	7.178707952	1.37439704	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6734	0	NO	1.557539279	15.8312	0.657832239	0.63793826	0	1.08947999	1.464124907	0.995794656	2.229551142	2.79633479	0.845620796	2.824268499	0	0	3.89028751	10.89447199	18.06142925	0.756391062	1.140544206	3.036914908	7.747423351	7.178707952	1.37439704	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6734	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.8493	0	1.1826	0.6374	0.0221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.6913	0	NO	0.106221688	15.8312	0.657832239	0.63793826	3.84928095	1.08947999	2.646687331	1.633158211	2.251687985	2.79633479	0.845620796	2.824268499	0	0	3.89028751	10.89447199	18.06142925	0.756391062	1.140544206	3.036914908	7.747423351	7.178707952	1.37439704	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3647
H6528_007_0	2012	5																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1308.994993	9.518673887	70.2238106	0	166.0248524	8.658317862	5.88877808	393.6997295	222.0197169	4.497292294	15.02039805	0	0	1239.387864	4091.589777	4940.515137	250.107095	299.844482	15.08331515	43.02069605	37.89768394	338.6766693	0	84.71151122	180.0749158	0	0	0	0	0											6700	$175/Days Custom for IP Medical; $175/Days Custom for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$110/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	110	0.2	0.2	64.60590885	150	0.2	0.2	0	0	36.37905685	35	48.05447343	39.7534037	50	0.2	0.185110112	0.2	49.19939953	0	10	10	0	0	0	0	0											YES	171.381305	979.3217428	127.3118266	0	107.7253917	0.195864349	0.195864349	63.26997125	146.8982614	0.195864349	0.195864349	0	0	35.62680136	34.276261	47.06079067	38.93137259	48.96608714	0.195864349	0.181282358	0.195864349	48.1820417	0	10	10	0	0	0	0	0											6700	18.6948	0.776820358	0.7450268	0	1.490424355	1.695855788	1.153401682	2.07578088	2.717859201	0.880859226	2.941960479	0	0	3.67961877	11.68703326	19.37537905	0.811417709	1.223517586	2.954283697	7.798893221	7.422805177	1.35984445	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7062	0	NO	1.889476385	18.6948	0.776820358	0.7450268	0	1.490424355	1.695855788	1.153401682	2.07578088	2.717859201	0.880859226	2.941960479	0	0	3.67961877	11.68703326	19.37537905	0.811417709	1.223517586	2.954283697	7.798893221	7.422805177	1.35984445	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7062	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	3.2754	0	1.3697	0.7382	0.0206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.404	0	NO	0.114105418	18.6948	0.776820358	0.7450268	3.275449239	1.490424355	3.065585462	1.891642436	2.096390965	2.717859201	0.880859226	2.941960479	0	0	3.67961877	11.68703326	19.37537905	0.811417709	1.223517586	2.954283697	7.798893221	7.422805177	1.35984445	0	0.070592926	0.15006243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1102
H6528_009_0	2012	7																															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	YES	661.7851931	14.57314261	57.31009865	0	41.92387871	98.45949154	69.80258244	67.84315336	99.20727861	12.87711529	32.18763669	0	1.254891074	39.20767024	101.9570838	89.61507864	3.880665036	6.947065717	37.18683348	114.7027006	45.73978652	8.939148352	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.083844068	0.083844068	0.185922056	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.22392235	0	15	0	0	0	0	0	0											YES	0.083844068	0.083844068	0.185922056	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.22392235	0	15	0	0	0	0	0	0											6700	55.4868	1.221871564	10.65521135	0	9.390948831	22.0549261	15.63577847	15.19686635	22.22243041	2.884473824	7.210030619	0	0.281095601	8.782518134	22.83838677	20.07377761	0.869268968	1.556142721	8.329850699	25.69340494	10.24571218	2.001675104	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	262.948	0	NO	1.71E-13	55.4868	1.221871564	10.65521135	0	9.390948831	22.0549261	15.63577847	15.19686635	22.22243041	2.884473824	7.210030619	0	0.281095601	8.782518134	22.83838677	20.07377761	0.869268968	1.556142721	8.329850699	25.69340494	10.24571218	2.001675104	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	262.948	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1514	0	NO	0	55.4868	1.221871564	10.65521135	0	9.390948831	22.0549261	15.63577847	15.34827021	22.22243041	2.884473824	7.210030619	0	0.281095601	8.782518134	22.83838677	20.07377761	0.869268968	1.556142721	8.329850699	25.69340494	10.24571218	2.001675104	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	263.0994
H6528_010_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	2363.619784	11.77983047	81.73699404	0	224.5982296	34.4645253	9.658884688	581.9068004	327.6292221	6.207178307	15.52808421	0	0.674445144	2171.141498	4281.318619	5289.221451	131.6136857	269.6119202	14.29221984	52.00110036	34.98645444	530.632061	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$30/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	150	0.2	0.2	64.56266587	150	0.2	0.2	0	0.2	37.99543211	35	49.0674627	39.7586933	50	0.2	0.175490018	0.2	49.84549459	0	10	30	0	0	0	0	0											YES	168.8104279	964.6310166	125.4020322	0	144.6946525	0.192926203	0.192926203	62.27915001	144.6946525	0.192926203	0.192926203	0	0.192926203	36.6515723	33.76208558	47.33199642	38.35246874	48.23155083	0.192926203	0.169283115	0.192926203	48.08251012	0	10	30	0	0	0	0	0											6700	33.2503	0.946932487	0.85416543	0	2.708180232	6.649110015	1.863451951	3.020055076	3.950516369	1.197527344	2.995774332	0	0.130118141	6.631312465	12.04552047	20.8624509	0.420642481	1.083650086	2.757343711	8.802908233	6.749803822	2.126176787	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4078	0	NO	4.36491676	33.2503	0.946932487	0.85416543	0	2.708180232	6.649110015	1.863451951	3.020055076	3.950516369	1.197527344	2.995774332	0	0.130118141	6.631312465	12.04552047	20.8624509	0.420642481	1.083650086	2.757343711	8.802908233	6.749803822	2.126176787	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4078	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.9387	0	7.1606	0.2482	0.0318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.3793	0	NO	0.563894127	33.2503	0.946932487	0.85416543	7.938736848	2.708180232	13.80969003	2.111665149	3.051812503	3.950516369	1.197527344	2.995774332	0	0.130118141	6.631312465	12.04552047	20.8624509	0.420642481	1.083650086	2.757343711	8.802908233	6.749803822	2.126176787	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.7871
H6528_011_0	2012	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	289.0617649	19.29719158	35.04748876	0	19.51767481	35.56652525	26.91281749	43.3045185	70.31148313	5.460975881	17.84311076	0	0	23.57874375	61.88607849	54.99496243	5.850953173	4.639556301	26.47966352	76.37045833	44.86073314	4.430063814	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.083844068	0.083844068	0.185922056	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.083844068	0.083844068	0.185922056	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	24.2361	1.617955049	6.516101158	0	4.371959157	7.966901657	6.028471117	9.700212144	15.74977222	1.223258597	3.996856811	0	0	5.2816386	13.86248158	12.31887158	1.310613511	1.039260611	5.931444628	17.10698267	10.04880422	0.992334294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3	0	NO	0	24.2361	1.617955049	6.516101158	0	4.371959157	7.966901657	6.028471117	9.700212144	15.74977222	1.223258597	3.996856811	0	0	5.2816386	13.86248158	12.31887158	1.310613511	1.039260611	5.931444628	17.10698267	10.04880422	0.992334294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0967	0	NO	1.39E-17	24.2361	1.617955049	6.516101158	0	4.371959157	7.966901657	6.028471117	9.796937305	15.74977222	1.223258597	3.996856811	0	0	5.2816386	13.86248158	12.31887158	1.310613511	1.039260611	5.931444628	17.10698267	10.04880422	0.992334294	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3968
H6528_012_0	2012	7																															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	YES	603.0191002	13.27905706	42.32679464	0	41.82614189	86.89105239	61.60116971	85.51057126	88.82419224	15.36245157	38.39998315	0	1.49709022	46.77086559	106.6067098	93.70186288	4.05763794	7.263878011	38.88269278	119.9335747	26.51960089	9.165001203	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.085300401	0.085300401	0.187311559	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223925967	0	15	0	0	0	0	0	0											YES	0.085300401	0.085300401	0.187311559	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223925967	0	15	0	0	0	0	0	0											6700	51.4378	1.132708897	7.928297873	0	9.369055783	19.46359574	13.79866202	19.15436796	19.89661906	3.441189153	8.601596225	0	0.335348209	10.47667389	23.879903	20.98921728	0.908910898	1.627108674	8.709723183	26.86512072	5.9403906	2.052281756	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.3254	0	NO	0	51.4378	1.132708897	7.928297873	0	9.369055783	19.46359574	13.79866202	19.15436796	19.89661906	3.441189153	8.601596225	0	0.335348209	10.47667389	23.879903	20.98921728	0.908910898	1.627108674	8.709723183	26.86512072	5.9403906	2.052281756	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.3254	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1908	0	NO	8.33E-17	51.4378	1.132708897	7.928297873	0	9.369055783	19.46359574	13.79866202	19.34519975	19.89661906	3.441189153	8.601596225	0	0.335348209	10.47667389	23.879903	20.98921728	0.908910898	1.627108674	8.709723183	26.86512072	5.9403906	2.052281756	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.5162
H6528_013_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	2051.523025	10.22439971	97.15109993	0	229.6756947	29.37181378	8.231622515	735.4995571	331.3462467	7.402810115	18.51911661	0	0.804357324	2687.473347	4604.574107	5688.577354	141.5510088	289.9686235	14.98196695	54.51069014	33.6778798	563.25837	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$30/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.56266587	150	0.2	0.2	0	0.2	37.99474913	35	49.0674627	39.7586933	50	0.2	0.176860311	0.2	49.82313972	0	10	30	0	0	0	0	0											YES	168.8568276	964.8961576	125.4365005	0	154.3833852	0.192979232	0.192979232	62.29626823	144.7344236	0.192979232	0.192979232	0	0.192979232	36.66098744	33.77136552	47.34500622	38.3630104	48.24480788	0.192979232	0.170651834	0.192979232	48.07415608	0	10	30	0	0	0	0	0											6700	28.8678	0.822123667	1.0155245	0	2.954842604	5.668150053	1.588532187	3.818239808	3.996434003	1.428588607	3.573804892	0	0.155224258	8.210452219	12.95856294	22.44381085	0.452526902	1.165790044	2.891208469	9.302349255	6.499131363	2.256514233	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4315	0	NO	4.368247155	28.8678	0.822123667	1.0155245	0	2.954842604	5.668150053	1.588532187	3.818239808	3.996434003	1.428588607	3.573804892	0	0.155224258	8.210452219	12.95856294	22.44381085	0.452526902	1.165790044	2.891208469	9.302349255	6.499131363	2.256514233	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4315	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.3177	0	6.1042	0.2116	0.0402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											13.6736	0	NO	0.497459522	28.8678	0.822123667	1.0155245	7.31771913	2.954842604	11.77231165	1.800125867	3.858390555	3.996434003	1.428588607	3.573804892	0	0.155224258	8.210452219	12.95856294	22.44381085	0.452526902	1.165790044	2.891208469	9.302349255	6.499131363	2.256514233	0	0.15006243	0.211778778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1051
H6528_014_0	2012	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	344.7520473	23.01496466	42.84602516	0	22.33113386	22.50087655	17.02617783	55.56113416	44.61818442	7.367926499	24.07385263	0	0	31.79329196	64.1191517	56.91952678	6.062076693	4.806968247	27.4351454	79.12618027	29.883758	4.335754484	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.085300401	0.085300401	0.187311559	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.085300401	0.085300401	0.187311559	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	29.4075	1.963185723	8.025555752	0	5.002173985	5.040196348	3.813863835	12.44569405	9.994473311	1.650415536	5.39254299	0	0	7.1216974	14.36268998	12.749974	1.357905179	1.076760887	6.14547257	17.72426438	6.693961793	0.971209004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.9395	0	NO	5.68E-14	29.4075	1.963185723	8.025555752	0	5.002173985	5.040196348	3.813863835	12.44569405	9.994473311	1.650415536	5.39254299	0	0	7.1216974	14.36268998	12.749974	1.357905179	1.076760887	6.14547257	17.72426438	6.693961793	0.971209004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.9395	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1241	0	NO	0	29.4075	1.963185723	8.025555752	0	5.002173985	5.040196348	3.813863835	12.56979564	9.994473311	1.650415536	5.39254299	0	0	7.1216974	14.36268998	12.749974	1.357905179	1.076760887	6.14547257	17.72426438	6.693961793	0.971209004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.0636
H6528_015_0	2012	7																															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	YES	585.9348936	12.9028465	39.60554995	0	31.8200827	75.24962654	53.34801326	61.73475057	81.44132419	10.47046549	26.17197499	0	1.020360026	31.88662388	106.4137232	93.53223745	4.05029253	7.250728449	38.81230471	119.7164628	44.98708306	8.464283772	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.080965465	0.080965465	0.18087309	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223927946	0	15	0	0	0	0	0	0											YES	0.080965465	0.080965465	0.18087309	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223927946	0	15	0	0	0	0	0	0											6700	47.4405	1.04468497	7.163578191	0	7.127698524	16.85591634	11.94995497	13.82858413	18.24285662	2.34538427	5.862522397	0	0.228560646	7.14260375	23.83667399	20.95122119	0.907265527	1.624163173	8.693956255	26.81648767	10.07710661	1.89538968	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	234.352	0	NO	0	47.4405	1.04468497	7.163578191	0	7.127698524	16.85591634	11.94995497	13.82858413	18.24285662	2.34538427	5.862522397	0	0.228560646	7.14260375	23.83667399	20.95122119	0.907265527	1.624163173	8.693956255	26.81648767	10.07710661	1.89538968	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	234.352	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1378	0	NO	0	47.4405	1.04468497	7.163578191	0	7.127698524	16.85591634	11.94995497	13.96635601	18.24285662	2.34538427	5.862522397	0	0.228560646	7.14260375	23.83667399	20.95122119	0.907265527	1.624163173	8.693956255	26.81648767	10.07710661	1.89538968	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	234.4897
H6528_016_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1778.092272	8.861672959	69.09301073	0	202.3985608	27.24598304	7.635846022	606.3450309	324.8106696	5.792073588	14.48964441	0	0.629341661	1726.528408	4811.955342	5900.282759	146.8734592	300.7600607	15.44649725	56.20085938	31.61564843	526.1943781	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $30/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $30/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$30/Visit for Office Surgery - PCP; $30/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $30/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$25/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.56266587	150	0.2	0.2	0	0.2	34.00173519	30	49.0674627	39.51385467	50	0.2	0.177185408	0.2	49.81128885	0	10	25	0	0	0	0	0											YES	169.5507779	968.861588	125.9520064	0	155.0178541	0.193772318	0.193772318	62.55228698	145.3292382	0.193772318	0.193772318	0	0.193772318	32.94297515	29.06584764	47.53957983	38.28345598	48.4430794	0.193772318	0.171668136	0.193772318	48.26024442	0	10	25	0	0	0	0	0											6700	25.1231	0.715477878	0.725200278	0	2.614615881	5.279517279	1.479615581	3.160689032	3.933707264	1.122343523	2.807691978	0	0.121948992	4.739748538	11.65529674	23.37474694	0.468568634	1.214145292	2.993103571	9.647896785	6.126237469	2.116189108	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7464	0	NO	3.516662668	25.1231	0.715477878	0.725200278	0	2.614615881	5.279517279	1.479615581	3.160689032	3.933707264	1.122343523	2.807691978	0	0.121948992	4.739748538	11.65529674	23.37474694	0.468568634	1.214145292	2.993103571	9.647896785	6.126237469	2.116189108	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7464	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.9804	0	5.6856	0.1971	0.0332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											13.8964	0	NO	0.446617854	25.1231	0.715477878	0.725200278	7.980413483	2.614615881	10.96515127	1.676701486	3.193925296	3.933707264	1.122343523	2.807691978	0	0.121948992	4.739748538	11.65529674	23.37474694	0.468568634	1.214145292	2.993103571	9.647896785	6.126237469	2.116189108	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.6427
H6528_017_0	2012	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	306.1482546	20.43785183	36.80738051	0	17.16211486	22.35449997	16.91541621	40.2981367	39.32505155	5.621067829	18.36619279	0	0	24.27053052	64.27088604	57.04135891	6.076422255	4.818343665	27.50006912	79.3134279	39.76821649	4.433094675	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.080965465	0.080965465	0.18087309	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.080965465	0.080965465	0.18087309	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	24.7874	1.654760182	6.657464639	0	3.844313728	5.007407994	3.789053231	9.02678262	8.808811547	1.259119194	4.114027186	0	0	5.436598836	14.39667847	12.7772644	1.361118585	1.079308981	6.160015484	17.76620785	8.908080494	0.993013207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8275	0	NO	0	24.7874	1.654760182	6.657464639	0	3.844313728	5.007407994	3.789053231	9.02678262	8.808811547	1.259119194	4.114027186	0	0	5.436598836	14.39667847	12.7772644	1.361118585	1.079308981	6.160015484	17.76620785	8.908080494	0.993013207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8275	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.09	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.09	0	NO	2.78E-17	24.7874	1.654760182	6.657464639	0	3.844313728	5.007407994	3.789053231	9.116792714	8.808811547	1.259119194	4.114027186	0	0	5.436598836	14.39667847	12.7772644	1.361118585	1.079308981	6.160015484	17.76620785	8.908080494	0.993013207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9175
H6528_018_0	2012	7																															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	YES	546.3359267	12.03083939	57.6872019	0	44.21386361	89.54911357	63.48559478	77.33159073	75.99184908	10.10003449	25.24604567	0	0.984261059	30.75653815	95.36811079	83.82370729	3.629877192	6.498111835	34.78363565	107.2900426	45.56121732	8.651344986	0	253.4838497	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.080883882	0.080883882	0.188738596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223928654	0	15	0	0	0	0	0	0											YES	0.080883882	0.080883882	0.188738596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.223928654	0	15	0	0	0	0	0	0											6700	44.1898	0.973100993	10.88780148	0	9.903905449	20.05900144	14.22077323	17.32227632	17.02217419	2.262407725	5.65511423	0	0.220474477	6.889464546	21.36245682	18.77651043	0.813092491	1.455577051	7.791534386	24.03296953	10.20571268	1.937284037	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.2983	0	NO	0	44.1898	0.973100993	10.88780148	0	9.903905449	20.05900144	14.22077323	17.32227632	17.02217419	2.262407725	5.65511423	0	0.220474477	6.889464546	21.36245682	18.77651043	0.813092491	1.455577051	7.791534386	24.03296953	10.20571268	1.937284037	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.2983	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1726	0	NO	2.78E-17	44.1898	0.973100993	10.88780148	0	9.903905449	20.05900144	14.22077323	17.49485528	17.02217419	2.262407725	5.65511423	0	0.220474477	6.889464546	21.36245682	18.77651043	0.813092491	1.455577051	7.791534386	24.03296953	10.20571268	1.937284037	0	0.316854812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.4708
H6528_019_0	2012	6																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	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	1699.43907	8.469680395	82.42910451	0	244.8347335	30.6809773	8.598523245	633.1876339	306.9406173	5.878979795	14.70705187	0	0.638784513	1722.057966	4864.151222	5964.283863	148.4666139	304.0224426	14.04101652	51.08712883	28.04696119	512.3071202	0	180.0749158	84.71151122	0	0	0	0	0											6700	$175/Days Custom: Inpatient1-15 for IP Medical; $175/Days Custom: Inpatient1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: SNF21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$160/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $30/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $30/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$30/Visit for Office Surgery - PCP; $30/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $30/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharm and Blood; PBP 15	"$50/Visit for Vision Exams; $50/Service for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$25/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	160	0.2	0.2	64.56266587	150	0.2	0.2	0	0.2	34.00204337	30	49.0674627	39.51385467	50	0.2	0.18328225	0.2	49.55507092	0	10	25	0	0	0	0	0											YES	169.6530417	969.4459525	126.0279738	0	155.1113524	0.193889191	0.193889191	62.59001512	145.4168929	0.193889191	0.193889191	0	0.193889191	32.96314332	29.08337858	47.56825312	38.30654648	48.47229763	0.193889191	0.177682236	0.193889191	48.04096293	0	10	25	0	0	0	0	0											6700	24.0263	0.684241448	0.865697752	0	3.164720553	5.948709853	1.667160712	3.302601965	3.719529239	1.139870634	2.851538383	0	0.123853412	4.730370294	11.78882929	23.64254704	0.473936937	1.228055527	2.722401327	9.077275269	5.438002602	2.050977281	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9731	0	NO	3.424216121	24.0263	0.684241448	0.865697752	0	3.164720553	5.948709853	1.667160712	3.302601965	3.719529239	1.139870634	2.851538383	0	0.123853412	4.730370294	11.78882929	23.64254704	0.473936937	1.228055527	2.722401327	9.077275269	5.438002602	2.050977281	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9731	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	6.1945	0	6.4063	0.2221	0.0347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											12.8576	0	NO	0.405232162	24.0263	0.684241448	0.865697752	6.194467379	3.164720553	12.35501277	1.889227769	3.337330516	3.719529239	1.139870634	2.851538383	0	0.123853412	4.730370294	11.78882929	23.64254704	0.473936937	1.228055527	2.722401327	9.077275269	5.438002602	2.050977281	0	0.15006243	0.176482315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8307
H6528_020_0	2012	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	302.0227842	20.16244359	48.67834579	0	26.03644875	34.02606441	25.74716689	59.79282971	56.39279973	4.797060483	15.67384354	0	0	20.71818468	60.47939583	53.73835515	5.717959864	4.534098279	25.87777559	74.63454289	33.36232359	4.419607651	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.080883882	0.080883882	0.188738596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.080883882	0.080883882	0.188738596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											6700	24.4288	1.630816707	9.187482628	0	5.832164521	7.621838428	5.767365383	13.39359386	12.63198714	1.074541548	3.510940953	0	0	4.640873368	13.54738467	12.03739155	1.280823009	1.015638015	5.796621732	16.71813761	7.473160485	0.989992114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5795	0	NO	2.84E-14	24.4288	1.630816707	9.187482628	0	5.832164521	7.621838428	5.767365383	13.39359386	12.63198714	1.074541548	3.510940953	0	0	4.640873368	13.54738467	12.03739155	1.280823009	1.015638015	5.796621732	16.71813761	7.473160485	0.989992114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5795	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1336	0	NO	0	24.4288	1.630816707	9.187482628	0	5.832164521	7.621838428	5.767365383	13.52714738	12.63198714	1.074541548	3.510940953	0	0	4.640873368	13.54738467	12.03739155	1.280823009	1.015638015	5.796621732	16.71813761	7.473160485	0.989992114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7131
H6609_001_0	2012	9	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	855.17	81.12	222.62	575.06	14.71	10.96	3.64	292.64	303.2	1106.08	818.86	112.26	0.18	891.21	2663.84	3168.73	66.76	629.59		1534.2	12.37	0		4.04	0.61				3.77	0.95	781.34	0.06									4000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	89.248563	41.764504	40.279271	40.806114	0.2	50	10	30.371317	35	42.75806		0	0.2	0		0	0				0	0	0	0									NO	152.881784	107.402834	33.35525	0	93.1942	0.186388	0.186388	60.57623	83.174485	38.922096	37.537945	38.028932	0.186388	46.5971	9.31942	28.304306	32.61797	39.848032		0	0.186388	0		0	0				0	0	0	0										10.895	0.726043158	0.61879548	0	0.114240557	2.04281248	0.67845232	1.477252329	2.101541988	3.587579329	2.561526804	0.355760659	0.03354984	3.460650124	2.068786981	7.474058629	0.18146464	2.090660206	0	0	2.30561956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7738	0	NO	4.55941	10.895	0.726043158	0.61879548	0	0.114240557	2.04281248	0.67845232	1.477252329	2.101541988	3.587579329	2.561526804	0.355760659	0.03354984	3.460650124	2.068786981	7.474058629	0.18146464	2.090660206	0	0	2.30561956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7738	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.3456	0.0824	0.2359	1.1102	1.1711	1.0039	0.3334	0.2162	2.3344	0.4863	1.2665	0.0375	0.0051	1.1923	1.3164	2.4058	0.022	0.1963		0.3362	0.5211	0		0	0				0	0	0.1096	0									18.7282	1000	NO	6.249583	15.2406	0.808398158	0.85465748	1.110223	1.285332557	3.04672948	1.01182632	1.693480329	4.435971988	4.073903329	3.828058804	0.393309659	0.03863684	4.652921124	3.385147981	9.879865629	0.20351064	2.286943206	0	0.336242	2.82671956	0	0	0	0	0	0	0	0	0	0.109578	0	0	0	0	0	0	0	0	0	61.502
H6609_002_0	2012	6	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	972.9	26.1	376.64	818.62	20.22	5.95	2.19	283.01	248.53	860.19	634.6	56.89	0.19	487.64	1947.71	2839.52	32.29	444.39		974.37	10.74	0			0.61				3.77	0.95	703.59	0									5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	87.18311	39.347559	40.802686	38.050609	0.2	50	10	32.299999	35	40.126189		0	0.2	0			0				0	0	0	0									NO	161.196944	113.244418	34.779474	0	96.3208	0.192642	0.192642	62.60852	83.975469	37.899884	39.301474	36.650651	0.192642	48.1604	9.63208	31.111617	33.71228	38.649866		0	0.192642	0			0				0	0	0	0										13.069	0.246306609	1.091611757	0	0.162300548	1.1462199	0.42188598	1.47656977	1.739201943	2.716758435	2.07839295	0.173754628	0.03660198	1.957078121	1.563374878	7.361838225	0.090714127	1.431301163	0	0	2.06897508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8319	0	NO	2.79345	13.069	0.246306609	1.091611757	0	0.162300548	1.1462199	0.42188598	1.47656977	1.739201943	2.716758435	2.07839295	0.173754628	0.03660198	1.957078121	1.563374878	7.361838225	0.090714127	1.431301163	0	0	2.06897508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8319	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	$0/Proc									6000	4.0317	0.0361	0.3405	1.6452	1.5212	0.4289	0.1577	0.1976	1.6879	0.2649	0.658	0.0176	0.0048	0.5835	0.8246	1.8779	0.0116	0.1423		0.1624	0.4774	0			0				0	0	0.0663	0									15.1379	500	NO	4.220812	17.1007	0.282386609	1.432124757	1.645157	1.683474548	1.5750919	0.57958598	1.67413977	3.427106943	2.981626435	2.73642595	0.191325628	0.04144998	2.540560121	2.388006878	9.239704225	0.102315127	1.573638163	0	0.162395	2.54634008	0	0	0	0	0	0	0	0	0	0.066271	0	0	0	0	0	0	0	0	0	53.9699
H6609_003_0	2012	9	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	1110.33	77.67	398.95	1252.2	18.61	10.59	4.91	310.26	343.79	1218.35	1038.12	260.9	0.29	566.19	3106.89	3778.85	101.99	681.99		1833.42	27.9	0		4.03	0.61				5.07	0.95	1133.44	0.1									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											163.989133	128.006658	38.754396	0	100	0.2	0.2	65	150	41.6801	39.482839	32.244442	0.2	50	10	28.019241	30	39.438882		0	0.2	0		0	0				0	0	0	0									NO	130.198188	101.630118	30.470954	0	90.8321	0.181664	0.181664	59.040865	136.24815	37.85891	35.863092	29.288304	0.181664	45.41605	9.08321	25.450465	27.24963	35.823165		0	0.181664	0		0	0				0	0	0	0										12.0469	0.657800939	1.013032258	0	0.140865448	1.92382176	0.89197024	1.526501565	3.903395957	3.843783583	3.102516089	0.636776543	0.05268256	2.142842779	2.351711193	8.014457472	0.231599147	2.035920025	0	0	5.0684256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.585	0	NO	7.192624	12.0469	0.657800939	1.013032258	0	0.140865448	1.92382176	0.89197024	1.526501565	3.903395957	3.843783583	3.102516089	0.636776543	0.05268256	2.142842779	2.351711193	8.014457472	0.231599147	2.035920025	0	0	5.0684256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.585	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.093	0.099	0.3717	1.865	1.1737	0.7678	0.3558	0.1816	2.2748	0.373	0.9729	0.0709	0.0063	0.7611	1.116	1.3574	0.0366	0.2047		0.6586	1.0019	0		0	0				0	0	0.1336	0									17.8754	500	NO	7.978015	16.1399	0.756795939	1.384717258	1.865	1.314583448	2.69164476	1.24780824	1.708054565	6.178229957	4.216763583	4.075446089	0.707691543	0.05899456	2.903928779	3.467704193	9.371817472	0.268235147	2.240641025	0	0.658564	6.0703056	0	0	0	0	0	0	0	0	0	0.133602	0	0	0	0	0	0	0	0	0	67.4605
H6609_004_0	2012	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			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	955.71	25.64	369.99	804.15	19.86	6.64	2.44	278.01	244.14	844.99	623.38	55.88	0.21	479.02	1913.29	2789.34	31.72	436.53		957.15	11.99	0			0.61				5.07	0.95	691.16	0									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											163.989133	128.006658	38.754396	0	100	0.2	0.2	65	150	39.347559	40.0362	34.067479	0.2	50	10	27.839999	30	36.834919		0	0.2	0			0				0	0	0	0									NO	140.526388	109.692105	33.22988	0	94.7991	0.189598	0.189598	61.619415	142.19865	37.301132	37.953957	32.295664	0.189598	47.39955	9.47991	26.392068	28.43973	34.919171		0	0.189598	0			0				0	0	0	0										11.1919	0.234375464	1.024560275	0	0.156892511	1.25893072	0.46261912	1.427567797	2.893031534	2.626590294	1.97164481	0.150390142	0.03981558	1.892111037	1.51148475	6.134704246	0.075175686	1.270272143	0	0	2.27328002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5953	0	NO	3.402635	11.1919	0.234375464	1.024560275	0	0.156892511	1.25893072	0.46261912	1.427567797	2.893031534	2.626590294	1.97164481	0.150390142	0.03981558	1.892111037	1.51148475	6.134704246	0.075175686	1.270272143	0	0	2.27328002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5953	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.1894	0.0375	0.3411	1.7622	1.4346	0.5513	0.2027	0.1863	1.808	0.2837	0.7048	0.0188	0.0052	0.625	0.8833	2.0115	0.0124	0.1525		0.1739	0.5113	0			0				0	0	0.0852	0									15.9806	500	NO	5.181451	15.3812	0.271866464	1.365616275	1.762202	1.591451511	1.81019172	0.66532312	1.613888797	4.701023534	2.910302294	2.67649181	0.169210142	0.04500858	2.517106037	2.39478575	8.146171246	0.087601686	1.422735143	0	0.173949	2.78460702	0	0	0	0	0	0	0	0	0	0.085183	0	0	0	0	0	0	0	0	0	52.5759
H6609_005_0	2012	9	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	794.11	29.67	346.82	268.69	13.77	6.8	2.81	242.35	263.31	1074.21	630.78	146.45	0.09	753.04	2227.94	2624.15	74.39	678.89		2260.09	14.65	0			0.61				5.58	0.95	556.38	0									4000	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											145.768118	128.006658	31.003517	0	100	0.2	0.2	65	150	48.462069	35.669121	35.34412	0.2	50	10	27.136351	30	40.353793		0	0.2	0			0				0	0	0	0									NO	129.255943	113.506448	27.753542	0	94.7642	0.189528	0.189528	61.59673	142.1463	45.924692	33.801557	33.493573	0.189528	47.3821	9.47642	25.715546	28.42926	38.240949		0	0.189528	0			0				0	0	0	0										8.5536	0.280644693	0.80212362	0	0.10874192	1.2887904	0.53257368	1.243997293	3.119045188	4.111063616	1.776778844	0.408761147	0.01705752	2.973384715	1.759407931	5.62345417	0.176237721	2.163449822	0	0	2.7765852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7157	0	NO	2.773935	8.5536	0.280644693	0.80212362	0	0.10874192	1.2887904	0.53257368	1.243997293	3.119045188	4.111063616	1.776778844	0.408761147	0.01705752	2.973384715	1.759407931	5.62345417	0.176237721	2.163449822	0	0	2.7765852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7157	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.3055	0.046	0.33	1.0943	0.9541	0.5415	0.2242	0.1558	1.9527	0.4485	0.7851	0.0466	0.0022	0.7647	0.9609	1.7431	0.0284	0.2139		0.5729	0.5461	0			0				0	0	0.0701	0									15.7866	500	NO	5.996512	12.8591	0.326646693	1.13211362	1.094322	1.06285592	1.8303264	0.75680968	1.399798293	5.071720188	4.559560616	2.561853844	0.455374147	0.01922452	3.738095715	2.720271931	7.36659417	0.204632721	2.377327822	0	0.572941	3.3226662	0	0	0	0	0	0	0	0	0	0.07008	0	0	0	0	0	0	0	0	0	53.5023
H6609_006_0	2012	8	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 - Other	OP Facility - Surgery	Professional			Prosthetics/Supplies	Lab	Radiology	Mental Health	Renal Dialysis	Other		Therapy (PT/OT/ST)			D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin			V				O	O	O	V	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			0	YES	595.82	40.32	242.84	417.26	13.35	4.78	1.27	219.03	4.99	5.94	7.88	0.08	0.13	12.39	1203.11	1933.08	21.56	1.31		864.23	6.37	0			0.61				5.58	0.95	327.28	70.4	197.29	44.47	0	0	159.73	210.18			6000	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% Surgery OP -- Physician	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	20% Coins: 7h. 20% Psych -- OP	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$50/Visit: 8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$35/Visit: 3, 7c, 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"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"					145.768118	128.006658	31.003517	0	125	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	15	31.357885	35	0.2		0	0.2	0			0				0	0	0	0	32.84336	35	0	0	150	35			NO	141.666786	124.405063	30.467001	0	123.829625	0.198127	0.198127	64.391405	0.198127	0.198127	0.198127	0.198127	0.198127	0.198127	14.859555	31.064281	34.672295	0.198127		0	0.198127	0			0				0	0	0	0	32.535848	34.672295	0	0	148.59555	34.672295				7.034	0.418001012	0.616550544	0	0.137760458	0.94704706	0.25162129	1.17530412	0.98865373	1.17687438	1.56124076	0.01585016	0.02575651	2.45479353	1.489806601	5.004145026	0.062294557	0.25954637	0	0	1.26206899	0	0	0	0	0	0	0	0	0	0	0	0.534916454	0.128489747	0	0	1.9779306	0.607285247	0	0	28.1299	0	NO	0.416242	7.034	0.418001012	0.616550544	0	0.137760458	0.94704706	0.25162129	1.17530412	0.98865373	1.17687438	1.56124076	0.01585016	0.02575651	2.45479353	1.489806601	5.004145026	0.062294557	0.25954637	0	0	1.26206899	0	0	0	0	0	0	0	0	0	0	0	0.534916454	0.128489747	0	0	1.9779306	0.607285247	0	0	28.1299	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	25% Coins	$125/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	30% Coins	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	30% Coins			7500	4.1404	0.1084	0.3465	1.1611	1.4452	0.3968	0.1058	0.176	0.2657	0.2669	0.3668	0.0038	0.004	0.5568	0.7166	1.663	0.0122	0.0589		0.2162	0.3198	0			0				0	0	0.0428	0.0108	0.2302	0.0182	0	0.0001	1.2506	0.0936			13.9772	500	NO	2.034548	11.1744	0.526370012	0.963075544	1.161093	1.582912458	1.34384706	0.35741429	1.35128412	1.25436673	1.44378738	1.92802176	0.01964816	0.02977951	3.01160453	2.206433601	6.667176026	0.074476557	0.31841137	0	0.216172	1.58191299	0	0	0	0	0	0	0	0	0	0.042789	0.010848	0.765160454	0.146664747	0	0.000093	3.2285626	0.700847247	0	0	42.1071
H6609_009_0	2012	6	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	O			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	656.99	73.15	386.22	509.43	14.79	12.55	5.86	364.42	378.38	1905.03	1116.29	307.55	0.14	6.9	2460.54	3642.2	112.91	1021.1		1296.71	10.81	0			0.61				4.84	0.93	1358.02										3400	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25-$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"												157.299288	129.289608	49.537808	0	150	0.2	0.14325	65	152.694961	0	32.004588	50	0.2	0.2	10	22.380545	25	26.955486		0	0.2	0			0				0	0	70.681619										NO	130.668204	107.400618	38.357174	0	136.10505	0.181473	0.12998	58.978855	138.550369	0	29.039907	45.36835	0.181473	0.181473	9.07367	20.307368	22.684175	24.458519		0	0.181473	0			0				0	0	64.134169											7.154	0.654696267	1.234525645	0	0.167749474	2.27748615	0.7616828	1.791089528	4.368724052	0	2.701413149	1.162753004	0.02540622	1.2521637	1.860510665	6.163624644	0.213439183	2.081216146	0	0	1.96172313	0	0	0	0	0	0	0	0	0	7.257957015	0	0	0	0	0	0	0	0	0	43.0901	0	NO	5.427023	7.154	0.654696267	1.234525645	0	0.167749474	2.27748615	0.7616828	1.791089528	4.368724052	0	2.701413149	1.162753004	0.02540622	1.2521637	1.860510665	6.163624644	0.213439183	2.081216146	0	0	1.96172313	0	0	0	0	0	0	0	0	0	7.257957015	0	0	0	0	0	0	0	0	0	43.0901	YES	$0-$275/Day(Days 1-5)	$0-$275/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins; $225/Visit										4500	0.8287	0.0758	0.3553	1.1659	1.0886	0.9448	0.4412	0.166	1.7475	0.3681	0.6451	0.0576	0.0023	0.1171	0.7948	1.5552	0.0251	0.2404		0.1398	0.255	0			0				0	0	0.6668										11.681	0	NO	2.939824	7.9826	0.730531267	1.589799645	1.165876	1.256335474	3.22231815	1.2029168	1.957064528	6.116203052	0.368089	3.346499149	1.220379004	0.02770822	1.3692537	2.655293665	7.718856644	0.238553183	2.321575146	0	0.139811	2.21673113	0	0	0	0	0	0	0	0	0	7.924711015	0	0	0	0	0	0	0	0	0	54.7711
H6609_011_0	2012	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			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	983.95	46.75	397.18	969.82	21.06	10.63	3.38	301.62	282.8	1194.6	856.27	139.91	0.37	5.92	2528.03	3256.23	78.73	599.5		1313.9	18.42	0			0.61				4.84	0.93	1140.8	497.37									3400	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											157.299288	129.289608	49.537808	0	150	0.2	0.2	65	156.262655	37.015003	79.616351	50	0.2	0.2	10	23.631579	25	32.285722		0	0.2	0			0				0	0	0	79.487125									NO	122.734342	100.879509	36.098746	0	134.5182	0.179358	0.179358	58.29122	140.134474	33.194611	71.398988	44.8394	0.179358	0.179358	8.96788	21.192516	22.4197	28.953448		0	0.179358	0			0				0	0	0	71.2831										10.0637	0.393009754	1.194808328	0	0.236079441	1.90657554	0.60623004	1.465149815	3.302502437	3.304523525	5.094734288	0.522790038	0.06636246	1.06179936	1.889255806	5.750642198	0.147091915	1.446466006	0	0	3.30377436	0	0	0	0	0	0	0	0	0	0	2.954506287	0	0	0	0	0	0	0	0	44.71	0	NO	7.194341	10.0637	0.393009754	1.194808328	0	0.236079441	1.90657554	0.60623004	1.465149815	3.302502437	3.304523525	5.094734288	0.522790038	0.06636246	1.06179936	1.889255806	5.750642198	0.147091915	1.446466006	0	0	3.30377436	0	0	0	0	0	0	0	0	0	0	2.954506287	0	0	0	0	0	0	0	0	44.71	YES	$0-$275/Day(Days 1-5)	$0-$275/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									4500	1.1959	0.0467	0.3461	1.908	1.5565	0.8033	0.2552	0.1379	1.3538	0.2435	0.5573	0.0292	0.0063	0.1009	0.7454	1.444	0.0177	0.1378		0.1601	0.414	0			0				0	0	0.1265	0.3515									11.9378	0	NO	3.063576	11.2596	0.439713754	1.540956328	1.907957	1.792558441	2.70991254	0.86145404	1.603069815	4.656302437	3.548062525	5.652081288	0.551981038	0.07268046	1.16265736	2.634693806	7.194615198	0.164787915	1.584254006	0	0.160138	3.71776736	0	0	0	0	0	0	0	0	0	0.12655	3.305971287	0	0	0	0	0	0	0	0	56.6478
H6609_012_0	2012	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	843.37	20.31	296.61	736.18	16.16	5.65	3.12	250.72	240.81	868.11	560.79	42.59	0.16	5.5	1571.02	2629.92	31.53	639.09		858.88	8.12	0			0.61				4.84	0.93	601.97	510.38									3400	"$0-$275/Day(Days 1-5): 1a. $275 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$275/Day(Days 1-5): 1b. $275 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$225/Visit: 3. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $225 Observation"											173.029216	142.218568	49.537808	0	150	0.2	0.2	65	153.085546	39.343084	78.995473	50	0.2	0.2	10	22.67127	25	33.86816		0	0.2	0			0				0	0	0	73.511678									NO	142.880606	117.438405	40.137216	0	139.36275	0.185817	0.185817	60.390525	142.229484	36.553069	73.393509	46.45425	0.185817	0.185817	9.29085	21.063536	23.227125	31.4664		0	0.185817	0			0				0	0	0	68.298597										10.0418	0.1987645	0.992091636	0	0.18767517	1.04986605	0.57974904	1.261759369	2.85419017	2.644340394	3.429862159	0.164873876	0.02973072	1.0219935	1.216342597	4.61628455	0.061029271	1.675821798	0	0	1.50883404	0	0	0	0	0	0	0	0	0	0	2.904853161	0	0	0	0	0	0	0	0	36.4398	0	NO	4.317156	10.0418	0.1987645	0.992091636	0	0.18767517	1.04986605	0.57974904	1.261759369	2.85419017	2.644340394	3.429862159	0.164873876	0.02973072	1.0219935	1.216342597	4.61628455	0.061029271	1.675821798	0	0	1.50883404	0	0	0	0	0	0	0	0	0	0	2.904853161	0	0	0	0	0	0	0	0	36.4398	YES	$0-$275/Day(Days 1-5)	$0-$275/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									4500	1.1322	0.0224	0.3219	1.5569	1.262	0.4511	0.2488	0.1212	1.2466	0.1896	0.4095	0.0095	0.0029	0.0992	0.5076	1.2404	0.008	0.2033		0.1057	0.197	0			0				0	0	0.0708	0.3047									9.7114	0	NO	1.709107	11.174	0.2211755	1.314013636	1.556894	1.44963617	1.50096605	0.82854104	1.382919369	4.10076517	2.833969394	3.839378159	0.174397876	0.03264772	1.1211575	1.723982597	5.85665455	0.069070271	1.879148798	0	0.105743	1.70579004	0	0	0	0	0	0	0	0	0	0.070818	3.209579161	0	0	0	0	0	0	0	0	46.1512
H6609_013_0	2012	8	r.	s.	t.								OP Facility - Other	OP Facility - Other	OP Facility - Surgery								Radiology	Other									D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	589.02	38.73	338.86	384.81	16.28	6.9	3.63	235.99	28.74	1333.45	13.67	200.39	0.1	5.09	2564.62	3486.08	58.43	925.61		1242.8	23.49	0			0.79				4.93	0.47	457.29	571.83	166.39								2900	"$0-$250/Day(Days 1-6): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-6): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$50/Day(Days 1-20), $100 (Days 21-100): 2. $50 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	20% Coins: 9a. 20% Surgery OP -- Facility	"$50/Visit: 8a. $50 Lab -- FSL,8a. $50 Lab -- OP"	"20% Coins: 8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$15-$200/Visit: 3. $15 Cardiac Rehab,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician"										171.209603	146.006518	65.501759	0	100	0.2	0.138301	65	0.2	50	0.2	50	0.2	0.2	10	34.512953	40	41.373004		0	0.2	0			0				0	0	35.752932	132.605248	225								NO	115.72331	98.688141	34.916106	0	80.2325	0.160465	0.110963	52.151125	0.160465	40.11625	0.160465	40.11625	0.160465	0.160465	8.02325	27.690605	32.093	33.194595		0	0.160465	0			0				0	0	28.685471	106.392505	180.523125									5.6803	0.318515975	0.98597264	0	0.108848758	1.1072085	0.40279569	1.025595332	4.6117641	4.45775113	2.19355655	0.669907945	0.0160465	0.81676685	1.714715618	8.044305357	0.156266166	2.560437423	0	0	3.76932285	0	0	0	0	0	0	0	0	0	1.093131586	5.069868845	2.503103564	0	0	0	0	0	0	0	47.3062	0	NO	13.674354	5.6803	0.318515975	0.98597264	0	0.108848758	1.1072085	0.40279569	1.025595332	4.6117641	4.45775113	2.19355655	0.669907945	0.0160465	0.81676685	1.714715618	8.044305357	0.156266166	2.560437423	0	0	3.76932285	0	0	0	0	0	0	0	0	0	1.093131586	5.069868845	2.503103564	0	0	0	0	0	0	0	47.3062	YES	$0-$250/Day(Days 1-6)	$0-$250/Day(Days 1-6)	"20% Coins(Days 1-20), 20% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$100/Trip	40% Coins	20%-40% Coins	$65/Visit	20% Coins	$50/Visit	20% Coins	$50/Visit	20% Coins	20% Coins	$10/Visit	$10-$40/Visit	$40/Visit	$40-$50/Visit		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0-$50/Visit	$15-$200/Visit	$0-$225/Visit								2900	2.0826	0.1168	0.5792	2.1916	0.9507	1.2782	0.5685	0.3687	1.6738	1.6026	0.8237	0.2536	0.0058	0.2963	0.6456	3.0286	0.0588	0.9568		0	1.4894	0							0	0	0.393	1.8226	0.8999								22.0866	0	NO	8.420409	7.7628	0.435290975	1.56512664	2.191586	1.059527758	2.3853715	0.97132269	1.394296332	6.2855811	6.06033613	3.01728455	0.923541945	0.0218145	1.11306885	2.360282618	11.07287736	0.215094166	3.517193423	0	0	5.25876485	0	0	0	0	0	0	0	0	0	1.486119586	6.892510845	3.402963564	0	0	0	0	0	0	0	69.3928
H6609_015_0	2012	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	O			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	899.5	38.15	337.69	574.69	25.76	8.14	3.71	286.41	285.38	989.74	618.55	186.95	0.2	2.72	2518.65	3282.82	54.59	619.32		1377.47	14.98	0			0.79				3.12	0.93	437.08										3400	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$25-$50/Visit: 5. $25 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$25/Visit: 7b. $15 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$25/Visit: 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$200/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"												157.299288	129.289608	49.537808	0	100	0.2	0.136441	65	102.777656	33.818156	32.778642	26.340987	0.2	0.2	15	23.681577	25	25		0	0.2	0			0				0	0	77.000427										NO	119.475573	98.201016	34.927375	0	89.3875	0.178775	0.121961	58.101875	91.870377	30.229204	29.300009	23.54555	0.178775	0.178775	13.408125	21.16837	22.346875	22.346875		0	0.178775	0			0				0	0	68.828757											8.9557	0.312197397	0.982885439	0	0.191885167	1.4552285	0.45247531	1.386746502	2.184830682	2.493254364	1.510293381	0.366820048	0.035755	0.486268	2.814197836	5.7909957	0.101659659	1.153322219	0	0	2.6780495	0	0	0	0	0	0	0	0	0	2.506972759	0	0	0	0	0	0	0	0	0	35.8595	0	NO	6.38539	8.9557	0.312197397	0.982885439	0	0.191885167	1.4552285	0.45247531	1.386746502	2.184830682	2.493254364	1.510293381	0.366820048	0.035755	0.486268	2.814197836	5.7909957	0.101659659	1.153322219	0	0	2.6780495	0	0	0	0	0	0	0	0	0	2.506972759	0	0	0	0	0	0	0	0	0	35.8595	YES	$0-$250/Day(Days 1-5)	$0-$250/Day(Days 1-5)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	$0-$125/Visit	20% Coins; $50/Visit	$0-$50/Visit	$25-$50/Visit	20% Coins	20% Coins	$15/Visit	$15-$25/Visit	$25/Visit	$25/Visit		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$15-$200/Visit										3400	3.2742	0.1142	0.7204	2.558	1.6705	1.2544	0.5725	0.497	0.783	0.9589	0.5467	0.138	0.0129	0.1757	1.0562	2.1734	0.0382	0.429		0	1.0547	0			0				0	0	0.8985										18.9263	0	NO	5.003764	12.2299	0.426348397	1.703320439	2.55804	1.862373167	2.7096265	1.02498731	1.883728502	2.967848682	3.452168364	2.056991381	0.504779048	0.048641	0.661934	3.870396836	7.9644247	0.139816659	1.582283219	0	0	3.7327655	0	0	0	0	0	0	0	0	0	3.405431759	0	0	0	0	0	0	0	0	0	54.7858
H6609_017_0	2012	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			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	1168.31	52.98	361.83	1288.13	21.53	10.89	3.36	342.76	320.38	1119.63	956.76	149.82	0.32	627.34	3015.96	3712.49	95.21	657.05		1625.12	18.42	0			0.61				1.34	0.95	1132.15	0.17									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											163.989133	131.206824	22.34531	0	100	0.2	0.2	65	150	35.389884	37.898541	32.687352	0.2	50	10	27.846114	30	36.406988		0	0.2	0			0				0	0	0	0									NO	131.667039	105.346091	18.572104	0	91.8095	0.183619	0.183619	59.676175	137.71425	32.491276	34.794461	30.010095	0.183619	45.90475	9.18095	25.565378	27.54285	33.425074		0	0.183619	0			0				0	0	0	0										12.819	0.465102992	0.559995366	0	0.164721545	1.99961091	0.61695984	1.704550479	3.676740951	3.031517279	2.774162376	0.374676036	0.05875808	2.399823822	2.307448164	7.909267514	0.218529562	1.830162073	0	0	3.38226198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2933	0	NO	6.269664	12.819	0.465102992	0.559995366	0	0.164721545	1.99961091	0.61695984	1.704550479	3.676740951	3.031517279	2.774162376	0.374676036	0.05875808	2.399823822	2.307448164	7.909267514	0.218529562	1.830162073	0	0	3.38226198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2933	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.1965	0.0623	0.2903	1.8499	1.4558	0.8467	0.2614	0.2151	1.8512	0.288	0.6877	0.039	0.0075	0.646	1.1617	1.43	0.0367	0.2256		0.626	0.6897	0			0				0	0	0.1124	0									16.9795	500	NO	6.028957	17.0155	0.527422992	0.850267366	1.849879	1.620526545	2.84627891	0.87836384	1.919636479	5.527985951	3.319472279	3.461874376	0.413671036	0.06625208	3.045832822	3.469168164	9.339281514	0.255203562	2.055783073	0	0.625981	4.07200698	0	0	0	0	0	0	0	0	0	0.112376	0	0	0	0	0	0	0	0	0	63.2728
H6609_019_0	2012	8	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	1117.03	50.66	345.94	1231.58	20.59	10.88	3.36	327.71	306.31	1070.48	914.76	143.24	0.32	599.8	2883.57	3549.51	91.03	628.2		1553.78	18.42	0			0.61				1.34	0.95	1082.45	0.17									5000	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											185.85435	128.006658	38.754396	0	100	0.2	0.2	65	150	35.389884	39.626171	41.343676	0.2	50	15	37.307643	40	43.203494		0	0.2	0			0				0	0	0	0									NO	155.441888	107.060161	32.968791	0	93.3699	0.18674	0.18674	60.690435	140.05485	33.0435	36.998916	38.602549	0.18674	46.68495	14.005485	34.834109	37.34796	40.339059		0	0.18674	0			0				0	0	0	0										14.4694	0.451972313	0.950435297	0	0.160207187	2.0317312	0.6274464	1.657405204	3.575016759	2.94770049	2.820427367	0.46078576	0.0597568	2.333469418	3.365483032	10.30366819	0.2833154	2.111749739	0	0	3.4397508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0498	0	NO	5.655132	14.4694	0.451972313	0.950435297	0	0.160207187	2.0317312	0.6274464	1.657405204	3.575016759	2.94770049	2.820427367	0.46078576	0.0597568	2.333469418	3.365483032	10.30366819	0.2833154	2.111749739	0	0	3.4397508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0498	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6700	4.6812	0.0695	0.3266	2.2545	1.6969	1.0319	0.3186	0.2507	2.2562	0.3509	0.944	0.0475	0.0091	0.7873	1.2962	2.4657	0.031	0.2214		0.3175	0.8406	0			0				0	0	0.137	0									20.3343	1000	NO	5.750989	19.1506	0.521489313	1.277074297	2.254525	1.857069187	3.0636002	0.9460284	1.908106204	5.831205759	3.29864349	3.764381367	0.50831076	0.0688898	3.120787418	4.661691032	12.76933819	0.3143144	2.333168739	0	0.317472	4.2803718	0	0	0	0	0	0	0	0	0	0.136957	0	0	0	0	0	0	0	0	0	72.3841
H6609_021_0	2012	6	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	1114.41	50.54	345.13	1228.7	20.54	11.51	3.55	326.95	305.6	1067.97	912.62	142.91	0.34	598.39	2876.81	3541.19	90.82	626.73		1550.14	19.63	0			0.61				1.34	0.69	1079.91	0.17									3400	"$0-$200/Day(Days 1-7): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											145.768118	128.006658	44.690621	0	100	0.2	0.2	65	150	35.389884	37.898541	32.687352	0.2	50	10	27.846114	30	36.406988		0	0.2	0			0				0	0	0	0									NO	114.097662	100.195163	34.015283	0	90.3099	0.18062	0.18062	58.701435	135.46485	31.960569	34.226134	29.519915	0.18062	45.15495	9.03099	25.147798	27.09297	32.879115		0	0.18062	0			0				0	0	0	0										10.596	0.421988628	0.978307885	0	0.154580446	2.0789362	0.641201	1.599369514	3.44983818	2.84441074	2.602954534	0.351557588	0.0614108	2.251689211	2.165036862	7.421094233	0.205048628	1.717193979	0	0	3.5455706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0862	0	NO	6.701237	10.596	0.421988628	0.978307885	0	0.154580446	2.0789362	0.641201	1.599369514	3.44983818	2.84441074	2.602954534	0.351557588	0.0614108	2.251689211	2.165036862	7.421094233	0.205048628	1.717193979	0	0	3.5455706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0862	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins; $35/Visit	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									5100	3.7935	0.0564	0.2447	1.8855	1.3386	0.863	0.2664	0.1978	1.8971	0.2957	0.6985	0.0546	0.0077	0.6634	1.0682	1.3149	0.0337	0.2132		0.5756	0.7083	0			0				0	0	0.1145	0									16.2911	500	NO	7.52136	14.3895	0.478393628	1.222966885	1.885465	1.493153446	2.9418912	0.907633	1.797135514	5.34695018	3.14012674	3.301407534	0.406116588	0.0691068	2.915111211	3.233206862	8.735953233	0.238769628	1.930407979	0	0.575573	4.2539076	0	0	0	0	0	0	0	0	0	0.114538	0	0	0	0	0	0	0	0	0	59.3773
H6609_022_0	2012	8	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	830.35	31.03	362.65	280.95	14.4	7.25	3	253.42	275.33	1123.23	659.57	153.14	0.1	787.4	2329.62	2743.91	77.78	709.87		2363.24	15.64	0			0.61				5.58	0.95	581.77	0									4000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	150	48.462069	36.892015	39.00809	0.2	50	15	32.136351	35	42.765345		0	0.2	0			0				0	0	0	0									NO	153.513507	107.846633	32.510792	0	93.072	0.186144	0.186144	60.4968	139.608	45.104616	34.336136	36.30561	0.186144	46.536	13.9608	29.909945	32.5752	39.802562		0	0.186144	0			0				0	0	0	0										10.6225	0.278873418	0.982503227	0	0.1116864	1.349544	0.558432	1.277591588	3.20318922	4.221904819	1.887257102	0.463320093	0.0186144	3.0535372	2.710279908	6.839183099	0.211141588	2.354553724	0	0	2.91129216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0554	0	NO	4.546907	10.6225	0.278873418	0.982503227	0	0.1116864	1.349544	0.558432	1.277591588	3.20318922	4.221904819	1.887257102	0.463320093	0.0186144	3.0535372	2.710279908	6.839183099	0.211141588	2.354553724	0	0	2.91129216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0554	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6000	4.3804	0.0468	0.3281	1.138	0.9719	0.5632	0.2332	0.1587	2.0306	0.4664	0.8164	0.0485	0.0023	0.7952	0.9992	1.8127	0.0295	0.2224		0.5958	0.5679	0			0				0	0	0.0729	0									16.2801	500	NO	6.73763	15.0029	0.325675418	1.310609227	1.138002	1.0836034	1.912695	0.791619	1.436300588	5.23380522	4.688302819	2.703669102	0.511794093	0.0208674	3.8487732	3.709496908	8.651901099	0.240669588	2.576968724	0	0.59581	3.47917016	0	0	0	0	0	0	0	0	0	0.072877	0	0	0	0	0	0	0	0	0	59.3355
H6609_023_0	2012	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			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	1218.98	55.28	377.52	1344	22.46	12.77	3.94	357.63	334.27	1168.19	998.26	156.32	0.38	654.54	3146.77	3873.5	99.34	685.54		1695.6	21.61	0			0.61				1.34	0.95	1181.25	0.18									5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $125 (Days 21-100): 2. $0 SNF - Facility 1,2. $125 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											182.210148	128.006658	38.754396	0	100	0.2	0.2	65	150	35.389884	37.898541	32.687352	0.2	50	10	27.846114	30	36.406988		0	0.2	0			0				0	0	0	0									NO	150.634951	105.824384	32.516101	0	93.2932	0.186586	0.186586	60.64058	139.9398	33.016356	35.356762	30.495077	0.186586	46.6466	9.32932	25.978531	27.98796	33.965244		0	0.186586	0			0				0	0	0	0										15.3017	0.487497662	1.022956537	0	0.174613773	2.38270322	0.73514884	1.807240885	3.898139746	3.214114743	2.941270103	0.397249203	0.07090268	2.544338797	2.446435358	8.385653319	0.231693662	1.940377781	0	0	4.03212346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0142	0	NO	6.036536	15.3017	0.487497662	1.022956537	0	0.174613773	2.38270322	0.73514884	1.807240885	3.898139746	3.214114743	2.941270103	0.397249203	0.07090268	2.544338797	2.446435358	8.385653319	0.231693662	1.940377781	0	0	4.03212346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0142	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins; $35/Visit	20% Coins	30% Coins; $35/Visit	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	$0/Proc									6700	4.7648	0.0708	0.3262	2.1178	1.4825	0.9693	0.2993	0.219	2.1194	0.3297	0.7793	0.0605	0.0086	0.739	1.183	1.4562	0.0373	0.2365		0.6375	0.7897	0			0				0	0	0.1287	0									18.7551	500	NO	7.121476	20.0666	0.558256662	1.349205537	2.117849	1.657103773	3.35201722	1.03441784	2.026269885	6.017552746	3.543780743	3.720546103	0.457730203	0.07948168	3.283313797	3.629449358	9.841879319	0.269040662	2.176917781	0	0.637455	4.82178346	0	0	0	0	0	0	0	0	0	0.128655	0	0	0	0	0	0	0	0	0	70.7693
H6609_024_0	2012	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	1006.56	27.01	389.67	846.94	20.92	6.11	2.25	292.8	257.13	889.95	656.55	58.86	0.19	504.51	2015.1	2937.76	33.41	459.76		1008.08	11.03	0			0.61				1.34	0.95	727.93	0									4000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											163.989133	131.206824	22.345311	0	100	0.2	0.2	65	150	39.347559	40.0362	34.067479	0.2	50	10	27.839999	30	36.834919		0	0.2	0			0				0	0	0	0									NO	139.650522	111.733632	19.556683	0	94.5769	0.189154	0.189154	61.474985	141.86535	37.213702	37.864997	32.219966	0.189154	47.28845	9.45769	26.330208	28.37307	34.837324		0	0.189154	0			0				0	0	0	0										11.7139	0.251493783	0.635054389	0	0.164879062	1.15573094	0.4255965	1.499989634	3.039819787	2.759861175	2.071688648	0.158038933	0.03593926	1.988124659	1.588182593	6.445985988	0.078995356	1.334734007	0	0	2.08636862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4344	0	NO	3.599896	11.7139	0.251493783	0.635054389	0	0.164879062	1.15573094	0.4255965	1.499989634	3.039819787	2.759861175	2.071688648	0.158038933	0.03593926	1.988124659	1.588182593	6.445985988	0.078995356	1.334734007	0	0	2.08636862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4344	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	25% Coins	25% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						25% Coins	$0/Proc									6000	4.089	0.0366	0.3429	1.7039	1.5872	0.4442	0.1633	0.2061	1.7482	0.2743	0.6107	0.0182	0.005	0.6043	0.8709	1.2696	0.0144	0.1804		0.4357	0.4944	0			0				0	0	0.0686	0									15.168	500	NO	4.348508	15.8029	0.288085783	0.977911389	1.703939	1.752057062	1.59992694	0.5889325	1.706132634	4.788033787	3.034192175	2.682376648	0.176236933	0.04096026	2.592455659	2.459040593	7.715588988	0.093432356	1.515126007	0	0.435661	2.58078962	0	0	0	0	0	0	0	0	0	0.068639	0	0	0	0	0	0	0	0	0	52.6024
H6609_028_0	2012	9	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	OP Facility - Other							Prosthetics/Supplies	Acute	Mental Health	Renal Dialysis							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	D	D	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	YES	226.56	8.41	356.36	1268.68	21.21	11.87	3.67	337.59	315.54	1102.72	942.31	147.56	0.35	617.86	2970.42	3656.43	93.77	647.12		1600.58	20.24	0		5.58	0.61				5.58	0.95	1115.05	0	0	0.17							3400	$350/Admit: 1a. $350 IP Acute - Facility 1	$350/Admit: 1b. $350 IP Psych - Facility 1	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$25/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0-$25/Visit: 5. $25 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$0-$25/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$0-$25/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Proc: 12. $0 Dialysis -- Dialysis Center									350	350	31.003517	0	0	0.2	0.2	65	50	0	4.319074	21.64081	0.2	0	10	23.384586	25	16.991265		0	0.2	0		0	0				0	0	0	0	0	0							NO	320.0659	320.0659	28.345523	0	0	0.192078	0.192078	62.425285	48.01945	0	4.147991	20.783596	0.192078	0	9.60389	22.458299	24.009725	16.318224		0	0.192078	0		0	0				0	0	0	0	0	0								6.0428	0.224312852	0.841767548	0	0	2.27996586	0.70492626	1.75617933	1.262671438	0	0.32572445	0.255568952	0.0672273	0	2.377298911	6.843099851	0.187615993	0.879987426	0	0	3.88765872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9368	0	NO	1.52412	6.0428	0.224312852	0.841767548	0	0	2.27996586	0.70492626	1.75617933	1.262671438	0	0.32572445	0.255568952	0.0672273	0	2.377298911	6.843099851	0.187615993	0.879987426	0	0	3.88765872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9368	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	25% Coins	$0/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins; $35/Visit	20% Coins	30% Coins; $35/Visit	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	30% Coins		"DEN749: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	$0/Proc							5100	3.3176	0.0581	0.251	1.7187	0	0.9439	0.2914	0.2166	2.0752	0.3235	0.7641	0.0597	0.0084	0.7251	1.1697	1.4398	0.0369	0.2334		0.6303	0.7748	0			0				0	0	0.1253	0.5941	0	0							15.7577	500	NO	7.30834	9.3604	0.282452852	1.092758548	1.718686	0	3.22391186	0.99636326	1.97274333	3.337834438	0.32347	1.08979945	0.315303952	0.0756453	0.725084	3.546998911	8.282936851	0.224541993	1.113401426	0	0.630281	4.66247572	0	0	0	0	0	0	0	0	0	0.125287	0.594125	0.000023	0	0	0	0	0	0	0	43.6946
H6609_029_0	2012	6	r.	s.									OP Facility - Other	OP Facility - Surgery									Other										D	D	D	V	Coin	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V				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	925.16	43.96	373.45	911.87	0.82	9.06	4.31	283.6	34.25	1123.22	805.11	131.55	0.33	5.27	2376.98	3061.68	74.02	563.68		1235.39	16.28	0			0.79				5.18	0.93	467.66	0									3400	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"15%-20% Coins: 9b. 15% Surgery ASC -- Facility,9a. 20% 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,14a. $0 SMAM -- FSR,14a. $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"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$25/Visit: 7b. $15 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"											157.299288	129.289608	49.537808	0	0.2	0.2	0.133704	65	0.190902	37.015003	78.027068	50	0.2	0.2	15	24.087719	25	32.285722		0	0.2	0			0				0	0	77.547162	0									NO	113.160793	93.010685	31.961298	0	0.17202	0.17202	0.114999	55.90637	0.164194	31.83653	67.110925	43.0049	0.17202	0.17202	12.90147	20.717799	21.50245	27.768885		0	0.17202	0			0				0	0	66.698159	0										8.7243	0.340729143	0.994662228	0	0.1410564	1.5585012	0.49564569	1.321253878	5.6236445	2.979952269	4.502639736	0.471441216	0.0567666	0.9065454	2.55554468	5.285939237	0.132634279	1.304397091	0	0	2.8004856	0	0	0	0	0	0	0	0	0	2.59933842	0	0	0	0	0	0	0	0	0	42.7955	0	NO	9.407694	8.7243	0.340729143	0.994662228	0	0.1410564	1.5585012	0.49564569	1.321253878	5.6236445	2.979952269	4.502639736	0.471441216	0.0567666	0.9065454	2.55554468	5.285939237	0.132634279	1.304397091	0	0	2.8004856	0	0	0	0	0	0	0	0	0	2.59933842	0	0	0	0	0	0	0	0	0	42.7955	YES	$0-$250/Day(Days 1-5)	$0-$250/Day(Days 1-5)	"$50/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	25% Coins	20% Coins	35% Coins	35% Coins	$65/Visit	15%-20% Coins	30% Coins; $50/Visit	$0-$150/Visit	$50/Visit	20% Coins	20% Coins	$15/Visit	$15-$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$30-$200/Visit	$0/Visit									4000	3.5627	0.1391	0.5183	2.1801	1.2991	1.6507	0.7845	0.4982	2.141	1.2092	1.7179	0.1863	0.0216	0.3449	1.0092	2.0875	0.0524	0.5047		0	1.1609	0			0				0	0	0.9802	0									22.0488	0	NO	4.518862	12.287	0.479859143	1.512948228	2.180126	1.4401854	3.2092222	1.28012569	1.819502878	7.7646395	4.189189269	6.220564736	0.657784216	0.0783756	1.2514904	3.56478268	7.373461237	0.185016279	1.809047091	0	0	3.9614136	0	0	0	0	0	0	0	0	0	3.57955842	0	0	0	0	0	0	0	0	0	64.8443
H6609_038_0	2012	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			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	1164.7	55.34	470.15	1147.98	24.93	11.37	3.61	357.03	334.75	1414.05	1013.57	165.61	0.4	6.33	2992.44	3854.41	93.19	709.63		1555.26	19.71	0			0.61				4.84	0.93	1350.37	588.74									3400	"$0-$250/Day(Days 1-5): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$200/Visit: 3. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											157.299288	129.289608	49.537808	0	150	0.2	0.2	65	156.262655	37.015003	74.792104	50	0.2	0.2	10	23.631579	25	32.285722		0	0.2	0			0				0	0	0	77.547162									NO	115.30085	94.76967	32.764009	0	131.1273	0.174836	0.174836	56.82183	136.602	32.357849	65.381911	43.7091	0.174836	0.174836	8.74182	20.658301	21.85455	28.223597		0	0.174836	0			0				0	0	0	67.790333										11.1909	0.437046128	1.283666569	0	0.272416966	1.98788532	0.63115796	1.690591497	3.810626625	3.812968032	5.522428628	0.603222004	0.0699344	1.10671188	2.179947653	6.635463496	0.169718793	1.669025928	0	0	3.44601756	0	0	0	0	0	0	0	0	0	0	3.325906721	0	0	0	0	0	0	0	0	49.8456	0	NO	10.20855	11.1909	0.437046128	1.283666569	0	0.272416966	1.98788532	0.63115796	1.690591497	3.810626625	3.812968032	5.522428628	0.603222004	0.0699344	1.10671188	2.179947653	6.635463496	0.169718793	1.669025928	0	0	3.44601756	0	0	0	0	0	0	0	0	0	0	3.325906721	0	0	0	0	0	0	0	0	49.8456	YES	$0-$275/Day(Days 1-5)	$0-$275/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									4500	1.3373	0.0522	0.3377	1.9942	1.7999	0.8397	0.2668	0.1595	1.415	0.2546	0.5825	0.0305	0.0066	0.1054	0.7791	1.5093	0.0185	0.144		0.1674	0.4327	0			0				0	0	0.1323	0.3674									12.7326	0	NO	3.748696	12.5282	0.489271128	1.621364569	1.994236	2.072331966	2.82755032	0.89792296	1.850082497	5.225645625	4.067520032	6.104977628	0.633733004	0.0765384	1.21213088	2.959094653	8.144732496	0.188215793	1.813044928	0	0.167379	3.87873156	0	0	0	0	0	0	0	0	0	0.132273	3.693264721	0	0	0	0	0	0	0	0	62.5783
H6609_051_0	2012	7	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	OP Facility - Other							Prosthetics/Supplies	Acute	Mental Health	Renal Dialysis							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	D	D	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	YES	193.07	5.44	369.73	286.44	14.68	7.46	3.09	258.36	280.71	1145.16	672.44	156.13	0.1	802.77	2375.08	2797.46	79.3	723.72		2409.36	16.08	0			0.61				5.58	0.95	593.13	0	0	0							3400	$350/Admit: 1a. $350 IP Acute - Facility 1	$350/Admit: 1b. $350 IP Psych - Facility 1	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$15/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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-$25/Visit: 5. $25 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 Psych -- Other Provider"	"$0-$25/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Proc: 12. $0 Dialysis -- Dialysis Center									350	350	31.003517	0	0	0.2	0.2	65	0	0	3.668684	18.31985	0.2	0	10	22.852264	25	12.057758		0	0.2	0			0				0	0	0	0	0	0							NO	330.01045	330.01045	29.23765	0	0	0.195712	0.195712	63.606335	0	0	3.590024	17.927054	0.195712	0	9.78559	22.362288	24.463975	11.799228		0	0.195712	0			0				0	0	0	0	0	0								5.3096	0.149604737	0.900836361	0	0	1.46001152	0.60475008	1.369444393	0	0	0.201172978	0.233245912	0.0195712	0	1.936796591	5.213133849	0.161666101	0.711611441	0	0	3.14704896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4185	0	NO	0.715024	5.3096	0.149604737	0.900836361	0	0	1.46001152	0.60475008	1.369444393	0	0	0.201172978	0.233245912	0.0195712	0	1.936796591	5.213133849	0.161666101	0.711611441	0	0	3.14704896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4185	YES	30% Coins	30% Coins	"30% Coins(Days 1-20), 30% (Days 21-100)"	25% Coins	$0/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						20% Coins	30% Coins	30% Coins	$0/Proc							5100	3.4779	0.0433	0.2762	1.214	0	0.7209	0.2985	0.2014	2.5994	0.597	1.0451	0.0621	0.0029	1.018	1.2791	2.3205	0.0378	0.2847		0.7627	0.7269	0			0				0	0	0.0622	0.5776	0	0							17.6081	1000	NO	8.017239	8.7875	0.192934737	1.177021361	1.213964	0	2.18090152	0.90325208	1.570884393	2.599391	0.597037	1.246261978	0.295296912	0.0224552	1.01798	3.215893591	7.533594849	0.199465101	0.996325441	0	0.762696	3.87398996	0	0	0	0	0	0	0	0	0	0.062193	0.577556	0	0	0	0	0	0	0	0	39.0266
H6609_801_0	2012	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	258.04	1.73	29.33	19.8	0.78	11.74	4.32	22.38	80.79	16.87	28.76	0.87	0.15	24.56	40.66	88.63	0.5	9.41		11.19	43.67	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																					0.0811	0.0811	0.1669	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.063881	0.063881	0.110262	0	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799	0.19799		0.19799	0.19799	0																				16.4839	0.11051413	3.23398446	0	0.1544322	2.3244026	0.8553168	4.4310162	15.9956121	3.3400913	5.6941924	0.1722513	0.0296985	4.8626344	8.0502734	17.5478537	0.098995	1.8630859	0	2.2155081	8.6462233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1099	0	NO	16.155694	16.4839	0.11051413	3.23398446	0	0.1544322	2.3244026	0.8553168	4.4310162	15.9956121	3.3400913	5.6941924	0.1722513	0.0296985	4.8626344	8.0502734	17.5478537	0.098995	1.8630859	0	2.2155081	8.6462233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1099	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			10000	2.2142	0.0148	0.4833	0	1.1779	0.5632	0.207	0.4842	1.8218	0.3651	0.6641	0.0209	0.0032	0.5315	1.0427	2.2726	0.0129	0.2264		0.287	1.1196	0																			13.5124	0	NO	1.093304	18.6981	0.12529113	3.71731846	0	1.3323362	2.8876256	1.0623558	4.9152512	17.8174061	3.7052193	6.3582854	0.1931073	0.0328525	5.3941064	9.0929324	19.8204087	0.111851	2.0895289	0	2.5025451	9.7658393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6224
H6609_802_0	2012	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	318.34	2.89	114.12	30.89	1.79	26.21	4.54	32.93	51.5	7.95	20.94	0.56	0.11	17.91	38.78	63.55	0.82	10.81		4.97	23.73	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																					0.0812	0.0812	0.1758	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.05915	0.05915	0.053552	0	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727	0.19727		0.19727	0.19727	0																				18.8298	0.1709435	6.11135424	0	0.3531133	5.1704467	0.8956058	6.4961011	10.159405	1.5682965	4.1308338	0.1104712	0.0216997	3.5331057	7.6501306	12.5365085	0.1617614	2.1324887	0	0.9804319	4.6812171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6937	0	NO	29.242328	18.8298	0.1709435	6.11135424	0	0.3531133	5.1704467	0.8956058	6.4961011	10.159405	1.5682965	4.1308338	0.1104712	0.0216997	3.5331057	7.6501306	12.5365085	0.1617614	2.1324887	0	0.9804319	4.6812171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6937	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	2.557	0.0231	1.1175	0	2.6696	1.2476	0.2162	0.7071	1.16	0.1707	0.4708	0.0138	0.0024	0.3845	0.9868	1.6173	0.0209	0.2664		0.1264	0.604	0																			14.362	0	NO	2.600444	21.3868	0.1940705	7.22885924	0	3.0227373	6.4180497	1.1118058	7.2032081	11.319401	1.7389815	4.6015968	0.1242522	0.0241017	3.9176357	8.6369176	14.1537725	0.1826274	2.3988437	0	1.1068799	5.2851821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0557
H6609_803_0	2012	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	246.93	1.65	28.07	18.94	0.75	11.24	4.13	21.42	77.31	16.15	27.52	0.83	0.14	23.51	38.91	84.82	0.48	9		10.71	41.79	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																					0.0805	0.0805	0.1451	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064749	0.064749	0.102801	0	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808		0.199808	0.199808	0																				15.9885	0.10683585	2.88562407	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6521	0	NO	14.022395	15.9885	0.10683585	2.88562407	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6521	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	2.1301	0.0142	0.4188	0	1.1334	0.5419	0.1992	0.4659	1.7529	0.3513	0.639	0.0201	0.003	0.5114	1.0033	2.1867	0.0124	0.2179		0.2762	1.0773	0																			12.955	0	NO	0.930787	18.1186	0.12105185	3.30437507	0	1.283246	2.78777992	1.02442204	4.74582336	17.20010248	3.5782292	6.13771216	0.18590864	0.03100812	5.20887208	8.77778428	19.13438656	0.10827784	2.016158	0	2.41613368	9.42728032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6072
H6609_805_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				18.94	0.75	11.24	4.13	21.42	77.31	16.15	27.52	0.83	0.14	23.51	38.91	84.82	0.48	9		10.71	41.79	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808		0.199808	0.199808	0																				0	0	0	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6712	0	NO	8.9198	0	0	0	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6712	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	1.1334	0.5419	0.1992	0.4659	1.7529	0.3513	0.639	0.0201	0.003	0.5114	1.0033	2.1867	0.0124	0.2179		0.2762	1.0773	0																			10.3919	0	NO	0.592083869	0	0	0	0	1.283246	2.78777992	1.02442204	4.74582336	17.20010248	3.5782292	6.13771216	0.18590864	0.03100812	5.20887208	8.77778428	19.13438656	0.10827784	2.016158	0	2.41613368	9.42728032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0631
H6609_806_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				31.67	1.84	26.87	4.66	33.76	52.8	8.15	21.47	0.58	0.11	18.36	39.76	65.16	0.84	11.09		5.09	24.33	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366	0.196366		0.196366	0.196366	0																				0	0	0	0	0.36131344	5.27635442	0.91506556	6.62931616	10.3681248	1.6003829	4.21597802	0.11389228	0.02160026	3.60527976	7.80751216	12.79520856	0.16494744	2.17769894	0	0.99950294	4.77758478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8298	0	NO	8.7011	0	0	0	0	0.36131344	5.27635442	0.91506556	6.62931616	10.3681248	1.6003829	4.21597802	0.11389228	0.02160026	3.60527976	7.80751216	12.79520856	0.16494744	2.17769894	0	0.99950294	4.77758478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8298	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	2.7292	1.2754	0.221	0.7229	1.1859	0.1745	0.4813	0.0141	0.0025	0.3931	1.0088	1.6533	0.0213	0.2723		0.1293	0.6174	0																			10.9022	0	NO	0.779141877	0	0	0	0	3.09047744	6.55178142	1.13608656	7.35219316	11.5539918	1.7748749	4.69724002	0.12798028	0.02405626	3.99838676	8.81630716	14.44854156	0.18627944	2.44999494	0	1.12877094	5.39501978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.732
H6609_807_0	2012	4																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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				18.94	0.75	11.24	4.13	21.42	77.31	16.15	27.52	0.83	0.14	23.51	38.91	84.82	0.48	9		10.71	41.79	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808	0.199808		0.199808	0.199808	0																				0	0	0	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6712	0	NO	8.9198	0	0	0	0	0.149856	2.24584192	0.82520704	4.27988736	15.44715648	3.2268992	5.49871616	0.16584064	0.02797312	4.69748608	7.77452928	16.94771456	0.09590784	1.798272	0	2.13994368	8.34997632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6712	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	1.1334	0.5419	0.1992	0.4659	1.7529	0.3513	0.639	0.0201	0.003	0.5114	1.0033	2.1867	0.0124	0.2179		0.2762	1.0773	0																			10.3919	0	NO	0.592083869	0	0	0	0	1.283246	2.78777992	1.02442204	4.74582336	17.20010248	3.5782292	6.13771216	0.18590864	0.03100812	5.20887208	8.77778428	19.13438656	0.10827784	2.016158	0	2.41613368	9.42728032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0631
H6609_808_0	2012	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	257.24	1.72	29.24	19.73	0.78	11.71	4.3	22.31	80.54	16.82	28.67	0.87	0.15	24.49	40.54	88.36	0.5	9.38		11.16	43.53	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																					0.0818	0.0818	0.1684	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064391	0.064391	0.111028	0	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024		0.198024	0.198024	0																				16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	0	NO	16.163422	16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	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	2.2254	0.0149	0.4856	0	1.1744	0.5615	0.2064	0.4828	1.8163	0.364	0.6621	0.0208	0.0031	0.5299	1.0395	2.2657	0.0128	0.2258		0.2862	1.1163	0																			13.4935	0	NO	1.094129	18.7894	0.12560452	3.73202372	0	1.32882372	2.88039204	1.0579202	4.90069544	17.76517296	3.69479468	6.33944708	0.19307388	0.0328476	5.37948176	9.06741796	19.76312764	0.111829	2.08322812	0	2.49612284	9.73623672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4776
H6609_809_0	2012	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	318.07	2.88	114.02	30.87	1.79	26.18	4.54	32.9	51.45	7.94	20.92	0.56	0.11	17.89	38.74	63.5	0.82	10.8		4.96	23.71	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																					0.0815	0.0815	0.1764	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.059332	0.059332	0.053599	0	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258		0.197258	0.197258	0																				18.8717	0.17087616	6.11135798	0	0.35309182	5.16421444	0.89555132	6.4897882	10.1489241	1.56622852	4.12663736	0.11046448	0.02169838	3.52894562	7.64177492	12.525883	0.16175156	2.1303864	0	0.97839968	4.67698718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6747	0	NO	29.321538	18.8717	0.17087616	6.11135798	0	0.35309182	5.16421444	0.89555132	6.4897882	10.1489241	1.56622852	4.12663736	0.11046448	0.02169838	3.52894562	7.64177492	12.525883	0.16175156	2.1303864	0	0.97839968	4.67698718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6747	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	2.5631	0.0232	1.1181	0	2.6672	1.2465	0.216	0.7065	1.1589	0.1705	0.4703	0.0138	0.0024	0.3842	0.9859	1.6158	0.0208	0.2661		0.1263	0.6034	0																			14.359	0	NO	2.608505	21.4348	0.19405816	7.22949098	0	3.02025982	6.41066944	1.11155232	7.1962452	11.3078531	1.73675752	4.59696736	0.12423248	0.02409838	3.91312262	8.62765392	14.141659	0.18259856	2.3964964	0	1.10473068	5.28039618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0337
H6609_810_0	2012	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	257.24	1.72	29.24	19.73	0.78	11.71	4.3	22.31	80.54	16.82	28.67	0.87	0.15	24.49	40.54	88.36	0.5	9.38		11.16	43.53	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																					0.0818	0.0818	0.1684	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064391	0.064391	0.111028	0	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024		0.198024	0.198024	0																				16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	0	NO	16.163422	16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	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	2.2254	0.0149	0.4856	0	1.1744	0.5615	0.2064	0.4828	1.8163	0.364	0.6621	0.0208	0.0031	0.5299	1.0395	2.2657	0.0128	0.2258		0.2862	1.1163	0																			13.4935	0	NO	1.094129	18.7894	0.12560452	3.73202372	0	1.32882372	2.88039204	1.0579202	4.90069544	17.76517296	3.69479468	6.33944708	0.19307388	0.0328476	5.37948176	9.06741796	19.76312764	0.111829	2.08322812	0	2.49612284	9.73623672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4776
H6609_811_0	2012	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	YES				19.73	0.78	11.71	4.3	22.31	80.54	16.82	28.67	0.87	0.15	24.49	40.54	88.36	0.5	9.38		11.16	43.53	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024		0.198024	0.198024	0																				0	0	0	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.063	0	NO	9.9776	0	0	0	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.063	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	1.1744	0.5615	0.2064	0.4828	1.8163	0.364	0.6621	0.0208	0.0031	0.5299	1.0395	2.2657	0.0128	0.2258		0.2862	1.1163	0																			10.7676	0	NO	0.675400389	0	0	0	0	1.32882372	2.88039204	1.0579202	4.90069544	17.76517296	3.69479468	6.33944708	0.19307388	0.0328476	5.37948176	9.06741796	19.76312764	0.111829	2.08322812	0	2.49612284	9.73623672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8306
H6609_812_0	2012	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				30.87	1.79	26.18	4.54	32.9	51.45	7.94	20.92	0.56	0.11	17.89	38.74	63.5	0.82	10.8		4.96	23.71	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258	0.197258		0.197258	0.197258	0																				0	0	0	0	0.35309182	5.16421444	0.89555132	6.4897882	10.1489241	1.56622852	4.12663736	0.11046448	0.02169838	3.52894562	7.64177492	12.525883	0.16175156	2.1303864	0	0.97839968	4.67698718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5207	0	NO	8.2047	0	0	0	0	0.35309182	5.16421444	0.89555132	6.4897882	10.1489241	1.56622852	4.12663736	0.11046448	0.02169838	3.52894562	7.64177492	12.525883	0.16175156	2.1303864	0	0.97839968	4.67698718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5207	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	2.6672	1.2465	0.216	0.7065	1.1589	0.1705	0.4703	0.0138	0.0024	0.3842	0.9859	1.6158	0.0208	0.2661		0.1263	0.6034	0																			10.6546	0	NO	0.729907175	0	0	0	0	3.02025982	6.41066944	1.11155232	7.1962452	11.3078531	1.73675752	4.59696736	0.12423248	0.02409838	3.91312262	8.62765392	14.141659	0.18259856	2.3964964	0	1.10473068	5.28039618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1753
H6609_813_0	2012	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				19.73	0.78	11.71	4.3	22.31	80.54	16.82	28.67	0.87	0.15	24.49	40.54	88.36	0.5	9.38		11.16	43.53	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	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO				0	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024		0.198024	0.198024	0																				0	0	0	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.063	0	NO	9.9776	0	0	0	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.063	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	1.1744	0.5615	0.2064	0.4828	1.8163	0.364	0.6621	0.0208	0.0031	0.5299	1.0395	2.2657	0.0128	0.2258		0.2862	1.1163	0																			10.7676	0	NO	0.675400389	0	0	0	0	1.32882372	2.88039204	1.0579202	4.90069544	17.76517296	3.69479468	6.33944708	0.19307388	0.0328476	5.37948176	9.06741796	19.76312764	0.111829	2.08322812	0	2.49612284	9.73623672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8306
H6609_814_0	2012	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	260.85	1.75	29.65	20.01	0.79	11.87	4.36	22.62	81.67	17.06	29.07	0.88	0.15	24.83	41.11	89.6	0.51	9.51		11.32	44.14	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																					0.0812	0.0812	0.1758	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.063597	0.063597	0.113346	0	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509	0.197509		0.197509	0.197509	0																				16.5893	0.11129475	3.3607089	0	0.15603211	2.34443183	0.86113924	4.46765358	16.13056003	3.36950354	5.74158663	0.17380792	0.02962635	4.90414847	8.11959499	17.6968064	0.10072959	1.87831059	0	2.23580188	8.71804726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9891	0	NO	16.792504	16.5893	0.11129475	3.3607089	0	0.15603211	2.34443183	0.86113924	4.46765358	16.13056003	3.36950354	5.74158663	0.17380792	0.02962635	4.90414847	8.11959499	17.6968064	0.10072959	1.87831059	0	2.23580188	8.71804726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9891	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	2.2326	0.0149	0.5071	0	1.1887	0.5684	0.2089	0.4887	1.8385	0.3685	0.6702	0.021	0.0032	0.5364	1.0522	2.2934	0.013	0.2285		0.2897	1.1299	0																			13.6538	0	NO	1.1457	18.8219	0.12619475	3.8677789	0	1.34475311	2.91282683	1.07007924	4.95633558	17.96908303	3.73798454	6.41177663	0.19485492	0.03280935	5.44050047	9.17182799	19.9902304	0.11370359	2.10683359	0	2.52547488	9.84794426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6429
H6609_815_0	2012	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	257.24	1.72	29.24	19.73	0.78	11.71	4.3	22.31	80.54	16.82	28.67	0.87	0.15	24.49	40.54	88.36	0.5	9.38		11.16	43.53	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																					0.0818	0.0818	0.1684	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064391	0.064391	0.111028	0	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024	0.198024		0.198024	0.198024	0																				16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	0	NO	16.163425	16.5639	0.11075252	3.24645872	0	0.15445872	2.31886104	0.8515032	4.41791544	15.94885296	3.33076368	5.67734808	0.17228088	0.0297036	4.84960776	8.02789296	17.49740064	0.099012	1.85746512	0	2.20994784	8.61998472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9842	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	2.2254	0.0149	0.4856	0	1.1744	0.5615	0.2064	0.4828	1.8163	0.364	0.6621	0.0208	0.0031	0.5299	1.0395	2.2657	0.0128	0.2258		0.2862	1.1163	0																			13.4935	0	NO	1.094127	18.7894	0.12560452	3.73202372	0	1.32882372	2.88039204	1.0579202	4.90069644	17.76517296	3.69479468	6.33944608	0.19307388	0.0328476	5.37948176	9.06741896	19.76312764	0.111829	2.08322812	0	2.49612284	9.73623672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4776
H6622_001_0	2012	4	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		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	1393.46	55.9	485.77	2076.62	152.78	9.43	3.43	355.68	278.54	583.19	1214.67	90.73	0.42	3.29	4151.43	4336.6	85.79	676.32		1860.81	22.69	0		2.79	0.61				5.23	2.42	331.95										3400	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$150/Day(Days 1-10): 1b. $150 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-13), $75 (Days 14-100): 2. $0 SNF - Facility 1,2. $75 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $20 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												122.545317	113.560792	35.638298	0	50	0.2	0.156243	65	100	0	23.860494	28.815628	0.199456	0.2	10	19.763242	20	20		0	0.2	0		0	0				0	0	75.977957										NO	100.701002	93.318013	30.933508	0	45.39745	0.18159	0.141861	59.016685	90.7949	0	21.664112	26.163121	0.181096	0.18159	9.07949	17.944016	18.15898	18.15898		0	0.18159	0		0	0				0	0	68.984111											11.6936	0.434706411	1.252214182	0	0.577985201	1.7123937	0.48658323	1.749254543	2.107500954	0	2.192895577	0.197814997	0.07606032	0.5974311	3.141072264	6.484668315	0.129821575	1.023440113	0	0	4.1202771	0	0	0	0	0	0	0	0	0	1.908272971	0	0	0	0	0	0	0	0	0	39.886	0	NO	5.508664	11.6936	0.434706411	1.252214182	0	0.577985201	1.7123937	0.48658323	1.749254543	2.107500954	0	2.192895577	0.197814997	0.07606032	0.5974311	3.141072264	6.484668315	0.129821575	1.023440113	0	0	4.1202771	0	0	0	0	0	0	0	0	0	1.908272971	0	0	0	0	0	0	0	0	0	39.886	YES	30% Coins	30% Coins	"30% Coins(Days 1-13), 30% (Days 14-100)"	30% Coins	$50/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		"DEN756: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										3400	1.3306	0.0192	0.117	0.8066	0.2619	0.4385	0.1596	0.058	0.35	0.0519	0.1676	0.007	0.0025	0.02	0.233	0.4036	0.0031	0.0333		0.0447	0.1065	0		0	0				0	0	0.0847										4.6996	0	NO	4.204349	13.0242	0.453889411	1.369195182	0.806636	0.839894201	2.1508537	0.64623223	1.807294543	2.457547954	0.051949	2.360504577	0.204778997	0.07858932	0.6174351	3.374114264	6.888271315	0.132968575	1.056778113	0	0.044678	4.2267901	0	0	0	0	0	0	0	0	0	1.992940971	0	0	0	0	0	0	0	0	0	44.5855
H6622_002_0	2012	6	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		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	1423.45	57.11	496.22	2121.32	156.06	10.84	3.95	363.34	284.53	595.74	1240.81	92.69	0.48	3.78	4240.78	4429.94	87.63	690.88		1900.86	26.07	0		2.79	0.61		0.26		5.14	1.24	339.1										3400	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-13), $84 (Days 14-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$50/Trip: 10a. $50 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$50/Visit: 8b, 9a. $20 DMAM -- OP,8b. $20 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$20-$100/Visit: 5. $20 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$20/Visit: 7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit: 7e, 7h. $20 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER834: Hearing 18a, 18b"		$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$20-$100/Visit: 3. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												182.210148	160.008323	39.914893	0	50	0.2	0.156243	65	100	0	23.860494	28.815628	0.199456	0.2	10	19.763242	20	20		0	0.2	0		0	0		0		0	0	75.977958										NO	134.824759	118.396718	31.463314	0	44.09015	0.176361	0.137776	57.317195	88.1803	0	21.040255	25.409708	0.175881	0.176361	8.81803	17.427286	17.63606	17.63606		0	0.176361	0		0	0		0		0	0	66.997591											15.993	0.563469714	1.301060473	0	0.573392401	1.91175324	0.5442152	1.735469136	2.090828397	0	2.175579901	0.19626882	0.08442288	0.66664458	3.116277105	6.433485945	0.128787328	1.015366761	0	0	4.59773127	0	0	0	0	0	0	0	0	0	1.893240259	0	0	0	0	0	0	0	0	0	45.021	0	NO	9.809193	15.993	0.563469714	1.301060473	0	0.573392401	1.91175324	0.5442152	1.735469136	2.090828397	0	2.175579901	0.19626882	0.08442288	0.66664458	3.116277105	6.433485945	0.128787328	1.015366761	0	0	4.59773127	0	0	0	0	0	0	0	0	0	1.893240259	0	0	0	0	0	0	0	0	0	45.021	YES	30% Coins	30% Coins	"30% Coins(Days 1-13), 30% (Days 14-100)"	30% Coins	$50/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		"DEN756: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										3400	1.3357	0.0193	0.1137	0.8855	0.2557	0.4813	0.1753	0.0567	0.3843	0.057	0.184	0.0076	0.0028	0.022	0.2558	0.4431	0.0035	0.0366		0.049	0.1169	0		0	0		0		0	0	0.0929										4.9785	0	NO	5.190563	17.3288	0.582725714	1.414740473	0.88548	0.829044401	2.39307024	0.7194692	1.792122136	2.475091397	0.057026	2.359571901	0.20391382	0.08719888	0.68860358	3.372098105	6.876538945	0.132241328	1.051962761	0	0.049044	4.71465627	0	0	0	0	0	0	0	0	0	1.986183259	0	0	0	0	0	0	0	0	0	49.9995
H6622_003_0	2012	5	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			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	1393.25	55.9	485.7	2311.85	231.5	11.25	4.1	350.62	274.58	574.9	1195	90.58	0.42	3.34	4035.86	4215.89	83.4	659.38		1809.01	22.74	0			0.6				5.23	1.24	327.23										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-13), $100 (Days 14-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												163.989133	144.00749	47.51773	0	100	0.2	0.156243	65	109.202935	35.394484	20.600286	42.07283	0.199456	0.2	5	34.289725	35	38.102071		0	0.2	0			0				0	0	77.092432										NO	128.943507	113.232082	38.768243	0	88.9505	0.177901	0.138979	57.817825	97.136556	31.48357	18.324057	37.423993	0.177417	0.177901	4.447525	30.500882	31.132675	33.891983		0	0.177901	0			0				0	0	68.574104											14.9709	0.527472782	1.569144635	0	1.716003396	2.00138625	0.5698139	1.689340483	2.222646296	1.508325366	1.824770676	0.282488774	0.07451514	0.59418934	1.495799021	10.71569695	0.216372091	1.862307979	0	0	4.04546874	0	0	0	0	0	0	0	0	0	1.869958671	0	0	0	0	0	0	0	0	0	49.7566	0	NO	8.627117	14.9709	0.527472782	1.569144635	0	1.716003396	2.00138625	0.5698139	1.689340483	2.222646296	1.508325366	1.824770676	0.282488774	0.07451514	0.59418934	1.495799021	10.71569695	0.216372091	1.862307979	0	0	4.04546874	0	0	0	0	0	0	0	0	0	1.869958671	0	0	0	0	0	0	0	0	0	49.7566	NO																																																																																		0	0	NO	0	14.9709	0.527472782	1.569144635	0	1.716003396	2.00138625	0.5698139	1.689340483	2.222646296	1.508325366	1.824770676	0.282488774	0.07451514	0.59418934	1.495799021	10.71569695	0.216372091	1.862307979	0	0	4.04546874	0	0	0	0	0	0	0	0	0	1.869958671	0	0	0	0	0	0	0	0	0	49.7566
H6622_801_0	2012	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	209.98	2.44	37.48	20.87	7.17	11.61	3.53	20.23	53.78	7.25	24.96	0.55	0.4	15.72	31.95	80.15	0.55	6.33		12.99	27.72	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																					0.0856	0.0856	0.1654	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07488	0.07488	0.138823	0	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976		0.204976	0.204976	0																				15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	0	NO	9.073067	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	NO																																																																																		0	0	NO	0	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042
H6622_802_0	2012	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	209.98	2.44	37.48	20.87	7.17	11.61	3.53	20.23	53.78	7.25	24.96	0.55	0.4	15.72	31.95	80.15	0.55	6.33		12.99	27.72	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																					0.0856	0.0856	0.1654	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07488	0.07488	0.138823	0	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976		0.204976	0.204976	0																				15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	0	NO	9.073067	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	NO																																																																																		0	0	NO	0	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042
H6622_803_0	2012	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	209.98	2.44	37.48	20.87	7.17	11.61	3.53	20.23	53.78	7.25	24.96	0.55	0.4	15.72	31.95	80.15	0.55	6.33		12.99	27.72	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																					0.0856	0.0856	0.1654	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07488	0.07488	0.138823	0	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976	0.204976		0.204976	0.204976	0																				15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	0	NO	9.073067	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042	NO																																																																																		0	0	NO	0	15.7233	0.1827072	5.20308604	0	1.46967792	2.37977136	0.72356528	4.14666448	11.02360928	1.486076	5.11620096	0.1127368	0.0819904	3.22222272	6.5489832	16.4288264	0.1127368	1.29749808	0	2.66263824	5.68193472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6042
H6642_001_0	2012	5																															D	D	D		T	Coin	Coin	V	Coin		P	V	Coin	Coin		V	V	V	P	Coin	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	1089.557245	6.250171154	534.0195335	0	156.7546951	5.821924247	3.382564992	332.3603612	49.23301076	0	110.9057622	1.15522178	0.354507392	21.66381968	0	6533.347071	89.6420979	164.9483164	141.9424651	6.507261693	24.64423847	4.602622847	0	2925	0	150.9779858	72.46892889	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 Ambulatory Surgical Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Service or 0-25% Coinsurance for OP Rad; 20% Coinsurance for OP Therapeutic Radiological Services PBP 8b	$200/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit or 25% Coinsurance for Cardiac Rehab; $30/Visit or 25% Coinsurance for Pulmonary Rehabilitation Services; $30/Visit or 25% Coinsurance for CORF;  25% Coinsurance for OP - Other; $30/Visit Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $10-$30/Visit for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 or 25% Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	"$10/Other, $250 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	200	200	100	0	125	0.2	0.2	48.58829413	0.229543582	0	194.6949008	200	0.2	0.226442585	0	28.87514638	29.81764461	60.69781297	56.88808896	0.255661181	0.095084555	0.2	0	4	0	20	10	0	0	0											NO	171.7107212	171.7107212	85.85536062	0	107.3192008	0.171710721	0.171710721	41.71565514	0.19707547	0	167.1560092	171.7107212	0.171710721	0.194413098	0	24.79086105	25.6000463	52.11232622	48.84147393	0.219498829	0.081635187	0.171710721	0	4	0	20	10	0	0	0												15.5907	0.089435116	3.820703302	0	1.40189905	0.999686811	0.580822674	1.155385851	9.702618758	0	1.544880384	0.01653033	0.06087272	4.211730297	0	13.49727495	0.191236821	0.71632004	0.577723267	1.428336321	2.011837026	0.790319689	0	0.975	0	0.251629976	0.060390774	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6754	0	NO	9.619456935	15.5907	0.089435116	3.820703302	0	1.40189905	0.999686811	0.580822674	1.155385851	9.702618758	0	1.544880384	0.01653033	0.06087272	4.211730297	0	13.49727495	0.191236821	0.71632004	0.577723267	1.428336321	2.011837026	0.790319689	0	0.975	0	0.251629976	0.060390774	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6754	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	15.5907	0.089435116	3.820703302	0	1.40189905	0.999686811	0.580822674	1.155385851	9.702618758	0	1.544880384	0.01653033	0.06087272	4.211730297	0	13.49727495	0.191236821	0.71632004	0.577723267	1.428336321	2.011837026	0.790319689	0	0.975	0	0.251629976	0.060390774	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6754
H6642_004_0	2012	2																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	Coin	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	674.3093347	12.15996681	620.5170263	0	173.7294404	9.520209985	6.027600432	206.6893356	43.67424761	0	111.1342893	0	0.388077034	22.91512883	0	3970.15787	103.1200665	3.75E-06	97.52721322	13.57638064	41.72851514	9.925017278	0	2925	0	303.8150757	147.3827631	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 Ambulatory Surgical Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Service or 0-25% Coinsurance for OP Rad; 20% Coinsurance for OP Therapeutic Radiological Services PBP 8b	$200/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit or 25% Coinsurance for Cardiac Rehab; $30/Visit or 25% Coinsurance for Pulmonary Rehabilitation Services; $30/Visit or 25% Coinsurance for CORF;  25% Coinsurance for OP - Other; $30/Visit Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $10-$30/Visit for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 or 25% Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	"$10/Other, $100 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	200	200	100	0	125	0.2	0.2	45.38214023	0.249999999	0	100	0	0.2	0.204906813	0	28.15048439	30	60.69781297	99.99999099	0.255250241	0.06495098	0.2	0	4	0	20	10	0	0	0											NO	177.5749001	177.5749001	88.78745005	0	110.9843126	0.1775749	0.1775749	40.29364509	0.221968625	0	88.78745005	0	0.1775749	0.181931535	0	24.99409727	26.63623502	53.89204038	88.78744206	0.22663018	0.057668319	0.1775749	0	4	0	20	10	0	0	0												9.9784	0.179942074	4.59117704	0	1.60677021	1.690550337	1.070350545	0.694022228	9.694312674	0	0.822277513	0	0.068912741	4.168984554	0	8.269209331	0.228894194	1.69E-08	0.721599316	3.076817588	2.406413325	1.762433952	0	0.975	0	0.50635846	0.122818969	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6352	0	NO	6.444469714	9.9784	0.179942074	4.59117704	0	1.60677021	1.690550337	1.070350545	0.694022228	9.694312674	0	0.822277513	0	0.068912741	4.168984554	0	8.269209331	0.228894194	1.69E-08	0.721599316	3.076817588	2.406413325	1.762433952	0	0.975	0	0.50635846	0.122818969	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6352	NO																																										0	0	0	0	0	0	0	0	0	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	9.9784	0.179942074	4.59117704	0	1.60677021	1.690550337	1.070350545	0.694022228	9.694312674	0	0.822277513	0	0.068912741	4.168984554	0	8.269209331	0.228894194	1.69E-08	0.721599316	3.076817588	2.406413325	1.762433952	0	0.975	0	0.50635846	0.122818969	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6352
H6642_007_0	2012	5																															D	D	D		T	Coin	Coin	V	P		P	V	Coin	V		V	V	V	P	V	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	2900.993646	3.310333507	1344.024588	0	4.19552692	2.087315754	1.688184267	431.8594263	322.9640925	0	76.25583226	0.627951491	0.038773542	389.880424	0	6012.237124	66.57633959	485.4804336	402.0301972	0	26.54595119	0	0	2925.329951	0	16.08140171	0.908126214	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	$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 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"	"$100/Visit for OP Fac - Surgery; $25/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Service or 0-25% Coinsurance for OP Rad; 20% Coinsurance for OP Therapeutic Radiological Services PBP 8b	$100/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit or 25% Coinsurance for Cardiac Rehab; $30/Visit or 25% Coinsurance for Pulmonary Rehabilitation Services; $30/Visit or 25% Coinsurance for CORF; $100/Visit for OP - Other; $30/Visit Coinsurance for OP Substance Abuse; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $10-$30/Visit for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 or 25% Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"No Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	100	100	75	0	100	0.2	0.2	48.47663012	58.79227817	0	166.0487772	100	0.2	97.14244995	0	29.76073005	30	60.69781297	54.07177946	0	0.2	0	0	4	0	20	10	0	0	0											NO	86.79704979	86.79704979	65.09778734	0	86.79704979	0.1735941	0.1735941	42.07628478	51.02996296	0	144.1254398	86.79704979	0.1735941	84.31678066	0	25.83143568	26.03911494	52.68391095	46.93270935	0	0.1735941	0	0	4	0	20	10	0	0	0												20.9831	0.023943932	7.29108557	0	0.030346613	0.362345699	0.293058828	1.514253351	1.373403806	0	0.915867114	0.004542028	0.006730858	2.739455183	0	12.94205971	0.144465747	2.131417328	1.572363866	0	4.608220495	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9394	0	NO	8.660806209	20.9831	0.023943932	7.29108557	0	0.030346613	0.362345699	0.293058828	1.514253351	1.373403806	0	0.915867114	0.004542028	0.006730858	2.739455183	0	12.94205971	0.144465747	2.131417328	1.572363866	0	4.608220495	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9394	NO																																										0	0	0	0	0	0	0	0	0	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	20.9831	0.023943932	7.29108557	0	0.030346613	0.362345699	0.293058828	1.514253351	1.373403806	0	0.915867114	0.004542028	0.006730858	2.739455183	0	12.94205971	0.144465747	2.131417328	1.572363866	0	4.608220495	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9394
H6642_008_0	2012	4																																																						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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2925	0	303.8151061	182.7371168	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; PBP 5	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 9a, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"No Cost-Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 8b, 14a"	"No Cost-Sharing; PBP 7d, 7g, 14a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost-Sharing; PBP 10b	"$0 Oral Exam; $0 Routine Cleaning 2/year; $0 Fluoride; $0-$75 Dental X-Ray; PBP 16a, 16b"	No Cost Sharing; PBP 17a	"$10/Other, $250 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Exam for Routine Hearing Test (non-cvd); PBP 18a	$0 copay; $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	20	10	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	20	10	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975	0	0.50635851	0.152280931	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6336	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	0.975	0	0.50635851	0.152280931	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6336	NO																																										0	0	0	0	0	0	0	0	0	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	0.975	0	0.50635851	0.152280931	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6336
H6705_001_0	2012	5																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V		P	Coin	Coin	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	705.7338086	12.79612554	608.2392328	0	175.5838409	8.070727314	5.116258008	214.5178604	40.0852485	0	104.9328733	0	0.345240756	19.47074111	3900.995592	4058.629981	107.2638116	0	100.6448093	12.30248003	39.25774771	9.51797487	0	2925	0	303.9559733	150.3928636	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 Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Procedure or 0%-25% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$200/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30 in facility, 25% in Outpatient Hospital/Visit for Cardiac Rehab; $30 in facility, 25% in Outpatient Hospital/Visit for Pulmonary Rehabilitation Services; $30 in facility, 25% in Outpatient Hospital, CMS Cap/Visit for CORF; 25% Coinsurance for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Diabetic Footcare; $10-$30/Visit for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 25% in Outpatient Hospital/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$5-$30/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0  Oral Exams, $0 Routine Cleanings, $0 Fluoride;  $0-$75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year; PBP 17a"	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Visit for Routine Hearing/Speech Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	"No Cost-Sharing; PBP 13a-c, 14b"											0	NO	200	200	100	0	125	0.2	0.2	45.46161459	0.25	0	100	0	0.2	0.222011711	5	28.13617824	30	0	100	0.257221455	0.063798907	0.2	0	4	0	20	10	0	0	0											NO	179.096105	179.096105	89.54805251	0	111.9350656	0.179096105	0.179096105	40.7099905	0.223870131	0	89.54805251	0	0.179096105	0.198807163	4.477402625	25.19539967	26.86441575	0	89.54805251	0.230336804	0.057130679	0.179096105	0	4	0	20	10	0	0	0												10.5328	0.19097802	4.538886563	0	1.637832396	1.445435827	0.916301882	0.727751672	8.973889843	0	0.783044537	0	0.061831275	3.87092281	1.455527325	8.521567038	0.240131636	0	0.751045556	2.833713927	2.242821765	1.704632227	0	0.975	0	0.506593289	0.125327386	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0361	0	NO	6.002753706	10.5328	0.19097802	4.538886563	0	1.637832396	1.445435827	0.916301882	0.727751672	8.973889843	0	0.783044537	0	0.061831275	3.87092281	1.455527325	8.521567038	0.240131636	0	0.751045556	2.833713927	2.242821765	1.704632227	0	0.975	0	0.506593289	0.125327386	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0361	NO																																										0	0	0	0	0	0	0	0	0	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	10.5328	0.19097802	4.538886563	0	1.637832396	1.445435827	0.916301882	0.727751672	8.973889843	0	0.783044537	0	0.061831275	3.87092281	1.455527325	8.521567038	0.240131636	0	0.751045556	2.833713927	2.242821765	1.704632227	0	0.975	0	0.506593289	0.125327386	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0361
H6705_003_0	2012	5																															D	D	D		T	Coin	Coin	V	P		P	V	Coin	V	V	V	V	V	P	V	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	2866.188412	3.270617138	1317.417814	0	4.156489968	1.681520258	1.373226465	429.4846603	318.3070243	0	75.83650656	0.619568177	0.033519439	384.9257048	4296.142585	6024.753358	66.71566245	482.8150058	399.8194601	0	22.44745912	0	0	2925.329951	0	16.08140171	0.908126214	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 Urgent Care; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery, $75/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-$100/Procedure or 0%-25% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$150/Day for Partial Hospitalization; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25 in facility, 25% in Outpatient Hospital/Visit for Cardiac Rehab; $25 in facility, 25% in Outpatient Hospital/Visit for Pulmonary Rehabilitation Services; $25 in facility, 25% in Outpatient Hospital/Visit for CORF; $150 for OP - Other; $25/Visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$20/Visit for Chiro (cvd); $25/Visit for SCP OV; $25/Visit for SCP - Other; $25/Visit for Podiatry; $25/Visit for Diabetic Footcare; $10-$25/Visit for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 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 in facility, 25% in Outpatient Hospital/Visit Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Phys Theraputic Radiological Services; PBP 8b, 14a"	"$5-$25/Service for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Rx; PBP 15	"20% Coinsurance for Misc Medical; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$0  Oral Exams, $0 Routine Cleanings, $0 Fluoride;  $0-$75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year; PBP 17a"	"$10/Other, $200 Every Year for Glasses/Contacts (non-cvd); PBP 17b"	$10/Visit for Routine Hearing/Speech Exams; PBP 18a	$0 copay; $250 limit 1 per year for Hearing Aids (non-cvd); PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	150	150	75	0	125	0.2	0.2	48.47663012	108.8371889	0	152.0912321	150	0.2	143.5297682	5	24.85239553	25	60.19781297	45.11186624	0	0.2	0	0	4	0	20	10	0	0	0											NO	125.1186589	125.1186589	62.55932946	0	104.2655491	0.166824879	0.166824879	40.43553966	90.78375413	0	126.8630066	125.1186589	0.166824879	119.7216807	4.170621964	20.72998933	20.85310982	50.21246419	37.62890803	0	0.166824879	0	0	4	0	20	10	0	0	0												29.8845	0.034101269	6.868064586	0	0.036114892	0.280519413	0.229088338	1.447203668	2.408092219	0	0.801737269	0.006459962	0.005591876	3.840329361	1.493132219	10.40775607	0.115935753	2.020277599	1.253730808	0	3.744794641	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8801	0	NO	12.90164674	29.8845	0.034101269	6.868064586	0	0.036114892	0.280519413	0.229088338	1.447203668	2.408092219	0	0.801737269	0.006459962	0.005591876	3.840329361	1.493132219	10.40775607	0.115935753	2.020277599	1.253730808	0	3.744794641	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8801	NO																																										0	0	0	0	0	0	0	0	0	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	29.8845	0.034101269	6.868064586	0	0.036114892	0.280519413	0.229088338	1.447203668	2.408092219	0	0.801737269	0.006459962	0.005591876	3.840329361	1.493132219	10.40775607	0.115935753	2.020277599	1.253730808	0	3.744794641	0	0	0.975109984	0	0.026802336	0.000756772	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8801
H6743_001_0	2012	8																															D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0.524230654	0.547498197	0.253623231	0.7209826	1.524673709	0.420339193	0.593847549	0	0	1.34142941	1.421059617	1.819158667	0.064322278	0.105227576	0.675044089	2.182278253	0.838156891	0.02791491	0	0	0	0	0	0	0	0											13.0598	YES	547.5532326	1.122710277	525.5053101	11.72666762	11.22870666	11.7270835	1.937252872	269.8343042	32.65759774	9.003413771	12.71985886		0	28.73261459	3256.235241	28.16196184	1.37774467	2.253911657	14.4590401	34.5597489	14.46470347	0	0	0	0	0	0	0	0	0											3400	$275/day (Days 1-7)	$250/day (Days 1-7)	$65/day (Days 1-100)	15% Coin HHC	20% Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	15% Coin Lab/15% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		20% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$35 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$45 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/$45 Copay Preventive Dental/$45 Copay Preventive Dental/$45 Copay Medicare Covered Vision Exams/$45 Copay Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$65 ER Waived/20% Coin Other/15% Coin Lab/20% Coin Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											150	YES	275	250	65	0.15	0.2	0.2	0.2	64.82437353	0.2	0.15	0.2	0	0	0.2	35	0.331823396	0.2	0.2	0.2	0.190033989	0.2	0	0	0	0	0	0	0	0	0											NO	255.1885552	231.9895956	60.31729486	0.139193757	0.185591676	0.185591676	0.185591676	60.1543208	0.185591676	0.139193757	0.185591676	0	0	0.185591676	32.47854339	0.307918302	0.185591676	0.185591676	0.185591676	0.176343633	0.185591676	0	0	0	0	0	0	0	0	0												11.6441	0.021704759	2.641421561	1.632278928	2.083954493	2.176449087	0.359538008	1.352641608	6.060978314	1.253218992	2.36069993	0	0	5.332534112	8.813148129	8.671583467	0.255697943	0.418307243	2.683477492	6.094391667	2.684528566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5407			5.165853524	11.6441	0.021704759	2.641421561	1.632278928	2.608185147	2.723947284	0.61316124	2.073624208	7.585652023	1.673558185	2.954547479	0	0	6.673963522	10.23420775	10.49074213	0.320020221	0.523534819	3.358521581	8.276669919	3.522685457	0.02791491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.6005	YES	$375/day (Days 1-7)	$375/day (Days 1-7)	$100/day (Days 1-100)	20% Coin HHC	20% Ambul	30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	30% Coin OP Hosp & Surg/30% Coin ASC	25% Coin Lab/25% Coin Lab	30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad		30% Coin Dialysis	30% Coin CORF/30% Coin Partial Hospitalization/30% Coin Rad/30% Coin OP Hosp & Surg/30% Coin OP Substance Abuse/30% Coin Cardiac Rehab/30% Coin PT & ST	$40 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$50 Copay Specialists/30% Coin Podiatry/30% Coin Psychiatric/$50 Copay Preventive Dental/$50 Copay Preventive Dental/$50 Copay Medicare Covered Vision Exams/$50 Copay Medicare Covered Hearing Exams	30% Coin Mental Health	30% Coin OT	30% Coin Rad	$65 ER Waived/30% Coin Other/25% Coin Lab/30% Coin Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	30% Coin Part B Rx - Chemo/30% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											5100	3.7432	0.0077	0.5838	0	0	0.8229	0.1359	0	0.6458	0.1347	0.2283	0	0	0.5158	1.8785	1.8061	0.0715	0.117	0.7507	1.7347	0.0528	0	0	0	0	0	0	0	0	0											13.2294			1.027066744	15.3873	0.029404759	3.225221561	1.632278928	2.608185147	3.546847284	0.74906124	2.073624208	8.231452023	1.808258185	3.182847479	0	0	7.189763522	12.11270775	12.29684213	0.391520221	0.640534819	4.109221581	10.01136992	3.575485457	0.02791491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8299
H6743_002_0	2012	7																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	Coin	V	V	Coin	V	Coin				V																0	0	0	0	0.364961865	0.381160395	0.176568857	0	1.072070535	0.292634119	0.416249713	0	0	0.942723736	1.174003483	1.248208492	0.04336875	0.0709488	0.459694176	1.471382595	0.565120172	0.018821391	0	0	0.071939187	0	0	0	0	0											8.7699	YES	665.2426114	1.364022111	611.150126	14.08169708	112.9308252	14.3584866	2.371946904	328.461628	164.647215	0	15.68031726		0	11.68827788	3937.682431	33.95375154	112.5746264	453.7368028	17.3168901	234.8431363	17.15215133	0	0	0	200.7837606	0	0	0	0	0											3400	$200/day (Days 1-8)	$200/day (Days 1-8)	$50/day (Days 1-100)	10% Coin HHC	$200 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$200 Copay OP Hosp & Surg/$200 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		20% Coin Dialysis	$30 Copay CORF/$30 Copay Partial Hospitalization/15% Coin Rad/$200 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay PT & ST	$25 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Psychiatric/$30 Copay Preventive Dental/$30 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health	$30 Copay OT	15% Coin Rad	$65 ER Waived/$30 Copay Other/$0 Copay Lab/$30 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											100	YES	200	200	50	0.1	200	0.2	0.2	64.82437353	200	0	0.15	0	0	0.24485094	25	0.229731835	30	30	0.15	30	0.2	0	0	0	30	0	0	0	0	0											NO	191.7505974	191.7505974	47.93764934	0.095875299	191.7505974	0.191750597	0.191750597	62.15056173	191.7505974	0	0.143812948	0	0	0.23475157	23.96882467	0.220256083	28.7625896	28.7625896	0.143812948	28.7625896	0.191750597	0	0	0	28.7625896	0	0	0	0	0												10.6301	0.021796005	2.441425036	1.350086913	1.804546099	2.753248383	0.454822236	1.701172891	2.630933485	0	2.255032651	0	0	2.743841579	7.865134983	7.478520331	0.269828148	1.087553787	2.490393016	0.562891396	3.288935263	0	0	0	0.481255075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3115			2.250519211	10.6301	0.021796005	2.441425036	1.350086913	2.169507964	3.134408778	0.631391093	1.701172891	3.70300402	0.292634119	2.671282364	0	0	3.686565315	9.039138467	8.726728823	0.313196898	1.158502588	2.950087192	2.03427399	3.854055435	0.018821391	0	0	0.553194262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0813	YES	$325/day (Days 1-8)	$325/day (Days 1-8)	$75/day (Days 1-100)	20% Coin HHC	$200 Ambul Waived	30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$325 Copay OP Hosp & Surg/$325 Copay ASC	$0 Copay Lab/$0 Copay Lab	30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad		30% Coin Dialysis	$40 Copay CORF/$40 Copay Partial Hospitalization/30% Coin Rad/$325 Copay OP Hosp & Surg/$40 Copay OP Substance Abuse/$40 Copay Cardiac Rehab/$40 Copay PT & ST	$30 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$40 Copay Specialists/$40 Copay Podiatry/$40 Copay Psychiatric/$40 Copay Preventive Dental/$40 Copay Preventive Dental/$40 Copay Medicare Covered Vision Exams/$40 Copay Medicare Covered Hearing Exams	$40 Copay Mental Health	$40 Copay OT	30% Coin Rad	$65 ER Waived/$40 Copay Other/$0 Copay Lab/$40 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	30% Coin Part B Rx - Chemo/30% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$40 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											5100	4.0722	0.0083	0.5261	0	0	1.0209	0.1687	0	0.2979	0	0.2852	0	0	0.289	1.7264	1.8063	0.0658	0.2652	0.9111	0.1373	0.0634	0	0	0	0.071	0	0	0	0	0											11.7148			0.503987713	14.7023	0.030096005	2.967525036	1.350086913	2.169507964	4.155308778	0.800091093	1.701172891	4.00090402	0.292634119	2.956482364	0	0	3.975565315	10.76553847	10.53302882	0.378996898	1.423702588	3.861187192	2.17157399	3.917455435	0.018821391	0	0	0.624194262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7961
H6743_003_0	2012	10																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	Coin	V	V	Coin	V	Coin				V																0	0	0	0	0.365095125	0.381299569	0.176633328	0	1.072461983	0.292740969	0.416401699	0	0	0.943067956	1.172477275	1.248664254	0.043384585	0.070974706	0.459862026	1.471919845	0.565326516	0.018828264	0	0	0.070718115	0	0	0	0	0											8.7699	YES	676.976283	1.388080984	621.9297043	14.33007264	114.9745021	14.61832803	2.41487135	334.2550946	167.6267886	0	15.96407949		0	11.8997973	4008.941545	34.56820288	114.6118573	461.9479481	17.63026891	239.0930254	17.46254891	0	0	0	200.8742303	0	0	0	0	0											3400	$200/day (Days 1-8)	$200/day (Days 1-8)	$50/day (Days 1-100)	10% Coin HHC	$200 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$200 Copay OP Hosp & Surg/$200 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		20% Coin Dialysis	$30 Copay CORF/$30 Copay Partial Hospitalization/15% Coin Rad/$200 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay PT & ST	$25 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Psychiatric/$30 Copay Preventive Dental/$30 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health	$30 Copay OT	15% Coin Rad	$65 ER Waived/$30 Copay Other/$0 Copay Lab/$30 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											100	YES	200	200	50	0.1	200	0.2	0.2	64.82437353	200	0	0.15	0	0	0.24485094	25	0.229731835	30	30	0.15	30	0.2	0	0	0	30	0	0	0	0	0											NO	191.7505974	191.7505974	47.93764934	0.095875299	191.7505974	0.191750597	0.191750597	62.15056173	191.7505974	0	0.143812948	0	0	0.23475157	23.96882467	0.220256083	28.7625896	28.7625896	0.143812948	28.7625896	0.191750597	0	0	0	28.7625896	0	0	0	0	0												10.8176	0.022180446	2.48448734	1.373899995	1.837202454	2.803073132	0.463053024	1.731178491	2.678544737	0	2.295841333	0	0	2.793496096	8.007468084	7.613856977	0.274711151	1.107234938	2.535460947	0.573077881	3.348454185	0	0	0	0.481471921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2422			2.290562385	10.8176	0.022180446	2.48448734	1.373899995	2.202297579	3.184372701	0.639686352	1.731178491	3.75100672	0.292740969	2.712243032	0	0	3.736564052	9.179945359	8.862521231	0.318095737	1.178209643	2.995322973	2.044997725	3.913780701	0.018828264	0	0	0.552190036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0121	YES	$325/day (Days 1-8)	$325/day (Days 1-8)	$75/day (Days 1-100)	20% Coin HHC	$200 Ambul Waived	30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$325 Copay OP Hosp & Surg/$325 Copay ASC	$0 Copay Lab/$0 Copay Lab	30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad		30% Coin Dialysis	$40 Copay CORF/$40 Copay Partial Hospitalization/30% Coin Rad/$325 Copay OP Hosp & Surg/$40 Copay OP Substance Abuse/$40 Copay Cardiac Rehab/$40 Copay PT & ST	$30 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$40 Copay Specialists/$40 Copay Podiatry/$40 Copay Psychiatric/$40 Copay Preventive Dental/$40 Copay Preventive Dental/$40 Copay Medicare Covered Vision Exams/$40 Copay Medicare Covered Hearing Exams	$40 Copay Mental Health	$40 Copay OT	30% Coin Rad	$65 ER Waived/$40 Copay Other/$0 Copay Lab/$40 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	30% Coin Part B Rx - Chemo/30% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$40 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											5100	4.144	0.0085	0.5354	0	0	1.0389	0.1716	0	0.3031	0	0.2902	0	0	0.294	1.7568	1.8382	0.067	0.2699	0.9271	0.1397	0.0646	0	0	0	0.071	0	0	0	0	0											11.92			0.512823242	14.9616	0.030680446	3.01988734	1.373899995	2.202297579	4.223272701	0.811286352	1.731178491	4.05410672	0.292740969	3.002443032	0	0	4.030564052	10.93674536	10.70072123	0.385095737	1.448109643	3.922422973	2.184697725	3.978380701	0.018828264	0	0	0.623190036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9321
H6743_004_0	2012	8																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	Coin	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	0	0											0	YES	786.9325294	1.613536703	722.9451424	16.65760027	137.135014	17.52308561	2.88032051	388.5456753	199.9356517	0	19.04104149		0	14.19339802	4828.059974	41.57067261	136.702472	550.9851072	21.028377	285.1764939	20.82833017	0	0	100	206.1137664	0	0	0	0	0.2557											2000	$200/day (Days 1-8)	$200/day (Days 1-8)	$50/day (Days 1-100)	10% Coin HHC	$100 Ambul Waived	15% Coin DME	15% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$200 Copay OP Hosp & Surg/$200 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		15% Coin Dialysis	$25 Copay CORF/$25 Copay Partial Hospitalization/15% Coin Rad/$200 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Psychiatric/$25 Copay Preventive Dental/$25 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health	$25 Copay OT	15% Coin Rad	$65 ER Waived/$25 Copay Other/$0 Copay Lab/$25 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	$25 Copay/ $250 Benefit	$25 Copay Non-Covered Vision Exams	$150 Vision Hardware Coverage	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	50% Coin Supp Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													200	200	50	0.1	100	0.15	0.15	64.82437353	200	0	0.15	0	0	0.237409604	20	0.192842351	25	25	0.15	25	0.15	0	0	25	25	0	0	0	0	0.5											NO	187.1693459	187.1693459	46.79233646	0.093584673	93.58467293	0.140377009	0.140377009	60.66567794	187.1693459	0	0.140377009	0	0	0.222179001	18.71693459	0.180470883	23.39616823	23.39616823	0.140377009	23.39616823	0.140377009	0	0	23.39616823	23.39616823	0	0	0	0	0.467923365												12.2741	0.025167051	2.819024362	1.558896073	1.069477953	2.459838353	0.404330779	1.964282234	3.118485429	0	2.67292446	0	0	3.153474996	7.530540226	7.502296003	0.266526169	1.074245022	2.951900675	0.556003102	2.923818699	0	0	0.194968069	0.401856029	0	0	0	0	0.119648004	0	0	0	0	0	0	0	0	0	0	55.0418	0	NO	3.773175683	12.2741	0.025167051	2.819024362	1.558896073	1.069477953	2.459838353	0.404330779	1.964282234	3.118485429	0	2.67292446	0	0	3.153474996	7.530540226	7.502296003	0.266526169	1.074245022	2.951900675	0.556003102	2.923818699	0	0	0.194968069	0.401856029	0	0	0	0	0.119648004	0	0	0	0	0	0	0	0	0	0	55.0418	YES	$325/day (Days 1-8)	$325/day (Days 1-8)	$75/day (Days 1-100)	20% Coin HHC	$100 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	$325 Copay OP Hosp & Surg/$325 Copay ASC	$0 Copay Lab/$0 Copay Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		20% Coin Dialysis	$30 Copay CORF/$30 Copay Partial Hospitalization/20% Coin Rad/$325 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay PT & ST	$25 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Psychiatric/$30 Copay Preventive Dental/$30 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health	$30 Copay OT	20% Coin Rad	$65 ER Waived/$30 Copay Other/$0 Copay Lab/$30 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	$30 Copay Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	50% Coin Supp Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											3500	4.702	0.0096	0.6075	0	0	0.7898	0.1298	0	0.3439	0	0.2196	0	0	0.2882	1.6773	1.592	0.057	0.2297	0.7013	0.1189	0.0488	0	0	0	0.052	0	0	0	0	0											11.5674	0	NO	0.792956215	16.9761	0.034767051	3.426524362	1.558896073	1.069477953	3.249638353	0.534130779	1.964282234	3.462385429	0	2.89252446	0	0	3.441674996	9.207840226	9.094296003	0.323526169	1.303945022	3.653200675	0.674903102	2.972618699	0	0	0.194968069	0.453856029	0	0	0	0	0.119648004	0	0	0	0	0	0	0	0	0	0	66.6092
H6743_005_0	2012	9																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	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	0	0	0											0	YES	892.5094701	1.830013037	819.9373668	18.89242779	155.5334087	19.97290469	3.266751895	440.6739865	227.3208313	0	21.74202456		0	16.17233618	5581.109162	4497.1157	155.0428357	624.9067203	24.08573409	323.4365234	23.6227138	0	0	100	206.1137664	0	22.22710481	0	0	131.9098754											1300	$175/day (Days 1-8)	$175/day (Days 1-8)	$25/day (Days 1-100)	10% Coin HHC	$50 Ambul Waived	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$40 ER Waived/$15 Copay Urgent Care	$175 Copay OP Hosp & Surg/$175 Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$15 Copay CORF/$15 Copay Partial Hospitalization/10% Coin Rad/$175 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$10 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$15 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	10% Coin Rad	$40 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	$15 Copay/ $500 Benefit	$15 Copay Non-Covered Vision Exams	$200 Vision Hardware Coverage	$15 Copay Non-Covered Hearing Exams	$300 Hearing Aids Coverage	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	$15 Copay Supp Chiro/$15 Copay Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													175	175	25	0.1	50	0.1	0.1	39.70728921	175	0	0.1	0	0	0.184642008	10	15	15	15	0.1	15	0.1	0	0	15	15	0	15	0	0	15											NO	167.7156608	167.7156608	23.95938011	0.09583752	47.91876023	0.09583752	0.09583752	38.05448142	167.7156608	0	0.09583752	0	0	0.176956322	9.583752045	14.37562807	14.37562807	14.37562807	0.09583752	14.37562807	0.09583752	0	0	14.37562807	14.37562807	0	14.37562807	0	0	14.37562807												12.474	0.02557682	1.637099253	1.810603435	0.621080676	1.914153662	0.313077402	1.397468336	3.177105286	0	2.083701724	0	0	2.861797128	4.457330529	5.387405224	0.185736512	0.748618882	2.308317033	0.38746693	2.263942317	0	0	0.119796901	0.246917904	0	0.026627383	0	0	0.158023942	0	0	0	0	0	0	0	0	0	0	44.6058	0	NO	1.937350447	12.474	0.02557682	1.637099253	1.810603435	0.621080676	1.914153662	0.313077402	1.397468336	3.177105286	0	2.083701724	0	0	2.861797128	4.457330529	5.387405224	0.185736512	0.748618882	2.308317033	0.38746693	2.263942317	0	0	0.119796901	0.246917904	0	0.026627383	0	0	0.158023942	0	0	0	0	0	0	0	0	0	0	44.6058	YES	$275/day (Days 1-8)	$275/day (Days 1-8)	$75/day (Days 1-100)	15% Coin HHC	$50 Ambul Waived	15% Coin DME	15% Coin Prosthetics/$0 Copay Diabetic Supplies	$40 ER Waived/$15 Copay Urgent Care	$275 Copay OP Hosp & Surg/$275 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		15% Coin Dialysis	$25 Copay CORF/$25 Copay Partial Hospitalization/15% Coin Rad/$275 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Psychiatric/$25 Copay Preventive Dental/$25 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health	$25 Copay OT	15% Coin Rad	$40 ER Waived/$25 Copay Other/$0 Copay Lab/$25 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	$25 Copay Preventive Dental	$25 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	$25 Copay Non-Covered Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	$25 Copay Supp Chiro/$25 Copay Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											3000	4.621	0.0095	0.7055	0	0	0.6914	0.1131	0	0.3388	0	0.1925	0	0	0.2763	1.5884	1.5999	0.0552	0.2223	0.617	0.1151	0.0425	0	0	0	0.0444	0	0	0	0	0											11.2329	0	NO	0.487880838	17.095	0.03507682	2.342599253	1.810603435	0.621080676	2.605553662	0.426177402	1.397468336	3.515905286	0	2.276201724	0	0	3.138097128	6.045730529	6.987305224	0.240936512	0.970918882	2.925317033	0.50256693	2.306442317	0	0	0.119796901	0.291317904	0	0.026627383	0	0	0.158023942	0	0	0	0	0	0	0	0	0	0	55.8387
H6743_006_0	2012	4																															D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0.524226014	0.547493351	0.253620987	0.720976218	1.524660214	0.420335472	0.593842293	0	0	1.341417537	1.421162634	1.819142565	0.064321709	0.105226645	0.675038114	2.182258937	0.838149472	0.027914663	0	0	0	0	0	0	0	0											13.0598	YES	546.0468236	1.119621516	524.0595586	11.69440563	11.19637703	11.69331895	1.931675145	269.0573989	32.56357019	8.977491198	12.68323592		0	28.64988783	3246.859909	28.0808781	1.373777876	2.247422208	14.41740972	34.46024468	14.42305678	0	0	0	0	0	0	0	0	0											3400	$275/day (Days 1-7)	$250/day (Days 1-7)	$65/day (Days 1-100)	15% Coin HHC	20% Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	15% Coin Lab/15% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		20% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$35 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$45 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/$45 Copay Preventive Dental/$45 Copay Preventive Dental/$45 Copay Medicare Covered Vision Exams/$45 Copay Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$65 ER Waived/20% Coin Other/15% Coin Lab/20% Coin Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	20% Coin Part B Rx - Chemo/20% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											150	YES	275	250	65	0.15	0.2	0.2	0.2	64.82437353	0.2	0.15	0.2	0	0	0.2	35	0.331823396	0.2	0.2	0.2	0.190033989	0.2	0	0	0	0	0	0	0	0	0											NO	255.1885552	231.9895956	60.31729486	0.139193757	0.185591676	0.185591676	0.185591676	60.1543208	0.185591676	0.139193757	0.185591676	0	0	0.185591676	32.47854339	0.307918302	0.185591676	0.185591676	0.185591676	0.176343633	0.185591676	0	0	0	0	0	0	0	0	0												11.6121	0.021645045	2.634154576	1.62778826	2.077954384	2.170182668	0.358502829	1.348747091	6.043527583	1.249610732	2.353903017	0	0	5.317180713	8.787773367	8.646616298	0.254961739	0.417102855	2.67575124	6.076844732	2.676799288	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3511			5.151138461	11.6121	0.021645045	2.634154576	1.62778826	2.602180398	2.717676019	0.612123815	2.069723309	7.568187797	1.669946204	2.94774531	0	0	6.65859825	10.208936	10.46575886	0.319283448	0.5223295	3.350789354	8.259103669	3.514948761	0.027914663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4109	YES	$375/day (Days 1-7)	$375/day (Days 1-7)	$100/day (Days 1-100)	20% Coin HHC	20% Ambul	30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies	$65 ER Waived/$50 Copay Urgent Care	30% Coin OP Hosp & Surg/30% Coin ASC	25% Coin Lab/25% Coin Lab	30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad		30% Coin Dialysis	30% Coin CORF/30% Coin Partial Hospitalization/30% Coin Rad/30% Coin OP Hosp & Surg/30% Coin OP Substance Abuse/30% Coin Cardiac Rehab/30% Coin PT & ST	$40 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$50 Copay Specialists/30% Coin Podiatry/30% Coin Psychiatric/$50 Copay Preventive Dental/$50 Copay Preventive Dental/$50 Copay Medicare Covered Vision Exams/$50 Copay Medicare Covered Hearing Exams	30% Coin Mental Health	30% Coin OT	30% Coin Rad	$65 ER Waived/30% Coin Other/25% Coin Lab/30% Coin Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	30% Coin Part B Rx - Chemo/30% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											5100	3.7329	0.0077	0.5822	0	0	0.8206	0.1356	0	0.6441	0.1343	0.2277	0	0	0.5143	1.8733	1.8011	0.0713	0.1167	0.7486	1.73	0.0526	0	0	0	0	0	0	0	0	0											13.193			1.024241114	15.345	0.029345045	3.216354576	1.62778826	2.602180398	3.538276019	0.747723815	2.069723309	8.212287797	1.804246204	3.17544531	0	0	7.17289825	12.082236	12.26685886	0.390583448	0.6390295	4.099389354	9.989103669	3.567548761	0.027914663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6039
H6801_002_0	2012	8		r.	s									COB/Subrogation	Risk Sharing																		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	1886.175006	95.66036471	1801.838998		305.4448733			409.7731384	319.4712825		203.357425			91.46749517	4204.387864	6829.529681	642.1106326	873.1219532		222.3796066					144.7840587		0.740667121														3400	"$250 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	"$250 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	$0 Copay / Day 1 to 20  $100 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$100 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4a) $50 copay, worldwide coverage, (4b) $25 copay"	$225 copay for Medicare covered OP facility and ASC visits	"$0 copay for routine x-rays, Medicare covered labs"	"$200 copay for PET, CT, MRI, MRA and nuclear medicine services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $0 copay, (5) $0/visit, (9C) $35/day for Individual SA session and $25/day for Group SA Session"	"$20 copay/visit, urgent care $25 copay"	"$40 copay/visit, urgent care $25 copay"	$25 copay/session	$10 copay/visit	(7D) $40/visit	"(7B) $15/visit (7D) $40/visit (7F) $40/visit,(14E) $0 Copay"	$0 copay	"(9D) $0 copay, 3 pint deductible waived, (14C)  $0 copay"	Not covered	(16B)  $40 Copay/ Max $225 Copay for Medicare covered benefits	$30 copay eye exam every year	$150 eyewear benefit every  year	$25 copay rountine hearing tests every year	Not Covered	(14C) No cost sharing	"(13A) ,(13B)  and (13C) Not Covered,"													81.05414988	66.14583333	14.2509286		100			50	225		200			24.53577474	20.74497771	39.87657912	25.03666035	10		15					29.9815278		9.440048305														NO	69.51817299	56.55163958	12.19378754		85.28212073			42.75045437	191.0392321		169.6643169			20.95393157	17.63294425	33.82105268	21.56541559	8.469385689		12.69838745					29.9815278		9.440048305															10.927	0.450812539	1.830936827	0	2.17074888	0	0	1.459832321	5.085962374	0	2.875208217	0	0	0.15971697	6.177978067	19.24849026	1.153948554	0.616233881	0	0.235321867	0	0	0	0	0.361737273	0	0.000582661	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7545	0		9.142776832	10.927	0.450812539	1.830936827	0	2.17074888	0	0	1.459832321	5.085962374	0	2.875208217	0	0	0.15971697	6.177978067	19.24849026	1.153948554	0.616233881	0	0.235321867	0	0	0	0	0.361737273	0	0.000582661	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7545	NO																																																																																		0	0		0	10.927	0.450812539	1.830936827	0	2.17074888	0	0	1.459832321	5.085962374	0	2.875208217	0	0	0.15971697	6.177978067	19.24849026	1.153948554	0.616233881	0	0.235321867	0	0	0	0	0.361737273	0	0.000582661	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7545
H6801_003_0	2012	6		r.	s									COB/Subrogation	Risk Sharing																		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	1635.613618	90.13811711			267.3945259			380.2088971	307.5881691		189.783252			53.72672203	4032.208904	6268.206499	540.9567148	867.3756328		224.8199723					142.4941269		0.863996832														3400	"$150 Copay / Day 1 to 5  $0 after day 5, unlimited coverage"	"$150 Copay / Day 1 to 5  $0 after day 5, unlimited coverage"	$0 Copay	$0 copay for Medicare covered visits	$50 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4a) $50 copay, worldwide coverage, (4b) $15 copay"	$100 copay for Medicare covered OP facility and ASC visits	"$0 copay for routine x-rays, Medicare covered labs"	"$100 copay for PET, CT, MRI, MRA and nuclear medicine services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $0 copay, (5) $0/visit, (9C) $30/day"	"$15 copay/visit, urgent care $15 copay"	"$30 copay/visit, urgent care $15 copay"	$25 copay/session	$20 copay/visit	(7D) $30/visit	"(7B) $15/visit (7D) $30/visit (7F) $30/visit,(14E) $0 Copay"	$0 copay	"(9D) $0 copay, 3 pint deductible waived, (14C)  $0 copay"	Not covered	(16B)  $30 Copay/ Max $100 Copay for Medicare covered benefits	$30 copay eye exam every year	$150 eyewear benefit every  year	$15 copay rountine hearing tests every year	Not Covered	(14C) No cost sharing	"(13A) ,(13B)  and (13C) Not Covered,"													68.87770609	60.97046414			50			50	100		100			24.70971091	15.37413199	29.87042253	25.03741816	20		15					29.9933933		8.830129276														NO	63.84422224	56.36780895			46.19625256			46.24368917	92.13893436		92.10786537			22.96266382	14.17272449	27.51245772	23.28065802	18.40256235		13.79849729					29.9933933		8.830129276															8.702	0.423407347	0	0	1.029385421	0	0	1.465188505	2.361737177	0	1.456710852	0	0	0.102809055	4.762282159	14.37114719	1.04948569	1.33016118	0	0.258514815	0	0	0	0	0.356156866	0	0.000635767	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6697	0		3.11109918	8.702	0.423407347	0	0	1.029385421	0	0	1.465188505	2.361737177	0	1.456710852	0	0	0.102809055	4.762282159	14.37114719	1.04948569	1.33016118	0	0.258514815	0	0	0	0	0.356156866	0	0.000635767	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6697	NO																																																																																		0	0		0	8.702	0.423407347	0	0	1.029385421	0	0	1.465188505	2.361737177	0	1.456710852	0	0	0.102809055	4.762282159	14.37114719	1.04948569	1.33016118	0	0.258514815	0	0	0	0	0.356156866	0	0.000635767	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6697
H6801_801_0	2012	2		r.	s									COB/Subrogation	Risk Sharing																		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	P	V	P	O	O																																																			0	YES	247.9512144	4.420171232	1227.888818		187.6025344	21.55932595	3.977589159	297.3816181	299.9797102	702.6839847	838.3843333	64.7524491		8717.798093	12060.07019	17461.60165	408.8758936	864.0546103	3449.747297	325.2280008	33.82971334	46.40169174																			6700	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	not covered													884.2074613	673.7305807	36.29520398		98.03635856	0.224	0.224	187.0352559	543.6586216	33.23329305	101.7385904	480.0510839		5.73210779	12.95194062	24.33729951	17.72049455	34.89397754	16.89646809	26.00141137	0.224	209.7450107																			NO	727.0821374	554.0073932	29.84547817		80.61511381	0.18419478	0.18419478	153.7987402	447.0494651	27.32767456	83.65945212	394.7451061		4.713501487	10.65035649	20.01251575	14.57152944	28.6932523	13.89393403	21.38091182	0.18419478	172.472929																				15.0234	0.204067295	3.053910742	0	1.260299972	3.971115299	0.73265116	3.811409853	11.17548075	1.600226604	5.844897832	2.130059366	0	3.424279523	10.70367056	29.1208815	0.496495593	2.066044745	3.994213447	0.579472601	6.231256606	0.66691964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0908	0		22.92663287	15.0234	0.204067295	3.053910742	0	1.260299972	3.971115299	0.73265116	3.811409853	11.17548075	1.600226604	5.844897832	2.130059366	0	3.424279523	10.70367056	29.1208815	0.496495593	2.066044745	3.994213447	0.579472601	6.231256606	0.66691964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0908	NO																																																																																		0	0		0	15.0234	0.204067295	3.053910742	0	1.260299972	3.971115299	0.73265116	3.811409853	11.17548075	1.600226604	5.844897832	2.130059366	0	3.424279523	10.70367056	29.1208815	0.496495593	2.066044745	3.994213447	0.579472601	6.231256606	0.66691964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0908
H6815_001_0	2012	5																															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	811.4550158	21.84887349	608.1243033	35.42119394	212.9164749	15.795161	4.266710951	335.0930952	392.778346	12.70243905	23.01459168	0	0.024147239	509.3155985	3780.178824	4805.671952	109.9820306	160.3496437	19.92502263	44.82816977	31.70919343	0	0	0	0	0	0	0	12650	250											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 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/day	11a:  Durable Medical Equipment - 20.0%/11c:  Diabetic Therapeutic Shoes or Inserts - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	"4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit ($50,000 Max)"	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%	3:  Cardiac Rehabilitation Services - $25/visit/3:  Pulmonary Rehabilitation - $25/visit/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $0/visit	7d:  Physician Specialist Services - $15/visit (including 16b Medicare Covered Dental @ $15 to $65)/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit (Glaucoma screenings @ $0)/14a:  Medicare-Covered Zero Cost-Sharing Preventive Services - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/13d:  Additional Pap Smears - $0/visit/13d:  Additional Pelvic Exams - $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%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service + 7g: Naturopathy - $15/service + 13a: Acupuncture - $15/service; $500 Max for Routine Chiro/Naturopathy/Acupuncture/14c:  Written health education materials - $0/service/14c:  Nursing Hotline - $0/service/14c:  Nutritional Benefit - $0/service/14c:  Smoking Cessation - $0/service/14c:  Disease Management - $0/service/	14b: Health Incentive / Gift Package - $50 Max per year													200	200	100	0	125	0.2	0.05115817	37.5321625	172.9526193	0	0.174104249	0	0.2	25	15	15	25	25	0	15.1796444	0.2	0	0	0	0	0	0	0	0.770750988	0											NO	168.4603596	168.4603596	84.23017982	0	105.2877248	0.16846036	0.043090619	31.61340797	145.6783022	0	0.146648322	0	0.16846036	21.05754495	12.63452697	12.63452697	21.05754495	21.05754495	0	12.78584177	0.16846036	0	0	0	0	0	0	0	0.770750988	0												11.3915	0.306722424	4.268534952	0	1.868124268	2.660858503	0.183855214	0.882786227	4.768273549	0	3.375051249	0	0.004067853	0.893744676	3.980064276	5.059782658	0.192995963	0.281380819	0	0.047763824	5.341742129	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	46.3197			8.52	11.3915	0.306722424	4.268534952	0	1.868124268	2.660858503	0.183855214	0.882786227	4.768273549	0	3.375051249	0	0.004067853	0.893744676	3.980064276	5.059782658	0.192995963	0.281380819	0	0.047763824	5.341742129	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	46.3197	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	11.3915	0.306722424	4.268534952	0	1.868124268	2.660858503	0.183855214	0.882786227	4.768273549	0	3.375051249	0	0.004067853	0.893744676	3.980064276	5.059782658	0.192995963	0.281380819	0	0.047763824	5.341742129	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	46.3197
H6864_001_0	2012	13																																			Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	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	9.45644964	12.42636734	23.06676872	20.40016788	33.91145456	16.43728921	12.16584407	0	2.707689211	24.12637882	40.72621109	71.13993436	4.149765505	18.82353087	10.24197912	38.60816812	24.47621367	24.22442527	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	10% Coinsurance for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics; PBP 11b-c	10% Coinsurance for ER - Facility; 10% Coinsurance for ER - Worldwide; 10% Coinsurance for PCP Urgent Care; 10% Coinsurance for Urgent Care - Worldwide; PBP 4a-b	10% Coinsurance for OP Fac - Surgery; PBP 9a-b	10% Coinsurance for OP Fac - Pathology; PBP 8a	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	10% Coinsurance for Renal Dialysis - Fac; PBP 12	"10% Coinsurance for OP Fac - Cardiovascular; 10% Coinsurance for OP Fac - Occ Therapy; 10% Coinsurance for OP Fac - Physical/Speech Therapy; 10% Coinsurance for OP Fac - CORF; 10% Coinsurance for OP Fac - Other; 10% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"10% Coinsurance for Prof - Asst Surgeon (OP); 10% Coinsurance for PCP Office Visits; 10% Coinsurance for PCP Immunizations; 10% Coinsurance for Physical Exams; PBP 7a, 14a-b, 14d-e"	"10% Coinsurance for Prof - Asst Surgeon (OP); 10% Coinsurance for Speclst Office Visits; 10% Coinsurance for Cardio; 10% Coinsurance for Chiropractor; 10% Coinsurance for Speclst Immunizations; 10% Coinsurance for Vision Exams; 10% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f"	"10% Coinsurance for OP Psych - Non-Physician; 10% Coinsurance for OP Psych - Psychiatrist; 10% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"10% Coinsurance for Occ Therapy; 10% Coinsurance for PT/ST; PBP 7c, 7i"	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office); 10% Coinsurance for Prof Radiology (Office); PBP 7d	"10% Coinsurance for Prof - Primary Surgeon (IP); 10% Coinsurance for Prof - Asst Surgeon (IP); 10% Coinsurance for Prof - Anesthesia (IP); 10% Coinsurance for Prof - Primary Surgeon (OP); 10% Coinsurance for Prof - Anesthesia (OP); 10% Coinsurance for Prof - IP Visits; 10% Coinsurance for Allergy Testing; 10% Coinsurance for Allergy Tx; 10% Coinsurance for Prof - ER Visits; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); PBP 7g, 18a"	10% Coinsurance for Part B Rx; 10% Coinsurance for Tx Injections; PBP 15	"10% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b, 17a"	PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	No Cost-Sharing; PBP 13a-e											0	NO	0	0	0	0	0.099966085	0.099952202	0.0996144	0.09982496	0.099744974	0.099536684	0.1	0	0.1	0.1	0.099667361	0.099594281	0.1	0.099469966	0.1	0.1	0.099927827	0.1	0	0	0	0	0	0	0	0											YES	0	0	0	0	0.099966085	0.099952202	0.0996144	0.09982496	0.099744974	0.099536684	0.1	0	0.1	0.1	0.099667361	0.099594281	0.1	0.099469966	0.1	0.1	0.099927827	0.1	0	0	0	0	0	0	0	0											3400	0	0	0	0	0.945324252	1.242042776	2.297782323	2.036445944	3.382497155	1.636113269	1.216584407	0	0.270768921	2.412637882	4.059073982	7.085130584	0.41497655	1.87237597	1.024197912	3.860816812	2.445854837	2.422442527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6251	0	NO	1.42E-14	0	0	0	0	0.945324252	1.242042776	2.297782323	2.036445944	3.382497155	1.636113269	1.216584407	0	0.270768921	2.412637882	4.059073982	7.085130584	0.41497655	1.87237597	1.024197912	3.860816812	2.445854837	2.422442527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6251	NO	6% Coinsurance for IP Medical; 6% Coinsurance for IP Surgical; PBP 1a	6% Coinsurance for IP Psych; 6% Coinsurance for IP Substance Abuse; PBP 1b	15% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b-c	22% Coinsurance for ER - Facility; 22% Coinsurance for ER - Worldwide; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for Urgent Care - Worldwide; PBP 4a-b	22% Coinsurance for OP Fac - Surgery; PBP 9a-b	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - PCP Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; 22% Coinsurance for Medical Nutrition Therapy; 22% Coinsurance for Pelvic Tests; 22% Coinsurance for Colorectal Cancer Screening; PBP 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Speclst Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; 22% Coinsurance for Prostate Cancer Screening; 22% Coinsurance for Influenza Virus Vaccine; 22% Coinsurance for Pneumococcal Vaccine; PBP 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Initial Preventive Physical Examination (IPPE); 22% Coinsurance for Glaucoma Screening; 22% Coinsurance for Other Vaccines - Rabies/Tetanus/etc.; PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); 22% Coinsurance for Ultrasound Screening for Abdominal Aortic Aneurysm; 22% Coinsurance for Cardio Screenings; 22% Coinsurance for Diabetes Screening Tests; 22% Coinsurance for Diabetes Self-Management Training; PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; 22% Coinsurance for Pap Tests; 22% Coinsurance for Bone Mass Measurements; 22% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 9d, 16b, 17a"	No Cost-Sharing; PBP 10b	No Cost-Sharing; PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	No Cost-Sharing; PBP 13a-e												7.6615	0.7095	4.5469	0	3.7168	1.2644	3.0185	1.3902	2.2089	1.3181	1.2195	0	0.2489	2.2841	6.0321	6.5988	0.7229	0.6043	1.7103	6.4008	3.1346	4.0354	0	0	0	0	0	0	0	0											58.8266	0	NO	3.55E-14	7.6615	0.709486835	4.546936739	0	4.66210055	2.506414098	5.316294608	3.426632135	5.591391895	2.954234241	2.43611908	0	0.519666725	4.696744263	10.09121448	13.68391781	1.137866646	2.476642313	2.734521108	10.2616138	5.580468296	6.457857313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4516
H6864_002_0	2012	11																																			Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	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	10.27429817	13.18916548	10.23276067	18.41907953	25.29053943	5.346457751	15.11265403	0	3.292695032	29.41879546	22.75953164	30.10881098	5.019748638	3.568561652	12.48751609	46.02573627	26.44482833	29.32726528	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	15% 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-c	15% Coinsurance for ER - Facility; 15% Coinsurance for ER - Worldwide; 15% Coinsurance for PCP Urgent Care; 15% Coinsurance for Urgent Care - Worldwide; PBP 4a-b	15% Coinsurance for OP Fac - Surgery; PBP 9a-b	15% Coinsurance for OP Fac - Pathology; PBP 8a	15% Coinsurance for OP Fac - Radiology; 15% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	15% Coinsurance for Renal Dialysis - Fac; PBP 12	"15% Coinsurance for OP Fac - Cardiovascular; 15% Coinsurance for OP Fac - Occ Therapy; 15% Coinsurance for OP Fac - Physical/Speech Therapy; 15% Coinsurance for OP Fac - CORF; 15% Coinsurance for OP Fac - Other; 15% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"15% Coinsurance for Prof - Asst Surgeon (OP); 15% Coinsurance for PCP Office Visits; 15% Coinsurance for PCP Immunizations; 15% Coinsurance for Physical Exams; PBP 7a, 14a-b, 14d-e"	"15% Coinsurance for Prof - Asst Surgeon (OP); 15% Coinsurance for Speclst Office Visits; 15% Coinsurance for Cardio; 15% Coinsurance for Chiropractor; 15% Coinsurance for Speclst Immunizations; 15% Coinsurance for Vision Exams; 15% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f"	"15% Coinsurance for OP Psych - Non-Physician; 15% Coinsurance for OP Psych - Psychiatrist; 15% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"15% Coinsurance for Occ Therapy; 15% Coinsurance for PT/ST; PBP 7c, 7i"	15% Coinsurance for Prof Radiology (IP); 15% Coinsurance for Prof Radiology (OP); 15% Coinsurance for Prof Radiology (OP); 15% Coinsurance for Prof Radiology (Office); 15% Coinsurance for Prof Radiology (Office); PBP 7d	"15% Coinsurance for Prof - Primary Surgeon (IP); 15% Coinsurance for Prof - Asst Surgeon (IP); 15% Coinsurance for Prof - Anesthesia (IP); 15% Coinsurance for Prof - Primary Surgeon (OP); 15% Coinsurance for Prof - Anesthesia (OP); 15% Coinsurance for Prof - IP Visits; 15% Coinsurance for Allergy Testing; 15% Coinsurance for Allergy Tx; 15% Coinsurance for Prof - ER Visits; 15% Coinsurance for Prof Path (IP); 15% Coinsurance for Prof Path (OP); 15% Coinsurance for Prof Path (Office); PBP 7g, 18a"	15% Coinsurance for Part B Rx; 15% Coinsurance for Tx Injections; PBP 15	"15% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b, 17a"	PBP 10b	PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14c	PBP 13a-e											0	NO	0	0	0	0	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0	0	0	0	0	0	0	0											YES	0	0	0	0	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0.15	0	0	0	0	0	0	0	0											3400	0	0	0	0	1.541144725	1.978374822	1.534914101	2.762861929	3.793580914	0.801968663	2.266898104	0	0.493904255	4.41281932	3.413929746	4.516321648	0.752962296	0.535284248	1.873127414	6.903860441	3.966724249	4.399089792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9478	0	NO	0	0	0	0	0	1.541144725	1.978374822	1.534914101	2.762861929	3.793580914	0.801968663	2.266898104	0	0.493904255	4.41281932	3.413929746	4.516321648	0.752962296	0.535284248	1.873127414	6.903860441	3.966724249	4.399089792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9478	NO	6% Coinsurance for IP Medical; 6% Coinsurance for IP Surgical; PBP 1a	6% Coinsurance for IP Psych; 6% Coinsurance for IP Substance Abuse; PBP 1b	15% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b-c	22% Coinsurance for ER - Facility; 22% Coinsurance for ER - Worldwide; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for Urgent Care - Worldwide; PBP 4a-b	22% Coinsurance for OP Fac - Surgery; PBP 9a-b	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - PCP Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; 22% Coinsurance for Medical Nutrition Therapy; 22% Coinsurance for Pelvic Tests; 22% Coinsurance for Colorectal Cancer Screening; PBP 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Speclst Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; 22% Coinsurance for Prostate Cancer Screening; 22% Coinsurance for Influenza Virus Vaccine; 22% Coinsurance for Pneumococcal Vaccine; PBP 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Initial Preventive Physical Examination (IPPE); 22% Coinsurance for Glaucoma Screening; 22% Coinsurance for Other Vaccines - Rabies/Tetanus/etc.; PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); 22% Coinsurance for Ultrasound Screening for Abdominal Aortic Aneurysm; 22% Coinsurance for Cardio Screenings; 22% Coinsurance for Diabetes Screening Tests; 22% Coinsurance for Diabetes Self-Management Training; PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; 22% Coinsurance for Pap Tests; 22% Coinsurance for Bone Mass Measurements; 22% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 9d, 16b, 17a"	No Cost-Sharing; PBP 10b	No Cost-Sharing; PBP 16a-b	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14c	No Cost-Sharing; PBP 13a-e												9.2462	0.8562	5.048	0	1.0675	1.4554	1.0601	1.7389	2.5961	0.5172	1.5083	0	0.2958	2.7546	3.5724	5.2584	0.8811	0.6348	2.103	7.6619	3.7437	4.9259	0	0	0	0	0	0	0	0											56.9257	0	NO	0	9.2462	0.856239456	5.047997756	0	2.608660639	3.433799026	2.595030115	4.501799078	6.389641545	1.319201724	3.775191803	0	0.789735256	7.167381055	6.986368337	9.774753791	1.634056129	1.170056937	3.976157292	14.56579278	7.710414527	9.324962567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8735
H6881_001_0	2012	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	1229.08355	33.57152431	863.0076784	11.26935345	326.9611672	18.35947124	5.691289476	340.7924943	263.6507624	445.1691077	22.57292378	5.846231075	0.025315906	387.2771609	10758.65259	3778.855916	238.34527	943.9014384	3351.188665	59.99258784	15.15814208	0.427773005	0	0	393.7887316	20.91377869	17.64184731	0	95.07966831	0											3400	$265 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500,4b: $23"	"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%"	9c1: $143	12: 20.0%	"31: $143,5: $265,9a2: $250"	7a: $10	"7b1: $20,7d1: $35,7f1: $35"	"7e1: $35,7h1: $35"	"7c: $35,7i: $35"	$0 	7g: $35	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	199.0714838	131.3683238	70.37195739	20	100	0.2	0.199820077	64.30648536	173.9048134	15	0.2	142.5	0.2	48.96476575	8.563584908	22.52544438	35	35	0	35	0.198452381	0	0	0	0	2.35762347	0	0	0	0											NO	183.3857863	121.0172492	64.8270485	18.42411407	92.12057034	0.184241141	0.184075395	59.23950107	160.202106	13.81808555	0.184241141	131.2718127	0.184241141	45.10662147	7.888823258	20.75056783	32.24219962	32.24219962	0	32.24219962	0.182815465	0	0	0	0	2.35762347	0	0	0	0												18.783	0.338561127	4.662186719	0.017302321	2.509987433	3.382569923	1.047626357	1.682364778	3.519783947	0.512615401	4.158861226	0.063953779	0.004664231	1.455730359	7.072759065	6.534450502	0.640397981	2.53612155	0	0.161191083	2.771142793	0	0	0	0	0.004108901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8594		NO	5.290724423	18.783	0.338561127	4.662186719	0.017302321	2.509987433	3.382569923	1.047626357	1.682364778	3.519783947	0.512615401	4.158861226	0.063953779	0.004664231	1.455730359	7.072759065	6.534450502	0.640397981	2.53612155	0	0.161191083	2.771142793	0	0	0	0	0.004108901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8594	YES	"$265 days 1-7;$0 days 8-90,1a2: $199"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $23"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											5100	2.2655	0.0408	0.5623	0	0	0	0	0.1869	0	0	0	0	0.0005	0	0	0	0	0	0	0	0.3039	0	0	0	0	0	0	0	0	0											3.36	5000	NO	0.042026451	21.0486	0.379396635	5.224515789	0.017302321	2.509987433	3.382569923	1.047626357	1.869294198	3.519783947	0.512615401	4.158861226	0.063953779	0.005175742	1.455730359	7.072759065	6.534450502	0.640397981	2.53612155	0	0.161191083	3.075044614	0	0	0	0	0.004108901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2194
H6881_002_0	2012	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	NO	1357.353451	37.07512348	953.073085	12.44544831	361.083564	20.27550661	6.285245141	376.3583593	291.1659441	491.6279488	24.92868447	6.456356791	0.02795793	427.6942694	11881.44957	4173.22575	263.219514	1042.409098	3700.92619	66.25354813	16.7400796	0.472416351	0	0	434.181112	23.09186963	18.84316023	0	95.07966831	0												$265 days 1-7;$0 days 8-90	$250 days 1-7;$0 days 8-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $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%"	9c1: $145	12: 20.0%	"31: $145,5: $265,9a2: $250"	7a: $10	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 												NO	199.0714838	131.3683238	70.37195739	20	100	0.2	0.199820077	64.34728033	173.9048134	15	0.2	145	0.2	49.01723261	8.563584908	25.6930906	39.97891804	40	0	40	0.198452381	0	0	0	0	2.356128329	0	0	0	0											NO	179.1105519	118.1959994	63.3157491	17.99459656	89.97298278	0.179945966	0.179784084	57.89516745	156.4673478	13.49594742	0.179945966	130.460825	0.179945966	44.10226626	7.704912774	23.11683998	35.97022504	35.98919311	0	35.98919311	0.178553526	0	0	0	0	2.356128329	0	0	0	0												20.2597	0.365177606	5.02871136	0.018662568	2.707313774	3.648495615	1.129987039	1.81577752	3.796496921	0.552915412	4.485816196	0.070191803	0.005030917	1.571857212	7.628794384	8.039315987	0.78900543	3.126288528	0	0.198700978	2.989000245	0	0	0	0	0.004533951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2318		NO	7.60356745	20.2597	0.365177606	5.02871136	0.018662568	2.707313774	3.648495615	1.129987039	1.81577752	3.796496921	0.552915412	4.485816196	0.070191803	0.005030917	1.571857212	7.628794384	8.039315987	0.78900543	3.126288528	0	0.198700978	2.989000245	0	0	0	0	0.004533951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2318	YES	"$265 days 1-7;$0 days 8-90,1a2: $199"	"$250 days 1-7;$0 days 8-90,1b2: $131"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	$0 	$0 	$0 	$0 	"4a1: $65,4b: $25"	$0 	$0 	$0 	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											5100	2.5019	0.0451	0.621	0	0	0	0	0.2018	0	0	0	0	0.0005	0	0	0	0	0	0	0	0.3224	0	0	0	0	0	0	0	0	0											3.6928	5000	NO	0.058478827	22.7616	0.410274799	5.649726347	0.018662568	2.707313774	3.648495615	1.129987039	2.017530577	3.796496921	0.552915412	4.485816196	0.070191803	0.005573626	1.571857212	7.628794384	8.039315987	0.78900543	3.126288528	0	0.198700978	3.311438243	0	0	0	0	0.004533951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9246
H6900_001_0	2012	7	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	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	968.28	44.18	445.82	649.22	1.54	12.87	2.36	384.2	330.32	2170.46	1133.75	124.38	0.31	2.89	2846.38	3549.36	90.94	752.63		1213.27	28.38	0		3.44	0.61		0.24		3.31	1.09	1307.55	762.22									6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	208.548677	42.678696	75.859704	38.134249	0.199923	0.2	10	31.762282	35	40.036192		0	0.2	0		0	0		0		0	0	0	67.092542									NO	148.205343	118.758183	31.090604	0	0.189646	0.189646	0.189646	61.63508	197.752529	40.469305	71.932599	36.160115	0.189573	0.189646	9.48232	30.118012	33.18812	37.963598		0	0.189646	0		0	0		0		0	0	0	63.619295										11.9587	0.437228044	1.155067756	0	0.29205484	2.44074402	0.44756456	1.973349811	5.443467948	7.319750644	6.79613201	0.374799592	0.05876763	0.54807694	2.2491905	8.908305589	0.251510636	2.38104523	0	0	5.38215348	0	0	0	0	0	0	0	0	0	0	4.040991586	0	0	0	0	0	0	0	0	62.4589	0	NO	4.099582	11.9587	0.437228044	1.155067756	0	0.29205484	2.44074402	0.44756456	1.973349811	5.443467948	7.319750644	6.79613201	0.374799592	0.05876763	0.54807694	2.2491905	8.908305589	0.251510636	2.38104523	0	0	5.38215348	0	0	0	0	0	0	0	0	0	0	4.040991586	0	0	0	0	0	0	0	0	62.4589	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									10000	5.2744	0.0754	0.5407	1.5382	2.595	1.0421	0.1909	0.2511	2.2039	0.6064	1.1683	0.0343	0.0075	0.1056	1.084	1.9971	0.0247	0.2659		0.1675	1.139	0			0				0	0	0.1669	0.6778									21.1567	500	NO	3.794585	17.2331	0.512604044	1.695786756	1.538166	2.88706984	3.48288602	0.63844556	2.224415811	7.647356948	7.926192644	7.96444201	0.409145592	0.06628563	0.65365494	3.3332355	10.90540159	0.276180636	2.64692723	0	0.167504	6.52113848	0	0	0	0	0	0	0	0	0	0.166917	4.718752586	0	0	0	0	0	0	0	0	83.6156
H6900_002_0	2012	8	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	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	1227.94	76.06	696.2	860.48	1.25	14.08	3.5	379.91	358.35	2158.21	1098.27	210.75	0.44	5.09	3307.41	4053.26	116.66	597.75		1702.47	18.21	0		3.44	0.61		0.24		3.31	1.09	2172.25	496.23									6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	205.813414	20.505218	79.851201	35.805339	0.199696	0.2	10	32.394593	35	37.56477		0	0.2	0		0	0		0		0	0	0	79.446365									NO	144.34799	115.667254	29.832326	0	0.189576	0.189576	0.189576	61.612135	195.086213	19.436466	75.689276	33.939129	0.189288	0.189576	9.47879	30.706155	33.175765	35.606857		0	0.189576	0		0	0		0		0	0	0	75.305541										14.7709	0.733137612	1.730772113	0	0.23697	2.66923008	0.663516	1.950588851	5.825762036	3.495664607	6.927271763	0.596055953	0.08328672	0.96494184	2.612520403	10.37166915	0.322523729	1.773666564	0	0	3.45217896	0	0	0	0	0	0	0	0	0	0	3.114072384	0	0	0	0	0	0	0	0	62.2947	0	NO	4.831118	14.7709	0.733137612	1.730772113	0	0.23697	2.66923008	0.663516	1.950588851	5.825762036	3.495664607	6.927271763	0.596055953	0.08328672	0.96494184	2.612520403	10.37166915	0.322523729	1.773666564	0	0	3.45217896	0	0	0	0	0	0	0	0	0	0	3.114072384	0	0	0	0	0	0	0	0	62.2947	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									10000	5.549	0.1259	0.5981	1.56	1.575	0.8537	0.2121	0.1858	1.6684	0.322	0.6667	0.046	0.0079	0.1392	0.9558	1.8115	0.0268	0.1519		0.1962	0.521	0			0		0		0	0	0.1972	0.4564									17.8264	0	NO	4.793909	20.3198	0.859025612	2.328844113	1.56002	1.811926	3.52293308	0.875598	2.136388851	7.494139036	3.817623607	7.593999763	0.642076953	0.09123372	1.10411784	3.568331403	12.18314915	0.349279729	1.925551564	0	0.196166	3.97318296	0	0	0	0	0	0	0	0	0	0.197172	3.570467384	0	0	0	0	0	0	0	0	80.1211
H6900_004_0	2012	10	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	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	993.55	77.78	413.97	568.39	0.9	7.92	2.52	257.58	315.85	2363.1	937.62	85.74	0.34	22.72	3291.2	3556.9	84.18	920.46		1584.7	17.37	0		3.44	2.86		0.24		3.31	1.09	910	375.62									6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	204.478562	45.813052	83.189723	37.473251	0.199981	0.2	10	31.966807	35	36.844494		0	0.2	0		0	0		0		0	0	0	68.868664									NO	147.944272	118.548984	31.13754	0	0.190005	0.190005	0.190005	61.75169	194.259951	43.52359	79.0324	35.600563	0.189987	0.190005	9.50026	30.369297	33.25091	35.003227		0	0.190005	0		0	0		0		0	0	0	65.427021										12.2492	0.768394998	1.074167286	0	0.1710045	1.5048396	0.4788126	1.325500026	5.113083794	8.570882961	6.175196574	0.254366023	0.06459558	4.3169136	2.605604643	9.001712708	0.233255134	2.684922527	0	0	3.30038685	0	0	0	0	0	0	0	0	0	0	2.047974802	0	0	0	0	0	0	0	0	61.9408	0	NO	4.028839	12.2492	0.768394998	1.074167286	0	0.1710045	1.5048396	0.4788126	1.325500026	5.113083794	8.570882961	6.175196574	0.254366023	0.06459558	4.3169136	2.605604643	9.001712708	0.233255134	2.684922527	0	0	3.30038685	0	0	0	0	0	0	0	0	0	0	2.047974802	0	0	0	0	0	0	0	0	61.9408	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	40% Coins	40% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						40% Coins	30% Coins									10000	5.1829	0.1444	0.4801	1.1424	1.1551	0.6503	0.2072	0.128	1.5175	0.3211	0.7061	0.0202	0.0063	0.631	0.9589	1.6059	0.0192	0.274		0.1647	0.4921	0		0			0		0	0	0.1309	0.3558									16.2942	0	NO	3.612037	17.4321	0.912768998	1.554234286	1.142427	1.3261485	2.1551756	0.6860336	1.453451026	6.630618794	8.892028961	6.881296574	0.274532023	0.07093558	4.9478996	3.564528643	10.60764571	0.252434134	2.958916527	0	0.164729	3.79244685	0	0	0	0	0	0	0	0	0	0.13089	2.403778802	0	0	0	0	0	0	0	0	78.235
H6900_005_0	2012	7																															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	279.18	9.4	52.48	1304.21	34.3	14.6	16748.59	441.49	393.66	1771.15	1231.66	175.56	0.68	736.12	3549.14	4374.96	123.46	656.71		1718.77	22.68	0		3.44	1.69		0.24		3.31	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199888	0	0	0	0	0	0	0.199888	0	0	0	0	0		0	0.199888	0		0	0		0		0	0												0	0	0	0	0	2.9183648	0	0	0	0	0	0	0.13592384	0	0	0	0	0	0	0	4.53345984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5877	0	NO	0.004251	0	0	0	0	0	2.9183648	0	0	0	0	0	0	0.13592384	0	0	0	0	0	0	0	4.53345984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5877	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		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"																7500	5.4818	0.079	0.4879	2.2622	0	0.974	0.4768	0	3.1231	0.5588	1.2442	0.058	0.0206	1.2589	1.6953	3.1192	0.0424	0.2536		0.3273	1.0909	0		0	0		0		0	0											22.5537	1000	NO	7.643532	5.4818	0.07897	0.487884	2.262153	0	3.8923448	0.476797	0	3.123074	0.558822	1.244219	0.057975	0.15647584	1.258895	1.695259	3.119242	0.042383	0.253579	0	0.327347	5.62432084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1415
H6900_006_0	2012	6																															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	288.87	9.73	54.31	1349.49	35.49	14.72	17330.09	456.81	407.33	1832.65	1274.42	181.65	0.69	761.68	3672.37	4526.86	127.74	679.51		1778.45	22.87	0		3.44	1.69		0.24		3.31	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199887	0	0	0	0	0	0	0.199887	0	0	0	0	0		0	0.199887	0		0	0		0		0	0												0	0	0	0	0	2.94233664	0	0	0	0	0	0	0.13792203	0	0	0	0	0	0	0	4.57141569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.6517	0	NO	0.004326	0	0	0	0	0	2.94233664	0	0	0	0	0	0	0.13792203	0	0	0	0	0	0	0	4.57141569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.6517	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		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"																7500	5.4937	0.0791	0.4873	2.2719	0	0.9782	0.4789	0	3.1366	0.5612	1.2496	0.0582	0.0206	1.2643	1.7026	3.1327	0.0426	0.2547		0.3288	1.0956	0		0			0		0	0											22.6366	1000	NO	7.757592	5.4937	0.079142	0.487263	2.27194	0	3.92053064	0.478859	0	3.136586	0.56124	1.2496	0.058225	0.15856303	1.264342	1.702594	3.132738	0.042567	0.254675	0	0.328763	5.66699569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2883
H6900_007_0	2012	6																															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	297.92	10.04	56.01	1391.75	36.61	15.28	17872.69	471.12	420.08	1890.03	1314.32	187.34	0.71	785.53	3787.35	4668.59	131.74	700.78		1834.13	23.73	0		3.44	1.69		0.24		3.31	1.09											5000	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Admit(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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	0.199882	0	0	0	0	0	0	0.199882	0	0	0	0	0		0	0.199882	0		0	0		0		0	0												0	0	0	0	0	3.05419696	0	0	0	0	0	0	0.14191622	0	0	0	0	0	0	0	4.74319986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9393	0	NO	0.004687	0	0	0	0	0	3.05419696	0	0	0	0	0	0	0.14191622	0	0	0	0	0	0	0	4.74319986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9393	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		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a,17b"																7500	5.5462	0.0799	0.4843	2.3164	0	0.9974	0.4882	0	3.198	0.5722	1.2741	0.0594	0.021	1.2891	1.7359	3.1941	0.0434	0.2597		0.3352	1.117	0		0			0		0	0											23.0116	1000	NO	8.282709	5.5462	0.079898	0.484298	2.31644	0	4.05155096	0.488239	0	3.198021	0.572233	1.274077	0.059366	0.16296222	1.289106	1.735942	3.194098	0.0434	0.259664	0	0.335202	5.86023886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9509
H6923_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1368.486206	74.82511932	1141.731582	789.676792	179.4544927	17.41623086	0	319.7939825	362.6172722	3477.108244	2569.938628	84.52559048	0.015853856	637.2513124	2581.616308	4502.433785	203.1774812	921.9587551	0	0	67.65995394	0.001592875	0	0	960.0166085	0	69.98136292	0	48.0351618	0											3400	$335/day 1-6; unlimited additional days	$295/day 1-6	"$0/d 1-20, $105/d 21-100; includes non-Medicare covered stays"	$15 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 to $50 per visit	$0 to $50 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$50 per visit	20% per visit	$0 to 300 per visit	$35 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$50 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	225.769432	129.0407918	42.34790568	15	200	0.03	0.03	62	300	5	20.63613596	50	0.2	50	35	50	40	25	50	50	0.1	0	0	0	0	0	0	0	0	0											NO	190.6303867	108.9567167	35.75682308	12.66538067	168.8717423	0.025330761	0	52.35024012	253.3076135	4.221793558	17.42430117	42.21793558	0.168871742	42.21793558	29.55255491	42.21793558	33.77434846	21.10896779	0	0	0.084435871	0	0	0	0	0	0	0	0	0												21.7396	0.679391611	3.402057847	0.833463098	2.525399403	0.441166388	0	1.395107648	7.654476318	1.223302765	3.731615387	0.297374661	0.002677268	2.241952904	6.357779807	15.84028829	0.571848921	1.621799805	0	0	5.712927153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2722	0	NO	15.11238448	21.7396	0.679391611	3.402057847	0.833463098	2.525399403	0.441166388	0	1.395107648	7.654476318	1.223302765	3.731615387	0.297374661	0.002677268	2.241952904	6.357779807	15.84028829	0.571848921	1.621799805	0	0	5.712927153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2722	NO																																																																																		0		NO		21.7396	0.679391611	3.402057847	0.833463098	2.525399403	0.441166388	0	1.395107648	7.654476318	1.223302765	3.731615387	0.297374661	0.002677268	2.241952904	6.357779807	15.84028829	0.571848921	1.621799805	0	0	5.712927153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2722
H6923_801_0	2012	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	0	0	0	0	0	0	0											0	YES	283.5335554	5.174765476	34.34965853	8.953604046	8.383524742	12.5390187	0	15.68061876	40.86616142	20.27894024	52.59887613	0.817120392	0.071362626	27.20111311	28.37909839	129.7873612	2.763359835	8.622270776	0	0	61.47406401	0.000315082	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	NO	0.080527075	0.080527075	0.147733815	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065749801	0.065749801	0.12062364	0	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0.182894455	0	0	0	0	0	0	0	0												18.6423	0.340239801	4.143380856	0	1.533300185	2.293316986	0	2.867898215	7.474194303	3.708905714	9.62004276	0.149446788	0.013051829	4.974932745	5.190379721	23.73738864	0.50540319	1.576965511	0	0	11.24326541	5.76E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0144	0	NO	22.02875551	18.6423	0.340239801	4.143380856	0	1.533300185	2.293316986	0	2.867898215	7.474194303	3.708905714	9.62004276	0.149446788	0.013051829	4.974932745	5.190379721	23.73738864	0.50540319	1.576965511	0	0	11.24326541	5.76E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0144	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		18.6423	0.340239801	4.143380856	0	1.533300185	2.293316986	0	2.867898215	7.474194303	3.708905714	9.62004276	0.149446788	0.013051829	4.974932745	5.190379721	23.73738864	0.50540319	1.576965511	0	0	11.24326541	5.76E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0144
H6923_802_0	2012	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	0	0	0	0	0	0	0											0	YES	330.3060889	6.076421174	40.33477332	10.51368791	9.844277483	13.6492726	0	17.09919054	42.31335317	20.51890723	57.32213318	0.95949617	0.083796913	28.15841456	28.3967029	141.5762299	3.244850088	8.994683609	0	0	71.07637919	0.000369982	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	NO	0.077953808	0.077953808	0.148036649	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.063325331	0.063325331	0.120256726	0	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0.181965121	0	0	0	0	0	0	0	0												20.9167	0.38479138	4.850527799	0	1.791315139	2.483691534	0	3.111456267	7.699554409	3.733725426	10.43062887	0.174594836	0.015248115	5.123849298	5.167209466	25.76193574	0.590449537	1.636718687	0	0	12.93342191	6.73E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8059	0	NO	24.67271914	20.9167	0.38479138	4.850527799	0	1.791315139	2.483691534	0	3.111456267	7.699554409	3.733725426	10.43062887	0.174594836	0.015248115	5.123849298	5.167209466	25.76193574	0.590449537	1.636718687	0	0	12.93342191	6.73E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8059	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		20.9167	0.38479138	4.850527799	0	1.791315139	2.483691534	0	3.111456267	7.699554409	3.733725426	10.43062887	0.174594836	0.015248115	5.123849298	5.167209466	25.76193574	0.590449537	1.636718687	0	0	12.93342191	6.73E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8059
H6952_002_0	2012	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	223.4660892	1.6781	18.5410131	1525.221781	20.06273556	16.53309155	23.23468443	43.68931622	86.53064119	18.2037121	52.03524966	0	0	46.99432161	36.45106883	94.00776874	0.8202	3.020968116	0	3.191334637	17.22701381	5.834491135	968.6225964	1449.411765	42.79069767	316.2666667	17.6381231	2.613989513	81.19209852	3966.773253											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"$0 (7b, 7f, 7f1); $0 n/c (7b1); Medicare FFS (7d)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 17a); $0 (16b, 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 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.070985328	0.070985328	0.176876847	0	0.224	0.224	0.224	0.160072617	0.224	0.224	0.224	0	0	0.224	0.219837114	0.220427201	0.224	0.224	0	0.224	0.224	0.215463272	0	0	0	0	0	0	0	0											NO	0.057564367	0.057564367	0.143435327	0	0.181649061	0.181649061	0.181649061	0.129822137	0.181649061	0.181649061	0.181649061	0	0	0.181649061	0.178273238	0.178851595	0.181649061	0.181649061	0	0.181649061	0.181649061	0.175194426	0	0	0	0	0	0	0	0												12.8637	0.096598764	2.659436269	0	3.644377074	3.003220554	4.220558608	5.671840414	15.71820971	3.306687209	9.452154236	0	0	8.53647439	6.498250058	16.81343943	0.14898856	0.548756021	0	0.57970294	3.129270881	1.022170326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9138	150	YES	22.8126249	12.8637	0.096598764	2.659436269	0	3.644377074	3.003220554	4.220558608	5.671840414	15.71820971	3.306687209	9.452154236	0	0	8.53647439	6.498250058	16.81343943	0.14898856	0.548756021	0	0.57970294	3.129270881	1.022170326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9138	NO																																										0	0	0	0	0	0	0	0	0	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	12.8637	0.096598764	2.659436269	0	3.644377074	3.003220554	4.220558608	5.671840414	15.71820971	3.306687209	9.452154236	0	0	8.53647439	6.498250058	16.81343943	0.14898856	0.548756021	0	0.57970294	3.129270881	1.022170326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9138
H7002_002_0	2012	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	1349.97	124.34	207.93	2809.84	26.39	13.53	3.63	508.13	386	1619.19	1191.65	198.86	0.28	8.3	3750.09	4329.99	67.03	705.49		1608.87	21.65	0			0.61				6.84	1.28	3197.03	631.18									3900	"$0-$175/Day(Days 1-8): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-8): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$10-$100/Visit: 3. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											133.708495	120.013094	49.537808	0	200	0.2	0.2	65	125	58.528386	67.969625	37.609995	0.2	0.2	10	33.807538	35	10		0	0.2	0			0				0	0	0	67.078739									NO	100.987084	90.64325	37.891123	0	174.8784	0.174878	0.174878	56.83548	109.299	51.176753	59.432097	32.885879	0.174878	0.174878	8.74392	29.561041	30.60372	8.74392		0	0.174878	0			0				0	0	0	58.653112										11.3608	0.939215142	0.656558434	0	0.384586748	2.36609934	0.63480714	2.406651038	3.5157845	6.905407224	5.901854866	0.544973825	0.04896584	1.4514874	2.732540579	10.66658433	0.170947279	0.514062343	0	0	3.7861087	0	0	0	0	0	0	0	0	0	0	3.085055936	0	0	0	0	0	0	0	0	58.0725	0	NO	10.668086	11.3608	0.939215142	0.656558434	0	0.384586748	2.36609934	0.63480714	2.406651038	3.5157845	6.905407224	5.901854866	0.544973825	0.04896584	1.4514874	2.732540579	10.66658433	0.170947279	0.514062343	0	0	3.7861087	0	0	0	0	0	0	0	0	0	0	3.085055936	0	0	0	0	0	0	0	0	58.0725	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	30% Coins	$200/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									5800	3.8445	0.1114	0.2011	2.9804	2.3445	0.9214	0.2471	0.2094	1.721	0.2136	0.7142	0.0542	0.0043	0.1913	1.0355	1.823	0.0136	0.1381		0.1707	0.5269	0			0				0	0	0.284	0.3585									18.1088	0	NO	10.237341	15.2052	1.050618142	0.857652434	2.98041	2.729079748	3.28753734	0.88188714	2.616092038	5.2367585	7.118993224	6.616063866	0.599162825	0.05325684	1.6427874	3.768071579	12.48957833	0.184558279	0.652196343	0	0.170682	4.3130517	0	0	0	0	0	0	0	0	0	0.284048	3.443542936	0	0	0	0	0	0	0	0	76.1813
H7006_001_0	2012	9																															D	D			T	Coin	Coin	V	V		Coin			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	494.5482686	6.774390507	0	0	158.1406418	8.518457949	1.606991229	361.0062915	279.1714984	0	5.848334489	0	0	521.8623085	3514.696275	4351.769153	133.5425875	921.8439925	1399.666709	604.2211143	12.77700273	0	0	0	352.545491	0	0	0	0	0											2500	"1a - Acute (150.00/0.00 per day-1-5/6-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (150.00/0.00 per day-1-5/6-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services - no cost sharing,2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($100 per trip)	11a - Durable Medical Equipment (10% coins per service)	"11b - Prosthetics Devices (10% coins per service),11b - Medical Supplies (10% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services ($100 per visit), 9b - Ambulatory Surgical Center Services ($100 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (min 0/ max 15 coins per visit),8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($15 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($15 per service),3 - Intensive Cardiac Rehabilitation Services ($15 per service),3 - Pulmonary Rehabilitation Services ($15 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($15 per visit),9c - Outpatient Substance Abuse Svcs - Group ($15 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($15 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($15 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($15 per visit),7f - Podiatry Services ($15 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($15 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 15.00 per visit),17a - Routine Eye Exams ($15 per visit),18a - Hearing Exams ($15 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($15 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($15 per visit),7h - Psychiatric Services - Individual ($15 per visit),7h - Psychiatric Services - Group ($15 per visit)"	"7c - Occupational Therapy Services ($15 per visit),7i - Physical/Speech Therapy ($15 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0/ max 15 coins per visit),8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($15 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($15 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - no cost sharing,16a - Preventive Dental - Prophylaxis - no cost sharing,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - no cost sharing, 16b - Comprehensive Dental ($15 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 15.00 per visit),17a - Routine Eye Exams ($15 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($15 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - Not covered,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1: Chronic Disease Self Management Program - no cost sharing,13e - Other 2:  - Not covered"											0	NO	150	150	0	0	100	0.1	0.1	49.54764389	100	0	0.15	0	0	52.20732396	15	15	15	15	15.21161959	15	0.1	0	0	0	15	0	0	0	0	0											NO	147.901669	147.901669	0	0	98.60111268	0.098601113	0.098601113	48.85452818	98.60111268	0	0.147901669	0	0	51.47700233	14.7901669	14.7901669	14.7901669	14.7901669	14.99882617	14.7901669	0.098601113	0	0	0	14.84448818	0	0	0	0	0												6.0954	0.083495305	0	0	1.299403603	0.839929432	0.158451123	1.46973267	2.293885031	0	0.864978432	0	0	2.238658939	4.331912044	5.363616008	0.164593096	1.136185542	1.749446472	0.744710927	1.259826686	0	0	0	0.436113114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5303	0	NO	0.43152536	6.0954	0.083495305	0	0	1.299403603	0.839929432	0.158451123	1.46973267	2.293885031	0	0.864978432	0	0	2.238658939	4.331912044	5.363616008	0.164593096	1.136185542	1.749446472	0.744710927	1.259826686	0	0	0	0.436113114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5303	YES	$250/Days Custom: IP 1-5 for IP Medical; $250/Days Custom: IP 1-5 for IP Medical; PBP 1a	No Cost Sharing; PBP 1b	$50/Days Custom: SNF 1-100 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; $50/Visit for OP ER; PBP 4a, 4b"	"$200/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9c, 9d"	"$30/Visit for OV; PBP 4b, 7a, 14b-c"	"$30/Visit for OV; $30/Visit for OV; $30/Visit for OV; $30/Visit for OV; $30/Visit for Vision Exams; $30/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych; PBP 7e, 7h"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 8b	$30/Visit for Office Path; $30/Visit for Office Path; $30/Visit for Office Path; PBP 7g	20% Coinsurance for Part B Rx; 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, 14b"	No Cost Sharing; PBP 13a-13e											5100	0.521	0.0069	0.2015	0.1032	0.0524	0.7793	0.0548	0.0783	0.3023	0	0.0427	0	0	0.3195	0.3148	0.8609	0.0522	0.0566	0.0327	0.1903	0.0499	0	0	0	0.0405	0	0	0	0	0											4.06	0	NO	0.057342816	6.6163	0.090369476	0.201546657	0.103169314	1.351852419	1.619221589	0.213237354	1.548061019	2.596205048	0	0.907688702	0	0	2.558205294	4.646731303	6.224525966	0.216808131	1.192812943	1.782132026	0.935011768	1.309770322	0	0	0	0.476620649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5903
H7006_002_0	2012	6																															D	D			T	Coin	Coin	V	V		Coin			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	502.4450043	7.059003283	0	0	131.8507611	8.185126113	4.218676957	216.3188708	240.5779989	0	6.539676677	0	0	768.783084	3116.934955	3577.683675	119.4259143	509.5918325	586.2357446	138.7397353	21.45841681	0	0	0	299.7797763	0	0	0	0	0											2500	"1a - Acute (150.00/0.00 per day-1-5/6-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych (150.00/0.00 per day-1-5/6-90),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services - no cost sharing,2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - Not covered"	6 - Home Health Services - no cost sharing	10a - Ambulance ($100 per trip)	11a - Durable Medical Equipment (10% coins per service)	"11b - Prosthetics Devices (10% coins per service),11b - Medical Supplies (10% coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services ($100 per visit), 9b - Ambulatory Surgical Center Services ($100 per visit)"	",8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services (min 0/ max 15 coins per visit),8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization ($15 per day)	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services ($15 per service),3 - Intensive Cardiac Rehabilitation Services ($15 per service),3 - Pulmonary Rehabilitation Services ($15 per service),3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($15 per visit),9c - Outpatient Substance Abuse Svcs - Group ($15 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care ($15 per visit),7a - In-Area Network Urgent Care Services ($25 per visit),14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - no cost sharing,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services ($15 per visit),7b - Routine Care - Not covered,7d - Physician Specialist Services ($15 per visit),7f - Podiatry Services ($15 per visit),7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services ($15 per visit),14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams (min 0.00/ max 15.00 per visit),17a - Routine Eye Exams ($15 per visit),18a - Hearing Exams ($15 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($15 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($15 per visit),7h - Psychiatric Services - Individual ($15 per visit),7h - Psychiatric Services - Group ($15 per visit)"	"7c - Occupational Therapy Services ($15 per visit),7i - Physical/Speech Therapy ($15 per visit)"	"8b - Outpatient Diagnostic Radiological Services (min 0/ max 15 coins per visit),8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services ($15 per visit)	"15 - Medicare Part B Chemotherapy Drugs (10% coins per service),15 - Other Medicare Part B Drugs (10% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services ($15 per visit),14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - Not covered	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - no cost sharing,16a - Preventive Dental - Prophylaxis - no cost sharing,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - no cost sharing, 16b - Comprehensive Dental ($15 per visit),16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams (min 0.00/ max 15.00 per visit),17a - Routine Eye Exams ($15 per visit)"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams ($15 per visit),18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - Not covered,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1: Chronic Disease Self Management Program - no cost sharing,13e - Other 2:  - Not covered"											0	NO	150	150	0	0	100	0.1	0.1	48.25439078	100	0	0.15	0	0	72.68133327	15	15	15	15	17.67912835	15	0.1	0	0	0	15	0	0	0	0	0											NO	147.8873974	147.8873974	0	0	98.59159825	0.098591598	0.098591598	47.5747751	98.59159825	0	0.147887397	0	0	71.6576881	14.78873974	14.78873974	14.78873974	14.78873974	17.4301352	14.78873974	0.098591598	0	0	0	14.93436715	0	0	0	0	0												6.1921	0.086994802	0	0	1.083281439	0.806984665	0.415926104	0.857610135	1.976580785	0	0.967135763	0	0	4.590768204	3.841294985	4.409119395	0.147179897	0.628018415	0.851514024	0.170982153	2.115619609	0	0	0	0.373085104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5142	0	NO	0.417926617	6.1921	0.086994802	0	0	1.083281439	0.806984665	0.415926104	0.857610135	1.976580785	0	0.967135763	0	0	4.590768204	3.841294985	4.409119395	0.147179897	0.628018415	0.851514024	0.170982153	2.115619609	0	0	0	0.373085104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5142	YES	$250/Days Custom: IP 1-5 for IP Surg; $250/Days Custom: IP 1-5 for IP Surg; PBP 1a	No Cost Sharing; PBP 1b	$50/Days Custom: SNF 1-100 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"	"$50/Visit for OP ER; $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; PBP 5	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 9c, 9d"	"$30/Visit for OV; PBP 4b, 7a, 14b-c"	"$30/Visit for OV; $30/Visit for OV; $30/Visit for Vision Exams; $30/Visit for Chiro; 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 8b	$30/Visit for Office Path; $30/Visit for Office Path; $30/Visit for Office Path; PBP 7g	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, 14b"	No Cost Sharing; PBP 13a-13e											5100	0.7774	0.016	0.4302	0.2505	0.1241	0.3159	0.0895	0.0834	0.3326	0	0.1132	0	0	0.848	0.6417	0.8072	0.0176	0.0637	0.0892	0.2165	0.1058	0	0	0	0.0641	0	0	0	0	0											5.3864	0	NO	0.076107936	6.9695	0.102990167	0.430150248	0.250493256	1.207378773	1.122874706	0.505394191	0.940974869	2.309188734	0	1.080380671	0	0	5.438761315	4.482986004	5.21631088	0.164768955	0.691697824	0.940709024	0.387515438	2.221460971	0	0	0	0.437139392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9006
H7015_001_0	2012	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	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	280.5392235	15.98866711	313.0873861	622.1051327	151.1994391	7.455604643	2.60139665	398.4532945	18.14466735	1.023081483	17.64014854		0.293363555	3.176233798	4059.157904	4160.32389	1.401024957	579.6918944	24.8471662	692.5838439	4.870979207			12.47055022	275	275	4				0	346.5703317	1.301427006	454.6324902	400						6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $175 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 - $65; 4B Urgent Care - $35	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient Lab - $0; D/T - 0-20%	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 Cardiac Pulmonary Rehab - 0-20%; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0	7A Primary Care - $0-$15; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $35	7E Mental Health - 40%; 7H Psychiatric Services - 40%; ; 9C Outpatient Sub Abuse - 40%	7C Occupational Therapy - $35; 7I PT and ST Services - $35	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%	7G Other Health Care - $35	15 Medicare Part B Rx Drugs - 20%		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) - $35	18B Hearing Aids - $0 ($500 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $35	18A Hearing Exams (Medicare Covered) - $35	17A Eye Exams (Medicare Covered) - $0-$35	13A Acupuncture - $5						0	NO	844.4430259	1056.450851	50	0	100	0.2	0.2	65	0.2	0.2	0.2		0.2	0.043030735	15	35	0.4	35	0.2	35	0.2	0		0.1	0	0	35				20	35	35	35	5						NO	799.6900014	1000.462028	47.35014542	0	94.70029084	0.189400582	0.189400582	61.55518904	0.189400582	0.189400582	0.189400582		0.189400582	0.040750231	14.20504363	33.14510179	0.378801163	33.14510179	0.189400582	33.14510179	0.189400582	0		0.1	0	0	35				18.94005817	33.14510179	33.14510179	33.14510179	5							18.6954	1.333004527	1.235394438	0	1.193219238	1.412095856	0.492706039	2.043905656	3.43661055	0.193772228	3.341054395	0	0.055563228	0.129432261	4.805042926	11.49119657	0.530709883	1.601162237	4.706067731	1.912980167	0.922566295	0	0	1.247055022	0	0	0.011666667	0	0	0	0	0.957259077	0.003594661	1.255736681	0.166666667	0	0	0	0	0	63.1738	0	NO	3.455625982	18.6954	1.333004527	1.235394438	0	1.193219238	1.412095856	0.492706039	2.043905656	3.43661055	0.193772228	3.341054395	0	0.055563228	0.129432261	4.805042926	11.49119657	0.530709883	1.601162237	4.706067731	1.912980167	0.922566295	0	0	1.247055022	0	0	0.011666667	0	0	0	0	0.957259077	0.003594661	1.255736681	0.166666667	0	0	0	0	0	63.1738	NO																																																																																		0				18.6954	1.333004527	1.235394438	0	1.193219238	1.412095856	0.492706039	2.043905656	3.43661055	0.193772228	3.341054395	0	0.055563228	0.129432261	4.805042926	11.49119657	0.530709883	1.601162237	4.706067731	1.912980167	0.922566295	0	0	1.247055022	0	0	0.011666667	0	0	0	0	0.957259077	0.003594661	1.255736681	0.166666667	0	0	0	0	0	63.1738
H7015_002_0	2012	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	V							0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0			0	0	0	0				0	0	0	0							0	YES	382.8645629	30.89397049	309.766574	665.1315783	278.5752562	8.816001047	2.879429503	636.1696391	23.80416775	1.045046068	18.16239165		0.283786817	5.330268611	4150.525888	4057.652858	1.67001053	379.4717957	23.02078739	805.2689763	4.509112776			1.486427723	275	275	4			200	0	268.8191505	1.367343705	463.1468255							6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $175 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 - $65; 4B Urgent Care - $35	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient Lab - $0; D/T - 0-20%	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 Cardiac Pulmonary Rehab - 0-20%; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0	7A Primary Care - $0-$15; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $35	7E Mental Health - 40%; 7H Psychiatric Services - 40%; ; 9C Outpatient Sub Abuse - 40%	7C Occupational Therapy - $35; 7I PT and ST Services - $35	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%	7G Other Health Care - $35	15 Medicare Part B Rx Drugs - 20%		10B Transportation - $0	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) - $35	18B Hearing Aids - $0 ($500 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0	13A Acupuncture - $5	7B Chiropractic Services - $20	7F Podiatry Services - $35	18A Hearing Exams (Medicare Covered) - $35	17A Eye Exams (Medicare Covered) - $0-$35							0	NO	844.4430259	1056.450851	50	0	100	0.2	0.2	65	0.2	0.2	0.2		0.2	0.070613174	15	35	0.4	35	0.2	35	0.2	0		0	0	0	35			5	20	35	35	35							NO	742.8290421	929.3254244	43.98337243	0	87.96674486	0.17593349	0.17593349	57.17838416	0.17593349	0.17593349	0.17593349		0.17593349	0.06211611	13.19501173	30.7883607	0.351866979	30.7883607	0.17593349	30.7883607	0.17593349	0		0	0	0	35			5	17.59334897	30.7883607	30.7883607	30.7883607								23.7002	2.39254602	1.135381549	0	2.042113207	1.55102983	0.506588081	3.031262668	4.187950302	0.183858602	3.195372944	0	0.049927605	0.331095553	4.563853148	10.41070665	0.587621561	0.973609543	4.050127462	2.066075975	0.793303946	0	0	0	0	0	0.011666667	0	0	0.083333333	0	0.689708414	0.003508189	1.188294293	0	0	0	0	0	0	67.7292	0	NO	9.251897727	23.7002	2.39254602	1.135381549	0	2.042113207	1.55102983	0.506588081	3.031262668	4.187950302	0.183858602	3.195372944	0	0.049927605	0.331095553	4.563853148	10.41070665	0.587621561	0.973609543	4.050127462	2.066075975	0.793303946	0	0	0	0	0	0.011666667	0	0	0.083333333	0	0.689708414	0.003508189	1.188294293	0	0	0	0	0	0	67.7292	NO																																																																																		0				23.7002	2.39254602	1.135381549	0	2.042113207	1.55102983	0.506588081	3.031262668	4.187950302	0.183858602	3.195372944	0	0.049927605	0.331095553	4.563853148	10.41070665	0.587621561	0.973609543	4.050127462	2.066075975	0.793303946	0	0	0	0	0	0.011666667	0	0	0.083333333	0	0.689708414	0.003508189	1.188294293	0	0	0	0	0	0	67.7292
H7015_003_0	2012	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	225.5855193	8.524610862	457.5436283	547.1249862	90.47752122	4.174329652	1.616090659	321.3791313	15.3915593	0.409791362	17.20979828		0.510751547	8.347870702	2192.784855	3403.845252	2.104750177	253.6263843	16.88523359	333.9817103	1.164417223			1.199016918	275	275	4				0	174.4710545	2.779263763	430.0336046							6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $175 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 - $65; 4B Urgent Care - $35	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient Lab - $0; D/T - 0-20%	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 Cardiac Pulmonary Rehab - 0-20%; 5 Partial Hosp - $0; 9D Outpatient Blood Svcs - $0	7A Primary Care - $0-$15; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - $35	7E Mental Health - 40%; 7H Psychiatric Services - 40%; ; 9C Outpatient Sub Abuse - 40%	7C Occupational Therapy - $35; 7I PT and ST Services - $35	8B Outpatient X-Rays - 20%; Outpatient Diagnostic Radiology - 20%; Therapeutic Radiology - 20%	7G Other Health Care - $35	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) - $35	18B Hearing Aids - $0 ($500 max every 3 years)	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0		7B Chiropractic Services - $20	7F Podiatry Services - $35	18A Hearing Exams (Medicare Covered) - $35	17A Eye Exams (Medicare Covered) - $0-$35							0	NO	844.4430259	1056.450851	50	0	100	0.2	0.2	65	0.2	0.2	0.2		0.2	0.081207689	15	35	0.4	35	0.2	35	0.2	0		0	0	0	35				20	35	35	35							NO	735.671667	920.3711021	43.55957977	0	87.11915955	0.174238319	0.174238319	56.62745371	0.174238319	0.174238319	0.174238319		0.174238319	0.070747457	13.06787393	30.49170584	0.348476638	30.49170584	0.174238319	30.49170584	0.174238319	0		0	0	0	35				17.42383191	30.49170584	30.49170584	30.49170584								13.8297	0.653817125	1.660867348	0	0.656860467	0.727328182	0.28158492	1.51657349	2.681799421	0.071401358	2.998606324	0	0.088992491	0.59059062	2.38791967	8.649087347	0.733456266	0.644458425	2.942054718	0.848639339	0.2028861	0	0	0	0	0	0.011666667	0	0	0	0	0.443326673	0.007062041	1.092704848	0	0	0	0	0	0	43.7214	0	NO	6.462624364	13.8297	0.653817125	1.660867348	0	0.656860467	0.727328182	0.28158492	1.51657349	2.681799421	0.071401358	2.998606324	0	0.088992491	0.59059062	2.38791967	8.649087347	0.733456266	0.644458425	2.942054718	0.848639339	0.2028861	0	0	0	0	0	0.011666667	0	0	0	0	0.443326673	0.007062041	1.092704848	0	0	0	0	0	0	43.7214	NO																																																																																		0				13.8297	0.653817125	1.660867348	0	0.656860467	0.727328182	0.28158492	1.51657349	2.681799421	0.071401358	2.998606324	0	0.088992491	0.59059062	2.38791967	8.649087347	0.733456266	0.644458425	2.942054718	0.848639339	0.2028861	0	0	0	0	0	0.011666667	0	0	0	0	0.443326673	0.007062041	1.092704848	0	0	0	0	0	0	43.7214
H7015_004_0	2012	6	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	341.4328013	31.40343957	19.27909015	1151.93184	24.20186526	11.27301569	3.002491895	4.807996442	27.55616067	5.689029653	8.636734745		0.309086583	4.843839999	38.79512707	60.44908401	5.45241648	5.789809561	12.12475986	11.89975023	8.478119158			7.613978207	206.25	412.5					0	3.233453729	0.018610383	4.754437509							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 - 0%	4A Emergency Care - 20%; 4B Urgent Care - 20%	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - 0-20%; Medicare Covered Lab - $0	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 Cardiac Pulmonary Rehab - 0-20%; 5 Partial Hosp - 20%; 9D Outpatient Blood Svcs - 20%	7A Primary Care - $0; 14A Medicare-covered Preventive Services - $0; 14D Kidney Disease Education Services - $0; 14E Diabetes Self-Management Training - $0	7D Physician Specialist - 20%	7E Mental Health - 40%; 7H Psychiatric Services - 40%; 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%		10B Transportation - NC	16A Preventative Dental - $0; 16B Comp Dental - $0	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14C Supplemental Education/Wellness Programs  - $0; 13D Pap/Pelvic Exams - $0	13A Acupuncture - $0; 13B OTC - $0	7B Chiropractic Services - 20%	7F Podiatry Services - 20%	18A Hearing Exams (Medicare Covered) - 20%	17A Eye Exams (Medicare Covered) - 0-20%							0	NO	0.06103826	0.06103826	0.140907176	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0.2	0.2	0	0.2	0.394860773	0.2	0.2	0.2	0.2	0.199236225		0	0	0					0.2	0.2	0.2	0.2							NO	0.060805162	0.060805162	0.140369069	0	0.199236225	0.199236225	0.199236225	0.199236225	0.199236225	0.199236225	0.199236225		0.199236225	0.199236225	0	0.199236225	0.393352848	0.199236225	0.199236225	0.199236225	0.199236225	0.199236225		0	0	0					0.199236225	0.199236225	0.199236225	0.199236225								20.7609	1.909491239	2.706187936	0	4.821888266	2.245993088	0.59820515	0.95792706	5.49018542	1.13346079	1.720750425	0	0.061581244	0.965068395	0	12.04364729	2.144723551	1.153539799	2.41569138	2.370861312	1.689148454	0	0	0	0	0	0	0	0	0	0	0.644221114	0.003707863	0.94725618	0	0	0	0	0	0	66.7844	0	NO	0.25601912	20.7609	1.909491239	2.706187936	0	4.821888266	2.245993088	0.59820515	0.95792706	5.49018542	1.13346079	1.720750425	0	0.061581244	0.965068395	0	12.04364729	2.144723551	1.153539799	2.41569138	2.370861312	1.689148454	0	0	0	0	0	0	0	0	0	0	0.644221114	0.003707863	0.94725618	0	0	0	0	0	0	66.7844	NO																																																																																		0				20.7609	1.909491239	2.706187936	0	4.821888266	2.245993088	0.59820515	0.95792706	5.49018542	1.13346079	1.720750425	0	0.061581244	0.965068395	0	12.04364729	2.144723551	1.153539799	2.41569138	2.370861312	1.689148454	0	0	0	0	0	0	0	0	0	0	0.644221114	0.003707863	0.94725618	0	0	0	0	0	0	66.7844
H7015_801_0	2012	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	YES	270.0320425	9.566816078	17.55385647	10.5231222	11.81154927	9.043059845	2.698626127	9.694839149	29.88529693	7.845984124	16.95530915		0.978929127	5.964860874	46.76288147	111.5395714	3.820057845	5.670113466	31.56347464	43.66226764	14.01518467																				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	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 Cardiac & Pulmonary Rehab - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Outpatient Blood Svcs- Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing; 14A Medicare-covered Preventive Services - Medicare FFS Cost-Sharing; 14B Supplemental Preventive Services - Medicare FFS Cost-Sharing; 14D Kidney Disease Education Services - Medicare FFS Cost-Sharing; 14E Diabetes Self-Management Training - 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; 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		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	14C Supplemental Education/Wellness Programs  - NA												0	NO	0.061370084	0.061370084	0.140399447	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.054432189	0.054432189	0.124565238	0	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052		0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052																					14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152	0	NO	11.13661837	14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152	NO																																																																																		0				14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152
H7015_802_0	2012	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	YES	270.0320425	9.566816078	17.55385647	10.5231222	11.81154927	9.043059845	2.698626127	9.694839149	29.88529693	7.845984124	16.95530915		0.978929127	5.964860874	46.76288147	111.5395714	3.820057845	5.670113466	31.56347464	43.66226764	14.01518467																				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	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 Cardiac & Pulmonary Rehab - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Outpatient Blood Svcs- Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing; 14A Medicare-covered Preventive Services - Medicare FFS Cost-Sharing; 14B Supplemental Preventive Services - Medicare FFS Cost-Sharing; 14D Kidney Disease Education Services - Medicare FFS Cost-Sharing; 14E Diabetes Self-Management Training - 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; 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		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	14C Supplemental Education/Wellness Programs  - NA												0	NO	0.061370084	0.061370084	0.140399447	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				NO	0.054432189	0.054432189	0.124565238	0	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052		0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052	0.198656052																					14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152	0	NO	11.13661837	14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152	NO																																																																																		0				14.6984	0.520742743	2.186600313	0	2.346435746	1.796458567	0.536098412	1.92593847	5.936895101	1.55865223	3.368274775	0	0.194470195	1.184955712	9.289729411	22.15801089	0.75887761	1.126402355	6.270275258	8.673773709	2.784201254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3152
H7086_001_0	2012	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	329.4782401	13.25965016	66.28210221	0	15.03360095	10.58789454	4.760600079	45.47001088	23.2982135	12.01168083	17.04648551	0	1.725891541	40.31760689	92.33094146	94.83726646	4.480744183	3.39957275	26.89766527	48.00560585	23.04011597	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"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	NO	0.068521452	0.068521452	0.145858933	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.06160129	0.06160129	0.131128255	0	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0.201377649	0	0	0	0	0	0	0	0	0												20.2963	0.81681155	8.69145641	0	3.027431221	2.132165314	0.958678454	9.156643909	4.69173947	2.418884051	3.432781183	0	0.347555982	8.119064904	18.59338796	19.09810579	0.902321731	0.684597969	5.416588606	9.667256062	4.639764396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0915	0	NO	13.82784792	20.2963	0.81681155	8.69145641	0	3.027431221	2.132165314	0.958678454	9.156643909	4.69173947	2.418884051	3.432781183	0	0.347555982	8.119064904	18.59338796	19.09810579	0.902321731	0.684597969	5.416588606	9.667256062	4.639764396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0915	NO																																										0	0	0	0	0	0	0	0	0	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	20.2963	0.81681155	8.69145641	0	3.027431221	2.132165314	0.958678454	9.156643909	4.69173947	2.418884051	3.432781183	0	0.347555982	8.119064904	18.59338796	19.09810579	0.902321731	0.684597969	5.416588606	9.667256062	4.639764396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0915
H7149_001_0	2012	9																															D	D	D	COIN	T	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	V	V	COIN	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	1284.90226	37.74664052	1032.763219	0	160.6582712	9.129452519	6.687032179	14.12836747	61.49284402	11.71589884	26.78919393	0.912621953	0.016228838	13.29087407	4198.906111	123.4659377	174.0389888	830.5069956	9.549895912	0	30.20535197	0	0	0	0	0	0	0	0	0											4500	1a $225 days 1-7	1b $200 days 1-7	"2 $50 days 1-22, $100 Days 21 to 55"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a 20%, 9b 20%"	"8a $0, 8a 20%, 14a $0"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	9a 20%	12 20%	"3 20%, 9a 20%, 9d $0"	"7a $10, 14a $0"	"7d $35, 17a $35, 17b 20%, 18a 20%, 7b $15 , 7f$35, 14a $0, 8a $0"	"7e $40, 7h $40, 9c $40"	"7c $35, 7i $35"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	14a $0	"15 20%, 11c 20%"				17a $0				14c $0													NO	189.311408	168.75	58.29769033	0	150	0.2	0.2	0.124763384	0.2	0.089382423	0.471811182	0.2	0.2	0.199102278	9.497515185	0.091733833	35	35	0.255000458	0	0.216956701	0	0	0	0	0	0	0	0	0											NO	160.4976974	143.0657916	49.42462349	0	127.1695925	0.169559457	0.169559457	0.105774058	0.169559457	0.075778175	0.400000239	0.169559457	0.169559457	0.168798371	8.051967572	0.077771694	29.67290492	29.67290492	0.216188695	0	0.183935302	0	0	0	0	0	0	0	0	0												17.1853	0.450021084	4.253661105	0	1.702570573	1.547985009	1.133849543	1.494414756	10.42669322	0.887809434	10.71568397	0.154743683	0.002751753	2.243477886	2.817454654	9.602155163	0.43035353	2.053629593	2.064579538	0	5.555830531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.723	0	NO	13.41481239	17.1853	0.450021084	4.253661105	0	1.702570573	1.547985009	1.133849543	1.494414756	10.42669322	0.887809434	10.71568397	0.154743683	0.002751753	2.243477886	2.817454654	9.602155163	0.43035353	2.053629593	2.064579538	0	5.555830531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.723	NO																																										0	0	0	0	0	0	0	0	0	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	17.1853	0.450021084	4.253661105	0	1.702570573	1.547985009	1.133849543	1.494414756	10.42669322	0.887809434	10.71568397	0.154743683	0.002751753	2.243477886	2.817454654	9.602155163	0.43035353	2.053629593	2.064579538	0	5.555830531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.723
H7149_801_0	2012	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	230.073204	4.9847817	29.14527678	0	6.355498695	9.020343342	6.391161468	17.57449457	57.3116122	12.35763567	24.65943083	1.226306165	0.060250941	16.80324817	35.60457033	125.9322283	3.74182914	6.341292213	11.77409991	8.369081242	28.21234971	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072479922	0.072479922	0.14499532	0	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0	0	0	0	0	0	0	0	0												16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	0	NO	12.43957556	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				100000	0	0	0	0	0	0	0	0	0	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	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798
H7149_802_0	2012	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	230.073204	4.9847817	29.14527678	0	6.355498695	9.020343342	6.391161468	17.57449457	57.3116122	12.35763567	24.65943083	1.226306165	0.060250941	16.80324817	35.60457033	125.9322283	3.74182914	6.341292213	11.77409991	8.369081242	28.21234971	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072479922	0.072479922	0.14499532	0	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0	0	0	0	0	0	0	0	0												16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	0	NO	12.43957556	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				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	NO	0	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798
H7149_803_0	2012	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	230.073204	4.9847817	29.14527678	0	6.355498695	9.020343342	6.391161468	17.57449457	57.3116122	12.35763567	24.65943083	1.226306165	0.060250941	16.80324817	35.60457033	125.9322283	3.74182914	6.341292213	11.77409991	8.369081242	28.21234971	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072479922	0.072479922	0.14499532	0	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0.198035777	0	0	0	0	0	0	0	0	0												16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	0	NO	12.43957556	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				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	NO	0	16.6757	0.361296591	4.225928723	0	1.258616123	1.786350704	1.265678628	3.480378691	11.34974966	2.447253984	4.883449549	0.242852494	0.011931842	3.327644311	7.050978756	24.9390867	0.741016042	1.255802732	2.331693026	1.657377508	5.587054601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8798
H7173_001_0	2012	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	345.7050187	23.88136591	99.79226773	0	15.28533201	19.32733583	15.23421559	29.17309426	39.27345387	6.396217775	22.71411261	0	3.702995019	35.66586629	34.08028087	45.65844088	6.553862926	4.495865527	15.03101257	63.87767324	35.6853256	38.87368603	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost-Sharing; PBP 13a-e											0	YES	0.080615313	0.080615313	0.174031735	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.080306567	0.080306567	0.173365216	0	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0.223142109	0	0	0	0	0	0	0	0												27.7624	1.917830518	17.30050808	0	3.410801224	4.312742481	3.399394998	6.509745784	8.76356133	1.427265525	5.068474994	0	0.826294119	7.958556628	7.604745753	10.1883208	1.462442796	1.003216916	3.354051848	14.25379873	7.962898821	8.674356291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1614	0	NO	0.550397448	27.7624	1.917830518	17.30050808	0	3.410801224	4.312742481	3.399394998	6.509745784	8.76356133	1.427265525	5.068474994	0	0.826294119	7.958556628	7.604745753	10.1883208	1.462442796	1.003216916	3.354051848	14.25379873	7.962898821	8.674356291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1614	NO																																										0	0	0	0	0	0	0	0	0	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	27.7624	1.917830518	17.30050808	0	3.410801224	4.312742481	3.399394998	6.509745784	8.76356133	1.427265525	5.068474994	0	0.826294119	7.958556628	7.604745753	10.1883208	1.462442796	1.003216916	3.354051848	14.25379873	7.962898821	8.674356291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1614
H7179_002_0	2012	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	1550.246637	155.2281193	372.4314983		334.6497282	10.28865232	6.489779252	480.1927011	193.5427306		11.48707479	105.1446864	0.026811882	17.40386231		3133.062379	53.61712942	785.3023778			17.5031637	0.335792598			159.1037094																4950	"1a - IP Acute 200 days 1-5, 1a1 - Add'l Days Unlimited"	1b - IP Psych 250 days 1-5	"2a - Skilled Nursing Facility (SNF) 50 days 1-20, 100 days 21-100"	6a - Home Health 0 copay	10a - Ambulance 225 copay	11a - Durable Medical Equipment (DME) 20% coin	"11b - Prosthetics & Medical Supplies 20% coin,11c - Diabetic Supplies and Services 20% coin"	"4a - ER 65 copay, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC 40 copay"	"9a4 - OP Surgical (Hospital) 250 copay,9b - OP Ambulatory Surgical Center (ASC) 250 copay"	8a - OP Diag Proc/Test/Lab  (M/C) 0% coin	8b1 - X-Ray 20% coin	9a1 - OP Observation 250 copay	12 - End Stage Renal Disease (ESRD) 20% coin	"3 - Cardiac and Pulmonary Rehab Services 50 copay/visit, 5 - Partial Hosp 50 copay, 9a2 - OP Other 20% coin, 9a3 - OP Chemo 20% coin, 9c - OP Substance Abuse (SA) 50 copay, 9d - OP Blood Services 0 copay, 9d1 (3 Pint Blood) 0 copay"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 20 copay,7b1 - Routine Chiro n/a,7d - SPC w/Copay 25 copay,7f (Podiatry) 25 copay,7f1 - Routine Podiatry n/a"	"7h - Psych 40 copay,,7e - MH Professional 40 copay"	"7i - Physical Therapy and Speech Pathology (PT/ST) 20 copay,7c - Occupational Therapy (OT) 20 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx 20% coin	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 25 copay,18a - Hearing Exam (M/C) 25 copay"	10b - Transportation n/a	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Gold,16b1 - Routine Comprehensive Dental Gold"	"17a - Eye Exam (M/C) 25 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 100	"18a1 - Routine Hearing Exam 25 copay,18a - Hearing Exam (M/C) 25 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 700 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx n/a"													123.7907681	142.4713977	60.09645318		225	0.2	0.2	64.75	250		0.2	250	0.2	0.200099145		24.71224528	40	20			0.2				5																NO	115.8213198	133.2993208	56.22754125		210.5148659	0.187124325	0.187124325	60.58150029	233.9054065		0.187124325	233.9054065	0.187124325	0.187217088		23.15260356	37.42486504	18.71243252			0.187124325				5																	14.9626	1.724316906	1.745075619	0	5.870728553	1.925257123	1.214395563	2.424232855	3.772557591	0	2.149511119	2.049492551	0.005017155	3.258300415	0	6.044879264	0.167217819	1.224576479	0	0	3.275267696	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8798	0		3.556455064	14.9626	1.724316906	1.745075619	0	5.870728553	1.925257123	1.214395563	2.424232855	3.772557591	0	2.149511119	2.049492551	0.005017155	3.258300415	0	6.044879264	0.167217819	1.224576479	0	0	3.275267696	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8798	NO																																																																																		0	0		0	14.9626	1.724316906	1.745075619	0	5.870728553	1.925257123	1.214395563	2.424232855	3.772557591	0	2.149511119	2.049492551	0.005017155	3.258300415	0	6.044879264	0.167217819	1.224576479	0	0	3.275267696	0	0	0	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8798
H7179_003_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	264.8062106	1.64340155	65.4647763		26.11008233	12.23739114	15.2556027	31.32310497	64.94113181	6.835864575	14.46863682	2.170011289	0.245606607	27.00062207		4624.695398	2.860480938	2121.416625		2962.884248	15.72596671	0.039353012			159.1037094		0.836296301														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 50"													0.082329321	0.082329321	0.223349263		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		3.113012391	0.224	1202.421981			5		10														NO	0.066833473	0.066833473	0.181310945		0.181839201	0.181839201	0.181839201	0.181839201	0.181839201	0.181839201	0.181839201	0.181839201	0.181839201	0.181839201		8.117821486	0.181839201	8.117821486		2.527087887	0.181839201	976.1046989			5		10															17.6979	0.109834233	11.86948043	0	4.747836516	2.22523743	2.77406661	5.695768389	11.80884354	1.243028154	2.630965363	0.39459312	0.044660909	4.909771551	0	3.128537639	0.520147569	1.435106789	0	0.623955741	2.859597227	0.003201055	0	0	0.066293212	0	0.000696914	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7895	0		17.32499049	17.6979	0.109834233	11.86948043	0	4.747836516	2.22523743	2.77406661	5.695768389	11.80884354	1.243028154	2.630965363	0.39459312	0.044660909	4.909771551	0	3.128537639	0.520147569	1.435106789	0	0.623955741	2.859597227	0.003201055	0	0	0.066293212	0	0.000696914	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7895	NO																																																																																		0	0		0	17.6979	0.109834233	11.86948043	0	4.747836516	2.22523743	2.77406661	5.695768389	11.80884354	1.243028154	2.630965363	0.39459312	0.044660909	4.909771551	0	3.128537639	0.520147569	1.435106789	0	0.623955741	2.859597227	0.003201055	0	0	0.066293212	0	0.000696914	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7895
H7179_013_0	2012	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	V	V	Coin	V	T	P	P	P	P	P	O	O																																																			0	YES	310.3938957	4.420598761	42.51433469		11.54027554	12.85839422	11.91011041	36.20783822	77.93929494	11.34010828	21.51238868	6.44395803	0.660659144	37.97359691		5762.27706	4.598305357	855.3006531		3766.63683	45.70984032	0.097768307			159.1037094		1.918947109														3400	"1a - IP Acute FFS, 1a1 - Add'l Days Unlimited"	1b - IP Psych FFS	2a - Skilled Nursing Facility (SNF) FFS	6a - Home Health 0 copay	10a - Ambulance FFS	11a - Durable Medical Equipment (DME) FFS	"11b - Prosthetics & Medical Supplies FFS,11c - Diabetic Supplies and Services FFS"	"4a - ER FFS, 4a1 - ER - Worldwide Coverage $10,000 annual max, 4b - UC FFS"	"9a4 - OP Surgical (Hospital) FFS,9b - OP Ambulatory Surgical Center (ASC) FFS"	8a - OP Diag Proc/Test/Lab  (M/C) FFS	8b1 - X-Ray FFS	9a1 - OP Observation FFS	12 - End Stage Renal Disease (ESRD) FFS	"3 - Cardiac and Pulmonary Rehab Services FFS, 5 - Partial Hosp FFS, 9a2 - OP Other FFS, 9a3 - OP Chemo FFS, 9c - OP Substance Abuse (SA) FFS, 9d - OP Blood Services FFS, 9d1 (3 Pint Blood) FFS"	"7a - PCP w/Copay 0 copay,14a - Zero Cost-sharing Preventive Services (M/C) 0 copay,14a2 (Routine Physical) 0 copay,14a3 (Pap & Pelvic Exam) 0 copay,14a4 (Prostate Screening) 0 copay,14a5 (Colorectal Screening) 0 copay,14a6 (Mammography) 0 copay,14b2 - Additional Pap Exams n/a,14b3 - Additional Pelvic Exams n/a,14a7 (Nutrition Therapy Diabetes) 0 copay,14b4 - Additional Prostate Exams n/a,14a8 (Bone Mass) 0 copay,14b5 - Additional Colorectal Exams n/a,14b6 - Additional Mammorgraphy Exams n/a,14e - Diabetes Self Management Training 0 copay"	"7b - Chiro 10 copay,7b1 - Routine Chiro 0% coin 5 visits,7d - SPC w/Copay 10 copay,7f - Podiatry 10 copay,7f1 - Routine Podiatry 0% coin 3 visits"	"7h - Psych FFS,,7e - MH Professional FFS"	"7i - Physical Therapy and Speech Pathology (PT/ST) 10 copay,7c - Occupational Therapy (OT) 10 copay"		"7g - Prof. Other (Nurse Midwives, Reg. Nurse Anesthetists, Respiratory Therapy Tech, Nurse Specialists, Nutritionists, Pharmacists, Physician Assistants.) 0% coin"	15 - Part B Rx FFS	"14a1 (Smoking Cessation - Mdcr Covered) 0 copay, , ,16b - Comprehensive Dental (M/C) 10 copay,18a - Hearing Exam (M/C) 10 copay"	10b - Transportation 24 trips/yr	"16a - Preventive Dental (Exams, Cleaning, Xray, Fluoride) Platinum,16b1 - Routine Comprehensive Dental Platinum"	"17a - Eye Exam (M/C) 10 copay 17b - Eyewear (M/C) 0% coin,17a1 - Routine Eye Exam 5 copay"	17b1 - Routine Eyewear Allowance (1 per 2yrs.) 150	"18a1 - Routine Hearing Exam 10 copay,18a - Hearing Exam (M/C) 10 copay"	18b1 - Routine Hearing Aids (1 aid per 3yrs.) 1200 allowance	"14c3 - Additional Smoking Cessation n/a, , 14c5 - Nursing Hotline n/a, 14c1 - Written Health Edu. Materials / incl. Newsletters 0 copay, 14c2 - Nutritional Benefit 0 copay,14c4 - Membership in Health Club/Fitness Classes 0 copay"	"13a - Acupuncture n/a,13b - OTC Rx 50"													0.083149805	0.083149805	0.221914707		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		10	0.224	10		3.821362868	0.224	1111.317866			5		10														NO	0.06522491	0.06522491	0.174075775		0.175711534	0.175711534	0.175711534	0.175711534	0.175711534	0.175711534	0.175711534	0.175711534	0.175711534	0.175711534		7.844264918	0.175711534	7.844264918		2.997578269	0.175711534	871.7471753			5		10															20.2454	0.288333156	7.400715754	0	2.027759519	2.259368176	2.092743772	6.362134802	13.69483309	1.992587824	3.779974818	1.132277752	0.116085432	6.672398972	0	3.766735649	0.807975289	0.559100409	0	0.940899059	8.03174617	0.007102437	0	0	0.066293212	0	0.001599123	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2461	0		22.58393876	20.2454	0.288333156	7.400715754	0	2.027759519	2.259368176	2.092743772	6.362134802	13.69483309	1.992587824	3.779974818	1.132277752	0.116085432	6.672398972	0	3.766735649	0.807975289	0.559100409	0	0.940899059	8.03174617	0.007102437	0	0	0.066293212	0	0.001599123	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2461	NO																																																																																		0	0		0	20.2454	0.288333156	7.400715754	0	2.027759519	2.259368176	2.092743772	6.362134802	13.69483309	1.992587824	3.779974818	1.132277752	0.116085432	6.672398972	0	3.766735649	0.807975289	0.559100409	0	0.940899059	8.03174617	0.007102437	0	0	0.066293212	0	0.001599123	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2461
H7187_003_0	2012	5																															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	1220.113141	112.1735218	804.85568	537.2074843	129.4831925	11.29352799	10.04001655	344.2601198	41.4792758	13.63826244	23.38375324	0	0.016779284	25.58066929	4580.451851	2820.606862	514.4543655	298.3383855	0	0	14.29974472	639.1214208	0	0	29.54389179	0	7.579252628	0	107.4217734	0											3950	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	186.94397	105.9099535	62.49751365	0	200	0.2	0.091549602	64.33913901	0.16	0.231884959	0.186715197	0	0.2	0.14617693	6.273969509	29.55163096	38.5	30	0	0	0.2	29.22456724	0	0	30	0	30	0	0	0											YES	145.7147787	82.5522505	48.71412206	0	155.8913922	0.155891392	0.071358974	50.16636793	0.124713114	0.180744346	0.14553646	0	0.155891392	0.113938625	6.039291523	28.44884142	37.05990654	28.87784925	0	0	0.155891392	22.77929237	0	0	30	0	30	0	0	0											5350	14.8157	0.771681389	3.26731982	0	1.682109596	1.760563801	0.716445282	1.439189986	5.173009641	2.465038822	3.403188673	0	0.002615746	2.914626298	2.30522367	6.686916443	1.588802559	0.717947577	0	0	2.229207113	1.213227809	0	0	0.073859729	0	0.018948132	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2456	0	NO	12.2801475	14.8157	0.771681389	3.26731982	0	1.682109596	1.760563801	0.716445282	1.439189986	5.173009641	2.465038822	3.403188673	0	0.002615746	2.914626298	2.30522367	6.686916443	1.588802559	0.717947577	0	0	2.229207113	1.213227809	0	0	0.073859729	0	0.018948132	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2456	NO	"$315 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$315 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-31 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$15 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.6658	0.0512	0.3744	0.6793	0.4705	0	0.6567	0.4026	2.1703	0.6895	1.3841	0	0.0007	1.2213	1.2311	2.5393	0.577	0.2692	0	0	1.0161	0.4312	0	0	0.028	0	0.0072	0	0	0											14.8653	0	NO	4.001657838	15.4815	0.82288712	3.641691117	0.679281098	2.152597963	1.760563801	1.373108098	1.841774872	7.343356508	3.154513571	4.787248349	0	0.003347374	4.135925221	3.536314344	9.226238793	2.165811732	0.987177783	0	0	3.245264653	1.644412268	0	0	0.101822077	0	0.026121652	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1109
H7187_009_0	2012	4																															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	1295.906732	112.2182569	764.1096912	878.1220706	129.1330461	11.12524112	11.95665977	373.3481522	40.70533945	14.92615981	28.93485312	0	0.018009469	26.37805207	5099.200629	3055.321893	506.696256	291.0234239	0	0	12.37951174	645.9815018	0	0	29.84783901	0	10.57244176	0	134.851124	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	63.29835554	0	200	0.2	0.10583282	63.74724307	0.16	0.236146708	0.183006101	0	0.2	0.146057066	6.450489276	29.7109193	38.5	30	0	0	0.2	28.7799316	0	0	30	0	30	0	0	0											NO	139.238098	74.34854591	47.10141936	0	148.8235167	0.148823517	0.078752062	47.45347661	0.119058813	0.175720917	0.136178058	0	0.148823517	0.108683631	6.167315206	28.41193224	36.80986438	28.6830112	0	0	0.148823517	21.41565316	0	0	30	0	30	0	0	0												15.0366	0.695272019	2.999220917	0	1.601502837	1.655697508	0.941611614	1.476388984	4.846329413	2.622838494	3.940292092	0	0.002680232	2.866862477	2.620698131	7.233966549	1.554285039	0.695619011	0	0	1.842362472	1.152842982	0	0	0.074619598	0	0.026431104	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8862	0	NO	14.88645326	15.0366	0.695272019	2.999220917	0	1.601502837	1.655697508	0.941611614	1.476388984	4.846329413	2.622838494	3.940292092	0	0.002680232	2.866862477	2.620698131	7.233966549	1.554285039	0.695619011	0	0	1.842362472	1.152842982	0	0	0.074619598	0	0.026431104	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8862	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)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$15 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												1.002	0.0863	0.6485	0.9868	0.6429	0	1.0714	0.5924	2.9181	1.0529	2.308	0	0.0011	1.7241	1.4513	2.8875	0.596	0.2754	0	0	1.2052	0.5886	0	0	0.0283	0	0.01	0	0	0											20.0767	0	NO	0	16.0386	0.781537843	3.647770809	0.986848185	2.24437298	1.655697508	2.013052555	2.068811121	7.764426475	3.675689928	6.248269343	0	0.003756123	4.590932113	4.071960448	10.12143526	2.15032426	0.971063366	0	0	3.047520237	1.741413223	0	0	0.102869622	0	0.036437582	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9628
H7187_801_0	2012	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	207.8653396	7.833429	24.48713631	566.7727635	5.054728734	9.217246772	10.64180473	15.64253929	43.96126459	14.45433296	24.78296315	0	0.017783303	27.09882463	24.97398435	53.8263249	2.883949	3.768945554	0	0	15.1568566	6.548423642	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.085635198	0.085635198	0.180355651	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.072905658	0.072905658	0.153546062	0	0.190702746	0.190702746	0.190702746	0.190702746	0.190702746	0.190702746	0.190702746	0	0.190702746	0.190702746	0.190702746	0.190702746	0.190702746	0.190702746	0	0	0.190702746	0.190702746	0	0	0	0	0	0	0	0												15.1546	0.571101295	3.759903357	0	0.963950649	1.757754269	2.029421384	2.983075196	8.383533871	2.756480987	4.726179124	0	0.003391325	5.167820269	4.762607392	10.26482796	0.549976993	0.718748266	0	0	2.890454173	1.24880237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6926	150	YES	11.99392569	15.1546	0.571101295	3.759903357	0	0.963950649	1.757754269	2.029421384	2.983075196	8.383533871	2.756480987	4.726179124	0	0.003391325	5.167820269	4.762607392	10.26482796	0.549976993	0.718748266	0	0	2.890454173	1.24880237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6926	NO	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"												0.5505	0.0207	0.257	0	0.3382	0.6167	0.712	1.0466	2.9414	0.9671	1.6582	0	0.0012	1.8132	1.5811	3.9126	0.2096	0.274	0	0	1.1017	0.476	0	0	0	0	0	0	0	0											18.478	150	YES	0	15.7051	0.59184822	4.016942127	0	1.302157954	2.374471871	2.741454865	4.029703279	11.32494212	3.723607265	6.384384659	0	0.004581189	6.98097799	6.343745094	14.17739579	0.759607617	0.992708176	0	0	3.992187008	1.724799045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1706
H7188_003_0	2012	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		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	1352.08	74.86	386.89	1118.86	23.59	14.61	3.74	399.06	391.08	998.3	1192.02	121.35	0.59	731.68	3023.81	3424.42	75.5	659.49		1794.96	22.31	0		3.07	1.87				3.93	1.19	1861.45										5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	128.006658	44.329117	0	150	0.2	0.2	65	225	0	38.818558	38.652259	0.2	46.746873	10	33.089636	35	46.85142		0	0.2	0		0	0				0	0	0										NO	134.343669	104.865998	36.428205	0	139.1655	0.185554	0.185554	60.30505	208.74825	0	36.014694	35.860406	0.185554	43.370346	9.2777	30.699572	32.47195	43.467342		0	0.185554	0		0	0				0	0	0											15.1369	0.654189051	1.174475686	0	0.273576179	2.71094394	0.69397196	2.005444438	6.803105468	0	3.577519628	0.362638356	0.10947686	2.644434563	2.337833503	8.760685696	0.204302685	2.388856448	0	0	4.13970974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9781	0	NO	6.620773	15.1369	0.654189051	1.174475686	0	0.273576179	2.71094394	0.69397196	2.005444438	6.803105468	0	3.577519628	0.362638356	0.10947686	2.644434563	2.337833503	8.760685696	0.204302685	2.388856448	0	0	4.13970974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9781	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"						30% Coins										5500	2.026	0.1077	0.3711	1.4759	1.76	0.8356	0.2139	0.1842	1.6651	0.2394	0.7207	0.028	0.0101	0.6113	0.8862	1.5408	0.0213	0.1417		0.2124	0.6231	0							0	0	0.1631										13.8377	0	NO	3.629517	17.1629	0.761885051	1.545567686	1.475873	2.033589179	3.54652494	0.90782896	2.189620438	8.468186468	0.239385	4.298260628	0.390688356	0.11954986	3.255773563	3.224082503	10.3014687	0.225643685	2.530598448	0	0.212433	4.76281174	0	0	0	0	0	0	0	0	0	0.163098	0	0	0	0	0	0	0	0	0	67.8158
H7188_005_0	2012	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	Skilled Nursing Facility							Prosthetics/Supplies	Acute	Mental Health								A	A	A	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O	O	D	D	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	YES	252.62	9.38	31.92	1414.66	23.65	13.65	4.21	376.43	351.85	1229.61	1050.74	164.53	0.4	688.96	3312.21	4077.15	104.56	721.59		1784.75	23.1	0			0.61				3.93	1.71	1243.35	0	0	0							3400	$0/Admit: 1a. $0 IP Acute - Facility 1	$0/Admit: 1b. $0 IP Psych - Facility 1	"$0/Admit(Days 1-1), $0 (Days 2-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Day(Days 1-100) : 2. $0 SNF - Physician									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	0	0	0	0							NO	0	0	0	0	0	0.199628	0.199628	0	0	0	0	0	0.199628	0	0	0	0	0		0	0.199628	0			0				0	0	0	0	0	0								0	0	0	0	0	2.7249222	0.84043388	0	0	0	0	0	0.0798512	0	0	0	0	0	0	0	4.6114068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.2566	0	NO	0.015399	0	0	0	0	0	2.7249222	0.84043388	0	0	0	0	0	0.0798512	0	0	0	0	0	0	0	4.6114068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.2566	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			"VIS775: Vision 17a,17b"						25% Coins	30% Coins	30% Coins	30% Coins(Days 1-100)							5100	3.4029	0.0596	0.2207	2.674	0	1.0199	0.3149	0	2.676	0.4162	1.1196	0.0564	0.0109	0.9338	1.5374	2.9244	0.0368	0.2626		0.3765	0.997	0							0	0	0.1354	0.6145	0	0.0219							19.8113	1000	NO	9.833744	3.4029	0.059635	0.220653	2.674005	0	3.7448052	1.15531688	0	2.675978	0.416239	1.119588	0.056367	0.0907362	0.933807	1.537382	2.924437	0.036767	0.262617	0	0.376541	5.6084348	0	0	0	0	0	0	0	0	0	0.135367	0.614475	0.000024	0.021883	0	0	0	0	0	0	28.0679
H7188_006_0	2012	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	1212.47	54.98	375.5	1336.81	22.34	12.25	3.78	355.72	332.49	1161.95	992.92	155.48	0.36	651.05	3129.95	3852.8	98.81	681.88		1686.54	20.73	0			0.61				3.93	0.69	1174.94										5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$75/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$75/Visit: 3. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $75 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$75/Visit: 7c, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	128.006658	44.329117	0	150	0.2	0.2	65	250	0	39.421917	37.015514	0.199029	46.179491	15	32.846114	35	47.813976		0	0.2	0			0				0	0	0										NO	149.657576	105.137757	36.579323	0	139.1829	0.185577	0.185577	60.31259	231.9715	0	36.579045	34.346177	0.184676	42.849304	13.91829	30.47745	32.47601	44.365919		0	0.185577	0			0				0	0	0											15.1213	0.481706157	1.144627982	0	0.259112166	2.27331825	0.70148106	1.78786621	6.427350336	0	3.026672113	0.445011967	0.06648336	2.324753281	3.630295982	9.78529328	0.267412879	2.521019404	0	0	3.84701121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1107	0	NO	6.540082	15.1213	0.481706157	1.144627982	0	0.259112166	2.27331825	0.70148106	1.78786621	6.427350336	0	3.026672113	0.445011967	0.06648336	2.324753281	3.630295982	9.78529328	0.267412879	2.521019404	0	0	3.84701121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1107	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										5500	2.2049	0.096	0.3663	2.018	2.1976	0.9236	0.2852	0.2165	2.0195	0.3141	0.8449	0.0425	0.0082	0.7047	1.1602	2.207	0.0277	0.1982		0.2842	0.7524	0			0				0	0	0.1226										16.9944	500	NO	3.457265	17.3262	0.577703157	1.510912982	2.01801	2.456743166	3.19693725	0.98664306	2.00432321	8.446850336	0.314126	3.871598113	0.487551967	0.07465836	3.029476281	4.790522982	11.99229928	0.295159879	2.719210404	0	0.284167	4.59944521	0	0	0	0	0	0	0	0	0	0.122589	0	0	0	0	0	0	0	0	0	71.1051
H7200_006_0	2012	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	345.3197481	9.28945158	34.7223817	0	14.90753455	13.02380437	8.850922677	41.66984971	43.32907781	17.7735634	14.49636534	0	4.915616071	21.9005616	49.55610926	108.3839189	3.560607332	6.968116835	15.97671057	37.8874543	27.97265567	4.654208815	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	19% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; 20% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Physical Exams; PBP 7a, 14a-b"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 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); 20% Coinsurance for Office-Rad Therapeutic; 20% Coinsurance for Office-Rad Diagnostic; 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; 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"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 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 13a-e, 14c"											0	NO	0.083747405	0.083747405	0.185099275	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.076526656	0.076526656	0.169139909	0	0.182755885	0.182755885	0.182755885	0.182755885	0.182755885	0.182755885	0.186553242	0	0.182755885	0.182755885	0.182755885	0.182785295	0.182755885	0.182755885	0.186923009	0.182755885	0.182755885	0.185979911	0	0	0	0	0	0	0	0												26.4262	0.710890663	5.872940469	0	2.724439669	2.380176893	1.617558206	7.615410259	7.918643959	3.248223308	2.704343949	0	0.898357765	4.002456515	9.056670602	19.81098662	0.650721944	1.273464359	2.986414813	6.924155238	5.112167442	0.865589343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7998	0	NO	10.49032594	26.4262	0.710890663	5.872940469	0	2.724439669	2.380176893	1.617558206	7.615410259	7.918643959	3.248223308	2.704343949	0	0.898357765	4.002456515	9.056670602	19.81098662	0.650721944	1.273464359	2.986414813	6.924155238	5.112167442	0.865589343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7998	NO																																										0	0	0	0	0	0	0	0	0	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	26.4262	0.710890663	5.872940469	0	2.724439669	2.380176893	1.617558206	7.615410259	7.918643959	3.248223308	2.704343949	0	0.898357765	4.002456515	9.056670602	19.81098662	0.650721944	1.273464359	2.986414813	6.924155238	5.112167442	0.865589343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7998
H7200_007_0	2012	7																															D	D	D		T	Coin	Coin	V	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	YES	883.7812642	37.18342161	514.4859784	0	284.9356085	9.565246261	5.594729039	335.8322982	314.4436802	211.4481423	588.4442723	0	11.33231634	852.7848985	4269.810666	4443.625324	175.2868887	533.1326846	675.4007734	0	32.82824914	0	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	$200/Days 1-7 for IP Psych; $200/Days 1-7 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $30/Visit for Speclst Urgent Care; PBP 4a, 4b"	$100/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; $60/Visit for Radiology - Therapeutic; $100/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	$30/Visit for Renal Dialysis - Fac; PBP 12	"$200/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; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP Office Visits; PBP 7a, 14a-b"	"$30/Visit for Speclst Office Visits; $20/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"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	$50/Visit for Prof Radiology (Office); $100/Visit for Prof Radiology (Office); $60/Visit for Office-Rad Therapeutic; $100/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; 20% Coinsurance for Rx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											0	NO	250	200	97.32949737	0	100	0.2	0.2	61.37486313	100	200	70.82246715	0	30	121.2590775	10	29.30191232	30	30	74.16423829	0	0.2	0	0	0	0	0	0	0	0	0											NO	232.8693476	186.2954781	90.66022623	0	93.14773905	0.186295478	0.186295478	57.18498983	93.14773905	186.2954781	65.96952689	0	27.94432172	112.9500891	9.314773905	27.29406883	27.94432172	27.94432172	69.08231116	0	0.186295478	0	0	0	0	0	0	0	0	0												17.1505	0.577258609	3.886951266	0	2.211758975	1.781962125	1.042272721	1.600380546	2.440809822	3.28265273	3.234949187	0	0.026389491	8.02684419	3.314360081	10.10705129	0.408189434	1.241502605	3.888187199	0	6.115754369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3377	0	NO	5.17380912	17.1505	0.577258609	3.886951266	0	2.211758975	1.781962125	1.042272721	1.600380546	2.440809822	3.28265273	3.234949187	0	0.026389491	8.02684419	3.314360081	10.10705129	0.408189434	1.241502605	3.888187199	0	6.115754369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3377	YES	$350/Days 1-7 for IP Medical; $350/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	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"	"$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a, 4b"	$200/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; $150/Visit for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"$40/Visit for Speclst Office Visits; $40/Visit for Chiropractor; $40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 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"	"No Cost-Sharing; PBP 7c, 7i"	$100/Visit for Prof Radiology (Office); $150/Visit for Prof Radiology (Office); $150/Visit for Office-Rad Diagnostic; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 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 13a-e, 14c"											6700	2.7547	0.0579	0	0	0	0	0	0.1579	0.5594	0	0.5911	0	0	0	0	1.4264	0.0539	0	0.5842	0	0	0	0	0	0	0	0	0	0	0											6.1856	0	NO	0.455033705	19.9052	0.635207447	3.886951266	0	2.211758975	1.781962125	1.042272721	1.75830711	3.000210021	3.28265273	3.826087495	0	0.026389491	8.02684419	3.314360081	11.53344658	0.462048408	1.241502605	4.472401502	0	6.115754369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5233
H7220_002_0	2012	4																															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	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	1081.471673	25.01122514	3454.140995	36.49411693	143.6329261	7.222909071	2.770540563	243.6217031	251.2400357	1513.661107	360.3427528	0.614365447	1.803722069	359.7426183	2608.688729	4523.186805	80.70194842	97.42928098	244.8298683	1616.541705	13.15630397	0	0	366	542.9293328	0.079130967	0.205906105	0	14.08880644	0											4500	1a (IP Acute): $210 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): $210 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): $65 Copay per trips;	11a (DME): 10% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $65 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $210 Copay per visits; 9b (OP Surg): $210 Copay per visits;	8a (OP Diag Proc/Test/Lab): $10 Copay;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay; 8b (X-Ray): $25 Copay;	9a (OP Observation): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (Cardiac Rehab): $0 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 (Blood): $0 Copay per visits;	14c (Education/Wellness): n/a; 14d (Kidney Disease Edu.): $0 Copay per visits; 14e (Diabetes Training): $0 Copay per visits; 7a (PCP w/Copay): $25 Copay per visits;	7d (SPC w/Copay): $40 Copay per visits;	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): $20 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;	14a (Medicare-covered Zero Cost-Sharing Preventive Services): $0 Copay per visits;	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $15 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 per visits;		14c (Supplemental Education/Wellness Programs): $25 copay per year;	13d (Other 1 - Supplemental Annual Pap Smear): $0 Copay per visits; 13e (Other 2 - Supplemental Physical): $0 Copay per visits													115.2296387	83.63755817	29.02460212	0	65	0.1	0.141747934	58.52486885	210	10	28.66293301	0	0	215.693129	17.20076165	39.25888955	40	15	0	4.074642718	0.2	0	0	10	15	0	0	0	25	0											NO	101.7330457	73.8412758	25.62501461	0	57.38669363	0.088287221	0.125145312	51.66998029	185.403164	8.828722097	25.305707	0	0	190.4294694	15.18607444	34.66058256	35.31488839	13.24308315	0	3.59738882	0.176574442	0	0	8.828722097	13.24308315	0	0	0	22.07180524	0												9.1685	0.153905064	7.376034454	0	0.686884894	0.637690569	0.346720163	1.04899405	3.881724795	1.113641105	0.75989401	0	0	5.708799661	3.30131177	13.06469081	0.237498358	0.107522006	0	0.484610755	2.323067031	0	0	0.269276024	0.599171525	0	0	0	0.025913783	0	0	0	0	0	0	0	0	0	0	0	51.2958	0		6.827058657	9.1685	0.153905064	7.376034454	0	0.686884894	0.637690569	0.346720163	1.04899405	3.881724795	1.113641105	0.75989401	0	0	5.708799661	3.30131177	13.06469081	0.237498358	0.107522006	0	0.484610755	2.323067031	0	0	0.269276024	0.599171525	0	0	0	0.025913783	0	0	0	0	0	0	0	0	0	0	0	51.2958	NO																																																																																		0	0		0	9.1685	0.153905064	7.376034454	0	0.686884894	0.637690569	0.346720163	1.04899405	3.881724795	1.113641105	0.75989401	0	0	5.708799661	3.30131177	13.06469081	0.237498358	0.107522006	0	0.484610755	2.323067031	0	0	0.269276024	0.599171525	0	0	0	0.025913783	0	0	0	0	0	0	0	0	0	0	0	51.2958
H7220_003_0	2012	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	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	1492.841368	34.45351807	4409.062975	17.42514951	215.062989	9.444957224	3.437047492	468.3407346	280.2371893	2445.375438	275.994552	1.269585183	1.197378107	382.6480241	3330.382362	7164.639542	143.7715486	85.5098519	0	729.1206143	17.81850602	0	0	366	673.9391171	0.047850703	0.076326519	0	14.08880644	0											5000	1a (IP Acute): $265 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): $265 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): $65 Copay per trips;	11a (DME): 10% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $65 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $265 Copay per visits; 9b (OP Surg): $265 Copay per visits;	8a (OP Diag Proc/Test/Lab): $10 Copay;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay; 8b (X-Ray): $25 Copay;	9a (OP Observation): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (Cardiac Rehab): $0 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 (Blood): $0 Copay per visits;	14c (Education/Wellness): n/a; 14d (Kidney Disease Edu.): $0 Copay per visits; 14e (Diabetes Training): $0 Copay per visits; 7a (PCP w/Copay): $25 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): $15 Copay per visits; 7i (PT/ST): $15 Copay per visits;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not Covered;	7b (Chiro): $20 Copay per visits; 7f (Podiatry): $15 Copay per visits; 8b (X-Ray): $25 Copay per visits; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	14a (Medicare-covered Zero Cost-Sharing Preventive Services): $0 Copay per visits;	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $15 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 per visits;		14c (Supplemental Education/Wellness Programs): $25 copay per year;	13d (Other 1 - Supplemental Annual Pap Smear): $0 Copay per visits; 13e (Other 2 - Supplemental Physical): $0 Copay per visits													164.9070599	106.05552	32.68939745	0	65	0.1	0.164773736	56.4959198	265	10	29.23883018	0	0	236.2405229	18.77499469	48.92501956	40	15	0	5.392723547	0.2	0	0	10	15	0	0	0	25	0											NO	145.0483364	93.2839186	28.75281824	0	57.17245748	0.087957627	0.144931068	49.69247035	233.0877113	8.79576269	25.71778116	0	0	207.7915577	16.51403978	43.03328617	35.18305076	13.19364403	0	4.743311657	0.175915254	0	0	8.79576269	13.19364403	0	0	0	21.98940672	0												18.0445	0.267829931	10.56441553	0	1.024639966	0.830756024	0.498134964	1.939417339	5.443320422	1.792411837	0.591497291	0	0	6.625919082	4.583172234	25.69316531	0.421526808	0.094015546	0	0.288203859	3.134547008	0	0	0.268270762	0.740976068	0	0	0	0.025817041	0	0	0	0	0	0	0	0	0	0	0	82.8726	0		11.35637645	18.0445	0.267829931	10.56441553	0	1.024639966	0.830756024	0.498134964	1.939417339	5.443320422	1.792411837	0.591497291	0	0	6.625919082	4.583172234	25.69316531	0.421526808	0.094015546	0	0.288203859	3.134547008	0	0	0.268270762	0.740976068	0	0	0	0.025817041	0	0	0	0	0	0	0	0	0	0	0	82.8726	NO																																																																																		0	0		0	18.0445	0.267829931	10.56441553	0	1.024639966	0.830756024	0.498134964	1.939417339	5.443320422	1.792411837	0.591497291	0	0	6.625919082	4.583172234	25.69316531	0.421526808	0.094015546	0	0.288203859	3.134547008	0	0	0.268270762	0.740976068	0	0	0	0.025817041	0	0	0	0	0	0	0	0	0	0	0	82.8726
H7220_004_0	2012	6																															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	Coin	V	Coin	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	2128.024425	14.7733365	5934.804789	73.76420506	264.4517786	10.43696672	5.624257109	295.1592001	435.3149508	2432.738349	754.1325721	1.631615258	5.599869857	656.0724951	4689.49636	10934.85926	141.9867209	205.1109377	0	911.7942436	21.27216615	0	0	347.7	1005.146431	0.115983318	0.656207887	0	14.08880644	0												1a (IP Acute): $195 Copay per admit; 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	1b (IP Psych): $195 Copay per admit; 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): $65 Copay per trips;	11a (DME): 10% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $65 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $195 Copay per visits; 9b (OP Surg): $195 Copay per visits;	8a (OP Diag Proc/Test/Lab): $0 Copay;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay; 8b (X-Ray): $25 Copay;	9a (OP Observation): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (Cardiac Rehab): $0 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 (Blood): $0 Copay per visits;	14c (Education/Wellness): n/a; 14d (Kidney Disease Edu.): $0 Copay per visits; 14e (Diabetes Training): $0 Copay per visits; 7a (PCP w/Copay): $15 Copay per visits;	7d (SPC w/Copay): $35 Copay per visits;	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): $20 Copay per visits; 7f (Podiatry): $10 Copay per visits; 8b (X-Ray): $25 Copay per visits; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	14a (Medicare-covered Zero Cost-Sharing Preventive Services): $0 Copay per visits;	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $0 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 per visits;		14c (Supplemental Education/Wellness Programs): $25 copay per year;	13d (Other 1 - Supplemental Annual Pap Smear): $0 Copay per visits; 13e (Other 2 - Supplemental Physical): $0 Copay per visits													195	195	33.54918267	0	65	0.1	0.141184161	60.29021559	195	0	28.58935526	0	0	134.5177339	9.345383577	34.51346064	35	15	0	5.185741088	0.2	0	0	10	0	0	0	0	25	0											NO	171.040454	171.040454	29.4270125	0	57.01348468	0.087713053	0.123836938	52.88238897	171.040454	0	25.07659643	0	0	117.9896117	8.197121283	30.27281014	30.69956867	13.156958	0	4.548571848	0.175426107	0	0	8.771305335	0	0	0	0	21.92826334	0												30.3315	0.210569848	14.55363123	0	1.256443119	0.915458219	0.696490781	1.300726969	6.204705569	0	1.575923181	0	0	6.450811581	3.203364202	27.58574319	0.363244257	0.224886333	0	0.345613469	3.731693289	0	0	0.254148572	0	0	0	0	0.025745255	0	0	0	0	0	0	0	0	0	0	0	99.2307	0		13.90094789	30.3315	0.210569848	14.55363123	0	1.256443119	0.915458219	0.696490781	1.300726969	6.204705569	0	1.575923181	0	0	6.450811581	3.203364202	27.58574319	0.363244257	0.224886333	0	0.345613469	3.731693289	0	0	0.254148572	0	0	0	0	0.025745255	0	0	0	0	0	0	0	0	0	0	0	99.2307	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;	14a (Medicare-covered Zero Cost-Sharing Preventive Services): $0 Copay per visits;	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;		14c (Supplemental Education/Wellness Programs): $25 copay per year;	13d (Other 1 - Supplemental Annual Pap Smear): $0 Copay per visits; 13e (Other 2 - Supplemental Physical): $0 Copay per visits											4500	5.2668	0.0196	1.7566	0.0131	0.1413	0.1518	0.0818	0.0729	0.914	0.1455	0.3334	0	0	0.348	0.3172	1.6088	0.0143	0.1925	0	0.0084	0.3093	0	0	0	0	0	0	0	0.0017	0											11.697	0		1.638535432	35.5983	0.230202979	16.31026932	0.01307036	1.397740416	1.067231555	0.77827817	1.373612412	7.118684622	0.145523249	1.909336534	0	0	6.798771383	3.52059588	29.1945609	0.377531007	0.417414125	0	0.354025394	4.041031022	0	0	0.254148572	0	0	0	0	0.027425061	0	0	0	0	0	0	0	0	0	0	0	110.9278
H7220_801_0	2012	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	NO	349.4448478	1.433680867	113.5052955	0.772874904	9.236575516	10.33493392	5.06763641	12.9395091	59.43442509	10.03766996	20.12013376	0.062730675	4.437752911	25.59439405	23.30600706	75.48585952	0.974938365	11.5680934	0	43.6493706	20.55760025	0.987011785	0	0	0	0.102081549	0.00243232	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance													0.075920585	0.075920585	0.191846219	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.216269733	0.224	0.224	0.224	0.224	0	0.003011865	0.224	0	0	0	0	0	0	0	0	0											NO	0.064366964	0.064366964	0.162650994	0	0.189911601	0.189911601	0.189911601	0.189911601	0.189911601	0.189911601	0.189911601	0.189911601	0.189911601	0.183357729	0.189911601	0.189911601	0.189911601	0.189911601	0	0.002553519	0.189911601	0	0	0	0	0	0	0	0	0												22.4927	0.092281685	18.46174911	0	1.754132848	1.962723852	0.962402946	2.457362896	11.28728685	1.906269977	3.821046823	0.011913283	0.842780762	4.69292998	4.426081124	14.33564047	0.185152106	2.196915143	0	0.111459481	3.904126785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.905	0		17.21456972	22.4927	0.092281685	18.46174911	0	1.754132848	1.962723852	0.962402946	2.457362896	11.28728685	1.906269977	3.821046823	0.011913283	0.842780762	4.69292998	4.426081124	14.33564047	0.185152106	2.196915143	0	0.111459481	3.904126785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.905	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance											4000	1.1838	0.0049	0.9717	0	0.0923	0.1033	0.0507	0.1293	0.5941	0.1003	0.2011	0.0006	0.0444	0.247	0.233	0.7545	0.0097	0.1156	0	0.0059	0.2055	0	0	0	0	0	0	0	0	0											5.0476	0		0.906029985	23.6765	0.097138616	19.43342011	0	1.84645563	2.066025107	1.013055733	2.586697785	11.88135458	2.006599976	4.02215455	0.012540298	0.887137644	4.939926295	4.659032762	15.09014786	0.194896954	2.312542256	0	0.11732577	4.109607142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9526
H7220_802_0	2012	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	NO	355.2944647	1.457680316	115.278429	0.796441183	9.396014891	10.51333287	5.155112638	13.15611316	60.4293421	10.20569798	20.45693962	0.06378077	4.512039754	26.02283763	23.86822864	77.30683981	0.998457254	11.84715587	0	44.70234455	20.91246022	1.004049326	0	0	0	0.103843655	0.002474307	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance													0.075920585	0.075920585	0.191846219	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.216269733	0.224	0.224	0.224	0.224	0	0.003011865	0.224	0	0	0	0	0	0	0	0	0											NO	0.064363297	0.064363297	0.162641726	0	0.18990078	0.18990078	0.18990078	0.18990078	0.18990078	0.18990078	0.18990078	0.18990078	0.18990078	0.183347282	0.18990078	0.18990078	0.18990078	0.18990078	0	0.002553373	0.18990078	0	0	0	0	0	0	0	0	0												22.8679	0.09382111	18.74908266	0	1.78431056	1.996490117	0.978959913	2.498356156	11.47557922	1.93807001	3.884788799	0.012112018	0.85683987	4.771216545	4.532595246	14.68062921	0.189607812	2.249784144	0	0.114141766	3.971292516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6456	0		17.53357082	22.8679	0.09382111	18.74908266	0	1.78431056	1.996490117	0.978959913	2.498356156	11.47557922	1.93807001	3.884788799	0.012112018	0.85683987	4.771216545	4.532595246	14.68062921	0.189607812	2.249784144	0	0.114141766	3.971292516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6456	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance											4000	1.2036	0.0049	0.9868	0	0.0939	0.1051	0.0515	0.1315	0.604	0.102	0.2045	0.0006	0.0451	0.2511	0.2386	0.7727	0.01	0.1184	0	0.006	0.209	0	0	0	0	0	0	0	0	0											5.1392	0		0.922819517	24.0715	0.098759064	19.73587649	0	1.878221642	2.101568544	1.030484119	2.629848585	12.07955708	2.040073695	4.089251367	0.012749493	0.901936706	5.022333205	4.77115289	15.45329391	0.19958717	2.368193836	0	0.120149227	4.180307911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7848
H7220_804_0	2012	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	367.8366819	1.509137754	119.4792584	0.813552531	9.722711069	10.87887781	5.334354116	13.6205359	62.56255273	10.56596838	21.17908816	0.066032289	4.671318854	26.94146742	24.53263901	79.4587995	1.026250911	12.17694042	0	45.9467059	21.63957921	1.038959773	0	0	0	0.107454262	0.002560337	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance													0.075920585	0.075920585	0.191846219	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.216269733	0.224	0.224	0.224	0.224	0	0.003011865	0.224	0	0	0	0	0	0	0	0	0											NO	0.063130129	0.063130129	0.159525594	0	0.186262379	0.186262379	0.186262379	0.186262379	0.186262379	0.186262379	0.186262379	0.186262379	0.186262379	0.179834442	0.186262379	0.186262379	0.186262379	0.186262379	0	0.002504452	0.186262379	0	0	0	0	0	0	0	0	0												23.2216	0.095272061	19.05999963	0	1.810975289	2.026325657	0.993589485	2.536993413	11.65304988	1.968042402	3.944867336	0.012299331	0.87009096	4.845003751	4.569507693	14.80018499	0.191151936	2.268105886	0	0.115071311	4.030639493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0127	0		20.06044173	23.2216	0.095272061	19.05999963	0	1.810975289	2.026325657	0.993589485	2.536993413	11.65304988	1.968042402	3.944867336	0.012299331	0.87009096	4.845003751	4.569507693	14.80018499	0.191151936	2.268105886	0	0.115071311	4.030639493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0127	NO																																																																																		0	0		0	23.2216	0.095272061	19.05999963	0	1.810975289	2.026325657	0.993589485	2.536993413	11.65304988	1.968042402	3.944867336	0.012299331	0.87009096	4.845003751	4.569507693	14.80018499	0.191151936	2.268105886	0	0.115071311	4.030639493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0127
H7220_805_0	2012	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	373.9941734	1.534400332	121.3457147	0.83835914	9.890541991	11.06666618	5.426434355	13.84854017	63.60983378	10.74283997	21.53362066	0.067137653	4.749515531	27.39246066	25.1244512	81.37562086	1.051007636	12.47069038	0	47.05509953	22.01311602	1.056894028	0	0	0	0.10930911	0.002604533	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance													0.075920585	0.075920585	0.191846219	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.216269733	0.224	0.224	0.224	0.224	0	0.003011865	0.224	0	0	0	0	0	0	0	0	0											NO	0.063126645	0.063126645	0.159516789	0	0.186252099	0.186252099	0.186252099	0.186252099	0.186252099	0.186252099	0.186252099	0.186252099	0.186252099	0.179824516	0.186252099	0.186252099	0.186252099	0.186252099	0	0.002504314	0.186252099	0	0	0	0	0	0	0	0	0												23.609	0.096861544	19.35667881	0	1.842134201	2.0611898	1.010684786	2.579319668	11.84746503	2.000876489	4.010682036	0.012504529	0.884607234	4.925835992	4.679481761	15.15638015	0.195752378	2.322692254	0	0.117840725	4.099989054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.81	0		20.43125949	23.609	0.096861544	19.35667881	0	1.842134201	2.0611898	1.010684786	2.579319668	11.84746503	2.000876489	4.010682036	0.012504529	0.884607234	4.925835992	4.679481761	15.15638015	0.195752378	2.322692254	0	0.117840725	4.099989054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.81	NO																																																																																		0	0		0	23.609	0.096861544	19.35667881	0	1.842134201	2.0611898	1.010684786	2.579319668	11.84746503	2.000876489	4.010682036	0.012504529	0.884607234	4.925835992	4.679481761	15.15638015	0.195752378	2.322692254	0	0.117840725	4.099989054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.81
H7281_001_0	2012	8																															D	D	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	950.7552061	56.13810991	725.0087014	14.36032013	200.0346496	7.337059508	1.579642356	245.0591551	163.0793108	6.785468309	6.425289206	0	0.015252425	281.4511655	2884.821733	2530.522082	316.6415078	96.08120275	17.95976352	42.7119089	13.247449	0.08001797	0	0	0	0	0	0	0	0											6700	1a:  Acute - $190/$0/day for 1-7/8-90	1b:  Psych - $190/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													190	190	60	0	150	0.2	0.124041613	48.25218475	190.7075467	0	0.190825311	0	0.2	46.94221127	5	37.66689956	20	40	0	39.87564345	0.2	0	0	0	0	0	0	0	0	0											NO	184.3942434	184.4080349	58.24635471	0	145.5683745	0.194151203	0.120421475	46.83205689	185.119925	0	0.185223996	0	0.194157974	45.57926984	4.852947485	36.56089291	19.41210507	38.83035684	0	38.70055061	0.194192822	0	0	0	0	0	0	0	0	0												14.6095	0.862693211	3.519092832	0	2.426559899	1.424498928	0.190222862	0.956385357	2.51576915	0	1.190117745	0	0.00296138	1.069028218	1.166657365	7.709845571	0.512223185	0.310905616	0	0.137747866	2.572559504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1768			1.246313574	14.6095	0.862693211	3.519092832	0	2.426559899	1.424498928	0.190222862	0.956385357	2.51576915	0	1.190117745	0	0.00296138	1.069028218	1.166657365	7.709845571	0.512223185	0.310905616	0	0.137747866	2.572559504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1768	NO	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%			4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				13.4398	0.0258	2.1302	1.177	0.6255	0	0	0.4519	1.8984	0.1519	0.8162	0	0.0009	0.4668	1.4536	2.7127	0	0.1689	0.6821	0.9515	1.1686	0.0172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3391			0	28.0493	0.888541627	5.649337189	1.17703423	3.052036253	1.424498928	0.190222862	1.408268051	4.414122852	0.151889051	2.006277272	0	0.003813213	1.53581518	2.62029724	10.42254534	0.512223185	0.479842993	0.682146243	1.089209668	3.741162983	0.017189147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5158
H7281_002_0	2012	8																															A	A	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	205.9097675	60.34006099	845.9198867	18.33185352	179.4459693	11.68983225	4.227702371	204.3749777	217.5409695	7.275402532	116.5822086	0	0.015185024	421.3620084	3441.758206	3380.050694	230.5140905	133.2505064	25.40680151	39.61020987	23.33068159	0.125376663	0	0	0	0	0	0	0	0											6700	1a:  Acute - $400/admit for 1-90	1b:  Psych - $400/$0/admit for 1-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $90/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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 - $5/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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	14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													400	400	60	0	100	0.2	0.154781481	37.55144956	134.3955047	0	50	0	0.2	35.12596983	5	23.70164683	20	25	0	25.00954394	0.2	0	0	0	0	0	0	0	0	0											NO	391.5610198	391.5803835	58.74404081	0	97.88586686	0.195784557	0.151493305	36.76181637	131.56948	0	48.94171935	0	0.195833861	34.39149006	4.894495346	23.20193598	19.57901917	24.47469444	0	24.4828525	0.19580171	0	0	0	0	0	0	0	0	0												6.7189	1.968998685	4.141062696	0	1.463768688	2.288688631	0.640468605	0.626099617	2.38514602	0	0.475477811	0	0.002973742	1.20760561	1.403805793	6.535309985	0.376103317	0.271772119	0	0.080814244	4.568187355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1551			0.755908912	6.7189	1.968998685	4.141062696	0	1.463768688	2.288688631	0.640468605	0.626099617	2.38514602	0	0.475477811	0	0.002973742	1.20760561	1.403805793	6.535309985	0.376103317	0.271772119	0	0.080814244	4.568187355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1551	NO	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%			4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $65/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%	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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, 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:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  3-Pints Deductible Waived - 20.0%																				12.7022	0	2.3774	1.5018	0.5739	0	0	0.2932	2.5858	0.2105	1.3541	0	0.0008	0.8163	1.7179	3.4331	0	0.2182	1.0588	1.2774	2.5114	0.0269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6599			0	19.4211	1.968998685	6.518430327	1.501807779	2.037681589	2.288688631	0.640468605	0.919322029	4.970987773	0.210510978	1.8295696	0	0.003822237	2.023917973	3.121739133	9.968446033	0.376103317	0.490007692	1.058800318	1.358193594	7.079592277	0.026904793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8151
H7281_003_0	2012	8																															D	D	D	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	1598.855738	227.0081538	2222.106012	28.2135157	13.59263894	15.10343347	4.405928061	500.2066525	18.84966442	9.735230085	9.354775419	0	1.75854715	13.15292387	89.30943644	89.34230158	12.63513835	4.739147671	18.45744951	16.07481813	19.3468434	0.100556145	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/day for 1-10/11-20/21-100	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 - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - 20.0%/3:  Pulmonary Rehabilitation - 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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													225	200	60	0	0.2	0.2	0.132369829	75.59798749	0.2	0	0.2	0	0.2	0.2	0	0.195574496	0.2	0.2	0.184842132	0.150145894	0.2	0.2	0	0	0	0	0	0	0	0											NO	202.6893647	181.1736235	54.7725562	0	0.181345405	0.181622077	0.120580039	67.59711831	0.181068625	0	0.180210995	0	0.177681894	0.182234903	0	0.176931614	0.181173624	0.181559304	0.167316697	0.135749174	0.18149854	0.182575187	0	0	0	0	0	0	0	0												27.0059	3.42732415	10.14253553	0	2.464962619	2.743116952	0.531266975	2.817710689	3.413082817	0	1.685833388	0	0.312461989	2.396921802	0	15.80747765	2.289153799	0.860436351	3.088239488	2.182143286	3.511423833	0.018359057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6984			8.93369443	27.0059	3.42732415	10.14253553	0	2.464962619	2.743116952	0.531266975	2.817710689	3.413082817	0	1.685833388	0	0.312461989	2.396921802	0	15.80747765	2.289153799	0.860436351	3.088239488	2.182143286	3.511423833	0.018359057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6984	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	27.0059	3.42732415	10.14253553	0	2.464962619	2.743116952	0.531266975	2.817710689	3.413082817	0	1.685833388	0	0.312461989	2.396921802	0	15.80747765	2.289153799	0.860436351	3.088239488	2.182143286	3.511423833	0.018359057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6984
H7281_004_0	2012	8																															D	D	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	2799.781171	260.8317124	535.5038788	2.752360827	65.26399277	4.660453877	6.873096772	96.00343765	11.69258194	6.14947369	6.183744132	0	0.077126938	48.02074114	0	0	14.55693243	1.018887561	26.30090028	23.16572068	5.282010147	0.22232362	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	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 - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 0%-20%	4a:  Emergency Care / Post Stabilization Care - $65/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%	3:  Cardiac Rehabilitation Services - $0/visit/3:  Pulmonary Rehabilitation - $0/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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:  Primary Care - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  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	14c:  Written health education materials - $0/service	13b:  Over-the-counter Rx - $0/visit/14b:  Member Quality Incentive Program - $0/service													225	200	0	0	0.2	0.2	0.120014537	65	0.2	0	0.2	0	0.2	0.01989694	0	0	0.2	0	0	0.000361264	0.2	0.2	0	0	0	0	0	0	0	0											NO	193.2052705	184.8822555	0	0	0.168952	0.191488899	0.114907258	58.04678771	0.184047732	0	0.177465446	0	0.191488899	0.019050216	0	0	0.184882255	0	0	0.00034589	0.189095037	0.191488899	0	0	0	0	0	0	0	0												45.0777	4.018596274	0	0	11.02648211	0.89242518	0.789768703	0.46439093	2.151993184	0	1.097400911	0	0.014768952	0.914805494	0	0	2.6913185	0	0	0.008012798	0.998801904	0.042572505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.189			10.55060627	45.0777	4.018596274	0	0	11.02648211	0.89242518	0.789768703	0.46439093	2.151993184	0	1.097400911	0	0.014768952	0.914805494	0	0	2.6913185	0	0	0.008012798	0.998801904	0.042572505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.189	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	45.0777	4.018596274	0	0	11.02648211	0.89242518	0.789768703	0.46439093	2.151993184	0	1.097400911	0	0.014768952	0.914805494	0	0	2.6913185	0	0	0.008012798	0.998801904	0.042572505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.189
H7281_005_0	2012	8																															D	D	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	1339.195235	49.13995476	1660.289522	34.47617165	299.6008548	14.65971755	5.100150388	269.3596082	287.572109	7.977871652	8.330339251	0	0.059092612	559.2916174	4005.422569	4042.302422	304.9348845	163.1882287	25.61973204	32.73884527	29.198016	0.506160362	0	0	0	0	0	0	0	0											6700	1a:  Acute - $190/$0/day for 1-7/8-90	1b:  Psych - $190/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service	14b:  Member Quality Incentive Program - $0/service													190	190	60	0	150	0.2	0.013838186	48.25221611	191.4348524	0	0.200550571	0	0.2	48.4628012	5	38.16606872	20	40	0	39.88264849	0.2	0	0	0	0	0	0	0	0	0											NO	179.6566832	179.660313	56.73679434	0	141.8175104	0.189100762	0.013086744	45.63267587	181.0224519	0	0.189639905	0	0.18907386	45.83327457	4.727880128	36.08956137	18.91161189	37.82741858	0	37.71257301	0.189124831	0	0	0	0	0	0	0	0	0												20.0496	0.735708304	7.849958761	0	3.540720612	2.772163758	0.06674436	1.024299975	4.338084021	0	1.579764744	0	0.011172868	2.136180522	1.578096481	12.15707678	0.480567516	0.514415786	0	0.102888841	5.522069844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4595			3.709434505	20.0496	0.735708304	7.849958761	0	3.540720612	2.772163758	0.06674436	1.024299975	4.338084021	0	1.579764744	0	0.011172868	2.136180522	1.578096481	12.15707678	0.480567516	0.514415786	0	0.102888841	5.522069844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4595	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	20.0496	0.735708304	7.849958761	0	3.540720612	2.772163758	0.06674436	1.024299975	4.338084021	0	1.579764744	0	0.011172868	2.136180522	1.578096481	12.15707678	0.480567516	0.514415786	0	0.102888841	5.522069844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4595
H7292_001_0	2012	4																																																																																																															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	NO																																																																																		0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	10																															D	D	D	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	O	COIN	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	1041.305446	8.914081314	616.4383543	0	134.1671848	5.875236622	4.193184841	289.969233	49.94111247	13.91991698	29.37693056	0.254180774	0	14.83577	3152.485592	9452.51015	163.7333644	689.065186	12.13199704	1674.433349	16.74778887	0	0	0	0	0	4.775614829	0	0	0											3315	1a $180 days 1-10	1b $175 days 1-10	"2 $0 days 1-20, $117 Days 21 to 48"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	"8a Lab $20, 8a Diagnostic proc/tests  20%"	"8b CAT Scan $150, 8b MRI $150, 8b Diagnostic proc/tests 20%, 8b therepeutic radiology 20%"	5 $40	12 0%	"3 $0, 4a $65 , 9d $0, 14b $0"	"7a PCP $10, $14a 0%, 14c-14e 0%"	"7b $20, 7d $35, 7f $35, 17a $0, 14c - 14e 0%"	"7e $40, 7h $40, 9c $40"	"7c $35, 7i $35"	8b $150	7g $35 14a 0%	15 20%			16a $0	17a $0		18a $35		14a $0													NO	164.2296073	156.5789474	13.4984456	0	150	0.2	0.2	64.97491819	0.2	0.317024841	0.272421897	0.2	0	0.198986598	9.726973168	15.65253545	40	35	0.192782117	30.89512555	0.221583483	0	0	0	0	0	35	0	0	0											NO	133.8379734	127.6031122	11.00048057	0	122.2416369	0.162988849	0.162988849	52.96185532	0.162988849	0.25835757	0.222008658	0.162988849	0	0.162162983	7.926940813	12.7559437	32.59776984	28.52304861	0.157106677	25.1778048	0.180578185	0	0	0	0	0	35	0	0	0												11.6139	0.09478871	0.565093178	0	1.366734691	0.957598056	0.683442372	1.279775714	8.139844448	3.596315928	6.521932925	0.041428632	0	2.405812717	2.082463892	10.04797394	0.444778544	1.637853316	1.906017741	3.513212999	3.02428531	0	0	0	0	0	0.013928877	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9371	0	NO	13.60690612	11.6139	0.09478871	0.565093178	0	1.366734691	0.957598056	0.683442372	1.279775714	8.139844448	3.596315928	6.521932925	0.041428632	0	2.405812717	2.082463892	10.04797394	0.444778544	1.637853316	1.906017741	3.513212999	3.02428531	0	0	0	0	0	0.013928877	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9371	YES	OON: 30%	OON: 30%	OON: 30%	OON: 30%	10a $150	OON: 30%	OON: 30%	"4a $65, 4b $35"	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%								14a $50												5100	2.4412	0	0.3735	0.6327	0.507	0.5796	0.8602	0.0902	1.5077	0.4127	0.4526	0.0021	0.0034	1.0422	1.4619	7.2736	0	0.9334	0.5405	0.5324	0.2743	0	0	0	0.0199	0	0.002	0	0	0											19.943	0	NO	0.459377238	14.0551	0.09478871	0.93860092	0.632670044	1.873763103	1.537225183	1.54360292	1.370020791	9.647521595	4.009033978	6.974502611	0.043543509	0.003361527	3.448004234	3.544348346	17.32152546	0.444778544	2.571241857	2.446538032	4.045618695	3.29857546	0	0	0	0.019922623	0	0.015914343	0	0	0	0	0	0	0	0	0	0	0	0	0	79.8802
H7301_801_0	2012	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	217.6483034	1.786760813	25.43297092	0	6.220304851	5.887141864	4.20168167	14.52828807	50.04231026	13.9481235	29.43645828	0.254695831	0.282182767	14.86583235	24.22418094	94.09222664	1.238017883	5.214120567	11.73630899	6.030692251	16.78172563	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.0857625	0.0857625	0.188706252	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.077543786	0.077543786	0.170622325	0	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0	0	0	0	0	0	0	0	0												16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	0	NO	8.681448411	16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																			10000	0.714	0	0.2399	0	0.3236	0.4437	0.6584	0.0868	1.154	0.3159	0.3464	0.0016	0.0026	0.7977	1.0803	5.3749	0	0.6897	0.3994	0.3934	0.21	0	0	0	0	0	0	0	0	0											13.2325	0	NO	0	17.5913	0.138552198	4.579368464	0	1.583466051	1.636010875	1.509377566	3.029300974	11.28928612	3.140874758	6.30829033	0.053203319	0.05972458	3.80856132	5.986505527	24.4317984	0.250740509	1.745782294	2.776428133	1.614851252	3.608817844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1422
H7301_802_0	2012	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	217.6483034	1.786760813	25.43297092	0	6.220304851	5.887141864	4.20168167	14.52828807	50.04231026	13.9481235	29.43645828	0.254695831	0.282182767	14.86583235	24.22418094	94.09222664	1.238017883	5.214120567	11.73630899	6.030692251	16.78172563	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.0857625	0.0857625	0.188706252	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.077543786	0.077543786	0.170622325	0	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0	0	0	0	0	0	0	0	0												16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	0	NO	8.681448411	16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																			10000	0.714	0	0.2399	0	0.3236	0.4437	0.6584	0.0868	1.154	0.3159	0.3464	0.0016	0.0026	0.7977	1.0803	5.3749	0	0.6897	0.3994	0.3934	0.21	0	0	0	0	0	0	0	0	0											13.2325	0	NO	0	17.5913	0.138552198	4.579368464	0	1.583466051	1.636010875	1.509377566	3.029300974	11.28928612	3.140874758	6.30829033	0.053203319	0.05972458	3.80856132	5.986505527	24.4317984	0.250740509	1.745782294	2.776428133	1.614851252	3.608817844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1422
H7301_803_0	2012	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	217.6483034	1.786760813	25.43297092	0	6.220304851	5.887141864	4.20168167	14.52828807	50.04231026	13.9481235	29.43645828	0.254695831	0.282182767	14.86583235	24.22418094	94.09222664	1.238017883	5.214120567	11.73630899	6.030692251	16.78172563	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																				NO	0.0857625	0.0857625	0.188706252	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.077543786	0.077543786	0.170622325	0	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0.202533834	0	0	0	0	0	0	0	0	0												16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	0	NO	8.681448411	16.8773	0.138552198	4.33943262	0	1.259822193	1.192345416	0.8509827	2.942469892	10.13526098	2.824966936	5.96187877	0.051584523	0.057151558	3.010834029	4.906216253	19.05685946	0.250740509	1.056035832	2.376999662	1.221419226	3.39886724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9097	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 18.9%		FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%	FFS Medicare 22.4%																			10000	0.714	0	0.2399	0	0.3236	0.4437	0.6584	0.0868	1.154	0.3159	0.3464	0.0016	0.0026	0.7977	1.0803	5.3749	0	0.6897	0.3994	0.3934	0.21	0	0	0	0	0	0	0	0	0											13.2325	0	NO	0	17.5913	0.138552198	4.579368464	0	1.583466051	1.636010875	1.509377566	3.029300974	11.28928612	3.140874758	6.30829033	0.053203319	0.05972458	3.80856132	5.986505527	24.4317984	0.250740509	1.745782294	2.776428133	1.614851252	3.608817844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1422
H7306_001_0	2012	7																															D	D	D	V	COIN	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	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	1370.869423	49.06603123	338.2994338	0	0.213377049	5.185216717	1.201326636	377.4770645	206.2050588	3.273854751	10.33242322	1.065297378	0.005889363	11.48641107	1972.191824	5713.124569	152.8701738	229.166722	12.30381075	1283.745813	1.503523286	0	0	0	0	0	0	0	0	0											3400	1a $195 days 1-6	1b $200 days 1-7	"2 $0 days 1-7, $50 Days 8 to 20, $100 Days 21 to 100"	6 $0	10a 20%	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $30"	"9a $200, 9b $200"	8a $0 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7e $40, 7h $40, 9c $40"	12 20%	3 20% 14b $0	"7a $10, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $200 14a $0"	"7g $40, 14a $0"	15 20%				17a $0	17b $0			14c $0													NO	129.6497137	200	30.14804845	0	0.2	0.2	0.2	65	200	0.08256493	0.312544144	40	0.2	0.095674024	9.74568574	14.46746156	40	40	0.160754695	9.730232558	0.2	0	0	0	0	0	0	0	0	0											NO	116.363741	179.5048175	27.05859968	0	0.179504818	0.179504818	0.179504818	58.33906569	179.5048175	0.074104013	0.280515898	35.9009635	0.179504818	0.085869741	8.746987701	12.98489523	35.9009635	35.9009635	0.144281211	8.733118098	0.179504818	0	0	0	0	0	0	0	0	0												13.2933	0.733965749	0.762825746	0	0.038302208	0.930771381	0.215643919	1.835138272	3.084566787	0.242605776	2.898408973	0.0031871	0.001057169	0.986335144	1.437561469	6.182026998	0.457348877	0.685608843	1.775208718	0.93425865	0.269889673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.768	0	NO	4.198031756	13.2933	0.733965749	0.762825746	0	0.038302208	0.930771381	0.215643919	1.835138272	3.084566787	0.242605776	2.898408973	0.0031871	0.001057169	0.986335144	1.437561469	6.182026998	0.457348877	0.685608843	1.775208718	0.93425865	0.269889673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.768	YES	0.25	0.25	0.25	$0 	10a 20%	0.3	0.3	"4a $65, 4b $30"	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.3				17a $0	17b $0			$50/visit												10000	20.2613	0	1.2419	1.317	1.1845	0.8313	1.7534	0.0412	5.7532	1.0826	1.3279	0	0.001	1.9336	4.9644	21.8561	0	0.6173	2.8859	1.3929	0.6035	0	0	0	0	0	0	0	0	0											69.049	0	NO	7.800746572	33.5546	0.733965749	2.004748172	1.317036964	1.222769109	1.76209675	1.969030533	1.876300687	8.837745601	1.325247083	4.226265315	0.0031871	0.002094684	2.919888393	6.401940937	28.0381562	0.457348877	1.302935522	4.661071809	2.327165552	0.873420105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.817
H7306_003_0	2012	8																															D	D	D	V	COIN	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	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	1421.807402	50.88919867	347.4632013	0	0.192960023	4.689068199	1.086377452	392.0861104	215.0178953	2.960595292	9.343763196	1.106526316	0.005325838	10.38733149	2089.489603	6052.917492	161.9622568	242.7966069	11.34904847	1360.097683	1.359658354	0	0	0	0	0	0	0	0	0											3200	1a $175 days 1-5	1b $175 days 1-5	"2 $0 days 1-8, $50 Days 9 to 20, $100 Days 21 to 100"	6 $0	10a 20%	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a $175, 9b $175"	8a $0 14a $0	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $175 14a $0"	"7e $40, 7h $40, 9c $40"	12 20%	"3 20%, 14b $0"	"7a $5, 14a $0"	"7b $20 , 7d $40 , 7f $40, 17a $40, 18a $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b Ther. 20% , X-Ray $0 , CT  $150, Other $175 14a $0"	"7g $40, 14a $0"	15 20%			16a $0	17a $0	17b $0			14c $0													NO	130.630923	111.6631799	39.20320145	0	0.2	0.2	0.2	65	175	0.08256493	0.337698654	40	0.2	0.096091653	4.87284287	14.46746156	40	40	0.16199577	4.865116279	0.2	0	0	0	0	0	0	0	0	0											YES	117.0523088	100.0561943	35.12816978	0	0.17921072	0.17921072	0.17921072	58.24348398	156.8093799	0.073982603	0.302596094	35.84214399	0.17921072	0.086103272	4.366328395	12.96362101	35.84214399	35.84214399	0.145156893	4.359404955	0.17921072	0	0	0	0	0	0	0	0	0											10000	13.8688	0.424314963	1.017145527	0	0.034580505	0.840331288	0.194690485	1.903038424	2.809735236	0.219032545	2.827386251	0.003305023	0.000954447	0.894383225	0.760283149	6.538977362	0.483756211	0.725195912	1.647392612	0.494101381	0.243665353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9311	0	NO	4.168174144	13.8688	0.424314963	1.017145527	0	0.034580505	0.840331288	0.194690485	1.903038424	2.809735236	0.219032545	2.827386251	0.003305023	0.000954447	0.894383225	0.760283149	6.538977362	0.483756211	0.725195912	1.647392612	0.494101381	0.243665353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9311	NO	0.2	0.2	0.2	$0 	10a 20%	0.25	0.25	"4a $65, 4b $40"	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25	0.25			16a $0	17a $0	17b $0			$50/visit													15.1363	0	0.9188	1.0264	1.1077	0.9718	1.3665	0.0442	4.5011	0.8437	1.0349	0	0.0008	1.5069	3.9463	17.3741	0	0.4907	2.2941	1.1073	0.5644	0	0	0	0	0	0	0	0	0											54.2361	0	NO	4.13308967	29.0051	0.424314963	1.93592353	1.02642257	1.142306645	1.812161783	1.561178781	1.94725464	7.310854331	1.062780674	3.86224082	0.003305023	0.001763027	2.401282995	4.706612903	23.9130507	0.483756211	1.215926859	3.941449192	1.601363626	0.808093481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1672
H7306_801_0	2012	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	243.8226263	4.898036459	15.31301887	0	0.215303452	5.331688742	1.235261716	17.63337124	30.5079453	3.366334614	10.62429355	0.026071084	0.006055726	11.81087926	18.3100625	76.36631572	4.072931627	2.127469886	12.65136885	4.6205744	4.987013396	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.076137019	0.076137019	0.190525691	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.069782827	0.069782827	0.174624928	0	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0	0	0	0	0	0	0	0	0											10000	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	0	NO	5.635571724	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	NO	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					6.6861	0	1.0142	0	1.4099	1.0085	1.4179	0.1415	4.6164	0.8832	1.1433	0	0.0008	1.5937	4.1042	18.0549	0	0.4992	2.3658	1.1514	0.7321	0	0	0	0	0	0	0	0	0											46.8233	0	NO	2.65236586	23.7008	0.341798833	3.688193859	0	1.454139817	2.103173662	1.671545723	3.761756761	10.87980788	1.574364233	3.324509628	0.005352539	0.002082299	4.018525325	7.863353838	33.73337382	0.83619551	0.936004986	4.963198399	2.099981955	1.755961711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7141
H7306_803_0	2012	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	243.8226263	4.898036459	15.31301887	0	0.215303452	5.331688742	1.235261716	17.63337124	30.5079453	3.366334614	10.62429355	0.026071084	0.006055726	11.81087926	18.3100625	76.36631572	4.072931627	2.127469886	12.65136885	4.6205744	4.987013396	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0.00%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.076137019	0.076137019	0.190525691	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.069782827	0.069782827	0.174624928	0	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0	0	0	0	0	0	0	0	0											10000	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	0	NO	5.635571724	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	NO	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0.00%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					6.6861	0	1.0142	0	1.4099	1.0085	1.4179	0.1415	4.6164	0.8832	1.1433	0	0.0008	1.5937	4.1042	18.0549	0	0.4992	2.3658	1.1514	0.7321	0	0	0	0	0	0	0	0	0											46.8233	0	NO	2.65236586	23.7008	0.341798833	3.688193859	0	1.454139817	2.103173662	1.671545723	3.761756761	10.87980788	1.574364233	3.324509628	0.005352539	0.002082299	4.018525325	7.863353838	33.73337382	0.83619551	0.936004986	4.963198399	2.099981955	1.755961711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7141
H7306_804_0	2012	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	243.8226263	4.898036459	15.31301887	0	0.215303452	5.331688742	1.235261716	17.63337124	30.5079453	3.366334614	10.62429355	0.026071084	0.006055726	11.81087926	18.3100625	76.36631572	4.072931627	2.127469886	12.65136885	4.6205744	4.987013396	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0.00%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					NO	0.076137019	0.076137019	0.190525691	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.069782827	0.069782827	0.174624928	0	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0.20530556	0	0	0	0	0	0	0	0	0											10000	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	0	NO	5.635571724	17.0146	0.341798833	2.674034814	0	0.044202996	1.094625344	0.253606099	3.620229162	6.263450803	0.691127214	2.18122654	0.005352539	0.001243274	2.424839184	3.759157641	15.67842924	0.83619551	0.436781397	2.59739637	0.948629616	1.02386158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8908	NO	Medicare FFS 7.6%	Medicare FFS 7.6%	Medicare FFS 19.1%	Medicare FFS 0.00%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					6.6861	0	1.0142	0	1.4099	1.0085	1.4179	0.1415	4.6164	0.8832	1.1433	0	0.0008	1.5937	4.1042	18.0549	0	0.4992	2.3658	1.1514	0.7321	0	0	0	0	0	0	0	0	0											46.8233	0	NO	2.65236586	23.7008	0.341798833	3.688193859	0	1.454139817	2.103173662	1.671545723	3.761756761	10.87980788	1.574364233	3.324509628	0.005352539	0.002082299	4.018525325	7.863353838	33.73337382	0.83619551	0.936004986	4.963198399	2.099981955	1.755961711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7141
H7352_002_0	2012	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	348.9783103	30.42571856	42.57352214		28.50292335	17.18863321	17.61314172	42.84150333	41.56949691	8.216348829	12.78052778	3.962687217		60.90420364	41.02240699	82.94344188	3.443011412	3.266742789	28.4626109	67.80066853	35.62540937	6.044782634																			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		Comprehensive Dental - $1500 Max	1 Exam/yr	$200 Eyewear/yr	1 Exam/yr	$1000 Hearing Aids/yr															0.081089698	0.081089698	0.173427396		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.063578317	0.063578317	0.135975619		0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032		0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032	0.175627032																				22.1875	1.934415977	5.788961036	0	5.005883823	3.018788629	3.093343799	7.524126062	7.30072735	1.443012956	2.244606157	0.695954993	0	10.6964245	7.204643571	14.56711049	0.604685874	0.573728339	4.998803866	11.90763016	6.256784901	1.061627231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1087	0		32.53069299	22.1875	1.934415977	5.788961036	0	5.005883823	3.018788629	3.093343799	7.524126062	7.30072735	1.443012956	2.244606157	0.695954993	0	10.6964245	7.204643571	14.56711049	0.604685874	0.573728339	4.998803866	11.90763016	6.256784901	1.061627231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1087	NO																																																																																		0	0		0	22.1875	1.934415977	5.788961036	0	5.005883823	3.018788629	3.093343799	7.524126062	7.30072735	1.443012956	2.244606157	0.695954993	0	10.6964245	7.204643571	14.56711049	0.604685874	0.573728339	4.998803866	11.90763016	6.256784901	1.061627231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1087
H7352_003_0	2012	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																																																					0	YES	402.4233369	43.85383413	41.89132004		24.87850637	18.40943492	12.85916123	46.38309664	50.80816462	8.492367195	11.49472709	10.73944441		51.08304278	41.98076133	100.5727998	3.415636015	7.392824131	34.92783522	79.43796028	25.58487262	6.543896374																			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		Comprehensive Dental - $1500 Max	1 Exam/yr	$200 Eyewear/yr	1 Exam/yr	$1000 Hearing Aids/yr															0.083124721	0.083124721	0.13529546		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.063753629	0.063753629	0.103766682		0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828		0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828	0.171799828																				25.6559	2.795841059	4.346923273	0	4.274123114	3.162737753	2.209201687	7.968608023	8.728833939	1.458987223	1.974792136	1.845034701	0	8.77605796	7.212287574	17.27838971	0.58680568	1.270085914	6.000596082	13.64742791	4.395476714	1.124240271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7124	0		37.89298714	25.6559	2.795841059	4.346923273	0	4.274123114	3.162737753	2.209201687	7.968608023	8.728833939	1.458987223	1.974792136	1.845034701	0	8.77605796	7.212287574	17.27838971	0.58680568	1.270085914	6.000596082	13.64742791	4.395476714	1.124240271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7124	NO																																																																																		0	0		0	25.6559	2.795841059	4.346923273	0	4.274123114	3.162737753	2.209201687	7.968608023	8.728833939	1.458987223	1.974792136	1.845034701	0	8.77605796	7.212287574	17.27838971	0.58680568	1.270085914	6.000596082	13.64742791	4.395476714	1.124240271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7124
H7352_004_0	2012	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																																																					0	YES	386.9015937	27.43432522	37.80840287		38.9153008	17.2572307	22.1025709	36.95475975	36.43975682	4.341878603	11.92151964	1.272567709	8.357387367	71.80881831	51.94286539	75.29518932	5.346267012	4.279204304	25.77273567	59.07417237	13.8184126	3.639826986																			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		Comprehensive Dental - $1500 Max	1 Exam/yr	$200 Eyewear/yr	1 Exam/yr	$1000 Hearing Aids/yr															0.075563616	0.075563616	0.142577097		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	0.075563616	0.075563616	0.142577097		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																				29.2357	2.073036827	5.39061234	0	8.717027379	3.865619677	4.950975883	8.277866184	8.162505528	0.972580807	2.6704204	0.285055167	1.87205477	16.0851753	11.63520185	16.86612241	1.197563811	0.958541764	5.77309279	13.23261461	3.095324422	0.815321245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1324	0		5.76E-11	29.2357	2.073036827	5.39061234	0	8.717027379	3.865619677	4.950975883	8.277866184	8.162505528	0.972580807	2.6704204	0.285055167	1.87205477	16.0851753	11.63520185	16.86612241	1.197563811	0.958541764	5.77309279	13.23261461	3.095324422	0.815321245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1324	NO																																																																																		0	0		0	29.2357	2.073036827	5.39061234	0	8.717027379	3.865619677	4.950975883	8.277866184	8.162505528	0.972580807	2.6704204	0.285055167	1.87205477	16.0851753	11.63520185	16.86612241	1.197563811	0.958541764	5.77309279	13.23261461	3.095324422	0.815321245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1324
H7475_001_0	2012	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	622.3206658		171.9096345		51.20458523	113.2428439		77.06911367	77.28048436					155.6261072						366.0178078	96.26437345	2.202925644																			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	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS													0.084175527		0.162550912		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																			NO	0.084175527		0.162550912		0.224	0.224		0.224	0.224					0.224						0.224	0.224	0.224																				52.3842	0	27.94406789	0	11.46982709	25.36639703	0	17.26348146	17.3108285	0	0	0	0	34.860248	0	0	0	0	0	81.98798894	21.56321965	0.493455344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6437	0		0	52.3842	0	27.94406789	0	11.46982709	25.36639703	0	17.26348146	17.3108285	0	0	0	0	34.860248	0	0	0	0	0	81.98798894	21.56321965	0.493455344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6437	NO																																																																																		0	0		0	52.3842	0	27.94406789	0	11.46982709	25.36639703	0	17.26348146	17.3108285	0	0	0	0	34.860248	0	0	0	0	0	81.98798894	21.56321965	0.493455344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6437
H7526_001_0	2012	7																															A	A			T	Coin	Coin	V	V	V	V	V		V		V	V	V	P	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	529.7889274	23.72180324	0	0	830.4352875	29.92241503	12.22058602	621.7091489	396.4005899	2855.611564	523.4427739	1.849928974	0	1542.119147	0	4635.317224	339.3137037	1028.072982	3879.603428	2514.409999	34.22013972	0	0	0	0	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; 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, and Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Case for OP ER and Urgent Care; PBP 4a, 4b"	"$25/Case for OP Surgery and ASC services; PBP 9a, 9b"	$25/Case for OP Diagnostic Procedures/Test; No Cost Sharing for Lab Services; PBP 8a	"$25/Case for OP Radiology - General, Complex Diagnostic, and X-Ray; $10/Case for OP Radiology - Therapeutic; PBP 8b"	$10/Visit for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$10/Visit for Cardiac Rehab, CORF, and OP Substance Abuse; $25/Case for OP - Other; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"$10/Visit for Chiro (cvd), SCP OV, SCP - Office Surg, Podiatry, and Diabetic Footcare; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for Mental Health and Psychiatric Services ; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$10/Visit for Phys Radiology - General, Complex Diagnostic, X-Ray, and Theraputic; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; PBP 7d, 14a, 14b"	"$10/Visit for SCP - Other; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; 20% Coinsurance for Eye Wear after Cataract; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	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 14c	PBP 13a											0	NO	100	100	0	0	50	0.2	0.2	50	25	12.5	24.65566154	10	0	24.25176814	0	10	10	10	10	10.10924625	0.2	0	0	0	0	0	0	0	0	0											NO	97.60673433	97.60673433	0	0	48.80336717	0.195213469	0.195213469	48.80336717	24.40168358	12.20084179	24.06558606	9.760673433	0	23.6713589	0	9.760673433	9.760673433	9.760673433	9.760673433	9.867305128	0.195213469	0	0	0	0	0	0	0	0	0												4.3092	0.192950646	0	0	3.37733652	5.841258429	2.385622986	2.528458322	0.806070147	2.903405409	1.049746427	0.001504713	0	3.042004649	0	3.77031814	0.275994188	0.83622372	3.155628509	2.067537557	6.680232172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2235	0	NO	1.059818409	4.3092	0.192950646	0	0	3.37733652	5.841258429	2.385622986	2.528458322	0.806070147	2.903405409	1.049746427	0.001504713	0	3.042004649	0	3.77031814	0.275994188	0.83622372	3.155628509	2.067537557	6.680232172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2235	NO																																										0	0	0	0	0	0	0	0	0	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	4.3092	0.192950646	0	0	3.37733652	5.841258429	2.385622986	2.528458322	0.806070147	2.903405409	1.049746427	0.001504713	0	3.042004649	0	3.77031814	0.275994188	0.83622372	3.155628509	2.067537557	6.680232172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2235
H7526_003_0	2012	8																															A	A			T	Coin	Coin	V	V	V	V	V		V		V	V	V	P	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	514.416041	5.749770204	0	0	445.2020061	58.21012149	15.74406772	571.6720516	628.7093804	2454.794908	946.040745	0.957626611	0	1617.285816	0	5822.370378	400.6936313	916.6673814	4409.46616	3867.60996	83.36762133	0	0	0	0	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; 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, and Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Case for OP ER and Urgent Care; PBP 4a, 4b"	"$25/Case for OP Surgery and ASC services; PBP 9a, 9b"	$25/Case for OP Diagnostic Procedures/Test; No Cost Sharing for Lab Services; PBP 8a	"$10/Case for OP Radiology - General, Complex Diagnostic, X-Ray, and Therapeutic; PBP 8b"	$10/Visit for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$10/Visit for Cardiac Rehab, CORF, and OP Substance Abuse; $25/Case for OP - Other; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"$10/Visit for Chiro (cvd), SCP OV, SCP - Office Surg, Podiatry, and Diabetic Footcare; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for Mental Health and Psychiatric Services ; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$10/Visit for Phys Radiology - General, Complex Diagnostic, X-Ray, and Theraputic; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; PBP 7d, 14a, 14b"	"$10/Visit for SCP - Other; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; 20% Coinsurance for Eye Wear after Cataract; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	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 14c	PBP 13a											0	NO	100	100	0	0	50	0.2	0.2	50	25	12.5	10	10	0	24.56845078	0	10	10	10	10	10.11292878	0.2	0	0	0	0	0	0	0	0	0											NO	96.17984778	96.17984778	0	0	48.08992389	0.192359696	0.192359696	48.08992389	24.04496195	12.02248097	9.617984778	9.617984778	0	23.62989856	0	9.617984778	9.617984778	9.617984778	9.617984778	9.726599503	0.192359696	0	0	0	0	0	0	0	0	0												4.123	0.046084335	0	0	1.784144216	11.19728125	3.028524073	2.290972121	1.259774427	2.459393756	0.758250457	0.000767537	0	3.184691648	0	4.666622472	0.321155437	0.734707743	3.534181533	3.134891093	16.03657026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5611	0	NO	2.325977133	4.123	0.046084335	0	0	1.784144216	11.19728125	3.028524073	2.290972121	1.259774427	2.459393756	0.758250457	0.000767537	0	3.184691648	0	4.666622472	0.321155437	0.734707743	3.534181533	3.134891093	16.03657026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5611	NO																																										0	0	0	0	0	0	0	0	0	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	4.123	0.046084335	0	0	1.784144216	11.19728125	3.028524073	2.290972121	1.259774427	2.459393756	0.758250457	0.000767537	0	3.184691648	0	4.666622472	0.321155437	0.734707743	3.534181533	3.134891093	16.03657026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5611
H7526_004_0	2012	6																															A	A			T	Coin	Coin	V	V	V	V	V		V		V	V	V	P	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	414.6022649	13.37808983	0	0	382.4876237	25.43917517	20.14425973	476.9654031	617.8541479	2615.266787	588.2075997	0.568077737	0	1554.28198	0	5202.481731	356.9768251	1090.998792	3225.468091	3078.418656	53.61013979	0	0	0	0	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; 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; 5% Coinsurance for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Case for OP ER and Urgent Care; PBP 4a, 4b"	"$25/Case for OP Surgery and ASC services; PBP 9a, 9b"	$25/Case for OP Diagnostic Procedures/Test; No Cost Sharing for Lab Services; PBP 8a	"$25/Case for OP Radiology - General, Complex Diagnostic, and X-Ray; $10/Case for OP Radiology - Therapeutic; PBP 8b"	$10/Visit for Partial Hosp; PBP 5	No Cost Sharing; PBP 12	"$10/Visit for Cardiac Rehab, CORF, and OP Substance Abuse; $25/Case for OP - Other; PBP 3, 9a, 9c"	"No Cost Sharing; PBP 7a, 14a, 14b"	"$10/Visit for Chiro (cvd), SCP OV, SCP - Office Surg, Podiatry, and Diabetic Footcare; PBP 7b, 7d, 7f, 17a, 18a"	"$10/Visit for Mental Health and Psychiatric Services ; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$10/Visit for Phys Radiology - General, Complex Diagnostic, X-Ray, and Theraputic; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; PBP 7d, 14a, 14b"	"$10/Visit for SCP - Other; No Cost Sharing for Medicare-Covered Zero-Cost Sharing Preventive Services; 20% Coinsurance for Eye Wear after Cataract; PBP 7d, 7g, 14a, 14b, 14d, 14e, 17b"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 9d, 14a"	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 14c	PBP 13a											0	NO	100	100	0	0	50	0.2	0.12294757	50	25	12.5	24.53207208	10	0	24.40275514	0	10	10	10	10	10.13675442	0.2	0	0	0	0	0	0	0	0	0											NO	97.57597435	97.57597435	0	0	48.78798717	0.195151949	0.11996729	48.78798717	24.39399359	12.19699679	23.93740836	9.757597435	0	23.81122609	0	9.757597435	9.757597435	9.757597435	9.757597435	9.891036896	0.195151949	0	0	0	0	0	0	0	0	0												3.3713	0.108781679	0	0	1.555066773	4.964504607	2.416652241	1.939181831	1.255994177	2.658200051	1.173347126	0.000461923	0	3.084113302	0	4.230310199	0.290269679	0.887127251	2.62273493	2.537396043	10.46212325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5575	0	NO	1.082075573	3.3713	0.108781679	0	0	1.555066773	4.964504607	2.416652241	1.939181831	1.255994177	2.658200051	1.173347126	0.000461923	0	3.084113302	0	4.230310199	0.290269679	0.887127251	2.62273493	2.537396043	10.46212325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5575	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	NO	0	3.3713	0.108781679	0	0	1.555066773	4.964504607	2.416652241	1.939181831	1.255994177	2.658200051	1.173347126	0.000461923	0	3.084113302	0	4.230310199	0.290269679	0.887127251	2.62273493	2.537396043	10.46212325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5575
H7678_001_0	2012	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;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	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	NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	8																															D	D	D		T	Coin	Coin	V	V		V		Coin	V	V	V	V	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	1231.31575	6.295205557	603.6365793	0	272.9039508	13.07429241	6.222461776	270.3759379	233.0778853	0	551.3758983	0	0.280850972	710.0165764	4750.324199	4747.585443	132.5740132	464.3861799	2589.550051	138.7668173	32.35652564	0	0	0	47.66403625	0	0	0	0	0											3200	$250/Days Custom for IP Medical; $250/Days Custom for IP Surgical;	$250/Days Custom for IP Psych; $250/Days Custom for IP Substance Abuse;	$125/Days Custom for SNF;	No Cost-Sharing;	$75/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $25/Visit for PCP Urgent Care;	$50/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	20% Coinsurance for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; $150/Case for OP Fac - Other; 20% Coinsurance for Prof - CORF; $25/Visit for OP Substance Abuse;	$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits;	$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $15/Proceedure for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist;	$20/Visit for Occ Therapy; $20/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$5/Visit for PCP Office Visits; $20/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$30/Exam for Vision Exams (Refractions);	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	250	250	125	0	75	0.2	0.2	62.00123986	57.33409865	0	39.98998098	0	0.2	88.34155826	5	18.77657582	20	20	9.278890327	18.876303	0.2	0	0	0	30	0	0	0	0	0											NO	218.5940173	218.5940173	109.2970087	0	65.57820519	0.174875214	0.174875214	54.21240039	50.13156381	0	34.96628238	0	0.174875214	77.24374446	4.371880346	16.41778856	17.48752138	17.48752138	8.113239651	16.50498761	0.174875214	0	0	0	30	0	0	0	0	0												22.4299	0.114674523	5.497972702	0	1.491379274	2.286369681	1.088154334	1.221477383	0.97371324	0	1.606630446	0	0.049113874	4.570361583	1.730654084	6.495404498	0.193199241	0.676746938	1.750803346	0.19086205	5.65835434	0	0	0	0.119160091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1449	0	NO	8.328285447	22.4299	0.114674523	5.497972702	0	1.491379274	2.286369681	1.088154334	1.221477383	0.97371324	0	1.606630446	0	0.049113874	4.570361583	1.730654084	6.495404498	0.193199241	0.676746938	1.750803346	0.19086205	5.65835434	0	0	0	0.119160091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1449	NO																																										0	0	0	0	0	0	0	0	0	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	22.4299	0.114674523	5.497972702	0	1.491379274	2.286369681	1.088154334	1.221477383	0.97371324	0	1.606630446	0	0.049113874	4.570361583	1.730654084	6.495404498	0.193199241	0.676746938	1.750803346	0.19086205	5.65835434	0	0	0	0.119160091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1449
H7731_001_0	2012	12																															D	D	D		T	Coin	Coin	V			V			V		V	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	656.3266896	44.78171798	295.8333405	0	231.945932	11.47315567	1.324482184	1743.215918	0	0	177.9586303	0	0	13.11733036	0	3107.155577	120.6511741	0	0	0	21.65731539	0	0	328.4723552	0	0	0	0	0	0											2400	"1a - Acute (100.00/0.00 per day-1-4/5-90),1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych ($250 per admit-),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services (0.00/75.00 per day-1-14/15-100),2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay (0.00/75.00 per day-1-14/15-100)"	6 - Home Health Services - no cost sharing	10a - Ambulance ($100 per trip)	11a - Durable Medical Equipment (15% coins per service)	"11b - Prosthetics Devices (15% coins per service),11b - Medical Supplies (min 0/ max 15 coins per service),11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services - no cost sharing, 9b - Ambulatory Surgical Center Services - no cost sharing"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services ($100 per visit),8b - Outpatient Therapeutic Radiological Services ($55 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	5 - Partial Hospitalization - no cost sharing	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services - no cost sharing,3 - Intensive Cardiac Rehabilitation Services - no cost sharing,3 - Pulmonary Rehabilitation Services - no cost sharing,3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($30 per visit),9c - Outpatient Substance Abuse Svcs - Group ($30 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care - no cost sharing,7a - In-Area Network Urgent Care Services - Not covered,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services - no cost sharing,7b - Routine Care - Not covered,7d - Physician Specialist Services ($10 per visit),7f - Podiatry Services - no cost sharing,7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services - no cost sharing,14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing,18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual ($30 per visit),7e - Mental Hlth Spec-Non-Physician - Group ($30 per visit),7h - Psychiatric Services - Individual ($30 per visit),7h - Psychiatric Services - Group ($30 per visit)"	"7c - Occupational Therapy Services - no cost sharing,7i - Physical/Speech Therapy - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services ($100 per visit),8b - Outpatient Therapeutic Radiological Services ($55 per visit),8b - Outpatient X-Ray Services ($0 per visit)"	7g - Other Health Care Professional Services - no cost sharing	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services - no cost sharing,14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - no cost sharing	"16a - Preventive Dental - no cost sharing,16a - Oral Exams ($15 per service-),16a - Preventive Dental - Prophylaxis ($20 per service),16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays ($5 per service), 16b - Comprehensive Dental - no cost sharing,16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - Not covered,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	100	43.87424061	75	0	100	0.15	0.15	50	0	0	62.12270476	0	0	30	0	10	30	0	0	0	0.2	0	0	15	0	0	0	0	0	0											NO	98.03208859	43.01083443	73.52406644	0	98.03208859	0.147048133	0.147048133	49.01604429	0	0	60.90018496	0	0	29.40962658	0	9.803208859	29.40962658	0	0	0	0.196064177	0	0	14.70481329	0	0	0	0	0	0												5.3618	0.160508255	1.812572515	0	1.894845346	1.687106119	0.194762632	7.120462389	0	0	0.903142792	0	0	0.032147982	0	2.538341257	0.295692165	0	0	0	4.246223723	0	0	0.402510388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6501	0	NO	0.534977694	5.3618	0.160508255	1.812572515	0	1.894845346	1.687106119	0.194762632	7.120462389	0	0	0.903142792	0	0	0.032147982	0	2.538341257	0.295692165	0	0	0	4.246223723	0	0	0.402510388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6501	NO																																										0	0	0	0	0	0	0	0	0	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	5.3618	0.160508255	1.812572515	0	1.894845346	1.687106119	0.194762632	7.120462389	0	0	0.903142792	0	0	0.032147982	0	2.538341257	0.295692165	0	0	0	4.246223723	0	0	0.402510388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6501
H7731_007_0	2012	7																																D			T			V									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	19.02406904	0	0	116.3044491	0	0	1030.787657	0	0	0	0	0	0	0	0	0.286012258	0	0	0	11.60533256	0	0	226.6859147	0	0	0	0	0	0											1000	"1a - Acute - no cost sharing,1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych ($250 per admit-),1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services - no cost sharing,2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - no cost sharing"	6 - Home Health Services - no cost sharing	10a - Ambulance ($100 per trip)	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care ($50 per visit),4a - Worldwide Coverage ($50 per visit), 4b - Urgently Needed Care / Urgent Care Centers ($25 per visit)"	"9a - Outpatient Hospital Services - no cost sharing, 9b - Ambulatory Surgical Center Services - no cost sharing"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services - no cost sharing,8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization - no cost sharing	12 - Renal Dialysis (20% coins per service)	"3 - Cardiac Rehabilitation Services - no cost sharing,3 - Intensive Cardiac Rehabilitation Services - no cost sharing,3 - Pulmonary Rehabilitation Services - no cost sharing,3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual ($30 per visit),9c - Outpatient Substance Abuse Svcs - Group ($30 per visit),9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7a - Primary Care - no cost sharing,7a - In-Area Network Urgent Care Services - Not covered,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers ($25 per visit),7b - Chiropractic Services - no cost sharing,7b - Routine Care - Not covered,7d - Physician Specialist Services - no cost sharing,7f - Podiatry Services - no cost sharing,7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services - no cost sharing,14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing,18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual - no cost sharing,7e - Mental Hlth Spec-Non-Physician - Group - no cost sharing,7h - Psychiatric Services - Individual - no cost sharing,7h - Psychiatric Services - Group - no cost sharing"	"7c - Occupational Therapy Services - no cost sharing,7i - Physical/Speech Therapy - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services - no cost sharing,8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services - no cost sharing	"15 - Medicare Part B Chemotherapy Drugs (20% coins per service),15 - Other Medicare Part B Drugs (20% coins per service),15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services - no cost sharing,14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - no cost sharing	"16a - Preventive Dental - no cost sharing,16a - Oral Exams ($15 per service-),16a - Preventive Dental - Prophylaxis ($20 per service),16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays ($5 per service), 16b - Comprehensive Dental - no cost sharing,16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - no cost sharing,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											0	NO	0	43.87424061	0	0	100	0	0	50	0	0	0	0	0	0	0	0	30	0	0	0	0.2	0	0	15	0	0	0	0	0	0											NO	0	43.04864257	0	0	98.11826249	0	0	49.05913124	0	0	0	0	0	0	0	0	29.43547875	0	0	0	0.196236525	0	0	14.71773937	0	0	0	0	0	0												0	0.068246696	0	0	0.950965872	0	0	4.214128914	0	0	0	0	0	0	0	0	0.000701576	0	0	0	2.277390133	0	0	0.278025351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7895	0	NO	0.149388258	0	0.068246696	0	0	0.950965872	0	0	4.214128914	0	0	0	0	0	0	0	0	0.000701576	0	0	0	2.277390133	0	0	0.278025351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7895	NO																																										0	0	0	0	0	0	0	0	0	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	0.068246696	0	0	0.950965872	0	0	4.214128914	0	0	0	0	0	0	0	0	0.000701576	0	0	0	2.277390133	0	0	0.278025351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7895
H7731_008_0	2012	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											100	"1a - Acute - no cost sharing,1a - Additional Days - no cost sharing,1a - Non-Medicare Covered Stay - Not covered,1a - Upgrades - Not covered"	"1b - Psych - no cost sharing,1b - Additional Days - Not covered,1b - Non-Medicare Covered Stay - Not covered"	"2 - Skilled Nursing Services - no cost sharing,2 - Additional Days - Not covered,2 - Non-Medicare Covered Stay - no cost sharing"	6 - Home Health Services - no cost sharing	10a - Ambulance - no cost sharing	11a - Durable Medical Equipment - no cost sharing	"11b - Prosthetics Devices - no cost sharing,11b - Medical Supplies - no cost sharing,11c - Diabetes Supplies - no cost sharing,11c - Diabetic Therapeutic Shoes or Inserts - no cost sharing"	"4a - Emergency Care / Post Stabilization Care - no cost sharing,4a - Worldwide Coverage - no cost sharing, 4b - Urgently Needed Care / Urgent Care Centers - no cost sharing"	"9a - Outpatient Hospital Services - no cost sharing, 9b - Ambulatory Surgical Center Services - no cost sharing"	"8a - Outpatient Diagnostic Procedures/Tests - no cost sharing,8a - Outpatient Lab Services - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services - no cost sharing,8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	5 - Partial Hospitalization - no cost sharing	12 - Renal Dialysis - no cost sharing	"3 - Cardiac Rehabilitation Services - no cost sharing,3 - Intensive Cardiac Rehabilitation Services - no cost sharing,3 - Pulmonary Rehabilitation Services - no cost sharing,3 - Additional Cardiac Rehabilitation Services - Not covered,3 - Additional Intensive Cardiac Rehabilitation Services - Not covered,3 - Additional Pulmonary Rehabilitaton Services - Not covered,9c - Outpatient Substance Abuse Svcs - Individual - no cost sharing,9c - Outpatient Substance Abuse Svcs - Group - no cost sharing,9d - Outpatient Blood Services - no cost sharing,9d - 3-Pints Deductible Waived? yes - no cost sharing"	"4b - Urgently Needed Care / Urgent Care Centers - no cost sharing,7a - Primary Care - no cost sharing,7a - In-Area Network Urgent Care Services - Not covered,14b - Supplemental Preventive Health Services - no cost sharing,14c - Supplemental Education/Wellness Programs - no cost sharing,14c - Written Health Education Materials, incl. Newsletters - Not covered,14c - Nutritional Benefit - Not covered,14c - Additional Smoking Cessation - Not covered,14c - Membership in Health/Fitness Classes - Not covered,14c - Nursing Hotline - Not covered"	"4b - Urgently Needed Care / Urgent Care Centers - no cost sharing,7b - Chiropractic Services - no cost sharing,7b - Routine Care - Not covered,7d - Physician Specialist Services - no cost sharing,7f - Podiatry Services - no cost sharing,7f - Routine Footcare - Not covered,7g - Other Health Care Professional Services - no cost sharing,14d - Kidney Disease Education Services - no cost sharing,14e - Diabetes Self-Management Training - no cost sharing,17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing,18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	"7e - Mental Hlth Spec-Non-Physician - Individual - no cost sharing,7e - Mental Hlth Spec-Non-Physician - Group - no cost sharing,7h - Psychiatric Services - Individual - no cost sharing,7h - Psychiatric Services - Group - no cost sharing"	"7c - Occupational Therapy Services - no cost sharing,7i - Physical/Speech Therapy - no cost sharing"	"8b - Outpatient Diagnostic Radiological Services - no cost sharing,8b - Outpatient Therapeutic Radiological Services - no cost sharing,8b - Outpatient X-Ray Services - no cost sharing"	7g - Other Health Care Professional Services - no cost sharing	"15 - Medicare Part B Chemotherapy Drugs - no cost sharing,15 - Other Medicare Part B Drugs - no cost sharing,15 - Home Infusion Bundled Services as Mand Supp - Not covered"	"7g - Other Health Care Professional Services - no cost sharing,14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing"	10b - Transportation - no cost sharing	"16a - Preventive Dental - no cost sharing,16a - Oral Exams - no cost sharing,16a - Preventive Dental - Prophylaxis - no cost sharing,16a - Preventive Dental - Fluoride Treatment - Not covered,16a - Preventive Dental - X-Rays - no cost sharing, 16b - Comprehensive Dental - no cost sharing,16b - Comprehensive Dental - Non-Routine Svcs - Not covered,16b - Comprehensive Dental - Diagnostic Svcs - Not covered,16b - Comprehensive Dental - Restorative Svcs - Not covered,16b - Comprehensive Dental - Endodontics/Periodontics/Extractions - Not covered,16b - Comprehensive Dental - Prosthodontics, Other - Not covered"	"17a - Eye Exams - no cost sharing,17a - Routine Eye Exams - no cost sharing"	"17b - Eye Wear - no cost sharing,17b - Contact Lenses - no cost sharing,17b - Eye Glasses - no cost sharing,17b - Frames - Not covered,17b - Lenses - Not covered,17b - Upgrades - Not covered"	"18a - Hearing Exams - no cost sharing,18a - Routine Hearing Exams - no cost sharing,18a - Fitting for Hearing Aid - Not covered,18b - Hearing Aids - Not covered"	18b - Hearing Aids - Not covered	"14a - Medicare-covered Zero Cost-Sharing Preventive Services - no cost sharing,14b - Supplemental Preventive Health Services - no cost sharing,14b - Other Immunizations - Not covered,14b - Additional Physical Exams - Not covered,14b - Additional Pap Smears - Not covered,14b - Additional Pelvic Exams - Not covered,14b - Additional Prostate Exams - Not covered,14b - Additional Colorectal Exams - Not covered,14b - Additional Mammography Exams - Not covered"	"13a - Acupuncture - Not covered,13b - Part C OTC Drugs - Not covered,13c - Meal Benefit - Not covered,13d - Other 1:  - Not covered,13e - Other 2:  - Not covered"											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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO																																										0	0	0	0	0	0	0	0	0	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
H7787_001_0	2012	7																															A	D	D	V	T	Coin	Coin	V	V	P	Coin	Coin	Coin	V	V	V	Coin	V	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	YES	218.4376256	58.67237738	268.2740094	0	160.7770681	6.545620608	9.573996853	187.0839464	314.7906655	0	12.06491235	0.256063213	0	749.4893669	4837.800173	4062.036223	1.792657561	431.2663076	0	0	24.97185957																				3400	1a. $450 per admit	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	11a. 20% Coinsurance for DME	"11b, c. 20% Coinsurance for Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $300 ASC & OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 20% coinsurance for MRI, CT, PET, CNM, Other Imaging"	"5, 9c. $30 per visit for all OP Behavioral Health visits"	12. 20% Coinsurance	"3, 9a, $30 for OP Rehab & $100 for Observation"	7a. $5 per visit	"7b, 7d, 7f, 7g. $30 per visit, Chiropractic $20 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $30 per visit"	$0 copay for Radiology professional component		15. 20% Coinsurance; $0 Cost Share for Immunizations																						450	150	100	0	50	0.2	0.096447162	48.84119427	300	0	0.2	30	0.2	15.07349765	5	29.71046858	0.2	30	0		0.2																				NO	380.906211	126.968737	84.64582466	0	42.32291233	0.169291649	0.081638496	41.34203166	253.937474	0	0.169291649	25.3937474	0.169291649	12.75908639	4.232291233	25.14867114	0.169291649	25.3937474	0	0	0.169291649																					6.9337	0.620796471	1.89235623	0	0.567046146	1.108118909	0.781606699	0.64453587	6.661428868	0	2.04248891	0.065024046	0	0.796899965	1.706248272	8.512901095	0.303481955	0.912622306	0	0	4.227527293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7768			6.852448527	6.9337	0.620796471	1.89235623	0	0.567046146	1.108118909	0.781606699	0.64453587	6.661428868	0	2.04248891	0.065024046	0	0.796899965	1.706248272	8.512901095	0.303481955	0.912622306	0	0	4.227527293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7768	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	11a. 30% Coinsurance	"11b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	8a-b. 30% coinsurance	"5, 9c. 30% coinsurance"	12. 30% Coinsurance	"3, 9a, 9c. 30% coinsurance"	7a. $40 per visit	"7b, 7d, 7f, 7g. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	8a-b. 30% coinsurance		15. 30% Coinsurance																				5100	12.1362	0.3163	2.2781	0.5984	0.1023	0.3635	0.5316	0.1163	2.5665	0.7263	1.2766	0.0142	0	0.2877	2.4624	3.1013	0.0995	0.3293	2.5248	0	1.3866																				31.2181	1000		2.309241527	19.0699	0.937140116	4.170485566	0.598422105	0.669338831	1.47157324	1.313215668	0.760807367	9.22797512	0.726250422	3.319106935	0.079242298	0	1.084605477	4.168647032	11.61421345	0.403021662	1.241888579	2.524848906	0	5.614123166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9948
H7787_002_0	2012	2																															A	D	D	V	T	Coin	Coin	V	V	P	Coin	Coin	Coin	V	V	V	Coin	V	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	YES	150.77862	4.339852819	410.7860244	0	185.3863478	6.739425074	5.336182155	135.5545101	122.1157721	0	6.292884503	4.516548226	0.423574288	313.2530706	2310.732934	3265.131925	1.351809526	191.2545381	0	0	17.51369874																				3400	1a. $450 per admit	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	11a. 20% Coinsurance for DME	"11b, c. 20% Coinsurance for Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $300 ASC & OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 20% coinsurance for MRI, CT, PET, CNM, Other Imaging"	"5, 9c. $35 per visit for all OP Behavioral Health visits"	12. 20% Coinsurance	"3, 9a, $35 for OP Rehab & $100 for Observation"	7a. $10 per visit	"7b, 7d, 7f. $35 per visit, Chiropractic $20 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $35 per visit"	$0 copay for Radiology professional component		15. 20% Coinsurance; $0 cost share for immunizations																						450	150	100	0	50	0.2	0.2	48.84119427	300	0	0.2	35	0.2	0	10	34.57834063	0.2	35	0		0.2																				NO	395.8695795	131.9565265	87.97101768	0	43.98550884	0.175942035	0.175942035	42.96609565	263.913053	0	0.175942035	30.78985619	0.175942035	0	8.797101768	30.41891815	0.175942035	30.78985619	0	0	0.175942035																					4.9741	0.047722659	3.011438718	0	0.67952607	1.185748165	0.938858749	0.485354004	2.685662185	0	1.107182908	1.390638703	0.074524522	0	1.693979398	8.276815065	0.237840119	0.490724977	0	0	3.081395803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3615			4.151566833	4.9741	0.047722659	3.011438718	0	0.67952607	1.185748165	0.938858749	0.485354004	2.685662185	0	1.107182908	1.390638703	0.074524522	0	1.693979398	8.276815065	0.237840119	0.490724977	0	0	3.081395803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3615	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	11a. 30% Coinsurance	"11b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	8a-b. 30% coinsurance	"5, 9c. 30% coinsurance"	12. 30% Coinsurance	"3, 9a, 9c. 30% coinsurance"	7a. $40 per visit	"7b, 7d, 7f, 7g. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	8a-b. 30% coinsurance		15. 30% Coinsurance																				5100	8.4688	0.1316	2.3062	0.368	0.1174	0.3724	0.2948	0.0838	1.1439	0.163	0.4658	0.0162	0.0234	0.0205	1.1703	2.4805	0.0747	0.1453	1.3749	0	0.9676																				20.1889	1000		1.601889336	13.4429	0.179276784	5.317598411	0.368044523	0.796888926	1.558100702	1.23368226	0.569180857	3.829540227	0.163001945	1.572967214	1.406793187	0.097926958	0.020479651	2.864267153	10.75729032	0.312527456	0.636018387	1.374923316	0	4.049025843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5504
H7787_004_0	2012	7																															A	D	D	V	T	Coin	Coin	V	V	P	Coin	Coin	Coin	V	V	V	Coin	V	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	YES	237.5962646	45.20596835	322.1114832	0	189.8954382	7.237955776	9.428476093	236.4755364	368.2278057	0	18.17955615	0.613146595	0	2642.280527	4527.158387	4159.029886	1.44586954	261.5088313	0	0	17.68437136																				3400	"1a. $450 per admit(Acute, Rehab, LTAC)"	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	11a. 20% Coinsurance for DME	"11b, c. 20% Coinsurance for Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $300 ASC & OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 20% coinsurance for MRI, CT, PET, CNM, Other Imaging"	"5, 9c. $35 per visit for all OP Behavioral Health visits"	12. 20% Coinsurance	"3, 9a, $35 for OP Rehab & $100 for Observation"	7a. $5 per visit	"7b, 7d, 7f, 7g. $35 per visit, Chiropractic $20 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $35 per visit"	$0 copay for Radiology professional component		15. 20% Coinsurance; $0 cost share for immunization																						450	150	100	0	50	0.2	0.116170093	48.84119427	300	0	0.2	35	0.2	8.443308001	5	34.33066986	0.2	35	0		0.2																				NO	382.725	127.575	85.05	0	42.525	0.1701	0.098802664	41.53943573	255.15	0	0.1701	29.7675	0.1701	7.181033455	4.2525	29.19823472	0.1701	29.7675	0	0	0.1701																					7.5778	0.480595951	2.282965138	0	0.672941959	1.231176277	0.931558556	0.818588362	7.829443719	0	3.092342502	0.182518413	0	1.581192071	1.604311753	10.11969423	0.245942409	0.648705345	0	0	3.008111569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3079			7.436842629	7.5778	0.480595951	2.282965138	0	0.672941959	1.231176277	0.931558556	0.818588362	7.829443719	0	3.092342502	0.182518413	0	1.581192071	1.604311753	10.11969423	0.245942409	0.648705345	0	0	3.008111569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3079	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	11a. 30% Coinsurance	"11b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	8a-b. 30% coinsurance	"5, 9c. 30% coinsurance"	12. 30% Coinsurance	"3, 9a, 9c. 30% coinsurance"	7a. $40 per visit	"7b, 7d, 7f, 7g. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	8a-b. 30% coinsurance		15. 30% Coinsurance																				5100	11.542	0.2817	1.4031	0.7011	0.1195	0.3974	0.5177	0.1453	2.8135	0.676	1.4199	0.0337	0	0.7667	2.2787	3.1402	0.0794	0.1974	1.2547	0	0.9711																				28.7392	1000		2.471917474	19.1198	0.762318039	3.686087833	0.701103938	0.792421352	1.628617536	1.44928283	0.96392696	10.64298315	0.675999189	4.512216243	0.216186725	0	2.347858953	3.883048481	13.25985414	0.325336125	0.846150318	1.254693662	0	3.979172878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0471
H7908_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1406.183087	121.362832	981.1085678	672.0722687	196.7422724	11.52492714	0	294.2892223	362.9555144	2082.801705	2516.999568	29.29752083	0.028160601	270.6648296	3154.622531	5225.677341	284.2008396	652.6498174	0	0	53.16071668	0.002502084	0	0	862.6970362	0	53.42601285	0	57.20914226	0											3400	$250/day 1-5; unlimited additional days	$250/day 1-5	"$0/d 1-20, $145/d 21-100; includes non-Medicare covered stays"	$20 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 to $35 per visit	$0 to $35 X-ray; 20% Therapeutic Radiology; 20% Complex Radiology	$35 per visit	20% per visit	$0 to 250 per visit	$15 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	20% per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	153.2096852	96.85527186	58.48044118	20	200	0.03	0.03	62	250	3.5	14.45055284	35	0.2	35	15	35	35	17.5	35	35	0.1	0	0	0	0	0	0	0	0	0											NO	125.9622382	79.63012788	48.08003653	16.4431169	164.431169	0.024664675	0	50.97366239	205.5389612	2.877545457	11.88060648	28.77545457	0.164431169	28.77545457	12.33233767	28.77545457	28.77545457	14.38772729	0	0	0.082215584	0	0	0	0	0	0	0	0	0												14.7605	0.805344819	3.930977982	0.920913573	2.695880154	0.284258586	0	1.250083288	6.216791618	0.499446382	2.491956782	0.070254123	0.004630481	0.649041959	3.241989191	12.53093675	0.681500696	0.782512299	0	0	4.370639394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1877	0	NO	13.09963172	14.7605	0.805344819	3.930977982	0.920913573	2.695880154	0.284258586	0	1.250083288	6.216791618	0.499446382	2.491956782	0.070254123	0.004630481	0.649041959	3.241989191	12.53093675	0.681500696	0.782512299	0	0	4.370639394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1877	NO																																																																																		0		NO		14.7605	0.805344819	3.930977982	0.920913573	2.695880154	0.284258586	0	1.250083288	6.216791618	0.499446382	2.491956782	0.070254123	0.004630481	0.649041959	3.241989191	12.53093675	0.681500696	0.782512299	0	0	4.370639394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1877
H7908_801_0	2012	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	0	0	0	0	0	0	0											0	YES	376.6668634	6.929289471	45.99604142	11.98935769	11.22599082	15.56504367	0	19.49918177	48.25232883	23.39887965	65.36769629	1.094168182	0.095558397	32.11064538	32.38237916	161.447446	3.700287538	10.25715049	0	0	81.05244713	0.000421911	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	NO	0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061314519	0.061314519	0.120056153	0	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0	0	0	0	0	0	0	0												23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865	0	NO	28.13570818	23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865
H7908_802_0	2012	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	0	0	0	0	0	0	0											0	YES	376.6668634	6.929289471	45.99604142	11.98935769	11.22599082	15.56504367	0	19.49918177	48.25232883	23.39887965	65.36769629	1.094168182	0.095558397	32.11064538	32.38237916	161.447446	3.700287538	10.25715049	0	0	81.05244713	0.000421911	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	NO	0.075585153	0.075585153	0.147998596	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.061314519	0.061314519	0.120056153	0	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0.181708335	0	0	0	0	0	0	0	0												23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865	0	NO	28.13570818	23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		NO		23.0951	0.424866051	5.522107805	0	2.0398561	2.828298168	0	3.543163851	8.767850328	4.251771461	11.87785525	0.198819478	0.017363757	5.834771905	5.884148199	29.33634658	0.672373087	1.863809737	0	0	14.72790521	7.67E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8865
H7917_008_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	793.7645708	16.63800298	917.7152259	31.57380469	198.3033532	24.03644415	5.094114271	302.0497333	437.1111834	2598.011889	10.67218052	0	0.016128841	239.5264126	4155.792292	4723.07619	277.8247654	262.5448894	24.72396378	21.72065431	49.30926854	0	0	0	255.5126041	0	63.19471973	0	450.00001	0											4650	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-4/5-90	2:  $0$/$50/$100/day for 1-7/8-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	175	175	56.39246637	0	175	0.2	0.2	64.91688951	150	33.96289459	0.218348657	0	0.2	35	15.00178464	31.58551728	35	35	0	16.87314326	0.2	0	0	0	35	0	15	0	0	0											NO	153.9038072	153.5544669	49.6586316	-1.76E-18	153.8554255	0.175837217	0.175798171	57.08005316	131.92503	29.84635095	0.191966896	0	0.175122662	30.77058941	13.19401071	27.78111479	30.76540237	30.77106477	0	14.83292622	0.175863182	0	0	0	35	0	15	0	0	0												10.1803	0.212903307	3.797706859	-5.55E-17	2.542503898	4.226501458	0.89553597	1.436751236	4.805492165	6.461764552	2.048705363	0	0.002824526	0.614197408	4.569297335	10.93436015	0.712282558	0.67323215	0	0.026848405	8.671684876	0	0	0	0.745245095	0	0.0789934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6371	0	NO	8.614784149	10.1803	0.212903307	3.797706859	-5.55E-17	2.542503898	4.226501458	0.89553597	1.436751236	4.805492165	6.461764552	2.048705363	0	0.002824526	0.614197408	4.569297335	10.93436015	0.712282558	0.67323215	0	0.026848405	8.671684876	0	0	0	0.745245095	0	0.0789934	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6371	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	5.5684	0.0429	0.7713	0.7886	0.2038	0.8514	0.1379	0.1399	1.7126	0.6589	0.3868	0	0.0003	0.3578	1.1379	2.3084	0.0498	0.0923	0.6262	0.4363	1.4758	0	0	0	0.1054	0	0.0112	0	0	0	0	0	0	0	0	0	0	0	0	0	17.8639	0	NO	10.92477841	15.7487	0.255815277	4.569011281	0.788570096	2.746303777	5.077876554	1.03343313	1.576675525	6.518082084	7.120679649	2.435542844	0	0.003135535	0.971948805	5.707202769	13.24272231	0.762083086	0.765538842	0.626165985	0.463156671	10.14750744	0	0	0	0.850678601	0	0.090169196	0	0	0	0	0	0	0	0	0	0	0	0	0	81.501
H7917_009_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	676.9178159	50.81107889	539.7049217	31.11521164	189.6153782	18.08549285	3.97735332	306.587409	443.6013664	2886.772493	20.04877954	0	0.165104984	682.2729765	4580.708643	4986.487991	533.6787707	324.8597264	23.53657718	26.78102103	52.01263011	0	0	0	259.2136833	0	73.4131526	0	450.00001	0											4650	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-4/5-90	2:  $0$/$50/$100/day for 1-7/8-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	175	175	56.39246637	0	175	0.2	0.2	64.15446768	150	39.55620342	0.159986481	0	0.2	35	15.00164255	31.67393408	35	35	0	17.89669804	0.2	0	0	0	35	0	15	0	0	0											NO	152.5324859	152.5627345	49.09716664	0	152.5472908	0.174297378	0.174176999	55.99137418	130.7545058	34.47525786	0.139445349	0	0.175837743	30.56378296	13.08569099	27.62565532	30.59815952	30.48392655	0	15.62157882	0.173643956	0	0	0	35	0	15	0	0	0												8.6043	0.645989761	2.208165206	0	2.410442686	3.152253978	0.692763465	1.430520861	4.833573119	8.29351884	2.795709069	0	0.029031688	1.737736931	4.995144818	11.47958321	1.360799013	0.825250003	0	0.034863486	9.031678834	0	0	0	0.75603991	0	0.091766441	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4092	0	NO	9.530711497	8.6043	0.645989761	2.208165206	0	2.410442686	3.152253978	0.692763465	1.430520861	4.833573119	8.29351884	2.795709069	0	0.029031688	1.737736931	4.995144818	11.47958321	1.360799013	0.825250003	0	0.034863486	9.031678834	0	0	0	0.75603991	0	0.091766441	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4092	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	5.6554	0.161	0.4648	0.7085	0.2182	0.7401	0.1245	0.1338	1.713	0.6095	0.5691	0	0.0032	0.5317	1.2039	2.4131	0.1164	0.1159	0.5817	0.3949	1.5005	0	0	0	0.1023	0	0.0124	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0739	0	NO	11.34631136	14.2597	0.806966804	2.672928189	0.708504563	2.628667943	3.892356385	0.817302068	1.564345097	6.546555177	8.903048577	3.364775548	0	0.032239142	2.269459407	6.199036626	13.8926595	1.477205254	0.941168449	0.581707414	0.429759028	10.53216902	0	0	0	0.858364367	0	0.104185308	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4831
H7917_010_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	800.3521223	23.80420349	603.2010683	36.00691942	245.3164931	22.92749623	5.653983335	332.3494921	465.0502791	2474.653742	15.06720449	0	0.037043916	388.3974072	4531.574652	5026.279199	353.0819075	374.2314913	24.48071156	19.7004124	64.30265299	0	0	0	273.995876	0	54.94067737	0	450.00001	0											4650	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-4/5-90	2:  $0$/$50/$100/day for 1-7/8-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	175	175	56.39246637	0	175	0.2	0.2	64.6263165	150	32.90295142	0.197301952	0	0.2	35	15.00175504	31.58700739	35	35	0	17.62466022	0.2	0	0	0	35	0	15	0	0	0											NO	151.6450592	151.6450592	48.86650801	0	151.6450592	0.173308639	0.173308639	56.00149481	129.9814793	28.51182866	0.170970664	0	0.173308639	30.32901184	12.99966875	27.37150632	30.32901184	30.32901184	2.27E-18	15.27252939	0.173308639	0	0	0	35	0	15	0	0	0												10.1141	0.300815821	2.45636082	0	3.100086177	3.973533169	0.979884157	1.551005697	5.037326937	5.879741956	2.576049959	0	0.006420031	0.981642464	4.909080784	11.46473607	0.892385446	0.945839278	5.55E-17	0.025072927	11.14420528	0	0	0	0.799154638	0	0.068675847	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2061	0	NO	10.2168	10.1141	0.300815821	2.45636082	0	3.100086177	3.973533169	0.979884157	1.551005697	5.037326937	5.879741956	2.576049959	0	0.006420031	0.981642464	4.909080784	11.46473607	0.892385446	0.945839278	5.55E-17	0.025072927	11.14420528	0	0	0	0.799154638	0	0.068675847	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2061	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	5.2959	0.067	0.5108	0.8732	0.2387	0.8035	0.1543	0.1325	1.5558	0.429	0.5057	0	0.0007	0.363	1.2463	2.3352	0.07	0.1407	0.6358	0.5537	1.9674	0	0	0	0.1093	0	0.0094	0	0	0	0	0	0	0	0	0	0	0	0	0	17.998	0	NO	11.1768	15.41	0.367864313	2.96714293	0.87315665	3.338752782	4.777042408	1.134223849	1.683548064	6.593120467	6.30871243	3.081759108	0	0.007152438	1.34463931	6.15541977	13.79994809	0.962390693	1.086543239	0.635810708	0.578725981	13.11164819	0	0	0	0.908480166	0	0.078070803	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2041
H7917_011_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	547.9378742	20.87382378	273.7449344	17.94349564	148.8549253	20.71519286	5.470086907	302.7329895	446.7288331	2684.199294	17.28909247	0	0.025404467	259.6480724	4280.15021	4822.324781	318.4986034	221.1799138	19.69568875	20.81061854	68.0314538	0	0	0	287.5029239	0	59.31740098	0	450.00001	0											4650	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-4/5-90	2:  $0$/$50/$100/day for 1-7/8-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $35/visit/3:  Pulmonary Rehabilitation - $35/visit/5:  Partial Hospitalization - $35/day/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $35/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	175	175	56.39246637	0	175	0.2	0.2	63.9016849	150	30.72632652	0.169739305	0	0.2	35	15.00194974	31.85772545	35	35	0	17.24127675	0.2	0	0	0	35	0	15	0	0	0											NO	154.9924101	154.9924101	49.9451673	0	154.9924101	0.177134183	0.177134183	56.59586374	132.8506373	27.21341373	0.150333165	0	0.177134183	30.99848203	13.28679055	28.21546085	30.99848203	30.99848203	0	15.27009736	0.177134183	0	0	0	35	0	15	0	0	0												7.0772	0.269607021	1.139353046	0	1.922615303	3.669368763	0.968939375	1.427786252	4.945684181	6.087185494	2.599123994	0	0.0045	0.670724675	4.739121615	11.33867634	0.822747769	0.571353465	0	0.026481681	12.05069599	0	0	0	0.838550195	0	0.074146751	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2438	0	NO	7.788	7.0772	0.269607021	1.139353046	0	1.922615303	3.669368763	0.968939375	1.427786252	4.945684181	6.087185494	2.599123994	0	0.0045	0.670724675	4.739121615	11.33867634	0.822747769	0.571353465	0	0.026481681	12.05069599	0	0	0	0.838550195	0	0.074146751	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2438	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	4.5325	0.0477	0.2568	0.5163	0.1416	0.6599	0.1375	0.1162	1.7904	0.6585	0.5735	0	0.0005	0.5327	1.3036	2.4006	0.058	0.0797	0.6245	0.552	2.3315	0	0	0	0.1223	0	0.0108	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4468	0	NO	10.0944	11.6097	0.317289926	1.396129665	0.51633944	2.064191897	4.329251138	1.106408226	1.543946852	6.736048599	6.745733271	3.172602471	0	0.005017986	1.203409474	6.042680428	13.73924207	0.880716282	0.651033403	0.624474676	0.578478207	14.38215219	0	0	0	0.960804979	0	0.084956832	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6906
H7917_012_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	910.436091	40.92308402	923.7902792	36.83194541	218.7676419	24.71973432	4.98321217	356.3715052	363.8589099	2967.948962	12.0065823	0	0.037533823	226.3684305	3724.348695	4113.073305	230.3553138	196.9525481	21.88306658	16.78033627	38.12884319	0	0	0	208.7688534	0	48.47033544	0	450.00001	0											4800	1a:  Acute - $275/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	275	275	71.78814225	0	175	0.2	0.2	64.94543587	250	34.71480926	0.203504409	0	0.2	40	20.00122031	34.91585093	40	40	0	17.51293081	0.2	0	0	0	35	0	15	0	0	0											NO	233.728592	233.960078	61.03525788	0	148.6126009	0.169708667	0.169635386	55.1650452	212.1506161	29.45902637	0.172767924	0	0.169963521	33.9422878	16.98126405	29.64026394	33.92611626	33.91430798	0	14.84764379	0.169615183	0	0	0	35	0	15	0	0	0												17.7329	0.797863994	4.69864816	0	2.709302354	4.195153151	0.84532912	1.638270849	6.432740994	7.286073895	2.074352298	0	0.006379381	0.640288535	5.270345717	10.15938153	0.651255096	0.556625781	0	0.020762371	6.467230721	0	0	0	0.608909156	0	0.060587919	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8524	0	NO	12.82687509	17.7329	0.797863994	4.69864816	0	2.709302354	4.195153151	0.84532912	1.638270849	6.432740994	7.286073895	2.074352298	0	0.006379381	0.640288535	5.270345717	10.15938153	0.651255096	0.556625781	0	0.020762371	6.467230721	0	0	0	0.608909156	0	0.060587919	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8524	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	6.31	0.1044	0.7547	0.8861	0.2185	0.8213	0.129	0.1548	1.5946	0.6719	0.4032	0	0.0007	0.3546	1.0613	2.07	0.0425	0.0659	0.5766	0.3827	1.2239	0	0	0	0.0869	0	0.0087	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9223	0	NO	11.07633792	24.0429	0.902282307	5.453339873	0.886053737	2.92783802	5.016415633	0.974378601	1.793041048	8.027322043	7.957953995	2.477513955	0	0.007120394	0.994883277	6.331673012	12.2294252	0.693708048	0.622569408	0.576629527	0.403487428	7.691120361	0	0	0	0.695837769	0	0.069278132	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7747
H7917_013_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	598.7577794	32.82482652	496.6203257	24.68584002	152.5437497	17.06793654	4.897639397	268.47042	366.5539655	2769.972502	15.88492101	0	0.039208559	493.0503185	3897.378118	4250.221822	427.7431986	270.8267817	21.33793978	19.72639145	43.16721372	0	0	0	212.2320806	0	53.29064104	0	450.00001	0											4800	1a:  Acute - $275/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	275	275	71.78814225	0	175	0.2	0.2	64.62324066	250	39.86730241	0.17637693	0	0.2	40	20.00118548	34.90501262	40	40	0	18.9693411	0.2	0	0	0	35	0	15	0	0	0											NO	238.3900592	233.641735	61.70219615	0	150.689764	0.173033279	0.173922106	56.14153271	215.6898431	34.610338	0.152686651	0	0.177517691	34.62422701	17.34602292	30.23500431	34.78108006	34.50930201	2.60E-18	16.38233012	0.170932702	0	0	0	35	0	15	0	0	0												11.8948	0.639104118	2.553547062	0	1.915565136	2.953321024	0.851807757	1.256028406	6.588497274	7.989140379	2.425415398	0	0.006960213	1.422623846	5.633667513	10.70878959	1.239780869	0.778836933	5.55E-17	0.026930355	7.378688485	0	0	0	0.619010235	0	0.066613301	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9492	0	NO	10.38896303	11.8948	0.639104118	2.553547062	0	1.915565136	2.953321024	0.851807757	1.256028406	6.588497274	7.989140379	2.425415398	0	0.006960213	1.422623846	5.633667513	10.70878959	1.239780869	0.778836933	5.55E-17	0.026930355	7.378688485	0	0	0	0.619010235	0	0.066613301	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9492	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	5.1539	0.0994	0.4166	0.6034	0.1861	0.7183	0.1765	0.1274	1.4072	0.6331	0.4815	0	0.0008	0.4407	1.1363	2.1599	0.0955	0.1034	0.5807	0.3955	1.3114	0	0	0	0.084	0	0.0091	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3208	0	NO	8.389855489	17.0488	0.73852982	2.970181959	0.603396218	2.101669818	3.671572132	1.028313264	1.383463008	7.995679091	8.62222951	2.90689302	0	0.007807373	1.863304163	6.76999494	12.86866929	1.335305925	0.882272303	0.580665314	0.422462099	8.690051102	0	0	0	0.703021199	0	0.075686716	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2699
H7917_014_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	584.2940719	33.77660479	418.034808	27.0313013	203.8287455	19.05590977	4.276902663	327.6864925	349.1201383	2025.073896	11.30079935	0	0.030603548	277.392193	3582.742568	3805.966976	295.1903107	220.8391925	16.3083541	16.57803125	33.84941055	0	0	0	174.0797105	0	46.31982375	0	450.00001	0											4800	1a:  Acute - $275/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	275	275	71.78814225	0	175	0.2	0.2	64.5043595	250	36.12751767	0.194511397	0	0.2	40	20.00105776	34.98562576	40	40	0	18.25378433	0.2	0	0	0	35	0	15	0	0	0											NO	245.0639862	245.0639862	63.973412	0	155.9498094	0.178228354	0.178228354	57.48252897	222.785442	32.19473997	0.17333723	0	0.178228354	35.64567072	17.82377797	31.1771524	35.64567072	35.64567072	0	16.26670964	0.178228354	0	0	0	35	0	15	0	0	0												11.9325	0.689785784	2.22859275	0	2.648921167	3.396303425	0.76226532	1.569687358	6.481573693	5.433060626	1.958849258	0	0.00545442	0.823985898	5.321500672	9.888267702	0.876854718	0.655996762	0	0.022472502	6.032924712	0	0	0	0.507732489	0	0.05789978	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2946	0	NO	7.4184	11.9325	0.689785784	2.22859275	0	2.648921167	3.396303425	0.76226532	1.569687358	6.481573693	5.433060626	1.958849258	0	0.00545442	0.823985898	5.321500672	9.888267702	0.876854718	0.655996762	0	0.022472502	6.032924712	0	0	0	0.507732489	0	0.05789978	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2946	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	4.6686	0.1042	0.3915	0.7487	0.2282	0.7373	0.1335	0.1535	1.3161	0.4261	0.4342	0	0.0007	0.3455	1.1407	2.0196	0.0597	0.0847	0.4612	0.4806	1.1089	0	0	0	0.0684	0	0.0079	0	0	0	0	0	0	0	0	0	0	0	0	0	15.1197	0	NO	6.4152	16.6011	0.793983334	2.620105424	0.7486671	2.877093633	4.1336521	0.895747486	1.723169754	7.797647542	5.859189254	2.393022104	0	0.006126136	1.169450908	6.462242175	11.90785866	0.936577195	0.740730293	0.46115656	0.503119927	7.141835726	0	0	0	0.576093352	0	0.065798988	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4143
H7917_015_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	614.6701153	14.15793054	353.0519223	18.29900582	187.4721859	20.01331018	4.473360414	295.8730379	383.4070625	2395.756487	19.21270575	0	0.011804841	201.983329	3906.551971	4382.686764	286.7638881	191.9760707	16.11054351	19.31165582	62.61889442	0	0	0	246.083783	0	55.25791675	0	450.00001	0											4800	1a:  Acute - $275/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	275	275	71.78814225	0	175	0.2	0.2	63.60265845	250	31.43693063	0.168370491	0	0.2	40	20.00137134	34.83608743	40	40	0	17.70562344	0.2	0	0	0	35	0	15	0	0	0											NO	235.4186501	228.2664401	60.99291106	0	149.4728343	0.173098476	0.172005402	55.18463179	215.2782435	26.88451264	0.144227806	0	0.166011956	34.37399144	17.26898896	30.03132814	34.44951606	34.01063486	0	15.12512488	0.169467065	0	0	0	35	0	15	0	0	0												12.0587	0.269315034	1.794472041	0	2.335166582	3.464273492	0.769442154	1.360637054	6.878266579	5.367395462	2.771006406	0	0.001959745	0.578581102	5.62185024	10.9681587	0.823239764	0.544102337	0	0.024340934	10.61184025	0	0	0	0.717744367	0	0.069072396	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0296	0	NO	11.03625363	12.0587	0.269315034	1.794472041	0	2.335166582	3.464273492	0.769442154	1.360637054	6.878266579	5.367395462	2.771006406	0	0.001959745	0.578581102	5.62185024	10.9681587	0.823239764	0.544102337	0	0.024340934	10.61184025	0	0	0	0.717744367	0	0.069072396	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0296	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												5900	5.0577	0.0505	0.3051	0.5255	0.182	0.6377	0.1132	0.1109	1.8414	0.5666	0.5793	0	0.0002	0.4191	1.1637	2.1888	0.0521	0.075	0.507	0.4751	2.0238	0	0	0	0.1033	0	0.01	0	0	0	0	0	0	0	0	0	0	0	0	0	16.9877	0	NO	9.547620618	17.1164	0.319776533	2.099552324	0.525462236	2.517122706	4.101959879	0.882598063	1.471559129	8.719660701	5.933997061	3.350286452	0	0.002175878	0.997726303	6.785527019	13.15693093	0.875343288	0.619080644	0.506978784	0.49943855	12.63567408	0	0	0	0.821036464	0	0.079025962	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0173
H7917_030_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	488.1343333	35.07552096	234.7000617	27.77780146	167.6737194	18.72563544	4.139764654	334.2829229	338.006444	2190.051994	11.80852734	0	0.028090166	227.4454996	3439.201971	3866.864707	299.7533509	206.8922217	15.79651958	71.17627731	35.45060521	0	0	0	295.6552137	0	129.1704633	0	450.00001	0											4950	1a:  Acute - $300/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $300/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $100/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $325/visit/9b:  Ambulatory Surgical Center Services - $325/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	300	300	71.78814225	0	175	0.2	0.2	64.91567983	325	35.56321229	0.190223744	0	0.2	40	20.00169956	35.50155683	40	40	0	15.7709243	0.2	0	0	0	35	0	15	0	0	0											NO	268.119136	268.119136	64.15924891	0	156.4028293	0.178746091	0.178746091	58.11297814	290.4623973	31.78392584	0.170008753	0	0.178746091	35.74921813	17.87612801	31.72882248	35.74921813	35.74921813	0	14.09495532	0.178746091	0	0	0	35	0	15	0	0	0												10.9065	0.783701531	1.254848307	0	2.18538701	3.34713413	0.739966748	1.618848016	8.181513503	5.80070418	2.007553009	0	0.005021007	0.677583231	5.123301224	10.22425532	0.89299566	0.61635293	0	0.083602204	6.336657093	0	0	0	0.862327707	0	0.161463079	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8097	0	NO	7.2248	10.9065	0.783701531	1.254848307	0	2.18538701	3.34713413	0.739966748	1.618848016	8.181513503	5.80070418	2.007553009	0	0.005021007	0.677583231	5.123301224	10.22425532	0.89299566	0.61635293	0	0.083602204	6.336657093	0	0	0	0.862327707	0	0.161463079	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8097	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $100/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												6000	4.2419	0.1268	0.253	0.8692	0.1968	0.7573	0.1332	0.1647	1.3055	0.5105	0.4574	0	0.0006	0.3004	1.0754	2.0313	0.0574	0.0755	0.4831	0.415	1.1686	0	0	0	0.1151	0	0.0216	0	0	0	0	0	0	0	0	0	0	0	0	0	14.76	0	NO	5.6784	15.1484	0.910519476	1.507882549	0.869218516	2.382152605	4.104408472	0.873127859	1.783518548	9.486979158	6.311182137	2.464939361	0	0.005624136	0.977987923	6.198669011	12.25558447	0.950346527	0.691818711	0.483061373	0.49862718	7.50522074	0	0	0	0.977465496	0	0.183021591	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5698
H7917_031_0	2012	7																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	419.9226892	30.17408545	207.7796622	25.5056154	167.9076181	19.90226995	4.399888802	367.0323025	292.4196223	1745.696529	12.25330659	0	0.025100799	142.7180575	3031.616547	3401.435592	262.0796353	180.8895141	12.31522147	62.73219448	28.76888418	0	0	0	263.5934896	0	115.1628369	0	450.00001	0											4950	1a:  Acute - $300/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $300/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $100/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $325/visit/9b:  Ambulatory Surgical Center Services - $325/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $40/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 - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	300	300	71.78814225	0	175	0.2	0.2	64.87076461	325	32.61111248	0.198211206	0	0.2	40	20.00169956	35.52365118	40	40	0	15.76476103	0.2	0	0	0	35	0	15	0	0	0											NO	273.94158	273.94158	65.55252372	0	159.799255	0.18262772	0.18262772	59.3033274	296.770045	29.7784656	0.180994303	0	0.18262772	36.525544	18.26432394	32.4380171	36.525544	36.525544	0	14.39541182	0.18262772	0	0	0	35	0	15	0	0	0												9.5862	0.688828054	1.135040103	0	2.235959357	3.634706184	0.80354166	1.813853067	7.231782039	4.332013669	2.217778688	0	0.004584102	0.434404557	4.614202222	9.194652159	0.797716771	0.550590659	0	0.075254648	5.253995725	0	0	0	0.768814345	0	0.143953546	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5179	0	NO	5.192	9.5862	0.688828054	1.135040103	0	2.235959357	3.634706184	0.80354166	1.813853067	7.231782039	4.332013669	2.217778688	0	0.004584102	0.434404557	4.614202222	9.194652159	0.797716771	0.550590659	0	0.075254648	5.253995725	0	0	0	0.768814345	0	0.143953546	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5179	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $100/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												6000	4.0971	0.1225	0.2455	0.8435	0.1909	0.7348	0.1292	0.1597	1.2603	0.4929	0.4419	0	0.0006	0.2901	1.0306	1.9423	0.0548	0.0721	0.4616	0.3964	1.1192	0	0	0	0.1103	0	0.0207	0	0	0	0	0	0	0	0	0	0	0	0	0	14.2173	0	NO	5.0076	13.6833	0.811338527	1.380574403	0.843454853	2.426892813	4.369534892	0.932755872	1.97355631	8.492123639	4.824933653	2.659639236	0	0.005158878	0.724525208	5.644850825	11.13698627	0.852560274	0.622736747	0.461593297	0.471701998	6.373188269	0	0	0	0.87914374	0	0.16461173	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7351
H7917_032_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	493.6028048	35.46846502	263.4995461	32.37162337	148.716807	16.79377187	3.712678453	321.7754633	353.3748953	2377.821922	13.69628583	0	0.027090392	222.6749993	3351.296192	3801.12692	276.4858666	190.8328131	16.67819268	71.29432132	35.10254219	0	0	0	302.4615049	0	132.144102	0	450.00001	0											4950	1a:  Acute - $300/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $300/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $100/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $45/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 - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $45/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	300	300	71.78814225	0	175	0.2	0.2	65.02092693	400	36.05121704	0.1890197	0	0.2	40	30.00058383	38.90906801	40	40	0	15.85188741	0.2	0	0	0	35	0	15	0	0	0											NO	274.3896719	274.3896719	65.65974933	0	160.0606419	0.182926448	0.182926448	59.55136915	365.8528959	32.97360538	0.172883511	0	0.182926448	36.58528959	27.43950117	35.58748801	36.58528959	36.58528959	0	14.49864728	0.182926448	0	0	0	35	0	15	0	0	0												11.2866	0.81101504	1.441776179	0	1.9836423	3.072025036	0.679147082	1.59684745	10.7736024	6.533780143	2.367861986	0	0.004955549	0.678885778	7.663157983	11.27271323	0.842942958	0.581806144	0	0.086139268	6.421183357	0	0	0	0.882179389	0	0.165180128	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1455	0	NO	6.3536	11.2866	0.81101504	1.441776179	0	1.9836423	3.072025036	0.679147082	1.59684745	10.7736024	6.533780143	2.367861986	0	0.004955549	0.678885778	7.663157983	11.27271323	0.842942958	0.581806144	0	0.086139268	6.421183357	0	0	0	0.882179389	0	0.165180128	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1455	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 40.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $100/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												6000	4.2948	0.1284	0.2557	0.8782	0.1988	0.7651	0.1691	0.1666	1.3221	0.5169	0.4632	0	0.0006	0.3042	1.0896	2.0592	0.0581	0.0765	0.4898	0.4208	1.1845	0	0	0	0.1196	0	0.0224	0	0	0	0	0	0	0	0	0	0	0	0	0	14.9841	0	NO	5.952	15.5814	0.939403524	1.697432847	0.878227022	2.182447156	3.837147705	0.848296363	1.763401456	12.09566187	7.050705074	2.831065851	0	0.005566071	0.983061133	8.752717474	13.33189139	0.901080173	0.658311596	0.489769597	0.506960556	7.605716819	0	0	0	1.001775069	0	0.187573339	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1296
H7917_033_0	2012	6																															D	D	D	coin	T	coin	coin	V	V	V	coin	O	coin	V	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	625.280575	44.93034072	218.2125464	29.67344399	169.0980441	19.1010376	4.222756583	290.193638	334.7836865	1218.465021	11.36627655	0	0.031110749	184.8648135	3446.650795	4061.944117	330.1902171	227.8999964	19.85878866	73.65501243	35.9870408	0	0	0	313.2214532	0	136.8450761	0	450.00001	0											4950	1a:  Acute - $300/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $300/$0/day for 1-4/5-90	2:  $0$/$50/$125/day for 1-4/5-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $100/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $50/visit/8a:  Outpatient Lab Services - $50/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $50/visit		12:  Renal Dialysis - 20.0%	3:  Cardiac Rehabilitation Services - $40/visit/3:  Pulmonary Rehabilitation - $40/visit/5:  Partial Hospitalization - $40/day/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Mammography - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - $0/visit/16b:  Comprehensive Dental - $45/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 - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $45/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175 Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												0	NO	300	300	71.78814225	0	175	0.2	0.2	65.07609374	400	37.94034186	0.18470758	0	0.2	40	30.0005838	38.39159652	40	40	0	15.98475024	0.2	0	0	0	35	0	15	0	0	0											NO	274.0000589	274.0000589	65.56651735	1.87E-18	159.8333677	0.182666706	0.182666706	59.53207962	365.3334119	34.65218635	0.168699626	0	0.182666706	36.53334119	27.4005391	35.06433236	36.53334119	36.53334119	1.40E-18	14.59940836	0.182666706	0	0	0	35	0	15	0	0	0												14.2772	1.025909667	1.192286393	5.55E-17	2.252292488	3.489123618	0.771357035	1.439652563	10.19230554	3.518539747	1.917486606	0	0.005682898	0.562810775	7.870007488	11.86911321	1.005245988	0.693829027	2.78E-17	0.089609967	6.5736342	0	0	0	0.913562572	0	0.171056345	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8307	0	NO	6.5208	14.2772	1.025909667	1.192286393	5.55E-17	2.252292488	3.489123618	0.771357035	1.439652563	10.19230554	3.518539747	1.917486606	0	0.005682898	0.562810775	7.870007488	11.86911321	1.005245988	0.693829027	2.78E-17	0.089609967	6.5736342	0	0	0	0.913562572	0	0.171056345	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8307	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 - 40.0%	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 40.0%	11b:  Prosthetics Devices - 40.0%/11b:  Medical Supplies - 40.0%/11c:  Diabetes Monitoring Supplies - 40.0%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $100/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 - 20.0%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 30.0%/5:  Partial Hospitalization - 30.0%/7i:  Physical/Speech Therapy - 30.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%	7d:  Physician Specialist Services - 40.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - $35/visit/14a:  Immunizations (Hepatitis B) - 30.0%/14a:  Physical Exams (Initial Exam) - 30.0%/14a:  Pap Smears and Pelvic Exams Screening - $9/visit/14a:  Prostate Cancer Screening - $9/visit/14a:  Colorectal Screening - $9/visit/14a:  Bone Mass Measurement - $9/visit/14a:  Mammography - $9/visit/14a:  Diabetes Monitoring - $9/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $9/visit/14d:  Kidney Disease Education Services - $0/service/14e:  Diabetes Self-Management Training - $0/service/14a:  Routine Exams - 30.0%/16b:  Comprehensive Dental - 40.0%	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 - 40.0%/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	9d:  Blood - $0/service/9d:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $175/Per Year	18a:  Routine Hearing Test - $15/visit		14c:  Written health education materials - $0/service/14c:  Membership in Health Club/Fitness Classes - $0/service/												6000	4.452	0.1331	0.2648	0.9097	0.2059	0.7925	0.1752	0.1726	1.3691	0.5363	0.4797	0	0.0006	0.315	1.1296	2.1352	0.0603	0.0793	0.5079	0.4364	1.2279	0	0	0	0.1274	0	0.0239	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5343	0	NO	6.6264	18.7293	1.158994403	1.457091702	0.909654267	2.458211551	4.281626107	0.946559302	1.612226825	11.56142402	4.054800133	2.397178019	0	0.006316037	0.877817231	8.999604807	14.00432798	1.065529399	0.773160455	0.507879101	0.526002695	7.801552566	0	0	0	1.040949146	0	0.194908331	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3651
H7917_801_0	2012	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	254.3559058	2.312954042	44.9234912	46.60359722	11.40644804	21.61420221	4.729598134	18.62605278	59.61515593	16.51588932	14.70586035	0	0.055998664	12.76418353	60.49456122	131.4946715	1.881197838	4.046927085	22.84242844	20.633094	14.97009917	0.872833535	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	NO	0.085454756	0.085454756	0.191845131	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.07603772	0.076134945	0.170649851	0	0.199298196	0.199347504	0.199358002	0.19934255	0.199315971	0.199385093	0.199349847	0	0.199208239	0.199404109	0.199322021	0.199344867	0.19941262	0.199220612	0.199315902	0.199277862	0.199044857	0.199116087	0	0	0	0	0	0	0	0											3300	19.3406	0.176096628	7.666187087	0	2.27328452	4.308737255	0.942883236	3.712964866	11.88225268	3.293022122	2.93161101	0	0.011155395	2.545230649	12.0578982	26.21278784	0.37513459	0.806231289	4.552859236	4.111718864	2.979721248	0.173795198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3542	0	NO	13.66601396	19.3406	0.176096628	7.666187087	0	2.27328452	4.308737255	0.942883236	3.712964866	11.88225268	3.293022122	2.93161101	0	0.011155395	2.545230649	12.0578982	26.21278784	0.37513459	0.806231289	4.552859236	4.111718864	2.979721248	0.173795198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3542	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	2.6592	0.0249	0.9558	0	0.288	0.6535	0.143	0.4812	1.7223	0.5827	0.4542	0	0.0019	0.4327	1.898	4.2946	0.0633	0.1405	0.8109	0.6357	0.5895	0.0342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8663	0	NO	1.13579926	21.9998	0.200987605	8.621989838	0	2.561245438	4.962284232	1.085924547	4.194157545	13.60457864	3.875738041	3.385779761	0	0.013103834	2.977953774	13.95594793	30.50740346	0.438467528	0.946765246	5.363710729	4.747441377	3.569228697	0.207977503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.2205
H7917_802_0	2012	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	212.8229263	7.214705365	27.14753423	38.30071377	9.293936613	21.84630229	5.828793	17.05227694	56.63998392	15.19949731	19.4463731	0	0.025259726	15.31360461	58.39403731	133.4670669	1.64614559	2.619566188	22.34414223	20.0780002	7.266954056	0.698896793	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	NO	0.085454756	0.085454756	0.191845131	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.076914301	0.077052515	0.17257496	0	0.201622546	0.201682698	0.201773734	0.201630657	0.201688194	0.201575943	0.201813734	0	0.201367986	0.201712653	0.201689148	0.201688327	0.201501765	0.201610853	0.201704364	0.201750507	0.201852043	0.201896549	0	0	0	0	0	0	0	0											3300	16.3691	0.555911191	4.684984631	0	1.873867161	4.406021197	1.176097328	3.438261805	11.42361608	3.063852996	3.924545171	0	0.0050865	3.088947819	11.77744365	26.91874949	0.331701241	0.528132973	4.506910997	4.050746714	1.466849521	0.141104851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.732	0	NO	11.48345393	16.3691	0.555911191	4.684984631	0	1.873867161	4.406021197	1.176097328	3.438261805	11.42361608	3.063852996	3.924545171	0	0.0050865	3.088947819	11.77744365	26.91874949	0.331701241	0.528132973	4.506910997	4.050746714	1.466849521	0.141104851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.732	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	2.4352	0.0865	0.6086	0	0.2407	0.6785	0.1817	0.4747	1.7155	0.5931	0.586	0	0.0008	0.5176	1.7998	4.2625	0.0527	0.0843	0.8042	0.5872	0.2928	0.0284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0308	0	NO	0.986064952	18.8043	0.64243955	5.293623094	0	2.114548859	5.084499597	1.357769611	3.912998071	13.13912772	3.656985521	4.510507582	0	0.005889409	3.606572993	13.57722227	31.18121003	0.38439224	0.612457324	5.31110597	4.637937028	1.759661251	0.169471492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7627
H7917_803_0	2012	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	238.4580139	3.471727182	35.83868016	43.9113877	10.25950215	21.79727322	4.879446557	18.57981923	55.96362074	18.02844632	14.90661311	0	0.039229615	14.46985126	57.59843387	131.8419283	2.167980743	2.945765451	21.43983157	17.63072134	5.079281387	0.433614305	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	NO	0.085454756	0.085454756	0.191845131	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.076775973	0.076775973	0.172361344	0	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0.201250565	0	0	0	0	0	0	0	0											3300	18.3078	0.266545233	6.177203081	0	2.064730605	4.386713552	0.981991376	3.739199118	11.26271029	3.628235007	2.999964311	0	0.007894982	2.912065742	11.59171736	26.53326255	0.436307349	0.592836961	4.314778216	3.548192631	1.022208249	0.087265124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8617	0	NO	11.8536	18.3078	0.266545233	6.177203081	0	2.064730605	4.386713552	0.981991376	3.739199118	11.26271029	3.628235007	2.999964311	0	0.007894982	2.912065742	11.59171736	26.53326255	0.436307349	0.592836961	4.314778216	3.548192631	1.022208249	0.087265124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8617	YES	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																			10000	2.6386	0.0384	0.8129	0	0.2629	0.6683	0.1496	0.5105	1.618	0.6805	0.4888	0	0.0012	0.4775	1.7564	4.1099	0.0689	0.0936	0.745	0.5194	0.1889	0.0161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8456	0	NO	0.9528	20.9465	0.304960873	6.990078002	0	2.327651159	5.055036886	1.131599447	4.249727238	12.88071038	4.308758548	3.488739035	0	0.009141466	3.389592816	13.34813718	30.64317539	0.505192877	0.686435858	5.059816009	4.067547361	1.211150292	0.103399282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.7073
H7949_001_0	2012	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1363.713846	88.36623532	1804.361762	1416.733474	377.7235284	14.40389888	28.5483641	222.9319212	97.81440864	5.145560665	14.51875901	0	5.318146685	177.4196503	5481.244437	6024.340622	599.8267656	481.6339592	0	0	14.2754263	979.1288109	701.7391304	501.6	42.79069767	0	17.6381231	65	540.608755	0											2950	"$75 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$50 Days 21-79 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$125 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$50 (9b)	20% (8a1a); $15 (8a2)	"$11 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $100 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $30 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$0/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 (10b)	"$25 (16a1, 16a2); $0 n/c (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 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	52.90867074	33.91423575	29.10257641	0	125	0.2	0.10339623	64.99372306	20.5	0.211926065	0.167690395	0	0.2	35.8732116	0.00088337	29.68231844	38.5	30	0	0	0.2	29.62541238	0	25	30	0	0	352.5	0	0											NO	43.31417038	27.76420132	23.8250921	0	102.3324008	0.163731841	0.084646276	53.23590391	16.78251372	0.173495224	0.137281285	0	0.163731841	29.36793493	0.00087081	29.26141899	37.9525657	29.57342782	0	0	0.163731841	24.25311658	0	25	30	0	0	352.5	0	0												4.9223	0.204451496	3.582423762	0	3.221112957	2.358376884	2.416512704	0.988998528	0.136797638	0.892730201	1.9931539	0	0.870749948	0.434204062	0.00039776	14.69006292	1.897080394	1.186963927	0	0	2.337341832	1.978910433	0	1.045	0.106976744	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	47.174	0	NO	6.08929559	4.9223	0.204451496	3.582423762	0	3.221112957	2.358376884	2.416512704	0.988998528	0.136797638	0.892730201	1.9931539	0	0.870749948	0.434204062	0.00039776	14.69006292	1.897080394	1.186963927	0	0	2.337341832	1.978910433	0	1.045	0.106976744	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	47.174	NO																																										0	0	0	0	0	0	0	0	0	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	4.9223	0.204451496	3.582423762	0	3.221112957	2.358376884	2.416512704	0.988998528	0.136797638	0.892730201	1.9931539	0	0.870749948	0.434204062	0.00039776	14.69006292	1.897080394	1.186963927	0	0	2.337341832	1.978910433	0	1.045	0.106976744	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	47.174
H7949_801_0	2012	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	514.8830935	5.072676169	35.10740908	761.9657969	26.7834172	13.47678178	11.63435352	20.89454472	89.19888976	54.91654525	118.3282039	0	0.318111748	45.84712853	60.12655043	174.5701788	1.465949065	11.136802	0	0	43.61754081	28.67177099	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075597648	0.075597648	0.1483052	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05192023	0.05192023	0.101855551	0	0.153842505	0.153842505	0.153842505	0.153842505	0.153842505	0.153842505	0.153842505	0	0.153842505	0.153842505	0.153842505	0.153842505	0.153842505	0.153842505	0	0	0.153842505	0.153842505	0	0	0	0	0	0	0	0												26.7328	0.263374515	3.575884506	0	4.120427991	2.073301867	1.789858088	3.214469099	13.72258063	8.448498881	18.20390729	0	0.048939108	7.053237095	9.250019128	26.85631358	0.225525276	1.713313516	0	0	6.710231734	4.410937068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4137	150	YES	63.12141276	26.7328	0.263374515	3.575884506	0	4.120427991	2.073301867	1.789858088	3.214469099	13.72258063	8.448498881	18.20390729	0	0.048939108	7.053237095	9.250019128	26.85631358	0.225525276	1.713313516	0	0	6.710231734	4.410937068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4137	NO																																										0	0	0	0	0	0	0	0	0	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	26.7328	0.263374515	3.575884506	0	4.120427991	2.073301867	1.789858088	3.214469099	13.72258063	8.448498881	18.20390729	0	0.048939108	7.053237095	9.250019128	26.85631358	0.225525276	1.713313516	0	0	6.710231734	4.410937068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4137
H7949_803_0	2012	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	456.8258839	3.68684175	30.72199478	664.8166907	23.30301311	11.61786565	10.78787857	17.81059227	76.78433158	49.00454623	105.0782139	0	0.390166937	42.38235562	52.0502096	153.5675908	1.370224866	9.700752484	0	0	41.27480182	24.72849741	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075596638	0.075596638	0.148280595	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.05429313	0.05429313	0.106494386	0	0.160875687	0.160875687	0.160875687	0.160875687	0.160875687	0.160875687	0.160875687	0	0.160875687	0.160875687	0.160875687	0.160875687	0.160875687	0.160875687	0	0	0.160875687	0.160875687	0	0	0	0	0	0	0	0												24.8025	0.200170177	3.27171998	0	3.748888233	1.869032112	1.735507372	2.865291259	12.35273206	7.883640018	16.90452981	0	0.062768374	6.818290556	8.373613204	24.7052916	0.220435866	1.560615216	0	0	6.640112079	3.978213997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9934	150	YES	50.22196379	24.8025	0.200170177	3.27171998	0	3.748888233	1.869032112	1.735507372	2.865291259	12.35273206	7.883640018	16.90452981	0	0.062768374	6.818290556	8.373613204	24.7052916	0.220435866	1.560615216	0	0	6.640112079	3.978213997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9934	NO																																										0	0	0	0	0	0	0	0	0	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	24.8025	0.200170177	3.27171998	0	3.748888233	1.869032112	1.735507372	2.865291259	12.35273206	7.883640018	16.90452981	0	0.062768374	6.818290556	8.373613204	24.7052916	0.220435866	1.560615216	0	0	6.640112079	3.978213997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9934
H7949_804_0	2012	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	394.1196427	3.295581217	30.22063801	558.3345551	20.60579761	10.79338912	11.04597139	16.33224251	69.10874307	40.95527034	89.84385123	0	0.38383919	36.17653157	46.49546473	130.8239725	1.228918617	8.683795688	0	0	41.88343589	22.00818715	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.075598264	0.075598264	0.148320164	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.056590845	0.056590845	0.111028521	0	0.167680428	0.167680428	0.167680428	0.167680428	0.167680428	0.167680428	0.167680428	0	0.167680428	0.167680428	0.167680428	0.167680428	0.167680428	0.167680428	0	0	0.167680428	0.167680428	0	0	0	0	0	0	0	0												22.3036	0.186499725	3.355352733	0	3.455188966	1.809840109	1.852193213	2.738597417	11.58818363	6.867397267	15.06505544	0	0.06436232	6.066096305	7.796379434	21.93661973	0.2060656	1.456102579	0	0	7.023032464	3.690342245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4609	150	YES	39.45210616	22.3036	0.186499725	3.355352733	0	3.455188966	1.809840109	1.852193213	2.738597417	11.58818363	6.867397267	15.06505544	0	0.06436232	6.066096305	7.796379434	21.93661973	0.2060656	1.456102579	0	0	7.023032464	3.690342245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4609	NO																																										0	0	0	0	0	0	0	0	0	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	22.3036	0.186499725	3.355352733	0	3.455188966	1.809840109	1.852193213	2.738597417	11.58818363	6.867397267	15.06505544	0	0.06436232	6.066096305	7.796379434	21.93661973	0.2060656	1.456102579	0	0	7.023032464	3.690342245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4609
H8050_001_0	2012	8																															D	D	D		T	Coin	Coin	V	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	792.9684594	13.73969914	381.0246536	0	177.8659985	9.036758929	4.842057502	226.3162014	40.70593837	474.9649704	660.3140975	0	0.15010208	8.242018941	0	3776.905054	163.3989879	880.6706216	0	12.72198334	25.23601969	0	0	0	263.9330903	0	0	0	0	0											3200	$100/Days Custom: 1-5 for IP Med/Surg; PBP 1a	$100/Days Custom: 1-5 for IP MH/SA; PBP 1b	$75/Days Custom: 21-100 for SNF; PBP 2	$0/Visit for HH; $0/Visit for Hospice; PBP 6	$100/Case for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for ER - Worldwide; $40/Case for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	$10/Case for OP Lab; PBP 8a	$15/Case for OP Rad - General; $15/Case for OP Rad - Complex Diagnostic; $15/Case for OP Rad - X-Ray; $15/Case for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Case for Cardiac Rehab; $15/Case for Pulmonary Rehabilitation Services; $15/Case for Partial Hosp; $0/Case for OP - Preventive; 20% Coinsurance for OP - Other; $15/Visit for OP Substance Abuse; PBP 3, 5, 9c"	"$0/Visit for PCP OV; $0/Visit for PCP - Facility Visit; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $15/Visit for SCP OV; $0/Visit for SCP - Facility Visit; $0/Procedure for SCP - Office Surg; $15/Visit for Podiatry; $0/Visit for Diabetic Footcare; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $0/Visit for Colorectal Screening; $15/Exam for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Procedure for Phys Rad - Complex Diagnostic; $0/Procedure for Phys Rad - X-Ray; $0/Procedure for Phys Rad - Theraputic; $0/Procedure for Bone Mass Measurement; $0/Procedure for Mammography Screening; PBP 7d, 14a"	"$0/Procedure for SCP - IP Surg; 20% Coinsurance for SCP - OP Surg; $0/Procedure for SCP - Other; $0/Procedure for Nutrition Training for Diabetes & Renal Dialysis; $0/Procedure for Diabetes Monitoring; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"$0/Procedure for Blood; $0/Procedure for Health Education/Wellness Programs; $0/Procedure for Kidney Disease Education Services; PBP 9d, 14c, 14d"			$15/Exam for Routine Eye Exams (non-cvd); PBP 17a	$0/Visit for Glasses/Contacts (non-cvd); PBP 17b		PBP 18b													0	NO	100	100	75	0	100	0.2	0.2	63.09213242	0.2	10	15	0	0.2	0.167180649	0	15	15	15	0	0.2	0.2	0	0	0	15	0	0	0	0	0											NO	93.22086996	93.22086996	69.91565247	0	93.22086996	0.18644174	0.18644174	58.81503472	0.18644174	9.322086996	13.98313049	0	0.18644174	0.155847256	0	13.98313049	13.98313049	13.98313049	0	0.18644174	0.18644174	0	0	0	15	0	0	0	0	0												6.1601	0.106735559	2.219965605	0	1.381735259	1.684829058	0.902761625	1.109232937	7.589285976	0.368972064	0.769438183	0	0.027985293	1.284496032	0	4.401079686	0.190402448	1.026211019	0	2.371908709	4.70504742	0	0	0	0.329916363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6301	0	NO	2.639791849	6.1601	0.106735559	2.219965605	0	1.381735259	1.684829058	0.902761625	1.109232937	7.589285976	0.368972064	0.769438183	0	0.027985293	1.284496032	0	4.401079686	0.190402448	1.026211019	0	2.371908709	4.70504742	0	0	0	0.329916363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6301	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for IP MH/SA; PBP 2	30% Coinsurance for HH; 30% Coinsurance for Hospice; PBP 6	30% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 30% Coinsurance for DMS; PBP 11b, 11c"	"30% Coinsurance for OP ER; 30% Coinsurance for ER - Worldwide; 30% Coinsurance for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; 30% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	30% Coinsurance for Renal Dialysis; PBP 12	"30% Coinsurance for Cardiac Rehab; 30% Coinsurance for Pulmonary Rehabilitation Services; 30% Coinsurance for Partial Hosp; 30% Coinsurance for OP - Preventive; 30% Coinsurance for OP - Other; 30% Coinsurance for OP Substance Abuse; PBP 3, 5, 9c"	"30% Coinsurance for PCP OV; 30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams (Initial); 30% Coinsurance Immunizations (non-cvd); 30% Coinsurance for Routine Exams; PBP 7a, 14a-b"	"30% Coinsurance for Chiro (cvd); 30% Coinsurance for SCP OV; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; 30% Coinsurance for Diabetic Footcare; 30% Coinsurance for Pap Smears and Pelvic Exams Screening; 30% Coinsurance for Prostate Cancer Screening; 30% Coinsurance for Colorectal Screening; 30% Coinsurance for Pap Smears and Pelvic Exams Screening (non-cvd); 30% Coinsurance for Prostate Cancer Screening (non-cvd); 30% Coinsurance for Colorectal Screening (non-cvd); 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"30% Coinsurance for MH - Non Phys; 30% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Theraputic; 30% Coinsurance for Bone Mass Measurement; 30% Coinsurance for Mammography Screening; / for Mammography Screening (non-cvd); PBP 7d	"30% Coinsurance for SCP - IP/OP Surg; 30% Coinsurance for SCP - Other; 30% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 30% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"30% Coinsurance for Blood; 30% Coinsurance for Health Education/Wellness Programs; 30% Coinsurance for Kidney Disease Education Services; PBP 9d, 14c, 14d"																			5000	5.4149	0.0504	1.0847	0.4019	0.4528	0.2224	0.2577	0.2755	0.93	0.0484	0.4263	0	0.0042	0.203	0.7104	1.3118	0.0529	0.2296	0.309	2.0409	0.5916	0	0	0	0	0	0	0	0	0											15.0187	500	NO	6.534297481	11.575	0.157102254	3.30469902	0.401892687	1.834580726	1.907270505	1.160503927	1.384740647	8.519238368	0.417367176	1.195784062	0	0.032203789	1.487529156	0.710363027	5.712879663	0.243339349	1.255819927	0.30901967	4.412810861	5.2966828	0	0	0	0.329916363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6488
H8050_005_0	2012	8																															D	D	D		T	Coin	Coin	V	Coin	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	660.8801026	14.13715691	382.1196438	0	171.6299536	7.428167971	4.404028282	232.0041773	38.64678802	687.0422606	16.97308478	0	0.172942377	10.53919315	3635.9162	3549.080173	96.65238433	655.3645366	3.189224043	10.58129847	23.72725692	0	0	0	0	0	0	0	0	0											3400	$250/Days Custom: 1-7 for IP Med/Surg; PBP 1a	$250/Days Custom: 1-7 for IP MH/SA; PBP 1b	$125/Days Custom: 21-100 for SNF; PBP 2	0% Coinsurance for HH; $0/Visit for Hospice; PBP 6	$200/Case for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for ER - Worldwide; $45/Case for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	$15/Case for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Complex Diagnostic; 20% Coinsurance for OP Rad - X-Ray; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for Pulmonary Rehabilitation Services; $35/Case for Partial Hosp; $0/Case for OP - Preventive; 20% Coinsurance for OP - Other; $35/Visit for OP Substance Abuse; PBP 3, 5, 9c"	"$10/Visit for PCP OV; $0/Visit for PCP - Facility Visit; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $35/Visit for SCP OV; $0/Visit for SCP - Facility Visit; $0/Procedure for SCP - Office Surg; $35/Visit for Podiatry; $0/Visit for Diabetic Footcare; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $0/Visit for Colorectal Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP PT/OT/ST; $35/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - Complex Diagnostic; 20% Coinsurance for Phys Rad - X-Ray; 20% Coinsurance for Phys Rad - Theraputic; $0/Procedure for Bone Mass Measurement; $0/Procedure for Mammography Screening; PBP 7d, 14a"	"$0/Procedure for SCP - IP Surg; 20% Coinsurance for SCP - OP Surg; $0/Procedure for SCP - Other; $0/Procedure for Nutrition Training for Diabetes & Renal Dialysis; $0/Procedure for Diabetes Monitoring; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"$0/Procedure for Blood; $0/Procedure for Health Education/Wellness Programs; $0/Procedure for Kidney Disease Education Services; PBP 9d, 14c, 14d"		"PBP 16a, 16b"																	0	NO	250	250	125	0	200	0.2	0.2	63.41702969	0.2	14.76190787	0.2	0	0.2	0.2	10	33.59490754	35	35	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	213.3934082	213.3934082	106.6967041	0	170.7147266	0.170714727	0.170714727	54.13110442	0.170714727	12.60037533	0.170714727	0	0.170714727	0.170714727	8.535736328	28.67572727	29.87507715	29.87507715	0.170714727	0.170714727	0.170714727	0	0	0	0	0	0	0	0	0												11.7523	0.251398008	3.397575547	0	2.441646717	1.268097664	0.751832484	1.046553529	6.59757585	0.721415863	2.897555527	0	0.029523811	1.799195476	2.5862685	8.481037927	0.240624787	1.631588841	0.54444751	1.806383475	4.050592178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2956	0	NO	8.971053813	11.7523	0.251398008	3.397575547	0	2.441646717	1.268097664	0.751832484	1.046553529	6.59757585	0.721415863	2.897555527	0	0.029523811	1.799195476	2.5862685	8.481037927	0.240624787	1.631588841	0.54444751	1.806383475	4.050592178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2956	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for IP MH/SA; PBP 2	30% Coinsurance for HH; 30% Coinsurance for Hospice; PBP 6	30% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 30% Coinsurance for DMS; PBP 11b, 11c"	"30% Coinsurance for OP ER; 30% Coinsurance for ER - Worldwide; 30% Coinsurance for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; 30% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	30% Coinsurance for Renal Dialysis; PBP 12	"30% Coinsurance for Cardiac Rehab; 30% Coinsurance for Pulmonary Rehabilitation Services; 30% Coinsurance for Partial Hosp; 30% Coinsurance for OP - Preventive; 30% Coinsurance for OP - Other; 30% Coinsurance for OP Substance Abuse; PBP 3, 5, 9c"	"30% Coinsurance for PCP OV; 30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams (Initial); 30% Coinsurance Immunizations (non-cvd); 30% Coinsurance for Routine Exams; PBP 7a, 14a-b"	"30% Coinsurance for Chiro (cvd); 30% Coinsurance for SCP OV; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; 30% Coinsurance for Diabetic Footcare; 30% Coinsurance for Pap Smears and Pelvic Exams Screening; 30% Coinsurance for Prostate Cancer Screening; 30% Coinsurance for Colorectal Screening; 30% Coinsurance for Pap Smears and Pelvic Exams Screening (non-cvd); 30% Coinsurance for Prostate Cancer Screening (non-cvd); 30% Coinsurance for Colorectal Screening (non-cvd); 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"30% Coinsurance for MH - Non Phys; 30% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Theraputic; 30% Coinsurance for Bone Mass Measurement; 30% Coinsurance for Mammography Screening; / for Mammography Screening (non-cvd); PBP 7d	"30% Coinsurance for SCP - IP/OP Surg; 30% Coinsurance for SCP - Other; 30% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 30% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"30% Coinsurance for Blood; 30% Coinsurance for Health Education/Wellness Programs; 30% Coinsurance for Kidney Disease Education Services; PBP 9d, 14c, 14d"																			5000	2.5936	0.0333	0.7553	0.266	0.1221	0.1508	0.0946	0.1921	0.5283	0.0323	0.2863	0	0.0028	0.1315	0.3521	0.689	0.0138	0.1367	0.1841	0.9954	0.4015	0	0	0	0	0	0	0	0	0											7.9616	1500	NO	2.826598739	14.3459	0.284713081	4.152873504	0.26604639	2.563740287	1.41886889	0.846472856	1.238610924	7.125881439	0.753730668	3.183818441	0	0.032316938	1.930668682	2.938321106	9.170017668	0.254400541	1.768330944	0.728573377	2.801766429	4.452110535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2572
H8050_006_0	2012	8																															D	D	D		T	Coin	Coin	V	Coin	V	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	704.1574679	13.88277602	330.7202273	0	153.0675425	6.97487135	3.900023453	219.3727936	29.06776078	390.0356373	547.2684074	0	0.140298966	7.097750828	3195.629582	3117.974108	99.6939994	527.7490731	0	9.503781762	22.78318275	0	0	0	0	0	0	0	0	0											3200	$175/Days Custom: 1-7 for IP Med/Surg; PBP 1a	$175/Days Custom: 1-7 for IP MH/SA; PBP 1b	$125/Days Custom: 21-100 for SNF; PBP 2	$0/Visit for HH; $0/Visit for Hospice; PBP 6	$150/Case for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; 0% Coinsurance for DMS; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for ER - Worldwide; $40/Case for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	$15/Case for OP Lab; PBP 8a	$35/Case for OP Rad - General; $35/Case for OP Rad - Complex Diagnostic; $35/Case for OP Rad - X-Ray; $35/Case for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Case for Cardiac Rehab; $30/Case for Pulmonary Rehabilitation Services; $30/Case for Partial Hosp; $0/Case for OP - Preventive; 20% Coinsurance for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 5, 9c"	"$10/Visit for PCP OV; $0/Visit for PCP - Facility Visit; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14a-b"	"$15/Visit for Chiro (cvd); $30/Visit for SCP OV; $0/Visit for SCP - Facility Visit; $0/Procedure for SCP - Office Surg; $30/Visit for Podiatry; $0/Visit for Diabetic Footcare; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $0/Visit for Colorectal Screening; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 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"	"$0/Procedure for Phys Rad - General; $0/Procedure for Phys Rad - Complex Diagnostic; $0/Procedure for Phys Rad - X-Ray; $0/Procedure for Phys Rad - Theraputic; $0/Procedure for Bone Mass Measurement; $0/Procedure for Mammography Screening; PBP 7d, 14a"	"$0/Procedure for SCP - IP Surg; 20% Coinsurance for SCP - OP Surg; $0/Procedure for SCP - Other; $0/Procedure for Nutrition Training for Diabetes & Renal Dialysis; $0/Procedure for Diabetes Monitoring; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"$0/Procedure for Blood; /Procedure for Health Education/Wellness Programs; $0/Procedure for Kidney Disease Education Services; PBP 9d, 14c, 14d"																			0	NO	175	175	125	0	150	0.2	0.2	63.22933105	0.2	15	35	0	0.2	0.179846771	10	28.76143008	30	30	0	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	157.9675495	157.9675495	112.8339639	0	135.4007567	0.180534342	0.180534342	57.07532848	0.180534342	13.54007567	31.5935099	0	0.180534342	0.162342593	9.026717115	25.96212932	27.08015135	27.08015135	0	0.180534342	0.180534342	0	0	0	0	0	0	0	0	0												9.2695	0.182752342	3.109706184	0	1.727121757	1.259203812	0.704088169	1.043397854	5.247729074	0.44009267	1.440844154	0	0.025328782	1.152267271	2.40383702	6.745770584	0.224977383	1.190960398	0	1.71575899	4.113146913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9965	0	NO	4.528164598	9.2695	0.182752342	3.109706184	0	1.727121757	1.259203812	0.704088169	1.043397854	5.247729074	0.44009267	1.440844154	0	0.025328782	1.152267271	2.40383702	6.745770584	0.224977383	1.190960398	0	1.71575899	4.113146913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9965	YES	30% Coinsurance for IP Med/Surg; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for IP MH/SA; PBP 2	30% Coinsurance for HH; 30% Coinsurance for Hospice; PBP 6	30% Coinsurance for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosth/Supplies; 30% Coinsurance for DMS; PBP 11b, 11c"	"30% Coinsurance for OP ER; 30% Coinsurance for ER - Worldwide; 30% Coinsurance for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 30% Coinsurance for ASC services; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	/ for OP Rad - General; / for OP Rad - Complex Diagnostic; 30% Coinsurance for OP Rad - X-Ray; 30% Coinsurance for OP Rad - Therapeutic; PBP 8b	No Cost Sharing;	30% Coinsurance for Renal Dialysis; PBP 12	"30% Coinsurance for Cardiac Rehab; 30% Coinsurance for Pulmonary Rehabilitation Services; 30% Coinsurance for Partial Hosp; 30% Coinsurance for OP - Preventive; 30% Coinsurance for OP - Other; 30% Coinsurance for OP Substance Abuse; PBP 3, 5, 9c"	"30% Coinsurance for PCP OV; 30% Coinsurance for PCP - Facility Visit; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams (Initial); 30% Coinsurance Immunizations (non-cvd); 30% Coinsurance for Routine Exams; PBP 7a, 14a-b"	"30% Coinsurance for Chiro (cvd); 30% Coinsurance for SCP OV; 30% Coinsurance for SCP - Facility Visit; 30% Coinsurance for SCP - Office Surg; 30% Coinsurance for Podiatry; 30% Coinsurance for Diabetic Footcare; 30% Coinsurance for Pap Smears and Pelvic Exams Screening; 30% Coinsurance for Prostate Cancer Screening; 30% Coinsurance for Colorectal Screening; 30% Coinsurance for Pap Smears and Pelvic Exams Screening (non-cvd); 30% Coinsurance for Prostate Cancer Screening (non-cvd); 30% Coinsurance for Colorectal Screening (non-cvd); 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"30% Coinsurance for MH - Non Phys; 30% Coinsurance for Psych Services ; PBP 7e, 7h"	"30% Coinsurance for OP PT/OT/ST; 30% Coinsurance for PT/ST; PBP 7c, 7i"	30% Coinsurance for Phys Rad - General; 30% Coinsurance for Phys Rad - Complex Diagnostic; 30% Coinsurance for Phys Rad - X-Ray; 30% Coinsurance for Phys Rad - Theraputic; 30% Coinsurance for Bone Mass Measurement; 30% Coinsurance for Mammography Screening; / for Mammography Screening (non-cvd); PBP 7d	"30% Coinsurance for SCP - IP/OP Surg; 30% Coinsurance for SCP - Other; 30% Coinsurance for Nutrition Training for Diabetes & Renal Dialysis; 30% Coinsurance for Diabetes Monitoring; PBP 7d, 7g, 14e"	30% Coinsurance for Part B Drugs - Gen; 30% Coinsurance for Part B Drugs - Chemo; 30% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"30% Coinsurance for Blood; / for Health Education/Wellness Programs; 30% Coinsurance for Kidney Disease Education Services; PBP 9d, 14c, 14d"																			5000	5.1917	0.0613	1.3141	0.4772	0.3572	0.2838	0.2907	0.3764	0.9828	0.0586	0.4995	0	0.0052	0.2702	0.7459	1.5824	0.0574	0.2587	0.372	2.0753	1.629	0	0	0	0	0	0	0	0	0											16.8895	1500	NO	5.481914235	14.4612	0.244096186	4.423841225	0.477183009	2.084306392	1.542968594	0.994753556	1.419841411	6.230575047	0.49871304	1.940391716	0	0.030567406	1.422417694	3.149740525	8.328188402	0.282338521	1.449649439	0.372044536	3.791026284	5.742153661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.886
H8050_007_0	2012	8																																			T	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	YES	0	0	0	0	335.6748704	15.77773167	9.075159791	309.9252974	0	0	0	0	0.268045717	0	0	0	0	0	0	0	41.36432937	0	0	0	0	0	0	0	0	0											3200	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Case for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for ER - Worldwide; $0/Case 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;	10% Coinsurance for Renal Dialysis - Fac; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c"	"No Cost-Sharing; PBP 7a, 14a-b"	"No Cost-Sharing; PBP 7b, 7d, 7f, 17a, 14a-b, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14a"	"No Cost-Sharing; PBP 7d, 7g, 14e"	10% Coinsurance for Part B Rx; 10% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"			No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b													0	NO	0	0	0	0	50	0.1	0.1	65	0	0	0	0	0.1	0	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	49.96565075	0.099931302	0.099931302	64.95534598	0	0	0	0	0.099931302	0	0	0	0	0	0	0	0.099931302	0	0	0	0	0	0	0	0	0												0	0	0	0	1.397684445	1.576689261	0.906892529	1.677608743	0	0	0	0	0.026786157	0	0	0	0	0	0	0	4.13359127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7193	0	NO	0.00668157	0	0	0	0	1.397684445	1.576689261	0.906892529	1.677608743	0	0	0	0	0.026786157	0	0	0	0	0	0	0	4.13359127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7193	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	20% Coinsurance for IP MH/SA; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance 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"	"20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; 20% Coinsurance for PCP Urgent Care; 20% Coinsurance for Urgent Care - Worldwide; 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;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for Pulmonary Rehabilitation Services; 20% Coinsurance for Partial Hosp; 20% Coinsurance for OP - Preventive; 20% Coinsurance for OP - Other; 20% Coinsurance for OP Substance Abuse; PBP 3, 5, 9c"	"20% Coinsurance for PCP OV; 20% Coinsurance for PCP - Facility Visit; 20% Coinsurance for Immunizations; 20% Coinsurance for Physical Exams (Initial); 20% Coinsurance Immunizations (non-cvd); 20% Coinsurance for Routine Exams; PBP 7a, 14a-b"	"20% Coinsurance for Chiro (cvd); 20% Coinsurance for SCP OV; 20% Coinsurance for SCP - Facility Visit; 20% Coinsurance for SCP - Office Surg; 20% Coinsurance for Podiatry; 20% Coinsurance for Diabetic Footcare; 20% Coinsurance for Pap Smears and Pelvic Exams Screening; 20% Coinsurance for Prostate Cancer Screening; 20% Coinsurance for Colorectal Screening; 20% Coinsurance for Pap Smears and Pelvic Exams Screening (non-cvd); 20% Coinsurance for Prostate Cancer Screening (non-cvd); 20% Coinsurance for Colorectal Screening (non-cvd); 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing Exams; PBP 7b, 7d, 7f, 17a, 14a-b, 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 OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 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); 20% Coinsurance for Initial Preventive Physical Examination (IPPE); 20% Coinsurance for Glaucoma Screening; 20% Coinsurance for Other Vaccines - Rabies/Tetanus/etc.; 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; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Renal Dialysis - Prof; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Ultrasound Screening for Abdominal Aortic Aneurysm; 20% Coinsurance for Cardio Screenings; 20% Coinsurance for Diabetes Screening Tests; 20% Coinsurance for Diabetes Self-Management Training; PBP 7d, 7g, 14e"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 9d, 14c, 14d"																			5000	4.958	0.0637	1.3236	0.5192	0.232	0.2864	0.1798	0.3568	0.9358	0.0629	0.5301	0	0.0052	0.2467	0.6536	1.2794	0.0265	0.2477	0.3395	1.8466	0.748	0	0	0	0	0	0	0	0	0											14.8415	500	NO	6.482837682	4.958	0.063685254	1.323648343	0.519230368	1.629636528	1.863122852	1.086689314	2.034386389	0.935793352	0.062902454	0.530094555	0	0.032015204	0.246704803	0.65357508	1.279362354	0.026525243	0.247710661	0.339460984	1.846608645	4.881623372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5608
H8091_001_0	2012	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	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	YES	926.2366679	37.49977453	377.8862504	0	220.8471966	15.76451779	0.930713089	254.5680828	497.4250825	0	224.3689052	0	0	1572.79946	3126.049382	3192.90403	124.1234617	544.844265	140.0000071	0	35.78545336	0	0	0	0	0	0	0	0	0	4.66003995	5.503813711									5000	"$250 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$95 copay per day for days 1-15, $0 after day 15, 190 day per lifetime limit"	"$0 copay for days 1-20, $146 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $750 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $65 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) $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 $280 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									0	NO	250	95	146	0	250	0.2	0.2	61.85383446	280	0	280	0	0	107.1110705	15	32.73001065	35	35	280	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	206.4739651	78.46010674	120.5807956	0	206.4739651	0.165179172	0.165179172	51.08482583	231.2508409	0	231.2508409	0	0	88.46258972	12.38843791	27.03158031	28.90635512	28.90635512	231.2508409	0	0.165179172	0.165179172	0	0	0	0	0	0	0	0	0.165179172	0.165179172										15.937	0.245186359	3.79715206	0	3.79993303	2.603969997	0.153734417	1.083713848	9.585830719	0	4.323791501	0	0	11.59449278	3.227239055	7.192436808	0.298996405	1.312455151	2.697926614	0	5.911011559	0	0	0	0	0	0	0	0	0	0.769741541	0.909115392	0	0	0	0	0	0	0	0	75.4437	0	NO	15.90401687	15.937	0.245186359	3.79715206	0	3.79993303	2.603969997	0.153734417	1.083713848	9.585830719	0	4.323791501	0	0	11.59449278	3.227239055	7.192436808	0.298996405	1.312455151	2.697926614	0	5.911011559	0	0	0	0	0	0	0	0	0	0.769741541	0.909115392	0	0	0	0	0	0	0	0	75.4437	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $750 copay air"	30% coinsurance	30% coinsurance	$65 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	3.9299	0.0505	0.5177	0.3399	0.2208	0.259	0.0157	0.1045	0.8755	0.0527	0.2278	0	0	0.3411	0.3233	0.4639	0.0198	0.0849	0.2284	1.3657	0.6159	0.1596	0	0	0	0	0	0	0.0676	0	0.1004	0.1121									10.4766	500	NO	6.283670314	19.8668	0.295675052	4.314813452	0.339939853	4.020762808	2.862932875	0.169411327	1.188193158	10.46130849	0.052679125	4.551577747	0	0	11.93560475	3.550586311	7.656317158	0.318761411	1.397337066	2.926333032	1.36574149	6.526952824	0.159570511	0	0	0	0	0	0	0.067621579	0	0.87010363	1.021209244	0	0	0	0	0	0	0	0	85.9203
H8098_001_0	2012	6																															A	A	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	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	NO	209.6471852	0	1198.663094	0	4.199937682	2.701686077	2.455988221	337.8567711	34.11744623	0	7.447484635	0	0.038244554	19.61186422	2545.74556	12284.92199	110.481694	610.648834	7.994912865	0.180070024	17.6362552	0	0	2642.864173	0	0	0.334937566	0	0	0												$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-20, $146/Day for 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 Prosth/Supplies; $5 (Mail order) or 20% Coinsurance for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	$0-$15/Visit for OP Lab; PBP 8a	$0-$100 or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit or 30% Coinsurance for Cardiac Rehab; $40/Visit or 30% Coinsurance for Pulmonary Rehabilitation Services; $40/Visit or 30% Coinsurance for CORF; 30% Coinsurance for OP - Other; $40/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $25-$40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$40/Visit or 30% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$15-$40(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Oral Exam; $20 Routine Cleaning 1/year; $0 Fluoride; $10 Dental X-Ray; PBP 16a, 16b"	$0/Visit Advantica Eye Care - Optometry; PBP 17a	$10/Other for Glasses/Contacts (non-cvd); PBP 17b	$40/Exam for Routine Hearing Exam (non-cvd); PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	1035.655048	0	88.40038641	0	125	0.2	0.2	56.38911597	0.237469161	0	0.270768585	0	0.2	0.297240089	15	39.84909338	40	53.2	0.239250486	0.3	0.2	0	0	17	0	0	40	0	0	0											NO	943.972792	0	80.57466598	0	113.9342672	0.182294828	0.182294828	51.39722086	0.216446999	0	0.246798562	0	0.182294828	0.270926654	13.67211207	36.32141802	36.45896551	48.49042413	0.21807063	0.273442241	0.182294828	0	0	17	0	0	40	0	0	0												16.4918	0	8.048489868	0	0.039876402	0.492503397	0.447713949	1.447074924	7.38461884	0	1.838028501	0	0.006971784	5.313376755	2.900476549	37.18381558	0.335670689	2.467551746	1.743455688	0.049238751	3.2149981	0	0	3.744057579	0	0	0.001116459	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1508	0	NO	8.683417647	16.4918	0	8.048489868	0	0.039876402	0.492503397	0.447713949	1.447074924	7.38461884	0	1.838028501	0	0.006971784	5.313376755	2.900476549	37.18381558	0.335670689	2.467551746	1.743455688	0.049238751	3.2149981	0	0	3.744057579	0	0	0.001116459	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1508	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	NO	0	16.4918	0	8.048489868	0	0.039876402	0.492503397	0.447713949	1.447074924	7.38461884	0	1.838028501	0	0.006971784	5.313376755	2.900476549	37.18381558	0.335670689	2.467551746	1.743455688	0.049238751	3.2149981	0	0	3.744057579	0	0	0.001116459	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1508
H8098_003_0	2012	3																															A	A	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	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	NO	209.7913537	1.574144275	1146.24935	0	110.4169328	6.784764061	4.393284354	258.2500527	36.47895465	0	6.438890083	0	0.18940722	20.3894154	3035.051907	6294.165111	100.1643503	184.6055711	4.837806468	7.888445732	27.2000279	5.226898449	0	2642.864173	666.6666667	0	81.82503489	0	0	0												$268/Day for Days 1-6 for IP Med/Surg; PBP 1a	$239/days 1-6 for IP Psych; $239/days 1-6 for IP Substance Abuse; PBP 1b	"$50/Day for Days 1-20, $146/Day for 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 Prosth/Supplies; $5 (Mail order) or 20% Coinsurance for DMS; PBP 11b, 11c"	"$60/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surg; 10% Coinsurance for ASC services PBP 9a, 9b"	$0-$15/Visit for OP Lab; PBP 8a	$0-$100 or 0%-30% Coinsurance for OP Rad; 20% Coinsurance for OP Rad - Therapeutic; PBP 8b	$268/Visit for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit or 30% Coinsurance for Cardiac Rehab; $40/Visit or 30% Coinsurance for Pulmonary Rehabilitation Services; $40/Visit or 30% Coinsurance for CORF; 30% Coinsurance for OP - Other; $40/visit for OP Substance Abuse; PBP 3, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a-b"	"$20/Visit for Chiro (cvd); $40/Visit for SPC OV; $40/Visit for SPC - Other; $40/Visit for Podiatry; $40/Visit for Diabetic Footcare;  $25-$40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services; PBP 7e, 7h"	"$40/Visit or 30% Coinsurance for OP PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Phys Rad; 20% Coinsurance for Phys Rad - Theraputic; PBP 8b, 14a"	"$15-$40(PCP or SPC)/Visit for Prof Other; PBP 7d, 7g, 14a"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	No Cost Sharing; PBP 10b	"$20 Oral Exam; $20 Routine Cleaning 1/year; $0 Fluoride; $10 Dental X-Ray; PBP 16a, 16b"	$20/Visit for Routine Eye Exams;$20/Visit Advantica Eye Care - Optometry; PBP 17a	$25/Other for Glasses/Contacts (non-cvd); PBP 17b	$40/Exam for Routine Hearing Exam (non-cvd);PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14c	"No Cost Sharing; PBP 13a-c, 14b"											0	NO	1035.655048	923.5878974	88.40038641	0	125	0.2	0.2	56.20090157	0.274030401	0	0.3	0	0.2	0.274472864	15	39.41533718	40	53.2	0.298273109	0.310501624	0.2	0.2	0	17	20	0	40	0	0	0											NO	965.4961621	861.0208312	82.41183584	0	116.5320639	0.186451302	0.186451302	52.39365643	0.255466626	0	0.279676953	0	0.186451302	0.255879115	13.98384767	36.74520473	37.29026045	49.5960464	0.278067048	0.289467161	0.186451302	0.186451302	0	17	20	0	40	0	0	0												16.8794	0.112947584	7.872042769	0	1.072259422	1.265028095	0.819133589	1.127555378	9.319155446	0	1.800809162	0	0.035315223	5.217225562	3.536808628	19.27336547	0.311262893	0.762975539	1.345234563	2.283445988	5.071480624	0.974562023	0	3.744057579	1.111111111	0	0.272750116	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2079	0	NO	5.746439157	16.8794	0.112947584	7.872042769	0	1.072259422	1.265028095	0.819133589	1.127555378	9.319155446	0	1.800809162	0	0.035315223	5.217225562	3.536808628	19.27336547	0.311262893	0.762975539	1.345234563	2.283445988	5.071480624	0.974562023	0	3.744057579	1.111111111	0	0.272750116	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2079	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	NO	0	16.8794	0.112947584	7.872042769	0	1.072259422	1.265028095	0.819133589	1.127555378	9.319155446	0	1.800809162	0	0.035315223	5.217225562	3.536808628	19.27336547	0.311262893	0.762975539	1.345234563	2.283445988	5.071480624	0.974562023	0	3.744057579	1.111111111	0	0.272750116	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2079
H8098_801_0	2012	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	257.9373236	2.424584576	68.89524584	0	9.492328178	11.96744322	7.881441804	15.61483527	48.88229184	5.574172608	22.27788575	0	0.34541815	23.19162428	41.80600192	93.38295115	1.560089629	5.75190483	31.00215953	58.46152239	48.90131918	12.5053303	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	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; PBP 5	20% Coinsurance: PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f-g, 14a, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14a"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14a"	20% Coinsurance: PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 9d, 14a, 14d-e"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	"PBP 13a-c, 14b"											0	NO	0.079285682	0.079285682	0.16940857	0	0.224	0.2	0.224	0.224	0.224	0.224	0.224	0	0.2	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.2	0.224	0	0	0	0	0	0	0	0											NO	0.065823395	0.065823395	0.140643897	0	0.185965993	0.166041065	0.185965993	0.185965993	0.185965993	0.185965993	0.185965993	0	0.166041065	0.185965993	0.185965993	0.185965993	0.185965993	0.185965993	0.185965993	0.185965993	0.166041065	0.185965993	0	0	0	0	0	0	0	0												16.9783	0.159594389	9.689695865	0	1.765250233	1.987087017	1.465680149	2.903828343	9.090443929	1.036606543	4.14292914	0	0.057353597	4.312853432	7.774494649	17.36605321	0.290123617	1.069658692	5.765347373	10.87185505	8.119627113	2.325566164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1724	0	NO	21.91903057	16.9783	0.159594389	9.689695865	0	1.765250233	1.987087017	1.465680149	2.903828343	9.090443929	1.036606543	4.14292914	0	0.057353597	4.312853432	7.774494649	17.36605321	0.290123617	1.069658692	5.765347373	10.87185505	8.119627113	2.325566164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1724	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	NO	0	16.9783	0.159594389	9.689695865	0	1.765250233	1.987087017	1.465680149	2.903828343	9.090443929	1.036606543	4.14292914	0	0.057353597	4.312853432	7.774494649	17.36605321	0.290123617	1.069658692	5.765347373	10.87185505	8.119627113	2.325566164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1724
H8130_001_0	2012	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;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	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	NO	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2012	6																																	D		T		Coin	V	V		V		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	0	0	903.3329107	0	274.611459	0	3.169199126	299.8442413	244.6144253	0	492.6554852	0	0.291320091	649.9695972	0	18.13097672	87.53669562	366.5298466	22.89815545	0	35.63091979	0	0	0	0	0	21.97782639	0	0	0											3400	No Cost-Sharing;	No Cost-Sharing;	$50/Days Custom for SNF;	No Cost-Sharing;	$125/Trip for Ambulance;	No Cost-Sharing;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics;	$65/Case for ER - Facility; $15/Visit for PCP Urgent Care;	$50/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $50/Case for OP Fac - Other; $30/Visit for Prof - CORF; $15/Visit for OP Substance Abuse;	No Cost-Sharing;	$10/Exam for Hearing/Speech Exams;	$12/Visit for OP Psych - Non-Physician; $12/Visit for OP Psych - Psychiatrist;	$10/Visit for Occ Therapy; $10/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$10/Exam for Hearing Exam;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	0	0	50	0	125	0	0.2	60.37795742	50	0	50.97716156	0	0.2	32.92164704	0	10	12	10	0.135652995	0	0.2	0	0	0	0	0	10	0	0	0											NO	0	0	49.16575656	0	122.9143914	0	0.196663026	59.37055913	49.16575656	0	50.12661431	0	0.196663026	32.37235368	0	9.836134989	11.79978158	9.833151313	0.133389642	0	0.196663026	0	0	0	0	0	10	0	0	0												0	0	3.701087165	0	2.812808363	0	0.623264291	1.483493355	1.002221107	0	2.057929291	0	0.057291891	1.753420473	0	0.014861561	0.086076157	0.300345287	3.054376769	0	7.007284513	0	0	0	0	0	0.018314855	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9728	0	NO	0.406454151	0	0	3.701087165	0	2.812808363	0	0.623264291	1.483493355	1.002221107	0	2.057929291	0	0.057291891	1.753420473	0	0.014861561	0.086076157	0.300345287	3.054376769	0	7.007284513	0	0	0	0	0	0.018314855	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9728	NO																																										0	0	0	0	0	0	0	0	0	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	3.701087165	0	2.812808363	0	0.623264291	1.483493355	1.002221107	0	2.057929291	0	0.057291891	1.753420473	0	0.014861561	0.086076157	0.300345287	3.054376769	0	7.007284513	0	0	0	0	0	0.018314855	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9728
H8145_001_0	2012	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			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	1460.87	56.39	322.66	3293.75	1.42	14.09	7.81	382.41	39.84	7.49	12.17	1.12	0.12	19.77	2862.83	2842.53	80.63	0.85		1183.56	26.19	0			0.79				3.35	1.19	1679.21	316.27	243.62	0	279.75							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	160.008323	44.329117	0	0.2	0.2	0.2	65	0.243751	0.25	0.241412	0.216217	0.2	0.2389	15	33.675923	35	0.25		0	0.2	0			0				0	0	0	0	18.953167	0	35						NO	106.04503	93.123724	25.91028	0	0.15915	0.15915	0.15915	51.72362	0.193964	0.198937	0.192103	0.172055	0.15915	0.190104	11.93622	26.797548	27.85118	0.198937		0	0.15915	0			0				0	0	0	0	15.081944	0	27.85118							12.9098	0.4376039	0.696684245	0	0.225993	2.2424235	1.2429615	1.64830246	7.72752576	1.49003813	2.33789351	0.1927016	0.019098	3.75835608	2.847614059	6.347736176	0.18713672	0.16909645	0	0	4.1681385	0	0	0	0	0	0	0	0	0	0	0	0.3061886	0	0.649280634	0	0	0	0	0	49.6046	0	NO	19.2095	12.9098	0.4376039	0.696684245	0	0.225993	2.2424235	1.2429615	1.64830246	7.72752576	1.49003813	2.33789351	0.1927016	0.019098	3.75835608	2.847614059	6.347736176	0.18713672	0.16909645	0	0	4.1681385	0	0	0	0	0	0	0	0	0	0	0	0.3061886	0	0.649280634	0	0	0	0	0	49.6046	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						3400	5.1602	0.1749	0.2788	0	2.0721	1.3615	0.7552	0.624	2.9536	0.5696	0.8933	0.0761	0.0074	1.4361	1.1289	2.5165	0.0742	0.0648		0	1.7343	0							0	0	0.2639	0	0.1214	0	0.2574						22.5241	0	NO	8.261144	18.07	0.6125139	0.975476245	0	2.298045	3.6039665	1.9981755	2.27227446	10.68109776	2.05966313	3.23122451	0.2687936	0.026504	5.19448408	3.976504059	8.864192176	0.26132072	0.23386545	0	0	5.9024205	0	0	0	0	0	0	0	0	0	0.263866	0	0.4275746	0	0.906678634	0	0	0	0	0	72.1287
H8145_003_0	2012	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			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	1164.96	76.75	618.33	810.69	1.33	14.77	3.31	429.12	33.51	9.83	10.65	1.16	1.11	22.68	2799.7	3304.35	254.92	1.45		1638.46	12.58	0			0.79				3.55	1.09	3275.43	364.04	224.59	0	427.56							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.244005	0.25	0.245189	0.208729	0.2	0.235983	15	37.458945	40	0.25		0	0.2	0			0				0	0	0	0	33.42997	0	40						NO	152.961957	108.536169	28.980403	0	0.184786	0.184786	0.184786	60.05532	0.225443	0.230982	0.226537	0.19285	0.184786	0.218032	13.85892	34.609368	36.95712	0.230982		0	0.184786	0			0				0	0	0	0	30.886886	0	36.95712							14.8495	0.694179248	1.493287716	0	0.24576538	2.72928922	0.61164166	2.147578243	7.55459493	2.27055306	2.41261905	0.223706	0.20511246	4.94496576	3.233401527	9.530122096	0.785092419	0.3349239	0	0	2.32460788	0	0	0	0	0	0	0	0	0	0	0	0.578073811	0	1.316782186	0	0	0	0	0	58.4858	0	NO	6.645183	14.8495	0.694179248	1.493287716	0	0.24576538	2.72928922	0.61164166	2.147578243	7.55459493	2.27055306	2.41261905	0.223706	0.20511246	4.94496576	3.233401527	9.530122096	0.785092419	0.3349239	0	0	2.32460788	0	0	0	0	0	0	0	0	0	0	0	0.578073811	0	1.316782186	0	0	0	0	0	58.4858	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	5.9106	0.2763	0.5944	0	2.2504	1.6527	0.3704	0.8103	2.8774	0.8648	0.9194	0.0887	0.078	1.8836	1.2776	3.7657	0.3102	0.1273		0	0.9637	0							0	0	0	0	0.2284	0	0.5203						25.7703	0	NO	2.850955	20.7602	0.970486248	2.087673716	0	2.49613038	4.38198722	0.98200366	2.957891243	10.43200693	3.13535006	3.33201105	0.31243	0.28308946	6.82859676	4.511046527	13.2958521	1.095314419	0.4622379	0	0	3.28830288	0	0	0	0	0	0	0	0	0	0	0	0.806492811	0	1.837101186	0	0	0	0	0	84.2562
H8145_004_0	2012	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			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	981.12	64.64	520.75	682.76	1.19	13.26	2.97	361.4	30.07	8.82	9.56	1.04	0.99	20.35	2357.88	2782.89	214.69	1.3		1379.89	11.29	0			0.79				3.55	1.09	2758.54	306.59	189.15	0	360.09							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.244005	0.25	0.245189	0.208729	0.2	0.235983	15	37.458945	40	0.25		0	0.2	0			0				0	0	0	0	33.429971	0	40						NO	159.427502	113.123881	30.411483	0	0.188171	0.188171	0.188171	61.155575	0.229573	0.235214	0.230687	0.196383	0.188171	0.222026	14.112825	35.243436	37.6342	0.235214		0	0.188171	0			0				0	0	0	0	31.452755	0	37.6342							13.0348	0.609360639	1.319731648	0	0.22392349	2.49514746	0.55886787	1.841802067	6.90326011	2.07458748	2.20536772	0.20423832	0.18628929	4.5182291	2.773028984	8.173217134	0.6733072	0.3057782	0	0	2.12445059	0	0	0	0	0	0	0	0	0	0	0	0.495774051	0	1.129308257	0	0	0	0	0	51.8505	0	NO	4.425881	13.0348	0.609360639	1.319731648	0	0.22392349	2.49514746	0.55886787	1.841802067	6.90326011	2.07458748	2.20536772	0.20423832	0.18628929	4.5182291	2.773028984	8.173217134	0.6733072	0.3057782	0	0	2.12445059	0	0	0	0	0	0	0	0	0	0	0	0.495774051	0	1.129308257	0	0	0	0	0	51.8505	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	5.1867	0.2425	0.5251	0	2.0558	1.5098	0.3383	0.6947	2.6287	0.79	0.8399	0.0811	0.0712	1.7208	1.0954	3.2286	0.266	0.1163		0	0.8804	0							0	0	0	0	0.1958	0	0.4461						22.9134	0	NO	1.91276	18.2215	0.851825639	1.844865648	0	2.27976849	4.00498746	0.89721587	2.536531067	9.53195111	2.86463248	3.04528872	0.28529332	0.25752629	6.2390411	3.868428984	11.40179913	0.9392792	0.4220872	0	0	3.00484459	0	0	0	0	0	0	0	0	0	0	0	0.691611051	0	1.575408257	0	0	0	0	0	74.7638
H8145_005_0	2012	7	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	1030.6	47.17	549.63	956.43	1.17	11.55	6.62	353.05	32.52	13.35	12.42	1.91	0.14	25.58	2021.61	2561.02	101.74	2.46		1052.67	18.45	0			0.79				3.56	1.24	241.74	283.07	0	383.04								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	131.206824	42.474818	0	0.2	0.2	0.121898	65	0.24212	0.25	0.247769	0.210676	0.2	0.235439	15	37.591148	40	0.25		0	0.2	0			0				0	0	0	6.17454	0	40							NO	131.465168	105.184575	32.917729	0	0.179301	0.179301	0.109282	58.27276	0.217062	0.224126	0.222126	0.188872	0.179301	0.211072	13.44756	33.700614	35.86016	0.224126		0	0.179301	0			0				0	0	0	5.5355	0	35.86016								11.2907	0.413463034	1.507714283	0	0.20978217	2.07092655	0.72344684	1.71443316	7.05885624	2.9920821	2.75880492	0.36074552	0.02510214	5.39922176	2.265476814	7.192328872	0.30403439	0.55134996	0	0	3.30810345	0	0	0	0	0	0	0	0	0	0	0.130577832	0	1.144656307	0	0	0	0	0	0	51.4218	0	NO	7.744243	11.2907	0.413463034	1.507714283	0	0.20978217	2.07092655	0.72344684	1.71443316	7.05885624	2.9920821	2.75880492	0.36074552	0.02510214	5.39922176	2.265476814	7.192328872	0.30403439	0.55134996	0	0	3.30810345	0	0	0	0	0	0	0	0	0	0	0.130577832	0	1.144656307	0	0	0	0	0	0	51.4218	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $137 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$40/Visit	$0/Visit	$40/Visit							5000	4.4891	0.1644	0.5992	0	1.9179	1.2525	0.718	0.6463	2.6864	1.1391	1.0498	0.1426	0.0094	2.0545	0.8943	2.8393	0.12	0.2097		0	1.3705	0							0	0	0	0.0515	0	0.4519							22.8065	0	NO	3.378463	15.7797	0.577845034	2.106942283	0	2.12769017	3.32343155	1.44145084	2.36070016	9.74524624	4.1311531	3.80862792	0.50337652	0.03453314	7.45371576	3.159810814	10.03162587	0.42405739	0.76109496	0	0	4.67861145	0	0	0	0	0	0	0	0	0	0	0.182124832	0	1.596529307	0	0	0	0	0	0	74.2283
H8145_006_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	860.6	34.17	490.93	241.96	0.88	6.99	3.08	268.94	41.67	20.2	18.54	1.22	0.67	25.26	1454.72	2544.65	52.92	2.64		1193.04	20.94	0			0.79				5.23	1.24	549.23	205.11	0	252.35								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	131.206824	42.474818	0	0.2	0.2	0.131795	65	0.246593	0.25	0.247953	0.229279	0.2	0.242287	15	31.52866	35	0.25		0	0.2	0			0				0	0	0	16.520944	0	35							NO	142.645291	114.129731	36.797762	0	0.18519	0.18519	0.122036	60.186815	0.228333	0.231488	0.229593	0.212301	0.18519	0.224346	13.889265	29.193994	32.408285	0.231488		0	0.18519	0			0				0	0	0	15.297585	0	32.408285								10.23	0.324984409	1.505427108	0	0.1629672	1.2944781	0.37587088	1.348886836	9.51463611	4.6760576	4.25665422	0.25900722	0.1240773	5.66697996	1.683749298	6.190708069	0.142920537	0.61112832	0	0	3.8778786	0	0	0	0	0	0	0	0	0	0	0.261473972	0	0.681519227	0	0	0	0	0	0	53.1894	0	NO	5.100436	10.23	0.324984409	1.505427108	0	0.1629672	1.2944781	0.37587088	1.348886836	9.51463611	4.6760576	4.25665422	0.25900722	0.1240773	5.66697996	1.683749298	6.190708069	0.142920537	0.61112832	0	0	3.8778786	0	0	0	0	0	0	0	0	0	0	0.261473972	0	0.681519227	0	0	0	0	0	0	53.1894	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $137 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit							6000	4.0647	0.1291	0.5979	0	1.4857	0.7825	0.3447	0.5082	3.6189	1.7784	1.6186	0.1	0.0471	2.1552	0.6643	2.4424	0.0564	0.2323		0	1.6056	0							0	0	0	0.1032	0	0.2689							22.6039	0	NO	2.184928	14.2948	0.454125409	2.103287108	0	1.6486592	2.0770261	0.72052188	1.857055836	13.13349611	6.4544836	5.87526122	0.35902622	0.1711993	7.82215096	2.348024298	8.633073069	0.199307537	0.84341332	0	0	5.4834516	0	0	0	0	0	0	0	0	0	0	0.364632972	0	0.950390227	0	0	0	0	0	0	75.7934
H8145_007_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	772.19	60.05	693.74	502.9	0.74	7.93	3.43	260.1	32.69	8.79	11.24	0.96	0.19	14.39	1834.33	2663.01	98.05	1.25		1384.59	26.76	0			0.79				5.23	1.24	183.08	288.44	0	390.77								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									163.989133	131.206824	42.474818	0	0.2	0.2	0.151272	65	0.241273	0.25	0.245761	0.213413	0.2	0.238351	15	32.611445	35	0.25		0	0.2	0			0				0	0	0	22.624594	0	35							NO	139.03917	111.244493	33.531703	0	0.183686	0.183686	0.138933	59.69808	0.221593	0.229608	0.225714	0.196006	0.183686	0.21891	13.77648	29.951395	32.14512	0.229608		0	0.183686	0			0				0	0	0	20.779151	0	32.14512								8.9471	0.556685984	1.938523637	0	0.13592764	1.45662998	0.47654019	1.293955884	7.24387517	2.01825432	2.53702536	0.18816576	0.03490034	3.1501149	2.105884213	6.6467387	0.262652418	0.28701	0	0	4.91543736	0	0	0	0	0	0	0	0	0	0	0.499461526	0	1.046779045	0	0	0	0	0	0	45.7416	0	NO	5.268593	8.9471	0.556685984	1.938523637	0	0.13592764	1.45662998	0.47654019	1.293955884	7.24387517	2.01825432	2.53702536	0.18816576	0.03490034	3.1501149	2.105884213	6.6467387	0.262652418	0.28701	0	0	4.91543736	0	0	0	0	0	0	0	0	0	0	0.499461526	0	1.046779045	0	0	0	0	0	0	45.7416	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $137 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit							5000	3.5572	0.2213	0.7703	0	1.2374	0.8804	0.3814	0.4877	2.7566	0.7684	0.9655	0.0743	0.013	1.1987	0.8313	2.6237	0.1037	0.1093		0	2.0362	0							0	0	0	0.1972	0	0.4132							19.627	0	NO	2.246582	12.5043	0.778030984	2.708867637	0	1.37337564	2.33707898	0.85794319	1.781690884	10.00047717	2.78668032	3.50248936	0.26249576	0.04790334	4.3488439	2.937150213	9.2704447	0.366328418	0.396273	0	0	6.95165436	0	0	0	0	0	0	0	0	0	0	0.696619526	0	1.459984045	0	0	0	0	0	0	65.3686
H8145_008_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	1398.46	51.37	744.84	933.51	1.54	12.3	6.57	352.8	38	12.98	14.18	1.89	0.38	22.06	2330.03	3103.16	110.37	2.1		907.72	18.7	0			0.79				2.8	1.24	430.07	207.28	0	492.67								"$0-$225/Day(Days 1-9): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$199/Day(Days 1-9): 1b. $199 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									178.386262	144.121139	57.180564	0	0.2	0.2	0.139106	65	0.243414	0.25	0.244868	0.20644	0.2	0.237992	15	33.497656	35	0.25		0	0.2	0			0				0	0	0	16.231154	0	35							NO	103.690404	83.77315	24.9353	0	0.158633	0.158633	0.110334	51.555855	0.193068	0.198292	0.194222	0.163741	0.158633	0.188768	11.897505	26.569236	27.760845	0.198292		0	0.158633	0			0				0	0	0	12.874016	0	27.760845								12.0839	0.358618893	1.547734071	0	0.24429482	1.9511859	0.72489438	1.515742137	7.336584	2.57383016	2.75406796	0.30947049	0.06028054	4.16422208	2.310128631	6.870715865	0.255330372	0.4164132	0	0	2.9664371	0	0	0	0	0	0	0	0	0	0	0.22237717	0	1.139744626	0	0	0	0	0	0	49.806	0	NO	20.304093	12.0839	0.358618893	1.547734071	0	0.24429482	1.9511859	0.72489438	1.515742137	7.336584	2.57383016	2.75406796	0.30947049	0.06028054	4.16422208	2.310128631	6.870715865	0.255330372	0.4164132	0	0	2.9664371	0	0	0	0	0	0	0	0	0	0	0.22237717	0	1.139744626	0	0	0	0	0	0	49.806	YES	$0-$225/Day(Days 1-9)	$0-$199/Day(Days 1-9)	"$0/Day(Days 1-7), $84 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit							3400	4.7932	0.1422	0.6134	0	2.2282	1.1787	0.6295	0.5705	2.788	0.9779	1.0462	0.1229	0.0229	1.5824	0.9106	2.7082	0.1006	0.1583		0	1.2269	0							0	0	0	0.0877	0	0.4492							22.3377	0	NO	8.815205	16.8772	0.500860893	2.161091071	0	2.47249582	3.1298609	1.35441438	2.086249137	10.12456	3.55177716	3.80024696	0.43240049	0.08316854	5.74666408	3.220709631	9.578939865	0.355973372	0.5747552	0	0	4.1933111	0	0	0	0	0	0	0	0	0	0	0.31003317	0	1.588994626	0	0	0	0	0	0	72.1437
H8145_009_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	1282.9	49.31	679.54	874.04	1.33	11.18	5.78	319.72	34.11	11.38	12.52	1.66	0.25	19.85	2130.3	2881.43	102.06	1.87		840.76	17	0			0.79				2.8	1.24	410.66	194.36	0	464.83								"$0-$225/Day(Days 1-9): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$199/Day(Days 1-9): 1b. $199 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $84 (Days 8-100): 2. $0 SNF - Facility 1,2. $84 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									178.386262	144.121139	57.180564	0	0.2	0.2	0.137235	65	0.243313	0.25	0.244786	0.20666	0.2	0.23744	15	33.455485	35	0.25		0	0.2	0			0				0	0	0	16.406589	0	35							NO	109.700772	88.629024	27.326592	0	0.162621	0.162621	0.111586	52.851955	0.197839	0.203277	0.199037	0.168037	0.162621	0.193064	12.196605	27.202889	28.458745	0.203277		0	0.162621	0			0				0	0	0	13.340312	0	28.458745								11.7279	0.364191431	1.547459361	0	0.21628593	1.81810278	0.64496708	1.408152254	6.74828829	2.31329226	2.49194324	0.27894142	0.04065525	3.8323204	2.165202303	6.531935038	0.242041626	0.38012799	0	0	2.764557	0	0	0	0	0	0	0	0	0	0	0.216068587	0	1.102373203	0	0	0	0	0	0	46.8348	0	NO	16.891837	11.7279	0.364191431	1.547459361	0	0.21628593	1.81810278	0.64496708	1.408152254	6.74828829	2.31329226	2.49194324	0.27894142	0.04065525	3.8323204	2.165202303	6.531935038	0.242041626	0.38012799	0	0	2.764557	0	0	0	0	0	0	0	0	0	0	0.216068587	0	1.102373203	0	0	0	0	0	0	46.8348	YES	$0-$225/Day(Days 1-9)	$0-$199/Day(Days 1-9)	"$0/Day(Days 1-7), $84 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit							3400	4.6562	0.1446	0.6139	0	1.9733	1.0989	0.5681	0.5303	2.5656	0.8799	0.9475	0.1111	0.0155	1.4569	0.854	2.5763	0.0955	0.1446		0	1.1445	0							0	0	0	0.0852	0	0.4348							20.8967	0	NO	7.295402	16.3841	0.508796431	2.161331361	0	2.18954093	2.91701178	1.21308208	1.938495254	9.31387829	3.19320026	3.43943924	0.39008142	0.05617825	5.2892554	3.019184303	9.108215038	0.337509626	0.52469399	0	0	3.909105	0	0	0	0	0	0	0	0	0	0	0.301287587	0	1.537159203	0	0	0	0	0	0	67.7316
H8145_011_0	2012	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			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	1206.1	45.91	761.15	1054.59	1.25	14.37	4.9	376.54	45.19	10.38	12.11	1.53	0.28	23.18	2406.41	3152.52	93.42	3.09		1157.4	13.23	0			0.79				4.32	1.09	1308.22	374.29	228.36	0	251.78							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.8754	34.03605	0	0.2	0.2	0.2	65	0.241226	0.25	0.245891	0.218813	0.2	0.236815	15	38.218114	40	0.25		0	0.2	0			0				0	0	0	0	36.989107	0	40						NO	153.870489	109.18083	28.070994	0	0.183573	0.183573	0.183573	59.661095	0.221413	0.229466	0.225695	0.20084	0.183573	0.217364	13.767945	35.078993	36.71452	0.229466		0	0.183573	0			0				0	0	0	0	33.950933	0	36.71452							15.4653	0.417707659	1.780519757	0	0.22946625	2.63794401	0.8995077	1.872065726	10.00565347	2.38185708	2.73316645	0.3072852	0.05140044	5.03849752	2.760943377	9.215602251	0.285822538	0.70904994	0	0	2.42867079	0	0	0	0	0	0	0	0	0	0	0	0.646086255	0	0.77033182	0	0	0	0	0	60.6368	0	NO	7.525191	15.4653	0.417707659	1.780519757	0	0.22946625	2.63794401	0.8995077	1.872065726	10.00565347	2.38185708	2.73316645	0.3072852	0.05140044	5.03849752	2.760943377	9.215602251	0.285822538	0.70904994	0	0	2.42867079	0	0	0	0	0	0	0	0	0	0	0	0.646086255	0	0.77033182	0	0	0	0	0	60.6368	YES	$0-$255/Day(Days 1-7)	$0-$255/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	6.1633	0.1665	0.7098	0	2.1133	1.5987	0.5447	0.7071	3.8153	0.9083	1.0424	0.1205	0.0194	1.9214	1.0921	3.6454	0.1131	0.2703		0	1.0081	0							0	0	0	0	0.2556	0	0.3047						26.5201	0	NO	3.176766	21.6286	0.584189659	2.490293757	0	2.34279525	4.23662801	1.4442247	2.579191726	13.82096747	3.29020608	3.77552545	0.4277882	0.07075144	6.95987952	3.853092377	12.86102825	0.398883538	0.97939294	0	0	3.43679379	0	0	0	0	0	0	0	0	0	0	0	0.901658255	0	1.07505182	0	0	0	0	0	87.1569
H8145_012_0	2012	9	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			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	1281.63	48.79	808.82	1120.63	1.37	15.72	5.36	400.12	49.44	11.36	13.25	1.67	0.3	25.36	2557.11	3349.94	99.27	3.38		1229.88	14.47	0			0.79				4.32	1.09	1390.15	397.73	242.66	0	267.55							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.8754	34.03605	0	0.2	0.2	0.2	65	0.241226	0.25	0.245891	0.218813	0.2	0.236815	15	38.218114	40	0.25		0	0.2	0			0				0	0	0	0	36.989107	0	40						NO	150.592205	106.85468	27.285204	0	0.181579	0.181579	0.181579	59.01311	0.219008	0.226974	0.223243	0.198659	0.181579	0.215003	13.61841	34.697996	36.31576	0.226974		0	0.181579	0			0				0	0	0	0	33.582189	0	36.31576							16.0836	0.43445332	1.839068225	0	0.24876323	2.85442188	0.97326344	1.967693798	10.82775552	2.57842464	2.95796975	0.33176053	0.0544737	5.45247608	2.901981033	9.686350393	0.300422125	0.76717212	0	0	2.62744813	0	0	0	0	0	0	0	0	0	0	0	0.679087832	0	0.809690132	0	0	0	0	0	64.3763	0	NO	8.991579	16.0836	0.43445332	1.839068225	0	0.24876323	2.85442188	0.97326344	1.967693798	10.82775552	2.57842464	2.95796975	0.33176053	0.0544737	5.45247608	2.901981033	9.686350393	0.300422125	0.76717212	0	0	2.62744813	0	0	0	0	0	0	0	0	0	0	0	0.679087832	0	0.809690132	0	0	0	0	0	64.3763	YES	$0-$255/Day(Days 1-7)	$0-$255/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	6.4099	0.1731	0.7331	0	2.2871	1.7302	0.5895	0.7433	4.1291	0.983	1.1281	0.1304	0.0209	2.0794	1.1479	3.8317	0.1188	0.2926		0	1.091	0							0	0	0	0	0.2686	0	0.3203						28.2081	0	NO	3.806426	22.4936	0.60759732	2.572145225	0	2.53588023	4.58457188	1.56277544	2.710944798	14.95681852	3.56147064	4.08604675	0.46217353	0.0754167	7.53186108	4.049925033	13.51801139	0.419259125	1.05974612	0	0	3.71847313	0	0	0	0	0	0	0	0	0	0	0	0.947715832	0	1.129977132	0	0	0	0	0	92.5844
H8145_020_0	2012	11	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			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	1297.58	57.35	494.7	1333.36	1.53	17.64	5.27	399.91	51.14	13.26	18.26	1.64	0.46	28.67	3364.05	3762.41	136.94	1.8		1550.75	20.25	0			0.79				4.43	1.09	2065.56	500.17	276.32	0	348.21							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.242105	0.25	0.244515	0.21051	0.2	0.234735	20	38.028622	40	0.25		0	0.2	0			0				0	0	0	0	32.869597	0	40						NO	145.833896	103.47836	27.980969	0	0.178972	0.178972	0.178972	58.165965	0.21665	0.223715	0.218807	0.188377	0.178972	0.210056	17.89722	34.030331	35.79444	0.223715		0	0.178972	0			0				0	0	0	0	29.413721	0	35.79444							15.7693	0.494540329	1.153515447	0	0.27382716	3.15706608	0.94318244	1.938429255	11.079481	2.9664609	3.99541582	0.30893828	0.08232712	6.02230552	5.017261912	10.66967147	0.408474218	0.402687	0	0	3.624183	0	0	0	0	0	0	0	0	0	0	0	0.677299949	0	1.038665163	0	0	0	0	0	70.023	0	NO	10.487123	15.7693	0.494540329	1.153515447	0	0.27382716	3.15706608	0.94318244	1.938429255	11.079481	2.9664609	3.99541582	0.30893828	0.08232712	6.02230552	5.017261912	10.66967147	0.408474218	0.402687	0	0	3.624183	0	0	0	0	0	0	0	0	0	0	0	0.677299949	0	1.038665163	0	0	0	0	0	70.023	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$20/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	6.2869	0.1972	0.4601	0	2.5124	1.9141	0.5714	0.7324	4.2268	1.1313	1.5245	0.1226	0.0314	2.297	1.9853	4.2219	0.1616	0.1535		0	1.5051	0							0	0	0	0	0.268	0	0.411						30.7147	0	NO	4.458936	22.0562	0.691700329	1.613597447	0	2.78625016	5.07115308	1.51455844	2.670858255	15.306238	4.0977189	5.51991282	0.43157528	0.11376712	8.31932252	7.002569912	14.89161847	0.570105218	0.556237	0	0	5.129318	0	0	0	0	0	0	0	0	0	0	0	0.945306949	0	1.449663163	0	0	0	0	0	100.7377
H8145_021_0	2012	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			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	1259.23	55.65	480.08	1293.95	1.45	16.68	4.98	388.09	48.35	12.53	17.27	1.55	0.44	27.1	3264.62	3651.21	132.89	1.7		1504.91	19.15	0			0.79				4.43	1.09	2004.5	485.39	268.16	0	337.92							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.242105	0.25	0.244515	0.21051	0.2	0.234735	20	38.028622	40	0.25		0	0.2	0			0				0	0	0	0	32.869598	0	40						NO	147.60844	104.737511	28.37657	0	0.180194	0.180194	0.180194	58.563115	0.21813	0.225243	0.220301	0.189663	0.180194	0.21149	18.01942	34.262686	36.03884	0.225243		0	0.180194	0			0				0	0	0	0	29.614554	0	36.03884							15.4894	0.485720207	1.135251977	0	0.2612813	3.00563592	0.89736612	1.893979942	10.5465855	2.82229479	3.80459827	0.29397765	0.07928536	5.731379	4.902213243	10.42502181	0.399100121	0.3829131	0	0	3.4507151	0	0	0	0	0	0	0	0	0	0	0	0.661786567	0	1.014853734	0	0	0	0	0	67.6834	0	NO	9.529512	15.4894	0.485720207	1.135251977	0	0.2612813	3.00563592	0.89736612	1.893979942	10.5465855	2.82229479	3.80459827	0.29397765	0.07928536	5.731379	4.902213243	10.42502181	0.399100121	0.3829131	0	0	3.4507151	0	0	0	0	0	0	0	0	0	0	0	0.661786567	0	1.014853734	0	0	0	0	0	67.6834	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$20/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	6.1761	0.1937	0.4527	0	2.3916	1.822	0.5439	0.7157	4.0235	1.0769	1.4512	0.1167	0.0299	2.1866	1.94	4.1256	0.1579	0.1462		0	1.4328	0							0	0	0	0	0.2619	0	0.4016						29.6465	0	NO	4.039949	21.6655	0.679405207	1.587997977	0	2.6528843	4.82767692	1.44126512	2.609685942	14.5700825	3.89915179	5.25578427	0.41071665	0.10921336	7.917935	6.842193243	14.55057281	0.557040121	0.5290791	0	0	4.8834701	0	0	0	0	0	0	0	0	0	0	0	0.923674567	0	1.416468734	0	0	0	0	0	97.3298
H8145_032_0	2012	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		V	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						0	NO	1436.86	52.98	932.38	2125.45	2.06	17.39	5.57	446.02	53.43	14.97	19.11	1.62	0.54	28.4	3535.53	3942.98	89.97	2.67		1439.08	21.36	0		3.23	0.61				4.33	1.09	1728.08	628.81	296.29	0	344.09							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	0.241156	0.25	0.245719	0.207915	0.2	0.237362	15	37.561853	40	0.25		0	0.2	0		0	0				0	0	0	0	27.379101	0	40						NO	139.164622	111.513777	28.666455	0	0.184226	0.184226	0.184226	59.873515	0.222136	0.230283	0.226339	0.191517	0.184226	0.218641	13.816965	34.599387	36.84524	0.230283		0	0.184226	0		0	0				0	0	0	0	25.219739	0	36.84524							16.6633	0.492333325	2.227335776	0	0.37950556	3.20369014	1.02613882	2.225398763	11.86872648	3.44733651	4.32533829	0.31025754	0.09948204	6.2094044	4.070857856	11.36872425	0.276247187	0.61485561	0	0	3.93506736	0	0	0	0	0	0	0	0	0	0	0	0.622696372	0	1.056506553	0	0	0	0	0	74.4232	0	NO	8.190006	16.6633	0.492333325	2.227335776	0	0.37950556	3.20369014	1.02613882	2.225398763	11.86872648	3.44733651	4.32533829	0.31025754	0.09948204	6.2094044	4.070857856	11.36872425	0.276247187	0.61485561	0	0	3.93506736	0	0	0	0	0	0	0	0	0	0	0	0.622696372	0	1.056506553	0	0	0	0	0	74.4232	YES	30% Coins; $0/Day(Days 1-1)	30% Coins; $0/Day(Days 1-1)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-30% Coins	30% Coins	20%-30% Coins	20%-30% Coins	20% Coins	20%-30% Coins	$15/Visit	$15-$40/Visit	$40/Visit	30% Coins		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	30% Coins; $0-$75/Visit	$0/Visit	$40/Visit						6700	5.571	0.0869	0.2451	0	4.6872	1.2674	0.4057	0.3933	2.4796	0.7383	0.9154	0.0648	0.0176	1.4001	0.8203	2.2907	0.0557	0.1317		0	0.8321	0			0				0	0	0	0	0.2214	0	0.2129						22.837	1000	NO	7.034276	22.2343	0.579259325	2.472447776	0	5.06672056	4.47105014	1.43184782	2.618740763	14.34830448	4.18559351	5.24069429	0.37501654	0.11707704	7.6095014	4.891109856	13.65944725	0.331912187	0.74657861	0	0	4.76714436	0	0	0	0	0	0	0	0	0	0	0	0.844055372	0	1.269384553	0	0	0	0	0	97.2602
H8145_033_0	2012	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		V	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						0	NO	1275.91	50.38	831.71	1582.08	1.8	15.15	4.7	417.59	47.45	13.79	17.5	1.46	0.48	26.21	3231.43	3715.58	85.93	2.33		1304.83	19.3	0		3.23	0.61				4.33	1.09	1576.05	560.29	266.02	0	306.78							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	0.241767	0.25	0.245552	0.208532	0.2	0.237516	15	37.324495	40	0.25		0	0.2	0		0	0				0	0	0	0	25.036625	0	40						NO	143.171204	114.724285	29.777187	0	0.186775	0.186775	0.186775	60.701875	0.22578	0.233469	0.229315	0.194743	0.186775	0.221811	14.008125	34.856413	37.355	0.233469		0	0.186775	0		0	0				0	0	0	0	23.381078	0	37.355							15.2228	0.48165079	2.063832017	0	0.336195	2.82964125	0.8778425	2.112374665	10.713261	3.21953751	4.0130125	0.28432478	0.089652	5.81366631	3.772189614	10.79264925	0.267492929	0.54398277	0	0	3.6047575	0	0	0	0	0	0	0	0	0	0	0	0.518319531	0	0.954980575	0	0	0	0	0	68.5122	0	NO	6.171715	15.2228	0.48165079	2.063832017	0	0.336195	2.82964125	0.8778425	2.112374665	10.713261	3.21953751	4.0130125	0.28432478	0.089652	5.81366631	3.772189614	10.79264925	0.267492929	0.54398277	0	0	3.6047575	0	0	0	0	0	0	0	0	0	0	0	0.518319531	0	0.954980575	0	0	0	0	0	68.5122	YES	30% Coins	30% Coins	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-30% Coins	30% Coins	20%-30% Coins	20%-30% Coins	20% Coins	20%-30% Coins	$15/Visit	$15-$40/Visit	$40/Visit	30% Coins		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	0%-30% Coins; $0-$75/Visit	30% Coins; $0/Visit	$40/Visit						6700	5.5806	0.0789	0.231	0	4.1268	1.1071	0.3435	0.3692	2.2167	0.6815	0.8394	0.0586	0.0159	1.2957	0.7516	2.1504	0.0533	0.1153		0	0.7536	0			0				0		0	0	0.3741	0.5517	0.1903						21.8851	1000	NO	6.730736	20.8034	0.56057579	2.294843017	0	4.462997	3.93670725	1.2213755	2.481574665	12.930006	3.90106951	4.8523805	0.34295878	0.10556	7.10938731	4.523783614	12.94304325	0.320791929	0.65923677	0	0	4.3583215	0	0	0	0	0	0	0	0	0	0	0	0.892375531	0.551674	1.145253575	0	0	0	0	0	90.3973
H8145_040_0	2012	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								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	V	V								0	0	0	0	0	0.399961349	0.123193672	0	1.725614104	0.377457879	0.656959545	0.040059903	0.013200496	0.716359034	0.831026593	1.522699466	0.02223633	0.136945085		0	0.523887803	0			0				0	0	0	0	0								7.0896	NO	230.91	3.28	48.63	25.57	1.57	12.62	3.89	346.27	54.45	11.91	20.73	1.26	0.42	22.61	26.22	48.05	0.7	4.32		1078.15	16.53	0			0.79				4.33	1.09	1303.97	467.99	145.6									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins: 6. 0% Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0825	0.0825	0.179	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.064727	0.064727	0.095475	0	0.18003	0.18003	0.18003	58.509815	0.18003	0.18003	0.18003	0.18003	0.18003	0.18003	0.18003	0.18003	0.18003	0.18003		0	0.18003	0			0				0	0	0	0	0									14.9461	0.21230456	4.64294925	0	0.2826471	2.2719786	0.7003167	1.68834947	9.8026335	2.1441573	3.7320219	0.2268378	0.0756126	4.0704783	4.7203866	8.6504415	0.126021	0.7777296	0	0	2.9758959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0469	0	NO	12.910248	14.9461	0.21230456	4.64294925	0	0.2826471	2.671939949	0.823510372	1.68834947	11.5282476	2.521615179	4.388981445	0.266897703	0.088813096	4.786837334	5.551413193	10.17314097	0.14825733	0.914674685	0	0	3.499783703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1365	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Share	Medicare FFS Cost Share	0% Coins	20% Coins	20% Coins	20% Coins	$65/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	20% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	5.2799	0.0874	1.7952	0	2.6067	1.6522	0.5089	0.6406	4.5831	0.9811	1.7489	0.1087	0.0343	1.862	2.3514	4.3085	0.0629	0.3729		0	1.4823	0							0	0	0	0	0								30.4668	0	NO	4.749275	20.226	0.29966556	6.43811925	0	2.8893201	4.324114949	1.332403372	2.32890047	16.1113446	3.502721179	6.137841445	0.375637703	0.123124096	6.648830334	7.902810193	14.48163297	0.21117533	1.287564685	0	0	4.982128703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6033
H8145_041_0	2012	9	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			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	1517.16	62.18	764.13	1169.71	1.38	15.09	3.46	459.23	32.9	11.5	10.88	1.36	0.73	25.83	2704.39	3301.44	245.28	2.21		1573.84	11.8	0			0.79				3.55	1.09	3102.82	476.21	244.8	0	356.94							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289607	34.03605	0	0.2	0.2	0.2	65	0.2421	0.25	0.246335	0.213832	0.2	0.231051	15	38.158336	40	0.25		0	0.2	0			0				0	0	0	0	24.697007	0	40						NO	155.340346	110.223786	29.574809	0	0.187721	0.187721	0.187721	61.00926	0.227236	0.234651	0.231211	0.200704	0.187721	0.216865	14.07906	35.815567	37.54416	0.234651		0	0.187721	0			0				0	0	0	0	23.180709	0	37.54416							19.6397	0.571142918	1.8832499	0	0.25905498	2.83270989	0.64951466	2.334773539	7.4760644	2.6984865	2.51557568	0.27295744	0.13703633	5.60162295	3.172939089	9.853578793	0.76740263	0.51857871	0	0	2.2151078	0	0	0	0	0	0	0	0	0	0	0	0.472886464	0	1.116751039	0	0	0	0	0	64.9891	0	NO	6.586076	19.6397	0.571142918	1.8832499	0	0.25905498	2.83270989	0.64951466	2.334773539	7.4760644	2.6984865	2.51557568	0.27295744	0.13703633	5.60162295	3.172939089	9.853578793	0.76740263	0.51857871	0	0	2.2151078	0	0	0	0	0	0	0	0	0	0	0	0.472886464	0	1.116751039	0	0	0	0	0	64.9891	YES	$0/Day(Days 1-1); $1100/Admit	$0/Day(Days 1-1); $1100/Admit	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	25% Coins; $0-$75/Visit	$0/Visit	$40/Visit						6700	2.5472	0.0849	0.2205	0	1.8507	0.6451	0.1479	0.2375	0.7678	0.2772	0.2583	0.0312	0.0142	0.6223	0.3679	1.1427	0.089	0.0533		0	0.2696	0							0	0	0	0	0.0991	0	0.1295						9.8557	0	NO	1.00978	22.1869	0.656029918	2.1037349	0	2.10979698	3.47782589	0.79741966	2.572279539	8.2438214	2.9757115	2.77383568	0.30411044	0.15119633	6.22391795	3.540888089	10.99624579	0.85639363	0.57185471	0	0	2.4846908	0	0	0	0	0	0	0	0	0	0	0	0.571977464	0	1.246254039	0	0	0	0	0	74.8448
H8145_042_0	2012	2	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			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	1341.91	46.12	640.2	1175	1.16	13.74	3.83	395.52	37.01	11.01	11.05	1.47	0.25	20.23	2605.16	3133.36	187.98	3.85		1457.93	17.31	0			0.79				3.55	1.09	2023.52	380.12	243.08	0	335.23							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.242637	0.25	0.246146	0.212326	0.2	0.23952	15	38.622962	40	0.25		0	0.2	0			0				0	0	0	0	34.492634	0	40						NO	149.378065	105.993172	28.324358	0	0.183558	0.183558	0.183558	59.65622	0.222689	0.229447	0.225909	0.19487	0.183558	0.219828	13.76682	35.447691	36.71152	0.229447		0	0.183558	0			0				0	0	0	0	31.656925	0	36.71152							16.7043	0.407367091	1.511104499	0	0.21292728	2.52208692	0.70302714	1.966269011	8.24171989	2.52621147	2.49629445	0.2864589	0.0458895	4.44712044	2.988730733	9.255864756	0.575085961	0.88337095	0	0	3.17738898	0	0	0	0	0	0	0	0	0	0	0	0.641263777	0	1.025566904	0	0	0	0	0	60.6181	0	NO	7.827167	16.7043	0.407367091	1.511104499	0	0.21292728	2.52208692	0.70302714	1.966269011	8.24171989	2.52621147	2.49629445	0.2864589	0.0458895	4.44712044	2.988730733	9.255864756	0.575085961	0.88337095	0	0	3.17738898	0	0	0	0	0	0	0	0	0	0	0	0.641263777	0	1.025566904	0	0	0	0	0	60.6181	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	6.655	0.1623	0.6022	0	1.9493	1.5276	0.426	0.7425	3.1421	0.9628	0.9517	0.1132	0.0177	1.6954	1.1819	3.6604	0.2274	0.3363		0	1.3184	0							0	0	0	0	0.2536	0	0.4056						26.3315	0	NO	3.289323	23.3593	0.569659091	2.113257499	0	2.16221828	4.04968392	1.12903114	2.708796011	11.38377689	3.48905047	3.44802445	0.3997039	0.0635545	6.14251044	4.170670733	12.91624876	0.802515961	1.21972095	0	0	4.49583098	0	0	0	0	0	0	0	0	0	0	0	0.894861777	0	1.431137904	0	0	0	0	0	86.9496
H8145_044_0	2012	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	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	1498.5	51.5	714.91	1312.12	1.28	15.83	4.42	441.68	40.86	12.15	12.2	1.62	0.28	22.34	2909.17	3499.02	209.92	4.25		1628.07	19.24	0			0.79				3.55	1.09	2259.66	424.48	271.45	0	374.35							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	129.289608	34.03605	0	0.2	0.2	0.2	65	0.242637	0.25	0.246146	0.212329	0.2	0.23952	15	38.622962	40	0.25		0	0.2	0			0				0	0	0	0	34.492634	0	40						NO	154.514205	109.637587	29.476955	0	0.186416	0.186416	0.186416	60.58533	0.226158	0.233021	0.229428	0.197908	0.186416	0.223252	13.98123	35.999768	37.28328	0.233021		0	0.186416	0			0				0	0	0	0	32.149963	0	37.28328							19.295	0.470527978	1.756114158	0	0.23861248	2.95096528	0.82395872	2.229944046	9.24081588	2.83120515	2.7990216	0.32061096	0.05219648	4.98744968	3.38948124	10.49699235	0.652208845	0.99033925	0	0	3.58664384	0	0	0	0	0	0	0	0	0	0	0	0.727258955	0	1.163082989	0	0	0	0	0	69.0024	0	NO	7.274194	19.295	0.470527978	1.756114158	0	0.23861248	2.95096528	0.82395872	2.229944046	9.24081588	2.83120515	2.7990216	0.32061096	0.05219648	4.98744968	3.38948124	10.49699235	0.652208845	0.99033925	0	0	3.58664384	0	0	0	0	0	0	0	0	0	0	0	0.727258955	0	1.163082989	0	0	0	0	0	69.0024	YES	$0/Day(Days 1-1); $1100/Admit	$0/Day(Days 1-1); $1100/Admit	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	25% Coins; $0-$75/Visit	$0/Visit	$40/Visit						6700	2.5433	0.0787	0.2051	0	1.694	0.6718	0.1874	0.2268	0.9488	0.2908	0.2874	0.0367	0.0053	0.5343	0.393	1.217	0.0756	0.1016		0	0.4365	0							0	0	0	0	0.1196	0	0.1348						10.1885	0	NO	1.114557	21.8382	0.549188978	1.961246158	0	1.93263148	3.62279428	1.01131272	2.456729046	10.18965288	3.12196315	3.0864246	0.35732396	0.05753048	5.52178868	3.78244524	11.71397535	0.727823845	1.09191025	0	0	4.02311184	0	0	0	0	0	0	0	0	0	0	0	0.846846955	0	1.297924989	0	0	0	0	0	79.1909
H8145_049_0	2012	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		V	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						0	NO	1653.98	89.97	464.55	1087.36	2.4	20.16	5.43	526.54	52.46	13.71	15.55	2.12	0.21	33.49	2973.81	3364.41	201.21	1.13		1254.08	13.66	0		2.89	2.86				3.43	1.09	2627.43	417.91	234.81	0	410.06							"$0-$245/Day(Days 1-7): 1a. $245 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$245/Day(Days 1-5): 1b. $245 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								178.565945	126.703815	34.03605	0	0.2	0.2	0.2	65	0.246373	0.25	0.247642	0.219119	0.2	0.23459	15	33.997804	35	0.25		0	0.2	0		0	0				0	0	0	0	26.45563	0	35						NO	133.18466	94.502928	26.422458	0	0.175681	0.175681	0.175681	57.09639	0.216415	0.219602	0.21753	0.192476	0.175681	0.206065	13.17609	29.863875	30.74421	0.219602		0	0.175681	0		0	0				0	0	0	0	23.238784	0	30.74421							18.3571	0.708535703	1.022879405	0	0.4216344	3.54172896	0.95394783	2.505294433	11.3531309	3.01074342	3.3825915	0.40804912	0.03689301	6.90111685	3.265265684	8.372859974	0.515503541	0.24815026	0	0	2.39980246	0	0	0	0	0	0	0	0	0	0	0	0.454724906	0	1.050580896	0	0	0	0	0	68.9105	0	NO	13.549535	18.3571	0.708535703	1.022879405	0	0.4216344	3.54172896	0.95394783	2.505294433	11.3531309	3.01074342	3.3825915	0.40804912	0.03689301	6.90111685	3.265265684	8.372859974	0.515503541	0.24815026	0	0	2.39980246	0	0	0	0	0	0	0	0	0	0	0	0.454724906	0	1.050580896	0	0	0	0	0	68.9105	YES	$0/Day(Days 1-1); $1100/Admit	$0/Day(Days 1-1); $1100/Admit	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						$0/Service	$0/Visit	25% Coins; $0-$75/Visit	$0/Visit	$35/Visit						5000	2.4282	0.0729	0.1175	0	2.9836	0.7998	0.2154	0.2528	1.1565	0.3067	0.3446	0.0454	0.0037	0.7492	0.3756	0.963	0.0593	0.0252		0	0.2896	0			0				0	0	0	0	0.0815	0	0.1208						11.3911	0	NO	2.33931	20.7853	0.781401703	1.140355405	0	3.4052664	4.34157596	1.16938383	2.758057433	12.5095969	3.31743042	3.7271435	0.45343012	0.04056901	7.65030585	3.640819684	9.335859974	0.574792541	0.27331526	0	0	2.68943046	0	0	0	0	0	0	0	0	0	0	0	0.536189906	0	1.171411896	0	0	0	0	0	80.3016
H8145_050_0	2012	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			V				O	O	O	V									0	0	0	0	0	0.519729155	0.139987043	0	1.787159883	0.368993446	0.592514949	0.057112037	0.005528977	0.901393417	0.774134309	1.37300032	0.034397772	0.111146522		0	0.36500225	0			0				0	0	0	0									7.0301	NO	231.34	3.89	24.79	869.89	1.92	15.42	4.15	421.23	53.03	11.99	17.58	1.69	0.16	26.75	22.97	40.74	1.02	3.3		1003.26	10.83	0			0.79				3.43	1.09	2101.94	121.59										Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									162	YES	0.0834	0.0834	0.1924	0	0.2	0.2	0.2	65	0.2	0.182712	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	0.067301	0.067301	0.132993	0	0.182411	0.182411	0.182411	59.28364	0.182411	0.166644	0.182411	0.182411	0.182411	0.182411	0.182411	0.182411	0.182411	0.182411		0	0.182411	0			0				0	0	0	0										15.5694	0.26180089	3.29689647	0	0.35022912	2.81277762	0.75700565	2.081003973	9.67325533	1.99806156	3.20678538	0.30827459	0.02918576	4.87949425	4.18998067	7.43142414	0.18605922	0.6019563	0	0	1.97551113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6091	0	NO	9.163529	15.5694	0.26180089	3.29689647	0	0.35022912	3.332506775	0.896992693	2.081003973	11.46041521	2.367055006	3.799300329	0.365386627	0.034714737	5.780887667	4.964114979	8.80442446	0.220456992	0.713102822	0	0	2.34051338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6392	YES	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit									6700	6.2385	0.1044	1.3123	0	3.2034	2.0499	0.5521	0.7823	4.518	0.9158	1.5088	0.1464	0.0137	2.2371	2.0915	3.7094	0.0929	0.2936		0	0.9861	0							0	0	0	0									30.7565	0	NO	4.163992	21.8079	0.36621489	4.60923147	0	3.55364012	5.382448775	1.449136693	2.863349973	15.97836621	3.282838006	5.308087329	0.511806627	0.048436737	8.018002667	7.055594979	12.51386246	0.313388992	1.006730822	0	0	3.32664038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3957
H8145_051_0	2012	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			V				O	O	O	V									0	0	0	0	0	0.556299864	0.16754582	0	1.77416499	0.362498284	0.662650955	0.091895106	0.004567569	0.998084369	0.762150721	1.241229221	0.030512682	0.124600796		0	0.281065305	0			0				0	0	0	0									7.0573	NO	235.15	3.04	17.39	988.7	1.7	16.39	4.94	376.27	52.26	11.58	19.52	2.71	0.13	29.4	22.45	36.56	0.9	3.67		1096.18	8.28	0			0.79				3.43	1.09	2756.18	137.64										Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"									162	YES	0.0834	0.0834	0.1924	0	0.2	0.2	0.2	65	0.2	0.18439	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	0.06796	0.06796	0.146529	0	0.183208	0.183208	0.183208	59.542665	0.183208	0.168909	0.183208	0.183208	0.183208	0.183208	0.183208	0.183208	0.183208	0.183208		0	0.183208	0			0				0	0	0	0										15.9808	0.2065984	2.54813931	0	0.3114536	3.00277912	0.90504752	1.86700988	9.57445008	1.95596622	3.57622016	0.49649368	0.02381704	5.3863152	4.1130196	6.69808448	0.1648872	0.67237336	0	0	1.51696224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0004	0	NO	8.165807	15.9808	0.2065984	2.54813931	0	0.3114536	3.559078984	1.07259334	1.86700988	11.34861507	2.318464504	4.238871115	0.588388786	0.028384609	6.384399569	4.875170321	7.939313701	0.195399882	0.796974156	0	0	1.798027545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0577	YES	8% Coins	8% Coins	"19% Coins(Days 1-8), 19% (Days 9-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit									6700	6.4091	0.0825	1.0173	0	2.8498	2.189	0.6593	0.7026	4.471	0.8975	1.6846	0.2379	0.0113	2.4712	2.0542	3.3455	0.0822	0.3283		0	0.7576	0							0	0	0	0									30.2508	0	NO	3.684461	22.3899	0.2890944	3.56542931	0	3.1612576	5.748055984	1.73186734	2.56957488	15.81958507	3.215991504	5.923508115	0.826327786	0.039693609	8.855604569	6.929386321	11.2847847	0.277640882	1.125269156	0	0	2.555579545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3085
H8145_052_0	2012	9	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			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	1112.37	84.09	489.97	695.64	1.12	9.53	3.06	279.81	33.33	13.33	13.91	1.47	0.17	21.73	2701.07	2810.25	126.03	2.06		1176.29	16.41	0			0.79				3.31	1.09	1207.46	545.34	215.79	0	488.08							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	0.237845	0.25	0.2458	0.211815	0.2	0.230784	15	33.382462	35	0.25		0	0.2	0			0				0	0	0	0	26.668557	0	35						NO	137.448148	110.138352	29.104975	0	0.184164	0.184164	0.184164	59.85317	0.219012	0.230205	0.226337	0.195043	0.184164	0.21251	13.81227	30.739172	32.22863	0.230205		0	0.184164	0			0				0	0	0	0	24.556888	0	32.22863							12.7411	0.771794502	1.188380383	0	0.20626368	1.75508292	0.56354184	1.395626291	7.29966996	3.06863265	3.14834767	0.28671321	0.03130788	4.6178423	3.108992344	7.198729843	0.338481187	0.4742223	0	0	3.02213124	0	0	0	0	0	0	0	0	0	0	0	0.441594238	0	1.310845811	0	0	0	0	0	52.9693	0	NO	6.101218	12.7411	0.771794502	1.188380383	0	0.20626368	1.75508292	0.56354184	1.395626291	7.29966996	3.06863265	3.14834767	0.28671321	0.03130788	4.6178423	3.108992344	7.198729843	0.338481187	0.4742223	0	0	3.02213124	0	0	0	0	0	0	0	0	0	0	0	0.441594238	0	1.310845811	0	0	0	0	0	52.9693	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5900	5.0692	0.3071	0.4728	0	1.8883	1.0618	0.341	0.5264	2.7796	1.1685	1.1987	0.1138	0.012	1.7582	1.228	2.8435	0.1337	0.1808		0	1.2525	0							0	0	0	0	0.1744	0	0.5178						23.0279	0	NO	2.605842	17.8103	1.078858502	1.661167383	0	2.09455668	2.81688192	0.90456284	1.922025291	10.07924496	4.23708465	4.34703167	0.40048021	0.04327188	6.3760393	4.337039344	10.04221184	0.472177187	0.6549823	0	0	4.27464924	0	0	0	0	0	0	0	0	0	0	0	0.616024238	0	1.828626811	0	0	0	0	0	75.9972
H8145_053_0	2012	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			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	2034.01	96.05	580.42	1371.37	2.02	20.73	6.71	435.14	53.39	15.68	16.38	2.44	0.34	26.59	3200.75	3410.63	142.85	1.98		1586.8	19.99	0			0.79				3.31	1.09	1974.6	501.41	232.04	0	538.35							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	0.243674	0.25	0.246048	0.222284	0.2	0.234475	15	33.43425	35	0.25		0	0.2	0			0				0	0	0	0	24.605944	0	35						NO	132.303317	106.015756	28.573536	0	0.182975	0.182975	0.182975	59.466875	0.222932	0.228719	0.225103	0.203362	0.182975	0.214515	13.723125	30.588159	32.020625	0.228719		0	0.182975	0			0				0	0	0	0	22.511363	0	32.020625							22.4255	0.84856778	1.382054314	0	0.3696095	3.79307175	1.22776225	2.156367999	11.90233948	3.58631392	3.68718714	0.49620328	0.0622115	5.70395385	3.660357695	8.693741061	0.381178857	0.45286362	0	0	3.65767025	0	0	0	0	0	0	0	0	0	0	0	0.435294723	0	1.436525289	0	0	0	0	0	76.3588	0	NO	10.648914	22.4255	0.84856778	1.382054314	0	0.3696095	3.79307175	1.22776225	2.156367999	11.90233948	3.58631392	3.68718714	0.49620328	0.0622115	5.70395385	3.660357695	8.693741061	0.381178857	0.45286362	0	0	3.65767025	0	0	0	0	0	0	0	0	0	0	0	0.435294723	0	1.436525289	0	0	0	0	0	76.3588	YES	$0/Day(Days 1-1); $1100/Admit	$0/Day(Days 1-1); $1100/Admit	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	25% Coins; $0-$75/Visit	$0/Visit	$35/Visit						6700	2.9418	0.1224	0.16	0	2.6151	0.8593	0.278	0.2183	1.2166	0.3666	0.3769	0.0547	0.0064	0.6216	0.4225	1.0034	0.044	0.0462		0	0.4431	0							0	0	0	0	0.094	0	0.1658						12.0568	0	NO	1.765004	25.3673	0.97093678	1.542087314	0	2.9847555	4.65239375	1.50577625	2.374679999	13.11895748	3.95294992	4.06411314	0.55090528	0.0686025	6.32559285	4.082809695	9.697108061	0.425172857	0.49906062	0	0	4.10073025	0	0	0	0	0	0	0	0	0	0	0	0.529305723	0	1.602319289	0	0	0	0	0	88.4156
H8145_054_0	2012	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			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	1267.94	96.59	561.95	812.84	1.41	11.98	3.89	321.53	39.58	16.7	17.16	1.84	0.16	27.25	3002.91	3235.49	141.44	2.66		1298.71	20.71	0			0.79				3.31	1.09	1382.77	666.02	238.23	0	545.14							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	0.237717	0.25	0.245759	0.209932	0.2	0.230133	15	33.409195	35	0.25		0	0.2	0			0				0	0	0	0	26.206285	0	35						NO	136.495699	109.375147	28.862673	0	0.183157	0.183157	0.183157	59.52609	0.217698	0.228947	0.225062	0.192253	0.183157	0.210753	13.73679	30.595673	32.05251	0.228947		0	0.183157	0			0				0	0	0	0	23.999349	0	32.05251							14.4224	0.880378787	1.351614924	0	0.25825137	2.19422086	0.71248073	1.594951976	8.61648684	3.8234149	3.86206392	0.35374552	0.02930512	5.74301925	3.437528672	8.249332836	0.377792251	0.60899902	0	0	3.79318147	0	0	0	0	0	0	0	0	0	0	0	0.476447076	0	1.456092108	0	0	0	0	0	62.2417	0	NO	7.516675	14.4224	0.880378787	1.351614924	0	0.25825137	2.19422086	0.71248073	1.594951976	8.61648684	3.8234149	3.86206392	0.35374552	0.02930512	5.74301925	3.437528672	8.249332836	0.377792251	0.60899902	0	0	3.79318147	0	0	0	0	0	0	0	0	0	0	0	0.476447076	0	1.456092108	0	0	0	0	0	62.2417	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	5.736	0.3501	0.5375	0	2.3576	1.3277	0.4309	0.6014	3.2801	1.4551	1.47	0.1404	0.011	2.1865	1.3574	3.2575	0.1492	0.2321		0	1.572	0							0	0	0	0	0.1881	0	0.575						27.2154	0	NO	3.238229	20.1583	1.230526787	1.889084924	0	2.61581537	3.52187886	1.14343073	2.196354976	11.89656384	5.2784899	5.33203292	0.49409652	0.04033812	7.92956125	4.794918672	11.50678584	0.526968251	0.84107402	0	0	5.36513247	0	0	0	0	0	0	0	0	0	0	0	0.664581076	0	2.031070108	0	0	0	0	0	89.457
H8145_055_0	2012	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	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	1412.74	76.29	595.61	1119.35	1.46	11.56	3.18	351.74	28.73	11.28	10.98	0.98	0.31	16.94	2335.98	2484.53	111.18	1.74		1004.19	10.32	0			0.79				3.31	1.09	1705.65	348.58	178.41	0	324.38							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.8754	34.03605	0	0.2	0.2	0.2	65	0.241291	0.25	0.245596	0.219496	0.2	0.236632	15	38.766963	40	0.25		0	0.2	0			0				0	0	0	0	30.448678	0	40						NO	152.912968	108.501408	28.770605	0	0.185943	0.185943	0.185943	60.43141	0.224331	0.232429	0.228334	0.204069	0.185943	0.22	13.94571	36.042188	37.18856	0.232429		0	0.185943	0			0				0	0	0	0	28.308562	0	37.18856							18.0022	0.689797701	1.428005004	0	0.27147678	2.14950108	0.59129874	1.771345346	6.44502963	2.62179912	2.50710732	0.19998762	0.05764233	3.7268	2.714741637	7.462324779	0.344552008	0.40442646	0	0	1.91893176	0	0	0	0	0	0	0	0	0	0	0	0.420877546	0	1.005268758	0	0	0	0	0	54.7331	0	NO	6.904614	18.0022	0.689797701	1.428005004	0	0.27147678	2.14950108	0.59129874	1.771345346	6.44502963	2.62179912	2.50710732	0.19998762	0.05764233	3.7268	2.714741637	7.462324779	0.344552008	0.40442646	0	0	1.91893176	0	0	0	0	0	0	0	0	0	0	0	0.420877546	0	1.005268758	0	0	0	0	0	54.7331	YES	$0-$255/Day(Days 1-7)	$0-$255/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$40/Visit						6700	7.1661	0.2746	0.5685	0	2.4861	1.3011	0.3585	0.6684	2.4551	0.9986	0.955	0.0788	0.0218	1.4198	1.0728	2.9489	0.1362	0.1539		0	0.7955	0							0	0	0	0	0.1663	0	0.3973						24.4231	0	NO	2.946287	25.1683	0.964395701	1.996467004	0	2.75753578	3.45060008	0.94978974	2.439767346	8.90014263	3.62037612	3.46208832	0.27875962	0.07943833	5.146618	3.787550637	10.41127278	0.480715008	0.55829846	0	0	2.71441676	0	0	0	0	0	0	0	0	0	0	0	0.587195546	0	1.402523758	0	0	0	0	0	79.1562
H8145_061_0	2012	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			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	1406.22	56.26	499.98	1076.2	29.07	11.56	3.38	302.8	33.21	7.96	13.18	1.31	0.17	31.86	2480.2	4533.48	66.24	2.16		994.28	28.19	0			0.79				3.95	1.98	948.12	662.98	271.87	0	451.16						6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$75/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$30/Visit: 7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.405866	34.03605	0	150	0.2	0.2	65	0.231841	0.25	0.232324	0.204962	0.2	0.231883	10	29.7481	30	0.25		0	0.2	0			0				0	0	0	0	44.049896	0	30						NO	135.740529	108.770023	29.004739	0	137.7459	0.183661	0.183661	59.68989	0.212901	0.229577	0.213345	0.188218	0.183661	0.21294	9.18306	27.317859	27.54918	0.229577		0	0.183661	0			0				0	0	0	0	40.451284	0	27.54918							15.9068	0.509950124	1.20848245	0	0.333689443	2.12312116	0.62077418	1.506174891	7.07044221	1.82743292	2.8118871	0.24656558	0.03122237	6.7842684	1.897985451	10.32041395	0.152071474	0.49588632	0	0	5.17740359	0	0	0	0	0	0	0	0	0	0	0	0.916457548	0	1.035757337	0	0	0	0	0	60.9767	0	NO	7.482492	15.9068	0.509950124	1.20848245	0	0.333689443	2.12312116	0.62077418	1.506174891	7.07044221	1.82743292	2.8118871	0.24656558	0.03122237	6.7842684	1.897985451	10.32041395	0.152071474	0.49588632	0	0	5.17740359	0	0	0	0	0	0	0	0	0	0	0	0.916457548	0	1.035757337	0	0	0	0	0	60.9767	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-6)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	$150/Trip	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$10/Visit	$20-$30/Visit	$30/Visit	25% Coins		$0/Visit	20% Coins	20% Coins			"VIS776: Vision 17a,17b"						40% Coins	$0/Visit	$0-$75/Visit	$0/Visit	$30/Visit						6700	6.2767	0.2012	0.4763	0	3.0372	1.2762	0.3729	0.5642	2.6744	0.6907	1.0633	0.098	0.0115	2.5657	0.7446	4.0487	0.0597	0.1872		0	2.1316	0			0				0		0.3884	0	0.3595	0	0.4063						27.634	0	NO	3.508047	22.1834	0.711156124	1.68479045	0	3.370892443	3.39932316	0.99362518	2.070401891	9.74480321	2.51812392	3.8751401	0.34454158	0.04274637	9.3499204	2.642564451	14.36911295	0.211731474	0.68304132	0	0	7.30896459	0	0	0	0	0	0	0	0	0	0.388389	0	1.275978548	0	1.442088337	0	0	0	0	0	88.6107
H8145_063_0	2012	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	T	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	NO	1175.8	68	493.48	1043.4	29.18	16.82	6.3	400.35	47.16	10.48	5.2	1.66	0.49	26.09	3670.63	4320.27	75.85	1.88		1937.35	20.16	0			0.61				3.99	0.81	2706.43	458.2	608.63	40.73	0	506.12						"$0-$250/Day(Days 1-6): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$20-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"							171.209603	129.289607	38.216144	0	200	0.2	0.2	65	0.243603	0.25	0.24556	0.208494	0.2	0.236232	20	39.062384	40	0.25		0	0.2	0			0				0	0	0	0	115.111399	150	0	20					NO	140.864241	106.374188	31.913805	0	179.8838	0.179884	0.179884	58.462235	0.219101	0.224855	0.220862	0.187524	0.179884	0.212472	17.98838	35.133451	35.97676	0.224855		0	0.179884	0			0				0	0	0	0	103.533379	134.91285	0	17.98838						13.8023	0.602787065	1.312402041	0	0.43741744	3.02564888	1.1332692	1.950446315	10.33280316	2.3564804	1.1484824	0.31128984	0.08814316	5.54339448	5.502390607	12.64883286	0.227403104	0.4227274	0	0	3.62646144	0	0	0	0	0	0	0	0	0	0	0	5.251126705	0.457916698	0	0.758689907	0	0	0	0	70.9405	0	NO	9.537979	13.8023	0.602787065	1.312402041	0	0.43741744	3.02564888	1.1332692	1.950446315	10.33280316	2.3564804	1.1484824	0.31128984	0.08814316	5.54339448	5.502390607	12.64883286	0.227403104	0.4227274	0	0	3.62646144	0	0	0	0	0	0	0	0	0	0	0	5.251126705	0.457916698	0	0.758689907	0	0	0	0	70.9405	YES	$0-$250/Day(Days 1-6)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-5), $50 (Days 6-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$20/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0			"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$150/Visit	$20-$150/Visit	$0/Visit	$20/Visit					5500	1.6045	0.0701	0.152	0	3.0715	0.679	0.2542	0.1956	1.046	0.2386	0.1162	0.0356	0.009	0.5612	0.629	1.4458	0.026	0.0428		0	0.4349	0			0				0		0.1938	0	0.5621	0.0459	0	0.0867					11.5007	0	NO	1.685133	15.4069	0.672863065	1.464429041	0	3.50893244	3.70465488	1.3875182	2.146016315	11.37884216	2.5950644	1.2646554	0.34689584	0.09710116	6.10463648	6.131348607	14.09467586	0.253396104	0.4655634	0	0	4.06138444	0	0	0	0	0	0	0	0	0	0.193771	0	5.813229705	0.503827698	0	0.845412907	0	0	0	0	82.4411
H8145_069_0	2012	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	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	NO	1526.03	98.39	409.78	1056.48	35	16.2	9.12	395.79	45.62	9.94	3.62	1.21	0.36	22.33	3328.55	4211.59	153.78	2.18		1888.66	25.41	0			0.79				4.09	0.81	2380.46	363.92	733.19	50.17	0	512.25						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	200	0.2	0.2	65	0.239531	0.25	0.245441	0.209313	0.2	0.229591	15	34.14946	35	0.25		0	0.2	0			0				0	0	0	0	100.643439	150	0	15					NO	117.432156	98.371353	27.785772	0	177.7222	0.177722	0.177722	57.759715	0.21285	0.222153	0.218101	0.185998	0.177722	0.204017	13.329165	30.345585	31.101385	0.222153		0	0.177722	0			0				0	0	0	0	89.432867	133.29165	0	13.329165						14.9337	0.806563118	0.948837804	0	0.518356417	2.8790964	1.62082464	1.9050598	9.710217	2.20820082	0.78952562	0.22505758	0.06397992	4.55569961	3.69723268	10.65026353	0.398564249	0.48429354	0	0	4.51591602	0	0	0	0	0	0	0	0	0	0	0	5.464273646	0.557270173	0	0.568988731	0	0	0	0	67.502	0	NO	10.812894	14.9337	0.806563118	0.948837804	0	0.518356417	2.8790964	1.62082464	1.9050598	9.710217	2.20820082	0.78952562	0.22505758	0.06397992	4.55569961	3.69723268	10.65026353	0.398564249	0.48429354	0	0	4.51591602	0	0	0	0	0	0	0	0	0	0	0	5.464273646	0.557270173	0	0.568988731	0	0	0	0	67.502	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0									20% Coins	$0/Visit	$0-$150/Visit	$15-$150/Visit	$0/Visit	$15/Visit					5000	1.7129	0.0925	0.1083	0	3.6027	0.6394	0.3601	0.189	0.9728	0.2212	0.0791	0.0253	0.0064	0.4563	0.4182	1.2047	0.0451	0.0485		0	0.5361	0			0				0		0.175	0	0.5764	0.0553	0	0.0644					11.5898	0	NO	2.090657	16.6467	0.899078118	1.057145804	0	4.121043417	3.5184594	1.98091164	2.0940938	10.683058	2.42944482	0.86861562	0.25036058	0.07039992	5.01203461	4.11545168	11.85498653	0.443647249	0.53279154	0	0	5.05198502	0	0	0	0	0	0	0	0	0	0.174961	0	6.040634646	0.612571173	0	0.633350731	0	0	0	0	79.0917
H8145_071_0	2012	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	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	NO	1458.65	68.62	497.17	1198.61	32.56	15.36	5.07	358.73	46.19	9.87	4.48	0.96	0.41	20.14	3223.21	3692.88	74.65	1.86		1632.79	20.29	0			0.79				4.09	0.81	2256.86	443.26	671.97	58.5	0	428.03						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	200	0.2	0.2	65	0.238791	0.25	0.24039	0.210535	0.2	0.233745	15	34.466377	35	0.25		0	0.2	0			0				0	0	0	0	94.280368	150	0	15					NO	120.142125	100.641459	28.092913	0	180.0658	0.180066	0.180066	58.521385	0.214991	0.225082	0.21643	0.189551	0.180066	0.210447	13.504935	31.031079	31.511515	0.225082		0	0.180066	0			0				0	0	0	0	84.88335	135.04935	0	13.504935						14.6038	0.57550141	1.163912796	0	0.488578537	2.76581376	0.91293462	1.749448037	9.93043429	2.22155934	0.9696064	0.18196896	0.07382706	4.23840258	3.627436795	9.549504251	0.196027883	0.41865252	0	0	3.65353914	0	0	0	0	0	0	0	0	0	0	0	4.753255392	0.658365581	0	0.481709777	0	0	0	0	63.2143	0	NO	9.080024	14.6038	0.57550141	1.163912796	0	0.488578537	2.76581376	0.91293462	1.749448037	9.93043429	2.22155934	0.9696064	0.18196896	0.07382706	4.23840258	3.627436795	9.549504251	0.196027883	0.41865252	0	0	3.65353914	0	0	0	0	0	0	0	0	0	0	0	4.753255392	0.658365581	0	0.481709777	0	0	0	0	63.2143	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0									20% Coins	$0/Visit	$0-$150/Visit	$15-$150/Visit	$0/Visit	$15/Visit					5000	1.6863	0.0665	0.1339	0	3.4124	0.6173	0.2038	0.1745	0.9998	0.2237	0.0977	0.0206	0.0075	0.4267	0.4124	1.0856	0.0223	0.0421		0	0.4358	0			0				0		0.1662	0	0.5071	0.0657	0	0.0548					10.8623	0	NO	1.717083	16.29	0.64195741	1.297766796	0	3.900942537	3.38315476	1.11669362	1.923903037	10.93020229	2.44527334	1.0672704	0.20252696	0.08130206	4.66513258	4.039807795	10.63510125	0.218311883	0.46079652	0	0	4.08938714	0	0	0	0	0	0	0	0	0	0.166207	0	5.260322392	0.724021581	0	0.536470777	0	0	0	0	74.0766
H8145_073_0	2012	6																															Coin	Coin	Coin	Coin	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	198.71	1.13	27.02	6.73	1.37	3.9	3.35	23.2	36.87	7.82	14.91	1.4	0.11	16.01	33.71	44.28	0.49	4.25		4.57	10.18	0			0.79				4.71	0.95												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											162	YES	0.0668	0.0668	0.1432	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0			0				0	0											NO	0.057658	0.057658	0.111474	0	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412	0.207412		0.207412	0.207412	0			0				0	0												11.4572	0.06515354	3.01202748	0	0.28415444	0.8089068	0.6948302	4.8119584	7.64728044	1.62196184	3.09251292	0.2903768	0.02281532	3.32066612	6.99185852	9.18420336	0.10163188	0.881501	0	0.94787284	2.11145416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3484	0	NO	6.108391	11.4572	0.06515354	3.01202748	0	0.28415444	0.8089068	0.6948302	4.8119584	7.64728044	1.62196184	3.09251292	0.2903768	0.02281532	3.32066612	6.99185852	9.18420336	0.10163188	0.881501	0	0.94787284	2.11145416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3484	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			"VIS776: Vision 17a,17b"																6700	4.5918	0.026	1.2035	0	2.5964	0.4885	0.4194	1.8278	2.9663	0.7462	1.2082	0.1149	0.009	1.2611	2.8909	3.7971	0.042	0.3559		0.3919	0.8731	0			0				0												25.8098	0	NO	2.777709	16.049	0.09115854	4.21549248	0	2.88050544	1.2974258	1.1142792	6.6397734	10.61355244	2.36817484	4.30068692	0.4052298	0.03182432	4.58172712	9.88272352	12.98126836	0.14361988	1.23738	0	1.33975184	2.98459516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1582
H8145_075_0	2012	10	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	NO	1441.25	92.06	283.63	1559.95	1.43	16.18	4.59	433.83	54.2	8.97	3.55	0.88	0.19	19.42	3394.49	3511.15	61.26	1.66		1570.32	22.34	0			0.61				3.47	1.15	2883.46	405.6	507.54	48.72	0	392.53						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	0.2	0.2	0.2	65	0.244276	0.25	0.247518	0.207318	0.2	0.231178	15	34.331063	35	0.25		0	0.2	0			0				0	0	0	0	108.12625	150	0	15					NO	120.416415	100.871227	28.873904	0	0.179994	0.179994	0.179994	58.49792	0.21984	0.224992	0.222758	0.18658	0.179994	0.208053	13.49952	30.896858	31.49888	0.224992		0	0.179994	0			0				0	0	0	0	97.310165	134.9952	0	13.49952						14.4625	0.77385043	0.682458783	0	0.25739142	2.91230292	0.82617246	2.114846053	11.915328	2.01817824	0.7907909	0.1641904	0.03419886	4.04038926	3.81866547	9.040291914	0.160801782	0.37348672	0	0	4.02106596	0	0	0	0	0	0	0	0	0	0	0	4.115733429	0.548080512	0	0.441580549	0	0	0	0	63.5123	0	NO	9.027347	14.4625	0.77385043	0.682458783	0	0.25739142	2.91230292	0.82617246	2.114846053	11.915328	2.01817824	0.7907909	0.1641904	0.03419886	4.04038926	3.81866547	9.040291914	0.160801782	0.37348672	0	0	4.02106596	0	0	0	0	0	0	0	0	0	0	0	4.115733429	0.548080512	0	0.441580549	0	0	0	0	63.5123	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$150/Visit	$15-$150/Visit	$0/Visit	$15/Visit					5000	1.7199	0.092	0.0812	0	1.8448	0.6662	0.1889	0.2162	1.2297	0.2082	0.0816	0.0191	0.0036	0.4169	0.445	1.0535	0.0187	0.0386		0	0.4918	0			0				0		0.2278	0	0.4426	0.056	0	0.0515					9.594	0	NO	1.26021	16.1824	0.86588243	0.763653783	0	2.10222042	3.57847492	1.01510046	2.331036053	13.145042	2.22634924	0.8724329	0.1832794	0.03780986	4.45733726	4.26366847	10.09379191	0.179540782	0.41210272	0	0	4.51283796	0	0	0	0	0	0	0	0	0	0.227846	0	4.558339429	0.604110512	0	0.493039549	0	0	0	0	73.1063
H8145_078_0	2012	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	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	NO	792.39	69.82	255.73	1099.8	1.38	13.74	4.77	284.94	39.93	8.51	12.86	1.69	0.33	15.76	2621.36	2564.27	87.35	0.98		989.75	15.21	0			0.61				3.7	1.43	1242.34	343.3	233.38	336.96								"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									127.547103	112.005826	31.003517	0	0.2	0.2	0.2	65	0.239068	0.25	0.239576	0.215084	0.2	0.238994	15	33.576012	35	0.25		0	0.2	0			0				0	0	0	0	18.222731	35							NO	111.866335	98.235718	27.966567	0	0.184181	0.184181	0.184181	59.858825	0.220159	0.230226	0.220627	0.198072	0.184181	0.220091	13.813575	30.920317	32.231675	0.230226		0	0.184181	0			0				0	0	0	0	16.781404	32.231675								7.3868	0.571568153	0.595990848	0	0.25416978	2.53064694	0.87854337	1.4213478	8.79094887	1.95922326	2.83726322	0.33474168	0.06077973	3.46863416	3.017529414	6.607336773	0.234619734	0.22562148	0	0	2.80139301	0	0	0	0	0	0	0	0	0	0	0	0.326370339	0.905065434	0	0	0	0	0	0	45.2086	0	NO	4.328389	7.3868	0.571568153	0.595990848	0	0.25416978	2.53064694	0.87854337	1.4213478	8.79094887	1.95922326	2.83726322	0.33474168	0.06077973	3.46863416	3.017529414	6.607336773	0.234619734	0.22562148	0	0	2.80139301	0	0	0	0	0	0	0	0	0	0	0	0.326370339	0.905065434	0	0	0	0	0	0	45.2086	YES	$0-$175/Day(Days 1-7)	$0-$175/Day(Days 1-7)	"$0/Day(Days 1-20), $100 (Days 21-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$35/Visit							5000	2.9349	0.2271	0.2368	0	2.3215	1.5291	0.5308	0.5354	3.4142	0.7447	1.0958	0.1317	0.023	1.3191	1.1903	2.6064	0.0925	0.086		0	1.16	0							0	0	0.2318	0	0.1287	0.357							20.8968	0	NO	2.011473	10.3218	0.798662153	0.832764848	0	2.57566178	4.05978094	1.40937137	1.9567308	12.20514987	2.70389826	3.93304422	0.46639368	0.08375373	4.78771716	4.207845414	9.213717773	0.327168734	0.31161548	0	0	3.96136801	0	0	0	0	0	0	0	0	0	0.231786	0	0.455110339	1.262085434	0	0	0	0	0	0	66.1054
H8145_079_0	2012	10	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	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	NO	1256.9	72.28	368.21	1200.58	31.4	13.33	5.47	348.88	50.18	9.3	13.84	1.78	0.23	23.46	3081.84	4903.33	116.54	3.15		1910.86	29.3	0			0.61				4.14	0.81	1472.89	512.79	353.28	0	0	685.85						"$0-$195/Day(Days 1-9): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$175/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $175 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit: 3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							154.601427	124.806492	34.03605	0	200	0.2	0.2	65	0.239699	0.25	0.236357	0.20473	0.2	0.231683	15	34.412652	35	0.25		0	0.2	0			0				0	0	0	0	85.798086	0	0	15					NO	132.033174	106.587614	30.082388	0	183.5352	0.183535	0.183535	59.64894	0.219966	0.229419	0.216899	0.187876	0.183535	0.21261	13.76514	31.579665	32.11866	0.229419		0	0.183535	0			0				0	0	0	0	78.734844	0	0	13.76514						13.8294	0.642012728	0.923053007	0	0.48025044	2.44652155	1.00393645	1.734193516	11.03789388	2.1335967	3.00188216	0.33441928	0.04221305	4.9878306	3.535163255	12.90379323	0.31192572	0.72266985	0	0	5.3775755	0	0	0	0	0	0	0	0	0	0	0	2.317953807	0	0	0.786735106	0	0	0	0	68.553	0	NO	7.363784	13.8294	0.642012728	0.923053007	0	0.48025044	2.44652155	1.00393645	1.734193516	11.03789388	2.1335967	3.00188216	0.33441928	0.04221305	4.9878306	3.535163255	12.90379323	0.31192572	0.72266985	0	0	5.3775755	0	0	0	0	0	0	0	0	0	0	0	2.317953807	0	0	0.786735106	0	0	0	0	68.553	YES	$0-$195/Day(Days 1-9)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0			"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$175/Visit	$15/Visit	$0/Visit	$15/Visit					5900	1.6041	0.0745	0.107	0	3.3642	0.5476	0.2249	0.1734	1.1145	0.2155	0.3031	0.0386	0.0042	0.5035	0.4031	1.4712	0.0356	0.0729		0	0.6435	0			0				0		0.11	0	0.2643	0	0	0.0897					11.3654	0	NO	1.396982	15.4335	0.716481728	1.030041007	0	3.84440844	2.99413055	1.22883745	1.907632516	12.15234888	2.3491377	3.30500916	0.37301528	0.04643505	5.4913726	3.938213255	14.37497523	0.34748972	0.79555785	0	0	6.0210905	0	0	0	0	0	0	0	0	0	0.110039	0	2.582225807	0	0	0.876432106	0	0	0	0	79.9184
H8145_080_0	2012	11	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	NO	1495.84	76.32	655.83	2123.79	1.9	19.26	7.61	420.97	39.82	8.96	3.16	1.27	0.16	22.64	3424.69	3653.7	161.43	2.12		1889.55	26.65	0			0.61				3.21	1.15	1713.55	343.67	583.94	47.33	0	424.74						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	0.2	0.2	0.2	65	0.237466	0.25	0.245862	0.206513	0.2	0.229885	15	34.1167	35	0.25		0	0.2	0			0				0	0	0	0	114.822319	150	0	15					NO	118.372279	99.158882	27.044909	0	0.178708	0.178708	0.178708	58.080165	0.212185	0.223385	0.219688	0.184527	0.178708	0.205411	13.403115	30.48467	31.273935	0.223385		0	0.178708	0			0				0	0	0	0	102.59845	134.03115	0	13.403115						14.7555	0.63065049	1.478071889	0	0.3395452	3.44191608	1.35996788	2.037500588	8.4492067	2.0015296	0.69421408	0.23434929	0.02859328	4.65050504	3.825126159	9.281819898	0.420712611	0.4735762	0	0	4.7625682	0	0	0	0	0	0	0	0	0	0	0	4.992611574	0.528641194	0	0.474403255	0	0	0	0	64.861	0	NO	10.079936	14.7555	0.63065049	1.478071889	0	0.3395452	3.44191608	1.35996788	2.037500588	8.4492067	2.0015296	0.69421408	0.23434929	0.02859328	4.65050504	3.825126159	9.281819898	0.420712611	0.4735762	0	0	4.7625682	0	0	0	0	0	0	0	0	0	0	0	4.992611574	0.528641194	0	0.474403255	0	0	0	0	64.861	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	20%-25% Coins; $0-$150/Visit	25% Coins; $15/Visit	$0/Visit	$15/Visit					5000	1.7554	0.075	0.1761	0	2.4353	0.7877	0.3112	0.2084	0.8723	0.2067	0.0716	0.0275	0.0029	0.48	0.4459	1.0821	0.049	0.049		0	0.5827	0			0				0		0.1359	0	0.483	0.0804	0	0.0553					10.3733	0	NO	1.466873	16.5109	0.70567549	1.654135889	0	2.7748862	4.22960808	1.67113388	2.245869588	9.3214647	2.2082156	0.76577808	0.26183029	0.03147228	5.13055504	4.271068159	10.3639129	0.469759611	0.5225562	0	0	5.3453042	0	0	0	0	0	0	0	0	0	0.135866	0	5.475569574	0.609012194	0	0.529710255	0	0	0	0	75.2343
H8145_084_0	2012	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	Inpatient Facility	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Mental Health	Lab	Radiology	Therapy (PT/OT/ST)						D	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin			V				O	O	O	D	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0	0	0	0						0	NO	1266.57	6.53	228.45	2082.27	1.07	12.26	4.33	252.78	50.89	5.96	18.14	1.2	0.48	22.34	2411.22	3602.77	87.71	1.52		1201.92	23.07	0			0.61				3.7	1.43	1064.87	0	706.83	302.97	324.51							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	$1400/Admit: 1b. $1400 IP Psych - Facility 1	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	1400	45.597948	0	0.2	0.2	0.2	65	0.238409	0.25	0.238822	0.205048	0.2	0.231927	10	34.067473	35	0.25		0	0.2	0			0				0	0	0	0	0	20.175399	35						NO	125.299177	1069.698	36.381371	0	0.175854	0.175854	0.175854	57.15255	0.209626	0.219818	0.209989	0.180292	0.175854	0.203926	8.7927	29.954507	30.77445	0.219818		0	0.175854	0			0				0	0	0	0	0	17.739623	30.77445							13.225	0.582093995	0.69261035	0	0.18816378	2.15597004	0.76144782	1.203918466	10.66786714	1.31011528	3.80920046	0.2163504	0.08440992	4.55570684	1.766761175	8.993266599	0.224935584	0.33412336	0	0	4.05695178	0	0	0	0	0	0	0	0	0	0	0	0	0.447881132	0.832218064	0	0	0	0	0	56.109	0	NO	10.151635	13.225	0.582093995	0.69261035	0	0.18816378	2.15597004	0.76144782	1.203918466	10.66786714	1.31011528	3.80920046	0.2163504	0.08440992	4.55570684	1.766761175	8.993266599	0.224935584	0.33412336	0	0	4.05695178	0	0	0	0	0	0	0	0	0	0	0	0	0.447881132	0.832218064	0	0	0	0	0	56.109	YES	$0-$225/Day(Days 1-7)	$1400/Admit	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$10/Visit	$10-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS775: Vision 17a,17b"						20% Coins	$0/Day(Days 1-1)	$0/Visit	$0-$35/Visit	$35/Visit						5000	5.2764	0.2321	0.2764	0	1.7275	1.3074	0.4615	0.4551	4.1614	0.4998	1.482	0.0863	0.0325	1.7386	0.6995	3.5605	0.0891	0.1275		0	1.6855	0							0	0	0.1947	0	0	0.1773	0.3295						24.6007	0	NO	4.295853	18.5014	0.814220995	0.96904735	0	1.91563778	3.46340004	1.22298382	1.659051466	14.82930814	1.80990228	5.29116346	0.3026274	0.11688892	6.29425984	2.466232175	12.5537626	0.313990584	0.46163336	0	0	5.74248278	0	0	0	0	0	0	0	0	0	0.194737	0	0	0.625201132	1.161697064	0	0	0	0	0	80.7097
H8145_087_0	2012	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	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	1891.6	124.99	342.88	3360.63	1.21	17.42	9.96	400.19	45.29	11.05	4.56	0.98	0.56	32.21	2786.62	3785.34	74.88	3.38		1641.21	19.08	0			0.61				3.47	1.28	2530.86	244.36	492.43	44.32	0	575.37						"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$150/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$15-$150/Visit: 8b. $150 Nuclear Medicine,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							163.989133	116.360647	49.537808	0	0.2	0.2	0.2	65	0.239376	0.25	0.241764	0.223847	0.2	0.22548	15	39.299506	40	0.25		0	0.2	0			0				0	0	0	0	110.52267	150	0	15					NO	134.082599	95.140072	42.3147	0	0.183471	0.183471	0.183471	59.62814	0.219593	0.229339	0.221784	0.205347	0.183471	0.206845	13.76034	36.051637	36.69424	0.229339		0	0.183471	0			0				0	0	0	0	101.388635	137.6034	0	13.76034						21.1359	0.990963133	1.209072028	0	0.22199991	3.19606482	1.82737116	1.988548779	9.94536697	2.53419595	1.01133504	0.20124006	0.10274376	6.66247745	3.195403221	11.37230863	0.228972058	0.77516582	0	0	3.50062668	0	0	0	0	0	0	0	0	0	0	0	4.160567128	0.508215224	0	0.659773902	0	0	0	0	75.4283	0	NO	9.834484	21.1359	0.990963133	1.209072028	0	0.22199991	3.19606482	1.82737116	1.988548779	9.94536697	2.53419595	1.01133504	0.20124006	0.10274376	6.66247745	3.195403221	11.37230863	0.228972058	0.77516582	0	0	3.50062668	0	0	0	0	0	0	0	0	0	0	0	4.160567128	0.508215224	0	0.659773902	0	0	0	0	75.4283	YES	$0-$225/Day(Days 1-7)	$0-$225/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$150/Visit	$15-$150/Visit	$0/Visit	$15/Visit					6700	2.5399	0.1191	0.1454	0	1.6034	0.7375	0.4218	0.2051	1.0355	0.264	0.1052	0.0225	0.0107	0.6936	0.3757	1.337	0.0269	0.0807		0	0.4319								0	0	0.2171	0	0.448	0.0524	0	0.0776					10.9507	0	NO	1.193188	23.6758	1.110044133	1.354461028	0	1.82540791	3.93352082	2.24915616	2.193626779	10.98082597	2.79815395	1.11654304	0.22377706	0.11343176	7.35605845	3.571070221	12.70929563	0.255892058	0.85582482	0	0	3.93256468	0	0	0	0	0	0	0	0	0	0.21706	0	4.608561128	0.560631224	0	0.737339902	0	0	0	0	86.379
H8145_089_0	2012	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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			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	709.08	45.99	527.08	330.09	0.87	6.44	2.5	224.81	40.82	12.1	13.98	0.58	0.2	23.71	1636.93	2178.97	61.64	2.13		1475.23	12.93	0			0.79				5.58	0.95	581.12	51.46	245.2	100.32	235.01							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.206824	22.34531	0	0.2	0.2	0.2	65	0.241948	0.25	0.246166	0.25	0.2	0.237478	15	32.275216	35	0.25		0	0.2	0			0				0	0	0	0	21.031503	35	35						NO	142.618725	114.108476	19.814525	0	0.18483	0.18483	0.18483	60.06975	0.223596	0.231038	0.227494	0.231038	0.18483	0.219466	13.86225	29.82714	32.34525	0.231038		0	0.18483	0			0				0	0	0	0	19.436264	32.34525	32.34525							8.4273	0.437320734	0.870319986	0	0.1608021	1.1903052	0.462075	1.125356708	9.12718872	2.7955598	3.18036612	0.13400204	0.036966	5.20353886	1.890961074	5.416036937	0.166146768	0.49211094	0	0	2.3898519	0	0	0	0	0	0	0	0	0	0	0	0.397147661	0.27040629	0.633454767	0	0	0	0	0	44.8073	0	NO	4.318036	8.4273	0.437320734	0.870319986	0	0.1608021	1.1903052	0.462075	1.125356708	9.12718872	2.7955598	3.18036612	0.13400204	0.036966	5.20353886	1.890961074	5.416036937	0.166146768	0.49211094	0	0	2.3898519	0	0	0	0	0	0	0	0	0	0	0	0.397147661	0.27040629	0.633454767	0	0	0	0	0	44.8073	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$35/Visit	$35/Visit						5000	3.35	0.1738	0.346	0	1.4658	0.7201	0.2792	0.4241	3.5414	1.0633	1.2255	0.0512	0.0139	1.9795	0.7463	2.1376	0.0656	0.1875		0	0.99	0			0				0		0.1057	0	0.1567	0.1075	0.25						19.3809	0	NO	1.870974	11.7773	0.611169734	1.216273986	0	1.6265901	1.9104302	0.741307	1.549484708	12.66858272	3.8589058	4.40581912	0.18516304	0.05089	7.18308486	2.637290074	7.553655937	0.231717768	0.67962494	0	0	3.3798069	0	0	0	0	0	0	0	0	0	0.105714	0	0.553893661	0.37792429	0.883466767	0	0	0	0	0	64.1881
H8145_091_0	2012	11	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	NO	1143.69	75.62	596.28	771.65	1.32	15.42	3.52	423.25	34.3	10.01	10.87	1.18	1.15	23.3	2748.14	3229.44	246.1	1.49		1624.97	13.09	0			0.61				1.34	1.15	3161.73	353.73	219.72	0	0	408.69						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit: 3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	0.2	0.2	0.2	65	0.244083	0.25	0.245232	0.2088	0.2	0.236036	15	33.519307	35	0.25		0	0.2	0			0				0	0	0	0	15.554448	0	0	15					NO	127.559566	106.85495	29.334753	0	0.185319	0.185319	0.185319	60.228545	0.226166	0.231648	0.22723	0.193472	0.185319	0.218709	13.898895	31.058755	32.430755	0.231648		0	0.185319	0			0				0	0	0	0	14.412643	0	0	13.898895						12.1574	0.673364277	1.457643877	0	0.24462108	2.85761898	0.65232288	2.124310973	7.7574938	2.31879648	2.4699901	0.22829696	0.21311685	5.0959197	3.183009109	8.358532146	0.665100734	0.34515552	0	0	2.42582571	0	0	0	0	0	0	0	0	0	0	0	0.263895493	0	0	0.473361616	0	0	0	0	53.9658	0	NO	5.532574	12.1574	0.673364277	1.457643877	0	0.24462108	2.85761898	0.65232288	2.124310973	7.7574938	2.31879648	2.4699901	0.22829696	0.21311685	5.0959197	3.183009109	8.358532146	0.665100734	0.34515552	0	0	2.42582571	0	0	0	0	0	0	0	0	0	0	0	0.263895493	0	0	0.473361616	0	0	0	0	53.9658	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	1.4359	0.0795	0.1721	0	1.7381	0.6498	0.1481	0.2158	0.7959	0.2378	0.2535	0.0263	0.0219	0.5228	0.3687	0.9682	0.077	0.0354		0	0.2949				0						0.2517	0	0.0306	0	0	0.0548					8.379	0	NO	0.835583	13.5933	0.752894277	1.629739877	0	1.98272008	3.50743098	0.80046288	2.340158973	8.5533578	2.55664548	2.7234451	0.25462096	0.23504085	5.6187547	3.551704109	9.326722146	0.742139734	0.38056952	0	0	2.72071571	0	0	0	0	0	0	0	0	0	0.251703	0	0.294462493	0	0	0.528191616	0	0	0	0	62.3447
H8145_093_0	2012	6	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	O			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	NO	844.77	52.99	333.53	439.81	22.6	11.37	5.01	370.58	269.81	1972.54	825.57	231.71	0.1	2.75	2847.2	2770.09	49.99	461.01		1084.23	15.62	0			0.79				3.12	0.93	858.84											"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50-$125/Visit: 5. $50 Partial Hospitalization,7h. $125 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$50-$200/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"												182.210148	160.008323	49.537808	0	100	0.2	0.117811	65	101.754771	78.638281	82.858439	67.07266	0.2	0.2	15	33.829704	35	61.303245		0	0.2	0			0				0	0	132.220838										NO	119.863119	105.258115	30.471944	0	79.6783	0.159357	0.09387	51.790895	81.076472	62.657645	66.020196	53.442355	0.159357	0.159357	11.951745	26.954933	27.887405	48.845383		0	0.159357	0			0				0	0	105.351316											8.4381	0.464802293	0.84694229	0	0.150060798	1.81188909	0.4702887	1.599389156	1.822936909	10.29955926	4.542024434	1.03192734	0.0159357	0.43823175	2.835750697	6.222299196	0.116174281	1.876517501	0	0	2.48915634	0	0	0	0	0	0	0	0	0	7.539993686	0	0	0	0	0	0	0	0	0	53.0119	0	NO	16.194552	8.4381	0.464802293	0.84694229	0	0.150060798	1.81188909	0.4702887	1.599389156	1.822936909	10.29955926	4.542024434	1.03192734	0.0159357	0.43823175	2.835750697	6.222299196	0.116174281	1.876517501	0	0	2.48915634	0	0	0	0	0	0	0	0	0	7.539993686	0	0	0	0	0	0	0	0	0	53.0119	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/Visit	$0-$125/Visit	20% Coins; $100/Visit	$0-$125/Visit	$50-$125/Visit	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	$35-$125/Visit		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$50-$200/Visit										3400	3.094	0.1704	0.7057	2.4494	1.3126	2.0928	0.9219	0.5758	0.6563	3.8037	1.6426	0.3833	0.0061	0.1591	1.0692	2.3461	0.0438	0.6885		0	0.985	0			0				0		2.7147										25.821	0	NO	10.139708	11.5321	0.635225293	1.55259929	2.449448	1.462661798	3.90466209	1.3921597	2.175237156	2.479263909	14.10327726	6.184589434	1.41522734	0.0220147	0.59736375	3.904953697	8.568381196	0.159976281	2.565023501	0	0	3.47413534	0	0	0	0	0	0	0	0	0	10.25466969	0	0	0	0	0	0	0	0	0	78.8329
H8145_095_0	2012	7	r.	s.	t.								OP Facility - Other	OP Facility - Other	Professional								Radiology	Other	Therapy (PT/OT/ST)								D	D	D	V	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	729.94	21.72	339.26	425.44	0.76	9.62	5.04	231.63	220.46	1626	16.8	1.37	0.09	23.21	1507.59	2177.32	21.93	2.57		769.99	12.78	0			0.79				5.18	0.93	251.9	109.83	414.67									"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8a. $0 Lab -- FSL,8a. $100 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%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$200/Visit: 9a. $200 Observation	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"										182.210147	160.008323	49.537808	0	0.2	0.2	0.155365	65	104.822904	89.978208	0.244143	0.220422	0.2	0.235865	15	32.293962	35	0.25		0	0.2	0			0				0	0	12.189358	200	35								NO	133.155714	116.931042	34.173013	0	0.169055	0.169055	0.131326	54.94281	88.604075	76.05624	0.206368	0.186317	0.169055	0.199371	12.67911	27.297247	29.58459	0.211319		0	0.169055	0			0				0	0	10.303347	169.0548	29.58459									8.0996	0.211645186	0.966128033	0	0.1284818	1.6263091	0.66188304	1.06053359	1.627804531	10.30562052	3.4669824	0.25525429	0.01521495	4.62740091	1.592908287	4.952903487	0.054065838	0.54308983	0	0	2.1605229	0	0	0	0	0	0	0	0	0	0.216284426	1.547274057	1.022320161	0	0	0	0	0	0	0	45.1423	0	NO	10.06156	8.0996	0.211645186	0.966128033	0	0.1284818	1.6263091	0.66188304	1.06053359	1.627804531	10.30562052	3.4669824	0.25525429	0.01521495	4.62740091	1.592908287	4.952903487	0.054065838	0.54308983	0	0	2.1605229	0	0	0	0	0	0	0	0	0	0.216284426	1.547274057	1.022320161	0	0	0	0	0	0	0	45.1423	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"$50/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	25% Coins	20% Coins	40% Coins	40% Coins	$65/Visit	0%-25% Coins; $75-$125/Visit	30% Coins; $100/Visit	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						25% Coins; $0-$35/Visit	25% Coins	$35/Visit								3400	3.0443	0.0796	0.4461	1.3439	1.1299	1.8882	0.9888	0.3837	1.0904	3.8074	1.2666	0.0958	0.0059	1.6898	0.6035	1.8765	0.0205	0.1986		0	0.8592	0			0				0		0.3118	0.4708	0.3873								21.9885	0	NO	6.002271	11.1439	0.291196186	1.412190033	1.343938	1.2583518	3.5144761	1.65071404	1.44419859	2.718225531	14.11305952	4.7335974	0.35105229	0.02106695	6.31718091	2.196398287	6.829370487	0.074550838	0.74165683	0	0	3.0197329	0	0	0	0	0	0	0	0	0	0.528061426	2.018124057	1.409642161	0	0	0	0	0	0	0	67.1307
H8145_097_0	2012	3																															Coin	Coin	Coin	Coin	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	194.86	3.02	32.12	13.88	0.97	9.67	4.79	19.5	45.11	12.9	19.73	1.53	0.29	22.19	19.32	37.75	0.55	5.24		3.74	17.62	0			0.79				4.84	0.93												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											0	YES	0.0862	0.0862	0.1565	0	0.195	0.195	0.195	0.195	0.195	0.180032	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195		0	0.195	0			0				0	0											NO	0.062533	0.062533	0.082192	0	0.168859	0.168859	0.168859	0.168859	0.168859	0.155897	0.168859	0.168859	0.168859	0.168859	0.168859	0.168859	0.168859	0.168859		0	0.168859	0			0				0	0												12.1852	0.18884966	2.64000704	0	0.16379323	1.63286653	0.80883461	3.2927505	7.61722949	2.0110713	3.33158807	0.25835427	0.04896911	3.74698121	3.26235588	6.37442725	0.09287245	0.88482116	0	0	2.97529558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5162	0	NO	12.721459	12.1852	0.18884966	2.64000704	0	0.16379323	1.63286653	0.80883461	3.2927505	7.61722949	2.0110713	3.33158807	0.25835427	0.04896911	3.74698121	3.26235588	6.37442725	0.09287245	0.88482116	0	0	2.97529558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5162	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			"VIS776: Vision 17a,17b"																4500	4.8832	0.0753	1.051	0	1.5002	0.986	0.4882	1.2516	2.9506	0.7643	1.2963	0.1022	0.0188	1.4241	1.3496	2.6372	0.0386	0.3549		0	1.2306	0			0				0												22.4029	0	NO	5.468053	17.0684	0.26412866	3.69105304	0	1.66402223	2.61889053	1.29705261	4.5443435	10.56785849	2.7753623	4.62786007	0.36055627	0.06781411	5.17110321	4.61191088	9.01167525	0.13149445	1.23972316	0	0	4.20592258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9192
H8145_099_0	2012	8	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							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			V				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	1032.58	47.1	541.02	722.47	1.29	13.43	6.65	336.44	46.87	17.25	17.41	2.04	0.39	23.43	2312.64	3078.2	79.57	2.61		1153.9	23.6	0			0.61				3.06	0.93	279.7	90.99	0	490.37								"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$200/Visit: 9a. $200 Observation	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									182.210148	160.008323	49.537808	0	0.2	0.2	0.142676	65	0.241514	0.229599	0.243928	0.21473	0.2	0.235175	15	33.003416	35	0.25		0	0.2	0			0				0	0	14.909562	200	0	35							NO	128.967249	113.252931	31.746849	0	0.168125	0.168125	0.119937	54.640755	0.203023	0.193007	0.205053	0.180508	0.168125	0.197694	12.609405	27.743563	29.421945	0.210157		0	0.168125	0			0				0	0	12.53338	168.1254	0	29.421945								11.0974	0.444517754	1.431306687	0	0.21688125	2.25791875	0.79758105	1.531944634	9.51568801	3.32937075	3.56997273	0.36823632	0.06556875	4.63197042	2.430084532	7.116686302	0.195092014	0.54850977	0	0	3.96775	0	0	0	0	0	0	0	0	0	0.292132199	1.274810846	0	1.202303264	0	0	0	0	0	0	56.2857	0	NO	13.778237	11.0974	0.444517754	1.431306687	0	0.21688125	2.25791875	0.79758105	1.531944634	9.51568801	3.32937075	3.56997273	0.36823632	0.06556875	4.63197042	2.430084532	7.116686302	0.195092014	0.54850977	0	0	3.96775	0	0	0	0	0	0	0	0	0	0.292132199	1.274810846	0	1.202303264	0	0	0	0	0	0	56.2857	YES	30% Coins	30% Coins	"$50/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	25% Coins	20% Coins	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins							3400	2.633	0.0406	0.0971	1.0691	1.1971	0.7963	0.3943	0.1207	0.9405	0.3674	0.3493	0.0456	0.0052	0.4238	0.6153	1.2024	0.0176	0.0523		0.1192	0.4217	0			0				0		0.2046	0.1221	0.3143	0.1045							11.6542	0	NO	11.810782	13.7304	0.485134754	1.528450687	1.069073	1.41397625	3.05425475	1.19187805	1.652681634	10.45618401	3.69673575	3.91929773	0.41385132	0.07079375	5.05576642	3.045406532	8.319126302	0.212701014	0.60078377	0	0.119248	4.389422	0	0	0	0	0	0	0	0	0	0.496700199	1.396958846	0.314295	1.306812264	0	0	0	0	0	0	67.9399
H8145_103_0	2012	7	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			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	NO	1468	38.39	598.89	1047.3	2.12	17.99	5.05	429.45	58.86	17.12	21.02	1.88	0.42	27.23	3499.05	4480.83	92.03	2.74		1499.6	35.75	0			0.61				3.89	0.95	1136.12	366.33	0	701.5								"$0-$225/Day(Days 1-5): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"									141.569359	116.360647	37.847069	0	0.2	0.2	0.2	65	0.238276	0.22712	0.236334	0.211843	0.2	0.239579	20	38.502657	40	0.25		0	0.2	0			0				0	0	0	14.67887	0	40							NO	121.145714	99.573762	32.766819	0	0.182884	0.182884	0.182884	59.43717	0.217884	0.207683	0.216108	0.193713	0.182884	0.219076	18.28836	35.207522	36.57672	0.228605		0	0.182884	0			0				0	0	0	13.422623	0	36.57672								14.8202	0.31855306	1.635310019	0	0.38771408	3.29008316	0.9235642	2.127107721	12.82465224	3.55553296	4.54259016	0.36418044	0.07681128	5.96543948	5.332657172	13.14657673	0.280512962	0.6263777	0	0	6.538103	0	0	0	0	0	0	0	0	0	0	0.409759124	0	2.13821409	0	0	0	0	0	0	79.3039	0	NO	8.657723	14.8202	0.31855306	1.635310019	0	0.38771408	3.29008316	0.9235642	2.127107721	12.82465224	3.55553296	4.54259016	0.36418044	0.07681128	5.96543948	5.332657172	13.14657673	0.280512962	0.6263777	0	0	6.538103	0	0	0	0	0	0	0	0	0	0	0.409759124	0	2.13821409	0	0	0	0	0	0	79.3039	YES	$0-$1200/Admit	$0-$1200/Admit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"	$0/Visit	20% Coins	35% Coins	35% Coins	$65/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			"VIS775: Vision 17a,17b"						35% Coins	25% Coins; $0/Visit	$0/Visit	25% Coins							6700	2.6269	0.0492	0.666	0	2.5861	1.2268	0.3443	0.2025	1.2931	0.3417	0.4619	0.0463	0.0074	0.5733	1.0451	2.0356	0.0203	0.0601		0	0.7445	0			0				0		0.1511	0.1154	0	0.1614							14.7592	0	NO	3.902835	17.447	0.36777006	2.301315019	0	2.97380508	4.51686716	1.2678992	2.329605721	14.11778224	3.89726796	5.00447916	0.41048844	0.08420528	6.53875048	6.377804172	15.18217873	0.300775962	0.6865037	0	0	7.282648	0	0	0	0	0	0	0	0	0	0.151093	0.525139124	0	2.29966009	0	0	0	0	0	0	94.0631
H8145_104_0	2012	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			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	843.79	45.23	460.21	901.39	1.09	15.72	3.18	340.58	56.02	15.88	20.77	1.47	0.82	31.42	1986.74	3006.5	62.25	2.24		1008.93	10.82	0			0.61				4.84	0.93	1102.88	329.36	180.76	107.25	0	658.69						"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Radiology OP -- Physician"	$200/Visit: 9a. $200 Observation	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"							182.210148	160.008323	49.537808	0	0.2	0.2	0.2	65	0.24128	0.25	0.239706	0.216697	0.2	0.234533	15	32.18264	35	0.25		0	0.2	0			0				0	0	0	0	0	200	0	35					NO	134.248064	117.890292	33.826298	0	0.169086	0.169086	0.169086	54.953015	0.203985	0.211358	0.202655	0.183202	0.169086	0.198282	12.681465	27.208202	29.590085	0.211358		0	0.169086	0			0				0	0	0	0	0	169.0862	0	29.590085						9.4398	0.444348159	1.297266717	0	0.18430374	2.65803192	0.53769348	1.559658154	11.4272397	3.35636504	4.20914435	0.26930694	0.13865052	6.23002044	2.099564481	6.816788276	0.153498566	0.47344192	0	0	1.82951052	0	0	0	0	0	0	0	0	0	0	0	0	1.511207913	0	1.624224424	0	0	0	0	56.26	0	NO	12.375476	9.4398	0.444348159	1.297266717	0	0.18430374	2.65803192	0.53769348	1.559658154	11.4272397	3.35636504	4.20914435	0.26930694	0.13865052	6.23002044	2.099564481	6.816788276	0.153498566	0.47344192	0	0	1.82951052	0	0	0	0	0	0	0	0	0	0	0	0	1.511207913	0	1.624224424	0	0	0	0	56.26	YES	0%-20% Coins	20% Coins; $0/Day(Days 1-1)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	20% Coins	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins					3400	1.9435	0.0352	0.2272	2.1018	1.0589	0.9752	0.1969	0.1278	1.1755	0.3332	0.446	0.0342	0.0114	0.5913	0.5213	1.0527	0.0125	0.047		0.0868	0.213	0			0				0		0.1219	0.0528	0.1279	0.1573	0.3394	0.1308					12.1213	0	NO	8.283956	11.3832	0.479541159	1.524422717	2.10183	1.24318974	3.63324192	0.73459948	1.687457154	12.6026967	3.68953204	4.65512235	0.30350494	0.15009552	6.82127644	2.620837481	7.869499276	0.166031566	0.52044592	0	0.086755	2.04254752	0	0	0	0	0	0	0	0	0	0.121865	0.052799	0.127944	1.668460913	0.339413	1.755015424	0	0	0	0	68.3813
H8145_107_0	2012	5																															Coin	Coin	Coin	Coin	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	186.88	2.85	31.26	38.15	0.97	20.08	7.72	23.9	59.44	15.25	19.69	1.17	1.1	17.36	21.39	38.26	0.64	5.19		3.25	26.61	0			0.79				4.86	0.93												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											0	YES	0.083	0.083	0.1617	0	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195		0.195	0.195	0			0				0	0											NO	0.0687	0.0687	0.112098	0	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335	0.177335		0.177335	0.177335	0			0				0	0												12.8387	0.195795	3.50418348	0	0.17201495	3.5608868	1.3690262	4.2383065	10.5407924	2.70435875	3.49172615	0.20748195	0.1950685	3.0785356	3.79319565	6.7848371	0.1134944	0.92036865	0	0.57633875	4.71888435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.004	0	NO	8.891774	12.8387	0.195795	3.50418348	0	0.17201495	3.5608868	1.3690262	4.2383065	10.5407924	2.70435875	3.49172615	0.20748195	0.1950685	3.0785356	3.79319565	6.7848371	0.1134944	0.92036865	0	0.57633875	4.71888435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.004	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			"VIS776: Vision 17a,17b"																6700	5.1696	0.0786	1.4056	0	1.5704	2.1578	0.8292	1.6157	4.0962	1.0508	1.3693	0.0825	0.0747	1.1739	1.5742	2.8165	0.0468	0.3744		0.2391	1.9584	0			0				0												27.6838	0	NO	3.796291	18.0082	0.274413	4.90976148	0	1.74245695	5.7187028	2.1981832	5.8540245	14.6370264	3.75515075	4.86103815	0.29003095	0.2697755	4.2524836	5.36735165	9.6013141	0.1603324	1.29474765	0	0.81542075	6.67732135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6878
H8145_108_0	2012	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				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	1317.46	47.61	590.18	1090.72	1.11	14.58	4.56	397.29	36.53	10.41	10.58	1.41	0.37	20.93	2533.68	3029.07	198.94	3.97		1560.36	18.41	0			0.61				3.55	1.15	2178.66	335.2	229.08	0	0	317.79						"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit: 3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"							148.989465	124.806492	34.03605	0	0.2	0.2	0.2	65	0.243212	0.25	0.246599	0.21284	0.2	0.239248	15	34.289136	35	0.25		0	0.2	0			0				0	0	0	0	15.830481	0	0	15					NO	121.087463	101.433356	27.749387	0	0.181504	0.181504	0.181504	58.98867	0.220719	0.22688	0.223793	0.193156	0.181504	0.217122	13.61277	31.118008	31.76313	0.22688		0	0.181504	0			0				0	0	0	0	14.366446	0	0	13.61277						13.294	0.40243684	1.364761102	0	0.20146944	2.64632832	0.82765824	1.952967392	8.06286507	2.3618208	2.36772994	0.27234996	0.06715648	4.54436346	2.874200258	7.854885374	0.526579757	0.9007136	0	0	3.34148864	0	0	0	0	0	0	0	0	0	0	0	0.274255454	0	0	0.360500182	0	0	0	0	54.4985	0	NO	7.484014	13.294	0.40243684	1.364761102	0	0.20146944	2.64632832	0.82765824	1.952967392	8.06286507	2.3618208	2.36772994	0.27234996	0.06715648	4.54436346	2.874200258	7.854885374	0.526579757	0.9007136	0	0	3.34148864	0	0	0	0	0	0	0	0	0	0	0	0.274255454	0	0	0.360500182	0	0	0	0	54.4985	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$20-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins				"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					4500	1.5767	0.0477	0.1619	0	1.4382	0.604	0.1891	0.1992	0.8301	0.2432	0.2438	0.0313	0.0069	0.4678	0.3342	0.9133	0.0612	0.0927		0	0.4076				0						0.1666	0	0.0319	0	0	0.0419					8.0894	0	NO	1.041317	14.8707	0.45016384	1.526669102	0	1.63969344	3.25037632	1.01675924	2.152150392	8.89298007	2.6050518	2.61153494	0.30360996	0.07410548	5.01216846	3.208372258	8.768142374	0.587801757	0.9933696	0	0	3.74910164	0	0	0	0	0	0	0	0	0	0.166607	0	0.306141454	0	0	0.402414182	0	0	0	0	62.588
H8145_109_0	2012	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	NO	781.12	65.07	438.06	428.53	21.63	9.75	5.62	356.59	240.58	1455.8	759.99	243.26	0.12	5.57	2322.35	2547.66	84.1	629.45		989.36	9.24	0			0.79				4.93	0.93	1002.09	1056.5										"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-7): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50-$125/Visit: 5. $50 Partial Hospitalization,7h. $125 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$125/Visit: 7c, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$50-$200/Visit: 3. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $125 OP Other,3, 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF,9a. $200 Observation"											182.210148	160.008323	49.537808	0	100	0.2	0.2	65	100.552091	52.793948	75.415229	58.561367	0.2	0.2	15	32.830726	35	61.317359		0	0.2	0			0				0	0	0	139.543203									NO	125.082893	109.841873	30.340421	0	81.8765	0.163753	0.163753	53.219725	82.328533	43.225836	61.74735	47.947997	0.163753	0.163753	12.281475	26.88065	28.656775	50.204508		0	0.163753	0			0				0	0	0	114.253091										8.1421	0.595617556	1.107577069	0	0.147582391	1.59659175	0.92029186	1.581468478	1.650549872	5.244014337	3.910614044	0.971985813	0.01965036	0.91210421	2.376823622	5.706896398	0.200836231	2.63343563	0	0	1.51307772	0	0	0	0	0	0	0	0	0	0	10.05903255	0	0	0	0	0	0	0	0	49.2902	0	NO	13.422796	8.1421	0.595617556	1.107577069	0	0.147582391	1.59659175	0.92029186	1.581468478	1.650549872	5.244014337	3.910614044	0.971985813	0.01965036	0.91210421	2.376823622	5.706896398	0.200836231	2.63343563	0	0	1.51307772	0	0	0	0	0	0	0	0	0	0	10.05903255	0	0	0	0	0	0	0	0	49.2902	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"20% Coins(Days 1-7), 20% (Days 8-20), 20% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/Visit	$0-$125/Visit	20% Coins; $100/Visit	$0-$125/Visit	$50-$125/Visit	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	$35-$125/Visit		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						40% Coins	$50-$200/Visit									3400	2.929	0.2143	0.8261	2.3722	1.275	1.8225	1.0503	0.5624	0.587	2.0658	1.3976	0.36	0.0068	0.3275	0.8852	2.1253	0.0748	0.9544		0	0.5916	0			0				0		0.2867	3.5771									24.2916	0	NO	9.533759	11.071	0.809884556	1.933663069	2.372201	1.422559391	3.41911775	1.97062186	2.143856478	2.237504872	7.309840337	5.308180044	1.332028813	0.02643336	1.23962021	3.261981622	7.832211398	0.275632231	3.58779263	0	0	2.10472072	0	0	0	0	0	0	0	0	0	0.286719	13.63615855	0	0	0	0	0	0	0	0	73.5818
H8145_110_0	2012	5	r.	s.	t.	u.							OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional							Lab	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O			V				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	1321.73	61.01	856.57	669.12	1.3	8.49	4.51	287.59	41.41	16.45	15.94	1.86	0.12	30.99	2070.1	2415.14	110.83	2.86		1045.25	26.14	0			0.79				5.23	1.24	624.2	196.57	0	419.03								"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									182.210148	131.206824	42.474818	0	0.2	0.2	0.138342	65	0.245408	0.25	0.248113	0.206774	0.2	0.239212	15	33.777218	35	0.25		0	0.2	0			0				0	0	0	13.348443	0	35							NO	147.63887	106.31256	32.784316	0	0.182444	0.182444	0.126198	59.294235	0.223866	0.228055	0.226333	0.188623	0.182444	0.218213	13.683285	30.81222	31.927665	0.228055		0	0.182444	0			0				0	0	0	12.176703	0	31.927665								16.2616	0.540510774	2.340171796	0	0.2371772	1.54894956	0.56915298	1.421035754	9.27029106	3.75150475	3.60774802	0.35083878	0.02189328	6.76242087	2.36048069	6.201318751	0.294878593	0.6522373	0	0	4.76908616	0	0	0	0	0	0	0	0	0	0	0.199464542	0	1.114887455	0	0	0	0	0	0	62.2756	0	NO	8.776949	16.2616	0.540510774	2.340171796	0	0.2371772	1.54894956	0.56915298	1.421035754	9.27029106	3.75150475	3.60774802	0.35083878	0.02189328	6.76242087	2.36048069	6.201318751	0.294878593	0.6522373	0	0	4.76908616	0	0	0	0	0	0	0	0	0	0	0.199464542	0	1.114887455	0	0	0	0	0	0	62.2756	YES	$0-$250/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $137 (Days 21-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS776: Vision 17a,17b"						$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit							6700	6.478	0.2153	0.9324	0	2.1703	0.9388	0.4987	0.5366	3.5341	1.4304	1.3756	0.1396	0.0081	2.5779	0.9334	2.4521	0.1166	0.2486		0	1.9791	0							0	0	0	0.0789	0	0.4409							27.0852	0	NO	3.693451	22.7396	0.755820774	3.272523796	0	2.4074392	2.48775956	1.06783598	1.957593754	12.80439906	5.18187875	4.98339302	0.49041678	0.03003028	9.34027387	3.29385669	8.653430751	0.411481593	0.9008713	0	0	6.74813716	0	0	0	0	0	0	0	0	0	0	0.278335542	0	1.555738455	0	0	0	0	0	0	89.3608
H8145_111_0	2012	8	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	O			V				O	O	O	V	V								0	0	0	0	0	0.538244246	0.152647502	0	2.29568375	0.298283997	0.754319565	0.029114829	0.006468587	0.752253191	1.203562884	1.920404538	0.016056448	0.169669414		0	0.743297116	0			0				0	0	0	0	0								8.88	NO	261.97	5.29	19.29	1559.95	1.43	16.18	4.59	433.83	69	8.97	22.67	0.88	0.19	22.61	36.17	57.72	0.48	5.1		1570.32	22.34	0			0.61				3.47	1.15	2883.46	405.6	141.68									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0918	0.0918	0.171	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.075321	0.075321	0.136428	0	0.183503	0.183503	0.183503	59.63841	0.183503	0.183503	0.183503	0.183503	0.183503	0.183503	0.183503	0.183503	0.183503	0.183503		0	0.183503	0			0				0	0	0	0	0									19.7318	0.39844809	2.63169612	0	0.26240929	2.96907854	0.84227877	2.156077618	12.661707	1.64602191	4.16001301	0.16148264	0.03486557	4.14900283	6.63730351	10.59179316	0.08808144	0.9358653	0	0	4.09945702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1574	0	NO	9.691365	19.7318	0.39844809	2.63169612	0	0.26240929	3.507322786	0.994926272	2.156077618	14.95739075	1.944305907	4.914332575	0.190597469	0.041334157	4.901256021	7.840866394	12.5121977	0.104137888	1.105534714	0	0	4.842754136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0374	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.3701	0.0477	0.3159	0	1.8821	0.8429	0.239	0.2206	1.686	0.2107	0.5756	0.0234	0.0046	0.5314	1.0075	1.6076	0.0134	0.1348		0	0.6222	0			0						0	0	0								12.3354	0	NO	1.292875	22.102	0.44614009	2.94755312	0	2.14446129	4.350193786	1.233967272	2.376629618	16.64342875	2.155015907	5.489882575	0.213997469	0.045903157	5.432654021	8.848365394	14.1197627	0.117578888	1.240333714	0	0	5.464966136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3728
H8145_112_0	2012	6	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	O			V				O	O	O	V	V								0	0	0	0	0	0.594841357	0.340217339	0	2.059178949	0.377585011	0.726710006	0.033480181	0.019112043	1.199647797	0.911472347	1.758042111	0.019410847	0.281221769		0	0.651766715	0			0				0	0	0	0	0								8.9727	NO	302.04	7.29	23.88	3360.63	1.21	17.42	9.96	400.19	60.29	11.05	21.28	0.98	0.56	35.12	26.68	51.47	0.57	8.23		1641.21	19.08	0			0.61				3.47	1.28	2530.86	244.36	129.6									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0869	0.0869	0.207	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.069435	0.069435	0.149382	0	0.182311	0.182311	0.182311	59.251205	0.182311	0.182311	0.182311	0.182311	0.182311	0.182311	0.182311	0.182311	0.182311	0.182311		0	0.182311	0			0				0	0	0	0	0									20.9721	0.50618115	3.56724216	0	0.22059631	3.17585762	1.81581756	1.975978311	10.99153019	2.01453655	3.87957808	0.17866478	0.10209416	6.40276232	4.86405748	9.38354717	0.10391727	1.50041953	0	0	3.47849388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1334	0	NO	11.638396	20.9721	0.50618115	3.56724216	0	0.22059631	3.770698977	2.156034899	1.975978311	13.05070914	2.392121561	4.606288086	0.212144961	0.121206203	7.602410117	5.775529827	11.14158928	0.123328117	1.781641299	0	0	4.130260595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1061	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.5404	0.0611	0.4326	0	1.5914	0.9226	0.5277	0.2035	1.507	0.2642	0.5379	0.0254	0.0134	0.8393	0.7557	1.4576	0.0161	0.2182		0	0.5404	0							0	0	0	0	0								12.4547	0	NO	1.440696	23.5126	0.56729615	3.99988916	0	1.81201931	4.693302977	2.683714899	2.179523311	14.55774214	2.656303561	5.144181086	0.237546961	0.134578203	8.441757117	6.531233827	12.59918528	0.139422117	1.999868299	0	0	4.670641595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5608
H8145_113_0	2012	6	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	O			V				O	O	O	V	V								0	0	0	0	0	0.633898225	0.250412403	0	1.816896178	0.294977931	0.719389307	0.041798089	0.005135543	0.861643241	1.201402201	1.911623468	0.03783544	0.197196175		0	0.877286863	0			0				0	0	0	0	0								8.8495	NO	278.66	4.38	44.91	2123.79	1.9	19.26	7.61	420.97	55.2	8.96	21.86	1.27	0.16	26.18	36.5	58.08	1.15	5.99		1889.55	26.65	0			0.61				3.21	1.15	1713.55	343.67	136.94									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.088	0.088	0.2047	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.069473	0.069473	0.11863	0	0.18088	0.18088	0.18088	58.78587	0.18088	0.18088	0.18088	0.18088	0.18088	0.18088	0.18088	0.18088	0.18088	0.18088		0	0.18088	0			0				0	0	0	0	0									19.3593	0.30429174	5.3276733	0	0.343672	3.4837488	1.3764968	2.062257308	9.984576	1.6206848	3.9540368	0.2297176	0.0289408	4.7354384	6.60212	10.5055104	0.208012	1.0834712	0	0	4.820452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0304	0	NO	14.504233	19.3593	0.30429174	5.3276733	0	0.343672	4.117647025	1.626909203	2.062257308	11.80147218	1.915662731	4.673426107	0.271515689	0.034076343	5.597081641	7.803522201	12.41713387	0.24584744	1.280667375	0	0	5.697738863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8799	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.3225	0.0364	0.6369	0	2.4632	0.9973	0.394	0.2108	1.356	0.2094	0.5512	0.0338	0.0036	0.6115	1.0104	1.6077	0.0318	0.1567		0	0.7378	0			0						0	0	0								13.3711	0	NO	1.987182	21.6819	0.34065374	5.9646073	0	2.806844	5.114974025	2.020889203	2.273008308	13.15745718	2.125016731	5.224648107	0.305343689	0.037721343	6.208614641	8.813939201	14.02486887	0.27766844	1.437337375	0	0	6.435564863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.251
H8145_114_0	2012	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	O			V				O	O	O	V	V								0	0	0	0	0	0.516931657	0.193561875	0	1.90565015	0.322118995	0.730197444	0.05107969	0.015117644	0.902726223	1.195534283	2.234933079	0.023258143	0.194034223		0	0.619409419	0			0				0	0	0	0	0								8.9046	NO	247.81	5.11	37.47	1043.4	1.46	16.82	6.3	400.35	62.01	10.48	23.76	1.66	0.49	29.37	38.9	72.72	0.76	6.31		1937.35	20.16	0			0.61				3.99	0.81	2706.43	458.2	141.56									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0819	0.0819	0.181	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.067158	0.067158	0.121418	0	0.182099	0.182099	0.182099	59.182045	0.182099	0.182099	0.182099	0.182099	0.182099	0.182099	0.182099	0.182099	0.182099	0.182099		0	0.182099	0			0				0	0	0	0	0									16.6424	0.34317738	4.54953246	0	0.26586454	3.06290518	1.1472237	1.974460976	11.29195899	1.90839752	4.32667224	0.30228434	0.08922851	5.34824763	7.0836511	13.24223928	0.13839524	1.14904469	0	0	3.67111584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5368	0	NO	11.368512	16.6424	0.34317738	4.54953246	0	0.26586454	3.579836837	1.340785575	1.974460976	13.19760914	2.230516515	5.056869684	0.35336403	0.104346154	6.250973853	8.279185383	15.47717236	0.161653383	1.343078913	0	0	4.290525259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4414	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	1.9901	0.041	0.5418	0	1.8951	0.8463	0.3169	0.2012	1.4697	0.2379	0.5759	0.0428	0.0112	0.6667	1.0463	1.9559	0.0204	0.1619		0	0.5421	0			0				0		0	0	0								12.5629	0	NO	1.562754	18.6326	0.38413038	5.09130546	0	2.16098154	4.426120837	1.657671575	2.175615976	14.66729214	2.468404515	5.632813684	0.39613903	0.115510154	6.917647853	9.325443383	17.43304836	0.182007383	1.504983913	0	0	4.832594259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0043
H8145_115_0	2012	3	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	O			V				O	O	O	V	V								0	0	0	0	0	0.515636011	0.290404801	0	1.909559851	0.316433859	0.738337246	0.038405992	0.011477303	0.810834666	1.098179562	2.090043692	0.035061689	0.21404588		0	0.808765393	0			0				0	0	0	0	0								8.8772	NO	270.68	6.37	29.69	1056.48	1.44	16.2	9.12	395.79	59.99	9.94	23.2	1.21	0.36	25.47	34.5	65.66	1.1	6.72		1888.66	25.41	0			0.79				4.09	0.81	2380.46	363.92	241.25									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0805	0.0805	0.1892	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.065924	0.065924	0.134578	0	0.182658	0.182658	0.182658	59.36372	0.182658	0.182658	0.182658	0.182658	0.182658	0.182658	0.182658	0.182658	0.182658	0.182658		0	0.182658	0			0				0	0	0	0	0									17.8443	0.41993588	3.99562082	0	0.26302752	2.9590596	1.66584096	1.957963895	10.95765342	1.81562052	4.2376656	0.22101618	0.06575688	4.65229926	6.301701	11.99332428	0.2009238	1.22746176	0	0	4.64133978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4205	0	NO	10.707553	17.8443	0.41993588	3.99562082	0	0.26302752	3.474695611	1.956245761	1.957963895	12.86721327	2.132054379	4.976002846	0.259422172	0.077234183	5.463133926	7.399880562	14.08336797	0.235985489	1.44150764	0	0	5.450105173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2977	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/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	2.1364	0.0501	0.4768	0	1.8775	0.825	0.4646	0.1997	1.4392	0.2284	0.5731	0.0314	0.0083	0.5852	0.9392	1.7875	0.03	0.1738		0	0.6917	0							0		0	0	0								12.5178	0	NO	1.466803	19.9807	0.47006488	4.47243882	0	2.14056852	4.299657611	2.420861761	2.157675895	14.30643327	2.360429379	5.549078846	0.290779172	0.085517183	6.048324926	8.339080562	15.87084297	0.265971489	1.61530564	0	0	6.141788173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8155
H8145_117_0	2012	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	O			V				O	O	O	V	V								0	0	0	0	0	0.399380052	0.164024294	0	2.000030007	0.278780082	0.650942209	0.05334651	0.006824705	0.702770853	1.030503746	2.445304368	0.022853977	0.28955243		0	0.877971695	0			0				0	0	0	0	0								8.9223	NO	257.42	5.18	28.04	1200.58	1.31	13.33	5.47	348.88	66.76	9.3	21.73	1.78	0.23	23.46	34.4	81.62	0.76	9.66		1910.86	29.3	0			0.61				4.14	0.81	1472.89	512.79	180.07									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0821	0.0821	0.1817	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.0674	0.0674	0.132512	0	0.182114	0.182114	0.182114	59.18705	0.182114	0.182114	0.182114	0.182114	0.182114	0.182114	0.182114	0.182114	0.182114	0.182114		0	0.182114	0			0				0	0	0	0	0									17.3501	0.349132	3.71563648	0	0.23856934	2.42757962	0.99616358	1.720764834	12.15793064	1.6936602	3.95733722	0.32416292	0.04188622	4.27239444	6.2647216	14.86414468	0.13840664	1.75922124	0	0	5.3359402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6078	0	NO	10.758605	17.3501	0.349132	3.71563648	0	0.23856934	2.826959672	1.160187874	1.720764834	14.15796065	1.972440282	4.608279429	0.37750943	0.048710925	4.975165293	7.295225346	17.30944905	0.161260617	2.04877367	0	0	6.213911895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.53	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/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			"VIS775: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.0824	0.0418	0.4452	0	1.7063	0.6708	0.2755	0.1758	1.585	0.2112	0.5263	0.0463	0.0052	0.5325	0.9252	2.1955	0.0205	0.2468		0	0.7883	0			0				0		0	0	0								12.4806	0	NO	1.42908	19.4325	0.390911	4.16082548	0	1.94490534	3.497758672	1.435682874	1.896599834	15.74293965	2.183663282	5.134593429	0.42383243	0.053882925	5.507633293	8.220454346	19.50494505	0.181780617	2.29553167	0	0	7.002190895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0106
H8145_120_0	2012	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin			V				O	O											0	0	0	0	0	0.426776969	0.164506891	0	1.696767183	0.319334547	0.683949974	0.04598384	0.012247774	0.849840412	0.754382946	1.358609346	0.02129394	0.165467751		0	0.587662487	0			0				0	0											7.0868	NO	200.74	3.19	23.3	17.13	1.07	11.98	6.59	287.65	47.63	9.53	20.44	1.29	0.34	23.86	21.18	38.14	0.6	4.65		4.82	16.5	0			0.79				1.34	1.19												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins: 6. 0% Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins: 8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"0%-20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14a. 0% SMAM -- FSR,14a. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"0% Coins: 14a, 14b, 14d, 14e. 0% Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											162	YES	0.0834	0.0834	0.1801	0	0.2	0.2	0.140133	65	0.2	0.18816	0.187887	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0											NO	0.06985	0.06985	0.134066	0	0.185113	0.185113	0.129702	60.161595	0.185113	0.174154	0.173901	0.185113	0.185113	0.185113	0.185113	0.185113	0.185113	0.185113		0	0.185113	0			0				0	0												14.0217	0.2228215	3.1237378	0	0.19807091	2.21765374	0.85473618	1.442123567	8.81693219	1.65968762	3.55453644	0.23879577	0.06293842	4.41679618	3.92069334	7.06020982	0.1110678	0.86077545	0	0	3.0543645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8376	0	NO	6.929361	14.0217	0.2228215	3.1237378	0	0.19807091	2.644430709	1.019243071	1.442123567	10.51369937	1.979022167	4.238486414	0.28477961	0.075186194	5.266636592	4.675076286	8.418819166	0.13236174	1.026243201	0	0	3.642026987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9245	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins	20% Coins	20% Coins	0%-20% Coins	$65/Visit	20% Coins	0%-20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		0% Coins	20% Coins	20% Coins			"VIS776: Vision 17a,17b"																6700	5.6276	0.089	1.2471	0	1.8076	1.6172	0.6234	0.5429	4.1335	0.7614	1.6781	0.1138	0.0292	2.0264	1.9581	3.5265	0.0553	0.4138		0	1.5254	0							0	0											27.7763	0	NO	3.040163	19.6492	0.3118275	4.3708088	0	2.00563991	4.261675709	1.642632071	1.985068567	14.64719937	2.740452167	5.916621414	0.39859161	0.104390194	7.293020592	6.633198286	11.94530817	0.18763374	1.440007201	0	0	5.167398987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7007
H8145_121_0	2012	3	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	NO	271.4	4.19	44.7	801.03	1.36	14.2	5.01	373.03	63.45	18.21	25.85	2.14	0.41	31.16	27.36	53.47	0.78	7.4		1279.39	24.91	0			0.79				5.23	1.24	1089.16	178.01										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"15% Coins: 4b, 7a, 8a, 8b. 15% Physician Services PCP,4b, 7a, 8a, 8b. 15% PCP Cap"	"15% Coins: 7b. 15% Chiropractic,7f. 15% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Spec Cap"	"15% Coins: 7e, 7h. 15% Psych -- Other Provider"	Medicare FFS Cost Sharing		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"											0.0816	0.0816	0.1693	0	0.195	0.195	0.195	65	0.185088	0.179087	0.181987	0.195	0.195	0.195	0.15	0.15	0.15	0.166728		0	0.195	0			0				0	0	0	0									NO	0.060948	0.060948	0.089041	0	0.172088	0.172088	0.172088	57.362565	0.16334	0.158045	0.160603	0.172088	0.172088	0.172088	0.132375	0.132375	0.132375	0.147138		0	0.172088	0			0				0	0	0	0										16.5413	0.25537212	3.9801327	0	0.23403968	2.4436496	0.86216088	1.783163135	10.363923	2.87799945	4.15158755	0.36826832	0.07055608	5.36226208	3.62178	7.07809125	0.1032525	1.0888212	0	0	4.28671208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4731	0	NO	15.229693	16.5413	0.25537212	3.9801327	0	0.23403968	2.4436496	0.86216088	1.783163135	10.363923	2.87799945	4.15158755	0.36826832	0.07055608	5.36226208	3.62178	7.07809125	0.1032525	1.0888212	0	0	4.28671208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4731	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		$0/Visit	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit									5000	1.952	0.0301	0.4649	0	1.6571	0.5512	0.1947	0.1798	1.1565	0.2929	0.477	0.0417	0.0072	0.5457	0.5679	1.1097	0.0163	0.1446		0	0.5169	0							0	0	0	0									9.906	0	NO	2.230656	18.4933	0.28543912	4.4449977	0	1.89118568	2.9948356	1.05685188	1.962929135	11.52044	3.17085145	4.62856655	0.40998532	0.07777708	5.90794108	4.18965	8.18779625	0.1195035	1.2334292	0	0	4.80364008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3791
H8145_122_0	2012	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			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	1224.05	66.37	312.41	1076.1	1.24	13.89	5.47	330.94	37.1	7.49	12.19	1.12	0.21	22.56	2315.27	2531.93	67.92	1.75		1445.57	14.88	0			0.79				3.93	1.19	1697.5	171.87	289.38	0	219.8							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$40/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$40/Visit: 7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	128.006658	44.329117	0	0.2	0.2	0.2	65	0.241759	0.25	0.239204	0.222962	0.2	0.234015	15	38.770465	40	0.25		0	0.2	0			0				0	0	0	0	26.966387	0	40						NO	144.518885	101.527713	36.458836	0	0.180894	0.180894	0.180894	58.79042	0.218663	0.226117	0.216352	0.201662	0.180894	0.211659	13.56702	35.066645	36.17872	0.226117		0	0.180894	0			0				0	0	0	0	24.390234	0	36.17872							14.7415	0.561532859	0.949175413	0	0.22430856	2.51261766	0.98949018	1.6213418	8.1123973	1.69361633	2.63733088	0.22586144	0.03798774	4.77502704	2.617609533	7.39885754	0.204771555	0.39570475	0	0	2.69170272	0	0	0	0	0	0	0	0	0	0	0	0.588170493	0	0.662673555	0	0	0	0	0	53.6417	0	NO	8.145146	14.7415	0.561532859	0.949175413	0	0.22430856	2.51261766	0.98949018	1.6213418	8.1123973	1.69361633	2.63733088	0.22586144	0.03798774	4.77502704	2.617609533	7.39885754	0.204771555	0.39570475	0	0	2.69170272	0	0	0	0	0	0	0	0	0	0	0	0.588170493	0	0.662673555	0	0	0	0	0	53.6417	YES	$0-$250/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$40/Visit	$0/Visit	$40/Visit						5500	5.8492	0.2228	0.3765	0	2.0503	1.5173	0.5971	0.6102	3.0819	0.6432	1.0024	0.0881	0.0145	1.8145	1.0316	2.9159	0.0807	0.1501		0	1.1133	0							0	0	0.3334	0	0.2318	0	0.2612						23.9859	0	NO	3.594863	20.5907	0.784327859	1.325628413	0	2.27464856	4.02990766	1.58655818	2.2314948	11.1943193	2.33680933	3.63972788	0.31392644	0.05244074	6.58957504	3.649213533	10.31476254	0.285477555	0.54579075	0	0	3.80502072	0	0	0	0	0	0	0	0	0	0.333432	0	0.819973493	0	0.923837555	0	0	0	0	0	77.6276
H8145_123_0	2012	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			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	762.2	41.37	404.14	613.61	0.85	15.02	3.14	280.97	34.98	9.99	14.81	1.92	0.2	19.07	2209.81	2893.91	66.83	2.64		875.3	14.35	0			0.79				6.13	1.19	633.04	211.17	215	0	653.44							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c$0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210148	128.006658	44.329117	0	0.2	0.2	0.2	65	0.235805	0.25	0.239396	0.207418	0.2	0.237985	15	33.422543	35	0.25		0	0.2	0			0				0	0	0	0	10.941641	0	35						NO	152.572938	107.185863	36.89242	0	0.181892	0.181892	0.181892	59.114965	0.214455	0.227365	0.217722	0.188639	0.181892	0.216438	13.641915	30.396499	31.831135	0.227365		0	0.181892	0			0				0	0	0	0	9.950996	0	31.831135							9.6909	0.369523263	1.242475218	0	0.1546082	2.73201784	0.57114088	1.384127643	7.5016359	2.27137635	3.22446282	0.36218688	0.0363784	4.12747266	2.512170016	7.330394368	0.177272896	0.6002436	0	0	2.6101502	0	0	0	0	0	0	0	0	0	0	0	0.178288678	0	1.733311405	0	0	0	0	0	48.8102	0	NO	5.93873	9.6909	0.369523263	1.242475218	0	0.1546082	2.73201784	0.57114088	1.384127643	7.5016359	2.27137635	3.22446282	0.36218688	0.0363784	4.12747266	2.512170016	7.330394368	0.177272896	0.6002436	0	0	2.6101502	0	0	0	0	0	0	0	0	0	0	0	0.178288678	0	1.733311405	0	0	0	0	0	48.8102	YES	$0-$250/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	3.8491	0.1468	0.4933	0	1.4127	1.6514	0.3454	0.5213	2.8523	0.8638	1.2264	0.1439	0.0139	1.5693	0.9908	2.8912	0.0699	0.2279		0	1.08	0									0.1195	0	0.0703	0	0.6836						21.2229	0	NO	2.587651	13.54	0.516296263	1.735793218	0	1.5672592	4.38336784	0.91654288	1.905424643	10.3539539	3.13517435	4.45086582	0.50605488	0.0502794	5.69680766	3.502999016	10.22159637	0.247192896	0.8281536	0	0	3.6901992	0	0	0	0	0	0	0	0	0	0.119508	0	0.248607678	0	2.416946405	0	0	0	0	0	70.033
H8145_124_0	2012	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			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	959.96	38.71	438.64	698.43	0.81	8.8	4.5	253.18	36.53	6.61	10.28	1.27	0.2	21	2171.56	2997.52	139.45	2.34		1429.64	27.07	0			0.79				5.82	1.19	1175.42	183.29	338.74	0	363.79							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	128.006658	44.329117	0	0.2	0.2	0.2	65	0.240086	0.25	0.244603	0.212422	0.2	0.242832	15	31.482562	35	0.25		0	0.2	0			0				0	0	0	0	25.556752	0	35						NO	134.545868	105.023831	35.993381	0	0.181041	0.181041	0.181041	58.83839	0.217327	0.226302	0.221416	0.192285	0.181041	0.219813	13.57809	28.498204	31.68221	0.226302		0	0.181041	0			0				0	0	0	0	23.134125	0	31.68221							10.7632	0.338789375	1.315678053	0	0.14664321	1.5931608	0.8146845	1.241391965	7.93895531	1.49585622	2.27615648	0.24420195	0.0362082	4.616073	2.457136427	7.118661371	0.368173682	0.52954668	0	0	4.90077987	0	0	0	0	0	0	0	0	0	0	0	0.653037792	0	0.960472598	0	0	0	0	0	49.8088	0	NO	6.649968	10.7632	0.338789375	1.315678053	0	0.14664321	1.5931608	0.8146845	1.241391965	7.93895531	1.49585622	2.27615648	0.24420195	0.0362082	4.616073	2.457136427	7.118661371	0.368173682	0.52954668	0	0	4.90077987	0	0	0	0	0	0	0	0	0	0	0	0.653037792	0	0.960472598	0	0	0	0	0	49.8088	YES	$0-$225/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	4.2724	0.1345	0.5219	0	1.3401	0.9625	0.492	0.4673	3.0169	0.5684	0.8654	0.0962	0.0138	1.7541	0.9686	2.8062	0.1451	0.2017		0	2.0272	0							0	0	0.2133	0	0.2574	0	0.3786						21.5036	0	NO	2.882082	15.0357	0.473276375	1.837593053	0	1.48670621	2.5557098	1.3067235	1.708683965	10.95588831	2.06422422	3.14152948	0.34041395	0.0499882	6.370203	3.425742427	9.924840371	0.513306682	0.73120668	0	0	6.92796687	0	0	0	0	0	0	0	0	0	0.213254	0	0.910469792	0	1.339089598	0	0	0	0	0	71.3125
H8145_125_0	2012	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			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	878.04	35.2	341.06	721.75	1.06	9.74	3.86	272.59	35.46	9.39	13.5	1.12	0.33	29.35	2098.61	2320.77	41.22	2.51		1397.8	11.65	0			0.79				4.73	1.19	903.21	289.83	206.05	0	154.64							"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c$0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								182.210147	128.006658	44.329117	0	0.2	0.2	0.2	65	0.243368	0.25	0.247963	0.216905	0.2	0.234205	15	32.986272	35	0.25		0	0.2	0			0				0	0	0	0	9.878504	0	35						NO	150.858523	105.981448	37.207112	0	0.182371	0.182371	0.182371	59.270445	0.221916	0.227963	0.226106	0.197785	0.182371	0.213561	13.677795	30.078631	31.914855	0.227963		0	0.182371	0			0				0	0	0	0	9.007744	0	31.914855							11.0383	0.310878914	1.057488135	0	0.19331326	1.77629354	0.70395206	1.34637755	7.86914136	2.14057257	3.052431	0.2215192	0.06018243	6.26801535	2.39202978	5.817132039	0.109627527	0.57218713	0	0	2.12462215	0	0	0	0	0	0	0	0	0	0	0	0.154670471	0	0.411276098	0	0	0	0	0	47.62	0	NO	5.965194	11.0383	0.310878914	1.057488135	0	0.19331326	1.77629354	0.70395206	1.34637755	7.86914136	2.14057257	3.052431	0.2215192	0.06018243	6.26801535	2.39202978	5.817132039	0.109627527	0.57218713	0	0	2.12462215	0	0	0	0	0	0	0	0	0	0	0	0.154670471	0	0.411276098	0	0	0	0	0	47.62	YES	$0-$250/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100)"	$0/Visit	20% Coins	20% Coins	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	4.3847	0.1235	0.4199	0	1.775	1.0732	0.4259	0.5071	2.9922	0.8137	1.161	0.0872	0.0227	2.3838	0.9435	2.2946	0.0432	0.2176		0	0.8796	0			0				0	0	0.1665	0	0.061	0	0.1622						20.9382	0	NO	2.608612	15.4231	0.434352914	1.477393135	0	1.96832326	2.84953054	1.12985106	1.85350655	10.86130736	2.95430957	4.213459	0.3086742	0.08292843	8.65178935	3.33555578	8.111682039	0.152868527	0.78977013	0	0	3.00418815	0	0	0	0	0	0	0	0	0	0.16649	0	0.215678471	0	0.573505098	0	0	0	0	0	68.5582
H8145_126_0	2012	2	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery							Prosthetics/Supplies	Radiology	Renal Dialysis								D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	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	NO	1266.57	52.92	228.45	2082.27	24.29	12.26	4.33	252.78	39.09	1134.62	11.14	151.17	0.48	497.2	2411.22	3602.77	87.71	493.95		1201.92	23.07	0			0.61				3.7	1.43	1064.87	710.3	0	114.59								"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"$0-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"20% Coins: 8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$35-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b. $50 Radiology OP -- Facility"	$0/Proc: 12. $0 Dialysis -- Dialysis Center	"$0-$75/Visit: 9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility"									163.989133	128.006658	45.597948	0	100	0.2	0.2	65	0.2	18.851424	0.2	35.932537	0.2	50	10	34.440484	35	40.145539		0	0.2	0			0				0	0	0	37.278621	0	75							NO	128.232778	100.095958	37.324519	0	89.5163	0.179033	0.179033	58.185595	0.179033	16.875097	0.179033	32.165477	0.179033	44.75815	8.95163	30.829847	31.330705	35.936801		0	0.179033	0			0				0	0	0	33.370443	0	67.137225								13.5346	0.441423175	0.71056553	0	0.181195911	2.19494458	0.77521289	1.225679559	6.99839997	1.595568547	1.99442762	0.405204597	0.08593584	1.854479348	1.798695774	9.256070656	0.229001345	1.479248571	0	0	4.13029131	0	0	0	0	0	0	0	0	0	0	1.975252139	0	0.641104551	0	0	0	0	0	0	51.5074	0	NO	8.366715	13.5346	0.441423175	0.71056553	0	0.181195911	2.19494458	0.77521289	1.225679559	6.99839997	1.595568547	1.99442762	0.405204597	0.08593584	1.854479348	1.798695774	9.256070656	0.229001345	1.479248571	0	0	4.13029131	0	0	0	0	0	0	0	0	0	0	1.975252139	0	0.641104551	0	0	0	0	0	0	51.5074	YES	$0-$225/Day(Days 1-7)	$0-$200/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100)"	$0/Visit	$100/Trip	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20% Coins	$0-$50/Visit	20% Coins	$35-$50/Visit	20% Coins	$35-$50/Visit	$10/Visit	$20-$35/Visit	$35/Visit	$35-$50/Visit		$0/Visit	20% Coins	0% Coins			"VIS775: Vision 17a,17b"						20% Coins	$0-$50/Visit	$0/Proc	$0-$75/Visit							5000	5.3875	0.1757	0.2829	0	1.661	1.3286	0.469	0.4625	2.7176	0.6021	0.7824	0.1606	0.033	0.6998	0.7108	3.6578	0.0905	0.5733		0	1.7128	0							0	0	0.1979	0.7535	0	0.2419							22.7012	0	NO	3.586557	18.9221	0.617122175	0.99341853	0	1.842215911	3.52355158	1.24422489	1.688184559	9.71603497	2.197658547	2.77679462	0.565801597	0.11894084	2.554275348	2.509496774	12.91385466	0.319498345	2.052550571	0	0	5.84312431	0	0	0	0	0	0	0	0	0	0.197892	2.728746139	0	0.883016551	0	0	0	0	0	0	74.2086
H8145_127_0	2012	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0	0	0	0						0	NO	745.88	34.48	295.42	309.44	0.54	5.8	1.68	231.25	49.31	10.3	13.33	0.22	0.33	20.63	1940.41	2613.77	66.32	2.15		1267.61	14.32	0			0.79				5.09	0.95	628.55	179.37	223.82	59.04	284.58							"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $50 (Days 21-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								163.989133	131.206824	15.501759	0	0.2	0.2	0.2	65	0.244834	0.25	0.248769	0.25	0.2	0.240385	15	31.100806	35	0.25		0	0.2	0			0				0	0	0	0	17.572195	35	35						NO	147.919018	118.349212	14.487943	0	0.188366	0.188366	0.188366	61.21908	0.230592	0.235458	0.234298	0.235458	0.188366	0.226402	14.12748	29.291734	32.96412	0.235458		0	0.188366	0			0				0	0	0	0	16.550056	32.96412	32.96412							9.1942	0.340056736	0.35666901	0	0.10171764	1.0925228	0.31645488	1.179742688	11.37049152	2.4252174	3.12319234	0.05180076	0.06216078	4.67067326	2.284425289	6.380154631	0.182181703	0.5062347	0	0	2.69740112	0	0	0	0	0	0	0	0	0	0	0	0.308686128	0.16218347	0.781744106	0	0	0	0	0	47.5879	0	NO	3.389011	9.1942	0.340056736	0.35666901	0	0.10171764	1.0925228	0.31645488	1.179742688	11.37049152	2.4252174	3.12319234	0.05180076	0.06216078	4.67067326	2.284425289	6.380154631	0.182181703	0.5062347	0	0	2.69740112	0	0	0	0	0	0	0	0	0	0	0	0.308686128	0.16218347	0.781744106	0	0	0	0	0	47.5879	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $50 (Days 21-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0-$35/Visit	$35/Visit	$35/Visit						6000	3.6595	0.1353	0.142	0	0.937	0.6619	0.1919	0.4451	4.396	0.9239	1.2055	0.0194	0.0236	1.7788	0.9026	2.5208	0.072	0.1929		0	1.1184	0			0				0		0	0	0.122	0.0646	0.3089						19.822	0	NO	1.405265	12.8536	0.475396736	0.49863501	0	1.03869064	1.7544148	0.50837188	1.624843688	15.76646952	3.3491624	4.32872534	0.07123676	0.08572078	6.44947426	3.187016289	8.900988631	0.254157703	0.6991257	0	0	3.81582512	0	0	0	0	0	0	0	0	0	0	0	0.430648128	0.22673747	1.090620106	0	0	0	0	0	67.4099
H8145_131_0	2012	2	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	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	NO	792.39	69.82	255.73	1099.8	1.38	13.74	4.77	284.94	39.93	8.51	12.86	1.69	0.33	15.76	2621.36	2564.27	87.35	0.98		989.75	15.21	0			0.61				3.7	1.43	1242.34	343.3	233.38	336.96								"$0-$175/Day(Days 1-7): 1a. $175 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$175/Day(Days 1-7): 1b. $175 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"									127.547103	112.005826	31.003517	0	0.2	0.2	0.2	65	0.239068	0.25	0.239576	0.215084	0.2	0.238994	15	33.576012	35	0.25		0	0.2	0			0				0	0	0	0	18.222731	35							NO	111.866335	98.235718	27.966567	0	0.184181	0.184181	0.184181	59.858825	0.220159	0.230226	0.220627	0.198072	0.184181	0.220091	13.813575	30.920317	32.231675	0.230226		0	0.184181	0			0				0	0	0	0	16.781404	32.231675								7.3868	0.571568153	0.595990848	0	0.25416978	2.53064694	0.87854337	1.4213478	8.79094887	1.95922326	2.83726322	0.33474168	0.06077973	3.46863416	3.017529414	6.607336773	0.234619734	0.22562148	0	0	2.80139301	0	0	0	0	0	0	0	0	0	0	0	0.326370339	0.905065434	0	0	0	0	0	0	45.2086	0	NO	4.328389	7.3868	0.571568153	0.595990848	0	0.25416978	2.53064694	0.87854337	1.4213478	8.79094887	1.95922326	2.83726322	0.33474168	0.06077973	3.46863416	3.017529414	6.607336773	0.234619734	0.22562148	0	0	2.80139301	0	0	0	0	0	0	0	0	0	0	0	0.326370339	0.905065434	0	0	0	0	0	0	45.2086	YES	$0-$175/Day(Days 1-7)	$0-$175/Day(Days 1-7)	"$0/Day(Days 1-20), $100 (Days 21-100)"	$0/Visit	20% Coins	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins			"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$35/Visit							5000	2.9349	0.2271	0.2368	0	2.3215	1.5291	0.5308	0.5354	3.4142	0.7447	1.0958	0.1317	0.023	1.3191	1.1903	2.6064	0.0925	0.086		0	1.16	0							0	0	0.2318	0	0.1287	0.357							20.8968	0	NO	2.011473	10.3218	0.798662153	0.832764848	0	2.57566178	4.05978094	1.40937137	1.9567308	12.20514987	2.70389826	3.93304422	0.46639368	0.08375373	4.78771716	4.207845414	9.213717773	0.327168734	0.31161548	0	0	3.96136801	0	0	0	0	0	0	0	0	0	0.231786	0	0.455110339	1.262085434	0	0	0	0	0	0	66.1054
H8145_135_0	2012	2	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		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	NO	321.88	5.71	53.2	1430.3	1.91	18.76	6.99	468.35	70.12	15.34	27.35	1.84	0.5	33.47	35.84	64.64	1.26	6.67		1762.85	23.73	0		3.23	0.79				4.33	1.09	2346.72	588.93	180.15									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0886	0.0886	0.1854	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0		0	0				0	0	0	0	0								NO	0.067188	0.067188	0.10042	0	0.17777	0.17777	0.17777	57.775185	0.17777	0.17777	0.17777	0.17777	0.17777	0.17777	0.17777	0.17777	0.17777	0.17777		0	0.17777	0		0	0				0	0	0	0	0									21.6265	0.38364348	5.342344	0	0.3395407	3.3349652	1.2426123	2.254917325	12.4652324	2.7269918	4.8620095	0.3270968	0.088885	5.9499619	6.3712768	11.4910528	0.2239902	1.1857259	0	0	4.2184821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4352	0	NO	18.674091	21.6265	0.38364348	5.342344	0	0.3395407	3.3349652	1.2426123	2.254917325	12.4652324	2.7269918	4.8620095	0.3270968	0.088885	5.9499619	6.3712768	11.4910528	0.2239902	1.1857259	0	0	4.2184821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4352	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$65/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	20% Coins		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.5888	0.0458	0.6367	0	2.4294	0.7617	0.2837	0.2301	1.3419	0.281	0.5315	0.0378	0.0092	0.6128	0.7776	1.4026	0.0273	0.1359		0	0.5148	0		0					0	0	0	0	0								12.6486	0	NO	2.53869	24.2153	0.42946348	5.979018	0	2.7689537	4.0966162	1.5262993	2.484986325	13.8071444	3.0079668	5.3934895	0.3648598	0.098075	6.5627749	7.1488928	12.8936828	0.2512962	1.3216689	0	0	4.7333261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0838
H8145_138_0	2012	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	859.06	86.25	449.45	281.91	12.71	6.38	2.77	260.67	42.51	12.3	16.87	0.79	0.13	28.34	1388.4	2492.91	88.16	2.36		1333.26	17.16	0			0.79				4.67	0.95	723.81	85.61	199.31	139.42	214.39							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$125/Trip: 10a. $125 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.206824	31.003517	0	125	0.2	0.2	65	0.240714	0.25	0.248655	0.25	0.2	0.240656	15	29.97667	35	0.25		0	0.2	0			0				0	0	0	0	15.145685	35	35						NO	155.577004	109.832052	26.55166	0	114.4965	0.183194	0.183194	59.53818	0.220487	0.228993	0.227761	0.228993	0.183194	0.220434	13.73958	27.45779	32.05902	0.228993		0	0.183194	0			0				0	0	0	0	13.873024	32.05902	32.05902							11.1375	0.789417874	0.994470299	0	0.121270876	1.16877772	0.50744738	1.293318115	9.37290237	2.8166139	3.84232807	0.18090447	0.02381522	6.24709956	1.589669406	5.704149939	0.235526934	0.54042348	0	0	3.14360904	0	0	0	0	0	0	0	0	0	0	0	0.230419368	0.372472381	0.572761108	0	0	0	0	0	50.8849	0	NO	5.970552	11.1375	0.789417874	0.994470299	0	0.121270876	1.16877772	0.50744738	1.293318115	9.37290237	2.8166139	3.84232807	0.18090447	0.02381522	6.24709956	1.589669406	5.704149939	0.235526934	0.54042348	0	0	3.14360904	0	0	0	0	0	0	0	0	0	0	0	0.230419368	0.372472381	0.572761108	0	0	0	0	0	50.8849	YES	$0-$255/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $100 (Days 21-100)"	$0/Visit	$125/Trip	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$35/Visit	$35/Visit						5400	5.4443	0.3859	0.479	0	1.6681	1.0611	0.4602	0.7322	5.4713	1.61	2.2293	0.1036	0.0138	3.5699	0.9425	3.3818	0.1396	0.3093		0	1.9556	0			0				0		0.2088	0	0.1366	0.2225	0.3396						30.865	500	NO	2.872162	16.5818	1.175320874	1.473450299	0	1.789348876	2.22987072	0.96765338	2.025503115	14.84424137	4.4265729	6.07160307	0.28452947	0.03757422	9.81703056	2.532129406	9.085931939	0.375165934	0.84973448	0	0	5.09922804	0	0	0	0	0	0	0	0	0	0.20884	0	0.367025368	0.594947381	0.912324108	0	0	0	0	0	81.7499
H8145_139_0	2012	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Lab	Radiology	Mental Health	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	847.36	45.36	372.1	176.89	12.64	6.75	1.89	219.91	38.91	11.55	17.48	0.32	0.09	23.82	1474.47	2140.31	57.65	2.08		1070.3	12.26	0			0.79				3.77	0.95	488.35	199.14	158.56	81.44	224.84							"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $100 (Days 21-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. 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 -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins: 7h. 25% Psych -- OP	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 25% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"								185.85435	131.206824	31.003517	0	150	0.2	0.2	65	0.241252	0.25	0.249	0.25	0.2	0.235971	15	30.481159	35	0.25		0	0.2	0			0				0	0	0	0	19.806756	35	35						NO	158.874432	112.159923	27.347117	0	139.15305	0.185537	0.185537	60.299655	0.223806	0.231922	0.230994	0.231922	0.185537	0.218907	13.915305	28.276975	32.469045	0.231922		0	0.185537	0			0				0	0	0	0	18.37447	32.469045	32.469045							11.2187	0.423964509	0.84798852	0	0.146574546	1.25237475	0.35066493	1.105041428	8.70829146	2.6786991	4.03777512	0.07421504	0.01669833	5.21436474	1.709808314	5.043457697	0.155986704	0.48239776	0	0	2.27468362	0	0	0	0	0	0	0	0	0	0	0	0.242787997	0.220356585	0.608361673	0	0	0	0	0	46.8131	0	NO	4.765865	11.2187	0.423964509	0.84798852	0	0.146574546	1.25237475	0.35066493	1.105041428	8.70829146	2.6786991	4.03777512	0.07421504	0.01669833	5.21436474	1.709808314	5.043457697	0.155986704	0.48239776	0	0	2.27468362	0	0	0	0	0	0	0	0	0	0	0	0.242787997	0.220356585	0.608361673	0	0	0	0	0	46.8131	YES	$0-$255/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-20), $100 (Days 21-100)"	$0/Visit	$150/Trip	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/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			"VIS776: Vision 17a,17b"						20% Coins	$0/Visit	$0-$35/Visit	$35/Visit	$35/Visit						5400	5.5791	0.2108	0.4178	0	2.0722	1.1683	0.3279	0.643	5.2258	1.5735	2.4029	0.0435	0.0099	3.0631	1.0418	3.0731	0.095	0.2833		0	1.4543	0			0				0		0.1518	0	0.1479	0.1353	0.3707						29.491	500	NO	2.322774	16.7978	0.634800509	1.26574852	0	2.218764546	2.42066375	0.67857293	1.747994428	13.93411246	4.2521781	6.44066312	0.11769204	0.02659933	8.27748974	2.751638314	8.116569697	0.251031704	0.76564776	0	0	3.72901262	0	0	0	0	0	0	0	0	0	0.151811	0	0.390723997	0.355620585	0.979049673	0	0	0	0	0	76.3041
H8145_140_0	2012	4																															Coin	Coin	Coin	Coin	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	229.46	3.54	37.79	16.6	1.15	12	5.94	23.13	53.62	15.38	23.47	1.81	0.35	26.32	23.14	45.21	0.66	6.25		4.48	21.04	0			0.79				4.71	0.95												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											162	YES	0.0704	0.0704	0.1467	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0			0				0	0											NO	0.060543	0.060543	0.110004	0	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907	0.206907		0.206907	0.206907	0			0				0	0												13.8922	0.21432222	4.15705116	0	0.23794305	2.482884	1.22902758	4.78575891	11.09435334	3.18222966	4.85610729	0.37450167	0.07241745	5.44579224	4.78782798	9.35426547	0.13655862	1.29316875	0	0.92694336	4.35332328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8767	0	NO	8.195367	13.8922	0.21432222	4.15705116	0	0.23794305	2.482884	1.22902758	4.78575891	11.09435334	3.18222966	4.85610729	0.37450167	0.07241745	5.44579224	4.78782798	9.35426547	0.13655862	1.29316875	0	0.92694336	4.35332328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8767	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			"VIS776: Vision 17a,17b"																6700	1.6655	0.0257	0.4973	0	1.7067	0.5677	0.2811	0.4935	1.1903	0.3483	0.5255	0.0429	0.0074	0.5615	0.5848	1.1429	0.0167	0.1489		0.1133	0.5319	0			0				0												10.452	0	NO	1.097472	15.5577	0.23997622	4.65437116	0	1.94462005	3.050545	1.51009858	5.27925491	12.28469734	3.53050266	5.38162429	0.41744967	0.07984845	6.00731424	5.37266998	10.49713647	0.15329562	1.44205775	0	1.04028336	4.88526028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3287
H8145_150_0	2012	3	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	O			V				O	O	O	V	V								0	0	0	0	0	0.519809449	0.171567923	0	2.039324619	0.334062557	0.74031667	0.032519812	0.013952628	0.847860177	1.193433712	2.075887632	0.019773001	0.192841098		0	0.686531229	0			0				0	0	0	0	0								8.8679	NO	297.18	4.63	32.36	1198.61	1.54	15.36	5.07	358.73	60.27	9.87	21.88	0.96	0.41	25.06	35.27	61.35	0.58	5.7		1632.79	20.29	0			0.79				4.09	0.81	2256.86	443.26	249.61									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"20% Coins: 4b, 7a, 8a, 8b. 20% Physician Services PCP,4b, 7a, 8a, 8b. 20% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"								162	YES	0.0807	0.0807	0.1883	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0			0				0	0	0	0	0								NO	0.065345	0.065345	0.129958	0	0.18292	0.18292	0.18292	59.44887	0.18292	0.18292	0.18292	0.18292	0.18292	0.18292	0.18292	0.18292	0.18292	0.18292		0	0.18292	0			0				0	0	0	0	0									19.4192	0.30254735	4.20544088	0	0.2816968	2.8096512	0.9274044	1.777174428	11.0245884	1.8054204	4.0022896	0.1756032	0.0749972	4.5839752	6.4515884	11.222142	0.1060936	1.042644	0	0	3.7114468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9239	0	NO	11.190822	19.4192	0.30254735	4.20544088	0	0.2816968	3.329460649	1.098972323	1.777174428	13.06391302	2.139482957	4.74260627	0.208123012	0.088949828	5.431835377	7.645022112	13.29802963	0.125866601	1.235485098	0	0	4.397978029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7918	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/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			"VIS776: Vision 17a,17b"						$0/Service	$0/Visit	$0/Visit								6700	2.325	0.0361	0.5018	0	2.0126	0.7971	0.2631	0.1813	1.4717	0.2311	0.5478	0.0254	0.0097	0.5865	0.9783	1.7017	0.0162	0.15		0	0.5628	0			0				0		0	0	0								12.3983	0	NO	1.525352	21.7443	0.33865835	4.70724888	0	2.2942998	4.126600649	1.362075323	1.958447428	14.53562902	2.370578957	5.29042727	0.233484012	0.098601828	6.018364377	8.623346112	14.99975063	0.142075601	1.385514098	0	0	4.960766029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1901
H8189_001_0	2012	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	353.9305396	23.70129876	60.39305163	0	18.0622477	22.55496372	18.01212885	29.5914117	43.37818372	9.299729145	25.51965995	0	7.204037324	62.76032687	42.84937603	53.68833962	7.855534569	5.330183991	15.10243361	75.1425521	46.98029929	46.66557505	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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	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 14c	No Cost-Sharing; PBP 13a-e											0	YES	0.077883354	0.077883354	0.162031592	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.077564919	0.077564919	0.161369107	0	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0.22308415	0	0	0	0	0	0	0	0												27.4526	1.838389319	9.745572812	0	4.029401183	5.031654918	4.018220461	6.601374939	9.67698526	2.074622175	5.693031657	0	1.607106546	14.0008342	9.559016647	11.97701763	1.752445255	1.189079567	3.369113571	16.76311239	10.48056015	10.41035016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.2705	0	NO	0.645658198	27.4526	1.838389319	9.745572812	0	4.029401183	5.031654918	4.018220461	6.601374939	9.67698526	2.074622175	5.693031657	0	1.607106546	14.0008342	9.559016647	11.97701763	1.752445255	1.189079567	3.369113571	16.76311239	10.48056015	10.41035016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.2705	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	YES	0	27.4526	1.838389319	9.745572812	0	4.029401183	5.031654918	4.018220461	6.601374939	9.67698526	2.074622175	5.693031657	0	1.607106546	14.0008342	9.559016647	11.97701763	1.752445255	1.189079567	3.369113571	16.76311239	10.48056015	10.41035016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.2705
H8393_001_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	V	COIN	COIN	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	1058.476794	60.35127172	889.4636069	0	130.4289967	8.535892431	7.285906438	346.4017403	57.50737896	11.19039264	23.78662879	1.005300633	0.029459511	16.09208128	4036.868014	122.6986896	368.8560504	904.0161545	8.422074117	0	36.92370157	0	0	0	0	0	0	0	0	0											4500	1a $225 days 1-7	1b $200 days 1-7	"2 $50 days 1-22, $100 Days 21 to 55"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $40"	"9a 20%, 9b 20%"	"8a $0, 8a 20%,14a $0"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	9a 20%	12 20%	"3 20%, 9a 20%, 9d $0"	"7a $15, 14a $0"	"7d $40, 17a $40, 17b 20%, 18a 20%, 7b $15 , 7f$40, 14a $0, 8a $0"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b MRI;CT;PET $300, 8b 20%,14a $0"	14a $0	"15 20%, 11c 20%"	0	0	0	17a $0	0	0	0	14c $0	0												NO	188.2820647	152.0710059	58.43344546	0	150	0.2	0.2	63.11816516	0.2	0.078857178	0.480431619	0.2	0.2	0.198342184	14.33258943	0.1091393	40	40	0.400501864	0	0.214966607	0	0	0	0	0	0	0	0	0											NO	159.7733245	129.0451654	49.58574179	0	127.2877409	0.169716988	0.169716988	53.56112437	0.169716988	0.066917014	0.407687037	0.169716988	0.169716988	0.16831019	12.16241953	0.092613966	33.94339759	33.94339759	0.33985985	0	0.182417425	0	0	0	0	0	0	0	0	0												14.093	0.64900332	3.675392728	0	1.383501029	1.448685953	1.236542095	1.546138891	9.759979141	0.748827658	9.697500206	0.170616595	0.00499978	2.708461265	4.091506866	11.36361231	1.043352298	2.55711498	2.862324844	0	6.735526562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7761	0	NO	13.52091543	14.093	0.64900332	3.675392728	0	1.383501029	1.448685953	1.236542095	1.546138891	9.759979141	0.748827658	9.697500206	0.170616595	0.00499978	2.708461265	4.091506866	11.36361231	1.043352298	2.55711498	2.862324844	0	6.735526562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7761	YES	0.2	0.2	0.2	0.2	150	0.2	0.2	"$65 ER,$40 UC"	0.2	"20%, 14a $0"	0.2	0.2	0.2	0.2	0.2	"20%, 17a $0 Glaucoma Scrn"	0.2	0.2	0.2	"20%, $14a $0"	"20%, $14a $0"	0	0	0	17a $0	0	0	0	14c $50	0											10000	4.4628	0.0182	0.7267	0.3291	0.1812	0.1897	0.1619	0.2024	1.2779	0.2469	0.4917	0.0223	0.0007	0.3474	0.7302	2.7266	0	0.1552	0.1872	0.2395	0.8819	0	0	0	0.0034	0	0	0	0	0											13.5828	0	NO	0	18.5559	0.667177332	4.402095781	0.329075563	1.564652414	1.638372451	1.398451127	1.748585579	11.0379209	0.995756191	10.18917409	0.192956609	0.005654435	3.055846499	4.821668886	14.09024985	1.043352298	2.712273125	3.049482047	0.239538316	7.617455766	0	0	0	0.003354102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3589
H8393_801_0	2012	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	207.0658836	4.608446979	26.23074911	0	5.719948826	8.118309008	5.752045321	15.81704511	51.58045098	11.1218721	22.19348775	1.103675549	0.054225847	15.12292336	32.04411329	113.3390055	3.526281606	5.707162992	10.59668992	7.532173117	25.39111474	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.074165353	0.074165353	0.148367006	0	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0	0	0	0	0	0	0	0	0												15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	0	NO	9.214279873	15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.8862	0.0309	0.478	0	0.1424	0.2021	0.1432	0.3937	1.2838	0.2768	0.5524	0.0275	0.0013	0.3764	0.7975	2.8209	0.0483	0.142	0.2637	0.1875	0.632	0	0	0	0	0	0	0	0	0											10.6864	0	NO	0	17.2433	0.372640024	4.369776195	0	1.301458481	1.847156754	1.308761388	3.598848194	11.7360867	2.530556691	5.049678541	0.251119013	0.012337993	3.440914849	7.290988831	25.78799467	0.762851361	1.298549323	2.411062123	1.713793406	5.777233787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1051
H8393_802_0	2012	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	207.0658836	4.608446979	26.23074911	0	5.719948826	8.118309008	5.752045321	15.81704511	51.58045098	11.1218721	22.19348775	1.103675549	0.054225847	15.12292336	32.04411329	113.3390055	3.526281606	5.707162992	10.59668992	7.532173117	25.39111474	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.074165353	0.074165353	0.148367006	0	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0	0	0	0	0	0	0	0	0												15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	0	NO	9.214279873	15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.8862	0.0309	0.478	0	0.1424	0.2021	0.1432	0.3937	1.2838	0.2768	0.5524	0.0275	0.0013	0.3764	0.7975	2.8209	0.0483	0.142	0.2637	0.1875	0.632	0	0	0	0	0	0	0	0	0											10.6864	0	NO	0	17.2433	0.372640024	4.369776195	0	1.301458481	1.847156754	1.308761388	3.598848194	11.7360867	2.530556691	5.049678541	0.251119013	0.012337993	3.440914849	7.290988831	25.78799467	0.762851361	1.298549323	2.411062123	1.713793406	5.777233787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1051
H8393_803_0	2012	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	207.0658836	4.608446979	26.23074911	0	5.719948826	8.118309008	5.752045321	15.81704511	51.58045098	11.1218721	22.19348775	1.103675549	0.054225847	15.12292336	32.04411329	113.3390055	3.526281606	5.707162992	10.59668992	7.532173117	25.39111474	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%			0	0	0	0	0	0	0												NO	0.081982674	0.081982674	0.164005474	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.074165353	0.074165353	0.148367006	0	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0.202640853	0	0	0	0	0	0	0	0	0												15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	0	NO	9.214279873	15.3571	0.341787097	3.8917777	0	1.15909531	1.645101063	1.165599371	3.205179516	10.45230659	2.253745651	4.49730729	0.223649755	0.010988372	3.06452209	6.493446456	22.96711276	0.714568713	1.156504378	2.147322285	1.526325986	5.145277153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4187	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 16.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	1.8862	0.0309	0.478	0	0.1424	0.2021	0.1432	0.3937	1.2838	0.2768	0.5524	0.0275	0.0013	0.3764	0.7975	2.8209	0.0483	0.142	0.2637	0.1875	0.632	0	0	0	0	0	0	0	0	0											10.6864	0	NO	0	17.2433	0.372640024	4.369776195	0	1.301458481	1.847156754	1.308761388	3.598848194	11.7360867	2.530556691	5.049678541	0.251119013	0.012337993	3.440914849	7.290988831	25.78799467	0.762851361	1.298549323	2.411062123	1.713793406	5.777233787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1051
H8552_001_0	2012	7	H.6	H.7									OP Facility - Other	OP Facility - Other									Lab	Radiology									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	V	Coin									2.300540993	0.069657621	0.455553048	0	0.44304161	0.298709726	0.132039365	0	0.855211741	0	0.795742502	0.005928598	0.000965644	0.446021375	0	0	0.006142203	1.024922924	1.579068494	0	1.283324395	0.013359196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7102	YES	161.9906495	4.904882511	197.399279	242.4157542	124.785602	7.011130968	4.255519437	199.8550095	259.3268084	3138.504686	453.735661	7.421461687	0.022664995	321.7220645	3136.65601	2680.415849	8.649959954	1154.705302	855.8309735	1439.081814	30.12140085	0.633030772	0	0	0	0	0	0	5872.8	181.4127245	14608.66022	0	0	0	0	0	0	0	0	0	3400	1A: $800/admit; no yrly max	1B: $800/admit; no yrly max	2: $130/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0-$250 copay; 9B: $0-$200 copay	8A: $0-$200 copay	8B: $65-$200 copay	5: $45 copay	12: 20% coin	3: $45 copay; 9A: $45-$250 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $65-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: 10% coin; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $0 copay	8B: 20% coinsurance									300	NO	800	800	130	0	200	0.2	0.145653042	64.50977061	185.7702635	51.57147718	98.79150441	45	0.2	78.09527941	15	41.34151591	40	50	103.9352646	0.891991083	0.2	0.099065902	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	NO	694.8741988	694.8741988	112.9170573	0	173.7185497	0.17371855	0.126513176	56.03271896	161.3587038	44.79461111	85.80958435	39.08667368	0.17371855	67.83299339	13.02889123	35.90894094	34.74370994	43.42963743	90.27741713	0.774776986	0.17371855	0.086047924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		9.3803	0.284023025	1.857478808	0	1.806464483	1.217963504	0.538379282	0.933201632	3.487053137	11.71567474	3.244572373	0.024173354	0.00393733	1.818614223	3.405595832	8.020907868	0.025044308	4.179036048	6.438517482	0.092913956	5.232646071	0.054470984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7609		NO	9.646233406	11.6808	0.353680647	2.313031857	0	2.249506093	1.51667323	0.670418647	0.933201632	4.342264879	11.71567474	4.040314875	0.030101952	0.004902974	2.264635598	3.405595832	8.020907868	0.031186511	5.203958972	8.017585976	0.092913956	6.515970466	0.067830179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4712	YES	1A: 15% coin	1B: 15% coin	2: 25% coin (for days 1-100)	6: 30% coin	10A: $200 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $65 copay; 4B: $45 copay	9A: 30% coin; 9B: 30% coin	8A: 30%	8B: 30% coin	5: 30% coin	12: 20% coin	3: 30% coin; 9A: 30% coin; 9C: 30% coin	7A: $35 copay; 7G: $35 copay	7B: $40 copay; 7D: $55 copay; 7F: $55 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14A: 0-30% coin; 14D: 30%; 14E: 30%; 17A: $0; 17B: $0; 18A: 30%	15: 20% coinsurance	9D: 30% coin; 14A 30% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $10 copay	8B: 30% coinsurance									3400	9.4813	0.1881	1.5325	0.6138	0.6465	0.5449	0.3307	0.2682	3.6283	2.5233	0.8243	0.0294	0.0014	0.3823	2.2839	2.9446	0.0118	1.1969	2.5456	0.4796	1.8728	0.059	0	0	0	0	0	0	0	0	3.7845	0	0	0	0	0	0	0	0	0	36.174		NO	4.648079815	21.1621	0.54176172	3.845558173	0.613839903	2.896049042	2.061567499	1.001151044	1.201418258	7.97058493	14.23895044	4.864611088	0.059526695	0.006312164	2.646901162	5.689511672	10.96547621	0.043033936	6.400811151	10.56322461	0.572533472	8.388761463	0.126867988	0	0	0	0	0	0	0	0	3.784541688	0	0	0	0	0	0	0	0	0	109.6451
H8552_002_0	2012	7	H.6	H.7									OP Facility - Other	OP Facility - Other									Lab	Radiology									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	V	Coin									2.14171275	0.064846598	0.437304262	0	0.425290818	0.288167645	0.127379424	0	0.820956311	0	0.763861605	0.005691083	0.000931564	0.428151607	0	0	0.005896117	0.983859446	1.515805575	0	1.238033234	0.012887722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2608	YES	162.9755109	4.934558752	198.3824225	243.6217683	125.406152	7.081036079	4.297949475	200.8488745	260.6193636	3154.114796	455.9927248	7.458391947	0.022890978	323.3222757	3152.254381	2693.745369	8.692985202	1160.44854	860.0890244	1446.239483	30.42172898	0.639342462	0	0	0	0	0	0	5872.8	182.3148773	14681.30806	0	0	0	0	0	0	0	0	0	3400	1A: $775/admit; no yrly max	1B: $775/admit; no yrly max	2: $130/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0-$250 copay; 9B: $0-$200 copay	8A: $0-$200 copay	8B: $65-$200 copay	5: $45 copay	12: 20% coin	3: $45 copay; 9A: $45-$250 copay; 9C: $40 copay	7A: $15 copay; 7G: $15 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $65-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: 10% coin; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $0 copay	8B: 20% coinsurance									300	NO	775	775	130	0	200	0.2	0.145653042	64.50977061	185.7702635	51.57147718	98.79150441	45	0.2	78.09527941	15	41.34151591	40	50	103.9352646	0.891991083	0.2	0.099065902	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	NO	668.9894177	668.9894177	112.2175797	0	172.6424304	0.17264243	0.125729476	55.6856179	160.3591489	44.51712579	85.27802711	38.84454683	0.17264243	67.41279419	12.94818228	35.68649891	34.52848607	43.16060759	89.71818338	0.769977542	0.17264243	0.08551489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		9.0857	0.275097299	1.855166277	0	1.804201906	1.222487278	0.540378936	0.932032807	3.482724944	11.70101043	3.240513329	0.024143155	0.003951954	1.816338169	3.401330359	8.010861766	0.025012968	4.173805339	6.430468735	0.09279766	5.252081227	0.0546733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4248		NO	10.05053563	11.2275	0.339943897	2.292470539	0	2.229492723	1.510654923	0.66775836	0.932032807	4.303681255	11.70101043	4.004374934	0.029834237	0.004883518	2.244489776	3.401330359	8.010861766	0.030909085	5.157664785	7.94627431	0.09279766	6.490114462	0.067561022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6856	YES	1A: 20% coin	1B: 20% coin	2: 25% coin (for days 1-100)	6: 30% coin	10A: $200 copay	11A: 25% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $45 copay	9A: 30% coin; 9B: 30% coin	8A: 30%	8B: 30% coin	5: 30% coin	12: 20% coin	3: 30% coin; 9A: 30% coin; 9C: 30% coin	7A: $30 copay; 7G: $30 copay	7B: $40 copay; 7D: $55 copay; 7F: $55 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14A: 0-30% coin; 14D: 30%; 14E: 30%; 17A: $0; 17B: $0; 18A: 30%	15: 20% coinsurance	9D: 30% coin; 14A 30% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $15 copay	8B: 30% coinsurance									3400	12.598	0.2499	1.5264	0.6114	0.6408	0.5427	0.3953	0.2679	3.6139	2.5326	0.821	0.0293	0.0014	0.3807	1.9552	2.9409	0.0118	1.1921	2.5355	0.4814	1.8654	0.0588	0	0	0	0	0	0	0	0	5.6263	0	0	0	0	0	0	0	0	0	40.8789		NO	5.48934162	23.8255	0.589850483	3.818915642	0.611404127	2.870283519	2.053386999	1.063062383	1.199913494	7.917603779	14.23365811	4.825400259	0.059142219	0.006287117	2.625238472	5.356520581	10.95174207	0.042709499	6.349767738	10.4818116	0.574198585	8.355474042	0.126364563	0	0	0	0	0	0	0	0	5.626307157	0	0	0	0	0	0	0	0	0	113.5645
H8552_003_0	2012	8	H.6	H.7									OP Facility - Other	OP Facility - Other									Lab	Radiology									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	V	Coin									2.013509938	0.060965243	0.463944666	0	0.426547957	0.289053653	0.127771068	0	0.906848104	0	0.766101083	0.005707768	0.000934406	0.449823894	0	0	0.005961165	0.994713718	1.532528516	0	1.241839726	0.012927347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2992	YES	163.323293	4.945118024	194.8814523	243.6506071	125.4209909	7.082711924	4.298966656	201.3958495	258.3995717	3154.41195	456.0356917	7.459095039	0.022895843	322.899505	3280.530699	2715.758238	8.764023159	1169.931569	867.1175882	1458.057957	30.42892879	0.639493773	0	0	0	0	0	0	5872.8	182.3364499	14682.69093	0	0	0	0	0	0	0	0	0	3400	1A: $725/admit; no yrly max	1B: $725/admit; no yrly max	2: $140/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $35 copay	9A: $0-$275 copay; 9B: $0-$225 copay	8A: $0-$200 copay	8B: $65-$200 copay	5: $45 copay	12: 20% coin	3: $45 copay; 9A: $45-$275 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $65-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: 10% coin; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $0 copay	8B: 20% coinsurance									300	NO	725	725	140	0	200	0.2	0.145653042	64.22661764	206.3835682	51.57147718	98.79150441	45	0.2	81.92331135	10	41.34151591	40	50	103.9352646	0.891991083	0.2	0.099065902	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	NO	626.3810127	626.3810127	120.9563335	0	172.7947621	0.172794762	0.125840414	55.49011559	178.3099979	44.55640566	85.35327252	38.87882148	0.172794762	70.77959548	8.639738106	35.71798704	34.55895242	43.19869053	89.79734659	0.770656935	0.172794762	0.085590344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		8.5252	0.258127336	1.964345494	0	1.806007523	1.223855522	0.540983744	0.931289914	3.839602257	11.7124382	3.243678223	0.024166735	0.003956282	1.904558029	2.361910507	8.083451463	0.025239622	4.211625982	6.488738216	0.09363854	5.257959512	0.054734492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5555		NO	9.848897728	10.5387	0.31909258	2.42829016	0	2.23255548	1.512909175	0.668754813	0.931289914	4.746450362	11.7124382	4.009779306	0.029874503	0.004890688	2.354381922	2.361910507	8.083451463	0.031200787	5.2063397	8.021266733	0.09363854	6.499799238	0.067661839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8547	YES	1A: 20% coin	1B: 20% coin	2: 20% coin (for days 1-100)	6: 30% coin	10A: $200 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $35 copay	9A: 30% coin; 9B: 30% coin	8A: 30% coin	8B: 30% coin	5: 30% coin	12: 20% coin	3: 30% coin; 9A: 30% coin; 9C: 30% coin	7A: $35 copay; 7G: $35 copay	7B: $40 copay; 7D: $55 copay; 7F: $55 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14A: 0-30% coin; 14D: 30%; 14E: 30%; 17A: $0; 17B: $0; 18A: 30%	15: 20% coinsurance	9D: 30% coin; 14A 30% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $15 copay	8B: 30% coinsurance									3400	12.6296	0.2505	1.2121	0.6123	0.6417	0.6523	0.3959	0.2677	3.6036	2.5354	0.8222	0.0294	0.0014	0.3813	2.376	2.9675	0.0119	1.2035	2.5598	0.4858	1.8681	0.0589	0	0	0	0	0	0	0	0	5.6339	0	0	0	0	0	0	0	0	0	41.2008		NO	5.507077921	23.1683	0.569626306	3.640349045	0.612316485	2.87422656	2.165159526	1.064648722	1.198957083	8.350087657	14.24785932	4.832009951	0.059225511	0.006296347	2.735689584	4.73788453	11.05098029	0.043113974	6.409835363	10.58103569	0.579459114	8.367942372	0.126553129	0	0	0	0	0	0	0	0	5.633900318	0	0	0	0	0	0	0	0	0	113.0555
H8552_005_0	2012	8	H.6	H.7									OP Facility - Other	OP Facility - Other									Lab	Radiology									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	V	Coin									2.379154752	0.072016087	0.486137903	0	0.487305478	0.344145826	0.152123591	0	1.036119651	0	0.875235502	0.00652096	0.001112499	0.513901043	0	0	0.006810338	1.136408905	1.750857773	0	1.478528132	0.015391234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.7418	YES	170.1731248	5.151074154	208.6310843	253.9251225	130.7076009	7.692381414	4.669015423	209.8848697	269.317354	3287.395929	475.2639483	7.773714541	0.024866684	336.5127673	3418.808083	2830.229944	9.133520754	1219.253944	903.6858622	1519.527324	33.04820651	0.694540463	0	0	0	0	0	0	5872.8	190.0220989	15301.57985	0	0	0	0	0	0	0	0	0	3400	1A: $750/admit; no yrly max	1B: $750/admit; no yrly max	2: $125/day (for days 21-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $35 copay	9A: $0-$275 copay; 9B: $0-$225 copay	8A: $0-$200 copay	8B: $65-$200 copay	5: $45 copay	12: 20% coin	3: $45 copay; 9A: $45-$275 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $65-$200 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: 10% coin; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $0 copay	8B: 20% coinsurance									300	NO	750	750	125	0	200	0.2	0.145653042	64.22661764	206.3835682	51.57147718	98.79150441	45	0.2	81.92331135	10	41.34151591	40	50	103.9352646	0.891991083	0.2	0.099065902	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	NO	645.6451116	645.6451116	107.6075186	0	172.1720298	0.17217203	0.1253869	55.29013562	177.6673893	44.39582952	85.04566919	38.7387067	0.17217203	70.524514	8.608601488	35.58926354	34.43440595	43.04300744	89.47372733	0.767879576	0.17217203	0.085281887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		9.156	0.277147154	1.870856107	0	1.875349413	1.324412922	0.585433369	0.967046909	3.987409264	12.16222244	3.36826171	0.025095304	0.004281347	1.977699948	2.452596363	8.393816615	0.026208947	4.373363049	6.738011868	0.0972345	5.689976794	0.059231721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4116		NO	10.5724044	11.5351	0.349163241	2.35699401	0	2.362654891	1.668558748	0.73755696	0.967046909	5.023528915	12.16222244	4.243497212	0.031616264	0.005393846	2.49160099	2.452596363	8.393816615	0.033019285	5.509771954	8.488869641	0.0972345	7.168504926	0.074622955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1534	YES	1A: 15% coin	1B: 15% coin	2: 15% coin (for days 1-100)	6: 30% coin	10A: $200 copay	11A: 25% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $35 copay	9A: 30% coin; 9B: 30% coin	8A: 30% coin	8B: 30% coin	5: 30% coin	12: 20% coin	3: 30% coin; 9A: 30% coin; 9C: 30% coin	7A: $35 copay; 7G: $35 copay	7B: $40 copay; 7D: $55 copay; 7F: $55 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14A: 0-30% coin; 14D: 30%; 14E: 30%; 17A: $0; 17B: $0; 18A: 30%	15: 20% coinsurance	9D: 30% coin; 14A 30% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8A: $15 copay	8B: 30% coinsurance									3400	10.4414	0.2071	1.0161	0.6753	0.6791	0.5995	0.4366	0.2779	3.9744	2.7437	0.9068	0.0324	0.0016	0.4205	2.4672	3.0815	0.0131	1.3273	2.8231	0.5257	2.0603	0.065	0	0	0	0	0	0	0	0	5.9622	0	0	0	0	0	0	0	0	0	40.738		NO	5.529600979	21.9765	0.556289761	3.373109734	0.675312203	3.04171856	2.268020834	1.174180821	1.244991193	8.997911932	14.905965	5.150319749	0.063986933	0.006944121	2.912137956	4.919796212	11.47528409	0.046158113	6.837084424	11.31199013	0.622972248	9.228844449	0.139573038	0	0	0	0	0	0	0	0	5.962208894	0	0	0	0	0	0	0	0	0	116.8913
H8552_801_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06180885	0.06180885	0.129069618	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	0.05172309	0.05172309	0.108008472	0	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859																				12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588		NO	18.32153408	12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588	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	1.3604	0.0141	0.6095	0	0.1384	0.2549	0.0869	0.3087	1.1323	1.3724	1.1886	0.0001	0.1355	0.0118	0.875	1.3024	0.0037	0.8271	0	0.0021	0.8069	0.0091																			10.4399		NO	2.035726009	13.604	0.141331833	6.094728558	0	1.383971188	2.548740573	0.869024759	3.087316216	11.32291297	13.72446358	11.88588452	0.001052649	1.355498286	0.117818122	8.750004321	13.02395788	0.03663873	8.270933776	0	0.020521671	8.068873485	0.091060002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3987
H8552_802_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06180885	0.06180885	0.129069618	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	0.05172309	0.05172309	0.108008472	0	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859																				12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588		NO	18.32153408	12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588	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	1.3604	0.0141	0.6095	0	0.1384	0.2549	0.0869	0.3087	1.1323	1.3724	1.1886	0.0001	0.1355	0.0118	0.875	1.3024	0.0037	0.8271	0	0.0021	0.8069	0.0091																			10.4399		NO	2.035726009	13.604	0.141331833	6.094728558	0	1.383971188	2.548740573	0.869024759	3.087316216	11.32291297	13.72446358	11.88588452	0.001052649	1.355498286	0.117818122	8.750004321	13.02395788	0.03663873	8.270933776	0	0.020521671	8.068873485	0.091060002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3987
H8552_803_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06180885	0.06180885	0.129069618	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	0.05172309	0.05172309	0.108008472	0	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859																				12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588		NO	18.32153408	12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588	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	1.3604	0.0141	0.6095	0	0.1384	0.2549	0.0869	0.3087	1.1323	1.3724	1.1886	0.0001	0.1355	0.0118	0.875	1.3024	0.0037	0.8271	0	0.0021	0.8069	0.0091																			10.4399		NO	2.035726009	13.604	0.141331833	6.094728558	0	1.383971188	2.548740573	0.869024759	3.087316216	11.32291297	13.72446358	11.88588452	0.001052649	1.355498286	0.117818122	8.750004321	13.02395788	0.03663873	8.270933776	0	0.020521671	8.068873485	0.091060002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3987
H8552_804_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06180885	0.06180885	0.129069618	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	0.05172309	0.05172309	0.108008472	0	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859	0.175481859																				12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588		NO	18.32153408	12.2436	0.12719865	5.485255702	0	1.245574069	2.293866516	0.782122283	2.778584595	10.19062168	12.35201723	10.69729607	0.000947384	1.219948457	0.10603631	7.875003889	11.72156209	0.032974857	7.443840398	0	0.018469504	7.261986137	0.081954002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9588	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	1.3604	0.0141	0.6095	0	0.1384	0.2549	0.0869	0.3087	1.1323	1.3724	1.1886	0.0001	0.1355	0.0118	0.875	1.3024	0.0037	0.8271	0	0.0021	0.8069	0.0091																			10.4399		NO	2.035726009	13.604	0.141331833	6.094728558	0	1.383971188	2.548740573	0.869024759	3.087316216	11.32291297	13.72446358	11.88588452	0.001052649	1.355498286	0.117818122	8.750004321	13.02395788	0.03663873	8.270933776	0	0.020521671	8.068873485	0.091060002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3987
H8558_002_0	2012	9																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	647.3328206	37.4586687	869.0823819		67.97375819	5.158494235	9.942419765	227.1047067	22.5952909		9.241937227	17.8313972		432.1792179	1369.128836	3016.482144	0.85071816	511.5871958			14.41146692	0.007662152			122.6189612		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.193488543	65	0.081071812		0.15	29		88.96227895	10.00323655	28.95603171	0.382691204	30			0.2	0.53389447			30		30														NO	62.59795777	69.29694724	45.86545322		133.1850096	0.177580013	0.17179849	57.71350416	0.071983667		0.13318501	25.74910186		78.98961317	8.88187437	25.7100624	0.339791545	26.63700192			0.177580013	0.474044934			30		30															3.3768	0.216314282	3.321738111	0	0.754423803	0.916045472	1.708092703	1.092250703	1.626491907	0	1.230887498	0.038261872	0	2.84480577	1.013369193	6.46282868	0.289066838	1.13559576	0	0	2.559188481	0.003632204	0	0	0.306547403	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3321	0		3.603465377	3.3768	0.216314282	3.321738111	0	0.754423803	0.916045472	1.708092703	1.092250703	1.626491907	0	1.230887498	0.038261872	0	2.84480577	1.013369193	6.46282868	0.289066838	1.13559576	0	0	2.559188481	0.003632204	0	0	0.306547403	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3321	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.1522	0.1308	2.4313		0.479	0.5453	0.9993	0.5201	1.9107		0.7815	0.0573		1.745	1.277	4.3547	0.1904	0.7538			1.2187	0.0018			0.1752		0.249														20.9729	0		2.589728547	6.529	0.34711657	5.753063527	0	1.233423043	1.461310634	2.707374653	1.612370085	3.537192882	0	2.01240337	0.095517724	0	4.589785532	2.29033509	10.81751912	0.47949189	1.889351291	0	0	3.777849662	0.005463568	0	0	0.481747338	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	50.305
H8558_004_0	2012	8																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	675.5816992	43.74633146	914.5506862		52.13375851	5.853085289	14.01562971	222.2746715	31.60226645		10.005197	2.532699981		270.1502631	1876.70337	3224.597645	1.051762723	620.0022506			18.0094932	0.004884963			122.5466151		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.193886961	65	0.081071812		0.15	29		100.5528881	10.00984152	29.3721708	0.378181535	30			0.2	0.27256072			30		30														NO	61.50344801	68.19431754	45.13565757		131.0658145	0.174754419	0.169413016	56.7951863	0.070838288		0.131065815	25.33939081		87.8603079	8.746320218	25.66458327	0.330444473	26.21316291			0.174754419	0.238155951			30		30															3.4626	0.248604268	3.439903883	0	0.569412794	1.022852521	2.374430106	1.052010948	2.238650439	0	1.311339294	0.00534809	0	1.977957108	1.367854052	6.896496231	0.347549178	1.354351667	0	0	3.147238527	0.001163383	0	0	0.306366538	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5598	0		4.452025052	3.4626	0.248604268	3.439903883	0	0.569412794	1.022852521	2.374430106	1.052010948	2.238650439	0	1.311339294	0.00534809	0	1.977957108	1.367854052	6.896496231	0.347549178	1.354351667	0	0	3.147238527	0.001163383	0	0	0.306366538	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5598	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.6252	0.1218	2.5178		0.3615	0.6088	1.3907	0.501	2.6298		0.8326	0.0244		1.2414	1.7227	4.6291	0.2317	0.9016			1.4987	0.0006			0.1751		0.249														22.2634	0		3.154976292	6.0877	0.370369624	5.957719996	0	0.930944726	1.631693308	3.765084022	1.552968542	4.868476975	0	2.143935672	0.029774502	0	3.219319792	3.090530191	11.52561547	0.579230082	2.255938035	0	0	4.645923541	0.001749963	0	0	0.481444882	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8232
H8558_012_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	698.8973837	42.94501326	809.0765283		88.78736472	5.376325627	6.719337013	210.2445095	28.89787014		9.290303067	8.635703817		314.5652828	1746.249667	3346.51193	0.966416315	610.095421			14.64624097	0.011262086			123.2568753		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.189638025	65	0.081071812		0.15	29		89.49921251	10.01881292	28.96440384	0.35446418	30			0.2	0.337191784			30		30														NO	62.27466121	69.04942989	45.70162933		132.7092945	0.176945726	0.16777819	57.50736097	0.071726554		0.132709295	25.65713028		79.1825157	8.863930632	25.62563734	0.313604608	26.54185891			0.176945726	0.298323225			30		30															3.627	0.247110724	3.081342967	0	0.981909045	0.951317842	1.127358204	1.007550575	2.072744632	0	1.232909566	0.018463948	0	2.075672537	1.289886326	7.146375089	0.30307261	1.349422215	0	0	2.591589743	0.003359742	0	0	0.308142188	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8509	0		3.792360353	3.627	0.247110724	3.081342967	0	0.981909045	0.951317842	1.127358204	1.007550575	2.072744632	0	1.232909566	0.018463948	0	2.075672537	1.289886326	7.146375089	0.30307261	1.349422215	0	0	2.591589743	0.003359742	0	0	0.308142188	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8509	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.7499	0.121	2.2554		0.6234	0.5663	0.6524	0.4798	2.4349		0.7828	0.0411		1.2078	1.6237	4.8128	0.2156	0.8997			1.2341	0.0017			0.1763		0.249														21.1277	0		2.697323669	6.3768	0.368144547	5.336712661	0	1.605343359	1.517578462	1.779733784	1.487336563	4.5076754	0	2.015709291	0.059592344	0	3.283477253	2.913623347	11.95922447	0.518622908	2.249172193	0	0	3.825680096	0.005053729	0	0	0.484414248	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9787
H8558_013_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	646.4665585	38.07039521	668.1557756		57.93507728	5.0810266	9.338003861	208.4241166	26.19744603		9.843003495	13.25318875		437.2232931	1426.861804	3006.801515	0.575856543	596.7827318			8.642582523	0.008208887			124.2116372		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.192353368	65	0.081071812		0.15	29		77.27893615	10.03720824	29.06043994	0.373005885	30			0.2	0.497183226			30		30														NO	63.44003953	70.34158799	46.55686783		135.192753	0.180257004	0.173365209	58.5835263	0.07306881		0.135192753	26.13726558		69.65034751	9.046385426	26.19173919	0.336184617	27.0385506			0.180257004	0.448103794			30		30															3.4177	0.223161005	2.592270011	0	0.652700216	0.915890632	1.618884988	1.01751831	1.91421621	0	1.33070274	0.028866843	0	2.537729526	1.075661819	6.56278009	0.193594111	1.344678341	0	0	1.557886032	0.003678434	0	0	0.310529093	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7342	0		2.955899018	3.4177	0.223161005	2.592270011	0	0.652700216	0.915890632	1.618884988	1.01751831	1.91421621	0	1.33070274	0.028866843	0	2.537729526	1.075661819	6.56278009	0.193594111	1.344678341	0	0	1.557886032	0.003678434	0	0	0.310529093	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7342	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	2.5912	0.1093	1.8974		0.4144	0.5452	0.9442	0.4845	2.2487		0.8449	0.0301		1.5097	1.3512	4.4243	0.1308	0.8957			0.7419	0.0019			0.1779		0.249														19.5922	0		2.099119718	6.0088	0.332464354	4.489665818	0	1.067113052	1.461063627	2.563086684	1.502050838	4.162917702	0	2.175593369	0.059000013	0	4.047471528	2.426863668	10.98703833	0.324437189	2.240353755	0	0	2.299736524	0.005533106	0	0	0.488405794	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3264
H8578_001_0	2012	7																															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	176.4241581	2.199715598	551.8654204	0	242.8001019	0	0	328.8316854	224.9123335	0	128.4909557	0	0	758.0524989	3915.43487	6293.141909	572.5509033	755.135271	0	0	0	0	0	0	402.8033465	0	47.87218644	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; PBP 4a	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Urgent Care; PBP 4b, 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $10/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"	No Cost-Sharing; PBP 14g-h	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	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	NO	300	300	75	0	50	0	0	50	150	0	50	0	0	15	15	14.680447	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	295.6436913	295.6436913	73.91092282	0	49.27394854	0	0	49.27394854	147.8218456	0	49.27394854	0	0	14.78218456	14.78218456	14.4672718	14.78218456	14.78218456	0	0	0	0	0	0	14.78218456	0	14.78218456	0	0	0												4.3466	0.054194337	3.399073541	0	0.996976644	0	0	1.350236295	2.770579687	0	0.527604728	0	0	0.933805996	4.823223408	7.587049541	0.705296094	0.930212412	0	0	0	0	0	0	0.496192784	0	0.058971291	0	0	0	0	0	0	0	0	0	0	0	0	0	28.98	0	NO	0.427019816	4.3466	0.054194337	3.399073541	0	0.996976644	0	0	1.350236295	2.770579687	0	0.527604728	0	0	0.933805996	4.823223408	7.587049541	0.705296094	0.930212412	0	0	0	0	0	0	0.496192784	0	0.058971291	0	0	0	0	0	0	0	0	0	0	0	0	0	28.98	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	NO	0	4.3466	0.054194337	3.399073541	0	0.996976644	0	0	1.350236295	2.770579687	0	0.527604728	0	0	0.933805996	4.823223408	7.587049541	0.705296094	0.930212412	0	0	0	0	0	0	0.496192784	0	0.058971291	0	0	0	0	0	0	0	0	0	0	0	0	0	28.98
H8578_003_0	2012	5																															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	193.2171671	2.078596699	692.5198202	0	227.4888885	0	0	314.0372447	238.9335186	0	152.0253877	0	0	698.2602812	3788.11926	6065.9938	605.8276869	745.0021123	0	0	0	0	0	0	384.8961547	0	44.56074419	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; PBP 4a	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9c"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Urgent Care; PBP 4b, 7a, 14a-b, 14d-e"	"$15/Visit for Speclst Office Visits; $10/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"$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 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 9d, 16b, 17a"	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 14c	No Cost-Sharing; PBP 13a-e											0	NO	300	300	75	0	50	0	0	50	150	0	50	0	0	15	15	14.66204325	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	295.3474065	295.3474065	73.83685162	0	49.22456775	0	0	49.22456775	147.6737032	0	49.22456775	0	0	14.76737032	14.76737032	14.43465482	14.76737032	14.76737032	0	0	0	0	0	0	14.76737032	0	14.76737032	0	0	0												4.7555	0.051159012	4.2611236	0	0.933170183	0	0	1.288195636	2.940349793	0	0.623615333	0	0	0.859289013	4.661713328	7.296710555	0.74554015	0.916810174	0	0	0	0	0	0	0.473658671	0	0.054837084	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8617	0	NO	0.470409743	4.7555	0.051159012	4.2611236	0	0.933170183	0	0	1.288195636	2.940349793	0	0.623615333	0	0	0.859289013	4.661713328	7.296710555	0.74554015	0.916810174	0	0	0	0	0	0	0.473658671	0	0.054837084	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8617	NO																																										0	0	0	0	0	0	0	0	0	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	4.7555	0.051159012	4.2611236	0	0.933170183	0	0	1.288195636	2.940349793	0	0.623615333	0	0	0.859289013	4.661713328	7.296710555	0.74554015	0.916810174	0	0	0	0	0	0	0.473658671	0	0.054837084	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8617
H8578_004_0	2012	8																															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	127.0701933	1.256422507	330.1819282	0	150.0176567	5.945682602	0.74784276	237.0110516	171.2984389	0	113.1923756	0	0	513.6283466	3170.552042	4896.085212	585.2898798	609.6987191	0	0	0	0	0	0	367.2096438	0	45.78310629	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; PBP 4a	"$300/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for PCP Office Visits; $20/Visit for PCP Urgent Care; PBP 4b, 7a, 14b-c"	"$20/Visit for Speclst Office Visits; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 4b, 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 14g-h	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	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	NO	600	600	75	0	50	0.15	0.15	50	300	0	100	0	0	20	20	20	20	20	0	0	0	0	0	0	20	0	20	0	0	0											NO	586.5148859	586.5148859	73.31436074	0	48.87624049	0.146628721	0.146628721	48.87624049	293.257443	0	97.75248098	0	0	19.5504962	19.5504962	19.5504962	19.5504962	19.5504962	0	0	0	0	0	0	19.5504962	0	19.5504962	0	0	0												6.2107	0.061409209	2.017256416	0	0.611024922	0.871807838	0.109655228	0.965350763	4.186211848	0	0.922069628	0	0	0.83680742	5.165488803	7.976741277	0.953558964	0.993326041	0	0	0	0	0	0	0.598260895	0	0.074590204	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5543	0	NO	0.748485833	6.2107	0.061409209	2.017256416	0	0.611024922	0.871807838	0.109655228	0.965350763	4.186211848	0	0.922069628	0	0	0.83680742	5.165488803	7.976741277	0.953558964	0.993326041	0	0	0	0	0	0	0.598260895	0	0.074590204	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5543	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.2107	0.061409209	2.017256416	0	0.611024922	0.871807838	0.109655228	0.965350763	4.186211848	0	0.922069628	0	0	0.83680742	5.165488803	7.976741277	0.953558964	0.993326041	0	0	0	0	0	0	0.598260895	0	0.074590204	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5543
H8578_007_0	2012	7																															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	121.6258154	3.373065374	312.2434927	0	135.7382559	6.6909518	0.644932687	213.5265811	164.1376113	0	115.3797846	0	0	376.7743602	2751.983432	4247.772029	522.00814	493.7945006	0	0	0	0	0	0	356.5268584	0	39.37892497	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"	$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a	"$400/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Urgent Care; PBP 4b, 7a, 14b-c"	"$35/Visit for Speclst Office Visits; $20/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 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"	No Cost-Sharing; PBP 14g-h	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	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	NO	800	800	100	0	75	0.2	0.2	65	400	0	150	0	0	30	30	34.13558789	35	35	0	0	0	0	0	0	35	0	35	0	0	0											NO	766.4577456	766.4577456	95.8072182	0	71.85541365	0.191614436	0.191614436	62.27469183	383.2288728	0	143.7108273	0	0	28.74216546	28.74216546	32.70435717	33.53252637	33.53252637	0	0	0	0	0	0	33.53252637	0	33.53252637	0	0	0												7.7684	0.215442674	2.492931703	0	0.812794044	1.282082958	0.123578413	1.108108503	5.24185598	0	1.381777025	0	0	0.902442583	6.591496928	11.57672114	1.458687643	1.379848093	0	0	0	0	0	0	0.996270523	0	0.11003957	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4425	0	NO	1.901160688	7.7684	0.215442674	2.492931703	0	0.812794044	1.282082958	0.123578413	1.108108503	5.24185598	0	1.381777025	0	0	0.902442583	6.591496928	11.57672114	1.458687643	1.379848093	0	0	0	0	0	0	0.996270523	0	0.11003957	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4425	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.7684	0.215442674	2.492931703	0	0.812794044	1.282082958	0.123578413	1.108108503	5.24185598	0	1.381777025	0	0	0.902442583	6.591496928	11.57672114	1.458687643	1.379848093	0	0	0	0	0	0	0.996270523	0	0.11003957	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4425
H8578_009_0	2012	5																															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	103.9988316	1.600540559	312.2660148	0	133.0540991	5.070720833	0.808106004	182.9034954	135.5804668	0	80.5979772	0	0	414.4223329	2265.080472	3566.99925	373.004196	432.4873824	0	0	0	0	0	0	347.8217195	0	41.84682979	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"	$65/Visit for ER - Facility; $65/Visit for ER - Worldwide; PBP 4a	"$400/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9c"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Urgent Care; PBP 4b, 7a, 14a-b, 14d-e"	"$35/Visit for Speclst Office Visits; $20/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"$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 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 9d, 16b, 17a"	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 14c	No Cost-Sharing; PBP 13a-e											0	NO	800	800	100	0	75	0.2	0.2	65	400	0	150	0	0	30	30	34.05115986	35	35	0	0	0	0	0	0	35	0	35	0	0	0											NO	774.9280836	774.9280836	96.86601045	0	72.64950783	0.193732021	0.193732021	62.96290679	387.4640418	0	145.2990157	0	0	29.05980313	29.05980313	32.98400007	33.90310366	33.90310366	0	0	0	0	0	0	33.90310366	0	33.90310366	0	0	0												6.716	0.103358652	2.520663588	0	0.805526234	0.982360994	0.156556009	0.959677978	4.377712972	0	0.975900563	0	0	1.003585951	5.485232716	9.80449196	1.053833327	1.221888713	0	0	0	0	0	0	0.982686317	0	0.118228117	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2677	0	NO	1.205753125	6.716	0.103358652	2.520663588	0	0.805526234	0.982360994	0.156556009	0.959677978	4.377712972	0	0.975900563	0	0	1.003585951	5.485232716	9.80449196	1.053833327	1.221888713	0	0	0	0	0	0	0.982686317	0	0.118228117	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2677	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.716	0.103358652	2.520663588	0	0.805526234	0.982360994	0.156556009	0.959677978	4.377712972	0	0.975900563	0	0	1.003585951	5.485232716	9.80449196	1.053833327	1.221888713	0	0	0	0	0	0	0.982686317	0	0.118228117	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2677
H8578_010_0	2012	7																															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	143.4198493	3.386406623	569.3879974	0	107.4542576	0	0	180.2886572	171.0301589	0	152.1141367	0	0	371.8188784	2869.095194	4020.370365	302.5500053	489.0660629	0	0	0	0	0	0	317.2249896	0	114.5845627	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 Urgent Care - Worldwide; PBP 4a	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Urgent Care; PBP 4b, 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $10/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"	No Cost-Sharing; PBP 14g-h	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	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	NO	300	300	75	0	50	0	0	49.85627679	150	0	50	0	0	15	15	14.56895801	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	296.8606261	296.8606261	74.21515652	0	49.47677102	0	0	49.33455181	148.430313	0	49.47677102	0	0	14.8430313	14.8430313	14.41649999	14.8430313	14.8430313	0	0	0	0	0	0	14.8430313	0	14.8430313	0	0	0												3.548	0.083774233	3.521434946	0	0.443040808	0	0	0.741205008	2.115505002	0	0.627176359	0	0	0.459909938	3.548839148	4.829972444	0.374229933	0.60493524	0	0	0	0	0	0	0.392381704	0	0.141731854	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4321	0	NO	0.22664984	3.548	0.083774233	3.521434946	0	0.443040808	0	0	0.741205008	2.115505002	0	0.627176359	0	0	0.459909938	3.548839148	4.829972444	0.374229933	0.60493524	0	0	0	0	0	0	0.392381704	0	0.141731854	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4321	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/Days Custom 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 Urgent Care - Worldwide; PBP 4a	"$300/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$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 Urgent Care; PBP 4b, 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $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"	No Cost-Sharing; PBP 14g-h	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 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	$30/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											3400	2.2486	0.0341	2.2593	0	0.1532	0.383	0.2113	0.2109	1.5969	0	0.3665	0	0	0.1482	1.4927	2.1394	0.2237	0.2268	0	0	0	0	0	0	0.1436	0	0.0582	0	0	0											11.8965	0	NO	0.123882971	5.7965	0.117889083	5.78076321	0	0.596268791	0.383029119	0.211310875	0.952081782	3.712421967	0	0.99364245	0	0	0.608131106	5.041544755	6.969390776	0.597957626	0.831717269	0	0	0	0	0	0	0.535975158	0	0.199901522	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3286
H8578_801_0	2012	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	NO	195.2292292	1.195219296	43.0395662	0	10.43465625	13.10102533	0.820773634	18.47393835	58.83391518	23.27500739	15.65604302	0	0	18.83369174	36.38346427	127.3037932	3.542044735	3.424584483	21.90094544	34.62943399	33.54246009	0	0	0	0	0	0	0	0	0												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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b, 17a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.075416565	0.075416565	0.160618038	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.06891737	0.06891737	0.14677641	0	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0	0	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0.204696286	0	0	0	0	0	0	0	0	0												13.4547	0.08237137	6.317193019	0	2.13593538	2.681731229	0.168009315	3.781546567	12.04308393	4.76430757	3.20473386	0	0	3.855186751	7.447560008	26.05861366	0.725043402	0.700999725	4.483042192	7.088516524	6.866017003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8586	0	NO	9.982905527	13.4547	0.08237137	6.317193019	0	2.13593538	2.681731229	0.168009315	3.781546567	12.04308393	4.76430757	3.20473386	0	0	3.855186751	7.447560008	26.05861366	0.725043402	0.700999725	4.483042192	7.088516524	6.866017003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8586	YES	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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - PCP Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Speclst Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 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 14c	No Cost-Sharing; PBP 13a-e											6700	0.7062	0.0043	0.3306	0	0.1119	0.1396	0.0088	0.1715	0.6263	0.2508	0.1676	0	0	0.2027	0.3677	1.2915	0.035	0.0345	0.2359	0.3617	0.3614	0	0	0	0	0	0	0	0	0											5.408	0	NO	0.509994892	14.1609	0.086689725	6.647785041	0	2.247825053	2.821351295	0.176764214	3.95306603	12.66934576	5.0150606	3.372359924	0	0	4.057884667	7.815249886	27.35015693	0.760047464	0.735467643	4.718991781	7.450201378	7.227386319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2666
H8578_802_0	2012	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	NO	182.5485885	1.453524846	31.90519804	0	9.908628892	12.90174834	1.235923905	20.93885131	56.12297715	24.76498561	17.68928673	0	0	18.59929087	37.50337218	125.4448239	4.480014452	3.6774177	24.13279715	34.4767104	27.86224999	0	0	0	0	0	0	0	0	0												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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b, 17a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.075416565	0.075416565	0.160618038	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069145187	0.069145187	0.147261603	0	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0	0	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0	0	0	0	0	0	0	0	0												12.6224	0.100504247	4.698410597	0	2.034964266	2.649670012	0.253825328	4.300273494	11.52614092	5.086057951	3.632900855	0	0	3.819791082	7.702177876	25.76297252	0.920073748	0.755242092	4.956223546	7.080583441	5.722152248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6243	0	NO	9.39859079	12.6224	0.100504247	4.698410597	0	2.034964266	2.649670012	0.253825328	4.300273494	11.52614092	5.086057951	3.632900855	0	0	3.819791082	7.702177876	25.76297252	0.920073748	0.755242092	4.956223546	7.080583441	5.722152248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6243	YES	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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - PCP Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Speclst Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 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 14c	No Cost-Sharing; PBP 13a-e											6700	0.6608	0.0053	0.2432	0	0.1061	0.1367	0.0132	0.1786	0.5926	0.2677	0.1893	0	0	0.2007	0.3617	1.2091	0.0432	0.0355	0.2609	0.3518	0.3012	0	0	0	0	0	0	0	0	0											5.1576	0	NO	0.467789258	13.2831	0.105765707	4.941611183	0	2.141092473	2.786360697	0.26704814	4.478906887	12.11878889	5.353745211	3.822210766	0	0	4.020469887	8.063924014	26.97204771	0.963286607	0.790713346	5.217077417	7.432427225	6.023318156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7819
H8578_803_0	2012	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	NO	182.5485885	1.453524846	31.90519804	0	9.908628892	12.90174834	1.235923905	20.93885131	56.12297715	24.76498561	17.68928673	0	0	18.59929087	37.50337218	125.4448239	4.480014452	3.6774177	24.13279715	34.4767104	27.86224999	0	0	0	0	0	0	0	0	0												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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 16b, 17a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.075416565	0.075416565	0.160618038	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069145187	0.069145187	0.147261603	0	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0	0	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0.205372942	0	0	0	0	0	0	0	0	0												12.6224	0.100504247	4.698410597	0	2.034964266	2.649670012	0.253825328	4.300273494	11.52614092	5.086057951	3.632900855	0	0	3.819791082	7.702177876	25.76297252	0.920073748	0.755242092	4.956223546	7.080583441	5.722152248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6243	0	NO	9.39859079	12.6224	0.100504247	4.698410597	0	2.034964266	2.649670012	0.253825328	4.300273494	11.52614092	5.086057951	3.632900855	0	0	3.819791082	7.702177876	25.76297252	0.920073748	0.755242092	4.956223546	7.080583441	5.722152248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6243	YES	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	22% Coinsurance for Ambulance; PBP 10a	22% Coinsurance for DME; PBP 11a	"22% Coinsurance for DME / Medical Supplies; 22% Coinsurance for Diabetes Monitoring Supplies; 22% Coinsurance for Prosthetics; PBP 11b, 11c"	22% Coinsurance for ER - Facility; PBP 4a	"22% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	22% Coinsurance for OP Fac - Pathology; PBP 8a	22% Coinsurance for OP Fac - Radiology; 22% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	22% Coinsurance for Renal Dialysis - Fac; PBP 12	"22% Coinsurance for OP Fac - Cardiovascular; 22% Coinsurance for OP Fac - Occ Therapy; 22% Coinsurance for OP Fac - Physical/Speech Therapy; 22% Coinsurance for OP Fac - CORF; 22% Coinsurance for OP Fac - Other; 22% Coinsurance for Prof - CORF; PBP 3, 5, 9c"	"22% Coinsurance for Prof - PCP Asst Surgeon (OP); 22% Coinsurance for PCP Office Visits; 22% Coinsurance for PCP Urgent Care; 22% Coinsurance for PCP Immunizations; 22% Coinsurance for Physical Exams; PBP 4b, 7a, 14a-b, 14d-e"	"22% Coinsurance for Prof - Speclst Asst Surgeon (OP); 22% Coinsurance for Speclst Office Visits; 22% Coinsurance for Cardio; 22% Coinsurance for Chiropractor; 22% Coinsurance for Speclst Immunizations; 22% Coinsurance for Vision Exams; 22% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f"	"22% Coinsurance for OP Psych - Non-Physician; 22% Coinsurance for OP Psych - Psychiatrist; 22% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"22% Coinsurance for Occ Therapy; 22% Coinsurance for PT/ST; PBP 7c, 7i"	22% Coinsurance for Prof Radiology (IP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (OP); 22% Coinsurance for Prof Radiology (Office); 22% Coinsurance for Prof Radiology (Office); PBP 7d	"22% Coinsurance for Prof - Primary Surgeon (IP); 22% Coinsurance for Prof - Asst Surgeon (IP); 22% Coinsurance for Prof - Anesthesia (IP); 22% Coinsurance for Prof - Primary Surgeon (OP); 22% Coinsurance for Prof - Anesthesia (OP); 22% Coinsurance for Prof - IP Visits; 22% Coinsurance for Allergy Testing; 22% Coinsurance for Allergy Tx; 22% Coinsurance for Prof - ER Visits; 22% Coinsurance for Prof Path (IP); 22% Coinsurance for Prof Path (OP); 22% Coinsurance for Prof Path (Office); PBP 7g, 18a"	22% Coinsurance for Part B Rx; 22% Coinsurance for Tx Injections; PBP 15	"22% Coinsurance for Renal Dialysis - Prof; PBP 9d, 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 14c	No Cost-Sharing; PBP 13a-e											6700	0.6608	0.0053	0.2432	0	0.1061	0.1367	0.0132	0.1786	0.5926	0.2677	0.1893	0	0	0.2007	0.3617	1.2091	0.0432	0.0355	0.2609	0.3518	0.3012	0	0	0	0	0	0	0	0	0											5.1576	0	NO	0.467789258	13.2831	0.105765707	4.941611183	0	2.141092473	2.786360697	0.26704814	4.478906887	12.11878889	5.353745211	3.822210766	0	0	4.020469887	8.063924014	26.97204771	0.963286607	0.790713346	5.217077417	7.432427225	6.023318156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7819
H8604_001_0	2012	8																															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	1247.462799	20.66356074	922.3048517	492.67	284.2	12.10082222	0	322.3	321.67	7533.975	1133.92	275.12	236.9	4701.835	2896.455	2761.46	199.12	167.39	617.025	0	8.844860403	0	0	0	162.1	102.7	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												14.8266	0.245595029	6.263987118	0	2.412739583	1.972434022	0	1.422820208	5.461688542	5.116824688	4.198934691	0	0.189307686	0	0	6.443251335	0.473324833	0.397899979	0	0	1.369626633	0	0	0	0.385325208	0.104625625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.285	0	NO	11.64138044	14.8266	0.245595029	6.263987118	0	2.412739583	1.972434022	0	1.422820208	5.461688542	5.116824688	4.198934691	0	0.189307686	0	0	6.443251335	0.473324833	0.397899979	0	0	1.369626633	0	0	0	0.385325208	0.104625625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.285	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	2.2688	0.0392	0.4306	0.0439	0	0.1704	0	0	0.3904	0.5802	0.0873	0.0212	0	0.3621	0.2071	0.4442	0.032	0.0269	0.0993	0	0.0866	0	0	0	0	0	0	0	0	0											5.2901	250	NO	1.200821241	17.0954	0.284811358	6.694611583	0.043880428	2.412739583	2.142800861	0	1.422820208	5.852095248	5.696974945	4.286251676	0.021185488	0.189307686	0.362062628	0.207071125	6.88744671	0.505354333	0.424825542	0.099251719	0	1.456213162	0	0	0	0.385325208	0.104625625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5751
H8604_002_0	2012	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	YES	1175.645615	25.38201161	1022.329311	416.195	286.2	9.042366305	0	348.3	326.8	7341.125	815.86	205.96	290.9	4220.185	2988.415	2693.82	125.78	306.09	594.13	0	9.601708191	0	0	0	160.6	106.5	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												13.973	0.301675784	6.943319907	0	2.42971875	1.473905708	0	1.537599375	5.548791667	4.985847396	3.021150396	0	0.23245929	0	0	6.285428473	0.298989542	0.727601438	0	0	1.486824513	0	0	0	0.381759583	0.108496875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7366	0	NO	11.28990458	13.973	0.301675784	6.943319907	0	2.42971875	1.473905708	0	1.537599375	5.548791667	4.985847396	3.021150396	0	0.23245929	0	0	6.285428473	0.298989542	0.727601438	0	0	1.486824513	0	0	0	0.381759583	0.108496875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7366	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	2.0188	0.0455	0.4473	0.0369	0	0.1273	0	0	0.4003	0.53	0.0589	0.0149	0	0.3047	0.2136	0.4333	0.0202	0.0492	0.0956	0	0.094	0	0	0	0	0	0	0	0	0											4.8905	250	NO	1.110121691	15.9919	0.347157731	7.390585857	0.036901143	2.42971875	1.601212707	0	1.537599375	5.949140088	5.515813263	3.080048447	0.014868534	0.23245929	0.304660934	0.213645458	6.718743598	0.319221917	0.776837625	0.095568937	0	1.580820183	0	0	0	0.381759583	0.108496875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6271
H8604_003_0	2012	8																															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	1527.515863	59.87551458	1353.546426	1953.485	334.1	12.79635365	0	398.7	281.2	12254.24	1079.2	210.9	17	5836.42	3017.105	2945.95	209.475	20.9	703.095	0	12.3938854	0	0	0	171.2	131.5	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												18.1552	0.711645439	9.192836145	0	2.836369792	2.085805645	0	1.760094375	4.774541667	8.322671333	3.996305135	0	0.013584764	0	0	6.873717624	0.497939531	0.049681042	0	0	1.919193155	0	0	0	0.406956667	0.133965625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7305	0	NO	14.01243808	18.1552	0.711645439	9.192836145	0	2.836369792	2.085805645	0	1.760094375	4.774541667	8.322671333	3.996305135	0	0.013584764	0	0	6.873717624	0.497939531	0.049681042	0	0	1.919193155	0	0	0	0.406956667	0.133965625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7305	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	1.999	0.0818	0.7039	0.1677	0	0.1802	0	0	0.4805	0.7371	0.0649	0.0127	0	0.3511	0.2157	0.4739	0.0337	0.0034	0.1131	0	0.1213	0	0	0	0	0	0	0	0	0											5.7399	250	NO	1.302925482	20.1542	0.793411452	9.896765876	0.167668351	2.836369792	2.265964835	0	1.760094375	5.255027422	9.059799418	4.061222146	0.012686247	0.013584764	0.351077594	0.215696542	7.347589186	0.531634688	0.053042917	0.113096531	0	2.04052277	0	0	0	0.406956667	0.133965625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4704
H8604_004_0	2012	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	YES	1186.511572	37.58490181	1260.329633	1644.45	269	9.757788054	0	265.7	217.835	8869.01	667.85	110.2	17.2	3655.885	2155.455	1988.73	115.33	21.185	475.475	0	9.264144114	0	0	0	120.2	98	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												14.1022	0.446712218	8.559738761	0	2.283697917	1.590519453	0	1.172954792	3.698656771	6.023535958	2.47306559	0	0.013744585	0	0	4.640258134	0.274149021	0.05035851	0	0	1.434552716	0	0	0	0.285725417	0.0998375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1497	0	NO	10.70269077	14.1022	0.446712218	8.559738761	0	2.283697917	1.590519453	0	1.172954792	3.698656771	6.023535958	2.47306559	0	0.013744585	0	0	4.640258134	0.274149021	0.05035851	0	0	1.434552716	0	0	0	0.285725417	0.0998375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1497	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	1.4913	0.0493	0.661	0.1385	0	0.1374	0	0	0.4112	0.5369	0.0404	0.0067	0	0.2213	0.1541	0.3199	0.0186	0.0034	0.0765	0	0.0907	0	0	0	0	0	0	0	0	0											4.3572	250	NO	0.989059806	15.5935	0.496007336	9.220747483	0.138530697	2.283697917	1.727898837	0	1.172954792	4.109870865	6.560437174	2.513495072	0.006671152	0.013744585	0.221315468	0.154096125	4.960155821	0.292700458	0.053766229	0.076482656	0	1.525243811	0	0	0	0.285725417	0.0998375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5069
H8604_005_0	2012	8																															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	1182.436838	27.16489253	1050.73926	422.085	290.2	9.089485645	0	323.3	298.965	6693.795	809.97	204.535	297.4	4140.1	2832.995	2508.57	128.25	150.67	546.155	0	9.700241597	0	0	0	144.5	89.6	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	100	100	75	$0.00 	125	20%	20%	$65.00 	$175.00 	$5.00 	48.02307506	$0.00 	11.76594525	0	0	34.355	$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	85.7	85.7	64.275	0	107.125	0.1714	0.1714	55.705	149.975	4.285	41.15577533	0	10.08341508	0	0	29.442235	29.995	29.995	0	0	0.16283	0	0	0	29.995	12.855	0	0	0	0												8.4446	0.194002608	5.62802216	0	2.590639583	1.55793784	0	1.500785542	3.736439656	2.390242631	2.777911945	0	0.249900637	0	0	6.154825621	0.320571563	0.376612221	0	0	1.579490339	0	0	0	0.361189792	0.095984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9591	0	NO	6.333903153	8.4446	0.194002608	5.62802216	0	2.590639583	1.55793784	0	1.500785542	3.736439656	2.390242631	2.777911945	0	0.249900637	0	0	6.154825621	0.320571563	0.376612221	0	0	1.579490339	0	0	0	0.361189792	0.095984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9591	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	2.0584	0.0473	0.4804	0.0391	0	0.134	0	0	0.415	0.5274	0.0638	0.0161	0	0.3262	0.213	0.4243	0.0217	0.0255	0.0924	0	0.0992	0	0	0	0	0	0	0	0	0											4.9838	250	NO	0.831609648	10.503	0.241292498	6.108463793	0.039111374	2.590639583	1.691935994	0	1.500785542	4.151396107	2.9176356	2.841728134	0.016114972	0.249900637	0.32619159	0.212971642	6.579137034	0.342264375	0.402097258	0.092379244	0	1.678739127	0	0	0	0.361189792	0.095984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.943
H8604_006_0	2012	8																															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	1561.72665	57.47072577	1344.004972	1854.59	331.3	12.0121514	0	349.4	261.63	11955.655	940.12	153.805	25.1	4818.4	2885.625	2549.515	168.15	30.875	650.465	0	13.26173762	0	0	0	166.9	127.4	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	100	100	75	$0.00 	125	20%	20%	$65.00 	$175.00 	$5.00 	48.02307506	$0.00 	11.76594525	0	0	34.355	$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	85.7	85.7	64.275	0	107.125	0.1714	0.1714	55.705	149.975	4.285	41.15577533	0	10.08341508	0	0	29.442235	29.995	29.995	0	0	0.16283	0	0	0	29.995	12.855	0	0	0	0												11.1533	0.410436767	7.198826631	0	2.957542708	2.05888275	0	1.621943917	3.269829938	4.26916514	3.224280625	0	0.021091143	0	0	6.255284981	0.420304938	0.077174635	0	0	2.159408737	0	0	0	0.417180458	0.13647725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6512	0	NO	7.617405057	11.1533	0.410436767	7.198826631	0	2.957542708	2.05888275	0	1.621943917	3.269829938	4.26916514	3.224280625	0	0.021091143	0	0	6.255284981	0.420304938	0.077174635	0	0	2.159408737	0	0	0	0.417180458	0.13647725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6512	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	1.9731	0.0726	0.7617	0.166	0	0.1771	0	0	0.5136	0.7662	0.0603	0.0099	0	0.3088	0.2169	0.4312	0.0284	0.0052	0.11	0	0.1357	0	0	0	0	0	0	0	0	0											5.7367	250	NO	0.957237216	13.1264	0.483043994	7.960489723	0.16604315	2.957542708	2.235967151	0	1.621943917	3.783443871	5.03538151	3.284531221	0.009857085	0.021091143	0.308802568	0.216928125	6.686522024	0.448746625	0.082396979	0.110022731	0	2.295097252	0	0	0	0.417180458	0.13647725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3879
H8604_801_0	2012	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	1229.296277	29.85640469	912.6025864	931.285	246.6	10.23540409	0	268.3	230.755	8595.22	693.88	124.355	89.6	3556.8	2450.81	2339.565	118.75	239.78	565.25	0	11.20516443	0	0	2.755	126.6	86.5	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												14.6107	0.35485581	6.198092566	0	2.09353125	1.668370867	0	1.184432708	3.918027604	5.837586917	2.569455344	0	0.071599699	0	0	5.458853399	0.282278646	0.569977042	0	0	1.735119711	0	0	0	0.30093875	0.088121875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9419	0	NO	10.65553254	14.6107	0.35485581	6.198092566	0	2.09353125	1.668370867	0	1.184432708	3.918027604	5.837586917	2.569455344	0	0.071599699	0	0	5.458853399	0.282278646	0.569977042	0	0	1.735119711	0	0	0	0.30093875	0.088121875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9419	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	1.9452	0.0493	0.5283	0.081	0	0.1441	0	0	0.3676	0.5601	0.0452	0.0081	0	0.2318	0.1752	0.3763	0.0191	0.0386	0.0909	0	0.1097	0	0	0	0	0	0	0	0	0											4.7707	250	NO	1.082920852	16.5559	0.404155135	6.726398193	0.081038502	2.09353125	1.812474583	0	1.184432708	4.285648118	6.397733876	2.614675219	0.008104164	0.071599699	0.231795196	0.175211417	5.835184743	0.301380208	0.608546917	0.090923438	0	1.844812374	0	0	0	0.30093875	0.088121875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7126
H8604_802_0	2012	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	1167.071696	36.12055499	1011.554973	1081.86	262.8	9.06729378	0	282.8	227.62	8194.415	735.49	143.45	108.2	3765.8	2373.955	2099.215	126.445	64.125	505.4	0	9.903878728	0	0	0	131.8	94	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-10	$100 / days 11-100	$0.00 	125	20%	20%	"$65.00 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 	$20.00 Chiro/$35.00 All Other	$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/Frames/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 											0	NO	175	175	100	$0.00 	125	20%	20%	$65.00 	$250.00 	$10.00 	54.52307506	$0.00 	11.76594525	0	0	34.355	$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	142.625	142.625	81.5	0	101.875	0.163	0.163	52.975	203.75	8.15	44.43630617	0	9.589245377	0	0	27.999325	28.525	28.525	0	0	0.15485	0	0	0	28.525	12.225	0	0	0	0												13.8711	0.429307846	6.870144188	0	2.2310625	1.477968886	0	1.248444167	3.864797917	5.565373521	2.723538236	0	0.086463029	0	0	4.898050252	0.300570302	0.152430469	0	0	1.533615621	0	0	0	0.313299583	0.0957625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.662	0	NO	10.36498533	13.8711	0.429307846	6.870144188	0	2.2310625	1.477968886	0	1.248444167	3.864797917	5.565373521	2.723538236	0	0.086463029	0	0	4.898050252	0.300570302	0.152430469	0	0	1.533615621	0	0	0	0.313299583	0.0957625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.662	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	1.5823	0.0511	0.5133	0.093	0	0.1277	0	0	0.3748	0.5366	0.0482	0.0094	0	0.2466	0.1697	0.3377	0.0203	0.0103	0.0813	0	0.097	0	0	0	0	0	0	0	0	0											4.2993	250	NO	0.975910407	15.4534	0.480407659	7.38343921	0.093047891	2.2310625	1.605626838	0	1.248444167	4.239610122	6.102018186	2.771704796	0.009394408	0.086463029	0.246618762	0.169716958	5.235720034	0.320909646	0.162745313	0.08129625	0	1.630569381	0	0	0	0.313299583	0.0957625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9612
H8644_003_0	2012	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			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	1469.77	65.81	279.02	2323.72	28.1	15.08	4.81	451.74	342.56	1095.18	894.13	87.09	0.19	599.43	3542.73	3434.91	91.3	674.84		1532.89	17.77	0			0.61				3.35	1.19	1549.54										3400	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$220/Day(Days 1-7): 1b. $220 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $35 Rad therapy,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	140.807324	44.329117	0	150	0.2	0.2	65	250	0	48.278481	37.572229	0.2	46.795995	10	32.751586	35	39.00141		0	0.2	0			0				0	0	0										NO	122.078977	94.339499	30.266414	0	129.9651	0.173287	0.173287	56.31821	216.6085	0	41.830117	32.553857	0.173287	40.545641	8.66434	28.377088	30.32519	33.792148		0	0.173287	0			0				0	0	0											14.9523	0.517373536	0.70374457	0	0.304334943	2.61316796	0.83351047	2.120099015	6.183450647	0	3.116796876	0.236259617	0.03292453	2.025356132	2.557951437	8.122728612	0.230724154	1.900357763	0	0	3.07930999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5304	0	NO	13.088754	14.9523	0.517373536	0.70374457	0	0.304334943	2.61316796	0.83351047	2.120099015	6.183450647	0	3.116796876	0.236259617	0.03292453	2.025356132	2.557951437	8.122728612	0.230724154	1.900357763	0	0	3.07930999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5304	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										5100	2.0827	0.0895	0.2813	2.2931	2.049	0.8432	0.2687	0.2038	1.6684	0.2143	0.6645	0.0218	0.0031	0.5381	0.9972	1.4809	0.0182	0.1689		0.1785	0.4718	0			0				0	0	0.1255										14.6626	0	NO	4.223401	17.0351	0.606907536	0.98505557	2.293051	2.353307943	3.45633996	1.10219947	2.323873015	7.851804647	0.214279	3.781288876	0.258100617	0.03605553	2.563501132	3.555198437	9.603643612	0.248876154	2.069298763	0	0.178511	3.55114799	0	0	0	0	0	0	0	0	0	0.125477	0	0	0	0	0	0	0	0	0	64.193
H8644_005_0	2012	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				O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0										0	YES	1222.54	55.44	378.62	1347.92	22.53	13.31	4.11	358.67	335.25	1171.6	1001.17	156.77	0.39	656.45	3155.95	3884.8	99.63	687.54		1700.55	22.53	0			0.61				3.35	1.19	1184.7										5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0-$100/Visit: 8b, 9a. $45 DMAM -- OP,8b. $45 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $45 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $45 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$100/Visit: 3. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $45 Rad therapy,3, 7c, 7i. $45 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$45/Visit: 7b. $15 Chiropractic,7f. $45 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $45 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $45 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$45-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $45 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												182.210148	128.006658	44.329117	0	150	0.2	0.2	65	250	0	51.620524	41.343676	0.199029	45.609959	15	41.769171	40	46.601747		0	0.2	0			0				0	0	0										NO	147.666383	103.7389	36.006591	0	137.7093	0.183612	0.183612	59.67403	229.5155	0	47.390841	37.956058	0.182721	41.87277	13.77093	38.346689	36.72248	42.783293		0	0.183612	0			0				0	0	0											15.044	0.479273718	1.136067957	0	0.258549211	2.44387572	0.75464532	1.783607028	6.412089281	0	3.953857357	0.495864268	0.07126119	2.290614989	3.621697211	12.41410145	0.30488839	2.451268772	0	0	4.13677836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0524	0	NO	7.588308	15.044	0.479273718	1.136067957	0	0.258549211	2.44387572	0.75464532	1.783607028	6.412089281	0	3.953857357	0.495864268	0.07126119	2.290614989	3.621697211	12.41410145	0.30488839	2.451268772	0	0	4.13677836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0524	YES	$0-$250/Day(Days 1-15)	$0-$250/Day(Days 1-15)	"30% Coins(Days 1-14), 30% (Days 15-21), 30% (Days 22-100)"	30% Coins	$150/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										7500	2.8304	0.1232	0.4936	2.6423	2.6695	1.2094	0.3734	0.2629	2.6443	0.4113	1.1063	0.0557	0.0107	0.9227	1.5192	2.8898	0.0363	0.2595		0.3721	0.9852	0			0				0	0	0.1605										21.9785	1000	NO	2.838551	17.8744	0.602503718	1.629670957	2.64233	2.928081211	3.65323772	1.12802832	2.046545028	9.056369281	0.411308	5.060183357	0.551564268	0.08196519	3.213360989	5.140868211	15.30389745	0.34122039	2.710774772	0	0.372081	5.12199636	0	0	0	0	0	0	0	0	0	0.160515	0	0	0	0	0	0	0	0	0	80.0309
H8649_003_0	2012	8																															D	D	D	V	T	COIN	COIN	V	COIN	O	O	COIN	O	COIN	P	COIN	P	P	P	P	COIN	V	T	COIN	V	COIN	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	711.0372425	17.13342753	484.0440572	0	73.89259357	17.90134508	10.62404352	306.7603085	48.60910832	1487.399676	1093.543693	0.751095705	0	20.23599129	3614.076187	113.1604525	95.56601116	762.3490597	1534.970687	0	19.78606386	0	0	0	0	0	0	0	0	0											3150	1a $200 days 1-8	1b $200 days 1-7	"2 $50 days 1-20, $133 Days 21 to 37"	6 $0	10a $200	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $35"	"9a 20%, 9b 20%"	"8a $50, 14a $0"	"8b MRI;CT;PET $150, 8b Rad Thpy;Nuclear;Chemo;Other $50, 8b X-rays $75,14a $0"	9a 20%	12 20%	"3 $25, 9a 20%, 9d 20%"	"7a $5, 14a $0"	"7d $35, 17a $35, 17b 20%, 18a $35, 7b $20 , 7f$35, 14a $0, 8a $50"	"7e $40, 7h $40, 9c $40"	"7c $35, 7i $35"	"8b MRI;CT;PET $150, 8b Rad Thpy;Nuclear;Chemo;Other $50, 8b X-rays $75,14a $0"	7g $35; 14a $0	"15 20%, 11c $10"				17a $0				14a $0													NO	172.0823799	129.0322581	57.45110087	0	200	0.2	0.2	61.41666667	0.2	49.8990103	70.04120879	0.2	0	0.202642082	4.790697674	0.149787602	40	35	41.2733216	0	0.203210305	0	0	0	0	0	0	0	0	0											YES	136.4145267	102.2874883	45.54309826	0	158.5456068	0.158545607	0.158545607	48.68671343	0.158545607	39.55634434	55.52362976	0.158545607	0	0.160640059	3.79772035	0.118740831	31.70912137	27.7454812	32.7185191	0	0.161090505	0	0	0	0	0	0	0	0	0											6500	8.083	0.146044606	1.837072171	0	0.976278841	2.838179619	1.684395427	1.244595936	7.706760577	4.903007814	5.059792926	0.119082924	0	3.250710841	1.14377089	13.43676619	0.252526187	1.762645125	4.185163979	0	3.187347024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8171	0	NO	16.16311837	8.083	0.146044606	1.837072171	0	0.976278841	2.838179619	1.684395427	1.244595936	7.706760577	4.903007814	5.059792926	0.119082924	0	3.250710841	1.14377089	13.43676619	0.252526187	1.762645125	4.185163979	0	3.187347024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8171	NO	0.3	NC	0.3	0.3	200	0.3	0.3	"$65 ER,30% UC"	0.3	"30%, 14a $0"	"30%, 14a $0"	0.3	0.2	0.3	"30%, 14a $0"	"30%, 17b 20%"	NC	0.3	0.3	"30%, 14a $0"	"30% Rx, 30% Diab Supplies"				NC				NC													0.4504	0	0.3781	0.8897	0.0944	0.5882	0.3824	0.0639	0.0671	0.0206	0.0155	0.0031	0	0.186	0.1151	1.6035	0	0.0435	0.0578	0.0469	0.0082	0	0	0	0.0037	0	0	0	0	0											5.0179	0	NO	0	8.5333	0.146044606	2.215209451	0.889729631	1.07063126	3.426363146	2.066836508	1.308477364	7.773817353	4.923567907	5.075273678	0.122199519	0	3.436700538	1.258826698	15.04026612	0.252526187	1.806107699	4.242981341	0.046856971	3.195596321	0	0	0	0.003678637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.835
H8649_007_0	2012	6																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	O	COIN	P	COIN	P	P	P	P	COIN	V	T	COIN	COIN	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	814.963245	19.43373892	591.3541015	0	90.23449719	21.18937641	12.69347928	362.443274	523.4052614	1722.534893	1246.495082	28.62372523	0	22.25834396	4146.309267	126.281359	108.1033499	869.7565937	1801.487746	0	21.1491875	0	0	0	0	0	0	0.92	0	0											3950	1a $200 days 1-8	1b $200 days 1-7	"2 $50 days 1-20, $133 Days 21 to 43"	6 $0	10a $200	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $30"	"9a $250, 9b $250"	"8a $50, 14a $0"	"8b MRI;CT;PET $150, 8b Rad Thpy;Nuclear;Chemo;Other $50, 8b X-rays $75,14a $0"	9a $250	12 20%	"3 $25, 9a $250, 9d 20%"	"7a $5, 14a $0"	"7d $40, 17a $40, 17b 20%, 18a $40, 7b $20 , 7f$40, 14a $0, 8a $50"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b MRI;CT;PET $150, 8b Rad Thpy;Nuclear;Chemo;Other $50, 8b X-rays $75,14a $0"	7g $40; 14a $0	"15 20%, 11c $10"				17a $0	17b $0 -- $50 Allowance		18b $0 -- $500 Allowance	14a $0													NO	172.0823799	129.0322581	61.98463902	0	200	0.2	0.2	60.76888889	250	49.89119683	70.27063969	250	0	0.687681871	4.789808917	0.170132888	40	40	40.12120051	0	0.204502307	0	0	0	0	0	0	1	0	0											NO	133.3613661	99.9981417	48.03720254	0	154.9971196	0.15499712	0.15499712	47.0950137	193.7463995	38.66495902	54.45873373	193.7463995	0	0.532943546	3.712032929	0.131850538	30.99942393	30.99942393	31.09335258	0	0.158486343	0	0	0	0	0	0	0.774985598	0	0												9.0571	0.161944815	2.367249729	0	1.165507263	3.284292311	1.967452727	1.422439246	8.450657074	5.550145089	5.656878648	0.462145309	0	11.86244077	1.282603044	16.65026514	0.279261798	2.246829447	4.667857805	0	3.351857385	0	0	0	0	0	0	0.71298675	0	0	0	0	0	0	0	0	0	0	0	0	80.5999	0	NO	23.40189357	9.0571	0.161944815	2.367249729	0	1.165507263	3.284292311	1.967452727	1.422439246	8.450657074	5.550145089	5.656878648	0.462145309	0	11.86244077	1.282603044	16.65026514	0.279261798	2.246829447	4.667857805	0	3.351857385	0	0	0	0	0	0	0.71298675	0	0	0	0	0	0	0	0	0	0	0	0	80.5999	NO																																										0	0	0	0	0	0	0	0	0	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	9.0571	0.161944815	2.367249729	0	1.165507263	3.284292311	1.967452727	1.422439246	8.450657074	5.550145089	5.656878648	0.462145309	0	11.86244077	1.282603044	16.65026514	0.279261798	2.246829447	4.667857805	0	3.351857385	0	0	0	0	0	0	0.71298675	0	0	0	0	0	0	0	0	0	0	0	0	80.5999
H8649_801_0	2012	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	O	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	174.6845947	2.988023247	21.76050636	0	5.586009929	18.23761581	10.82361259	17.78877464	49.28526286	12.45413526	25.07625214	0.765204784	0	20.61611756	28.7803164	109.1527863	0.658654666	6.648033125	10.15052804	7.465221125	21.73634763	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.08151497	0.08151497	0.170538322	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072598414	0.072598414	0.151883904	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0	0	0	0	0	0	0	0												12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	0	NO	10.44897835	12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.1254	0	0.227	0	0.0492	0.4474	0.2909	0.1033	0.0508	0.0165	0.0118	0.0024	0	0.1415	0.0852	1.181	0	0.0313	0.0416	0.0397	0.0063	0	0	0	0	0	0	0	0	0											2.8513	0	NO	0	12.8072	0.21692575	3.532069597	0	1.163615974	4.085788302	2.450205346	3.652095284	9.883059592	2.501081956	5.014429439	0.155027325	0	4.254347961	5.826830463	22.95672939	0.131400057	1.357569719	2.066647867	1.529001206	4.342625428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9267
H8649_802_0	2012	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	O	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	174.6845947	2.988023247	21.76050636	0	5.586009929	18.23761581	10.82361259	17.78877464	49.28526286	12.45413526	25.07625214	0.765204784	0	20.61611756	28.7803164	109.1527863	0.658654666	6.648033125	10.15052804	7.465221125	21.73634763	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.08151497	0.08151497	0.170538322	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.072598414	0.072598414	0.151883904	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0	0	0	0	0	0	0	0												12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	0	NO	10.44897835	12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	YES	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.1254	0	0.227	0	0.0492	0.4474	0.2909	0.1033	0.0508	0.0165	0.0118	0.0024	0	0.1415	0.0852	1.181	0	0.0313	0.0416	0.0397	0.0063	0	0	0	0	0	0	0	0	0											2.8513	0	NO	0	12.8072	0.21692575	3.532069597	0	1.163615974	4.085788302	2.450205346	3.652095284	9.883059592	2.501081956	5.014429439	0.155027325	0	4.254347961	5.826830463	22.95672939	0.131400057	1.357569719	2.066647867	1.529001206	4.342625428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9267
H8649_803_0	2012	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	O	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	174.6845947	2.988023247	21.76050636	0	5.586009929	18.23761581	10.82361259	17.78877464	49.28526286	12.45413526	25.07625214	0.765204784	0	20.61611756	28.7803164	109.1527863	0.658654666	6.648033125	10.15052804	7.465221125	21.73634763	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.08151497	0.08151497	0.170538322	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.072598414	0.072598414	0.151883904	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0.199497649	0	0	0	0	0	0	0	0	0											10000	12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	0	NO	10.44897835	12.6818	0.21692575	3.305070649	0	1.114395848	3.638361477	2.159285266	3.548818719	9.83229407	2.484570704	5.002653346	0.152656555	0	4.112866984	5.741605459	21.77572426	0.131400057	1.326266979	2.02500648	1.489294064	4.336350249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0754	NO	Medicare FFS 8.2%	Medicare FFS 8.2%	Medicare FFS 17.1%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.1254	0	0.227	0	0.0492	0.4474	0.2909	0.1033	0.0508	0.0165	0.0118	0.0024	0	0.1415	0.0852	1.181	0	0.0313	0.0416	0.0397	0.0063	0	0	0	0	0	0	0	0	0											2.8513	0	NO	0	12.8072	0.21692575	3.532069597	0	1.163615974	4.085788302	2.450205346	3.652095284	9.883059592	2.501081956	5.014429439	0.155027325	0	4.254347961	5.826830463	22.95672939	0.131400057	1.357569719	2.066647867	1.529001206	4.342625428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9267
H8684_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	Coin	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	1443.051381	98.75704002	1214.021807	1016.900124	237.4285866	18.23398517	0	287.6959962	328.6581272	3153.625357	2323.665003	44.07671407	0.050127425	719.1774479	2098.694729	6385.067044	351.0786178	908.9056726	0	0	269.3819216	0.004214012	0	0	1129.457918		45.70597436		0	0											6700	$200/day 1-7; unlimited additional days	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100; includes non-Medicare covered stays"	$0 per visit	$200 per trip	20%	20% for Prosthetics/Medical Supplies; $0 for Diabetes Monitoring Supplies/Diabetic Therapeutic Shoes and inserts	$65 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 to $30 per visit	$0 to $30 X-ray; $60 Therapeutic Radiology; 20% Complex Radiology	$30 per visit	20% per visit	$0 to 300 per visit	$10 PCP visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit; Chiropractic Visits $20 per visit; Preventive Services as described in the PBP lines 14a and e $0 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	Not Covered	Nursing Hotline	0											0	NO	144.5710156	96.15686456	71.93854446	0	200	0.03	0.03	62	300	3	16.23299738	30	0.2	30	10	30	30	15	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	129.8275673	86.35072359	64.60220388	0	179.6038671	0.02694058	0	55.67719879	269.4058006	2.694058006	14.57754552	26.94058006	0.179603867	26.94058006	8.980193353	26.94058006	26.94058006	13.47029003	0	0	44.90096676	0	0	0	0	0	0	0	0	0												15.6123	0.710645155	6.535707024	0	3.553591026	0.491234137	0	1.334842264	7.378533822	0.708004137	2.822777696	0.098954354	0.009003079	1.614588134	1.570557038	14.33478416	0.788188468	1.020268585	0	0	1.007959059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.592	0	NO	6.76736831	15.6123	0.710645155	6.535707024	0	3.553591026	0.491234137	0	1.334842264	7.378533822	0.708004137	2.822777696	0.098954354	0.009003079	1.614588134	1.570557038	14.33478416	0.788188468	1.020268585	0	0	1.007959059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.592	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 copay	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$65 copay	$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	$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	Not Covered	$500 ded; 20% coinsurance; $10000 max OOP	Not Covered	Nursing Hotline	0											10000	7.9991	0.1872	1.1941	0.2979	0.5215	0.5334	0	0.2716	1.406	0.6216	1.6769	0.0223	0.0015	0.9386	0.7943	4.0252	0.1221	0.3385	0	0	1.819	0	0	0	0.1906	0.0011	0.0093	0	0	0											22.9716	500	NO	3.156767826	23.6114	0.897889934	7.729822913	0.297877782	4.075044098	1.02460849	0	1.606465259	8.784534863	1.329565279	4.499659395	0.121206921	0.01046939	2.55321993	2.36481211	18.35995347	0.910261499	1.35881289	0	0	2.826963749	0	0	0	0.190626581	0.001079377	0.009252362	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5635
H8684_801_0	2012	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	292.3758967	3.541977886	37.61172329	8.267339695	12.06701367	14.2396518	0	15.91473751	43.22754563	25.76129587	62.07703884	1.549612327	0.048845662	28.78893323	34.19315618	139.798866	2.870750525	13.17789411	0	0	53.80064388	0.000215664																			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	NO	0.070669709	0.070669709	0.150498082	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.059154333	0.059154333	0.125974958	0	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0.187500002	0	0	0	0	0	0	0	0												17.2953	0.20952334	4.738135276	0	2.262565091	2.669934746	0	2.98401332	8.105164906	4.830243035	11.63944493	0.290552315	0.009158562	5.397925048	6.411216862	26.21228769	0.53826573	2.470855176	0	0	10.08762085	4.04E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.1522	0	NO	24.02825905	17.2953	0.20952334	4.738135276	0	2.262565091	2.669934746	0	2.98401332	8.105164906	4.830243035	11.63944493	0.290552315	0.009158562	5.397925048	6.411216862	26.21228769	0.53826573	2.470855176	0	0	10.08762085	4.04E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.1522	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	2.999	0.0363	0.8216	0	0.3923	0.463	0	0.5174	1.4054	0.8376	2.0183	0.0504	0.0016	0.936	1.1117	4.5452	0.0933	0.4284	0	0	1.7492	0	0	0	0	0	0	0	0	0											18.4069	0	NO	2.237629291	20.2943	0.245854935	5.559733543	0	2.654896557	3.132904592	0	3.501444763	9.510610096	5.667812897	13.65773846	0.34093443	0.010746667	6.333931642	7.522929457	30.75752941	0.631601645	2.899304389	0	0	11.83682625	4.74E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5592
H8684_802_0	2012	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	301.4835114	4.776957474	32.40101436	10.16784891	9.999056654	13.07639244	0	17.88035482	55.05396456	20.60750435	52.71850213	0.754304593	0.065876653	36.66295348	28.61158142	142.6633633	2.773075979	10.68393339	0	0	58.15202729	0.00029086																			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	NO	0.071935937	0.071935937	0.152531616	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060159991	0.060159991	0.127562119	0	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0.187331095	0	0	0	0	0	0	0	0												18.1372	0.287381718	4.133142042	0	1.873134235	2.449614919	0	3.349546452	10.31331948	3.860426362	9.875814746	0.141304706	0.012340746	6.868111233	5.359838885	26.72528409	0.51948336	2.001432943	0	0	10.89368297	5.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8012	0	NO	24.3089151	18.1372	0.287381718	4.133142042	0	1.873134235	2.449614919	0	3.349546452	10.31331948	3.860426362	9.875814746	0.141304706	0.012340746	6.868111233	5.359838885	26.72528409	0.51948336	2.001432943	0	0	10.89368297	5.45E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8012	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	3.1461	0.0498	0.7169	0	0.3249	0.4249	0	0.581	1.7889	0.6696	1.7131	0.0245	0.0021	1.1913	0.9297	4.6358	0.0901	0.3472	0	0	1.8896	0	0	0	0	0	0	0	0	0											18.5257	0	NO	2.263765359	21.2833	0.337230921	4.850076432	0	2.198047905	2.874524868	0	3.930558431	12.10226681	4.530055518	11.58887255	0.165815405	0.01448137	8.059453094	6.289555982	31.3610491	0.60959289	2.348601294	0	0	12.78330008	6.39E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.3269
H8684_805_0	2012	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	296.2052236	5.449090263	36.17060342	9.428252709	8.827952348	12.24011903	0	15.33386676	37.9449143	18.40053123	51.40418493	0.860437597	0.075145704	25.25133432	25.46502174	126.9598722	2.90985113	8.066070712	0	0	63.73843989	0.000331785																			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	NO	0.070638876	0.070638876	0.150445119	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.055217312	0.055217312	0.117600611	0	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0	0	0	0	0	0	0	0												16.3557	0.300884115	4.253685055	0	1.545750782	2.143212017	0	2.684918949	6.644052737	3.221883673	9.000734929	0.150660316	0.013157811	4.421440923	4.458857016	22.23033315	0.509507129	1.412347351	0	0	11.1604299	5.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5076	0	NO	22.67109768	16.3557	0.300884115	4.253685055	0	1.545750782	2.143212017	0	2.684918949	6.644052737	3.221883673	9.000734929	0.150660316	0.013157811	4.421440923	4.458857016	22.23033315	0.509507129	1.412347351	0	0	11.1604299	5.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5076	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	2.9115	0.0536	0.7572	0	0.2752	0.3815	0	0.478	1.1827	0.5735	1.6023	0.0268	0.0023	0.7871	0.7937	3.9573	0.0907	0.2514	0	0	1.9867	0	0	0	0	0	0	0	0	0											16.1116	0	NO	2.111243771	19.2672	0.354445574	5.010898763	0	1.820915414	2.524732862	0	3.162870985	7.826784355	3.795422722	10.60298798	0.177479898	0.01550008	5.208517454	5.252594119	26.18763436	0.600206318	1.66376436	0	0	13.14713798	6.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6191
H8684_806_0	2012	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	296.2052236	5.449090263	36.17060342	9.428252709	8.827952348	12.24011903	0	15.33386676	37.9449143	18.40053123	51.40418493	0.860437597	0.075145704	25.25133432	25.46502174	126.9598722	2.90985113	8.066070712	0	0	63.73843989	0.000331785																			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	NO	0.070638876	0.070638876	0.150445119	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.055217312	0.055217312	0.117600611	0	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0.175097318	0	0	0	0	0	0	0	0												16.3557	0.300884115	4.253685055	0	1.545750782	2.143212017	0	2.684918949	6.644052737	3.221883673	9.000734929	0.150660316	0.013157811	4.421440923	4.458857016	22.23033315	0.509507129	1.412347351	0	0	11.1604299	5.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5076	0	NO	22.67109768	16.3557	0.300884115	4.253685055	0	1.545750782	2.143212017	0	2.684918949	6.644052737	3.221883673	9.000734929	0.150660316	0.013157811	4.421440923	4.458857016	22.23033315	0.509507129	1.412347351	0	0	11.1604299	5.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5076	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	2.9115	0.0536	0.7572	0	0.2752	0.3815	0	0.478	1.1827	0.5735	1.6023	0.0268	0.0023	0.7871	0.7937	3.9573	0.0907	0.2514	0	0	1.9867	0	0	0	0	0	0	0	0	0											16.1116	0	NO	2.111243771	19.2672	0.354445574	5.010898763	0	1.820915414	2.524732862	0	3.162870985	7.826784355	3.795422722	10.60298798	0.177479898	0.01550008	5.208517454	5.252594119	26.18763436	0.600206318	1.66376436	0	0	13.14713798	6.84E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6191
H8707_001_0	2012	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		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	1345.91	158.26	250.63	1339.6	32.6	15.09	5.97	516.66	437.25	1035.88	1125.99	179.06	0.21	7.66	3480.29	4232.09	108.03	794.33		1964.8	29.02	0		4.32	0.61				4.09	0.81	2106.44	417.2									4900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	225	64.054543	105.723394	38.44663	0.2	0.2	15	33.845797	35	15		0	0.2	0		0	0				0	0	0	71.315615									NO	112.851079	99.100473	27.822224	0	178.2906	0.178291	0.178291	57.944445	200.576925	57.101615	94.247437	34.273364	0.178291	0.178291	13.371795	30.171937	31.200855	13.371795		0	0.178291	0		0	0				0	0	0	63.574519										12.6573	1.306970071	0.581090333	0	0.48435613	2.69041119	1.06439727	2.494798079	7.308521705	4.929201746	8.843472632	0.511415713	0.03744111	1.36570906	3.878143702	10.64086274	0.280885697	0.885134827	0	0	5.17400482	0	0	0	0	0	0	0	0	0	0	2.210274111	0	0	0	0	0	0	0	0	67.3444	0	NO	10.18073	12.6573	1.306970071	0.581090333	0	0.48435613	2.69041119	1.06439727	2.494798079	7.308521705	4.929201746	8.843472632	0.511415713	0.03744111	1.36570906	3.878143702	10.64086274	0.280885697	0.885134827	0	0	5.17400482	0	0	0	0	0	0	0	0	0	0	2.210274111	0	0	0	0	0	0	0	0	67.3444	YES	40% Coins	40% Coins	"40% Coins(Days 1-7), 40% (Days 8-100)"	40% Coins	$200/Trip	40% Coins	40% Coins	$65/Visit	40% Coins	40% Coins	40% Coins	40% Coins	20% Coins	40% Coins	40% Coins	40% Coins	40% Coins	40% Coins		40% Coins	20%-40% Coins	$0/Service		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						40% Coins	40% Coins									7300	5.0209	0.1888	0.2983	3.9307	3.3522	1.1897	0.4707	0.2465	2.7122	0.2711	1.0134	0.0486	0.0037	0.2724	1.6017	2.9086	0.0378	0.2529		0.3426	1.0858	0			0				0	0	0.2653	0.4989									26.0127	500	NO	14.929507	17.6782	1.495779071	0.879432333	3.930658	3.83656413	3.88010719	1.53512227	2.741325079	10.0207187	5.200292746	9.856880632	0.559977713	0.04109211	1.63807106	5.479802702	13.54944074	0.318702697	1.138083827	0	0.342568	6.25976882	0	0	0	0	0	0	0	0	0	0.265339	2.709170111	0	0	0	0	0	0	0	0	93.3571
H8707_003_0	2012	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	1145.18	64.29	342.26	1028.29	32.13	12.97	3.95	400.44	299.23	1045.4	936.96	76.11	0.16	7.95	3642.34	4226.44	134.72	599.23		1788.69	20.74	0			0.61				4.09	0.81	2103.26	359.71									3900	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$75/Visit: 5. $35 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$10-$150/Visit: 3. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											142.123915	124.806492	34.03605	0	200	0.2	0.2	65	195	66.110655	94.657414	40.302502	0.2	0.2	10	34.029468	35	10		0	0.2	0			0				0	0	0	73.897652									NO	111.583049	97.986949	26.747604	0	177.4482	0.177448	0.177448	57.670665	173.011995	58.656083	83.983938	35.758032	0.177448	0.177448	8.87241	30.192339	31.053435	8.87241		0	0.177448	0			0				0	0	0	65.565027										10.6486	0.524965079	0.762886245	0	0.475117556	2.30150056	0.7009196	1.924470091	4.314198272	5.109922431	6.557465879	0.226795318	0.02839168	1.4107116	2.69302782	10.63384244	0.348626564	0.443051187	0	0	3.68027152	0	0	0	0	0	0	0	0	0	0	1.965366322	0	0	0	0	0	0	0	0	54.7501	0	NO	8.70734	10.6486	0.524965079	0.762886245	0	0.475117556	2.30150056	0.7009196	1.924470091	4.314198272	5.109922431	6.557465879	0.226795318	0.02839168	1.4107116	2.69302782	10.63384244	0.348626564	0.443051187	0	0	3.68027152	0	0	0	0	0	0	0	0	0	0	1.965366322	0	0	0	0	0	0	0	0	54.7501	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									5800	3.9176	0.0622	0.3008	1.6982	2.9099	0.9007	0.274	0.1683	1.3655	0.1858	0.564	0.0149	0.0025	0.1869	1.0277	1.7244	0.0239	0.1323		0.2026	0.5208	0			0				0	0	0.2211	0.2886									16.6929	0	NO	9.565369	14.5661	0.587156079	1.063642245	1.698228	3.385057556	3.20222656	0.9749316	2.092758091	5.679702272	5.295772431	7.121482879	0.241731318	0.03093868	1.5975796	3.72075482	12.35821344	0.372506564	0.575370187	0	0.202561	4.20108952	0	0	0	0	0	0	0	0	0	0.221098	2.253996322	0	0	0	0	0	0	0	0	71.4429
H8707_005_0	2012	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	1311.45	48.29	363.6	1417.7	34.2	12	6.31	385.62	360.44	1055.07	1112.4	122.41	0.3	4.9	3051.62	4305.62	88.81	639.46		2154.33	23.16	0			0.61				4.09	0.81	1956.31	459.79									4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$175/Visit: 8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$75/Visit: 5. $40 Partial Hospitalization,7h. $75 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $75 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"											163.989133	116.360647	38.216144	0	200	0.2	0.2	65	225	61.602702	103.313675	48.049257	0.2	0.2	15	38.978022	40	15		0	0.2	0			0				0	0	0	78.093503									NO	129.556171	91.928285	30.434152	0	178.9652	0.178965	0.178965	58.16369	201.33585	55.123699	92.447762	42.995724	0.178965	0.178965	13.42239	34.878548	35.79304	13.42239		0	0.178965	0			0				0	0	0	69.880097										14.1589	0.36993474	0.922154806	0	0.51005082	2.14758	1.12926915	1.869090178	6.047457815	4.846613425	8.569907537	0.438592215	0.0536895	0.8769285	3.413336148	12.51448115	0.264898324	0.715256792	0	0	4.1448294	0	0	0	0	0	0	0	0	0	0	2.67751415	0	0	0	0	0	0	0	0	65.6705	0	NO	9.999943	14.1589	0.36993474	0.922154806	0	0.51005082	2.14758	1.12926915	1.869090178	6.047457815	4.846613425	8.569907537	0.438592215	0.0536895	0.8769285	3.413336148	12.51448115	0.264898324	0.715256792	0	0	4.1448294	0	0	0	0	0	0	0	0	0	0	2.67751415	0	0	0	0	0	0	0	0	65.6705	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									7300	4.683	0.0694	0.3508	2.884	4.0878	0.8251	0.434	0.2139	1.9264	0.233	0.8243	0.0311	0.0063	0.1519	1.2506	2.6088	0.0232	0.1802		0.3349	0.7855	0			0				0	0	0.1956	0.3981									22.498	500	NO	8.015389	18.8419	0.43932774	1.272949806	2.884036	4.59782782	2.972636	1.56331815	2.082992178	7.973815815	5.079623425	9.394231537	0.469709215	0.0599765	1.0288515	4.663959148	15.12332315	0.288137324	0.895437792	0	0.334883	4.9303494	0	0	0	0	0	0	0	0	0	0.195558	3.07560015	0	0	0	0	0	0	0	0	88.1684
H8707_007_0	2012	7																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0											0	YES	265.52	9.65	358.54	1431.28	31.39	16.51	15875.69	457.59	423.14	1287.73	1154.9	160.91	0.34	676.18	3770.94	5627	145.76	1327.48		2081.17	22.62	0			0.61				4.09	0.81											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $0 (Days 21-100): 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													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											NO	0	0	0	0	0	0.199689	0	0	0	0	0	0	0.199689	0	0	0	0	0		0	0.199689	0			0				0	0												0	0	0	0	0	3.29686539	0	0	0	0	0	0	0.06789426	0	0	0	0	0	0	0	4.51696518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.8817	0	NO	0.012279	0	0	0	0	0	3.29686539	0	0	0	0	0	0	0.06789426	0	0	0	0	0	0	0	4.51696518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.8817	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			"VIS775: Vision 17a,17b"																5100	3.6541	0.0651	0.2603	2.803	0	1.104	0.6409	0	2.3155	0.3648	0.9352	0.044	0.0068	0.6742	1.331	2.9854	0.0341	0.3689		0.2985	0.7263	0			0				0	0											18.6122	500	NO	10.787693	3.6541	0.065116	0.260328	2.803049	0	4.40084439	0.640913	0	2.315483	0.364814	0.935227	0.043957	0.07467526	0.674216	1.330995	2.985358	0.034127	0.368937	0	0.298472	5.24331318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.494
H8748_001_0	2012	5																															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	1338.243103	95.99540761	760.9569189	1154.093817	135.8667708	11.60826933	11.6539207	353.7332116	48.69548871	16.43099865	29.03615072	0	0.023826846	27.18696307	5601.917485	3437.086656	475.5834587	352.095416	0	0	15.35655093	742.7111155	0	0	35.33269012	0	12.49174281	65	455.5145167	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$20 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	188.6431743	98.80365233	66.94762456	0	200	0.2	0.10070564	62.22495817	0.16	0.241079122	0.185699921	0	0.2	0.145892947	12.93994569	39.34268621	38.5	40	0	0	0.2	38.16628089	0	0	40	0	20	352.5	0	0											YES	147.1576524	77.0752166	52.22481702	0	156.0169382	0.156016938	0.078558928	48.55805725	0.124813551	0.188062132	0.144861665	0	0.156016938	0.113808854	12.45740331	37.87991733	37.06429987	38.5083635	0	0	0.156016938	29.77293144	0	0	40	0	20	352.5	0	0											7500	16.4111	0.616572236	3.311736321	0	1.766459798	1.811086638	0.915519522	1.431383128	6.077856843	3.090048641	4.206225151	0	0.003717392	3.094117116	5.815445451	10.8497132	1.46893066	1.129884855	0	0	2.395882057	1.842723927	0	0	0.117775634	0	0.020819571	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	68.2863	0	NO	13.98689531	16.4111	0.616572236	3.311736321	0	1.766459798	1.811086638	0.915519522	1.431383128	6.077856843	3.090048641	4.206225151	0	0.003717392	3.094117116	5.815445451	10.8497132	1.46893066	1.129884855	0	0	2.395882057	1.842723927	0	0	0.117775634	0	0.020819571	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	68.2863	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.4225	0.0266	0.4983	0.6293	0.3862	0.9899	0.5963	0.313	1.9931	0.6756	1.3391	0	0.0008	1.0135	1.6694	2.6917	0.3623	0.2775	0	0	0.7598	0.4381	0	0	0.0291	0	0.0103	0	0	0											15.1223	0	NO	3.555953808	16.8336	0.643145861	3.810070517	0.629314586	2.152647671	2.800947401	1.511771651	1.744335134	8.070991312	3.765602828	5.54537141	0	0.004530097	4.107625058	7.484839807	13.5413726	1.831259131	1.40738253	0	0	3.15567648	2.280800638	0	0	0.14686047	0	0.031102408	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	83.4086
H8748_002_0	2012	5																															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	1112.159461	93.75116219	589.3552922	830.9732079	135.1521638	9.482288328	13.10241441	333.5846802	45.38661694	15.27670352	25.24306296	0	0.018406622	27.15674445	5325.93789	3064.554444	479.3437564	342.2542406	0	0	14.72319584	674.5287982	0	0	41.77693909	194.8519013	11.48371824	0	135.2211409	0											3600	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-41 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	157.9430369	97.17450918	65.9414011	0	200	0.2	0.108568399	62.31257961	0.16	0.224115743	0.185244083	0	0.2	0.145287051	6.902330348	29.70641635	38.5	30	0	0	0.2	28.93954112	0	0	30	30	30	0	0	0											YES	122.0963942	75.11984964	50.97538621	0	154.608138	0.154608138	0.08392779	48.18879933	0.12368651	0.173250588	0.143201213	0	0.154608138	0.112312803	6.636080443	28.56413496	37.01490427	28.84278255	0	0	0.154608138	22.37144284	0	0	30	30	30	0	0	0											9500	11.3159	0.586881101	2.503551136	0	1.741302033	1.466038943	1.099656684	1.339587101	5.613712269	2.646697871	3.614837249	0	0.002845814	3.050050076	2.945279356	7.294695561	1.478571938	0.822630386	0	0	2.276325894	1.257515204	0	0	0.104442348	0.487129753	0.028709296	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6763	0	NO	11.80924278	11.3159	0.586881101	2.503551136	0	1.741302033	1.466038943	1.099656684	1.339587101	5.613712269	2.646697871	3.614837249	0	0.002845814	3.050050076	2.945279356	7.294695561	1.478571938	0.822630386	0	0	2.276325894	1.257515204	0	0	0.104442348	0.487129753	0.028709296	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6763	NO	"$295 Days 1-33 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-33 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$15 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3421	0.027	0.4646	0.5218	0.4318	0.9088	0.7534	0.3321	2.0879	0.6563	1.3056	0	0.0007	1.1331	1.034	2.1799	0.3717	0.244	0	0	0.8187	0.4016	0	0	0.0306	0	0.0084	0	0	0											14.0541	0	NO	1.975399984	11.6579	0.613859405	2.968165523	0.521827356	2.173070054	2.374825473	1.853101253	1.671699234	7.701651114	3.302965124	4.920420021	0	0.003551453	4.183179632	3.979322329	9.474549394	1.850224695	1.06664164	0	0	3.095067003	1.659151467	0	0	0.13501084	0.487129753	0.037112016	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7305
H8748_003_0	2012	5																															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	1027.095383	93.93495661	313.5760601	613.2390485	113.5690328	5.939000066	10.5592891	292.2732034	39.27410898	17.88294527	24.36511022	0	0.208475806	17.94606231	4336.274731	3456.963607	476.2277758	821.7026428	0	0	24.17186348	645.4886466	0	0	41.02803234	176.9140967	12.08359241	0	140.2888338	0											4250	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	67.70576583	0	200	0.2	0.106150609	63.44726204	0.16	0.190490963	0.181960688	0	0.2	0.145632585	6.70342404	34.12725596	38.5	35	0	0	0.2	34.38350235	0	0	35	30	35	0	0	0											YES	157.0007321	82.23062297	55.39393516	0	163.6313672	0.163631367	0.086847847	51.92762739	0.130905094	0.155851483	0.148872381	0	0.163631367	0.119150295	6.500133168	33.0958203	37.33243272	33.9385752	0	0	0.163631367	28.1310975	0	0	35	30	35	0	0	0											7000	13.4379	0.643694167	1.447517662	0	1.548621342	0.971806701	0.91705152	1.2647545	5.14118092	2.787083549	3.627291961	0	0.034113181	2.138278622	2.3488636	9.534253861	1.481561783	2.323951411	0	0	3.955275069	1.513192004	0	0	0.119665094	0.442285242	0.035243811	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7136	0	NO	9.252278099	13.4379	0.643694167	1.447517662	0	1.548621342	0.971806701	0.91705152	1.2647545	5.14118092	2.787083549	3.627291961	0	0.034113181	2.138278622	2.3488636	9.534253861	1.481561783	2.323951411	0	0	3.955275069	1.513192004	0	0	0.119665094	0.442285242	0.035243811	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7136	NO	"$325 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.3201	0.0257	0.2044	0.4337	0.343	0.5382	0.5741	0.2802	1.7082	0.6174	1.1725	0	0.0076	0.7093	1.0871	2.7138	0.3661	0.6535	0	0	1.2709	0.4141	0	0	0.0338	0	0.0099	0	0	0											13.4834	0	NO	2.34329219	13.758	0.669389663	1.651891934	0.433704724	1.891655966	1.509968188	1.491148439	1.544922956	6.849412959	3.404449544	4.799766931	0	0.041669581	2.847541834	3.435921688	12.24803866	1.847653967	2.977403387	0	0	5.226156988	1.927313868	0	0	0.15343817	0.442285242	0.045190671	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1969
H8748_004_0	2012	5																															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	1271.792525	92.87480542	628.1127138	972.6146219	179.0298275	10.69616269	11.05366742	445.182818	56.84659078	17.22437048	30.87279676	0	0.024634613	33.85403413	5475.876721	3325.330377	484.6106664	372.3339529	0	0	15.26294436	750.2810339	0	0	42.9973065	185.2348618	11.49083863	0	135.2812935	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $17 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	67.22500685	0	200	0.2	0.101162948	62.45595118	0.16	0.201593445	0.182787597	0	0.2	0.145198436	9.953323695	29.62827998	38.5	30	0	0	0.2	28.75463168	0	0	30	30	30	0	0	0											YES	144.5694143	77.19529274	51.93866248	0	154.5218511	0.154521851	0.07815943	48.26853813	0.123617481	0.155752962	0.141223389	0	0.154521851	0.112181656	9.568601101	28.48773428	37.01187198	28.84041973	0	0	0.154521851	22.21609457	0	0	30	30	30	0	0	0											5200	15.3219	0.597458149	2.718611187	0	2.305335028	1.652790859	0.863948347	1.790693652	7.027232347	2.682746713	4.35996099	0	0.003806586	3.797801595	4.366373336	7.894260679	1.494695662	0.894855623	0	0	2.358458415	1.3890262	0	0	0.107493266	0.463087154	0.028727097	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1192	0	NO	14.38147507	15.3219	0.597458149	2.718611187	0	2.305335028	1.652790859	0.863948347	1.790693652	7.027232347	2.682746713	4.35996099	0	0.003806586	3.797801595	4.366373336	7.894260679	1.494695662	0.894855623	0	0	2.358458415	1.3890262	0	0	0.107493266	0.463087154	0.028727097	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1192	NO	"$295 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $17 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$25 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"												0.2954	0.0182	0.2874	0.4744	0.4541	0.8139	0.5047	0.3528	2.0763	0.5284	1.2542	0	0.0007	1.1211	1.5894	2.2888	0.3634	0.2568	0	0	0.6739	0.3526	0	0	0.0315	0	0.0084	0	0	0											13.7466	0	NO	4.796215333	15.6172	0.615648073	3.006034159	0.47443593	2.759440498	2.466708749	1.368621542	2.143495899	9.103571321	3.211194831	5.614186922	0	0.004556408	4.918927522	5.955739018	10.18309414	1.858120479	1.151614216	0	0	3.032344826	1.741657779	0	0	0.13895471	0.463087154	0.037135027	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8658
H8822_001_0	2012	8																															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	Coin	Coin	Coin	Coin																																																			0	YES	296.3747489	2.9171261	55.62467256	39.25748413	8.042859588	13.93703	5.492123869	9.236894523	0.060106506	23.8274138	42.76358659	0	0	53.10645794	21.00777687	24.06246022	1.422280355	6.839141191	27.61736431	74.02182472	28.70646266	2.938243963	0.644163786	466.3112928	305.9020314	50.56687736	0	0	0	0											6700	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		$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years																	0.075279444	0.075279444	0.191703929	0	0.224	0.224	0.224	0.223971306	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	10	20	0	0	0	0	0											NO	0.074312743	0.074312743	0.189242164	0	0.221123505	0.221123505	0.221123505	0.22109518	0.221123505	0.221123505	0.221123505	0	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	9.871585038	19.74317008	0	0	0	0	0												22.0244	0.216779643	10.5265334	0	1.778465301	3.081804921	1.214437679	2.042232854	0.013290961	5.268801251	9.456034147	0	0	11.74308611	4.64531325	5.320775539	0.314499617	1.51229487	6.106848392	16.36796532	6.347673635	0.649714803	0	0.383602632	0.503289653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5179			1.473112054	22.0244	0.216779643	10.5265334	0	1.778465301	3.081804921	1.214437679	2.042232854	0.013290961	5.268801251	9.456034147	0	0	11.74308611	4.64531325	5.320775539	0.314499617	1.51229487	6.106848392	16.36796532	6.347673635	0.649714803	0	0.383602632	0.503289653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5179	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	22.0244	0.216779643	10.5265334	0	1.778465301	3.081804921	1.214437679	2.042232854	0.013290961	5.268801251	9.456034147	0	0	11.74308611	4.64531325	5.320775539	0.314499617	1.51229487	6.106848392	16.36796532	6.347673635	0.649714803	0	0.383602632	0.503289653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5179
H8822_004_0	2012	6																															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	205.1356946	3.97853393	75.00561719	108.7536385	171.0171723	8.580779314	3.261059518	280.3016698	1.000249519	2441.330324	1412.839795	0	0	980.2442473	3050.264747	2962.072293	166.9514987	678.3745501	5639.769501	5204.496504	20.9840724	333.217629	0	381.3211171	221.5609973	41.35052799	0	0	0	5075.344085											3400	Days 1-5: $100 copay	Days 1-5: $100 copay			$50 copay/trip	20% coinsurance	20% coinsurance for prosthetics/medical supplies; 0% - 20% for diabetes monitoring supplies	$50 copay/visit	$100 copay/visit		$0 copay/visit for x-rays; $50 copay/visit for all other			$100 copay/visit for outpatient hospital surgeries; $25 copay/visit for outpatient substance abuse services; 20% coinsurance for renal dialysis; $0 copay for all other	"$0 copay for immunizations and routine exams, $10 copay for all other"	$20 copay/visit for chiro; $25 copay/visit for all other	$25 copay/visit	$25 copay/visit	$0 copay/visit for lab; $0 copay/visit for x-ray; $50 copay/visit for diagnostic/therapeutic radiology	20% for nutritional training and dialysis; $0 copay/visit for all other	20% coinsurance	$25 copay/visit for Medicare covered eye exams; $0 copay/visit for all other		$10 copay/visit	$20 copay/visit	$0 copay; $100 limit every two years				$0 copay/visit for health education/wellness programs; $50 annual copay for gym benefits (add'l $10 for at-home gym benefits); Days 1-5: $100 copay for IP-acute non-Medicare covered stays													354.8896777	354.8896777	0	0	50	0.2	0.13022493	50	100	0	5.6	0	0	24.96274537	8.354056933	24.58344292	25	25	0	0.037913773	0.2	22.2383343	0	10	20	0	0	0	0	4.166666667											NO	326.8332199	326.8332199	0	0	46.0471578	0.184188631	0.119929758	46.0471578	92.09431561	0	5.157281674	0	0	22.98926951	7.693611558	22.63995351	23.0235789	23.0235789	0	0.03491643	0.184188631	20.48024178	0	9.209431561	18.41886312	0	0	0	0	3.83726315												5.5871	0.108359755	0	0	0.656237893	1.580481997	0.391098079	1.075591269	0.007676441	0	0.607201065	0	0	1.877924932	1.955629343	5.588431583	0.320318417	1.301550832	0	0.015143537	3.865027573	0.568698134	0	0.292645894	0.34007514	0	0	0	0	1.622952569	0	0	0	0	0	0	0	0	0	0	27.7621			2.471951773	5.5871	0.108359755	0	0	0.656237893	1.580481997	0.391098079	1.075591269	0.007676441	0	0.607201065	0	0	1.877924932	1.955629343	5.588431583	0.320318417	1.301550832	0	0.015143537	3.865027573	0.568698134	0	0.292645894	0.34007514	0	0	0	0	1.622952569	0	0	0	0	0	0	0	0	0	0	27.7621	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	5.5871	0.108359755	0	0	0.656237893	1.580481997	0.391098079	1.075591269	0.007676441	0	0.607201065	0	0	1.877924932	1.955629343	5.588431583	0.320318417	1.301550832	0	0.015143537	3.865027573	0.568698134	0	0.292645894	0.34007514	0	0	0	0	1.622952569	0	0	0	0	0	0	0	0	0	0	27.7621
H8822_005_0	2012	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	V	V																																																			0	YES	260.1115883	2.229978708	74.61927192	28.86875781	7.60824927	12.79895429	5.748860127	8.041536159	0.089335991	20.05447569	40.32251384	0	0	44.99207639	30.76369753	35.22560799	2.057359048	9.900625856	44.44970454	105.2721187	49.80889572	4.762949189	268.2228857	539.3508298	338.987921	56.03611245	0	0	0	314.7446109											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing				$0 copay; $150 limit every two years																	0.075279444	0.075279444	0.191703929	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.199266404	0	0	0	0	0	0	0	0											YES	0.075279444	0.075279444	0.191703929	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.199266404	0	0	0	0	0	0	0	0											3300	19.5811	0.167871557	14.30480762	0	1.704247837	2.866965761	1.287744669	1.8013041	0.020011262	4.492202555	9.0322431	0	0	10.07822511	6.891068247	7.890536189	0.460848427	2.217740192	9.956733818	23.58095458	11.15719264	0.94909576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4408			0	19.5811	0.167871557	14.30480762	0	1.704247837	2.866965761	1.287744669	1.8013041	0.020011262	4.492202555	9.0322431	0	0	10.07822511	6.891068247	7.890536189	0.460848427	2.217740192	9.956733818	23.58095458	11.15719264	0.94909576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4408	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	19.5811	0.167871557	14.30480762	0	1.704247837	2.866965761	1.287744669	1.8013041	0.020011262	4.492202555	9.0322431	0	0	10.07822511	6.891068247	7.890536189	0.460848427	2.217740192	9.956733818	23.58095458	11.15719264	0.94909576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4408
H8822_801_0	2012	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	YES	168.9575318	1.602618623	49.31444123	20.74710791	5.391841408	9.057603555	4.107544517	5.453536525	0.062543736	14.1951928	27.46267766	0	0	26.54116246	19.41735793	25.09476391	1.276054045	6.895901471	31.78901343	71.99003711	26.85380673	3.410016214	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078747604	0.078747604	0.190217133	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0	0	0	0	0	0												13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049			1.09928587	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049
H8822_802_0	2012	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	YES	168.9575318	1.602618623	49.31444123	20.74710791	5.391841408	9.057603555	4.107544517	5.453536525	0.062543736	14.1951928	27.46267766	0	0	26.54116246	19.41735793	25.09476391	1.276054045	6.895901471	31.78901343	71.99003711	26.85380673	3.410016214	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078747604	0.078747604	0.190217133	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0	0	0	0	0	0												13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049			1.09928587	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049
H8822_803_0	2012	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	YES	168.9575318	1.602618623	49.31444123	20.74710791	5.391841408	9.057603555	4.107544517	5.453536525	0.062543736	14.1951928	27.46267766	0	0	26.54116246	19.41735793	25.09476391	1.276054045	6.895901471	31.78901343	71.99003711	26.85380673	3.410016214	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078747604	0.078747604	0.190217133	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0	0	0	0	0	0												13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049			1.09928587	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049
H8822_804_0	2012	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	YES	168.9575318	1.602618623	49.31444123	20.74710791	5.391841408	9.057603555	4.107544517	5.453536525	0.062543736	14.1951928	27.46267766	0	0	26.54116246	19.41735793	25.09476391	1.276054045	6.895901471	31.78901343	71.99003711	26.85380673	3.410016214	0	0	0	0	0	0	0	0											6700	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing																					0.079771996	0.079771996	0.192691581	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.078747604	0.078747604	0.190217133	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0.221123505	0	0	0	0	0	0	0	0												13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049			1.09928587	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	13.305	0.126202376	9.380451631	0	1.19226287	2.002849044	0.90827464	1.20590511	0.01382989	3.138890783	6.072643537	0	0	5.868874867	4.29363424	5.549042149	0.282165543	1.524845902	7.029298064	15.91868932	5.938007862	0.754034737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5049
H8953_001_0	2012	4	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	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	1127.97	40.22	343.48	1149.36	8.42	11.37	2.3	316.9	381.45	1185.33	923.22	102.05	0.67	9.04	5055.09	3480.28	49.51	522.64		453.53	20.8	0		2.49	1.52		0.24		4.33	1.61	801.37	252.74									3750	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	204.733543	22.939235	84.591871	40.729896	0.2	0.2	10	39.907938	40	42.103009		0	0.2	0		0	0		0		0	0	0	84.87988									NO	135.630984	108.682244	30.075207	0	0.177522	0.177522	0.177522	57.694715	181.723745	20.361117	75.084675	36.152303	0.177522	0.177522	8.87611	35.422725	35.50444	37.371094		0	0.177522	0		0	0		0		0	0	0	75.340315										12.749	0.364266654	0.860852675	0	1.49473524	2.01842514	0.4083006	1.523621265	5.776543544	2.011220234	5.776639471	0.30744521	0.11893974	1.60479888	3.739127908	10.27341678	0.146485402	1.627635714	0	0	3.6924576	0	0	0	0	0	0	0	0	0	0	1.586792601	0	0	0	0	0	0	0	0	56.0807	0	NO	8.186906	12.749	0.364266654	0.860852675	0	1.49473524	2.01842514	0.4083006	1.523621265	5.776543544	2.011220234	5.776639471	0.30744521	0.11893974	1.60479888	3.739127908	10.27341678	0.146485402	1.627635714	0	0	3.6924576	0	0	0	0	0	0	0	0	0	0	1.586792601	0	0	0	0	0	0	0	0	56.0807	NO																																																																																		0	0	NO	0	12.749	0.364266654	0.860852675	0	1.49473524	2.01842514	0.4083006	1.523621265	5.776543544	2.011220234	5.776639471	0.30744521	0.11893974	1.60479888	3.739127908	10.27341678	0.146485402	1.627635714	0	0	3.6924576	0	0	0	0	0	0	0	0	0	0	1.586792601	0	0	0	0	0	0	0	0	56.0807
H8953_002_0	2012	4	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	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	1622.81	65.11	565.72	2692.76	10.44	15.34	4.36	408.39	319.82	669.62	1391.9	105.5	0.58	4.55	4700.83	4910.51	97.14	768.02		2107.07	30.99	0		2.49	0.6				4.33	1.28	830.93	381.15									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0				0	0	0	75.810065									NO	134.864827	108.068315	29.831441	0	0.178659	0.178659	0.178659	58.064175	180.714234	31.617715	73.731419	36.703819	0.178173	0.178659	8.93295	35.097315	35.7318	37.579177		0	0.178659	0		0	0				0	0	0	67.720752										18.2383	0.586360666	1.406353567	0	1.86519996	2.74062906	0.77895324	1.976069036	4.816335526	1.764321193	8.552230176	0.322687742	0.10334034	0.81289845	3.499356612	14.36214302	0.289248921	2.40512996	0	0	5.53664241	0	0	0	0	0	0	0	0	0	0	2.150980385	0	0	0	0	0	0	0	0	72.2072	0	NO	10.471975	18.2383	0.586360666	1.406353567	0	1.86519996	2.74062906	0.77895324	1.976069036	4.816335526	1.764321193	8.552230176	0.322687742	0.10334034	0.81289845	3.499356612	14.36214302	0.289248921	2.40512996	0	0	5.53664241	0	0	0	0	0	0	0	0	0	0	2.150980385	0	0	0	0	0	0	0	0	72.2072	NO																																																																																		0	0	NO	0	18.2383	0.586360666	1.406353567	0	1.86519996	2.74062906	0.77895324	1.976069036	4.816335526	1.764321193	8.552230176	0.322687742	0.10334034	0.81289845	3.499356612	14.36214302	0.289248921	2.40512996	0	0	5.53664241	0	0	0	0	0	0	0	0	0	0	2.150980385	0	0	0	0	0	0	0	0	72.2072
H8953_003_0	2012	4	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	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	1602.3	64.28	558.57	2658.72	9.97	14.64	4.17	403.23	315.77	661.15	1374.3	104.17	0.55	4.34	4641.41	4848.44	95.91	758.31		2080.44	29.59	0		2.49	0.6		0.24		4.33	1.61	820.43	376.33									3900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0		0		0	0	0	75.810065									NO	124.808685	100.010245	27.455146	0	0.171621	0.171621	0.171621	55.776695	173.594867	30.372113	70.826717	35.257846	0.171154	0.171621	8.58103	33.714631	34.32412	36.098718		0	0.171621	0		0	0		0		0	0	0	65.052844										16.6651	0.535721546	1.277968408	0	1.71106137	2.51253144	0.71565957	1.874236394	4.568004263	1.673376876	8.111429764	0.306067485	0.0941347	0.74483514	3.319006538	13.62194713	0.274335529	2.281168237	0	0	5.07826539	0	0	0	0	0	0	0	0	0	0	2.040111399	0	0	0	0	0	0	0	0	67.4049	0	NO	13.796775	16.6651	0.535721546	1.277968408	0	1.71106137	2.51253144	0.71565957	1.874236394	4.568004263	1.673376876	8.111429764	0.306067485	0.0941347	0.74483514	3.319006538	13.62194713	0.274335529	2.281168237	0	0	5.07826539	0	0	0	0	0	0	0	0	0	0	2.040111399	0	0	0	0	0	0	0	0	67.4049	NO																																																																																		0	0	NO	0	16.6651	0.535721546	1.277968408	0	1.71106137	2.51253144	0.71565957	1.874236394	4.568004263	1.673376876	8.111429764	0.306067485	0.0941347	0.74483514	3.319006538	13.62194713	0.274335529	2.281168237	0	0	5.07826539	0	0	0	0	0	0	0	0	0	0	2.040111399	0	0	0	0	0	0	0	0	67.4049
H8953_005_0	2012	4	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	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	1479.47	59.35	515.75	2454.91	9.42	13.83	3.94	372.32	291.57	610.47	1268.95	96.18	0.52	4.1	4285.61	4476.77	88.56	700.18		1920.96	27.96	0		2.49	0.6		0.24		4.33	1.61	757.54	347.48									3950	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS768: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0		0		0	0	0	75.810065									NO	129.028618	103.391712	28.447671	0	0.174499	0.174499	0.174499	56.712175	176.506379	30.88151	72.014614	35.849186	0.174025	0.174499	8.72495	34.280089	34.8998	36.704161		0	0.174499	0		0	0		0		0	0	0	66.143902										15.9078	0.511358176	1.222657193	0	1.64378058	2.41332117	0.68752606	1.75958975	4.288663744	1.571019617	7.61524537	0.287331226	0.090493	0.7154459	3.115977747	12.78867284	0.257560524	2.141626621	0	0	4.87899204	0	0	0	0	0	0	0	0	0	0	1.915306922	0	0	0	0	0	0	0	0	63.8124	0	NO	11.436302	15.9078	0.511358176	1.222657193	0	1.64378058	2.41332117	0.68752606	1.75958975	4.288663744	1.571019617	7.61524537	0.287331226	0.090493	0.7154459	3.115977747	12.78867284	0.257560524	2.141626621	0	0	4.87899204	0	0	0	0	0	0	0	0	0	0	1.915306922	0	0	0	0	0	0	0	0	63.8124	NO																																																																																		0	0	NO	0	15.9078	0.511358176	1.222657193	0	1.64378058	2.41332117	0.68752606	1.75958975	4.288663744	1.571019617	7.61524537	0.287331226	0.090493	0.7154459	3.115977747	12.78867284	0.257560524	2.141626621	0	0	4.87899204	0	0	0	0	0	0	0	0	0	0	1.915306922	0	0	0	0	0	0	0	0	63.8124
H8953_006_0	2012	4	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	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	1644.28	65.97	573.21	2728.38	9.93	14.58	4.15	413.8	324.05	678.48	1410.31	106.9	0.55	4.33	4763.03	4975.48	98.42	778.18		2134.95	29.47	0		2.49	1.52		0.24		4.33	1.61	841.93	386.19									3950	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-6): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$40/Visit: 7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.405866	34.03605	0	0.2	0.2	0.2	65	202.300734	35.394484	82.538712	41.088128	0.199456	0.2	10	39.289725	40	42.068048		0	0.2	0		0	0		0		0	0	0	75.810064									NO	124.297039	99.600259	27.329451	0	0.171335	0.171335	0.171335	55.68381	173.305779	30.321534	70.708769	35.199131	0.170869	0.171335	8.56674	33.658486	34.26696	36.038603		0	0.171335	0		0	0		0		0	0	0	64.944511										17.0316	0.547552424	1.305459551	0	1.70135655	2.4980643	0.71104025	1.920163382	4.67997814	1.714379532	8.310107001	0.313565592	0.09397795	0.74188055	3.400303302	13.95559366	0.281046184	2.33704334	0	0	5.04924245	0	0	0	0	0	0	0	0	0	0	2.090076725	0	0	0	0	0	0	0	0	68.6824	0	NO	14.265346	17.0316	0.547552424	1.305459551	0	1.70135655	2.4980643	0.71104025	1.920163382	4.67997814	1.714379532	8.310107001	0.313565592	0.09397795	0.74188055	3.400303302	13.95559366	0.281046184	2.33704334	0	0	5.04924245	0	0	0	0	0	0	0	0	0	0	2.090076725	0	0	0	0	0	0	0	0	68.6824	NO																																																																																		0	0	NO	0	17.0316	0.547552424	1.305459551	0	1.70135655	2.4980643	0.71104025	1.920163382	4.67997814	1.714379532	8.310107001	0.313565592	0.09397795	0.74188055	3.400303302	13.95559366	0.281046184	2.33704334	0	0	5.04924245	0	0	0	0	0	0	0	0	0	0	2.090076725	0	0	0	0	0	0	0	0	68.6824
H8953_007_0	2012	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	T	V	V		V		O	O	O	V	V								0	0	0	0	0	1.049481025	0.265975702	0	2.145156192	0.265892752	1.006475225	0.062293785	0.035151705	0.721112929	0	3.145596229	0.060855921	0.215914123		0	1.245879258	0	0	0	0		0		0	0	0	0	0								10.2198	YES	401.31	8.62	51.98	55.28	18.14	25	6.34	690.99	51.1	6.33	23.98	1.48	0.84	17.18	45.88	74.93	1.45	5.14		1737.1	29.68	0	2.75	4.14	2.5		0.24		4.33	1.61	1348.93	368.86	234.99								6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	0% Coins: 6. 0% Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"0% Coins: 4b, 7a, 8a, 8b. 0% Physician Services PCP,4b, 7a, 8a, 8b. 0% PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.085	0.085	0.1718	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2		0	0.2	0	0	0	0		0		0	0	0	0	0								NO	0.067886	0.067886	0.124437	0	0.181762	0.181762	0.181762	59.07252	0.181762	0.181762	0.181762	0.181762	0.181762	0.181762	0	0.181762	0.181762	0.181762		0	0.181762	0	0	0	0		0		0	0	0	0	0									27.2433	0.58517732	6.46823526	0	3.29716268	4.54405	1.15237108	3.401543383	9.2880382	1.15055346	4.35865276	0.26900776	0.15268008	3.12267116	0	13.61942666	0.2635549	0.93425668	0	0	5.39469616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2454	162	YES	14.590061	27.2433	0.58517732	6.46823526	0	3.29716268	5.593531025	1.418346782	3.401543383	11.43319439	1.416446212	5.365127985	0.331301545	0.187831785	3.843784089	0	16.76502289	0.324410821	1.150170803	0	0	6.640575418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4652	NO																																																																																		0	0	NO	0	27.2433	0.58517732	6.46823526	0	3.29716268	5.593531025	1.418346782	3.401543383	11.43319439	1.416446212	5.365127985	0.331301545	0.187831785	3.843784089	0	16.76502289	0.324410821	1.150170803	0	0	6.640575418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4652
H8953_008_0	2012	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		V	Coin	Coin	T	V	V		V		O	O	O	V	V								0	0	0	0	0	1.051284254	0.266432627	0	2.148842005	0.266349572	1.008204726	0.062400858	0.035212101	0.722351893	0	3.151001041	0.060960531	0.216285108		0	1.248019951	0	0	0	0		0		0	0	0	0	0								10.2373	YES	410.63	8.82	53.19	56.56	18.57	25.58	6.48	694.12	52.29	6.48	24.53	1.52	0.86	17.58	4796.26	76.67	1.48	5.26		1744.95	30.37	0	2.75	4.14	2.5		0.24		4.33	2.27	1355.03	370.52	236.05								6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	0% Coins: 6. 0% Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20% Coins: 9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	20% Coins: 8a. 20% Lab -- OP	"20% Coins: 8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 20% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	"20% Coins: 5. 20% Partial Hospitalization,7h. 20% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20% Coins: 3. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a, 9c, 9d, 14d. 20% OP Other,8b. 20% Rad therapy,3, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF,9a. 20% Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"20% Coins: 7b. 20% Chiropractic,7f. 20% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 20% Spec Cap"	"20% Coins: 7e, 7h. 20% Psych -- Other Provider"	"20% Coins: 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7i. 20% Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"20% Coins: 9d, 7g. 20% Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 17a,17b"		"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"										0.0781	0.0781	0.1684	0	0.2	0.2	0.2	65	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2		0	0.2	0	0	0	0		0		0	0	0	0	0								NO	0.062961	0.062961	0.122805	0	0.181834	0.181834	0.181834	59.09618	0.181834	0.181834	0.181834	0.181834	0.181834	0.181834	0	0.181834	0.181834	0.181834		0	0.181834	0	0	0	0		0		0	0	0	0	0									25.8537	0.55531602	6.53199795	0	3.37665738	4.65131372	1.17828432	3.418320038	9.50809986	1.17828432	4.46038802	0.27638768	0.15637724	3.19664172	0	13.94121278	0.26911432	0.95644684	0	0	5.52229858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0308	162	YES	13.97933	25.8537	0.55531602	6.53199795	0	3.37665738	5.702597974	1.444716947	3.418320038	11.65694187	1.444633892	5.468592746	0.338788538	0.191589341	3.918993613	0	17.09221382	0.330074851	1.172731948	0	0	6.770318531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2682	NO																																																																																		0	0	NO	0	25.8537	0.55531602	6.53199795	0	3.37665738	5.702597974	1.444716947	3.418320038	11.65694187	1.444633892	5.468592746	0.338788538	0.191589341	3.918993613	0	17.09221382	0.330074851	1.172731948	0	0	6.770318531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2682
H8953_801_0	2012	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	248.61	2.89	44.37	24.7	8.49	13.74	4.17	23.95	63.67	8.58	29.55	0.66	0.47	18.62	37.83	94.9	0.65	7.49		15.38	32.82	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																					0.085	0.085	0.1718	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07145	0.07145	0.133058	0	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982	0.19982		0.19982	0.19982	0																				17.7632	0.2064905	5.90378346	0	1.6964718	2.7455268	0.8332494	4.785689	12.7225394	1.7144556	5.904681	0.1318812	0.0939154	3.7206484	7.5591906	18.962918	0.129883	1.4966518	0	3.0732316	6.5580924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0025	0	NO	13.854896	17.7632	0.2064905	5.90378346	0	1.6964718	2.7455268	0.8332494	4.785689	12.7225394	1.7144556	5.904681	0.1318812	0.0939154	3.7206484	7.5591906	18.962918	0.129883	1.4966518	0	3.0732316	6.5580924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0025	NO																																																																																		0	0	NO	0	17.7632	0.2064905	5.90378346	0	1.6964718	2.7455268	0.8332494	4.785689	12.7225394	1.7144556	5.904681	0.1318812	0.0939154	3.7206484	7.5591906	18.962918	0.129883	1.4966518	0	3.0732316	6.5580924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0025
H8953_802_0	2012	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	246.03	2.86	43.91	24.45	8.4	13.6	4.13	23.71	63.01	8.49	29.25	0.65	0.47	18.42	37.43	93.92	0.64	7.41		15.22	32.48	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																					0.085	0.085	0.1718	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07164	0.07164	0.133719	0	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149		0.200149	0.200149	0																				17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013	0	NO	13.517737	17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013	NO																																																																																		0	0	NO	0	17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013
H8953_803_0	2012	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	246.03	2.86	43.91	24.45	8.4	13.6	4.13	23.71	63.01	8.49	29.25	0.65	0.47	18.42	37.43	93.92	0.64	7.41		15.22	32.48	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																					0.085	0.085	0.1718	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.07164	0.07164	0.133719	0	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149	0.200149		0.200149	0.200149	0																				17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013	0	NO	13.517737	17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013	NO																																																																																		0	0	NO	0	17.6256	0.2048904	5.87160129	0	1.6812516	2.7220264	0.82661537	4.74553279	12.61138849	1.69926501	5.85435825	0.13009685	0.09407003	3.68674458	7.49157707	18.79799408	0.12809536	1.48310409	0	3.04626778	6.50083952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2013
H8980_002_0	2012	9																															D	D	D	COIN	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	V	P	O											0	0	0	0	-9.95E-22	0	0	0	-5.11E-20	0	0	-3.39E-21	-1.21E-23	-3.40E-22	-4.36E-20	-6.53E-20	-3.69E-21	-7.15E-21	0	-1.45E-20	0	0	0	0	0	0	0	0	0	0											0	YES	1268.499508	31.93356547	1030.474409	0	296.9491776	12.32026815	11.00153172	469.9883449	478.4098963	13.95053314	34.32445247	69.51409359	0	0	4265.386195	143.8832162	160.4914387	842.9888707	15.4266086	12.9738648	27.77878984	0	0	0	0	0	0	0	0	0											4900	1a $185 days 1-6	1b $185 days 1-6	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $100	11a 20%	"11b 20%,"	"4a $65, 4b $50"	"9a $175, 9b $175"	"8a Lab $0, 8a $0-$20 (other Dx), 14a $0"	"8b $60 (Therapeutic),8b $105(MRI/CT/PETS),8b 15% (CT Drugs)"	"9a $175, 9b $175"	12a $0	"3 $0, 9a $0 , 9d $0, Other $0"	"7a $5, 14a $0, 17a $35"	"7b $20 , 7d $35, 7f $35, 8a $0, 14a $0, 17a $35, 17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b $20 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$35"	"11c 20% , 15 20%"				17a $0				14c $0													NO	150.3489313	163.3766234	36.54317219	0	100	0.198725818	0.2	64.02459107	175	0.070242273	0.22397158	175	0	0	4.859668813	0.095287396	35	35	0.158489999	0.41339562	0.193981209	0	0	0	0	0	0	0	0	0											NO	132.1842321	143.6379582	32.12813762	0	87.9183051	0.174716371	0.17583661	56.29365986	153.8570339	0.061755816	0.198688934	153.8570339	0	0	4.272538454	0.083775064	30.77140678	30.77140678	0.139346813	0.363450423	0.170544991	0	0	0	0	0	0	0	0	0												13.973	0.382239345	2.758935301	0	2.1756057	2.152552538	1.934472045	2.204780336	6.133893971	0.861526555	6.819888869	0.891269355	0	0	1.518668878	12.05382564	0.411545612	2.161662788	2.149648741	4.715356645	4.737533468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0364	0	NO	9.279873661	13.973	0.382239345	2.758935301	0	2.1756057	2.152552538	1.934472045	2.204780336	6.133893971	0.861526555	6.819888869	0.891269355	-1.21E-23	-3.40E-22	1.518668878	12.05382564	0.411545612	2.161662788	2.149648741	4.715356645	4.737533468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0364	YES					100	0.2	0.2	"4a $65, 4b $25"	0.2	"8a Lab $0, 8a $0-$20 (other Dx), 14a $0"	0.2	0.2	0.2	0.2	0.2	0.2	0.45	0.2	0.2	0.2	0.2																				10000	2.3245	0.0013	0.3902	0	0.174	0.1676	0.1468	0.1165	0.8868	0.0874	0.3714	0.0524	0.0001	0.0055	0.3311	0.6397	0	0.1161	0.1623	0.0437	0.3701	0	0	0	0	0.0002	0	0	0	0											6.3878	500	NO	0	16.2975	0.383512017	3.149110165	0	2.349626919	2.320120712	2.081309674	2.321323997	7.020673734	0.948932624	7.191241604	0.943626259	9.07E-05	0.00553275	1.849811744	12.69356526	0.411545612	2.277801669	2.311996214	4.759101234	5.107623984	0	0	6.83E-06	0	0.00015428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4242
H8980_003_0	2012	10																															D	D	D	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	V	P	O											16.13830596	0.307548775	2.104025854	0	3.979606676	0	0	0	22.01953727	0	0	0.897913403	0.009154944	0.143929765	0	0.936385441	0	2.867374857	0	0	0	0	0	0.000512739	0	0	0	0	0	0											49.4043	YES	1294.270741	63.25065081	1041.85973	0	0	10.75797422	11.63510845	447.9913187	0	0	37.23572805	0	0	0	4152.907526	143.0233871	0	0	11.61847252	13.39914543	24.20414217	0	0	0	0	0	0	0	0	0											6475	1a $100 days 1-5	1b $100 days 1-5	"2 $0 days 1-5, $50 Days 6 to 20, $90 Days 21-100"	6 $0	10a $0	11a 20%	"11b 20%,"	"4a $65, 4b $50"	"9a $0, 9b $0"	"8a $0 , 14a $0"	"8b $60 (Therapeutic),8b $140(MRI/CT/PETS),8b 15% (CT Drugs)"	9a $0	12a $0	"3 $0, 9a $0 , 9d $0"	"7a $15, 14a $0, 17a $40"	"7b $0 , 7d $40, 7f $40, 8a $0, 14a $0, 17a $40, 17b $0"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $25 (x-ray), 15 15%(chemo), 8b $60(Therapeutic), 14a $0"	"14a $0,7g $0-$40"	"11c 20% , 15 20%"				"17a $0, 17b $0"	17b  $0 -- $150			14c $0													NO	75.83666865	83.11688312	36.54317219	0	0	0.198529063	0.2	63.66143599	0	0	0.247089482	0	0	0	14.47549343	0.086072282	0	0	0.253242199	0.439063572	0.224841442	0	0	0	0	0	0	0	0	0											NO	70.85757387	77.65980217	34.14391177	0	0	0.185494537	0.186868899	59.48418294	0	0	0.232189049	0	0	0	13.5250976	0.080421163	0	0	0.236620227	0.410236632	0.210079364	0	0	0	0	0	0	0	0	0												7.6424	0.409336086	2.964430557	0	0	1.995545452	2.174239905	2.220699796	0	0	8.645728284	0	0	0	4.680706634	11.50210708	0	0	2.749165603	5.496820288	5.084790791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.566	1500	NO	3.851712004	23.7807	0.716884861	5.068456411	0	3.979606676	1.995545452	2.174239905	2.220699796	22.01953727	0	8.645728284	0.897913403	0.009154944	0.143929765	4.680706634	12.43849252	0	2.867374857	2.749165603	5.496820288	5.084790791	0	0	0.000512739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9703	YES	0.3	0.3	0.3		0	0.3	0.3	"4a $65, 4b $50"	0.3	0.3	8b 30%	0.3	0.3	0.3	0.3	0.3	0.45	0.3	0.3	0.3	0.3				0.3																10000	0.8915	0.008	0.449	0	0.09	0.2658	0.153	0.0081	1.3663	0.1957	0.378	0.0197	0.0002	0.0038	0.7969	1.4391	0	0.078	0.0706	0.1649	0.0045	0	0	0	0	0.0003	0	0	0	0											6.3834	2000	NO	0	24.6722	0.724852294	5.517477371	0	4.069566207	2.261324032	2.327264432	2.228796862	23.38586262	0.195698264	9.023720102	0.917623423	0.00936778	0.147749175	5.477602537	13.87760667	0	2.945344692	2.819749399	5.661722881	5.089327719	0	0	0.000524416	0	0.000305277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3537
H8980_801_0	2012	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	262.0410674	3.64208295	49.5154206	0	14.52980979	14.20743897	14.31352909	21.08350453	54.40668038	14.41792826	54.03525836	2.829063069	0.046141543	18.69392183	29.68486373	175.5345233	3.131475537	10.86702339	27.47308174	14.24152549	49.66234161	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 17.6%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.082887409	0.082887409	0.176105508	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.069217347	0.069217347	0.147061613	0	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0	0	0	0	0	0	0	0	0												18.1378	0.252095319	7.281817643	0	2.717905382	2.657603604	2.677448524	3.943821101	10.17716072	2.696977138	10.10768356	0.529196587	0.008631107	3.496832478	5.55276718	32.83499459	0.585765013	2.032754854	5.139037457	2.663979732	9.289698044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.784	0	NO	24.24918544	18.1378	0.252095319	7.281817643	0	2.717905382	2.657603604	2.677448524	3.943821101	10.17716072	2.696977138	10.10768356	0.529196587	0.008631107	3.496832478	5.55276718	32.83499459	0.585765013	2.032754854	5.139037457	2.663979732	9.289698044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.784	YES	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 17.6%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.0191	0	0.0209	0	0.0221	0.0047	0.0138	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1428	0	0.0133	0.0021	0.0082	0.023	0	0	0	0	0	0	0	0	0											0.3025	0	NO	0	18.1569	0.252095319	7.302710949	0	2.740023912	2.662271959	2.691207083	3.943821101	10.17926222	2.706804783	10.10872611	0.529196587	0.008631107	3.499104379	5.570086774	32.97774798	0.585765013	2.046046918	5.141119744	2.672167032	9.312718149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0864
H8980_802_0	2012	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	262.7274407	3.916629359	40.08372303	0	14.68434072	13.22001162	17.48656913	18.73109577	47.58223579	13.67333369	44.80286242	3.263722771	0.032187381	17.0480101	30.58878113	173.704107	2.329032024	9.831090417	29.06104206	15.36513236	53.01019246	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%		0	0	0	0	0	0	0	0												NO	0.082862752	0.082862752	0.186791162	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.069824585	0.069824585	0.15740022	0	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0.188754376	0	0	0	0	0	0	0	0	0											10000	18.3448	0.273477021	6.309186838	0	2.771733573	2.495335047	3.300666449	3.535576298	8.981355237	2.580901572	8.45673635	0.616041956	0.006075509	3.217886513	5.773766302	32.78741036	0.439614987	1.855661339	5.485398865	2.900235974	10.00590581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1378	0	NO	22.43302543	18.3448	0.273477021	6.309186838	0	2.771733573	2.495335047	3.300666449	3.535576298	8.981355237	2.580901572	8.45673635	0.616041956	0.006075509	3.217886513	5.773766302	32.78741036	0.439614987	1.855661339	5.485398865	2.900235974	10.00590581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1378	NO	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.7%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.0133	0	0.0155	0	0.0854	0.0033	0.0626	0	0.0015	0.0159	0.0007	0	0	0.014	0.0548	0.4535	0	0.0093	0.0044	0.0236	0.0176	0	0	0	0	0	0	0	0	0											0.7754	0	NO	0	18.3582	0.273477021	6.324645934	0	2.857160748	2.498591595	3.363237876	3.535576298	8.9828212	2.59678384	8.457463607	0.616041956	0.006075509	3.231880459	5.828553451	33.24093926	0.439614987	1.864933607	5.489815322	2.923857631	10.02354957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9132
H8980_803_0	2012	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	262.0410674	3.64208295	49.5154206	0	14.52980979	14.20743897	14.31352909	21.08350453	54.40668038	14.41792826	54.03525836	2.829063069	0.046141543	18.69392183	29.68486373	175.5345233	3.131475537	10.86702339	27.47308174	14.24152549	49.66234161	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 17.6%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.082887409	0.082887409	0.176105508	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											YES	0.069217347	0.069217347	0.147061613	0	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0.187057189	0	0	0	0	0	0	0	0	0											10000	18.1378	0.252095319	7.281817643	0	2.717905382	2.657603604	2.677448524	3.943821101	10.17716072	2.696977138	10.10768356	0.529196587	0.008631107	3.496832478	5.55276718	32.83499459	0.585765013	2.032754854	5.139037457	2.663979732	9.289698044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.784	0	NO	24.24918544	18.1378	0.252095319	7.281817643	0	2.717905382	2.657603604	2.677448524	3.943821101	10.17716072	2.696977138	10.10768356	0.529196587	0.008631107	3.496832478	5.55276718	32.83499459	0.585765013	2.032754854	5.139037457	2.663979732	9.289698044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.784	NO	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 17.6%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																					0.0191	0	0.0209	0	0.0221	0.0047	0.0138	0	0.0021	0.0098	0.001	0	0	0.0023	0.0173	0.1428	0	0.0133	0.0021	0.0082	0.023	0	0	0	0	0	0	0	0	0											0.3025	0	NO	0	18.1569	0.252095319	7.302710949	0	2.740023912	2.662271959	2.691207083	3.943821101	10.17926222	2.706804783	10.10872611	0.529196587	0.008631107	3.499104379	5.570086774	32.97774798	0.585765013	2.046046918	5.141119744	2.672167032	9.312718149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.0864
H8991_017_0	2012	7																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin							Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	271.7128017	16.42626927	21.60152205	0	12.28550509	4.94319255	3.071259155	54.27302122	31.73750301	11.52023356	5.81821411	0	0.205874231	5.142113278	0	0	0	0	0	0	2.068569824	0	0	0	0	0	0	0	0	0											6700	9% Coinsurance for IP Medical; 9% Coinsurance for IP Surgical; PBP 1a	9% Coinsurance for IP Psych; 9% Coinsurance for IP Substance Abuse; PBP 1b	17% Coinsurance for SNF; 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; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 0% Coinsurance for Speclst 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; 20% Coinsurance for Radiology - Therapeutic; 20% Coinsurance for Radiology - Diagnostic; PBP 8b	No Cost-Sharing;	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; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14a-b"	"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	"No Cost-Sharing; PBP 7d, 7g"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13a-e, 14c"											0	NO	0.09181991	0.09181991	0.168969581	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0.089911751	0.089911751	0.165458133	0	0.195843692	0.195843692	0.195843692	0.195843692	0.195843692	0.195843692	0.195843692	0	0.195843692	0.195843692	0	0	0	0	0	0	0.195843692	0	0	0	0	0	0	0	0	0												24.4302	1.476914639	3.574147498	0	2.406038675	0.96809308	0.601486732	10.62902885	6.215589765	2.256165074	1.139460532	0	0.04031917	1.007050449	0	0	0	0	0	0	0.405116352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1496	0	NO	1.170416341	24.4302	1.476914639	3.574147498	0	2.406038675	0.96809308	0.601486732	10.62902885	6.215589765	2.256165074	1.139460532	0	0.04031917	1.007050449	0	0	0	0	0	0	0.405116352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1496	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	NO	0	24.4302	1.476914639	3.574147498	0	2.406038675	0.96809308	0.601486732	10.62902885	6.215589765	2.256165074	1.139460532	0	0.04031917	1.007050449	0	0	0	0	0	0	0.405116352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1496
H9001_001_0	2012	5																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	258.9874766	7.653056957	1733.579235	0	550.8537673	15.94150369	2.114349427	1502.713143	1785.736223	0	479.7580613	154.113583	0	0	9313.996091	3293.855353	183.972834	496.1925281	0	36.64329726	33.99290073	0	0	1396.688868	367.9883596	0	0	0	197.1367212	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	$35/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Case for Diagnostic Radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $25/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$30/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$15/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	35	0	75	0.1	0.1	61.59735811	125	0	100	125	0	0	15	24.76965639	25	20	0	25	10.11176471	0	0	26.00948287	25	0	0	0	15	0											NO	379.7644466	379.7644466	33.22938907	0	71.20583373	0.094941112	0.094941112	58.48121653	118.6763895	0	94.94111164	118.6763895	0	0	14.24116675	23.51658712	23.73527791	18.98822233	0	23.73527791	9.600221818	0	0	24.69369217	23.73527791	0	0	0	14.24116675	0												8.1962	0.242196578	4.800481574	0	3.268666814	1.513504081	0.200738685	7.32337439	17.66039397	0	3.795730304	1.524136967	0	0	11.05351428	6.455019698	0.363887195	0.78515117	0	0.072478237	0.027194949	0	0	2.87411708	0.727858832	0	0	0	0.233954743	0	0	0	0	0	0	0	0	0	0	0	71.1186	0	NO	3.789517314	8.1962	0.242196578	4.800481574	0	3.268666814	1.513504081	0.200738685	7.32337439	17.66039397	0	3.795730304	1.524136967	0	0	11.05351428	6.455019698	0.363887195	0.78515117	0	0.072478237	0.027194949	0	0	2.87411708	0.727858832	0	0	0	0.233954743	0	0	0	0	0	0	0	0	0	0	0	71.1186	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.1962	0.242196578	4.800481574	0	3.268666814	1.513504081	0.200738685	7.32337439	17.66039397	0	3.795730304	1.524136967	0	0	11.05351428	6.455019698	0.363887195	0.78515117	0	0.072478237	0.027194949	0	0	2.87411708	0.727858832	0	0	0	0.233954743	0	0	0	0	0	0	0	0	0	0	0	71.1186
H9001_010_0	2012	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	160.5252204	2.847764378	629.528362	0	257.3093701	10.02471809	0.738328373	1087.242356	1260.828138	0	354.9166093	108.5910665	0	0	7979.655653	2803.702412	236.6206796	407.2023122	0	43.27599008	56.37239978	0	0	0	371.8990662	0	0	0	196.7849889	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	61.31120697	150	0	125	150	0	0	25	29.2974188	30	20	0	29.98050967	12.65789474	0	0	0	30	0	0	0	25	0											NO	479.2881481	479.2881481	47.92881481	0	71.89322222	0.09585763	0.09585763	58.7714697	143.7864444	0	119.822037	143.7864444	0	0	23.96440741	28.08381121	28.75728889	19.17152592	0	28.73860591	12.13355785	0	0	0	28.75728889	0	0	0	23.96440741	0												6.4115	0.113741643	2.514379023	0	1.541566643	0.960945714	0.070774408	5.324902596	15.10749958	0	3.543902592	1.301160279	0	0	15.93564325	6.561554101	0.567047437	0.650557474	0	0.103640969	0.056999815	0	0	0	0.891234074	0	0	0	0.392986304	0	0	0	0	0	0	0	0	0	0	0	62.05	0	NO	2.681415919	6.4115	0.113741643	2.514379023	0	1.541566643	0.960945714	0.070774408	5.324902596	15.10749958	0	3.543902592	1.301160279	0	0	15.93564325	6.561554101	0.567047437	0.650557474	0	0.103640969	0.056999815	0	0	0	0.891234074	0	0	0	0.392986304	0	0	0	0	0	0	0	0	0	0	0	62.05	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.4115	0.113741643	2.514379023	0	1.541566643	0.960945714	0.070774408	5.324902596	15.10749958	0	3.543902592	1.301160279	0	0	15.93564325	6.561554101	0.567047437	0.650557474	0	0.103640969	0.056999815	0	0	0	0.891234074	0	0	0	0.392986304	0	0	0	0	0	0	0	0	0	0	0	62.05
H9001_011_0	2012	10																															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	248.0041612	3.419205105	1444.238969	0	472.7032254	19.93587894	2.05554748	1533.423936	1599.705606	0	505.1910722	165.740475	0	0	9303.543379	3220.01519	678.1878354	522.517782	0	47.39570474	192.558695	0	0	0	416.0926457	0	0	0	196.8421102	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	62.10376725	150	0	125	150	0	0	25	29.45863031	30	20	0	29.95851157	5.391449016	0	0	0	30	0	0	0	25	0											NO	469.3592882	469.3592882	46.93592882	0	70.40389323	0.093871858	0.093871858	58.29795998	140.8077865	0	117.3398221	140.8077865	0	0	23.46796441	27.65336351	28.16155729	18.77437153	0	28.12261133	5.061053345	0	0	0	28.16155729	0	0	0	23.46796441	0												9.7003	0.133736306	5.648891454	0	2.773345617	1.87141799	0.19295806	7.44962394	18.77091712	0	4.939919209	1.944795784	0	0	18.19460208	7.420354213	1.591568799	0.817495247	0	0.111074249	0.081212486	0	0	0	0.97648474	0	0	0	0.38495697	0	0	0	0	0	0	0	0	0	0	0	83.0036	0	NO	5.418641379	9.7003	0.133736306	5.648891454	0	2.773345617	1.87141799	0.19295806	7.44962394	18.77091712	0	4.939919209	1.944795784	0	0	18.19460208	7.420354213	1.591568799	0.817495247	0	0.111074249	0.081212486	0	0	0	0.97648474	0	0	0	0.38495697	0	0	0	0	0	0	0	0	0	0	0	83.0036	NO																																										0	0	0	0	0	0	0	0	0	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	9.7003	0.133736306	5.648891454	0	2.773345617	1.87141799	0.19295806	7.44962394	18.77091712	0	4.939919209	1.944795784	0	0	18.19460208	7.420354213	1.591568799	0.817495247	0	0.111074249	0.081212486	0	0	0	0.97648474	0	0	0	0.38495697	0	0	0	0	0	0	0	0	0	0	0	83.0036
H9001_013_0	2012	10																															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	175.7435069	5.916414613	828.7434156	0	316.9148464	15.37213237	1.259454119	1187.742924	1461.172157	0	439.4426793	145.628081	0	0	9233.723847	3076.261279	595.7495617	520.1127297	0	47.20716404	147.4129058	0	0	0	419.6095355	0	0	0	196.324621	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	61.06944847	150	0	125	150	0	0	25	29.21890314	30	20	0	29.88721795	11.46838798	0	0	0	30	0	0	0	25	0											NO	474.1924868	474.1924868	47.41924868	0	71.12887302	0.094838497	0.094838497	57.91734727	142.257746	0	118.5481217	142.257746	0	0	23.70962434	27.71076868	28.45154921	18.96769947	0	28.3445884	10.87644683	0	0	0	28.45154921	0	0	0	23.70962434	0												6.9447	0.23379328	3.274865843	0	1.878482989	1.457869935	0.119444736	5.732576617	17.32192147	0	4.341258685	1.726393547	0	0	18.2440103	7.103797058	1.412499831	0.822111829	0	0.111505636	0.133610719	0	0	0	0.994878446	0	0	0	0.387898584	0	0	0	0	0	0	0	0	0	0	0	72.2416	0	NO	3.931686564	6.9447	0.23379328	3.274865843	0	1.878482989	1.457869935	0.119444736	5.732576617	17.32192147	0	4.341258685	1.726393547	0	0	18.2440103	7.103797058	1.412499831	0.822111829	0	0.111505636	0.133610719	0	0	0	0.994878446	0	0	0	0.387898584	0	0	0	0	0	0	0	0	0	0	0	72.2416	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.9447	0.23379328	3.274865843	0	1.878482989	1.457869935	0.119444736	5.732576617	17.32192147	0	4.341258685	1.726393547	0	0	18.2440103	7.103797058	1.412499831	0.822111829	0	0.111505636	0.133610719	0	0	0	0.994878446	0	0	0	0.387898584	0	0	0	0	0	0	0	0	0	0	0	72.2416
H9001_015_0	2012	10																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	123.1627235	1.89567564	880.8199644	0	519.5307284	18.94404669	2.224709361	1478.09176	1732.807888	0	521.2586031	172.6645991	0	0	10335.93579	3535.288317	501.1162643	656.7494928	0	45.70754199	191.5466943	0	0	735.3651685	418.7771636	0	0	0	195.5340652	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	$35/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Case for Diagnostic Radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $25/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$30/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$15/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	35	0	75	0.1	0.1	61.05169929	125	0	100	125	0	0	15	24.71741533	25	20	0	25	17.05349593	0	0	26.00948287	25	0	0	0	15	0											NO	381.7902576	381.7902576	33.40664754	0	71.58567331	0.095447564	0.095447564	58.27236	119.3094555	0	95.44756441	119.3094555	0	0	14.31713466	23.59217091	23.8618911	19.08951288	0	23.8618911	16.27714652	0	0	24.82541791	23.8618911	0	0	0	14.31713466	0												3.9185	0.060312541	2.452103508	0	3.099246417	1.808163117	0.21234309	7.17765793	17.2283638	0	4.146072008	1.716709942	0	0	12.33174871	6.950427183	0.996465144	1.044752325	0	0.090889032	0.259819467	0	0	1.521312302	0.832734589	0	0	0	0.233290629	0	0	0	0	0	0	0	0	0	0	0	66.0809	0	NO	3.151774701	3.9185	0.060312541	2.452103508	0	3.099246417	1.808163117	0.21234309	7.17765793	17.2283638	0	4.146072008	1.716709942	0	0	12.33174871	6.950427183	0.996465144	1.044752325	0	0.090889032	0.259819467	0	0	1.521312302	0.832734589	0	0	0	0.233290629	0	0	0	0	0	0	0	0	0	0	0	66.0809	NO																																										0	0	0	0	0	0	0	0	0	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	3.9185	0.060312541	2.452103508	0	3.099246417	1.808163117	0.21234309	7.17765793	17.2283638	0	4.146072008	1.716709942	0	0	12.33174871	6.950427183	0.996465144	1.044752325	0	0.090889032	0.259819467	0	0	1.521312302	0.832734589	0	0	0	0.233290629	0	0	0	0	0	0	0	0	0	0	0	66.0809
H9001_017_0	2012	10																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	290.8695773	5.019737626	2419.208618	0	686.794977	24.79953287	2.093621818	1857.92701	1892.127494	0	559.8427825	175.5721111	0	0	11141.1402	3933.997254	556.3876599	765.9017592	0	46.72124585	273.0834234	0	0	1654.675933	421.0999077	0	0	0	196.3385661	0											3400	$150/Admit for IP Acute; PBP 1a	$150/Admit for IP Psych; PBP 1b	$20/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $10/Visit for Urgent Care; PBP 4a, 4b"	$50/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for Diagnostic Radiology; PBP 8b	$50/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$10/Visit for Chiropractic; $15/Visit for Podiatry; $15/Visit for Physician Specialist; $15/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"	"$10/Visit for Occupational Therapy; $10/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$15/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$15/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$10/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	150	150	20	0	50	0.1	0.1	61.0265994	50	0	75	50	0	0	10	14.7101099	15	10	0	14.95502616	11.22769448	0	0	22.98103426	15	0	0	0	10	0											NO	145.1965375	145.1965375	19.35953833	0	48.39884582	0.096797692	0.096797692	59.0723395	48.39884582	0	72.59826873	48.39884582	0	0	9.679769164	14.23904682	14.51965375	9.679769164	0	14.47612011	10.86814908	0	0	22.24511068	14.51965375	0	0	0	9.679769164	0												3.5194	0.060737377	3.90289683	0	2.770007017	2.400537535	0.202657759	9.146007923	7.631398904	0	3.386968064	0.708123961	0	0	8.986972113	4.668030925	0.673213014	0.617812686	0	0.056361864	0.247325946	0	0	3.067370773	0.509518738	0	0	0	0.158376	0	0	0	0	0	0	0	0	0	0	0	52.7138	0	NO	1.743902121	3.5194	0.060737377	3.90289683	0	2.770007017	2.400537535	0.202657759	9.146007923	7.631398904	0	3.386968064	0.708123961	0	0	8.986972113	4.668030925	0.673213014	0.617812686	0	0.056361864	0.247325946	0	0	3.067370773	0.509518738	0	0	0	0.158376	0	0	0	0	0	0	0	0	0	0	0	52.7138	NO																																										0	0	0	0	0	0	0	0	0	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	3.5194	0.060737377	3.90289683	0	2.770007017	2.400537535	0.202657759	9.146007923	7.631398904	0	3.386968064	0.708123961	0	0	8.986972113	4.668030925	0.673213014	0.617812686	0	0.056361864	0.247325946	0	0	3.067370773	0.509518738	0	0	0	0.158376	0	0	0	0	0	0	0	0	0	0	0	52.7138
H9001_019_0	2012	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	748.7287405	20.66592357	170.9008024	0	48.51973924	28.22064817	25.20351095	24.67999483	54.42157355	26.89739452	27.69058381	16.62689283	4.958902077	39.18908903	91.59714129	60.73120159	5.055333347	5.079244494	9.068732764	49.31736691	33.57390725	29.09172516	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d		"PBP 16a, 16b"	PBP 17a	PBP 17b			"PBP 13e, 14c"	"PBP 13a, 13b"											0	NO	0.06470796	0.06470796	0.152219873	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.054352794	0.054352794	0.12786024	0	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0.188153447	0	0	0	0	0	0	0	0												40.6955	1.123250682	21.85141767	0	9.129156187	5.309812231	4.742127462	4.643626099	10.23960666	5.060837495	5.210078794	3.128407199	0.933034519	7.373562187	17.23431787	11.42678492	0.951178395	0.95567736	1.70631333	9.279232583	6.31704638	5.47370837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7847	0	NO	32.91853065	40.6955	1.123250682	21.85141767	0	9.129156187	5.309812231	4.742127462	4.643626099	10.23960666	5.060837495	5.210078794	3.128407199	0.933034519	7.373562187	17.23431787	11.42678492	0.951178395	0.95567736	1.70631333	9.279232583	6.31704638	5.47370837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7847	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	NO	0	40.6955	1.123250682	21.85141767	0	9.129156187	5.309812231	4.742127462	4.643626099	10.23960666	5.060837495	5.210078794	3.128407199	0.933034519	7.373562187	17.23431787	11.42678492	0.951178395	0.95567736	1.70631333	9.279232583	6.31704638	5.47370837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7847
H9001_020_0	2012	11																															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	158.1739619	1.731905987	895.626091	0	376.1073074	13.45105952	1.351704319	1213.469947	1261.885029	0	367.2904875	121.445094	0	0	6810.999386	2367.620954	452.9730558	411.5139648	0	39.67794295	150.9018422	0	0	0	386.4350798	0	0	0	196.7849048	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	62.917187	150	0	125	150	0	0	25	29.47608599	30	20	0	29.97046771	7.708333333	0	0	0	30	0	0	0	25	0											NO	479.146706	479.146706	47.9146706	0	71.8720059	0.095829341	0.095829341	60.29312581	143.7440118	0	119.7866765	143.7440118	0	0	23.9573353	28.24673901	28.74880236	19.16586824	0	28.72050176	7.386845051	0	0	0	28.74880236	0	0	0	23.9573353	0												6.3157	0.069153087	3.576135761	0	2.252632218	1.289006172	0.129532934	6.096991347	15.11570137	0	3.666375568	1.454750419	0	0	13.597783	5.573130931	1.085202738	0.657251869	0	0.094964203	0.092890711	0	0	0	0.925795478	0	0	0	0.392870162	0	0	0	0	0	0	0	0	0	0	0	62.3859	0	NO	2.715141436	6.3157	0.069153087	3.576135761	0	2.252632218	1.289006172	0.129532934	6.096991347	15.11570137	0	3.666375568	1.454750419	0	0	13.597783	5.573130931	1.085202738	0.657251869	0	0.094964203	0.092890711	0	0	0	0.925795478	0	0	0	0.392870162	0	0	0	0	0	0	0	0	0	0	0	62.3859	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.3157	0.069153087	3.576135761	0	2.252632218	1.289006172	0.129532934	6.096991347	15.11570137	0	3.666375568	1.454750419	0	0	13.597783	5.573130931	1.085202738	0.657251869	0	0.094964203	0.092890711	0	0	0	0.925795478	0	0	0	0.392870162	0	0	0	0	0	0	0	0	0	0	0	62.3859
H9001_021_0	2012	10																															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	114.4347956	2.709824073	472.1090976	0	237.3966786	9.380526557	0.743256401	994.9135994	1042.773287	0	344.2033332	106.8951184	0	0	7574.764324	2656.325212	377.8669434	345.0255101	0	43.16926393	98.13171345	0	0	0	378.2752045	0	0	0	194.9297591	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	62.26992863	150	0	125	150	0	0	25	28.92554771	30	20	0	29.9335436	6.013333333	0	0	0	30	0	0	0	25	0											NO	482.3362127	482.3362127	48.23362127	0	72.35043191	0.096467243	0.096467243	60.07008309	144.7008638	0	120.5840532	144.7008638	0	0	24.11681064	27.90367826	28.94017276	19.29344851	0	28.87606411	5.800896852	0	0	0	28.94017276	0	0	0	24.11681064	0												4.5997	0.108920523	1.897627618	0	1.431312686	0.904913531	0.071699896	4.980378548	12.57418295	0	3.458786086	1.288984664	0	0	15.22326307	6.17677034	0.911294552	0.55472766	0	0.103879869	0.047437662	0	0	0	0.912279148	0	0	0	0.391757007	0	0	0	0	0	0	0	0	0	0	0	55.6379	0	NO	2.037532662	4.5997	0.108920523	1.897627618	0	1.431312686	0.904913531	0.071699896	4.980378548	12.57418295	0	3.458786086	1.288984664	0	0	15.22326307	6.17677034	0.911294552	0.55472766	0	0.103879869	0.047437662	0	0	0	0.912279148	0	0	0	0.391757007	0	0	0	0	0	0	0	0	0	0	0	55.6379	NO																																										0	0	0	0	0	0	0	0	0	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	4.5997	0.108920523	1.897627618	0	1.431312686	0.904913531	0.071699896	4.980378548	12.57418295	0	3.458786086	1.288984664	0	0	15.22326307	6.17677034	0.911294552	0.55472766	0	0.103879869	0.047437662	0	0	0	0.912279148	0	0	0	0.391757007	0	0	0	0	0	0	0	0	0	0	0	55.6379
H9001_022_0	2012	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	158.2780509	3.422641191	812.095023	0	356.5523658	11.67289786	1.11245964	924.5389777	1106.253401	0	303.4009631	98.43301932	0	0	5725.480604	1993.426377	96.79684453	271.9226358	0	24.60279389	28.75248092	0	0	1376.394122	359.3031184	0	0	0	190.4458244	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	$35/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Case for Diagnostic Radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $25/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$30/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$15/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	35	0	75	0.1	0.1	62.22106763	125	0	100	125	0	0	15	24.79974287	25	20	0	25	18.92857143	0	0	26.00948287	25	0	0	0	15	0											NO	389.8314838	389.8314838	34.11025484	0	73.09340322	0.097457871	0.097457871	60.6393278	121.8223387	0	97.45787096	121.8223387	0	0	14.61868064	24.1693014	24.36446774	19.49157419	0	24.36446774	18.44738272	0	0	25.34828825	24.36446774	0	0	0	14.61868064	0												5.1418	0.111187775	2.308397349	0	2.171802154	1.137615774	0.108417948	4.671951845	11.23053137	0	2.464067659	0.999278385	0	0	6.974914374	4.014976912	0.196533633	0.441683353	0	0.049952832	0.044200668	0	0	2.907436246	0.729519103	0	0	0	0.232005557	0	0	0	0	0	0	0	0	0	0	0	45.9363	0	NO	1.198219986	5.1418	0.111187775	2.308397349	0	2.171802154	1.137615774	0.108417948	4.671951845	11.23053137	0	2.464067659	0.999278385	0	0	6.974914374	4.014976912	0.196533633	0.441683353	0	0.049952832	0.044200668	0	0	2.907436246	0.729519103	0	0	0	0.232005557	0	0	0	0	0	0	0	0	0	0	0	45.9363	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	NO	0	5.1418	0.111187775	2.308397349	0	2.171802154	1.137615774	0.108417948	4.671951845	11.23053137	0	2.464067659	0.999278385	0	0	6.974914374	4.014976912	0.196533633	0.441683353	0	0.049952832	0.044200668	0	0	2.907436246	0.729519103	0	0	0	0.232005557	0	0	0	0	0	0	0	0	0	0	0	45.9363
H9001_024_0	2012	11																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	89.93120405	0.999727299	495.5311475	0	393.7783541	13.49526155	1.679881311	1250.911023	1350.351811	0	414.3347812	139.0194167	0	0	8822.555594	3060.353613	321.1770447	546.9459196	0	40.39015411	157.4901578	0	0	651.4526212	397.3573138	0	0	0	193.5310917	0											3400	$400/Admit for IP Acute; PBP 1a	$400/Admit for IP Psych; PBP 1b	$35/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Case for Diagnostic Radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $25/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$30/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$15/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	400	400	35	0	75	0.1	0.1	61.99788157	125	0	100	125	0	0	15	24.73040103	25	20	0	25	8.31875	0	0	26.00948287	25	0	0	0	15	0											NO	386.7559567	386.7559567	33.84114621	0	72.51674188	0.096688989	0.096688989	59.94512501	120.8612365	0	96.68898918	120.8612365	0	0	14.50334838	23.91157478	24.17224729	19.33779784	0	24.17224729	8.043315287	0	0	25.14830608	24.17224729	0	0	0	14.50334838	0												2.8985	0.032220874	1.397445168	0	2.379626939	1.304843198	0.162426026	6.248834802	13.60043246	0	3.338467598	1.40017155	0	0	10.66304978	6.09815619	0.646964246	0.881394135	0	0.081360066	0.105561916	0	0	1.365244159	0.800418271	0	0	0	0.23390407	0	0	0	0	0	0	0	0	0	0	0	53.639	0	NO	1.836809179	2.8985	0.032220874	1.397445168	0	2.379626939	1.304843198	0.162426026	6.248834802	13.60043246	0	3.338467598	1.40017155	0	0	10.66304978	6.09815619	0.646964246	0.881394135	0	0.081360066	0.105561916	0	0	1.365244159	0.800418271	0	0	0	0.23390407	0	0	0	0	0	0	0	0	0	0	0	53.639	NO																																										0	0	0	0	0	0	0	0	0	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	2.8985	0.032220874	1.397445168	0	2.379626939	1.304843198	0.162426026	6.248834802	13.60043246	0	3.338467598	1.40017155	0	0	10.66304978	6.09815619	0.646964246	0.881394135	0	0.081360066	0.105561916	0	0	1.365244159	0.800418271	0	0	0	0.23390407	0	0	0	0	0	0	0	0	0	0	0	53.639
H9001_025_0	2012	11																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			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	178.9981348	2.038197009	1251.482829	0	463.1606139	14.59458103	1.272094622	1349.902426	1315.455381	0	459.5337277	127.7945816	0	0	9116.772705	3180.535105	349.5092855	567.8075987	0	50.75434371	165.1194464	0	0	1489.024282	412.8810317	0	0	0	193.6248901	0											3400	$150/Admit for IP Acute; PBP 1a	$150/Admit for IP Psych; PBP 1b	$20/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $10/Visit for Urgent Care; PBP 4a, 4b"	$50/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for Diagnostic Radiology; PBP 8b	$50/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$10/Visit for Chiropractic; $15/Visit for Podiatry; $15/Visit for Physician Specialist; $15/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"	"$10/Visit for Occupational Therapy; $10/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"$15/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Procedure for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$15/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$10/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	150	150	20	0	50	0.1	0.1	62.13213885	50	0	75	50	0	0	10	14.80139865	15	10	0	14.98022359	5.542857143	0	0	22.98103426	15	0	0	0	10	0											NO	147.1781363	147.1781363	19.6237515	0	49.05937875	0.098118758	0.098118758	60.96328265	49.05937875	0	73.58906813	49.05937875	0	0	9.811875751	14.52294845	14.71781363	9.811875751	0	14.69840926	5.438582559	0	0	22.54870528	14.71781363	0	0	0	9.811875751	0												2.1954	0.02499817	2.04656567	0	1.893530999	1.432002157	0.124816344	6.857873596	5.377951981	0	2.8180549	0.522460232	0	0	7.454386752	3.849228947	0.42866771	0.464271467	0	0.062167343	0.074834645	0	0	2.797964141	0.506392173	0	0	0	0.158318614	0	0	0	0	0	0	0	0	0	0	0	39.0899	0	NO	0.749474685	2.1954	0.02499817	2.04656567	0	1.893530999	1.432002157	0.124816344	6.857873596	5.377951981	0	2.8180549	0.522460232	0	0	7.454386752	3.849228947	0.42866771	0.464271467	0	0.062167343	0.074834645	0	0	2.797964141	0.506392173	0	0	0	0.158318614	0	0	0	0	0	0	0	0	0	0	0	39.0899	NO																																										0	0	0	0	0	0	0	0	0	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	2.1954	0.02499817	2.04656567	0	1.893530999	1.432002157	0.124816344	6.857873596	5.377951981	0	2.8180549	0.522460232	0	0	7.454386752	3.849228947	0.42866771	0.464271467	0	0.062167343	0.074834645	0	0	2.797964141	0.506392173	0	0	0	0.158318614	0	0	0	0	0	0	0	0	0	0	0	39.0899
H9001_026_0	2012	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	160.4737939	3.77933926	800.3593311	0	340.3772606	15.02473186	1.331689564	1186.800907	1357.798536	0	411.9949534	134.2431946	0	0	8755.402151	2983.771591	532.2701002	481.3703763	0	45.61892878	139.4126847	0	0	0	406.4783087	0	0	0	196.4344644	0											3400	$500/Admit for IP Acute; PBP 1a	$500/Admit for IP Psych; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$75/Trip for Ambulance; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Case for Diagnostic Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$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 Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $30/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"	"$20/Visit for Occupational Therapy; $20/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, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	500	500	50	0	75	0.1	0.1	61.5653681	150	0	125	150	0	0	25	29.28576496	30	20	0	29.92604066	12.65789474	0	0	0	30	0	0	0	25	0											NO	475.8136235	475.8136235	47.58136235	0	71.37204353	0.095162725	0.095162725	58.58728176	142.7440871	0	118.9534059	142.7440871	0	0	23.79068118	27.86913189	28.54881741	19.03254494	0	28.47843569	12.04559752	0	0	0	28.54881741	0	0	0	23.79068118	0												6.363	0.149855092	3.173515612	0	2.024451721	1.429794422	0.126727207	5.794286593	16.15147604	0	4.084016909	1.596868522	0	0	17.35808176	6.929593666	1.266306825	0.763475277	0	0.108262977	0.139942424	0	0	0	0.967039585	0	0	0	0.389442476	0	0	0	0	0	0	0	0	0	0	0	68.8161	0	NO	3.498033993	6.363	0.149855092	3.173515612	0	2.024451721	1.429794422	0.126727207	5.794286593	16.15147604	0	4.084016909	1.596868522	0	0	17.35808176	6.929593666	1.266306825	0.763475277	0	0.108262977	0.139942424	0	0	0	0.967039585	0	0	0	0.389442476	0	0	0	0	0	0	0	0	0	0	0	68.8161	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	6.363	0.149855092	3.173515612	0	2.024451721	1.429794422	0.126727207	5.794286593	16.15147604	0	4.084016909	1.596868522	0	0	17.35808176	6.929593666	1.266306825	0.763475277	0	0.108262977	0.139942424	0	0	0	0.967039585	0	0	0	0.389442476	0	0	0	0	0	0	0	0	0	0	0	68.8161
H9001_027_0	2012	10																															D	D	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	1185.027673	16.7042454	1175.569196	0	399.8717578	15.77017503	1.530855378	1406.263128	1499.915312	0	452.8861561	146.9566278	0	0	10038.83956	3084.134731	520.8877127	487.6514354	0	46.04303291	144.7341837	0	0	0	382.584287	0	0	0	191.856652	0											3400	$300/Days 1-5 for IP Acute; PBP 1a	$300/Days 1-5 for IP Psych; PBP 1b	$65/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$150/Trip for Ambulance; PBP 10a, 10b"	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$175/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$150/Case for Diagnostic Radiology; PBP 8b	$175/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Immunizations; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $40/Visit for Podiatry; $40/Visit for Physician Specialist; $40/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$40/Visit for Mental Health; $40/Visit for Psychiatric; $40/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$20/Visit for Occupational Therapy; $20/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$40/Exam for Medicare Covered Hearing Exams; $33/Visit for Other Health Care; PBP 7g, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$40/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	300	300	65	0	150	0.2	0.2	61.82708973	175	0	150	175	0	0	25	38.80990798	40	20	0	39.95542596	5.391449016	0	0	0	40	0	0	0	25	0											NO	245.0493838	245.0493838	53.09403316	0	122.5246919	0.163366256	0.163366256	50.50230081	142.9454739	0	122.5246919	142.9454739	0	0	20.42078199	31.70114679	32.67325118	16.33662559	0	32.63684171	4.403904198	0	0	0	32.67325118	0	0	0	20.42078199	0												24.1992	0.341113753	5.201309157	0	4.082846994	2.576314449	0.250090111	5.918293625	17.86717542	0	4.624144729	1.7505654	0	0	17.08341284	8.147550653	1.418257923	0.663881576	0	0.125224931	0.05311629	0	0	0	1.041689376	0	0	0	0.326488572	0	0	0	0	0	0	0	0	0	0	0	95.6707	0	NO	21.45348032	24.1992	0.341113753	5.201309157	0	4.082846994	2.576314449	0.250090111	5.918293625	17.86717542	0	4.624144729	1.7505654	0	0	17.08341284	8.147550653	1.418257923	0.663881576	0	0.125224931	0.05311629	0	0	0	1.041689376	0	0	0	0.326488572	0	0	0	0	0	0	0	0	0	0	0	95.6707	NO																																										0	0	0	0	0	0	0	0	0	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	24.1992	0.341113753	5.201309157	0	4.082846994	2.576314449	0.250090111	5.918293625	17.86717542	0	4.624144729	1.7505654	0	0	17.08341284	8.147550653	1.418257923	0.663881576	0	0.125224931	0.05311629	0	0	0	1.041689376	0	0	0	0.326488572	0	0	0	0	0	0	0	0	0	0	0	95.6707
H9001_028_0	2012	10																															D	D	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	743.614854	10.33627987	737.1308107	0	295.9146511	11.51812016	1.116401329	996.4726179	1061.705994	0	318.7701141	103.5369873	0	0	7365.734963	2263.08424	380.4199136	359.9316904	0	34.10952641	107.2745771	0	0	0	380.103139	0	0	0	191.7848197	0											3400	$300/Days 1-5 for IP Acute; PBP 1a	$300/Days 1-5 for IP Psych; PBP 1b	$65/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$150/Trip for Ambulance; PBP 10a, 10b"	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"$65/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$175/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$150/Case for Diagnostic Radiology; PBP 8b	$175/Visit for OP Hospital; PBP 9a	"No Cost Sharing; PBP 12, 14d"	"No Cost Sharing; PBP 3, 5"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Immunizations; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Prostate Screening; PBP 7a, 14a-b"	"$20/Visit for Chiropractic; $40/Visit for Podiatry; $40/Visit for Physician Specialist; $40/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$40/Visit for Mental Health; $40/Visit for Psychiatric; $40/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$20/Visit for Occupational Therapy; $20/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$40/Exam for Medicare Covered Hearing Exams; $33/Visit for Other Health Care; PBP 7g, 14e, 18a-b"	$4-50/Case for Part B Drugs; PBP 15	No Cost Sharing; PBP 9d		"PBP 16a, 16b"	$40/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			"$25/Service for Health Education / Wellness Programs; PBP 13e, 14c"	"No Cost Sharing; PBP 13a, 13b"											0	NO	300	300	65	0	150	0.2	0.2	61.89465222	175	0	150	175	0	0	25	38.81368968	40	20	0	39.95644938	5.391449016	0	0	0	40	0	0	0	25	0											NO	261.8483516	261.8483516	56.73380951	0	130.9241758	0.174565568	0.174565568	54.02337552	152.7448718	0	130.9241758	152.7448718	0	0	21.82069597	33.87766887	34.91311354	17.45655677	0	34.87510135	4.705806792	0	0	0	34.91311354	0	0	0	21.82069597	0												16.2262	0.22554482	3.485019917	0	3.228531817	2.010667185	0.194885232	4.486067869	13.51417882	0	3.477892871	1.317895321	0	0	13.3937886	6.389001542	1.106803637	0.523597332	0	0.099131099	0.042067786	0	0	0	1.105882004	0	0	0	0.348739853	0	0	0	0	0	0	0	0	0	0	0	71.1759	0	NO	10.37042047	16.2262	0.22554482	3.485019917	0	3.228531817	2.010667185	0.194885232	4.486067869	13.51417882	0	3.477892871	1.317895321	0	0	13.3937886	6.389001542	1.106803637	0.523597332	0	0.099131099	0.042067786	0	0	0	1.105882004	0	0	0	0.348739853	0	0	0	0	0	0	0	0	0	0	0	71.1759	NO																																										0	0	0	0	0	0	0	0	0	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	16.2262	0.22554482	3.485019917	0	3.228531817	2.010667185	0.194885232	4.486067869	13.51417882	0	3.477892871	1.317895321	0	0	13.3937886	6.389001542	1.106803637	0.523597332	0	0.099131099	0.042067786	0	0	0	1.105882004	0	0	0	0.348739853	0	0	0	0	0	0	0	0	0	0	0	71.1759
H9001_801_0	2012	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	316.6617645	3.809204601	73.21848599	0	16.57561408	22.34326844	11.44761871	22.05292927	62.33339896	58.68089973	44.13821175	75.08283984	0.029236517	1.555223465	83.55714981	52.08067688	3.229300204	6.329999753	0	0.368174692	4.121466219	0.881102331	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d		"PBP 16a, 16b"	PBP 17a	PBP 17b			"PBP 13e, 14c"	"PBP 13a, 13b"											0	NO	0.065047543	0.065047543	0.152051045	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058536094	0.058536094	0.13683029	0	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0.201576945	0	0.201576945	0.201576945	0.201576945	0	0	0	0	0	0	0	0												18.5361	0.222975958	10.01850671	0	3.341261647	4.50388779	2.307576006	4.445362108	12.56497613	11.82871649	8.897245877	15.13496947	0.005893408	0.313497195	16.84319498	10.49826373	0.650952469	1.275982011	0	0.074215529	0.830792569	0.177609916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.472	0	NO	13.62356651	18.5361	0.222975958	10.01850671	0	3.341261647	4.50388779	2.307576006	4.445362108	12.56497613	11.82871649	8.897245877	15.13496947	0.005893408	0.313497195	16.84319498	10.49826373	0.650952469	1.275982011	0	0.074215529	0.830792569	0.177609916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.472	NO																																										0	0	0	0	0	0	0	0	0	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	18.5361	0.222975958	10.01850671	0	3.341261647	4.50388779	2.307576006	4.445362108	12.56497613	11.82871649	8.897245877	15.13496947	0.005893408	0.313497195	16.84319498	10.49826373	0.650952469	1.275982011	0	0.074215529	0.830792569	0.177609916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.472
H9001_803_0	2012	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	306.5146763	7.193121596	58.58247088	0	15.20544718	19.14944643	10.40761728	21.43072506	59.56503458	63.75665555	45.42623384	81.98695913	0.107085493	1.21816801	81.82789804	46.10972212	4.505513811	6.133590834	0	0.394952631	5.884722689	1.980249909	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, 10b"	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, 14d"	"Medicare-FFS Cost Sharing; PBP 3, 5"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"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, 14e, 18a-b"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 9d		"PBP 16a, 16b"	PBP 17a	PBP 17b			"PBP 13e, 14c"	"PBP 13a, 13b"											0	NO	0.065054668	0.065054668	0.15206022	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.058729812	0.058729812	0.137276362	0	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0.20222189	0	0.20222189	0.20222189	0.20222189	0	0	0	0	0	0	0	0												18.0015	0.422450678	8.041988497	0	3.074874273	3.872437258	2.10464804	4.333761734	12.04535389	12.89299141	9.186178881	16.57955786	0.021655031	0.246340238	16.54739223	9.324395172	0.91111352	1.240346333	0	0.079868068	1.190019747	0.40044988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5174	0	NO	12.97901296	18.0015	0.422450678	8.041988497	0	3.074874273	3.872437258	2.10464804	4.333761734	12.04535389	12.89299141	9.186178881	16.57955786	0.021655031	0.246340238	16.54739223	9.324395172	0.91111352	1.240346333	0	0.079868068	1.190019747	0.40044988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5174	NO																																										0	0	0	0	0	0	0	0	0	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	18.0015	0.422450678	8.041988497	0	3.074874273	3.872437258	2.10464804	4.333761734	12.04535389	12.89299141	9.186178881	16.57955786	0.021655031	0.246340238	16.54739223	9.324395172	0.91111352	1.240346333	0	0.079868068	1.190019747	0.40044988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5174
H9003_001_0	2012	9	q.1.	q.2.	q.3.								Other Non-Covered	Other Non-Covered	Other Non-Covered								Other - Residential Treatment Facility	Other - Travel Benefit	Other - Silver & Fit								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		D	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	966.2867266	56.18628116	633.8501927	766.1188512	329.6862396	13.28003213	0.753426399	349.7757284	187.081121	0.045741475	160.7230467	0.092928381	5.78148459	364.8023427	6285.612748	5247.489121	373.4026856	496.6527595	3405.941516	6453.151539	1352.670741	0.228800925	0	0	374.282745	0	63.76434895	0	73.28485503	0	25.36682325	26.84058009	0.045478764	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, $100/day (days 1 - 4)"	"$25 for Urgent Care, $20 for PCP, $0 for Preventive services and other health care professional services"	$0-$20 per visit	$10 - $20 per visit	$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		$100/day $400max/admit	$800/year plan benefit coverage amount with 20% coinsurance	$0 Copay								0	NO	124.257652	124.257652	0	0	100	0.122628934	0.116341327	47.29117136	150	0	0	0	0	19.72017481	17.11543787	14.59023092	18.4557862	20	7.944924361	0	4.550536612	0	0	0	20	0	20	0	15	0	62.12882601	0.03	0	0	0	0	0	0	0	0	NO	112.1057177	112.1057177	0	0	95.75023838	0.117417496	0.111397098	45.28140931	143.6253576	0	0	0	0	18.88211439	16.38807256	13.97018089	17.67145928	19.15004768	7.607284015	0	4.357149653	0	0	0	19.15004768	0	19.15004768	0	15	0	56.05285887	0.03	0	0	0	0	0	0	0	0		9.0272	0.524900281	0	0	2.630628003	1.559308126	0.083929514	1.319861494	2.239132742	0	0	0	0	0.574019964	8.584089814	6.109031019	0.549880863	0.792577002	2.159163704	0	0.491149071	0	0	0	0.597294368	0	0.101757527	0	0.091606069	0	0.118490247	6.71E-05	0	0	0	0	0	0	0	0	37.5541	0	NO	2.28177009	9.0272	0.524900281	0	0	2.630628003	1.559308126	0.083929514	1.319861494	2.239132742	0	0	0	0	0.574019964	8.584089814	6.109031019	0.549880863	0.792577002	2.159163704	0	0.491149071	0	0	0	0.597294368	0	0.101757527	0	0.091606069	0	0.118490247	6.71E-05	0	0	0	0	0	0	0	0	37.5541	NO																																																																																		0	0	NO	0	9.0272	0.524900281	0	0	2.630628003	1.559308126	0.083929514	1.319861494	2.239132742	0	0	0	0	0.574019964	8.584089814	6.109031019	0.549880863	0.792577002	2.159163704	0	0.491149071	0	0	0	0.597294368	0	0.101757527	0	0.091606069	0	0.118490247	6.71E-05	0	0	0	0	0	0	0	0	37.5541
H9003_006_0	2012	8	q.1.										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		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	616.1737079	34.09015204	260.6333367	392.1536895	197.2655497	7.332060418	0.426022422	235.7845531	141.8100065	0.211478336	170.0843701	0	5.43287845	243.143269	5045.805232	3845.031721	505.8205496	400.0217659	2854.825671	4838.167293	1214.054199	0.230838489	0	0	306.8129416	0	46.38439919	0	65.37146165	0	24.38112591	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-$65/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	"$0-$30 per visit, $137/Day (days 1-4)"	"$35 for Urgent Care, $30 for PCP, $0 for Preventive services and other health care professional services"	"$20 for Chiropractic services, $0 for Colorectal screening and nutritional therapy, $30 for other specialist services"	$15 - $30 per visit	$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		$137/day $548max/admit										0	NO	170.8542715	170.8542715	0	0	150	0.122628934	0.116341327	60.87732479	250	0	0	0	0	30.91622718	24.59957529	22.5240093	27.35540255	30	19.93787436	0	3.31509517	0	0	0	30	0	30	0	15	0	85.11649163	0	0	0	0	0	0	0	0	0	NO	153.3950962	153.3950962	0	0	142.9310672	0.116849896	0.1108586	58.00840668	238.2184454	0	0	0	0	29.45926231	23.44029032	21.46253792	26.06624587	28.58621344	18.99827774	0	3.158867271	0	0	0	28.58621344	0	28.58621344	0	15	0	76.41864792	0	0	0	0	0	0	0	0	0		7.8765	0.435771846	0	0	2.349614629	0.856750496	0.047228249	1.13979052	2.815146606	0	0	0	0	0.596901778	9.85626163	6.877011591	1.098736901	0.952925632	4.519730917	0	0.31958634	0	0	0	0.73088502	0	0.110496195	0	0.081714327	0	0.15526439	0	0	0	0	0	0	0	0	0	40.8203	0	NO	2.559789265	7.8765	0.435771846	0	0	2.349614629	0.856750496	0.047228249	1.13979052	2.815146606	0	0	0	0	0.596901778	9.85626163	6.877011591	1.098736901	0.952925632	4.519730917	0	0.31958634	0	0	0	0.73088502	0	0.110496195	0	0.081714327	0	0.15526439	0	0	0	0	0	0	0	0	0	40.8203	NO																																																																																		0	0	NO	0	7.8765	0.435771846	0	0	2.349614629	0.856750496	0.047228249	1.13979052	2.815146606	0	0	0	0	0.596901778	9.85626163	6.877011591	1.098736901	0.952925632	4.519730917	0	0.31958634	0	0	0	0.73088502	0	0.110496195	0	0.081714327	0	0.15526439	0	0	0	0	0	0	0	0	0	40.8203
H9003_801_0	2012	5																															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	206.4001287	2.283131872	527.3091099	695.6465469	271.6410983	10.65634539	0.974535707	294.9945688	182.1705848	0.050336414	125.4811185	0.205714855	4.810489967	350.2591205	5461.113093	4981.751681	255.7611578	558.092788	3250.856064	6107.542075	9.34419536	0.231982028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	"$1,000/admit"	"$1,000/admit"	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$65/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	"$0-$45 per visit, $500/admit"	$0-$40 per visit	$0-$45 per visit	$17-$35 per visit	$45 per visit	$0-$150 copay	$0 per visit	0 or 20% Coin	$0 copay																			0	NO	225.6279878	225.6279878	0	0	150	0.122628934	0.116341327	61.76064131	250	0	0	0	0	45.06915999	30.5342655	33.16295214	31.58707395	45	24.29630291	0	0.093708428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	195.2519633	195.2519633	0	0	139.905997	0.114376822	0.108512329	57.60456067	233.1766617	0	0	0	0	42.03630509	28.47951239	30.9313059	29.46147383	41.97179911	22.66132322	0	0.087402474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3.3583	0.037148832	0	0	3.167018224	1.218838916	0.105749139	1.416086045	3.539827402	0	0	0	0	1.226966604	12.96081983	12.84100709	0.627925055	1.952013199	6.139058335	0	0.816705789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4075	0	NO	3.847943629	3.3583	0.037148832	0	0	3.167018224	1.218838916	0.105749139	1.416086045	3.539827402	0	0	0	0	1.226966604	12.96081983	12.84100709	0.627925055	1.952013199	6.139058335	0	0.816705789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4075	NO																																																																																		0	0	NO	0	3.3583	0.037148832	0	0	3.167018224	1.218838916	0.105749139	1.416086045	3.539827402	0	0	0	0	1.226966604	12.96081983	12.84100709	0.627925055	1.952013199	6.139058335	0	0.816705789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4075
H9003_802_0	2012	5																															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	232.2605957	0.357094748	582.3852001	1058.775626	292.1502717	11.93662484	1.468898068	283.3025886	176.510836	0.354411262	222.7502425	0.36001096	9.833211343	308.2733681	5670.558341	4996.395294	192.364271	543.6635832	3211.285975	6386.176047	5.731092745	0.231238499	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	"$1,000/admit"	"$1,000/admit"	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$65/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	"$0-$45 per visit, $500/admit"	$0-$40 per visit	$0-$45 per visit	$17-$35 per visit	$45 per visit	$0-$150 copay	$0 per visit	0 or 20% Coin	$0 copay																			0	NO	225.6279878	225.6279878	0	0	150	0.122628934	0.116341327	60.99875218	250	0	0	0	0	46.61260593	30.39345324	32.95315865	33.72670152	45	23.80215293	0	0.030061592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	200.1649159	200.1649159	0	0	140.3892012	0.114771854	0.108887106	57.09044062	233.982002	0	0	0	0	43.62604342	28.44608415	30.84178413	31.56576457	42.11676037	22.27710158	0	0.028135486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3.8742	0.005956487	0	0	3.417895273	1.369988561	0.15994406	1.347822468	3.441696565	0	0	0	0	1.120728945	13.44209831	12.84147876	0.506010441	1.908112404	5.961511988	0	0.161247078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5587	0	NO	3.620669225	3.8742	0.005956487	0	0	3.417895273	1.369988561	0.15994406	1.347822468	3.441696565	0	0	0	0	1.120728945	13.44209831	12.84147876	0.506010441	1.908112404	5.961511988	0	0.161247078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5587	NO																																																																																		0	0	NO	0	3.8742	0.005956487	0	0	3.417895273	1.369988561	0.15994406	1.347822468	3.441696565	0	0	0	0	1.120728945	13.44209831	12.84147876	0.506010441	1.908112404	5.961511988	0	0.161247078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5587
H9003_805_0	2012	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	213.3611781	1.921610203	580.4985437	859.2353746	314.5720165	13.00748984	0.459909392	328.8161839	183.2717877	0.383297652	136.1332207	0.783230423	5.514273344	355.3482595	5370.036113	5032.352143	251.2138988	637.9080702	3485.11298	6588.82256	8.838118532	0.063084023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	"$1,000/admit"	"$1,000/admit"	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$65/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	"$0-$45 per visit, $500/admit"	$0-$40 per visit	$0-$45 per visit	$17-$35 per visit	$45 per visit	$0-$150 copay	$0 per visit	0 or 20% Coin	$0 copay																			0	NO	225.6279878	225.6279878	0	0	150	0.122628934	0.116341327	61.4291193	250	0	0	0	0	45.37983525	30.06121576	33.03009244	31.21688181	45	24.87007909	0	0.098837925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	197.1729953	197.1729953	0	0	140.4650723	0.11483388	0.108945952	57.52430456	234.1084538	0	0	0	0	42.49521225	28.15033897	30.93049548	29.23254373	42.13952169	23.28918305	0	0.092555176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3.5058	0.031574137	0	0	3.682198419	1.493700532	0.050105267	1.576243525	3.575456238	0	0	0	0	1.258383309	12.59736141	12.97109544	0.61196844	2.24009508	6.763786177	0	0.818013613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1757	0	NO	3.744238065	3.5058	0.031574137	0	0	3.682198419	1.493700532	0.050105267	1.576243525	3.575456238	0	0	0	0	1.258383309	12.59736141	12.97109544	0.61196844	2.24009508	6.763786177	0	0.818013613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1757	NO																																																																																		0	0	NO	0	3.5058	0.031574137	0	0	3.682198419	1.493700532	0.050105267	1.576243525	3.575456238	0	0	0	0	1.258383309	12.59736141	12.97109544	0.61196844	2.24009508	6.763786177	0	0.818013613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1757
H9011_003_0	2012	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	1658.973706	1.59035269	484.7907281	3941.886228	181.3540258	5.265514845	12.7042734	396.40684	333.3167604	19973.19097	5435.978071	0	0.07577002	564.5528951	5486.669733	4408.749005	1.770477399	818.063749	0	0	32.13198668	1080.270712	701.7391304	274.0577732	48.85401255	216.8077277	6.194948477	65	514.5173575	2581.838309											3400	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$100 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $25 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9a, 9c); $60 (5)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $5 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $0 (18b2, 18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	106.6104145	46.88858484	0	100	0.2	0.098500033	62.95233582	0	0	0	0	0.2	0.033149575	0.050453123	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	101.4403875	44.61474275	0	95.15054229	0.190301085	0.093723316	59.90401345	0	0	0	0	0.190301085	0.031542	0.048006421	0	0	0	0	0	0.190301085	0	0	0	0	0	0	0	0	0												0	0.013443833	1.802401135	0	1.437994491	1.002033186	1.190686631	1.978863389	0	0	0	0	0.014419117	0.001483927	0.021949615	0	0	0	0	0	6.114751915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.578	0	NO	0.691862821	0	0.013443833	1.802401135	0	1.437994491	1.002033186	1.190686631	1.978863389	0	0	0	0	0.014419117	0.001483927	0.021949615	0	0	0	0	0	6.114751915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.578	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	0	0.013443833	1.802401135	0	1.437994491	1.002033186	1.190686631	1.978863389	0	0	0	0	0.014419117	0.001483927	0.021949615	0	0	0	0	0	6.114751915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.578
H9011_011_0	2012	3																															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	1947.898476	293.8423364	465.7526957	6902.356821	245.2354663	5.139028876	12.77147611	480.5970235	380.1362605	21465.37551	5961.382199	0	0.074348954	774.8379732	9597.880607	5658.758561	1125.891891	935.7377852	0	6.914488778	31.90150216	1164.978112	701.7391304	1608.583214	45.97863971	204.2201119	0	2.64	81.19209852	5369.8374											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)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	$0 (4a); $65 (4a1); $40 (4b)	$0 (9b)	"$0 (8a1a, 8a2)"	"$15 (8b1); $0 (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5, 9a, 9c)"	"$0 (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$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 (9d, 9d1, 14a10, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1); $0 n/c (14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	0	0	0	150	0.2	0.099395486	1.695636389	0	0	3.17233431	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	147.9367219	0.197248963	0.098028282	1.67331679	0	0	3.128698258	0	0.197248963	0	0	0	0	0	0	0	0.197248963	0	0	0	0	0	0	0	0	0												0	0	0	0	3.023277582	1.013668114	1.251965865	0.067015922	0	0	1.554280508	0	0.014665254	0	0	0	0	0	0	0	6.292538205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2174	0	NO	0.184302872	0	0	0	0	3.023277582	1.013668114	1.251965865	0.067015922	0	0	1.554280508	0	0.014665254	0	0	0	0	0	0	0	6.292538205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2174	NO																																										0	0	0	0	0	0	0	0	0	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	3.023277582	1.013668114	1.251965865	0.067015922	0	0	1.554280508	0	0.014665254	0	0	0	0	0	0	0	6.292538205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2174
H9011_016_0	2012	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	1405.065985	115.6291543	307.6800564	3004.172233	133.0054763	8.384011458	13.42264258	357.5197939	318.7432326	16216.32278	4499.923274	0	0.043761634	775.3311672	4961.920341	4406.971444	509.2892346	932.6659744	0	0	25.17369615	912.3376972	701.7391304	397.2986841	42.79069767	178.4126984	11.28910989	65	479.6058429	0											3400	"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$110 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$5 (3); $60 (5); $0 (9a, 9c)"	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $5 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$5 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 n/c (18b1, 18b3); $0 (18b2, 18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0	106.6104145	46.67765835	0	110	0.2	0.125679653	63.85248563	0	0	0	0	0.2	0.023651033	0.050691532	0	0	5	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	101.0338068	44.23603019	0	104.2460889	0.189538343	0.119105566	60.51711261	0	0	0	0	0.189538343	0.022413888	0.050136966	0	0	4.945299895	0	0	0.189538343	0	0	0	0	0	0	0	0	0												0	0.973537803	1.134212022	0	1.155441725	1.589091643	1.598711445	1.803005469	0	0	0	0	0.008294508	0.001448182	0.020731302	0	0	0.384359412	0	0	4.771380665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4402	0	NO	0.723814496	0	0.973537803	1.134212022	0	1.155441725	1.589091643	1.598711445	1.803005469	0	0	0	0	0.008294508	0.001448182	0.020731302	0	0	0.384359412	0	0	4.771380665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4402	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	"$0 n/c (6a, 6a2)"	$110 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3); $0 n/c (5, 9c); 30% (9a)"	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 n/c (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (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)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.0272	0	0.2506	0	0.1428	0	0.4717	0.2228	1.202	0	1.2479	0	0.001	1.1597	1.7986	2.0734	0	0.4393	0	0	0	0.4044	0	0.0697	0	0	0.0054	0	0	0											10.5166	0	NO	0.385505855	1.0272	0.973537803	1.384848498	0	1.29824913	1.589091643	2.070371442	2.025848842	1.201977507	0	1.24794395	0	0.009319671	1.161137414	1.819380875	2.073419065	0	0.823627312	0	0	4.771380665	0.404428365	0	0.069701524	0	0	0.005375767	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9568
H9011_018_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1633.548723	33.0959691	1450.750377	3187.826757	251.7840154	12.98009746	12.0998035	454.2625612	501.8316166	22.69094937	46.29660034	0	0.146294973	310.0796128	7092.237064	5987.930425	174.7774067	704.0311931	0	0	36.52056009	1574.928211	0	175.2941176	42.79069767	0	17.6381231	65	540.608755	0											3400	"$125 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$115 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$15 (3); $60 (5); $115 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $15 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$15 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$15 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	88.1811179	56.52372625	43.04364757	0	200	0.2	0.127020456	63.69574154	47.15	0.206590734	0.1826241	0	0.2	40.67218809	0.136749455	15	38.5	15	0	0	0.2	14.80745133	0	0	15	0	0	352.5	0	0											NO	70.45298404	45.1600669	34.3900541	0	159.791542	0.159791542	0.101483973	50.90554351	37.67085603	0.16505726	0.145908932	0	0.159791542	32.49535826	0.132123951	14.49432468	37.19775043	14.49263004	0	0	0.159791542	11.83052741	0	0	15	0	0	352.5	0	0												9.5907	0.124551348	4.157615329	0	3.352746339	2.074109789	1.227936128	1.927040214	1.575368882	3.745305925	6.755087531	0	0.023376699	0.839679009	0.078087865	7.232583978	0.541777196	0.850271968	0	0	5.835676613	1.552685947	0	0	0.053488372	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.4475	0	NO	11.0683041	9.5907	0.124551348	4.157615329	0	3.352746339	2.074109789	1.227936128	1.927040214	1.575368882	3.745305925	6.755087531	0	0.023376699	0.839679009	0.078087865	7.232583978	0.541777196	0.850271968	0	0	5.835676613	1.552685947	0	0	0.053488372	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.4475	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	9.5907	0.124551348	4.157615329	0	3.352746339	2.074109789	1.227936128	1.927040214	1.575368882	3.745305925	6.755087531	0	0.023376699	0.839679009	0.078087865	7.232583978	0.541777196	0.850271968	0	0	5.835676613	1.552685947	0	0	0.053488372	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.4475
H9011_019_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1592.710005	125.5830603	1363.705354	3187.826757	224.0877737	12.98009746	10.76882511	404.2936795	446.6301388	20.19494494	41.2039743	0	0.130202526	280.1841468	6300.071535	5239.439122	655.1382479	616.027294	0	0	36.52056009	1378.062185	0	485.0588235	37.44186047	0	15.43335771	65	493.081673	0											4500	"$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 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$140 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$25 (3); $60 (5); $140 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $25 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$0/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	105.8173415	67.8284715	67.73453207	0	200	0.2	0.127020456	63.69574154	57.4	0.206590734	0.1826241	0	0.2	49.29439067	0.256573689	24.88769132	38.5	25	0	0	0.2	24.67908555	0	0	25	0	0	352.5	0	0											NO	86.07848126	55.17594499	55.09952875	0	162.6925796	0.16269258	0.103326428	51.82835544	46.69277034	0.168053897	0.148557929	0	0.16269258	40.09915789	0.248543856	24.11135517	37.29508869	24.21759006	0	0	0.16269258	20.07552045	0	0	25	0	0	352.5	0	0												11.4248	0.577430335	6.261626865	0	3.038118163	2.11176554	1.112704236	1.746156377	1.737866541	3.393839201	6.121177101	0	0.021182985	0.936262362	0.130487006	10.52749813	2.036119922	1.243224706	0	0	5.94162413	2.305442964	0	0	0.078003876	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	62.6547	0	NO	11.16431241	11.4248	0.577430335	6.261626865	0	3.038118163	2.11176554	1.112704236	1.746156377	1.737866541	3.393839201	6.121177101	0	0.021182985	0.936262362	0.130487006	10.52749813	2.036119922	1.243224706	0	0	5.94162413	2.305442964	0	0	0.078003876	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	62.6547	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	"$0 n/c (6a, 6a2)"	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3); $0 n/c (5, 9c); 30% (9a)"	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 n/c (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.9994	0	0.9597	0	0.3755	0	0.3248	0.2158	1.4245	0.4195	1.1088	0	0.0026	0.413	2.0802	2.4139	0	0.2842	0	0	0	0.5272	0	0.0851	0.0178	0	0.0073	0	0	0											11.6594	0	NO	1.705110484	12.4243	0.577430335	7.22131751	0	3.413615913	2.11176554	1.437514696	1.961973457	3.162349159	3.813302473	7.230006574	0	0.023801107	1.349223056	2.21070354	12.941413	2.036119922	1.527390353	0	0	5.94162413	2.832640101	0	0.085098039	0.095833333	0	0.007349218	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	74.3141
H9011_020_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1556.336607	33.37811586	1382.178498	3037.149373	239.8830685	11.78204926	10.98300542	432.8163684	478.1117971	19.9709677	40.74699101	0	0.128758481	295.5176079	6764.402298	5705.847297	175.6445797	670.7541093	0	0	31.79477826	1500.486881	0	175.2941176	42.79069767	0	17.6381231	65	540.608755	0											3900	"$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 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$90 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$20 (3); $60 (5); $90 (9a); $40/$30 (9c)	"$0 (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $20 (7a1); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$0/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	83.26107297	60.92023687	38.36734515	0	200	0.2	0.127020456	63.69581749	36.9	0.223632973	0.185384888	0	0.2	31.87880508	0.182133401	20	38.5	20	0	0	0.2	19.74326844	0	0	20	0	0	352.5	0	0											NO	69.92195074	51.16030396	32.22057465	0	167.9583225	0.167958323	0.106670714	53.50404303	30.9883105	0.187805095	0.155684674	0	0.167958323	26.77155312	0.177315569	19.47281009	37.48158971	19.47095569	0	0	0.167958323	16.58023124	0	0	20	0	0	352.5	0	0												9.0685	0.142302879	3.711215456	0	3.357529816	1.97889323	1.171565026	1.929785467	1.234656402	3.75064948	6.343682007	0	0.021626059	0.659288778	0.09995282	9.259073399	0.548619839	1.088351962	0	0	5.34019762	2.073201622	0	0	0.071317829	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.7598	0	NO	8.077572376	9.0685	0.142302879	3.711215456	0	3.357529816	1.97889323	1.171565026	1.929785467	1.234656402	3.75064948	6.343682007	0	0.021626059	0.659288778	0.09995282	9.259073399	0.548619839	1.088351962	0	0	5.34019762	2.073201622	0	0	0.071317829	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.7598	NO																																										0	0	0	0	0	0	0	0	0	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	9.0685	0.142302879	3.711215456	0	3.357529816	1.97889323	1.171565026	1.929785467	1.234656402	3.75064948	6.343682007	0	0.021626059	0.659288778	0.09995282	9.259073399	0.548619839	1.088351962	0	0	5.34019762	2.073201622	0	0	0.071317829	0	0	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	53.7598
H9011_021_0	2012	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1517.428192	131.6931565	1299.247788	3037.149373	213.495931	11.78204926	9.774874826	385.2065679	425.5194994	17.77416125	36.264822	0	0.114595048	267.1238768	6008.755854	4992.616384	654.3379379	586.9098456	0	0	31.79477826	1312.926021	0	485.0588235	37.44186047	0	15.43335771	65	493.081673	0											4900	"$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 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	$175 (9b)	20% (8a1a); $15 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$30 (3); $60 (5); $175 (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	178.8857688	109.9065555	66.46906749	0	200	0.2	0.127020456	63.69581749	71.75	0.223632973	0.185384888	0	0.2	61.39200162	7.061789852	29.75954436	38.5	30	0	0	0.2	29.61490266	0	0	30	0	10	352.5	0	0											NO	143.3515582	88.07450751	53.26552503	0	160.2716182	0.160271618	0.10178887	51.05906627	57.49744302	0.179210092	0.14855968	0	0.160271618	49.19697721	6.828735951	28.78024868	37.22941912	29.00993697	0	0	0.160271618	23.73214185	0	0	30	0	10	352.5	0	0												18.1271	0.966567492	5.767092964	0	2.851444861	1.8883281	0.994973465	1.639023973	2.038856931	3.185309073	5.387490344	0	0.018366334	1.095140607	3.419350594	11.97406176	2.030051778	1.418851469	0	0	5.095800561	2.596545548	0	0	0.093604651	0	0.012861131	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	72.5102	0	NO	13.44480222	18.1271	0.966567492	5.767092964	0	2.851444861	1.8883281	0.994973465	1.639023973	2.038856931	3.185309073	5.387490344	0	0.018366334	1.095140607	3.419350594	11.97406176	2.030051778	1.418851469	0	0	5.095800561	2.596545548	0	0	0.093604651	0	0.012861131	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	72.5102	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	"$0 n/c (6a, 6a2)"	$200 (10a)	$0 n/c (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $15 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3); $0 n/c (5, 9c); 30% (9a)"	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 n/c (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.938	0	0.911	0	0.3524	0	0.2904	0.2026	1.2351	0.3937	0.9744	0	0.0023	0.3581	1.9755	2.296	0	0.2703	0	0	0	0.4937	0	0.0851	0.0178	0	0.0073	0	0	0											10.8038	0	NO	1.677909389	19.0652	0.966567492	6.678121431	0	3.203870631	1.8883281	1.285417033	1.84159997	3.273929491	3.578998959	6.361896498	0	0.02063633	1.453190902	5.394875639	14.27007942	2.030051778	1.689108892	0	0	5.095800561	3.09029085	0	0.085098039	0.111434109	0	0.020210349	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	83.3141
H9011_801_0	2012	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	281.5169417	8.0928	17.03623324	3677.875955	6.025793739	4.773346121	11.49177601	16.89201759	44.86082041	18.91169375	42.62061772	0	0.07775106	45.57852351	69.28270468	92.17093146	3.8008	4.815031887	0	0	27.54779964	6.893127308	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079024462	0.079024462	0.160999601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065163696	0.065163696	0.132760523	0	0.184710752	0.184710752	0.184710752	0.184710752	0.184710752	0.184710752	0.184710752	0	0.184710752	0.184710752	0.184710752	0.184710752	0.184710752	0.184710752	0	0	0.184710752	0.184710752	0	0	0	0	0	0	0	0												18.3447	0.527356755	2.26173924	0	1.11302889	0.881688349	2.122654583	3.120137264	8.286275853	3.493193165	7.87248633	0	0.014361457	8.418843331	12.79726045	17.02496202	0.702048624	0.889388159	0	0	5.088374774	1.273234725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2317	150	YES	20.04373519	18.3447	0.527356755	2.26173924	0	1.11302889	0.881688349	2.122654583	3.120137264	8.286275853	3.493193165	7.87248633	0	0.014361457	8.418843331	12.79726045	17.02496202	0.702048624	0.889388159	0	0	5.088374774	1.273234725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2317	NO																																										0	0	0	0	0	0	0	0	0	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	18.3447	0.527356755	2.26173924	0	1.11302889	0.881688349	2.122654583	3.120137264	8.286275853	3.493193165	7.87248633	0	0.014361457	8.418843331	12.79726045	17.02496202	0.702048624	0.889388159	0	0	5.088374774	1.273234725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2317
H9011_802_0	2012	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	281.5169417	8.0931	17.03623324	3677.875955	6.025793739	4.773346121	11.49177601	16.89201759	44.86082041	18.91169375	42.62061772	0	0.07775106	45.57892351	69.28270468	92.17093146	3.8006	4.815031887	0	0	27.54779964	6.893127308	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079024462	0.079024462	0.160999601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065163684	0.065163684	0.132760501	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0	0.18471072	0.18471072	0	0	0	0	0	0	0	0												18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	150	YES	20.04376317	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	NO																																										0	0	0	0	0	0	0	0	0	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	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318
H9011_803_0	2012	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	281.5169417	8.0931	17.03623324	3677.875955	6.025793739	4.773346121	11.49177601	16.89201759	44.86082041	18.91169375	42.62061772	0	0.07775106	45.57892351	69.28270468	92.17093146	3.8006	4.815031887	0	0	27.54779964	6.893127308	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079024462	0.079024462	0.160999601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065163684	0.065163684	0.132760501	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0	0.18471072	0.18471072	0	0	0	0	0	0	0	0												18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	150	YES	20.04376317	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	NO																																										0	0	0	0	0	0	0	0	0	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	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318
H9011_805_0	2012	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	281.5169417	8.0931	17.03623324	3677.875955	6.025793739	4.773346121	11.49177601	16.89201759	44.86082041	18.91169375	42.62061772	0	0.07775106	45.57892351	69.28270468	92.17093146	3.8006	4.815031887	0	0	27.54779964	6.893127308	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 14b2, 14b3, 14b4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13d, 13d1, 13d2, 13d3, 13d4, 13d5, 13e)"											0	NO	0.079024462	0.079024462	0.160999601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.065163684	0.065163684	0.132760501	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0.18471072	0	0	0.18471072	0.18471072	0	0	0	0	0	0	0	0												18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	150	YES	20.04376317	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318	NO																																										0	0	0	0	0	0	0	0	0	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	18.3447	0.527376215	2.261738857	0	1.113028702	0.8816882	2.122654224	3.120136736	8.286274449	3.493192573	7.872484997	0	0.014361454	8.41891579	12.79725828	17.02495914	0.702011563	0.889388008	0	0	5.088373912	1.27323451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2318
H9047_001_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	856.6489558	27.51407639	464.1191698	0	323.3679192	19.59751421	4.729678551	429.6194693	215.8375994	0	15.76627264		0	32.46214211	7335.541798	58.81812278	567.5490305	112.9163063	15.14777011	828.7792795	28.48239433	0	0	0	312.810956	0	0	0	0	0											2500	$125/day (Days 1-6)	$125/day (Days 1-6)	$50/day (Days 21-100)	$0 Copay HHC	$100 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$115 Copay OP Hosp & Surg/$115Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		$0 Copay Dialysis	$15 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$115 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	10% Coin Rad	$50 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$15 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													125	125	50	0	100	0.1	0.1	48.24818386	115	0	0.1	0	0	0.130848168	15	15	15	15	0.1	15	0.1	0	0	0	15	0	0	0	0	0											NO	119.7128054	119.7128054	47.88512214	0	95.77024428	0.095770244	0.095770244	46.20740355	110.1357809	0	0.095770244	0	0	0.12531361	14.36553664	14.36553664	14.36553664	14.36553664	0.095770244	14.36553664	0.095770244	0	0	0	14.36553664	0	0	0	0	0												8.546	0.274482273	1.852033595	0	2.580752051	1.876858723	0.45296247	1.654300016	1.980953546	0	1.509939782	0	0	4.067948221	8.781582874	0.070412825	0.679428866	0.135175278	1.450705644	0.992154926	2.727765863	0	0	0	0.374474771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0079	0	NO	1.76697602	8.546	0.274482273	1.852033595	0	2.580752051	1.876858723	0.45296247	1.654300016	1.980953546	0	1.509939782	0	0	4.067948221	8.781582874	0.070412825	0.679428866	0.135175278	1.450705644	0.992154926	2.727765863	0	0	0	0.374474771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0079	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.546	0.274482273	1.852033595	0	2.580752051	1.876858723	0.45296247	1.654300016	1.980953546	0	1.509939782	0	0	4.067948221	8.781582874	0.070412825	0.679428866	0.135175278	1.450705644	0.992154926	2.727765863	0	0	0	0.374474771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0079
H9047_013_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	894.7008466	30.52054615	484.7350964	0	337.7419641	20.46802536	4.939768355	448.7029376	225.4249907	0	16.46660208		0	33.93791373	7661.382662	61.4307925	628.4173075	117.9319885	15.820626	865.5932142	29.74561712	0	0	0	327.628493	0	0	0	0	0											2500	$125/day (Days 1-6)	$125/day (Days 1-6)	$50/day (Days 21-100)	$0 Copay HHC	$100 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$115 Copay OP Hosp & Surg/$115Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		$0 Copay Dialysis	$15 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$115 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	10% Coin Rad	$50 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$15 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													125	125	50	0	100	0.1	0.1	48.24818386	115	0	0.1	0	0	0.13125135	15	15	15	15	0.1	15	0.1	0	0	0	15	0	0	0	0	0											NO	119.7128054	119.7128054	47.88512214	0	95.77024428	0.095770244	0.095770244	46.20740355	110.1357809	0	0.095770244	0	0	0.125699739	14.36553664	14.36553664	14.36553664	14.36553664	0.095770244	14.36553664	0.095770244	0	0	0	14.36553664	0	0	0	0	0												8.9256	0.304475017	1.934299941	0	2.6954692	1.960227789	0.473082822	1.727783142	2.068946449	0	1.577010504	0	0	4.265986897	9.171656113	0.073540525	0.752295988	0.141179692	1.515145216	1.03622592	2.848745018	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8639	0	NO	1.848945711	8.9256	0.304475017	1.934299941	0	2.6954692	1.960227789	0.473082822	1.727783142	2.068946449	0	1.577010504	0	0	4.265986897	9.171656113	0.073540525	0.752295988	0.141179692	1.515145216	1.03622592	2.848745018	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8639	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	8.9256	0.304475017	1.934299941	0	2.6954692	1.960227789	0.473082822	1.727783142	2.068946449	0	1.577010504	0	0	4.265986897	9.171656113	0.073540525	0.752295988	0.141179692	1.515145216	1.03622592	2.848745018	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8639
H9047_024_0	2012	8																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																2.935485084	0.086987113	0.29131074	0	0.105691513	0.155362106	0.058348504	0	1.158628529	0.257042119	0.28945806	0	0.000911615	0.758130829	0	0	0	0	0	0	0.499752528	0.010914132	0	0	0	0	0	0	0	0											6.608	YES	503.9515964	28.56186235	339.3051425	12.73647333	150.0762849	8.674966624	2.573606812	294.0964371	250.3863171	0	13.63214458		0.050901896	29.39999604	6766.412135	251.5426903	528.8598056	261.9808437	13.93708844	624.4898367	19.4523668	0	0	0	321.9131782	0	0	0	0	0											3400	$225/day (Days 1-6)	$225/day (Days 1-6)	$50/day (Days 11-100)	15% Coin HHC	$150 Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$200 Copay OP Hosp & Surg/$200 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		15% Coin Dialysis	$20 Copay CORF/10% Coin Partial Hospitalization/15% Coin Rad/$200 Copay OP Hosp & Surg/$20 Copay OP Substance Abuse/$20 Copay Cardiac Rehab/$20 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$20 Copay Specialists/$20 Copay Podiatry/$20 Copay Psychiatric/$20 Copay Preventive Dental/$20 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$20 Copay Mental Health	$20 Copay OT	15% Coin Rad	$50 ER Waived/$20 Copay Other/$0 Copay Lab/$20 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$25 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											75	NO	225	225	50	0.15	150	0.2	0.2	46.56330723	200	0	0.15	0	0.15	0.230274391	20	20	20	20	0.15	20	0.15	0	0	0	25	0	0	0	0	0											NO	209.6122331	209.6122331	46.58049624	0.139741489	139.7414887	0.186321985	0.186321985	43.37883915	186.321985	0	0.139741489	0	0.139741489	0.214525908	18.6321985	18.6321985	18.6321985	18.6321985	0.139741489	18.6321985	0.139741489	0	0	0	23.29024812	0	0	0	0	0												8.8029	0.498909646	1.317083493	1.779813744	1.747656956	1.616337001	0.47951953	1.06313017	3.8877063	0	1.904976178	0	0.007113107	6.307060841	10.5060945	0.390566111	0.82115174	0.406773257	1.947589487	0.969634883	2.718302695	0	0	0	0.624786483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7971			3.508813538	11.7384	0.585896759	1.608394233	1.779813744	1.853348469	1.771699107	0.537868034	1.06313017	5.046334829	0.257042119	2.194434238	0	0.008024721	7.065191671	10.5060945	0.390566111	0.82115174	0.406773257	1.947589487	0.969634883	3.218055223	0.010914132	0	0	0.624786483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4051	YES	20% Coin IP Acute	20% Coin IP MH	20% Coin SNF	20% Coin HHC	$150 Ambul	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		15% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$30 Copay PCP/20% Coin Immunizations/20% Coin Immunizations - Addl/20% Coin Physical Exams/20% Coin Supp Physical Exams	20% Coin Chiro/$30 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/20% Coin Preventive Dental/20% Coin Preventive Dental/$30 Copay Medicare Covered Vision Exams/20% Coin Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/20% Coin Other/20% Coin Lab/20% Coin Other/20% Coin Pap & Pelvic/20% Coin Supp Pap & Pelvic/20% Coin Prostate Screen/No Coverage Supp Prostate Screening/20% Coin Colorectal Screen/No Coverage Supp Colorectal Screening/20% Coin Bone Mass/20% Coin Bone Mass/20% Coin Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/20% Coin Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	20% Coin HE SM Cess/20% Coin HE SM Cess/20% Coin HE News Letter/20% Coin Fitness/20% Coin Nurse Hotine/20% Coin Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											3400	1.3892	0.0417	0.0998	0.0095	0	0.1793	0.0673	0	0.1724	0.0208	0.0197	0	0.0001	0.0584	0.8767	0.0445	0.0761	0.0063	0.1478	0.2404	0.0117	0	0	0	0.0133	0	0	0	0	0											3.4749			0.255098103	13.1276	0.627565317	1.708231639	1.789320449	1.853348469	1.950986629	0.605202077	1.06313017	5.218739317	0.277823334	2.214172463	0	0.008079998	7.123546606	11.38280736	0.435016428	0.897239587	0.4130678	2.09539105	1.210083377	3.229729099	0.010914132	0	0	0.638097593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.88
H9047_033_0	2012	7																															D	D	D		T	Coin	Coin	V	V		Coin			Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	977.6807248	3.517316169	600.4948869	0	315.8418288	11.4093027	3.952978347	369.4905638	196.2319591	0	15.12920048		0	28.19155567	7017.088619	55.15645317	331.2974544	92.98541229	14.56853442	775.8373318	23.84698274	0	0	0	327.628493	0	0	0	0	0											2500	$125/day (Days 1-6)	$125/day (Days 1-6)	$50/day (Days 21-100)	$0 Copay HHC	$100 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$115 Copay OP Hosp & Surg/$115Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		$0 Copay Dialysis	$15 Copay CORF/$0 Copay Partial Hospitalization/10% Coin Rad/$115 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	10% Coin Rad	$50 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$15 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													125	125	50	0	100	0.1	0.1	47.45869228	115	0	0.1	0	0	0.127955687	15	15	15	15	0.1	15	0.1	0	0	0	15	0	0	0	0	0											NO	119.7128054	119.7128054	47.88512214	0	95.77024428	0.095770244	0.095770244	45.45130553	110.1357809	0	0.095770244	0	0	0.122543474	14.36553664	14.36553664	14.36553664	14.36553664	0.095770244	14.36553664	0.095770244	0	0	0	14.36553664	0	0	0	0	0												9.7534	0.035088982	2.396230917	0	2.520687425	1.092671706	0.378577702	1.399485709	1.801013338	0	1.448927226	0	0	3.454691175	8.40035364	0.066029337	0.396605477	0.111315446	1.3952321	0.928776635	2.283831362	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2551	0	NO	1.689563374	9.7534	0.035088982	2.396230917	0	2.520687425	1.092671706	0.378577702	1.399485709	1.801013338	0	1.448927226	0	0	3.454691175	8.40035364	0.066029337	0.396605477	0.111315446	1.3952321	0.928776635	2.283831362	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2551	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	9.7534	0.035088982	2.396230917	0	2.520687425	1.092671706	0.378577702	1.399485709	1.801013338	0	1.448927226	0	0	3.454691175	8.40035364	0.066029337	0.396605477	0.111315446	1.3952321	0.928776635	2.283831362	0	0	0	0.39221326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2551
H9047_035_0	2012	9																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																3.05148074	0.080378907	0.290788413	0	0.106664906	0.127713569	0.076392091	0	1.111300698	0.233649261	0.215617894	0	0.000311653	0.656682615	0	0	0	0	0	0	0.626540391	0.030501737	0	0	0	0	0	0	0	0											6.608	YES	498.260606	24.84424067	282.2165428	10.52703306	138.1192424	6.336495519	3.312733546	247.9148534	212.2247606	0	8.941735594		0.015462639	23.18763439	5843.509854	219.7900895	310.6122741	229.638938	14.57670282	529.7626637	21.66984989	0	0	0	327.628493	0	0	0	0	0											3400	$225/day (Days 1-6)	$225/day (Days 1-6)	$50/day (Days 11-100)	15% Coin HHC	$150 Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$200 Copay OP Hosp & Surg/$200 Copay ASC	$0 Copay Lab/$0 Copay Lab	15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad		15% Coin Dialysis	$20 Copay CORF/10% Coin Partial Hospitalization/15% Coin Rad/$200 Copay OP Hosp & Surg/$20 Copay OP Substance Abuse/$20 Copay Cardiac Rehab/$20 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$20 Copay Specialists/$20 Copay Podiatry/$20 Copay Psychiatric/$20 Copay Preventive Dental/$20 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$20 Copay Mental Health	$20 Copay OT	15% Coin Rad	$50 ER Waived/$20 Copay Other/$0 Copay Lab/$20 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$25 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											75	NO	225	225	50	0.15	150	0.2	0.2	46.09622223	200	0	0.15	0	0.15	0.217918572	20	20	20	20	0.15	20	0.15	0	0	0	25	0	0	0	0	0											NO	212.455397	212.455397	47.21231045	0.141636931	141.6369313	0.188849242	0.188849242	43.52618308	188.8492418	0	0.141636931	0	0.141636931	0.205768786	18.88492418	18.88492418	18.88492418	18.88492418	0.141636931	18.88492418	0.141636931	0	0	0	23.60615522	0	0	0	0	0												8.8215	0.439857751	1.110341253	1.491016659	1.630232137	1.196642374	0.625607218	0.899232275	3.339873761	0	1.26647999	0	0.002190081	4.771291374	9.196186711	0.345893265	0.488824104	0.361392828	2.064599457	0.833710645	3.069251041	0	0	0	0.644504088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5986			2.515271595	11.873	0.520236658	1.401129665	1.491016659	1.736897043	1.324355944	0.701999309	0.899232275	4.451174459	0.233649261	1.482097884	0	0.002501734	5.427973988	9.196186711	0.345893265	0.488824104	0.361392828	2.064599457	0.833710645	3.695791432	0.030501737	0	0	0.644504088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2067	YES	20% Coin IP Acute	20% Coin IP MH	20% Coin SNF	20% Coin HHC	$150 Ambul	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		15% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$30 Copay PCP/20% Coin Immunizations/20% Coin Immunizations - Addl/20% Coin Physical Exams/20% Coin Supp Physical Exams	20% Coin Chiro/$30 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/20% Coin Preventive Dental/20% Coin Preventive Dental/$30 Copay Medicare Covered Vision Exams/20% Coin Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/20% Coin Other/20% Coin Lab/20% Coin Other/20% Coin Pap & Pelvic/20% Coin Supp Pap & Pelvic/20% Coin Prostate Screen/No Coverage Supp Prostate Screening/20% Coin Colorectal Screen/No Coverage Supp Colorectal Screening/20% Coin Bone Mass/20% Coin Bone Mass/20% Coin Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/20% Coin Nutrition Ther	15% Coin Part B Rx - Chemo/15% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	20% Coin HE SM Cess/20% Coin HE SM Cess/20% Coin HE News Letter/20% Coin Fitness/20% Coin Nurse Hotine/20% Coin Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											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	11.873	0.520236658	1.401129665	1.491016659	1.736897043	1.324355944	0.701999309	0.899232275	4.451174459	0.233649261	1.482097884	0	0.002501734	5.427973988	9.196186711	0.345893265	0.488824104	0.361392828	2.064599457	0.833710645	3.695791432	0.030501737	0	0	0.644504088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2067
H9047_801_0	2012	8																															A	A			T			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	201.6949158	2.228948274	0	0	242.6824096	0	0	370.1951527	0	0	248.5942831		0	866.4329824	8562.369556	76.78507808	393.3187145	178.3244012	0	937.0615307	0	0	0	0	327.628493	0	0	0	0	0											6700	$250/Admit	$250/Admit	$0 Copay	$0 Copay HHC	$50 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$15 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	$0 Copay Rad	$50 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$15 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													250	250	0	0	50	0	0	44.92964767	0	0	0	0	0	15	15	15	15	15	0	15	0	0	0	0	15	0	0	0	0	0											NO	247.5	247.5	0	0	49.5	0	0	44.48035119	0	0	0	0	0	14.85	14.85	14.85	14.85	14.85	0	14.85	0	0	0	0	14.85	0	0	0	0	0												4.16	0.045972058	0	0	1.001064939	0	0	1.372200867	0	0	0	0	0	1.072210816	10.59593233	0.095021534	0.486731909	0.220676447	0	1.159613644	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6148	0	NO	0.20823053	4.16	0.045972058	0	0	1.001064939	0	0	1.372200867	0	0	0	0	0	1.072210816	10.59593233	0.095021534	0.486731909	0.220676447	0	1.159613644	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6148	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	Medicare Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	4.16	0.045972058	0	0	1.001064939	0	0	1.372200867	0	0	0	0	0	1.072210816	10.59593233	0.095021534	0.486731909	0.220676447	0	1.159613644	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6148
H9047_804_0	2012	8																															A	A			T			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	173.6190403	1.435502789	0	0	186.0817531	0	0	296.0265392	0	0	311.7996128		0	818.4783108	7661.955339	71.11633054	280.5288457	151.4496076	0	845.3142325	0	0	0	0	327.628493	0	0	0	0	0											6700	$250/Admit	$250/Admit	$0 Copay	$0 Copay HHC	$50 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$15 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay PT & ST	$15 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Psychiatric/$15 Copay Preventive Dental/$15 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health	$15 Copay OT	$0 Copay Rad	$50 ER Waived/$15 Copay Other/$0 Copay Lab/$15 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	$0 Copay Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$15 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													250	250	0	0	50	0	0	45.89935986	0	0	0	0	0	15	15	15	15	15	0	15	0	0	0	0	15	0	0	0	0	0											NO	247.5	247.5	0	0	49.5	0	0	45.44036626	0	0	0	0	0	14.85	14.85	14.85	14.85	14.85	0	14.85	0	0	0	0	14.85	0	0	0	0	0												3.5809	0.029607245	0	0	0.767587232	0	0	1.120962864	0	0	0	0	0	1.01286691	9.481669733	0.088006459	0.347154447	0.187418889	0	1.046076363	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0677	0	NO	0.18250185	3.5809	0.029607245	0	0	0.767587232	0	0	1.120962864	0	0	0	0	0	1.01286691	9.481669733	0.088006459	0.347154447	0.187418889	0	1.046076363	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0677	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambul	$0 Copay DME	$0 Copay Prosthetics/$0 Copay Diabetic Supplies	$0 ER/$0 Copay Urgent Care	$0 Copay OP Hosp & Surg/$0 Copay ASC	$0 Copay Lab/$0 Copay Lab	$0 Copay Rad/$0 Copay MRI/CT/PET/$0 Copay Rad		$0 Copay Dialysis	$0 Copay CORF/$0 Copay Partial Hospitalization/$0 Copay Rad/$0 Copay OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay PT & ST	$0 Copay PCP/$0 Copay Immunizations/No Addl Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$0 Copay Chiro/$0 Copay Specialists/$0 Copay Podiatry/$0 Copay Psychiatric/$0 Copay Preventive Dental/$0 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$0 Copay Medicare Covered Hearing Exams	$0 Copay Mental Health	$0 Copay OT	$0 Copay Rad	$0 ER/$0 Copay Other/$0 Copay Lab/$0 Copay Other/$0 Copay Pap & Pelvic/No Coverage Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	Medicare Part B Rx - Chemo/$0 Copay Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	No Coverage Supp Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	No Coverage HE SM Cess/No Coverage HE SM Cess/No Coverage HE News Letter/No Coverage Fitness/No Coverage Nurse Hotine/No Coverage Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals												0	0	0	0	0	0	0	0	0	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	3.5809	0.029607245	0	0	0.767587232	0	0	1.120962864	0	0	0	0	0	1.01286691	9.481669733	0.088006459	0.347154447	0.187418889	0	1.046076363	0	0	0	0	0.40544026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0677
H9047_805_0	2012	8																															A	A	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	140.6584103	1.452008315	252.1261578	19.91798709	165.2204571	9.694772703	3.219250468	253.2998995	228.5756716	0	10.55419895		0	26.8246931	6819.37816	51.94170996	242.9925378	119.243725	13.09821427	631.6010966	20.00112739	0	0	0	293.4718069	0	0	0	0	0												$350/Admit	$350/Admit	$50/day (Days 21-100)	10% Coin HHC	$50 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$100 Copay OP Hosp & Surg/$100 Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$20 Copay CORF/10% Coin Partial Hospitalization/10% Coin Rad/$100 Copay OP Hosp & Surg/$20 Copay OP Substance Abuse/$20 Copay Cardiac Rehab/$20 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$20 Copay Specialists/$20 Copay Podiatry/$20 Copay Psychiatric/$20 Copay Preventive Dental/$20 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$20 Copay Mental Health	$20 Copay OT	10% Coin Rad	$50 ER Waived/$20 Copay Other/$0 Copay Lab/$20 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$20 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													350	350	50	0.1	50	0.1	0.1	45.04766836	100	0	0.1	0	0	0.130430641	20	20	20	20	0.1	20	0.1	0	0	0	20	0	0	0	0	0											NO	339.2465115	339.2465115	48.46378736	0.096927575	48.46378736	0.096927575	0.096927575	43.66361241	96.92757472	0	0.096927575	0	0	0.126423257	19.38551494	19.38551494	19.38551494	19.38551494	0.096927575	19.38551494	0.096927575	0	0	0	19.38551494	0	0	0	0	0												3.9765	0.041049063	1.018249042	1.930602182	0.667267425	0.939690806	0.31203414	0.92166572	1.84627379	0	1.022992907	0	0	3.391265063	11.01642977	0.083909733	0.392544623	0.192633418	1.269578143	1.020326041	1.93866077	0	0	0	0.474091842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4558	0	NO	1.02878752	3.9765	0.041049063	1.018249042	1.930602182	0.667267425	0.939690806	0.31203414	0.92166572	1.84627379	0	1.022992907	0	0	3.391265063	11.01642977	0.083909733	0.392544623	0.192633418	1.269578143	1.020326041	1.93866077	0	0	0	0.474091842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4558	YES	20% Coin IP Acute	20% Coin IP MH	20% Coin SNF	20% Coin HHC	$50 Ambul	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		10% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$30 Copay PCP/20% Coin Immunizations/20% Coin Immunizations - Addl/20% Coin Physical Exams/20% Coin Supp Physical Exams	20% Coin Chiro/$30 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/20% Coin Preventive Dental/20% Coin Preventive Dental/$30 Copay Medicare Covered Vision Exams/20% Coin Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/20% Coin Other/20% Coin Lab/20% Coin Other/20% Coin Pap & Pelvic/20% Coin Supp Pap & Pelvic/20% Coin Prostate Screen/No Coverage Supp Prostate Screening/20% Coin Colorectal Screen/No Coverage Supp Colorectal Screening/20% Coin Bone Mass/20% Coin Bone Mass/20% Coin Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/20% Coin Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	20% Coin HE SM Cess/20% Coin HE SM Cess/20% Coin HE News Letter/20% Coin Fitness/20% Coin Nurse Hotine/20% Coin Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4964	0.0235	0.0335	0.0024	0.0787	0.1153	0	0	0	0	0.0828	0	0	0	0	0											0.8326	0	NO	0.026389923	3.9765	0.041049063	1.018249042	1.930602182	0.667267425	0.939690806	0.31203414	0.92166572	1.84627379	0	1.022992907	0	0	3.391265063	11.51282977	0.107409733	0.426044623	0.195033418	1.348278143	1.135626041	1.93866077	0	0	0	0.556891842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2884
H9047_806_0	2012	8																															A	A	D	Coin	T	Coin	Coin	V	V		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	96.89145865	3.070954421	127.2340163	9.002810331	110.1686617	8.881956762	2.257692987	230.8519226	229.8808199	0	8.590661823		0	20.68733767	5740.561507	365.8479737	390.1355461	283.2588339	10.34672784	506.5222241	11.6276768	0	0	0	313.8670633	0	0	0	0	0												$350/Admit	$350/Admit	$50/day (Days 21-100)	10% Coin HHC	$50 Ambul	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	$100 Copay OP Hosp & Surg/$100 Copay ASC	$0 Copay Lab/$0 Copay Lab	10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Dialysis	$20 Copay CORF/10% Coin Partial Hospitalization/10% Coin Rad/$100 Copay OP Hosp & Surg/$20 Copay OP Substance Abuse/$20 Copay Cardiac Rehab/$20 Copay PT & ST	$20 Copay PCP/$0 Copay Immunizations/$0 Copay Immunizations - Addl/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$20 Copay Chiro/$20 Copay Specialists/$20 Copay Podiatry/$20 Copay Psychiatric/$20 Copay Preventive Dental/$20 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$20 Copay Mental Health	$20 Copay OT	10% Coin Rad	$50 ER Waived/$20 Copay Other/$0 Copay Lab/$20 Copay Other/$0 Copay Pap & Pelvic/$0 Copay Supp Pap & Pelvic/$0 Copay Prostate Screen/No Coverage Supp Prostate Screening/$0 Copay Colorectal Screen/No Coverage Supp Colorectal Screening/$0 Copay Bone Mass/$0 Copay Bone Mass/$0 Copay Mammogram/No Coverage Supp Mammography/$0 Copay Diab Monitor/$0 Copay Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	$0 Copay Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$20 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	$0 Copay HE SM Cess/$0 Copay HE SM Cess/$0 Copay HE News Letter/$0 Copay Fitness/$0 Copay Nurse Hotine/$0 Copay Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals													350	350	50	0.1	50	0.1	0.1	42.69502834	100	0	0.1	0	0	0.135989456	20	20	20	20	0.1	20	0.1	0	0	0	20	0	0	0	0	0											NO	339.2465115	339.2465115	48.46378736	0.096927575	48.46378736	0.096927575	0.096927575	41.3832555	96.92757472	0	0.096927575	0	0	0.131811282	19.38551494	19.38551494	19.38551494	19.38551494	0.096927575	19.38551494	0.096927575	0	0	0	19.38551494	0	0	0	0	0												2.7392	0.086817548	0.513853526	0.872620571	0.444932549	0.860906528	0.218832706	0.796117008	1.856815862	0	0.832672016	0	0	2.726824499	9.273645073	0.591012613	0.630248205	0.457593196	1.002883236	0.818266179	1.127042512	0	0	0	0.507039554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3573	0	NO	0.835477699	2.7392	0.086817548	0.513853526	0.872620571	0.444932549	0.860906528	0.218832706	0.796117008	1.856815862	0	0.832672016	0	0	2.726824499	9.273645073	0.591012613	0.630248205	0.457593196	1.002883236	0.818266179	1.127042512	0	0	0	0.507039554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3573	YES	20% Coin IP Acute	20% Coin IP MH	20% Coin SNF	20% Coin HHC	$50 Ambul	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$25 Copay Urgent Care	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab	20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad		10% Coin Dialysis	20% Coin CORF/20% Coin Partial Hospitalization/20% Coin Rad/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin PT & ST	$30 Copay PCP/20% Coin Immunizations/20% Coin Immunizations - Addl/20% Coin Physical Exams/20% Coin Supp Physical Exams	20% Coin Chiro/$30 Copay Specialists/20% Coin Podiatry/20% Coin Psychiatric/20% Coin Preventive Dental/20% Coin Preventive Dental/$30 Copay Medicare Covered Vision Exams/20% Coin Medicare Covered Hearing Exams	20% Coin Mental Health	20% Coin OT	20% Coin Rad	$50 ER Waived/20% Coin Other/20% Coin Lab/20% Coin Other/20% Coin Pap & Pelvic/20% Coin Supp Pap & Pelvic/20% Coin Prostate Screen/No Coverage Supp Prostate Screening/20% Coin Colorectal Screen/No Coverage Supp Colorectal Screening/20% Coin Bone Mass/20% Coin Bone Mass/20% Coin Mammogram/No Coverage Supp Mammography/20% Coin Diab Monitor/20% Coin Nutrition Ther	10% Coin Part B Rx - Chemo/10% Coin Part B Rx/N	20% Coin Blood	No Coverage Supp Transportation	No Coverage Supp Preventive Dental	$30 Copay Non-Covered Vision Exams	No Coverage Supp Vision Hardware	No Coverage Supp Hearing Exams	No Coverage Supp Hearing Aids	20% Coin HE SM Cess/20% Coin HE SM Cess/20% Coin HE News Letter/20% Coin Fitness/20% Coin Nurse Hotine/20% Coin Other 1/No Coverage Other 2	No Coverage Suppl Chiro/No Coverage Supp Podiatry/No Coverage Acupuncture/No Coverage OTC/No Coverage Meals											3400	0	0	0	0.0063	0	0.0434	0.0142	0	0.1752	0.0056	0.005	0	0	0.0146	0.7707	0.0481	0.0598	0.0062	0.1121	0.2005	0.0099	0	0	0	0.0333	0	0	0	0	0											1.5049	0	NO	0.047704013	2.7392	0.086817548	0.513853526	0.878920571	0.444932549	0.904306528	0.233032706	0.796117008	2.032015862	0.0056	0.837672016	0	0	2.741424499	10.04434507	0.639112613	0.690048205	0.463793196	1.114983236	1.018766179	1.136942512	0	0	0	0.540339554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8622
H9082_002_0	2012	4																															D	D	D		T	Coin	Coin	V	V		V		Coin	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	662.1719924	24.66148331	295.9400465	0	170.8299762	15.2753084	4.241936357	357.5895248	172.3694238	0	418.4541882	0	0.178033942	485.1089821	3635.415819	3558.008044	188.404821	357.9774296	1229.668455	164.8201024	35.42542992	0	0	0	113.1632742	0	13.5576929	0	0	0											2800	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$250/Days Custom for IP Psych; $250/Days Custom for IP Substance Abuse;	$125/Days Custom for SNF;	No Cost-Sharing;	$125/Trip for Ambulance;	20% Coinsurance for DME;	20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $35/Visit for PCP Urgent Care;	$100/Case for OP Fac - Surgery;	No Cost-Sharing;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac;	20% Coinsurance for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; $125/Case for OP Fac - Other; 20% Coinsurance for Prof - CORF; $20/Visit for OP Substance Abuse;	$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits;	$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $15/Proceedure for Cardio; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist;	$20/Visit for Occ Therapy; $20/Visit for PT/ST;	20% Coinsurance for General Diagnosic Radiology; $100/Case for Complex Diagnosic Radiology; 20% Coinsurance for Therapeutic Radiology;	$5/Visit for PCP Office Visits; $20/Visit for Speclst Office Visits;	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;	$15/Exam for Vision Exams (Refractions);	No Cost-Sharing;	$15/Exam for Hearing Exam;	No Cost-Sharing;	No Cost-Sharing;	No Cost-Sharing;											0	NO	200	250	125	0	125	0.2	0.2	47.71736191	106.035472	0	47.32496097	0	0.2	85.4076329	5	19.8229715	20	20	12.17844183	19.59114988	0.2	0	0	0	15	0	15	0	0	0											NO	179.4491438	224.3114297	112.1557149	0	112.1557149	0.179449144	0.179449144	42.81419869	95.13987327	0	42.46211863	0	0.179449144	76.63163298	4.486228595	17.78607632	17.94491438	17.94491438	10.92705479	17.57807536	0.179449144	0	0	0	15	0	15	0	0	0												9.9022	0.460987715	2.76594729	0	1.596629842	2.741141013	0.761211847	1.275825747	1.366600428	0	1.480704282	0	0.031948038	3.097891123	1.359108867	5.27358355	0.281742365	0.53532286	1.119721215	0.241435015	6.357063068	0	0	0	0.141454093	0	0.016947116	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8074	0	NO	4.655205979	9.9022	0.460987715	2.76594729	0	1.596629842	2.741141013	0.761211847	1.275825747	1.366600428	0	1.480704282	0	0.031948038	3.097891123	1.359108867	5.27358355	0.281742365	0.53532286	1.119721215	0.241435015	6.357063068	0	0	0	0.141454093	0	0.016947116	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8074	NO																																										0	0	0	0	0	0	0	0	0	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	9.9022	0.460987715	2.76594729	0	1.596629842	2.741141013	0.761211847	1.275825747	1.366600428	0	1.480704282	0	0.031948038	3.097891123	1.359108867	5.27358355	0.281742365	0.53532286	1.119721215	0.241435015	6.357063068	0	0	0	0.141454093	0	0.016947116	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8074
H9104_006_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1091.956336	16.45269585	1184.198267	0	419.4683986	30.69719841	1.749462839	380.5353238	831.8981999	11.38480698	20.83761427	16.54499188	0	671.8181932	0	3048.666242	427.8723588	2178.880392	7.006562384	1694.325642	147.6274345	0	0	0	0	259.898625	0	0	0	276											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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10/visit for Routine Podiatry (6 visits/year)													50	50	20	0	100	0.06	0.055702532	47.95934453	66.5	0.02	0.045	50	0	10	0	5	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	49.5	49.5	19.8	0	99	0.0594	0.055145506	47.47975108	65.835	0.0198	0.04455	49.5	0	9.9	0	4.95	24.75	9.9	0.099	9.9	0.198	0	0	0	0	25	0	0	0	10												4.5043	0.06786737	1.95392714	0	3.460614289	1.823413586	0.096475014	1.505643538	4.564001499	0.225419178	0.928315716	0.068248092	0	0.554250009	0	1.257574825	0.88248674	1.797576324	0.693649676	1.397818654	29.23023204	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	55.7833			0.555072186	4.5043	0.06786737	1.95392714	0	3.460614289	1.823413586	0.096475014	1.505643538	4.564001499	0.225419178	0.928315716	0.068248092	0	0.554250009	0	1.257574825	0.88248674	1.797576324	0.693649676	1.397818654	29.23023204	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	55.7833	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				4.5043	0.06786737	1.95392714	0	3.460614289	1.823413586	0.096475014	1.505643538	4.564001499	0.225419178	0.928315716	0.068248092	0	0.554250009	0	1.257574825	0.88248674	1.797576324	0.693649676	1.397818654	29.23023204	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	55.7833
H9104_007_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	933.4894794	13.85376886	1027.835267	0	349.0568398	25.89016329	1.475505288	369.6297846	776.2100981	7.779599104	17.62577576	15.45064597	0	727.7697641	0	2367.22199	370.0465056	1884.410289	5.500972617	1465.341872	112.5024411	0	0	0	0	259.898625	0	0	0	276											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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10/visit for Routine Podiatry (6 visits/year)													50	50	20	0	100	0.06	0.055702532	48.17525337	66.5	0.02	0.045	50	0	10	0	5	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	49.5	49.5	19.8	0	99	0.0594	0.055145506	47.69350083	65.835	0.0198	0.04455	49.5	0	9.9	0	4.95	24.75	9.9	0.099	9.9	0.198	0	0	0	0	25	0	0	0	10												3.8506	0.057146797	1.695928191	0	2.879718928	1.537875699	0.081367486	1.469078203	4.258482651	0.154036062	0.78522831	0.063733915	0	0.600410055	0	0.976479071	0.763220918	1.554638489	0.544596289	1.208907044	22.27548335	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	45.5284			0.480451998	3.8506	0.057146797	1.695928191	0	2.879718928	1.537875699	0.081367486	1.469078203	4.258482651	0.154036062	0.78522831	0.063733915	0	0.600410055	0	0.976479071	0.763220918	1.554638489	0.544596289	1.208907044	22.27548335	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	45.5284	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				3.8506	0.057146797	1.695928191	0	2.879718928	1.537875699	0.081367486	1.469078203	4.258482651	0.154036062	0.78522831	0.063733915	0	0.600410055	0	0.976479071	0.763220918	1.554638489	0.544596289	1.208907044	22.27548335	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	45.5284
H9104_008_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	791.5144969	11.80727067	866.6426932	0	329.0806371	24.47671354	1.394951428	328.6531927	619.4991409	8.841153803	13.6295073	12.34180872	0	465.4232766	0	2043.929144	303.6003136	1546.042311	5.887101075	1202.222545	93.7317744	0	0	0	0	259.898625	0	0	0	276											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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10/visit for Routine Podiatry (6 visits/year)													50	50	20	0	100	0.06	0.055692475	48.46986048	66.5	0.02	0.075	50	0	10	0	5	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	49.5	49.5	19.8	0	99	0.0594	0.055135551	47.98516188	65.835	0.0198	0.07425	49.5	0	9.9	0	4.95	24.75	9.9	0.099	9.9	0.198	0	0	0	0	25	0	0	0	10												3.265	0.048704992	1.429960444	0	2.714915256	1.453916784	0.076911415	1.314206388	3.398727162	0.175054845	1.011990917	0.050909961	0	0.383974203	0	0.843120772	0.626175647	1.275484907	0.582823006	0.9918336	18.55889133	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	38.9741			0.386059267	3.265	0.048704992	1.429960444	0	2.714915256	1.453916784	0.076911415	1.314206388	3.398727162	0.175054845	1.011990917	0.050909961	0	0.383974203	0	0.843120772	0.626175647	1.275484907	0.582823006	0.9918336	18.55889133	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	38.9741	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				3.265	0.048704992	1.429960444	0	2.714915256	1.453916784	0.076911415	1.314206388	3.398727162	0.175054845	1.011990917	0.050909961	0	0.383974203	0	0.843120772	0.626175647	1.275484907	0.582823006	0.9918336	18.55889133	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	38.9741
H9104_009_0	2012	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	861.2782317	12.84795824	943.1783671	0	359.5983886	26.23277811	1.495031235	358.027983	674.5514803	9.480548625	14.61519724	13.43450673	0	506.6301285	0	2242.3684	333.076003	1696.143154	6.412427175	1318.942906	102.0546336	0	0	0	0	259.898625	0	0	0	276											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	10% coinsurance for specialized diagnostics	10% diagnostic radiology; 20% coinsurance for therapeutic radiology; 0% for routine X-rays	$50/day	$0 Copay	$10/visit cardiac rehab	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST	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	$0 Copay	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10/visit for Routine Podiatry (6 visits/year)													50	50	20	0	100	0.06	0.055692475	48.46986048	66.5	0.02	0.075	50	0	10	0	5	25	10	0.1	10	0.2	0	0	0	0	25	0	0	0	10											NO	49.5	49.5	19.8	0	99	0.0594	0.055135551	47.98516188	65.835	0.0198	0.07425	49.5	0	9.9	0	4.95	24.75	9.9	0.099	9.9	0.198	0	0	0	0	25	0	0	0	10												3.5528	0.052997828	1.556244306	0	2.966686706	1.55822702	0.08242937	1.431669227	3.700758059	0.187714863	1.085178395	0.05541734	0	0.417969856	0	0.924976965	0.686969256	1.399318102	0.63483029	1.088127898	20.20681745	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	42.3606			0.422122132	3.5528	0.052997828	1.556244306	0	2.966686706	1.55822702	0.08242937	1.431669227	3.700758059	0.187714863	1.085178395	0.05541734	0	0.417969856	0	0.924976965	0.686969256	1.399318102	0.63483029	1.088127898	20.20681745	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	42.3606	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				3.5528	0.052997828	1.556244306	0	2.966686706	1.55822702	0.08242937	1.431669227	3.700758059	0.187714863	1.085178395	0.05541734	0	0.417969856	0	0.924976965	0.686969256	1.399318102	0.63483029	1.088127898	20.20681745	0	0	0	0	0.541455469	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	42.3606
H9184_002_0	2012	7																															D	D	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	972.3201695	32.56723009	884.7483066	8.512778061	153.8860647	8.754241993	2.133328894	282.8996154	267.0097822	0.967624789	15.29092979	0	0.117222821	389.7525314	2992.254652	2298.023764	185.5835988	87.29351785	22.4111351	29.935696	27.05667641	0.292017182	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	1b:  Psych - $200/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$50/$120/day for 1-10/11-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/$120/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%-20%	4a:  Emergency Care / Post Stabilization Care - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - $15/visit/3:  Pulmonary Rehabilitation - $15/visit/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/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - $0/visit14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/	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:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 0.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 0.0%"	"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:  Primary Care - $5/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - $0/service/9d:  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			14c:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service													250	200	60	0	150	0.2	0.13289217	48.43360549	233.4108825	0	0.2	0	0.2	66.94966191	5	39.66867576	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	237.5666966	190.048329	56.99982608	0	142.5293847	0.189985982	0.126300753	46.0460794	221.6673415	0	0.190000669	0	0.19012685	63.59983082	4.749345937	37.67520075	18.99481881	37.95939617	0	37.96178037	0.19002571	0	0	0	0	0	0	0	0	0												19.2492	0.515778972	4.202541633	0	1.827773843	1.663183264	0.269441046	1.085534846	4.932279047	0	2.905286886	0	0.022287206	2.065682922	1.184271039	7.214875552	0.29376057	0.276134102	0	0.094701026	5.141464142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9442			2.783213867	19.2492	0.515778972	4.202541633	0	1.827773843	1.663183264	0.269441046	1.085534846	4.932279047	0	2.905286886	0	0.022287206	2.065682922	1.184271039	7.214875552	0.29376057	0.276134102	0	0.094701026	5.141464142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9442	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 - $65/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $65/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%	3:  Cardiac Rehabilitation Services - 30.0%/3:  Pulmonary Rehabilitation - 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%/14d:  Kidney Disease Education Services - $0/service/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/17a:  Vision Exams - $0/visit/14b:  Routine Exams - 20.0%14e:  Diabetes Self-Management Training - $0/service/	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $0/visit/14a:  Physical Exams (Initial Exam) - $0/visit/14a:  Pap Smears and Pelvic Exams Screening - $0/visit/14a:  Bone Mass Measurement - $0/visit/14a:  Colorectal Screening - $0/visit/14a:  Immunizations (Hepatitis B) - $0/visit/14a:  Diabetes Monitoring - $0/visit/14a:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14d:  Kidney Disease Education Services - $0/service/14a:  Prostate Cancer Screening - $0/visit/14a:  Mammography - $0/visit/14e:  Diabetes Self-Management Training - $0/service/16b:  Comprehensive Dental - Non-Routine Svcs - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - 0.0%/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  Primary Care - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	9d:  Blood - 20.0%/9d:  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:  Written health education materials - $0/service	14b:  Member Quality Incentive Program - $0/service											10000	12.0167	0.035	1.6551	0.5288	0.3124	0.8647	0.2296	0.343	1.7126	0.0526	1.0843	0	0.0054	0.5696	1.2563	2.1369	0.0219	0.1563	0.6925	0.6656	1.5962	0.0169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9523			3.580526231	31.2659	0.550729065	5.8576551	0.52877637	2.140181805	2.52792857	0.499020018	1.428540008	6.644841184	0.05258243	3.989589922	0	0.027706614	2.635253745	2.440576492	9.351804882	0.315640754	0.432397296	0.692506859	0.760294053	6.737661288	0.016935873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8965
H9285_001_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	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	1709.243329	292.7879704	598.0640514	9.096412761	356.0848188	6.33607804	2.32730132	314.5844336	193.4451409	899.6164795	16.18343633	33.8395234	0.426802169	1272.153484	12919.08481	5989.180007	551.6422675	1102.654296	4100.676364	843.0257735	12.73387611	0.759344959	0	279.0914533	558.6441634	280.1394746	1.945096298	4.117996668	0	0											3400	$225 days 1-7;$0 days 8-90	$225 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	6: $20	10a: $100	11a: 20%	"11b1: 20%, 11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $25"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $25-$200	12: 20%	"31-33: $25-$200, 5: $225,9a2: $200"	$0 	"7b1: $20,7d1: $25,7f1: $25"	"7e1: $25,7h1: $25"	"7c: $25,7i: $25"	$0 	7g: $25	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	169.022958	118.2314915	43.13699935	20	100	0.2	0.195457878	49.76865313	179.6131994	0	0.119711782	42.5	0.2	43.40083693	0	21.01863895	25	25	0	25	0.199903965	0	0	0	0	10	0	0	0	0											NO	142.5996819	99.74842045	36.39341342	16.87340982	84.3670491	0.168734098	0.164902044	42.04192974	151.5343561	0	0.100997298	35.85599587	0.168734098	36.6160054	0	17.73280544	21.09176228	21.09176228	0	21.09176228	0.168653076	0	0	0	0	10	0	0	0	0												20.3115	2.433761465	1.813799356	0.012790625	2.50348545	1.069112414	0.383776744	1.102144721	2.442798739	0	1.634483334	0.101112484	0.072016079	3.881764905	0	8.850413652	0.969592297	1.938076857	0	1.481741601	2.147607376	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3834	0	NO	9.846853126	20.3115	2.433761465	1.813799356	0.012790625	2.50348545	1.069112414	0.383776744	1.102144721	2.442798739	0	1.634483334	0.101112484	0.072016079	3.881764905	0	8.850413652	0.969592297	1.938076857	0	1.481741601	2.147607376	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3834	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	20.3115	2.433761465	1.813799356	0.012790625	2.50348545	1.069112414	0.383776744	1.102144721	2.442798739	0	1.634483334	0.101112484	0.072016079	3.881764905	0	8.850413652	0.969592297	1.938076857	0	1.481741601	2.147607376	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3834
H9285_002_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	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	1874.957701	321.1484737	655.9389427	9.979952391	390.5942956	6.950893363	2.552659385	345.0987006	212.2585296	987.022608	17.75899247	37.10118615	0.467982242	1395.630714	14171.78198	6570.404541	605.206029	1209.784001	4498.552128	924.8274747	13.9708881	0.832405908	0	279.0914533	558.6441634	280.1394746	1.945096298	4.117996668	0	4819.296545											3400	$95 days 1-7;$0 days 8-90	$95 days 1-7;$0 days 8-90	$0 days 1-8;$95 days 9-100	$0 	10a: $100	11a: 20%	"11b1: 20%, 11b2: 20%, 11c1: 0%-20%, 17b1: $10"	"4a1: $50,4a2: $500,4b: $20"	"9a1: $200,9b: $50"	$0 	"8b2: $50-$100; 8b3: 20% or $75; 8b4: 20%, 8b5: $25"	9c1: $20-$200	12: 20%	"31-33: $20-$200, 5: $95,9a2: $200"	$0 	"7b1: $20,7d1: $20,7f1: $20"	"7e1: $20,7h1: $20"	"7c: $20,7i: $20"	$0 	7g: $20	"152: 20%,153: 20%"	$0 	$0 	16a4: $0-$75	$0 	"17b2: $10, 17b3: $10"	$0 	$0 	$0 	$0 												NO	71.36524892	49.91996306	43.13699935	0	100	0.2	0.195457224	49.6330912	179.602489	0	0.119718332	38	0.2	24.65004772	0	16.85552647	20	20	0	20	0.199904005	0	0	0	0	10	0	0	0	0											NO	66.33548375	46.40164433	40.09673843	0	92.95208067	0.185904161	0.181681556	46.15701329	166.9442504	0	0.111280681	35.32179066	0.185904161	22.91273224	0	15.66756256	18.59041613	18.59041613	0	18.59041613	0.185814932	0	0	0	0	10	0	0	0	0												10.3647	1.241818105	2.191751018	0	3.025546039	1.292200001	0.463771129	1.327393776	2.952945094	0	1.976232772	0.109206694	0.086999846	2.664809406	0	8.578518684	0.937585994	1.874199001	0	1.432743967	2.595999625	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3499	0	NO	3.268540321	10.3647	1.241818105	2.191751018	0	3.025546039	1.292200001	0.463771129	1.327393776	2.952945094	0	1.976232772	0.109206694	0.086999846	2.664809406	0	8.578518684	0.937585994	1.874199001	0	1.432743967	2.595999625	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3499	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	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	10.3647	1.241818105	2.191751018	0	3.025546039	1.292200001	0.463771129	1.327393776	2.952945094	0	1.976232772	0.109206694	0.086999846	2.664809406	0	8.578518684	0.937585994	1.874199001	0	1.432743967	2.595999625	0	0	0	0	0.233449562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3499
H9302_001_0	2012	9																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	799.1436587	5.864371603	527.1146324	0	154.1035355	9.404982733	5.837403853	395.5824761	497.3977262	0	176.9740745	0	0.00127989	261.0373039	5312.506454	4733.39098	139.8788956	1081.122518	454.4539631	0	39.9537487	0	0	0	0	56.37329515	1.78508433	0	0	0											1400	$125/IP Days 1-5 for IP Med/Surg; $125/IP Days 1-5 for IP Med/Surg; PBP 1a	$150/IP Days 1-5 for IP MH/SA; PBP 1b	$100/SNF 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 Prosth/Supplies; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $15/Case for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Complex Diagnostic; $15/Case for OP Rad - Therapeutic; PBP 8b	$100/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for CORF; $15/Case for OP - Other; $15/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $5/Visit for Diabetic Footcare; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$150/Visit for Phys Rad - Complex Diagnostic; $15/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	125	150	100	0	100	0.2	0.2	45.42583155	80.73347395	0	116.9649143	0	0.2	15	4.999744235	15.30568571	15	15	54.16811393	0	0.2	0	0	0	0	15	15	0	0	0											NO	93.63959116	112.3675094	74.91167293	0	74.91167293	0.149823346	0.149823346	34.02925036	60.47879595	0	87.62037402	0	0.149823346	11.23675094	3.745392049	11.46574522	11.23675094	11.23675094	40.57824034	0	0.149823346	0	0	0	0	11.23675094	11.23675094	0	0	0												6.236	0.054913736	3.290586578	0	0.962012804	1.409085981	0.874579376	1.12178126	2.506834632	0	1.292211217	0	0.000191757	0.244434264	1.658118286	4.522654582	0.130982026	1.012358706	1.536745178	0	5.98600431	0	0	0	0	0.052787723	0.001671546	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8939	0	NO	11.78508674	6.236	0.054913736	3.290586578	0	0.962012804	1.409085981	0.874579376	1.12178126	2.506834632	0	1.292211217	0	0.000191757	0.244434264	1.658118286	4.522654582	0.130982026	1.012358706	1.536745178	0	5.98600431	0	0	0	0	0.052787723	0.001671546	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8939	NO	$125/IP Days 1-5 for IP Med/Surg; $125/IP Days 1-5 for IP Med/Surg; PBP 1a	$150/IP Days 1-5 for IP MH/SA; PBP 1b	$100/SNF 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 Prosth/Supplies; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $15/Case for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Complex Diagnostic; $15/Case for OP Rad - Therapeutic; PBP 8b	$100/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $15/Visit for CORF; $15/Case for OP - Other; $15/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$5/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $5/Visit for Diabetic Footcare; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$150/Visit for Phys Rad - Complex Diagnostic; $15/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e												0.4352	0.0038	0.2296	0	0.0671	0.0983	0.061	0.0783	0.1749	0	0.0902	0	0	0.0171	0.1157	0.3156	0.0091	0.0706	0.1072	0	0.4177	0	0	0	0	0.0037	0.0001	0	0	0											2.2954	0	NO	0	6.6711	0.058745696	3.520208475	0	1.029143451	1.507414041	0.935608792	1.200060781	2.681765183	0	1.382383587	0	0.000205139	0.261491241	1.773824181	4.838251968	0.140122141	1.083002562	1.643981482	0	6.403716359	0	0	0	0	0.056471327	0.001788189	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1893
H9302_003_0	2012	10																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	536.8827817	3.137729033	387.5335547	0	85.79612257	6.75383133	3.638028731	290.6718736	394.0659467	0	138.0859358	0	0.279255394	209.7877846	4388.116523	3510.165221	90.89751364	789.3243277	476.122104	0	27.63110619	0	0	0	0	64.47477442	1.299894115	0	0	0											2250	$200/IP Days 1-5 for IP Med/Surg; $200/IP Days 1-5 for IP Med/Surg; PBP 1a	$200/IP Days 1-5 for IP MH/SA; PBP 1b	$100/SNF 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 Prosth/Supplies; PBP 11b, 11c"	"$60/Case for OP ER; $60/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$150/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Complex Diagnostic; $30/Case for OP Rad - Therapeutic; PBP 8b	$150/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for Cardiac Rehab; $30/Visit for Pulmonary Rehabilitation Services; $30/Case for OP - Other; $30/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $10/Visit for Diabetic Footcare; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$150/Visit for Phys Rad - Complex Diagnostic; $30/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$30/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	200	200	100	0	150	0.2	0.2	54.92530756	122.6374892	0	122.5211487	0	0.2	30	10	29.1123456	30	30	70.20844494	0	0.2	0	0	0	0	15	30	0	0	0											NO	173.2377897	173.2377897	86.61889483	0	129.9283422	0.17323779	0.17323779	47.57569439	106.2272378	0	106.1264649	0	0.17323779	25.98566845	8.661889483	25.21679202	25.98566845	25.98566845	60.81377909	0	0.17323779	0	0	0	0	12.99283422	25.98566845	0	0	0												7.7507	0.04529777	2.797310685	0	0.928945665	1.170018811	0.630244056	1.152409686	3.488378085	0	1.221214352	0	0.048377587	0.454289651	3.167448363	7.376258861	0.196836054	1.709260023	2.412898704	0	4.786751763	0	0	0	0	0.069809171	0.002814885	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4093	0	NO	6.088042273	7.7507	0.04529777	2.797310685	0	0.928945665	1.170018811	0.630244056	1.152409686	3.488378085	0	1.221214352	0	0.048377587	0.454289651	3.167448363	7.376258861	0.196836054	1.709260023	2.412898704	0	4.786751763	0	0	0	0	0.069809171	0.002814885	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4093	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	7.7507	0.04529777	2.797310685	0	0.928945665	1.170018811	0.630244056	1.152409686	3.488378085	0	1.221214352	0	0.048377587	0.454289651	3.167448363	7.376258861	0.196836054	1.709260023	2.412898704	0	4.786751763	0	0	0	0	0.069809171	0.002814885	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4093
H9302_004_0	2012	4																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	535.0511847	1.980152839	416.9567429	0	72.46879058	5.538052179	3.029006772	253.1252656	345.1398525	0	122.0549486	0	0.041573925	172.966376	3686.61444	3487.641626	77.32939325	667.980095	428.6773046	0	21.20222683	0	0	0	0	64.47477442	2.519280256	0	0	0											2250	$150/IP Days 1-5 for IP Med/Surg; $150/IP Days 1-5 for IP Med/Surg; PBP 1a	$200/IP Days 1-5 for IP MH/SA; PBP 1b	$100/SNF 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 Prosth/Supplies; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $30/Case for Urgent Care; PBP 4a, 4b"	"$150/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Complex Diagnostic; $30/Case for OP Rad - Therapeutic; PBP 8b	$150/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for Cardiac Rehab; $30/Visit for Pulmonary Rehabilitation Services; $30/Visit for CORF; $30/Case for OP - Other; $30/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $10/Visit for Diabetic Footcare; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$150/Visit for Phys Rad - Complex Diagnostic; $30/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$30/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	150	200	100	0	150	0.2	0.2	46.66664026	102.3098281	0	122.0961862	0	0.2	30	10	29.10978677	30	30	63.25517012	0	0.2	0	0	0	0	15	30	0	0	0											NO	134.1067275	178.80897	89.404485	0	134.1067275	0.17880897	0.17880897	41.72206939	91.46957492	0	109.1594665	0	0.17880897	26.8213455	8.9404485	26.02545495	26.8213455	26.8213455	56.55295908	0	0.17880897	0	0	0	0	13.41067275	26.8213455	0	0	0												5.9795	0.029505757	3.106483572	0	0.809879363	0.990253406	0.541613581	0.880075825	2.630816299	0	1.110287757	0	0.007433791	0.386599244	2.746665545	7.563955	0.172839864	1.49301041	2.020247505	0	3.791148341	0	0	0	0	0.072054175	0.005630874	0	0	0	0	0	0	0	0	0	0	0	0	0	34.338	0	NO	4.06946883	5.9795	0.029505757	3.106483572	0	0.809879363	0.990253406	0.541613581	0.880075825	2.630816299	0	1.110287757	0	0.007433791	0.386599244	2.746665545	7.563955	0.172839864	1.49301041	2.020247505	0	3.791148341	0	0	0	0	0.072054175	0.005630874	0	0	0	0	0	0	0	0	0	0	0	0	0	34.338	NO																																										0	0	0	0	0	0	0	0	0	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	5.9795	0.029505757	3.106483572	0	0.809879363	0.990253406	0.541613581	0.880075825	2.630816299	0	1.110287757	0	0.007433791	0.386599244	2.746665545	7.563955	0.172839864	1.49301041	2.020247505	0	3.791148341	0	0	0	0	0.072054175	0.005630874	0	0	0	0	0	0	0	0	0	0	0	0	0	34.338
H9302_007_0	2012	9																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	497.4618608	6.544695616	545.7071815	0	69.57358683	6.921467136	3.212527782	289.4703144	291.1223558	0	78.51721872	0	0.014452134	140.3898656	3725.172202	2897.93925	78.11332801	524.9222423	228.8720997	0	19.79186204	0	0	0	0	64.47477442	0.869317239	0	0	0											3400	$275/IP Days 1-8 for IP Med/Surg; $275/IP Days 1-8 for IP Med/Surg; PBP 1a	$250/IP Days 1-7 for IP MH/SA; PBP 1b	$100/SNF Days 1-30 for SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for OP ER; $40/Case for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $250/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$250/Case for OP Rad - Complex Diagnostic; $40/Case for OP Rad - Therapeutic; PBP 8b	$300/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$40/Case for Cardiac Rehab; $40/Case for Pulmonary Rehabilitation Services; $40/Visit for CORF; $40/Case for OP - Other; $40/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $40/Visit for Podiatry; $15/Visit for Diabetic Footcare; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OP PT/OT/ST; $40/Visit for PT/ST; PBP 7c, 7i"	"$250/Visit for Phys Rad - Complex Diagnostic; $40/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	275	250	100	0	200	0.23	0.23	60.56585205	273.6894844	0	234.0098026	0	0.2	40	15	37.85582066	40	40	137.3928296	0	0.2	0	0	0	0	15	40	0	0	0											NO	253.6451861	230.5865328	92.23461313	0	184.4692263	0.21213961	0.21213961	55.86267933	252.4364371	0	215.8380361	0	0.184469226	36.89384525	13.83519197	34.91616973	36.89384525	36.89384525	126.7237448	0	0.184469226	0	0	0	0	13.83519197	36.89384525	0	0	0												10.5149	0.125759889	4.19442423	0	1.069515477	1.46831734	0.681504391	1.347548945	6.124157521	0	1.412250191	0	0.002665974	0.431626831	4.294872711	8.432078228	0.24015842	1.613866665	2.416960796	0	3.650989477	0	0	0	0	0.074335073	0.002672705	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0986	0	NO	4.04950231	10.5149	0.125759889	4.19442423	0	1.069515477	1.46831734	0.681504391	1.347548945	6.124157521	0	1.412250191	0	0.002665974	0.431626831	4.294872711	8.432078228	0.24015842	1.613866665	2.416960796	0	3.650989477	0	0	0	0	0.074335073	0.002672705	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0986	NO																																										0	0	0	0	0	0	0	0	0	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	10.5149	0.125759889	4.19442423	0	1.069515477	1.46831734	0.681504391	1.347548945	6.124157521	0	1.412250191	0	0.002665974	0.431626831	4.294872711	8.432078228	0.24015842	1.613866665	2.416960796	0	3.650989477	0	0	0	0	0.074335073	0.002672705	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0986
H9302_009_0	2012	6																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	444.655649	4.183568087	463.4782458	0	52.69411008	5.013698655	2.31008764	239.0693175	250.9723922	0	73.01827952	0	0.000503584	123.7002592	3172.055104	2692.427263	62.95848137	458.045763	246.4337206	0	14.38481627	0	0	0	0	64.47477442	1.518648748	0	0	0											3400	$275/IP Days 1-8 for IP Med/Surg; $275/IP Days 1-8 for IP Med/Surg; PBP 1a	$250/IP Days 1-7 for IP MH/SA; PBP 1b	$100/SNF Days 1-30 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $40/Case for Urgent Care; PBP 4a, 4b"	"$250/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$200/Case for OP Rad - Complex Diagnostic; $40/Case for OP Rad - Therapeutic; PBP 8b	$250/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for Cardiac Rehab; $40/Case for OP - Other; $30/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$10/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 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"	"$200/Visit for Phys Rad - Complex Diagnostic; $40/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	275	250	100	0	150	0.23	0.23	48.23534858	223.7165769	0	180.6701186	0	0.2	39.47892809	10	28.88541319	30	30	100.6007917	0	0.2	0	0	0	0	15	40	0	0	0											NO	262.1350859	238.3046235	95.3218494	0	142.9827741	0.219240254	0.219240254	45.97882634	213.2507785	0	172.2180984	0	0.190643699	37.63204438	9.53218494	27.53411006	28.59655482	28.59655482	95.89453518	0	0.190643699	0	0	0	0	14.29827741	38.12873976	0	0	0												9.7133	0.083080301	3.681633629	0	0.627862503	1.099204565	0.5064642	0.916010553	4.460004835	0	1.047922437	0	9.60E-05	0.38792447	2.519717991	6.17779905	0.150032972	1.091544231	1.969303924	0	2.74237458	0	0	0	0	0.076823184	0.004825347	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2559	0	NO	1.828425739	9.7133	0.083080301	3.681633629	0	0.627862503	1.099204565	0.5064642	0.916010553	4.460004835	0	1.047922437	0	9.60E-05	0.38792447	2.519717991	6.17779905	0.150032972	1.091544231	1.969303924	0	2.74237458	0	0	0	0	0.076823184	0.004825347	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2559	NO																																										0	0	0	0	0	0	0	0	0	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	9.7133	0.083080301	3.681633629	0	0.627862503	1.099204565	0.5064642	0.916010553	4.460004835	0	1.047922437	0	9.60E-05	0.38792447	2.519717991	6.17779905	0.150032972	1.091544231	1.969303924	0	2.74237458	0	0	0	0	0.076823184	0.004825347	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2559
H9302_010_0	2012	9																															D	D	D		T	Coin	Coin	V	V		V	V	Coin	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	520.8921592	4.900843651	542.9419029	0	61.25249505	5.796873821	2.670939657	267.5656925	291.7083002	0	85.53731268	0	0.000582247	144.8594241	3599.78402	3035.461022	72.6267591	528.3859865	288.6849478	0	16.63182624	0	0	0	0	64.47477442	1.518648748	0	0	0											3400	$275/IP Days 1-8 for IP Med/Surg; $275/IP Days 1-8 for IP Med/Surg; PBP 1a	$250/IP Days 1-7 for IP MH/SA; PBP 1b	$100/SNF Days 1-30 for SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	"$65/Case for OP ER; $65/Case for OP ER; $40/Case for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $250/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$250/Case for OP Rad - Complex Diagnostic; $40/Case for OP Rad - Therapeutic; PBP 8b	$300/day for Partial Hosp; PBP 5	20% Coinsurance for Renal Dialysis; PBP 12	"$40/Case for Cardiac Rehab; $40/Case for OP - Other; $40/Case for OP Substance Abuse; PBP 3, 7i, 9a, 9c"	"$15/Visit for PCP OV; PBP 7a, 14a, 14b"	"$20/Visit for Chiro (cvd); $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $40/Visit for Podiatry; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OP PT/OT/ST; $40/Visit for PT/ST; PBP 7c, 7i"	"$250/Visit for Phys Rad - Complex Diagnostic; $40/Visit for Phys Rad - Theraputic; PBP 7d, 14a, 14b"	"No Cost Sharing; PBP 7d, 14a, 14e"	20% Coinsurance for Part B Drugs - Gen; 20% Coinsurance for Part B Drugs - Chemo; 20% Coinsurance for Part B Drugs - Pharmacy; PBP 15	"No Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd); PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	PBP 13a-e											0	NO	275	250	100	0	200	0.23	0.23	60.38239948	273.715812	0	224.6295307	0	0.2	40	15	37.95466146	40	40	119.5385391	0	0.2	0	0	0	0	15	40	0	0	0											NO	253.7291525	230.6628659	92.26514637	0	184.5302927	0.212209837	0.212209837	55.71190926	252.5442946	0	207.2547652	0	0.184530293	36.90605855	13.83977196	35.01892395	36.90605855	36.90605855	110.2924081	0	0.184530293	0	0	0	0	13.83977196	36.90605855	0	0	0												11.0138	0.094203554	4.174551178	0	0.941911737	1.230153647	0.566799668	1.242216298	6.139105574	0	1.477334638	0	0.000107442	0.445515865	4.151682494	8.858214891	0.223363952	1.62505368	2.653313173	0	3.069075765	0	0	0	0	0.074359681	0.004670612	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9854	0	NO	4.022756958	11.0138	0.094203554	4.174551178	0	0.941911737	1.230153647	0.566799668	1.242216298	6.139105574	0	1.477334638	0	0.000107442	0.445515865	4.151682494	8.858214891	0.223363952	1.62505368	2.653313173	0	3.069075765	0	0	0	0	0.074359681	0.004670612	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9854	NO																																										0	0	0	0	0	0	0	0	0	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	11.0138	0.094203554	4.174551178	0	0.941911737	1.230153647	0.566799668	1.242216298	6.139105574	0	1.477334638	0	0.000107442	0.445515865	4.151682494	8.858214891	0.223363952	1.62505368	2.653313173	0	3.069075765	0	0	0	0	0.074359681	0.004670612	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9854
H9302_801_0	2012	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	213.9695704	0.589868498	41.08854938	0	6.096696881	7.0636232	4.113384739	17.07019755	66.41665271	5.756238901	11.89658092	0	0.085361038	9.172493921	44.47576602	58.9897221	0.950993582	6.773401159	24.45969085	65.2882301	27.52754452	0.070803586	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, 7i, 9a, 9c"	"Medicare-FFS Cost Sharing; PBP 7a, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14a, 14b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14b"	"Medicare-FFS Cost Sharing; PBP 7d, 14a, 14e"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 9d, 14a, 14d"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14c	PBP 13a-e											0	NO	0.074901555	0.074901555	0.143506669	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.069997878	0.069997878	0.134111532	0	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0.209335103	0	0	0	0	0	0	0	0												14.9774	0.041289543	5.510448324	0	1.276252667	1.478664287	0.861075816	3.573391554	13.9033368	1.204982861	2.490371988	0	0.017869062	1.920124956	9.31033904	12.34861952	0.199076339	1.417910626	5.120271893	13.66711834	5.762481355	0.014821676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0959	0	NO	6.66190742	14.9774	0.041289543	5.510448324	0	1.276252667	1.478664287	0.861075816	3.573391554	13.9033368	1.204982861	2.490371988	0	0.017869062	1.920124956	9.31033904	12.34861952	0.199076339	1.417910626	5.120271893	13.66711834	5.762481355	0.014821676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0959	NO																																										0	0	0	0	0	0	0	0	0	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	14.9774	0.041289543	5.510448324	0	1.276252667	1.478664287	0.861075816	3.573391554	13.9033368	1.204982861	2.490371988	0	0.017869062	1.920124956	9.31033904	12.34861952	0.199076339	1.417910626	5.120271893	13.66711834	5.762481355	0.014821676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0959
H9385_001_0	2012	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	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	63.52054469	0	16.96564894	0	21.69184047	43.07765139	2.591427683	29.55166429	133.5578708	6.912723261	20.82227558	0	0	16.12200474	112.3655656	27.42527812	3.777735276	14.91080788	5.99538772	19.41487227	85.89436459	0	0	0	476.2426937	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	$0 cost sharing	$25/visit for routine vision	$0 cost sharing	Not Covered	Not Covered	Not Covered	Not Covered													0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	25	0	0	0	0	0											NO	0.082293474	0.082293474	0.133942505	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0.22176	0	0	0	25	0	0	0	0	0												5.2273	0	2.27242152	0	4.810382543	9.552899971	0.574675003	6.553377073	29.61779344	1.53296551	4.617547832	0	0	3.575215772	24.91818783	6.081829676	0.837750575	3.306620755	1.329537181	4.305442075	19.04793429	0	0	0	0.992172279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1541			2.405949177	5.2273	0	2.27242152	0	4.810382543	9.552899971	0.574675003	6.553377073	29.61779344	1.53296551	4.617547832	0	0	3.575215772	24.91818783	6.081829676	0.837750575	3.306620755	1.329537181	4.305442075	19.04793429	0	0	0	0.992172279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1541	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				5.2273	0	2.27242152	0	4.810382543	9.552899971	0.574675003	6.553377073	29.61779344	1.53296551	4.617547832	0	0	3.575215772	24.91818783	6.081829676	0.837750575	3.306620755	1.329537181	4.305442075	19.04793429	0	0	0	0.992172279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1541
H9385_002_0	2012	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	471.1876201	7.944461828	684.7102229	0	185.0184992	14.42680641	1.666772991	204.3394208	264.1929702	0	7.336428344	5.288474212	0	425.3038468	8861.502423	751.8843296	119.7352418	424.7404379	1.70597529	832.268861	50.9147433	0	0	0	0	0	0	0	0	0											6700	$200/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	$200/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	$200 per day.	20% coinsurance	$30/Visit for Cardio/Pulmonary Rehab	$10/visit	$35/visit	$35/visit	$30/visit PT/OT/ST	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$20/Visit for Chiropractor; $35/Exam for Vision/Hearing/Dental/Podiatry	20% coinsurance	$0 Copay	$0 Copay	Not Covered	$0 copay for routine vision	Not Covered	Not Covered	Not Covered	$0 Health Club Membership	0													200	200	100	0	200	0.2	0.2	48.43239486	162.5	0	0.2	200	0	30	10	35	35	30	0.2	32.33079079	0.2	0	0	0	0	0	0	0	0	0											NO	194	194	97	0	194	0.194	0.194	46.97942301	157.625	0	0.194	194	0	29.1	9.7	33.95	33.95	29.1	0.194	31.36086707	0.194	0	0	0	0	0	0	0	0	0												7.6175	0.128435466	5.534740969	0	2.991132403	2.798800443	0.32335396	0.799979007	3.470284744	0	1.423267099	0.085497	0	1.031361828	7.163047792	2.127206083	0.338750955	1.029995562	0.330959206	2.175056093	9.8774602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2469			1.517635281	7.6175	0.128435466	5.534740969	0	2.991132403	2.798800443	0.32335396	0.799979007	3.470284744	0	1.423267099	0.085497	0	1.031361828	7.163047792	2.127206083	0.338750955	1.029995562	0.330959206	2.175056093	9.8774602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2469	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				7.6175	0.128435466	5.534740969	0	2.991132403	2.798800443	0.32335396	0.799979007	3.470284744	0	1.423267099	0.085497	0	1.031361828	7.163047792	2.127206083	0.338750955	1.029995562	0.330959206	2.175056093	9.8774602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2469
H9385_805_0	2012	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	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	297.518978	1.768835599	65.28444908	3107.152923	12.8905727	25.59928457	1.539979376	17.51580011	79.36797462	4.045923144	27.49980499	0	0	18.64599271	135.0084071	244.989636	4.538988608	17.91549225	94.19352477	79.31915616	106.7704599	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.081462227	0.081462227	0.132589551	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0	0												24.2366	0.144093287	8.656035761	0	2.82973852	5.619554948	0.338056273	3.845068441	17.42285779	0.888161049	6.036757191	0	0	4.093168321	29.63704553	53.78012489	0.996398779	3.93280886	20.67736256	17.41214116	23.43825136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	223.9842			2.944051843	24.2366	0.144093287	8.656035761	0	2.82973852	5.619554948	0.338056273	3.845068441	17.42285779	0.888161049	6.036757191	0	0	4.093168321	29.63704553	53.78012489	0.996398779	3.93280886	20.67736256	17.41214116	23.43825136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	223.9842	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				24.2366	0.144093287	8.656035761	0	2.82973852	5.619554948	0.338056273	3.845068441	17.42285779	0.888161049	6.036757191	0	0	4.093168321	29.63704553	53.78012489	0.996398779	3.93280886	20.67736256	17.41214116	23.43825136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	223.9842
H9385_807_0	2012	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	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	253.3045503	1.505968154	55.58249805	2843.906775	10.97489896	21.7949635	1.311122356	14.91276927	67.57306459	3.444656705	23.41304673	0	0	15.87500344	115.0417601	208.7576584	3.867709055	15.26593645	80.26306742	67.58849713	90.97997601	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.081462227	0.081462227	0.132589551	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0	0												20.6348	0.12267952	7.369658434	0	2.409209819	4.784430387	0.287817579	3.273651109	14.83363914	0.75617104	5.139632018	0	0	3.484880755	25.25396719	45.82648118	0.849039492	3.351178368	17.61934856	14.83702689	19.97192433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.8055			2.745952077	20.6348	0.12267952	7.369658434	0	2.409209819	4.784430387	0.287817579	3.273651109	14.83363914	0.75617104	5.139632018	0	0	3.484880755	25.25396719	45.82648118	0.849039492	3.351178368	17.61934856	14.83702689	19.97192433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.8055	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				20.6348	0.12267952	7.369658434	0	2.409209819	4.784430387	0.287817579	3.273651109	14.83363914	0.75617104	5.139632018	0	0	3.484880755	25.25396719	45.82648118	0.849039492	3.351178368	17.61934856	14.83702689	19.97192433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.8055
H9385_808_0	2012	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	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	243.877745	1.449923095	53.51397861	2784.906942	10.56646478	20.98385735	1.262328541	14.35778606	65.0583126	3.316462766	22.54172313	0	0	15.2842104	110.7866308	201.0361942	3.724651419	14.70128467	77.29432172	65.08855455	87.61483658	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0.083124721	0.083124721	0.13529546	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.081462227	0.081462227	0.132589551	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0.21952	0	0	0	0	0	0	0	0	0												19.8668	0.118113964	7.095394372	0	2.319550349	4.606376366	0.277106361	3.151821195	14.28160078	0.728029906	4.948359062	0	0	3.355189866	24.3198812	44.13146536	0.81763548	3.227226011	16.9676495	14.28823949	19.23320893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.7337			2.701589724	19.8668	0.118113964	7.095394372	0	2.319550349	4.606376366	0.277106361	3.151821195	14.28160078	0.728029906	4.948359062	0	0	3.355189866	24.3198812	44.13146536	0.81763548	3.227226011	16.9676495	14.28823949	19.23320893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.7337	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0				19.8668	0.118113964	7.095394372	0	2.319550349	4.606376366	0.277106361	3.151821195	14.28160078	0.728029906	4.948359062	0	0	3.355189866	24.3198812	44.13146536	0.81763548	3.227226011	16.9676495	14.28823949	19.23320893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.7337
H9503_001_0	2012	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	O		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	1593.05	47.34	561.02	1127.25	26.87	16.3	5.33	289.56	332.7	1501.5	1326.78	115.45	0.37	6.37	3429.2	5453.84	72.37	870.24		1164.9	37.42	0		4	0.61				4.11	0.93	298.88										6000	"$0-$195/Day(Days 1-7): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $35 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$150/Visit: 5. $40 Partial Hospitalization,7h. $150 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$50-$150/Visit: 3. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF,9a. $145 Observation"												142.123915	124.806492	49.537808	0	100	0.2	0.14923	65	123.677978	39.45063	61.133624	44.788512	0.2	0.2	10	34.201145	35	36.661468		0	0.2	0		0	0				0	0	142.796915										NO	118.119896	103.727299	39.843754	0	92.1266	0.184253	0.137481	59.88229	113.940316	36.344524	56.32033	41.262134	0.184253	0.184253	9.21266	31.508352	32.24431	33.774964		0	0.184253	0		0	0				0	0	131.553943											15.6809	0.409204195	1.862761906	0	0.206286812	3.0033239	0.73277373	1.444959658	3.158995261	4.547608566	6.227057286	0.396976114	0.06817361	1.17369161	2.632671139	14.32012587	0.19446006	2.449360389	0	0	6.89474726	0	0	0	0	0	0	0	0	0	3.276570207	0	0	0	0	0	0	0	0	0	68.6807	0	NO	8.058457	15.6809	0.409204195	1.862761906	0	0.206286812	3.0033239	0.73277373	1.444959658	3.158995261	4.547608566	6.227057286	0.396976114	0.06817361	1.17369161	2.632671139	14.32012587	0.19446006	2.449360389	0	0	6.89474726	0	0	0	0	0	0	0	0	0	3.276570207	0	0	0	0	0	0	0	0	0	68.6807	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"40% Coins(Days 1-7), 40% (Days 8-20), 40% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										7500	2.4524	0.064	0.7153	2.6204	1.7102	1.1935	0.3905	0.171	2.1866	0.3725	1.1925	0.0396	0.0082	0.1403	1.6513	3.7196	0.0226	0.3021		0.2513	1.0367	0		0	0				0	0	0.5244										20.7653	500	NO	4.652252	18.1333	0.473199195	2.578093906	2.620419	1.916485812	4.1968539	1.12325173	1.615998658	5.345642261	4.920149566	7.419578286	0.436577114	0.07637861	1.31402761	4.283976139	18.03976587	0.21705906	2.751442389	0	0.251267	7.93147826	0	0	0	0	0	0	0	0	0	3.801012207	0	0	0	0	0	0	0	0	0	89.446
H9503_003_0	2012	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			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	1456.22	102.4	621.6	1019.28	32.22	14.64	4.98	389.47	317.48	1280.19	883.48	284.07	0.31	5.86	2938.94	3659.87	109.99	663.5		1333.42	23.18	0			0.61				4.11	0.93	1436.22	444.98									3400	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$150/Visit: 5. $40 Partial Hospitalization,7h. $150 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$25/Visit: 7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit: 7e, 7h. $25 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$50-$150/Visit: 3. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											125.83943	103.431686	49.537808	0	100	0.2	0.2	65	125.381299	107.469877	91.279496	83.222957	0.2	0.2	10	23.8605	25	31.263509		0	0.2	0			0				0	0	0	142.541078									NO	87.376608	71.817791	28.483497	0	84.3159	0.168632	0.168632	54.805335	105.716371	90.614194	76.963129	70.170185	0.168632	0.168632	8.43159	20.118195	21.078975	26.360109		0	0.168632	0			0				0	0	0	120.184793										10.6033	0.61284515	1.475445145	0	0.226388192	2.46877248	0.83978736	1.778752819	2.796902789	9.666948751	5.666282101	1.661103704	0.05227592	0.98818352	2.06499476	6.135831528	0.193206372	1.45749436	0	0	3.90888976	0	0	0	0	0	0	0	0	0	0	4.456652432	0	0	0	0	0	0	0	0	57.0541	0	NO	14.280129	10.6033	0.61284515	1.475445145	0	0.226388192	2.46877248	0.83978736	1.778752819	2.796902789	9.666948751	5.666282101	1.661103704	0.05227592	0.98818352	2.06499476	6.135831528	0.193206372	1.45749436	0	0	3.90888976	0	0	0	0	0	0	0	0	0	0	4.456652432	0	0	0	0	0	0	0	0	57.0541	YES	$0-$250/Day(Days 1-5)	$0-$250/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	40% Coins	$100/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									5000	1.4928	0.0863	0.4593	2.12	1.5576	1.0855	0.3692	0.1747	1.5008	0.2378	0.6448	0.0742	0.0052	0.098	0.8948	1.6778	0.0281	0.156		0.1715	0.5053	0			0				0	0	0.1599	0.3855									13.8851	0	NO	4.641238	12.0961	0.69913015	1.934741145	2.120044	1.783945192	3.55423048	1.20902636	1.953484819	4.297744789	9.904774751	6.311089101	1.735339704	0.05751692	1.08613452	2.95976376	7.813636528	0.221355372	1.61344736	0	0.171461	4.41414076	0	0	0	0	0	0	0	0	0	0.159891	4.842119432	0	0	0	0	0	0	0	0	70.9391
H9503_005_0	2012	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	988.33	26.52	375.3	843.02	20.83	6.85	2.52	286.96	252	872.19	641.97	57.77	0.21	4.38	1945.18	2848.33	33.25	455.23		973.11	12.12	0			0.61				4.11	0.93	724.57	421.23									6700	"$0-$195/Day(Days 1-5): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-5): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$50/Visit: 5. $50 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$145/Visit: 3. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $145 Observation"											122.693444	100.845894	49.537808	0	150	0.2	0.2	65	105.457775	39.347559	76.420125	50	0.2	0.2	10	32.22811	35	40.07397		0	0.2	0			0				0	0	0	65.929135									NO	116.696434	95.916748	47.361315	0	147.07305	0.196097	0.196097	63.731655	103.399978	38.57977	74.928939	49.02435	0.196097	0.196097	9.80487	31.599242	34.317045	39.292007		0	0.196097	0			0				0	0	0	64.64266										9.6112	0.211976013	1.481225127	0	0.255294303	1.34326445	0.49416444	1.52403631	2.171399538	2.804074133	4.008510914	0.236011392	0.04118037	0.85890486	1.589353086	7.500422414	0.095086812	1.490575029	0	0	2.37669564	0	0	0	0	0	0	0	0	0	0	2.269118973	0	0	0	0	0	0	0	0	40.3625	0	NO	1.151207	9.6112	0.211976013	1.481225127	0	0.255294303	1.34326445	0.49416444	1.52403631	2.171399538	2.804074133	4.008510914	0.236011392	0.04118037	0.85890486	1.589353086	7.500422414	0.095086812	1.490575029	0	0	2.37669564	0	0	0	0	0	0	0	0	0	0	2.269118973	0	0	0	0	0	0	0	0	40.3625	YES	$0-$225/Day(Days 1-5)	$0-$225/Day(Days 1-5)	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100); $0/Day(Days 1-100)"	40% Coins	$150/Trip	40% Coins	40% Coins	$65/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			"VIS775: Vision 17a,17b"						40% Coins	30% Coins									10000	1.2879	0.0284	0.6015	1.9164	1.7812	0.5995	0.2204	0.1519	1.4399	0.2265	0.561	0.0151	0.0041	0.0864	0.6987	1.5936	0.0101	0.1235		0.1376	0.3192	0			0				0	0	0.0926	0.3694									12.265	0	NO	0.639913	10.8991	0.240377013	2.082710127	1.91644	2.036523303	1.94277445	0.71461044	1.67589331	3.611276538	3.030605133	4.569501914	0.251073392	0.04532637	0.94531886	2.288049086	9.094026414	0.105221812	1.614049029	0	0.137594	2.69588464	0	0	0	0	0	0	0	0	0	0.09264	2.638527973	0	0	0	0	0	0	0	0	52.6275
H9503_006_0	2012	6																															Coin	Coin	Coin	Coin	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	YES	226.61	3.47	26.51	18.55	1.06	12.14	5.77	22.7	57.88	10.88	23.6	1.15	0.42	22.45	28.09	54.42	0.67	5.45		6.04	21.04	0			0.79				4.11	0.93											6000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b											0	YES	0.0759	0.0759	0.1551	0	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195	0.195		0.195	0.195	0			0				0	0											NO	0.063477	0.063477	0.113006	0	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993	0.179993		0.179993	0.179993	0			0				0	0												14.3845	0.22026519	2.99578906	0	0.19079258	2.18511502	1.03855961	4.0858411	10.41799484	1.95832384	4.2478348	0.20699195	0.07559706	4.04084285	5.05600337	9.79521906	0.12059531	0.98096185	0	1.08715772	3.78705272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8755	0	NO	8.082537	14.3845	0.22026519	2.99578906	0	0.19079258	2.18511502	1.03855961	4.0858411	10.41799484	1.95832384	4.2478348	0.20699195	0.07559706	4.04084285	5.05600337	9.79521906	0.12059531	0.98096185	0	1.08715772	3.78705272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8755	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			"VIS776: Vision 17a,17b"																7500	1.821	0.0278	0.4015	0	1.3942	0.5123	0.2435	0.4322	1.1511	0.2071	0.4739	0.0248	0.0081	0.4275	0.6338	1.2278	0.015	0.1172		0.1362	0.4746	0			0				0	0											9.7295	0	NO	0.730951	16.2055	0.24809419	3.39724306	0	1.58500258	2.69740902	1.28201961	4.5180291	11.56909884	2.16539984	4.7217338	0.23181295	0.08365506	4.46831985	5.68983137	11.02299506	0.13564231	1.09811985	0	1.22331872	4.26165572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6049
H9572_001_1	2012	9																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	865.6591597	26.45405892	59.79888227	0	393.2457562	8.433239549	0.151249281	331.7717751	85.2556376	1303.875338	1098.180625	0	0	1496.599777	5240.28367	1090.670284	343.3071202	355.6646319	315.0633706	1677.81929	86.93328791	445.6476403	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	59.38178755	52.82164484	0	0	70.55842827	30.79342172	28.42524135	40	40	100	34.95817183	40	40	0	0	10	10	40	0	0	0.5											YES	145.5440923	145.5440923	118.254575	0	45.48252885	0.2	0.2	59.12728751	136.4475866	54.01667731	48.04923971	0	0	64.18351499	28.01125383	25.8570372	36.38602308	36.38602308	90.9650577	32.04397979	36.38602308	36.38602308	0	0	10	10	40	0	0	0.5											5000	10.4993	0.320852666	0.589290951	0	1.490484288	1.68664791	0.030249856	1.634730428	0.969410499	5.869251115	4.397228673	0	0	8.004752854	12.232243	2.350125175	1.040965067	1.078435126	2.38831314	4.480333952	0.263596385	1.351278777	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	62.0251	0	NO	5.81861169	10.4993	0.320852666	0.589290951	0	1.490484288	1.68664791	0.030249856	1.634730428	0.969410499	5.869251115	4.397228673	0	0	8.004752854	12.232243	2.350125175	1.040965067	1.078435126	2.38831314	4.480333952	0.263596385	1.351278777	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	62.0251	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	8.3968	0.1661	2.1169	0.2717	0.2669	0.9118	0.0114	0.3314	1.8478	0.3802	0.8727	0	0	1.5441	1.7022	0.25	0.1144	0.1063	0.6243	4.9393	0.9329	0.144	0	0	0	0	0	0	0	0											25.9314	500	NO	16.1543667	18.8961	0.486999136	2.706222451	0.271730448	1.757431294	2.598496969	0.041684061	1.966130195	2.817199241	6.249433081	5.2699438	0	0	9.548885407	13.93447521	2.600081524	1.155322661	1.184782495	3.012635524	9.419626548	1.196454667	1.495284673	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	87.9565
H9572_001_2	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	275.2854323	7.864545532	202.4577451	0	473.6305913	7.630131216	0.77097037	317.9355219	145.9254875	1037.839612	1152.638598	0	0	1346.834134	7558.012165	1148.361543	261.4614372	336.8909447	687.2313474	1748.98093	291.1296069	593.2485327	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Ther Injections; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	68.21861649	52.7477086	0	0	67.56186485	30.79333716	26.17657068	40	40	100	38.16070259	40	40	0	0	10	10	40	0	0	0.5											YES	146.1347434	146.1347434	118.734479	0	45.66710732	0.2	0.2	59.36723952	137.001322	62.30693761	48.17670539	0	0	61.70709866	28.12485266	23.90816525	36.53368586	36.53368586	91.33421464	35.10123975	36.53368586	36.53368586	0	0	10	10	40	0	0	0.5											5000	3.3524	0.095773612	2.003226241	0	1.80244492	1.526026243	0.154194074	1.572912857	1.665998725	5.388717332	4.627527513	0	0	6.925768901	17.71399821	2.287934795	0.796012501	1.025655662	5.230644616	5.115949911	0.886336467	1.806129627	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	65.3253	0	NO	5.871287504	3.3524	0.095773612	2.003226241	0	1.80244492	1.526026243	0.154194074	1.572912857	1.665998725	5.388717332	4.627527513	0	0	6.925768901	17.71399821	2.287934795	0.796012501	1.025655662	5.230644616	5.115949911	0.886336467	1.806129627	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	65.3253	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	4.7267	0.0558	0.8977	0.0886	0.1199	0.3211	0.0334	0.1536	0.9859	0.1666	0.4098	0	0	0.9315	1.1584	0.1082	0.0432	0.0613	0.4945	2.7611	0.331	0.1017	0	0	0	0	0	0	0	0											13.9499	500	NO	9.190340507	8.0791	0.151608777	2.900918377	0.088575011	1.922364763	1.847112292	0.187560991	1.726512318	2.651853848	5.555348691	5.03733152	0	0	7.857222915	18.8723562	2.396144024	0.839171853	1.086947448	5.725194165	7.87709058	1.217304669	1.907844353	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	79.2752
H9572_001_3	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	796.2683134	24.74991552	208.7718502	0	439.6508282	6.86378951	0.105584694	345.1818857	257.1217638	1788.974143	1429.379414	0	0	2023.719728	4923.5412	917.7870347	196.2710925	295.8962951	309.5720348	1533.551841	269.8544317	536.4450474	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Ther Injections; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	72.74778537	47.52794868	0	0	76.66547498	30.90825158	28.31829327	40	40	100	34.8241357	40	40	0	0	10	10	40	0	0	0.5											YES	144.2019791	144.2019791	117.164108	0	45.06311846	0.2	0.2	58.582054	135.1893554	65.56484141	42.83515164	0	0	69.09570762	27.85644405	25.52221208	36.05049477	36.05049477	90.12623693	31.64829707	36.05049477	36.05049477	0	0	10	10	40	0	0	0.5											5000	9.5686	0.297415567	2.038380634	0	1.651003113	1.372757902	0.021116939	1.685121989	2.896677125	9.77448383	5.102306994	0	0	11.65252889	11.4293625	1.951996279	0.589639166	0.888933987	2.325046879	4.044525353	0.810698815	1.611592448	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	71.0598	0	NO	7.447364742	9.5686	0.297415567	2.038380634	0	1.651003113	1.372757902	0.021116939	1.685121989	2.896677125	9.77448383	5.102306994	0	0	11.65252889	11.4293625	1.951996279	0.589639166	0.888933987	2.325046879	4.044525353	0.810698815	1.611592448	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	71.0598	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	3.9748	0.1004	0.8654	0.0402	0.1224	0.2903	0.0035	0.1551	1.1403	0.281	0.5303	0	0	1.1253	0.7759	0.0926	0.0288	0.0534	0.3064	2.2066	0.2897	0.0861	0	0	0	0	0	0	0	0											12.4687	500	NO	8.33020822	13.5434	0.397813459	2.903803519	0.040218075	1.773390577	1.663060051	0.024572338	1.840185384	4.037019944	10.05553257	5.632647682	0	0	12.77785872	12.2052285	2.044615019	0.618391307	0.942358336	2.631479803	6.251139143	1.100416756	1.697742168	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	83.5285
H9572_001_4	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	637.76287	20.6476091	208.2392422	0	598.6012235	9.585321228	0.115011078	365.1840861	339.2244352	1547.258847	1718.046941	0	0	1894.840754	5977.414848	1353.896531	351.445596	807.0167908	409.7923547	1622.074515	272.5214267	698.4293803	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Ther Injections; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	45.23640274	49.88091875	0	0	75.88826241	30.88016457	27.77445513	40	40	100	36.53539335	40	40	0	0	10	10	40	0	0	0.5											YES	143.5118228	143.5118228	116.6033561	0	44.84744464	0.2	0.2	58.30167803	134.5423339	40.57474135	44.74063484	0	0	68.06789294	27.69792942	24.91226677	35.87795571	35.87795571	89.69488927	33.03088491	35.87795571	35.87795571	0	0	10	10	40	0	0	0.5											5000	7.6272	0.246931335	2.023449542	0	2.237144602	1.917064246	0.023002216	1.774237084	3.803337269	5.231635628	6.405542569	0	0	10.74815146	13.79683455	2.810719297	1.050762461	2.412842723	3.063023323	4.464879717	0.81479264	2.088184864	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	73.8874	0	NO	8.071989358	7.6272	0.246931335	2.023449542	0	2.237144602	1.917064246	0.023002216	1.774237084	3.803337269	5.231635628	6.405542569	0	0	10.74815146	13.79683455	2.810719297	1.050762461	2.412842723	3.063023323	4.464879717	0.81479264	2.088184864	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	73.8874	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	3.5735	0.1027	0.7584	0.0583	0.1215	0.3354	0.004	0.1294	0.9285	0.1277	0.51	0	0	0.7191	0.8258	0.1328	0.0545	0.1318	0.3159	2.3054	0.4233	0.0989	0	0	0	0	0	0	0	0											11.6569	500	NO	8.164170142	11.2007	0.349655644	2.781876682	0.058263435	2.358676271	2.252492191	0.0269662	1.903648272	4.731887114	5.359318291	6.915500252	0	0	11.4672266	14.62265479	2.943555217	1.105275683	2.544654812	3.378960526	6.770242248	1.238061199	2.187053349	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	85.5443
H9572_001_5	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	449.41786	23.66501177	215.9597243	0	505.469377	9.850024624	0.487712545	341.2263289	174.3627412	1495.976494	1221.658576	0	0	1581.181634	6873.700793	1246.395091	277.1991625	566.5191812	536.8858296	1801.520477	379.9586879	567.6585046	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Ther Injections; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	54.32143832	51.18703957	0	0	65.50465337	30.8900528	28.25812316	40	40	100	39.04202888	40	40	0	0	10	10	40	0	0	0.5											YES	145.3234637	145.3234637	118.0753143	0	45.41358241	0.2	0.2	59.03765714	136.2407472	49.33862232	46.4917368	0	0	59.49601948	28.05655917	25.6660521	36.33086593	36.33086593	90.82716483	35.71850057	36.33086593	36.33086593	0	0	10	10	40	0	0	0.5											5000	5.4426	0.286590123	2.12495936	0	1.912931268	1.970004925	0.097542509	1.678766918	1.979609179	6.150784935	4.733085748	0	0	7.83950111	16.07103275	2.665836779	0.839240467	1.715177702	4.063651479	5.362300848	1.150352346	1.718627086	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	69.1502	0	NO	6.596124887	5.4426	0.286590123	2.12495936	0	1.912931268	1.970004925	0.097542509	1.678766918	1.979609179	6.150784935	4.733085748	0	0	7.83950111	16.07103275	2.665836779	0.839240467	1.715177702	4.063651479	5.362300848	1.150352346	1.718627086	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	69.1502	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	4.1752	0.0846	0.8888	0.1042	0.1109	0.3671	0.018	0.135	0.8027	0.1587	0.3958	0	0	0.7853	0.9604	0.1294	0.0378	0.088	0.4345	2.3902	0.3954	0.0795	0	0	0	0	0	0	0	0											12.5416	500	NO	8.82910849	9.6178	0.371161704	3.013724347	0.104179631	2.023797061	2.337133322	0.115569016	1.813781587	2.782288216	6.30953361	5.12891155	0	0	8.62483573	17.03145722	2.795268198	0.877012447	1.803212068	4.498155917	7.752500182	1.545762521	1.798117666	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	81.6918
H9572_001_6	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	796.3099423	26.91146002	261.2557784	0	573.5148642	9.031665952	0.280842833	294.184709	286.6268871	1443.004951	1422.340253	0	0	1637.058227	8092.928813	1862.272148	555.8276176	777.0407808	654.5518841	2582.957197	578.86417	902.0618814	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5000	$160/Day: IP 1-5 for IP; PBP 1a	$160/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$150/Case for OP Surg; PBP 9a-b	$100/Visit for OP Path; PBP 8a	$35/Visit for OP Rad; $100/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $100/Visit for Cardio; $40/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$31/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$40/Visit for Consult; $20/Visit for Chiro; $40/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$100/Procedure for Office CT/MRI/PET; PBP 7d	$75/Visit for OP Surg; $37/Visit for Office Surgery; $40/Visit for Ther Injections; $40/Visit for Allergy Test; $30/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$40/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	160	160	130	0	50	0.2	0.2	65	150	56.09512999	52.87615363	0	0	65.17995207	30.93273429	30.30618771	40	40	100	37.5716226	40	40	0	0	10	10	40	0	0	0.5											YES	140.99034	140.99034	114.5546512	0	44.05948124	0.2	0.2	57.27732561	132.1784437	49.43044655	46.59391798	0	0	57.43589751	27.25760452	26.70549818	35.24758499	35.24758499	88.11896248	33.32798886	35.24758499	35.24758499	0	0	10	10	40	0	0	0.5											5000	9.356	0.316187992	2.494005381	0	2.105730617	1.80633319	0.056168567	1.404176114	3.157157989	5.944031591	5.522700425	0	0	7.835492377	18.38282109	4.144408787	1.632631766	2.282400914	4.806536077	7.173730722	1.700297003	2.649625236	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	84.1181	0	NO	10.85497447	9.356	0.316187992	2.494005381	0	2.105730617	1.80633319	0.056168567	1.404176114	3.157157989	5.944031591	5.522700425	0	0	7.835492377	18.38282109	4.144408787	1.632631766	2.282400914	4.806536077	7.173730722	1.700297003	2.649625236	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	84.1181	YES	40% Coinsurance for IP; PBP 1a	40% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											10000	2.036	0.0434	0.5128	0.0625	0.0472	0.1404	0.0045	0.0415	0.3832	0.0611	0.1803	0	0	0.303	0.4835	0.0888	0.0325	0.0495	0.2182	1.3855	0.2006	0.0579	0	0	0	0	0	0	0	0											6.3323	500	NO	5.743667796	11.392	0.359625373	3.006772704	0.0625	2.152922387	1.946745966	0.060648821	1.445669176	3.54032594	6.00518021	5.703021746	0	0	8.138457749	18.86629649	4.233192446	1.665093261	2.331927931	5.024777447	8.559238496	1.900894708	2.707496738	0	0	0.3932712	0.1966356	0.516	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	90.4504
H9572_002_1	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	824.9979026	19.27869425	186.4076211	0	130.2564644	5.415406869	0.139230976	190.0293722	192.2648414	905.7533411	564.6434863	0	0	1331.842425	4457.233107	894.9520909	236.5126373	324.885238	254.7796215	1815.746112	264.4097018	518.959587	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.1765439	32.86582065	31.49178192	40	45	122.1589471	40.88777187	45	45	0	0	10	10	45	0	0	0.5											YES	187.8543546	187.8543546	119.1271517	0	45.81813527	0.2	0.2	59.56357585	160.3634734	92.81364023	61.56069463	0	0	92.71441147	30.11701232	28.85789448	36.65450821	41.23632174	111.9419033	37.70409507	41.23632174	41.23632174	0	0	10	10	45	0	0	0.5											3700	12.915	0.301798889	1.850517413	0	0.497342359	1.083081374	0.027846195	0.943235743	2.569354815	7.005522061	2.89665377	0	0	10.29008222	11.18654537	2.15220275	0.722437867	1.116422684	2.376709645	5.705088668	0.908606961	1.783332042	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	67.7439	0	NO	5.913785245	12.915	0.301798889	1.850517413	0	0.497342359	1.083081374	0.027846195	0.943235743	2.569354815	7.005522061	2.89665377	0	0	10.29008222	11.18654537	2.15220275	0.722437867	1.116422684	2.376709645	5.705088668	0.908606961	1.783332042	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	67.7439	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	6.4769	0.1165	2.6579	0.1141	0.0613	0.3059	0.0065	0.248	1.8111	0.5085	1.0244	0	0	1.5767	1.0365	0.1514	0.0541	0.0847	0.5941	3.4577	0.5194	0.1139	0	0	0	0	0	0	0	0											20.9197	500	NO	14.45412685	19.3918	0.418313882	4.508437024	0.114149954	0.558667342	1.388935324	0.034380154	1.1912042	4.380409851	7.513986157	3.921094868	0	0	11.86679565	12.22308625	2.30362386	0.776556869	1.201146418	2.970784839	9.16283683	1.427981126	1.8972227	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	88.6636
H9572_002_2	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1011.057886	23.62657626	228.4477267	0	139.8968881	5.816207066	0.149535613	232.8862834	235.6259132	1110.025923	691.9863045	0	0	1632.167416	4787.117815	961.1884761	254.0171968	348.9303506	299.5359732	1984.337935	283.9789537	557.3683548	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.175923	32.86582065	31.49178192	40	45	120.9781875	40.74001917	45	45	0	0	10	10	45	0	0	0.5											YES	186.9408378	186.9408378	118.5478484	0	45.59532629	0.2	0.2	59.27392418	159.583642	92.36229685	61.26133117	0	0	92.26298446	29.97055633	28.71756145	36.47626103	41.03579366	110.3207986	37.382349	41.03579366	41.03579366	0	0	10	10	45	0	0	0.5											3700	15.7507	0.36806433	2.256832205	0	0.531553688	1.163241413	0.029907123	1.150340326	3.133503448	8.543711988	3.532666848	0	0	12.54905308	11.95604868	2.300249094	0.772133131	1.193219489	2.753753982	6.181601101	0.971108479	1.9060044	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	78.4558	0	NO	7.285498517	15.7507	0.36806433	2.256832205	0	0.531553688	1.163241413	0.029907123	1.150340326	3.133503448	8.543711988	3.532666848	0	0	12.54905308	11.95604868	2.300249094	0.772133131	1.193219489	2.753753982	6.181601101	0.971108479	1.9060044	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	78.4558	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	1.8382	0.0409	0.7506	0.0795	0.0443	0.2327	0.0048	0.0812	0.5263	0.1698	0.3077	0	0	0.4743	0.7599	0.1075	0.0395	0.0624	0.3017	1.7459	0.3701	0.0821	0	0	0	0	0	0	0	0											8.0195	500	NO	5.903605755	17.5889	0.408945047	3.00748185	0.079490479	0.575903389	1.395968965	0.034698567	1.231534929	3.659770188	8.713495538	3.840411066	0	0	13.02332471	12.71594345	2.407756026	0.811681963	1.255589577	3.055412986	7.927548741	1.341239065	1.988075611	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	86.4753
H9572_002_3	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	905.9144055	21.16956514	204.6906407	0	125.3485165	5.211359149	0.133984877	208.6676162	211.1223422	994.5904068	620.0242045	0	0	1462.432561	4289.288524	861.2310913	227.6010512	312.6438509	268.3861693	1777.979624	254.4469792	499.4056508	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.175923	32.86582065	31.49178192	40	45	120.9781875	40.74001917	45	45	0	0	10	10	45	0	0	0.5											YES	189.3437666	189.3437666	120.0716569	0	46.18140649	0.2	0.2	60.03582843	161.6349227	93.5495175	62.04878146	0	0	93.44892855	30.35579646	29.08669564	36.94512519	41.56326584	111.738857	37.82998013	41.56326584	41.56326584	0	0	10	10	45	0	0	0.5											3700	14.2941	0.3340271	2.048128697	0	0.482397566	1.04227183	0.026796975	1.0439611	2.843728621	7.753621055	3.205978864	0	0	11.38856299	10.85039745	2.087530552	0.700729111	1.082874957	2.499096983	5.60507782	0.881303953	1.729744152	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	71.3125	0	NO	5.659138005	14.2941	0.3340271	2.048128697	0	0.482397566	1.04227183	0.026796975	1.0439611	2.843728621	7.753621055	3.205978864	0	0	11.38856299	10.85039745	2.087530552	0.700729111	1.082874957	2.499096983	5.60507782	0.881303953	1.729744152	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	71.3125	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	1.7563	0.0391	0.7138	0.0756	0.0428	0.2127	0.0043	0.0785	0.5005	0.1615	0.2927	0	0	0.4517	0.7226	0.1022	0.0376	0.0593	0.2869	1.6618	0.352	0.078	0	0	0	0	0	0	0	0											7.6301	500	NO	4.980109155	16.0504	0.373087149	2.761976269	0.075593302	0.525196504	1.254936189	0.031125493	1.122508736	3.344194101	7.915080633	3.498635317	0	0	11.84030154	11.57303688	2.189766746	0.738338984	1.142187229	2.786029595	7.266898838	1.233288161	1.80779166	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	78.9425
H9572_002_4	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	995.6991417	23.26767045	224.9774305	0	137.771747	5.72785442	0.147264053	229.3485622	232.0465748	1093.163778	681.4745019	0	0	1607.373541	4714.397824	946.587286	250.1584807	343.6298309	294.9857921	1954.19432	279.6650956	548.901502	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.175923	32.86582065	31.49178192	40	45	120.9781875	40.74001917	45	45	0	0	10	10	45	0	0	0.5											YES	187.302728	187.302728	118.7773397	0	45.6835922	0.2	0.2	59.38866986	159.8925727	92.54109681	61.37992419	0	0	92.44159216	30.02857496	28.77315446	36.54687376	41.11523298	110.5343636	37.44976366	41.11523298	41.11523298	0	0	10	10	45	0	0	0.5											3700	15.5414	0.363174846	2.226851725	0	0.524492359	1.145570884	0.029452811	1.135058837	3.091876987	8.430214587	3.485737772	0	0	12.38234745	11.7972207	2.269691849	0.761875868	1.17736838	2.717172234	6.098676286	0.958207963	1.880684428	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	77.4292	0	NO	7.031027659	15.5414	0.363174846	2.226851725	0	0.524492359	1.145570884	0.029452811	1.135058837	3.091876987	8.430214587	3.485737772	0	0	12.38234745	11.7972207	2.269691849	0.761875868	1.17736838	2.717172234	6.098676286	0.958207963	1.880684428	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	77.4292	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	1.8265	0.0406	0.7453	0.0789	0.0441	0.2298	0.0047	0.0808	0.5225	0.1686	0.3056	0	0	0.471	0.7545	0.1067	0.0393	0.0619	0.2995	1.7338	0.3675	0.0815	0	0	0	0	0	0	0	0											7.9635	500	NO	5.76861686	17.368	0.403795964	2.972197007	0.07892877	0.568628115	1.375393681	0.034176855	1.215892396	3.614424935	8.598798384	3.791307358	0	0	12.85338237	12.55174578	2.376439099	0.801145234	1.239297738	3.016709658	7.832521162	1.325723073	1.962175694	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	85.3928
H9572_002_5	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1131.215229	26.4344339	255.5971828	0	156.5226802	6.507423654	0.167306902	260.5632317	263.6284478	1241.944943	774.2241628	0	0	1826.139395	5356.034155	1075.419179	284.2054102	390.3983457	335.1337831	2220.16298	317.7279178	623.6077868	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.175923	32.86582065	31.49178192	40	45	120.9781875	40.74001917	45	45	0	0	10	10	45	0	0	0.5											YES	183.8508984	183.8508984	116.5883746	0	44.84168254	0.2	0.2	58.2941873	156.9458889	90.83564326	60.2487445	0	0	90.7379724	29.47517392	28.24288975	35.87334603	40.35751428	108.4973095	36.80677993	40.35751428	40.35751428	0	0	10	10	45	0	0	0.5											3700	17.3312	0.404999535	2.483305007	0	0.584895028	1.301484731	0.03346138	1.265776819	3.447950089	9.401072313	3.887169481	0	0	13.80834883	13.15583652	2.531078774	0.849616585	1.312958901	3.030092816	6.809754185	1.068559082	2.09727168	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	86.217	0	NO	9.54622828	17.3312	0.404999535	2.483305007	0	0.584895028	1.301484731	0.03346138	1.265776819	3.447950089	9.401072313	3.887169481	0	0	13.80834883	13.15583652	2.531078774	0.849616585	1.312958901	3.030092816	6.809754185	1.068559082	2.09727168	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	86.217	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	1.9228	0.0428	0.7892	0.0836	0.0459	0.2554	0.0053	0.0838	0.5533	0.1785	0.3235	0	0	0.4978	0.7989	0.113	0.0416	0.0656	0.3171	1.8338	0.3891	0.0863	0	0	0	0	0	0	0	0											8.4271	500	NO	6.987893856	19.2541	0.44776264	3.27246062	0.083568091	0.630790612	1.556880075	0.03877963	1.349576935	4.00121266	9.579565226	4.21070001	0	0	14.30610839	13.9547115	2.644100475	0.891194148	1.378528378	3.347152277	8.643542424	1.457676204	2.183552886	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	94.6441
H9572_002_6	2012	7																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1350.504738	31.55882924	305.1454733	0	186.8650773	7.768907503	0.199739854	311.0742059	314.7336235	1482.699744	924.3098693	0	0	2180.142065	6394.317652	1283.892454	339.2994925	466.0782513	400.1004853	2650.54832	379.3204401	744.4960512	0	0	471.92544	235.96272	154.8	0	0	0.4834375											5500	$205/Day: IP 1-7 for IP; PBP 1a	$205/Day: IP 1-7 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$175/Case for OP Surg; PBP 9a-b	$125/Visit for OP Path; PBP 8a	$40/Visit for OP Rad; $150/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $125/Visit for Cardio; $45/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$33/Visit for OV; $25/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$33/Visit for Consult; $20/Visit for Chiro; $45/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$40/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$150/Procedure for Office CT/MRI/PET; PBP 7d	$100/Visit for OP Surg; $41/Visit for Office Surgery; $45/Visit for Ther Injections; $45/Visit for Allergy Test; $40/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$45/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	205	205	130	0	50	0.2	0.2	65	175	101.2848293	67.17939771	0	0	101.175923	32.86582065	31.49178192	40	45	120.9781875	40.74001917	45	45	0	0	10	10	45	0	0	0.5											YES	179.064996	179.064996	113.5534121	0	43.67438926	0.2	0.2	56.77670604	152.8603624	88.47106126	58.68038332	0	0	88.37593292	28.70789289	27.50768684	34.93951141	39.30695033	105.672969	35.91492222	39.30695033	39.30695033	0	0	10	10	45	0	0	0.5											3700	20.1523	0.470923469	2.887525806	0	0.680101511	1.553781501	0.039947971	1.471814062	4.009191312	10.93133499	4.519904786	0	0	16.05600741	15.29728219	2.943075964	0.987913207	1.526676223	3.523317182	7.932853064	1.242494142	2.438655776	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	100.0773	0	NO	13.97620871	20.1523	0.470923469	2.887525806	0	0.680101511	1.553781501	0.039947971	1.471814062	4.009191312	10.93133499	4.519904786	0	0	16.05600741	15.29728219	2.943075964	0.987913207	1.526676223	3.523317182	7.932853064	1.242494142	2.438655776	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	100.0773	YES	25% Coinsurance for IP; PBP 1a	25% Coinsurance for IP MH/SA; PBP 1b	40% Coinsurance for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	40% Coinsurance for OP Surg; PBP 9a-b	40% Coinsurance for OP Path; PBP 8a	40% Coinsurance for OP Rad; 40% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 40% Coinsurance for Cardio; 40% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"40% Coinsurance for OV; 40% Coinsurance for Immunization; 40% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"40% Coinsurance for Consult; 40% Coinsurance for Chiro; 40% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"40% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	40% Coinsurance for Office Gen Rad; 40% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 40% Coinsurance for Office Surgery; 40% Coinsurance for Ther Injections; 40% Coinsurance for Allergy Test; 40% Coinsurance for Office Path; 40% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"40% Coinsurance for Vision Exams; 40% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											9200	2.061	0.0458	0.8519	0.0902	0.0484	0.2967	0.0063	0.0881	0.5973	0.1927	0.3493	0	0	0.5361	0.8624	0.122	0.0449	0.0708	0.3422	1.977	0.4201	0.0931	0	0	0	0	0	0	0	0											9.0964	500	NO	9.039317044	22.2134	0.516759407	3.739465661	0.090216664	0.728529854	1.850484414	0.046227124	1.559888551	4.606470766	11.12402857	4.869175004	0	0	16.59207824	16.15971467	3.065089531	1.03279863	1.597462327	3.865488424	9.909894759	1.66256894	2.531801407	0	0	0.3932712	0.1966356	0.5805	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	109.1736
H9572_003_1	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1027.558793	30.79387364	387.1305597	0	208.6326513	8.560405409	0.281880615	250.3916482	200.2323948	931.2504651	671.8848309	0	0	1500.690045	5214.794001	1109.027368	244.0552062	383.4412553	304.9628744	2046.717479	314.130963	623.6338195	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82229316	22.88044904	26.85070239	35	35	75	26.44819367	35	35	0	0	10	10	35	0	0	0.5											YES	74.2513858	74.2513858	107.2520017	0	41.25076989	0.2	0.2	53.62600085	82.50153978	61.87615483	34.40580233	0	0	61.72954395	18.87672277	22.15224291	28.87553892	28.87553892	61.87615483	22.10043204	28.87553892	28.87553892	0	0	10	10	35	0	0	0.5											4000	6.3581	0.190540649	3.460043955	0	0.717188124	1.712081082	0.056376123	1.118958562	1.376623407	4.80184983	1.926394723	0	0	7.719742673	8.203185053	2.047286972	0.5872688	0.922672741	1.572494169	3.769445046	0.755891737	1.500646886	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	50.08	0	NO	9.916710708	6.3581	0.190540649	3.460043955	0	0.717188124	1.712081082	0.056376123	1.118958562	1.376623407	4.80184983	1.926394723	0	0	7.719742673	8.203185053	2.047286972	0.5872688	0.922672741	1.572494169	3.769445046	0.755891737	1.500646886	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	50.08	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; 40% Coinsurance for DME; PBP 11a	40% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	9.1685	0.1617	3.6853	0.1598	0.0643	0.368	0.0273	0.173	1.4699	0.4469	0.8681	0	0	1.4162	0.9758	0.1514	0.0421	0.0768	0.5351	3.8061	0.7389	0.0941	0	0	0	0	0	0	0	0											24.4292	0	NO	22.23897494	15.5266	0.352206442	7.145322052	0.159769241	0.781480144	2.080105875	0.083723256	1.292004996	2.846569194	5.248754055	2.794476215	0	0	9.135936892	9.178953308	2.198686664	0.629347421	0.999446664	2.107591543	7.575501939	1.494831716	1.594716258	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	74.5091
H9572_003_2	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1258.408052	37.71196237	474.1025202	0	223.9147368	9.187444589	0.302528024	306.6441243	245.2161955	1140.463292	822.8291041	0	0	1837.79907	5596.771256	1190.262261	261.9319502	411.5278562	360.2955769	2234.513321	337.1406702	669.3142306	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82228997	22.88044904	26.85070239	35	35	75	26.26867385	35	35	0	0	10	10	35	0	0	0.5											YES	73.5772473	73.5772473	106.2782461	0	40.8762485	0.2	0.2	53.13912305	81.752497	61.31437275	34.09342733	0	0	61.16909036	18.70533841	21.95111966	28.61337395	28.61337395	61.31437275	21.74633501	28.61337395	28.61337395	0	0	10	10	35	0	0	0.5											4000	7.7159	0.231228532	4.198898693	0	0.762732868	1.837488918	0.060505605	1.357899988	1.670586357	5.827232614	2.337755356	0	0	9.368041451	8.72412503	2.17729911	0.62456307	0.981266703	1.840941442	4.04937294	0.803894339	1.595944864	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	57.4488	0	NO	12.05103027	7.7159	0.231228532	4.198898693	0	0.762732868	1.837488918	0.060505605	1.357899988	1.670586357	5.827232614	2.337755356	0	0	9.368041451	8.72412503	2.17729911	0.62456307	0.981266703	1.840941442	4.04937294	0.803894339	1.595944864	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	57.4488	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; 30% Coinsurance for DME; PBP 11a	30% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"40% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	3.4927	0.0524	1.4839	0.1258	0.051	0.2296	0.0186	0.0752	0.5779	0.1914	0.3529	0	0	0.7177	0.7922	0.1211	0.0329	0.0613	0.3069	2.295	0.6153	0.0751	0	0	0	0	0	0	0	0											11.6687	0	NO	11.01779386	11.2085	0.283601455	5.682818575	0.125758867	0.813694182	2.067044515	0.07907168	1.433101904	2.248488495	6.018616095	2.690694225	0	0	10.08573555	9.51630072	2.298392078	0.65747432	1.042516952	2.147882679	6.344381144	1.419187276	1.671064892	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	69.1175
H9572_003_3	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1174.568816	35.19946882	442.5162689	0	208.996809	8.575347159	0.282372623	286.2144957	228.8790953	1064.481919	768.0095539	0	0	1715.358921	5223.896158	1110.963119	244.481192	384.1105324	336.2915141	2085.642779	314.6792626	624.7223404	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82228997	22.88044904	26.85070239	35	35	75	26.26867385	35	35	0	0	10	10	35	0	0	0.5											YES	74.87336603	74.87336603	108.1504176	0	41.59631446	0.2	0.2	54.0752088	83.19262892	62.39447169	34.69400879	0	0	62.24663005	19.03484707	22.3378052	29.11742012	29.11742012	62.39447169	22.10404663	29.11742012	29.11742012	0	0	10	10	35	0	0	0.5											4000	7.3287	0.219625226	3.988193273	0	0.724458082	1.715069432	0.056474525	1.289759052	1.58675447	5.534815581	2.220444184	0	0	8.897942681	8.286338704	2.068039811	0.593221798	0.932025646	1.748560946	3.841762104	0.763554024	1.515858571	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	54.5947	0	NO	10.36028444	7.3287	0.219625226	3.988193273	0	0.724458082	1.715069432	0.056474525	1.289759052	1.58675447	5.534815581	2.220444184	0	0	8.897942681	8.286338704	2.068039811	0.593221798	0.932025646	1.748560946	3.841762104	0.763554024	1.515858571	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	54.5947	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; 30% Coinsurance for DME; PBP 11a	30% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"40% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	3.3683	0.0505	1.4311	0.1213	0.0491	0.2143	0.0173	0.0725	0.5573	0.1846	0.3404	0	0	0.6921	0.764	0.1168	0.0317	0.0591	0.296	2.2133	0.5934	0.0724	0	0	0	0	0	0	0	0											11.2456	0	NO	9.929451008	10.697	0.270133663	5.419285329	0.121281828	0.773605164	1.929331289	0.073803668	1.362283766	2.144083184	5.719385775	2.560818363	0	0	9.590086731	9.050312791	2.184821848	0.624961402	0.991095374	2.044575019	6.055067586	1.356942417	1.588304311	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	65.8403
H9572_003_4	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1266.20967	37.94576119	477.0417629	0	225.302917	9.244403007	0.304403574	308.5451931	246.7364361	1147.5337	827.9303097	0	0	1849.192677	5631.46896	1197.641402	263.5558217	414.0791615	362.5292628	2248.366395	339.2308051	673.4637065	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82228997	22.88044904	26.85070239	35	35	75	26.26867385	35	35	0	0	10	10	35	0	0	0.5											YES	73.45615474	73.45615474	106.1033346	0	40.80897485	0.2	0.2	53.05166731	81.61794971	61.21346228	34.03731678	0	0	61.068419	18.67455339	21.91499277	28.5662824	28.5662824	61.21346228	21.71291427	28.5662824	28.5662824	0	0	10	10	35	0	0	0.5											4000	7.7509	0.232279142	4.217976817	0	0.766198423	1.848880601	0.060880715	1.364069744	1.678176836	5.853709238	2.348377185	0	0	9.4106061	8.763763979	2.18719189	0.627400836	0.985725188	1.849305946	4.068215564	0.807546915	1.603196202	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	57.7075	0	NO	12.2151646	7.7509	0.232279142	4.217976817	0	0.766198423	1.848880601	0.060880715	1.364069744	1.678176836	5.853709238	2.348377185	0	0	9.4106061	8.763763979	2.18719189	0.627400836	0.985725188	1.849305946	4.068215564	0.807546915	1.603196202	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	57.7075	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; 30% Coinsurance for DME; PBP 11a	30% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"40% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	3.5042	0.0525	1.4888	0.1262	0.0511	0.231	0.0187	0.0755	0.5798	0.192	0.3541	0	0	0.7201	0.7948	0.1215	0.033	0.0615	0.308	2.3026	0.6173	0.0754	0	0	0	0	0	0	0	0											11.708	0	NO	11.11910384	11.2551	0.284825404	5.706808045	0.126175092	0.817328404	2.07985935	0.079561892	1.439520558	2.257991663	6.045726144	2.70248418	0	0	10.13067556	9.558561542	2.308685641	0.660421013	1.047178157	2.157263071	6.370819585	1.424876294	1.678564855	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	69.4156
H9572_003_5	2012	8																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1373.656832	41.16573689	517.5222497	0	244.4215193	10.0288583	0.330234447	334.7275121	267.6738295	1244.910337	898.1862591	0	0	2006.110217	6109.340338	1299.270045	285.9204631	449.2168105	393.2925255	2439.156747	368.017023	730.6120335	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82228997	22.88044904	26.85070239	35	35	75	26.26867385	35	35	0	0	10	10	35	0	0	0.5											YES	71.92850609	71.92850609	103.896731	0	39.96028116	0.2	0.2	51.94836551	79.92056232	59.94042174	33.32945151	0	0	59.79839489	18.28618353	21.45923234	27.97219681	27.97219681	59.94042174	21.29119818	27.97219681	27.97219681	0	0	10	10	35	0	0	0.5											4000	8.2338	0.246749163	4.480739165	0	0.813929386	2.005771659	0.066046889	1.449045595	1.782720248	6.218370888	2.494671281	0	0	9.996847577	9.309709892	2.323444814	0.666485289	1.047131753	1.964509987	4.327714141	0.857853717	1.703068633	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	61.2717	0	NO	14.4755771	8.2338	0.246749163	4.480739165	0	0.813929386	2.005771659	0.066046889	1.449045595	1.782720248	6.218370888	2.494671281	0	0	9.996847577	9.309709892	2.323444814	0.666485289	1.047131753	1.964509987	4.327714141	0.857853717	1.703068633	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	61.2717	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; 30% Coinsurance for DME; PBP 11a	30% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"40% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	3.6452	0.0547	1.5487	0.1313	0.0532	0.2506	0.0203	0.0785	0.6031	0.1997	0.3684	0	0	0.749	0.8268	0.1264	0.0343	0.0639	0.3203	2.3952	0.6422	0.0784	0	0	0	0	0	0	0	0											12.1902	0	NO	12.57395124	11.879	0.301409577	6.029472191	0.131251635	0.867116536	2.256350646	0.086313301	1.527532105	2.385863408	6.418113422	2.863025455	0	0	10.74588838	10.13648543	2.449826759	0.700834003	1.111057227	2.284857492	6.722961382	1.500020793	1.781469677	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	73.4619
H9572_003_6	2012	9																															D	D	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V	P	V	O	V			V	P	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	1684.165986	50.47107272	634.505904	0	299.671941	12.29583811	0.404882507	410.3912108	328.1803348	1526.316906	1101.217358	0	0	2459.582708	7490.330158	1592.96439	350.5515406	550.7603173	482.1945908	2990.517524	451.2056709	895.7637069	0	0	471.92544	235.96272	154.8	0	0	0.4834375											4000	$90/Day: IP 1-5 for IP; PBP 1a	$90/Day: IP 1-5 for IP MH/SA; PBP 1b	$130/Day: SNF 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosth; PBP 11b-c	$65/Visit for OP ER; PBP 4a-b	$100/Case for OP Surg; PBP 9a-b	$75/Visit for OP Path; PBP 8a	$30/Visit for OP Rad; $75/Visit for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"15% Coinsurance for Rx/Blood; $75/Visit for Cardio; $35/Visit for OP PT/OT/ST; PBP 3, 5, 9c"	"$23/Visit for OV; $15/Visit for Physical; PBP 7a, 14a-b, 14d-e"	"$23/Visit for Consult; $20/Visit for Chiro; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	$75/Procedure for Office CT/MRI/PET; PBP 7d	$50/Visit for OP Surg; $31/Visit for Office Surgery; $35/Visit for Ther Injections; $35/Visit for Allergy Test; $20/Visit for Office Path; PBP 7g	No Cost Sharing; PBP 15	"$35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 9d, 16b"	PBP 10b	No Cost Sharing; PBP 16a-b	$10/Exam for Vision; PBP 17a	$10/Service for Frames; PBP 17b	$35/Exam for Hearing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	50% Coinsurance for Lift Bar; PBP 13a-e											0	NO	90	90	130	0	50	0.2	0.2	65	100	75	41.70322447	0	0	74.82228997	22.88044904	26.85070239	35	35	75	26.26867385	35	35	0	0	10	10	35	0	0	0.5											YES	67.90635284	67.90635284	98.08695411	0	37.72575158	0.2	0.2	49.04347705	75.45150316	56.58862737	31.46570973	0	0	56.45454248	17.26364273	20.25925856	26.40802611	26.40802611	56.58862737	20.1806023	26.40802611	26.40802611	0	0	10	10	35	0	0	0.5											4000	9.5305	0.285608873	5.186395958	0	0.942112433	2.459167621	0.080976501	1.677250994	2.063474964	7.197681554	2.88754881	0	0	11.57121804	10.77586531	2.689356454	0.771447853	1.21204107	2.273894168	5.029203737	0.992954261	1.97127928	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	70.8811	0	NO	21.69849814	9.5305	0.285608873	5.186395958	0	0.942112433	2.459167621	0.080976501	1.677250994	2.063474964	7.197681554	2.88754881	0	0	11.57121804	10.77586531	2.689356454	0.771447853	1.21204107	2.273894168	5.029203737	0.992954261	1.97127928	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	70.8811	YES	30% Coinsurance for IP; PBP 1a	30% Coinsurance for IP MH/SA; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for HH; PBP 6	$50/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; 30% Coinsurance for DME; PBP 11a	30% Coinsurance for Prosth; PBP 11b-c	$50/Visit for OP ER; PBP 4a-b	30% Coinsurance for OP Surg; PBP 9a-b	30% Coinsurance for OP Path; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP CT/MRI/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"40% Coinsurance for Rx/Blood; 30% Coinsurance for Cardio; 30% Coinsurance for OP PT/OT/ST; PBP 3, 5, 9c"	"30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Physical; PBP 7a, 14a-b, 14d-e"	"30% Coinsurance for Consult; 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; PBP 7b, 7d, 7f, 17a, 18a"	"30% Coinsurance for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	30% Coinsurance for Office Gen Rad; 30% Coinsurance for Office CT/MRI/PET; PBP 7d	40% Coinsurance for OP Surg; 30% Coinsurance for Office Surgery; 30% Coinsurance for Ther Injections; 30% Coinsurance for Allergy Test; 30% Coinsurance for Office Path; 30% Coinsurance for Ind Lab; PBP 7g	No Cost Sharing; PBP 15	"30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 9d, 16b"	No Cost Sharing; PBP 10b	No Cost Sharing; PBP 16a-b	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13a-e											8000	4.0173	0.0602	1.7068	0.1447	0.0586	0.3072	0.0248	0.0865	0.6647	0.2201	0.406	0	0	0.8255	0.9112	0.1393	0.0379	0.0705	0.3531	2.6398	0.7077	0.0864	0	0	0	0	0	0	0	0											13.4683	0	NO	16.89375896	13.5478	0.34584937	6.893233521	0.144650638	1.000729267	2.766388899	0.105824048	1.763749907	2.728190821	7.41781508	3.293506926	0	0	12.39672571	11.68704336	2.828640273	0.809303103	1.282492464	2.626944788	7.66897308	1.700677845	2.057684002	0	0	0.3932712	0.1966356	0.4515	0	0	0.24171875	0	0	0	0	0	0	0	0	0	0	84.3493
H9572_801_0	2012	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	311.3476753	5.882138491	102.3448949	12.43576808	10.9180953	23.22170407	0.313216601	18.79750805	50.54478079	44.0752014	6.929345744	0	0	17.10888281	53.97228501	14.36488081	1.34920468	9.747158638	27.69096621	149.4610425	11.76553706	30.46473447	0	0	0	0	0	0	0	0											4500	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	not covered											0	NO	0.076982058	0.076982058	0.177558601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.070261524	0.070261524	0.162057735	0	0.2044448	0.198114679	0.198114679	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0	0	0	0	0	0	0	0											4500	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	0	NO	12.07696158	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	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	not covered												0.8723	0.0165	0.6613	0	0.089	0.1893	0.0026	0.1399	0.412	0.3593	0.0565	0	0	0.1395	0.44	0.1171	0.011	0.0795	0.2257	1.2184	0.0959	0.2483	0	0	0	0	0	0	0	0											5.374	0	NO	5.735998863	22.748	0.429767223	17.24711373	0	2.321151184	4.789861785	0.064606121	3.982910968	10.7456543	9.370242986	1.473156135	0	0	3.637292265	11.47433044	3.053926456	0.286836481	2.072213897	5.887008423	31.7749265	2.501314517	6.47670244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.337
H9572_802_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	299.6754859	6.335633951	97.60056164	12.22402116	10.73050401	23.40005993	0.317962598	18.55767749	50.39130973	33.25726218	7.681073551	0	0	26.0584886	47.66214982	15.27247667	4.70760474	10.50475886	26.10785741	152.0747941	11.49985225	29.51568854	0	0	0	0	0	0	0	0											4500	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	not covered											0	NO	0.076949247	0.076949247	0.177242037	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.070200798	0.070200798	0.16169791	0	0.2043552	0.198114679	0.198114679	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0.2043552	0	0	0	0	0	0	0	0											4500	21.0375	0.444766557	15.78180688	0	2.192834293	4.635895367	0.062993058	3.792357895	10.29772618	6.796294464	1.569667322	0	0	5.325187649	9.74000816	3.121010024	0.962023508	2.146702098	5.335276423	31.07727497	2.350054607	6.031684434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.701	0	NO	13.06897797	21.0375	0.444766557	15.78180688	0	2.192834293	4.635895367	0.062993058	3.792357895	10.29772618	6.796294464	1.569667322	0	0	5.325187649	9.74000816	3.121010024	0.962023508	2.146702098	5.335276423	31.07727497	2.350054607	6.031684434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.701	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	not covered												0.8392	0.0177	0.6296	0	0.0875	0.1908	0.0026	0.138	0.4108	0.2711	0.0626	0	0	0.2124	0.3885	0.1245	0.0384	0.0856	0.2128	1.2397	0.0937	0.2406	0	0	0	0	0	0	0	0											5.2862	0	NO	5.733799008	21.8767	0.462508698	16.41135745	0	2.280308439	4.826650643	0.065585062	3.930371178	10.7085118	7.067404805	1.632282773	0	0	5.537614206	10.12854591	3.24550994	1.000399497	2.232335989	5.548105431	32.31697561	2.443800414	6.272293788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9872
H9572_803_0	2012	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	311.3476753	5.882138491	102.3448949	12.43576808	10.9180953	23.22170407	0.313216601	18.79750805	50.54478079	44.0752014	6.929345744	0	0	17.10888281	53.97228501	14.36488081	1.34920468	9.747158638	27.69096621	149.4610425	11.76553706	30.46473447	0	0	0	0	0	0	0	0											4500	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	not covered											0	NO	0.076982058	0.076982058	0.177558601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.070261524	0.070261524	0.162057735	0	0.2044448	0.198114679	0.198114679	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0	0	0	0	0	0	0	0											4500	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	0	NO	12.07696158	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	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	not covered												0.8723	0.0165	0.6613	0	0.089	0.1893	0.0026	0.1399	0.412	0.3593	0.0565	0	0	0.1395	0.44	0.1171	0.011	0.0795	0.2257	1.2184	0.0959	0.2483	0	0	0	0	0	0	0	0											5.374	0	NO	5.735998863	22.748	0.429767223	17.24711373	0	2.321151184	4.789861785	0.064606121	3.982910968	10.7456543	9.370242986	1.473156135	0	0	3.637292265	11.47433044	3.053926456	0.286836481	2.072213897	5.887008423	31.7749265	2.501314517	6.47670244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.337
H9572_804_0	2012	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	311.3476753	5.882138491	102.3448949	12.43576808	10.9180953	23.22170407	0.313216601	18.79750805	50.54478079	44.0752014	6.929345744	0	0	17.10888281	53.97228501	14.36488081	1.34920468	9.747158638	27.69096621	149.4610425	11.76553706	30.46473447	0	0	0	0	0	0	0	0											4500	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	not covered											0	NO	0.076982058	0.076982058	0.177558601	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.070261524	0.070261524	0.162057735	0	0.2044448	0.198114679	0.198114679	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0.2044448	0	0	0	0	0	0	0	0											4500	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	0	NO	12.07696158	21.8758	0.413288015	16.58578183	0	2.232147811	4.600560451	0.062052806	3.843052773	10.3336176	9.010945736	1.416668705	0	0	3.497822124	11.03435301	2.936825183	0.275837881	1.992755898	5.661274048	30.55653294	2.405402871	6.228356545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.963	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	not covered												0.8723	0.0165	0.6613	0	0.089	0.1893	0.0026	0.1399	0.412	0.3593	0.0565	0	0	0.1395	0.44	0.1171	0.011	0.0795	0.2257	1.2184	0.0959	0.2483	0	0	0	0	0	0	0	0											5.374	0	NO	5.735998863	22.748	0.429767223	17.24711373	0	2.321151184	4.789861785	0.064606121	3.982910968	10.7456543	9.370242986	1.473156135	0	0	3.637292265	11.47433044	3.053926456	0.286836481	2.072213897	5.887008423	31.7749265	2.501314517	6.47670244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.337
H9615_002_0	2012	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	212.2281766		666.0887809		94.3560679	8.474788567	2.843092059	245.5763453			878.3153978	0.799922949		735.9291129	3806.211892	6707.772754	5.564637269	1029.855369	3045.446482		1368.372875	15.25378166			271.0773298		0.802830614			0.087554133											2000	(1a). $150 per stay/$450 max	(1b). $150 per stay/$450 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% coinsurance	(11b). 20% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). $0 copay	(8a). $0 copay	(8b1). $15 copay	(7e). And (9c). $15 copay	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). $15 copay"	"(7a). $10 copay ,(14a). $0 copay"	(7b1). And (7d). $15 copay	(7e). $15 copay	(7i). $15 copay	"(7a). $10 copay, (7d). $15 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f). $15, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $15 copay	(17b). Non-Med: $100 allowance	(18a). $15 exam	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% - 10 visit max													139.3008884		29.23796791		75	0.2	0.2	64.83713355			15	15		15	10.00048611	15	15	15	14.90407204		18.20991282	39.01635719			15		15			0.5											NO	120.4346735		25.27812392		64.84237549	0.172913001	0.172913001	56.05591679			12.9684751	12.9684751		12.9684751	8.646070343	12.9684751	12.9684751	12.9684751	12.88553914		15.7436534	33.73217711			15		15			0.5												2.13	0	1.403122895	0	0.509855965	1.465401127	0.491607581	1.147167265	0	0	0.949200947	0.000864482	0	0.795323198	2.74239798	7.249131993	0.006013738	1.112971142	3.270184988	0	1.795265689	0.042878605	0	0	0.338846662	0	0.001003538	0	0	0.043777066	0	0	0	0	0	0	0	0	0	0	25.495	0		3.933719763	2.13	0	1.403122895	0	0.509855965	1.465401127	0.491607581	1.147167265	0	0	0.949200947	0.000864482	0	0.795323198	2.74239798	7.249131993	0.006013738	1.112971142	3.270184988	0	1.795265689	0.042878605	0	0	0.338846662	0	0.001003538	0	0	0.043777066	0	0	0	0	0	0	0	0	0	0	25.495	YES	(1a). 25% coinsurance	(1b). 25% coinsurance	(2). 25% coinsurance	(6). 25% coinsurance	(10a). $75 copay	(11a). 25% coinsurance	(11b). 25% coinsurance	"(4a). $65 copay, (4b). $15 copay"	(9a1). And (9b). 25% coinsurance	(8a). 25% coinsurance	(8b1). 25% coinsurance	(7e). And (9c). $35 copay	(12a). $0 copay	"(3). ,(5). And (7d). $35 copay ,(8b1). 25% coinsurance"	"(7a). $35 copay ,(14a). $0 copay"	"(7b1). $20 copay, (7d). $35 copay"	(7e). $35 copay	(7i). $35 copay	(7a). And (7d). $35 copay	(14a). $0 copay	(15). 25% coinsurance	"(7f). 35, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay, (14b). $0 copay"	(10b). No coverage	(16a). $300 benefit coverage	(17a). $35 copay	(17b).Non-Med: $100 allowance	(18a). $35 copay	(18b). $600 every 3 yrs	(14c). $0 copay	(13a). 50% coinsurance											5000	1.4044		1.0481	0.0042	0.3036	0.2746	0.1585	0.0638	0.2409	0.5185	0.1592			0.0963	0.1982	0.6814	0.0068	0.1126	0.283		0.0627	0.0011			0.0267		0.0094			0.066											5.7198	0		3.05708236	3.5344	0	2.451193817	0.004190308	0.813443481	1.739980187	0.650065783	1.210948887	0.240927885	0.518505291	1.108358637	0.000864482	0	0.891642472	2.940596638	7.930493505	0.012770511	1.225584016	3.553218678	0	1.85793234	0.043991113	0	0	0.365510549	0	0.010369895	0	0	0.109772488	0	0	0	0	0	0	0	0	0	0	31.2148
H9615_802_0	2012	2																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	239.0174009	0.23696715	857.7842442		165.5967244	689.0418963	339.5570296	12.14562332	49.14870881	25.17267995	21.44024346	0.027962027	0.056536538	26.32144155	48.76539526	126.4029789		5.186767126	30.55623969	4.396108541	24.98688235	39.82857274																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													912.269682	2225.445842	75.34269772		125.7282082	26.45994209	23.18425144	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	71.74639588																			NO	765.7670528	1868.058467	63.24331141		105.5373443	22.210704	19.46106096	0.188027535	0.188027535	0.188027535	0.188027535	0.188027535	0.188027535	0.188027535	0.188027535	0.188027535		0.188027535	0.188027535	0.188027535	0.188027535	60.22454457																				15.2526	0.036889041	4.520759673	0	1.456386543	1.275342133	0.550678338	2.283711618	9.24131058	4.733156967	4.031356134	0.005257631	0.010630426	4.94915578	9.169237078	23.76724058	0	0.975255039	5.745414437	0.826589454	4.698221902	0.199888138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7291	0		17.93177484	15.2526	0.036889041	4.520759673	0	1.456386543	1.275342133	0.550678338	2.283711618	9.24131058	4.733156967	4.031356134	0.005257631	0.010630426	4.94915578	9.169237078	23.76724058	0	0.975255039	5.745414437	0.826589454	4.698221902	0.199888138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7291	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.6515	0.0023	0.6		0.6293	0.215	0.1563	0.2272	0.2925	0.8398	0.1753	0.0002	0.0003	0.5906	0.5668	2.405	0.0016	0.1351	0.3053	0.0494	0.1981	0.0863																			8.1281	0		0	15.9042	0.039202013	5.120808531	0	2.085641205	1.490337761	0.706978944	2.510906376	9.533814488	5.572968813	4.206700197	0.005444494	0.010900216	5.539765666	9.736039834	26.17223043	0.001605776	1.110362406	6.050743363	0.876030543	4.896341436	0.28622959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8572
H9615_804_0	2012	2																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	227.6540654	1.483625146	1103.922724		171.9402802	627.4757906	326.4021782	9.652524229	52.23733488	26.32213409	22.34615462	0.025399752	0.036671833	24.54589045	49.76785498	134.3607677		5.707935102	33.61401234	5.96306352	24.47332516	35.78601104																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													952.2282795	928.1316061	83.15273972		121.4655835	27.86772167	30.29784693	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	81.61198174																			NO	786.9418084	767.0278024	68.71920188		100.3817551	23.03048099	25.03878846	0.185118389	0.185118389	0.185118389	0.185118389	0.185118389	0.185118389	0.185118389	0.185118389	0.185118389		0.185118389	0.185118389	0.185118389	0.185118389	67.44588654																				14.9292	0.094831811	6.321724042	0	1.438305591	1.204255772	0.681059591	1.786859735	9.670091281	4.872711059	4.136684145	0.004701961	0.006788631	4.543895697	9.212945139	24.87264887	0	1.056643751	6.222571813	1.103872713	4.530462528	0.201134937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8914	0		20.35072607	14.9292	0.094831811	6.321724042	0	1.438305591	1.204255772	0.681059591	1.786859735	9.670091281	4.872711059	4.136684145	0.004701961	0.006788631	4.543895697	9.212945139	24.87264887	0	1.056643751	6.222571813	1.103872713	4.530462528	0.201134937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8914	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												1.2497	0.0036	0.5426		0.7186	0.2207	0.1471	0.2405	1.2903	0.7698	0.3666	0.0003	0.0004	0.614	0.6519	2.646		0.088	0.4786	0.1834	0.2382	0.0132																			10.4635	0		0	16.1789	0.098425177	6.864303813	0	2.156866171	1.424988335	0.828119484	2.027349805	10.96034244	5.642552172	4.503324896	0.005001411	0.007220972	5.15790618	9.864818451	27.51864822	0	1.144647729	6.7012091	1.287293072	4.768646611	0.214331939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3549
H9615_807_0	2012	2																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	301.2328236	3.763170312	1524.420915		298.686084	997.6612644	264.3547861	14.9430469	56.08823939	28.92539721	13.39616809	0.061162999	0.038579914	57.77701131	44.54953443	134.4432209	0.990975742	5.732335292	35.4806092	3.382316438	40.69816845	27.26054503																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													823.6037725	503.0483569	91.81230307		103.2834129	38.11988806	48.22505033	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	112.1113938																			NO	653.4337613	399.1103379	72.84237948		81.94337037	30.24369565	38.26096611	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	0.177717936	88.947346																				16.403	0.125160015	9.253537231	0	2.039612034	2.514413637	0.842872459	2.655647452	9.967886139	5.140561891	2.380739344	0.010869762	0.006856343	10.2680112	7.917251309	23.89297172	0.176114163	1.018738797	6.305540636	0.601098296	7.232794496	0.202062761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9557	0		28.37471254	16.403	0.125160015	9.253537231	0	2.039612034	2.514413637	0.842872459	2.655647452	9.967886139	5.140561891	2.380739344	0.010869762	0.006856343	10.2680112	7.917251309	23.89297172	0.176114163	1.018738797	6.305540636	0.601098296	7.232794496	0.202062761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9557	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												1.0881	0.0083	0.6139		0.1353	0.1668	0.0559	0.1762	0.6613	0.341	0.1579	0.0007	0.0005	0.6815	0.5252	1.585	0.0117	0.0676	0.4183	0.0399	0.4798	0.0134																			7.2283	0		0	17.4911	0.133462895	9.86739949	0	2.174916061	2.68121511	0.898787033	2.831818111	10.62913696	5.4815771	2.538673115	0.011590841	0.007311179	10.94956096	8.442466873	25.47798654	0.187797246	1.086320013	6.723838345	0.640974027	7.712604482	0.215467225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.184
H9670_003_0	2012	6																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	5.937085155	0.110284489	0	0	3.373218058	2.78180183	0	0	8.825970506	0	25.57013819	1.932857638	0.007868489	0	2.25274535	8.662701971	0.044439283	1.405550136	0	0	1.400093731	2.394665971	0	0	0	0	0.006071206	0	0.206127983	0.048074273											64.9597	YES	282.1336211	5.349154703	1307.594009	0	289.1286696	14.75925472	0	1369.795078	1512.782097	0	9781.546585	2208.857998	0	107.051673	39377.11413	6816.583047	46.22116697	803.1658685	0	0	757.447196	434.9224437	0	0	0	0	0	0	0	0											3400	1a $0/admit	1b $0/admit	2 $30/days 1 - 10; $70/days 11-54; $0/day 55-100	6 $0/visit	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $65/visit, 4b $30/visit"	"9a $0/visit, 9b $0/visit"	8a $0/lab	8b $0/all x-rays/diag	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $30/visit, 9d $0/visit"	"7a $20/PCP; $30/IN Urgt, 14a $0/visit, 14d $0/visit, 14e $0/visit"	"7b $20/visit, 7d $30/visit, 7f $30/visit, 7g $30/visit, 16b $30/visit, 17a $0-$30/visit, 18a $30/visit"	"7e $30/visit, 7h $30/visit"	"7c $0/visit, 7i $0/visit"	0	0	"15 15% coinss - $2,500 max/drug"	"15 15% coinss - $2,500 max/drug"	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	14c $0/visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											1200	NO	0	0	46.94159598	0	0	0	0	28.31712476	0	0	0	0	0	28.5	1.525757343	16.15058924	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	46.05979237	0	0	0	0	27.78518412	0	0	0	0	0	27.96462402	1.497095805	15.84719845	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	5.018959048	0	0	0	0	3.171667369	0	0	0	0	0	0.249471649	4.912609364	9.001978689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3547	1200	NO	0.427975072	5.9371	0.110284489	5.018959048	0	3.373218058	2.78180183	0	3.171667369	8.825970506	0	25.57013819	1.932857638	0.007868489	0.249471649	7.165354714	17.66468066	0.044439283	1.405550136	0	0	1.400093731	2.394665971	0	0	0	0	0.006071206	0	0.206127983	0.048074273	0	0	0	0	0	0	0	0	0	0	87.3144	YES	1a 30% coins/admit	1b 30% coins/admit	2 30% coins/admit	6 30% coins/visit	10a 30% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 30% coins/item"	refer to In Network	"9a 30% coins/visit, 9b 30% coins/visit"	8a 30% coins/lab	8b 30% coins/all x-rays/diag	5 30% coins/visit	12 30% coins/visit	"3 30% coins/visit, 9c $50/visit, 9d 30% coins/visit"	"7a $30/visit, 14a 30% coins/visit, 14d 30% coins/visit, 14e 30% coins/visit"	"7b $30/visit, 7d $50/visit, 7f $50/visit, 7g $50/visit, 16b $50/visit, 17a $0-$50/visit, 18a $50/visit"	"7e $50/visit, 7h $50/visit"	"7c 30% coins/visit, 7i 30% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	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	14c 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	3.9364	0.0619	0.03	0	0.3038	0.4665	0	0.1651	1.0463	0	2.0385	0.2505	0.0006	0.0273	1.0379	1.7895	0.0086	0.1544	0	0	0.4816	0.2353	0	0	0	0	0.0005	0	0.0136	0.003											12.0513		NO	0.17	9.8735	0.17214448	5.048936155	0	3.67704337	3.248295751	0	3.336788447	9.87231577	0	27.60868004	2.183356574	0.008422705	0.27674231	8.203276533	19.45416823	0.053001424	1.5599801	0	0	1.881664866	2.629984905	0	0	0	0	0.006544706	0	0.219723741	0.051116702	0	0	0	0	0	0	0	0	0	0	99.3657
H9670_004_0	2012	6																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	5.937085155	0.110284489	0	0	3.373218058	2.78180183	0	0	8.825970506	0	25.57013819	1.932857638	0.007868489	0	2.25274535	8.662701971	0.044439283	1.405550136	0	0	1.400093731	2.394665971	0	0	0	0	0.006071206	0	0.206127983	0.048074273											64.9597	YES	282.1336211	5.349154703	1307.594009	0	289.1286696	14.75925472	0	1369.795078	1512.782097	0	9781.546585	2208.857998	0	107.051673	39377.11413	6816.583047	46.22116697	803.1658685	0	0	757.447196	434.9224437	0	0	0	0	0	0	0	0											3400	1a $0/admit	1b $0/admit	2 $30/days 1 - 10; $70/days 11-54; $0/day 55-100	6 $0/visit	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $65/visit, 4b $30/visit"	"9a $0/visit, 9b $0/visit"	8a $0/lab	8b $0/all x-rays/diag	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $30/visit, 9d $0/visit"	"7a $20/PCP; $30/IN Urgt, 14a $0/visit, 14d $0/visit, 14e $0/visit"	"7b $20/visit, 7d $30/visit, 7f $30/visit, 7g $30/visit, 16b $30/visit, 17a $0-$30/visit, 18a $30/visit"	"7e $30/visit, 7h $30/visit"	"7c $0/visit, 7i $0/visit"	0	0	"15 15% coinss - $2,500 max/drug"	"15 15% coinss - $2,500 max/drug"	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	14c $0/visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											1200	NO	0	0	46.94159598	0	0	0	0	28.31712476	0	0	0	0	0	28.5	1.525757343	16.15058924	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	46.05979237	0	0	0	0	27.78518412	0	0	0	0	0	27.96462402	1.497095805	15.84719845	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	5.018959048	0	0	0	0	3.171667369	0	0	0	0	0	0.249471649	4.912609364	9.001978689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3547	1200	NO	0.427975072	5.9371	0.110284489	5.018959048	0	3.373218058	2.78180183	0	3.171667369	8.825970506	0	25.57013819	1.932857638	0.007868489	0.249471649	7.165354714	17.66468066	0.044439283	1.405550136	0	0	1.400093731	2.394665971	0	0	0	0	0.006071206	0	0.206127983	0.048074273	0	0	0	0	0	0	0	0	0	0	87.3144	YES	1a 30% coins/admit	1b 30% coins/admit	2 30% coins/admit	6 30% coins/visit	10a 30% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 30% coins/item"	refer to In Network	"9a 30% coins/visit, 9b 30% coins/visit"	8a 30% coins/lab	8b 30% coins/all x-rays/diag	5 30% coins/visit	12 30% coins/visit	"3 30% coins/visit, 9c $50/visit, 9d 30% coins/visit"	"7a $30/visit, 14a 30% coins/visit, 14d 30% coins/visit, 14e 30% coins/visit"	"7b $30/visit, 7d $50/visit, 7f $50/visit, 7g $50/visit, 16b $50/visit, 17a $0-$50/visit, 18a $50/visit"	"7e $50/visit, 7h $50/visit"	"7c 30% coins/visit, 7i 30% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	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	14c 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	3.9364	0.0619	0.03	0	0.3038	0.4665	0	0.1651	1.0463	0	2.0385	0.2505	0.0006	0.0273	1.0379	1.7895	0.0086	0.1544	0	0	0.4816	0.2353	0	0	0	0	0.0005	0	0.0136	0.003											12.0513		NO	0.17	9.8735	0.17214448	5.048936155	0	3.67704337	3.248295751	0	3.336788447	9.87231577	0	27.60868004	2.183356574	0.008422705	0.27674231	8.203276533	19.45416823	0.053001424	1.5599801	0	0	1.881664866	2.629984905	0	0	0	0	0.006544706	0	0.219723741	0.051116702	0	0	0	0	0	0	0	0	0	0	99.3657
H9670_801_0	2012	1																															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	0	0	0	0											0	YES	328.6841853	2.468899664	1702.189979	0	354.581852	23.56864367	0	1485.122184	1804.592479	0	11721.86569	329.9633876	0	2455.683723	41393.20276	9406.678443	53.34722928	1934.177768	0	0	957.0192207	882.4400772	0	14.66550415	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	59.18157863	33.01435407	40.75828738	0	41.7446528	0.141882935	0	8.364145445	5.345003462	0	1.089472106	22.01029831	0	2.096735467	0.652699513	14.32946343	0	19.08899272	0	0	14.33099825	41.0068861	0	0	0	0	0	0	0	0											NO	56.20651046	31.35471679	38.70936124	0	39.6461419	0.134750456	0	7.94367841	5.076309216	0	1.034704155	20.90383682	0	1.991332213	0.619888196	13.60911883	0	18.12938576	0	0	13.6105765	38.94546286	0	0	0	0	0	0	0	0												1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	0	NO	1.650577721	1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	4.3946	0.0374	0.6072	0	0.2598	0.6634	0	0.1886	1.4685	0	2.2143	0.0007	0	0.3236	1.6183	2.5144	0.0108	0.2308	0	0	0.6068	0	0	0	0	0	0	0	0	0											15.1393	500	NO	0.18	5.9342	0.04385923	6.098061912	0	1.43133273	3.839252645	0	1.171723649	2.231850633	0	3.2250043	0.575488091	0	0.731072718	3.756584565	13.18243875	0.010839222	3.152963565	0	0	1.692282716	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9408
H9670_802_0	2012	1																															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	0	0	0	0											0	YES	328.6841853	2.468899664	1702.189979	0	354.581852	23.56864367	0	1485.122184	1804.592479	0	11721.86569	329.9633876	0	2455.683723	41393.20276	9406.678443	53.34722928	1934.177768	0	0	957.0192207	882.4400772	0	14.66550415	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	59.18157863	33.01435407	40.75828738	0	41.7446528	0.141882935	0	8.364145445	5.345003462	0	1.089472106	22.01029831	0	2.096735467	0.652699513	14.32946343	0	19.08899272	0	0	14.33099825	41.0068861	0	0	0	0	0	0	0	0											NO	56.20651046	31.35471679	38.70936124	0	39.6461419	0.134750456	0	7.94367841	5.076309216	0	1.034704155	20.90383682	0	1.991332213	0.619888196	13.60911883	0	18.12938576	0	0	13.6105765	38.94546286	0	0	0	0	0	0	0	0												1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	0	NO	1.650577721	1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	4.3946	0.0374	0.6072	0	0.2598	0.6634	0	0.1886	1.4685	0	2.2143	0.0007	0	0.3236	1.6183	2.5144	0.0108	0.2308	0	0	0.6068	0	0	0	0	0	0	0	0	0											15.1393	500	NO	0.18	5.9342	0.04385923	6.098061912	0	1.43133273	3.839252645	0	1.171723649	2.231850633	0	3.2250043	0.575488091	0	0.731072718	3.756584565	13.18243875	0.010839222	3.152963565	0	0	1.692282716	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9408
H9670_803_0	2012	1																															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	0	0	0	0											0	YES	328.6841853	2.468899664	1702.189979	0	354.581852	23.56864367	0	1485.122184	1804.592479	0	11721.86569	329.9633876	0	2455.683723	41393.20276	9406.678443	53.34722928	1934.177768	0	0	957.0192207	882.4400772	0	14.66550415	0	0	0	0	0	0											3400	1a $150/admit	1b $150/admit	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/visit	10a $100/trip	11a 20% coins/item	"11b 20% coins/item, 11c $25-$50/item, 11c $25 per pair"	"4a $65/visit, 4b $65 visit"	"9a $100/visit, 9b $100/visit"	8a $0/lab	8b $25/x-ray; $75/diag x-ray; $0/therapeutic visit	5 $0/visit	12 $0/visit	"3 $0/visit, 9c $25/visit, 9d $0/visit"	"7a $15/PCP visit; 7a $25/IN Urgt visit, 14a $0/visit, 14d $0/visit, 14e $0/visit,"	"7b $20/visit, 7d $25/visit, 7f $25/visit, 7g $25/visit, 16b $25/visit, 17a $0-$25/visit, 18a $25/visit"	"7e $25/visit, 7h $25/visit"	"7c $25/visit, 7i $25/visit"	0	0	15 20% coins/drug	15 20% coins/drug	10b not covrd	"16a $25/visit, 16b 20% coins/visit"	17a $200 combined max (IN/OON) - 2 yr (17a/17b)	17b $200 combined max (IN/OON)-2yr (17a/17b)	18a $25/visit	18b $1000 max (IN/OON) - 3yr	14c $0 visit	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											0	NO	59.18157863	33.01435407	40.75828738	0	41.7446528	0.141882935	0	8.364145445	5.345003462	0	1.089472106	22.01029831	0	2.096735467	0.652699513	14.32946343	0	19.08899272	0	0	14.33099825	41.0068861	0	0	0	0	0	0	0	0											NO	56.20651046	31.35471679	38.70936124	0	39.6461419	0.134750456	0	7.94367841	5.076309216	0	1.034704155	20.90383682	0	1.991332213	0.619888196	13.60911883	0	18.12938576	0	0	13.6105765	38.94546286	0	0	0	0	0	0	0	0												1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	0	NO	1.650577721	1.5395	0.006450971	5.490890565	0	1.171483535	3.175885474	0	0.983111086	0.763389119	0	1.010721928	0.574791734	0	0.407506842	2.138263148	10.66805039	0	2.922121241	0	0	1.085465276	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8016	YES	1a 20% coins/admit	1b 20% coins/admit	2 20% coins/admit	6 20% coins/visit	10a 20% coins/trip	11a 50% coins/item	"11b 50% coins/item, 11c 50% coins/item"	refer to In Network	"9a 20% coins/visit, 9b 20% coins/visit"	8a 20% coins/lab	8b 20% coins/all x-rays/diag	5 20% coins/visit	12 20% coins/visit	"3 20% coins/visit, 9c 20% coins/visit, 9d 20% coins/visit"	"7a 20% coins/visit, 14a 20% coins/visit, 14d 20% coins/visit, 14e 20% coins/visit"	"7b 20% coins/visit, 7d 20% coins/visit, 7f 20% coins/visit, 7g 20% coins/visit, 16b 50% coins/visit, 17a 20% coins/visit, 18a 20% coins/visit"	"7e 20% coins/visit, 7h 20% coins/visit"	"7c 20% coins/visit, 7i 20% coins/visit"	0	0	15 50% coins/drug	15 50% coins/drug	10b not covrd	"16a 50% coins/visit, 16b 50% coins/visit"	17a $200 combined max (INN/OON) - 2yr (17a/17b)	17b $200 combined max (INN/OON) - 2yr (17a/17b)	18a 20% coins/visit	"18b 50% coins $1,000 max (IN/OON) - 3yr"	14a 50% coins/visit - $250 OON max	"13a not covrd, 13b not covrd, 13c not covrd, 13d not covrd, 13e not covrd"											5100	4.3946	0.0374	0.6072	0	0.2598	0.6634	0	0.1886	1.4685	0	2.2143	0.0007	0	0.3236	1.6183	2.5144	0.0108	0.2308	0	0	0.6068	0	0	0	0	0	0	0	0	0											15.1393	500	NO	0.18	5.9342	0.04385923	6.098061912	0	1.43133273	3.839252645	0	1.171723649	2.231850633	0	3.2250043	0.575488091	0	0.731072718	3.756584565	13.18243875	0.010839222	3.152963565	0	0	1.692282716	2.863919772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9408
H9720_038_0	2012	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	1547.959501	53.29531745	924.2155547	20.22375415	428.5843759	23.15175873	6.295001467	362.5645153	456.6918414	758.6836792	18.73857376	3.486197262	0.065294362	349.7091629	12783.03309	4506.007269	343.5119204	1330.38442	3967.355746	35.59280139	16.34440621	0.871549316	0	0	272.6742962	12.15666389	23.28169381	0	101.1141904	0												$295 days 1-5;$0 days 6-90	$295 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											0	NO	191.2902331	126.8631676	70.37195739	20	100	0.2	0.199848971	64.6875	142.7958015	15	0.2	145	0.2	42.95327103	13.02967685	27.38920781	40	40	0	40	0.199834986	0	0	0	0	2.362273084	0	0	0	0											NO	150.7472348	99.97516027	55.45697661	15.76110106	78.8055053	0.157611011	0.157491992	50.97731124	112.5309529	11.82082579	0.157611011	114.2679827	0.157611011	33.84954227	10.26810268	21.58420361	31.52220212	31.52220212	0	31.52220212	0.15748097	0	0	0	0	2.362273084	0	0	0	0												19.4459	0.444017325	4.271183367	0.026562386	2.814567359	3.64897209	0.991412319	1.540213678	4.282664009	0.747355634	2.953405547	0.033196727	0.01029111	0.986457924	10.9381247	8.104881531	0.902354349	3.494720547	0	0.093496957	2.573932951	0	0	0	0	0.002393113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3061	0	NO	18.37006561	19.4459	0.444017325	4.271183367	0.026562386	2.814567359	3.64897209	0.991412319	1.540213678	4.282664009	0.747355634	2.953405547	0.033196727	0.01029111	0.986457924	10.9381247	8.104881531	0.902354349	3.494720547	0	0.093496957	2.573932951	0	0	0	0	0.002393113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3061	YES	"$295 days 1-5;$0 days 6-90,1a2: $191"	"$295 days 1-5;$0 days 6-90,1b2: $127"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $145	12: 20.0%	"31: $145,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $40,7f1: $40"	"7e1: $40,7h1: $40"	"7c: $40,7i: $40"	$0 	7g: $40	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	19.4459	0.444017325	4.271183367	0.026562386	2.814567359	3.64897209	0.991412319	1.540213678	4.282664009	0.747355634	2.953405547	0.033196727	0.01029111	0.986457924	10.9381247	8.104881531	0.902354349	3.494720547	0	0.093496957	2.573932951	0	0	0	0	0.002393113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3061
H9720_039_0	2012	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	1433.834634	37.57130735	738.22056	19.14311414	397.8396778	20.41417598	5.302760318	369.020779	453.0999631	784.7359822	18.98748032	2.457645345	0.045939037	450.344287	12322.41909	4773.92237	375.1357105	1091.044076	3732.698554	36.87399071	24.52429071	0.614411336	0	0	333.6223025	13.50620709	21.31614454	0	95.11826204	0												$295 days 1-5;$0 days 6-90	$295 days 1-5;$0 days 6-90	$50 days 1-9;$100 days 10-100	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $148	12: 20.0%	"31: $148,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											0	NO	191.2902331	126.8631676	70.37195739	20	100	0.2	0.19987718	64.47138095	143.3164568	15	0.2	147.5	0.2	24.71924145	13.00995593	30.25133727	40	45	0	45	0.199908667	0	0	0	0	1.506990571	0	0	0	0											NO	151.3622529	100.3830386	55.6832298	15.82540315	79.12701574	0.158254031	0.158156848	51.01427976	113.4020353	11.86905236	0.158254031	116.7123482	0.158254031	19.55959807	10.29438988	23.93698041	31.6508063	35.60715708	0	35.60715708	0.158181762	0	0	0	0	1.506990571	0	0	0	0												18.0857	0.3142935	3.425542091	0.025245625	2.623322204	3.230625648	0.838667856	1.568777438	4.281871502	0.776172705	3.004845308	0.02390313	0.007270038	0.734046104	10.57098219	9.522773853	0.989445642	3.237414818	0	0.109414832	3.879295529	0	0	0	0	0.001696144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2513	0	NO	17.73983397	18.0857	0.3142935	3.425542091	0.025245625	2.623322204	3.230625648	0.838667856	1.568777438	4.281871502	0.776172705	3.004845308	0.02390313	0.007270038	0.734046104	10.57098219	9.522773853	0.989445642	3.237414818	0	0.109414832	3.879295529	0	0	0	0	0.001696144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2513	YES	"$295 days 1-5;$0 days 6-90,1a2: $191"	"$295 days 1-5;$0 days 6-90,1b2: $127"	"$50 days 1-9;$100 days 10-100,22: $70,23: $70"	6: $20	10a: $100	11a: 20.0%	"11b1: 20.0%,11b2: 20.0%,17b1: $10"	"4a1: $65,4a2: $500"	"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%"	9c1: $148	12: 20.0%	"31: $148,5: $295,9a2: $250"	7a: $15	"7b1: $20,7d1: $45,7f1: $45"	"7e1: $40,7h1: $40"	"7c: $45,7i: $45"	$0 	7g: $45	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	17b2: $10	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	NO	0	18.0857	0.3142935	3.425542091	0.025245625	2.623322204	3.230625648	0.838667856	1.568777438	4.281871502	0.776172705	3.004845308	0.02390313	0.007270038	0.734046104	10.57098219	9.522773853	0.989445642	3.237414818	0	0.109414832	3.879295529	0	0	0	0	0.001696144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2513
H9847_001_0	2012	10																															D	D	D	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	V	V	V	COIN	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	1069.723229	54.42818778	648.5516176	0	235.9539177	8.850787135	10.0975115	400.574385	40.43736258	8.586843882	21.30018798	1.424893782	0.077997138	16.04949886	3981.583765	120.9891255	562.7119585	646.390639	8.849341232	0	17.71318738	0	0	4.549329473	0	0	0	0	0	0											3900	1a $240 days 1-6	1b $235 days 1-6	"2 $0 days 1-12 $50 days 13-20, $100 Days 21 to 90"	6 $0	10a $150	11a 20%	"11b 20%, 11c 20%"	"4a $65, 4b $30"	"9a $190, 9b $190"	"8a $15, 8b 20%, 9a 20%, 14a $0"	"8b 20%,14a $0"	9a 20%	12 20%	"3 $35, 9a 20%, 9d $0"	"7a $15, 14a $0, 14b $0"	"7d $30, 17a $35, 17b $35, 18a $35, 7b $20 , 7f$35, 14a $0, 8a $15"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"8b 20%,14a $0"	7g $0; 14a $0	"15 20%, 11c 20%"	0	0	16a $115 allowance	17a $0	17b $100 allowance	0	0	14a $0	0												NO	198.5340314	144.9616858	32.63140712	0	150	0.2	0.2	57.66405485	0.122863395	0.197770968	0.190653554	0.2	0.2	0.204610395	14.33675419	0.164535971	34.99506805	35	0.337144196	0	0.212645945	0	0	35	0	0	0	0	0	0											NO	171.657903	125.3378014	28.21399877	0	129.6940644	0.172925419	0.172925419	49.85790428	0.106231021	0.170998138	0.164844229	0.172925419	0.172925419	0.176911692	12.39594614	0.142262259	30.25768406	30.26194836	0.291504007	0	0.183859446	0	0	30.26194836	0	0	0	0	0	0												15.3022	0.568492449	1.524852879	0	2.550151883	1.530526075	1.746116409	1.664316612	4.295702298	1.468334314	3.511213065	0.246400355	0.013487688	2.839343999	4.112958158	17.21218633	1.418863388	1.630086678	2.579618431	0	3.256736822	0	0	0.011472631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4831	0	NO	10.56568599	15.3022	0.568492449	1.524852879	0	2.550151883	1.530526075	1.746116409	1.664316612	4.295702298	1.468334314	3.511213065	0.246400355	0.013487688	2.839343999	4.112958158	17.21218633	1.418863388	1.630086678	2.579618431	0	3.256736822	0	0	0.011472631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4831	YES	0.2	0.2	0.2	30	150	0.25	0.25	"$65 ER,$30 UC"	0.2	0.2	0.2	0.2	0.2	40	25	40	40	40	0.2	$25/$40	0.2	0	0	16a $115 allowance	0.2	17b $100 allowance	0	0	0.2	0											6000	7.7302	0.1423	1.0164	0.1537	0.5989	0.4493	0.5126	0.3909	1.6423	0.3411	0.8247	0.0579	0.0032	0.6653	1.61	5.4133	0.3808	0.2076	0.8143	0	0.7649	0	0	0.0056	0	0	0	0	0	0											23.7253	0	NO	0.204117837	23.0324	0.710804679	2.541245189	0.153656631	3.149097814	1.979863217	2.258747307	2.055209276	5.938042906	1.809443381	4.33588033	0.304271609	0.016655497	3.504612826	5.722953476	22.62550116	1.799701831	1.837730728	3.393904482	0	4.021636075	0	0	0.017072935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2084
H9847_801_0	2012	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	212.7627153	6.297188315	18.09280107	0	8.425420844	5.096568427	6.23138529	18.47892166	46.50674284	9.268792076	25.61933213	1.510999018	0.087446987	16.67587678	30.68841113	106.8254488	9.071608156	3.540898436	7.257264922	7.453975549	18.7262961	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%		0	0	0	0	0	0	0	0												NO	0.08263641	0.08263641	0.184768276	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.07697919	0.07697919	0.172119193	0	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665272	0.208665922	0.208665146	0.208665146	0.208665146	0.208665146	0	0	0	0	0	0	0	0	0												16.3783	0.484752456	3.114118322	0	1.758091667	1.063476193	1.300272919	3.855906878	9.704336266	1.934073848	5.345861669	0.31529283	0.018247138	3.479674256	6.403601776	22.29076134	1.892935475	0.738862088	1.514338241	1.555384893	3.907525302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0558	0	NO	6.397731838	16.3783	0.484752456	3.114118322	0	1.758091667	1.063476193	1.300272919	3.855906878	9.704336266	1.934073848	5.345861669	0.31529283	0.018247138	3.479674256	6.403601776	22.29076134	1.892935475	0.738862088	1.514338241	1.555384893	3.907525302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0558	YES	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.9822	0.0996	2.0354	0	0.5351	1.474	1.5672	0.4972	1.0189	0.2022	0.2683	0.0288	0.0017	0.5273	2.2403	9.0201	0.4256	0.6595	0.7596	0.671	0.9466	0	0	0	0	0	0	0	0	0											23.9607	0	NO	0	17.3605	0.584328769	5.149482715	0	2.29321352	2.537473964	2.867511599	4.35307396	10.72327338	2.136259821	5.614181707	0.344097004	0.019980766	4.006957662	8.6439369	31.31083762	2.318557794	1.398370737	2.273938029	2.226409515	4.854138791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0165
H9847_802_0	2012	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	205.3074732	6.111349577	12.0130005	0	7.35951894	5.039867072	6.333887195	16.21466778	57.93249676	9.131483077	37.1482486	1.124019951	0.108141629	16.68799464	34.29888198	136.6493841	8.113692438	7.417069392	9.057127382	9.065899444	34.61330418	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	0	0	0	0	0	0	0	0	0												NO	0.08290101	0.08290101	0.184694378	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.074933518	0.074933518	0.166943679	0	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0.202471697	0	0	0	0	0	0	0	0	0												15.3844	0.457944924	2.005494498	0	1.490094286	1.020430437	1.282432886	3.283011295	11.7296909	1.848866871	7.521468919	0.227582226	0.021895619	3.378846586	6.944552825	27.66763264	1.642793073	1.501746623	1.833811947	1.835588041	7.00821442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0865	0	NO	10.42929058	15.3844	0.457944924	2.005494498	0	1.490094286	1.020430437	1.282432886	3.283011295	11.7296909	1.848866871	7.521468919	0.227582226	0.021895619	3.378846586	6.944552825	27.66763264	1.642793073	1.501746623	1.833811947	1.835588041	7.00821442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0865	YES	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.6534	0.0662	2.803	0	0.4618	1.4988	1.3972	0.3974	0.8278	0.1509	0.2038	0.0191	0.0011	0.4032	1.7223	7.6849	0.4622	0.4787	0.5568	0.5395	0.6328	0	0	0	0	0	0	0	0	0											20.9609	0	NO	0	16.0378	0.524185639	4.808469847	0	1.951934054	2.519183725	2.679641207	3.680445116	12.55751774	1.999744187	7.725314927	0.246682343	0.023045192	3.782013738	8.666811234	35.35255338	2.104973368	1.980439613	2.390637629	2.375113995	7.640976153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0474
H9847_803_0	2012	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	212.7627153	6.297188315	18.09280107	0	8.425420844	5.096568427	6.23138529	18.47892166	46.50674284	9.268792076	25.61933213	1.510999018	0.087446987	16.67587678	30.68841113	106.8254488	9.071608156	3.540898436	7.257264922	7.453975549	18.7262961	0	0	0	0	0	0	0	0	0											6700	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%		0	0	0	0	0	0	0	0												NO	0.08263641	0.08263641	0.184768276	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0	0											NO	0.07697919	0.07697919	0.172119193	0	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665146	0.208665272	0.208665922	0.208665146	0.208665146	0.208665146	0.208665146	0	0	0	0	0	0	0	0	0												16.3783	0.484752456	3.114118322	0	1.758091667	1.063476193	1.300272919	3.855906878	9.704336266	1.934073848	5.345861669	0.31529283	0.018247138	3.479674256	6.403601776	22.29076134	1.892935475	0.738862088	1.514338241	1.555384893	3.907525302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0558	0	NO	6.397731838	16.3783	0.484752456	3.114118322	0	1.758091667	1.063476193	1.300272919	3.855906878	9.704336266	1.934073848	5.345861669	0.31529283	0.018247138	3.479674256	6.403601776	22.29076134	1.892935475	0.738862088	1.514338241	1.555384893	3.907525302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0558	YES	Medicare FFS 8.3%	Medicare FFS 8.3%	Medicare FFS 18.5%	Medicare FFS 0%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%	Medicare FFS 22.4%																				10000	0.9822	0.0996	2.0354	0	0.5351	1.474	1.5672	0.4972	1.0189	0.2022	0.2683	0.0288	0.0017	0.5273	2.2403	9.0201	0.4256	0.6595	0.7596	0.671	0.9466	0	0	0	0	0	0	0	0	0											23.9607	0	NO	0	17.3605	0.584328769	5.149482715	0	2.29321352	2.537473964	2.867511599	4.35307396	10.72327338	2.136259821	5.614181707	0.344097004	0.019980766	4.006957662	8.6439369	31.31083762	2.318557794	1.398370737	2.273938029	2.226409515	4.854138791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0165
H9859_001_0	2012	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	214.4557846		928.7189064		220.9267919	8.305976152	1.906722049	222.72521	250.6260608	10916.82126	691.4530352	0.459403115		415.4204838	3523.541734	5582.34232		482.5851337	2611.321508		1064.703185	11.62048931			225.7022365		0.461073014			0.190294009											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25 copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395		29.23796791		75	0.2	0.2	64.5098636	134.3371032	10	40	25		33.25549831	14.99018856	24.99106663		25	24.84158451		23.15735444	47.47506359			25		10.63354562			0.5											NO	249.2178497		26.00760126		66.71359994	0.177902933	0.177902933	57.38246976	119.4948235	8.895146658	35.58058663	22.23786665		29.58125347	13.34157878	22.23056758		22.23786665	22.09695374		20.59880639	42.22976533			25		10.63354562			0.5												4.4539	0	2.012812583	0	1.228235134	1.47765752	0.339211445	1.065043552	2.495709741	8.092227182	2.050192052	0.000851345	0	1.024054885	3.917467469	10.34155318	0	0.894305321	4.808520881	0	1.827634564	0.040894211	0	0	0.470212993	0	0.00040857	0	0	0.095147005	0	0	0	0	0	0	0	0	0	0	46.636	0		5.719473108	4.4539	0	2.012812583	0	1.228235134	1.47765752	0.339211445	1.065043552	2.495709741	8.092227182	2.050192052	0.000851345	0	1.024054885	3.917467469	10.34155318	0	0.894305321	4.808520881	0	1.827634564	0.040894211	0	0	0.470212993	0	0.00040857	0	0	0.095147005	0	0	0	0	0	0	0	0	0	0	46.636	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered	(2). Not Covered	(6). Not Covered	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered	"(7f). Not Covered, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered"	(10b). Not Covered	(16a). Not Covered	(17a). Not Covered	(17b). Not Covered	(18a). Not Covered	(18b). Not Covered	(14c). Not Covered	(13a). Not Covered												0.1644													0.1195	0.0509	0.3716																									0.7065	0		0	4.6183	0	2.012812583	0	1.228235134	1.47765752	0.339211445	1.065043552	2.495709741	8.092227182	2.050192052	0.000851345	0	1.143587333	3.968396691	10.71317668	0	0.894305321	4.808520881	0	1.827634564	0.040894211	0	0	0.470212993	0	0.00040857	0	0	0.095147005	0	0	0	0	0	0	0	0	0	0	47.3425
H9859_002_0	2012	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	209.1153867		753.3375249		224.6047793	7.420216865	2.103330119	238.4921809	288.0340349	11527.73252	710.2919299	1.152136139		526.5262157	3503.611069	5628.104643		528.9765731	2652.897662		1160.31728	6.359782414			214.1095653		1.156324075			0.169793492											3800	(1a). $300 per stay/$900 max	(1b). $300 per stay/$900 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $75 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay,(4b). $25 copay"	"(9a1). $150 copay, (9b). $75 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). and (9c). $25 copay	(12a). $0 copay	"(3). ,(5). and(7d). $25 copay ,(8b1). $40 copay"	"(7a). $15 PCP, $25 PCP urgent care,(14a). $0 copay"	"(7b1). $20 copay,(7d). $25 copay"	(7e). $25 copay	(7i). $25 copay	"(7a). $15 copay, (7d). $25 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f).$25, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay,(14b). $0 Annual Phys. Exam"	(10b). No coverage	"(16a). $300 Limit including 2 Oral Exams, x-rays & Prophylaxis"	(17a). $25 copay	(17b). Medicare Covered: 20%Non-Med: $100 allowance	(18a). $25 exam	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													280.1728395		29.23796791		75	0.2	0.2	64.61352657	137.1	10	40	25		34.09190372	15.00490196	24.99384793		25	24.86404834		24.99827132	47.61951339			25		10.63354562			0.5											NO	247.8757334		25.86754217		66.35432628	0.17694487	0.17694487	57.16516032	121.2957084	8.847243504	35.38897402	22.11810876		30.16193737	13.27520214	22.11365692		22.11810876	21.99782901		22.11657936	42.13014305			25		10.63354562			0.5												4.3196	0	1.623915849	0	1.241958234	1.312969309	0.372173475	1.136120313	2.911441026	8.499054724	2.094708554	0.002123589	0	1.323420895	3.875928763	10.37149793	0	0.974996781	4.863165764	0	2.138520767	0.022328212	0	0	0.446061594	0	0.001024652	0	0	0.084896746	0	0	0	0	0	0	0	0	0	0	47.6159	0		6.134294437	4.3196	0	1.623915849	0	1.241958234	1.312969309	0.372173475	1.136120313	2.911441026	8.499054724	2.094708554	0.002123589	0	1.323420895	3.875928763	10.37149793	0	0.974996781	4.863165764	0	2.138520767	0.022328212	0	0	0.446061594	0	0.001024652	0	0	0.084896746	0	0	0	0	0	0	0	0	0	0	47.6159	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered	(2). Not Covered	(6). Not Covered	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered	"(4a). $65 copay,(4b). $25 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). and (8b1).  30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). Not Covered, (9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered"	(10b). Not Covered	(16a). Not Covered	(17a). Not Covered	(17b). Not Covered	(18a). Not Covered	(18b). Not Covered	(14c). Not Covered	(13a). Not Covered																									0.1885	0.0675	0.4013																									0.6573	0		0	4.3196	0	1.623915849	0	1.241958234	1.312969309	0.372173475	1.136120313	2.911441026	8.499054724	2.094708554	0.002123589	0	1.511912999	3.943394712	10.77280238	0	0.974996781	4.863165764	0	2.138520767	0.022328212	0	0	0.446061594	0	0.001024652	0	0	0.084896746	0	0	0	0	0	0	0	0	0	0	48.2731
H9859_004_0	2012	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	191.5228143		920.0845621		190.363543	6.292960837	1.813561737	244.894745	324.5564991	8148.474173	572.3021388	0.688394598		423.8198654	3916.026243	6063.928873	3.392008327	578.3757162	2508.847756		1237.408533	4.941813531			243.2574949		2.974658408			0.242238748											3800	(1a). $500 per stay/$1500 max	(1b). $500 per stay/$1500 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $100 copay	(11a). 20% coinsurance	(11b). 20% coinsurance	"(4a). $65 copay, (4b). $30 copay"	"(9a1). $250 copay, (9b). $100 copay"	(8a). $10 copay	(8b1). $40 copay	(7e). And (9c). $30 copay	(12a). $0 copay	"(3). ,(5). And (7d). $30 copay ,(8b1). $40 copay"	"(7a). $15 copay ,(14a). $0 copay"	"(7b1). $20 copay, (7d). $30 copay"	(7e). $30 copay	(7i). $30 copay	"(7a). $15 copay, (7d). $30 copay"	(14a). $0 copay	(15). 20% coinsurance	"(7f). $30, 20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay and (14b). $0 Annual Phys. Exam"	(10b). No Coverage	"(16a). $300 Limit including 2 Oral Exams, x-rays & Prophylaxis"	(17a). $30 coapy	(17b). Non-Med: $100 allowance	(18a). $30 exam	(18b). No Coverage	(14c). $0 copay	(13a). 50% - 10 visit max													466.9547325		29.23796791		100	0.2	0.2	64.80323129	223.1735785	10	40	30		35.03610671	15.00371136	29.98876315	30	30	29.83735808		26.69597897	46.12547242			30		11.47039158			0.5											NO	401.6477826		25.14882956		86.01428676	0.172028574	0.172028574	55.74003719	191.9611618	8.601428676	34.4057147	25.80428603		30.13605729	12.90552394	25.79533043	25.80428603	25.80428603	25.66439074		22.96235591	39.67449611			30		11.47039158			0.5												6.4104	0	1.928254153	0	1.364498698	1.082569076	0.311984439	1.137536849	5.191853552	5.840709951	1.640872009	0.001480294	0	1.064354979	4.211530869	13.03508742	0.007294029	1.243714368	5.365670761	0	2.367817929	0.016338663	0	0	0.608143737	0	0.002843375	0	0	0.121119374	0	0	0	0	0	0	0	0	0	0	52.9541	0		8.490674958	6.4104	0	1.928254153	0	1.364498698	1.082569076	0.311984439	1.137536849	5.191853552	5.840709951	1.640872009	0.001480294	0	1.064354979	4.211530869	13.03508742	0.007294029	1.243714368	5.365670761	0	2.367817929	0.016338663	0	0	0.608143737	0	0.002843375	0	0	0.121119374	0	0	0	0	0	0	0	0	0	0	52.9541	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered	(2). Not Covered	(6). Not Covered	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay, (4b). $30 copay"	"(9a1). And (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). And (9c). Not Covered	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). And (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). ,(9d). 30%; $5,000 Max. Comb. Annual POS Benefit, (14b). Not Covered"	(10b). Not Covered	(16a). Not Covered	(17a). Not Covered POS	(17b). Not Covered	(18a). Not Covered	(18b). Not Covered	(14c). Not Covered	(13a). Not Covered																									0.1604	0.0448	0.3957																									0.6009	0		0	6.4104	0	1.928254153	0	1.364498698	1.082569076	0.311984439	1.137536849	5.191853552	5.840709951	1.640872009	0.001480294	0	1.224765828	4.256338571	13.43075903	0.007294029	1.243714368	5.365670761	0	2.367817929	0.016338663	0	0	0.608143737	0	0.002843375	0	0	0.121119374	0	0	0	0	0	0	0	0	0	0	53.555
H9859_013_0	2012	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	211.6800533		762.5767283		227.3594134	7.511221083	2.129126119	241.4171351	291.5665882	11652.02893	719.0032066	1.166266353		532.9837233	3546.58062	5697.12975		535.4641328	2685.433757		1163.844858	6.437781081			216.7354823		1.170505651			0.1718759											4600	(1a). $500 per stay/$1500 max per yr	(1b). $500 per stay/$1500 max	(2). $0 days 1-20; $135/day days 21-100	(6). $0 copay	(10a). $125 copay	(11a). 20% Coinsurance	(11b). 20% Coinsurance	"(4a). $65 copay, (4b). $40 copay"	"(9a1). $250 copay, (9b). $150 copay"	(8a). $10 copay	(8b). $60 copay	(7e). and (9c). $40 copay	(12a). $0 copay	"(3). ,(5). And(7d). $40 copay ,(8b1). $60 copay"	"(7a). $20 copay ,(14a). $0 copay"	"(7b1). $20 copay,(7d). $40 copay"	(7e). $40 copay	(7i). $40 copay	"(7a). $20 copay, (7d). $40 copay"	(14a). $0 copay	(15) 20% coinsurance	"(7f). $40,20% of the cost for diabetic related shoe inserts. $250 for non-diabetic custom shoe orthotics, (9d). $0 copay and (14b). $0 Annual Phys. Exam"	(10b). No coverage	(16a). No coverage	(17a). $40 copay	(17b). Medicare Covered: 20%	(18a). $40 copay	(18b). No coverage	(14c). $0 copay	(13a). 50% - 10 visit max													466.9547325		29.23796791		125	0.2	0.2	64.75845411	232.8	10	60	40		52.12253829	20.00980392	39.98011586		39.99330288	39.72809668		32.68371701	47.61951339			40		10.63354562			0.5											NO	398.661202		24.96182739		106.718375	0.1707494	0.1707494	55.28733591	198.7523016	8.537469999	51.22481999	34.14987999		44.49946069	17.08331007	34.13416134		34.14951417	33.91774335		27.90362534	40.65501669			40		10.63354562			0.5												7.0324	0	1.586275722	0	2.021952262	1.282536493	0.363547007	1.112275853	4.829127539	8.28990395	3.069234153	0.003318988	0	1.976457354	5.0489447	16.20556217	0	1.523819999	7.590321079	0	2.706290906	0.021810675	0	0	0.722451608	0	0.001037219	0	0	0.08593795	0	0	0	0	0	0	0	0	0	0	65.4732	0		11.07638886	7.0324	0	1.586275722	0	2.021952262	1.282536493	0.363547007	1.112275853	4.829127539	8.28990395	3.069234153	0.003318988	0	1.976457354	5.0489447	16.20556217	0	1.523819999	7.590321079	0	2.706290906	0.021810675	0	0	0.722451608	0	0.001037219	0	0	0.08593795	0	0	0	0	0	0	0	0	0	0	65.4732	NO	"(1a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(1b). Not Covered POS	(2). Not Covered POS	(6). Not Covered POS	"(10a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(11a). 30%; $5,000 Max. Comb. Annual POS Benefit"	(11b). Not Covered POS	"(4a). $65 copay, (4b). $40 copay"	"(9a1). and (9b). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8a). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(8b). 30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). and (9c). Not Covered POS	(12a). $0 copay	"(3). ,(5). ,(7d). And (8b1).  30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a). 30%; $5,000 Max. Comb. Annual POS Benefit ,(14a). $0 copay"	"(7b1). and (7d).30%; $5,000 Max. Comb. Annual POS Benefit"	(7e). Not Covered POS	"(7i). 30%; $5,000 Max. Comb. Annual POS Benefit"	"(7a).  and (7d). 30%; $5,000 Max. Comb. Annual POS Benefit"	(14a). $0 copay	(15). Not Covered POS	"(7f). and (9d). 30%; $5,000 Max. Comb. Annual POS Benefit and (14b). Not Covered POS"	(10b). Not Covered POS	(16a). Not Covered	(17a). Not Covered POS	(17b). Not Covered POS	(18a). Not Covered POS	(18b). Not Covered POS	(14c). Not Covered POS	(13a). Not Covered POS																									0.1908	0.0683	0.4062																									0.6653	0		0	7.0324	0	1.586275722	0	2.021952262	1.282536493	0.363547007	1.112275853	4.829127539	8.28990395	3.069234153	0.003318988	0	2.167261193	5.117238076	16.61178836	0	1.523819999	7.590321079	0	2.706290906	0.021810675	0	0	0.722451608	0	0.001037219	0	0	0.08593795	0	0	0	0	0	0	0	0	0	0	66.1385
H9859_802_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	240.0376078	0.686802884	1000.789331		275.1436924	756.8110818	355.105152	11.11536345	48.94243976	27.50480848	17.6925531	0.04593796	0.066324633	27.92745736	49.8082659	140.3738741		5.124727582	31.82113781	5.22284203	30.14549707	56.64145317																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													931.0755615	2267.610504	98.66153962		120.6212933	28.3620964	24.54214979	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0.224	0.224	83.19626306																			NO	777.5118344	1893.610009	82.38913985		100.7270376	23.68429214	20.49437521	0.187055335	0.187055335	0.187055335	0.187055335	0.187055335	0.187055335	0.187055335	0.187055335	0.187055335		0.187055335	0.187055335	0.187055335	0.187055335	69.47457519																				15.5527	0.108378068	6.871181013	0	2.309534087	1.49371123	0.606471518	2.079188031	9.154944457	5.14492116	3.309486445	0.008592941	0.012406376	5.223979888	9.316901855	26.25768203	0	0.958607634	5.952313588	0.976960465	5.638876048	0.327928408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3047	0		20.00835557	15.5527	0.108378068	6.871181013	0	2.309534087	1.49371123	0.606471518	2.079188031	9.154944457	5.14492116	3.309486445	0.008592941	0.012406376	5.223979888	9.316901855	26.25768203	0	0.958607634	5.952313588	0.976960465	5.638876048	0.327928408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3047	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.0182													0.0671	0.0172	0.2549																									0.3574	0		0	15.5709	0.108378068	6.871181013	0	2.309534087	1.49371123	0.606471518	2.079188031	9.154944457	5.14492116	3.309486445	0.008592941	0.012406376	5.291058817	9.334117464	26.51259159	0	0.958607634	5.952313588	0.976960465	5.638876048	0.327928408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6621
H9859_804_0	2012	1																															D	D	D	V	T	P	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	321.4907709	0.493930716	1164.709219		336.3138943	942.1907633	390.1589987	13.89779203	64.62204867	38.3828914	20.72369596	0.033037383	0.047698946	34.36565801	64.79486804	184.7899331	0.042414816	5.647869353	44.55202756	6.935839685	54.33755277	69.13362604																			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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage													883.8800372	1971.473139	80.9939101		133.6120016	28.00971062	19.00906968	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	112.5068259																			NO	682.2879901	1521.826933	62.52112256		103.1382769	21.62136077	14.67355229	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	0.172910919	86.84669062																				18.2791	0.062639756	6.068243987	0	2.890569629	1.697620534	0.477084872	2.403079995	11.17385784	6.636821038	3.58335332	0.005712524	0.008247669	5.942197518	11.2037402	31.95219722	0.007333985	0.976578282	7.703532043	1.199282416	9.395556202	0.500335553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.1671	0		36.09606877	18.2791	0.062639756	6.068243987	0	2.890569629	1.697620534	0.477084872	2.403079995	11.17385784	6.636821038	3.58335332	0.005712524	0.008247669	5.942197518	11.2037402	31.95219722	0.007333985	0.976578282	7.703532043	1.199282416	9.395556202	0.500335553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.1671	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	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage	No coverage												0.0505													0.085	0.0577	0.317																									0.5101	0		0	18.3296	0.062639756	6.068243987	0	2.890569629	1.697620534	0.477084872	2.403079995	11.17385784	6.636821038	3.58335332	0.005712524	0.008247669	6.027207291	11.26141217	32.26915893	0.007333985	0.976578282	7.703532043	1.199282416	9.395556202	0.500335553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6772
H9947_001_0	2012	8	H.6										OP Facility - Other										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	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	YES	1008.271815	103.8441144	188.6687829	280.9839927	132.3504082	3.825896454	3.39985518	228.7927073	212.5558055	14884.31869	439.3804035	16.72892914	0	108.7380394	2654.310256	1932.772341	2.738284308	906.8284866	694.6114527	1352.712448	57.07014361	24.52864132	0	0	0	0	0	0	5872.8	82.14852923	11.83895036	0	0	0	0	0	0	0	0	0	4900	1A: $230/day (days 1-6); no yrly max	1B: $230/day (days 1-6); no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$230 copay; 9B: $230 copay	8A: $0-$170 copay	8B: $50-$170 copay	5: $40 copay	12: 20% coin	3: $30 copay; 9A: $30-$230 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $45 copay; 7I: $45 copay	8B: $50-$170 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	146.9735643	78.01762115	146	0	175	0.2	0.095435476	50	223.0787037	11.59052593	96.49496081	40	0.2	67.01357466	0	30	40	45	78.14717477	0.738866397	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	135.5720567	71.96538651	134.6740169	0	161.4243353	0.184484955	0.088032048	46.12123867	205.7733227	10.69138826	89.00934236	36.89699094	0	61.81498142	0	27.6727432	36.89699094	41.5091148	72.08488998	0.681548669	0.184484955	0	0	0	0	0	0	0	0	0	0.184484955	0	0	0	0	0	0	0	0	0		11.3911	0.622765152	2.117398571	0	1.78038139	0.705820334	0.299296214	0.879350255	3.64485953	13.26116917	3.259080063	0.051437262	0	0.560136657	0	4.457092721	0.008419538	3.13680398	4.172582512	0.076828281	10.52858286	0	0	0	0	0	0	0	0	0	2.184108221	0	0	0	0	0	0	0	0	0	63.1372		NO	5.309793881	11.3911	0.622765152	2.117398571	0	1.78038139	0.705820334	0.299296214	0.879350255	3.64485953	13.26116917	3.259080063	0.051437262	0	0.560136657	0	4.457092721	0.008419538	3.13680398	4.172582512	0.076828281	10.52858286	0	0	0	0	0	0	0	0	0	2.184108221	0	0	0	0	0	0	0	0	0	63.1372	YES	1A: $330/day (days 1-6); no yrly max	1B: $330/day (days 1-6); no yrly max	2: 30% coin (for days 1-100)	6: 10% coin	10A: $175 copay	11A: 30% coin	11B: 30% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $0-$330 copay; 9B: $330 copay	8A: $0-$200 copay	8B: $100-$200 copay	5: $40 copay	12: 20% coin	3: $45 copay; 9A: $45-$330 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $45 copay; 7F: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $100-$200 copay	14A: $0-$45 copay; 14D: $0; 14E: $45; 17A: $0; 17B: $0; 18A: $45	15: 25% coinsurance	9D: $0 copay; 14A $45 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 25% coinsurance										4900	4.7232	0.2594	1.3707	0.1067	0.5117	0.3043	0.129	0.2527	1.5031	6.0504	1.3469	0.0148	0	0.2311	1.4661	1.9216	0.0024	1.0017	1.8946	0.7886	3.7826	0.0054	0	0	0	0	0	0	0	0	0.7847	0	0	0	0	0	0	0	0	0	28.4515		NO	2.392748812	16.1144	0.882173305	3.48806363	0.106692062	2.292090621	1.010115904	0.428329776	1.13208916	5.147922256	19.31152114	4.605933841	0.066221129	0	0.791188933	1.466059551	6.378649109	0.010839443	4.13854412	6.067167035	0.865415058	14.31118042	0.005364986	0	0	0	0	0	0	0	0	2.968791453	0	0	0	0	0	0	0	0	0	91.5887
H9947_002_0	2012	8	H.6										OP Facility - Other										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	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	YES	1008.140501	103.83059	188.6441772	280.9473902	132.3331712	3.824899968	3.39896966	228.7629099	212.5281228	14882.38019	439.3231797	16.7267504	0	108.7238776	2653.964565	1932.520621	2.73792768	906.7103835	694.5209882	1352.536274	57.05527922	24.52544677	0	0	0	0	0	0	5872.8	82.13783041	11.83586681	0	0	0	0	0	0	0	0	0	3400	1A: $195/day (days 1-6); no yrly max	1B: $195/day (days 1-6); no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $210 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0-$195 copay; 9B: $195 copay	8A: $0-$165 copay	8B: $50-$165 copay	5: $40 copay	12: 20% coin	3: $20 copay; 9A: $20-$195 copay; 9C: $40 copay	7A: $10 copay; 7G: $10 copay	7B: $20 copay; 7D: $20 copay; 7F: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $50-$165 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $20	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	124.6080219	66.14537445	146	0	210	0.2	0.095435476	65	189.1319444	11.5612707	94.55767077	40	0.2	53.30316742	10	20	40	50	76.97437582	0.492577598	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	110.9042124	58.87101446	129.9436005	0	186.9051788	0.178004932	0.084939928	57.85160295	168.3320947	10.28981604	84.15865886	35.60098643	0	47.44113351	8.900246608	17.80049322	35.60098643	44.50123304	68.50909273	0.438406209	0.178004932	0	0	0	0	0	0	0	0	0	0.178004932	0	0	0	0	0	0	0	0	0		9.3173	0.509384347	2.042758632	0	2.061146252	0.680851059	0.288708237	1.10285842	2.981275341	12.76141286	3.081070801	0.049624068	0	0.429831999	1.968411593	2.866651684	0.008122744	3.362477506	3.965083566	0.049413358	10.15612111	0	0	0	0	0	0	0	0	0	2.106842669	0	0	0	0	0	0	0	0	0	59.7893		NO	7.387827193	9.3173	0.509384347	2.042758632	0	2.061146252	0.680851059	0.288708237	1.10285842	2.981275341	12.76141286	3.081070801	0.049624068	0	0.429831999	1.968411593	2.866651684	0.008122744	3.362477506	3.965083566	0.049413358	10.15612111	0	0	0	0	0	0	0	0	0	2.106842669	0	0	0	0	0	0	0	0	0	59.7893	YES	1A: $295/day (days 1-6); no yrly max	1B: $295/day (days 1-6); no yrly max	2: 30% coin (for days 1-100)	6: 10% coin	10A: $210 copay	11A: 30% coin	11B: 30% coin; 11C: 0% coin	4A: $65 copay; 4B: $45 copay	9A: $0-$295 copay; 9B: $295 copay	8A: $0-$200 copay	8B: $100-$200 copay	5: $40 copay	12: 20% coin	3: $30 copay; 9A: $30-$295 copay; 9C: $40 copay	7A: $20 copay; 7G: $20 copay	7B: $20 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $100-$200 copay	14A: $0-$30 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 25% coinsurance	9D: $0 copay; 14A $30 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 25% coinsurance										3400	4.0735	0.2237	1.3222	0.1029	0.5924	0.2935	0.1245	0.317	1.2963	5.8371	1.2994	0.0143	0	0.1826	1.1315	1.2359	0.0023	0.9664	1.8278	0.5005	3.6488	0.0035	0	0	0	0	0	0	0	0	0.7569	0	0	0	0	0	0	0	0	0	25.7528		NO	3.182131364	13.3907	0.73310507	3.364934706	0.102917698	2.65355166	0.974381795	0.413177076	1.419837038	4.27755796	18.59848629	4.380447173	0.063886795	0	0.612415879	3.09991565	4.102531932	0.010457346	4.328905705	5.792882846	0.549893789	13.80490456	0.003450578	0	0	0	0	0	0	0	0	2.863766753	0	0	0	0	0	0	0	0	0	85.5421
H9947_003_0	2012	10	H.6										OP Facility - Other										Radiology										A	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	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	YES	162.0723738	11.08902519	188.4030663	280.9764958	132.3468777	3.825692344	3.399673798	228.7866042	209.6871665	14659.5238	432.8664233	16.48022446	0	107.1120466	2614.412274	1903.784336	2.697207141	893.268135	684.3399726	1332.390309	57.06709893	24.52798702	0	0	0	0	0	0	5872.8	82.1463379	11.83831876	0	0	0	0	0	0	0	0	0	6700	1A: $275/admit; no yrly max	1B: $275/admit; no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $275 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $0-$275 copay; 9B: $275 copay	8A: $0-$275 copay	8B: $40-$275 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $40-$275 copay; 9C: $40 copay	7A: $0 copay; 7G: $0 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $40-$275 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0-$40; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 20% coinsurance										0	NO	275	275	146	0	275	0.2	0.095435476	50	266.724537	6.915308585	131.0526316	40	0.2	79.2760181	0	40	40	40	95.12155059	8.690958165	0.2	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	262.0837849	262.0837849	139.142664	0	262.0837849	0.190606389	0.090953058	47.65159725	254.1970043	6.590509991	124.8973444	38.1212778	0	75.55257772	0	38.1212778	38.1212778	38.1212778	90.65387637	8.282760764	0.190606389	0	0	0	0	0	0	0	0	0	0.190606389	0	0	0	0	0	0	0	0	0		3.5397	0.242187808	2.184575379	0	2.890497553	0.729201403	0.309210727	0.908503927	4.441820798	8.051144837	4.505322228	0.052353935	0	0.674382602	0	6.047890962	0.008568415	2.837710227	5.169839273	0.919655848	10.87735366	0	0	0	0	0	0	0	0	0	2.25645919	0	0	0	0	0	0	0	0	0	56.6464		NO	2.791691084	3.5397	0.242187808	2.184575379	0	2.890497553	0.729201403	0.309210727	0.908503927	4.441820798	8.051144837	4.505322228	0.052353935	0	0.674382602	0	6.047890962	0.008568415	2.837710227	5.169839273	0.919655848	10.87735366	0	0	0	0	0	0	0	0	0	2.25645919	0	0	0	0	0	0	0	0	0	56.6464	YES	1A: 35% coin	1B: 35% coin	2: 35% coin (for days 21-100)	6: 0% coin	10A: $275 copay	11A: 35% coin	11B: 35% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: 0%-35% coin; 9B: 35% coin	8A: 0%-35% coin	8B: 35% coin	5: 35% coin	12: 20% coin	3: 0% coin; 9A: 35% coin; 9C: 35% coin	7A: 35% coin; 7G: 35% coin	7B: 35% coin; 7D: 35% coin; 7F: 35% coin	7E: 35% coin; 7H: 35% coin	7C: 35% coin; 7I: 35% coin	8B: 35% coin	14A: 0% coin; 14D: 0%; 14E: 0%; 17A: 0%-35%; 17B: $0; 18A: 35%	15: 35% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	N/A	N/A	14C: Silver Sneakers	7B: OSB; 7F: Not covered; 13A: OSB	8B: 35% coinsurance										6700	14.8259	1.0591	0	0	0.8308	0.3668	0.1555	0.2611	2.1915	2.2445	0.9134	0.0304	0	0.1337	2.0525	1.9018	0.0026	1.1483	1.6113	0.6208	5.4711	0	0	0	0	0	0	0	0	0	1.1349	0	0	0	0	0	0	0	0	0	36.956		NO	1.821295814	18.3657	1.301263813	2.184575379	0	3.721271391	1.095973045	0.464736657	1.169622049	6.633328446	10.29561465	5.418760069	0.082746471	0	0.808102242	2.052475025	7.94966756	0.011212243	3.986011004	6.781176078	1.540414683	16.34841398	0	0	0	0	0	0	0	0	0	3.391406599	0	0	0	0	0	0	0	0	0	93.6024
H9947_801_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071909498	0.071909498	0.158031427	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	0.059680647	0.059680647	0.131156774	0	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646																				14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118		NO	19.75523638	14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118	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	1.5697	0.0163	0.7401	0	0.1373	0.2528	0.0862	0.3062	1.123	1.3612	1.1788	0.0001	0.1344	0.0117	0.8678	1.2917	0.0036	0.8203	0	0.002	0.8003	0.009																			10.7124		NO	2.195026264	15.6969	0.163075626	7.40094664	0	1.372589016	2.527779007	0.861877653	3.061925251	11.22979012	13.6115897	11.78813163	0.001043991	1.344350283	0.116849153	8.678041802	12.91684515	0.036337403	8.202911269	0	0.020352895	8.002512779	0.090311098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1242
H9947_802_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071909498	0.071909498	0.158031427	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	0.059680647	0.059680647	0.131156774	0	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646																				14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118		NO	19.75523638	14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118	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	1.5697	0.0163	0.7401	0	0.1373	0.2528	0.0862	0.3062	1.123	1.3612	1.1788	0.0001	0.1344	0.0117	0.8678	1.2917	0.0036	0.8203	0	0.002	0.8003	0.009																			10.7124		NO	2.195026264	15.6969	0.163075626	7.40094664	0	1.372589016	2.527779007	0.861877653	3.061925251	11.22979012	13.6115897	11.78813163	0.001043991	1.344350283	0.116849153	8.678041802	12.91684515	0.036337403	8.202911269	0	0.020352895	8.002512779	0.090311098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1242
H9947_803_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071909498	0.071909498	0.158031427	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	0.059680647	0.059680647	0.131156774	0	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646																				14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118		NO	19.75523638	14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118	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	1.5697	0.0163	0.7401	0	0.1373	0.2528	0.0862	0.3062	1.123	1.3612	1.1788	0.0001	0.1344	0.0117	0.8678	1.2917	0.0036	0.8203	0	0.002	0.8003	0.009																			10.7124		NO	2.195026264	15.6969	0.163075626	7.40094664	0	1.372589016	2.527779007	0.861877653	3.061925251	11.22979012	13.6115897	11.78813163	0.001043991	1.344350283	0.116849153	8.678041802	12.91684515	0.036337403	8.202911269	0	0.020352895	8.002512779	0.090311098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1242
H9947_804_0	2012	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	236.7140017	2.459223739	50.78542091	13.58979568	7.098021864	13.07181571	4.456997945	15.83402762	58.0722233	70.38914065	60.95955533	0.005398757	6.951991889	0.604257962	44.87645591	66.79643231	0.187910347	42.4194299	0	0.10525022	41.38311615	0.467022644																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071909498	0.071909498	0.158031427	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	0.059680647	0.059680647	0.131156774	0	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646	0.174038646																				14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118		NO	19.75523638	14.1272	0.146768063	6.660851976	0	1.235330114	2.275001107	0.775689887	2.755732726	10.10681111	12.25043073	10.60931847	0.000939592	1.209915255	0.105164237	7.810237622	11.62516063	0.032703662	7.382620142	0	0.018317606	7.202261501	0.081279989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4118	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	1.5697	0.0163	0.7401	0	0.1373	0.2528	0.0862	0.3062	1.123	1.3612	1.1788	0.0001	0.1344	0.0117	0.8678	1.2917	0.0036	0.8203	0	0.002	0.8003	0.009																			10.7124		NO	2.195026264	15.6969	0.163075626	7.40094664	0	1.372589016	2.527779007	0.861877653	3.061925251	11.22979012	13.6115897	11.78813163	0.001043991	1.344350283	0.116849153	8.678041802	12.91684515	0.036337403	8.202911269	0	0.020352895	8.002512779	0.090311098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1242
H9988_002_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	852.9237226	50.42309805	595.5815527		90.70620606	6.984137193	7.922182998	204.4012508	28.64157169		9.088066396	5.985941553		179.751369	2116.35699	3860.447957	0.92660226	440.1632908			16.71558815	0.005197953			123.5296579		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.188540855	65	0.081071812		0.15	29		87.38545059	10.01213707	29.53635953	0.377475505	30			0.2	0.510064758			30		30														NO	61.74948132	68.46711645	45.31621452		131.5901194	0.175453493	0.165400757	57.02238507	0.071121663		0.131590119	25.44075642		76.66041251	8.78332208	25.91128718	0.331146979	26.31802388			0.175453493	0.447463216			30		30															4.389	0.287693677	2.249125117	0	0.99467004	1.225391263	1.310335067	0.971287236	2.037036216	0	1.195899742	0.012690573	0	1.148317841	1.549053757	8.335764638	0.306841539	0.965352333	0	0	2.932808321	0.002325893	0	0	0.308824145	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6581	0		4.185003139	4.389	0.287693677	2.249125117	0	0.99467004	1.225391263	1.310335067	0.971287236	2.037036216	0	1.195899742	0.012690573	0	1.148317841	1.549053757	8.335764638	0.306841539	0.965352333	0	0	2.932808321	0.002325893	0	0	0.308824145	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6581	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.6973	0.1566	1.6462		0.6315	0.7294	0.7558	0.4625	2.393		0.7593	0.0549		0.7035	1.9503	5.6094	0.2049	0.6399			1.3966	0.0012			0.1767		0.249														22.2182	0		3.048831612	8.0863	0.444261665	3.895358167	0	1.626206574	1.954790824	2.066146865	1.433804967	4.430018971	0	1.955201166	0.067605696	0	1.851813196	3.499397892	13.94516578	0.511768769	1.605296581	0	0	4.329383712	0.003498612	0	0	0.485554662	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8763
H9988_004_0	2012	8																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	864.3279293	42.53863907	693.0541511		88.25648533	6.89937749	8.003651272	194.4774528	27.05449397		11.42811586	8.908283192		225.1964897	2244.860749	3792.883734	1.151595821	419.8070867			15.69892199	0.013425272			123.7700737		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.187940888	65	0.081071812		0.15	29		82.12011696	10.00942987	29.46442981	0.379822947	30			0.2	0.499623797			30		30														NO	61.64743734	68.35397125	45.2413273		131.3726604	0.175163547	0.164601963	56.92815285	0.071004131		0.13137266	25.39871435		71.92225492	8.76643621	25.80547021	0.332655673	26.27453208			0.175163547	0.437579383			30		30															4.4403	0.242307076	2.612890807	0	0.96620744	1.208519435	1.317416713	0.922603513	1.920980841	0	1.501341984	0.018854912	0	1.349719945	1.63995238	8.156429017	0.383084883	0.919186231	0	0	2.749878864	0.005874622	0	0	0.309425184	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1007	0		4.304115593	4.4403	0.242307076	2.612890807	0	0.96620744	1.208519435	1.317416713	0.922603513	1.920980841	0	1.501341984	0.018854912	0	1.349719945	1.63995238	8.156429017	0.383084883	0.919186231	0	0	2.749878864	0.005874622	0	0	0.309425184	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1007	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	3.3665	0.1187	1.9125		0.6135	0.7194	0.7585	0.4393	2.2566		0.9532	0.0501		0.8197	2.0658	5.4905	0.2543	0.6088			1.3095	0.003			0.1771		0.249														22.1659	0		3.082483884	7.8068	0.360988093	4.525379876	0	1.579672481	1.927876241	2.075948299	1.361938519	4.177628999	0	2.454574989	0.068972597	0	2.169389691	3.705771834	13.64688574	0.637350777	1.527962106	0	0	4.059344989	0.008838023	0	0	0.486559762	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2666
H9988_014_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	925.5954955	47.5510031	929.0180032		122.5173494	6.115302935	8.577298169	208.4167683	28.5004893		11.04287284	7.574208385		307.0313469	2701.785153	4741.986948	1.774803018	461.9537537			16.65121454	0.012545392			122.5131851		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.188177905	65	0.081071812		0.15	29		78.75929961	10.01675804	29.44931123	0.359103199	30			0.2	0.442654933			30		30														NO	59.83325704	66.34242895	43.9099512		127.5065842	0.170008779	0.159959479	55.25285315	0.068914599		0.127506584	24.65127294		66.94886177	8.514684015	25.03320721	0.305253482	25.50131684			0.170008779	0.376276123			30		30															4.6151	0.26288742	3.399427932	0	1.30181406	1.039655185	1.37202015	0.959635091	1.964099797	0	1.408038996	0.01555949	0	1.712949933	1.917070571	9.892261819	0.541764802	0.98170242	0	0	2.830852652	0.004720531	0	0	0.306282963	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9616	0		6.036670014	4.6151	0.26288742	3.399427932	0	1.30181406	1.039655185	1.37202015	0.959635091	1.964099797	0	1.408038996	0.01555949	0	1.712949933	1.917070571	9.892261819	0.541764802	0.98170242	0	0	2.830852652	0.004720531	0	0	0.306282963	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9616	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.3198	0.159	2.4882		0.8265	0.6188	0.7904	0.457	2.3073		0.894	0.036		1.048	1.7842	5.0894	0.2811	0.5297			1.348	0.0018			0.175		0.249														23.4033	0		4.053777023	8.9349	0.421851847	5.887617926	0	2.12836267	1.658497557	2.162466006	1.416604182	4.271401409	0	2.302032009	0.051559655	0	2.760972551	3.701306672	14.9816721	0.822881659	1.511392193	0	0	4.178877724	0.006479736	0	0	0.481299342	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3649
H9988_015_0	2012	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	V	P	V	V	Coin	V	P	P	Coin	Coin	T	V	V	P	V	P	V	O																																																			0	NO	848.8945394	39.27544892	664.1601384		105.7470391	7.151481566	8.167712607	193.3858922	29.65053147		10.10570295	3.586949721		209.5854998	2248.769383	4087.704902	0.868913275	429.5714221			16.82701545	0.002529412			122.6178659		174.3															Days 1-7: $125/day; Days 8-90: $0/day; Days 61+ $100/day; unlimited days	Days 1-7: $175/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-20: $0, Days 21-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$150/trip	20% min/max Coinsurance	20% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, or $300 copay, OP Surgery: 20% min/max Coinsurance, or $300 copay"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $10, max $30"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 15% min/max, therapeutic radiological services - 15% min/max, diagnostic radiological services - 15% min/max; Separate Office Visits: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: %65copay; OP Hospital Services: Min $65 copay; OP SA Services: Min $65 copay	PCP Services: Copay min/max $10 / visit; Routine PE: $0 copay	"Chiro Services: Copay $20 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $10, max $30"	"Individual; $30 copay, group; $20 copay"	OT PT & SP Services: $30 copay	$ 30 min/max	"Other Healthcare Prof Services: Copay min $10, max $30; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $10, max $30"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $30 copay	$175 / wear max	Routine hearing tests; $30 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											0	NO	70.3884322	78.04588608	51.65609857		150	0.2	0.186749529	65	0.081071812		0.15	29		70.61420464	10.00974146	29.48391766	0.417919127	30			0.2	0.461430099			30		30														NO	61.18525819	67.84151232	44.90214697		130.3877419	0.173850322	0.162332329	56.50135481	0.070471804		0.130387742	25.20829676		61.38151124	8.700983901	25.62894297	0.363276875	26.07754837			0.173850322	0.401098857			30		30															4.3283	0.222042154	2.485184679	0	1.149009803	1.243287377	1.325883812	0.910547076	2.089526434	0	1.317659788	0.007535074	0	1.072056226	1.630542183	8.730296318	0.315656099	0.933514128	0	0	2.925382062	0.001014544	0	0	0.306544665	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4298	0		4.615850544	4.3283	0.222042154	2.485184679	0	1.149009803	1.243287377	1.325883812	0.910547076	2.089526434	0	1.317659788	0.007535074	0	1.072056226	1.630542183	8.730296318	0.315656099	0.933514128	0	0	2.925382062	0.001014544	0	0	0.306544665	0	0.43575	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4298	YES	Days 1-7: $225/day; Days 8-90: $0/day; Days 61+ $125/day; unlimited days	Days 1-7: $200/day; Days 8-90: $0/day; 100 days per benefit period: $0	"Days 1-10: $0, Days 11-100: $100/day, no 3-day prior hospital stay waiver"	No Cost Sharing	$200/trip	25% min/max Coinsurance	25% min/max Coinsurance	"ER: $65 min/max per visit, waived if admitted to hospital within 1 day; Worldwide coverage: $65 copay / service; UC: $35 min/max"	"ASC: 20% min/max Coinsurance, OP Surgery: 20% min/max Coinsurance"	"Diagnostic Procedures / Labs: 0% min/max for MC covered procedures, 0% min/max for MC covered labs; Separate Office Visits: Copay min $25, max $40"	"Diagnostic Diagnostic & Therapeutic Radiological Services: X-ray services - 20% min/max, therapeutic radiological services - 20% min/max, diagnostic radiological services - 20% min/max; Separate Office Visits: Copay min $25, max $40"	Individual and group; 50% Coinsurance	OP Dialysis $0 copay	CORF: $65 copay; Partial Hospitalization: $65 copay; OP Hospital Services:$65 copay; OP SA Services: 50% Coinsurance	PCP Services: Copay min/max $25 / visit; Routine PE: $0 copay	"Chiro Services: Copay $30 min/max; Podiatry Services: Not covered; Other Healthcare Prof Services: Copay min $25, max $40"	Individual; group; 50% Coinsurance	OT PT & SP Services: $40 copay	$ 40 min/max	"Other Healthcare Prof Services: Copay min $25, max $40; Pap & Pelvic, Prostate, Colorectal, Bone Mass Measurement, Mammography, Diabetic Monitoring:Copay min $25, max $40;"	20% min/max	20% Coinsurance	Not Covered	Preventive Dental Services: $200 / year	Routine eye exam; $40 copay	$175 / wear max	Routine hearing tests; $40 copay	Hearing Aids; Not covered	No Cost Sharing	Silver and Fit; OTC $45/qtr allowance											4000	4.0514	0.1343	1.819		0.7295	0.7401	0.7607	0.4336	2.4546		0.8366	0.0351		0.6622	2.0537	5.8693	0.1904	0.6174			1.393	0.0005			0.1752		0.249														23.2056	0		3.426179354	8.3797	0.356308007	4.304200047	0	1.878539836	1.983339386	2.086575288	1.344140922	4.544171415	0	2.154269176	0.042599304	0	1.734288325	3.684215092	14.59963594	0.506068939	1.550912476	0	0	4.31842114	0.001526079	0	0	0.481742759	0	0.68475	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6354
R3175_001_0	2012	3																															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	901.5938216	80.20550759	515.4551152	83.72028924	116.7091107	4.161456918	6.144965469	354.3892808	41.56590467	22.04607427	26.56733647	0	0.453239348	23.03890345	5965.769929	2568.413701	391.9981583	766.0232568	0	0	6.854821062	1016.898316	0	0	43.01178239	142.1500777	7.95050644	0	104.6366278	0											4900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$290 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$22 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	75.65092202	0	290	0.2	0.081034058	64.80156353	0.16	0.235247005	0.190455415	0	0.2	0.146511613	10.39444088	39.28003205	38.5	40	0	0	0.2	39.73147455	0	0	40	0	40	0	0	0											NO	174.8633799	91.58635426	63.55065306	0	243.6148681	0.168010254	0.068072763	54.4513132	0.134408203	0.197619545	0.159992313	0	0.168010254	0.123077267	10.11734016	38.23720286	37.47364585	38.93365802	0	0	0.168010254	33.37647562	0	0	40	0	40	0	0	0												13.138	0.612144169	2.729792433	0	2.36933955	0.699167433	0.41830478	1.608080143	5.586798556	4.356735176	4.250569611	0	0.076148858	2.835565267	5.029810309	8.184079641	1.224133346	2.485340626	0	0	1.151680227	2.828373488	0	0	0.143372608	0	0.026501688	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7539	0	NO	8.584786893	13.138	0.612144169	2.729792433	0	2.36933955	0.699167433	0.41830478	1.608080143	5.586798556	4.356735176	4.250569611	0	0.076148858	2.835565267	5.029810309	8.184079641	1.224133346	2.485340626	0	0	1.151680227	2.828373488	0	0	0.143372608	0	0.026501688	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7539	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)"	40% (6a); $0 n/c (6a2)	$290 (10a)	50% (11a)	"40% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $20 (8a2)	"$28 (8b1); 40% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 40% (9a); $45/$35 (9c)	"$35 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 40% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$35/$45 (7g)	"40% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 40% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.1286	0.0102	0.0594	0.0676	0.2633	0.1942	0.2294	0.1787	1.2415	0.4841	0.8486	0	0.0085	0.6289	2.188	1.6457	0.2441	0.4934	0	0	0.4065	0.5607	0	0	0.0285	0	0.0053	0	0	0											9.915	0	NO	1.135147752	13.2666	0.622343241	2.789180459	0.06764464	2.6325995	0.893380609	0.647730826	1.786755715	6.828309346	4.840816863	5.099182602	0	0.084609842	3.464444617	7.217814549	9.829760948	1.468211882	2.978753839	0	0	1.558155601	3.389045469	0	0	0.171836287	0	0.031763053	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6689
R3175_002_0	2012	3																															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	987.1158192	80.34725949	493.9430978	126.6226626	131.1956642	4.407607224	5.847797835	379.0394377	45.59832891	23.58248983	29.16267512	0	0.387816302	23.7515844	6434.239334	3370.005898	379.1854722	864.8186771	0	0	6.198733014	1080.278433	0	0	39.75065621	178.8281217	14.01472583	10.659	142.466659	574.1563856											4200	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$290 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$22 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$10 (7b, 7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$10 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	70.58775586	0	290	0.2	0.088727489	64.80121898	0.16	0.235218639	0.190547701	0	0.2	0.146496141	10.20421141	33.60791536	38.5	40	0	0	0.2	39.74656054	0	0	40	0	40	0	0	10											NO	167.4117238	87.68347866	56.7704278	0	233.233425	0.160850638	0.071359366	52.13334304	0.12868051	0.18917534	0.153248597	0	0.160850638	0.117819989	9.872670924	32.57978733	37.24911365	38.70037782	0	0	0.160850638	31.96629809	0	0	40	0	40	0	0	10												13.7712	0.587093934	2.336780081	0	2.549934508	0.708966434	0.417295147	1.646716086	5.867616235	4.461225539	4.469139035	0	0.0623805	2.798411405	5.293593966	9.149506288	1.177026896	2.789067462	0	0	0.99707016	2.877708533	0	0	0.132502187	0	0.046715753	0	0	0.478463655	0	0	0	0	0	0	0	0	0	0	62.6184	0	NO	11.1990264	13.7712	0.587093934	2.336780081	0	2.549934508	0.708966434	0.417295147	1.646716086	5.867616235	4.461225539	4.469139035	0	0.0623805	2.798411405	5.293593966	9.149506288	1.177026896	2.789067462	0	0	0.99707016	2.877708533	0	0	0.132502187	0	0.046715753	0	0	0.478463655	0	0	0	0	0	0	0	0	0	0	62.6184	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)"	40% (6a); $0 n/c (6a2)	$290 (10a)	50% (11a)	"40% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $20 (8a2)	"$28 (8b1); 40% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $75 (5); 40% (9a); $45/$35 (9c)	"$35 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 40% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"50% (7b); $50 (7b1); $45 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$35/$45 (7g)	"40% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 40% (14a10, 17b); $45 (16b, 17a, 18a)"	$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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$50 (13a); $0 n/c (13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.1348	0.0098	0.0546	0.0736	0.2833	0.1969	0.209	0.183	1.3039	0.4957	0.895	0	0.0069	0.6207	2.3567	2.0395	0.2347	0.5537	0	0	0.3519	0.5704	0	0	0.0263	0	0.0093	0	0	0.2899											10.8996	0	NO	1.472207434	13.906	0.596875639	2.391392163	0.073585482	2.833260565	0.905901554	0.626322261	1.82968454	7.171530954	4.956917266	5.364097986	0	0.069311666	3.419091411	7.650252183	11.1890342	1.411712931	3.342779385	0	0	1.348977275	3.448138403	0	0	0.158807769	0	0.055990204	0	0	0.768398417	0	0	0	0	0	0	0	0	0	0	73.5181
R3175_003_0	2012	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	370.620419	22.033341	48.98607072	850.423352	29.93890028	9.574977696	12.03066951	39.05131415	64.44320167	25.50091007	27.52258287	0	0	46.70742003	39.69194515	69.5585604	10.049224	4.038229903	0	1.872539241	8.733502323	10.97328972	0	318.6592612	0	0	0	0	179.9428484	3041.337518											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											750	YES	0.064122272	0.064901085	0.141436971	0	0.224	0.224	0.224	0.106298901	0.224	0.224	0.224	0	0	0.224	0.222602068	0.223715872	0.24134116	0.224	0	0.224	0.224	0.216756764	0	0	0	0	0	0	0	0											NO	0.053818502	0.054472168	0.118709549	0	0.188005574	0.188005574	0.188005574	0.089230552	0.188005574	0.188005574	0.188005574	0	0	0.188005574	0.177084459	0.177970512	0.191991786	0.178196542	0	0.178196542	0.188005574	0.18677588	0	0	0	0	0	0	0	0												19.9462	1.200203856	5.815114369	0	5.628680139	1.80014918	2.26183293	3.484570334	12.11568114	4.794313241	5.174398996	0	0	8.781255325	7.028826614	12.37937264	1.929368466	0.719598604	0	0.333680017	1.641947119	2.049545842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0848	150	YES	19.99177583	19.9462	1.200203856	5.815114369	0	5.628680139	1.80014918	2.26183293	3.484570334	12.11568114	4.794313241	5.174398996	0	0	8.781255325	7.028826614	12.37937264	1.929368466	0.719598604	0	0.333680017	1.641947119	2.049545842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0848	YES	"45% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"45% (1b); $0 n/c (1b1, 1b2)"	"45% (2a); $0 n/c (2a1, 2a2)"	45% (6a); $0 n/c (6a2)	45% (10a)	45% (11a)	"45% (11b, 11b1, 11c)"	"$65 (4a, 4a1); 20% (4b)"	45% (9b)	45% (8a1a); $0 (8a2)	"45% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"45% (3, 5, 9a, 9c)"	"45% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"45% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"45% (7e, 7h)"	"45% (7c, 7i)"	Included in h.2.	45% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"45% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"75% (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.397	0.0841	1.3926	0.106	0.8835	0.2826	0.3386	0.1833	1.6455	0	0.7064	0	0	1.1281	2.977	5.8521	0.8456	0.3398	0	0	0.5926	0.8826	0	0.0979	0	0	0	0	0	0											19.7353	0	NO	3.332187147	21.3432	1.284262113	7.207703233	0.105983411	6.512186936	2.082709922	2.600409298	3.667912466	13.76121556	4.794313241	5.880815761	0	0	9.909393119	10.00580469	18.23146416	2.77500585	1.059413715	0	0.333680017	2.234593038	2.932187684	0	0.097852116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8201
R3175_801_0	2012	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	219.1184466	4.130046	21.5383194	86.45495895	9.071239389	4.22228293	6.23478347	20.15937252	42.17345347	22.36831112	26.95565843	0	0.459864129	23.36518733	36.65736719	51.14825219	1.68691	7.11518729	0	0	6.95501468	11.99323674	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.068932268	0.068932268	0.145292194	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060391064	0.060391064	0.127289447	0	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0	0.19624479	0.19624479	0.196359296	0.196359296	0.196359296	0.196359296	0	0	0.19624479	0.19624479	0	0	0	0	0	0	0	0												13.2328	0.249417874	2.741600775	0	1.780183473	0.828601029	1.223543776	3.956171837	8.276320541	4.389664529	5.289907542	0	0.09024594	4.585296293	7.19801483	10.04343481	0.331240461	1.39713317	0	0	1.364885399	2.353610231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3321	0	NO	9.793116881	13.2328	0.249417874	2.741600775	0	1.780183473	0.828601029	1.223543776	3.956171837	8.276320541	4.389664529	5.289907542	0	0.09024594	4.585296293	7.19801483	10.04343481	0.331240461	1.39713317	0	0	1.364885399	2.353610231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3321	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.0665	0.0013	0.0277	0	0.1978	0.0921	0.1359	0.4396	0.9196	0.4877	0.5878	0	0.01	0.5095	1.1555	1.7724	0.0585	0.2466	0	0	0.2409	0.4153	0	0	0	0	0	0	0	0											7.3646	0	NO	1.039428936	13.2993	0.25067123	2.769293712	0	1.977981637	0.92066781	1.359493084	4.395746485	9.195911712	4.877405032	5.877675046	0	0.100273266	5.094773659	8.353552839	11.81580566	0.38969466	1.643686083	0	0	1.605747528	2.768953213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6966
R3175_802_0	2012	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	219.1184466	4.130046	21.5383194	86.45495895	9.071239389	4.22228293	6.23478347	20.15937252	42.17345347	22.36831112	26.95565843	0	0.459864129	23.36518733	36.65736719	51.14825219	1.68691	7.11518729	0	0	6.95501468	11.99323674	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.068932268	0.068932268	0.145292194	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.060391064	0.060391064	0.127289447	0	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0.19624479	0	0.19624479	0.19624479	0.196359296	0.196359296	0.196359296	0.196359296	0	0	0.19624479	0.19624479	0	0	0	0	0	0	0	0												13.2328	0.249417874	2.741600775	0	1.780183473	0.828601029	1.223543776	3.956171837	8.276320541	4.389664529	5.289907542	0	0.09024594	4.585296293	7.19801483	10.04343481	0.331240461	1.39713317	0	0	1.364885399	2.353610231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3321	0	NO	9.793116881	13.2328	0.249417874	2.741600775	0	1.780183473	0.828601029	1.223543776	3.956171837	8.276320541	4.389664529	5.289907542	0	0.09024594	4.585296293	7.19801483	10.04343481	0.331240461	1.39713317	0	0	1.364885399	2.353610231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3321	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.0665	0.0013	0.0277	0	0.1978	0.0921	0.1359	0.4396	0.9196	0.4877	0.5878	0	0.01	0.5095	1.1555	1.7724	0.0585	0.2466	0	0	0.2409	0.4153	0	0	0	0	0	0	0	0											7.3646	0	NO	1.039428936	13.2993	0.25067123	2.769293712	0	1.977981637	0.92066781	1.359493084	4.395746485	9.195911712	4.877405032	5.877675046	0	0.100273266	5.094773659	8.353552839	11.81580566	0.38969466	1.643686083	0	0	1.605747528	2.768953213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6966
R3332_001_0	2012	12	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	Dialysis	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V			Coin			V						O	V	V	V	Coin	V	V	Coin	O	O	Coin																																									0	YES	909.1566643	25.75628224	330.5790148		26.16869155	7.848272868	2.166793136	150.5908428	30.28915332	294.9040033	0.809318329	0.456664031	0.017018852	13.6425568	4786.604444	10658.84525	135.9584575	1176.594696	0	0	25.21802657	0	0	0	0	0	0	0	0	255.1130286	183.3998526	165.3012627	500.4393049	0.025044005	119.4110451	68.8363097	6.012352291	93.73323546	0	0.224045243	4750	285 Copay for 5 days(#1A)	285 Copay for 5 days(#1B)	"$50 days 1-20, $100 days 21-58 (#2)"		200 Copay(#10A)	Non-Diabetic 0.2 Copay(#11A)	0.2 Coins(#11B)	65 Copay(#4A)	0.2 Coins(#9A)	15 Copay(#(9A)	0.2 Coins(#9A)	40 Copay(#7E/#7H)	0.2 Coins(#9A/#12)	0.2 Coins(#9A)	10 Copay(#7A/#14B)	"30 copay (#7D/#14C), $20 copay (#7B)"	40 Copay(#7H)	30 Copay(#7I)			0.2 Coins(#15)			0(#16A)						(Many)	200 Copay(#9B)	100 Copay(#8B)	75 Copay(#8B/#8A)	0.2 Coins(#9A/#12)	30 Copay(#9A)	40 Copay(#4B)	0.2 Coins (#8B)	5 Copay(#7G)	5 Copay(#7G)	0.2 Coins(#11A)	0	NO	161.0749286	171.4798072	40.55987331		162.1993127	0.126983047	0.2	61.51259689	0.189205399	3.506740617	0.136889914	32	0.116773048	0.1525343	7.333205497	18.47143732	38.38685961	16.33540575	0	0	0.158459705	0	0	0	0	0	0	0	0	26.42831917	188.4769845	90.81852769	34.57060612	0.2	28.34033098	35.1476164	0.117313764	4.876308278	5	0.158705744	YES	152.8167497	169.4851313	34.04813157		149.0985989	0.121560115	0.1980235	60.74376738	0.17516103	3.340540025	0.132456384	32	0.048770775	0.137197061	7.216503189	17.88514428	37.45659969	16.21514944	0	0	0.122817396	0	0	0	0	0	0	0	0	26.23224803	187.8129926	89.49182786	34.16728108	0.182704786	26.85876961	35.04804808	0.108605774	4.800190295	5	0.156542847	10000	11.5779	0.363775573	0.937966483	0	0.325142937	0.95403695	0.42907596	0.762287927	5.305479296	0.082094886	0.10719938	0.001217771	0.000830023	1.871718695	2.87854552	15.88624875	0.42437846	1.589888236	0	0	3.097212351	0	0	0	0	0	0	0	0	0.557682354	2.870406263	1.232759346	1.424887533	0.00457566	0.267269479	0.201048191	0.652976172	0.037494781	0	0.03507268	53.8791	0	NO	3.263603799	11.5779	0.363775573	0.937966483	0	0.325142937	0.95403695	0.42907596	0.762287927	5.305479296	0.082094886	0.10719938	0.001217771	0.000830023	1.871718695	2.87854552	15.88624875	0.42437846	1.589888236	0	0	3.097212351	0	0	0	0	0	0	0	0	0.557682354	2.870406263	1.232759346	1.424887533	0.00457566	0.267269479	0.201048191	0.652976172	0.037494781	0	0.03507268	53.8791	YES	375 Copay 0 Ded(#1A)	375 Copay 0 Ded(#1B)	175 Copay 0 Ded(#2)		200 Copay 0 Ded(#10A)	0.4 Coins 0 Ded(#11A)	0.4 Coins 0 Ded(#11B)	65 Copay 0 Ded(#4A)	0.4 Coins 0 Ded(#9A)	0.4 Coins 0 Ded(#9A)	0.4 Coins 0 Ded(#9A)	40 Copay 0 Ded(#7E/#7H)	0.2 Coins 0 Ded(#9A/#12)	0.4 Coins 0 Ded 0.3 Coins 0 Ded(#9A)	40 Copay 0 Ded(#7A/#14B)	40 Copay 0 Ded(#7D/#14C)	40 Copay 0 Ded(#7H)	40 Copay 0 Ded(#7I)			0.3 Coins 0 Ded(#15)			(#16A)						(Many)	0.3 Coins 0 Ded(#9B)	0.3 Coins 0 Ded(#8B)	0.3 Coins 0 Ded(#8B/#8A)	0.2 Coins 0 Ded(#9A/#12)	0.4 Coins 0 Ded(#9A)	40 Copay 0 Ded(#4B)	0.3 Coins 0 Ded(#8B)	0.3 Coins 0 Ded(#7G)	0.3 Coins 0 Ded(#7G)	0.4 Coins 0 Ded(#11A)	10000	4.974	0.4134	0.549		1.5974	1.2728	0.2021	0.229	1.7884	0.9885	0.1413	0.0018	0.0003	0.5011	0.9426	1.9461	0.3597	0.7544	0	0	0.1484	0	0	0	0	0	0	0	0	0.2532	2.5717	0.412	0.3892	0.0222	0.0896	0.0378	0.0552	0.0057	0	0	20.6468	0	NO	0.571024454	16.5519	0.777200099	1.486957144	0	1.922540544	2.226878211	0.631133404	0.991326507	7.093903593	1.070571296	0.24845752	0.00303433	0.001092208	2.372853564	3.821182792	17.83231437	0.784035487	2.344285703	0	0	3.245634749	0	0	0	0	0	0	0	0	0.810888466	5.442074616	1.644722669	1.814095511	0.02673753	0.356836891	0.238859127	0.708135773	0.043166742	0	0.03507268	74.5259
R3444_008_0	2012	8																															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	YES	377.8677096	1.180774228	9.62791528	0	22.36123058	55.03674701	52.51062306	39.32496624	59.70040475	9.759660232	17.97291248	0	1.187910642	33.65369189	56.24087054	51.984707	1.346074396	2.330794079	17.67122463	71.63256351	29.28503564	3.893450382	0	344.6141482	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.084403786	0.084403786	0.189479112	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	15	0	0	0	0	0	0											YES	0.080660704	0.080660704	0.181076219	0	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0.214066198	0	15	0	0	0	0	0	0											6700	30.4791	0.09524208	1.743386499	0	4.786783611	11.78150718	11.24074943	8.418146005	12.77983866	2.089213359	3.84739304	0	0.254291515	7.204117869	12.03926932	11.12816858	0.288149028	0.498944227	3.782811868	15.33411052	6.268936234	0.83345612	0	0.430767685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3244	0	NO	6.723827797	30.4791	0.09524208	1.743386499	0	4.786783611	11.78150718	11.24074943	8.418146005	12.77983866	2.089213359	3.84739304	0	0.254291515	7.204117869	12.03926932	11.12816858	0.288149028	0.498944227	3.782811868	15.33411052	6.268936234	0.83345612	0	0.430767685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3244	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0837	0	NO	0.003885573	30.4791	0.09524208	1.743386499	0	4.786783611	11.78150718	11.24074943	8.501877266	12.77983866	2.089213359	3.84739304	0	0.254291515	7.204117869	12.03926932	11.12816858	0.288149028	0.498944227	3.782811868	15.33411052	6.268936234	0.83345612	0	0.430767685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.4081
R3444_009_0	2012	8																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2021.649211	7.316878672	96.59489432	0	268.157144	30.86202642	5.137325338	629.3219178	332.3751647	6.697236422	17.51788396	0	0.902743586	2525.411063	3910.751049	5186.589582	149.9520638	229.7699881	12.84304052	51.73799269	31.17362564	460.0075929	0	93.58525157	181.044923	0	0	0	0	0											6700	$155/Days Custom: 1-15 for IP Medical; $155/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$30/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	155	1000	130	0	150	0.2	0.2	63.22251451	150	0.2	0.2	0	0.2	37.68092195	35	48.51336449	39.75360121	50	0.2	0.178160763	0.2	49.25367551	0	10	30	0	0	0	0	0											YES	150.3341296	969.8976106	126.0866894	0	145.4846416	0.193979522	0.193979522	61.31936576	145.4846416	0.193979522	0.193979522	0	0.193979522	36.54663616	33.94641637	47.0529963	38.55692283	48.49488053	0.193979522	0.172797699	0.193979522	47.7710222	0	10	30	0	0	0	0	0											6700	25.3269	0.591385262	1.014944203	0	3.251062165	5.986601136	0.996535914	3.215801738	4.029623476	1.299126721	3.398110759	0	0.175113769	7.691273274	11.06299862	20.33704837	0.481807513	0.928555677	2.491286863	8.940206065	6.047045004	1.831252744	0	0.07798771	0.452612308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6273	0	NO	3.385997522	25.3269	0.591385262	1.014944203	0	3.251062165	5.986601136	0.996535914	3.215801738	4.029623476	1.299126721	3.398110759	0	0.175113769	7.691273274	11.06299862	20.33704837	0.481807513	0.928555677	2.491286863	8.940206065	6.047045004	1.831252744	0	0.07798771	0.452612308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6273	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	4.3406	0	6.4471	0.2235	0.0332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											11.0444	0	NO	0.342782154	25.3269	0.591385262	1.014944203	4.340641251	3.251062165	12.43371005	1.220017464	3.248995361	4.029623476	1.299126721	3.398110759	0	0.175113769	7.691273274	11.06299862	20.33704837	0.481807513	0.928555677	2.491286863	8.940206065	6.047045004	1.831252744	0	0.07798771	0.452612308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6717
R3444_011_0	2012	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	YES	351.9018642	16.25969917	17.6931567	0	10.53211557	13.52579171	10.15535815	28.75394123	36.86037547	6.492881889	22.26215629	0	0	25.0008826	50.58917148	45.48830385	0.707425672	0.487009659	12.6261364	47.55788351	43.75852148	2.497281202	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.084590326	0.084590326	0.189803971	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.082021094	0.082021094	0.184039124	0	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0	0	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0.217196529	0	0	0	0	0	0	0	0											6700	28.8634	1.333638319	3.256233052	0	2.287538948	2.937755014	2.205708545	6.245256238	8.005945621	1.410231411	4.835263081	0	0	5.43010493	10.98779246	9.87990172	0.153650401	0.105776808	2.742353003	10.32940724	9.504198991	0.54240081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0565	0	NO	3.478738219	28.8634	1.333638319	3.256233052	0	2.287538948	2.937755014	2.205708545	6.245256238	8.005945621	1.410231411	4.835263081	0	0	5.43010493	10.98779246	9.87990172	0.153650401	0.105776808	2.742353003	10.32940724	9.504198991	0.54240081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0565	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0621	0	NO	0.001946589	28.8634	1.333638319	3.256233052	0	2.287538948	2.937755014	2.205708545	6.307399858	8.005945621	1.410231411	4.835263081	0	0	5.43010493	10.98779246	9.87990172	0.153650401	0.105776808	2.742353003	10.32940724	9.504198991	0.54240081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1187
R3444_012_0	2012	7																															D	A	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1141.681421	7.003034156	58.52605628	0	159.3707289	7.587021385	5.084767053	457.8296735	214.5431681	4.51520829	15.67529982	0	0	1736.463162	2825.612925	3629.973024	198.9620527	188.6017213	11.74143706	36.09992355	24.91651709	308.6907772	0	130.9556485	176.5562762	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $40/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$30/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	150	0.2	0.2	63.87973334	150	0.2	0.2	0	0	37.21506261	35	47.98615549	39.75353357	50	0.2	0.17958057	0.2	49.05940312	0	10	30	0	0	0	0	0											YES	172.3740247	984.9944269	128.0492755	0	147.749164	0.196998885	0.196998885	62.92118133	147.749164	0.196998885	0.196998885	0	0	36.65662927	34.47480494	47.26609572	39.15700901	49.24972134	0.196998885	0.176885861	0.196998885	48.32323866	0	10	30	0	0	0	0	0											6700	16.3997	0.574829135	0.624518259	0	1.962240997	1.494634756	1.001693442	2.400598658	2.641547811	0.889491	3.088016593	0	0	5.304407199	8.117704535	14.2978877	0.649229908	0.774048518	2.313050013	6.385566062	4.908526095	1.243078175	0	0.109129707	0.44139069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6213	0	NO	1.143640672	16.3997	0.574829135	0.624518259	0	1.962240997	1.494634756	1.001693442	2.400598658	2.641547811	0.889491	3.088016593	0	0	5.304407199	8.117704535	14.2978877	0.649229908	0.774048518	2.313050013	6.385566062	4.908526095	1.243078175	0	0.109129707	0.44139069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6213	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	2.8673	0	1.2072	0.6506	0.0247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.7498	0	NO	0.072359297	16.3997	0.574829135	0.624518259	2.867273599	1.962240997	2.701839751	1.652338559	2.425277151	2.641547811	0.889491	3.088016593	0	0	5.304407199	8.117704535	14.2978877	0.649229908	0.774048518	2.313050013	6.385566062	4.908526095	1.243078175	0	0.109129707	0.44139069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3711
R5287_001_0	2012	4																															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	1166.699946	82.52331812	733.8213657	1612.28276	140.8762492	9.356665627	12.20267816	423.9604301	70.17368307	26.32215261	49.35209589	0	0.068839993	22.02904062	6471.623793	5714.345155	417.6241776	849.8466341	0	0	25.26549058	1209.626336	0	305.6761583	43.72974695	0	5.528532547	61.75	688.748781	0											5900	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$130 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$280 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$19 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $40 (16b, 18a); $0/$40 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	79.31046753	0	280	0.2	0.118523137	62.83066461	0.16	0.240542704	0.182946305	0	0.2	0.145705573	7.052134097	39.32809111	38.5	40	0	0	0.2	39.39435707	0	0	40	0	10	352.5	0	0											NO	166.8783104	87.40409835	63.58246016	0	224.4733816	0.16033813	0.095018891	50.38815341	0.128270504	0.192840837	0.146666342	0	0.16033813	0.116810795	6.815701571	38.01046117	37.20923438	38.65894481	0	0	0.16033813	31.58208767	0	0	40	0	10	352.5	0	0												16.2247	0.601073018	3.888180645	0	2.635247338	1.500230267	1.159484945	1.780215266	9.00121368	5.07598593	7.238291378	0	0.011037676	2.573229754	3.675721371	18.10040789	1.294956326	2.737847844	0	0	4.051021506	3.183543751	0	0	0.145765823	0	0.00460711	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	86.6967	0	NO	15.46963492	16.2247	0.601073018	3.888180645	0	2.635247338	1.500230267	1.159484945	1.780215266	9.00121368	5.07598593	7.238291378	0	0.011037676	2.573229754	3.675721371	18.10040789	1.294956326	2.737847844	0	0	4.051021506	3.183543751	0	0	0.145765823	0	0.00460711	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	86.6967	YES	"$495 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$495 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	50% (6a); $0 n/c (6a2)	$280 (10a)	50% (11a)	"40% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $20 (8a2)	"$24 (8b1); 40% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 40% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 40% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$40/$50 (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 40% (14a10, 17b); $50 (16b, 17a, 18a)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 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, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.7405	0.0454	0.3784	0.4268	0.1682	0.2394	0.2498	0.1136	1.1491	0.324	0.8619	0	0.0007	0.3278	1.1999	1.8546	0.1186	0.2775	0	0	0.8212	0.3211	0	0.0536	0.0148	0	0.0014	0.0955	0	0											9.7838	0	NO	1.64425626	16.9653	0.64648657	4.26655544	0.426758921	2.803454615	1.739628714	1.409257872	1.893846028	10.15030479	5.399985032	8.100237349	0	0.011742208	2.901014852	4.87566244	19.95504953	1.413588688	3.015332423	0	0	4.872174515	3.504631168	0	0.053627396	0.160539386	0	0.006039201	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	96.4806
R5287_002_0	2012	4																															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	1074.728533	84.77451584	718.7482093	1166.57669	123.0762996	5.578784168	7.069736372	328.3115426	53.4469599	18.62648308	42.0845701	0	0.012104981	16.35190634	4581.234685	4409.899321	396.1075261	541.6059248	0	0	18.82557832	932.9067603	0	314.369152	38.1968029	0	6.311813985	61.75	512.1478782	0											4500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$130 Days 21-47 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$225 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $20 (8a2)	"$19 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $40 (16b, 18a); $0/$40 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$10 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c4, 14c5); $0 n/c (14c2, 14c3, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	208.1579855	109.0247198	74.10408389	0	225	0.2	0.137167245	62.84421052	0.16	0.228764153	0.183031375	0	0.2	0.145763495	7.253792348	39.41946058	38.5	40	0	0	0.2	39.45659383	0	0	40	0	10	352.5	0	0											NO	166.9433914	87.43818512	59.43171986	0	180.4507426	0.16040066	0.110008583	50.4238415	0.128320528	0.183469605	0.146791767	0	0.16040066	0.116902804	7.013783289	38.11636898	37.22613547	38.67650438	0	0	0.16040066	31.64431848	0	0	40	0	10	352.5	0	0												14.9516	0.617710817	3.559703519	0	1.850767472	0.894840663	0.777731679	1.379560765	6.858342118	3.417393501	6.177668398	0	0.001941647	1.911583698	2.67764894	14.00744581	1.228796035	1.74561866	0	0	3.019635189	2.460099886	0	0	0.127322676	0	0.005259845	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	69.4845	0	NO	12.49166058	14.9516	0.617710817	3.559703519	0	1.850767472	0.894840663	0.777731679	1.379560765	6.858342118	3.417393501	6.177668398	0	0.001941647	1.911583698	2.67764894	14.00744581	1.228796035	1.74561866	0	0	3.019635189	2.460099886	0	0	0.127322676	0	0.005259845	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	69.4845	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)"	50% (6a); $0 n/c (6a2)	$225 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $20 (8a2)	"$24 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$50 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$40 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$40/$50 (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $50 (16b, 17a, 18a)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 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, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c5, 14c7, 14c10, 14c11); $0 (14c4)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.5943	0.0418	0.3691	0.2858	0.1181	0.1428	0.1086	0.0881	0.6566	0.2181	0.5756	0	0.0001	0.1827	0.8485	1.4334	0.1126	0.1769	0	0	0.6121	0.2481	0	0.0552	0.0129	0	0.0018	0.0955	0	0											6.9787	0	NO	1.134662213	15.5459	0.659508206	3.928831876	0.285773309	1.968901566	1.037634386	0.886305227	1.467617836	7.514991896	3.635525001	6.753281183	0	0.002065582	2.094312833	3.526165854	15.44086623	1.341367382	1.92253947	0	0	3.631723403	2.708154275	0	0.055152483	0.140227002	0	0.007029318	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	76.4632
R5287_003_0	2012	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	384.5721137	22.560714	59.22232279	3703.394432	16.21805275	25.86252661	20.97923063	47.13108398	76.49970495	25.86697015	54.06309189	0	0.191310153	48.63214342	38.74344839	140.2202452	9.8080525	6.48780306	0	952.4721027	43.75009773	8.925188747	848.5551963	288.7783058	40.37302326	199.4848	0	0	168.8315713	2030.102477											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$65 (4a, 4a1); 20% (4b)"	20% (9b)	20% (8a1a); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c)"	"20% (7a, 7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"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% (9d, 9d1, 16b, 17a, 18a); $0 (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											0	NO	0.088875199	0.089954655	0.165787411	0	0.2	0.2	0.2	0.103172112	0.16	0	0.16345666	0	0.2	0.145982829	0.172111681	0.199964678	0.2	0.2	0	0	0.2	0.19961664	0	0	0	0	0	0	0	0											NO	0.070585844	0.071443162	0.131670526	0	0.158842612	0.158842612	0.158842612	0.081953151	0.127074089	0	0.129819414	0	0.158842612	0.115941469	0.134361925	0.156105842	0.156133417	0.156133417	0	0	0.158842612	0.159109385	0	0	0	0	0	0	0	0												27.1453	1.611808744	7.797834414	0	2.576117856	4.108071273	3.332395785	3.862540836	9.721130343	0	7.018438902	0	0.030388204	5.638482167	5.205644298	21.88919951	1.531364753	1.012962862	0	0	6.949379786	1.420081289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8512	0	NO	29.36281557	27.1453	1.611808744	7.797834414	0	2.576117856	4.108071273	3.332395785	3.862540836	9.721130343	0	7.018438902	0	0.030388204	5.638482167	5.205644298	21.88919951	1.531364753	1.012962862	0	0	6.949379786	1.420081289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8512	YES	"50% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"50% (1b); $0 n/c (1b1, 1b2)"	"50% (2a); $0 n/c (2a1, 2a2)"	50% (6a); $0 n/c (6a2)	50% (10a)	50% (11a)	"50% (11b, 11b1, 11c)"	"$65 (4a, 4a1); 20% (4b)"	50% (9b)	50% (8a1a); $0 (8a2)	"50% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"50% (3, 5, 9a, 9c)"	"50% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"50% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"50% (7c, 7i)"	Included in h.2.	50% (7g)	"50% (15, 15a1); $0 n/c (15a2)"	"50% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$40 (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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.5241	0.0905	0.48	0.8595	0.3748	0.5977	0.4849	0.2248	1.4145	0	1.0212	0	0.0018	0.8204	1.0911	4.438	0.3104	0.2053	0	0	1.4087	0.2884	0	0.0507	0.0179	0	0	0	0	0											15.7046	0	NO	4.177194551	28.6694	1.702303763	8.277784844	0.859465155	2.95094982	4.705806511	3.817268188	4.0873448	11.13558053	0	8.03964033	0	0.03215683	6.458896239	6.296782902	26.32720337	1.841776527	1.218293172	0	0	8.358037851	1.708486438	0	0.050662861	0.0179469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5558
R5342_001_0	2012	5																															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	1281.61802	88.35642574	663.2697929	246.4207764	147.6358816	7.209949231	9.955031042	292.7882149	41.02366931	20.42183251	34.44389927	0	0.039944856	30.75301226	4487.705646	3146.249864	363.5600506	925.488544	0	0	16.05708806	661.8547283	0	0	21.02126539	0	4.430389804	61.75	79.33367116	0											4900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $16 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	67.36136978	0	200	0.2	0.100968034	64.18745276	0.16	0.147652591	0.17675266	0	0.2	0.146113824	9.769672866	34.15084879	38.5	35	0	0	0.2	34.14119632	0	0	35	0	15	352.5	0	0											NO	154.5225961	80.93267577	54.242262	0	161.0485718	0.161048572	0.081303789	51.70615636	0.128838857	0.118896195	0.142328817	0	0.161048572	0.117657114	9.451370086	33.03939957	37.24564305	33.8596755	0	0	0.161048572	27.49195454	0	0	35	0	15	352.5	0	0												16.5032	0.595910163	2.99810449	0	1.981378991	1.161152027	0.80938174	1.261579435	5.285442684	2.428078178	4.902359442	0	0.006433062	3.618310658	3.534580574	8.662517202	1.128418989	2.611395148	0	0	2.5859711	1.516306675	0	0	0.061312024	0	0.005537987	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	63.4713	0	NO	11.57765411	16.5032	0.595910163	2.99810449	0	1.981378991	1.161152027	0.80938174	1.261579435	5.285442684	2.428078178	4.902359442	0	0.006433062	3.618310658	3.534580574	8.662517202	1.128418989	2.611395148	0	0	2.5859711	1.516306675	0	0	0.061312024	0	0.005537987	1.81390625	0	0	0	0	0	0	0	0	0	0	0	0	63.4713	YES	"$325 Days 1-28 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-28 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $16 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $390 (18b2); $340 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											8800	0.4102	0.0258	0.3431	0.4958	0.5427	0.7951	0.6587	0.3455	2.1714	0.665	1.9707	0	0.0018	1.4853	1.7454	3.363	0.425	0.9948	0	0	1.293	0.5787	0	0	0.0234	0	0.0047	0.0955	0	0											18.4344	0	NO	3.06643026	16.9134	0.621724348	3.341174112	0.495773932	2.52404967	1.956208351	1.468039115	1.607107561	7.456850666	3.09309322	6.873050602	0	0.008194983	5.103640514	5.2800298	12.02554329	1.553407959	3.606212348	0	0	3.87895665	2.094991188	0	0	0.084668986	0	0.010224308	1.909375	0	0	0	0	0	0	0	0	0	0	0	0	81.9057
R5342_002_0	2012	4																															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	1189.242389	80.10245561	721.817044	196.9005394	124.3462841	5.257880028	6.937199647	233.3942132	34.9806215	16.79451827	27.6187736	0	0.050016982	25.5617834	3627.724099	2722.581388	340.2450742	679.2249715	0	0	10.95467849	628.2713622	0	0	26.88494103	0	9.347274302	61.75	124.3964981	0											3900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-4 (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); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$35 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$15 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 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)"	$15 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	191.8956429	100.5071636	62.46842749	0	200	0.2	0.097351777	64.17434689	0.16	0.089438693	0.17814251	0	0.2	0.146247238	9.850122892	33.96123975	38.5	35	0	0	0.2	34.3750742	0	0	35	0	15	342.5	0	0											NO	152.9194013	80.09298726	49.7803618	0	159.377669	0.159377669	0.077578497	51.16482355	0.127502135	0.071272652	0.14195969	0	0.159377669	0.11654272	9.512836955	32.80204462	37.1816907	33.801537	0	0	0.159377669	27.39309599	0	0	35	0	15	342.5	0	0												15.1549	0.53463708	2.994359467	0	1.651501743	0.837988663	0.538177519	0.995131145	4.460103933	1.19698986	3.920752536	0	0.00797159	2.979039758	2.875828989	7.442186347	1.054240593	1.913237334	0	0	1.745931123	1.434191478	0	0	0.078414411	0	0.011684093	1.762447917	0	0	0	0	0	0	0	0	0	0	0	0	53.5897	0	NO	10.27015628	15.1549	0.53463708	2.994359467	0	1.651501743	0.837988663	0.538177519	0.995131145	4.460103933	1.19698986	3.920752536	0	0.00797159	2.979039758	2.875828989	7.442186347	1.054240593	1.913237334	0	0	1.745931123	1.434191478	0	0	0.078414411	0	0.011684093	1.762447917	0	0	0	0	0	0	0	0	0	0	0	0	53.5897	YES	"$325 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	$40 (3); $75 (5); 30% (9a); $45/$35 (9c)	"$20 (7a); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b3); $380 (18b2); $330 (18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											6800	0.3689	0.0217	0.3682	0.4358	0.4523	0.5738	0.4542	0.2726	1.8323	0.3278	1.575	0	0.0022	1.2228	1.4218	2.8997	0.3971	0.7289	0	0	0.873	0.5466	0	0	0.0299	0	0.0104	0.0928	0	0											14.9077	0	NO	2.567198187	15.5238	0.556330192	3.362598223	0.435752619	2.103823877	1.411770709	0.992403244	1.267682987	6.292439625	1.524827848	5.495751607	0	0.010154892	4.201834223	4.297650929	10.34193281	1.451292244	2.642089652	0	0	2.618896684	1.980773692	0	0	0.108286568	0	0.022069953	1.855208333	0	0	0	0	0	0	0	0	0	0	0	0	68.4974
R5342_003_0	2012	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	298.6320149	22.374184	26.3094035	487.2501295	14.32623132	13.93860256	11.14912458	23.48801898	38.81047383	17.51931582	32.29996192	0	0	31.40709582	23.47537769	58.57689239	8.925408	5.169043197	0	690.4594277	16.73427278	4.243985271	754.4612625	0	33.3895814	199.4848	0	0	163.5500228	2994.798349											6700	"Medicare FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"$65 (4a, 4a1); Medicare FFS (4b)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 7a1, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (13d2)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"20% (9d, 9d1); Medicare FFS (14a10, 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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5); $0 (13b1)"											635	YES	0.086575196	0.087626717	0.181115678	0	0.224	0.224	0.224	0.137331962	0.224	0.224	0.224	0	0	0.224	0.218627004	0.223954412	0.231339137	0.224	0	0	0.224	0.222465157	0	0	0	0	0	0	0	0											NO	0.066698845	0.067508953	0.139534267	0	0.172573	0.172573	0.172573	0.105821301	0.172573	0.172573	0.172573	0	0	0.172573	0.165850821	0.169892202	0.175494268	0.169926785	0	0	0.172573	0.17285877	0	0	0	0	0	0	0	0												19.9184	1.510457727	3.671063337	0	2.472320718	2.405426461	1.924037876	2.485532725	6.697639902	3.02336089	5.574101331	0	0	5.420016748	3.893410664	9.951757227	1.56635794	0.878358894	0	0	2.887883658	0.733610073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0137	150	YES	22.67481928	19.9184	1.510457727	3.671063337	0	2.472320718	2.405426461	1.924037876	2.485532725	6.697639902	3.02336089	5.574101331	0	0	5.420016748	3.893410664	9.951757227	1.56635794	0.878358894	0	0	2.887883658	0.733610073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0137	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)"	"$65 (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)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"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% (9d, 9d1, 14a10, 16b, 17a, 18a); $0 (17b)"	75% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	1.3917	0.1055	0.6756	1.4092	1.6733	1.628	1.1806	0.8284	3.935	0	3.308	0	0	3.0167	2.1711	6.2345	0.95	0.5502	0	0	1.8012	0.4476	0	0	0.0562	0	0	0	0	0											31.3629	0	NO	7.160554823	21.3101	1.615992897	4.34670213	1.40921594	4.145600678	4.033432026	3.104687534	3.31394408	10.63263505	3.02336089	8.882137081	0	0	8.436698003	6.064546233	16.18623383	2.516336069	1.428527355	0	0	4.689121972	1.181180413	0	0	0.05623362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.3767
R5342_801_0	2012	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	230.365556	3.661639	28.86927104	217.3455869	6.560452865	7.222660604	9.050710315	12.38326173	41.02083588	20.15273903	33.13836679	0	0.028789636	36.17207742	25.92047867	58.78206501	1.304025	6.352316435	0	0	16.90868692	7.366883467	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.086528869	0.086528869	0.179791869	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.073204513	0.073204513	0.152106186	0	0.189506822	0.189506822	0.189506822	0.189506822	0.189506822	0.189506822	0.189506822	0	0.189506822	0.189506822	0.189919031	0.189919031	0.189919031	0.189919031	0	0	0.189506822	0.189506822	0	0	0	0	0	0	0	0												16.8638	0.268048501	4.391194699	0	1.24325057	1.368743454	1.715171344	2.346712571	7.773728224	3.819081519	6.279946561	0	0.005455832	6.854855419	4.922792184	11.16383281	0.247659164	1.20642578	0	0	3.204311514	1.39607467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0711	0	NO	13.61909986	16.8638	0.268048501	4.391194699	0	1.24325057	1.368743454	1.715171344	2.346712571	7.773728224	3.819081519	6.279946561	0	0.005455832	6.854855419	4.922792184	11.16383281	0.247659164	1.20642578	0	0	3.204311514	1.39607467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0711	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2568	0.0041	0.2311	0	0.3405	0.3749	0.4698	0.6427	2.1291	1.046	1.72	0	0.0015	1.8774	1.4226	3.7213	0.0826	0.4021	0	0	1.0681	0.4654	0	0	0	0	0	0	0	0											16.256	0	NO	2.944394982	17.1206	0.272130458	4.622310209	0	1.583758688	1.743622234	2.184931649	2.989442765	9.902838503	4.865071999	7.999931925	0	0.006950105	8.732299897	6.345400241	14.88511041	0.330212219	1.608567707	0	0	4.272415353	1.861432894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.327
R5342_802_0	2012	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	289.1144457	3.5937725	36.23164607	243.559575	8.233529899	9.064616919	11.35886432	15.54129841	51.48215919	25.29218376	41.58946637	0	0.036131702	45.39390081	32.53083904	73.77293913	1.288875	7.972313555	0	0	21.22081847	9.245620164	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.069029933	0.069029933	0.160120699	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.055631803	0.055631803	0.129042616	0	0.180523482	0.180523482	0.180523482	0.180523482	0.180523482	0.180523482	0.180523482	0	0.180523482	0.180523482	0.180748435	0.180748435	0.180748435	0.180748435	0	0	0.180523482	0.180523482	0	0	0	0	0	0	0	0												16.084	0.199928042	4.675426397	0	1.486345484	1.636376207	2.050541736	2.8055693	9.293738623	4.565833072	7.507875272	0	0.006522621	8.194665023	5.879898254	13.33434331	0.232962139	1.440983201	0	0	3.830856035	1.669051543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8949	0	NO	20.41346775	16.084	0.199928042	4.675426397	0	1.486345484	1.636376207	2.050541736	2.8055693	9.293738623	4.565833072	7.507875272	0	0.006522621	8.194665023	5.879898254	13.33434331	0.232962139	1.440983201	0	0	3.830856035	1.669051543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8949	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2449	0.003	0.2461	0	0.4071	0.4482	0.5616	0.7684	2.5454	1.2505	2.0563	0	0.0018	2.2444	1.6992	4.4448	0.0777	0.4803	0	0	1.277	0.5564	0	0	0	0	0	0	0	0											19.313	0	NO	4.640915938	16.3289	0.202972632	4.92150147	0	1.893433738	2.084555677	2.612155078	3.573973631	11.83915748	5.816347862	9.564172321	0	0.008309071	10.43906372	7.579094628	17.77912442	0.310616186	1.921310934	0	0	5.107808046	2.225402057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2079
R5342_803_0	2012	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	294.9285589	3.643121	36.13522886	246.4320496	8.454594873	8.707280027	10.73643362	15.65101171	58.26786962	26.17519639	42.72191315	0	0.03145511	44.98764308	33.00920987	74.53128654	1.2855	7.744668084	0	0	23.1492864	10.30787041	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.086365363	0.086365363	0.177645415	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.068280351	0.068280351	0.14044625	0	0.177094128	0.177094128	0.177094128	0.177094128	0.177094128	0.177094128	0.177094128	0	0.177094128	0.177094128	0.17752127	0.17752127	0.17752127	0.17752127	0	0	0.177094128	0.177094128	0	0	0	0	0	0	0	0												20.1378	0.248753581	5.07505737	0	1.497259105	1.542008162	1.901359347	2.771702269	10.31889755	4.635473575	7.565799948	0	0.005570515	7.967047414	5.859836859	13.23088864	0.228203593	1.374843314	0	0	4.099602685	1.82546332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2856	0	NO	23.8504295	20.1378	0.248753581	5.07505737	0	1.497259105	1.542008162	1.901359347	2.771702269	10.31889755	4.635473575	7.565799948	0	0.005570515	7.967047414	5.859836859	13.23088864	0.228203593	1.374843314	0	0	4.099602685	1.82546332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2856	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.3067	0.0038	0.2671	0	0.4101	0.4223	0.5208	0.7591	2.8262	1.2696	2.0722	0	0.0015	2.1821	1.6879	4.4103	0.0761	0.4583	0	0	1.3665	0.6085	0	0	0	0	0	0	0	0											19.6489	0	NO	5.184111788	20.4445	0.252541706	5.342165652	0	1.90733644	1.964341608	2.422113818	3.530830916	13.14509242	5.905061879	9.637961717	0	0.007096198	10.14910499	7.547720944	17.64118486	0.304271457	1.833124419	0	0	5.466136913	2.433951094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9345
R5566_005_0	2012	9																															A	A	D	V	Coin	Coin	Coin	V	Coin	V	Coin	V	V	V	P	P	V	V	P	P	Coin	O	T	P	P	P	P	V	V	V																																																			0	YES	203.6208951		978.987575		3.618249267	6.659739696	1.163179477	204.5886399	46.35530258		25.01570596	14.97677266		686.0017407	5277.451892	1496.188891	172.6980027	356.9541669			13.96072933	21.73861616			391.5743879		33.70183748														3400	"$275 / Day, Days 1-4 (1a, 1b)"	(included in a.1 above)	$0 Days 1-20; $125 Days 21-100 (2)	$0 (6)	20% (10a)	20% (11a)	"20% (11b, 11c)"	"$65 (4a), $35 (4b)"	"20% (9a, 9b)"	$0 (8a)	20% (8b)	"$35 (7e, 7h)"	$0 (12)	"$125 (5) $35 (3) $35 (9a, 9c, 9d)"	"$25 (7a) $0 (14a, 14b, 14c, 14d, 14e)"	"20% (7b) $35 (7d, 7f)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	$0 (8b)	$35 (7g)	20% (15)	"$35 (16b) 20% (17b) $0 (13a, 17a)"	$0 n/c (10b)	$0 n/c (16a)	$35 (17a)	$0 n/c (17b)	$35 (18a)	$0 n/c (18b)	$0 n/c (14c)	$0 n/c (13b)											0	NO	940.9638554		17.79607888		0.2	0.2	0.2	64.60121269	0.2		0.2	35		35	20.88287137	13.05274265	35	35			0.2	14.01447958			35		35														NO	762.3008381		14.41709558		0.16202553	0.16202553	0.16202553	52.3352287	0.16202553		0.16202553	28.35446779		28.35446779	16.91779153	10.57438775	28.35446779	28.35446779			0.16202553	11.35351743			28.35446779		28.35446779															12.935	0	1.176179787	0	0.586248756	1.079047855	0.188464772	0.892266105	7.51074248	0	4.053183023	0.035388201	0	1.620934522	7.440235912	1.318440123	0.40806333	0.843437119	0	0	2.261994572	0.02056748	0	0	0.925240281	0	0.079633139	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3751	0	NO	10.16878655	12.935	0	1.176179787	0	0.586248756	1.079047855	0.188464772	0.892266105	7.51074248	0	4.053183023	0.035388201	0	1.620934522	7.440235912	1.318440123	0.40806333	0.843437119	0	0	2.261994572	0.02056748	0	0	0.925240281	0	0.079633139	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3751	YES	"OON: 40%; OOA: $275 / Day, Days 1-4 (1a, 1b)"	(included in a.1 above)	OON: 40%; OOA: $0 Days 1-20; $125 Days 21-100 (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: $65 (4a), $35 (4b)"	"OON: 40%; OOA: 20% (9a, 9b)"	OON: 40%; OOA: $0 (8a)	OON: 40%; OOA: 20% (8b)	OON: 40%; OOA: $35 (7h)	OON: 40%; OOA: $0 (12)	"OON: 40%; OOA: $125 (5) $35 (3) $35 (9a, 9c, 9d)"	"OON: 40%; OOA: $25 (7a) $0 (14a, 14b, 14c, 14d, 14e)"	"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, 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 n/c (14c)	OON: 40%; OOA: $0 n/c (13b)											5100	3.9238		1.0117	0.3871	0.4402	0.45	0.1937	0.0801	0.5981	0.6182	0.3077	0.0112	0	0.5603	1.4416	0.4677	0.1307	0.1109	0.4026		0.2129	0.0476			0.0148		0.0034														11.4145	0	NO	4.209514463	16.8588	0	2.187929341	0.387109303	1.026482483	1.529064538	0.382202462	0.972396785	8.108795268	0.618234686	4.360897208	0.046587714	0	2.181246498	8.881831649	1.786151932	0.53876613	0.954304182	0.40259086	0	2.474864219	0.068159385	0	0	0.940086528	0	0.083061103	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7896
R5566_805_0	2012	6																															Coin		Coin		Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin																																																											0	YES	205.7934214		49.24511138		4.407731739	8.890731971	2.261670037	272.0887631	63.71698164		28.40209606	0.191916801	0.009741544	39.25676796	84.24575119	20.33713218	1.135439462	4.089114311	17.68434727		39.53509936	0.673653472																			3400	FFS Cost Sharing	(included in a.1 above)	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	"$65 (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	NO	0.090359894		0.127200947		0.224	0.224	0.224	65	0.224		0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224																			NO	0.056355057		0.07933184		0.139702829	0.139702829	0.139702829	40.53876741	0.139702829		0.139702829	0.139702829	0.139702829	0.139702829	0.139702829	0.139702829	0.139702829	0.139702829	0.139702829		0.139702829	0.139702829																				11.5975	0	3.906705289	0	0.615772594	1.24206041	0.315961703	0.91917859	8.901442604	0	3.967853175	0.02681132	0.001360921	5.484281549	11.76936979	2.841154904	0.158624105	0.571260838	2.470553346	0	5.523165233	0.094111296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4072	0	NO	36.44989412	11.5975	0	3.906705289	0	0.615772594	1.24206041	0.315961703	0.91917859	8.901442604	0	3.967853175	0.02681132	0.001360921	5.484281549	11.76936979	2.841154904	0.158624105	0.571260838	2.470553346	0	5.523165233	0.094111296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4072	YES	0.5	(included in a.1 above)	0.5	0.5	0.5	0.5	0.5	"$65 (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	5.5482		1.6338	0.3743	0.5013	1.3164	0.473	0.0837	1	0	0.2457	0.0068	0	0.6131	1.8496	0.8402	0.3661	0.1321	0.4319		0.1442	0.0889																			15.6492	0	NO	4.953698592	17.1457	0	5.54055075	0.374277791	1.117073087	2.55850342	0.788917539	1.002848561	9.901457174	0	4.213515957	0.033629227	0.001360921	6.097335858	13.61895922	3.681369731	0.524680777	0.703331455	2.902421884	0	5.66741282	0.18302317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0563
R5674_001_0	2012	5																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	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	811.8650658	92.82317486	400.6444219	283.862912	174.7343828	14.15792821	8.518096	254.7301995	50.03412857	10217.50515	39.46264517	0	0.008657837	22.47506343	4029.542359	4186.438386	106.3741064	865.1133076	0	0	10.10798472	4.012314756	0	0	0	0	0	0	213.2	0											4500	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	$250 Days 1-5 (1b); $0 (1b1); $0 n/c (1b2)	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1); $0/20%/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	$15 (8a1a); $18 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9c); $0 (5); 20% (9a)"	"$10 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 14d, 14e); $0 n/c (14b1, 13d3, 13d4, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10); $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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	187.1184086	99.91505047	66.03068343	0	148.503	0.2	0.182415314	64.9070632	0.16	4.32	0.17153195	0	0.2	0.145684254	7.317918221	34.33229934	35	35	0	0	0.2	0.296900304	0	0	0	0	0	0	0	0											NO	154.9387988	82.73220156	54.67508434	0	122.9642588	0.165605084	0.151044517	53.76594405	0.132484067	3.577069811	0.142032815	0	0.165605084	0.120630266	7.121263003	33.41094081	34.05944116	34.05944116	0	0	0.165605084	0.245840998	0	0	0	0	0	0	0	0												10.4824	0.639955468	1.825438963	0	1.79050699	2.344624888	1.286611696	1.141317471	6.628724846	3.045727434	5.60499057	0	0.001433782	2.711172875	2.39128591	11.65607043	0.301920218	2.45543965	0	0	1.673933658	0.986391465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.968	0	NO	8.804678246	10.4824	0.639955468	1.825438963	0	1.79050699	2.344624888	1.286611696	1.141317471	6.628724846	3.045727434	5.60499057	0	0.001433782	2.711172875	2.39128591	11.65607043	0.301920218	2.45543965	0	0	1.673933658	0.986391465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.968	YES	"$375 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	"30% (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9c); $0 (5); 30% (9a)"	"$40 (7a); $0 n/c (7a1, 14b1, 13d3, 13d4, 14b5, 14b6, 14b7); $0 (14a1, 14a9); 30% (14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 14d, 14e)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$40/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10); $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 (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	3.4515	0.2627	0.2275	0.2137	0.1771	0.5797	0.2093	0.1129	0.9834	0.1414	0.7913	0	0.0001	0.4021	2.4687	3.7719	0.097	0.7892	0	0	0.4185	0.3198	0	0	0	0	0	0	0	0											15.4179	0	NO	1.918166714	13.934	0.902695656	2.052974556	0.213674934	1.967590098	2.924339832	1.495882466	1.254195023	7.612107103	3.187077753	6.396306028	0	0.001575584	3.113254395	4.860008183	15.42800665	0.398966003	3.244688109	0	0	2.092417072	1.306177652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3859
R5674_801_0	2012	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	179.869842	7.579851821	16.79291231	303.5637498	12.48807204	15.39161856	9.260343925	23.99036477	54.39399117	26.0617812	42.90133224	0	0.009412262	24.43349044	23.54070981	67.51354625	0.988045174	9.093730363	0	0	10.98877201	4.242790354	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.075712953	0.075712953	0.150910895	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064047857	0.064047857	0.127660052	0	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0	0.189488317	0.189488317	0.191018462	0.191018462	0.191018462	0.191018462	0	0	0.189488317	0.189488317	0	0	0	0	0	0	0	0												11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	0	NO	13.64889659	11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	2.5288	0.1066	0.1128	0	0.234	0.2884	0.1735	0.4496	1.0194	0.4884	0.804	0	0.0002	0.4579	0.9746	3.2241	0.0472	0.4343	0	0	0.5206	0.201	0	0	0	0	0	0	0	0											12.0654	0	NO	2.153170425	14.0491	0.592040569	2.256614791	0	2.600377756	3.20498011	1.928271415	4.995487749	11.32640204	5.426816555	8.933298082	0	0.001959905	5.087759328	5.471337963	16.12041721	0.235918587	2.171337984	0	0	2.602804897	1.004949006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0099
R5674_802_0	2012	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	179.869842	7.579851821	16.79291231	303.5637498	12.48807204	15.39161856	9.260343925	23.99036477	54.39399117	26.0617812	42.90133224	0	0.009412262	24.43349044	23.54070981	67.51354625	0.988045174	9.093730363	0	0	10.98877201	4.242790354	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.075712953	0.075712953	0.150910895	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064047857	0.064047857	0.127660052	0	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0	0.189488317	0.189488317	0.191018462	0.191018462	0.191018462	0.191018462	0	0	0.189488317	0.189488317	0	0	0	0	0	0	0	0												11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	0	NO	13.64889659	11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	2.5288	0.1066	0.1128	0	0.234	0.2884	0.1735	0.4496	1.0194	0.4884	0.804	0	0.0002	0.4579	0.9746	3.2241	0.0472	0.4343	0	0	0.5206	0.201	0	0	0	0	0	0	0	0											12.0654	0	NO	2.153170425	14.0491	0.592040569	2.256614791	0	2.600377756	3.20498011	1.928271415	4.995487749	11.32640204	5.426816555	8.933298082	0	0.001959905	5.087759328	5.471337963	16.12041721	0.235918587	2.171337984	0	0	2.602804897	1.004949006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0099
R5674_803_0	2012	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	179.869842	7.579851821	16.79291231	303.5637498	12.48807204	15.39161856	9.260343925	23.99036477	54.39399117	26.0617812	42.90133224	0	0.009412262	24.43349044	23.54070981	67.51354625	0.988045174	9.093730363	0	0	10.98877201	4.242790354	0	0	0	0	0	0	0	0											6700	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	0.075712953	0.075712953	0.150910895	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0	0	0	0	0	0	0	0											NO	0.064047857	0.064047857	0.127660052	0	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0.189488317	0	0.189488317	0.189488317	0.191018462	0.191018462	0.191018462	0.191018462	0	0	0.189488317	0.189488317	0	0	0	0	0	0	0	0												11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	0	NO	13.64889659	11.5203	0.485473267	2.143784052	0	2.366343758	2.9165319	1.754726988	4.545893852	10.30702586	4.938403065	8.129301255	0	0.001783514	4.629860988	4.496710181	12.89633376	0.18873487	1.737070387	0	0	2.082243918	0.803959205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9445	YES	"Medicare FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"Medicare FFS (1b); $0 n/c (1b1, 1b2)"	"Medicare FFS (2a); $0 n/c (2a1, 2a2)"	Medicare FFS (6a); $0 n/c (6a2)	Medicare FFS (10a)	Medicare FFS (11a)	"Medicare FFS (11b, 11b1, 11c)"	"Medicare FFS (4a, 4b); $0 n/c (4a1)"	Medicare FFS (9b)	"Medicare FFS (8a1a, 8a2)"	"Medicare FFS (8b1, 8b2, 8b3)"	Included in h.5.	Medicare FFS (12)	"Medicare FFS (3, 5, 9a, 9c)"	"Medicare FFS (7a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14d, 14e); $0 n/c (7a1, 14b1, 13d2, 13d3, 13d4, 14b5, 14b6, 14b7)"	"Medicare FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"Medicare FFS (7e, 7h)"	"Medicare FFS (7c, 7i)"	Included in h.2.	Medicare FFS (7g)	"Medicare FFS (15, 15a1); $0 n/c (15a2)"	"Medicare FFS (9d, 14a10, 16b, 17a, 17b, 18a); $0 n/c (9d1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	2.5288	0.1066	0.1128	0	0.234	0.2884	0.1735	0.4496	1.0194	0.4884	0.804	0	0.0002	0.4579	0.9746	3.2241	0.0472	0.4343	0	0	0.5206	0.201	0	0	0	0	0	0	0	0											12.0654	0	NO	2.153170425	14.0491	0.592040569	2.256614791	0	2.600377756	3.20498011	1.928271415	4.995487749	11.32640204	5.426816555	8.933298082	0	0.001959905	5.087759328	5.471337963	16.12041721	0.235918587	2.171337984	0	0	2.602804897	1.004949006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0099
R5826_001_0	2012	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			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	1642.75	111.92	546.27	2002.89	33.12	9.3	3.46	463.91	323.36	1159.58	823.97	118.98	0.2	391.58	3416.18	3213.23	103.03	493.52		1515.41	21.15	0			0.61				2.79	1.15	1190.66										4900	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												163.989133	116.360647	34.03605	0	200	0.2	0.2	65	240.835006	40.532188	87.344097	36.710453	0.2	68.083339	15	34.037193	35	15		0	0.2	0			0				0	0	0										NO	126.680129	89.887552	25.194539	0	179.815	0.179815	0.179815	58.439875	216.528733	36.441477	78.528894	33.005451	0.179815	61.212028	13.486125	30.601989	31.467625	13.486125		0	0.179815	0			0				0	0	0											17.342	0.838351235	1.146918402	0	0.4962894	1.6722795	0.6221599	2.259236868	5.834727592	3.521400658	5.392121066	0.327249047	0.035963	1.997450494	3.839252542	8.194269093	0.270175784	0.554639368	0	0	3.80308725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1476	0	NO	10.114514	17.342	0.838351235	1.146918402	0	0.4962894	1.6722795	0.6221599	2.259236868	5.834727592	3.521400658	5.392121066	0.327249047	0.035963	1.997450494	3.839252542	8.194269093	0.270175784	0.554639368	0	0	3.80308725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1476	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins										7300	4.3371	0.1085	0.305	3.2043	3.1167	2.6676	0.9918	0.1905	1.4599	0.2107	0.5365	0.0248	0.0031	0.4123	1.0161	1.4267	0.0256	0.1126		0.1667	0.5084	0			0				0	0	0.4796										21.3047	0	NO	9.492429	21.6791	0.946886235	1.451906402	3.204288	3.6130294	4.3398615	1.6139759	2.449703868	7.294668592	3.732093658	5.928661066	0.352073047	0.039038	2.409739494	4.855333542	9.621005093	0.295747784	0.667272368	0	0.166743	4.31150025	0	0	0	0	0	0	0	0	0	0.479636	0	0	0	0	0	0	0	0	0	79.4523
R5826_002_0	2012	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	1427.53	183.63	527.41	982.29	33.55	7.03	1.26	407.66	208.96	1217.38	747.28	216.76	0.16	8.28	2363.92	2573.42	200.76	587.24		980.01	20.88	0		4.85	0.79				5.4	1.61	972.77	661.66									5000	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN814: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210147	129.289607	34.03605	0	200	0.2	0.2	65	250	42.074122	92.81416	37.422049	0.2	0.2	15	34.153187	35	39.272414		0	0.2	0		0	0				0	0	0	67.768622									NO	129.687708	92.02162	22.666307	0	174.2354	0.174235	0.174235	56.626505	217.79425	36.654008	80.857562	32.601229	0.174235	0.174235	13.067655	29.753471	30.491195	34.213224		0	0.174235	0		0	0				0	0	0	59.038465										15.4278	1.40816084	0.996203081	0	0.487133139	1.22487205	0.2195361	1.923696752	3.792523873	3.718488022	5.035269911	0.588886867	0.0278776	1.4426658	2.574240917	6.380681445	0.510117692	1.674281138	0	0	3.6380268	0	0	0	0	0	0	0	0	0	0	3.255282563	0	0	0	0	0	0	0	0	54.3257	0	NO	12.71448	15.4278	1.40816084	0.996203081	0	0.487133139	1.22487205	0.2195361	1.923696752	3.792523873	3.718488022	5.035269911	0.588886867	0.0278776	1.4426658	2.574240917	6.380681445	0.510117692	1.674281138	0	0	3.6380268	0	0	0	0	0	0	0	0	0	0	3.255282563	0	0	0	0	0	0	0	0	54.3257	YES	20% Coins	20% Coins	"20% Coins(Days 1-8), 20% (Days 9-100)"	20% Coins	$200/Trip	20% Coins	20% Coins	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins		"DEN814: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						20% Coins	20% Coins									7500	11.8413	0.4988	0.9801	2.1282	4.403	2.2112	0.3952	0.7012	2.5625	0.5496	1.4289	0.1145	0.0102	0.5339	1.6567	2.7286	0.0862	0.3092		0.2475	1.4585	0			0				0	0	0.3374	0.9504									36.1331	0	NO	12.572109	27.269	1.90697684	1.976304081	2.128226	4.890177139	3.43607305	0.6147131	2.624874752	6.355017873	4.268039022	6.464218911	0.703427867	0.0380706	1.9765358	4.230981917	9.109260445	0.596287692	1.983469138	0	0.247461	5.0965598	0	0	0	0	0	0	0	0	0	0.337439	4.205667563	0	0	0	0	0	0	0	0	90.4588
R5826_003_0	2012	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	1065.43	85.36	380.87	789.02	24.92	6.55	1.76	404.09	228.55	971.56	653.58	187.79	0.16	9.44	2621.23	2829.83	133.34	482.16		1349.15	17.43	0		3.36	0.61				3.99	0.81	996.71	490.52									5900	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$175/Visit: 3. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	200	0.2	0.2	65	250	39.080047	97.393931	39.028742	0.2	0.2	15	34.322538	35	15		0	0.2	0		0	0				0	0	0	73.667253									NO	151.618339	107.582787	27.910956	0	184.0278	0.184028	0.184028	59.809035	230.03475	35.959076	89.615954	35.911868	0.184028	0.184028	13.802085	31.581506	32.204865	13.802085		0	0.184028	0		0	0				0	0	0	67.784113										13.4616	0.765272225	0.885870484	0	0.382164398	1.2053834	0.32388928	2.014019413	4.381203509	2.911366657	4.880932935	0.561990808	0.02944448	1.73722432	3.014869939	7.447524427	0.357849725	0.554567775	0	0	3.20760804	0	0	0	0	0	0	0	0	0	0	2.770788592	0	0	0	0	0	0	0	0	50.8935	0	NO	6.170343	13.4616	0.765272225	0.885870484	0	0.382164398	1.2053834	0.32388928	2.014019413	4.381203509	2.911366657	4.880932935	0.561990808	0.02944448	1.73722432	3.014869939	7.447524427	0.357849725	0.554567775	0	0	3.20760804	0	0	0	0	0	0	0	0	0	0	2.770788592	0	0	0	0	0	0	0	0	50.8935	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-7), $50 (Days 8-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	$0-$250/Visit	$0-$50/Visit	$0-$175/Visit	$35-$50/Visit	20% Coins	20% Coins	$15/Visit	$20-$35/Visit	$35/Visit	$15/Visit		$0/Visit	20% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						25% Coins	$15-$175/Visit									5900	4.9795	0.2831	0.3264	0	3.4535	2.1761	0.583	0.7341	1.597	1.0612	1.8016	0.2068	0.0106	0.6432	1.1415	2.8199	0.1355	0.2063		0	1.2857	0		0	0				0	0	0.561	1.0099									25.0159	0	NO	3.217096	18.441	1.048336225	1.212238484	0	3.835664398	3.3814694	0.90691128	2.748124413	5.978172509	3.972558657	6.682545935	0.768808808	0.04004848	2.38044032	4.156413939	10.26743843	0.493347725	0.760876775	0	0	4.49331504	0	0	0	0	0	0	0	0	0	0.560996	3.780734592	0	0	0	0	0	0	0	0	75.9095
R5826_005_0	2012	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	1431.79	38.13	588.89	1215.75	27.92	6.81	2.17	311.35	397.57	725.32	1325.97	116.48	0.55	7.96	3602.11	7280.94	87.32	828.64		1587.57	34.82	0		3.22	1.69				3.1	0.61	587.22	352.78									4750	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$150/Visit: 5. $30 Partial Hospitalization,7h. $150 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN762: Dental 16a, 16b"	"VIS742: Vision 17a,17b"				$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$150/Visit: 3. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $150 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	131.206824	34.03605	0	150	0.2	0.2	65	121.229321	78.600447	90.17257	34.935583	0.198313	0.2	5	29.654155	30	38.268654		0	0.2	0		0	0				0	0	0	148.724034									NO	125.444471	100.367448	24.202797	0	131.03715	0.174716	0.174716	56.782765	105.903631	68.663857	78.773044	30.519061	0.173242	0.174716	4.367905	25.905306	26.20743	33.430769		0	0.174716	0		0	0				0	0	0	129.922491										14.9675	0.318917566	1.187732094	0	0.304879769	1.18981596	0.37913372	1.473276157	3.508675548	4.150272397	8.704224429	0.296238352	0.0952831	1.39073936	1.311139523	15.71791489	0.190702732	2.308506035	0	0	6.08361112	0	0	0	0	0	0	0	0	0	0	3.819504698	0	0	0	0	0	0	0	0	67.3981	0	NO	12.548992	14.9675	0.318917566	1.187732094	0	0.304879769	1.18981596	0.37913372	1.473276157	3.508675548	4.150272397	8.704224429	0.296238352	0.0952831	1.39073936	1.311139523	15.71791489	0.190702732	2.308506035	0	0	6.08361112	0	0	0	0	0	0	0	0	0	0	3.819504698	0	0	0	0	0	0	0	0	67.3981	YES	$0-$225/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$150/Trip	28% Coins	35% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $100/Visit	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	0% Coins		"DEN762: Dental 16a, 16b"	"VIS742: Vision 17a,17b"						35% Coins	30% Coins									7500	1.5167	0.0323	0.4344	1.8957	2.1174	1.9585	0.7807	0.1374	1.8785	0.19	0.8338	0.0228	0.0091	0.1975	1.0951	2.2135	0.0265	0.2449		0.4826	0.9247	0		0	0				0	0	0.2722	0.4796									17.7441	0	NO	3.672167	16.4842	0.351236566	1.622114094	1.895738	2.422269769	3.14832996	1.15980572	1.610635157	5.387225548	4.340266397	9.538002429	0.319088352	0.1043391	1.58828536	2.406229523	17.93141589	0.217248732	2.553435035	0	0.482641	7.00830112	0	0	0	0	0	0	0	0	0	0.272242	4.299080698	0	0	0	0	0	0	0	0	85.1422
R5826_006_0	2012	5	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		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	1566.63	77.68	548.05	1431.4	30.12	7.16	3.2	394.12	327.58	2302.71	928.83	229.83	0.2	9.76	3139.74	3392.37	128.27	711.25		1538.99	19.01	0		5.58	0.61		0.24		3.56	2.42	609.58										3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-20), $137 (Days 21-100): 2. $0 SNF - Facility 1,2. $137 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$5/Visit: 4b, 7a, 8a, 8b. $5 Physician Services PCP,4b, 7a, 8a, 8b. $5 PCP Cap"	"$5-$35/Visit: 7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$35-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												163.989133	131.206824	42.474818	0	100	0.2	0.120525	65	137.385847	90.283928	74.164301	45.65265	0.2	0.2	5	32.157258	35	54.298815		0	0.2	0		0	0		0		0	0	100										NO	103.417287	82.743616	22.372336	0	80.9458	0.161892	0.09756	52.61477	111.208073	73.081048	60.032887	36.953903	0.161892	0.161892	4.04729	26.02995	28.33103	43.95261		0	0.161892	0		0	0		0		0	0	80.9458											13.5014	0.535627008	1.021763229	0	0.203173958	1.15914672	0.312192	1.728044429	3.035795046	14.023705	4.646695536	0.707759627	0.0323784	1.58006592	1.058953192	7.35860179	0.302835102	2.605107822	0	0	3.07756692	0	0	0	0	0	0	0	0	0	4.11191173	0	0	0	0	0	0	0	0	0	61.0027	0	NO	19.954426	13.5014	0.535627008	1.021763229	0	0.203173958	1.15914672	0.312192	1.728044429	3.035795046	14.023705	4.646695536	0.707759627	0.0323784	1.58006592	1.058953192	7.35860179	0.302835102	2.605107822	0	0	3.07756692	0	0	0	0	0	0	0	0	0	4.11191173	0	0	0	0	0	0	0	0	0	61.0027	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-7)	"30% Coins(Days 1-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins										5000	1.5125	0.0659	0.2996	2.2556	1.4138	2.0477	0.9153	0.1614	1.6218	0.4031	0.6557	0.0423	0.0031	0.1499	0.9876	1.6776	0.0273	0.161		0.1804	0.3879	0			0				0	0	0.4975										15.4668	0	NO	5.255092	15.0138	0.601480008	1.321369229	2.255596	1.616948958	3.20688772	1.227518	1.889447429	4.657569046	14.426836	5.302353536	0.750025627	0.0354754	1.72995092	2.046503192	9.03615379	0.330138102	2.766108822	0	0.180446	3.46542792	0	0	0	0	0	0	0	0	0	4.60943973	0	0	0	0	0	0	0	0	0	76.4695
R5826_007_0	2012	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	1770.09	73.58	1036.03	1771.77	47.04	9.39	3.11	533.33	339.13	2408.69	987.35	221.14	0.4	11.85	3332.8	3441.72	155.32	557.27		1175.57	22.15	0			0.61				4.33	1.09	932.94	960.98									6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289607	34.03605	0	200	0.2	0.2	65	250	41.171499	86.482086	41.670391	0.2	0.2	20	38.499894	40	44.705944		0	0.2	0			0				0	0	0	82.055368									NO	144.359451	102.432148	24.376483	0	180.1318	0.180132	0.180132	58.542835	225.16475	37.081481	77.890869	37.530813	0.180132	0.180132	18.01318	34.675276	36.02636	40.264811		0	0.180132	0			0				0	0	0	73.903906										21.2941	0.628079787	2.104563974	0	0.706116656	1.69143948	0.56021052	2.601887516	6.363343472	7.443149372	6.408795792	0.691630332	0.0720528	2.1345642	5.002860525	9.94521591	0.466301186	1.869864269	0	0	3.9899238	0	0	0	0	0	0	0	0	0	0	5.918347966	0	0	0	0	0	0	0	0	79.8924	0	NO	12.743674	21.2941	0.628079787	2.104563974	0	0.706116656	1.69143948	0.56021052	2.601887516	6.363343472	7.443149372	6.408795792	0.691630332	0.0720528	2.1345642	5.002860525	9.94521591	0.466301186	1.869864269	0	0	3.9899238	0	0	0	0	0	0	0	0	0	0	5.918347966	0	0	0	0	0	0	0	0	79.8924	YES	20% Coins	20% Coins	"20% Coins(Days 1-7), 20% (Days 8-100)"	20% Coins	$200/Trip	20% Coins	20% Coins	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS775: Vision 17a,17b"						20% Coins	20% Coins									10000	5.2865	0.0823	0.5432	2.5093	7.642	3.0996	1.0251	0.378	1.9387	0.5006	0.7897	0.0433	0.0105	0.3149	1.0033	1.7411	0.0351	0.1792		0.1346	0.6872	0			0				0	0	0.4409	0.7643									29.1495	1000	NO	5.847548	26.5806	0.710407787	2.647802974	2.509267	8.348155656	4.79101948	1.58527952	2.979870516	8.302059472	7.943752372	7.198475792	0.734910332	0.0825818	2.4494862	6.006146525	11.68629991	0.501417186	2.049091269	0	0.13458	4.6771228	0	0	0	0	0	0	0	0	0	0.440938	6.682667966	0	0	0	0	0	0	0	0	109.0419
R5826_008_0	2012	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			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	1483.62	66.11	494.67	1195.96	33.15	10.12	3.12	458.06	369.91	1666.9	1032.5	151.14	0.79	9.25	3560.51	3570.41	106.67	479.91		1494.23	21.54	0			0.79				3.52	0.79	1233.38	736									6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	200	0.2	0.2	65	250	39.579179	100.749962	42.1752	0.2	0.2	20	38.46855	40	43.92156		0	0.2	0			0				0	0	0	78.861356									NO	151.673184	107.621704	28.006019	0	182.886	0.182886	0.182886	59.43795	228.6075	36.192389	92.128788	38.566268	0.182886	0.182886	18.2886	35.176797	36.5772	40.163192		0	0.182886	0			0				0	0	0	72.113189										18.7521	0.592905904	1.154478118	0	0.505222575	1.85080632	0.57060432	2.268845615	7.047016694	5.027424435	7.926914468	0.485742145	0.14447994	1.6916955	5.426395266	10.46629898	0.325140827	1.606226456	0	0	3.93936444	0	0	0	0	0	0	0	0	0	0	4.422942259	0	0	0	0	0	0	0	0	74.2046	0	NO	9.168991	18.7521	0.592905904	1.154478118	0	0.505222575	1.85080632	0.57060432	2.268845615	7.047016694	5.027424435	7.926914468	0.485742145	0.14447994	1.6916955	5.426395266	10.46629898	0.325140827	1.606226456	0	0	3.93936444	0	0	0	0	0	0	0	0	0	0	4.422942259	0	0	0	0	0	0	0	0	74.2046	YES	20% Coins	20% Coins	"20% Coins(Days 1-8), 20% (Days 9-100)"	20% Coins	$200/Trip	20% Coins	20% Coins	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS776: Vision 17a,17b"						20% Coins	20% Coins									10000	4.5476	0.0615	0.3769	1.2187	3.5549	2.2051	0.6799	0.2143	1.2228	0.2417	0.521	0.0174	0.0138	0.1622	0.6914	1.028	0.0142	0.0669		0.1144	0.4411	0			0				0	0	0.3383	0.3859									18.1181	0	NO	3.402163	23.2997	0.654389904	1.531345118	1.218739	4.060083575	4.05588632	1.25054332	2.483118615	8.269834694	5.269121435	8.447937468	0.503179145	0.15828194	1.8539425	6.117748266	11.49431998	0.339316827	1.673119456	0	0.114417	4.38043844	0	0	0	0	0	0	0	0	0	0.338347	4.808844259	0	0	0	0	0	0	0	0	92.3227
R5826_009_0	2012	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		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	307.68	4.85	42.39	1102.62	1.38	6.53	2.77	379.8	47.77	10.85	18.98	2.09	0.6	25.67	24.13	44.32	1.37	7.46		1064.27	16.18	0		3.59	0.61				4.23	0.78	835.7	125.86									5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"15% Coins: 4b, 7a, 8a, 8b. 15% Physician Services PCP,4b, 7a, 8a, 8b. 15% PCP Cap"	"15% Coins: 7b. 15% Chiropractic,7f. 15% Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. 15% Spec Cap"	"15% Coins: 7e, 7h. 15% Psych -- Other Provider"	Medicare FFS Cost Sharing		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"											0.0816	0.0816	0.1693	0	0.195	0.195	0.195	65	0.184755	0.180658	0.180839	0.195	0.195	0.195	0.15	0.15	0.15	0.173817		0	0.195	0		0	0				0	0	0	0									NO	0.060624	0.060624	0.075421	0	0.175199	0.175199	0.175199	58.39964	0.165995	0.162313	0.162476	0.175199	0.175199	0.175199	0.134768	0.134768	0.134768	0.156167		0	0.175199	0		0	0				0	0	0	0										18.6528	0.2940264	3.19709619	0	0.24177462	1.14404947	0.48530123	1.848348606	7.92958115	1.76109605	3.08379448	0.36616591	0.1051194	4.49735833	3.25195184	5.97291776	0.18463216	1.16500582	0	0	2.83471982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0157	0	NO	14.476211	18.6528	0.2940264	3.19709619	0	0.24177462	1.14404947	0.48530123	1.848348606	7.92958115	1.76109605	3.08379448	0.36616591	0.1051194	4.49735833	3.25195184	5.97291776	0.18463216	1.16500582	0	0	2.83471982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0157	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	15% Coins	15% Coins	15% Coins	Medicare FFS Cost Sharing		$0/Visit	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Service	$0/Visit									5000	1.8987	0.0294	0.3202	0	1.7165	1.3708	0.5814	0.1757	0.7894	0.17	0.3108	0.0366	0.0102	0.4342	0.3665	0.6733	0.0209	0.1202		0	0.3194	0		0	0				0	0	0	0									9.3441	0	NO	1.973753	20.5515	0.3234034	3.51732319	0	1.95823162	2.51484747	1.06667423	2.024063606	8.71897615	1.93113905	3.39456148	0.40274491	0.1152914	4.93158433	3.61842784	6.64617976	0.20551516	1.28519682	0	0	3.15413982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3598
R5826_010_0	2012	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	Mental Health	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	V				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0	0	0	0	0	0				0	YES	1588.34	76.27	600.04	1530.86	1.76	8.97	2.43	432.63	48.59	10.67	16.41	0.72	0.2	32.83	3033.57	3347.46	108.66	2.72		1455.16	21.9	0			0.61				3.93	0.69	881.38	224.72	290.73	118.56	0	0	256.24				6700	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-7): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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: 7h. 25% Psych -- OP	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"						163.989133	128.006658	44.329117	0	0.2	0.2	0.2	65	0.242156	0.25	0.241682	0.25	0.197441	0.215852	15	33.866206	35	0.25		0	0.2	0			0				0	0	0	0	19.88062	35	0	0	35				NO	138.576229	108.16985	35.645752	0	0.185473	0.185473	0.185473	60.278595	0.224567	0.231841	0.224127	0.231841	0.183099	0.200173	13.910445	31.406266	32.457705	0.231841		0	0.185473	0			0				0	0	0	0	18.436552	32.457705	0	0	32.457705					18.3422	0.687509538	1.782406419	0	0.32643248	1.66369281	0.45069939	2.173194046	10.91171053	2.47374347	3.67792407	0.16692552	0.0366198	6.57167959	3.51652572	8.760934932	0.293904519	0.63060752	0	0	4.0618587	0	0	0	0	0	0	0	0	0	0	0	0.446671564	0.320682125	0	0	0.693080194	0	0	0	67.989	0	NO	7.619008	18.3422	0.687509538	1.782406419	0	0.32643248	1.66369281	0.45069939	2.173194046	10.91171053	2.47374347	3.67792407	0.16692552	0.0366198	6.57167959	3.51652572	8.760934932	0.293904519	0.63060752	0	0	4.0618587	0	0	0	0	0	0	0	0	0	0	0	0.446671564	0.320682125	0	0	0.693080194	0	0	0	67.989	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	20% Coins	20% Coins	$65/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			"VIS775: Vision 17a,17b"						20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins				8000	5.1941	0.0971	0.3505	3.3649	3.2954	2.8372	0.7676	0.294	1.8577	0.4079	0.6275	0.0275	0.005	1.2553	1.3003	2.2475	0.0343	0.1039		0.2655	0.8875	0			0				0	0	0.3683	0.0263	0.4214	0.0295	0.0003	0.6613	0.0842				26.8119	1000	NO	8.450798	23.5362	0.784631538	2.132857419	3.364909	3.62184048	4.50087081	1.21825839	2.467238046	12.76940353	2.88169047	4.30538507	0.19441852	0.0416578	7.82701359	4.81680772	11.00842393	0.328212519	0.73450552	0	0.265495	4.9493527	0	0	0	0	0	0	0	0	0	0.368347	0.026267	0.868023564	0.350147125	0.000328	0.661268	0.777316194	0	0	0	94.8009
R5826_011_0	2012	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	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	1252.59	78.25	192.64	2186.11	18.64	6.06	3.6	335.9	338.64	1062.46	818.4	131.42	0.3	506.99	2651.92	3275.52	54.14	574		1361.21	19.93	0			0.61				4.5	1.28	920.2										6700	"$0-$195/Day(Days 1-8): 1a. $195 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-7): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$15-$150/Visit: 3. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												148.989465	124.806492	49.537808	0	200	0.2	0.2	65	195	38.066969	92.000809	42.244806	0.2	70.804339	15	39.293584	40	15		0	0.2	0			0				0	0	0										NO	128.7193	107.826444	43.034385	0	186.2358	0.186236	0.186236	60.526635	181.579905	35.447162	85.669222	39.337476	0.186236	65.931514	13.967685	36.58936	37.24716	13.967685		0	0.186236	0			0				0	0	0											13.436	0.70311827	0.690845327	0	0.289286276	1.12859016	0.6704496	1.694241391	5.124184919	3.138432645	5.84264094	0.430810925	0.0558708	2.785551524	3.086765267	9.987431706	0.16804677	0.668120933	0	0	3.71168348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6121	0	NO	5.197122	13.436	0.70311827	0.690845327	0	0.289286276	1.12859016	0.6704496	1.694241391	5.124184919	3.138432645	5.84264094	0.430810925	0.0558708	2.785551524	3.086765267	9.987431706	0.16804677	0.668120933	0	0	3.71168348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6121	YES	$0-$195/Day(Days 1-8)	$0-$195/Day(Days 1-7)	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes 11c20% Coins: DME 11a	20% Coins	$65/Visit	$0-$195/Visit	$0-$50/Visit	$0-$150/Visit	$40-$50/Visit	20% Coins	$15-$150/Visit	$15/Visit	$20-$40/Visit	$40/Visit	$15/Visit		$0/Visit	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						$0/Service										6700	5.0179	0.2626	0.2579	0	2.6395	2.054	1.221	0.6234	1.8854	1.1548	2.1788	0.1602	0.0207	1.0249	1.1798	3.8174	0.0642	0.2516		0	1.5017	0			0				0	0	0										25.3159	0	NO	2.461832	18.454	0.96570027	0.948699327	0	2.928769276	3.18256216	1.8914166	2.317633391	7.009627919	4.293206645	8.02141194	0.591041925	0.0765918	3.810491524	4.266581267	13.80481171	0.23228077	0.919728933	0	0	5.21342948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.928
R5826_012_0	2012	6	r.	s.	t.								DME/Prosthetics/Supplies	Inpatient Facility	OP Facility - Other								Prosthetics/Supplies	Mental Health	Renal Dialysis								D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	D	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	1494.78	10.23	348.9	2032.41	25.44	7.65	2.78	390.16	330.8	1039.9	1199.55	120.38	0.25	525.27	3167.46	4310.17	102.68	514.22		1664.03	23.22	0			0.61				3.7	1.43	869.39	0	0.08								5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	$1400/Admit: 1b. $1400 IP Psych - Facility 1	"$0/Day(Days 1-14), $50 (Days 15-20),  $125 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c15% Coins: DME 11a	"15%-20% Coins: 11b. 20% Supplies,11b. 15% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$100/Visit: 5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$40-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	$0/Proc: 12. $0 Dialysis -- Dialysis Center										163.989133	1400.000001	45.597948	0	100	0.15	0.179177	65	128.502181	54.121539	83.666361	50.551659	0.2	93.278889	15	38.726183	40	56.995035		0	0.2	0			0				0	0	0	0	0								NO	128.407919	1096.237801	34.681708	0	89.3367	0.134005	0.160071	58.068855	114.799608	48.350397	74.744766	45.161184	0.178673	83.332281	13.400505	34.596694	35.73468	50.917484		0	0.178673	0			0				0	0	0	0	0									15.9951	0.934542725	1.00837066	0	0.189393804	1.02513825	0.44499738	1.888012039	3.164642527	4.18996482	7.471673671	0.453041944	0.04466825	3.64766227	3.537130297	12.42646938	0.305769745	2.181899052	0	0	4.14878706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0573	0	NO	10.393939	15.9951	0.934542725	1.00837066	0	0.189393804	1.02513825	0.44499738	1.888012039	3.164642527	4.18996482	7.471673671	0.453041944	0.04466825	3.64766227	3.537130297	12.42646938	0.305769745	2.181899052	0	0	4.14878706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0573	YES	$0-$240/Day(Days 1-7)	$1500/Admit	"30% Coins(Days 1-14), 30% (Days 15-20), 0% (Days 21-100)"	20% Coins	$100/Trip	25% Coins	25% Coins	$65/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			"VIS775: Vision 17a,17b"						25% Coins	$0/Day(Days 1-1)	$0/Proc								7500	2.0848	0.1223	0.3653	2.3436	1.734	2.6492	0.9611	0.2321	2.2816	0.2972	1.0003	0.0354	0.0055	0.7477	1.3322	2.8625	0.0299	0.1669		0.3076	0.8153	0							0	0	0.3967	0	0								20.7712	500	NO	2.726669	18.08	1.056874725	1.37366366	2.343561	1.923408804	3.67430325	1.40614638	2.120063039	5.446281527	4.48711782	8.471932671	0.488459944	0.05017825	4.39536727	4.869286297	15.28899138	0.335687745	2.348796052	0	0.307575	4.96405906	0	0	0	0	0	0	0	0	0	0.396725	0	0	0	0	0	0	0	0	0	83.8284
R5826_013_0	2012	3	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	Mental Health	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	V				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0	0	0	0	0				0	YES	1651.59	88.43	591.5	1777	1.94	9.66	4.53	409.96	54.67	10.15	16.44	0.23	0.26	32.26	3042.73	3751.25	137.94	1.87		1307.42	23.5	0		3.13	0.61				5.82	1.19	834.05	294.31	293.53	198.25	0	0	356.74				3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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: 7h. 25% Psych -- OP	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"						163.989133	144.00749	44.329117	0	0.2	0.2	0.2	65	0.242927	0.25	0.239284	0.25	0.197132	0.219283	15	33.789506	35	0.25		0	0.2	0		0	0				0	0	0	0	17.715193	35	0	0	35				NO	101.508125	89.139628	22.253394	0	0.161691	0.161691	0.161691	52.549445	0.196395	0.202113	0.19345	0.202113	0.159372	0.17728	12.126795	27.317227	28.295855	0.202113		0	0.161691	0		0	0				0	0	0	0	14.321901	28.295855	0	0	28.295855					13.9708	0.656884775	1.096906879	0	0.31368054	1.56193506	0.73246023	1.795264206	10.73691465	2.05144695	3.180318	0.04648599	0.04143672	5.7190528	3.074880246	8.539478982	0.325260853	0.37795131	0	0	3.7997385	0	0	0	0	0	0	0	0	0	0	0	0.350325633	0.467471104	0	0	0.841188609	0	0	0	59.6799	0	NO	20.506292	13.9708	0.656884775	1.096906879	0	0.31368054	1.56193506	0.73246023	1.795264206	10.73691465	2.05144695	3.180318	0.04648599	0.04143672	5.7190528	3.074880246	8.539478982	0.325260853	0.37795131	0	0	3.7997385	0	0	0	0	0	0	0	0	0	0	0	0.350325633	0.467471104	0	0	0.841188609	0	0	0	59.6799	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins				5100	3.419	0.0629	0.1758	2.1133	1.9529	2.4696	1.1581	0.1501	1.1258	0.2091	0.3385	0.0048	0.0035	0.6644	0.7406	1.407	0.0213	0.0384		0.13	0.5102	0			0				0	0	0.2574	0.018	0.2466	0.0298	0.0003	0.3793	0.078				17.7047	0	NO	13.643178	17.3898	0.719808775	1.272717879	2.113311	2.26655854	4.03151806	1.89059223	1.945343206	11.86274865	2.26054695	3.518865	0.05128699	0.04489872	6.3834088	3.815458246	9.946461982	0.346591853	0.41640031	0	0.130049	4.3099525	0	0	0	0	0	0	0	0	0	0.257394	0.01796	0.596960633	0.497250104	0.000253	0.379303	0.919187609	0	0	0	77.3846
R5826_014_0	2012	8	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	O		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	1116.99	45.8	327.31	425.9	21.93	7.76	3.23	394.15	296.94	530.73	1114.51	84.1	0.21	4.17	3087.26	3949.57	56.54	563.99		1215.67	23.01	0		3.29	0.79				5.13	0.95	319.58										5000	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$205/Day(Days 1-7): 1b. $205 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$100/Visit: 5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	"$35-$100/Visit: 3. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"												185.85435	131.206824	37.847068	0	100	0.2	0.153206	65	100	81.345053	65.270795	38.09215	0.193805	0.2	15	34.114874	35	44.254764		0	0.2	0		0	0				0	0	100										NO	154.804408	109.286625	31.242869	0	91.8159	0.183632	0.140667	59.680335	91.8159	74.687692	59.928968	34.97465	0.177944	0.183632	13.772385	31.322878	32.135565	40.63291		0	0.183632	0		0	0				0	0	91.8159											14.4096	0.417110619	0.852175288	0	0.167793557	1.42498432	0.45435441	1.960250337	2.271984446	3.303249898	5.565952844	0.245114005	0.03736824	0.76574544	3.543244443	10.30932494	0.15141207	1.909712909	0	0	4.22537232	0	0	0	0	0	0	0	0	0	2.445210444	0	0	0	0	0	0	0	0	0	54.4599	0	NO	6.610804	14.4096	0.417110619	0.852175288	0	0.167793557	1.42498432	0.45435441	1.960250337	2.271984446	3.303249898	5.565952844	0.245114005	0.03736824	0.76574544	3.543244443	10.30932494	0.15141207	1.909712909	0	0	4.22537232	0	0	0	0	0	0	0	0	0	2.445210444	0	0	0	0	0	0	0	0	0	54.4599	YES	$0-$255/Day(Days 1-7)	$0-$205/Day(Days 1-7)	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100)"	$0/Visit	$100/Trip	20% Coins	20%-25% Coins	$65/Visit	$0-$100/Visit	30% Coins; $100/Visit	$0-$100/Visit	$35-$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$15-$35/Visit	$35/Visit	$35-$100/Visit		$0/Visit	20% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						$35-$100/Visit										5000	1.4309	0.0414	0.0844	0	1.1858	1.7049	0.7513	0.186	0.2155	0.325	0.5312	0.0242	0.0035	0.0739	1.0037	1.0952	0.0161	0.1959		0	0.4752	0		0	0				0	0	0.232										9.576	0	NO	1.125359	15.8405	0.458529619	0.936588288	0	1.353578557	3.12993332	1.20562641	2.146210337	2.487516446	3.628216898	6.097160844	0.269292005	0.04089824	0.83960344	4.546966443	11.40447494	0.16749707	2.105596909	0	0	4.70057432	0	0	0	0	0	0	0	0	0	2.677174444	0	0	0	0	0	0	0	0	0	64.0359
R5826_018_0	2012	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	974.06	24.88	441.52	792.15	19.35	3.43	1.77	223.42	285.56	456.02	803.42	39.64	0.12	3.56	2363.71	4093.82	27.57	529.48		992.81	14.8	0			0.61				3.19	1.07	311.91	180.08									4000	"$0-$150/Day(Days 1-10): 1a. $150 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$140/Day(Days 1-10): 1b. $140 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$150/Trip: 10a. $150 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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"	"$0-$125/Visit: 8b, 9a. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$30-$100/Visit: 5. $30 Partial Hospitalization,7h. $100 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$100/Visit: 7c, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c$0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$125/Visit: 3. $100 Cardiac Rehab,8b. $125 Nuclear Medicine,9a, 9c, 9d, 14d. $100 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"											122.545317	105.990073	34.03605	0	150	0.2	0.2	65	83.924644	49.860256	67.104396	33.732919	0.2	0.2	10	29.332223	30	39.228095		0	0.2	0			0				0	0	0	102.203381									NO	108.29636	93.666077	28.834593	0	140.82855	0.187771	0.187771	61.025705	78.793239	46.81165	63.001432	31.670388	0.187771	0.187771	9.38857	27.538763	28.16571	36.829572		0	0.187771	0			0				0	0	0	95.954359										8.7906	0.194201	1.060920792	0	0.227086037	0.64405453	0.33235467	1.136196918	1.875016444	1.778920719	4.218050875	0.104617848	0.02253252	0.66846476	1.8493214	9.394894895	0.064710719	1.625043482	0	0	2.7790108	0	0	0	0	0	0	0	0	0	0	1.439955081	0	0	0	0	0	0	0	0	38.2059	0	NO	3.207448	8.7906	0.194201	1.060920792	0	0.227086037	0.64405453	0.33235467	1.136196918	1.875016444	1.778920719	4.218050875	0.104617848	0.02253252	0.66846476	1.8493214	9.394894895	0.064710719	1.625043482	0	0	2.7790108	0	0	0	0	0	0	0	0	0	0	1.439955081	0	0	0	0	0	0	0	0	38.2059	YES	$0-$150/Day(Days 1-10)	$0-$140/Day(Days 1-10)	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$150/Trip	28% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $75/Visit	30% Coins	0%-20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									6000	0.8477	0.0187	0.3757	1.5746	1.5413	1.0351	0.5731	0.1035	1.4524	0.1083	0.4939	0.0097	0.0021	0.0928	0.6605	1.144	0.0077	0.1489		0.2774	0.4356	0			0				0	0	0.1386	0.2354									11.2769	0	NO	1.623131	9.6382	0.212929	1.436575792	1.574598	1.768416037	1.67913753	0.90541867	1.239740918	3.327390444	1.887198719	4.711960875	0.114291848	0.02465652	0.76122076	2.5098464	10.5388909	0.072415719	1.773895482	0	0.277434	3.2146568	0	0	0	0	0	0	0	0	0	0.138608	1.675327081	0	0	0	0	0	0	0	0	49.4829
R5826_021_0	2012	4	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	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	1203.71	32.25	527.49	797.73	1.64	4.63	1.23	354.05	252.33	1275.08	607.83	47.22	0.78	6.22	1876.07	2389.49	41.78	338.6		755.63	12.13	0			0.61				3.42	0.39	393.64	523.68									6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"17% Coins: 11b. 17% Supplies,11b. 17% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$40/Visit: 7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210147	129.289608	34.03605	0	0.2	0.17	0.17	65	207.011119	38.317706	89.701647	41.756923	0.2	0.2	15	36.663714	40	43.739179		0	0.2	0			0				0	0	0	85.393453									NO	163.637832	116.111376	30.350422	0	0.191903	0.163117	0.163117	62.368345	198.62986	36.766337	86.069897	40.066311	0.191903	0.191903	14.392695	35.17931	38.38052	41.968311		0	0.191903	0			0				0	0	0	81.936128										16.4144	0.312049323	1.334128675	0	0.31472092	0.75523171	0.20063391	1.840126046	4.176689381	3.906668415	4.359655458	0.157660934	0.14968434	1.19363666	2.250141942	7.005050788	0.133628177	1.184205842	0	0	2.32778339	0	0	0	0	0	0	0	0	0	0	3.575692626	0	0	0	0	0	0	0	0	51.5918	0	NO	3.475287	16.4144	0.312049323	1.334128675	0	0.31472092	0.75523171	0.20063391	1.840126046	4.176689381	3.906668415	4.359655458	0.157660934	0.14968434	1.19363666	2.250141942	7.005050788	0.133628177	1.184205842	0	0	2.32778339	0	0	0	0	0	0	0	0	0	0	3.575692626	0	0	0	0	0	0	0	0	51.5918	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	20% Coins	20% Coins	17% Coins	17% Coins	$65/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			"VIS775: Vision 17a,17b"						20% Coins	30% Coins									10000	5.8508	0.0554	0.514	1.6402	3.7013	1.5045	0.3992	0.2908	2.4332	0.576	0.9275	0.0179	0.0242	0.2876	1.0397	2.1677	0.0202	0.1869		0.161	0.6188	0			0				0	0	0.2242	0.7925									23.4337	1000	NO	4.763132	22.2652	0.367491323	1.848133675	1.640173	4.01600392	2.25975371	0.59980191	2.130935046	6.609880381	4.482640415	5.287195458	0.175521934	0.17385534	1.48122366	3.289826942	9.172752788	0.153846177	1.371129842	0	0.161045	2.94653539	0	0	0	0	0	0	0	0	0	0.224232	4.368222626	0	0	0	0	0	0	0	0	75.0254
R5826_023_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	OP Facility - Other								Acute	Mental Health	Other								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	D	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	YES	187.1	3.04	499.54	490.98	17.97	3.13	1.53	260.27	241.11	1243.29	641.7	75.25	0.16	6.72	1789.44	2573.72	29.51	571.52		1032.19	11.42	0		3.59	0.61				4.32	0.23	0	0	710.92								3400	$550/Admit: 1a. $550 IP Acute - Facility 1	$550/Admit: 1b. $550 IP Psych - Facility 1	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"										550	550.000001	44.690621	0	100	0.2	0.147716	65	90.240097	42.565501	40.373884	34.999074	0.2	0.2	10	26.914564	30	39.610508		0	0.2	0		0	0				0	0	0	0	50								NO	478.35975	478.359751	33.802868	0	93.1576	0.186315	0.137608	60.55244	84.065508	39.652999	37.611341	32.604297	0.186315	0.186315	9.31576	25.072962	27.94728	36.900198		0	0.186315	0		0	0				0	0	0	0	46.5788									7.4584	0.12118447	1.407157057	0	0.139503506	0.58316595	0.21054024	1.313331963	1.689086219	4.108348094	2.01126646	0.204456112	0.0298104	1.2520368	1.389166131	5.377565313	0.068727019	1.75743343	0	0	2.1277173	0	0	0	0	0	0	0	0	0	0	0	2.759483375	0	0	0	0	0	0	0	34.0084	0	NO	3.426203	7.4584	0.12118447	1.407157057	0	0.139503506	0.58316595	0.21054024	1.313331963	1.689086219	4.108348094	2.01126646	0.204456112	0.0298104	1.2520368	1.389166131	5.377565313	0.068727019	1.75743343	0	0	2.1277173	0	0	0	0	0	0	0	0	0	0	0	2.759483375	0	0	0	0	0	0	0	34.0084	YES	$800/Admit	$800/Admit	"30% Coins(Days 1-14), 30% (Days 15-100)"	30% Coins	$100/Trip	30% Coins	20%-30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Day(Days 1-1)	$0/Day(Days 1-1)	30% Coins								5100	1.0051	0.0163	0.3867	0.703	0.9474	1.0041	0.4499	0.1197	1.2973	0.332	0.5644	0.0148	0.0028	0.1158	0.4962	0.7137	0.0082	0.149		0.2862	0.2648	0		0	0				0	0	0	0	0.4447								9.3223	0	NO	1.81437	8.4636	0.13751147	1.793890057	0.703046	1.086924506	1.58722195	0.66040224	1.433028963	2.986340219	4.440383094	2.57568746	0.219221112	0.0326534	1.3678758	1.885381131	6.091263313	0.076910019	1.90645943	0	0.286228	2.3925643	0	0	0	0	0	0	0	0	0	0	0	3.204160375	0	0	0	0	0	0	0	43.3307
R5826_026_0	2012	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			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	1171.02	39.04	316.38	1408.67	21.63	3.95	1.31	281.06	234.92	598.68	702.15	56.98	0.14	323.47	1844.26	2977.63	28.98	331.19		914.83	13.82	0			0.61				2.94	0.88	409.05	0									3400	"$0-$200/Day(Days 1-5): 1a. $200 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$200/Day(Days 1-5): 1b. $200 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $100 (Days 15-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c15% Coins: DME 11a	"15%-20% Coins: 11b. 20% Supplies,11b. 15% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 9a, 12. 20% Dialysis -- OP Hosp"	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Proc: 12. $0 Dialysis -- Dialysis Center											125.83943	103.431686	44.690621	0	100	0.15	0.177019	65	86.926949	30.925792	40.915118	37.641997	0.2	50	10	28.388833	30	36.860488		0	0.2	0			0				0	0	0	0									NO	105.978696	87.107477	35.810237	0	93.6582	0.140487	0.165793	60.87783	81.414215	28.96454	38.320363	35.254817	0.187316	46.8291	9.36582	26.58847	28.09746	34.522869		0	0.187316	0			0				0	0	0	0										10.3419	0.283389659	0.944136899	0	0.168818906	0.55492365	0.21718883	1.425860242	1.593818949	1.445040901	2.24222024	0.167401623	0.02622424	1.262317415	1.439417266	6.597552161	0.067855366	0.952802415	0	0	2.58870712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3196	0	NO	3.630279	10.3419	0.283389659	0.944136899	0	0.168818906	0.55492365	0.21718883	1.425860242	1.593818949	1.445040901	2.24222024	0.167401623	0.02622424	1.262317415	1.439417266	6.597552161	0.067855366	0.952802415	0	0	2.58870712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3196	YES	$0-$250/Day(Days 1-5)	$0-$250/Day(Days 1-5)	"30% Coins(Days 1-14), 30% (Days 15-100)"	20% Coins	$100/Trip	20% Coins	20% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins			"VIS775: Vision 17a,17b"						20% Coins	$0/Proc									5000	1.592	0.0436	0.3051	1.6317	1.7327	1.2848	0.4249	0.1964	1.951	0.2129	0.7058	0.0231	0.0037	0.5652	0.7773	1.2549	0.0122	0.1305		0.3856	0.6161	0			0				0	0	0.1819	0									14.0314	500	NO	1.686062	11.9339	0.327015659	1.249268899	1.631653	1.901532906	1.83971665	0.64206483	1.622306242	3.544805949	1.657928901	2.94799424	0.190547623	0.02991624	1.827551415	2.216671266	7.852460161	0.080067366	1.083332415	0	0.385551	3.20480712	0	0	0	0	0	0	0	0	0	0.181854	0	0	0	0	0	0	0	0	0	46.351
R5826_053_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	OP Facility - Other								Acute	Mental Health	Other								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		V		O	O	D	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	YES	188.66	4.32	265.37	804.63	16.59	3.89	1.61	298.47	230.51	1428.01	607.13	73.8	0.27	6.12	1792.41	2268.83	30.04	386.74		883.05	17.88	0		5.56	0.61		0.24		3.56	2.42	0	0	508.75								3400	$550/Admit: 1a. $550 IP Acute - Facility 1	$550/Admit: 1b. $550 IP Psych - Facility 1	"$0/Day(Days 1-15), $100 (Days 16-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	0%: Diabetic Shoes 11c20% Coins: DME 11a	"0%-20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"										550	550.000001	42.05401	0	100	0.2	0.110183	65	89.221695	45.280419	40.028406	34.029579	0.2	0.2	10	27.021392	30	38.273167		0	0.2	0		0	0		0		0	0	0	0	50								NO	483.11835	483.11835	35.818031	0	93.3882	0.186776	0.102898	60.70233	83.322535	42.286568	37.381808	31.779611	0.186776	0.186776	9.33882	25.234791	28.01646	35.742622		0	0.186776	0		0	0		0		0	0	0	0	46.6941									7.5954	0.173922606	0.792085907	0	0.129109187	0.72655864	0.16566578	1.509818703	1.600556462	5.032136831	1.891301424	0.195444608	0.05042952	1.14306912	1.394916196	4.771120905	0.070134538	1.151925136	0	0	3.33955488	0	0	0	0	0	0	0	0	0	0	0	1.979635281	0	0	0	0	0	0	0	33.7128	0	NO	2.994214	7.5954	0.173922606	0.792085907	0	0.129109187	0.72655864	0.16566578	1.509818703	1.600556462	5.032136831	1.891301424	0.195444608	0.05042952	1.14306912	1.394916196	4.771120905	0.070134538	1.151925136	0	0	3.33955488	0	0	0	0	0	0	0	0	0	0	0	1.979635281	0	0	0	0	0	0	0	33.7128	YES	$800/Admit	$800/Admit	"30% Coins(Days 1-15), 30% (Days 16-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	0%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	0% Coins		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Day(Days 1-1)	$0/Day(Days 1-1)	30% Coins								5100	1.0301	0.0236	0.3066	1.4003	0.8751	1.251	0.5186	0.1374	1.3164	0.2828	0.4684	0.0154	0.0047	0.1057	0.4974	0.6296	0.0083	0.096		0.2451	0.5281	0			0				0	0	0	0	0.3686								10.1092	0	NO	1.595539	8.6256	0.197488606	1.098724907	1.400277	1.004172187	1.97753564	0.68430378	1.647183703	2.916955462	5.314931831	2.359710424	0.210868608	0.05515452	1.24872612	1.892317196	5.400730905	0.078470538	1.247931136	0	0.245051	3.86764588	0	0	0	0	0	0	0	0	0	0	0	2.348263281	0	0	0	0	0	0	0	43.822
R5826_062_0	2012	4	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	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	1149.23	20.2	469.65	722.04	1.67	3.64	1.18	286.97	195.99	942.95	485.7	60.56	0.23	1.72	1703.8	2240.42	71.84	353.35		700.26	12.8	0		4.85	0.79				5.4	1.78	701.42	377.39									3400	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-7): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$30/Visit: 7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN814: Dental 16a, 16b"	"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	144.00749	34.03605	0	0.2	0.2	0.2	65	208.303553	40.115694	82.981327	33.44348	0.2	0.2	10	28.442953	30	35.429392		0	0.2	0		0	0				0	0	0	72.471292									NO	128.915137	113.207168	24.934538	0	0.18234	0.18234	0.18234	59.260435	189.910141	36.573438	75.653993	30.490388	0.18234	0.18234	9.11699	25.931412	27.35097	32.300941		0	0.18234	0		0	0				0	0	0	66.072004										12.3461	0.190565399	0.975875481	0	0.3045078	0.6637176	0.2151612	1.417163919	3.101707378	2.87391028	3.062095367	0.153874825	0.0419382	0.3136248	1.29446063	4.841437839	0.16374114	0.951128125	0	0	2.333952	0	0	0	0	0	0	0	0	0	0	2.077909466	0	0	0	0	0	0	0	0	37.3229	0	NO	6.073197	12.3461	0.190565399	0.975875481	0	0.3045078	0.6637176	0.2151612	1.417163919	3.101707378	2.87391028	3.062095367	0.153874825	0.0419382	0.3136248	1.29446063	4.841437839	0.16374114	0.951128125	0	0	2.333952	0	0	0	0	0	0	0	0	0	0	2.077909466	0	0	0	0	0	0	0	0	37.3229	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	20% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN814: Dental 16a, 16b"	"VIS776: Vision 17a,17b"						20% Coins	30% Coins									5100	3.4681	0.0259	0.2322	1.2325	3.1001	1.1448	0.3722	0.1939	1.3358	0.2737	0.5905	0.0215	0.0059	0.0653	0.765	1.6647	0.0239	0.1235		0.1091	0.5425	0		0	0				0	0	0.3072	0.3581									15.9565	500	NO	5.339369	15.8142	0.216425399	1.208049481	1.232514	3.4046508	1.8085136	0.5873852	1.611036919	4.437459378	3.14759928	3.652618367	0.175375825	0.0478722	0.3789468	2.05943863	6.506166839	0.18766814	1.074664125	0	0.10915	2.876474	0	0	0	0	0	0	0	0	0	0.307152	2.435990466	0	0	0	0	0	0	0	0	53.2793
R5826_063_0	2012	3	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	OP Facility - Other							Prosthetics/Supplies	Acute	Mental Health	Other							A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V				O	O	O	D	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	YES	167.63	4.61	346.77	871.67	18.98	3.98	2.86	311.89	198.88	698.31	515.95	121.9	0.21	3.22	2047.18	2471.51	59.75	458.56		1104.92	9.17	0		3.36	1.87				3.99	0.81	694.81	0	0	393.56							3400	$550/Admit: 1a. $550 IP Acute - Facility 1	$550/Admit: 1b. $550 IP Psych - Facility 1	"$0/Day(Days 1-5), $100 (Days 6-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$10/Visit: 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$10-$65/Visit: 3. $10 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"									550	550	76.432288	0	200	0.2	0.2	65	88.564404	39.624586	91.459954	34.00281	0.2	0.2	10	29.000607	30	10		0	0.2	0		0	0				0	0	0	0	0	46.358029							NO	485.3002	485.3002	56.386086	0	187.9754	0.187975	0.187975	61.092005	83.239647	37.242237	85.961107	31.958459	0.187975	0.187975	9.39877	27.257004	28.19631	9.39877		0	0.187975	0		0	0				0	0	0	0	0	43.570845								6.7792	0.18643616	1.62941692	0	0.297314424	0.7481405	0.5376085	1.58783212	1.379558416	2.167218877	3.69596943	0.324644679	0.03947475	0.6052795	1.603414497	5.61382983	0.140394127	0.359158331	0	0	1.72373075	0	0	0	0	0	0	0	0	0	0	0	0	1.42897848	0	0	0	0	0	0	30.8476	0	NO	2.931519	6.7792	0.18643616	1.62941692	0	0.297314424	0.7481405	0.5376085	1.58783212	1.379558416	2.167218877	3.69596943	0.324644679	0.03947475	0.6052795	1.603414497	5.61382983	0.140394127	0.359158331	0	0	1.72373075	0	0	0	0	0	0	0	0	0	0	0	0	1.42897848	0	0	0	0	0	0	30.8476	YES	$800/Admit	$800/Admit	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $150/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"						30% Coins	$0/Day(Days 1-1)	$0/Day(Days 1-1)	30% Coins							5100	0.9213	0.0254	0.3218	1.5602	1.9992	1.2773	0.9191	0.1433	1.0937	0.1914	0.4089	0.0269	0.0036	0.0832	0.5671	0.6846	0.0165	0.1166		0.3061	0.265	0		0	0				0	0	0.3315	0	0	0.325							11.5876	0	NO	1.814605	7.7005	0.21179616	1.95123892	1.560211	2.296487424	2.0254595	1.4567385	1.73111912	2.473234416	2.358607877	4.10482243	0.351498679	0.04306475	0.6885225	2.170506497	6.29846683	0.156944127	0.475752331	0	0.306075	1.98876575	0	0	0	0	0	0	0	0	0	0.331506	0	0	1.75394448	0	0	0	0	0	0	42.4353
R5826_064_0	2012	6	r.	s.	t.	u.							DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility	OP Facility - Other							Prosthetics/Supplies	Acute	Mental Health	Other							A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V				O	O	O	D	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	YES	172.03	4.07	182.01	618.52	18.26	3.7	1.63	327.88	236.04	542.71	583.71	39.21	0.17	3.04	1801.93	2898.61	29.06	524.94		1013.05	14.54	0		3.1	1.87				3.23	0.35	474.72	0	0	254.07							4900	$750/Admit: 1a. $750 IP Acute - Facility 1	$750/Admit: 1b. $750 IP Psych - Facility 1	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$100/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$35/Visit: 7b. $20 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"				$0: Additional Smoking Cessation 14c$0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$15-$100/Visit: 3. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"									750	750	34.03605	0	200	0.2	0.2	65	150	39.117302	66.833536	37.652983	0.2	0.2	15	33.496738	35	15		0	0.2	0		0	0				0	0	0	0	0	55.728267							NO	691.44075	691.44075	31.779494	0	192.5428	0.192543	0.192543	62.57641	144.4071	37.658774	64.34158	36.249054	0.192543	0.192543	14.44071	32.247779	33.69499	14.44071		0	0.192543	0		0	0				0	0	0	0	0	53.650383								9.9124	0.234513654	0.482015475	0	0.292985961	0.7124091	0.31384509	1.709796109	2.840487657	1.703149436	3.129735305	0.118443784	0.03273231	0.58533072	2.168429048	7.789477891	0.081598034	0.631708859	0	0	2.79957522	0	0	0	0	0	0	0	0	0	0	0	0	1.135912734	0	0	0	0	0	0	36.6745	0	NO	1.902355	9.9124	0.234513654	0.482015475	0	0.292985961	0.7124091	0.31384509	1.709796109	2.840487657	1.703149436	3.129735305	0.118443784	0.03273231	0.58533072	2.168429048	7.789477891	0.081598034	0.631708859	0	0	2.79957522	0	0	0	0	0	0	0	0	0	0	0	0	1.135912734	0	0	0	0	0	0	36.6745	YES	$1000/Admit	$1000/Admit	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	25% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	$0/Service		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"						30% Coins	$0/Day(Days 1-1)	$0/Day(Days 1-1)	30% Coins							7300	1.2609	0.0299	0.3187	2.8278	2.0001	1.0291	0.5443	0.1566	1.1602	0.1355	0.4593	0.0087	0.003	0.0817	0.5932	0.9543	0.0096	0.1669		0.3335	0.4444	0		0	0				0	0	0.2348	0	0	0.2989							13.0511	0	NO	1.26699	11.1733	0.264381654	0.800702475	2.827767	2.293059961	1.7414791	0.85810409	1.866438109	4.000647657	1.838609436	3.589058305	0.127119784	0.03577531	0.66703672	2.761649048	8.743738891	0.091165034	0.798561859	0	0.33351	3.24394622	0	0	0	0	0	0	0	0	0	0.234789	0	0	1.434822734	0	0	0	0	0	0	49.7257
R5826_065_0	2012	9	r.	s.	t.								DME/Prosthetics/Supplies	Inpatient Facility	Inpatient Facility								Prosthetics/Supplies	Acute	Mental Health								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	D	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	YES	185.64	6.17	243.71	1084.94	20.39	4.43	3.35	305.81	255.87	669.97	549.98	56.77	0.18	346.88	2070.9	2541.28	22.27	378.23		1118.17	9.55	0		3.12	1.87				2.87	1.15	543.74	0	0								3400	$550/Admit: 1a. $550 IP Acute - Facility 1	$550/Admit: 1b. $550 IP Psych - Facility 1	"$0/Day(Days 1-7), $100 (Days 8-100): 2. $0 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$150/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$30-$150/Visit: 3. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $100 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician										550	550	68.0721	0	200	0.2	0.2	65	86.882757	40.787241	95.595609	31.253963	0.2	65.206389	10	28.97995	30	37.137258		0	0.2	0		0	0				0	0	0	0	0								NO	482.4523	482.4523	55.222674	0	187.2384	0.187238	0.187238	60.85248	81.338942	38.184689	89.495845	29.25971	0.187238	61.0457	9.36192	27.130797	28.08576	34.767604		0	0.187238	0		0	0				0	0	0	0	0									7.4635	0.248060891	1.12152649	0	0.318149248	0.82946434	0.6272473	1.550774742	1.734349591	2.131883007	4.101743736	0.138422811	0.03370284	1.764627701	1.615633344	5.745579317	0.05212249	1.095845905	0	0	1.7881229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3608	0	NO	2.944173	7.4635	0.248060891	1.12152649	0	0.318149248	0.82946434	0.6272473	1.550774742	1.734349591	2.131883007	4.101743736	0.138422811	0.03370284	1.764627701	1.615633344	5.745579317	0.05212249	1.095845905	0	0	1.7881229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3608	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a,17b"						30% Coins	$0/Day(Days 1-1)	$0/Day(Days 1-1)								5100	2.8697	0.0419	0.1754	1.4781	1.9598	1.2975	0.9817	0.1282	1.2933	0.1463	0.4099	0.0102	0.0028	0.3971	0.6242	1.0594	0.0055	0.0798		0.132	0.2488	0		0	0				0	0	0.2469	0	0								13.5885	0	NO	5.136024	10.3332	0.289969891	1.29695149	1.478084	2.277937248	2.12692534	1.6089833	1.679000742	3.027629591	2.278213007	4.511612736	0.148665811	0.03651084	2.161769701	2.239821344	6.805003317	0.05766549	1.175631905	0	0.131956	2.0369459	0	0	0	0	0	0	0	0	0	0.246858	0	0	0	0	0	0	0	0	0	45.9493
R5826_066_0	2012	6	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	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	953.51	22.2	384.5	830.97	1.01	4.49	1.33	288.78	277.4	922.45	568.86	56.92	0.23	5.69	2035.73	2430.5	40.32	311.74		949.84	12.17	0		3.22					3.52	0.63	490.09	363.45									5000	"$0-$225/Day(Days 1-7): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$225/Day(Days 1-5): 1b. $225 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$225/Visit: 9b. $0 Surgery ASC -- Physician,9b. $175 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-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$10-$35/Visit: 7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$35-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											163.989133	116.360647	34.03605	0	0.2	0.2	0.2	65	208.542551	39.172959	95.104944	36.427659	0.2	0.2	10	32.410023	35	39.219273		0	0.2	0		0					0	0	0	84.937394									NO	146.685491	104.08262	30.18174	0	0.190254	0.190254	0.190254	61.83255	198.380273	37.264061	90.47048	34.65254	0.190254	0.190254	9.5127	30.830682	33.29445	37.308118		0	0.190254	0		0					0	0	0	80.798395										11.6555	0.192552847	0.967073253	0	0.19215654	0.85424046	0.25303782	1.488000316	4.585890644	2.864519422	4.288753104	0.164368548	0.04375842	1.08254526	1.613774064	6.244497717	0.111869352	0.969202725	0	0	2.31539118	0	0	0	0	0	0	0	0	0	0	2.447181389	0	0	0	0	0	0	0	0	42.3343	0	NO	3.033379	11.6555	0.192552847	0.967073253	0	0.19215654	0.85424046	0.25303782	1.488000316	4.585890644	2.864519422	4.288753104	0.164368548	0.04375842	1.08254526	1.613774064	6.244497717	0.111869352	0.969202725	0	0	2.31539118	0	0	0	0	0	0	0	0	0	0	2.447181389	0	0	0	0	0	0	0	0	42.3343	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	20% Coins	20% Coins	20% Coins	$65/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		"DEN767: Dental 16a, 16b"							20% Coins	30% Coins									7500	4.1468	0.0343	0.3539	2.0513	1.811	1.3694	0.4068	0.1891	1.9107	0.2911	0.6446	0.0167	0.0058	0.2097	0.8329	1.6394	0.0127	0.0997		0.1524	0.5009	0		0					0	0	0.2263	0.5102									17.4157	500	NO	3.890751	15.8023	0.226850847	1.320978253	2.051278	2.00314054	2.22368946	0.65984382	1.677081316	6.496593644	3.155596422	4.933317104	0.181055548	0.04952442	1.29229326	2.446706064	7.883887717	0.124535352	1.068943725	0	0.152381	2.81630018	0	0	0	0	0	0	0	0	0	0.226328	2.957411389	0	0	0	0	0	0	0	0	59.7501
R5826_067_0	2012	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	Mental Health	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	V				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0	0	0	0	0				0	YES	743.03	7.42	266.96	547.41	0.99	4.11	0.97	260.03	29.39	4.52	6.98	0.04	0.13	11.22	1418.84	1847.07	16.21	0.97		802.91	9.1	0		3.1	0.61				3.97	0.23	356.44	111.67	105.44	24.83	0	0	143.99				3400	"$0-$225/Day(Days 1-9): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-9): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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: 7h. 25% Psych -- OP	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"						178.386262	141.224232	44.329117	0	0.2	0.2	0.2	65	0.242109	0.25	0.24361	0.25	0.2	0.227743	15	31.978474	35	0.25		0	0.2	0		0	0				0	0	0	0	20.866388	35	0	0	35				NO	152.380756	120.636281	36.638148	0	0.18658	0.18658	0.18658	60.63837	0.225863	0.233225	0.227264	0.233225	0.18658	0.212461	13.99347	29.832655	32.65143	0.233225		0	0.18658	0		0	0				0	0	0	0	19.466212	32.65143	0	0	32.65143					9.4353	0.074593434	0.815076666	0	0.1847142	0.7668438	0.1809826	1.313982946	6.63811357	1.054177	1.58630272	0.009329	0.0242554	2.38381242	1.654541248	4.591916839	0.04410664	0.22622825	0	0	1.697878	0	0	0	0	0	0	0	0	0	0	0	0.171043116	0.067561251	0	0	0.39178995	0	0	0	33.3125	0	NO	3.44756	9.4353	0.074593434	0.815076666	0	0.1847142	0.7668438	0.1809826	1.313982946	6.63811357	1.054177	1.58630272	0.009329	0.0242554	2.38381242	1.654541248	4.591916839	0.04410664	0.22622825	0	0	1.697878	0	0	0	0	0	0	0	0	0	0	0	0.171043116	0.067561251	0	0	0.39178995	0	0	0	33.3125	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins				5100	2.982	0.0118	0.2051	0.6896	1.2055	1.2716	0.3006	0.1153	0.7331	0.1126	0.1741	0.001	0.0022	0.28	0.4112	0.9267	0.0037	0.0242		0.0856	0.2541	0		0	0				0	0	0.1732	0.0086	0.1278	0.0046	0	0.2511	0.0291				10.3845	0	NO	3.498585	12.4172	0.086406434	1.020226666	0.68961	1.3901992	2.0384878	0.4815756	1.429277946	7.37117557	1.166795	1.76042572	0.010341	0.0264414	2.66376642	2.065751248	5.518633839	0.04775864	0.25047125	0	0.085601	1.951988	0	0	0	0	0	0	0	0	0	0.173158	0.008565	0.298881116	0.072208251	0	0.251146	0.42085695	0	0	0	43.697
R5826_068_0	2012	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		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	215.45	7.37	192.45	1536.82	18.77	4.54	1.57	307.93	323.59	891.29	715.02	58.99	0.18	454.55	2132.11	3218.33	29.32	533.85		1082.92	9.65	0		4.47	2.86				4.5	1.28	581.03										3400	"$0-$550/Admit: 1a. $550 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$550/Admit: 1b. $550 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$30-$50/Visit: 5. $30 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$30-$65/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,8b. $50 Rad therapy,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $65 Observation"	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 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: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN750: Dental 16a, 16b"	"VIS752: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies												550	550	49.537808	0	100	0.2	0.2	65	86.187772	41.286146	40.409129	34.758535	0.2	52.423896	10	29.360559	30	36.921919		0	0.2	0		0	0				0	0	0										NO	474.82325	474.82325	42.025251	0	93.1205	0.186241	0.186241	60.528325	80.258484	38.445865	37.629183	32.367322	0.186241	48.817394	9.31205	27.340699	27.93615	34.381876		0	0.186241	0		0	0				0	0	0											8.5251	0.291620613	0.673979963	0	0.145655982	0.84553414	0.29239837	1.55320726	2.164236903	2.855534585	2.242134869	0.15911236	0.03352338	1.849162204	1.654526244	7.332615984	0.068257327	1.529563709	0	0	1.79722565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0133	0	NO	3.328191	8.5251	0.291620613	0.673979963	0	0.145655982	0.84553414	0.29239837	1.55320726	2.164236903	2.855534585	2.242134869	0.15911236	0.03352338	1.849162204	1.654526244	7.332615984	0.068257327	1.529563709	0	0	1.79722565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0133	YES	$0-$800/Admit	$0-$800/Admit	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	30% Coins	$100/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins; $35/Visit		$35/Visit	20%-30% Coins	$0/Service		"DEN750: Dental 16a, 16b"	"VIS752: Vision 17a,17b"						30% Coins										5100	1.1675	0.0399	0.1778	1.9029	0.9832	1.4486	0.5022	0.1407	1.5845	0.1666	0.4839	0.0156	0.0031	0.5196	0.5875	0.8868	0.0081	0.1302		0.2984	0.2703	0		0	0				0	0	0.2903										11.6077	0	NO	1.735912	9.6925	0.331567613	0.851784963	1.902857	1.128883982	2.29418114	0.79457537	1.69392026	3.748702903	3.022169585	2.726033869	0.17475636	0.03665638	2.368726204	2.241998244	8.219380984	0.076335327	1.659752709	0	0.298383	2.06755565	0	0	0	0	0	0	0	0	0	0.290253	0	0	0	0	0	0	0	0	0	45.621
R5826_069_0	2012	3	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	Mental Health	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	V				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0	0	0	0	0				0	YES	958.16	20.33	342.74	910.3	1.14	4.17	0.77	270.39	29.79	6.22	9.85	0.08	0.21	16.27	1720.91	2580	25.98	1.94		879.08	13.69	0		3.11	0.61				5.82	1.71	396.14	139.92	235.45	17.78	0	0	196.59				3400	"$0-$225/Day(Days 1-9): 1a. $225 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$195/Day(Days 1-9): 1b. $195 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $50 (Days 15-21),  $125 (Days 22-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $125 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	20% Coins: 10a. 20% Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 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: 7h. 25% Psych -- OP	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 20% Observation"	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$35/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit: 5. $35 Partial Hospitalization	"$35/Visit: 3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$35/Visit: 7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"						178.386262	141.224232	44.329117	0	0.2	0.2	0.2	65	0.241509	0.25	0.242998	0.25	0.2	0.228893	15	31.511999	35	0.25		0	0.2	0		0	0				0	0	0	0	26.198698	35	0	0	35				NO	141.221625	111.801858	32.722956	0	0.18052	0.18052	0.18052	58.66913	0.217986	0.225651	0.219331	0.225651	0.18052	0.206599	13.53903	28.442793	31.59107	0.225651		0	0.18052	0		0	0				0	0	0	0	23.646997	31.59107	0	0	31.59107					11.2761	0.189410981	0.934622162	0	0.2057928	0.7527684	0.1390004	1.321962172	6.49380294	1.40354922	2.16041035	0.01805208	0.0379092	3.36136573	1.94162101	6.115200495	0.068394667	0.43776294	0	0	2.4713188	0	0	0	0	0	0	0	0	0	0	0	0.463973787	0.046807435	0	0	0.517540704	0	0	0	40.3573	0	NO	6.365506	11.2761	0.189410981	0.934622162	0	0.2057928	0.7527684	0.1390004	1.321962172	6.49380294	1.40354922	2.16041035	0.01805208	0.0379092	3.36136573	1.94162101	6.115200495	0.068394667	0.43776294	0	0	2.4713188	0	0	0	0	0	0	0	0	0	0	0	0.463973787	0.046807435	0	0	0.517540704	0	0	0	40.3573	YES	30% Coins	30% Coins	"30% Coins(Days 1-14), 30% (Days 15-21), 0% (Days 22-100)"	30% Coins	20% Coins	30% Coins	30% Coins	$65/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		"DEN767: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins				5100	3.0934	0.0233	0.2229	1.0409	1.3497	1.2481	0.2294	0.116	0.7188	0.15	0.2377	0.002	0.0034	0.3927	0.4935	0.9437	0.0052	0.0468		0.0963	0.3746	0		0	0				0	0	0.166	0.0096	0.1721	0.0035	0	0.2864	0.0449				11.4708	0	NO	4.708622	14.3694	0.212674981	1.157549162	1.040919	1.5554798	2.0008944	0.3683794	1.437951172	7.21262194	1.55355922	2.39815635	0.02008308	0.0412732	3.75406073	2.43510501	7.058941495	0.073621667	0.48456294	0	0.096293	2.8459088	0	0	0	0	0	0	0	0	0	0.165973	0.009599	0.636046787	0.050293435	0.000015	0.28638	0.562417704	0	0	0	51.8282
R5826_070_0	2012	5	r.	s.	t.								Inpatient Facility	Inpatient Facility	OP Facility - Other								Acute	Mental Health	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	D	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	YES	169.51	1.42	295.71	355.92	17.01	3.68	1.83	256.1	236.33	298.85	680.69	21.78	0.21	0.67	1792.74	3011.11	25.58	440.24		808.15	9.03	0			0.61				5.89	0.95	0	0	161.45								6700	$800/Admit: 1a. $800 IP Acute - Facility 1	$800/Admit: 1b. $800 IP Psych - Facility 1	"$0/Day(Days 1-14), $50 (Days 15-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$100/Trip: 10a. $100 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"0%-10% Coins: 11b. 10% Supplies,11b. 10% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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"	"$35-$50/Visit: 5. $35 Partial Hospitalization,7h. $50 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$15-$35/Visit: 7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit: 7e, 7h. $35 Psych -- Other Provider"	"$35-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Day(Days 1-1): 1a. $0 IP Acute - Physician	$0/Day(Days 1-1): 1b. $0 IP Psych - Physician	"$30-$50/Visit: 3. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $50 Observation"										800	800	37.847069	0	100	0.1	0.079732	65	100	43.428546	40.995363	35.266136	0.2	0.2	15	33.689299	35	37.495643		0	0.2	0			0				0	0	0	0	50								NO	768.1528	768.1528	36.661131	0	98.6304	0.09863	0.07864	64.10976	98.6304	42.833749	40.433891	34.783131	0.197261	0.197261	14.79456	33.22789	34.52064	36.982102		0	0.197261	0			0				0	0	0	0	49.3152									10.8508	0.090898081	0.903421921	0	0.139808592	0.3629584	0.1439112	1.368209128	1.942443536	1.066738824	2.293578772	0.063131383	0.04142481	0.13216487	2.210233291	8.337735988	0.073586498	1.356750049	0	0	1.78126683	0	0	0	0	0	0	0	0	0	0	0	0.66349492	0	0	0	0	0	0	0	33.8226	0	NO	0.788032	10.8508	0.090898081	0.903421921	0	0.139808592	0.3629584	0.1439112	1.368209128	1.942443536	1.066738824	2.293578772	0.063131383	0.04142481	0.13216487	2.210233291	8.337735988	0.073586498	1.356750049	0	0	1.78126683	0	0	0	0	0	0	0	0	0	0	0	0.66349492	0	0	0	0	0	0	0	33.8226	YES	$800/Admit	$800/Admit	"30% Coins(Days 1-14), 30% (Days 15-20), 30% (Days 21-100)"	30% Coins	$100/Trip	15% Coins	15%-30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $40/Visit	30% Coins; $40/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		$40/Visit	20%-30% Coins	$0/Service			"VIS775: Vision 17a,17b"						$0/Day(Days 1-1)	$0/Day(Days 1-1)	30% Coins								10000	1.5844	0.0133	0.4296	1.3153	1.6684	1.1006	0.6568	0.2192	2.3072	0.1864	0.7262	0.0128	0.0066	0.0216	1.0574	1.776	0.0151	0.2477		0.4767	0.3802	0			0				0	0	0	0	0.4297								14.6313	599	NO	0.265232	12.4352	0.104157081	1.333069921	1.315313	1.808222592	1.4635534	0.8007372	1.587414128	4.249628536	1.253183824	3.019822772	0.075963383	0.04801681	0.15379887	3.267632291	10.11375599	0.088671498	1.604454049	0	0.476663	2.16144083	0	0	0	0	0	0	0	0	0	0	0	1.09319692	0	0	0	0	0	0	0	48.4539
R5826_072_0	2012	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		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	299.84	6.12	26.74	1414.7	1.38	8.74	1.95	473.82	58.29	14.3	24.66	1.28	0.19	30.25	33.13	56.46	1.14	6.8		1389.55	31.13	0		5.56	0.61		0.24		3.56	2.42	1130.35	182.88									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	"15% Coins: 4b, 7a, 8a, 8b. 15% Physician Services PCP,4b, 7a, 8a, 8b. 15% PCP Cap"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$0/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP"											0.0816	0.0816	0.1693	0	0.195	0.195	0.195	65	0.195	0.183335	0.195	0.195	0.195	0.195	0.15	0.193944	0.195	0.195		0	0.195	0		0	0		0		0	0	0	0									NO	0.06647	0.06647	0.112723	0	0.178742	0.178742	0.178742	59.58056	0.178742	0.16805	0.178742	0.178742	0.178742	0.178742	0.137494	0.177773	0.178742	0.178742		0	0.178742	0		0	0		0		0	0	0	0										19.9304	0.4067964	3.01421302	0	0.24666396	1.56220508	0.3485469	2.352538412	10.41887118	2.403115	4.40777772	0.22878976	0.03396098	5.4069455	4.55517622	10.03706358	0.20376588	1.2154456	0	0	5.56423846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3365	0	NO	10.597693	19.9304	0.4067964	3.01421302	0	0.24666396	1.56220508	0.3485469	2.352538412	10.41887118	2.403115	4.40777772	0.22878976	0.03396098	5.4069455	4.55517622	10.03706358	0.20376588	1.2154456	0	0	5.56423846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3365	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	15% Coins	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		$0/Visit	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"DEN814: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						$0/Service	$0/Visit									10000	2.2592	0.0453	0.3815	0	1.8427	1.971	0.4404	0.2353	1.1029	0.2441	0.4695	0.024	0.0035	0.5493	0.5402	1.1901	0.0241	0.1385		0	0.6597	0			0				0	0	0	0									12.1213	0	NO	0.766593	22.1896	0.4520954	3.39573802	0	2.08932296	3.53325108	0.7889299	2.587823412	11.52178118	2.647225	4.87725972	0.25283376	0.03749898	5.9562455	5.09535322	11.22716058	0.22786588	1.3539116	0	0	6.22390146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4578
R5826_074_0	2012	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	1713.33	71.56	471.52	1532.26	33.43	8.14	2.53	457.29	399	1058.92	1326.34	153.33	0.3	7.84	3679.58	5361.41	128.2	600.69		1679.92	21.77	0		3.22	0.61				5.1	0.61	1043.95	534.26									4950	"$0-$290/Day(Days 1-5): 1a. $290 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$285/Day(Days 1-5): 1b. $285 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$50/Day(Days 1-20), $100 (Days 21-58),  $0 (Days 59-100) : 2. $50 SNF - Facility 1,2. $100 SNF - Facility 2,2. $0 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"$0-$290/Visit: 9b. $0 Surgery ASC -- Physician,9b. $250 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $290 Surgery OP -- Facility"	"$0-$290/Visit: 8a. $0 Lab -- FSL,8a. $290 Lab -- OP"	"$0-$290/Visit: 8b, 9a. $290 DMAM -- OP,8b. $100 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $290 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $290 Radiology OP -- Facility"	"$30-$290/Visit: 5. $30 Partial Hospitalization,7h. $290 Psych -- OP"	"0%-20% Coins: 12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$10/Visit: 4b, 7a, 8a, 8b. $10 Physician Services PCP,4b, 7a, 8a, 8b. $10 PCP Cap"	"$20-$30/Visit: 7b. $20 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit: 7e, 7h. $30 Psych -- Other Provider"	"$30-$290/Visit: 7c, 7i. $290 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins: 9d, 7g. 0% Other Part B"		"DEN762: Dental 16a, 16b"	"VIS775: Vision 17a,17b"				$0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$30-$290/Visit: 3. $290 Cardiac Rehab,8b. $290 Nuclear Medicine,9a, 9c, 9d, 14d. $290 OP Other,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF,9a. $290 Observation"											182.467174	147.390153	61.381103	0	200	0.2	0.2	65	269.263198	201.084372	140.80509	52.512184	0.197233	0.2	10	29.513324	30	98.288146		0	0.2	0		0	0				0	0	0	290									NO	120.432166	97.280596	34.717029	0	161.8842	0.161884	0.161884	52.612365	217.947287	162.761913	113.970597	42.504465	0.159645	0.161884	8.09421	23.888704	24.28263	79.55649		0	0.161884	0		0	0				0	0	0	234.73209										17.195	0.580116621	1.364147793	0	0.450982401	1.31773576	0.40956652	2.004925699	7.246747293	14.36265374	12.59698014	0.543100802	0.0478935	1.26917056	2.481941103	10.67309471	0.259419431	3.982398998	0	0	3.52421468	0	0	0	0	0	0	0	0	0	0	10.45066387	0	0	0	0	0	0	0	0	90.7608	0	NO	27.067479	17.195	0.580116621	1.364147793	0	0.450982401	1.31773576	0.40956652	2.004925699	7.246747293	14.36265374	12.59698014	0.543100802	0.0478935	1.26917056	2.481941103	10.67309471	0.259419431	3.982398998	0	0	3.52421468	0	0	0	0	0	0	0	0	0	0	10.45066387	0	0	0	0	0	0	0	0	90.7608	YES	20% Coins; $375/Day(Days 1-27)	20% Coins; $375/Day(Days 1-27)	"30% Coins(Days 1-100) ; $175/Day(Days 1-20), $175 (Days 21-58),  $0 (Days 59-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/Visit	30% Coins	30% Coins	30% Coins; $100/Visit	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins; $40/Visit		30% Coins	20%-30% Coins	0% Coins		"DEN762: Dental 16a, 16b"	"VIS775: Vision 17a,17b"						30% Coins	30% Coins									10000	4.2631	0.1415	0.3909	2.7447	3.3815	2.5096	0.7789	0.2018	1.9995	0.2515	0.8402	0.0307	0.005	0.1947	1.119	1.6304	0.039	0.1675		0.2271	0.554	0		0	0				0	0	0.4416	0.686									22.5981	0	NO	5.627148	21.4581	0.721661621	1.755030793	2.744679	3.832472401	3.82734376	1.18842752	2.206726699	9.246271293	14.61419874	13.43717414	0.573778802	0.0528455	1.46385956	3.600911103	12.30351571	0.298404431	4.149925998	0	0.227084	4.07819368	0	0	0	0	0	0	0	0	0	0.441588	11.13670087	0	0	0	0	0	0	0	0	113.3589
R5826_076_0	2012	4																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0											0	YES	249.28	9.18	412.75	1335.61	25.36	6.45	8542.47	365.5	310.3	1113.15	973.92	137.26	0.31	555.89	2872.72	3881.3	94.66	546.52		1359.53	20.87	0			0.61				5.13	0.95											3400	"$0/Admit: 1a. $0 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0/Admit: 1b. $0 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-14), $0 (Days 15-20),  $0 (Days 21-100) : 2. $0 SNF - Facility 1,2. $0 SNF - Facility 2,2. $0 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$0/Trip: 10a. $0 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"$0/Service: 11b. $0 Supplies,11b. $0 Prosthetics,11c. $0 Diabetic Monitoring Supplies"	"$0/Visit: 4a, 4b. $0 Emergency Room"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $0 Surgery OP -- Facility"	"$0/Visit: 8a. $0 Lab -- FSL,8a. $0 Lab -- OP"	"$0/Visit: 8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	"$0/Visit: 5. $0 Partial Hospitalization,7h. $0 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0/Visit: 3. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a, 9c, 9d, 14d. $0 OP Other,8b. $0 Rad therapy,3, 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF,9a. $0 Observation"	"$0/Visit: 4b, 7a, 8a, 8b. $0 Physician Services PCP,4b, 7a, 8a, 8b. $0 PCP Cap"	"$0/Visit: 7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $0 Spec Cap"	"$0/Visit: 7e, 7h. $0 Psych -- Other Provider"	"$0/Visit: 7c, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b													0	0	0	0	0	0	0	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	0	0	0	0	0	0	0.199928	0	0	0	0	0		0	0.199928	0			0				0	0												0	0	0	0	0	0	0	0	0	0	0	0	0.06197768	0	0	0	0	0	0	0	4.17249736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.2345	0	NO	0.00152	0	0	0	0	0	0	0	0	0	0	0	0	0.06197768	0	0	0	0	0	0	0	4.17249736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.2345	YES	0%-30% Coins	0%-30% Coins	"30% Coins(Days 1-14), 30% (Days 15-20), 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			"VIS775: Vision 17a,17b"																5100	3.3496	0.0631	0.2064	2.8624	0	3.1156	1.5524	0	2.2471	0.346	0.9578	0.0402	0.0081	0.8645	1.2983	2.66	0.0297	0.1886		0.2507	0.8562	0			0				0	0											20.8967	1000	NO	7.326406	3.3496	0.06315	0.206409	2.862379	0	3.115625	1.552365	0	2.247096	0.346005	0.957791	0.040202	0.07006368	0.864513	1.298291	2.660033	0.029674	0.188561	0	0.250677	5.02868636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1312
R5826_077_0	2012	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	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	1097.2	66.64	223.51	922.66	22.54	6.63	2.55	342.45	43.07	7.09	3.52	1.01	0.2	17.63	2645.66	3524.29	83.25	1.49		1391.56	21.83	0			0.61				3.23	0.81	903.77	174.11	525.75	0	0	413.16					5900	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 Emergency Room"	"20%-25% Coins: 9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins: 8a. 25% Lab -- OP	"20%-25% Coins: 8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 25% Radiology OP -- Facility"	"20%-25% Coins: 5. 20% Partial Hospitalization,7h. 25% Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins: 3. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a, 9c, 9d, 14d. 25% OP Other,8b. 20% Rad therapy,9a. 25% Observation"	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"25% Coins: 7c, 7i. 25% Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	$0/Visit: 8a. $0 Lab -- FSL	"$0-$175/Visit: 14a. $0 SMAM -- FSR,14a. $0 SMAM -- OP,8b. $175 Advanced Imaging -- FSR,8b. $175 Advanced Imaging -- Office,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician"	"$20/Visit: 3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit: 9b. $0 Surgery ASC -- Physician,9a. $0 Surgery OP -- Physician"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"							182.210148	129.289607	38.216144	0	200	0.2	0.2	65	0.240643	0.25	0.241686	0.207649	0.2	0.236217	20	39.012593	40	0.25		0	0.2	0			0				0	0	0	0	120.820664	0	0	20					NO	147.952089	104.981351	31.159265	0	179.806	0.179806	0.179806	58.43695	0.216345	0.224758	0.217283	0.186683	0.179806	0.212366	17.9806	35.073492	35.9612	0.224758		0	0.179806	0			0				0	0	0	0	108.621401	0	0	17.9806						13.5278	0.582996436	0.580367277	0	0.337735603	1.19211378	0.4585053	1.667644461	9.31797915	1.59353422	0.76483616	0.18854983	0.0359612	3.74401258	3.96421285	10.30076309	0.249480825	0.33488942	0	0	3.92516498	0	0	0	0	0	0	0	0	0	0	0	4.758975131	0	0	0.619072058	0	0	0	0	58.1445	0	NO	8.279017	13.5278	0.582996436	0.580367277	0	0.337735603	1.19211378	0.4585053	1.667644461	9.31797915	1.59353422	0.76483616	0.18854983	0.0359612	3.74401258	3.96421285	10.30076309	0.249480825	0.33488942	0	0	3.92516498	0	0	0	0	0	0	0	0	0	0	0	4.758975131	0	0	0.619072058	0	0	0	0	58.1445	YES	$0-$250/Day(Days 1-7)	$0-$250/Day(Days 1-5)	"$0/Day(Days 1-5), $50 (Days 6-100)"	$0/Visit	$200/Trip	$10: Diabetic Shoes20% Coins: DME	20% Coins	$65/Visit	20%-25% Coins	25% Coins	20%-25% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$20/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	$0/Service			"VIS775: Vision 17a,17b"						20% Coins	$0/Visit	$0-$175/Visit	$20/Visit	$0/Visit	$20/Visit					7300	5.3615	0.2311	0.2312	0	3.1712	2.2327	0.8606	0.6314	3.5834	0.6129	0.294	0.073	0.0137	1.4395	1.559	4.0511	0.0981	0.1289		0	1.634	0			0				0	0	0.3985	0	1.83	0	0	0.2435					28.6792	0	NO	2.931578	18.8892	0.814059436	0.811549277	0	3.508889603	3.42480878	1.3190753	2.299009461	12.90137515	2.20645922	1.05887616	0.26157583	0.0496832	5.18353558	5.52326185	14.35185309	0.347595825	0.46378842	0	0	5.55917598	0	0	0	0	0	0	0	0	0	0.398486	0	6.588939131	0	0	0.862538058	0	0	0	0	86.8237
R5826_078_0	2012	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	1500.77	83.29	446.88	2017.6	25.97	8.93	2.51	461.91	373.05	1240.63	1021.47	105.8	0.28	13.33	3143.11	3848.66	85.48	667.82		1636.88	20.33	0			0.61				4.5	1.28	1332.61	604.53									5900	"$0-$255/Day(Days 1-7): 1a. $255 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$255/Day(Days 1-5): 1b. $255 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-20),  $100 (Days 21-100) : 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $100 SNF - Facility 3,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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,14a. $0 SMAM -- FSR,14a. $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"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$15/Visit: 4b, 7a, 8a, 8b. $15 Physician Services PCP,4b, 7a, 8a, 8b. $15 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$15/Visit: 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c$0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$15-$200/Visit: 3. $15 Cardiac Rehab,8b. $200 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											185.85435	131.8754	49.537808	0	200	0.2	0.2	65	239.906253	39.068789	112.976887	42.00632	0.2	0.2	15	39.088645	40	15		0	0.2	0			0				0	0	0	74.324669									NO	148.371059	105.278637	37.759798	0	180.5612	0.180561	0.180561	58.68239	216.588805	35.271537	101.996211	37.923558	0.180561	0.180561	13.54209	35.289463	36.11224	13.54209		0	0.180561	0			0				0	0	0	67.100757										18.5559	0.730721473	1.406174878	0	0.39076453	1.61240973	0.45320811	2.258831897	6.733204475	3.646577246	8.682172471	0.33435937	0.05055708	2.40687813	3.547023208	11.31809539	0.257239523	0.753639879	0	0	3.67080513	0	0	0	0	0	0	0	0	0	0	3.380368386	0	0	0	0	0	0	0	0	70.1889	0	NO	10.63969	18.5559	0.730721473	1.406174878	0	0.39076453	1.61240973	0.45320811	2.258831897	6.733204475	3.646577246	8.682172471	0.33435937	0.05055708	2.40687813	3.547023208	11.31809539	0.257239523	0.753639879	0	0	3.67080513	0	0	0	0	0	0	0	0	0	0	3.380368386	0	0	0	0	0	0	0	0	70.1889	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-20), 30% (Days 21-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									8800	4.9158	0.0856	0.3067	2.6396	2.5399	2.6622	0.7473	0.1971	1.6812	0.269	0.731	0.0219	0.0044	0.32	0.9168	1.7509	0.018	0.1537		0.1929	0.4879	0			0				0	0	0.5874	0.5084									21.7377	0	NO	7.729228	23.4717	0.816336473	1.712849878	2.639564	2.93063653	4.27459173	1.20052511	2.455942897	8.414382475	3.915555246	9.413189471	0.35629637	0.05499508	2.72687713	4.463834208	13.06897539	0.275223523	0.907370879	0	0.192876	4.15868713	0	0	0	0	0	0	0	0	0	0.587404	3.888724386	0	0	0	0	0	0	0	0	91.9266
R5826_079_0	2012	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	1407.1	54.5	432.25	1253.68	34.24	7.63	2.63	473.69	282.24	1033.12	937.06	153.96	0.96	9.56	3261.68	3579.58	110.32	436.97		1591.88	22.14	0			0.61				3.99	0.81	1502.69	490.27									5900	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-5), $50 (Days 6-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$10: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$20/Visit: 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS775: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$20-$175/Visit: 3. $20 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	38.216144	0	200	0.2	0.2	65	250	37.429094	101.536062	40.8586	0.2	0.2	20	39.062804	40	20		0	0.2	0			0				0	0	0	76.289217									NO	150.066638	106.481757	30.942656	0	182.882	0.182882	0.182882	59.43665	228.6025	34.225538	92.845591	37.361512	0.182882	0.182882	18.2882	35.719418	36.5764	18.2882		0	0.182882	0			0				0	0	0	69.759623										17.5966	0.483604646	1.114580255	0	0.521823307	1.39538966	0.48097966	2.346212228	5.3767308	2.946590652	7.250157459	0.479348199	0.17556672	1.74835192	4.970854681	10.65504286	0.336259037	0.665949563	0	0	4.04900748	0	0	0	0	0	0	0	0	0	0	2.850087531	0	0	0	0	0	0	0	0	65.4431	0	NO	8.46372	17.5966	0.483604646	1.114580255	0	0.521823307	1.39538966	0.48097966	2.346212228	5.3767308	2.946590652	7.250157459	0.479348199	0.17556672	1.74835192	4.970854681	10.65504286	0.336259037	0.665949563	0	0	4.04900748	0	0	0	0	0	0	0	0	0	0	2.850087531	0	0	0	0	0	0	0	0	65.4431	YES	30% Coins	30% Coins	"30% Coins(Days 1-7), 30% (Days 8-100)"	30% Coins	$200/Trip	30% Coins	30% Coins	$65/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			"VIS775: Vision 17a,17b"						30% Coins	30% Coins									8800	4.905	0.061	0.2939	2.2367	3.4034	2.3106	0.7979	0.2054	1.2902	0.244	0.6196	0.0276	0.0156	0.2333	0.9587	1.5838	0.0216	0.0875		0.1798	0.573	0			0				0	0	0.5923	0.4009									21.0417	0	NO	6.895306	22.5016	0.544611646	1.408430255	2.236731	3.925199307	3.70594166	1.27886166	2.551587228	6.6669068	3.190561652	7.869775459	0.506983199	0.19114172	1.98161292	5.929563681	12.23882986	0.357831037	0.753498563	0	0.179844	4.62196048	0	0	0	0	0	0	0	0	0	0.592342	3.250962531	0	0	0	0	0	0	0	0	86.4848
R5826_081_0	2012	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			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	1662.45	163.9	607.22	1220.41	32.79	6.82	1.74	431.91	290.42	1464.77	909.39	191.85	0.98	5.97	2959.16	3693.26	169.76	703.33		1343.93	24.44	0			0.79				5.4	1.09	915.85	639.81									6700	"$0-$250/Day(Days 1-7): 1a. $250 IP Acute - Facility 1,1a. $0 IP Acute - Physician"	"$0-$250/Day(Days 1-5): 1b. $250 IP Psych - Facility 1,1b. $0 IP Psych - Physician"	"$0/Day(Days 1-7), $50 (Days 8-100): 2. $0 SNF - Facility 1,2. $50 SNF - Facility 2,2. $0 SNF - Physician"	$0/Visit: 6. $0 Home Health	$200/Trip: 10a. $200 Ambulance Emergency	$0: Diabetic Shoes 11c20% Coins: DME 11a	"20% Coins: 11b. 20% Supplies,11b. 20% Prosthetics"	"$65/Visit: 4a, 4b. $65 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-$50/Visit: 8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$175/Visit: 8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14a. $0 SMAM -- FSR,14a. $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. $50 Radiology OP -- Facility"	"$40-$50/Visit: 5. $40 Partial Hospitalization,7h. $50 Psych -- OP"	"20% Coins: 12. 20% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins: 8b. 20% Rad therapy	"$20/Visit: 4b, 7a, 8a, 8b. $20 Physician Services PCP,4b, 7a, 8a, 8b. $20 PCP Cap"	"$20-$40/Visit: 7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit: 7e, 7h. $40 Psych -- Other Provider"	"$40-$50/Visit: 7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit: 14a, 14b, 14d, 14e. $0 Preventive Services"	"20% Coins: 15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service: 9d, 7g. $0 Other Part B"			"VIS776: Vision 17a,17b"				$0: Additional Smoking Cessation 14c              $0: Health Education Materials 14c                $0: Membership in health club/fitness class 14c   $0: Nurse hotline 14c	$0: Member Incentive Program 14c                  $0: Nutritional benefit 13c                       $0: OTC items 13b	$0/Service: 11c. $0 Diabetic Monitoring Supplies	"$40-$175/Visit: 3. $50 Cardiac Rehab,8b. $175 Nuclear Medicine,9a, 9c, 9d, 14d. $50 OP Other,3, 7c, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF,9a. $150 Observation"											182.210148	129.289608	34.03605	0	200	0.2	0.2	65	250	38.733142	88.646234	41.457302	0.2	0.2	20	39.122681	40	42.687237		0	0.2	0			0				0	0	0	72.801703									NO	148.935841	105.679386	27.244258	0	183.8582	0.183858	0.183858	59.753915	229.82275	35.607029	81.491685	38.111325	0.183858	0.183858	18.38582	35.965129	36.77164	39.241993		0	0.183858	0			0				0	0	0	66.925951										20.6332	1.44340428	1.378604862	0	0.502392532	1.25391156	0.31991292	2.150692786	5.562093588	4.346342322	6.175643619	0.609304808	0.18018084	1.09763226	4.533881926	11.06904769	0.520196134	2.300005911	0	0	4.49348952	0	0	0	0	0	0	0	0	0	0	3.568324392	0	0	0	0	0	0	0	0	72.1383	0	NO	9.549923	20.6332	1.44340428	1.378604862	0	0.502392532	1.25391156	0.31991292	2.150692786	5.562093588	4.346342322	6.175643619	0.609304808	0.18018084	1.09763226	4.533881926	11.06904769	0.520196134	2.300005911	0	0	4.49348952	0	0	0	0	0	0	0	0	0	0	3.568324392	0	0	0	0	0	0	0	0	72.1383	YES	20% Coins	20% Coins	"20% Coins(Days 1-7), 20% (Days 8-100)"	20% Coins	$200/Trip	20% Coins	20% Coins	$65/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins			"VIS776: Vision 17a,17b"						20% Coins	20% Coins									10000	4.3814	0.1469	0.3836	1.3982	3.5266	1.4908	0.3792	0.2027	0.9821	0.1868	0.4157	0.0255	0.0173	0.105	0.617	1.2164	0.0218	0.1118		0.1059	0.5019	0			0				0	0	0.264	0.3145									16.795	0	NO	3.128447	25.0146	1.59033428	1.762200862	1.398159	4.028997532	2.74468056	0.69914192	2.353349786	6.544176588	4.533111322	6.591295619	0.634824808	0.19749184	1.20260926	5.150914926	12.28547269	0.541982134	2.411791911	0	0.105924	4.99536352	0	0	0	0	0	0	0	0	0	0.26401	3.882814392	0	0	0	0	0	0	0	0	88.9333
R5826_801_0	2012	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	YES	272.33	3.25	32.38	24.99	1.48	6.98	3.41	23.06	69.74	10.32	29.21	0.41	0.12	32.41	36.4	80.11	0.56	8.99		8.75	39.24	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																					0.0915	0.0915	0.1934	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.070377	0.070377	0.106133	0	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076	0.196076		0.196076	0.196076	0																				19.1658	0.22872525	3.43658654	0	0.29019248	1.36861048	0.66861916	4.52151256	13.67434024	2.02350432	5.72737996	0.08039116	0.02352912	6.35482316	7.1371664	15.70764836	0.10980256	1.76272324	0	1.715665	7.69402224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.691	0	NO	18.453826	19.1658	0.22872525	3.43658654	0	0.29019248	1.36861048	0.66861916	4.52151256	13.67434024	2.02350432	5.72737996	0.08039116	0.02352912	6.35482316	7.1371664	15.70764836	0.10980256	1.76272324	0	1.715665	7.69402224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.691	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	2.2235	0.0261	0.4646	0	2.2096	1.7589	0.8597	0.468	1.4711	0.2093	0.6261	0.0086	0.0025	0.6576	0.8621	1.8973	0.0132	0.2037		0.2073	0.9292	0																			15.0984	0	NO	1.434328	21.3893	0.25483525	3.90115354	0	2.49974248	3.12755648	1.52831616	4.98947756	15.14545624	2.23284532	6.35348396	0.08896516	0.02601112	7.01242116	7.9992534	17.60492436	0.12302856	1.96642424	0	1.922965	8.62324424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7894
R5826_802_0	2012	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	YES	274	1.17	50.33	24.09	1.34	7.04	2.65	22.27	69.24	24.62	33.14	0.49	0.13	33.82	34.62	86.51	0.36	13.03		6.51	38.48	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																					0.0815	0.0815	0.1809	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062605	0.062605	0.083435	0	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626	0.194626		0.194626	0.194626	0																				17.1538	0.07324785	4.19928355	0	0.26079884	1.37016704	0.5157589	4.33432102	13.47590424	4.79169212	6.44990564	0.09536674	0.02530138	6.58225132	6.73795212	16.83709526	0.07006536	2.53597678	0	1.26701526	7.48920848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2651	0	NO	21.098049	17.1538	0.07324785	4.19928355	0	0.26079884	1.37016704	0.5157589	4.33432102	13.47590424	4.79169212	6.44990564	0.09536674	0.02530138	6.58225132	6.73795212	16.83709526	0.07006536	2.53597678	0	1.26701526	7.48920848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2651	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	1.986	0.0083	0.5966	0	1.9869	1.7627	0.6639	0.4493	1.4604	0.4967	0.7001	0.01	0.0027	0.6823	0.8152	2.0373	0.0084	0.2986		0.1533	0.9061	0																			15.0247	0	NO	1.644103	19.1398	0.08155785	4.79589555	0	2.24766484	3.13283204	1.1796189	4.78357702	14.93629524	5.28834912	7.14996864	0.10541074	0.02799438	7.26460032	7.55316112	18.87442926	0.07843536	2.83454878	0	1.42036426	8.39535448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2898
R5826_803_0	2012	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	YES	224.56	4.26	45.32	24.76	1.2	6.08	2.61	19.73	60.89	13.78	26.3	0.98	0.11	22.64	33.87	83.93	0.63	9.87		8.97	41.57	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																					0.0812	0.0812	0.1814	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065512	0.065512	0.093337	0	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899	0.198899		0.198899	0.198899	0																				14.7114	0.27908112	4.23003284	0	0.2386788	1.20930592	0.51912639	3.92427727	12.11096011	2.74082822	5.2310437	0.19492102	0.02187889	4.50307336	6.73670913	16.69359307	0.12530637	1.96313313	0	1.78412403	8.26823143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4857	0	NO	15.943843	14.7114	0.27908112	4.23003284	0	0.2386788	1.20930592	0.51912639	3.92427727	12.11096011	2.74082822	5.2310437	0.19492102	0.02187889	4.50307336	6.73670913	16.69359307	0.12530637	1.96313313	0	1.78412403	8.26823143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4857	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	1.6716	0.0312	0.5795	0	1.7967	1.5468	0.6643	0.4041	1.3012	0.2821	0.5719	0.0207	0.0023	0.4637	0.8097	2.0064	0.0151	0.2273		0.2145	0.9937	0																			13.6028	0	NO	1.187503	16.3829	0.31029212	4.80952184	0	2.0353508	2.75609092	1.18338239	4.32838027	13.41217411	3.02297022	5.8029167	0.21565202	0.02420089	4.96672736	7.54642713	18.69997707	0.14040137	2.19045613	0	1.99864203	9.26195343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0884
R5826_804_0	2012	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	YES	232.68	3.41	19.28	31.25	1.13	7.41	2.83	20.1	73.08	9.8	28.32	0.61	0.14	20.06	35.49	101.56	0.39	8.96		9.43	39.13	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																					0.0824	0.0824	0.1858	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067163	0.067163	0.128715	0	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391	0.198391		0.198391	0.198391	0																				15.6275	0.22902583	2.4816252	0	0.22418183	1.47007731	0.56144653	3.9876591	14.49841428	1.9442318	5.61843312	0.12101851	0.02777474	3.97972346	7.04089659	20.14858996	0.07737249	1.77758336	0	1.87082713	7.76303983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4494	0	NO	13.876526	15.6275	0.22902583	2.4816252	0	0.22418183	1.47007731	0.56144653	3.9876591	14.49841428	1.9442318	5.61843312	0.12101851	0.02777474	3.97972346	7.04089659	20.14858996	0.07737249	1.77758336	0	1.87082713	7.76303983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4494	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	1.7806	0.0257	0.31	0	1.6976	1.8839	0.7188	0.4118	1.5616	0.2007	0.6112	0.0128	0.0029	0.411	0.8488	2.4288	0.0093	0.2084		0.2255	0.9358	0																			14.2853	0	NO	1.018438	17.4081	0.25471983	2.7916032	0	1.92180983	3.35402431	1.28021853	4.3994791	16.05996628	2.1449448	6.22966312	0.13386351	0.03071874	4.39069346	7.88966959	22.57736096	0.08669249	1.98599736	0	2.09636213	8.69880983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7347
R5826_805_0	2012	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	YES	215.23	1.43	28.41	18.12	0.86	6.33	2.23	20.84	69.41	7.68	36.35	1.02	0.07	36.09	38.67	126.23	0.64	10.04		8.01	48.15	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																					0.0876	0.0876	0.1666	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069792	0.069792	0.103339	0	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765	0.194765		0.194765	0.194765	0																				15.0213	0.09980256	2.93586099	0	0.1674979	1.23286245	0.43432595	4.0589026	13.51863865	1.4957952	7.07970775	0.1986603	0.01363355	7.02906885	7.53156255	24.58518595	0.1246496	1.9554406	0	1.56006765	9.37793475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4209	0	NO	17.717771	15.0213	0.09980256	2.93586099	0	0.1674979	1.23286245	0.43432595	4.0589026	13.51863865	1.4957952	7.07970775	0.1986603	0.01363355	7.02906885	7.53156255	24.58518595	0.1246496	1.9554406	0	1.56006765	9.37793475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4209	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	1.7298	0.0112	0.3824	0	1.2759	1.5858	0.5586	0.4202	1.4666	0.1548	0.7733	0.0215	0.0013	0.7278	0.9103	2.9715	0.015	0.2289		0.1885	1.1334	0																			14.5568	0	NO	1.318018	16.7512	0.11102556	3.31821499	0	1.4433559	2.81866545	0.99290395	4.4791286	14.98519665	1.6506442	7.85296775	0.2201173	0.01497055	7.75683685	8.44181455	27.55672095	0.1396556	2.1843186	0	1.74861565	10.51137475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9777
R5826_806_0	2012	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	YES	368.18	2.1	47.67	24.25	1.4	7.19	4.04	27.47	82.35	22	29.36	1.49	1.7	32.25	38.37	85.93	0.54	11.05		7.16	29.36	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																					0.0794	0.0794	0.1798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.057801	0.057801	0.081008	0	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185	0.192185		0.192185	0.192185	0																				21.2812	0.1213821	3.86165136	0	0.269059	1.38181015	0.7764274	5.27932195	15.82643475	4.22807	5.6425516	0.28635565	0.3267145	6.19796625	7.37413845	16.51445705	0.1037799	2.12364425	0	1.3760446	5.6425516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6135	0	NO	24.849728	21.2812	0.1213821	3.86165136	0	0.269059	1.38181015	0.7764274	5.27932195	15.82643475	4.22807	5.6425516	0.28635565	0.3267145	6.19796625	7.37413845	16.51445705	0.1037799	2.12364425	0	1.3760446	5.6425516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6135	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	2.5141	0.0141	0.5487	0	2.0537	1.7862	1.003	0.5494	1.7127	0.44	0.6147	0.0307	0.034	0.6449	0.8957	2.006	0.0125	0.2404		0.1672	0.6854	0																			15.9535	0	NO	1.973561	23.7953	0.1354831	4.41038336	0	2.322731	3.16802615	1.7793934	5.82872795	17.53911275	4.668115	6.2572696	0.31706865	0.3606645	6.84290025	8.26985645	18.52048405	0.1162799	2.36400825	0	1.5432886	6.3279416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5671
R5826_807_0	2012	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	YES	310.12	2.49	79.74	31.89	1.78	7.68	2.99	26.71	60.73	20.92	26.15	1.02	0.39	41.19	30.37	71.34	0.7	6.96		4.93	23.42	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																					0.0822	0.0822	0.1739	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.06148	0.06148	0.060907	0	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517	0.195517		0.195517	0.195517	0																				19.0662	0.1530852	4.85672418	0	0.34802026	1.50157056	0.58459583	5.22225907	11.87374741	4.09021564	5.11276955	0.19942734	0.07625163	8.05334523	5.93785129	13.94818278	0.1368619	1.36079832	0	0.96389881	4.57900814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0648	0	NO	24.809279	19.0662	0.1530852	4.85672418	0	0.34802026	1.50157056	0.58459583	5.22225907	11.87374741	4.09021564	5.11276955	0.19942734	0.07625163	8.05334523	5.93785129	13.94818278	0.1368619	1.36079832	0	0.96389881	4.57900814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0648	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	2.2188	0.0175	0.7369	0	2.6395	1.9282	0.7499	0.5402	1.2811	0.4231	0.5499	0.0211	0.0079	0.833	0.7168	1.684	0.0166	0.1528		0.1165	0.5529	0																			15.1865	0	NO	2.040694	21.285	0.1705722	5.59360918	0	2.98749026	3.42974556	1.33447383	5.76247407	13.15485241	4.51331764	5.66263955	0.22056834	0.08411763	8.88634923	6.65460329	15.63216278	0.1534489	1.51363032	0	1.08036081	5.13188614	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2513
R5826_808_0	2012	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	YES	281.21	3.38	49.44	25	1.45	8.1	3.23	22.31	67.56	15.51	26.44	0.31	0.14	28.21	28.87	72.16	0.22	5.46		6.5	27.45	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																					0.0828	0.0828	0.1906	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064412	0.064412	0.088416	0	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233	0.198233		0.198233	0.198233	0																				18.1133	0.21771256	4.37128704	0	0.28743785	1.6056873	0.64029259	4.42257823	13.39262148	3.07459383	5.24128052	0.06145223	0.02775262	5.59215293	5.72298671	14.30449328	0.04361126	1.08235218	0	1.2885145	5.44149585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9316	0	NO	18.373297	18.1133	0.21771256	4.37128704	0	0.28743785	1.6056873	0.64029259	4.42257823	13.39262148	3.07459383	5.24128052	0.06145223	0.02775262	5.59215293	5.72298671	14.30449328	0.04361126	1.08235218	0	1.2885145	5.44149585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9316	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	2.0793	0.0246	0.6182	0	2.17	2.0536	0.8193	0.4553	1.4355	0.3167	0.5691	0.0065	0.0029	0.5758	0.6879	1.7195	0.0053	0.1204		0.1548	0.6541	0																			14.4689	0	NO	1.453439	20.1926	0.24231156	4.98953304	0	2.45743585	3.6592753	1.45955259	4.87791923	14.82813048	3.39131083	5.81038452	0.06792823	0.03062662	6.16796993	6.41088271	16.02400628	0.04894926	1.20279218	0	1.4432855	6.09559985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4005
R5826_809_0	2012	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	YES	287.68	1.87	62.09	13.68	1.05	4.93	2.47	20.06	68.36	17.27	24.44	1.09	0.54	28.49	26.79	63.71	0.7	8.18		6.86	36.91	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																					0.0851	0.0851	0.1773	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065428	0.065428	0.074598	0	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148	0.198148		0.198148	0.198148	0																				18.8223	0.12235036	4.63178982	0	0.2080554	0.97686964	0.48942556	3.97484888	13.54539728	3.42201596	4.84273712	0.21598132	0.10699992	5.64523652	5.30838492	12.62400908	0.1387036	1.62085064	0	1.35929528	7.31364268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3689	0	NO	20.13425	18.8223	0.12235036	4.63178982	0	0.2080554	0.97686964	0.48942556	3.97484888	13.54539728	3.42201596	4.84273712	0.21598132	0.10699992	5.64523652	5.30838492	12.62400908	0.1387036	1.62085064	0	1.35929528	7.31364268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3689	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	2.1671	0.0139	0.6666	0	1.5722	1.2477	0.6251	0.4087	1.4418	0.3518	0.5257	0.0228	0.0111	0.5805	0.637	1.5152	0.0167	0.182		0.1631	0.8777	0																			13.0266	0	NO	1.514872	20.9894	0.13623236	5.29840282	0	1.7802164	2.22457664	1.11453256	4.38353288	14.98722328	3.77383496	5.36842012	0.23882032	0.11806992	6.22570952	5.94538692	14.13916708	0.1553576	1.80286664	0	1.52239928	8.19133468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3955
R5826_810_0	2012	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	YES	261.32	1.72	28.73	20.27	1.04	6.74	2.52	19.05	68.28	10.61	28.81	0.67	0.11	28.98	31.25	80.24	0.37	9.05		8.11	28.61	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																					0.0857	0.0857	0.1851	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.068447	0.068447	0.112689	0	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369	0.199369		0.199369	0.199369	0																				17.8866	0.11772884	3.23755497	0	0.20734376	1.34374706	0.50240988	3.79797945	13.61291532	2.11530509	5.74382089	0.13357723	0.02193059	5.77771362	6.23028125	15.99736856	0.07376653	1.80428945	0	1.61688259	5.70394709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9251	0	NO	14.609225	17.8866	0.11772884	3.23755497	0	0.20734376	1.34374706	0.50240988	3.79797945	13.61291532	2.11530509	5.74382089	0.13357723	0.02193059	5.77771362	6.23028125	15.99736856	0.07376653	1.80428945	0	1.61688259	5.70394709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9251	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	2.0455	0.0132	0.4234	0	1.5626	1.7178	0.6415	0.3909	1.4652	0.2177	0.6228	0.0142	0.0023	0.5946	0.7483	1.9215	0.009	0.2098		0.1942	0.6851	0																			13.4796	0	NO	1.058359	19.9321	0.13093384	3.66091297	0	1.76989676	3.06157006	1.14387788	4.18888245	15.07809032	2.33297609	6.36663789	0.14774123	0.02425259	6.37229162	6.97861925	17.91890056	0.08274153	2.01413645	0	1.81112359	6.38900509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4047
R5826_811_0	2012	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	YES	281.34	1.66	20.56	38.21	1.3	8.37	2.97	20.3	83.79	13.08	35.37	0.75	0.15	24.54	35.04	100.91	0.42	10.05		8.5	33.68	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																					0.0822	0.0822	0.2147	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064083	0.064083	0.133888	0	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527	0.19527		0.19527	0.19527	0																				18.0291	0.10637778	2.75273728	0	0.253851	1.6344099	0.5799519	3.963981	16.3616733	2.5541316	6.9066999	0.1464525	0.0292905	4.7919258	6.8422608	19.7046957	0.0820134	1.9624635	0	1.659795	6.5766936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9385	0	NO	17.683613	18.0291	0.10637778	2.75273728	0	0.253851	1.6344099	0.5799519	3.963981	16.3616733	2.5541316	6.9066999	0.1464525	0.0292905	4.7919258	6.8422608	19.7046957	0.0820134	1.9624635	0	1.659795	6.5766936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9385	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	2.0912	0.0121	0.3651	0	1.9384	2.1102	0.7483	0.4121	1.7772	0.2655	0.7603	0.0156	0.003	0.498	0.8301	2.3909	0.0098	0.2294		0.2014	0.798	0																			15.4568	0	NO	1.33403	20.1203	0.11851378	3.11779928	0	2.192233	3.7446589	1.3282239	4.3761	18.1388403	2.8196156	7.6669849	0.1621005	0.0323255	5.2899668	7.6723848	22.0956287	0.0918634	2.1919085	0	1.861225	7.3747056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.3954
R5826_812_0	2012	9																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	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	310.29	1.6	23.82	28.84	1.1	7.45	3.4	22.42	72.37	10.86	30.82	0.69	7.4	21.1	38.2	102.19	0.55	8.27		9.66	51.53	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																					0.0754	0.0754	0.1924	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.058474	0.058474	0.117911	0	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735	0.194735		0.194735	0.194735	0																				18.1439	0.0935584	2.80864002	0	0.2142085	1.45077575	0.662099	4.3659587	14.09297195	2.1148221	6.0017327	0.13436715	1.441039	4.1089085	7.438877	19.89996965	0.10710425	1.61045845	0	1.8811401	10.03469455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6052	0	NO	18.40851	18.1439	0.0935584	2.80864002	0	0.2142085	1.45077575	0.662099	4.3659587	14.09297195	2.1148221	6.0017327	0.13436715	1.441039	4.1089085	7.438877	19.89996965	0.10710425	1.61045845	0	1.8811401	10.03469455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6052	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	2.1063	0.0107	0.3692	0	1.6295	1.8703	0.8536	0.4535	1.5235	0.2196	0.6595	0.0145	0.1497	0.4267	0.9018	2.4124	0.013	0.1852		0.228	1.2166	0																			15.2438	0	NO	1.388995	20.2502	0.1042734	3.17784902	0	1.8436715	3.32112275	1.515649	4.8194147	15.61651895	2.3343971	6.6612657	0.14887115	1.590783	4.5356505	8.34072	22.31237265	0.12014425	1.79569445	0	2.1091291	11.25128355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.849
R5826_813_0	2012	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	YES	240	2.89	36.05	8.14	1.05	5.89	2.47	21.19	72.59	12.68	24.83	1.19	0.11	38.48	30.71	81.41	0.59	9.87		7.12	35.18	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																					0.0867	0.0867	0.1509	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069487	0.069487	0.091121	0	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483	0.198483		0.198483	0.198483	0																				16.6769	0.20081743	3.28491205	0	0.20840715	1.16906487	0.49025301	4.20585477	14.40788097	2.51676444	4.92833289	0.23619477	0.02183313	7.63762584	6.09541293	16.15850103	0.11710497	1.95902721	0	1.41319896	6.98263194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7107	0	NO	15.148501	16.6769	0.20081743	3.28491205	0	0.20840715	1.16906487	0.49025301	4.20585477	14.40788097	2.51676444	4.92833289	0.23619477	0.02183313	7.63762584	6.09541293	16.15850103	0.11710497	1.95902721	0	1.41319896	6.98263194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7107	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	1.8989	0.0225	0.4312	0	1.5655	1.4902	0.6264	0.4321	1.5373	0.2585	0.5389	0.0249	0.0023	0.7847	0.7308	1.9376	0.0139	0.2201		0.1695	0.8373	0																			13.5224	0	NO	1.134765	18.5758	0.22332443	3.71610405	0	1.77385815	2.65923187	1.11670101	4.63797677	15.94513097	2.77524544	5.46725289	0.26108177	0.02413913	8.42227884	6.82620693	18.09607703	0.13104597	2.17909521	0	1.58267096	7.81994494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2331
R5826_814_0	2012	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	YES	254.33	0.67	18.43	14.84	0.92	5.36	1.98	22.92	63.1	5.85	31.64	0.49	0.16	12.69	34.31	102.96	0.25	11.17		7.96	46.27	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																					0.081	0.081	0.1381	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.066264	0.066264	0.103491	0	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562	0.199562		0.199562	0.199562	0																				16.8529	0.04439688	1.90733913	0	0.18359704	1.06965232	0.39513276	4.57396104	12.5923622	1.1674377	6.31414168	0.09778538	0.03192992	2.53244178	6.84697222	20.54690352	0.0498905	2.22910754	0	1.58851352	9.23373374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2582	0	NO	12.900507	16.8529	0.04439688	1.90733913	0	0.18359704	1.06965232	0.39513276	4.57396104	12.5923622	1.1674377	6.31414168	0.09778538	0.03192992	2.53244178	6.84697222	20.54690352	0.0498905	2.22910754	0	1.58851352	9.23373374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2582	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	1.9178	0.005	0.2276	0	1.3808	1.3643	0.503	0.47	1.3534	0.12	0.6681	0.0103	0.0033	0.2602	0.8213	2.4646	0.0059	0.2635		0.1905	1.1077	0																			13.1372	0	NO	0.92206	18.7708	0.04938288	2.13496813	0	1.56436204	2.43394532	0.89813276	5.04398504	13.9457912	1.2874397	6.98221768	0.10806938	0.03523592	2.79260278	7.66826922	23.01150352	0.0557845	2.49258654	0	1.77897252	10.34143574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3954
R5826_815_0	2012	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	YES	323.78	2.38	83.93	50.61	2.16	10.09	3.71	23.53	64.13	8.85	25.15	0.65	0.65	15.7	35.07	74.84	0.77	9.23		8.24	34.53	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																					0.0864	0.0864	0.201	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062902	0.062902	0.059232	0	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487	0.194487		0.194487	0.194487	0																				20.3664	0.14970676	4.97134176	0	0.42009192	1.96237383	0.72154677	4.57627911	12.47245131	1.72120995	4.89134805	0.12641655	0.12641655	3.0534459	6.82065909	14.55540708	0.14975499	1.79511501	0	1.60257288	6.71563611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1982	0	NO	28.927292	20.3664	0.14970676	4.97134176	0	0.42009192	1.96237383	0.72154677	4.57627911	12.47245131	1.72120995	4.89134805	0.12641655	0.12641655	3.0534459	6.82065909	14.55540708	0.14975499	1.79511501	0	1.60257288	6.71563611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1982	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	2.382	0.0172	0.7832	0	3.199	2.5232	0.9287	0.4741	1.3462	0.1782	0.54	0.0136	0.0132	0.3163	0.8247	1.7599	0.0181	0.2026		0.1937	0.8119	0																			16.5257	0	NO	2.526453	22.7485	0.16691976	5.75455076	0	3.61905692	4.48555083	1.65024177	5.05035011	13.81866431	1.89939395	5.43135505	0.14000355	0.13959455	3.3697559	7.64532909	16.31526208	0.16790499	1.99767201	0	1.79626688	7.52758511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7239
R5826_816_0	2012	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	YES	309.06	1.99	49.46	27.15	2.49	9.97	3.94	29.51	71.01	17.66	26.75	0.98	0.64	35	33.1	71.73	0.64	10.56		6.24	25.95	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																					0.0836	0.0836	0.1928	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.062825	0.062825	0.085212	0	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679	0.194679		0.194679	0.194679	0																				19.4167	0.12502175	4.21458552	0	0.48475071	1.94094963	0.76703526	5.74497729	13.82415579	3.43803114	5.20766325	0.19078542	0.12459456	6.813765	6.4438749	13.96432467	0.12459456	2.05581024	0	1.21479696	5.05192005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1483	0	NO	21.933079	19.4167	0.12502175	4.21458552	0	0.48475071	1.94094963	0.76703526	5.74497729	13.82415579	3.43803114	5.20766325	0.19078542	0.12459456	6.813765	6.4438749	13.96432467	0.12459456	2.05581024	0	1.21479696	5.05192005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1483	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	2.2587	0.0143	0.6028	0	3.6736	2.4941	0.9843	0.5945	1.488	0.3558	0.565	0.0202	0.0129	0.705	0.7783	1.6865	0.015	0.2388		0.1467	0.6101	0																			17.2446	0	NO	1.947035	21.6754	0.13930875	4.81734852	0	4.15835571	4.43505763	1.75131526	6.33944429	15.31212979	3.79386614	5.77265025	0.21093942	0.13753856	7.518748	7.2221439	15.65087467	0.13963956	2.29462924	0	1.36145496	5.66205505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3929
R5826_817_0	2012	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	YES	273.92	2.18	72.77	36.4	2.05	8.04	4.12	26.88	55.62	12.34	26.49	2.01	2.3	23.84	38.05	80.05	1	13.25		9.27	24.06	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																					0.0812	0.0812	0.1813	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.06223	0.06223	0.067298	0	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192	0.196192		0.196192	0.196192	0																				17.046	0.1356614	4.89727546	0	0.4021936	1.57738368	0.80831104	5.27364096	10.91219904	2.42100928	5.19712608	0.39434592	0.4512416	4.67721728	7.4651056	15.7051696	0.196192	2.599544	0	1.81869984	4.72037952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6987	0	NO	22.693029	17.046	0.1356614	4.89727546	0	0.4021936	1.57738368	0.80831104	5.27364096	10.91219904	2.42100928	5.19712608	0.39434592	0.4512416	4.67721728	7.4651056	15.7051696	0.196192	2.599544	0	1.81869984	4.72037952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6987	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	1.9616	0.0154	0.7341	0	3.0451	2.0234	1.0363	0.5448	1.1774	0.25	0.5645	0.042	0.0466	0.4832	0.9001	1.8937	0.0236	0.3006		0.2194	0.5692	0																			15.831	0	NO	1.929645	19.0076	0.1510124	5.63134146	0	3.4472616	3.60082468	1.84456804	5.81839296	12.08962504	2.67102928	5.76160808	0.43634292	0.4978756	5.16044628	8.3652376	17.5988716	0.219787	2.900173	0	2.03809084	5.28962052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5297
R5826_818_0	2012	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	YES	271.75	3.96	72.44	34.82	1.72	8.17	3.47	22.1	75.86	8.92	27.65	1.55	0.11	17.34	36.03	97.76	0.61	13.85		8.1	34.28	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																					0.0812	0.0812	0.1848	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.061595	0.061595	0.066905	0	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418	0.194418		0.194418	0.194418	0																				16.7384	0.2439162	4.8465982	0	0.33439896	1.58839506	0.67463046	4.2966378	14.74854948	1.73420856	5.3756577	0.3013479	0.02138598	3.37120812	7.00488054	19.00630368	0.11859498	2.6926893	0	1.5747858	6.66464904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3373	0	NO	24.521587	16.7384	0.2439162	4.8465982	0	0.33439896	1.58839506	0.67463046	4.2966378	14.74854948	1.73420856	5.3756577	0.3013479	0.02138598	3.37120812	7.00488054	19.00630368	0.11859498	2.6926893	0	1.5747858	6.66464904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3373	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	1.9406	0.0277	0.7287	0	2.5475	2.0427	0.8667	0.4452	1.5889	0.1796	0.5877	0.0323	0.0022	0.3492	0.8473	2.2987	0.0143	0.3111		0.1904	0.806	0																			15.8068	0	NO	2.044351	18.6791	0.2716192	5.5752722	0	2.88193096	3.63110206	1.54136846	4.7417898	16.33744948	1.91383556	5.9633167	0.3336649	0.02357798	3.72042512	7.85216054	21.30498468	0.13286798	3.0038243	0	1.7651768	7.47068404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1441
R5826_819_0	2012	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	YES	297.39	1.68	75.8	32.88	1.57	8.38	4.11	26.11	82.52	9.85	35.36	0.44	0.24	20.57	43.39	135.48	0.49	13.25		7.64	30.23	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																					0.0889	0.0889	0.162	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064048	0.064048	0.058439	0	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483	0.189483		0.189483	0.189483	0																				19.0472	0.10760064	4.4296762	0	0.29748831	1.58786754	0.77877513	4.94740113	15.63613716	1.86640755	6.70011888	0.08337252	0.04547592	3.89766531	8.22166737	25.67115684	0.09284667	2.51064975	0	1.44765012	5.72807109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.0973	0	NO	29.766427	19.0472	0.10760064	4.4296762	0	0.29748831	1.58786754	0.77877513	4.94740113	15.63613716	1.86640755	6.70011888	0.08337252	0.04547592	3.89766531	8.22166737	25.67115684	0.09284667	2.51064975	0	1.44765012	5.72807109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.0973	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	2.2573	0.0125	0.6661	0	2.2755	2.059	1.009	0.5166	1.7009	0.1949	0.7448	0.0091	0.0048	0.4069	1.0022	3.1289	0.0113	0.2915		0.1764	0.6982	0																			17.1657	0	NO	2.499398	21.3045	0.12008364	5.0957572	0	2.57299331	3.64686354	1.78781313	5.46398013	17.33707216	2.06126855	7.44490988	0.09245152	0.05023692	4.30458131	9.22381737	28.80001384	0.10410767	2.80212875	0	1.62401312	6.42631109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2629
R5826_820_0	2012	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	YES	428.6	3.49	86.86	46.49	2.39	7.98	3.17	34.83	72	21.29	31.61	0.97	0.15	32.21	41.37	103.26	1.12	11.11		7.42	22.9	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																					0.0794	0.0794	0.1798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.053815	0.053815	0.051954	0	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018	0.188018		0.188018	0.188018	0																				23.0651	0.18781435	4.51272444	0	0.44936302	1.50038364	0.59601706	6.54866694	13.537296	4.00290322	5.94324898	0.18237746	0.0282027	6.05605978	7.77830466	19.41473868	0.21058016	2.08887998	0	1.39509356	4.3056122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8034	0	NO	36.328635	23.0651	0.18781435	4.51272444	0	0.44936302	1.50038364	0.59601706	6.54866694	13.537296	4.00290322	5.94324898	0.18237746	0.0282027	6.05605978	7.77830466	19.41473868	0.21058016	2.08887998	0	1.39509356	4.3056122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8034	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	2.7819	0.0222	0.719	0	3.4584	1.9525	0.7758	0.6867	1.4762	0.4196	0.6517	0.0198	0.0029	0.635	0.9519	2.376	0.0257	0.2392		0.1707	0.5268	0																			17.8921	0	NO	3.124079	25.847	0.21004435	5.23170244	0	3.90777902	3.45291264	1.37185506	7.23533694	15.013477	4.42255222	6.59496898	0.20215646	0.0311247	6.69108878	8.73016666	21.79075768	0.23627116	2.32810398	0	1.56575056	4.8324322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6955
R5826_821_0	2012	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	YES	311.48	2.49	93.18	34.13	2.04	8.77	4.61	28.84	70.39	19.23	29.41	1.03	0.88	31.34	32.88	79.14	0.72	9.02		5.66	26.37	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																					0.0813	0.0813	0.1744	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.059802	0.059802	0.053171	0	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305	0.193305		0.193305	0.193305	0																				18.6271	0.14890698	4.95447378	0	0.3943422	1.69528485	0.89113605	5.5749162	13.60673895	3.71725515	5.68510005	0.19910415	0.1701084	6.0581787	6.3558684	15.2981577	0.1391796	1.7436111	0	1.0941063	5.09745285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.451	0	NO	28.798833	18.6271	0.14890698	4.95447378	0	0.3943422	1.69528485	0.89113605	5.5749162	13.60673895	3.71725515	5.68510005	0.19910415	0.1701084	6.0581787	6.3558684	15.2981577	0.1391796	1.7436111	0	1.0941063	5.09745285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.451	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	2.1702	0.017	0.7744	0	2.999	2.1818	1.147	0.5777	1.4702	0.3853	0.6139	0.0214	0.0176	0.6279	0.7689	1.8508	0.0169	0.1976		0.1323	0.6168	0																			16.5866	0	NO	2.518907	20.7974	0.16592398	5.72885678	0	3.3932972	3.87707485	2.03817605	6.1526612	15.07693295	4.10253215	6.29901905	0.22046515	0.1876644	6.6861237	7.1247314	17.1489227	0.1561136	1.9412221	0	1.2263723	5.71424085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0377
R5826_822_0	2012	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	YES	282.67	2.95	68.5	27.16	1.62	8.09	3.47	22.92	72.79	14.25	27.69	0.84	0.46	30.91	30.49	76.28	0.58	8.56		7.52	24.77	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																					0.083	0.083	0.1912	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.063077	0.063077	0.070758	0	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006	0.196006		0.196006	0.196006	0																				17.83	0.18607715	4.846923	0	0.31752972	1.58568854	0.68014082	4.49245752	14.26727674	2.7930855	5.42740614	0.16464504	0.09016276	6.05854546	5.97622294	14.95133768	0.11368348	1.67781136	0	1.47396512	4.85506862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.788	0	NO	23.213991	17.83	0.18607715	4.846923	0	0.31752972	1.58568854	0.68014082	4.49245752	14.26727674	2.7930855	5.42740614	0.16464504	0.09016276	6.05854546	5.97622294	14.95133768	0.11368348	1.67781136	0	1.47396512	4.85506862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.788	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	2.0583	0.0211	0.7252	0	2.404	2.0341	0.8725	0.4639	1.5309	0.2885	0.5903	0.0175	0.0094	0.6257	0.7204	1.8021	0.0138	0.1911		0.1777	0.5853	0																			15.1317	0	NO	1.914693	19.8883	0.20717015	5.57215	0	2.72153272	3.61983554	1.55262182	4.95632152	15.79813574	3.0815505	6.01773114	0.18217904	0.09953376	6.68420246	6.69661094	16.75346968	0.12748148	1.86889836	0	1.65168012	5.44034562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9197
R5826_823_0	2012	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	YES	326.29	2.14	92.3	23.33	1.68	6.37	3.1	26.08	61.15	19.77	27.92	0.92	0.58	30.89	27.59	61.95	0.65	10.03		4.09	25.34	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																					0.0848	0.0848	0.1709	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.06256	0.06256	0.05391	0	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073	0.196073		0.196073	0.196073	0																				20.4127	0.1338784	4.975893	0	0.32940264	1.24898501	0.6078263	5.11358384	11.98986395	3.87636321	5.47435816	0.18038716	0.11372234	6.05669497	5.40965407	12.14672235	0.12744745	1.96661219	0	0.80193857	4.96848982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9345	0	NO	26.707381	20.4127	0.1338784	4.975893	0	0.32940264	1.24898501	0.6078263	5.11358384	11.98986395	3.87636321	5.47435816	0.18038716	0.11372234	6.05669497	5.40965407	12.14672235	0.12744745	1.96661219	0	0.80193857	4.96848982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9345	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	2.3733	0.0153	0.7693	0	2.4965	1.5993	0.7776	0.5272	1.2831	0.3997	0.5908	0.0191	0.0117	0.6246	0.651	1.4619	0.0153	0.2225		0.0966	0.598	0																			14.533	0	NO	2.19951	22.786	0.1491724	5.745202	0	2.82588864	2.84832101	1.3853803	5.64083384	13.27299595	4.27607721	6.06517616	0.19949516	0.12540734	6.68131597	6.06069407	13.60864735	0.14273045	2.18906819	0	0.89856557	5.56651382	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4675
R5826_824_0	2012	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	YES	299.37	2.87	55.15	32.33	1.85	7.91	2.65	23.58	64.19	12.12	26.18	0.86	0.33	22.85	32.26	71.34	0.44	8.4		7.59	27.4	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																					0.0845	0.0845	0.1896	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064497	0.064497	0.081477	0	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473	0.197473		0.197473	0.197473	0																				19.3085	0.18510639	4.49345655	0	0.36532505	1.56201143	0.52330345	4.65641334	12.67579187	2.39337276	5.16984314	0.16982678	0.06516609	4.51225805	6.37047898	14.08772382	0.08688812	1.6587732	0	1.49882007	5.4107602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1938	0	NO	20.231109	19.3085	0.18510639	4.49345655	0	0.36532505	1.56201143	0.52330345	4.65641334	12.67579187	2.39337276	5.16984314	0.16982678	0.06516609	4.51225805	6.37047898	14.08772382	0.08688812	1.6587732	0	1.49882007	5.4107602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1938	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	2.2339	0.0211	0.6488	0	2.7597	2.0017	0.6699	0.4803	1.3609	0.2469	0.5614	0.0179	0.0067	0.4655	0.7673	1.6965	0.0105	0.1912		0.1805	0.6517	0																			14.9723	0	NO	1.630087	21.5424	0.20619439	5.14221155	0	3.12500805	3.56370643	1.19317745	5.13673734	14.03672187	2.64027776	5.73126614	0.18767678	0.07185309	4.97775305	7.13774798	15.78425082	0.09739012	1.8499752	0	1.67930207	6.0624352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1661
R5826_825_0	2012	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	YES	376.67	3.96	79.27	57.66	1.89	9.21	3.68	27.28	75.29	10.26	27.54	0.72	0.56	32.57	34.38	79.25	0.72	11.95		8.44	34.32	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																					0.0834	0.0834	0.205	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.058347	0.058347	0.059513	0	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984	0.190984		0.190984	0.190984	0																				21.9776	0.23105412	4.71759551	0	0.36095976	1.75896264	0.70282112	5.21004352	14.37918536	1.95949584	5.25969936	0.13750848	0.10695104	6.22034888	6.56602992	15.135482	0.13750848	2.2822588	0	1.61190496	6.55457088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3099	0	NO	32.890945	21.9776	0.23105412	4.71759551	0	0.36095976	1.75896264	0.70282112	5.21004352	14.37918536	1.95949584	5.25969936	0.13750848	0.10695104	6.22034888	6.56602992	15.135482	0.13750848	2.2822588	0	1.61190496	6.55457088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3099	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	2.6196	0.0271	0.7492	0	2.7634	2.2828	0.9118	0.5444	1.5601	0.2047	0.5818	0.0149	0.0112	0.6498	0.8008	1.8458	0.0168	0.2648		0.1965	0.7994	0																			16.845	0	NO	2.764675	24.5972	0.25812712	5.46681751	0	3.12437676	4.04174464	1.61458412	5.75442852	15.93932236	2.16421984	5.84149836	0.15239448	0.11811504	6.87019588	7.36687392	16.981238	0.15435248	2.5471048	0	1.80841696	7.35395188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.155
R5826_826_0	2012	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	YES	370.33	2.9	77.15	65.34	1.85	8.44	3.44	28.67	72.79	11.93	30.8	0.62	3.2	25.03	36.38	96.59	1.5	9.7		8.2	28.61	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																					0.0768	0.0768	0.1934	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.054999	0.054999	0.061088	0	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401	0.191401		0.191401	0.191401	0																				20.3678	0.1594971	4.7129392	0	0.35409185	1.61542444	0.65841944	5.48746667	13.93207879	2.28341393	5.8951508	0.11866862	0.6124832	4.79076703	6.96316838	18.48742259	0.2871015	1.8565897	0	1.5694882	5.47598261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6279	0	NO	30.333493	20.3678	0.1594971	4.7129392	0	0.35409185	1.61542444	0.65841944	5.48746667	13.93207879	2.28341393	5.8951508	0.11866862	0.6124832	4.79076703	6.96316838	18.48742259	0.2871015	1.8565897	0	1.5694882	5.47598261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6279	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	2.4136	0.0186	0.7396	0	2.7228	2.0981	0.8557	0.5741	1.5135	0.2388	0.6465	0.0128	0.0641	0.5012	0.8504	2.2578	0.035	0.2143		0.1916	0.6689	0																			16.6175	0	NO	2.486222	22.7814	0.1781111	5.4525522	0	3.07686985	3.71356344	1.51416344	6.06153367	15.44562079	2.52226093	6.5416398	0.13149462	0.6765722	5.29200803	7.81361038	20.74519159	0.3221325	2.0708657	0	1.7610582	6.14483661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.2454
R5826_827_0	2012	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	YES	301.7	3.87	63.99	43.38	1.68	8.92	3.48	23.99	65.18	11.11	27.44	1.04	0.52	24.95	35.56	83.72	0.69	9.7		7.58	20.44	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																					0.086	0.086	0.169	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064767	0.064767	0.069976	0	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936	0.195936		0.195936	0.195936	0																				19.5402	0.25064829	4.47776424	0	0.32917248	1.74774912	0.68185728	4.70050464	12.77110848	2.17684896	5.37648384	0.20377344	0.10188672	4.8886032	6.96748416	16.40376192	0.13519584	1.9005792	0	1.48519488	4.00493184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1438	0	NO	21.973926	19.5402	0.25064829	4.47776424	0	0.32917248	1.74774912	0.68185728	4.70050464	12.77110848	2.17684896	5.37648384	0.20377344	0.10188672	4.8886032	6.96748416	16.40376192	0.13519584	1.9005792	0	1.48519488	4.00493184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1438	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	2.2756	0.0287	0.6555	0	2.5066	2.2474	0.8758	0.487	1.378	0.2256	0.5875	0.0219	0.0105	0.5065	0.8425	1.9838	0.0164	0.2157		0.1796	0.4842	0																			15.5288	0	NO	1.774941	21.8158	0.27932729	5.13329224	0	2.83574948	3.99517312	1.55766028	5.18750064	14.14915148	2.40246496	5.96395784	0.22568944	0.11238272	5.3950732	7.81002816	18.38754792	0.15159084	2.1162842	0	1.66475588	4.48917584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6726
R5826_828_0	2012	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	YES	343.78	4.21	66.74	29.52	1.76	8.77	2.64	26.79	61.73	7.94	27.49	0.72	0.29	13.97	35.03	99.67	0.51	11.42		6.84	23.74	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																					0.0807	0.0807	0.143	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.060203	0.060203	0.063017	0	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584	0.195584		0.195584	0.195584	0																				20.6966	0.25345463	4.20575458	0	0.34422784	1.71527168	0.51634176	5.23969536	12.07340032	1.55293696	5.37660416	0.14082048	0.05671936	2.73230848	6.85130752	19.49385728	0.09974784	2.23356928	0	1.33779456	4.64316416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5636	0	NO	21.828433	20.6966	0.25345463	4.20575458	0	0.34422784	1.71527168	0.51634176	5.23969536	12.07340032	1.55293696	5.37660416	0.14082048	0.05671936	2.73230848	6.85130752	19.49385728	0.09974784	2.23356928	0	1.33779456	4.64316416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5636	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	2.4197	0.0291	0.6003	0	2.6176	2.2042	0.6626	0.5422	1.2986	0.1607	0.5774	0.015	0.0059	0.2827	0.8278	2.3551	0.012	0.2625		0.1616	0.5609	0																			15.5959	0	NO	1.76995	23.1163	0.28255963	4.80604358	0	2.96182684	3.91950068	1.17894776	5.78194136	13.37199132	1.71360296	5.95400716	0.15582348	0.06260736	3.01503248	7.67907552	21.84897528	0.11172784	2.49608828	0	1.49943156	5.20401716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1595
R5826_831_0	2012	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	YES	263.86	2.62	32.54	28.98	1.31	7.53	2.98	21.24	73.11	13.79	31.02	0.66	0.13	27.56	35.32	92.08	0.47	10.38		8.63	37.56	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																					0.0826	0.0826	0.1859	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064895	0.064895	0.105351	0	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299	0.196299		0.196299	0.196299	0																				17.1232	0.1700249	3.42812154	0	0.25715169	1.47813147	0.58497102	4.16939076	14.35141989	2.70696321	6.08919498	0.12955734	0.02551887	5.41000044	6.93328068	18.07521192	0.09226053	2.03758362	0	1.69406037	7.37299044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.129	0	NO	17.415905	17.1232	0.1700249	3.42812154	0	0.25715169	1.47813147	0.58497102	4.16939076	14.35141989	2.70696321	6.08919498	0.12955734	0.02551887	5.41000044	6.93328068	18.07521192	0.09226053	2.03758362	0	1.69406037	7.37299044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.129	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	1.9726	0.0193	0.4604	0	1.9458	1.8995	0.7514	0.4317	1.5508	0.2802	0.665	0.0138	0.0027	0.5601	0.8379	2.1842	0.0112	0.2383		0.2048	0.891	0																			14.9207	0	NO	1.328765	19.0958	0.1892829	3.88850154	0	2.20296869	3.37764947	1.33632802	4.60106776	15.90217189	2.98717821	6.75422998	0.14339434	0.02823487	5.97012244	7.77116468	20.25945492	0.10343353	2.27584162	0	1.89888937	8.26403144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0497
R5826_832_0	2012	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	YES	227.71	2.26	27.79	24.22	1.09	6.29	2.49	18.21	62.7	11.82	26.61	0.57	0.11	23.63	30.32	78.88	0.39	8.73		7.41	32.2	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																					0.0812	0.0812	0.1813	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067214	0.067214	0.116975	0	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574	0.201574		0.201574	0.201574	0																				15.3053	0.15190364	3.25073525	0	0.21971566	1.26790046	0.50191926	3.67066254	12.6386898	2.38260468	5.36388414	0.11489718	0.02217314	4.76319362	6.11172368	15.90015712	0.07861386	1.75974102	0	1.49366334	6.4906828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4882	0	NO	11.988883	15.3053	0.15190364	3.25073525	0	0.21971566	1.26790046	0.50191926	3.67066254	12.6386898	2.38260468	5.36388414	0.11489718	0.02217314	4.76319362	6.11172368	15.90015712	0.07861386	1.75974102	0	1.49366334	6.4906828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4882	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	1.7284	0.0169	0.4193	0	1.6544	1.615	0.6388	0.3765	1.3532	0.2444	0.5803	0.0121	0.0024	0.4886	0.7318	1.9038	0.0095	0.2036		0.1789	0.7772	0																			12.9351	0	NO	0.849866	17.0337	0.16879364	3.66999725	0	1.87409366	2.88291446	1.14074026	4.04719354	13.9918448	2.62702268	5.94423314	0.12703818	0.02454214	5.25176262	6.84350468	17.80394912	0.08811286	1.96336502	0	1.67255434	7.2678968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4232
R5826_833_0	2012	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	YES	251.78	4.81	22.1	23.59	1.23	6.91	3.17	20.68	68.84	9.97	29.55	1.02	3.77	21.53	33.98	79.23	0.32	7.85		9.04	31.34	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																					0.0829	0.0829	0.1914	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.067138	0.067138	0.126961	0	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726	0.199726		0.199726	0.199726	0																				16.904	0.32293378	2.8058381	0	0.24566298	1.38010666	0.63313142	4.13033368	13.74913784	1.99126822	5.9019033	0.20372052	0.75296702	4.30010078	6.78668948	15.82429098	0.06391232	1.5678491	0	1.80552304	6.25941284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6288	0	NO	13.440181	16.904	0.32293378	2.8058381	0	0.24566298	1.38010666	0.63313142	4.13033368	13.74913784	1.99126822	5.9019033	0.20372052	0.75296702	4.30010078	6.78668948	15.82429098	0.06391232	1.5678491	0	1.80552304	6.25941284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6288	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	1.9266	0.0362	0.3578	0	1.8545	1.7626	0.8086	0.425	1.4737	0.2049	0.642	0.0217	0.0775	0.4425	0.8151	1.9006	0.0076	0.177		0.217	0.7519	0																			13.9028	0	NO	0.995449	18.8306	0.35916278	3.1636131	0	2.10018198	3.14272066	1.44176342	4.55533368	15.22283184	2.19615822	6.5439373	0.22539152	0.83044202	4.74259178	7.60174848	17.72490898	0.07152232	1.7448301	0	2.02248904	7.01135284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.5316
R5826_834_0	2012	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	YES	214.26	1.42	28.28	18.03	0.86	6.3	2.22	20.74	69.09	7.64	36.19	1.02	0.07	35.92	38.49	125.66	0.63	10		7.97	47.93	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																					0.0865	0.0865	0.1657	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069162	0.069162	0.103499	0	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009	0.195009		0.195009	0.195009	0																				14.8187	0.09821004	2.92695172	0	0.16770774	1.2285567	0.43291998	4.04448666	13.47317181	1.48986876	7.05737571	0.19890918	0.01365063	7.00472328	7.50589641	24.50483094	0.12285567	1.95009	0	1.55422173	9.34678137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9399	0	NO	17.406087	14.8187	0.09821004	2.92695172	0	0.16770774	1.2285567	0.43291998	4.04448666	13.47317181	1.48986876	7.05737571	0.19890918	0.01365063	7.00472328	7.50589641	24.50483094	0.12285567	1.95009	0	1.55422173	9.34678137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9399	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	1.7045	0.0111	0.3804	0	1.2712	1.58	0.5565	0.4187	1.4612	0.1543	0.7705	0.0214	0.0013	0.7251	0.9069	2.9607	0.015	0.228		0.1879	1.1293	0																			14.4842	0	NO	1.291807	16.5231	0.10926804	3.30739872	0	1.43893374	2.8086027	0.98946898	4.46318766	14.93440581	1.64415576	7.82782671	0.22028818	0.01498263	7.72985028	8.41284341	27.46557694	0.13780767	2.178138	0	1.74208573	10.47610637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.424
R5826_835_0	2012	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	YES	326.04	3.34	72.44	45.48	1.9	8.98	3.36	24.9	68.27	9.89	27.32	0.88	0.85	20.25	35.18	86.91	0.77	10.71		7.91	29.95	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																					0.091	0.091	0.1931	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.065525	0.065525	0.064611	0	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266	0.193266		0.193266	0.193266	0																				21.3638	0.2188535	4.68042084	0	0.3672054	1.73552868	0.64937376	4.8123234	13.19426982	1.91140074	5.28002712	0.17007408	0.1642761	3.9136365	6.79909788	16.79674806	0.14881482	2.06987886	0	1.52873406	5.7883167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5928	0	NO	28.086841	21.3638	0.2188535	4.68042084	0	0.3672054	1.73552868	0.64937376	4.8123234	13.19426982	1.91140074	5.28002712	0.17007408	0.1642761	3.9136365	6.79909788	16.79674806	0.14881482	2.06987886	0	1.52873406	5.7883167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5928	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	2.5204	0.0254	0.7183	0	2.8009	2.2392	0.8379	0.5002	1.4269	0.1987	0.5784	0.0183	0.0171	0.4069	0.825	2.0383	0.0181	0.239		0.1855	0.7025	0																			16.2971	0	NO	2.34751	23.8842	0.2442095	5.39870184	0	3.1681424	3.97476768	1.48726976	5.3125564	14.62117782	2.11009274	5.85843012	0.18839808	0.1813281	4.3205115	7.62411388	18.83509706	0.16693882	2.30886986	0	1.71418406	6.4908547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8899
R5826_836_0	2012	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	YES	346.45	1.98	44.86	22.81	1.32	6.77	3.8	25.85	77.49	20.7	27.62	1.4	1.6	30.34	36.1	80.86	0.5	10.39		6.74	27.63	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																					0.0794	0.0794	0.1798	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.059212	0.059212	0.085799	0	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435	0.19435		0.19435	0.19435	0																				20.514	0.11723976	3.84894314	0	0.256542	1.3157495	0.73853	5.0239475	15.0601815	4.023045	5.367947	0.27209	0.31096	5.896579	7.016035	15.715141	0.097175	2.0192965	0	1.309919	5.3698905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2732	0	NO	21.898537	20.514	0.11723976	3.84894314	0	0.256542	1.3157495	0.73853	5.0239475	15.0601815	4.023045	5.367947	0.27209	0.31096	5.896579	7.016035	15.715141	0.097175	2.0192965	0	1.309919	5.3698905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2732	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	2.4048	0.0135	0.5384	0	1.9478	1.6941	0.9512	0.5211	1.6244	0.4174	0.583	0.0291	0.0322	0.6117	0.8495	1.9026	0.0119	0.228		0.1586	0.65	0																			15.1692	0	NO	1.699684	22.9188	0.13072676	4.38733814	0	2.204312	3.0098545	1.689776	5.5450215	16.6845405	4.440398	5.950967	0.301219	0.343159	6.508255	7.865563	17.617722	0.10903	2.2472655	0	1.468538	6.0199375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4424
R5826_837_0	2012	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	YES	310.05	2.49	79.72	31.88	1.78	7.68	2.99	26.71	60.71	20.92	26.14	1.02	0.39	41.18	30.36	71.33	0.7	6.96		4.93	23.42	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																					0.0819	0.0819	0.1753	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.061279	0.061279	0.061086	0	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553	0.19553		0.19553	0.19553	0																				18.9996	0.15258471	4.86977592	0	0.3480434	1.5016704	0.5846347	5.2226063	11.8706263	4.0904876	5.1111542	0.1994406	0.0762567	8.0519254	5.9362908	13.9471549	0.136871	1.3608888	0	0.9639629	4.5793126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0032	0	NO	24.865198	18.9996	0.15258471	4.86977592	0	0.3480434	1.5016704	0.5846347	5.2226063	11.8706263	4.0904876	5.1111542	0.1994406	0.0762567	8.0519254	5.9362908	13.9471549	0.136871	1.3608888	0	0.9639629	4.5793126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0032	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	2.2103	0.0174	0.7397	0	2.6388	1.9277	0.7497	0.5401	1.2808	0.423	0.5497	0.0211	0.0079	0.8328	0.7166	1.6836	0.0166	0.1528		0.1164	0.5527	0																			15.1778	0	NO	2.046982	21.2099	0.17000571	5.60948592	0	2.9868784	3.4293814	1.3343327	5.7626913	13.1514233	4.5134886	5.6608912	0.2205776	0.0841207	8.8847294	6.6528708	15.6307309	0.153454	1.5136838	0	1.0803969	5.1320576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1811
R5826_838_0	2012	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	YES	281.16	3.38	49.43	25	1.45	8.1	3.23	22.3	67.55	15.51	26.44	0.31	0.14	28.2	28.86	72.15	0.22	5.46		6.49	27.45	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																					0.0831	0.0831	0.1936	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064564	0.064564	0.088973	0	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174	0.198174		0.198174	0.198174	0																				18.1528	0.21822632	4.39793539	0	0.2873523	1.6052094	0.64010202	4.4192802	13.3866537	3.07367874	5.23972056	0.06143394	0.02774436	5.5885068	5.71930164	14.2982541	0.04359828	1.08203004	0	1.28614926	5.4398763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9679	0	NO	18.55154	18.1528	0.21822632	4.39793539	0	0.2873523	1.6052094	0.64010202	4.4192802	13.3866537	3.07367874	5.23972056	0.06143394	0.02774436	5.5885068	5.71930164	14.2982541	0.04359828	1.08203004	0	1.28614926	5.4398763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9679	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	2.0845	0.0247	0.6235	0	2.1691	2.0527	0.8189	0.4552	1.4349	0.3166	0.5689	0.0065	0.0029	0.5756	0.6876	1.7188	0.0053	0.1204		0.1547	0.6538	0																			14.4746	0	NO	1.468997	20.2373	0.24288632	5.02148039	0	2.4564563	3.6579504	1.45902402	4.8744332	14.8215707	3.39026474	5.80858956	0.06790794	0.03061736	6.1640868	6.40691464	16.0170581	0.04893428	1.20242004	0	1.44085626	6.0937113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4425
R5826_839_0	2012	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	YES	303.33	1.98	65.46	14.42	1.11	5.2	2.61	21.15	72.08	18.21	25.77	1.15	0.57	30.04	28.24	67.18	0.74	8.62		7.23	38.91	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																					0.0854	0.0854	0.1825	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064316	0.064316	0.071228	0	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288	0.196288		0.196288	0.196288	0																				19.509	0.12734568	4.66258488	0	0.21787968	1.0206976	0.51231168	4.1514912	14.14843904	3.57440448	5.05834176	0.2257312	0.11188416	5.89649152	5.54317312	13.18662784	0.14525312	1.69200256	0	1.41916224	7.63756608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8404	0	NO	22.833495	19.509	0.12734568	4.66258488	0	0.21787968	1.0206976	0.51231168	4.1514912	14.14843904	3.57440448	5.05834176	0.2257312	0.11188416	5.89649152	5.54317312	13.18662784	0.14525312	1.69200256	0	1.41916224	7.63756608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8404	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	2.2606	0.0145	0.6838	0	1.647	1.3071	0.6549	0.4281	1.5105	0.3686	0.5507	0.0239	0.0116	0.6081	0.6673	1.5873	0.0174	0.1907		0.1709	0.9195	0																			13.6225	0	NO	1.754119	21.7695	0.14182568	5.34636288	0	1.86489468	2.3278106	1.16718168	4.5796342	15.65891404	3.94297448	5.60905276	0.2496572	0.12348116	6.50460152	6.21050412	14.77392584	0.16270012	1.88268456	0	1.59003124	8.55704608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4628
R5826_840_0	2012	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	YES	232.72	2.31	29.19	24.58	1.11	6.39	2.53	18.71	64.62	12.14	27.44	0.58	0.12	24.27	31.54	81.98	0.4	8.88		7.71	33.08	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																					0.0843	0.0843	0.1932	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.068668	0.068668	0.117602	0	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025	0.20025		0.20025	0.20025	0																				15.9804	0.15862308	3.43280238	0	0.2222775	1.2795975	0.5066325	3.7466775	12.940155	2.431035	5.49486	0.116145	0.02403	4.8600675	6.315885	16.416495	0.0801	1.77822	0	1.5439275	6.62427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9522	0	NO	13.515484	15.9804	0.15862308	3.43280238	0	0.2222775	1.2795975	0.5066325	3.7466775	12.940155	2.431035	5.49486	0.116145	0.02403	4.8600675	6.315885	16.416495	0.0801	1.77822	0	1.5439275	6.62427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9522	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	1.8158	0.0177	0.4513	0	1.6725	1.6327	0.6458	0.3851	1.3891	0.25	0.5963	0.0123	0.0024	0.4997	0.7579	1.9701	0.0096	0.2063		0.1853	0.7949	0																			13.295	0	NO	0.970831	17.7962	0.17631108	3.88414938	0	1.8947445	2.9122695	1.1524385	4.1318005	14.329295	2.68103	6.09117	0.128485	0.026453	5.3597835	7.073803	18.386599	0.089703	1.984566	0	1.7292075	7.419219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2472
R5826_841_0	2012	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	YES	274.88	2.73	33.55	29.23	1.32	7.59	3	22.09	75.97	14.34	32.23	0.69	0.14	28.67	36.6	95.21	0.48	10.54		8.95	39.07	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																					0.0845	0.0845	0.2068	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.064971	0.064971	0.108287	0	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658	0.194658		0.194658	0.194658	0																				17.8592	0.17737083	3.63302885	0	0.25694856	1.47745422	0.583974	4.29999522	14.78816826	2.79139572	6.27382734	0.13431402	0.02725212	5.58084486	7.1244828	18.53338818	0.09343584	2.05169532	0	1.7421891	7.60528806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0343	0	NO	19.784709	17.8592	0.17737083	3.63302885	0	0.25694856	1.47745422	0.583974	4.29999522	14.78816826	2.79139572	6.27382734	0.13431402	0.02725212	5.58084486	7.1244828	18.53338818	0.09343584	2.05169532	0	1.7421891	7.60528806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0343	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	2.0725	0.0203	0.499	0	1.9517	1.9053	0.7536	0.4465	1.6022	0.2898	0.6869	0.0143	0.0028	0.5794	0.8633	2.2458	0.0112	0.2405		0.211	0.9216	0																			15.3177	0	NO	1.524188	19.9318	0.19762483	4.13199485	0	2.20864456	3.38271122	1.337601	4.74649322	16.39034426	3.08123172	6.96072834	0.14865402	0.03006112	6.16019786	7.9877718	20.77923418	0.10464284	2.29216832	0	1.9532281	8.52692306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.352
R5826_842_0	2012	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	YES	310.36	1.61	23.82	28.84	1.1	7.45	3.4	22.42	72.38	10.86	30.82	0.69	7.41	21.1	38.21	102.21	0.55	8.28		9.66	51.54	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																					0.0795	0.0795	0.1977	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.061006	0.061006	0.118963	0	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305	0.194305		0.194305	0.194305	0																				18.9338	0.09821966	2.83369866	0	0.2137355	1.44757225	0.660637	4.3563181	14.0637959	2.1101523	5.9884801	0.13407045	1.43980005	4.0998355	7.42439405	19.85991405	0.10686775	1.6088454	0	1.8769863	10.0144797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2716	0	NO	19.169613	18.9338	0.09821966	2.83369866	0	0.2137355	1.44757225	0.660637	4.3563181	14.0637959	2.1101523	5.9884801	0.13407045	1.43980005	4.0998355	7.42439405	19.85991405	0.10686775	1.6088454	0	1.8769863	10.0144797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2716	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	2.2061	0.0112	0.3744	0	1.6273	1.8679	0.8524	0.4529	1.5215	0.2193	0.6587	0.0145	0.1495	0.4262	0.9006	2.4092	0.013	0.185		0.2277	1.215	0																			15.3324	0	NO	1.448373	21.1399	0.10944166	3.20813766	0	1.8410425	3.31544525	1.513058	4.8091741	15.5853269	2.3294373	6.6471401	0.14855545	1.58934605	4.5260125	8.32504405	22.26912505	0.11989075	1.7938364	0	2.1046733	11.2294597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.6041
R5826_843_0	2012	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	YES	239.99	2.89	36.05	8.14	1.05	5.89	2.47	21.19	72.59	12.68	24.83	1.19	0.11	38.48	30.7	81.41	0.59	9.87		7.12	35.18	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																					0.0862	0.0862	0.1531	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.069119	0.069119	0.092023	0	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494	0.198494		0.198494	0.198494	0																				16.5879	0.19975391	3.31742915	0	0.2084187	1.16912966	0.49028018	4.20608786	14.40867946	2.51690392	4.92860602	0.23620786	0.02183434	7.63804912	6.0937658	16.15939654	0.11711146	1.95913578	0	1.41327728	6.98301892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.655	0	NO	15.158935	16.5879	0.19975391	3.31742915	0	0.2084187	1.16912966	0.49028018	4.20608786	14.40867946	2.51690392	4.92860602	0.23620786	0.02183434	7.63804912	6.0937658	16.15939654	0.11711146	1.95913578	0	1.41327728	6.98301892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.655	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	1.8883	0.0224	0.4361	0	1.5654	1.4901	0.6264	0.4321	1.5372	0.2585	0.5389	0.0249	0.0023	0.7846	0.7308	1.9375	0.0139	0.2201		0.1695	0.8373	0																			13.5163	0	NO	1.135891	18.4761	0.22213491	3.75356715	0	1.7738167	2.65924566	1.11670618	4.63819586	15.94587746	2.77537592	5.46750802	0.26109386	0.02414034	8.42267512	6.8245348	18.09690654	0.13105246	2.17919678	0	1.58274328	7.82030392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1712
R5826_844_0	2012	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	YES	264.82	0.7	19.19	15.45	0.96	5.58	2.06	23.86	65.7	6.09	32.95	0.51	0.17	13.21	35.72	107.2	0.26	11.63		8.28	48.18	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																					0.0715	0.0715	0.1488	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224		0.224	0.224	0																			NO	0.05881	0.05881	0.10944	0	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927	0.198927		0.198927	0.198927	0																				15.5741	0.041167	2.1001536	0	0.19096992	1.11001266	0.40978962	4.74639822	13.0695039	1.21146543	6.55464465	0.10145277	0.03381759	2.62782567	7.10567244	21.3249744	0.05172102	2.31352101	0	1.64711556	9.58430286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7986	0	NO	13.210123	15.5741	0.041167	2.1001536	0	0.19096992	1.11001266	0.40978962	4.74639822	13.0695039	1.21146543	6.55464465	0.10145277	0.03381759	2.62782567	7.10567244	21.3249744	0.05172102	2.31352101	0	1.64711556	9.58430286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7986	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	1.7687	0.0046	0.2535	0	1.4344	1.4173	0.5225	0.4883	1.406	0.1247	0.694	0.0107	0.0034	0.2703	0.8532	2.5603	0.0061	0.2737		0.1979	1.1507	0																			13.4402	0	NO	0.959385	17.3427	0.045765	2.3536736	0	1.62535492	2.52728566	0.93232362	5.23467422	14.4754919	1.33612743	7.24866465	0.11213577	0.03725259	2.89809167	7.95886244	23.8852844	0.05784402	2.58723201	0	1.84497056	10.73502186	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2388
R5941_003_0	2012	8	H.6										OP Facility - Other										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	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	YES	1177.899362	73.09188063	347.5415742	330.0100946	29.66327666	11.55724616	6.56803105	292.096846	321.4301669	6348.318248	664.7725539	5.180388949	0	412.201279	2859.806589	2764.452692	6.09529582	997.9632744	577.9501857	1524.061283	25.94763076	7.704597473	0	456.2721669	234.4	234.4	259.2	0	5872.8	139.9828328	9.27377002	0	0	0	0	0	0	0	0	0	3400	1A: $165/day (days1-9) no yrly max	1B: $165/day (days1-9) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $30 copay	9A: $0 - $200 copay; 9B: $0-$200 copay	8A: $0-$140 copay	8B: $85-$140 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $30-$200 copay; 9C: $40 copay	7A: $20 copay; 7G: $20 copay	7B: $15 copay; 7D: $30 copay; 7F: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $40 copay; 7I: $40 copay	8B: $85-$140 copay	14A: $0 copay; 14D: $0 copay; 14E: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $30 copay, $75 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	136.2696754	118.3771008	146	0	150	0.2	0.136907082	64.94493024	183.2189076	18.53885543	105.4428061	40	0.2	73.71764706	20	28.66971568	40	40	99.53141103	0.449204146	0.2	0	0	0	0	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	118.9347187	103.3182706	127.4272422	0	130.9183995	0.174557866	0.11949104	56.68324217	159.9115076	16.18051521	92.02935612	34.91157321	0	64.3399758	17.45578661	25.02262194	34.91157321	34.91157321	86.86995357	0.392060586	0.174557866	0	0	0	0	0	30	0	0	0	0.174557866	0	0	0	0	0	0	0	0	0		11.6744	0.629310558	3.690522029	0	0.323622392	2.017408228	0.784820862	1.379749688	4.283365216	8.559921667	5.098215841	0.015071294	0	2.210085027	4.160014462	5.764487883	0.017733031	2.903372326	4.183875484	0.049793697	4.529363054	0	0	0	0	0	0.648	0	0	0	1.618809505	0	0	0	0	0	0	0	0	0	64.542		NO	9.312665032	11.6744	0.629310558	3.690522029	0	0.323622392	2.017408228	0.784820862	1.379749688	4.283365216	8.559921667	5.098215841	0.015071294	0	2.210085027	4.160014462	5.764487883	0.017733031	2.903372326	4.183875484	0.049793697	4.529363054	0	0	0	0	0	0.648	0	0	0	1.618809505	0	0	0	0	0	0	0	0	0	64.542	YES	1A: 30% coin	1B: 30% coin	2: 25% coin (for days 1-100)	6: $0 copay	10A: $150 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $65 copay; 4B: $30 copay	9A: $275 copay; 9B: $275 copay	8A: 0% - 25% coin	8B: 25% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $40-$275 copay; 9C: $50 copay	7A: $30 copay; 7G: $30 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $80 copay; 7I: $80 copay	8B: 25% coin	14A: $0 copay; 14D: $0 copay; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 1 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $40 copay, $75 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										3400	15.0125	0.2022	1.3582	0	1.8378	0.4972	0.6732	0.4358	2.7665	1.7725	0.9573	0.0003	0	0.801	2.1179	2.3886	0.0043	1.0981	1.7345	0.0252	1.3694	0	0	0.2434	0	0	0.216	0	0	0	0.5472	0	0	0	0	0	0	0	0	0	36.0592		NO	5.188744063	26.6869	0.831540324	5.048728748	0	2.161468099	2.514626863	1.458060461	1.815544581	7.049861677	10.33239764	6.055467441	0.015346423	0	3.0110965	6.277961156	8.153074655	0.022053918	4.001492766	5.91838065	0.075016967	5.898766686	0	0	0.24340081	0	0	0.864	0	0	0	2.16601047	0	0	0	0	0	0	0	0	0	100.6012
R5941_007_0	2012	6	H.6										OP Facility - Other										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	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	YES	812.5896896	62.25399007	379.5964633	403.1986554	87.44457416	6.197114637	1.859397729	257.8134997	289.0658663	4695.129684	554.2417564	0	0.000477764	448.3317955	2457.696139	2370.014749	2.959106029	744.9422808	462.2823339	1184.030882	11.56159318	15.66635193	0	702.9904829	234.4	234.4	259.2	0	5872.8	232.3638938	7.140728291	0	0	0	0	0	0	0	0	0	5000	1A: $205/day (days1-7) $1435 yrly max	1B: $205/day (days1-7) $1435 yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $25 copay	9A: $0 - $225 copay; 9B: $0-$225 copay	8A: $0-$125 copay	8B: $80-$125 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $25-$225 copay; 9C: $40 copay	7A: $5 copay; 7G: $5 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $80-$125 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $25 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	142.3932706	97.10891247	146	0	150	0.2	0.099972306	64.96818604	194.8124416	23.42206088	95.1070088	40	0.2	70.4851686	5	22.96358312	40	50	90.37126894	0.318849166	0.2	0	0	0	0	0	25	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	134.7207746	91.87644791	138.1331646	0	141.9176349	0.189223513	0.094585555	61.46754204	184.3154731	22.16002323	89.98241168	0	0.189223513	66.68725616	4.73058783	21.72624937	37.84470264	47.3058783	85.50184501	0.301668797	0.189223513	0	0	0	0	0	25	0	0	0	0.189223513	0	0	0	0	0	0	0	0	0		9.1227	0.476639623	4.36957173	0	1.034160596	1.172639803	0.175872166	1.320596845	4.439942658	8.670348574	4.156000824	0	9.04E-05	2.491501441	0.968862287	4.290960954	0.009332207	2.936679073	3.293832705	0.029765431	2.187725279	0	0	0	0	0	0.54	0	0	0	1.351193694	0	0	0	0	0	0	0	0	0	53.0384		NO	2.989843921	9.1227	0.476639623	4.36957173	0	1.034160596	1.172639803	0.175872166	1.320596845	4.439942658	8.670348574	4.156000824	0	9.04E-05	2.491501441	0.968862287	4.290960954	0.009332207	2.936679073	3.293832705	0.029765431	2.187725279	0	0	0	0	0	0.54	0	0	0	1.351193694	0	0	0	0	0	0	0	0	0	53.0384	YES	1A: 20% coin	1B: 20% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $150 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $25 copay	9A: $300 copay; 9B: $300 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $45-$300 copay; 9C: $50 copay	7A: $30 copay; 7G: $30 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $90 copay; 7I: $90 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $160 Hardware Per Yr"	"18A: $45 copay, $100 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										5000	11.1389	0.1257	0.345	0	1.4904	0.2865	0.4522	0.4263	1.1855	1.238	1.0885	0	0	0.9873	1.1552	1.7933	0.0045	0.6922	1.1396	0.0343	0.3754	0	0	0.247	0	0	0.243	0	0	0	0.1053	0	0	0	0	0	0	0	0	0	24.5541		NO	1.370472186	20.2616	0.602379629	4.714542771	0	2.524559914	1.459148112	0.628075382	1.746898112	5.625408922	9.908389284	5.244456926	0	9.04E-05	3.47884568	2.1240419	6.084227414	0.01378851	3.62886562	4.433437435	0.064035526	2.563155268	0	0	0.247044534	0	0	0.783	0	0	0	1.456520612	0	0	0	0	0	0	0	0	0	77.5925
R5941_008_0	2012	8	H.6										OP Facility - Other										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	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	YES	1063.449547	42.27058275	461.2695564	684.7454712	127.9093226	9.602105979	5.17740978	301.8656477	384.5373276	6849.583687	711.6254439	0.187701478	0.012099913	625.5909522	3046.176963	3015.332151	7.083052062	1239.728299	659.2916346	1796.974316	24.68042995	7.194407238	0	702.9904829	234.4	234.4	129.6	0	5872.8	233.8375886	10.18740592	0	0	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: $146/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $35 copay	9A: $0 - $250 copay; 9B: $0-$250 copay	8A: $0-$155 copay	8B: $95-$155 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $35-$250 copay; 9C: $40 copay	7A: $20 copay; 7G: $20 copay	7B: $20 copay; 7D: $35 copay; 7F: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $50 copay; 7I: $50 copay	8B: $95-$155 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: $0 Co-Pay, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $35 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										0	NO	133.2831746	126.7531381	146	0	150	0.2	0.11008577	64.91029859	218.2857889	23.35048236	117.2268085	40	0.2	78.17013118	20	34.07406653	40	50	110.4542111	0.496092011	0.2	0	0	0	0	0	35	0	0	0	0.2	0	0	0	0	0	0	0	0	0	NO	120.0107283	114.1309581	131.4612019	0	135.0628787	0.180083838	0.09912334	58.44647857	196.5487136	21.02522245	105.5532681	36.01676766	0.180083838	70.38588631	18.00838383	30.68094344	36.01676766	45.02095957	99.45509147	0.446690767	0.180083838	0	0	0	0	0	35	0	0	0	0.180083838	0	0	0	0	0	0	0	0	0		10.6354	0.402031842	5.053254192	0	1.43965011	1.7291841	0.513202151	1.470248676	6.298359755	12.00116839	6.259532604	0.000563367	0.002178999	3.669397803	4.571393663	7.709436263	0.021259053	4.65114647	5.464159152	0.066890986	4.444546555	0	0	0	0	0	0.378	0	0	0	1.83458716	0	0	0	0	0	0	0	0	0	78.6156		NO	8.652600121	10.6354	0.402031842	5.053254192	0	1.43965011	1.7291841	0.513202151	1.470248676	6.298359755	12.00116839	6.259532604	0.000563367	0.002178999	3.669397803	4.571393663	7.709436263	0.021259053	4.65114647	5.464159152	0.066890986	4.444546555	0	0	0	0	0	0.378	0	0	0	1.83458716	0	0	0	0	0	0	0	0	0	78.6156	YES	1A: 30% coin	1B: 30% coin	2: 25% coin (for days 1-100)	6: $0 copay	10A: $150 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $35 copay	9A: $300 copay; 9B: $300 copay	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $45-$300 copay; 9C: $50 copay	7A: $30 copay; 7G: $30 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $90 copay; 7I: $90 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	"16A: 20% coin, 2 Exams/Cleanings per Yr"	"17A: $0 copay, 1 Exam per Yr"	"17B: $0 copay, $100 Hardware Per Yr"	"18A: $45 copay, $50 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance										4800	13.9584	0.3676	1.0606	0	1.4109	0.6091	0.7487	0.4749	1.2213	1.4696	1.1248	0	0.005	1.1232	1.5457	1.9747	0.0156	1.1088	1.215	0.0264	0.8047	0	0	0.247	0	0	0.1215	0	0	0	0.2512	0	0	0	0	0	0	0	0	0	30.8848		NO	3.374906087	24.5939	0.769654772	6.113884756	0	2.850595443	2.338264904	1.261921968	1.945152096	7.519641234	13.47073842	7.384339202	0.000563367	0.007176065	4.792646546	6.117092295	9.684116681	0.036828735	5.759899021	6.679174172	0.093278327	5.249275064	0	0	0.247044534	0	0	0.4995	0	0	0	2.085763777	0	0	0	0	0	0	0	0	0	109.5004
R5941_009_0	2012	9	H.6	H.7									OP Facility - Other	OP Facility - Other									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	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	YES	1049.181661	35.49444195	256.9134141	271.0876953	20.51100625	9.534180557	5.870539243	269.5676071	325.2649459	5960.111355	656.3706639	0	0.043005734	328.5750844	2551.390928	2360.548906	1.886435319	861.6165657	482.6214124	1590.669142	25.25797013	9.129697113	0	0	0	0	259.2	0	5872.8	121.7007106	9.630567673	0	0	0	0	0	0	0	0	0	4200	1A: $200/day (days1-7) no yrly max	1B: $200/day (days1-7) no yrly max	2: $146/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $65 copay; 4B: $40 copay	9A: $0 - $185 copay; 9B: $0-$185 copay	8A: $0-$160 copay	8B: $85-$160 copay	5: $40 copay	12: 20% coin	3: $0 copay; 9A: $40 copay; 9C: $40 copay	7A: $25 copay; 7G: $25 copay	7B: $20 copay; 7D: $40 copay; 7F: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $60 copay; 7I: $60 copay	8B: $85-$160 copay	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $40	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $40 copay, $75 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance	9A: $185 copay (Obs)									0	NO	155.0666009	144.6870451	146	0	175	0.2	0.114289891	64.98199981	170.4742302	19.06564271	113.0904349	40	0.2	28.10341783	25	37.70841473	40	60	104.5374299	0.542217145	0.2	0	0	0	0	0	40	0	0	0	0.2	185	0	0	0	0	0	0	0	0	NO	139.1461445	129.8322422	131.010398	0	157.0330113	0.179466299	0.102555919	58.31039492	152.9718955	17.10820164	101.4796088	0	0.179466299	25.21808189	22.43328733	33.83694809	35.89325972	53.83988959	93.80472805	0.48654852	0.179466299	0	0	0	0	0	40	0	0	0	0.179466299	0	0	0	0	0	0	0	0	0		12.1658	0.384026915	2.80486072	0	0.268408756	1.711064095	0.602058545	1.309882802	4.146366277	8.497232237	5.550686516	0	0.00771808	0.690502782	4.769673814	6.656147567	0.005642526	3.865778397	3.772680862	0.06449481	4.53295441	0	0	0	0	0	0.864	0	0	0	1.728362334	0	0	0	0	0	0	0	0	0	64.3983		NO	7.269304577	12.1658	0.384026915	2.80486072	0	0.268408756	1.711064095	0.602058545	1.309882802	4.146366277	8.497232237	5.550686516	0	0.00771808	0.690502782	4.769673814	6.656147567	0.005642526	3.865778397	3.772680862	0.06449481	4.53295441	0	0	0	0	0	0.864	0	0	0	1.728362334	0	0	0	0	0	0	0	0	0	64.3983	YES	1A: 30% coin	1B: 30% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $175 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $65 copay; 4B: $40 copay	9A: 30% coin; 9B: 30% coin	8A: 0% - 30% coin	8B: 30% coin	5: $50 copay	12: 20% coin	3: $0 copay; 9A: $45 copay; 9C: $50 copay	7A: $35 copay; 7G: $35 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $100 copay; 7I: $100 copay	8B: 30% coin	14A: $0 copay; 14D: $0; 14E: $0; 17A: $0; 17B: $0; 18A: $45	15: 20% coinsurance	9D: $0 copay; 14A $0 copay	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	"18A: $45 copay, $75 limit per Yr"	N/A	14C: Silver Sneakers	7B: Not coverd; 7F: Not covered; 13A: Not covered	8B: 20% coinsurance	9A: 30% coinsurance (Obs)									4200	12.8318	0.103	1.7771	0	1.625	0.5087	0.7899	0.308	3.081	1.9316	0.965	0	0	0.1834	2.2428	2.7891	0.0028	1.0238	1.8827	0.0274	1.6849	0	0	0	0	0	0.243	0	0	0	0.6032	0	0	0	0	0	0	0	0	0	34.6042		NO	3.931448716	24.9976	0.486992768	4.581948379	0	1.893432515	2.219778596	1.391977581	1.617929419	7.227378674	10.42878627	6.515687711	0	0.00771808	0.873947626	7.012484503	9.445241558	0.008405619	4.889623847	5.655351968	0.091908687	6.21782033	0	0	0	0	0	1.107	0	0	0	2.331543825	0	0	0	0	0	0	0	0	0	99.0025
R5941_801_0	2012	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	152.9075508	1.588557822	29.96057105	4.270606282	2.691089355	8.320506154	2.83697993	13.34686484	39.48516956	36.89216406	31.94995556	0.002829582	3.643658992	0.316702032	34.88274609	51.921279	0.146063872	32.97288461	0	0.081811645	24.3217578	0.355043769																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.059195383	0.059195383	0.125061936	0	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383	0.174418383																			NO	0.054187571	0.054187571	0.114481943	0	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933	0.159662933																				8.2857	0.08608009	3.429944396	0	0.429667219	1.328476416	0.452960536	2.130999585	6.304317979	5.890311116	5.101223612	0.000451779	0.581757281	0.050565575	5.569481549	8.289903687	0.023320986	5.264547464	0	0.013062287	3.883283185	0.056687329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1727		NO	5.283689708	8.2857	0.08608009	3.429944396	0	0.429667219	1.328476416	0.452960536	2.130999585	6.304317979	5.890311116	5.101223612	0.000451779	0.581757281	0.050565575	5.569481549	8.289903687	0.023320986	5.264547464	0	0.013062287	3.883283185	0.056687329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1727	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	2.8281	0.0294	0.956	0	0.8541	0.253	0.0863	0.6131	1.7083	2.4096	2.0868	0.0002	0.238	0.0207	1.8116	2.6965	0.0076	1.7124	0	0.0042	0.8867	0																			19.2025		NO	1.774624205	11.1138	0.115460871	4.385983182	0	1.283754663	1.581476726	0.539224135	2.744126008	8.012597372	8.299898049	7.188013515	0.000636592	0.819740423	0.071250756	7.381078424	10.98637794	0.030906652	6.976957793	0	0.017311085	4.770007949	0.056687329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3752
R5941_802_0	2012	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	187.1849805	1.944666325	33.56083377	4.650190059	2.555813945	10.82807753	3.691967541	19.76875958	60.85737083	49.58605099	42.94332323	0.003803186	4.897372252	0.425673134	37.1883356	55.35303738	0.155718024	35.15224104	0	0.08721902	36.03967693	0.83987612																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.056317124	0.056317124	0.135121474	0	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601	0.17491601																			NO	0.049314698	0.049314698	0.11832058	0	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096	0.153167096																				9.231	0.095900633	3.97093732	0	0.3914666	1.65850519	0.565487947	3.027923495	9.321346757	7.59495143	6.577504109	0.000582523	0.750116286	0.065199118	5.696029367	8.478263989	0.023850878	5.384166676	0	0.013359084	5.520092654	0.128641386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4953		NO	9.725968237	9.231	0.095900633	3.97093732	0	0.3914666	1.65850519	0.565487947	3.027923495	9.321346757	7.59495143	6.577504109	0.000582523	0.750116286	0.065199118	5.696029367	8.478263989	0.023850878	5.384166676	0	0.013359084	5.520092654	0.128641386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4953	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	3.1633	0.0329	1.1112	0	0.7813	0.3171	0.1081	0.8747	2.5359	3.1193	2.7014	0.0002	0.3081	0.0268	1.8601	2.7687	0.0078	1.7583	0	0.0044	1.2655	0																			22.7451		NO	3.229681731	12.3942	0.128763885	5.082182523	0	1.172722418	1.975617042	0.673611172	3.902584974	11.85722204	10.71425614	9.278935416	0.00082177	1.058194788	0.091976895	7.556177147	11.24700391	0.03163984	7.142469705	0	0.017721749	6.78559973	0.128641386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2404
R5941_805_0	2012	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	243.5079706	2.529806339	30.04089607	7.645497201	3.648407424	12.52449117	4.270380843	18.65946574	48.37454805	42.89319044	37.14706262	0.003289853	4.23635108	0.368218046	36.54210038	54.39114754	0.153012056	34.54138777	0	0.085703383	24.36518476	0.538037708																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.059081265	0.059081265	0.124820838	0	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135	0.174082135																			NO	0.052204705	0.052204705	0.110292748	0	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447	0.153820447																				12.7123	0.132067794	3.313292982	0	0.561199659	1.926522824	0.656871888	2.870207352	7.440994583	6.597849706	5.71397776	0.000506047	0.651637415	0.056639464	5.620922197	8.366470602	0.023536383	5.313171691	0	0.013182933	3.7478636	0.0827612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8019		NO	8.667627538	12.7123	0.132067794	3.313292982	0	0.561199659	1.926522824	0.656871888	2.870207352	7.440994583	6.597849706	5.71397776	0.000506047	0.651637415	0.056639464	5.620922197	8.366470602	0.023536383	5.313171691	0	0.013182933	3.7478636	0.0827612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8019	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	4.347	0.0452	0.9252	0	1.1176	0.3676	0.1253	0.8273	2.02	2.704	2.3418	0.0002	0.2671	0.0232	1.8317	2.7264	0.0077	1.7314	0	0.0043	0.8574	0																			22.2706		NO	2.933546938	17.0593	0.177228811	4.238533053	0	1.678818399	2.294099142	0.7822016	3.697551312	9.461025147	9.301888665	8.055773823	0.000713443	0.918702146	0.079852378	7.452648272	11.0929062	0.031206335	7.044609128	0	0.01747894	4.605256163	0.0827612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0725
R5941_806_0	2012	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	187.0303461	1.943059827	33.53291694	4.646244133	2.553690383	10.83574539	3.694581992	19.75275999	60.95738446	49.79649958	43.12557936	0.003819327	4.918157232	0.427479737	37.19381802	55.3611977	0.155740981	35.15742329	0	0.087231878	36.01204567	0.839193672																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.056315464	0.056315464	0.135117491	0	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854	0.174910854																			NO	0.049303853	0.049303853	0.118294559	0	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411	0.153133411																				9.2213	0.095800336	3.966761613	0	0.391055319	1.659314653	0.565763943	3.024807515	9.334612213	7.62550784	6.603967072	0.000584867	0.753134193	0.06546143	5.695616224	8.477649044	0.023849148	5.383776153	0	0.013358115	5.514647393	0.12850859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5455		NO	9.748006963	9.2213	0.095800336	3.966761613	0	0.391055319	1.659314653	0.565763943	3.024807515	9.334612213	7.62550784	6.603967072	0.000584867	0.753134193	0.06546143	5.695616224	8.477649044	0.023849148	5.383776153	0	0.013358115	5.514647393	0.12850859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5455	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	3.1598	0.0328	1.11	0	0.7804	0.3172	0.1082	0.8737	2.5393	3.1317	2.7121	0.0002	0.3093	0.0269	1.8599	2.7684	0.0078	1.7581	0	0.0044	1.2642	0																			22.7644		NO	3.237382843	12.3811	0.128627374	5.076775936	0	1.171446517	1.976563462	0.673933865	3.898519834	11.87395378	10.75718645	9.316114623	0.000825062	1.062434805	0.092345431	7.555524642	11.24603269	0.031637107	7.141852925	0	0.017720219	6.778835128	0.12850859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3099
R6801_008_0	2012	9																															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	YES	599.3109117	4.065252678	59.72866571	0	31.66578276	57.98036157	47.3279512	50.60630283	53.3958208	10.60498108	18.26289489	0	1.466321418	36.69597028	88.84041565	73.39283961	1.309310218	3.164207916	29.97963516	94.14429969	32.51145376	5.145679587	0	185.8307305	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.077630212	0.077630212	0.197274861	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	15	0	0	0	0	0	0											YES	0.072945859	0.072945859	0.185370923	0	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0.210483417	0	15	0	0	0	0	0	0											6700	43.7172	0.296543347	11.07195789	0	6.665122147	12.2039046	9.961748873	10.65178753	11.2389348	2.232172652	3.844036515	0	0.308636342	7.723893203	18.69943423	15.44797564	0.275588088	0.666013293	6.31021604	19.81581386	6.84312187	1.083080221	0	0.232288413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.2895	0	NO	12.14066097	43.7172	0.296543347	11.07195789	0	6.665122147	12.2039046	9.961748873	10.65178753	11.2389348	2.232172652	3.844036515	0	0.308636342	7.723893203	18.69943423	15.44797564	0.275588088	0.666013293	6.31021604	19.81581386	6.84312187	1.083080221	0	0.232288413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.2895	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.1059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1059	0	NO	0.006802233	43.7172	0.296543347	11.07195789	0	6.665122147	12.2039046	9.961748873	10.7577135	11.2389348	2.232172652	3.844036515	0	0.308636342	7.723893203	18.69943423	15.44797564	0.275588088	0.666013293	6.31021604	19.81581386	6.84312187	1.083080221	0	0.232288413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.3954
R6801_009_0	2012	9																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2415.196982	4.964281805	105.0238901	0	331.623733	28.4694105	8.944729181	644.0255447	297.9607748	7.439763477	15.86815763	0	0.842045398	2121.090036	4874.553033	6255.709175	117.6760999	291.4206052	16.52010276	64.9728567	27.61245036	626.5551683	0	82.13533646	195.3667899	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $25/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $25/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $25/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$25/Visit for Office Surgery - PCP; $25/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $25/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Case for Vision Exams; $50/Case for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	150	0.2	0.2	62.41356186	150	0.2	0.2	0	0.2	30.12767361	25	49.16378942	39.28315712	50	0.2	0.174019866	0.2	49.96813349	0	10	10	0	0	0	0	0											YES	168.1608103	960.9189158	124.9194591	0	144.1378374	0.192183783	0.192183783	59.9743722	144.1378374	0.192183783	0.192183783	0	0.192183783	28.95025146	24.0229729	47.24241523	37.74792875	48.04594579	0.192183783	0.167218981	0.192183783	48.01532466	0	10	10	0	0	0	0	0											6700	33.8451	0.397522691	1.093293962	0	3.983293975	5.471359015	1.719031893	3.21875231	3.578951808	1.429801891	3.049602565	0	0.16182747	5.11717416	9.758437949	24.62790087	0.370169086	1.166798217	3.174895847	10.86469487	5.306665174	2.507020819	0	0.068446114	0.162805658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0736	0	NO	4.914721445	33.8451	0.397522691	1.093293962	0	3.983293975	5.471359015	1.719031893	3.21875231	3.578951808	1.429801891	3.049602565	0	0.16182747	5.11717416	9.758437949	24.62790087	0.370169086	1.166798217	3.174895847	10.86469487	5.306665174	2.507020819	0	0.068446114	0.162805658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0736	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	17.8341	0	5.8922	0.2042	0.0332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											23.9637	0	NO	0.974616609	33.8451	0.397522691	1.093293962	17.83406111	3.983293975	11.3635918	1.923279306	3.251915046	3.578951808	1.429801891	3.049602565	0	0.16182747	5.11717416	9.758437949	24.62790087	0.370169086	1.166798217	3.174895847	10.86469487	5.306665174	2.507020819	0	0.068446114	0.162805658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0373
R6801_011_0	2012	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	YES	614.6885944	1.382548923	91.94306393	0	28.63676251	31.34991606	21.52047905	38.59457512	102.8208033	7.239711499	41.22512178	0	0	16.89047816	100.1028348	93.91135074	2.073659054	0.216982487	91.60337187	107.8700383	10.2691493	4.972072218	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	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	No Cost Sharing; PBP 14c	PBP 13b											0	YES	0.076940584	0.076940584	0.197336358	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0	0	0	0	0	0	0											YES	0.071854988	0.071854988	0.184292879	0	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0	0	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0.209194115	0	0	0	0	0	0	0	0											6700	44.1684	0.099343036	16.94445194	0	5.990642194	6.55821795	4.501957572	8.073757991	21.50950696	1.514505041	8.624052871	0	0	3.533388633	20.94092395	19.64570192	0.433797271	0.045391459	19.16288632	22.56577721	2.148245601	1.040128248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.5011	0	NO	14.68606161	44.1684	0.099343036	16.94445194	0	5.990642194	6.55821795	4.501957572	8.073757991	21.50950696	1.514505041	8.624052871	0	0	3.533388633	20.94092395	19.64570192	0.433797271	0.045391459	19.16288632	22.56577721	2.148245601	1.040128248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.5011	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0802	0	NO	0.005676565	44.1684	0.099343036	16.94445194	0	5.990642194	6.55821795	4.501957572	8.153962848	21.50950696	1.514505041	8.624052871	0	0	3.533388633	20.94092395	19.64570192	0.433797271	0.045391459	19.16288632	22.56577721	2.148245601	1.040128248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.5813
R6801_012_0	2012	7																															D	A	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1285.832069	9.113367	56.77471663	0	161.364216	9.148142391	6.89614612	391.5351973	221.9153736	4.656364495	15.10623587	0	0	1452.171495	3596.425371	4662.909431	213.7620999	330.8551052	15.23346915	48.52549067	30.92725103	368.5626021	0	155.463051	209.0293355	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$10/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	150	0.2	0.2	62.98867439	150	0.2	0.2	0	0	35.72857812	35	48.23564288	39.75360121	50	0.2	0.167433173	0.2	49.45225757	0	10	10	0	0	0	0	0											YES	171.2752889	978.7159366	127.2330718	0	146.8073905	0.195743187	0.195743187	61.64801945	146.8073905	0.195743187	0.195743187	0	0	34.9681288	34.25505778	47.2089924	38.90748304	48.93579683	0.195743187	0.163869515	0.195743187	48.39971258	0	10	10	0	0	0	0	0											6700	18.3526	0.743283127	0.601968466	0	1.974121622	1.79068655	1.349873622	2.011447455	2.714901409	0.911451627	2.956942757	0	0	4.231643322	10.26631324	18.34427133	0.693078773	1.349221517	2.981847805	7.951848617	6.053798691	1.486527001	0	0.129552543	0.174191113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0696	0	NO	1.88689016	18.3526	0.743283127	0.601968466	0	1.974121622	1.79068655	1.349873622	2.011447455	2.714901409	0.911451627	2.956942757	0	0	4.231643322	10.26631324	18.34427133	0.693078773	1.349221517	2.981847805	7.951848617	6.053798691	1.486527001	0	0.129552543	0.174191113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0696	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.4811	0	1.4463	0.7795	0.0205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											9.7274	0	NO	0.211541437	18.3526	0.743283127	0.601968466	7.481089056	1.974121622	3.237010301	2.129396148	2.031929815	2.714901409	0.911451627	2.956942757	0	0	4.231643322	10.26631324	18.34427133	0.693078773	1.349221517	2.981847805	7.951848617	6.053798691	1.486527001	0	0.129552543	0.174191113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.797
R7439_001_0	2012	10																															D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V	Coin	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	1450.364377	11.40435137	1239.07661		34.61928916	4.04571505	1.570279821	281.184842	44.14994776		18.07979029	21.99229097		37.46556814	4732.108327	6655.416747	225.7252655		18.08776847		15.9030109	1.039886548								15.07941974											3400	$220/day days 1-17	$220/day days 1-8	"$100/Day days 1-26, $0/Day days 27-100"	$0 copay	$100 copay/trip	30% coinsurance	30% coinsurance	"$50 copay ER, $50 copay Urgent Care"	20% coinsurance	$0 copay	"25% coins Diagnostic, 20% Therapeutic"	"$40 copay individual, $30 copay group"	0% coinsurance	20% coinsurance	$10 copay	$40 copay	$40 copay	$40 copay	25% coins	$20 copay for chiro and podiatry	20% coinsurance	20% coinsurance	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											0	NO	195.0121293	158.028169	93.91304348		100	0.3	0.3	50	0.2		0.24118925	69.7112373		0.185885523	10	39.88786356	40		0.25		0.2	0.2								20											NO	162.1136683	131.3688859	78.06995404		83.13004366	0.249390131	0.249390131	41.56502183	0.166260087		0.200500729	57.950982		0.154526716	8.313004366	33.15879839	33.25201746		0.207825109		0.166260087	0.166260087								20												19.5937	0.124848078	8.061221164	0	0.239825252	1.008961406	0.39161229	0.973954508	7.34037417	0	3.625011125	0.106206238	0	5.789431227	3.278169765	18.39046851	0.625485039	0	3.759092457	0	2.644035981	0.172891628	0	0	0	0	0	0	0	0.025132366	0	0	0	0	0	0	0	0	0	0	76.1504	0		15.44844108	19.5937	0.124848078	8.061221164	0	0.239825252	1.008961406	0.39161229	0.973954508	7.34037417	0	3.625011125	0.106206238	0	5.789431227	3.278169765	18.39046851	0.625485039	0	3.759092457	0	2.644035981	0.172891628	0	0	0	0	0	0	0	0.025132366	0	0	0	0	0	0	0	0	0	0	76.1504	YES	$375/day days 1-21	$375/day days 1-21	"$175/day days1-58, $0/day days 59-100"	$0 copay	$150 copay/trip	30% coinsurance	30% coinsurance	"$50 copay ER, $50 copay Urgent Care"	30% coinsurance	$10 copay	30% coinsurance	"$40 copay individual, $30 copay group"	0% coinsurance	30% coinsurance	$37 copay	$42 copay	$42 copay	$42 copay	30% coinsurance	$37 copay for chiro and podiatry	30% coinsurance	30% coinsurance	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											5100	0.2797		0.0201	0.0007	1.0943	0.0459	0.1458	0.0077	0.1305	0.001	0.144	0.0075		0.1007	0.1461	0.077	0.0092		0.1094		0.0734									0.0005											2.3936	0		0.485644035	19.8734	0.124848078	8.081335099	0.000710402	1.334139821	1.05486963	0.537432928	0.981672765	7.470878804	0.001029101	3.769000984	0.113725149	0	5.890105669	3.424242337	18.46751035	0.634686062	0	3.868467945	0	2.717417843	0.172891628	0	0	0	0	0	0	0	0.025645555	0	0	0	0	0	0	0	0	0	0	78.544
R7439_003_0	2012	9																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	533.67085	3.195440556	198.3162434		34.58739154			280.9257632	443.957563		680.8369899	21.97202765		96.33229914	4727.748244	6649.28456	225.5172861				15.88347689									15.06552582											3400	$300 copay per visit	$200 copay per visit	$100 copay per visit	No cost sharing	$50 copay per Trip	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$15 copay	$0 copay	$15 copay	$15 copay	No cost sharing	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	No cost sharing	20% coinsurance	No cost sharing	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$15 copay for Non-covered Podiatry/Chiro											0	NO	300	200	100		50			50	15		15	15		15	15	15	15				0.2									15											NO	289.2563872	192.8375914	96.41879572		48.20939786			48.20939786	14.46281936		14.46281936	14.46281936		14.46281936	14.46281936	14.46281936	14.46281936				0.192837591									15												12.864	0.051350088	1.593451114	0	0.13895311	0	0	1.128605157	0.53507317	0	0.820568533	0.026481456	0	0.116103053	5.698047402	8.013950121	0.271801314	0	0	0	3.062931427	0	0	0	0	0	0	0	0	0.018831907	0	0	0	0	0	0	0	0	0	0	34.3401	0		1.274767576	12.864	0.051350088	1.593451114	0	0.13895311	0	0	1.128605157	0.53507317	0	0.820568533	0.026481456	0	0.116103053	5.698047402	8.013950121	0.271801314	0	0	0	3.062931427	0	0	0	0	0	0	0	0	0.018831907	0	0	0	0	0	0	0	0	0	0	34.3401	YES	$400 copay per visit	$400 copay per visit	$200 copay per visit	No cost sharing	$100 copay per Trip	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$100 copay	$0 copay	$30 copay	$30 copay	No cost sharing	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	No cost sharing	No cost sharing	25% coinsurance	No cost sharing	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A											5100	0.1732		0.0053	0.0008	0.8454			0.0089	0.0423		0.0038	0.0021		0.0015	0.1372	0.0639	0.0076				0.0708									0.0004											1.3634	0		0.050601923	13.0372	0.051350088	1.5987786	0.000822952	0.984337609	0	0	1.137548967	0.577329433	0	0.824380516	0.028555383	0	0.117626199	5.835290833	8.077842069	0.279417042	0	0	0	3.133771238	0	0	0	0	0	0	0	0	0.019247623	0	0	0	0	0	0	0	0	0	0	35.7035
R7439_006_0	2012	8																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	533.711374	3.1956832	198.3313025		34.59001791			280.9470951	443.9912747		680.8886889	21.97369608		96.33961408	4728.107243	6649.78947	225.5344107	6.18631476			15.88508505									15.06666982											3400	$300 copay per visit	$200 copay per visit	$100 copay per visit	No cost sharing	$50 copay per Trip	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$15 copay	$0 copay	$15 copay	$15 copay	No cost sharing	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	No cost sharing	20% coinsurance	No cost sharing	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$15 copay for Non-covered Podiatry/Chiro											0	NO	300	200	100		50			50	15		15	15		15	15	15	15	15			0.2									15											NO	289.2461271	192.8307514	96.41537571		48.20768785			48.20768785	14.46230636		14.46230636	14.46230636		14.46230636	14.46230636	14.46230636	14.46230636	14.46230636			0.192830751									15												12.8645	0.051352166	1.593515587	0	0.138958732	0	0	1.128650822	0.53509482	0	0.820601734	0.026482527	0	0.116107751	5.698277953	8.014274377	0.271812312	0.007455698	0	0	3.063132886	0	0	0	0	0	0	0	0	0.018833337	0	0	0	0	0	0	0	0	0	0	34.349	0		1.276361935	12.8645	0.051352166	1.593515587	0	0.138958732	0	0	1.128650822	0.53509482	0	0.820601734	0.026482527	0	0.116107751	5.698277953	8.014274377	0.271812312	0.007455698	0	0	3.063132886	0	0	0	0	0	0	0	0	0.018833337	0	0	0	0	0	0	0	0	0	0	34.349	YES	$400 copay per visit	$400 copay per visit	$200 copay per visit	No cost sharing	$100 copay per Trip	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$100 copay	$0 copay	$30 copay	$30 copay	No cost sharing	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	No cost sharing	No cost sharing	25% coinsurance	No cost sharing	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A											5100	0.1732		0.0053	0.0008	0.8454			0.0089	0.0423		0.0038	0.0021		0.0015	0.1372	0.0639	0.0076	0.0112			0.0708									0.0004											1.3747	0		0.051071444	13.0377	0.051352166	1.598843289	0.000823006	0.984377437	0	0	1.137594994	0.577352792	0	0.824413908	0.028556538	0	0.117630958	5.835526937	8.078168909	0.279428348	0.01867933	0	0	3.133977357	0	0	0	0	0	0	0	0	0.019249084	0	0	0	0	0	0	0	0	0	0	35.7237
R7439_801_0	2012	2																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	559.2672213	3.152829114	207.0367755		38.3913539	4.197729086	1.620115354	286.7026814	43.62796027	2.981526569	17.96909261	0.671725053	0.14626415	39.90714035	54.8480469	94.19250057	2.395742735	7.834021529	18.00829508	55.59533282	15.90779945	1.014419607																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	427.6568648	253.4974166	506.495054		238.7271083	0.224	0.224	157.4017981	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	361.3165794	214.1895301	427.8981779		201.6824546	0.189241564	0.189244247	132.9824258	0.189265274	0.189255446	0.189262417	0.18923526	0.189207444	0.189229276	0.189254187	0.189259405	0.18923225	0.189264058	0.189261558	0.189261163	0.189259237	0.189271741																				16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	0		17.69982646	16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	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											6700	0.3096		0.0166		0.9195	0.0347	0.111	0.1007	0.0961	0.0337	0.106	0.0055	0.0005	0.094	0.3551	0.0683	0.0101	0.0187	0.0806	0.1074	0.0865																				2.5545	0		0.468980521	17.1489	0.056275249	7.399150742	0	1.564755584	0.829068351	0.417552205	3.277905354	8.353332928	0.597967398	3.506876558	0.132649347	0.028195669	7.645583198	10.73530382	17.89507208	0.463428991	1.501427825	3.488910192	10.62945726	3.097184928	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.961
R7439_802_0	2012	3																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	559.2672213	3.152829114	207.0367755		38.3913539	4.197729086	1.620115354	286.7026814	43.62796027	2.981526569	17.96909261	0.671725053	0.14626415	39.90714035	54.8480469	94.19250057	2.395742735	7.834021529	18.00829508	55.59533282	15.90779945	1.014419607																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	427.6568648	253.4974166	506.495054		238.7271083	0.224	0.224	157.4017981	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	361.3165794	214.1895301	427.8981779		201.6824546	0.189241564	0.189244247	132.9824258	0.189265274	0.189255446	0.189262417	0.18923526	0.189207444	0.189229276	0.189254187	0.189259405	0.18923225	0.189264058	0.189261558	0.189261163	0.189259237	0.189271741																				16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	0		17.69982646	16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	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											6700	0.3096		0.0166		0.9195	0.0347	0.111	0.1007	0.0961	0.0337	0.106	0.0055	0.0005	0.094	0.3551	0.0683	0.0101	0.0187	0.0806	0.1074	0.0865																				2.5545	0		0.468980521	17.1489	0.056275249	7.399150742	0	1.564755584	0.829068351	0.417552205	3.277905354	8.353332928	0.597967398	3.506876558	0.132649347	0.028195669	7.645583198	10.73530382	17.89507208	0.463428991	1.501427825	3.488910192	10.62945726	3.097184928	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.961
R7439_805_0	2012	2																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	559.2672213	3.152829114	207.0367755		38.3913539	4.197729086	1.620115354	286.7026814	43.62796027	2.981526569	17.96909261	0.671725053	0.14626415	39.90714035	54.8480469	94.19250057	2.395742735	7.834021529	18.00829508	55.59533282	15.90779945	1.014419607																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	427.6568648	253.4974166	506.495054		238.7271083	0.224	0.224	157.4017981	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	361.3165794	214.1895301	427.8981779		201.6824546	0.189241564	0.189244247	132.9824258	0.189265274	0.189255446	0.189262417	0.18923526	0.189207444	0.189229276	0.189254187	0.189259405	0.18923225	0.189264058	0.189261558	0.189261163	0.189259237	0.189271741																				16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	0		17.69982646	16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	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											6700	0.3096		0.0166		0.9195	0.0347	0.111	0.1007	0.0961	0.0337	0.106	0.0055	0.0005	0.094	0.3551	0.0683	0.0101	0.0187	0.0806	0.1074	0.0865																				2.5545	0		0.468980521	17.1489	0.056275249	7.399150742	0	1.564755584	0.829068351	0.417552205	3.277905354	8.353332928	0.597967398	3.506876558	0.132649347	0.028195669	7.645583198	10.73530382	17.89507208	0.463428991	1.501427825	3.488910192	10.62945726	3.097184928	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.961
R7439_806_0	2012	2																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO	559.2672213	3.152829114	207.0367755		38.3913539	4.197729086	1.620115354	286.7026814	43.62796027	2.981526569	17.96909261	0.671725053	0.14626415	39.90714035	54.8480469	94.19250057	2.395742735	7.834021529	18.00829508	55.59533282	15.90779945	1.014419607																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same 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	NO	427.6568648	253.4974166	506.495054		238.7271083	0.224	0.224	157.4017981	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224																			NO	361.3165794	214.1895301	427.8981779		201.6824546	0.189241564	0.189244247	132.9824258	0.189265274	0.189255446	0.189262417	0.18923526	0.189207444	0.189229276	0.189254187	0.189259405	0.18923225	0.189264058	0.189261558	0.189261163	0.189259237	0.189271741																				16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	0		17.69982646	16.8394	0.056275249	7.382554917	0	0.645238541	0.794384816	0.30659751	3.177201505	8.257257848	0.564270139	3.400873906	0.127114065	0.027674266	7.551599269	10.3802225	17.82681661	0.453351787	1.482698705	3.408277975	10.52203735	3.010697995	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4065	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											6700	0.3096		0.0166		0.9195	0.0347	0.111	0.1007	0.0961	0.0337	0.106	0.0055	0.0005	0.094	0.3551	0.0683	0.0101	0.0187	0.0806	0.1074	0.0865																				2.5545	0		0.468980521	17.1489	0.056275249	7.399150742	0	1.564755584	0.829068351	0.417552205	3.277905354	8.353332928	0.597967398	3.506876558	0.132649347	0.028195669	7.645583198	10.73530382	17.89507208	0.463428991	1.501427825	3.488910192	10.62945726	3.097184928	0.192000965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.961
R7444_001_0	2012	6																															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	1224.753313	156.7907762	1091.61911	1261.071956	229.1513295	6.889253599	10.18989195	376.100368	54.6413422	23.94788896	42.24469548	0	0.040846086	38.06399298	5379.979521	3969.554684	680.1476657	644.054425	0	0	8.635522504	946.0221902	0	0	43.71307202	-3.04E-15	5.369095094	0	80.02588956	0											6700	"$400 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$125 Days 21-66 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$65 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	$45 (3); $60 (5); 20% (9a); $40/$30 (9c)	"$20 (7a); $30 (7a1); $0 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (14b1, 14b5, 14b6, 14b7)"	"$20 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1, 14a10, 17b); $45 (16b, 18a); $0/$45 (17a)"	$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 (14c1, 14c5); $0 n/c (14c2, 14c3, 14c4, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											0	NO	231.5818746	109.1010254	79.76419953	0	200	0.2	0.087542698	61.60298229	0.16	0.090195409	0.174900695	0	0.2	0.145030497	12.62938962	43.47341162	38.5	45	0	0	0.2	43.64650414	0	0	45	0	38.3918739	0	0	0											NO	191.9383076	90.42446091	66.10968796	0	165.7628067	0.165762807	0.072556616	51.07110437	0.132610245	0.07475522	0.14496015	0	0.165762807	0.120203311	12.0358155	41.44588542	36.69052191	42.88502561	0	0	0.165762807	36.17483515	0	0	45	0	38.3918739	0	0	0												19.5898	1.181476784	6.013883227	0	3.165397296	1.141982013	0.739344081	1.600655096	7.246001798	1.790229718	6.123797411	0	0.006770762	4.575417986	5.396036741	13.71014238	2.079581069	2.301690876	0	0	1.431448448	2.851849732	0	0	0.16392402	0	0.017177468	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1266	0	NO	13.01993686	19.5898	1.181476784	6.013883227	0	3.165397296	1.141982013	0.739344081	1.600655096	7.246001798	1.790229718	6.123797411	0	0.006770762	4.575417986	5.396036741	13.71014238	2.079581069	2.301690876	0	0	1.431448448	2.851849732	0	0	0.16392402	0	0.017177468	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1266	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)	50% (11a)	"30% (11b, 11b1, 11c)"	"$65 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a); $75 (5); $45/$35 (9c)"	"30% (7a, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 13d2, 13d3, 13d4, 14d, 14e); $0 n/c (7a1, 14b1, 14b5, 14b6, 14b7); $0 (14a1, 14a9)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (9d, 9d1); 30% (14a10, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14c1, 14c2, 14c3, 14c4, 14c5, 14c7, 14c10, 14c11)"	"$0 n/c (13a, 13b, 13b1, 13c, 13e, 13e1, 13e2, 13e3, 13d5, 13e4, 13e5)"											10000	0.2884	0.0147	0.2558	0.4482	0.4316	0.3893	0.3455	0.2183	1.4821	0.2441	1.167	0	0.0009	0.9349	0.7166	1.9206	0.2324	0.1756	0	0	0.2124	0.2181	0	0	0.0209	0	0.0005	0	0	0											9.718	0	NO	1.520660299	19.8781	1.1962235	6.269638002	0.44822893	3.597042382	1.531294063	1.08484285	1.818926245	8.72813853	2.034351952	7.29080283	0	0.007694048	5.510342833	6.112665451	15.63069929	2.311964682	2.477281239	0	0	1.643806185	3.069959948	0	0	0.184858113	0	0.01768713	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8446
R9896_008_0	2012	8																															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	YES	607.0569679	2.17014976	33.19927495	0	29.05647068	57.4118189	45.33870452	45.4645627	64.75000016	9.647576815	23.84458956	0	1.008723999	30.02497399	83.72105589	71.79043104	1.144485913	4.478921242	27.15676227	86.66871392	39.48785294	4.879256645	0	341.4530651	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$15/Visit for Dental - Non Covered ; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	No Cost Sharing; PBP 13b											0	YES	0.081806965	0.081806965	0.190115867	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0.224	0	15	0	0	0	0	0	0											YES	0.076984327	0.076984327	0.178908265	0	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0.21079488	0	15	0	0	0	0	0	0											6700	46.7339	0.167067519	5.939624675	0	6.124955241	12.10211746	9.557166764	9.583697023	13.64896849	2.033659794	5.026317387	0	0.212633854	6.329110779	17.6479699	15.13305527	0.24125177	0.944133664	5.724506434	18.26932112	8.32383721	1.028522317	0	0.426816331	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.1986	0	NO	11.57491922	46.7339	0.167067519	5.939624675	0	6.124955241	12.10211746	9.557166764	9.583697023	13.64896849	2.033659794	5.026317387	0	0.212633854	6.329110779	17.6479699	15.13305527	0.24125177	0.944133664	5.724506434	18.26932112	8.32383721	1.028522317	0	0.426816331	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.1986	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, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-b"	"Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 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 14c	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0953	0	NO	0.005967041	46.7339	0.167067519	5.939624675	0	6.124955241	12.10211746	9.557166764	9.67894959	13.64896849	2.033659794	5.026317387	0	0.212633854	6.329110779	17.6479699	15.13305527	0.24125177	0.944133664	5.724506434	18.26932112	8.32383721	1.028522317	0	0.426816331	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.2939
R9896_009_0	2012	8																															D	A	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2121.776734	9.993884618	81.3227314	0	378.7850194	33.65413582	9.431190359	765.1328511	329.3818424	6.560616615	18.67777336	0	0.636215689	1917.595011	4763.787595	6044.7044	147.4576599	293.0319196	15.05546874	56.66565676	32.96688764	493.2612011	0	94.35434404	195.0151481	0	0	0	0	0											6700	$165/Days Custom: 1-15 for IP Medical; $165/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $30/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $30/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $30/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$30/Visit for Office Surgery - PCP; $30/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $30/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$25/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	165	1000	130	0	150	0.2	0.2	63.18911413	150	0.2	0.2	0	0.2	34.0805675	30	49.25088044	39.51051263	50	0.2	0.176798534	0.2	49.74378886	0	10	25	0	0	0	0	0											YES	159.1952774	964.819863	125.4265822	0	144.7229795	0.192963973	0.192963973	60.96611244	144.7229795	0.192963973	0.192963973	0	0.192963973	32.88160847	28.94459589	47.51822772	38.12052738	48.24099315	0.192963973	0.170578737	0.192963973	47.99379555	0	10	25	0	0	0	0	0											6700	28.1481	0.803524866	0.850002688	0	4.568241382	6.494035743	1.819879958	3.887264619	3.972426801	1.265962645	3.604137346	0	0.122766707	5.254467361	11.49049224	23.93613668	0.468430314	1.178012569	2.905163057	9.665956164	6.361421603	1.97278977	0	0.07862862	0.406281559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2541	0	NO	4.330669647	28.1481	0.803524866	0.850002688	0	4.568241382	6.494035743	1.819879958	3.887264619	3.972426801	1.265962645	3.604137346	0	0.122766707	5.254467361	11.49049224	23.93613668	0.468430314	1.178012569	2.905163057	9.665956164	6.361421603	1.97278977	0	0.07862862	0.406281559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2541	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	40% Coinsurance for Durable Medical Equipment; PBP 11a	"40% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	7.8934	0	6.9936	0.2424	0.0401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.1696	0	NO	0.55312607	28.1481	0.803524866	0.850002688	7.893448382	4.568241382	13.4876127	2.062304189	3.927369955	3.972426801	1.265962645	3.604137346	0	0.122766707	5.254467361	11.49049224	23.93613668	0.468430314	1.178012569	2.905163057	9.665956164	6.361421603	1.97278977	0	0.07862862	0.406281559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.4236
R9896_012_0	2012	7																															D	A	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin	V		V	V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1213.976434	7.61981179	40.01637419	0	169.7169812	10.21431883	6.753728402	459.3686645	250.0513703	4.878945304	15.34993087	0	0	1338.507431	3583.351002	4478.349608	210.5133657	196.9636055	14.54745584	43.17915256	28.60007748	302.6196983	0	142.2565627	238.1970352	0	0	0	0	0											6700	$175/Days Custom: 1-15 for IP Medical; $175/Days Custom: 1-15 for IP Surg; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP S/A; $1000/Admit for IP S/A; PBP 1b	$130/Days Custom: 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for Durable Medical Equipment; PBP 11a	"20% Coinsurance for Durable Medical Equipment - Med Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$65/Visit for OP ER; $35/Visit for OP ER; PBP 4a, 4b"	"$150/Case for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for Radiology X-Ray - OP; 20% Coinsurance for Radiology Therapuetic - OP; 20% Coinsurance for Radiology Diagnostic- OP; PBP 8b	No Cost Sharing;	20% Coinsurance for Renal Dialysis; PBP 12	"$50/Visit for CORF; $50/Visit for OP PT/OT/ST; $35/Visit for OP PT/OT/ST; $40/Visit for Outpatient Substance Abuse; $35/Visit for Outpatient Substance Abuse; PBP 3, 5, 9c, 9d"	"$35/Visit for Office Surgery - PCP; $35/Visit for Office/Home Visits - PCP; PBP 4b, 7a, 14a-b"	"$50/Visit for Office Surgery - SCP; $50/Visit for Office/Home Visits - SCP; $50/Visit for Cardiovascular - PHYS; $20/Visit for Chiropractor; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for Outpatient Psychiatric; $35/Visit for Outpatient Psychiatric; PBP 7e, 7h"	"$50/Visit for Physical Therapy; PBP 7c, 7i"	20% Coinsurance for Radiology; 20% Coinsurance for Radiology; 20% Coinsurance for Radiology; PBP 7d	"$50/Visit for Outpatient Surgery - PHYS; 20% Coinsurance for Pathology; $50/Visit for Hearing/Speech Exams; 20% Coinsurance for Miscellaneous Medical; 18% Coinsurance for Other; PBP 7d, 7g"	20% Coinsurance for Phys Pharm and Blood; 20% Coinsurance for Phys Pharmacy; 20% Coinsurance for Part B Rx; PBP 15	"$50/Visit for Vision Exams; $50/Visit for Glasses/Contacts - Medicare; PBP 7g, 14a"	No Cost Sharing; PBP 10b	"$10/Visit for Dental - Non Covered ; PBP 16a, 16b"	$25/Visit for Vision Exams - Non Covered ; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14c	PBP 13b											0	YES	175	1000	130	0	100	0.2	0.2	63.28295488	150	0.2	0.2	0	0	38.31637352	35	48.56721366	39.75356784	50	0.2	0.183779102	0.2	49.62223657	0	10	25	0	0	0	0	0											YES	171.6931866	981.1039235	127.5435101	0	98.11039235	0.196220785	0.196220785	62.08715533	147.1655885	0.196220785	0.196220785	0	0	37.5923444	34.33863732	47.64948387	39.00238138	49.05519618	0.196220785	0.180306398	0.196220785	48.68457099	0	10	25	0	0	0	0	0											6700	17.3693	0.622985604	0.425319069	0	1.387583301	2.004261656	1.325221887	2.376741135	3.066579756	0.957350476	3.01197548	0	0	4.193136028	10.25394921	17.78258729	0.684210214	0.805174026	2.8545132	7.785477466	5.611929646	1.227742515	0	0.118547136	0.496243823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3608	0	NO	1.612949773	17.3693	0.622985604	0.425319069	0	1.387583301	2.004261656	1.325221887	2.376741135	3.066579756	0.957350476	3.01197548	0	0	4.193136028	10.25394921	17.78258729	0.684210214	0.805174026	2.8545132	7.785477466	5.611929646	1.227742515	0	0.118547136	0.496243823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3608	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	40% Coinsurance for Private Duty Nursing/Home He; PBP 6	No Cost Sharing; PBP 10a	30% Coinsurance for Durable Medical Equipment; PBP 11a	"30% Coinsurance for Durable Medical Equipment - Med Supplies; PBP 11b, 11c"	"$65/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, 9c, 9d"	"No Cost Sharing; PBP 4b, 7a, 14a-b"	"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	"No Cost Sharing; PBP 7d, 7g"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 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 14c	No Cost Sharing; PBP 13b											6700	0	0	0	4.2151	0	1.6188	0.8725	0.0243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6.7308	0	NO	0.129634563	17.3693	0.622985604	0.425319069	4.215095474	1.387583301	3.623088378	2.19771803	2.401083982	3.066579756	0.957350476	3.01197548	0	0	4.193136028	10.25394921	17.78258729	0.684210214	0.805174026	2.8545132	7.785477466	5.611929646	1.227742515	0	0.118547136	0.496243823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.0916
